As you’ve no doubt heard, details of the latest COAG agreement on health reform have been released, and related documents can be downloaded here.
These were finalised out of session – the next COAG meeting is scheduled for 19 August in Canberra.
I have written on related issues for today’s Crikey bulletin, but to give you some of the detail of the agreements, below is yesterday’s media statement from the PM and Health Minister, and extracts from the agreement on improving public hospital services and from an Expert Panel’s review of elective surgery and emergency access targets.
National health reform finalised: Statement from Prime Minister, Minister for Health and Ageing (2nd Aug)
The Gillard Government today signed off on the final details of national health reforms with all States and Territories to secure the future of health in Australia.
This historic agreement will deliver the funding public hospitals need, with unprecedented levels of transparency and accountability, less waste and significantly less waiting for patients.
The reforms, agreed to by COAG in February and finalised today, will see the Australian Government invest an extra $19.8 billion in public hospitals through to 2019-20, rising to a total extra $175 billion to 2029-30.
This extra Commonwealth funding will mean our hospitals will be able to take on millions of extra services that would never have been possible under the old arrangements including:
2.9 million extra cases in our emergency departments
2 million additional in-patient services, such as major surgery or treatment for severe conditions such as kidney failure or a heart attack
19 million more outpatient consultations, such as minor surgery or physiotherapy.
Over the last decade the Commonwealth’s share of public hospital funding has been in sustained decline, and States and Territories have had to enter negotiations over health funding with the Commonwealth every five years.
Today’s agreement permanently puts an end to the uncertainty of public hospital funding. It is money the States – and Australian patients – can depend on.
Specifically, the agreement will deliver:
Faster access to emergency department and elective surgery procedures, through the establishment of:
A 4-hour target for emergency waiting times, with the aim that 90 per cent of patients across all triage categories are seen within four hours.
A 100 per cent elective surgery target, aimed at ensuring all patients waiting for elective surgery are treated within clinically recommended times.
Less waste with hospitals funded for what they actually deliver.
Greater local control of hospitals.
Unprecedented new levels of public reporting on health services and expenditure for every hospital in Australia.
The Australian Government will step up to permanently pay for 45 per cent of growth in hospital services in 2014-15, increasing to 50 per cent in 2017-18.
This means the Commonwealth and States and Territories will share future funding growth for hospitals in an equal partnership.
In fundamentally changing the way that governments pay for hospital services, the final agreement is the biggest change to public hospital financing since the introduction of Medibank and its successor Medicare.
Less Waiting and Millions of Extra Patient Services
Under the final agreement reached today the Commonwealth will provide at least an additional $19.8 billion to 2019-20, supporting millions of additional hospital services.
Over $1 billion of this has already been provided to States and Territories – resulting in new beds and services already being rolled out around the country.
States and Territories have agreed to open new hospital beds and work towards tough new national targets for elective surgery and emergency departments.
In 2009-10, 16 per cent of the 606,255 elective surgeries performed in Australia were not carried out within clinically recommended times. Under the final deal reached today, the States and Territories will work to ensure that by 2016 everyone needing surgery will have their operation within a clinically appropriate time.
Similarly, in emergency departments, 36 per cent wait more than four hours. In this final agreement, the States and Territories will work to ensure that 90 per cent of all patients presenting to an Emergency Department in a major public hospital will receive all necessary care or have been admitted to hospital within four hours by 2015.
Less waste and increased transparency and accountability
In exchange for improved funding arrangements, states and territories have agreed to unprecedented transparency in our health care system.
The new National Health Performance Authority (NHPA) will ensure that Australians can access accurate and up to date information on the MyHospitals website about how their hospitals perform so they can choose the best care.
Australians will also have access to greater information about their primary health care system through healthy community reports.
To improve the transparency of public hospital funding a single National Health Funding Pool will be established.
The Administrator of the pool will report on Commonwealth and State funding flowing through the pool and the services delivered by this funding.
This will ensure that all hospitals are funded under the same arrangements, allowing all Australians to clearly see where and how their tax dollars are being spent.
A new Independent Hospital Pricing Authority will set the national price for public hospital services and will develop a national activity-based funding system.
This will ensure that public hospitals are properly funded for each and every service that they provide, based on a fair price. It will also mean much greater efficiency in hospital funding than ever before – no more blank cheques.
New Local Hospital Networks will ensure decisions about hospital management are devolved to the local level. In addition, local clinicians will be engaged to advise about patient pathways which best meet the needs of the local community.
Improving GP, Primary Health Care and Aged Care
The Gillard Government’s new investments in hospitals are being supported by significant Commonwealth investments in primary health care services – including after hours services, new GP training places, and new GP Super Clinics – to help take pressure off public hospitals.
New Medicare Locals will support the day-to-day delivery of better integrated GP and primary health care services in the community ensuring more patients can get the care that they need in the right settings.
Reforms to aged care will see the Commonwealth becoming directly responsible for funding basic community care in most States and Territories for people aged 65 and over, in addition to its existing responsibility for community aged care packages and residential aged care.
This will enable simplified access to a wider range of care for older people. The reforms also ensure clearer lines of accountability for care of younger people with disabilities and older people requiring care.
More information on this announcement is available at www.yourhealth.gov.au.
Meanwhile, here are some extracts from The National Health Reform Agreement – National Partnership Agreement on Improving Public Hospital Services.
The objectives and outcomes of this Agreement will be achieved by:
(a) a higher proportion of elective surgery patients seen within clinically recommended times, and a reduction in the number of patients waiting beyond the clinically recommended time
(b) a higher proportion of Emergency Department (ED) patients to either physically leave the ED for admission to hospital, be referred to another hospital for treatment, or be discharged within four
(c) more subacute care beds available for patients
(d) projects completed to support increased access to elective surgery, reduced emergency department waiting times and more subacute care
The following data, collected under the Performance and Accountability Framework, will be used to measure the impact of the implementation of both National Emergency Access Target (NEAT) and National Elective Surgery Target (NEST) on the safety and quality of patient care:
(a) hospital standardised mortality ratio;
(b) in-hospital mortality rates for selected diagnostic categories;
(c) unplanned hospital re-admission rates for selected diagnostic categories;
(d) healthcare associated Staphylococcus aureus bacteraemia;
(e) healthcare associated Clostridium difficile infection; and
(f) measures of the patient experience with health services.
The agreement provides for:
• an increase in the percentage of elective surgery patients seen so that 100 per cent of all Urgency Category patients waiting for surgery are seen within the clinically recommended time, and to reduce the number of patients who have waited longer than the clinically recommended time (long waits).
• a four hour National Emergency Access Target (NEAT) where 90 per cent of all patients presenting to a public hospital ED will either physically leave the ED for admission to hospital, be referred to another hospital for treatment, or be discharged within four hours. The safety of patients is the utmost priority, and the target is not intended to overrule clinical judgment. Decisions on whether it is clinically appropriate for a patient to be retained in an ED for more than four hours will be at the discretion of the clinicians.
• The Commonwealth Government will provide up to $1.623 billion in capital and recurrent funding from 2010-11 to 2013-14 to States and Territories to deliver and operate over 1,300 new subacute care beds nationally, in hospital and community settings, by the end of this period. These reforms will improve patient health outcomes, functional capacity and quality of life by increasing access to subacute care services including rehabilitation, palliative care, subacute mental health and Geriatric Evaluation and Management and psycho-geriatric services in both hospitals and the community. The reforms will also increase capacity in the public hospital system by freeing up acute care beds for those who need them and reducing pressure on EDs. In delivering new subacute care beds, States and Territories will take local needs and the needs of disadvantaged groups in the community into account and aim to improve the mix of services and distribution of subacute care across the region.
The Expert Panel’s revew
The agreement incorporates the recommendations of a report reviewing elective surgery and emergency access targets that had been previously set. One of these recommendations was that surgical taskforces, as already exist in some jurisdictions, be established in all jurisdictions and linked nationally as a means of sharing information on best practice elective surgery waiting list management.
The panel’s report, dated 30 June, says “the targets should be viewed as a means of stimulating reform and measuring progress, not as an end in themselves”.
It identifies critical principles to for successful implementation of the national elective surgery and emergency access targets.
1. Targets and the changes required to meet them will require commitment right across the health and hospital system
2. Hospital executives will need to work in partnership with clinicians to achieve sustainable change
3. Clinical engagement and clinical leadership will be essential if the targets are to be met
4. Targets must drive clinical redesign with a whole-of-hospital approach
5. Clinical redesign must ensure patient safety and enhance quality of care
6. Clinical redesign will improve system capacity and delivery of care
7. Definitions to be clear and consistent across all jurisdictions
8. The performance of jurisdictions is not comparable
9. Progress towards the targets needs to be linked with continual monitoring of safety and quality performance indicators and audit
10. The impact of targets on demand needs to be monitored and early strategies developed to ensure achievements are sustainable
11. Quality of training is maintained
The Expert Panel, which conducted this review, is to continue to provide advice to COAG. It is clear that this latest agreement – while important from both a political and policy viewpoint – is not an end to health reform but just another step on a long road, and that flexibility will be needed to respond to the many challenges likely to arise in implementation.
OK the States have more cash and it is all so much more transparent. Why then are Bulk Billing Quick Consultation Clinics in Public Hospitals being opened across the States? No transparency there, they bypass the performance figures, allow the 4 hour rule to be dodged by coercing patients to go “private”, and use salaried medical Officers in clear contravention of the Medicare agreement. Oh and if you need follow up go and see a GP. The state rort of Medicare is rife, and set to grow, completely unchecked. The game hasn’t changed at all, just the players assume we are all Stupid.
There isn’t any point in changing funding strategies or announcing new policies until key issues in hospitals are looked at:
Why are patients presenting to emergency departments? The majority are elderly with chronic conditions, many are from nursing homes where there are no qualified staff to assess and treat any changes or manage complex issues.
How effective is current health management? 50% of patients are not compliant with their medications, due to lack of education, support and management of side effects in the community.
How are hospitals funded? By pushing patients through the system at high speed, instead of looking at all their health issues, developing a plan and following it through.
What feedback can patients give about basic nursing care, pain management and medical management they receive in hospitals? Non.
What input do doctors, nurses, pharmacists and allied health have about the way hospitals are run? Non.
My suggestion is:
Publish the demographics of all patients admitted to ED including age, past medical history, where they currently live, what (if any) community support they received before they were admitted, previous hospital admissions and what effect (if any) this current ED admission is likely to have on their long term mortality and morbidity status.
Publish their previous medical management plan in the community (and how effective this has been).
Publish the facts of hospital funding eg fines for going on bypass, excess costs of
keeping patients in hospital for longer than their allocated payment per condition.
Publish feedback from patients about their issues like excessive time between actual diagnosis and treatment, lack of basic nursing care, unresolved pain, even lack of food and drink.
Publish feedback from all health professionals about their view of waiting times for treatments, quality and even relevance of treatments, lack of basic care, lack of education, lack of follow up support etc.
Also, publish statistics of how many patients are admitted to private hospitals for conditions that would refused as reason for an admission in public hospitals…
Then, make a plan, strategy, funding announcement.
Duggy, I think you need to re-read the Medicare Agreement. Its not in contravention of any legislation for Salaried medical officers to treat public inpatients as private patients if they elect to be so treated. That is in fact one of the winning incentives for keeping some of the best medical talent in Australia intrinsically involved in the public health system.