One layer of government to run health
THERE will be little, if any, change in the delivery of health services unless one level of government takes responsibility for all health services. While the blame game and political point scoring is happening in Tasmania, the fact is all state health systems are in crisis.
The Commonwealth Government is responsible for the Pharmaceutical Benefits Scheme, primary healthcare (general practice, specialist and allied health services) and aged care and it contributes to public hospital services.
State governments are responsible for public hospitals, health transport (ambulances) and community health services and they provide some support for rural health services.
How can a system operate efficiently when we have parts of each service operated by separate bodies?
It is critical for our health system to operate in a coordinated way. Any part of the system operating inefficiently will have a domino effect through the whole system. There are many examples — bed blocking in hospitals by patients for whom there is no aged care facility, pressure on after-hours hospital services by a lack of GP services and pressure on state hospitals to provide drugs not listed on the PBS.
It has been stated that there are cultural problems in our public hospitals.
I would suggest this cultural crisis through the nation’s health systems results mostly from the lack of co-ordination of services. An example is when a Commonwealth government decided to fund GP super clinics. Millions of dollars were rolled out to these clinics, which were to provide a range of services, including after-hours medical services, to take the pressure off overworked emergency departments.
On the Eastern Shore, the Clarence Health Centre was demolished and a new one built which to my knowledge has few, or no, after-hours services. Today we have state governments going down the same path, funding GP services to provide after-hours services. There is always the blame game between state and federal governments as to which is at fault.
Dr John Burgess has highlighted bureaucratic issues in Tasmania’s health department (“Shine a light on health bureaucracy,” Talking Point, November 18). Multiply that by each state and territory, then add the bureaucracy at a Commonwealth level.
In Canberra, the business district of Woden is health bureaucracy central, with multiple high-rise office blocks occupied by Commonwealth Department of Health.
For years I visited Canberra to attend meetings and in hindsight I question what we achieved. Nationally we have thousands of public servants travelling daily to meetings, many of them duplicating roles. Some time ago I was made aware we have more than 50 people developing policy at a state level, so if this is duplicated by each state and territory, we have hundreds if not thousands of staff developing policy that should be driven at one national level.
It is time to stop the point scoring. Look around the country and see that no state government of any persuasion has solved the problems of healthcare. Allocating more money is not the answer!
Unless radical change is made to restructure services under the responsibility of one level of government, nothing will change. Tasmania cannot solve its problems alone.
John Cleary is a former state Liberal health minister and community pharmacist and a former chairman of the Commonwealth Community Pharmacy Authority.
NATIONALLY WE HAVE THOUSANDS OF PUBLIC SERVANTS TRAVELLING
DAILY TO MEETINGS ... WE HAVE HUNDREDS IF NOT THOUSANDS OF STAFF DEVELOPING POLICY THAT SHOULD BE DRIVEN AT ONE NATIONAL LEVEL