Beth Mohle opinion piece for Courier-Mail
Published: 3 October 2011
Achieving change for the better involves getting people to think differently. In a traditional word-association test most people would probably give answers like “hospital”, “doctor”, “nurse” in response to the prompt “healthcare”.
Fair enough. However, think about this – the overwhelming majority of healthcare is provided outside hospitals in the general community.
There is the parent putting a bandaid on a cut, chemists filling our prescriptions and the physiotherapist dealing with our sports injury. There are also GP surgeries, community-nursing programs, midwifery services and aged care facilities. And the list goes on.
Then, of course, we have hospitals and acute-care settings, which deal with things when they get more serious and even life threatening. That is their role when you need intensive care and close monitoring.
The point is, everything is interconnected. It is the cut finger, not properly dressed at home, that leads to infection and a possible hospital visit. It is the shortage of nurses in the aged care facility, which leads to resident falls and the need for hospitalisation. Again the list of examples goes on.
Once we acknowledge this total picture then we can genuinely start to explore ways of making community based services work better and reduce costly hospitalisations for things that can be done by health professionals outside hospitals.
Enhanced community health services will also help ensure the sustainability of our high-quality healthcare system. This is something Australians clearly want, because the popularity of our world-class, affordable health system based on the “fair go” ethos, is so popular it now virtually has bipartisan political support.
A lot of the public debate is on our hospitals and the acute care health sector. This is understandable, to some extent, given it is a big absorber of funding and problems are easily seen. The nurses, midwives, doctors, allied health professionals, administrative and other support workers in our public hospitals struggle daily to match supply with demand for health services. However, they do continue to provide world-class care, often in difficult conditions. The great work of these people is sometimes lost in the negativity, resulting in deteriorating staff morale.
The reality is Queensland health budgets have grown significantly in recent years, after decades of under- funding, especially since the 2005 five-year Health Action Plan package following the Bundaberg Hospital Inquiry. However, demand continues to grow strongly – mainly because there is no real end game with things like health research and technology. Our health services are getting better, but that leads to greater usage especially with the ageing of our population. When a new cure is found, people with the disease want access to the cure. This is a never-ending process in healthcare.
However, it also leads to efficiencies such as shorter hospital stays and more things being done at home or in the doctor’s surgery. Therefore we must break down barriers between hospital (public and private) and community-based care.
Adopting entrenched positions risks denying the reality of how the vast majority of healthcare is and can be provided. That means we must focus on things like health promotion and disease prevention, which involves increased emphasis on primary and preventative healthcare and chronic disease management, outside of hospitals.
Nurses and midwives stand ready and willing to do this and to expand the capacity of community-based health services. Given our numbers, widespread geographical and sectoral dispersion and our 24/7 presence in the acute and aged care sectors, we are the lynchpin of our health and aged care sectors and can help effect this change.
However, one problem to be addressed is the ongoing nurse and midwife shortage. With health and aged care services expanding to meet demand, much of our health workforce is approaching retirement age. For Queensland Health’s planned expansions alone it is estimated an additional 5500 nurses and midwives are needed by 2016. This shortage also involves many specialist positions, which require a longer lead-time to fill because of their educational preparation and clinical experience requirements. Therefore, we need concerted efforts by governments, health and aged care providers, unions, universities and other stakeholders to attract, recruit and retain nurses and midwives in all sectors.
Clearly there are some big, but not insurmountable, issues. It is easy to find the problems. The challenge is to continue delivering timely, effective, patient-centred care, which, by its very nature, involves more community-based and preventative options. Queensland’s nurses and midwives are up to the challenge.
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