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Building a collective wish list for health reform

In the run up to the Federal budget on 29 March and an election by 21 May, this article continues a Croakey series asking: what health issues should be elevated in national debate?

Previous articles called for efforts to address racism and inequality and for a renewed commitment to Medicare and universal healthcare, including addressing out-of-pocket costs, as well as health workforce planning.

Below, we give an overview of key recommendations from the Australian Physiotherapy Association, the Australasian College for Emergency Medicine, and Philanthropy Australia.


National leadership to drive implementation

Australian Physiotherapy Association

National president Scott Willis

Australia needs a health ‘czar’ with oversight and sufficient resources to coordinate and manage the implementation of key recommendations from health-related inquiries policies across portfolios and jurisdictions.

This would help ensure whole-of-government responses and also help to progress implementation of key plans, including the Primary Health Care 10-Year Plan, the National Preventive Health Strategy, the National Obesity Prevention Strategy, the Fifth National Mental Health and Suicide Prevention Plan, and the Medicare Benefits Schedule (MBS) Review.

This approach would bring a whole-of-nation leadership role to health reforms, recognising that many initiatives and measures that will improve the health and well-being of Australians are outside of the Department of Health’s portfolio responsibilities.

It would also provide a single point of coordination so that the findings of major inquiries and reports are not entangled in cross-portfolio and cross-jurisdictional bureaucracy.

Anchoring significant reform in the midst of a pandemic is difficult but it is critical that we move beyond this point. We remain at the planning phase with five key reform pieces drafted but without any progress towards implementation. To keep pace with increasing demand, the implementation work needs to start now.

However, we lack the funding commitment and systems to guide it. Governments know what to do but seemingly not how to do it. The evidence for implementation of reform is overwhelming, yet vested interests and competition for funding stifle reform implementation.

Short-term political objectives make governments reluctant to set targets and timeframes, and to facilitate independent evaluation.

The APA submission calls for wide-ranging reforms to integrate physiotherapists into primary care and to address inequities in access to physiotherapy, especially for Aboriginal and Torres Strait Islander people, and people in rural areas, aged care, people with disabilities and for veterans.

The APA wants to see a much stronger equity lens and a focus on integrating prevention into the management and delivery of care. Patients must have access to physiotherapists as part of a multidisciplinary team. Right now, they don’t. Nationally, we still await fundamental reform to provide a way forward to overcome the barriers to integrated multidisciplinary team-based care.

Australia’s referral system to specialist care needs reform to better align to care needs. More attention on new models of service delivery beyond the traditional silos of GP-specialist frameworks is required.

We need a new referral pathway and more linear approach to referrals to support patient access to MBS-subsidised services regardless of which health care professional identifies the need for specialised care in the first instance. Enabling Primary Health Networks (PHNs) to advance physiotherapy-led models of care to address service delivery challenges in rural areas is key.

The APA calls for:

  • The expansion of chronic disease and pain-related items of the MBS encompassing physiotherapy to strengthen multidisciplinary team-based care.
  • A funded pilot of the First Contact Physiotherapy (FCP) model to strengthen access to diagnosis, treatment, and care of MSK pain and conditions in primary care.
  • Investment in public funded physiotherapy to increase the coverage of preventive health services in Australia.
  • A leading role for physiotherapy in Long COVID pathway planning and delivery.
  • A funded pilot for physiotherapy-led rehabilitation for cancer care.
  • Public funded pre and post-natal physiotherapy care (6 sessions).

The APA calls for a National Allied Health Workforce Strategy encompassing needs assessment and targets for rural physiotherapy workforce growth, and funding for an advanced skill pathway to support physiotherapists to upskill to meet a need in their community.

A lack of national leadership means that allied health workforce planning, where it does exist, is predominantly undertaken by the states and territory governments. We currently lack measures of service demand to inform physiotherapy workforce planning. This is further compounded by a lack of planning and coordination between supply (training) and demand. In physiotherapy, more focus is needed on skill supply issues to meet increasing unmet demand and support sub-specialty training. It is vital to plan now to target
areas of critical need to meet the growing demand.

Read the full submission.


Improve resourcing and coordination of primary and community care

Australasian College for Emergency Medicine

President Dr Clare Skinner

During the lead-up to the 2022 Federal Election and the Federal Budget 2022 – 2023, ACEM is strongly advocating for federal investment that will deliver improvements in areas of federal responsibility that contribute towards the biggest pressures in EDs: acute hospital access block, emergency department overcrowding and ambulance ramping.

Better healthcare for older persons in aged care

As a nation, we need to put the caring back into aged care. Too often, older people needing medical care get stuck in waiting rooms or the ED when they could be receiving the care that they need where they live – in their home, aged care facility or in the community.

Solutions include:

  • Fund increased access to clinically trained staff and appropriate systems in RACFs, including increasing care minutes by registered nurses, and the use of nurse practitioners.
  • Increase Medicare rebates for Level C and D consultations by 10% to better recognise and support complex care.
  • Introduce post-hospitalisation GP visits, seven days after any unplanned hospital admission.
  • Fund rebates and service to improve the documentation and implementation of consumer preferences for care (for instance advanced care planning) in RACFs.
  • Improve funding for access to high quality palliative care services to be provided both in RACFs and via community programs.
  • Fund programs to better integrate IT services such as MyHealthRecord and MyAgedCare.

Better access to specialist accommodation through the NDIS for people with disability

We believe all Australians deserve excellent healthcare, and a place to live that meets their specific needs.

Too often, people with disability are stuck living in hospital wards because, despite having an approved NDIS plan, there is no place for them to live that meets their specific needs or appropriate services available. Or, because of lengthy delays receiving an approved NDIS plan in the first place.

Supporting people with disability to have somewhere appropriate to live would ensure hospital beds are available for people requiring hospital care, including other people with disability.

Solutions include:

  • Invest in the creation of streamlined systems to support patients in hospital to access the NDIS, particularly where specialist disability accommodation is required, in collaboration with state and territory governments.
  • Increased permanent staffing within NDIA to provide individualised service within the timeframes set out in the participant service guarantee.

Better regional, rural, and remote healthcare

We also believe that all Australians deserve excellent healthcare, wherever they live. But too often there is a lack of available and affordable primary care in rural, regional, and remote settings. This can cause people who live outside of city areas to have poorer health, and too often end up in the ED as they couldn’t get the care they needed anywhere else.

Solutions include:

  • Directly fund the expansion of primary care services in rural and regional settings, by developing community-led services in areas of need.
  • Increase investment in local mental health primary care, including the attraction and retention of staff.
  • Fund an expansion of the Specialist Training Program to facilitate greater regional training opportunities for medical specialists.

Let’s double philanthropic giving by 2030, and here’s how

Philanthropy Australia

Sam Rosevear, Executive Director, Policy, Government Relations and Research

Philanthropy Australia’s Election Statement calls on parties and candidates to commit to working with the philanthropic, for-purpose and business sectors on a policy development process aimed at doubling philanthropic giving by 2030.

Australians yearn to be part of creating a more generous and giving Australia – one in which we recognise we are all in it together, we do our bit to support people in need, and together we solve our biggest challenges.

Philanthropy supports the charities that change millions of people’s lives every year, like the Salvation Army helping people in poverty get life back on track or The Royal Flying Doctor Service helping people in desperate need in the outback. It kickstarts numerous innovations that deliver massive impact in society (think the bionic ear restoring the gift of hearing, or Bush Heritage Australia protecting more than 11 million hectares of land).

Philanthropy helps achieve a better sharing of wealth and opportunity. With Australia’s ‘Top 200’ holding $480 billion in wealth, or an average of $2.3 billion each, philanthropy can spread opportunity to Australians less fortunately placed.

With Federal net debt headed towards $1 trillion, philanthropy can share the load at a time of fiscal pressure.  And philanthropy empowers communities, positioning local people to play a role in shaping their futures in the place they love and call home.

Yes, we can double philanthropic giving

The goal is ambitious, but achievable. Australia has an unparalleled opportunity to draw on our rising wealth to increase giving, with $2.6 trillion expected to pass to the next generation over the next 20 years. Nations like New Zealand (where giving is 1.84 per cent of GDP compared with 0.81 per cent in Australia), clearly demonstrate what can be achieved.

Reforms are available that would deliver billions to charity.

We recommend:

  • allowing Australians to make a bequest to charity through their superannuation
  • reforming the Deductible Gift Recipient (DGR) framework (so people can get a tax deduction for donating to more of Australia’s 58,000 charities, rather than just 30,000)
  • Community Foundations reform to remove restrictions on giving to charitable activities
  • allowing Private Ancillary Funds to make distributions to Public Ancillary Funds
  • creating an incentive to leave a ‘living bequest’ to charity
  • running a National Campaign to create a stronger culture of giving, and
  • establishing a single national fundraising regulation regime to cut red tape and free up more funds for people in need.

We encourage election parties and candidates to embrace this powerful agenda. Doubling philanthropic giving would be transformational for our society.

It would help Australians in greatest need and help solve our biggest challenges. It is achievable. It would be enormously popular with the Australian people. And it would create the more generous Australia we all want to see.

Read the full election statement.


Further reading

Our first article in this series featured the priorities of the Australian Healthcare and Hospitals Association, Consumers Health Forum of Australia, LGBTIQ+ Health Australia, National Rural Health Alliance, Public Health Association of Australia, and health policy analyst Charles Maskell-Knight.

Our second article in this series featured the priorities of the National Health Leadership Forum, Australian College of Nursing, and Association of Australian Medical Research Institutes.

See Croakey’s archive of stories on the 2022 Federal election

See Croakey’s archive of stories on the 2022-2023 Federal budget.

 

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