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Health is a solution, not a problem

medicSA December 2018 | President's Report | A/Prof William Tam 

As I write this, the KordaMentha reports are making waves, and the Opposition is making much of what they hold, and the implication of handing responsibility to a consultancy to “turn around” CALHN’s financial situation.

For an $18 million contract it is hoped the plan will deliver savings of $41 million by mid-next year, and $101 million and $134 million in the years following. On the agenda are “improving the efficiency of care”, in particular “unnecessarily long” hospital stays; better workforce planning; and increasing financial controls and accountability.

Reading some of the rhetoric about what is planned and what is hoped, I cannot help hearing echoes of some of the phrases, promises and objectives of the failed Transforming Health exercise. Of course, that was a much different branding exercise, with bright colours in place of shades of grey and blue, colourful pictures, a summit and a slogan. This one is more of an austerity sell, but still ...

The AMA(SA)’s take on all this, so far, has been that while we are in favour of efficiency, it must not be at the expense of patient care. We don’t want bed closures or a reduction in services to the community. We also strongly hold that if you are talking about improving efficiency, that needs to be driven by clinicians – doctors and others in the health team – not accountants.

Doctors know what is working well and what isn’t at their services, and they want to see improvements. Too often, they are not listened to.

We also need sound data to drive health policies and service planning. We have seen too many decisions driven by poor or poorly understood data, or inaccurate comparisons or benchmarks. That’s why the AMA(SA) has been calling for an independent clinical data analytics entity that can sit independent of government and SA Health, and provide sound information and analysis for sound decisions.

The need for better workforce planning, highlighted in the report, is something the AMA(SA) has been talking about for years.

What we don’t want to see, is for morale in our public system to continue its current trajectory. Cuts, reconfigurations, reforms, shiny new problems, and hoary old ones, have been adding up.

It’s not all doom and gloom though, and one of the risks in focussing on the fixes we want, the fixes we don’t, and the fixes someone has determined we have to have, is that we – including those in charge, and the public at large – lose sight of the great bits.And there are plenty of them. We have amazing people in our system delivering fantastic care to patients, through all this. As doctors, we strive to do better, and we will. With help; without it; or in spite of it.

At the AMA(SA), our messages to the government and Department are to do this with us, not to us. Work with those who are on the front lines delivering care to patients on how our system can do better, and what comes next.

Too often, when we pick up the newspaper, or in our workplaces, or even in the Parliament, it is almost as though Health – and our health system – is presented as a problem. It’s not a problem, it’s a solution. 

It is not perfect. But every day it is making things – and people – better. Whether that is repairing broken bones or damaged bodies; picking up the aftermath of major trauma; or getting to the root of chronic disease.
There are things we need to fix in our health services, in our institutions and in how things are done. We are no orphans there. But we are ready to do that and we are ready to do that in a way that is constructive. We doctors like to fix things; it is what most of us get up for in the morning.

The AMA, both at state and national levels, is engaged in solutions. In public health, in policy, in law, in how the health system works, and beyond it. If you are an AMA member, you have a part in those solutions. You need them, your patients need them, and we need you. Your ideas, your priorities, and your membership dues.

The AMA is not government funded. We are independent. We are beholden to no one except our members and to nothing except the ideals we uphold and promote, and the public trust that is afforded us.

Whether or not you are a member of the AMA makes a difference. It makes a difference for you, and for us. It is something you yourself can do for any of the many issues that concern you and the AMA as well. They will be many. If you are not a member now, please join today: If you are a member, thank you!