Ideas@TheCentre
NSW health problems 100 years in the making
Cataloguing the ‘achievements’ of the O’Farrell government’s first 100 days is an artificial measure of its progress, particularly when the major policy problems facing NSW have been decades in the making.
Take the poison chalice of health, for instance.
The location of NSW’s 150 public hospitals, some in close proximity to each other, reflects the medical and transportation realities of the system’s founding age. In the late-nineteenth century, suburban and country local hospitals provided the basic medical and surgical care of the day. Modern-day technological advances make it financially impossible and clinically insupportable to provide specialised services at every hospital. Optimising the provision of hospital care across the state requires a judicious mix of:
(1) closing or redefining the role of small rural and remote hospitals and concentrating more complex services in larger regional or metropolitan facilities
(2) avoiding duplication in metropolitan areas by merging and relocating services
(3) developing an appropriate mix of core specialist services in outer metropolitan growth areas, and
(4) ensuring, by striking the right balance between 1, 2 and 3, that sufficient recurrent resources are available to run services efficiently.
This inevitably means significant change for many of the 40 or so hospitals in metropolitan areas and the 100 or so in rural areas. Hence, recent governments of all persuasions have only unevenly implemented sound planning principles because hospital closures and downgrades are unpopular – especially in country areas – among local members, affected communities, and health providers.
But without the political will to justify the necessary reorganisation, recurrent funding has to be spread so thinly as to compromise the hospital system’s overall capacity. The alternative is to continue with a cost-ineffective system that imposes large fixed costs on the health budget, which leaves units underutilised due to chronic shortages of recurrent funding for frontline services.
The inevitable result is longer waiting times for treatment.
The O’Farrell government should take note of the 2008 Garling Special Commission, which found the existing configuration of the hospital system is unsustainable and in need of a systematic, open and candid reconfiguration.
Dr Jeremy Sammut is a Research Fellow with the Health and Ageing Program at The Centre for Independent Studies.
