Why I created the 'Inside Aged Care' website
As a surgeon I have cared for many elderly patients but I have no direct experience of actually providing aged care outside hospitals. So I need to explain why I have the temerity to criticise what those with vast amounts of experience in managing aged care companies are doing and tell them what I think they should be doing.
I have spent approximately 20 years closely tracking aged care in three countries, studied vast numbers of documents and in particular looked at what the people directly involved in the care situation are saying and thinking. This in my experience, with both health and aged care. It is very different to what management sees.
My experience of dysfunctional systems in politics and in health/aged care over a long life is that those looking in from outside can often see what is happening much more clearly than those directly involved. But they can also get the wrong impression when there is insufficient information available.
It is very important that outsiders who see problems speak up but this must be followed by a dialogue between those inside the system and those outside it. Those inside must carefully consider what their critics are saying and if they don’t accept that view they must be able to explain and justify their reasons for this. If the issues raised are serious and remain unresolved then accurate data must be collected by a third party to resolve the matter.
My experience is that too often those inside the system are dedicated and believe implicitly in what they are doing. They reject the criticisms, get angry and then demonise their critics. The more likely that they are wrong, the more likely that they will do this. What Aged Care Crisis is trying to do is to create a forum within which these issues can be debated and in which policy, practices and failures can be debated without anger and acrimony.
My other reason for writing at this time is that I am getting old myself and am looking critically at what the future might hold for me. I don’t like what I see. I have the experience and feel that I have a social responsibility to speak out and explain why.
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I grew up in a minority English community in a country town in South Africa in the 1930s where my father was a doctor. Our view of the world was a paternalistic colonialist one. During this period, the much larger Afrikaans non-English white community in the town became increasingly fascist adopting a pro-Nazi, anti-Semitic and anti-British position. The country was soon at war with Nazi Germany but with an active 5th column supporting Germany and undermining the war effort by secretly refueling German U-boats. After the war we were confronted by the horrors of the holocaust. At this time, my family moved to a city. The country entered the apartheid era.
I trained in medicine in South Africa and then specialised in surgery in England working in the NHS and experiencing socialised medicine. I found that I got a far clearer picture from outside South Africa looking at media and talking to those who had fled than from inside it. I first learned of unethical and harmful commercial conduct in the USA from a colleague who had returned to the UK after a spell of training in the USA.
I returned to South Africa. There I became interested in what was happening around me in South Africa as well as in the outside world. It puzzled me that vast numbers of obviously good, decent and intelligent people could adopt belief system that quite obviously harmed others, sometimes, as in Germany, Russia and China resulting in millions of deaths. Yet these people seemed blind to the consequences for others. I was also puzzled at the way some doctors in these systems abandoned their ethical responsibility to their patients in order to serve these ideologies. Under apartheid, many of these things were happening around me on a daily basis and I knew many obviously decent people who were supporting this.
This led me to study social sciences. I became interested in frames of analysis that had developed in sociology during the previous few years. They offered ways of understanding how these harmful belief systems became so important for believers that they simply could not see the consequences for others. They had no doubts and would get angry, reject criticisms and demonise their critics and in South Africa labelling them as communist which immediately discounted any arguments they made. Since that time, those general frames of analysis have become a sub-discipline called the Sociology of Knowledge. It has influenced communication theory, which I studied, and also education.
Although I have not followed the further development of these ideas in depth, they have influenced the way I have addressed social issues. I do not see the people themselves as primarily responsible, but the patterns of thinking that are a critical component of failed systems are revealed in what they say and do. To study them, we need to look at what is said by and about individuals, and study the things they do. When they do bad things we can see them as also being victims. We can avoid getting lost in the blame game as that is a dead end leading nowhere.
I emigrated to Australia with my family in 1997 and because of my interest in teaching (and the use of technology) I joined the University of Queensland where I worked until my retirement in 1997. I watched the Reagan and Thatcher political developments and economic policies without understanding their significance or their ideological nature. I spent four months visiting hospitals in the UK and the USA in 1986 looking at developments in technology. The UK hospital system was not that different to the one I had worked in nearly 20 years earlier. The US system had always been very commercial and those I met there (and also the US professors I met visiting Australia), were confronted by and worried about the corporatisation of their health system.
I did not see that as something that would become an issue in Australia until two years later in 1988. While I realised what was happening during the 1990s, it was only in 1996 when I went to listen to Dr Michael Wooldridge, the new Minister for Health in the Howard government, that I realised the full extent to which Australian politicians had embraced the economic ideology that had originated in the school of econmics in Chicago in the 1970s, and their determination to turn both health and aged care into free markets.
Health Care: An unhappy encounter with a large corporate run international US hospital at the end of the 1980s turned me into a whistleblower. When I found that the problems I had identified were industry wide and country wide in the USA, I visited the USA to study the sector there, meeting with politicians, lawyers, whistlebowers and fraud investigators. I became a dissenting voice opposing the corporatisation of medicine in Australia.
I like to flatter myself that my efforts and the Corporate Medicine Information web site I started in 1996 contributed to four of the largest US multinationals, who either entered Australia or planned to do so, leaving the country or abandoning their plans.
The medical profession, whom I supplied with information were also active. In the 1990s they successfully scuttled many government plans. They put one big Australian company out of the hospital business in the early 2000s. This clearly establishing the sort of conduct that would be acceptable in Australian hospitals. As a consequence, we have so far escaped the full consequences of corporatisation and not followed the US path. The battle in health care is ongoing.
Aged Care: There have been major problems in the corporatisation of aged care in both the USA and the UK. I have written about those in the USA on my Corporate Medicine website. Over the years I have made submissions to inquiries in Australia and challenged government aged care policy. More recently I have worked more closely with Aged Care Crisis.
Australia has been slower in corporatising aged care than these countries, but that is now changing rapidly. The coalition government is driving that process and the labour opposition is supporting it.
Aged Care Crisis (ACC)
Those of us who support and work with ACC come from different disciplines and different perspectives. We have different understandings of what is happening in aged care and see different solutions. The views I am expressing are my own and not necessarily shared by everyone else.
We all share the view that there is a crisis in aged care, that the system is not working, that Australia is not collecting the information we need to evaluate what is happening in aged care, and that as a community we need to debate these problems urgently. The market system we are forcing aged care to become a part of is not serving the community well. We need to develop strategies to address them.
The ACC website has a section in it called Solving Aged Care - which aims to open up a discussion in the community where issues can be analysed and debated and where the community’s understanding and analysis of aged care can be nourished and grow.
We do not want to exclude the industry but we want them to confront our views and debate them with us within the context of our concerns and not theirs - a context where our voice dominates, is credible and cannot be ignored or discounted. We also want our voices to be heard nationally and eventually have community representatives appointed to aged care bodies.
I am contributing to this debate by writing two sets of complementary web pages.
I am opening the debate about what we can do to sort out the failed aged care system by writing pages for Solving Aged Care section of the Aged Care Crisis web site. The focus is on solutions. This site is directed to a more general audience.
I am extending and deepening that debate by writing a second set of web page here on my own web site "Inside Aged Care". Here I examine what is happening in aged care in much greater depth using several different perspectives. I illustrate what is happening by using many examples and with quotes from publicly available material. I indicate how the proposals I am making would work to counter the problems.
It is an in-depth analysis underpinning the proposals. The 'Inside Aged Care' website is intended for those with a deeper academic interest wanting to look more deeply at the social processes, or whose interest has been sufficiently aroused by the ACC pages. Those wanting to criticise my analysis and comments in Part 5 on the Aged Care Crisis website may need to explore this website and the examples given here before doing so.
Both websites seek criticism and comment. Both will put up proposals, arguments and criticisms from others that further the debate. The intent is to engage and to get people talking about aged care. Life expectancy is increasing rapidly and almost all of us will be old one day. What happens in aged care will affect every one of us.
I have worked in three different countries with different health systems. I have worked in private hospitals, university hospitals and in private practice. I have known about dysfunction in health care in the USA since the 1960s and watched similar problems developing elsewhere. I have broad and direct experience of dysfunctional social systems and the people who believe in them.
I have experienced the pluses and minuses of different political and medical systems and seen how communities and the professions respond to these. I have studied social sciences with an interest in understanding what was happening in these situations. I have studied and written about and been an activist in both health and aged care. I feel I am well qualified to criticise and raise issues that are relevant and need careful consideration.
There is an urgent need for the community to debate issues and to be involved in what is happening. They need independently collected and accurate information if they are to participate effectively. ACC is trying to initiate this process and these are my contributions.