Health system’s diagnosis will lead to bitter medicine
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.