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We are promised “bold and ambitious” health reform. What are the chances?

In announcing changes to his Ministry today, the Prime Minister put health matters near the top of his agenda. And he pointedly used the phrase, “universal health system”.

Let’s hope he really does understand what this means: “that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship,” according to the World Health Organization.

The PM said:

We will be implementing our mental health policy and Health Care Home policy, as an important reaffirmation of our commitment to a first-class health system – a first-class universal health system.

“I have met and spoken with the new President of the AMA and I am confident we will have a better working relationship with the AMA and its general practitioner membership.”

It’s not only that sentence above which rings alarm bells (is the AMA really going to be seen as the voice for general practice and health policy more widely?)

The PM also stressed the “strong mandate” for his Government’s policies, which suggests a failure to grasp the depth of concerns surrounding the Medicare rebate freeze, amongst other things. Eventually, this will come back to bite.

No doubt many will see it as a positive that Sussan Ley retained her gig as the Minister for Health, Aged Care and Sport; rather than spending time developing relationships with a new Minister and helping to train them up, presumably health groups will have an idea of the opportunities ahead (or not).

Asked by a journalist if he had consulted any Aboriginal and Torres Strait Islander people before reappointing Nigel Scullion as Indigenous Affairs Minister, the PM replied:

“Nigel has been doing an outstanding job as Indigenous Affairs Minister and I am delighted that he is continuing in that role. I have met with many Indigenous people, including recently at the handover or conclusion, if you like, of the title deeds of the Kenbi land claim in Darwin not so long ago, which I think many of you were present at.”

That sounds like a big fat non-acknowlegement of the Redfern Statement in which Indigenous organisations, with the backing of many health groups and NGOs, issued a landmark election challenge calling for transformative action to address structural inequalities, and to improve the lives of Aboriginal and Torres Strait Islander people.

If the PM and his Government fail to engage with the substantive issues identified by the Statement, then let’s hope the front-page headline writers hold them to account. If not, maybe the Twittersphere will?

Rural health agendas

The Rural Doctors Association of Australia (RDAA) paid tribute to the outgoing Federal Minister for Rural Health, Senator Fiona Nash, describing her as “a strong champion for the rural health sector over many years”, while noting that this meant the rural health portfolio had lost its Cabinet clout.

Nash will retain a number of other portfolios relevant to rural health, however, including as Minister for Regional Development and Regional Communications, and will remain in Cabinet.

The RDAA welcomed the appointment of the Federal Member for Lyne, Dr David Gillespie, as Assistant Minister for Rural Health. He is expected to take over Senator Nash’s previous role in Indigenous Health.

RDAA President, Dr Ewen McPhee, said a key issue would be the development and implementation of a National Rural Generalist Pathway — which RDAA has called for over many years and which the Government committed to during the election campaign.

Dr McPhee said:

The National Rural Generalist Pathway has real potential to deliver more of the right doctors with the right skills to the rural and remote communities where they are most needed, and we look forward to seeing real action taken to progress this over the coming months.

“We also look forward to working with Dr Gillespie to bring into place the role of National Rural Health Commissioner — a measure for which RDAA also advocated and to which the Federal Government committed — and to drive forward many critical policy measures to attract and retain more much-needed doctors in rural and remote areas.”

Who is Dr David Gillespie?

This bio is from his website.

Dr Gillespie
Dr Gillespie

David was elected to the Australian Parliament on 7 September 2013, representing The Nationals – which he joined in 2008. David stood for the Federal seat of Lyne in 2010 and although unsuccessful, recorded a 12% swing at that election against the incumbent Member and won 15 polling booths. David stood successfully in 2013 to win the seat with nearly 65% of the vote.

David and his wife Charlotte married in 1990 and have three children: Isabelle 22, Oliver 20 and Alice 17. David and Charlotte have raised their family on their farm in the Hastings Valley, on which they run grass-fed Angus beef for the export market.

David graduated MB BS from University of Sydney in 1981 and Fellow of Royal Australasian College of Physicians (FRACP)in 1991. As an undergraduate, he gained experience training both in Papua New Guinea and British Columbia. David’s post graduate specialist training included stints at hospitals at Bathurst, Orange and Dubbo while based at Royal Prince Alfred Hospital (RPAH) in Sydney (1981-1982 and 1987-1990). David also gained two years of paediatric experience at Royal Alexandra Hospital for Children (RAHC) Camperdown (1983-84), St George Hospital (1991) and at Sydney’s St Vincent’s Hospital (1992). David obtained a Diploma of Anaesthetics (London) and Diploma of Child Health (UK) in 1986 after working in the UK NHS (1985-6).

Before entering Federal Parliament, David had 33 years of medical practice, including 21 years as specialist Gastroenterologist and Consultant Specialist Physician in Port Macquarie (1993 -2013). David was active in Postgraduate Medical Training as Director of Physician training at Port Macquarie Base Hospital (1995 – 2009) and was instrumental in the Base Hospital achieving accreditation by Royal Australasian College of Physicians for Specialist Training and becoming a Centre for College Examinations.

David and Charlotte built, licensed and ran the free standing Hastings Day Surgery in Port Macquarie for 12 years. During this period, David also lectured and tutored at UNSW Rural Medical School since its inception.

David uses his first-hand experience in public and privately managed health delivery and small business to ensure Australia’s health system delivers high quality cost-effective care in an affordable and fiscally sustainable manner.

David wants to see Australian business, particularly small business, released from unnecessary government red-tape and green-tape at federal, state and local levels of government. David understands the complexity and pressures of primary production in Australia and works to ensure primary producers and processors receive equitable treatment by retailers under Australia’s consumer and competition laws.

Some pragmatic advice

Given the health sector’s generally gloomy pre-election assessment of the Coalition’s health credentials, many must be wondering what the future will hold over the next term.

Let’s revisit the Croakey archives for some ways forward. Former Health Minister Nicola Roxon advised back in the early days of the Abbott Government that there is “opportunity to be had with any new government” (and we all know how that turned out!)

Roxon advised public health advocates to develop relationships with as many potential political allies as possible, and “to be talking to and befriending them before you present them with a big list of demands”.

According to her advice, now is the time to be scoping future health leaders and influencers, who may be Opposition spokespeople, backbenchers on both sides, committee heads – and advocates should also listen to new MPs’ maiden speeches for insights.

We can also revisit an excellent two-part series providing advice to health lobbyists, by Jennifer Doggett – see here and here.

She detailed the importance of central agencies in setting health agendas:

The role of the Minister for Health today is more like a warm-up act and cheerleader for those who really run the political agenda: the Prime Minister and his/her advisers, the Treasurer and Finance Ministers (and advisers), the central agencies of Prime Minister and Cabinet, Treasury and Finance and the governing party’s pollsters, media advisers and campaign strategists.

…policy proposals to improve the functioning of the health system will be considered through a political and short-term budgetary lens, rather than on the basis of their long-term impact on the health of the community.”

All of which suggests that the claim in Minister Ley’s statement (reproduced at the bottom of the post) suggesting we can expect a “bold and ambitious health reform agenda” seems like over-promising. We shall see.

The PM has promised this will be “a term of government for delivery”, and said: “We will be judged in 2019 by the Australian people as to whether we have delivered on the plans and the programs and the investments that we have promised and set out and described in the lead-up to the election.”

In which case, the Government will really need to lift its game – and that will mean a lot more than simply cosying up to their pal at the AMA.


Response from health groups

Below are edited extracts of statements from key health groups.

Consumers Health Forum

“We are encouraged by Prime Minister Turnbull’s commitment to Medicare.  But we urge the Government not to shy away from the reasonable reforms needed to ensure Australia’s universal health system is sustainable in the 21st century,” the CEO of the Consumers Health Forum, Leanne Wells said.

“In responding to the “Mediscare” campaign, the Prime Minister has said that consumers will not pay more to see their GPs because of the freeze on Medicare benefits.  He has reaffirmed ‘the faith of the Australian people in our commitment to health and to Medicare’. And a government spokesperson has also said that a GP co-payment will not be put back on the table.

“These are signals the Consumers Health Forum warmly welcomes.

“However after a decade of health reviews by both sides of politics, Australia now needs to see real action over the next three years that delivers for patients.

“ ‘Don’t touch Medicare’ should not be taken to mean that consumers and the community will be satisfied with the status quo. Medicare and our primary care arrangements are long overdue for reform.

“We must keep universal access but address limitations of fee for service, and ramp up the Medicare benefits system review to stimulate best practice and weed out outmoded services.  And we need to see the benefits of digital technology now taken for granted in other spheres rolled out in health care to deliver better targeted, coordinated and effective services.

“Community expectation is that we have accessible and affordable health care – as clearly demonstrated throughout the election campaign.  Australians deeply value the universal nature of Medicare, our public health insurance scheme.  Medicare is NOT merely a safety net but works best when quality health care is available to all Australians regardless of income.

“Let’s rethink the heavy focus on hospitals and rebalance the system.  Evidence shows that countries with high performing health care have strong primary health care systems.  That means recognising the value of general practice in encouraging people to have a health care “home” so that they assured of the right continuing care

“The Primary Health Networks open a new era of Commonwealth- states cooperation including public-private partnerships. By planning and commissioning regionally in consultation with consumers, clinicians and communities, more responsive and targeted services are within our reach.

“These developments must be spear-headed by real commitment to health care arrangements that will deliver value, invest in innovation and preserve universal access through Medicare and the Pharmaceutical Benefits Scheme.

“Today CHF has written to the Health Minister to outline our priorities on behalf of Australia’s healthcare consumers for the 45th parliament.  These priorities include:

  • Commonwealth leadership on primary health care to drive patient centred health care homes
  • Consolidate Primary Health Networks as regional commissioning organisations to foster place-based, consumer centred health care
  • Pharmacy reform to support new roles for pharmacists
  • Workforce reform to spur integrated care including by specialist and allied health practitioners outside hospitals
  • The national roll-out of personally-controlled electronic health records
  • Reform to the private health insurance arrangements to deliver better consumer value.

The Australian Healthcare and Hospitals Association

“We look forward to continuing to work with Minister for Health and Aged Care Sussan Ley, Assistant Minister for Health and Aged Care Ken Wyatt AM and newly-appointed Assistant Minister for Rural Health Dr David Gillespie in the coming months and years,” AHHA Chief Executive Alison Verhoeven said.

“The clear message from the election is that Australians value universal healthcare highly and want our Government to commit to an accessible, equitable and affordable health system.

“While the Coalition’s recent health initiatives have made some amends for the damaging cuts in the 2014 Budget, there is much work still to be done to address issues of access, equity and affordability.”

With a number of review processes underway, the Turnbull Government must ensure its health system reforms are innovative, patient-centred, sustainable and adequately funded, evidence-based and data-informed, and must look beyond siloed issues and consider their impacts on the broader health system.

“A number of primary care reform packages, for example in chronic disease, mental health and drugs and addictions, underscore the vital role Primary Health Networks (PHNs) play in implementing the Commonwealth’s reform agenda,” Ms Verhoeven said.

“Adequate primary care funding, linked to quality of care, is required to address the growing burden of chronic disease. The Turnbull Government’s Health Care Homes trial needs appropriate resourcing and a focus on quality outcomes to be truly effective. A properly-resourced chronic disease strategy would help millions of Australians improve their quality of life, and provide economic benefits by reducing the impact of chronic disease on the workforce.”

Ms Verhoeven also called on the new health ministry to reverse the Medicare freeze and commit to long-term sustainable hospital funding.


AMA

AMA President, Dr Michael Gannon, said that Ms Ley’s experience in the portfolio, and the lessons learned from the election, will help her lead a new direction for Coalition health policy in the Government’s second term.

Dr Gannon said the close election result, and the prominence of health issues in campaigning right up to Election Day, mean that the Government must review and renew its health platform to appeal to voters.

“The Government, led by Health Minister Ley, must first scrap the Medicare rebate freeze, reverse the cuts to pathology and medical imaging bulk billing incentives, and properly fund public hospitals,” Dr Gannon said.

“Having admitted that health worked against the Government in the election, the Prime Minister must also take an active role in setting a new health policy direction for the Coalition.

“I have already had preliminary talks with the Prime Minister about the way forward in health.

“A renewed commitment to prevention must be at the centre of the Government’s fresh approach to health, along with stronger support for primary care, especially through general practice.”

Dr Gannon said the AMA shares the Government’s view that health care funding into the future must be sustainable, and would welcome close collaboration to ensure universal access to quality health services for all Australians for the long term.

“The Government must consult closely with the whole health sector in the development of new health policies and the reshaping of existing policies to ensure better outcomes.

“The key to good health policy is talking to the doctors and other health professionals who work in the health system every day looking after patients and hearing their concerns.”


Questions from @WePublicHealth

AlisonReplaceWPH2WPH1


Statement from Minister Ley

LeyStatement

The Opposition response

Labor’s health spokesperson Catherine King urged Minister Ley “to end her party’s three year war against Medicare by abandoning her government’s disastrous health cuts”. During the election campaign the minister publicly complained that she had been unable to persuade her colleagues to abandon the Medicare freeze. King’s statement called for the Minister to end the Medicare rebate freeze, abandon cuts to bulk billing incentives for pathology and diagnostic imaging, and to properly fund public hospitals.