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Local boards to run hospitals – does Abbott really understand what he’s suggesting?

Tony Abbott sure knows how to grab airtime and a headline, and has made a respectable media splash for his bid for local boards to run hospitals. But does he really understand what he’s suggesting?

Perhaps not, observes Professor Gavin Mooney, a health economist with an interest in the use of citizen’s juries for informing health policy. He writes:

“Tony Abbott’s idea of local community boards for hospitals is really about who exercises power in our health care system. The idea of power to the people has a nice ring to it.

But Tony Abbott supporting power to the people? And the idea getting an overall positive welcome by the AMA President, Dr Andrew Pesce?  Something amiss here…

Does this really mean people power?

No, this announcement is about two things. First it continues the obsession that politicians have with hospitals and their seeming inability to recognize that there are really rather a lot of health services outside of hospitals and indeed, on a day to day basis, the general public have much more contact with non hospital services.

This obsession applies to both sides of parliament. In the wake of the publication of the NHHRC Report last year, Kevin Rudd went on a national tour – not of health services – but of hospitals only.

Second, having small local boards plays into the hands of the powerful AMA who are then yet better placed to influence what goes on. Dr Pesce states: “It’s very, very fundamental that decision-making is returned back as close to the patient care delivery as possible, rather than being made at a very central [bureaucratic] level.”

So the AMA does not see this in terms of being community driven at all but of getting decision making “as close to patient care delivery as possible” i.e. into the hands of doctors.

So of course on these grounds the AMA welcomes Abbott’s plans.

Does Abbott really believe in the community voice in health care? Well he might now but he didn’t when he attacked the idea of citizens’ juries on the 7.30 Report in 2006.

A more fundamental question: are local community boards really the voice of the community?

No, they normally do not represent the community in any genuine sense but rather are selected from the great and the good. It is of note that in the South West of WA when efforts were being made to get to the voice of the community through citizens’ juries, those who were most vociferously opposed were the former members of local community boards who didn’t like the idea of their role being usurped by these ‘ignorant’ citizens!

Local voices to influence health care decision making is a good idea and it is  a good idea for all health services and not just for hospitals.

But let’s have (as in citizens’ juries) the informed, randomly selected voices of the community. If we do have to have local boards, Mr Abbott, as a minimum require them to have to set up citizens’ juries – and require them to listen to them.”

Comments 7

  1. C@tmomma says:

    It’s just Abbott getting Dr Pesce on board in an election year by throwing him a bone. TA probably thought Dr Pesce was way too close to the government, I mean he had actually said some positive things about Labor. The move also reflects the lock that the Howard government put on Hospitals on behalf of the doctors, allowing their fees to blow out, and which Nicola Roxon tried to do something about with the Opthalmologists last year.
    If Abbott cons the electorate again, it’ll jst go back to being the way it was under Howard, except worse, because the Doctors will have taken over and won’t even have any public service quality control and oversight of their decision-making. The Drs will be able to build their local empires to their heart’s content.

  2. jenauthor says:

    My objection to local boards taking over the running of hospitals is that it will be open to both a ‘clique’ mentality, where a chosen few form a little club and wield a lot of power (cf local council activities), and that it will be open to rorting (cf local council activities .. again).

    While doctors and other health professionals should have a greater say, they are providing a service and that service should be what is uppermost in their minds. What would make a ‘local’ board better equipped to understand the health needs of it’s community? I certainly wouldn’t want the local business owner/teacher/councillor dictating policy in an area where they have no expertise.

    When we are discussing a fundamental service that should be available equally to all, then a centralised, unbiased body should be running the show. Look at the US model and see how inequitable it is — with different services available in varying states … thus people with life-threatening diseases are endangered or rewarded by the fact that they live in one particular place or another.

    I agree that there is an erroneous focus solely on hospitals. It is a bit like the political focus on ‘boat people’ when most of the refugee/illegal immigrants are people who arrive by plane and outstay their visas. Ahh, but that wouldn’t make much of a headline, would it!

  3. Dave Smartt says:

    If the AMA opposes a new health initiative, it’s usually a good one. And, quite often, vice versa.

  4. Trevor Kerr says:

    A plea for citizen’s juries in The ethical minefield of bringing the dead back.
    But citizens are up against powerful media outlets, as explained by Media Watch in On
    the Lap-Bandwagon
    .

  5. Andrew Pesce says:

    Gavin Mooney has had an interest in citizen’s juries and consumer involvement in health delivery. Although not an automatic and complete solution to the problems in our hospitals, local boards can certainly be a move in that direction. The AMA has emphasised clinician involvement, because that has been curtailed to the detriment of the hospitals.
    For those who would like to see the AMA response to Mr Abbott’s announcement, see our press release at http://ama.com.au/node/5334. This makes it clear hospital boards can only be part of a more comprehensive solution.
    The AMA believes that the pendulum has swung too far toward centralized decision making. The position that decision making be returned to a point closer to patient care can fully integrate clinician and consumer/patient involvement in that process.
    Andrew Pesce
    AMA President

  6. Gavin Mooney says:

    Above Dr Pesce asks us to look at the AMA media release on Abbott’s announcement and I did. After the lead in on ‘local community-controlled management boards for major public hospitals’ there are various quotes from Dr Pesce. In not a single one is there mention of the word ‘community’ or ‘citizen’! Remarkable. Even more remarkable, several mentions of ‘clinical input’ and ‘clinical engagement’. Clearly Dr Pesce thinks that making judgements about equity and priorities between hospitals and community care and between prevention and treatment are all too too hard for the lay citizen and doctors are the ones, the only ones, who know about such matters.

    Time to recognise Dr Pesce that the community is not stupid especially when it is given good information on which to make social value judgments (see for examples http://www.gavinmooney.com)

    This whole issue is about power and whether the people have a right to say what sort of health service they want. When it comes to social value judgements I prefer people power rather than doctor power. Over to you Dr Pesce!

  7. Andrew Pesce says:

    Thanks Gavin.
    The AMA would definitely support local community (ie citizens) input to a hospital board governance process, and would see this as an essential component.
    However any attempt however to run hospitals without the input of doctors and nurses would lead to decision making without relevant clinical input.
    Individually, good patient care results from a process where patients are given appropriate information by their treating clinicians.
    Hospital governance would similarly be strengtherned by a partnership between clinicians and the community
    Andrew Pesce

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
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Closing the Credibility Gap 2013
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2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
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National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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Population Health Congress 2015
2016 conferences
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2017 conferences
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