NACCHO Aboriginal #Healthmatters : @AustralianLabor National #HealthPolicy Summit Agenda this week and getting evidence into health policy

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Question to the Honourable Nicola Roxon, former Australian Labor Minister for Health and Ageing (2007–2011) : Can you give an example of this more courageous leadership during your time as minister?

A: One example is a cause close to my heart: Australia’s introduction of plain packaging for tobacco products. We are proud to be world leaders in introducing our shocking and ugly plain packs, and even more proud of the lively discussion and action it is generating elsewhere around the world on the future of tobacco control.

Picture above : Lessons learnt : Plain packaging for tobacco products is a great example of implementing good health policy where trusted health organisations worked across political groups, provided expert research and supported the government to take action

What’s planned for this weeks Labor National Health Policy Summit 

According to the Federal Opposition, Labour will build on a legacy as the party of health care reform by hosting a National Health Policy Summit next Friday 3 March in Canberra , led by Leader of the opposition Bill Shorten and Shadow Minister for Health Catherine King :

See interim Full day Agenda below

 “One of the most challenging aspects of the current Government is the complete lack of any vision for health in Australia. Instead of building our health system up and preparing for the future, the tenure of the Abbott/Turnbull Governments has been characterised by cuts and chaos.

Not only does our health system deserve more – it needs more. The government simply isn’t filling this space, so Labor will.”

The National Health Policy Summit will put the people who know best at the centre of health discussions – giving patients, providers, stakeholders and experts a much-needed voice in health reform.

It will give representatives the chance to not only contribute to our health debate, but to challenge the direction of our health system.

Labor has a long history of reforming Australia’s healthcare system for the benefit of all.”

 NACCHO Note : Both NACCHO and Croakey will be covering

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See Croakey Coverage

We welcome articles and press releases from all political parties

Interview with the Hon. Nicola Roxon:

Getting evidence into health policy

Editor-in-Chief of Public Health Research & Practice, Don Nutbeam spoke to the Honourable Nicola Roxon, former Australian Labor Minister for Health and Ageing (2007–2011), to gain some insight into the process, and advice on how to engage most productively with government.

Q: Often ministers and policy makers must try to make good policy decisions in areas where evidence is incomplete or contested. What strategies or processes did you employ when trying to make good public health decisions at a federal level when the evidence was insufficient? What were the main challenges involved and how did you overcome them?

A: I think it is very rare for ministers or governments to want to make decisions where evidence is incomplete or contested (provided the contest is real, not fabricated by vested interests). There are so many competing, worthy, evidence based causes – especially in health – that these will usually be given priority. However, in a crowded political agenda, having a worthy cause isn’t always enough to capture the imagination of government. The biggest single mistake I saw when I was Health Minister was repeated over and over again, by decent, hard-working researchers, medicos and advocates – and it was the naive assumption that, because they were working on something good, or had developed a worthy project, the government would therefore act on it.

As a minister, I was able to act on some fabulous ideas, and I’m proud of that. But many good ideas were not acted upon – often because of financial constraints, but also many other reasons played a role.

Just because your idea is good, even worthy, isn’t enough.

Q: So, how does evidence inform policy decisions in the real world?

A: To get real decisions and actions in your area, you must think closely and carefully about who you are putting your evidence to, their needs and priorities, and why your proposal will help them. In a world where most interventions cost money – and, in health, usually a lot of money – simply appealing to their good nature is too simplistic. You need to make it easy for decision makers to see how acting on your idea is worth taking up time, money and political energy.

Knowing what is going on in the decision maker’s portfolio, what is troubling them, what is taking up their time and giving them sleepless nights helps you find a way to fit your issue into their thinking space. Start by putting yourself in the position of the minister you want to take action. Do you know what they are trying to achieve? Have you read any of their speeches or policies or recent interviews? Demonstrating your understanding of their issues and pressures is good manners, but also helps you shape your pitch to their current interests or pressures.

For example, when the Australian Government announced health reform negotiations with the states, a few groups came to us with proposals that could be part of those discussions. Not all were successful, but it showed they were tuned in to opportunities, and ready to make the most of them in a way that might suit government.

Even a scandal or problem can sometimes be a chance to offer a helpful solution. It might help solve the problem, or detract from it! Either way, this might be welcome.

The more in tune you are with the decision maker’s pressures, the more likely you are to be agile and think laterally, to find good opportunities to raise your cause at the right time.

Q: When these opportunities present themselves, what is the best way to communicate?

A: Are you clear on what you would say and how you would say it if you got a brief chance to pitch your idea? A lot of people talk about having an ‘elevator pitch’ – this is the idea of what you would say if you were, by good luck, in an elevator with the decision maker. Could you explain your idea simply? And quickly enough?

The aim is to first capture the imagination of the decision maker – get them to be interested in your idea, impressed with your focus and your offer to help them.

I had too many meetings to recall where people tried to download 20 years of in-depth research in a 10-minute meeting – the minister needs to know it is there, to appreciate your expertise or credibility, but they don’t need to be able to present a paper on it to the next technical meeting of the World Health Organization (WHO)!

Stick to the headline message or your core thesis to support a proposal – then you can leave the detailed summary for an adviser or official to mull over.

What you want from your meeting is to spark enough interest that the minister asks for more work to be done on your issue – not that they decide to write a book on it. Worse, your clear message will be diluted or lost if you try to do too much in a short meeting.

Q: What do you say to the researchers who feel that their work is ignored?

A: I am frustrated that governments are almost universally criticised for not taking action on public health. Sometimes that criticism of governments is fair and well based. We are right to expect courage and leadership from our governments. But, in truth, criticism of governments is also sometimes lazy. It can be easier to criticise a government for not acting on your issues than to ask whether you’ve done all you can to help them take that decision.

From the perspective of a former minister, I want to urge researchers, advocates and clinicians to assess whether they have done all they can to create a fertile environment to encourage government leadership. When they do, governments will provide leadership.

Q: Can you give an example of this more courageous leadership during your time as minister?

A: One example is a cause close to my heart: Australia’s introduction of plain packaging for tobacco products. We are proud to be world leaders in introducing our shocking and ugly plain packs, and even more proud of the lively discussion and action it is generating elsewhere around the world on the future of tobacco control.

I have been very flattered, and often overwhelmed, by the recognition I get from introducing this measure. But the truth that ought to be acknowledged is that there were many people and many factors that made this courageous public health decision a good one for government, and easier than people imagine.

What made us choose this courageous path, when there were so many other competing issues on the table? It offers a good case study about advocacy.

The work of so many researchers, advocates, doctors, past governments, journalists and ordinary Australians moved this seemingly courageous decision into a political ‘sweet spot’. Ultimately, it was a good policy decision that was good politics too.

It was an inexpensive policy with high impact; a policy with lots of supporters and a disliked opponent (the tobacco industry); a highly visible policy that complemented other measures important to the government, but perhaps less ‘sexy’.

On each of these issues, advocates and supporters of the initiative sought to make the necessary links to our broader health reforms, our fresh focus on prevention and our interest in Indigenous health.

And it helped that the public had responded well in the past to tobacco control interventions, showing the huge benefits of a comprehensive approach to tobacco control measures. The research was strong, and the international treaty on tobacco (the WHO Framework Convention on Tobacco Control) supportive.

Q: What role would you expect from civil society in this process?

A: The Cancer Council and Heart Foundation in Australia were the rolled-gold best examples of this on plain packaging – they worked across political groups, and had expert research as well as highly responsive media teams. They are trusted voices for consumers and were prepared to use that voice to not just criticise, but to help government act, as well. Their expertise and advice were vital.

Their advice on potential problems was also invaluable to the government. In tobacco control, you need a good working knowledge of international tobacco control developments and global industry tactics. Being carefully prepared for attacks is smart for governments, but just as vital is for other civil society participants to be ready to explain to the media or to parliamentary committees.

Q: What of more contested issues, such as alcohol regulation and tackling obesity in the population?

A: In Australia, it has been harder to garner support for strong interventions on alcohol and obesity. On obesity in particular, the mixed approaches from advocates and researchers about what is needed to be successful have made it more difficult for governments to act decisively. When multifactorial approaches are likely to be needed, this can make the ‘ask’ confusing – governments often want a clear plan, or a clear starting point. In some public health areas, it is often hotly contested where one should start.

With alcohol, at least in Australia, it is sometimes difficult to find the lever. Do we target individuals or the community? Consumers or business? And it can be even more perplexing with food, where mixed messages make the need to improve public awareness of the risks of obesity even more complicated.

The challenge to advocates on these issues and most other public health priorities is to find that lever – the right lever, at the right time for the decision maker you are trying to convince. Be careful, of course, not to weaken the argument by going in too many directions at once.

Developing alliances across consumers, clinicians, advocates and researchers will always be very powerful. The same proposal from multiple groups gives your argument weight and depth. Instead of all asking for something slightly different, if you can agree on one major initiative or a good starting point, it is a very much more convincing request. It automatically lifts it above the 20 other meetings and requests the minister has that day. You can be confident that everyone else asking the minister for something that day will probably not have done that work – so it is a way to make your cause better and more attractive, easier to sit up and take notice.

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What’s planned for the Summit

Labor says the Summit will bring together more than 130 of Australia’s leading thinkers on health to be part of roundtable discussions via a packed program, with two blocks of four concurrent sessions, led by Shadow Ministers and leading health figures.

The event will begin with a welcome from Shadow Health Minister Catherine King and a keynote from Opposition Leader Bill Shorten and will end with a panel discussion between chairs to report back on the following policy roundtables (see also the co-chairs, some who are still to be announced).

1.Opportunities and challenges in our health sectors

Protection, prevention and promotion

Public Health Association of Australia CEO Michael Moore
Stephen Jones, Shadow Minister for Regional Services, Territories and Local Government Stephen Jones.

  • the preventable chronic disease crisis
  • risk factors
  • protective factors

Primary, secondary and community care

 Sharon Claydon, Chair, Medicare Caucus Committee

  • general practice
  • specialist primary health
  • allied health
  • pathology & imaging
  • pharmacy & medicines
  • dental

 Hospitals

Brian Owler, former President, Australian Medical Association

  • post-2020 public hospital funding
  • reducing emergency department and elective surgery waiting times
  • interaction between public and private hospitals
  • private health insurance
  • improving quality, safety and value in hospitals
  • outpatient clinics

Mental health and suicide prevention

Frank Quinlan, Mental Health Australia and Sue Murray, Suicide Prevention Australia
Julie Collins, Shadow Minister for Ageing and Mental Health

Mental health priorities

  • Mental health reform
  • Measuring outcomes
  • Stigma and awareness
  • Workforce

Suicide reduction priorities

  • Early intervention and prevention
  • Integrated services
  • Research and data collection

2.Where to for health reform?

Ensuring universal access for all Australians

Dr Stephen Duckett, Grattan Institute
Jenny Macklin, Shadow Minister for Families and Social Services

  • access, including out-of-pocket costs and waiting times
  • integration of primary care
  • coordination of primary, secondary and acute care
  • health financing

Designing our health workforce for the future

Professor Mary Chiarella, Sydney University
Tony Zappia, Shadow Assistant Minister for Medicare

  • future health service needs
  • health workforce reform
  • Commonwealth health workforce programs

Tackling health inequality and other whole-of-government challenges

 Professor Sharon Friel, Australian National University
Mark Butler, Shadow Minister for Climate Change and Energy

  • Regional, rural and remote health
  • Indigenous health
  • Other health inequalities
  • Interface with aged care
  • Interface with NDIS
  • Other social policy issues
  • Climate change and health

Innovation across our health system

Professor Christine Bennett AO, School of Medicine, Sydney, The University of Notre Dame Australia and past Chair of Research Australia
Murray Watt, Senate Community Affairs Committee

  • Health, medical and translational research
  • eHealth and digital technologies
  • Safety and quality
  • Precision medicine
  • New technologies
  • Partnerships and collaboration.

 

NACCHO #GP16Perth @RACGP Conference Clinical, Digital, Leadership : Catherine King MP Speech

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 “At conferences like this, it is easy to be energised and inspired about potential paths for reform. The challenge is putting it into action – not only developing a clear and articulated vision, but having the political will to see it through.

Step one must be prevention. Australia cannot afford to have a Federal Government which continues to be completely disengaged with preventative health.”

Catherine King MP Pictured above with RACGP President Dr Bastian Seidel and RACGP CEO Dr Zena Burgess

Speech Download      catherine-king-mp-speech-gp16perth

Let me begin by acknowledging the traditional owners of the lands upon which we gather and I pay my respects to their elders past and present.

And let me thank Tim Koh and the College for having me here at GP16.

I particularly want to acknowledge the leadership of Frank Jones. Frank has steered the College through a difficult time in our national health debate, and has always been a fearless advocate for quality general practice.

I also want to congratulate Bastian Seidel on his election to lead the College. I have met with Bastian many times and had previously visited his practice in the beautiful Huon Valley. So I’m looking forward to working with him and congratulations to you and Alexandra on becoming new parents.

Introduction

I am no stranger to the College and its structures.  I well remember spending several months in the bowels of the College’s then premises in Palmerston Crescent in Melbourne searching through files to try and come up with an accurate audit of your committee structure, when I was doing some work for you.

I think I discovered over 40 different committees but could never be confident I had got all of them as I kept finding more. I was tasked with trying to reduce the number and suspect I failed abysmally.

They were difficult times for the College – with significant changes being undertaken to GP training – but what I learnt from that time was the incredible willingness of the GPs I worked with to engage in public policy debates.

To teach, to lead and to question.

The theme of your conference – Clinical, Digital, Leadership is very much in that continued tradition.

The value of General Practice

Three weeks ago today, I was enjoying a quiet Friday night in my home town of Ballarat when my Twitter feed started getting linked to the hashtag ‘Just a GP’.  I read every tweet, including John Crimmins who is always very equal in his criticism of both the current serving Health Minister and I.

I don’t want to get into who said what to spark the Twitter explosion, but I think the fact that it happened is noteworthy.

I think the reaction speaks to a deep seated distress about how you – as GPs – feel you are being devalued not just by politicians, but more broadly.

So I want to say at the outset a couple of things.

Firstly I am able to be here today working, across the other side of the country from where I live, because of the support a GP has given my family.

This GP, who I have never met in person, visited my mum out-of-hours in residential aged care and spent time talking to my sister so we as a family could make an informed decision about what care should be provided as my mother’s health declines.

Our experience is replicated in thousands of families and GP practices across the country every day. The patient is just one part of the story.  You help entire families to meet their work and family responsibilities every single day and that is not lost on me.

Secondly, something I have been saying for some time is that for the relatively small investment – and it is an investment – Australians are able to enjoy some of the best health outcomes in the developed world.

The reason for this is our primary care system, a system based on affordable access to general practice.

The evidence is clear. The stronger a country’s primary care system, the better its health outcomes. The stronger a country’s primary care system, the more efficient our health care system is as a whole.

That is not to say that there is not room for improvement. In particular, growing health inequality, as highlighted by Michael Marmot in Boyer lectures earlier this month, continues to be a significant challenge for not just for health professionals but for our society in general.

As Marmot noted, health inequalities parallel broader social inequalities, and Australia needs clear and concerted effort to close these health gaps – particularly in the persistent gap in indigenous health.

At the same time, we should be encouraged by the progress we have made as a result of the investment in our health system. The recent AIHW Australia’s Health report confirmed that Australia’s life expectancy is one of the highest in the world and above the OECD average.

The values of political discourse in health

Health reform is intrinsically linked with political discourse – I think this room nows that better than most.

One of the most challenging aspects of the current Government is the complete lack of any vision for health in Australia, let alone any vision for the future of our health care system.

What they label “health reform”, I see as little more than shuffling the deck chairs around.

We have a seriously large number of reviews, external consultancies, consultations, new advisory groups and committees. I think the MBS review alone has challenged even my recollection of the College’s appetite for committees.

There is no coherent view about where any of these may end up or how they relate to and influence each other.

The Minister, who remains relatively inexperienced in this policy area, seems to be engaging in more and more frenetic activity, trying to solve every problem that has ever existed in health policy, while unfortunately creating quite a few more.

Labor has a different approach. For Labor, our starting point has always been our values.

Despite all of the posturing, spin and public spats that exist in modern politics – and they are all there in spades – at the core, politics is about values. Your values are reflected in the choices you make.

At conferences like this, it is easy to be energised and inspired about potential paths for reform. The challenge is putting it into action – not only developing a clear and articulated vision, but having the political will to see it through.

Step one must be prevention. Australia cannot afford to have a Federal Government which continues to be completely disengaged with preventative health.

I am very proud of the preventive health policies Labor took to the election. These included Australia’s first national physical activity strategy, tackling social determinants of health and health inequality at the community level, continuing our world leading tobacco reforms, and a new national alcohol strategy – to name a few.

We must put patient needs at the core of our health care system – not funding streams and institutions.

These are just a few of the priorities and values that help Labor shape our policy development, but also how we assess and respond to the decisions of Government.

The current state of political play

We are in a very unusual political cycle. The reality is we simply don’t know how long this Parliament will last.

Labor is already heavily engaged in policy development – somewhat earlier than we might have been in a standard political cycle.

Of course, the first job of any Opposition is to hold the Government to account. And in health, they have a lot to account for.

Under this Government, there are billions of dollars of cuts to health. These cuts are either just now beginning to bite or that still remain on the Government’s balance sheets, awaiting passage of the Parliament.

Medicare freeze

The big one is the freeze on Medicare rebates, now extended until 2020. I know this a critical issue for GPs in the room today.

As the freeze drags on, we know that more and more practices will have to abandon bulk billing. Only yesterday, we heard from the College that bulk billing has dropped 10 per cent since July.

So when I hear the Government quote bulk billing figures and claim that the freeze on Medicare rebates won’t impact bulk billing, I know just how wrong they are.

The domino effect of this freeze should not be underestimated. When bulk billing drops, patients have to pay more. One in 20 Australians already delays or avoids seeing a GP because of cost – this is only going to get worse.

And the final domino is prevention. The freeze undermines our system of primary health care and does not align with a focus on preventative health.

But just when we thought we had seen the worst of health cuts, the Government slashed more.

In last December’s mini budget, the Government cut $650 million from bulk billing incentives for vital blood tests and scans.

Patients and stakeholders rightly reacted furiously, campaigned hard and made the Government listen.

I wish I could say they listened by dropping the cuts – instead, they did what they could to hush the issue until after the election, doing deals with both industries during the campaign.

Pathology Australia agreed that its members would accept the abolition of their patients’ bulk-billing incentives, in exchange for rent regulation. Four months later we have not seen the Government’s proposed regulations. The only thing we know for certain is that the Government remains committed to its cuts to Medicare bulk-billing incentives.

The Government’s second campaign deal committed to re-indexing diagnostic imaging rebates when it re-indexes GP items.

That may be good policy – a $150,000 review by Deloitte will tell us more. But either way the Government’s commitment has huge ramifications for GPs that have slipped under the radar.

As the College points out, re-indexing GP items alone would cost around $160 million a year. But the Government’s deal means it cannot unfreeze GP rebates without re-indexing diagnostic imaging, which will cost around $4 billion over the medium term.

That’s more than this Government has ever been prepared to spend on health. So there’s a risk that both GP and imaging items will remain frozen indefinitely.

On election night Malcolm Turnbull stood up and said he had heard a message and learnt a lesson – but the magnitude of these cuts still on the table stands in complete contrast to that statement.

And while the Government continues to shuffle deck chairs and tinker at the edges with reviews and committees, these cuts are the clearest marker that we have of their direction for our health care system.

Labor policy

Of course, the second job of an Opposition is to develop its own agenda for Government – something particularly important considering the likely truncated nature of the current Parliament.

I have said before that the Coalition came to power with no vision for health but cuts. That will not be true of Labor.

In the recent election campaign Labor put its money where its mouth was. Most notably, we committed $12.2 billion to unfreeze the Medicare Benefits Schedule from 1 January 2017.

Our policy applied to all services provided by GPs, other specialists and allied health providers.

I can tell you that $12 billion commitments don’t automatically sail through the Shadow Expenditure Review Committee. Chris Bowen and other colleagues ask hard fiscal and policy questions – as they should.

But budgets are about values, and Labor was always going to value Medicare over tax cuts.

Labor also held the line against other health cuts, listening to GPs and experts about the impact they would have on patients.

We committed to reverse:

  • Cuts to the Medicare bulk billing incentives for pathology and diagnostic imaging
  • Price hikes to PBS medicines;
  • Cuts to the Medicare Safety Nets; and
  • Cuts to public hospitals over the next four years.

Again, in this fiscal environment, all of those were big decisions.

But as the College and others have pointed out, reversing cuts doesn’t improve our health care system. Reversing cuts just maintains the status quo – which none of us think is good enough.

I’m particularly proud of our efforts in carving out a positive health agenda to implement in Government.  We went to the election with policies with a comprehensive suite of proactive policies, including palliative care and patient centred-medical homes.

I’m revisiting these policies with you today not only because I’m proud of the work that we did – I am incredibly proud – but because these policies signal the vision Labor thinks our health system should have – and what we think is missing in the Government’s agenda.

Labor and the College

Of course, Labor will not get to implement those policies in this term of Parliament. But we will keep the pressure on Malcolm Turnbull and Sussan Ley, and we will refine our own agenda for Government. Coming to GP16 is part of that policy development process – I am keen to hear your ideas.

I said I would touch on how I see the College’s role, and I want to finish on this note before taking questions.

The College is not a political organisation, and never should be.

But there are times when your patients need the College to be an advocate – as you have been through the ‘You’ve Been Targeted’ campaign. You need to keep the pressure on governments – and oppositions for that matter – to protect GPs and patients.

Labor and the College will not always agree. But I do think that we will always share a vision for universal access to world-class general practice.

I look forward to continuing to work with you in this term of Parliament.

NACCHO #IndigenousVotes : Labor policy committed to addressing the injustice of poor health outcomes

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Labor is committed to the efforts to Close the Gap in Aboriginal and Torres Strait Islander Health and believes that central to this is the need to implement the Aboriginal and Torres Strait Islander Health Plan developed in partnership with Aboriginal and Torres Strait Islander people during the period of the Gillard Government.

No group of Australians will be hit harder by the Government’s cuts to Medicare than Aboriginal and Torres Strait Islander Australians.

No group of Australians will be hit harder by the Government’s attempts to drive down bulk billing and push up health costs.

Aboriginal Community Controlled Health Organisations would find it impossible to absorb the costs of these actions and their patient services would be compromised.”

Labor committed to addressing the injustice of poor health outcomes for Aboriginal and Torres Strait Islander peoples.

Presented by Catherine King, Warren Snowdon and Shayne Neumann

Download 24 Page PDF Aboriginal Health Newspaper HERE

A Shorten Labor Government would continue to work in partnership with Aboriginal and Torres Strait Islander Peoples, through the National Congress of Australia’s First Peoples and relevant health organisations such as NACCHO to implement the Health Plan.

In Government Labor would, in consultation with Congress, re establish the National Aboriginal and Torres Strait Islander Health Equality Council, with its costs being met through the Administered funds of the Commonwealth Department of Health.

Consistent with the Health Plan, Labor is committed to  improving preventative health strategies for Aboriginal and Torres Strait Islander Australians and helping to close the gap in chronic disease  and life expectancy  and this will be a major commitment of a Shorten Labor government.

Labor understands that a primary vehicle for improving health outcomes are community based Aboriginal and Torres Strait Islander Health Organisations who provide a very high standard of comprehensive primary health services in a culturally safe and respectful environment.

A Shorten Labor Goverment would continue to work closely with these services as they continue to grow in a sustainable way.

The shameful facts remain, despite the improvements in service delivery over recent years, that the burden of ill health among Aboriginal and Torres Strait Islander people is two-and-a-half times higher than that of other Australians.

In large part this is due to the higher incidence of chronic diseases such as diabetes, cardiovascular disease, respiratory disease and kidney disease; much of this is preventable.

This is simply unacceptable to Labor, is a national disgrace and must be addressed..

In response to this crisis and after having consulted widely, a Shorten Labor Government will invest in tailored, culturally-appropriate health programs aimed at preventing chronic disease for Aboriginal and Torres Strait Islander Australians.

Child and Maternal Health

As a first step Labor acknowledges the importance of the first thousand days of a child’s life from conception. A Shorten Labor Government will continue to prioritise programmes, such as the Nurse Family Partnership,  Abicadarian and other successful maternal and child health programme as a primary tool for the prevention of the onset of chronic disease later in life.

Labor sees a strong relationship between these programmes and our commitment to Children and Family Centres in improving the life outcomes for Aboriginal and Torres Strait Islander children.

Deadly Choices

Empowering Aboriginal and Torres Strait Islander Australians to make their own healthy lifestyle choices is a most important step to improving health outcomes and another key prevention tool

Deadly Choices is a successful initiative of the Institute of Urban Indigenous Health (IUIH) that aims to encourage Aboriginal and Torres Strait Islander Australians to improve their own and their families’ health by improving their diet, exercising regularly and quitting smoking.

A Shorten Labor government will provide $5.5 million per year to partner with the IUIH in rolling out Deadly Choices across the country.

(Again depending on space this next bit could be foregone)Elements of the roll-out will include:

  • National campaigns to promote positive health and lifestyle choices.
  • Partnerships with sporting organisations and sporting ambassadors.
  • Training and licensing for state and territory affiliates.
  • Local Deadly Choices coordinators.

Aboriginal and Torres Strait Islander kidney health taskforce

Aboriginal and Torres Strait Islander peoples are more than twice as likely as other Australians to have indicators of chronic kidney disease.

The incidence of end-stage kidney disease for Aboriginal and Torres Strait Islander people is especially high in remote and very remote areas.

The patient pathway for Aboriginal and Torres Strait Islander kidney patients is often confusing, fragmented, isolating and burdensome.

A Shorten Labor government will convene a national taskforce on Aboriginal and Torres Strait Islander kidney disease as a priority to look for holistic solutions to the current crisis.

( Not sure that this sentence is necessary)In particular, it will address coordination of the complex and fragmented health and social supports for Aboriginal and Torres Strait Islander families affected by kidney failure.

The taskforce will bring together experts in Indigenous health, kidney disease, general practice, food security, health systems, consumer representation and the non-government sector to develop strategies in prevention, early identification, management, treatment and transplantation.

A Shorten Labor government will commit $295,000 to the national kidney health taskforce.

Improving Indigenous eye health

Aboriginal and Torres Strait Islander adults are six times more likely to suffer from blindness and 94 per cent of this vision loss is either preventable or treatable.

Remedying this would alone account for an 11 per cent improvement in health outcomes between Aboriginal and Torres Strait Islander peoples and other Australians.

Australia is the only developed nation where the infectious and wholly preventable eye disease trachoma still exists and it only exists among Aboriginal and Torres Strait Islander people.

Around 35 per cent of Aboriginal and Torres Strait Islander adults have never had an eye exam. Trachoma can be eliminated from Australia by 2020 if we give this problem the attention it is due.

A Shorten Labor government will invest $9.5m to close the gap in Aboriginal and Torres Strait Islander vision loss.

This will go toward increasing visiting optometry services, supporting specialist ophthalmology services, and investing in trachoma prevention activities recommended by the World Health Organisation.

Protecting Medicare

Labor will also improve health outcomes of Indigenous Australians by protecting Medicare.

No group of Australians will be hit harder by the Government’s cuts to Medicare than Aboriginal and Torres Strait Islander Australians.

No group of Australians will be hit harder by the Government’s attempts to dive down bulk billing and push up health costs.

Aboriginal Community Controlled Health Organisations would find it impossible to absorb the costs of these actions and their patient services would be compromised.

That’s why Labor will protect Medicare, ensuring universal and affordable healthcare is available to all Australians.

Labor will protect bulk-billing by ending the Medicare Freeze and abolishing Malcolm Turnbull’s GP tax-by-stealth.

  • We will keep medicines affordable by scrapping the Liberals’ price hikes.
  • And we will legislate to prevent Medicare from being privatized.

Only Labor cares about a public health system for all Australians and is committed to addressing the injustice of poor health outcomes for Aboriginal and Torres Strait Islander peoples.

Please note this is the corrected  IAHA ad for Page 3 of our printed newspaper

IAHA

NACCHO health news : Making Medicare relevant in the 21st Century: AMA and Catherine King

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AMA President Dr Steve Hambleton (pictured right with NACCHO chair Justin Mohamed at a recent Canberra Event) ,

AHHA Medicare Anniversary Roundtable

Making Medicare Relevant in the 21st Century

I would like to acknowledge the traditional owners of the land on which we meet and pay my respects to their elders past and present.

The future of Medicare

I want to speculate about Medicare’s future today – and the key role of doctors, particularly GPs, in that future.

I will make some suggestions about how Medicare can improve its relevance in a changing environment, and how it can best serve the Australian people by continuing to deliver quality, affordable and accessible health services.

As you know, I am not the only person into Medicare speculation recently.

December and January are traditionally the silly season in the Australian media.

The news is full of sport and celebrations … and stories that are recycled, and stories that normally would not see the light of day.

For health, it has been a very silly season.

We have recently seen many opinions about the health system and health financing

People are speculating about the changes to be made to ensure we have a sustainable health care system.

These opinions became stories that inevitably focused on Medicare – because for most Australians Medicare is the Australian health system.

The most notable proposal was the oft-recycled patient co-payment.

The AMA does not support this concept and we have made our view very well known.

There are better ways.

It is interesting that this speculation has come at a time when a new Lancet Commission, when considering global health up to 2035, has recommend that countries should lower the barriers to early use of health services and increase access to disease prevention and minimise the impact of medical expenses.

While I acknowledge the growth in Medicare expenditure, it is important that any changes do not throw the baby out with the bath water.

Any changes must be in the context of the long term goal to improve population health, which will deliver real cost savings.

In terms of spending on medical services, via the Medicare Benefits Schedule, doctors have done their bit over the past decade on containing costs.

As I have said in other fora, medical services costs are not the problem.

Let’s once again set the record straight.

Here are the facts …

Health expenditure

The proportion of health expenditure on medical services was 18.8 per cent in 2001-02 compared to 18.1 per cent in 2011-12.

The average annual growth in total health expenditure on medical services in the decade to 2011-12 was four per cent, compared to growth in PBS expenditure of 6 per cent and 9.3 per cent for products at the pharmacy.

The growth in average health expenditure by individuals on medical services in the decade to 2011-12 was four per cent, compared to 5.3 per cent for PBS medicines and 7.5 per cent for products at the pharmacy.

The average growth in Medicare benefits paid per service in the decade to 2012-13 was 4.7 per cent, less than the real growth in total health spending of 5.4 per cent in the decade to 2011-12.

It is clear that the MBS – combined with the private health insurers’ schedules – is an effective price dampener for medical services.  At least that is what my members keep telling me!

In terms of access to care – despite the low growth in the Medicare Rebate, today, 81 per cent of GP consultations are bulk billed.

And 89 per cent of privately insured in-hospital medical services are charged according to the patient’s private health insurer’s schedule of medical benefits.

This means that patients had no out-of-pocket cost for their doctor’s fee for 93.5 million GP consultations in 2012-13, and over 26 million privately insured in-hospital services.

When Governments get nervous about spending in health, they have three options: reduce the price they pay; spend more wisely; or collect more revenue.

I think that the recent focus on price, in terms of the Medicare Benefits Schedule, is a bit misdirected.

The focus should be on spending that money wisely.  Today, Minister Dutton is quoted as saying that we need to invest in the areas of greatest benefit.

The medical profession stands ready to do its bit in this regard, too.

Australia must change the way it provides health care, where it provides care, and when it is provided for the major driver of health care costs – non-communicable diseases.

Medicare needs to facilitate this.

With the rapid increase in medical knowledge and the rate of change of best practice care, evaluation and change must be part of the medical practitioner DNA.

In terms of our clinical practice, we are going to have to translate what we know into what we do – and we need the tools to do it.

We will need to do this in a structured way so that we stop doing the things we do that don’t provide real outcomes for the patient.

Our clinical practice must be about doing the right things at the right time in the right part of the health system.

Once people get to hospital, their care becomes very expensive.

Keeping people out of hospital is cheaper and it frees up resources, but it might need an increased investment from Medicare, not a decrease.

That investment must be sufficient to improve the coordination of primary care services.

Population Health in the Community – Medicare Locals

The AMA understands the need for community-based health care organisations to improve the coordination of health care outside of the hospital environment.

Such organisations can help to break down the silos in the non-hospital space, build better links between the hospital sector and community based care, support improved population health, and address gaps in the delivery of primary care services.

The former Government set up 61 Medicare Locals to undertake this role.

Despite now having been in operation for a number of years, few Australians understand what Medicare Locals do.

Many GPs feel disenfranchised by them – and so do almost all community-based medical specialists.

We have welcomed the incoming Government’s review and have made a strong submission, based on frontline medical practitioner input.

We believe the former Government pursued the wrong governance model.

They substituted or downplayed the role of GP leaders in Medicare Locals and in their decision-making structures.

They made the same mistakes that the New Zealand Government made in 2001 when it decided to implement ‘skills based boards’ that excluded GPs.

These boards were initially made up of people who, while experienced in governance, did not understand the complexity of health care delivery.

Clinical leadership was absent in many areas in New Zealand and the models failed to deliver.

The leadership role of GPs has now been restored.

The PHOs in New Zealand are now playing a more meaningful role in support of improved health outcomes for local communities.

In New Zealand, the PHOs are now:

  • supporting GPs to focus on population health;
  • supporting improved quality in general practice by facilitating information sharing among GPs;
  • supporting pro-active management of chronic disease;
  • supporting e-health initiatives;
  • funding specific initiatives to keep people out of hospital; and
  • helping support more sustainable general practice by building improved IT and delivering business support.

These are initiatives that are being built from the ground up and led by GPs, not imposed from the top down.

We are calling on the Abbott Government to overhaul the Medicare Locals model to make them responsive to local health needs and to be fully engaged with GPs, who are the engine room of non-hospital based care.

But enough about Medicare Locals, which have got nothing to do with Medicare.

That is why we have suggested a name change.

Complex and chronic disease

The challenges for primary care are growing with our ageing population.

Complex and chronic disease represents a huge burden to the health system.

It accounts for about 70 per cent of the allocated health expenditure on disease and is estimated to increase significantly in the immediate future.

This is both a threat and an opportunity for the Medicare of tomorrow.

Current Medicare-funded chronic disease management arrangements are limited, can be difficult for patients to access, and involve considerable red tape and bureaucracy.

We need less red tape and more streamlined arrangements allowing GPs to refer patients to appropriate Medicare-funded allied health services.

We need a more structured, pro-active approach to managing patients with complex and chronic disease.

The Department of Veterans Affairs is doing some great work in this area with its Coordinated Veterans Care (CVC) Program.

DVA is supporting GPs to provide comprehensive planned and coordinated care to eligible veterans with the support of a practice nurse or community nurse contracted by the Department.

The CVC program is a proactive interactive approach to the management of high acuity chronic and complex diseases.

It supports GPs to spend more time on these patients on a longitudinal basis.  This is something that Medicare currently works against.

The CVC program recognises the non-face-to-face work required, including regular follow-up to see how patients are going without relying on the patient returning to the surgery.

We need to look at how we can roll out this type of pro-active approach more broadly.

It would allow us to invest in a healthier future with better disease management, and prevention of avoidable costly hospital admissions.

The overall message is that if we as a nation do not wish to spend more on health – and that is the clear message coming from the new Government – than we must spend smarter.

We must invest in the things that work.

We must share the knowledge that our various organisations gather from the coalface of health service delivery.

Above all, we must be spending more time building on the things we agree on – and there are a lot of things that we agree on.

Doctors are ready to be a major part of the solution.

GPs are the foundation of primary care – and they save the health system money.

The GP role in population wellness and, ultimately, cost control must be enhanced by Medicare – not eroded or substituted.

The AMA strongly believes that 2014 and beyond must be the years of the GP who can deliver the right care at the right time to the right person.

Medicare must rise to the challenge.

CATHERINE KING MP SHADOW MINISTER FOR HEALTH

MEMBER FOR BALLARAT

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Introduction

Thank you Alison Verhoeven for that introduction, and thank you for the invitation to make this address today.

May I also acknowledge AMA President Steve Hambleton, Con Costa the President of the Doctors Reform Society, Stephen Duckett from the Grattan Institute, John Glover and all of the other esteemed speakers and guests here with us today.

When Bob Hawke introduced Medicare 30 years ago he warned that without it, two million Australians ‘faced potential financial ruin in the event of major illness’. Today more than 39% of Australia’s population is under 30 – that’s more than eight and a half million Australians who are growing up without knowing what healthcare in Australia looks like without Medicare.

And of the two million Australians who faced potential financial ruin in 1984, it’s worth considering just how many hundreds of thousands of people have had their lives changed thanks to Medicare. It’s quite an achievement, particularly given how hard Labor has had to fight not just to introduce, or reintroduce, the architecture of a universal healthcare system, but to protect it.

That we are celebrating Medicare’s 30th birthday is particularly commendable when a comparison is made of international health systems.  No one health system is perfect, but on this 30th anniversary it is right to be celebrating and reflecting on what is important about our health system.

It’s also important that we focus on what needs to be done to preserve the fundamental principles on which it is based:

  • Universal access
  • Overcoming health inequality
  • Access to new medicines and treatments
  • And prevention.

History

For the millions of Australians who have grown up with Medicare it must be difficult to appreciate how different Australia’s healthcare system was in 1984 compared with the system of universal care we are afforded today.

Of course the Medicare we know is different from the scheme that was originally introduced. Gough Whitlam introduced Medibank in August 1974 only to have Malcolm Fraser and his government overturn it in 1976. The legislation for Medibank had been blocked in the Senate, and was one of the key issues Labor campaigned on during the 1974 election – indeed it was one of the measures on which the Governor-General granted a double dissolution.

At the time, Whitlam argued that the conservatives had:

‘Preserved the inequity, inefficiency and injustice of an antiquated health scheme. They have prevented one million of our fellow-citizens from having any protection against hospital and medical charges.’

Whitlam’s victory in ’74 would prove to be one of the most important steps in achieving a system of universal healthcare but it would not be a decisive one. It took two Labor governments more than two decades to embed what is now Medicare.

When Neal Blewett, the reforming health minister in the Hawke government, introduced the legislation that would re-establish a system of universal care he told the parliament:

“In a society as wealthy as ours there should not be people putting off treatment because they cannot afford the bills. Basic health care should be the right of every Australian.”

It’s a statement that says everything about what Labor stood for 30 years ago and it says everything about what Labor stands for today.

Bulk billing and co-payments

It’s appropriate therefore to focus on some of the achievements of the past two terms in government. When Labor left office bulk billing rates were at more than 80%. This is an achievement I’m very proud of but also something that also causes me deep concern. The increase in bulk billing rates to this historical high did not happen by accident.

The incentives my colleague Tanya Plibersek introduced, and before her Nicola Roxon, for GPs to bulk bill, particularly to bulk bill concessional patients, have made it easier for all Australians to get to see a doctor, but in particular they have benefited those members of the community who most need the assistance Medicare affords. Over the past month we’ve seen the government repeatedly refuse to rule out the introduction of a Medicare co-payment. This would end bulk billing and put considerable pressure on some of the most vulnerable Australians, many of whom already have very low access to GPs.

Labor’s legacy

To strengthen primary care Labor established a network of 61 Medicare Locals servicing every region. Medicare Locals are intended to save money on secondary care and prevent hospital admissions. They are also one of the important ways Labor strengthened Medicare when in government by refocussing on the importance of primary care.

The benefits of the work Medicare Locals are undertaking are already being seen in communities across Australia. Medicare Locals are identifying specific needs for local services and planning for services to address these gaps, such as through the engagement of additional nurses and other allied health professionals at GP clinics, as well as the provision of after-hours GP services.

But most importantly Labor made funding available to ensure these services could be delivered effectively.  Medicare Locals provide the architecture for a stronger reengagement of the Commonwealth in local primary care and planning. Medicare Locals for example are working to increase breastfeeding rates in areas where breastfeeding rates are low; in areas where smoking rates are high there are programs tailored specifically to those communities to reduce smoking rates, as there are programs to reduce rates of type two diabetes in communities that have a significant prevalence of this disease.

Despite the rhetoric of the new government, the vast majority of people employed by Medicare Locals are directly responsible for providing care and improving health services in local regions.

Viability of Medicare

As the demands on the MBS and PBS continue, it’s important to ensure governments get the best value for money on health expenditure and that all Australians continue to get access to the best quality medical care. The sustainability of Medicare is about much more than purely academic arguments.  It’s important that new policies be pragmatic and can actually be implemented by governments. A good example of this is the price disclosure reforms we pursued when in government.

But it’s important to acknowledge too the challenges that had to be met to implement this policy.  I am concerned however that some of the rhetoric of the past few months is more about softening the Australian public and media up for an assault on the universality of Medicare and a further move towards a two tiered health system. Today for example we have seen the Health Minister use a Productivity Commission report as an excuse to talk about cutting ‘waste’ in health.

On its record to date it’s difficult to trust this government, and I fear the Minister is only using this rhetoric as an opportunity to justify cuts to satisfy the Prime Minister’s agenda. Over the next couple of years I am particularly interested in working with you to develop new ways we can ensure greater equity in our health system and make sure the Medicare of the 21st century is something its original architects and the Labor party that introduced it, can be proud of today.

Private Health Insurance

It’s important to acknowledge that the private health insurance industry does play an important role in healthcare in Australia. Labor’s position remains that governments have a responsibility to ensure that the private health insurance industry remains sustainable and that private health insurance is affordable and provides good value. The means testing of the private health insurance rebate that Labor introduced in government meant a number of the health programs and infrastructure projects I’ve already mentioned could be delivered.

Despite the criticism at the time we did not see tens of thousands of Australians giving up their cover as was claimed would occur. On the contrary, the number of people with both general and hospital cover is at the highest rate ever and continues to grow. For the first time ever, 55% of Australians have general cover, with 47% having hospital treatment cover.

The challenge for the government now is to ensure the cost of private health insurance is kept as low as possible and that the system does not undermine Medicare. At the end of last year Minister Dutton announced the largest increase to private health insurance premiums in a decade. In government, we had always taken several months to agree on premium increases, often going back to individual insurers several times to ensure consumers received the smallest increase possible. This was a particularly cynical announcement by this government and one that would be a mistake to repeat.

I want to mention briefly the government’s intention to sell Medibank Private.  Labor has reservations about what the sale of Medibank will do for competition in the sector and what this will mean for consumers. Having a government-owned insurer has had a balancing factor in the sector which would be lost should Medibank be sold.  More concerning again is the new government’s rhetoric about the move of the private health insurance industry into general practice.

I am interested from a policy perspective in good models of care. I am interested in how there can be a stronger role for prevention and more integrated case management, better consumer health literacy, more consumer engagement. There are very good examples across the country, including some of the work private health insurers are doing with their captured population of patients.

But I remain fundamentally concerned as a Labor Shadow Health Minister about health inequality and my very real fear is that there is a genuine danger of a shift toward a two tiered health system.

Conclusion

Today, some 30 years since the introduction of our universal health system – Medicare – debates about its structure, its funding, its principles and its implementation continue. But it is clear that Australians value it and that it is embedded as a fundamental aspect of our society.

I want to wish you well in your deliberations today.

I wish to congratulate the AHHA on pulling together speakers who have been responsible for the establishment, implementation and defence of Medicare.

Labor stands for a system of universal care.

As Neal Blewett told parliament 30 years ago, basic healthcare should be the right of every Australian.

30 years later, it is.

Medicare is a system worth defending and we will do exactly that.