Has Kevin Rudd learnt from his part in "reform" of the Queensland health system which saw the abolition of hospital boards in favour of centralised bureaucratic control?
One of the earliest things that the Goss government did when it
gained power in Queensland in 1989 was to abolish the hospital boards
that up until then had helped to administer the state's hospitals. It
was part of their allegedly "economically rational" agenda, in which
Rudd was an integral player. It happened in most states, and now, two
decades later, we have a conservative prime minister promising to reverse it.
There was in fact nothing "economically rational" about abolishing
Queensland's hospital boards. Economic rationalism is about a number of
things, including devolving decision-making down as close as possible
to the people affected by a system. Abolishing boards wasn't rational
in any economic sense, because it moved control away, not towards, the
community.
It did, however, make good political sense. Most hospital boards had
become stacked to some extent, particularly in country areas, with
National Party hacks. Eliminating the boards eliminated political
opponents and whistleblowers.
Modern economies are as efficient and wealthy as they are partly
because they have moved away from centralised, bureaucratic, industrial
age structures into networked communities of linked producers. Today,
when you buy a car, for example, there is a good chance that only some
parts of the car were made by the manufacturer. Many will have been
made by smaller components manufacturers, like PBR in Australia who produce brakes for GMH, Daimler Chrysler and Fiat, to name just three.
Another example is the franchise system, which has dramatically
improved the survival prospects of small businesses. Yet another is the
Internet, which using a network structure has facilitated efficiency in
industries as diverse as dating and terrorism.
Networks succeed by allowing for nodes of specialisation and linking them together.
The federal government has been very good at embracing this modern
management approach to running large scale social infrastructure. One
of their innovations is the Job Network, from which, ironically, the
Rudd family made its millions.
When you look at where Labor states have gone wrong with hospitals,
it isn't so much for lack of funds, but the way those funds have been
spent. The numbers of administrative staff have increased in size,
while the numbers of doctors and nurses stagnated. Command and control
solutions just don't work, and similar tricks have been played in the
hospital system to those that the Soviet era managers used to play.
Need to decrease a waiting list? No problems. Create a waiting list for
the waiting list and you can cut the official waiting list at the same
time that the total number of people wanting a particular operation
actually increases!
The Liberal proposal appears to be to directly fund hospitals
themselves, while leaving some sort of light touch bureaucracy over the
top of them. It's where Rudd should have gone in his Queensland days.
Hopefully it's an issue where he will again play Howard lite having
learnt from his previous experience.
First published on Ambit Gambit, 2 October, 2007
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