Fix­a­tion on hav­ing four hos­pi­tals costs a for­tune — and lives

Let’s hope Can­berra agrees to an ur­gent in­quiry into our health sys­tem, says

Mercury (Hobart) - - TALKING POINT - An­drew Wilkie

THE di­ag­no­sis is clear. Tas­ma­nia’s health sys­tem is fun­da­men­tally bro­ken.

The new Health Min­is­ter has not re­solved the health cri­sis, and nor is she likely to, given the chronic sys­temic and cul­tural prob­lems she’s in­her­ited, com­bined with the State Gov­ern­ment’s con­tin­u­ing ap­a­thy.

Over many years politi­cians from all sides have demon­strated they’re in­ca­pable of pro­vid­ing Tas­ma­ni­ans with the world­class health sys­tem we need.

So it’s time to strip away the pol­i­tics and parochial­ism that have paral­ysed this state and bring in an out­sider, an in­de­pen­dent hon­est bro­ker to find out why Tas­ma­nia’s hos­pi­tals are the worstper­form­ing in the coun­try.

The Pro­duc­tiv­ity Com­mis­sion, whose work has helped spawn ground­break­ing re­forms such as the Na­tional Dis­abil­ity In­surance Scheme, is best placed to do the job. I’m meet­ing with the Fed­eral Trea­surer next week to make the case for him to di­rect the Com­mis­sion to ur­gently hold a pub­lic in­quiry into Tas­ma­nia’s fail­ing health sys­tem.

The Com­mis­sion is an in­de­pen­dent ad­vi­sory body to the Aus­tralian Gov­ern­ment with the power to in­ves­ti­gate all lev­els of gov­ern­ment. Its core func­tion is in­quiries into key pol­icy ar­eas bear­ing on eco­nomic per­for­mance and com­mu­nity well­be­ing. It al­ready looks at pub­lic hos­pi­tal per­for­mance, and is well placed to hold an in­quiry into why Tas­ma­nia’s hos­pi­tals are fail­ing, de­spite the heroic ef­forts of staff and sim­i­lar re­sourc­ing from Can­berra. The Com­mis­sion is ex­am­in­ing men­tal health now and in the past has stud­ied Tas­ma­nia’s ship­ping and freight. It is per­fectly cre­den­tialed to look at the big pic­ture.

Al­bert Ein­stein is cred­ited with say­ing: “The definition of in­san­ity is do­ing the same thing over and over again, but ex­pect­ing dif­fer­ent results”. Tas­ma­nia’s health sys­tem is a prod­uct of this in­san­ity. It suf­fers a chronic case of parochial­ism and po­lit­i­cal paral­y­sis. The Aus­tralian Col­lege for Emer­gency Medicine re­leased data show­ing the Royal Ho­bart Hos­pi­tal and Launce­s­ton Gen­eral Hos­pi­tal are the coun­try’s worst per­form­ing when it comes to how long peo­ple wait for treat­ment in emer­gency. The peak body for emer­gency medicine said sim­ply throw­ing more money at hos­pi­tals was not the so­lu­tion. It shows doc­tors on the front­line know the health sys­tem has sys­temic prob­lems.

Since then we have heard the RHH is lurch­ing around in the dark with­out a bud­get, fear­ful to spend money with­out an in­di­ca­tion from the State Gov­ern­ment of its an­nual bud­get half­way through the fi­nan­cial year. Last week, 17 peo­ple in men­tal health crises were sit­ting in its emer­gency depart­ment, some wait­ing more than three days. Doc­tors have pointed the fin­ger at mid­dle man­age­ment and warned of a cri­sis of cul­ture, not ca­pac­ity. Now there are fears of a mass walk­out of doc­tors, nurses and paramedics who can no longer face work­ing in the bro­ken sys­tem.

There are prece­dents for the Fed­eral Gov­ern­ment get­ting in­volved in the

Tas­ma­nian health sys­tem be­yond the dis­as­trous Mersey hos­pi­tal takeover and hand­back. On my elec­tion in 2010 the Fed­eral Gov­ern­ment com­mit­ted $340 mil­lion for re­de­vel­op­ment of the RHH, and in 2012 I se­cured the $325 mil­lion Tas­ma­nian Health As­sis­tance Pack­age in recog­ni­tion the pop­u­la­tion was older and sicker than other states. The Fed­eral Gov­ern­ment could show a keener in­ter­est in the fact the Hodg­man State Gov­ern­ment has di­verted $1.6 bil­lion of GST money from Tas­ma­nia’s health sys­tem since 2014. This is an emer­gency and it’s time for fed­eral in­ter­ven­tion, start­ing with a Pro­duc­tiv­ity Com­mis­sion re­view to iden­tify the root cause.

The ills have been well doc­u­mented in the 2004 Richard­son Re­port, the 2007 Tas­ma­nian Health Plan, the Re­port of the Com­mis­sion on De­liv­ery of Health Ser­vices in Tas­ma­nia, and the One State, One Health Sys­tem, Bet­ter Out­comes re­form pack­age. All make the same di­ag­no­sis: a rapidly age­ing, ge­o­graph­i­cally dis­persed pop­u­la­tion, high rates of chronic dis­ease, ris­ing costs and wors­en­ing per­for­mance, and an ur­gent need to stop try­ing to of­fer all ser­vices at four ma­jor hos­pi­tal cam­puses.

It’s time for Tas­ma­ni­ans to pause and con­sider why on earth we are so fix­ated on main­tain­ing four hos­pi­tals in a state of just half a mil­lion peo­ple. All this is achiev­ing is longer waits, higher costs and worse out­comes, un­doubt­edly lead­ing to un­nec­es­sary deaths.

In a num­ber of do­mains, main­te­nance of sep­a­rate health re­gions leads to clin­i­cal caseload spread too thinly across too many fa­cil­i­ties. The du­pli­ca­tion is waste­ful, gen­er­ally lead­ing to higher costs. It also has the po­ten­tial to be un­safe. This as­sess­ment has been in­de­pen­dently con­firmed three times in the past decade and ac­knowl­edged by suc­ces­sive gov­ern­ments. Shame on po­lit­i­cal par­ties for putting self-in­ter­est in Brad­don and Bass ahead of pub­lic in­ter­est and health­care.

We should be guided by ev­i­dence and should not be in the po­si­tion of de­fend­ing poor out­comes on the ba­sis of his­tor­i­cal or parochial in­ter­ests. A bi­par­ti­san ap­proach is needed here. It’s time to stop play­ing pol­i­tics with the health of Tas­ma­ni­ans. Peo­ple are dy­ing.

An­drew Wilkie is the fed­eral in­de­pen­dent mem­ber for Clark.

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