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07 Dec 2017

 

BY AMA PRESIDENT DR TONY BARTONE

It certainly has been a very busy and eventful year wherever you look in the arena of medico politics.  This against a backdrop of increasing nervousness and instability up on the Hill and the possibility of an earlier than planned federal election adding intense flavour. Indeed, an election is becoming increasingly more likely with each new breaking news story.

Currently, and in the last few months especially, a number of issues continue to require persistent and intense lobbying and will do so for the foreseeable future.

Consensus of the States on the vexed issue of mandatory reporting is one such issue which continues to require intense advocacy. It seems that in many jurisdictions the penny just has not yet dropped, failing to realise the significant barrier it poses to doctors seeking help at an earlier point in their condition.  Agreement between States and Territories is crucial for a national framework consistency and for the health and well-being of all doctors.

The up-scheduling of codeine also is proving difficult to reach jurisdictional consensus. Increasingly we are finding ourselves defending the actions of an independent regulator, the Therapeutic Goods Administration, in removing codeine form the over-the-counter shelves; a decision based solely on evidence regarding efficacy, safety and the threat to patients in terms of the significant risk of  codeine dependency and harm.

With so much misinformation in the market place and media the battle for the hearts and minds of patients and consumers has been difficult but may be turning our way as we speak, but the politicians are yet to be firmly convinced. It is disappointing that an argument about health safety, and efficacy of pain relief and management, is being so difficult to mount against a backdrop of vested commercial interests.

Medical indemnity remains on significant watch for the AMA, which has lodged its submission to the First Principles review into the Indemnity Insurance Fund (IIF).

The MBS reviews continue at, some might say, a glacial pace. Although supportive of the thrust and principles of the review there are a few worrying concerns especially in the extent or relevance of the clinical consultation process and remains an area of extremely close scrutiny.

The Medical Workforce Committee has been clear in highlighting the workforce issues. Lack of appropriate training opportunities in regional and remote Australia continues to be a significant dilemma and one needing further intensive work and collaboration.

We continue to be a strong voice in the private health insurance debate. We argue that private health insurers need to improve the value of the product they are offering Australians. They must offer clear, easily understood policies that give Australians security in the knowledge that they will be covered at their time of need.  Insurance needs to cover the items that people expect it will; such as mental health and pregnancy.

Most importantly, insurers need stop blaming others for their problems.

Aged care is clearly another area desperately crying out for direction. A solution is needed to the lack of quality care options for many senior Australians requiring permanent care.  Any solution will need to be multi-pronged and structured. Our submission to the aged care inquiry argues that medical practitioners should be included as part of the aged care workforce which will significantly struggle to meet the rapidly growing demands and needs of this sector and in the process; ensure residents of aged care facilities are receiving quality care.

Additionally, aged care needs funding for the recruitment and retention of registered nursing staff and carers, specifically trained in dealing with the issues that older people face. The system also needs an overarching, independent, Aged Care Commissioner that provides a clear, well-communicated, governance hierarchy that brings leadership and accountability to the aged care system.

The obvious other large area of concern and work for the coming year is the public hospital system and its funding. Appropriate and timely access to public hospitals, especially to the disadvantaged and those who cannot afford care otherwise, is fundamental. Funding must be commensurate with the need to ensure this. The Review can’t be used as a stick to punish poor performers.

We have been active in dealing through many issues surrounding the implementation of Health Care Homes during the early phase of the trial. We were crucially active in calling for the delay to the implementation of the trial in the face of lack of time and resources to prepare for the significant change required. This is more than just an alternative payment mechanism for primary care. Ultimately it will be about ensuring improved quality outcomes for patients with an ever increasing burden of chronic and complex disease. However it will need time, support and leadership to achieve the necessary endpoints.

E-Health is an area of significant implementation as it enters the new strategic direction of ‘opt out’. Ongoing reports about privacy concerns are unfounded. But there is a need for better communications and education. E-health is a vital enabler for quality clinical outcomes and this current project is too important to fail. It must be adequately and appropriately resourced and supported, to ensure that its useability remains paramount

Many, perhaps most, of these issues will continue to be fought for and supported long and hard in 2018. The Minister has signalled a number of waves of reform and no doubt the 2018/19 budget is well into the early planning stages. It might be too much to ask for but now, more than ever, a visionary long-term strategy for health is required.

It will need to be one that meaningfully rewards prevention activities with no shortage of issues and problems, especially in primary care. Smoking, alcohol, obesity and mental health preventative care activities are all underfunded and crying out for more money.

An early election, however, could make brave, long-term, visionary policy extremely unlikely. This will no doubt require more strategic and intensive engagement with current and future policy makers to ensure that our politicians and policy makers are not just ‘kicking the can down the road’ in 2018. 


Published: 07 Dec 2017