Australia is in the midst of a Federal Election and for the next 3 weeks we are going to be hearing a lot of promises being made.
Reflecting on this election I’ve been thinking about the similarities between some of the medical consultations I conduct and electioneering.
Many patients come to me wanting be to impart hope. I might get them to live just that little bit longer by giving a new chemo or drug treatment. In political terms this is the promise of money. If you re-elect me I’ll give your electorate/community/organisation X million dollars to build Y & Z. Or I will cut a tax and reduce an expense.
But we (the electorate) are not iterate about these matters. We aren’t prepared to accept the real story…..that throwing some more dollars into the ring isn’t going to change much..it could ecen be wasteful. In the same way many patients are pursue the path that offers hope even though, in reality, the solution offered has little chance of changing the overall situation.
The politicians probably do actually understand the reality of the situation but they choose to play politics. The doctors also understand the reality of situations and either choose not to or are unable to communicate it effectively to patients.
The underlying problem in both circumstances concerns literacy. The economically literate would say you can’t increase spending without increasing revenue (aka taxes). Likewise the health literate individual would be able to acknowledge you sometimes run out of options.
National Health Care Reform, and in fact all of Australian government, is built around the principle of subsidiarity – i.e. that delivery and implementation of services, and decisions concerning services should be made as close to the ‘coalface’ as reasonably possible. This has resulted in the creation of local health districts or LHD. The LHD receive a mixture of State and Federal funding that is predominantly administered through State ministries. The LHD governance consists of a Board and a CEO with his/her executive team.
The remit of the LHD Board is to ensure good management of the district and philosophically the Board must protect, and indeed pursue, the interests of the local community. At inception the CEO were appointed by the States rather than by the Boards and the Chairmanship of the Boards, albeit voluntary, was also essentially at the discretion of the States.
The CEO has in effect two masters – the State Ministry of Health and the Board. The CEO is bound to try and achieve the performance targets set by the State. At the current time these are largely around activity based funding. The CEO and Board and hospitals must bring the budget in on target.
The problem for hospitals and their Boards is that hospitals new improvement, renovation and redevelopment. States tend to do little to cater for recurrent infrastructure related capital expenditure so the LHD must compete politically and make the case why their institutions are more deserving than others (that might be in more politically sensitive electoral seats). The Board has a responsibility to the community it serves to try and advocate for its’ cause. The CEO should support the actions of the Board but must also accommodate the bidding of the State and not cause embarrassment for it.
We must be recognize these issues but also manage them. The Board must not let the the CEO control its’ agenda. The Board must manage the performance of the CEO and be prepared to penalise him/or for failing in either management of the LHD budget or in advocacy for the LHD.
Congratulations to Barack Obama for his Nobel Peace Prize. His critics are partially correct in saying that the concrete achievements are still thin on the ground but they really are missing the point that it is his inspiration which is getting people to talk about the issues. His critics are the barrier to any changes and have not themselves done anything to address the issues that concern the Nobel selection committee.