Rob Brooks: Welcome to ‘Progress? Where Are We Heading?’ A miniseries from the UNSW Centre for Ideas, where we'll explore the ideas shaping our future. Today we're talking about something that affects us all, healthcare. As Australia's population grows and ages, we're faced with some big questions. What will healthcare look like in the next decade or the decade after that? How do we make sure it's equitable, affordable and ready for the challenges ahead? Today we're joined by Professor Michael Kidd, who's been at the forefront of healthcare reform and is here to help us understand where we're heading. Michael, thank you so much for joining us. 

Michael Kidd: Thanks for the opportunity, Rob. 

Rob Brooks: Michael, to begin with, can you just tell us a little bit about your role, because it is a really unique role, and the International Centre for Future Health Systems. 

Michael Kidd: Yes, so we established the centre just over the last year and the centre has been set up to bring together researchers from across the university with an interest and a commitment to looking at how our health systems evolve and develop over time. Basically, we're looking at 10 years or more from now on where we would like our health systems to be, both at a local level, a state level, a national level and indeed around the world. And looking at what are the areas that we need to be focusing on now to achieve the sorts of changes that we'd like to see happen.  

Among the big areas of focus for our centre, not only looking at how new technologies and digital innovations are going to change how we deliver and receive our healthcare services, but also looking at how do we ensure that our health services become more equitable, available to everybody in our community. Looking at different ways of delivering healthcare, not only through our hospitals, but also looking at expanding the way we deliver healthcare out in the community and looking at better ways of linking together different health services so that people receive a more seamless care journey for their healthcare. And also looking at the future healthcare workforce, who are the people who we need to be training to better meet future population needs.  

Finally, we're looking at a number of external factors which are going to have a big impact on our health systems over the next decade or so. That includes our growing population in Australia with increasing migration, the increasing number of older people in our community, recognising that as we get older, we're more likely to need to access healthcare services at a more frequent nature. Looking at the impact of climate change, as our climate does indeed change with increased risk of heat stress, increased environmental emergencies, and the possibility of future climate migration occurring to Australia.  

And finally, and very importantly, looking at what happened during the COVID-19 pandemic and making sure that our healthcare systems are even better equipped for the future challenges of the next epidemic or pandemic. But also, that we learn the lessons that we learned during the COVID-19 pandemic about how we design our health systems, how we deliver healthcare safely, and look at the inequities that we saw arise during COVID-19 and how we might prevent those in the future as well. 

Rob Brooks: Wow. That's an enormous number of moving parts. I'm glad it's you and not me in charge because, well, firstly, you're the expert. But so, I recently had one of those encounters one has with the health system, and I must say I was astounded at just the quality across the board of the interactions that I had and the experience that I had. But I think it's obviously a matter of perspective. I know a lot of people have to go to hospital or have something, their interactions in something like COVID-19 leave them quite unhappy. And you can hear if you tune into it, a great deal of sort of a fairly bleak view of the Australian healthcare system. Where do we stack up in relation to the rest of the world? 

Michael Kidd: Yes. So, Rob, your experience is not unusual. We do have excellent healthcare services available in Australia. We have very well-trained and experienced and well-equipped healthcare professionals delivering healthcare to the people of our nation. But, as you also point out, there is always room for improvement. And as I mentioned earlier, there are inequities in the access that some people have to our healthcare services and indeed inequities in the outcomes of what happens when different people encounter health services. And of course, for people living in rural and remote areas in Australia, this is nothing new. This is where we do see inequities. But also, it affects different population groups as well, even in our cities.  

However, having said that, there was a recent report released by the Commonwealth Fund in New York, which compared the performance of healthcare systems in the 10 wealthiest countries in the world. And Australia came first out of the 10 wealthiest countries in the world. We won the gold medal, if you like, for our healthcare system. And in particular, looking at areas like the quality of services, the training of our health professional workforce, and how well we do in delivering quality healthcare to everybody in our nation. But the report also, of course, highlighted that there are areas where we do still need to focus on and where we need to provide further improvements. 

Rob Brooks: Aussies do love to top the medal table, especially if the US and the UK are on that table as well. 

Michael Kidd: As they were.  

Laughter 

Rob Brooks: Yeah. So COVID-19, probably the number one encounter people have had with the healthcare system as a system and their chance to view only a tiny number of the moving parts there. But, and that's true across the world. We had a slightly different trajectory than most other countries, the ones that we were watching at least. What in particular did we in Australia get right? What do you think we got wrong? What are the lessons that we've learned to carry forward for future planning? 

Michael Kidd: Yes, so as some of you listeners may know, I was the Deputy Chief Medical Officer of Australia during the first four years of the COVID-19 pandemic. So, I have a very particular viewpoint on what happened during the pandemic and my own opinions about what we did well and what needs to be addressed for next time. The areas that we did well, I think, were the rapid decision-making, which was made in order to not only protect the health and well-being of the people of Australia, but also to protect our health systems.  

You may remember early on, as COVID-19 started to spread around the world, we saw health systems becoming overwhelmed with the number of people who very rapidly became gravely unwell and needed hospitalisation and hospitals in the north of Italy and elsewhere, needing to ration health services and make life or death decisions about who got admitted to hospital and who didn't. We were able to prevent that from happening in Australia by the measures to close our borders and the quarantine of people coming back into the country and to keep those measures up until the vaccines became available and then until we had high levels of vaccine protection of our community and then Australia progressively opened up again to the rest of the world. 

But we also saw our health systems pivot very rapidly. We saw the rapid introduction of telehealth to allow health services to continue when the nation went into periods of lockdown. We saw the rapid establishment of general practice respiratory clinics, clinics where people could go away from those who are receiving normal care from their GPs, a place where people could go and be assessed if they had respiratory symptoms and then tested and treated as appropriate. We saw a very rapid change in the delivery of care to allow us to vaccinate the population very quickly and most of the vaccines in Australia were delivered through general practices. The second group delivering the most vaccines were community pharmacies. So, again, it reinforced the importance of the very strong system of community-based healthcare services we have in Australia and the contributions they play and how they're an integral part of any public health response. And then when the oral antiviral treatments became available, particularly to support older people who were diagnosed with COVID-19, again, we saw those rolled out very quickly, approved very quickly by our regulatory mechanisms so that they were available to people across Australia and rolled out through general practice prescribing and community pharmacy dispensing. 

So, lots of things that we saw that worked well. We did, however, as I mentioned earlier, uncover with COVID-19 a lot of the inequities in our health system. We saw the impact of COVID-19 being particularly profound on older Australians, particularly those living in residential aged care facilities where many of the deaths from COVID-19 occurred, particularly during the early phases of the pandemic. We saw a lot of inequity affecting families living in lower socioeconomic areas of our big cities, for example, in the southwest and west of Sydney, the north and northwest of Melbourne, and disproportionately affected by public health measures, but also by the impact of COVID-19. So, a lot of areas that we need to continue to focus on improving. We also saw how rapidly digital innovation can be adopted in our healthcare system with not only the very rapid uptake of telehealth, but digital prescriptions and home monitoring and the ability for our states and territories to share with the Commonwealth real-time data about what was happening with the pandemic to allow for planning and responses right across the country. 

So, there's been a lot of reforms which have taken place during the pandemic. There's now a government inquiry underway, and I expect we'll come out with some very strong and firm recommendations on things that we need to do in the future. And indeed, a lot of the health system is already picking up the lessons from COVID-19 and applying them into their ongoing reforms. 

Rob Brooks: So, with all of those sort of mechanistic insights that you've given us, and it is really remarkable to see all of those parts and you having a handle on all of those parts, when there's something like a pandemic that affects people, and obviously there's fear, etc, there's this whole other side besides the institutional kind of responses, there's this sort of public discourse issue. We've seen COVID obviously being an incredibly polarising issue. We look back at SARS and sort of the panic around that. HIV, AIDS, obviously an enormous amount of public discourse that we kind of look back on in shame, I guess. And now with Mpox sort of somewhere out there, there's just a great deal of nonsense and misinformation and disinformation. How do we get past that? How do we let the professionals get on with doing their job and get on with living safely? 

Michael Kidd: Well, one of the lessons from past epidemics and pandemics, which we saw applied during COVID-19, is the need of the public and the health professions to have clear, consistent information, especially from governments, about what is happening, what the responses are, and what people should be doing. And I think we saw that play out very well in Australia. The Australian government and the state and territory governments had a very strong commitment to getting messages out, often on a daily basis, to the public about what was happening and what people should be doing to protect themselves, protect their loved ones, and protect the wider community. And we had websites like the Australian Government Department of Health and Aged Care website, health.gov.au, being put forward as the single source of truth that people could go to and get information. However, as you rightly point out, there are also lots of sources of misinformation, and these were nothing new. They existed out there long before the COVID-19 pandemic. 

But of course, people use these and sometimes for quite malicious and negative purposes to seed concern and distress in the community. Sometimes it's people who are well-meaning, wanting to share messages, but which can sometimes create confusion in the minds of those who read it. And some of it was quite malicious information. And so there is this need to counter this misinformation. A lot of that, of course, occurred through social media. And as social media continues to have an increasing impact on many of our lives, this came to the fore during the COVID-19 pandemic. So, there's how do you counter that information? It was very much part of the government responses was to ensure that we had clear and consistent communication with the public and with our health workforce about what was happening though. 

Rob Brooks: Right. This is all expensive. Infrastructure is expensive, technology is expensive, people are expensive. And there's a great deal of all three of those in the health system. And you've said that throwing more money at hospitals isn't the answer. Can you explain why that is and what we should be doing instead? 

Michael Kidd: Yes. So, you're right, Rob. Healthcare is expensive. And especially in a country like Australia, where we pride ourselves on having healthcare available to everybody through our free public hospitals, through our subsidised visits to general practitioners and medical specialists, through our subsidised medications available from our pharmacies. There is a big burden on taxpayers, but also there are costs which are incurred by individuals contributing to their own healthcare as well.  

And then, of course, we have private healthcare system for those with private insurance that exists in parallel with our public system. At the same time, the public has very high expectations about the quality of care, which they'll receive when they encounter our healthcare systems, or they bring a member of their family to our healthcare systems. What we can't afford to do is continue to spend more and more and more of our national GDP on health. We have to look at ways of using the funding that we have available in the most cost-efficient ways possible. 

And one of the ways that many countries around the world are looking to do this is looking at how expensive healthcare delivered through hospitals is compared to healthcare delivered out in the community. And looking at other services we deliver through our hospitals, which would be both more cost efficient, but also more equitably available if we delivered them out in the wider community. Looking at procedures where people may not need to be admitted to hospital, but which could be carried out as day patients, looking at if people can be discharged home early from hospital with support at home, using both a combination of telehealth support and also visiting nurses and other health professionals, providing hospital in the home services, if you like. And then looking at services which maybe are better delivered out in the community in conjunction with general practice and community nursing and allied health services as well. So, are there specialty services that we might deliver out in the community? 

And so, by doing so, can we save on some of the rebuilds of hospitals which takes place over time and invest some of that money into building even better comprehensive community-based health services out where the population is based? 

Rob Brooks: This model is based on best practice around the world and the up-and-coming bronze medal winners on that medal table or is it something that is entirely Australian as a solution? 

Michael Kidd: Yes. So no, we're seeing this happen in many countries around the world. One of the countries that we look at for some guidance is Denmark, which made a decision now nearly 20 years ago to look at what services could be best delivered out in the community and keeping the hospitals just for those services where people did need to be admitted to the hospital for high level care. For example, for intensive care, for coronary care, for major surgery and so forth. And so, in Denmark over the last 20 years, they’ve moved a lot of services and healthcare personnel out into the community, integrating these services with local general practices and also looking at greater integration between general practice care and aged care and disability care and mental healthcare. And over the 20 years, the number of hospitals in Denmark has fallen by two thirds, because now the hospitals are just the place that people go to when they need that very intense inpatient care and support and recognising that a lot of services which were previously delivered in the hospitals can be delivered more cost efficiently out in the community. 

And of course, by reducing the expenses of hospital infrastructure, because hospitals are very expensive to run and maintain, you actually end up freeing more money to then invest in delivering even better healthcare services and more equitable healthcare services to the population. So, it's actually resulted in more funds being available for direct patient care, than for some of the support that sat in the background to support the infrastructure of the hospital system. It doesn't mean that hospitals aren't important, doesn't mean that we're not gonna continue to need hospitals. It's just looking at rationalising the care that's provided in the hospital setting and the care that can be provided out in the community. 

Rob Brooks: I'm excited at the long-term thinking a lot of our guests on this podcast have, in fact, are railing against short-termism in their own areas of expertise. So, it's great that obviously this is something that has to be planned long-term, but to see something like Denmark's moves coming to fruition 20 years later is excellent. Looking 10 years down the road from where you are right now, what do you think the most exciting aspects of Australia's sort of healthcare future look like and what do we need to do now in order to get there? 

Michael Kidd: Well, there are so many exciting things in healthcare happening coming down the road. I kind of wish, Rob, that I was at the beginning of my career rather than moving more towards the other end of my career because there are so many things which are going to change the way we do. I'm very excited about the genomics revolution which is taking place and the ability of new technology, artificial intelligence and so forth, to deliver more understandings of each of our genetic makeup and how that impacts the decisions that we should be making with our healthcare providers about preventive health measures, about predicting what may happen with our healthcare needs in the future and being able to personalise the healthcare solutions which are offered to each of us both in preventing disease and in early detection and management of disease over our lifetimes. I'm incredibly excited about looking at new models of how we deliver healthcare, and we've talked a little bit about digital innovations like telehealth. I think this is going to really take off in the future. I'm excited about looking at how we better look at health across our whole system, looking at all government policies and how we assess what the health impacts of different government policies might be on our population and how we look at how we maximise the health and wellbeing of people.  

Because, of course, the more we can invest in preventive healthcare and health promotion and keeping people as well as possible for as long as possible, that's even better for our nation as well as being obviously in the interests of every individual. We all want to live healthy, long lives if we can. And also getting right back to addressing the issues we were talking about right at the start about how do we ensure equity in our healthcare services? So, make sure that we have in this country of the fair go, make sure everybody gets a fair go when it comes to accessing healthcare services and that nobody is missing out. 

Rob Brooks: Well, I certainly wish you every success, Michael. Thank you so much for sharing with our listeners your expertise and your thinking. It's clear that we've got a strong healthcare system, but that there's a tremendous amount left to do. So, I appreciate you coming on the podcast today. 

Michael Kidd: Thanks, Rob. 

Rob Brooks: For our listeners, healthcare is something that we all rely on, but it's also something we need to keep improving. The choices we make today and how we embrace change will shape how well we're able to care for each other in the years to come. Until next time, keep exploring and stay curious.