SWSLHN and Bowral's Health - 7

NSAIDs may block antidepressants

2nd May 2011 - Medical Observer

 
Catherine Hanrahan   all articles by this author

COMMON anti-inflammatory drugs may antagonise the effects of antidepressants, scientists have found.

US researchers analysed the effects of ibuprofen and other NSAIDs on citalopram in an animal model of depression and in a human population.

They showed that in 1500 patients with depression who took citalopram over a 12-week period, 55% of those who had taken an NSAID at least once were treatment-resistant to citalopram, compared with 45% who had not taken an NSAID.

The clinical data was supported in a mouse model, where all the NSAIDs and analgesics tested blocked the antidepressant effect of citalopram.

In vitro studies showed the anti-inflammatories antagonised p11, a biochemical marker for depression. This protein was regulated by frontal cortical levels of the cytokines tumour necrosis factor alpha and interferon gamma, which were also abolished by ibuprofen.

Clinical pharmacologist Professor  Ric Day, from St Vincent’s Hospital and the University of NSW, said the findings may explain why a large proportion of patients are resistant to antidepressants.

However, Professor Ian Hickie, executive director of the Brain and Mind Research Institute, University of Sydney, said the results were contrary to other cytokine hypothesis studies. “Most people have tended to think the opposite – that cytokines appear to be increased in some people with depression and might be driving… things like sleep disturbance, changed body temperature and lack of energy,” he said.

The clinical data could be confounded if taking NSAIDs indicated medical conditions which made patients less likely to respond to standard treatments, he added.

PNAS 2011, online first

Comments:

ondocfarm
2nd May 2011
1:49pm

At the Sydney 11th IASP World Congress on Pain (2005) it was shown that NSAIDS interfere at the midbrain ( RVN & PAG level) level with the opioids and can stop them working. Reference: Workshop 394 Page 154 Abstracts. Christopher Vaughan Uni of Sydney Royal North Shore........ So people on higher doses of opioids should never be given doses of NSAIDS concurrently. I have had a few whose pain levels exploded when given NSAIDS by an unwary doctor!

SWSLHN and Bowral's Health

Plain packaging will hit sales hard, and big tobacco is worried

Craig Seitam

April 20, 2011

An example of what the new plain cigarette packets will look like.

So, the move to cigarette plain packaging will do nothing to reduce the rate of smoking, but it will be a pain in the proverbial for shopkeepers. I'm told this at least once an hour on talk radio, so it must be true.

But things aren't always what they appear to be. I know this as a reformed tobacco executive. I was employed by Rothmans of Pall Mall from 1994 to 1998 in Queensland, NSW and Victoria in charge of about $250 million in annual supermarket sales.

Working for big tobacco is a double-edged sword. Sure, it's a legal product, and you could get hit by a bus tomorrow (although I'd take my chances with the bus versus smoking). Over time, I started to feel the imaginary horns attached to my head, especially when asked by my child's teacher what I did for a living.

But other than that, we ruled the world. In those days, cigarettes made up six of the top 10 supermarket products. Not exactly part of the fresh food mantra, but it wasn't hard to get an audience with the bigwigs at short notice. The guys flogging baked beans and shoe polish had to stand in line. Our products were money in the bank.

The industry was cashed-up and was not afraid to spend it. The laws were slightly more relaxed, and often tobacco retailers had to do no more than sign a lease. The three tobacco companies would fight tooth and nail to do the shop-fit free, and in some cases pay the rent in exchange for the rights to a window display.

The rule of market share dictated that ''if it can't be seen, it can't be sold''. We employed all kinds of surveys measuring our visibility in stores, and lived and died by the results.

For marketing, the brand was everything. People don't just smoke a brand, they are the brand. What's inside the cigarette doesn't really matter, but what the smoker thinks about themselves (true or not) is absolute. If you're a bus driver, but aspire to being an internationalist with a passport to smoking pleasure, you'll buy accordingly.

And it's not just the brand, but the appearance of the pack . . . how it feels, the fonts used: everything was analysed and tested to the extreme.

When NSW tightened the noose on in-store advertising, cigarette package images were replaced with tantalising shots of sunflowers and Uluru. The theory was that people would associate these images with the colour of the brand they smoked. Publicly, the big round of packet health warnings in the '90s was treated as a speed bump. Like a duck on a lake, beneath the surface things weren't so calm. One of our bosses referred to the move as an ''absolute disaster'' and our focus moved to producing retail stands and lighting that deflected from the top of the packet.

Removing cigarettes from visibility in stores has introduced an impediment to the process, but the allure of the brand still remains - even with an ugly health warning. Olive-green packets will not be cool; there will be no differentiation between one brand and the next. Even the mythology, for those of us who remember the Hoges and Stuart Wagstaff TV ads, will disappear.

The tobacco companies invest a lot in research, particularly in statistics. Every move in price and circumstance is modelled to the N-th degree. As the it-won't-affect-us-honestly-it-won't ads increase, you can bet they reflect the anxiety of the industry.

My opinion as a former insider? The proposed plain packaging changes will hit sales hard.

Craig Seitam is a marketing consultant.

Follow the National Times on Twitter: @NationalTimesAU

Read more: http://www.smh.com.au/opinion/politics/plain-packaging-will-hit-sales-hard-and-big-tobacco-is-worried-20110419-1dnbi.html#ixzz1K1Y7Sm8r

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 34

At last, there is something more substantial in the way of the every-growing backlash against the Federal government's Super Clinics and Medicare Locals. Socrates notes that this survey of GPs is of just a small sample, but it does seem to confirm the anecdotal view that there is mass confusion amongst the general practitioners of just what will be the business of the Medicare Locals and of the Super Clinics and how either will in any way change the delivery of health services in the Australian community.

Secondly, it confirms what seems to have been evident in this blog, and elsewhere, that there has been very little information provided to local communities about how the Medicare Locals will operate to improve their local health services. The big exception has been the Bankstown GP Division and their SWS Health Coalition.

Let's hope that the Federal Government budget focusses on what works and what does not when it comes to making cuts in health spending.

GPs: Axe Medicare locals to free up health funding

19th Apr 2011

Byron Kaye all articles by this author

JUST weeks out from what is predicted to be a tight Budget, GPs have pointed the way for the Gillard Government to reach its all-important surplus: freeze the rollout of super clinics and scrap Medicare Locals altogether.

Winding back incentive payments for pharmacists to dispense generic drugs also rated a high mention in MO’s latest national poll of 150 GPs.

Asked where health spending should be cut in the May Budget, 77% of GPs nominated the super clinics program – now $630.4 million deep in promised Commonwealth funding.

Nearly 40% recommended Medicare Locals for the chopping block, freeing up at least some of the $416 million that has so far been committed to their rollout, which begins on 1 July.

“If you took the super clinics money from Canberra, the leverage that you would get would train five times as many students and doctors,” AMA vice-president Dr Steve Hambleton said.

“Nobody can understand anything about whether super clinics are any benefit to the health system at all.”

Health economist Professor Gavin Mooney said the super clinics program was too advanced to be stopped, but “what could be possible and a good thing would be if Medicare Locals were delayed”.

The survey, conducted by Cegedim Strategic Data, also found 45% of GPs wanted to see a reduction in the $1.50 payment that pharmacists receive each time they substitute branded medicines with generic ones.

One area where some GPs and the Government appear to agree is the chronic disease dental scheme, which the Gillard Government claims is costing close to $63 million a month.

Nearly a quarter of those surveyed would be happy to see the scheme axed.

The poll comes as medical researchers held a series of rallies protesting widely tipped budget cuts to the sector of $400 million.

GPs were not short of ideas for where to spend the savings. Two-thirds nominated indexing MBS rebates to inflation as a priority.

Dr Hambleton said the rebates had been “systematically underdone” for years, making out-of-pocket expenses harder for patients to meet.

A quarter of GPs wanted MBS rebates for point-of-care testing (PoCT).

Robert Wells, director of the Menzies Centre for Health Policy at the ANU, said Government support for PoCT was inevitable, but a rebate now could undermine the new funding deal with pathologists. But given PoCT was both safe and convenient, he said, rebates for this should be supported.

This poll was conducted for Medical Observer by Cegedim Strategic Data research company.

Share:

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.

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.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 6

On the Bankstown GP Division Twitter a question was raised about the scope and scale of the Southern Discomfort felt in Bowral about the state of health services and, I guess, about the comments I made about the Southern Highlands Division of General Practice.

My purpose was to draw attention to the extreme variance between the actions taken by the Bankstown Division and the lack of action taken by their counterparts in the Southern Highlands, in respect of the advocacy for a more appropriate Medicare Local. In the case of Bankstown the Division there took an active role in developing a coalition of organisations and other health providers to agitate and advocate for the maintenance of a family focused medical practice. Their community was being supported by the Division and was being invited to participate in the process.

In the Southern Highlands the Division of General Practice has not made any public comment, has not issued any press releases, and has not even published any information about the proposed changes on their website. The whole process of change appears to have become the Southern Highlands Division of General Practice "secret business".

To my knowledge no NGO or community group with a stake in the way in which health services are meant to be delivered has been advised about, or invited to, anything to do with the development of a Medicare Local as a "Branch" or "semi-autonomous rural network". One of my informants has recently advised me that the nearest that any such explanation has been forthcoming is a promise from the CEO of the Division to address some of the local psychologists about what impact the changes may have on their private practices. It also seems that the meeting has only come about because the CEO is a neighbour of the psychologist arranging the meeting.

The question needs to be asked: "Why has there not been the same level of discussion, activity and collaboration with consumers, health care providers and NGOs in the Southern Highlands as there has been in the Bankstown and similar areas?"

Possibly, the Southern Highlands Division of General Practice CEO and Board may feel that they are on top of the issues related to the implementation of the "semi-autonomous rural network" but it seems that the GPs, who the Division purportedly represents, have been left in the dark as much as has been the local community. To my knowledge there has been no dialogue with the GPs, and there certainly has been nothing in the local press. Nor has there been a public meeting for community members, health care providers and health care organisations who will obviously be affected by any implementation of a local Medicare Local.

To the Bankstown GP who asked the question about the scope and scale of the Southern Discomfort I ask "How would you feel if you had no input or feedback as to what was about to (perhaps) radically change the way in which health services would be delivered to you, as a consumer, or by you as a medical practitioner?" My belief is that most people would want to know about the change or, hopefully, want to take an active role in any proposed change. Unfortunately, in the Southern Highlands, no one other than the Division of General Practice CEO and the Board knows of the change, nor has any organisation appeared to have an active collaboration within the process.

Yes, the Southern Discomfort is extensive in scope and scale - and just wont go away.

SSWAHS = SWSLHN + SLHN and the Medicare Locals

Well it seems that it's not just the natives who are rebellious within the re-branded monoliths of the Sydney Local Health Network and the South West Sydney Local Health Network, but the northern GPs are up in arms because they appear to have been forcibly married to the southern GPs in this redevelopment of the health services. The article to follow comes from a meeting of the northern coalition in November 2010.

On the other hand, the Southern Highlands Division of General Practice has been remarkably silent about the transition, appearing now as they do as a "branch" of the Macarthur Division of General Practice which, effectively, now extends from Fairfield through to the Southern Highlands.

There have been no announcements on the Southern Highlands Division's website about the proposed liaison with the Macarthur Division. One wonders whether the Southern Highland's 63 or so GPs have had any say in the matter of where they want to be lodged and how they want to be represented on the Board of the Macarthur Division of General Practice.

The normally vocal Chief Executive and the Board Chairman of the Southern Highlands Division have been remarkably coy about what they are planning. Perhaps, it has become secret Board business. The Division's "Highland Doctor" has not been published (publicly) since July 2010 so either the area's GPs are being kept in the dark, along with rest of us, or they have felt the local Division has been so ineffective that they don't care about what happens to it.

Obviously, those GPs in the far north of the new Medicare Local do care and this is what they have to say:

GPs reject giant health bureaucracy in South West Sydney

by the South West Sydney Health Coalition - 05/11/2010

A report, prepared by Cranny and Associates proposes a giant bureaucracy in south west Sydney, ranging from Bowral to Bankstown.

Under proposed changes, family doctors influence over local issues would be silenced, putting at risk the promised benefits of government reforms to family medicine.

On the evening of November 4, over 150 GPs, health,and community leaders met at the Bankstown Sports Club to launch the South West Sydney Health Coalition, to call on the government to reject the proposal for a single giant health bureaucracy.

Mr Alan Ashton MP and Mr Tony Stewart MP attended the launch.

Community leaders included Dr. Ken Cho, from the Fairfield Liverpool Association of Medical Practitioners, Dr. Vinh Bin Lieu of the Vietnamese Australian Medical Association, Mr. Harry Allie, of the ATSI Advisory Committee Bankstown City Council, Mr. Si Banks of the Pharmacy Guild, Ms. Randa Kattan of the Arab Council of Australia, Dr.N.C.Patel of the Australian Indian Medical Graduates Association, Ms. Gunjan Tripathi from the Cancer Council, as well as the CEO of the Macarthur Division of General Practice, Mr. Rene Pennock.

At the launch, Dr Jim Gillespie first spoke about proposed changes to hospitals and family medicine. He described how communities now have an opportunity to shape their future health.

The Coalition was then launched by Dr. Sue Harnett, Chair of the Bankstown GP Division.

“We have real concerns that Bankstown, Fairfield and Liverpool are going to miss out on the benefits of family medicine reform,” said Dr. Harnett.

“The Cranny Report proposed much smaller locally connected organisations, “Medicare Locals,” in the wealthier parts of Sydney, and a giant disconnected Medicare Local for the economically deprived, ethnically diverse and fastest growing south western Sydney region,” she said.

“A single giant bureaucracy won’t fix the health problems in Bankstown, Fairfield and Liverpool - some of the most diverse and disadvantaged parts of Sydney.”

“Two smaller Medicare Locals are the only solution – a South West Sydney Medicare Local covering the natural grouping of Bankstown Fairfield and Liverpool, and a Macarthur – Southern Highlands Medicare Local, serving the fast-growing suburbs south of Liverpool”, said Dr. Harnett.

“Given that the government is now looking for local ideas, we have a once in a lifetime chance to change health for the better,” said Dr. Harnett. “This means family doctors working more closely with hospitals, other health professionals, local government, and actively engage the strengths of our many diverse community organisations.”

“We now call on families, individuals, health professionals and community organisations to join us, to contact their local MPs, and together, to shape the future of health in south west Sydney.”

This raises an interesting point for the residents of the Southern Highlands. Do they want to be in a Mega Medicare Local (from Fairfield to Bundanoon) in which the population is so skewed in age as well as in cultures, or do they think it would be any better to be connected as a branch with the Macarthur Medicare Local in which the population is equally skewed in age and cultures.

I find it abysmal, though not surprising, that Dr Warwick Ruscoe and Dr Vince Roche and their fellow Board members of the Southern Highlands Division of General Practice have not bothered to see what local residents have to say about this marriage they propose. Surely the patients who are the health consumers do have a right to make their views heard. Where has there been any public discussion about a significant effect that such amalgamations will have on their patients. Dr Ruscoe your silence has been deafening.