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State of NSW: What next for patients suffering health reform fatigue?

Both major parties in the NSW election campaign have pledged to increase spending on hospitals. AAP/Paul Miller

The debate about health in the lead-up to the Saturday March 26 NSW election has been unusually civilised and intelligent. The main contestants – the current minister, Carmel Tebbutt, and shadow minister, Jillian Skinner – bring to the contest none of the bluster of people fired by ideologies. Both have demonstrated an openness to listen to clinicians and patients.

Indeed, getting health announcements to feature in the media has been a challenge. This does not reflect disinterest in health but rather the saturation of the health reform debate that has followed from the Commonwealth reform agenda for over two years. People are exhausted by reform and proposals for further reform need to be luminous, terrifying or both to attract attention.

The Commonwealth reforms are extensive – changes in hospital organisation, the delivery of general practice, an enhanced national agenda of prevention and more.

Hospital care is being reorganised into local networks that are smaller than the pre-existing area health services in NSW. Governing Councils will oversee these networks and link with general practice. The new networks commenced in NSW early this year – making it the first Australian jurisdiction to implement this Commonwealth health reform.

The Commonwealth has also proposed a move to payment for services provided by hospitals according to a specific price – $X for fixing a hernia, $Y for treating a heart attack. This would change the current pattern of federal contribution to hospital costs, which is capped, to an open one, based on what they do.

This resembles the way in which services are paid for under Medicare where there is no restriction on the volume of services, and also for the Pharmaceutical Benefits Scheme. Activities such as research and education, and compensating for the disadvantages experienced by remote and rural hospitals, would be covered by special provisions.

There has likewise been a shake-up in general practice with an emphasis on the provision of care in the community that makes more use of nurses, physiotherapists, psychologists and others who would be organised into Medicare Locals, roughly the same geographic area, where possible, as the new hospital networks.

General practitioners would bring into the Medicare Locals the best of their experiences from working in recent years in Divisions of General Practice. Divisions bring GPs together in a virtual community of interest rather than leaving them alone like corner store proprietors. Divisions have also improved the level of continuing education for GPs.

What do these reforms leave the next minister of health at a state level to do?

Carmel Tebbutt, Jillian Skinner and David Shoebridge, the latter being the lead Green’s Candidate, recently discussed their health plans at The Great Election Debate: Public Health in NSW. The debate was hosted by The NSW Branch of the Public Health Association of Australia, in partnership with the Menzies Centre for Health Policy, and the NSW Branch of the Australian Health Promotion Association.

Carmel Tebbutt told of the difficulty of shifting money from acute care to prevention. In addressing alcohol and mental health issues, she spoke of the need to decrease access to and demand for alcohol through health promotion campaigns and a focus on young people. She also promoted a shift in mental health funding from treatment to the community sector and the importance and challenge of working across silos and portfolios in effecting change.

Ms Tebbutt also confirmed support for the Commonwealth health reforms and spoke about the future challenges of integrating Medicare Locals and Local Health Networks and government efforts to address them through clinical support clusters. She spoke about current NSW research funding support for the Non-Government Organisation sector and the importance of research in mental health.

Jillian Skinner said if elected she hopes to increase NSW public health expenditure. She spoke of the need to work at providing care for Aboriginal people where people live. Her approach to dental health is to address workforce shortages, better engage with the private sector and establish an expert taskforce.

Ms Skinner also noted that the Coalition had already announced its policy on prevention of alcohol problems and that a whole of government approach was needed.

She supported more acute psychiatric beds and greater assistance for people living with mental health illness in the community. If elected, the Coalition will review the details of the new COAG agreement on the Commonwealth heath reforms, in particular boundaries for the local hospital networks, governance arrangements, local involvement of clinicians in the Governing Councils, the participation of people with skills in business and strategic planning in the Governing Councils and the link between acute and community care.

Ms Skinner argued the single greatest disappointment in the Commonwealth health reforms is the lack of action on cost shifting. She also pledged, if elected, she will appoint Mr Peter Wills to head a taskforce to develop a NSW health and medical research strategic plan. She discussed the need for preparedness to enter into partnerships with the private sector, as articulated in the Liberal Party’s Making it Work policy. Jillian Skinner also confirmed that she will be the NSW Minister for Health if the Coalition wins the March election.

In his responses to the questions, David Shoebridge proposed an increase of public health expenditure to 4% by sourcing funds from additional taxes on the gambling and alcohol industries. He supported training of more public dentists and the implementation of a national dental health scheme.

He affirmed the Greens’ harm minimisation approach to drug and alcohol issues, taxation on alcohol content and alcohol advertising restrictions. He advocated for reform and investment in the criminal justice system to better support Aboriginal people and people with mental health illness. He supported the generation of evidence on how to deliver mental health services, particularly to homeless people.

David Shoebridge confirmed his support for local hospital networks but expressed concerns about casemix funding and duplication with Medicare Locals. He thought there was great potential for public health to get squeezed out in the new health reform structures. He called for a commitment from the NSW government to review perverse incentives and cost shifting.

The NSW election campaign has brought expected financial pledges from the main political parties for new and improved hospital facilities, more frontline staff and medical research.

After the election dust settles, we also need a clear vision for health in NSW from the Minister: a clear exposition of where we’re going with health and health care, why we’re going there and what we may expect when we get there.

We wish the candidates well.

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