Last year's headlines were full of Queensland Health job cuts and cuts to other health prevention programs in the sunshine state. It's a new year, but the consequences of budget settings by Campbell Newman's government are now becoming apparent.
The reorganisation of governance in the state health system, that is devolving budgetary decisions to Health and Hospital Services (HHS) boards, has led to a series of controversies around cuts not just to jobs, but to programs and facilities. Boards and HHS CEOs are constrained by the amount of funding made available by Queensland Health. Decisions now being taken, and in prospect, are having a severe impact on both urban and regional health services, their communities and workforces.
In south-east Queensland, the Children’s Health and Hospital Board has axed school nurses, closing 126 hearing clinics, as well as impacting on other preventative health measures. At the same time, meetings called to consider "workforce redesign" at the Royal Children’s Hospital and in Metro North District have led staff to fear more job cuts are on the horizon. It seems that authorities are not being transparent about the scope and timing of the process.
Meanwhile, Wide Bay is just one region where local feeling about service closures and potential privatisation is running high.
It hasn't been sufficiently noted that the combined impact of many of these decisions is the privatisation of health services and facilities. The Queensland Nurses Union has compiled a list of cuts and an assessment of impact, which shows multiple closures and privatisations.
Legitimate questions about safe staffing and fair remuneration are raised, as is the question of whether this move was ever envisaged in the LNP’s election policy. The LNP’s pre-election health policy is hardly a detailed document.
The government is paying a political price for the decisions of the boards, with the local nature of the services enabling a range of stakeholders and activists to campaign effectively. Independent MP Peter Wellington has charged that the government is hiding behind the boards to avoid responsibility for its cuts, describing the boards as "puppets" of the government.
Perhaps in response, Newman has announced that when the boards’ membership is renewed in May, a doctor and a nurse should sit on each body.
But this could be read more as providing political cover, particularly when the Premier’s preference that nurses should be QH employees implies that there might be a conflict between their advocacy and governance roles, and their employment rights. There has already been criticism of the political allegiances of some board members. For instance, Mike Horan, a former Nationals Leader and health minister, is chair of the Darling Downs Board.
The LNP’s policy document stated a commitment to "returning control of health services to local clinicians and communities". It's worth observing that the party committed to "investing in health awareness and prevention".
At present, control -- exercised through budgetary and staffing constraints -- is still firmly with the government in George Street and QH head office in Charlotte Street.
The current firestorms around the decisions of the boards, and the continuing opposition to their decisions by bodies such as the AMA and the QNU, point to the fact that in no way are these boards either accountable to communities, or to the best in clinical and health management thinking. It would be much better to have a governance model combining genuine community, patient and workforce representation with a clinical senate model to have input on health service practice and planning.
Similarly, health impacts and social assessments should be factored into decision-making at the local level. There is no reason why local community representatives should not be elected. This would be in line with the governing party’s emphasis on decentralisation of decision making.
Is that something the government "Can Do"?
*Dr Mark Bahnisch is a Fellow of the Centre for Policy Development and a Postdoctoral Research Fellow in the Centre for Medical Education Research and Scholarship, School of Medicine at The University of Queensland. A sociologist, he has for many years been active in policy debates and in social consultation. He has recently been researching and publishing on health workforce and health services.