Gov­ern­ment de­ci­sion ig­nores changed role of hospi­tal

The Weekend Australian - Travel - - Health - PRUE POWER

GOOD pol­i­tics and good poli­cies rarely go hand-in-hand dur­ing the hot­house of a pre­elec­tion pe­riod. How­ever, the Prime Min­is­ter’s an­nounce­ment, on Au­gust 1, of the Com­mon­wealth takeover of Mersey Hospi­tal near Devon­port on the north-west coast of Tas­ma­nia has left even the most cyn­i­cal po­lit­i­cal com­men­ta­tors aghast at its bla­tant dis­re­gard of all the prin­ci­ples of good health­care plan­ning and pol­icy-mak­ing.

Al­most ev­ery­one who has an un­der­stand­ing of health pol­icy and the re­al­i­ties of pro­vid­ing health care for pop­u­la­tions has op­posed the plan. One of Aus­tralia’s lead­ing health economists, pro­fes­sor Jeff Richard­son, speak­ing on ABC ra­dio, has gone so far as to pre­dict deaths at the hospi­tal as a re­sult of the Prime Min­is­ter’s in­ter­fer­ence.

How­ever, the Aus­tralian Health­care As­so­ci­a­tion (AHA) sees this event as an op­por­tu­nity to gen­er­ate dis­cus­sion of the is­sues in­volved in an at­tempt to bring about a more ra­tio­nal approach to na­tional health­care plan­ning and fund­ing out­side the elec­tion­eer­ing hot-bed. The AHA is the na­tional or­gan­i­sa­tion repre- sent­ing the pub­lic health­care sec­tor.

Aus­tralia’s dual health fund­ing sys­tem has al­ways been a ma­jor bar­rier to an ef­fi­cient health sys­tem. In­stead of a sys­tem ca­pa­ble of de­liv­er­ing high-qual­ity, cost-ef­fec­tive care, what we get is du­pli­ca­tion of bu­reau­cracy and ser­vices, re­duced qual­ity be­cause pa­tients are not nec­es­sar­ily treated in the set­ting most ap­pro­pri­ate to their needs, and com­pro­mised con­ti­nu­ity be­tween ser­vices (such as hos­pi­tals and com­mu­nity or aged care).

Re­gret­tably, the Com­mon­wealth Gov­ern­ment’s in­ter­ven­tion to main­tain the Mersey Hospi­tal as an au­ton­o­mous in­sti­tu­tion run by a com­mu­nity-led group op­er­at­ing out­side the state sys­tem will dis­play all th­ese flaws.

So what is wrong with the Com­mon­wealth Gov­ern­ment throw­ing dol­lars at an ‘‘ ail­ing’’ re­gional hospi­tal?

Well, the fact is that the prob­lem was not only about money. The rea­son the Tas­ma­nian Gov­ern­ment down­scaled the hospi­tal was much more about safety of health ser­vices than it was about dol­lars. The state Gov­ern­ment has a re­spon­si­bil­ity to its cit­i­zens to en­sure high qual­ity clin­i­cal ser­vices, de­liv­ered by an ap­pro­pri­ately skilled work­force.

Af­ter ex­ten­sive re­search backed by health ex­perts and broad com­mu­nity con­sul­ta­tion, it be­came clear that the lo­cal com­mu­nity was sim­ply not large enough to pro­vide the pa­tient through­put re­quired to sus­tain a full-scale hospi­tal. Doc­tors and other health­care work­ers keep­ing their skills cur­rent enough to pro­vide an in­ten­sive care ser­vice re­quire a pop­u­la­tion of some­thing like 150,000 to 200,000. Devon­port has just 26,000.

The changed role of Devon­port hospi­tal was out­lined as part of an ex­ten­sive health plan for Tas­ma­nia, which has re­ceived bi-par­ti­san sup­port in the state. The plan ad­vo­cates ac­cess to high-tech­no­log­i­cal and com­plex hospi­tal ser­vices for all Tas­ma­ni­ans, in set­tings where they can be safely pro­vided. Im­por­tantly, it fo­cuses on in­creas­ing co-or­di­na­tion be­tween the com­mu­nity and hospi­tal sec­tor. It also sup­ports in­creased spend­ing in other ar­eas that will help keep peo­ple out of hospi­tal, such as pri­mary/gen­eral prac­tice care and pre­ven­tion.

In fact, th­ese im­por­tant prin­ci­ples of mod­ern health­care plan­ning are sup­ported across the board — by ex­perts as well as con­sumer and provider health groups from both the com­mu­nity care and hospi­tal sec­tors. They all agree that ad­di­tional fund­ing into the health sys­tem should tar­get in­te­gra­tion and co­or­di­na­tion of health ser­vices, rather than fund­ing sep­a­rate en­ti­ties, thereby en­trench­ing its cur­rent frag­men­ta­tion.

Of­ten the best strat­egy for sup­port­ing pub­lic hos­pi­tals and im­prov­ing co-or­di­na­tion for peo­ple is to also fund com­mu­nity-based ser­vices, such as gen­eral prac­tice, den­tal ser­vices and aged care.

Putting money into one hospi­tal or health ser­vice in iso­la­tion will make no dif­fer­ence to over­all health sys­tem per­for­mance and will not achieve the best out­comes for the com­mu­nity. On the north-west coast of Tas­ma­nia, this ad­hoc in­ter­ven­tion is more likely to cre­ate a sit­u­a­tion where nearby hos­pi­tals in Burnie and Launce­s­ton have to com­pete for doc­tors, nurses and other re­sources, thereby jeop­ar­dis­ing the sus­tain­abil­ity of clin­i­cal ser­vices in the en­tire re­gion.

As the Com­mon­wealth Gov­ern­ment al­ready has re­spon­si­bil­ity for a high level of health ser­vices through its aged care and Medi­care pro­grams, the AHA sug­gests that it would make much more sense for both lev­els of gov­ern­ment, fed­eral and state, to agree to pool their health funds through a sin­gle author­ity in or­der to pay for all health ser­vices. Such a mech­a­nism could be pi­loted in re­gional ar­eas. In a small state like Tas­ma­nia, the author­ity could well be the state Gov­ern­ment.

Ben­e­fits in hav­ing a sin­gle fund­ing body ac­count­able for health out­comes in­clude the alle­vi­a­tion of cost and blame-shift­ing be­tween gov­ern­ments, plus much bet­ter co-or­di­na­tion be­tween var­i­ous health pro­grams.

Prop­erly co-or­di­nated, ad­di­tional Com­mon- wealth spend­ing could re­sult in in­te­grated ser­vices where they are most needed, while tak­ing pres­sure off pub­lic hos­pi­tals. This need not be the sub­ject of ‘‘ cloak and dag­ger’ ’ de­ci­sion-mak­ing and pre-dawn an­nounce­ments, with­out con­sult­ing ei­ther the hospi­tal in­volved or the state Gov­ern­ment. Most health stake­holder groups would sup­port work­ing with the Com­mon­wealth and state Gov­ern­ments on such an approach.

It will be a tragedy for the fu­ture of the health sys­tem, and will not give the peo­ple of the north-west coast of Tas­ma­nia the high­qual­ity health ser­vices they de­serve, if the Prime Min­is­ter ig­nores the united voices of the health sec­tor and misses an op­por­tu­nity to de­liver real and last­ing ben­e­fits through his planned takeover of the Mersey.

Let our lead­ers take this op­por­tu­nity to have a se­ri­ous de­bate and com­mit to a plan for change to give Aus­tralia a health sys­tem which is even bet­ter than it cur­rently has. Let’s work to­wards a health sys­tem which has one point of ac­count­abil­ity for all Aus­tralians. Prue Power is ex­ec­u­tive di­rec­tor of the Aus­tralian Health­care As­so­ci­a­tion

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