As previously mentioned at Croakey, plans for recording last night’s NSW public health election debate had to be abandoned thanks to a blackout imposed by the NSW Opposition – which was such a shame as this may have been the only chance we had for a public discussion that went beyond a focus on hospital bed numbers.

Thankfully, Amanda Dominello, manager of the Menzies Centre for Health Policy, was there to provide this report for Croakey readers.

Amanda Dominello writes:

With their public health helmets on, Carmel Tebbutt, Deputy Premier and Minister for Health; Jillian Skinner, Deputy Leader of the NSW Opposition and Shadow Minister for Health; and David Shoebridge, Lead Green’s Candidate, last night participated in The Great Election Debate: Public Health in NSW.

The event commenced with an opening address from each candidate.

Carmel Tebbutt outlined the government’s achievements – decline in death rates for cancer, cardiovascular disease and accidents, campaigns to increase vaccination rates and decrease smoking rates, the 1999 Drug Summit and the NSW response to the swine flu pandemic – and identified obesity as a major public health challenge for the future.

Jillian Skinner told us the story of Mrs Western Sydney, who drives home after a long day’s work on the polluted and congested M5, buys a fast food dinner for the family, has little time in the evening to spend with her children, flops into bed at night, only to wake in the morning and start the same exhausting cycle again.  Jillian Skinner identified 3 priorities for the Coalition: prevention and better management of people with chronic disease; fixing hospitals; and investment in infrastructure, equipment, staff and medical research.

David Shoebridge said that recognition of Aboriginal people is a key part of the public health debate.  He spoke of the need to go beyond GPs and hospitals and address matters outside the health portfolio such as urban planning and transport.  He advocated for public health impact statements for new developments, advertising restrictions for unhealthy foods and an extension – and enforcement – of smoking bans in public places.

Five set questions were then posed to each candidate on the issues:

1.    Funding for prevention;

2.    Aboriginal health and social disadvantage;

3.    Alcohol and mental health;

4.    Climate change; and

5.    ‘Health in All’ policies and health reforms.

How they answered

Carmel Tebbutt spoke of the difficulty of shifting money from acute care to prevention.  She identified successful programs established by the government in response to the National Partnership Agreement (NPA) on Closing the Gap in Indigenous Health Outcomes and supported a federal dental health scheme.  In addressing alcohol and mental health issues, Carmel Tebbutt spoke of the need to decrease access of and demand for alcohol through health promotion campaigns and a focus on young people.  She promoted a shift in mental health funding from treatment to the community sector.  She provided support for a price on carbon and the NSW Energy Savings Scheme.  Carmel Tebbutt recognised the importance and challenge of working across silos and portfolios and noted Families NSW as an initiative that has successfully brought agencies together.  In her final response she spoke about the future challenges of integrating Medicare Locals and Local Health Networks (LHNs) and government efforts to address them through clinical support clusters.

Jillian Skinner said if elected she hopes to increase NSW public health expenditure to meet the national average percentage expenditure on public health.   She spoke of the need to work at providing care for Aboriginal people where people live and criticised the government for failing to report on NPA implementation.  Her approach to dental health is to address workforce, better engage with the private sector and establish an expert taskforce.  Jillian Skinner noted that the Coalition had already announced its policy on prevention of alcohol problems and that a whole of government approach was needed.  She supported more acute psychiatric beds and greater assistance for people living with mental health illness in the community.  In responding to climate change, the Coalition believes a price on carbon will have a negative impact on vulnerable populations and will invest in public transport and research.  If elected, the Coalition will review the details of the new COAG agreement, in particular boundaries for the LHNs, governance arrangements, local involvement of clinicians in the Governing Councils and the link between acute and community care.

David Shoebridge proposed an increase of public health expenditure to 4% by sourcing funds from additional taxes on the gambling and alcohol industries.  He supported training of more public dentists and the implementation of a national dental health scheme.  He affirmed the Greens’ harm minimisation approach to drug and alcohol issues, taxation on alcohol content and alcohol advertising restrictions.  He advocated for reform and investment in the criminal justice system to better support Aboriginal people and people with mental health illness.  The Greens stance on climate change is clear he said and he made mention of the need to reign in the coal industry in the Hunter Valley.  David confirmed his support for LHNs but expressed concerns about casemix funding and duplication with Medicare Locals.  He thought there was great potential for public health to get squeezed out in the new health reform structures.

Questions from the audience

The final component of the debate program was an audience question and answer session.

• On mental health
When asked about policies on medical research funding, especially for mental health, Jillian Skinner said that,  if elected, she will appoint Mr Peter Wills to head a taskforce to develop a NSW health and medical research strategic plan. David Shoebridge supported the generation of evidence on how to deliver mental health services, particularly to homeless people.  Carmel Tebbutt spoke about current NSW research funding support for the NGO sector and the importance of research in mental health.

• On health service funding
In response to a question about health service delivery funding, David Shoebridge called for a commitment from the NSW government to review perverse incentives and cost shifting.  Carmel Tebbutt confirmed a commitment to getting good integration between Medicare Locals and LHNs.  Jillian Skinner said that the single greatest disappointment in the health reforms is the lack of action on cost shifting.  She discussed the need for preparedness to enter into partnerships with the private sector, as articulated in the Liberal Party’s Making it Work policy.  Jillian Skinner also confirmed that she will be the NSW Minister for Health if the Coalition wins the March election.

Other questions from the audience addressed:

  • Needle and syringe exchange in prisons – Jillian Skinner supported this program.
  • Corporate donations – Jillian Skinner and David Shoebridge supported a ban on all corporate donations, Carmel Tebbutt did not.
  • Medical graduate student placements – Carmel Tebbutt committed to placements for all domestic students, Jillian Skinner committed to training places for all graduates and safe working hours, David Shoebridge supported safe working hours for junior doctors and claimed that this would result in both increased capacity to accommodate more students and better health outcomes for doctors and patients.
  • Composition of the LHN Governing Councils – Jillian Skinner questioned if the right mix of people with skills in business and strategic planning had been appointed to the Councils, David Shoebridge expressed concerns about the composition and representativeness of the Governing Councils.

Their concluding punchlines

Each candidate had an opportunity to provide a brief concluding remark.  David Shoebridge confirmed the need for investment in public health.  Jillian Skinner expressed a desire for deliverable reforms.  Carmel Tebbutt made a commitment to public health and the need to work across government sectors.

We welcome your comments on the debate.  With no worm to measure highs, lows and declare a winner, we’d especially like your feedback about the event if you were in the audience.

• The debate was hosted by The NSW Branch of the Public Health Association of Australia, in partnership with the Menzies Centre for Health Policy, and the NSW Branch of the Australian Health Promotion Association.

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