Hang On – Are Local Hospital Boards Really A Good Idea?

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The Coalition released their health and hospitals policy today, including a pledge to establish local hospital boards. Before the paperwork stacks up too high, Jennifer Doggett has a closer look at the policy

For a party that professes to support efficiency and aims to reduce bureaucracy, the Coalition’s policy to establish local hospital boards for every public hospital is curious.

There are 737 public acute hospitals in Australia. Tony Abbott’s proposal will create 737 new local hospital boards. This means the creation of 737 Board secretariats, 737 sets of meeting papers to be prepared every time the Boards meet, 737 sets of resolutions to be recorded and monitored and reported against and 737 separate bodies fighting each other for a share of the health resource pie.

This is bureaucracy gone mad.  It will tie up valuable resources, impose a massive administrative burden on hospital management and establish hospitals as competitive fiefdoms rather than collaborative partners in an integrated health system.

Abbott’s plan will create no incentives for hospitals to achieve efficiencies across the spectrum of the heath system, for example, by reducing unnecessary hospital admissions. In fact it will encourage wasteful duplication of services as hospitals compete with each other for limited health funding.

Of course it is essential that doctors and nurses have input into hospital management. However, it makes no sense for hospitals already struggling with workforce shortages, to take doctors away from patient care to discuss non-clinical issues such as the location of a new car park or the tendering arrangements for the hospital canteen.

Similarly, while it is vital that the community has input into the allocation of health resources and the provision of health services, there are more effective models for achieving this aim than the inclusion of a single community representative on a hospital board.

Citizens’ juries are a proven mechanism for obtaining community views on priorities for resource allocation across the spectrum of the health system, not just for one service in isolation. Another preferred model for engaging the community is to involve consumers in broader governance bodies, such as local area health authorities which have jurisdiction over a range of health services. This gives the community a real say in where resources are allocated and the ability to promote greater coordination and integration across different sectors of the health system.

Abbott’s plan for hospitals will entrench the worst features of the Australian health system and do nothing to drive the improvements needed to ensure we can meet the health care challenges of the future.

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Blog Comments

It worries me that the Libs plan to pay on a patient and service basis.
Such a policy is partly responsible for the Patel debacle in Queensland where the administration preferred for financial reasons surgery be retained at Bundaberg Hospital rather then sent to Brisbane.
Treat more patients, do more surgery and receive more money next year is a recipe for disaster.
It happens in schools – attract gifted/disabled/immigrant/Aboriginal students and get extra teacher assistant help, lower student teacher ratios and extra funding.
Similar happened during the outstation movement – Aboriginal people encouraged to camp away from the community while the Department of Aboriginal Affairs people came to take a look, get the funding and move back to the community.
Seen it all before and it leads benign corruption, fudging and dishonesty.

Jennifer Doggett has used an old ploy to denigrate an idea with which she does not agree. The ploy is to extrapolate the idea in a totally unintended direction and then bag the idea on the basis of the extrapolation. Hospitals should be run by a Chief Executive Officer and this CEO should be responsible to the local community through a voluntary Hospital Board. In the old days, the Hospital CEO was the Matron. This idea worked well and I would like to see it tried again where suitable people are available.
If we got rid of inefficient, centralising State Governments and replaced them (and Local Government) with Regional Assemblies, funding for hospitals could also be localised. With a National allocation of funding to each region on the basis of population, a Regional Assembly could decide what proportion of their budget could be allocated to hospitals depending on the needs of the local community.
All we would need then is a tiny Health bureaucracy at National level to articulate National Policy on Hospitals.
Such an arrangement would greatly reduce bureaucracy and the number of elected representatives – not increase them as suggested by Doggett.

Charles, I’ve been there too and heaven forbid we go back to having the ‘Matron-in-Charge’! I would also say heaven forbid we go back to anything like the old Hospital Boards.
Your alternative swing to doing away with the State and Local Governments has been canvassed by many but it won’t happen in our life-time, let alone in time for this election.
The Labor Health Reform originally suggested one or the next best ideas and they probably thought least disruptive method of getting as close as they could to decreasing the influence of the states, if only for the Public Health System, was to be resposible for the majority funding using Local Health Networks (or Boards) giving responsibility to local stakeholders for the management of the hospitals and other community aspects of health delivery in a designated “region”, following the Victorian model.
We all know what happened to that suggestion! The States, seeing their control of the funding diminishing, only partially came to the table and the compromise was not as satisfactory as one might have hoped. However, it is certainly better than having a ‘matron- in-charge’ or CEO of each hospital and full responsibility lying with individual ‘hospital boards’, a situation which would be like going back into the dark-ages.

It is even worse Jennifer. Three things. First this will mean clincians having yet more say as they and not local communities will dominate these boards. Second the distinction needs to be made between local values and local management. We need local values from, as you say, citizens’ juries (and I am involved in facilitating one todayand tomorow for the ACT Health Council) but centralised management. We simply do not have enough good health service managers in Australia for this sort of devolved nonsense. And finally health service management is bloody difficult and needs bloody good professional managers not part time clinical amateurs. We need the clinicians to treat patients and to advise managers techincally. We do not need them to manage local health services.

There is also the issue of regional coordination of services. A regional hospital may nott provide a particular services, and need to send patients to a larger hospital. If that hospital is acountable to a local board rather than concnerned with region-wide health requirements, this is going to just result in another round of jousting between state and local level administrations.

What is the evidence that having local boards improves hospital efficiencies or health outcomes?

I agree that it curous and stupid policy but to Abbott and hismotlet crew it represents a great oportuity to derail the introduction of the idea and so save money. we do not get hospital policywe get an enlargd local bureaucracy with which TheLiberal National can reward their cronies with sinecures.

Totally agree with Jennifer Dogget’s comments, but I would like to add a couple of other concerns.
First a return to hospital boards for each public hospital runs the risk of derailing a struggling trend to more emphasis on primary health care. Secondly it runs the risk of downplaying moves towards integrated services the need for which has been identified by many consumers. Boards are hospital boards and as such they will concentrate on the needs of hospitals.
Rather than going back to the future there is a need to view hospitals as the avenue of last not first resort. Certainly we need well resourced and well managed hospitals when episodes of acute illness and disease strike but the level of chronic illness suggests we need a stronger focus on keeping people well and out of hospital, even those who have a chronic disease. Hospital boards run the risk of not paying attention to these broader needs.
It is important communities be engaged in discussions re the direction, organisation and management of health services but hospital boards are not the answer. Instead we need ways that the community can provide advice that includes but is not restricted to the provision of hospital services. Developing, educating and resourcing existing community engagement forums/committees is perhaps a better way forward.

The proof of the pudding is in eating. Ask just about any (actually practicing) doctor and you will learn that the most inefficient and unsatisfactory system currently in Australia must be the “NSW Area Health Services”. Characterized by a heavy top-down approach where clueless unaccountable bureaucrats steamroll any budding local developments and shoehorn them into destructive uniformity at high cost. Workplace satisfaction and morale is at an all time low for clinicians (doctors, nurses, and much of allied health)

In contrast, when I worked in a small rural hospital in Victoria with a local hospital board, where indeed the matron was the CEO, everything ran smooth and efficient. We doctors could focus on delivering quality primary and secondary care without constantly having to get bureaucratic road blocks out of our way or being ensnared in suffocating red tape.

Local hospital boards might not be the optimal solution – but certainly – in the real world where I live and practice as opposed to some ivory tower la-la-land – they are delivering better outcome at lower cost with higher work place satisfaction than the alternatives currently in place in Australia.

Yes, we need a health reform – but just reshuffling the bureaucrat’s deck chairs and letting non-clinicians with poor understanding of how health systems actually work decide the course is not going to deliver any outcome tat we would wish for or could afford.

I may not know the optimal solution, but having lived and worked in a variety of countries (on 4 continents) with very different health systems (and related to that, health outcomes) I have a very good understanding of what definitely does not work. In that context I can only say that Roxon is wrong, Gilliard is wrong, just as Abbott is wrong too.

All they present are rather naive ideas that have already failed in other times and places, demonstrating that they haven’t got the necessary understanding of the problem required to solve it. Public health should not be a playground for well meaning but clueless amateurs – we are talking about playing with real human lives after all!

Jennifer Doggett recycles the pro-community care ideology she is renowned for and which has given us the ridiculous GP Super Clinics policy that is totally non-evidence based in terms of the realising the ‘keeping patients well and out of hospital’ mantra.

Gavin Mooney says there aren’t enough good administrators in Australia to run hospitals at the local level despite NSW alone having nearly as many bureaucrats as public hospital beds. Maybe he should take this up with the Australian Hospital and Health Association and the Public Health Administrators College. Oh sorry, they too have been ‘captured’ by the same anti-hospital pro-community ideology.

Regional coordination of specialist services can be achieved by competitive tendering arrangements like in Victoria. Activity-based funding will mean hospitals are paid to perform and won’t compete for resources through their political pull as in the old days. It will also drive efficiency and productivity improvements.

We need local boards because they are the first step in spending less on bureaucracy and more on beds to eliminate emergency queues and cut elective waits.

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