Health expenditure in Western Australia is in desperate need of a “systematic rational priority setting system”; “competition for extra resources currently is on the basis of who can shout the loudest”

These are among the conclusions of health economist Prof. Gavin Mooney, speaking on ABC WA’s Stateline program last Friday about his new paper, A Report Card on the WA State Health Service. Health workers in the Kimberley do not need to be told.

Last Monday’s Crikey article, about Noonkanbah and surrounding areas, generated a ‘Ministerial: an internal “please explain” from the political bosses in Perth. An ambivalent attitude to ministerials prevails amongst clinical staff. On the one hand, “something” may be done, possibly leading to a little more funding; conversely, the requirement to address only the precise terms of the ministerial excludes the possibility of any structural reform being considered. So, the ministerial may be limited to the problems at Noonkanbah, not the context of the Fitzroy Valley or the Kimberley region in general.

There are countless other examples. When someone at Halls Creek blew the whistle about children with sexually transmitted infections, no one asked about the neighbouring regions, one of which had four times the number of notifications at that time. The Federal Government is no better. A laptop-wielding researcher asked whether community “x” had a midwife. One midwife was serving 80-odd antenates spread amongst 50 communities. The laptop rejected proportional calculation, requiring a “yes or no” for each of the 50 locations. The purpose of the research: to allow Canberra to determine which of the communities were “sustainable”.

Clinicians are banned from contacting their minister, indeed anyone above their line manager, and the media. For clinical staff in the Kimberley, the totalitarian experience is reinforced by apparatchiks’ reminders to “S.T.R.I.V.E.!”, the “V” is for “Valuing” people. Such entreaties often accompany advice that a particular “service-wide” directive is not to be adopted, or must be “modified”, because implementation in the Kimberley is seen as too expensive.

Workers are reminded that any funding increases can only be incremental with spending based on “historical precedent”. Sadly, “Westminster accountability” is not an equally popular precedent. Instead, ministers rely on “plausible deniability”: they are far too clever at politics to be caught actually knowing what is going on. Meanwhile, many clinicians experience undeniable feelings of complicity in the preventable loss of life.

Would a transparent review of public spending lead to equitable resource allocation? Surely, assertions that remote communities are “unsustainable” should beg questions about the relative efforts being made to sustain such communities and, perhaps, what we will lose with their passing?

Governments know their voters: a poll suggesting that people desire equity in health spending may not prevent electoral carnage if the local CT scanner closes or mother has to wait an extra month for a new hip; whereas remote populations have long been resigned to health rationing.

Here’s to waiting for the great leap forwards!