Neither side’s policies inspired health workers with confidence
DURING the election campaign nearly every survey revealed health care as the most important issue to voters. It was no coincidence that the backlash against the Coalition was greatest in states where the crisis in health care has been frontpage news: Queensland, NSW and Tasmania.
Kevin Rudd made some noise on health during the campaign — promising to fix hospitals and declaiming that the ‘‘ buck stops with me’’ — but sadly, this noise has quickly subsided in the aftermath of the poll, with education and other issues taking precedence.
The Coalition’s record on health in the past year has been appalling. The Howard Government chose to avoid health in the May budget. Then during the election campaign, despite having $62.5 billion to spend, they chose to all but ignore the problems many Australians face accessing quality health care, and neglected rural health problems.
Howard’s lack of interest in health made it easier for Rudd to play the role of reformist, but Labor’s policies have to date received minimal scrutiny. Like the Government, Rudd also chose to ignore health in his May budget reply. The policies that followed in the election campaign did little to inspire confidence among healthcare workers.
The ‘‘ super clinics’’ — chosen for mainly marginal electorates — will suffer from the fact that few, if any, GPs will be available to work in them. The push for these clinics has come from a myth encouraged by state governments that emergency departments are being clogged up by patients who ought to be attending a GP.
In fact the reverse is true: GP surgeries are filled with patients who should have already been seen by a hospital specialist or had surgery years before.
Rudd has promised $600 million to eliminate waiting lists, but he will need a miracle similar to the loaves and fishes for this to be successful. Where are the beds, doctors, specialists and nurses that would be required? Labor suggests surgeons will operate in private at weekends to eliminate waiting lists. This ignores the simple fact that at present, most GPs are unable to find surgeons at 9am on a weekday. The low point for health during the election campaign came with the official Labor Party policy launch, two days after the Coalition’s own launch. It was no surprise that Howard ignored health, but Rudd had promised ‘‘ new health initiatives’’ for weeks. He assumed the mantle of being fiscally responsible, and avoided further announcements: a win for politics, a blow for health care.
Crucial to any reform will be Rudd’s ability to negotiate with the states. This will not be easy. The state and territory Labor governments have a long record of putting politics before quality health care. They have already stated their opposition to any federal takeover, and they will push for any measure that reduces the financial pressure on state-run public hospitals. We will see increased pressure for early discharge, community/home care and similar measures.
This will result in a tsunami of complex work for the primary health workforce, particularly GPs. Under normal circumstances family doctors would welcome this work, but at present general practice, with its ageing and depleted workforce, will be overwhelmed. The weakness of health policies to date is the failure to recognise the fragility of this remaining workforce. Any reform or new policy will rely heavily on the few remaining experienced doctors, nurses and allied health workers.
Few recent policies have been directed at retaining our existing GP workforce. While Labor has pledge to simplify the phone-booklike Medicare Benefits Schedule — brandished during the campaign by health spokeswoman Nicola Roxon — and reduce red tape, we have not seen any concrete proposals to achieve this. Meanwhile, there has been silence on other issues that would help retain doctors, including retention grants for older doctors working in areas of workforce shortage, and an urgent review of indemnity issues.
The existing workforce will be not only required to carry a huge workload, but also train a much larger replacement workforce.
One problem for those GPs that remain is the poor job the representative bodies do in advancing GPs’ real interests. There can be no better example of this than during the election campaign. The Australian Medical Association chose to support the Coalition in order to protect the private health industry. The Royal Australian College of General Practitioners chose to remain silent, while the Australian General Practice Network gambled correctly and chose to protect its funding by supporting its new masters, the Labor Party. The Rural Doctors Association of Australia pushed hard, but its pleas were once again ignored by both parties.
Not only must health be fixed, it must become the number one priority for both state and federal governments. Put simply, all ‘‘ working families’’ will need access to health care.
Health can be fixed but it will need strong leadership. It will need well-funded and welldefined health policies. If these do not eventuate, Rudd may well find that his comment ‘‘ the buck stops with me’’ will prove Labor’s equivalent to Howard’s fatal promise to keep interest rates low. Graeme Alexander is a GP in Claremont, Hobart