‘Economic reform’ gets blamed for many things. I heard someone complaining about growth at all costs, they then segued into its costs on the environment. Then we had the greenhouse effect and the poor person couldn’t help themselves and went on to wonder about the tsunami. Dear oh dear.
In any event for a long time there’s been a gung ho tendency in economic reform in which ‘private sector’ methods are seen as inherently worthy and better than public sector methods, ignoring the different circumstances in which the two sectors have evolved their own approaches to things.
Sadly the Cassandras who are nevertheless enthusiasts for reform properly done (like me and a few others) don’t get listened to too much and things roll along. In fact poorly designed reform rolls along and what begins as corners being cut turns into downright rorts. But things only come to a head (it seems) when they become worse again, and turn into outrages. Whereupon the media who have been soft-pedaling the issue rearrange their posture into one of righteous anger.
One recent example is the way in which the Cross-Sydney tunnel turned into something like a tax farming scheme. And the Review of Queensland Hospitals has turned up another example, where ‘case-mix’ type funding led to a cost cutting mentality not itself necessarily a bad thing, but obviously a bad thing if implemented without adequate regard for safety and quality of treatment and a bunch of other safeguards. Even allowing for the likelihood of a bit of a simplistic approach to the issue from the Commissioner, his comments seem pretty telling.
Some excerpts follow beneath the fold:
1.18 Notwithstanding the isolation from scrutiny that Dr Patel was able to achieve, it may now seem astonishing that the number and seriousness of the complaints against him did not cause either Dr Keating or Mr Leck to institute some thorough independent investigation of his conduct, at the latest by the end of October 2004. But their failure in this respect becomes less surprising, although no less reprehensible, when it is seen how they saw their role of running the Hospital, and where their priorities lay.
1.19 In the first place, both saw themselves as running a business of providing hospital services. They were not solely at fault in this for that is how Queensland Health officers also saw their role. Indeed, the terminology used was that Queensland Health was ‘purchasing medical services’ from the hospitals and that patients were ‘consumers’ of these services. The hospital budget was fixed on an historical basis, that is based on that of the previous year, with an additional incentive payment based on elective surgery throughput. Up until quite recent times it also provided for a small percentage reduction from the historically fixed budget on the assumption that improved efficiencies would enable that to be achieved. In other words the budget was fixed as if the hospital was running a business of selling goods or services. Patient care and safety was not a relevant factor.
1.20 There was a strong incentive to Mr Leck, and consequently to Dr Keating, to maintain that budget. Mr Leck said that District Managers had been sacked for exceeding budget. And because achievement of the elective surgery target was necessary to obtain maximum funding for the following year, there was considerable pressure on both of them to achieve that target.
1.21 In this respect Dr Patel was a considerable asset. He was very industrious and, no doubt also partly because of his careless surgery, and lack of proper after care, maintained a high throughput of general surgery. Without him, the hospital would not have been able to achieve its elective surgery target. Mr Leck’s and Dr Keating’s greater concern with maintaining their elective surgery target than with patient care or safety is reflected in a great deal of the evidence.
1.78 And the fifth problem was a tendency of administrators to ignore or suppress criticism. Bringing to light these and other problems in the public hospital system was made very much more difficult by a culture of concealment of practices or conduct which, if brought to light, might be embarrassing to Queensland Health or the Government. This culture started at the top with successive governments misusing the Freedom of Information Act to enable potentially embarrassing information to be concealed from the public. Unsurprisingly, Queensland Health adopted a similar approach, and because inadequate budgets meant that there would be inadequate health care, there was quite a lot to conceal. I make findings and recommendations in this respect against Cabinets in successive Governments, against former Minister Edmond and Minister Nuttall, against Dr Buckland and against Dr FitzGerald. Again unsurprisingly, the same approach was adopted by administrators in public hospitals, and this, in turn, led to threats of retribution to those who saw it as their duty to complain about inadequate health care.