April Newsletter Web - National Rural Health Alliance

Newsletter
April 2015
Regardless of what happens as a result of any
Mental Health Plan or Review, rural and remote
consumers have a right to a more comprehensive,
local (or near as possible) service which meets their
specific needs.
In This Issue
- Marg talks about the importance of
consultation on mental health issues facing rural
and remote communities.
People living in regional, rural and remote areas of
Australia make up 30 per cent of the population,
but do not receive anywhere near 30 per cent of
funding and services for mental health.
- Primary Health Networks are coming but that
does not spell the end for Medicare Locals.
- Consumer Advisory Committees: we pose
some frequently unanswered questions.
That is just not good enough! No wonder there is a
huge unmet need.
- Choosing Wisely: are we being over serviced?
The Review found:
- What does the RFDS actually do?
… high levels of unmet mental health need in rural
and remote communities which require immediate
attention.
- Bowel cancer screening tests: there will be
more of them in the future, but there’s a
problem.
Further, this inequity compounds the mental health
challenges facing the significant numbers of
Aboriginal and Torrens Strait Islander people living
in in these areas.
- Medicare is set for a major review and
everyone seems to like the idea.
From The Chair
Given the persistent difficulty in expanding face-toface services and workforces in these areas, we
need innovative, local ways of mitigating this
situation in the short term, while adopting a longterm focus to improve quality and outcomes. These
should be locally targeted to take into account
community- specific issues.
This month I will be quoting from the National
Review of Mental Health Programmes and Services
Fact Sheet 3 and commenting from a rural and
remote consumer perspective in regard to mental
health.
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We have all experienced the so called short term
quick fix programs but sadly they hardly ever have
positive outcomes, mainly due to people being
very hesitant to actually enrol and begin a
program. Why? Because a lot of the time the short
term fix is not followed on by a long term solution.
Community people must be included in both a
personal consultation as well as a broader
conversation in regard to what is really needed in
their individual communities.
PHNs Take Shape
Health Minister Sussan Ley this month announced
that Australian patients are set to receive better
access to frontline health services in their local
area…
Just think about that for a minute. It’s a big call.
Minister Ley’s optimism springs from the fact that
31 (or thereabouts – we’re not exactly sure yet)
new Primary Health Networks (PHNs) will officially
begin operations from 1st July replacing the 61
Medicare Locals set up by the previous Labor
Government. The Minister has released the list of
successful applicants which were selected through
a tender process run at arm’s length by the
Department of Health.
Recognition of other forms of patient consultation
can have positive outcomes, such as video links
and telephone hook ups, BUT they are not always
the most appropriate for particular patients.
Remember that people are nervous, could have
experienced stigmatisation or face other personal
issues.
We are not sure exactly who was at an arm’s
length during the tender process – the
Government or the Department of Health – but the
important thing is that decisions have been made
and, with only a couple of months to go, probably
not before time.
We also need professional people on the ground
and expansion of the current workforce is required.
Let`s all get behind this Review and put forward
our comments. We live in rural and remote
Australia, so we know the needs of our
populations, be they hundreds or thousands.
Minister Ley listed six key areas she wants the new
PHNs to focus on:
Mental Health service provision is vital for us!
- Mental health
- Aboriginal and Torres Strait Islander health
- Population health
- Health workforce
- e Health
- Aged care
Marg Brown
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The Minister also makes it very clear in her media
release that she was not a big fan of the soon-to-be
-defunct Medicare Locals:
could be a foot in the door for them and that their
primary focus would be to look after the interests
of their members rather than address the health
needs of the whole community, including the
uninsured.
The key difference between Primary Health
Networks and Medicare Locals is that PHNs will
focus on improving access to frontline services, not
backroom bureaucracy.
Of course, the same might be said about other
members of the PHN Boards in that there is a
temptation for each of them to look after their
own. Doctors could tend to look after doctors’
interests; hospitals could focus on hospitals;
universities could be expected to work to the
benefit of universities and so on.
Hardly anyone favours backroom bureaucracy
anymore.
Interestingly, despite the criticisms, we are told a
significant proportion of the new Networks will
have Medicare Locals as a dominant or major
partner in the consortiums running them. Other
groups include doctors, allied health providers,
universities, hospital networks and, perhaps a little
ominously, private health insurers.
In fact, let’s face it – the only group we are sure has
the interests of health consumers at heart is…
well… health consumers. So what kind of influence
will we have in this brave new PHN world? While it
is doubtful that many of us will sit on any actual
governing bodies, we will get to have some input
through (the now almost compulsory) Consumer
Advisory Committees…
Shadow Health Minister - Catherine King – believes
that allowing private health insurers into the mix is:
…opening a way for them to interfere in the
relationship between doctors and patients and
expand their reach into general practice.
Consumer Advisory Committees
She also believes:
We told you the CACs back in July of last year.
Allowing private health insurers to run PHNs is the
first step towards a two-tiered health system with
health insurance members able to jump the queue.
They are to be a formal part of the process, report
to their PHN board and collaborate with their
Clinical Council. Their role will be to reflect the
diversity of their region, ensure local accountability
and promote patient centred care. The aim is to
ensure all patients and local communities can
provide feedback and have direct input into their
PHN.
Ms King may have a point. While the role of private
health insurers in the PHN consortiums is still a bit
vague, (we understand the insurers will have no
operational role and are to be involved only as
support players at this stage) the fear is that this
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That sounds fine on paper and HCRRA is basically
very supportive of the idea but, given we are so
close to kick off, we would have hoped for a few
more specific details by this stage. Basically, we
want to know if the CACs are going to have any
teeth.
A Few More PHN Issues
The Department of Health has helpfully provided
some informative answers to a number of
Frequently Asked Questions regarding PHNs:
First, we know the new Networks will operate
under an outcome focused performance
management contract with the Department of
Health. What we don’t know is what the
ramifications will be if their performance is not up
to scratch – a strongly worded email, a
disapproving scowl across the conference table
perhaps?
At the risk of appearing a bit negative about PHNs
(we’re not), there are just a few more things we
think need a bit of clarification.
http://bit.ly/1yt3HTF
But there wasn’t much on the CACs themselves. All
we really know is that:
PHNs will be expected to ensure that Community
Advisory Committee members have the necessary
skills to participate in a committee environment
and are representative of the PHN.
Secondly, the sheer size of some of the PHNs is
obviously an issue. One look at the boundary map:
http://bit.ly/1wL9RZ9 will leave you wondering just
how the vast areas involved could possibly be
serviced by just one network and the diverse needs
of consumers taken into account by a single CAC.
As far as we can tell, the questions we raised last
July have gone unanswered. So, in an effort to
make them frequently asked and get them on the
agenda, we will ask them again:
Finally, we know PHNs will only become involved in
the direct provision of services where there is a
clear case of market failure. This is a concept which
can be open to interpretation and probably needs
to be clearly defined in this instance. For example,
under any definition, the market has not provided
a solution to the patient transport problems which
plague rural and remote areas. As we suggested
previously, travel to access care is an intrinsic
aspect of healthcare in the bush and must surely
fall within the jurisdiction of the new PHNs.
-What is the actual selection process to decide who
will represent consumers on the CACs? Will local
communities be involved or are we leaving it solely
up to the PHN board?
-Will consumer reps be funded to compensate them
for their time and expenses? Surely this question
should not be left up to individual PHNs to decide.
-What structures will be put in place to ensure they
are formal part of the process and that their views
be genuinely considered? Our fear is that CACs
could just become a ‘ticked box’.
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Choose Wisely
What You May Not Know About
the RFDS
This month will see the introduction of a new
initiative which has the potential both to reduce
health costs and, at the same time, deliver better
outcomes for patients. Choosing Wisely Australia
will be facilitated by the National Prescribing
Service and will aim to:
A little while back we had the opportunity to share
office space with a couple of very nice people from
The Royal Flying Doctor Service (Hi Lauren and
Martin). They were in the process of moving into
new premises and were kind of homeless at the
time. Putting HCRRA and the RFDS together for a
while seemed like a good fit.
…identify tests, treatments and procedures which
that are commonly used but can often provide no
or limited benefit to the patient and in some cases,
lead to harm.
Like most people, we knew what the RFDS was
about and complimented them on the great work
their organisation did in evacuating sick or injured
people from remote areas. They accepted our
plaudits with a kind of resigned grace but were
quick to tell us that retrieval was only one part of
what their organisation actually did, pointing out
that in fact the majority of their efforts went into
providing primary healthcare services directly to
rural and remote areas.
What are these tests, treatments and procedures you
ask? For a start, think about things like:
- Investigations for fatigue
- X-rays and other scans for back pain
- Vitamin D tests
- Medicines for acid reflux
We learnt that the RFDS use their bases located
around the country to provide rural and remote
residents with access to medical professionals,
pharmaceuticals and first aid as well as medical
and nursing clinics run on a regular basis. Just to
give you an idea, in the past year, over 29,000
patients attended RFDS GP clinics, over 9,000
attended Community Health Nurse clinics and GPs
specialising in remote health provided around
82,000 consultations over the phone or by radio.
- The use of antibiotics
The program will be led by health professionals
(with consumer input) and should, at the very
least, encourage some interesting conversations
between doctor and patient.
Choosing Wisely will be based on similar campaigns
already operating in the US and Canada and you
can keep up to date using the Twitter handle:
@ChooseWiselyAu
One day a very substantial, securely-locked green
box arrived at our office. It turned out to be a RFDS
Medical Chest and, after a bit of persuasion, we got
to have a look inside. There was enough stock in
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there to set up a fair-sized pharmacy. It turns out
that these chests have been around, in one form or
another, for about 75 years and the RFDS currently
has over 3,000 of them in remote locations around
Australia – places like police stations, hotels,
mining sites, schools and Aboriginal and Torres
Strait Islander communities.
week, screening kits obviously have the potential
to save many lives. But here’s the thing folks… it
turns out that you have to use them to get any real
benefit.
Currently, only one third of Australians actually
use the free testing kits sent to them.
The chests are designed so that, at a pinch, anyone
can use them but it is preferable that they have
completed a senior First Aid Certificate. The idea is
that an RFDS doctor can diagnose a problem and
prescribe over the phone without the patient
having to travel long distances to access care. The
patient can usually get the medications they need
on the spot. What a great idea.
So health consumers - let’s be very clear on this when a kit arrives in your letterbox, you’ll need to
physically take it out of the packet and follow the
instructions. Just putting the kit away in a drawer
really won’t do you much good.
Bowel cancer often has no symptoms but, with
early detection and treatment, 90% of cases can be
successfully treated.
So, when next you run into someone from the
RFDS, don’t make our mistake of just talking about
their headline - grabbing emergency retrieval work.
Congratulate them on all the other primary
healthcare stuff they do as well.
Medicare Review
It’s no secret that the Federal Government is keen
to reform Medicare, but apparently there is also a
groundswell of support for change coming from
within the general community. Health Minister
Sussan Ley tells us that, during recent wide-ranging
consultations, she received overwhelming feedback
that Medicare no longer efficiently supported
patients and practitioners to manage chronic
conditions or the complex interactions between
primary and acute care.
Bowel Cancer Screening
Health Minister Sussan Ley announced this month
that her Government would invest an additional
$95.9 million to ensure that Australians aged 50 to
74 would receive a free, at home bowel cancer
screening kit every two years by 2020. Up until
now, people were only sent screening kits once
every five years between the age of 50 and 65 with
nothing sent to those aged 66 to 74.
The Minister has identified three priority areas she
feels we need to look at:
Given that bowel cancer is the second most
common cause of cancer deaths in this country and
is responsible for around 80 Australians dying each
- A Medicare Benefits Schedule (MBS) Review
Taskforce will be set up to consider how services
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can be aligned with contemporary clinical evidence
and improve health outcomes for patients.
review comes up with later this year.
Meanwhile, the medical profession was quite
effusive in their support for a review of Medicare.
The Royal Australian College of General
Practitioners certainly liked the idea although they
sounded a bit miffed because their organisation
had: …just last week released (their) own model
proposing a major overhaul of primary healthcare
funding. Harrumph!
- A Primary Health Care Advisory Group will be
established to come up with options to provide
better care for people with complex and chronic
illness; innovative care and funding models; better
recognition and treatment of mental health
conditions; and greater connection between
primary health care and hospital care.
- The Government will also work with clinical
leaders, medical organisations and patient
representatives to develop clearer Medicare
compliance rules and benchmarks.
The Rural Doctors Association of Australia (RDAA)
seemed particularly enthusiastic:
There is enormous scope within the health system
to generate both resource and time efficiencies,
while also improving the patient journey and
retaining high quality care.
So what can we expect out of all this consulting
and reviewing? We suspect Minister Ley already
has a pretty good idea of what the outcomes will
be and gives us a clue when she says:
And they didn’t stop there…
There is real potential for this review to be a win for
patients, a win for the health system and a win for
the Government.
Doctors and patients alike have raised various
issues from over-testing and outdated or unproven
treatments to unnecessary referrals, duplication,
inefficiencies and systemic waste.
This unbridled enthusiasm was tempered only
slightly with the warning that:
(Is it just us or does anyone else see eerie
similarities between this review and the Choosing
Wisely campaign we told you about earlier?)
Health reform cannot be a 'one size fits all'
approach — the Medicare review must carefully
consider the impact of any reform proposals on
rural and remote healthcare, to ensure the rural
health system and rural patients are not adversely
impacted by any specific reforms.
The Minister was at pains to point out that the
review was not about saving money so much as
developing health policies that deliver the best
health outcomes possible for taxpayer dollars. To
us, that sounds pretty much like code for saving
money – which may not necessarily be a bad thing
of course. It will be interesting to see what the
Wise words indeed from the RDAA and Minister
Ley would do well to take note.
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Sussan Ley, Health Minister:
Notes ‘n’ Quotes
Turf wars and politicking are core underlying
contributors to the significant fractures in the
current mental health system and I simply ask all
parties to put aside their own interests and
differences so we can all work together to deliver
the best outcomes for the most important people
in this process: the patients.
Mental Health Commission’s (leaked) Review of
Mental Health Services:
Despite almost $10 billion in Commonwealth
spending on mental health every year, there are no
agreed or consistent national measures of whether
this is leading to effective outcomes or whether
people’s lives are being improved as a result.
Consumers Health Forum:
…we need to ensure that clinicians and consumers
are working together in the PHN context and that
the patient experience and consumer-led ideas
about health system improvement inform their
work.
Jan Mclucas, Shadow Minister for Mental Health:
The leaking of the report highlights the anger and
intense frustration that the Government has been
sitting on the report since December 1 while it
attempted to stitch up its response.
Consultation Paper on the National Diabetes
Strategy:
Sussan Ley, Health Minister:
The National Mental Health Commission’s Review
of Mental Health Programmes and Services paints
a complex, fragmented, and in parts, disturbing
picture of Australia’s mental health system.
Read the paper and make comments at:
https://consultations.health.gov.au/
A Better Way to Care: Actions for Clinicians:
beyondblue:
Suicide is the biggest killer of young people in
Australia, with around 350 people aged between
15 and 24 dying by suicide in 2013… This is around
one death a day, double the number killed in car
accidents.
Are you a clinician wanting to identify and provide
high quality care to hospital patients with cognitive
impairment? There’s an app. for that.
Download the iPhone app
Download the android app
More information and resources for A better way
to care
Pharmaceutical Society of Australia (on the
National Review of Mental Health):
Sussan Ley:
Basically, there’s wide agreement the Medicare
system in its current form is sluggish, bloated and
at high risk of long-term chronic problems and
continuing to patch it up with band aids won’t fix it.
Pharmacists are pivotal… as they are the most
accessible of all health professionals and often the
first health professional consulted by a person with
mental health issues.
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Keeping You Posted
Join the happy throngs following us on twitter
https://twitter.com/HCRRA
What’s new on the HCRRA website this month?
http://nrha.org.au/hcrra/
-
The RDAA is very happy that Health Minister Sussan Ley has agreed to continue funding mental
health programs while a review is underway. As are we all. http://bit.ly/1a3mMzS
-
Shadow Health Minister Catherine King thinks a lot more needs to be done to provide some
certainty for health programs. http://bit.ly/1CWFxiA
-
The Department of Health answers the most common questions concerning the new Primary health
Networks http://bit.ly/1yt3HTF
-
AHCRA is in favour of the new PHNs, but have a couple of well-founded concerns.
http://bit.ly/1EJgHp7
-
Health Minister Sussan Ley announces increased funding for bowel cancer screening.
http://bit.ly/1J0UpBt
-
The NRHA has some good advice on the establishment of PHNs in rural and remote areas. They tell
us we need to define market failure and use the knowledge we already have. HCRRA couldn’t agree
more. http://bit.ly/1aQvnpU
…and remember
Humans put a man on the moon before they put wheels on luggage.
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HCRRA Committee Contact Details
Chair and South Australian Rep
Marg Brown
Phone 0419 859 886 or 08 8577 4033 Email: strathwood@internode.on.net
New South Wales
Victoria
Patricia Le Lievre
Bev Cook
Phone 02 6287 5558
Email: gemtra@westnet.com.au
Phone 03 50781224
Email: bevcooknan@yahoo.com.au
Tasmania
Queensland
Mary Downie
Moya Sandow
Phone 0409 363 250
Email: nareen4730@gmail.com
Phone 07 4161 3162
Email: moya52@bigpond.com
Western Australia
Northern Territory
Alison Comparti
Lesley Reilly
Phone 0417 917 464
Email: alibeans@hotmail.com
Phone 08 8955 0678
Email: reilly5@activ8.net.au
Executive Officer
Jeff Wearne
Phone 02 6285 4660 Email: jeff@ruralhealth.org.au
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