Australian hospitals are being propped up by the "goodwill and broken bodies" of healthcare workers, an expert says, after a warning the system is facing a deadly bottleneck.
The Australian Medical Association has painted a dire picture of Australia after reopening, claiming years of poorly-allocated funding would see depleted emergency departments overrun and wait times for elective surgeries explode.
The report - sent to state, territory, and Commonwealth leaders - called for an urgent revamp, including the federal government taking on a bigger share of funding and better access to in-home care to reduce the number of patients presenting to emergency departments.
Australians are braced for a rise in COVID-19 cases as it emerges from lockdown once 70 and 80 per cent full-vaccination is achieved.
But David Caldicott, senior lecturer in medicine at the Australian National University, predicted pressures would last well after the inevitable spike subsided, with Australia facing the likelihood of new viruses and bushfire crises.
'Goodwill and broken bodies'
Dr Caldicott said cracks in Australia's healthcare system had been papered over by staff working longer hours, usually to the detriment of their health. While they had produced over the odds given what they were provided, COVID-19 had "unmasked" deficiencies in the system, he said.
"At the moment [it] is being held together by the goodwill and broken bodies of healthcare workers, and the smell of an oily rag," he said.
"There's literally no fat in the system, and there hasn't been for quite some time ... on a sunny day, we cope. When it rains, we don't."
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It came amid a push from the state and territories for increased federal funding, with ACT Chief Minister Andrew Barr predicting a crisis at Canberra's hospitals without extra support. But concerns over bed shortages at Canberra Hospital predated COVID-19, which the AMA said had simply exacerbated the crisis.
The Commonwealth increased funding from 45 to 50 per cent throughout the pandemic, but argued it was now up to the states and territories to do the same. The AMA called for that rate to be maintained, and a guarantee states would reinvest funds towards improving capacity. It also wanted the 6.5 per cent annual cap on funding growth to be lifted.
Dr Caldicott described the cap as "artificial" given an ageing population and the threat of future crises meant Australia had "no control" over hospital admissions.
"It's not like there's this steady growth in terms of how many sick people we have; As we've seen in the COVID era, there's been an enormous surge," he said.
"The number really needs to be what's required to treat the number of sick people."
Labor MP Alicia Payne, federal member for Canberra, described the states' call for a 50-50 funding model until mid-2024 as a "reasonable request". ACT hospitals were the first port of call for over 200,000 NSW residents, in what Ms Payne said was proof a national approach was needed.
"The states and territories have done the heavy lifting so far in the pandemic and they want to guarantee that our health system won't buckle under the load as we open up," she said.
"If we really are 'in this together', the Morrison Government should provide a national response to ensure our hospitals can support all Australians."
'No fixed formula'
The AMA also called for Commonwealth support for digital health care, alternatives to out-of-hospital care, and performance incentives.
University of New South Wales public health expert Anurag Sharma accepted overcrowding was a "serious issue" and there were opportunities to divert patients away, with half of those presenting to EDs not requiring emergency care.
But Dr Sharma argued the current funding cap incentivised states to reduce many inefficiencies behind delays, and there was "no fixed formula" on funding with an increased Commonwealth share no guarantee of improvement.
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He said having GPs located next to EDs reduced waiting times by 20 per cent, while increased funding for short-stay units, and expanded 24-hour telehealth would further ease the strain.
"Throwing money at the problem is not always a best strategy, especially in this complex issue. There are many bottlenecks in the system that cause access block," he said.
Dr Sharma also urged caution over locking-in performance targets for EDs, which he said could produce "perverse" outcomes.
"For example, a 4-hour target might lead to early discharge and increase in readmissions thereby affecting quality of care and increasing burden on emergency department resources," he said.