Deadbeat Australian public hospital getting supplies from a veterinary practice!

It has been known for months that this hospital cannot pay its bills but the problem continues

A doctor has dipped into his own pocket to buy equipment for patient tests as supply shortages reach crisis point at a western New South Wales hospital. The doctor bought the equipment so a diagnostic blood test could be processed at Dubbo Base Hospital, while nursing staff say they are tired of sourcing medical supplies from the local vet.

Dubbo medical staff council chairman Dr Dean Fisher said there had been ongoing problems at the hospital, but patient care was now threatened. The hospital's pathology department had recently advised staff not to order blood tests because the associated equipment stocks were running low. "It is the first time that I'm aware that a doctor has had to buy supplies and that stems mostly from bills unpaid by GWAHS (Greater Western Area Health Service), which stopped supplies being sent up to us to use," Dr Fisher said. "In the past it's been unpaid food bills, unpaid transport bills, now it's affecting patient safety and that's of extraordinary concern."

On Monday, medical staff cast a vote of no-confidence in hospital management. Staff now want to meet with management and ask that NSW Premier Nathan Rees and Health Minister John Della Bosca visit the hospital to discuss supply shortages. "We've had enough of nursing staff having to go down the the local veterinary clinic to get bandages and urinary dip sticks to be able to continue patient care," Dr Fisher said.

"Every six to 12 months we have a crisis here. "We are short from a workforce point of view, both medically and with nursing personnel. They (GWAHS) bring in a external auditor at great expense to look at the problems. That money could be so much better spent."

The Australian Medical Association (AMA) said rural hospitals urgently needed state government funds to boost patient care. "If there are funds available to be spent, rural hospitals should be the first in line," AMA NSW president Dr Brian Morton said in statement today.

Mr Della Bosca, appointed health minister last month, has said previously he planned to visit hospitals in rural NSW. A spokeswoman for his office could not confirm when the minister would visit Dubbo. Mr Della Bosca last month could not confirm reports from Independent Dubbo MP Dawn Fardell that businesses were waiting for $150,000 worth of bills to be paid by the area health service. But he admitted there was a systemic problem and the service had "cash flow problem".

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State health boss pledges to fix "broke" public hospital

The blowhard is "investigating" it. Why not get the checkbook out first so suppliers are paid and can resume supplies?

NEW South Wales Health Minister John Della Bosca has promised to fix a "systemic failure" that forced doctors at a hospital in the state's west to buy their own medical supplies. Mr Della Bosca today said he had launched an investigation into cash-flow problems at the Greater Western Area Health Service which led to shortages of medical gear at Dubbo Base Hospital. "The direct answer is cash flow, and it is totally unacceptable for doctors and nurses to be paying for supplies out of their own pocket,'' he told Fairfax Radio Network. "It is totally unacceptable, if it is true, that doctors and nurses are having to borrow bandaging from local veterinary scientists. "I'm immediately having that investigated as of today.''

Mr Della Bosca said before medical staff went public with their concerns, he had held a meeting with the GWAHS's chief financial officer a week ago. The meeting had led to the payment of about 5000 outstanding accounts. "Those creditors are now satisfied and supplies have been restarted,'' Mr Della Bosca said. '(But) we need to fix the system, there's a systemic failure here and I'm getting to the bottom of it. "I expect to have it fixed and fixed very quickly.'' ....

The GWAHS has brought forward to Monday a meeting with the staff council originally scheduled for next month.

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Australian doctor-training catches the British disease

Britain too turns out thousands of medical school graduates who are given no chance of completing their training. That great government "planning" again, of course

Andrew Hobson isn't bad at maths, a factor contributing to his selection as a first-year medical student at the University of Queensland. So when he compares the 734 students to be awarded Queensland medical degrees in 2011 and the 667 hospital internships on offer in 2012, he worries. The numbers don't compute. Everyone sits there and says: 'Wow.' All of a sudden there's added pressure, almost competition, between the students because most of us know that as of 2012, here in Queensland, we no longer have that guaranteed intern spot."

Hobson is a product of a belated government realisation in the late 1990s that Australia was about to run out of doctors. In the years that followed, it did, to the point where it now draws 36 per cent of its general practitioners from overseas. That figure jumps to 41 per cent in the bush. Canberra was forced into a hasty rethink of its earlier policies aimed at limiting over-servicing by doctors. Its complaints about too many GPs and blow-outs in Medicare billing costs were replaced by a hefty catch-up investment in medical schools. By 2012, 19 medical schools - almost double the number operating throughout the '90s - will struggle with record throughput. Domestic graduate numbers will total almost 3000, an 86 per cent increase on last year's output. But although one problem seems solved, another has emerged.

Australia may have students in the pipeline, but a lack of training places before and after graduation - in hospitals, in general practice and the specialties - threatens to block the workforce flow just as it starts. The country's medical deans warned earlier this year the number of young doctors was starting to exceed the capacity of some clinics, hospitals and medical colleges to give them on-the-job training and access to patients. "The situation is becoming critical," they said.

The cracks first appeared in 2005, however. That year, the Australian Medical Workforce Advisory Committee concluded the country was short of 800 to 1300 GPs. It was also the year that a Medical Journal of Australia study revealed teaching hospitals in the University of Newcastle medical school catchment had started to fall behind on clinical placements for the next generation of doctors. The school's student population outnumbered patients available on any given day by two to one.

It reminds Australian Medical Students Association president Michael Bonning of the British debacle, where a dearth of National Health Service training positions left thousands of young doctors jobless. "That's exactly what we're worried about," Bonning says. "The situation here hasn't yet reached those dire projections that we've seen in the UK, but what we want to do is learn from the mistakes over there."

After years of importing doctors, Britain earlier this year announced it was shutting the door to applicants from other Commonwealth countries, including Australia. Australia, which also has counted overseas-trained doctors among its biggest imports for many years, could start engaging in its own form of exclusion as soon as next year. Queensland, for example, may have to start limiting hospital internships to Australian graduates of its medical schools from the end of next year, when applicants start surpassing demand, Bonning notes. Bar a change of policy, by the time Hobson graduates, virtually none of the 67 overseas students awarded medical degrees from his and other Queensland universities are likely to find a home at the state's hospitals....

Australian medical graduates aren't able to go into independent practice straight out of university. Instead, they are put through long years of supervised training, first as hospital interns and postgraduate trainees, then through vocational training. The country's biggest vocational training program is one designed to turn graduates into GPs, who provide most of Australia's out-of-hospital health care. The Australian General Practice Training Program for next year, however, is already vastly oversubscribed. As of June 30 this year, there were 600 training spots and 733 applications.

The lack of certainty over future placements frustrates Bonning, who wants another 100 places added annually to the program during the next three years. "I think it's very unlikely and very much out of line with the Government's current push in primary care to think that they won't look at increasing the number of people in general practice," he says....

It's where the commonwealth, eight states and territories and about 20 medical colleges overlap that things get messy. The states and territories provide initial training for medical graduates in their teaching hospitals, in the form of a one-year internship and pre-vocational training. For each young doctor, cash-strapped public hospitals have to find the time and resources to supervise training while tending to their growing patient workloads. The Victorian Department of Human Services reportedly has gone as far as charging for clinical placements for students, according to the deans of the country's medical schools. This year, they called on governments to include explicit funding streams for medical education in hospital budgets as part of the next federal-state health funding agreement, to be signed within three months.

"Public hospitals have been able to shift much-needed funds away from teaching and research to meet the increasing costs of service delivery," they told the commonwealth's health reform adviser. "This has placed an increasing burden on medical schools to ensure adequate and quality clinical training placements."

Bonning, who graduates from UQ in seven weeks, has secured a hospital internship for next year. But his later years of vocational training, which qualify doctors for independent practice, are still not assured. The process of entry to general practice or a specialty involves not just multiple governments and agencies but the medical college that young doctors aspire to join. "It's just more complicated because there are more parties involved and any one of them can cause some problems," Bonning says. The relationship between the different parties has often been a strained one....

Successive federal governments have tried to unclog the bottlenecks and expose doctors to non-traditional practice by expanding areas in which training takes place to private hospitals, community medicine and public health. But the federal Department of Health and Ageing, too, has been overwhelmed bydemand. As of July this year, it had received about 500 applications for the 180 places it had funded for its 2009 program, which aims to give specialists experience working outside of public hospitals.

Bonning says Canberra needs to continue looking for placements beyond state hospital settings if it is to make its grand experiment in medical workforce planning work. "No matter how many students you put into a system, you essentially have to train them all the way through to independent practice," he says. "If we stop or neglect their training at any stage, you won't get the full pay-off that the community demands."

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