Wednesday, Oct 20, must have been a gruelling day for politicians and health bureaucrats attending the Senate Community Affairs Legislation Committee hearing. It went all day and finished just before 11pm.
The 142 pages of transcript have many interesting snippets. Below are some that may be of interest, including news on GP super clinics and Medicare Locals (honestly, which of those names is the worst?), a national rural health framework, pandemic flu, diabetes, mental health, and how the AMA cruelled general practice.
And finally at the bottom of the post, you will find a few snatches of humour…
GP super clinics
Decisions about the location of super clinics are being made by the Government, and the criteria for location are not readily available in a published document. The Department of Health and Ageing has no input. The department’s secretary Jane Halton said: “… that is not a decision-making process for which we are responsible; therefore I cannot comment on it”.
The location of the first 15 Medicare Locals is not yet decided. But it likely to be the divisions/organisations “that are ready to move” in this space. However, Halton suggested that rural and remote areas would not miss out. She said: “There will be a natural prejudice inside the department to make sure that there is a representation there. You can be assured of that.”
The health Red Book
The Department of Health and Ageing is processing several FOI requests for the release of its Red Book of advice for the new Government.
Departmental secretary Jane Halton accompanied Minister Roxon to Paris last October (correction, it was this October), where the Minister chaired an half-day OECD Forum on Quality of Care and was vice-chair of the ministerial health ministers’ meeting over two days at the OECD.
The Boston Consulting Group is conducting a $6.8 million strategic review of the Health and Ageing portfolio. It is looking at structures, organisational arrangements, operating costs and efficiencies. Will we ever get to read it?
Asked whether taxpayers had had value for money from the government’s response to pandemic influenza, Halton said: “I have absolutely no hesitation, none, in saying that I am absolutely confident that the technical and professional health advice that was given to government on which decisions were taken by government was of the highest order. In fact, that advice was double, second and third counselled by people of very great experience before it was given. I am also very confident that the decisions of government were taken based on that advice. So a great deal of care was exercised in the decision-making process to ensure that those decisions were absolutely based on that advice. We all understand that, with hindsight, you can see certain things, but because there was a great deal of time and energy spent on ensuring that advice was very, very carefully framed, in conjunction with what we were being told by the WHO, there were endless teleconferences with the Americans and the Brits—and I could go on—to ensure that we had the best understanding and were framing the best technical and professional advice to government upon which decisions could be made. Of that I am absolutely confident. I would say that, in my view, the decisions that were taken did actually represent the best value for citizens. It is frankly fortunate that this virus was not as lethal as it looked like in Mexico. The notion that we would have taken different decisions later, based on waiting to see, I am absolutely confident that it would have been the wrong thing to do.”
Rural and remote health
The rural health standing subcommittee of AHMAC is developing the strategic framework for rural and remote health. Work began in late November 2009, with consultations earlier this year. The framework is now being drafted and there will be more consultations in coming months, with a draft planned to go to AHMAC by the end of this year.
In July 2010, the government announced the establishment of a diabetes advisory group to help with implementation of its plan for enrolment of diabetes patients. The group has not yet met. The terms of reference are not believed to be finalised.
The National Mental Health Advisory Council has not met since Professor John Mendoza resigned as chair.
DOHA staff were delighted by the passage of healthcare identifier legislation. Halton said: “Can I say, just while the officers are coming to the table, from a health perspective how absolutely, really, over-the-moon delighted we were that that legislation was the last piece of legislation that passed the parliament. I genuinely think that in terms of long-term revolution in health care it will be one of the most significant decisions the parliament will have taken, so we were very pleased that it was passed….That was something that there was much cheering about in the department. I can tell you we were very pleased…”
Since Medicare Australia started the Healthcare Identifiers Service on 1 July, identifiers have been assigned to about 23.5 million individuals since then, approximately 390,000 healthcare professionals and to the Tasmanian and the ACT health departments.
A home truth about ‘savings’ in health
Halton: “The thing I know about health is there is no such thing as a saving because someone else will come along and spend the money. It is like there is no such thing as an empty hospital bed. What it enables you to do though is to spend the money that you do have more wisely and more efficiently…In other words, we can use the dollar that we have in the health system to deliver more services, to deliver better quality of care and therefore to improve outcomes. The department of finance will find that in evidence and then I will be on the fatwa list for not delivering a saving.”
The AMA’s downer on general practice
According to Halton, the AMA previously contributed to a decline in doctors chosing to become GPs because of its emphasis on the low pay relative to other specialists. The hearing was told that in 2005 there were 668 applications to the general practice training program, compared with 1,100 applications for 2011.
Halton said: “I should tell you that my experience of this, which goes back to when I first was secretary, was there was a period of quite significant talking down of general practice as a vocation….There were reasons for that. The AMA had a particular view, some of which I think had substance, but the consequence in saying that general practice was under-remunerated and so on, and they turned a whole generation of graduates off the notion of doing general practice as their preferred specialty. I think that has significantly reversed itself as a position. I think now people understand that there is a huge opportunity and interest in the opportunity that is available in general practice, so that is what you are seeing in the numbers. We did have a bit of a fallow patch and there are reasons for that.”
I must be a sick puppy because I quite enjoy reading the estimates transcripts. The flash of humour and repartee make it all worthwhile.
At one stage when Senator Fierravanti-Wells was grilling Halton, and insisting that Prime Minister and Cabinet has been driving health policy, the Senator says:
“It seems to me that you are doing some work but, really, the organ grinder is sitting in Prime Minister and Cabinet.”
Halton: “I will be happy to tell Terry Moran he has been described as the organ grinder; I am sure that will improve his day. I would say to you, Senator—
Senator Fierravanti-Wells: “I am sure you will not be happy to be described as the monkey, but I will not go there.”
Halton: “I have taken that as being the import of your comment…”
At another point, discussions come to the “yellow book” about COAG reforms.
Halton: “The colour has been described in various ways. I think for the delicate sensibilities of Hansard, I am not going to repeat some of them.”
At another stage, she says: “I will tell you offline what I call that colour.”
At another point, the AMA president Dr Andrew Pesce’s name is mispronounced as Dr Pesky.
Halton comments: “I should say Dr Pesce will probably think it amusing to be described as Dr ‘Pesky’, and sometimes he is, but he is Dr Pesce.”