Ben Harris-Roxas, Research Fellow, Centre for Health Equity Training, Research and Evaluation, writes:

“At the end of the Prime Minister’s Press Club speech I was left wondering ‘what do they hope to achieve?’ It wasn’t at all clear from what was announced.

As always with policy, a lot of the critical detail will lie in the implementation.  If the Commonwealth are taking over all aspects of primary health, broadly defined, there will be a lot of change in store.  Many community health services, like community mental health teams or child and family teams, are currently provided by state governments through Area Health Services.  Will these now be contracted out, with competition between existing providers and new players?  Or would it be through a fee-for-service model?  I’m still not clear.

Also unclear was how the 60/40 split is going to work.  It may make this more, rather than less complicated. And what’s the role of these hospital networks and how will they be distinct from Area or District Health Services? Clearly the PM sees clinicians as playing a critical role in the governance of these networks.  What role will community representatives and people with a broader system perspective play in their administration? If we don’t address that we risk creating more inefficiencies rather than reducing them. Clinicians are extremely skilled at what they’re trained to do, but that usually isn’t administration.

Disappointingly there was little on health inequalities in the announcement, though we’re promised further announcements on mental health and other issues.  I can almost imagine the PM would have said “Health inequities? What? Never heard of them. That’s just jargon!” if questioned on it, given his dismissiveness of Karen Middleton’s use of the word “discourse” in a question.

A cynical interpretation is that this round of health reform sets up a point of differentiation between the Government and both the Opposition and the states for an election year, rather than addressing the bigger issue of how we keep people healthy. Unfortunately cynical interpretations are often right.

The Prime Minister made a good point in relation to the final question at the Press Club.  He suggested that it’s hard for governments to invest in prevention because the benefits won’t be seen for 10 years or more.  Real reform would put this, rather than hospitals, front and centre.

Finally, there was decidedly too much levity at the National Press Club announement, with jokes and back-and forth between the PM and journos.  At the risk of sounding like the old man telling the kids to get off his lawn, this issue is not a political fun-park ride.  There’s a very real risk that if these changes aren’t implemented sensibly we could end up with a worse health system at the end of it.

The policy is now up at

I’ve only skimmed through it. Read it – I’d be interested in your collective analysis.”