Can PHNs reflect consumer priorities? (Part 1)
Leanne Wells, CEO, discusses how the views of consumers can and ought to be reflected in the work of Primary Health Networks.
Can Primary Health Networks reflect consumer priorities? That question was put to me recently as the theme for a speech I was asked to deliver.
We have to hope PHNs can respond to what consumers need, because if they can’t they will fail a central requirement of a contemporary primary health organisation.
If PHNs are not reflecting consumer priorities, what are they there for?
The PHNs have the benefit of at least two years’ worth of comprehensive needs assessments done by their predecessor Medicare Locals.
My concern is that unless PHNs seize the opportunity to develop and embed themselves as modern, consumer-focused organisations they risk becoming white elephants --- a failed attempt to provide an effective primary health care system in Australia.
To ask whether PHNs can reflect consumer priorities seems an entirely reasonable question.
However it also reflects an unthinking or default view of many within and outside the health system that somehow the consumer is there because of the system - and NOT vice versa!
That common view is demonstrated in the way many of us still think about hospitals --- as institutions to which patients come and are “subject to”.
It was the sort of thinking that prompted the “Yes Minister” gag - the triumph of political fix-its: the patient-free hospital. It fuels the tempting thought that patients get in the way of good health care. That instinctive thought is fading, I hope!
In any health system, what priority is higher than meeting the medical and health needs of the consumer, the patient?
Health care is now rapidly moving towards the realisation that the best outcomes for health happen when the patient is at the centre.
And that means at the centre at all levels:
At the individual care level where consumers are empowered to make choices and decisions about their own health care in partnership with clinicians,
At the systemic level where consumers participate in governance and in policy, planning, delivery and valuation of health services, and where service design and improvement draws directly from not only their needs but equally importantly their experience of care, amd
At the system-wide level where consumers as citizens have access to information about the safety and performance of the health care system and its parts.
PHNs must work, act and be held accountable across all these levels.
PHNs as innovation catalysts
CHF holds much hope for PHNs – we are among their strongest proponents.
As a brand new construct in the health world they offer the opportunity to start off on the right foot with the right principles and adopting the right practices.
Firstly, they can do this by putting the patient first and gearing their governance, operations and the clinical practice they promote around the cornerstone principle of patients as partners in care.
Anybody who has even a passing experience with complex, chronic illness knows that our health system for all of its treasures fails to provide an acceptable level of coordinated and effective care - a level of care well within the health capacities.
Secondly, PHNs pose a fresh attempt to integrate and improve the care of those with chronic and complex conditions - those who inevitably benefit from individually tailored care and support. And we include mental illness in that.
Recently our government leaders have talked about roles of the Commonwealth and States in health. While they may have focused on options to raise more revenue to pay for rising health care costs, what’s more compelling is the case for health reform itself and the role it can play in stemming costs by delivering better value, less waste and less duplication.
It’s not an either/or debate: at the same time as we look at how, and who pays for health, we need to look at the system’s fundamental design and orientation.
It’s about different, not more of the same.
When it’s all boiled down, the most vexing thing in all of this is: what happens to the consumer, the patient?
That’s where we need to put the spotlight.
We hear about patients being discharged from hospital and failures to assist their transition back to their GP’s care only to see them readmitted at great, preventable personal distress to them and cost to the system.
Even worse, we hear about adverse events associated with this process because medication has been poorly managed or inadequate rehabilitation plans put in place.
We hear about people with mental illness discharged without appropriate community supports to link them back in with social networks, to reconnect with their families, and to access employment and housing services.
We hear about hospital ‘bed block’ by older people because we can’t get the coordination between the hospital system and aged care providers right.
Despite the current funding and state-federal obstacles to expansive changes to health care, these issues can – and are being – addressed locally.
Change doesn’t have to be revolutionary, but it can be accelerated.
So here, then, is a third area where PHNs can help us “act our way into a new system” that is beneficial to consumer needs.
Under the right conditions, PHNs have the potential to conquer the weakness and failures of disjointed Commonwealth and State arrangements and to integrate the system.
They can take responsibility for getting the system working better, they can be system stewards.
They can do this by taking a regional federalism approach to working with Local Hospital Networks, local government and other providers to integrate the system, to integrate care.
NEXT: How can PHNs develop as consumer-focused health organisations?