Sunday, October 16, 2011

Is The Overall Direction of The Australian Health System Out of Control? I Suspect So and The Problem Is At the Top!

The following very useful article appeared the other day.

Weary troopers on the front lines of an overburdened system

  • by: Adam Cresswell, Health editor
  • From: The Australian
  • October 15, 2011 12:00AM
LUNCH was supposed to start 40 minutes ago, but the trays of sandwiches and cake brought by a waiting drug rep still sit cling-wrapped on the table.
"I can't, I'm still busy," general practitioner Jeff Regnis tells staff who are gathering for the pre-booked rep's visit, intently filling a hissing steel flask with liquid nitrogen, his grim expression a more effective warning against interruption than his words.
"Jeff's had eight 'extras' this morning," nurse Donna Buckley explains in a lowered tone, as Regnis hurries back into his office through the still-packed waiting room.
Extras, also known as fit-ins, are the urgent patients who somehow have to be squeezed into the schedule of the Thornton Medical Centre on the NSW Central Coast. Today, as a glance at the busy 12-doctor clinic's computerised booking system shows, the schedule is chockers, the handful of slots left empty for priority cases on the day having already been filled.
The booking screen resembles a bathroom wall done in multicoloured mosaic tiles, each tile bearing a different name, each name a living, breathing person with their own story of what happens when the body, or sometimes the mind, decides to go its own way.
The staff who automatically cleared a path for Regnis's trip to the nitrogen bottle barely exchange looks. This is how it goes at the coalface of general practice, where the patients come thick and fast and the problems cover everything from men with lower legs that are threatening to turn gangrenous to a two-year-old girl whose four-year-old sister has tried to chop off her younger sibling's finger with a pair of scissors.
"Luckily, they must have been blunt scissors," Buckley says with the deadpan air of someone who has seen it all.
The pace seems manic but Buckley and the other staff say this is typical, even though today is a Thursday, not even the "crazy day" of Monday when the weekend warriors, the have-a-go renovators, those stuck nursing sick children on the weekend and workers seeking a sick note all flood the phone lines.
Heaps more here:
Later in the article some experts turned to the Medicare Locals and the GP Super Clinics.
“However, the GP super clinics have been tainted by accusations of mismanagement and claims they have been chosen according to political rather than medical need. Most of the government's remaining focus on primary care lies in its strategy to introduce Medicare Locals, a $416m attempt to set up an national network of primary health organisations that will help to co-ordinate GP services with those of hospitals and other health providers. They are also meant to play a leading role in improving after-hours services. But much confusion remains about what they will - or should - be doing.
Lightbody, with most of the Thornton clinic's GPs, believes the health reforms in train "don't touch us", and staff remain unclear about what role Medicare Locals will play: a confusion shared by some of the country's top health experts.
At a recent policy round table hosted by The Weekend Australian as part of the Health of the Nation series, Philip Davies, professor of health systems and policy at the University of Queensland and a board member of one of the first wave of 19 Medicare Locals, revealed even one other member of his own organisation's board was confused about the purpose of Medicare Locals, appearing to believe they were GP super clinics.
"That to me is indicative of an abject failure on the part of the government to actually explain what these bodies are," Davies said at the event.
Another expert on the panel, University of Sydney professor of surgery Mohamed Khadra, says the panel discussion, which involved seven of the country's top medical and health policy experts, turned up "four different definitions of a Medicare Local. Clearly nobody knows what a Medicare Local is."
Yet observing the daily struggles and successes of the Thornton Medical Centre's staff yields a quick checklist of some of the things that go wrong at the GP-hospital interface, which Medicare Locals could devote some of their energies trying to fix.
Regnis says one of the main frustrations GPs face is continuing poor communication from hospitals, which happily discharge their patients into the community, leaving them to the care of the GP surgery long before any account of what treatment they received on the wards arrives.”
Inevitably the PCEHR got a mention - and hardly a positive one from the coalface:
"We have had people come back after having strokes . . . and you are ringing people up, chasing imaging results, blood tests, trying to get to talk to the doctor. We need to know why they went in, what was done and what is the post-discharge care schedule," Regnis says.
The planned system of electronic health records may address this, but there remains doubt about the extent to which patients will trust the system enough to opt in, and whether doctors will want to risk heavy penalties for privacy breaches.”
You can read the views of the experts in more detail here:

If I were health minister . . .

THE Weekend Australian convened a panel of some of the nation's leading health policy experts to discuss how to fix the system. We began by asking, if they were health minister, what would be the first thing they would do.
Interviews here:
If there is a theme running through all these interviews it is that the reforms are partial, at best, and not likely to deliver what is needed in the present form.
When you go to the Federal Government Health Reform Site the emphasis is on the following:
GP Super Clinics:
There is a very current update here:

More Opportunity for Health Investments as Primary Health Care Reforms Being Delivered

The Australian Government is improving access to frontline health services across the country in a snap shot of primary health care reforms released by Minister for Health and Ageing Nicola Roxon on 12 October.
The sort of issues that are emerging is illustrated here:

AMA calls for super clinics inquiry

13th Oct 2011 AAP
HEALTH Minister Nicola Roxon has taken a swipe at the AMA following the association’s call for the auditor-general to investigate the federal government's GP super clinics program.
The move by the AMA comes after Ms Roxon announced the scrapping of a planned clinic in Darwin on Wednesday and the axing of a Tasmanian super clinic last week.
AMA president Dr Steve Hambleton has written to Auditor-General Ian McPhee "urging a thorough audit of the program by the Australian National Audit Office".
Dr Hambleton accused the government of putting political needs ahead of patients.
"There is emerging evidence that the GP super clinics program is a failed initiative in concept, design and implementation," he said in a statement.
"In terms of planning, the location of clinics appears to be largely a political process that is not necessarily linked to community need."
More here
Medicare Locals:
You can read all about these here:
For at least one on the ground view try here:
Lyn Morgain, CEO of the Western Region Health Centre in Victoria, argues that Medicare Locals are a disappointingly long way from the original vision of primary health care reform.”
Lastly, of course is the PCEHR, which is covered in detail in the blog:
The link to the main Health Reform Site is here:
Additionally we have to recognise that the reform of Health Funding was blocked by the States and we still have a Therapeutic Goods Administration that can’t actually make sure materials which make therapeutic claims actually have any evidence for those claims.
Bottom line is as follows:
1. Nation Health Funding Reform essentially failed.
2. No one really knows what Medicare Locals are.
3. The GP Super Clinics are being rolled at very slowly with all sort of issues about scope of services, short funding, displacement of established practices and so on.
4. The TGA is an under-resourced toothless tiger, and nonsense scams are able to collect punters money and flourish.
5. Of course the PCEHR is hardly a project which is going well - with 'panic' as to the risk failure now upon us!
With all that going wrong, we now have the Minister responsible for all these implementation difficulties and failures attempting to push the same rather pushed primary care sector into happily and excitedly taking up the extra work associated with the PCEHR.
Dream on Minister is all I can say!
Am I the only one who can’t work out why change (good, bad, misguided or not) is always called reform? I thought reform implied improvement and I can’t see much actual improvement here - and many others seem to have much the same view.

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