The latest round of budget cuts to Victorian hospitals has a major impact on the safety of Patients and nobody wants to take responsibility for the Patients who are missing out on essential health care.
Let's face it. There will always be competition about money, resources and funding in any health system in any country. These fights may be more political in Australia, where the current funding structure with the "fee for service" system isn't really geared for creating choice for Patients and their Families and improving Patients and their Families lives, whilst also looking at cost effectiveness and inefficiencies. The system has been geared towards running and perpetuating inefficiencies. But rather than getting caught up in a political argument, we should be looking at the causes of the disease, fix the underlying issues and look at possible solutions.
I think it's hypocritical to announce budget cuts across Public health services in Victoria- even though by the time you are reading this, the commonwealth government is on the verge of injecting cash back into the Victorian health system- whilst one of the most expensive areas within hospitals is wasting hundreds of thousands of dollars every month to keep long-term ventilated Adults & Children with Tracheostomy in Intensive Care with no Quality of Life and/or Quality of-end-of Life. Some of those Patients have been in Intensive Care for more than 60 days, costing the tax payer up to $ 5,000 per day, not even mentioning that these Patients are blocking beds, that could be used for another Patient and therefore adding on to the long list of Patients waiting for surgery and for a bed in Public Hospitals.( Surgery waiting list 'could hit 65,000', article in 'the age' from the 19/2/2013). There is also the 4 hour rule now, to get Patients out of the Emergency department within less than 4 hours. What if you don't have any beds for an ED Patient needing an ICU bed in the first place? 4 hours won't cut it, maybe not even 4 days...
The current 'fee for service' system discourages thinking outside of the box and does not look at and fix inefficiencies. If health professionals in hospitals were able to spend less time and less resources undertaking tasks that nurses can competently perform in a Client's own home, health professionals time and resources could be devoted to those acutely ill Patients who would benefit the most in Intensive Care. On the other side of the spectrum would be the long-term ventilated Adult or Child with Tracheostomy who can finally leave ICU. Not even mentioning the Families of those long-term ventilated Adults & Children with Tracheostomy, who are putting their lives on hold, while their loved one is in Intensive Care.
Some cases that I see in Intensive Care are kept in ICU for longer than 60 days, usually the only reason keeping them in Intensive Care is the ventilator dependency. Does anybody still think that Intensive Care is the right place for those Patients? What about some long-term ventilated children who stay in Intensive Care for up to 18 months? Does anybody think that a toddler growing up in Intensive Care is funny for the child or for the Family? I certainly don't think it is. How much longer do Patients, Families, health professionals and the health industry want to tolerate those inefficiencies in Intensive Care while at the same time politicians scream out for saving money? Have you tried saving money, by looking at inefficiencies in one of the most expensive areas in a hospital like Intensive Care?
The argument that Quality and safety can only be maintained in a hospital does not cut it. Plenty of other countries have adopted a far more Patient centred health system and approach, with long-term ventilated Adults & Children with Tracheostomy going home as being the norm. Where else would you want to be if given a choice? How much longer do we want to wait to create choice for the very people we care for? Why not making use of a highly skilled critical care nursing workforce and take long-term ventilated Adults & Children out of Intensive Care?
The whole health system is shackled by professional silos that do not encourage thinking outside of the box or encourage innovation. No other industry is so inflexible and bureaucratic like the health industry, with the result that Patient Care is not optimised and not holistic. Any other industry thrives on innovation and as a direct result creates win-win situations and value for their Clients and Customers.
Here is my suggestion. If the Victorian minister of health David Davies, the Victorian department of health with Dr Pradeep Phillip and hospitals are serious about saving money- and I believe they are not- let's start and save money in high cost areas such as Intensive Care, give Quality of life back to long-term ventilated Adults & Children with Tracheostomy and their Families and take them out of Intensive Care. I think that being in Intensive Care for more than 60 days is more than enough. Very few Patients can't go home after 60 days in Intensive Care and some Patients could go home even earlier. So let's get right to the bottom of saving money, work on inefficiencies and also improve people's lives.