22nd Feb 2011
I have to admit to a frustrating sense of déjà vu with the recent COAG reform discussions.
The Commonwealth-State relationship is like many dysfunctional relationships. Some of the danger signs that you are in a dysfunctional relationship are:
• Your needs are not met in one way or another
• Being there is not what you want but you are afraid to leave
• It seems there is always something to fix in the relationship
• One partner holds most of the power.
It seems like forever that we have been hearing about attempts – feeble and more robust – to sort out the quagmire that is the Commonwealth-State arrangement which attempts to fund and govern our health system.
There was a brief glimmer of hope when Kevin Rudd came out guns blazing declaring a determination to clear this up or else. But all to no avail.
So dysfunctional it remains, but I suspect that this unhealthy arrangement is here to stay as there is a good reason why a relationship like this is kept dysfunctional. It means there is always someone else to blame for any inadequacies or problems.
The Prime Minister Julia Gillard made the most of a $16 billion “handshake, in principle but short on detail” deal. That in itself has an ephemeral air about it which sets off my bullshit detector. And it speaks volumes that the Health Minister Nicola Roxon was nowhere to be seen either on the day or in the announcements that followed.
The proposed COAG reforms are supposed to deliver new beds, relief for waiting lists and local control. It’s anyone’s guess if any of these outcomes will actually happen once the Premiers and (eventually) any actual hospitals get to see any detail, let alone any extra funding.
How could there be a hope of anything more than tepid agreement from the Premiers on the day? For a start, the briefing proposal went out on Friday for a Sunday meeting. No state health bureaucracy could hope to decipher the implications of a complex funding change in effectively 24 hours.
Especially when it came with the prospect of yet another layer of bureaucracy and red tape to administer a proposed new national pool of hospital funding.
Previous attempts at health system reform so far have not exactly been a raging success.
‘Medicare locals’ carries no proof that they will deliver more for primary care or patient outcomes.
The admission that GP super clinics were rolled out before any analysis was done about existing GP services in these areas shows an alarming trend to ideology before practicality or fiscal responsibility.
And what happened to the promised preventive health agency? Lots of rhetoric, but where is the action?
A large problem is the chronic malaise that is the Commonwealth-State relationship. I wonder what this all means to our patients, to our ability as GPs to provide best practice primary care and facilitate timely and high quality hospital care. More importantly, how will these proposed reforms help keep our patients out of hospital by keeping them well?
I see nothing in these announcements for general practice and broader community-based primary care.
And yet therein lies the only long-term answer to the much larger question about the future of next-generation public health and healthcare delivery.
Professor Kerryn Phelps
GP, Conjoint Professor, Faculty of Medicine, University of New South Wales
