Today is the first day of the rest of my life.
Choosing to leave a team and patients that I love, after a 30-year career in medicine, has not been an easy decision. But the Australian health system that I joined is not the one that is failing now.
Having trained for 10 years in a medical specialty, and spent time practising in the UK, I was drawn to the public system that had some similarities with the NHS on my return in 1990. It catered for all specialties and provided the academic stimulus to build knowledge and skills. There was scope for innovation for those with foresight.
Most of all, healthcare workers had job satisfaction through pride in their work. Funding agencies respected the challenges that were expensive. Teaching and research were not dirty words and the brightest minds were attracted into the healthcare professions.
Now, confidence in public health systems is at its lowest ebb ever.
Where is the research? Gone. What happened to teaching? Slipped. What about the quality of care we so cherished and were proud of delivering? It’s not A-grade any more.
One senior nurse administrator recently responded to a request for better support by saying: “Stop asking for gold class, we don’t do that.”
While it may be true that public hospitals cannot – nor should – afford extravagances, staff at the same salary can deliver quality of care over a very wide range. Leading them to do their best – for the same money – is called leadership. Sadly, I have never been asked, “What do you need to do your job better?” Possibly the suggestion box has been removed.
Our system is failing and needs urgent attention. We now have a major dependency on public hospitals for care – up 20% in the five years before Covid-19. There’s a failure of emergency departments to cope with demand and ambulance ramping; telemedicine in place of closed outpatient services; long delays for medical inpatient beds; prolonged elective surgery waiting lists; deterioration in “hotel” services; and caps on activity.
Jan Filochowski, the author of Too Good to Fail and a past chief executive of various NHS Trusts, argues the signs of a failing system are there to see. Some are financial, but most are human.
One astute observer asked me if I was “burnt out”. Sadly, I replied that I didn’t know. If I didn’t know from looking at myself in the mirror, how many others are already burnt out and still pushing on in the system?
After hundreds of hospital deaths in the British Midlands, Robert Francis QC was commissioned to investigate. His report speaks of “awful conditions” as well as “fear and bullying” in the hospitals examined.
Francis found inadequate performance on audit reports, criticisms by medical colleges left unanswered, patients not heard and, possibly worst of all, the silence of professional disengagement. Francis wrote that “clinicians did not pursue management with any vigour with concerns they may have had. Many kept their heads down. A degree of passivity about difficult personnel issues is all too common in the NHS as, perhaps, elsewhere.”
In Australia, few of my colleagues had any interest in the pursuit of such issues and were content to consider their income and hours worked each week. Raising these issues is assumed by many to be criticism of them, rather than reflections on our team’s performance. Bullying, harassment and discrimination are the icing on the cake.
What is the cure? The strategy for change involves the big three.
First, resourcing needs to be appropriate for the need. As a percentage of GDP, Australia spends 9.4% on health, compared with the UK at 10.2% and the US at 17%. Any focus on funding must involve both amount and distribution – reducing red tape and limiting administrative costs.
Second, we need an urgent back-to-basics on policy – with patient care at the centre.
Finally, leadership needs to be appropriate for the task. We have failed badly by allowing good clinicians to be morphed into average, underperforming, figurehead administrators with little, or no, training. Clinical leadership has been squeezed out and needs to be resuscitated to regain the trust of colleagues and the community.
I no longer felt able to improve the situation from within. An external perspective is critical to affect the cultural and quality change so desperately needed. The standard I walk past is the standard I accept. This is not a standard I can accept.
• Prof John Wilson recently resigned as the head of the cystic fibrosis service at Alfred Health and is the immediate past president of the Royal Australasian College of Physicians.
