No names, no pack drill, but here are the thoughts exercising the big brains in healthcare when they’re not obliged to speak as representatives of their organisations.
It was a cracking couple of days in Canberra this week when about 200 policy makers, clinicians, digital health and data wonks, PHNs, consumer advocates, academics, administrators, allied health, and nursing providers turned up for HSD’s Towards One Healthcare System summit.
Hopefully you’ve been reading our coverage of day two of the summit – here, here, here, here, and here – but today I’m going to talk about day one’s events, including a “provocation session” where some prominent names voiced some Big Ideas, under Chatham House rules.
I’ll be honest, journos hate Chatham House rules. Basically, people with power get to say what they really think, instead of what they are forced to say in public because of the pressure – real or perceived – from their employers. And we don’t get to tell anyone who said what.
It’s anathema to what journalism is about. It’s anathema to accountability, honesty and transparency. It’s like waving a plate of hot jam doughnuts under the nose of someone with a refined sugar allergy – looking at you, whoever catered the summit.
On the other hand, it gives people a safe place to talk, and journos like me learn a lot under Chatham House rules, which can only make our reporting better and more useful.
So, in the spirit of no names, no pack drill, here are the Big Ideas in four domains that came out of day one’s provocation session.
Primary care
Blended funding models
If we make a compelling value proposition for primary care practitioners, we might just attract the workforce we’re going to need in the future.
A blended model uses a mix of time, interaction and incentives to create that value proposition, in a way that fee-for-service doesn’t. FFS also doesn’t support multidisciplinary care in an optimal way.
If junior doctors, and doctors-in-training can see financial incentives for moving into general practice, who knows how many more might choose it as a long-term career. In British Columbia, for example, a blended funding model was the main reason 84% of those who chose general practice, did so.
We all know this is where the federal government is heading – specifically a move to a 60-40 blended model.
When it happens is a good question, however. Likely it’s going to be an incremental thing that comes with small policy shifts that bring us to the endpoint with little fanfare.
We need to pay GPs (and general practice nurses) at least as much as they can earn in other sectors.
Change the way we train doctors
Here’s a quote that hit me in the feels:
“Grow health professionals in areas where they are needed instead of training them in the cities and trying to persuade them to work in the regions.”
Are we picking the right people to train as doctors? Should we lower the HECS debt of medical students so they’re not looking for higher paid specialities from the moment they graduate?
Prevention and community education
What if it’s impossible to ever create the workforce needed to meet demand? Goodness knows that demand is never going to stop growing if we continue the way we are.
So, what if we educated the community, giving them more information to guide their healthcare choices and accountability for their own everyday health?
Finding a way to measure the value of prevention – healthy lifespan, perhaps? – would be a good thing. It’s hard to measure what you don’t get.
Funding and governance
Federation
Stop fretting about the states/commonwealth divide and get on with finding solutions within our federated model. Find someone in another part of the system who has found a solution that also gels with your local needs and scale it up.
Function, not location
A principle that needs to be embedded in the next round of the national health reform agreement is that funding must continue to follow function even if the location changes. Hospital in the home, for example, should be funded as it would be if the same care was happening in the hospital.
Implementation
We need to get better at turning research into practice.
The data shows that 85% of our funded research is not replicable in practice. We over-diagnose and over-treat – prostate cancer, anyone?
Related
Digital health culture
We have the technology
Guess what? It’s not about the technology – we largely have the technology. It’s about a mindset shift.
Putting patients in the middle is not about taking away from clinicians but changing the flow of the data that follows the patient across the continuum of their health and wellbeing needs.
Here’s another quote that blew my hair back:
“We have an ethical obligation to give our patients a better experience, and … if we don’t use the technology that’s available to us, that we know improves patient outcomes and experience … then we are actually doing a disservice to our patients.”
Boom.
Start again
We’re pouring a lot of time and effort into fixing and/or improving things that already exist – My Health Record, for example. Why don’t we stop trying to fix what we’ve got and start again, building from scratch?
Connectivity
Digital health is all very well unless you live in the still large tracts of our wide, brown land that don’t have connectivity.
It’s wide, and it’s brown, but it’s also bloody flat. There’s no excuse for the poor quality of internet coverage in disturbingly big and populated parts of the country.
The public/private partnership
It should be symbiotic, but it’s actually parasitic, said one delegate, because the “too sick” end up back in the public system where the doctors are.
“The public system and GPs are the lowest echelon that pick up the cost for everything,” they said.
Universality
Do we really want the public health system to be universal, because we can’t afford it to be. Perhaps we need to optimise private health insurance, providing a hybrid model for everyday people and keeping the public system for complex, vulnerable people who need help but can’t afford PHI.
There you have it, readers. Whether those ideas can make the leap from Chatham House rules to working policy and practice, is a question only time and a whole bunch of talking can answer.
I’m off for a couple of weeks, so I leave you in the tender care of HSD publisher Jeremy Knibbs. Godspeed.