Vision for Australia's Health

Pillar 2: Public Hospitals

An evolved and adequately funded public hospital sector, providing for more timely elective and emergency treatment, greater linkages to primary care and more transparent and simplified Commonwealth-State funding arrangements. Key to this will be striking the right balance, so our focus is patient care and improving outcomes, and reforming burdensome audit and accreditation requirements which can, if poorly designed, detract from limited resources. A new funding approach to supplement the current focus on activity-based funding – one that includes funding for positive improvement, increased capacity, and reduced demand, and puts an end to the blame game.


2.1 Simplified funding arrangements, which see the Commonwealth increasing their contribution to 50 per cent for activity (as per current COVID-19 partnership agreement), as well as providing funding for improvement and capacity. The States and Territories could use the 5 per cent of ‘freed-up’ funds on improvement, as determined by the needs of the region/ network.

  • Greater responsibility for all Governments with equal funding commitment to activity.
  • State and Territory Governments benefit from a 5 per cent increase in funding, but are required to invest these additional funds into improved capacity and quality of care.
  • Patients do not remain in emergency departments after decision to admit.
  • Reduced waiting times for elective surgery and emergency admissions.
  • No overcrowding of emergency departments and improved hospital flow, with elimination of access block in emergency departments.
  • Elimination of ambulance ramping.
  • Hospitals are funded to resolve the cause of complications and adapt future workflow, resulting in fewer patient complications, re-admissions and shorter length of stay – rather than a penalty approach.
  • Improved efficiencies and patient throughput.
  • Compliance with industrial conditions that facilitate doctors’ health and safety, education and training and quality of patient care delivery.
  • Residual and surge capacity in our health system. This is essential both to maximise efficiency in the setting of entirely predictable normal surges, but also to accommodate for predictable future pandemics and disasters. Residual capacity that is not used every day can be invested back into improving quality, culture, teaching, training and research.
2.2 Commonwealth and State and Territory funding at a sufficient scale to allow increased capacity and growth, beds where needed, and improved performance. Thismeans funding that is appropriately indexed and incentivises positive outcomes.
  • Commonwealth funding is fully indexed, and additional funding is made available, so that hospitals are resourced to increase capacity as needed and invest in improving their performance. A shift in focus from penalising struggling hospitals operating at breaking point, to resourcing hospitals for scalable, efficient and improved care.
  • Hospitals are funded so that staff are not working unsafe hours and overtime is recognised and rewarded.
  • Funding to support investment and wellness of hospital staff, including fostering medical leadership in hospital administration and management.
  • Funding to adapt to post-COVID-19 healthcare, allowing implementation of:
    • Methods of managing patient flow in light of social distancing and infection control;
    • Additional infrastructure and modifications to ensure safety for healthcare staff, patients and visitors;and
    • Surge facilities and Personal Protective Equipment (PPE) in case of winter spike, and to deal with increased testing requirements during winter months.
2.3 Transition of Medicare public hospital outpatient clinic funding to an appropriately indexed funding system.
  • Scalable, simplified and transparent funding that significantly reduces the administration workload within public hospitals to capture Medicare income.
  • Measurable reduction in administration costs, with savings reinvested into clinical care.
2.4 Deeper connections between General Practice and public hospitals, with appropriate funding provided.
  • Hospitals provide best practice, full discharge summaries and seamless integration of clinical systems between hospital and community to facilitate information sharing.
  • Governments fund improved delivery of integrated care post-discharge to prevent avoidable admissions, co-designed with the profession.
  • Improved integration of medical care to nursing homes, hospital in the home, and GP integration pre-discharge.
  • Lower emergency presentations and re-admissions, post-discharge.
  • Greater management of chronic patients in the community.
  • GP download rate of hospital discharge summaries
2.5 Alternative delivery options for outpatient care.
  • Adopt digital health technologies to maintain clinical connections with vulnerable patients post-discharge.
  • Expand hospital in the home services for simple treatments that otherwise require hospital admission.
  • Invest in communications channels to facilitate quality and efficiency across health spheres – GPs, hospital, aged care.
  • Reduced re-admission rates post-discharge for vulnerable patients.
  • Reduced cost and improved quality of patient care.
  • Increased GP satisfaction with hospital communication.
2.6 Expanded uptake of telehealth across hospital networks.
  • Telehealth is an integral part of care delivery across hospital networks.
  • Deeper connections between public hospital clinicians and primary care services across hospital networks.
  • Reduced patient acuity for chronic disease patients and reduced complications if admission is required.
2.7 Regulation change to ensure patient is offered choice when presenting for care, and availability of private sector options are investigated and discussed with patients holding credible private hospital insurance cover. This to be documented before public hospital admission.
  • Enhanced fully informed financial consent provided to patients before proceeding with care.
  • Increase in genuine attempts to allow patients holding private hospital insurance to transfer care to a private facility where spare capacity exists in order to unburden the public hospital system for patients without insurance.
  • Regulation change to prevent public hospitals from advertising to patients in order to pressure them to use their private health insurance in public hospitals to enhance system capability or resourcing.
  • Increased transfer of patients from public hospital emergency departments to private hospitals for ongoing inpatient care.
  • Greater coordination and streamlining of the system, including timely patient transfers to private emergency department facilities. 

2.8.1 Ensure adequate representation and diversity of practicing medical practitioners from the full range of public and private services, on government working groups and committees.

2.8.2 Hospital accreditation requirements for a fully empowered executive director of medical services (or equivalent) who is a registered medical practitioner with a Fellowship of the Royal Australasian College of Medical Administrators (RACMA), to have responsibility for clinical service delivery, safety/quality and credentialing within each hospital.

  • Ensure appropriate training via the RACMA or equivalent as a basis for all medical leadership roles.
  • Medical responsibility for health and workplace culture within organisations recognised at executive level.
  • Recognition that diversity is essential for quality of leadership and organisational performance. 
  • Hospital accreditation to require further training for current medical leaders in management and healthcare policy, and identification of new medical leaders.
  • More appropriate policy, and importantly implementation, that does not impact negatively on patients or practitioners, while reflecting the specific requirements of differing medical environments.
  • Hospital accreditation process amended or introduced.
  • Increase in appointments of Executive Director of Medical Services in line with these criteria.
2.9 Accreditation of all pre vocational training years for junior doctors.
  • Postgraduate Medical Council (PMC) accreditation of pre vocational training prior to vocational training would provide a structured, safe, high-quality training experience for all doctors.
  • Accreditation by PMC of all postgraduate year 2+ training places by end of 2023.