Health and aged care reform

Published: 6 April 2010

We have always known that a key battleground for the next federal election would be health and aged care policy. The release in March of the Rudd government’s initial response to the National Health and Hospitals Reform Commission (NHHRC) report marks the commencement of the debate  about health reform in Australia.

It is worth noting that the foreword of A National Health and Hospitals Network for Australia’s Future was signed by the Prime Minister, Treasurer and Minister for Health and Ageing and the report is framed within a context of the need to ensure economic sustainability of any reform in health and aged care. Given the significant challenges posed by the ageing of our population, getting this reform right is critical to ensuring the sustainability of Australia’s public finances, a key point made by the Australian Treasury’s 2010 Intergenerational Report.

The government’s plan for a national health and hospitals network is a broad document, very short on detail. (A summary of key points from the plan can be found on page 9.) The Prime Minister has said that further announcements will be made in coming weeks and months on a number of critical areas central to sustainable health reform. The scope of this reform agenda is so large that a challenge for us will be to draw the various proposals together into a coherent framework.

While there are many issues in this plan that require further clarification, we need to briefly summarise some important threshold issues for the current reform debate. These are:

  • A mechanism needs to be established to facilitate ongoing dialogue and consultation with key stakeholders about the detail of the health reform agenda.
  • A coherent framework for health reform announcements needs to be established, one that views the health and aged care sectors as one system.
  • Health and aged care workforce planning must be a priority.
  • Aged care reform must be a central component of the health and hospitals reform agenda.
  • Potentially competing reform agendas (such as the industrial relations and health and aged care reform agendas) must be reconciled.

The plan itself begs more questions than it answers. Important areas that require urgent clarification include:

  • employment and industrial relations arrangements under the new system, especially given that the Commonwealth will be taking over 100% funding for non-acute care
  • ensuring ongoing adequacy of the funding base to meet growing demand for services, an issue that will require community debate given that our taxes fund these services
  • the need for strategies to improve integration of the acute and non-acute sectors and thereby improve patient centred care
  • further details on the efficiency gains that are predicted and arrangements for activity based funding, including how the proposed “independent umpire” that will set the “efficient price” for hospital services will operate
  • governance structures in the new system, be this between governments at the federal and state level, between governments and the local hospital networks and non-acute care networks, between the acute and non-acute care sectors and within sectors
  • the proposed national performance indicator framework and standards for a unified health system, especially the need for nurse and midwife sensitive indicators and ensuring that quality and safety performance measurements apply equally to the public and private sectors.

Within a week of launching the plan Prime Minister Kevin Rudd met with the Australian Nursing Federation (ANF) Federal Secretary Ged Kearney and ANF state branch secretaries including QNU Secretary Gay Hawksworth. At this meeting Gay, Ged and the other ANF Branch Secretaries were able to raise with him many of the issues highlighted above. He wanted to hear more, so the ANF will provide a written issues paper.The QNU has already provided detailed input for this.  

The Prime Minister has stressed the important role that he saw nurses and midwives playing in the health and aged care reform agenda and we are prepared to shape this agenda through the provision of strategies and the highlighting of areas of concern. There is still a way to go, but the channels for dialogue are open.

The lead up to the next federal election will be extremely busy and challenging.  We have a vision for health and aged care reform in Australia, one that sees nurses and midwives playing a central role, and we will strenuously advance this vision in 2010. 

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