Tasmanian Times

The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. No price is too high for the privilege of owning yourself. ~ Friedrich Nietzsche

The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. No price is too high for the privilege of owning yourself. ~ Friedrich Nietzsche

Economy

The parallel worlds of public hospitals and Peter Gutwein …

*Pic: of Peter Gutwein, from his website

image
Pic: of Michael Ferguson from his Facebook page

It should, by now, be no news to anyone that Tasmania has the least capable, most under-funded public hospital system in the country. The evidence is copious: not only from the funding figures themselves but also from the data describing the things dependent on that money.

The number of beds. The numbers of nurses and doctors. The time people needing a bed have to spend on trolleys in emergency. The frequency of ‘code yellow’ alerts, indicating an internal emergency caused by overcrowding. The time it takes to have an operation. The time it takes even to get onto the elective surgery waiting list ‒ over five years in some cases.

No news to anyone. Except the Treasurer, Peter Gutwein. And, sadly, to the Health Minister, Michael Ferguson.

Last week, I released a lengthy, number-heavy report on how the state’s public hospitals had fared during the first two years of the Hodgman government. There is a link to that report at the end of this story. I concluded, on the basis of the evidence, that $423 million in GST money, allocated to us from other states in recognition of Tasmanians’ high health needs, was not being spent on health this financial year. Instead, it was being diverted into other areas of the budget, particularly the chase for a budget surplus.

I concluded, on the basis of the evidence, that Tasmania would need another 82 acute hospital beds if this state was to meet the national average of beds to population. If the Commonwealth Grants Commission’s calculation of the specific needs of our population for admitted care were to be factored in, that figure would rise to 200.

So we need 200 beds to give our people the same level and quality of inpatient care that other Australians have. That money is given to us, specifically because of our health needs, as part of our overall GST allocation. The Grants Commission’s documents, freely available on their website, are quite clear about why they are giving us that money.

In response, Peter Gutwein fronted the cameras. Michael Ferguson issued a press release. The message was precisely the same, as if it came from the same hand.

‘Martyn Goddard is wrong.’ said Mr Ferguson’s release, ‘in asserting that GST funding is tied to health ‒ it is not tied to specific areas.’

I have never made such an assertion. I have always been quite specific: that GST money is given to us in recognition of our health needs but the Grants Commission does not have the constitutional power to direct a state how to use it.

It’s not a tied grant. So?

Just because they are allowed to use that money in any way they like does not mean they should. It’s a matter of priorities. One would have hoped that running a decent public hospital system was at the top of any state government’s priority list. Apparently not in Tasmania.

The release went on to say: ‘Our record investment in health includes an additional $50 million in frontline health and the continued roll-out of $76 million in reducing the elective surgery waiting list, which has reduced the waiting list to a record low.’

Let’s look in some detail at the reality of that statement.

In his first budget, Mr Gutwein announced cuts to health of $210.4 million over four years. The next year, he said he would give some of that back, hence the $50 million. But that still leaves a cut. That ‘additional $50 million’ is in fact a cut of $160 million.

Then there’s the mythical $76 million. This was announced some 18 months before the 2014 election by Jeremy Rockliff, then the shadow Health Minister. It has been re-announced many times since and, in the absence of much else positive to talk about, they are still doing so over four years later.

But the $76 million did not exist and never has. This amount was supposed to be spent over four years ‒ $19 million a year ‒ but was immediately swamped by cuts.

Over the past year, Mr Ferguson has concentrated ‒ rightly, in my view ‒ on treating those elective surgery patients who have been waiting the longest. The money for that has come from two sources ‒ money that would otherwise be spent elsewhere in the portfolio, particularly on other patients; and, mostly, from $20 million left over from a $325 million Commonwealth grant negotiated between Andrew Wilkie and Tanya Plibersek, then the federal Health Minister.

According to this year’s Commonwealth budget papers, $12 million of that was paid last year and $8 million this year. On June 30 2017, that money will run out and the program will have to end.

‘The Hodgman government has made a record investment in health allocating $6.4 billion over the next four years in the last budget,’ Mr Ferguson’s release said.

That claim needs examination too. Yes, this is ‒ narrowly ‒ more dollars than went before. But what matters is not the number of dollars, but whether there are enough dollars to keep up with costs. Otherwise, it amounts to a cut.

As my paper points out in some detail, the dollar rise in funding for patient treatment ‒ the money actually paid to hospitals ‒ was to rise by just 0.9 per cent this year. But costs have been going up by about 7.6 per cent a year. That 0.9 per cent rise in the number of dollars represents a real cut, when inflation and other costs are taken into account, of 6.7 per cent, or $91.5 million.

‘According to the latest Commonwealth Grants Commission data, the independent agency which actually calculates the GST distribution,’ said Mr Ferguson’s release, ‘Tasmania is spending more in health per capita than other states and territories, and we devote a bigger share of our budget to health than the national average.’

Not so, actually.

Two years ago, the Commission quoted in one document ‒ as an incidental table not central to their work ‒ figures on state budgets they did not themselves compile. It has not been seen again.

Those figures did not separate the amount of money state governments put into health from their own resources ‒ from their own taxes and charges and their share of the GST ‒ and money from other sources. And there is no consistency between states in how these figures are worked out and how they are expressed. These figures cannot be validly used to compare one state’s performance with another. And state budget papers are highly vulnerable to political spin.

There are other reasons to conclude that these figures do not accurately represent the contribution made by the Tasmanian government to its public hospital system. By quoting them this way, Mr Ferguson is misleadingly including the one-off sugar hit of the Royal Hobart Hospital rebuild; the $325 million Wilkie-Plibersek deal, the money paid by people treated as private patients in our public hospitals (in 2014, 23 per cent of inpatients at the Royal Hobart Hospital alone paid for their own treatment); the amount raised from worker’s compensation and third-party accident insurance.

The only figures capable of separating the state government’s own contribution, and which are designed to be compared across the nation, are those I used ‒ from the Australian Institute of Health and Welfare, the independent federal bureau of statistics for health. The AIHW obtains patient-level data from right across the nation, reported in line with the same Institute’s own consistent data definitions.

But Mr Ferguson prefers to ignore them.

This technique, of putting up competing but shonky figures to confuse journalists and the public, has worked for the government. Most journalists ‒ fortunately, not all ‒ see it as one set of figures against another. It all becomes too hard, and they ignore the whole thing. That’s a pity, because this is important stuff.

On my calculations, using data from the AIHW and the Grants Commission, successive Tasmanian governments over the past decade have diverted $2.1 billion in GST money, that was given to us so we could address our health needs, away from health and hospitals. That could have treated an awful lot of patients. What has happened to them, do you think?

‘The Hodgman government,’ concluded Mr Ferguson, ‘inherited a broken health system and we are getting on with the job of fixing it.’

When, Minister?

Download Health of Health report …

health_of_health_2016.pdf

*Martyn Goddard is a Hobart-based policy analyst specialising in health issues. He is a former journalist and ABC documentary maker who became involved in health policy during the AIDS crisis in Sydney. Since then he has been a member of the main Commonwealth advisory bodies on AIDS and hepatitis and was the first consumer member of the committee that lists drugs on the PBS. He was also health policy officer for the Australian Consumers’ Association. For the past decade he has concentrated on examining and explaining Tasmania’s health issues.

WHAT THE MINISTER for Health Michael Ferguson thinks …

Record investment in health

• Mike Bolan in Comments: Well done Martyn. One structural reason that politicians and bureaucrats find it so easy to degrade our health system is that they don’t have to use it! Their health needs are met because taxpayers have to provide Private Health Cover for these people. Hence they have no real idea of how the system performs from the public’s viewpoint, nor do they suffer the consequences of their own decisions. Change this one thing and politicians will quickly change their attitudes.

• (Dr) Alison Bleaney in Comments: Thank you Martyn for giving us the facts so plainly; as a health professional I find it painful to read and comprehend and as a Tasmanian I am outraged. Political doublespeak and the apparent need for ‘jobs’ and keeping ‘mates’ happy and profitable knows no bounds it would seem. Where to from here?

WEDNESDAY, December 14 …

ABC: Royal Hobart Hospital rated as ‘third world’

Author Credits: [show_post_categories parent="no" parentcategory="writers" show = "category" hyperlink="yes"]
10 Comments

10 Comments

  1. Claire Gilmour

    December 16, 2016 at 10:46 pm

    I wrote to Ms Fey, she pretty much told me I had to live without teeth for 3 months! How many politicians have to do that?

    http://www.theadvocate.com.au/story/4361954/dental-cuts-anger-minister/?cs=5312

  2. William Boeder

    December 16, 2016 at 10:09 am

    I wonder if there is any bonus money for a State of Australia that creates all of its achievements in the reverse?
    Another question is to the number of smiling Tasmania Liberal State government ministers as I am unable to read of anything at all to smile about.
    My analysis of this ‘Tasmanian syndrome’ is presently showing that Macquarie Island (as opposed to the Tasmanian Island) has a more robust economy than Tasmania, also, at least it has less State created debt, as here in Tasmania this State’s GBE’s are now generating debt via 6 of them being recipients of Letters of Comfort.

    The word around Rosebery is that one must not mention the word ‘Liberal’ in this town otherwise one can expect a bashing from the residents of this State revenue ‘generating’ part of Tasmania.
    I would like to propose a change to the road laws in Tasmania, a fine of five hundred dollars for running over and killing a Tasmanian Devil, though if one runs over a Liberal minister a $500 cheque will be presented to the vehicle driver from Service Tasmania.
    (A photo of a road-kill Liberal minister will be required as proof of evidence although one could get by with a seven day waiting period along with a signed and witnessed Statutory Declaration.)
    Should a Tasmanian driver hit the jackpot and be found to have skittled a Liberal party Senator then Service Tasmania will provide the lucky driver with a cheque for $10,000-00.
    One day soon the Tasmanian citizens will be advised of the sacking of the entire executive board of each failingly mismanaged Tasmania GBE,
    whereupon a selection panel consisting of 12 persons that still do not have healthy drinking water supplied to their homes.
    As I understand the statutes set by this State’s legislative council relating to this State’s GBE’s, they are under strict regulation to the Government Minister Business Enterprises Act 1995 (No. 22 of 1995)

    Government Business Enterprises Act 1995 (No. 22 of 1995)
    Requested: 17 Dec 2016
    Consolidated as at: 7 Feb 2016
    12. Role of Board
    A Board is responsible to the Portfolio Minister and Treasurer, jointly–
    (a) for ensuring that the business and affairs of the Government Business Enterprise are managed and conducted in a manner that is in accordance with sound commercial practice; and

    (b) for the performance by the Government Business Enterprise of its functions; and

    (c) for the achievement by the Government Business Enterprise of its objectives as specified in this Act, any other Act and the corporate plan of the Government Business Enterprise.

    I believe a letter to the State’s Liberal party Attorney General will by law be required to report the apparent malefactors now rife among this State’s guilt plagued dysfunctional GBE’s.
    This to be followed by another letter to the State’s Treasurer Mr Peter Gutwein MP requesting the balance figure remaining from the Federal government grant monies achieved by Mr Andrew Wilkie MP of which $240 million dollars had been set aside for the refurbishment of the Hobart Hospital.

    https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0005/195305/2015-2016_Service_Agreement_-_Signed.pdf

  3. Leveller

    December 14, 2016 at 12:04 am

    No one has even bothered to ask about the $5 Million plus that has been slashed from the Tasmanian Ambulance Service (TAS). How many death’s have occurred as a result of not enough salaried PARAMEDICS’S and AMBULANCE’S being available?. I sincerely hope for my fellow Tasmanian’s that Mr Goddard can please examine this as well. The fact that no Chief of the TAS was appointed for over a year show’s a complete lack of incompetence on Minister Ferguson’s part and ultimately the buck stop’s with the PREMIER.

  4. Simon Warriner

    December 11, 2016 at 7:59 pm

    re 5. if you want to change that repetitive cascade of lies as our precious political petals clamour for re-election, Pete, you know exactly what to do.

    Set about informing the voting public that there is another choice, look for independents and give the party bludgers the flick.

  5. Leveller

    December 11, 2016 at 3:06 pm

    Well done Mr Goddard another one of your well thought out, well researched no BS or window-dressing with regard to the State of our health system. The fact that each successive Tasmanian Government continues to fail by recruiting and appointing the puppet’s to run our $1.65Billion Department of Health and Human Services. The current Chief of the DHHS was recruited from WA (deleted for anonymous inference). No succession planning no ideological rationale thinking put into any of these critical appointments. The fact that the Current Chief of the DHHS is paid more than the Prime Minister of Australia must make us the laughing stock of the Nation. It’s no wonder we have the worst health system in Australia as well and we suffer the highest rates of chronic disease’s. This will never improve with the current Senior Executive Service of the DHHS as all the appointees are simply “job’s for the boys” keyboard warriors and desk jockeys meanwhile the critical coal face clinical service delivery of all our Hospital’s continue’s to suffer and carry the burden of a hugely over-bloated and over-paid bureaucracy.

  6. Pete Godfrey

    December 11, 2016 at 11:44 am

    It is a pity that people can be swayed by spin really.
    As costs for health care go up every year like everything else, it means that every year there is a ‘record amount of spending ‘ on health care.
    Same as our groceries take a record amount of spending each year, our fuel, our clothes, our car maintenance.
    There is nothing to crow about there, just deceptive spin.
    It has always been Liberal party policy that the poor suffer.
    They have always done their best to make sure that education at a tertiary level is only for the rich, then they added the destruction of the TAFE system to make it harder for the unwashed massed to even get a trade.
    They have pushed private health care insurance onto people for years as a way of making sure we could stay healthy.
    User pays they call it, problem is that the user is already paying.
    Unfortunately political parties just take the money and put it to their own benefit. They try to buy their jobs back every 3 or 4 years with our money.

  7. Alison Bleaney

    December 11, 2016 at 10:22 am

    Thank you Martyn for giving us the facts so plainly; as a health professional I find it painful to read and comprehend and as a Tasmanian I am outraged. Political doublespeak and the apparent need for ‘jobs’ and keeping ‘mates’ happy and profitable knows no bounds it would seem. Where to from here?

  8. Brenda Rosser

    December 11, 2016 at 5:03 am

    I wonder how many hospitals would be required if the general public were warned about the slow chronic poisoning that is happening in our food system. Modern ‘frankenwheat’ with a protein (alpha-gliadin) that can’t be digested properly. It’s consumption leads on to a wide range of serious (often fatal) diseases. Link: https://www.youtube.com/watch?v=7khKHqpiRws

  9. john hayward

    December 10, 2016 at 11:49 pm

    When you are bankrolling phantom fox hunts and subsidising cable logging and peeler bargains to Sarawak you can’t really afford fripperies such as health care, which actually squanders money on the public.

    We should bless our stars for a nation-leading illiteracy rate, which may be saving our pollies from dangerous civil uprisings and unpleasant incarcerations.

    John Hayward

  10. Mike Bolan

    December 10, 2016 at 11:22 pm

    Well done Martyn.

    One structural reason that politicians and bureaucrats find it so easy to degrade our health system is that they don’t have to use it! Their health needs are met because taxpayers have to provide Private Health Cover for these people. Hence they have no real idea of how the system performs from the public’s viewpoint, nor do they suffer the consequences of their own decisions.

    Change this ONE thing and politicians will quickly change their attitudes.

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