Wednesday, October 24, 2007

Lance the bloated beast of hospital bureaucracy

Even better to abolish the bureaucracy altogether and send the money direct from the Treasury to the hospitals. Comment below from Australia

In another bout of me-tooism Opposition Leader Kevin Rudd has picked up John Howard's proposal to encourage retired nurses back into the public hospital system by declaring, yet again, whatever you can do I can do better. Confronting the chronic shortage of hands-on nursing staff in the country's public hospitals, a problem encouraged by the introduction of university training for nurses, Howard has announced plans to establish 25 hospital-based training schools for nurses. Howard has also foreshadowed plans to replace state government management of the 750 public hospitals around the country with community-based boards - something that Rudd has rejected, claiming it will add another tier of bureaucracy in the system.

This is rubbish. It is in fact what is urgently needed to attack the bureaucratic monster created by the state Labor governments which is sucking the life out of our public hospital system. It is a sad fact that only about one in six people employed in the public health system is engaged in face-to-face patient care. The bulk of the remainder are involved in what are essentially administrative areas. Hospital funding needs to be directed away from the back office staff and towards the areas where it is needed most - direct patient care.

You can see where the money goes when you look at the plethora of bureaucratic bodies that administer public hospitals in NSW alone under the state Government's Health Department. The charter for these Area Health Services sounds simple - even altruistic: to keep people healthy; provide the health care they need; deliver high-quality health services and manage these services well; and to provide sound resource and financial management with skilled and motivated staff, and so it goes on. Pity it's not working.

And it will be interesting to see if the parliamentary inquiry into a string of patient care and administrative crises at Sydney's Royal North Shore Hospital, which the Iemma Labor Government has reluctantly agreed to hold, will address the real problem of a bloated and dysfunctional bureaucracy. Royal North Shore is one of 20 hospitals situated in the area from Sydney's north shore to the NSW central coast covering a population of 1.3 million. These are administered by the Northern Sydney Central Coast Health Service, which is one of eight similar health service administrative bureaucracies overlording all public hospitals and health care facilities in the state through a complex web of sub-services and committees.

The NSCCHS has a 50-member executive structure operating under a chief executive, with a total staff, including casuals, of 15,700. The 2005-06 annual report by the NSCCHS gives an insight into how this bureaucratic system staggers along in the state. It is clear that an enormous amount of time is spent in strategic planning to identify areas of need and improve efficiencies through seemingly endless reviews. But to what end? For example, detailing its workforce strategies, it says, in part, that it was unlikely the medical and nursing workforce would be enhanced significantly in the next five years. And the report shows that about 35 per cent of emergency department patients had still not been admitted to a hospital bed within eight hours of active treatment starting.

In pointing to a major challenge in clinical sustainability the report acknowledges "a lack of critical mass" in a range of services offered at many acute facilities such as intensive care, emergency services and maternity. It goes on to state that this situation "has the potential to produce many undesirable effects such as inefficiencies, quality and safety concerns, unsustainable rostering demands for current staff and insufficient volumes for teaching purposes". It seems to have concluded that the best way to address this was to instigate a five-year review plan.

But as one senior specialist told The Australian this sort of approach to the crisis in public hospitals was like sending a fire engine to a burning building and then initiating an inquiry into how the fire started before rescuing those trapped inside. Another specialist recounted the story of a senior nurse in a NSW baby health care centre who wanted to change one line in a brochure given to new mothers to make it more intelligible. The process took 12 months and was the subject of innumerable conferences and committee meetings before the change was finally agreed to.

Rudd, like Howard, has identified the extent of the hospital crisis. That is why he announced plans on Friday for a federal Labor government to spend $600 million to help reduce the waiting list for elective surgery in public hospitals. But simply pouring more money into the hospital system in the fond hope that it will go where it is needed it is like filling a bucket full of holes: it's an endless and pointless process. And by the time these funds have gone through the administrative sieve there is not enough left to maintain the sort of health care standard the community deserves.

Howard's move to restore the traditional system of individual hospital boards is a sound start to dealing with waste and mismanagement which has flowed from the over-bureaucratised structure of hospital administration established under the Labor state governments. If the Liberals and Labor are serious about addressing this disgraceful waste of tax dollars and resources they should commit to a national audit of public health care spending to identify where the areas of greatest need are and make sure that commonwealth funding is not sidetracked away from these.


Australia: Leftist State government blames hospital boss for keeping the doors open

They say he should put his budget first, not patients

The boss of the Princess Alexandra Hospital said it was overworked as he slammed Government claims his overspending had led to crucial patient services being cut back. As Premier Anna Bligh yesterday blamed clinical chief executive David Theile for bed and waiting list closures, Dr Theile sent an email to staff explaining how they were recently praised by Queensland Health for efficiency and performance. He said the PA had handled trying conditions "extremely well" in recent months, frequently saving southeast Queensland's health system from "crisis".

A budget blowout over the first quarter forced 40 of the hospital's 892 beds to close and 10 per cent of operating theatre procedures to be cancelled. "For an increased expenditure of 2.1 per cent, we delivered 7.8 per cent more crucial clinical services," Dr Theile said in the email obtained by The Courier-Mail . "When all others were on bypass, we kept our doors open by ad hoc setting up of beds in radiology and theatre recovery. "Please be assured of my pride in this organisation and its achievements, and continue to deliver with the same professionalism in these times of restricted activity. "The administrative efficiency of our delivery has been acknowledged by Queensland Health."

The revelations come less than a week after Ms Bligh praised the progress of the Government's $10 billion health action plan in State Parliament. In a thinly veiled swipe at Dr Theile yesterday, Ms Bligh rejected more funding for the hospital, saying taxpayers were "entitled to see strong management ensuring that budgets are maintained". "The PA, like every other hospital, has to live within its budget," Ms Bligh said. "The PA Hospital budget this year has increased by $33 million. That is a very significant increase that will buy extra and additional services."

The war of words comes after the Government blamed Dr Theile on Friday for the closures. Acting Health Minister Rod Welford distanced the Government from the overspending, saying the PA was managed by a clinical chief executive and not a bureaucrat. "The decision about managing the work flow of surgery is a local hospital decision made by the most senior medical officer in the hospital, the CEO," Mr Welford said.


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