Dr Clare Skinner speaks on the continuing pressures on Australia’s health system

19 January 2022

https://www.abc.net.au/7.30/dr-clare-skinner-speaks-on-the-continuing/13721058

LAURA TINGLE, PRESENTER: Pressures remain on the health system. Hospitals in Victoria have been put on a Code Brown emergency alert as cases surge.

At the national level, the Government has ordered tens of thousands of nurses and other staff from private hospitals to be made available to treat patients in the public system.

Dr Clare Skinner is an emergency doctor and the president of the Australasian College for Emergency Medicine.

Dr Clare Skinner, yesterday we saw Victoria declare a Code Brown in its hospital system, and the Federal Government announced the resuscitation of a deal with the private hospital system to take pressure off the public hospitals.

Can you tell us what these things mean in practice to our hospitals, and particularly in emergency departments?

CLARE SKINNER, AUST. COLLEGE FOR EMERGENCY MEDICINE: The Code Brown is acknowledgement by the Victorian Government that they're struggling to provide usual services.

It's actually welcomed by emergency doctors because hopefully that will allow them to mobilise the resources they need to manage the current Omicron COVID waves and we also hope it might help them build structures for better coordination across the Victorian health system.

LAURA TINGLE: Can you give a sense of how COVID patients are now spread through the hospital system? There's always focus on ICUs, but it seems there are now a lot of patients requiring high levels of care but not necessarily in intensive care.

How does that change the workload in hospitals?

CLARE SKINNER: Thanks, Laura. That's a really good question. A few weeks ago in Sydney, we were seeing high numbers of people present to emergency departments with mild symptoms. They tended to be in their 20s and 30s. So they were catching COVID because they're quite socially mobile and they're also the group who are least likely to have a regular GP. They came to ED because there were no other ways to seek care at that stage.

We have seen support in the community beef up for COVID, which is great to see but unfortunately, now - as the wave progresses through Sydney - we're tending to see people who are more clinically vulnerable presenting with COVID.

So people who are elderly or who have chronic and complex disease and, unfortunately, they're more prone to severe COVID and they're more prone to deterioration and needing hospitalisation and possibly intensive care.

LAURA TINGLE: There's growing talk of us having reached a peak in new cases of COVID, particularly in New South Wales. What's your sense of it in the hospital system or is it something that will always be a bit delayed?

CLARE SKINNER: Look, the numbers out of New South Wales Health for the last couple of weeks have been encouraging.

But it's important to note first of all, I'm a clinician, not an expert modeller and secondly, what we're seeing is the test numbers and we know there has been a change in the testing strategy.

I think it's too early to tell. It has felt like Sydney's in a pseudo-lockdown. So as people increase their socialisation, we're probably likely to see a little bit of an upward tick.

And the other problem is that people who tend to deteriorate with COVID don't do that on day 1 or 2, they tend to do it a bit later down the track. So we're not quite sure what the numbers means just yet.

Definitely, it feels like the numbers aren't as extreme across Sydney as they were over New Year's, but they're definitely way busier than usual and obviously other parts of Australia are yet to face what we started to go through in Sydney. So we're watching and waiting.

LAURA TINGLE: Has the system got much capacity left for an even bigger number of daily cases, if that was to eventuate?

CLARE SKINNER: Look, everyone in healthcare is working exceptionally hard at the moment, both in the hospitals but also out in the community.

The work is physically and emotionally demanding. Emergency departments are under extraordinary levels of pressure across the entire system.

We've got a perfect storm of people presenting with COVID-19, but also high levels of staff shortages. That's due to people having COVID-19, but also being at home as close contacts or caring for family members. So things are really difficult at the moment.

Working in PPE and maintaining infection control is more difficult than running the emergency department under usual conditions. People are doing their best.

The care we can provide might look a little bit different to usual, but we really encourage everyone who's got urgent or life-threatening symptoms, please, do seek care either with your GP or, if you do have life-threatening symptoms, at your local emergency department, and we'll do our very best to look after you.

LAURA TINGLE: Well, just to help keep that pressure off you and all the staff in emergency departments, are there any particular indicators you can give to people about when they should make the decision to go to an emergency department?

CLARE SKINNER: I would really encourage people to look at federal and state government websites. There is good information there and make sure they have a trusted source of advice about when to seek care.

And, of course, if they're worried, reach out to their GP or come to their local emergency department. We're not going to judge anyone.

It's really important that we don't blame the general public for seeking care inappropriately. The hospital system has been fragmented and difficult to navigate for years.

This is just not a COVID phenomenon - this has been building for years, with increasing out-of-pocket costs.

What we need to do is make sure that we remember how it feels right now. We're seeing the fault lines exposed through COVID.

Care is difficult to access, but it's particularly difficult to access for the most vulnerable in our community - those with complex and chronic disease, those with low levels of education or income, and those who are marginalised for other reasons.

So I encourage everybody, remember how it feels now, and then as we emerge from this wave, we need to make sure that health reform is on the political agenda, because we need to make sure we design a health system that is safe and fair and accessible for all Australians.

LAURA TINGLE: Dr Clare Skinner, thank you so much for your time, and all the best to you and your colleagues.

CLARE SKINNER: Thank you very much.