Hospitals crippled by poor planning

Australia's public health system shows total lack of foresight

NSW's health system is groaning under the weight of bad management and poor planning, with a doctors' group warning of increasing discontent among staff in public hospitals. An Australian Medical Association survey of 632 visiting medical officers found bureaucrats had failed to plan for the impact of an ageing medical workforce, especially in regional areas. The NSW president of the association, John Gullotta, said the survey painted a picture of a rural medical workforce nearing retirement. "The average [visiting medical officer] in regional and rural NSW is in his or her early 50s ... but [the health system] is not planning for that reality," Dr Gullotta said. "The survey shows that the state's most senior doctors are extremely dissatisfied with the standard of planning, management and quality initiatives - there is a clear need to prevent additional senior doctors leaving the public hospital system out of frustration and to encourage doctors to pursue a career outside the big cities."

The association wants hospital management to be held accountable for its performance in areas such as cancellation of elective surgery lists, access to theatres, training and retention of junior medical staff and access to beds. "The cancellation of elective surgery lists is a deceitful method used to meet budgets," Dr Gullotta said. "Dedicated elective surgery lists must be established that are not affected by demands in other parts of the hospital." The association was also critical of the newly amalgamated area health service model, which is to be run by advisory councils - a move that doctors say will further undermine their role in the public health system.

However the NSW Health Minister, Morris Iemma, rejected the association's criticisms of the health service model, saying doctors had had significant representation on each of the health advisory committees, guaranteeing clinician input. He acknowledged that the cancellation of elective surgery lists was a source of frustration for doctors, pointing to a committee of prominent surgeons that had been reviewing the provision of surgical services. "In any and every event, emergency surgery will always take precedence and that will always lead to some elective surgery being displaced," a spokesman for Mr Iemma said.

The committee, headed by the director of surgery for Wentworth Area Health Service, Patrick Cregan, will release its findings on December 11. It is expected to recommend that area health service management overhauls its planning processes and stops using the cancellation of elective surgery as a way of managing budget blow-outs. Mr Iemma also warned that the country was "sleepwalking its way into a medical workforce crisis", brought on by the lack of places for medical and nursing graduates in universities. Mr Iemma said the blame lay squarely at the feet of the Federal Government.

But Dr Gullotta said that unless the NSW Government took action the crisis would worsen. "There are already 70,000 on the elective surgery waiting lists, if we leave it longer we are going to have no workforce and a waiting list topping 100,000," he said.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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