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Samantha Hodgson met all the criteria for a possible heart attack: “A tight, crushing pain that started in my shoulders and spread through my chest and rib cage. I was dizzy and the pain had gotten worse within 24 hours, so much so that I had trouble breathing.

Hodgson was also on day nine of being infected with Covid-19, and until the chest pain hit, she was feeling better. According to health guidelines, she needed an ambulance for a suspected heart attack.

But when Hodgson, who lives in Potts Point in Sydney, rang triple zero, the operator told him: “You could wait a while, we don’t know how long that might be.” Too ill to walk far, she put on two masks and called an Uber to take her to the nearest public hospital.

When she arrived she was told to wait outside in the rain as she had Covid.

“I sat under a small tarp outside the ER next to a parking lot,” Hodgson said. “I stayed outside for at least two hours. I don’t remember exactly because I was so out of it.

“A doctor came to see me after about an hour and a half, and she said they really needed to get me in but they had no beds. I begged her to put me in a wheelchair and put me in a closet to treat me as I wanted to ease the pain and know what was going on with my chest. But she just said, ‘There’s nowhere to put you’.”

Hodgson’s discharge letter said there was no cause for concern for his pain and that his symptoms were Covid-related. A month later, Hodgson is still trying to get access to his discharge notes, including the ECG results.

“I feel like Covid pain has become so normalized in emergency rooms that my chest pain hasn’t been taken seriously,” she said.

Hodgson’s story relates to many of the health care system issues that have led to “blocked access”: the term used when emergency patients delay being placed in a hospital bed. The relationship between blocked access and poor patient outcomes, including death, is well established.

Patients find it difficult to exit the ambulance, let alone be admitted. A report by the Australian Medical Association released on Thursday found that no jurisdiction is meeting its targets for getting patients out of ambulances and into the care of emergency service personnel within a safe and acceptable time frame.

AMA National President Dr Omar Khorshid said this surge in ambulances means patients are not getting timely care and paramedics cannot respond to new emergencies.

“That’s what we see when our public hospitals are at a standstill,” he said.

Sydney doctor and president of the Australasian College for Emergency Medicine, Dr Clare Skinner, said the rise in Covid cases and a persistently high death rate had highlighted the pressures hospitals face. But the pandemic and the easing of restrictions are not the cause of the blocked access and the hospital crisis, she said.

The blocking of access has many other long-standing and unresolved causes, such as the struggles for resources and funding faced by other sectors, including general medicine, paramedical health, personal care disabilities and care for the elderly. Patients cannot leave hospitals to free up beds if they have nowhere to go due to the National Disability Insurance scheme and lack of funding for home care, or if they are homeless. Patients also end up in hospital and could be treated in elderly care – if only this sector had nurses and other health workers.

When there are waiting lists and high costs for mental health care in the community, these patients also end up in the hospital. “We are seeing a sharp increase in the number of people presenting to emergency rooms with mental health issues, psychological distress, and drug and alcohol issues,” Skinner said.

Funding new hospital beds for these patients does little to help if the staff needed to care for them leaves en masse. Skinner says senior clinicians in particular are leaving, retiring early, or cutting shifts due to burnout, stress, and “moral injury.” The nurses are also fed up. The many years of specialized training they have cannot be quickly or easily replaced.

“Healthcare workers across Australia are saying current conditions in emergency departments are the worst they have ever seen in their careers, and at the moment the access blockage is worse than when major Covid outbreaks,” Skinner said.

The deplorable investments of successive federal governments in preventive health, the increase in out-of-pocket health costs, the lack of general practitioners and specialists in rural and regional areas and the difficulty in finding billed medical appointments en bloc means that patients are not treated early and end up in hospital with more complex problems.

That’s why focusing solely on hospitals — whether it’s funding beds or hiring and training new staff — will never be enough to address the crisis in the hospital system, Skinner says. Any action must coincide with major reform in other areas of health and community support.

“With all of these systems such as social support and wellbeing, elder care, community health…as the load increases on these, the backup plan for each of them is the service of the emergencies,” Skinner said.

During major Covid-19 outbreaks, federal and state governments diverted resources to the health system to meet acute needs. Elective surgery has also been postponed to allow health workers to focus on acute cases.

“But in times of the status quo, we don’t have that and I think we need the federal government to step up and maintain the additional funding for the hospital system that was made available in the time of Covid,” said Skinning.

“We couldn’t postpone surgery indefinitely, so now we’re trying to do everything from catch up on surgeries and care delayed during the pandemic, while also treating urgent patients and still treating acute Covid cases.”

As a result, the number of patients, the complexity of their cases and the costs of treatment are constantly increasing.

The states are responsible for running the hospitals, but the federal government shares responsibility for paying them. The federal government pays 45% of the growth in hospital service delivery each year, capped at 6.5%, but state and territory governments are united in their demand for the Commonwealth’s share to be increased permanently to 50% and the cap be removed.

“There are people who fall through the cracks of state and federal systems, and we tend to see blame and cost shifting between those systems,” Skinner said.

Guardian Australia has contacted many major hospitals to ask about the main issues they are currently facing and what is needed to address them. None responded to requests for comment.

An ‘exhausted’ senior surgeon working at two Melbourne hospitals, who cannot be named as he was not cleared by his workplace to speak to the media, told Guardian Australia that ‘this hospital crisis has not been caused by the pandemic”.

“I think people are so fed up with Covid being used as an excuse for what is happening, or as a reason to fix it. Covid has only exposed and aggravated the situation. Reinstating restrictions will not bring nurses back, it will not inject money into all areas of the community and the health system where it is needed.

He fears that because health workers have been talking about the system in crisis for so long, politicians will “lose the importance” of their message; and while patients suffer, staff are overwhelmed, and system-wide reform and funding are still lacking.

“I worry about what will happen if it takes five or 10 years for something significant to happen to fix this problem, because reform takes time,” he said.

“Because right now I don’t even know how we’re going to get through the next six months. How are we going to spend the winter? We are going to see more surgeries canceled due to understaffing and due to Covid or flu infections, and more pressure on emergency services.

“And meanwhile, in health, we lack real political cooperation and leadership.”

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