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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

federalism supercharged « Previous | |Next »
August 3, 2007

Howard is back on his game the commentators say. You can see the grit in his eye as the Howard Government makes a health-funding takeover of the Mersey Hospital in Devonport, Tasmania. It shows that health care is more about winning elections rather than good public policy. It's a political winner in Braddon, but it's an electoral move that makes no sense in terms of strategic health planning. Indeed, it cuts across all the hard work and community consultation that has occurred in the context of the changing nature of hospitals and health care in the region.

The proposal is to establish a trust to rescue the hospital, funded by the Commonwealth but managed by the local community. We have the assurances by the Health Minister, Tony Abbott, that this is not a "power grab", but rather a necessary intervention to prevent the closure of a regional hospital. "Closure ' gives the game away as the Mersey hospital was never going to be closed.

federalism.jpg
Alan Moir

No one was informed of the commonwealth intervention. It had no connection to state health planning. It ignores health workforce shortages. It's a white knight approach that rides roughshod over months of planning to save the Mersey hospital despite declining intensive care admissions and an ageing population. Abbott says that this kind of intervention may be a model for the future.

Hayden Walters says that in terms of Tasmania's north-west coast, Tasmanians have been left the poisonous legacy of having two district general hospitals pretty close together (a 20-minute drive) with one at the Mersey (near Devonport) and one at Burnie. He adds:

Because of the realities of local funding and manpower constraints, neither hospital is adequately funded, adequately staffed, or adequately supported with technology and staff. Both have been marginally viable for some time. There have been seven external reports, usually produced at enormous cost, over the last 20 or so years, all of which have come out saying there needs to be just one viable and sustainable general hospital serving the north-west coast population (and the smaller population down Tasmania's west coast). In general, Burnie is probably the most suitable place for this but there has been a lot of argument between the communities and no consensus. AMA policy has been that the best way to proceed would be a new Greenfield site somewhere that everybody could agree on (probably Ulverstone).

The Devonport and Mersey Hospital has had enormous problems over the last five years or so in attracting adequate quality staff. Things have recently come to a head and the Intensive Care Unit had to be closed because of dangerous staffing levels.The emergency department is under huge pressure for similar reasons.

Walters says that the Federal Government could have been constructive and invest their $45 million a year to properly construct a single excellent acute general hospital for the north-west with good primary health care. Or different levels of hospital care--low care (rehabilitation and aged care) in Devonport, intensive level care in Burnie, and specialist care in Hobart.

| Posted by Gary Sauer-Thompson at 8:45 AM | | Comments (33)
Comments

Comments

Invasion and occupation is flavour of the month at the moment. It looks as though the States are going to be invaded and occupied by the Federal Government. What happened in Tassie is just a skirmish, a sign of things to come.

Will NSW and QUEENSLAND finally have a civil war instead of a football game?

I wrote about this today, too. At what point are Australians going to say enough to Emperor Howard and his band of merry men. What is it going to take to toss these guys out on their ear.

He alone seems to be able to ride roughshod over a well planned, sensible plan for health care in this part of Tasmania.

I lived in Braddon for twelve months - it is an interesting seat.

This is a disaster on so many levels. Long term, this just isn't sustainable.

There may well be votes for Howard here, but Baker is a dud member and his margin slim.

Strange isnt it. I was living in Melbourne when Jeff Kennett was in power.

Up until then there was an extensive state-wide network of community hospitals which altogether did an excellent job. They were created and sustained by all kinds of community inputs including Saturday morning fund raising cake stalls and sausage sizzles.

At one swoop Kennett & Co abolished the lot and sold off the prime real estate to his rent-seeking buddies.

And very much in the face of widespread opposition, even (or perhaps especially) in areas which were solidly middle class Liberal electorates. The Burwood Community hospital comes to mind---the various community groups, plus doctors etc, who were part of that excellent institution mounted a solid protest campaign against the closure of THEIR hospital.
They off course lost.

The government sets a dangerous president reopening Mersey hospital. The hospital didn't work as a private hospital with a Very experienced operator. Clearly it needs to be at least scaled down to a level that it is as close to being as viable as possible. The AMA's idea that the solution is to build another hospital somewhere in between is ludicrous and smells of their money tree mentality.
But still it is good for the area that the Mersey people still have their jobs and the ambulance doesn't have to travel that extra 20 minutes in emergencies.

Sorry Les, they will most probably have that extra ride anyway.

The biggest problem in Tas (all hospitals) is staff. They simply will not be able to staff Mersy adequately. If they do, they will be taking staff from Burnie.

Simple really - the state government was correct on this call. Burnie is the better site.

BigBob,
John Menadue, a former head of the Department of Prime Minister and Cabinet who now chairs the Centre for Policy Development, rejected the hospital takeover as politically motivated, dangerous and a waste of money. He said that:

Australia had too many hospitals. People expected too much from their health system and governments were unwilling to rationalise resources and risk antagonising voters. We cannot sustain the number of hospitals we have. We don't have the specialists and staff to man them. The understaffing of hospitals was one of a range of reasons why up to 10,000 Australians died each year because of avoidable mistakes within the health system. This [Howard initiative] will only intensify the problem. It leads to enormous waste and duplication.

Menadue said the answer was to replace small hospitals with community health centres that would refer people to larger hospitals as needed. And the commonwealth should seek direct deals with individual states prepared to pool health resources and work together under agreed frameworks.

BigBob,
I know little about the electorate of Braddon or the local Liberal member--Mark Baker. But the Mersey hospital can become a site for the delivery of rehabilitation and aged care services. Aged care and rehabilitation are very important services in an ageing population and rely on allied health care professionals not GP's.

The failure to work with the state government to reshape the delivery of health care services indicates a pork barrell. Abbott was talking in terms of closure (?) a population of 70,000 (?) on Radio National Breakfast and saying that staffing was not a problem.(?) The community hospital can just buy it in.

Buthen Abbott and Howard are not intersted dn health care reform. They are interested in the politics of health --negating the ALP.

So looks like Health is now an election issue again.
Well that will put Abbott in fron t of the camera's and divert a lot of attention away from Howard. Regardless of content Abbott is a trusted spokeman. It will be interesting to see if Rudd allows his Health spokeman to do the talking or do it himself. Whats the guys name anyway? Mac something? Ronald?

Les,
Re your remark:

Clearly it needs to be at least scaled down to a level that it is as close to being as viable as possible. The AMA's idea that the solution is to build another hospital somewhere in between is ludicrous and smells of their money tree mentality.

Mersey needs to be scaled down from an old fashioned crisis care type of hospital to a more community based one that provides aged care and rehabilitation services. If Tasmania has an ageing population, then the health services need to reflect that.

The AMA is arguing for crisis care hospital at Burnie--and if that location cannot be agreed to by the parochical locals, then one located between Burnie and Devonport.

From the comments I heard on Radio National this morning the expectations of the locals are rather high, given the shortage of staff in the region and the difficulties of attracting highly qualified staff to the regional Australia. Maybe there hasn't been an honest debate about the changing nature of hospitals and community care in the region.

Colin,
You are right. North western Tasmania cannot sustain two district general hospitals (one at Mersey and the other at Burnie) within 60km of each other. Several independent reports have recommended an amalgamation of the two to create one acute-care general hospital for the area.

However, Devonport and Latrobe residents have fought to maintain as many services as possible at Mersey.Consequently, neither neither hospital has had the resources or staff to enable it to operate efficiently.

Last year the state Government adopted a plan to amalgamate services at the Burnie hospital, which everyone in Tasmania, bar those in Devonport, agreed was a sensible development.

Enter Howard and his pork barreling.

The consequences? All the indications are that the quality of care at both hospitals could decline because both will continue to compete for the same numbers of specialist staff. Without sufficient patient numbers, each will struggle to achieve the economies of scale that a single district hospital in the area could obtain.

This does not improve the cost-effectiveness and efficiency of the health services, nor help turn different services into a rational health care system.

Howard's electoral strategy is clear. Buy marginal electorates with buckets of cash and dam the consequences.

I think this was a clear strategic maneuver to put health on the agenda.
Ok so what do we have to work with says the Coalition. The states are in charge of hospitals (Labor) and Labor is closing hospitals. No hospitals no beds, lots of unhappy people. The white night opens one hospital and gives hope to all others. So now the balls in Rudd's court to come out with a credible Health plan presented by a credible alternative Health Minister.
Now I wonder if the Coalition has a marvelous plan that the AMA will likely give support to waiting in the wings ready to go.
I reckon Rudd hasn't got many more Mee too cards to play.
I think it was quite a smart play by Howard. Game on!

Daniel,
another metaphor. Tony Abbott once described Australia’s health system as a “dog’s breakfast”. With the federal takeover of Mersey Hospital in Devonport, it appears that the current government is perfectly happy to go on making a mess feeding the dog – as long as it lives in a marginal seat.

Les,
re your comment:

Ok so what do we have to work with says the Coalition. The states are in charge of hospitals (Labor) and Labor is closing hospitals. No hospitals no beds, lots of unhappy people. The white night opens one hospital and gives hope to all others. So now the balls in Rudd's court to come out with a credible Health plan presented by a credible alternative Health Minister.

As Nan pointed out there was no intention to close the Mersey hospital by the state Labor Government. Nor did the reviews recommend that. It was not going to be an intensive care hospital because the specialised resources were not there.

To keep on saying "closure" about this is to spin for the Howard Government. Abbott is simply lying on this.

Politicians are liars! OMG! They arent are they?

The hospital will be downsized in 18 months time anyway regardless of which government we get. So what does it matter.

Hmmmm me spinning for howard. I have never voted for him or his friends so I dont think I will be spinning for them anytime soon.
I just don't see Rudd's mob as a better option.

Les,
downsize is different from closure.

"Downsize" also implies possiblities for possiblities for the hospital to become something different --rehabilitation and aged care-- in more of a system of health care.

In this case 'downsize' is not necessarily 'worse' as you imply.The health system needs to change and adapt to changing community needs.

When Howard and Abbott are saying the State government is bad they ignore all the planning that has been done to change the health care system so that it is not reduced to crisis care in a big general hospsital.

Gary,
wasn't it only a few months ago that the Treasury secretary, Ken Henry, privately warned his Treasury of the dangers of politicians going feral at election time. He remarked:

At this time, there is a greater-than-usual risk of the development of policy proposals that are, frankly, bad. Both the probability and the cost of policy error in the current environment is especially high.

The Prime Minister's throwing uncounted millions of pork-barrel dollars at a struggling hospital in the Tasmanian town of Devonport, which just happens to be bang in the middle of the knife-edge Liberal electorate of Braddon, is an example of what Henry warned us about.

yep, it's pork barrel politics. this is what happens when you let pollies run you. are you going to get up and take control of your nation? not likely.

Its not really important but if you re-read my comment that you re posted you will realise that I was making it as what a bunch of coalition fellows sitting around a table hatching a cunning plan.

I was not actually saying that I thought that labor was closing hospitals.

I was more emphasing the point that both major parties realise that the dumb people will decide the next government and will as usual lead them along by the nose ring to the ballot boxes with carrots and scare mongering.

But I am getting off the point. Yes health! Private health cover is the best defence against either parties germs.

Les,
It is probably less a strategy to put health on the agenda, as you suggest, and more a case of what Michelle Grattan is saying: the Howard Government is opening up an all-out war against what it is calling "Kevin Rudd's premiers".

Howard's Minister's have been accusing the Labor states of economic irresponsibility, incompetence and doing the Opposition Leader's dirty work. Everything that is bad in the country has been caused by the states according to Howard.

Nan,
A good description of politicians from Kenneth Davidson in The Age:

Their forte is politics, which requires a low, rat cunning to get the numbers, intimidate the opposition, accommodate the rich and powerful and gull the electorate that providing lots of oil for the squeaky wheels is all in the public interest.

He adds that the function of the bureaucrats has been politicised in the name of making government responsive and the game of politics has been professionalised but without the constraints, which kept the politicians reasonably honest in that they had to follow due process.

So we have decisive government. Davidson says that he understands decisive to be

taking decisions with a small cabal of ministers, backed up by business lobbies.... The business of these groups and individuals is essentially rent seeking and their stock-in-trade is influence peddling.Decisive governments, involved in cutting corners in order to satisfy myopic vested interests, are likely to have short lives, especially when it results in expenditures or structures that starve higher-priority infrastructure projects or resources.


Les,
Okay. Your comment was unclear cos I misread your perspective.

It does look as if John Howard will try and buy this election, marginal seat by marginal seat. Whilst Kevin Rudd floats high in the polls nationally talking about good policy Howard's strategy is a marginal seat buy-off, whilst increasingly, linking local interventions with a generalised attack on state government performance in the delivery of services.

Al,
I'm inclined to agree with Nan ---Howard's current strikes against the states is a means to derail Rudd's promise of delivering co-operative federalism based on good sound policies.

The coalition needs to attack Labor on many issues and ways to win. The wait till they shoot themselves in the foot time is no longer an option (at the moment). Haven't heard boo from the opposition member for health but I may of missed it??.
Haven't heard much from Wayne Swan either....The first week of Parliament with be a doosie. Better get some popcorn.

Les,
Parliament is back tomorrow. There is legislation on water and indigenous affairs, which the ALP supports but many members are uncomfortable with. The context is Costello's quotes about Howard's fiscal and reckless election spending.

The Labor states are proxy for Rudd. Swan has been out there hitting back at the Liberal's advertising attempts to blame the Labor states for any interest rate rises. He's talking about inflationary pressure and Costello's comments about Howard's reckless election spending.

It is John Brumby from Victoria that is more effective by pointing out that it is the states that are investing in capital and skills. They look economically responsible.

Les,
It is Rudd who has been doing the talking about health and Tasmania. He was on Radio National Breakfast this morning. He said that Howard has a deal for one of Australia's 700 public hospitals. So what is his plan for the totality of the hospital system for Australia for the future.

Yes Rudd is an eloquent speaker. But the government isn't just one man.
Australia has a right to have the potential ministers put out there to be judged.
Seems they have all been a bit quiet to me.
Why is Rudd doing all the talking?

Les,
same reason as Howard--it's the presidential style of Australian politics.

The state premiers have having a regular go especially around interest rates, as I noted with Brumby above. It's the co-operative style of Australian politics.

I would have thought that the conservatives in Queensland are preparing themselves for political slaughter. You could say they are 'Not Happy, John.'

I reckon the mood of the country has changed. They are concerned for the future of their kids. Co-operative federalism has some promise--unlike hostility, antagonism and conflict.

Gary,
re your comment 'I reckon the mood of the country has changed. They are concerned for the future of their kids.' Glen Milne has an op- ed in The Australian on this. Did you see it?

Milne says:

A new study conducted by the National Seniors, an organisation with 300,000 members aged 50 and older across Australia, the fourth largest lobby group for older people in the world. To be launched at Parliament House this Wednesday, the report, compiled by professional pollsters, Winton Sustainable Research Strategies, has surprised even those who commissioned it. Because what it shows is that apart from expected issues of concern, such as access to health services generally, the main worry of the ageing population is the future of the planet.

Milne comments that the greying population is turning green. This is a phenomenon that can only benefit Kevin Rudd, based on published opinion poll findings on which party is regarded as best to handle issues of climate change and the environment in general. It's an area in which Howard is still scrambling to find a toehold.

The National Seniors findings indicate that Howard would want to get a toehold to happen sooner, rather than later as an average of almost 40 per cent of Liberal voters say they would be prepared to change their vote on these global environmental concerns if Howard doesn't act.


Nana,
The AFR editorial--I'm in the Qantas Lounge waiting for a evening flight to start my fortnightly stint in Canberra-- says that:

The Howard Government's vision of how the federalism mess can be fixed is no more coherent than a Paris Hilton monologue on Californian justice.Ad hoc interventions seem motivated more by political opportunism than principle.

There is a despairing tone to the editorial.

Howard most likely can't win a one on one fight against rudd in a presidential style election unless new factors arise.
The coalition will need to draw the others in to negate Rudds power.
Its also time for the Nationals to earn their keep.

Les,
There is an interesting article by Philip Adams in The Australian on the presidential style of politics. He says we don't need a president.We’ve got one already.

Unprotected by a two-term limit, we’ve had president John Howard for 11 years. Building on the bad example of his predecessors, he’s happily downgraded the parliament and doesn’t hesitate to brush aside the cabinet system. Increasing power has been gathered into Howard’s hands, with local versions of Dick Cheney, Donald Rumsfeld and Condoleezza Rice (Peter Costello, Brendan Nelson and Alexander Downer) reduced to the status of Snow White’s dwarfs.

Adams adds that So Howard must have been concerned to see Kevin v Kerry on ABC TV’s The 7.30 Report last week. Rudd’s grasp of the detail was Nixonian - all those figures in his head - but his performance was closer to Kennedy’s. Cheerful, good-humoured and poised. Not a single um, ah or er, and certainly no five o’clock shadow. Like JFK, Rudd looked youthful and relaxed, turning the “me too” argument on its head by listing issues on which Howard has “me too’d” him. If he can remain focused and relaxed when he faces Howard in the heavyweight bouts, he’ll be a shoo-in.

Nan,
Adams ends the article with an idea that links up with Les's concerns that Howard most likely can't win a one on one fight against rudd in a presidential style election unless new factors arise.The coalition will need to draw the others in to negate Rudds power.
Adams concludes:

We’re preparing for arguably the most presidential election we’ve had: if not in terms of the personalities or the issues, then certainly in terms of the contenders’ styles and their parties’ tactics. Given the slump in president Howard’s personal polling - though it’s nowhere near as bad as the nosedive of President Bush - the Libs should change strategy, moving away from the presidential to emphasise local candidates. Even the ones we’ve never heard of. They’re probably the Libs’ only hope.

Sounds good to me.