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Medicare Locals

Estimates & Committees
Rachel Siewert 23 Feb 2011

23 February 2011 – Community Affairs

Senator SIEWERT—In the guidelines you say that Medicare locals will reflect the local communities et cetera. I will not read it all out. How are you going to ensure that these groups are reflected in the Medicare Locals—in particular, consumers?

Ms Morris—I cannot remember which page it is on.

Ms Huxtable—Can you tell us the page?

Senator SIEWERT—I cannot tell you which page, sorry.

Ms Morris—Somewhere in there it is very explicit that there needs to be in the governance arrangements engagement with clinicians and engagement with the local community.

Senator SIEWERT—That is what I am saying. You do make that statement. I can read out for you the exact statement. I was just trying to save time, I am sorry. It says: ‘which reflect the local communities and healthcare services and their governance including consumers, doctors, nurses, allied health, state funded community health providers.’ You are really clear about saying that. My question is: how are you going to make sure they do it?

Ms Morris—They are going to have to make the case for how they will do it in their application. Yet again in the selection criteria it is very clear that they will be expected to do that.

Senator SIEWERT—It is clear that they have to do it. How are you going to look at it and say, ‘We are confident they are going to be able to do this’?

Ms Huxtable—If you look through the selection criteria—I am struggling myself to find the right page now—there are a range of assessment requirements around demonstrated compliance with contractual arrangements; demonstrated evidence of ability to engage with informed productive relationships. Then we will be basically assessing the cases that are put before us in terms of, firstly, their strategy to effect these things and, secondly, their track record in the past. That will be in the process of the assessment itself. I would say in the process of their being Medicare Locals organisations there will be requirements upon them to meet the commitments that they have made in this regard.

The absolute expectation is that consumers will have a very central role, that the broad range of primary care providers in an area will have a central role, and that there will be governance arrangements in place that allow them to link outside of the primary care sector into the acute care sector, for example. These are all the things that we would expect them to have at their centre and we will be looking at that, both in the assessment process but also in how they operate on the ground.

Ms Morris—I would also add that how a community defines itself as a community and the role consumers may or may not have in that community varies a lot across the country. You cannot mandate one model and assume that that is going to be replicated uniformly. We are looking to them to make the case and prove that they are serious about it and intend to deliver on it.

Senator SIEWERT—I was not trying to suggest at all that they should—

Ms Morris—I didn’t take it like that. I would expect, too, that community engagement would grow. It is not something that there is currently a role for. You would hope that the interest of local communities would grow over time and people would seek the engagement.

Ms Huxtable—Particularly with healthy communities reports and as communities themselves become more aware of the primary care network of services in their area.

Senator SIEWERT—The guidelines also say that the guidelines form the basis of the application and assessment. What else is there for the assessment? Is there another set of guidelines or criteria that you have not released that you will use?

Ms Morris—No, although these guidelines may be updated over the life of the program. There will be the first tranche, which has been advertised, and we may find after that first round there is a need to make changes, to be more specific in some areas and to allow for more flexibility in others. We will effectively use the learnings of that first round to feed in.

Senator SIEWERT—It is the start of the process.

Ms Morris—Yes.


Senator SIEWERT—I would like to go to the selection process. I understand it is an in-house DoHA process. Why was it decided to make it in-house and has consideration been given to getting some sort of outside assistance in doing that?

Mr Booth—The decision was made that the department had considerable expertise over the years, in particular, in dealing with primary care and with divisions, and had quite a bit of internal expertise, so the idea was that the assessment process would be done by divisional officers, but would also pull in expertise in particular areas such as legal, probity and financial advice as and when needed to provide that independent advice. It is a core of divisional officers, but pulling in the independent advice as needed.

Ms Huxtable—Mr Booth means primary care division officers, in case there was any confusion.

Senator ADAMS—Yes, not general practice officers.

Senator SIEWERT—I will link this back to my original question, which was around involving those people in the local community. I totally agree with you: each community is different. How are you going to be confident that you have picked up the essence of the community in the consultation process or in the development process and in the Medicare Local, that they are truly able to engage and understand that community?

Mr Booth—A key aspect to Medicare Locals and one of the key things that they will need to do initially is the health needs assessment process, which is quite a detailed process of determining the health needs across the whole of their community. To do that effectively, you need to pull in all those different aspects and different parts of the community to make sure that you have covered across. That will be a key lever in proving that has actually happened.

Senator SIEWERT—I accept that. I will pick the area of Cannington in WA as an example, because I know some of the health issues. How can you be confident that you know Cannington well enough to be able to make the call that in fact that body has made the call? Do you understand what I mean?

Mr Booth—Yes. We would also pick on and use our contacts in local areas, like our state and territory officers who know the local areas very well. We would use our state and territory officers to provide advice as to what is happening in the local area and to give that local knowledge so that we could take that on board. The reports that they produce will also be independent and verified in terms of the healthy community reports and, again, there will be a process to look at what is being produced there, so we can have a kind of feedback loop on that.

Senator SIEWERT—So, in other words, you will be going to other outside people to verify that?

Mr Booth—Yes.


Senator SIEWERT—I will have to put the rest of my questions on notice. Can I check that I have asked the key questions?

Senator SIEWERT—Senator Adams picked up one of my questions about how you will be engaging with consumers. Are you confident you are going to get that agreement and support to include consumers? I can tell you that the feedback I have had has been a bit negative from people in divisions of general practice.

Mr Booth—Again, there are parts within the guidelines that talk specifically around local communities, ensuring that local communities have a voice and that end parties are taken into account. One broader thing is that Medicare Locals are intended to look much more broadly across the primary healthcare system, as a whole rather than the focus that it has perhaps traditionally had.

Ms Morris—We say two things quite clearly in the guidelines. Firstly, there needs to be some sort of formal governance arrangement that ensures community engagement and, secondly, there needs to be some sort of consumer local community involvement in the board. We have not spelt out exactly how that would work. We want to leave it to applicants to come up with proposals that are going to address that. Quite frankly, we sit in Canberra. They are out there in the community so they will have a better idea of what may or may not work. We have been quite clear about that, and it has been in all the words about Medicare Locals ever since they were first announced.

Ms Halton—I would like to add to that and it goes to Senator Adams’s question about how we will know. Ms Morris is absolutely right. In Canberra, you might have some passing familiarity with some communities but you cannot know them all. One of the things that we have the benefit of is our state officers, who have quite robust relationships right across states and territories. There will be a number of sources of advice to us about those things, which we will be taking.

To go to Senator Adams’s point and I think to yours as well, this is not divisions rebadged. I have been giving that message very clearly, as has the minister. Some of the divisions do a fantastic job and there are some very high performing divisions. The guidelines make it quite clear and people should not be under any illusion that, if they just come forward with the same pattern or package, that will not meet the objectives located in here. We are quite clear about that.


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