It’s time for change and resolve

Curiously, during the recent federal election campaign, the health policy pronouncements of both the Labor and Liberal parties1,2 failed to address one of the major issues with the potential to affect the quality of Australia’s health systems, namely: progressive job dissatisfaction among health professionals. These health care workers must surely be utterly demoralised, for every day they are confronted by the deterioration, indeed, decay, of the systems in which they work and struggle to deliver high-quality care.

Of prime concern to the public and health professionals is the systemic deterioration of our public hospitals, burdened as they are with ever-expanding waiting lists, reduced bed capacity, poorly coordinated clinical services, access block and overcrowded emergency departments.3 Add to this the stress of staff shortages, chronic underfunding and dysfunctional management, and it is easy to understand why our public hospitals scored so low in the recent Public hospital report card of the Australian Medical Association.3 This report provides an independent analysis of performance indicators such as bed capacity, access and equity, productivity and funding. Tellingly, all states and territories attracted criticism — not one escaped a pressing need for reform.3

So disturbing is this sorry state of affairs that one fears a repeat of the infamous Bundaberg Hospital scandal.4 Indeed, there has already been a flurry of distressing reports cataloguing near misses and clinical mishaps in emergency departments across the nation.5

General practice also has its share of problems. These include: increasing workforce shortages, especially in rural areas; the burden of red tape; inefficiencies in the interface between general practice and hospitals or community aged care; and numerous other issues related to continuity of care and access.6 And these difficulties will definitely be further stressed by the ageing of our population.

With a newly elected Labor government, all Australians look forward to the inherent energy of a new government with a mandate for reform, expecting them to produce the best health system for all Australians. And for this to happen, both the new Health Minister and Prime Minister must be held accountable.

The community has wearied of the cynical and perpetual denial of political responsibility and desperately longs for an enactment of Harry Truman’s dictum: “The buck stops here”.

But this expectation has to be tempered by the need for plain speaking and honesty. It is deceitful for any government to promise the delivery of a Rolls-Royce health care system, but fund it as though it were an FJ Holden.

As to the precise nature of the health reforms the government should pursue, there is a plethora of advice and recommendations.7-10 The Journal has only a few priorities:

• The present debate about federal–state government responsibility for health services should cease. We need a decision now about whether one level of government or two should be responsible for all Australian health care delivery, and the debilitating and destructive blame game should then cease.

• Preventive medicine should be given first priority. The inertia in tackling the obesity epidemic is an indictment of the profession and, in particular, the impotence of its public health sector. We desperately need enactment of a national policy with an array of incentives and penalties.

• In Indigenous health, the momentum engendered by the Northern Territory intervention needs to be sustained, in real partnership with Indigenous Australians.

• Patients and the public should have a stronger voice in decisions related to health care. To quote Peter Baume, a public health commentator and former Liberal senator and minister:

• Finally, changes in health need to involve doctors and return the practice of medicine to its appropriate focus: health care that is enabling and effective.12

Three principles should guide this reform: first, the goal at all times should be ensuring value for patients; second, changes in medical practice should be organised around medical conditions and care cycles; and, third, outcomes and cost should be measured.12

This tripartite approach is necessary to ensure that value for patients is achieved by a move from the current practice paradigm, focused on discrete, uncoordinated and episodic service delivery, to one characterised by integrated and coordinated care, wherein patients actively participate in their own management and are responsible for compliance with care plans.12

The role of organised medicine in Australia is to ensure that health reform is not only realistic, but is realised. It must be said, however, that any cynic, observing the system’s downward spiral, might reasonably question the strength of the profession’s advocacy role and political power. After all, the decline and decay in health care delivery has occurred despite professional protestations. Doctors’ advocacy must become more aggressive, and doctors need to become a politicised profession.13 We have had enough of commissions and inquiries! The time for talking is over. We need action. We need reform.

Is the time not ripe for a united and independent task force — one with appropriate professional and consumer representation, which will ensure that the government remains on-task, pursues a reform agenda and reports widely on progress?

Is it not time for doctors and other health professionals, who are arguably the only thing our health system has going for it, to question whether they should continue propping up a second-rate system that is jeopardising the quality of care and is increasingly of risk to patients?

Doctors and their patients are resolved that the time for change is now. All expect the newly elected government to deliver.

And soon.