Western Australian Premier Mark McGowan’s announcement on January 20 that the border, set to reopen on February 5, would remain indefinitely closed, came as Omicron cases spiked in the eastern states and deaths reached new daily levels.
The government said the 90% vaccination target is no longer enough and is seeking higher rates of booster adherence and for COVID-19 cases to stabilise before determining the re-opening date.
The hard WA border has been central to the government’s popularity since its introduction in April 2020 as well as federal and state governments’ criticism, so much so that Labor’s landslide victory last March was seen as a referendum on this matter.
However, there has been little media focus on doctors and nurses’ warnings that the deterioration of the WA healthcare system has reached breaking point.
Despite the government’s repeated claims that the public health system is “COVID-19 ready”, years of neglect means it is at a point of near-collapse — even before any major local virus spread.
Urgently addressing this is of equal importance to how and when the hard border is lifted.
WA health has suffered from years of funding cuts and a refusal to properly invest across both the metro and regional areas of the state. Under pressure, McGowan allocated an extra $400 million to health late last year.
Severe underfunding
The original sum for the health budget over 2020–21, CPI-adjusted, was 0.36% less than the previous year and another 3.72% cut is proposed for 2022–23. Yet, this miserly government boasted a $5.6 billion budget surplus last year.
The severe underfunding of healthcare led to doctors and nurses last year making public the staff shortages that many believed would inevitably lead to patients dying. The tragic and unnecessary death from sepsis of seven-year-old Aishwarya Aswath was the horrible result.
Junior staff involved in Aishwarya’s care were referred to the Australian Health Professional Registration Authority (AHPRA) in what the then-Australia Medical Association WA president Andrew Miller described as the Labor government throwing doctors and nurses “under the bus”. Aishwarya’s parents resorted to a hunger strike in frustration at the pace of an inquiry that later described the staff as “exhausted” and “demoralised”.
Since then extra funding and staff have been allocated to Perth Children’s Hospital, but there are similar shortages across the public system.
For instance, ambulance ramping continues to worsen. Last year ambulances spent more than 52,000 hours outside emergency departments waiting to transfer their patients — the equivalent of 6.5 years — caused largely by a lack of available hospital beds.
In a state where COVID-19 cases are next to zero, ramping time has already blown out to almost nine times what it was in 2017, when Labor took power.
While they agree the state’s health system is in crisis, the WA branches of the Australian Medical Association (AMA) and the Australian Nursing Federation (ANF) have taken different positions on postponing the border opening.
Part of the ANF’s support for a delayed reopening was to give the 800 or so newly-graduated nurses, scheduled to start on the wards in coming months, experience in running wards when they would likely “[lose] staff through isolation and illness and caring for family members”.
Many nurses and other health staff are yet to be fitted for N95 masks — front-line measures — and nurses without appointments have not been told when they will have one. Refurbishments to create special delivery rooms for COVID-19 positive patients at King Edward Memorial Hospital (KEMH), the high risk maternity hospital, is only starting now.
KEMH was advertising last May for 42 full-time midwife positions while universities were pulling their students out for lack of clinical supervision. Recently, KEMH managers have been asking nurses and midwives how they would cope with the mass absence of staff with Omicron and with a patient load of 10 or more (not including new-born babies who are not counted as patients in staffing ratios). What a question.
Overseas recruitment?
The ANF and the government agree on the need to recruit interstate as well as the healthcare workers from overseas.
Given that Australia is a one of the wealthiest countries in the world, the recruitment of doctors and nurses, particularly from countries where regular medical care, let alone COVID-19 vaccines, is far less available, continues the drain of scarce resources from poorer countries and should be opposed.
Federal and state governments have had two years to implement local recruitment and training strategies to bolster the failing health service and they have chosen not to act. It is imperative that governments be pressured to fast-track training and the deployment of healthcare workers where they are most needed.
Such measures could include the full or partial return to hospital-based learning, with part- and full-time wages paid to students. While university training has its merits, the objective now must be to train workers as quickly and efficiently as possible to properly staff hospital wards and prepare for a major spike in staff having to isolate because they are sick with Omicron.
It is absurd, especially during a pandemic, that nursing and medical students are still being charged for studying. Also absurd is that health care workers still have to find and pay for childcare.
The Australia Institute said at the beginning of the pandemic that the single measure to optimise people’s availability to work is to be able to access free childcare. Many nurses are primary carers for their children and quality, available childcare would allow them the option of returning to work to help out.
Delaying the border opening gives workers more time to prepare for the Omicron wave to hit, but only to the extent that the chronic deficiencies of WA healthcare system are addressed. Union and community pressure are needed to push the McGowan government to act. Once that’s done we can talk about the border reopening.
[Polly Watkins is a pseudonym. The author is a member of the Australian Nurses Federation.]