The Australian Health and hospital system is like a lot of its patients, very ill, with not good prospects for recovery.
The Federal Government has just finagled a deal with GST and the States (except WA.) on returning some GST funding to go towards their respective Health systems and hospitals. The PM and his Health Minister trumpet that this new flow of funds will reduce waiting periods in Emergency, provide more funds for primary care, reduce waiting time for elective surgery, increase nursing staff, become the cornerstone of a new Federal/State relationship, etc etc. But the sorry truth is that it will not make one iota of difference to what the general public experience at their local hospital. There will still be anecdotal (and true) stories of waiting 8 hours or greater at Emergency, patients dying from infection or being given overdoses or wrong doses of antibiotics, inadequate nursing care while in hospital due to skilled nurse shortages, negligence by nursing and medical staff including registrars, surgeons and consultants, and other medical catastrophes which have made the newspapers with much more regularity. People are now genuinely distressed and fearful of hospitals. Multi resistant viruses and inoperable cancers are increasing the risk of dying. We are losing or have lost faith in our medical system. Here is my opinion why.
There are six major vested interests involved in our health systems- Federal and State Governments, the Medical Profession and associated other health professionals, the Health Funds including Medicare, the Pharmaceutical corporations, and the Public. Look at the Public interest first. You and I will at some stage become ill or suffer injury, or be subjected to ia virus, and will look to the medical profession to help us. The first line of defence is the local GP, and after that, the Specialist, and after that, well it is usually Hospital, either for observation or further tests, or if a full diagnosis has been completed, surgery or medical care of some description. For a patient with an elongated recuperation, you start to notice some serious flaws in the system. A lot of medical staff are foreign, English is a second language, communication is difficult, and its very hard to find out exactly what is wrong, what is the path to recovery, and on a daily basis, how are you progressing. Are you told the results of pathology tests, ECG’s, x-rays, CT and MRI scans, and any or all other tests? Why are there so few Registered Nurses in your ward? Why are casual Agency staff being used predominately to augment the few RNs? Why are night staff reduced to the level of so few, that they cannot cope? Why don’t you get to talk to your doctor when you want to? Why does it take an infinite time for someone to answer my buzzer? The answer is money, and the lack of funding. And who controls the funding? The Bureaucrats.Which is our next vested interest.
If the Federal Government and each State Government is funding their Hospitals, the Community Nursing Services and all associated health services, then in all prudence and legally, they require administration and financial management of the funds and where the funds are spent. This requires an army of administrators, in fact a bigger army than we presently have in our Australian Defence Forces. How does this conglomerate mass of part of humanity think? Well read George Orwell, 1984 or observe the Gorgons in the film, The Hitchhikers Guide to the Galaxy. There is an unwritten law in the corporate world, that if you want real power then as a senior manger you have to have a large financial budget and resources. For “resources” read people. So government bureaucratic thinking is the same. Create more bureaucrats each time the government releases more funds. But what about the IT systems and the databases, can’t they do away with staff? Yes, of course, but who is going to input the data? Data Entry Personnel!
As for the Health Funds and the Pharmaceutical companies, well they are dependent on the government to fund Medicare and to set the rates for the Private Health Funds. As for the big Pharmas, well they need to get their drugs on to the Public Benefit list, so the price is subsidised, and so all the GP’S and the Hospital doctors prescribe the latest pill for curing left handed toe-itis.
The Medical Profession. The doctors, consultants, specialists and University Professors are all highly educated people with the altruism and dedication directed toward helping people in their time of health need. Many do amazing operations which are on the bleeding edge of technology, researchers spend years ( and lots of money) on programs that lead to vaccines which cure a range from influenza to the HIV virus, to stem cell research which may cure Spinal Cord Injury through to Parkinson’s disease. Neuro surgeons now regularly carry out brain operations which were unheard of a mere ten years ago. Medical journals publish research into every area and hospitals and universities vie for medical academics who will give them the best publicity. Which will assist them in attracting more funding. Which will enable them to attract more medical academics, which will,……..etc.
When governments seek to enhance their profiles, decide on populist measures, seek votes from particular industry bodies, invest in infrastructure, or move closer to an election, then greater funding flows to recipient bodies who are malleable or who are prepared to pledge their loyalty to the fund provider. The desperate clawing for funds, far outweighs the funds. Who should receive more funding? What is the measurable criteria? The public good now, or in the future? The higher profile organisations? The indigenous community? The Vested Interests?
At grass roots level in the Hospital system, the standards are mediocre at best. How can things change? How can we instill professionalism, a basic level of customer service and customer satisfaction as we see those performance indicators being used in business? How can we change a systemic and endemic culture that says near enough is good enough, I do a fair days work for not enough money, but no more; I don’t get a bonus, but the fat cats do; why no incentives for me if I work hard, but get no reward other than the same again tomorrow? If I can work out a more efficient and productive process, which eliminates risk, and saves money, why is that saving not passed on to me? Why does it go back into general funds and gobbled up by the bureaucracy? If bureaucrats are such great administrators and managers, how come hundreds of suppliers around the State, are owed large amounts of money, for goods or services delivered a considerable time ago? The Universities and Nursing Colleges who provide tertiary qualifications are not blame free. Where else does the systemic mediocrity start? The Unis are only too well aware that the more foreign students they enroll, the larger the revenue. Thirty thousand dollars for a three year degree course is not to be interrupted by failing a non English speaking student who is unable to reach the pass rate standard after 6 months of tuition. Registered nursing staff I have spoken with complain that communication in English in some wards is non existent. The hands -on training for graduates is minimal, and when they hit the hospital system, there are inadequately supervised as the few registered nurses have no time.
An increasing redirection of Government funds from the taxpayers to the Health system will not solve the problem, because the problem is not money, but culture