Crisis in WA hospitals

This op ed piece by Professor Gavin Mooney appeared in the West Australian on Friday September 24th in response to ongoing problems in the WA health care system, highlighted by a recent crises involving ambulance ramping at the city's major public hospitals.

Ambulance ramping

By Gavin Mooney

The accounts of the ramping of ambulances at the major Perth hospitals last week are worrying and one feels very much for the patients involved and their families. Something clearly is going wrong and, while last week was particularly bad, these events do occur with some regularity.

 But let’s stop and think this through a bit more. There will never be a health care system in WA or anywhere else that can meet all demands and needs for health care. No society can ever achieve that. If we tried to, it would be so expensive and we would end up with very poor educational, transport and justice systems. Or we would have to cut back markedly on private consumption as we paid more and more in taxes. Or, if we went further down the private road, we’d be spending enormous amounts on private health insurance.

Taking public and private together, as a country or as a state, do we spend enough on health care? Well in comparison with other countries we seem to be getting it about right – although out of the total we do spend rather a high proportion on hospitals.

But then of course we need hospitals!  My questions however are these.

First have we got the right mix of types of hospitals? And second have we got the right mix of types of health services? The Reid Review of 2004 which is the most recent assessment of the WA health service indicated that 80% of patients in our big teaching hospitals did not need to be there. That is a staggering figure, especially as these are very expensive places to be. 

There is a ‘law’ in health policy that says ‘a built bed is a filled bed’ meaning that if we create more beds they automatically get used. That 80% figure clearly suggests an oversupply of beds in our big hospitals. Many patients could be treated just as well but at less cost in other hospitals. Rather than building the Fiona Stanley Hospital what we should be doing is expanding other, cheaper hospitals. 

But maybe we need to increase services outside of hospitals – GP and community services, preventive services. It is of note that in the “Citizens’ Juries” (of randomly selected citizens brought together and given good information) in this state that I have facilitated, when asked about their priorities, not one has wanted more hospital beds. Indeed to pay for the priorities that they as citizens want – prevention, mental illness, greater equity, community care - some juries have suggested closing hospital beds!

The push for more and more beds is simply not working. I have been in the west for 10 years and over that period we have pumped more and more money into these teaching hospitals and we still have the ramping of last week. These hospitals are ‘sick’ but the ‘treatment’ over the last decade is not working. We need more ‘investigations’ so that we can up with a better ‘diagnosis’. 

What to do? Well the first thing - and I have asked for this repeatedly – is to conduct a detailed investigation into our teaching hospitals. Where is the money going? What is driving costs? Can the services be provided as well but at less cost i.e. more efficiently? That sort of detailed study was not done by Reid and it has not been done since. We cannot make sense of any of this until that study is done.

The second thing is to put in place more policies to keep people in the community – bolster prevention and invest in programs to keep people out of hospital. Most people want to live as long as they can in their own homes. Let’s respect that. And it is cheaper. 

And third let’s find out what the people of WA want from our health services – and they are our health services, not the doctors’, not the politicians’, not the Health Department’s. They are ours, the citizens’. Let’s have a series of these “Citizens’ Juries”, say ten across the state, so that critically informed citizens can have a genuine say in the future of the WA health service.

Early last month I did one of these Citizens’ Juries in the ACT at the request of the Minister of Health in the ACT, with fascinating results for their services.

Dr Hames, Mr Snowball, I make this plea. In response to ambulance ramping, instead of pouring more and more money into these expensive hospitals, let’s have an investigation into how the vast sums of money they are currently getting current are being used. And rather than assume that supplying more and more beds is the answer, let’s work on reducing demand.  And finally will you please fund a program of Citizens’ Juries across the state so that you can learn what we as citizens want from our WA health services?

Professor Gavin Mooney, Health Economist and Co-convenor, WA Social Justice Network 

For an an alternative perspective on economic policy: read Billy blog

Bill Mitchell's blog Billy Blog-alternative economic thinking is an excellent site to read about the myths and propaganda promulgated by mainstream economists, economic commentators in the media and most politicains and political commentators. 

As a non-economist interested in economic matters I greatly appreciate Billy blog's sustained critique of neoliberal and neo conservative market economics.

Reading one of his latest posts about the standard myths that dominate most neoliberal economic thinking I found this:

"The overwhelming sentiment of the business community and the conservative nature of our political system (and its participants) leads to a largely anti-government swell of opinion which is continually reinforced by the media – the “debt-deficit hysterics”. The neo-liberal expression of this over the last three decades has overwhelmingly imposed massive political restrictions on the ability of the government to use its fiscal policy powers under a fiat monetary system to ensure we have full employment.

We now accept very high unemployment and underemployment rates as a more or less permanent feature of our economic lives because of the political constraints imposed on government"

Why we need more public investment in public services and public infrastructure

Interesting to read a recent US study that found that the most effective options for creating jobs and building a prosperous regional and state economy is for governments to spend and invest more in public services and public infrastructure.

Disputing the idea promulgated by pro-business and pro-market politicians and advocates that funding public services and economic development are competing interests the study found that:

" The tax cuts and business subsidies approach to economic development will do little to create jobs in the short run and is not the most effective to generating growth over the long term".

The study found that investing public funds in public services, such as education and health and in public assets and public infrastructure is the best approach for state and local development, and raises gross state product, expands productive capacity, increases employment and raises personal income.

The study found that providing incentives to corporations and business such as tax breaks, public subsidies, employment subsidies and other forms of business incentives are not effective and are often counterproductive because they deplete resources that could be spent on education and investments in public services and public infrastructure. 


Strategies that shift resources and assets from the public sector to the private sector- privatization, marketization and corporatization- reduce costs and increase corporate and business profits but are not effective in terms of state and local development and building a prosperous state and regional economy.

The study concludes:

Instead of trying to lure firms with deals and lower corporate taxes, an approach to economic development that builds the skills of the current and future workforce, improves the physical infrastructure of regions, and makes communities more attractive places for families and firms represents a more effective use of a state’s scarce resources.

When "public" ownership means better outcomes

As the Barnett government moves to privatize more of the WA prison system, Susie Byers's piece on the Boronia pre-release centre in suburban Perth is a reminder that well resourced, State run prisons can deliver, rehabilitation, recovery and integration of prisoners into the community far better than can the market- that is privately run prisons.

Susie's other articles can be found at Eureka St.

A model of modern justice

Susie Byers*

(This article first appeared in Online Opinion)

Western Australian Premier Colin Barnett once said that he didn’t approve of female prisoners being taught pastry-cooking by French chefs. Not, presumably, because he has anything against the French, but because he was furious at what he claimed were the luxurious living conditions afforded women detained in the Boronia Pre-Release Centre for Women: a minimum security correctional facility in Bentley, Western Australia.

During the 2005 state election, then Opposition Leader Barnett promised to close the 70-bed facility, which had been opened just a year earlier. He lost that election, and luckily, when finally elected in September 2008 he appeared to have changed his mind: in the month after polling day, Barnett’s Attorney-General Christian Porter was proud to announce the opening of another pre-release centre in the south-west of WA, apparently similar to Boronia and housing up to 72 inmates.

I say “luckily” because Boronia has proved to be a model for modern justice and rehabilitation, drawing praise from criminal justice experts within Australia and across the world. Boronia should become a model for prisons across the country: it’s time to rethink the way criminal justice is administered.

Opened in 2004, Boronia is styled to provide women nearing release (who have attained a minimum-security rating before consideration for transferral there) with the capacity to operate successfully on the outside. Its website states its four basic principles: personal responsibility and empowerment, family responsibilities, community responsibility and respect and integrity.

Personal responsibility is engendered in part through the housing arrangements: living in shared units, women are responsible for their own cooking, cleaning, shopping (at a shop inside the facility), and budgeting. Women share self-contained units rather than cells, and although they are locked inside the units at night they are free to move about inside them. The idea is for Boronia to mirror the outside world as much as possible, so women can prepare themselves for their post-incarceration lives.

Additionally, women in Boronia are required either to work or to study, with an average day at Boronia starting at 8.30 and finishing at 3.30. During these times women (unless they are sick) must be engaged in either looking after their children if they have them, undertaking one of the courses available to them (including horticulture, hospitality and community services) or working. Some women work in the commercial catering business operated by Boronia, serving staff as well as businesses in the local community. Others leave the centre to do community work in organisations like the RSPCA or the Good Samaritans.

In a radical departure from traditional prison structures women are allowed to keep their children with them (up to their fourth birthday), and can have regular overnight visits from their children up to the age of 12(subject in all cases to the best interests of the child). If a child is approved to live in the prison, a “care plan” is formulated, and when the child arrives it is housed with its parent in “mother and child” units.

The Centre has been applauded by former Western Australian Inspector of Custodial Services Richard Harding, who, in his 2007 report on the facility called it a “model for good practice”. Harding’s successor, Neil Morgan, termed Boronia “one of a kind” and “first rate” due to its “women-centred approach”. (See report here.) Prisoners, too, have praised the facility. On January 19, 2005, the ABC’s 7.30 Report interviewed inmates and former inmates who called their guards “lovely” and “more like friends” and who called the progams offered by Boronia a “really, really good thing”.

This is the moment, no doubt, at which the obvious objection will be made: surely the point of prison construction is not to win praise from inmates? Why on earth should women convicted of crimes be sent off to be taught cooking by a chef who might (or might not) be French?

Susie Byers is a PhD student at the University of Western Australia. She has previously been published in Eureka Street and The New Critic (online journal of the UWA Institute of Advanced Studies).