As noted at Croakey recently, the AMA’s Federal Council has voted to oppose the establishment of Medicare Locals, and called on the Government “to defer the establishment of any primary health care governance organisations until there has been genuine consultation with the medical profession”.
Meanwhile, Gordon Gregory, executive director of the National Rural Health Alliance, says below that while there are many uncertainties surrounding the direction and implementation of primary health care reform, now is the time to “seize the day”.
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What can we learn from the national rural health conference?
Gordon Gregory writes:
Proceedings at the 11th National Rural Health Conference in Perth last week demonstrated that, despite how busy health professionals are in rural and remote areas, they have a firm grasp of the risks and opportunities associated with the health reform agenda.
In her speech to the closing session, Nicola Roxon reminded her listeners of the substantial investments the Rudd and Gillard Governments have made in rural and remote health. Not for the first time, the Minister was at pains to emphasise that these rural commitments were in place before the hung parliament added another reason for a regional focus.
The majority of those at the conference were people engaged at the coalface in the real work of managing rural and remote health services. For them the bigger picture is a thing of great importance but of considerable mystery.
Quite how the establishment of Medicare Locals and Local Hospital Networks over the next 18 months will impact on them and their work cannot possibly be clear: if it’s not plain and obvious to the painters of big pictures, it certainly won’t be obvious to the Director of Nursing at Nyngan.
What is certain is that most of the hopes generated through the health reform process of the last three years are now hanging on Medicare Locals. If they succeed (and everyone accepts that it will take some time), there is the prospect of a more integrated primary care system and a better patient journey.
The more ambitious people – and those with even greater patience – even have hopes that Medicare Locals will be effective on the broad primary health care front, by helping at the local and regional level to integrate the contributions that education, food and water policies, housing and public transport etc make to health status. (Handy hint: if the paragraph you’re reading or writing doesn’t encompass primary or secondary education, or food policy, or employment status or community development, it is not about primary health care.)
The health reform process might be described as ‘stuttering’ due to the recent decision of Western Australia to join in and continued uncertainties hanging over the situation in Victoria and New South Wales. Nevertheless people at the conference were optimistic that there is light at the end of the tunnel – and that it is not coming from the construction team extending its length.
For many people, therefore, the future and the success of Medicare Locals is a matter of trust. In rural and remote areas (we argue) surely we can have better access to integrated care from the right person at the right time – and surely a good way to achieve this (we believe) is through us (consumers and providers) having greater local control over our health services. This belief certainly reflects the number one word that was on people’s lips at the Perth conference: empowerment.
So the immediate challenge is to make sure that everyone who ought to be involved in a Medicare Local application is involved.
Some people are calling for a delay in the first tranche so there can be better understanding, more consultation. Others want, at this very late stage, to unpack the whole proposal and re-shape it yet again.
Let’s get on with it I say: how much longer do we all need, how much more patience have we all got!
The Alliance has an agreed set of principles for Medicare Locals – particularly those in rural and remote areas – and the challenge now is to move from theoretical constructs, to getting all the right people involved and committed to acting on those principles.
Seize the Day!
The people who truly understand the needs of Rural and remote health are too busy trying to deliver what they can with the limited resources they have, in an underfunded and undermanned sector. The people who have the time, inclination and Corporate Knowledge to understand such a broad brush approach to reform simply must acknowledge that consultation is the key or the whole thing becomes another Disaster of administrative incompetence.