First step for health reform – September 2009

The National Health and Hospitals Reform Commission has delivered a report on reforming our health system, with many laudable recommendations, but some are cause for concern. After so many years of neglect, reform is going to be a long-term task.

In the short and long term, at the micro and macro levels, the public health system is in major flux and nurses need to stand our ground if we are to maintain our professional integrity.

The National Health and Hospitals Reform Commission has delivered its final report to the Federal Government and in the medium to long term it will be a stimulus for big-picture reform.

There are many laudable recommendations in the report, which will be supported by all who care about our public health system – in particular a shift in emphasis towards better primary care, closing the gap in Aboriginal health, improving mental health services and the establishment of a universal dental health scheme.

As is often the case with these reports, the devil will be in the detail and some of the Commission’s main recommendations are a little loose on specifics.

The recommendation to investigate a new model called Medicare Select is a case in point. Under this proposal, the Federal Government would be the sole founder of health services. This has been recommended by progressive health commentators for many years. But the Commission’s references to ‘greater consumer choice’ and ‘provider competition’ and a greater role for private health insurers in the provision of health and hospital plans sets off alarm bells.

This jargon has become tainted as code for the abrogation of public responsibility and a shift to private provision. The American experience (see p28) suggests this path should be avoided at all costs.

A greater role for private health insurers was a theme throughout the recommendations and is a matter of concern – perhaps not surprising, given the representation of those interests on the Commission.

There are other reasons for concern. Aged care and workforce issues are areas of deep and immediate importance to nurses and they have been dealt with in an underwhelming way in the report.

However, it is too early to be cynical. As one of the Commissioners Sabina Knight told NSWNA members at our recent professional issues day, reforming our health system after so many years of neglect is a decade-long task.

What is clear is nurses need to be organised and vocal if we are to have a say in the reform of a system that depends so much on our expertise and commitment.

There are many vested interest groups with ample resources and much to lose who have historically had a strong influence on the development of health policy: health bureaucracies, the private health insurance industry, doctors and others. They will be active and forthright in protecting those interests.

It is paramount that we maintain a strong public voice and access to decision makers so that nurses are listened to and have a prominent role in the shaping of the future health system.

It is widely acknowledged that nurses hold the system together and that should give us a reasonable say in how the system goes forward.

While a robust and healthy debate evolves about how a future health system should look, we should not be distracted from addressing the ‘here and now’ problems.

Real reform means making the right decisions from now, not from some hazy moment in the future. Making the wrong decisions now will just exacerbate the problems.

That is why we will continue to fight hard against any dilution of the nursing role in our public hospitals. Undermining the one support that has kept the whole system propped up is a recipe for disaster.