Yesterday the LNP in Queensland announced its “Blueprint for Better Healthcare”. Michael Moore, CEO Public Health Association of Australia and Adjunct Professor Health Policy and Governance University of Canberra, reports on the launch and the challenges ahead.
Michael Moore writes:
The Premier of Queensland and his Minister for Health were quite upbeat about the launch of the “Blueprint for Better Healthcare”. Although the argument was about patient centred healthcare, the framework of the launch was largely about economics. The position is not hard to understand. The LNP government is focussed on getting into surplus and health consumes more than a quarter of the budget. The thinking is that if the services for patients can be delivered more efficiently, with less expenditure on overheads, there will be more money for frontline services.
After the opening speech by senior executive of Macquarie Capital – a major sponsor of the event – the two ministers emphasised the importance of reform in Queensland Health if the myriad of issues are to be managed effectively.
It is not surprising with an economic framework and the intention to move from “repair to recovery” that the issues were focused on hospitals, outsourcing to the private sector and key conservative values such as smaller government, lower taxation, better management and individual enterprise. “We are not undermining public healthcare,” he stated, “we are finding innovative ways to deliver”.
The “Blueprint for Better Healthcare” is really a blueprint for better sickness care. But politicians delight in talking in positive terms. The Queensland Premier Campbell Newman and his Health Minister Lawrence Springborg were certainly upbeat on what they see as positives in health reform in their state. In dismissing the protestors outside the $200 dollar lunch/launch Springborg provided a choice about either being “on his train” or “being under it”. An interesting turn of phrase for a minister who has a choice himself about improving the care of people who have fallen underneath a locomotive or taking preventative action to stop people falling underneath it in the first place.
More than 500 people attended the lunch with private industry having an overwhelming presence. And they were not disappointed. Examples of services to be outsourced included pathology and radiation oncology. But that is not enough. More money for the private sector was in stark contrast to his attitude to grants to organisations which were often “little more than a gratuity”. A portal will be established for the private sector to have better access to the bureaucracy “so they can negotiate the maze of bureaucracy” even though “we now have much less bureaucracy”.
In response to my question about the lack of prevention in the plan and how it contrasted with the sensible statements on obesity he had made that very morning in the Courier Mail, the Minister pointed out that he had a very wide portfolio and could not cover every issue in detail. However, the government was keen on encouraging individual responsibility recognising the level of obesity in Queensland. Prevention should largely be the work of Medicare Locals however he was keen to work with them to deliver better primary health care. Why? He explained the Commonwealth failures at the primary health care level wound up his responsibility in the hospital system.
A close colleague of mine who sat with me at the Population Health Network table has recognised the importance of working with the elected government of the day – no matter where they are on the political spectrum. Although she suggests the need to collaborate more and drip feed public health principles, I cannot help feeling that a rapid transfusion would be more efficient – providing better value for money.
My colleague had the following reflections on the launch:
In getting ready for my first official LNP function, I got dressed as corporately as I could. I pulled out the private sector high heels. This is a new world order in Queensland. “There’s a new train leaving the station” as Lawrence Springborg put it in his speech “and you can either be on it or under it”. I was keen not to be under it!
Walking from the hotel carpark, I passed PSU and QNU protestors who included several of my former colleagues. I probably knew more of them than the luncheon guests I was about to join. But no point lamenting the past! It is now time to get on board and work out how to work with this government for the health of Queenslanders.
I was adopting an optimistic approach and was keen to look for leverage points and understand how to speak the language of this government. After all the front page of our newspaper that morning headlined the minister’s possible plans to regulate the sale of junk food, perhaps acknowledging that solutions to the obesity epidemic lay beyond personal responsibility.
Wishful thinking! There was none of that at this policy launch. The premier first spoke of fiscal responsibility, returning the state to surplus, the failure of unions to responsibly represent their workers…. On health, he talked about outsourcing, co-sourcing, hospital in the home and the need for Queensland Health to return to its core business – “looking after the sick”.
Lawrence Springborg spoke next.
The LNP’s “Blueprint for better healthcare” has six key values and a framework for delivery with four elements. Prevention does not appear in the document. The minister went on to speak about the alignment of the policy with core LNP values which included personal responsibility, small government and small bureaucracy. He spoke with pride over the number of jobs cut from Queensland Health corporate office with a glint in his eye that even more cuts could be made. He spoke about changing regulations to make outsourcing easier for health and hospital networks.
How interesting! On the matter of obesity, he has chosen to invest in a hotline for one on one counselling – perhaps the easiest of the obesity strategy options to outsource – rather than tackle broader environmental determinants which often require less investment. Reiterating issues from his speech to the Health Media Club he said there was no evidence of any previous investment in obesity prevention in Queensland actually working. On this occasion he added that we were instead taking the WA Health approach , although there was no mention of any evidence of its effectiveness.
He spoke very little about Indigenous Health – around half a minute in the last few minutes of the talk – but he is interested in capacity building in this area. Ironic given this is one of the workforces hardest hit by recent job cuts.
There were positives. During question time he affirmed the government’s commitment to research and teaching irrespective of whether or not services are outsourced. He announced an “innovation portal” through which he was keen to hear about ways in which the department could perform better.
Afterwards, those few of us with a population health background talked about the need to collaborate more and drip feed public health principles to the new administration. We all had examples of how this had successfully been done in the past.
The challenge in public health is to remain optimistic, defend areas that remain and look for opportunities to inform action in a collegiate, collaborative way. Perhaps public health can even provide leadership.