It's only fair to share…

The opening of government funded “super clinics” without doctors is straight from the script of Yes Minister. The British comedy from the 1980’s is as relevant today as it was when first aired. The fictional antics of the Minister and public service are hilarious on TV. When life imitates art is it as funny?

In the hospital episode the Minister discovers that a hospital has been opened but has no doctors nurses or patients. It has a very busy staff of 500 administrators and has won an award for cleanliness. The scaffold has been left up to make it less obvious that the building was finished 18 months previously. Nobody seems bothered that the hospital does not “tend the sick” as the Minister believes is the appropriate role of a hospital.

Prior to the 2007 election we had promises of around 25 clinics, which the government would fund and build. By this years election around two had opened. The government is spending over $500 million on the project with 64 planned.

In the last two weeks two have opened –with no doctors! One of the original rationales for the clinics was that there were areas without enough General Practitioners. Building these clinics was to improve access to medical services in these marginal electorates (oops, areas).

Here is the key point that health departments and politicians never seem to get. People, not buildings deliver services! The politicians love building things because they can officially open them and have a photo opportunity. Departments like them because a building has a fixed cost and no ongoing recurrent expenses.

However if there is a shortage of medical services this reflects a shortage of doctors not a lack of buildings. There are many areas in Australia where existing practices have been trying to recruit doctors to work. The buildings are already there. They are just not fully utilized.

Opening a new clinic does not change the doctor numbers. If a doctor moves to a new government clinic another area has lost a doctor. There are no unemployed doctors waiting for a new position to become available. If the total doctor head count is unchanged the total capacity to provide medical services is unchanged. The only thing that can change is where the services are delivered.

Given that the clinics are opening with no doctors clearly those services will continue to be delivered in the same places as at present as the doctors are not moving. Maybe in time some will. The Minister will hail this, but who will be seeing patients that this doctor used to see in the “old “ practice?

You do not have to not be an economist to work out that this is money not well spent. Clinics with shiny floors and an administration staff but no doctors and hence no patients will achieve roughly the same impact on the health of the area as the hospital in Yes Minister. Not surprisingly the Health Minister has used all the usual justifications and said what a great thing these empty clinics are.

We can laugh at government waste in a TV show. Given it is real money being wasted I think the joke has worn off. After 30 years it seems that Yes Minister has ceased to be a satire and has become a template for government policy in health.

Sir Humphrey Appleby would certainly approve. I can even hear him saying,” Yes Minister”.