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