Issue 9 / 14 March 2011

Political fiefdoms silence doctors

ANY casual observer of health care in Australia quickly becomes aware of the debilitating distrust that exists between doctors, politicians and bureaucrats.

This parlous state of affairs is particularly endemic among those charged with addressing perceived inefficiencies and problems in Australian health care.

Fuelling this distrust is the fact that the many bureaucratic silos in our multilayered system seem to work independently of each other. So it is inevitable that each silo will promote its own agenda or that of its political masters.

Whenever propositions eventually emerge from public service think tanks, a ferocious battle for the supremacy of ideas and minds ensues.

The latest skirmish has been ignited by the release of an Australian Government discussion paper, Lead Clinicians Groups: enhancing clinical engagement in Australia’s health system, effectively highlighting the differing views on the precise roles of these so-called Lead Clinicians Groups.

The discussion paper notes in its preamble: “As part of the National Health and Hospital Network reforms the Australian Government has committed to establishing National and Local Lead Clinicians Groups. The Lead Clinicians Groups measure recognises the role of clinical leadership and expertise in delivering safer and higher quality health care to the benefit of patients and their families.”

The palpable problem with the discussion paper is that although it gives a passing nod to the “role” of doctors in clinical leadership, it remains silent on what that role might actually be.

Through its singular refusal to address this component of the organisational reform, it has effectively neutered the role of doctors in the clinical governance of health and hospital networks.

Significantly, its silence on this crucial role is an irrefutable disregard of former prime minister Kevin Rudd’s public promise, given last year, to set up panels of doctors and nurses to help manage hospitals.

Mr Rudd also proclaimed that Lead Clinicians Groups would “guide” Local Health Networks in planning the most efficient allocation of clinical services.

The AMA is understandably disturbed by this blatant disregard of Mr Rudd’s commitments in the discussion paper and has let its displeasure be widely known. Federal Minister of Health Nicola Roxon, in response to AMA public protests, noted that she looked forward to receiving a “formal” submission detailing the AMA’s concerns.

In an article in The Australian she also claimed: “The government remains strongly committed to strengthening clinical engagement in our health system — in all settings including hospitals and primary care services — and we look forward to continuing to work with the AMA to deliver this.”

But interested observers may well wonder at the real value of any political promise — in the context of political promises, in general, and the latest ruckus over the carbon tax — irrespective of the position held in that particular debate.

However, it is patently clear that this denial of doctors’ roles in clinical governance is a further manifestation of the political thrust to undermine their professional role and influence.

There is tangible evidence of this changing political philosophy in the moves to broaden the scope of practice of lesser-qualified health professionals in areas previously seen as the province of doctors.

Denying doctors any role in clinical governance in health and hospital services demonstrates a cynical disregard for due process and honesty. One can but wonder at the rationale underpinning this classic doublespeak.

In response, and with humble apologies to Karl Marx, clinicians could perhaps adopt the slogan: “Doctors of Australia unite. You have nothing to lose but your political and bureaucratic chains.”

Dr Martin Van Der Weyden is emeritus editor of the Medical Journal of Australia.


Posted 14 March 2011

3 thoughts on “Martin Van Der Weyden: From the sidelines

  1. Max King says:

    I’m puzzled. I don’t understand why Martin has made such fatalistic comments about a discussion paper. My reading of the paper did not leave me feeling that doctors had been dudded.
    Nor did I get the sense that,
    “Through its singular refusal to address this component of the organisational reform, it has effectively neutered the role of doctors in the clinical governance of health and hospital networks.”
    Yes, there is a degree of gobbledegook, and, we may well be wary of bureaucrats bearing gifts. But we must be heard, we must discuss, and we must find a consensus position to build on the paper’s “starting point to form the basis of further discussion”.
    So, if Lead Clinicians Groups is the sort of revolution in health care management that you want to see, then, “Doctors of Australia unite – provide the AMA with bountiful evidence for the best outcome”

  2. Anonymous says:

    I agree with Martin’s assessment. The government’s actions in this area represents a broader agenda whereby they view government as having to have a broad influence across all aspects of life. Instead of governing and letting the states, society in general, the professions and business get on with what they do best, this government is intent on increasing control in these areas, despite ongoing “pink batts” episodes. Their increasing interference in the profession of medicine if countinued could have negative long-term consequences. If, as they seem to be doing, they continue to exclude doctors from decision making, cede traditional areas of practice to other professions and tie the profession in red tape, young intelligent independent thinking people will walk away or not train in the profession. I hope Martin’s call to arms is heeded.

  3. Philip Dawson says:

    It depends whether or not you trust untrained bureacrats to be able to adequately analyse the situation and make funding decisions. An accountant friend of mine resigned from a state education department because they wanted him to make decisions on WHAT they should spend their money on, rather than how much money they had and how much each item of need would cost. He said this was outside his expertise and he refused to do it. Unfortunately many others in government employment don’t see this conflict. I think unless trained health professionals are involved in the decision making we won’t get a good result. Bear in mind there are vested interests on both sides. If decisions are all by clinicians, experience is they want to spend top dollar, if all by bureaucrats (eg, UK NHS) they want to get by on a minimalist system. There must be a middle way where money is not wasted, but everyone has reasonable access to timely health care.That in turn depends on how much individuals and the taxation system wishes to spend!

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