Report card on the WA state health service

22 May 2007

How is the WA health service now travelling? We have many dedicated, hard working, highly skilled health care workers doing the very best they can for their patients. Yet despite their efforts the people of WA are not getting the health care they deserve.

In the wake of the Reid Review of March 2004, this report reviews some key aspects of the WA health service and argues that most of the problems of the sector are not related to under funding as is often claimed. The causes of the problems lie much more in a lack of concern for efficiency; poor management at a senior level; an obsession with resourcing the tertiary hospital sector and with hospital waiting lists and emergency departments; an all too ready emphasis on keeping the health service off the front page of The West Australian and state TV and radio news bulletins rather than on what the informed public want from their health service; too little concern among policy makers with equity; an absence of any rational priority setting system; a neglect, amounting to negligence, of Aboriginal health; a failure to promote transparency and accountability in resource use; and a too great willingness on the part of health politicians and bureaucrats to listen to the special pleading of the AMA.

Fundamentally, the costs of the WA health service are out of control. The target for expenditure growth, according to the performance indicators of Neale Fong, the Director General of Health, is 5.5 per cent. It is difficult to obtain figures to show what the current growth is but it is more like 9-10 per cent. That is not sustainable even with the current minerals-led boom in the state. Yet more worrying is that when the Fiona Stanley Hospital opens around 2012, given the lack of budget integrity surrounding the forecast running costs of that hospital, the annual rate of expenditure growth will rise yet further or we will see services being cut elsewhere, especially to disadvantaged groups - in the community, in rural and remote WA and for Aboriginal people. And the minerals boom may well be over by then.

A related but separate issue is that it is so difficult to get any sort of debate mounted on the state of wellness of the health service. Those of us, including this author, who try are criticised for airing our views.

Que faire? The answers lie in providing first staff, second patients and third the community with improved health service management and leadership at the highest level and giving our top managers the skills to do the job or employing top managers who can do the job; financial management and resource stewardship must become recognised as key features of health chiefs’ jobs; resources in health care must be recognised as being limited and using these as best we can (i.e. efficiently) matters; listening to the voice of the informed public, especially in their concerns for greater equity and for improving Aboriginal health; having an open explicit rational system for setting priorities; and making real the central proposal of Reid to keep people out of hospital.

All of this needs an open public debate about our health service. The key here is to hand the health service back to the people and give the task of determining the value base and priorities to citizens rather than as now to senior members of the medical profession. Doctors have a key role to play in the delivery of health care to patients; they are not equipped, trained or well placed to manage and plan health care resources. We have many first class doctors, nurses and other health care professionals. What we as patients and as a community need and what they, the doctors, nurses and other health care professionals need is good, inspiring leadership from our health politicians and top bureaucrats. That we currently lack in WA.

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