Hospital Boards - true health reform starts on the ground

Abbott is heading the right way by pledging community control of hospitals, writes Terry Barnes.

Tony Abbott and Peter Dutton’s ambush of the Prime Minister last Sunday is the first shot fired by the Coalition in the 2010 election health debate.  Despite the carping of some pundits and Big Government healthcare advocates, it is an effective shot that’s characteristic of Mr Abbott.

The Opposition Leader plans to renegotiate the Australian Healthcare Agreements with the underperforming hospital systems of New South Wales and Queensland, the compacts that govern Commonwealth public hospital funding.  He wants to ensure that local hospital boards are restored and local control and responsibility promotes better management, better services and better outcomes for patients.  While some media and big government health advocates dismiss this, Mr Abbott has drawn on his own experience to respond to the concerns of the community.

In 2007 John Howard and Tony Abbott intervened to stop the closure of the Mersey Hospital near Devonport in Tasmania.  Everyone remembers the TV footage of Mr Howard being greeted rapturously by staff, patients and the local community, but the Howard government acted because northern Tasmanians were dudded by their own State government.  Until the then Prime Minister’s intervention, the community’s wishes and their support for “their” hospital was totally ignored.

But what was more popular locally than the takeover itself was Mr Howard and Mr Abbott’s decision to make the Mersey a “Commonwealth-funded but community-controlled hospital”.  It was reconstituted with the CEO, medical superintendent and director of nursing responsible to – and part of – a community board consisting of a mix of financial, legal, governance, and above all clinical skills.  Sadly, that board was unceremoniously dumped by the Rudd government in handing back operational control of the Mersey to its Tasmanian counterpart.

Mr Howard and Mr Abbott’s confidence in the Devonport community wasn’t misplaced.  Locals had the skills needed to run the hospital, they had the best interests of the hospital and its community at heart and they wanted to work realistically with the wider Tasmanian hospital system to keep the Mersey operating viably.  They benefited from in-house and local knowledge and staff support that no head office bureaucrat could hope to have.

Now Mr Abbott has drawn on his experience to give some direction and hope to the hard-pressed professionals and general staff who keep  NSW and Queensland public hospitals running in spite of, not because of, their State governments.  He understands that while Mr Rudd may talk of grand systemic reform with lots of big concepts and slogans, no major healthcare reform can succeed unless it starts from the ground up.  Local people and staff who stand up for their public hospital, and take responsibility for its operation, are more likely to give a solid foundation to wider reforms in patient management, hospital funding and quality and safety.

And if something goes wrong, as happened in Bundaberg Base Hospital in recent times, an active and engaged board, working with a CEO and senior staff, could act promptly rather than await instructions from head office.

Community control won’t solve all the problems in our public hospitals, but it’s a great place to start.  Tasmania and South Australia also have struggling public hospital systems – what if Will Hodgman and Isobel Redmond make election commitments following Mr Abbott’s lead?  It would be especially sweet for the Devonport community to see the Mersey Hospital once more under community control.

Terry Barnes was involved in the Mersey Hospital intervention as senior adviser to Tony Abbott and is an editor of Menzies House.

Comments

[Vince Schultz]

1.

I could not imagine the chaos if a federal department tried to run health. There would just be an additional layer of incompetent midlevel managers in the fray.

Actually I can't imagine big government running anything beyond tax collection.

[Terry Barnes]

2.

Thanks Vince. This isn't necessarily about the feds running hospitals, it's about removing the layer of incompetent or unnecessary middle managers who are already there now.

From my experience with the Mersey, and as a former bureaucrat who once was responsible for doling out public hospital funding to the states, I have absolutely no confidence in the Commonwealth health bureaucracy to run a hospital directly. Fund them yes, manage no.

The beauty of local boards involving staff and committed citizens is that decisions are entrusted to people who know about what's happening on the ground, and care about much more then their paycheque when it comes to the best interests of their hospital.

[Ben]

3.

I lived in England –and can tell you that Big Government hospitals don’t work. They’re filthy, run by tax-hungry bureaucrats and smell suspiciously like the bums on London’s Tube.

On the weird side, they give terrorist-friendly doctors without proper qualifications many opportunities to experiment on patients.

[Terry Barnes]

4.

NHS Trusts and Trust Hospitals have done a lot to improve services on the ground in many UK hospitals. Abbott's measure is going one step further by bringing community directors in the hospital door. On the UK, it's a great shame that the Tories want to sink a heap of taxpayers' money into the NHS rather than say enough is enough, this monster needs root and branch reform. "We'll cut the deficit, not the NHS": what populist tosh from David Cameron.

[Grantley]

5.

A decade and more ago every State had Hospital Boards at the local level. These boards evolved from basic assett managers to Executive Boards of Directors as Medicare unrolled and funding (or lack of) issues dominated.

I know, I was one such board member.

In that were some very good Boards of Directors that were innovative, highly responsible, very dedicated to their local communities and able to determine the difference between the needs of a community and the wants. There were others that were inward looking and totally incompetent.

The challenge in returning to this structure is to get the right people on boards and to train them in their responsibilities of corporate governance.

Boards of Directors can get it wrong on a few fronts, they can either become bastions for local community 'identities' who are incapable of seeing beyond the town limits or they can become Govt appointed stooges who are token apparatchiks. Local Boards need strong and inspired leadership.

I support effective, responsible, committed Boards at the local level, but much care is needed in how they are formed and how they operate.
There are many good examples of effective Boards of Directors over the years in SA, Vic, NSW and WA and it would be good to see the positives of these experiences used as a blueprint for the future.

I do not support tokenistic or lazy boards. Therein lies the challenge to get it right.

[TerjeP (Say Tay-a)]

6.

Privatisation is the wrong solution for hospitals. However Abbotts proposal takes us closer to community hospitals funded on a combination of charity and fee for service basis. If this is done right it could be a powerful demonstration of the power of civil society unleashed from the shackles of government. However I suspect Abbott won't go far enough. Communities should not merely sit on the board of local hospitals they should own and operate and fund the hospitals. Take the government out of health care and restore community.

[Terry Barnes]

7.

Your goal is noble but reality sadly isn't. Until we can change the culture of using government as a substitute for charity or personal benevolence, taxpayer funding is not going to go away. Putting local communities in a position where they can ensure that government is not oppressive or suffocating is the next best thing, and that's what underpins the thinking on hospital boards in my mind.

[Terry Barnes]

8.

Well said. One thing that the Bracks-Brumby Labor government has done in Victoria is to appoint known a number of well-known Liberal supporters on the understanding that (1) politically it shuts down criticism and more importantly (2) accepting that having people in business and the professions who can make a contribution on a hospital board is more important than their political connections. Boards will only work if suitably skilled and motivated community members are appointed and participate actively. Political hacks, local big-noters and time-servers generally of all persuasions need not apply.

[Terry Barnes]

9.

And if Labor can do it (actually in Victoria continuing what Jeff Kennett's reforms started), Liberal State governments have to raise themselves still higher. And they have the added motivation of knowing that if poor appointments and cronyism undermine their boards, public hospitals will be even worse off than they find them - and that they will wear the electoral consequences. Fortunately there are a lot of knowledgeable and committed people out there who are willing and able to serve and contribute for little or no remunerative reward, just the satisfaction of serving their communities.