A decade ago, the former CEO of Mental Health Australia, John Mendoza, produced a massive three-volume reflection on 30 years of mental health reform in Australia and visions for the future.

He titled this landmark collection of essays and articles Obsessive Hope Disorder.

The heading reflected an obsessive optimism that, any day now, reforms will be delivered to improve healthcare.

I also suffer from a form of obsessive hope disorder.

The symptoms include believing that every change of government and every election promise will bring about the changes, investments and reforms that will convert a very good (but inconsistent and inequitable) health system into the world’s best.

There is no relief for the obsessively hopeful because, realistically, healthcare is innovating and evolving at a pace that governments and their bureaucracies are too unwieldy to keep up with.

Before anything gets done, we undergo the policy equivalent of a pre- surgery period: endless consultations, submissions, trials, pilot schemes and research funding grant applications.

As a leading researcher told me in relation to physiotherapists working as publicly funded first contact practitioners in primary care, ‘We know it works but proving it to government is very difficult.’

The difficultly lies in governments insisting on a preconceived set of measures and data—a classic ‘chicken and egg’ scenario whereby we must prove a reform works before it is even implemented.

Perversely, we are not always funded and supported to provide this evidence in the ways bureaucrats want it provided.

The good news for us obsessive hopefuls is that the physiotherapy sector is now much better positioned to understand the barriers and obstacles to reforms and how to position ourselves to achieve them.

Over the past few years, the APA has detailed our policy agenda through the groundbreaking Future of Physiotherapy in Australia: A 10- Year Vision Policy White Paper, the Value of Physiotherapy in Australia report (and a similar version recently released by the American Physical Therapy Association), our annual pre- Budget submissions, position statements, scope of practice assets and media output.

The APA’s vision and direction remain absolutely clear and consistent.

The barriers to sector reform are almost entirely medico- political.

Allied health and nursing are still being relegated by the medical establishment—seen as important but not as important as GPs and specialists.

I see this medical snobbery as overriding the most critical aspect of healthcare—we are here for patients and to improve patient experiences, including by making healthcare more affordable and more accessible.

Minister for Health and Aged Care Mark Butler repeatedly talks about the government’s major first-term agenda: ‘Reforms to strengthen Medicare [and] changing the game across a whole range of areas for practices and patients alike.’

The minister says he wants to strengthen ‘the funding structures that enable health teams to do their important work [and] we also need to support more health workers in those teams to actually do that important work’.

Professor Mark Cormack is leading the Unleashing the Potential of our Health Workforce Review, established to examine opportunities for healthcare workers to operate to their full scope of practice and to use their full skill set.

As Minister Butler said, ‘I’d like to see every health professional work to the top of their skills, training and experience.’

Hence the importance of the APA defining our skills, scope and training.

To sum up—we have a health minister committing the government to reform of Medicare and championing the work of nurses and allied health.

We have the health workforce review and the Strengthening Medicare review and we have record investment in general practice.

We also have a crisis boiling away in future workforce needs and crises usually expedite reforms, as we saw with telehealth during the COVID-19 pandemic.

In 2024 the pre-election cycle will begin or we may have an early election.

Governments traditionally are wary of initiating reforms that antagonise powerful sectors (such as medical colleges and associations) before elections.

I hope that Minister Butler’s strong rhetoric is sending an unambiguous message.

Reforms to Medicare and primary care are coming—if not immediately, then soon.

One measure the APA will pursue in 2024 is reforming referral pathways so that physiotherapists can directly refer to orthopaedic surgeons.

This should be an easy policy reform win for government; however, if precedent is a guide, we anticipate some pushback from certain medical groups.

We saw opposition to pharmacy prescribing trials— a much needed and welcomed reform that benefits everyone.

It may sound laughable today, but there was opposition from doctors’ groups to having flu and then COVID vaccinations delivered in pharmacies.

My obsessive hope disorder makes me believe that the window for reform lies with the current minister and government and their willingness to leave a legacy of sustained and substantial health reform.

Minister Butler stared down opposition to 60-day prescribing and delivered a very important health reform.

Emboldened by this, I am hopeful that he will similarly stand up to vested interests and use physiotherapists, nurses and other allied health professionals to their full scope of practice, making the most of their skills and training.

While they may not be delivered in 2024, the ground is being laid for significant changes to Medicare and primary care.

>> Go to australian.physio/advocacy to learn more about the APA’s work on behalf of members and the profession.