What’s the verdict on Labor’s Health Summit? Cautious optimism, but devil is in the detail and big concerns on disability

    CRE in Disability and Health blog in Croakey on the Labor Health Summit - March 30 2017
Editor: Marie McInerney  Author: Anne Kavanagh, Helen Dickinson and Gwynnyth Llewellynon: In: #HealthMatters, disabilities, Healthcare and health reform, public health, Public health and population health

What’s the verdict on the recent Labor National Health Policy Summit which sought the views of more than 150 health experts?

Croakey was pleased to cover the summit, held earlier this month in Canberra, thanks to generous support of our crowdfunding #HealthMatters campaign. You can read our stories, watch video interviews with delegates, and read other posts in response here. Please see the bottom of this post too for a final report on the crowdfunding for the project.

Labor has now released its communique from the Summit and told delegates it will convene more detailed discussions on priority issues that it has helped identify and may consider another summit, perhaps ahead of Labor’s National Conference.

See its communique below and an accompanying letter to participants from Opposition Leader Bill Shorten and Shadow Ministers Catherine King and Julie Collins.

National Health Policy Summit – Communique

Shorten King Collins letter

In the post below, leading academics and researchers from the Centre of Research Excellence (CRE) in Disability and Health deliver their verdict on the summit process to date. Anne Kavanagh, Helen Dickinson and Gwynnyth Llewellyn applaud Labor for bringing together leading thinkers in health to inform its health policies but are concerned both the summit and communique still “largely ignore” the pressing health issues of people with disability.

The Australian Healthcare Reform Alliance (AHCRA) has also released a statement in response to the communique, welcoming the consultations and, mindful that the hard road of managing competing agendas lies ahead, noting the need for a re-think of the resources committed to health care. It says:

“For example, there is at least $2.5 billion in savings available annually through reductions in spending on pharmaceuticals, hospital care, and health technology assessment.  There is a further $7-9 billion annually spent on private health insurance rebate and over $300 million spent on avoidable public hospital care which could be re-allocated more efficiently.”

Finally, Stephen Duckett, Director of the Health Program at the Grattan Institute, has published his appraisal at the Pearls and Irritation blog run by former Prime Minister and Cabinet secretary John Menadue.

Duckett, who led one of the round tables at the summit, also congratulates Labor for holding the event but says the problem with its communique is that it gives no clear indication of where it may be heading with policy.

It’s worth noting Menadue’s PS: “It is interesting that there was little or no discussion on the role of private health insurance. This is the ‘elephant in the room’ which is eroding Medicare.”

Anne Kavanagh, Helen Dickinson and Gwynnyth Llewellyn write:

With the advent of the National Disability Insurance Scheme (NDIS) it is easy to think that all is fixed for people with disability; in reality this is far from the case. If you have a disability you are more likely to have poor health outcomes; for example, people with intellectual disability die at least 25 years earlier than the general population.  Much of this life expectancy gap is due to avoidable causes.

Recently the NHMRC funded a Centre of Research Excellence (CRE) in Disability and Health.  This is a world-first, bringing together leading researchers from across the country and internationally with key stakeholders in the government, non-government and advocacy sectors. Our aim is to gather evidence and provide policy and practice solutions to improve the health of the one in five Australians with disability.

When we heard that Labor were holding a National Health Policy Summit we were keen to be involved to get the health of people with disability on the ALP’s agenda.  This event sought to bring together consumers, providers, stakeholders and experts to help set the frame for Labor’s health policies going into the next election.

The chance to extend the promise of the NDIS?

In government, the ALP had introduced the National Disability Insurance Scheme (NDIS) – a major social policy reform transforming the delivery of disability services. Could we extend this commitment by the ALP to reform that improves the health of Australians with disability?

In the pre-summit communication, the interface with the National Disability Insurance Scheme (NDIS) was mentioned as one possible topic so we went with high expectations that at least some of our suggestions and concerns might be heard.

We wanted to make sure that the ALP took account of the mounting evidence that the poorer health of people with disability relative to people without disability is in large part a consequence of their disadvantaged circumstances such as discrimination, higher levels of unemployment, poor housing, and higher levels of poverty.

We wanted to make sure that Labor embraced policies to improve health services across primary care and hospitals, for people with disability. This is important because people with disability use health services more than people without disability.  Further, the evidence suggests the quality of their care is much lower.

We wanted to make sure that people with disability don’t slip through the cracks of turf wars between health and disability services.  The evidence suggests that there has been a re-emergence of these boundary-disputes as the NDIS rolls out across the country.

We were not the only attendees at the summit to be concerned about the intersection of disadvantage and disability and how this drives poor health outcomes.  Indeed, collaborating became an important theme of the summit.  We advocated for a whole-of-government approach to addressing these issues which would deliver considerable economic benefits in addition to health gains.

Mental health is quite rightly a national priority. All too often it fails to be recognised that some people have multiple disabilities, which often include mental health disorders, and so it is important that both disability and mental health services work together to enable optimal health and wellbeing outcomes

Another pressing issue in the disability sector is the lack of slow-stream rehabilitation services which means that younger people may be discharged to nursing homes and other inappropriate environments. Slow-stream rehabilitation is chronically under-funded and again we find boundary disputes as this is the responsibility of health, rather than disability, services. While the NDIS and others are trying to find better housing solutions for these people at least some of the problem might have been avoided if high-quality slow-stream rehabilitation was available.

Lack of attention to disability does not bode well

Following the summit attendees received a Communique summarising main discussion points from the event.  There was recognition that people with disability, along with other groups such Aboriginal and Torres Strait Islanders and people in rural and remote areas, require targeted attention because they have inequitable health outcomes. This is a major win – people with disability are rarely acknowledged as a group who experience avoidable and unjust inequalities in health. There was also a recognition that there is a need to break down the silos between health and disability services. But this is where the discussion of disability ends.

An overall criticism of the Communique is that it lacks specific detail on the broad range of issues discussed. The lack of attention to disability in particular is a missed opportunity and does not bode well for innovative health reform for people with disability.

The Communique did not focus on the social and economic determinants of health for people with disability, despite recognition of the critical importance of this in the opening and closing sessions of the Summit.  For example, we know the labour force participation of Australian’s with disability is the worst in the OECD. We know unemployment is bad for health. We know people with disability experience discrimination in all aspects of life including education, finding a job, career progression and remuneration.  It is therefore crucial that we see a commitment to work across government to improve social and economic outcomes for Australians with disability, in the same way that we see a commitment to these issues in relation to Indigenous health.

The Communique does not address the very real problem of poor quality health services for people with disability.  The reform of mainstream health services was an underpinning recommendation of the Productivity Commission when it released its inquiry into disability care and support in a document that is widely seen to have been instrumental in making the case for the NDIS.  Since this time the reform of mainstream health services has slipped off the agenda. We want a commitment from the ALP to tackle this with people with disability at the core of any reform.

As the Communique acknowledges, the health sector is in a position to take policy stewardship of areas that affect health such as taxation, housing and employment.  We urge that in assuming this stewardship role, the circumstances of people with disability is a core driver for reform across the whole-of-government.

People with disability are falling through the gap between disability and health services. Slow stream rehabilitation and mental health services are just two examples. We want to see a commitment from the ALP to finding a solution to this problem.

We applaud the ALP for bringing together ‘leading thinkers in health’ to inform its health policies. However, we argue that the summit and Communique largely ignore the pressing health issues of people with disability. In line with the ALP’s commitment to enabling better lives for people with disability, we recommend that disability is a core focus of their health policy reform agenda going forward.  The CRE would be happy to work with the ALP on finding such solutions.

Professor Anne Kavanagh is Director of the Gender and Women’s Health Unit in the Melbourne School of Population and Global Health.

Associate Professor Helen Dickinson is Director of the Centre for Public Service Research at the University of New South Wales.

Gwynnyth Llewellyn is Professor of Family and Disability Studies and Director at the Centre for Disability Research and Policy at the University of Sydney.

They are all Chief Investigators on the NHMRC Centre of Research Excellence on Disability and Health along with other collaborators from the University of Melbourne, University of Sydney, Monash University, University of New South Wales, and RMIT.


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Ruth Hentschel - Twitter: @HlthEquityMDHS