I would like to officially announce “austerity” as healthcare’s middle name. Although the title “health austerity care” (as it will now be known), has only just been announced, its impact is already bringing governments to their knees.
So why do we need austerity measures? Well, basically the baby boomers are about to cause an unprecedented spike in health service utilisation, and our system hasn’t been designed to accommodate it. In fact, over the next two to three decades the population over the age of 65 will double. Considering the 65-plus age demographic contributes to over 80% of total healthcare demand, we know that demand will at least double, with dire projections suggesting it could quadruple.
So, is Queensland’s decision to put downward pressure on healthcare costs rational?
I believe there is some method to the madness, but the approach leaves a lot to be desired. If we continue “business as usual”, the rising costs associated with our ageing population will consume every state budget within 20 years.
Yes, you heard right, if we don’t transform the way we deliver healthcare quick smart, state governments will soon have no money for water, no money for schools, no money for roads, nothing; the cost of healthcare will consume every last penny. Considering this, you can begin to understand why state governments are taking such radical action.
Are massive workforce cuts are the answer? Hardly. Slashing wages is a “quick and dirty” way of putting downward pressure on costs, and although it works as an economic solution, it fails to recognise that there is more to the business of healthcare than economics.
When the government and Treasury made this decision, I wonder if they considered what impact this might have on quality and safety? I wonder how many lives was it acceptable to lose to make this saving worthwhile? Did they factor in the cost of the long-term societal and community impacts? Did they account for the loss of productivity and higher workforce turnover? Or the impact on organisational culture? Did it cross their mind that it might be difficult to reorient the system towards a more cost-effective preventive model when the entire preventive health workforce has been axed?
Does the government have a plan to mitigate these risks, or was this decision as blunt and shallow as it appeared to be?
Unfortunately, health-austerity-care measures are not only confined to Queensland. I recently returned from Tasmania where a similar number of its health workforce was cut over the past six months. The only difference being that Tasmania only had a workforce of 12,000 to start with. An already flailing Tasmanian health system has compounded the challenges it faces by cutting 25% of its health workforce. Of course this might save money in the short term, but what about the long-term sustainability of the health system?
If blunt and short-sighted policies are the best the state governments can do to enhance the sustainability of our health system, then we are in for some tumultuous times over the next 20 years. It is simply impossible to avoid serious and long-lasting consequences when you decimate a workforce in this way.
So what would good leadership look like in these situations?
Good leadership would begin by having an honest conversation with the community. If the community understands the gravity of the challenge we face, I believe they would support us and find solutions. At the moment the public have not been informed that we face an impending crisis in healthcare, nor are they aware of the urgency for change.
Secondly, I believe the government needs to create a 10-year change vision for health services and communicate the vision for buy in. This is essential if our governments have any hope of wanting the public to understand and support their actions, otherwise all they will get from the community is anger, frustration and confusion; has anyone seen any evidence of this lately?
Once good leaders have created an urgency for change, established a strong vision, and developed a coalition of support, they need to empower broad-based action. Often that means getting out of the way and trusting the community and the health system to come up with sustainable and innovative solutions.
The role of government should be to remove obstacles wherever they can by doing things such as reviewing legislation and regulation, and generating public support. Governments need to create an environment conducive to change, rather than driving change down people’s throats. They should invest more time into recognising and rewarding success, as opposed to sacking experienced leaders within their departments for system failures typically not within their control.
Great leadership would see governments create quick wins, and then build on the change before incorporating the changes into the culture by articulating the connections between the new behaviours and organisational success.
Great leadership is achievable. In fact, the model outlined above is drawn from the most widely used leadership model in the world called “Kotter’s eight-step model for leading change“, a simple but effective leadership approach taught in many ACHSM leadership courses.
So while austerity remains the dominant discourse in healthcare, let’s hope the practice of great leadership does too.
*This article was first published at the ACHSM blog
This from the smh 12 July-
“Treasury’s internal budget figures show $24 million in labour costs will be cut from the family and community budget this financial year – equivalent to an estimated 242 workers or nearly seven per cent.” So that’s employee costs of $100,000 per FTE.
From the NSW Health careers page-
“NSW Health currently employs more than 100,000 people across the public health system.”
So that’s $10 billion in wages from a $17.3 billion budget or well over 50% of the costs. If that’s so, why is attention on wage and employee costs so inappropriate? When you add to this the infrastructure, transport, space, I.T., management, training and energy costs that each FTE employed generates and is extra to the $100,000 per FTE, it is absolutely reasonable to seek productivity improvements from the workforce.
As the baby boomers retire, the health workforce will grow but we are all winners if it grows slower than demand through the enabling of more efficient and flexible work practices.
Ah, you say, but quality will suffer and patients will die.
From the Medical Search website –
“The latest Clinical Excellence Commission report reveals there were 183 preventable deaths in NSW public hospitals between January and June 2008,”
Yep, that’s 2 plane loads of patients a year being killed by the system in NSW alone, so they’re killing them now. What I expect is that any change at all that requires the entrenched culture of hospital services to look at its efficiency will be blamed for such numbers. Today Tonight will have a field day as people trying to address your main point are persecuted and have their careers destroyed by one of the most hidebound and change resistent cultures in western civilisation.
And another thing.
Unless you can prevent death, “Preventive health” from a cost point of view is an oxymoron. I see the benefit of people’s wellbeing and quality of life improving through preventive health but if they will still die eventually, they will still become customers of the health system.
What would be interesting but brave, is to find out whether or not dementia at 101 is a cheaper way to go than a heart attack at 75 or diabetes at 55.
I suggest it is important to know where the proposed savings are to be made. For that we need to distinguish between front line health providers and administration personnel.
If Queensland Health is like many Government run operations there would be considerable savings to be made from the paper pushers without detriment to the level of health provision.
Many, many (a majority?) of senior citizens have priate health insurance,
so at least they try to pay for some of their own health care costs.
But if that doesn’t excite you, I have two suggestions:
1. As a senior citizen, I would like the politicians to stop “pussy-foorting”
around and pass the laws to enable me, and around 80% of the people
in this country who support it, to practice voluntary euthanasia. That
should assist all you bean-counters.
2. If that is not acceptable, then I suggest we raise the Medicare levy.
How long since that has even been thought about? A few dollars/year
from everyone would make a huge difference, and people often express
their support in the media for this to happen, rather than services be
withdrawn for anyone.
And if all else fails, you can always remove us – you know, put us out of
our (your?) misery!! We would all hate to be a burden to those younger
than us, who are never going to grow old!!!
The only certainty in NSW Health is that no one will take responsibility for their actions.
There are less beds available now in public hospitals than there were 35 years ago.
Griener removed the RMR budget for hospitals. Buildings that should have lasted 100 years needed major repair after 20, and after 30 years are un-salvageable.
There are less nurses and doctors in public hospitals and up to 30% more office staff and bean counters than there were 20 years ago.
There are less operations and less births in public hospitals than there were 20 years ago.
we did not have “an acceptable post op infection rate”, 20 years ago. A post op infection is a sign of a sick system and bad management. the system has created a disgrace and then labelled it “acceptable”. To effing whom? The system?
Every single conservative government at state and federal level has set out to wreck a world class health system & has been very efficient by starving it of funds or staff or both and redirecting money to an inefficient greedy private system; and their allies and architects are about to do the same job on education.
Change resistant? Yeah right. Every single “change” has meant another passenger on that friggin plane. When will they own up to their mistakes? Continuous improvement is only for the plebs.
The trash running the show has striven for mediocrity and failed.