Speech - 26th August 2008
The Hon Nicola Roxon MP
Catholic Health Australia National Conference: “Catching the Wave ”
Keynote Address, Surfers Paradise, 26 August 2008
Thank you for having me here to as keynote speaker at your national Conference – “Catching the Wave”. It is a timely conference theme, given the wave of needed change that is washing across the country following the election of the Rudd Labor Government.
It is an honour to be part of a team which has put the propeller in the water and stirred up some momentum in the health reform debate. Organisations like CHA have always been prepared to look at new ideas, often come up with them yourselves and we look forward to working with you in the coming months and years – that is why I am here although parliament is sitting today and I’ll need to head promptly back to a colder climate after this address!
Today I’d like to talk about the future of the Australian health system, and in particular where the Government’s reform agenda is heading. I’d also like to address a key issue of concern to you – the way we see the public and private systems fitting together in the modern health system for the coming generations.
In my view, only the most ardent sceptics believe there is any life left in the question of whether or not to reform. To us, whether to reform is now no longer an option – it’s a matter of why, when and how. The “do nothing” alternative – that favoured by the last government - is to be engulfed by a wave of a different kind –
• of poor health outcomes due to preventable chronic disease, fuelled by obesity;
• of unsatisfied demand for health care due to rising costs, rising demand, workforce shortages, mal-distribution and underutilisation and the ageing of the population (to name just a few!); and
• very worryingly, an increasing gap between communities and individuals which have the health services they need, and those which do not.
At this stage in the process – we have taken fast action to protect against further damage. While we deal with this restoration of calm – we need to survey the waters and try to plumb the depths of problems, and chart our course of action.
The real waves of reform will flow through the system next year when the new health agreements come online with the States and we receive our recommendations from the Health and Hospital Reform Commission and the Preventative Health Taskforce mid next year.
Catholic Health Care, as the largest non-government provider grouping of health, community and aged care services in Australia has a lot of experience to offer in developing and implementing real change. I thank you for participating in the process by making a submission to the Reform Commission.
You represent about 13 per cent of the health care industry - 21 public hospitals, 54 private hospitals, and more than 550 aged care services - and more than that, you have direct experience of the interaction between the public and private hospital sectors, as well as the interface with increasingly important aged care services.
This gives you, I believe, a depth of understanding of the Australian health system, of its great strengths and of where it is struggling, failing even, particularly for some our most vulnerable people. Our common aim is to ensure that all Australians can access quality, affordable health care – from primary care at the GP level to acute hospital care and aged care – from the start to the end of life.
Where we have come from?
You know, as do I, that the system has been straining at the seams for some time. It’s not just been about more and more patients and clients coming through the health system. The former coalition government substantially contributed to this on a number of levels through the sins of commission and omission.
• It ripped one billion dollars of health funding allocated in the forward estimates out of our public hospitals;
• It capped the numbers of doctors being trained and allowed the training of nurses and allied health workers to stall;
• Investment in vital infrastructure and equipment languished as issue was left to the states alone; and
• And importantly, the coalition vacated the policy-field in relation to the Preventative Health agenda, whether it be the issues of tackling the growing obesity crisis or the human disaster of alcohol abuse.
The legacy of these decisions will take a long time to undo – but we have started so quickly out of the blocks because we are absolutely determined not to waste any time and to make a lasting and enduring difference.
Our First Eight Months
Improving health outcomes for Australians through reforming the system needs short, medium and long term action to be applied concurrently. No one element alone is sufficient. Firstly, upon coming to office the Rudd Government decided with that sort of legacy, there was no time spare, and has acted quickly on a number of fronts.
This financial year we are injecting an extra $1 billion dollars into the hospital system in recognition that the system needed immediate resuscitation. Secondly, a further $600 million is being invested to reduce elective surgery waiting times for those patients that have been waiting for too long. An extra 25,000 patients will receive their operations as a result of this program, and I’m pleased to say that about 14,000 procedures have been performed so far.
We are also progressing well with the establishment of 31 GP Super Clinics at a cost of $275 million. Our community consultations have made clear that under-serviced communities are desperate for the investment which will help provide families with better access to health services in their local communities, without needing to attend hospital emergency departments. Each GP Super Clinic will be tailored to the local community and address specific local health needs and priorities – and help address some workforce issues too.
Medium Term
In the coming months there is a massive amount of work ahead to deliver progress on our reform agenda. The Prime Minister, Treasurer and I, through the vehicle of COAG – the Council of Australian Governments – are re-negotiating the Australian Health Care Agreements with each state and territory. We are working to drive reform and to put the system on a sustainable funding basis, and those Agreements will be finalised in December.
In the past these negotiations were characterised by bickering and blame shifting. In contrast, our approach has been to work constructively with the state and territory governments to end the blame game. After all - we are all in this together, and the Australian people have had enough of the old way.
A major part of these negotiations and the work of COAG revolves around the establishment of agreed performance indicators, so that governments, agencies, and most importantly, the Australian people can measure whether we are living up to their expectations.
We, all of us, whether it is the Federal Government, a state government or a health service provider – will now be able to be held to account so that problems can be identified, and work undertaken to address them.
Developing these indicators is no small task and we have engaged the Australian Institute of Health and Welfare (AIHW) to work with us to ensure we are measuring the right things, across the spectrum – factors that will help drive change in themselves (infection rates being a prime example). The AIHW has in turn built upon work already carried out by the National Health and Hospitals Reform Commission.
Most of the public attention to date has focused on how these will apply to public hospitals – and whether the states will go along with them. So far, progress has been good, and I expect there to be much clearer performance measures in our public hospitals than have existed before.
What often goes unremarked is that these indicators need also to apply to private hospitals. In fact, it is our intention that these performance indicators will apply to all hospitals – public, private, big, small, urban and regional.
There are several important reasons for expanding accountability measures beyond public hospitals. First, it is a fundamental step in pushing for a health system that is prepared to compare and contrast – in order to improve itself and drive investment in change. By enabling comparisons, you encourage competition and innovation and allow the results to be measured. If a private hospital is achieving outcomes that far exceed the mean, we will be able to burrow into the “why”, when previously we haven’t even been aware of the “what”.
Second, this allows States and Territories better data on which to base their funding decisions – which, on the flipside, allows organisations like your own to make its case for funding where you deem that necessary, based on open and transparent benchmarking. We have expressly involved the private sector in this part of our work with the states in the hope of getting a truly national system in place.
Catholic Health has a major interest in these deliberations as they progress, as not-for-profit private providers and operators of some of the largest and most respected teaching hospitals in the nation, such as St Vincent’s in Sydney and Melbourne, the Brisbane Mater, Calvary in Canberra. But you also operate smaller and regional facilities too. And we have a major interest in your views precisely because of this unique experience.
Third, it is worth noting that this is a measure that private health insurance funds have long campaigned for. And not only because it will help improve the overall state of private health care – as Fred Brenchley and Allan Fels pointed out last week, in an article arguing for greater accountability in our health system, a study in north-west England showed that performance reporting at hospitals is linked to lower death rates after major heart surgery – which delivers obvious benefits to individuals, and should also lower costs to insurers in the long run.
By providing comparable data on efficiency and quality of care, like infection rates and adverse events, indicators will allow purchasers of health services (both government and insurers) to legitimately distinguish between effective providers of health care and less effective providers – which should further lower government and insurers’ costs, to everyone’s benefit.
Prevention
But any improvements will be quickly surpassed unless we act now to prevent illness and better promote healthier lifestyles. For too long governments have focussed on the remedial aspects of health care – treating people when they become sick.
This year I established the Preventative Health Taskforce, chaired by Prof Rob Moodie. The Preventative Health Taskforce will provide evidence-based advice to government and health providers – both public and private – on preventative health programs and strategies, and support the development of a National Preventative Health Strategy.
In developing the National Preventative Health Strategy, the Taskforce is focussing on obesity, smoking and alcohol abuse, and will report back in mid 2009. Just last week a new report on obesity commissioned by Diabetes Australia found that in 2008 3.71 million Australians, or 17.1%, were obese. So this work is ever more pressing.
As you know, and I have already mentioned, the Government has also established the National Health and Hospitals Reform Commission, Chaired by Dr Christine Bennett – to look at system design, gaps, funding and much more. The Commission’s work is now well underway, with a final report also due in the middle of next year, and may well recommend more extensive reforms that the Government will need to take to the next election should we wish to pursue them.
All of these reform processes will have an impact on the work of Catholic Health’s many services.
Workforce
And none of this reform can happen unless we have a well trained and appropriate workforce equipped to deal with the challenges of the coming decades. The availability of a workforce is I know a major concern for your agencies in both the acute and aged care sectors, and it is indeed a concern that is shared right around the world, not just in Australia.
COAG has agreed on a national registration and accreditation scheme starting in 2010, which will reduce red tape and improve workforce mobility. In addition we are considering workforce issues through new reform measures under development, including COAG’s Health and Ageing Working Group, which I Chair – particularly the new pressures on clinical placement.
There’s no doubt we need to train more health workers, and we are acting on this, but we also need to use our existing health professionals more effectively. I envision less rigid divisions between disciplines, more flexible training and service delivery, widespread use of interdisciplinary teams – and new roles for care providers.
We will also establish an extra 50,000 vocational education and training places over three years for priority health occupations – with the first 4500 places opening by the end of this year. The Rudd Government is also investing $39.4 million to bring 8,750 trained nurses back into the nursing workforce within five years including:
• 1,000 into residential aged care
• 6,200 into public hospitals; and
• 1,550 into private hospitals.
I believe Catholic Health Australia has been allocated 376 places over the next five years. You can see from this breakdown we are looking across the matrix of public and private, acute and aged care. As well as this, we wil be creating up to a further 1,170 nursing education places each year from 2009.
At the same time, we need a far-reaching debate on appropriate roles for nurses, Nurse Practitioners, and allied health professionals, like pharmacists, physiotherapists and dieticians. They can and should play a much larger role in health care.
If we get this right, we will ease some of the burden on our GPs, and provide more variety and recognition for other professions. In doing so, all the health professionals could be much better utilised, get more professional satisfaction and recognition, and provide more access to health care. We really need to open our minds - and our health system - to these new roles.
Aged Care
Some of these workforce issues are particularly relevant when you look at the pressures on the aged care system – particularly in residential care. But we also know that older people want to stay in their own homes and their own communities for as long as possible, and they have an incredible amount of experience to hand down to their communities.
Your experience in providing the full range of services from maternity to aged care will have lessons for the rest of the system in terms of where the blockages to an integrated continuum of health care lie, and how to get around them.
Then Rudd Government is investing $293.2 million to improve the transition that older people make between hospital and aged care, once they no longer need hospital care. The aged care sector is a prime example of the need for the Government to work with private – including of course, not for profit – operators to achieve our goals.
Our older people deserve appropriate care, regardless of their income and assets, where they live, their culture, or their race.
Closing the Gap on Indigenous Health
Of course we could not think about health inequality and social justice, without thinking of the appalling 17-year life expectancy gap between Indigenous and non-Indigenous Australians. The Rudd Government has committed to tackle this problem - recognising that Indigenous health is not just about health services, but is part of the broader, complex issue of Indigenous disadvantage.
We cannot ensure better health for Indigenous people throughout their lives unless they also have opportunities for education, employment and a sense of community. We have committed to reporting to Parliament each year on our progress against 3 important targets, or outcomes –
• Halving the mortality gap for children under 5, in 10 years;
• Halving the gap in literacy and numeracy in 10 years; and
• Closing the life expectancy gap within a generation.
We are have set these ambitious objectives to ensure accountability is clear and so we can measure progress – openly and up front. And we are getting on with the job through a broad range of programs addressing factors from alcohol and drug abuse to providing training to Indigenous aged care workers to maternal and child health.
Conclusion
I am pleased to be a reformist minister, in a reformist government – not because we desire change for the sake of change, but because change is needed. I believe our reforms will restore, refresh and revitalise the Australian health and aged care system - so that, in all its diverse elements, it can remain one of the most equitable and effective in the world.
I thank you all at Catholic Health Australia for your willingness to “catch the wave” of reform. I hope it will be a good ride, but more importantly, I hope that the wave takes us all safely to shore.