 | Peter Sayers |
Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability. | |
Following on from the Rudd/Abbott debate on health reforms a great deal of expected commentary resulted. That statement is so sensible it is hard to think in any other terms. When Nicola Roxon first took up her position as Minister for Health and Ageing she came out in strong support of prevention, which meant a large slab of primary health care that pharmacy expected to be part of.
One of the better versions was published in theage.com.au and is found at this link:
http://www.theage.com.au/opinion/society-and-culture/health-system-is-more-than-just-hospitals-20100324-qwmg.html#comments [2]
The article was written by Trevor Carr, who is chief executive of the Victorian Healthcare Association, that represents public hospitals, rural and regional health services, community health services and aged-care facilities in Victoria.
He states:
"The focus on beds and waiting lists ignores the role of primary care.Reform should move the health system from its current simplistic emphasis on hospitals and waiting lists to a system of interlinking elements that include acute care, primary care, early intervention, health promotion and illness prevention."
Her first foray was to establish GP super clinics.
They have been progressively introduced, but establishment costs seem to be a problem.
Also, the role of pharmacy within these clinics has never been properly negotiated or thought through.
open this article full screen [3]
"The debate between Kevin Rudd and Tony Abbott has failed to deliver any suggestion of health system reform. Instead, it concentrated on credentials for economic management and trust, and as a result has simply reinforced the status quo model of health service, albeit under different administrative arrangements."
If this is truly the intent of the current government then we are going to witness a health disaster.
The current system is intolerable to those who have to make it work, and positive changes must occur.
The last successful model for a public hospital system in NSW was the local board version with a mix of requisite skills involving maximum support from the local community.
This worked and I can recall always paying into the highest table in the hospital fund because it was affordable!
"All we know of the opposition's health policy is that it will devolve governance responsibility to boards in NSW and Queensland. While not expecting a complete policy, it may have helped the Opposition Leader to, at the very least, identify the key alternative principles of reform the conservatives would apply if in government."
More detail here would have definitely gained more "brownie points".
"In releasing his health policy in pieces, the Prime Minister lends support to a view that hospitals, primary care and prevention are separate functions within the health system. They are, in fact, functions that must successfully meld as one to create the health system. Rudd refers to integrated health system reform but does not clearly articulate how his proposed changes will achieve this."
As currently structured, hospitals, prevention and primary care exist as separate functions.
The gears do not mesh and they must become integrated.
All the players in health clearly see that perspective - why not government?
"His reform agenda splits responsibility for the healthcare system between funding (Commonwealth) and distribution (states). The Commonwealth government's decision to take on 60 per cent of the efficient price of hospital care is not reform, nor will it end the blame game.
To end the blame game, the Commonwealth must assume 100 per cent funding responsibility. A total takeover would enable new approaches to service delivery that could reduce demand for hospital bed-based services."
A complete takeover of the public hospital system was a core election promise by Rudd.
If this is not addressed, Rudd will lose votes at the next election as the opposition list all of the shortcomings of Labour's policies and performance deficiencies.
This requires a funding model that creates and encourages choice in clinically safe service options - be they bed-based, ambulatory care centres, or home treatment.
A "pharmacy in the home" service is looming as a very real option for pharmacy in its race to stay relevant, viable and visible.
A community pharmacy delivering this service on a broad front will not need a prime retail position to operate. Pharmacies wishing to provide a range of professional services will be able to do so in lower rent locations and direct the funds saved in this major expense towards the employment of extra pharmacists, by contract or in-house.
"If Australia can reduce hospital demand by 5 per cent, it will free up $1.6 billion nationally to develop primary care options. Unfortunately, activity-based funding will not achieve this goal, as it merely reinforces a service model that requires admission and discharge from a hospital bed - a high-cost option."
Every effort needs to be made to prevent hospital admissions from occurring unnecessarily.
"Pharmacy in the Home" programs would go a long way to meeting this objective.
Further, "Hospital in the Home" programs that have been properly established and introduced also go a long way to meeting this objective.
Originally the federal government provided seed funds to introduce this service provided the area health service picked up ongoing funding after the seed funds ran out.
Even when careful monitoring disclosed major savings, the majority of health services simply left the program starved, so they progressively closed down.
I personally spent countless hours determining stability of antibiotics in pre-filled delivery devices (pumps, syringes etc) to successfully keep people out of hospital beds and even going to work with pumps attached discretely.
This is an activity that both hospital and community pharmacists can develop in partnership.
"With 75 per cent of hospital costs consumed by wages, there is little doubt that reducing industrial demarcation issues that stymie the most productive use of scarce health professionals represents the greatest potential to efficiency.
Industrial relations remains a state responsibility under the Prime Minister's reform agenda. In proposing a funding model based on the efficient price, the Commonwealth government must ensure industrial reform that enables efficiency."
The simple fact is that hospital employees have been stretched for so long "doing more with less" they are simply exhausted. Motivation has been destroyed and people struggle to balance their professional obligations against the resources provided.
Workplace bullying has also increased as managers introduce fear as a means of covering their own backsides, and to get things done.
This process never works - it just destroys productive workplaces.
"That efficient infrastructure is essential to efficient pricing was confirmed in work commissioned last year by the Victorian Healthcare Association from Access Economics. In Victoria alone, an estimated $10 billion will be required for the next decade to ensure the infrastructure needed to service the Victorian health system is of a contemporary standard, and provides equal opportunities for health services to work to an efficient price.
There is no indication that anywhere near this level of investment is being contemplated by either side of politics at the national level."
And so we arrive at the real reason for Rudd not taking over the hospital system.
He lacks the political will because he knows there are insufficient funds-now or later.
"It is disingenuous of the Prime Minister to suggest that system improvement can only be achieved by directly funding local hospital networks. Victoria - the ''efficient'' state - currently receives the funds from the Commonwealth and redistributes them through an activity-based formula to hospitals that are independently governed by boards.An alternative is for the Prime Minister to seek nationally agreed minimum standards for service access and service quality as a prerequisite for the transfer of funds from the Commonwealth to the states. The proposed local hospital network model could represent the minimum standard in such an arrangement, therefore allowing the continuation of a higher standard, as represented by the Victorian model.
To fund its reform, the Commonwealth wants to retrieve from the states a third of their GST allocations. For the Northern Territory, this equates to $900 million when combined with its health special-purpose payment, at a time when its acute health budget is under $600 million. It is imperative that the Commonwealth's fiscal assessment be transparently debated, as the current proposal adds up for very few states."
Rudd should listen more closely to those people already delivering primary healthcare - right to the coalface. Listen and then work backwards to the middle ground of infrastructure building from the bottom up.
Once in the middle ground a fusion with the "top" will make more sense, because the current "top down" delivery mechanism will never work - the distance separating top from bottom is too great.
It is a high cost process.
"Unfortunately, the health complications associated with ageing have become an inconvenient truth to policymakers working within election cycles. More money is needed to ''fix'' the problem. More investment is needed in primary care options. More leadership is needed in changing the key performance indicators of system effectiveness away from waiting list data to a focus on reducing bed demand through primary care initiatives."
The anti-ageing and aged care markets represent the biggest opportunity pharmacy will ever see.
Unfortunately, the division between professional service pharmacists and pharmacies currently prevents this from occurring.
It is time the PGA abandons its power plays.While it may satisfy some egos, most of the profession simply wants to lift its game and flesh out the core business of primary care, particularly in the areas of preventive medicine, aged care and anti-ageing services.
A whole of profession approach where the pharmacy provides infrastructure and the pharmacist provides professional service will help to restore an appropriate balance.