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The Health Wrap: an election with high health stakes, questioning reform efforts, and music for health and wellbeing

In her latest column, Adjunct Associate Professor Lesley Russell takes readers from the Rocky Mountains to lutruwita/Tasmania, Canberra, and Borroloola in the Gulf of Carpentaria, investigating wide-ranging health matters along the way, including how music can influence our physical and mental health.

The quotable?

Everyone knows that we can’t just do more of the same and get a health system that’s set up for the future.”


Lesley Russell writes:

The next few editions of The Health Wrap will come to you from our home at Keystone in the Colorado Rockies.

Most days here start with skiing or snowshoeing, and later we fire up the computers and get to  work.


#TasVotesHealth2024

By now I expect everyone knows that lutruwita/Tasmania is headed for a state election on March 23. As the only State currently with a Liberal Government, this is being watched closely by the political pundits.

The Tasmanian Premier, who has been working with a minority government for some time after a number of Liberal Party MPs retired or rebelled and moved to the crossbench, was forced to call an election a year ahead of schedule.

The dissenters were unhappy about the lack of transparency over a controversial deal with the AFL to build a publicly funded stadium on the Hobart waterfront and the proposed Marinus electricity link across Bass Strait and Rockliff’s conservative stance on social issues.

The pundits fully expect that, given Tasmania’s Hare Clark electoral system, the next government will also be a minority or coalition government.

This is reinforced by polling data suggesting Tasmanian voters are turning their backs on both major parties. Forty percent of voters said they would support the Jacquie Lambie Network, the Greens, and other independents.

When voters were asked in December about the most important issues for them in the election, healthcare (85 percent) cost of living (85 percent), access to a GP (76 percent) and cost of housing (69 percent) came out on top. A new football stadium did not rate.

Labor leader Rebecca White has positioned the election as a battle of priorities. She says cost of living relief is more important than a football stadium on Hobart’s waterfront. And she has supported providing extra money for regional hospitals and ambulance services, and funding rent incentives.

The question will be how to pay for this – although given that the current Rockliff Government has enmeshed the State finances in debt, it is somewhat churlish of them to be campaigning against Labor on the funding issue.

Tasmania’s public healthcare system is constantly in the headlines for negative reasons. The state’s four major public hospitals have had adverse findings in regards to deficiencies in care and sub-standard treatment.

Last August, Health Minister Guy Barnett urged Tasmanians to make use of alternative primary healthcare options where appropriate to avoid adding to the demand at public hospitals.

He claimed that almost 40 percent of all presentations to Emergency Departments in Tasmania in June 2023 were not urgent and may have been appropriate for treatment in an alternative health care setting, including virtual care and advice, mental health support, pharmacies, general practices, and Urgent Care Clinics (Tasmania now has four Urgent Care Clinics funded by the Commonwealth Government).

A summary of the data from the June 2022 report, Drivers of Tasmania’s Future Population Health Needs, highlights why more attention must be paid to Tasmanian health disparities.

Tasmania already has the oldest population of any State or Territory; the median age is projected to increase to 44.9 years by 2040.

Since 2009, the proportion of Tasmanians reporting excellent/very good health has declined and the proportion reporting their health as either good or fair/poor has increased. It is projected around 32.5 percent of Tasmanians will report their self-assessed health status as fair/poor by 2032 (compared to 21.7 percent in 2019).

Tasmanians are more at risk of having a long-term health condition than is the case nationally, even when age is taken into account.

Tasmania remains behind the national rate for several health risk factors, including obesity, smoking and vaping, alcohol use, physical activity, and consumption of fruit and vegetables.

Compared to the other states and territories, Tasmania has the poorest levels of educational attainment, and the lowest average weekly full-time earnings.

• Please join us at Croakey in using #TasVotesHealth2024 to share related news and create a collective platform.

Compilation of election headlines from The Mercury newspaper in Hobart
https://www.abc.net.au/news/elections/tas/2024/guides

National health reform matters

In the December 5, 2023 edition of The Health Wrap I wrote about the much awaited mid-term review of the National Health Reform Agreement (NHRA) 2020-2025, which was due for completion that month.

Little did I know that the final report of the review was already in the Government’s hands (It was publicly released, or at least put up on the APO website, on 7 December 2023).

Peter Breadon from the Grattan Institute has done an excellent job of summarising the report and what it means for healthcare reform in his recent article for Croakey Health Media, What will it take to unlock big health reform.

I would highlight just two points from the review.

  1. The NHRA (and its subsequent Addenda) does not operate as a health system agreement, but as a technical hospital financing agreement and, while it has had success in this area (ie it has improved technical efficiency), its broader aspiration to take a system-wide approach and drive innovation and integration and improved health outcomes has not been realised (ie it has not delivered allocative efficiency and, as the population ages and complex conditions increase, the delivery of the right care in the right place at the right time is not happening).
  2. The review recommends the establishment of a national innovation and reform entity (the National Innovation and Reform Agency), authorised and resourced to work with jurisdictions and national bodies to establish priorities, develop innovative approaches and implement a long-term reform program driven by performance data and supported by an Innovation Fund.

This latter recommendation was music to my ears – I have long been advocating that Australia establishes the local equivalent of the Center for Innovation that was established under Obamacare within the Centers for Medicare and Medicaid Services (there is more information about this center here).

What can we expect in response to this review, with its clear statements about problems and needed reforms, from the Commonwealth and State and Territory Governments?

The Commonwealth has already committed to increasing its funding for public hospitals – the new addenda to the NHRA in 2025 will include an additional $13.2 billion over five years from the Commonwealth. This was part of a series of commitments made by National Cabinet in exchange for the States and Territories agreeing to double the annual increase in state funding for the NDIS.

Is this enough to stop the ongoing argy-bargy over funding? And will it deliver needed reforms?

As pointed out by Breadon: “Everyone knows that we can’t just do more of the same and get a health system that’s set up for the future.

“This investment shouldn’t crowd out reforms to make hospital care more efficient, or investment in prevention and primary care to keep people out of hospital in the first place.”

We might ask what happened/is happening with the funding provided under the NHRA Addenda 2020-2025 for new models of care?  These are outlined in the Long-term Health Reforms Roadmap which was agreed to by the Health Ministers in September 2021.

See my article in Croakey Health Media from 1 February, 2023: After years of reform recommendations and agreements, brave leadership is required.

And although the National Health and Hospitals Reform Commission was some years ago, many of its recommendations, specifically those that look to lessen the pressure on acute care services through better prevention and early intervention, are still relevant.


Whither the Australian Centre for Disease Control?

The establishment of the Australian Centre for Disease Control (CDC), an election commitment made by the Albanese Government, is underway, although as is increasingly becoming the case with health-related issues and this Government, information is in short supply.

There is next to nothing on the website of the Department of Health and Aged Care and on the website for the interim CDC.

A discussion paper was released in November 2022 and there was also a Stakeholder Consultation Report issued sometime in 2023.

There is a Statement of Intent, issued in November 2023, that outlines how the Commonwealth and State and Territory governments will work together and in partnership with Indigenous Australians to support the establishment and operation of the interim CDC (launched January 1 this year within the Department of Health and Aged Care and currently headed by Chief Medical Officer, Professor Paul Kelly) and a timeline for delivering an agreement to support the fully developed CDC. No indication is given of when this might be expected.

Just two short sentences outline the scope of the CDC. These are:

  • To facilitate, support, and strive to deliver better population health outcomes for all Australians.
  • To work with state and territory governments to prevent and control communicable and non- communicable diseases and protect Australia against future emergencies that affect human health.

The Statement outlines five objectives:

  1. Incr