Tuesday, October 02, 2012

A bloated public service not healthy


IN order to avoid the winter chills of Melbourne, I hang out in Queensland quite a bit these days. A few weeks ago, I was tuned in to the evening news to be told that the LNP government was planning to cut 1500 jobs in health.

Gosh, I thought, 1500 jobs sounds quite a lot. So I decided to find out how many people are employed in Queensland Health. The answer is more than 80,000. Annual natural attrition would account for more than double the proposed job cuts of 1500, which represent a mere 1.9 per cent of total employment.

But here's the rub. A decade ago, employment in Queensland Health stood at 49,000. So in 10 years there has been an increase of more than 32,000 employees - an increase of two-thirds.

But here's a further rub. Whereas the number of nurses in effective full-time terms increased by 65 per cent over the decade, the number of managerial and clerical staff rose by 103 per cent during the same period. There are now nearly 15,000 managers and clerical staff in Queensland Health, a fair proportion of whom hang out in the head office in Brisbane.

The observant reader might make the point that Queensland's population has grown over that time; indeed, population growth has been higher in Queensland than in Australia as a whole. However, the average annual growth in the number of Queensland Health staff has been well over two times higher than the growth in the population.

The media, particularly in Queensland, has been making much of the supposedly "savage" job cuts being implemented by the LNP government, in part picking up the campaign being waged by the trade union movement in the state. What is less often reported is the fact the Queensland public service had been growing at a ridiculous rate under the Bligh Labor government, which had in part led to a 10-fold increase in the state's debt and the downgrading of its credit rating.

As Ken Wiltshire, an expert in public administration, and a Queenslander, pointed out on this page last week, there "was a blowout in the amount spent on public servants across the past decade, at 8.7 per cent a year. Of that, 3.5 per cent was attributed to the number of employees and 5.2 per cent to growth of wages.

"All this is far higher public expenditure growth than the national average."

A very dubious arrangement also emerged in the Queensland public service in which a category of "permanent temporary" staff was created. Many of these permanent temporaries are - quite legitimately - being targeted by the LNP government.

Into this politically toxic atmosphere, made worse by lazy journalism, the federal government has now weighed in with its unbelievable epithet: "We make hard decisions, but we focus on finding efficiencies. The Coalition slashes jobs." But is Penny Wong really telling the truth?

The first point to note is that if there are all these inefficient practices in the federal arena, why has it taken the Labor government five years to do something about them? The second point is that shifting the budget from a $44 billion deficit last financial year to a $1.5bn surplus will not be achieved by shaving a few dollars off printing costs or making senior public servants travel cattle class. (I wonder whether the politicians will also be made to travel down the back of the plane - I don't think so.)

But the most important point is this year's budget explicitly plans for a cut of 3073 in the average staffing level of agencies in the Australian government general government sector - a cut of 1.3 per cent (not much lower than the planned cut to Queensland Health).

And with the super-efficiency dividend of 4 per cent being imposed on government agencies, the number of job cuts will be higher again. Indeed, it is entirely plausible the number could be double the planned reduction of 3000. So, yes, the federal Labor government also slashes jobs; it should just be more explicit about it. Having been told by Kevin Rudd that the "reckless spending" must stop and that a "meat axe" would be taken to the "bloated" public service, in government, Labor went weak at the knees.

The Australian public service has grown by an average of just under 1 per cent a year since the Labor government has been in office.

Evidently, the meat axe was very blunt. It is only now that job cuts are being made.

Returning to the Queensland situation, the LNP government has no alternative but to push on with its planned reduction to the size of the public sector. But in order to sustain a smaller public sector, more thinking needs to be done about the future of particular activities and programs. The experience of the Howard government was that initial cuts to public sector jobs are only temporary, unless constant attention is paid to limiting new spending and new programs.

Ever keen to play politics rather than prosecute good public policy, federal Workplace Relations Minister Bill Shorten has also decided to become involved in Queensland politics by proposing an amendment to the Fair Work Act to limit the ability of the Queensland government to contract out work.

Shorten's idea is that there will be a new transmission of business provision in the act that will mean any public servant who shifts to work for an outside provider of government services must retain all employment conditions.

He really should know better. He obviously hasn't been paying any attention to the successful outsourcing of employment services, which is undertaken by the federal government through his own department.

Just because there is a case for governments to fund, in full or in part, particular services for eligible persons does not mean that those services have to be provided by permanent public servants. Indeed, present thinking - and this applies to how the National Disability Insurance Scheme will operate - is that competitive outsourcing of many government services leads to both superior offerings and cost savings.

It would not be a surprise if the Queensland government were to give serious consideration to withdrawing the referral of its IR power to the commonwealth government. If Shorten is intent on interfering with the ability of the LNP government to rationalise and reform the public service on its own terms, such a move by the Queensland government makes sense.

The bottom line is the public service, both federally and in a number of states, has become too large and needs to be trimmed. In making the job cuts, it is also important for governments to analyse the rationale behind spending and to concentrate on those areas where there are very high net public benefits.

Experimentation with different means of delivering taxpayer-funded services should also be part of the mix.


Freedom of speech gets a hearing as street preachers challenge law

A LANDMARK High Court hearing which could enshrine freedom of speech in the Australian Constitution will be heard on Tuesday.

Thanks to Adelaide's controversial street preachers, the challenge could see free speech recognised as a Constitutional right  - comparable to the US First Amendment - and trigger a rewriting of state and council laws that were drafted to stop people being able to "preach", "canvass" or "harangue".

Tuesday's hearing in Canberra has such widespread ramifications that South Australia's Attorney-General has been joined in the matter by the Attorneys-General for the Commonwealth, NSW, Victoria, Queensland and WA.

The Human Rights Law Centre has sided with the Adelaide street preachers Caleb and Samuel Corneloup.

High Court Chief Justice Robert French has made it clear the hearing will be about legal principles rather than religion, telling the preachers: "It will not really be anything to do with, as you would appreciate, the merits of your preaching".

At present there is no guarantee of freedom of speech written into the Constitution.

If the court decides in favour of the preachers it may opt for a narrow interpretation limiting such freedom to political speech - but the justices could use the case as a vehicle for a much broader and more significant decision regarding rights relating to freedom of communication.

The case was triggered by anger at the aggressive style of preaching in public spaces such as Rundle Mall.

Attempts to silence the preachers under Adelaide City Council bylaws, saw the preachers appeal to the full bench of the Supreme Court which in August 2011 ruled certain bylaws were invalid to the extent they prevented free political communication.

The State Government appealed to the High Court, with a spokesman for Attorney-General John Rau saying the appeal concerns the ability of the City Council to regulate its streets.

"It constrains the legislative and executive power necessary to maintain the system of responsible and representative government required by the Constitution," he said.

While the hearing is likely to take an hour, a decision could take months.

SA Law Society president Ralph Bonig said the decision had considerable implications.  "The legal community will be interested in the outcome given its potential for the concept of freedom of speech to be implied in the Constitution," he said.

Lawyer Peter Campbell of Kelly and Co. said the case had the potential to drastically alter the legal landscape.  "A number of legal restrictions and permit regimes may be invalid and unenforceable," he said.


Chaos at RNS hospital again

PATIENTS are being left overnight on trolleys in rooms intended for waits of several hours at the crowded Royal North Shore Hospital, a senior doctor says.

Dr Greg Purcell, an anaesthetist at Royal North Shore Hospital for 30 years, said the patients were staying in "inappropriate rooms for inappropriate periods", heightening their risk of inadequate care and spreading infections.

Dr Purcell and other senior doctors interviewed by the Herald blamed the situation on a budgetary method to clear overcrowded wards.

Two rooms - the emergency department's medical assessment unit (intended to hold patients for up to six hours) and the transit lounge (intended as a pick-up area for discharged patients) - had been operating as "pseudo wards", they said.

It has been alleged acute patients were regularly left on trolleys or chairs in the transit lounge for up to 12 hours and in some extreme cases overnight when the hospital has been full, Dr Purcell said.

The emergency department's medical assessment unit is a cramped room with four beds, two chairs and one toilet down the corridor.

"It is as far removed from patient- and family-centred care as imaginable and comprehensively abandons any commitment to patient safety, dignity or confidentiality," Dr Purcell said.

The general manager of Royal North Shore Hospital, Sue Shilbury, denied that patients were kept for more than six hours in the medical assessment unit. She added that "any infectious patient in [a medical assessment unit] is isolated in a single room".

A spokesperson for NSW Health said public hospitals were not routinely "using short-stay units, medical assessment units, transit lounges/discharge lounges for prolonged periods of time".

But the Herald can confirm that three major NSW hospitals are misusing such units: Royal North Shore, Dubbo Base Hospital and St Vincent's.

Dr Tony Nocera, an emergency physician at Dubbo Base Hospital, said due to its overcrowded emergency department, the hospital had been leaving hospital in-patients in its emergency medical unit for several days and longer. The hospital's acting general manager, Debbie Bickerton, said this only happened during "periods of high activity", but Dr Nocera said it happened almost every week.

The Herald revealed a week ago that St Vincent's Hospital was misusing a corridor of beds called the medical and surgical transit unit, which was only intended for stays of less than 24 hours. The hospital has been keeping patients in the corridor for up to six days.

A St Vincent's spokesman has since told the Herald the hospital is trying to "fast-track" a move to a more appropriate facility.

The Health Minister, Jillian Skinner, said: "If any patient has a concern about the care they have received in a short-stay unit, they should raise it with hospital management and it will be investigated".


Skepticism about blood transfusions catching on at last

The bad effects were evident in Swedish research some time ago.  See also here

SURGEONS are being urged to cut their use of blood transfusions, with experts saying the life-saving but risky procedure is being used unnecessarily.

Rates of blood transfusion use differ noticeably between surgeons, and research indicates some are not careful enough to ensure patients don't bleed unnecessarily during surgery.

James Isbister, a professor from the University of Sydney's medical school, said some doctors were using blood transfusions too freely because they believed them to be benign. "If [blood transfusion] is not used appropriately it's got more possible complications than other therapies because you are basically doing a transplant," he said.

"We have talked about alternatives to transplants for years but … a lot of alternatives shouldn't be alternatives - stopping a patient bleeding is not an 'alternative'."

Hospital patients who are Jehovah's Witnesses - who refuse blood transfusions on religious grounds - actually do better than other patients.

Professor Isbister said adherents of Christianity were given better treatment by doctors trying to preserve their blood. As a result they had better survival rates, and shorter hospital and intensive care stays than people who received blood transfusions during surgery.

Studies comparing surgeons have found some used transfusions in only 10 per cent of patients, while others used them in 80 per cent of cases.

Blood transfusions put stress on the lungs and can cause lung injury and organ failure, as well as potentially having long-term consequences, although the reason is unknown.

On Sunday, Professor Isbister addressed the scientific congress of the Australian Society of Anaesthetists about the issue. He said it was also important for patients to consult their GPs before surgery to ensure they had a healthy blood count.

In 2012-13 governments will spend more than $1 billion on blood and blood-related products, according to the National Blood Authority.

Its general manager, Leigh McJames, said while transfusions can be life-saving, evidence showed up to 20 per cent of them could be unnecessary in some patient groups.



No comments: