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The Tasmanian health rescue: don’t break out the champagne just yet

The Federal Health Minister Health Minister Tanya Plibersek recently announced a $325 million emergency rescue package for Tasmania’s health system.

Part of the deal, she said, was “that these investments result in improved health services by imposing a strict reporting and accountability regime on the Tasmanian Government”.

The Tasmanian Government will be required to report monthly on how it spends the dough, and what services it provides.

As well, a Commission on Tasmanian Government Delivery of Health Services will be established, led by independent experts, to examine how the Tasmanian Government is delivering health services and whether they are being provided as effectively and efficiently as possible.

The Tasmanian Health, Michelle O’Byrne, welcomed the package, and said it would help the State Government to “confront the unique challenges in the Tasmanian health system including our older and decentralised population”. She said it would allow an additional 650 elective surgery procedures to be conducted every year for the next four years, and she also acknowledged that Tasmania would have to increase the efficiency of its health system.

Premier Lara Giddings also welcomed the package, and said she was particularly pleased the Commonwealth had agreed to exempt the deal from the GST distribution process.

The Tasmanian branch of the Australian Medical Association has reportedly also welcomed the package, while warning it does not provide a long-term solution.

But in the article below, health policy analyst Martyn Goddard warns that the news is not as positive as the reported reaction might suggest.

***

The federal health package: less than meets the eye

Martyn Goddard writes:

The federal health package, negotiated between the Commonwealth government and the Denison independent, Andrew Wilkie, comes with an impressive price tag. In a small state like Tasmania, $325 million – even spread over four years – makes a great headline.

The Minister’s announcement can be seen here. But a closer examination reveals that much of this money is poorly targeted and many millions of dollars will be spent without improving people’s health or the services they so desperately need. Much, in other words, will be wasted.

First, the positives. This money will improve the Tasmanian health and hospitals system, which the state government – even more than other state and territory governments around the nation – simply cannot afford to run. Some of the cutbacks in elective surgery – though by no means all – will be reversed.

There is likely to be better – or at least better funded – care for patients at GP clinics for people with chronic disease, though how much of this will be new money is uncertain. There will be more money for community-based palliative care for the dying and for patients recently discharged from hospital.

All good stuff. But it’s a whimper, not a bang.

Let’s look at the detail.

• An elective surgery ‘blitz’ aiming to provide extra 2600 operations over four years, costing $31.2 million. That amount of money, spent in a single year and then repeated through the life of the agreement, would have made serious inroads into the huge backlog of elective surgery cases.

And let’s not forget that ‘elective’ means anything that can be delayed for 24 hours. Some of these people have been waiting for years. This money will not be enough to reverse last year’s budget cuts, let alone to address the backlog.

And much depends on the design of the package. Previous federal money for elective surgery has focused on the raw numbers of operations rather than on what is actually being done. So, to boost the figures, there were a lot of cataract operations (cheap, quick) and not many hip replacements (expensive, slow). The federal minister’s concentration on a simple number – 2600 – leads one to think the lesson may not have been learnt.

• About $22 million for ‘walk-in clinics’ in Hobart and Launceston ‘that provide care for minor illnesses and injuries, for extended hours and at no charge to patients’.

It is not clear from the announcement whether these will be intended to reduce pressure on hospital emergency departments by treating GP-type cases that don’t need emergency department care, or are to be an extension of the ‘GP Super-Clinic’ policy which has failed so embarrassingly already.

Either way, this money will almost certainly be wasted. Overcrowding in emergency departments is not caused by GP-type patients, who are easy to treat, but by seriously ill people unable to find room on a ward.

Research has shown that taking away the 20% least complex cases would reduce ED staff workload by only about three per cent. Walk-in clinics attached to emergency departments have been tried before and have made no appreciable difference. If this measure means more GP Super-Clinics, experience shows the money will be wasted. Most people who need free GP treatment can already get it: over 80% of consultations are bulk-billed.

These clinics have been extraordinarily expensive to establish and have often merely displaced existing practices, with no net benefit to the population.

• $48.7 million over four years ‘to support better care in the community to prevent and manage chronic diseases’. This money will be delivered through the Tasmanian Medicare Local, a network of GPs and others that replaced the former Divisions of General Practice.

Much will depend on how this money is spent, but better – and better coordinated – community-based care for people with chronic illness is urgently needed. Past programs in this area have tended to be restrictive, and have therefore neglected people in need of care, and have run into opposition from doctors over money and administration. Perhaps it will be better this time: $48.7 million is reasonably generous for such a program, assuming it is all new money.

• $74.5 million over four years for community-based palliative care and for newly-discharged patients. Potentially very important and beneficial, but it will again depend on whether this is new money or is simply recycled from existing programs, and on how well it is spent.

• $53.9 million over four years to train more medical specialists. This measure is likely to fail. More medical students does not mean more doctors. We have plenty of medical students in our university lecture theatres; the problem comes when they cannot get internships to continue their specialist training at hospital level.

And that bottleneck is not caused primarily by funding but by experienced specialists not having enough time both to train more students and to treat their patients. For too long, governments have assumed that by putting more students in at one end of the medical education system, more doctors will come out of the other. We are now at the stage when this simple equation is no longer working.

• $15.4 million over four years to address gaps in mental health services. Again, much depends on whether this is new money and on how it is spent. $3.84 million a year is hardly generous.

• $36.8 million over four years ‘to roll out the Personally Controlled Electronic Health Records’. This measure has no business being included in this package. It relates to a quite separate, existing Commonwealth program. But to the extent that some of this money can be used to improve hospital information technology – a huge problem in Tasmania – it is welcome.

• $42 million over four years ‘to support innovation in clinical services’ through more research. Good news for the Menzies Research Centre and the University of Tasmania, which will get most of the funding – assuming, again, that this is new money. It is unlikely to produce much practical benefit to patients in the short to medium term and should probably not be included in this package.

Unless these measures are locked down in a watertight contract between the federal and state governments – and there is little sign in the federal or state announcements that this will be the case – an incoming Liberal government in Canberra could tear the whole thing up.

Unless there is an electoral earthquake of a magnitude not envisaged by the Richter scale, Tony Abbott will be Prime Minister by this time next year. He and his new health minister will have their own priorities and policies, and will not automatically continue those begun by the Gillard government so late in its term.

And unless the European financial crisis quickly goes away, the world may be by then heading into a second global financial crisis. In that case, both federal and state governments will be cash-strapped and looking for what they can cut.

Tasmania’s doctors, nurses and patients would be well advised to keep the corks securely in their champagne bottles, at least for the moment.

Some of this money will make a difference to people’s health: much will not. Either way, this is not a time to celebrate.

***

Martyn Goddard’s previous Croakey posts

The financial crunch and its impact

How Tasmanians lost out in the Royal Hobart deal

The argument for a federal takeover of health in Tasmania

 

 

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Croakey Conference News Service 2013 – 2019
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Closing the Credibility Gap 2013
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Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
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2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
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Cultural Solutions - Healing Foundation forum 2014
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National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
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Population Health Congress 2015
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