The hospital cure: more spin doctors

WHAT is wrong with our health-care system? Too few doctors and nurses? Not enough allied health-care professionals ? Not enough hospitals, hospital beds and operating theatres? Not enough equipment? Not enough money?

Think again. According to Kevin Rudd, the correct answer is “none of the above”. The real problem with our healthcare system is a chronic shortage of bureaucrats.

Ask anyone who has spent hours in a public hospital emergency ward or anyone who has been waiting for (so-called) “elective” surgery, such as a hip or knee replacement, for upwards of three years and they will doubtless give the Prime Minister’s diagnosis and course of treatment their ringing endorsement:

“No, don’t put any more money into the system just ensure that an even greater proportion of it goes to pen pushers and bean-counters.”

It has been said, unkindly, that health bureaucrats use statistics the way that drunks use lampposts: for support rather than illumination. But, in this instance, the statistics strongly support the case for more bureaucracy.

Take Queensland Health, the state’s biggest employer, with more than 65,000 people on the payroll, as many as 30 per cent of them doctors or nurses. How could anyone expect an efficient and effective hospital system, when up to three out of every 10 staff members are preoccupied with caring for patients ?

The situation is so acute that QH has to make do with a team of only 65 in public relations, clearly a case of too many real doctors and not enough spin doctors.

Another estimate has between 20 per cent and 25 per cent of QH’s budget getting through to actual health care.

Little wonder that QH’s waiting lists leap with every quarterly announcement, when up to a quarter of QH’s revenue is being squandered on treating the sick rather than massaging the figures.

The only surprising thing about Rudd’s solution is that it took nine months longer to come up with than he had promised. At the last election, he set himself a deadline of June 2009 to improve hospital services. Now he has come up with a plan which, if it can be carried into effect at all, will not become operational, on present estimates, for another two years, at least.

But nobody could deny that the nine-month gestation period (or, more accurately, 39 months until the actual birth) has been worth the wait. For one thing, Rudd’s proposal will, he promises,

“put an end to the tiresome cycle of the blame game between the Australian government and the states”.

This, apparently, is because about $50 billion of GST revenue will be taken from the states, and, at the same time, state input for hospital funding will be reduced from 65 per cent to 40 per cent, while the federal government’s share will increase from 35 per cent to 60 per cent. Hence, patients and taxpayers will have the comfort of knowing that state responsibility for inadequate services has reduced from two-thirds to two-fifths, while federal responsibility has risen from one-third to three-fifths.

Obviously, though, the problems go much deeper than not knowing the precise proportions in which the blame should be attributed; at present, there are simply not enough bodies to shoulder the blame. As Rudd points out,

“There is too much blame and fragmentation, making it hard for patients to work out which level of government is responsible for the care they need.”

The Rudd solution is so self-evident that it is astonishing nobody thought of it sooner. With only two levels of government (state and federal) to blame, there is too much blame to go around. Introducing a third tier of hospital administration will certainly ensure that the blame is distributed more equably.

At present, state governments run most public hospitals sometimes directly through their health departments, sometimes indirectly through local community boards or similar bodies. Goodness knows why a federal health department even exists when the federal government does no more than provide 35 per cent of the funding state governments use to pay for these services.

Now, however, there will be three tiers of administration, each with its bureaucratic mechanisms to deal with the projected increase in complaints. A federal directorate will divvy up the funds that have been “clawed back” from the states. There will also be a federal “umpire”, who will ensure that funds are distributed fairly.

The term “umpire” is a nice touch. In this, though not in all, cricketing nations, it is a by-word for fairness and impartiality. To accept the umpire’s decision gracefully is a great Australian virtue. Only the most obdurate cynic would suggest that Rudd’s “umpire” is likely to be subject to parochial biases more reminiscent of the crowd at a Twenty20 match and to have a bureaucratic staff almost as numerous.

And states governments will still be involved, paying their share of the costs at 40 per cent, somewhat more than the share borne at present by the federal government and therefore also taking their fair share of the blame. As Rudd put it, employing his well-known fluency in the Australian vernacular, “it is important that the states have some skin in the game too”. They will still own the hospitals and Rudd will still expect them to build new ones, even after the $50bn GST “clawback”.

In addition, though, there will be new “regional networks” to run hospitals at the local level. Rudd’s announcement was a bit light on the details of who is to constitute these networks. But some lack of detail is only to be expected, when the Prime Minister is proposing (in his own words), “one of the most significant reforms to the federation”.

However, Rudd did give one hint: the networks will be run by “local health, financial and managerial professionals”. Thank goodness for that. One doesn’t want the serious business of health care in the hands of amateurs such as elected politicians or community representatives who might reflect public opinion, or even respond to public concerns.

In this context, the word “professionals” may be taken as code for “bureaucrats”, which is as it should be. If health is still going to be administered by bureaucrats at state and federal levels, regional networks will need their share as well. As Rudd observes, there is presently “just too much duplication, overlap and waste”. Why should patients be satisfied with duplication, when Rudd can offer them triplication?

I am reminded of a Wizard of Id cartoon. Rodney comes upon the headsman, practising the art of decapitation on melons. He explains that he practises on 50 melons every day. When Rodney suggests that this must be expensive, the headsman answers,

“Yes, but who can count the cost when human life is at stake”.

Perhaps such gallows humour is out of place in discussing health-care reforms. But if one did not laugh at the absurdity of Rudd’s “fix”, the only alternative would be to cry at the shamefully cynical political opportunism with which this retrograde package of non-solutions is presented as the universal panacea for a healthcare system already in extremis.

By Tony Morris QC, who led the first royal commission investigating Bundaberg Hospital and Dr Jayant Patel.