The expression ‘last chance saloon’ is used when a situation is considered to be the last opportunity for success, beyond which hope for good fortune will greatly diminish.

The next term of government is a last chance saloon for comprehensive health reform.

If reform does not happen now, it will become increasingly difficult to initiate the restructuring needed to keep Australia a world leader in health.

Although health is always at the forefront of electioneering, campaigns follow a very predictable template—a contest as to which party will promise to pour more money into the existing health system.

For decades now, we’ve seen turf wars between the Commonwealth and state and territory governments because Australia’s health system is so unnecessarily complex and bureaucratic.

Increasing expenditure will benefit patients only if it’s accompanied by other measures that make it easier and less costly to get the right diagnosis, treatment and continuity of care.

Political parties are nervous about offering policies that might be ‘radical’.

We hear a lot about dollars offered yet very little about how to reshape the ageing Medicare system and the fee-for-service model into innovative, adaptive, integrated care that puts the patient first.

The COVID-19 pandemic has shown us what reform at pace looks like.

We’ve seen how quickly barriers can be removed to make major health system transformations when needed.

Telehealth is an example of this.

We thought it would take years to get telehealth embedded in primary care but when the crisis hit, it happened literally overnight.

The reality is that governments can move decisively when they want to.

We must maintain this momentum if we are to address the significant structural, governance and funding inefficiencies that remain in the Australian health system.

During elections, politicians always tell us that they’re listening and consulting.

Before each Budget, the government of the day invites stakeholders to present their pre-Budget submissions.

Whether they really do read and respond to health groups’ advocacy is questionable.

Before the May election, the APA outlined to the Australian Government, Labor, crossbenchers and key independents new health models with advanced pathways to strengthen care for all Australians.

What we propose is a way for the next government to reorientate the health system towards primary care with a structure that properly encompasses physiotherapy.

We outlined ways to address social determinants and health inequities by using physiotherapy-led models.

There are other solutions, but obviously our focus is on the role physiotherapists play in better health outcomes.

We know that patient pathways will be improved by removing structural barriers and this means reforming Medicare and the referral model, which has really reached its ‘use-by’ date.

The current GP-centric system doesn’t work for many people, especially those with musculoskeletal and mental health problems.

For those in urgent need—and we’re talking about patients experiencing physical and mental pain, immobility, stress or loss of independence—the choice is to wait for a GP appointment to get a referral to a physiotherapist or other practitioner, to pay out-of-pocket costs or, as happens too often, to use the overstretched public hospital system.

Patients in regional and rural areas face undue delays in accessing a GP and these deferments can exacerbate pain and escalate conditions.

The UK introduced first contact physiotherapy, an evidence-based model in which patients with certain conditions, such as lower back pain, see a physiotherapist first.

The results show how successful this model is—for patients and GPs and in savings to the health system.

Improving patient pathways by addressing the structural barriers to reform means adopting innovations used overseas, such as publicly funded physiotherapy treatment pathways.

Yes, it’s a big ask.

But you can’t just keep throwing money into the same fractured system and pretend that that’s ‘reform’.

Now that the election is over, we must shift debate on healthcare to actions prioritising those most in need.

It’s frustrating that governments have at their fingertips access to dozens of detailed, practical and sensible recommendations from royal commissions, inquiries, reports and strategic plans and yet nothing seems to happen about implementing them.

No MP should be asking, ‘How can we improve healthcare?’

This is already largely documented.

Health reform doesn’t come cheap but it’s essential.

We have been led to believe that the single greatest impediment to better healthcare is cost.

However, the reality is that major parties are reluctant to undertake systemic reforms for fear of upsetting vested interests and powerful health lobby groups.

That’s why we want the focus to be on the structural changes in healthcare that matter most to Australians.

And this means connecting patients to the most clinically appropriate and cost-effective healthcare.

It means lifting barriers and allowing physiotherapists to directly refer patients and to fund imaging requests for patients.

It means investing in publicly funded first contact physiotherapy.

Elections are an opportunity to have serious policy issues discussed and debated.

Now it’s time to implement the reforms needed and recognise the role physiotherapy plays in enhanced healthcare.