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

health governance, Howard style « Previous | |Next »
August 9, 2007

Jeff Richardson, a health economist and Foundation Director of the Centre for Health Economics at Monash University, is critical of the Howard Government's $45 million intervention in Tasmania to "save" the Mersey Hospital. As we know the Lennon State Government, after a second review of services had announced in May that the Mersey would not close. It would lose its intensive care and many specialist surgery units and be downgraded to an elective day surgery and rehabilitation centre. Richardson comments:

The state plans were to add aged services, renal dialysis, rehabilitation, a 24-hour emergency centre and high-speed ambulance services to nearby Burnie. Many small population areas in Australia have a far inferior service...Howard's intervention will cement in place a system in which adverse events will flourish and in which Tasmanians will die unnecessarily. First-class specialists seek to practise in centres of excellence and it is hard for Tasmania to achieve these even in Hobart and Launceston.

In 2004, he undertook a detailed study of the Tasmanian health system in which he recommended a scaling back of complex procedures in smaller country hospitals because they couldn't get the specialists with the necessary skills and experience to perform such procedures safely. Even if they could, the population of north-west Tasmania is too small to generate the clinical workload to keep their skills honed to world standards.

The study recommended that one large, not two small hospitals in North West Tasmania should provide comprehensive specialist services. This would allow the delivery of safe world class, not second class, specialist services.

It's not just a case of skilled staff being flown in from time to time. We also have the problem of adverse events--- mistakes which would not have occurred in a higher quality system. Richardson refers to a study in 1995 on quality of health care in the Medical Journal of Australia that estimated that at least 10 per cent of hospital admissions are associated with an adverse event including up to 9000 unnecessary deaths annually. He points out that:

these events are not primarily the fault of doctors (who make mistakes like all of us) but of systems which have not been properly designed to avoid errors and which force doctors to work in unsafe hospitals.

So there is a danger that adverse events would continue in a "saved" Mersey hospital. Richardson says that for political reasons, it is unlikely that Burnie specialist services will be trashed. It is more likely that two hospitals will be allowed to struggle for existence, providing second class medical care as in the past — thus ensuring the continuation of adverse events.


| Posted by Gary Sauer-Thompson at 2:24 PM | | Comments (5)
Comments

Comments

Gary,
Jeff Richardson's article in New Matilda is good. The way he concludes is sobering:

The governance structure announced for the Mersey Hospital could not set a more damaging precedent. The announced partnership between the Commonwealth and the hospital makes the Mersey immune to the effects of future State planning. Tasmania will have to plan its medical workforce, spending, emergency services, bed supply, primary health care around whatever the Mersey chooses to do. Unnecessary technology in the Mersey will breed discontent and pressure elsewhere.According to the Prime Minister these fortified bunker hospitals may spring up across Australia adding to the funding and service confusion which currently characterises Australia’s Health Non-System. Two standards of public hospital will emerge — Commonwealth and State — each seeking to demonstrate their superiority at the time of the relevant election and forcing the other constituency into competitive spending. The explosive costs of a US-style hospital technology race is a likely outcome.

Maybe this is the reason why Tony Abbott backed off and now talks in terms of a one off intervention.

I understand from elsewhere that Howard actually encouraged Lennon to close it.
Fancy Lennon being on the sharp end of a knife for once. And there is only one person we know of who could have been so utterly unprincipled as to, Iago-like, wield the blade.
As far as Tasmanians go, this time the writer goes along with the saying that a people gets the government it deserves, regardless of any subsequent criticism and despite in this cases the reward for inbred idiocy being at both state and fed, which is a hard burden.
( Yes... it's not just New Zealanders, is it!?.. at least with them its only woolly four legged...)

Paul,
In Question Time today Tony Abbott said that the state government had refused to allow the clinicians to meet with the commonwealth bureuacrats and Abbott.

If they did, Abbott said, they would lose their jobs.

The government should look to wards doubling the number of ambulances in Australia. Being in the back of a well equipped ambulance with a well trained operator with support from a major hospital is better than being in the emergency ward of a poorly equipped under staffed regional hospital

Les,
I agree. You can have a helicopter as an ambulance that takes you to the central regional hospital.