A Health System More Responsive To Patient Needs Is A Cure-all For Many

Sydney Morning Herald

Monday January 23, 2006

Judy Lumby Professor Judy Lumby is executive director of the College of Nursing.

Medical services need to change their focus beyond the traditional role of the doctor, writes Judy Lumby.

IN A world where the buck-passing between state and federal health ministers renders meaningful change all but impossible, the Productivity Commission's Australia's Health Workforce report is a wake-up call.

By honestly addressing what governments and ministers have grappled with for more than 60 years, the report identifies key competing interests that impede change, and outlines proposals to move towards a more sustainable system which is equitable in its distribution of care and cost.

The present structural and hierarchical arrangements of our health-care system were established at a time when the health workforce, available technology and patient populations were very different to today. Cardiac surgery was rare, organ transplantation unthinkable, the mentally ill were institutionalised, major trauma cases died at the site, and bush nurses and honorary specialists were available around the clock. In those days, hospital nurses and midwives were not university educated and general practitioners were the linchpin of health care.

Those days have long gone. The Productivity Commission has recognised this by addressing the "systemic impediments in workplace arrangements that reduce efficiency, effectiveness and responsiveness" in its latest report.

The commission has proposed radical changes to the system for registering and accrediting the health workforce. Not only will these changes remove unnecessary and costly duplication and inefficiencies, more importantly, if adopted, they will lead to a much-needed standardisation of practices and education nationally. The report also embraces the full scope of the health workforce rather than focusing simply on doctors. After all, increasingly common chronic conditions such as Type II diabetes and dementia are not necessarily amenable to technology or surgery, but require long-term lifestyle management, habilitation and care.

Optimising levels of service matched to the needs of patient populations is both a moral and practical endeavour. Patient needs should determine the level and type of practitioner required, particularly given that it is taxes paid by patients, insurance and up-front fees that fund the services provided. This is borne out by the increased demand for certain services not routinely available in hospitals or through GP services.

These are in areas of traditional therapy such as acupuncture, chiropractics and Chinese medicine. Many of these practitioners are not required to register or obtain accreditation, and many are not included on the medical benefits scheme schedule despite being qualified and experienced. But they obviously meet a much-needed gap in the system for patients.

The commission recommends establishing an independent health workforce improvement agency to aid innovative workplace reform, while ensuring the quality and safety of care. If followed up, this would go some way to overcoming the sort of resistance to reform such as that which lengthened and complicated the introduction of nurse practitioners and independent midwives.

The commission's proposal for more responsive education and training arrangements with a better alignment of courses, graduates and workforce needs of hospitals and the population, while sensible, would require far-reaching reform against strong resistance.

Even so, the sooner we begin the better.

Opening up medical benefits rebates to a range of health practitioners beyond just doctors trained in Western medicine has tended to draw most popular interest, but this was inevitable given the failure of the present system to adequately meet the needs of patients in a timely fashion.

While someone with a life-threatening illness will usually receive immediate, life-saving care following admission to a hospital, the greater number of people who are sick struggle to find their way through a confusing system of clinics, referrals, lengthy waiting times, changing faces, multiple prescriptions - and often, differing opinions.

Surely we can offer a simpler system, which is set up for patients rather than health professionals.

The health-care system should be about matching patient need with service and skill. After all, patients need different kinds of care at various stages of their illness. There is no evidence that doctors are unique providers of the very best care for an individual, indeed quite the contrary. In reality, many others are already providing primary, secondary and tertiary-level care with excellent outcomes.

At last, at the highest level, we have the offer of solutions which could begin rebuilding the health-care system from the ground up rather than continuing to spackle the edges of a crumbling foundation.

This will surely be Tony Abbott's ultimate test of courage.

© 2006 Sydney Morning Herald

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