Broader healthcare discussions needed for sustainable delivery

Self-responsibility and end-of-life decisions must be part of the discussion if Australia is to deliver healthcare in a sustainable way into the future, a CEDA audience in Brisbane was told.

Queensland Minister for Health Lawrence Springborg said the major pressures on healthcare provision are chronic disease and lifestyle type diseases but this is not recognised by the public.

"People see chronic diseases and the morbidities that go with them as someone else's problem," he said.

Referring to statistics presented at a recent international healthcare conference, Mr Springborg said self-responsibility must be considered one of the principles in future healthcare design.

"Forty per cent of people don't follow the instructions of their doctor and 80 per cent of people do not change their habits based on health professionals' advice," he said.

Mr Springborg said he believed those statistics would also be true in Queensland.

"We have as a society increasingly moved towards the expectation that it is someone else's responsibility to fix you up if something goes wrong," he said.

Asked how changing demographics were influencing long-term health service, health facility and funding planning Mr Springborg said the ageing population was a major challenge.

"Queensland's population will increase by one-third to 6.1 million people between 2011 and 2026," he said.

"Almost 20 per cent of these people, or 1.1 million, will be over 65 years."

Initiatives such as remote monitoring of people with chronic diseases and Hospital in the Home (HITH) services would respond to increased demands, but advanced healthcare planning needs to improve, Mr Springborg said.

"It is true that people consume up to 80 per cent of the entire amount of health resources they will consume in the last 18 months of their life," he said.

"(But) only six per cent of people in aged care facilities have an advanced care directive."

With a high proportion of extraordinary interventions at late stages of life, advanced healthcare planning was something we do very, very badly, Mr Springborg said.

The Minister briefed CEDA members on progress of the State's health services reforms under the Queensland Government Blueprint for better healthcare. He said:

• Hospital emergency department performance had improved, with up to 75 per cent of patients processed within four hours over the first three months of 2013, compared to 64 per cent 12 months ago.
• Bed utilisation had improved by 7.4 per cent - freeing up the equivalent of 430 beds, or the equivalent of the total capacity of Cairns Base Hospital.
• Hospital mortality rates had fallen.

On the reform's contestability and infrastructure programs Mr Springborg said:

• The first contestability projects being undertaken are central pharmacy, medical typing, supply chain and logistics, information technology desktop support, group linen services, medical equipment services, diagnostic imaging and pathology services and the Health Contact Centre.
• Queensland Health is currently formalising the Ministerial Health Infrastructure Council, which will provide independent advice about key private-public sector investments opportunities.
   

Mr Springborg said that under the national healthcare agreement primary and preventative healthcare is the responsibility of the Federal Government.

"I would like the Commonwealth Government to talk more about and invest more in what is supposed to be their responsibility so we can get on with the things we have to do," he said.

"We have to be clear on who is responsible for what and get on with it, so we are not tripping over each other."

AECOM, Director of Infrastructure Advisory, Geoff Hardy, said healthcare was a "complex, ever evolving, labour intense and technology rich system".

"When we talk about reform, there are usually no easy answers or quick fixes," he said.

Mr Hardy said apart from the national reform agenda there are several other factors driving changes to the health system in Queensland. He noted:

• The Independent Hospital Pricing Authority estimates that the cost of delivering public hospital services in Queensland is 11 per cent above the national average.
• The Queensland Government's Commission of Audit found that expenditure on health in Queensland had more than tripled in the 10 years to 2010-11.
   

Referring to COAG reports released earlier this year, Mr Hardy summarised findings in relation to Queenslanders.

"Queenslanders are an unhealthy lot with proportionally more adult smokers, more obese people and more potentially avoidable deaths than the nation as a whole," he said.