second articleAbbott's health plan meets mixed response
By Lyndal Curtis for AM
Updated 3 hours 10 minutes ago
Federal Opposition Leader Tony Abbott is targeting two of Australia's biggest states with plans for major changes in their hospital systems.
Mr Abbott wants to bring in local control over major hospitals in both New South Wales and Queensland.
But the states warn the move would lead to hospitals being isolated and say Mr Abbott's last attempt to impose local control, through the takeover of Tasmania's Mersey Hospital, was not a success.
This weekend Mr Abbott announced that every major hospital in New South Wales and Queensland would be given its own management board, appointing a chief executive and managing budgets, within three months of the Coalition forming government.
The Australian Medical Association's (AMA) head Andrew Pesce thinks it is a good idea.
"It is very important that clinical decision-making is returned to the hospital level and Mr Abbott's announcement is a way that that could go forward," Dr Pesce said.
But he says it is not the whole solution.
"We also need to sort out the funding problems which have given rise to the blame game between states and Commonwealth governments," he said.
The states being targeted by Mr Abbott are scathing in their criticism of the plan. The Queensland Health Minister, Paul Lucas, says Mr Abbott's last go at the strategy failed.
"Mr Abbott thinks the solution is a local hospital board with Liberal Party mates on it," Mr Lucas said.
"The solution is more money. We know when Mr Abbott was health minister we had the worst public policy decision in Australian health history - the takeover of Mersey hospital."
Wider system
Both Mr Lucas and the New South Wales Health Minister, Carmel Tebbutt, say hospitals function within a state and a national system and putting local boards in charge would risk seeing them lose sight of the wider
system.
"Individual hospitals don't exist on their own. They are part of a network of services and the best outcomes we get in health terms is when health services work together," Ms Tebbutt said.
Mr Lucas agrees.
"Frankly they are beyond the capacity of individuals. I wouldn't want them thinking about their own patch of turf and then not thinking about regional Queensland as well," he said.
More local input
Federal Health Minister Nicola Roxon, perhaps aware of the attraction local boards may have, is signalling there will be room in the Government's major reform plan for more local input.
She has dismissed the idea of local hospital boards, but says there are many other arrangements that might meet the challenge. And those options, she says, are being examined by the Government.
Mr Abbott has announced his plan ahead of the Government's reform proposal which was expected last year in line with an election promise from Kevin Rudd. That reform has been delayed for further consultation to take place.
While both New South Wales and Queensland say the system needs reform, neither health minister is concerned at the delay.
"We have to make sure that in reforming it, we work carefully to make sure that the end result is better than what we've got now," Ms Tebbutt said.
Mr Lucas says he wants "a proper job - not a rush job". He says he is not worried if the plan results in a federal takeover.
"I am very concerned though to make sure we get a good outcome. Whether it makes me in charge of a smaller department is neither here nor there with me," he said.
The Commonwealth and state meeting to discuss the Government's proposal is scheduled for the end of next month, although there are some signs the Government's plan may see the light of day earlier than that.
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Kings of bureaucracy: Dutton slams states
By Alexandra Kirk for AM
Updated 1 hour 31 minutes ago
The Opposition's health spokesman, Peter Dutton, says he does not care what the states say about the Coalition's plan to create local boards to run hospitals in New South Wales and Queensland.
Opposition Leader Tony Abbott said on the weekend that the Coalition would put local boards in charge of hospitals in the two states within three months of it forming government.
The plan has been met with disdain by the states' health ministers who say it would lead to hospitals being left isolated.
Mr Dutton says the more critical the states are, the surer he is the Opposition's policy is the right one.
"We're taking bureaucracy away and that's why the state Labor health ministers wouldn't like it," he said.
"They are kings of bureaucracy just like the Prime Minister. That's been a big part of the problem in health over the last 10 years and it's been a big part of why Labor has trashed the health system at the state level.
"Our plan removes bureaucracy. It will put efficiencies and savings into the system so that we can get more doctors and nurses onto the front line."
Mr Dutton dismisses suggestions the plan would fragment the health system.
When asked if the system would be rolled out to other states, he said further plans would soon be announced.
"We've been working for months now on our policy and this is just the first instalment," he said.
Delay
The Federal Government promised comprehensive health reform before the last federal election. That reform is now overdue after the Government postponed announcing changes in order to consult further.
Mr Dutton criticised the Government for its delay.
"The Government's been hinting at things in health for the last two years," he said.
"In [Senate] estimates last week Jane Halton, the secretary of the Health Department, confirmed that she'd seen no document at all in two years from Kevin Rudd which details even a first step in fixing health.
"So, Kevin Rudd has been all spin on health. He hasn't delivered one tangible aspect of reform which is going to fix our system into the future."
Federal Health Minister Nicola Roxon has criticised the Opposition's plan, saying it does not provide a national solution to problems in the health system.
She has defended the delays in the release of the Government's health and hospitals plan.
"Whilst it may take a little longer than we wish we would much rather get it right because we have pressures - it's not just the work force it's the changing demographics, it's the increased complexity of technology," she said.
AMA support
The Australian Medical Association (AMA) has welcomed the Opposition's plan, but they has also raised some concerns, saying local management boards are only part of the solution.
The AMA wants to see clarification about how the Coalition would end the blame game between the Commonwealth and the states and about who would fund and own public hospitals.
But Mr Dutton dismissed those concerns.
"The important point here is that we have a plan which I think Australians are going to be impressed with," Mr Dutton said.
"In particular what is most important to me is that patients' doctors and nurses are impressed with it and that is the focus of our policy. Now we have announced the first stage in what is an extensive policy announcement," he said.
"As we draw closer to the election we'll be making further announcements. The Coalition has a direct action plan. We've announced that first element of that plan, which is more than what Kevin Rudd has done in two years.
Unfinished business
Mr Abbott was health minister in the Howard government. Critics argue he had the chance to hand management of public hospitals to local communities when the Coalition was in office.
He intervened in the Mersey Hospital in Tasmania, but that was seen as a failure.
Mr Dutton blamed the states for the administration of hospitals.
"Tony Abbott, sure, was frustrated just like Kevin Rudd is frustrated now by the management of the hospitals by the Labor [state] governments," he said.
"He gave them the benefit of the doubt for the time that he was in the portfolio. By the end of his term, he'd had more than enough of the way in which these state governments were wasting billions of dollars.
"Now Kevin Rudd has tried to protect and hide them from accountability over the last two years. He is now complicit in the problems that are in our public hospitals and he still has no plan to fix it.
"Tony Abbott has the experience, he has the understanding, he has the knowledge of the health system to implement change."
Mr Dutton says there may be an aspect of unfinished business in hospital reform for his leader.
"He saw the waste that went on and he saw the frustration of the doctors and nurses. I've seen that since I've been in this portfolio over the last year as well and that is why I say I don't care what state health ministers have to say about our plan," he said.
"The more critical they are, the more I think we are on the money."
The decision by the then Liberal government to take over a hospital (mersey) which apparently was costing lots of money when there was another hospital which provided more services within a short driving distance looks politically motivated. Reduplication of services and all that.
That being said I can't see a problem with local boards as long as there is someone who overseas all hospitals in a state with view of better coordinating things. There is lots of talk in WA about reduplication of services, where right wing retards throw that line like some type of holy mantra. The problem is, we do want reduplication of services where the hospitals are far apart, unless the service is really rare.
While small rural hospitals may be only staffed by GPs, I think its fair to say we expect ALL better equipped metropolitan hospitals to at least be able to provide some specialties, eg general physicians etc. Oh, that rules out Spoiler
.
To further elucidate, some specialties eg neurosurgery, radiation oncology cover all major hospitals and are predominantly based at one location. That is if a patient presents with a bleed in the brain, a doctor in hospital one has to call another doctor in hospital two for advice, and if its decided that patient needs an operation he will be transferred. This applies to even if hospital one is large metropolitan teaching hospital and not some peripheral country hospital. Straight away one can see that time will be lost in organising an ambulance to transfer a patient from one hospital to the other before they are seen by a specialist. Obviously it would be faster is hospital one had neurosurgeons on hand. This fact seems to fly over certain commentators.
Another example is a PET scanner. IIRC there is only one scanner in WA. However we can get away with this because PET scans have limited applications so demand is not that high (although they are apparently almost always booked out). Also there is not really a clinical situation I can think off where you need an "urgent" ie done within the next few hours PET scan. Whereas urgent CT (Cat) scans are needed in some clinical situations eg suspected strokes (to rule out a bleed in the brain).
Thus we must calculate which specialties are in less demand and less urgent if we want to play this reduplication of services bit. You can't just throw that line out like some holy mantra guaranteeing you an instant win. To do that you would need someone higher up calling the shots and deciding which hospital gets which of these rare services.
That being said, besides that little rant I can see how local hospital boards might help for certain services simply because they would be more aware of the needs locally. For services such as payroll it would help greatly. No more ringing somewhere else where staff are either at meetings or leave early and are goddamn retarded anyway, to complain that they have mispaid you for the nth time.
However, the MAIN problem seems to lie in that we simply do not have adequate funding. In WA with increasing demand the state government decided we need to slash 3% off the health budget to keep the state surplus. When the top doctor said that was not feasible he received a public dressing down from the treasurer prompting him to resign with his position untenable. This had led to certain outpatient services being cut, various research projects shelved and bastardry where Doctor's has their hours cut (in effect expecting us to do the same job in less time for less pay) without even consulting the staff or even letting nurses know that doctors now leave earlier. Until this problem is resolved, I don't forsee local hospital boards being much of a game changer.
Note I have already stated in several threads how I would keep costs down, so I won't repost them here.
