If there was one issue aside from privatisation that doomed Anna Bligh’s government to defeat, it was healthcare. Health had been a running sore for successive Labor administrations in Queensland. If it wasn’t the spectacularly expensive payroll bungle, it was the revelations, aired in a royal commission and successive criminal trials, of alleged criminal malpractice by Jayant Patel, nicknamed “Dr Death”. Or it was a self-styled Tahitian Prince living it up on embezzled millions.
Add that to the usual pressures on a public health system and you have a toxic mix. Bligh herself gave credence to the salience of the issue by promising to “blow up” Queensland Health. (Although arguably she was onto something, as the bureaucracy is notoriously cumbersome and unresponsive.)
Now the Campbell Newman government finds itself in an epic fight with public hospital doctors, a fight it cannot win in the court of public opinion if we go by recent polling. Doctors are being asked to sign new employment contracts by April 30. All indications are that mass resignations from the public system are being contemplated.
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Newman and the Liberal National Party claim to be acting on the advice of the Auditor-General, who raised concerns about private practice arrangements for salaried specialists. Many doctors argue that the “rorts” were a consequence of an ill-designed scheme by the former government to retain staff. It’s crucial to understand that unlike other states, many of Queensland’s public hospital doctors (particularly in specialties like anaesthesia) are employees rather than visiting medical officers.
Very little rationale has been offered publicly about the shift from award and enterprise agreement-based employments to individual contracts, and it’s not clear that it’s a necessary consequence of the deficiencies in accountability and remuneration identified by the Auditor-General. The contracts, read in conjunction with changes to the Industrial Relations Act, deny salaried doctors unfair dismissal protections, control over work location and timing of shifts, and require doctors to take direction on appropriate medical care from hospital and health service administrators.
The suggestion is that, having failed to find private operators for public hospitals that could actually provide cheaper services, the government’s agenda is to substitute bureaucratic cost controls for clinical judgement. That’s something the federal policy shifts towards paying hospitals for the “efficient price” of a procedure encourages.
Unsurprisingly, doctors are up in arms. The Queensland Health Director-General was affronted by being presented with a pineapple at a public meeting (the protesting doctors are calling themselves the Pineapple Group, after meeting at the Pineapple Hotel), Health Minister Lawrence Springborg has been loudly decrying “interstate union thugs”, and now the government is taking legal action against unions for “deceptive and misleading conduct”. Assistant Health Minister Chris Davis, a former Australian Medical Association president himself, has barely been corralled within the government’s ranks. The AMA is running TV ads, the Facebook “Keep Our Doctors” page has 8846 likes, and on Tuesday night, doctors rallied along with other public servants outside Parliament House.
None of this is a good look for a government that recently lost the Redcliffe byelection to Labor with a massive swing. Polling conducted by ReachTEL for the Australian Salaried Medical Officers’ Federation in Ashgrove (the Premier’s seat), Cairns, Ipswich West and Mundingburra shows massive public opposition and significant impacts on the LNP’s vote. Newman would easily lose his seat to the ALP on these numbers, and it could be reasonably inferred that the LNP’s majority would be in danger. (It would be fascinating to see polling in seats higher up the pendulum).
Perhaps most inflammatory is the Premier’s suggestion (on which some hospital and health services are reportedly now acting) that interstate and overseas doctors will be recruited to replace specialists. There’s also talk of contingency plans to pay private hospitals to provide services for public patients, an objective in any case common to the state LNP and federal Coalition governments.
The Newman government faces a potential meltdown of the public hospital system in May. While Springborg has given some ground in negotiations, taking the system to the brink of disaster in a dispute with a profession overwhelmingly trusted by the public is hardly a savvy “crash through or crash” strategy. And this from a government that’s found it hard enough to successfully demonise bikies.
Meanwhile, in pursuit of its new focus on consultation, Treasurer Tim Nicholls has been touring the state touting the benefits of privatisation. It seems that memories are short in George Street.
*Dr Mark Bahnisch is a fellow of the Centre for Policy Development. He has covered several Queensland election campaigns for Crikey and has worked in health policy and health professional education since 2010. He blogs at The New Social Democrat.