NACCHO Aboriginal healthly debate: Medicare Locals (MLs) their future is unclear ?

QUESTION TIME

We are committed to reducing waste and spending on administration

and bureaucracy, so that greater investment can be made in services

that directly benefit patients and support health professionals who

deliver those services to patients.”

Health Minister Peter Dutton:

For more info about review

NACCHO has provided our members the following viewpoint in the interest of “healthy debate”

From the CONVERSATION Joan Corbett VIEW HERE

Adjunct Associate Professor Public Health at University of Canberra

Primary health care in Australia is a messy beast, with many heads and all sorts of body parts. But it’s centrally important because it plays a major role in achieving public health outcomes, such as better co-ordinated care for people with chronic conditions, good immunisation rates and programs to help people quit smoking and lose weight.

Medicare Locals (MLs) now have a role in coordinating and improving this care, but their future is unclear.

MLs were set up during the Rudd-Gillard health reforms to tame the beast, plan for better preventive health, fill gaps in service and improve coordination by drawing on local knowledge.

This means working with hospitals, Aboriginal medical services, community health services, patient advocacy groups, the aged, refugees and immigrants, as well as state and local governments.

Before the election, health minister Peter Dutton derided MLs as merely an “extra layer of bureaucracy”, foreshadowing the possibility they could be axed under a Coalition government. Professor John Horvath, chief medical officer from 2003 to 2009, is now reviewing the role and function of MLs. Submissions closed last month and he will report to government in March.

There are 61 Medicare Locals across the country, the first of which have been operating for a little over two years. Since MLs have now provided more than 500,000 services and 4,700 professional development and education sessions for health professionals, it will take more than a click of the fingers to cut them out and return to the pre-2011 system where the Divisions of General Practice did some (but nowhere near all) of this work.

Submissions to the review

There are many more services and providers involved in Medicare Locals than general practitioners and specialists, though listening to some of the dominant voices involved in the review gives the opposite impression.

Disappointingly, the submission of the Australian Medical Association (one of the doctors’ advocacy groups with a big voice in policy debates) takes the simple view that Medicare Locals don’t work because they are not dominated by doctors. The AMA role is to protect the earnings and interests of doctors but its submission is a thin piece of analysis referring to none of the successes, strengths or potential of MLs.

On the other side, the submission from the Australian Medicare Local Alliance is all sunshine and flowers. It gives a very positive set of reasons to give MLs a longer go and is thin on the real criticisms that may have to be addressed. Helpfully, it attaches appendices with some statistics and many examples of the work and success stories so far.

The Greater Metro South Brisbane Medicare Local, for instance, has offered 11 Chronic Disease Self-Management Programs to Aboriginal and Torres Straight Islander peoples, including for diabetes.

In between these extremes we have some mixed views in other submissions.

On the positive side, there is some great work on health promotion and coordination which might deliver considerable health savings in the longer term if not cut off at the knees. There are also more voices at local level getting together to map what services exist, weigh up what is needed and plan to get the care the community prioritises.

But there is some duplication and wasted effort when MLs provide services now that are competing with other providers rather than filling gaps.

The name is also a problem, as people think they can make payment claims at the ML – a role for the national Medicare offices.

Overall, there is a strong case to let the MLs have a few more years to prove their worth and to see what savings elsewhere in the health system may be countable by the ML-driven effect on reducing hospital costs, unnecessary tests, screening and doctor visits and the burden of chronic conditions. The current UNSW-Monash-Ernst and Young evaluation, (separate to the review), should shine some light on these questions.

What are the likely review outcomes?

There are three broad categories of possible outcomes and we may not know before the federal budget in May.

The first is a “let it run longer and see what the evaluation says” approach, with minor tweaks to clarify roles and perhaps changing the name.

The second is more drastic: to cut the ML roles by, for example, taking much of the preventive health planning and education functions out. This would leave a focus on service delivery, while trying to reduce duplication of effort.

The third is to axe the MLs entirely and phase a return to something more like the old Divisions of General Practice.

The two more drastic approaches would weaken Australia’s primary health care system. It would go against the professional and community input to the national health reform discussions in 2008-09. And state governments might have very negative views about radical chopping and changing of this scale at this time.

How do the economics stack up?

MLs were set up with a modest budget. Depending how they are counted, the savings from axing them are likely to be less than A$1 billion over four years, allowing for transition arrangements and current contract commitments to be met.

There are certainly bigger fish to fry in health savings. These include the Grattan Institute’s proposed Pharmaceutical Benefits Scheme reform, which might save A$1.3 billion a year, or removing the private health insurance rebate. Reducing the rebate by 25% could save A$549 million per year.

We need a rational analysis rather than an ideological knee-jerk reaction to another Labor hangover; we need to give Medicare Locals a chance to improve health outcomes and consider building on their strengths after more

NACCHO welcomes your COMMENTS in the section below

NACCHO Medicare Locals news:Coalition to conduct formal review of Medicare Locals if elected

Question Time in the House of Representatives

Speaking at the Australian Medical Association (AMA) conference in Sydney on Friday, opposition health spokesman Peter Dutton said questions remained over the role of Medicare locals, the 61 organisations set up by Labor to co-ordinate primary care.

“Some Medicare locals appear to be doing a good job,” Mr Dutton said.

“But in some cases, health professionals have expressed their frustration, or indeed indifference, to their existence.”

Read NACCHO previous coverage of Medicare Locals

Medicare Locals and the Aboriginal Community Controlled Health Sector: Where are we? Where are we going?

Response from AML Alliance CEO Claire Austin is in the comments below

Mr Dutton has previously criticised Medicare Local, labelling it a bureaucracy that has not improved health services.

On Friday, he said he was concerned Medicare Local could act as a commonwealth-subsidised competitor that disrupted other health services, rather than raising the level of care.

“Contracts have been signed secretly, and the government refuses to provide any further detail about 3000 people now employed across the Medicare Local network,” Mr Dutton said.

He said the coalition would consult experts including general practitioners and clinicians in its review.

The Australian Healthcare and Hospitals Association (AHHA) called on the coalition to reveal its plans for Medicare Local ahead of September’s election.

“Deferring decisions until after the election leaves patients, families, communities and health service providers in limbo,” AHHA chief Prue Power said.

“The health sector is a complicated system and changes in one area can have significant implications for the rest of the system.

“The coalition need to be upfront about their plans for Medicare locals and for primary health care more broadly.

“Health and access to health care services are important issues for all Australians and they have a right to know what is planned before the election so they can make an informed decision on election day.”

AML Alliance, the peak body for Medicare Local, said it would welcome the opportunity to outline to the coalition how Australia’s primary health care system was improving.

“We have a wealth of data available to inform the opposition about the Medicare Local sector and I look forward to the opposition actively seeking this information from us,” AML Alliance chief executive Claire Austin said in a statement.

“Medicare Locals are … ensuring better management of chronic diseases such as diabetes, heart disease, smoking cessation programs and asthma, for example.”

Ms Austin said AML Alliance would treat a review as an opportunity “to fill in the information gaps the coalition seems to have about Medicare locals”.

Read more:

NACCHO political alert: Federal Government to establish Chief Allied Health Officer

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Minister for Health, Tanya Plibersek, has announced that the Government would establish the Commonwealth’s first Chief Allied Health Officer to support the work of thousands of important health professionals.

“Allied health professionals make up about 20 per cent of the health workforce in Australia, providing vital services to patients and the establishment of a Chief Allied Health Officer will further strengthen and support their work,” said Ms Plibersek.

Refer INDIGENOUS ALLIED HEALTH PROFESSIONALS

“They play a key role in patient care, especially for people with chronic and complex conditions, and the services that they provide are becoming increasingly important with an ageing population.

“The Government recognises the work that allied health professionals do and the Chief Allied Health Officer will provide advice on how best to strengthen their role,” said Ms Plibersek.

The establishment of a Chief Allied Health Officer also responds to a recommendation of the Senate Community Affairs References Committee, following its inquiry into the factors affecting the supply of health services and medical professionals in rural areas.

The committee found that allied health professionals face additional challenges in delivering services to regional, rural and remote Australia.

While the Chief Allied Health Officer will have improving the delivery of allied health services in the bush as a key focus, all Australians will benefit from well integrated medical, nursing and allied health care services.

Medicare Locals also provide important new opportunities for allied health services to be more effective and more accessible in local communities across Australia.

The Minister has congratulated Allied Health Professions Australia (AHPA), Services for Australian Rural and Remote Allied Health (SARRAH) and Indigenous Allied Health Australia (IAHA) on their commitment to advancing allied health care and supporting allied health students and practitioners across Australia.

NACCHO political alert: Speech to Medicare local Forum Canberra Hon Tanya Plibersek MP

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Medicare local forum Canberra

The speech is provided to NACCHO members for information only and is not NACCHO Policy

Please note: NACCHO will be responding next week

As Health Minister, it’s always such a privilege to meet with some of the brightest minds and passionate advocates in the Australian health system. So thank you for the opportunity to do that again today.

And congratulations on playing such an important part in reshaping the Australian health system.

The establishment of Medicare Locals is emblematic of how this Government has acted to shift the gravity in the health system towards primary healthcare.

Medicare Locals are part our Government’s National Health Reform agenda. An agenda that’s changing the landscape of Australian healthcare – from a system focussed on the best treatments for people who are sick in hospital, to one that keeps people well too.

It’s change based on the best evidence about what works to give patients quality healthcare when they need it, where they need it.

As we all know, the evidence is clear. Health systems centred on primary healthcare have better outcomes.

As I’ve said before, but it’s important to reinforce, we just have to look at the findings of the World Health Report in 2008. The Report found that where countries at the

same level of economic development are compared, those that were organised around the tenets of primary healthcare produced better health outcomes for the same investment.

Today I wanted to speak with you about three things:

  • Firstly, how Medicare Locals are transitioning from the establishment to the delivery phase;
  •  Secondly, about engaging with Australians on what their Medicare Local is doing for them; and
  •  Thirdly, why the devolution of decision making and responsibility to Medicare Locals is so important, and how that flexibility supports innovation.

Medicare locals transitioning from establishment to delivery

Since 2009, we have worked to set up the architecture for Medicare Locals, so each organisation can operate with the confidence of strong governance and support.

But as important as that architecture is, we’re now on to the exciting stuff – the transition of Medicare Locals from establishment to the delivery phase.

That is, health professionals on the ground delivering services to people – across the nation.

I find it extremely disappointing to hear some describe Medicare Locals as just another layer of red tape.

I’ve spoken to health professionals and the people they help in Medicare Locals throughout Australia – and nothing could be further from the truth.

You know, as I know, that Medicare Locals are health services, not health bureaucracies. And those who suggest otherwise do so in spite of the facts.

The truth is that around seven out of ten Medicare local staff work directly with patients -More than 1740 workers across Australia

I fail to see which doctor, which nurse, which psychologist, or which patient would be helped by cutting the $1.2 billion for Medicare Locals out of the system.

The word Medicare in the name ‘Medicare Local’ reminds us all what an integral part Medicare Locals play in Australia’s world-class universal health system.

Any assault on Medicare Locals is an assault on Medicare and our system of universal healthcare. And it’s an insult to those health professionals who work so hard to help so many.

Make no mistake – to me, and to this Government, Medicare Locals are no optional extra. Although much newer, Medicare Locals are as important to our healthcare system as the MBS or the PBS.

They are also the vital link between community health and hospitals – the other three out of ten Medicare Local workers are helping to ensure patients are cared for properly whether in their own home, a community setting, or going into or coming out of hospital.

Engaging with australians on what their medicare local is doing for them

Because Medicare Locals are in their infancy, it is critical we work together to engage with Australians about what Medicare Locals mean for them.

As I visit Medicare Locals throughout the country, I see first-hand the incredible work going on – and the difference that work is making to people’s lives.

And they are the stories we must share.

Only last Thursday I visited the Footprints program at Newstead in Brisbane which is supported by Metro North Brisbane Medicare Local through its flexible fund.

Footprints uses the money to provide an active outreach service targeting the homeless community in their region to access primary healthcare services, and to help them with advanced care planning.

Or the new after-hours service that’s just opened at the Nepean Hospital – helping families in Penrith and the Blue Mountains access a GP instead of having to turn up at an emergency room.

And there are many many other examples of fine work happening across Australia.

But for the public and for healthcare professionals to grow confident in Medicare Locals, they must hear about what it is you are doing, and they must be a part of it.

That is why this forum is so important.

I understand the purpose of you all being here together in Canberra is to clearly articulate a shared strategy for Medicare Locals …

…what is your common story and how do you tell it?

…here are you going as a network of Medicare Locals and how are you going to get there?

…ow do you continue building trust and respect amongst the people you serve?

…ow do you not only perform and succeed, but share that performance and success with your communities, and with each other?

…how do you build capacity and capability to take on increasingly sophisticated and complicated roles and responsibilities within the health system?

These are important questions and it is timely for you to be planning together about how you respond to them.

The importance of devolving decision making and responsibility to medicare locals – flexibility to support innovation

As a Government, we have given Medicare Locals the opportunity to play a central leadership role in reform of primary healthcare and consequently of the Australian health system more broadly.

This is both a great privilege and responsibility.

The devolution of decision making to a local level and more flexible funding allows Medicare Locals to be innovative and responsive to the unique health needs of their communities.

But it’s important to remember that the investments you are making in your communities are with the nation’s health dollar. And it’s critical that you get bang for our buck.

Your achievements so far have been impressive.

In recognition of that, I continue to look for other Commonwealth funded programs that can be devolved to the Medicare Local level.

Already, about 30 major health programs are being delivered through Medicare Locals.

And today, another program will be added to that list.

I am very pleased to announce that the Government’s

More Doctors for Outer Metropolitan Areas Relocation Incentive Grants  will be devolved to the Medicare Local level.

As you probably know, this program has been supporting doctors to relocate from inner to outer metropolitan areas.

This is helping even out medical care services in our communities and is reducing some of the geographical inequities that persist.

The transfer means 30 outer-metro Medicare Locals will be funded to administer the grant – which is backed by a $15 million Government investment over the next four years.

Responding to emerging community needs

In recent years, our Government has invested record amounts for more hospital beds, more clinics, more equipment for high-tech procedures and better health infrastructure.

We’ve also opened the door for thousands more doctors, nurses and allied health professionals.

But, at the primary healthcare end of the spectrum, what confronts today’s patients?

Will they share in the full benefits of the health resources of an advanced, developed nation?

Do people, especially the disadvantaged, see a clear pathway to wellbeing?

We know that lower-SES Australians still find it harder to access health services compared to their higher-SES counterparts.

Medicare Locals are instrumental in helping to address that inequality.

A great example – just a few days ago in Perth a new StreetDoctor Truck was launched at the headquarters of the Perth Central and East Metro Medicare Local.

This will provide healthcare services in inner Perth and the surrounding area for homeless and disadvantaged people.

The service provides general health checks, wound dressings, immunisations, harm minimisation and other counselling, and links patients to mainstream services.

This service launches with 2,500 active patients, four in every ten are under-25-year-olds, 30 per cent are Aboriginal and Torres Strait Islander people, and the vast majority have mental health issues.

The service has important partnerships with Passages, Red Cross’ soup kitchens, Pharmacy Ashfield, The Town of Bassendean, Catholic volunteer friendship, and support workers.

Recognising this important community need, the Medicare Local has built the StreetDoctor up so that it now provides 40 hours of service a week – an incredible example of a collaborative response to a local health need.

And Medicare Locals are there in times of crisis.

Like in Queensland after the recent floods, the Sunshine Coast Medicare Local offered free mental health counselling to support the well-being of residents in Sunshine Coast and Gympie. And the Wide Bay Medicare Local was also very active in supporting Aboriginal and Torres Strait Islander people who were hit particularly hard.

Conclusion

It’s examples like those that really do speak volumes about the importance of Medicare Locals.

Local control and local solutions are seeing Medicare Locals delivering for communities across Australia.

Medicare Locals are an essential part of our universal healthcare system.

Our Government stands shoulder to shoulder with you all as you continue your fantastic work delivering healthcare to Australians when they need it, where they need it.

Medical student inspired by remote health trip to Central Australia

GoRuralNT-JasminDes (2)

Medical student Jasmin Grajzman meets Des Smith during a dialysis session at the Santa Teresa clinic in Central Australia. The clinic is community controlled and auspiced by NACCHO member  Congress Alice Springs (CAAC) . Picture: Diana Carli-Seebohm

Story

A trip to Central Australia has ignited an interest in remote health for WA medical student Jasmin Grajzman.

Jasmin was one of eight students, selected from more than 100 applicants around Australia, who took part in the Go Rural “City to Centre” experience last month.

They visited remote communities, met local health workers, learnt basic emergency skills and swam in spectacular gorges during a four-day visit to Alice Springs and beyond.

“It opened my eyes to the fact that you don’t have to go overseas to see third world medicine,” says Jasmin, a second year medical student at the University of Notre Dame in Fremantle. “It’s right here in our own backyard.”

The students discovered that Central Australia is the dialysis capital of the nation, with a huge effort being made to treat above-average levels of kidney disease amongst Indigenous people.

Jasmin spent time talking to Des Smith, a resident of the Santa Teresa community 80km from Alice Springs, while he was undergoing one of his regular dialysis sessions at the local clinic.

Des was very interested in the Go Rural program and the young visitors to the clinic. He liked the idea that they might return to practice medicine in his community.

“So they might come back to work here in Santa Teresa when they’ve finished studying? That’s a good thing. We’d like to see more doctors coming here.”

The Go Rural “City to Centre” visit was organised by NT Medicare Local in collaboration with Rural Health Workforce Australia. It is part of a national campaign, funded by the Department of Health and Ageing, to attract medical students and young doctors to careers in rural medicine.

“The Northern Territory Medicare Local was delighted to kick off this year’s Go Rural program with a red centre adventure, showcasing rural practice to some of Australia’s next generation of doctors,” says Debbie Blumel, CEO of NT Medicare Local.

“Our workforce team is dedicated to bringing more health professionals to the NT and Go Rural is a great opportunity to plant the seed that will hopefully bear fruit once students graduate.”

It seems that seed is already germinating with Jasmin Grajzman. She says the Go Rural trip has inspired her to further explore remote medicine during an elective year at Notre Dame.

Find out more about the Go Rural Australia campaign at www.rhwa.org.au/gorural

Media inquiries: David Ball, Northern Territory Medicare Local, 0458 672 961,

or Tony Wells, RHWA, 0417 627 916.

NACCHO MEDICARE LOCAL PRESS RELEASE:Recognition of Aboriginal health as ‘core business’ for Medicare Locals.

The Aboriginal Community Controlled Health Service sector congratulates  Australian Medicare Local Alliance (AML) Alliance Chair, Dr Arn Sprogis, on his clear and unambiguous statements regarding the centrality of Aboriginal and Torres Strait Islander health to the current health reform agenda  and for the recognition of Aboriginal and Torres Strait Islander health as ‘core business’ for Medicare Locals.

Speaking after attending NAIDOC celebrations  in Hobart, NACCHO chair, Mr Justin Mohammed, said that NAIDOC week reminds us all that much has been gained by the Aboriginal and Torres Strait Islander community but there still exists much work to  be done to ensure that the health needs and the health aspirations of Aboriginal peoples are met.

The increase in the Aboriginal & Torres Strait Islander population, as reflected in the recently release Census data, is a testament to the dynamic nature of our culture, Mr Mohamed said.

 However, since the vast majority of the population growth is due to a healthy increase is the Aboriginal & Torres Strait Islander birth rate, the data also underlines the need for well-planned and culturally delivered health services that comprehensively address the needs of all members of extended Aboriginal & Torres Strait Islander  families, he said.

While NACCHO recognises and encourages people to identify as Aboriginal and/or Torres Strait Islanders when engaging with mainstream health services, this will only happen in environments where Aboriginal people feel safe and where their input and their decisions will be respected, Mr Mohamed continued.

While the numbers of Aboriginal & Torres Strait Islander people identifying at mainstream health services continues to grow, there is concern that the uptake of Aboriginal-specific Medicare Benefits Schedule (MBS) item numbers has shown no significant growth as a result of these increased registrations and remains alarmingly low overall, he said.

It is no longer appropriate to see Aboriginal and Torres Strait Islander people’s health as simply a matter of ‘access’, Mr Mohamed said.

Our people’s health must now be framed around assurances of high-quality and evidence-based services that are firmly grounded within the concept of the social determinants of health and which recognise the influence the social gradient has upon the health status of Aboriginal & Torres Strait Islander people. Health is a human rights issue, not just a medical one, Mr Mohamed pointed out.

Mr Mohamed said NACCHO is the peak body representing almost 150 Aboriginal Community Controlled Health Services (ACCHS) across the country. Our member services have extensive experience and expertise in the design, delivery and evaluation of comprehensive primary healthcare services to Aboriginal  people and the communities where they live; this experience and expertise has been built up over forty years of Aboriginal communities  delivering health services.

Our sector stands ready to work with Medicare Locals in a genuine partnership as they begin their long but ultimately rewarding journey in addressing  and improving comprehensive primary healthcare for all Australians. Working in a spirit of cooperation and collaboration, we can ensure Medicare Locals  bring about the necessary reforms to clinical and support systems within mainstream services that will bring benefits to the entire community, not just to Aboriginal and Torres Strait Islander peoples.

These are testing times for all of us involved in health, Mr Mohamed said. With the continued shrinking of already finite health resources, we must ensure that we work in genuine partnership and not in competition: competition will simply weaken us all and bring negative impacts to our respective communities, he said.

 NACCHO and its members look forward to playing a strong role in the new and emerging health environment and to working to ensure that Aboriginal peoples receive the highest-quality health services that are the right of all Australians, Mr Mohamed concluded.

For media interviews Contact Colin Cowell

National Media and Communications Advisor

0401 331 251

 Please note if you have not subsribed to our NACCHO communique please send us your email (top Right at site )

Tailor the health care to Close the Gap: hence Medicare Locals

 

Australia’s increasing Indigenous population is being urged to sign up for quality chronic disease management in general practice to ensure this cohort of Australian society gets the primary health care services they need.

During NAIDOC week, in which the nation celebrates and acknowledges the achievements of Aboriginal and Torres Strait Islander peoples, AML Alliance Chair, Dr Arn Sprogis says the good news is more individuals are identifying as Aboriginal and/or Torres Strait Islander which is fundamental to how we as a nation work towards closing the gap on health inequities between Indigenous and non-Indigenous Australians.

“According to the latest Australian Bureau of Statistics’ Census data for 2011 there has been a 20 percent increase in the Indigenous population since 2006 – that’s an increase from just over 455,000 to nearly 550,000 people,” Dr Sprogis said.

“While much of this increase is due to the Indigenous birth rate, a sizeable factor to this increase can also be attributed to people increasingly identifying as Indigenous,” he said.

“For the health sector, particularly in general practice, the more GPs and practice nurses and allied health professionals are aware of the Indigenous status of patients the greater the opportunity to ensure Indigenous Australians can be made aware of their health rights locally.

“One of the biggest tasks ahead for Medicare Locals is to ensure health service programs can respond to the particular needs and requirements as well as the clinical needs of Aboriginal and Torres Strait Islanders,” Dr Sprogis said.

“To achieve this, the PIP IHI has been designed to get general practices to register for the incentive program and from there encourage their Aboriginal & Torres Strait Islander patients to register to claim the benefits that can be offered through the program,” he said.

“While there is still room to improve these incentives, since this program started 2,600 general practices across the country have registered which is nearly 45 percent of practices nation-wide.

“Over 100,000 eligible patients are currently benefiting from funding directed towards various Indigenous Health programs and over 1.5 million prescriptions have been dispensed from pharmacies and four of the top five scripts have been for treating cardiovascular disease and diabetes.

“Adding to the efforts to improve access to mainstream health services, Medicare Locals across the country are doing a mix of employing and funding a health workforce which currently consists of more than 260 Indigenous Outreach Workers, Indigenous Health Project Officers and Care Coordinators.

“Supported by their Medicare Locals, this workforce has deep outreach into the community so that the right services can be accessed at the right time.

“As Medicare Locals continue to grow, their integration of Indigenous health services will improve significantly and the right balance for health services for their respective Aboriginal & Torres Strait Islander population will be achieved, helping to make inroads into closing the gap in health inequities ” Dr Sprogis said