Sunday, May 11, 2014

Will The Budget Answer Two Big Questions? - The Fate Of The PCEHR and Medicare Locals.

These two are unrelated other than both being initiatives of the previous Labor Government that have been somewhat controversial.
The other e-Health element we will find out about on Tuesday will be at least an idea of what will be happening to NEHTA in the future. Note a glance at the NEHTA web site does not seem to indicate much in the way of staff replacement and hiring happening. Remember that Mr Abbott founded NEHTA as Health Minister.
On Medicare Locals this interesting article appeared on Croaky.

A Croakey #longread: Localism – a way forward

| May 11, 2014 9:49AM |
This week we will learn much about the current government’s vision for the health system through the federal budget. Amongst the revelations will be the future of Medicare Locals.  Many thanks to David Briggs, Chair of the New England Medicare Local,  for allowing us to republish his editorial on localism from the Asia Pacific Journal of Health Management.
Dr Briggs writes: 
The implementation of the national health reforms has seen the introduction of the word ‘local’ into the reform agenda. It is used in the name of State jurisdictions acute care providers and in the national primary health care framework organisations currently described as Medicare Locals. Why is this so? Why has ‘local’ become central to the language of national health reform and of the organisational structures that deliver health services across Australia?
A review of the Final Report of the National Health and Hospital Reform Commission  [1] and the subsequent National Health Reform Agreement  [2] provides limited indicators as to why ‘local’. Neither document includes an underlying philosophy or clear public policy that enshrines ‘local’ with a clear definition or implications about how the word might drive the reforms and the subsequent organisation and delivery of health services. The Final Report sets the word in the context of health system levels describing what might be done at ‘national, regional and local levels’.[1, p.8] It also talks about ‘connection ‘ and ‘integration’ and the need to ‘redesign health services around people’, [1, p.6]‘foster community participation’ [1, p.7] and to ‘foster local implementation models’. [1, p.8]
The National Health Care Agreement is more specific in intent, describing objectives in terms of acute services to ‘improve local accountability and responsiveness to the needs of communities…’ and to ‘decentralise public hospital management…’, ‘to shape local service delivery according to local needs…’, to integrate services and improve the health of local communities’. [2, p 46] According to the Agreement the strategic objective of the newly created Medicare Locals is to identify health needs of ‘local areas’ and the ‘development of locally focused and responsive services’ and in achieving this objective they are to reflect their local communities and health services in their governance arrangements’. [2, p.50]
How do we put this language into practice? Perhaps in the spirit of localism and the concept of subsidiarity, Government should focus on what only it can do best. Firstly, work towards the removal of perversity in funding and payment systems, the impediments to workplace reform that all currently limit initiative and innovation. Secondly, allow generative space and incentives for providers to pool resources to meet common agendas through better use of existing resources. Thirdly, make all new program funding contestable, requiring collaborative partnerships or networks to be developed and governed locally. Fourthly, provide innovation funding for new models of governance and service delivery that substantially address identified local need. Fifthly, reduce the performance management reporting regime to manageable proportions.
It would be good to start the discussion and, perhaps debate about how we might make a real difference in the Australian healthcare system through localism by utilising a diversity of governance models at the local level that engage both communities and stakeholders.
See the original publication here.
See full article and references here:
Worth a read to see how ‘localism’ is being thought about in the Medical Local Sector.
In contrast I found on a ML web site the following information.
A position being described as Project Integration Coordinator - Partners in Recovery occupied by a university trained naturopath. Not sure what a Project Integration Co-ordinator is and why Medicare Locals would be employing naturopaths or am I just to jaded and cynical?

Addit Monday: MLs seem to be going: See here:
As far as the PCEHR is concerned it will be fascinating to see what funding is allocated and to see if there is any explanatory statement as to what any spending announced is intended to achieve.
All will become clear real soon now!

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