Media Transcript - Dr Glasson discusses Productivity Commission Call for Health Review

                                               Surgeons say that operating theatres are lying empty while their waiting lists are getting longer, we've had reports of Royal North Shore Hospital over the last couple days, where there seems to be a sort of civil war going on between the medical staff and the administrators, and in some cases between surgeons and anaesthetists.  And so on and on it goes.

                                               The Federal Productivity Commission has now bought into the act, or they will this morning, calling or suggesting an independent review of the entire health system.  Now the Productivity Commission advises governments on how to make the economy more efficient, and they say in this case that reforming the health system could go a long way to doing it, and this is what their report will say: 

                                               "It is now generally accepted that Australia's health system is beset by structural problems that require nationally coordinated action.  But there is less agreement on the best way forward.  An independent review of the whole system is needed to provide a road map for reform". 

                                               Now that's what a lot of doctors, and the State Governments, have been pushing for a while.

All the State Premiers and Health Ministers, OK, they're all Labor, but they're saying we need a full scale, overall sweeping inquiry into the health system.  Surgeons have been saying it as well.  You've heard me speak to Professor John Dwyer from Prince of Wales about that time and time again, it's what he says is necessary.  For some reason the Federal Government seems to keep resisting, I don't know why. 

                                               Let's take another look at it this morning, Bill Glasson, Doctor Bill Glasson is the president of the AMA, good morning.

BILL GLASSON: Good morning Mike, how are you, mate?

CARLTON:                            I'm fine, good to talk to you.

GLASSON:                            Good.

CARLTON:                            Do you think we need a full-scale root and branch review of the whole thing?

GLASSON:                            Yes, I think we do Mike, I think that essentially the system is - as I said, we've got a good system in this country, we've got the best system in the world, but there are pressure problems particularly and obviously around the public hospitals, particularly in relation to aged care and that sub-acute care, and also to try and rebuild our primary care sector around the general practitioners.  So we do have major issues with the system, a lot of those as you've indicated are around the workforce, around the lack of doctors, lack of nurses, and probably lack of coordination, or lack of streamlining between the different interfaces, that's public, private, aged care, acute care et cetera. 

                                               So I commend the Productivity Commission for making this move, all I ask is that they get the input from the people on the ground who actually provide the services, and that's the doctors and nurses and the people who actually run the system, because at the end of the day we've got to make sure that the dollars we spend, we spend most appropriately, and to make sure that people out there who need care get it in a timely and appropriate manner.

CARLTON:                            Yes.  Every time you look at this it seems to get back to the root cause, which is our Federal system.  The States blame Canberra, Canberra blame the States, various governments are responsible for spending, you know, various parts of the taxpayer dollar, there seems to be a total confusion about who is actually running the show.  Is that so?

GLASSON:                            That's exactly right, there's no clear lines of accountability Mike, and as you know, the buck passing and blame shifting that occurs drives us as clinicians mad, because we want to be able to point the finger and say listen, the buck stops with you, you're the one that's supposed to deliver, you haven't. But at the moment we in fact can't point the finger because they just simply pass, you know, from State to Commonwealth, Commonwealth to State, and they're trying to drag money from one system to another, and it's not in the interests of good patient care.  And I think we can do things smarter and as I said, make the system accountable to those who - you know, for the taxpayers who provide that money.

CARLTON:                            Yes.  Bob Carr floated the idea the other day of handing over state control of hospitals to the Commonwealth to run. Does that make any sense to you?

GLASSON:                            Well I mean, I think the important thing to say there, just because there's one funder, doesn't mean that necessarily all the problems will be solved.  I think that the State and Commonwealth can still run the system, but they've got to have clear lines of accountability, and the trouble at the moment is they don't, and so whether at the end of the day we go through this review and decide that yes, we do need one funder, then so be it.  But I don't think people - I think people must realise that just because we've got the Commonwealth funding the system or the State funding the system, that all the problems will disappear.

CARLTON:                            But it does make - if one government is responsible it makes that government accountable, surely?

GLASSON:                            Well it does Mike, you're correct, you're absolutely correct, and the buck has to stop then with one level of government.  I mean, I don't know whether the Commonwealth really wants to take it over

anyway, I think the reality is there's a bit of politics being played at a State level obviously, because of the forthcoming election, but if at the end of the day we review all this and say listen, this is really the best way to have it, is to have one system and one funder, then so be it.  But we need to debate around this issue, because I'd hate to think we go through all this reform and then have a system that's not even functioning as well as the current one is.

CARLTON:                            Yes.  Now this Productivity Commission is particularly concerned apparently about health care for our ageing population, which will over the next decade add billions of dollars to the bill for the taxpayers. What needs to be done there?

GLASSON:                            Well you're right, I mean essentially we're getting older by the year, so to speak, and we'll have increased medical demands for that group as we age.  We've got increasing technology, increasing expectations, so there'll be an increased pressure on the system across the board.  So I think we've specifically got to look at that group, and make sure that they can get appropriate care in a timely way.  I don't think we should see that as a threat, I think it's an opportunity here to make the system better, to ensure particularly that the interface between acute care, aged care and primary care gets sorted out, because if you can provide more care at the primary care level, and particularly at that sub-acute level, that's where the best bang for the buck is. 

                                               Treatment in major public hospitals is expensive, and a lot of those patients who end up in major public hospitals shouldn't be there in the first place, and I think we've got to ensure that we have a system that is flexible, so that patients can move freely from one system to the other, and not be hung up because there's a different funding mechanism, you know, between systems.

CARLTON:                            Yes.  Well that's part of the problem.  So you can free up beds for emergency and critical patients, and with elderly folk looked after properly in nursing homes.

GLASSON:                            Exactly right.

CARLTON:                            So would you be then asking, pressuring, requesting, advising the Federal Government to have this full scale inquiry?

GLASSON:                            Well I think we do need a major inquiry into the whole system, and I think that would be a very commonsense thing to do, obviously, given the ageing population, and we'd certainly be supporting any review of the overall system, to make sure we make the system even better.

CARLTON:                            Good to talk to you, thanks very much.

GLASSON:                            Thanks, Mike.

CARLTON:                            Thank you kindly.  Doctor Bill Glasson from the AMA, the AMA president.  I would have thought it was so bleeding obvious to have a full scale inquiry, I cannot see why the Federal Government is resisting the idea, maybe they're worried about the cost or whatever, I don't know. But surely the cost to the health system is now rocketing out of control. 

            You and I know it, you know, we're not stupid, we're taxpayers, we can see it, and yet every time you get to one of these stories, you talk about the health care system or shortage of beds in hospitals, or ambulance waiting times, or emergency wards packed to the doors, and you and I both know that the Commonwealth will blame the States, and the States will blame the Commonwealth.  It is the politicians' job to bloody-well fix it, is it not?  That's what they're there for.  We have nine Ministers for Health in this country, and sometimes you wonder if any one of them is even worth feeding.