Monday, February 16, 2009

A Healthier Future for all Australians - NHHRC Interim Report

It is an exciting time for those committed to strengthening our public health system. The National Health and Hospital Reform Commission today issued their Interim report, A Healthier Future for all Australians.

At 392 pages, the interim report is an impressive document. The Commission has done well to address the many issues raised in the submissions and consultations. Over the coming days (and weeks) we will continue to work through the document to identify ways in which it may influence health services in the ACT.

The Report warrants a big tick by consumers. The Commission has picked up on many of the things consumers have been saying for a long time.

In particular we are pleased to see the report comment on the importance of coordination of care between the various levels of health care. there is strong support for personal held medical records. This is very positive as it is a strategy that ensures all of the pieces of information that are important to our care are transferred and available to the personnel who are involved in decisions about our health. This will provide health professionals with a better, more complete picture and they will be better placed to make decisions that will result in safer interventions.

The Report also acknowledges the lack of resources for step up and step down facilities and other transition care services. The importance of the sub-acute care “glue” that links acute with community care is recognised. The need to enhance such programs including step-up and step-down programs is strongly supported. The report notes the variation across the country in the development of such programs and proposes increased access, improved funding, including infrastructure. This is something consumers are very keen to see extended.

We have a health system that is built in divided responsibilities between levels of government. This has resulted in disintegrated care and gaps in services which has not always serviced consumers well. The Commission is looking to strengthen primary and community based care. This move has the potential to provided integrated care and help consumers to overcome the confusing system.

The report presents the Commission’s reform agenda under four themes, which are:

  • Taking responsibility: individual and collective action to build good health and well-being – by people, families, communities, health professionals, employers and governments;
  • Connecting care: comprehensive care for people over their lifetime;
  • Facing inequities: recognise and tackle the causes and impacts of health inequities; and
  • Driving quality performance: better use of people, resources, and evolving knowledge.
Having identified these four themes the Commission discusses in more detail the elements comprising the themes and the strategies to achieve them.

There is recognition of the consumer empowerment perspective as a strategy to build healthier communities and people, which considers how individuals can take greater responsibility for their own health. This strategy is seen as relying heavily on health literacy - proposed as a component of a National Curriculum at both primary and secondary education levels. HCCA supports this positive move. Unfortunately the Report does not go on to address the imbalance of power between health professionals and health consumers –this is a critical part of the equity jigsaw. This imbalance is institutionalised and will not be addressed by better information alone. the system will need to have more strategies to enable consumers to take a stronger role in their own health care. While the establishment of citizen juries is proposed as a systematic mechanism to formulate health care priorities, the report does not seek to empower consumers through direct participation in the health care system or processes. We hope that there will be further considerations on ways in which health services can build on more consumer involvement.

Building health promotion and prevention capacity is supported but there needs to be a specific focus for individual consumers, organisations, and businesses on identified issues covering well-being, chronic conditions, self management and lifestyle issues. As part of this theme there needs to be a strong emphasis on improving health outcomes for both populations and individuals not just increased health outputs. Health services need to be linked to health outcomes.

The Interim Report is a good start and we will continue to follow the work of the Commission with great interest.

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