Health needs must over-rule Treasury
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