23 March 2021
Prof John Dwyer has some relatively good news.
23 March 2021
Prof John Dwyer has some relatively good news.
21 February 2021
There are two quarantine stories extant, one short-term, one long-term:
The Sun Herald front page story is ‘State Debt Collectors eye hotel millions’. It is about how 5264 invoices covering 7214 travellers who stayed at quarantine hotels have not paid and thus have to be chased for the money. The fact that they had to stay at these very expensive hotels for 2 weeks to be allowed to come home seems irrelevant. The fact that they may have had to stay in hotels for 9 months overseas in lockdown situations, had to come home on very expensive flights and may have no money and no job is also not mentioned. What might have been thought of as repatriating citizens caught in a situation that was not of their making is now a routine debt like a speeding fine, to be chased by the NSW government’s privately contracted debt collectors.
Meanwhile down in Victoria in today’s Age there is talk of building a quarantine hotel at Avalon Airport. Avalon airport was ex-RAAF and is about 3 hours from Melbourne (as I discovered to my cost when taking a Jetstar fight to Melbourne without looking where it landed). It is now owned by Linfox Transport group, and the Wagner Corporation of Townsville was keen to build the quarantine facility. When asked by an interviewer what accommodation would cost, Mr Wagner replied that this was ‘commercial in confidence’. There was none of this nonsense about giving arriving travellers a ‘fair go’; presumably such assurances are not necessary to get the contracts these days.
The colonial-era Manly Quarantine Station, which was saved from developers some years ago and remains in the dangerous situation of being a historic site in NSW used to have 3 levels of accommodation, for the rich, middle class and poor. At least the financial reality was recognised then.
Presumably backpackers who needed to come home would be happy to stay in backpacker accommodation, whereas some business folk really cannot manage less than the Ritz. But the government ought to make provision for Australians who want to come home and returning travellers needing to be quarantined should have the right to return without having to pay whatever a privatised accommodation facility chooses to charge them, without the government’s contribution being to unleash the debt collectors.
14 February 2021
Here is Dr Peter Sainsbury, Prof of Public Health. writing about the health effects of coal. Many of the deaths related to the polluting effects are not in Australia, which is not a very reason for us not to be concerned about it.
Some years ago, as we tried to stop the subsidy to Tobacco Growers in Australia, the number of deaths of tobacco-caused disease was compared to the number of jobs in the tobacco industry, which was orders of magnitude lower.
Sainsbury says it will be about 6 deaths per year per job in the coal industry, which is yet another good reason to transfer to renewable energy.
The practice of looking at the number of deaths caused versus the number of jobs created seems a sound basis for looking at the cost benefit of industries. The ‘defence’ industry needs to be looked at in a similar way.
The other interesting fact in this article is that he estimates that Electric Vehicles will be the same price as petrol ones in about 3 years because of the falling price of batteries. Presumably the Morrison government cannot retard progress forever.
7 February 2021
Prof Raina McIntyre argues that the COVID19 problems in the developed world, particularly the Anglo world are the result of an understanding of and a lack of respect for public health. She charts this as within the medical profession, which has its own hierarchies, but also in the political arena. The overwhelming influence of the corporate sector and the profit motive, and the managerial approach which assumes that if you are not an expert, you can quickly find one, bone up and take over has been found sadly wanting. For a manager or politician, selecting an expert is not as easy as it sounds as there are many people who want to tart up their CVs and market themselves with dubious claims to expertise.
This has resulted in a very suboptimal preparation for and response to the pandemic. The failure in the managerial decision-making process has been laid bare in the COVID situation, but this is not an isolated example. The lack of respect for expertise, the replacement of knowledge with marketing spin, and public good with corporate profits will lead to more bad decisions, which often take a crisis to become evident. It happened in the bushfires, and is happening with climate change. Examples in foreign policy, education, health and defence all come to mind.
Here is Raina’s paper about COVID19
I attended a DRS (Doctors Reform Society) zoom webinar on the future of health care with Professor Stephen Duckett and aged care with Professor Joseph Ibrahim of Monash Uni, a geriatrician whose experience is in evidence-based aged care.
It was not encouraging.
My own experience of nursing homes was initially as an after-hours doctor when I used to judge nursing homes by what I turned the Urine Smell Index; the worst ones smelled of urine when you opened the door at night. As a GP years ago I found it increasingly difficult to find someone trained to talk to about the patients’ treatments.
In New South Wales Parliament as an MP I was asked to pass legislation that lessened the number of trained nurses required on staff. ‘Flexibility’ was the key and many homes and facilities ‘had people who were not really sick’ we were told. I was not convinced but the legislation went through anyway.
When my widowed mother was no longer able to cope at home and the family went looking for supported accommodation it soon became clear that the driving force in Aged Care is real estate profits. The family home is sold and the object is to get the family to buy an overpriced retirement Villa with varying levels of support in the villa and then hopefully automatic entry into an attached nursing home, usually with quite a poor urine smell index. When the old person dies the villa profit largely reverts to the corporation.
A dear old widower professor who lived up the road needed support in his 90s. The home support contract offered needed at least 4 hours per week at $65 per hour. The person delivering the care was paid $20 an hour. I am unsure how District Nurses are allocated.
In 2000 Prime Minister Rudd asked for ideas for his ‘2020 Vision’. I wrote and suggested that he register the skills and training of Home Care workers so that they could be hired and evaluated like Uber of any other online service and the ‘quality control and insurance’ would not be why the contracting agency became so ‘vital and expensive’ (that it would end up costing more than the person who actually did the work). I never even had an acknowledgement of my suggestion.
Prof Duckett was of the opinion that things had got a lot worse since the 1997 Aged Care Act, John Howard’s work, which created ‘a business opportunity’ Prior to this there was a system called CAMSAM which was two modules; Care Aggregated Module and Standard Aggregated Module. These were funded separately. If they did not spend their Care money it was forfeited, so they could only profit on Services.
After 1997 there was no distinction so profits could be made from either component, so the quality of care declined, usually with lower staffing levels.
Some private-for-profit nursing homes have good care, but this is not common. Some not-for-profits also had very poor care, but the general rule is that the standard of care relates to the number and training of staff. The low wages (approximately equals $20 per hour) mean that the staff need to work multiple jobs in multiple locations which is what spread the COVID epidemic in Melbourne. Government run homes tended to have better staffing ratios, so were better able to act against the infection.
Professor Joseph Ibrahim commented that the terms of reference of the current Royal Commission on Aged Care were very narrow, only covering 5 years, and could not lead to prosecution. He felt that this was deliberate. The issues of overprescribing and assault have come up often.
He felt that this meant that it’s conclusions might be weaker and then not implemented, with a tendency to kick difficult problems down the road.
The commissioners themselves were of interest:
Richard Tracey had died before the enquiry started
Another, a Western Australian prosecutor had opted out (an unusual action as being on a Royal Commission is normally a good career move).
The two final commissioners are:
Commissioner, Briggs has put out a report asking that aged care be returned to the control of the health department. Prof Ibrahim comments that is very unusual for one Commissioner to make a public statement before the final report and this indicates that the commissioners are not in agreement.
Currently there are about 250,000 care workers and about 200,000 Professionals. The care workers need six weeks training at a TAFE level to get a ‘Certificate 3’ About 1/3 are new migrants. They are paid about $20 per hour and casualised to decrease staff costs. The unions are worried that the new RECP (Regional Comprehensive Economic Partnership) trade treaty actually allows trade in people and that more visas for cheap labour in these areas will not help residents or local jobs.
The $20 billion dollar industry is founded approximately $14.5 billion from government, $4 billion from RADS and $2-4 billion for additional services.
There are not-for-profits, but the large for-profit providers have increased since the 1977 act and are largely highly profitable big corporations, some multinational like BUPA.
Professor Ibrahim is concerned that there is a lack of supervision.
There are no forensic accountants looking at what it costs to run an aged care facility and this has allowed supernormal profits by big players. Money has been spent poorly or ‘hived off’. Obviously if the government runs some homes themselves there will be public service experience.
Prof Ibrahim believes that the future directions of aged care will be set by the multinational for-profit providers because these are the people who have direct access to the government. There is no significant advocacy for aged care residents. He contrasts this with breast cancer advocates who pressed for less radical operations, and for Gay men who pressed for more enlightened AIDS/HIV policies.
There have been discussions of ‘quality-of-life’ that have tended to be spoken of as needing less healthcare, but quality of life cannot be good without good health care.
The aged care industry likes home care as it lessens their costs and also pushes the liability back onto GPs. A sense of proportion is necessary:
There are 2.5 million well older people and 200,000 in aged care.
More radical treatments are now done in older age groups such as dialysis or cardiac surgery in the over 90s, very is some debate over this period some would say that it is a just to deny routine treatments but there is some distortion of priorities by having these lucrative procedures as fee-for-service, and there is also some inequity.
Since the development of antibiotics, medicines are seen as curative, but in fact they should be seen as being in three classes:
There is quite a lot of cost-ineffective medication use, such as for osteoporosis.
Solutions. (These are not just from the presenters)
Note there are a large number of public submissions on the Royal Commission website, many of which make discouraging reading. The privatisation seems to have led to profit-seeking rather than an improvement in care, and the political forces seem likely to continue this.
It seems that COVID-19 affects not only the lungs, but the heart, kidney, brain, gut, clotting and blood vessels, and that a lot of facts are still not clear.Here is an article from ScienceMag from the Australian Association for the Advancement of Science.www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes
27 May 2020
Sweden likes to present itself as a highly sophisticated welfare society where a caring State looks after all its citizens. But conservative governments have been quietly undermining its welfare system for some time, and this opening up of the country and talk of ‘herd immunity’ may be both hypocritical and very poor public policy.
The assumption that healthy people will not die, and the rest do not matter is a very callous moral judgement. The assumption that without normal commerce the economy will not function and thus it is the economy versus a few oldies welfare is a morally appalling position, which is creeping in by default.
When I was a NZ sheep and beef farmer standard practice was that the breeding females had a performance criterion. If they did not get pregnant before winter, they went to the abattoirs as they were too expensive to feed over winter.
Managers love performance criteria, and as Management now dictates political actions people now have to perform also. Not strong enough to survive a COVID19 infection? Funeral for you! It is assumed that the rest will be infected once and then be immune. And when most people have been infected so that the virus cannot propagate in the society, we (hopefully) have ‘herd immunity’.
Politics being what it is, things have to dressed up a bit. Less tests, fewer masks, omit certain types of hospitals, change the death certification. Do not state the policy bluntly, and give no mandatory orders from the top, but make it vague enough with scope for non-implementation of best practice and plausible deniability. Make concerned statements of good intent, select some good figures to quote, and praise the people for their fortitude. If the odd whistleblower says something and manages to get publicity, be surprised, deny, promise to investigate and call it a ‘one off’ case or situation.
Brave New World is here. The only surprise is that it has started in Sweden.
3 May 2020 In a move that will surely damage it credibility the Australian Electoral Commission has approved a name change for the ‘Involuntary Medication Objectors (Vaccination/Fluoride) Party’ to be called the ‘Informed Medical Options Party’. Amazingly this was under the Australian Electoral Act, as it did not allow confusion with another party, was not […]
30 April 2020The US health system which is largely private is poorly set up to handle a pandemic. It is set up to make money, so is not flexible when different equipment and procedures are needed. Added to this 12% of people have no health care insurance, so cannot get healthcare and of those insured, […]