Informed, engaged communities for health

Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
@WePublicHealth 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

National health reform – what’s beneath the hood?

Introduction by Croakey: It seems we’ve had two significant, related initiatives in national health reform that have operated in parallel universes and in remarkable isolation from each other.

The Mid Term Review of the National Health Reform Agreement Addendum 2020-2025 was released last week – just a few days after the long-awaited National Health and Climate Strategy (NHCS).

Given the many areas of overlap, you might have thought there would be some cross-pollination. But the NHRA review doesn’t address the implications of climate change for health reform, despite this being clearly laid out in the NHCS.

And while the NHCS, with its focus on Health in All Policies, clearly has a bigger remit than reform within the health portfolio, at least two of its objectives – to build a climate-resilient health system with enhanced capacity to protect health and wellbeing from climate impacts, and health system decarbonisation – have clear implications for the NHRA, especially as the review recommends a National Innovation and Reform Agency and an Innovation Fund be established.

As another example of overlap: the review says the role of Aboriginal Community Controlled Health Organisations (ACCHOs) is not articulated or embedded within local and broader governance arrangements within the NHRA, detracting from the ability of community-controlled organisations to participate in local commissioning and service design.

Meanwhile, the NHCS says the Australian Government will work in partnership with states, territories, Aboriginal Community-Controlled Health Services and other relevant stakeholders to enable state and territory health systems, local health systems, Aboriginal Community Controlled Health Services (ACCHS) and hospitals to undertake climate risk assessment and develop adaptation plans.

Perhaps there are efforts to connect and integrate the NHCS and the NHRA behind the scenes, but it seems beyond strange there is no front-facing effort to do this.

Meanwhile, health policy analyst Charles Maskell-Knight has been reviewing the review of the NHRA, and raises many other questions below.


Charles Maskell-Knight writes:

On 3 December Croakey published an article I had written the previous week about the mid-term review of the National Health Reform Agreement (NHRA), which sets out the Commonwealth-state public hospital funding deal.

While researching the article I asked the Department Health and Aged Care when the review report would be released. I was told on 24 November that “as the review was commissioned by all Health Ministers, this is a matter for their joint decision”.

At a press conference on 7 December Minister Mark Butler foreshadowed release “over the next little while, by which I mean day or two”. However, the report was posted on the Departmental website later that day, with no fanfare, and accompanying text implying the document had been released six weeks earlier (when it was finalised).

Anyway, it is good that the report is in now in the public domain.

Ten themes

The review makes 45 recommendations, with 64 sub-recommendations. Fortunately these are grouped into ten key themes, articulated in the executive summary.

The first theme sets the context for the rest of the report: the NHRA should not be a “technical hospital financing agreement”, but “a single collaborative health system Agreement that recognises that all elements of the health system need to work effectively together to improve patient outcomes, is performance-focused, predicts and prepares for future challenges and is clear on shared and individual accountabilities”.

The second theme is that the Agreement should establish “a platform for intersectoral collaboration” with mechanisms to make LHNs, PHNs and ACCHOs work together on joint planning and commissioning.

The review claims both that the NHRA has “tend[ed] to drive care towards inpatient settings”, and that activity based funding has responded to demand rather than shaped demand. The third theme is thus that the next Agreement should shape demand by establishing shared incentives and payment streams to fund early intervention outside hospitals.

The fourth theme “Financing reform” is not so much a theme as a miscellany of recommendations about the trajectory and calculation of Commonwealth payments. Some of these issues were apparently addressed at the National Cabinet meeting of 6 December – although the detail of what was actually agreed remains unclear.

The 2020 Agreement identified half a dozen “long term reform priorities”, but progress on them so far has been limited. The fifth theme is that these should be pursued, supported by a “National Innovation and Reform Agency” with the keys to an Innovation Fund.

The sixth theme addresses rural and remote service delivery by proposing that the Agreement should “establish a coordinated national approach to address health disparities in rural and remote communities, that encompass models of care able to function where workforce and infrastructure is limited, with health providers operating at a full scope of practice and greater integration across sectors to get the most from available resources”.

The seventh theme relates to Closing the Gap, with a recommendation that a new Agreement should “enunciate the shared commitment of the parties to improve the health of First Nations’ people through specific actions and accountabilities”.

The eighth theme covers workforce and digital health, and recommends that these should be dealt with in schedules to the new Agreement “reflecting shared commitments and actions, accountabilities and performance milestones”.

The review notes that while the 2020 Agreement includes an Australian Health Performance Framework, it has “not enabled reflection on system pressures nor development of shared solutions”. The ninth theme is an improved performance framework to measure the success of the Agreement, and to track the progress of the parties against their accountabilities.

Finally, the review notes that the COVID-19 pandemic has highlighted the need for a future Agreement to include a framework for responding to national emergencies, and concludes that governments should agree a recovery plan to address the ongoing impact of COVID-19 on “workforce availability, cost escalation, increased disease burden and the backlog of delayed care”.

The summary concludes that:

“The next stage of reform requires a single collaborative whole of health system Agreement, that incorporates a National Health Funding and Payments Framework that can deliver optimal models of care and increase the Commonwealth funding share over time.

“Critical system priorities and enablers need to be embedded into the Agreement, not just as aspirational statements, but with clear accountabilities and programs of action. A focus on innovation and reform and measurement of performance can better map and enable the system to respond to future pressures”.

Even a semi-detailed review of the recommendations would take far more space than the most generous Croakey editor would allow, so here are some overarching observations and comments.

One agreement to bind them all

The view that “everything should be in one agreement” pervades the review’s recommendations.

There should be an audit of all existing agreements to find out what could be incorporated (Recommendation 3), and the Agreement should reaffirm the commitments in the National Mental Health and Suicide Prevention Agreement (Recommendation 4), include a schedule reflecting the “critical importance” of the National Agreement on Closing the Gap (Recommendation 38), and include a schedule on progressing digital health that “reflects” the current IGA on National Digital Health (Recommendation 40).

The new Agreement should inter alia contain: detailed requirements for local joint planning and commissioning (Recommendation 7); mechanisms to develop optimal models of care (Recommendation 11); a structured program of work to develop bundled payments (Recommendation 13); a focus on prevention complementing the National Preventive Health Strategy 2021-30; a schedule on improving access to health in rural and remote areas (Recommendation 36); and a schedule recognising the role of the health workforce (Recommendation 39).

Wading through all this gives the sense of an “every child deserves a prize” approach to consideration of ideas put forward in submissions and consultations.

Somebody must have suggested that the Agreement should “include a commitment to the continued development of the national regulation scheme through AHPRA” (Recommendation 39(d)), but is it really necessary?

A more important concern is that the envisaged Agreement would be incredibly unwieldy. I spent a number of years working under the short-lived 2010 version and then the 2011 version, and they were difficult to navigate.

The 2010 and 2011 versions were also very difficult to negotiate, as many of my former colleagues who worked in PMC at the time will attest, yet the scope of those agreements was far narrower than what the review proposes.

With only 18 months to go before a new Agreement is required, work on negotiating it should have started three years ago if it is to include everything proposed in the review.

Consistent themes identified in the review (p. 24). (No mention of the climate crisis).

We are committed, you are responsible, they are accountable

The notions of commitment, responsibility, and accountability are used a great deal throughout the review report. For governments, commitment comes cheap, responsibility is a bit more serious, but only accountability is potentially onerous, depending on the mechanism used to enforce it.

At a Commonwealth level the Auditor-General, the Ombudsman, and even Senate estimates (on a good day) are powerful accountability mechanisms. Maladministration can be exposed, and those responsible exposed to public embarrassment and humiliation.

However, it is not clear how accountability would work in the context of a new Agreement.

For example, recommendation 35(b) is that the Agreement should “establish clear accountability and escalation mechanisms to address market failures in rural and remote primary, aged and disability care”.

Given the Commonwealth’s responsibility for primary care, how will it be “accountable” if it can’t replace the one third of GPs in Armidale who are leaving practice? Or provide enough doctors in Sorrell so that patients don’t have to wait a month for an appointment? And to whom will it be “accountable”?

Can care optimisation integrate across funding sources?

The review makes a series of recommendations about optimal models of care, including: developing “innovative financing mechanisms”; extending the Agreement to cover services outside hospital if they reduce demand on acute care; and implementing bundled payments covering end-to-end episodes of care, such as maternity services.

The difficulty with all of these initiatives is that they involve (at least) three funding streams: the Commonwealth’s contribution to public hospitals; the states’ contribution to public hospitals; MBS funding; and potentially PBS and patient out-of-pocket costs.

Any system of bundled payments will need to combine funds from these funding streams and provide them to a fundholder who will disburse them to providers as elements of the bundle are delivered.

But who will the fundholder be? And what accountabilities (there’s that word again) will they have to the two levels of government providing the funds?

Yes Virginia, there is a Commonwealth Grants Commission

As Professor Stephen Duckett pointed out in a recent article in The Conversation, any state’s allocation under the NHRA is effectively offset against its GST entitlement calculated by the Commonwealth Grants Commission.

The fact the NHRA pays a much lower share of the cost of hospitals in the NT than other jurisdictions just means that the NT receives a larger slice of the GST pot than it otherwise would.

The review elides any discussion of the GST. Its call to increase the percentage NHRA share for those jurisdictions below the median through a once-off injection of funds would have no direct impact on the funding available to those states – although it would increase the size of the overall NHRA and GST pot.

Roadmap for the future? Or a maze?

At its meeting on 6 December, National Cabinet apparently adopted a version of several of the review’s short-term recommendations.

It agreed to an increase in the Commonwealth’s NHRA contributions “to 45 percent over a maximum of a 10-year glide path from 1 July 2025, with an achievement of 42.5 percent before 2030”, and to replacing the current 6.5 percent annual cap on increases in the Commonwealth contribution with “a more generous approach that applies a cumulative cap over the period 2025-2030 and includes a first year ‘catch up’ growth premium”.

As I and various other commentators have suggested, more detail on how this will work is needed before these changes can be properly evaluated.

Beyond the immediate changes, National Cabinet also agreed that:

“Health Ministers will commence the renegotiation of the National Health Reform Agreement (NHRA) Addendum to embed long-term, system-wide structural health reforms, including considering the NHRA Mid-Term Review findings.

These reforms will focus on the entire health system and move towards a more integrated, equitable, efficient and sustainable system. This will give Australians better access to health services they need, when they need them, and alleviate current pressures in public hospitals across the country.”

Well, they would say that, wouldn’t they?

My view is that the complexity of the Agreement envisaged by the review’s recommendations means that they will not be implemented, and that in 18 months’ time First Ministers will again ink a “technical hospital financing agreement”, with a few bells and whistles on the side.

A postscript on consultation

In my earlier article I said that the absence of a public consultation process and decision to invite submissions from a limited (and secret)