Nei­ther side’s poli­cies in­spired health work­ers with con­fi­dence

The Weekend Australian - Travel - - Career One -

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

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