Best Practice

Issue 20 | Spring/Summer 2007

Professor Steven Wesselingh

If we are to best combat issues like the AIDS pandemic we need to better link outstanding medical research to health care innovation and training, writes the incoming Dean of Medicine, Nursing and Health Sciences, Professor Steven Wesselingh.

I recently attended the International AIDS Society HIV/AIDS conference in Sydney.

It was a great conference attended by 6500 delegates from all over the world.

One of the most exciting aspects was the "Sydney Declaration" calling for set benchmarks in funding to control the epidemic.

It proposed that all HIV management programs spend at least 10 per cent on research to "enable rapid implementation of new technologies to prevent, diagnose, and treat HIV infection".

The International AIDS Society (IAS) made the declaration: "We believe that without such funding we will fail to maintain a sustained and effective response to the AIDS pandemic."

In other words, unless we spend money on research as well as on HIV/AIDS care delivery we cannot be sure we are delivering the best and most cost effective care. This declaration should make us think more clearly about research and innovation in the Australian health system.

Despite our excellence in medical research we have not been very good at linking the research excellence in our medical schools to the delivery of innovative and high-quality health care and the creation of internationally renowned teaching hospitals.

The reasons for this are complex but have a significant amount to do with the separate funding models for health and higher education. David Penington recently wrote an insightful article on this issue in the Australian Financial Review and suggested "perhaps a fixed proportion of the Commonwealth's contribution to the Medicare system from 2008 onwards should be specifically tied to funding of innovative programs integrated with research in university hospitals and with training of new health professionals".

Funding of this sort could strongly link our teaching hospitals and medical schools into joint delivery of outstanding medical care and best-practice, cost-effective health care innovation.

During my career I have been lucky enough to train at two institutions that have had the vision of a seamlessly integrated hospital and medical school. The first was Flinders University and its onsite teaching hospital Flinders Medical Centre as a medical student in the 1970s this was an inspirational institution, with young talented professors leading both research and clinical services. Unfortunately Flinders' performance has not stayed on the same trajectory over the past decades due to the divisiveness of separate and diminishing funding streams.

Following my time at Flinders I went to Johns Hopkins, an internationally renowned medical institution, with a well integrated hospital and university created in the vision of its first Professor of Medicine, William Osler. Hopkins is a US leader in research, health care innovation and health delivery and still sets a benchmark as the "best of the best". We have the ingredients in Australia to emulate and compete with the major international teaching hospitals.

The Monash Faculty of Medicine, Nursing and Health Sciences has a unique opportunity to play a leadership role in these developments. On the Monash campus we are developing Australia's leading bioscience campus with national and international leadership in biomedical science, with space for ongoing expansion and unique positioning in relation to the new Australian Synchrotron and CSIRO.

If we can seamlessly integrate our biomedical and public health research excellence with clinical excellence at our research clusters next to two of Melbourne's leading teaching hospitals, Monash Medical Centre and The Alfred Hospital, we will have a model that ensures our international competitiveness. This model would strongly support the case to link research funding with health care expenditure.

We have high-quality faculties of medicine in our universities and very good hospitals; unfortunately the current funding models are a disincentive rather than an incentive to the integration that is necessary to make them great.

If we are to link our outstanding medical research to health care innovation and the training of a quality health care workforce, we must be aware that unless like the Sydney Declaration we link health care expenditure with research funding, we will continue to expend increasing amounts of our GDP on health without achieving our real potential in the delivery of cost-effective, innovative health care.