NSW CHO calls for boost to preventive care

More funding should be directed towards preventive health to help ease the strain on hospitals, a major new inquiry has been told.
 
A report for the NSW Government’s Special Commission of Inquiry into Healthcare Funding co-authored by the state’s Chief Health Officer Dr Kerry Chant indicated that relatively little funding goes towards stopping conditions from developing in the first place.
 
Alongside co-authors and senior NSW Health bureaucrats Dr Nigel Lyons and Deborah Willcox, Dr Chant warns that the health burden will increase substantially if reform does not take place in the state, which has the largest public health system in Australia.
 
‘Low proportional investment in preventive health, the wider determinants of health and increasing burden of chronic disease has led to increased spending on treatments to manage conditions that could be prevented, detected earlier or managed more effectively in a comprehensive primary care setting reducing the need for hospitalisation,’ they wrote.
 
The officials’ report emphasised the pressures created by an ageing population, both in aged care facilities and in the wider community.
 
‘Access to quality clinical care in [residential aged care facilities] is critical in preventing unnecessary admissions to hospital,’ the report states.
 
‘This includes effective medication management, nutrition and hydration, pressure care, oral care and access to GPs and allied health professionals to provide specific advice regarding clinical needs of individual clients.
 
‘Hospitals and emergency departments have also been used as a last resort for older people and those living with a disability when there are no other services available to support them either at home or in the community.’
 
Healthcare demand, especially in mental health, diabetes and other chronic diseases, has been driven by population growth and demographic changes, they said.
 
Under current models of care, the amount of health service activity could increase by 70% in the next nine years, the authors stated, citing research published in last year’s report Future Health: Guiding the next decade of care in NSW 2022–2032.
 
‘Funding models must enable the system to respond to the changing burden of disease,’ they warned.
 
‘The current funding models do not effectively support the delivery of innovative and new models of care.’
 
According to the authors, the impact of activity-based funding (ABF) in both NSW and other states, is exactly such a concern.
 
‘The introduction of ABF has brought considerable national transparency to the funding of public hospital services, but at the expense of supporting innovation and care outside the hospital,’ they wrote.
 
They said that ABF as it is currently implemented across the country ‘focuses on throughput [activity] and not on output’.
 
‘An increased focus on outcome-based funding and preventive health could improve access and equity particularly for vulnerable cohorts and those in regional and rural communities,’ they wrote.
 
They also called for a ‘far greater focus on prioritisation and disinvestment from low value care and further work to reduce futile care’.
 
According to the officials, demographic shifts mean such reform is required to ‘ensure the ongoing sustainability of the public health system’.
 
A greater emphasis on the role of ‘generalist practitioners’ to provide whole of person care is also among the changes required, they state, as is improved cohesion.
 
‘The changing burden of disease has placed increasing pressure on health and social care systems which are not sufficiently connected or coordinated in the provision of care,’ they wrote.
 
‘Given the ageing population, increasing comorbidities and workforce challenges, it will be increasingly important to work as one system, engaging effectively with partners, both across governments and with non-government organisations, the private sector and communities,’ the report states.
 
Improving data will help design better funding models, as well as evaluate of models of care, they said.
 
The RACGP has also provided a submission to the inquiry, with several points that echo the findings of Dr Chant.
 
Specifically, the college highlighted the ‘pivotal position’ of general practice to deliver preventive healthcare.
 
‘Preventive care is also critical in addressing the health disparities faced by vulnerable population groups,’ the RACGP submission states.
 
The college also recommends introducing better support for training in general practice, improved MBS and Workforce Incentive Program (WIP) funding, and reduced red tape for overseas-trained doctors to help address ongoing workforce shortages.
 
Other suggestions include incentives for medical practitioners to work in more remote areas, as well as greater access to GP rotations for junior hospital doctors, and ‘ensuring non-GP and GP workforces are being best utilised within their existing scope of practice’.
 
‘The RACGP looks forward to working with all levels of government to collaboratively develop and introduce appropriate models for improving healthcare in the interests of all Australians,’ the college submission concludes.
 
The inquiry held its first public hearing on 27 November, with Drs Chant and Lyon as well as Ms Willcox due to appear this week.
 
Full details on the inquiry timetable as well as the submissions are available on the Inquiry’s website.
 
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