Thank you Peter Baume, but whither the Community? How much money did the Governments spend on Early Discharge, and the Hospital in
the Home projects out of Westmead (Sydney) hospital in the early
90's? They were on the right track then, only that their reasons
were financial and not patient-centred. They espoused early discharge writ large for years...of course it was going to Free Up hospital beds for acute cases was their mantra. But as we know, it is 'cheaper' to service a person in their home than in a hospital.
Whilst beaurocrats are driven by budgets, the care for the people will worsen. I have retired from nursing now (4 years), but the decline was already obvious. Whilst factoring in lack of experience in nursing care, impossible working targets for nurses involving
more paperwork than patient care, you'd be better off in the Community than in most hospitals I've worked in over the past 15
years. The fracturing of Community in every area of our lives now
does not bode well for the small population of Australia. You mention the ageing and dementia increase. I, for one, have documents
in place so that the Govt. won't have to pay for any bed nights for me.

Is this the most sensible article you too have ever had the pleasure of reading on OLO?

And I like Lesley's contribution too!

Makes you think that instead of boards full of the great, the good and the self interested we could elect members of the community to run our hospitals.

A very enlightened article that shows people how to really solve the problem of ill health.

So what's the real problem? Lack of political will is often cited as one of them. But, we know that in the end politicians do what the people want them to do. It follows, then, that ultimately the ball lies in the court of each individual. In other words, problems persist because the majority of the public are just too damn lazy to tackle them!

Peter makes the point that we have citizen juries to determine guilt in court cases, so why not have citizens determine resource priority in hospitals? Good point. For the reason, you have to go back to history and the Magna Carta, Oliver Cromwell, The Declaration of Independence et al. Things like citizen juries and the common law came out of people fighting oppression by those in power. In other words, something bad had to happen to people before they did anything about the situation. The same looks like it will happen in reforming the health system. In reality, it's only when people feel some pain that they do something about it. And in that reciprocal sense, society overall bears the consequences of its own laziness.

Excellent article, Peter.

I agree, 'health' at the moment is predominantly about surgery and medication and, yes, we do need to change the emphasis to one of preventative health.

A big part of this is what we eat and at the moment this is largely controlled by corporations, who are far more interested in increasing their profit margins than in what the junk they peddle actually does to people. I agree, we have to get serious about advertising. Junk food and alcohol shouldn't be advertised.

Medicare must also be widened to include natural practitioners. It would be far more cost effective in the end as people healed and educated in this way are much less likely to go on and develop dementia, heart disease, cancer, diabetes, etc.

Naturopaths and other alternative healers are usually more knowledgeable than doctors about real healing. They take a holistic approach and look at the connections between different organs and the symptoms occurring. Lasting health outcomes can be achieved this way, whereas many doctors just 'fix' the immediate problem without any acknowledgement or real understanding of the underlying cause/s.

I don't agree with your take on fluoridation though Peter. The jury is still out on whether or not we should be ingesting this chemical cocktail. It might lead to less tooth decay but it is very debatable as to whether it adds to overall health. In fact, there are very strong arguments to suggest it doesn't. Once again, the real answer lies in education, both in good oral health practices and in correct food and beverage choices.

Thanks though for a timely and sensible contribution to our very muddled health debate.

Bronwyn:

"A big part of this is what we eat and at the moment this is largely controlled by corporations, who are far more interested in increasing their profit margins than in what the junk they peddle actually does to people"

Rubbish. People need to show some self control and not ingest it themselves, and to also show some backbone and not cave into their kids. The only reason why these companies produce this food is because it sells.

Plus, there is nothing wrong with eating this food IN MODERATION! Those last two words are the key. Once a fortnight isn't a problem. Once a day (or more) is.

Re natural practioners, they have their place. There is a time when the different viewpoint is perhaps valid, but that isn't at all times as suggested by your comment.

We are all really responsible for the state of our public hospitals. For many years we have been getting the message that things are only done well in the private sector and government policy and popular culture has been working to make this be true, regardless of the reality. Public hospitals have been suffering for many years from changes in management ideologies, government gameplaying, and schemes to give business to the private sector. The lack of time to do jobs properly and to support new staff (?efficiency and productivity) have seen a lowering of standards in many areas of our society. Can we really say we are behaving in the way we would like to as grown-ups? Behaviours like bullying have become necessary to survive in these irrational structures.

"We are all really responsible for the state of our public hospitals."
That statement apart from being untrue actually covers up for those who are responsible. Most people are appalled and angry at the war being carried out on public health so that a minute few can enrich themselves. Millions must suffer at the hands of a few. This one sided war has criminal overtones in causing un-necessary deaths, loss of limbs and suffering. Whereas, the politicians of all stripes are on the make, looking for an edge, whats in it for them. They have a method in play and that is 'run the hospitals into the ground and create a market through making people wait till they are desperate to pay anyone. When the hospitals are handed over to their well heeled cronies to turn into 'big business' supply a veneer of respectability. Call it private health care with the emphasis on caring. Then their cronies will be lauded as saviours.

johncee1945, I am very happy to read your comments. I came back to Australia in the early 1990`s and have been shocked to see the downgrading and victimisation of most of the public services since then. I have had a few arguments over my observations so am happy to see there are people who think as I do. I work in health data collection and the disrespect with which the public servants were treated with in the early 1990`s when this con started was unbelievable. None of it had anything to do with the quality of work done, in fact the more experience people had the more they wanted you to go. Sheer arrogance(along with a qualification) is a big problem. Look now at the attempted victimisation of John Buchanan and his groups` report on AWAs. Makes you think Australians now feel threatened by decent people. Very unAustralian.

"They espoused early discharge writ large for years...of course it was going to Free Up hospital beds for acute cases was their mantra. But as we know, it is 'cheaper' to service a person in their home than in a hospital."

This creates a huge paradox.

It is cheaper to treat people in their own home, however what happens is that our public hospitals then become much more expensive simply because only people who are far too ill to recieve treatment at home will remain in hospitals. By increasing the ratio of critically ill patients in public hospitals, means that resources need to be increased to meet the increased demand.

So hospital budgets need to be increased to meet these increased costs. That is the last thing that politicans want to do.

There simply no quick fix for our public hospitals now, especially since it has taken a decade or more to reach this point, it will take many years of investment before any positive changes will be felt.

A great piece, Peter. John Menadue has proposed a joint State/Cwth Health Commission for each state and territory to do those things that can and should be done together. That is really worth considering. Of course, you could argue that the Commonwealth has no business in health other than in quarantine and medical benefits...

But, yes, good health starts with each of us — as responsible, educated and caring people who take good care of ourselves and of those for whom we are responsible.

Great article!

Our whole illness industry (usually called a health system)has the incentives built totally the wrong way. We should reward health practitioners when they keep their patients well (not when they are ill).

The challenges of obesity and smoking (as the predominant but certainly not the only lifestyle issues) are not principally medical but rather behavioural. We have to bring in allied health practitioners (such as nutritionists, exercise physiologists, and psychologists - only lets call the latter Lifestyle Coaches so potential patients don't consider they are being labelled as mad) to work in general practices alongside general practitioners and nurses and funded to prevent illness. Currently general practice is too dominated by doctors. If you give a person a hammer they will see every problem as a nail. Leaving doctors as the key practitioner means that they see the solutions to obesity in terms of drugs and lap banding, nutritionists see them as diet, and exercise physiologists see them as physical activity. They all need to bring their own skills to the problem and tackle the issues much much earlier.