For a sustainable health system, the Victorian public deserves so much more than election promises focused on more hospital beds, according to Tom Symondson, Acting Chief Executive of the Victorian Healthcare Association.

His analysis of election health policies echoes some themes raised previously at this blog by Dr Christine Walker of the Chronic Illness Alliance.

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Tom Symondson writes:

Throughout this election campaign, a number of things have been prominent in the public consciousness: the possibility of Victoria’s first one-term government since 1955; the major parties tussling over transport, particularly the East West Link; Labor’s big red campaign bus; and of course, the attack ads.

One thing that doesn’t appear to have captured the public imagination or that of the media is the main parties’ approach to health.

And it’s not for want of trying on the part of our politicians. We’ve seen over 80 health announcements from Labor, the Coalition and the Greens since the campaign started, worth a combined total of more than $3b.

There have been eye-catching funding announcements from all sides.

We saw the Coalition commit $70m for a specialist cardiac hospital at Monash Health, followed by Labor’s own plan for a $150m heart hospital at Monash University.  The Greens $200m pledge for a women’s and children’s hospital in Sunshine was later matched by Labor, while the Coalition committed $5m to a public-private partnership to build capacity across the western suburbs, and $98m to expand the Northern Hospital.

On the ever-present issue of hospital beds, the Coalition announced $944m to increase bed capacity and run beds built under their capital promises, and the ALP announced an independent audit of hospital capacity and $200m to open beds and theatres that are not operational.

It should come as no surprise that the major parties have focused many of their announcements on investing capital dollars in projects across the state – and these are largely necessary projects with positive local impacts.

Lack of vision
However, what is lacking is a clear policy thread linking all these initiatives together to build a compelling long-term vision for the future of our health system.

One of the problems facing all parties is the fixation of the mainstream media with reporting health system performance in terms of how many hospital beds there are, and how many dollars are being spent. As a result, politicians are hamstrung by a growing belief that ever-increasing bed numbers alone are the silver bullet which will solve our health challenges.

Don’t get me wrong – more bed capacity is needed, particularly in regional and metropolitan growth corridors.

But we need a coherent plan for deciding where that capacity should go, and what type of capacity is actually required.  It is well-established that all beds are not created equal.  Acute beds are easier to define, but how should we categorise hospital-in-the-home for example? This is a recognised service model, which matches many people’s desire to be treated at home where possible.

Yet when governments attempt to include hospital-in-the-home bed equivalents in bed figures, they tend to receive criticism from across the board for welching on promises.  Dialysis chairs are another good example.

Even with a wider definition of beds, we need to drastically grow funding for non-acute services, including community health, primary care, rural healthcare and services for our ageing community.  These services will play an increasingly crucial role in reducing demand for expensive acute inpatient care.  Yet they tend not to get the attention they deserve.

Primary and community health services and prevention programs have received some support from the major parties during this campaign.  Labor has promised to fund GP visits to disadvantaged schools to the tune of $42.6m and provide free whooping cough immunisations for all new parents.  Labor’s platform also includes a commitment to support the sustainability of community health.

The Coalition has provided greater detail, with promises including $127.5m to tackle obesity and chronic disease, $40m of additional support to community health, funding for sexual health services, and early intervention for dementia sufferers.

Both sides plan to increase funding for community mental health.  Many of these initiatives have merit, yet they still do not constitute a system-wide approach.

Why is such an approach necessary?  It’s not as though our system is broken.  On the contrary, it delivers excellent care, efficiently and effectively.

System under pressure
However, it is under unprecedented pressure. Victoria’s population is predicted to increase by 19% (to 6.6 million people) by 2021.  Over 75s will increase by 40% in metropolitan Melbourne and 29% in regional Victoria over the same period.  People aged over 75 access health services five times more than those aged under 75.

Even more pressing is the Commonwealth’s move to shrink its support for state health spending in future years, signalled in the Abbott Government’s first budget. If implemented, this will drastically reduce the states’ ability to meet growing health expenditure beyond 2017-18.

Faced with this scenario, the argument for a fundamental rethink is all the more compelling to enable Victoria to continue delivering excellent care, but also to improve health outcomes, and provide the cross-sector integration which is a hallmark of the world’s best health systems.

Whoever is in government after Saturday must address one major question – what should our health system look like into the future?

Prior to the 2010 state election, the VHA called for a long-term plan to guide the development of our health system.  We have since welcomed the Coalition’s Victorian Health Priorities Framework 2012-2022 but are yet to see significant progress against its objectives.

The VHA election platform, entitled Rethinking our health system, provides a road map for whoever wins government to develop and deliver a long-term plan.  It proposes, amongst other things:

  • much stronger emphasis on prevention and community-based care, including a clear primary care plan;
  • giving health services greater autonomy to plan and manage their services, particularly in relation to capital planning;
  • funding that keeps up with population growth and cost inflation;
  • using information technology to support integrated care;
  • better matching supply with demand.

For now, it’s a waiting game to see whether the next Victorian Government is up for the challenge.

• Tom Symondson is Acting Chief Executive of the Victorian Healthcare Association

• Previously at Croakey: So many health promises, so little vision

 

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