farmdoc's blog post number 483

Dr Bernard Nicholson (1917-2003) was a President of the Royal Australasian College of Medical Administrators (1972-4). The Bernard Nicholson Prize is awarded annually to the top candidate in the College’s Fellowship examination. I won it in 1978. So I know a thing or two about the structure and function – and dysfunction – of health systems. During the five decades of my medical career (so far), the only constant in our health system – at national, state and local levels – is change. Incessant inquiries and stakeholder submissions have led to reports. And restructuring. Oh yes – the restructuring. Pulling the bits apart. Then putting them together again. Like Humpty Dumpty. But in ever changing permutations. Redrawing organisational charts. Devising new lines of upward reporting and downward delegation. New department names. New agency names. New job titles. As if any of this matters. I assume the aim’s to improve prevention, service access, waiting times, treatment efficacy, and error and complication rates – with the bottom line of maximising the nation’s health. If so, I’ll bet anything that changing the status quo won’t bring us one jot closer to the aim. None of the past restructures has. So why would the current ones – including this Victorian one announced last Thursday – do better. The only winners are the politicians – who show they’re doing something – and the printers and signwriters. Maybe in my next life I’ll return as a printer or signwriter. I wonder if they have the equivalent of a Bernard Nicholson Prize.