Putting health navigation on the map
The challenges in providing vitally important health care for older and frail people have been amply demonstrated by the Government’s struggle to ensure all residents in aged care homes are vaccinated against COVID-19 in good time.
It is not as if the Government is not mindful of the needs for targeted support for those facing difficulty in receiving the care they need.
Indeed, it announced that face-to-face support to access and navigate aged care would be the centrepiece of new services to help senior Australians. This is part of measures in the Federal Budget to provide face-to-face aged care support in 325 Services Australia centres, aged care specialists in 70 additional service centres and $93.7 million to introduce a network of up to 500 local "Community Care Finders". These will staff local organisations specifically charged with helping vulnerable senior Australians who need specialist support.
The Government says it understands the difficulties senior Australians, their families and carers face as they make the transition to care. The new face-to-face supports would ensure those seeking information would be able to tap into the knowledge of local experts.
The Royal Commission on Aged Care found that aged care required a much greater face-to-face presence to support access and utilisation of available services and Government evaluation found it was a clear indicator of the way forward.
CHF strongly supports this aged care navigation development. We believe the initiative should be expanded to cover the many patients who may not be older but live with chronic and complex conditions facing comparable barriers in getting the right care they need.
As health care becomes more powerful and complicated by increasing specialisation, the need grows for more guidance through the thickets, not only of medical care but also through the linkages between health and social services.
Last year CHF established the Consumer Commission to inquire into the lessons for health care arising from the of COVID-19 experience.
As the Consumer Commission stated, Australians out of necessity have adopted significant changes at great speed. Now we must consider what should be retained, what fault lines have been exposed and what practical and structural changes are needed to address the gaps.
Many parts of the system operate in silos, e.g. aged care, disability, mental and physical health, and fee-for-service funding drives a transactional approach to care. Links within and beyond health systems are needed to provide a coordinated and continuous patient journey.
The Commission in its report proposed the adoption of blended funding approaches to incentivise team-based care, and systematically to introduce care coordinators and/or navigators. Coordinated arrangements and co-commissioning should be developed across state-federal, primary-tertiary and public-private divides and permanent national governance forums are needed to facilitate timely, coordinated decision-making.
It said all levels of government should improve coordination by investing in a jointly funded network of care coordinators and health system navigators, developed collaboratively with local communities drawing on existing expertise and funding and as part of efforts to expand the health workforce in areas of need.
Among the principles it set out to guide health system change was collaborative leadership with consumer experience and representation present in all policy development, whilst consumers and the community are partners in all levels of healthcare governance and leadership.
Under the coordination principle, health and social care providers and systems should work together with consumers to collaboratively meet consumer needs.
The report also urged a number of other steps to enhance care coordination and integration:
- Finalise, fund and implement the 10 Year National Primary Health Care Plan
- Invest in a network of care coordinators and health system navigators
- Align all Primary and Local Health Network (PHN and LHN) boundaries and equip the organisations to jointly plan and co-commission services.
The Commission considered a sector of the health system that has seen accelerated application as a result of COVID and which expands the potential for patient navigation: digital health.
Digital health has considerable benefits when integrated alongside face-to-face care, the Commission said. “We need to address access barriers such as poor internet and low digital literacy and overcome systemic issues with interoperability which prevent information sharing across the system. Investment to encourage continued innovation is important.”
Its prescription is that high quality telehealth and virtual care should be embedded as an ongoing part of healthcare for all.
“We should develop a national plan to guarantee digital access and adopt platforms that enable information sharing, real-time data collection and reporting. We should invest in digitisation across healthcare as an enabler to improve patient care.”
Given the call by the Royal Commission for a strengthening of face-to-face care, it seems clear the success of digital health will depend on keeping the balance with human health right.