National Health and Hospitals Reform Commission: Developing a Blueprint for a Better Health System

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National Health and Hospitals Reform Commission: Developing a Blueprint for a Better Health System

Speech by NHHRC Chair Dr Christine Bennett to AMA National Conference 31 May 2008

Thank you, Madam Chair.

Good morning, Minister, fellow panellists, colleagues, ladies and gentlemen.

It is a pleasure to speak at this important policy session for the AMA.

Given the title of this session, let me say at the outset that I am the Chair of the National Health and Hospitals Reform Commission – not the National Health and Hospitals Nationalisation Commission.

I will be talking today about the work of the Commission, which was established in February this year to take a long-term view in reshaping health care in Australia.

The Government has asked the Commission to provide a blueprint for design and a plan of action to tackle current and future challenges in the Australian health system.

These challenges include:

• The burden of chronic disease,
• Inequities in the health care system, including for rural and remote communities
• Unhealthy behaviours and lifestyles,
• Unacceptable waiting times to access services,
• The ageing of the population,
• Rising health costs, and
• Inefficiencies and waste in the system made worse by cost shifting and the blame game.

And we have a year in which to do this. So, we are moving at a pace.

I should point out at this stage that our health reform plan will maintain the principles of the universality of Medicare, the Pharmaceutical Benefits Scheme and public hospital care, and preserve the rebates for private health insurance.

I am privileged to be working with a group of truly committed, passionate and clever thinking people on the Commission.

The ten Commissioners have considerable experience and expertise across the health spectrum.

But our work will not be limited to our knowledge or our individual or collective views.

The health system belongs to all Australians and they deserve to have a say about its future.

But we are also looking to our dedicated health professionals who will hold many of the answers.

You will be key contributors in helping us make our design real and achievable.

We all know there are many problems and many challenges for us to consider in the reform process.

In fact, it is very easy to talk about what we think – and know - is wrong with the health system.

The Commission, however, needs to go beyond this.

We want to hear practical ideas and solutions and we want to build on what is good with our health system.

Our job is to look at structural and system solutions.

By international standards, we have a very good health system, which is the envy of many countries.

But the system is under growing pressure and we must act now – especially if we are to build a system that will serve our children and, frankly, all of us as we get older.

So, how are we going about this?

First of all, we are accumulating and harnessing a lot of work and thinking done by others through a submission process.

In addition we have a national consultation and engagement process.

This will involve a lot of meetings and a lot of listening on the part of the Commission.

And that is what we have been doing this week in Hobart.

Tasmania was first port of call on what we are calling our 'national listening tour'.

For the next seven weeks, we will visit all the capital cities and four regional centres ... to listen and learn.

We are talking to frontline health workers – the doctors, nurses, dentists, pharmacists, paramedics, and physios and other health workers.

We are talking to the State and local government agencies.

And we are talking to members of local communities – the local people who use the health system.

In each capital city we are conducting a separate forum with 'experts' in certain areas including:

• research and innovation,
• wellness and prevention,
• primary care,
• the care of people with chronic and complex needs,
• rural and remote care,
• acute and hospital care,
• Indigenous health,
• e-health,
• healthy start to life, and
• Aged care.

Now let me share with you the types of issues that are front of mind with the people we have been listening to this week:

• we need more community based care in the home and other settings,
• a greater emphasis on prevention and health promotion,
• better access to primary care,
• reviewing Commonwealth and State roles in health service delivery,
• workforce – not enough health professionals, problems with distribution, and low morale,
• better use of public hospital resources, especially in emergency,
• people see value in the private system, but they see the public hospital system deteriorating,
• more community-based services,
• more action on smoking, drug and alcohol abuse, and obesity,
• end of life decisions and better care for older people
• more assistance and information to help people navigate their way around the health system,
• we need to get people to take a greater role in their own health and wellness,
• healthy eating and better food labelling,
• health isn't free – people need to know that and use health services responsibly,
• work/life balance – for everyone – health and wellbeing go beyond physical health
• and an impassioned plea for local GPs who families can 'know and love' and trust – and see when they are needed.

And those views came from community members and health professionals alike.

The overlap and agreement was fascinating and encouraging.

These are the views of the community and frontline health workers we have spoken with here in Hobart.

In addition to these things they want changed, they also gave us ideas on how to improve health service delivery, including examples that are working locally.

And this is only week one of seven. We will have amassed a considerable collection of health system opinion and advice by the end of our listening tour.

The tour is just part of the work we must do to design our new health system – and it follows an important task we undertook as part of our Terms of Reference.

Last month we presented the Minister with our first report – Beyond the Blame Game.

There are copies available here at the Conference or can find it on our website at nhhrc.org.au.

This report provided advice on the framework of the next Australian Health Care Agreements - and it has been generally well received.

In preparing the report, we took the approach that the next generation of Health Care Agreements should go beyond hospitals and that accountability should be clear and two-way.

We suggest that the States should be accountable for public hospitals, mental health, maternal and child health and public health.

We suggest that the Commonwealth be accountable for primary care, prevention, aged care, and Indigenous health.

We welcome the acknowledgement from all governments that there must be greater accountability in health service delivery.

To improve accountability, the Report suggests major opportunities for improvement by the Commonwealth and the State governments.

I should point out to this audience that the Commission made medical training a priority in this report.

Remember, also, that this is advice to the Government, and there are many sources of advice to this process.

Our task was to provide advice that reflected the health system of the future the direction of reform we saw as necessary to get there.

And this brings me to the principles we believe should underpin our health system.

One of the first things the Commission did was develop a set of principles to guide our work toward the final design for the future health system.

They guided us in preparing our first report.

We value these principles highly.

We believe they should shape the design of the entire Australian health and aged care system - public and private, hospital and community-based – and be evident in how the system functions for patients and their carers.

Let me run through the principles for you.

People and family-centred

The direction of our health system and the provision of health services must be shaped around the health needs of individuals, their families and communities.

The health system should be responsive to individual differences, cultural diversity and preferences through choice in health care.

Pathways of care, currently often complex and confusing, should be easy to navigate.

Where necessary, people should be given help to navigate the system, including through reliable and evidence based information and advice to make appropriate choices.

Equity and universal access

Health care in Australia should be accessible to all based on health needs, not ability to pay.

The multiple dimensions of inequality should be addressed, whether related to geographic location, socio-economic status, language, culture, or Indigenous status.

Shared responsibility

All Australians share responsibility for our own health and the success of the health system.

We each make choices about our lifestyle and personal risk behaviours.

These are shaped by our physical and social circumstances, life opportunities and environment, which impact our health risks and outcomes.

Keep in mind that 40 to 50 per cent of our community's health burden relates to decisions about personal behaviour.

As consumers or patients, we make decisions about how we will use the health system and work with the professionals who care for us.

The health system has a particularly important role in helping people of all ages become more self reliant and better able to manage their own health care needs.

This includes helping people to make informed decisions through access to health information and by providing support and opportunities to make healthy choices, and by providing assistance for managing complex health needs.

Strengthening prevention and wellness

We need a comprehensive and holistic approach to how we organise and fund our health services and work towards improving the health status of all Australians.

The balance of our health system needs to be reoriented.

Our health system must continue to provide access to appropriate acute and emergency services to meet the needs of people when they are sick.

Comprehensive

People have a multiplicity of different health needs, which change over their life course.

Meeting those needs requires a system built on a foundation of strong primary health care services, with timely access to acute and emergency services, in both community and hospital settings.

Value for money

The resources available to support our health care system are finite, and the system must be run as efficiently as possible and to the greatest effect - and be positioned to respond to future challenges.

Delivering value for money and meeting local needs will require appropriate local flexibility in financing, staffing and infrastructure.

The health system should deliver appropriate, timely and effective care in line with the best available evidence, aiming at the highest possible quality.

Information relating to the best available health evidence should be easily available to professionals and patients.

Introduction of new technology should be driven by evidence and cost-effectiveness.

Pathways to care should be seamless with continuity of care maximised.

Systems must be in place to ensure a smooth transfer of information at each step of the care pathway, making effective use of information technology.

Providing for future generations

We live in a dynamic environment with changing populations.

Health needs are changing with improved life expectancy, rising community expectations, advances in health technologies, an exploding information revolution, and developments in clinical practice.

There are new avenues and opportunities for how we organise and provide necessary health care to individuals, using the health workforce and technologies in innovative and flexible ways.

Health professionals need to be able to adapt to future health needs.

The education and training of health professionals across the education continuum are a responsibility of the whole health community, in partnership with the education sector.

Continuing education ensures that health professionals are prepared to meet these changing needs.

The health sector’s commitment to education and research, and its relationship with the education and training sector, should be planned and implemented in a logical and seamless way.

All relevant sectors - public and private, institutional and community – must be involved.

Recognise that broader environmental influences shape our health

Our environment plays an important role in affecting our health and in helping us to make sensible decisions about our health.

We recognise that there are other key contributors to our good health.

It is not just the health system we need engaged. Cross-community and cross-sectoral awareness and action are needed, including by employers, schools, food manufacturers, transport and recreational facilities, to name a few.

Taking the long term view

A critical function for effective governance of the health system is that it acts strategically - that short-termism and the pressure of the acute do not crowd out attention and planning for the long term.

A responsible forward-looking approach demands that we actively monitor and plan the health system of the future to respond to changing demographics and health needs, clinical practices and societal influences.

Safety and quality

There should be effective systems of clinical governance at all levels of the health system to ensure we learn from mistakes and ensure the safety and improve the quality of services.

The first step to effective clinical governance is a culture that embraces improvement in patient safety and quality.

This includes an emphasis on open, transparent reporting and a positive culture in dealing with and learning from adverse events.

Transparency and accountability

The decisions that governments, other funders and providers make in managing our health care system should become clearer and more transparent.

The responsibilities of the Commonwealth and State governments and the private and non-government sectors should all be clearly delineated so when expectations are not met, it is clear where accountability falls.

It also helps parties to work more effectively together when they are clear on their roles and responsibilities.

Australians are entitled to regular reports on the status, quality and performance of our whole health care system - both public and private.

This reporting should range across the spectrum from primary to tertiary care - and at local, state and national levels.

Public voice

Public participation is important to ensuring a viable, responsive and effective health care system that meets people's needs.

A respectful, ethical system

Our health care system must apply the highest ethical standards.

Our health system must recognise the worth and dignity of the whole person - including their biological, emotional, physical, psychological, cultural, social and spiritual needs.

Importantly the health system must respect and value the health workforce.

Responsible spending on health

There should be no waste or inefficiency with health spending.

Good management should ensure that resources flow effectively to the front line of care, with accountability requirements efficiently implemented and red tape and wastage minimised.

Funding mechanisms should reward best practice models of care, rather than models of care being inappropriately driven by funding mechanisms.

Funding systems should be designed to promote continuity of care with common eligibility and access requirements to avoid program silos or ‘cracks’ in the health system.

There should be a productive, balanced and effective use of both public and private resources.

New technologies should be evaluated in a timely manner, and, where shown to be cost effective, should be implemented promptly and equitably.

Information and communication technologies, in particular, should be harnessed to improve access in rural and remote access on a cost effective basis to support and extend the capacity of all health professionals to provide high quality care.

A culture of reflective improvement and innovation

Reform, improvement and innovation are continuous processes and not fixed term activities.

The Australian health system should foster innovation, research and sharing of practices shown to be effective and to improve not only the specific services it provides, but also the health of all Australians.

The continuum of basic science to applied clinical and health services research will underpin this and needs to be embedded in the system.

I hope these principles reflect your hopes for a future health system as well.

We are consulting on these principles and invite you to help us improve them further.

I hope, also, that you appreciate the enormity – and the importance – of the task being undertaken by the Commission.

In fact it was the AMA magazine – Australian Medicine – that first depicted the Commissioners as crew members from Star Trek.

It is pretty close to the mark.

Rather like the crew of the Starship Enterprise – perhaps the Health Enterprise - the Commission will ‘go boldly’ in creating a vision for the Australian health system of the future.

We want our vision for the health system to be relevant and meaningful to the Australian people.

We want to inspire and re-energise our dedicated health workers.

We want your help in our task.

We want your ideas and suggestions, we want constructive debate and, ultimately, we will want your support.

I think we are all seeking the same thing – a better health system for all Australians now and into the future – and harnessing a pivotal role for doctors within that system.

On behalf of the Commission, I look forward to further meetings with the AMA and strong input from you in helping us shape a system that meets the future health care needs of all Australians.

I look forward to your questions – and even more to your answers.

Thank you.

Page currency, Latest update: 05 June, 2008