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(Re)form with Substance? Restructuring and governance in the Australian health system 2004/05

(Re)form with Substance? Restructuring and governance in the Australian health system 2004/05 The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004–2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus in 2004–2005 at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004–2005, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress. where governments' responsibilities intersect. After sev- Review The Council of Australian Governments' (COAG) 15th eral years of apparent stalemate, it seemed that the discus- meeting on 3 June 2005 in Canberra endorsed a national sion had re-opened on ways to improve Australia's health health reform agenda with an unusual level of national system. In its most ambitious section, the COAG 2005 consensus. The heads of Governments agreed that Aus- Communique "agreed that where responsibilities tralia has one of the best health systems in the world, between levels of government need to change, funding albeit with room for improvement, particularly in areas Page 1 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 arrangements would be adjusted so that funds would fol- ment of Australian health system restructuring, Dwyer low function." [1] lamented that 'Unfortunately, the Commonwealth: state responsibility split, the one structural barrier most central The governments stated in their Communique that the to the systemic weakness of Australian primary care (and health system can be improved by clarifying roles and therefore most important for the capacity to develop and responsibilities, and by reducing duplication and gaps in support new models of care for chronic diseases), is one services. They recognised that many Australians, including that a state can't address, at least not alone [7].' the elderly and people with disabilities, still face problems at the interfaces of different parts of the health system. Before the COAG announcement in June 2005, there was They restated the aim of integration and a smooth transi- little prospect of progress. The Prime Minister had tion between acute care, home and residential care, and announced in October 2004 a Task Force headed by helping younger people with disabilities. The necessary Andrew Podger, the previous head of the Department of themes of workforce supply and flexibility, prevention, Health and Ageing (DHA). Consisting of officers from the electronic records, a national call centre, and rural and Departments of Prime Minister and Cabinet, Health and remote services were reinforced. Senior officials were Ageing and the Treasury, its role was to review the opera- given till December 2005 to come up with a plan of action tion of health policy to examine how to improve the to progress these reforms. delivery of health services. Finalised in early 2005, its report has not been released. Federal Health Minister The core ideas behind this change of climate have been Tony Abbott referred briefly to it earlier in 2005 by com- well rehearsed in both health bureaucracies and the sub- menting that it has been commissioned so that "the Gov- missions of industry groups. In 2004 the Australian ernment can respond to any state proposal" [8]. Healthcare Association (AHA) released five policies, the first of which called for a National Health System so that, by At that time Minister Abbott had outlined the problems of 2008, all Australian governments will have adopted a the health system from the point of view of the Australian nation-wide approach to health policy and service deliv- Government when he addressed the Committee for Eco- ery. AHA argued that "a National Health System is funda- nomic Development of Australia Conference in February mental to successful health system reform in Australia and 2005. In his address, Minister Abbott was not concerned will provide access to health care services for Australians with primary care, but with the 'big health issue' for 2005 irrespective of borders or payers" [2]. – hospitals. For the Minister, this was primarily a matter for the states and territories rather than the Common- The rest of the policy agenda was a call for a National Pack- wealth, and a good opportunity for some "free-kicks". He age of Healthcare Services, so that the next Australian pointed out that Section 51 of the Constitution relegates Healthcare Agreement (2008–2013) would govern all the Commonwealth to little more than a funding author- public sector health programs and services administered ity having no operational control of public hospital sys- by all Australian governments in partnership [3]. This was tems in the subordinate jurisdictions. While he did accompanied by a National Approach to Quality and Safety concede that it would make more sense for one level of in Health [4], and policies for better integration and coordi- government to be responsible for the entire health system, nation of health care [5], and a national approach to workforce the real issue of the day was not so much who funds hos- reform [6]. pitals but how they are managed. While no doubt ambitious, there is little dispute about the The Minister complained that 'years of poor management merit of these policies and their potential impact on mean that public hospital patients now face long waits for health in Australia. Given the renewed relevance of larger essential as well as elective treatment (Abbott 2005).' Pri- scale reform under the 2005 COAG announcements, vate hospitals, in stark contrast, were in the business of these policy signposts form a useful framework by which providing patients 'with what they want, when they want to assess the state of the Australian health care system and it'. The challenge for the federal government was to exer- its attempts at reform in 2004/05. cise effective leadership over the public hospital systems that are run by the states and the territories and private sector hospitals which, the minister remarked, 'aren't run The state of play in Australian-state/territory government relations in 2004/05 – ritual or by the government at all [8].' reform? Without a clear strategy to move to a more truly national Fortunately, the national health reform agenda is too system, all reform is going to be counterbalanced by the important to be left to health ministers alone. Continuing inbuilt tendencies of the current system to move towards its previous calls for more reform, the Productivity Com- increased fragmentation. In a recent overview and assess- mission recommended in February 2005 an independent Page 2 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 Table 1: Outcomes of Australian Health Ministers' Conferences 2004–2005 in relation to structural reform Agreement / Outcome Press release date Agreement to take "immediate action to progress reform of the Australian health care system in the areas of after 28 November 2003 hours GP services; aged care; chronic disease and cancer services; medical workforce planning; and, renal disease services" [10] Establishment of a national nursing taskforce to drive major nursing education and workforce reforms [11] 28 November 2003 Release of Australia's first national health workforce strategic framework [12] 23 April 2004 Agreement to take further steps "to progress reform of the Australian health care system in the areas of after hours GP 23 April 2004 services; aged care; chronic disease and cancer services; medical workforce planning; and, renal disease services" [13] Agreement on a nationally consistent approach to medical registration [14] 23 April 2004 Agreement on the first National Health Workforce Action Plan [15] 29 July 2004 Agreement to continue the Health Reform Agenda and the future priorities for reform [16] 29 July 2004 Agreement to establish a Review of the Future Governance Arrangements for Safety and Quality in Health Care [17] 29 July 2004 Agreement to establish a new national entity to drive critical e-health initiatives – NEHTA [18] 28 January 2005 Endorse development of a National Framework for Action on Dementia [19] 28 January 2005 public review of Australia's health care system, as the first agreed to at the November 2003 meeting of Health Min- step in the development of an integrated reform program. isters (the Health Ministers had first agreed to the Reform "The review should include consideration of: the future agenda at their April 2003 meeting). Instead of a large sys- determinants of demand for and supply of health services; tematic process of reform as suggested by the Productivity health financing (including Federal/State responsibilities Commission and others, health reform in Australia is to and their implications); coordination of individual serv- be progressed in a series of small steps. ices (including with aged care); the interface between pub- lic and private services; information management; and the The first step was the establishment of a Health Reform appropriate balance of resourcing between prevention Agenda Working Group (HRAWG) to progress the Health and treatment" [9]. Reform Agenda. It reports to the Australian Health Minis- ters' Advisory Council (AHMAC). As shown in Table 1, If a revived impetus for a national approach to reform there are optimistic signs in 2005 of some progress toward through heads of government can broaden the debate genuine reform, albeit in small steps. beyond who runs hospitals, and look at primary care and the relationships to residential aged care and community At the April 2004 meeting, the Health Ministers acknowl- care, then the latest review under COAG will be able to edged the need for immediate action to ensure progress in build on progress that has been made under the auspices reforming after hours GP services, aged care, chronic dis- of the health ministers' conferences at national level over ease and cancer services, medical workforce planning, and the last year. renal disease services. Among other matters, the Health Ministers agreed to establish a 'set of principles' that would allow jurisdictions to work together towards improving Toward a national reform agenda – small steps in the right direction? delivery of after hours GP services in certain regions and The perennial issue of the Commonwealth: state/territory building collaborative working relationships with emer- split of responsibility for health is hardly the only matter gency departments in public hospitals. of concern in assessing the effectiveness of public health policy in Australia – even though, as Dwyer comments, it They also agreed to a range of initiatives such as enhanced is 'probably the single most significant problem in health transition care, rehabilitation and step-down care that system design [[7], p 4].' The treatment and prevention of would improve the transition between acute and aged chronic disease are also of great concern with chronic dis- care services. In addition, the Ministers reached agreement ease accounting for '80% of the total burden of disease' to finalise an integrated Chronic Disease Strategy and and approximately '40% of total health expenditure' [[7], Service Improvement Framework for Cancer services [13]. p 6]. At their July 2004 meeting, Health Ministers were asked Chronic disease and related issues were high on the by clinicians to consider three issues that they regarded as agenda of the meeting between Australian Health Minis- important: ters and clinicians in Hobart in July 2004. The meeting was reviewing the progress of the Health Reform Agenda Page 3 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 Table 2: Management of health and human services by jurisdiction – the state of play in 2004–2005 Jurisdiction Scope Organisational divisions Regions Australian Health and Ageing Acute Care Each states and territory is a region Government Separate authorities for Family and Ageing and Aged Care Community Services and Veterans' Business Affairs Health Services Improvement Medical and Pharmaceutical Services Office of Aboriginal and Torres Strait Islander Health Population Health Portfolio Strategies Primary Care ACT Health Allied Health Adviser None. All services directly managed by Separate authorities for Disability, Clinical operations the Department Housing and Community Services. Financial and Risk Management ACT Emergency Services Authority Government Relations and Planning provides the ambulance service Human Resource Management Separate Community and Health Information Services Services Complaints Commissioner Nursing and Midwifery Office established in late 2004 Policy Population health Northern Territory Health and community services Aboriginal Health, Family & Social None. All services directly managed by Separate authorities for Community Policy the Department Development, Sport and Cultural Acute Care St John Ambulance Service is Affairs Community Services separately incorporated, as are some Separate Health and Community Corporate Management Services Aboriginal Health Services Services Complaints Commission Health Services Information Strategy & Quality NSW Health Health System Performance 8 Area Health Services (no Boards) Separate authorities for Ageing, Health System Support reporting directly to the department Disability and Home Care, Housing, Population Health plus: Community Services and Medical Strategic Development Ambulance Service of NSW Research Children's Hospital at Westmead Separate Health Care Complaints (with Board of Directors) Commission Justice Health Clinical Excellence Commission NSW Cancer Institute Queensland Health Health Services 3 Zones Separate authorities for Child Safety, Information 37 Districts within zones Communities, Emergency Services Innovation and Workforce Reform All services directly managed by the [including Ambulance Service], Resource Management. Department Housing, Disability Services Strategic Policy and Government Separate Health Rights Commission of Liaison Queensland South Australia Health Population and Environmental 2 metropolitan health regions and Department of Families and Healthy SA Children, Youth and Women's Health Communities manages other human Service Planning Service with own Boards. services, including Aged and State Dental managed in a region 4 country regional health services Community Care Mental Health managed in a region Separate Health and Community Drug and Alcohol managed in a region Services Complaints Commission SA Health Reform announced in 2004 Separately incorporated bodies deliver ambulance services Veterans Repatriation Hospital separate Hospitals and Dom care separate incorporation Tasmania Health and Human Services Children and Families None. All services directly managed by Separate Health Complaints Community, Population and Rural the Department Commissioner Health Corporate Services Hospitals and Ambulance Housing Tasmania Page 4 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 Table 2: Management of health and human services by jurisdiction – the state of play in 2004–2005 (Continued) Victoria Health and Human Services Disability Services 8 departmental Regions Separate Office of the Health Services Financial & Corporate Services 12 Melbourne networks with own Commissioner Housing & Community Building boards within metropolitan regions Office for Children that now reports Metropolitan Health & Aged Care 71 agencies with own boards in rural to Minister for Children Services regions Operations Victorian Ambulance Service Policy & Strategic Projects Rural & Regional Health & Aged Care Services Western Australia Health Clinical Policy Division. 3 Area Health Services, 1 Country Separate authorities for Community Statewide Health Support Health Service and Women's and Development, Disability Services and Population Health Division Children's Health Service, all directly Housing, Office of Health Review. Country Health Services managed by the Department Separate Office of Safety and Quality Central Wait List Bureau St John Ambulance Service is separately incorporated  integration and coordination of services at the commu- increasing priority being given to governance arrange- nity-based and hospital-based services interface; ments for quality and safety in 2004–2005.  improving the community's access to better health out- Meeting in Sydney in January 2005, the Australian Health comes, in particular, for children, people with chronic Ministers' Conference agreed to establish the National E- care needs, older Australians, and indigenous Australians; Health Transition Authority (NEHTA). This is a new entity and in the form of a company limited by guarantee and gov- erned by a board of directors comprising the CEOs of the  the need for a sustainable, skilled and flexible workforce national, state and territory Health Departments. Its core to enable the adequate provision of health services into activities include 'the development of timelines for the the future. urgent advancement of the e-health agenda; option assess- ment and business case development; standards develop- As these issues were already on their Health Reform ment and implementation support; and provision of Agenda, Health Ministers agreed to endorse child health advice and resources to assist implementation of already and well being as a specific area for reform. In turn, the cli- agreed solutions [18].' It is also expected to advance other nicians recommended that a way to progress a number of significant national priorities in key areas including clini- the important items on the Reform agenda was to conduct cal data standards and terminologies, consent models, a trial in each state and territory of specific services that electronic health record (EHR) standards, and health integrate community-based and hospital based-services, informatics industry reform. suggesting coordinated chronic care and integrated aged care as possible cases [16]. Those trials are yet to Incremental and crisis-driven reforms at state/ eventuate. territory level – just more change or so me real progress? At the same meeting, the ministers agreed to establish a Australian states and territories have a long history of Review of the Future Governance Arrangements for Safety independent reviews leading, cyclically, to the centralisa- and Quality in Health Care. The review is to advise on tion and decentralisation of management and governance future arrangements for the effective leadership and at various times. In 2004–05, Australian jurisdictions are, national coordination of safety and quality initiatives in in the main, in a centralisation phase. Queensland is the health care. It is to report before the Australian Council for subject of an independent review at the time of writing Safety and Quality in Health Care completes its current while Western Australia has a Health Reform Implemen- term in June 2006. National governance arrangements for tation Taskforce in progress. Dwyer [7] reviewed the leadership and coordination of safety and quality in round of reviews in the Australian health system between health care were accordingly included in the Terms of Ref- 2002 and 2004. These resulted in restructuring in New erence of the health care safety and quality governance South Wales, South Australia, the Northern Territory, arrangements review [17]. In parallel, several states and Western Australia, and the ACT. There is a strong tendency territories introduced their own initiatives, reflecting the towards increasing centralisation so that, in 2005, 6 of 8 jurisdictions now directly manage public sector health Page 5 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 services, with Victoria and South Australia having mixed are managed by departments of emergency services (ACT, models. With the recent centralisation of management in Queensland), by the health department (New South New South Wales, Dwyer calculated that two thirds of Wales) or are separately incorporated services (South Australians now live in areas under centralised control [7]. Australia). Given this, the structure and effectiveness of jurisdictional All jurisdictions now have independent authorities (how- health authorities is becoming increasingly important in ever named) to review health care complaints. The ACT determining whether reforms are achieved in areas such as and South Australia established theirs in 2004. However, clinical governance, quality and safety and others important differences in the philosophy and role of such included in the National Reform Agenda. This is espe- bodies were identified in evidence given to the Special cially the case given that, at the same time, the centralised Commission of Inquiry into Campbelltown and Camden authorities will continue to devote considerable resources Hospitals [20], particularly in relation to their role in to responding to each new 'crisis' in their service system. 'blaming' those responsible for errors. Table 2 summarises the management structures in place Western Australia and New South Wales have gone fur- in each jurisdiction in May 2005. As this summary indi- ther. An independent Office for Safety and Quality in cates, there are significant differences in the role and scope Health Care was established in Western Australia in 2002. of the various health authorities. This has important It is responsible for supporting the establishment of effec- implications in relation to structural opportunities to tive quality and safety systems, as well as investigating reform and improve the coordination and planning of complaints. New South Wales established a separate Clin- service delivery, particularly for those with complex and ical Excellence Commission in 2005 (replacing its previ- continuing care needs. At the same time, there is little sim- ous Institute of Clinical Excellence). Not surprisingly, ilarity in how the various departments are organised, as both initiatives followed major media coverage of 'hospi- reflected in their executive level divisional structures tal scandals' in those two states. (listed in alphabetical order in the table). Organisational and executive structures differ between At a national level, the department is responsible for both jurisdictions. As one example, public (or population) health and ageing. But the health care needs of war veter- health is its own division, and reports directly to the ans are the responsibility of the Department of Veterans departmental head, in the ACT, WA and NSW. In Victoria, Affairs (DVA) and not the Department of Health and Age- it is an office within the Rural and Regional Health and ing (DHA). The 'ageing and aged care' functions of DHA Aged Care Services Division while in Queensland it is a include community care programs and services such as branch within the Health Services Division. Population the Home and Community Care (HACC) program that health functions in the Northern Territory also sit in a are managed by the health authority in all but two juris- Health Services Division, but not in one branch. Instead, dictions. New South Wales has a separate Department of population health is the responsibility of several sections Ageing, Disability and Home Care. In South Australia, the including the Centre for Disease Control and a Health previous Department of Human Services was split on 1 Development and Oral Health Branch. In Tasmania, pop- July 2004 into two, with a new Department of Families ulation health is a subdivision of the Community, Popu- and Communities taking responsibility for, among other lation and Rural Health Division. At least in part, these portfolios, community care and disability. differences reflect the scope of the various departments. However, there is no evidence to suggest whether any of In 2005, an authority with broader human and commu- these structures produce more effective policy than others. nity services responsibilities is managing health care in Nor is there evidence on what structure is best able to the Northern Territory, Tasmania and Victoria. These manage the health system and its reform. other responsibilities include, among some others, disa- bility services and housing. Neither function is now As one further example, workforce reform (one of the five within scope of the health departments in the other 2004 AHA policies and also on the Australian Health Min- jurisdictions. isters Health Reform Agenda) is managed differently across the jurisdictions. In 2005, Queensland has a new Tasmania has the broadest role and is responsible for both Innovation and Workforce Reform Directorate while the policy and direct operations of its ambulance service. Western Australia announced in May 2005 the creation of This is not the case in either Victoria or the Northern Ter- a new Clinical Reform and Policy Division. In other juris- ritory where the department manages policy but ambu- dictions, there is either no organisational unit responsible lance services are separately incorporated. In other states for workforce reform or it is incorporated in the functions with a narrower 'health department', ambulance services of other sections such as human resource departments. As Page 6 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 before, there is no evidence to suggest whether any of jurisdictions will be watching in an attempt to learn the these structures will be more effective than others in deliv- lessons. ering on the workforce reform agenda. Conclusion One reason for the differences between jurisdictions We noted that the five AHA policies released in 2004 form appears to be the circumstances that triggered each of their a useful framework by which to assess the state of the Aus- latest restructures. As Dwyer [7] notes, all but one (NSW) tralian health care system and its attempts at reform in arose from an independent review with the reorganisation 2004/05. In 2005, Australia does not have a National of NSW coming in the aftermath of a hospital 'scandal' Health System. Some progress has been made in 2004/05 that attracted much media coverage. On the same basis, a and there is now a national health reform agenda under number of reviews are now underway in Queensland. COAG. However, the current evidence suggests it is still a reform agenda in separate bits and will not be systemic. In response to the so-called 'Doctor Death' scandal in rela- Little or no progress was made toward a National Package tion to the appointment of Dr Jayant Patel in Bundaberg of Healthcare Services and there are no indications of any (Queensland), the Queensland Premier (not the Health progress in the near future on that front. A National Minister) announced in April 2005 the Queensland Approach to Quality and Safety is emerging, with significant Health Systems Review. Its establishment had been the advances in some jurisdictions. Better integration and coor- suggestion of the major doctors lobby group, the Austral- dination of health care remained a fashionable idea in ian Medical Association (AMA) [21]. This major review of 2004/05 but this goal has been acknowledged as impor- Queensland Health's administration, management and tant for decades and real progress is dependent on more performance systems is due for public release on 30 Sep- systemic change. More progress was made on a national tember 2005. approach to workforce reform with the release of a national "strategic framework to guide national health workforce At the same time, three other inquiries have been commis- policy and planning throughout the decade". But a frame- sioned. A Commission of Inquiry has been established to work is still a long way from a strategy. investigate events at Bundaberg Hospital, including the role and conduct of the Queensland Medical Board in At the state and territory level, reviews and restructuring relation to overseas trained medical practitioners. Like the continued in several jurisdictions. In 2005, there are sig- Queensland Health Systems Review, it has also been nificant organisational differences between them, with lit- asked to consider changes to recruitment, employment tle evidence of the strengths and weaknesses of the and supervision of medical practitioners, management of different approaches. What is becoming increasingly complaints and measures to increase the availability of apparent is that the structure and effectiveness of jurisdic- medical practitioners across the State. In parallel, the tional health authorities is now more important. All Crime and Misconduct Commission is also conducting a health authorities are being expected to drive an ambi- public inquiry into Queensland Health's handling of tious set of national and local reforms. At the same time, complaints regarding care at Bundaberg Hospital and a most have now blurred the boundary between policy and Queensland Health review of clinical services at Bundab- service delivery and are devoting significant resources to erg Hospital is also underway [22]. 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. The Queensland Health Systems Review has broad terms. The administrative systems to be examine include (among With scandals, public criticism and concern with rising other matters) district and corporate organisational struc- costs increasingly being the impetus to restructure, the tures and layers of decision making; corporate planning prospects for 2006 are for more of the same. At the same and budgeting systems; the effectiveness of performance time, delivering on the reform promises of 2004/05 will reporting and monitoring systems; quality and safety sys- become increasingly difficult but more important than tems; and clinical audit and governance systems. On the ever. workforce front, it will examine recruitment; retention; training and clinical leadership. It will also review per- Competing interests formance management systems including asset manage- The author(s) declare that they have no competing ment and planning, information management and interests. monitoring systems. References 1. Council of Australian Governments 2005 Communique, Regardless of the detail, it seems unlikely that the status June 3 [http://www.coag.gov.au/meetings/030605/ quo will remain in Queensland in 2006. No doubt other index.htm#health] Page 7 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 2. Australian Healthcare Association: AHA 2004 Policy 1. A 22. Queensland Health: Other reviews. 2005 [http://www.healthre National Health System. [http://www.aushealthcare.com.au/pub view.com.au/other_reviews.asp]. lications/publication_details.asp?pid = 90]. 3. Australian Healthcare Association: AHA 2004 Policy 2. A National Package of Healthcare Services. [http://www.aush ealthcare.com.au/publications/publication_details.asp?pid = 91]. 4. Australian Healthcare Association: AHA 2004 Policy 3. A National Approach to Quality and Safety in Health. [http:// www.aushealthcare.com.au/publications/publication_details.asp?pid = 92]. 5. Australian Healthcare Association: AHA 2004 Policy 4. Better integration and coordination of healthcare. [http://www.aush ealthcare.com.au/publications/publication_details.asp?pid = 93]. 6. Australian Healthcare Association: AHA 2004 Policy 5. A National Approach to Workforce Reform. [http://www.aush ealthcare.com.au/publications/publication_details.asp?pid = 94]. 7. Dwyer JM: Australian health system restructuring – what problem is being solved? Australia and New Zealand Health Policy 2004, 1:6. 8. Abbott T 2005 Minister for Health and Ageing: The Hon Tony Abbott MHR, addresses the Committee for Economic Development of Australia conference in Sydney. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2005-ta-abbsp250205.htm]. Press release 25 February 9. Productivity Commission: Review of National Competition Pol- icy Reforms, Report no. 33. Canberra 2005 [http:// www.pc.gov.au/inquiry/ncp/finalreport/index.html]. 10. Australian Health Ministers' Conference 2003 Joint Communique: Australian Health Ministers agree to Reform Agenda. [http:/ /www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2003-jointcom-jc001.htm]. 28 November 2003 11. Australian Health Ministers' Conference 2003 Joint Communique : National Nursing and Nursing Education Taskforce. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2003-jointcom-jc004.htm]. 12. Australian Health Ministers' Conference 2004 Joint Communique : National health workforce strategic framework. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc004.htm]. 13. Australian Health Ministers' Conference 2004 Joint Communique: Health Ministers Agree to Reform Agenda. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc001.htm]. 14. Australian Health Ministers' Conference 2004 Joint Communique: Australian Health Ministers agree on nationally consistent approach to medical registration. [http:// www.health.gov.ainternet/wcms/publishing.nsf/Content/health-medi- arel-yr2004-joint com-jc003.htm]. 15. Australian Health Ministers' Conference 2004 Joint Communique: National health workforce strategic framework. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc004.htm]. 16. Australian Health Ministers' Conference 2004 Joint Communique: Health Ministers Agree to continue reform agenda. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc006.htm]. 29 July 2004 17. Australian Health Ministers' Conference 2004 Joint Communique: Review of Future Governance Arrangements for Safety and Quality in Health Care. [http://www.health.gov.au/internet/ wcms/publishing.nsf/Content/health-sqreview.htm]. 29 July 2004 Publish with Bio Med Central and every 18. Australian Health Ministers' Conference 2005 Joint Communique: scientist can read your work free of charge National entity to drive E-Health. [http:// www.health.gov.ainternet/wcms/publishing.nsf/Content/health-medi- "BioMed Central will be the most significant development for arel-yr2005-joint com-jc001.htm]. 28 January 2005 disseminating the results of biomedical researc h in our lifetime." 19. Australian Health Ministers' Conference 2004 Joint Communique: Sir Paul Nurse, Cancer Research UK Australian Health Ministers endorse development of a National Framework for Action on Dementia. [http:// Your research papers will be: www.health.gov.au/internet/wcms/publishing.nsf/Content/ available free of charge to the entire biomedical community Media+Releases+Communiques-1]. 28 January 2005 20. Walker B: Final Report of the Special Commission of Inquiry peer reviewed and published immediately upon acceptance into Campbelltown and Camden Hospitals. 2004 [http:// cited in PubMed and archived on PubMed Central www.lawlink.nsw.gov.au/special_commission]. 30 July 2004 21. Beattie P: 2nd Inquiry Will Check Health Systems To Aim For yours — you keep the copyright Better Results. [http://statements.cabinet.qld.gov.au/cgi-bin/dis BioMedcentral play-statement.pl?id = 6420&db = media]. Press Release 26 April 2005 Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 8 of 8 (page number not for citation purposes) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australia and New Zealand Health Policy Springer Journals

(Re)form with Substance? Restructuring and governance in the Australian health system 2004/05

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Springer Journals
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Copyright © 2005 by Rix et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; Public Health; Social Policy
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1743-8462
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1743-8462
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10.1186/1743-8462-2-19
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16120207
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Abstract

The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004–2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus in 2004–2005 at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004–2005, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress. where governments' responsibilities intersect. After sev- Review The Council of Australian Governments' (COAG) 15th eral years of apparent stalemate, it seemed that the discus- meeting on 3 June 2005 in Canberra endorsed a national sion had re-opened on ways to improve Australia's health health reform agenda with an unusual level of national system. In its most ambitious section, the COAG 2005 consensus. The heads of Governments agreed that Aus- Communique "agreed that where responsibilities tralia has one of the best health systems in the world, between levels of government need to change, funding albeit with room for improvement, particularly in areas Page 1 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 arrangements would be adjusted so that funds would fol- ment of Australian health system restructuring, Dwyer low function." [1] lamented that 'Unfortunately, the Commonwealth: state responsibility split, the one structural barrier most central The governments stated in their Communique that the to the systemic weakness of Australian primary care (and health system can be improved by clarifying roles and therefore most important for the capacity to develop and responsibilities, and by reducing duplication and gaps in support new models of care for chronic diseases), is one services. They recognised that many Australians, including that a state can't address, at least not alone [7].' the elderly and people with disabilities, still face problems at the interfaces of different parts of the health system. Before the COAG announcement in June 2005, there was They restated the aim of integration and a smooth transi- little prospect of progress. The Prime Minister had tion between acute care, home and residential care, and announced in October 2004 a Task Force headed by helping younger people with disabilities. The necessary Andrew Podger, the previous head of the Department of themes of workforce supply and flexibility, prevention, Health and Ageing (DHA). Consisting of officers from the electronic records, a national call centre, and rural and Departments of Prime Minister and Cabinet, Health and remote services were reinforced. Senior officials were Ageing and the Treasury, its role was to review the opera- given till December 2005 to come up with a plan of action tion of health policy to examine how to improve the to progress these reforms. delivery of health services. Finalised in early 2005, its report has not been released. Federal Health Minister The core ideas behind this change of climate have been Tony Abbott referred briefly to it earlier in 2005 by com- well rehearsed in both health bureaucracies and the sub- menting that it has been commissioned so that "the Gov- missions of industry groups. In 2004 the Australian ernment can respond to any state proposal" [8]. Healthcare Association (AHA) released five policies, the first of which called for a National Health System so that, by At that time Minister Abbott had outlined the problems of 2008, all Australian governments will have adopted a the health system from the point of view of the Australian nation-wide approach to health policy and service deliv- Government when he addressed the Committee for Eco- ery. AHA argued that "a National Health System is funda- nomic Development of Australia Conference in February mental to successful health system reform in Australia and 2005. In his address, Minister Abbott was not concerned will provide access to health care services for Australians with primary care, but with the 'big health issue' for 2005 irrespective of borders or payers" [2]. – hospitals. For the Minister, this was primarily a matter for the states and territories rather than the Common- The rest of the policy agenda was a call for a National Pack- wealth, and a good opportunity for some "free-kicks". He age of Healthcare Services, so that the next Australian pointed out that Section 51 of the Constitution relegates Healthcare Agreement (2008–2013) would govern all the Commonwealth to little more than a funding author- public sector health programs and services administered ity having no operational control of public hospital sys- by all Australian governments in partnership [3]. This was tems in the subordinate jurisdictions. While he did accompanied by a National Approach to Quality and Safety concede that it would make more sense for one level of in Health [4], and policies for better integration and coordi- government to be responsible for the entire health system, nation of health care [5], and a national approach to workforce the real issue of the day was not so much who funds hos- reform [6]. pitals but how they are managed. While no doubt ambitious, there is little dispute about the The Minister complained that 'years of poor management merit of these policies and their potential impact on mean that public hospital patients now face long waits for health in Australia. Given the renewed relevance of larger essential as well as elective treatment (Abbott 2005).' Pri- scale reform under the 2005 COAG announcements, vate hospitals, in stark contrast, were in the business of these policy signposts form a useful framework by which providing patients 'with what they want, when they want to assess the state of the Australian health care system and it'. The challenge for the federal government was to exer- its attempts at reform in 2004/05. cise effective leadership over the public hospital systems that are run by the states and the territories and private sector hospitals which, the minister remarked, 'aren't run The state of play in Australian-state/territory government relations in 2004/05 – ritual or by the government at all [8].' reform? Without a clear strategy to move to a more truly national Fortunately, the national health reform agenda is too system, all reform is going to be counterbalanced by the important to be left to health ministers alone. Continuing inbuilt tendencies of the current system to move towards its previous calls for more reform, the Productivity Com- increased fragmentation. In a recent overview and assess- mission recommended in February 2005 an independent Page 2 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 Table 1: Outcomes of Australian Health Ministers' Conferences 2004–2005 in relation to structural reform Agreement / Outcome Press release date Agreement to take "immediate action to progress reform of the Australian health care system in the areas of after 28 November 2003 hours GP services; aged care; chronic disease and cancer services; medical workforce planning; and, renal disease services" [10] Establishment of a national nursing taskforce to drive major nursing education and workforce reforms [11] 28 November 2003 Release of Australia's first national health workforce strategic framework [12] 23 April 2004 Agreement to take further steps "to progress reform of the Australian health care system in the areas of after hours GP 23 April 2004 services; aged care; chronic disease and cancer services; medical workforce planning; and, renal disease services" [13] Agreement on a nationally consistent approach to medical registration [14] 23 April 2004 Agreement on the first National Health Workforce Action Plan [15] 29 July 2004 Agreement to continue the Health Reform Agenda and the future priorities for reform [16] 29 July 2004 Agreement to establish a Review of the Future Governance Arrangements for Safety and Quality in Health Care [17] 29 July 2004 Agreement to establish a new national entity to drive critical e-health initiatives – NEHTA [18] 28 January 2005 Endorse development of a National Framework for Action on Dementia [19] 28 January 2005 public review of Australia's health care system, as the first agreed to at the November 2003 meeting of Health Min- step in the development of an integrated reform program. isters (the Health Ministers had first agreed to the Reform "The review should include consideration of: the future agenda at their April 2003 meeting). Instead of a large sys- determinants of demand for and supply of health services; tematic process of reform as suggested by the Productivity health financing (including Federal/State responsibilities Commission and others, health reform in Australia is to and their implications); coordination of individual serv- be progressed in a series of small steps. ices (including with aged care); the interface between pub- lic and private services; information management; and the The first step was the establishment of a Health Reform appropriate balance of resourcing between prevention Agenda Working Group (HRAWG) to progress the Health and treatment" [9]. Reform Agenda. It reports to the Australian Health Minis- ters' Advisory Council (AHMAC). As shown in Table 1, If a revived impetus for a national approach to reform there are optimistic signs in 2005 of some progress toward through heads of government can broaden the debate genuine reform, albeit in small steps. beyond who runs hospitals, and look at primary care and the relationships to residential aged care and community At the April 2004 meeting, the Health Ministers acknowl- care, then the latest review under COAG will be able to edged the need for immediate action to ensure progress in build on progress that has been made under the auspices reforming after hours GP services, aged care, chronic dis- of the health ministers' conferences at national level over ease and cancer services, medical workforce planning, and the last year. renal disease services. Among other matters, the Health Ministers agreed to establish a 'set of principles' that would allow jurisdictions to work together towards improving Toward a national reform agenda – small steps in the right direction? delivery of after hours GP services in certain regions and The perennial issue of the Commonwealth: state/territory building collaborative working relationships with emer- split of responsibility for health is hardly the only matter gency departments in public hospitals. of concern in assessing the effectiveness of public health policy in Australia – even though, as Dwyer comments, it They also agreed to a range of initiatives such as enhanced is 'probably the single most significant problem in health transition care, rehabilitation and step-down care that system design [[7], p 4].' The treatment and prevention of would improve the transition between acute and aged chronic disease are also of great concern with chronic dis- care services. In addition, the Ministers reached agreement ease accounting for '80% of the total burden of disease' to finalise an integrated Chronic Disease Strategy and and approximately '40% of total health expenditure' [[7], Service Improvement Framework for Cancer services [13]. p 6]. At their July 2004 meeting, Health Ministers were asked Chronic disease and related issues were high on the by clinicians to consider three issues that they regarded as agenda of the meeting between Australian Health Minis- important: ters and clinicians in Hobart in July 2004. The meeting was reviewing the progress of the Health Reform Agenda Page 3 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 Table 2: Management of health and human services by jurisdiction – the state of play in 2004–2005 Jurisdiction Scope Organisational divisions Regions Australian Health and Ageing Acute Care Each states and territory is a region Government Separate authorities for Family and Ageing and Aged Care Community Services and Veterans' Business Affairs Health Services Improvement Medical and Pharmaceutical Services Office of Aboriginal and Torres Strait Islander Health Population Health Portfolio Strategies Primary Care ACT Health Allied Health Adviser None. All services directly managed by Separate authorities for Disability, Clinical operations the Department Housing and Community Services. Financial and Risk Management ACT Emergency Services Authority Government Relations and Planning provides the ambulance service Human Resource Management Separate Community and Health Information Services Services Complaints Commissioner Nursing and Midwifery Office established in late 2004 Policy Population health Northern Territory Health and community services Aboriginal Health, Family & Social None. All services directly managed by Separate authorities for Community Policy the Department Development, Sport and Cultural Acute Care St John Ambulance Service is Affairs Community Services separately incorporated, as are some Separate Health and Community Corporate Management Services Aboriginal Health Services Services Complaints Commission Health Services Information Strategy & Quality NSW Health Health System Performance 8 Area Health Services (no Boards) Separate authorities for Ageing, Health System Support reporting directly to the department Disability and Home Care, Housing, Population Health plus: Community Services and Medical Strategic Development Ambulance Service of NSW Research Children's Hospital at Westmead Separate Health Care Complaints (with Board of Directors) Commission Justice Health Clinical Excellence Commission NSW Cancer Institute Queensland Health Health Services 3 Zones Separate authorities for Child Safety, Information 37 Districts within zones Communities, Emergency Services Innovation and Workforce Reform All services directly managed by the [including Ambulance Service], Resource Management. Department Housing, Disability Services Strategic Policy and Government Separate Health Rights Commission of Liaison Queensland South Australia Health Population and Environmental 2 metropolitan health regions and Department of Families and Healthy SA Children, Youth and Women's Health Communities manages other human Service Planning Service with own Boards. services, including Aged and State Dental managed in a region 4 country regional health services Community Care Mental Health managed in a region Separate Health and Community Drug and Alcohol managed in a region Services Complaints Commission SA Health Reform announced in 2004 Separately incorporated bodies deliver ambulance services Veterans Repatriation Hospital separate Hospitals and Dom care separate incorporation Tasmania Health and Human Services Children and Families None. All services directly managed by Separate Health Complaints Community, Population and Rural the Department Commissioner Health Corporate Services Hospitals and Ambulance Housing Tasmania Page 4 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 Table 2: Management of health and human services by jurisdiction – the state of play in 2004–2005 (Continued) Victoria Health and Human Services Disability Services 8 departmental Regions Separate Office of the Health Services Financial & Corporate Services 12 Melbourne networks with own Commissioner Housing & Community Building boards within metropolitan regions Office for Children that now reports Metropolitan Health & Aged Care 71 agencies with own boards in rural to Minister for Children Services regions Operations Victorian Ambulance Service Policy & Strategic Projects Rural & Regional Health & Aged Care Services Western Australia Health Clinical Policy Division. 3 Area Health Services, 1 Country Separate authorities for Community Statewide Health Support Health Service and Women's and Development, Disability Services and Population Health Division Children's Health Service, all directly Housing, Office of Health Review. Country Health Services managed by the Department Separate Office of Safety and Quality Central Wait List Bureau St John Ambulance Service is separately incorporated  integration and coordination of services at the commu- increasing priority being given to governance arrange- nity-based and hospital-based services interface; ments for quality and safety in 2004–2005.  improving the community's access to better health out- Meeting in Sydney in January 2005, the Australian Health comes, in particular, for children, people with chronic Ministers' Conference agreed to establish the National E- care needs, older Australians, and indigenous Australians; Health Transition Authority (NEHTA). This is a new entity and in the form of a company limited by guarantee and gov- erned by a board of directors comprising the CEOs of the  the need for a sustainable, skilled and flexible workforce national, state and territory Health Departments. Its core to enable the adequate provision of health services into activities include 'the development of timelines for the the future. urgent advancement of the e-health agenda; option assess- ment and business case development; standards develop- As these issues were already on their Health Reform ment and implementation support; and provision of Agenda, Health Ministers agreed to endorse child health advice and resources to assist implementation of already and well being as a specific area for reform. In turn, the cli- agreed solutions [18].' It is also expected to advance other nicians recommended that a way to progress a number of significant national priorities in key areas including clini- the important items on the Reform agenda was to conduct cal data standards and terminologies, consent models, a trial in each state and territory of specific services that electronic health record (EHR) standards, and health integrate community-based and hospital based-services, informatics industry reform. suggesting coordinated chronic care and integrated aged care as possible cases [16]. Those trials are yet to Incremental and crisis-driven reforms at state/ eventuate. territory level – just more change or so me real progress? At the same meeting, the ministers agreed to establish a Australian states and territories have a long history of Review of the Future Governance Arrangements for Safety independent reviews leading, cyclically, to the centralisa- and Quality in Health Care. The review is to advise on tion and decentralisation of management and governance future arrangements for the effective leadership and at various times. In 2004–05, Australian jurisdictions are, national coordination of safety and quality initiatives in in the main, in a centralisation phase. Queensland is the health care. It is to report before the Australian Council for subject of an independent review at the time of writing Safety and Quality in Health Care completes its current while Western Australia has a Health Reform Implemen- term in June 2006. National governance arrangements for tation Taskforce in progress. Dwyer [7] reviewed the leadership and coordination of safety and quality in round of reviews in the Australian health system between health care were accordingly included in the Terms of Ref- 2002 and 2004. These resulted in restructuring in New erence of the health care safety and quality governance South Wales, South Australia, the Northern Territory, arrangements review [17]. In parallel, several states and Western Australia, and the ACT. There is a strong tendency territories introduced their own initiatives, reflecting the towards increasing centralisation so that, in 2005, 6 of 8 jurisdictions now directly manage public sector health Page 5 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 services, with Victoria and South Australia having mixed are managed by departments of emergency services (ACT, models. With the recent centralisation of management in Queensland), by the health department (New South New South Wales, Dwyer calculated that two thirds of Wales) or are separately incorporated services (South Australians now live in areas under centralised control [7]. Australia). Given this, the structure and effectiveness of jurisdictional All jurisdictions now have independent authorities (how- health authorities is becoming increasingly important in ever named) to review health care complaints. The ACT determining whether reforms are achieved in areas such as and South Australia established theirs in 2004. However, clinical governance, quality and safety and others important differences in the philosophy and role of such included in the National Reform Agenda. This is espe- bodies were identified in evidence given to the Special cially the case given that, at the same time, the centralised Commission of Inquiry into Campbelltown and Camden authorities will continue to devote considerable resources Hospitals [20], particularly in relation to their role in to responding to each new 'crisis' in their service system. 'blaming' those responsible for errors. Table 2 summarises the management structures in place Western Australia and New South Wales have gone fur- in each jurisdiction in May 2005. As this summary indi- ther. An independent Office for Safety and Quality in cates, there are significant differences in the role and scope Health Care was established in Western Australia in 2002. of the various health authorities. This has important It is responsible for supporting the establishment of effec- implications in relation to structural opportunities to tive quality and safety systems, as well as investigating reform and improve the coordination and planning of complaints. New South Wales established a separate Clin- service delivery, particularly for those with complex and ical Excellence Commission in 2005 (replacing its previ- continuing care needs. At the same time, there is little sim- ous Institute of Clinical Excellence). Not surprisingly, ilarity in how the various departments are organised, as both initiatives followed major media coverage of 'hospi- reflected in their executive level divisional structures tal scandals' in those two states. (listed in alphabetical order in the table). Organisational and executive structures differ between At a national level, the department is responsible for both jurisdictions. As one example, public (or population) health and ageing. But the health care needs of war veter- health is its own division, and reports directly to the ans are the responsibility of the Department of Veterans departmental head, in the ACT, WA and NSW. In Victoria, Affairs (DVA) and not the Department of Health and Age- it is an office within the Rural and Regional Health and ing (DHA). The 'ageing and aged care' functions of DHA Aged Care Services Division while in Queensland it is a include community care programs and services such as branch within the Health Services Division. Population the Home and Community Care (HACC) program that health functions in the Northern Territory also sit in a are managed by the health authority in all but two juris- Health Services Division, but not in one branch. Instead, dictions. New South Wales has a separate Department of population health is the responsibility of several sections Ageing, Disability and Home Care. In South Australia, the including the Centre for Disease Control and a Health previous Department of Human Services was split on 1 Development and Oral Health Branch. In Tasmania, pop- July 2004 into two, with a new Department of Families ulation health is a subdivision of the Community, Popu- and Communities taking responsibility for, among other lation and Rural Health Division. At least in part, these portfolios, community care and disability. differences reflect the scope of the various departments. However, there is no evidence to suggest whether any of In 2005, an authority with broader human and commu- these structures produce more effective policy than others. nity services responsibilities is managing health care in Nor is there evidence on what structure is best able to the Northern Territory, Tasmania and Victoria. These manage the health system and its reform. other responsibilities include, among some others, disa- bility services and housing. Neither function is now As one further example, workforce reform (one of the five within scope of the health departments in the other 2004 AHA policies and also on the Australian Health Min- jurisdictions. isters Health Reform Agenda) is managed differently across the jurisdictions. In 2005, Queensland has a new Tasmania has the broadest role and is responsible for both Innovation and Workforce Reform Directorate while the policy and direct operations of its ambulance service. Western Australia announced in May 2005 the creation of This is not the case in either Victoria or the Northern Ter- a new Clinical Reform and Policy Division. In other juris- ritory where the department manages policy but ambu- dictions, there is either no organisational unit responsible lance services are separately incorporated. In other states for workforce reform or it is incorporated in the functions with a narrower 'health department', ambulance services of other sections such as human resource departments. As Page 6 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 before, there is no evidence to suggest whether any of jurisdictions will be watching in an attempt to learn the these structures will be more effective than others in deliv- lessons. ering on the workforce reform agenda. Conclusion One reason for the differences between jurisdictions We noted that the five AHA policies released in 2004 form appears to be the circumstances that triggered each of their a useful framework by which to assess the state of the Aus- latest restructures. As Dwyer [7] notes, all but one (NSW) tralian health care system and its attempts at reform in arose from an independent review with the reorganisation 2004/05. In 2005, Australia does not have a National of NSW coming in the aftermath of a hospital 'scandal' Health System. Some progress has been made in 2004/05 that attracted much media coverage. On the same basis, a and there is now a national health reform agenda under number of reviews are now underway in Queensland. COAG. However, the current evidence suggests it is still a reform agenda in separate bits and will not be systemic. In response to the so-called 'Doctor Death' scandal in rela- Little or no progress was made toward a National Package tion to the appointment of Dr Jayant Patel in Bundaberg of Healthcare Services and there are no indications of any (Queensland), the Queensland Premier (not the Health progress in the near future on that front. A National Minister) announced in April 2005 the Queensland Approach to Quality and Safety is emerging, with significant Health Systems Review. Its establishment had been the advances in some jurisdictions. Better integration and coor- suggestion of the major doctors lobby group, the Austral- dination of health care remained a fashionable idea in ian Medical Association (AMA) [21]. This major review of 2004/05 but this goal has been acknowledged as impor- Queensland Health's administration, management and tant for decades and real progress is dependent on more performance systems is due for public release on 30 Sep- systemic change. More progress was made on a national tember 2005. approach to workforce reform with the release of a national "strategic framework to guide national health workforce At the same time, three other inquiries have been commis- policy and planning throughout the decade". But a frame- sioned. A Commission of Inquiry has been established to work is still a long way from a strategy. investigate events at Bundaberg Hospital, including the role and conduct of the Queensland Medical Board in At the state and territory level, reviews and restructuring relation to overseas trained medical practitioners. Like the continued in several jurisdictions. In 2005, there are sig- Queensland Health Systems Review, it has also been nificant organisational differences between them, with lit- asked to consider changes to recruitment, employment tle evidence of the strengths and weaknesses of the and supervision of medical practitioners, management of different approaches. What is becoming increasingly complaints and measures to increase the availability of apparent is that the structure and effectiveness of jurisdic- medical practitioners across the State. In parallel, the tional health authorities is now more important. All Crime and Misconduct Commission is also conducting a health authorities are being expected to drive an ambi- public inquiry into Queensland Health's handling of tious set of national and local reforms. At the same time, complaints regarding care at Bundaberg Hospital and a most have now blurred the boundary between policy and Queensland Health review of clinical services at Bundab- service delivery and are devoting significant resources to erg Hospital is also underway [22]. 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. The Queensland Health Systems Review has broad terms. The administrative systems to be examine include (among With scandals, public criticism and concern with rising other matters) district and corporate organisational struc- costs increasingly being the impetus to restructure, the tures and layers of decision making; corporate planning prospects for 2006 are for more of the same. At the same and budgeting systems; the effectiveness of performance time, delivering on the reform promises of 2004/05 will reporting and monitoring systems; quality and safety sys- become increasingly difficult but more important than tems; and clinical audit and governance systems. On the ever. workforce front, it will examine recruitment; retention; training and clinical leadership. It will also review per- Competing interests formance management systems including asset manage- The author(s) declare that they have no competing ment and planning, information management and interests. monitoring systems. References 1. Council of Australian Governments 2005 Communique, Regardless of the detail, it seems unlikely that the status June 3 [http://www.coag.gov.au/meetings/030605/ quo will remain in Queensland in 2006. No doubt other index.htm#health] Page 7 of 8 (page number not for citation purposes) Australia and New Zealand Health Policy 2005, 2:19 http://www.anzhealthpolicy.com/content/2/1/19 2. Australian Healthcare Association: AHA 2004 Policy 1. A 22. Queensland Health: Other reviews. 2005 [http://www.healthre National Health System. [http://www.aushealthcare.com.au/pub view.com.au/other_reviews.asp]. lications/publication_details.asp?pid = 90]. 3. Australian Healthcare Association: AHA 2004 Policy 2. A National Package of Healthcare Services. [http://www.aush ealthcare.com.au/publications/publication_details.asp?pid = 91]. 4. Australian Healthcare Association: AHA 2004 Policy 3. A National Approach to Quality and Safety in Health. [http:// www.aushealthcare.com.au/publications/publication_details.asp?pid = 92]. 5. Australian Healthcare Association: AHA 2004 Policy 4. Better integration and coordination of healthcare. [http://www.aush ealthcare.com.au/publications/publication_details.asp?pid = 93]. 6. Australian Healthcare Association: AHA 2004 Policy 5. A National Approach to Workforce Reform. [http://www.aush ealthcare.com.au/publications/publication_details.asp?pid = 94]. 7. Dwyer JM: Australian health system restructuring – what problem is being solved? Australia and New Zealand Health Policy 2004, 1:6. 8. Abbott T 2005 Minister for Health and Ageing: The Hon Tony Abbott MHR, addresses the Committee for Economic Development of Australia conference in Sydney. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2005-ta-abbsp250205.htm]. Press release 25 February 9. Productivity Commission: Review of National Competition Pol- icy Reforms, Report no. 33. Canberra 2005 [http:// www.pc.gov.au/inquiry/ncp/finalreport/index.html]. 10. Australian Health Ministers' Conference 2003 Joint Communique: Australian Health Ministers agree to Reform Agenda. [http:/ /www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2003-jointcom-jc001.htm]. 28 November 2003 11. Australian Health Ministers' Conference 2003 Joint Communique : National Nursing and Nursing Education Taskforce. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2003-jointcom-jc004.htm]. 12. Australian Health Ministers' Conference 2004 Joint Communique : National health workforce strategic framework. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc004.htm]. 13. Australian Health Ministers' Conference 2004 Joint Communique: Health Ministers Agree to Reform Agenda. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc001.htm]. 14. Australian Health Ministers' Conference 2004 Joint Communique: Australian Health Ministers agree on nationally consistent approach to medical registration. [http:// www.health.gov.ainternet/wcms/publishing.nsf/Content/health-medi- arel-yr2004-joint com-jc003.htm]. 15. Australian Health Ministers' Conference 2004 Joint Communique: National health workforce strategic framework. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc004.htm]. 16. Australian Health Ministers' Conference 2004 Joint Communique: Health Ministers Agree to continue reform agenda. [http:// www.health.gov.au/internet/wcms/publishing.nsf/Content/health- mediarel-yr2004-jointcom-jc006.htm]. 29 July 2004 17. Australian Health Ministers' Conference 2004 Joint Communique: Review of Future Governance Arrangements for Safety and Quality in Health Care. [http://www.health.gov.au/internet/ wcms/publishing.nsf/Content/health-sqreview.htm]. 29 July 2004 Publish with Bio Med Central and every 18. Australian Health Ministers' Conference 2005 Joint Communique: scientist can read your work free of charge National entity to drive E-Health. [http:// www.health.gov.ainternet/wcms/publishing.nsf/Content/health-medi- "BioMed Central will be the most significant development for arel-yr2005-joint com-jc001.htm]. 28 January 2005 disseminating the results of biomedical researc h in our lifetime." 19. Australian Health Ministers' Conference 2004 Joint Communique: Sir Paul Nurse, Cancer Research UK Australian Health Ministers endorse development of a National Framework for Action on Dementia. [http:// Your research papers will be: www.health.gov.au/internet/wcms/publishing.nsf/Content/ available free of charge to the entire biomedical community Media+Releases+Communiques-1]. 28 January 2005 20. Walker B: Final Report of the Special Commission of Inquiry peer reviewed and published immediately upon acceptance into Campbelltown and Camden Hospitals. 2004 [http:// cited in PubMed and archived on PubMed Central www.lawlink.nsw.gov.au/special_commission]. 30 July 2004 21. Beattie P: 2nd Inquiry Will Check Health Systems To Aim For yours — you keep the copyright Better Results. [http://statements.cabinet.qld.gov.au/cgi-bin/dis BioMedcentral play-statement.pl?id = 6420&db = media]. Press Release 26 April 2005 Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 8 of 8 (page number not for citation purposes)

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Australia and New Zealand Health PolicySpringer Journals

Published: Aug 24, 2005

References