The Great Breastscreen Unhinging
So, it seems that Breastscreen Queensland is on its way out as part of the Queensland LNP’s hospital reform agenda. Twitter was not impressed. I posted a couple of messages into the #breastscreen tag and got an interesting discussion and a small flurry of people telling me stuff I already know. So here’s a slightly longer take on the whole shemozzle.
First, you can expect today’s media to contain generous use of the phrase “cancer survivor” and (once people get organised) quotes from various high profile celebrities who have survived or lost someone to breast cancer.
Now, to be completely clear, I think that cancer screening is very important, and I personally think that a state-wide program makes most sense. Anyone who thinks I’m an LNP apologist, can have a read of my tweetstream. Also, the making an announcement like this late on Saturday evening in the middle of the Olympics is a great example of what a classy outfit politics in Australia is at the moment – and I include the ALP in that as well.
So, first of all (and expect to hear this in the official releases from the Government, as well) is that breast cancer screening in Queensland is NOT being abolished. A state-wide program for this screening is going and the funding is being reassigned to the local health boards. Cancer services in Queensland are not all of a sudden $44mil worse off. The boards will then be required to provide (and pay for) performing the same service to the population of their healthservice area. So all the people foaming up in outrage about “slashes to cancer funding” may want to actually take the time to read around the issue, and not just fly off the handle based on a retweet or a glib headline.
So are the boards set up to do this sort of program? Not really, but it’s probably both better and worse than people think.
The former ALP government ‘s answer to the problems in Queensland Health was to split the organisation in half – essentially a clinical services division and a support services division. The LNP’s answer is a more radical reform. The local area Hospital and Health Services will be responsible for the provision of all health services in their area to their area. It’s a clever idea because it includes populism (“local people in charge of local health”) and a mechanism for the government to shift costs from the government purse to the board’s purse (an accounting trick so Campbell can be victorious in his war on debt) and also a great mechanism for weaseling out of responsibility for cock-ups (next Dr Patel? Nothing to do with the Queensland Government – blame the HHS Board!)
The problem isn’t really the restructure; this sort of thing happens in Government all the time. It’s the unseemly haste with which it’s being done. Not all of the boards have even been appointed yet. But they are expected by the government to come into existence, get running smoothly and, oh, by the way, while you’re finding your feet, please take over all these services previously provided by the state. kthxbai.
Although the boards of the HHSs are new, the facilities they are mainly responsible for (ie the current hospitals and associated community health facilities ) have been around for a long time. On first pass, this looks like it might make the transition easier. The major hospitals all have radiology departments – which is where the clinical work of breast cancer screening happens. Sure, it will be an increase in workload, but remember that the funding is coming with it. One of the problems with decentralised service, though is duplication. Rather than having a single screening administration service for breast cancer in the state, each HHS will have to have its own. There will be no guarantee it will be done the same way (“those sort of decisions are up to the board”). Do you have a job that moves you around the state? Imagine the hassle with getting your screening records transferred between two separate boards using different systems.
The other concern is that of programs being sustained. Health Boards are responsible for acute services; nothing gets the media going like bed block, patients on trolleys in the Emergency department and elective surgical waiting times. Presumably, the government will require the boards to maintain cancer screening as part of a service agreement, but what’s to stop a bit of “temporary reallocation of funds”? None of this is being made clear… I’m sure that is partly because it’s all being done with such breakneck speed that no-one is considering all the implications.
The final thing that gets up my nose about the furor over Breastscreen is the differential attention different health issues get in the media. Of course, breast cancer is the leading cause of cancer deaths in women and deserves its run on the front Page, and but when the break-up and decentralisation of a different government health service was announced last week (state-wide Tuberculosis control – see here), it went off with barely a whimper. Mention cancer services, such though, and the world goes mad. Given that all of the state-wide services are up for review, and are people going to come forward with the same enthusiasm to save the chronic disease management groups, nutritionists or communicable diseases teams?
I won’t hold my breath.
So, if you want to go off your head about Breastscreen, go crazy, but spare a thought for all the other statewide services who don’t have such a front-page friendly job description who are also impacted by the reform agenda.
(minor edit at 1230, Aug 5 to fix some grammar errors)