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 

Industrialising the Kimberley: Colin Barnett's hubris

image of James Price Point, Kimberley, courtsey of Wangle

Excellent piece here by Martin Pritchard, Director of Environs Kimberley about the hubris and nightmarish impact of Colin Barnett's plan to industrialise the Kimberley.

Pritcard shows that the James Price Point development is the first step in the Barnett vision to gift much of the Kimberley region to mining and resource companies and turn into an industrial and mining zone.

Market illogic and the manufacture of "defecit hysteria"

Three hundred US economists have warned that current US economic policies risk plunging the US into a deep depression, unseen since the 1930's. 

As the economic circumstances of ordinary Americans worsen, the economists are warning against "deficit hysteria", the contemporary obsession with short term government deficits which lead governments down the path of severe austerity measures and massive reductions in public spending. 

The economists argue that defecit hysteria is a manufactured crises and is being used as cover for other agendas, including more privatization and slashing of social security and social spending.

The economists stress the need for increased public investment to thrust the US economy back into recovery.

The economic crises confronting the US is borne out by recent data which shows that more Americans are poor than ever before (since data was collected). Unemployment and job losses continues to rise and there are now 43.6 million Americans who are poor, as measured by the US Census Bureau. 


Juxtapose this information with the graph below about US income growth (posted before) and we can begin to understand what David Harvey means by accumulation by dispossession, the process whereby the rich, the wealthy and upper middle class gain greater wealth and power at the expense of the rest.

WA miners spend their money everywhere except where the mines are

image courtesy of the ABC

 The mining and resource companies are always telling us that local economies and local communities benefit from all the money spent by those who work in the mines. 

In the Pilbara and Kimberley  region of WA 78% of mining salaries earned in the region are not spent in the region. The reason is the fly in fly out workforce.

Compare that figure to Queensland where 39% of mining salaries are spent outside the area.

For every $100 earned by miners in those regions, workers in the social welfare and health sectors earn $48 and workers in the retail trade earn $29. 

Those other workers actually live in the Pilbara and Kimberley towns and have to survive the massively inflated costs of living, housing and basic good and services that are driven up by the mining boom, without the huge salaries of their mining counterparts. 

They also live in towns suffering from the lack of long term investment by governments, the mining companies and the private sector in an adequate level of social infrastructure and public goods and services.  And they face the health, social and environmental consequences of living in close proximity to industrial plants and mining sites.

The boom economy does not reach many of those who have to live in the shadow of the mining industry.

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"

The harm that markets cause: event in Fremantle

Great to see this event The Global Economy and Human Wellbeing  being run by Rob Lambert* at the Edmund Rice Centre for Social Justice in Fremantle this Saturday 4 September, 2010 between 10:00 AM - 5:00 PM.

The event is designed to provide people with a deeper understanding of what global free markets are doing to persons, families and societies;  the nature of corporate restructuring of work, and its social and psychological impacts for families and communities; - basic analytic techniques of ‘political economy’ necessary for understanding these changes; - the values underlying these changes, and how they might be ethically assessed; and - how to envisage (imagine) alternative models of work, and the process of realising such change.

 *Winthrop Professor Rob Lambert is based at the University of Western Australia’s Business School, where he specialises in labour studies. He is co-author of the award-winning book, Grounding Globalization: Labour in the Age of Insecurity (Oxford, Blackwell, 2008),a critique of the free market economy that identifies destructive impacts for the environment, society, families and persons. Rob is the founder and coordinator of the Southern Initiative on Globalization and Trade Union Rights (SIGTUR), founded some 20 years ago. This movement brings together democratic trade unions across 15 countries and four continents in the global south. Rob has a background as a South African activist, and was National Secretary of the South African Young Christian Workers and then advisor to the Southern African Catholic Bishops Conference before coming to Perth.

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.