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John Graham | The Australian,October 04, 2007
LET me say from the outset that I am not a professor of medicine or surgery. I am not a professor of nursing. I am not an economist, a bureaucrat or a politician. I am simply a medical practitioner with 40 years' experience in five public hospitals in Sydney, two of them teaching hospitals. My comments are thus based on experience limited to NSW.
Until I entered medical school in 1962 at the University of Sydney, no medical student in Australia had been subject to an entry quota.
But now young Australians have to be Albert Einstein to gain entry to any medical faculty anywhere in Australia. This is sad. To be a good doctor, one probably only needs a Universities Admissions Index of about 85 to 90 (certainly not 99 plus), an aptitude for rote learning and a passionate desire to help one's fellow man.
When I began my student clinical years in 1966 at Sydney Hospital, student nurses lived and trained in the hospitals. Their practical skills and compassion were fantastic. Then some disgruntled soul decided to move nurse education into universities. Another big mistake.
Resident medical officers also resided in the hospitals, thus enabling a far greater opportunity for learning than is available today.
Medicare, introduced as Medibank by the Whitlam Labor government, hasn't helped either. It lets the well-off take up beds in public hospitals, which should be available for the disadvantaged. Reinstatement of a means test, or more accurately a wealth test, for classification of public-private status in public hospitals is long overdue.
During the 1970s, some huge advances occurred in the technologies relevant to diagnosis, therapeutics and surgery. As a result it was possible to treat many more patients in considerably shorter times in the available hospital beds, but that put more pressure on the public purse, especially as Medicare had made the treatment notionally free.
To cut the costs, and with little regard for the general wellbeing of the community, it was decided the number of beds should be cut. But there was no health minister with the courage to make the cuts. And so in the '80s the NSW Labor government dreamed up the idea of area health boards to make the cuts on behalf of the minister. These cuts, however, also required the silencing of all adversaries to the plan, and so the NSW Labor government removed nearly all the independent public hospital boards.
Next to go were the general medical superintendents who, until then, had made sure the interests of patients were paramount. And from that point onwards the chain of communication from clinicians to administration collapsed, and out the window went efficiency, morale, trust and institutional loyalty. You didn't have to be a Harvard business school professor to know that corporate disaster for public hospitals would be just around the corner.
Governments, through their area boards, became deceptive on budgets. No longer was a hospital budget a firm commitment, and few hospitals would be given their budgets until nearly six months into a financial year. That made it easier for governments to throw all the blame on clinicians for budget overruns that were artificially orchestrated.
The health bureaucracy burgeoned with countless people who have since spent their working lives attending endless meetings, staring at computer screens and doing precious little else. As a result, much of the funding intended for patient care and for the salaries for nurses and hospital doctors had to be switched to salaries for health bureaucrats. In NSW alone more than $2 billion each year is spent by NSW Health on salaries for people who don't heal anyone.
The reasonable expectation of young doctors that they will be granted a Medicare provider number as soon as they are qualified has also no doubt caused federal governments to put a limit on entry into university medical faculties, which brings us back to the start. It is quite outrageous that Australia should be importing doctors.
Fortunately for all Australians, the Howard Government has indicated it is going to roll back the mistakes that have been made by health bureaucrats and state politicians during the past 40 years.
The recent announcement by John Howard and Tony Abbott that they wish to see nurse training reintroduced to the hospital setting is to be greatly applauded. Universities can still play their part by providing the postgraduate nursing courses in intensive care unit nursing and the like.
The further announcement that a Howard Government would return a discrete community board of directors to every public hospital in Australia will bring joy to the heart of every nurse, doctor and patient across the land.
This has been the single most important health initiative to be announced by any government in Australia for a half century.
By comparison, the federal Labor Opposition so far has offered only a few hypothetical platitudes that won't cure anything before mid-2009.
In fact, Kevin Rudd has amazingly offered to pour another $2 billion into a system that is patently faulty.
John Graham, a GP [General Physician], is an emeritus honorary consultant physician at Sydney Hospital, where he is also chairman of the department of medicine. The views expressed are his own.
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