State health systems in crisis

Aishwarya Aswath was 7 years old when she was carried by her father into the emergency department at Perth Children’s Hospital. She had a high temperature, her hands were cold, her eyes were cloudy and her body was floppy. Despite her parents’ efforts, for 90 minutes she received only sporadic attention from nurses, clerks and doctors. Three hours after entering the emergency department, Aishwarya went into cardiac arrest. Her death was avoidable.

A coronial inquest, just concluded, has revealed how chronic understaffing and lack of appropriate and functioning medical equipment has plagued the department. The triage nurse working that night was performing three different roles. She had to see patients and assign them a triage score, and escort critical cases through to the emergency department (ED) waiting room as well as letting people in and out.

The nurse responsible for the waiting pods and the waiting room care was also required to attend to other emergencies in the “resus” section. The ED admitted 300 patients per day, but was staffed for only 150. Nurses and doctors spoke at the inquest about the pressure of attending to Aishwarya, knowing that there were ten more patients also needing urgent care. The nurses also declared at the inquest that they were suffering from fatigue and operating under extreme pressure.

Aishwarya’s death, and her parents’ tireless efforts to uncover the truth, have made the conditions in Western Australia’s public health system front-page news. While the McGowan Labor government initially insisted that staffing was adequate, hospital administrators have been forced to implement changes, doubling the number of nurses in the Children’s Hospital ED.

But how much has changed more broadly? Red Flag spoke to a nurse who works in Perth’s public hospitals about the realities of a health system in crisis.

“Both as a father and as a nurse, Aishwarya’s death really shook me up”, said Simon Clay.* “As a father because I dread the idea that if my daughter gets sick, she won’t be able to get the care she needs. As a nurse because I know that the conditions that led to Aishwarya’s death still exist.

“It isn’t just the ED at the Children’s Hospital that was, and is, understaffed. It’s EDs and wards everywhere. At Sir Charles Gairdner Hospital, we are constantly and chronically understaffed. We get emails every day asking if we want to come in early, stay late, change to night shifts or pick up extra shifts. Last week, the night shift was missing 30 percent of the staff. We had 21 nurses instead of 30. It is not unusual to be five to seven nurses short per shift. It is a disaster waiting to happen.”

During the coronial inquest, a senior nurse wrote to all the nursing staff in the ED:

“There are lots of similarities to the conditions that we currently put you in day in day out, especially at triage and in the waiting room ... The system in its current state is not ideal or effective for our staff to deliver safe care to our patients.”

The nurses’ union backs up such claims. It says, for example, that the Children’s Hospital executive was made aware of the pressures staff were under before Aishwarya’s death, but failed to act until after there was a tragedy. The executives, for their part, claim that they alerted the Department of Health. But the department maintains that the problem was the pandemic.

Clay says that there are serious structural issues that underpin the current crisis. A lack of funding is primary, but there are other problems: increased casualisation of the nursing workforce, the introduction of agency nurses who aren’t committed to a particular ward and a lack of time for ongoing on-the-job training, have all led to a deskilling of staff.

“The issues can’t be solved just within the context of the hospital”, Clay argues. “The problems are much broader.” Lack of free, easy and regular access to GPs, for example, increases the pressure on emergency departments. “We have people coming in all the time who simply can’t afford regular care from a GP. This means they suffer at home, in silence, until their conditions become more acute and they come into emergency”, he says.

Several articles in the mainstream press have reported a decrease in the number of GPs who offer bulk billing. As cost-of-living pressures increase, seeing a doctor becomes unaffordable.

“Working-class people and the poor are unable to get regular treatment for their illnesses, let alone receive any preventive care. What’s more, many of the social services that are able to help people in their everyday lives have had their funding cut or have been privatised”, Clay continues. “We have many mental health patients coming into emergency who are just not coping with the difficulties of their lives and can’t get ongoing help or care. It’s devastating, but we can’t do much for them.”

In this context, many of the state and federal government plans to deal with the healthcare crisis are inadequate:

“Albo’s 50 urgent care clinics would be a drop in the bucket. Also, while [Victorian Premier] Dan Andrews’ pledge to pay the university fees of nurses is supportable, if the conditions in the hospitals remain as they are, nurses and other hospital staff will continue to get burnt out and leave the sector.

“So what’s the solution? Massively higher levels of funding for a start. The nurses’ strikes in NSW have been so important. Every time I see them on the news, I think about how familiar their stories are. The comments on their placards are thoughts that race around my head every day. The difference in NSW is that the nurses are saying them out loud. They are taking action. When they strike, they show how much their work matters. When we are faced with managers, bureaucracies, departmental heads and a broader system that won’t do what needs to be done to ensure a healthy population, we need to try to force the issue.

“In WA, all the nurses I work with know the issues, but because there is no fight back, everyone feels the pressure as an individual. But I know that would change if more of a lead was given [by union leaders]. Last year, when the union organised a rally in the wake of Aishwarya’s death, the response was enormous. The mood went from individual despair to collective anger in seconds. The same thing could happen today if the union organised it. We desperately need a national, unified fight back from all hospital staff.”

* Simon asked that his real name not be used.