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RUBY:

From Schwartz Media, I’m Ruby Jones, this is 7am.

Everyone wants more hospitals – as populations move and grow there are communities in desperate need of them.

But what good is a building without staff? What good is a bed without the nurses and doctors to care for someone in it?

That’s the question one state is facing, after The Saturday Paper’s Rick Morton revealed that NSW Health believe they will need billions more in operational budgets to sufficiently staff the new hospitals being opened.

Today, senior reporter for The Saturday Paper, Rick Morton on the big shiny hospitals without enough staff to run them.

It’s Wednesday, September 28.

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RUBY:

Rick, this story begins with some promises that were made by politicians before the last two elections in New South Wales. And those promises, they were around money for new health facilities. So tell me what it was it was committed to and why?

RICK:

Money everywhere. Money, money, money. And a lot of it.

So in 2015, there were about $5 billion worth of health announcements made by the New South Wales State Government.

Archival tape -- Mike Baird:

“Well delighted to be here at Blacktown Hospital. Behind me, what used to be here was a block of dirt and a big dream.”

RICK:

And we're talking about, you know, money, hundreds of millions of dollars for Dubbo Hospital, Mudgee Hospital, Wagga Wagga Hospital, stage two of the Hornsby Korangi Hospital upgrade.

Archival tape -- Mike Baird:

“And today, we announce stage two - 30 million dollars going towards stage two, over 400 million dollars. Great development for health infrastructure, great for the local community here, and just a sample of what this budget’s going to bring.”

RICK:

And then in 2019, they're back again. It's another election and they've got even more money on the table for a further 29 hospital and health facility projects.

Archival tape -- Gladys Berejiklian:

“A Liberals and Nationals government will invest $780 million to redevelop John Hunter Hospital in Newcastle.”

RICK:

The list is extremely long. I've got it in front of me as we’re going and I won't drag you through it. But it is billions and billions and billions of dollars worth of new hospital or upgraded hospital announcements. This is big bickies.

RUBY:

So let's talk a little bit more about the actual facilities, Rick. What kind of redevelopments does that sort of money allow for? And to what extent were these redevelopments really needed by the people who lived in these areas?

RICK:

Yeah. I mean, health infrastructure is out of date pretty much everywhere you look in Australia. And as we develop our understanding of how to provide the best kind of health care, it's not just about the best staff - of course that is a large part of the picture, but it's also about having a building that's designed to allow those staff to do their best work, as much as anything else, and as well as the fact that we've got these ageing buildings, our population demographics are changing. A lot of the country is getting older and the hospitals themselves are nearing the end of their use by date. So just as an example, there’s Tweed Valley Hospital, which has received $725 million for this enormous redevelopment, it's, you know, by some accounts, it's about five times the size of the previous or the current hospital that's servicing the Tweed area and it's going to open in less than a year, and it serves not just Tweed Heads but the Byron, Ballina, Lismore region. And this entire enterprise is designed to reduce the need for about 5000 patients to travel outside the region each year because that's what's currently happening. There are, you know, thousands of people in northern New South Wales who have to either go to the Gold Coast or Brisbane, heaven forbid, or further south to John Hunter Hospital in Newcastle, if they need certain types of either emergency or trauma care, but also specialist care such as, you know, cardiology and certain types of chemotherapy or radiology services as well. So that's what this building is designed to do, is to stop some of that flight elsewhere and actually serve the local population. It's a much needed boost.

RUBY:

So it all sounds like a good thing Rick, new hospitals for people who need them. So where's the catch?

RICK:

Yeah, I mean, and I want to be really clear. There's nothing wrong with providing new facilities. It's an amazing thing to do, actually. But it is one half of the equation and certainly a lot of people that I've been speaking to over the last week are really quite alarmed by the propensity for the New South Wales Government to announce the shiny new building without doing any of the work on what it would take to run these things. So, you know, the politicians make these promises but they get away on some of the details really. So let’s just take that northern New South Wales local health district, which serves the Tweed Valley region, including this brand new three quarters of $1,000,000,000 hospital, I was given some vacancy data from within that region. It's information that should not be public. And almost on one day on Monday last week, almost 17% of the entire workforce was permanently vacant.

RUBY:

What does that mean?

RICK:

It means that they haven't filled these positions that are required, these full time equivalent positions that are required to actually run the district. And as of one day on Monday, last week, 17% or more than 800 of those full time equivalent positions were permanently vacant, as in they had not been filled, they hadn't been recruited for, they were either not going to be filled or they were having trouble filling them. Now I was speaking to one source who told me that this is just part of that ongoing concern, which is that a if you want to staff a new hospital that's much bigger and provides much more service than the existing one in Tweed Heads, for example, not only do you need to fund it, but you actually need to do the workforce planning well in advance because we're dealing with these kinds of vacancy issues right now. And they were saying that, you know, they knew of senior staff in the current Tweed Valley Hospital who've tried to notify their local members and say, you know, these things that you're talking about every time you do a press conference, they're not going to be delivered when you cut that ribbon. And that comes down to there not being enough money to staff them essentially.

RUBY:

Right. So we have big infrastructure projects promised during election campaigns and then after the election, building gets underway and a few years on, some of these projects are presumably reaching completion. So in theory, they're ready to go. But you're saying that there’s this one major problem, that is that the money to pay the staff to actually run them isn't there?

RICK:

Correct. And I know this because I managed to get some leaked documents which show that New South Wales Health was asking specifically for billions of dollars to fund exactly these projects. Now, just to give you one example, in the year 2021-2022, New South Wales Health noted that there were nine capital projects that were due for commission, which is bureaucratese for “have been built, they're about to open”. Nine capital projects due for commission in that year, which would deliver, and I'm quoting them here, “nearly 630 overnight and ambulatory beds and over 90 treatment spaces in emergency departments and over 20 operating theatres.” So that is a lot of service. But you can't just open a bed. You need to open a ward with those beds and the staff attached to them. And it appears that the government either didn't factor in the cost of staffing them or deliberately didn't want to know about the cost of staffing them because in these secret cabinet documents that I've obtained, New South Wales Health urgently asks for money outside of and in addition to the ordinary health budget. So every year, every health budget, every education budget, every policing budget, it automatically goes up just because of the existing cost of salaries and wages and inflation. So every year you'll see governments announce a record spend on health, a record spend on education that happens every single year without them even trying. So New South Wales Health, in their response to me, they said, and rightly so, they've got a $30 billion health budget. It's the largest on record. But what they don't go into detail on is how much of that money is for the hospitals, in general. And specifically, what they refused to answer when I asked them was how much extra money in the operational budget has been allocated to the new hospital projects. They either couldn't or wouldn't answer that, and it's because a lot of that record budget that they're flagging in their response to me is from that automatic growth in salaries and wages of the existing workforce.

New South Wales Health was deliberately asking for money in addition to that budget and just as an example for that 2021-2022 financial year they were asking for $2.6 billion over the next decade to meet the costs of staffing the hospitals that opened in that year. This is not all of the hospitals promised by the government, just the hospitals that opened in that year. And so this is essentially, they're asking for the recurrent budget for those hospitals to be increased permanently. And the government said no, they rejected it. And what this means is that healthcare workers won't be able to provide the same level of service or even an expanded level of service in these facilities without there being some kind of cutback. And you know, New South Wales Health actually said this in their budget submissions, which I obtained, that the extra costs attached to a new hospital cannot be met from within the existing funding envelope. That cannot be met from efficiency drives, and I was talking to one source in the Northern Rivers, or the northern New South Wales Health District, I should say, he told me on condition of anonymity, that if operational budgets had not expanded to match the increased services, i.e. new hospitals with more beds, then the government will just be opening a shell of a facility.

RUBY:

We'll be back in a moment.

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RUBY:

So Rick, it sounds like there are several brand new health facilities in New South Wales that are on the cusp of becoming operational. But the New South Wales Government is refusing to meet the funding requirements that are needed to staff. And they have, according to these documents that you’ve seen, just given an outright no when the department has asked for the money for the $2.6 billion that it says that it needs. Do we have any sense of why that is, why the New South Wales government has rejected the funding proposal?

RICK:

No, unfortunately we don't have any real insight except that the reason governments love capital election promises, as in we've got to build a new hospital as opposed to, you know, funding staffing for those hospitals so much is because one of them is essentially a one off cost. But then you've got the recurrent costs. And when you staff something that doesn't go away after five years or ten years, that gets baked into the budget forever. As long as that facility is open, those costs have to be there. And the moment you put staff in, it's very hard to take them out - as the government. And so they don't want to put more money in than they have to. And what we've been seeing not just in New South Wales, but this is very common in State Governments and the Commonwealth over many years is that there's been this efficiency drive, which is, they call it an efficiency dividend. It's code for a cut. They're saying do more with less. We're going to give you this new service. We're going to announce it, but we're not going to give you any more money to run it. So you have to find the money from within your existing resources to provide this new service, which means the decision making about what actually gets delivered is then outsourced from the government minister responsible for making that decision in the first place to a bean counter or a middle manager or director general, someone in a department who then has to decide what services get cut to fund this new shiny thing, this new bauble, that's been announced by the ministerial political masters. And it happens everywhere you look. But with health, it's particularly insidious because it actually becomes dangerous for patients.

RUBY:

And so ultimately, what does all of this end up meaning for people who need care, for patients, both those who, you know, perhaps now can't go and get the care that they used to get from an older facility and those who might go to a new one that isn't properly staffed.

RICK:

So this is all, it all comes down to patient safety, right? And we've seen it throughout the pandemic and we've done so much reporting of it on this podcast about corners that have to be cut because staff are sick and we can't fill these vacancies. Now, hospitals, and I know this from my own experience living with nurses and talking to other nurses in my extended family, that there was this almost constant begging and desperation from the nursing managers and other hospital managers saying, hey, if anyone's free to fill this shift, you’ll get overtime, you can do all these extra things, which is what they they have been relying on to get through the last two and a half years. It's locum staff. It's other temporary staff, agency staff, overtime, overwork, all of the above. And even with all of those things, sometimes positions go vacant on any given day, right? And so this is the living, breathing kind of outcome of being told to do more with less. And it's never been worse because of the pressure that's been put on this workforce over the last two and a half years. And now we've got all of these election promises coming due. And so what we're seeing is that patients are going to keep coming through the door, and that's going up year on year. That doesn't change. But we've never had a squeeze on staffing like this. And the people who suffer are the staff themselves, who have to make decisions that give them moral injury about how to best provide care within a really restricted envelope.

RUBY:

And so, Rick, what we're dealing with here is really the legacy of two rounds of election promises and in New South Wales there's another election coming next year, in Victoria where health care is a very live political issue as well, there's an election in only a couple of months time. So do you think that it's likely that we're going to see another round of these types of promises? And if so, I mean, I think we should probably be pretty wary of it right?

RICK:

Oh 100% and, I don't know, I don't have any special insight about what projects are going to get announced in the election, if any. But I would bet everything I own, I would bet the people I love on the fact that there will be announcements from both sides, Labor and the Liberal-National coalition - lots of politicking around new health precincts, new hospitals, money for new upgrades and I think people should be sceptical because it's nice to have those things and they are needed, but you can't run a facility based on bricks and mortar. You have to run on flesh and bone, you have to run on the people that work in those buildings. And if it doesn't come with an operational budget increase and doctors and nurses and cleaners and midwives, this puts more pressure on them and in turn it puts more pressure on patients. And so I think the scepticism has to creep in saying, all right, great, we've got $500 million for this hospital, where are the people? Because without that, you are announcing a shell, and you're not doing the whole job. You can't expand the service without the staff. And that’s just the bottom line.

RUBY:

Rick, thank you so much for your time.

RICK:

Thanks, Ruby.

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RUBY:

Also in the news today,

In the wake of the Optus data breach, which saw the details of 11.2 million customers exposed, a post on an online forum which purported to have released 10,000 customer records, has now been deleted, and another post now claims the hacker has removed the data and would not sell it to anyone.

The post also apologised to Optus and said they would have reported the exploit if Optus had made it possible to report it to them.

And Peter Dutton’s defamation case against refugee advocate Shane Bazzi has come to an end, with the Liberal Leader dropping his attempted high court appeal, but he’ll not have to pay any costs to Bazzi.

Bazzi said that being sued by “one of the most powerful men in the country had been a harrowing ordeal.”

Peter Dutton released a statement saying, “This has demonstrated that it is completely unacceptable to call someone a rape apologist, or descriptions of a similar grotesque nature.”

I’m Ruby Jones, this is 7am. See you tomorrow.

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