Would splitting the Hunter New England health service empower our communities?
That's the question we should be asking, according to businessman and former health board member, Dick Estens AO.
"State governments have got to let go. They have got to give more decision making back to the bush and get out of our communities," Mr Estens said.
A call made following the unanimous vote by local mayors as part of the New England Joint Organisation of councils to investigate the amputation of the giant district.
Mr Estens recommended a model similar to America, and not just for health, but across the board.
"In America they have far more community responsibility. Communities appoint their own sheriff, school superintendent and they bid heavily for business and manufacturing; out here they don't.
"They get competition between cities to see who can be the best.
"The only competition we get, is the local football match."
Mr Estens said one of his major issues with the country was that it "manages down" on to its communities and dis-empowers communities and their people.
"In a lot of ways we manage to the lowest common denominator in Australia, and what I always say to people to shock them a bit is, generally governments are sitting to identify the weakest, most useless prick in this country and put walls around him to defend him.
State and Federal MPs don't trust local government and there lies a really bad problem for Australia.- Dick Estens AO
"State and Federal MPs don't trust local government and there lies a really bad problem for Australia.
"Every time they send money to (a local government area), they'll send a 50-page booklet to tell them where they've got to spend the money. Generally council, don't have a lot of decision making on where to put those funds.
"Towns in my opinion should be partly responsible for employment in the town, partly responsible for schools... The shire council should be engaging with the school superintendent and the police area commanders, the ambulance management, the health management and taking more responsibility for the community."
Mr Estens said there had always been more health service bureaucrats then there had been health service workers.
"Essentially what happens, what I find, is nurses should be coming to work for the passion and commitment to helping people and essentially if you have a top-down management system and a state bureaucrat in there - because it's usually poorly managed from a monetary point of view and from an empowerment model - they keep the door shut and don't spend any money.
"If they stop listening to the health workers that are delivering the service, they then start to come to work for the money, rather than the passion, and then you get mistakes made and the government piles in more bureaucrats to make sure people are not making mistakes. That's generally what happens.
"In a good business, really well managed, they run a team atmosphere and they manage up to the CEO," Mr Estens said.
"The board sets the directions, and the parameters and has an executive that reports to the board. The first thing I always look for is to make sure your meeting structure feeds into your executives so the information flows up, not down. It's the biggest single issue that happens in health. Everything gets managed down, not up.
"By splitting (the local health district) in half, you can localise and empower more."
Mr Estens said the government was also to blame for the current GP shortage.
"We're flat out to get doctors at the moment. Everyone's running skinny. And that is a government fault because they set the parameters too high for people to do medicine.
"My nephew is a doctor, he got 98.6 PER and couldn't do medicine. He had to go off and do a science degree, and then do a medical degree. Talking to some of the old doctors, going back 50 years, if you got 75 per cent on your higher school certificate you could do a medical degree.
"Once you realise you've got a mistake, it takes decades to fix. And that's when we suffer."
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