The state Labor MP Paul Gibson tells a bleak anecdote about the sorely needed nuclear medicine centre he ”opened” some years ago at Blacktown Hospital in the heart of his electorate. Last Christmas he returned to the hospital and asked to inspect the centre, only to find it empty – the promised equipment was never installed.It is one example of the struggle Blacktown Hospital has faced to meet the needs of a rapidly growing and often disadvantaged patient population. Even when the old hospital (which did have a nuclear medicine centre) was rebuilt 10 years ago, a plan for more beds was axed because of budget cuts.Gibson says Blacktown’s safe Labor status means its hospital has a funds drought, while swing electorates such as Penrith have been lavished with a hospital expansion.This is despite the relatively sickly status of his community, whose high levels of cardiovascular disease are combined with the highest rate of smoking- and alcohol-related admissions in NSW.This is where chronic disease, frail aged, mental illness and alienation among young people, and the troubles of young mothers with sickly children, pose problems that often stretch the conventional healthcare that is available.Their plight also highlights the inequities of Australia’s health system, in which so often the carers, whether they are nurses, doctors, physiotherapists, psychologists or podiatrists, are scarce where they are needed most.Out of this challenging landscape has emerged the beginnings of ”wrap-around” community healthcare, which has drawn together local doctors, nurses, other health professionals and school counsellors to apply something more than a temporary solution to deep-seated health and social dilemmas.At Blacktown’s neighbouring HealthOne centre at Mount Druitt, state-funded nurses and other health and community workers have joined with federally funded GPs to take a team approach to care.The blight on the country’s primary healthcare is that it is ”disgracefully fragmented”, says a local wrap-around pioneer, Associate Professor Michael Fasher.Connected care is possible and it is happening in ”one of our country’s most socio-economically deprived communities”, he says. He cites Lisa, 24, single mother of Toby, 3, and Jade, 4 weeks (not their real names).The family, recently relocated from the country, have fled a background of domestic violence and child abuse. Lisa is concerned because a recent check has found a delay in Toby’s development and language skills. Lisa herself is exhausted as Jade is an unsettled baby with feeding problems.At the home visit provided to all newborn babies in NSW, the child and family health nurse identified multiple problems. With Lisa’s consent the nurse discussed the issues with the Mount Druitt HealthOne liaison nurse who plays a pivotal role in bringing together the care required.Toby was referred to the child and family team at the state-financed community health centre, and the family GP attends for the initial visit and receives a Medicare payment for taking part in a case conference. Toby is prescribed occupational therapy and language stimulation from a speech therapist.A GP liaison nurse organised breastfeeding support for Lisa, while the family health nurse also kept in touch.As Lisa was found to be at risk of post-natal depression, the liaison nurse met the GP and they organised counselling with a psychologist under a federally funded psychological services scheme. Lisa was introduced to a play group and to a kindergarten. ”Lisa is now less isolated and feels well-supported by her community,” Fasher says. ”The outcome could have been very different.” It all sounds simple and sensible, even with the organisational challenges that Australia’s traditional healthcare demarcations throw up. It is an approach that its advocates hope will be nourished by the Rudd government’s health reforms, which include ultimately a takeover of all community health funding.The aim is to end the divide between federally funded doctors and state financed community health and social services.Organisation is the key, and the pivotal player is the liaison nurse, says one supporter of HealthOne, Tracey MacFadyen, of Dean Park. One of her sons, Kyle, 5, suffers a challenging combination of conditions – attention deficit hyperactivity disorder and oppositional defiant disorder – which had left MacFadyen at her wit’s end. ”I didn’t know what to do. He was like a wind-up toy. Once he was wound up it was very hard to get him down again.”The condition had also meant Kyle had speech and gross motor development problems impeding his writing. Four months ago MacFadyen attended a HealthOne case conference with her husband, John, that was organised by the liaison nurse at the Mount Druitt centre. The conference involved not only her GP, and the liaison nurse, but also an occupational therapist, and the principal and counsellor from Kyle’s school.As a result, Kyle now has fortnightly sessions of occupational therapy and speech therapy, with both the doctor and a paediatrician kept in the loop, thanks largely to the liaison nurse. All of this is at no out-of-pocket cost to the MacFadyens – a compelling benefit for a family with three young children.This month the federal Health Minister, Nicola Roxon, met doctors and hospital and community health executives at Blacktown Hospital. She listened to their pleas for more funding and for the locally organised arrangements to be supported under the proposed Medicare Local arrangements.Fasher says he was encouraged by Roxon’s response and her support for collaboration between community health services and GPs. The Mount Druitt scheme has been made possible by the combination of committed GPs and innovative community health executives at Sydney West Area Health Service, he says.The pay-off has been not only increased satisfaction among patients and their carers but also significant decreases in costly hospital re-admissions and longer in-patient stays. But Roxon has been given a hint of the trials ahead in applying reforms that will challenge the predominance of hospitals and Medicare-financed doctors who have little financial incentive to practise wrap-around care.The changes are now unlikely to be legislated before the federal election if it is held later this year, and it now appears unlikely Western Australia will agree, because of its refusal to release 33 per cent of its GST revenue. A Senate inquiry, which this week uncovered the fact that the Commonwealth and states have agreed to dump a national authority proposed to oversee the distribution of health funding, is expected to find more flaws in the reform plan.Some GP and nursing groups have criticised the Medical Local proposals for failing to offer more to encourage integrated care that develops the Medicare model. This would involve not only more routine use of nurses and allied health practitioners but also more involvement with education, housing and other life influences.Even the Australian Medical Association, which has been largely supportive, has raised concerns that the proposed funding structure will not end the blame game, a central point of the government’s promise to revamp health.While the plan would expand the federal government’s role in primary healthcare, it does not make it the sole funder. Details about which level of government will be responsible for many parts of primary healthcare are still to be considered, says the AMA president, Dr Andrew Pesce.HealthOne advocates hope that once the smoke clears, Kevin Rudd’s oft repeated promise for health services to be run locally will finally be met. A veteran crusader in Western Sydney for integrated community healthcare, Dr Di O’Halloran, says its advocates have been hanging out for decades for a system that supports ”wrap-around” care. The World Health Organisation and health reformers all say the same thing, she says: ”’The only way you can do that is at the local level.”’
Nanjing Night Net