Labor strains

Just about everyone else in these parts seems to have expressed an opinion on the matter of tomorrow's ALP leadership, so, for what it's worth, here's mine.

I believe that  Kevin Rudd was shabbily and grossly unfairly treated when he was deposed in 2010. I find it hard if not impossible to believe, not so much the stories about his alleged poor management practices, quick temper etc, that nobody close to him, especially his then deputy Ms Gillard and treasurer Mr Swan, could muster whatever it might have taken to put him on notice to change his way or at least do something to address them..

In a week of intemperate comments and backtracking Mr Swan's stand out. Michelle Grattan : Michelle Grattan in The Age on Friday put it well:

Ministers are not only tearing Rudd to shreds, they are destroying their own credibility.Take Treasurer Wayne Swan. He said on May 18, 2010, just a month before he was party to the coup that ousted Rudd: ‘‘Kevin Rudd has a deep commitment to Australia, a fantastic work ethic, and a very good record to put to people at the next election.”

On Wednesday this week, in his brutal attack on Rudd, Swan said: ‘‘The party has given Kevin Rudd all the opportunities in the world and he wasted them with his dysfunctional decision making and his deeply demeaning attitude towards other people, including our caucus colleagues.’’

Was Swan telling the truth when he was  serving under Rudd, or is he telling it now? Swan explains discrepancies in his comments by saying he has ‘‘been a team player all of my life’’.  He can’t say he only became aware of the Rudd negatives in retrospect. He was one of the gang of four that ran the government under Rudd. He tried to get change, he says, but Rudd’s ‘‘behaviour then became increasingly erratic and that is why the leadership changed’’. Yet remember how late in the piece Swan was still praising Rudd.

Since Swan's tirade he seems to have kept his mouth shut, and other Gillard supporters have generally been more measured in their comments. IMO far and away the best statement from either side has come from  Anthony Albanese , about whose position http://www.theage.com.au/opinion/politics/albanese-integrity-puts-colleagues-to-shame-20120225-1tuvb.html"> Michelle Grattan says

Albanese is using this ballot to register a retrospective protest over the 2010 coup: he believes it was wrong that it happened, and the manner in which it was conducted was equally reprehensible...By his decision, Albanese is also contesting his colleagues' argument that Rudd is too dangerous and shambolic to be in charge of a government. Albanese was a senior minister through the Rudd period; as leader of the House he worked very closely with the then PM. Even if Rudd is a difficult character, Albanese is saying, by his support, that Rudd's personality defects are not so great that he should never again be let near The Lodge.

I concur.

Despite this, and polling which confirms that Rudd is the popular choice to win the ballot, it is widely agreed by commentators that tomorrow will see Prime Minister Gillard confirmed by a substantial majority of the caucus, who on this occasion, in contrast to 2010, will disregard the polls.

Whatever happens it will be very hard to pull the ALP into shape to put up a reasonable fight in the next federal election. One of the few silver linings is that the election need not, provided the independents hold firm, need not be held until 2013. Many Australians would like to see that happen sooner rather than later, and I am inclining towards that view.

Backroom machinations lead to change of PM

As The New York Times put it succinctly

Party officials decided to replace Prime Minister Kevin Rudd with his deputy, Julia Gillard, who becomes the nation’s first female prime minister.

This came as a surprise. The Rudd government has clearly been in trouble with public opinion lately but I'd have thought (and hoped) that he and his inner circle would have been put on notice to improve. What has happened is a cabinet reshuffle with Mr Rudd ruthlessly dispatched (to where isn't quite clear) by a combination of Labor Party and union machinations with Julia Gillard, Wayne Swan etc moving up a notch or two.

I watched events unfold on TV, alternating between the ABC and Sky. The ABC had more people on the ground and in front of the camera (Kerry O'Brien a noteworthy exception); Sky used more voiceovers but, perhaps because it's used to covering events like this, IMO it gave the public broadcaster a good run for its money.

Both networks seemed to cover the day's major events, including Kevin Rudd's farewell speech. His family stood by his side as he worked his way slowly, and with several lengthy pauses, through his notes. It left a bitter taste in my mouth: I tweeted suggesting that someone should pull the plug on him, not to stop him speaking but as an act of kindness if not mercy. While his words quite properly referred to what he considered his achievements, the images on the screen often reminded me of those of someone found guilty at a show trial in a dictatorship such as Stalin's Russia.

Has the combination of party factional and union ruthlessness and the media's hunger for good images brought us to this?

Honours recipients support republic

Today is a public holiday in South Australia, ostensibly for the Queen's birthday.

As far as I can tell nobody who's entitled to the day off has refused the offer because of their republican principles. I expect that people (an increasing number) who rely on casual work may have opted to spend a day or part thereof at the coalface (or waiting on the bistro table) to help make ends meet.

Nor, to the best of my knowledge and belief, has anyone who was awarded an honour in the Queen's Birthday honours list which was published today rejected their award. But this hasn't stopped several of them from criticising our current constitutional arrangements .

It's easy to suggest other names who could (perhaps should) be included in the Honours list. Yet what strikes me, without naming recipients' names, is that it's easier to receive an award if you are either a prominent business person or a longserving officeholder in a (usually non profit) community based organisation who has acquiesced in the changes (supported by all major parties) which have made it easier for private sector (and often offshore) organisations to come in and take over government funded for services eg employment placement.

Perhaps it's time to create a Wiki Honours list where people can nominate prospective recipients without having to go through the labyrithine processes required to get one's name in the paper on Australia Day or the Queen's Birthday.

Honours recipients support republic | Adelaide Now

Committee and people choose different Words of the Year

Macquarie Dictionary's Word of the Year 2009 (chosen by a Committee) is shovel-ready, It means, according to the report on the website " adjective: (of a building or infrastructure project) capable of being initiated immediately as soon as funding is assured."

I can't see why tweet didn't win: in fact it (at least the verb) did win the People's Choice Award . (The Committee did at least give it an "honourable mention").

Neither term is peculiarly Australian but surely tweet is much more widely used. It was (as both noun and verb) chosen (by a committee) as the American Dialect Society's 2009 Word of theYear .

Perhaps the Macquarie Committee, a member of which is Les Murray (much of whose poetry has a distinctly Australian voice) felt it needed to distance itself from the Yanks and any perception of linguistic cringe.

Shovel-ready (which IMO is two words: a Google search will show some support for this view) sounds as like a term chosen by a committee. Despite being first used (or popularised) by President Obama it doesn't seem to have caught on to the same degree as tweet.

Anyone like to put money on which of the two terms we'll be using most in a year (or 6 months)?

Catalina

When I heard on the radio that a Catalina was going to fly over Adelaide I ventured on to my roof with camera. This was the best photo I could take with the 42-150 mm zoom on my Olympus E410 DSLR at its max focal length. My photoshopping skills are deficient so I've not been game enough to tinker with the raw material, but if you're interested you can enlarge it by clicking on the image, when you'll be able to see the characteristic (and quite elegant) outline of the plane, even if this one lacks the floats suspended from each (high) wing which I'd assumed was one of the model's defining characteristics.

After warm winter, early taste of summer

Today's estimated max temp is 29deg C, 10 deg above the September average.

The BOM records that it's already reached 27 at 10.27 though it's fallen to about 25 at noon.

Climatologist Blair Trewin in The Punch reflects on the warm August many Australians have just experienced:

August 2009 was Australia’s warmest on record. Temperatures averaged over the country were 2.47C above the long-term average, nearly a degree above the previous August record set in 1998, and 25% of the country had its hottest August day on record at some stage during the month.

Trewin points out

Average temperatures in Australia have warmed by about 0.8C over the last 100 years, most of it in the last 50.

and concludes

...while we can’t blame global warming for any individual extreme warm event it is certainly making these events more common.

The entire piece, which includes several graphs, is worth reading.

Spring

Today is the first day of spring. With very little assistance from me (I didn't prune the bush during winter) this rose bloomed right on time for the official opening of the season.

Not everything is rosy in our national garden, though, as today's Australian reports

Australia has just experienced its warmest winter on record.

While the claim won't be official until data for August 31 is collected from the nation's 850 temperature observing stations, yesterday's relatively warm temperatures across the country should see the winter of 2009 rewrite the record books.

The Bureau of Meteorology's National Climate Centre has produced a Special Climate Statement whose title " Exceptional winter heat over large parts of Australia" is self-explanatory.

South Australia appears to have had its warmest winter on record. This doesn't surprise me as I saw a snake in the Adelaide Hills on 20 July when the max temp in the city was a springlike 21.7 deg C (today it was 18.0).

Detailed records for Adelaide and other weather stations can be found here

"Breath" wins Miles Franklin Prize

Tim Winton's novel Breath has won the Miles Franklin award

I've read it, as I've done many of Winton's other books, and enjoyed it, as I enjoyed them, despite sometimes taking a while to enter into the worlds he creates.

I'm neither a dancer, a surfer nor a paramedic, but do have adult children. I find the last words of the novel resonate with me. Speaking of his adult daughters, the narrator says

They probably don't understand this, but it's important for me to show them that their father is a man who dances - who saves lives and carries the wounded, yes, but who also does something competletely pointless and beautiful, and in this at least he should need no explanation.

At the award presentation ceremony Winton criticised proposed changes to Australian laws which are likely to make it harder for local authors to be published. For further information and to see a video click here .

If it happens you read it here first...

From the June Adelaide Review

Innocent abroad?

The ABC reports

Prime Minister Kevin Rudd says the Government worked hard to help secure the release of Victorian woman Annice Smoel, who spent time in a Thai prison after being accused of stealing a bar mat.At the same time, Victorian Premier John Brumby has accused Thai authorities of overreacting in the case.

Ms Smoel, 36, was greeted with hugs and cheers by her four daughters and other relatives when she arrived at Melbourne Airport this afternoon.She was released late yesterday after pleading guilty to stealing a bar mat almost three weeks ago. A Thai court suspended her six-month jail sentence after the Governor of Phuket paid her $38 fine.

Mr Rudd said the Department of Foreign Affairs did a lot of work behind the scenes to secure her release.

"Helping the family, helping the individual, and negotiating quietly with the Thai authorities to make sure that this can be dealt with," Mr Rudd said. "And they've done a very good job, and I congratulate them.And I would say to the family concerned, that we're pleased that the little ones have that anxiety removed."

Mr Brumby, meanwhile, says the Thai authorities "gravely" infringed Ms Smoel's human rights when they charged and jailed her.

"To be honest, that message did get through to the Thai authorities and they saw common sense and that this was a trivial matter, that there'd been an over reaction and that a woman's rights had been gravely infringed," he said.

However Mr Brumby says he hopes the relationship between the two countries will be repaired.

Despite his propensity to bang the populist drum , I thought that Andrew Bolt had a pretty sensible take on the matter before it was resolved.

"Next time, pack some manners" was the headline of his comment after it was all over . One succinct sentence is IMO a fair comment on our times:

It strikes me that our public manners in fact no longer meet the standard required in most other countries, and improving them might make us a lot safer when we travel.

Perhaps this point could be emphasised more on the DFAT General Travel Advice web page.

Clarification 25 May 11am

The title of this post is not meant to refer to the book by Martin Indyk about peace talks in the Middle East which was the subject of an item on ABC RN Breakfast this morning.

Criticism of tender continues

The discussion (mostly critical) continues.

ABC TV's Insiders showed some clips of Minister for Employment Participation O'Connor (a title which is looking more Orwellian by the day) stumbling over some answers to questions about the tender outcomes.

Elsewhere on the ABC website Greens Senator Rachel Siewert has a succinct and IMO incisive analysis of the situation. Worth reading it all, but here's a longish extract:

The previous government privatised the Commonwealth Employment Service to create the Job Network - by outsourcing its services to a mixture of community based non-for-profit organisations, Australian based for-profit companies and one or two international for-profit companies. In 2002 a Productivity Commission into the manner in which Job Network services were being outsourced concluded that this was not an efficient way to run a tender process.

The Rudd Government has continued the outsourcing of these services this week - now re-badged as Employment Services Australia - but the process now seems to have gone totally off the rails. The decisions on these contracts announced in the last couple of days show neither rhyme nor reason. It is fair enough to change providers if a quality service is not being provided but this does not seem to have been the basis for the decision making of the Government. Some of the highest rated providers (4 and 5 stars) have been overlooked, and in some cases have seen their services handed over to other providers from different regions whose services have rated poorly (1 or 2 stars). We have also seen a couple of large overseas commercial providers brought in - including A4e from the UK.

The community sector is understandably upset by the inequity and lack of logic of the outcomes - but the thing that has rankled more has been the manner in which the process has been run. Having had to submit complex and time consuming submissions, there appears to have been little cross-checking of claims and evaluation of the capacity to deliver a particular service in a particular location, and service quality.

Over the last two weeks, organisations have struggled to get any useful information from the department - they have not been contacted and informed about the status of their applications and have been given the run around when seeking information. Many are still struggling to get an understanding of exactly what the on the ground impacts of these decisions will be. This makes things particularly difficult when they are bound to give staff advance notification of whether or not their jobs will soon be terminated.

The whole process has undermined the relationship between the Government and the community sector right at the time when this relationship is crucial to their ability to tackle the impacts of the financial crisis on those most at risk. It has undermined their trust and is likely to have derailed the discussions of a 'compact' with the sector ... and left their much vaunted 'social inclusion' policy in tatters.

This is the kind of ignorance that can only creep into government departments which have spent over a decade managing contracts rather than actually delivering services. It is clear that DEEWR hasn't engaged in or simply doesn't get the 'whole-of-government' approach to 'joined-up-policy' and 'wrap around services'.

The results of the tender process demonstrates that the values underpinning the tender focused much more heavily on the false God of the market rather than the values of equity, sustainability and community, despite Mr Rudd's recent comments.

How else could you decide to redirect your funds away from your best performing employment services at a time when the nation is sliding into recession and unemployment rates are expected to go through the roof?

As unemployment rises dramatically, these services will be at the front line. Local community based providers are best placed to develop the innovative programs that will be needed with high unemployment and few new jobs.

Well put!

Elsewhere The Australian and Indaily report the opposition's call for a senate inquiry.

GG under scrutiny again

In The Australian Malcolm Colless reports that some eyebrows have been raised by the Governor-General's recent activities .

Kevin Rudd may feel comfortable with an interventionist governor-general but this view is by no means unanimous within his ministry.

In fact a number of ministers are known to be not just concerned but angered by Governor-General Quentin Bryce's involvement in the affairs of government. The fact that no one has apparently conveyed this to the Prime Minister is more a reflection of the autocratic way Rudd runs his ministry than the level of concern about politicising the role of Australia's head of state. "Voicing disapproval of the Prime Minister's judgment on this issue, even in private, would be tantamount to committing political suicide. But it is nevertheless outrageous," one senior minister told The Australian.

Reluctance to buy into this may have also been influenced by persistent rumours in Canberra that Rudd is likely to reshuffle his ministry after thebudget.

Attention is at present focused on Bryce's 10-nation, 19-day lobbying tour through Africa to drum up support for Rudd's push to gain a non-permanent seat for Australia on the UN Security Council. But ministers are still bristling over the unprecedented private briefing she ordered in February from the heads of the departments of Foreign Affairs and Treasury and the head of the defence forces, Air Chief Marshall Angus Houston.

Presumably the relevant ministers signed off on these security briefings and received the Prime Minister's blessing before they took place.

But after media reports about the meetings at least one other senior minister issued a blunt instruction that any request from Yarralumla for departmental briefings should be unambiguously declined.

Whether this justifies calling Ms Bryce an "interventionist" G-G is questionable.

Regarding Ms Bryce's trip to Africa, the program on her website isn't detailed enough to draw many firm conclusions from.

An itinerary including fuller details of all meetings etc would have helped.

Many of her appearances, eg laying a wreath at a war memorial in Dar es Salaam, receiving Botswana's Senior Female Minister and Minister for Local Government (one and the same person) and attending a morning tea with "prominent Kenyan women", seem to be the sort of things you'd expect the Queen to do. Therefore it should be appropriate for our G-G, as the Queen's rep here, to do the same.

But of course it raises other questions such as why the representative of our "real" according to the Constitution) head of state rather than the head of state herself should be making such a tour. A (minor?) anomaly in our current constitutional arrangements.

Opposition leader crosses line?

"PM's cheap money shot" Malcolm Turnbull's article in The Weekend Australian has attracted a lot of comment criticism, especially for its references to Therese Rein, the PM's wife: .

In 1998, the Howard government closed the Commonwealth Employment Service and outsourced its functions to the private sector, and one of the private firms that benefited conspicuously from this deregulation was the Rudd family business.

I congratulate the Rudds, especially Therese Rein, on their success. Their business grew into a very substantial one in Australia and as other countries followed the Australian approach, grew there as well exporting the expertise developed by them when they seized the opportunity created by Howard's decision in 1998.

But what are we to think of the wealthiest Prime Minister Australia has ever had, a man greatly enriched by the privatisation and outsourcing of government services, standing up again and again to denounce the very policies from which he and his family have profited so extensively.

Other politicians eg Foreign Minister Smith on yesterday's ABC TV Insiders have condemned Turnbull for attacking the PM's wife

You know, you can have a go at me, you can have a go at the Prime Minister, we can have a go at Mr Turnbull. That's regarded as fair play, however inelegant from time to time the Australian public might think that is.

But you cross the line when you bring in spouses. And I think some of the wiser, older heads in the Liberal Party, Mr Howard, Mr Costello, Senator Minchin, they might just want to have a quiet word to Mr Turnbull and tell him he has crossed a line here and he might actually want to retract it and get back to having a conversation about policy rather than attacking people's wives.

And many others, eg letter writers to The Australian have had their say.

Some extracts:

• Turnbull is quite wrong is to cast Rudd, indeed the ALP, as socialist. It is safe to say that there are no socialists in the ALP.

• Mr Turnbull made his money off the backs of employees in the financial sector while Ms Rein made her money getting workers back into jobs via her workplace rehabilitation and participation programs. I know which one I think is worthy of having made a considerable income and contribution to Australians.
  

• Kevin Rudd and Therese Rein are multi-millionaires, thanks to the eleven years of the Howard government.You can’t separate Ms Rein’s financial business successes from Mr Rudd, because he has always been a beneficiary. And good luck to them. But for Mr Rudd to now blame the “neo-liberal’ system for this crisis, spinning off further blame upon George W. Bush, Tony Blair, Howard, Bob Hawke and Paul Keating, is hypocritical.

Ms Rein has done nothing illegal, and has obviously worked hard to take advantage of the changing employment services environment which the previous federal government set up in the face of what I, as someone with some knowledge of the industry, thought at the time was toothless Labor opposition.

I don't begrudge her and the PM the wealth they've earned but do think, as Mr Turnbull might have put it without overstating his case, that Mr Rudd's attempts to distance his and the ALP's positions from responsibility for the Global Financial Crisis rest on shaky logical ground.

.

Single rooms too expensive for aged care

Adele Horin writes in today's Age:

An aged-care survey by accountancy firm Grant Thornton showed modern high-care facilities with single bedrooms reported the worst financial results in 2008, with a return on investment of about 1 per cent. The operating profit on a bed in single-room facilities was about half that of older facilities with shared rooms.

A report by accountancy firm Stewart Brown showed more depressing results, with average operating losses of $10 a bed in single-room facilities, double that of shared-room facilities. Stewart Brown also reported that 70 per cent of high-care facilities in the non-profit sector were operating at a loss.

.....

The aged-care industry is stepping up its lobbying of the Federal Government to review the funding of nursing homes, known as high-care facilities. The Government will not allow operators to charge bonds for high-care facilities to avoid residents having to sell the family home. But nursing homes are allowed to charge a maximum, daily accommodation fee of $26.88 to help fund new buildings and refurbish old ones.

A group of church-based operators is expected to soon release a report that shows the charge needs to be increased to at least $40 a day.

The chief executive of Japara, a big private operator, Andrew Sudholz, recently told a Senate inquiry new high-care facilities were not being built because the cost "far exceeds the end value" under funding policies.

Operators said they had survived by building low-care facilities — or hostels — for which they are allowed to charge a bond.

Heat and fire

Bushfires have caused huge loss of life and property damage in Victoria.

As I post it appears that at least 65 people have died and 600 homes been destroyed . This figure may well be exceeded.

After almost a fortnight of extreme heat in Adelaide spanning late January and early February without any major fires I'd assumed that the worst was over. This may have been true for South Australia, but it was not for Victoria where a cocktail of high temperatures and high winds wrought destruction yesterday and overnight.

I, like many others in southern Australia, have been uncomfortable in the heat of the last two weeks but seeing what has happened to so many people in Victoria has put my discomfort into perspective. It is trivial in comparison to their sufferings. My sympathies to them and condolences to those who have lost family and friends.

More older Australians opt to remain in their homes

Siobhain Ryan in The Australian reports an emerging trend in aged care:

Elderly Australians are breaking down the retirement village walls, with aged care operators lodging twice the interest in providing care in the community than in nursing homes.

Official figures obtained by The Australian show the federal Government has received 10 times the number of applications to provide care in people's homes as there are places available.

The 27,039 bids for the government-funded community care places dramatically outnumbered the 13,956 received for nursing home places.

Minister for Ageing, Justine Elliot, said the Government was looking at ways to expand community care in response to the demand. "It is wonderful that the aged-care sector are listening and responding to the concerns and preferences of older Australians," Ms Elliot said.

"Older Australians are telling us they want the choice to remain in their homes and only want to enter nursing homes when it is absolutely necessary.

"Older Australians are healthier and more active (when) they are in familiar surroundings."

Community care offers in-home support services such as cleaning, washing, showering and preparing meals for the frail aged, including those with dementia. Almost 465,000 Australians are forecast to develop dementia by 2031, more than double the current number, forcing many of them into nursing homes unless at-home services are available.

Sounds like an eminently sensible approach.

A-SPAN

A-SPAN is the acronym for Australian Subscription Public Affairs Network which was, as reported in today's Australian, launched by the Prime Minister yesterday.

A-SPAN, or Australian Subscription Public Affairs Network, will begin broadcasting on January 20 next year with live coverage of the inauguration of US president-elect Barack Obama.

Operators say it will become part of the subscription TV platform and will be available for broadcast as a free-to-air digital channel, online and on mobile phones.

A joint initiative of Foxtel, Austar and the Australian News Channel (ANC), provider of Sky News, it will be an Australian version of US network C-SPAN, which provides live coverage of the US Senate and Congress.

.....

“Political junkies will of course love it, they'll now have one more way to drive their family and friends absolutely mad,” Mr Rudd said.

He described the new network as “a good thing” for our democracy and valuable to educators, students and all Australians who want to understand how democracy works.

The venture jumps ahead of the ABC, which a few months ago announced that it was considering a dedicated news and public affairs channel.

The chief executive of Sky News, Angelo Frangopoulos, said A-SPAN would be available on pay TV from January 20.

He expected it would initially be available on free-to-air digital TV only in Sydney.

Former Nine and Seven network political correspondent Laurie Wilson will host a program on A-SPAN, which will also provide broadcasts of the British and New Zealand parliaments and question time from parliaments in Queensland, NSW and Victoria, with more to come.

There will also be live broadcasts of speeches from the National Press Club, think-tanks such as the Lowy Institute and the Sydney Institute, and from universities.

The ABC report is slightly different: it implies that the network will be available on free to air TV throughout the country, not just in Sydney.

I'm currently a pay-TV subscriber but believe that this kind of material should be as widely available as possible, which means on a free to air network (and preferably one free of commercials). The ABC comes to mind but it appears, as the report indicates, to have been caught napping. Once again it seems the ABC will be left with the radio rights to broadcast the national parliament but little else.

In the new world of digital TV (15 " Freeview" channels) which we are being promised parliament should fund a direct telecast and online streaming of all its proceedings, not just Question Time and a few other highlghts which is all we get nowadays. It may be that few people watch it but it shold not be left to solely to private commercial interests.

Joshua Gans makes some good points on his blog post, including one about the cost to users of online streaming, which sounds good in theory but can be expensive in practice.

Don Bradman centenary

Today is the 100th anniversary of the birth of Sir Donald Bradman , IMO the greatest cricketer ever.

I doubt whether many cricket followers would disagree with me, even though the Don did not play the shorter versions of the game.

There are tributes and assessments aplenty in the media, including from the Federal Parliament via Cricket Australia and, as you'd expect, a wide coverage on Cricinfo, including pieces by Suresh Menon and Gideon Haigh.

[Also posted at Nudges and Deflections ]

Restrictive work practices in health

Mike Steketee in today's Australian analyses succinctly one of the major weaknesses of our health system:

In the days before labour market deregulation, unions would go on strike over a shearer being asked to pick up a fleece or a plumber asked to disconnect a piece of wiring. These days it is the Australian Medical Association that defends with religious fervour the exclusive right of doctors to issue prescriptions and to make or at least supervise any number of procedures that a junior nurse can perform. Even in remote areas where there seldom is a doctor in sight, woe betide any other health professional who suggests taking over some of their duties.

Health Minister Nicola Roxon wants to do something about a situation that discriminates not only against highly qualified nurses but also other allied health professionals such as physiotherapists, psychologists, dieticians, podiatrists and diabetes educators. It could be one of the most significant of the many health reforms on her plate, if she can carry it off.

Australia's health system compares favourably with that in many other countries but this is an area in which we are way behind the rest of the world. Greater workforce flexibility in health would increase efficiency and reduce costs in a sector of the economy that is looming increasingly large as medical technology advances and the population ages.

But Roxon has a fight on her hands. The AMA always has been a strong union but these days it arguably is the most powerful in the country. Most unions have suffered from a sharp decline in members, and from laws that greatly restrict their activities, including under a Labor government. But the AMA, representing a respected profession and with a tradition of articulate and very tough leaders, continues to fiercely defend the interests of its members.

In 2006, the Productivity Commission laid out in stark terms the case for reforming work practices in the health sector. It heard that the inability of physiotherapists to directly refer patients for diagnostic imaging cost taxpayers $1 million a year in 9500 hours of unnecessary GP consultations.

That is just one small example in one area of health. Physiotherapists and other allied health professionals cannot refer patients directly to specialists under Medicare: they have to go through a GP.

In the US, not generally held up as an example of world's best practice in health policy, podiatrists perform 80 per cent of foot surgery. In Australia, most of this work is carried out by orthopedic surgeons specialising in foot and ankle surgery. Although there are podiatric surgeons in Australia, they are not recognised as medical practioners, which means they cannot operate in public hospitals. Those who supply services to them, such as anaesthetists, pathologists and radiologists, cannot claim Medicare rebates for their services.

Radiographers cannot do the work of radiologists, even though the shortage of radiologists in hospitals creates problems when rapid results are needed, for instance in emergency departments. Only sonologists can prepare formal reports on ultrasound examinations, even though they often simply repeat the interpretation by sonographers. And so on.

Of course, the doctors have a justification for such restrictions. As AMA president Rosanna Capolingua argued at the National Press Club yesterday, "GPs are the pivotal gatekeepers: the people who select the services that each patient requires to get the best health outcome possible, in the most efficient and cost-effective way.

"Without appropriate medical diagnoses and supervision, patients' problems won't be dealt with properly in the first instance. Missed diagnosis, false reassurance, misdiagnosis, delay in care, all cost dollars and time and human expense." In short, see your GP or die.

Other countries, the Productivity Commission, and most Australian health experts - at least those outside the AMA - think that is a little extreme. Nurse practitioners and other allied health professionals working independently of doctors play significant roles in countries such as the US, Canada, Britain and South Korea.

The Howard government introduced Medicare rebates for practice nurses but they are not the same as nurse practitioners: they have fewer qualifications and can work only under the supervision of doctors, who are the ones who claim the payments from the Government.

Australia has just 300 of the more highly educated nurse practitioners and they are severely restricted in what they can do. Those limitations are all the harder to justify in rural and remote areas where it is hard to find a GP, let alone specialist doctors.

The Productivity Commission concluded that extending Medicare services to allied health professionals "would improve patients' access to quality care, enhance the convenience of care (and) lead to a more efficient use of the mix of skills in the workforce without compromising safety and quality".

This would mean Medicare funding a wider range of services but, to the extent that they substituted for those provided by doctors, it would save money. A study in Denmark of nurse practitioners working with elderly patients in the community found there were extensive savings.

The Productivity Commission recommended an independent committee look at the range of services covered under Medicare, together with referral and prescribing rights. Roxon announced something similar last week, despite the strident opposition of the AMA. A 13-member reference group will report by the middle of next year on, among other things, ways of "addressing the growing need for access to other health professionals".

It is yet another item on the list of Rudd reviews. If the results are not compromised out of existence, they have the potential to significantly improve the health system.

Number 157

Alan Bond is no 157 on the BRW Rich List:

Former billionaire Alan Bond is back in the money, placing 157th on a list of richest Australians with a relatively small but still respectable estimated wealth of $265 million.

Bond, who hit rock bottom in 1992, earns his spot on the 2008 BRW Rich 200 list mainly through interests such as holdings in Madagascar Oil and Lesotho Diamond Corporation.

The former media proprietor last made the list in 1989, after peaking in 1987 at fourth spot with $400 million.

His return to the 200 comes eight years after he was released from jail and coincides with the Packer family losing its spot atop Australia's annual rich list for the first time in 20 years.

Such is life in modern Australia.