Libby Mettam: A royal commission could be a circuit breaker for WA’s sick health system

The call for a royal commission into the WA health system was not made lightly. It was one that will inevitably attract scepticism about the intent, the scope and whether it can produce meaningful and timely recommendations in such a complex area. I think it can and more importantly, it must. I think the evidence provided in the coronial inquest into the death of Aishwarya Aswath highlighted just how urgently a review is needed. If the alarm bells weren’t already ringing, the evidence of a nurse who said not much had changed since the night Aishwarya died and that she believed it was going to happen again, should have management worried. It must be incredibly difficult turning up to a shift day in, day out with this in mind. It was also sobering to hear the former CEO of the Child and Adolescent Health Service Aresh Anwar say that “it was an organisation that was very, very fragile in terms of integrity and working as a team”. That sounds like a politically correct way of saying it was chaos. Clearly there are major, systemic issues from the top down in culture, leadership, staffing and resources. The warnings from frontline health workers about the consequences on patient care are loud and numerous but they are not being heeded. And these issues are not unique to Perth Children’s Hospital. They are happening across the whole health system in both metropolitan and regional areas and despite a new Health Minister and a banker’s bag full of Budget commitments, the reality is the health system is not getting any better. The system has been in freefall since this Government was elected. It spent the first couple of years on a cost-cutting mission and now we are seeing — and many are experiencing — the dire consequences. In the past year it has tried throwing money back at the health system but this is clearly not just about funding. It is about where that money is going. The deep sickness in the system is evidenced by staff morale, culture and difficulty in retaining and attracting staff. The Premier correctly points out that we pay the most per capita in the nation but until recently we also had the lowest number of ICU beds per capita in the country. The decision to invest $578 million in rapid antigen tests — more than double the amount spent on emergency department reform — also raises questions about funding priorities. While we have sheds full of RATs the Government can’t give away, last financial year there were 102 “bed state blacks” across the health system. Bed state blacks are called when the ICU cannot accept any more patients. There is no capacity. Despite a closed border keeping us “safe”, the rolling suspensions to elective surgeries has seen the waitlist explode from 19,000 in 2017 to almost 30,000 today. Maternity bypasses are now commonplace — there’s almost one a day. Pregnant women in Carnarvon are driving 10 hours return to the nearest hospital to give birth due to a lack of specialist staff. Other regional hospital services have also been reduced. With a $5.7 billion surplus and a growing and ageing population, our health services should not be getting scaled back — they should be improving. The most obvious indicator of a system that is sick is the record ambulance ramping in WA. Almost 7000 hours in each of the past two months due to bed block. The issues are undeniably complex, but the Government must front up and provide something more effective than its standard deny and deflect response. There’s always someone or something else to blame. This week it was the GPs’ fault. We need an honest and thorough look at the issues from the top down, something we can only get from a royal commission. Obviously, there are inquiries that can be undertaken by parliamentary committees, and many have led to substantive change. But with a Labor majority, it is hard for any committee to appear impartial when investigating itself. If we want genuine change, we need a line in the sand. A royal commission, with commissioners appointed based on their independence and qualifications and with greater investigative powers than politicians or bureaucrats, is the only way to achieve an apolitical and transparent review. We are more likely to get objective feedback and workable and effective solutions with buy-in from the advocates and groups most affected. I know there’ll be criticism that past commissions have been expensive and take too long. There is also the opportunity for the Government to reject the recommendations outright. However, we have seen with the Perth Casino Royal Commission that they can happen relatively quickly. The commissioners were appointed in March last year and the final report was handed down 12 months later with clear recommendations. It does not have to be a drawn-out affair, but it would be a valuable opportunity for all sectors of the health system to provide an honest picture of the state of the system. It would also give the ever-expanding health bureaucracy a chance to explain how it is prioritising the Government’s Budget. We need to see a genuine circuit breaker and I believe a royal commission can offer that. For the health of all West Australians, we cannot afford to have another three years of this chaos and dysfunction. Libby Mettam is deputy Liberal leader and shadow health minister.