Items for discussion:

• What has the pandemic taught us?
• How does the pandemic redefine roles in the health / healthcare system, especially nursing?
• Where are we with integration (especially community care and aged care)?
• What’s happening with training pipelines and career development for junior clinicians?
• Tackling out-of-pocket expenses.
• Update on MBS Review.

 

What has the pandemic taught us?

Huge problems in the health care system have been exposed. But the system has good bones and is integral to Australia’s success in tackling the pandemic. Now fears that future austerity measures will destroy this.

Key among issues discussed:

• Need to move beyond FFS for primary care.
• The central role of the public health system and the inadequacy of the private system in pandemic times.
• Need to establish what we have learned / are learning that will help deliver better care.
• Teamwork is essential.
• Roles in the healthcare system have been redefined.
• Nursing is at the frontlines in every aspect.
• The strength of the professions has been highlighted.
• Telehealth has opened possibilities but is not a solution to all problems.
• Quality and safety remain real issues (this includes availability of proper PPE).
• Real time data important for analysing, targeting, evaluating.
• A plethora of research publications – but where is the implementation?
• Better communications needed.

 

How does the pandemic redefine roles in the health / healthcare system, especially nursing?

• Concerns about what pandemic has meant for clinical training.
• Mental health of clinical staff has been battered, will be an issue into the future.
• Need to see nursing role and capabilities across the health / healthcare system/s (acute, community, prevention, aged care, disability care, etc)
• Nursing voice is rarely heard.
• Professional turf fights hamper progress.

GHRG must do more to make the case for nursing

 

Where are we with integration (especially community care and aged care)?

• Better integration of community care requires coordination between Commonwealth and States and Territories.
• Commonwealth funds community care but it totally divorced from provision of that care.
• States run hospitals but the function of these is curative, not prevention.
• Commonwealth funds aged care for sickest Australians.
• There is a gulf between primary care and acute care – leads to disconnected care, duplication, waste.
• The case for Community Health Centres as set up in 1970s (initially hospital based, then separated from acute care)
• Integrated, multi- professional
• Covered chronic disease, aged care, child health, later HIV/ AIDS
• CHCs represent an alternative institution to hospitals and a redistribution of power.
• ACCHOs are excellent model
• Look to what can be learned from US models of CHCs and similar.
• Aged care issues discussed:
• National ACAT teams in 1980s dismantled because thought unaffordable.
• Compare this to current MyAgedCare system (with recognition that people needing aged care often unable to make decisions).
• DVA, NDIS, Aged Care operators all compete for same, limited workforce.
• Importance of functional, usable MyHealthRecord for such an integrated health / healthcare system.

References:

Rosen et al. The future of community-centred health services in Australia: lessons from the mental health sector. Australian Health Review 2009, 4(1); 106-115. https://www.publish.csiro.au/ah/fulltext/AH09741

Community health. Victorian Government https://www2.health.vic.gov.au/primary-and-community-health/community-health

Aboriginal Community Controlled Health Services are more than just another health service — they put Aboriginal health in Aboriginal hands. NACCHO website. https://www.naccho.org.au/wp-content/uploads/Key-facts-1-why-ACCHS-are-needed-FINAL.pdf

Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community‐controlled health services: Leading the way in primary care. Med J Aust. 2014;200(11):649–52. https://www.mja.com.au/journal/2014/200/11/aboriginal-community-controlled-health-services-leading-way-primary-care

Whelan.  The Importance of Community Health Centers: Engines of Economic Activity and Job Creation, Center for American Progress. 2010. https://www.americanprogress.org/issues/healthcare/reports/2010/08/09/8195/the-importance-of-community-health-centers/

 

What’s happening with training pipelines and career development for junior clinicians?

Concerns that this has been adversely impacted by coronavirus pandemic.

 

Tackling out-of-pocket expenses

• MBS Review has recommended a tribunal where patients can take outrageous billing. But will it have teeth?
• Outpatient specialist clinics for specialists would help.
• Specialist care not always essential for disease management but offer this is patient’s choice.
• Need to assess wasted dollars (low-value care, over-servicing)

References:

Holden et al. Overtreatment as an ethical dilemma in Australian private dentistry: A qualitative exploration. Community Dent Oral Epidemiol 2020; 00:1-8. https://onlinelibrary.wiley.com/doi/abs/10.1111/cdoe.12592

Russell & Doggett. A Roadmap for Tackling Out-of-Pocket Health Care Costs. APO. 11 Feb 2019. https://apo.org.au/node/219221

 

Update on MBS Review

• Final report is with the Minister (note – no acknowledgement of this on website). To date, about one-third of recommendations have been implemented. Reduction of some 200 / 5000 MBS items.  But acknowledgement that this is micro-economic reform and not a realignment of values.
• What happens next? Report makes a recommendation for ongoing MBS review alongside integration with MSAC which determines what gets on to MBS.
• Need to implement time -tiered payments for consultations – balancing time vs skills.
• Fate of primary care recommendations up I the air because of failure to get agreements from various components of primary care workforce.
• Proposed voluntary patient registration with GP practice.

 

Research

• Concerns that Australia is not getting value for research dollars.
• Funding provided thus far for coronavirus research does not reflect needs.
• Is Morrison Government using MRFF as a slush fund – handing out small sums in a scatter-gun approach?
• Little funding available for health services research.
• Too many failures around implementation of research into practice and continued R&D into commercial initiatives.

 

 

Driving issues forward

• The case for public health services has never been stronger.
• But how to drive revitalisation of public health/healthcare mission?
• Concerns that we are not on a pathway to reform but “Build back Worse”. Governments will use pandemic costs as an excuse to implement austerity measures with disastrous consequences.
• Lots of plans written but implantation is poor.
• Who are the agents of change? How to build on the strength of the professions? In the absence of government appetite and action for reform, this is where drive for change must come from. Patients’ agency also critical.
• Concerns that many in medical professions are more concerned about their own back pocket interests – do they care if the current healthcare system is far from universal and unfair.
• Health administration and universities are increasingly about managing the money, so not seen as major source of leadership.
• FFS remuneration is a problem. Need to look to New Zealand’s mixed capitation / FFS system which has been in place for 20 years.

Reference:

Williams et al. When Systems Fail UK acute hospitals and public health after Covid-19. Foundational Economy Collective. June 2020. https://foundationaleconomycom.files.wordpress.com/2020/08/when-systems-fail-uk-acute-hospitals-and-public-health-after-covid-19.pdf

 

Conclusions

Lots of ideas – not so many solutions.

For February meeting:  nursing forum?