Western Australia’s health system is struggling. The state has the lowest number of ICU beds in the country. It’s the only state with non-permanent contract options for doctors, contributing to staff shortages. Elective surgeries were cancelled last year. Patients are being left in the back of ambulances with no free beds in the emergency departments.
The state has yet to see a significant outbreak of COVID-19.
Premier Mark McGowan has scored record highs in popularity polls, winning in a landslide last year largely thanks to his harsh stance on borders. But as a wave of inevitable Omicron cases approach, the state’s already overburdened health system is set to be completely overwhelmed.
It’s a catch-22: the state needs to open up to address skill shortages but will struggle to do so as appetite for risk remains low.
How bad is it?
According to the latest Australian Medical Association hospital report card, WA’s ramping hours — where an ambulance waits outside a hospital with a patient until space becomes available — increased from 1000 hours a month in 2017 to 6500 hours in August 2021.
WA has the lowest number of hospital beds per capita in the country, with just 2.24 beds per 1000 population compared with a national average of 2.53 — meaning WA was 612 beds short to meet the national average. It also has just six beds per 100,000 people.
There were 490 “code yellows”, when hospitals struggle to cope with the volume of patients — in the health system across June 2020-21.
A huge cause for alarm is the lack of staff; many have left the sector due to overwork, understaffing and insecure employment thanks to five-year contracts instead of permanent ones. The border restrictions have caused a staffing shortage, with 100 staff including specialists, consultants and locums for remote areas locked out of WA.
The sector is so dire tht an independent review of the governance of the WA health system was announced in January. A recent Australian Medical Association WA COVID survey found 78% of doctors believe WA’s health system would not cope with an Omicron surge if the border had opened on February 5.
What’s being done?
President of AMA WA Mark Duncan-Smith tells Crikey he’s concerned the government has had a head-in-the-sand approach. Testing levels are low, meaning the true spread of COVID isn’t known. The state government secured a contract with the federal government for RATs only in late January, with a delay in tests arriving. The government postponed categorising preparedness from green alert level to amber — something Duncan-Smith says still doesn’t represent the current crisis.
“The medical system is capacity in WA at the moment,” he said. “It doesn’t cope with business as usual — forget about COVID.”
In December the McGowan government announced an extra $1.28 billion for the health and mental health system to prepare for the state’s reopening. While nearly 300 additional hospital beds were announced by McGowan late last year, one in six have been leased by private hospitals.
This, Duncan-Smith tells Crikey, represented a short-term investment in health and poor planning.
“All of a sudden [the government] came to a realisation of the inadequacy of the hospital capacity and funding and started to spend cash, but it’s essentially too little too late,” he said.
It comes down to penny-pinching
Hospital demand increased by 3 to 4% every year for the past four years, yet WA public hospital funding increased by just 1.57% in 2018-19 compared with 2008-09 levels (with a 1.86% increase provided by the federal government). Yet in the latest state budget, WA recorded a $5.8 billion surplus.
Sydney University school of public health Professor emeritus Bruce Armstrong says a lot of Australia’s hospital problems come down to penny-pinching.
“Commonwealth and state agreements to fund health are part of the problem because nobody wants to be someone to foot the bill, so there’s be a tendency to cost-shift,” he said. “When you’re trying to run a lean ship, staffing will become one of the things that are tightly managed.”
He predicts a dire outcome for WA if case numbers surge: “Ambulance shortages seem probable given the extent of ramping.”
Once an ambulance arrives at a hospital, staff will have to treat patients as if they are infectious, creating further delays and putting pressure on staffing numbers.
While the government has announced hospital triage tents outside major hospitals, Armstrong says ICU bed and ventilator shortages were a key area of concern.
