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Abbott hospital plan needs federal takeover: -

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Abbott hospital plan needs federal takeover: expert

Alexandra Kirk reported this story on Monday, February 15, 2010 12:10:00

ELEANOR HALL: But first today - who should run Australia's hospitals? As the Federal Government
continues to fend off criticism of its failure to take over the hospital system from the states,
the Coalition Leader Tony Abbott says local boards should run hospitals in New South Wales and

But one of Australia's leading health administrators says it is not that simple. Professor John
Dwyer argues that the only way for the Coalition to turn the management of public hospitals over to
local communities would be to launch its own federal takeover.

In Canberra, Alexandra Kirk reports.

ALEXANDRA KIRK: The Prime Minister's own deadline for his big health reform plan has come and gone.
Pressing home the point, Tony Abbott's delivered the first instalment of his election year health
policy - that within since months of being elected the new federal government would renegotiate
healthcare agreements with New South Wales and Queensland requiring them to install a local board
for every major public hospital.

The Opposition's health spokesman Peter Dutton says it's a bold plan based on direct action,
delivering control back to the people who make the decisions in the best interests of patients.

PETER DUTTON: Now our plan removes bureaucracy. It will put efficiencies and savings into the
system so that we can get more doctors and nurses onto the front line and what Labor really hate
about this plan is that it is designed to remove the spin doctors and bring in the real doctors.

There is no sign of Kevin Rudd's promised land. He made a promise that he would fix hospitals by
mid-2009. We are now into February of 2010 and the Prime Minister hasn't even detailed a plan.

ALEXANDRA KIRK: He's dismissed the criticisms of the two Labor states, saying the more critical the
states are the surer he is the Coalition's on the right track.

Not surprisingly, the Federal Health Minister Nicola Roxon is critical too, describing the Abbott
plan as a tiny, scant idea for a major problem. But for now all she can say about the Government's
grand reform plan is "watch this space".

NICOLA ROXON: We have made very clear that it will be soon. We want a national comprehensive
lasting solution. We have seen no such thing from the Opposition and whilst it might take a little
longer than we wish, we would much rather get it right.

ALEXANDRA KIRK: Professor John Dwyer has long argued the nation's public health system is crumbling
and needs a major overhaul. He says of the dozens of problems besetting the sector, the one the
Coalition's unveiled is way down on the priority list.

JOHN DWYER: We have our public hospitals around Australia really struggling with ever increasing
numbers of patients, ever increasing number of sicker patients, not sufficient money, not enough
staff, internal morale at an all time low and we absolutely have to be concentrating on taking
pressures off hospitals and also working out what role in the modern system each hospital should be

Now these things are infinitely more important than the governance issue which I had no objection
to hospitals having community input into their governance etc but that is way down the track.

ALEXANDRA KIRK: Professor Dwyer founded the Australian Health Care Reform Alliance. A former head
of medicine at the Prince of Wales Hospital, now emeritus professor of medicine at the University
of New South Wales.

JOHN DWYER: We need national policy. Most of us are advocating to Mr Rudd and Minister Roxon that
we need definitely at the end of this reform process that the current Government is looking at, we
need one set of brains with one pile of money running the health system and we want to nationalise
our approach and get away from this wretched jurisdictional mess we've got with states running
hospitals and the Commonwealth paying the bills for primary care and drugs etc.

So it should be a national program but you know, inherent in what Mr Abbott is saying is that he
would be taking over at the federal level the running of our hospitals otherwise he wouldn't have
the authority to be imposing this structure on hospitals currently run by the states. So that all
needs to be worked out by what he means by that.

And the other major issue is of course is, in a modern system we want a network of hospitals all
with a defined role, helping each other. Hospitals no longer should operate as islands in an ocean
of health care. When you had boards before, naturally, the local board members wanted their
hospital to be the Taj Mahal and have everything that opens and shuts and we simply can't afford to
have all hospitals doing all things for all peoples.

ALEXANDRA KIRK: The Australian Medical Association says that local management boards are a good
idea but only part of the solution. Don't you think doctors do want more power when it comes to
decision making in hospitals?

JOHN DWYER: Absolutely. I mean there is no question but one of the major problems at the moment is
that the fiscal pressures have seen what we call clinician manager disconnect become a real problem
in our hospitals. Because the budget is so tight, doctors and nurses and allied health
professionals are being excluded more and more from the decision making about their local hospital.

But without, it is going to be a very hollow victory saying, you know, you are going to be part of
a board if the hospital is still broke as 3 per cent more sick patients coming in the door every
year can't find the staff to look after those patients and is being asked to care for people that
it doesn't have the skills to look after.

ALEXANDRA KIRK: You've had a lot to do with Tony Abbott as health minister over the years. You
don't think he understands the problems besetting the public hospital system well?

JOHN DWYER: Well, he didn't when he was a health minister. I mean it is a bit rich for Tony Abbott
who, when many of us who were trying to talk to him as health minister about healthcare reform
found that he was totally unreceptive to any idea of major reform of the health care system in

Just tinkering at the margins is all we need he would say and wouldn't use the term reform but of
course, the truth is that we need radical reform of the Australian health care system to sustain it
to make it more equitable and to really swing it around, put the emphasis on prevention and give us
the win-win situation of having a healthier older population and less dependence on hospitals.

I hope he has suddenly learned his lesson and now that he is in Opposition, changed his mind about
all this. Whoever is leading us in this has to realise that the Australian healthcare system is in
need of a major urgent overhaul from top to bottom.

ELEANOR HALL: That is Professor of Medicine John Dwyer from the University of New South Wales
ending that report by Alexandra Kirk.