Thursday, November 17, 2022

Idiotic: WA patients stuck in hospital despite being fit to leave

Surely some hospital funding could be diverted into setting up nursing homes. It would greatly reduce overall running costs

Auditor-general Caroline Spencer found some patients stay in hospital months, and even years longer than medically necessary when often they would be better served in aged, disability or other care.

It is not a new problem and there is a myriad of complex cross-agency, cross-sectoral and cross-governmental issues behind it.

But Ms Spencer found WA Health faces one major hurdle getting in the way of addressing any of the underlying problems.

The report sets out that WA Health lacks any real-time monitoring system to show when a patient should be discharged or why discharge is delayed.

As a result, the report states the Health Department has a limited understanding of the scale, cost, and impact of long-stay patients on public hospitals.

"And then they can manage their patient cohort on a systemic level, they understand why people are there, and who to actively help transition out of hospital.

"If the Department of Health, as system manager, doesn't have real-time information on how many patients no longer need to be in hospital, they are not able to identify best patient flows, where those people are best to receive care, also where best investment in additional bed capacity is made, or if it even needs to be made."

'Snapshot' reports of limited use

While WA Health does not have real-time data on long-stay hospital patients, it does conduct periodic "snapshots" on some cohorts of long-stay patients.

Ms Spencer said because the information is static it has limited usefulness, but it does suggest how significant the problem is.

The report looked at two "snapshot" studies across 2021 and 2022 which indicated at various times over that period 486 people were stranded in Western Australian hospitals while they waited for NDIS or aged care services.

Using basic analysis, the report found if that cohort of patients were in more appropriate accommodation it could have freed up capacity to allow over 14,000 more people to access a hospital bed and saved the state $71.8 million.

In addition to blocking access to beds and the significant financial burden, the report found patients staying in hospital despite being medically fit to discharge suffer personally in several ways:

Long-stay patients often do not have enough stimulation and activity, leading to reduced physical, mental and emotional wellbeing. Extended hospital stays may also increase the risk of hospital acquired infections and falls.

Ms Spencer said the concerns about WA Health's data system for long-stay patients were not new. "This isn't a new issue, we have commented through successive audits on WA Health not using to best effect the data it has to make evidence-based decisions, both around patient flows and investment decisions," she said.

"This really is about best patient care and making sure that patients are in the best patient care setting for their needs, so that they're not in higher cost settings that don't meet their needs."

The report found a new WA Health committee and working group focused on long-stay patients had an impact for "some individual patients" but there was "little evidence to suggest a system-wide improvement on the size of the problem".

The auditor-general noted the limited data available showed that between March 2021 and March of this year, 377 long-stay patients waiting for NDIS care were discharged.

But during the same period 379 new long-stay patients in that cohort were identified, suggesting "the underlying causes of the issue have not been effectively addressed".


Unjustifiable vaccine mandates did a lot of harm

In the 1980s movie Rain Man, the autistic Dustin Hoffman reliably informed Tom Cruise that Qantas was the safest airline in the world. Indeed, our national carrier has safely transported generations of Aussies around the world. The ‘flying kangaroo’ is our de facto international mascot and one of our most respected enterprises. Yet the ‘spirit of Australia’ now resides in a man who likes to tell members of the Australian public to ‘eff off’.

This occurred the other day when a disgruntled former employee attempted to ask Qantas CEO Alan Joyce about the vaccine mandates still in place for the airline’s employees.

During the same-sex marriage debate, Mr Joyce developed a taste for political campaigning and even encouraged people travelling on Qantas to wear a black ring on their finger to show their support for same-sex marriage – presumably so cabin crew could easily distinguish between those who were morally superior on supporting LGBT issues and those who were not. One Anglican archbishop complained that this sort of campaign was nothing short of corporate bullying of everyday Australians.

At the time Peter Dutton also maintained that it was completely unacceptable for Mr Joyce to use the Qantas brand in this way, saying, ‘Don’t use an iconic brand and the might of a multi-billion-dollar business on issues best left to the judgements of individuals….’

And that is the point. Whether it is political or cultural issues or medical interventions, the same principle should be true in a democracy: corporations and businesses should wherever possible leave judgment on non-corporate matters to the individual. But instead, Covid provided many corporations the opportunity to behave like the worst schoolyard bullies – imposing mandates and restrictions on loyal staff and customers despite then prime minister Scott Morrison insisting that there were no vaccine mandates in this country and that companies could only apply mandates that were ‘reasonable’.

Coerced vaccination is offensive and wrong under any circumstances. And the sort of draconian mass mandates imposed by Qantas, Woolworths and many other corporations were certainly not ‘reasonable’.

As we now know, and many writers in this magazine anticipated, the vaccines do not and never did protect other people from catching the coronavirus. By definition, all compulsory vaccine mandates and restrictions – which potentially damaged people’s mental health or income yet did not stop transmission – were futile and therefore unreasonable.

Many loyal long-serving employees of these companies had their lives, careers and livelihoods completely turned upside down. Ex-Qantas pilot Graham Hood who was forced to lose his career thanks to Mr Joyce’s unreasonable mandate was one, Alan Dana at Jetstar another. There were many, many others.

Woolworths appointed its own chief medical officer in August 2020 to ‘provide expert medical advice to help shape policies’ around Covid. In October last year, Woolies implemented a mandatory vaccination policy similar to that of Qantas and other large firms. At the time their chief medical officer stated that, ‘A vaccinated team member is far less likely to get Covid, much less likely to pass it on [our italics] and also significantly less likely to become seriously ill.’

But that was simply untrue. As was revealed in a recent article by the left-leaning Washington Post, the Biden administration knew in the early northern summer of 2021 – several months prior to that statement – that ‘the vaccines did a far worse job of blocking infection than originally expected.’ Similarly, Pfizer have also admitted that they never tested the vaccines for immunistation.

So Woolworths need to explain who specifically informed or advised them that the vaccines did stop transmission? As with so many other companies, where did this advice come from and what was it based on?

Furthermore, what steps were taken by each individual CEO, health officer or HR officer to verify that that information was factually correct before forcing people to lose their jobs because of an unnecessary mandate? Wasn’t there a duty of care to the mental health and wellbeing of all those individuals who lost their jobs because of reluctance to take the jab? A reluctance that with each passing day looks more and more understandable.

Indeed, read Rebecca Weisser in this week’s magazine on some of the disturbing questions that are now surfacing around issues of women’s reproductive health and potential vaccine injuries.

All of which is why we need a royal commission into the abuse of political and corporate power during Covid


The Queensland Public Trustee again

QCAT seems to be covering up for them

The Family of a victim of the Queensland Public Trustee has written an open letter to the Premier of Queensland asking her to unblock the blockage to justice in their case before the Queensland Civil and Administrative Tribunal (QCAT).

The victim is a forty year old Aboriginal man with disabilities living in Brisbane. He cannot be identified for legal reasons but his QCAT file number is G8252. His family has made a financial compensation claim on behalf of G8252 against the Public Trustee for its maladministration and loss of G8252’s assets. QCAT has reserved its final decision on the claim for over fourteen months.

John Tracey, the spokesperson for the family, said –

“We have been repeatedly complaining to QCAT about the length of time the decision has been reserved. We complained to the Ombudsman and the Attorney General and were told by both that they had no jurisdiction to investigate QCAT and referred us back to QCAT. We have nobody else “up the right channels” to complain to except the Premier, so we have asked her for help”

“The QCAT reserved decision policy is to release a decision within three months of the final hearing. QCAT has a duty under the QCAT Act to release decisions in a reasonable time. The decision in our case has been reserved for over fourteen months so far”

“QCAT is deciding on a major life issue for a person with disabilities, it is cruel to keep him and his family waiting so long for a decision. Hopefully the Premier will show some compassion and ensure justice is done and seen to be done soon.”

“QCAT is responsible for ensuring and enforcing the legal rights of people with impaired capacity. If QCAT is so dysfunctional that it cannot administer justice then the legal rights of Queensland’s most vulnerable people are effectively denied to them. I hope the Premier will take this situation seriously”


Older asset-rich Australians in the firing line for taxing challenge

There’s a lot going on in policy land, especially with the vogue for intervention. In case you missed it, the fuse has been lit on tax. As a nation, we’re going to pay more – it’s simply a matter of how much more, by whom, and when.

This year’s election recklessly skirted the fundamental issue of how to pay for Canberra’s bipartisan compact: to succour an ageing population, deal with a geostrategic miasma, service debt after a pandemic binge, make more things here, pull off decarbonisation and keep a life-changing disability scheme from imploding.

The campaign’s policy void betrayed a homegrown cargo cult: in the misty out years, superior growth and productivity would be dispensed from above the clouds to make evil deficits disappear.

There’s been some truth-telling since May. People who claim growth and spending cuts, as necessary as they will be, are sufficient to fixing the budget are likely to be spectators in the main arena. We need to talk about tax.

In a prepared statement to the Senate this week, Treasury secretary Steven Kennedy outlined a path to “rebuilding fiscal buffers”. He welcomed the Albanese government’s return of much of the upgrade in tax receipts to the bottom line and its “constrained spending, significantly lowering near-term deficits and debt”.

If we get more tax receipts, it would be “prudent to take the same approach”, Kennedy informed the budget estimates hearing. “However, beyond the near-term, the budget pressures are more profound and will likely require a combination of spending restraint and increases in taxes to reduce deficits and lower debt,” he said.

Jim Chalmers is on the same page, adding “reform” to the mix, while ruling out avenues to raise taxes, including the GST. Closing loopholes for multinationals and extending compliance programs for locals is fine. But it’s small beer. The fiscal strategy needs more meat on the bones.

At last week’s Economic and Social Outlook Conference, hosted by The Australian and Melbourne Institute, the Treasurer vowed to target the cost-effectiveness of tax concessions. How could he not? The dollars are huge, at about $200bn a year, or 8 per cent of gross domestic product. The budget papers note “tax expenditures” are tricky; fiddling with them changes taxpayers’ behaviour. For instance, Treasury calculates the revenue forgone each year from the family home’s exemption from capital gains tax ($33.5bn) and the pension asset test ($29bn). But abolishing the concession would not translate into an equal gain to the budget.

The government will soon publish an enhanced tax expenditures statement, showing their cost and who benefits. Chalmers will use the fresh evidence to lead the conversation about whether we can afford them.

The idea of trimming superannuation tax breaks for the very wealthy was floated by Assistant Treasurer Stephen Jones. He said 32 self-managed super funds had more than $100m in assets, with the largest valued at more than $400m. Asset management firm Mercer estimates the tax concessions on a single $10m SMSF could support 3.1 age pensions.

These are lurid examples, but cover few taxpayers. The industry is comfortable with a discussion on tax breaks for the super-wealthy, drawing a line at balances of $5m, with about 11,000 people above that. Dropping the cap to $2m would affect 80,000 people and, according to the Grattan Institute, would save the budget $2.8bn a year.

The salient issue for super concessions is lifetime tax-free status on investment earnings Peter Costello gave retirees in 2006. They cost $26.4bn a year, or about 1 per cent of GDP. Across the next 40 years, Treasury estimates their real cost will double.

Concessions on employer and personal super contributions cost the budget $23.2bn a year, but as a proportion of the economy are not expected to rise, according to the Intergenerational Report. Labor’s hitch on budget repair, like the overreach in its workplace relation bill, is it did not prepare the electorate for the taxing challenge ahead. In fact, it ruled out changes on super, as the Opposition is gleefully reminding us.

In 2016 Scott Morrison, the treasurer at the time, put a $1.6m cap (now $1.7m) on the tax-free amount people could have in pension accounts and cut from $180,000 to $100,000 (now $110,000) annual non-concessional super contributions. His star shines in Treasury as a staunch revenue saviour, especially brave as it was a poke in the eye to the Liberal base.

With a 3.5 per cent jobless rate and bumper export prices (historically high compared with imports), it’s dispiriting to confront a decade-long $50bn budget deficit.

In his prepared text at Senate estimates, read by a Treasury colleague, Kennedy noted Australia was fortunate to begin fiscal repair with a relatively lower level of debt than in many countries. But difficult decisions lay ahead: “I am hopeful that having so fulsomely laid out the fiscal challenges in this budget, the subsequent policy debate will be productive, considered and understanding of the need for trade-offs.”

Taxing is an art. The guiding principles are simplicity, efficiency, fairness and sustainability. It’s a delicate matrix, where you never reach policy nirvana, but the evidence is in front of us about how to improve the system.

Raising more from income tax on individuals and companies is not the way to go. It invites tax planning, already a national obsession. Two-thirds of all revenue comes from those sources, pretty much the highest income-tax burden among rich countries. The OECD advises a greater reliance on land tax would ease the burden on ordinary workers.

A report by the Australian National University’s Trevor Rose and Robert Breunig, published in July, examined eight revenue options to reduce debt over 33, 20 and 10 years, taking into account economic efficiency, equity and simplicity. They found a federal land tax on unimproved land value, set at a rate of 0.1 per cent over 33 years, was the best option.

As well, Rose and Breunig recommended three alternatives: including the principal residence in the pension assets test, introducing an inheritance tax, and reducing the capital gains tax exemption for the principal residence. The ANU authors concluded reducing the CGT discount on other assets and increasing the rate of the GST were reasonable options but rejected increasing personal income tax and corporate income tax. Even though all measures could do the job over the medium to long term, and most over the short term, or used in combination to address the debt, they said “a single dedicated revenue-raising option is more politically feasible than any scattered combination”.

A federal land tax is not unprecedented. The federal government imposed one in 1910 and removed it in 1952. Its primary functions, Rose and Breunig noted, were to encourage more efficient use of land and to serve as a quasi-wealth tax.

“Government responses to COVID-19 disproportionately benefited older Australians and Australians who own assets,” they said. “Most of the reduced mortality generated by lockdowns and economic restrictions occurred at older ages. The benefits of surging house and other asset prices generated by government policy have accrued primarily to wealthier and typically older Australians. It seems fair that those who benefited most should pay most for the induced debt.

“This suggests that older and asset-rich Australians do their part to pay down the debt and that the burden on younger people should be smaller. In terms of income and job loss and reduced opportunities for human capital accumulation, younger people were, and remain, victims of COVID-19 policy.

“Under current tax system settings, they will disproportionably bear the burden of future debt repayment. One massive and growing weakness of the Australian tax system is that it does a good job of taxing income but a poor job of taxing wealth.”

Ahead of last month’s budget, former competition watchdog Rod Sims said Australia needed higher taxation to fund community preferences, to make the carbon transition and to rebuild fiscal buffers to cope with the next shock. “Only by raising taxes will we get our debt and deficit under control,” he told The Australia Institute event.

Sims argued personal and corporate income tax was “maxed out”. He proposed five areas to focus on: stop transfer mispricing, where companies fudge obligations on inbound loans and outbound commodities; raise more revenue from energy and mining companies; impose a carbon tax; have all states and territories introduce a broadly based tax on land and replace stamp duty; and introduce a new way of paying for roads.

“I think many good ideas are put to the community without sufficient explanation and dwell time so that the arguments can be sensibly weighed,” Sims said.

“Ideas are often mentioned, there is an instant negative reaction, and so the ideas are dropped. Public policy change requires a serious investment from politicians and others.”

Anthony Albanese declares a new era of adult government is here. It’s certainly “issues-rich”, as they say at the lobbyists’ trough. We’re about to learn how able he and his Treasurer are at leading debate about the fairness and fitness of taxing, creating consensus not rancour, and showing courage amid the political tumult to come.




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