Opening speech, Australian Healthcare and Hospitals Association Congress 2008, Rydges Lakeside Resort, "Reform - the New Era", Canberra, 25 September 2008,
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25 September 2008
Dr David Panter - AHHA President and Executive Director, Statewide Services Strategy, SA Health
Dr Christine Bennett - Chair, National Health and Hospitals Reform Commission
Prue Power – Australian Healthcare and Hospitals Association executive director and Congress Convenor
Dr Patrick Bolton - AHHA Vice-President
Conference speakers, and participants.
Thank you for inviting me here to open your Congress.
It’s interesting how the wheels of reform turn.
Looking at the AHHA today, who would have guessed that it was formed as a national body in 1947 in opposition to health reform proposals floated by the then Prime Minister Ben Chifley!
Well, the AHHA today stands as one of the more progressive voices in the field of health policy development and I’m pleased to be here today to open your Congress.
Chifley did not succeed with his plan to create a national health service, to the relief of the AHHA founders.
But he did succeed in setting up Commonwealth grants to the states to subsidise public hospitals and - after a lot of stops and starts - the fledgling Pharmaceutical Benefits Scheme.
These have grown into pillars of our public health system – along with Medicare - just as the AHHA has evolved into a stalwart supporter of public health care and reforms.
Over the last decade or more, the AHHA and its members have acknowledged the need for wide ranging reform of the public hospital system.
The Rudd Government shares your belief in:
- the right of all Australians to universal coverage and equity of access to the healthcare system; and
- national healthcare policy solutions that are socially and economically sustainable.
The national reforms that I am developing will be devised and implemented in cooperation with the states and territories and the public health services they administer.
And despite some resistance, I discern a level of excitement about potential change.
Unless we make the effort to fix our system now, and equip it for the 21st century, we will see it decline in terms of health outcomes, hospital performance, unsatisfied demand and rising costs, as well as a growing gap between those who have the health services they need, and those who do not.
And whilst some at the very conservative end of the debate would not shed a tear at the demise of Medicare, the principle of universality, or free access to public hospitals, the Rudd Government and, I am sure, the community, believes that the universal benefits of Medicare and the PBS are worth fighting for.
They are a part of our culture, a reflection of the core Australian value of a fair go for all.
So let me gallop through these strong first steps to show what we have done in less than 10 months in Government to rebuild, to show how the Rudd Government has moved very swiftly to provide funding support as a down-payment on reform. Then I’ll explain how, at the same time, we are also working through, step by step, the medium and longer term reforms which are needed.
We have injected an extra $1 billion dollars into the public hospital system – which needed immediate resuscitation. This will go some way towards redressing the $1 billion that the Liberals cut from public hospitals during the last Australian Health Care Agreements negotiation.
In addition, we have allocated $600 million to reduce elective surgery waiting times for patients who have exceeded the clinically appropriate waiting time. The first $150 million has already been delivered, to treat over 25,000 long-wait elective surgery patients. The second $150 million will go on capital projects to bring about lasting changes.
We are well advanced in plans to relieve 31 under-serviced communities around Australia, by setting up GP Super Clinics at a cost of $275 million.
The GP Super Clinics will provide the health care that families need, using new service and ideally teaching models, and relieve the pressure on overloaded hospital emergency departments.
To help with our strained health workforce we will create 1,170 new university nursing places - per year - from 2009 – and spend $39.4 million to bring 8,750 trained nurses back into the health and ageing sector workforce within five years, including 6200 into public hospitals. We have also recently extended the Pre-vocational General Practice Placement Program to accommodate growing demand and need in general practice.
And in addition, in our first budget, the Government announced the establishment of a $10 billion Health and Hospitals Fund, which will be available to fund major health infrastructure, new medical technology and new medical research facilities. This is the biggest Commonwealth investment in health infrastructure ever.
The scale of such commitments, the sheer dollar figures, are incomprehensible to your average citizen. But by anyone’s measure, not least Treasury’s, these are massive investments. And more so when you think of the contrast between the 10 months just past and the previous decade.
Of course, you and I understand this sort of funding will not of itself fix the system, but it will certainly help start moving us in that direction.
Reform is about much, much more than just funding.
Too often individuals and bodies repeatedly state that what’s needed to fix the system is simply more funding to do things in the same way as they’ve always been done.
This is in my mind not reform – it is just a bid for growth funding. If the whole system worked faultlessly, and there was growth, then this might be fair. But no-one seriously argues we have yet achieved that nirvana.
Now don’t get me wrong, growth funding is required, and it’s required on a sustainable level. Through COAG, the PM, the Treasurer and I are all talking to all the states and territories about this right now.
But unless we work out new ways of doing things to better manage demand, and to innovate in the way we deliver services, we as a sector will always be playing catch-up football.
When advocating for your agencies, for more and better quality services, think about how this will be coupled with very specific and concrete reforms.
I can tell you now, that proposals and bids which involve new, creative, innovative, more efficient, and better quality services have a much greater chance of getting the attention of policy makers across Governments than mere requests for more money to carry on.
Over the next nine months or so there will be a massive amount of work to finalise our reform agenda. I note that Christine Bennett, the Chair of our National Health and Hospitals Reform Commission, is here today as your keynote speaker. Christine has the job of examining the longer term aspects of our reform program – from funding and State / Commonwealth responsibilities, to inequities in the system, the public/private divide and so much more.
The Commission has already produced its first report - Beyond the Blame Game: Accountability and performance benchmarks for the next Australian Health Care Agreements.
I thank those of you here who have put in submissions - it will make the work of our Commission much stronger.
I’m sure Christine will take you through emerging issues and ideas – the final report is due to the Government in the middle of next year.
More immediately, we are working through the Council of Australian Governments - and particularly its Health and Ageing Working Group, which I chair, to negotiate a new Australian Health Care Agreement.
In stark contrast to the table thumping and finger pointing that has characterised these negotiations for some years, we are working to end the blame game.
That doesn’t mean everyone will get everything they ask for. This is the real world! But it does mean we can talk rationally and find the solutions that work best for the people of each jurisdiction. There are some very exciting proposals that are now well developed and cover a range of options to be considered, from the prevention and sub-acute care end through to indigenous health and new hospital systems.
This agreement will include better health and hospital indicators and clearer benchmarks - which I hope will span both the public and private sectors.
I’ve spoken previously on other occasions about my belief that these indicators will be a breakthrough in giving us objective information about how parts of our health system are performing so that we can raise standards across the board.
But today I’d like to focus on another aspect of reform we’re working through, and that is a nationally consistent Activity Based Funding system for hospitals.
Now, all jurisdictions currently use some form of activity-based funding to varying degrees – with the crucial word being “varying”.
If we move in this direction, the key to success will be a consistent, nationally applied system where the efficiency of similar hospitals in undertaking similar procedures is assessed accurately, whether they are in Perth or Sydney, Adelaide or Brisbane, Geelong or Coolamon.
It is technically difficult, but done properly, activity-based funding could help drive the system towards best practice, while providing clear incentives for innovation and improvements – driving the reforms we all need.
By collecting nationally consistent information, we would be able to develop a clear picture of just how much particular procedures currently cost – and how much they should cost, if delivered effectively.
Even if not used to set a national price it would immediately mean hospitals could be compared, and benchmarks quickly developed.
Efficient hospitals will thrive, while those less efficient will have to have a good look at their systems to come up to standard. The overall picture would be one where hospitals across the country will have to benchmark against similar hospitals, driving their costs towards the most efficient hospitals, with the best standards.
I need to emphasise here that I strongly believe that people within hospitals are working as hard as they can – but that ineffective structures often get in their way.
While these steps are some way off, moving to this structure would allow the Commonwealth in the future to work with the states and territories to set targets, based on a combination of activity, efficiency, safety and quality.
Efficient hospitals will thrive, and will be able to use any surplus funding to treat more patients, deliver better quality services, or to drive reform in other areas of the hospital - while those less efficient than the benchmark will have to have a good look at their systems to come up to standard.
This has direct benefits to patients – as every health dollar will be driven further to treat more patients, better.
This could lead to one of the biggest efficiency reforms ever implemented at a national level in hospitals – but without a national tool it will falter.
It is vital that reforms like this happen hand-in-hand with an emphasis on safety and quality. These will be key to our national performance indicators, and they will be strictly monitored through the Australian Health Care Agreements.
At the same time as moving to fundamentally improve our hospitals, we are focussing on enhancing front line primary care (particularly in rural and remote communities) and investment in prevention. For too long governments have focussed on the remedial aspects of health care – treating people when they become sick instead of preventing sickness.
This demands that we look at workforce skills and duties in new ways. Health workforce shortages are now the norm across the world, and we have no choice but to respond creatively.
I firmly believe that we need the right professionals in the right place to provide the right care, and this will involve a better role delineation.
For instance, I see no reason why appropriately trained, nurses, physiotherapists, psychologists or dieticians, for example, could not relieve doctors of some of their workload and allow them to better utilise their skills.
This would have to be done with care – and doctors would remain central – but if we can encourage doctors to focus on the more complex elements of their craft, while encouraging other health professionals to take on other aspects, then we could deliver significant improvements in the way we use our existing workforce.
And of course, the reformed system that I envisage will include preventative health as an integral element, not an optional extra; because this is what we need, to reduce the onslaught of chronic and avoidable disease.
The Preventative Health Taskforce which I set up in April, chaired by Professor Rob Moodie, is advising on strategies to promote prevention – especially in relation to obesity, tobacco and alcohol.
The Taskforce will shortly be issuing a discussion paper to elicit comment on the key issues and ways we all can - as a community, not just a health sector - bring about this important shift in approach.
Of course, last but by no means least, we could not think about reforming health without considering inequality and social justice, and the appalling 17-year life expectancy gap between Indigenous and non-Indigenous Australians.
The Rudd Government has committed to tackle this problem - recognising that Indigenous health is not just about health services, but is part of the broader, complex issue of Indigenous disadvantage.
We cannot ensure better health for Indigenous people throughout their lives unless they also have opportunities for education, housing, employment, and a sense of community.
We have committed to reporting to Parliament each year on our progress against 3 important targets, or outcomes –
• Halving the mortality gap for children under 5, in 10 years;
• Halving the gap in literacy and numeracy in 10 years; and
• Closing the life expectancy gap within a generation.
We have set these ambitious objectives to ensure accountability is clear, and so that we can measure progress – openly and up front.
And we are getting on with the job through a broad range of programs addressing factors from alcohol and drug abuse through to providing training to Indigenous aged care workers and new intensive maternal and child health services.
In agreed in principle to a National Partnership with joint?July 2008, COAG funding of around $547.2 million over six years to address the needs of Indigenous children in their early years.
So I hope this has given you the flavour of our commitments to date and our determination to bring about real and lasting reform.
Reform is hard work and sometimes involves challenging existing structures and interests – so of course we need and want your support and encouragement when you see us taking these important steps.
The agenda for your Congress certainly sets out the challenge to be part of this reform process, and I very much look forward to hearing what you collectively come up with.
Thank you, and good luck.
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