Professor David Penington, who recently wrote this article for Crikey warning the Prime Minister against “blindly following” the National Health and Hospitals Reform Commission’s recommendations, has some further advice in the lead up to the COAG meeting.
“On Monday 7 December Kevin Rudd will present to COAG what recommendations of the National Health and Hospitals Reform Commission, or what alternatives should be adopted. COAG will reach final decisions at a further meeting in March 2010.
In 2007, he promised to ‘fix’ the public hospitals, taking them over if the States had not fixed them in a year. This followed the problems in Bundaberg but since then, similar problems emerged in the Royal North Shore Hospital in Sydney and in the Road Trauma Unit at the Alfred Hospital in Melbourne.
They reflect fundamental flaws in ‘clinical governance’ in hospitals performing well on the normal bureaucratic yardsticks of performance on budget and numerical patient ‘throughput’.
Peter Garling SC stated, in his 2008 NSW review, “I have identified one impediment to good, safe care which infects the whole public hospital system. I liken it to the Great Schism of 1054. It is the breakdown of good working relations between clinicians and management which is very detrimental to patients.”
Public hospitals are there to deliver medical services to the community, but over the past 15 years, have come to be controlled against numerical yardsticks of throughput by State health officials, regardless of quality of services, with clinical specialists largely removed from any oversight.
The British National Health Service had suffered a similar fate, primarily controlled by central bureaucratic regulation with deteriorating services. Gordon Brown intervened. Remarkable reforms, led by Lord Darzi, brought the system back from the brink, with dramatic improvement in quality over just 2-3 years. Medical faculties played the key role to bring medical expertise into partnership with administration at every level. Medical professionals take pride in the quality of services if given the chance to contribute.
The NHHRC would not only reinforce the current flawed regulation of hospitals with outside authorities telling them how to treat their patients, but such regulation be from a greater distance, making matters worse.
The new Health Workforce Australia would interrupt the direct relationship of medical faculties with their teaching hospitals, through which comes the vital clinical research, testing the quality, safety and effectiveness of clinical services. If this is damaged, not only will sick people not have care informed by ongoing advances in health science and technology, but the whole process of medical and nursing education would become ‘backward looking’ under a mantra of ‘competencies based training’ rather than looking to new and better ways to deliver services.
We believe the PM should recommend:
• Measures to bring clinical doctors to interface with health administration at every level.
• Measures to assess quality of services, to be used alongside current KPIs for hospitals.
• Safeguard the relationship between the medical faculties and their teaching hospitals.
• Encourage development of Academic Health Science Centres around major teaching hospitals, as recommended in the 2008 International Review of NHMRC, to secure continuing advances in quality of health care for Australia.
• Bring together the various ‘silos’ of primary care, public hospitals, preventive strategies and aged care in Regional Clusters, using the resources already present in university faculties, to further enhance regional and remote health care as new intern and training positions are urgently developed for new medical and nursing graduates.”
• David Penington AC is a Senior Fellow at the Grattan Institute, and Former Vice-Chancellor and Dean of Medicine at the University of Melbourne.