Final report of National Health and Hospitals Reform Commission released today

After 16 months of submissions and deliberations, today saw the release of the final report the National Health and Hospitals Reform Commission.

Detailed analysis will be published widely over the next few days, as the potential impact on all Australians is assessed, and the Government's response emerges.

Jim Simpson at NSW CID has drawn our attention to these highlights today, that are of particular relevance to people with intellectual disability:

Our recommendations on major system redesign in Chapter 4 will tackle some other important service gaps, but will do so through more fundamental system redesign in how we rebalance our investment to provide better connected services that take us from ‘cradle to grave’. In particular, we noted in our Interim Report the stark health and access inequalities for the more than 300,000 people living with an intellectual disability. Many of our reform recommendations, such as voluntary enrolment with a primary health care service as their ‘health care home’ and the broad purview of health promotion and prevention, will assist. Access to specialist medical services is also a major gap to be addressed for people living with an intellectual disability. (p. 68)

Acting early to keep our children healthy is one of the most powerful investments our society can make. The evidence is overwhelming. If we act early, we can prevent or reduce the magnitude of many disabilities, developmental delays, behavioural problems and physical and mental health conditions. Providing a stimulating balance of quality antenatal and early childhood health services, community and education services is vital for all children. For the most disadvantaged families, a healthy start to life is equivalent to providing a lifeline to help lift children out of generational cycles of poverty and unhealthy environments and give them the best health and life opportunities.

Our recommendations for a healthy start involve ensuring that children get access to the right mix of universal and targeted service[1]], based on their age and their individual health and social needs. What this would look like is as follows: .....

• Special needs: Children with particular health or developmental issues (as identified by the universal child and family health services or the family’s primary health care service) would be referred and eligible to get an enhanced package of care (for example, access to specialist services such as paediatricians, allied health, speech pathologists and other services required to manage disabilities or developmental delays). A care coordinator who is linked into a primary health care service would help support families of children with the most complex needs through coordinating and packaging the best range of services for these children and their families. (pp82-83)

We want to stress the value of prevention, health promotion and early intervention regardless of people’s age, health status or disability. It is important that everyone – including older people living in residential aged care or in the community, people with an intellectual disability, people living with a degenerative condition (such as multiple sclerosis) and people with other complex and chronic conditions – is given the opportunity to achieve their maximum health potential.(p85)

Recommendation 18:

We recommend that young families, Aboriginal and Torres Islander people and people with chronic and complex conditions (including people with a disability or a long-term mental illness) have the option of enrolling with a single primary health care service to strengthen the continuity, co-ordination and range of multidisciplinary care available to meet their health needs and deliver optimal outcomes. This would be the enrolled family or patient’s principal “health care home”. To support this, we propose that: there will be grant funding to support multidisciplinary services and care coordination for that service tied to levels of enrolment of young families and people with chronic and complex conditions; there will be payments to reward good performance in outcomes including quality and timeliness of care for the enrolled population and over the longer term, payments will be developed that bundle the cost of packages of primary health care over a course of care or period of time, supplementing fee-based payments for episodic care.

Recommendation 24:

We recommend that universal child and family health services provide a schedule of core contacts to allow for engagement with parents, advice and support, and periodic health monitoring (with contacts weighted towards the first three years of life). The initial contact would be universally offered as a home visit within the first two weeks following the birth. The schedule would include the core services of monitoring of child health, development and wellbeing; early identification of family risk and need; responding to identified needs; health promotion and disease prevention (for example, support for breastfeeding); and support for parenting. Where the universal child and family health services identify a health or developmental issue or support need, the service will provide or identify a pathway for targeted care, such as an enhanced schedule of contacts and referral to allied health and specialist services. Where a child requires more intensive care for a disability or developmental concerns, a care coordinator, associated with a primary health care service, would be available to coordinate the range of services these families often need.