Australia's brave new Healthcare crucible

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Modern day metaphorical usage of 'crucible' is used with controversial topics such as Mr Abbott’s continuing troubles, described as a ‘crucible of crisis’. Dr Leong Ng explains the relationship in the context of recent happenings in Australian healthcare.

Part 1 — the Background

IN  PLAIN English, a crucible is a receptacle, which can withstand extremes of physical insult. It was an essential tool of the alchemist in medieval times.

The Crucible was a 1953 prize winning then controversial Broadway play written by Arthur Miller about the flawed 17th century witch trials of Salem something the USA would probably prefer to forget in their early history.

Modern day metaphorical usage falls on controversial topics being dealt with, restricted in space or time – as with Mr Abbott’s continuing troubles – described as a "crucible of crisis". 

How are these related in the context of recent happenings in Australian healthcare?    

Constitutionally, the power vested in the Commonwealth Government in regulating health care services falls mainly on the Health Insurance Act 1973 and the Human Services (Medicare) Act 1973 and their associated acts.

The regulation of health practitioners, misleadingly termed “National Law” is by individual state statutes enacted in 2010 following the lead of Queensland in 2009 which formed the "template" statute. These were inherited from similar separate state statutes before the formation of the Australian Health Practitioners Regulatory Agency (AHPRA).

The head of power appears to be truncated from the Australian Constitution and presently stops with the Council of Australian Governments (COAG) which was streamlined into eight councils in 2013.  One is the COAG Health Council (CHC) and it works with the Australian Health Ministers’ Advisory Council (AHMAC) to advise the Government regarding health policy etc. AHMAC in turn has 6 principal committees to advise and support its function.

AHMAC met in Darwin on 7 August and decided to publicly release a commissioned report of an independent statutory inquiry the Snowball Review Report. This was completed on time in December 2014 but never released in the public domain and now tossed into another crucible.

As it stands in the public domain, there are concerns that it may have been a harsh and critical report, which had been "whitewashed" and edited during the time of its 8-month suppression. In essence, one does not know the accuracy or the authenticity of this ‘independent’ report. 

The Review was a pre planned one which was delayed a year. It focussed on AHPRA, the nation’s nouveau regulator of health practitioners and thus indirectly, the implementation of health policy.

Some Facts

Firstly, Australia’s global effrontery as "one of the best healthcare systems in the world" remains, in my view, a delusional proposition to its proponents. The independent ranking by the World Health Organisation placed Australia no 32 in 2015, even behind developing countries like Morocco and Colombia and little publicised Oman.

Even Greece ranked 14. This week, the Grattan Institute published a damning report on ‘questionable care’ all in Australia

Secondly, the released "independent" report of Mr Kim Snowball illustrates, in my view, the usual perfunctory approach to greater problems with the regulator.

Thirdly, a major thorn mandatory reporting of practitioners as it stood was offered no major reform. This serious misapplication of the law may not have recommended by Mr Snowball and its implications gently alluded to by Dr J Flynn, Chair of the Medical Board of Australia recently, after the hushed up unexpected deaths of 4 junior doctors in Victoria.  

The reader is left to conclude whether regulators are "protecting the public and guiding the profession" as they so claim. WA lawmaker N Goiran et al  have previously independently commented against it as was also hinted to by the Queen of Australia in an opening speech to Parliament.

Fifthly, this was not the first nor was it a different inquiry. Numerous ones were held over the past decades, each yielding outcomes which governments have not heeded or yet to heed. NSW tried hard to bury the Garling Report and the hunger strike triggered privately published Kerkyasharian Report (extracts here).

Further north in Queensland, the Morris Inquiry during the Patel saga had been suddenly shut down when the truth was getting close. Of course, one should not forget the NSW Walker Inquiry, which led to the strengthening of the non-accountability of an inconsistent and unpredictable entity called the HCCC.

Generally, Tony Fitzgerald’s viewpoints remain pertinent for Queensland and, also for the rest of the Australia.

Finally, some of the members of the Snowball Review team e.g. Dr Mary Foley, Director General of NSW Health had connections with organisations and alleged perpetrators complained of by submitters. She did not disqualify herself which should have been the case. This alone makes the credibility of the report dubious. Professionally incestuous relationships have not been declared – at least publicly.

The intended Goals of the National Scheme

  1. Protection of public safety
  2. Facilitation of workforce mobility
  3. Facilitation of high quality education and training
  4. Facilitation of the assessment of overseas trained practitioners
  5. Promotion of access to health services
  6. Development of a flexible, responsive and sustainable workforce

Guiding principles include elements of transparency, accountability, efficiency, efficacy and fairness.

Have any of these been achieved under the guiding principles?  I would say perhaps only goals 2 and 6.  None of the guiding principles have been consistently applied as demonstrated by various AHPRA (and the NSW Medical Council) actions.

Mr Snowball stated that his task was to (sic) identify the achievements and recommend improvements based on his consultation with stakeholders etc.

None of the stated 230 submissions by stakeholders are presently available in the public domain for scrutiny and debate. None of the submission recommendations were mentioned or referred to. Not all stakeholders were invited to consultations or public interviews.

Conclusion to Part 1

Essentially, in the perspective of hope by the Australian public and the professions when the Review was commissioned, one is very concerned about the 8 month delay in the release to the public and the perceived non transparency.

Part 2 (to come) discusses some of the Recommendations, ongoing challenges including a ‘Reissued Comminique’ on 17 August 2015.

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