Hidden in the details of the recent Federal Budget was important news about major changes to the NPS MedicineWise program that works to improve the quality use of medicines, as Associate Professor Lesley Russell reported for Croakey recently.
On Twitter, medical journalist Dr Norman Swan described the move as “a free kick to Pharma”, while pharmacist Dr Geraldine Moses, an expert on drug safety information, called it “a short-sighted cost-cutting blow to medication safety in Australia”.
NPS MedicineWise today issued a media statement calling for a review of the decision. Below, the CEO of NPS MedicineWise, Katherine Burchfield, argues that the move’s costs seem to clearly outweigh the benefits. The implications are particularly important for aged care, mental health, general practice and disability care, she says.
Katherine Burchfield writes:
For 25 years I have been working in healthcare, in different roles, in different countries. Throughout this period, I have had one consistent, driving theme: creating better health systems that deliver the best health for the people who need it (especially for those who need it most) within the resources available.
I believe in good systems design, evidence-based policy and data-driven decision making – using this to create the foundations and incentives for excellent, affordable healthcare. This same commitment led me to join NPS MedicineWise as CEO in October of last year.
In the Federal budget this year, it was announced without warning that NPS MedicineWise’s core Quality Use of Medicines (QUM) functions will move to the Australian Commission on Safety and Quality in Health Care (the Commission) by January 2023, and education programs for health professionals and consumers will move to contestable funding. NPS MedicineWise will no longer receive uncontested funding from the Commonwealth Government to support the quality use of medicines.
This significant change came without consultation and while the National Medicines Policy (NMP) is still under review. It comes at a time when the complexity around medicines and their use is growing and an independent, evidence-based QUM voice in Australia is more important than ever.
We are seeing exciting innovations in medicines and healthcare, but also growing tensions between access, affordability and safety. The aged care and disability Royal Commissions identified significant QUM issues, and Quality Use of Medicines and Medicines Safety is the 10th National Health Priority Area.
In this context, the Federal Budget decision is a bitter pill to swallow.
An implementation arm of the National Medicines Policy
NPS MedicineWise was established 24 years ago as a critical implementation arm for the National Medicines Policy. Its establishment as an independent, not-for-profit organisation working alongside government could be considered both progressive and insightful.
Over the years, NPS MedicineWise has developed a unique set of expertise, tools and networks that is internationally recognised and difficult to replicate. Our resources and programs to support the safe and wise use of medicines are valued by health professionals and consumers alike. Our value and impact come from the trust and credibility we have built within the health sector, our independence from any one health discipline, industry segment and government, and, most importantly, from placing consumers at the heart of our work.
Each year, millions of people use our resources to guide their decisions around medicines use. Our education programs reach 16,000 general practitioners and one third of all residential aged care facilities across Australia, and have significantly improved health outcomes for Australians: for example, improving diabetes management and reducing thousands of major cardiovascular events, improving stroke prevention and avoiding thousands of hospitalisations, improving the management of chronic non-cancer pain and avoiding millions of unnecessary opioid prescriptions, and improving the management of low back pain and reducing thousands of unnecessary scans and ultimately many cases of cancer from radiation.
At the same time NPS MedicineWise has delivered a net return on investment of more that 2:1 to the Government through over $1.1 billion in direct savings for the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Scheme (MBS).
NPS MedicineWise has a sophisticated toolkit that it uses to support the quality use of medicines. These include:
- an extensive suite of resources for consumers and health professionals
- a workforce of educational facilitators spread across the country
- MedicineInsight, a large research-grade primary care dataset that is valued by health professionals and academics alike
- the national prescribing curriculum, an online learning system used by all university medical and pharmacy schools in Australia
- the MedicineWise App which supports consumers with complex medication management and is the only truly independent app of its kind in Australia
- the Medicines Line, which provides advice to patients about medicines over the phone – extended during the COVID-19 pandemic to provide information around vaccines and anti-viral medicines
- the Choosing Wisely Australia initiative, which engages health professionals and consumers to drive appropriate, sustainable healthcare.
The depth and breadth of NPS MedicineWise’s programs and how they work together to change behaviours around the use of medicines is not well understood by many in the sector.
A diluted focus?
Reducing duplication and introducing contestable funding in the delivery of programs to drive better value – both publicly stated as the rationale for the Government’s decision to change QUM roles and funding – are excellent goals.
However, this decision in this context and in this way risks simultaneously fragmenting and diluting the focus on Quality Use of Medicines at a critical time.
The Commission is a corporate Commonwealth entity that supports improvements in safety and quality in healthcare across Australia. It has an established track record in developing clinical care standards and ensuring they are translated into practice through accreditation and other activities. There is no question that the Commission has a valuable role in QUM.
However, it performs a different role and function to NPS MedicineWise. The two organisations should be working together, as they do now, using their different strengths and levers to drive quality use of medicines.
Together with contestable funding, the transfer of QUM functions to the Commission will result in NPS MedicineWise functions being split across different organisations, and the sector losing a critical “go-to” resource for the quality use of medicines, particularly impacting primary care and aged care.
It is also not clear whether, after transition funding in 2022-23 is accounted for, the current level of funding for QUM will be maintained.
A review of the decision is in order
As an economist, I am trained to look at costs and benefits. And the costs of this decision seem to clearly outweigh the benefits.
It is not clear why this decision was made at this time, in this way, and without consultation, or how it will benefit health practitioners or consumers.
If a restructure of QUM in Australia is in fact needed to ensure the very best outcomes, surely this should be undertaken in the context of a refreshed National Medicines Policy and with a transparent approach.
Having listened to voices from across the health and aged care sectors, NPS MedicineWise is calling for a review of the decision and, at minimum, finalisation of the National Medicines Policy before any structural and funding changes are agreed and implemented.
Katherine Burchfield is CEO of NPS MedicineWise. She is an established healthcare leader with over 25 years’ experience in Australia and internationally. An economist by background and an alumni of the McKinsey Executive Leadership Program, she has held senior roles in the public, private and not-for-profit sectors, spanning strategy, service delivery, health financing, policy and research. She is passionate about improving health systems and addressing health inequalities, and has a particular interest in the effective use of information and incentives to support better decisions across the health sector.
See Croakey’s archive of articles on safety and quality of healthcare