Monday, November 23, 2009

Rudd government’s non-solution to hospital crisis a wasteful threat to private practice

By Dr Jeremy Sammut

Under the $275 million Super Clinics program, the Rudd government is funding the start-up costs involved in bringing together GPs and allied health professionals, such as physiotherapists and podiatrists, who want to amalgamate their practices into an initial 36 ‘one-stop shops.’

This move has the potential to nationalise Australian general practice, and the Doctors’ Action group is right to be worried about the impact of Super Clinics on the traditional family GP.

Why would young doctors buy into an established practice when they join a Super Clinic for free with the capital costs paid for courtesy of taxpayers?

The legitimate fear is that state-funded Super Clinics represent creeping socialism and will render private practice uncompetitive. Once it becomes too costly and difficult to establish a private surgery from scratch, future governments might force doctors to work in Super Clinics on a salaried basis.

The official rationale for Super Clinics is they will take the pressure off overcrowded public hospitals. But in reality, taxpayer’s money is being wasted on a non-solution for the hospital crisis.

Every credible study shows that public hospitals are dangerously overcrowded because of the national shortage of hospital beds, which forces over one-third of all seriously ill emergency patients to wait longer than eight hours to be admitted to a bed.

Yet the Rudd government maintains Super Clinics have already proven worthwhile. A Tasmanian Super Clinic has reportedly reduced the number of people with minor illness turning up at the nearby emergency department by 13%.

A number of previous studies have demonstrated that patients with minor conditions such as a cold or sore toe account for only between 10 and 15% of total emergency presentations.

The same studies have also shown that treating these patients constitutes a mere a fraction, 2 to 3%, of the total emergency workload, and that it is far cheaper to treat them in the emergency department rather than incur the capital and infrastructure cost of establishing alternative GP facilities.

In other words, diverting ‘GP-style’ patients into Super Clinics is imposing a huge cost per occasion of service on the federal budget. The Rudd government’s highly inefficient spending on Super Clinics makes a mockery of its supposed commitment to micro-economic reform.

Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies and author of ‘The False Promise of GP Super Clinics’ and ‘Why Public Hospitals are Overcrowded.’

The above is a press release from the Centre for Independent Studies, dated November 20. Enquiries to Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.

Teachers warned off online Facebook contact with students

This is a bit authoritarian but is probably prudent

TEACHERS would be banned from contacting students on social-networking websites like Facebook or Myspace under proposed changes to their code of ethics. The move comes after the WA College of Teaching disciplinary committee reprimanded about 10 teachers in the past year for inappropriate cyber interaction with students. The behaviour included teachers sharing private photos with students and in some cases engaging in online sexual innuendo.

WACOT's disciplinary committee chairwoman, Theresa Howe, said the code of ethics needed to be updated to specifically target inappropriate and over-friendly computer correspondence between students and teachers. ``We're seeing an increase in it and it has to be specifically addressed," she said. ``That should be in both the code of ethics and in professional development courses for teachers."

Under proposed changes, teachers would be banned from becoming friends with students on social-networking sites. Ms Howe said she would take the matter to the WACOT board. She revealed that online behaviour was central to half the investigations conducted by the committee in the past year.

WA Council of State School Organisations president Rob Fry last night agreed that any cyber contact between teachers and students was fraught with problems. ``I do know that there have been issues where teachers have gone down this track and it has caused some very distressing problems," Mr Fry said. ``The problem for a teacher can be that they form a close relationship of a platonic nature that unfortunately can get misinterpreted. ``Once the damage is done and the finger is pointed, the mud sticks. ``There has got to be a barrier between the relationship of a student and a teacher. ``That barrier cannot be crossed."

Catholic Education Office of WA director Ron Dullard said his schools already banned teachers from becoming friends with students on social-networking websites. ``It is covered by our internet protocols and relationships with students," he said. ``We would see that it would be inappropriate for it to occur. ``Teachers shouldn't accept students as a friend unless it is a relative." Mr Dullard said internet guidelines for teachers at Catholic schools were revised every two years to keep pace with the changing medium.

Some independent WA schools have started advising teachers against creating personal profiles on websites such as Facebook or MySpace. Association of Independent Schools of WA executive director Valerie Gould said teachers were told to remember that any information on public websites could be accessed by students and parents.

Education Department boss Sharyn O'Neill said teachers and staff must maintain appropriate boundaries in their relationships with pupils. ``The department expects teachers to exercise common sense and act on the side of caution when dealing with students," she said. The Education Department is reviewing its code of conduct for teachers.


A typical Telstra experience

I too have got this sort of "service". One overseas helpline operator could not understand what I was saying at all so just hung up on me. Sheer arrogance. I should have been referred to someone higher up, preferably back in Australia

Like most horror stories, this one begins with an everyday setting where the familiar gradually gives way to the sinister. The first harbinger of the pain to come, not recognised at the time, was a letter sent out to me and millions of other Australians on July 20 by Ramon Gregory, "Executive Director, Customer Sales and Service", at Telstra, Australia's largest service company. This places Gregory at the centre of an enormous commercial machine, with huge databases, thousands of operators in call centres, and billions of customer inquiries recorded with Orwellian efficiency.

A study of the conditions in call centres conducted by Ruth Barton of RMIT University, released last week, found high stress levels and oppressive management control, as call centres field an average of 16 million calls a day.

Ramon Gregory's letter was also oppressive. It announced that people who paid their Telstra bill by return mail, or in person, or by credit card, would in future be charged a $2.20 "payment administration fee". He suggested various ways to avoid the fee, which actually did not avoid the fee at all. The letter was so infuriating and so poorly drafted that Telstra customers made their displeasure known in an outbreak of spontaneous combustion. Telstra rescinded the fee earlier this month.

But the company's latent aggression remains. Last Wednesday, my internet service was cut off by Telstra even though I have paid my bills on time, year-in, year-out, with a Telstra home phone account, and a Telstra cable account, and a Foxtel account. My bank statement shows Telstra banked my latest cheque on October 19. I had assumed I would be treated as a valued customer and notified before any drastic, summary action took place. How naive.

Telstra has shown, repeatedly, that it does not grasp the concept of political and consumer blowback. That's why the Rudd Government is destroying Telstra's market value, and why I have the Telstra support number, 133 933, programmed into my mobile phone, because losing service is part of the Telstra experience.

When I called Telstra's inquiry number at 9am last Wednesday, I got a "consultant" called Craig. When he turned out to be a drama queen, I began taking notes. When I suggested that Telstra should have contacted me before taking such draconian action, given my long history of reliability, Craig threw a tantrum. "You can't expect us to send out 50,000 notices to people," he said. Yes, I do. It's part of the service.

"You have to step up to the plate!" Craig replied. "It's your responsibility!" I asked him why he was treating me like a retard. He directed me to "credit management". I called credit management and got a message: "All our operators are busy. You have been placed in a queue." I was not surprised.

A heavily-accented young man came on the line and gave his name as "Matt". I realised I had been directed to a call centre in India when Matt insisted my name was not Sheehan. After he had called me "Mr Goodhope" three times I hung up.

The next operator was "Beau". He, too, was Indian, and simply not coherent. I politely abandoned the call and tried again. Next on the line was "Chari", another Indian. He was the first person I could describe as pleasant and competent that day. He set up a direct debit payment system for future bills, took care of the small outstanding amount, and thanked me for the call, the first of the five Telstra operators to do so. He said my service would be quickly restored.

It was not. It was still blocked the next day. And so the merry-go-round resumed. I was directed to technical support, because the billing department said there was no problem. A technician told me to switch off my modem and then try again. That did not work.

I called the original number again. Another heavily accented operator eventually responded. Her name was "Marie". "Are you in Australia?" I asked. "No," she replied. She told me I could not have my service restored because my account had not been paid. "You need to speak to the billing department." I told her I had spoken to the billing department at great length. She was adamant.

I called the billing department and Kirsty came on the line. She was working from a call centre on the Gold Coast. When I explained that she was the eighth person I had spoken to in two days, and my account was fully paid, she put me on hold and got someone further up the food chain. When she came back, she said the problem was a "shadow" payment system, which was showing my account to be inoperative. Kirsty was a pleasure to deal with, and restored my service.

The real problem was not the shadow payment system. It was the incompetent Indian call centre operators, and it was Telstra's attitude towards its customers. Nothing of my experience will show up on Telstra's key performance indicators.

And Ramon Gregory, it turns out, is yet another American brought in to run Australia's service giant. That explains his tin ear. I received another letter from him on Friday: "Telstra is reinventing the home phone," he proclaimed. He was selling an upgrade called the Telstra T-Hub. I'm interested in going in exactly the opposite direction - getting rid of the Telstra fixed line altogether. And that's just the start.

By the standards of global telco giants, Telstra is an efficient, productive enterprise, but you have to ask at what cost to us, the people who used to own the company, and are now the company's serfs?


Unbelievable: New South Wales shark spotters gagged

Someone should drop Nathan Rees into the middle of a pack of sharks at this rate

Helicopter shark patrols over NSW beaches this summer will be gagged by the State Government, which last year kept secret warnings about the predators. Despite New South Wales Premier Nathan Rees's promises of open and transparent government, secrecy demands are part of the tender documents for a trial of government-funded helicopter surveillance this summer.

The tender document includes the condition: "Neither the contractor nor crew shall communicate in any way with any media organisation or media representative concerning any aspect of aerial surveillance shark patrol trial without the express written authority of I&I NSW, and must refer all such inquiries to the I&I NSW Media Unit." I & I NSW is the state government department Industry & Investment NSW, based in Orange.

Primary Industries Minister Ian Macdonald, sacked by Mr Rees last weekend, did not mention warnings of unusually high shark numbers last summer by a privately funded chopper patrol. Within months of the warnings he kept secret, there were three serious shark attacks in Sydney. The trial patrols beaches from December 19 to January 10.


No ambulance service: Uproar as patients must travel in the back of a truck from a Queensland country town

The interesting thing about this story is that it represents a deterioration of service. In earlier times, there was a regular railmotor service on which patients could be transported in some comfort. The railway line is still there but it is used for occasional tourist outings only. The budget of Queensland Health must have increased at least 100 times since then but the service is worse

THE sick and injured are being carted to the Mt Surprise airport on the back of trucks and utes [pickups] because the town does not have a helipad or suitable patient transfer vehicle.

The rural community, 290km southwest of Cairns, is demanding the State Government provide the basic services after a patient's trauma, following a serious accident, was increased because of the situation. In the most recent example, a patient was loaded on to the back of a ute and was subjected to an excruciatingly painful journey on the rough 5km trip. Open-sided trucks have also been used.

Outraged Mt Surprise resident Rick Tomkies told The Weekend Post these incidents highlighted the need for a suitable transfer vehicle and a helipad in the community. "Not only is the carriage of persons on the rear of a vehicle illegal but it could also cause further trauma to a seriously ill or injured person with serious consequences," he said. "Already there has been an occasion when an attending Royal Flying Doctor was injured by a flapping tarpaulin, used to shade a patient from the sun. And on another occasion, the legs of a patient became sunburnt."

Mr Tomkies said police figures showed the Mt Surprise area had a higher rate of medical evacuation rates compared with neighbouring communities and it was vital the standards were lifted to an acceptable and legal level.

A spokeswoman from Queensland Ambulance Service said the organisation recently held a community meeting at Mt Surprise to set up a first responder unit in the area. "The community were very supportive of the development of this group and several residents were identified as possible members for a first responder unit," she said. "QAS approved the application to develop a first responder unit in Mt Surprise in September and the establishment of the unit in the area will occur over the coming months."

A Department of Main Roads spokesman said: "The question of whether or not a helipad should be built at Mt Surprise is an issue for the Etheridge Shire Council". "Should Council decide to construct a helipad, the Department of Transport and Main Roads would be happy to discuss with them possible avenues for funding assistance," he said.


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