Maybe he’s telling the truth but given his experience in the Queensland bureaucracy, it’s simply impossible to believe Kevin Rudd when he says he “didn’t properly estimate the complexity” of health reform.
A few minutes talking to anyone involved in healthcare delivery is enough to know the sector is hopelessly complex, a spaghetti-bowl of accountability. Everybody’s hands are tied, it’s a black hole for money, it is impossible to please the stakeholders from state governments through doctors’ and nurses’ associations to the voting public, and the line of managers required to sign off on simple things stretches almost as far as the line of patients waiting for treatment at a hospital door.
What Rudd outlined yesterday is in some ways about changing which bank account gets debited for healthcare services. But most people don’t really care about structural reform – they just want to know Aunt Ethel doesn’t have to shuffle around on the bad hip for too long. And when she does, they want someone to blame. Now Rudd is saying you can blame him.
In his speech to the Press Club yesterday he said he was honouring a commitment that “the buck would stop with me”.
OK then. If Rudd wants his government to be responsible for healthcare delivery he needs to be prepared to take political responsibility for it too.
So the next time a woman miscarries in a hospital toilet, Rudd or at least his health minister Nicola Roxon should be ready for that phone call in the middle of the night looking for an explanation. And handle the calls for a public inquiry into service delivery at that hospital if they arise. (Many will recall this did happen in New South Wales three years ago.)
With Rudd taking control of how hospitals are funded and managed essentially out of their hands the state governments won’t want to be copping the political damage when the mines go off.
Rudd said there had been a mixed response when he talked to the state premiers about his plan yesterday morning. But surely the state governments must be inclined to relinquish control. They may even be enthusiastic about it, as they currently shoulder all the blame for problems but cannot raise any money to try and fix them.
And if you think the political blame game is dull you should try reading the policy document Rudd unveiled yesterday. Much of it is nothing new – bringing in old announcements under the umbrella of a bigger reform package – and two things you might expect in a major health reform are notable for their absence.
These are discussions of the needs of patients, and the skills and capabilities in hospitals.
Odd, perhaps, but it underscores that this is not a typical healthcare reform. This is not about taking better care of sick people – who doesn’t want that? – but the political and fiscal labyrinth that makes up how it is paid for and who is responsible for it.
The pointy end is addressed by the national standards which, at least according to the plan, will apply across the country. So if you are due for a hip replacement there will be a standard waiting time. There will also be standards for waiting times in emergency departments.
If these standards are published and performance is reported on a regular basis – and the policy says they will be – it will set off a bomb in the health system. Think a hospital and GP clinic website from the people who brought you My School.
Rudd and Roxon said yesterday there would be a number of other health reform announcements in the coming weeks and months on hospitals (“especially public hospital emergency departments”), GP care, the health workforce and e-health.
These will be more familiar healthcare announcements – changes to front-line stuff, like reassurances that you’ll be able to see a doctor when you need to, and putting the training and recruitment plans in place to ensure there are enough doctors and nurses with the right kinds of skills.
For an indication of what’s in there you could look at the report of the National Health and Hospitals Reform Commission, which contains 123 recommendations. (There’s a link to it on yourhealth.gov.au.) What Rudd has announced this week is just laying the groundwork for delivering on them if they are to be made government policy.
One last little point. For all the talk about ending the buck-passing, there’s a little clause near the back that more than hints at what you might call wriggle-room. It says: “As part of its national leadership role the Commonwealth will be alerted to poorly performing hospitals … and require states to step in and fix these problems”.
To me this says when Aunt Ethel is still hobbling around and you ask the feds why she can’t get the hip fixed, they can tell you it’s up to your state government to lift its game. Sounds like a licence to pass that buck.
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