Partnership the key to recovery

Across the Tasman, a decade of doctor-led reforms, particularly in the area of primary care, has significantly improved health outcomes and cost effectiveness.

A majority of New Zealand's general practitioners, working side by side with other clinicians, have amalgamated their practices to form integrated Primary Healthcare Organisations. Proving yet again that size does matter, successful PHOs may involve 200 or more doctors and even more practice nurses. Most conglomerates are organised as "not for profit" entities.

These large practices have skilled business teams, advanced IT programs (largely self-funded) and revitalised partnerships with the hospitals in their areas. Monthly meetings between hospital and community clinicians are common.

Imagine receiving a "green script" which allows you to go to a gym and pool, run by your local council, where sophisticated equipment and a personal trainer await you. Imagine a GP practice so big that it can run its own 24-hour observation ward where patients can be cared for and a better decision be made about the need for hospitalisation. Countries such as Canada, Sweden, France and even the US are all dedicated to introducing appropriate variations on this theme.

What about Australia? Frustratingly, we are missing out on the introduction of these and many other such sensible strategies, not from a lack of professional willingness to embrace change but rather from political intransigence. We can't implement these reforms without uniting myriad divorced state and federal programs.

Our current healthcare system is no longer capable of providing us with our contemporary needs. It is distressingly unfair with outcomes increasingly related to personal financial circumstances, ever more expensive and dysfunctional.

The latter is due, of course, to the wretched jurisdictional inefficiencies inherent in Canberra buying our primary care and the states providing us with hospitals: two worlds that should be one. This reality led the Productivity Commission to urge the Australian Government to try once again to find a way forward - after all, it is 15 years since the last serious intergovernment effort to solve the continuing dilemmas.

It is of relevance that the countries making major improvements have but one source of government funding and one bureaucracy for their health systems. Can we devise a journey that would lead us to such a situation?

In response the Australian Government asked experienced bureaucrat Andrew Podger to come up with some suggestions. These, or at least the Federal Government's preferred suggestions, are due to be revealed to the state premiers at the Council of Australian Governments tomorrow.

Podger's review was a closed-door affair and the brief did not, we believe, include hospitals and therefore can only be of limited value. One fears that health may get less attention tomorrow than previously promised; it is no doubt significant that Prime Minister John Howard has challenged premiers to come up with their own suggestions for reform.

What should happen is not the subject of much controversy: it is designing the political process to achieve what is necessary that is the problem. Instead of our current emphasis on hospital care (we have more hospital beds per capita than any other country), we need to choose health and resource programs that will maintain wellness and diagnose problems when they are more readily managed.

We must have hospital and community care integrated; and, given the shortage of doctors available for the hospital system, make it financially possible for our GPs to care for their own patients in hospital. We need the integrated team approach and there is no lack of professional interest in moving in that direction. Of course, there is a frightening lack of professionals, a situation that is set to get worse; so there needs to be an equally necessary commitment to train sufficient healthcare professionals within 10 years.

The much publicised and tragic incompetence of an Indian surgeon working in Bundaberg is an extreme example of a problem that is worsening.

Removing Australia's unique impediments to reform will require a collaborative and collegial partnership between all governments, clinicians and the community. Surely in a mature democracy that is not too much to expect?

To that end the Australian Healthcare Reform Alliance, by far the largest coalition of health professionals and consumer organisations working for the restructuring of our health system, has written to all attending COAG urging them to commit to a six-month program that could break the decades-old impasse.

The plan calls for the establishment of four task forces composed of the best brains available to produce blueprints for providing us with the primary care system we need, solving our workforce problem, accelerating the introduction of electronic health records (essential for quality and safety) and finding ways around the jurisdictional divide.

The solution to so many specific problems (such as Indigenous and mental health) can only flow from these primary reforms.

To achieve this, all governments must allow their senior policy experts to work with clinicians, relevant academics and consumers to produce practical and politically acceptable plans. No other process has any chance of success.