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THE imminent end of a national funding agreement for subacute care services will have negative flow-on effects for the rest of the health care system, according to the authors of an article published online today by the MJA. (1)
The authors said two National Partnerships Agreements (NPA) — the Hospital and Health Workforce Reform (HHWR) and the Improving Public Hospital Services (IPHS) — had provided public hospitals with unprecedented opportunities to develop new inpatient and ambulatory rehabilitation services and to expand existing services.
“Between them, these two agreements represented a turning point in the development of public sector rehabilitation services across the country”, they wrote.
However, with the HHWR NPA due to end on 30 June 2008, “many of these new and expanded rehabilitation programs will cease”, they said. The IPHS NPA is due to expire in June 2014.
Victorian Minister for Health David Davis has called on the federal government to make ongoing provisions in this week’s federal Budget for subacute care funding beyond the life of the current agreement.
Victoria is facing a shortfall of more than $570 million in federal funding, a spokesperson for Mr Davis told MJA InSight.
The spokesperson said the federal government had so far refused to seriously engage with the states on the future of expiring NPAs and tied grants.
The MJA authors said the HHWR NPA has not been reviewed at a national level, and the loss of funding would mean closure of rehabilitation services, loss of jobs and increased pressure on acute care services.
“The sudden closure of rehabilitation and other subacute services will have flow-on effects to the acute care system, as it will increasingly have to manage patients who would otherwise have been referred to rehabilitation”, the authors wrote.
“The net effect is likely to be that the length of stay in acute care will increase, along with bed occupancy and waiting times.
“No provision was made for funding to continue beyond the term of the NPA, or for a formal evaluation of outcomes at its conclusion. Consequently, the effectiveness of the developed services cannot be fully assessed because they have not been subjected to rigorous evaluation.”
The authors said that of the total $3042 million in funding negotiated under the 5-year HHWR NPA, almost $1400 million was provided by the federal government to the states and territories, including $500 million for subacute services.
They said the NPAs had provided public hospitals with “unprecedented opportunities to develop new inpatient and ambulatory rehabilitation services and to expand existing services”, particularly in aged care.
Lead author Associate Professor Chris Poulos, chair of Positive Ageing and Care at the University of NSW School of Public Health and Community Medicine, told MJA InSight that there were many positives in the NPA model.
“This really was the first time since [the early 1970s] that there had been such a big injection of funds”, Professor Poulos said. “It was a good initiative which started really well but it seems that no one planned the end evaluation.
“Why haven’t the state and federal departments been working together to plan for what happens after the NPA?
“Politics is getting in the way”, he said. “There is no political incentive for the state and federal governments to come together over this.”
NSW Minister for Health Jillian Skinner said her department was working with Federal Health Minister Tanya Plibersek’s office to “finalise funding options”.
She said NSW would continue to work with the federal government “to identify how these important services can be supported.”
Ms Plibersek’s office was contacted for comment, but had not responded by publication.
Palliative care services are similarly under threat.
Even though most states only allocated a small percentage of this subacute funding to palliative care, vital services have been established and staff employed. These staff do not have contracts beyond June 30, for many their only option is to start looking outside the sector for employment.
One area deeply affected is the SA Paediatric Palliative Care Service. This service is threatened with losing all medical funding, 20% of its nursing funding, all psychosocial funding and 70% of its administrative support. It can be difficult to provide support for children to die at home with their family, yet this service is helping 70% of their young patients to die at home (50% if neonatal figures are also included).
In total more than 30 FTE positions are threatened in South Australia and 54 FTE in NSW.
This is against a background of a 25% increase in referrals to some services.
It is a great pity that a blame argument has ensued instead of simply fixing the problem. Re-allocating some of the funding for the coming financial year to adequately fund palliative care would be a positive move towards a solution.
Next week is National Palliative Care Week. Providing the best possible quality of life until the end for all Australians should be integral to our health system. Palliative care really is everyone’s business.
Let’s make it a National Palliative Care Week to celebrate by protecting and supporting these essential services and the staff that deliver them.