An excellent article Andrew. You should be our next Health Minister. Sadly that cannot happen under our rigid politics of winner takes all.

There does seem to be an emerging agreement from all sides of politics that the problems of duplication, cost shifting and buck passing between the Commonwealth and states and territories is legendary and must end. Bold action is required. It's an unwieldy mess that the states have next to no chance fixing within Rudd's two year ultimatum. The trial hospital takeover of the Mercy Hospital by Tony Abbott is taking place in a longer term strategic vaccuum.

The solution? I'd love to see the States completely exit health care. The middle man costs and red tape are primarily responsible for the crisis. Health funding and health policy should be urgently transferred into the hands of the Australian Government with local government authorities having responsibility for identifying community priorities and meeting national health standards at local public hospitals. Empowering local citizens in their own communities is the way forward.

Councils should also be rewarded and acknowledged for innovation and excellence in public health prevention. We need to broaden the role of local government to cover not only public health but education and economic development by way of enacting a national Local Government Act replacing the state legislation that relegates inconsistent functions and provides an impoverished existance to local councils.

Should we be thinking in terms of a more holistic approach to community development, as a national - local partnership, in order to make the biggest impact on our quality of life and the value we receive for our taxation expenditure.

We can be a world leader in public health if we restructure health policy in such a way that there is creative competition, streamlined delivery notable for its openess in reporting health outcomes.

Modern medicine has at its basis, a reductive paradigm. It seeks to find solutions to the problem of disease through looking at what is wrong with the parts, rather like a watchmaker, who mends the watch by repairing the faulty cogs ,in order to make it a whole again.

Modern medicine goes as far as to incorrectly define, the DNA as being the brain of the cell, which has to be changed, if it is faulty. The reductive paradigm is part of the Newtonian basis of the philosophy of modern medicine, which is defined in chronological, hydraulic and mechanical ways of thinking.

The modern Doctor follows the manual of management and treatment, rather like a car mechanic. In psychiatry, the brain is still considered to be the organ, which is faulty, when there is a mental disturbance. Doctors are becoming more and more, the technologists for administering the latest allopathic chemicals, for the pharmaceutical companies.

Allopathic medicine consists of chemicals, which attack and change chemically the disease processes. At the same time, these chemicals, have side-effects. Western healthcare including surgery and drugs is now the third leading cause of death in America. Journal American Medical Association July 26, 2000;284(4):483-5) The British Medical Journal also declared that in America alone, 199,000 A YEAR are being killed by errant medical procedures However this is not a local problem.. In the UK, blunders by doctors are killing 40,000 a year. In Australia, The Quality in Australian Health Care Study (QAHCS), published in the Australian Medical Journal in 1995, reported that 16.6% of hospital admissions were associated with an iatrogenic patient injury, termed an adverse event (AE) In Western society, medical treatment has enormous side-effects of morbidity and mortality.
www.medicalrenaissance.com

http://www.mja.com.au/public/issues/185_04_210806/sco10244_fm.html

Good article - a veritable catalogue of the best ideas to date in health as well as an expose of major problems and imbalances in the system.

I agree that emphasising teamwork at as local a level as possible is the way to go. This gives health workers a sense of ownership which guarantees the best job possible is done for patients.

There are also lots of spongers in the system (eg the health insurance industry, greedy doctors etc) that position themselves so as to maximise their personal return for putting in as little (useful) work as possible. It would be good if the money going to them be redeployed to help in providing frontline services. This would need to go hand-in-hand with changing the prevailing culture in health delivery to a more many-hands-make-light-work model.

Great article, Andrew!

As for the comments by Quick Response, they seem to have come straight from the Liberal Party propaganda machine.

I have no doubt that the Liberal Party health agenda is one of divide, undermine and conquer - so as to privatise the whole health system by stealth. Presumably, another obvious but insidious goal is to incorporate all government functions so as to lower health care wage costs, by deviously imposing WorkChoices by stealth.

One of my main objections to the so-called "community" board-based model is that it would create competition for staff and inefficient duplication of resources - which would only further disadvantage communities in rural, regional and outer-metropolitan areas.

But it seems that there are broader socio-economic and political agendas at play here - some of which I intend to touch on below.

It has become clear, that one of the major Liberal Party agendas, is to strategically undermine the States through co-opting LGA's and regions via the relevant Chambers of Commerce. Hence the Mersey Hospital takeover and plebiscite proposals.

The "community" board-based model would most likely create dangerous conflicts of interests, by further concentrating power into the hands of the business unionists of local, regional, state and national Chambers of Commerce - some of whom have already set themselves up, so as to self-servingly co-opt many Local Councils. Some of whom have apparently secured dubious corporate wealthfare funding, for private schools and training institutions which are seemingly unfettered in feeding back resources into their other enterprises.

The latest Nursing Hospital Training scam seems to be an yet another extension of this publicly-subsidised corporativist theme. The Liberal's proposals for schools would seem to have similar WorkChoices and wage/salary cost objectives.

To be continued due to word limit.

Continued from previous post.

At the broader level, the Liberals are a imposing a corporativist non-society, which is focused on short-term economic gains for the privileged few at the expense of long-term socio-economic and environmental sustainability - and is accelerating polarisation of income, wealth and power along the pseudo "free-market" lines of the increasingly dysfunctional USA.

This cynical coporativism agenda can only get much worse - whether or not the Coalition retains any power at the Federal level. Either way, this goes against both the egalitarian "fair-go" and the spirit of our Federalism under our Constitution - and any change should be resisted where it is for patently self-serving financial and/or political purposes.

Now is time to stop the vicious cycle of corporativist rot which is eroding essential public services and infrastructure. These and other elitist Howardian trends are subversive cancers on our formerly egalitarian society and the potential socio-economic risks are huge - as are the sometimes less obvious opportunity costs.

I personally trust that, if given the balance of power in the Senate, the Australian Democrats and/or the Greens would work actively and responsibly towards improved equity in access to appropriate public health services - and promote longer term efficiency, effectiveness and sustainability of same.

I would also hope that a Labor government would be amenable to far more co-operative, transparent and accountable governance than the Liberals politicians are disposed to.

Andrew Bartlett is a politician.

All fine stuff but the practicalities get in the way.

The hard line view would be that public healthcare is run in a Stalinist way because it has to be rationed because that is what the public have shown they are willing to pay for.

All the ideas are great but where will you get the workers
from ? There are not enough nurses let alone nurse practitioners, or allied health etc etc. these days you can't even find clerks and cleaners!

Next e health is great, money is probably no object, but find the qualified IT people to do it and enough will to persuade cautious medicos about the need to let go of their paper files.

Most States have comprehensive plans which have been well thought out and cover most if not all of Bartlett's objectives. Their problems are implementing the plans - no workers to do the work, resistance to change from an aging and increasingly money hungry medical fraternity, and difficulty in retaining skilled and capable leaders.

And that's before the politicians get involved !

There isn't much buck passing from the Federal Government on this issue. I'm not a fan of this government but it has my respect as it has to work as both government at both federal and state levels as the states refuse to do their job.

NSW has seen the health system crumble under Carr/Iemma. In Queensland, we had a working system before Beattie came in. From the time he was elected, political cancer is rotting the entire health system where emergency rooms are closed, ambulance services withdrawn, dodgy doctors employed as the good doctors fled Beattie's destructive leadership.

Myself, I am dealing with a leg operation gone wrong. This mistake almost killed me three weeks later yet I can't get them to just go inside the knee to see what needs corrected. No, instead they decided to blame me for it. Almost 12 months later, I'm having the same problems and throwing down Warfarin thanks to their mistake.

If Rudd become Prime Minister, the Labor Premiers won't have Howard to blame for their incompetence any more.