No more Dr Deaths!

Sometimes short-term pressures undermine our longer-term effectiveness. The urgent drives out the important. The short term pressures on politicians are all about the management - that is media management - of issues. Voters can’t complain. We’re in favour of politicians showing more “vision”. But that’s in theory. The last politician who tried to get us to embrace a comprehensive long-term policy vision was Dr John Hewson - last seen plummeting Earthward. We prefer our politicians to treat promises like a skydiver treats his main parachute after it fails to open.

Whether we end up with anything to show for all the suffering Jayant Patel has visited upon us remains very much up for grabs, but it depends on how effectively some important figures can transcend the urgent to ensure that they deliver on the important.

Queensland Premier, Peter Beattie, is yet again, in “something must be done” mode - dispatching senior bureaucrats to give press conferences in Oregon and firing letters to all and sundry in US bureaucracies (though they’re already well aware of the situation). Tony Morris’s Royal Commission has been no less frenetic, though perhaps more industrious producing a substantial interim report an astonishing six weeks after being appointed.

Such a well written report is a remarkable achievement in the time it took. But subsequent discussion suggests that the public call for a murder prosecution might have been ill judged, both because it intensifies Patel’s motives in going to ground, and because it prejudged evidence from a medical audit now suggesting that Patel’s error rate was not clearly outside acceptable limits.

And to my economist’s eye there’s another danger of too legalistic a focus. As my former colleagues at the Productivity Commission often observed, lawyers with whom we worked often took their own frame of reference from existing legislation - when the point of our inquiries was invariably to consider how the policy, including the legislation, could be improved.

In addition to recommending criminal action against Patel - which was appropriately an essentially legal discussion - the Interim Report’s other main focus is the “area of need” policy under which Patel was appointed. Under this system, if a medical need cannot be met locally, it is then met from elsewhere in the state or from interstate. Failing that it can be filled from overseas. That’s where Dr Patel came in - rather literally I’m afraid.

Morris found Queensland Health administered the policy with “scandalous ... lassitude”.

• Queensland Health still works under a five-page policy document that is nine years old and thus based on legislation which was repealed four years ago!
• Though it claims to have been working on a new policy for two years, it could not provide even a draft to the Commission.
• It took no steps to ensure that “area of need” appointments are temporary as required in the legislation.

Damning of Queensland Health as it is, these findings are also a bit of a red herring if one’s focus is on how any future system should work. There’s something about the “area of need” legislation that smacks of parochialism, if not protectionism. Doctors should be assessed on the merit of their training in the first instance and their performance after that. You may prefer locals, but if I need to get my insides messed with I want the best surgeons available - and I want to know that proper checks have been made, wherever they’re from.

We should be aiming for a system that’s rich in information about health outcomes. Its overwhelmingly greatest benefit would be in encouraging everyone in the system to do their best. But as a useful byproduct it would detect the worst - from wherever they hailed. And not just at the outset, but whenever their performance fell below acceptable standards.

Perhaps the other inquiry into Queensland Health Systems by consultant Peter Forster will ultimately attend to the important. It has been almost invisible compared with the sound and fury with which Messers Morris and Beattie have attended to the urgent.

Perhaps the Morris inquiry will go on to develop its policy thoughts for the future more coherently. And well before the hi-jinks set off by the Interim Report, Premier Beattie’s own initial sketch of his ideas on improving Queensland’s health system was wide-ranging, thoughtful and constructive. There’s no logical reason why Mr Beattie’s current Vaudeville on the trail of Dr Patel - need necessarily compromise the important. Let’s hope it doesn't.

But whether we’re aiming to make Queensland’s Health system once again the best in the world, or just detect the next Dr Patel, his status as a foreigner is, at best a minor detail and at worst a dangerous distraction. If we miss that basic truth, the next Dr Death we’ll be talking about might not be a Jayant Patel. Instead he’ll be a Bill Smith, or a Dick Jones.

Let’s hope we don’t leave it till then to build the system back to good health.