5 July 2005

Mr Anthony Morris, QC
Bundaberg Commission of Inquiry

Proposed Health system solutions require further consideration

On 17 May 2005, I made a formal submission to your Inquiry (and also to the Health Systems Review to which I understand that your Inquiry has been referring relevant matters).

I should like to make a revised submission in the light of the three discussion papers released in late June 2005, which suggested possible institutional changes in Queensland's public health sector.

My revised submission takes the form of a document which is now on my web-site (Intended Submission to Bundaberg Hospital Royal Commission). It includes comments on the Commission's discussions papers. In brief, it submits that the proposed changes embodied in these discussion papers require further consideration. In particular:

• the GOC model that has been suggested for hospitals in future has not in fact been, and can not be, very effective;
• the 'cost cutting' culture can not be changed within the health system alone, as it emerges from the public sector wide commercialization and corporatisation models that have been part of Queensland's response to National Competition Policy;
• the proposed Health Regulation and Standards Commission (HRSC) would not really be accountable to Parliament, if the majority of members were accountable to other constituencies;
• the HSRC's role in integrating the efforts of autonomous hospitals would require very careful consideration;
• eliminating the positive 'spin' placed on the health system for media purposes by a re-renewed Health Department would require that public servants gain tenure to protect them from political reprisals for negative reports;
• the organizational dysfunctions which affect Queensland Health will not be eliminated by making the department smaller, as its size is unlikely to be the main problem;
• arrangements for dealing with whistle-blowers and complaints should not be limited to Queensland Health, because similar problems are pervasive across the whole public sector;
• without care, proposals for better recruitment processes can become a vehicle for appointment of 'cronies' and 'yes men'.

The suggested requirements for a solution that were presented in my original submission remain essentially unchanged, ie:

• recognising that many problems have their origin outside the Queensland health system;
  viewing renewal as a process that is not separated from ongoing operations and ongoing responses to strategic challenges;
• giving high priority to creating: (a) a system of civil institutions able to take the lead in stimulating changes within health functions and (b) an effective system for real professional accountability in making senior Public Service appointments; and
• a 'build-on-what-works' change process - rather than one that involves 'tearing it all down and starting again'.

Regards

John Craig