Rudd’s health plan un­con­vinc­ing, but it’s wor­thy of sup­port

The Weekend Australian - Travel - - Health - JEF­FREY BRAITH­WAITE

THE $2 bil­lion plan for health care re­leased by Kevin Rudd’s La­bor op­po­si­tion last Thurs­day trumps Prime Min­is­ter John Howard’s pro­posed $45 mil­lion bail-out of the Mersey Hos­pi­tal in Devon­port, Tas­ma­nia, by $1.955 bil­lion of your hard-earned taxes. So it had better be good. What will the Rudd health plan give us? La­bor says that rather than hand over money to hos­pi­tals in mar­ginal elec­torates, which it thinks Howard is plan­ning in the elec­tion run-up, ev­ery hos­pi­tal will get some in­vest­ment. There will be in­cen­tives for hos­pi­tals to avoid un­nec­es­sary care, and pro­vide more-needed care, such as to older peo­ple. Pre­ven­tion is better than cure, says La­bor, so money is there for more of this. The logic is it takes the pressure off hos­pi­tals and it’s better to have a health­ier pop­u­la­tion.

If states and ter­ri­to­ries fail to fix their hos­pi­tals with this large fund­ing in­jec­tion they will face the prospect of a ref­er­en­dum. It will be put to the peo­ple whether they want the fed­eral Gov­ern­ment to run hos­pi­tals di­rectly, with lo­cal com­mu­nity in­volve­ment, ef­fec­tively cut­ting out the states and ter­ri­to­ries.

Many ob­servers think it is a very good idea to stream­line the health sys­tem and elim­i­nate one level of gov­ern­ment, as there are too many fin­gers in the health pol­icy pie and so this seems to make sense.

In fact, Fed­eral Health Min­is­ter Tony Ab­bot has oc­ca­sion­ally had dreams to run pub­lic hos­pi­tals from Can­berra, but Howard and the Coali­tion’s Cabi­net wouldn’t let him. It’s too hard, they thought, and in any case you can blame the states and ter­ri­to­ries — a par­tic­u­larly tempt­ing thing to do when they are wallto-wall La­bor, such as now.

But what would a bril­liant hos­pi­tal sys­tem ac­tu­ally look like?

Most ex­perts can tell you. It is hard to achieve, of course, but why don’t we ask both sides of pol­i­tics what they can do to de­liver this. So here is the real test for any Rudd or Howard health pol­icy. Gentle­men, achieve this:

En­sure clin­i­cal staff act vig­i­lantly and fol­low pro­ce­dures scrupu­lously — even re­li­giously. Ev­ery clin­i­cian should ap­ply the best, most ap­pro­pri­ate care to each case. Sur­pris­ingly, they don’t all do this now.

Give pa­tients’ lobby groups ad­e­quate air time and some in­flu­ence. Lis­ten to them prop­erly and gen­uinely let their views shape lo­cal health ser­vices — it is, af­ter all, their health sys­tem, not the Gov­ern­ment’s or the doc­tors’.

Stop harm­ing pa­tients. Many are in­jured by the sys­tem they need to rely on. Pre­vent pa­tients fall­ing, ac­quir­ing hos­pi­tal in­fec­tions or be­ing given the wrong med­i­ca­tions. Er­rors of this na­ture are higher than most peo­ple think, so this would be a mighty achieve­ment.

In fact, deal with pa­tients as real peo­ple, not as ‘‘ through­put’’, ‘‘ bed block­ers’’ or ‘‘ ad­mis­sion tar­gets’’. Put their needs first, not the needs of the sys­tem or those pro­vid­ing care.

Pa­tients would have trust in the sys­tem, as no one would be fall­ing through the cracks be­tween the acute, com­mu­nity and gen­eral prac­tice sec­tors. Pa­tients would be seen very quickly, in the mode of their choice — whether that was at home, in the doc­tor’s surgery, as an out­pa­tient or in an acute set­ting.

So care would be aero­dy­nam­i­cally smooth, pro­duc­tiv­ity would be up, re­sources would be be­ing used wisely, and wait­ing lists would have al­most dis­solved. What else? Team­work amongst clin­i­cians would be ob­serv­ably more col­le­giate and pro­fes­sional. There would still be a mod­icum of lo­cal pol­i­tics, nat­u­rally enough, but com­mu­ni­ca­tion within teams and across dif­fer­ent ser­vices would be ef­fec­tive.

Then there’s tech­nol­ogy, which would be reap­ing all the re­wards it once merely promised. Ev­ery pa­tient would carry a smart card con­tain­ing their full health pro­file, swiped when­ever they in­ter­face with any clin­i­cian in the health sys­tem. Elec­tronic in­for­ma­tion about pa­tients would be avail­able to com­mu­nity and hos­pi­tal doc­tors at their fin­ger­tips, so that the right pa­tient was be­ing di­ag­nosed and treated at the right time by the right clin­i­cian mak­ing the right de­ci­sions and pro­vid­ing the right re­sults.

It’s even clear in an ex­cel­lent health sys­tem how those in charge should be­have. Politi­cians and health depart­ment bu­reau­crats would be nur­tur­ing staff and lead­ing im­prove­ments where pre­vi­ously they spent time mi­cro­manag­ing is­sues and mas­sag­ing the front pages of news­pa­pers. There would be a lot less spin, more me­dia ac­cess and more hon­esty.

The as­pi­ra­tions which re­searchers and com­men­ta­tors have for the health sys­tem for the last 20 years would ac­tu­ally have been met, and ser­vices would be uni­fied and in­vig­o­rated. A good test is staff morale. Clin­i­cians would be uni­formly bright-eyed and bushy-tailed, on the ball, highly mo­ti­vated, cre­ative and sat­is­fied.

Better still, the sys­tem would have solved its big­gest cri­sis — things would be so good, staff would be be­ing at­tracted to the sec­tor. Aus­tralian doc­tors, nurses and al­lied health pro­fes­sion­als who have left would be com­ing back from over­seas to work here. Univer­sity en­rol­ments would be up. Clin­i­cally trained health work­ers who had drifted into other in­dus­tries would be queu­ing to get back in.

Ef­fi­cien­cies cre­ated by all th­ese im­prove­ment ef­forts could be added to the $2 bil­lion Rudd in­jec­tion, so the sys­tem would be in a spi­ral of im­prove­ment which would feed on it­self. Th­ese dol­lars would be avail­able for new ser­vices — and a big new push could be on in tack­ling can­cer, mit­i­gat­ing drug ad­dic­tion, ad­dress­ing obe­sity, im­prov­ing car­diac care, and for faster emer­gency re­sponses.

Will Rudd’s plan for health care do this? The truth is, it may go some way to cre­at­ing a health sys­tem that’s better, but it doesn’t con­vince that it can achieve what we re­ally need. It goes a lot fur­ther than the Coali­tion’s Mersey-manic ex­per­i­ment. So at this stage, it de­serves sup­port. Pro­fes­sor Jef­frey Braith­waite is di­rec­tor of the Cen­tre for Clin­i­cal Gov­er­nance Re­search at Univer­sity of New South Wales, and a mem­ber of the Hos­pi­tal Re­form Group.

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