Pillar 4: Health for All

4.1 Prevention of illness becomes a foundation of Australia’s health system policy and funding response in the immediate future.

• Increased funding directed towards preventative health.
• A tax on sugar sweetened beverages.
• GPs at the centre of preventative health system design. 
• Increased Medicare rebates and improved indexation to lessen patient out-of-pocket costs and encourage greater access to medical services.
• An Australian Centre for Disease Control (CDC) is established with a focus on current and emerging communicable disease threats, and to engage in global health surveillance, health security, epidemiology, and research.
• Maintain the funding and support needed for each sector of the health system to remain vigilant in response to COVID-19, while allowing treatment and prevention services to run.

• Five per cent of total health expenditure dedicated to illness prevention.
• Number of GP MBS items dedicated to preventative health.
• Funding to establish a CDC.
• Application of best-practice principles of infection prevention, control and treatment of COVID-19, which reflect continuously evaluated emerging evidence.
• Increased prevention and identification of disease at earlier stages.
• Reduced acute demand on hospital facilities.
• Evidence of improved patient experience and flow through the health system.

• Specific needs-based Aboriginal and Torres Strait Islander health funding allocated to address health needs of Aboriginal and Torres Strait Islander communities, including unimplemented parts of the National Aboriginal and Torres Strait Islander Health Plan 2013-2023, as well as greater investment in primary care.
• Build on the fine examples of Aboriginal and Torres Strait Islander healthcare service delivery already operating in Australia – such as the Institute for Urban Indigenous Health – and replicate this or equivalent models as appropriate throughout Australia.
• Mandate regular cultural safety training for all medical practitioners.

• Health outcomes of Aboriginal and Torres Strait Islander communities improved against the new National Agreement on Closing the Gap targets and health policy benchmarks – including at least 90 per cent population access to fluoridated water.
• Significant performance uplift against the age-standardised rate of potentially preventable hospitalisations, as outlined in the National Health Reform Agreement and State and Territory Aboriginal and Torres Strait Islander health plans.
• The level of funding for healthcare for Aboriginal and Torres Strait Islander people is based on the level of need indicated by the Burden of Disease studies.
• Increase in Aboriginal and Torres Strait Islander people having a health assessment with a GP, as measured by an increase in MBS item 715 - Indigenous Health Assessment.

4.2.2 Ensure that health policy addresses the needs of those who are marginalised and those who suffer socioeconomic disadvantage, as well as those in aged care who have limited access to health services.

• Adequate nursing staff in nursing homes and enhanced integration between the aged care and health systems.

• Universal healthcare and affordability achieved for all, particularly people in socioeconomic disadvantage.

• Options for telehealth between the GP and a carer or nursing home nurse on behalf of a patient, where patients are non-communicative.

• Adequate healthcare for those in other institutional care settings, and those within the disability sector.

• Disadvantaged communities accessing healthcare more regularly and achieving improved health outcomes.

4.3.1 Establishing a Community Resident Program (CRP).

• Stronger recruitment into General Practice, by providing doctors in training with more opportunities to undertake pre vocational training in General Practice.

• Ensuring more doctors have a fundamental understanding of the functioning of General Practice and primary care.

• All CRP places filled each year.

4.3.2 Expand the Commonwealth Government’s Specialist Training Program (STP) to 1700 places by 2022, giving priority to rural areas, generalist training and specialties that are under-supplied.

• An increased focus on generalism within the specialist workforce.
• Improved access to specialist services in rural Australia.

• All STP places filled each year.
• Evidence of improved recruitment into under-supplied medical specialties.

4.3.3 Increase the focus of medical schools on rural training opportunities by supporting end-to-end rural medical school programs.

• Improve workforce distribution by encouraging the development of a rural training pipeline which takes students all the way through to the completion of specialist fellowship training.
• Dedicating at least one-third of all domestic first-year medical school places to students with a rural background and requiring one-third of all medical students to undertake at least one year of clinical training in rural areas.

• Increased numbers of Australian-trained specialists working in rural Australia.
• Evaluation of end-to-end rural medical training to ensure it is providing positive rural exposure, leading to retention of rural medical practitioners.

4.3.4 Rollout of the National Rural Generalist Pathway (NRGP) nationally by 2021.

• Improved access to GPs in rural areas.

• NRGP places fully subscribed by end of 2021.

4.3.5 Regulate all medical school places, including domestic and overseas full fee-paying places to match medical school intakes with community need.

• Avoiding the boom-bust cycle that has characterised medical workforce planning.
• Ensuring that medical school intakes are matched to the available number of training places in the pre vocational and vocational training pipeline.
• Ensuring medical school intakes are linked to workforce planning and community need.
• Regulation to limit the number of full-fee paying overseas medical student in Australian universities to no more than 15 per cent of the total number of students.
• Ensuring the 10-year moratorium rules for overseas trained doctors (OTDs) are enacted simply, fairly and uniformly.

• Medical school intakes reflect the advice of the Medical Workforce Reform Advisory Committee (MWRAC).
• Annual reporting of medical school places through the Medical Education and Training data reporting.
• Greater proportion of OTDs serving full 10-year moratorium and current loop-holes closed, while working towards dismantling the 10-year moratorium over time. More robust incentives and support mechanisms should be introduced to encourage increasing numbers of locally-trained doctors and appropriately skilled international medical graduates alike to consider a career in rural and remote practice.

4.3.6 Promotion of regional training and research teaching hospital hubs to grow non-GP specialist capacity outside metropolitan areas.

• Quarantined National Health and Medical Research Council research grant funding for regional teaching hospitals.
• Commonwealth Medical Workforce Strategy to recognise importance of development and investment in regional teaching hospitals with sufficient capacity to host STP-funded non-GP specialist registrars.

• Greater coverage and access to non-GP specialist capacity in regional training centres, aiming for a 20 per cent increase by end of 2023.

4.4.1 Mental health-specific investment in developing capacity in mental health support services in GP practices in a coordinated manner, rather than siloed funding to non-government organisations.

• Accredited mental health nurses/ social workers embedded in General Practice, with appropriate training and support.

• Greater continuity of care, shorter follow-up times, increased compliance with mental health plans.

4.4.2 Mental Health - Investment in evidence-based nursing programs, integrated in General Practice, and funded increased support by psychiatrists, and mental health nurses.

• Greater GP rebates for longer consultations and management of complex medical conditions.
• Improved rebates and continuation of telehealth for psychiatrists.

• Greater linkage between mental health concerns and physical health and wellbeing through GP integration.
• Improved access to psychiatrists.

4.5 Mental Health - Invest in alternatives to emergency department and acute presentations for mental health patients, including active deployment of hospital in the home options and improved Medicare rebates.

• Community mental health services expanded and commensurately staffed to provide comprehensive care, including an immediate focus on the impact of COVID-19.
• Rapid development of metropolitan and rural outreach telehealth resources (videoconferencing) and administrative support specifically for mental health consultations.

• Decrease in emergency department and acute presentations for mental health patients.

4.6 Place renewed emphasis on healthcare services operating in an environmentally sustainable manner; and plan for climate change’s impact on population health.

• A national sustainable development unit is established to reduce carbon emissions in the healthcare sector.
• Health benefits of addressing climate change are promoted.
• A national strategy for health and climate change is developed.
• Waste-reduction strategies incorporated as a requirement in hospital accreditation.

• Carbon emissions attributable to the health sector are reduced.
• A reduction in deaths and adverse health outcomes attributable to climate change.

4.7 Develop new partnerships between colleges and professional associations, encourage diversity in leadership, and necessary reforms to achieve cultural change.

• Medical leadership training curriculums developed, standardised and recognised as part of continuous education programs.

• Number of leadership training programs available.
• Increased diversity in training program leadership.
• Number of doctors taking part.
• Number of partnerships.

4.8 Achieve positive cultural change that eliminates harassment, bullying and racism through improved reporting structures available and ongoing training.

• Improved and safe rostering of doctors and registrars.
• Progress toward implementation of the Every Doctor, Every Setting: A National Framework to improve the mental health of doctors and medical students.
• Greater availability and uptake of training programs on bullying, racism and harassment.
• Funding support for hospital investment in staff wellness and positive cultural change.
• Avenues for reporting and addressing racism in the workplace, including promoting the Australian Health Practitioner Regulation Agency reporting mechanism.
• Encouraging greater participation of women in the medical workforce (including leadership and management) and the health workforce more broadly.
• Fostering diversity in leadership.
• Providing equal access to parental leave for both parents.

• Improved work satisfaction by doctors and registrars.
• Lower reports in AMA State and Territory hospital health checks of junior doctors, both in measures of fatigue and workplace culture.
• Lower number of complaints.
• Increased participation of women in the medical workforce, particularly in leadership positions.
• Increased percentage of male doctors taking parental leave and being able to access flexible work arrangements.