This article was first published in the VicDoc Winter 2021 edition, written by Dr Ines Rio (Chair of our Board).
Although Australia’s response to the coronavirus pandemic has not always been perfect, we still have much of which to be proud.
The human and economic cost has been high, but not nearly as high as it could have been. And it has shown us time and again what we are capable of; from the millions who endured the many effects of lockdown to the tireless efforts of healthcare workers; there are many success stories from 2020.
However, there is no doubt we will be left with ongoing health and economic burdens that need acknowledgement and addressing.
We have seen cancer diagnosis fall, fewer presentations to general practice for cardiovascular events, preventative health screening and chronic disease management, and more presentations for distress and mental health concerns. All of these can be expected to have flow on effects in the next few years.
Cancer stage progression, more end organ effects from vascular diseases and diabetes, and the impact of poor mental health on the wellbeing of individuals, families, and communities.
It is incumbent on government and services to consider the changes we need in our healthcare system to best address such challenges. And we need to make and embed those enhancements now.
As a GP, I often tell registrars that clinically I almost always know what to do or can readily find out what to do.
It’s getting it done that is the hardest part. Which service will accept this patient? How long will they wait for an outpatient appointment? What happened at the hospital? Who can help me help the patient to increase their physical activity, get involved in social activities or get stable and safe housing? So, what do we need to progress on?
I think the following are crucial areas of system development that would make the care people receive improve overnight:
REFERRAL TO TREATMENT TIMES
The AMA has long argued for referral to treatment times for public specialist outpatient services.
This is well established in the United Kingdom (see my article from 2019).
Yet, I still have no idea when I refer patients to hospital how long they will wait for an outpatient appointment. And as any GP who needs to use public outpatients for their patients knows, this can be many, many months and even years.
As we are likely to see increased demand on specialist outpatient services in the next few years, my patient and I need to know this so we can choose and modify management as needed.
The Victorian Government should require this of all outpatient services in all public hospitals.
CENTRAL REFERRAL POINT FOR SPECIALIST OUTPATIENTS
It is becoming increasingly complex to know which health service does what and which ‘catchment’ of patients they will accept.
Who does gastric banding? Who will do a breast reduction for pain? Who offers an allergy service? Who has a short wait time; who has a long one? What maternity service will accept a woman with a multiple pregnancy?
Hospitals in a region should link up and develop a central point for electronic referrals (yes, electronic please).
This way referrals can be better managed according to the services and the wait times. It’s been done in Western Australia for over a decade.
CONTINUUM OF CARE AND CENTRAL REFERRAL POINT FOR MENTAL HEALTH
The cost of mental illness in Australia is $600 million a day, and only likely to grow with the ongoing fallout from the pandemic and recent drought and bushfires. I
have argued previously that the problem in many areas is not so much the lack of services, but rather the difficulty for patients, families, and GPs and other care providers in finding a way through the maze of different providers and a lack of coordination between services.
From where I sit, a successful system development has been the HeadtoHelp service in Victoria. Announced by the Federal Government last August as a measure to support Victorians struggling through a protracted lockdown, it is run by Victoria’s six Primary Health Networks.
It consists of a state-wide single point intake service where patients, families or GPs and other health professionals can refer all but the most acutely unwell person.
The central intake service is staffed by experienced mental health professionals who (along with a referring GP if a GP has referred) make an initial assessment and determine the level of care required and then connect that person to the service.
At lower level acuity it may be mental health coaching, cognitive behavioural or talking therapy and mindfulness apps and social connection, at low-to medium it may be referral to a psychologist or social worker for more structured psychological therapies.
At medium acuity, it may be referral to more targeted supports including dedicated HeadtoHelp mental health hubs that have multidisciplinary teams that include mental health nurses, psychologists, social workers, alcohol, and other drug workers and at higher acuity, it’s commonly referral to the regional hospital run mental health services.
This should be expanded, with HeadtoHelp also having access to psychiatrists and drug and alcohol medical specialists.
This could then provide a ‘single door’ for most people into the vast majority of mental health services resulting in streamlined access and a greater continuum of care that meets the person’s needs.
It should also be extended (both the central intake model and the hubs), so that it is a permanent part of the system and continues to evolve in response to feedback from patients, families, GPs, and performance indicators.
With the State Government considering its actions in response to Victoria’s mental health Royal Commission, the time for this is ripe.
The COVID-19 pandemic is a key moment for Australian health, and provides an opportunity we must take. If the past year has taught us anything, it is that when pressed, we can adapt our systems rapidly and effectively to meet a crisis.
Just as Victoria has evolved in leaps and bounds on systems for contact tracing in COVID-19 when it was apparent there were many failures, it is time to recognise failure in these other areas and make these measured changes which will have major positive impacts.