Commonwealth Control of Hospitals


LOANE:         Well the Premier painted rather a grim picture of the future, one that we've heard before of course, but he talked about that huge bubble of baby boomers moving on into old age, and costing the Sates and the Commonwealth billions more in health costs, as we all live to around 100.  He says it's time for a radical new plan, money has to be saved somehow.  And he says the only way we can do that is to completely rip out duplication of bureaucracy, so that the Commonwealth should take over health in its entirety while the Sates take over education. 

Now you can bet that Bob Carr has done his sums, health will undoubtedly cost more than education into the future, we're having fewer children but we're living longer.  Now the plan has yet to be given the thumbs up by either Tony Abbott, the Health Minister, he's on leave at the moment, we did put in a call to him but he's away.  The other Premiers, I'm not sure how they've responded this morning. 

                        But joining me on the line is the president of the AMA, Dr Bill Glasson.  Bill Glasson, good morning and welcome.

GLASSON:    And a good morning to you, how are you?

LOANE:         I'm very well.  What did you think of Bob Carr's plan?

GLASSON:    Well I mean I think it's exciting in the sense that we're talking about it Sally, and talking about it in the sense of actually trying to get a solution.  And I think when the - you know, like the Premier of New South Wales stands up on this issue and makes a strong point about it, I think it's a good sign that we want a solution.

                        And I think that if Tony Abbott can be reappointed as the Health Minister, and I plead for the Prime Minister to do that, I think we've got a great opportunity to make a difference.  Now if you said to me, "Just because we have a single funder, is this going to take all the problems away"?  No it's not, OK, it's going to have some cost savings in one sense, but I just hope we don't double the Commonwealth bureaucracy in the other sense. 

                        Having said that, and I plead to everybody involved with this, let's look at the medical model we need first, don't look at the money, let's look at what we need to deliver the services to the ageing population of Australia, and that is really rebuilding our primary care around our GPs, our nurses and the community care nurses particularly.

LOANE:         So that people don't end up in emergency areas of hospitals for something minor.

GLASSON:    We actually have to prevent them going to hospital in the first place, in other words identifying these people early in the phase, and saying, "Mrs Jones, we don't intervene if you're going to have a fall", and that's one of the commonest reasons for these people ending up in hospital.  Keep them in their home, that may mean a nurse dropping in a couple of times a week, it may mean a carer dropping in, whatever.  But that is far cheaper than paying $900 a day for someone to sit in a public hospital bed where that may not be the most appropriate place for them.

LOANE:         Has anyone put forward some sort of prototype for a medical model for a Commonwealth - you know, a medical model?

GLASSON:    It's interesting, we're doing a lot of work on this right as we speak actually, and I've said to the AMA that one of your responsibilities is really to develop a model that we think is acceptable, and that really meets the needs of the ageing community, to make sure that you have been treated in the most appropriate facility.  Now that may mean a public hospital bed, but it may just as well mean your bed at home, it may mean within the community, it may mean the aged care facility. 

                        But the other I suppose parameter we're not talking about much is this sub-acute care.  Now sub-acute care, you think of as transitional care or interim care or whatever, but it's all about rehabilitation, it's all about getting people and saying, "Mrs Jones, we can fix you up now, we can keep you in your home which will stop you having a fall", et cetera, et cetera. 

                        So we have to develop all those interfaces, and if we do that properly, then we can go back and say to Tony Abbott and all the Health Ministers, "Well look, this is the sort of money we're going to need, this is where it comes from, and this is where the buck stops.

LOANE:         You know Tony Abbott pretty well, do you think he would embrace an idea like this?

GLASSON:    Yes I do, in fact I think he's very progressive from the point of getting some change.  I think he's desperate to get change, and I think if we can continue with him as the Health Minister, I think we have an opportunity to really make a big difference.  And so I plead for the Prime Minister to make sure that we reappoint him and if we do then I think that we can get all the states together, take off their political hats and say, "Listen, we've got a problem with health, how can we actually fix this once and for all"?  Because we are getting older, we're all going to live to 100, certainly our children will anyway, and as you said, we're not having children at the other end, so I think we've just got to be sensible.  And I don't think necessarily it means a huge - it's not going to need a lot more money, well it will be if it's spent properly and spent effectively, it's in fact - it should be a saving to the community, not a net loss.

LOANE:         Yes, well Bob Carr's saying it should be saving because it'll cut out so much of the duplication, because there's a huge amount of bureaucratic duplication between the states and the Commonwealth isn't there, in health?

GLASSON:    There's about $1 billion at least, Sally.

LOANE:         A billion?

GLASSON:    A billion dollars we could pull back out of duplication.  And you know, when you work in the systems it drives you crazy with sort of the shift from Commonwealth to State, State to Commonwealth, playing these games, they've got people sitting up there who - it's all they do is play these games shifting money, and it drives you crazy.  But if we get rid of that, that would be nice, but having said that we don't want to develop a bigger and bigger Commonwealth bureaucracy either, because I keep saying to give the money to the grass roots, let the doctors and nurses deliver the services.  That's where you get the gains.  But if you've got this big tree filtering from the top to the bottom, by the time it gets to the bottom there's about 10 cents in the dollar left for the patient.

LOANE:         Yes, you don't want to just have a giant bureaucracy twice the size of the one that's already in Canberra.

GLASSON:    That's the worrying thing about having one system, we end up saving a billion on this side and costing us $2 billion on the other side.

LOANE:         Yes.  I mean do you know whether the other States are thinking about it?  You're in Queensland, has Peter Beattie ever floated this?

GLASSON:    No, not at this stage, but I think they've obviously got problems up here, all the states have got problems with their public hospitals, in the sense of the demand that's on them, they've just got this uncapped demand and they just can't meet the needs, and so the rationing occurs, which will always occur, that rationing hopefully should be fair.

                        But having said that, we do not have enough public hospital beds to meet the needs of our population at the moment, and in the short term that's where we've got to I suppose deliver some resources.  But in the long term the resources have to go into the community, and that's around our GPs and private care.

LOANE:         Yes, Bob Carr was saying that the problem at the moment in New South Wales, he went to visit I think an emergency section of a hospital and he saw people there who had, you know, a swollen knee from soccer, there were no GPs open, they didn't bulk bill, so people were just turning up in hospital emergency departments.

GLASSON:    The big issue we keep talking about is our workforce.  We actually have got very few doctors out there, it's going to get worse, I believe, until it gets better, and so it's the medical workforce across the board, doctors, nurses, we don't have nurses in hospitals, we can't get them, and so we're struggling with resources.  Now we're desperately trying to get overseas trained doctors and nurses, but that's not the solution, we have to train our own.  But having said that, it'll take 10 years to actually get the numbers we need.

LOANE:         Yes, the labour shortages again mentioned last night in nursing is huge, and they've just had a second big pay rise too, so it's going to be interesting times.

GLASSON:    Well it will be Sally, it will be interesting how the whole nursing arena I suppose, gets rejigged, because we just do not have enough nurses in theatre, in the wards, and in aged care we're desperately short of nurses, and we have to rebuild our nursing and our aged care facilities because I believe again, if you medicalise aged care facilities, in other words give a much higher level of medical care, that will again stop the need for these people to go to public hospitals, they can be treated in an aged care bed.

LOANE:         Yes, and I guess the whole question too comes around to preventative as you were talking about, trying to keep - you know, allow people to lead healthier lives at home.

GLASSON:    Absolutely, because one of the biggest reasons our aged population end up in hospital is because of falls, and therefore we need to go into their homes, identify how we can sort of rejig their home, keep them in their home and prevent this occurring.  So a lot of prevention strategies need to be put in place around our aged population, and that can save us a huge amount of money.

LOANE:         Just following on from Bob Carr's idea, would you say it'd be a good idea for all the State Premiers or Health Ministers plus the AMA, plus Tony Abbott, to get together on this?

GLASSON:    Look, very much so, I mean I went to the last AHMAC meeting, the Australian Health Ministers' meeting in Tasmania, and there was a lot of good will then, with all the State Health Ministers and Tony Abbott, and I believe that Tony Abbott's got a huge amount of respect from the likes of Bob Carr and people around the country, to actually be able to deliver something, and we do need someone who is actually a change person.  My concern is that if Tony Abbott's not reappointed we'll get somebody who's - you know, will take 12 months to educate, and they won't pick up that change mentality and we'll go back to the drawing board.  So I think we do have - the AMA has to drive this with the Commonwealth and the States, to actually deliver what the Australian people need.

LOANE:         Yes.  Thank you very much for your time.

GLASSON:    Thank you very much Sally.

LOANE:         That's Doctor Bill Glasson, federal president of the AMA endorsing Bob Carr's idea that the Commonwealth do take over all responsibility for health to, as he said, save about $1 billion just straight off the line in duplication of bureaucracy.  But the fear of course is replicating the State bureaucracy in Canberra, which we don't need.  But it would be good wouldn't it, because this I think is the big issue, the one that we're all facing, the aging issue, the health costs into the future.  Big one for States and the Commonwealth to tackle.


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