Australian Practice Nurses Association: “Golden Opportunities”
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7 May 2010
Acknowledgements
- I would like to thank Aunty Patricia Leavy for her warm welcome;
- Karen Booth Vice, President APNA, and APNA board members;
- Belinda Caldwell, CEO APNA;
- Rachael Calverly, President NZ College of Practice Nurses;
- Ged Kearney, Secretary, Australian Nursing Federation; and
- Kim Ryan, President, Coalition of National Nursing Organisations.
Thank you for having me here this morning. It already seems like it was months ago, but it has been just two weeks since the COAG meeting where the Australian Government reached a historic agreement on health and hospitals reform with all States and Territories with the exception of WA.
This agreement represents the most significant reform package to our health system since the introduction of Medicare almost three decades ago.
It provides a secure, long term financial footing for the public hospital system; and much needed reforms to primary health care and aged care.
It will come as no surprise to you that we believe practice nurses will play a key role in these reforms, which I why I was so keen to make it to the Gold Coast today, with so many of you in the one room it was too good an opportunity to miss!
We already know you are a profession that is going from strength to strength – with your numbers increasing by 15 per cent in the latest practice survey from 7,728 to 8,914.
What we also know is that there is so much more to harness for the benefit of the community if we can lift some of those barriers that prevent many of you from working to your full scope of practice. We are committed to working with you to make this happen.
Taking Action to Reform the Health System
As many of you know, we started down the reform road as soon as we came to Government.
We made the immediate investments in the system needed to take the pressure off and improve services. For example:
- We increased spending on public hospitals by 50%;
- We invested $872 million into prevention;
- We invested $1.1 billion in training and planning the future health workforce;
- We have committed to giving nurse practitioners and midwives the right to access Medicare for the first time and increased GP training places; and
- We’ve invested significantly in health and hospital infrastructure.
This included the most comprehensive root and branch review of Australia’s health system in decades – the National Heath and Hospitals Reform Commission.
Alongside this work, we established the Prevention Task Force and started to develop the National Primary Health Care Strategy – both areas the Government knew needed attention if we were to strengthen our health system and improve health outcomes for the Australian community.
It is this work that led to a National Health and Hospitals Network which will be funded nationally, and run locally.
The reforms to the health system are focused on three key areas which cut across the health and hospitals system:
- focusing the system on patient needs and seamless care;
- improving the quality of care thanks to high-performance standards and because local health professionals have more say; and
- providing a secure funding base for health and hospitals into the future.
These changes will replace the complex and fragmented mix of federal and state funding that we currently have and put health financing onto a more sustainable footing into the future.
While this is a very brief outline of the key elements of the overall reform, I am aware that much of the public commentary to date has been on hospital financing and reform.
This is of course understandable when key negotiations with the states centre around hospital care and government relationships and responsibilities, including financing.
But let’s not forget a very non-controversial but significant part of this deal was 100 per cent takeover of primary care.
This takeover recognises the importance of primary care in keeping people well, taking pressure off our hospitals and the critical interactions with sub acute care and aged care. New, local primary health care organisations will be a key part of reorganising and helping connect disparate primary health care providers and our diabetes initiative will promote truly flexible multi-disciplinary care.
And announced last week - we are taking world leading action by implementing plain packaging of tobacco and increasing tobacco excise by 25 per cent.
This is just part of a broad story. For all of the past two and a half years I have been approaching health reform with three parts of the system in mind – hospitals, primary care and prevention.
In fact, this is so important that next week the Government will announce not only the funding for its complete package, but also its official response to all three reform reports we commissioned – in primary care, prevention and the broader health and hospital reform.
Ahead of that, I particularly want to take the opportunity to highlight the significance of the primary care reforms which have not yet received a lot of publicity.
Primary care
The Government agrees with the Reform Commission and Primary Care Strategy that improved primary health care is the lynchpin, the critical element in making major improvements in our future health outcomes.
Essentially, better primary care delivers better health, keeping people healthy and out of hospitals. Across the world, we see evidence of strong primary health care improving health outcomes, and providing quality care at an efficient price.
It is why you’ve seen a lot of action from us in this area in the last two years – from extending PBS and MBS access to midwives and nurse practitioners through to our Superclinics and more recently our diabetes package.
And it is why the Rudd Government has committed to take full funding responsibility for all primary health care and GP services, including currently operated by the states and territories.
In time, we will also take full funding responsibility for “primary care equivalent” outpatient services.
This will allow us to put in place a system where people are treated in the community, and closer to home, where possible.
And deliver better integrated, better coordinated healthcare that is more responsive to the needs of patients, families and communities.
With a single source of government funding, we will be able to draw primary health care and acute hospital care together, into an integrated system – that most importantly makes it easier for patients to get the care they need from the health care professional that is best placed to deliver it.
This will remove many of the perverse incentives in the system currently – whereby the Commonwealth has no real financial incentive to get primary care right, because the States pick up the tab for the majority of hospital costs.
We’ve already announced that we will establish independent primary health care organisations across Australia to help drive improved access to care and drive integration across the primary care system.
We have outlined our plan to start paying for better health outcomes rather than just one-off visits to doctors and specialists for patients with diabetes.
And I am pleased that we’ll have more to say on our other directions in primary care very soon, which will build on these significant reforms.
Primary Health Care Organisations
As part of our National Health and Hospital Network, the Commonwealth will support a new national network of primary health care organisations.
Too many patients find themselves shunted from one part of the health system to another, with no assistance, little consistency and constant duplication.
The current system doesn’t allow good planning of GP and primary health care services, or encourage the Government to fix the gaps in service.
Joining up the primary health care system will allow coordination of care for patients with complex or chronic conditions.
Primary health care organisations will;
- Support GPs, practice nurses and other health professionals;
- Drive integrated and co-ordinated care, and provide a strong platform for delivering primary health care reform;
- Make it easier for patients to navigate the health care system and get the care they need as close as possible to home.
- identify groups of people missing out on GP and primary health care- like those with mental illness- and better target services to respond to these gaps;
We know that some of you are worried that this will mean that nurses are not given a place at the table – or may not be recognised for the role they do and can play in the system.
I can reassure you that we will require the new PHCOs be not just about the GP, but are about the health team, including nurses, other health professionals and the communities they serve. Not to mention our hope of strong linkages with universities, other training providers and Local Hospital Networks.
We will expect their governing bodies include people with clinical expertise that reflects the broad health professions that work within the primary care system.
We know that too often, those who need our health services most- are actually the ones that fall through the cracks. For example, the elderly, those with mental illness, rural Australians and those requiring care outside of “regular business hours”.
Primary Health Care organisations provide us with an opportunity to look across our communities, see where the gaps in the services are and have the structure in place that means we can target those gaps.
A great example of this in action right now is the mental health program, ATAPS – which we know helps to target services to those who may not otherwise be able to have access.
They will also provide a platform for community prevention initiatives. For example, co-ordinating walking groups and communication campaigns to target particular problems in their communities.
We believe that practice nurses are a key part of the primary care workforce, and we want to make sure that Primary Health Care Organisations are set up in a way that helps to support and nurture the entire practice team, without of course taking away the vital role of individual professional organisations, like your own.
We know how important the practice team is in meeting the health challenges - like diabetes – into the future.
Diabetes Voluntary Enrolment Program
We announced in recent weeks a new way of managing care for patients with chronic illness – estimated to be responsible for more than 80 per cent of the total burden of disease and injury in Australia – by first targeting diabetes.
We will invest $436 million in coordinated care for people living with diabetes so that people with diabetes can be offered the option of signing up with a general practice of their choice.
The practice will become responsible for managing their care, including and be paid, in part, on the basis of their performance in keeping their patients healthy and out of hospital.
This way of funding care for diabetes means that practices are provided with the flexibility to ensure that the person with diabetes is provided with the range of care they need- from the range of primary care health professionals that are best placed to deliver it.
Practices I have recently visited in Ulverstone in Tasmania and Woodend in Victoria have been enthusiastic about the type care this funding could support like diabetes education sessions, lifestyle coaching as well as the necessary medical, nursing and allied health care required – without rigid numbers of sessions or referrals to make a person fit the system, rather than the other way round..
Other investments in primary care
I am pleased that we’ll have more to say on our other directions in primary care very soon. I won’t give you any budget scoops today, but I can assure you that these directions will be of significant interest to those of you here today.
In releasing the practice nurse survey earlier this year, the Australian General Practice Network identified the geographic restriction on the PIP incentive, infrastructure restraints and cost effectiveness as the 3 key barriers to preventing an expansion of the Practice Nurse Workforce.
Let me just say- we have kept these firmly in mind!
Conclusion
I can’t help but notice the theme of your conference is “Golden Opportunities”. That is a very appropriate theme, but I might add that is a theme that can apply for all of us working in health at the moment!
We have a set of health reforms that we are taking forward that provide us with a once in a generation opportunity to help drive changes in the system that will deliver better health and better hospitals for all Australians.
I’d like to thank many of you here today for your statements of support, and for working with us to deliver these historic changes to our health system.
I look forward to working with you as we move forward through a very exciting and challenging time for all involved in health, and I hope we can all take advantage of the opportunities presented at this critical time in the health debate in this country.
I wish you all the best with your conference and I thank you once again for having me here today to participate in your opening ceremony.
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