A major challenge for the next Queensland Government will be to address systemic problems within the health sector, says Professor Andrew Wilson, Executive Dean of the Faculty of Health at Queensland University of Technology (and who has previously held senior positions within the Queensland and NSW health departments).
In the article below (cross-posted from The Conversation), Wilson outlines some areas requiring the attention of the incoming government, including the need for more out-of-hospital care, a regional focus, and new approaches to governance and management.
The five priorities in health for the next Queensland Government
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Andrew Wilson writes:
No matter who wins the Queensland election this Saturday, the next premier of Queensland will have to face up to some serious challenges within the state’s health system.
There were improvements made under the Bligh government, including major improvements in hospital infrastructure. But without addressing issues of governance, skills, and quality access to care in regional areas all these gains will come to nothing.
The following are the top five priorities for the winner of the election and their next government.
Queensland Health, the state government department responsible for public health services, has been a key vulnerability for the Bligh Labor government for its whole term of office. The Labor government did make gains here, but it is more likely to be remembered for the safety failures at Bundaberg Hospital and the mess of its failed payroll system.
Both of these are clear examples of a failure of governance and accountability. The decision to proceed with a new payroll system with Queensland Health was high risk given its complexity and size. Responsibility was split between two departments.
Delays in development led to a decision to introduce the system too fast without appropriate fallback mechanism because of concern the existing system would fail. The goodwill and improved morale fostered from investing in better remuneration agreements for clinical staff disappeared within a couple of pay, or no-pay, cycles.
Building confidence among health employees that they will be reliably paid and in the community that there will be accountability have to be priority issues for any new government.
2. Regional care
Queensland has the most decentralised population in Australia with nearly 25% of its population in outer regional and rural centres, more than double that of any other state.
Until recently, most public hospital services in regional Queensland were allowed to be run-down. Around the same period, the number of special purpose medical registrants trebled between 1995 and 2005, with more than 1,500 being registered every year in Queensland.
These effects compounded each other. Few specialists covering after hours calls meant those available did not want to work in the public hospitals because they ended up carrying the load. Accredited specialist training posts outside of Brisbane were few because of lack of specialist supervision. In a tight medical labour market, the only recourse was international medical graduates.
The Bligh government has done a lot to address infrastructure requirements, with major hospital rebuilds in almost every major regional centre. But the challenge now is to develop the services to utilise this infrastructure effectively.
In regional centres, there has to be special arrangements to attract private medical specialists to provide services and participate in after hours call. Special consideration will have to be made under activity-based funding for regional services or yet again services will be centralised.
The excellent work undertaken to develop the Rural Generalist Medical Pathway, the most successful rural medical strategy program in Australia, needs to be expanded.
The public perception that you have to go to Brisbane to get good high level care has to change.
3. Go beyond central Brisbane
The South-eastern corridor of Queensland and Northern NSW will soon be the largest geographic conurbation in Australia, progressively filling in the region from Byron Bay to Gympie. It will rapidly grow to a population of more than 5 million people.
But the two largest tertiary hospitals still sit within five kilometres of each other in central Brisbane, and still command the lion’s share of new resources. Having two children’s hospitals didn’t make sense and they sit even closer together.
There will need to be the political will to build services in the outer metropolitan areas, on the Gold Coast and Sunshine Coast.
4. More out-of-hospital care
There is a seemingly limitless demand for more hospital beds in Queensland. Queensland population is growing and ageing, which, combined with the epidemic of chronic disease, is creating a real increase in need.
On a population basis, bed numbers are somewhat lower in Queensland than the rest of Australia, but not dramatically so.
The overall number hides a larger problem in that some beds are of little practical use being in hospitals with limited medical capacity (22 of the 150 public hospitals in Queensland provide more than 85% of services).
But what stands out in Queensland is the lower number of sub-acute beds and the capacity to provide care in the community. In the longer term, these services need to be substantially increased or Queensland will never get on top of the impact of a changing population.
5. A new name for a new authority
The brand name of Queensland Health is toxic. It has been continuously associated with poor management, planning and service for ten years. Changing brands won’t fix the faults, but without a new start, any new leadership will be hamstrung by its history.
The tendency to centralise control under both Labor and previous National-Liberal party governments in Brisbane has impeded the development of local accountability and local service development. In a state the size of Queensland, you cannot effectively run services in the Torres Strait, more than 2000 km from Brisbane from an office in Brisbane.
The model of local health networks adopted under the national reforms can be made to work if boards are given the appropriate authority and resources, and are held accountable. A variation of the national model more like hospital boards but with a shared regional provider may be necessary in Western Queensland where the sheer distance between towns makes it hard for communities to feel a real sense of accountability under a regional model.
There will be a need for a health ministry, at least while states remain in the hospital business. There are some services which have worked well on a statewide basis with regional or local nodes, such as pathology and public health, which should be retained.
To learn from the mistakes of the recent past and to crystallise opportunities, a new approach to governance and management is required regardless of who wins government.
• For more background reading on plans for restructuring of Queensland Health, see this recent Croakey article, with commentary from health policy analyst Dr David Briggs.