The traditional acute geriatric medicine model of hospital care is not sustainable. There are just not enough Geriatricians to look after all the older patients.
All Doctors should be practising comprehensive General Medicine!
Both Governments and the public can’t recognise that the majority of inpatients in public and private hospitals are elderly.
The problem with the public hospital system is that we haven’t changed the way we do things in the last 40 years.
Western OECD countries are facing a massive tsunami of older people with their rapidly ageing populations.
The cost savings per year for Governments for better health care for Seniors from Dr Lipski’s “White Paper” on a new direction for Geriatric Medical services are:
· Australia $6 billion.
· USA $80 billion.
· UK£9 billion.
· NZ $1 billion.
· Canada $9 billion.
Since Dr Lipski’s “White Paper” was written back in 2007, the Australian government could have saved now $96 billion or the USA $US 1.28 trillion!
Holistic comprehensive geriatric medical care results in shorter length of hospital stay, less complications, reduced health care costs and better health outcomes.
Dr Lipski’s core premise and philosophy- Revising thinking about “Old Age”, combating ageism, massive economic impact by better holistic medical care, community and primary care expansion rather than more acute hospitals,
Aged care integration including nursing homes which are currently isolated from the main stream health system,
Focus on geriatric malnutrition which for every $ dollar spent on better nutritional care, then $10 is saved in health care costs with massive improvements in health outcomes,
Reducing adverse drug reactions- the single most common cause of preventable emergency department presentations among older adults,
Reducing common diagnostic errors,
Correct measurement of blood pressure to reduce falls risk,
Avoiding the chronic over-treatment of frail, diabetic elderly individuals,
Prescribing ignorance,
Prioritising correct medical diagnoses over new pills, reducing doses of medications, stop blaming “old age”,
System wide Geriatric Screening -Dr Lipski advocates for the mandatory focus on key "Geriatric Syndromes" in hospitals.
Targeting the "Prescribing Cascade",
Mandatory Multi-Disciplinary Reviews,
Avoiding the Hospital Cascade: Malnourished patients suffer from compromised immune systems, impaired wound healing, and accelerated muscle loss. This directly leads to longer hospital stays, a higher rate of surgical complications, and increased mortality..
Holistic Over Single-Organ Care.
Hospital Governance: Running hospitals by medical professionals and Clinical Leadership Group (CLEG) structures.
Historical Recognition but Bureaucratic Inaction-
The 2008 NSW Health Endorsement: Dr Lipski noted that his evidence-based model was formally recognised by the NSW Health in 2008 as "the best improvement in NSW Health ever".
The Cost of Inaction: Despite receiving top praise from leadership, no systemic operational changes were ever implemented over the subsequent decade and a half.
An Evidence-Based, Peer-Reviewed Framework-
Peer-Reviewed Foundation: Dr Lipski emphasised to the Commission that his health reform roadmap is completely evidence-based.
Scientific Backing: The metrics, clinical paradigms, and logistics built into his proposal are supported by his own published research papers in peer-reviewed medical journals and formal presentations accepted at recognized international medical scientific meetings.
Operational Critiques Lodged with the Commission
In addition to his written submission, his broader systemic feedback to the NSW state's inquiry focused heavily on immediate clinical shifts to alleviate pressure on NSW public hospitals:
Exposing Systemic Ageism: He argued that the current framework defaults to treating minor conditions in the elderly as an unfixable consequence of getting old, driving up avoidable ambulance ramping and emergency room bottlenecks.
Flawed Resource Misallocation: He challenged state funding metrics, stating that pouring money into building new hospitals or funding single-organ medical specialists is a poorly optimized approach. Instead, he advised that funding holistic general medicine to keep older adults stable in their communities yields better outcomes.
Clinical Oversight Deficits: He highlighted structural training gaps within NSW Health facilities, calling out poor pharmacological prescribing knowledge (which triggers adverse drug reactions) and widespread incorrect blood pressure measuring practices by hospital staff.
The NSW Special Commission of Inquiry into Healthcare Funding 2025 accepted Dr Lipski’s written submission.
Dr Peter Lipski’s clinical philosophies and health reform models are built on a solid foundation of his own academic research, post-graduate degrees, and peer-reviewed articles.
His academic profile spans his time as a researcher at Gosford Hospital and as a Conjoint Associate Professor at the University of Newcastle. The principal research papers and medical literature he has authored—and directly cites in his White Paper and book to back up his systemic claims—focus on several key areas of geriatric care:
Dr Peter Lipski's 2007 White Paper on NSW Health Reforms proposes an evidence-based roadmap designed to overhaul how the Australian healthcare system manages elderly patients. Although the document was highly praised by healthcare leaders at the time, its systemic solutions were ultimately sidelined by bureaucratic inertia.
The primary components, endorsements, and financial assessments of the 2007 White Paper include:
The 2008 NSW Health Endorsement
Top-Level Recognition: In 2008, the NSW Health formally reviewed Dr Lipski's White Paper and lauded it as "the best improvement in NSW Health ever".
Political Consensus: The reform framework was also actively recognized and endorsed by various State and Federal Ministers for Health and Ageing across Australia in 2008.
The Implementation Gap: Despite receiving unanimous backing from top administrative and political leadership, no state or federal bodies ever executed the operational changes outlined in the paper.
Projected Financial Savings-
Dr Lipski's 2007 White Paper argued that the standard medical practice of misdiagnosing treatable conditions as "old age" creates an immense, unnecessary financial drain on taxpayers. He backed his reforms with exact fiscal projections:
Annual Systemic Savings: Fully implementing the model was calculated to save state and federal governments $6 billion per year in unnecessary acute care costs.
The Cost of Delays: In his subsequent testimony to the NSW Healthcare Funding Inquiry, 2025, Dr Lipski calculated that the failure to implement his 2007 White Paper cost Australian governments a cumulative $98 billion in missed savings between 2007 and 2023.
Advocacy for Systemic Health Reform
Through submissions to healthcare commissions and public White Paper, Dr Lipski has pushed for structural overhauls of the Australian aged care system:
Hospital Integration: He advocates that all Australian nursing homes should be directly attached to public hospitals to ensure senior medical staff conduct regular ward rounds, stopping unnecessary emergency room presentations.
Mandatory Training: He believes that any surgeon operating on a patient over 70 should be required to work within a multidisciplinary team alongside a geriatrician, and that every hospital patient over 70 should undergo mandatory delirium screening and cognitive assessment.
For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.