What does national health reform mean for Aboriginal and Torres Strait Islander peoples?

Australia’s health system is one of the best in the world. Demands on the system are increasing due to an ageing population, increased rates of chronic and preventable disease, new treatments becoming available and rising health care costs.

Working in partnership with state and territory governments, the Commonwealth Government has taken action to address these challenges and in August 2011 secured a National Health Reform Agreement.

The Agreement commits to improving health outcomes for all Australians and builds on reforms to our health system that are already underway.

The reforms will mean:

Improved hospital services

More training for more doctors and nurses

Greater support for practice nurses and Aboriginal health workers

Improved access to health care

Integrated GP and primary care

Major reforms to mental health

Building a national, secure e-Health system

Major investments in preventive health

Engaging Consumers

Improved hospital services

In public hospital emergency departments, almost one-in-three patients wait longer than is recommended to be treated, with a similar number waiting more than eight hours for a bed when being admitted.

Aboriginal and Torres Strait Islander peoples are twice as likely as other Australians to visit casualty or require hospital outpatient services.

Under National Health Reform, the Australian Government is working with states and territories to implement new targets to shorten the wait in emergency departments and improve waiting times for elective surgery.

The National Partnership Agreement on Improving Public Hospital Services will provide $750 million to the state and territory governments over seven financial years (2009-16) for the National Emergency Access Target. The objective of the National Emergency Access Target is that 90 per cent of all patients presenting to a public hospital emergency department will, within four hours, either physically leave the emergency department for admission to hospital, be referred to another hospital for treatment, or be discharged.

The National Partnership Agreement is also providing $800 million to improve elective surgery waiting times and $1.6 billion for 1,316 subacute beds or bed equivalent services.

This funding and other National Health Reform funding will assist Aboriginal and Torres Strait Islander peoples to access the health care they need in a more timely way.
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More training for more doctors and nurses

The Australian Government will invest $632 million over four years to tackle doctor shortages, with the aim of making it easier for patients to access GPs and specialist doctors. There will be a particular focus on ensuring the needs of people living in rural, regional and remote Australia are met.

Training places have been increased in General Practice training programs.

The Australian General Practice Training Program offers training for GP registrars in Indigenous health. Some Indigenous health training posts are in accredited Aboriginal medical services.

Places for the Australian General Practice Training Program will increase in stages from 700 places in 2010, to 1,200 places in 2014, with the aim of increasing Indigenous health training by 33 per cent.

The Prevocational General Practice Placement Program gives junior doctors supervised experience in General Practice communities to encourage them to consider General Practice as a career.

There were 380 places for this program in 2010, and around 75 of those were in Aboriginal medical services. The number of places for the Prevocational General Practice Placement Program will increase in stages from 380 in 2010 to 975 by 2012.

Scholarships are also available for nurses working in an Aboriginal medical service to undertake continuing professional development and for undergraduate nurses to undertake a clinical placement in an Aboriginal medical service through the Nursing and Allied Health Scholarship and Support Scheme. Further information on nursing scholarships is available at www.rcna.org.au/scholarships/government_scholarships

The Nursing and Allied Health Rural Locum Scheme enables nurses, midwives and eligible allied health professionals in rural and remote locations to take leave and undertake continuing professional development activities without impacting on service delivery. It also allows interested nurses and midwives to experience rural practice through locum placement.
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Greater support for practice nurses and Aboriginal health workers

Under the Practice Nurse Incentive Program, which commences on 1 January 2012, additional funding of $575.6 million over five years will allow nurses who work in Aboriginal medical services to have a broader and more flexible role. New arrangements will be available for accredited Aboriginal medical services to help meet the cost of employing a practice nurse.

The new arrangements will also include:

Support for all accredited practices to employ an Aboriginal health worker instead of or in addition to a practice nurse.

Support for Aboriginal medical services to employ an allied health professional instead of or in addition to a practice nurse and Aboriginal health worker.

These arrangements will make it easier for patients to access health services that suit their needs at their local primary health care service.
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Improved access to health care

There has been a significant increase in the number of hospitalisations for Aboriginal and Torres Strait Islander peoples for conditions that could have been treated in primary health care, particularly chronic conditions. Chronic disease contributes to two-thirds of the gap in health outcomes between Aboriginal and Torres Strait Islander peoples and other Australians.

National Health Reform puts a focus on the delivery of stronger primary health care to get people the services they need in their local communities, so they stay healthy and out of hospital.

Hospital management is being devolved through Local Hospital Networks to drive greater accountability and be more responsive to local community need.

Medicare Locals

A new system of primary health care organisations – Medicare Locals – will work closely with the new Local Hospital Networks and other health organisations, including Aboriginal health services, to promote a more effective response to local needs.

Medicare Locals will work to better integrate health systems and support communities to access the health services they need. Part of their role will be to indentify the health needs of their local community, identify gaps in service provision, address these gaps, and work with health services in the area to introduce improvements.

Local Hospital Networks

Local Hospital Networks are being established by state and territory governments so that public hospitals will be governed and managed locally. This will give communities and health professionals a greater say in how hospitals are run, and enable the services to better respond to the needs of the local community.

Local Hospital Networks and Medicare Locals will have formal communication processes, and will engage with the local community and local health professionals so that community and consumer views are considered when decisions are made about service delivery at the local level.

After hours GP telephone service

Better connecting Australians with health professionals is a key part of National Health Reform. The new after hours GP telephone advice service has operated since 1 July 2011. The service provides callers with after hours medical advice from a registered nurse, and if necessary, a GP. The after hours GP telephone advice service will particularly benefit Australians living in areas with limited access to after hours services – including remote, rural, regional and outer-metropolitan Australia.

The service builds on the nurse triage, information and advice telephone service currently provided by the National Health Call Centre Network, trading as healthdirect Australia. Callers first speak to a registered nurse, who will forward the call to a GP if needed.

The helpline is available in most states and territories by calling healthdirect Australia on 1800 022 222. The service will be available in Queensland from early 2012 by calling 13HEALTH. Negotiations are progressing so that the helpline can be accessed through Victoria’s NURSE-ON-CALL service (1300 606 024). For people living in Tasmania, access to after hours GP telephone advice is available through GP Assist (1300 780 011).

GP Super Clinics

GP Super Clinics are open for extended hours and are staffed by teams of health professionals, including doctors, nurses and allied health professionals. The first stage in the delivery of the 28 new GP Super Clinics is underway. Over time, 64 GP Super Clinics will be operational.

Telehealth

Australians living in rural, remote and outer metropolitan locations will benefit from the Government’s telehealth initiative. Since 1 July 2011, Medicare rebates have been provided for online consultations across a range of medical specialities and training and financial incentives are also available to assist specialists, GPs and other health professionals to access the necessary infrastructure.

Telehealth facilities, located in general practices, aged care facilities and Aboriginal medical services will videolink patients and their GPs in rural, remote and outer metropolitan areas with specialists in cities or major regional centres.

Through online consultations, Australians living in these areas will, in many cases, have access to specialists sooner, without the time and expense involved in travelling to major cities.

While specialists can be located anywhere in Australia, patients must be located in rural, remote or outer metropolitan areas. An exception to this is where the patient is a resident of an aged care facility or a patient at an eligible Aboriginal medical service. Medicare rebates are available across Australia in these circumstances.

Further details are available at www.mbsonline.gov.au/telehealth.
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Integrated GP and primary care

The Australian Government is funding the upgrade of around 425 general practices, primary care services, community health services, and Aboriginal medical services to improve access to integrated GP and primary health care.

Upgrades to existing facilities will improve their capacity to deliver team based care, and local communities will benefit from improved access to a broad range of services that specifically target the health needs and priorities of local communities.

Following an open tender process in May 2011, a group led by McKinsey and Company has been selected to finalise the design, implementation, management and evaluation of the Coordinated Care for Diabetes pilot.
The purpose of the pilot is to assess the effectiveness of the Coordinated Care for Diabetes program to inform future arrangements for chronic disease management in the primary care setting.

If you are an Aboriginal or Torres Strait Islander person, you do not need to wait until the pilot is finished to take advantage of the benefits of coordinated care. You can talk to your GP now about enrolling with your general practice or Aboriginal medical service for coordinated care for diabetes under the Indigenous Chronic Disease Package.
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Major reforms to mental health

To improve access to mental health services, and to provide a foundation for further reforms to community mental health services, Medicare Locals will work with mental health services to promote better integration and more responsiveness to the mental health needs of communities.

The 2010-11 Budget allocated $197.3 million over five years (on top of the current commitment of $133.3 million to 2013-14) to expand existing and establish new youth focused mental health services through the headspace program. The Budget measure provides funding for 90 fully sustainable headspace sites across Australia by 2014-15, through boosting funds to the 30 current and 10 developing headspace sites and ensuring a robust funding base for the further 50 sites to be established by
2014-15. Once all 90 sites are fully established, headspace will have the capacity to help up to 72,000 young people each year.

The 2009 evaluation of headspace found that services need to engage more with certain groups, including Aboriginal and Torres Strait Islander peoples. This finding has led to the development of a headspace Aboriginal and Torres Strait Islander Strategy. The Strategy sets out priorities and strategies to ensure headspace services are culturally accessible and appropriate.

The Access to Allied Psychological Services program will expand to include $36.5 million over five years to increase Indigenous suicide prevention and mental health services, as part of the mental health reform package. This funding will support approximately 18,000 additional Aboriginal and Torres Strait Islander people.

The Kimberley Indigenous Suicide Prevention Initiative was jointly announced in April 2011 by Ministers Butler and Snowdon. The Initiative will inform the development of the broader Indigenous sub-component on training and linkages required to deliver culturally appropriate suicide prevention and mental health services. Under the Initiative, additional funding has been provided to the Kimberley Division of General Practice to increase its capacity to provide culturally appropriate suicide prevention services. Discussions are taking place with Aboriginal and Torres Strait Islander experts to ensure training and service delivery are culturally appropriate for Aboriginal and Torres Strait Islander peoples.
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Building a national, secure eHealth system

From July 2012 all Australians will have the choice to register for an online personally controlled electronic health record. The personally controlled electronic health record will, with the permission of the patient, enable improved sharing of information and better integration of the patient's care. Those who choose to have a personally controlled electronic health record will no longer need to remember and repeat their health information to different health care providers. This will help people who have chronic and complex conditions to manage their care more effectively.

The personally controlled electronic health record system is expected to focus initially on people who have the most contact with the health and hospital system, including people with chronic and complex health conditions, older Australians, Aboriginal and Torres Strait Islander peoples and mothers and their newborn children.

Twelve eHealth lead implementation sites have been set up to progress elements of the personally controlled electronic health record system in practical settings. These sites are developing and deploying eHealth infrastructure and standards in real-life settings.

The eHealth sites are being set up progressively in two stages, or waves.

The first-wave sites are using eHealth infrastructure and standards around general practice across state borders. The second-wave sites will expand on this approach, to allow information exchanges between healthcare providers and specific health groups and provide national coverage.

The Northern Territory Department of Health Project is one of the sites chosen as a second-wave site. The project will build on the existing shared electronic health record system in the Northern Territory, and extend the service to Aboriginal and Torres Strait Islander peoples in Western Australia and South Australia.
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Major investments in preventive health

Helping people to lead healthier lifestyles is a key component of National Health Reform. The Australian Government is providing unprecedented support to keep people healthy and out of hospital.

A number of important preventive health initiatives are underway:

The Australian National Preventive Health Agency

The first ever Australian National Preventive Health Agency commenced operation in January 2011. The Agency will work to reduce preventable diseases and health conditions through campaigns that target obesity and substance use.

The Agency will work closely with Medicare Locals, Local Hospital Networks and local primary health care services and organisations, including Aboriginal medical services, to invigorate preventive health efforts at the local level and reduce the burden of chronic diseases and health conditions in Australia. The Australian National Preventive Health Agency will provide evidence-based advice to Health Ministers; support the development of evidence and data on the state of preventive health in Australia and the effectiveness of preventive health interventions; and establish national guidelines and standards to guide preventive health activities in communities.

National Tobacco Campaign

The $61 million National Tobacco Campaign, launched in January 2011 is the largest national public education campaign on smoking to date.

National Indigenous Tobacco Campaign

As part of the National Tobacco Campaign, the Australian Government has launched a campaign for Aboriginal and Torres Strait Islander peoples. The campaign urges Aboriginal and Torres Strait Islander peoples to break the chain and quit smoking.

Further information on the campaign can be found at: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/ntc-break-the-chain.

These initiatives will complement the $161 million provided under the Indigenous Chronic Disease Package, which was developed to address chronic disease risk factors including smoking, poor nutrition and lack of exercise.

The Indigenous Chronic Disease Package includes the rollout of a national network of regional tobacco coordinators, tobacco action workers and healthy lifestyle workers to work with Aboriginal and Torres Strait Islander communities to reduce the number of people who smoke, improve nutrition and increase the level of physical activity.

The workforce will implement a range of community-based smoking prevention and quitting support activities tailored to local Aboriginal and Torres Strait Islander communities. One particular element of this measure is to train health workers and community educators to deliver brief interventions to help people to quit smoking.

More information about this initiative can be found at:
http://www.health.gov.au/internet/ctg/publishing.nsf/Content/national-action-to-reduce-indigenous-smoking-rate.

The Australian Health Survey

The Australian Health Survey, which commenced in March 2011, will see about one in every 400 Australians (approximately 50,000 people in total) interviewed on key lifestyle factors that affect their health, providing a better understanding of the health of people living in Australia.

Results from the Survey will provide the community, health researchers and governments with important clues about health problems and emerging health issues. The results will be particularly important to work in preventive health - a key element of National Health Reform.

Results of the first wave of the Survey (conducted over 2011-12) will be available from October 2012. A sample group of Aboriginal and Torres Strait Islander peoples will be surveyed from March 2012, with results expected from October 2013.

More information on the Australian Health Survey is available at the Australian Bureau of Statistics website - http://www.abs.gov.au/australianhealthsurvey.
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Engaging Consumers

Engaging consumers is an important part of National Health Reform. Local Hospital Networks and Medicare Locals are required to consider the views of consumers in responding to local health needs. The National Health Reform Agreement provides the capacity to have consumer representatives included on the governing boards of Medicare Locals and Local Hospital Networks. Consumer representation may also be included on the advisory bodies that will assist the governing boards.

The Consumers Health Forum has been funded to conduct a three-year project, Our Health, Our Community, aimed at providing resources to assist consumer representatives who are involved in the governing boards and advisory bodies of Medicare Locals and/or Local Hospital Networks, or for consumers who simply want to be more informed about health issues.

Our Health, Our Community includes the development of a Consumer Health Platform that uses digital communication and platforms to engage health consumers in National Health Reform.

Membership of the National Lead Clinicians Group and Local Lead Clinicians Groups will also include consumer representatives to enhance the focus on improving coordination of services to consumers. The aim of these groups is to enhance the engagement of clinicians in the health system.
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Frequently asked questions about what National Health Reform means for Aboriginal and Torres Strait Islander peoples

How will National Health Reform help to close the gap?


National Health Reform initiatives complement existing programs aimed at closing the gap between Indigenous and non-Indigenous health outcomes, such as the Indigenous Chronic Disease Package.
National Health Reform re-focuses the health system towards early intervention and prevention to take pressure off hospitals and other areas of the health system. This focus aims to reduce the burden of preventable health conditions and support a more sustainable health system.

As part of these efforts, the Australian Government is investing $56 million in preventive health measures, which builds on the $872 million COAG National Partnership Agreement on Preventive Health - the largest commitment to health promotion by an Australian government.

This investment will tackle the rise of chronic and preventable conditions through a range of initiatives to help people adopt a healthier lifestyle.

National Health Reform aims to make it easier for all Australians to access the care they need, when and where they need it. For example, Medicare Locals are working with hospitals, Aboriginal medical services, general practices, community health centres and other primary health care providers to identify the health services needed in local communities.

Medicare Locals also have a major focus on the prevention, early detection and management of chronic disease. They are working with health care providers to promote delivery of care that is tailored to meet local needs, which will work towards reducing the number of Aboriginal and Torres Strait Islander deaths from chronic disease, and help to the close the gap.

Local Hospital Networks will ensure greater local responsiveness and more local autonomy. Local Hospital Networks will work with Medicare Locals to improve patient care, the quality of health and hospital services, and to build pathways that will enable people to transition smoothly between health services.
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Will community controlled health services continue to receive funding from the Department of Health and Ageing or will they be funded through Medicare Locals?

Aboriginal Community Controlled Health Organisations may continue to receive separate and direct funding from the Australian Government to support the delivery of comprehensive primary health care services for Aboriginal and Torres Strait Islander peoples.

Aboriginal Community Controlled Health Organisations may also be able to access additional funding through Medicare Locals – for example, for the delivery of face-to-face after hours care.

How will I know my Medicare Local is doing its job to improve health services in my area?

Medicare Locals will work to better connect health service providers to ensure patients are getting the services they need.

Under National Health Reform, nationally consistent information about the performance of primary health care services will be publicly available.

The National Health Performance Authority will use a new Performance and Accountability Framework to produce Healthy Communities Reports which will report on the performance of Medicare Locals and primary health services within Medicare Local boundaries.

Healthy Communities Reports will provide information about access to primary health care services (including access to GP services and out of hours GP care), the quality of service delivery, funds management and patient outcomes and/or patient experience. Medicare Locals will not report details of particular patients to the National Health Performance Authority.

However, given that in some circumstances the National Health Performance Authority may come to hold information that might identify particular patients, mechanisms will exist to ensure that the National Health Performance Authority does not make public, without patient agreement, identifying information.

Reporting on Medicare Locals will highlight chronic disease risk factors, community health and wellbeing requirements, and the quality of service delivery.

In order to be responsive and accountable to the local community, Medicare Locals will provide transparent and accessible processes for engaging with local communities. These processes may include the use of advisory groups or formal governance sub groups which are then represented on the Medicare Local board. For example, advisory groups or formal governance sub-groups may be required to represent consumers, clinicians and, in relevant areas, Aboriginal and Torres Strait Islander peoples.
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Does National Health Reform mean there will be more Aboriginal and Torres Strait Islander doctors, nurses and allied health workers?

National Health Reform will build on health workforce programs already underway with $1.2 billion for new training and support initiatives, including rural and remote nursing and allied health locum schemes. There will also be more training places for work in general practice. This will help build the workforce to meet the health needs of all Australians – especially in areas where there is currently a shortage of health professionals.

Aboriginal and Torres Strait Islander students and health professionals will be able to benefit from the new workforce initiatives, including more training for more health professionals, support for the rural, regional and remote health workforce, and support for practice nurses.

Medicare Locals will work with universities and other education and training providers to support the education of health professionals in communities.

How do I use the after hours GP telephone advice service?

If you need to use a health service at night or on the weekend, simply call the after hours GP telephone advice service on 1800 022 222. Your call will be answered by a trained nurse who will talk to you about your condition.

The nurse will be able to give you the right advice and treatment options.

If you need to speak to a GP, the nurse will be able to transfer your call to a GP.

If your call is transferred to a GP, the GP will discuss your condition and give you further medical advice and treatment options.

If the nurse or GP decide that you need to visit a health professional immediately, you will be given contact details of the closest suitable face-to-face after hours service to contact.

The after-hours service operates from 6pm to 8am weekdays, from 12 noon on Saturdays until 8am on Mondays, and 24 hours on public holidays.

The GP helpline began operating on 1 July 2011 in most states and territories. Queensland will connect from early 2012, to build on the existing 13HEALTH nurse advice line. Negotiations are progressing with Victoria so that the GP helpline can be accessed in that state. For people living in Tasmania, access to after-hours GP telephone advice is available through GP Assist (1300 780 011).
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How will my regular GP know about the advice provided by the after hours service?

The after hours GP helpline allows for continuity of care. Your usual GP will be able to obtain a record of your telephone consultation with your permission.

How much does the after hours GP helpline service cost?

The after hours GP helpline service is free and if you call from a landline, the call is free. Call charges will apply if you call from a mobile phone.

How will my privacy be protected when I use my personally controlled electronic health record?

You can choose whether or not to have a personally controlled electronic health record, and you will decide who has access to your information.

With your consent, the personally controlled electronic health record system will allow authorised healthcare professionals to view a summary of your key clinical health information, like symptoms and conditions, treatments, medications, test results and allergies.

How secure will my electronic health record be?

The Australian Government will ensure your health information is protected by building a secure system that follows strict standards and legislative and regulatory controls. The personally controlled electronic health record is being introduced in stages to make sure it is both effective and secure. The first step in the personally controlled electronic health record system has been the establishment of eHealth lead implementation sites. The sites will develop and deploy eHealth infrastructure and standards before nation-wide implementation. This will enable the Australian Government to be confident that the different components of the system work.

How will the new Coordinated Care for Diabetes pilot improve care for patients with diabetes?

The purpose of the Coordinated Care for Diabetes pilot is to test a new model of care which aims to improve the quality of care for Australians living with diabetes.

The pilot commenced on 1 July 2011 to assess the effectiveness of the Coordinated Care for Diabetes program, including voluntary patient enrolment, and to inform future arrangements for chronic disease management in the primary care setting.

If you are an Aboriginal or Torres Strait Islander person, you do not need to wait until the pilot is finished to take advantage of the benefits of coordinated care. You can talk to your GP now about enrolling with an eligible general practice or Aboriginal medical service for coordinated care for diabetes under the Indigenous Chronic Disease Package.
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When will I see changes from National Health Reform?

Many important National Health Reform initiatives are underway. For example:
The first tranche of 19 Medicare Locals began operation on 1 July 2011. The second and third tranches will commence in January and July 2012.

New Medicare items providing specialists’ consultations via video conferencing commenced from 1 July 2011 for Australians living in rural, remote and outer metropolitan locations.

The MyHospitals website, live since December 2010, is providing increased transparency on hospital performance by making it possible to compare a hospital’s performance against the national average.

The after hours GP telephone advice service, connecting Australians to a GP, commenced from 1 July 2011.

The Australian National Preventive Health Agency began work on 1 January 2011.

There have been significant advances in establishing new national bodies to drive improved standards and greater performance across our health system. Increased transparency and consistent accountability measures across Australia’s health system will give communities greater confidence that they know what is happening in their health system.

The National Health Performance Authority, which will produce Hospital Performance Reports, as well as Healthy Communities Reports on primary health care performance, was established as a statutory agency in October 2011.

An expanded Australian Commission on Safety and Quality in Health Care was permanently established in July 2011. The Commission will play an important role in developing, implementing and monitoring national clinical safety and quality standards.

The implementation of the new front end for aged care commenced on 1 July 2011. The new front end will continue to work with Medicare Locals and Local Hospital Networks to promote care that is integrated at a local level across the acute, primary and aged care sectors.

The implementation of National Health Reform measures to date has been guided by experts and stakeholders. The Minister for Health, the Hon Tanya Plibersek MP, and the Minister for Indigenous Health, the Hon Warren Snowdon MP, will continue to consult with all governments and with the many groups who have an interest or involvement in the health system, including peak Aboriginal and Torres Strait Islander health organisations.

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Page last updated 20 December, 2011