Thinking global while acting local

This paper is a personal view and demonstrates my opinions and observations.

From a global perspective the Australia health system is considered to be high quality, accessible and innovative delivering good patient outcomes. While there is much to be positive about a closer look reveals we have much more to do as we strive to span the boundaries created by differing policy, funding and delivery mechanisms across Federal and State systems. Our everyday context is shaped by a system of care that has its fair share of fragmented service delivery, incompatible information systems, a lack of coordination and a funding mechanism that frustrates integration. If we consider a health system under increasing financial pressure driven by growing demand where the proposed solution remains a largely hospital centric response, we have a problem and traditionally we look to Government to create a policy solution.

IFIC Australia’s own Professor David Perkins February 2019 commentary ‘Reflections on the Australian Productivity Commission Report 2017: “Shifting The Dial” proposes the report is not the burning platform required to encourage health policy reforms that promote and support integrated care as an alternative approach and key to a sustainable solution. He is not alone in his disappointment, when one considers that an integrated system of patient centred health care has been a policy objective in all Australian jurisdictions at least since a Council of Australian Governments (COAG) agreement in 1995.

As a system we don’t appear to have made much headway in almost twenty five years. Perhaps our expectations of what it takes to effect the necessary change and to truly integrate across a Federated system are too high. Perhaps we need to approach the problem from a different angle. Perhaps we need a dual strategy that continues to promote and advocate for system reform while we invest in working at a local level to deliver improved outcomes, develop the evidence base, build networks/communities of practice that have currency in a networked environment.

We know that there is no single model of integrated care that will be the panacea, we also know that a commissioning mindset and approach, which links resource allocation with assessed need is where collaboration and partnerships develop that can drive necessary reform and improved integration. Such reform can have a significant influence in developing enabling strategies that bring disparate parts of the health system together and with them other agencies to create a context where we can formulate, test, evaluate and invest in models of integrated care that are nuanced to reflect the particular needs of communities. Integrated care in such a context has a good prospect of becoming the norm rather than the exception and establishes itself as the default position from which to deliver improved outcomes. Are we doing enough to support and highlight this success?

Throughout our States and Territories we have excellent examples of successful approaches and initiatives that integrate care, our challenge as I see it, is how to connect these up and translate them into a suite of options that become a reference point for our political leaders, policy makers, funders, commissioners and health professionals. In this regard IFIC Australia’s perspective and expertise as a critical friend, advisor and network of informed peers provides us with a fantastic resource to help support and drive local initiatives. I encourage you to log into the IFIC Australia website there you will find a host of references resources and opinion that can assist you in ‘thinking global while acting local’.

The upcoming 2nd Asia Pacific Conference on Integrated Care will take place in Melbourne, Australia, from 11-13 November 2019. The overarching conference theme is ‘Achieving better value for people and populations’. There is a packed program including global and local experts who will share their experiences and knowledge. What a fantastic environment in which to make important connections and to test your thinking.

I look forward to seeing you there.


Frank Tracey
Health Service Chief Executive
Children’s Health Queensland Hospital and Health Service