As state governments continue to slash their spending, they say front-line healthcare is safe – but the reality on the ground seems to be different. Flynn Murphy reports
The catchcry “cuts will not affect front-line services” comes from every government that slashes its health budget in Australia.
Recently the big hits were in Queensland, NSW and WA, while Victoria and Tasmania are coping with earlier tough budget measures.
But according to leading health academic Mike Daube, it’s a fiction – one that ignores the complexities of any functional health system.
“With health, so much of the health budget is immovable,” said Daube, who is a professor of health policy at Curtin University and director of the Public Health Advocacy Institute.
He has closely analysed the impact of the latest tranche of cuts in Queensland, and their long-term impact on health in the state. “The talk about front-line services is meaningless. The bottom line is [when] you cut health systems and cut services, you impact on health outcomes. You cut prevention, you impact on future outcomes.”
Daube said even though health budgets all across the nation were being slashed, the case of Queensland needed to be treated separately: “Around the country health departments are having to tighten their belts, but in Queensland they’ve thrown away the belt and they’re using a garrotte. It’s less considered and more drastic, and it’s going to do more harm than anything else.”
So what exactly is being cut in Queensland? Despite a pre-election pledge to make health a priority in the state, the Newman government, in handing down its 2012-13 budget, announced it would seek to cut almost $4 billion from Queensland Health over the next four years. The government claimed this was mainly due to the previous government’s payroll debacle, which an independent review concluded in June would cost $1.25 billion to fix.
The Newman government broke its cuts down to a “corporate restructure” intended to free up $2 billion, staff reductions to deliver more than $1.6 billion, the scrapping of other services to add up to $120 million, as well as a reduction in spending on consultants, travel and advertising for $283 million.
Queensland loses 2754 jobs
In September came the announcement that 2754 jobs were to go from Queensland Health. At a press conference that month, Health Minister Lawrence Springborg said the figure included 1217 full-time-equivalent jobs from the corporate head office, and 1537 from Queensland Health’s 17 regional hospital boards.
“It’s not about health solutions,” said Queensland Nurses Union branch secretary Beth Mohle, “The agenda that’s driving this is a negative, cost-cutting one.” Mohle called the cuts “incredibly shortsighted”, and said they were symptomatic of a government that viewed health as a “cost rather than a benefit” in a state where demand was already outstripping delivery of services.
Mohle said the government was “running a line” about the jobs to be cut being “administrative, bureaucratic positions”, the scrapping of which would not affect health outcomes. “But we’re talking about areas like primary preventative health services, public health nurses, BreastScreen Queensland, TB clinics. TB clinics – that’s unsafe, and it’s the sort of thing nobody is going to think about until something goes wrong.”
Mohle added that “job creep” would be an issue when jobs that directly support nurses are cut, from clerks to cleaners, and nurses find themselves forced to take on secondary tasks such as more paperwork and cleaning, giving them less time to deliver the vital services for which they are trained.
In his address, Springborg said the cuts would not impact the efficiency of health service provision. But Daube said this was a dangerous way to think: “It’s fine to say these cuts are coming from head offices, or wherever else, but Queensland has historically had problems because there wasn’t the right kind of supervision.
“Catastrophes like Bundaberg happened because there wasn’t enough focus on safety and quality,” he said, referring to Base Hospital in 2005, when surgeon Jayant Patel was accused of gross incompetence. Patel was later convicted of manslaughter and grievous bodily harm and sentenced to seven years’ jail. He is appealing the conviction.
“Queensland had a national reputation as being the worst-funded health system in the country, and in the last decade they’ve climbed out from that. Now they’re going back down into the abyss again,” Daube said.
Mohle said these job losses were just the beginning: the state budget allocated more than 4100 redundancy packages for Queensland Health.
The government lauded an $800 million budgetary increase in health funding, but Mohle told Nursing Review this actually represented a cut in real terms. She said health inflation of 3 per cent, and patient growth of about 4 per cent made it the first time the health budget had been cut in Queensland since Bundaberg.
Cuts to front-line services
Mohle said that the government’s promise of “more nurses, not red tape” (a Liberal election slogan), along with its repeated pledges on front-line positions, were directly contradicted by the experience of nurses in Townsville – the first of Queensland’s 17 regions to implement the cuts.
“Townsville is the first cab off the rank and they’ve been going at it like a bull at a gate,” Mohle said.
“It’s all very unplanned and it’s all very ad hoc.”
Mohle said of the 200 health positions to be cut in Townsville, the union was advised 45 would be nursing positions. Though that number, she said, had gone down after a number of industrial relations actions were brought by the union, but it was impossible to predict how many nurses would lose their jobs.
“These are clinical positions. These are positions like outreach education for oncologists in rural and remote areas, or nurses in the discharge lounge. You can’t get much more frontline than that.”
Climate of fear
Nursing Review had great difficulty finding nurses willing to go on the record in Queensland. Those speaking on condition of anonymity said they were in the dark about cuts, and that nobody really knew where the axe would fall.
“I’ve never seen members so fearful,” said Mohle.
“People are certainly intimidated, yes,” said Daube. “They either work for the government or they are in agencies that are funded by the government. So they’re terrified to speak out.”
Daube said the climate of fear was a deliberate move on the part of the government to gag health professionals and dampen public debate on the cuts.
The Queensland cuts have also impacted the health system’s capacity to find placements for new nursing graduates. “We already know that not all of the graduates got jobs from this year,” said Mohle.
“We have an overhang of people already waiting for meaningful employment and now Toowoomba hospital, for instance, is not taking on any graduates next year. So that’s an additional 20 to 25 positions that won’t be available. They can’t afford it. They’ve been told to cut the budget.”
The Queensland Nurses Union is calling for members and the public to help track the impact of cuts by lodging their concerns on its website.
Daube argued that political expediency rather than health outcomes was driving the cuts, demonstrated by the fact they were set to “hit soft targets hardest”.
“If you cut emergency departments, the heavens descend on you. If you cut direct clinical services, people complain. But if you cut prevention, nobody is going to be on the front page of the newspaper.
“The outcomes take a while. When you look at the list of what’s being cut in Queensland, it’s the vulnerable who are being targeted – alcohol and drug services, Indigenous support services, HIV/AIDS – and the vulnerable can’t make a lot of noise.
“On the other hand, they’re going to make access to licences easier, and it looks like they’re going to kill off alcohol management programs. With gambling, they’ve said they’re going to make it easier for casino operators.
“The [Newman government] has gone cutting and slashing before they even understood what the system was about.”
Queensland is by no means the only state where nurses are feeling the sting.
In NSW, the O’Farrell government has claimed it can cut $3 billion out of the health system over four years without affecting front-line services. Health Minister Jillian Skinner told a press conference in Sydney that nurses would be exempt and that there would be no cuts to nurse positions.
The department has confirmed, however, that it will axe $89 million in overtime payments for hospital staff, despite the fact this risks leaving vital shifts unstaffed. It has been reported that even the directive to protect nurse positions has been ignored, with nurses offered voluntary redundancies in the Hunter-New England area, says the NSW Nurses Association.
“The NSW health system has got problems enough anyway. It’s going to be very bleak,” said Daube.
The Tasmanian health system, meanwhile, has become something of a cautionary tale. Earlier this year, Nursing Review reported on cuts of $100 million dollars to the Tasmanian health budget, resulting in the axeing of 280 full-time-equivalent nursing positions.
Neroli Ellis, secretary of the Australian Nursing Federation’s Tasmanian branch, said it’s now clear that the short-term and long-term impacts of the cuts were never factored in. “The cuts were too harsh, too sudden and too far. Beds were closed and elective surgery almost came to a standstill,” she said.
“The result is now nurses are working double shifts to cover roster shortages.”
According to ANF figures, 420 double shifts have been worked in the Royal Hobart Hospital in the past two months alone. Ellis said staff vacancies have now opened up which can’t be filled as many experienced nurses have left the state. “It will take years to recover and rebuild capacity,” she said.
The shifting demographics of the Tasmanian health system have now created a perfect storm for the state. Recent graduates, too, are unable to gain employment in Tasmania. Next year, 375 new graduates will compete for 120 positions. “With a whole generation of nurses leaving the state, and the oldest average workforce, it will have a serious impact on future workforce planning,” Ellis said.
Daube said the health system in WA was doing “reasonably well”, owing in part to the mining boom. But with the iron ore price falling, he said, the state government, too, had been forced to make cuts. In October, The Sunday Times reported $12 million dollars would be pulled from the health budget.
It was reported that the Barnett government planned to slash at least 130 unfilled full-time health jobs to achieve a budget surplus for 2012-13. This was something it aimed to achieve through a 1.5 per cent cut in government agencies’ procurement spending and an indefinite staff hiring freeze, on the back of a 2 per cent cut to all government departments.
For Mohle, while many of the impacts of the health cuts around Australia were obvious, some would be more subtle. “It’s not only the people who are losing their jobs, it’s the people who have to tell their staff they are losing their jobs, and it’s not their choice.
“In a system that’s predicated on co-operation and trust, and is all about relationships, how are you ever going to rebuild those relationships?”
Looking at other states, the Victorian health system was reportedly hit by a year-on-year cut, in real terms, of five to seven per cent for 2011-12 and it is feared greater cuts will come.
This is understood to have resulted in staffing freezes (despite increased workloads), cuts to hours, and increased pressure to privatise public hospital services. The Age reported that despite waiting lists blowing out in the state, $40 million dollars might be pulled from Victoria’s public hospitals.
In South Australia, state Health Minister John Hill has confirmed cuts forced by budget pressures will result in 114 beds closing and 350 job losses from the public hospital system. The government said the jobs cuts, both front-line and from head office, would be achieved by natural attrition and the use of fewer agency staff. Hill said the cuts would save $270 million over four years, and that another $230 million in savings remain to be found.Do you have an idea for a story?
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