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August 09, 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.
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Gary,
Jeff Richardson's article in New Matilda is good. The way he concludes is sobering:
Maybe this is the reason why Tony Abbott backed off and now talks in terms of a one off intervention.