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