AMA Federal President, Dr Kerryn Phelps, to AMA Victoria meeting re state industrial claim, Melbourne

20 Sep 2002

"YOU CAN'T HAVE A HEALTH SYSTEM WITHOUT DOCTORS"

Good afternoon. My thanks to the AMA Victoria for giving me the opportunity to speak to you today.

Mukesh and the other speakers have provided the detail of the current problems confronting doctors, their patients and the health system here in Victoria.

To cut doctors' conditions at this time is to cut away at the very viability of the health system.

With the exodus of doctors out of the public system to the private system and the burden of medical indemnity, it is the straw that will break the camel's back.

I join with you all in urging the Victorian Government to re-visit this issue and offer a better deal to your hospital doctors.

Our public hospitals are the totality of the health system for many people, including the poorest and the most disadvantaged.

They are overcrowded and under-resourced.

Conditions for doctors are poor. If conditions are poor for doctors, they are worse for patients.

Doctors need to be assured of a sustainable practice whether as a VMO or a full-time specialist.

Doctors-in-training who work long hours - unsafe hours - without a break is not good medicine. There have been 30,000 more inpatient episodes in Victorian hospitals this year but no recognition of the increased demand on doctors.

Outdated and inadequate equipment is not good medicine, either.

Long waiting lists and overcrowded wards are not indicative of a health system in good shape.

But that is what we have today in Victoria…and around Australia.

Governments and hospital administrations have to act…now!

Voters don't take kindly to Governments that make it harder for them to look after their health.

A recent AC Nielsen poll showed that health is the most important issue for the Victorian public ahead of education, law and order, economic management, and transport.

It is the job of the AMA to ensure that Governments are constantly reminded about their responsibilities in maintaining an affordable and accessible health system for all Australians.

Part of this responsibility is to ensure safe and doctor-friendly conditions in our public hospitals.

Later this year we will see just how serious our Federal and State Governments are about health policy when they get together to nut out the next round of Australian Health Care Agreements.

In the past these agreements have been about who doesn't have the responsibility or the accountability. Health has been a hot potato in Commonwealth/State relations.

We hold out a bit more hope this year. Why?

In an unprecedented move in April this year, the Health Ministers signed a communique to the effect that they would cooperate on health policy. Yes, cooperate.

In the words of the Health Ministers, they said:

Commonwealth/State relations in the Health arena should focus on the provision of best care and health outcomes regardless of jurisdictional boundaries

And

It is in the best interests of all Australians for the Commonwealth, States and Territories to work co-operatively to improve the health and well-being of the community and the way in which health services are provided.

This is the first occasion on which the re-negotiation of the Australian Health Care Agreements has been opened up to a broad section of the health community, including health professionals.

The current Agreements have many deficiencies.

In particular, they mainly focus on acute inpatient activity and ignore the many issues that impact on the continuum of health care.

They encourage cost-shifting.

Although they specify the Commonwealth contribution, they do not require that the States spend a specified amount on public hospital care.

By privatising State Government outpatient services, States can transfer the costs of such services to the Commonwealth.

Through inadequate MBS rebates for General Practice consultations, the Commonwealth can induce demand on Emergency Departments in public hospitals.

Health services are currently stretched across the board.

The AMA believes that at the same time as governments look at the organisational arrangements for improvement, they must not drop the ball on funding.

Governments should ensure that the level of health expenditure is increased in real terms. (The percentage of GDP spent on health has remained at 8.5% for many years).

The focus of future negotiations for health financing should be on outcomes for patients, across the health sector.

As the peak national body representing the medical profession in Australia, the AMA has much to contribute to the development of a more outcomes-based approach.

The AMA is willing to work with governments towards this end.

There should be agreement to address the perverse incentives created by the current dual funding mechanism between the Commonwealth and the States for different aspects of health-related care.

These issues impact on costs but also on care.

For example, many thousands of older Australians linger in acute hospital care because no alternative care is available in the community or in residential aged care facilities.

Key reform areas that demand attention in the intergovernmental negotiation process are:

1. Workforce

There needs to be acknowledgement of the medical and nursing workforce shortages, including GP shortages, which require effort by both federal and State levels of government.

Governments, in consultation with stakeholders, need to develop a plan to tackle the issue with an appropriate timetable and resources, before it becomes a national crisis.

The situation is already approaching crisis proportions in the emergency departments of public hospitals, in the availability of general practitioners and other qualified professionals in outer metropolitan, rural and remote Australia, and in aged care.

Funding should include compliance conditions for occupational health and safety standards.

Given the crucial care coordination role of the GP and the key role of the GP in pre-admission and post-discharge activity, the AMA strongly recommends that appropriate resources must be allocated for relevant GP training, support and infrastructure.

The shortage of nurses in the acute and aged care sector is one of the most serious issues facing the health system.

Governments need to acknowledge this problem, take ownership and make joint efforts to provide the planning and resources necessary to resolve it.

2. National standards

There are no national standards against which the performance of the public hospital system can be judged.

The rudimentary standards that exist now are not taken seriously and there is no way to make States and the Commonwealth accountable for deficiencies.

Agreed national standards of reporting to facilitate stronger public accountability for both outcomes and funding are necessary.

Such national standards should cover issues of access, quality, equity and efficiency of the public hospital system.

There needs to be nationally consistent collection and timely reporting of data on measures which can identify the discrepancies in access to health care services between different populations and which improve accountability of governments.

These agreed benchmark standards should be taken into account when governments determine health funding allocations.

This commitment should form part of the terms of the Agreements and be reported by a relatively independent body, such as the Australian Institute of Health and Welfare.

At present there is little compulsion for governments to provide consistent and timely data.

3. Level of government responsibility

The next Health Agreements should hold governments more accountable.

For example, State/Territory (and Commonwealth if appropriate) governments should be required under the next agreements to report planned expenditure and to acquit that expenditure.

Data should be readily available to make national and international comparisons.

Funding appropriations for health should be transparently spent on health.

Acceptable strategies should be negotiated to improve the continuity of care across programs and to address any cost-shifting measures that impede patient care.

In doing this, clinician involvement is vital to ensure that proposals are effective.

We recognise that dramatic change to levels of government responsibility may not be achievable because the politics are difficult.

Even if it were, not all cost shifting and blame shifting would be automatically resolved.

Nevertheless, it is important that all governments seek to make progress on this issue of accountability and transparency by focusing reform efforts on those programs where progress is possible and significant benefits will follow.

A start could be made in reducing the complexity in the key area of pharmaceutical expenditure, which has a significant impact on health outcomes.

A new national pharmaceutical program which brings together the PBS and public hospital pharmaceutical activity should be pursued.

Home and Community Care (HACC) is another example of a program whose contribution could be immensely enhanced with improved coordination and accountability.

HACC is a jointly funded program that involves enormous complexity in the allocation of funding to a large number of providers.

Because of this, there are great complexities involved in the co-ordination of these activities at the community level…and this leads to waste.

4. Aged Care

The AHCAs should contain a specific measure to improve the co-ordination of care for older persons, such as transitional care.

There are significant numbers of elderly patients in acute care facilities because there are no appropriate community based facilities or residential aged care facilities available for their particular needs.

Because of this, many thousands of older Australians are trapped in the acute hospital sector in clinical circumstances that are less than optimal.

Last year, the AMA commissioned independent research to determine hospital administrators and medical professionals' views of the Australian public hospital system.

The major concerns of the doctors and administrators working in public hospitals who responded to the questionnaire were:

Inadequate funding levels (80%)

Staff morale and satisfaction (75%)

The dual Federal and State funding system (74%)

Long term vision and planning of the overall system (73%)

Availability of aged care residential facilities (69%)

Length of time on waiting list prior to admission for elective surgery/treatment (66%)

Long-term commitment to supplying public hospital services by local State/Territory Government (62%)

Long-term commitment to supplying public hospital services by current Federal Government (61%)

Sufficient staff wanting to work in public hospitals (60%)

And the availability of sub-acute and rehabilitative care (52%).

When respondents were asked how the problems could be resolved they offered the following solutions:

Sixty-nine per cent of respondents indicated that there was no point allocating more funds to public hospitals without changing the way the system is managed

Greater involvement of medical staff in decision making

Reduce the amount of administration/management

Use of GPs to provide a broader range of services, relieving pressure on public hospitals

Rewards for staff and attention to staff morale issues

Reviewing the philosophy of a 'free' hospital system for all

Greater long-term planning and strategic thinking.

Other issues such as inadequate resources for teaching and research, inadequate planning for aged care, and access to services in rural and remote areas are also major concerns for the AMA.

If we can get this feedback from grassroots doctors - hospital doctors - into the next round of Health Care Agreements, we might just see some positive outcomes.

Our hospitals might just become safer and more efficient places in which to work…to care for patients.

Your presence here today will send very loud and clear messages out to the community.

You are telling your colleagues in the medical profession and everyone who works in our public hospitals that working conditions have got to get better.

You are telling the patients of Victoria that you care about them and you want them to have the best possible public hospital services when they are sick or injured.

And you are telling the Victorian Government to lift their game on health.

Are you listening, Mr Bracks? Are you listening, Mr Thwaites? LIFT YOUR GAME!!!!!

Thank you for giving your time today. It has been worth it. You work hard and you AE important people in the Victorian community. You must be looked after.

The AMA Victoria and the Federal AMA are behind you all the way.

Thank you.

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