Australian Healthcare and Hospitals Association (AHHA) Congress, Hotel Grand Chancellor, Hobart
View by date:Previous Ministers
Thursday 8 October 2009
- Traditional custodians of the land;
- Dr David Panter, President, AHHA;
- Prue Power, Executive Director, AHHA;
- Dr John Deeble AO;
- Ladies and gentlemen.
It’s a pleasure to be here today to open this congress and to have the opportunity to give you a progress report on the Australian Government’s health reform agenda.
First of all let me say to all members and executive of the AHHA, thank you for your continued and valuable input and contribution to the health reform agenda over many years.
Thank you also for your support for Government efforts to turn around Commonwealth investment in the public hospital system after more than a decade of neglect by the Howard Government.
For more than six decades you have been a strong voice for public and not-for-profit healthcare. Your commitment to public health – universal public health – is unquestioned.
This is a passion you share with the Rudd Labor Government.
This passion is why we are all here today, and it is why the Government has embarked upon an ambitious, long term reform process for health.
We came to office determined to end the blame game, to right the wrongs.
Our current health reform program – the largest undertaken by an Australian government since the introduction of Medicare – is the next major step or, the next leap in the evolution of health care in this country.
In that sense the theme of your conference is timely – Shaping up in health: how does Australia become the world’s best?
I think it is worth noting that we aren’t in too bad a shape. Australia’s health system consistently ranks among the best health systems in the world. We have, on the whole, very good health outcomes, backed by a highly skilled and dedicated health workforce.
But all of us here know that it is a health system under considerable pressure. There are serious, systemic issues that need addressing and action:
- We need to close the gap between the health of Indigenous and non-Indigenous Australians;
- We need to improve hospital capacity, as waiting times are too long and need to come down;
- We need to prepare our health system for the needs of an ageing population where the rates of chronic disease are rising;
- Parts of the system don’t talk to each other, which results in patients falling through gaps; and
- Our health system focuses on treating, rather than preventing, illness and disease.
So we have set about reshaping health care in Australia.
The reform agenda
I’m sure you’ve all noticed recently that I have been travelling around the country with the Prime Minister discussing the future of our health system.
At the end of my speech I will take you more formally through the Health and Hospitals Reform Commission report, together with the draft National Primary Health Care Strategy and the National Preventative Health Strategy. These 3 reports, taken together, present the government with a blueprint for the root-and-branch reform of our health system.
No more band-aids, no more sticky tape – we want to truly plan and invest in long term change, and leave our children with a stronger health system that we found.
The key directions of the reports build on and extend many areas of the Government’s health reform agenda so far, in areas like workforce initiatives, primary care, prevention, better performance and accountability and addressing gaps and inequities.
Investments in public hospitals
And I make this point because whilst we have an ambitious long term plan for reform, we have moved quickly to address some of the more urgent priorities, especially in our public hospitals.
For many members of the community, the public hospital is the first, sometimes only, port of call in times of crisis. More than that, for regional communities, the local hospital is the local hub, the local nerve centre. It is part of the glue that binds communities together. This is why it distresses so many people to see our public hospitals struggle.
We saw it in opposition. That’s why one of the first acts we did upon coming to government was immediately inject $500 million into our hospitals. We then built on this first step with the new National Healthcare Agreement signed last year. The Health and Hospital Reform Package provides $64 billion over five years to the states and territories which is an increase of 50 per cent on the last ACHA of the Howard Government.
The new agreement includes:
- $60 billion for the new National Healthcare Agreement;
- $750 million to help reduce pressure on emergency departments – the fruits of which are beginning to take shape, such as in NSW where they are rolling out more Medical Assessment Units;
- $500 million to help improve subacute care – in the ACT, Calvary Hospital has used their allocation to upgrade their fantastic Older Persons Unit;
- $872 million for preventative health – the largest investment in prevention by a Commonwealth Government;
- $1.1 billion to build a sustainable and skilled workforce;
- $1.6 billion to close the gap in Indigenous health outcomes; and
- $153 million to move towards a nationally consistent activity-based funding system for public hospitals.
Stage Two funding under this program is rolling out across the country, and I’ve been delighted to be able to don the hard hat and personally inspect construction work on new operating theatres at Royal Brisbane and Royal Melbourne Hospitals. Here in Hobart, it means $800,000 for new quipment for Royal Hobart Hospital.
The point is – our extra money is starting to hit the front line, and have a direct impact on service. The rubber is starting to hit the road.
This is a fact confirmed just last week by the AIHW, when it released its latest report which showed that the share of Commonwealth funding for public health increased in 2007/08 – the first time this has happened since 2000/01 – and this is before the new agreement had taken effect.
Our aim is to achieve lasting and sustainable improvements to ensure patients receive the care they need at the right time and at the right place.
Health and Hospitals Fund
The Rudd Government is also working hard to create world-class health infrastructure for the nation.
We established the Health and Hospitals Fund in 2008 and deposited $5 billion into the kitty. This is a new and more strategic foray into infrastructure spending to help transform our nation’s health infrastructure.
This year’s budget saw the first down payments from the HHF, with $3.2 billion for 36 projects across the country. This includes:
- $1.3 billion towards building a world-class cancer system, including $560 million for a network of up to 10 Regional Cancer Centres;
- $1.5 billion towards 17 health projects of national significance; and
- $430 million towards medical research infrastructure.
Projects include a new Acute Medical and Surgical Service Unit at Launceston General Hospital, Stage 2 of the Menzies Building for the University School of Medical, Nursing and Pharmacy, and the construction of a primary care centre in Scottsdale.
All these projects will support a health and hospital system for a modern Australia and have the added benefit of creating jobs for Australians during this difficult economic time.
As you can see, the Rudd Government has been busy. We have been working hard to take immediate steps to better support our public hospitals and put in place the programs and policies to ensure our health workforce can continue to provide quality health care to the Australian community.
We will need to discuss, debate and agree on our choices and priorities if we are to make the system better for the long term and I invite you all to join the conversation.
In terms of our public hospitals, we have on the table for consideration a range of recommendations to consider.
I can’t give the scoop this morning on which NHHRC recommendations the Government will take forward – as we take seriously the road testing we are doing at forums across the country, just like this one.
But it is worth contemplating the directions proposed.
Take Activity Based Funding for example – and the way the NHHRC propose we take this forward. Given COAG agreed to some of these steps last November – albeit not quite as boldly as proposed – I think the days of the Commonwealth simply handing over block funding to health service without sufficient idea on what or how much we are paying for, are close to gone.
There will need to be debate about how to fund specialised services like trauma services or transplant services, but it is time to get serious about funding hospitals to deliver outcomes.
Why is it we can’t compare the cost of a knee replacement in one hospital to the cost of delivering it in a peer hospital down the road? Public to private and state to state this is still notoriously hard. Shouldn’t the hospital which delivers quality treatment outcomes more efficiently be rewarded for its performance? The public is starting to ask these questions, and we believe quite rightly. Of course, in some areas of Australia the cost of treatment will be higher, and patient choice will be limited. But where it is possible to compare similar services, ‘apples with apples’, I think we should.
Comparisons are the simplest way for us, as health care consumers, to find the best care for our particular ailments. When we talk about making the system about the patient, that means giving the patient the information like this – information they want, and need, to make informed choices about their care. Our hospitals could benefit from a bit of 'healthy' competition to help drive efficiency and innovation and this is why we have already agreed to make comparable information available. No doubt this should go even further.
Likewise, we believe it is time for the community to be entitled to a minimum level of service. The development and adoption of National Access Targets for timeliness of care is something that many people consider is a good idea - and is under serious consideration.
As I travel the nation, talking with health professionals in our hospitals, I am struck with the level of disengagement many of our staff feel from key hospital planning and service delivery. The Commission has recommended the introduction of Clinical Senates at various levels of service delivery. I am not going to endorse a particular model at this stage, but I believe quite strongly that we need to look at how we better include our front line staff in the decisions that affect they way they perform their duties, without compromising patient care – in fact, we’d be looking to improve it.
And the Commission asks whether it is time for the Commonwealth to assume responsibility for all health services delivered outside the hospital. Not just primary care but, for example, the recommendation for the Commonwealth to assume responsibility for outpatient services is a lightning rod for those who are interested in the debate over federal-state relations. Given our emphasis to date on prevention and primary care – it won’t surprise you that this option is under serious consideration by the Government.
I’m interested in its potential to meld with more comprehensive primary care in our communities. So we are testing these ideas.
For people committed to good quality hospital care we want to know what you think about trying to divert some of the patient demand by so many roads leading to our hospitals, when a detour more directly to GPs, community care or enhanced outpatients care in the community might be more effective – using our resources more sensibly and keeping people well and out of hospital more effectively.
I want the health system configured so that patients enjoy a seamless treatment journey – from the maternity ward, to the GP surgery, to the acute hospital setting, step down care, the outpatient clinic or maybe an ambulatory care centre, and eventually the aged care facility – or palliative care at home.
The patient shouldn’t notice whether the treatment they are receiving is state or federal responsibility. I was at St Vincent’s Hospital in Sydney the other day, where they pointed out they have different colour carpet to delineate between the different funders. An amusing anecdote, but also an example of how we need to change this mindset. The only other place I can think of where this applies is the House and the Senate – and these truly are different worlds!
The Government’s vision is for a health system where integrated services are delivered as close to home, in the community, as possible. Our hospitals should be the last port of call, not the first.
The recommendations to boost sub-acute care and outpatient services are designed with this in mind. In future, we want a patient to have confidence they can expect a certain level of access and treatment when they need care, can expect the same outcome and access wherever they happen to be in Australia, can access their health records electronically wherever they go.
Let’s get the patient at the centre of the treatment journey – and then work out which level of government is best placed to deliver which service.
Next steps in process
So what’s next?
We will convene a special meeting of COAG at the end of the year to present the results of the feedback and consider the commission’s report.
In early 2010 we will present the Commonwealth’s plan for comprehensive reform to the states and territories.
We’ve been able to achieve a lot already by working with our colleagues in the states and territories. But if they are not prepared to join us on this next step, or won’t take a big enough step with us, we will seek a mandate from the people at the next election.
We are on the verge of the biggest reforms to health since the introduction of Medicare 25 years ago.
This is a once-in-a-generation opportunity.
Dr John Deeble
When I speak of long term reform and inter-generational legacies, it is easy to segue to Dr John Deeble – the chief architect of Medicare, which introduced universal healthcare to our country.
Ask any Australian on the street what they like most about our health system, and I’ll wager they will say Medicare. I am proud to be Health Minister of a system with Medicare as its solid foundation.
On behalf of Dr David Panter, the National Council and all the members of the AHHA, I have great pleasure in presenting Honorary Life Membership of the AHHA to Dr John Deeble.
<Invite John to the stage>
It was in 1968, while at the Institute of Applied Economic Research at Melbourne University, that John and his colleague, Dr Dick Scotton, provided the economic analysis which led to the introduction of an alternative national health policy by the newly elected Whitlam Labor government.
This was the universal health insurance scheme, then known as Medibank, which Australians enjoy today as Medicare. It was then, and is now, the envy of many nations.
The immense benefit of John’s work is recognised through his administration, writings and research. It was also recognised by the nation when he was made an Officer of the Order of Australia.
John, can I just say that all of the work we are trying to do is to protect, strengthen, support and enhance the system you helped create.
The AHHA recognises that his work on so many aspects of our healthcare services has been greatly influential in the development of the Australian health system.
The Association also wishes to acknowledge John’s generous commitment to the public healthcare sector and the many hours of work and advice he has given to the AHHA over the years.
I am delighted to be able to present Dr Deeble with life membership of the AHHA.
<Present John with certificate>
On that note, I wish you all the best with your congress over the next two days, and look forward to working with you all over the coming months and years as we continue on our reform journey.
And now, I’ll launch straight into my slide show, to give you all a taste of what is contained in the Reform Commission Report.