Dr Hambleton, speech to the AMA Parliamentary Dinner, Wednesday 17 August 2011

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The Unfinished Business of Health Reform

Last month at the National Press Club, I spoke of how the wheels of big health reform had fallen off.

I am pleased to say that we have seen some action since then.

In recent weeks, we have had announcements on hospital reform, aged care, and a national disability insurance scheme.

Health is back on the agenda.

The Government shifted the focus to the sick, the aged, and the disabled in our community – all core business for the AMA.

This broadening of the current political landscape has been encouraging.

Given the changed circumstances from two years ago – minority Federal Government and Coalition governments in three States – we have to look at health reform and health policy in a different light.

We acknowledge the challenges of negotiating at both levels.

We acknowledge the increased degree of difficulty in getting change.

Last year at this event, the AMA mantra was ‘no change is not an option’.

This year it may have to be ‘some change is a start’.

National Health Reform Agreement

While the National Health Reform Agreement is not what it had the potential to be two years ago, it is a significant achievement in the current environment.

It has responded to some of the key AMA questions.

Greater clinician involvement in decision-making - both the Prime Minister and the Health Minister are now regularly talking about it.

Greater transparency – the performance agency and the pricing authority should deliver it.

There is more Federal funding for our hospitals and funding certainty into the future.

Activity based funding.  We can track health dollars to ensure they are spent on health.

We do not have a single funder, but we do have a single funding pool.

The States and Territories, however, have effectively won their battle to remain the managers of our hospitals.

That makes them responsible for improving things.  That makes them accountable.

And the AMA at all levels – Federal, State and Territory - will monitor progress.

What we really have is a health financing agreement.

Genuine reform will come when doctors have a say in system re-design at the local level.

AMAs health reform plan

The AMA has a plan to help this genuine health reform happen.

It is based on clear and achievable principles:

• Innovation needs to be simple and practical;
• Changes need to be transparent; and
• Service improvement must be informed by medical competence and must improve patient outcomes.

First, we believe that public hospitals must be financed by one public funder.

That means one level of government funding and one level taking real responsibility.

This will result in less blame shifting and better value for money and accountability to the community.

Two, we need a watchdog to make sure that resources dedicated to open more hospital beds genuinely open more hospital beds.

Three, we need to better support general practice.

This means ensuring that the GPs’ patients can access well-integrated support from nurses and other allied health services without the red tape.

Four, we need an overarching medical workforce plan for the next decade.

It is simply not enough to graduate more medical students.

They need jobs and training that meet the needs of the community.

We need to know that the full range of medical services will be available across the country. 

Five, we need medical involvement in hospital and primary care governance.

Evidence shows that where doctors run the management of hospitals, results improve and morale is better.

They have the knowledge and the experience to make the system work better – better for patients, better for the doctors and nurses, and better for governments.

We will know we have genuine meaningful 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 in a timely way.

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

But hospital reform alone is not the end game in health reform.

There is much more to be done in primary care, aged care, mental health, and disability support, to name a few. 

All the pieces have to fit together.

Prime Minister, you know we have concerns in some key areas.

I won’t go into detail now, but a few things need fixing.

Just as you and your Health Minister took advice that change was needed to the diabetes care plan, we can offer similar advice on the mental health cuts to GP services, Medicare Locals, and the GP Super Clinics program.

I acknowledge the Government’s preparedness to at least discuss these issues.

The AMA will engage to achieve positive changes to the system that will help patients.

The key is to talk these things through openly and honestly.

That goes to the Opposition as well.  You will be developing new policies ahead of the next election.  We can help.

My message to both sides of politics is that you cannot improve the health system by ignoring the opinions and advice of doctors.

I urge all the politicians here tonight to get to know the doctors at your table.  They are your best possible health policy advisers.  They are from the front line of health care.

Plain packaging

In closing, Prime Minister, may I pay tribute to your Government’s world-leading action to combat smoking.

Your Health Minister has led the way against some pretty tough customers and won the day.

The plain packaging legislation is landmark health policy.  It is also an important social policy.  The AMA supports it 100 per cent.

Asylum seekers

Another important social policy is the health of people seeking asylum.

I would like to finish with a message to all politicians and the broader community.

The AMA believes that the system of mandatory detention of asylum seekers is inherently harmful to the physical and mental health of detainees.

The harm is especially acute in the case of children.

Despite improvements in the provision of health care to immigration detainees, the policy of mandatory detention and the remote location of most detainees mean that the health status of detainees continues to decline.

As the representative body of Australian doctors, the AMA is voicing its concerns about an ethical and public health issue.

Prime Minister and Opposition Leader, we leave the politics of asylum seekers to you.

But we urge both sides of politics to do all that is possible to ensure that these poor people are assured access to quality health care.

Thank you everybody for joining us tonight.

Enjoy the rest of the evening.  Make contacts and talk health.

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17 August 2011

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