Vice President's Message

By Prof Geoffrey DobbAlready 2012 looks to be no less challenging for those working in health care than any of the last few years. 

With a new Minister at the helm there is the opportunity for reappraisal of Government health policy.  Certainly, the AMA wishes Minister Tanya Plibersek well in her new role in Health, always a most challenging portfolio.

It can be argued that the Government has given greater weight to Health by having two Ministers with Health portfolio responsibilities within Cabinet.  Minister Mark Butler’s focus on Mental Health and Ageing gives him areas that have experienced years of relative under-resourcing, combined with escalating and unmet demand, which will make his job particularly challenging.

Minister Butler’s Department will be watching closely for fallout from the cuts to the Better Access Scheme in general practice.  Will we see an increase in services provided with a patient gap?  Will there be an increase in referrals to public hospital psychiatric services?  Will more patients need acute admission for psychiatric care in the public and private sectors?  Will all of these occur?

The evidence from the frontline is that mental health services are already stretched to breaking point every day.  For example, it has not been unusual for patients to wait for days in our Emergency Department - surely the most inappropriate environment for acutely disturbed patients - before a psychiatric ward bed becomes available.

A better answer for patients, and almost certainly more cost-effective for the health system as a whole, is for treatment to be available in general practice and the community to prevent deterioration to the point where hospital admission is the only option.  Many GPs have had additional training in mental health.  Perhaps 2012 will bring the announcement of new programs that can make the most effective use of this resource.

General practice also holds the key to the health needs of the Ageing component of Minister Butler’s portfolio.

A priority should be improving the access to medical care within residential aged care facilities.  It is clear that the current business model for general practitioner services just doesn’t work. 

Corporate practices, in particular, with their responsibilities to shareholders, will only be involved if the business model works.  The AMA has called for a doubling of the MBS rebates for services in residential aged care to ensure it does.  Hopefully, somebody somewhere is modelling this initiative for presentation to the Council of Health Ministers.  Without it, an ambulance trip to the local hospital will remain the only option for access to health care, not the last resort that it should be.

Both Ministers, and Parliamentary Secretary Catherine King, are no doubt acutely aware of the need to work closely as a team across the broad Health portfolio.  Their challenge will be to ensure that their staff and public servants share this approach and maximise integration and prevent new silos developing.

The bureaucracy is an overhead on health expenditure that needs to be minimised whenever possible to maximise the resources available at the frontline.

This is the year when some of the Government’s health reform programs become fully operational - the Independent Hospital Pricing Authority, more comprehensive reporting to the performance authority, ‘Medicare Locals’, and Lead Clinician Groups, for example.

Ensuring that these contribute to more effective and efficient health care, rather than just increasing the administrative overhead, will challenge all with a health care portfolio, especially in a Government committed to achieving a budget surplus.

I hope 2012 is happy and productive for Ministers Plibersek and Butler, and Parliamentary Secretary King.  The AMA looks forward to working with them to bring our perspective from the frontline of medicine in what promises to be a challenging year.