Australia 2020 Summit - A long term national health strategy

Here are "A long term national health strategy" items accepted by the Australian Government in its "Responding to the Australia 2020 Summit" on 22 April 2009:

Australia is fortunate to have a health system which has delivered, in international terms, very good health outcomes due to Medicare, a strong public hospital system, and a high quality workforce. However, the challenges which our health system faces are substantial. Health costs are rapidly increasing, due to expensive technologies, higher pharmaceutical costs and increasing community expectations. Australia's ageing population also poses great challenges to the health system, generating the need to provide increasing levels of aged care and support in a system already under pressure. Australia is also experiencing the increasing burden of preventable chronic disease such as diabetes. The Government has made health a major priority in its first term and is committed to delivering national policy solutions that are socially and economically sustainable. This agenda is being progressed through the Council of Australian Governments (COAG) as part of a wide range of health reforms currently under consideration.

Participants in the Health Stream at the 2020 Summit agreed on the need to have a health system integrated at all levels, focused on both illness and wellness, drawing on the latest technological advances and research to deliver improved health outcomes for all Australians by 2020. These ideas covered a broad range of themes, including healthy lifestyles, health promotion and disease prevention, the health workforce and service provision, addressing health inequalities, and future challenges and opportunities in health and health research. The ideas from the Summit have made a significant contribution to the Government's health policy.

The Health Stream developed a broad range of ambitions, themes and ideas that have influenced and guided the Government's policy in this area, including:

• National Plan to Boost Organ and Tissue Donation - The Government's National Plan to Boost Organ Donation is a $151.1 million national reform package to boost the number of life-saving organ transplants for Australians.

• National Healthcare Agreement - In November 2008, COAG agreed to an historic package of broad reforms of the health and hospital system. Under a new National Healthcare Agreement and associated national reform proposals, the Government will provide $64.4 billion in funding over five years. This includes an increase to the Healthcare Specific Purpose Payment of $4.8 billion over the forward estimates period, and a package of health reforms in priority areas totalling $3.9 billion. One important reform is the Preventative Health National Partnership to improve the health of all Australians, which includes the establishment of a national preventative health agency. Other reforms include the Indigenous Health National Partnership, which expands primary health care and targeted prevention activities, and the Hospital and Health Workforce Reform National Partnership, providing the single largest investment in the health workforce ever made by Australian governments as well as improvements to hospital efficiency, sub-acute care and emergency department services.

• Research in Bionic Vision Science and Technology - The Government is committed to supporting research where Australia is on the leading edge of innovation as a crucial investment in our nation's future. One such area is research into the bionic eye, which is a critical advancement for millions of vision impaired Australians and promises the development of technologies to translate into other areas of need. Australia is already a world leader in bionics based on our expertise in the bionic ear. The Government is committed to conducting a competitive grants process to fund this important work.

The following tables provide the Government's response to the ideas raised by the Health Stream at the 2020 Summit.

Key ideas being taken forward by the Government

Topic	2020 proposed ideas	Government response
Research in Bionic Vision Science and Technology	Promote better commercialisation of intellectual property, by taking the lead in developing innovative health technologies, such as inventing a 'bionic eye' by 2020.	As discussed at the 2020 Summit, the Government is committed to supporting research where Australia is on the leading edge of innovation. One such area is research into the bionic eye, which is a critical advancement for millions of vision impaired Australians and promises the development of technologies to translate into other areas of need. Australia is already a world leader in bionics based on our expertise in the bionic ear. The Government is committed to conducting a competitive grants process to fund this important work.
Preventative Health - Healthy Food and Living Also raised by: Rural	Making healthy food choices easy (e.g. delivering 'fast fruit' to primary schools, fresh food to Indigenous communities, banning junk food advertising to children, regulating allowable content of unhealthy ingredients). Healthy food leads to healthy nations. Model of food labelling (traffic light), label all food ingredients including trans-fats. Use positive social marketing to encourage healthy living by making poor health habits expensive and healthy living habits less expensive. Provide incentives to employers/schools to introduce healthy food exercise. Develop a physical activity pathway for all Australians at all stages of life. Introduce physical activity every day - 30 minutes throughout the workforce. Design healthier buildings and neighbourhoods. Develop health and lifestyle plans for every city. Develop a wellness rating scheme for all suburbs, towns and cities. Abolish duty-free alcohol and cigarettes into Australia.	The Government agrees that helping Australians to make healthier choices is an important goal. Not all of these ideas will necessarily be adopted in achieving that goal. In November 2008, COAG agreed to a Preventative Health National Partnership (to which the Australian Government contributes funding of $872.1 million over 6 years) to support a range of nutrition, physical activity, obesity and smoking initiatives, including: Access to services for children to increase physical activity and improve nutrition Provision of support for workplaces and local communities to provide physical activity and healthy living programs. Rewarding States and Territories for achieving specified targets in the areas of healthy weight, healthy eating, physical activity and smoking. The Preventative Health Taskforce will also be providing evidence-based advice to governments and health providers on health programs and strategies. The Taskforce will develop a National Preventative Health Strategy by June 2009, which is likely to address some or all of the issues raised by the 2020 Summit.
Preventative Health - National Agency and Strategy	Introduce a National Preventative Health Agency, based on the VicHealth model, to commission research, design interventions based on evidence, develop and deliver preventative health policy, and implement marketing and public health campaigns. Investigate successful preventative health interventions from overseas and consider incentives, including financial ones, to encourage lifestyle changes - for example, to give up smoking or drugs. Commission the National Preventative Health Agency to develop research and evidence to help employers establish healthier work places. Establish a new preventative health strategy across life, with a major focus on Indigenous Australians. Establish a whole-of-life wellness model incorporating whole-of-life activity pathway. Establish a health and education task force charged with identifying risk profiles (for example chronic illness, disabilities, Indigenous people, remote and the ageing population. Expand existing national literacy and numeracy assessments to include physical fitness and health literacy, supported by 'catch-up' programs for 'high-risk' children, delivered away from healthy peers. Establish health literacy programs. Promote healthy lifestyles and education. Remunerate health practitioners to provide lectures in schools or to community groups. Establish performance indicators and mandatory curriculum for health and wellbeing in schools, including the ethics of health care.	Agree in-principle. The Government is committed to improving preventative health outcomes. In November 2008, the Commonwealth and the states agreed to a Preventative Health National Partnership to improve the health of all Australians, with the Australian Government providing funding of $448.1 million over four years, and $872.1 million over six years, starting from 2009-10. This funding supports elements such as: Increased access to services for children to increase physical activity and improve nutrition Provision of support for workplaces and local communities to provide physical activity and other risk modification and healthy living programs National marketing campaigns to increase public awareness of the risks associated with lifestyle behaviour and its links to chronic disease Enabling infrastructure, including a national preventative health agency, surveillance program, workforce audit, eating disorders collaboration, partnerships with industry and a preventative health research fund. The Preventative Health Taskforce, established by the Government in April 2008, will also be providing evidence-based advice to governments and health providers on health programs and strategies. The taskforce will develop a National Preventative Health Strategy by June 2009. The Government has introduced Healthy Kids Checks to give every four year old child in Australia a basic health check to see that they are healthy, fit and ready to learn when they start school.
COAG Health and Ageing Working Group - Information and Reporting	Use health system information to improve the quality of decision making and policy development, including: Combine data held by governments and specialist colleges with state hospital data to look at the effectiveness of treatment outcomes Reduce the system input and output data to focus on consumer and community outcomes, to provide better targeted treatments Establish a system of allowing reporting positive outcomes in the health system. Health Performance Measurement Conduct a health audit to identify the programs that are working well and those that are not. Introduce measurement of national level of key public health outcomes to determine what is being achieved in public health. Measure performance indicators based on the patient's experience of the care received. Develop national outcomes data to drive resource allocation. Measure citizens' wellbeing as a health performance indicator and report these outcomes to hold Governments accountable for the wellbeing of their citizens. Develop a clever health system; coordinate health and service organisations with a national framework of targets, measures audited with a regional focus. Establish zero-tolerance stretch targets in health care.	Agree in-principle. Leveraging critical performance indicators is crucial to improving health care outcomes. In November 2008, the Commonwealth and the states and territories agreed to an outcomes based policy and reporting framework that will report against preventable disease and injuries; timely access to GPs, dental and other primary health care professionals; life expectancy, including the gap between Indigenous and non-Indigenous Australians; waiting times for services; and net growth in the health workforce. The COAG Reform Council will report progress against these performance measures annually, commencing in 2009-10. In addition, the Commonwealth and the states and territories agreed to the introduction of Activity Based Funding to provide the basis for more efficient use of taxpayer funding of hospitals and for increased transparency in the use of those funds. It will also allow comparisons of efficiency across public hospitals. The Australian Institute of Health and Welfare and the Australian Bureau of Statistics also regularly produce health statistics and report on outcomes in health.
COAG Health and Ageing Working Group - E-Health	Introduce an individual e-health record, plus 'Healthbook' (like Facebook) for Australians to take ownership of their health and to electronically share health information. Develop incentives to improve the uptake of e-health. Introduce national online access to a system of health information for tertiary, secondary and primary health care providers and individuals. Improve genomic diagnosis and treatment: for example, making gene space part of the 'Healthbook' concept. Introduce a universal health card with universal information.	Agree in-principle. The Summit recognised the importance of e-health, and in November 2008, COAG agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the states) to the National E-Health Transition Authority. The authority is a not-for-profit company established by the Australian, state and territory governments to develop better ways of electronically collecting and securely exchanging health information. For example, it is working on standardising certain types of healthcare information to be recorded in e-health systems. The authority will continue to operate until June 2012.
Medical Benefits Schedule	Review the Medical Benefits Schedule to examine the need for GP appointments for repeat prescriptions.	Agree in-part. In the 2008-09 Budget, the Government extended the period for which a repeat prescription can be written for patients with chronic conditions from six months to twelve months.
Develop Hospital Based Schedule	Develop a hospital-based schedule similar to the Medical Benefits Schedule.	In November 2008, COAG agreed to introduce Activity Based Funding for hospitals. Activity Based Funding will enable governments and hospital managers to monitor and compare performance; drive technical efficiency in the delivery of hospital related services; and enhance public accountability by increasing the transparency of the relationship between funding and the services provided. The National Health and Hospitals Reform Commission will also report on future reform options.
Health Institutes/ Organisations	Establish national institutes for key issues such as cancer and mental health. This could be done under the National Health and Medical Research Council, but ensuring that a range of input factors are brought together.	The Government will provide $5.1 million over three years to support the work of the National Centre for Gynaecological Cancers. The National Health and Medical Research Council also already supports heath and medical research on key areas at a national level.
National Indigenous Health Equalities Council and National Health and Hospitals Reform Commission	Create a Health Equalities Commission, responsible for monitoring not delivering services, with a focus on disadvantaged and Indigenous communities. Establish a National Institute of Aboriginal and Torres Strait Islander Health and Wellbeing.	Agree. The National Indigenous Health Equality Council was announced at a summit convened in March 2008. The Council was launched and members appointed in July 2008. The National Health and Hospitals Reform Commission is also in the process of making recommendations regarding long term macro reforms to improve Australia's health system (including for Indigenous and rural communities). Their final report is expected in mid-2009.
Eradicate Trachoma in Indigenous Children Also raised by: Indigenous	Eradicate trachoma amongst Indigenous children within five years through a comprehensive health strategy. This could include a national hand-washing campaign in Indigenous communities.	Trachoma is a preventable and treatable disease which still causes blindness in an unacceptable number of Indigenous Australians. The Government has committed $58.3m to expand eye and ear health services for Indigenous Australians. This includes $16m to address trachoma.
Australian Medical Research Institutions Partnerships - Indigenous Health	All major Australian research institutions to have responsibility for developing partnerships with Indigenous communities to build the Indigenous health and medical research skill base and focus research on addressing major Indigenous health problems.	Agree in-part. The Department of Education, Employment and Workplace Relations funds the Cooperative Research Centre for Aboriginal Health, which involves a number of major research institutes with expertise in Aboriginal health. To further build understanding on effective Indigenous initiatives, in 2008-09 the Government has provided funding for a Closing the Gap Clearing house and agreed joint funding arrangements with state and territory governments. The clearinghouse is a knowledge management service, run by research specialists, which provides a centralised repository of information, resources and networks that can be accessed by interested stakeholders.

Oral/Dental Health Strategy	Oral health promotion to have a national approach and well-known interventions such as fluoridated water to be put in place. Oral health to be on the preventative health agenda.	Agree. The Australian Government is promoting oral health in a number of ways: The new Medicare Teen Dental Plan delivers the Government's election commitment to provide financial assistance to families to encourage teenagers to care for their teeth by having annual check-ups and to maintain good oral health habits once they leave home. The program commenced on 1 July 2008 The Government intends to close the chronic disease dental scheme in order to make funding available for the Australian Government Dental Health Program which will provide funding to the states and territories to address waiting lists for public dental services The existing National Oral Health Plan has been endorsed by state and territory health ministers and commits to extending the fluoridation of public water supplies to communities across Australia with populations of 1,000 or more.
National Plan to Boost Organ and Tissue Donation	Improve Australia's organ and transplantation rates.	Agree. The Summit noted the importance of improving transplant rates, and on 2 July 2008, the Government announced a $151.1 million national reform package, including new funding of $136.4 million over four years, to boost the number of life-saving organ transplants for Australians. This package provides a nationally coordinated and integrated approach which, as international comparisons have shown, is the best way to achieve a significant and lasting increase in the number of life-saving and transforming transplants.
Inter-Governmental Agreement on National Registration and Accreditation Also raised by: Rural	Develop and implement a system of common accreditation and registration for all health professionals. Establishment of a national system for registration of medical professionals.	Agree. In March 2008, COAG agreed to create a single national registration and accreditation system for health professions to create a more flexible, responsive and sustainable health workforce. The system will be in place by July 2010, initially for ten health professions.
Hospital and Health Workforce Reform	Create a self-sufficient and flexible health workforce for Australia with competence-based training for accreditation. Develop a model to guide where additional undergraduate training places are needed to support the health workforce. Consider doubling the number of medical students or upskilling the defence force to assist with workforce shortages. Develop a model to deliver clinical training for the health workforce in communities. Examine prescribing rights for non-physicians - for example, allow physiotherapists with appropriate qualifications to prescribe from a limited range of drugs for which they are qualified. Review whether savings would be generated by allowing non-GPs to treat and prescribe medicines within the extent of their competence. Examine whether nurse practitioners could support health care provision in aged care. Develop nationally accredited, multi-disciplinary, competency-based modular training for health professionals supported by an appropriate legislative framework. Consider training older people so they can join the health workforce. Consider offering mature workers a 50 per cent salaried position and allow them time for education, training and research. Establish a second tier of providers (non-traditional) such as those who could take blood pressure readings. Train health professionals in caring. Improve support for health workers by providing administrative support that allows them to do their job and reduces red tape. Cascade health professionals into organised teams as appropriate.	The Government is committed to delivering a more flexible and responsive healthcare workforce. Accordingly, the Australian Governments signed an Intergovernmental Agreement in March 2008 to develop and implement a new single national registration and accreditation system, initially for ten health professions. In November 2008, the Commonwealth and the states also committed to an unprecedented reform package of $1.6 billion - the single largest investment in the health workforce ever made by Australian governments. The package comprises $1.1 billion of Commonwealth funding and $539 million in state funding, and includes almost $500 million to support the expansion of undergraduate clinical training places, and directly subsidise clinical training for undergraduate medical, nursing and allied health students. The Government will establish a National Health Workforce Agency to drive a more strategic, long-term plan for the health workforce The National Health and Hospitals Reform Commission (NHHRC) will also make further recommendations regarding long term reform to the health and hospital workforce and is due to report to Government in June 2009.

Health Workforce - Aged Care workforce	Undertake a review of the training and funding of aged care workers. Train specialised health care teams to care for older people in the community.	The Government is committed to delivering a more flexible and responsive healthcare workforce. The aged care workforce will be supported by the $1.6 billion reform package for the health workforce agreed to by COAG in November 2008 - the single largest investment in the health workforce ever made by Australian governments. This is also supported by the Government's $138.9 million plan to bring extra nurses and midwives into the Australian health workforce. The plan includes cash bonuses for people no longer working as nurses or midwifes to return and work in a public or private hospital, or residential aged care home.
Office for Youth Also raised by: Communities	Create a child and young person's commission (or similar body) to allow education, social and health issues to be coordinated. Create a Commissioner for Children and Youth and establish a cohesive national youth policy that includes all departments and covers all areas, including health, education, participation and the rights of children.	The Office for Youth was established in September 2008 to lead the Australian Government's youth affairs reform agenda and to create and promote opportunities for the engagement and greater participation of young people in Australian society. In addition, the Government has launched the Australian Youth Forum, which aims to engage young people and the youth sector in ongoing public discussion and facilitate their input into policy and decision making about issues that affect their lives.
Environmental Health - Water Research	Support research and technology for clean water in Australia and the region (in the face of climate change).	Agree. CSIRO's Water for a Healthy Country Flagship already undertakes research on 'clean water' for Australia. The Flagship program aims to achieve a tenfold increase in the economic, social and environmental benefits from water by 2025.
Stephanie Alexander Kitchen Garden Also raised by: Rural	Support kitchen gardens in schools to enable school children to see how food is grown and experience truly fresh food Each child should be required to produce a real or virtual primary product' in order to better understand its origin and appreciate the effort and resources needed to produce it.	Agree in-principle. The Stephanie Alexander Kitchen Garden National Program was launched by the Minister for Health and Ageing on 21 August 2008. The National Program will see up to 190 primary schools across Australia receive grants to build kitchens and gardens. Within four years, around 20,000 Australian primary school children in Years 3 to 6 will experience growing, harvesting, preparing and sharing fresh food each week, laying the foundations for a life time of healthy food choices.
National Health and Medical Research Council priority-setting	Include key health issues on the research agenda, for example obesity and mental health. Improve consultation between the National Health and Medical Research Council and the Consumers Health Forum to determine research that would be valuable for communities.	Agree in-principle. The National Health and Medical Research Council (NHMRC) is already focusing on national health priorities, including obesity and mental health. The NHMRC undertakes extensive consultation in setting priorities that best meet Australia's needs. The NHMRC also has a representative on its board to consider the needs of consumers.
Children and Family Centres Also raised by: Productivity	Parents' and Children's Centres - integrated, regionally based, health and wellness centres for children. Joining up initiatives in early life (testing, intervention) - integrated primary care centres for children. Childhood development should be supported through a place-based culture that offers integrated services and community support. Children one-stop centres.	In October 2008, COAG agreed to the first National Partnership covering Indigenous Early Childhood Development. As part of the initiative, 35 Children and Family Centres will be established across Australia to deliver integrated services that offer early learning, child care and family support programs. At its July 2008 meeting, COAG agreed to the development of a broad national strategy for early childhood development. The strategy will set the direction for collaborative early childhood reform across the Commonwealth and states and territories. The strategy will be considered by COAG in 2009 and will include consideration of integrated service delivery approaches. The Australian Government is also investing $114.5 million over the next four years to establish, as a first phase, early learning and care centres, including six autism specific centres. Where states and territories are interested in partnering with the Australian Government to create integrated service models, the Government will pursue opportunities to deliver a broader range of services within these centres. The Government will also work in partnership with other private providers to establish these centres.
Review of Medicare Benefits Schedule Primary Care Items	Expand opportunities for providing 'health checks' within the Medical Benefits Schedule. Use primary health care infrastructure for health screening; use GPs for a health check.	The Government has introduced Healthy Kids Checks to give every four year old child in Australia a basic health check to see that they are healthy, fit and ready to learn when they start school. The Government is also undertaking a review of the primary care items listed by the Medicare Benefits Schedule, which is expected to be completed by mid-2009. The review will consider health checks with a view to improving efficiency. There may also be related recommendations from the Preventative Health Taskforce in June 2009.
National Binge Drinking Strategy	Implement a program to combat alcohol abuse. Redefine the unacceptable: change community views on alcohol use, similar to the change that has occurred with tobacco use. Bring the impact of alcohol abuse to the public's attention.	The Government has prioritised and targeted alcohol abuse among young Australians through the introduction of the National Binge Drinking Strategy, a $53.5 million initiative. In addition, the Commonwealth is working with states and territories through COAG on other strategies to address broader alcohol abuse, including looking at responsible service of alcohol, secondary supply of alcohol to minors and closing hours. COAG is expected to consider further developments in 2009.