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, for the appointment of a health ‘czar’ to drive health reform across portfolios and jurisdictions, 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 Change the Record coalition, Mitchell Institute at Victoria University and the Royal Australasian College of Physicians.
Fund affordable housing, address systemic inequalities
Change the Record
Executive officer Sophie Trevitt
You can’t have First Nations justice without First Nations health – and that means affordable housing, ending poverty and ending family violence.
COVID has exposed the inequality in our community. Not enough housing, punitive and inadequate Centrelink and family violence and social services starved of funding, means people – particularly Aboriginal and Torres Strait Islander peoples – are being driven into poverty, and into the criminal legal system.
We saw the Government step in last year and raise Jobseeker above the poverty line for the first time. Governments introduced bans on evicting people into homelessness, and they’ve promised to do more to tackle family violence.
This is a political choice. We are calling on the incoming government to choose to end the inequality that is driving mob into prisons, and instead fund affordable housing, social security and services for everyone.
Everyone should have a safe, secure, comfortable place to call home. First Nations peoples disproportionately experience homelessness and housing stress, and overcrowded housing which increases the risk of poor health outcomes, engagement with the criminal justice system and family violence. The incoming government should invest in Aboriginal and community-controlled housing, and fund the services needed to end homelessness once and for all.
Similarly, we all have a right to be safe from violence. Nationally, Aboriginal and Torres Strait Islander women are 32 times more likely to be hospitalised due to family violence than non-First Nations women, 10 times more likely to die due to assault, and 45 times more likely to experience violence.
Yet successive governments have failed to adequately fund family violence prevention and legal services to meet community need.
We urge all political parties to commit to restore funding to and adequately fund the national peak, the National Forum for Family Violence Prevention Legal Services (FVPLS), to meet community need, and to put First Nations women in the driver’s seat by establishing a self-determined, dedicated National Safety Plan – developed for and by Aboriginal and Torres Strait Islander women.
Finally, we saw during the pandemic that it is possible for the government to raise the rate of Centrelink so no-one is forced to live in poverty. For the first time, the Government raised Centrelink payments above the poverty line and families could put food on the table and pay the rent. Desperately low rates of social security, racist compulsory income management and punitive mutual obligations disproportionately affect First Nations peoples and push people into the justice system.
The COVID-19 pandemic exposed the inequalities that already existed in our communities, but it also made clear the role government could play in reducing inequality if it chose to.
We are calling on all political parties to show leadership and address the systemic discrimination that drives poverty, homelessness and family violence in our communities. Without taking action on these systemic inequalities, and addressing discrimination in our laws and policies, government will not ‘close the gap’ or end to the mass incarceration of First Nations peoples.
Fund new initiatives to cut 23-year life expectancy gap
Mitchell Institute at Victoria University
Professor Rosemary Calder
Current healthcare services are simply and starkly failing to provide adequate physical healthcare for people with serious mental illness.
Nearly 80 percent of people with serious mental illness die prematurely of chronic physical health conditions, such as cardiovascular disease, respiratory illness, diabetes and cancer, that could be effectively managed and often prevented.
Leading mental and physical health experts, consumers and carers delivered the Being Equally Well Roadmap last year, which laid out a suite of feasible, affordable and practical recommendations for cutting the up to 23-year life expectancy gap for people with a severe mental illness.
Launched by the Federal Health Minister Greg Hunt, it lays out the systemic changes needed to help ensure those with serious mental illness receive healthcare that can prevent or manage their physical health conditions.
In a pre-budget submission to the Federal Government, the Mitchell Institute at Victoria University calls for implementation of the Being Equally Well recommendations through an investment of $13.7m to deliver four new pilot health initiatives, including:
- developing National Clinical Shared Care Guidelines to assist psychiatrists and GPs, together with pharmacists, nurses and consumers, to coordinate the treatment and management of mental and physical health;
- establishing a National Mental Health Clinical Quality Registry (NMHCQR) to provide high quality data to measure and report national progress towards parity in life expectancy for people with serious mental illness;
- establishing nurse (or clinical) navigator roles and services, supported through Primary Health Networks to work with GP clinics to provide clinical care coordination and support for patients;
- establishing a national network of Physical and Mental Health Quality Improvement Collaborative for rapid and comprehensive implementation of clinical guidelines and constant improvements in clinical practice.
A vital report on what needs to be done to improve the healthcare of disadvantaged individuals and population groups can achieve nothing without a commitment to and investment in implementation.
Through funding and implementing better, joined-up care and supports, some 470,000 consumers in Australia can receive quality care for both their mental and physical health, and lead longer, healthier lives.
Address telehealth concerns, for the sake of regional and remote communities
Royal Australasian College of Physicians
President Professor John Wilson, a respiratory physician
This year’s budget must include an extension of specialist telehealth items by phone as a permanent feature of the healthcare system.
Removing the telehealth phone Medicare Benefits Schedule (MBS) services will impact many patients in rural and remote areas, those living with disability, Aboriginal and Torres Strait Islander people and other people who may have limitations in travelling or accessing video technology.
Without the option of telehealth phone consultations, many patients will simply be cut off from their specialist care provider.
If these MBS phone items are not carried forward beyond June 30, it will be the elderly, those with less advanced technical knowledge, some Aboriginal and Torres Strait Islander people, some people living with disability, and people in rural and remote locations – who will suffer.
A silver lining of the COVID-19 pandemic was the way it opened up a way of improving access to specialist care for everyone through telehealth.
If we let that go, we’ve really wasted some important lessons from the pandemic.
People in regional and rural areas struggle to travel to specialist clinic, and some may simply not have access to or knowledge of video-conferencing technology.
We want to see the Federal Government and the Opposition recognise the importance of equitable access to specialist care and include phone consultations in their 2022-23 Budget.
Phone consultations are preferred by many patients or necessitated by patient-specific circumstances such as old age, fragility, intellectual disabilities, less advanced technical knowledge, low bandwidth, geographical barriers, and inability to access in-person care.
The RACP Pre-Budget Submission focuses on seven key areas:
- Boosting the COVID-19 response, recovery and preparedness system
- Delivering integrated and innovative health care to improve access and quality
- Building an appropriately funded and safe medical specialist workforce
- Closing the gap on Aboriginal and Torres Strait Islander health
- Prioritising children and young people’s recovery from the setbacks of COVID-19
- Strengthening support for preventive health
- Making our health system low-carbon and climate resilient.
The RACP Pre-Budget Submission can be accessed here.
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.
Our third article in the series featured priorities from the Australian Physiotherapy Association, the Australasian College for Emergency Medicine, and Philanthropy Australia.