Monday, February 08, 2010


Red News Readers,

Having been in the health system a very long time, I take a jaundiced view of promises for more funding for community based services. There have been several attempts at this over the last 40 years with some initial success, but as soon as economic circumstances change, it is community based services that take the cuts to services and staffing levels first, and usually without much protest, as it is an area that unions find hard to organise into activity. Health bureaucrats mouth platitudes about their commitment to community based health and mental health services but they don't like the autonomy of the services and the practitioners in them and they certainly don't like community based services that overrun their budget, hence the latest move over the last couple of years, placing community health and mental health under the operational control of hospitals. It all seems to go around in one big cycle!

Jenny Haines

States push back against national hospital takeover


February 8, 2010

THE federal government appears increasingly unlikely to seek a mandate to take over public hospitals, as a revamp of community health and GP services instead moves to the centre of the national health reform agenda.

The Prime Minister's pledge before the last election to seek a federal takeover of public hospital funding if the state governments failed to fix them before the middle of last year is being undermined by state resistance.

Having injected an extra $20 billion over five years into public hospitals, the federal government faces a growing campaign to expand primary care in the community provided by doctors, nurses and other health professionals. This is being seen as a more practicable way of reducing the pressure on public hospitals, whose defenders say they have been hit by crises because of years of inadequate funding.

Last week the Health Minister, Nicola Roxon, repeated the threat of taking the issue of a federal health takeover to the election or a referendum if the states failed to join the government's health reforms.

But yesterday the Victorian Premier, John Brumby, dismissed any notion of a federal takeover. His view is also shared by the NSW Government. Both states say, however, they want to see a co-operative arrangement to dispense with blame-shifting and cost-shifting, which blights health administration.

A recent top-level meeting between NSW and federal government representatives is believed to have focused on a restructure of primary healthcare services, electronic health records and workforce issues, rather than a wholesale takeover of public hospitals.

Under the proposals, being driven by federal treasury and the Department of the Prime Minister and Cabinet along with the Department of Health and Ageing, general practitioner services - now paid for by the federal government - would be integrated with state-funded community health services.

The resulting services could either be directly funded by the federal government or in a state-federal partnership, would give doctors incentives to work in a team, and would aim to reduce the number of people admitted to hospital because of inadequate treatment of a long-term condition.

Australians are 20 to 30 per cent more likely to be admitted to hospital overnight than people in Britain or US, according to the Australian Institute of Health and Welfare, which says 9 per cent of all hospital stays are potentially preventable, involving complications from diabetes and other chronic illnesses.

Electronic health records, to support integrated GP and hospital treatment, also figured prominently in the discussions, along with planning for the expanded health workforce needed to handle increasing disease in an ageing population. State-run public hospitals argue they need more federal support to accommodate a massive influx of inexperienced new doctors, nurses and health workers.

The talks also canvassed increasing performance-based health funding to states.

The federal government has continued its predecessor's policy of tying large grants to reducing emergency department and elective surgery waiting times and hospital infections, in a strategy which increases the federal control over public hospital priorities while avoiding administrative responsibility.