Spending too little each year, then a paltry catch-up, sets up our health system for failure.
There’s a surreal aspect to the current public commentary on the health crisis gripping Tasmania. We know there’s a problem and we need a solution.
Everyone avoids talking about the giant elephant in the room, the Government’s unsustainable fiscal position.
Addressing the health crisis requires looking at all factors that have contributed to the mess. Otherwise, suggested remedial action is about as useful as relying on backburning alone to address climate change challenges.
The State Government is in the same position as it was when it took over government in 2014.
It is looking into a fiscal abyss. We spend more than we receive. The imbalances will worsen. There are no cash buffers. There are no funds set aside for a rainy day. The Government surely can’t believe its own rhetoric that we’re basically on track, because why would it have allowed the health crisis to spiral out of control? The Opposition doesn’t admit to major underlying problems, for to do so would require a solution. The robust adversarial contest of ideas long championed as the hallmark of our parliamentary democracy has been reduced to a sniping battle between the disingenuous and the frightened.
Health budgets are set to fail each year as each year the health budget is less than the preceding year’s actual spending. When more money is needed, the Government crows that the additional amounts are evidence of its commitment. It’s not. It’s the inevitable consequence of poor budgeting that fails to provide management with realistic goals.
In 2018-2019, hospital (Tasmanian Health Service) spending was $1674 million or $164 million over budget. The previous year the overrun was $161 million. The budgets for this and the next year are both less than the amount spent in 2018/19. After a disastrous 2018/19 marked by ambulance ramping, emergency room overcrowding and real risks to patient outcomes, the Government is planning to spend less. Spending more won’t necessarily solve all problems but there is no evidence to suggest spending less is the answer.
We don’t need any more inquiries. We can’t waste time waiting to confirm what we already know perhaps hoping for a new or better minister. That’s not the problem anyway. We’re approaching the point of no return. Remember we were told majority government was a prerequisite for steering the state into a sensible future. Nonsense. It hasn’t happened. One cannot blame the Legislative Council for obstructing government plans for health.
As a minimum, a health budget needs to be based on the previous year’s actual spending plus 5 per cent. Why 5 per cent? That’s the amount, confirmed by Treasury Secretary Tony Ferrall, by which spending will need to increase based on past outcomes driven mostly by new technology and treatment. Of course, that will immediately place strain on the rest of government, where the remaining 70 per cent of outlays are spent. That crystallises the challenge for the Government (and Opposition): To find new sources of revenue. As soon as that is accepted, the next reality is that Tasmania can’t go it alone. That’s where our 12 senators need to step up to the plate. At this stage, 11 of the 12 wear party hats, usually putting their party’s interests ahead of other considerations. Federalism is in as bad a shape as our health system. Surely we can work together to improve the system.
We need a new way. I have written to the Premier and Leader of the Opposition detailing my concerns, suggesting a nonpartisan health reform panel with membership from of all parties. Its role would include developing short, medium and long term reforms and to recommend and monitor agreed reforms. The panel would be supported by Department of Premier and Cabinet to ensure a whole-of-government approach and meet monthly, reporting regularly to Parliament and thus, the people of Tasmania.
Health, while comprising a large part of the budget, roughly 30 per cent, is relatively self-contained. From an operations viewpoint, it doesn’t overlap with other areas to anywhere the same extent as some departments. The health reform panel will not interfere with other government operations. Once a health operating budget is agreed the Minister can get on with administering it.
Healthcare must be above party politics and I offer my services as a member of such a panel to oversee a nonpartisan approach to the health system and restoring faith and hope for all who rely on it. Which means most of us.
As a health professional in my earlier life, I have a valuable insider’s view on how the health system works. A nonpartisan approach has the capacity to enable frank and bold discussions about the future of health services with a better chance of progressing to courageous decisions which are often too difficult in an adversarial environment.
There are lots of things we can do if we are prepared to work together. We need to question everything we do and not be afraid to try something new. Our future depends on it.
The Mercury Tuesday 17 December, 2019