SSWAHS = SWSLHN + SLHN and the Medicare Locals - 42

A conversation we ought to be having about healthcare

May 5, 2011 – 5:40 pm, by Melissa Sweet

Anne-marie Boxall from the Commonwealth Parliamentary Library has written a timely and important article for the FlagPost blog, titled: Paying for health care: how can we sustain it?
It is republished below with her permission, and will be worth revisiting when the post-budget protests erupt.

Anne-marie Boxall writes:

At budget time, the federal health minister has one of the toughest jobs. We got a glimpse into this a few weeks ago when the Government announced that it had decided to defer listing some new drugs on the Pharmaceutical Benefits Scheme even though they work and have been deemed by experts to be cost-effective. The announcement sparked outcry from consumer groups and health care organisations alike.

The Minister found herself in this unenviable position because the amount of money available to spend on health care is finite. This is not just a dilemma that arises at budget time however.
Governments around the world are becoming increasingly concerned about how they will fund health care into the future because in most OECD countries, health expenditure is growing at a faster rate than gross domestic product.

The harsh reality is that we cannot afford to do everything that we want or need to do to improve people’s health, at least not without finding new revenue sources (for example from taxes, the private sector and individuals). As Minister Roxon explained last week, the constraints on public sector financing mean that governments will need to play a more active role in determining what will, and will not, be funded in health care. In health circles, this exercise is known as priority setting.
In a forthcoming Parliamentary Library Research Paper I examine the fiscal sustainability of the Australian health system in more depth. In addition to priority setting, I outline a range of mechanisms currently being used to help control health expenditure and examine how effective they are. I also outline a number of other options that could be considered, including:
• paying health care providers in different ways (there are numerous options but the World Health Organisation considers salaries, setting strict budgets, and using capitation payments to have the most potential for containing costs);
• stimulating competition between the public and private sectors, as long as it drives improvements in the quality of care and delivers better value for money;
• monitoring and exerting greater control over the capacity of the health system (for instance the number of health care professionals and health facilities makes a significant difference to overall health expenditure); and
• ensuring government funds are only used to fund the highest quality and most effective of all the treatment options (physiotherapy, for example, might be more effective for back pain than drugs or surgery).

One thing the paper makes clear is that there is virtually no easy savings to be made in the health care sector anymore. Doing anything to make Australia’s health system more affordable will be tough, so beware of anyone spruiking simple solutions. It is not simply a matter of compiling a list of the most cost-effective or cheapest treatments and funding them first. Other countries have tried this ultra-rational approach and found that decisions provoked so much outcry that they were politically untenable.

In the United States, recent attempts to make resource allocation in health care more rational led to claims that the government was introducing ‘death panels’. In the United Kingdom, the decision to deny access to certain cancer drugs led to similar claims. Even if governments hold out against such protests, often there just isn’t enough evidence available to make an informed decision about which treatments deliver the best bang for the buck.

Making the health system more sustainable is also not as simple as getting those people who can pay more to do so. Individual contributions, such as fees, co-payments and other out-of-pocket payments, already account for about 17 per cent of total health expenditure in Australia.

And there is already compelling evidence that the cost of health care poses a real burden for some people and stops them from getting necessary care (see here, here and here). Shifting more of the cost burden onto individuals would make it even more difficult for people with low incomes to get essential health care, and it would make our health system less equitable.

It would also mean that Australia was moving in the opposite direction to most other OECD countries, which have reduced the proportion of total health expenditure coming from individuals over the last decade. It’s not possible to explain the reasons for this trend without further analysis, but it may be that other countries have come to agree with the World Health Organisation that relying on individual contributions to control the growth in health care costs is a relatively blunt instrument and the least equitable way of funding health care.
With no easy solutions on offer, the only way this or any future government is likely to make our health system more sustainable is to undertake more fundamental and potentially unpopular reform (this would include considering some of the options outlined earlier).

Governments will have to make the public more aware that there are limits on what they can spend on health care. No one will like it when the funding cuts affect them, but it might help if they have some understanding of why. Governments will also have to convince health care providers that changes are needed so that better care can be provided at a lower cost.

If reforms threaten the incomes of health providers, then they may need to innovate and find new and more profitable ways of delivering services.

Governments will also have to initiate a national debate on some of the key issues that underpin the issue of sustainable health funding. Are we, for example, prepared to consider solutions such as paying more tax? Or, do we want to move away from public financing and encourage the private sector and individuals to play a greater role?

Admittedly, a reform agenda along these lines would be politically difficult for any government. However, it is likely to be more effective than the current approach.

To date, governments have tended to view the health system in its components parts because it is so large and unwieldy. As a result, there does not appear to have been an overarching strategy for reigning in the growth in health expenditure. Instead, it appears that governments have had a series of one off battles in various sectors of the health system over time.

Instead, governments could consider viewing the health system as just that, a system, and begin developing a clear strategic plan for how we as a nation will tackle the problem of ensuring the sustainability of the health system.

Given that just about any proposal for constraining health expenditure provokes outrage, when it comes to engaging in battles over health funding, it seems that governments would have little to lose by being strategic about the battles it takes on in order to deliver outcomes in the long-run.

One Comment

1. Dr George Margelis
   Posted May 5, 2011 at 7:33 pm
   
   It is great to see that the discussion has moved on to the real problem, The way we currently pay for healthcare in Australia and many other countries drives the current problem of increasing costs without driving better outcomes.
   Anne-Marie has summarised the option, what we now need is leadership to drive them through. The health cost problem is potentially much more dangerous than many of the other issues the government has turned its attention to. We can try introducing more taxes to help cover the costs, but at some stage you just run out of taxable income, so reform of the system now is really the only option.
   

SSWAHS = SWSLHN and mental health in the Southern Highlands - 13

A tick for Opposition’s plans to improve employment services for people with mental illness

April 22, 2011 – 11:09 pm, by Melissa Sweet

With mental health in the news, thanks in part to Tony Abbott’s recent funding promises, below is a Q and A piece with Professor John Mendoza, first published by The Conversation on April 21.

Why do so many mentally ill Australians struggle to maintain employment?

This is a critical policy issue for all Australian governments over the next decade. We’re clearly facing a skills shortage and that’s across the board, it’s not just in the mining sector.

We have to get a lot better at engaging people of working age who are not in employment.

Mental illness, often untreated, is one of the primary causes for the situation that we face.

About 28% of all Australians on the disability support pension have a primary mental health-based disability. Of the remaining 70%, around half have mental health problems as a secondary contributor.

The rate of employment for people with mental health conditions in OECD nations is nearly three times the rate of employment than Australia. Needless to say, Australia does very poorly in this area.

There are a number of reasons for this and the announcement by the Federal Opposition starts to address some of these issues.

***

How does the Coalition’s announcement build on existing infrastructure?

We’re already spending a lot of money increasing employment services for people with mental health disorders.

Commonwealth spending on disability support pensions and employment-related programs is around $5 billion. This provides income and support for people on the disability support pension, Newstart allowance and other benefits who are there because of mental health problems. But we’re not getting good outcomes from that spending.

What today’s announcement does is target a couple of specific areas where we know we can do better.

It’s not just a matter of preparing a person with significant mental illness to enter the workplace.

We need to place people in a workplace where they can receive support. A truly supportive work environment is where the culture recognises the way mental illness presents and manifests.

These workplaces support the employer to help keep that person engaged, modify activities, train co-workers on how to deal with mental health episodes and crises if they occur, and retain that person in employment.

The mental health blueprint, released last month, calls for a minimum investment across 30 targeted programs over four years.

We’ve got to lift our current rate of mental health funding as a proportion of total health spending – from around 6% towards 12% to 13%.

That’s a very big ask and no government of any persuasion is going to be able to do that in one or two terms. I think the Coalition is mindful that what was announced today is not enough.

***

Will we see more than just a bidding war from today’s announcements?

I have to be optimistic that this announcement is more than a bidding war. I certainly believe what the Coalition took to the last election and what they’re building on today could bring about real improvements.

The Rudd Government and, to an extent, the Gillard Government are “blowhards” when it comes to mental health. They’ve talked long and hard but they’ve delivered almost nothing.

Suicide prevention was the cornerstone of their mental health policy leading into the last election, with promises of spending $274m over four years.

In the first year, they’ve spent $10m. There’s a bit of a credibility gap when you say you’re going to deal with an issue and in the first year you spend only 2% of the funding that you’ve allocated.

The situation is similar when we look at the Headspace initiatives for increasing early intervention sites around the country.

Labor is spending most of the money not in the second term, but in the third term of government if they’re re-elected. I think that is gilding the lily on this issue.

We need to see the investment flying through fairly evenly, but building up over the four-year budget cycle.

Tony Abbott has basically picked out elements of the blueprint that were released by the working group last month. Many of the working group’s members are advisors to the Federal Mental Health Minister Mark Butler.

These are things members of this group have said privately to the government about what needs to be done.

Tony Abbott has said, very wisely, we know we’ve got a problem with employment participation for people with mental illness and I’m going to target that because it’s one of the areas where investments will produce dividends. The impact on the budget in the longer term will be a positive one.

We know employment participation is critical to people’s recovery, in lifting them out of poverty and helping them regain their sense of self.

Certainly social inclusion is improved dramatically by participating in work. So I think it’s a wise investment, it’s a smart policy, and it won’t cost the budget bottom line in the first instance.

Over the longer term, it will save an enormous amount in terms of the money we’re spending at the moment on disability support pensions and the like.

We’re spending this money now but without getting any movement on people going back to employment.

• John Mendoza is the Director of ConNetica Consulting Pty Ltd. He is the former chair of the the National Advisory Council on Mental Health (appointed by the Rudd Government in June 2008) and resigned in June 2010 citing a lack of vision or commitment to the issue.

One Comment

1. Murf
   Posted April 22, 2011 at 11:49 pm

   If we’re going to get people who have mental health issues back into the workforce (and most of us who’ve been employed before are really keen to get back to it), we need to start training CentreLink not to send away unemployed females who don’t qualify for a benefit. I haven’t even been able to talk to anyone- just a quick dismissal on the phone, several times over the past 12 years (when I’ve had the occasional part-time job). They say “Use your professional networks- we can’t help people like you. We don’t have the sorts of jobs you’re looking for”. Slam. How can we have networks when we’ve been out of work for months or years? Huh? Will we just happen to bump into an employer who won’t run a mile as soon as we mention mental health issues? Better to keep it to yourself when there’s no one to back you up. Also, no one seems to realise how soul-destroying it is for females who have always been financially independent, to suddenly tie their fate to someone else because there are no supports in the community for them to fall back on. It makes mental health issues worse. Someone has to have a good think. Get back to me when there’s some news.

SWSLHN and Bowral's Health - 1

Challenging accepted wisdoms about young peoples’ health and wellbeing

April 22, 2011 – 1:19 am, by Melissa Sweet

Mental health is in the political limelight in the lead-up to the federal budget, with the Government and Opposition both promising support for mental health services.

The researcher and writer Richard Eckersley argues that we need to develop a much broader understanding of mental health and wellbeing in young people. In particular, he challenges the conventional narrative around the social determinants of health.

***

Challenging the accepted wisdom about young peoples’ health

Richard Eckersley writes:

The widely accepted story of young people’s health in developed nations is that it is continuing to improve in line with historic trends and the progress of nations. Death rates are low and falling, and most young people say they are healthy, happy and enjoying life. For most, social conditions and opportunities have improved. Health efforts need to focus on the minorities whose wellbeing is lagging behind, especially the disadvantaged and marginalised.

There is another, very different story. It suggests young people’s health may be declining – in contrast to historic trends. Mortality rates understate the importance of non-fatal, chronic ill-health, and self-reported health and happiness do not give an accurate picture of wellbeing. Mental illness and obesity-related health problems and risks have increased. The trends are not confined to the disadvantaged. The causes stem from fundamental social and cultural changes of the past several decades.

The contrast between the old and new stories is graphically illustrated by these Australian statistics: about 40 per 100,000 young people (aged 12-24) die each year and the rate is falling; 26,000 per 100,000 (26%) (aged 16-24) suffer a mental disorder each year and the rate has probably risen, perhaps steeply. Which statistic says more about young people’s wellbeing?

Stories inform and define how governments and society as a whole address youth health issues, so which story is the more accurate matters. The usual narrative says interventions should target the minorities at risk. The new narrative argues that broader efforts to improve social conditions are also needed. The old story may still generally hold true in developing nations, but the issues raised in the new story are also of increasing importance to these countries as modernisation and globalisation impact more on the lives of their young people.

A central dimension of the changed trajectory in health over recent decades, and which underpins the new story, concerns the declining significance of material and structural determinants of health and the growing importance of existential and relational factors to do with identity, belonging, certainty and purpose in life. There is a shift in emphasis from socio-economic causes of ill-health to cultural; from material and economic deprivation to psychosocial deprivation; from a problem of material scarcity to one of excess. With this has come a shift in significance from physical health to mental health.

This argument is not to suggest sharp, categorical distinctions and clear breaks from the past. Physical and mental health are closely interwoven and interdependent. Physical illness, including infectious diseases, still matter. Disadvantage and inequality still matter. Indeed, the cultural changes of past decades may well have exacerbated their effects by making material wealth and status more important to how people see and judge themselves. Environmental problems such as climate change have serious implications, including the risk of possible catastrophic effects on human health.

The contrast between the old and new stories of young people’s health and wellbeing is part of a larger contest between the dominant narrative of material progress and a new narrative, sustainable development. Material progress sees economic growth and a rising standard of living as the foundation for a better life; sustainable development seeks a better balance and integration of economic, social and environmental goals to produce a high, equitable and enduring quality of life.

Material progress represents an outdated, industrial model of progress: pump more wealth into one end of the pipeline of progress and more welfare flows out the other. Sustainable development reflects (appropriately) an ecological model, where the components of human society interact in complex, multiple, non-linear ways. Not only does sustainable development better fit the new story of youth health, it is likely to achieve better outcomes in relation to the old story’s focus on socio-economic disadvantage and inequality because it less intent than material progress on economic growth and efficiency.

The health of young people should be a focal point in the larger contest of social narratives. They should, by definition, be the main beneficiaries of progress; conversely, they will pay the greatest price of any long-term economic, social, cultural or environmental decline and degradation.

If young people’s health and wellbeing are not improving, it is hard to argue that life is getting better.

• This is an edited extract from: Eckersley, R. 2011. A new narrative of young people’s health and wellbeing. Journal of Youth Studies. First published 13 April 2011 (iFirst) (http://dx.doi.org/10.1080/13676261.2011.565043). An author version is available at www.richardeckersley.com.au

• Richard Eckersley is a director of Australia21 Ltd, an independent, non-profit research company and a visiting fellow at the Australian National University.

SWSLHN + SLHN = SSWAHS : Tobacco marketing and use

Smoking out The Australian

April 14, 2011 – 11:56 am, by Melissa Sweet

The Australian newspaper has recently run a series of articles attacking the Federal Government’s cigarette packaging reforms, including one quoting Nobel Laureate Professor Barry Marshall’s reservations about the measures.

Dr Ross MacKenzie, Lecturer in Health Studies at Macquarie University, says we shouldn’t lose sight of the evidence suggesting the packaging will prove to be a major boost for public health.

***

What’s smoking at The Australian?

Ross MacKenzie writes:

Editors at The Australian have made clear their opposition to the Federal Government’s proposals to legislate plain cigarette packaging that incorporates graphic health warnings.

The paper’s Friday 8 April editorial Smokescreen or deterrent? argues that smoking rates have been dropping for decades without this “latest proposal for even more hideous cigarette packaging”, managing to imply that tobacco control legislation enacted to date has played no part in this trend.

The editorial states that cigarette manufacturers should be allowed to present their brands to consumers in much the same way that other legal products are packaged, and suggests that significant price hikes may well deter more smokers than would the proposed packaging regulation. That the government’s 2009 tax increase on alcopops is dismissed in the same piece as a “cynical revenue-grab” is apparently not contradictory.

In The Weekend Australian (In the care of a nanny state, Saturday 9 April 2011), the paper’s legal affairs editor Chris Merrit reveals no such inconsistencies. Plain cigarette packaging is nothing less than a demonstration of the growth of the nanny state in Australia, and an example of social engineering.

Merritt has called on representatives of the Centre for Independent Studies and the Institute of Public Affairs to support his analysis, although he fails to mention that both of these free-market think tanks have consistently opposed tobacco control initiatives, have received funding from the tobacco industry, or that the Institute of Public Affairs has had tobacco industry executives on its board, as described in ASH Australia’s 2010 report Countering Tobacco Tactics.

Given the apparent difficulties in establishing a logical and objective opposition to the proposed legislation, The Australian’s editors must have been delighted to be able to publish the opinions of Dr Barry Marshall on this issue. (Roxon’s gone too far, says Nobel winner. The Australian 11/4/2011). In the report, Marshall is quoted as stating that as it’s not illegal to smoke there needs to be a limit to tobacco control legislation, and that such regulation persecutes smokers.

Dr Marshall’s credentials and contributions to public health are unimpeachable – Nobel laureates are few and far between, after all.

But what the article reports are Marshall’s personal beliefs, not a scientific evaluation of the legislative proposal or its potential impacts. Certainly, many people will find some of the graphic health warnings sickening and extreme, as he describes them, but this is their very point – to remind smokers that the potentially extreme consequences of smoking include numerous types of cancers and other chronic illnesses.

There is a compelling body of research that points to the effectiveness of such warnings on cigarette packs but as no country as yet requires plain packaging, related research on its specific impact has been necessarily experimental.

Perhaps the most revealing indication that plain packs featuring graphic health warnings will indeed prove to be a successful public health measure is that the tobacco industry in Australia has spent millions of dollars fighting the initiative since it was first announced in 2010.

***

PS from Croakey: Readers wanting more background on the rationale for the packaging measures should have a look at the Preventative Health Taskforce’s work in this area.

One Comment

1. Alex H
   Posted April 14, 2011 at 1:43 pm
   

   It boils down to the last paragraph. If it won’t reduce tobacco sales, why would big tobacco fight it so vigorously?

   Companies use brands products to sell more product, I would imagine that any unbiased marketer worth their salt would tell you that removing brands will impact on sales.

   Less sales = less tobacco smoked = public health benefit = successful policy outcome.

SSWAHS = SWSLHN and mental health in the Southern Highlands - 12

Mental health: a continuing history of neglect

April 12, 2011 – 11:01 pm, by Melissa Sweet

Chronic disease prevention is gathering increasing steam, at a national and international level. So why is mental health not part of this agenda? Richard Eckersley argues that the importance of mental health continues to be neglected, and not only in Australia.

Richard Eckersley writes:

Physical and mental health are closely interwoven and deeply interdependent, the result of a complex interaction of biological, psychological and social factors. Medicine, however, continues to focus on the biological and neglect the psychosocial, despite the growing recognition of its importance to population health.

This artificial separation has been a formidable obstacle to understanding mental health; as a consequence, its importance to the wellbeing of individuals, communities and societies has been underestimated. Both developing and developed countries show this bias towards physical health, and especially mortality.

Developing countries tend to give priority in health to infectious disease and reproductive and child health; developed countries prioritise non-communicable diseases that cause early death (such as cancer and heart disease) over those that cause years lived with disability (such as mental disorders).

The relative neglect of mental health is seen in the growing efforts in disease prevention and health promotion, both internationally and nationally. These include: the WHO global strategy for the prevention and control of non-communicable diseases; the Oxford Health Alliance; the Trust for America’s Health (in a report, ‘Prevention for a healthier America’); and the Australian National Preventative Health Taskforce (in its strategy paper, ‘Australia: the healthiest country by 2020’).

All imply a wide health perspective, but focus on the physical diseases that contribute most to premature mortality, notably cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. These diseases account for about 60% of all deaths globally.

The efforts will culminate in the United Nations’ first high-level meeting of the General Assembly on chronic non-communicable diseases in September 2011, billed in Lancet as ‘a once in a generation opportunity to put chronic diseases on the global and national agendas’. These diseases have been ‘surprisingly neglected elements of the global-health agenda’. Mental illnesses, while also chronic, non-communicable diseases, are not part of this agenda, but are acknowledged to be ‘similarly ignored’.

About 450 million people worldwide are suffering mental illness; only a small minority receives treatment. Worldwide, community-based studies have estimated the lifetime prevalence of mental disorders at 12%-49%, and 12-month prevalence at 8%-29%. In 2004, neuropsychiatric conditions as a group accounted globally for 13.1% of the total burden of disease, measured as both death and disability (disability-adjusted life years or DALYs), the second largest contributor after infectious and parasitic diseases. They account for about a third of the burden of disability, making them the most important source. Depressive disorders are the third largest specific cause of death and disability (and the largest in high- and middle-income countries), and are projected to become the leading cause by 2030. Yet the median allocation of the total health budget of nations to mental health is only 3.8%.

The ‘global burden of disease’ study has played a seminal part in exposing the importance of mental health to overall population health. However, its estimates of the burden of mental illness may still understate its significance for several reasons:

• mental disorders might affect many more people than the burden of disease estimates suggest, especially in middle- and low-income countries.
• the estimates do not include the growing burden of suicide and self-inflicted injuries, which is counted under injuries.
• the burden of mental disorders (in sharp contrast to chronic, physical diseases) falls mostly on those under 60, so increasing the personal, social and economic costs.
• mental disorders increase the risk of physical diseases and injuries, with one estimate that depressive disorders raise the risk of all-cause mortality by about 70%, and affect adherence to treatment for other diseases.

Aspects of this picture of mental health have been contested. For example, it has been argued that the high prevalence of mental disorders reflects changed DSM diagnostic criteria and the medicalisation of normal human emotions. This is part of a wider concern about the medicalising of life itself, and ‘disease mongering’: the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments, including the medicalisation of health problems previously regarded as ‘troublesome inconveniences’.

While medicalisation is undoubtedly occurring in the sense that new treatments are being developed for new conditions, this does not negate the core argument here that mental illness has been neglected relative to physical illness. The charge of ‘disease mongering’ applies to both physical and mental health, and is directed particularly at treatment provision. Indeed, it has been specifically associated with a policy priority of market-based economic development at the expense of more equitable social policies, such as public-health strategies. (Ironically, the medicalisation of mental health has contributed to greater awareness of its importance.)

Questions of definition, diagnosis and treatment aside, the disability associated with mental health problems is generally higher than for other chronic conditions. Even mild cases cause levels of impairment equivalent to those associated with clinically significant, chronic physical disorders.

People attribute higher disability to mental disorders than to commonly occurring physical disorders, especially with respect to their ‘social and personal role functioning’ (with ‘productive role functioning’, the disability of mental and physical disorders is comparable). A comparison of the disability of 15 disease stages found severe depression ranked third behind quadriplegia and being in the final year of a terminal illness, and ahead of stroke and acute myocardial infarction.

• This is an edited extract from:
Eckersley R. 2011. The science and politics of population health: giving health a greater role in public policy. WebmedCentral PUBLIC HEALTH 2011; 2(3):WMC001697.

• Richard Eckersley is a director of Australia21 Ltd, an independent, non-profit research company and a visiting fellow at the Australian National University.

One Comment

1. carolinestorm@iinet.net.au
   Posted April 13, 2011 at 11:33 pm

   “… focus is on the physical diseases that contribute most to premature mortality.”
   So, are the seriously mentally ill to be allowed slowly to become more deprived of treatment and hospital care? Already only a third receive these when in crisis, according to the MHCA. Are they still to be deprived of psychotherapy, essential to to their well-being; are they further to be deprived of social therapies, and more and more descend into homelessnness and complete social exclusion? Why does focussing on the diseases which contribute most to premature mortality exclude the seriously mentally who, in Australia, have a life expectancy of some 55 years.
   More and more suicides will occur as the seriously mentally ill realise, finally, the greatest stigma of all: this is too hard; we’ll just leave it and see what happens.
   What can be done? How can we help? Many people care, but how do we become a force for change?
   But even hope lessens as Richard Eckersley cites the WHO as excluding mental illness from its global strategy of prevention and control of non-communicable diseases.
   The Australian Budget, 2011, is to be made public tomorrow…and little hope there.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 27

With the close of the submission phase for the funding of the Medicare Locals perhaps it is timely for us to "go back to the future" and ask the bleeding obvious. Given that we have not had any discussion with, or debate from, the Macarthur-Southern Highlands Divisions of General Practice, is it pointless to expect that a Medicare Local, managed by the corporatised Macarthur-Southern Highlands Divisions of General Practice, will ever improve the health services the residents of both jurisdictions, seek. Sadly, Socrates, says "Yes, it is pointless".

What could have been a great step forward for health providers in the private and public sector, and the health consumers, to provide and access a cohesive, diverse and well funded point of contact and coordination, a future Medicare Local is unlikely to enhance any of the existing, or future, health and welfare services in the Southern Highlands. Just in the same way that the current Division of General Practice is failing to deliver the support and services expected, and required, by the general practitioners in the Southern Highlands.

What will we learn from the Medicare Locals tender documents?
Melissa Sweet

The tender documents for the first of the new primary health care organisations known as Medicare Locals are expected to be released any day now. Presumably, this is the place to keep an eye for them.

Dr Harry Hemley, president of the Australian Medical Association Victoria, has some questions about how they will work, as per his piece below.

Croakey has plenty of other questions too – including what will be their impact on the inverse care law, and population health more broadly? And will they entrench or address some of the problems associated with fee-for-service health care?

Are there better alternatives to Medicare Locals?

Dr Harry Hemley writes:

Prime Minister Gillard’s revised health proposal is an improvement on Kevin Rudd’s complicated hospital financing plan, with promises to deliver increased funds, more beds, transparency, greater clinical input and less red tape.

But the PM’s proposed expansion of Rudd’s Medicare Locals could prove a costly exercise without improving access to GPs and allied health providers in the community. So far Medicare Locals are mysterious bodies that promise to increase bureaucracy and reduce patient choice – not a wise investment if we’re striving to keep patients out of hospitals.

And given the current boundaries span hundreds of kilometres, they may not even be local.

Since the Commonwealth Government first announced Medicare Locals in April last year, health workers, consumers and even state government representatives have puzzled over their role and how they will work. And if these health care providers and bureaucrats are puzzled just imagine the need to provide clarity to the people who will be dependent upon the Medical Locals - the health consumers.

The health sector is awaiting the release of the tender documents from the Commonwealth that should make it clear what these new Medicare Locals will actually do. So far we have just been told that Medicare Locals will make things better, but not how.

We know they will provide (or maybe coordinate) after-hours care to communities and coordinate access to specialists and allied health professionals but we don’t know who will run them, whether they will offer health services, and whether they will be an improvement on current services. Socrates notes that none of these questions have been discussed with, let alone, described to, the local communities and service providers of the Southern Highlands and the Macarthur area by the respective Boards of the Divisions of General Practice.

With an initial price tag of almost half a billion dollars, this was an enormous cost for such vague objectives. We have been asked to take on Medicare Locals as an act of faith.

To justify such a cost, the Commonwealth needs to show how patient care will be improved with Medicare Locals. I’m yet to be convinced.

One of the biggest frustrations in primary care is patients’ difficulty getting an appointment to see a GP. There are no quick fixes to increase the supply of GPs – it takes around ten years for a GP to finish their training – and Medicare Locals are certainly not going to produce more GPs. In actual fact, given the primary care gatekeeper role that Medicare Locals will provide, it is conceivably possible that only those general practitioners and the Division of General Practice's "preferred" clinical practitioners will be receiving the referrals of patients from the Medicare Local.

My fear is that Medicare Locals could actually reduce patients’ ability to choose their health care provider. If a new central bureaucracy is in charge of rationing care and linking patients with providers, what is to stop them attempting to contain costs by referring the patient to the least expensive provider? Or only those practitioners who are in favor with the Division's "Medicare Local"

GPs currently coordinate the care of patients with chronic diseases such as diabetes, cancer and heart disease and the conditions that lead to these diseases like obesity. For a diabetic patient, for instance, their GP would oversee their care and coordinate the services of a diabetes nurse, a dietician, a podiatrist, and an endocrinologist. So what will change with a Medicare Local run by the Macarthur-Southern Highlands Divisions of General Practice?

There are flaws to this system but these would be fixed with minor adjustments, such as an increase in patient rebates to see their doctor, nurse or allied health practitioner, and better rebates for longer consultations. It’s not a system that requires a complete overhaul, especially when the alternative is care coordination on a bureaucratic scale. So, do we really need a Medicare Local - or would us having access (as we now do) to our preferred General Practitioner simply suffice? After all, not even the current Divisions of General Practice have the veracity and collegiate governance to inspire all general practitioners to want to join them! Will a Medicare Local be any better for the residents of the Southern Highlands? Do we even need a local Division of General Practice?

With extra funding for general practice clinics to take on additional nurses or expand their premises to accommodate extra psychologists, dieticians, other allied health providers (and even specialist doctors), patients with chronic diseases would see vast improvements.

Another cheaper and more effective way to improve the care coordination of a patient with complex medical needs is to fund care coordinators within primary care settings. This would ensure patients connected with all of the services they needed – meals on wheels, home help, their pharmacist and home nursing care – and allow their clinic-based doctors, nurses and allied health practitioners to spend more time seeing patients rather than organising services.

The PM has promised that access to after-hours medical care would improve with Medicare Locals. The plan is to establish an after-hours national call centre which can refer to a nearby after-hours clinic. This makes for a great announcement but it fails to address the problem: GPs are reluctant to open after hours because patient rebates barely cover the cost of opening, paying reception staff, hiring security guards and attracting practice nurses.

Again, some improvements to the current system would achieve better access for patients. With fair funding for general practice clinics to remain open after hours, patients would be able to visit the clinic of their choice at a time convenient to them.

Prime Minister Gillard has given herself and the states until the middle of the year (2011) to work out the details of the health deal. No level of tweaking can fix the problems with Medicare Locals. The whole concept – spending half a billion dollars to employ bureaucrats to coordinate the care of patients they’ve never seen – is flawed. The Prime Minister should consider simpler and more streamlined alternatives. It could even save millions of dollars. Given the current discussion about the severity of the proposed Budget cuts for existing programs to enable the Federal government to bring the Budget back into surplus, perhaps this is one program where the "less rather than more" principle can apply to the proposed Medicare Locals, especially here in the Southern Highlands and the Macarthur areas. Socrates would be happy to have no such Medicare Local, or even a Division of General Practice if it meant that other more worthwhile programs could continue to be funded.

• Dr Harry Hemley is president of the Australian Medical Association Victoria

SSWAHS = SWSLHN and mental health in the Southern Highlands - 8

What will it cost to move beyond “60 years of band-aids” for mental health?

April 6, 2011 – 1:41 am, by Melissa Sweet

Continuing the theme of recent Croakey posts on mental heath and the federal budget, John Mendoza argues that it’s well past time we moved past band-aid solutions. Instead, Australia needs to spend about $9-10 billion per annum on mental health services, or around 12% of current health care spending, he says.

John Mendoza writes:

In the past week there has been another round of calls from a variety of groups for major investments in mental health. These have in part being timed to influence the framing of the May Federal Budget. These have included calls for an extra $5 billion over five years from the Australian Medical Association and others.

A Blueprint to Transform Mental Health Services was also released and called for an investment of $3.5 billion over the same period. This came from an “independent mental health reform group” lead by Professors Pat McGorry and Ian Hickie and Monsignor David Cappo.

The latter are all members of the expert advisory group announced by Minister for Mental Health and Ageing, Mark Butler and the Prime Minister late in 2010 after a year of mounting calls for action on mental health. Minister Butler chairs both this group and the National Advisory Council on Mental Health.

Federal Labor knows that it must deliver a substantial boost to mental health funding come the May Budget after the chorus of criticism in 2010 and its oft stated pledges to make “mental health a second term priority”.

The “Blueprint” document released by McGorry and co has been largely positively received. Some criticisms – including the Croakey piece from Alan Rosen – from within the mental health sector have focused on the government’s piecemeal and confused approach to consultation (not the fault of the Blueprint authors I would have thought).

Rosen’s criticisms point to the omission of some evidence-based services including assertive community treatment teams, better forensic mental health care for the vast numbers of people with mental illness in corrections systems and the inadequate size of the investment.

Criticisms were also voiced by consumers at the ACOSS conference last week on the failure to advocate for the re-establishment of a national consumer representative body following defunding of the body by the Department of Health and Ageing in 2008.

In their defense, McGorry and colleagues say the 30 initiatives in the Blueprint are areas where the Commonwealth can act with or without state government cooperation and with a large dose of realism given the “tight Budget” rhetoric of the Government. They also believe that if the Commonwealth can get its act together, as it did under the leadership of Howard in 2006, then a commensurate investment could be forthcoming from the states and territories.

This would be a massive $7 billion over five years building on the $5 billion flowing from the 2006 COAG action plan.

The Australian public are entitled I would have thought for someone to tell them what amount of new funding is required to fix the seemingly contiguous crisis in mental health services.

Firstly, it’s important to understand no presently serving politician in either Federal or state governments created the shambles we now see in mental health in Australia. But all those First Ministers (i.e. PM, Premiers and Chief Ministers) and the respective state and territory Ministers have an opportunity to join a very small group of politicians who have taken bold and effective action in this area. To succeed, they will need to respect history in mental health reform efforts.

Australia has had a long history of responding to crises within mental health services. Indeed Prime Minister Menzies was forced to act following widespread and continuous public concern about the state of services in 1954. Somewhat reluctantly, Menzies and his Health Minister, Earle Page, appointed a Melbourne psychiatrist Allan Stoller, to review mental health care. Stoller was “shocked” by what he found – inhuman conditions, overcrowding, little or no therapeutic care, abuse and neglect. Menzies responded with a capital grants program to modernize the facilities. While some work was done, within six years, again public concerns forced the NSW Government to set up a Royal Commission into mental health services.

This cycle of crisis, review, government action and then within a decade another full cycle, has now characterized mental health reform in this country for close to 60 years.

There are a number of reasons for this, but a consistent one has been a failure by both state and Federal governments to ever undertake a systematic assessment of service requirements. No one has even taken up the challenge to fully scope requirements: the range of services based on available evidence, the scale of services to meet demands and then commit the funds to the development.

The consequence is that we have had 60 years of bandaids applied to mental health. We see dozens of excellent programs or small scale programs all round the country that have never been scaled up or linked with a spectrum of care to support recovery in the community.

The implementation of the policy of deinstitutionalisation from the 1960s to the so-called community based services of today, represents arguably the greatest failure of public policy in the post-war period.

The calls in the last week for major new investments in mental health, while they will improve the access to services and quality of some services, they will fall far short of providing people with mental illness with equality of care when compared with those experiencing physical health problems.

Both Pat McGorry and colleagues and the AMA have presented pragmatic proposals – proposals that take account of the political context. That’s fair enough, but it runs the risk that again we have another band aid – albeit maybe a full size plaster!

The question remains how much do we need to invest in mental health to end this terrible history of neglect? The Senate in 2006 argued that between 9-12% of health expenditure was required. The Mental Health Council of Australia has long argued for the 12% figure. Rosen is his Croakey article refers to 13% of health spending up from the current 7%. All of these are simply sound estimates.

Two health economists, Darrell Doessel and Ruth Williams have attempted to take a more analytical approach and they find that current resources and structures meet about 35% of the mental health needs of the community. They also find that significant resources go to those without a mental health need – in essence a wasteful use of scarce resources. Using their analysis and assuming one could significantly reduce the resources going to ‘non-needs’ as they define them, the funding required to provide for the mental health needs of the Australian community is in the order of $9-10 billion per annum. Maybe coincidentally, this is close to the 12% of current health care spending that many have called for and is almost double the current combined spending of all Australian governments.

This is an enormous challenge and one which will only be solved through a more strategic and sustained 10-15 year reform agenda. We also need to put in place as a first step, an appropriately empowered Commonwealth statutory authority to drive the restructuring of services and report to the Australian community on the progress and the outcomes from this investment.

• John Mendoza is Director, ConNetica , and Adjunct Professor, Health Science, University of the Sunshine Coast, and Adjunct Associate Professor, Medicine, University of Sydney

Comments

1. Shooba
   Posted April 6, 2011 at 9:24 am

   I don’t want to hijack the conversation here, because I think “what portion of the budget should go to health” is a conversation worth having… but… surely bowel cancer screening is priority one? Croakey’s fixation on mental health and physician assistants recently has kind of duopolised discussion at the expense of topics like the FOB test and its glaring need for a full national program

2. Shooba
   Posted April 6, 2011 at 10:08 am

   Awww shucks Croakey… you DO listen!

3. Melissa Sweet
   Posted April 6, 2011 at 10:10 am

   Shooba, I was just about to comment and say: your wish is my command (well, at least sometimes).
   But you got in first…

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 22

Here is more on the Medicare Local debate: Should we have them, who should run them, what are the benefits and what are the losses for the communities which they will serve? Will they just be another name for the Divisions of General Practice?

If we acknowledge that there are set criteria for their establishment we, in the Southern Highlands, can see that the CEOs and Boards of the Southern Highlands and Macarthur Divisions of General Practice appear to be taking the view that the funding they get will simply extend their Division's power and influence without necessarily improving the health outcomes for their health consumers.

On the other hand, the Bankstown GP Division continues to adhere to the guidelines for the Medicare Locals and has established a coalition of health services and agencies to bring about real change and collaboration in the access to, and delivery of, reformed health services in the SWSLHN area.

A reality check for the AMA’s contrary stance on Medicare Locals

March 21, 2011 – 6:33 pm, by Melissa Sweet

The timing of the AMA’s dummy spit about the new primary health care organisations to be known as Medicare Locals (MLs) was impeccable. The AMA announced last Friday that its Federal Council had voted to oppose MLs.

AMA President Dr Andrew Pesce said the AMA could not support primary care reforms that “do not guarantee they would maintain and support the leadership role of GPs in primary care”, and warned against any moves to fundholding.

The timing was impeccable because it so superbly illustrated the points made by a number of speakers at the national rural health conference in Perth last week – about the need for a more prominent place for the community in health debates, to try and counter the voices of the overly powerful vested interests. (You can see some of these comments in this previous Croakey post, quoting presentations from the Centre for Policy Development’s John Menadue and the University of South Australia’s Professor Robyn McDermott, although they were far from the only presenters making such comments).

Notably, some of the priority resolutions put forward by the 1,000-plus people attending the conference were supporting not only Medicare Locals but also models of care not based upon the AMA’s holy grail of fee-for-service.

The Australian Health Care Reform Alliance (AHCRA) has issued a statement expressing its disappointment with the AMA’s stance on Medicare Locals and fund-holding, and hoping “that the AMA will reconsider it positions to more forward-looking and collaborative ones”. The AHCRA statement also noted that “the future of health care is about teamwork”.

Meanwhile, health policy Jennifer Doggett suggests that perhaps we should read the AMA’s screams of protest as the mark of good health policy. If the AMA isn’t complaining, then presumably the status quo isn’t threatened…

The AMA: not exactly famous for its leadership in health reform

Jennifer Doggett writes:

"The Australian Medical Association (AMA) continued its tradition of opposing key health reforms when its Federal Council voted last week to oppose the establishment of Medicare Locals.

"Just as in the early 1980s it opposed the introduction of Medicare and in the 1940′s argued that the proposed Pharmaceutical Benefits Scheme (PBS) represented a dangerous slide into socialism.

"Thanks to these programs, Australians now have access to universal health care and some of the cheapest medicines in the developed world.

"Had the governments of the day bowed to pressure from the AMA and scrapped those planned reforms, we may well have ended up with a health system like the USA’s which costs more than double that of Australia’s and delivers poorer health outcomes.

"Luckily for the Australian community, the Health Ministers at the time were able to resist pressure from the AMA’s scare campaigns and propaganda machine.

"They pushed ahead with the introduction of these health programs which greatly benefited the Australian community and which are the envy of many other countries today.

"Even the AMA eventually agreed that perhaps there were some benefits to publicly subsidised health care. It’s hard to find an AMA spokesperson today who will publicly advocate the abolition of these programs.

"Similarly, the objection to Medicare Locals (MLs) is likely to turn out to be short-term paranoia about doctors losing control over the health agenda rather than substantial objections to the detail of the ML initiative.

"The fact that there is strong support for MLs among many other health groups – including some representing GPs – demonstrates how isolated the AMA is on this issue.

"In fact, the main concerns of other health groups about MLs are precisely the opposite of the AMA’s. They are worried that they will simply entrench the power of the medical profession in the primary care sector and fail in their stated aim to support better integrated and coordinated primary care.

"For example, the Royal College of Nursing Australia recently wrote to all political leaders describing Medicare Locals as ‘a reconfiguration and rebranding of the Divisions of General Practice’ and stating that it was ‘unconvinced that Divisions would be able.. to achieve the organizational cultures and attitudes required…to genuinely and effectively coordinate multidisciplinary health care’

"You don’t have to be Machiavelli to see that this tactfully worded letter is code for ‘don’t let the doctors take over’.

"The fact that the AMA is opposing Medicare Locals for not being doctor-focussed enough and other health professional groups are concerned that they are too doctor-centric, shows how tricky this area of health policy can be. It also is good evidence that the Government has probably made the right judgement about how far to push the reform agenda, at least from a political perspective.

"The political juggling act needed now is to progress the needed changes without getting the AMA offside to the point that it undermines the reform process while also not alienating other health professional groups by bowing to AMA pressure to maintain medical control over primary care budgets.

"It’s a difficult challenge but Nicola Roxon and her colleagues should take heart from the lessons of the past that it is possible – and indeed sometimes necessary – to deliver major health reform in the face of resistance from the AMA.

"In fact, looking at the public support and longevity of both Medicare and the PBS, it could be argued that the AMA’s opposition to a proposed health reform is a good predictor of its success.

"On this basis, it’s likely that one day the AMA will come around to supporting MLs, just as they did with Medicare and the PBS.

"It might just take them a little longer than the rest of the community.

5 Comments

1. Andrew Pesce
   Posted March 22, 2011 at 12:58 am | Permalink

   Before people accept what has been written here, perhaps they might actually
   read the AMA statement which stimulated this piece.

   http://ama.com.au/node/6494

   If they do, they will see that the AMA is not opposing the concept of a PHCO
   to coordinate primary care services.

   They might also note that our initial response to the announcement of
   Medicare Locals was cautiously optimistic about the role they might play in
   improving health care for Australians.

   http://ama.com.au/node/6433

   Many seem concerned that doctors insist they should be adequately
   represented on the governance structures of our health systems, but we only
   need to look at the chaos wrought upon our public hospitals when they are
   administered without appropriate reference to the doctors (and other health
   workers) who actually deliver the health services in the hospitals. Garling in NSW, incidentally, was not an agent of the AMA

   The statement that the Rural Health Alliance “has great hopes for Medicare Locals” is hardly an ringing endorsement of the announced structures, even if they do manage to change the name. And AHCRA’s comments contained as much criticism of the Medicare Local structure and function as it did of the AMA’s position.

   Inconvenient truth 1. New Zealand’s initial experience with PHCOs run by
   “skills based” boards was heading for disaster until the situation was
   retrieved by an increased presence of doctors on those boards.

   Inconvenient truth 2. Medicare Locals will be funded separately, governed
   separately and will function separately to the acute hospital system. Chance
   of evolving a ML inspired integrated health system: just about zero. Likelihood of continued cost and blame shifting between commonwealth and states: extreme
   Like it or not, the assumption that health care is improved by marginalising the role of doctors in decision making is to say the least contestable, and the AMA will certainly continue to argue against it.

   Andrew Pesce
   President, Australian Medical Association

2. Tim Woodruff
   Posted March 22, 2011 at 8:22 am | Permalink

   Whilst the negative response of the AMA is to be expected, it is hard for those interested in genuine health reform to become too excited by Medicare Locals. The vision is limited, the plans are sketchy at best, and it is hard to know whether MLs will be just another white elephant or worse.
   Regional entities could have the capacity to pursue the Federal Government’s rhetoric of ‘central funding, local control’. Unfortunately, the current plan is more likely to result in central funding and control and local blame.
   It is proposed that MLs will be engaged in population health planning. That requires knowledge of health needs which is also flagged. But there is no mention of information on current health spending at a regional level. (Remember how hard it was to get the Government to put in expenditure on the MySchools website). With health expenditure data at a regional and subregional level we would see the very stark inequities which exist in health funding and could plan to address them. That could then form the basis for health planning.
   Governance of MLs remains vague especially with respect to consumer and citizen involvement. This is partly because the Government has no national policy framework for consumer involvement and generally pays lip service to the concept. The transition of MLs from Divisions inevitably means that governance will be biased towards control by general practitioners currently involved in Divisions. Whilst this may work well in some regions, it is hardly the best way to achieve balanced governance with all stakeholders well represented.
   There are no plans for MLs to have sufficient funds at their disposal for them to exert much influence on current models of care. Whilst it will take time for MLs to build the capacity to use funds appropriately, it does not appear to be a significant part of the vision. In addition, they will be relatively powerless in their relationship with the well funded Local Hospital Networks. This is despite the rhetoric that we need a much greater emphasis on primary health care.
   The recent backflip by the Federal Government to abandon its plans to take over all primary health care funding will now mean that MLs will have to work with three levels of government in their co-ordination and integration role. That role would be hard enough with one level of government funding everything. It will now be even harder.
   Adequate data, resources, governance, and needs based funding at a regional level with national standards including for marginalised groups are required for MLs to evolve into anything useful.
   Where is the vision?

   Tim Woodruff
   Vice President
   Doctors Reform Society

3. rechoboam
   Posted March 22, 2011 at 7:12 pm | Permalink

   Could the author please explain in 25 words or less what a Medicare Local is and does?

   After Medicare Gold, the epic COAG reforms that never quite occured, the federal takeover that Rudd threatened, which never occured, I’m very confused by this government’s plans and have not seen a single example of how MLs or anything else will actually relate to human beings and their health requirements.

4. rechoboam
   Posted March 22, 2011 at 7:15 pm | Permalink

   For example I googled Medicare Locals and this is an example of what I found:

   “The South West Sydney Health Coalition has recently been made aware of certain assertions made by the Macarthur and Southern Highlands Divisions of General Practice concerning the formation of a Medicare Local in south west Sydney.

   The purpose of this letter is to inform you that the South West Sydney Health Coalition denies each of these assertions categorically as being completely without basis in fact.

   The Macarthur-Southern Highlands Divisions are not the official bid for the South West Sydney Medicare Local. The Macarthur-Southern Highlands Divisions do not enjoy any exclusive right to lodge a bid for a Medicare Local covering the Bankstown, Fairfield, Liverpool, Campbelltown, Camden, Wollondilly, and Wingecarribee local government areas. “

5. Melissa Sweet
   Posted March 24, 2011 at 11:35 am | Permalink

   Hi Rechoboam

   Take a look at this previous Croakey post which links to a series of posts about Medicare Locals: what they’re intended to do, and debate about how they will work etc.

   http://blogs.crikey.com.au/croakey/2011/03/03/a-comprehensive-analysis-of-the-plans-for-medicare-locals/

One Trackback

1. By On Medicare Locals, it’s time to seize the day, says rural health lobby – Croakey on March 25, 2011 at 4:24 pm

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SSWAHS = SWSLHN + SLHN and mental health in the Southern Highlands - 2

Socrates suggests that now the NSW election has produced the outcome that everyone knew was to happen, we carefully watch whether the Liberal-National coalition government delivers on its promised changes to improve mental health in NSW and in particular to the Southern Highlands community. Here is a reminder of what the, then, Government, and the, now, new Government promised the people of NSW.

What is on the table for mental health in the NSW election?

March 20, 2011 – 7:06 pm, by Melissa Sweet

The Mental Health Coordinating Council has been analysing the mental health policies of the major parties in the run-up to the NSW election (at least those released so far).

Thanks to Tully Rosen, the Council’s policy and research officer, and his colleagues for providing this summary.

Tully Rosen and colleagues write:

MHCC has gathered the details from the specific mental health policies announced by the major parties for the NSW election. Although the Greens have a mental health policy listed on their website, as far as we are aware they have made no specific program announcements. As usual, the funding directed by both major parties specifically to community managed organisations is only a fraction of the total new funds promised for mental health.

Liberal/National

• Establish a Mental Health Commission ($30mil)

This Commission will have full responsibility for mental health budget which will be quarantined. It will be able to focus resources on where they are needed and on the most appropriate models of care. The legislation to establish the Commission will be developed by a specially appointed working group. The Commission will have three specialist units to: manage the experience of patients and carers; divert mental health patients away from the prison system; and help ensure a smooth operation of the Mental Health Review Tribunal

• Extra funding for LifeLine ($8mil over 4 years) for telephone and counselling services

  Highlights for Community Managed Organisations – The proposed Mental Health Commission and quarantining of mental health funding will potentially be a good thing in the face of all the other health changes such as new local health areas and the ever present temptation to use mental health funding for other services. How funds for CMOs are quarantined or managed will need to be worked out. Funding for Lifeline is the only specific program or CMO mentioned (so far). All up extra for CMOs is $8mil over 4 years.

  ***

  Labor

• New public perinatal mental health service ($29.6mil over 4 years). This includes a new 8 bed mother and baby inpatient unit (location to be determined) and an expanded maternity and post-natal home visit program to support mothers at risk of post-natal depression.

• Doubling HASI (Housing and Accommodation Support Initiative) ($20.8mil over 4 years). Extra 1,100 places but no indication of support level mix or target groups.

• Setting up Assertive Community Response teams ($14mil over 4 years). Three pilot sites in Western Sydney, the Hunter and the Illawarra to deliver “community based” mental health interventions for children and adolescents.
  

• Family and Carer Mental Health Program extra funding ($8mil over 4 years). Extra funds for NGOs to provide these services.

• Expanding the number of Declared Mental Health Facilities throughout rural and regional NSW ($5.92mil over 4 years).

• Mental health research ($5mil over 4 years). $500K each year for leading schizophrenia researcher Prof Cyndi Shannon Weickert and $3mil to set up a Mental Health Clinical Academic Research Program.

• Expanding specialist Older Persons Mental Health Unit in the Hunter ($3mil).

• Continuing beyond blue national depression initiative in NSW funding for another year ($1.2mil)

• Expanding inpatient mental health infrastructure

  • A new Psychiatric Emergency Care Centre (PECC) at Blacktown Hospital

  • A Safe Assessment Room at Mt Druitt Hospital

  • A 20-bed sub-acute unit at Wyong Hospital

  • An additional 70 beds at Campbelltown Hospital and new mental health services as part of the Liverpool Hospital redevelopment

  Highlights for Community Managed Organisations – The major item for CMOs is the doubling of the HASI packages to 2,200. HASI is an effective program and its expansion is a good thing. The other main item for CMOs is the extra funding for the Family and Carer Mental Health Program. Beyond blue depression initiative is the only CMO specifically mentioned with this program being renewed for another year. Total extra funding announced for CMOs is $30mil over 4 years.

4 Comments

1. Murf
   Posted March 20, 2011 at 7:44 pm

   The MH Commission proposed by Lib/Nats sounds promising, but it would be good to know what sort of staffing they propose and how much salaries for them will cost; how often will they meet, what targets will they monitor, who do they believe will give the best value services to the various diagnostic groups (social workers, psychologists, family therapists, psychiatrists)? The rest of their plan sounds too vague to comment on.
   The Labor proposals are nicely detailed although they don’t state what sort of personnel will be providing services under the funded programs. I don’t like the idea that a specific researcher gets a great lump of funds they haven’t competed for on the open market, no matter how innovative or promising the program so far. Other researchers who compete for ARC and NHMRC money will be put offside! Better to provide salary and facilities for some research officers to be employed while directed by senior personnel already in NSW Mental Health. The Beyond Blue extension doesn’t sound enough to be meaningful since it must cover admin, communications, mental health workers and possible security- 12 months psychiatrist salary takes $250 000 already! The wonderful funding for the mothers/bubs program will have to be carefully allocated across buildings and staff as buildings cost a fortune- usually a lot more than first quoted for, especially when its all custom designed and built, not a couple of project homes cobbled together! I like the Labor proposals better than Libs, but it would help people deeply concerned about making the most of funds to see even more details and any flexibility with funds and personnel that may be shared with other health sub-sectors.

2. Melissa Sweet
   Posted March 21, 2011 at 6:57 pm

   Sally Rose, Blogger-in-Chief, Global Access Partners, asked me to post this comment on her behalf:

   Not working in the field I am only able to judge the relative merits of those lists by tallying the numbers. Painting a rough picture of a $38million + commitment from Lib/Nats VS a $79.52Million + commitment from Labor.

   Given that spending twice as much doesn’t always produce twice as much benefit, and given that there is never enough money in the budget for every worthy initiative to receive funding I’d like to pose a hypothetical question.

   Let’s imagine the funding commitments were met halfway and the Mental Health Coordinating Council was given the opportunity to outline how to spend $60million on improving mental health services in Australia how would you advocate spending it?

3. jass
   Posted March 21, 2011 at 7:32 pm

   At the moment, Western Australia is the only state with a mental health commission. Having been involved in the process – for a part of it anyway – my impression is that there are aspects of it which are quite promising. The old way of doing things in mental health is simply not working, and it is time to start something new. But in WA the commission does not have a legislative basis and the primary motivation is the government’s ‘markets are everything’ philosophy. so the commission becomes a market mechanisms, effectively, and a body that purchases services from mental health providers. the purchaser/provider relationship is thereby sharply divided.

4. Tully Rosen
   Posted March 21, 2011 at 9:12 pm

   Hi Sally,

   As we outline in our “Call to Action” position paper, there are a number of high-priority and cost effective programs that could be immediately invested in that would provide substantial benefit to people living with mental illness in NSW. To date, Labor has been more financially supportive of our identified priority areas, while the Coalition has committed to overdue broad structural reform. Neither is anywhere near enough.

   Our greatest concern, along with many many others in the mental health sector, remains that mental health overall is grossly underfunded – NSW remains around the bottom of the rankings for spending on mental health, for the percentage of mental health funding allocated to community mental health, and for the percentage of mental health funding allocated to NGOs. We need to be talking billions of dollars.