Health has veered into the realm of politics this week with the resignation of former Queensland Health Minister Gordon Nuttall from his post as Minister for Primary Industries and Fisheries. It follows a long line of incidents that have placed the Queensland health system in the spotlight of news and interrogation for months. Sean Parnell’s article in The Australian points out that with Nuttall’s resignation, not only has he become the “highest-profile casualty of the Dr Death scandal” but Queensland Premier Peter Beattie now faces his fourth reshuffle in nine months. The former Bundaberg Base Hospital head of surgery Dr Jayant Patel earned himself the nickname ‘Doctor Death’ through his connection with more than 80 deaths – 13 of which his were directly caused by his negligence, and the dominance of the story in the news has almost turned him into the face of Queensland health. But Patel hasn’t been the only person copping the flak. The Queensland police were accused of taking too long to make an arrest (click here for more details) and the Queensland CMC is preparing to prosecute Bundaberg health service district manager Peter Leck for official misconduct. (More details here) It was a damning report from the CMC that led to Nuttall’s resignation and almost his prosecution, had the Parliament not have accepted his apology for lying to them.
The report raises two important issues in the Australian health system. Its criticisms of Nuttall lie in his failure to address problems that may arise with overseas-trained doctors.
This problem is not unique to Australia. Similar issues abound in the US, UK, Canada and New Zealand also, and are detailed in a Medical Journal of Australia publication about the Integration of overseas-trained doctors into the Australian medical workforce. The paper highlights the importance of overseas-trained doctors (OTDs) in the Australian medical healthcare system, pointing out that it has become “increasingly reliant on OTDs to sustain our medical workforce”, as it faces escalating strains.
This strain is seen particularly in outer metropolitan and rural hospitals and general practices, where workforce shortages result in significant numbers of OTDs whose background training, communication skills, clinical skills and orientation to the Australian healthcare system can vary markedly.
Such issues may be identifiable in the case of Dr Jayant Patel practising at Bundaberg hospital. For example, there are many concerns that for many OTDs, conditional registration to practise in “area of need” positions and geographic “districts of workforce shortage”, does not involve standardised assessment processes, and may “COMPROMISE PATIENT SAFETY”. If Patel failed to receive any standardised assessment of knowledge and skills, then this Dr Death case may actually be a result of the failure of the system, rather than simply the incompetence of one man.
ABC radio’s PM program raised a further concern of Commissioner Davies in a recent report:
COMMISSIONER DAVIES (read by actor): The question whether free hospital services may be limited in any significant way may be one which can be and should be addressed only on a whole of Australia basis.
MELANIE CHRISTIANSEN: Mr Beattie is urging the Federal Government to respond to that.
PETER BEATTIE: And the reality is this: Unless we get a national summit or a national inquiry or some national reform in relation to health, what’s happened in Queensland will happen in another state in Australia in the next 10 years.
Davies questions Australia’s capacity to continue to provide the same level of free hospital care.
In Online Opinion, Hughes argues that Australia’s healthcare system must be better integrated. On the one hand he writes, while Medicare “retains popular support”, it is “structurally incapable” of meeting demand for health services, while private insurers are “unable to curb health treatment costs, and remain unable to attract significant new members.” Hughes’ solution lies in Integrated Health Care, a consortium working in health insurance and reform.
This may or may not be the answer. But if any good can come of the Jayant Patel ‘Dr Death’ case, it would be in the stoking of public debate over the inadequacies of Australia’s healthcare system and the policies affecting it.
