Stop passing the buck on healthcare

What is one of the biggest and least attended to health issues facing Australia?

Not, as many would think, the issue of doctor competence or the whole issue of overseas trained doctors. Apart from Queensland, now hastily reviewing its work in these areas, most states are already examining how they credential doctors, and mentor and monitor their work.

Instead, the major issue that I believe needs discussion, and some urgent action, is the lack of joint future health planning by the Commonwealth and states.

Let me use my own district as an example, because although it has its own peculiarities, its major problems are typical of most other fast growing areas across Australia - particularly the outer metropolitan areas of Brisbane, Sydney, Melbourne and Perth.

My local area is growing rapidly and that’s likely to continue. Within five years there will be an additional 60,000 people in this area. By 2015 there will be an additional 130,000. That’s a lot of new people looking for health services.

The area’s population is ageing even more rapidly. Growth in the numbers of those over the age of 65 is two to three times the overall population growth across the region. People over the age of 65 also need around three times as many health services as those under 65. So health workloads would substantially increase even if there were no new patients.

Parts of this outer metropolitan area have become solidly middleclass. But drought-stricken rural fringes and public and low cost housing in other areas means we also have high welfare dependency - around 17 per cent of the population according to one recent survey - and large numbers of working poor. We also have a high Indigenous and a relatively high migrant population.

That socio-economic demographic means that the area has some of the worst health statistics in the State. We certainly have very high rates of chronic disease - but not all that much higher than the rapidly escalating numbers in the general population. Finally this area, like many in Australia, is desperately and consistently short of doctors, nurses, specialists and allied healthcare providers. This area is just not attractive to health professionals who can pick and choose where they live and work.

So what happens when these trends of population growth, poverty, high rates of chronic disease, ageing and an inadequate workforce converge? The answer of course is that no-one knows - but the prognosis is poor.

So, what’s the solution?

Well, training more healthcare workers is a start, but one that will only go part way to finding an answer.

The major need is for integrated healthcare planning. Bringing together information about population trends and probable demand patterns with information about the expected supply side - from doctors to hospital intensive care nurses to podiatrists. For example, this area has a number of doctors in their 50s looking at retirement. We need to work out who is likely to be available when that next 60,000 people arrive and to use that information to plan how all healthcare workers, private and public, can work together more closely and effectively to maximise the benefits of their work.

And there’s the rub. Who is responsible for such planning?  Unfortunately, no-one.

The State funds the hospitals, outpatient specialists and publicly funded allied healthcare providers in community health services. The Commonwealth directly oversees and funds doctors and specialists in private practice. Private allied healthcare providers are generally funded by the consumer except in some limited circumstances. And the local private hospital is funded by private health insurance and consumer co-payments. So, it’s nobody’s baby.

In fact, despite the rhetoric from the Australian Council of Health Ministers about encouraging integration between the private and public sectors, old habits die hard. Getting support from either the states or Commonwealth government for integrated planning appears nearly impossible and, as close as we’ve come on several occasions to getting such support, it’s fallen over each time. It’s always the other government’s problem.

So what should be a major focus of discussion and action in terms of the health of Australians? There’s one big one from where I’m sitting: just what is going to happen to all those increasingly old, increasingly unwell, increasingly poorly serviced consumers who are already in my area - and what’s going to happen to that next 60,000 of them?