The government is currently developing a National Maternity Services Framework (NMSF) that is intended to provide a vision and the principles for the delivery of maternity services in Australia. It is essential that the NMSF deliver a maternity-care system that meets the health needs of all Australians.
An article in The Conversation – Five tips to get the government started on real health reform – July 22, 2016; provides insightful options that must be included in the National Maternity Services Framework.
In summary the five tips focused on maternity care are:
- Put women must be the centre of the maternity care system
- Invest in health promotion, not just pregnancy treatment
- Make maternity-care reforms sustainable
- Apply a whole-of-government approach to maternity care
- Data is key
My one criticism of the article is that it does not mention maternity care. Preventing chronic disease starts at birth and one area that can contribute significantly to the prevention of chronic disease is a focus on maternity care and infant health. A healthy, strong and confident mother gives a baby the best start at birth, influencing the long-term wellness of her child. Diabetes, obesity, mental health and auto immune diseases often have linkages / causes that research shows relate back to maternity care and the early years of life.
Five tips to get the government started on real health reform
The Conversation, July 22, 2016
- Patients must be the centre of the health system
The health-care system exists primarily for the benefit of patients/consumers/clients, however their voices are so rarely heard. Every policy, budget measure and proposal must be considered through the patient lens.
That does not mean the impacts on providers (hospitals, clinicians and health insurers) should not be considered; they are also stakeholders and usually the decision-makers. But the government’s first instinct has been to consult with privileged groups such as the Australian Medical Association and private health insurers, rather than with the public, patients and providers at the coalface.
Importantly, viewing health reform through a patient lens will help policymakers identify disadvantaged groups so they can target their specific needs.
- Invest in health promotion, not just illness treatment
Prevention is as much a responsibility of government as it is for individuals. This is particularly the case for obesity.
As a nation, we all bear the substantial and growing economic and social costs of obesity and its consequences, especially diabetes. Every day, 12 Australians have an amputation related to diabetes at a cost of A$875 million a year. Almost all of this is preventable.
The investments made in prevention must be proportional to the burden of disease in terms of resources and commitment. Concerns about sensible budget policies must override ideological concerns about the nanny state.
- Make health-care reforms sustainable
This means ceasing the start-stop approach of small-scale pilot programs that never go beyond three years and are evaluated only after they are concluded in reports that never see the light of day. Real reforms will also require time frames well beyond those of the election cycle.
Labor has proposed a promising way forward: a permanent Australian Healthcare Reform Commission, which would include a new Centre for Medicare and Healthcare System Innovation to embed continuous reform into the health-care system.
This type of approach – where models can be seamlessly developed, implemented, assessed, adjusted and expanded – is essential for reforms such as the government’s proposed Health Care Homes trial to better manage chronic disease, and for complicated issues such as mental health reforms.
Indigenous disadvantage can only be reduced with effective, whole-of-government responses. AAP Image/Dan Peled
- Apply a whole-of-government approach to health
The health and well-being of the population depend on issues well beyond the health portfolio and require a health-in-all policy approach in all government portfolios. This is a matter of leadership and cultural change, not new expenditures and regulations.
“Wicked” issues such as obesity, mental health, healthy ageing and Closing the Gap on Indigenous disadvantage can only be effectively addressed through such whole-of-government approaches.
- Data is key
Research, data analyses and evaluation are key to health-care reforms.
The antipathy of the previous government to evidence-based policymaking was exemplified by the scrapping or downgrading of key agencies and the defunding of the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy and the Better Evaluation and Care of Health (BEACH) study.
These losses must be rectified, but it is also time for the Department of Health to start mining the archives. There are mountains of reports, papers and evaluations, together with significant, policy-relevant primary health care research commissioned by the department through the Australian Primary Health Care Research Institute, to be used in improving the delivery and financing of health-care services.
At the same time, there should be a moratorium on shunting off difficult problems to committees as an excuse for inaction. There will be occasions when it is necessary to convene advisory groups. That should be done using the experts who will provide the advice that is needed, not the usual hacks who provide the advice the government wants.