The Guardian 17 October, 2007
Hospital wars with real casualties
Bob Briton
The human cost of the crisis in the country’s hospital system is incalculable. Some of that cost came to the public’s attention recently when the facts of how Sydney woman Jana Horska miscarried in a toilet at the Royal North Shore Hospital in Sydney were splashed over the front pages of our dailies. She had spent two hours in the emergency department and received no medical attention in that time. Guidelines for prioritising cases meant that under-resourced and overworked staff simply could not deal with her needs. NSW Health Minister Reba Meagher has made a number of recommendations and set up an emergency care task force. At the same time, Prime Minister John Howard and his Health Minister Tony Abbott are doing their cynical best to dodge their own responsibility for the crisis facing public hospitals and to pin the blame on "Labor mismanagement".
The Federal Government claims that the biggest problem besetting our public hospitals is remote and unresponsive state government bureaucracy. The Commonwealth is proposing to force changes on the big hospital networks so that each and every hospital would be run by it own governing board composed of hospital clinicians and experts in governance, finance or health delivery. It is a business model in the best neo-liberal tradition and mirrors the PM’s thinking that running a hospital is just like running a club.
Abbott originally said he would use Tasmania’s Mersey Hospital as a test case for the effectiveness of stand-alone hospital boards. The looming Federal Election has no doubt prompted the Minister to appear to be doing something about the unfolding nationwide disaster and to set about imposing the new arrangements in the face of growing scepticism and opposition. If he is still the federal Health Minister, Abbott will seek to usher in the new system when the signing of the next five year public hospitals funding agreement with the states falls due next year. In 2004-05, the Commonwealth met 44 per cent of the bill ($22 billion) for public hospitals. It used to share the cost 50/50 with the states.
Very few commentators expect the Howard Government’s decentralised "fix" to work. It existed before in a number of states including NSW where it became a debt-ridden mess. The system was abolished in Queensland in 1992 after the National Party had stacked the boards with political appointees who created $313 million-worth of debt for the people of the state. Queensland’s current health Minister, Stephen Robertson, would like to know how the Abbott experiment would deliver better outcomes. "Where’s the proof?" he asked last week. "How will a hospital board employ one extra doctor?"
Howard and his successive health ministers have argued hard against providing the public health system with the additional funding it needs to keep up with the demands of an aging population and increased costs. The current level of indexation (5 per cent) is woefully inadequate. All over the world, health is a happy hunting ground for price-gouging pharmaceutical and medical technology monopolies. Governments like Howard’s are not about to do anything to limit the role of those very influential players.
In fact, the Howard Government’s overarching pro-corporate, neo-liberal program is the real reason public hospitals and other vital services like education are in a state of decay. Its priorities run to US-led military adventures, tax cuts for the already wealthy, increased funds for private hospitals and schools and, of course, the Private Health Insurance Rebate (a gift to private health insurance companies of over $3 billion a year) but not to proper funding for public hospitals.
Opposition leader Kevin Rudd is promising a $2 billion health system overhaul and the establishment of a health and hospitals reform commission. He wants funding agreements to be renewed every three years instead of the current five and to give current state-based hospital administration arrangements until the beginning of 2009 to turn present trends around. If this does not happen, he is promising to launch a federal takeover involving regional boards. Labor would start building 24-hour, bulk-billing super clinics to take some of the pressure off hospital emergency departments.
Unfortunately for public hospital patients across the country, the alternative PM is also a self-confessed economic "conservative". This means that the broad priorities set down by Howard & Co are not about to be upended. Funding to public hospitals is not about to be increased to the extent needed to stop experienced nurses and other staff simply walking away demoralised at their inability to serve the health needs of the community.