PM plans back to basics for nurse training

JOHN Howard has moved to dramatically overhaul nursing education, with a $170 million plan to build 25 privately operated nursing schools in hospitals. The radical shake-up, which will increase the number of nurses by 500 a year, involves a return to a traditional model of hospital-based training to supplement university-based degrees. The Prime Minister will reveal the plan in Sydney today in the first of a series of back-to-basics policy announcements aimed at battlers, the elderly and the bush, and designed to peg back Labor's huge poll lead.

The plan emerged last night with the news that the Government would also consider reviewing all pensions and offering retirees up to $30,000 in taxpayer-funded bonuses if they returned to work to help ease critical labour shortages.

The policy shifts came as the International Monetary Fund yesterday warned the Government against populist election initiatives, saying there should be no new government spending this year. In its annual review, the IMF praised the federal Government's handling of the economy as world-leading but cautioned against further stimulus to a stretched economy.

Coalition MPs were yesterday regrouping after a week of damaging leadership speculation that had many flirting with the idea ofdumping the Prime Minister and replacing him with Peter Costello. Having discarded the option of leadership change, the Government refocused yesterday, with senior ministers confirming Mr Howard would seek to turn the Labor tide by returning to his electoral roots with a large-scale policy revamp.

The new nursing schools will be modelled on the Government's 24 Australian Vocational Training Colleges, built by the commonwealth but run by community groups working with employers. The trainee nurses will provide immediate relief to hospitals suffering staff shortages. The courses will run for three years and students will emerge with a nationally recognised TAFE qualification - equivalent to university-based study. While they study, the commonwealth will subsidise their wages and also pay bonuses in the middle of their courses and at the end of their studies, to encourage their completion. Doctors, hospital administrators and private hospital employers will have input into the training programs to ensure the nurses emerge with skills sought by their industry.

According to a 2004 Australian Health Workforce Advisory Committee report, Australia will need up to 13,500 new registered nurses each year to meet the demand for nursing services over the next 10 years. In 2004 only 5631 nurses completed their training. Despite the shortfall, 2408 eligible applicants were turned away from university nursing courses last year because there were not enough places.

The Government's move is likely to be welcomed by the medical community because university training is often criticised as producing book-trained nurses with inadequate practical experience. The Government has already raised the plans with some hospitals and its announcement will come as the Australian Nursing Federation launches phase two of a four-week TV advertising campaign outlining the negative impact of the Howard Government's industrial relations laws on nurses working in aged care....

The new Government policy proposals followed heavy pressure from Labor yesterday. Kevin Rudd used parliamentary question time to pepper Mr Howard with questions aimed at convincing voters that the Prime Minister had no new policy ideas.

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A modest proposal: Government-funded health "Trainers" for all

The Fascist writer below recognizes that people mostly ignore "health" messages so "make people behave" is the proposed solution. That people have any right to eat what they want is not recognized. Nor is it recognized that "health" wisdom often goes into reverse.

THE idea that taxpayers should subsidise weight loss programs sparked an outcry this week, but it is the first solid policy proposal we have seen to stem a health problem that is costing Australia billions. It comes on the back of calls for cartoon characters to be banned from food packaging, for a tax to be placed on high sugar breakfast cereals and as some hospitals ban surgery on obese people and smokers. Unlike a weight loss program, none of these proposals does anything to change behaviour. That's why both sides of politics say they are seriously considering the weight loss subsidy.

Sixty per cent of our population is overweight. The problem - in defiance of government advertising campaigns to eat more fruit and vegetables and do more exercise - is, like Australians, only getting bigger.

A study in the Medical Journal of Australia has found these public health messages are being absorbed by the public. But it also found this knowledge does not readily translate into behavioural changes. We know what's good for us - but we won't do it.

Every year our public hospitals treat 500,000 people for preventable illnesses. Every year over 50,000 people die from illnesses caused by their poor lifestyle. It's time we asked whether scarce public health dollars should be spent fixing up health problems that are caused by our own unhealthy habits. We're making the unemployed take some responsibility for the public funding they get by working for the dole. In Aboriginal communities bureaucrats have taken control of welfare payments so they can't be spent on alcohol and drugs. The health system is the next area ripe for the new responsibility agenda.

Why should taxpayers fund repeated heart by-pass operations unless the patient receiving them signs a contract agreeing to give up smoking, do 30 minutes of exercise a day and lose weight? What's the point of the public subsidising diabetes or cholesterol tablets if the patient won't exercise and continues eating fatty foods?

A National Heart Foundation study estimates that seven lifestyle factors - obesity, low fruit and vegetable consumption, tobacco use, alcohol consumption, low physical activity, high cholesterol and high blood pressure - cause 52,738 deaths in Australia every year - 39 per cent of all deaths. If we don't start heeding these public health messages (and it doesn't seem likely we will) that number is bound to get even worse.....

The answers aren't necessarily expensive or difficult. We all know what we've got to do to address these health problems: eat healthier food, eat less food overall, quit smoking, take up regular exercise, and control our alcohol intake. But knowing isn't doing. That's why we need to consider a more interventionist approach to preventive health.

The health fund Australian Health Management, which runs an intensive diet and exercise preventive health program, has found spending $600 a year on a personalised health management program for its chronically ill members saves the fund $1800 a year per person. This health fund has found a much more intensive personalised coaching approach to preventive health does pay off.

Instead of spending millions kitting out our ambulances, hospitals and morgues with beds and stretchers that can cope with the morbidly obese, perhaps we should be spending the money on personal coaches that help the chronically ill reinvent their lifestyles. This health fund shows why a subsidy for weight loss programs is worth a trial. The doctors group proposing the plan wants to keep its costs down to $27 million by restricting it to obese people at risk of a chronic illness . But the extra expense of extending it to all overweight Australians could save us much more than it costs.

Telling people what's good for them hasn't worked. If we want cheaper health insurance and lower taxes, it's time to make people take that 30 minute walk and cut down on their calorie intake.

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Unify health systems to free up $4 billion

A reduction in bureaucracy is a commendable aim but abolishing health bureaucracies altogether would be much better. The many high-quality private hospitals show that no government bureaucracy at all is needed to run hospitals

AN extra $4 billion could be available to spend on patient treatment across Australia if duplication and inefficiency in the health system were fixed. The Australian Institute of Health Policy Studies argues that the nation's health services are not just financially inefficient but they also place Australians in physical danger. "Our healthcare system is unnecessarily dangerous and causes needless deaths and injuries, most of which we never hear about," said Monash University professor of public health Brian Oldenburg, a member of AIHPS. "(And) $4billion could be transferred into treating people without an added cent of taxpayers' money if we improved the productivity of health services."

Professor Oldenburg said there were large differences in healthcare efficiency among the states and territories. "The gap between the most efficient state (South Australia) and the least efficient (the Northern Territory) delivering healthcare (per patient) in public hospitals is 35 per cent."

The AIHPS will today release a paper calling for business to become more involved in efforts to reform the health system. "They are just beginning to realise how important it is to the economy and that the more a consumer spends on health, the less discretionary spending they have elsewhere," Professor Oldenburg told The Australian. As well, he said, "business leaders know how to get things done and that's what we need to have in this debate."

The AIHPS points to a report by the Productivity Commission, released in February last year, that identified billions that could be saved across the health sector. "It's the duplication, the unnecessary tests being conducted. It's no communication between hospitals and doctors on the one hand and community services on the other. It's also people being in hospital when they should be either supported in the community or in the aged care service." Early intervention programs for health problems such as diabetes should also be encouraged, as they had the potential to save thousands of hospital hours.

Despite strong recommendations contained in numerous previous inquiries, virtually none had been acted upon, said Peter Brooks, executive dean of the Health Sciences faculty at Queensland University. "Every opinion poll indicates that health is one of the most important issues for consumers in who wins their vote in federal elections," he said. "It's time for both major political parties to give the public the detail on how they will reform the health system."

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Forced adoption for kids of addicts

THE forced adoption of infants and toddlers should be the first response of child protection authorities dealing with at-risk children whose parents are drug addicts, according to a federal government report. The parliamentary committee on families said children under the age of five whose parents were drug addicts would be better off being permanently adopted out rather than being "shunted" between foster carers. Children adopted under the scheme would never be returned to their parents, even if the parents stopped using drugs, although the proposal would not preclude contact visits, committee chairwoman Bronwyn Bishop said yesterday.

Ms Bishop said making adoption the default response put the onus on parents and departments of community services "to show why adoption shouldn't be an option". Ms Bishop said an "anti-adoption attitude" permeated Australia's child protection bureaucracy and that the report aimed to put the spotlight on the "collateral damage" caused to children by drug use. "There was so much need to look at the rights of the child - not the rights of the mother, not whether giving the child back to the parent is going to help them get better," she said.

Ms Bishop repeated her criticism of the "drug industry" of treatment services, counsellors and research organisations, accusing them of not wanting to put themselves "out of business" by eliminating drug addiction altogether. The "drug industry" had captured the term "harm minimisation" and given it the meaning of "reduction of drug use but not with the aim of having an individual made drug-free". "We find that that's an unacceptable way to go," she said. "The aim should be to make the individual drug-free. We have found those in the drug industry take an amoral stance; they say that by harm minimisation the question of morality is out of the equation and they make no judgment as to whether drugs are good or bad."

The 31 recommendations of the Winning It For The Kids: Protecting Families From Illicit Drugs report include adding controversial detox drug naltrexone to the Pharmaceutical Benefits Scheme and cutting funding to organisations that don't aim to make drug users drug-free. It also called for a review of the methadone program and recommended parents be banned from receiving takeaway doses of methadone if they were caring for, or had access to, their children.

Ross Fitzgerald, who advises the federal and NSW governments on illicit drugs, said he supported the report's effort to focus policy on abstinence rather than controlled or moderate use, but said suggestions such as forced adoption were "absolutely over the top". Despite delivering a minority report, the Labor Party did not issue responses to the individual recommendations, saying only that it would consider them if it formed government.

Brian McConnell, president of Families and Friends for Drug Law Reform, which made a submission to the committee, said the report was a "road map to disaster" that ignored evidence and research. "It is a disgrace that a committee of our national parliament should display the ignorance that it has done and close its mind to science and reason," he said. "The course of the inquiry has been a scandal, with the committee refusing to consider a mountain of scientific evidence that is out there in support of existing drug policy."

Alex Wodak, president of the Australian Drug Law Reform Foundation and director of the alcohol and drug service at Sydney St Vincent's Hospital, said the report was "very disapointing" because it favoured moralism over science. He said the forced adoption would be "wanton cruelty". [As if the present policy is not!] "It would be totally counterproductive," Dr Wodak said. "Drug users would never go near a doctor or a nurse or a counsellor then because they would be worried that their kids would be taken from them

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