Wednesday, May 7, 2008

HCCA Response to ACT Health Budget

The ACT Government’s 2008-2009 Health Budget deserves support for responding to a broad range of need identified in the health system with a series of worthwhile capital and recurrent funding initiatives.

In the context of the ACT Governments’ undertaking to grow health services provision ahead of CPI increases it is appropriate that recurrent outlays for public health services will increase in real terms by 8% from an estimated $641.6m in 2007/08 to $693.5m in 2008/09.

In particular, commitment to providing an enhanced intensive care (ICU)/ high dependency unit (HDU) at Calvary for better coronary care and opening more beds and a surgical assessment and planning unit at TCH, are to be welcomed. The construction and provisioning for a dedicated operating theatre for neurosurgery should also be welcomed as it should enable safer and higher quality outcomes for neurosurgery patients. There remains a need to develop additional cancer services and integrate existing ones better within a comprehensive Canberra Cancer Centre, but I guess we might have to wait the outcomes of feasibility planning of the overall health facilities at the TCH site before seeking budget commitment to that.

Much more significant in this budget in dollar terms is the $300m commitment towards revamping our public health facilities in the Territory, especially at the two public hospital sites. However, potentially even more significant in the context of necessary health service reforms are the new community health centre in Gungahlin and promised nurse practitioner led walk-in primary health care centres in both the northern and southern suburbs. The current estimate for the full capital upgrade of the ACT’s public health facilities is thought to be of the order of $1B. We shall see if that full amount is forthcoming over coming years and whether it is enough.

This planning for capital works is timely and will position the ACT to meet anticipated increases in demand for services which are expected to peak in 8 to 10 years time. A consolidated women and children’s precinct at the TCH site makes sense, and can easily be progressed while planning for the rest of the site and the long awaited psychiatric services units at Woden now seem almost tangible at last. All of this capital asset development needs to go hand in hand with flexible clinical services planning that reflects changes in capital asset needs when models of care or health technologies change.

Digitising image capture used in breast cancer screening is also a welcome initiative, in this budget, but is only one of many e-health initiatives needed to bring our health system into the modern IT/ information management age. There may well be scope for doing more in this area with some of the capital works development and fast tracking funds provided in this budget, but consumers will be wanting to see that these IM/IT problems are not overlooked or placed in the too hard basket. Most of the remaining money will be needed for feasibility planning for new single bed wards and better integrated surgical and imaging services in a new building at TCH and we look forward to that being achieved with minimum disruption to those who will have to continue to use the site during the construction phase..

But all this spending on physical and other supportive infrastructure will amount to very little in terms of better outcomes for healthcare consumers unless there are concurrent reforms of the ways in which health care services are delivered,

In particular, the health system in the ACT, like many others, is facing serious challenges like the need for structural reform of health service delivery modes (both for models and locations of care) and in the recruitment and retention of qualified staff in areas of need. Also the relationship between government provided services and those provided in the community and private sectors will need to be re-examined to ensure that inequities in access are not being systematically entrenched. More funds will also need to be directed to community health literacy and maintenance of wellbeing rather than just providing episodic treatment for periods of illness arising from chronic conditions and acute illness or injury. These areas will all need further attention in future budgets.

It is hoped that between now and the end of the year that there will be further Commonwealth funds earmarked through the Health Care Agreements for structural reform of the models of care which impact most on health outcomes for ACT consumers. These agreements need to be extended to cover more population health and illness prevention measures, as well as better provision of supportive care for the frail aged in community and specific aged care settings rather than just consigning them to hospital beds when their health care needs become too challenging.

Remember that the outcomes consumers are looking for are not just impressive health care facilities or mere increases in life expectancy, but also improvements in the quality of our lives and the quality of care we receive. It’s the personal experiences of consumers and our health outcomes that ultimately measure the success of any health system. This mans reformers will need to focus on the access and affordability dimensions of quality and not just the efficiency dimension beloved of bureaucrats and governments or the convenience and reward dimensions seemingly focussed on by some health care providers.

Russell McGowan

7 May 2008

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