Healthcare reform – the right time is now
This blog by CHF CEO Leanne Wells was originally published in The Canberra Times.
It's nearly a decade since John Howard made the Commonwealth government's most emphatic step into mental health funding. His $1.8 billion program in association with the states and with bipartisan support heralded a decisive step away from a hospital-dependent approach to serious mental illness. We haven't gone far enough.
Today, millions of Australians, many of them on the edge of adulthood but struggling with depression, anxiety or bipolar conditions, still cannot readily get the care they need. Increasingly, many Australians live with both chronic disease and mental health problems taking a great toll on their lives.
The gaps in Australia's mental health services were highlighted yet again recently when the Senate estimates committee heard that 13 out of 61 regions in Australia remain without the Partners in Recovery program designed to provide much needed nationwide community-based support services for those with severe and chronic mental illness.
The Partners in Recovery program has become an important part of most Medicare Locals, whose essential aim was to ensure that every community in Australia had reasonable access to co-ordinated services that reduce the need for hospital care, whether because of physical or mental illness.
The absence of these community-based mental health services in some regions points to an inherent weakness in so many parts of Australia where hospitals remain the unchallenged health citadels and co-ordinated primary health services, particularly in mental health, don't get the investment and attention they need.
The 61 Medicare Locals cease operations at the end of this month, to be replaced by 31 Primary Health Networks, covering much larger areas and populations than their predecessors.
On the basis of evidence before the estimates committee – the transition to new architecture for primary care – it would be a pity if we had a hiatus in much-needed primary care of the kind that supports patients with chronic and complex conditions, including mental illness. Yes, there are still general practitioners to provide the basic day-to-day care but ,with the rise in prevalence of chronic illness, many cases, including diabetes or severe depression, require much more than a 12-minute consultation with a GP.
It is hoped the transition to a new structure provides a fresh start for a reinvigorated primary care system that will enable GPs to assume strong leadership roles that stretch well beyond their practice rooms.
Health Minister Sussan Ley has given encouraging signals about the need for stronger systems to care for those with chronic and complex conditions who, with the right co-ordinated care, can live happier lives without the need for costlier hospital admissions.
And this week, the new Health Department secretary, Martin Bowles, pointed to the prospect of fundamental changes to general practice and primary care. He told the estimates committee that "a real conversation has started" among GPs about a patient enrolment model. Mr Bowles did not spell out what this might involve but such an approach could conceivably result in doctors being funded for the overall care of patients with chronic illness rather than under the one-off fee-for-service basis.
He says the start-up of the Primary Health Networks presented almost perfect timing to trial different approaches which were ultimately about reducing admissions to public hospitals.
Well-co-ordinated care that focuses on the individual needs of the patient is much more likely to result in better outcomes for the patient, clinician and the system, particularly if it reduces need for hospital care.
We already know this from experience. The National Mental Health Commission Report makes the point repeatedly that too much Commonwealth funding is going to "the wrong end of the pendulum" on treatment and hospital care that can be avoided with better services and support in the community.
We urge the government to act quickly to move that pendulum towards community care in the early days of the new Primary Health Networks and in a climate where reform to primary healthcare is firmly on the table.
Leanne Wells is chief executive of the Consumers Health Forum of Australia.