How much does Medicare care?

Hospitals are community assets and should be run for the community.

From November 2016 until September 2017 I was as a guest of New South Wales Health. For much of that time I was in a desperate situation. I entered Campbelltown Hospital in septic shock and would certainly have died had it not been for the fabulous efforts of the doctors and nurses who treated me.

The hospital system is an excellent place for saving lives. Unfortunately, it is not geared for long-term inmates. The longer you have to stay, the more is likely to go wrong.

I am sincerely indebted to those who helped me. However, once a life is saved it must also be sustained. Bits of the body that have not made it have to be removed. In my case that was both legs (below knee), and the fingers on both hands. That is when the fun really begins.

I began my journey in Emergency and the Intensive Care Unit. After a few weeks, once I was stabilised, I was moved to the renal ward of Liverpool Hospital. My kidneys had shut down for a time, but even though I no longer required dialysis, I was shunted into the renal ward as a kind of holding pen, until they worked out what to do with me.

Staffing

Last year, the Sun-Herald ran a feature article on the treatment of the elderly in nursing homes.

One of the central complaints was that residents are often left in unsanitary conditions for long periods of time. Patients were told not to ask for nursing assistance until the continence pad (nappy) they were wearing was completely soaked; not just wet, but soaked.

My experience of the renal ward of Liverpool Hospital was not dissimilar.

I was very weak, my legs and hands were gangrenous. Even so I was told not to call nursing staff unless the pad I was wearing was completely soaked. This often meant lying in my own mess for hours.

Like in nursing homes, the key problem with public hospitals is understaffing.

I stayed in Fairfield Hospital, a busy suburban hospital that also conducts all public hand surgery in southwest Sydney, for about three months. Nurses would complain bitterly when a staff member was sick, as they are not replaced. Ratios of one nurse to four patients are mandatory in Sydney hospitals, but this requirement is not always enforced.

Indifference

I was unlucky enough to acquire methicillin resistant staphylococcus aureus (MRSA) — antibiotic resistant golden staph — soon after my hospital admission. The reason why remains unclear, but it is likely to have been a matter of poor hygiene on the part of my carers.

Hospital-sourced MRSA infection is so common as to be almost a cliche. While hospitals seek to isolate those infected, new infections are routine. Unrelenting pressure on nursing staff and an unsustainable workload are undoubtedly a large part of the problem.

Being infected with MRSA meant that whenever I needed an operation, and I required a few, I was always left to the end of the surgeon’s list. Routinely I would wake post-operatively in the early evening, after the surgeons and anaesthetist had gone home.

On more than one occasion, I was left to languish in extreme pain once the local anaesthetic block had worn off, sometimes for hours, before a consultant anaesthetist could be contacted to authorise appropriate pain medication. Had this occurred only once, it might be understandable. But the fact it occurred again and again is hardly acceptable.

Bullying

Bullying happens when there is an imbalance of power and a lack of accountability. Bullying becomes even more likely when people are overworked, overstretched and placed under unrelenting pressure.

I was in a very vulnerable position throughout my time in hospital, but more so at the beginning. I was completely reliant on assistance — to eat, get out of bed, or relieve myself. This often left me in a very difficult position, as I required far more help than many other patients.

I was casually bullied, by both nurses and support staff, at a number of hospitals. I was yelled at, told to stop calling the nurses, left screaming in pain and handled roughly. Bullies were a significant minority among staff, but were nevertheless present in almost every hospital I stayed in.

New South Wales Health has policies to protect patients from bullying. “Everyone working in NSW Health should expect to be treated, and must treat others, with respect, dignity and fairness,” the New South Wales Health Code of Conduct states. “In particular, bullying and/or harassment will not be tolerated.”

On one occasion, after a particularly egregious incident of bullying, I made a formal complaint to Fairfield Hospital. Despite assurances that action was being taken, I have not received any response from the hospital after almost six months.

More funding needed

An obvious fix is more funding. And without question, the public health system is seriously starved of funds.

The Tony Abbott Coalition government cut about $50 billion from hospital funding over 10 years in the 2014 budget. Although the Malcolm Turnbull government has restored some of that funding, severe shortfalls remain.

Increasing health funding is only one part of the solution, however. The two-tier health system in Australia privileges those who are able to pay over those who cannot.

Healthcare should be a right and not a privilege. Everyone should expect that if they need hospital treatment they will receive it, regardless of their wealth.

One step in the right direction would involve nationalising the private health industry. The assets of private health could be rolled into the public health system. Abolishing the private health rebate would free a further $3 billion a year.

All healthcare should be publicly funded. No copayments, no gaps, just provided on a needs basis. An adequately funded public health system could also be expanded, to take on the load currently carried by the private system, and radically reduce waiting times for so-called elective surgery in the public system.

Hospitals are community assets and should be run by and for the community. The insular health bureaucracy cultivates an environment of secrecy and servility. It must be replaced with direct control by health workers and the community.

Hospitals should be democratically run by, and accountable to, the communities they serve, and those who work in them. Until then, hospitals will remain at the darkest edge of the health system, out of sight and out of control.

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