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Australia's health call network

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(7)2006
Author(s): 
Marion Haas
Health Policy Issues: 
Responsiveness
Reform formerly reported in: 
Health Call Centres
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes yes no no

Abstract

The national and State governments have agreed to establish a National Health Call Centre Network. It will be accessible 24 hours, 7 days a week for the provision of health advice and information. It will be a co-operative arrangement jointly funded by the national and state governments. Funding/Service Delivery Contract(s) will provide for the amount and timing of funding to be given by either each or all of the governments for the management and operation of the Network.

Recent developments

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Characteristics of this policy

Degree of Innovation traditional traditional innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low neutral very high
Transferability strongly system-dependent system-neutral system-neutral
current current   previous previous

This policy follows both international and local ideas and can be expected to produce the same sorts of outcomes. It is an agreed objective of both national and state governments and its implementation is in line with similar national-State agreements. It received some media attention in the days immediately following its announcement, but has not generated any ongoing comments nationally.

There are now many examples in the developed world of telephone triage systems so this is not a world-first innovation. Nevertheless, because it challenges the traditional way of providing services, it is relatively controversial amongst some medical practitioners. Amongst rural providers, both doctors and nurses, there is greater experience with non-traditional provision of services and the use of nurses in first-contact triage systems which means that the provision of infrastructure to support this will be welcomed.

Although it will have some impact on utilisation and cost of services, because these are at a GP level, they are not likely to be great. As yet, the overall public visibility of the proposal has been low, although it has received greater attention in those States where a system is already operating. It is transferable to any health system in the developed world.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes yes no no

Initiators of idea/main actors

  • Government: The national and State governments of Australia have reached an agreement.
  • Providers: some provider groups have expressed sceptism about the motives for the establishment of the Network whlist others have questioned its effectiveness.

Stakeholder positions

The National HCC Network will be a co-operative arrangement that is jointly funded and badged by the national and State governments. Funding/Service Delivery Contract(s) will be made between either each or all of the governments providing for the amount and timing of funding to be given by either each or all of the governments for the managements and operation of the National HCC Network.  

The medical profession has not been completely supportive of the idea and warned that if nurses have the responsibility to diagnose over the phone, unnecessary deaths might result. But the evaluation of current services indicate that it can supplement after hours services, provide support and reassurance to patients and result in increased visits to doctors, especially GPs. In Australia, nurses in remote areas have been providing this sort of advice and assistance over the phone for many years.

There has also been some concern in the State and Territories already operating telephone triage systems that the local knowledge and expertise that they have built up for their particular areas will be lost in the formation of the new national centre. But the national Minister for Health has reassured States and Territories that the national centres will have access to detailed up-to-date information about local services.

Actors and positions

Description of actors and their positions
Government
governments of Australiavery supportivevery supportive strongly opposed
Providers
Provider groups eg AMA and Doctors' Reform Societyvery supportiveopposed strongly opposed
current current   previous previous

Influences in policy making and legislation

A Heads of Agreement (i.e. a memorandum of understanding) has been signed between the governments regarding the foundation, governance and implementation of the National HCC Network. No legislative change is required.

Actors and influence

Description of actors and their influence

Government
governments of Australiavery strongvery strong none
Providers
Provider groups eg AMA and Doctors' Reform Societyvery strongstrong none
current current   previous previous
governments of AustraliaProvider groups eg AMA and Doctors' Reform Society

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

Establishment of the National Health Call Centre Network

At the most recent meeting of the heads of the national and State governments of Australia in 2006, it was agreed to establish a National Health Call Centre Network. The Network would operate in the same way as other "telephone triage systems" such as NHS direct.  Currently Western Australia, the Northern Territory and the Australian Capital Territory are operating health call centres and other States may commence operations of health call centres prior to the establishment of the National HCC Network.  It is intended that these centres will become part of the National HCC Network. Discussions have taken place among the governments and their officials in regard to the National HCC Network and how best to establish and operate that Network. The initial agreement between the governments (the Heads of Agreement) has been signed and it is proposed that the operational arrangements will commence in March 2006 so that the Network will be operational in 2007.  There is no opposition to the idea amongst the governments although some provider groups have expressed scepticism about the governments' motives and the effectiveness of telephone triage.

There is some concern in the States already operating telephone triage systems that their local knowledge and expertise will be ignored and that their residents will not receive as high a quality of service as they currently do, but the proposers of the idea have moved to allay these fears, stating that local services will be used within the new system.

Management of the network

The national and State governments will establish a public company to manage the National HCC Network which will be governed by the terms of its Constitution.  Before the Network is incorporated the governments will enter into a Shareholders' Agreement to set out in detail their respective rights and obligations relating to the Network. The Network will be responsible for procuring the operator/s contracted to provide the Core Services, Add-on Services and Emergency Services, for negotiating the resultant contract/s, and then for managing the service contract arrangements. 

The services provided by the Contracted Service Provider/s must be performed in Australia. Funding/Service Delivery Contract(s) will be required between either each or all of the governments and the operators of the Network. The Contracted Service Provider/s and the operators of the Network must operate within an appropriate agreed accountability regime. There will need to be some negotiations about how to incorporate the current telephone triage systems into the National Network. Obstacles may be created by the State and territories that perceive that their political objectives are being harmed by the national Network 'taking over' a local system or if the cooperation of providers such as nurses and GPs cannot be obtained.

The assurance that local expertise and knowledge would still be available is intended to facilitate the negotiations around such issues.

The financial arrangements are designed such that all governments contribute to the cost of implementing and running the Network and that all communities benefit. Details of the arrangements are not available.

Monitoring and evaluation

At this time, no details about any plans for evaluation are available. However, all the local initiatives have been evaluated and have been regarded as a success. In a paper reviewing the implementation of four telephone triage systems (statewide call centre, regional call centre, deputising service and local triage and advice service), Dunt et al (2005) conclude that the impacts of telephone triage were generally smaller in Australia than reported elsewhere. The impact on utilisation was affected by whether a service was standalone or embedded as well as the goals of the agency providing the service and the local context.

Expected outcome

Based on the evaluations of local initiatives, the outcomes of the proposed network would be expected to be:

  • increased attendances at GPs and, in some areas, emergency departments
  • increased reassurance for patients
  • increased use of other local services such as mental health crisis teams, counselling services etc

The results of published evaluations indicate that a stand-alone service (such as that proposed for the HCC network) is likely to increase the use of services, particularly after hours GP and ED services where these are available. Thus it may increase equity of access in some areas and result in pressure to provide additional after-hours services in others, both of which will add to the cost of services. It is not clear if this will have any effect on quality of care.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable four system more equitable
Cost Efficiency very low neutral very high
current current   previous previous

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References

Sources of Information

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Reform formerly reported in

Health Call Centres
Process Stages: Idea

Author/s and/or contributors to this survey

Marion Haas

Suggested citation for this online article

Marion Haas. "Australia's health call network". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/au/a7/3