A Swan Dive Into Reform

Sydney Morning Herald

Tuesday January 15, 2008

TWO of the Rudd Government's hardest working ministers are obviously going to be the Treasurer, Wayne Swan, and the Health Minister, Nicola Roxon. No issue is going to be more demanding than getting better delivery of front-line services in health, education, transport, water and infrastructure from our federal system of government. Yesterday's meeting in Brisbane between the ministers and their state and territory counterparts is but the start.

The most easily understood item on the agenda was divvying up the $150 million that Labor had promised to cut the queues for elective surgery in hospitals. Echoing the old premiers' conference rituals, each state delegation has come away with a triumph - even NSW's Health Minister, Reba Meagher, with a cut of $43.3 million that is distinctly below the one-third share the state's percentage of the Australian population would justify. Far from being a tribute to a more efficient hospital system, critics would say it is the unintended boomerang effect of spin doctoring that has reduced the apparent surgery backlog by getting doctors to hold names off the waiting lists.

This "blitz" on the current waiting list will be followed by another $150 million for systemic improvements, including more day surgery units, and then a further $300 million for those health services that demonstrate improved delivery of elective operations. Let us hope the NSW Government can meet this challenge - the results should be obvious by the next state election.

But these are just patches and welds on a creaking apparatus. The hospital and health system in this state, and throughout Australia, needs redesign and rebuilding. Too many resources are consumed by management, while not enough services are available to the really needy, especially indigenous communities. Similar inefficiencies riddle other sectors.

Mr Swan's approach at Brisbane has been to get agreement on bundling the 90-odd "special purpose payments" to the states totalling about $40 billion a year into a quarter that number of programs, and thereby, in theory at least, reducing the bureaucratic resources needed to run and monitor them. He and the state treasurers have also agreed on restoring the previous incentive grants, which ran for a decade up to 2005, for the states that carry out tough efficiency reforms. He will have to be tough, in case states take the money, do little, and rely on Labor mateship to excuse their failings. It may be the last hope of our federal system.