CHF Consultation Paper on the National Health and Hospitals Reform Commission Final Report A Healthier Future for All Australians August 2009
CHF Consultation Paper on the National Health and Hospitals Reform Commission Final Report A Healthier Future for All Australians Introduction August 2009 The National Health and Hospitals Reform Commission s (NHHRC) final report provides a comprehensive review of Australia s health system, with 123 recommendations for change and reform. Consumers Health Forum of Australia s (CHF) Consultation Paper on this report is based around five key areas of particular relevance to our members and stakeholders: Access and equity; Consumer engagement and involvement; Consumer experience of the health system; E-health; and Prevention and early intervention. To inform a more comprehensive response to the report, CHF has developed questions to prompt further discussion. This Consultation Paper provides a starting point for gathering the views of our members in relation to many of the report s recommendations, and will form the basis for CHF s contributions to the consultation process currently underway. August 2009 1
Access and Equity The report acknowledges the current major discrepancies in equitable access to health services. We know that the health system is not fair and some people miss out because of where they live; others may experience a health system that does not meet their needs because of their different culture or language; and yet other people with a disability or a mix of complex health problems may find that there are major gaps in access to medical and other specialist services and the system does not connect up all their care needs. 1 A range of initiatives in the report relate directly to equitable access to health services, and tackling major access and equity issues is one of the report s overarching three reform goals. Strategies are identified to improve access and equity issues for various population groups who experience systemic disadvantage, particularly Aboriginal and Torres Strait Islander people, people with mental illness and rural and remote populations. Strategies are also identified to improve access to dental services across the population, and to improve the timeliness of access to public hospital care. The report stresses the need to change from a concept of universal entitlement to universal access, recognising that universal entitlement has not resulted in adequate access to health care for many groups. This would include providing people with complex needs with access to additional services you get more if you need more. However, some of the report s recommendations about funding and distribution of services raise questions about whether they will facilitate truly equitable access. These include the proposed new Medicare Select model, which is discussed in detail below. Timely access to care: National Access Targets The report argues that we need an ongoing way in which we can continuously measure and report on whether people are getting access to the health services they need. 2 It recommends the implementation of National Access Targets for timeliness of access to care, including for patients attending emergency departments, requiring urgent primary health care and requiring planned surgery or procedures. These should be developed using clinical, economic and community perspectives, through methods such as citizen juries. CHF welcomes the inclusion of the community perspective in the development of National Access Targets but notes that little detail is provided on how proposed citizen juries would be selected and how they would operate if this recommendation is accepted. CHF would like to be involved in the development of the structure and operation of citizen juries. 1 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p81. 2 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p90. August 2009 2
The preliminary National Access Targets are: Primary health care services no more than 1 day to access a primary health care professional; no more than 2 days to access a medical practitioner. Health telephone support no more than 10 minutes to receive initial advice. Postnatal care home visit to new mothers within 2 weeks of giving birth. Crisis mental health services response within 1 hour for emergency patients; within 12 hours for priority patients. Community mental health services contact within 7 days of discharge from acute mental health service for patients with psychosis and within 1 month for other patients. Drug and alcohol treatment program within 1 month following referral. Aged care assessment assessment within 48 hours for patients requiring immediate response or 14 days for those whose condition is deteriorating. Public hospital outpatient services within 2 weeks for first appointment for urgent patients with a life-threatening condition; within 3 months for other patients. Radiotherapy within 1 day for emergency care patients, 2 weeks for high priority patients, 1 month for other patients from referral to commencement of therapy. Planned surgery 1 month for high priority patients and 3 months for priority patients. Ambulance services 15 minutes for potentially life-threatening events in metropolitan areas. Emergency departments immediately for resuscitation patients, within 10 minutes for emergency patients, within 30 minutes for urgent patients. Question 1 Do the proposed National Access Targets reflect reasonable waiting times for consumers access to health care? The report also recommends that there should be financial incentives to reward good performance in outcomes and timeliness of care, including the timely provision of suitable clinical information. CHF questions whether the use of financial incentives is the most effective approach to improve performance around the National Access Targets. Question 2 Are incentive payments to health services the most efficient way of ensuring that health services meet access targets? What would you suggest as an alternative? August 2009 3
Access to dental care The recommendation relating to universal access to dental care, including preventative and restorative dental care and dentures, through a new Denticare Australia scheme were widely publicised following the release of the report. CHF supports the concept of universal dental care in principle, particularly given the cost and timely access barriers faced by many people in their attempts to access dental care, and the links between poor dental health and other chronic conditions. The proposed approach to Denticare would involve everyone having the choice of having dental services paid for by Denticare Australia, through private health insurance or through public dental services. People who chose to access dental services through private health insurance would have that portion of their premium paid by Denticare, but would also have the option to take out health insurance for additional dental services. The report argues that it makes sense to build on this predominantly private approach to delivering and paying for dental services, rather than building a new Dental Benefits Schedule in Medicare. 3 Those who choose to have a private dental plan will likely have to pay a co-payment, while publicly insured people will not have to pay co-payment but will probably have to wait for services. Question 3 Is the proposed public and private approach to Denticare equitable, given that the option to pay more to access services without waiting periods will advantage those who can afford to pay? If not, how could the equity issues be addressed? Improving health care for disadvantaged groups The report makes a number of recommendations targeted at improving health outcomes for groups that historically have poor health outcomes and access to services. Several recommendations are aimed at closing the gap in health outcomes for Aboriginal and Torres Strait Islander people, most notably a new aggregated funding model for Aboriginal and Torres Strait Islander health services with all health services to be purchased and commissioned by a new National Aboriginal and Torres Strait Islander Health Authority. On the whole, CHF supports these recommendations, though more detail is required about how the strategies would be implemented. CHF also stresses the importance of consulting with Aboriginal and Torres Strait Islander health consumers in the design, development and implementation of any new health services or service delivery models, to ensure that the proposed services will meet their needs and will be used. This is particularly important given the long history of poor health outcomes and the many barriers to service access experienced by this population. 3 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p84. August 2009 4
Rural and remote populations are also identified in the report as requiring additional strategies to ensure access to health care. The question of universal entitlement is particularly pertinent in relation to rural and remote health, as services are often simply not available in these areas. The report proposes a range of strategies to fund and support expanded services in rural and remote areas, and to bring care to the person or the person to the care. Strategies include networks of primary health care services, expansion of specialist outreach services, a range of telehealth services, referral and advice networks for remote and rural practitioners and on-call 24 hour telephone and internet consultations and advice. CHF particularly welcomes the recommendation for better funding for the Patient Travel and Accommodation Assistance Scheme, which will address the out-of-pocket costs experienced by many rural and remote consumers and their families who have to travel long distances to receive health care. The report also acknowledges the service issues and lack of support experienced by many people living with severe and/or chronic mental illness, and makes a number of recommendations to improve service access and health outcomes for these people. Question 4 Do the measures to address the health needs of disadvantaged groups go far enough? Next generation Medicare The report proposes an evolution of Medicare to improve access to health services, promote integrated and comprehensive primary health care services, create continuity and better coordinated care, respond more effectively to chronic disease, to provide greater emphasis on prevention, early intervention and self-management, to support new and effective ways of providing more responsive health services, and to improve the quality of health services, among other goals. This evolution would flow on from the Commonwealth Government assuming responsibility for primary health care services and public hospital outpatient services. Changes would include: Supplementing medical services with other health services; Encouraging access to multidisciplinary care; Paying for a mix of public and privately delivered services; Broadening the mix of payment arrangements; Providing a stronger focus on prevention, health promotion, early intervention and support for self-management; Providing support for a broader range of specified services to be provided by health professionals through innovative, collaborative care models within services; Allowing people with complex issues the option of having a single health care home with eligibility to access additional services; Creating more integrated safety net arrangements to protect people from unaffordable costs; Paying for a broader range of health services such as those delivered by telephone or email; and Allowing top up funding of primary health care services in underserved areas. August 2009 5
The report also recommends rethinking the universal service entitlement that is, what health services the Commonwealth Government believes should be funded (at least, in part) from public monies. The report argues that the scope of the universal service entitlement should be debated over time to ensure that it is realistic, affordable and fair and will deliver the best health outcomes. The report calls for community debate about health spending including consumer perspectives. CHF welcomes the recognition that consumer views must be included if changes are to be made to Medicare entitlements, and would like to be involved in the proposed public conversation. Importantly, the report recommends that the scope and structure of safety net arrangements should be reviewed to protect people from unaffordably high co-payments for using health services. we are essentially acknowledging the need to recognise and tackle the high costs faced by some people for health services that fall outside our current universal service entitlement. 4 Question 5 Will the proposed evolution of Medicare deliver better outcomes for consumers? Medicare Select In order to open the health system up to greater consumer choice and provider competition, the report proposes a new Medicare Select model, for which it recommends extensive consultation. Under this model, the Commonwealth Government would be the sole government funder of health services. All Australians would automatically belong to a government operated health and hospital plan, which could be a national plan, state government plan or a plan operated by not-for-profit or for-profit organisations. An important part of the model is that people would be able to easily choose to move to another health and hospital plan, and there must be enough alternative plans to allow for competition and consumer choice. Each health and hospital plan provider would negotiate contractual agreements with both private and public providers. All plans would cover a mandatory set of health services covering universal service entitlements determined by the Commonwealth Government. Additional coverage could be purchased from private health insurers. Question 6 Will the proposed Medicare Select model improve or reduce choice in access to health care in Australia? Question 7 Will the proposed Medicare Select model improve or reduce equity in access to health care in Australia? 4 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p116. August 2009 6
The proposed exploration of the design, benefits, risk and feasibility of the new Medicare Select model must include consumer consultation, as consumers are the people who will be using, and funding, the new model. CHF welcomes the recognition that any exploration of the Medicare Select Model would need to examine the regulatory framework required to protect consumers. August 2009 7
Consumer Engagement and Involvement The report strongly states the case for strengthened consumer engagement and voice as part of an agile and self-improving health system. Strategies to facilitate this include improved health literacy, fostering community participation and empowering consumers. As the report notes, Governments also have an important role in reflecting how consumers can participate through investing in health literacy or strengthening consumer engagement mechanisms in the management of health services. 5 The report also argues that Good health is not something that is simply done to us through our interaction with the health system. We must be active participants in our own good health, working in partnership with our health professionals, our carers and families. 6 However, none of the report s 123 recommendations directly promote stronger consumer participation or engagement. Some of the report s recommendations would have a positive impact in assisting consumers to be active participants in their own health care and in incorporating the consumer voice as a key part of performance monitoring. The recommendations relating to e-health (see section on e-health below) could be highly beneficial in empowering consumers to be involved in their health. Consumer engagement The report contains some very positive words around the importance of consumer involvement, consumer choice and consumer voice. We believe the health system of the future should be organised around the integral roles of consumer voice and choice, citizen engagement and community participation. This is about giving people real control and choice about whether, how, where and when they use health services, supported by access to evidence-based information that facilitates informed choices. It is also about ensuring that the experience and views of consumers and whole communities are incorporated into how we redesign and improve health services in the future. 7 This is a strong statement that CHF fully supports. However, there is little discussion in the report around how this new consumer-focused health system would work. While initiatives such as those relating to health literacy are welcome, CHF wants to see initiatives around real and robust structures to facilitate consumer participation and consultation. The report s section on Fostering genuine participation calls for robust processes that promote and value the participation of the community providing the example of citizen juries. However, it does not go into detail, arguing that Listening to the views of the community on health reform must be 5 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p73. 6 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p96. 7 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p122. August 2009 8
an ongoing commitment backed up by a robust process, which transcends the lifespan of short-term inquiries such as this one. 8 CHF considers that the words around consumer participation are some of the most important in the report, and would like to see, as part of the consultation and review process now underway, detailed consideration given to strategies that can make these words a reality. Question 8 What should a robust process for listening to the views of the community on health reform look like? How do you see this working on a long-term basis? Recommendation 3 identifies that there should be regular monitoring and reporting of community confidence in the health system to contribute to the ongoing sustainability and responsiveness of the health system. However, the indicative action plan in Appendix G goes into no detail about how this would work, except to note that the Commonwealth Government would lead reform in this area. CHF would like to be involved in the development of processes for regular monitoring and reporting of community confidence, and stresses that adequate funding must be made available for this to be effective. Question 9 What processes or systems should be in place to ensure that the consumer voice is taken into account when measuring the success of health reform? Health literacy The report cites research that indicates that 60 per cent of Australians cannot participate effectively in their health care due to a lack of basic health literacy. Increasing health literacy will empower consumers to play a greater role in their own health care and to make informed decisions about their health. Recommendation 10 supports strategies that help people take greater personal responsibility for improving their health, while Recommendation 11 proposes that health literacy should be a core element of the National Curriculum in both primary and secondary schools. Recommendation 12 urges all relevant groups, including health services and professionals, non-government organisations, media, private health funds, food manufacturers and retailers, employers and governments, to provide access to evidence-based, consumer friendly information that supports people in making healthy choices and in better understanding and making decisions about their use of health services. Question 10 Do you think that the recommendations relating to health literacy will be sufficient to assist consumers to make informed decisions about their health and become active participants in their own health care? What else might be required? 8 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p123. August 2009 9
Providing information to consumers The report calls for a shift in the power balance between consumers and clinicians by empowering consumers to make fully informed decisions. Again, however, the report makes no clear recommendations about how this empowerment could take place. The example of increased development of decision aids is provided, and the need for a national approach to advanced care planning is also raised. However, as identified above in relation to consumer engagement, CHF would like to see clear and robust strategies to make these commendable principles around consumer empowerment a reality. Question 11 What initiatives and strategies could the Federal Government implement to empower consumers to make fully informed decisions and shift the power imbalance between consumers and clinicians? The report also identifies the need for a culture of improvement through health system reporting, including providing comparative clinical performance data back to health services, hospitals and clinicians. CHF would like this information to also be available to health consumers. Recommendation 33, which would require hospitals to report publicly against national indicators including access, efficiency and quality of care, could potentially assist consumers to make informed decisions about where they seek treatment. This information would need to be easily accessed by consumers and presented in user friendly language and format. The report notes that public reporting should be tailored, not just a by-product of clinical or bureaucratic reporting. Question 12 What should be included in public reporting from hospitals and health service providers? How should this information be made available to consumers? August 2009 10
Consumer Experience of the Health System As is noted in the report, the current health system is provider focused, not patient focused. Currently it is usually the patient who must find a way of seeing multiple health professionals while navigating across various locations, rather than health professionals functioning as a team practising together and providing care around the whole needs of a person. 9 The report calls for a new approach that connects and integrates health services, so that consumers experience it as one health system regardless of funding sources or governance arrangements. As the report argues, We need to redesign health services around people. 10 Key aspects of this include strengthened multidisciplinary primary health care services as a point of first contact, an option for some groups for voluntary enrolment with a health care home to facilitate access to services, review of public hospital outpatient services to design them more closely around the needs of patients, and expansion of subacute services. Workforce reforms are recommended to encourage multi-disciplinary learning and a team based approach. Transfer of functions to Federal Government The report argues that the current arrangements, with split responsibilities between Commonwealth and state governments, results in fragmented, poorly integrated care, and a lack of accountability for patient outcomes. To facilitate the one health system approach, the report recommends that a number of functions will be funded and governed at the national level to ensure a consistent approach; these are primary health care, aged care, dental care and purchasing Aboriginal and Torres Strait Islander health services. Funding arrangements for public hospitals and health care services would also be changed, with the Federal Government to initially pay 40 per cent of the efficient cost of each episode of public hospital care and 100 per cent of the efficient cost of public hospital outpatient services. In addition, under the proposed Healthy Australia Accord, several defined functions would be governed at a national level: Patient quality and safety; Health promotion and prevention; Professional registration; Workforce planning and education; Performance reporting and monitoring; Private hospital regulation; E-health; Technology Assessment; and Research and innovation. 9 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p51. 10 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p6. August 2009 11
Question 13 Will transferring responsibility for primary health care and other health functions to the Federal Government result in better health outcomes and better experiences of the health system for consumers? Safety and quality Safety and quality are key aspects of consumers experience of the health system, and CHF has undertaken extensive work in this area. The importance of safety and quality is highlighted by various statistics included in the report, including a 1994 study (which has not been repeated) that found that 16.6 percent of all hospital admissions were associated with adverse events, half of which were highly preventable. The study also noted that avoidable adverse events each year were equivalent to 13 jumbo jets landing and killing all 350 passengers on board. 11 The report recommends continuous improvement through health performance reporting, including publicly available information on health services to assist consumers to make informed decisions, as well as making the Australian Commission on Safety and Quality in Health Care a permanent national body. CHF welcomes the permanency of the Australian Commission on Safety and Quality. Recommendation 19 calls for the development of patient outcomes data for primary health care, and the development of incentive payments for prevention, timeliness and quality care. Similarly, recommendation 112 calls for a nationally consistent approach to collection and comparative reporting of safety and quality indicators, again with incentive payments for safe and timely access, continuity of care and service improvement. Question 14 Are incentive payments the most effective way of ensuring safety and quality in health care? It is recommended that safety and quality data should be collated, compared and fed back to hospitals, clinicians etc to encourage them to improve performance where this is necessary. CHF considers that safety and quality information should also be publicly available to help consumers to make informed decisions. Better service coordination and multidisciplinary service provision One of the 'headline recommendations of the report is the widespread establishment of Comprehensive Primary Health Care Centres and Services, to provide multidisciplinary primary care services in one setting with better coordination of patient care. Comprehensive primary health care is presented in the report as the cornerstone of the future health system, building on the current central role played by GPs to improve access to a multidisciplinary range of primary health care and 11 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p56. August 2009 12
specialist services in the community. The report envisages the Comprehensive Primary Health Care Centres and Services as one stop shops, with access to an expanded range of services. Strengthened primary health care services would bring together specialists and primary health care specialists to improve health for the most complex patients across all settings, hospitals and the community. These strengthened primary health care services should become the first contact for most health care needs of most people. 12 Question 15 Will Comprehensive Primary Health Care Centres and Services provide better consumer access to health care and better service coordination for consumers? Recommendation 98 proposes various strategies for the health workforce that would support multidisciplinary health care delivery and better communication and interaction between the health professions, while recommendation 100 calls for a new education framework that would support this approach and use interprofessional learning across the health professions. CHF welcomes strategies that will encourage health professionals to work together and collaboration for better health outcomes for their patients, but calls for consumer involvement in the development of the new education framework, and for the education framework to recognise the importance of consumer input to the education of health professionals. CHF was particularly pleased to note recommendation 20, which calls for better management of chronic and complex conditions through shared care arrangements in a community setting. As the report notes, The people in most need are often the least well equipped to navigate their way around our incredibly complex health system. 13 One strategy identified is to provide certain groups with the option of enrolling with a single primary health care service to strengthen the continuity, coordination and range of multidisciplinary care available to meet their health needs and deliver optimal outcomes. These groups are young families, Aboriginal and Torres Strait Islander people and people with chronic and complex conditions. The primary health care service would take responsibility for coordinating care across all health service needs, and patients would be able to access additional services that are not part of the MBS. CHF notes that that enrolment with a single service will be voluntary, and considers that this is an important element to ensure that consumers retain choice about how they manage their health services. This is particularly important when the system is first implemented, as some consumers are likely to want to wait to see if enrolling with a single service does deliver better health outcomes before making a decision about enrolment. CHF also considers that is important that there should be sufficient flexibility if a consumer wants to seek a second opinion or consult another provider. 12 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p 103-104. 13 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p 101. August 2009 13
E-Health The report promotes the benefits of e-health systems, and recommends that every Australian should have access to a person-controlled electronic health record by 2012. The report argues that this will provide people with better access to their own health information, promoting consumer participation and supporting self-management and informed decision making. It is important to note that the report clearly identifies that e-health records should at all times be owned and controlled by the person. This is important and has been a key point throughout CHF s advocacy on e-health. The recommendations relating to e- health records make it clear that the user will have the opportunity to approve and authorise access and choose their electronic health record provider. Indeed, one of the advantages of electronic health records identified in the report is that it will give people control over their own health information. As the report argues, Giving people better access to their own health information through a person-controlled electronic health record is absolutely essential to promoting consumer participation, and supporting self-management and informed decision-making. 14 CHF is pleased to see that the report s vision of the electronic health record would give consumers the ability to add information relevant to self-management and healthy lifestyles, and would view a person s own notes (and their carers ) as a respected source. The ability of consumers to view an audit trail indicating who has added to, or viewed, their record is also essential. Recommendations also call for the Commonwealth Government to legislate to protect the privacy of health information, and the development of a social marketing strategy to inform consumers about the benefits of an e-health system. Importantly, the report identifies the need for all consumers to be able to access their electronic health record via the internet, and recommends ensured access to a national broadband network for all Australians. Under the proposal, funding sources for the electronic health record would be varied, and would include individuals. The report notes that Governments would have an important role in ensuring those with the greatest need have ready access to a record. 15 CHF would like clarification on how the greatest need will be defined when governments are providing assistance in accessing electronic health records for example, whether this refers to greater financial needs (those on low incomes), greater health needs (those with chronic or multiple conditions), or some other criteria. 14 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p129. 15 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p130. August 2009 14
CHF made several recommendations in its submission to the NHHRC on e-health: That consumers have the choice about what information health care providers can access in their electronic health records. That a national electronic health record should provide consumers with access to their personal health information but not require consumers to be responsible for holding and transporting their electronic health record. There needs to be a strong governance processes around the development and ongoing monitoring of electronic health record. That the NHHRC provide information on how the proposed person-controlled electronic health record will work with the Individual Electronic Health Record currently being developed by the National E-Health Transition Authority. That the NHHRC consult extensively with health consumers about the proposed person-controlled electronic health record. The first three recommendations have been addressed in the proposed model in the NHHRC report, though CHF would like to see more information about governance arrangements, including the role of consumers. CHF would also like to see more information about how the proposed model will fit in with past and current work of the National E-Health Transition Authority. In addition, the report recommends that a national social marketing strategy is implemented to inform consumers and health professionals about the benefits of the proposed approach. However, there is no discussion of consumer consultation on e-health. CHF calls strongly for consumer consultation to play a key role in the ongoing consultation processes around the NHHRC report, including in particular the e-health recommendations. Question 16 How will the recommendations relating to e-health improve consumers control of their health information and their participation in their health care? August 2009 15
Prevention and Early Intervention The report acknowledges a long focus in the Australian health system on illness at the expense of wellness, and calls for a greater focus on prevention and early intervention, particularly in relation to chronic conditions. Shifting health spending towards prevention The report calls for a shift towards spending on health prevention, and identifies that some preventive interventions can be an efficient use of our resources. This reflects the point made in CHF s original submission to the NHHRC: A significantly stronger focus is needed by the Australian Government on optimising health outcomes for consumers, particularly those related to lifestyle illnesses that lead to chronic conditions. In addition to the personal and financial impacts on individuals, chronic conditions are a financial burden to the health system. A focus on optimising health, including a stronger focus on preventing chronic conditions, will reap longer-term benefits for all Australians. 16 CHF is largely supportive of the recommendations in relation to prevention. However, some concerns are discussed below. National Health Promotion and Prevention Agency The report argues strongly for an increased focus on prevention and early intervention, with the establishment of a National Health Promotion and Prevention Agency. This agency would go beyond the National Preventative Health Agency that has already been proposed and funded in the 2009-10 Federal Budget to incorporate a broader focus on promotion. As the report says, The Agency should have a broad role to drive a fundamental paradigm shift in how Australians, and our health system, think and act about health and keeping well, including through better education, evidence and research. 17 Its roles should include: Driving cross portfolio and cross industry sector actions to support a health promoting environment and society; Holding the major responsibility for commissioning, collecting and disseminating evidence on prevention best buys ; Leading the development of Healthy Australia Goals ; Reporting to the Australian community about progress on prevention. 18 The report clearly states that this body should be independent. However, legislation proposed for introduction and passage in the 2009 Spring Sittings will establish an 16 http://www.chf.org.au/docs/downloads/490_submission_nhhrc_aug08.pdf. 17 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p5. 18 NHHRC 2009 A Healthier Future for All Australians: Final Report, Commonwealth of Australia, Canberra, p97. August 2009 16
Australian National Preventive Health Agency as a statutory agency within the Health and Ageing portfolio, to provide evidence-based policy advice to governments on preventive health, and to implement associated programs as tasked by Health Ministers. If the Agency is to fall within the Health and Ageing portfolio and be answerable to Health Ministers, it is extremely unlikely to be truly independent and able to provide frank and possibly uncomfortable advice. The need to increase our investment and returns from preventative health is a fundamental issue in any serious discussion about the health and well being of Australians. The proposed establishment of a new Preventative Health Agency is clearly an important component in enacting health reform. The structure, operation and resourcing of this agency is critical to the future health of Australians. The worst case scenario is that this new agency will become simply another government advisory group dominated by those with a strong stake in existing health systems and with limited capacity to act independently or pursue the more challenging health agendas requiring working against the short term interests of key groups such as alcohol, tobacco and fast food interests. Having each jurisdiction represented on the Board of this new agency (for instance) would be a recipe for inaction. The best case scenario is that this new agency is governed by an independent Board appointed on merit, and that it has the capacity to develop its own work-plan against key deliverables as well as having the resources required to meet those deliverables. If this is the case, health groups across Australia will be more than willing to not only support, but actively engage in advancing the preventative health agenda. Question 17 Will the Australian National Preventative Health Agency as constituted in the upcoming legislation adequately fulfil the proposed functions of the recommended independent National Health Promotion and Prevention Agency? A healthy start to life CHF has previously commented favourably on the concept of a care coordinator for families who have a child with intensive care needs, as such families report having an increased need for assistance with navigating the health system. However, CHF has also noted that these services also need to be made available for consumers who develop a disability in adulthood. Where consumers have intensive or ongoing health concerns, it is advantageous to have someone to advocate for them (and their families) and coordinate the range of services. In recent consultations with CHF members, consumers strongly voiced the need for access to system navigators to assist them to effectively use the complex health system. 19 While the report continues to recommend care coordinators for children with intensive care needs, it does not recommend that adults with similar needs should also have access to an equivalent service. CHF calls for the provision of care coordinators and system navigators for all age groups to be favourably considered in the ongoing consultations about the NHHRC report. 19 See http://www.chf.org.au/docs/downloads/494-private-health-reforms-report-nov08.pdf; http://www.chf.org.au/docs/downloads/sub-517-nhhrc-interim-report.pdf. August 2009 17
Question 18 How would consumers benefit if care coordinators/system navigators were made available to adults as well as children? Conclusion CHF welcomes the release of the NHHRC s final report: A Healthier Future for All Australians. However, there are a number of issues and recommendations within the report that CHF considers require further exploration or consideration, particularly to ensure that the consumer voice is heard and addressed. This Consultation Paper has addressed a number of concerns across five areas in the report that CHF considers are of particular interest to our members and stakeholders. CHF will provide further comment on the NHHRC report as part of the ongoing consultation process that is now underway. This Consultation Paper provides a starting point for gathering the views of our members in relation to many of the report s recommendations. Further information Please contact CHF for further information about the Consultation Paper. August 2009 Consumers Health Forum of Australia Inc PO Box 3099 Manuka ACT 2603 Telephone (02) 6273 5444 Fax (02) 6273 5888 Email info@chf.org.au August 2009 18
Background information The Consumers Health Forum of Australia Inc (CHF) is the national voice for health consumers. As an independent non-government organisation, CHF helps influence Australia s health system by representing and involving consumers in health policy and program development. Health consumers have a unique and important perspective on health as the users and beneficiaries of health care and, ultimately, those who pay for it. CHF takes consumers views to government and policy makers, providing an important balance to the views of health care professionals, service providers and industry to achieve a health system that reflects the needs of all stakeholders. CHF member organisations reach millions of Australian health consumers across a wide range of health interests and health system experiences. Health policy is developed through wide consultation with members, ensuring a broad, representative, health consumer perspective. Current priorities include safety and quality in health care, safe and appropriate use of medicines and health care for people with chronic conditions. CHF also facilitates the appointment of consumer representatives on over 200 national health-related committees. CHF believes all consumers should receive affordable, safe, good quality health care at the time they need it. The best outcomes are achieved when consumers are involved in decisions about and management of their own health care. Consumers should receive health care information when they need it in a form they can understand, particularly about using medicines. Established in 1987, CHF receives funding from the Australian Government Department of Health and Ageing and membership fees. It seeks external funding for priority projects. With its ability to access a variety of health consumer networks and extensive knowledge of consumer issues, CHF is a respected and influential contributor to the Australian health debate. Consumers Health Forum of Australia Inc PO Box 3099 Manuka ACT 2605 Telephone (02) 6273 5444 Fax (02) 6273 5888 Email info@chf.org.au www.chf.org.au August 2009 19