THE NSW government's discussion paper on implementing federal Labor's proposed reforms of national health funding and administration gives grounds for optimism that the reforms can succeed.
Large bureaucracies are cumbersome and difficult to steer but, enthusiastic at the prospect of hefty extra federal funding for front-line services, NSW Health has managed to map out what seems to be a sensible transition plan.
The key aim of the federal government's plan is to achieve a streamlined system where locally based "health networks" receive funds more or less directly from the Commonwealth, with relatively minimal intervention from state governments.
The advantage of this model would be the elimination of incentives for cost-shifting and other inefficiencies that have arisen under the present dual-paymaster system in which federal and state priorities often diverge.
Under the new system local health authorities would receive funding based on an agreed assessment of the fair value of their activity.
The state would retain a role, receiving the federal funds and acting as a buyer of health services from the local health networks, providing and maintaining capital equipment and buildings, setting statewide priorities and monitoring performance.
In NSW 15 health networks would take the place of the existing eight area health services.
The Hunter New England area would experience no change in boundaries. The area is already considered by many to be at the limits of manageability, so making it larger may have been risky. On the other hand, reasonably effective area-wide clinical and management systems have been created, so hiving off any of the area's parts could be counterproductive.
This positive assessment of progress towards implementation of the reforms may be academic, however.
The continuation of the program is presumably dependent on Labor's re-election in this month's poll - an outcome that can't be predicted with certainty.
Yesterday, Opposition Leader Tony Abbott spelt out his own prescription for health reform, promising to spend $3.1 billion to create 2800 new hospital beds over four years, prompting a predictable round of finger-pointing over which party's set of promises was the better.
Unfortunately, at this stage of a close-fought election campaign, rational debate - even about something as important as health spending - is too much to expect.
Lake's budget woes
APART from health, another area in need of a new funding deal is local government. The predicament of Lake Macquarie City Council, which is trying to find budget savings of up to $15 million a year, is typical of many organisations of a similar size that are caught between rising costs and static income.
No matter how the council finds the cuts it will inflict pain one group of people or another. A staff review has predictably failed to produce a solution, leaving the elected councillors with the thankless task.
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