Friday, November 12, 2010

Two Quotes


'Between the idea
And the reality
Between the motion
And the act
Falls the Shadow.'

- TS Eliot
The Hollow Men

There's something about the nature of politics that calls this quote from Eliot's famous poem to mind pretty often for me.

For example, take the health system in Victoria. More specifically, the hosiptal system in Victoria. More specifically, the way the operation of the hosp[ital system in Victoria is measured and assessed.

So, the operation of our hospitals generates a mass of data which is analysed; patient waiting lists, emergency room wait times, bed capacity and a thousand and one other things. The health department sets statewide targets for hospitals to meet, to ensure that services are being provided in a timely and efficient fashion. By meeting these targets, hospitals ensure good service delivery and also, often times, qualify for additional government funding. Conversely, by not meeting their targets, the state government is able to identify which hospitals need additional staff or resources or just an overhaul of their operating practice. Which is all very ordinary and as you'd expect...

... or it would be, if that's how the system actually operated.

But back in reality, what actually happens is this:

1. Government sets hospitals ambitious targets and then denies them adequate funding to meet those targets.

2. The health department provides heavy pressure to hospital administrations to meet these unrealistic targets.

3. Hospital administrators manipulate the data generated by their hospitals to make it look like they're meeting their targets when, in fact, they simply can't.

This last part of the process is done in a variety of ways.


When a hospital emergency room reaches capacity they activate an indicator called 'Emergency Bypass,' meaning they are unable to take any more patients. The ambulance service is notified and ambulances instructed not to deliver any more patients to that hospital.

The government wishes to minimise the occurrence of this - so that emergency patients can be taken to the nearest hospital, say - so they set a target of hospitals only activating their 'Emergency Bypass' indicator 3% of their operating time. Hospitals that achieve this target receive bonus funding.

However, due to a decline in bulk billing private practice GPs, a more general decline in affordable, private, after hours medical care, combined with years of underfunding, hospital emergency rooms have become stretched beyond capacity and need to activate their 'Eemergency Bypass' indicator much more often than the 3% target.

So what happens?

Emergency room staff are instructed not to activate the bypass and just to continue accepting patients, even if there are no staff available to treat them or any beds available. A recent survey of emergency room doctors by 'The Age' confirmed that this practice is widespread and, according to those surveyed, puts lives at risk.

The last part of this sorry process is the State Government health spokesman calling a press conference to announce that no hospital in the state activates their 'Emergency Bypass' indicator more than 3% of the time, all thanks to State Government initiatives.

And this is just one example, among many.

Other examples cited in the 'Age' story noted above included the creation of 'virtual wards' that exist only in the memory banks of hospital computers (to make it look like people who are languishing on trolleys or waiting room chairs are in beds), and the exclusion of rafts of patients from surgery waiting lists to make it look like there's not a problem in this State of people waiting years and years for required surgery.

And the loser in all of this is, as always, us.

When someone we know is in a car accident and gets rushed by ambulance to a hospital where no one is available to treat them. Or when a relative has their quality of life dramatically lowered through having to put up with treatable medical conditions while they wait on a list somewhere.

But where is the politics of this issue?

When confronted with the 'virtual wards' scandal last year, after whistle blowing from courageous hospital staff, State Health Minister Daniel Andrews aggressively denied that such a problem existed. When he was shown evidence that fudging of data occurred, the Minister scrapped some of the target based carrot-and-stick funding and announced that independent audits of hospital data would be conducted.

The Health Minister wasn't sacked, nor reprimanded by The Premier and the 'virtual wards' scandal hasn't featured in our current election campaign in any form. Nor have any of the other issues, serious problems all, listed above. The State Government has gone with its usual 'Business as usual' approach and the State Opposition seems unable to say anything without the words 'Law and order!!!' attached to it.

And yet the problem remains. 90% of surveyed emergency room doctors state that inaccurate data is still being submitted by hospitals and that the independent audits fail to uncover this practice.

And this reminds me of another quote, from George Orwell's '1984' this time:

The fabulous statistics continued to pour out of the telescreen. As compared with last year there was more food, more clothes, more houses, more furniture, more cooking-pots, more fuel, more ships, more helicopters, more books, more babies--more of everything except disease, crime, and insanity. Year by year and minute by minute, everybody and everything was whizzing rapidly upwards. (Yet) always in your stomach and in your skin there was a sort of protest, a feeling that you had been cheated of something that you had a right to.

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