Ideas@TheCentre
Plus ça change: O’Farrell government and NSW Health
Is the O’Farrell government content to merely govern and better manage Labor Party programs or is it committed to reforming the NSW public sector?
The so-called ‘tough’ but actually underwhelming state budget suggests the former and the impression is reinforced by the limitations of Coalition policy in key portfolios such as health.
The Coalition’s blueprint for improving health care in NSW (released in March 2009) rightly criticised the existing administrative structure for its ‘over-centralisation, additional layers of bureaucratic red tape, and remote decision making.’
Since the 1980s, public hospitals and health services in NSW have been centrally administered within designated regions. Initially, there were 23 metropolitan and 23 country ‘area health service’ bureaucracies. This was cut to nine and eight respectively in 1997, and then reduced to just eight for the entire state in 2005.
The Coalition promised to fix management problems by replacing Labor’s ‘huge and out-of-touch Area Services’ with smaller health districts based on the principle of localised management of health services.
Since coming to office, the Coalition government has reorganised the management of the NSW health system (the fifth in less than 30 years), which is now administered by 18 Local Health Districts (LHDs), eight in metropolitan Sydney, seven in rural and regional NSW, plus three specialty networks.
The revised structure closely resembles the deeply unpopular one that Labor established in 1997, which generated widespread complaints from frontline clinicians concerning excessive centralisation, red tape, and remote decision-making.
Just as embarrassing is the way the Coalition’s policy was gazumped by the Rudd-Gillard national health reform deal. In return for additional federal health funding, the Keneally government replaced the ‘huge’ area bureaucracies with 18 Local Health Networks (LHNs).
The Coalition maintains it has ‘scrapped’ the LHNs by establishing LHDs. But the change is largely cosmetic: the LHDs have the same geographic boarders as the LHNs. In reality, the government has re-established the virtually identical and unsuccessful ‘Area’ system abolished by then health minister Morris Iemma in 2005.
The Coalition’s singular focus on management issues is at the expense of more complex, deep-set, and politically sensitive problems in health such as planning anomalies that adversely affect operational performance. Nor does it seem committed to micro-economic reform of the rigid public monopoly model of health service delivery by reviving the Greiner government’s innovative public private partnership (PPP) policy.
Instead, it appears that under the O’Farrell government, the more things change in NSW Health, the more they will stay the same.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies.
