Thursday, November 27, 2014

Medicare Local: Future Thinking Symposium : “whole system working” Consumer Representative Conference Report Bernard Borg Caruana

Medicare Local: Future Thinking Symposium : “whole system working”Friday 17 October.By Bernard Borg Caruana

Introduction:   Whole of Systems Thinking
‘Whole system working’ is a radical way of thinking about change in complex situations.  To solve some of our most challenging health and wellbeing issues, we will sometimes have to look outside of health for some of the answers. They are beyond the ability of any one agency or individual to fix. To drive better outcomes and get systems such as health working better, we need to think about the connections between the parts – how things fit together.

This was an all day session 9am to 5 pm held at the Canberra Rex.
Sessions were hosted by the ACT, Murrumbidgee ans Southern NSW Medicare Locals and facilitated by Dr Norman Swan.
It was attended by over 100 people

There were 4 plenary sessions which ran in succession:
  • ·         Vision for Primary Healthcare
  • ·         Order from Chaos: whole system primary health planning
  • ·         Whole System Working: Why the Mantra; and
  • ·         Whole of system in Practice.

Some of the presentations can be found at:

Medicare Locals and Health Networks

Medicare Locals will cease to exist as of June 301 2015 and replaced with Health Networks.
The ACT boundaries will not be changed but Murrumbidgee will have one Health Network replacing 6 Medicare Locals covering some 0.5 Million square kilometres.

1.      Vision For Primary Healthcare

A significant theme here that was raised by a number of speakers was the need to write the policy and drag the politicians behind us. We do not need permission to act when it is our health system. We need to galvanise communities and move it forward.

Professor Di O’Halloran had a number of interesting points in her slides regarding the Western Sydney vision for Medicare Locals. She urged us to “Stay true to our values and drive with ideals and health objectives.”

She proposed an approach for working across 3 levels to meet the various needs in Western Sydney. I have attached her Universal Triangle of the work of Medicare Locals

Proessor O’Hallon outlined some Medical Home principles and showed that they were close to the RACGP principles and also suggested some improvements

High priority, high risk groups need new integrated models of care: Patient centred, integrated Mdels of Care  for high priority groups Enrolment, Care Plan


Whole System Primary Care Planning

This session outlined the development of The Peninsula Model in the Frankston/Mornington district of Victoria.

Their starting point was:
Problem of short horizons and Services were not aware of one another or did not value one another.

A small team of well placed leaders were able to transform this chaos and bring som collaboration..
The team was 4 people but they were senior people from different organisations, Local Government, Exec Director of the Hospital, Regional Director of the State Department and CEO of the Medicare Local.

Although much was achieved, some factors that can still work against them is the sources of funding dealing with the resource contribution of various entities. Also there is a high cost of collaboration and from Jan to Sept 2014 they had 284 meetings.

However a key message is that “goodwill” is required. Organisations benefit by moving away from their “silos”. Alliances outside the organisation does not detract from the agency’s mission; it enhances or “spices” up the work.

3Whole System Working

I had high expectations regarding the speaker from Canterbury, New Zealand where they seem to be making great progress in integrated care. I had hoped that there would be more discussion regarding their Health pathways but this had been discussed the previous day in a more closed session. (see

From what I gathered from the presentation, they have achieved a great level of cooperation across professions and providers and consumers. This contrasts heavily with Australia where such cooperation and collaboration is lacking. They are focussed on the “right thing for the patient”.

One of the key messages was “Progress not Perfection”.

Where possible the decision should be made where the clinician and the patient meet rather than applying broad policy.
Enable them NOT tell them what to do.

This presentation was followed by  a panel to discussion regarding integration in practice.
Some principles for implementation from the panel which struck a chord with me include:

·         Highest needs have multiple needs. Allocation of a house is easy; keeping them in the house is much harder

·         The system complicates the provision of support. Make the system easy for complex needs

·         Failures: cultures of some providers and professional cultures do not mix
  • ·         Go for one size fits most (rather than all).
  • ·         Provide a spectrum of services rather than one size

  • ·         Try different approaches:
  • ·         Top down systems do not always work;
  • ·         It is more effective if you give actors permission to act (actors = professionals and consumers)

These echoed key messages from previous sessions.

4    Whole of system in Practice

The final presentation discussed the Human Services Blueprint in the ACT which integrates: social services, housing, Justice, health and child welfare and is performing a trial in partnership with 50 families in the West Belconnen area for families with complex needs. They are just commencing a trial which will run for 18 months. It seeks to improve economic and social participation. 
By Bernard Borg Caruana

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