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    Federal health failures.
    Ministers' conference disappointing – again
    By Jenny Haines

    Once again Australia’s health Ministers have met and once again the outcome is disappointing. The state Labor health ministers went to the Health Ministers’ Conference on January 28 with their intimate knowledge of the health system from the problems that they have trying to manage with an insufficient allocation of tax dollars to the states for health services, and an unbalanced distribution of the tax dollar on a per-capita basis. The states asked the federal health minister for an urgent injection of cash to prop up the failing system.

    Tony Abbott, the federal health minister went to the conference with his usual attitude that the states were just whingeing for political reasons. Once again the Federal Government rejected any increase in its funding of public hospitals, saying the financial pressure and the rising costs of health care and increasing demand on the system are the responsibility of the states and territories.

    So the impasse continues. The only agreement that came out of the conference was a timetable for a national electronic recording system and a small change to the organ donor register that would allow families to veto a donation but not require them to approve it.

    These are important changes to small sections of the administration of the health system, but they do not address the enormous problems that the system faces. Large area health services in NSW now run cash deficits of $10-$40 million each year and they have cut their services to the bone in previous years. Surgical waiting lists are blowing out. Emergency Departments are on Code Red 36 per cent of the time. Two years ago it was 17 per cent of the time. Access block in public hospital wards is an everyday event. This can’t go on.

    There is serious doubt that Tony Abbott has a mandate to be so uncaring about the state of the health system. With up to 90 per cent of voters in survey after survey saying they wanted the problems of the public health system addressed by government at both levels, what do we have from Tony Abbott – more buckpassing.

     Tony Abbott has said there are no problems in the health system that the federal Government can fix and all the problems stem from the states' administration of the health system, so they must be fixed by the states. Tony Abbott and the federal cabinet take the view that the states get the goods and services tax funds as well as the distribution of the Medicare dollar, and that should be sufficient to cover the costs of the health system in each state.

    The needs of the health system, however, compete very much with other priorities at state level for the allocation of GST monies. In addition, the states think of health spending as building new hospitals and health centres – the infrastructure. What is failing in the health system, however, is not the replacement of infrastructure but the operational costs.

    The federal Government says if it's operational costs that are failing, the states must introduce more efficiencies! So we get the program of privatisation, corporatisation and contracting out in the NSW health system. Next will be industrial deregulation. If the federal Government abolishes the state industrial jursidictions, state awards will become null and void. Roll out the enterprise agreements and Australian workplace agreements.

    There are alternatives to this madness, most of them canvassed by the Labor Party, the Greens and the Democrats at the 2004 federal election. I was impressed by a number of swinging voters who said after the election that they liked Labor’s health policies, but were nervous about their economic credentials. Does this tell us that there is more widespread community support than it appears for these reforms?

    What must be done to restore the health system?

    1. The Health Reform Alliance has put up a model for an independent health commission that would channel health funds directly from federal level to health services. I have some reservations about how accessible, informed and consultative this commission would be, but if such a commission could stop the cost shifting and the blame shifting in health services and ensure a more equitable distribution of funds, particularly to areas of need, it is worth a try.

    2. The rebate to the private hospitals/private insurance companies, must be abolished. Introduced in 1999 to encourage Australians to take up private hospital insurance, it was thought that if more Australians took up private insurance, public hospital activity would increase and waiting lists would be reduced. Now up to about $3 billion, the monies from this rebate could be well spent in the public sector on reducing waiting lists, opening beds, funding the filling of vacant positions in all health professions, training and education budgets and all of the day-to-day operational areas that currently run on starvation rations.

    Stephen Duckett’s work on this rebate, released in the last week, is very interesting. He maintains, after studying Australian Institute of Health and Welfare data on 15 of the most commonly performed surgical procedures, that the federal Government’s health insurance policies were contributing to longer waiting times at public hospitals. If he is right, the whole basis of federal Government policy since 1996, to increase the incentive to the private sector to solve the problems of the public sector, is a failure. Stephen Duckett says that a 1 per cent increase in the private sector proportion of funding translates into a 46-day additional wait for public hospital patients.

    3. The states must proceed with the establishment of GP-type services next to public hospital emergency departments, to divert from emergency departments those consultations that are more appropriate to a GP surgery. It can be done, and it has been done, as a trial in the Hunter Area Health Service in NSW. But unfortunately, the states need the co-operation of the federal Government to make this work, and Tony Abbott has, in an almost childish way, put obstacles in the way of the provision of these services. Whose interests is he looking after here: the community’s or those of vested interests in the medical profession who don’t like the idea?

    4. The Commonwealth Dental Scheme must be restored. The situation in dental health is beyond scandalous. People waiting for years for public dentistry while living on inadequate diets should not be a problem in a wealthy country like Australia. This was one of Latham Labor’s core promises and one of the saddest losses from the outcome of last year's federal election.

    5. There must be a better nationally co-ordinated approach to the nursing shortage. A lot of the problems of the system stem from the fact that there is a desperate shortage of trained nurses. Several federal Government inquiries have identified for Tony Abbott and Education Minister Brendan Nelson the fact that there will be a shortage of 30,000 nurses nationally between 2001 and 2006.

    However, Nelson has provided universities with funding models that give them no choice but to close nursing schools and Abbott refuses to take specialist nursing advice by refusing to appoint a chief nursing officer at federal level.

    Jill Iliffe, national secretary of the Australian Nursing Federation, reported in the federation's last journal, how embarassed she was that at the last Asia-Pacific Nurses Conference in 2004, that Australia, Papua New Guinea and Vanuatu were the only countries not to have national chief nursing officers present.

    Tony Abbott, who opened the conference, was asked why Australia did not have a chief nursing officer, and he replied that such an officer could only represent nurses and nursing.

    This is a very antiquated view of nursing that nurses Australiawide find insulting. And it was news to the chief medical officer that he was supposed to represent the views of nursing to the federal Government. He would never have presumed to do so.

    The federal Government does have a long-term aim to deprofessionalise nursing and drive down costs by having a less skilled workforce. The Labor Party’s policy at the 2004 election committed an incoming Labor government to the appointment of a chief nursing officer at federal level. A Labor government was committed to creating more nurse education places by funding an additional 3125 new full-time and part-time undergraduate nursing places by 2008. Labor also was committed to providing an additional $43.4million for clinical training for undergraduate nurses so they had a smooth transition from university to working in a modern hospital. The Labor Party said during the election camapign that all of these promises were funded and could and would be done.

    6. There must be greater emphasis on primary care and properly funded health care in the community. A lot of lip service is paid to primary care and community based care and much has been done over the past 30 years, as these forms of care have proved more cost-efficient than institutional care.

    As these services take on greater proportions of the work of health services, however, they do not receive the proportion of budget needed to maintain quality in service delivery. The Whitlam government had it right when it directly funded such services from Commonwealth funds. Those days are long gone.

    One of the most dramatic examples of underfunding in the health service is mental health. Always the poor relation, community based mental health services are struggling. The recent release of figures on adverse incidents in the NSW health service show a high number of suicides by patients being supervised by community mental health services – a sure symptom of a system under severe stress.

    There is a desperate need for federal state co-operation to restore the health system to a level of performance that the public want and expect. I have listed above only some of the most-needed initiatives. Instead of trying to understand and fix the problems of the health system, Tony Abbott is championing the charge against a woman’s right to choose whether or not to have an abortion! I’d like to think that his failure in his portfolio would reflect badly on the government overall, but I thought that before the election in 2004, and the population voted the other way for other reasons.

    However, the Australian public wants a well-resourced, well-managed, efficient health system, that is there when they need it, and can provide a safe and reliable service. That is surely the basic right of every taxpaying citizen!

    Jenny Haines is a nurse, lawyer, social worker and trade unionist. She was general secretary of the NSW Nurses Association from 1982 to 1987 and has since been an activist in the health system.

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    Since February 2, 2005