by Dr. Robbie Lloyd
While COVID continues to ravage our society, the Federal Government has quietly released a Discussion Paper from the Primary Health Reform Steering Committee (which was meant to be out in Sept 2020), which could see us stuck with “more of the same” for the next ten years. It is time for all Australians to become much more active in the movement to reclaim our role in managing a health system which will actively involve and serve the community, not just wait for the politicians, bureaucrats and clinicians to decide everything.
Just as we all appreciate “experts” helping us with specific advice and guidance in the epidemiology of the pandemic (ie. how diseases can spread), we should listen to the science on Climate Change. But the hotel quarantine stuff ups, the inadequate vaccine contracting and roll-outs, and the lack of foresight in preparing for future epidemics, all show that politics often works against the people’s best interest, and against their health outcomes.
So it may well be with the next phase of our whole national health program. The Primary Health Care Ten Year Plan could be a recipe for more of the same inadequate response to people’s needs, and a top down clinical focus above all else ignoring the community’s role.
Parishes, schools and Catholic NGOs are major members of their communities. But do they know what’s happening in the health services in their precincts? As we come to the end of the Australian Catholic Bishops’ Social Justice year of focusing on Mental Health, it pays to spend some time investigating all aspects of our primary health care services (ie. GPs & allied health, physios, occupational therapy, psychology, hearing support etc).
The Discussion Paper is full of vague statements that fail to reassure us that real benefits will come to the people, in their local community. “Person-centred care” is the rhetoric the health bureaucrats like to use loosely, but it seldom translates into giving “consumers and carers” oversight of what is rolled out in Local Health Districts and Primary Health Networks, who have all the money for health services. Nor does it invest in employing people with Lived Experience alongside clinicians to make the system more empathetic and responsive.
There is a distinct move to privatise health services, and to go on-line rather than investing in more face-to-face support in the community (not just the clinic, ie. hospital or GPs). Universal access to healthcare has been Australia’s great achievement since Medicare was begun. But there is a whittling away of Medicare happening right now, and this paper gives little reassurance that its future is secure.
The paper provides a telling admission in its own assessment of “significant weaknesses” in the current structure and funding of general practice and primary care, including: (a) not responding well to the burden of chronic disease, mental health needs and growing rates of frailty; (b) it focuses more on the unwell than promoting health & wellbeing & prevention of disease; (c) primary care is not well integrated into the rest of healthcare; (d) fee-for-service dominates along with patients’ out-of-pocket payments; (e) duplication, waste and slippage of care send too many people away frustrated and worse off than when they arrived.