After the tumult, the Liberal party may be getting back on track

Decision on Warmist laws (the ETS) now likely to be deferred

AFTER a tumultuous two weeks, the leadership and policy of the Liberal Party appears on track to match the sentiment of the Liberal Party faithful. Joe Hockey is set to replace Malcolm Turnbull, but based on a policy of voting against the ETS until after the Copenhagen climate conference next month.

Hockey's popularity over Turnbull and his other potential rival, Tony Abbott, is carrying the day for him among the public and Coalition supporters. Turnbull's unpopularity with the public as an alternative prime minister and among Coalition supporters who favour both Hockey and Abbott over the Liberal leader, is reflected in the collapse of support within the parliamentary Liberal Party. However, in what could be an early warning for Labor of a change in sentiment on the emissions trading scheme, the Rudd government failed to get a significant boost out of what was the most calamitous week for their opponents in more than 50 years.

Turnbull's decision to support Kevin Rudd's ETS has gained strong approval among the voting public and Labor voters who support "action on climate change", but it is being repudiated by Coalition voters. On the policy side, the leadership ructions have led to a dramatic turnaround for the Liberals, with Hockey and his expected deputy, Peter Dutton, as well as Abbott and Nick Minchin, supporting a deferral of an ETS vote until February.

This dichotomy of views between the public, Labor voters and Coalition voters has been at the heart of the Liberal dilemma. The prime objective of the Liberal Party now is to unify itself and Hockey, Dutton and Abbott have all demonstrated a wish for consensus on personnel and policy.

The Liberals will now be led by a popular leader seen to be a conciliator who has accepted compromise on the ETS to satisfy the party membership and heal the divisions within the parliamentary party. The final result will be that the Liberals, like the Nationals, have decided to try to restore their lost bedrock support by deferring the ETS instead of trying to go after swinging voters who voted for Rudd at the last election.

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Vandals destroy artwork at community festival



I must say that I have a distinct lack of sympathy for the "artists" below. I don't see why public property should be defaced by some arty-farty nonsense. I think the bridge looks just fine by itself. It is a REAL work of art. The arty-farties are entitled to their obsessions but there are plenty of art galleries to hang their stuff in without trying to force it down everybody's throat. I am sure that they are completely aware that most people do NOT like what passes for art these days but they are determined to assert their superiority

ART lovers danced on a bridge in defiance yesterday after vandals destroyed an artwork that took over a year to create. The large knitted art installation had been slashed and cut down just hours after it was put on display across a bridge in Melbourne's inner suburbs. But organisers behind the community-based arts and culture festival continued with their party as parts of the project sagged into a creek in tatters.

"Our spirit was not going to be dampened," The Big West Festival director Karen Hadfield said. "We all danced on the bridge. It was a bittersweet moment." About 40 people had volunteered over 18 months to make The Big Knit, a giant sheet of knitted neon plastic strips that was hung across the historic Footscray walking bridge.

The art installation, 150 metres long, was designed to take a domestic craft such as knitting and put it in a contemporary context. "It was this big, loud, beautiful, wonderful piece that just stuck out from the trees and everyone passing on the train would see it," she said. "It created this whole dialogue about art and life."

Police are attempting to track down the persons who used scissors or a knife to destroy the installation. It's believed the vandals cut up the artwork between 11pm on Friday and 6am yesterday (AEDT), causing $40,000 damage. Ms Hadfield said the vandals would have needed at least two hours to complete their mayhem. Police are asking anyone who saw the vandalism on the bridge across Maribyrnong Creek to contact them.

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A PUBLIC MEDICINE ROUNDUP

Four current articles below

State's hospital beds fail to keep pace with population

QUEENSLAND health authorities have responded to booming population growth with just one extra hospital bed for every 13,553 new residents. The abysmal planning failure is exposed in state and federal health figures analysed by The Courier-Mail. Between 1995 and 2008, Queensland grew by 1.03 million people. During the same period, the number of overnight beds in the state public hospital system stagnated. There were 10,115 beds in 1995 and 10,191 in 2008 – a 13-year net increase of 76 beds.

Australasian College for Emergency Medicine Queensland chairman David Rosengren said funds had been siphoned from in-patient care to hospital bureaucracy as part of a "close a bed, open an office" syndrome. He said the number of hospital administrators rose sharply in the first half of this decade. "There are buildings and buildings . . . floors and floors and floors of administrators in Queensland Health," Dr Rosengren said.

Statistics from Queensland Health show the State Government began tearing at the heart of acute-care hospitals with the rise to power in 1998 of Premier Anna Bligh's predecessor Peter Beattie. Bed numbers tumbled each year under the false assumption that new medical techniques and efficiencies would reduce gross occupancy. New and redeveloped hospitals were built with less [fewer beds], culminating in a low-point of 9262 beds in 2002.

The Government has bolstered bed stock in the past three years, and embarked on a new $6 billion hospital infrastructure makeover. Health Minister Paul Lucas says the building and refurbishment agenda will deliver more than 1800 beds over the next seven years. The Gold and Sunshine coasts, Cairns, Townsville and Mackay are among the beneficiaries. "On any examination of the statistics of health care in Australia, we have (one of the) best if not the best systems in the world," Mr Lucas said.

But research by QUT public health academic Gerry Fitzgerald indicates otherwise. In a 2008 report, Professor Fitzgerald, a former Queensland chief health officer, calculated that the state was around 3000 beds in arrears. From 1997 to 2007, the effective bed reduction – taking in population growth – was double the national rate. Since then, Auditor-General Glenn Poole has issued a rebuke over the disarray of the hospitals' infrastructure program.

Following that report in June, Queensland Health director-general Mick Reid confessed that some future services may have been wrongly placed. He also said hospital buildings had been announced without recurrent funding to operate them.

Meantime, the pressure on hospital beds is destined to accelerate with the most recent 12-month population increase a record 112,666.

QUT School of Public Health head MaryLou Fleming said the focus needed to turn from more hospital beds to greater investment in health maintenance. "Currently, 2 per cent of the money that is spent in health federally goes to promotion and prevention strategies," Professor Fleming said. "Unless we turn that around, we are headed for a catastrophe." [Typical theory-driven academic ignorance. All the research shows that prevention strategies are not overall cost-effective. I quote from a comprehensive recent survey of the research evidence: "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not." MaryLou's gross ignorance of the research makes her a disgrace to her university. The journal I quoted is NEJM. I wonder has MaryLou ever had anything published in NEJM? -- JR]

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National cash infusion wasted on paperwork, says doctor chief

The Rudd Government has spent too much on hospital pen pushers at the expense of patient care as waiting lists rise and overcrowded emergency departments struggle to cope, the president of the Australian Medical Association said yesterday. Andrew Pesce said Labor had broken its election promise to reduce red tape in the health system, and called for an independent review into how much money has been spent on bureaucrats and unnecessary administration.

Dr Pesce, who marks six months as AMA president tomorrow, said the public hospital system was no better off than under the Howard government. "There's been too much spent on administration and bureaucracy. Administrators at a local level in hospitals have stopped being assistants to clinicians, to ask them, 'What is it that you need and we'll see how we can help you deliver that,"' Dr Pesce said. "They're [doctors] just told, 'You can't do this, you can't do that; there's no money for this, there's no money for that."'

The AMA has had discussions with the Federal Government on reducing the complex paperwork doctors must complete to satisfy funding requirements, but Dr Pesce said the debate had "fallen into a hole", with little progress made since Labor took power.

Dr Pesce, an obstetrician and clinical director of women's health for Sydney West Area Health Service, said clinical decisions were increasingly being made by bureaucrats, potentially putting patients at risk. "Often the replacement of staff who leave is tied up for ages because of budgetary constraints so people are working understaffed and overstretched … That contributes to the lack of morale and is going to increase the risk of poor outcomes and adverse events because people are working very much at capacity," he said.

"I can guarantee that if you walk into the maternity ward [at Westmead], of the eight midwives on duty at the time, six would be sitting down at the desk filling out paperwork rather than looking after the women."

Dr Pesce believes that during his tenure relations between the AMA and the Federal Government have thawed, after a frosty relationship under former president Rosanna Capolingua. He described plans to cut Medicare rebates for cataract surgery, IVF and some obstetric services, without consulting doctors, as a "cock-up".

The move announced in the federal budget was part of a crackdown on specialists who were rorting the system by charging excessive fees. Health Minister Nicola Roxon said Australian ophthalmologists were among the highest paid in the world, with some eye surgeons earning up to $28,000 a day for performing cataract surgery.

"The Government basically unilaterally announced they were going to do these things that didn't acknowledge it was going to cause a lot of problems for some patients," Dr Pesce said. "The solution they came up with meant that even the doctors who were charging very reasonably, their patients were getting punished just as much as those who weren't."

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Patients die prematurely because they lack access to radiotherapy in NSW public hospitals

Radiotherapy is an essential cancer treatment needed by half of all cancer patients, according to national benchmarks, yet in NSW from 1996 to 2006 only about a third of newly diagnosed cancer patients were treated with it. More than 50,000 cancer patients were not treated, and we estimate that 8000 patients died prematurely.

Access to radiotherapy in Australia has been subject to more than 20 reports in the period since 1989. The three factors that stop Australians receiving appropriate radiotherapy for the cure or palliation of their cancer are: a lack of linear accelerators and staff; reliance by state governments on the private sector shouldering the burden of supply in regional areas; and a rigid and inappropriate regime of assessment of new technology.

Radiotherapy is a cost-effective service that requires a particular configuration of technology, buildings and professional staff. Establishing new centres demands careful planning so that all these features come together at the right time and in the right place.

Radiotherapy is not a novel cancer treatment. The demand for services is easily determined from central cancer registry figures that have been available for decades. Health departments have developed detailed and thoughtful plans but these have not been supported by governments. Consequently, the expansion of facilities has only just kept pace with the ever-increasing number of new cases of cancer.

State governments seem to have preferred to shift their responsibility for service provision onto the private sector. Private medicine is supposed to increase patient choice, but in some parts of NSW, the only radiotherapy treatment centre is a private facility.

In those areas local residents have to decide between travelling further afield to a public centre, or using the closer centre and incurring the costs. Fees charged by private providers exceed the amount covered by Medicare; patients using private centres must pay the difference or "gap fee". Private health insurance does not cover outpatient radiotherapy, which is sometimes a surprise to cancer patients who have private health insurance.

Country patients who do not wish to forgo the benefits of radiotherapy but cannot afford gap payments must live away from home or travel large distances each day for treatment for many weeks, often because patients need to run their businesses or care for their families. These trips can be distressing for people who are in pain or suffering the side effects of treatment.

NSW Health offers a financial assistance scheme for country patients travelling for treatment - at the rate of about $30 a day for accommodation. It would be difficult to find a tent site in Sydney for $30, and it is hard to imagine a public servant accepting such meagre travel support.

While no one is saying that taxpayers should be subsidising patients in luxury accommodation, most would support a more reasonable level of comfort for cancer patients undergoing treatment away from home.

To add to the burden, patients must pay $20 per application for "administrative costs" when accessing the scheme and patients reported many months delay in reimbursements.

Australians have good access to new drugs through the pharmaceutical benefits scheme. Unfortunately, the rigid evidence-based medicine approach applicable to drugs has been a key impediment to the introduction of cancer treatment technologies widely available elsewhere in the world. Even minor improvements to linear accelerators may take 10 years or more to enter Australian departments.

Major improvements such as intensity modulated radiotherapy are only used on a tiny fraction of Australian patients despite being a standard of practice in North America and Europe. Proton therapy and tomotherapy are not available at all in Australia. The Government has sponsored a handful of patients to have treatment overseas, but the vast majority miss out.

It has been said that survival from cancer in NSW is second only to the United States; it is surely not an honour to be second in any measure to the developed world's most notoriously inequitable health service. With a small investment and commitment we could have the best survival rates for cancer patients.

NSW must commit to a strategic plan and back it with associated funding to expand radiotherapy services so that there is capacity to treat all the cancer patients who can benefit from it. Fifteen new accelerators are planned for NSW, but these will only keep pace with the expected growth in demand. To overcome the gap, only 12 more accelerators are needed.

There is a universal and often expressed hope in the community for a cure for cancer. Yet here is a treatment known to be beneficial, but unavailable to all who need it, and those who do receive treatment are enduring hardship in the process.

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Some comments from a doctor who has seen it all



FOR 50 years, Colin Owen has been the bush doctor you can rely on. The medical marvel has never had a sick day – not once in the 53 years he has been on Queensland Health's books. Want proof? Check his latest pay slip. The accrued sick leave column shows 5416 hours, or more than 135 weeks. And the numbers will keep piling up because Dr Owen, 70, has no plans to leave the town of Inglewood, southwest of Warwick....

Dr Owen has been a trailblazer for the nation's rural doctors, taking their fight for better conditions to Canberra where he was on a first-name basis with several federal health ministers....

"Health should be about the delivery of health services. But it isn't at this stage. It's about the economic delivery," he said. "In Queensland, it's dreadfully obvious that it's about the economics of health care rather than the delivery of patient services. There is no doubt about that."

Dr Owen says he often does not get his budget from Queensland Health until three months into the financial year, and then it changes as the year unfolds. And it often doesn't make room for factors such as a 4 per cent pay increase for nurses.

The Inglewood hospital is controlled by six layers of bureaucracy, including one federal level. Just which level is responsible for what tests even someone of Dr Owen's experience and brilliance. "If the administrative people in Queensland Health were as effective as the health and medical staff I wouldn't have a problem. The qualifications and the background of some administrative people are quite worrying," he said. "There is a culture of micromanaging and a culture of bullying, although the latter has gone a bit quiet.

"The circle keeps going around. Over the decades people have tried to reinvent the wheel. They will say 'we're going to try such and such' and I'll say that we tried that in the 1960s and it didn't work then."

Would a federal government takeover improve the delivery of health services, particularly in the rural areas which often feel a long way from Queensland Health's Brisbane headquarters? "The closer government is to the area concerned, the better. Whenever there is centralisation, the voices near the periphery are not heard," Dr Owen said. "Local hospital boards bring the governance back to the local area. They are the best way to go providing they have local medical professionals on them. The boards in the days of the old National Party government were dreadful because they were often political appointments.

"Maybe you could have one control authority in Canberra and local boards – maybe that would be a good way to go. But the thing that worries me is the middle-range public servants who will move wherever they can go regardless of which level of government runs it." ...

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