The price of reinventing the wheel

An interesting snippet from The Age today. It seems that the Federal Government of the day in 2005 was warned that its proposed $226m dial-in hotline, known as healthdirect Australia would not reduce Emergency Department demands and might in fact increase it, based on the experience elsewhere.

The idea of being able to get rapid access to an experienced clinician on demand seems reasonable on paper. The drawbacks only become apparent when one thinks it through a bit further. Imagine you are the nurse or GP on the end of the line, and someone who may be scared, distressed or just not very good at explaining things is on the line. You have a duty of care to give safe and responsible advice. You may not be able to get a really clear picture of what is going on. So what are you going to do? Of course you’re obliged to advise the caller to seek further help, because you can’t see what’s going on, you can’t examine the patient and you feel responsible for ensuring that there is not a serious problem that is being missed.

The evidence presented in the journal Emergency Medicine Australasia suggests that in fact the idea that EDs are being overcrowded by patients who should see their GP instead is a myth. Attempts to solve the problem of ED overcrowding by increasing remote triage or diverting patients to GP superclinics or bulk-billing centres are therefore pointless. ED demand has boomed in the last decade in Australia, and neither population growth or the ageing of the population accounts for it.

The trouble is, once it’s in the policy of both major parties and the bureaucrats who advise them, not to mention that the Commonwealth has sunk nearly a quarter of a billion dollars into it, the pollies have to say it is working well. Both the current Health Minister and her predecessor have made public statements supporting the concept, despite the fact that the evidence-based view from the troops on the front line is that it is not helping at all. Before it was introduced here in 2005, almost identical schemes in New Zealand and the UK had completely failed to improve the same problem so this cannot have been much of a surprise.

You can’t help but get the feeling that the experts who advised the Health Minister back in 2005 would much rather have had the $225m to spend on other ways of improving their services. The money would have gone a long way.