Health was a major focus of the Budget, with the release of the first national Primary Health Care Strategy (though the government also called it a primary care strategy) and the government’s response to the National Preventative Health Taskforce’s final report.

In recent months, the government’s health reform announcements have been copping something of a hammering from policy experts at Croakey — apart from the applause for the tobacco initiatives.

Mental health and dental health were the clear losers last night. But will the other health announcements be a circuit breaker for the government?

Here is a wrap of some of the comments landing at Croakey:

Professor Simon Chapman, University of Sydney:

In 35 years in public health, I have never seen such a massive commitment to prevention … it is an historical announcement that will provide unprecedented momentum to three key areas in public health.

One concern is where the (national preventative health) agency will be located. If it is in Canberra, that will severely limit the number of serious people who will be prepared to join it. Have I missed this? Has its location been disclosed?

Professor Pat McGorry, psychiatrist and Australian of the Year:

Tonight’s Budget has deepened concern within the mental health sector that the government has not yet acted on the Prime Minister’s commitment to a ‘historic reshaping of mental health services’ made at the COAG health summit last month.

Government commitments to expanding access to mental health services for young people are positive in direction, but very limited in scale.  At a time of major new health investments, the government has yet to explain why it is pumping all its precious fuel into acute health while mental health is left to run on fumes.

Professor Ian Hickie, Brain and Mind Research Institute:

The Rudd government commonly contends that it acts on evidence not polls or simplistic interpretations of public perceptions. If that is the case, the narrow concentration of new expenditure on hospitals, elective surgery and GP surgeries is not explicable.

As we finally commence a period of substantial new health expenditure, many of Australia’s most vulnerable families — particularly those most affected by chronic illness, mental ill-health, alcohol and other drug use and dental problems must be asking themselves: ‘Why have we been actively excluded?

Is it something about us? Is it something about the problems we have? Haven’t we recognised that these problems occur in all our families, and not just those who need care today?’ — and perhaps most importantly, ‘Do we have any real champions in this first-term Rudd government’?

Professor Mark Harris, professor of general practice, University of NSW:

… it is clear that there have been some significant changes in thinking about primary health care. These are reflected broadly in the final primary health care strategy, which was released with the Budget and in two specific announcements:

  1. Although an additional 23 GP super clinics were funded (bringing the total to 58) there is recognition that these will, for the foreseeable future, provide only be a small part of the solution to providing more integrated care for chronic conditions.  425 grants were also allocated to ‘expand existing general practices and primary care, community health and indigenous medical services, to deliver GP Super Clinic style services’.    This recognises the need for a variety of models to scale up the approach used in integrated primary health care services such as GP super clinics to make high quality care more accessible to all patients.
  2. The extension of incentive grants for all practices, not only those in rural areas, to employ practice nurses.  This represents recognition that practice nurses have key role to play not only in addressing workforce need but also in enhancing quality of care.

A little more detail on primary health care organisations (‘Medicare Locals’) was also provided in the Budget papers — especially their role in providing or facilitating after-hours services. However, there are still many unanswered questions from the patchwork of announcements about primary health care organisations over the past few weeks.

Todd Harper, Vic Health:

For prevention, there is much more wore work to do on reforming the alcohol taxation system, sustained investment in advertising campaigns on alcohol use, overhauling regulation of alcohol and junk food marketing, and increasing investment in prevention over time but this budget makes some good (and welcome) initial steps in that long journey …

Professor Mike Daube, Public Health Association of Australia:

For the first time, we have a comprehensive approach to reducing our massive toll of preventable ill health and death, with substantial commitments in the Budget to funding for prevention.  Of course, there are other measures we would like to see accepted — such as alcohol tax reform, and legislated controls on alcohol and junk food promotion, but this is a very encouraging start, and we note that the government has not closed the door on some of the tough measures proposed in the Taskforce Report.

Prue Power, Australian Healthcare and Hospitals Association:

The AHHA welcomes COAG’s commitment to a universal and equitable health system, however this commitment is undermined by the failure of successive governments to ensure better access to dental care for all Australians. The result is that Australia is a country where the poor and disadvantaged can be identified by the state of their teeth. The biggest loser in tonight’s Budget is mental health, which continues to be short-changed in the current health reform process.

The short-term nature of the media news cycle encourages immediate, definitive statements about the rights and wrongs of Budget announcements. Apart from the obvious and legitimate concerns about the neglect of mental and dental health in particular, for my money it’s a tad premature to make a call on the impact of the primary health care announcements. There’s a lot of detail to be sorted, and questions to be answered yet.

Peter Fray

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