3.2 Conclusions

The NSIF is well researched and sound; it had high levels of input from key stakeholders; consultations indicate its content is still held to be current and applicable. However, despite being endorsed by the Australian Health Ministers in 2006, the Framework has not been fully utilised and has only been partially implemented, often in an ad hoc fashion by the jurisdictions.

There are various reasons why this is the case; key amongst these has been a limited take up of the Framework as a base for structured planning with associated actions, resource allocation and performance measures. In this absence, other priorities have taken over, some complementary and some competing.

A number of themes for moving forward have emerged through the work undertaken. These are:

• the current inequities in health status and access to timely and appropriate care for disadvantaged Australians, particularly Indigenous Australians;

• the role that prevention strategies have in reducing the overall and individual burden of disease and the importance of early prevention strategies to reduce risk of CVD in children, adolescents and younger adults;

• the value of supporting general practice and primary health care in CVD risk assessment, early detection and ongoing management of CVD;

• the importance of improving care processes at presentation to and throughout acute and immediate post-acute episodes of care;

• the need to improve uptake and support of clinical guidelines across all settings and at all stages of CVD;

• the importance of key performance indicators within an accountability framework against specific performance measures to monitor and improve acute, sub-acute and primary care performance for CVD;

• the importance of regularly monitoring and evaluating the impact of national strategies at a population level;

• the requirement for adequate information systems, research and data to support clinical care and outcomes measurement; and

• a desire for identified national leadership for CVD moving forward, through the development of a National Action Plan for CVD or similar.

These themes link to major health reforms and health strategies underway in Australia, particularly the following:

• National Health Preventative Taskforce

• National Primary Health Care Strategy

• National Health and Hospitals Reform Commission

• Social Inclusion approaches

• E-Health

• National Chronic Disease Strategy

• Rural Health Review

• Review of the Medicare Schedule

Ernst & Young has taken the consistent themes, tested them against evidence and practice, balanced them with key national priorities and developed a set of prioritised recommendations for action, using as reference points key documents such as the National Service Improvement Framework for Heart, Stroke and Vascular Disease and Time for Action – the action plan developed jointly by the National Heart Foundation and the National Stroke Foundation.