Health care changes as the caravan moves on

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At a recent health conference I heard a nurse talk about an innovative solution she had found to help support one of her patients. “Keith” had been rehabilitating from an acquired brain injury and was ready to be discharged. He was able to live independently with some assistance, such as paying bills.

Keith’s home was a small rural community hundreds of miles from the rehabilitation facility and he had no family members who were able to take on the responsibility of assisting him once he was discharged. Without this help, Keith would have to live in supported accommodation in a city a long way from his community – not his preferred option.

After some discussions with Keith the nurse contacted the owner of the caravan park where he planned to live and together they agreed on a plan. The caravan park owner would provide Keith with the oversight and assistance he needed while Keith lived in the park as a permanent resident.

On this basis, the nurse was happy to discharge Keith and her follow-up contact with both men has found that this arrangement is working well.

It struck me that this story has a number of useful lessons for how the implementation of current reforms in health, aged and disability care will impact on our health workforce.

One of the major challenges facing Australia’s health system is the rising rate of chronic disease and disability and our ageing population. Our health, aged and disability care sectors are not currently prepared to deal with the increased need for care and the complexities of dealing with consumers with multiple chronic conditions.

As part of the Government’s response to this challenge, it has implemented a number of reforms within these sectors which change the way in which care is funded and delivered. These include the National Disability Insurance Scheme (NDIS), individual aged care funding packages and the Health Care Homes pilot project.

A common feature of these initiatives is their rhetoric that they aim to support consumer-focussed care. This includes facilitating a more flexible approach to coordinating and managing care across different service providers and sectors.

These aims have been broadly supported by consumers. However, whether the proposed changes are successful will depend to a large extent on the response of the health workforce.

If the reforms simply result in new ways to pay for the same old models of care, they are unlikely to deliver any benefits to consumers.

However, if the reforms can promote changes within the health workforce that facilitate new ways of working there is the potential for them to result in better quality care and improved outcomes for consumers.

Keith’s story provides some useful lessons for how the reforms should be implemented in order to influence changes within the health workforce that benefit consumers. These include the following.

Partnering with consumers: consumers are all individuals with their own diverse needs and priorities. This is particularly the case for consumers with complex needs. Therefore there is unlikely to be any single solution that will meet the needs of all consumers with similar conditions. The aim of the reforms should be to support health care providers to work with consumers to identify the best options for their unique needs, rather than developing models of care which are based on non-existent ‘standard’ patients. For many health professionals this may involve a major change from their current practices and it is important that there are given the support and training required to develop new ways of working.

Developing new skills and positions: moving towards a more ‘market based’ and flexible system of funding can create increased options for consumers but this also requires them to make more choices. Where consumers need assistance to make informed choices about their care there will need to be additional support provided. This could come from a number of sources, including GPs, nurses, carers, other health providers or dedicated care coordinators. Regardless of their title, these ‘health system navigators’ will need a range of skills, such as negotiating, advocating and communication, which should be explicitly supported by new funding systems.

Looking outside the health workforce: as in Keith’s example, sometimes the support and assistance required by a consumer can come from outside the health system. Many rural and remote communities have shortages of health professionals. This is unlikely to change as a result of the current funding reforms. However, if they allow increased flexibility of resource allocation they can provide the opportunity to increase the ‘health’ workforce by involving people from outside the health sector.

Looking outside of the traditional categories of health professionals can allow for new entrants into the health workforce who can cost-effectively meet emerging needs for care.

Build on what is there already: as the nurse responsible for Keith’s discharge amply illustrates, there are already examples of flexible and innovative thinking within the health system. In many cases these occur in environments with significant workforce shortages and constrained resources, such as rural, remote and Indigenous communities. Looking at where these occur and how they are supported by funding, administrative and organisational structures will help ensure the current reforms can replicate these ‘pockets’ of innovation and flexibility on a broader scale. By building on existing examples of consumer-focussed care through the implementation of the current funding changes we can help promote a more flexible and innovative approach to meeting consumers’ needs in the future.