The greatest challenge isn’t designing new structures – it’s building a system that invests early, measures what matters, and makes primary care the foundation of health.
Australia is at a crossroads in health reform.
The United Kingdom’s experience shows how system redesign can become a distraction rather than a solution. Structural integration sounded bold – yet it has proved more bureaucratic than transformative.
Australia’s goal is sound: to shift care closer to home under the National Health Reform Agreement. But to succeed, we must avoid the UK’s mistake of focusing on structure over substance.
Structure without substance
In the UK, Integrated Care Boards were created to support local decision-making and better coordination across services.
In practice, they’ve become entangled in bureaucracy. Local leaders report being inundated with central directives, limiting their ability to focus on what matters most to their communities.
As Lord Darzi warned of health and social care systems:
“Too many people end up in hospital, because too little is spent in the community.”
Rather than empowering leadership, these reforms have consumed time and resources. Australia should avoid replicating this top-down approach. Reorganisation without a clear focus on outcomes risks delaying the shift to preventive, community-based care.
When targets undermine strategy
Narrow performance targets have distorted UK priorities. Hospitals chase throughput metrics while prevention, equity and quality suffer.
If Australia wants general practice, aged care and mental health to become genuine system pillars, funding and performance measures must reward value, not volume.
Funding drives behaviour
Despite years of rhetoric about “moving care upstream”, the share of NHS funding going to hospitals has grown from 47% in 2006 to 58% today. This isn’t a failure of intent – it’s a reflection of incentives that reward hospital activity while neglecting prevention.
Australia’s reforms must avoid repeating this imbalance.
Without bold investment and improved measurement in general practice, aged care, mental health and community services, the system will continue to drift towards hospital dependency. Lord Darzi aptly described this as the “inverse of its stated strategy”.
Unless payment models support community-based care, funding will default to hospitals. Capitation, bundled payments and integrated funding need to move from pilots to policy.
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Stay focused on what matters
The UK’s biggest lesson is that endless structural reform distracts from results. Real reform happens when we invest in people, data and capability – not committees.
It’s not who sits at the top table that defines success, but whether the system delivers care that is earlier, closer and better.
Key takeaways for Australia’s reform agenda
- Embed pooled funding around local populations. Use the NHRA extension year to pilot pooled budgets between PHNs and LHNs for key cohorts – older people with multimorbidity, frequent ED users and First Nations communities. Fund partnerships that deliver measurable outcomes such as fewer preventable hospitalisations and better access to care;
- Expand blended payments through MyMedicare. Build on the 2025 chronic condition reforms with flexible, risk-adjusted payments for registered patients. Reward continuity, proactive care and multidisciplinary teamwork – and enable every clinician to work to full scope;
- Measure and publish what matters. Develop a national indicator set that tracks outcomes, experiences and equity by cohort. Link funding to access, continuity and avoidable hospital use – not structure – and use data for learning, not league tables.
Australia can still chart a smarter path. The greatest challenge isn’t designing new structures – it’s building a system that invests early, measures what matters, and makes primary care the foundation of health.
Jay Rebbeck is CEO of Rebbeck, working with public-sector leaders to create brilliant services and thriving communities through commissioning excellence.
This article was originally published on LinkedIn. Read the original here.