A call for hospital management to return to arrangements of the past has drawn fire from former senior health service manager Michael Moodie and health economist Professor Gavin Mooney.
“John Graham’s suggestion for saving NSW hospitals, as outlined in his recent Centre for Independent Studies monologue, dreams of hospitals managing their own affairs unfettered by outside interference. His piece is called ‘The past is the future for public hospitals’.
He argues in essence: just let us (primarily doctors) get on with it – as we used to do – and all will be well.
The arrogance and lack of ‘back-sight’ in learning from the past are stunning.
We are not going to speculate on how to address the problems of NSW hospitals beyond arguing that Graham’s suggestion is not the way to go.
What is at stake is the question of who has the power to decide how resources in hospitals and health services more generally are used.
Do we want another Bristol or another King Edward Memorial Hospital? Are doctors to be left in charge? They are trained in medicine but not hospital management which is a major and important discipline in its own rights. We risk producing a culture of ‘medocrats’ and that as the Bristol Inquiry indicated is to be avoided.
The logic of Area Health Services is to address the health of a population not just the patients of a hospital. So what is the role of the hospital in the community under this view from the past? How are questions of equity to be addressed?
Central to any recommendation on governance of our public hospitals must be a recognition of three things.
First hospitals are responsible for allocating resources – for example, setting priorities within the funds available for example – as well as treating patients. Second there needs to be some clear explicit mechanism for ensuring that the culture of hospitals is genuinely conducive to good patient care. And three, hospitals are about power, both power within the hospital and power in the health service more widely.
Whatever else we can learn from Bristol and King Edward’s – and surely from these there must be a learning process – it is that ‘internal’ auditing of hospitals is simply not good enough.
There needs to be openness in all aspects of both patient safety and resource management. Ideally if hospitals are to serve communities, there needs to be accountability to the citizens in the community they serve such as through citizens’ juries as one of us (MM) organised in the south west of WA [This book has more details].
Graham bemoans the advent of Medicare: “The ideologically driven decision to allow all comers to be treated free regardless of means fundamentally changed the dynamic that underpinned the successful operation of the public hospital system.”
It certainly did. But unlike Graham we welcomed Medicare and want to defend it particularly given the current attempt to undermine it in the floating of Medicare Select by the NHHRC.
Given the ideologically driven ideas in proposing a return to the past in Graham’s CIS paper, it is superfluous to ask what concerns he might have in his proposal for equity (which interestingly was given a big tick in that WA citizens’ jury).”