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Hospitals crisis prompts public funding schem -

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(generated from captions) tonight. Tonight. Australia's public hospitals While few would dispute that by political arm wrestles are bogged down between the states and Commonwealth, the raft of problems the crisis over years that have combined to create are far more complex political tug-of-war. than a simple black and white How to actually break the deadlock many would-be reformers to tears. is a challenge which has brought Rebel health professionals ginger group seeking radical reform who, in desperation, have formed a doesn't only lead to Canberra. say the road to reform in our look Tonight, in the second part at the future of public hospitals, the wood on members of the public we scrutinise a scheme that puts to directly decide available to their communities how the health dollars should be spent Jonathan Harley reports.

Dr Darryl Mackender is on his daily

rounds through the halls of Gosford

Hospital, north of Sydney. He's not

visiting patients, but hospital

administrators. His mission - to

find a casual doctor or locum to

fill the endless Greenpeaces in his

staff roster. Dave will just have

find a registrar from somebody else. staff roster. Dave will just have to

Talk one of his day residents into

doing nights. He'll love it. I'll

walk around this now. Sounds like a

good plan. Alright. In Sydney,

accident and emergency resident

Clare Skinner is confronting the

realities of embarking on a career

in public hospitals. It's a mess

unfortunately it's real people that in public hospitals. It's a mess and

fall between those gaps and we need

to start sorting it out. In

Canberra, they're joining veteran

medico Kerry Goulston to tread the

halls of poeer. They call

the hospital reform group and halls of poeer. They call themselves

they'll tell any politician who

listen by working in public they'll tell any politician who will

hospitals has become a labour of

love. It's a feeling of battling

with a huge system and the system

has become bureaucratised. There's

no question about it. So it's a

tougher system to work in. Across no question about it. So it's a much

the country on the south-west coast

of Western Australia, dairy farmer

Ross Woodhouse has more on his mind

than his new carves. He's helping

decide how to best spend health

dollars in Margaret River. My whole

concern about the health service is

sustainability, whether our health

service is in the long term

sustainable. Ross Woodhouse was

drafted to an unusual experiment in

health care reform, one which the

hospital reform group believes is

key to taking pressure off public

hospitals. The initiative is called

Citizens Juries. I was a little bit

sceptical, I guess. I thought it

just a whitewash. The whole thing sceptical, I guess. I thought it was

was designed to be a PR exercise,

really not to get to the bottom of

what a health service requires.

The idea sits somewhere between a

Town Hall meeting and a focus group,

randomly select 14 voters, sit them

down with the hard facts about the

health of the local population and

the money available to look after

them. Then make them choose how

to spend the budget. And we had them. Then make them choose how best

actuals thrown up to us that it

$1.5 million to have thee or four actuals thrown up to us that it cost

patients basically in a hospital

costs $1.5 to run a hospital so the patients basically in a hospital and

question arises is this efficient

use of capital? If the you are

going to have these what are you

going to give up? Fascinatingly

they were prepared to give up is going to give up? Fascinatingly what

some of their small, as they saw it,

hospitals and small emergency

departments. The jury had to

identify six main priorities for

their hospital system. The program

was run by the State Health

Department and chaired by health

economist Gavin Mooney. What they

came up with was a strong view of

what they wanted more of was

equity and fairness for the way what they wanted more of was greater

things are used particularly for

disadvantaged people and especially

Aboriginal people. They also wanted

more resources for mental health,

for people suffering from mental

illness. They wanted Mr Resources

for prevention and public health.

The results closely echo the reform

group's prescriptions. Spend more

hospital money on keeping people out of

hospitals so as to ease the burden

on a straining system. You have to

be bloody sick to get into hospital.

We're the end of the line as far as

health care goes. The the vast bulk

of health care is delivered outside

hospitals and therefore if we can

prevent illness, we can keep people

well, if we can prevent them coming

into hospital unnecessarily, if we

can support them better once they

are leaving hospital, this will be

beneficial across the community

These priorities are now being beneficial across the community 6789

implemented. Progress will be

reviewed next year. But whatever

merits of the jury's verdict, not reviewed next year. But whatever the

everyone shares the reform group's

faith in the actual process.

They're no substitute for

decision making. In the end, They're no substitute for political

politicians and policy makers can't

subcontract out the decision making

process. This is actually taking

health service back into the hands process. This is actually taking the

of people, but it does put a lot of

pressure on health service

administrators. It takes a lot of

guts to do this sort of thing. It

takes a lot of leadership. The

biggest problem that we have in a

health service in Australia at the

present time is lack of good

leadership, both political and

bureaucratic. Dr Darryl Mackender

at a Crossroads in his career. This bureaucratic. Dr Darryl Mackender is

gastro-enterologist and the

Australian taxpayer have invested a

great deal in his professional

development. I trained for 10 years,

worked for 10 years. So, yeah, I'm

40 and I guess the next 10 or 15

years is probably the most

productive 10 or 15 years the

productive 10 or 15 years the system will get out of me. But the public

hospital system might not get much

more out of Dr Mackender. The the

lucrative path to private practice

looks increasingly attractive, away

from the pressures of patching

together staffing rosters. It's not

about incomes, it's not about - you

try so hard to fix something and

eventually you say, "Well, there's

not much I can fix. Let's move on.

not much I can fix. Let's move on." As everywhere, Gosford hospital

depends on casual doctors or locums

to fill big gaps among the doctors

and nursing staff. It's another

symptom of Australia's and the

world's doctors' shortage. The

problem is, casual fills are an

unknown quantity. There 's very

little regulation in terms of the

locum system, in knowing who you

locum system, in knowing who you are getting, what training they've had

and whether they are adequately

registered orable to do the job

you've asked them to do. And they

are expensive. Casual rates means a

locum earns around three times the

normal rate. The casual doctors

usually better than none at all,

usually better than none at all, but how can hospitals know what they

how can hospitals know what they are getting? The reform group is

getting? The reform group is pushing for a national accreditation scheme,

but who'd run it? Well, it's back

but who'd run it? Well, it's back to that old state Commonwealth tennis

match. That's really a matter for

the states that have total

responsibility for the running of

the public hospital system. I know

that there are many concerns in

local communities, there are many

concerns in the various professions

about it. But this the end, that's

about it. But this the end, that's a matter for the states. It's very

easy when run ago Department of

easy when run ago Department of some 20,000 bureaucrats in Canberra

spending $1.1 billion buts not

treating a single patient to be

divorced from the interface that

state ministers daily deal with.

Dr Clare Skinner does deal with

these problems every day. I think

the a bad day in emergency medicine

is the worst day of your life but a

good day is far and away the best.

Her generation will inher writ the

job of staffing Australia's public

hospitals, a job all the more

daunting in the face of an ageing

population. By 2020, a third of

Australian hospital beds, a third,

are expected to be taken up by

senior women with broken bones.

I've watched the the system sort of

start to crumble at the edges and I

don't think it is anything

particularly new, it just soaps to

be encroaching and encroaching, but

I think it is also heartbreaking to

see inefficiencies in the system

see inefficiencies in the system and lack of good equipment and lack of

staff that cause patients to have

bad outcomes. That's heartbreaking.

That will increase as we see more

staff pressures and less decision

making, things crumbling away. We

need to actually get in there now

and start thinking about what we want. and start thinking about what .

and start thinking about what . I don't want to spend the rest

of my life looking after baby

boomers without the doctors to do

it. Being worried about the level

it. Being worried about the level of care to the community putting sick

people in the rock place at the

wrong time and inevitably somebody

will get hurt. The patients get

hurt, but also the poor staff get

hurt. They don't like being

hurt. They don't like being involved or looking after things they don't

like doing, being asked to look

after people without the resources

and being paraded in front of the

local paper as being the person at

fault when really it was the

fability they shouldn't have been

there in the first place with that

patient without more help. For the

long waiting patient we met last

night Danny Rappard, he appears to

be moving up the list. No thanks to

an overnight improvement in the

Queensland hospital system, but

public pressure. The State Health

Minister's office has told us that

Danny Rappard is now booked to see

an orthopaedic specialist by the

an orthopaedic specialist by the end of the month. That's a year after

being told he needed specialist

treatment immediately. Hopes

treatment immediately. Hopes support speedy surgery now are tempered by

years of experience. You know, you

lose heart. I have. I've given up.

lose heart. I have. I've given up. I gave up end of last year sort of

thin. I just gave up and said this

is my life. My parents have sort of

got me down here and lifted me up a

little bit, hopes up a little bit.

They've sort of been dash add

They've sort of been dash add little bit again. You u just give up. What

can you do? There's nothing you can

do. Absolutely nothing. Scratching