$7.7 billion in preventable hospitalisations: It's time to refresh Medicare
Leading nursing and midwifery organisations will gather at Parliament House today with a united call for the Federal Government to address the unprecedented strain on the healthcare system by acting on review recommendations to let nurses and midwives care for people using all their skills and knowledge.
Nearly one-third of primary health care nurses are not routinely working to the full extent of their expertise.
That represents an untapped resource that could be better used to address Australia's struggling primary health care system, with Australia recording higher rates of preventable hospitalisations than the Organisation for Economic Co-operation and Development (OECD) average.
Rates of preventable hospitalisations – a key indicator of primary care effectiveness – are worse than in comparable countries such as Canada and the United Kingdom, and come at a cost of about $7.7 billion a year. That's despite Australia spending more per person on healthcare than most of the OECD.
A significant proportion of those admissions are attributable to chronic conditions – including diabetes, heart failure and chronic respiratory disease – that nurses are educated to prevent and manage in the community. Evidence indicates that nurse-led models of care for chronic disease are associated with reduced hospitalisations and readmissions.
Australia has almost 410,000 employed registered nurses, nurse practitioners and midwives, and more than 40 per cent work outside hospitals – across a broader range of settings and communities than any other healthcare profession. There are five nurses for every medical professional in small rural towns. Yet current funding arrangements limit nurses' ability to deliver care to these communities using the full scope of their skills and expertise.
"Australians are rightly proud of Medicare, but the system is under extraordinary pressure, and we are failing to make the most of our most distributed clinical workforce," said ACN Chief Executive Officer Adjunct Professor Kathryn Zeitz FACN. "The Scope of Practice Review, and review after review of the primary healthcare system have already told governments how to fix this. We have the evidence – now we need the action."
Midwives: Underutilised across the system
In the maternity sector, evidence shows that privately practising midwives deliver the most positive birth experiences and the lowest rates of birth trauma, yet they represent just over 2% of maternity services. The current default, fragmented public hospital model of maternity care costs the health system 20% more than continuity of midwifery care in community-based group practice or birth centre settings. The evidence supporting continuity of midwifery care, from clinical outcomes to workforce sustainability, is well established. In three years, the number of endorsed midwives has doubled, yet this highly skilled workforce continues to face barriers to working to full scope and providing primary maternity care. In rural and remote areas, midwives are key to providing equitable and accessible maternity care to Australians.
"When poor health outcomes are preventable, the system has failed to act early enough. For women and babies, this means ensuring access to continuity of midwifery care provided by midwives working to their full scope. Continued underuse of this workforce is holding back better outcomes, and it must change. It's time for decisive investment and reform to make this model of care the standard," said Australian College of Midwives CEO, Mia Dhillon.
Nurses and midwives to gather at Parliament House today
At the Showcase of Contemporary Nursing and Midwifery, hosted by ACN's Parliamentary Friends of Nursing, nursing and midwifery organisations will show parliamentarians first-hand what nurses and midwives can deliver in the primary care sector – from nurse-led skin-cancer checks and wound closure to rural and remote-area advanced care, and maternity care for both mothers and babies – and demonstrate the case that Australia's largest and most widely distributed health workforce is being held back by an outdated funding model.
The organisations are calling on the Government to refresh the Medicare settings that keep nurse- and midwife-led care on the outside, by:
- implementing the recommendations of the 2024 Scope of Practice Review;
- directing the proposed Baseline Practice Payment to nurse-led primary care;
- allowing nurse-led clinics to register for MyMedicare and access bulk-billing incentives; and
- enabling Endorsed Midwives to access multi-disciplinary care funding, such as bundled funding, practice accreditation and primary health incentives.
"Nurse- and midwife-led models are safe, proven and already working in communities across the country," said Adjunct Professor Zeitz. "With the right funding settings, they can reach the Australians the current system leaves behind."
Quotes from nursing and midwifery leaders
"Nurse practitioners remain underutilised within the health system, with funding and system constraints limiting full-scope practice. Inadequate transition-to-practice pathways delay endorsement and restrict highly qualified advanced practice nurses from fully using their skills and expertise." – Australian College of Nurse Practitioners, CEO Geri Sumpter
"Nurses and midwives are at the frontline of healthcare and are uniquely placed to identify community needs and deliver innovative, person-centred solutions." – Annie Butler, Federal Secretary of the Australian Nursing and Midwifery Federation.
"Primary health care nurses are highly educated and experienced healthcare professionals, but the data shows that almost a third are not working to their full scope of practice. If we act on funding reform and other recommendations of the Scope of Practice review, we can do more to tackle chronic disease and reduce hospitalisations." – Australian Primary Health Care Nurses Association President, Denise Lyons
"Aboriginal and Torres Strait Islander nurses and midwives strengthen the community controlled and mainstream health sectors across the nation. Without Indigenous nurses and midwives working to scope, in culturally safe models of healthcare, we will fail to improve the health outcomes of Aboriginal and Torres Strait Islander communities." – Congress of Aboriginal and Torres Strait Islander Nurses and Midwives
"Well qualified nurses and midwives are key to the health of our communities. Universities play an essential role in delivering their education – including for advanced and expanded practice. It's vital that this continues." – Rachel Yates, Chief Executive Officer, Council of Deans of Nursing and Midwifery
"Remote area nurses and midwives are the foundation of health care in Australia's most isolated communities; they deliver care where distance and complexity demand extraordinary skill and commitment. Distance should never determine quality of care, and we must continue to invest in the nurses and midwives who make rural and remote health possible." – Emma Barritt, Chief Executive Officer, CRANAplus
Proudly sponsored by the Australian College of Nursing, and supported by the Australian College of Mental Health Nurses, the Australian College of Midwives, the Australian College of Nurse Practitioners, the Australian Nursing and Midwifery Federation, the Australian Primary Health Care Nurses Association, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, the Council of Deans of Nursing and Midwifery, and CRANAplus.
With thanks to the Parliamentary Friends of Nursing convenors Trish Cook MP, Member for Bullwinkel; Dr Helen Haines MP, Member for Indi; and Dr Anne Webster MP, Shadow Minister for Regional Health, Member for Mallee.
