Hospital Boards – true health reform starts on the ground

by on 18 February, 2010

Terry-Barnes 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.

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