Involving communities in their health

Surprisingly, the Queensland Government has identified problems with Queensland Health (well, OK, it has had the problems well and truly thrust down its throat), but it has now identified a solution. Unsurprisingly, their solution is to spend lots of taxpayer money on nurses, doctors, specialists and hospital beds. It sounds like a very committed, very determined and very typical government response to all the problems.

Unfortunately, there are even more problems with the so-called solution, problems that are true for every state of Australia.

On my and others’ calculations, we are training fewer than half the doctors we need to be graduating. When you look at the average age of doctors, estimate their likely retirement rates and take into account their growing burnout rate, we are clearly getting further and further behind on doctor numbers.

Nothing indicates that state health departments are adequately taking that issue into account.

General practitioners (GPs) currently provide around 70 per cent or more of primary healthcare services. So, what will happen as GPs retire, as most will over the next ten years, if they aren’t being replaced? The answer is that workloads in hospitals will soar as people who can’t find a GP turn up at emergency departments. Already overworked emergency departments are being swamped.

Our other problem is nurses. The Commonwealth Productivity Commission expects an Australia-wide shortage of 40,000 nurses by 2010. Nothing suggests that any state will be immune to that issue.

Health departments could offer lots of money to attract scarce doctors and nurses and still not meet the shortfall caused by private and public sector retirements. And, of course, if one state improves its position, all that will do is to transfer the problem elsewhere and increase the likelihood of a bidding war between jurisdictions for resources that will now always be in short supply.

The latest estimates are that Australia will be short 20,000 tradespeople in the construction industry within 10 years. There are similar statistics for every profession, trade and career in Australia. From dentists to engineers, from teachers to doctors, from carpenters to geriatricians. It’s what happens in an ageing society as more people retire than enter the work force.

Every one of our trades and professions is already competing to get school leavers into their particular area. Medical and nursing careers are also competing, often against far more attractive, more lucrative and more “normal hours” careers. Medicine and nursing are careers that are becoming less and less attractive to potential students as working hours, workloads and patient expectations rise. As well as doctors and nurses, this is also true of all the other skilled people to whom we might otherwise delegate various healthcare work. They will generally just not be there. Inner-suburban Sydney and Melbourne are not too bad. But outer metropolitan or rural areas: not a hope.

So, money for staff as a solution for health just doesn’t stand up. It’s too simplistic. The staff simply aren’t and won’t be there. But are there real answers? The answer is a qualified yes.

What are the ways in which we can arrive at these real answers? One answer to this just might be by asking the community.

The West Australian Government has recently trialed a process where it chose random residents within a geographic area, got them together, taught them about the basic constraints and issues within which the health system must work and then asked them to come up with recommendations.

This process had been trialed earlier by a former WA health administrator who believed in empowering communities, but was rapidly abandoned by a successor who apparently did not.

Basically, what these informed community representatives decided they needed was more money on preventative healthcare, more money on mental health, a much more targeted focus on the genuinely disadvantaged, and less money spent on hospitals and emergency departments.

The more you think about it, the more radical you may see that as being. But it is a prime example of a community that, given an understanding of the economic and health big picture and empowered to come up with its own answers, is willing to take responsibility for making hard choices.

Now, we are waiting with interest to see whether the recommendations will be instigated. Because, if they are not, it may just be because the solutions the community has suggested would be unpopular with health and hospital administrators, whose world would be turned upside down, and that would be equally unpopular with many vested medical interests.

But, is it really possible to empower the broader community to participate in decision-making and goals setting? Is it really possible to take reasonably complex issues and break them down to something understandable by everyone? Is it possible to trust consumers and the community to have as good or possibly even better strategic sense than parliamentarians, bureaucrats and ministers?

Judging by the very practical solutions suggested by these focus groups, I believe that the answer is yes. Now all we need is for ministers and bureaucrats to agree.