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Are you aware of the irony, Mr Rudd?

How ironic.

The Prime Minister launches the National Health and Hospitals Reform Commission report stressing the need to boost primary care. And then what does he do? Takes off, with Minister Roxon, on a tour of teaching hospitals. The impact will be to once again focus public attention and debate upon hospitals. You can bet the news will be full of pictures of hospital wards rather than of primary care services in the community.

It’s not so surprising that people like Professor Mark Harris, Executive Director of the Centre for Primary Health Care and Equity at the University of NSW, is frustrated by the level of public debate about primary health care. He has sent in this comment about recent media coverage:

“The level of debate in the media about primary health care tends to be simplistic.  An example is the statement in the news that large multi-disciplinary health centres (1 per 300,000 people) provide better quality of care.

Unfortunately the evidence is more complex. Larger practices/centres can more effectively provide multi-disiciplinary team care than very small practices and community health centres can improve access to care especially in disadvantaged areas.

However, smaller practices (<4 or 5 GPs) provide better quality of care and patients assess their care to be better than larger practices (4 or 5+GPs).

There have been virtually identical results from studies in Australia, UK and Canada.

Thus in advocating for more integrated multi-disciplinary primary health care (which I think we should), we need to be careful to create a system which protects patient centred continuity of care.  We need to careful unpick the complexity in the evidence if we are to avoid policy change which has unintended consequences.”

Meanwhile, we await the launch of the Primary Health Care Strategy – another important arm of health reform efforts. Word around the traps was that its release was initially planned for  yesterday, together with the NHHRC report and the Preventative Health Taskforce report.

One can only speculate about why plans changed and the implications of this. One thing’s for sure: it will help to keep health in the headlines although the primary health care strategy will probably struggle to gain anything like the attention being given to the “hospitals” report.

Comments 5

  1. EnergyPedant says:

    My take on public perception:

    The focus on hospitals is because that’s where you go when you are really sick. Emergency department is life and death, the rest of the health system is only for old people and people who don’t take care of their own health.

    In reality primary care is incredibly important and probably a more effective use of money. However GP offices are a crappy photo-op. Each hospital serves multiple marginal electorates….

  2. Croakey says:

    Two quick things:

    1. Re your point about hospitals being for people who are really sick – many people who end up in hospital are there because their chronic diseases haven’t been effectively prevented or managed in the community (swine flu is a good example with this, given that people who are obese or have underlying medical conditions seem to be more at risk). Also there are plenty of elderly people stuck in hospitals who really would be better off elsewhere.

    2. I completely agree that primary care hasn’t really worked out how to effectively “sell itself” whether to politicians in marginal seats or to newspaper photographers. Many reasons for this but one that may be worth noting is the lack of cohesiveness between professions/disciplines and services. Also, I’ve yet to meet a PR for a community health service that comes anywhere close to competing with the PR machines of hospitals. Those cute pic stories of kids saved by hospital heroes don’t end up in the news pages by chance.

  3. EnergyPedant says:

    I agree entirely with point number 1, I was stating what I thought public opinion was. Primary care and prevention are I think both more effective and cheaper ways to deal with the majority of chronic diseases. A good health system would reduce the supply of illness before it reached the hospitalization stage, although there are plenty of diseases and conditions for which this is not possible (e.g. most cancers, trauma).

  4. gloworm says:

    Maybe our health care system would cope better if our doctors patients medical files were audited on a regular basis. It seems many of our doctors are poorly skilled in the mixtures of many medications and this causes many deaths and hospital emergencies.

  5. Jon Hunt says:

    That’s a bit of a worry gloworm. Stay away from those ones.

    I’m beginning to take the view that maybe it is all too hard and we are expecting the impossible, particularly because as a rule governments have problems doing anything clever or difficult. That everybody has a different view usually means there is some truth in all of them, meaning no-one has a cohesive picture. Sometimes changes introduce more problems than they solve, sometimes trying to fix something just makes it more broken.

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