Indicator: Health Services
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During the reporting period, the number of general practitioners (GPs) per capita in the ACT declined. Access and equity issues also emerged in relation to declining levels of bulk billing by GPs.
The proportion of elective surgery patients with extended waiting times increased slightly from 2000–01, however additional ongoing funding for elective surgery was announced in 2003. The proportion of emergency department patients seen within the appropriate time increased despite greater demand for the service.
Per capital expenditure on health services was higher in the ACT than in any other Australian jurisdiction and was increasing at a higher rate. The ACT health system responded impressively to the challenges of the January 2003 bushfires.
During the reporting period, the ACT suffered a crisis in the mental health system and implemented major reforms to address the problems. Children with mental illnesses were identified as being particularly at risk because of a lack of facilities.
Equity and access emerged as important issues amid growing emphasis on private sector provision of health services. For community wellbeing it is important that the ACT maintain a strong and accessible public health care system.
The rate of GP full-time workforce equivalents (FWEs) per 100,000 population is used as an indicator of the availability of primary health care services. The rate of GP FWEs per 100,000 population for the ACT declined significantly since the last reporting period while the national figure decreased slightly (see Table 1).
|Table 1: Access to primary health care services (GP FWEs per 100,000 people)|
Source: SCRCSSP 2003
Of all Australian jurisdictions, only the Northern Territory had a lower rate of GP FWEs per capita than the ACT (ACT Health, 2003). The ACT Select Committee on Estimates 2001–02 concluded that the ACT has a GP shortage of approximately 50 GPs (Standing Committee on Health, 2003).
During the reporting period the ACT Council of Social Services and the Smith Family (ACT) were concerned declining bulk billing rates by ACT GPs further reduced primary health accessibility for disadvantaged ACT residents. This was attributed to the inadequacy of the Medicare rebate ( Canberra Times, 5 September 2002).
In the two years to September 2002 bulk billing for general practitioner services fell from 64.7% to 38.8% in the Fraser electorate and from 58.3% to 44.1% in the Canberra electorate. Consequently, disadvantaged people increasingly had to forego primary care or visit already pressured public hospital emergency departments. The number of people presenting at emergency departments with less urgent conditions increased by 15% between 1998–99 and 2001–02 (ACT Government Media Release 120/3, 3 March 2003).
In the previous reporting period there was a dramatic increase in the proportion of the ACT population with private health cover, up from 34% in 1998 to 56% in 2000. The increase was associated with federal initiatives promoting private health insurance. During the current reporting period however, the proportion of the ACT population with private health insurance declined from 57% in 2001 to 52% in 2002 (Private Health Insurance Administration Council, 2003).
The number of available hospital beds in public acute care hospitals in the ACT continued to decline during the reporting period, following the national trend. The decrease was partly offset by an increase in the number of private hospital beds. However, data for ACT private hospitals were incorporated into New South Wales statistics, so it was not possible to trace trends in the total number of available (private plus public) hospital beds for the ACT (AIHW 2002b; AIHW 2003).
The proportion of ACT patients facing long hospital waiting times increased slightly from 2000–01 to 2001–02 across all three indicators (see Table 2): days waited at the 50th percentile (50% of patients were treated within the time given); the 90th percentile (90% of patients were treated within the time given); and the percentage of patients waiting more than 365 days. Nationally, the three indicators remained stable (AIHW 2002b; AIHW 2003).
|Table 2: Waiting times for patients admitted from waiting lists|
|Days waited at 50th percentile||44||27||40||27|
|Days waited at 90th percentile||266||202||268||202|
|Patients waiting more than 365 days||5.3%||4.4%||6.8%||4.5%|
Source: AIHW 2002, Australian Hospital Statistics 2000–01 , AIHW, Canberra AIHW 2003, Australian Hospital Statistics 2001–02 , AIHW, Canberra
The proportion of emergency department patients seen on time was higher in the ACT than nationally in 2000–01 and in 2001–02. This figure increased between 2000–01 and 2001–02 in line with a national trend (AIHW 2002b; AIHW 2003) (see Table 3).
|Table 3: Public hospital emergency department patients seen on time|
Source: AIHW 2002, Australian Hospital Statistics 2000–01, AIHW, Canberra AIHW 2003, Australian Hospital Statistics 2001–02, AIHW, Canberra
In May 2003 the ACT Government announced it would allocate an extra $2 million annually to increase access to elective surgery. The extra investment was expected to allow more than 600 people to undergo surgery each year and was accompanied by introduction of more detailed and accountable reporting of waiting lists and waiting times for elective surgery in public hospitals (ACT Minister for Health, Media Release 23 May 2003).
In 2001 an unpublished ACT Health Department survey of patient satisfaction found that 86% of inpatients and day surgery patients and 76% of emergency patients were satisfied with the public hospital services ( Canberra Times, 31 January 2002).
The January 2003 bushfire was a significant event during the reporting period which provided an opportunity to assess the capacity of the ACT health system to cope with a crisis. According to the McCloud Inquiry, ‘the health and medical profession responded magnificently and handled record numbers of people on the day’ (p. 56).
On 18 January 2003, 280 people presented at the Canberra Hospital emergency department, most with fire-related conditions including smoke inhalation, minor respiratory complaints and injuries associated with motor vehicle accidents and falls. At all times during the crisis, beds were available for those needing hospital care. To maximise availability, elective surgery was suspended on 19–20 January.
St John Ambulance Australia (ACT), volunteer GPs and counsellors provided primary care at evacuation centres. Public health information, warnings and surveillance were also provided about air and water quality and hygiene (ACT Health submission to the Inquiry into the Operational Response to the January Bushfires).
In 2000–01 the ACT had the highest health expenditure per capita of all Australian jurisdictions, $3499 per person compared with $3153 per person nationally. Growth in health spending in the ACT was also the highest in Australia between 1997–98 and 2000–01, averaging 6.3% per annum, 1.4% higher than the national average (AIHW, 2002b).
The reporting period was characterised by crisis in the mental health system and implementation of major reforms to address the problems. ACT residents who are mentally ill are not receiving an appropriate level of health care or support. This is due, in part, to a lack of funding and also to a shortage of qualified workers.
Children with mental illnesses were identified as being particularly at risk because of a deficit in services. Many studies have recommended that dedicated age-appropriate acute care, day care and long-stay accommodation in the ACT be provided for children and adolescents (Office of the Community Advocate, Annual Reports 2000–01, 2001–02).
Significant concerns also emerged in relation to Mental Health ACT data that show there were four confirmed suicide deaths in the Psychiatry Services Unit during the reporting period and a possible 12 other deaths by suicide in the community by mental health clients.
The reliability of the community figure needs to be interpreted with caution, as it is often difficult to differentiate between suicide and misadventure by mental health clients.
The government commissioned several reviews and has accepted all recommendations from the reports (for example, the Mann/LaRoche report and Patterson’s report). A number of measures have now been taken within Mental Health ACT to improve mental health services and to manage the suicide issue, in particular (see note).
Mental Health ACT coordinates the Suicide Prevention Working Party, which released the Bereavement Pack for Suicidea few months ago as a resource for bereaved families and carers. This pack has been distributed widely across the community. In June 2002, the ACT Health and Community Care Board was abolished and the purchaser–provider funding model was phased out ( Canberra Times20 June 2002).
Increased government commitment to improving health outcomes for these vulnerable members of society is crucial to the overall wellbeing of the ACT community.
ACT Government action on deaths
The ACT Government has taken the following actions in response to recommendations mental health services inquiries:
- The Psychiatry Services Unit has updated its risk assessment tool and patient observation regime, which is reviewed daily at handover and/or during a transfer between care units.
- The Psychiatry Services Unit has reviewed its staff mix and has included a social worker and a psychologist on the ward. A discharge planner has also been employed to improve continuity of care after an inpatient admission.
- Risk assessment is a constant factor in all triage contacts and during clinical contacts. The New South Wales Institute of Psychiatry provides regular risk assessment training for all staff.
- A service-wide policy on Management of Consumers with Suicidal Behaviour, which includes protocols for providing counselling and support for family and carers has been introduced. Policies and procedures on possession of dangerous items have also been revised.
- Work on refurbishing the Psychiatry Services Unit, in response to the recommendations of the Mann/LaRoche Report, has begun.
- Mental Health ACT has provided funding to various suicide prevention programs in the ACT.
- Mental Health ACT has employed a project officer to focus on mental health promotion, prevention and early intervention initiatives, including suicide prevention.
The ACT Chief Health Officer's Report is tabled in the Legislative Assembly biannually in accordance with the Public Health ACT 1997. The 1999–2000 report is available at < http://www.health.act.gov.au/c/health?a=da&did=5000000 >. The 2000–02 report, a draft of which was a data source for this indicator, is forthcoming.
ACT Community and Health Services Complaints Commissioner 2002, Investigation into the risk of harm to clients of mental health services, ACT Community (The Paterson Report) , ACT Community and Health Services Complaints Commissioner, Canberra ACT Health 2002, ACT Health Action Plan, ACT Health, Canberra.
ACT Health and Community Care Services Board 2000 , The Canberra Hospital Annual Report 1999–2000 , The Canberra Hospital, Canberra.
ACT Health 2003, ACT Chief Health Officer’s Report 2000–02 , ACT Health, Canberra .
Australian Institute of Health and Welfare 2002a, Australian Health Expenditure 2000–01 , AIHW, Canberra.
Australian Institute of Health and Welfare 2002b, Australian Hospital Statistics 2000–01 , AIHW, Canberra.
Australian Institute of Health and Welfare 2003, Australian Hospital Statistics 2001–02 , AIHW, Canberra.
Note: Australian Hospital Statistics summarises data on Australian hospitals and is published annually by the Australian Institute of Health and Welfare (AIHW).
Health Expenditure 2000–01 replaces Health Expenditure Bulletin as the annual AIHW report on health expenditure in Australia. AIHW publications are available at < http://www.aihw.gov.au/publications/index.cfm >.
Australian Institute of Health and Welfare and the ACT Chief Minister’s Department 2003, The need for and provision of human services in the ACT , AIHW, Canberra. < http://www.cmd.act.gov.au/documents.html >
‘Shake-up for ACT Health’, by Danielle Cronin, Canberra Times , 20 June 2002.
Mann R and LaRoche K 2003, Review of the design and operation of the Psychiatry Services Unit, Canberra Hospital , for ACT Health, Canberra.
Office of the Community Advocate 2001, Annual Report 2000–01 , ACT Government, Canberra.
Office of the Community Advocate 2002, Annual Report 2001–02 , ACT Government, Canberra.
Private Health Insurance Administration Council 2003, < http://www.phiac.gov.au/statistics/membershipcoverage/survey/index.htm >.
SCRCSSP (Steering Committee for the Review of Commonwealth/State Service Provision) 2003, Report on Government Services 2003 , AusInfo, Canberra.
Standing Committee on Health 2003 , Looking at the health of school-age children in the ACT , Legislative Assembly for the Australian Capital Territory, Canberra.