In 2007, Kevin Rudd promised to fix Australia’s public hospitals if the states had not done so in a year. He would be foolish to blindly follow his National Health and Hospitals Reform Commission’s recommendations.

Senior practitioners around Australia believe the NHHRC recommendations would make hospitals worse, not better. The report includes an international assessment of our failures in quality, safety and choice of “right care”, yet it proposes no change to current bureaucratic interference and control, the cause of most of our problems. It wants outside bodies to tell hospitals how to treat their patients and bureaucrats to continue controlling patterns of spending.

Transferring bureaucratic control to the Commonwealth just makes this worse, despite frequently voiced frustrations of many about state bureaucracies.

Public hospitals are about delivery of medical care to sick people. Many other countries now recognise the imperative of medical involvement in management. Huge improvement in hospital care has recently come in Britain with this approach, following leads from Sweden, Finland, the Netherlands, Belgium and Singapore. University hospitals are at the core of these systems in country after country, testing through their clinical research the quality and safety of current and new treatments as they become available with advances in medical science, new drugs and technologies. Australia’s community deserves this, but the commission ignores overseas experience.

University hospitals provide education for future practitioners who need to “grow up” in a professional environment committed to testing quality and safety. NHHRC, however, is committed to be a “manufacturing industry” approach to health workforce reform dating from Laurie Carmichael’s model of 1986, setting minimum standards of “competency”. Minister Peter Baldwin in 1993 resolved that competencies-based training would not apply to university education. We need to ensure that tomorrow’s doctors, nurses, physiotherapists are real professionals committed to excellence in health care, which will continue to evolve in meeting the needs of our community.

All health care should be grouped together in 17 “clusters” around Australia, with faculties of medicine and health sciences, bringing professional skills into delivery of medical, nursing and other services. Northern Territory should use the outstanding Menzies School of Medical Research. Northern WA also needs a cluster meeting its special needs.

General practice matters as much as hospitals, but these need to be linked, rather than operating as separate “silos”. Preventive care needs to be integrated rather than separate. Aged care also needs to become part of the mix, supporting people to stay at home as long as possible with good community nurses, rather than depending on bureaucratic regulation and more poorly staffed nursing homes handling failures of care.

The legacy of failure by bureaucrats to meet inevitably growing need for beds must be tackled. To relieve pressure on hospitals, the private sector could rapidly bring on stream new “sub-acute” hospitals, which would be quicker and cheaper to build and operate than traditional hospital structures.

I have spelled out many of these issues in an editorial in the Medical Journal of Australia. Is the government listening?

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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