N.S.W. (Australia) public hospitals: Health rebels' charter to save lives

More than 70 prominent doctors and nurses have joined forces to push for sweeping changes in the public hospital system. The rebels say many hospitals in NSW are unsafe, understaffed and dying because they are unaffordable in their current state. They say the problems are now so bad they are prepared to defy the State Government and force a public debate on the thorny issue of the viability of emergency departments in small hospitals.

The Hospital Reform Group, made up of some of NSW's most senior and respected clinicians, believes the Government has accepted the system is unsustainable but will not admit it for fear of a voter backlash. Today the rebels take their manifesto directly to the public, saying the public's expectations of health care have been unreasonably raised by politicians more intent on retaining seats than dealing with reality. Their plan to save the system requires drastic changes, such as a reclassification of jobs in the hospital sector and the possible closure of some small emergency departments, which will bring them into conflict with the public, the Government and the Australian Medical Association.

The rebels say bandaid solutions are no longer an option if hospitals are to provide safe and accessible services. One of their demands is the assessment of smaller emergency departments for either closure or revamping as GP-style care clinics, so resources can be better spread throughout the system. "We need to address unrealistic and unaffordable expectations with honesty, transparency and creativity. There is not enough money to meet the community's expectations of health care," their manifesto says. "The provision of all available hospital services in all areas of the state is no longer possible, or in the best interests of the community."

One of the rebels, Kerry Goulston, a gastroenterologist and emeritus professor at Sydney University, said: "We can't keep 35 emergency departments going in greater Sydney, staffing them as we think they should be staffed, and we have to tell the public that. Very few people have stood up and said, 'Hey, we have one of the best health systems in the world but it exists on the goodwill of the people working in it.' "

Another rebel, Brad Frankum, director of medicine at Campbelltown and Camden hospitals, said the public had to face reality. "The argument that 'we have had a hospital in that town for 100 years, we do not want to see it close' is really a sentimental argument, rather than one focused on caring for sick people. The reality of public hospitals is harsh; the over-reliance on locum staff is an unavoidable issue, and until there is political will to start moving resources out to the west and south and developing areas, we are better off not having a facility than having an unsafe, understaffed one."

The reform group says hospitals should be better integrated with primary and community care and other health services. Governments and health departments must also develop ways of stemming the steady flow of clinicians from the public to the private sector. The group says human resources are spread too thinly and too unevenly and that staff shortages are only going to worsen.....

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Is Big Brother planning to tag and track drugs?: "Since the federal government now is the largest payer for health care in the United States, it has the ability to coerce physicians into implementing anti-privacy practices they might not set up in a truly free-market system. Citizens should watch to make sure the federal government does not use its Medicare muscle to apply financial penalties to physicians who do not write electronic prescriptions. All told, a national mandatory (or coerced) electronic prescribing system would make it much easier for Big Brother to tag and track citizens' use of prescription drugs."

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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