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03 Dec 2019

BY AMA PRESIDENT DR TONY BARTONE  

Is this Government up to the challenge of meaningful health reform? I must say I am beginning to severely doubt it.

Why? During the election campaign in May 2019, the AMA put out its popular election scorecard. It drew significant attention from the media, and some uncomfortable comment from both sides as the election day beckoned. The media commentary focused on our headline that neither party had articulated a clear vision for our health system during the campaign.

The Coalition was returned and yet, just over six months since the Federal election, there is still to be any hint of an overarching vision put forward to the community and to our patients about a way forward with health reform.

Don’t get me wrong. The Minister is trying.

He has announced three taskforces and three separate 10-year plans/visions for Primary Care, Preventative Health, and Mental Health. As AMA President and a GP, I am the only person common to all three taskforces.

This is an immensely opportune situation to ensure that a vision across all three areas speaks to the necessary issues of funding, coordination, and collaboration required across these three domains – and indeed the rest of the heath system.

But this is only seriously exciting if there is genuine commitment to appropriately fund the various plans with new investment. And this can be only if the investment is not at the expense of other parts of the health sector. Otherwise it cannot and simply will not work. 

In fact, we all know words are cheap. They are very cheap especially if they are not accompanied by funding commitments to ensure actions and outcomes.

We really need to ask ourselves some very poignant and pressing questions.

How long before the penny drops in Government and the wider community that 10 per cent of GDP is never going to fund the current demand driven activity in our health system?

How long before we accept that we need to change the model of health care from a disease driven activity model to a proactive preventative coordinated and integrated one?

How long must we fumble along without an overarching vision and keep trying to tinker with different parts of the health service, hoping to eventually cobble a complete puzzle?

How long before we understand that without patient-centred primary care, which is properly resourced with infrastructure and coordinated integration, that we will keep seeing worsening clinical outcomes for our patients and the population as a whole?

If it sounds like I am frustrated, I am. In fact, I am downright disappointed that we are still having the same conversations that we have had for many years now. Clearly, we have a limited tolerance to this kind of activity. Our patience is being severely tested.

Perhaps it has gone even too far now. We are being carefully managed and every attempt is being made to water down, neutralise, and even distract from the main game.

We are being politely engaged and listened to, but then essentially dismissed, deferred, delayed, obfuscated, and buried with multiple – yes, multiple indeed – stakeholder forums, round tables, requests for information, or submissions. So many as to potentially distract, bury, and deviate from overall targeted and effective advocacy, and create inefficiencies or distractions in our responses and input – and try to weary us down strategically.

We are talking about frenetic activity. So frenetic that one hand does not know what the other hand is doing. Various parts of the Department of Health (DOH) not talking to one another. And all along, this slapstick approach is occurring while the Government is trying to come out with solutions to very difficult issues. Issues such as the dwindling membership of PHI, especially among the younger members of the community.

My message to the Minister is to get real.

My message to the DOH is get your house in order and realistically program the consultation. There is no point having consultation forums if they are at short notice with poor visibility and time frames – combined with an inability to effectively brief and prepare attendees, let alone the last minute voluminous papers dumped on secretariat and the representatives at ‘T minus 5’ minutes – and then wonder why invariably no one is appropriately across the brief or can even attend.

Then, to add fuel to the fire, the Department or Minister brazenly reports back that they widely consulted with industry and the health sector.

The question clearly is what next? What to do if the Government continues to create such administrative barriers and obstacles to consultation with the profession?

Is it time to call out the Government and, in particular, the Minister for not really being across his portfolio in a future-proofing way, but rather being still very much focused on cost containment?

I intend to put further pressure on the Minister and the Government. We need to be very clear about what is needed to improve our health system.

The AMA Federal Council has agreed to take up this challenge. A lot of work has been done producing some excellent reports and advocacy, such as the reports cards on PHI and public hospitals and submissions on aged care to name just a few.

We will be distilling it further and joining the dots to clearly articulate the lack of an overarching vision from the Government, and offer a plausible coherent and coordinated strategy to it.

Meanwhile, we will continue to vigorously advocate for the issues that can’t wait. Our Aged Care Can’t Wait campaign will continue to ramp up. The Government cannot blame GPs and use them as scapegoats for its own complete lack of funding in this area. Rhetoric like this will only inflame our relationships and drive more GPs out of visiting aged care facilities, worsening an already fractured service provision.

PHI continues to stagger along in search of a meaningful solution. The November quarter APRA statistics continue to show a trend of dwindling membership. Perhaps this dispels once and for all the notion of doctors being the cause of out-of-pockets and rising premiums. Particularly when we see recent record highs in the no-gap and known-gap statistics (to a combined total of more than 97 per cent).

Public Hospital queues are significantly, but perhaps not surprisingly, ramping up even further, given the increased drop out in PHI membership and surprise budget blowouts confronting some of the States as well. This is a calamity occurring on our doorsteps and under our noses.

Governments still defend record funding amounts, which are never in their wildest dreams going to keep up with the triple drivers or threats i.e. a rapidly increasing population; ageing population; and of course the increasing burden of chronic and complex disease.

This is all at a time when the MBS is hurtling along with an avalanche of work – draft recommendations and implementation groups, yet still no sign of genuine new investment. Rather, ongoing savings are being racked up.

At the same time, further compliance activities are being planned and further legislation proposed in an attempt, you might say, to further unnerve the profession.

All of this at time when economic growth is being highlighted as being at risk, and a wafer-thin budget surplus being protected as we approach both MYEFO and the preparation for next year’s Federal Budget.

Now, more than ever, the Government needs to get serious and invest in the infrastructure of our health system and its workforce.

It is the right time and it is need-imperative.

So, is this Government up to the challenge? Early in 2020 the answer will soon become apparent.


Published: 03 Dec 2019