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Election Focus: primary healthcare is critical

Nursing leaders have spoken out about a raft of issues including primary healthcare reform, and are calling on nurses to become more vocal in public debate. 

Primary healthcare reform and nursing workforce concerns are among the critical health issues that should be prioritised in federal election policies, according to nursing leaders.

They also want initiatives to address the health impacts of climate change, while action on food security and other social determinants of health is also a priority.

Nursing Review surveyed nursing leaders ahead of the release of election health policies by the ALP, Coalition and Greens.

Many stressed the importance of continuing work on national health reform, as well as calling for policies to enable locally led innovation.

They also nominated equitable access to high-quality broadband as a crucial election issue. This was the top priority to emerge from the National Rural Health Conference earlier this year and is also backed by the Australasian College of Health Service Management.

“Good connectivity is vital to improve education, diagnostics and support,” said Carole Taylor, CEO of CRANA plus, which represents remote area health professionals.

While health policy has shown little sign of surfacing as a prominent election issue, nursing leaders expect there will be some important points of differentiation.

A pressing question, they say, is whether a Coalition government would retain the architecture of national health reform, including the Australian National Preventive Health Agency (ANPHA), the Australian Commission on Safety and Quality in Health Care, the National Health Performance Authority, Health Workforce Australia, and the Independent Hospital Pricing Authority, as well as the regional structures of Health and Hospitals Networks and Medicare Locals.

Election policies should also outline the parties’ plans for the National Health and Medical Research Council and the Australian Institute of Health and Welfare, they say.

The Coalition’s promises of sweeping public sector job cuts and attacks on the bureaucracy raise questions about the future of these organisations, although its initial hardline opposition to Medicare Locals seems to have softened somewhat.

Professor Sabina Knight, director of the Mount Isa Centre for Rural and Remote Health, who was a member of the National Health and Hospitals Reform Commission, said the architecture of national health reform built over more than two consecutive governments “absolutely need to be retained in order to go forward”.

“It’s taken more than 10 years to get these health system pillar organisations,” she said. “Each is a really, really important component of a national health system, and we need to use language that explains and values those institutions’ contributions to a national system of care.”

Although some are still in their formative stages, these organisations provide important functions and information to guide national and regional system policy as well as practice, Knight said.

“As nurses in constrained times and with competing demands, we need to know where to put our efforts, that our care is safe and effective, where can we amend our efforts, where we get our evidence from.

“As health professionals, we rely on reliable and timely information from each of those agencies.”

She also called for regional funding to promote innovation and enable nurses and other front-line professionals to identify and address gaps in care – for example to the homeless and those with chronic needs.

A similar call came from Professor Helen Keleher, whose background in nursing and public health informs her work as director of population health with the Frankston-Mornington Peninsula Medicare Local in Victoria.

Professor Keleher said the priority for national health policy must be to strengthen primary healthcare, and to enable locally led innovation to plug gaps and reduce fragmentation and duplication.

Medicare Locals had a vital role in providing the “authorising environment” tomake integration happen, she said, as well as in bringing to the table the non-health sectors that contribute to community health.

Mary Chiarella, professor of nursing at the University of Sydney, also backed the ongoing development of national health reform. “It would be madness to undo all the work that we’ve done, particularly with the Medicare Locals,” she said.

Professor Lesley Barclay, director of the Northern Rivers University Department of Rural Health in Lismore, NSW, also stressed the importance of maintaining the new primary healthcare organisations.

“It’s really important that Medicare Locals survive,” she said. “We’ve got the opportunity to employ nurses in some very innovative models through some of the forward-thinking Medicare Locals.”

Professor Barclay urged the Coalition to support the ANPHA or offer an alternative model for promoting public health and tackling health inequalities.

“Unless we start to change the way we understand and look after our health at a community and a public health level, we are going to be continually spending money on expensive, potentially avoidable hospital services,” she said.

Professor Barclay also called for both major parties to commit to implementing the recommendations of the Mason Review to address nursing and wider workforce concerns.

Meanwhile, the Australian Primary Health Care Nurses Association (APNA) is pushing for measures to improve the retention of nurses in primary care, including the development and implementation of an education and career framework for primary care nurses.

Some nursing leaders believe, however, that the major parties don’t understand the scope of primary healthcare.

“We need to look at implementing primary healthcare rather than primary care,” said Debra Thoms, CEO of the Australian College of Nursing.

“We need to recognise that primary healthcare in this country is not just about GPs but that nurses are often providing services to parts of the community that do not and will not access GPs.”

Enabling and supporting nurses to work to their full scope of practice would also improve retention, she said.

Another area where election policies are likely to diverge is around climate change.

Fiona Armstrong, a nurse who convenes the Climate and Health Alliance, wants nurses to evaluate the parties’ policies on reducing emissions and in tackling the health impacts of climate change.

“It’s not evident that the Coalition has got much of an appetite for responding to climate change and health,” she said.

“There is some awareness from Labor about the links between climate change and health, but that hasn’t led to any particular initiatives. The Greens have been calling for a national climate and health plan and climate and health taskforce for some time.”

Armstrong, who has been involved in an online campaign against sexism (http://www.seeitsayitstopit.com), also urged nurses to scrutinise candidates and policies on gender equality.

“Another thing for nurses to consider, as a largely female workforce, is [what] political parties might offer in their approach to the role of women,” she said.

“We’ve had a very unpleasant public debate in relation to women in leadership in recent times and it would be good to see political parties committed to stamping out that misogyny and sexism, and committed to recognising women’s issues and promoting equity.”

Professor Linda Shields, a professor of nursing in tropical health at James Cook University in Townsville, said both major parties had little understanding of the role and scope of nursing, particularly in primary healthcare.

She urged nurses to become more vocal and to engage with their organisations, the media and the blogosphere in influencing public debate.

“We’re not good at promoting ourselves,” she said. “We don’t know how to lobby. We can take half of the blame; the other half of the blame goes to health ministers and those who don’t consult as well as they should.

“The policy people and media seem to be much more likely to listen to doctors.”

A leading consumer health advocate also wants nurses to take a leadership role in public debates about health.

Carol Bennett, CEO of the Consumer Health Forum, said nurses were the professional group most aligned with the interests of consumers because of their strong focus on quality patient care.

“Nurses have huge community support,” she said. “I think when they speak, people do listen. We’d like to hear more of their voices. They have influenced political debates in the past and there’s no reason they couldn’t now.”

The role of nurses in primary care was of critical importance and deserved greater recognition, Bennett said.

“Primary healthcare is where we have to focus our attention – not just because it saves money but because it’s the best thing to do for patients,” she said. “We focus too much on hospitals; it’s time to shift the focus onto the community.”

One way for nurses to engage in the election debate is to submit political claims for verification by The Conversation’s new fact-checking service: www.theconversation.com/topics/fact-check

• Declaration: Melissa Sweet is involved in the Sexism: See it, Say it, Stop it campaign.

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