A message from St Vincent’s Hospital Melbourne Chief Executive Nicole Tweddle

Across almost every indicator, First Nations Australians experience worse health outcomes than non-Indigenous Australians.

Despite good intentions, efforts to close the gap in terms of those indicators have, sadly, largely failed.

As a health care provider, we own some of those failures.

If you work in hospitals – as I have for more than 25 years – you learn pretty quickly why First Nations peoples distrust, and often fear, receiving care in such institutions.

Over generations, hospitals have undoubtedly played a role, mostly through ignorance, in delivering very negative experiences for First Nations patients. 

Only last month the Australian Human Rights Commission identified racism in healthcare as a key factor in contributing to people’s illness.

For First Nations Australians, the response has traditionally been to either avoid hospitals altogether – which just left people getting sicker – or if not, discharging themselves and disengaging from care before its completion.

That’s what we found at St Vincent’s. First Nations patients were three times more likely than non-Indigenous patients to leave our Emergency Department (ED) without being seen.

They were also waiting, on average, three times longer compared to non-Indigenous patients.

Frankly, we were sick of good intentions. We wanted to do something about it.

We worked with the Victorian Aboriginal Health Service and others – including First Nations staff and patients – to implement what’s known as a Minimum Category Three Triage policy.

The idea is pretty straightforward: in an ED, patients assigned as being ‘Category Three’ are targeted to receive medical assessment and start their treatment within 30 minutes of arrival.

Under our policy, we decided to assign a minimum Category 3 to all First Nations patients so they would begin their treatment more promptly.

And you know what? It worked.

Since introduction, we have successfully closed the gap in ED wait times between First Nations and non-Indigenous patients.

In a health landscape where ‘closing the gap’ success stories are few and far between, that was something to celebrate.

And so we did.

We were proud of what we’d achieved. We were emulating the spirit of our founders, the Sisters of Charity, who staked their reputation on caring for the most vulnerable and marginalised. 

We were so proud, that we put in a submission to the Victorian Public Healthcare awards because, at the very least, we wanted our staff to have their efforts celebrated.

Imagine my sadness this week to find public figures misrepresenting the efforts of our frontline people in an ugly and unnecessary display of wilful ignorance.

Their charge? First Nations people ‘queue jumping’ at the expense of urgent medical cases. 

The subsequent abuse directed at St Vincent’s and my team on social media, and in messages to our hospital, egged on by these figures, has been disgraceful.

So, I’d like to set the record straight about our ED approach. I want to be very clear about what it does not do…

Analysis of our approach shows it has had no impact on overall ED flow.

Patients presenting with a serious or life-threatening emergency – regardless of their background – will always be seen first. That's what ED triage is designed to do.

We’re not ignoring medical urgency. We’re simply addressing the factors that were causing First Nations patients to be waiting three times longer than everyone else in our ED.

And do you know how we can do that? 

Because among the roughly 150 people our ED sees daily, our triage policy only applies to around two First Nations patients per day.

Two.

We’ve simply arranged our resources and processes to benefit a small number of vulnerable Australians without sacrificing urgent care in other areas. 

And it could mean a world of difference in the healthcare of those few people while minimising the risk of our health system becoming overburdened by escalating chronic disease. 

People get confused between equality and equity, but this is how I explain it to my teenagers. 

Equality is giving every person a pair of the same sized shoes. Sounds nice at first but it would be unworkable. 

Equity is making sure that everyone has a pair of shoes that fits them.

This is healthcare equity in action. Recognising the unique challenges facing First Nations Australians and responding to them. 

And it’s better for everybody. We have fewer patients in hospital beds they don’t need; fewer patients having their treatment start again; and fewer patients coming back much sicker than they were.

We've closed the gap between two groups without negatively affecting either.

This is what good healthcare looks like.