*** This article was updated on 15 September to include a response from Health and Aged Care Minister Mark Butler and a link to the rapid review, which was published by the Department of Health and Aged Care on 14 September ***
Health leaders have slammed the Federal Government’s decision to de-fund NPS MedicineWise, which has announced it will cease operations by the end of this year after a 24-year history of supporting better use of medicines.
An NPS MedicineWise statement issued on 14 September said the “difficult” decision followed advice by Federal Health and Aged Care Minister Mark Butler that he would proceed with funding changes included in the Morrison Government’s budget in March.
Clinicians, consumer health advocates, researchers and health policy experts used a range of adjectives when describing the Minister’s decision including: disappointing, illogical, unfathomable, sad, concerning, and short sighted. They also warned of significant implications for patient care.
Some highlighted the significance of NPS MedicineWise – the implementation arm of the National Medicines Policy – in addressing concerns about medication safety raised by Royal Commissions into disability and aged care.
Before the federal election, Butler committed as Opposition health spokesman to review the Morrison Government’s budget decision in the wake of widespread concern by health and consumer organisations.
However, in a letter to NPS MedicineWise dated 22 August, Butler said he planned to proceed with the redesign of the Quality Use of Therapeutics, Diagnostics and Pathology Program, following a “rapid review” of the budget measure by Deloitte.
NPS MedicineWise said Minister Butler’s decision had “catastrophic implications” for the organisation’s role and funding, and had left the Board with no alternative but to wind up the company by 31 December 2022. The future for the organisation’s 170 staff is unclear.
From 1 January 2023, NPS MedicineWise will no longer receive Federal Government funding to deliver Quality Use of Medicines activities, and existing functions will transfer either to the Australian Commission on Safety and Quality in Health Care (ACSQHC) or to new contestable funding arrangements.
“NPS MedicineWise does not agree with the decision to proceed with the redesign. We believe it will prove to be a poor decision, and will make the safe and wise use of medicines in Australia much harder to achieve,” said Dr Andrew Knight, Chair of the NPS MedicineWise Board.
No sense
Health consumer advocate Darlene Cox called on Minister Butler to review the decision, saying it made no sense, especially as it came before a review of National Medicine Policy had been completed. This suggested the decision was about saving money rather than improving health outcomes, she said.
“I just don’t think it’s a well thought out decision,” she told Croakey, calling on the Minister to release the Deloitte review (update from Croakey: it was published on 14 September).
Cox, Executive Director of Health Care Consumers Association Inc, a peak consumer health group covering the ACT and Canberra region, added that she felt an “overwhelming sadness” for the staff and the loss of an organisation that had built up so much expertise over decades.
“It’s a very sad day,” said Cox. “Medication safety is one of the biggest issues for health consumers. So many of us are hospitalised due to medication safety issues.
“NPS is a trusted brand. We can trust the information that they provide for consumers, it is relevant and it meets our information needs.”
Cox, who co-chairs the NPS MedicineWise Clinical Intervention Advisory Group, said the organisation had been highly successful and its great strength was in being an independent company at arms-length from government. Her concern about the decision was not a criticism of the ACSQHC, she added, but she feared the move would dilute the focus on quality use of medicines as the Commission had many other competing priorities.
Like others, Cox raised questions about the future of Choosing Wisely Australia, an initiative between NPS and medical colleges.
Tim Usherwood, Emeritus Professor of General Practice at the University of Sydney, said he was “deeply disappointed” in this “unfathomable” decision.
“NPS has a remarkable track record of excellence in its work, and of strong engagement with both primary care and consumers,” he told Croakey.
“As a chair of its Clinical Intervention Advisory Group, I’ve been constantly aware of the expertise, professionalism and commitment of its staff. I fear for the impact of loss of this trusted steward for quality use of medicines and medical tests, and source of impartial information for consumers, prescribers and other primary healthcare practitioners.”
Leaving a critical gap
Paul Glasziou, Professor of Evidence-Based Practice at Bond University and the Director of the Institute for Evidence Based Healthcare, lamented the “sad news” and said “the loss of the NPS MedicineWise’s vital role in implementing antimicrobial stewardship in primary care across Australia will leave a major and critical gap that cannot be quickly filled”.
Glasziou joined more than a dozen expert members of the Australian-New Zealand General Practice Respiratory Infections Network (ANZ-GRIN) in writing to Minister Butler in July “to convey our apprehension over the potential loss of the NPS MedicineWise’s vital role in implementing antimicrobial stewardship in primary care across Australia”.
The letter cited research showing the organisation’s impact in “influencing and educating both the public and general practitioners in the wiser use of antibiotics to avoid the rising disaster of antimicrobial resistance”, and said the work by NPS has been important to contain the growth in overuse, and “needs to be strengthened rather than cut”.
“The Australian Commission on Safety and Quality in Health Care has an vital role in setting set standards for antimicrobial stewardship, but does not undertake implementation or deliver programs. We sincerely hope that the urgent review of the NPS MedicineWise work includes a contingency for the antimicrobial stewardship work in primary care,” said the letter.
A prominent consultant clinical pharmacist, Debbie Rigby, who was a director of NPS MedicineWise from 2008-2020, said she was “incredibly disappointed” by the “short sighted” and “illogical” decision.
The NPS had built up trust and respect with consumers consumer organisations as well as health professionals, especially general practitioners and pharmacists, she said.
“I think Australians deserve better [and so do] our health professionals, GPs, pharmacists, nurses and aged care workers, who have gone through so much in the last couple of years, to have the loss of this support from an independent organisation.”
Learn from past mistakes
Health policy analyst and Croakey editor Jennifer Doggett said Minister Butler’s decision to go ahead with the closure of NPS Medicinewise is concerning, particularly since there does not seem to be a solid plan in place to ensure the important work being undertaken by this agency will be continued by ACSQHC.
“We’ve seen the impact of agency closures in other areas of health, for example, the axing of Health Workforce Australia in 2014 in the first Budget of then Prime Minister Tony Abbott,” she said.
“Once that agency was gone, we lost the valuable in-house expertise it had built up in health workforce policy and planning, as well as the continuity of the data collection it was undertaking and the trusted relationships it had established with the health professions.
“These losses are now significantly hampering our current ability to address the health workforce crisis, which will cost us far more over the long term than the savings resulting from HWA’s closure.
“Given the importance of NPS’s functions and its successful track record of collaboration with the medical profession, it makes sense to hit the pause button and re-assess whether this decision is really in the long-term interests of the community.”
Adjunct Associate Professor Lesley Russell – who has previously outlined her concerns at Croakey – said it should be acknowledged that the ACSQHC is a well-respected body whose work overlaps with that of NPS MedicineWise.
“I am sure that the QUM work will continue to proceed under its aegis – indeed it must continue, as QUM and medicines safety is a National Health Priority area,” she said.
Russell said her concerns now go to the following issues:
- The potential loss of long-standing expertise in this area with the closing down of this program. Will NPS experts be employed by ACSQHC?
- There is now no agency with the sole responsibility for delivering QUM programs. They will be just a small part of the work the ACSQHC must do. And ACSQHC must do this with a very reduced budget. The 2022-2023 Portfolio Budget Papers for the Department of Health show that the Federal Government’s contribution will decrease to $18.542 million in 2022-2023, down from $26.205 million in 2021-2022. The 2022-2023 Budget allocation of $5.7 million over 7 years for the redesign of the QUM program hardly offsets this. Meanwhile the Government is pocketing savings – in 2021 the NPS received $23.8 million from the Department of Health for operating expenses.
- This is almost certainly a decision based on budget priorities (originally those of the Morrison Government, now apparently those of the Albanese Government). It was inappropriately made ahead of the final report from the National Medicines Policy Review (itself subject to concerns and issues as outlined in the 8 November 2021 edition of The Health Wrap).
- The 2022-2023 Budget papers indicated that projects to deliver professional education and consumer education and health literacy around QUM will now be subject to competitive grant processes. Contestability in healthcare is usually code for ‘given to the cheapest bidder’ and rarely delivers the best outcomes.
The Consumers Health Forum said it respects the decision to centralise the core quality use of medicine functions under the ACSQHC.
“NPS MedicineWise has made a substantial contribution to the education of health professionals and consumers alike, and I really feel for the organisation’s staff and supporters who will be impacted by its closure,” said Dr Elizabeth Deveny, interim CEO of the Forum.
“However, it is reassuring to note that the new Health Minister Mark Butler will continue to fund consumer educational programs to improve health literacy around the use of medicines and tests. CHF’s report into this issue last year found that consumers benefit greatly by taking medicines correctly, not just by improving their health and wellbeing but also their quality of life, access and affordability of healthcare.”
“CHF believes that with the increasing number of new medicines available on the PBS, strong health literacy education is more critical than ever. The Government spends some $14 billion each year on medicines through the PBS and any proportion of this amount spent on consumer education will deliver a great return on investment for Australia.”
The Commission released the short statement below.
Open review needed
Katherine Burchfield, CEO of NPS MedicineWise, called on the Government to monitor the new arrangement and require the Department to conduct and publish a review of the outcomes in a year’s time.
“There are some big risks around this decision and it is a big change,” she told Croakey.
The review should examine health professionals’ perspectives on the changes, and whether prescribers felt they still have resources and support they need to make good prescribing choices around medicines, and whether consumers felt they still had good access to resources and information.
Other important indicators would be the impact on prescribing patterns and PBS costs.
She said the organisation was working on a transition plan with the Department of Health and the ACSQHC, and there needed to be a “relentless focus” on ensuring NPS functions and capabilities were protected and transferred.
Burchfield also raised concerns about the unexpected shock inflicted on the organisation and staff, first finding out about the decision in the Federal Budget without any prior discussions or consultation. “I don’t think governments should be making decisions in this way, impacting hundreds of peoples’ jobs with no notice,” she said.
The organisation had been unable to get a meeting with Minister Butler or his staff since the election, but had met with Assistant Minister Emma McBride.
She said it was concerning the Deloitte review team did not consult with key stakeholders including health professionals and consumers.
(See Burchfield’s Croakey article in May: A bitter pill to swallow: Federal budget changes raise medication safety concerns).
Impact
Asked for evidence of the organisation’s impact, NPS MedicineWise provided this list of publications, referred to this article by former CEO Dr Lynn Weekes and provided the details below:
Diabetes management: Contributed to the avoidance of 5,745 major cardiovascular events and microvascular disease.
Prevention of stroke: Improved antithrombotic prescribing resulted in the first-time stroke hospitalisations decreasing by 17.3%.
Safe and effective use of antipsychotic medicines for people with dementia has averted an estimated 177 strokes.
Antibiotic stewardship: A 5-year program contributed to a 24.8% reduction in selected antibiotic GP prescriptions from 2012 levels.
Reduction in imaging: A program targeting inappropriate imaging for low back pain resulted in a reduction of 50,000 scans over a 20-month period and an estimated 36 cases of cancer.
Opioids and chronic non-cancer pain: Our program reduced opioid prescriptions by 501,989 with a benefit of $8,771,975.
Social media reaction
The NPS MedicineWise statement generated considerable reaction on LinkedIn and Twitter.
Croakey has sought comment from Minister Butler’s office.
Update: On 15 September, the Minister’s office provided the following:
“The Government has delivered on its commitment to independently review the proposed redesign of the Quality Use of Diagnostics, Therapeutics and Pathology program to ensure they support the quality use of medicines and diagnostics, and best outcomes for Australian patients. The independent review supported proceeding with the reforms.
From 1 January 2023, the redesigned program will include additional funding of $3.9 million to support more activities to boost confidence and knowledge about using medicines and diagnostics tests safely and effectively, both for consumers and health care providers. These activities will be sourced through open, competitive application processes.
The redesign of the program will also recognise the extensive medicines quality and safety programs, standards and information already provided by the Australian Commission on Safety and Quality in Health Care and consolidate stewardship for quality use of medicines and diagnostic tests in the Commission. The redesigned program will build on the Commission’s existing expertise, network and reach across the heath system. It will enhance the ability of the Commission to co-ordinate and drive quality and safety improvements related to use of medicines and diagnostics across the Australian health system.
The Department of Health and Aged Care will also promote the delivery of targeted quality use of medicines and diagnostic educational activities, for both health professionals and consumers, to support the optimal use of therapeutics and diagnostics. This will be done by way of a series of competitive grants and procurement processes.
This means that education providers such as medical colleges, consumer groups, NGOs, universities and professional organisations will be able to apply for new grants to support activities that will improve medicine use.
The Government acknowledges the work of NPS Medicinewise over many years to improve the quality use of medicines and diagnostic tests. NPS Medicinewise staff are being supported through the transition of functions.”
Update: The Society of Hospital Pharmacists of Australia (SHPA) issued this statement to members on 14 September, saying:
“As a proud member of NPS MedicineWise, SHPA collaborated with NPS MedicineWise on many important QUM projects since the National Prescribing Service was established in 1998, rebranding to its current name in 2010. For a time, the SHPA secretariat even shared offices with the NPS MedicineWise staff based in Melbourne.
SHPA acknowledges this difficult decision for the NPS MedicineWise Board and offer our gratitude to the Board and staff during this challenging time, for their long history of partnership and leadership in QUM. During their 24-year stewardship of national QUM activities in Australia, NPS MedicineWise has contributed significantly to QUM, health literacy and education for Australian clinicians and the Australian public. SHPA was proud to be the very first Australian pharmacy organisation to be a part of the Choosing Wisely Australia movement, which NPS MedicineWise has championed since 2015. NPS MedicineWise resources are used daily by SHPA members in their practice and continuing professional development, and SHPA will advocate for these important projects and programs to continue. Its annual National Medicines Symposium was also a calendar highlight for the SHPA community, with many of our members represented at this national event.
SHPA will continue to support independent QUM programs which place Australians’ health as the utmost priority. SHPA highly respects the Commission’s work, with whom we also have a long history of partnership and a close working relationship. SHPA looks forward to working with the Commission alongside our medical and pharmacy colleagues to deliver vital QUM activities for Australian clinicians and the public and meaningfully address Australia’s 10th National Health Priority Area.”
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