Lack of progress is hard to swallow

9 February 2011

The big challenges that faced us in health care last year pay no homage to our new year celebrations. They take no vacations.

The provision of timely care for those seeking emergency help and ensuring that those who need surgery for non-urgent but troublesome problems are persistent and universal demands from the community.

As well, we must improve our capacity to harness hospital and community resources to provide support for people with serious and continuing chronic problems and their carers who live at home. The Productivity Commission's latest declarations about ways of improving the care of older people give a sharp edge to that concern.

These are the big-ticket items demanding attention that we can foresee. They form the substance of the health reforms now being rolled out.

The unforseen includes epidemics of new diseases, natural disasters including droughts and flooding rains, and changing personalities and politics at high levels.

More storm clouds are visible. The future power and function of the Council of Australian Governments may change as more state governments turn from Labor to the Coalition. As well, critics argue COAG usurps powers properly allocated to federal and state governments and is insufficiently accountable, thus calling its future into question.

This matters as the present rounds of health reform - including linking public hospitals into local networks with representative governing councils as well as funding changes involving more direct support from the commonwealth and less from the states - were negotiated through COAG by the former prime minister Kevin Rudd, with Western Australia abstaining.

Linking community care and general practice in geographic regions, aided by the construction of multi-purpose super clinics, was also debated and ratified at COAG. This too may unravel if COAG takes new directions.

Victoria viewed the Rudd reforms with little enthusiasm and under the leadership of the new Coalition it may change its position to one of active opposition.

Health reform agendas that take months or years to negotiate - as those apparently secured in the US last year by President Obama - can be undone quite quickly when politics change, as Malcolm Fraser did with Medibank.

Another way politics can alter the course of reform is seen in the extent to which rural and regional concerns have suddenly achieved visibility under the agreement between the largely rural independent members of federal parliament and the Labor Party.

Many would argue this attention is long deserved but, in the fiercely competitive world of health care, hasn't been given in favour of placating the heavy-hitting coastal cities. Imagine what might have happened if the independents had a passion for palliative care, prevention, mental health or co-ordinated care for chronic disease.

If we had no special need for a huge improvement in the way we care for people with chronic problems, and if paying for health care was not increasing at an unsustainable rate, we might prefer to turn our attention to matters of higher priority than health reform. Unfortunately, both the chronic disease care problem and the unsustainable rate of increase in costs are such that we cannot afford to leave health care alone.

It would be wonderful if this year rhetoric about the National Broadband Network and the presumably large investments in it led to more enlightened discussion about where IT fits in health care.

It's now perfectly possible to view fully integrated hospital and community healthcare services flourishing - at relatively low cost and with high degrees of quality - with professional and patient satisfaction. A quick trip to Kaiser Permanente in California shows how it can be done. We don't do it. It is laziness, lethargy, lack of political leadership and forward thinking and professional conservatism served up in one indigestible hamburger that leads to this indigestible outcome.

Last year there was clear recognition, though little action, about the need for greater attention to the importance of research and continuing education of all professionals in the health system.

The future of research and education should be defined more clearly this year and the way in which they are to be financed specified.

In response, the research community should take a serious look at the full spectrum of research necessary for the functioning of an effective health system, assessing where the gaps are in our research activity profile.

Research transcends what occurs in laboratories. It extends to the conduct of trials of alternative models of care, experimentation with preferred approaches to prevention, and using critical appraisal of new technologies to liberate us from the technology-driven cost increases in health care.

How is it, for instance, that hospital admission rates in the Californian Kaiser system are so much lower than in Australia? This question may seem like dull science but it's of the utmost importance for us to answer it. Who will do it?

As a wise senior bureaucrat observed recently, we embarked on a sizeable program of change to the way we deliver health care last year. For him, and for us, the question is this: will these changes lead to real reform? Happy New Year!

Professor Stephen Leeder is director of the Menzies Centre for Health Policy at the University of Sydney.

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