Thursday, January 21, 2010

Doctors highlight a cancerous medical bureaucracy in Queensland

Medicos wage war on billions wasted on bureaucrat jobs

AUSTRALIA'S peak medical group will demand Queensland Health stop hiring bureaucrats as part of a new name and shame campaign targeting the hundreds of millions of dollars it claims are being wasted in hospitals. The Australian Medical Association will today unveil a "War on Waste" campaign in a bid to highlight problems in the beleaguered health system, ahead of proposed reform by the Rudd Government later this year.

AMA Queensland president Mason Stevenson last night told The Courier-Mail the campaign would attempt to pressure both the state and federal governments to act on health reform, given an estimated $4 billion was being wasted nationwide. The group claims, for example, one in 10 surgery patients is admitted to hospital and prepared for surgery but discharged before their operation because of a lack of theatres. "The wastage is widespread and is costing lives," Dr Stevenson said.

The move comes amid a heated debate over a proposed federal takeover of hospitals, with the Rudd Government still considering recommendations from a top-level report.

But the Bligh Government last night produced a letter written last year by Queensland Health director-general Mick Reid asking to consult with the AMA about red tape. It claimed that request has been met with silence from the AMA.

The AMA campaign includes a list of questions Queensland Health will be asked to answer within two weeks, including how much extra hospital floor space bureaucrats have been given in the past decade. The AMA has also called for a moratorium on hiring bureaucrats, saying department figures showed the number of administration jobs had swollen from 5060 to 13,645 positions since 1995. Doctor jobs, meanwhile, had risen from 3095 to 6715 positions.

But Health Minister Paul Lucas defended the administration staff, saying they were crucial to taking paperwork from doctors and nurses who had been hired in record numbers. He instead accused the AMA of trying to introduce its own red tape and waste. "The AMA criticises Surgery Connect now but this is just sour grapes from an organisation that in 2006 supported the initiative and wanted to charge the State Government a $1.7 million 'management' fee to administer the program," he said. "Every hour of paperwork taken out of doctors' hands by booking clerks and patient liaison officers is an extra hour spent treating patients."

But Dr Stevenson said a moratorium was necessary to stop wastage.


A "Soviet style" hospital bureaucracy in NSW

Over the past 18 months I have spent an inordinate amount of time in public hospitals in NSW, not as a patient but as a witness to the ordeals of family members. There were multiple trips to the emergency department - where elderly people were piled up in corridors - and wards in which four very sick people crammed in one room managed to be pleasant to each other while overstretched nurses remained cheerful and the doctors adept.

There was the hand clinic with an inexplicable waiting time every week of four to six hours, but with world-class doctors fixing broken fingers for free, and the deserted endocrinology clinic, which a specialist opens by himself on Saturdays so his sickest patients don't have to wait.

I walked along deserted corridors at night and marvelled at how such a massive, ingenuity-sapping bureaucratic institution somehow still manages to save lives and bring out the best in people who work there. Two things were notable: first, the professionalism, expertise and good humour of most doctors and nurses; and second, the extent to which they must work around a government bureaucracy of Soviet-style ineptitude. Their successes are in spite of the system, about which they are openly scathing.

How did our hospitals become so remote from the needs of patients and the good sense of medical professionals? Two doctors with a combined total of more than 80 years in the NSW public hospital system, and a passion for public service, are speaking out about their experience of the "chaos, tragedy and sometimes downright farce" they have encountered in the second half of their careers.

Dr John Graham, the chairman of the Department of Medicine at Sydney Hospital and Sydney Eye Hospital, and Dr X, a staff specialist physician at a large hospital in the Northern Tablelands, (who cannot give his name for fear of being sacked) say the problem is not a lack of funding but the dead hand of bureaucracy. They have prescribed the remedy to restore public hospitals to their former place among the most trusted and well run institutions in the country: to reinstate local autonomy, with independent hospital boards taking full control of the budget.

Dr X, who is also a senior officer in the army reserve who served in Rwanda, Afghanistan and Banda Aceh after the tsunami, knows a thing or two about organising medical teams. "I have an appreciation of organisations, of command and control, of man management and of assessing clinical priorities and planning for them," he says. "In criticising the Department of Health, I am not an anarchist or privateer; I believe in our public institutions."

He says the amalgamation in 2004 of the Hunter and New England Health services into one giant administration was "an absolute disaster". "I can honestly say that in my three decades here I have never seen the system more dysfunctional. It just gets more and more bloody difficult."

His hospital is so stretched for doctors he has been without a day off and on call every second night since November. In an impassioned letter written on New Year's Eve while he was on call, he stated: "At the moment I have no resident medical officer, no registrar or secretary. I am expected to be all of these. "Meanwhile, in hospital I have patients waiting for investigations and treatment which will not be available for several weeks [due to holiday closures]. I am being pressured to discharge patients before they are ready, and to not admit patients who should be admitted.

"I am supposed to compromise patient care in order to save the hides of non-clinical incompetents who make irresponsible decisions without any consultation or consideration of the likely consequences. "Such a situation would never have occurred when communities had 'ownership' of their local hospitals and governed them though their local hospital boards . . . "And it is not as though the Hunter-New England Area Health Service is short of money; with a budget of $1 billion dollars, you could be forgiven for thinking that the staffing of its hospitals with appropriately experience doctors would be a priority."

Like Dr X, Dr Graham traces the rot back to the 1980s and 1990s when local hospital boards were replaced with area health services. In a policy paper for the Centre for Independent Studies in October, he argued that "the disastrous reorganisation of public hospital administration over the past 25 years needs to be reversed". Decision-making in hospitals used to be quick and effective, but now "funding is not spent optimally and trust, co-operation, morale and institutional loyalty has been sapped . . . Resource misallocation involving extraordinary growth in the size and cost of the bureaucracy has led to a massive waste of taxpayer's money."

The bimonthly department meetings that he attends at Sydney Hospital show how dysfunctional the system has become. "The department's time is mainly occupied in dealing with centralised directives issued by the South Eastern Sydney and Illawarra Area Health Service and NSW Health . . . Doctors and nurses these days are forever wasting time and energy complying with the new sets of orders issued by an intrusive, arbitrary, and seemingly unaccountable bureaucracy." For instance, there are new rules issued to medical staff every day about everything from handwashing to how to write a blood test request or talk to the grieving relatives of a patient. "They're constantly telling you your business," Dr Graham says.

And if you buck the system, "there is a lot of heavy-handed pressure brought to bear, especially on younger doctors and nurses. NSW is really like what it would have been in Moscow 20 years ago." Dr Graham, who is semi-retired, says that he is able to speak out because he is in the "lucky situation where they can't hurt me".

In an indication that the deteriorating state of our hospitals will be a major election issue, the Australian Medical Association this week called for wide-scale health reform in its submission to the 2010 budget. It's about time someone listened to the doctors.


Prince William popular in Australia

Yesterday, from his impeccable performance on an Australian Army rifle range to his conversation with a disadvantaged youngster about rap music - an exchange which passed off more successfully than anyone might have imagined - William gave the impression of a Prince who could do no wrong. The newspaper headlines are already the stuff of which St James's Palace could scarcely dream. "King of the Kids" said one front page about his meeting with a group of children; "How Willie Wombat charmed The Block" said another about his visit to the deprived inner city suburb of Redfern.

Before he had even started William appeared to have won over the female population of Sydney; yesterday it was his chance to see if the Army was as easily impressed. At the firing range at Holsworthy the Prince, who has spent four and a half years with the Armed Forces, shot at targets 100m away with an F88 Austeyr - a rifle he has never used before - and a Minimi machine gun.

Getting his shots within a spread of 150mm would have been deemed a pass; Prince William got his down to 104mm. "For someone who has just picked up a weapon that is excellent," said Lance Corporal Peter Phillips, a section commander with Alpha Company of 3 Bn Royal Australian Regiment. "If we had a soldier that came in on the first day and did that they would be a master shot in a couple of weeks."

At a homeless centre the Prince - and Prime Minister Kevin Rudd - was treated to a rap performance by four disadvantaged young blacks. "Awesome!" said the Prince. "Get them signed up straight away!" Asked about his own taste in music, William said: "Mine is very varied. A bit of rock, a bit of Linkin Park, Kanye West." "That's my man!" said Austin Anyimba.

After the laughter died down, the Prince added: "I've done something right then. Quite rappy. I cannot do beat box. I normally get a bit of stick for my interest in music."

Chris Reason, who has been covering the visit for Channel 7, said: "He is doing exceptionally well. That moment at Redfern was absolutely historic. For someone of his stature to go there was deeply appreciated. "He is carrying on the legacy of Diana in so many ways. Australians are a cynical and hard bunch with a republican streak. But they have a genuine affection for this member of the Royal Family."

SOURCE. More detail here and here

Does Monckton go too far?

Janet Albrechtsen says that Lord Monckton should not call Warmists Nazis and Communists even though Warmists frequently abuse skeptics that way. She may be right

IS it too much to ask for a measured climate change debate in 2010? Looking back at 2009, it's hard to think of a more frustrating debate than the one about anthropogenic global warming.

One side says the science is settled and will not countenance dissent. Within that group sit the alarmists who preach death and destruction, those who define humanity as the problem and those who have long harboured an ideological grudge against Western progress. Those on the other side of the debate say man-made global warming is all bunkum. Though they describe themselves as sceptics, for many of them the science is equally settled: in their favour.

And in between is a far larger group of people, those who are open-minded and genuinely sceptical, who are trying to understand the debate as best they can. Yet frustration only grows at the extremism on both sides.

So what will Christopher Monckton bring to this exasperating state of affairs? The former adviser to Margaret Thatcher is in Australia next week, speaking about the flaws of the push for a global solution to global warming. Last year, Monckton blew the whistle on a draft Copenhagen treaty that political leaders seemed keen to keep away from the prying eyes of taxpayers, who will fund the grand promises.

While nothing concrete came out of Copenhagen, the push for global commitments and a foreign aid bonanza continues. And in this respect, Monckton has plenty more to say. He has written to the Prime Minister outlining legitimate concerns that billions of dollars will be wasted on a problem that does not exist.

When Monckton talks about the science he is powerful. Watch on YouTube his kerb-side interview of a well-meaning Greenpeace follower on the streets of Copenhagen last month. With detailed data behind him, he asks whether she is aware that there has been no statistically significant change in temperatures for 15 years. No, she is not. Whether she is aware that there has in fact been global cooling in the past nine years? No, she is not. Whether she is aware that there has been virtually no change to the amount of sea ice? No, she does not. Whether, given her lack of knowledge about these facts, she is driven by faith, not facts. Yes, she is driven by faith, she says.

To those with an open mind, Monckton's fact-based questions demand answers from our political leaders. To this end, he will impress his Australian audience over the next few days. Unfortunately, while Monckton has mastered the best arts of persuasion, he also succumbs to the worst of them when he engages in his made-for-the-stage histrionics. In Copenhagen, when a group of young activists interrupted a meeting, he berated them as Nazis and Hitler Youth. Elsewhere he has called on people to rise up and fight off a "bureaucratic communistic world government monster". This extremist language damages his credibility. More important, it damages the debate. You start to look like a crank when you describe your opponents as Nazis and communists. You can see how it happens. Talking to a roomful of cheering fellow travellers, the temptation is to hit the high gear of hyperbole. But if your aim is to persuade those with an open mind, this kind of talk will only turn people away. Warning people about the genuine threat to national sovereignty from a centralised global-warming bureaucracy is one thing. Talking about a new front of communists marching your way is another. It sounds like an overzealous warrior fighting an old battle.

The debate about global warming is as much a political debate as it is about the science. Writing in Macleans earlier this month, Andrew Coyne highlighted the errors made by the global warmists who deride their opponents. "If your desire is to persuade the unpersuaded among the general public, the very worst way to go about it is to advertise your bottomless contempt for your adversaries. That the IPCC scientists reacted in this way shows how unprepared they were, for all their activist enthusiasm, to enter the political arena."

The great shame is that those on the other side of the debate are making precisely the same error. And that is why Monckton's fact-based concerns are left unaddressed by our political leaders. They have sidelined him from debate. Kevin Rudd has not responded to his letter. Tony Abbott will not meet him. Neither should he. There is no political gain for the Opposition Leader in doing so.

And the reason is clear enough. Inflationary language deflates an argument. Moreover, Monckton is making the worst political error at the worst possible time, right when this debate is slipping from the control of those determined to punish countries for their carbon emissions. Even The Guardian's resident alarmist George Monbiot admitted last November, "There is no point in denying it: we're losing. Climate change denial is spreading like a contagious disease."

It's neither denial nor a disease, of course. Just healthy scepticism. And it's growing in all the right directions for all the right reasons. Scepticism about the science: the revelation that scientists massaged data to suit their case has damaged the public's trust in the scientific community. Scepticism about the costs: after Copenhagen, we now know more about the grab for a new gravy train of foreign aid from developed nations set to flow to developing countries under the cloak of climate change. Scepticism about the government: the Rudd government will come under increased pressure to explain its rush to implement an emissions trading system ahead of the rest of the world. And scepticism about the role of a campaigning media: even the BBC Trust has called for a review of the BBC's cheerleading coverage of climate change. What took it so long? Large sections of the Australian media are no less complicit in the same kind of climate change advocacy.

In 2010, healthy scepticism will continue to rise against the global warming alarmists. But only if those such as Monckton treat the public with respect by sticking to the facts and using measured language, not fanciful claims and name-calling.


1 comment:

rloader said...

I agree. How about telling Lord Monkton! or his organizers. I will
send you the e-mail advising where he will be speaking.