The Victorian opposition has pledged to offer free public transport for nurses, aged care workers and allied healthcare workers for four years, if it wins the November election.
Key points:
The opposition says the policy is aimed at easing cost-of-living pressures for health workers
The policy is likely to cost about $468 million a year
Earlier this year the government announced a “surge payment” in a bid to retain healthcare workers
Shadow Health Minister Georgie Crozier, a former nurse, said the plan was designed to recognize the difficulties of the past few years of the pandemic.
“It’s really to recognize all of those who have worked in our healthcare system, both public and private, over the last two-and-a-half years, who have done it so hard and so tough,” she said.
Ms Crozier said the policy would be extended to nurses, allied healthcare workers, clerical staff, patient transport orders, dental assistants, midwives, aged care workers, paramedics and aged care workers.
The policy would make public transport across Victoria free for public and private sector nurses for four years.(Reuters: Sandra Sanders)
“That will be assisting with their cost-of-living pressures,” she said.
“We know this is becoming a very big issue, cost of living. And this is one way that we can ease that burden.”
The opposition said the more than 260,000 healthcare workers covered by the policy could end up $1,800 a year better off.
That upper-end estimate was based on someone who was using public transport daily across zones one and two in Melbourne, the opposition said.
Based on those figures, the policy could cost up to roughly $468 million a year, but Ms Crozier also noted not everyone who was eligible would take up the opportunity.
Opposition Leader Matthew Guy said the policy would be easy to administer, with eligible workers offered a specific public transport card for free travel.
He said there would be further health policy announcements from the opposition in the months ahead.
The opposition’s announcement comes after a fortnight of turmoil for the Coalition, with several staff leaving Mr Guy’s office after details of a proposed arrangement between a Liberal donor and his former chief of staff came to light.
Earlier this year, the Victorian government announced a $3,000 “winter retention and surge payment” to try and support and retain public sector healthcare workers as the state battles its deadliest phase of the COVID-19 pandemic so far.
A senior doctor at Adelaide’s biggest hospital says the health system is under “siege” and pinpoints Mondays as the busiest day.
Key points:
South Australia’s hospitals are usually busiest on Mondays
Discharging patients on weekends is harder due to fewer available services
Patients coming in for elective surgery on Monday also add to demand
SA’s struggling health system was again in focus this week due to the death of a 47-year-old man while he waited for an ambulance in suburban Adelaide on Monday.
Problems around ramped ambulances, overcrowded emergency departments and full inpatient hospital beds, trouble doctors and nurses on any day of the week.
But each Monday a perfect storm of complications aligns, cranking up pressure on health staff and patients.
So, what makes Monday the busiest day in SA’s hospitals, and what can be done about it?
Dr Peter Subramaniam says having fewer doctors working and community services unavailable on weekends leads to lower discharge rates.(ABC News: Ethan Rix)
A weekend hangover
As medical lead of the surgery program at the Royal Adelaide Hospital and chair of the Australian Medical Association Council, Peter Subramaniam knows South Australia’s health system well.
He says it is under “siege”.
“The system is under pressure and there is a significant demand and our capacity to meet that demand is not working,” Dr Subramaniam said.
The qualified vascular surgeon pinpointed Mondays as the busiest days for hospitals.
“You can see from the data we have that ours are lower on the weekend compared to weekdays,” he discharge said.
“So that contributes to the log jam that occurs on a Monday.”
Experts say more resources are needed every day of the week, including weekends.(Rawpixel: Chanikarn Thongsupa)
Dr Subramaniam said fewer doctors working to patients over the weekend had an impact discharge.
“Most acute care hospitals operate on reduced staffing,” he said.
But that’s not the only thing bringing down discharge numbers.
“We rely heavily on community services to be available and accessible over weekends and often that’s difficult to organize,” Dr Subramaniam said.
“You might need a rehab bed or a step-down bed or a community nursing service to be able to manage the patient once they’re discharged.
“Once we’ve discharged the patients, they need to go somewhere.”
Elizabeth Dabars says a criteria-led discharge policy was never fully implemented.(ABC News: Michael Clements)
monday blues
Chief executive of the Australian Nursing and Midwifery Association’s SA branch Elizabeth Dabars said the “absence of senior clinicians” on the weekend was driving up ramping times.
Professor Dabars wants to see nurses, allied health professionals and junior doctors able to discharge more acute patients under something called criteria-led discharge (CLD).
“It’s a win for the people wanting to go home and it’s a win for the broader community who would have better access to hospital beds,” the qualified nurse said.
CLD has been hotly debated for decades and was a policy directive issued by SA Health in 2019.
The state’s emergency departments have been under extreme pressure.(ABCNews)
Professor Dabars said it was never fully implemented.
“That has not really seriously been put in place and that is a blocker to people being discharged,” she said.
“It doesn’t actually make sense for it not to be enabled.”
But the former president of the South Australian Salaried Medical Officers Association, Dr David Pope, said the number of patients that would fit the CLD criteria was small.
“Item [CLD] works quite well in some areas but I defy anyone to go around and find patients sitting around in the hospital for want of a doctor to come in on a Monday morning,” Dr Pope said.
“That just doesn’t happen.”
David Pope says elective surgery admissions make Mondays busier than other days.(ABC News: Ethan Rix)
He said a crowded start to the week was a side effect of elective surgery.
“That worse effect on a Monday is purely a function of when elective surgery patients arrive,” he said.
The doctor said the idea that senior clinicians were unwilling to provide care on weekends was damaging to an already stretched workforce.
“Doctors are in the hospitals 24/7, so if there’s a need for a doctor to be in the hospital they will be there if they exist,” he said.
What will change?
The state government said it was looking to make criteria-led discharge “a regular part of hospital operations.”
“Expanding its use will reduce bed-block by ensuring patients ready for discharge can leave hospital, freeing up beds for those in the emergency department and easing pressure on frontline workers,” a government spokesperson said.
Dr Subramaniam said he supported the “safe” implementation of the policy.
“Criteria-led discharging is part and parcel of a modern healthcare facility and it’s strongly supported,” he said.
But he said it needed support to work effectively.
“We need the right level of resources,” he said.
“We need more efficient ways of using those resources and we need to strengthen our community care.”
He said addressing other issues, such as transitioning long-stay NDIS patients out of hospitals, was complex and would take time.
“If we don’t achieve a system response to dealing with acute care and the challenges that are going to come, we’re going to find patients are going to be left by the wayside,” he said.
An aged care advocate wants the federal government to support facilities in rural and remote areas to have registered nurses, rather than giving them an exemption to the requirement.
Key points:
Proposed aged care reforms would mean registered nurses would need to be in aged care facilities at all times
Rural aged care facilities want more information about how exemptions will be applied
Many rural facilities are finding it difficult to recruit staff
Labor’s aged care reforms include a requirement for there to be a registered nurse (RN) on-site at aged care facilities at all times, but there will be exemptions for rural facilities that are unable to find staff.
Charles Sturt University academic Maree Bernoth acknowledged the regional workforce shortages but said the government was taking an “easy” option.
“Our older people in rural areas deserve the same standards of care as everywhere else,” Dr Bernoth said.
Maree Bernoth wants a long-term strategy to recruit and retain nurses in aged care.(ABC Riverina: Emily Doak)
“We shouldn’t be looking for a lesser standard or a lesser qualification of people working with our rural older people than is available in metropolitan areas.”
A Senate committee is considering the proposed legislation for 24-7 registered nursing in aged care and will report back at the end of August.
Paul Sadler of the Aged and Community Care Association said exemptions were necessary, particularly for facilities in rural and regional areas.
Paul Sadler from the Aged and Community Care Providers Association is lobbying for clarity around exemptions.(Source: Paul Sadler Twitter)
“In particular we don’t want the process of making it mandatory to have a registered nurse 24-7 mean at the end of the day that small aged care homes in country towns have to close because they fail to do that,” Mr Sadler said.
RNs ‘like hen’s teeth’
At Hillston in south western NSW, the community-run aged care facility has first-hand experience of the challenges in recruiting a registered nurse.
Board member John McKeon said the first registered nurse for the 18-bed facility was employed last year after but finding her somewhere to live was also a problem.
“It’s very hard to get accommodation for people, especially out of town people,” Mr McKeon said.
“The manager we have now has to live in a caravan park which is far from satisfactory.
“It’s almost double the cost to have a nurse on your staff as it is a standard care worker, if we need to have more than one nurse it’s going to cost a lot more money and we would struggle without government assistance.”
It is a similar story at Coleambally, also in southern NSW, where the not-for-profit aged care home provides 18 beds for full-time residents and one for respite service.
Manager of Cypress View Lodge at Coleambally, Karen Hodgson is calling for more detail about the aged care reforms.(Supplied: Karen Hodgson)
Manager Karen Hodgson said she was lucky to have two part-time registered nurses.
“Registered nurses are just like hen’s teeth, they’re just not out there, they’re certainly not in our community but they are not even the wider community,” she said.
Concern for the future
Ms Hodgson said there had been no detail about how the proposed exemptions to the aged care reforms would be applied.
“We just want to keep providing the excellent care that we do but I worry about these 19 people; what’s going to happen to them,” she said.
“We run here so that the elderly in our community can stay here, so that they don’t have to go to the nearest town, which is 50 minutes away… My concern is where do they go if we shut our doors? “
Dr Bernoth said long-term strategies were needed to tackle the underlying problem of workforce shortages.
“In our smaller centers we need to think about reliability and certainty of employment, accommodation once they’re there, and a career pathway for them,” Dr Bernoth said.
“I would suggest we think of a another model … where a team of registered nurses might be able to move around a number of smaller facilities.”
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A last-minute proposal from the state government to improve working conditions for Tasmania’s nurses has failed to stop a strike from going ahead at the Launceston General Hospital.
Key points:
The government has announced a number of incentives to stop nurses and midwives from striking and to prevent the healthcare system from buckling
Incentives include a “return-to-work” bonus, a plan to put clinical coaches in all wards with a high proportion (30 per cent) of novice practitioners and improved anti-viral access
The Australian Nursing and Midwifery Federation said the offer had some “real positives” but came too late to delay industrial action
Nurses have been quitting in droves as they grapple with the pressures of the pandemic, rising workloads, long hours and tight resources.
But the Tasmanian government hopes a $2,000 “return to work” bonus will persuade those who recently resigned to give the job a second chance.
It is one of a suite of incentives the government has put on the table to stop nurses and midwives from striking and to prevent Tasmania’s troubled healthcare system from buckling.
Following a short but serious strike at the Royal Hobart Hospital last week, unionized workers at the Launceston General Hospital walked off the job for 15 minutes on Wednesday.
Australian Nursing and Midwifery Federation state secretary Emily Shepherd said the government’s latest offer had some “real positives” but came too late to delay the industrial action.
“Of course, we’ll take our members’ feedback on this and go back to the Premier but there certainly isn’t a quick fix to this,” she said.
“We all need to work together and it’s pleasing the government have come with a suggestion around a collaborative way forward.”
‘We have clearly been listening’
The union received the government’s latest offer on Tuesday night, which included the “return-to-work” bonus, a plan to put clinical coaches in all wards with a high proportion (30 per cent) of novice practitioners and improved anti-viral access .
The government is also promising to increase private hospital support for public hospitals, review workplace vacancies and trial a state-wide “transition to practice model”, with an immediate appointment to permanency alongside a six-month probation period.
As with many industrial disputes, pay is a key concern, however, the government has so far only promised to commence negotiations to address the wages of nurses and midwives.
Nurses have been quitting in droves as they grapple with a variety of pressures.(ABC News: Damian McIntyre)
Premier Jeremy Rockliff said he has recognized the demands being placed on health staff.
“We have clearly been listening and today we are acting,” he said.
The government said there were also other measures in place to help health staff, such as a COVID-19 allowance.
A daily allowance of up to $60 a day for a frontline nurse would be paid on top of salary at a hospital that has spent at least 30 consecutive days at COVID escalation level 3 and remained there.
It would work out to an average of an extra $300 a week for full-time staff.
The government’s offer came too late to delay the industrial action, nurses said.(ABC News: Damian McIntyre)
To further address workload pressures and in an effort to keep people out of the hospital the government is also increasing antiviral access for Tasmanians over the age of 70, and providing grants for participating community pharmacies in rural and regional areas to purchase antiviral medications.
Extra community paramedics will also be deployed across the state from today to attend low-level triple-0 calls that are aimed at reducing ramping at public hospitals and purchasing additional beds from private hospitals to transfer suitable patients out of the public system.
Mr Rockliff said the measures would bring more staff back to public hospitals and bolster the workforce to meet demand.
“There is no one simple fix,” he said.
“There are a multitude of areas of which we need to address when it comes to alleviating the pressure on our health system.”
