Transcript: Dr Andrew Pesce, Canberra Hospital, Wednesday 16 September 2009

TRANSCRIPT OF DOORSTOP INTERVIEW, Dr Andrew Pesce, Canberra Hospital, Wednesday 16 September 2009
E &0E

Subjects: AMA Priority Investment Plan for Australia’s Health System, GP Super Clinics, NSW Health Minister

DR PESCE:   
Okay, well, the AMA is pleased to be here today at Canberra Hospital - to have input and to listen to the Prime Minister give a summary of the Government's response to the National Health and Hospitals Reform Commission report.
   
The AMA has used today as an opportunity to - having analysed the report from the Commission - give our priority list as to what we see as the immediate and necessary steps for the Government to make to help kick along the reform agenda in a way which is going to help the Australian community.
   
So we, today, are releasing our Priority Investment Plan for health in Australia and it focuses on seven key areas.
   
There is a reasonable range of areas but we think they're all important, ranging from the need to improve resourcing in Indigenous health, recognising the need for further infrastructure development, and support for general practice as the centre for primary care initiatives in the reform agenda.
   
Very importantly and centrally, ending the blame game - finally taking responsibility for a single funder to fund the public hospital system so that we don't have the cost and blame shifting that the Prime Minister, himself, referred to in his talk today.
   
We need to focus very much on workforce planning.  There isn't a robust workforce planning system in place at the moment so that there is a dislocation between what we know that we can provide with our medical graduates, and the training that's being given in the hospital system and general practices to make sure we have effective doctors serving the community in the future.
   
We, once again, remind people and remind the country of the forgotten people, those that seem to have somehow slipped off everyone's priority list.
We need to remind ourselves of the extra effort that needs to be made to improve delivery of health in the areas of mental health and mental health patients, for rural and remote communities that always seem to miss out. And long-term care for our disabled people who don't get cared for unless their families pay the price.
           
So, I am happy to take any questions.

QUESTION:   
Dr Pesce, you want a single funder for hospitals - is that the Federal Government or the State Government and who do you actually want to run them?

DR PESCE:   
We want the Federal Government to fund the health system.  We don't believe the Federal Government has the capacity or experience to actually run hospital services. But it does substantially fund primary care and we believe that it would be better to end the blame and the cost-shifting game and have the Commonwealth Government as a single-funder allocating resources.
   
Now, to make sure that that gave communities the health services that they need, that needs to have a local management authority.
   
Now, we believe that the funder should be single but then there should be national targets agreed between the Commonwealth and States so that we know what we're aiming to achieve and then the State Governments need to manage the public hospitals and consult the local workforce, consult the doctors to make sure that local hospitals can respond to those targets.
   
And very, very importantly, we need independent auditing of this process to see where the targets are being met, where they're not being met, and what needs to be done to make sure they are met.

QUESTION:   
How will it end the blame game, though, won't the States be able to say the Commonwealth haven't given us enough money to meet those targets?

DR PESCE:   
No. The main thing will be to have a single funder which is responsible for providing the funds. The States have to run their hospitals.
   
We've had a lot of consultation with communities and doctors. They're very worried about a centralised bureaucracy managing at the local level.
   
So what we need is a division between purchaser and provider responsibilities, which is the fundamental underpinning of a lot of good healthcare delivery.
   
If the Commonwealth was the purchaser and the States were the providers and we had an independent audit process then we'd know whether the targets were being met and if they weren't being met who was responsible.

QUESTION:   
What about letting the private sector be the provider, the Federal Government provide the services of the?

DR PESCE:   
The problem with the private sector being the provider is that there's a big risk that that means that there won't be adequate resourcing of the public hospital system.
   
There's too much of a danger and it's too easy to allow transfer of funding to the private sector to pick up pieces that it does well and you end up with a sort of downward spiral of resourcing of the public hospital system.
   
At the end of the day, we still need our public hospital system to be robust, to be there, to care for the patients, to provide the acute need, to provide the elective surgery need and to train our future generations of doctors and health care workers.
   
I don't think we can just walk away and say we'll privatise and devolve to the private sector because there's too much of a danger that that will downgrade a public hospital system already under pressure.

QUESTION:   
But if that's the risk, I mean, have you seen that occur in the private sector at present?

DR PESCE:   
No, there hasn't been a whole lot of that happening but it's too easy to pick off bits and pieces which the private hospital sector can pick up without too much difficulty.

But then who's going to man the emergency department, who's going to take those really acute high-level care cases that need to be managed in a very complex, and usually public health system?
   
The problem that we see all the time is that it's not a cost-neutral exercise. We see too much of the time the resources can be diverted to the detriment of our public hospital system.
   
And my first responsibility is to protect the public hospital system from further downgrading and to make sure it's there to provide the services that the community needs.

QUESTION:
What can you tell us about this Bed Watch scheme?

DR PESCE:
What we see is one of the fundamental easy targets to monitor if not implement, is to adopt the Health Reform Commission's access target of having 85 per cent bed occupancy in our hospital system.
   
This isn't rocket science, it's been verified by studies independently for many years now. If you don't have some spare capacity in the public hospital system then you ultimately start falling apart at the seams during periods of high demand which are unpredictable.
   
So what we want to see is the establishment of the principle that 85 per cent occupancy is what the Government target is.

We need to then take a stocktake of the existing bed infrastructure.  And beds aren't just beds, beds means fully staffed beds with the necessary resources and staff to make sure that they can look after patients properly and make sure that the 85 per cent target reflects itself in a stocktake, recognising and calculating how many beds need to be opened up and more importantly make sure that no other beds are closed to open up new ones.

QUESTION:
Can I just get clear, you're saying that the State Governments will still be responsible for allocating funds for services. I mean, doesn't that mean you still have a blame game situation?
   
Secondly, what is the sort of process by which the money goes from the Federal Government to the hospital? Is it through a hospital board, a regional health body, what?

DR PESCE:
Having consulted throughout the entire country, we see that different areas seem to have different priorities in this regard.
   
Some States seem to be able to distribute their funds in a way which has the confidence of the doctors and the health workers much more confidently and we see that they want that local accountability.
   
They do not want a centralised bureaucracy managing.  So they want clear funding targets, they want management targets, they want targets for what they should be achieving, but they want input at the local level and they see that that will work better if State Governments continue to manage the hospitals.

QUESTION:
So are we talking about local hospital boards here?

DR PESCE:
I think that depends.  I would leave that to each jurisdiction to make its mind up. I've got some of my colleagues who say that local hospitals work - boards work very, very well and others who work in areas where there has been a regionalisation of that oversight of public hospitals.
   
So, I think that is something which doesn't have to be a national plan, uniform over the whole country.  I think we need to allow States that are doing it well to continue doing it well and allow doctors to have input at the local level.

QUESTION:
But you're from New South Wales.  They can't even pay their bills.  Their bureaucracy is overrun.  Would you trust them with the money from the Federal Government?

DR PESCE:
I think the Federal Government have a clear interest in making sure that its money was well spent.  I think that's why we need independent auditing of the process and that's one of the parts of our plan - that we don't leave it to governments to argue together.

We'll have an independent audit process to ensure that there's accountability in the way that the money's spent; that the proportion that's spent on direct coalface health care delivery is identifiable and quantifiable.  The proportion that's spent on bureaucracy and management is identifiable and quantifiable.

QUESTION:
Dr Pesce, on another issue.  Can you confirm that the Federal Government is building - seems to be building these GP super clinics in marginal electorates?

DR PESCE:
Look, I think that we need to provide care to patients where it's most needed.  I think there are objective measures of communities that - where there is unmet need and that's where extra help has to be met.
   
Now the Government has focused on GP super clinics.  We would argue that the - you could get good results by improving infrastructure grants and payments to existing general practices, to help them upgrade and provide the multidisciplinary care that's necessary.
   
So I think that, you know, I can accept that there are some areas of Australia where the unmet need is greatest and the Government focuses its effort.  We would ask them to make sure that they just didn't focus on one model, but see where they can build on existing infrastructure, rather than have to build it up from scratch.

QUESTION:
Are you concerned that they're using health funds as a potential pork barrel?

DR PESCE:
Look, I think that the proof's always in the pudding in that.  As I said, as long as we have a way to assess are the dollars going where the need is greatest, where the unmet need is greatest, then that's an acceptable use of public health dollars.  If it's just for pork barrelling, then it's not.

QUESTION:
Speaking about unmet needs, this is a local Canberra issue.  The ACT Government tabled a report from its GP task force yesterday, which showed that the doctor shortage in Canberra is going to get worse before it gets better.  Do you think that there's any scope for the Federal Government to look at declaring, I guess, Canberra, as a district workforce shortage area, to perhaps attract more doctors here?

DR PESCE:
There was consultation, which included the ACT AMA, which led to various recommendations from that.  It's clear that Canberra has a large degree of unmet need when it comes to general practice.  And we need to probably adopt several strategies to improve that.
   
Declaring it as an area of need, to allow importation of doctors from overseas, can only be a very stopgap, short-term measure.  Obviously the long-term improvement has to come from recognising the problems that led to the infrastructure shortage and correcting it.

QUESTION:
We've got a new Health Minister in New South Wales this week.  It's also been revealed the hospitals owe $90 million and that waiting lists are growing.  Have you got a message for Carmel Tebbutt?

DR PESCE:
I'd say talk to the doctors, talk to the nurses.  Make sure you see what they need.  Ask them how they can bring you the efficiencies that you want, to help solve this.  But I'm afraid we need extra resources as well.  There is no fat in the system.  We need extra resourcing.  And it's time that that was recognised.

QUESTION:   
How much extra resourcing?

DR PESCE:
Look, I think that the number is close to what you say.  I think that, you know, the deficits are not due to wasteful practices.  The deficits are used - a chronic mismatch between the service demands that present to hospitals every day and the funding that's given to them to meet those demands.  It's accumulated this deficit over some period of time and we need to make sure that we have a re-alignment of funding to meet the resource demands that are placed on the hospitals.

QUESTION:
Is it time to cut the bureaucracy from New South Wales?

DR PESCE:
I think that we have to look at the percentage of funding that's tied up in management and administration.  There's certainly been a huge growth in that, in New South Wales.

Doctors need administrators to help them manage the hospitals.  I'm not calling for the scalps of the administrators.  What I think we'll get best value from is when administrators see - administrators and bureaucrats see that they need to consult the doctors and the nurses and ask them what it is that they need, to provide the care that they need to provide to their patients.

QUESTION:
Is there evidence that the number of management and administrative staff has been growing faster than the number of clinical staff in hospitals?

DR PESCE:
There's no doubt that, over a period of time, there has been a significant growth and I believe it has exceeded the growth of clinical doctors and nurses.

QUESTION:   
Do you have figures on that Dr Pesce?

DR PESCE:   
Not at the top of my head.  But we can provide you that.

QUESTION:   
Okay.

QUESTION:   
Great. Thank you.

DR PESCE:   
Thanks.

ENDS


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