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'Already drowning': Nurses demand changes to under-pressure health system

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The South Australian nurses’ union has accused the Health Minister of failing to take “leadership” of the state’s struggling health system, and warns of “disastrous consequences” if he doesn’t take immediate action.

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The union’s plea follows concerns raised by the doctors’ union in a parliamentary committee yesterday that medicos are being directed by hospital administrators to discharge patients before they are clinically ready to free up beds, and that data is being manipulated to make wait lists look better than they are.

In a letter sent to Health Minister Stephen Wade two weeks ago, Australian Nursing and Midwifery Federation SA secretary Elizabeth Dabars says nurses have been raising with him “dire patient flow issues” within hospitals for the past three years, “putting both patients and nurses at risk”.

“Despite our continuous advocacy there has been no substantial improvement in the flow of mental health clients through the system, with these clients having the longest Emergency Department wait times of any patient cohort,” the letter says.

“The results for patient care and for nursing staff in the emergency departments have been horrendous.

“All of these issues have been raised with you on several occasions by ourselves and others but without you taking leadership of the issue, leaving it to the department and to LHNs (local health networks) for their action and response.

“Given the continuing systemic issues we ask that you immediately outline strategies that will address the needs of the patients and staff (within) the metropolitan hospital system.

“We fear that failing to appropriately address this problem will result in disastrous consequences for the future of health care in this state.”

Dabars told InDaily she had not heard first hand accounts of concerns raised by SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland that doctors were being ordered by administrators to discharge patients before they were ready.

“I’ve heard different versions of that,” she said.

“I have heard there’s been questions raised about discharges. Clearly we would absolutely not support discharges being made that were not clinically recommended or safe.

“No one should be sent home if they’re clinically unsafe to go home – absolutely not. That’s completely inappropriate.”

Dabars echoed concerns from Mulholland about staff burnout.

“Our members are absolutely getting tired, they’re getting frustrated, they’re getting angry, there is an urgency to this because the system as a whole is in a very difficult position,” she said.

“They are already drowning and we’re really concerned that it’s only a matter of time before it’s a situation of the straw that broke the camel’s back.

“If and when the system does collapse the impact will be vast and the impact on the community will be devastating.

“It could be catastrophic. These are the types of scenarios where care gets missed, mistakes are made, particularly when staff are completely fatigued.”

In her letter to Wade, seen by InDaily, Dabars says the new mental health treatment centre in the CBD will have “minimal impact”.

“The lack of capacity in community teams along with the bed utilisation almost constantly means that the prospect of significant improvement in ED length of stay is low without increased resourcing in inpatient and/or community teams,” her letter says.

Dabars says the flow from acute hospitals into “subacute care” remains an issue, “with a large number of patients being cared for in the wrong clinical environment”.

“Patients waiting to move into aged care facilities, National Disability Insurance Scheme services and other community or convalescent services, are occupying acute care beds when their care needs could be better met by other services,” her letter says.

Dabars also echoed concerns from paramedics about the extent of recent ambulance ramping.

In her letter, she says there’s been no improvement in ramping despite assurances from SA Health and the Central Adelaide Local Health Network.

She says systems to manage discharge on weekends and out of hours “are clearly not working well enough to sustain flow across our hospitals”.

“To make the situation worse SA Health are continuing to progress Voluntary Separation Packages for frontline clinical staff when they do not currently have enough staff to meet everyday demand,” she says.

“Nurses are fed up with constantly working overtime and double shifts just to ensure safe patient care.”

Wade has urged the doctors’ union to back its claim of administrators ordering doctors to discharge patients by providing him with specific details.

“I’m concerned with any reports that administrators might be overriding clinical decisions,” he told reporters yesterday.

“The reality is SA Health is fundamentally predicated on clinicians running healthcare and if there are any reports of that being undermined I would be keen to act.

“We have made it clear clinicians manage healthcare in our hospitals.”

Meanwhile, paramedics are set to begin industrial action this afternoon, where patients kept waiting won’t be billed, in protest against ambulance ramping amid demands for more resources.

The Ambulance Employees Association says that from 5pm, those who receive “a sub-standard ambulance experience”, such as being ramped, won’t be charged, with the government forced to cover the cost.

Ambulance Employees Association state secretary Phil Palmer and Treasurer Rob Lucas went head to head on ABC Radio this morning, each accusing one anther of failing to take action to fix the problem.

Palmer said the government hadn’t provide enough resources to help but Lucas rejected that and accused the union of failing to agree to changes in shift times and meal breaks that he says would help improve the situation.

Lucas said the government wanted to reduce shifts from 12 hours to 10 or eight hours “which will be much better for the ambos and it makes it much better in terms of our rostering reform”.

“At the moment the union won’t agree to what we think is a very simple change and that is at the moment we have a situation where when the ambos need to take their important meal break they have to go to their home ambulance station so we have examples where the ambulance will actually drive past four other ambulance stations to go back to their original home station to take their meal break,” Lucas said.

“It wastes time, it means we have less ambulances available for the sorts of urgent calls that we’re talking about yet the union won’t agree to these sorts of fundamental reforms.”

Palmer said it was important for crews to return to their home base for breaks not only for their own “respite” but so they were in their local area when the next emergency call came in.

“You have to ask why they’re that far away from home and that’s because there’s a shortage of ambulances,” he said.

“This is in the government’s hands – to blame members, blame their rosters, blame their meal arrangements, it’s all just a furphy.”

Palmer said Flinders Medical Centre had 110 patients in its ED last night, with a capacity for 65.

“So already scarce resources were tied up in hospital ramping and the community was left basically to fend for itself – people getting taxis, driving themselves, whatever means, to hospital in the absence of an ambulance being able to arrive in time,” he said.

In a statement to InDaily this afternoon, Wade said a report from the Auditor-General had shown the Marshall government had boosted the public health workforce by 286 full-time equivalent nurses and midwives since the 2018 election.

“Employment in the health system can be a demanding work choice and I thank our hardworking, professional and dedicated nurses for every shift they do to keep South Australians safe and healthy,” he said.

“We have acted to reverse the downgrade of our Emergency Department networks under the former Labor Government’s Transforming Health experiment and currently have major upgrades underway at every suburban Adelaide hospital.

“Such substantial and unprecedented investment in our health system is a win for patients, a win for South Australian construction jobs and a win for our hardworking health staff by providing them with world-class facilities which will improve patient flow.”

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