Continuing the theme of a recent Croakey post, below are some more suggestions for the new Health Minister Tanya Plibersek from Crikey Health and Medical Panel members, who were asked:
1. What useful advice might the outgoing Health Minister Nicola Roxon give her successor?
2. What have been Nicola Roxon’s most significant achievements as Health Minister?
3. What have been the most disappointing aspects of her time as Minister?
4. Your overall assessment of Minister Roxon’s tenure?
5. What should be the top three priorities for the new Minister Plibersek?
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Prue Power, Australian Healthcare and Hospitals Association
1. What useful advice might Nicola Roxon give the new health minister?
Federalism, remember federalism. Virtually nothing that happens in health care is the sole responsibility of one level of government. Investing the time and energy into re-building trust and co-operation between the two levels of government will be vital to making progress on just about any health policy issue in the next few years.
2. What have been Nicola Roxon’s most significant achievements as health minister?
Ensuring survival of the health reform process with some of the key elements of reform intact – most notably:
Capacity for local decision making about healthcare delivery via establishment of Medicare Locals and Local Hospital Networks but their success or otherwise will depend on how well these new entities work together to achieve better integration and coordination and to ensure the most appropriate balance of investment across sectors;
A national approach to financing arrangements, including transition to national standards for activity-based funding in public hospitals;
A national approach to data collection and performance reporting.
Ensuring successful passage of the plain cigarette packaging legislation through the Parliament.
3. What have been the most disappointing aspects of her time as Minister?
Not rectifying the failure of the national health reform process to include a clear funding stream for community health services.
4. Your overall assessment of her tenure?
Survived, relatively unscathed and made positive headway in key areas of health services delivery and prevention. In a portfolio as difficult and complex as health, this is noteworthy.
5. What should be the top three priorities for the new Minister Plibersek?
Ensuring the structural aspects of the Government’s health reforms – the establishment of new national governance agencies and the creation of Medicare Locals and Local Hospital Networks at the local level – deliver tangible improvement in health service delivery.
Ensure a culture within the system which encourages new and innovative models of patient care to emerge and be funded, subject to clinician-led assessment; such as expanding alternatives to inpatient care and opportunities for patients to be discharged to supported acute care.
Establish a phased approach to funding oral health care which ensures, over time, that all Australians have access to preventive and restorative, regardless of their ability to pay, commencing with a focus on early intervention and treatment for children and disadvantaged groups concurrently with enhancing health promotion and prevention programs.
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Carol Bennett, Consumers Health Forum
1. What useful advice might Nicola Roxon give the new health minister, Tanya Plibersek?
Put consumers at the heart of the health system – keep people well and away from the expensive end of care provision. Greater transparency in funding arrangements; supporting a Senate inquiry into the Community Pharmacy Agreements between the Government and the Pharmacy Guild of Australia would be a great start.
2. What have been Nicola Roxon’s most significant achievements as health minister?
The stand out is introducing the world’s first plain packaging legislation to combat tobacco. Clearly she has made an enormous contribution to many areas of reform – the most significant for us has been the active involvement of the consumer voice in the health reform agenda.
3. What have been the most disappointing aspects of her time as Minister?
Perhaps the most challenging issue for any health minister is managing the vested and powerful sectional interests in the health sector, which often conflict with the best health outcomes for Australian consumers.
4. Your overall assessment of her tenure?
Minister Roxon’s legacy was her willingness to listen to the views of those who use and fund the health system – not just the medical providers and industry. Funding for Our Health, Our Community will enable consumers to have a voice in health reform. Her desire to make a difference was stifled by the reality that health is not as much about health outcomes as it is about constitutional, political and funding issues.
5. What should be the top three priorities for the new Minister Plibersek?
1. Listen to the views of consumers and put their needs at the heart of the health system.
2. Reprioritise health towards prevention and primary health care and away from the acute end of the spectrum.
3. Measure the consumer experience of health services and act on that information to improve the health system.
Other comments: Australia spends around 1% of its total health budget on prevention, which says everything about where that sits as a priority. There are real opportunities to promote better health literacy through practical measures such as labelling and advertising in the areas of complementary medicines, food and alcohol.
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Jon Wardle, University of Queensland
1. What useful advice might Nicola Roxon give the new health minister?
Don’t shy away from conflict from the numerous vested interest groups holding back health reform in Australia. Nicola was one of the few health ministers who was brave enough to public acknowledge what most public health academics already knew – that what was good for vested interest groups (the AMA in particular) was not always good for Australia’s health system. These groups have already formed a long line outside Tanya’s office.
2. What have been Nicola Roxon’s most significant achievements as health minister?
Being the first health minister in a long time to be brave enough to take on many of the vested interests in Australia’s health system to. Initiating discussion on primary care reform and bringing a shift to focusing on preventive medicine (though it remains to be seen whether this focus results in action).
3. What have been the most disappointing aspects of her time as Minister?
Her appetite for reform has not always been matched with the proper support to deliver them. Big-ticket items have been rolled out quicker than they probably should have, without the proper foundational work needed to underpin them. The mess made of AHPRA is a good example, though not one that she is fully responsible for.
Similarly Medicare Locals are a fantastic idea but one that seems doomed to fail without further support in this embryonic stage – support that may or may not be forthcoming. Politics has sometimes been more important than good policy, and unfortunate compromises made as a result.
4. Your overall assessment of her tenure?
Big on vision but not always big on practicalities. She has been brave enough to take on many of the vested interests holding good health reform to ransom for decades.
Unfortunately the politics means that her achievements will not be fully appreciated for some time, but if her vision pays off she will be one of the few health ministers that has left an enduring and positive legacy, even if there have been a few mistakes along the way.
5. What should be the top three priorities for the new Minister Plibersek?
Continue the push for a multi-disciplinary Australian health system, ignore the Chicken Little antics of vested interest groups.
Focus on primary care and preventive medicine, and try to remember that health is not just dependent on hospitals and GPs, but the result of social and policy factors as much as health ones.
An E-Health focus is good but E-health can’t exist without data. Collecting it isn’t enough, it needs to be accessible to organisations involved in health reform – there is already useful data waiting to be used but inaccessible to health analysts. Health system reform won’t happen without good data, and Australia has a lot of work to be done in this area.
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Professor Hal Kendig, Health Sciences, University of Sydney
Let us hope that the move of Mark Butler into Cabinet will provide the impetus necessary for Government to accept and implement the crucial recommendations by the Productivity Commission into Caring for Older People.
Further, his new responsibilities for social inclusion augers well for the belated inclusion of older people into a social justice agenda that to date has largely excluded vulnerable older people. In both of these areas Minister Butler should be informed and empowered by his extensive consultations with older people, carers, and their advocates.
