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Reform will continue

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The Coalition took a very conservative set of health policies to the election. There were no big spending promises, and no pledges of major reform. The talk was more about getting rid of waste and doing things more efficiently.

This does not mean that health reform should cease under the new Government.

In fact, Prime Minister Tony Abbott has committed to supporting general practice and getting rid of red tape, which continues the sort of health reform that should be very beneficial to the medical profession – and that means it will benefit patients.

The AMA supports practical and affordable changes that help improve frontline health services. This is what we will work towards with the new Government.

I told the National Press Club in July that, if we want to drive real health reform, we must first define the problem.

I said that our health system is perfectly designed to get the results that it gets. The problem is, it was designed for a different set of problems.

It is set up to focus on acute care needs – with the ability to rapidly escalate to secondary and tertiary services.

We do this very well, but is it enough? Are people getting easy access to the quality health care they need?

Genuine practical health reform must recognise the changing needs of our society and redesign the system to meet the new challenges.

This can be achieved with new policy based on sound advice from the people who know what is going on in the health system on a daily, even hourly, basis – the doctors at the front line.  That is us.

The economic environment means that the Government will want to do more with less. We see the same challenges the world over. We can help with that strategy.

It is important in this environment to get back to basics. We must protect and support the fundamentals of the health system.

If new funding is limited – and it is – it must go towards building on the things that work, the things that respond to our changing needs.

Any change must be tested against the major reasons we need reform – our increasing burden of chronic disease and our ageing population.

Proposals should be moving us toward a joined-up, strengthened primary health care system built on team-based solutions. 

We know that doctors are the stewards of community health resources. The clinical decisions we make can either be a cost or a saving to the health budget, depending on the individual situation, which is often about improving or saving a life.

There is now much greater transparency in our public hospitals, which means we can measure many more things, make comparisons, and devise ways to make things more efficient and affordable – all based on clinical insight.

This sort of decision-making is all about the best possible outcome for the patient, not the structure or the funding system, but one often follows the other.

To be successful, health reform must involve empowering the health workers.

There are similar health problems all around the world, and the universal trend is greater involvement of clinicians in decision-making. The Francis Inquiry in the UK shows us what happens when they are not.

Self-analysis is routine in some specialties. The College of Surgeons is committed to excellence in clinical care, and all surgeons in operative practice are expected to participate in regular surgical audit, peer review and quality assurance activities. This leads to improved standards, better care, and better outcomes.

Cardio-thoracic surgeons at St Andrew’s War Memorial Hospital have turned this into an art form with peer review in place since 1985. Their monitoring has provided a rich source of data for near-real time feedback to detect problems and improve outcomes.

Clinical input and review can make all the difference. This is a practical reform and patients are the winners – along with the health budget.

We need clinicians to be able to influence governance of our Local Hospital Networks.  We can and must apply the same principles to primary care through proper clinical influence over Medicare Locals, and with the strategic direction, design, and implementation of the PCEHR.

These may sound like small reforms, but they will make a big difference.

We look forward to working with the new Government to make this reform process a reality.