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Healthier politics

Last month at the National Press Club I spoke about a pretty barren political landscape for health.  Two years ago it was hard to see or hear a news bulletin without a health story near the lead.  But the big picture health reforms of the Rudd years have all now but disappeared.  Instead, all we have been hearing is angry debates about a carbon price and asylum seekers.

14 Aug 2011

By AMA President Dr Steve Hambleton

Last month at the National Press Club I spoke about a pretty barren political landscape for health. 

Two years ago it was hard to see or hear a news bulletin without a health story near the lead.  But the big picture health reforms of the Rudd years have all now but disappeared.  Instead, all we have been hearing is angry debates about a carbon price and asylum seekers.

This last fortnight we have seen a change.  There have been policy announcements on hospital reform, aged care, and a national disability insurance scheme.  The Government has put out policies to help the sick, the aged, and the disabled.  This is core business for the AMA.

The political landscape has changed since the last election.  There are two new key factors at play.  We have Coalition Governments in three States, with the polls unfavourable to Labor in a number of the other States and Territories, and we have a minority Federal Labor Government.

On top of that, we have a Federal Opposition that is playing hardball at every opportunity and taking the challenge right up to the Government.

The chances of courageous policy changes are small in these circumstances, so we must seize on policy opportunities and build on them.

That is why the Federal AMA welcomed the National Health Reform Agreement, albeit conditionally.  We can build on the transparency, push for decentralised management and meaningful clinical engagement.  We can hold the States to account.

We also welcomed the Productivity Commission’s aged care report.  We can build on its acknowledgement of the inadequacy of the Medicare rebates for this sector.

We welcomed the commitment to the National Disability Insurance Scheme because it is something the AMA has been fighting for since the days of the medical indemnity crisis a decade ago.  More importantly, it is good social policy that looks after the disabled in the community and their carers.

Both the aged care and disability processes are some years off, but the hospital changes are with us now.

States and Territories have signed up to the new funding agreement, which signals the beginning of the task of getting real improvements into our hospitals.

This deal is nowhere near as attractive as the original Rudd package of reforms unveiled two years ago.  Sure, the money’s about the same but the Commonwealth has backed away from its aim of a 60 per cent share of the public hospital cake.  It is starting at 45 per cent and moving up to 50-50.

Many have expressed concern that the States and Territories have won their battle to remain the managers of our hospitals.

As I suggested above, this is offset to a degree by greater transparency and reporting in the system.  We will now be able to track the health dollars in the system to ensure that they are spent on health – on beds, equipment, staff, and efficiencies.  The chances of diversion or waste have been reduced significantly.

When money is promised for beds, we should be able to count the beds.

While the blame game is not buried, the States will be far more accountable for performance than is the case now.

The other thing we have seized on is the signal that the Gillard Government is finally getting the message that it may be a good idea to consult with doctors before creating or altering major health policy - and this must flow on to the States and Territories.

The Prime Minister and the Health Minister took advice from the COAG Expert Panel about the hospital reforms at the heart of the Agreement.  Yes, they listened to doctors and acted. 

They reduced national emergency access targets from 95 per cent (where clinically appropriate) to 90 per cent for all emergency department patients across all triage categories – on the advice of the Expert Panel.

Elective surgery targets for those to be treated within clinically recommended times will be raised from 95 per cent to 100 per cent – again, on the advice of the Expert Panel.

There will also be more sub-acute beds and there is new funding to train more doctors and nurses.

Importantly, we are hearing from the Federal Government that it is now serious about clinician engagement in decision-making at the local level.

Since the announcement of the Agreement, the Prime Minister and the Health Minister have regularly responded to questions about the reasons for the change in emergency department and elective surgery targets as being clinician-driven.

The key is to spend health funding wisely and strategically.

The deal locks in a minimum funding growth into public hospital of over $20 billion in the next decade.  It locks in activity based funding and increased transparency. 

We will not see genuine health reform until the States and Territories actually deliver on the new transparency and engage with local doctors in their management of our public hospitals. 

Genuine positive health reform will only occur when there is serious system re-design at the local level under the guidance of local doctors.

The medical profession has been calling for new funding, greater transparency, and genuine clinician engagement.  The AMA focus will be on each State and Territory Government to ensure the deal translates into reform.  Decentralising management and being engaged with doctors will deliver it.

We will know we have health reform when there are more beds.

We will know we have health reform when our patients can get into the right place at the right time for the right care.

We will know we have health reform when patients can get into emergency departments and out of emergency departments.

We will know we have health reform when elective surgery waiting times are coming down.

There is much more to be done in primary care, aged care, and disability support.  All the pieces have to fit together.  Hospital reform alone is not health reform.


Published: 14 Aug 2011