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Voting for a better change

With an election on the horizon, health reform is a popular topic. Annie May recaps the latest developments.

Reform is defined as improving on something. Change is to make something different, yet not necessarily better.

This was pointed out in a four-line email to Nursing Review by an unnamed NSW registered nurse who had just finished listening to last month’s health debate between the Prime Minister and Leader of the Opposition.

The writer of the email had the same thought when Tony Abbott released his plan to hand over control of hospitals to local communities and when Kevin Rudd announced it would deliver better health services by establishing a National Health and Hospital Network.

“It is an election year and both parties are focused on winning votes by promising to fix, or reform, our health system. Maybe after working in the profession for close to two decades I have become too cynical, but I’m not sure whether once the votes are counted we will get reform or just more change. Are we just audience to a political game where the main goal is to get the trophy and then wait to until the rematch to finally act,” read the email.

Tracey Osmond, College of Nursing chief executive, can understand this cynicism saying the debate provided little substance about the future of health.

“In short, the Prime Minister reiterated the information he has already provided in the policy document announcing the National Health and Hospitals Network (NHHN) and the Leader of the Opposition dwelt largely on his record as Federal Health Minister in the Howard Government,” says Osmond.

“The opportunity to debate one of the most pressing issues facing Australia was wasted. The Prime Minister is correct when he says doctors, nurses and patients want reform. However, the reforms outlined in the NHHN policy document are sketchy and I will wait for more details before endorsing the policy.”

“On the other hand, the Leader of the Opposition said little of his plans other than the re-establishment of health boards.”

Both leaders avoided answering a number of good questions from the floor, says Osmond, and neither leader provided details on the future of health policy – a fact that was known before the debate.
Health has dominated political talk of late. Last month, Nursing Review covered the coalition’s controversial plan to have Queensland and NSW public hospitals run by local boards if elected.
Not long after, Rudd announced the government would deliver better health services and better hospitals by establishing National Health and Hospital Network. It was met with mixed reaction, but overall was welcomed.

In a move described as the biggest health care reform since Medicare, the government will take back $50 billion in GST revenue from the states to redirect to what is commonly referred to as the National Hospital Network.

In return, the government will fund 60 per cent of hospital services, up from 35 per cent, and take over full financial and policy responsibility for general practice and primary care.

Under the plan there will be between one and four hospitals to each network, except in regional areas where there may be more. These networks will be expected to provide a reasonable range of services across an area.

The state and territory governments will be expected to set up the networks. States will be responsible for deciding which services will be provided by which networks.

For this plan to work the states and territories need to come on board. If the changes are rejected, the government will ask the community to resolve the stalemate via a referendum.

The Opposition attacked the plan, saying it was a disaster.

“I don’t think any patients are going to notice any difference any time soon and I don’t think any of the doctors or nurses are going to notice any difference any time soon,” says Abbott.

“This is really a fix for the election, it’s not a fix for public hospitals.”

Rudd says the plan would put an end to the blame game between state and federal governments, but also admitted it was a long-term plan with patients unlikely to see the benefits for another three years.

Next came the health debate.

There was talk of more medical staff and shorter waiting lists, but it became clear that specifics won’t be made available until the election campaign.

Many, including television stations’ worms, crowned Rudd the winner. But just as many said neither came out victorious. Both sides were again criticised for focusing on hospitals and not health.
Robert Wells, director of the Menzies Centre for Health Policy at ANU, says neither side of politics was a clear winner, and that the debate lacked substance.

“It’s becoming clearer that both sides of politics are heading towards the same hospitals focus for health policy in this election year, but there are still big questions to be answered about primary health care and aged care,” says Wells.

“And on the question of hospitals, both parties are advocating various levels of local control, yet we don’t have firm details yet on how that would actually work in a way that is accountable, or firm details on whether or not there will be additional funding for hospitals.”

Nursing groups and health reform advocates have long been pushing the government to put more focus on primary health care and keeping people out of the hospital system. However, there is now doubt on this happening if the debate is a preview of further discussion.

The Public Health Association of Australia (PHAA) says neither side touched on prevention and other areas such as mental health, chronic disease, ageing and remedying inequities.

“Hospitals dominate our expenditure and we need good treatment services. But public health can prolong our lives, keep us healthy and reduce inequalities in our society. It is too important to ignore,” says Professor Mike Daube, PHAA president.

“We need clear commitments from both sides on prevention now, so we know what they will do to prevent the hundreds of thousands of premature deaths that will occur in the absence of action.

The Prime Minister touched on this issue, and the government has generated some important initiatives, but prevention is much too important to sit on the sidelines of health of debates.”

The PHAA believes that we need a special debate specifically on prevention and reducing inequities in health.

There was much talk about the past, but very little about how to better serve those people in our community who are most in need, according to Catholic Health Australia (CHA).

“We are disappointed at the lack of detail from either the government or the Opposition on the specific proposals that would ensure all Australians have access to quality health and aged care,” says Martin Laverty, CHA CEO.

The nurse who wants reform and not just change may sum up the general feeling in the last sentence of the email: “For now all there is, is talk. Talking without listening isn’t going to work and talking without action is just pointless.”

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