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So what is Rudd actually trying to achieve in health? And enough of the jokes, thanks

Ben Harris-Roxas, Research Fellow, Centre for Health Equity Training, Research and Evaluation, writes:

“At the end of the Prime Minister’s Press Club speech I was left wondering ‘what do they hope to achieve?’ It wasn’t at all clear from what was announced.

As always with policy, a lot of the critical detail will lie in the implementation.  If the Commonwealth are taking over all aspects of primary health, broadly defined, there will be a lot of change in store.  Many community health services, like community mental health teams or child and family teams, are currently provided by state governments through Area Health Services.  Will these now be contracted out, with competition between existing providers and new players?  Or would it be through a fee-for-service model?  I’m still not clear.

Also unclear was how the 60/40 split is going to work.  It may make this more, rather than less complicated. And what’s the role of these hospital networks and how will they be distinct from Area or District Health Services? Clearly the PM sees clinicians as playing a critical role in the governance of these networks.  What role will community representatives and people with a broader system perspective play in their administration? If we don’t address that we risk creating more inefficiencies rather than reducing them. Clinicians are extremely skilled at what they’re trained to do, but that usually isn’t administration.

Disappointingly there was little on health inequalities in the announcement, though we’re promised further announcements on mental health and other issues.  I can almost imagine the PM would have said “Health inequities? What? Never heard of them. That’s just jargon!” if questioned on it, given his dismissiveness of Karen Middleton’s use of the word “discourse” in a question.

A cynical interpretation is that this round of health reform sets up a point of differentiation between the Government and both the Opposition and the states for an election year, rather than addressing the bigger issue of how we keep people healthy. Unfortunately cynical interpretations are often right.

The Prime Minister made a good point in relation to the final question at the Press Club.  He suggested that it’s hard for governments to invest in prevention because the benefits won’t be seen for 10 years or more.  Real reform would put this, rather than hospitals, front and centre.

Finally, there was decidedly too much levity at the National Press Club announement, with jokes and back-and forth between the PM and journos.  At the risk of sounding like the old man telling the kids to get off his lawn, this issue is not a political fun-park ride.  There’s a very real risk that if these changes aren’t implemented sensibly we could end up with a worse health system at the end of it.

The policy is now up at http://www.yourhealth.gov.au

I’ve only skimmed through it. Read it – I’d be interested in your collective analysis.”

Comments 10

  1. The Australian has put up the text of the National Press Club speech at http://j.mp/cLkOGi

  2. Doctor Whom says:

    I notice he didn’t mentioned Working Families even once – but when he got on a roll with local networks, local services, local decisions – I thought he’d say ” Its a local shop for local people”

    No all I can think of is Kev in Royston Vasey.

    https://www.thisisalocalshop.com/

  3. Haha! “This is a local shop. Run nationally, delivered locally.”

  4. Scott Grant says:

    I need to spend more time reading it (the PDF not the speech) to form a better idea of whether I approve or not. But, as Ben says, it is the detail which will be all important.

    Here is my initial impression:

    So far I have counted 1 “leverage”, 7 “transition” (but only once as a verb!), 2 “architecture” (no use of the verb “to architect”!), 27 “drive”, 11 “bureaucracy”, and 191 “network” (including page footers). Not too bad an effort in avoiding the common verbed nouns.

    The clear message is “bureaucracy” is bad, “network” is good.

    It looks a bit like a continuation of the old cycle of centralisation – decentralisation that seems to have been going on for ever. I counted 17 “accountable/accountability” and 123 “efficient/efficiency”, which is a surprise. Normally decentralisation is justified by “accountability” while centralisation is regarded as “efficient”. Here we have decentralisation being justified as being both “accountable” and “efficient”. Presumably this is because a few “bureaucracies” are going to be replaced by many “networks” with a new (ahem) bureaucracy on top.

    In NSW, given the time, effort and money already spent in implementing Morris Iemma’s grand vision of combining area health services into bigger area health services, I wonder how it will all get disentangled again. And how long it will take and how much it will cost. And who is going to do it, given that bureaucrats are not wanted.

    (disclaimer: I am a minor bureaucrat in a hospital)

  5. Thanks for scrutinising the policy Scott. It reminds me a bit of the old joke:

    The new Director-General of the Health Department finds a note from her predecessor. Its says there are three letters in the desk drawer, to be opened when there’s a crisis.

    Six months later there is the inevitable media crisis. The D-G opens the first letter. It says “blame the previous Director-General”. She does, and the problem eventually goes away.

    Later there’s another crisis, presumably something on the front page of the Tele. The second letter is just one word: “restructure”. Deck chairs are re-shuffled and the problems appear to be solved.

    Final crisis. In desperation the D-G looks at the third envelope. It says “time to write three letters”.

    I think the Government might be up to their second letter…

  6. jenauthor says:

    @Ben
    ‘given his dismissiveness of Karen Middleton’s use of the word “discourse” in a question.’

    I think you missed the point of that particular discourse. One of the reasons the PM had a simple and more direct announcement today was that he is constantly criticised for the complexity of his communications. The press seem to think that if they don’t understand it straight away, it must be a lemon. Thus, simple, clear undertakings that anyone of average intelligence can take — but this is only stage 1.

    If you truly listened to what was said, and the commitments made on future aspects of the health system that would be addressed, you’d see this was a measured announcements of what the govt. intends. YES there is detail to be discussed and decided upon, but explaining that would have gotten in the way of the broad picture being created here.

    I just sat through a panel on the 7:30 report who kept bringing up stuff that was not addressed because it wasn’t intended to be addressed in this particular articulation of the policy. Already all the ‘what if’ thisers, and ‘what if’ thaters have come out of the woodwork trying to muddy the picture.

    This was the structural and funding model designed to bring about efficiencies and accountability into a system that despite all the naysayers is still quite good compared to many other countries.

    For craps sake — take in stage one, then, when stage 2 is announce, the building platform for it will be clear enough for everyone to see how that fits into the overall picture. I know we live in an instant world — but in all seriousness, fixing the problems and making worthwhile changes takes a lot of time and recalibration.

  7. centaur009 says:

    Incentivise the public system , and set some efficiency guidlines. I work in a community health centre with some of the laziest people on the planet. Meanwhile their waiting lists blow out to 5 and 6 months. That has got to change.
    The plan is good, long live the plan!

  8. @jenauthor I got that he was trying to speak plainly. I guess I just though it was a bit disingenuous as he was dealing with a complex issue.

    Your point about reserving judgement until we see the next phase and the recalibrated implementation details is probably reasonable. I saw the 7:30 Report as well, and I was a little surprised to see some of the panelists, who up until now had been enthusiastic champions of reform, hemming and hawing about the detail.

    So, how much information do we need before we can make a judgement? I’m not being rhetorical, I’m genuinely curious. What do we need to know before we can know if this policy is a winner or a dud?

  9. The transcript of the Q&A is now up at http://bit.ly/bpauhk

  10. jenauthor says:

    @ Ben

    Re: the ‘discourse’ with Middleton, I reckon he was also having a return shot at the media in general about their criticisms of his style (damned if he does and damned of he doesn’t, sort of thing).

    “What do we need to know before we can know if this policy is a winner or a dud?”

    Unfortunately, that is really hard to say. The idea of funding per procedure to my thinking makes the whole system more equitable. That he guaranteed 60% of infrastructure and training/research covers some of the other necessary costs that will be difficult to factor in.

    I can see, for instance, that private hospitals will end up with ‘public wards’ (a bit like home brands in the supermarket) where they can earn extra money servicing the public sector as well as the private.

    The most important aspect of the shake up needs to be increasing the non-hospital services in order to reduce the number of hospital beds taken up by patients who aren’t really hospital patients. (Like lonely single older australians and alcoholics who get ‘sick’ on Christmas day because he/she doesn’t want to spend the day alone.) That is in the works, but as always, these things take time to have an impact.

    Meanwhile, the states need to understand that their capacity to pay reduces over time and it makes perfect sense to give the bill to someone else.

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co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
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
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
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
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
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences