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

Dominic Giannini 29 September 2020 34
Rachel Stephen-Smith

Health Minister Rachel Stephen-Smith took on the health portfolio last year. Photo: Region Media.

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.

READ ALSO: Report says progress being made on Health culture, but bullying must be addressed

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.

READ MORE: Two-thirds of health staff don’t trust bosses, says culture survey

“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.”

Meegan Fitzharris

Former Health Minister Meegan Fitzharris ordered an inquiry into allegations of bullying and misconduct within ACT Health. Photo: File.

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.”

READ ALSO: $60m injection to maintain swamped hospital services

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.”

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34 Responses to Labor’s had two decades to fix the health system, so what’s gone wrong?
Kieren Reynolds Kieren Reynolds 8:15 am 04 Oct 20

Transport is similar, they've had years collecting data and it tells a very different picture to what we all assume. It's a case of the loonies running the madhouse.

Barry Mckee Barry Mckee 11:44 pm 02 Oct 20

Try reading the constitution - and besides - you are not even a state

Tania Shaw Tania Shaw 8:31 am 01 Oct 20

you can never win in this portfolio, there is always something not right, someone desperate for treatment that can't get it, some decision that people don't agree with. We only have a limited number of hospitals and don't have the population and ability to create specialist centres to deal with the demand, like a larger jurisdiction can. From memory the previous Liberal and Labor ministers, before this long stretch of Labor were also criticised for the health system performance.

Simon Gallagher Simon Gallagher 6:47 am 01 Oct 20

One of the biggest issues with health is the two stream funding model. The hospitals are controlled by the territory government while the GPs are funded from the federal government. With the Medicare freeze over the last few years and the increase in costs to GPs they are loosing money if they bulk bill and try and give proper medical care. Because of this pressure is put back on the hospitals and the emergency departments. The fix is a system wide response no local government is going to be able to fix it without the federal government increasing the Medicare payments to GPs so they can bulk bill more and make their services more affordable.

    Charny Barney Charny Barney 10:38 am 01 Oct 20

    That is why the ACT Government established the nurse led Walk In Centres, to divert people with minor issues (relatively) from clogging up the emergency departments. very successful strategy, but the AMA hate it because it isn't full of doctors.

    Neekie M Ford Neekie M Ford 5:54 pm 02 Oct 20

    Charny Barney I went to a Walk in Clinic the other day, only one other person there. I waited five minutes and then had excellent service. Not sure what the emergency department wait would have been at the same time? Don't know why more people don't use them?

wildturkeycanoe wildturkeycanoe 9:21 pm 30 Sep 20

I’m still waiting for surgery, almost up to my “expected” 365 days on the Category 3 list. This is after initially waiting for over 6 months needlessly, while thinking I was on the list but then discovering I wasn’t, because of the ridiculous system at Canberra hospital that “lost” the referral from my GP. But hey, we are in a 1st world country with up to date technology like the NBN at our disposal aren’t we? So glad it’s an election year.

Heather Purvis Heather Purvis 9:13 pm 30 Sep 20

One of the problems with the ACT Health system is the 'fluid borders' & the catchment size/area of the only Tertiary hospital between Sydney & Melbourne...

HiddenDragon HiddenDragon 6:38 pm 30 Sep 20

This year’s Annual Rates Assessment Notices tell ratepayers that 31% of rates payments go towards funding the health system – a pointed reminder that effectiveness and efficiency (and lack of it) in the ACT health system is not just important to people who are using that system.

    bj_ACT bj_ACT 10:28 am 01 Oct 20

    The 31% of Rates claim is a bit of a furphy. The ACT Government gets the majority of health dollars from the Federal Government which raises the money from the Medicare levy and other federal taxes.

    I wish the ACT Government wouldn’t spin every tax dollar to suit their narrative of the day.

Stephen Page-Murray Stephen Page-Murray 3:59 pm 30 Sep 20

I’ve been in Calvary for a week. I really don’t know what all the whingeing is about...

John Dawe John Dawe 2:10 pm 30 Sep 20

If voting truly made a difference, it would be banned

Richard Flanigan Richard Flanigan 2:08 pm 30 Sep 20

Time to invest in health, education and services rather than bloody trams. At least they got the colour right. It will always run in the red.

    Stephen Page-Murray Stephen Page-Murray 3:58 pm 30 Sep 20

    Richard Flanigan

    It’s been successful beyond even the most optimistic expectations

    Andrew Cairns Andrew Cairns 4:09 pm 30 Sep 20

    Richard Flanigan Health and education have had immense amounts of money thrown at them...its been going up for isn't the problem!

    Lara Zangl Lara Zangl 4:18 pm 30 Sep 20

    Richard Flanigan hut he tram is a service....

    Charny Barney Charny Barney 10:36 am 01 Oct 20

    They built the University of Canberra public hospital WHILE they were building the tram. We can do both 👍

Lea Powell Lea Powell 1:36 pm 30 Sep 20

This has got to be the biggest red herring topic of any election in the ACT, where locally we have a labor Government and federally a liberal one. The issues with health hark back to the times of dishonest Johnny and the rabid monk, who were so destructive to much of our service industry. Ever since Whitlam it has been core business of liberals to dismantle Medicare, and they couldnt, so they ......... up health instead, and blame it on everyone else.

    Robert Knight - Canberra Progressives Robert Knight - Canberra Progressives 2:30 pm 30 Sep 20

    Lea Powell nailed it.

    Lea Powell Lea Powell 3:15 pm 30 Sep 20

    Robert Knight - Canberra Progressives for Murrumbidgee thank you

    Brenton Higgins Brenton Higgins 4:25 pm 30 Sep 20

    Well said. Blame the really prob. Federal liberals.

Mark Bowell Mark Bowell 12:25 pm 30 Sep 20

And does anyone think the liberals will be able to fix it that is the question ?

    Marc Edwards Marc Edwards 12:29 pm 30 Sep 20

    Mark Bowell well they couldn’t do any worse. It’s already bad:

    Mark Bowell Mark Bowell 12:42 pm 30 Sep 20

    Marc Edwards that’s true don’t think any local government can fix it tbh

    Marc Edwards Marc Edwards 12:43 pm 30 Sep 20

    Mark Bowell the problem seems to be throw more money at health, that hasn’t worked so money isn’t the issue, maybe look at the processes and clinics.

    Mark Bowell Mark Bowell 1:07 pm 30 Sep 20

    Marc Edwards I have no faith in either

    Anthony Chase Anthony Chase 1:18 pm 30 Sep 20

    Marc Edwards the problem is how the funds are being used..there is a lot of waste!

    Robert Knight - Canberra Progressives Robert Knight - Canberra Progressives 2:29 pm 30 Sep 20

    The two tiered system of public and private leads to serious inefficiencies, particularly when profit is prioritised over outcome. I’d be looking there as part of a comprehensive review.

    Gordon Gullock Gordon Gullock 4:09 pm 30 Sep 20

    Mark Bowell if elected and when they fail to fix the problem, Scotty from marketing will help them blame blame Labor.

    Sean Bishop Sean Bishop 8:58 pm 30 Sep 20

    Mark well bud, surely it'd be a better option then 10 wasted years on Labor

    Mark Bowell Mark Bowell 9:04 pm 30 Sep 20

    Sean Bishop more like 19 years

    Stas Idowu Stas Idowu 6:36 pm 01 Oct 20

    Mark Bowell you didn't answer their initial question.

Acton Acton 11:53 am 30 Sep 20

The failing ACT health system is yet another example of long term incompetence, overseen by routine denial and entrenched self interest. Treatment should commence with voters discarding their habitual complacency and giving Barr and his ACT government a much needed and long overdue electoral enema.

A_Cog A_Cog 9:16 am 30 Sep 20

It’s a shame this article doesn’t do what the heading says – look back over the TWENTY years (not just the last few years). It’s also important to remember the ACT Govt only has to manage ONE hospital (TAS has 4, WA has 80). Running one building with one workforce is actually not that hard.
– Has everyone forgotten that ACT Health was caught fabricating wait time and throughput data TWICE in 4 years, back when Katy was CM? They were lying to the Commonwealth, in order to unlock their KPI target funding.
– What about the wiring and electrical fire issues?
– The wait times have been shocking for over ten years.

What you’ve got is a caravan of ministers and staffers who aren’t up to the job, a feeding frenzy of senior execs who are the same and don’t stick around long enough to get found out, and a political culture of denying responsibility and spinning by restructuring. The bullying stories show how much the nurses and doctors endure just so they can work hard and care for the unwell.

There are some key areas of government you’d expect (demand?) that Labor get right. Health has gotta be #1 so I’m astounded that the ACT is the worst performer in its KPIs – take a look at the PC’s ROGS, and go through the last 10 years.

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