Protect General Practice
- Text Decrease
- Text Increase
- Print Page
Is central control best for Victoria?
vicdoc, September 2009
The recommendations of the National Health and Hospitals Reform Commission (NHHRC) are extensive and will involve much comment in vicdoc in the coming months.
In this issue I wish to concentrate on the NHHRC approach to public hospitals. The NHHRC has stopped short of recommending a wholesale takeover, but there’s plenty of hand grabbing centralisation on display in the report’s 123 recommendations.
A Federal Government take over of Victorian hospitals must be resisted. I’d rather wrestle with a bureaucrat in Melbourne than a commissar in Canberra.
Victoria’s public hospitals are the most efficient in the country. Unlike other states we have local hospital boards responsible to local communities, so the Victorian Government takes a hands-off approach to management.
Make no mistake – there’s plenty of reform work needed. The Victorian Government’s hands-off approach often extends to its accountability, with a lack of coordination between hospitals and with the community. Information technology in hospitals is often disgraceful. We don’t have enough beds, leading to delays in treatment and bed block in emergency.
That being said, hospitals in other states are worse, and often much worse. Centralising hospital administration in Canberra will not improve things for Victorians.
The Commission is recommending a number of hospital functions be taken over by the Rudd Government, and the most worrying of these is in clinical training — Canberra wants to determine who gets trained and where.
This must be rejected out of hand. Trainee doctors in hospitals are the lifeblood of the medical workforce. They do the night shifts and the day to day grind and they look after the welfare of patients. I can’t imagine a system where state governments are responsible for caring for patients, but the Federal Government controls how many trainee doctors are working in Victorian hospitals and the manner of their training.
There must be a significant increase in funding for training and supervision if we are to produce quality doctors.
The Commission also recommends that the Commonwealth Government take full control of hospital outpatient funding — but that the funding be capped. The Victorian Government currently hides the outpatient waiting list figures, so it would be very difficult to work out the required level of outpatient funding. Outpatient waiting times must be made available to the public so that GPs can better plan our patients’ care.
GPs will refer public patients to hospital outpatient clinics as this is the key path to public hospital elective surgery, as well as providing many other medical services. However, waiting times for an outpatient appointment are measured in months, or occasionally years. A federally imposed cap on outpatient services is a high risk strategy that could severely limit access to essential care.
Having one bureaucracy running the hospital outpatient service and another running the inpatient service won’t work. Transferring outpatient funding to Medicare – as is the case in many outpatient clinics now – does seem to work, so there may be an argument for making this process universal. However this does expose our doctors, who often lend their provider numbers to this process without question.
Some of the NHHRC’s other recommendations seem trained on fixing the health systems in New South Wales and Queensland rather than Victoria. For example, the Commission recommends that all primary care and all aged care funding be centralised in Canberra.
The Commission’s recommendations ignore the significant investments already made by the Victorian Government in community health centres, community-based aged care services and residential aged care. A nationalised approach could either bring other states up to the benchmark set by Victoria, or result in lowest common denominator care.
Victoria leads the nation in many aspects of health care. Though there is room for improvement, the areas where we need to improve are different to those of other states. The risk is that a nationalised system designed to standardise and harmonise may strangle innovation, limit funding and fail to be responsive to local needs.
Too often federal authorities demand adequacy rather than pushing for achievement. Rarely does a bureaucrat in Canberra know what works best in Castlemaine, Corryong, Carnegie or Cranbourne.
We need innovation and reform. Any national approach must foster innovation, reward reformers, provide enough resources for hospitals to build the necessary infrastructure and deliver the best possible care to all Victorians.
Preferred Providers
Next
Prev