Home Care Crucial To Protect Patients

Sydney Morning Herald

Thursday September 25, 2008

Natasha Wallace and Brian Robins

NSW must vastly improve out-of-hospital care or patients will suffer in a system already under "severe strain", the NSW Auditor-General has said.

In releasing his audit on delivering health care out of hospitals, Peter Achterstraat warned yesterday that if more patients were not cared for at home or in the community, funding for health would consume the state budget by 2033.

At this rate, NSW would need at least 300 more public hospital beds each year to keep pace with demand, he said.

Each year about 45,000, or 3 per cent of NSW patients are cared for at home or in the community - freeing up 500 hospital beds for more urgent cases - but this could increase to 10 per cent of patients, Mr Achterstraat, said.

With the increasing prevalence of chronic disease such as diabetes and cancer being blamed for much of the rise in demand on emergency departments, out-of-hospital care saves the state about $55 million a year.

Mr Achterstraat said NSW Health had developed effective programs which could provide care as good as in hospitals and reduce the time patients spent there. But the programs were not adequately monitored.

Mr Achterstraat said NSW Health had made "little progress" in ensuring the programs successfully reduced avoidable hospital admissions.

"If we continue to deliver health care the same way we always have, then NSW Health will have to open at least 300 new beds - equivalent to a new hospital the size of Hornsby or Wyong hospitals - every year just to keep up with patient demand," Mr Achterstraat said.

"The pressure needs to be taken off an already overworked system. The health and welfare of patients will suffer if we continue the way we are currently going," he said.

His recommendations included establishing an interim team to plan the expansion of out-of-hospital programs, a public campaign on the service, better systems to monitor its effectiveness and determining the number and location of potential patients that can be treated in such programs.

Care at home may include anything from help with shopping and bathing to administering medication, physiotherapy and nutrition advice.

The Health Minister, John Della Bosca, said decisions on out-of-hospital care should be made by doctors.

"I want to emphasise this can't be a matter of an artificial target, a decision by an accountant, or a bureaucrat, as to what the number of patients that should be treated in this way are," Mr Della Bosca said. "It's something we can't just simply adopt as a bureaucratic economic target.

"I emphasise, the Government believes, it should be a judgment made by responsible clinicians, with their patients and their families."

Ron Penny, a senior clinical adviser to NSW Health on chronic disease, said there was evidence community care decreased demand on hospitals but was difficult to achieve and NSW Health had been working to improve it for the past eight years.

© 2008 Sydney Morning Herald

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