Liberal Market Values have a lot to offer patients.

IMG_3115Dr. Grant Ross discusses the benefits that free markets bring to patients: 

Janet Albrechtsen argued in Peter van Onselen’s 2008 book, Liberals and Power: The Road Ahead, that the Liberal party has surrendered the moral high ground to the left. This is particularly the case for education and health.  

Publicly funded Health is a good thing but there is a point where the health stops and the public institution largesse and inefficiency supersedes. We must be honest about this reality.

There is a sentiment among doctors lately that the government is bending towards special interest groups who want to usurp doctors’ autonomy, money and power. These include Federal, State and Hospital bureaucrats, allied health professions, Nurse Practitioners and drug companies. This is a misuse of government power to steal market ground from doctors and exercise the politics of envy. This mechanism has potential to hinder the ability of the individual to decide which practitioner they want to go to, as per market practice.

The Roxon reign has not introduced a single reform that worked towards health care efficiency.

The e-health records involved inadequate medical input such that they are a useless diversion that actually increases doctor workload for no appreciable gain.

‘Nurse on call’ proved to do nothing to ameliorate the doctor workload as the nurses generally had little more clout on whether a patient needed to see a doctor than the patients themselves.

The Nurse Practitioner scheme, designed to create a new breed of ‘health professional’ to take over in General Practice proved so financially ridiculous that the scheme was shelved. Not only did a patient now have to pay to see a nurse practitioner, but then had to pay twice once they realized that the Nurse Practitioner had little ability to treat any of their presenting complaints and they still had to present to their doctor.

Then there was the push for prescribing rights and Medicare billing rights for allied health. Pharmacists wanted to be able to prescribe drugs. Psychologists wanted to bill Medicare. Who was going to pay for all this?

Most doctors know that free health care is wasted health care from over-servicing. Medicare is not there to drum up business for allied health. I am all for providing state dollars to get services when and where needed; but this model has no believable provision for rationalization of those services. Fee for service and GP referral does.

Ideologically, the widening of prescribing rights is just plain dangerous. It makes a mockery of medicine as a craft and brings danger and higher costs to the health industry.

The political push by allied health and nursing to usurp doctors’ work is dangerous and misguided. The recipe is well known; take an easy part of medicine, take it out of the ‘unknown diagnosis’ context, prove that somebody else can do it better than doctors already are, then claim that this should be a future model.

Unfortunately, humans are not as simple as cars and nor are they identical; a production line does not work. ‘Substitution’ to allied health increases the infrastructure costs by multitudes and rarely reduces the need for a doctor as allied health and nurses cannot integrate the findings based on their limited knowledge. Simply put, a doctor is the corner you just cannot cut. 

My honest view on the assault on doctors is that no government can recreate what Aristotle left behind. Both in homage to the great philosopher’s role as a physician himself and to his dictum ‘the whole is more than the sum of the parts’ I want to impart the purity of the role of a doctor in both vocational and philosophical terms. In Liberal terms, doctors are a self-defined market product that the government is trying to usurp. In Liberal terms, this is market interference by government and it is wrong.  

Kevin Rudd’s federal takeover of health excites me as a doctor, but scares me as a Liberal. On one hand, I love the idea of the fragmented state funding being taken out of the equation. Less fighting and blame shifting between governments, less complexity, less delay in approvals and policy change and greater concordance of workforce planning.

On the other hand, one sprawling enormous bureaucracy with eyes to taking jurisdiction over every patient, health record, nurse, doctor and hospital in the country is a recipe for inefficiency and complexity. I have a concern that this would make it easier for special interests to capture policy making when they only have to do so with a single government, i.e. the federal government.

Medicare Locals were a bad idea from the outset. They take a reasonably well functioning private and independent industry group and more or less nationalise it in order to ‘make it better’; without any extant support or endorsement from the AMA.

This has failure written all over it.

First of all, none of these models worked overseas and we knew that well back when this sorry saga started. Secondly, the Medicare Locals aim to replace the doctor to patient care model by creating schemes and incentives to control chronic disease and use other peoples’ money to do so. This is not about ‘patient care’; it’s about arrogant governments holding the belief that they can get ‘better results than doctors’.

Once you open up this ground to any purpose, you open it to all purposes and I disagree with the replacement of the doctor patient primacy on every level.

Every single doctor I speak to is against the changes to healthcare. This is particularly the case in General Practice. Allowing vocal special interests to manipulate health policy is a perversion of the intention of publicly funded health and is amount to theft from patients.

If you want quality, effective and rationalised medical services in Australia; the General Practice fee for service primacy model is the only one worth supporting. And we won’t see that with Roxon.

Grant Ross is a graduate of Medicine and Surgery from The University of Melbourne, where he was also President of the Rural Health Society. 


The Facts Behind The Victorian Nurses Strike

IMG_3115Dr. Grant Ross discusses the damaging impact of the illegal Victorian Nursing Strike:

There is nothing respectable about the nursing strike. 

The Australian Nursing Federation (ANF) voted to strike after failing to reach an agreement with the Victorian Hospitals Industry Association (VHIA), subsequent to the previous Enterprise Bargaining Agreement expiring on November 1. The ANF demanded an 18.5% pay increase whilst the VHIA on behalf of the government offered 2.5% annually with bankable productivity gains. Industrial action began November 12 and was ordered to stop on November 16 by Fair Work Australia after an application by VHIA.

The ANF defied this order and continued striking until a third order to suspend industrial action was issued November 25th. During this period hundreds of beds had been closed across 86 health providers in the state with major effects on hospitals.

According to news reports, during the nursing strike a two-year-old girl with a broken arm had to wait more than a day for treatment after staff vacated the Casey Hospital emergency department.

Nurses refused to admit a 96 year old woman to a ward, until senior management was called in. A man at Northern Hospital waited 40 hours on a trolley.

In my hospital, 5/6 of theatres were closed, grinding theatre to a halt and forcing patients, some of whom have waited years in crippling pain, to forego operations that would have restored their ability to walk. Over 800 such elective operations were cancelled by nurses during the 13 day strike. 

Contained in a series of instructions published on the ANF website the ANF somehow gave themselves the power and expertise to decide who would and would not get an operation:

Contained in only 2 brief lines, the document ‘How to Cancel Beds’ tells nurses:

“CANCEL 1 in 3 booked operations or the equivalent in operating theatre including endoscopy and day surgery…be mindful of the clinically optimum time for surgery”

Out of keeping with normal practice, union delegates were deciding who did and did not get their treatment as nurses were deciding which patients got beds in relation to the strike. For the ANF to argue that they always found a bed for the patient when it was required deviates from the purpose of why the patient is there is the first place; aka for treatment from trained professionals.

In this regard every patient should be deserving of a bed, not having nurses decide who was and wasn’t safe without treatment is more or less an unacceptable departure from the principles of usual practice. Furthermore, it raises some ethical questions about the rise of unionism in nursing.  

Everybody supports that nurses, just like any other worker, have a democratic right to undertake industrial action and put their case forward for what they view as better working conditions. But that right does not extend to abrogating the industrial relations process as set out by our democratic parliament. 

The ANF had a means of negotiating on pay that involved minimal striking and arbitration with the FWA and minimal disruption to the hospital system. Displeased with the prospects of a fair arbitration towards them, they chose to strike beyond the order of the FWA.

Instead of striking, nurses should have sought arbitration and accepted the necessity for wages to be based on enterprise bargaining and productivity assessments. This is what FWA and EBA are for; despite how inadequate the current industrial relations legislation is exposed as being.

The recent strike raises serious questions about the effect of the unions on nurses. Nurses have chosen to make their claims through destabilizing the health system and perpetuating a public campaign on false grounds of ‘gender discrimination’, ‘nurses work harder than doctors’ and spurious claims of ‘disrespect’.

Claims such as these are simply decerebrate.

In the context of such constantly toxic claims, one seriously must wonder whether these arguments are genuinely about pay disputes of nurses or rather an attempt by some officials to revive unionism within the hospital systems. The challenges in running a first class health system are difficult enough without having to battle self-interested elements of the industrial dispute business that are intent on turning professional against professional to grow their power.

Nurses must continue to advocate for the very important role they play. However, a professional does not blackmail their employer to get what they want. It may get results, but it is not dignified when other options are available.

Grant Ross is a graduate of Medicine and Surgery from The University of Melbourne, where he was also President of the Rural Health Society.