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.