15 November 2005

Mr Jamie Walker
Courier Mail

Queensland Public Hospitals: Beyond the Band Aid Solution

You are to be congratulated for being the first to publicly state that the Queensland Government's proposed solution to problems in its public hospitals is unlikely to be more than a 'band-aid'.

My interpretation of your article: Proposed solution to the public hospital problem is not too severe, but may only be a band-aid. Funding measure depends on maintaining conditions that allowed $3.12bn surplus in 2004-05 budget. Given economic strength driven by population growth and mining (especially coal) this is possible. Growth needs to be well above the national average to lift the state's tax take. But the economic boom is slackening, and growth may be at a peak. Revised budget surplus has not been revealed. $3.1bn surplus is only $2bn when superannuation obligations are factored in. Reliance is being placed mainly on coal exports to China (Walker J. 'Heroic assumptions not so healthy', Courier Mail, 22-23/10/05).

I should like to draw your attention to a perspective on health system reform proposals that comes to even more pessimistic conclusions about the uncertainty of the economic / revenue projections on which the proposed increased hospital spending is based.

However the reform proposal seems not only a 'band-aid' financially, but also in terms of its failure to seriously address the systemic problems in Queensland's public administration that seem most likely to be responsible for mismanagement in Queensland Health (see Systemic Defects in Public Administration). In fact the various inquiries into the Bundaberg Hospital fiasco could never have found anything but 'band-aid' solutions, because they all had terms of reference that were too narrow to identify the underlying institutional problems.

Some suggestions about how those underlying problems might be reduced are outlined on my web-site.

The latter also argues that the proposed Service Delivery and Performance Commission will be an inefficient way of achieving its nominated goal of reducing inefficiency in the public sector if it takes a 'cost-cutting' or 'priorities review' approach to its role. This is because government machinery weaknesses seem to make inefficient resource usage unavoidable in all public programs (see Improving Public Sector Performance in Queensland).

Regards

John Craig