Health needs must over-rule Trea­sury

The Weekend Australian - Travel - - Health -

DR Michael Wooldridge fa­mously re­marked that the Aus­tralian health min­is­ter needs to de­cide whether he or she is the Min­is­ter for Health or the Min­is­ter for Health Fi­nanc­ing. That is, the key role of the na­tional health min­is­ter is to ad­vo­cate for those strate­gic in­vest­ments that will de­liver real health and so­cial ben­e­fits. There is no doubt that Trea­sury and Fi­nance will al­ways ad­vo­cate for re­duced ex­pen­di­tures.

Of course, work­ing fam­i­lies’’ wish to pay less tax, lower private health in­sur­ance pre­mi­ums and less out-of-pocket health ex­penses. For­tu­nately, the com­mu­nity does have an un­der­stand­ing of what is re­ally at stake in the wider health de­bate. When asked, the com­mu­nity has con­sis­tently pri­ori­tised new in­vest­ments in child health, in­dige­nous health and men­tal health.

In 2006, then Prime Min­is­ter John Howard and NSW Pre­mier Mor­ris Iemma recog­nised those com­mu­nity con­cerns and led the bold new $4 bil­lion in­vest­ment in men­tal health re­form. In 2008, the fu­ture of that re­form process is now in the bal­ance. Health min­is­ter Ni­cola Roxon needs to make it clear she will con­tinue to im­ple­ment that process by in­vest­ing in gen­uine men­tal health re­form.

To its credit, the Rudd Gov­ern­ment has in­di­cated that men­tal health is an on­go­ing health and so­cial pri­or­ity. It will es­tab­lish a new na­tional ad­vi­sory body that in­cor­po­rates gen­uine com­mu­nity voices. Im­por­tantly, the Gov­ern­ment has hon­oured its elec­tion com­mit­ment to fund the roll-out of a new na­tional peri­na­tal men­tal health pro­gram in part­ner­ship with the states.

The Prime Min­is­ter’s di­rect sup­port for new early child­hood pro­grams is also likely to re­sult in ear­lier recog­ni­tion and man­age­ment of early-on­set be­havioural and de­vel­op­men­tal dif­fi­cul­ties.

Roxon has in­di­cated her per­sonal sup­port for im­proved men­tal health. Un­like her pre­de­ces­sors, she has taken di­rect re­spon­si­bil­ity for this area. She has also pri­ori­tised child and pre­ven­ta­tive health care — both key fac­tors in im­prov­ing men­tal health.

Times get tough for a health min­is­ter, how­ever, when Trea­sury sig­nals that sav­ings, rather than new in­vest­ments, are the or­der of the day.

In Aus­tralia, we strug­gle to de­liver 21stcen­tury men­tal health care via our hos­pi­tal­cen­tric and 19th-cen­tury sys­tem.

Of the $1.9 bil­lion al­lo­cated by the Com­mon­wealth in 2006 for the de­vel­op­ment of new men­tal health ser­vices, over $500 mil­lion was tar­geted for new psy­cho­log­i­cal ser­vices. Sadly, the Howard Gov­ern­ment chose to de­liver th­ese much-needed in­ter­ven­tions largely via tra­di­tional fee-for-ser­vice ar­range­ments.

The end re­sult has been an over­spend of funds, a lack of ac­cess to clin­i­cal psy­chol­o­gists in re­gional and rural ar­eas, un­ac­cept­ably low bulk-billing rates (about 30 per cent) and sig­nif­i­cant out-of-pocket ex­penses.

By con­trast, a fur­ther $191 mil­lion was al­lo­cated for de­vel­op­ment of an in­no­va­tive model of com­mu­nity-based men­tal health nurs­ing. Th­ese new ser­vices work in part­ner­ship with private clin­ics or GP-based ser­vices to de­liver op­ti­mal forms of col­lab­o­ra­tive care.

This is ex­actly the type of multi-dis­ci­plinary and or­gan­i­sa­tion-based ser­vice de­vel­op­ment that Aus­tralia des­per­ately needs. It only pro­vides funds to the nurses when they work in close co­op­er­a­tion with the doc­tors and other health pro­fes­sion­als.

Un­for­tu­nately, this ex­cit­ing new de­vel­op­ment has stalled due to a lack of high­lyqual­i­fied nurses. The al­ter­na­tive model of fund­ing nurses to work un­der su­per­vi­sion un­til they de­vel­oped the nec­es­sary skills was never sup­ported. The model of ju­nior staff work­ing un­der the su­per­vi­sion of more se­nior staff is the way pub­lic hos­pi­tals train nurses and doc­tors of the fu­ture, while en­sur­ing that we pro­vide ef­fec­tive ser­vices to­day. So, what has hap­pened? Pre­dictably, the pro­gram has not used the al­lo­cated funds. In­stead of re­fram­ing the project to sup­port this crit­i­cal ser­vice de­vel­op­ment, $188 mil­lion was re­turned in the 2008 bud­get to con­sol­i­dated rev­enue.

Al­though, the Gov­ern­ment will sup­port train­ing schol­ar­ships, it has done noth­ing to en­sure that the com­mu­nity-based ser­vices re­quired to train those nurses are avail­able.

For those of us who have pushed hard to get new monies into men­tal health — and par­tic­u­larly to get new monies into new and in­no­va­tive ser­vice mod­els — this is a great dis­ap­point­ment. Un­less the Min­is­ter for Health, and the Prime Min­is­ter, take a strong stand, key ar­eas such as men­tal health and pri­mary care (which lack his­toric in­fra­struc­ture and hospi­tal-based work­forces) will al­ways lose the fi­nance game.

For the men­tal health needs of the com­mu­nity to be met, tough de­ci­sions need to be made. If we sim­ply give in to the ex­ist­ing pro­fes­sional groups and con­tinue to cut the new or­gan­i­sa­tion-based men­tal health ser­vice de­vel­op­ments, then we know who will miss out. It will be work­ing fam­i­lies’’, the young, the so­cially dis­ad­van­taged and those who live in re­gional and rural ar­eas.

It is now time for the Rudd Gov­ern­ment to in­vest real money and real po­lit­i­cal cap­i­tal in new and in­no­va­tive men­tal health pro­grams. To do so, the min­is­ter will need to chal­lenge the ex­ces­sive in­flu­ence of the pro­fes­sions.

Col­lec­tively, the pro­fes­sions de­mand na­tional in­sur­ance for in­di­vid­ual prac­tice mod­els that al­ways fail to de­liver ac­ces­si­ble, af­ford­able and high qual­ity care.

Ad­di­tion­ally, she will need to en­sure that the com­mon­wealth funds the com­mu­nity work that trainee nurses can de­liver now, as well as fund­ing the train­ing ex­pe­ri­ences that will al­low them to func­tion in­de­pen­dently in the fu­ture. Pro­fes­sor Ian Hickie AM is ex­ec­u­tive di­rec­tor of the Brain and Mind Re­search In­sti­tute at the Univer­sity of Syd­ney

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.