To the Editor: Although the Garling report1 is the latest (and longest, at 1195 pages) in a long line of reports on the state of public hospitals to be commissioned by state and territory governments, the three articles in the Journal commenting on this report are timely and have brought out the fundamental problems with public hospitals Australia-wide, not just in New South Wales.2-4

These problems were highlighted by Van Der Weyden in pointing out the “pervasive sense of loss — loss of control, loss of direction, and loss of ownership by the hospitals’ serving health professionals, politicians, and the community”;2 by Skinner and colleagues commenting on “the progressive centralisation . . . and disempowerment of both clinicians and the community” and the failure of this approach;3 and by Stewart and Dwyer with their comments on resourcing, and the seriousness of the divide between clinicians and managers.4 These remarks in particular are entirely consistent with my own observations from my work in a number of hospitals throughout Australia in the course of doing consultancies or accreditation surveys in recent years.

It is now time to stop “resort[ing] to conducting inquiries”2 and for the federal and state governments to work cooperatively to implement the three main solutions that clearly emerge from the issues raised by Garling and the MJA commentators, which are:

• appropriately resourcing public hospitals, including opening and staffing sufficient numbers of additional beds (to replace the many shut by economic rationalists);

• re-establishing community boards for individual hospitals or small related groups of hospitals in those states in which they have been abolished. These boards must have members chosen for their skills and experience, not their politics, and be accountable to the communities they serve; and

• reversing the alienation of clinicians by engaging them in all levels of governance, not only by consulting them but by ensuring that they are actively involved and part of the whole decision-making process. Offering Executive Clinical Director posts1 is necessary but not sufficient to achieve these aims, and must not amount to tokenism.

Despite the huge number of recommendations in Garling’s and other reports, addressing these three matters would go a long way toward fixing the problems in public hospitals across jurisdictions. This would help to restore the faith of doctors in the public hospital system, help give communities and clinicians a sense of ownership and pride in their hospitals, and boost morale, so that hospitals can once again become centres of excellence in a re-energised health system.