Ask the community

John
David
Deidre

Participating in health care debates

I’m a local GP and a member of the Doctor’s Reform Society. I joined DRS because I wanted to participate in the policy debates that set the funding parameters within which medicine operates. I believe that ‘to refuse to play means you will have no say in the rules of the game or even which game is being played. To play as an individual means it is easier for larger stakeholders to divide and conquer their opposition.

In my opinion, participating in healthcare debates means being able to:

  1. think strategically and for the long-term
  2. think tactically and trade pros and cons to achieve a negotiated outcome
  3. understand group dynamics and contributing to a group effort
  4. solve problems in the absence of specific data
  5. proactively propose and organise to deliver results in a changing environment
  6. manage projects management, stakeholder engagement and change
  7. engage in conflict resolution and create coalitions from competing interests
  8. engage in public speaking and meeting management
  9. write reports, submission generation and lobbying
  10. network, profile creation and generate recognised policy related expertise
  11. understand funding, budgets and opportunity costs

More information about the DRS: http://www.drs.org.au/

Where I think General Practice needs to go

Things really need to change in health. I've always believed that. Just look at what they did in the airline industry - they've reduced costs as well as increased safety and taken the ego of pilots down a notch at the same time. I think we need to do the same thing.

I mean, doctors are important but no less important than the other people around them and the whole system in general. I think health is a team challenge and not everybody gets it.

I think we need to embrace technology a bit more too. There are so many options around care, I mean there's so much new knowledge all the time.

Everything's getting so complex - these days we all have to know so much about preventative care, screening, case management, chronic disease etc. And this is happening at the same time as all our funding is being squeezed.

Clive

In the mid 1960s and 1970s entry into the building industry was a reasonable bet for a stable living. The baby boomers were starting to need housing. Many accepted the growing number of apprenticeships, expecting to run small building firms and construct bespoke homes for families in their local area. This had been the model for many decades.

In the 1970s and 1980s the economy experienced some large shocks, increasing the price sensitivity of home buyers. Some suppliers to the industry went bust, creating an opportunity for large companies to buy up timber milling, plumbing and a range of other suppliers. These corporatized groups started demanding minimum order quantities or offering large discounts if certain annual purchase limits were reached. Small builders started being squeezed. On their order quantities, it became harder and harder to build a house for the same price as some of the larger builders (firms able to build 2-3 houses at the same time with each build taking 3-5 months).

In the 1980’s technology also affected the sector. Pre-fabricated frames and kitchens started the rise of specialty sub-contractors who performed a discrete aspect of a build, further driving down costs and reducing risks. Larger firms started to arise with capacity to build 30-50 houses per year.

The 1990’s saw the emergence of project builders. These were successful firms, often tracing their origins back to a small builder, who had the access to finance and project management skills to build entire townhouse developments or work with land developers to undertake construction of parts of suburbs. Their business model propelled nearly every chippee, sparky and plumber into an era of fluid, fixed price sub-contracting. To minimise risk, some carpenters started specialising in exterior cladding and soffits, others morphed into hanging interior sheeting or final fits of architraves and doors.

By the 2000’s the construction market was split into:

  • sub-contractors doing specific types of work for project builders
  • project building firms which build 200+ houses per year
  • specialty, small construction firms which largely do renovations and fit outs
  • boutique builders responsible for architect designed bespoke homes

The result has been dramatic growth in the average size of house and vast reductions in the time taken to build properties, with tighter and tighter margins achieved by builders and sub-contractors alike. Concurrently, the regulatory environment for building has tightened, placing more onus on anyone involved in construction to comply with standards and rectify faults for up to six years. Access to financing and credit for new projects has also become more difficult, restricting the number of firms able to compete for new jobs. Without the mining boom creating other employment options for a half a generation of trade contractors, real wages within the sector would have continued a multi-decade decline.