Well Mr Rudd and Ms Roxon have almost got their Health Reform Package through. Now to see how they go implementing it!
The first thing to be said about the communiqué is that it is amazing how many times the phrase – “COAG agreed, with the exception of Western Australia,” gets used!
The second thing that is really of some considerable concern is the number of times it is assumed that information will be available to guide various aspects of implementation – and how there has been no investment to ensure that information will be available. Any investment in e-Health has been put off into the (distant) future and it is now not clear who will pay for what.
With Mr Rudd funding 60% of public hospitals – does that include Health IT and so on. He has been saying he is picking up all new capital expenses so I wonder what that means for HealthSMART and NEHTA?
For the record here is what was said about e-Health.
“E-Health
COAG noted the importance of continuing to work towards a National Individual Electronic Health Record system and agreed to prioritise discussions over the coming months to move towards the implementation phase.”
Page 12 of Communiqué.
Sadly we still have rubbish about IEHRs and so on and no plan for implementation of the National E-Health Strategy. Fortunately mention of the Personally Controlled EHRs seems to have been weeded out.
The third thing that really caught my eye was this from the Network Agreement.
Responsibilities of the States
A1. States will be responsible for:
a. being the system manager and single purchaser of public hospital services, in order to ensure clear responsibility for day-to-day hospital system operation to deliver strong performance and patient outcomes;
b. system-wide public hospital service planning and policy, including arrangements for providing highly specialised services and adjusting services between LHNs to meet changes in demand;
c. system-wide public hospital capital planning and management, and capital planning and project management for hospital capital projects;
d. in most cases, ownership of existing and new public hospital capital and assets, unless decided otherwise by the State; and
e. managing LHN performance.
A2. States will be responsible for purchasing services from LHNs under a LHN Service Agreement, which will include:
a. the number and broad mix of services to be provided by the LHN;
b. the quality and service standards that apply to services delivered by the LHN, including the Performance and Accountability Framework;
c. the level of funding to be provided to the LHN under the LHN Service Agreement, through ABF and block funding; and
d. the teaching and research functions to be undertaken at the LHN level.
- Page 16.
To the uninformed eye this looks remarkably like the States retain control – to mess up – the public hospitals but have a bigger bucket of money to do it with.
Fourth, it is clear there are a lot of people at the ‘coal face’ who are deeply sceptical as to how this will all work – especially in the hoped for integration with primary, aged, preventive and mental health services. Most seem to think the ‘blame game’ is still on for one and all!
This link provides a very useful transcript and discussion.
http://www.abc.net.au/worldtoday/content/2010/s2878916.htm
Play MP3 of Panel picks apart Prime Minister's plan ( minutes)
- (Presenter) Eleanor Hall
12:14:00 21/04/2010
Panel picks apart Prime Minister's plan
The World Today invites John Dwyer, Professor of Medicine at the University of NSW; Prue Power, head of the Australian Health Care and Hospitals Association; Dr Sally McCarthy, president of the Australasian College of Emergency Medicine; and Professor Ian Hickie, from the Brain and Mind Research Institute at Sydney University, to discuss the merits, or otherwise, of the Prime Minister's plan.
Last we do have the issue of implementation risk. The Australian Health System has a very large number of moving parts and I suspect all sorts of ‘unintended consequences’ will emerge from all this.
Well pretty much enough on all this – we shall wait, watch and despair at the incoherent approach to Health Information Technology being adopted by this Government.
Those who suggest this was a lot about politics and a little about health may be right.
A useful summary of the reactions is found here:
Doctors divide over status quo in pools
- Adam Cresswell and Lanai Vasek
- From: The Australian
- April 21, 2010
THE price of health reform -- allowing states to play a continuing key role in the running of hospitals -- is a disappointment for many doctors and experts are concerned it may create a business as usual mentality.
Handing states the role of funding the new local hospital networks -- instead of funding them directly from Canberra -- emerged as one of the concessions that persuaded rebel states NSW and Victoria to sign on.
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As a near final comment I found these remarks really offensive and ill considered.
Deal adds cash but no big reform: doctor
April 21, 2010 - 9:34AM
.....
Prof Dwyer, chair of the Australian Healthcare Reform Alliance, believes the problems with the hospitals system won’t change under an arrangement where the Commonwealth becomes the dominant funder.
The bickering that occurred during this week’s meeting of the Council of Australian Governments was just a preview of what was to come given the states and territories and the commonwealth were still sharing responsibility.
“It’s not going to change the inefficiencies, the duplications,” Prof Dwyer said.
“We’re still going to have nine departments of health for 22 million people, we’ve still got all the cross-border area problems because we don’t have a single funder.”
The federal government and state counterparts lost an opportunity to implement significant change, such as integrating primary, community and hospitals care into one, Prof Dwyer said.
“We could live with the fact that it might take us three or four years to change this and that, but that journey’s not laid out on the table.”
Prime Minister Kevin Rudd dismissed the criticism, saying he was just one of thousands of doctors across the country who had their own ideas about how best to tackle health reform.
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Obviously a man suffering from a very large dose of arrogance and rudeness. John Dwyer and Ian Hickie have forgotten more about health services than this PM will ever know.
I think this from Adam Cresswell best summarises my view.
Health deal trade-offs limit the utility of pact
- COMMENT: Adam Cresswell
- From: The Australian
- April 21, 2010
KEVIN Rudd's original plan envisaged the states still having "some skin in the game", namely a financial incentive to make sure hospitals were efficient and not wasting cash.
The trouble is, the compromise worked out yesterday gives the states not just skin, but arms, legs and hands as well. And many fear they will be using those limbs to meddle in the remodelled arrangements far more than originally planned.
.....
The consensus appears to be that it's all a lost opportunity for the Rudd reforms, which some feel may now never accomplish their full potential.
What went wrong? For one thing, Rudd and his Health Minister, Nicola Roxon, almost certainly spent too long -- seven months -- jetting around more than 100 of the nation's hospitals to consult on last year's Bennett report findings, but then left themselves just seven weeks to sell their response to the report.
For another, the proposed reforms were simply not sold very well.
As many have pointed out, there was undue emphasis on hospitals at the expense of primary care -- which could help keep patients out of hospitals in the first place -- and the government's response deteriorated into a series of ever less coherent announcements more designed to buying off doubters than contributing to systemic reform.
The response came to resemble everything that the two-year reform process was supposed not to be: rushed, politicised and ad-hoc. The government's reform credentials will hinge on its ability to turn that perception around.
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David.
