More and more hospital beds: Health promises lack vision

Yet again opinion polls show that health is shaping up as a critical issue in the Victorian election and ranks second behind cost of living in a poll conducted earlier this month. There is no detail about why health ranked so highly but failures in ambulance response times, emergency department ramping, long waits for elective procedures, and mental health care probably all contribute. COVID-19 deniers might also have ranked health highly. Although the government has taken action in some of these areas, it remains an area where Labor is traditionally strong but perceived to be behind in 2022.

The response of both parties has been a tsunami of policies, with the vast majority being promises for more hospital beds, a similar strategy to that pursued by the government in 2019. According to the Victorian Parliamentary Budget Office, the Liberal and Nationals have promised $7.7 billion for health so far, about one-quarter of their total commitments. Labor is recorded as promising $4.4 billion, about 40 per cent of all their recorded commitments, but the Budget Office data do not yet include the massive $5 billion Arden-Parkville commitment.

Premier Daniel Andrews (left) and Opposition Leader Matthew Guy have both made announcements on health during the election campaign.Credit: The Age

The government’s 2019 hospital promises have so far resulted in some impressive billboards marking the site of the promised facilities but not a single extra patient has been treated as a result of those election commitments. This is not unexpected because of the long lag involved in planning and building a new hospital. So, if voters think that any of the commitments, by either party, will be delivered this decade they will be sorely disappointed.

But the delay is not the key issue with these hospital promises.

The big question is whether the promised spending reflects the right priorities. Health policy should start, naturally enough, with health. It should include policies to keep the public healthy, including investing in pandemic preparedness. Empowering people to manage their own illnesses, and addressing the social, economic and commercial determinants of health, should be at the forefront of any health policy. Nothing much, unfortunately, has been heard from either party in these areas.

The second element of good policy should be boosting care in the community. Expanding primary care, including community-based mental health care and community health centres, should also have been prioritised. It would include additional hospital services such as hospital in the home, rehabilitation in the home, and virtual outpatient care. We have a paragraph or two in the promises lists, but nowhere near the emphasis that ought to be seen in a 21st-century policy.

Only after we have invested in these areas does the third element of policy, beds, come to the fore. Beds are expensive to build and staff, and for this reason, politicians should ensure that the first two elements are properly resourced and functioning before investing in more acute hospital facilities.

Politicians love hospitals, an example of the so-called “edifice complex”. Hospitals have impressive machines with flashing lights and provide almost unlimited opportunities for turning sods and cutting ribbons. The public understands hospitals and so promising more hospitals is an easy policy to explain and promote. But the public should not be blamed for politicians’ failure to bring the public along about good health policy over the last decade, and the lack of a compelling public vision of what good health policy should be.

Another big disadvantage of a hospital-focused policy is that hospitals have to be staffed and paying staff costs money. As a rough rule of thumb for every one dollar government spends building a hospital, it will have to find 50 cents a year every year into the future running the hospital. A $1 billion hospital build will require a few thousand additional staff to be employed, and there is nothing in either party’s promises about talking to universities and TAFEs about expanding enrolments. Similarly, the election announcements don’t mention how the spending time bomb that is created will be addressed.

The bigger the hospital promises in 2022, the more money that has to be found in 2032 and beyond, and this is why a rational policy emphasises prevention and community care.

Unfortunately, 2022 looks like another election where neither major party is offering a 21st-century vision for a better health system. Instead, we have policies that promise more of the same old expensive solutions of more and more hospital beds seemingly without end.