Tuesday, October 08, 2013

Will Mr Dutton Be A Health Minister We Can Have Some Confidence In? At Least He Talks The Talk!

It really is interesting times in the Federal Health sector. The only words to come from the Federal Minister in public seems to be an interview on ABC’s Life Matters.
25/09/2013
Transcript of interview of Minister Dutton on Radio National by Natasha Mitchell on the Life Matters program.

Transcript of Interview on Radio National

Transcript of interview of Minister Dutton on Radio National by Natasha Mitchell on the Life Matters program.

Page last updated: 25 September 2013
25 September 2013
Topics: Mental Health, Priorities for Government
Natasha Mitchell: It's been a big first week for Australia's new Prime Minister, Tony Abbott, and the federal government. His new ministers were officially sworn in last week. Peter Dutton was the Shadow Minister for Health and Ageing for five years while in opposition. Now he takes the posts of both the Minister for Health and for Sport. This means that he's effectively responsible for what were three separate roles under the Rudd Government. You'll recall that mental health was a separate portfolio as well.
Now, health is always near the top of Australians' list of priorities. The minister certainly has a complex job ahead and a significant recent legacy of national health reform to pick up on, and so what are the minister's priorities for your health? What will stay, what will go, and what might be new? Peter Dutton joins us on the line from Canberra.
Thank you very much for joining us on Life Matters, Minister.
…… (Lots omitted).
Peter Dutton: Well let's again look at the facts Natasha. I mean the Government imposed the so called alcopops tax. In actual fact the consumption of spirits has gone up since the introduction of that tax. What we've said is that we're very keen to pursue evidence based policies and ideas that can work, but we don't think for argument sake that prohibition would work in terms of alcohol or tobacco. I think if we're starting with a clean slate and we're having a discussion about the federation today and we were starting fresh as a country I'm sure that we would approach things differently both in terms of the way in which regulation's imposed at a state and federal level, but also in relation to tobacco for argument sake. I mean I think wherever we can discourage the take up of tobacco we should because we know of the health outcomes, we should do whatever we can [indistinct].
Natasha Mitchell: [Talks over]Do you acknowledge though, Minister, that regulation has a place in targeting some of those powerful vested interests that contribute significantly to poor outcomes? So, the tobacco industry, the alcohol industry, the junk food industries, who are in our face with their products in a major way and target young people too?
Peter Dutton: Well let's again take, sort of, a factual case study into consideration. When Tony Abbott was the Health Minister, we introduced the graphic warnings onto cigarette packaging. Now, that has had the greatest impact in terms of the reduction of smoking rates in addition to the increase in excise. In Opposition, I proposed an increase in the tobacco excise, and the Rudd Government eventually took it up. They announced increase in tobacco excise, again during the course of the last couple of months we adopted that same policy.
So, we're happy to adopt measures that have proven to be successful and an increase pricing around tobacco has been part of the reason that we've been able to reduce smoking rates in this country to some of the lowest in the western world. Part of the tobacco problem, that I don't think we've concentrated on, to be frank, is in indigenous communities, or in the take up around young women and young men, for arguments sake. And I think that part of our focus going forward really needs to be about how we can reduce smoking rates in indigenous communities. I think that is a national shame, the smoking rates within indigenous communities at the moment. And I think we can start to target some effort in those areas and I think, frankly, that would be a great and positive outcome for our country if we could start to target more those indigenous smoking rates.
Natasha Mitchell: Okay.
Peter Dutton: So we're not opposed to evidence based, but the only point that I'd make here…
Natasha Mitchell: Good to hear.
(More omitted)
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The full transcript is here:
(Italics and emphasis is mine.)
So Mr Dutton says he wants to be evidence based in making policy. That is just great but what does it mean for e-Health?
To me the first thing he needs to do is access and release and evidence base on which the design and implementation of the NEHRS / PCEHR is based ad facilitate and expert review of the evidence to understand just how justifiable and evidence based the whole program is.
Without trying to prejudice the outcome of the review I have to say that at present I can find no publicly available evidence backing the architecture, design and implementation approach of the PCHER. This is especially true of one is looking for evidence of improved clinical outcomes based on such an implementation.
Indeed it is very hard to find good evidence supporting improved clinical outcomes from national Shared Electronic Health Records Systems - for example the UK NHS Shared Care Record Program.
There are a number of evaluation studies that have been conducted on the UK system.
Here are some links:
A defence of summary care records - Mark Walport [Wellcome Trust]
These links are taken from an excellent article which is important reading.

Trisha Greenhalgh on Summary Care Record - where does the truth lie?

Ted Ritter
Found here:
So Mr Dutton’s challenge is really pretty simple. First to test the evidence that shows worthwhile clinical utility from the e-Health program as it presently is and then to reshape it based on what proper sound evidence actually shows.
We can all wait and watch!
David.

9 comments:

Bernard Robertson-Dunn said...

I do hope Mr Dutton isn't promoting evidence based policy as something new or as a magic bullet.

If they haven't already, he and his advisers would be well served by reading the Productivity Commission's publications on "Strengthening Evidence-based Policy in the Australian Federation" which came from a roundtable held at Old Parliament House in Canberra on 17-18 August 2009.

http://www.pc.gov.au/research/conference-proceedings/strengthening-evidence

They should also have a look at the many warnings about being cautious and not misusing the techniques of evidence based policy. It's not always (ever?) as good as it is claimed to be.

e.g.
The current enthusiasm for evidenced-based policy needs to be met with a greater degree of methodological caution. 11 April 2013

"Michael Bassey encourages the (UK) government’s foray into evidence-based policy-making, yet with a note of methodological caution: good research only provides an indication of what may work, rather than a definitive solution. Instead of expecting policy to be evidence-based, it should be seen as evidence-informed."
http://blogs.lse.ac.uk/impactofsocialsciences/2013/04/11/the-current-enthusiasm-for-evidenced-based-policy/

and...

Is evidence enough? The limits of evidence-based policy making
June 17, 2013
http://www.instituteforgovernment.org.uk/events/evidence-enough-limits-evidence-based-policy-making

IMHO,it is very easy to misuse what seems to be evidence.

e.g there is evidence that IT has worked well in other industries, therefore IT should work well in health.

e.g a health record in a hospital has proven to be a success, therefore a national health record should also be a success.

Evidence is only a start. The conclusions you draw and predictions you make based upon that evidence is the big weakness.

Dr David More MB PhD FACHI said...

Bernard,

However, using properly assessed evidence is still way better than guessing - as the previous Government did - would you not agree?

David.

Bernard Robertson-Dunn said...

David,

I was pointing out that evidence based policy is not new nor the answer to a maiden's prayers.

However, all policy, all business cases, all architectures are a matter of guessing. They are predicting that something will work - there are no guarantees.

Evidence is important as long as it is used in conjunction with well thought through proposals. It makes for better predictions.

Evidence is also important when evaluating initiatives - as long as the criteria are meaningful. e.g. health outcomes not registration numbers.

I'm not disagreeing with you that properly assessed evidence has been missing, I'm adding that what's also been missing is smart thinking.

Anonymous said...

There was enough evidence that a national summary care record would probably not work as expected, available and known to DOHA (although clearly ignored), prior to PCEHR launch:

https://www.mja.com.au/journal/2011/194/2/do-we-need-national-electronic-summary-care-record?0=ip_login_no_cache%3D583f9f0affe97b153bd599e61d2e7472

Terry Hannan said...

David, this is a pertinent part of this blog. "Without trying to prejudice the outcome of the review I have to say that at present I can find no publicly available evidence backing the architecture, design and implementation approach of the PCHER. This is especially true of one is looking for evidence of improved clinical outcomes based on such an implementation.
Indeed it is very hard to find good evidence supporting improved clinical outcomes from national Shared Electronic Health Records Systems - for example the UK NHS Shared Care Record Program."
There is positive evidence out there and the tendency for the Australian community to focus in the UK rather than elsewhere Europe (other than UK) and North America, means our Federal health policies on e-health are likely to stutter and fall over. Maybe again there will be lost of "funded" trips to the UK. An excellent example of evidence and the need to focus on CLINICAL DECISION MAKING is from this weeks publication from the National Academies (free and downloadable) on variation and decision making. "Variation in Health Care Spending: Target Decision Making, Not Geography Joseph P. Newhouse, Alan M. Garber, Robin P. Graham, Margaret A. McCoy, Michelle Mancher, and Ashna Kibria, Editors; Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care; Board on Health Care Services; Institute of Medicine."

Bernard Robertson-Dunn said...

re my comment about being careful with evidence based policy:

Quote from http://www.instituteforgovernment.org.uk/events/evidence-enough-limits-evidence-based-policy-making#sthash.nbL5gnhM.dpuf

Cartwright argued that while social-scientists often stress that the populations must be “sufficiently similar” to ensure external validity, this condition is too vague to be useful. She went on to give a more precise pair of conditions, which are jointly necessary and sufficient for external validity:

* there must be the same underlying causal structure in the two populations
* there must be the same distribution of ‘supporting’ or ‘helping’ factors (what social scientists might call mediating variables, or economists call interaction variables.)


Just because there is evidence, does not mean that evidence is valid when applied to a different population.

The UK does not have states. The USA is much larger. Singapore is much smaller and, effectively, a single city.

Which country does have a socio/politico/health environment similar to that of Australia?

Anonymous said...

Be careful what you are arguing.

The counter proposition - that we are 'special' so that the international evidence does not apply here - is exactly the line used by DOHA to support the PCEHR, despite the unsuccessful UK experience.

Yet the failure of the PCEHR seems pretty much a textbook replication of the UK one if the main themes are examined - poor and late clinical engagement, political design independent of use cases, meaningless business case fabricated for funding ends alone, centrally procured and maintained infrastructure etc etc.

Yes, one should always be careful when extrapolating evidence from one setting to another, but that does not mean that extrapolation is not possible, not informative, and not worth doing.

Bernard Robertson-Dunn said...

Anon said "The counter proposition - that we are 'special' so that the international evidence does not apply here ..."

That is not the counter proposition to my argument.

My argument is "be careful". The counter argument would be "don't be careful".

If DoHA argued that Australia is special then why choose the Singapore system? Which, based upon today's PulseIT article, is going to undergo a major upgrade next April.

IMHO, the PCEHR has been less than a success because there is no evidence of health outcomes.

Dr David More MB PhD FACHI said...

The only thing you can be sure of is that the upgrade will not correct the fundamental architectural / design flaw of the PCEHR. Namely the PCEHR was not designed to meet the needs of clinicians providing patient care.

David.