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.
I was pretty ‘fired-up’ after reading your previous article Amber but here you have presented some very compelling arguments to support your case that the W.A. Health Care System is underfunded and underresourced. You have also identified the cause of this problem – “penny pinching” – which of course, is a hallmark of economic rationalism, a disease which is every bit as toxic as COVID.
Thanks for your articles anyway, even if I don’t always agree entirely with everything in them.
Have we Sandgropers got our heads in the sand? A long rave, in reply to Amber Shultz of Crikey’s very naive analysis of WA.
A very disappointing analysis. Allow me, as an ageing Sandgroper scientist, provide some local insights:
First, WA is not a “Hermit Kingdom” – it is a “Hermit Republic”. It had an election in 2021 and the people spoke.
Secondly, the McGowan Government is putting people first and by doing so, the economy functions well (See more below). He has said repeatedly, that he has observed the Eastern States situation with Omicron, where about 100 people are dying each day – who would not have died on the day without the widespread virus. Pro-rata, that translates into about 10 deaths/day in WA is we “opened up”. Plus, of course, the pro-rata 50 or so more people hospitalised each day.
Although the WA hospitals are pretty full, I know that they are well prepared for an “Eastern States scenario” – if it came to that. It simply means that elective surgery would be deferred.
There is a perception problem here: Journalists ask doctors and health-managers whether “the system would cope”. Sure, they say – bring it on, open up! But health people mainly look at health from a management perspective – yes – we could manage 10 deaths and 50 severe cases a day. But what about the perspective of the citizens of our Glorious Hermit Republic? Simply, they do not want to die or get sick, even if they are reassured that there would be a hospital bed or a funeral parlour at the ready. We love being alive and well here!
And the inconvenience of not travelling. As a moderately affluent and serial traveller, I’m inconvenienced more than many. But most people aren’t affluent travellers, so it doesn’t really affect them.
And the “Economy”. Certainly, some service industries have been affected and we have to accept more home-grown entertainment – but the WA Academy of performing Arts has served us well – a lot of brilliant locals now have gigs!
The “Real engine of the Economy” is actually the resources industry. A billion tonnes of iron ore exported each year – $200 billion worth. Plus $50billion of gas and $20billion of gold, plus others in smaller proportions – not only employing people, but providing royalties to the State and taxes to the Commonwealth and dividends to all Australians with superannuation. McGowan – and most West Australians – know that Covid 19 in the mining camps would be disastrous.
Is there an end to this? new “variants” aside, WA is now 97.6% double vaxxed and over 40% boosted, increasing at about 3% day. Having been isolated for 2 years, another month would mean that over 80% of us would be in a situation to weather “opening up” with a minimum of deaths and illness.
We in WA are used to being ignored and taken for granted by the Eastern Staters. The 10% State doesn’t get 10% of the National attention. So be it.
There have been some “hardships” in WA – certainly not “terrible hardships” as Morrison calls it. Most service industries have been compensated and internal tourism is pumping.
I’ve visited about 50 countries in the past few years – including Turkmenistan – I’ve lived most of the past decade in Sydney. Like most Sandgropers, I know that at present, there is no place in the World that I would rather be than here in Perth.
From one ageing Sandgroper to another, Mark’s most important job was to keep the mines open. And unlike some other state leaders he understood that also entailed keeping the workers and the rest of population healthy.
Elections are also held in kingdoms, so not sure what your point is? I returned home to WA in 2018 after nearly 30 years away, and if this is what a hermit kingdom is like, I’m all for it (except the incessant heat waves, we really need the elected government in this royal state to lift its game on responding to climate change).
Thank you – I posted separately to the effect that Amber has swallowed the AMA line including the hook and the sinker, without stopping to ask what the AMA is or what it wants.
“WA has the lowest number of hospital beds per capita in the country”
It also has the lowest share of GST per capita. Funny that…
If WA does finally succumb to the ES’s sad state of affairs then your obvious efforts to find a story will be proven right or extravagant.Having unfortunately family members needing the WA hospitals in recent times and finding them more than adequate I will hold any criticism until if and when needed.In the mean time be careful quoting the WA AMA representative.His criticism has been proven wrong in the past on a few occasions.As might yours.
Care to comment on the geographic distribution of the number of actual hospital beds and what the difference between requiring ICU in suburban Perth compared to Kununarra?
About 2221 km. The logistics of supporting reasonable health services over such the vast area of WA isn’t an easy task by any standard; so JM, how are you going to sort the issue – people in remote area suffer health issues and die like everywhere else even in non pandemic times why is it any different now?