NSW voters are expected to return Mike Baird’s Coalition Government this weekend (see reports at The Conversation and The Guardian), but the results in the Upper House are less certain, as former MP Rob Oakeshott pointed out at Croakey earlier this week.
What are the health issues and concerns at play? Croakey contributors give their assessments below.
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Public health nutritionist Dr Rosemary Stanton
1. What are the key public health issues facing NSW electors? How should they weigh up the respective parties’ policies in these areas?
The need for the State Government to sort out with the feds who pays for health care from GPs and in hospitals. The ageing of the population needs to be tackled – primarily from the point of preventing common ill health in old age, due to lifestyle factors.
Voters need to weigh up who will tackle the Federal government most effectively on these issues. Will the Coalition stand up to the Abbott government or will they just lie low? Can Labor make enough fuss to achieve better equity on these issues?
2. What are the key healthcare issues facing NSW electors? How should they weigh up the respective parties’ policies in these areas?
Prevention is crucial. Which party cares enough about kids’ health to tackle the school canteen system (which is currently hopeless in NSW with kids fed junk by catering companies that have taken over many school canteens), the siting of fast food outlets, the provision of decent food in hospitals and aged care facilities (the latter two need urgent attention).
3. What have been the major developments, from a health perspective, during the election campaign?
Nothing much seems to be on the agenda for action, but at least the Labor party has been fighting against the Federal government plans to make GP care less affordable for the poorer members of society.
4. What is your headline advice to the next NSW Government (in one sentence)?
Save money later by spending on preventative health measures now.
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Anonymous
The biggest problem for the NSW health system is the Abbott Government’s intention to walk away in 2017 from the needs based funding growth component of the current, bipartisan, commonwealth-state health funding agreement.
This will leave the NSW Government with insufficient funds to offer free comprehensive hospital care to all based on medical need from 2018 (or 2019 at the latest).
So if Baird accepts the Abbott Government’s intention – and it is clearly not just a barnacle – he would have to plan to either raise taxes, hospital based charges or debt to keep the hospital network operating at its current barely sufficient level.
While it has been easy in the election campaign to say he does not accept Abbott’s position, the question of what he will do after the election remains.
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Wendy Oakes, Policy and Advocacy Manager, Heart Foundation NSW
Below are the issues the Heart Foundation NSW focused its advocacy on during the election campaign. They’re not the only – or even most important – issues in cardiovascular care but they’re achievable in the current climate and would improve the lives of the 1.2 million people living with cardiovascular disease in NSW as well as the increasing number of people at risk.
1. What are the key public health issues facing NSW electors? How should they weigh up the respective parties’ policies in these areas?
Increasingly sedentary lifestyle and obesity. While there was a lot of talk about building roads (admittedly with some mention of public transport in Sydney), building infrastructure to support walking and cycling was rarely mentioned. We need to get people out of their cars and onto their feet.
2. What are the key healthcare issues facing NSW electors? How should they weigh up the respective parties’ policies in these areas?
Sadly the election discourse was largely about hospital care rather than healthcare. It was good to see major announcements about buildings but the limited big dollar commitments to providing comprehensive health services, especially for Aboriginal people, was disappointing.
The two urgent issues which need to be addressed in cardiovascular health are the low use of cardiac rehabilitation services which can significantly reduce a second event, and the continuing high rates of Acute Rheumatic Fever and Rheumatic Heart Fever in Aboriginal people, conditions rarely seen in non-Aboriginal Australians.
3. What have been the major developments, from a health perspective, during the election campaign?
It was pleasing to hear Liberal, Labor and Greens commit to varying degrees of regulation of e-cigarettes but it needs to go further than the Liberal Party’s commitment to just banning sales to children. NSW had legislation to ban sales to children back in 1901 which didn’t stop smoking rates rising to 27% in 1984. It was only comprehensive tobacco control measures, including State legislation restricting marketing and providing smoke-free environments, which delivered the current 7.5% smoking rate in NSW school children.
4. What is your headline advice to the next NSW Government (in one sentence)?
Heed the lessons from the past 50 years of tobacco control in Australia and regulate e-cigarettes with comprehensive legislation now, rather than fight for one regulation at a time for the next 50 years.
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Associate Professor Gawaine Powell Davies, CEO, Centre for Primary Health Care and Equity, UNSW
1. What are the key public health issues facing NSW electors? How should they weigh up the respective parties’ policies in these areas?
Influence of the urban environment on health, as we continue to in-fill cities and fail to deal adequately with transport
The environmental impacts (especially on water) of CSG.
The contribution of expanding coal mining on global warming.
2. What are the key healthcare issues facing NSW electors? How should they weigh up the respective parties’ policies in these areas?
Building strong links with Primary Health Networks and through them general practice, to strengthen health care in the community.
Developing effective models for linking with private and non-government services – models that don’t simply outsource and fragment.
Dealing with expanding demand and restricted budgets.
3. What is your headline advice to the next NSW Government (in one sentence)?
Don’t be spooked by the doomsayers.
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Meanwhile the Hunter Primary Care Ltd (aka Hunter Medicare Local) has shared its briefing to NSW election candidates:
Background
Hunter Primary Care Ltd (HPCL), trading as Hunter Medicare Local is a not for profit, Company Limited by Guarantee. We have been delivering quality health care programs to the Hunter community for more than twenty years.
Currently the organisation trades as Hunter Medicare Local, though in previous years as a Division of General Practice). We are governed by a Board of Directors, currently comprising six clinicians (including three GPs) and three community/business skills based representatives.
In May 2014, the Commonwealth Government announced that from July 1 2015 Medicare Locals would be replaced with Primary Health Networks (PHNs). We have joined with the New England and Central Coast Medicare Local to submit a collaborative bid to operate the Primary Health Network (PHN) that will cover the Hunter, Central Coast and New England regions. We expect an announcement on successful bids in the coming weeks.
How can we help the state government deliver efficient and effective health care?
We acknowledge that the state government is not responsible for funding primary care. However, we believe the state versus commonwealth blame shifting that has plagued health reforms in the past needs to be rejected. The evidence is overwhelming that if you want to reduce health expenditure you need to stop people going to hospital in the first place. The way you do that is by integrating care across the entire system.
In the Hunter we are currently engaged in a formal partnership with Hunter New England Local Health District and Calvary Health called the Hunter Alliance. The Hunter Alliance is approaching the management and treatment of chronic health conditions from a true partnership perspective. All three organisations are sharing responsibility for developing innovative ways to improve people’s healthcare in the Hunter region.
The Hunter Alliance is operating as one system and can provide a practical model for improving health care across NSW.
Examples of how we are “keeping people well and out of hospital”
Outlined below are brief details on three service we are operating that clearly demonstrate how we are helping to reduce unnecessary hospitalisations and providing the right care, in the right place and at the right time.
General Practice Access After Hours (GPAAH)
GPAAH provides an exemplar model for the provision of after-hours primary care. The GPAAH Service is strongly valued by the community and is seen as essential in reducing inappropriate hospitalisations. Preliminary analysis of a formal review being undertaken by Hunter Medical research Institute (HMRI) and hunter Valley Research (HRF) show GPAAH is delivering significant savings to the health system.
Key facts about GPAAH include:
- established in 2003 with more than 1,000,000 patient services delivered
- in the last financial year, over 250 GPs work in an integrated model with nurses
- the patient streaming service received over 90,000 phone calls in the last year, with 25% of those callers not requiring clinical care or hospitalisation
- over 50,000 patients seen annually in 5 clinics co-located in Local Health District facilities
- around 10,000 of those patients initially presented to the ED
- over 90% of patients attending GPAAH see a GP within 30 minutes.
Care Coordination Program
The Care Coordination Program (CCP) is a hospital avoidance program that reduces the burden on the acute health system by assisting individuals to manage their own health care needs outside hospital. Hunter ML receives referrals for patients identified by Hunter New England Local Health District as being frequent users of the acute health system and falling within the top 2% of the patient complexity range.
A review of patients receiving CCP services show that most require assistance beyond those relating specifically to health. Many of the patients have issues such as low socioeconomics, mental health, health literacy, isolation (both physical and social) and housing instability.
In 2014 an audit of the program was undertaken involving one hundred and forty-nine (149) patients with a total of 1217 encounters with the acute health system. Data 12 months prior to activation and 12 months post activation was analysed and compared.
Results demonstrate a 30% reduction in the overall number of acute events in the 12 months post CCP activation (both emergency and elective admissions). Further, a significant decrease in the number of emergency presentations pre (533 events) and post (382 events) CCP activation led to a 28.4% reduction in emergency presentations. Significantly the data indicates that there has been a shift in patient acuity (triage category) post CCP activation demonstrating that when patients do present to hospital they present generally for health needs which require emergency interventions, that is, they are presented to ED for issues unrelated to their chronic health condition.
Aged Care Emergency (ACE) service
ACE is a service that aims to reduce potentially avoidable presentations to the Emergency Department (ED) by elderly patients in Residential Aged Care Facilities (RACFs).
The ACE service is a collaborative partnership between Hunter ML, Hunter New England Local Health District, Ambulance NSW, RACFs and local GPs. The service piloted in 2012 at John Hunter Hospital and now operates across 7 EDs (John Hunter, Belmont, Calvary Mater, Maitland and Manning Rural, Tamworth and Tomaree) with over 80% of RACFs in the Hunter region having implemented the system
ACE provides RACF staff with training and support to complete a full assessment for clinical handover to a GP. If a GP is unavailable, as is often the case ‘out of hours’, staff call the ACE phone number for advice and support from a Registered Nurse (RN). Clinical support is provided using evidence based algorithms and a decision is made to treat in the RACF with GP support or transfer to ED. The ACE RN coordinates the sharing of clinical information between the RACF, GP and the ED. A recent evaluation of the ACE service has been conducted by the Hunter Medial Research Institute (HMRI) to measure the costs and savings of the service. Preliminary data show:
- $994,000 or $16,800 per 100 RACF bed, savings in ambulance and ED costs.
- 74 % of calls to the ACE phone line during business hours prevented a transfer to ED
- In the afterhours period this rose to 86% of calls preventing an ED transfer.
ACE is reducing potentially avoidable presentations to the ED. ACE is a tangible demonstration of a program that is providing the right care, in the right place and at the right time. Even more impressively it is doing this while saving the health system money by reducing avoidable ED presentations and freeing up ambulance services to respond more readily to urgent calls in the general community.
• Track Croakey’s NSW election coverage here.
