Dr Christopher McGowan, CEO of our client The Silver Chain Group, speaks about the importance of quality health care at the end of life.
It is well recognised that Australians enjoy one of the best health care systems in the world. This fact is regularly reinforced by external independent surveys placing us on the top two or three countries in the world. However, when it comes to treating the elderly as they approach the end of life, we often fall short of delivering what people need and deserve.
This is primarily because we are reliant on a health care funding and delivery framework that remains largely focused around short episodic treatments for particular illnesses or events – going to the doctor with a sore throat or ’flu shot'.
Our existing health care system was designed to respond to an early 20th century community profile, where trauma and infectious diseases were the principal causes of death. Today 90 per cent of deaths have at least one chronic disease as an underlying cause.
While our approach to health service provision and delivery has served Australians well in the past, it is not ‘fit-for purpose’ for our ageing population who are living longer but often with multiple chronic diseases and increasing frailty.
Further, we are placing increasing pressure on already stretched State and Federal budgets as health issues associated with ageing increasingly requires management approaches that cannot be effectively nor efficiently delivered under the current episodic-based system.
The Commonwealth Government recognises change is needed, as seen in its Health Care Homes initiative, which presents a practical shift from the incentive and reward system for GPs to one that considers a patient’s needs over a continuous period.
The Federal Labor Opposition is on the same page, taking an end-of-life package to the 2016 Federal Election.
However, improved patient outcomes will be more appropriately generated by better designing how a person’s interaction between various healthcare providers and systems is managed.
As with patients with multiple chronic conditions, aging Australians consistently refer to the distressing experience of being passed between healthcare services and providers.
Australia, has historically relied on GPs to deliver integrated care from within their current general practice business model, which is optimised around a fee-for-service, 10-minute consultation system.
It is clear, when GPs endeavor to deliver more integrated care, their ability to coordinate clinical and aged care providers who are not captured within their GP practice (for example, medical specialists, aged care, disability care) is limited, time-consuming and often frustrating to practitioners and patients alike. What is needed is a payment mechanism that allows GPs to become a central part of an organisation that integrates multiple clinical and aged care providers around a group of patients. While such a mechanism would assist patients within their last years of life, it would also be relevant to other specific high-risk groups.
Silver Chain believes organisations should be developed to meet the specific needs of patient groups that require complex integrated care rather than simply to expect the local General Practice to address the varied and increasingly complex integration challenges required to respond appropriately to the current reality of health and aged care needs in Australia.
Our organisation - a national not-for-profit based in Western Australia for over 110 years and in South Australia more over 120 years as RDNS, exists to deliver World’s best health and the aged care so people can remain at home – is not alone in highlighting shortcomings in healthcare delivered to older Australians.
The Grattan Institute has said that “despite the high level of funding to encourage good practice – to pay for planning, team care coordination, health assessments and care reviews in primary care – the quality of care and clinical outcomes for people with chronic disease remains poor or unknown due to the lack of data”.
The Productivity Commission has raised similar concerns.
In its draft June 2017 report - Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services – the Commission says:
“General practitioners and practice nurses could play a much larger role in helping people to articulate their preferences for end-of-life care through advance care planning. Changes to Medicare items numbers are needed to enable this to occur”.
Silver Chain has worked with the Western Australian Primary Care Alliance (WAPHA), and McKinsey and Co, to develop a world first Peri-End-of-Life (PEoL) model Integrum Aged Care+ aimed at optimising health and wellbeing for people in their last few years of life.
The evidence-based model of care, designed to meet Australia’s needs whilst taking account of international examples of best practice, provides a one-stop shop approach to health and aged care. The model integrates in-home aged care services with primary care (GP), specialist care, pharmacy, radiology and pathology and 24/7 nursing/medical support.
Key to the success of the model is a multidisciplinary team care approach. The GP-led team will work to optimise outcomes for a restricted panel of patients (approximately 400).
Importantly in this model, case managers who are in frequent contact and aged care workers who visit patients at home every day, extend the clinical influence of the GP into the home.
The service is intended to deliver a better lived experience for patients and their families and improved clinical and cost outcomes for the Australian health system.
Australia’s rapidly aging population makes it imperative that a more integrated approach to health care for older Australians is adopted. Not only will it make health care more efficient, reducing costs to tax payers, it will ensure our oldest citizens, who have contributed so much, are afforded a better quality of care and a greater sense of control at the end of life’s journey.
Silver Chain Group is a not-for-profit organisation delivering community health and aged care services in WA, SA, Victoria, NSW and Queensland.
The Shell Issue 10
1. Chairman Address, John Wells
2. A tale of two infernos, Benjamin Haslem
3. A negative agenda will not save Queensland, Robert Masters
4. What's the John Dory?, Alexandra Mayhew
5. Brussels sprouts ideas, Alexandra Mayhew
6. Parliamentary inquiries and your role in policy, Kathy Lindsay
7. Delivering better health care at journey's end, Chris McGowan
8. Cross-cultural brainstorming in Paris, Isabelle Walker
9. Federal Election: 2018?, Tim Mantiri
10. Someone old, someone new, brows are furrowed at Kiwis' blue, Daniel Paul