I believe we need a health system where the patient is centre of everything.
I would like to start today by reading a real-life example about inefficiencies in emergency departments that a GP wrote to me about this week:
“We are becoming rather a “scans on” profession rather than a “hands on” profession. Patients clutter the Emergency Department and they have an excessive amount of investigations because nobody takes the time to take a history or to do a physical examination. Emergency Departments can also have the attitude that they are the front line diagnostic unit of the hospital and they cannot discharge a patient without leaving any stone unturned. This is just one aspect of care and one aspect of ways in which our health dollar could be spent more efficiently.”
In this one example from a GP, I feel that they have managed to encapsulate many of the issues facing our health system right now and why we need an integrated approach to fixing them.
This is a very important time for Australia’s health system. It’s undeniable that Australia has a world-class health system. It is fair and accessible. It has served us well. But its foundation is now close to 50 years old.
We are facing significant challenges in maintaining the sustainability of our health system;
Challenges that when Medicare was introduced, were not as clear as they are today.
A lot has happened in that time.
Our society has changed significantly. Our economy has changed enormously. Our technology changes on what now seems to be a daily basis. Our health needs are more complex. Our expectations are much higher.
Is it therefore not logical, that if the requirements of patients change so should our health system?
At a simple level, consider the example of hip replacements. Thirty years ago they were performed to keep patients out of residential aged care. Now they’re done to keep you on the tennis court.
As such, our health system now seems to be suffering from an identity crisis – unsure whether its focus is on making a person well or improving their wellbeing.
And like one in two Australians, our health system is also struggling under the added burden of chronic disease. No longer are we dealing with heart and stroke issues as just episodic incidents. Instead they are now on-going clinical management issues; or in other words ‘chronic conditions’.
Thirty years ago when we talked about Diabetes, it was all about Insulin Dependent Diabetes an auto-immune disease. Very rarely did we talk about Type II Diabetes, yet it’s now one of our most common and costly chronic lifestyle diseases.
Thirty years ago mental illness was the unspoken health issue or the hidden institutionalised family member. Nowadays the ABC devotes a week of its airtime to bringing mental health out in the open.
And medical researchers have done such wonderful work that in many cases cancer is no longer a death sentence; but a chronic disease to manage, which is a positive, but presents its own set of unique challenges.
We have had discussion and debate about the need for health reform for many years. But apart from the previous Government raising public expectations – you’ll remember Kevin Rudd’s famous broken promise ‘the buck stops with me’ in 2007 – Not a lot of progress has been made since.
I believe the main reason behind this is because Governments and stakeholders alike have tried too hard to simplify it to just one solution; the easy solution; the politically-palatable and inherently lazy solution: we need more money.
In a perfect world money wouldn’t be an issue. But it is.
Like families; like businesses; Governments must manage their budget and do their best to balance the books as well. And just pouring more money into the same inefficient system day-after-day; year-after-year; without complementary reform won’t necessarily deliver the improved outcomes we want.
To put it in perspective, total expenditure on health in Australia for the 2014 financial year was $154.6 billion. Governments collectively provide around 70 per cent of this. And it adds up, with 1 in every 4 dollars Governments raised through taxes now going towards supporting our health nation’s spend.
What the root of the problem really comes down to is the fact we need to continue to get the best health outcomes we can for what we invest in, rather than just throwing wads of cash at the problem in the hope it will go away.
For example, we continue to spend more; but are we getting good value from this in terms of better health outcomes? We are certainly getting access to more treatments and more and more expensive cures; but they’re often for situations which could have and should have been avoided with better preventative health and early intervention.
Treasury’s March 2015 Intergenerational Report in particular highlights some of the challenges we face: – a population that is getting older, Australians are now living 11 years longer than they were 50 years ago, a workforce as a proportion of the total population that is shrinking and technology that allows us to do so much more but also comes with a hefty price tag.
And above all, we have rising consumer expectations. Expectations that have outstripped most Western Governments’ ability to meet them. But this challenge shouldn’t be seen as all doom and gloom.
I promised when I took on the job of Health and Sport Minister about ten months ago that I would listen and learn. And that I would use this consultative approach to make the important – and at times tough – decisions in a fair and considered way.
It’s an approach I took during my time as the Minister responsible for child care and early learning and one I feel I have remained true to during my time in charge of the nation’s health.
I believe this is evidenced best in our delivery of landmark reforms of the Pharmaceutical Benefits Scheme and pharmacy.
They were reforms we intensely consulted on with all members of the pharmaceutical supply chain every step of the way, rather than just a few select high-profile players.
Reforms I discussed with my parliamentary colleagues of all persuasions to hear their views and seek their support.
And, most importantly, reforms we had a conversation with the people of Australia about to ensure they understood what we were doing and why.
As with any negotiation; with any policy debate; I’m the first to admit that not everyone agreed all the time.
But at the end of the day, we were able to reach a common goal and pass through the parliament a fair, balanced package that:
– supports consumers through measures to make the cost of common medicines more affordable from next year, some by as much as half, through greater competition in medicine pricing, including the introduction of the ability for pharmacists to discount the PBS co-payment for the first time;
– supports pharmacists to ensure they have the stability to continue to deliver patients the services they need, including a doubling of investment in primacy care services to $1.2 billion; and
– supports the sustainability of the budget through a $6 billion saving that will allow us to continue to invest in new medicines now and into the future.
And we did it without parliamentary amendment and the appreciated support of Labor, the Greens and the majority of our cross-bench colleagues when it mattered.
It’s certainly not the only example of where this government has worked with the public, stakeholders and the Parliament to pass important measures. And I am determined to ensure they’re not the last.
We have draft amendments to the Narcotic Drugs Act to be introduced into Parliament by the end of the year to allow the cultivation of cannabis for medicinal and scientific purposes.
We also have our proposed improvements to the Medicare Safety Net to make it fairer and ensure more Australians with expensive medical costs can access it faster, particularly concessional patients.
It’s therefore important to recognise that amongst the day-to-day politics and headlines, this is a Government that is getting on with the job of delivering sensible health policies in a conciliatory, constructive way the community expects of its law makers.
However, as you heard earlier in my speech, we are under no illusion there still isn’t significant reform work to be undertaken to deliver a more sustainable health system that puts the patient at the centre of everything.
Primary care is the foundation of our health care system.
But increasingly for patients, for doctors, for nurses, for allied health practitioners – and indeed for politicians and taxpayers – this foundation is under increasing stress.
Medicare is based on a fee for service model. This works well for episodic and acute care. Your child has a fever; you have a stomach ache; you sprain your ankle. Fee for service is the appropriate funding model.
But what about the one in two Australians who now live with some form of chronic disease?
Is fee for service the appropriate funding model for these patients, who have ongoing expensive costs and require ongoing interaction with multiple health professionals for the rest of their lives?
The fact the Medicare services are now hitting one million per day suggests not.
And its little surprise really, when you consider there is no incentive for doctors to work with other health professionals for the good of patients with complex conditions who need different types of care.
This is certainly not a criticism of doctors, but a criticism of the flaws in a funding system which does not support patients to consistently stick with health professionals.
My listening and learning approach has helped to develop much of the Government’s current reform work, including: rebuilding primary care through our healthier Medicare package, relaunching and re-imagining digital health, delivering better mental health services and integrating sport into the portfolio as a way towards living a longer, healthier and productive life without avoidable medical intervention.
In order to support this internal Government policy work, we have instigated a comprehensive, but also practical, series of key initiatives providing us with expert technical advice, including:
– The MBS Taskforce reviewing all 5700 items on the Medicare Benefit Schedule to ensure it reflects contemporary clinical practice headed up by Professor Bruce Robinson; as we move towards more integrated models of care, it’s important we have an MBS which reflects best clinical practice and that’s what we’re delivering.
– The Primary Health Care Advisory Group reviewing new and existing funding models to ensure our primary health system best supports the ongoing needs of patients, particularly those with chronic illness
headed up by Dr. Steve Hambleton.
I have tasked our Primary Health Care Advisory Group with investigating new and innovative funding models to deliver much-more localised and personalised care for patients.
Our working group has already undertaken extensive consultations across the country and it’s clear there is an appetite for change amongst patients and health professionals and a strong resolve that doing nothing is not an option.
– The Mental Health Expert Reference Group providing advice to Government on how best to implement the broad ranging recommendations of the National Mental Health Commission’s Review and take them from paper to policy headed up by Kate Carnell
Mental health is now recognised as a chronic disease in Australia with a significant burden on patients and the health system.
We know that mental health issues can often take many months and years, if not a lifetime, to overcome or manage.
So therefore it doesn’t make sense for mental health to be run on an episodic fee for service model that sees patients bounce from the GP to the Psychologist to the Emergency Department and back again.
One way that’s been championed by many in the mental health sector to address this issue is a move towards a “stepped care” model where patients can access the type of care that matches their needs.
-easy access to self-help support for those with mild or moderate symptoms;
-stepping through to complex case packages for those with severe and complex mental illness if need be;
-and stepping back.
This is a classic demonstration of how, for example, our reviews of primary care and mental health service delivery are integrated, considered policy work, not rash budgetary measures in isolation of each other.
In addition; the Federation White Paper is looking at federal State responsibilities including health, and in particular hospital funding; and finally the Aged Care Sector Committee is reporting to me by the end of the year on a roadmap for the next wave of aged care reforms. These should not to be seen as a series of isolated initiatives.
Individually each is only part of the health puzzle.
Together they offer an opportunity to make the whole system more capable, more modern, more efficient and more appropriate for our 21st century needs.
But, above all, I am about ensuring that Australians have access to information, choice and affordable health care.
To truly achieve this, we must therefore recognise there is one other piece that is essential to completing the health puzzle – private health insurance.
Roughly half the population now has it and obviously any changes we make to primary care, Medicare, hospitals and mental health will all have knock-on impacts for them, as well as patients who don’t, and we need to ensure it is considered as part of any integrated policy mix.
It’s also important to recognise that consumers are becoming increasingly concerned with the value for money – or lack thereof – they are currently receiving from their private health insurance products.
As are taxpayers, with an annual $6 billion investment.
Therefore, today I’m announcing that in the coming weeks the Turnbull Government will launch a public consultation to seek consumer feedback on private health insurance.
Individuals will be able to make online comments about their views to ensure our policy work over the coming months delivers the best value for consumers first and foremost.
At the same time, the Department of Health will be conducting a series of roundtable discussions with key industry and consumer representatives to explore opportunities to amend unnecessary and inefficient regulation which add costs for the consumer and identify reform options which would enhance the inherent value proposition of private health insurance to the consumer.
I have also asked Professor Graeme Samuel, working with my Department, to provide his technical expertise to these industry consultations.
There are certainly questions that need to be asked, such as perhaps the current ancillary model would be better directed to encourage Australians to save for their out of pocket primary care expenses, perhaps specifically for their later years.
This is essential to ensure we can find inefficiencies and unnecessary regulatory burdens in the system that will free up private health providers to offer consumers the best value services available.
Not all decisions coming out of these initiatives will please everyone all the time.
What I am endeavouring to do is find solutions which benefit everyone but the priority, frankly, is what works best for Australian patients.
I have ensured that the reform processes under way are heavily based on consultation not just with doctors and other clinicians, but with other governments, with service providers and above all, with consumers.
Consumers and patients are the reason we have a health system. They should never be regarded as just an input or a number. They should be at the very centre of what the health system does. However the reality is this is no longer the case.
Their needs have changed, and our system has not changed to match them.
Before I go on I would like acknowledge how aged care has been well served by Mitch Fifield in social services and a number of reforms were introduced and implemented that possibly wouldn’t have occurred otherwise.
But with Mitch’s deserved promotion, I saw the opportunity to bring it home to health, where I believe we are best placed to implement the reforms he started.
My priority in doing this is to ensure choice and flexibility for older people.
Currently Government runs a centralised planning system which determines how many residential care beds and home care packages are available in any area in Australia.
Currently if you move from Broken Hill to Sydney to be closer to family your home care package doesn’t come with you.
From February 2017 home care packages will be allocated to consumers who will be able to direct Government funding to the provider of their choice.
Residential care needs to be the next area of reform.
We should allow service providers to make business decisions about where to build a residential care service; and then allow them to attract customers through price and service.
There are areas in Australia where this market based approach won’t always work. Representing the people of Farrer, I am more than aware of this, so I am also looking into the issue of financing of rural and remote aged care;
Finally I want to touch on the issue of quality in Aged Care.
While we hear some terrible stories of elder abuse from time to time, I genuinely believe the vast majority of Aged Care providers offer a safe environment for our older Australians.
We have an accreditation system in place which focusses on this safety of the older person and the subsequent compliance of providers. Yet this is only a part of what quality is.
Quality is really defined by the individual’s experience and expectations.
I want Australia’s aged care system to have an approach to quality that understands and anticipates what’s important to the individual and then strives to exceed that. A quality facility and service should be one that exceeds the consumer’s expectations; not one that is simply safe and compliant. That should be a given.
And then consumers need to be able to find the services that are going to deliver on what is important to them. Which is why I want the My Aged Care Gateway to move to be more like TripAdvisor.
We all know the value of that when planning a holiday. This style of information will be progressively available on My Aged Care to help older people make even more important life decisions.
It’s also essential for the health of our nation that we are a physically active one.
Some 13,000 deaths annually in Australia are attributed to physical inactivity, while one-in-four children are now considered overweight or obese. Too many Australians, young and old, are living sedentary lives and, frankly, it’s killing us.
Having Sport and Health together in my portfolio gives me a unique opportunity to promote the combined benefits of the two and put them squarely on the Cabinet table. This includes having a balanced approach to sport that focusses on grassroots participation, as well as elite results.
We currently spend about $100 million a year through our Play.Sport.Australia program on various initiatives building stronger grassroots sports participation. Essentially, we need more people up off the couch, putting down the remote and getting active. Not just early in life, but the millions of adults who think their sporting days are behind them.
Another area I am focussed on is greater integrity at all levels of sports, whether it be doping, illegal gambling, illicit drugs and the criminal activities associated with them.
How can we as policy makers expect Australians to engage, and reengage, with sport if they don’t have faith in the integrity of the sport they’re playing?
We have a proud sporting pedigree in this country and I want to leverage that to make us happier and healthier as well.
As we’ve seen this afternoon, we are a Government that continues to be focussed on ensuring Australian patients get affordable access to high-quality health care services. However, like any industry, this should not be the limit when it comes to health policy.
The Prime Minister has made it clear we want to deliver a 21st Century Government that embraces the digital economy and health is no different. We need to embrace digital health and innovation in the health sector if we are to deliver better integrated care.
Most importantly, we need to embrace the concept of personal choice – ways to empower patients to build a healthcare model that suits their individual needs.
When we talk about innovation, automatically our minds go straight to new technologies in the treatment of diseases, whether they are a diagnostic camera, a bionic arm or the latest breakthrough drug.
These are certainly essential to the future of health care in this country and we must continue to innovate.
This is why this Government set up our landmark Medical Research Future Fund to identify and co-ordinate national health priorities, as well as continued support for individual research projects through the NHMRC.
However, it’s time we reset the agenda when it comes to digital health and innovation and open our minds to the wider possibilities available.
As consumers, digital health has obvious benefits when it comes to the storage of our personal medical information that will vastly improve the way diseases and conditions are diagnosed and managed for Australian patients.
This concept is also designed to support doctors and other allied health professionals with accessing patient information at their fingertips, will help deliver better health outcomes for patients the first time and cut down on unnecessary risks and inefficiencies in the system currently frustrating doctors.
That’s why this Government has committed to revamping Labor’s mishandled Personally Controlled Electronic Health Record into a model that is easy to use and understand for patients and health professionals.
Admittedly, we could have walked away and put it in the too hard basket.
But as I said earlier, we are committed to delivering 21st Century Government for Australian patients.
One of the great criticisms of Labor’s model that was that it could not be used unless a patient signed up, rather than an all-inclusive system that simply gives those consumers who do not want their medical history made available the option to opt-out.
Therefore, in order to address this issue, I can announce today that all-inclusive trials of the Government’s new My Health Record will commence in early 2016 for around 1 million Australians.
The trials will be held in Far North Queensland and in the New South Wales Nepean Blue Mountains region. But the great digital health revolution lies literally in the palms of consumers. We now live in an age of smartphones, watches and wallets.
So, what if we, as government, got out the way and gave consumers full access to their own personalised health data and full control over how they choose to use it?
What if you, as a consumer, were able to take your personal Medicare and Pharmaceutical Benefit Scheme data to a health care service; to an app developer; to a dietician; to a retailer and say how can you deliver the best health services for my individual needs?
It’s a revolutionary concept in health – but it shouldn’t be – given it’s already happening with industries like finance across the globe. Therefore it now really becomes a question of why not?
Why can’t we allow people to use their own personal health information in the same ways they would to access and customise a banking product?
Why can’t we allow people to create a health portfolio of products and services customised to their own needs simply by providing their data?
Why can’t we allow someone’s doctor to use an app developed on the free market to monitor their patient’s blood pressure at home following an operation, or keep a real time count on their insulin levels?
Why can’t we keep informed of our parents’ health well-being via digital connections so they can remain in their own homes, rather than prematurely entering residential aged-care?
The Answer is – we can and allowing consumers open-source access to their health data is the way to do it.
As I said earlier, this is what delivering 21st Government is all about and something I am keen to explore as health minister to better support the patients of this nation and give them greater control over their health and how they manage it.
I have thoroughly enjoyed the last ten months as Minister of this portfolio. I have shown that I’m willing to listen and work with people to achieve a common goal, whilst also standing up for Australians and taxpayers.
And as a former Health Minister once told me ¬-the average term for a health minister is 20 months, so I took that message as you’re here for a good time not a long time so get on with it.
All of these reforms I have set up to last beyond this election cycle and to undoubtedly last beyond my term as Health Minister. They need to last for the long term.
Australia’s health system was built for the patient and it’s important they remain at the centre of everything.