The National Health and Hospitals Reform Commission recommended moving more public hospital outpatient services outside the walls of hospitals.

The idea is to make more health care and services available where people live - in their local communities and homes.

The Commission said that Australia’s public hospital outpatient services should be reviewed, so they could be designed more closely around the needs of patients.

“The traditional organisation of outpatient departments – large waiting rooms, block appointment sessions rather than scheduled consultations, and lack of continuity of staff involved in monitoring a patient’s care – did not put patients first,” said the Commission.

Outpatient services, said the Commission, “have been described as the ‘poor cousins’ of the Australian health system – ‘a remnant of the pre-Medicare system which provided free specialist care for “the poor”’.”

The Commission envisaged a more responsive, patient-focused model of delivering outpatient specialist care.

This included better linking up these specialist services with comprehensive primary health care provided in the community by doctors and other health professionals, and by locating more specialist services in the community.

What kinds of hospital outpatient services do you believe could be placed in local communities?

What else do you believe could be done to improve the care and treatment of hospital outpatients and assist their return to health in the community?

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Innovative use of communication technologies is helping improve the safety and care of older people in nursing homes, and of those in community care in their own homes.

Suggestions by the National Health and Hospitals Reform Commission include electronic prescribing by doctors, new personal security technology, online and telephone health advice for older people and their carers, as well as electronic clinical records in aged care homes.

The Commission said the technology available for aged care services has changed dramatically in recent times.

“Mobile phones, personal digital assistants, and wireless computing technology have transformed the way we interact and communicate with others …

“Around 75 per cent of Australians now use the Internet and, as a consequence, are able to learn a remarkable amount about their own health problems, diagnoses, prevalence and treatments.

“This has driven consumer knowledge and patient expectation for a desired service or a particular outcome. It has also opened up opportunities to deliver health care services in a different, more time-effective way, which we have not yet fully exploited.”

One of the fears people have about going into aged care is of losing control by becoming ‘the person talked about’, rather than staying in control of their care as ‘the person talking to’ their carers, family and health professionals.

New technologies could help turn this around. The Commission pointed out that today’s Web 2.0 technologies, such as “patient portals, electronic health record platforms, blogs, video chat, ‘tweets’ and the myriad of social networking possibilities such as Facebook all have the potential to alter relationships between care givers and care receivers.

“They may change the locus of control to the patient (to, for example, choose when to ask for advice and enable more flexible interaction, book an appointment, or view a test result) and offer the opportunity to engage in richer and deeper doctor-patient relationships.”

The Commission said some primary health care practices are already turning to these mediums - benefiting practitioners and patients alike. One new platform being used is www.hellohealth.com – which helps doctors communicate, document, and transact with their patients in person and online.

“Web-based therapy and telephonic support have already been demonstrated to be helpful in supporting people who have mental disorders and the Internet is likely to deliver a plethora of innovative modes of interacting with many other health professionals,” said the Commission.

Using broadband, it is now possible, for instance, for a carer’s own TV and remote control to be complemented with a multimedia PC, a web camera, a video-telephone link and Internet connection to enable the person receiving care or their carer to link to and talk to the outside world whenever they wish.

Even general developments such as Internet shopping for weekly groceries, with home delivery, can assist people to remain independent in their own home.

Which communication technologies do you believe would help improve aged care? Do you have a personal experience which would serve as an example?

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The National Health and Hospitals Reform Commission has recommended a sustained national community awareness campaign to increase mental health literacy and reduce the stigma attached to mental illness.

It also proposed “targeted approaches to improving health literacy in particular domains, such as mental health literacy.

“For too long, people with mental illness have been stigmatised.”

The Commission said it was vital that “governments, private health insurers, health services, non-government organisations and the media all contribute to improving health literacy among the general population”.

In our earlier blog on improving general health literacy, claracmwa suggested the health system should be easier to navigate – as it “seems quite fragmented with multiple providers and no unifying vision.

Claracmwa suggested creating a "home" for all health-related information – as well as "ambassadors" who could work with people who have complex health needs and need support from a variety of providers.

In addition, the National Health and Hospitals Reform Commission strongly supports greater mental health competency training for the primary health care workforce.

What do you think should be included in a national community awareness strategy to build awareness and understanding of mental health? Is a media campaign needed, or could other approaches be used?

What else could be done to reduce the stigma of mental health in the community?

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The National Health and Hospitals Reform Commission has recommended that, to help ensure children get a healthy start to life, new kinds of partnerships between health care professionals and parents should be established.

“Research shows that the first three years of life are particularly important for early development, we also note the importance of the period of the transition to primary school,” the Commission said.

It favoured “a child and family-centred approach to shape the provision of health services around the health needs of children and their families”.

The Commission believed that these partnerships would provide more useful knowledge to parents and extended families – including health promotion, such as support for breastfeeding, and disease prevention.

This knowledge could aid families to become more skilled in early detection and intervention. They could be shown how to manage health risks and the health needs of their children at different stages of life.

These partnerships could also help families get improved access to doctors and other primary health care services, as well as to other health services – such as those needed by children experiencing chronic or severe health or developmental challenges.

How would you see these partnerships between health care professionals and parents working to help ensure a healthy start for their children?

What else could be done to improve health outcomes for children?

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The National Health and Hospitals Reform Commission in its final report found that about six out of every 10 Australians would find it difficult to understand or make the choices necessary to stay healthy or to find their way around the health system.

The Commission uses the term “health literacy” to describe a person’s ability to use information effectively to make appropriate decisions about their own or their family’s health and health care services.

The Commission found clear evidence that people with lower health literacy can have poorer health outcomes.

For example, the Commission says that people “with poor health literacy have lower rates of screening for preventable health conditions, poorer experience in managing the health of their children, and difficulty in following instructions from their health care practitioner.”

The Commission said the health system must become more people- and family-centred and provide stronger opportunities for engagement and participation.

Australians need to be able to choose whether, how, where and when they use health services, and to be supported by access to evidence-based information that helps make their choices easier.

The Commission believes that it is vital that governments, private health insurers, health services, non-government organisations and the media all contribute to improving health literacy among the general population.

The Commission recommends that one important approach is for health literacy to be included as a core element in the curriculum for both primary and secondary schools.

What do you believe the government should do to raise the health literacy of Australians?

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The National Health and Hospitals Reform Commission’s Final Report suggests that people are frustrated over long waiting times for elective surgery.

The Commission gave a high priority to providing more timely care in public hospitals, both care in emergency departments as well as planned surgical and medical care (also known as ‘elective surgery’ or ‘elective procedures’).

The Commission recommended “public hospitals with major emergency departments be funded to ensure beds are available at all times for people needing to be admitted from the emergency department …”

“For patients, this would mean quicker access to a hospital bed if it is needed in an emergency and less crowded emergency departments with care being provided more quickly and safely.”

The Australian Government has committed $600 million over four years to 2011 through the Elective Surgery Waiting List Reduction Plan to improve elective surgery performance. In 2008, this funding helped the states and territories to treat an extra 41,000 patients.

The Commission recommended extending this additional funding beyond 2010-11 – as well as extra funding to address unmet needs for surgery that will emerge when existing waiting lists are cleared.

The Commission also recommended setting access targets for emergency departments and elective surgery.

This would see waiting-time targets set and require hospitals to report on their rates of meeting these targets.

For instance, the Commission has suggested national access targets for people attending emergency departments (measured in minutes to hours), a national access target for patients requiring coronary artery surgery or cancer treatment (measured in weeks or days), and a national access target for patients who need other planned surgery or procedures (measured in months).

What do you think about setting waiting-time targets?

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The hospital sector offers great potential for efficiency gains - a major finding reported to the National Health and Hospitals Reform Commission (NHHRC).

As an example, the NHHRC suggested that improved practices – such as a higher uptake of information technology to enable the use of computerised physician-order entry systems, electronic health records and decision aids – would enable hospitals to improve their efficiency.

Improved efficiency could include shorter stays in hospital or getting faster access to treatment through shorter waiting lists. Improved efficiency frees up money - so that more services can be provided.

The Productivity Commission has estimated that the 'productivity gap' between existing and optimal efficiency for Australian hospitals could be between 20 to 25 per cent.

Wise investment and improved efficiency should occur in tandem, says the National Health and Hospitals Reform Commission.

The NHHRC also recommends the use of ‘activity-based funding’ to help improve the efficiency of both public and private hospitals.

This would mean hospitals being funded by government for what they actually provide to patients - at an efficient cost.

A price would be set for each efficiently-delivered service, such as accommodation services, theatre operations, pathology, radiology, nursing and allied health services, pharmaceutical and medical services.

Government would then have a common measure of efficiency - being able to compare across different hospitals their costs for similar activities (such as a hip operation).

Government could then use this measure of hospital efficiency when it decides where to invest taxpayer dollars.

Do you think activity-based funding could help make Australia’s hospitals more efficient? Can you suggest other ideas to improve their efficiency?

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The idea of having personal electronic health records, controlled by each individual, has been recommended by the National Health and Hospitals Reform Commission.

In its report A Healthier Future for All Australians , the Commission said, “Much like the state and private railways of the 19th century, Australia runs the risk of un-linked electronic health infrastructure.

“From remote communities to metropolitan hospitals, governments, private companies and clinicians have implemented dozens of innovative e-health projects.

“But much more can be gained by taking advantage of synergies and committing to a truly national effort to optimise the system.”

Each individual’s e-health record would be designed to give them better access to and more control over their own health information.

With an individual’s approval, health care providers and carers could instantly access the same, up-to-date patient information - avoiding asking them the same questions and manually re-entering patient data.

The Commission believes this approach would help reduce waste and inefficiency in the creation and use of health information and lead to better, safer care and improved health outcomes.

In Tell Us What You Think , David says that he believes e-health should be a national responsibility. Martin would like to choose to share information with his health care providers as he sees fit. And Michael believes quality and efficiency would improve with an up-to-date record of medication, allergies, vaccinations and recent results.

What do you think?

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Nearly a quarter of Australia’s children are now overweight or obese. It is possible they will have shorter lives than healthy children.

“Australia is one of the most overweight nations in the developed world, with over 60 per cent of adults and one in four children overweight or obese,” according to the National Preventative Health Taskforce.

“This is one of the greatest public health challenges confronting Australia and many other industrialised countries,” it says.

Preventing obesity means we need policies to help encourage the population to become more physically active. Policies are also needed to promote healthier eating – as Australians should eat less nutrient-poor sweet and starchy foods.

In order to create environments conducive to healthy living, the Taskforce recommended:

• bringing together governments, industry and community organisations through a new PM’s Council for Active Living to boost physical activity

• a Healthy Food Compact between governments, industry and non-profit community organisations to re-shape Australia’s food supply towards healthier products.

In order to encourage healthy behaviours, the Taskforce recommended:

• a comprehensive, sustained social marketing strategy to increase healthy eating, physical activity and reduce sedentary behaviour - building on the Measure Up campaign

• specifically for children: incorporating Health and Physical Education for all Australian children into the second stage of National Curriculum development; monitoring a requirement for at least two hours of physical activity per week for students K–10; and expanding coverage of out-of-school-care programs.

What do you think about these recommendations?

Are there any good examples of communities and business getting together to collaborate on reducing obesity?

Who else do you think could help reduce Australia’s waistline?

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Research has found that if you live in rural or remote areas of Australia you’re likely to face poorer health outcomes than if you live in cities and big towns.

Compared to the major cities, people’s life expectancy in regional areas can be one to two years lower. For remote areas, it is up to seven years lower.

The National Health and Hospitals Reform Commission recommended more flexible funding. This would mean spending more money on local health services where they are most needed in the bush.

It recommended that under-served remote and rural communities should be given ‘top-up’ funding.

The idea is that this would be equal funding (on a per-head basis) to that received by communities with better access to medical, pharmaceutical and other primary health care services.

Do you agree that this is how health care can be improved in the bush?

Is there another approach you’d suggest?

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Mental health problems are much more common than many people realise. One in five Australians will experience a mental health disorder in any given year.

The National Health and Hospitals Reform Commission says about three per cent of Australians may be severely disabled due to mental disorders like psychosis, bipolar disorder, or severe depression or anxiety.

The Commission says “the tragedy of suicides and preventable violence, coupled with police often being used as de facto first responders to people suffering a mental health crisis, demands a better response.

“We also know that busy emergency departments are often the worst place for someone experiencing psychosis, yet this becomes the default setting.”

The Commission recommended rapid response outreach teams, available 24 hours a day to urgently assess people having a mental health crisis and to provide short-term treatment – in Australia’s local communities, as well as in hospitals.

How would you suggest improving the care of people experiencing a mental health crisis?

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On average Aboriginal and Torres Strait Islander people experience poorer health and shorter lives than other Australians.

In fact, if you are an Indigenous Australian, your lifespan is likely to be 9.7 to 11.5 years shorter than that of non-Indigenous people (Australian Bureau of Statistics estimate).

The National Health and Hospitals Reform Commission said that health is a fundamental human right and improving indigenous health should be a priority.

The Commission recommended the creation of a strategy that would improve the affordability of fresh food – particularly fruit and vegetables – in targeted remote communities.

This is because good nutrition and a healthy diet are essential for ensuring people get a healthy start to life and to their ongoing health.

Do you agree that this could help improve Indigenous health?

How would you suggest improving the affordability of fresh food in remote communities?

Is there another approach you’d suggest?

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When seeking health care Australians are most likely to visit health professionals in their local communities – such as GPs, nurses, psychologists, physiotherapists, and dieticians.

In fact almost one in four Australians visits a doctor in their community in any two-week period. There are more than 110 million visits to GPs each year.

The National Health and Hospitals Reform Commission has recommended that community-based care should be the cornerstone of a future health system.

The recommendation involves setting up comprehensive, one-stop health care centres in communities across Australia. At them you’d be able to get many services in addition to a GP – such as pathology, imaging, or community nursing. They would have extended opening hours to be more convenient to your needs.

These centres would become the first point of contact for diagnosis and treatment, helping Australians better manage their health and reducing the need for higher-level, hospital-based care.

What benefits would a one-stop community health care centre provide to you and your family?

What challenges do you believe would need to be faced to deliver these centres?

Or, if you believe that a different approach would deliver a better outcome, what would it be?

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