Wednesday, May 5, 2010

National Health Reform - Consumer Information Session in Canberra

On 29 April 2010 the Hon Mark Butler MP (Parliamentary Secretary for Health) spoke with members of CHF and HCCA at Scarborough House, Woden.  

Photo: Russell McGowan, Mark Butler, Darlene Cox and Carol Bennett at the Consumer Information Session

Mr Butler spoke about the Government's reform agenda announced in the National Health and Hospitals Network for Australia's Future.  He also spoke about the key issues that emerged from the consideration of the context for health reform by the National Health and Hospital Reform Commission (NHHRC) consideration of the health system.  His presentation included a summary of the recommendations arising from the Preventative Health Taskforce, Primary Care Task Force as well as the NHHRC.

The challenges in the Australian health system include:
  • fragmentation of care
  • gaps and poor coordination of services
  • pressure on public hospitals and health professionals
  • unsustainable funding model
  • too much waste and inefficiency, and
  • not enough local clinical engagement
Participants were fortunate in that the timing allowed us to ask Mr Butler about the agreement that had been reached at the Council of Australian Governments (COAG) on 19-20 April 2010. 

The COAG communique is worthwhile reading.  The Communique claims that the reforms will deliver better health and hospitals by:
  • helping patients receive more seamless care across sectors of the health system;
  • improving the quality of care patients receive through high-performance standards and improved engagement of local clinicians; and
  • providing a secure funding base for health and hospitals into the future.
The rhetoric is good and we look forward to further consumer involvement in fleshing out the detail.

One area of interest is the 4 hour targets for the emergency departments.  This target is for consumers to be triaged, admitted, or referred and discharge within 4 hours.  It is in the process of being rolled out in WA and South Australia and will work from triage category 1 - 5 over a progressive period.  This is a signficant improvement.  Mr Butler cited figures that more than 600 000 people wait more than 8 hours at ED each year.  He also pointed to the ACT figures that show taht  only 58% people are seen within clincially recommended time for their triage category.  He compared this with NSW where 78% of people are seen in within the clinically recommended time.

Consumers need to be a little cautious about embracing such targets as we need meaningful performance indicators.  we need to push for indicators for improvement which involve reform to clinical practices to improve outcomes for consumers.  The UK introduced 4 hour targets and the BBC reported that there is a practice of 'fiddling' ED waiting time targets.

There was around 40 minutes for questions from the floor.  Below are a few of the questions and the answers Mr Butler gave:

Q: People with palliative care needs have to go to hospital to get the care they need in terms of pain and sympton relief?  do these announcements deliver more sub-acute care for people needing palliative care?
A: The Sub-acute care funding does not relate to palliative care.
Note: this means that consumers need to continue to advocate for community based palliative care and access to sub-acute care for people who need palliative care.
Q: How will this plan improve health outcomes for women? Is there any dedicated funding for women's health?
A: Women's health is not specifically dealt with in this agreement
Q: There are activity based funding payments on basis of outputs delivered by providers but what about incentives to reward prevention?
A: There will be incentives to jurisdictions to improve prevention
Q: there is lots of talk about consumer centred care but it seems once again we are talking about health economics and health financing.  How does the government plan to engage with consumers to make sure there is nothing about us without us?
A: These reforms will bring the consumer to the centre of each sector and level of care.  this will enable consumers to be at the centre of care as individuals as as communities.  the community based governance will enable community input into how services will be delivered.  The Primary Health Care Organisations will provide more 'patient centred care' (Mr Butler's words) with case management by multidisciplinary team rather than consumers accessing the health silos.
Q: Is there an architecture for governance that enables consumers and the community to have a discussion about how it will hang together in respect of the electronic agenda that has to support all of this?
A:  With respect to e-health, the Prime Minister will make comments about this in the future and it is reflected in the communique to COAG
Note: the Communique says "COAG noted the importance of continuing to work towards a National Individual Electronic Health Record system and agreed to prioritise discussions over the coming months to move towards the implementation phase".

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