4 May 2023

Live blog: Wild Health Canberra – Australian Health Leaders Summit

Government Interoperability Technology

The Wild Health Canberra – Australian Health Leaders Summit has wound up, leaving delegates to head home with plenty to think about.

In next week’s Wild Health newsletter we will bring you a rundown of what happened at the summit and what it means for the future.

Wrap up

Many big questions were grappled with in the last panels of the Health Leaders Summit.

Q. Where are we at with interoperability?

A. “The opposite of world class” said Grahame Grieve, but it’s not a technology barrier. Other panelists said the barriers included a lack of political will, clinician reticence, plus health services not understanding interoperability enough to write it into tenders.

Q. How can data change inequity?

A. There are solutions in play across Australia and internationally but we need the data and outcomes need to be rewarded says Tracey Johnson, CEO at Inala Primary Care.

Q. Is there any low hanging fruit for relieving workforce pressures?

A: If every GP worked with a nurse we could really extend the scope of the GP, says Jane Bollen, Primary Healthcare Nurse Consultant.

These, and a hundred other questions and answers were covered off throughout the day. The ‘C’ words dominated; Complexity, Collaboration, (regional) Commissioning, and a strong theme throughout was Consumer Centric Care.

Conversation and debate continued at drinks alongside Chardonnay and Champagne.

The next Wild Health Summit will be 22nd August 2023 in Sydney.

Building a sustainable nursing and midwifery workforce

Workforce sustainability was tackled by Professor Alison McMillian, chief nursing and midwifery officer, and Karen Booth, chair of the Australian Primary Health Care Nurses Association.

Professor McMillian said burnout and fatigue was a major issue and that Australian trends reflected global studies. However, it was not a lack of qualified nurses that was the problem.

“We have a significant sized workforce. One of the largest workforces per population compared to other OECD nations,” she said.

Professor McMillian said nurses were not working to full scope of practice in many situations and this caused attrition due to workplace dissatisfaction and frustration. She said it was also a latent capability that had the potential to relieve other workforce stressors for GPs.

Ms Booth pointed out that nurses in hospitals have far greater ability to work to scope.

“You don’t see specialists looking over their shoulders. They are allowed to manage the patients,” she said.

She said “scope of practice” could mean different things, including skills, legislation, and current job description.

“How can we support each other with the skills sets we have,” she asked.

While there is overwhelming consensus around the need for reform, it’s far from all doom and gloom. Dr Hamish Meldrum has spoken about the success of Ochre Health Group in relieving workforce pressures in rural areas.

Ochre Health currently contracts hospital workers to the NSW and Tasmanian governments. They’ve opted out of the fee-for-service model and have instead recruited and staffed hospitals for a set fee per-day, per-year.

“Typically funding follows the practitioner”, Dr Meldrum explained. “We need a funding model where funding follows the person.

Dr Meldrum suggested speeding up the hiring of overseas doctors to fill workforce gaps in rural areas, a process currently riddled with red tape.
He also recommends the uptake of single employer models to train rural generalists, which has been trialled in Tasmania and NSW.

Bronwyn Phillips currently leads remote patient monitoring at Bendigo Health and formerly led allied health programs.

She shared the details of a successful integrated care model in Bendigo, Victoria, which notably reduced the rate of amputations in diabetes patients.

“The program was vertically integrated but it was really more of a seamless horizontal scale across the spectrum of funding types and sites; from community pods right through to acute inpatient management,” Ms Phillips said.

A model was created where there was “no wrong entry” to podiatry services for patients with diabetes. The model removed red tape for referrers and made patient access to podiatrist seamless, she said.

“One thing going for rural areas is that we have strong relationships and when we harness those relationships we achieve excellent outcomes,” Ms Phillips said.

Panel moderator Rob Grenfell, head of strategy at Grampians Health PHN, asked “why can’t we replicate successful models like these?”

“It comes back to integrated data,” Ms Phillips said, alluding to the inability to share patient data between patient management systems.

“And also bravery. To make any integration successful for health outcomes there needs to be a collaboratively designed and agreed set of outcome measures that are inclusive of patient reported outcome measures (PROMS). The outcomes need to give weight to PROMS.” 

Findings of the pre-summit workshop

Many of the delegates at the summit came a day earlier for the pre-summit health reform workshop yesterday.

The sold-out workshop, run by international co-commissioning expert Jay Rebbeck, aimed to map out and achieve consensus on the basic components for healthcare reform.

Mr Rebbeck, managing director at Rebbeck Consulting, acknowledged that currently there “isn’t a simple narrative with a clear vision that we can work towards over the next 15-20 years”.

Workshop participants believed that Australia needed to move away from the current institutional approach that exacerbates power imbalances between government and health consumers.

There was an emphasis on a “nationally planned, regionally coordinated and locally delivered” healthcare system, which will “empower communities and consumers”.

Australian Healthcare and Hospitals Association chief executive Kylie Woolcock believes that a nationally consistent outcome framework will allow Australia’s healthcare system to become “nationally consistent”.

She acknowledged that it was a “complex issue” but stressed the need to develop “systems for us to learn from each regional system so we’re not repeating the same pilot and trials”.

Additionally, Tracey Johnson, CEO and company secretary at Inala Primary Care, said she believed health services needed to “tap into” datasets so that they were aware of their priority populations to fund proportionately.

Tim Blake, managing director of Semantic Consulting attributed Australia’s disengagement with interoperability to a lack of understanding of the different systems and technology from medical professionals.

“It’s a clinical thing delivered through a technical channel. One of the reasons we haven’t asked for it is because we don’t understand it,” he said.

Is this the health system Australia wants in 10 years’ time?

Futuristic scenarios of PHN and LHD integration were thrown at the first panel to hit the stage at the Australian Health Leaders Summit.

Moderator Jeremey Knibbs, publisher of Wild Health, asked what this would mean for budgets, turf wars and importantly, the consumer?

Mr Knibbs posed the idea to Ray Messom, head of Western Sydney’s PHN, asking “How would you feel about Went West [PHN] merging with Western Sydney Local Health District?”

Mr Messom said that although regional collaboration was essential, a giant PHN/LHD merger could dilute the effectiveness of community-led providers delivering care on the ground.

Jeremy Knibbs pressed Mr Messom for details of what he would do.

“I would align all those providers on the ground toward a shared purpose and vision such that you’d almost force a regional system of care,” Mr Messom said.

He added that social determinants of health was “where we should be heading” and that the community needed to be driving the change.

“We need to bestow more power into regional collaborative bodies. We need those bodies to govern us under a shared vision and strategy,” he said.

Mr Messom said Went West PHN spent a lot of time building relationships with hundreds of organisations who were delivering high value services within the existing structure.

“There’s a big value in having great providers delivering care on the ground and we need a mechanism to face the more complicated issues like homelessness, domestic violence – you’re not going to address those by a big merger,” he said.

“You need to recognise the smaller more specialist providers on the ground.”

Mr Messom also asserted the critical role of technological infrastructure.

He said that engaging and including consumers was the lever for boosting political for regional collaboration.  

“If we had that in place we could tackle lack of political will for change,” he said.

Clare Mullen, deputy director, Health Consumers’ Council WA, said she was glad to be at the Health Leaders Summit but was probably the only consumer advocate in the room.

“There a role for all parts of the health system to be engaging with consumers at every level of change,” she said.

“There are lots of people who don’t get to attend important conversations like we are having at this summit. We need to be creating the deliberate structures that make it possible for grassroots community structure.”

She challenged summit attendees to reflect on why they didn’t bring a consumer with them to the summit.

“Most of us, in these settings, are not coming from the place of a lack of power,” she said.

Ms Mullens said that equipping consumers to engage in advocacy conversations would also add value to healthcare planning. She called for healthcare providers to develop the “health system literacy” of consumers to be able to contribute more meaningfully.And maybe healthcare needs to develop “consumer literacy” as well.”

Why do we need healthcare reform in Australia?

When federal Health Minister Mark Butler released the Australian Institute of Health and Welfare’s biennial report on the health of Aussies in July last year, the nation scrubbed up pretty well. 

The report showed Australians were generally living longer – life expectancy at birth was 83 years in 2020, the sixth highest among the world’s 38 OECD (Organisation for Economic Co-operation and Development) countries. 

Over the past century there has been a 98% decline in the age-standardised death rate from infectious diseases such as tuberculosis, polio and diphtheria, due to childhood immunisation and disease control measures. 

But life expectancy is only a small chapter in the story of our nation’s health.  

Aussies now have higher rates of chronic and age-related conditions. In 2020-21, almost half of all Australians were estimated to have one or more common chronic health conditions, including diabetes, cancer, mental and behavioural conditions, and chronic kidney disease. 

Two in three Australian adults are now either overweight or obese, dementia is on the rise and coronary heart disease remains the leading single cause of death for males and the second for females. So we might be living longer, more of us are surviving heart attacks and cancer diagnoses and managing chronic diseases more effectively, but it is far from a level playing field. 

Drill down a little further into the AIHW report and you will see that generally, the higher a person’s socioeconomic position, the better their health.  

If all Australians had experienced the same disease burden as people living in the highest socioeconomic areas in 2018, the total burden could have been reduced by one-fifth, the report shows. 

In 2019-20, $202.5 billion was spent on health in Australia – about $7900 per person – and about $3.9 billion a week. 

Despite such a massive injection of cash, Australia’s health system is failing Aussies. The health workforce is buckling under the pressure. The argument for reform has never been stronger or louder. 

Today, Wild Health is gathering more than 200 of Australia’s brightest and most influential healthcare minds in Canberra for a ground-breaking health summit

Health reform strategist Michelle O’Brien has curated the line-up for the summit that she believes is an Australian first. 

“I don’t believe Australia has ever had all sectors represented in a room for a conversation about health reform,” she said. 

“We’re bringing together people who want to share their ideas about how we could improve the system. We’re providing them that forum to have the conversation.” 

Delegates represent the nation’s entire health sector, including local health districts (LHDs), public and private hospitals, strategy and policy executives, peak bodies, consumer groups, service providers, doctors, digital health experts and technology providers. 

“You’ve got all the ingredients in the room for a recipe to fix the health system,” she said. 

Wild Health will be covering the summit here through its first ever live blog from 9am. Our team of journalists will be at the summit to provide live coverage of panel discussions and presentations – and the line-up of speakers promises plenty of opposing views about what’s working, what’s blocking change and what are the solutions to our health reform crisis. 

Among the speakers are Dr Stephen Duckett, Honorary Enterprise Professor, University of Melbourne; Dr Nicole Higgins, president of the Royal Australian College of General Practitioners; Kylie Woolcock, CEO of the Australian Healthcare & Hospitals Association; Elizabeth Koff, managing director of Telstra Health; Karen Booth, president of the Australian Primary Health Care Nurses Association; Ben Chiarella, director of Clinical Innovation at Ramsay Connect. For the full list of speaker and their bios see here

Reporting by Wendy John, Sharlotte Thou, Harriet Grayson and Amanda Sheppeard.

Note: Correction to a panellist’s name made 22 May 2023.