Elizabeth Dabars: Nurses are struggling to keep health system working as demand for care reaches unprecedented levels
HOSPITAL beds do not need to be closed if well-planned changes to the public health system are implemented, writes Elizabeth Debars.
PUBLIC hospitals in South Australia are going through a significant period of stress caused at least in part by seasonal factors such as flu and respiratory illnesses.
Nurses are concerned that the demand for care has been at unprecedented levels and that staff are struggling to keep the system working.
We are seeing hospital beds full to capacity with many more patients waiting for beds in Emergency Departments which are not well equipped to meet their needs for ongoing care and privacy.
Our members are reporting being tired and worn out, often working without breaks and doing longer shifts.
Emergency Department staff are struggling to meet the needs of new arrivals and managing ongoing care for patients waiting for beds. The competition creates tension and elevates risk in an area of health care which is always a bit of a highwire act.
There is a perception that senior bureaucrats and government fail to provide the support that they need.
At present, health regions are forecasting a reduced number of beds into the future — which raises the question: how on earth would we cope with this level of demand if the bed reductions, rumoured to be in excess of 200 beds, were put into place?
The ANMF (SA Branch) has sought assurances from Government that any major changes to the way the health system operates and, in particular the beds available must be the subject of consultation and agreement.
We believe that any reforms must be directed to achieving positive change to the efficiency and effectiveness of care. Change has to result in a clear benefit to patient care and the way that nurses and midwives are enabled to work.
We recently secured a recommitment from the State Government that beds will only be closed when sustainable efficiencies can be demonstrated.
However, we needed to act swiftly following rumours of a shift in this position identified by members concerned about proposed bed closures at the Royal Adelaide Hospital. Those beds remain open as a result of our actions.
We need a clear set of strategies that will alleviate some of the pressures that the system is experiencing at the moment.
We then need to look at how the health system can be reconfigured to cope better with these seasonal factors which create massive spikes in demand.
Along with the policies for reform there need to be clear strategies and management of change. Without them we will continue to see confusion about direction and a continuing collapse in morale.
It is possible, indeed desirable, that our health system continue to reform.
Changes in practice and technology mean that many procedures that required hospital stays of more than a week 20 years ago can now be safely undertaken with only a single nights stay in a hospital — or they can be undertaken as day surgery. The procedures are less invasive and less risky.
A win for patients with faster and safer recovery. A win for health systems and funders through lower costs and less bed days.
Further reductions in hospital stay are achievable with effective change management and through effective consultation with clinical staff.
Empowering nurses to make decisions over discharge of patients is one example of a reform that can speed the discharge process when patients achieve their agreed recovery goals.
Moving more patients with elective surgery needs into day surgery programs where that can be achieved safely still offers gains for both patients and the system.
Provided that we make sure that the supports are there for them when they are returned home, then everyone wins. Patients are better off, nurses are able to provide care to those in greatest need and the system only provides care in hospital when it is needed.
There clearly needs to be greater investment in community and home based care which provide alternatives to admission to hospitals.
Older people at risk of respiratory illness and flu need to be targeted with greater support and early intervention programs to help them avoid the kind of ill health that is driving them to our emergency departments and hospital beds.
A plan for the reform of health care that focuses on hospital services alone is doomed to failure. We need an approach that tackles the health system as a whole with GP, community based and home nursing services along with aged and residential care services all playing their part.
Such an approach challenges the split between state and federal governments who manage different components of a system that sorely needs integration.
Health reform can only be achieved through an effective partnership between health service leaders and governments on one hand and the clinical and managerial staff of health services, notably nurses and midwives on the other.
Unless we work to create an integrated system, patients will not receive the care they need when they need it and will be placed at risk by the very system that should be assisting them.
Elizabeth Dabars is chief executive of the Australian Nursing and Midwifery Federation (SA)