Thursday, January 29, 2009

Hospitals Plan Futile Without Management Reform

Now that the crew of the good ship Titanic have finished squabbling over the choice of deckchairs and two new minister have been selected for the New South Wales Cabinet, can we please get back to the more important business of running the state’s health system? While the politicians have been busy out-maneuvering each other, the people of New South Wales have been left aghast at the unending reports of health and hospital failures.

The Greater Western Area Health Service has been making the front pages repeatedly for not paying its bills. Butchers, plumbers, medical suppliers, and now their own doctors have all been left without payment for unacceptable periods of time. The government has admitted that $23 million remains outstanding, despite the uproar since the problem was revealed last year. But it’s worse than that. Around the state the total for all Area Health Services comes to $117.5 million.

How any government can get away with not paying its bills is difficult enough to explain, but right now with the world in the grip of an unprecedented financial crisis, it is more vital than ever that government payments are made on time as part of the process of propping up the economy. Clearly, lack of adequate forward planning must be part of the explanation, born out by the revelation health is expected to be $900 million over budget by the end of March. So where has all the money gone? It’s easy to suspect that too much of it pays for the overblown and inefficient bureaucratic structure of the Area Health Services. And I wonder how many of the desk jockeys have been left waiting more than six weeks for their wages to be paid, like the specialists at Dubbo have.

The Premier, having finally sorted out his ministerial lineup, has presented the Prime Minister with a request for $2.5 billion to rebuild major hospitals around the state. It is certainly a proposal which would fit the bill in so far as providing infrastructure investment to boost the economy at the same time as modernizing the stat’s hospitals. But there are two big questions which would have to be asked.

Firstly, even if the money is forthcoming, what is the guarantee that the project will be delivered as promised? The New South Wales government has broken so many promises that no one believes anything they say anymore. Secondly, if the new facilities are built, what then? Where will the doctors and nurses be found to staff these facilities? And if they are found, how will they be paid? Unless the problems besetting the health system now are resolved now, spending billions on new hospitals will be futile.

Yes, the plan to rebuild our hospitals is a good one, and if it goes ahead it will do so over a period of time stretching beyond the next election. But how many other good plans have been announced by this government only to never see the light of day? More pressing is the matter of managing the facilities we have now, and on that score current efforts have been an utter failure. That’s why reform of the bureaucracy is the most urgent priority.

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