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The Health Wrap: as National Cabinet sets a course for health reform, here are some key issues to address

Introduction by Croakey: Is Australia on the verge of a long-awaited and sorely needed move towards cooperative federalism to drive health reform? Encouraging noises to this effect emerged today from the first National Cabinet meeting since the Federal election.

The Prime Minister later told journalists that there had been “a very good spirit, a spirit of engagement, one that recognised our common interests and our common purpose”.

The NSW Premier said “what is incredibly pleasing is a real focus of working with the States and Territories in relation to substantive health reform going forward. This is something that has been in the too-hard basket for too long”.

The Queensland Premier said it had been “a refreshing change to be able to discuss health. Previously, we have tried to get this on the agenda. We’ve got a Prime Minister who listens and understands that health is a big issue and it is a national issue that’s affecting everybody across our nation”.

The Victorian Premier said: “…on behalf of every nurse, every ambo, every doctor, every patient in Victorian public hospitals I want to thank the Prime Minister. Politics was put aside at this meeting and we’ve put patients first and that is the most important thing. Now, the test for all of us will be to work hard in the weeks and months to come, to come up with practical ways in which we can make the system work as a true system”

A statement issued after the meeting said:

• The Federal Government agreed to extend the National Partnership on COVID-19 Response for a further three months to 31 December 2022, at a cost of approximately $760 million.

• There was a commitment to work together to identify practical improvements to the health system and specifically the connections between GPs and hospitals, and “practical ways to get aged care residents and NDIS participants out of hospital and into a more appropriate setting”.

• The Federal Government will work with the states and territories, drawing on local knowledge, to determine locations for Medicare Urgent Care Clinics.

• The First Secretaries Group, chaired by Professor Glyn Davis, has been tasked with developing health system improvements and reporting back to National Cabinet.

• States and Territories expressed their support for the Commonwealth’s commitment to progress a referendum to constitutionally enshrine a Voice to Parliament in the Constitution as a matter of priority.

• The Council on Federal Financial Relations, chaired by Treasurer Dr Jim Chalmers, will provide advice within three months to National Cabinet on pressures on Commonwealth and State and Territory budgets, including anticipated fiscal pressures with a focus on areas of joint funding responsibility.

National Cabinet will next meet before the Commonwealth Budget in October to discuss these reforms.

In The Health Wrap, Associate Professor Lesley Russell delves into more detail about many of the key issues on reform agendas.


Lesley Russell writes:

A key focus for Croakey Health Media and policy wonks in the weeks and months ahead will be the efforts of the Albanese Government to deliver on their election commitments in health, healthcare, Indigenous health and climate change (and in fact any issue that improves the health status and reduces the health disparities of Australians).

I will do my best to keep track of what is happening and report it in The Health Wrap. As part of that effort, there will be a regular segment on the work that the previous Morrison Government left undone in health – an ongoing update to The Accountability Report.

Here are some recent post-election reports on what experts and key stakeholder groups want to see done.

Reform of hospital funding

Professor John Dwyer in Pearls and Irritations:  Desperate Premiers call for radical redesign for health care funding.

The Guardian: ‘Can’t sit in the too-hard basket’: premiers push Anthony Albanese to overhaul health system.

As the national ambulance/Emergency Department/hospital/workforce crisis grows, it is clear that the current National Health Reform Agreements (NHRAs) between the Federal and State and Territory governments must be reworked or the public hospital system will collapse.

Recent State Budgets have shown the Premiers and First Ministers are (finally) willing to put more resources into acute care – Victoria; South Australia; Western Australia; Tasmania; Northern Territory; the NSW and Queensland 2022 Budgets are due this month, although NSW has already announced a $4.5 billion healthcare package ahead of the Budget; the ACT Budget is due in October.

At the same time the States and Territories have called for the Federal Government to abandon a 6.5 percent cap on the growth in NHRA funding and they want total hospital costs, including those incurred as a result of the pandemic, split 50-50 with the Commonwealth (currently the Federal Government contributes only 45 percent of hospital funding).

The current situation is a crisis that daily borders on being unsafe for patients and healthcare workers, but it offers a unique opportunity to address the Federal/State and Territory divides in financing and the disconnects between community-based care, aged care, and acute and sub-acute care.

NSW has already indicated its interest in such an approach (see comments by Premier Dominic Perrottet here and comments by Regional Health Minister Bronnie Taylor here). Medical Republic reports that Perrottet and Victorian Premier Dan Andrews will push for the new National Cabinet to address how hospitals and GPs might work more closely.

More recently South Australian Premier Peter Malinauskus has also chimed in with his support for primary care reforms.

There was a refreshing level of comity at the first meeting of the Council on Friday June 17. Albanese has offered the States and Territories a $760 million extension to the additional funds provided for COVID-19 costs ($934.1 million in 2022-23). For the moment at least he has rejected demands for an extra $5 billion annually into public hospitals, citing the need for budget repair.

That State and Territory leaders leave the meeting apparently satisfied with this is a certain indication they have been promised further considerations of their requests for healthcare reforms in the near future.

The NHRAs commit all governments to explore better ways to pay for healthcare and small budgets are provided for pilot programs of integrated care. It seems that the various initiatives that have been undertaken with this funding take a rather loose definition of integrated care. This work, yet to be evaluated, is described in more detail here.

When was the last time we saw a smiling group of government leaders?

Mental health reforms

Professor Stephen Duckett and Professor Graham Meadows in The Conversation: Mental distress is rising, especially for low-income middle-aged women. Medicare needs a major shakeup to match need.

Work is this area could begin immediately, following the short-term and medium-term recommendations of the Sydney Mental Health Policy Forum (April 2022). Dr Sebastian Rosenberg and Professor Ian Hickie have written about these in Croakey Health Media: A federal election manifesto: options for strategic mental health reform in Australia.

This work outlines reforms that would end the fragmentation which characterises current mental health services, boost accountability, and establish effective, regional control over planning, funding and implementation of community-focused mental healthcare.

Two other aspects of mental health should accompany this work. The first is ensuring that there is an appropriate mental health workforce (see the paper by Rosenberg and Hickie in Australasian Psychiatry (2020): W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design ).

Secondly, this work should be accompanied by implementation of the National Mental Health Research Strategy, released in April by the National Mental Health Commission.

New models of primary care

Dawda et al in Medical Journal of Australia: Value-based primary care in Australia: how far have we travelled?

True et al in Medical Journal of Australia: Lessons from the implementation of the Health Care Homes program

There is general agreement that general practice/primary care needs not just more funding but also reforms to ensure it is fit for purpose and addresses patients’ needs.

The recent paper from Dawda et al makes the case that the primary care sector should be more focused on value-based care, something that is missing in the 10-Year Primary Health Care Plan which was released alongside the 2022-2023 Budget.

A key focus of this paper is on pilot programs (most relatively small in scale and short-term) that have been implemented by both Federal and State Governments and how little we have learned from them, both in terms of what works and what does not.

The list of such projects includes:

The paper by True et al uses information from the interim evaluations to extract three lessons learned from the Health Care Homes initiative. These are relevant to efforts to change the model of care in general practice.

Health Care Homes is a preferred model of care for healthcare professionals and patients, but it was difficult to demonstrate clinical health benefits due to the short implementation time.

Changing the model of care in general practice is complex. It demands changes in workforce, care processes, and patient expectations. Practice facilitators can help with implementing and retaining fidelity to the new model of care.

System enablers such as workforce development, digital technologies, integrated information systems, quality data and alternative payment mechanisms are prerequisites to delivering value-based health care.

Both these papers highlight that new models of primary care require a coordinated team-based approach. A national medical workforce strategy has been developed but a comprehensive health workforce strategy is lacking and workforce issues specific for rural and regional areas are yet to be addressed.

An Australian Centre for Disease Control

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