The unhealthy state of health

The QNU works with other like-minded organisations to promote debate on these matters through our membership of the Public Hospitals Health and Medicare Alliance of Queensland (PHHAMAQ) and the Australian Health Care Reform Alliance (AHCRA). The other interest that we need to declare is that the QNU is currently affiliated to the Australian Labor Party (ALP). This relationship has not prevented the union from engaging in debate and critical analysis on health policy or inaction by government and we have done so without fear or favour. For example, the QNU opposes the federal government’s 30 per cent rebate for private health insurance on equity, effectiveness and sustainability grounds. We believe it is poor public policy and will continue to argue against the federal ALP’s support for this initiative.

Why all this talk of interests? I think it is essential to go back to basics and look at both interests, objectives and values before we consider the unhealthy state of our health system. The debate about the future of health must be framed in terms of interests and values.

Every person interested in the current health debate must first ask themselves what are the interests of the many and varied players in this debate - the community, governments, organised health labour groups such as the QNU and the Australian Medical Association (AMA), the media, professional organisations, regulators, educational institutions, opposition parties, health bureaucrats - to name a few. Of course there are competing interests at play here, even within each of the groups mentioned. We all need to critically look at each argument that is put to us - what are the interests at play here and are there any hidden agendas.

Health is intensely political and this must be actively acknowledged and factored into the health debate. Don’t swallow everything you hear uncritically - yet at the same time it is also important not to be paralysed by undue cynicism. An open mind and healthy scepticism are important tools for embarking on an examination of the current state of our health system.

The other vitally important issue that needs to be considered is values. What are the values that underpin health policy development? What are the values of each of the key stakeholders in health and how and where do these differ? The QNU believes our community must be active in determining our collective values that will underpin health service policy and delivery. To date, debate on such matters has not occurred in a large scale, structured and co-ordinated manner in Australia as it has in other countries: for example, in the Romanow Inquiry into the future of health care in Canada conducted a few years ago. The final report of this ground breaking inquiry (Building on Values: The future of health care and Canada) explicitly positions the health care debate within a values framework.

Such a framework has been absent from the Australian debate, at least from our politicians. To us, this is a critical failure that must be addressed. It is essential that the community be genuinely engaged in an informed, structured and rational debate on health needs and expectations and how these are best funded. The shared values of our community must inform such a debate.

There is no doubt there are many problems facing our health system - the multitude of reports from recent times highlight these. In our 2005 submission to the Forster review of Queensland Health the QNU discussed in some detail what these problems were but more importantly potential solutions for many of these problems. It is easier to throw rocks rather than play a constructive role in the rebuilding of our health system. Many of the problems that beset our public health system apply equally to the private hospital and aged care sector. Public hospitals aren’t in this “crisis” alone - we are all in it together and we all have a stake in ensuring the future sustainability and quality of our health system.

Similar problems exist in all Australian states and territories and indeed internationally. We believe they arose first and in such a spectacular way in Queensland last year because Queensland has historically under funded health services and because of particular cultural issues peculiar to Queensland.

Rather than focus on what is wrong with the current health system the QNU believes we need to re-frame the debate and instead ask what sort of health system do we want and need and how do we achieve it.

From the QNU’s perspective we believe we need a health system where:

• the system is patient and staff focused - this requires a shift in focus to quality and effectiveness from efficiency and budget bottom lines;
• there is equity of access to health service and equality of health outcomes - where access to health services is determined by clinical need and not ability to pay;
• services are integrated across settings and there is support for innovation and improved service delivery;
• a safe and supportive environment for staff and patients is provided;
• community and staff have genuine input into decision making and health service planning;
• openness, respect, transparency and accountability are the principles that underpin the operation of the system;
• words are matched with action and expectations matched with appropriate funding;
• evidence underpins all decision making and a culture of critical analysis and debate flourishes;
• there is consistency of approach and sound systems upon which to base decision making;
• staff and patients are treated fairly and with respect and are valued for their contribution;
• workloads of staff are fair and enable the delivery of high quality patient centre care;
• health workers receive fair remuneration and conditions of employment - there is pay parity with interstate counterparts and work value is consistently and appropriately determined;
• there is a rigorous, simple and open complaints system established for staff and patients that enables concerns to be promptly and appropriately addressed.

The QNU is committed to working with government and other key stakeholders to achieve our vision for the health system. Reform is needed if we are to ensure that our health system delivers equitable, high quality outcomes and is sustainable. Nurses are strategically placed across our health and aged care system to drive a positive collaborative reform agenda. We all have a role to play in the debate about the future of our health system and we must all be prepared to take on this task constructively and enthusiastically.