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Mersey Hospital fix sets scene for wider turmoil

Mersey Hospital fix sets scene for wider turmoilThe Prime Minister’s pledge to maintain a full range of acute and intensive care services at the Mersey hospital in the marginal electorate of Braddon, in Tasmania, has all the hallmarks of political wishful thinking.

The concept of non-government owned (or community-based) public hospital services is not a new one, and does work. But this decision has more to do with bolstering a recognised inadequate service than it does with instigating a new structure for public hospital management. Moreover, the decision appears to fly in the face of what many Australians realise — compromises are necessary if essential health services are to remain viable and reasonably accessible.

It is always tempting for politicians to promise the world rather than educate the community about restraint. It is virtually impossible to do so in the context of a general election. A populist approach seeks to prevail, and often pits expert opinion against ordinary voters. The casualty is sensible public policy, and in turn frustrated community expectations.

For some time the Tasmanian health service has been taking the difficult but necessary step of rationalising services in the interests of the general public. The public purse only stretches so far. The challenge for the health service is the limited capacity of the health workforce. Put simply, there are not enough clinical specialists, doctors and nurses to staff every hospital, aged care home and community health service. This is true regardless of whether the services are publicly or privately owned.

Moreover, some major specialties are being duplicated within relatively short distances and this both raises health costs and reduces the capacity for those specialists to perform the necessary number of procedures to guarantee an acceptable level of patient safety. Thus, some rationalisation on the grounds of safety alone is needed. The trade off is between the proximity of services and the quality of the service.

Of course local communities baulk at the loss of hospital services. But at the same time, health services can be refashioned to address immediate health needs, particularly through day surgery and visiting specialist programs, whilst neighbouring services can complement with higher order specialist offerings. If the Prime Minister’s initiative is planned carefully it could usher in a more sustainable public hospital management arrangement.

Interestingly, as it currently stands, the Prime Minister is offering around $45 million a year to keep open a tenuous hospital service for a catchment area of 35,000 people. This is an extraordinary handout. When compared to the $465 per capita the Commonwealth presently contributes nationally to public hospitals, the Mersey funding package would deliver $1285 per resident in the area. Surely the federal treasury blanches at such profligacy.

The reality of the Mersey hospital situation is telling. It doesn’t help any government to withdraw services from local communities. The Tasmanian government’s motivation is best understood as being less about ‘bloody mindedness’ and more to do with the practical solution to the limits of scarce health resources.

The Commonwealth already contributes to the funding of Mersey hospital and has a strong interest in the best use of public funds. It beggars belief that the federal treasury would perform a back flip on its previous position of exacting robust value for money from its financial contributions. The rational analysis of specialist services presently on the table is being ignored. Any future Commonwealth funding package should seek to provide complementary services that bolster the regional health service, not duplicate inadequate coverage.

Accepting that the Mersey hospital situation is distorted by the static of an election campaign, there is still a broader policy issue worthy of attention. At present there is no need for public hospital services to be owned and operated by governments. The Prime Minister’s suggestion of community trusts, funded by a single layer of government, similar to residential aged care, will work. It will work best if state governments play their part and integrate their contribution into health service planning. This system works for Catholic public hospitals and can be duplicated. Where there is a will and a way. 



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