Reaction to the debate: underwhelming

If you followed Croakey’s contributions to the live blog of the Rudd vs Abbott debate at Crikey today, you may have noticed a distinct lack of enthusiasm for the content of their little chat.

It was always going to be about the politics, the game, the biff – rather than any sensible or meaningful talkfest. As Bernard Keane remarks at The Stump: “For health wonks looking for actual content, however, the debate was decidedly light-on. Just as Abbott failed to address the details of Rudd’s plan, Rudd gave minimal additional information about it even in response to detailed questions from journalists.  Without his own policy, of course, Abbott was left to repeat that he would provide his policy well before the election.”

Many of the health commentariat – including some Croakey regulars visiting The Drum – seem to have been left rather uninspired.

Here is some of what is being said around the traps (new comments are being added at the bottom, as they land):

Professor Glenn Salkeld, Sydney School of Public Health, University of Sydney:
It’s hard to have a debate on health when we don’t know where one side of the debate, the Coalition, stand.  That said, both leaders appealed to the public – the families, pensioners, rural communities and what is in it for them.
We should have had a debate about public health –  everything that helps us lead healthy lives, whether it’s in the hospital, the home, the community or where we work.  Instead we got a debate on institutional health – the health of our hospitals.  Most people get their health care outside of hospitals. It is very important to have hospitals with the capacity and management to work efficiently and meet population needs for acute care. More beds won’t solve our problems. Rudd did recognize the importance of prevention, the need for education and the importance of primary care, aged care and other care outside the hospital. But it clearly is not seen by our leaders as the main game.  Real reform comes from making it the main game.  By all means let’s ensure that the health of our institutions is assured but please let’s have more attention to the health of the public. Real reform comes from helping people manage their health where they live and work, knowing that hospitals are there for those times when everything else fails.

A statement from The Public Health Association of Australia:
The PHAA is disappointed that the Rudd-Abbott debate hardly touched on prevention and other areas such as mental health, chronic disease, ageing and remedying inequities.
PHAA President Professor Mike Daube said, “Hospitals dominate our expenditure and we need good treatment services; but public health can prolong our lives, keep us healthy and reduce inequalities in our society. It is too important to ignore”.

Statement from Dr Tim Woodruff of the Doctors Reform Society:
“The Prime Minister’s defence today of the hospital funding reform proposal against the anti-reform agenda of the Opposition Leader is to be commended,” said Dr Tim Woodruff, President, Doctors Reform Society, “but we are still waiting for reform proposals for the total health system”.

“Our health system consists of public hospitals, private hospitals, GP services, community services, mental health services, dental services, aged care services, and much more. So far, we have heard plans for the single most expensive part of the system, the public hospitals, and for increased doctor training,” said Dr Woodruff. “But nothing is to be done for four years to address the current Federal funding shortfall to public hospitals. Nothing is to be done to address the taxpayer funded support of the growth of publicly funded private hospitals which attracts specialists away from public hospitals. And we know nothing of reform of the non hospital sector.”

“There is little so far to convince us that we are heading for an equitable, universally accessible, integrated, patient centred health system based around the health of patients from cradle to the grave.”

“The issues about which we have heard nothing are at least as important as, if not more important than the announcements so far”, said Dr Woodruff. “Addressing current problems whilst planning reforms for the whole system would do much to convince our patients and us that Mr Rudd is genuinely committed to a health system for all Australians.”

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Statement from ANU:

A policy expert from The Australian National University has described the health debate between the nation’s federal political leaders today as disappointing and lacking in substance.

Mr Robert Wells, Director of the Menzies Centre for Health Policy at ANU, said neither side of politics was a clear winner after the debate today between the Prime Minister Kevin Rudd and Leader of the Opposition Tony Abbott at the National Press Club in Canberra.

“It’s becoming clearer that both sides of politics are heading towards the same hospitals focus for health policy in this election year, but there are still big questions to be answered about primary health care and aged care,” Mr Wells said. “And on the question of hospitals, both parties are advocating various levels of local control, yet we don’t have firm details yet on how that would actually work in a way that is accountable, or firm details on whether or not there will be additional funding for hospitals.”

Mr Wells did welcome a comment from the Prime Minister that any activity-based funding model would not disadvantage rural hospitals, but said both sides of politics needed to consult more widely before implementing reforms. “There was a lot of talk about consultation with health professionals, but not a lot of input from community groups,” Mr Wells said.

“I hope that the political parties will reflect on these gaps and come forward with detailed and costed policies as soon as possible.”

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Statement from ANF:

The Australian Nursing Federation said the prime minister won the health debate today because he focused on issues and solutions.

But federal secretary Ged Kearney said she was disappointed with the healthcare debate contribution by Opposition leader Tony Abbott this afternoon.

“The prime minister spoke about the need for improvement in the healthcare sector,” she said. “Mr Rudd spoke about real issues facing real people. He spoke about a need for more nurses and doctors and better services under his proposed reform agenda.”

“It is vital that we act now to ensure future Australians, including the elderly, get the care they require.”

But Ms Kearney said Mr Abbott had little of substance to say. “Although it can be difficult to have a clear policy while in opposition, Mr Abbott could have made more effort at a meaningful contribution.”

“Tony Abbott refused to put forward any real health policies of his own. Throughout the debate a tense opposition leader said very little about how he would solve health sector issues.”

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Statement from Catholic Health Australia:

Catholic Health Australia (CHA) today welcomed the recognition by Prime Minister Kevin Rudd and Opposition Leader Tony Abbott that non-government health services have an important role to play in caring for Australians.

CHA CEO Martin Laverty said he was also pleased to hear Mr Rudd acknowledge during the leaders’ health debate today that thousands of hospital beds could be freed up by expanding access to aged care.

“However we remain disappointed at the lack of detail from either the Government or the Opposition on the specific proposals that would ensure all Australians have access to quality health and aged care,” Mr Laverty said. “There was much talk about the past, but very little about how to better serve those people in our community who are most in need.

“And while it is heartening to see that both sides of politics appreciate the vital role of non-government health providers in Australia, we need to hear more on how they plan to better use the mix of public and non-government health services.”

CHA has asked the Prime Minister to provide detail on the design, size and roles of Local Hospital Networks, how non-government hospitals fit into the networks, and how the Government plans to integrate primary care and hospital networks.

Mr Laverty acknowledged the Prime Minister’s commitment to 2,000 transitional aged care beds, but said CHA would still like to see the Government’s full plans for reforming aged care.

“The Government should immediately release the terms of reference for the Productivity Commission inquiry into aged care and outline the Government’s blueprint to provide for access, choice and sustainability in aged care,” he said.

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Jon Wardle, NHMRC Research Scholar, School of Population Health, University of Queensland:

The Rudd v Abbott debate resulted in a a lot of talk about health action, but little talk of actual health reform – and there is a very real difference.
Whilst the health system will undoubtedly be far bigger as a result of this debate, whether it will be better remains to be seen.

We still know very litttle of what will be paid for – or whether we’ll be getting bang for our buck – even though we’ve had opinions aplenty over who should, could’ve and who did and didn’t pay.

Abbott and Rudd both were equally myopic in their focus on reactive rather than proactive approaches to healthcare.

In fact in both camps health and hospital system reform seems to be far more about hospitals than health, and the PMs definition of primary care as merely “GP and GP-related care” should send shivers down the spines of unattended patients and overworked GPs everywhere.

Although preventive care was given its usual cursory nod, it again was used to mean early treatment rather than real prevention. Education, workplace, non-health policy and non-hospital interventions already known to be very effective internationally – both in clinical and cost-effective terms– were remarkably absent from the debate.

The debate needs to move away from superficial doctor, nurse and waiting list numbers and start talking about whole-of-government approaches actually can make a difference.

Why are we still talking about more hospital beds rather than stopping people  gettting onto them in the first place? Unfortunately these endeavours, though incrediblyeffective, are simply not electorally sexy. New hospital beds or doctors, though probably the least effective option in both real, economic and clinical terms, will ultimately prevail with fickle voters.

As it stands any new hospital beds, doctors or nurses will simply be soaked up by new patients until we begin addressing upstream factors.
If we continue to focus on simply rolling out more of the same failing system, the chance of Australia getting a health system that can really face future challenges head-on diminishes considerably.