Budget priorities for safe, high-quality, patient-centred care in NSW
It’s time to invest in healthcare
NSW has an opportunity in the 2022/2023 Budget to demonstrate a commitment to fixing a healthcare system that is struggling to cope with current demand. With less than 12 months before the next State election, this Budget will signal the priorities of the NSW Government and AMA (NSW) is calling on the Government to put the health of NSW residents first.
We have a growing and ageing population that is increasingly presenting with complex chronic conditions. Wards are full with patients who have nowhere to go – they might be waiting for an aged care placement, community mental health, or disability support. This creates bed block, which has a downstream effect on emergency departments. EDs are overcrowded, which means ambulances aren’t able to transfer patients. Patients who could be treated in primary care are going to hospital because they are unable to get a GP appointment, due to the GP shortage. Each part of the system is under stress and when one piece falls, the rest topples like dominoes.
The pandemic really shone a light on how vital it is to have a well-resourced, properly funded health system. COVID taught us that when the health of residents is at risk, then jobs are at risk, and the economy is at risk. Healthcare should not be viewed as an economic burden, but as the centrepiece of a prosperous society.
AMA (NSW) is seeking a Budget that addresses the current workforce shortages that contribute to ambulance ramping, bed block, declining trends in hospital performance, and health inequity across the State, particularly in rural NSW.
We want to see a Budget that addresses the elective surgery waitlists that are leading to poorer health outcomes for patients – not short-term ‘blitz’ funding, but structured funding that sees a well-managed ramping up of elective surgery over the coming years.
We want to see a Budget that delivers on more than the usual recurrent spending. We need a cash injection that meets the non-COVID needs of the community. There is a raft of non-COVID care that was sidelined during the pandemic and now needs to be dealt with. This includes routine screening for mental health, cancer, and chronic disease.
We want to see a Budget that supports general practice. Primary care is the cornerstone of our healthcare system and yet, often taken for granted. We’re calling on the State to grant medical practices an exemption to payroll tax, which threatens the financial viability of practices across the State.
And we want to see a Budget that includes a wage increase for the health workforce, including doctors. Doctors may not choose to strike, but they have made significant sacrifices during the pandemic and should not be left out of any changes to public sector wages.
We would like the see a significant Budget commitment in these key areas:
• Workforce
• Medical salaries
• Health expenditure for non-COVID care
• Payroll tax
If we fail to adequately fund our system, and build capacity to handle the increased demands from our growing population – then we will fail patients and put lives at risk.
Election Priorities
As we head in the countdown to the State election we will be seeking greater commitment from the Government to address these priorities.
Workforce
Building the health workforce in NSW is central to the resilience and sustainability of the health system going forward. Senior doctors are facing workplace stress, which was exacerbated by the pandemic. The AMA (NSW) Senior Doctor Pulse Check published last year, revealed that eight in 10 doctors are experiencing workplace stress, with the majority citing excessive workloads (60%) and lack of resources (69%).
And while the pandemic is easing, the pressure on doctors is not. NSW has a growing and ageing population that is increasingly presenting with complex, chronic health needs. Australia’s Health Reimagined, a report produced by Deloitte in March 2022, found that expected shifts in the age profile of the health workforce, combined with the increased demands of an ageing population pose a significant challenge over the next 30 years.
Australia’s population is estimated to be 35.9 million by 2050, and the proportion of people over 65 years of age will increase by 6% to almost a quarter of the population. During that same period the workforce participation rate is expected to decrease from 66% to 64%. Based on figures from the ABS and the National Health Funding Body, Deloitte modelling found that if the system doesn’t change, the health workforce must become four times more productive by 2050 to meet forecast demand. Or, as the report identifies, the health workforce would need to grow from 11% to 45% of the total Australian workforce.
Whilst training more doctors isn’t the only answer to this developing issue, there does need to be an emphasis on attracting and retaining doctors in NSW to meet the needs of the most populated state in the country.
Medical salaries
A number of NSW health workers, including ambulance paramedics, pathologists, hospital cleaners, as well as nurses and midwives have been vocal in their demands for a wage increase this year.
The same factors that have driven other healthcare workers to strike also exist for our members.
Healthcare workers have borne the brunt of COVID stress over the last two years, and doctors were already under significant pressure prior to the pandemic. Inflation, which has grown 5.1% over the last 12 months, is outstripping the state’s public sector wage cap of 2.5%.
About 60% of wages in the healthcare sector are directly tied to agreements or awards and workers in outdated agreements are falling behind.
Doctors may choose not to strike, but that doesn’t mean their contribution should be ignored.
AMA (NSW) will be calling on the NSW Government to ensure doctors receive the same wage rise it gives to other healthcare worker groups. The NSW nurses and midwives union is seeking 4.75% wage increase, while the HSU is pushing for a 5.5% pay rise.
Health expenditure for non-COVID care
AMA (NSW) is calling on the NSW Government to deliver a Budget that includes more than the usual recurrent spending and planned growth. We desperately need a cash injection that meets the non-COVID needs of the community.
The latest Bureau of Health Information’s quarterly report (October to December 2021) found overall activity returned to near pre-pandemic levels and triage category 2 presentations continued a gradual upward trend over the past five years. Meanwhile demand for ambulance responses was high, with more ambulance responses than any final quarter on record, and almost 95,000 patients were on the waiting list at the end of the quarter, with 10,770 patients waiting longer than clinically recommended.
It is clear that emergency departments are full and ambulances are ramping, while elective surgery waiting lists are blowing out.
We need a Budget that addresses these critical problems facing the health system.
Payroll Tax
Payroll tax threatens the financial viability of medical practices across NSW and risks exacerbating the challenges patients already face, particularly in rural and regional NSW, in accessing healthcare services.
Payroll tax has implications for all medical practices, but general practices have the potential to be hardest hit. The financial stability of general practice has been under threat for years and recent payroll tax decisions will push some practices to consider whether they can continue to remain open.
NSW is already facing a GP-shortage, particularly in rural and regional Australia. Payroll tax will exacerbate challenges to healthcare access if some practices are forced to close their doors.
Healthcare professionals have worked tirelessly and with little financial reward to assist the NSW Government with the vaccination roll-out and to protect the health of the community throughout the pandemic.
The application of payroll tax in light of these sacrifices is particularly disappointing.
AMA (NSW) is seeking a payroll tax exemption for medical practices.