SSWAHS = SWSLHN + SLHN and the Medicare Locals - 40

Mr Stephen Jones MP
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600
 
Tel: (02) 6277 4661
Fax: (02) 6277 8548  

27 April 2011

Dear Mr Stephen Jones MP,

Medicare Local Submissions - April 5, 2011

I am aware that there were two applications by organisations bidding for the funding allocated for the SWS Medicare Local which was to include the Southern Highlands of NSW. It is my understanding that the Bankstown GP Division (SWS Health Coalition) has done so, and the Macarthur-Southern Highlands Divisions of General Practice have also submitted their application.

I am also aware that the intent of DoHA was that there should be extensive consultation with the local communities, local health practitioners in both the public and private health services, and the non-government organisations who provide health and welfare services to the residents of the Southern Highlands.

It is my understanding that the Macarthur-Southern Highlands Division’s application proposed that the current Southern Highlands Division would be a discrete part of the enhanced Macarthur Division of General Practice, who would have responsibility for the area between Fairfield- Bankstown and Bowral. I say it is my understanding simply because there has been no public discussion with the local Southern Highlands- Wollondilly communities, with the private health practitioners or with the NGOs by the Southern Highland Divisions of General Practice or, apparently, by the Macarthur Division of General Practice.

There have been no public meetings, nothing in the local press about the transition to Medicare Locals, and the only discussion by the CEO of the Southern Highlands Division of General Practice with a few members of the local private psychologist practitioners was to talk to them about introducing the ARGUS electronic communication system to their practices. The only discussion the CEO of the Southern Highlands Division of General Practice has been to inform some of the heads of Departments of the Bowral Hospital and Community Health Services that the funding of the current Division will end in July 2012 and that the liaison with the Macarthur Division was their Board’s proposed option. This does not amount to any form of robust discussion and involvement by the local community in how the Medicare Local would help the people of the Southern Highlands.

The contrast between the Macarthur-Southern Highlands Division’s lack of involvement with the local community and its health care providers, and the community-involvement actions seen in the Bankstown GP Division’s-SWS Health Coalition’s process for developing its application is extreme.

Yet when confronted with that significant difference the CEO of the Southern Highlands Division states that the assertion is “wrong” and “offensive” to say that there has been no community consultation. However, even a cursory examination of the Southern Highlands Division’s Newsletter (The Highlands Doctor) to its members shows that it has not been updated since July 2010. It would, therefore, seem that even its member GPs have not been kept informed as to what their Board has been negotiating with the Macarthur Division of General Practice.

The purpose of this letter, therefore, is to let you, and DoHA, know that the application by the Macarthur-Southern Highlands Divisions of General Practice is questionable in that:

1.       There does not appear to have been any significant community consultations with the people and health care providers in the Southern Highlands.

2.       There has been a veil of secrecy from the Southern Highlands Division of General Practice and the Macarthur Division in regard to what their planned intentions are in respect of how they would operate as a Federally-funded Medicare Local.

3.       There have been no public presentations to the community in the Southern Highlands and, possibly, in the Macarthur – Wollondilly jurisdictions to encourage community involvement and collaboration in the development of the Medicare Local proposed for the South West Sydney area.

4.       There has been no explanation to the local community as to how the Medicare Local would purchase the health services that would improve their health needs, in contrast to the existing available Medicare-funded health services in both the public and private sectors.

5.       There has been no indication that the general practitioners are aware of what their relevant Boards have proposed for the changed delivery of health services and how those changes will affect the viability of the whole health practitioner’s network.

6.       The AMA organisations in states and nationally appear to be gaining feedback from their members that the majority of GPs are unable to describe what the proposed Medicare Locals will do for their community members, or are opposed to the concept altogether. Since the outcome for Medicare Locals is dependent upon the GPs as well as other health professionals in the private sector one has to wonder if funded Medicare Locals will in fact obtain local support.

7.       It is questionable that, if the current Divisions of General Practice have difficulty in establishing transparent governance of their actions, how those same Boards will manage to introduce the transparent governance to the new Medicare Locals.

Yours sincerely,

A local resident.

SWSLHN + SLHN = SSWAHS

The NSW State Government's approach to health, immediately after the election, gets a big tick from Socrates for terminating the incumbent Director General of Health, Ms Debra Picone.

Her departure is possibly the first of many who will depart from a Health Department, populated as it was by the previous government and Minister, of political appointees who had their snouts in the trough to obtain the best outcome for themselves and their pet projects.

Now to the last thing the previous NSW government did before it was shown the door in March. On the 1st of January 2011, the Health Minister announced that the new Local Health Networks (LHNs) had commenced in NSW. This meant that the previous Area Health Services had, in many cases, been divided into (marginally) smaller LHNs.

For us in the Southern Highlands it simply reverted back to the partition of SSWAHS into the old Central Sydney AHS and the old South West Sydney AHS, with this time, an additional layer of bureaucratic governance with a CEO overseeing a cluster of such LHNs.

Now here was the catch. Previously the old SSWAHS had streamed their clinical services to provide their specialist services across the entire jurisdiction of the SSWAHS. This meant, for example, that cancer services, cardiac services, mental health services, etc, would be provided to, and be accessible by, all residents in the SSWAHS.

After initially stating that the Area-wide clinical services will still provide access to all the residents of the old SSWAHS it now seems that the current administration of the Sydney LHN (the old Central Sydney AHS) is suggesting that they have sole right to all the clinical services within the Sydney LHN jurisdiction. Put simply, that means no resident of the Southern Highlands can expect to have access to the clinical services located at Concord Hospital, Royal Prince Alfred Hospital, Sydney Hospital, Balmain Hospital and St Vincent's Hospital.

This may seem very little loss to residents in the Southern Highlands as we still have access to Campbelltown Hospital, Camden Hospital, Liverpool Hospital and Bankstown Hospital as well as our own Bowral Hospital. The reality is, however, there are not a sufficient range of medical specialties in Bowral, and Camden Hospitals and the distance to Bankstown Hospital is considerable.

So, for example, suppose someone in the Southern Highlands requires treatment and residential care for an acute mental illness. Bowral Hospital has a couple of beds available for people with a sub-acute episode which does not require involuntary treatment. The beds are embedded within the whole complement of available beds in the hospital so they could be available, but then again, they may not. And what if the person requires an involuntary treatment and admission?

In the old SSWAHS people from the Southern Highlands requiring specialist treatment in one of the old clinical streams went first to Campbelltown Hospital and then to Liverpool, Concord, RPAH and Bankstown hospitals wherever the specialist beds were available. With the new LHNs our residents will be limited to Campbelltown, Liverpool and Bankstown hospitals.

Another feature of the old SSWAHS was that the local health funding for Bowral Hospital and its Community Health Services was drawn back into the specialist Clinical Divisions to fund, among other things, the budget over-runs of the big northern hospitals. It was also used to fund the budget over-runs and other capital costs associated with the building and renovations of the big northern hospitals. At the same time, Bowral Hospital survived on the donations and fund-raising of the local people, businesses and community groups to fund our two renal dialysis chairs and the refurbishment of the children's ward.

It is, perhaps, not unexpected that a SSWAHS Executive, that was appointed by the previous NSW Labor government, was drawn mainly from the old Central Sydney AHS. After all the previous Labor Minister for Health has her seat in Marrickville - central to Central Sydney AHS. The SSWAHS CEO, his Deputy and most of the Directors and Executive members all came from Central Sydney AHS. Some, but not all have headed back to the Sydney LHN taking with them the bulk of the funding and the capital works developments of Concord Hospital and RPAH.

As I have said in the blog many times, SSWAHS administration has overlooked Bowral Hospital and the Southern Highlands, probably because it was seen as a "safe" Liberal seat. Now that we have a new Liberal/National coalition government we appear to be again overlooked because we are an even "safer" Liberal seat!

By now some of you may be wondering why the title of this blog posting has changed to SWSLHN + SLHN = SSWAHS. Well, it does seem as the wheel may have turned full circle again. An informant has told me that the Federal Labor government is unhappy about the additional layer of bureaucracy imposed on the NSW health system with the LHNs and the LHN Cluster overseers. It would appear that even prior to the dismal showing of the NSW Labor government in March they had been advised to revert back to the super Area Health Services. Hence, the Southern Highlands will likely come under a re-formed SSWAHS but, hopefully, without the Executive misfits who always found it hard to look beyond Campbelltown.

Socrates, ever the optimist, is hoping that the new coalition government, and their new Director-General for Health, will not only accept the advice of the Commonwealth but also ensure that any new NSW health structure will take into consideration the possibility of local members having a greater say in their local hospitals, and that funding be commensurate to ensure that the hospital and community health services can provide the services required by the local people, locally.

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.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 20

First Medicare Local applications accepted, after-hours care funding fast-tracked

22nd Feb 2011

Staff writers all articles by this author

4 comments

THE Federal Government has today begun accepting applications from GP divisions and primary care organisations to form its new Medicare Locals (MLs).

Meanwhile, new guidelines for establishing MLs, released by Prime Minister Julia Gillard as part of the Invitation to Apply process launch, have been welcomed by the AGPN as further clarifying the roles the new organisations will play in ongoing health reforms.

AGPN chair Dr Emil Djakic said the guidelines announced today by Ms Gillard and Minister for Health and Ageing Nicola Roxon provided "tangible steps for the network as it transitions from the divisions of general practice program" to MLs.

"Now that the [Invitation to Apply] criteria have been released, the divisions of general practice across Australia can work with their partners in the primary health sector to formulate their respective ML proposals," he said.

The praise, however, follows recent criticism by Dr Djakic that the Gillard Government risked stymieing health reform by increasing the number of MLs after the expansion was announced as part of its health reform and funding deal with the states.

Dr Djakic had expressed concerns that raising the number of MLs beyond the planned 57 risked diluting the provision of services, resulting in weaker, less effective organisations.

The Gillard Government has allocated a total of $477 million over four years to establish the national ML network to replace the existing divisions of general practice.

The first group of Medicare Locals is scheduled to begin operating from 1 July.

According to a joint statement by the ministers, the new guidelines aim to provide support to GPs and improve patient care as well as developing locally focused services based on community needs.

Ms Gillard urged primary health care organisations to apply to become MLs through the invitation process.

GPs have meanwhile welcomed the government's announcement that it will fast-track plans to reform funding for after-hours care also announced as part of its health reform agreement with the states.

The changes may entitle practices to receive greater funding for providing after-hours care as the government has delayed the phasing-out of Practice Incentive Program (PIP) payments for after-hours consultations until 2013.

Tags: Medicare locals, AGPN, Emil Djakic, after-hours, PIP

Comments:

ed
22nd Feb 2011
6:10pm

A new name but the same old rubbish that divisions have promoted. The divisions were created to help old GPs find jobs which paid a cushy salary for no work. It also paid useless administrators to draw up programs such as"better communication with aborigines". Treat the aborigine as a human and he bleeds just like anybody.

TIBOR
22nd Feb 2011
7:21pm

The Division of General Practices have unfortunately paved the way for the establishment of the Medicare Locals, with expanded memorandum of understanding, beyond general practice run preventative community activities, with the intended incorporation of wider community representation, pharmacies, nurses and other health sectors.

The Divisions were perceived by the RACGP as having poor managerial abilities and fluctuating general practitioner staff membership. How Locals will implement and improve preventative health measures, access to hopital service and specialist sectors is rather vague. But what is obvious, they will be extensions of the government health departments at more so called specific local levels. But will they be more efficient and cost effective then the present system? To my mind and to others it appears to be another tier, requiring a whole lot of administrators, accountant, employees and governances. It is true the Divisions were fairly useless in their community preventative tasks and no real measurement were undertaken, but I cannot see the Locals doing any better. One of their aims is to provide after hours services. But if the doctors are continually poorly remunerated, then they will not have the workforce. Perhaps they think nurses and phamacists making house call is the answer. I just wonder. No matter what, Divisions are out and Locals are in! The GP's, so called, in this press release, who have been said to apparently 'welcomed the government' announcements' I would like to know their affiliations.

Solidarity
26th Feb 2011
6:33am

"Transition" is a noun. It cannot possibly be a verb.
This quote from Dr Djakic "Now that the [Invitation to Apply] criteria have been released, the divisions of general practice across Australia can work with their partners in the primary health sector to formulate their respective ML proposals," sounds just like Kevinruddspeak . Australians, read "1984" - your Government is wasting every penny to establish dictatorship and call it "freedom" or "better services". Then take to the streets to get rid of these Marxist drones.

ed
28th Feb 2011
7:25pm

News release 2 years in advance: 28 Feb 2013:

Nicola dropped from Cabinet. Applies to WHO for job. Appointed Secretary Useless Projects, WHO by Ban Kee Moon. Now a resident of Geneva. Holds dinner parties for Drs given a Medicare Local. Medicare locals collapse because of a shortage of doctors. Witch doctors from Africa and Barefoot Doctors from China invited to join Nicola's folly

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 18

Socrates says: "Almost one year on! This is still relevant, still do-able, and still to be done!"

Gillard can fix shattered mental health services

25th Jun 2010

Professor Patrick McGorry all articles by this author

2 comments

PRIME Minister Julia Gillard starts her new job faced with many challenges, but also with many opportunities. One of those opportunities is a unique set of circumstances that can enable profound change in mental health.

On Friday 18 June, then Prime Minister Kevin Rudd explicitly stated that mental health and aged care were the two next priority actions in healthcare. Less than a week later, at the exact time he was due to meet with the mental health sector to discuss ways of achieving progress in mental health, he was voted out of office.

But although mental health’s face time with the PM was gazumped by the ALP leadership battle, there is still momentum gathering for action on mental health reform.

Firstly, it helps that Julia Gillard is one of the politicians who “gets it” about mental health – something I observed first hand on her visits to the Orygen youth mental health service for which I work. But more importantly there are now political dynamics in play that are enablers of meaningful reform in mental health. Those enabling dynamics are greater sectoral unity, increased community support and “cut-through” to the national debate.

On the day that Julia Gillard replaced Kevin Rudd, leaders of the mental health sector presented the Government she will now lead with an agreed, common position. More than 60 signatories – virtually every key mental health body, including representatives of doctors, psychiatrists, psychologists, mental health nurses and social workers – made it clear to Government as to what needs to happen next.

Julia Gillard’s Government now has an unprecedented opportunity to work with a unified sector and can seize this opportunity by orienting policy around ending unequal access to quality care between mental and physical health.

Also on the same day that Julia Gillard was voted in to become Australia’s first female Prime Minister, her office was presented with a petition from 80,000 Australians asking her to take urgent action on mental health. These signatories were mobilised in just 48 hours and are an early expression of growing community awareness and concern about mental health.

GetUp!, which organised the petition, also published an Auspoll last month showing 83% of Australians would support a $500m p.a. package of investment to begin implementing the 12 mental health recommendations of the National Health and Hospitals Reform Commission.

Such an investment could be made immediately as a confidence-building measure by Government before working to develop the national reform program in mental health that is one of the core recommendations of the sector to Government.

That wider package of reform will involve a lot more money – probably a doubling of mental health’s share of the health budget (now 6%) to bring it close to or equal to its share of the health burden (13 per cent). This involves several billion dollars a year of public money and can only be accomplished with public support.

However, the national conversation on mental health as reflected in recent media coverage reflects a growing understanding that services are severely underfunded, that this is discriminatory and detrimental to Australian families and that sustained action to address these failings is needed.
Whisper it softly, but we may be close to a tipping point on mental health reform.

Comments:

Shikha

25th Jun 2010
5:49pm

The stumbling block, rate limiting step and bottle-neck to any such health reforms would certainly be the health minister, overlooked in this article. It was this very government and this cabinet and Madam Roxon's department that have deemed only qualified psychologists dish out mental health care under the Mental Health Plan guidelines. They have undermined and side-lined other workers in this area already carrying a large burden and caring for a great many patients, risking fragmentation of care and more burden on the already over-stretched system. Rearranging the proverbial deck chairs won't save this sinking ship under this governance. When the Minister won't listen to legitimate arguments about the flaws in the direction of health reform what difference does it make who's at the top and who she reports to? Nurse prescribing, nurse practitioners setting up next to GP's, midwife indemnity fiasco, superclinics, diabetes budget-holding and so on. Damage already done.

sickofpoliticians

5th Jul 2010
1:40pm

Its just such a pity that it takes a change in Prime Minister to forge us toward a so-called 'tipping point'. Realistically, whoever is in government, the system will still stink until someone with some sort of experience of the mental health system, reforms it. The first question we need to answer is 'How can the mental health system sustain itself when the need clearly outweighs what is given?'.

My name was one of the 80,000 handed to parliament. I did so because I have seen the system at work, I have experienced the frustration, the never-ending cycle because patients are over medicated and dependent. I have experienced the heart ache of carers who struggle to get their person a diagnosis, just so they will be eligible for the hundreds of badly planned out "programs" that the goverment has presented us with.

Spend some money on therapy, spend some money on more staff and start paying the people that work the hardest the money they need to be able to sustain the jobs they face on a daily basis. Spend some more money on research, and put Australia in the running to be best practice for mental health. Spend money to ensure that those who are caring for someone living with a mental illness feels supported. Spend some money to ensure that the person living with the illness can obtain a diagnosis quickly, and without mistake. Train the clinicians, careworkers and stop spening money without doing your research - if you have a spare $1.1 billion dollars lying around somehwere, before you spend the money, ask youself... Where do people need to money the most?

We are a nation of over-weight people already, lets not add increased rates of mental illness to that as well. Stop spending money on opening up Australia to other nations, fix the situation we have here, first! People are taking their own lives everyday, and we are all sitting here arguing about what to do next. Get is right Julia, get it done!

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 17

Are we getting the right primary care policies?

7th Mar 2011

Dr Steve Hambleton all articles by this author

2 comments

JUST about everybody wants to see practical achievable reform in primary healthcare. Things can and should be done better. With the right policies and proper support for GPs, it is achievable.

But are we getting the right policies? Judging by the reaction from health professionals – not only GPs – the Government does not seem to be getting much bang for its primary care reform buck.

In the same way that GP super clinics have failed to spark the imagination of health professionals or patients, it looks like Medicare Locals are getting similarly poor reviews. And I think the criticism for the most part is justified – and not just for the lack of detail or clarity of the proposals.

The Government seems convinced that Medicare Locals will somehow take the pressure off emergency departments (EDs). Wrong. This simply will not happen. The ED problems are there because of bed block, not Category 4 or Category 5 patients. Besides, many of these patients should not be seen by a GP in any case. They are appropriately seen in the ED and often need admission.

The ability of Medicare Locals to help ‘join up’ the health system has been severely compromised by the change in the balance of healthcare funding back to almost the status quo.

There should be a single funder. The previous reform arrangements were not perfect either, but at least the Commonwealth was taking more responsibility.

The fact is that there is no momentum any longer for any parts of our health system to come together because the funding keeps going to separate silos. There is the hospital money silo. There is the community services silo. There is the GP and related primary care silo. The aged care silo. The Indigenous care silo. And so on.

We do not have a health system. We have health systems – totally disconnected. We will know that we have real health reform when they have all been re-connected.

At its most recent meeting, the AMA Council of General Practice agreed that there are gaps in Australia’s population health coverage that need to be identified and targeted, but I don’t see that the proposed structure under the COAG Agreement will make it any easier. It is frustrating.

The collection of data by Medicare Locals is also problematic. The ‘monitor and provide feedback’ approach to the performance of primary healthcare providers is also problematic. It does not reflect the reality of private general practice.

Blindly putting your faith into GP Super Clinics being the saviours of primary care cannot be supported either, especially as they are so badly located and so lacking in planning and consultation.

They have the capacity to backfire badly on the Government.

Providing infrastructure grants and supporting the GPs who are already committed to their communities would be a much smarter investment – economically and politically.

Governments seem wedded to Medicare Locals and they are already in the process of being established, but these are not the primary healthcare organisations that were envisaged by the National Health and Hospitals Reform Commission.

Given this political reality, it is up to us – the AMA and the medical profession – to do all we can to shape and influence this policy so it actually delivers tangible benefits to patients and communities and supports hardworking GPs.

The AMA is pushing heavily for medical practitioner involvement in the governance of Medicare Locals to avoid repeating the bureaucratisation of primary care that we saw in public hospital care.

The priority for general practice is to build on the chronic disease management gains that have been made and to promote teaching in general practice to support the next generation of doctors.

The current system is not completely broken. We are getting some of the best health outcomes in the world, but we do need further support and it has to be the right support.

The Government is not helping its cause by using terms such as fund-holding and managed care or by continuing to allow the hint of role substitution to linger in the primary care reform debate.

The Government must heed the profession’s warnings, or Medicare Locals could soon be a distant memory.

Comments:

John Wellness
7th Mar 2011
4:29pm

I agree with many of Dr Hambleton's diagnoses. The original GP Superclinic Policy put out by Kevin Rudd and Nicola Roxon in June 2007 had so much promise. Admittedly reducing ED visits was always unlikely to happen and interestingly no-one seems to understand that good proactive primary health care could reduce the number of Category 1-3 patients (strokes, heart attacks and diabetes for starters) but the preventative angle looked promising. Sadly the bureaucrats failed to bring preventative care into the decision-making process and the superclinics presenting at two national conferences barely mention it. This is simply because existing "illness" funding will not allow multidisciplinary preventative care. The location of the Superclinics too has been inept. At a time when there are lots of areas needing services to help meet population growth needs putting them in established areas was simply woeful. Putting them on hospital grounds will work directly against keeping patients out of hospitals.

The Medicare Locals don't look like being very different. Giving the inside track to divisions of general practice is unlikely to generate new ideas and new ways of delivering care. When nearly 1/3 of the total burden of care is preventable by lifestyle improvement that there is so little attention given to looking at new ways of preventing chronic disease is scandalous. The primary health sector could make a huge difference if its funding system could lead to new forms of practice and program delivery. Just don't hold your breath waiting for proper reform.
John Wellness

Detracter
7th Mar 2011
5:56pm

We have a Health Care System built around Disease Management rather than Disease Prevention so you can get funding and administration set ups for diabetics but nothing for the obese person they were for the last twenty years.
Western medicine is falling apart financially as we keep diseased people alive and dependent upon us for ever increasing decades. Politicians have by nature a three year thinking cycle ,so every bureaucratic strategy they come up with in their Health Care tent, such as Superclinics in marginal seats, is aimed at getting themselves out of that boggy tent onto drier more publicly recognised land such as the environment or climate change.
We doctors are in an elite group of highly intelligent articulate people who are trained primarily to think differently to the rest of the population, and secondarily with technical and practical skills unreachable by the rest of the community.
We have a responsibility to actively change the health agenda away from the money for disease formula, to a health prevention formula. The health agenda is quickly moving away from and diluting our clinical skills, and a doctors hand on the abdomen in the middle of the night in former years is now being replaced by a nurse with a MRI scan request.
Our society is not training enough doctors of our standards as it is easier and cheaper to import them, so we as a group need to actively get into the health care debate and challenge and re-educate the politicians, media and general public. We need to stop being seen as a group always whinging about money and repaint ourselves as the caring intelligent professionals our patients see us as.
We need to take control of the Health Care debate away from the politicians and run it ourselves.
Detracter

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 16

Now it’s time for the real health reform

22nd Feb 2011

Robert Wells all articles by this author

The Government is to be congratulated on reaching agreement this week with the states and territories to break the impasse that arose following the previous ‘agreement’ in April 2010.

The new agreement provides for a phased growth in Common­wealth funding for hospitals to reach 50% by about 2014 (from its current level of around 40%) and to remain at that level, including for growth.

Commonwealth and state/terri­tory contributions will be paid into pooled accounts and funds will be distributed from those accounts by an independent agency based on ‘efficient’ price for services in larger hospitals and block funds for smaller institutions.

The price, too, will be set independently. The agreement includes targets of a maximum waiting time of four hours for service in emergency depart­ments and 95% of elective surgery being undertaken within the clinically indicated times.

The MyHospital website will continue and report data on individual hospital performance.

The agreement is in principle only at this stage, with more detail to be discussed by officials on technical implementation issues.

There is some concern that the detail will be the Achilles heel that will ultimately bring the whole edifice down but presumable a spirit of cooperation and the national interest will prevail.

Is the agreement a good outcome?

The agreement achieves a key objective of getting hospital funding arrangements between governments on to a clear footing for the next decade.

The move to casemix as the basis of funding and the Commonwealth’s commitment to match 50% of costs, including growth, should remove some of the traditional argy-bargy, although the ‘blame game’ will continue.

The transparency of the funding arrangements is a strong point, although likely to provide many ‘sticking points’ for assiduous bureaucrats. The targets for ED and elective surgery will no doubt result in gaming and distortions, but what’s new? Improved performance can be expected over time with the public reporting of hospital level data.

Overall, it is a good outcome from that limited set of perspectives.

Does the agreement constitute a landmark health reform? Are there any gaps still left? The strength of the agree­ment is that it clears the decks for a few years around vexed questions of hospital funding.

However, it does not provide a long-term answer to the question of how we cope with rising hospital costs; at best it buys us time to work through that issue in a more considered way.

Inevitably the states’ and territories’ capacities to cover half hospital operating costs plus invest in new capacity will be all-consuming. We need to start planning for that now and asking ourselves how we will tackle that problem.

While the agreement includes some initiatives in relation to primary health care, that area needs much more attention and that is where more comprehensive health reform is needed.

The agreement takes a step back from the previous commitment that the Commonwealth would become the sole funder of primary health care and so the current fragmented system will continue. Reform now needs to focus on how the fragmentation can be overcome within the multiple-funder environments.

The sharp end of this reform now seems to be with the Medi­care Locals, which have been given a boost through the new agreement, with a bringing forward of their establishment and a plan to have more of them.

Fortunately, the agreement spells out in more detail than has previously been available just what the Medicare Locals will be expected to do. Key elements of their role will be to:

• Identify local service gaps with the funding flexibility to do something to address them;

• A specific focus on improving access to after-hours care;

• Clear reporting and accountability against a national performance framework; and

• Improve coordination of primary healthcare across various providers.

So the challenge for us all now is to get the primary health reform process happening within this framework.

Robert Wells

Director, Menzies Centre for Health Policy

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 15

Building the future of healthcare

28th Mar 2011

The good, the bad and the ugly of Medicare Locals. Pamela Wilson reports.
Pamela Wilson all articles by this author

2 comments

LAST month, the medical profession finally got its first real glimpse of the Commonwealth’s vision for its new health reform tool, Medicare Locals.

The Commonwealth’s 21-page document, Guidelines for the Establishment and Initial Operation of Medicare Locals, gave a broad outline of what these primary healthcare organisations will be expected to do, how they will do it and who will govern them. It also formally invited interested parties to step up to the challenge.

So far, many health commentators agree the aspirations in the guidelines – although they are mere statements at this stage rather than policy – are promising.

Robert Wells, director of the Menzies Centre for Health Policy at the Australian National University, feels there is potential for Medicare Locals to better tailor services to communities. Given they will be tasked with identifying gaps in local services, there is a real opportunity for the new bodies to focus on disadvantaged populations, such as Indigenous or refugee patients.

“The guidelines seems to give Medicare Locals a much better role in working with the Local Hospital Networks in their area and state/territory government community health… and there is a greater capacity [to develop] a more localised approach to healthcare,” says Mr Wells.

Although pointing out the new bodies are not an end point in themselves, AGPN chair Dr Emil Djakic agrees Medicare Locals are the tool through which the Commonwealth’s national primary healthcare strategy can be delivered.

“Medicare Locals are going to be the organisational infrastructure that builds on what has already been happening in the division network to try and deal with some of these things which our existing system had not been addressing,” he says, referring to access, inequity, prevention, better management of chronic conditions and accountability.

But not everyone has been won over. The AMA recently took a strong stance against the formation of the new bodies, claiming none of the details released by the government about Medicare Locals explains exactly how they will benefit patients or communities.

AMA president Dr Andrew Pesce has in fact called for the roll-out of Medicare Locals – set to begin from 1 July – to be shelved until greater consultation with clinicians has taken place.

There are still too many unanswered questions, he argues, particularly on the issue of fund-holding and GP involvement.

The consensus among health commentators seems to be that while the initial framework looks promising, the true test of success will be in the program’s implementation.

They argue this will require the Commonwealth not only to ensure adequate and flexible funding for the new bodies, but also to ensure that Medicare Local executive bodies have an understanding of the integral role that general practice must play in their functioning, and in overall primary healthcare reform.

It is this last point – how involved general practice, and general practitioners, will be in Medicare Locals – that is weighing on everyone’s minds.

The Medicare Locals boards will be skills-based and not representative, meaning there are no mandated seats for GPs or other practitioners.

However it is widely hoped that clinicians with governance skills will put up their hands to be involved.

“Unless GPs are significantly represented on those boards, I think the concept will not work well,” says Dr Pesce.

RACGP president Dr Claire Jackson says the main query from the college’s GP members is the amount of support they can expect from Medicare Locals, given that they will succeed divisions of general practice.

“GP groups are obviously very keen to see Medicare Locals embrace a broader health professional network but not to lose sight of the fact… there needs to be a heavy emphasis on general practice as the central pivot for primary care service delivery in the community,” she says.

Eastern Ranges GP Association CEO Kristin Michaels, who hopes her Victorian division will be among the first successful 15 tenders, says that among her colleagues there is strong recognition that general practice must be highly engaged in this process.

“It’s about those skills you bring to the table, but ideally you want a couple of GPs with [governance] skills,” she says.

As confident as Ms Michaels is in the success of her division’s bid, she is not as optimistic about the Commonwealth’s claim in the guidelines that “over time, Medicare Locals will be given the capacity to use Commonwealth program funding flexibly”.

“We’ve not really seen the Commonwealth able to achieve that [flexibility in control of funding] completely in the past. It’s difficult for governments to let go of things,” she says.

Dr Djakic believes it won’t be clear how much control Medicare Locals will truly have until the Healthy Communities Report for each area is produced by the National Performance Authority.

“How much funding and flexibility will depend on what questions or accountability a Medicare Local has to have against the Healthy Communities Report,” he says.

There are also questions about the funding mechanisms of the new bodies, after Prime Minister Julia Gillard stated they would become fund-holding organisations in the future.

United General Practice Australia released a statement last month urging the Commonwealth not to introduce fund-holding arrangements for MBS and PBS.

Dr Pesce also told MO he was concerned that a lack of consultation with the profession on this issue by the Commonwealth meant fund-holding was being considered.

“There have been references to Medicare Locals as fund-holding. We were previously given reassurances that funding for medical services would be for primary care and not through primary healthcare organisations,” he says.

“We’ve tried to get clarification on that [from the government], we haven’t been able to.”

Another funding concern relates to the distribution of money for the after-hours reform with which Medicare Locals are being tasked.

Dr Djakic is urging the Commonwealth not to strip funding from those after-hours services that are working well and instead have a critical look at what it genuinely takes to sustain them.

Dr Pesce agreed that the Commonwealth shouldn’t try to fix programs that aren’t broken.

“We all recognise that after-hours care can be done better… [but] we have to be careful that where something is working, the change doesn’t harm that.”

Already, in every way, it seems Medicare Locals will not lock into a one-size-fits-all model.

Ms Michaels points out that among her colleagues in other divisions there is already a strong difference in opinion on things such as the organisational structure Medicare Locals should take, and whether divisions themselves will transition into Medicare Locals or contract as service providers.

No matter what model each division decides upon, one thing is clear: this is the end of divisions of general practice as they have been known for the past 19 years.

On 30 June 2012, funding to divisions – including the AGPN – will be transferred to Medicare Locals.

But it is expected that the new model won’t simply be the divisions program by another name.

“Medicare Locals have the capacity to do something bigger and better than divisions have been able to do… with a little bit more funding and more formalised relationship expectations,” says Ms Michaels.

The reality is that the true shape of Medicare Locals won’t be known until July this year when the first 15 are up and running.

Medicare Locals

What are they?

- There are 42 agreed boundaries (with the exception of Victoria and Western Australia). However, the final number may exceed the planned 57.

- $477 million over four years will be used to establish the Medicare Local network.

- Annual core funding for each will be about $171 million.

- They will be expected to have some common membership of governance structures with Local Health Networks (LHNs).

- Boards will comprise seven to nine members.

- Although not mandatory, an organisational membership – with community groups and local health services – is preferred over an individual membership model.

They will be required to:

- form strong working relationships with LHNs and Lead Clinician Groups to deliver coordinated healthcare;

- undertake certain responsibilities such as fast-tracking after-hours reform, driving telehealth services and supporting the development of e-health and GP super clinics;

- undertake analyses of gaps in health services in their area and provide evidence-based strategies to improve patient outcomes;

- participate in the performance and accountability framework, including the Healthy Communities Reports prepared by the National Performance Authority.

Comments:

Dr Manda
29th Mar 2011
8:28am

Does the $477m include what was spent on Divisons etc or is it on top of? How many more bureaucrats or other health professionals are going to be paid from this money to ensure MLs run as per primary care "changes" (not reforms till proven please!? Dollars given usually contain political spin.
Dr Manda, Sydney

Dr Manda
29th Mar 2011
9:08am

The ALP rants eternally about "equality of access". It uses this as a pretext for nationalising medical care. This benefits middle class lefties only, not the poor. But even the cockatoo who sits on my back porch every morning can see that Medicare Locals are Stage 2 of the socialisation of medicine. The public hospitals have been impoverished by Medicare. General practice is next. What brand of socalism we end up with depends only on who owns the facilities and employs the doctors. if it is the state, we become International socialists( i e Communists), or if the Medicare Local facilities are left in corporate hands, we are "only" National Socialists (that is, Nazis).
Some choice.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 14

Just to emphasise the problems we Southern Highlands health consumers may face in the near future if the Macarthur-Southern Highlands marriage takes place with two entrepreneurs jockying for the presidency!

Bitter split emerges in race towards Medicare Locals

17th Mar 2011

Byron Kaye all articles by this author

3 comments

GP networks vying to become Medicare Locals (MLs) have been urged to cooperate after a joint bid by three divisions to become Australia’s biggest primary care hub collapsed into a bitter split.

With the 4 April deadline for the first round of ML tenders looming, the Sydney-based General Practice Network Northside (GPNN) unexpectedly broke from neighbouring Northern Sydney General Practice Network (NSGPN) and Manly Warringah Division of General Practice (MWDGP) to prepare a solo bid.

In his division’s newsletter, due to be sent to members this week, NSGPN chair Dr Harry Nespolon suggested he had been “double crossed” and questioned whether GPs could “trust or support such an organisation”.

“It’s pretty hard to see how a GP in Palm Beach is going to feel warm and cuddly about [being serviced by a Medicare Local] which is basically the Hornsby division,” he told MO.

The remaining two networks would continue to work on their own joint bid, he added.

GPNN chair Dr Jennie Kendrick said governance, membership and function were the key issues that led to the decision to pursue the solo bid, but she hoped all parties would be able to work together regardless of the outcome.

“It’s a practical decision,” Dr Kendrick told MO.

“We don’t have any problems working with them.”

AGPN CEO David Butt urged cooperation among divisions bidding for MLs.

Tags: medicare locals, divisions, tender

Comments:

ed
17th Mar 2011
5:36pm
These networks only provide a cushy paid job to GPs who have no skills in looking after patients. Some of the GPs involved would not be able to treat a diabetic seizure or a serious complaint. They can all write care plans but not see anything wrong in a child that has difficulty reading and hearing. As one who told me at a clinical meeting, "I like my red wine and earn money via Medicare so that my children can go to a private school". He was...(sorry, I am a coward)

ondocfarm
17th Mar 2011
6:25pm
Oh..so power and glory cannot be shared.....? Well each should go it alone! Our area has seen three different divisions merge into one that has a ?? degree of usefulness, but keeps the combined egos of those involved ensconced and well paid (many are NOT GPs) even if the bulk of the GPs covered find it hard to define what benefit occurs.

MLs just a bigger mess and also of undefined usefulness?

Solidarity
17th Mar 2011
11:27pm
The whole concept is flawed; leave traditional GP structures alone and stop twiddling knobs to prop up a Federal government in meltdown. ML already smells like BER and insulation and every other scheme that has gone wrong. Toxicity rising from it already.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 13

Socrates is pleased to announce that, for the very first time, the CEO of the Southern Highlands Division of General Practice - Dr Warwick Ruscoe, has uttered some words about his plans (or lack of them) for a "local" Medicare Local.

More divisions split over Medicare Locals

29th Mar 2011

Byron Kaye all articles by this author

BIDDING for Medicare Locals (MLs) has led to another bitter rift between GP divisions, with accusations that some are spreading false information now tainting the contest to become the hub for Sydney’s south-west.

With the deadline for the initial round of ML submissions next week, an AGPN-appointed mediator has been called in to instigate talks between Bankstown-based South West Sydney Health Coalition (SWSHC) and rival joint bidders the Macarthur Division of General Practice and the Southern Highlands Division of General Practice.

The talks came after Bankstown GP Division CEO Andrey Zheluk, whose division is spearheading the SWSHC bid, accused his rivals of claiming to be the “official bid” for the area’s ML.

He said in a statement that his rivals “do not enjoy any exclusive right” and the claims “adversely reflect… on the future formation of a Medicare Local”.

Mr Zheluk told MO mediation was progressing “slowly” but could result in a joint bid.

Southern Highlands Division CEO Dr Warwick Ruscoe denied claiming exclusive rights.

“We don’t consider ourselves the official bid,” he said. “If someone else wants to make a bid, that’s fine.”

The latest rift follows a recent stoush between divisions in the city’s northern suburbs, after a joint bid between three divisions broke down.

It also came as the AMA presented its own vision for MLs. Last week the association called for the rollout of the new bodies to be put on hold pending further consultation with the profession.

It its position statement, the AMA reaffirmed its staunch opposition to any fundholding arrangements for GP and specialist services or the PBS.

It also stated that local doctors must hold leadership roles on the new bodies.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 12

What can we learn from the national rural health conference?

Gordon Gregory writes:

Proceedings at the 11^th National Rural Health Conference in Perth last week demonstrated that, despite how busy health professionals are in rural and remote areas, they have a firm grasp of the risks and opportunities associated with the health reform agenda.

In her speech to the closing session, Nicola Roxon reminded her listeners of the substantial investments the Rudd and Gillard Governments have made in rural and remote health. Not for the first time, the Minister was at pains to emphasise that these rural commitments were in place before the hung parliament added another reason for a regional focus.

The majority of those at the conference were people engaged at the coalface in the real work of managing rural and remote health services. For them the bigger picture is a thing of great importance but of considerable mystery.

Quite how the establishment of Medicare Locals and Local Hospital Networks over the next 18 months will impact on them and their work cannot possibly be clear: if it’s not plain and obvious to the painters of big pictures, it certainly won’t be obvious to the Director of Nursing at Nyngan.

What is certain is that most of the hopes generated through the health reform process of the last three years are now hanging on Medicare Locals. If they succeed (and everyone accepts that it will take some time), there is the prospect of a more integrated primary care system and a better patient journey.

The more ambitious people – and those with even greater patience – even have hopes that Medicare Locals will be effective on the broad primary health care front, by helping at the local and regional level to integrate the contributions that education, food and water policies, housing and public transport etc make to health status. (Handy hint: if the paragraph you’re reading or writing doesn’t encompass primary or secondary education, or food policy, or employment status or community development, it is not about primary health care.)

The health reform process might be described as ‘stuttering’ due to the recent decision of Western Australia to join in and continued uncertainties hanging over the situation in Victoria and New South Wales. Nevertheless people at the conference were optimistic that there is light at the end of the tunnel – and that it is not coming from the construction team extending its length.

For many people, therefore, the future and the success of Medicare Locals is a matter of trust. In rural and remote areas (we argue) surely we can have better access to integrated care from the right person at the right time – and surely a good way to achieve this (we believe) is through us (consumers and providers) having greater local control over our health services. This belief certainly reflects the number one word that was on people’s lips at the Perth conference: empowerment.

So the immediate challenge is to make sure that everyone who ought to be involved in a Medicare Local application is involved.

Some people are calling for a delay in the first tranche so there can be better understanding, more consultation. Others want, at this very late stage, to unpack the whole proposal and re-shape it yet again.

Let’s get on with it I say: how much longer do we all need, how much more patience have we all got!

The Alliance has an agreed set of principles for Medicare Locals – particularly those in rural and remote areas – and the challenge now is to move from theoretical constructs, to getting all the right people involved and committed to acting on those principles.

Seize the Day!

One Comment

1. Duggy the DC3
   Posted March 25, 2011 at 6:31 pm

   The people who truly understand the needs of Rural and remote health are too busy trying to deliver what they can with the limited resources they have, in an underfunded and undermanned sector. The people who have the time, inclination and Corporate Knowledge to understand such a broad brush approach to reform simply must acknowledge that consultation is the key or the whole thing becomes another Disaster of administrative incompetence.

SSWAHS = SWSLHN + SLHN and the NSW State Election - 2

What has the NSW Coalition promised for health?

March 27, 2011 – 2:31 pm, by Melissa Sweet - Croakey on Crikey

"What will the change of Government mean for health in NSW?

"These are the headlines of what has been promised, according to the incoming Health Minister Jillian Skinner’s website.

• An extra 1,390 beds and 2,475 more nurses for the NSW health system. This includes 550 more beds and 275 more nurses over-and-above those currently promised by Labor at an additional cost of $340 million

• Increased funding for chronic disease management by $57 million to improve sufferers’ quality of life and drive down unnecessary hospital admissions.

• Establishment of a NSW Mental Health Commission, based on best practice models around the world, including the Western Australian Mental Health Commission. It will also provide quarantined and accountable funding for mental health expenditure; and establish three specialist units within the Mental Health Commission to better manage the experience of mental health patients and carers, divert mental health patients away from the prison system, and help ensure a smooth operation of the Mental Health Review Tribunal.

• Development of a state-wide NSW Pain Management Plan to ease the burden of suffers of chronic pain, improve their quality of life and help them re-enter the workforce. They will also maintain existing pain management and research programs across NSW.

• Establishment of an Office of Preventative Health. Located in South West Sydney, the office will have a state-wide focus and be established in partnership with the University of Western Sydney.

• A NSW Liberals & Nationals Government will fix hospitals (a promise that will no doubt come back to bite!) by investing over $3 billion in health infrastructure over the next term of government. The $3 billion investment includes an injection of an additional $885 million to fast track hospital upgrades, redevelopments and other health infrastructure priorities over the next four years, as well as the existing health infrastructure projects in the State Budget.

• A NSW Liberals & Nationals Government will appoint Peter Wills AC to help develop a 10-Year Medical Research Strategic Plan for NSW. They will also boost medical research in NSW by $20 million to drive innovation aimed at providing better patient care.

• A NSW Liberals & Nationals Government will commit $10 million to provide local health checks and improved management of chronic diseases is expected to dramatically improve the health of those at risk of, or who suffer from conditions such as diabetes, asthma, obesity and cardiovascular disease.

• A new Telehealth Technology Centre – devised and driven by doctors and their patients will be set up at Nepean Hospital under a Libnerals & Nationals Government in NSW.

• The NSW Liberals & Nationals have announced plans to increase funding for drug and alchol treatment – the first new money for respected bodies successfully treating addictions since the 1999 drug summit.

• The NSW Liberals & Nationals have released a policy outlining its intention to increase funding for the IPTAAS scheme by 50% – an extra $28million over four years.

• NSW Liberals & Nationals will deliver change to close the gap, an article Jillian wrote for the AMA’s medical journal. It was published in NSW Doctor in May 2010.

• A speech Jillian gave to the Australian Industry Information Association in April on e-health

• The Coalition’s plans to reform the management of the public health system are outlined in a document called ‘Making it Work’ released in March 2009.

***

"Meanwhile, we shall wait to see the implications for national health reform. No doubt some senior health bureaucrats are also wondering about their jobs…"

These promises seem very promising but, as far as the Southern Highlands community is concerned, they are short on detail as how these promises will result in improved health services and provide a more substantial, new and enhanced public hospital to meet the needs of our expanding and ageing population. Unfortunately, we may have to wait another four years to find out.

Dr Warwick Ruscoe - SSWAHS = SWSLHN + SLHN and the Medicare Locals - 9

Mediator steps in over Medicare Local rivalry

• By Gemma Collins on 23 March 2011

"An independent mediator has been called in to resolve disputes between rival divisions of general practice bidding to form a Medicare Local in outer Sydney.

Tensions are rising between two consortiums, the South West Sydney Health Coalition (SWSHC) and the Macarthur and Southern Highlands Divisions who have both submitted bids to form a Medicare Local covering the city’s south west region and beyond.

The Federal government’s controversial planned boundaries for the new primary health care organisations means it will be one of the biggest Medicare Locals in the country.

The SWSHC, which includes the Bankstown GP Division, released a statement claiming the Macarthur and Southern Highlands Divisions had been making “certain assertions” over who is going to win the bid.

And CEO of the Bankstown GP Division, Andrey Zheluk, told 6minutes they had been in discussions with the independent mediator on how to resolve the tensions.

“This is what happens when you try and bring together independent organisations,” he said.

“It is not unique to south west Sydney as there are similar problems going on across Australia. But we have been brought together by a government policy and we have to make the best of it.”

The CEO of Southern Highlands Division, Dr Warwick Ruscoe, was contacted by 6minutes but he refused to comment." http://www.6minutes.com.au/

This article is the compelling reason why there needs to be a community response to the inaction and obfuscation of the CEO of the Southern Highlands Division of General Practice - a refusal to comment! When it comes down to the wire the only benefit that the health consumers of the Southern Highlands will obtain is when they agitate, advocate and become activists, for themselves and on behalf of their community.

Take note of what the South West Sydney Health Coalition (SWSHC) and the Bankstown GP Division have been able to achieve while the CEO of the Southern Highlands Division of General Practice has been colluding with his counterpart in the Macarthur Division of General Practice to see how much of the Federally-funded financial pie they can each consume.

In my study of the history of the Age of Enlightenment the above scenario reminds me of the time when the world was divided into two - with what the King of Spain and the King of Portugal each considered to be part of their kingdoms - the Divisions of the Southern Highlands and Macarthur should take a lesson in history and take note of what a relatively small kingdom can do to the expansionist plans of others. The rise of England as a significant power saw the demise of both Spain and Portugal and led to the maps of the world being changed for centuries to come.

So also can it be that a people revolt in the Southern Highlands and the SWS Health Coalition's area of interest can sink the ambitions of the entrepreneurs in both the Southern Highlands and Macarthur Divisions of General Practice!

Write letters of support for the application bid for the SWS Health Coalition to enable them to manage the Medicare Local that will incorporate the Southern Highlands community.

Central DoH&A Office postal address:

Department of Health & Ageing
(Medicare Locals)
GPO Box 9848,
Canberra ACT 2601, Australia

SSWAHS = SWSLHN + SLHN - and the Medicare Locals - 8

To Socrates, the truth about the medical entrepreneurs seem to have a life of its own! Our friendly community and family-focused general practitioners and community organisations in the Bankstown area appear to have had enough of the "spin" from the southern brotherhood of the Macarthur-Southern Highlands Divisions. In their latest media release the SWS Health Coalition have made it very clear that they will not be rolled by the Juggernaut from the south, and that the proposed Medicare Local to be operated by the Macarthur-Southern Highlands Divisions is not a done deal.

All power to the SWS Health Coalition! However, let's take note that we, as community members and consumers of health services, need to support this northern movement for self-determination. Community members are being asked (and expected) to take some control of the planning of health services in their local area: health services that are inclusive of health and welfare organisations, general practitioners, allied health practitioners and public health services.

Rather than wait to have something unhelpful being imposed upon us by the Macarthur-Southern Highlands Divisional consortium in the the roll-out of the Medicare Locals, let us be proactive enough to demand what we know will be of benefit to our local communities rather than passively accepting something being of benefit only to the Macarthur-Southern Highlands Divisions of General Practice.


"Medicare Locals? An open letter to communities, elected officials and families across south west Sydney.

"Medicare Locals are new federally funded organisations that will build stronger links between family doctors, hospitals and other health and community services.

"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 do not represent 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.

"We believe these assertions by the Macarthur- Southern Highlands consortium adversely reflect upon the actions and integrity of the South West Sydney Health Coalition, and on the future formation of a Medicare Local that will serve all local families equally across south west Sydney.

"The South West Sydney Health Coalition is made up of over 20 organisations. The South West Sydney Health Coalition represents health, community and aged care organisations from across south west Sydney, and is now the largest and most geographically diverse collaboration lodging a bid for the Medicare Local in south west Sydney. The South West Sydney Health Coalition is lodging a competitive bid for the entire South West Sydney Medicare Local, ranging from The Southern Highlands to Bankstown.

"Whatever the outcome of the competitive Medicare Local application process, the members of the South West Sydney Health Coalition remain committed to working collaboratively and harmoniously with all family doctors, community and health organisations across the region now and into the future.

"Furthermore, we sincerely hope that individuals’ personal views in this manner will not undermine the genuine efforts of the health, community and aged care organisations in the south west Sydney area to establish a Medicare Local that will ensure a healthy future for local families."

MEDIA
Andrey Zheluk 0425 278 398
Website: www.swshc.org.au

Socrates suggests that we all write to the Canberra office of the Department of Health and Ageing with our letters of support for the Bankstown application to operate the Medicare Local in our area.

Central DoH&A Office postal address

Department of Health & Ageing
(Medicare Locals)
GPO Box 9848,
Canberra ACT 2601, Australia