Labor's had two decades to fix the health system, so what's gone wrong?

Canberra’s health portfolio has become a constant pressure point that the Canberra Liberals love to press, criticising the affordability and efficiency of the system, confirmed by reports and inquiries that have consistently found systemic culture problems including bullying and harassment, stretched out emergency department waiting times and a failure to improve services for people with chronic conditions.

So why are there still systemic problems in the health system after one party has been in government for the past two decades?

The cause of ACT Health’s tribulations are fourfold, ANU health policy expert, Visiting Fellow at the Research School of Management, Robert McMahon, told Region Media.

Workforce and structural issues; a small population; difficulty attracting medical staff and specialists; and health inflation – where health costs have risen faster than the consumer price index – because of expensive new treatments, all impact the efficacy of the system, he said.

People coming across from rural areas to use Canberra’s health system does increase the cost, but its effect on the ACT has been exaggerated by the government, Mr McMahon said, citing the fact that patients from northern-NSW travel to Brisbane for treatment, as do Tasmanians to Melbourne hospitals.

While health inflation and inefficiencies related to the economies of scale (where products become cheaper in larger amounts) due to a small population are not localised to the ACT, or directly controllable by ACT Health, the poor culture and structure of the department have not been adequately addressed, Mr McMahon said.

“There seems to be a real problem with how they manage their workforce and the relationships and conduct within the workforce,” he said. “There are stories within ACT Health of bullying and it seems like the government has had difficulty getting on top of that.

“Similarly, they have been unable to develop a structure to adequately manage the health system.

“This is a bit more within the government’s purview and control, but they have not been able to land it and I am not 100 per cent sure why. Other governments have landed it but the ACT Government seems unable to do that.”

A few years ago, Labor introduced a bifurcated model, where policy and planning are done by one agency and the implementation – including hospital services – are done in another, Mr McMahon said. The policy was tried in the Greiner Government in NSW in the late 1980s but was scrapped within a few years after it was found to be unsuccessful.

“It remains to be seen whether [the ACT Government] will be able to make a go of it, but I do think it is a bit curious the way they have developed this bifurcated model, particularly when it has not worked elsewhere,” he said.

Attracting and retaining specialist and adequate medical staff have also been a problem.

“I have never quite understood why this is the case because Canberra is a very nice place to live and you would think that medical practitioners would have a well renumerated and pleasant lifestyle, but they have real difficulty attracting and retaining clinicians,” Mr McMahon said.

“They often pay a lot of money to get them here and then do not keep them, in part because of the structural issues.

“I have a friend who was a specialist who came down for two years and took off back to Sydney because he said working in the ACT health system was just so frustrating and so bureaucratic and difficult.”

Health Minister Rachel Stephen-Smith acknowledged that there were some shortcomings with the Territory’s health system, but says it has been improving over the last decade despite growing demand.

“We have increased the number of people who are seen on time in category two elective surgeries from 44 per cent 10 years ago to 77 per cent in 2019, so you can make a change but it does take time,” she said.

“We have grown elective surgeries over the last five years at about double the rate of the rest of the country, growing at around 2.4 per cent a year compared to the national average which is around 1.2 per cent.

“In terms of GP bulk-billing, that is in part because the Federal Government does not fund GPs sufficiently, so we have made investments of $12 million over the last 10 years that have seen bulk-billing grow from around 51 per cent in 2009 to 64 per cent in 2018-19.”

The ACT has the lowest rate of bulk-billing rates in the country and the lowest number of GPs per capita.

Ms Stephen-Smith took over the health portfolio last year after the shock resignation of then-Minister Meegan Fitzharris, who had held the portfolio since 2016.

It was Ms Fitzharris who launched the inquiry into allegations of bullying and misconduct in the ACT health system after fighting off calls for a royal commission into bullying allegations.

The decision to downgrade the type of inquiry was a wasted opportunity, Mr McMahon said.

“You can change culture in the face of external shock [from royal commission revelations],” he said.

“It would have been embarrassing [for the governemnt] but it would have given them the ammo and shock to change the system.”