In the fourth instalment of a Croakey series on the implications for national health reform of the new government in Victoria, questions are raised about the neglect of aged care planning, and the lack of integration between teaching hospitals and the community-based sector.
Professor David Penington, Senior Fellow, Grattan Institute, University of Melbourne, writes:
Comments in some quarters suggesting that the new Baillieu Government will ‘rip up’ the health reforms are grossly misplaced.
They rightly want to be fully informed about what is happening in the very opaque process of implementation of the decisions taken by COAG on 27 April of this year and need to ensure that the strengths of Victoria’s health services are not jeopardised.
They have well founded concerns about a system which is structured in such a way to be controlled by a small group of national bodies, now being developed, to which over 700 public hospitals, through currently being developed Local Hospital Networks, will be reporting quarterly.
They will be reporting against yet to be determined criteria which are to include primarily patient throughput and waiting list or emergency room waiting data, at least in the first instance, and then issues yet to be resolved relating to quality of services and safety criteria.
Health care is a fast evolving scene with new science, technology and ways to deliver services.
New methods for evaluation of quality and innovation in services depend heavily on clinical research, based primarily in major teaching hospitals and their associated medical schools.
The new State government, in its election plan, said that it sees the role of major teaching hospitals as important in many respects and wants to ensure they play a real leadership role in partnership with State administration. The COAG structure makes absolutely no provision for this, regarding all LHNs as uniform.
In reality, as we move into the realm of telemedicine for chronic disease and aged care, teaching hospitals have much to offer working in partnership with general practice and community nursing.
The COAG structure leaves these in a completely separate area, managed through Medicare Locals.
It assumes it is managing a fixed system with a mind-set remarkably like that of Eastern Europe managing industries in the Soviet era, with a passion for central control when constructive innovation only occurs at the interface of service delivery linked with clinical research and evaluation.
The Centres of Primary Care, envisaged in the March release by Kevin Rudd, were to be co-located wherever possible with LHNs, so that close liaison on all the several functions, including aged care and mental health, could be achieved.
However, it was agreed that Victoria would retain its 83 public hospital Boards, but the Medicare Locals, to which general practice and many other services will now relate, bear no relation to hospital Boards and will presumably be offshoots of the Commonwealth Dept of Health and Aged Care.
Furthermore, it would seem that there is to be no recognition of the special role of major teaching and major specialist hospitals to the many other services which the community needs access in a planned and co-ordinated manner.
How far the Commonwealth will move in negotiating these many issues remains to be seen.
I would be surprised if they do not make major concessions, but if not, Baillieu might have to withdraw agreement to the package in the interests of Victoria’s health care.
Although support for development of general practice has long been seen as a Commonwealth responsibility, Victoria has all along wanted to see a better interface between primary care and its hospital networks. I have no doubt the new government will pursue this.
Brumby failed to agree to surrender all aged care control to the Commonwealth in April and the lack of any realistic Commonwealth long term plan, apart for provision of many more nursing home places to cope with the fast growing number of frail elderly people, is little short of a scandal.
Perhaps the Productivity Commission will develop different proposals and the able new Minister Mark Baker may have something to offer.
The Deloitte international review of Aged Care in 2009 points to the need to develop care in the community and experience in Denmark and other countries points strongly in this direction.
It implies the need for planning and tax incentives for development of retirement villages with greatly expanded community nursing. This will not be handled by Medicare Locals!
The previous posts in this series:
What does the changing political landscape mean for health reform?
A free health consultatio for Ted Baillieu and co
Health advice for the new Victorian Government – and a killer question