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No change is not an option


15 Mar 2010





By Dr Andrew Pesce

AMA President

The Government's National Health and Hospital Network isthe biggest recasting of the way health care has been funded in this countryfor more than 30 years. It is a bold plan that gives the Commonwealth greaterresponsibility and a greater stake in the complicated processes by whichgovernments fund our public hospitals.

Like it or not, it is major reform. I think too manycommentators and critics are looking at it as a one-off policy. It is thebeginning of the reform process. People should wait to see the accompanyingsuite of reforms flagged by the Prime Minister before passing final judgement.

That is what the AMA is doing, but we are also commendingaction - long-awaited action. No change is not an option.

We need reform of the whole health system. So far, we haveseen plans for reform of the funding and management of our public hospitals.

This is long overdue and, at last, we are seeing a seriouscoordinated attempt to address the waste and duplication of scarce healthdollars and provide for the increasing cost of health care into the future. Itis big-ticket health reform but in isolation it is not the panacea for all thewoes in our health system. It is the framework - a vital first step - for theother major reforms we need to see before the election later this year.

The other reforms will need to be in place before patientsrelying on a robust sustainable high-quality health care system can see howthis week's reform will improve their lives and the care that they receive.They need to see the whole health reform picture before they fully understandhow the new health system will give them better access to health services and abetter environment in which to provide health services.

One thing is certain about any reform, and that is, that itrequires change. Our challenge is to embrace change courageously. So toogovernments, as they reconfigure the system in the interests of patients thebetter to meet the health needs of the community. As this debate progresses, wemust be determined to embrace the changes that direct more resources to thebedside, to surgeries and into the community so that not only can we addresssickness more quickly but that we can also promote wellness more concertedly.

The AMA has provided the Government with strong advice onthe priorities that are necessary to complete the big picture of health reform.The Prime Minister said last week that there would be further majorannouncements on general practice and primary care, emergency departments, IT,mental health, aged care and the health workforce. We want to be sure that theGovernment has heeded our advice in these key areas.

To start with, we need increased capacity in our hospitalsto take pressure off emergency departments and to shorten waiting lists. Thismeans more beds and more doctors and nurses as well.

We need more sub-acute facilities and capacity withinhospitals and in the community to provide rehabilitation care to help patientsrecover more quickly.

To provide more doctors to work in the hospitals we musthave the time, the infrastructure, the funds and the teachers that togetherconstitute a modern professional high-quality training environment in ourpublic hospitals.

Building hospital capacity alone will not fix the hospitalproblem. The Government must also build the capacity of general practice tomeet the primary care needs of the community. It cannot be an either/orsolution. It must be both.

The trap for the Government is to think that bureaucraticstructures and processes can substitute for better-resourced family doctorservices in the community. Some current reform proposals that have been put tothe Government suggest that we create new organisations that will fundamentallyration and manage primary care, as opposed to governments providing benefitsand entitlements to patients to ensure that they get all the care they need.

General practice works. Patients want to see their familydoctor. So the answer is to build the capacity of general practice and supportGPs. Any plan by the Government to place a constricting bureaucraticorganisational bubble around general practice would be a disaster.

The Commonwealth directly funding the new hospitalnetworks, rather than sending money through State bureaucracies, is a principlethat should apply in general practice. We don't need extra layers ofbureaucracy organising general practice. We need streamlined and efficientfunding for patients to get the services they need - when and where they needthem.

What is also heartening about the Prime Minister's newapproach to hospital funding is that he has committed to pay for the servicesactually provided, and not place artificial rationing caps on the number ofhospital services he is prepared to fund.

Similarly, this must apply in general practice reform. TheGovernment's reform in this area must not recreate the types of problems wemust now address in the public hospital system.

Another piece of the health puzzle that needs urgentattention is aged care. Aged care is one of the forgotten areas of the healthsystem. The debate in recent years has been more about bricks and mortar whenit should be about flesh and blood.

We need to put humanity and compassion back into agedcare. The health needs of the elderly should not be ignored the moment theyenter a nursing home.

For too long, the Commonwealth has dismissed the plea toensure that medical services are properly provided in nursing homes. For toolong, the quality standards for aged care facilities have not included arequirement that all residents have access to appropriate medical care.

The frail elderly deserve a response from the PrimeMinister that addresses this problem.

To his credit, the Prime Minister has said that majorannouncements on aged care, mental health, rural health, IT, dental care,Indigenous health, workforce and general practice will be among the pieces ofthe bigger picture to come.

The Prime Minister has also made clinician input part ofhis health reform mantra. Doctors stand ready to provide expert advice and helpshape and implement the health reforms needed for patients and the community.

Published: 15 Mar 2010