More to health than hospitals, Mr Rudd

It’s been widely reported that one of Kevin Rudd’s first moves as Prime Minister elect was to send all Labor MPs back to school. Under instructions to visit one government and one non-government school in their electorates over two days, the MPs will test the waters of Labor’s Education Revolution.
Specifically, the plan to put a computer on the desk of every year 9 to 12 student, and the increased emphasis of trades education in schools will be on the agenda of meetings at schools today, as MPs prepare to report back to the partyroom tomorrow.
To his credit, Mr Rudd has wasted no time, although it does seem a big call to expect MPs and schools to think through such weighty issues in such a limited time. It’s also not clear how much input he’s inviting from state education departments, who might be thought to know a thing or two about the issues at stake.
So when it comes to firming up the party’s health policy, I’m hoping for a more considered approach, as well as one that recognises hospitals are not the only component of our health system. Mr Rudd has announced he will meet with premiers within three months to discuss health, but he must be careful.
It’s an understandable trap for young players with an ER mentality to equate the health system with busy hospitals and big machines. Hospitals may well be at the pointy end of the system, as well as generating most of the scary headlines feared by politicians, but the majority of health care takes place in primary, not secondary, care. Good evidence now exists to show that it’s accessible, high quality primary that has most influence over the state of the nation’s health.
Encouragingly, Labor has promised to develop a long-awaited National Primary Health Care Policy, but on the other hand has already announced GP clinics which may not be in the best interests of patients if they fragment care.
So please Mr Rudd, remember two things when it’s health’s turn.
Take it slowly. When sending out the troops to gather information, allow more than two days.
And please don’t focus on hospitals alone. Sit in with GPs and private specialists, outpatient mental health units, and boarding houses where the mentally ill sit alone smoking themselves to death.
Otherwise, you’re going to get a very warped view of what Australians need and what they’re getting.

Super GP clinics not health panacea

It’s like some sort of trump card dragged out by pollies of all persuasions before each election – “GP clinics”. Now Kevin Rudd’s promising us “GP super clinics”; “super-duper GP clinics” will probably be next.
While it’s great that health, especially primary health, is so firmly on the agenda in the upcoming federal election, I can’t be the only one with a sense of déjà vu.
But while overall the clinics have much to recommend them, what really troubles me about the promises, regardless of which side of politics is doing the promising, is the underlying muddy thinking.
To listen to Kevin Rudd you’d think “GP super clinics” are the panacea for all the health system’s ills.
For instance, Mr Rudd says they will reduce the pressure on emergency departments and people will no longer have to go to A and E for every little thing. He’s on thin ice here. For a start, GPs and emergency doctors agree on this one, only a minority of patients attending A and E are in the most serious categories. As well, the clinics are to be set up in the bush and outer suburbs, not necessarily where ED and hospital overcrowding is at its worst.
Nor will new clinics, whether super or not, fix the politicians’ problem of patient demands for medical access 24/7 for non-emergency care.
Furthermore, according to reports most of the funds would go to infrastructure, in other words for the actual buildings by providing grants of between $1 million and $10 million. But lovely as a large purpose-built clinic might be, the lack of them is not our main problem – which is a shortage of GPs willing to work in rural and outer metropolitan areas. The health system won’t be improved significantly by clinics pinching the doctor down the road.
On the other hand, some of the claimed benefits are real. True integrated, multidisciplinary care benefits patients with chronic illnesses, regardless of where they live. And such clinics would be great for training some of the upcoming flood of medical graduates, so long as they’re in the right hands, which brings us to the need for quality assurance. Funding issues are another unacknowledged stumbling block which needs to be overcome.
So bring on “GP super clinics”, but let’s be very careful about expecting them to solve all our problems, and even more careful about how they’re set up and by whom.