00:01This report is telling us that more old people are presenting to our emergency departments,
00:06that they're waiting longer to be seen, that they're waiting longer to get to a hospital
00:10bed when they need to be admitted, and that they're waiting longer to get out of hospital
00:14and be placed safely in the community.
00:17How much of the presentations to emergency departments are elderly people in Australia?
00:22We've had about a 7% overall rise in emergency presentations over the last five years, but
00:29if you look specifically at the older population, they're rising at four times the rate of the
00:35rest of the population in the numbers that are attending emergency departments.
00:38It used to be really rare to have anybody over the age of 80 in your emergency department
00:42whenever I first started, and now, most days, we've got several people over 100 in our emergency
00:47departments as well.
00:47And this is a positive thing, actually, a testament to modern science and public health planning
00:54that Australians are living longer, healthier lives.
00:57But our health system just hasn't prepared for the inevitable incoming increase of older
01:04people presenting to emergency departments.
01:06And can you briefly describe to us what that would be like for a patient?
01:10I mean, we hear these figures, we hear the numbers, but what is it like for a patient presenting
01:14in a common experience in an emergency department in Australia, where the worry lies in that it
01:20shouldn't be the experience they have?
01:21It categorically should not be the experience. It's now become almost routine for anybody
01:27that turns up to spend 12 hours sitting in a plastic chair in a waiting room. Recently,
01:33I'm aware of a 97-year-old that spent all night sitting in a plastic chair in one of my
01:39local
01:39emergency departments. We have older people bringing inflatable mattresses to spend the night
01:44in the waiting room, patients spending the nights in cars rather than...and then coming in every
01:49couple of hours into the waiting room to get their obs checked. It's really...and the frightening
01:54thing for us is the statistics...the modelling of the statistics would suggest we're just at the
02:00beginning of the exponential increase here. So, we're already not coping.
02:04Yeah. Why...why can't the hospitals cope with this?
02:08It's...it's a failure of planning across governments of all level over the last 20 years. We have a flat
02:16number of beds per capita in Australia across the last five years, despite the increasing
02:21frailty and old population. We have...it's been well publicised and Minister Butler has talked about
02:28it as well. We've got a severe shortage in aged care beds in the community as well.
02:33Something like 10,000 beds need to be built every year for the next 20 years. And last year,
02:38we built 800. So, patients are getting stuck in hospitals. Hospitals are the...becoming the aged
02:43care facility of last resort, because there's nowhere else for these people to go. And that just,
02:48you know, blocks the whole system. And it's absolutely not the patient's fault. It's the
02:51system's fault and the decisions that have been made over the last couple of decades.
02:57And you mentioned the health minister there, the federal health minister, Mark Butler.
03:00He said the responsibility for improving the health system lay with state and territory
03:04governments. But, you know, as you have pointed out, the federal government is responsible for
03:09largely aged care. So, where does the responsibility, in essence, lie here?
03:13It lies everywhere. There's no... And that's part of the problem with the state and federal divide,
03:19is that there's the risk of different governments blaming each other, when we actually just want
03:24people to work together and fix the problem. The state governments are in charge of hospital capacity,
03:29and that has not increased over the last five years, by any significant measure,
03:34when you look at an upper population basis. So, the state governments have got work to do there.
03:39But they're also partially crippled in their response by having more than 3,000 patients
03:46stuck in hospitals who are fit and ready for discharge, but there's just not anywhere to
03:51provide the care that they deserve in the community, because the aged care sector just hasn't kept up.
03:57Are there any bright spots in this report? Well, the bright spots are... Well, I've said already,
04:02we should be celebrating the fact that we're all living longer, healthier lives, and that's fantastic.
04:06The bright spots are that we know how to fix it as well, and we just want the governments to
04:11work
04:11together and to direct resources to stuff that works. We need them to direct money to our GP colleagues,
04:20so they can provide the excellent long-term clinical care that they can in the community. And it's been
04:25shown, you know, robust scientific evidence showing that GPs keep people out of hospitals.
04:30So, if we've got the best primary healthcare system in the world, we will keep more and more people
04:35out of hospital. We need drivers for change throughout our healthcare system, and our college has targets
04:41that we would very much like to see adopted nationally. But also, there's an accountability
04:45issue. I think there's sometimes a lack of accountability across the sector, because we
04:49can blame shift. And we would like to see our targets adopted and used to enforce accountability
04:55across the system and hold us accountable in the emergency department, but everyone else in the
04:59healthcare sector, too.
