The government seems willing to fund reform, but integration is the key.
The federal budget 2023-2024 delivered by Treasurer Jim Chalmers this month was heartening as it signalled the Australian government’s willingness to tackle the hard issues and progress reform of the health, aged care and social support sectors.
The budget included investments to:
- strengthen Medicare, increase access to primary care with coordinated teams and fund digital health initiatives;
- respond to recommendations of the Royal Commission into Aged Care Quality and Safety including by developing a new Aged Care Act and regulatory model;
- lay the groundwork for mental health and suicide prevention system reform;
- improve the effectiveness and delivery of the NDIS; and,
- deliver place-based partnerships that enable community led change to address disadvantage.
These are the right pieces of the puzzle; however, the ongoing question lies in how these related investments and reforms fit together to support people to live the best life they can.
When we design reforms around the sector (or the constitutional power), rather than the person and community, we risk duplication and inefficiency, or people falling through the gaps.
Previous attempts to design and achieve integrated care across the health and social support sectors in Australia have not been sustained.
This is not due to lack of desire or effort but rather the sheer struggle of designing programs and funding models at scale across state and federal governments.
We have the vehicles to co-commission services (Primary Health Networks, Local Health Districts and local government) but are just starting to build the roads to support seamless care journeys and experiences.
The budget announcement funding Primary Health Networks to commission allied health services to improve access to multidisciplinary care for people with chronic conditions in underserviced communities is a good start, but $79.4 million over four years will only touch the surface.
The delay of the Support at Home Program until 1 July 2025 to further refine the program’s design provides an important opportunity to talk to government about the realities of caring for people in their homes and communities when their needs span sectors (and government departments).
We need to articulate the roles and responsibilities of providers and workers with respect to caring for people with diverse health and social needs in a manner that allows for self-determination, respects choice, while also effectively managing risk, reducing inequities, and improving the quality of care.
We need to understand how digital systems work together to enable shared care planning, care management and secure information transfer across providers and settings.
How do we do this?
We start by capturing and ethically sharing people’s stories including by mapping care journeys, interactions, and pain points.
We ask people to “tell me about your health and wellbeing and the services and supports you receive” and then we can start to construct an understanding of where our systems are working and where they are weak.
We can also interrogate consumer incident and feedback data. Most care providers are required to report consumer incidents and complaints and conduct thorough investigations, particularly where there has been serious harm.
Constructing a timeline, particularly for events that occur when people are living at home and in the community, usually reveals failures across the care journey, rather than specific to one provider. Understanding how providers (GP, mental health, aged care and disability services, and hospital) partner to learn from these events and implement continuous improvements to reduce the risk of recurrence is critical.
We have a golden opportunity in that we have progressive governments across mainland Australia who appear willing to listen and respond.
We must take the opportunity to amplify the voices of consumers and community to influence the design and implementation of reforms that enable effective and efficient delivery of care and improve people’s quality of life.
Sarah Barter is managing director of Quality Care Coach.
