Health sys­tem’s di­ag­no­sis will lead to bit­ter medicine

The Advertiser - - NEWS - SATUR­DAY NOVEM­BER 10 2018

per­ceived mis­han­dling of the health sys­tem, which in­cluded clos­ing the Repat and cut­ting ser­vices at key sub­ur­ban hospi­tals.

With a clear eye on po­lit­i­cal op­tics, La­bor hastily dumped the “trans­form­ing health” brand in the fi­nal months of its po­lit­i­cal life. It was a stark con­ces­sion that the plan it put for­ward to fix prob­lems which emerged un­der its own watch had failed with the pub­lic.

But, with each pass­ing day, the tol­er­ance given to Mr Wade in blam­ing his pre­de­ces­sor shrinks a lit­tle as the ex­pec­ta­tion that he take con­trol grows.

A key mo­ment will be the re­lease of a Kor­daMen­tha au­dit, ex­pected be­fore the end of this month, into the Cen­tral Ade­laide Lo­cal Health Net­work that is set to di­ag­nose causes of chronic over­spend­ing and a plan to mirac­u­lously de­liver bet­ter ser­vices at a lower cost.

The Gov­ern­ment’s task ex­plic­itly will move from deal­ing with the legacy is­sues of La­bor’s re­jected plans and im­ple­ment­ing its own. Very lit­tle is known about what Kor­daMen­tha has found in the fi­nan­cial records and clin­i­cal op­er­a­tion of the SA Health unit which over­sees the new Royal Ade­laide and Queen El­iz­a­beth hospi­tals.

But whis­pers em­a­nat­ing from the Gov­ern­ment are that its con­clu­sions have been “sav­age”, and pro­posed fixes yet to be re­vealed could be “bru­tal”.

An Au­di­tor-Gen­eral’s re­port re­leased last month shed some light on just how out of con­trol CALHN is. And it’s un­der­stood Kor­daMen­tha’s find­ings mir­ror many of the find­ings.

It is the “largest con­trib­u­tor” to bud­get blowouts in SA Health, run­ning at about $300 mil­lion over de­spite be­ing given $2 bil­lion as a base­line each year.

Fur­ther, it finds past strate­gies to achieve bud­get tar­gets “have not worked over many years” un­der the for­mer ad­min­is­tra­tion and “a new gov­er­nance and ac­count­abil­ity frame­work should com­mence” im­me­di­ately.

Trea­surer Rob Lucas has given a small in­di­ca­tion of what Kor­daMen­tha has dis­cov­ered, say­ing they have iden­ti­fied the cause of an over­spend­ing “scan­dal” to be a “sys­temic and wide­spread break­down and lack of re­spect for fi­nan­cial con­trol and per­for­mance ac­count­abil­ity”. In short, the tenured bu­reau­crats in the Health Depart­ment don’t care about keep­ing to a bud­get.

And if the chronic catas­tro­phes in child pro­tec­tion have taught SA any­thing, it’s that cul­ture is crit­i­cal within de­part­ments and chang­ing them can be a close to im­pos­si­ble task. That’s even more true of SA Health, which has close to 40,000 pub­lic ser­vants and its own fief­doms and power struc­tures.

Laws gov­ern­ing the pub­lic ser­vice also make it very hard for min­is­ters to do much at all about staff, from se­nior man­age­ment down, who aren’t on board with a par­tic­u­lar pol­icy agenda.

One of the big­gest chal­lenges for the Gov­ern­ment when the big sell on re­form starts will be coun­ter­ing a mind­set that more money means bet­ter health ser­vices. For years, the for­mer gov­ern­ment would mea­sure its com­mit­ment to the health sys­tem more by the money that was be­ing put in than by the qual­ity of ser­vices com­ing out.

It was com­mon for press re­leases to fo­cus on how many mil­lions of dol­lars were be­ing in­jected, as it was claimed no cost should be spared. Mr Wade is go­ing to have to con­vince the pub­lic that health has be­come like en­ergy, with high prices and poor ser­vice, and sav­ings don’t just al­ways mean cuts.

And it has a com­pli­cated mes­sage to com­mu­ni­cate in mak­ing ef­fi­cien­cies, which it says are cru­cial, at the same time as lift­ing over­all health spend­ing on health and dump­ing other sav­ings that were baked into La­bor’s fi­nal Bud­get but Pre­mier Steven Mar­shall now says are just “un­achiev­able”. But cri­sis can also bring op­por­tu­nity. If the Gov­ern­ment can stop the over­crowd­ing and ramp­ing and de­liver demon­stra­bly bet­ter ser­vices than its pre­de­ces­sor, Mr Mar­shall can make ma­jor po­lit­i­cal gains in an area that’s usu­ally a brand strength for the La­bor side of pol­i­tics and al­ways a top or­der is­sue in any state elec­tion.

And it would be es­pe­cially po­tent as the for­mer health min­is­ter, now-La­bor Leader Peter Malin­auskas, will be the man cam­paign­ing to take his job.

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