NHHRC Commissioner Rob Knowles on Radio 2DU Dubbo 3 June 2008

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Transcript

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NHHRC Commissioner Rob Knowles on Radio 2DU Dubbo 3 June 2008

INTERVIEWEES:

Rob Knowles, National Health and Hospitals Reform Commission

LEO DEKROO:
Now last night in Dubbo, the National Health and Hospitals Reform Commission sat and some people were invited, some were not. When we spoke about it on Friday a number of people were a little disturbed that they couldn't have a say or didn't think they could, but today of course it goes on.

But Rob Knowles knows a lot more than I do and he's sitting with me right now. Hi, how are you?

ROB KNOWLES:
I'm very well thanks Leo.

LEO DEKROO:
Now you're actually the chair of all this, are you?

ROB KNOWLES:
No I'm chairing or acting as one of the co-chairs of the consultation here. Dr Christine Bennett is the chair of the commission and there are nine other members coming from a wide range of backgrounds, experiences and expertise.

So we've been asked by the Australian Government to provide some advice on where the health system needs to be in five, 10 years.

LEO DEKROO:
So this is part of their newly established look at to see where Australia is at, I mean this is Kevin Rudd and the team.

ROB KNOWLES:
Yes.

LEO DEKROO:
And it's only happened since and that's pretty quick action, isn't it?

ROB KNOWLES:
It is. It was within 100 days of the election of the government they appointed the commission. You might recall prior to the election the now Prime Minister indicated that the Labor - a federal Labor government would want to see significant change in the way the public hospital system and in fact at one stage said that at unless they could achieve some improvements then they would look at taking over the…

LEO DEKROO:
Function.

ROB KNOWLES:
…the operation and funding of the public hospital system.

Since then, there has been a commitment on the part of COAG, that's all of the states and territories and the Australian Government to try and work together to see if we can't eliminate the blame game, remove some of the inefficiencies, integrate the system much more, address some of the gaps that your listeners would only be only too well aware of exist within the current system.

So while we have a good - generally we have a good health system in this country but there are areas where we could see some significant improvement and some changes in the way it's operating.

LEO DEKROO:
Rob, your background, you were in politics for a number of years yourself weren't you, in Victoria?

ROB KNOWLES:
Yes I was, in Victoria. And ended up I had seven years as a minister, including a stint as Minister for Health…

LEO DEKROO:
So what side of the fence were you on?

ROB KNOWLES:
I was Liberal Minister for Health.

LEO DEKROO:
Liberal okay.

ROB KNOWLES:
And then since that time, I left nearly a decade ago now, since that time I've been involved in a number of broad public policy issues. I have a keen interest in aged care and I did some work with the Commonwealth aged care program, as Commissioner for Complaints. I chaired the board of Food Standards Australia New Zealand which sets food standards in both countries and…

LEO DEKROO:
So we do have the same standards in two countries?

ROB KNOWLES:
Yes, we do.

LEO DEKROO:
Okay, alright.

ROB KNOWLES:
So - and that's been a significant achievement and it works extremely well for both countries.

And I was struck when I was involved in parliament at how disabling and debilitating it was when someone developed a psychotic illness, often not only just for them but for their entire family. And the way, as a society and our healthcare system responds, isn't ideal. So I've been doing quite a bit of advocacy in that work and am currently chairman of the Mental Health Council which is the peak body for all of the mental health bodies.

LEO DEKROO:
Yeah, very big, it is a big problem. So coming back on this particular - the hearings that you're having around the nation, I think you've only got to pick up any newspaper or listen to a radio station or talk to anyone in the street, and whilst everyone sings the praises of staff in hospitals, generally the services are totally inadequate as far as infrastructure.

And now, and I don't know whether you can comment, or what knowledge you have of this, the talk about the Federal Government changing, almost discouraging people to go into private health. You may not agree with that, you may have another point of view on this of course, putting more and more load on the public health system, is that a concern, is that showing up in the early…

ROB KNOWLES:
Well I think the commission isn't focused on today's issues as such, but it has really been charged with taking a helicopter view of saying, well don't let's get bogged down in the day-to-day issues that are always around the health system, but to take a step back and say, well this is where we are in terms of the Australian health system today.

We know there are a few things changing, we're becoming an ageing population and that it will have an impact on demand for health services. It also has a significant impact on the workforce within the health service, most of our health workers or a large proportion of them are in the older age group and it's sometimes - and particularly like this part of Australia, it's often hard to attract young new health professionals.

So to take that longer term view and say, well rather than how do we get a quick fix today, where does the health system need to be in five, 10 years?

LEO DEKROO:
But you'd have to include that, wouldn't you?

ROB KNOWLES:
Yes well…

LEO DEKROO:
Those fears, because down the track, if already what we're talking about and people are saying it's going to put a lot more load on the system, you'd have to almost incorporate that into your research, wouldn't you?

ROB KNOWLES:
Yes, as part of our challenge, we were asked to look at how we maintain a public and private system in this country, working together. And I think one of the - it's still relatively early days for the commission but we've talked about how we can get some better integration, better utilisation of the strengths of both systems.

So yes, all of those sorts of issues are on our agenda. What has been explicitly excluded is the commission looking at the 30 per cent private health insurance rebate; the Australian Government have made a commitment to maintain that.

LEO DEKROO:
Okay sorry, is that right, they are committed to maintaining that?

ROB KNOWLES:
Yes.

LEO DEKROO:
Because that came up this morning on the program and I wasn't…

ROB KNOWLES:
Well that was their election commitment prior. And the terms of reference that they've given the commission explicitly excludes us examining or reviewing if you like. So what they're saying in the terms of reference, we intend to maintain the 30 per cent health rebate.

LEO DEKROO:
Okay.

ROB KNOWLES:
And they've also said in the terms of reference they want to maintain the universality of the medical benefit schedule, that's the scheme that provides rebates for patients visiting general practice and providing rebates for specialist service, and the pharmaceutical benefits scheme which provides subsidised pharmaceuticals for those who…

LEO DEKROO:
Okay, so Rob, when you have a meeting like you did on Monday, is it like branch stacking a little bit to say that not everyone is welcome to come, it would appear it was by invite only.

ROB KNOWLES:
Yes.

LEO DEKROO:
Now is that a fair proportion of what you're supposed to take back in information, do you think?

ROB KNOWLES:
No, no I need to explain our timelines because they're really quite short. We were appointed in February and we were asked by the end of April to provide some advice on the framework and some benchmarks for the next Australian health care agreements which are in the process of being negotiated. So that was an incredibly tight time frame.

And then we've been asked to deliver a draft report on where we think the health system needs to be in five, 10 years, and a roadmap as to how government might help achieve that outcome by December this year, and then a final report in June. So that's an incredibly tight time frame.

So we're trying to balance that time frame with the widest consultation process we can undertake. So we've called for public submissions. So we've invited anyone who has a view about how we could improve the current system and suggestions about the ways that might be achieved. We've invited people to submit those thoughts to us in writing and they will all be taken into account.

Then we've got a couple of other processes, this is one, where we go into each capital city, some key regional centres which would have - which would reflect a wider part, because it's simply not possible for us to go to every community throughout Australia.

And rather than have a process where whoever feels like turning up, does, and we might end up with very few, or very many, what we tried to do is to particularly structure it so we get key groups. So last night we had a range - a group of people, all of whom are consumers, or users of the health system.

And we delved deeply into their views; what works, what doesn't, their suggestions about the way it might be improved because we are interested in more than just hearing about the problems, we want people's ideas about the way we improve it. So to try and delve deeply into that, we had to constrain numbers a little. So we had - we've got an organisation who selected, at random, a group of people, who if you like, are a microcosm of the broader community.

This morning we've spent a couple of hours with the leaders of government agencies: Premier and Cabinet, the New South Wales Health Department, ageing and disability agencies and getting their perspective of the system.

And then this afternoon we've got again, a group of frontline staff: doctors, nurses, physiotherapists, pharmacists, people working in dental health, people in mental health. So we are trying to get a discreet group, but broadly representative of consumers, of frontline staff and then the government agencies so that we can delve in much more detail.

And then we'll have some targeted consultations with the key groups, like the consumer, Health Consumer Forum, the AMA, the Nurses Federation. So there'll be consultation, if you like, occurring at a myriad of levels.

LEO DEKROO:
I keep thinking of you as Craig, isn't that funny because Knowles of course was…

ROB KNOWLES:
At one stage we were both housing ministers at the same time and then we were both health ministers at the same time.

LEO DEKROO:
Astounding isn't it. Rob, with your experience in another state, but we are now talking nationally of course.

ROB KNOWLES:
Yes that's right.

LEO DEKROO:
Your personal idea of this working together, I mean most of us tend to think, boy that should have been happening for years. In a practical sense, having had the experience of being in opposition at one time yourself with this, do you see it as a real possibility that we are going to pull this thing together and actually make it work for the people?

ROB KNOWLES:
Yes, I think - well I think there are. And in our first report what we suggested, and we termed it 'ending the blame game' because I think those involved with health have so often experienced when something goes wrong, one level of government blames the other level of government.

LEO DEKROO:
Certainly.

ROB KNOWLES:
And they've said no, it's not our fault, it's their fault. So one of the ways we see of moving forward is to be much clearer about which level of government is responsible for which part of the health system, so that we've got that much more direct accountability so that we at least eliminate some of that blame game.

The second thing we've tried to do is put in some specific benchmarks against which we can, as a community, measure the performance of the level of government responsible for that area.

Now the more we get into it, the more it becomes clearer to anyone who isn't yet aware of it, that we actually need, for both levels of government to meet their responsibilities, they need to work together.

Now, we have in this country a federated system of government where historically the states and territories have been responsible for health. But over the last 70 or so years the Commonwealth have developed some specific programs which have worked to the benefit.

But what we now need to do is to make sure that all parts of the system - we have silos in health; we have a whole system that worries about physical health, and in many areas, that's completely separate and distinct from the mental wellbeing of the person. And oral health is a further silo.

So the commission has said, well, if we're going to get a system that focuses on us as an individual person and our family and the community in which we live, we need to think about the physical, mental wellbeing of the whole person, who also has a need for good oral health. That's what's sort of trying…

LEO DEKROO:
Okay. Rob, you're obviously the right man for the job, I think you're very passionate about what you're doing, and whatever the outcome, can I make one submission?

ROB KNOWLES:
Yes of course.

LEO DEKROO:
In Dubbo we desperately need not to be ignored any longer when it comes to health services. We have a private hospital, we have the Dubbo Base, we have Lourdes. There is some talk now about all of it needing replacing. If you built one massive hospital that the three levels could be accommodated in, you go in the front door, if you're a private patient you go that way, if you're a public patient you go that way. But in the centre is all the gear, you don't have to double up. You've got all the gear, the MRI, you've got everything there that we could all use. And it's only the entry level that is different, the service is the same. We'd save a lot of money. Are you taking notes here?

ROB KNOWLES:
Yes, we are taking - you're just making the 501st submission; we've already had 500 so I'll take this as a written submission from you and many of your listeners.

LEO DEKROO:
Thank you. Right Rob, nice to catch up with you. Thank you for making the time.

ROB KNOWLES:
Thank you, pleasure.

LEO DEKROO:
I know you're a very busy man while you're in Dubbo here.

Rob Knowles joining us there and that was to do if course with the Hospitals Reform Commission currently in Dubbo. Thank you for your time.

ROB KNOWLES:
Thanks Leo.

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