One of the many ironies about Kevin Rudd’s health reform agenda was that he took a controlling, centralised approach to instituting what was billed as developing “local control” for health services.

There is a widespread view around the traps that the health reform agenda began to head off the rails when Rudd, his staffers and Department took over the process.

Much of the useful work that had already been done, including by the National Health and Hospitals Reform Commission, was sidelined and one key concern about our health system – the lack of equity as highlighted in a recent Croakey series – seemed to have disappeared from the table.

A more equitable and efficient health system relies on a far greater focus and investment in primary health care and public health. But the PM’s political priorities were focused firmly on hospitals.

The latest report card of Australia’s health, released yesterday by the Australian Institute of Health and Welfare, shows that a continuing focus on hospitals as the supremos of the health sector will result in a system that cannot be sustained in to the future.

The report (ages 484 and 485) says in 2007-08 there were 2 million attendances at public hospital emergency departments that could have potentially been avoided through the provision of appropriate non hospital services in the community. From 2002-03 to 2007-08, for every 1,000 people, there were 33.6 admissions to hospitals that could have been potentially prevented through the provision of appropriate non-hospital health services.

What will the change of leadership mean for health reform?

While we wait for the answers to this question, many will be thinking back to Gillard’s time as opposition spokeswoman on health and ageing, when Abbott was health minister. She was an effective match for him then, in both policy and political terms.

Don’t mistake me; I am not arguing that the business of health, or health reform, should be left entirely to health ministers. We hear, ad nauseam, that the greatest gains in health require efforts not only across jurisdictions, but also across governments. Many of the solutions for improving the community’s mental health may not lie within the domain of the health minister, for example.

The question is not whether the new PM should be closely involved in health reform; it’s how she does it that matters.

PostScript (12.45pm): Having just watched the new PM’s first press conference, two comments of particular relevance for health. Her commitment to every child having quality access to education, and to stressing the importance of quality government services for the less well off.

Update (5.45pm): I missed the first part of the departing PM’s speech, so missed his comments about health. This report is from the 6Minutes newsletter, which says Kevin Rudd cited his government’s health reforms and investments in cancer services as among his proudest achievements. He said he was “really proud” of the deep health reforms he had initiated, and the National Health and Hospital Networks in particular. He was especially proud of the government’s new investments in cancer services, and also singled out the creation of a new National Transplant Donation  Authority as one of his  major achievements, citing his own aortic valve transplant as making this of personal as well as political significance to him.

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