*** This post was updated several times on 9 May, and also on 10 May ***
This post compiles reaction to health-related measures in the Federal Budget, regarding the social determinants of health, Aboriginal and Torres Strait Islander health, climate change, public health and prevention, healthcare reform, mental health, aged care, rural and remote health, the NDIS, and medical research. It includes statements from 39 organisations.
While there is positive news for some areas (notably aged care, mental health and rural health), all the signs are that the social determinants of health will worsen for many people.
And don’t mention climate change (the Treasurer certainly didn’t).
Also absent is a vision for public and preventive health, while funding for human rights initiatives is slashed, and National Congress has issued a devastating critique of the implications for Aboriginal and Torres Strait Islander people (published in full below).
Compare and contrast the reactions from the Indigenous and social sectors with those of the health and medical sectors in the post below.
Such an analysis might suggest that one reason governments are slow to act on the social determinants of health is the failure of the powerful health and medical lobby to hold them to account for this.
(And the same might be said about the health sector’s almost universal failure to call out the lack of action on climate change in their budget responses).
So many elements of this Budget will make life harder for people who are already doing it tough – and yet the overwhelming sound from health organisations is of grateful applause (with a few notable exceptions).
Perhaps it’s just that the sector has been starved of forward-looking, equity-based policy making for so long that it’s a case of being grateful for small mercies.
The Health budget papers are available here and are covered by Jennifer Doggett in this excellent analysis: Public relations trumps policy.
Social determinants of health
ACOSS
ACOSS said the personal tax cuts would not help the majority of people on low incomes, and will deprive governments of the ability to fund essential services.
CEO Dr Cassandra Goldie said:
“No sooner have we seen five minutes of budget sunshine then the Government has committed itself to seven years of income tax cuts. This is not a disciplined and responsible approach to budgeting. There is a seven year plan for tax cuts, but where’s the seven year plan for reducing poverty among adults and children, guaranteeing growth funding for health care, and closing the gaps in essential services such as mental and dental health and affordable housing?
“It is shameful that the Government has chosen to ignore the overwhelming consensus to help people on the lowest incomes, by increasing the woefully inadequate Newstart and student payments, as a matter of priority.
“Instead the Government has chosen to give away personal income tax cuts for people including the highest income-earners in the country. The maximum benefits of the new tax offset ($11 a week) will go to people earning $48,000 to $90,000, not low income-earners. Higher income earners will be the beneficiaries of lifting the $87K threshold to $90K taxable income. The lowest 40% of individuals by income will receive nothing or very little, up to $4 per week. This first stage of tax cuts alone will cost the budget $13 billion.
“The seven year tax plan hands out increasingly generous tax cuts that will disproportionately benefit higher income-earners. These tax cuts, on top of the corporate tax cuts, will clearly deprive future governments of the revenue we need to guarantee essential services. There are some welcome measures to stem tax avoidance, such as refusing tax deductions for vacant land, modest measures to tackle the use of trusts for tax avoidance purposes, and action to limit profit shifting by multinational corporations. Measures on the black economy are also welcome. However, these measures go nowhere near compensating for the lost revenue from the 7 year tax plan.
“The planned tax cuts and the arbitrary revenue cap of 23.9% to GDP place us in a damaging fiscal straightjacket. Australia is already one of the lowest taxing countries in the OECD, and with tax cuts for years ahead, we clearly could not guarantee essential services and a decent safety net to meet community needs. Tax cuts risk extending user pays for essential services leading to greater out of pocket costs.
“The increase of 14,000 home aged care packages is welcome, and starts to deal with a backlog of 100,000 packages. The focus on quality and transparency is also welcome. However, this aged care package highlights the yawning gaps that remain in essential services, and tonight’s announcement only begins to fill those gaps.
“The $1B increase in hospitals funding is also welcome, but only restores funding cuts that would have otherwise commenced in 2020. Similarly, the Medicare rebate freeze is ending. We cannot afford to keep taking one step forward and another step back in health funding. Adequate growth funds must be guaranteed and a stronger revenue base is the only way to achieve this.
“Other more modest measures that we welcome include the remote housing funding for the Northern Territory ($550 million), a small boost mental health services and continuity of support services for some people not eligible for the NDIS ($92 million).
“Commitments in education, including schools and early childhood funding, are also welcome but do not give the assurances we need that public schools and preschools will be adequately funded into the future.
“The harshest change in this budget affects some of the most vulnerable people in the community: new migrants lacking paid work, who will be left without income support for the first four years. This is not the way to welcome people to this country and help them contribute to its future prosperity.
“There are small changes to one of the harshest existing schemes, the Community Development Program for remote Indigenous communities, including a new wage subsidy scheme and slight reduction in the hours they need to work for their benefits, but the changes do not restore incomes to the thousands of people losing income support when they are penalised under this scheme, and some could make matters worse.
“The proposal to deduct State Government fines from social security payments without their agreement is unnecessary, intrusive, and could leave many people homeless. The ball is in the States’ court to reform the system of court-ordered fines so that people are no longer imprisoned because they can’t afford to pay.
“A responsible budget would strengthen the revenue base so that the government can do its job, especially to provide the essential services people need and protect people from poverty. Unfortunately this budget does the opposite, and the budget mistakes of the 2000s are being repeated.”
The Brotherhood of St Laurence
In this Budget, Brotherhood of St Laurence executive director Conny Lenneberg welcomed additional places for the highly successful Transition to Work program which prepares young people for jobs in their communities.
“I am also pleased to see funding for the Brotherhood to establish a Youth Employment Body to help young people into work with new approaches informed by research and, importantly, harnessing employer effort.” Ms Lenneberg said older Australians were also hit hard by unemployment and new expanded measures would help respond to challenges mature-aged job seekers faced.
“But the Brotherhood remains deeply concerned about Australia’s fraying social safety net, which undermines efforts to get people into jobs,” she said. “The very low rate of the Newstart Allowance acts as a barrier to people securing work and fully participating in Australia’s economy.”
Australia’s ‘long forgotten people’: Newstart recipients
“The long forgotten people of this federal Budget – yet again – are Australians who rely on Newstart to make ends meet,” said Ms Lenneberg. ”After 25 years of economic growth, our country’s unemployment benefit remains far too low.”
Ms Lenneberg said increasing Newstart is not just about being fair – it makes good economic sense. “Newstart is so utterly inadequate – as little as $38.98 a day – that many people on the payment can’t afford to properly conduct their job search. They are struggling to cover the basics of life. The truth is that there are costs involved in looking for work: maintaining a mobile phone, paying for transport and having presentable clothing to attend interviews.
“Disturbingly, housing costs are so high these days that an increasing number of vulnerable people on Newstart are forced into homelessness. Newstart should enable people to get into work, but the unintended consequences of very low rates is that it presents a huge barrier to employment. How can you properly look for a job when you can’t even afford to keep a roof over your head?”
In the lead up to the next federal election, the Brotherhood of St Laurence urges all parties to commit to address this deep flaw in our social security system.
“Fixing Newstart is a moral challenge for our democracy. It is not fair to consign people searching for work to poverty amid such a run of economic prosperity. It is not only welfare groups, but economists and business who are calling for an urgent increase in Newstart. We must share the pie,” Ms Lenneberg said.
Homelessness Australia
Homelessness Australia labelled the Federal Budget ‘short-sighted and heartless’, after it was revealed there will not be any extra funding for either social housing or homelessness services. This is despite the number of people needing homelessness assistance increasing year-on-year.
The budget shows that federal homelessness and housing funding will drop to $1.54 billion next financial year, the lowest level in a decade. HA’s analysis of the Budget papers shows that there has been a 16 per cent decline in federal spending on housing and homelessness over the five years to 2018-19.
“It’s short-sighted and heartless to neglect homelessness services, and to let ageing social housing stock dwindle. We’ll be forced to turn even more people away, many of whom will end up in our hospitals, prisons and mental health facilities; when all they need is a home,” said Jenny Smith, Chair, Homelessness Australia.
“It is irresponsible for government to stand on the sidelines wringing its hands while Rome burns. We need the government to bolster the services that do the heavy lifting, and to build more housing that people on the lowest incomes can afford; it’s as simple, and as difficult, as that.”
Difficult times ahead for Centrelink clients
Aboriginal and Torres Strait Islander health
National Congress
National Congress and its members are dismayed that the Federal Budget has once again failed to significantly address many of the key concerns of Aboriginal and Torres Strait Islander communities, organisations, and peoples. First Peoples have come last.
The Government’s priority for First Australians focuses primarily on economic prosperity. While many would welcome this outcome, the Government’s roadmap to accomplishing this prosperity is fanciful, incoherent and sorely lacking in the detail necessary for success.
Although the Government has listened to a few of our concerns regarding the Community Development Program, major issues largely remain unresolved in this budget. The harsh and discriminatory penalty system is largely intact. In fact, penalties have worryingly been strengthened in cases involving participants who need the greatest amount of support. For this reason alone we renew our call for the CDP to be replaced with a wage-based program which provides meaningful employment and training for our peoples.
We are deeply concerned by the Government’s proposal to withhold income support payments from individuals who default on fines. This is a recipe for ensuring that the poorest and most vulnerable members of our society will remain so, with unpaid fines likely leading to increased rates of incarceration rather than pathways to prosperity. Our peoples cannot achieve economic prosperity if we cannot meet our basic needs.
In claiming that it will provide $550 million in new funding for remote housing in the Northern Territory, the Government has attempted to hide its abandonment of a national housing strategy. The National Partnership Agreements on Remote Indigenous Housing have expired. Prospects of renewal are slim, particularly if negotiations with state and territory governments are unsuccessful. If Aboriginal and Torres Strait Islander peoples are forced to live in insecure, overcrowded and unsafe homes, or are homeless, the barriers to economic empowerment are overwhelming.
The Federal Budget fails to address the shameful over-incarceration of Aboriginal and Torres Strait Islander peoples. We make up 3% of Australia’s population, but 27% of its prisoners. If anything, the Government’s callous disregard for our basic human rights to equality and quality health, education, housing and employment opportunities makes this problem worse. These factors are also responsible for child removal rates being ten times greater than for non-Indigenous Australians, which threatens to create a new Stolen Generation and perpetuates intergenerational trauma.
Aboriginal and Torres Strait Islander legal services have highlighted gross inadequacies in
government f unding for civil cases. As Centrelink breaches, inability to repay fines and housing tenancy disputes become more commonplace due to Budget measures, thedemand for legal services will only increase and these inadequacies are likely to becomemore severe.
Attempts to Close the Gap appear to have stalled, with Minister Scullion making no
reference to the program in his media release. No new funding has been allocated to the
strategy, despite a dire need for further community consultation and national co-operation
between governments and our organisations. The Government’s failure to Close the Gap
must not be used as an excuse to abandon the targets altogether, lower expectations and
widen the life expectancy gaps or shift responsibilities to state and territory governments.
We note in this budget that $50 million has been allocated for the memorialisation of the
250th Anniversary of Captain Cook’s voyage to Australia. Whilst gaining pockets of local
support, this appears a controversial investment in the Treasurer’s own electorate. Our
preference would be to redirect these funds into community based Closing the Gap
initiatives to address the negative impacts of the European invasion of Australia.
National Congress welcomes the renewal of funding for our health organisations and
programs.
In particular, we appreciate the recognition of the crucial role which the Aboriginal
and Torres Strait Islander workforce plays in delivering positive health outcomes for our
peoples. However, we note that the provision of culturally safe and appropriate healthcare
must also be integrated into the mainstream health system. We also acknowledge the
Government’s commitment to provide new funding to aged care, but unless the large gap in
life expectancy is resolved, many of our peoples may not enjoy the longevity to benefit from
these services.
We reiterate our call for the Government to work collaboratively with us. The need for an
independent and well funded national representative body to inform Governments is greater
now than ever. Our organisations are in the best position to provide culturally safe and
appropriate services to our peoples. However, we cannot achieve this without adequate
resources and support.
On reflection this budget leaves so many of us uncertain of the true value of our extensive
consultations with Government over the past year. So little of what we have said, like so little
of what we have recommended, has been taken up by this Government in this
underwhelming budget.
Our political leaders have seemingly exhibited an attention deficit; one proportional to the
surplus evident in their own self-interest.
National Aboriginal and Torres Strait Islander Legal Services
While the over-incarceration of Aboriginal and Torres Strait Islander people has been squarely on the Commonwealth’s agenda in 2018, the Federal Budget has not delivered any funding for solutions.
“The Australian Government has ignored the findings from their own Law Reform Commission and Northern Territory Royal Commission inquiries,” said Cheryl Axleby, co-chair of NATSILS. “Instead, they have introduced oppressive, punitive measures which will disproportionately affect Aboriginal and Torres Strait Islander people’s quality of life.”
The recommendations, including introducing national justice targets, support for justice reinvestment and Aboriginal and Torres Strait Islander Legal Services to deliver essential legal help, did not form part of the Budget. Nor did Closing the Gap, despite a year-long refresh agenda.
Yet stringent measures deducting welfare payments from people with unpaid fines and outstanding warrants have been introduced. These measures come in the face of increasing rates of over-representation, and a demonstrated connection between poverty and imprisonment for Aboriginal and Torres Strait Islander people.
“All governments around Australia should immediately abolish imprisonment for unpaid fines, not deduct welfare payments from people who are already oppressed by the system,” said Ms Axleby. “This will likely have a huge impact on Aboriginal and Torres Strait Islander communities. We cannot afford to lose more lives to unpaid fines.”
In addition, a number of Indigenous people accessing Aboriginal and Torres Strait Islander legal Services relate to housing and tenancy issues. Despite this, National Partnerships on Remote Housing remain in doubt in WA, Qld and SA.
“Increases in Indigenous health won’t outweigh the government’s changes to housing and welfare, which will further entrench disadvantage,” said Ms Axleby. “This will lead to more unmet legal need for Aboriginal and Torres Strait Islander legal services, already at crisis level. This need must be comprehensively mapped to determine the gaps in providing essential legal help.”
The concerning welfare measures include extending a punitive demerit point system to Community Development Program (CDP) participants. This cuts and suspends welfare payments for weeks at a time, risking further deep financial disadvantage for a very vulnerable group.
Since the introduction of the CDP, 300,000 financial penalties were applied, despite having only around 33,000 participants. Despite the clear failures of the CDP to date, only minor improvements were introduced, including a new wage subsidy scheme and slight reduction in the hours participants need to work for their benefits.This flies in the face of constant calls for community-led solutions with a holistic, trauma-informed approach.
“The Government has not acted on their commitment to “do things with us, not to us”, once again ignoring the solutions that have been put forward to them by Aboriginal and Torres Strait Islander representative bodies in the 2016 Redfern Statement,” concluded Ms Axleby.
NACCHO
The National Aboriginal Community Controlled Health Organisation (NACCHO) has welcomed the Budget announcement of a new needs based funding formula model for the Indigenous Australians’ Health Program (IAHP). Although this new model requires further refinement, feedback and work.
This new model for our 144 Aboriginal Community Controlled Health Service (ACCHS) provides funding for our primary health care services and now excludes 7 inconsistent data points related to NKPIs.
NACCHO Chair Mr John Singer believes ‘that funding certainty is critical to ACCHSs achieving good health outcomes.
Mr John Singer called on the government to ensure there was no adverse impact on our Model of Care.
NACCHO welcomes the 5-year funding agreements and grandfathering arrangements under this new model.
NACCHO welcomes the new money for preventing and treating complex chronic health conditions such as Eye disease ($34.3 million) hearing loss ($30.0 million) and crusted scabies ($4.8 million).
Acknowledges the new investment in remote renal services and infrastructure with a MBS item for dialysis.
Also, the $105.7 over four years to deliver additional residential aged care places and home care packages in remote Indigenous communities.
The Government has advised that the new funding model can be varied up to July 2019 and NACCHO will continue work in consultation with the Funding Model committees.
Aboriginal controlled health services provide about three million episodes of care each year for about 350,000 people and employ about 6,000 staff.
Meanwhile, the Indigenous health funding announcement included the news that up to $23 million will be provided to the Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation for continued renal support activities in remote Australia, including expansion into eight new communities.
Australian Indigenous Doctors’ Association
The Australian Indigenous Doctors’ Association (AIDA) welcomes the news of increased government investment into Aboriginal and Torres Strait Islander peak workforce organisations of $33.4 million over four years from 2018-2019. We take this as a tangible measure of the genuine commitment of the Turnbull Government to work with us to build the Aboriginal and Torres Strait Islander health workforce.
As the only professional association for both Aboriginal and Torres Strait Islander doctors and medical students, AIDA is committed to improving the health of our people and enriching the health profession by growing the numbers of Indigenous doctors. This renewed funding certainty will allow AIDA, through our strong relationships with key stakeholders, to keep supporting efforts to increase the cultural safety of mainstream medical education and health care systems.
This continued financial support from the government means job security for our employees, increased resourcing for emerging issues and the ability to continue to implement our long-term strategic agenda. This includes:
– Development of our 2018 policy priorities
– Further investment in Indigenous-led health research
– The delivery of a cultural safety program for doctors, by Indigenous doctors
– Ongoing support to our student and doctor member base
Doing things with, not to Aboriginal and Torres Strait Islander Peoples
AIDA encourages the Turnbull Government to maintain its stated commitment to work in a consultative and collaborative way with Aboriginal and Torres Strait Islander Peoples.
We remain concerned that there is no commitment in the 2018/19 Budget to adequately resource the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. AIDA maintains that this is the roadmap for the government to work with us to genuinely redress health disparity and deliver culturally appropriate and needs-based health care to Aboriginal and Torres Strait Islander Peoples. We encourage the government to commit to implementing the social determinants of health framework into future Indigenous health policy development.
AIDA also remains concerned about the lack of targeted funding commitment around Closing the Gap. We maintain that measureable targets, accountability mechanisms and appropriately funded policy design and program delivery are essential to closing the gap on Indigenous disadvantage.
With this renewed funding certainty, AIDA will continue working towards our vision for an Australian health care system that is free of racism, and one that affords Aboriginal and Torres Strait Islander Peoples the health care they have a right to expect and receive.
Reconciliation Australia
Reconciliation Australia acknowledges the Federal Government’s continued investment in services and programs for Aboriginal and Torres Strait Islander peoples. However, we are concerned that a crucial opportunity to reset the Closing the Gap strategy will be lost, given the absence of substantial needs-based measures to realise the strategy in the 2018-19 budget.
The budget includes spending on measures that will have a modest impact on areas relevant to improving life outcomes for Aboriginal and Torres Strait Islander people.
However, the budget papers delivered this evening do not outline a coherent and comprehensive funding plan to deliver the Federal Government’s overhaul of the strategy, due in October 2018.
In February, the Close the Gap campaign’s 10-year review said the Closing the Gap strategy had been “effectively abandoned” after $534 million in funding was cut from Aboriginal and Torres Strait Islander programs in 2014-15.
Despite a decade of consistent advice, key recommendations to address the increasing disparity between Aboriginal and Torres Strait Islander people and other Australians are yet to be funded.
For example, the National Aboriginal and Torres Strait Islander Health Plan Implementation Plan has not been funded. Also, the complementary National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 needs an implementation plan and funding as appropriate.
Additionally, there is no funding support to tackle the increasing rate of incarceration of Aboriginal and Torres Strait Islander people, despite recommendations from the Australian Law Reform Commission and the Change the Record campaign.
Reconciliation Australia CEO Karen Mundine said closing the gap was an agreed national priority, yet the budget failed to allocate the funds necessary to realise this commitment.
“Closing the gap is a national priority. Now is the time to invest in outcomes for Aboriginal and Torres Strait Islander people – to set this strategy up to make real progress,” she said.
“To get this right, we need a commitment to ongoing funding that is commensurate with the substantially greater and more complex needs of Aboriginal and Torres Strait Islander people, and is allocated in a way that allows Aboriginal and Torres Strait Islander people to design and develop our own solutions. Yet that’s not what’s been delivered.”
In addition to needs-based funding, Ms Mundine said an effective approach to closing the gap requires partnership with Aboriginal and Torres Strait Islander peoples to develop comprehensive, preventative, long-term approaches to address the issues affecting their communities.
“We welcome the $33.4 million commitment to Aboriginal and Torres Strait Islander health professional organisations to grow the Aboriginal and Torres Strait Islander health workforce, as recommended by the Close the Gap campaign,” she said.
“It’s promising that the government has previously indicated its intention to use a strengths-based approach in its Closing the Gap refresh, in order to empower Aboriginal and Torres Strait Islander communities to make key decisions.”
“However, this intention can’t be realised unless it is backed up with a strong commitment to provide adequate ongoing funding.”
Indigenous Allied Health Australia
Allied Health Undervalued in 2018 Federal Budget: Improving Aboriginal and Torres Strait Islander health and wellbeing must remain a national priority. Action is needed to improve outcomes for Aboriginal and Torres Strait Islander people.
Those actions must involve: a coherent strategy to tackle the causes of disadvantage and enable our people to achieve their potential; governments showing the stamina to address issues that come from generations of trauma and disadvantage; and commitment to work with, hear and respect Aboriginal and Torres Strait Islander people and the knowledge they bring to issues that shape their lives.
IAHA now has a commitment of funding for a further four years. We also have a commitment of $1.55M per year in additional funding to share with our fellow Aboriginal and Torres Strait Islander health workforce peak organisations: AIDA, CATSINAM and NATSIHWA. We have proven our approaches deliver results and build the Aboriginal and Torres Strait Islander health workforce.
IAHA has a significant advocacy role and interest in several other initiatives announced in the 2018-19 Budget, including measures responding to urgent needs across Australian communities, including:
• $105M over four years to improve access to aged care for Aboriginal and Torres Strait Islander people
• $30M over four years for ear health assessment in pre-schools
• $34.3M over four years for eye health and
• Extra commitment to suicide prevention, additional mental health care.
IAHA CEO Donna Murray said “For initiatives to deliver for Aboriginal and Torres Strait Islander people, community must be involved in how those measures are developed and implemented. This applies to new measures and to addressing existing acute allied health shortages in health, disability, aged care and other social services.”
A culturally safe and responsive skilled workforce is critical in working with Aboriginal and Torres Strait Islander people and communities. To ensure the workforce has the skills needed to deliver results, strategies and solutions need to be developed and delivered in partnership with IAHA, our members and communities.
“IAHA’s success thus far in developing and implementing innovative allied health career pathway programs and supports, providing leadership opportunities and development, mentoring, in partnering and in promoting person-centred, multidisciplinary care needs to be leveraged further. We, therefore, welcome a stronger partnership with Government to enable this success to continue and grow”, said Ms Murray.
IAHA chairperson, Nicole Turner,commented: “By leading and facilitating inter-professional approaches that fit with Aboriginal and Torres Strait Islander notions of health and wellbeing, we’ve supported and enabled rapid growth in the Aboriginal and Torres Strait Islander health workforce. But we still represent less than 1 percent of the allied health workforce. Our workforce must continue to grow. Continued funding for IAHA is a vital step in the right direction.”
IAHA welcomes the $550M allocated to the Stronger Rural Health Strategy and the aim of ensuring the right health professionals are available when and where they are needed. However, IAHA remains concerned and disappointed that acute shortages in rural and remote allied health services have been largely ignored, and particularly that there appears to be almost no gain for Aboriginal and Torres Strait Islander communities who have little or no access to allied health services at present.
CEO, Donna Murray, added: “IAHA will continue to advocate for the National Aboriginal and Torres Strait Islander Health Plan and Implementation Plan to be fully funded. IAHA will continue to seek opportunities to work constructively with Government to achieve this result.”
The National Aboriginal and Torres Strait Islander Health Workers Association
The National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA) welcomes the 2018 Australian Government budget announcement that signal growth in funding for Aboriginal and Torres Strait Islander workforce organisations.
These organisations (NATSIHWA, CATSINaM, IAHA and AIDA) work together to support the Aboriginal and Torres Strait Islander health workforces and improve health outcomes for Aboriginal and Torres Strait Islander people…
“We thank the Australian government for the continued support of NATSIHWA. This funding will not only enhance the sustainability of our profession, but will also lead to opportunities that promote the recognition and professionalism of Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners,” said Ms Josslyn Tully, NATSIHWA Chairperson.
In particular, the budget announcement supports the progression of NATSIHWA’s strategic plan 2017-2020. “Today’s budget announcement presents an important opportunity for NATSIHWA. It will enable us to progress
key strategic priorities, including the development of a National Mentor program to support Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners. This is a very exciting time for our members”, said Mr Karl Briscoe, NATSIHWA CEO.
“NATSIHWA looks forward to progressing these initiatives with our membership, which includes over 750 full members who are qualified Aboriginal and/or Torres Strait Islander Health Workers and Health Practitioners across Australia,” said Ms Josslyn Tully.
Climate change
Public health and prevention
Public Health Association of Australia
The Budget continues to fund the health care systems, but is woefully short on preventative health measures to keep Australians from becoming sick in the first place, according to PHAA Chief Executive Michael Moore AM.
“Despite repeated advice – and repeated commitments in principle – the Government is still not developing a preventative health focus for our health system,” said Mr Moore.
“It’s true there are a few modest measures tonight – including additional vaccinations funded, very welcome measures to promote mental wellbeing, and the Good Sports Program to reduce alcohol consumption in sporting contexts.”
“But Australia’s people will continue to experience avoidable chronic disease in the years ahead. People who should be destined to live healthy lives will not because of the preventable diseases they will suffer. While we need to look after the aged populations and those requiring medical treatment, we need to focus even more heavily on the younger generation we are failing,” Mr Moore said.
“The inevitable cost to Budgets far into the future will be greater than the investments that might have been funded.”
“What is also noticeable is that there are no preventive measures in this budget which impact negatively on industry.”
“Just last week we saw Australia’s first ever dedicated conference of preventative health professionals, with 300 expert Australians gathering in Sydney to debate the way forward to a more preventive approach to health and wellbeing.
“Yet tonight, preventive health has again been relegated to a low priority.”
“Future Health Ministers and Treasurers will rue the mistakes of this generation, including tonight’s Budget, in failing to invest in preventive health.”
Mr Moore also acknowledged Minister for Aged Care and Indigenous Health Ken Wyatt for securing a number of important initiatives in Indigenous health, Australia’s most agonizing continuing health crisis.
The Public Health Association welcomed a number of specific initiatives in tonight’s Budget:
– Improving physical activity with a $50.4m investment to get people moving and expanding other physical activity.
– Funding to expanding four forms of vaccinations, including Pertussis, and a targeted program to address low vaccination rate areas.
– A National Injury Prevention Strategy for children and older people, including a program to prevent water and snow sport injuries
– Additional funding for suicide prevention
Mr Moore also welcomed the government’s focus on quality in aged care.
The Australian Injecting and Illicit Drug Users League
The AIVL has welcomed some additional funding for drug treatment in tonight’s Federal Budget but is disappointed that other key harm reduction measures have missed out.
AIVL is calling on the Australian Government to abandon its planned trial of drug testing for welfare recipients and redirect that funding into frontline services in the wake of the Budget. AIVL is also calling for a stronger focus on people exiting custodial settings to strengthen Australia’s efforts under the new national blood borne virus (BBV) and sexually transmissible infections (STI) strategies.
“While the Government will provide $40M over 3 years to expand GP services ($20M) and provide additional funding for residential rehabilitation services ($20M), further investment will be required to ensure that the alcohol and other drug (AOD) service system is able to meet existing demand.
“Just yesterday, the Government reaffirmed its commitment to implementing a trial of drug testing for welfare recipients in its majority report for the inquiry into the Social Services Legislation Amendment (Drug Testing Trial) Bill 2018. However, the inquiry report is filled with expert testimony urging the Government not to proceed. We would like to see the funding that has been allocated for drug testing of welfare recipients redirected into frontline services,” explained Melanie Walker, Chief Executive Officer (CEO) of AIVL.
“There’s a full suite of evidence-based interventions in the AOD sector but services are currently under-resourced and struggling to keep up with demand. For instance, we already knew from previous studies that investment in Needle and Syringe Programs (NSPs) between 2000 and 2009 prevented nearly 97,000 Hepatitis C infections and 32,050 HIV infections – for every dollar spent on NSPs, more than $4 will be returned in savings to the health system. AIVL recently released a new report looking at ways to enhance the effectiveness of NSPs across the country to address access issues and maximise the public health benefits[ii]. NSPs remain a very cost effective way of preventing the transmission of BBVs – increasing access to NSPs should be a high priority.
“Evidence-based AOD treatment is also a good investment. For every $1 invested in AOD treatment, society gains $7. However, while approximately 200,000 people receive AOD treatment in any one year in Australia, it is estimated that an additional 200,000 – 500,000 people seeking treatment are unable to access it[iii]. People don’t need to be coerced into accessing drug treatment – there just aren’t enough treatment places to meet demand. This Budget will go some way towards addressing unmet need but there’s a long way to go if we are to meet the needs of those individuals, families and communities struggling to address AOD problems.
“It is also important that people entering and exiting custodial contexts are not forgotten. Ensuring access to the full suite of preventive, harm reduction measures – and ensuring that people are able to continue their engagement with AOD and BBV treatments post-release – are tangible ways that we could protect more Australians from contracting BBVs. There is a real need for a national policy to guide prisons in jurisdictions[iv].
“It would be great to see enhanced investment in these types of cost effective harm reduction and demand reduction measures as part of future federal budgets,” said Ms Walker.
AIVL is the national organisation representing people who use/have used illicit drugs and is the peak body for the state and territory peer-based drug user organisations.
The Australasian Injury Prevention Network
The Australasian Injury Prevention Network (AIPN) has welcomed the allocation of $0.9 million over three years to develop a new National Injury Prevention Strategy in the 2018-19 budget.
“The current National Injury Prevention and safety Promotion Plan, 2004-2014, urgently needs to be reviewed and updated,” said AIPN President Rebecca Ivers.
“With injury the leading cause of death and disability in young people and those of working age, the government cannot ignore the impact of preventable injuries on the health of the Australian population and the new budget measures are a much needed support to the relentless work of injury prevention professionals around the country,” Professor Ivers said.
“The AIPN will be talking to government officials to provide input into the new Strategy. In particular we are delighted to hear that the strategy will have a whole-of-population approach and that populations with high rates of injury – including Aboriginal and Torres Strait Islander people, people at socioeconomic disadvantage, people with mental illness, and people living in remote, rural and regional locations – will be specifically addressed through the strategy,” she said.
As well as the development of a new National Injury Prevention Strategy, the budget provides for the expansion of a range of injury prevention initiatives including $6.3 million over four years to sports safety; $15.5 million over five years to water and snow safety and $1.2 million to develop a suicide prevention campaign.
The AIPN will continue to advocate for more support and resources towards injury prevention and provide a united voice to injury prevention professionals from all settings.
General Practice Registrars Australia
The President of General Practice Registrars Australia (GPRA), Dr Melanie Smith said today that one set of initiatives in the Federal Budget 2018 is critically important for protecting the health of Australians into the future.
“The measures listed under ‘supporting the development of preventive health initiatives’ may not get much media attention but they will help turn the tide against unhealthy lifestyles and Australia’s escalating chronic disease burden,” said Dr Smith.
“Of particular note is the intention to encourage healthy lifestyles through increased physical activity and better nutrition,” she said.
“One of the proposed projects is the development of training and educational resources for general practitioners to support their patients to embrace healthy lifestyles.”
“An important next step, to support this initiative, will be to develop an effective way of funding GPs to allocate time to assist patients to make critical lifestyle changes, “ she said.
“Resources are important but we must also ensure that GPs are funded in a way that allows them to be effective change agents and foster the patient behaviours that will improve health outcomes.”
“We must acknowledge and support the cornerstone role of general practice in managing the whole patient and this Budget initiative supports recognition of that role.”
“General practice is the logical home for new initiatives to influence behaviours,” said Dr Smith. “It is the one part of the health system that can take a holistic approach to ensuring the well-being of Australians.”
“Within this context, it is critically important that we continually review the role of GPs, and their training arrangements, if we are to ensure they are highly effective in making a contribution to reducing the burden of chronic disease in Australia and to make sure we get the maximum benefit from key measures funded in the 2018 Federal Budget,” said Dr Melanie Smith.
Mental health
National Mental Health Commission
The Federal Government’s budget firmly demonstrates a commitment to making the mental health of our nation a top priority, according to the National Mental Health Commission. The Government will invest $338.1 million over the next 4 years in a range of worthy initiatives.
The Commission’s CEO, Dr Peggy Brown AO said the Commission’s annual budget increase of $3.1million will strengthen its important role to identify what’s working and what’s not in the mental health and suicide prevention systems, and to provide advice to government and the community, to achieve better outcomes for people who need mental health support.
“This includes monitoring and reporting on the implementation of the Fifth National Mental Health and Suicide Prevention Plan and aspects of the National Disability Insurance Scheme (NDIS) relating to psychosocial disability,” Dr Brown said.
“The mental health sector is looking for significant improvement from these reforms and it’s important to know whether the desired outcomes are being achieved.”
The Commission’s Chair Lucy Brogden praised the Government’s commitment to the mental health of all Australians and noted that the mental health funding announced in the budget will enable the delivery of improved services and programs.
“The Commission has a suicide target towards zero. The government’s provision of $33.8 million towards Lifeline to significantly boost its telephone service and $37.6 million to beyondblue to provide aftercare following a suicide attempt will provide vital help to many people who have reached a crisis point in their lives,” Mrs Brogden said
“Older Australians in residential care will also benefit from the $82.5 million committed to ensuring that they can receive adequate mental health support when they require it. In addition, those over the age of 75 years living in the community whose mental and physical health are at risk because of social isolation and loneliness will also receive support from a $20 million mental health nurse led service .
“Digital mental health services are a cost-effective treatment option for many people seeking help for mental health issues. Further supporting the Government’s Head to Health service through $4.7 million for an improved telephone service and enhanced portal provides for greater accessibility for anyone seeking help is a welcome investment.”
Dr Brown also commended the much needed focus on mental health research, with $125 million over 10 years going to the Million Minds Mission from the Medical Research Future Fund.
“Ongoing research into the causes, prevention and treatment of mental illness is critical for reducing its prevalence and impact. This initiative will assist an additional one million people who might not otherwise be part of mental health research and clinical trials, to access new approaches to diagnosis, treatment and recovery,” Dr Brown said.
“The needs of rural Australians have not been overlooked, with $20.4 million provided to the Royal Flying Doctor Service to enhance their mental health outreach services. For many Australians who are not otherwise able to access mental health care, this will be a much needed boost,” she said.
Mrs Brogden concluded: “While there remains a high level of need for mental health and suicide prevention services across the nation, the commitment shown by this Government to meeting that need is exemplary.”
Community Mental Health Australia
The measures for mental health are positive, if not unexpected. There is a focus on suicide prevention with more money going to PHNs and the expansion of programs already in operation.
The funding to Lifeline crisis support line had already been announced. Much of the funding is focused more on the crisis side of services, a pattern we are seeing in state and territory budgets as well.
The inclusion of a rural health strategy is a positive; however, there is a not a strong role for the community managed mental health sector articulated and a focus on GPs and doctors.
A comprehensive rural health strategy needs to include all aspects of the workforce, particularly those profession that are more likely to be the ones doing the work on the ground, which often is the community sector. CMHA have called for all parts of the sector to be included in an overall mental health workforce strategy.
The most significant the inclusion for the sector is funding for Continuity of Support arrangements. The funding will go to the PHNs, however, it is unclear at this stage how this will be administered; what will be the eligibility criteria (e.g. do people have to be existing clients in PIR, PHaMs and D2DL or can they have been clients in the past); and what a continuity of support service will look like.
DSS are continuing to argue people have to test their eligibility to access the support. CMHA has stated strongly and will continue to do so that people should not have to test their eligibility and that the intent of the Continuity of Support policy must be applied in that people must be provided with the same level of access to services.
CMHA developed a continuity of support positions statement, which predicted that PHNs would have a role in administering this funding. The statement notes that people whether eligible for the NDIS or not will have to access one of four pools of funding – NDIS, continuity of support, the $80m from the 2017-18 budget, or the PHN flexible pool of mental health funding.
People shouldn’t have to go through an expensive and stressful test of NDIS eligibility in order to access the services they need and are entitled to. Preventing access is against Australia’s obligations under the UN Convention on the Rights of People with Disability.
There is also $64.3 million over four years from 2017‑18 to establish an NDIS Jobs and Market Fund which will invest in targeted initiatives to promote the development of the market for the NDIS workforce.
The Fund will develop resources to assist disability service providers to take advantage of NDIS opportunities, including provider toolkits, good practice guides and service coordination platforms.
We welcome this initiative; however, the key issue that remains for the community mental health sector is the loss of qualified expertise in the mental health workforce. This is an issue of safety and quality which won’t be addressed through such a measure as it is more complex than just encouraging more providers to come into the market. In fact it is about maintaining and enhancing existing expertise to be able to deliver appropriate support to complex clients.
SANE Australia
SANE Australia welcomes the Australian Government’s announcement of a $1.2m investment for a new suicide prevention campaign, led by SANE in collaboration with other leading mental health organisations.
SANE Australia Chief Executive Officer Jack Heath explained the funds will see the development of a pilot suicide prevention campaign targeted specifically at people contemplating suicide. He said:
“The campaign plans to share the stories of real Australians who have survived a suicide attempt in an effort to connect those at risk with appropriate resources and support.
“The concept has been developed off the back of international evidence that reveals a sense of burdensomeness plays a significant part in the thinking of people who are at risk of suicide.”
In its initial phase, the campaign will be trialed in three locations nationally.
“The number of Australians dying by suicide every year is tragically high, with the latest figures revealing 2866 people took their life in 2016,” Mr Heath said.
“Suicide is the leading cause of death for people aged 14 to 44 years and the third leading cause of death for people aged 45 to 55.
“We are very pleased that the Government has recognised the need to invest in new and innovative approaches to prevent suicide.
“This campaign will allow us to connect with vulnerable Australians who believe that the world is better off without them.”
The campaign will be underpinned by a rigorous research and development phase and will be designed with learnings from people who have contemplated suicide
“We expect these real stories will resonate strongly with vulnerable viewers as they’re coming first hand from someone who has walked their path and understands what they’re feeling,” Mr Heath said.
Suicide Prevention Australia
Suicide Prevention Australia welcomes funding commitments to the health and wellbeing of older Australians alongside significant investment in core crisis support infrastructure, scaling of innovative trials in aftercare and a campaign inspired by personal stories of suicide attempt survivors.
Suicide Prevention Australia Chair Matthew Tukaki said: “We applaud an increase in services to older people to live the lives they aspire to, and call for ongoing support for programs that seek to minimise social isolation and increase civic participation of older people as a balanced way to address the growing trend of depression and suicidal ideation in older people.”
Also in the Budget tonight, and in the days preceding the announcements, we saw a number of commitments to suicide prevention funding including:
$33.8m for Lifeline Australia crisis support services over the next four years
$37.6 m for beyondblue and colleagues for the Way Back Support Service
$12.4m to strengthen the National Mental Health Commission including expanded role under Fifth National Mental Health and Suicide Prevention Plan
$1.2m for SANE Australia’s campaign inspired by personal stories of suicide attempt survivors.
“Suicide is a complex public health issue that requires long term solutions. While the quantum of funding in suicide prevention is still yet to match the magnitude of the public health problem at hand, the 2018/19 Federal Health Budget is a step in the right direction.”
Healthcare reform
The National Oral Health Alliance
The National Oral Health Alliance (NOHA) was very disappointed with the lack of investment in the Commonwealth Budget for oral health.
Spokesperson for the Alliance, Dr Chris Bourke, noted: “NOHA is very concerned with the continued refusal by the Commonwealth Government to make oral health a priority”.
“Much more could have been done including restoring the $155 million that has previously been cut out of the National Partnership Agreements for public dental care; effective promotion of the Child Dental Benefit Scheme that continues to be underutilised by those who need it most; more fluoridation of water supplies in rural and remote townships; and support to increase dental practitioner numbers, and improve workforce mix, in rural and remote Australia.”
“Whilst the modest support for dental outreach by the Royal Flying Doctor Service is welcomed this is simply insufficient to meet the demand in remote communities.”
NOHA is also frustrated dental practitioners were specifically excluded from the Workforce Incentive Program announced in the Budget.
“The shortages of dental practitioners in rural and remote Australia are well known, and yet the Government has deliberately excluded oral health from this new program.”
Consumers Health Forum
Record funding for hospitals from 2020 and a $5 billion rise for aged care are contained in a Federal Budget which also provides for more consumer-focused approaches to care and research.
Hospital funding will include $100 million for innovation in providing hospital services aimed at bringing down avoidable admissions, including through better coordinated primary and transitional care.
“This is a welcome measure that will leverage co-investment from the states and recognises that hospital reform must be about so much more than simply investing in more beds,” Leanne Wells, the CEO of the Consumers Health Forum, said.
“The scope to look at models of care that involve specialist hospital providers working in innovative ways outside of the hospital walls and better integrating with primary and community health services is an exciting, patient-friendly prospect that should be actively pursued with this funding.
“We also welcome greater consumer focus in the sharply increased medical research funding which will include $150.4 million over four years form the Medical Research Future Fund to support better translation of research into better patient care.
“It is appropriate that this measure includes a pledge that consumers will have a role in helping to identify research priorities, a move we have supported for some years. We welcome that research focus as it is likely to mean that Australians can benefit more quickly from research which can be translated into more effective treatment and better care,’’ Ms Wells said.
“We also welcome the commitment to explore consumer-driven research – so often research is investigator driven when there are benefits to be gained in health system research agendas that are co-designed by clinicians, consumers and researchers.
“In aged care, the provision of 20,000 more high level home care packages for older people to remain in their own homes and receive the support services they require is a step in the right direction that will go some way meet the expanding demand for home-based care,”
“People want to remain in their own homes and prefer home care. Add to that the fact that it is often more cost-effective for the individual and for government and it makes good sense to increase the number of places.
“Poor health literacy and difficulty understanding the health and aged care system can be a major barrier to access for many older Australians. Bolstering the home care packages with navigators helps ensure older Australians living at home get maximum benefit out of other supports available to them in the community.
“Change is constant in health care and we are seeing the consequences of this with changes to payments for different services flowing from the Medicare Benefits Schedule review. This will mean new payments for some diagnostic services while others will no longer be eligible for Medicare benefits.
“The review is identifying areas of unmet need for evidence-based new therapies while delisting those therapies for which there is insufficient evidence.
“There will be increases in funding for mental health services. We particularly welcome the support for the critical services provided by Lifeline and to better support people discharged from hospital after a suicide attempt. That this funding will be directed through Primary Health Networks to implement will ensure integration with the work PHNs are doing on mental health stepped care.
“Attention to promoting good infant and maternal health is long overdue. This Budget contains a raft of measures designed to address this, including significant measures such as $241m for the spinal muscular atrophy drug Spinraza for the infants and the additional funding to make whooping cough immunisations available for pregnant women.
“While the additional funding for hospitals, Medicare, aged care and medicines is welcome, there is a strong case for greater emphasis on primary health care that focuses on local health services to respond to local need for integrated care, particularly for chronic illness.
“There are some very good down payments such as the Workforce Incentive Program that will enable general practices in all locations to strengthen team-based multi-disciplinary primary care by employed non-dispensing pharmacists and allied health providers. However longer-term primary health care reforms must remain on the radar as part of keeping Medicare up to date. We remain concerned about people’s ability to access the care they need because of expense as demonstrated by our recent Out of Pocket Pain survey.
“We are disappointed that the Government has not taken up the many calls for a national obesity strategy. This is the number one preventable public health challenge for Australia.
“A comprehensive obesity strategy should include curbs on the exposure of children under 16 to promotion of unhealthy food and drink marketing, strengthen the healthy food star rating system and fund a comprehensive national plan to promote routine physical activity and public transport use,” Ms Wells said.
Australian Healthcare and Hospitals Association
‘The substantial boost in funding for better health data in this year’s Federal Budget is a great building block for much-needed reform of the system—and the government is to be congratulated for it’, Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven said today.
The Australian Government announced a boost of $30 million over 4 years to the Australian Institute of Health and Welfare to improve accessibility to health information and statistics, including better data sharing capability and information and communications technology upgrades.
‘As outlined in our Healthy people, healthy systems blueprint for healthcare, which we released last December, we need to reorientate our healthcare system to focus on patient outcomes and value rather than throughput and vested interests. To make things better we have to have an accurate picture of what is going on now—and we can get this through better healthcare data.
‘While the news on data is good, it’s disappointing that there have been no major announcements boosting the capacity of public hospitals to cater for what is now overwhelming demand, nor to better coordinate the two-way divide between primary care and hospital care.
‘Another critical area specified in our blueprint is moving care away from high cost hospitals where possible to patient-centred primary and community care, including disability care, aged care and mental health care services.
‘The $1.6 billion in increased funding for 14,000 additional high level home care packages by 2021–22 is therefore welcome news—however over 100,000 people are waiting, so much more needs to be done.
‘We also welcome the increased $82.5 million investment in mental health services in residential aged care facilities, and the broader mental health investments announced in this Budget.
‘Other community services have largely been overlooked, and there is no commitment in the Budget to meaningful reform of the health and community services workforce to best deliver integrated care. Investment in workforce development, particularly in rural Australia, is welcome, but this is only one part of the jigsaw. Much more needs to be done to develop a workforce that will support the needs of an ageing population.
‘In terms of modernisation of the system we also welcome the continuation of the Medicare Benefits Schedule Review process, where old treatments and procedures are being phased out in favour of those that are more effective and of better value. It is, however, a significant oversight that palliative care in general practice has not been prioritised for funding reforms.
‘The lack of any concrete action on preventive health is concerning—it has been allowed to slip down health budget priorities, despite its proven benefits in preventing big health bills later. This particularly applies to dental health, which once again has been overlooked.
‘In terms of Closing the Gap in Aboriginal and Torres Strait Islander health, we note some modest investments, including the commitment of $5 million per year for the next 3 years to address trachoma in Aboriginal communities’, Ms Verhoeven said.
‘It is disappointing that the government didn’t take the opportunity to address one of our pre-Budget recommendations to make the administrative changes to ensure patients discharged from hospital have access to Closing the Gap prescriptions. This would have been a practical and relatively inexpensive measure to improve health outcomes for Aboriginal and Torres Strait Islander peoples.’
ACEM President Dr Simon Judkins said this message was more important than ever following announcements of investment in hospital infrastructure and record funding for hospitals across the country, contained in tonight’s budget.
“While assistance to the States and Territories for public hospitals is welcome, attention needs to turn solving long-term system wide issues such as access block in emergency department — the inability to admit patients to the hospital because of inadequate bed numbers,” Dr Judkins said.
“The nation’s emergency physicians care for any patient, any time. Patients are living longer and are managing more complex and chronic conditions. This is on top of the spike in patient numbers emergency departments experience when peak winter demand hits.
“All this puts an increased demand on an already stretched system.
“We need investments in staff to support patient’s experience of care and evidence-based solutions that are underpinned by clinical expertise – too often emergency specialists are removed from key decisions made about emergency departments.
“‘We’re committed to working in partnership with the Federal Government to ensure long-term system wide reforms are implemented.”
Emergency medicine workforce
ACEM acknowledges workforce maldistribution is an issue facing all specialities including emergency medicine.
“We are committed to doing our bit, and to working with stakeholders to address emergency medicine workforce needs in Australia, especially in rural, regional and remote areas,” Dr Judkins said.
ACEM’s role in providing a trained workforce to provide emergency care for all populations including rural, regional and remote communities continues – through the FACEM Training Program, Emergency Medicine Certificate, Emergency Medicine Diploma, the Emergency Medicine Education and Training Program, the externally-funded Specialist Training Program and the Integrated Rural Training Pipeline.
Mental health care
ACEM has been outspoken that that emergency departments are seeing an increasing number of patients with mental health disorders across all age groups.
Earlier this year, ACEM identified the unacceptable wait times of patients with acute mental and behavioural conditions in emergency departments, and called for a new approach to mental health care in emergency departments.
“Alarm bells should be ringing when people who come to the hospital in a crisis and need to be admitted, because there just are not the beds for them, they are spending extraordinary amounts of time – sometimes days – in emergency departments; I don’t think that’s something that our community would think is fair,” Dr Judkins said.
“Emergency physicians on the front line are best placed to be involved in the planning and implementation of any new model of care for some of the most vulnerable people in our communities.”
Dr Judkins added that preventative measures, such as funding for Lifeline’s 24-hour telephone service, more mental health services for the elderly and initiatives for mental health nurses in rural areas, are welcomed and will hopefully increase community support for those needing mental health care.
Keeping Australians Out of Hospital program
Dr Judkins commented: “The combination of an aging population, increasing numbers of emergency department presentations and reduced inpatient capacity contributes to overcrowding and access block. Preventative measures that address specific patient groups have the potential to correct this scenario.”
St Vincent’s Health Australia
St Vincent’s Health Australia – Australia’s largest not-for-profit health and aged care service provider – has welcomed the Turnbull Government’s commitments in the health and aged care portfolios in this year’s federal budget.
“After years of cuts and savings in the health portfolio, last year’s health budget made up lost ground,” said St Vincent’s Health Australia CEO, Toby Hall.
“This year’s budget is undoubtedly a further move in a positive direction.
“As a provider of 17 aged care facilities in NSW, Queensland and Victoria, we welcome the government’s extra efforts in this area. The number of older Australians is growing rapidly, aged care services across Australia are already at full tilt trying to meet demand.
“St Vincent’s strongly supports the increase in new residential aged care places as well as the extra funding to ramp up the number of Home Care Packages for older Australians who want to receive aged care in their home.
“We are particularly happy with the Government’s extra investment to improve palliative care and mental health care for older Australians in residential aged care. Both are areas of real need.
“And we also welcome the Government’s attention towards fighting elder abuse, particularly expanding health-justice partnerships. St Vincent’s Hospital Melbourne is a national leader in tackling elder abuse in healthcare settings, so this is an issue that’s close to our hearts.
“St Vincent’s is a partner in three of Australia’s leading medical research institutes – the Victor Chang Institute, the Garvan Institute and St Vincent’s Institute of Medical Research – so we applaud the new National Health and Medical Industry Growth Plan to fund genomic research projects, medical technologies and clinical trials of new drugs.
“Genomics and biomedical engineering – for which St Vincent’s hospitals and research institutes are at the forefront – are this century’s big game-changer. They will produce many of the most exciting and important medical advances of the next 50 years along with lower health costs, the creation of new industries and high-skilled jobs, and significantly, the commercialisation of new products.
“Australia has the chance to be a world leader in this area and so this funding is extremely good news.
“And it won’t grab the headlines, but the Government putting extra money towards improving follow-up care for people discharged from hospital following a suicide attempt will no doubt save the lives of some of our most vulnerable – it should not go unremarked on.
“But while the Government might have found $40 million to support training for GPs in treating and responding to alcohol and drug addiction it’s left the genuine unmet demand out there for treatment services untouched.
“Unmet demand for alcohol and drug addiction treatment services in Australia is estimated at between 200,000 and 500,000 people over and above those already receiving care. This needs urgent attention.”
Australian College of Nursing
The Australian College of Nursing (ACN) supports the investments that have been announced in tonight’s Federal Budget, particularly those designed to strengthen Australia’s valued nursing workforce.
Initiatives funded include:
- 3,000 extra nurses to improve the health of people living in rural, regional and remote areas;
- Exploring nurse models of health care delivery that can provide primary health care to support the nursing workforce;
- An independent review of current nursing preparation and education which will explore improvements to the system and consider factors that affect nurses entering the nursing workforce;
- Funding for frontline service delivery by nurse practitioners; and
- $20 million for a mental health nurse led service focused on reducing mental health impacts of social isolation for Australians over 75 years of age.
“By investing in and supporting our nursing workforce, the Australian community can feel confident that nurses will be available to provide care now and into the future,” said CEO of the Australian College of Nursing, Adjunct Professor Kylie Ward FACN.
“We are pleased to see that aged care reform is a major topic in the Budget announcement and this needs to remain front and centre as a Government priority.
“Care for older Australians is a priority for the Australian College of Nursing and so is meeting the needs of ageing Australians, particularly with a focus on healthy ageing. ACN will be looking to see funding support for gerontological nursing to provide safe and appropriate care for the complex needs of the elderly.”
The Australian College of Nursing is pleased to see that whooping cough vaccine to be made available to all pregnant women free of charge as ACN strongly advocates for immunisation for vulnerable people.
“According to the Commonwealth Fund’s Comparative Analysis of Health Systems, Australia’s health care system performance is a close second to the United Kingdom. Yet we rank in the bottom half when it comes to equity. This means, Aboriginal and Torres Strait Islander peoples, low income families, those who live outside our major metropolitan cities, or people who are new to Australia, do not always have the same access to best practice care that many of us take for granted,” said Adjunct Professor Ward.
“Whilst there is an investment in rural and remote areas, the ACN would like to see that nursing specialisation is essential to providing care to these communities.
“What is pleasing about the focus of these investments tonight is that it makes a number of vital health care services more affordable for all.
“Nurses need to be at the table where all decisions will be made regarding new funding announcements to ensure they will be successful. The aged care promises in particular are ones that will be closely examined to ensure the changes are creating better outcomes for older Australians.”
The Society of Hospital Pharmacists of Australia
SHPA welcomes strong and sustainable focus on medicines and public hospitals For immediate release
A continued focus on supporting sustainable access to new and existing high-value medicines while affirming support for public hospitals and equity of healthcare access in rural and regional Australia were welcome aspects of the 2018 Health Budget, the Society of Hospital Pharmacists of Australia (SHPA) said this evening.
Chief Executive Kristin Michaels says SHPA shares the Federal Government’s vision for the Pharmaceutical Benefits Scheme (PBS) to offer maximum value to Australian patients in a sustainable manner.
‘The $2.4bn commitment to both currently-scoped and future new medicines on the PBS shows strong ongoing support for streamlined access to the best treatments for Australian patients, as soon as they are available.’
‘Hospital pharmacists facilitate 22 per cent of PBS expenditure – a proportion that is growing each year – and play a crucial role managing the introduction of cutting-edge medicines and, on behalf of our members, we welcome tonight’s strengthening of the Life Saving Drugs Program, including the introduction of additional listings.
‘We would welcome further consultation on how medicines remuneration can be best managed to achieve optimal health outcomes for all Australians.’
‘SHPA also supports funding for education and training modules for health providers to increase prescribing of generic and biosimilar medicines – hospital pharmacists have led the way supporting greater use of these medicines, which are of comparable quality, safety, and efficacy but can deliver significant cost savings.’
Ms Michaels says the 2018 Health Budget contained a vote of confidence in the public hospitals as key drivers of healthcare innovation.
‘It is positive to see $30.2bn in increased funding for public hospitals though the National Health Reform Agreement, which acknowledges their central role in providing care for our nation.
‘SHPA will maintain particular interest in the implementation and outcomes of $100m for health innovation – set aside within this funding – given hospital pharmacists are important drivers of innovation within the public healthcare system.’
Ms Michaels says SHPA also welcomes the Budget’s focus on healthcare equity in rural and regional areas.
‘By encompassing allied health professionals in the newly announced incentive scheme, this Budget adds impetus for primary healthcare settings across the country to hire a pharmacist, and include a medicines expert in their team, perhaps for the first time.
‘Additional loading makes this prospect particularly attractive outside major cities, which is appropriate recognition of the importance of pharmacists’ roles and the support they can provide in areas where equitable access is harder to achieve.’
Pain Australia
The government has championed its spending measures in the Health Budget as increases in Medicare funding ($4.8 billion); public hospital funding increase of $30 billion; investment of $2.4 billion in new medicines and funding of $5 billion for aged care.
However, there are four additional measures that will provide some impact in the pain area. They include:
• a mental health funding of increase in the form of $338.1 million focussed on a range of measures such as suicide prevention ($1.2 million), crisis support ($33.8 million to Lifeline), outreach (beyondblue $37.6 million, Royal Flying Doctor Service $20.4 million), research ($125 million), psychological services in residential aged care for older Australians ($82.5 million) and in the community ($20 million)
• investment of $6 billion for health and medical research
• a rural health strategy including more training for doctors and growth in multidisciplinary care and increased access to nursing and allied health services in the regions ($95.4 million)
• Indigenous health to receive $3.9 billion over four years.
While the word ‘pain’ is non-existent in the many statements in the Health Budget pack, it does specifically include $1 million for a program aimed to assist GPs and frontline health professionals to learn more about endometriosis to enable them to better diagnose and treat the condition.
The other major initiative in the Budget that will impact on people living with pain but does not specifically address the condition is a sport and physical activity initiative worth $230 million.
General Practice Registrars Australia
The CEO of General Practice Registrars Australia (GPRA), Dr Andrew Gosbell said today that, although it is receiving no new funds, the continuing commitment in the Budget to supporting national health and peak advisory bodies remains a critical cornerstone for achieving a more effective health system.
“There are a number of powerful new initiatives in the Budget,” said Dr Gosbell. “However, continuing support for national peak organisations will be critical for underpinning the success of those new initiatives.”
“The confirmation of the government’s intention to maintain agreements with health-related national peak and advisory bodies may not receive much media attention but it is critically important.”
“It is ‘information sharing and relevant, well-informed advice’ that can inform, shape and ensure the success of what is a well-considered and strategically sound Budget.”
“GPRA has undertaken, and will continue to undertake, national quantitative and qualitative research to better understand the perceptions and circumstances of general practice registrars,” said Dr Gosbell.
Aged care
Catholic Health Australia
The central theme for the Federal Government’s 2018-19 Aged Care Budget is More Choices for a Longer Life. The major item is an additional 14,000 high-level home care packages to enable older Australians to choose to stay in their homes longer. Additionally pensioners will be able to earn more without reducing their pension and there will be greater flexibility to use home equity to increase retirement incomes.
Catholic Health Australia Director Aged Care, Nick Mersiades, said by any measure this is a good budget for older Australians. “The extra Home Care Packages will ease the pressure on the waiting list for places and together with the other measures shows the Government is on the Aged Care Sector Roadmap journey.”
Additional aged care Budget measures include:
13,500 new residential aged care places and 775 short-term restorative places to be made available where they are most needed, plus $60 million for capital investment;
$40.0 million to support aged care providers in regional, rural and remote Australia for urgent building and maintenance works;
More than $105 million will improve access to culturally safe aged care services in remote Indigenous communities;
The Government will establish an Aged Care Quality and Safety Commission with an additional $50 million to assist providers implement the new standards;
A MyAged Care investment of $61.7 million to make it easier to use, along with simplifying the forms required to apply for aged care services, and $7.4 million to trial navigators to assist people to choose the aged care services that suit their needs.;
$32.8 million to improve palliative care for older Australians living in residential aged care and $5.3 million for innovations in managing dementia, and $102.5 million for mental health programs for older Australians.
COTA Australia
Australia’s leading seniors’ advocacy organisation, COTA Australia has welcomed the Federal Budget as a positive step towards preparing for and supporting an older population and capitalising on the opportunities it presents.
COTA Australia Chief Executive Ian Yates said the Government’s More Choices for a Longer Life Packagewill ensure better co-ordination of services across government and more support for Australians at every stage of their life.
“This is the first time we have had a full ageing package that takes a proactive approach to an ageing Australia and takes a life cycle approach that recognizes the need to prepare properly for an ageing population and support all Australians as they move through life.
“The challenge now is to make sure that this is not a one off, so we will be asking the Government to commit to an Ageing Strategy that will tie the Budget measures together, monitor their progress and recommend change and expansion based on experience, making sure the momentum begun tonight carries through for all Australians as they age.
“Every cent spent on supporting independence as we age, keeping people connected to the workforce and community, and on preventative health, is money saved in emergency wards, acute health care and on our already stretched aged care system.
“This Budget goes a significant way towards helping Australians continue to work if they choose to do so, help Australians plan financially for their retirement, and support us all as we get older by improving access to home care and choice in aged care.”
Aged care (home and residential)
“The aged care package is a substantial implementation of the recommendations of the Tune Legislated Review and will change the face of aged care towards greater consumer control.
“The injection of 20,000 high needs home packages (6,000 in MYEFO and 144,000 tonight), in addition to the growth already built into the forward estimates, will ensure more older Australians waiting for home care will receive a package over the next year and the merging of Home Care and Residential funding pools will make more Home Care Packages possible in future.
“We strongly welcome the government’s in principle decision to put residential beds in the hands of consumers and funding the development of a plan to achieve this. We need a commitment to a specific date for this change at latest by next year’s Budget”.
“Until then with residential care allocated to providers, not in response to consumer demand, older Australians still do not have the ability to choose their nursing home, and good providers are retrained from responding to consumer preferences.
“We also strongly welcome the government’s commitment of $82 million to a new mental health program for residential care, as well as a $20 million trial of new mental health initiatives in the community, and other support services to keep people connected to community.
“We also welcome increased funds for palliative care in residential aged care, where too many older people now end their life in less than ideal circumstances.
Supporting mature age workers
“We welcome the proactive approach to an ageing Australia that takes a whole life cycle approach, which includes some very good measures to support employment opportunities for mature aged workers, particularly the employment and health checkpoint at age 45 backed up by a range of support services.
“It’s good to see the government tacking the issue from a number of angles, including support for older entrepreneurs wanting to set up a small business. Investing in growing the productivity of the mature age workforce will pay big dividends over time.
“COTA looks forward to working with the government to promote programs and fight ageism in our employment market.”
Retirement Incomes
The Budget includes a welcome range of measures to improve the standard of living of older Australians, including:
Increasing the Pension Work Bonus by $50 a fortnight so that retirees on the Age Pension can earn up to $300 per fortnight that’s not taken into account for the pension income test, encouraging them to supplement pension income and stay connected to the workforce.
Amending the pension means test to encourage the development and take-up of lifetime retirement income products, supporting the development of Comprehensive Income Products for Retirement (CIPRs)
Dramatically expanding access to the Pension Loan scheme to everyone over pension age and increasing the maximum fortnightly income to 150% to of the Age Pension rate, which will allow older people to access their home equity to supplement retirement income, pay for extra aged care, undertake home modifications, and other needs
“We also welcome the measures in the Protecting your Super Packageto cap admin fees, ban exit fees, stop people having to have multiple insurance policies, and returning lost super.
Elder Abuse
“We welcome additional funds for elder abuse initiatives and the Federal Government asking leadership in the development of a national framework and approach, including a national register of enduring powers of attorney.
Palliative Care Australia
Palliative Care Australia CEO Liz Callaghan welcomes the comprehensive palliative care in aged care measure announced in today’s Federal Budget.
“The $32.8 million investment into specialist palliative care support in residential aged care is welcomed and supports PCA’s call that palliative care should be core business in aged care, however this is contingent on matched funding from the states and territories.
“The measure shows the Commonwealth’s commitment to ensure palliative care is included in aged care service provision, and not just end-of-life care. Like the Productivity Commission, we call on cross jurisdiction cooperation to avoid problems resulting from poor stewardship, which ultimately leads to aged care services not responding as they should to users’ palliative care needs and choices.
“Australian studies have shown that when specialist palliative care services are brought into residential aged care settings, there is a reduction in unnecessary hospitalisations and an improvement in symptom and pain management.
“I also am pleased to see 20,000 more high level needs home care packages to support people to live longer at home. Palliative care support must be a component of this care as many of these people would choose to receive care at home and to die in their own homes.
“The Government has also announced streamlined and faster consumer assessments for all aged care services. This must enable rapid access to palliative care if required and will ensure care is received at the right time and in the right place. We only get one chance to die, so we must get it right.
“The Government will introduce a performance rating for aged care service providers against the new quality standards and improve complaints processes, and put in place an approach to respond to care failures.
“PCA would like to see specific palliative care quality indicators across residential and community aged care. For example, all staff need to be trained and equipped to recognise the need for appropriate end-of-life or palliative care, including appropriate pain management and the signs of approaching death.
“We look forward to the Government working with us and our state and territory members to improve palliative care delivery in aged care. However we must also recognise that caring for people who are approaching and reaching the end of life at any age is everybody’s business – everybody in health, aged and social care has a role to play,” Ms Callaghan said.
The Government also announced significant expansion of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program, which will mean people will have greater access to culturally safe aged care services in remote Australia.
“PCA welcomes support for culturally appropriate palliative care and end-of-life care provision on country, which allows access to family and community support, in addition to models of care that support culturally appropriate grief and bereavement practices,” Ms Callaghan said.
The announced $102.5 million investment to support the mental health needs of older Australians is also welcomed.
“The Principles for Palliative and End-of-Life Care in Residential Aged Care call for the mental health needs of consumers to be assessed, documented and met including treatment for anxiety or depression. This measure will address some of the mental health issues for chronic or serious health conditions. Grief, bereavement and spiritual support must be included in this initiative.
“Among a range of measures in rural health, the Government will strengthen the role of nurses in primary health care, including greater awareness of the role and skills of nurse practitioners, who are integral to the delivery of specialist palliative care.
“PCA looks forward to the release of the National Palliative Care Strategy later this year and its implementation plan. The ‘comprehensive palliative care in aged care measure’ is a start to the required reform and investment needed in palliative care to ensure that every Australian is able to live and die well,” Ms Callaghan said.
The Australian Nursing and Midwifery Federation The Australian Nursing and Midwifery Federation (ANMF) has welcomed aged care funding in the 2018/19 Federal Budget for additional home care packages, but says this will not fix the crisis in aged care and is disappointed that, once again, the Government has failed to address the urgent need for safe staffing in nursing homes.
The ANMF’s A/Federal Secretary, Annie Butler, said with over 100,000 elderly Australians on high-priority waiting lists for home care packages, (almost 80% of them higher level three and four care packages) funding to meet the ever-growing demand for in-home aged care services was long-overdue.
“It’s simply unacceptable that waiting lists have blown out to this point, with thousands and thousands of people waiting more than a year for the care services they need to remain in their home,” Ms Butler said.
“Our members are pleased the Government has allocated funding into additional home care packages and palliative care services, but they know that this will do nothing to ensure safe and timely care for elderly Australians already in residential care, and those who will need it soon, because the Government has done nothing to ensure that aged care providers are employing enough nurses and carers.
“We know that from 2003 to 2016, there’s been a 13% reduction in qualified nursing staff working full-time in aged care while over the same period there’s been a 400% increase in preventable deaths in nursing homes.
“This chronic staffing crisis has led to dangerous workloads for nurses and carers resulting, too often, in missed care for vulnerable nursing home residents, yet the Government is still not prepared to guarantee safe staffing levels in residential aged care.
“We also know that the only way to guarantee safe staffing levels in aged care is to tie Government funding to the provision of care. And the best way to achieve this is through mandated minimum staff ratios.
“While small not-for-profit, particularly rural and remote, aged care providers are struggling to make ends meet, we know that the large for-profit providers have the financial capacity to improve staffing to ensure safe and effective care for residents but are choosing to focus on maximising profit rather than providing safe staffing levels.
“Last week, the ANMF released a comprehensive report, prepared by the Tax Justice Network, which shows that the six largest for-profit providers, some foreign entities, are benefitting from $2.17 Billion in Government subsidies, yet paying little or no tax – at the expense of residents.
“If the Government is serious about ensuring quality service provision, it needs to shift its focus from company tax cuts to company tax collection by closing the loopholes that allow large for-profit companies to profit from taxpayers’ money.
“This Saturday, 12 May, the ANMF will be launching our new national campaign calling on our politicians to stand up for elderly Australians and make staffing ratios law, as a matter of urgency to fix the crisis in aged care.”
The ANMF also welcomed Budget funding for capital works for aged care providers in rural, regional and remote areas; dementia and mental health programs for older Australians.
Rural and remote health
National Rural Health Alliance
New funding to attract more doctors to country areas has been welcomed by the National Rural Health Alliance, Australia’s peak body for rural and remote health.
“We are pleased tonight’s Federal Budget allocates $550 million over 10 years to help fill the health workforce gaps that exist in so many parts of country Australia,” said Alliance CEO Mark Diamond.
The government says it will deliver 3,000 new specialist GPs, and 3,000 additional nurses over ten years mainly through providing end to end training in country areas.
“It’s not only doctors and nurses that are missing outside major cities. Equally there are not enough allied health professionals. Some areas have no psychologists, no physiotherapists, no occupational therapists,” Mr Diamond said.
A new Workforce Incentive Program will provide some funds to general practices to employ more nurses, doctors and, for the first time, allied health workers.
“It’s the first step in increasing the very low numbers of allied health workers in rural and remote areas,” Mr Diamond said.
There was a very small increase in funding for Indigenous health.
From $3.6 billion allocated last year, the new figure has crept forward to $3.9 billion. But half of that increase is CPI indexing.
There is new funding of $105.7 million dollars to provide culturally appropriate aged care services in remote communities, through the existing Flexible Aged Care program.
There is also $35 million to fund a new MBS item covering delivery of dialysis by health workers in remote areas.
The National Rural Health Alliance represents 34 national rural health groups including the Royal Flying Doctor Service, Country Women’s Association and National Aboriginal Community Controlled Health Organisation (NACCHO).
“We congratulate the Royal Flying Doctor Service for winning $84 million in extra funding for operational support, including $20.4 million for new mental health services,” said Mr Diamond.
“Overall the Budget allocated an extra $338.1 million in mental health funding. Suicide prevention is a key focus. Particular mention was made of men over 85 years old having the highest risk of suicide, with $82.5 million earmarked for psychological services in residential aged care. Previously residents have not had access to government supported psych services,” Mr Diamond said.
Other moves welcomed by the National Rural Health Alliance are:
- A Murray Darling Medical School Network will be established. However there will be no extra Commonwealth Supported Places
- 100 vocational training places for rural generalists from 2021
- A new department at La Trobe University for nursing and allied health training
- A new medical training program at Curtin University
- $40 million to support aged care providers in rural and remote areas for urgent building and maintenance works
”While announcing some solid initiatives, tonight’s Budget funding for rural health is not enough,” said Mr Diamond.
“There is so much work to do to deal with the huge disparity in health outcomes between urban and rural Australia.”
Country people don’t live as long, and have higher rates of disease and injury.**
“Past programs have failed to solve these long running issues, so it’s important to see if these new Budget measures make a difference.”
Royal Flying Doctor Service
Budget announcements providing more doctors, nurses, and allied health professionals in rural and remote Australia will lead to improved health service access.
The new measures, in addition to $327 million in funding for Royal Flying Doctor Service (RFDS) programs over the next four years, is a needed boost for rural health outcomes.
RFDS CEO Dr Martin Laverty said “The Budget delivered on the Prime Minister’s pledge of $327 million for RFDS medical, nursing, dental, and mental health programs.
“This funding commitment enables continued emergency care, visiting health clinics, telehealth, and medicine distribution by the RFDS across remote Australia. It further allows the RFDS to continue dental services and to initiate a new mental health program. Remote Australians see doctors at half the rate of city residents. They see mental health professionals at a fifth the rate. RFDS will be able to deliver more to areas needing it most.”
Dr Laverty also commended Rural Health Minister Bridget McKenzie’s efforts to improve health workforce distribution across rural and remote Australia.
“Government has been working with communities and health service providers to improve teaching, training, and recruitment of health staff to underserved country areas.
Minister McKenzie’s Rural Health Strategy lays out the building blocks for improvement in health workforce numbers in areas where they are needed the most. The ability to track over and under supply of health workforce geographically has been an impediment to proper use of incentives to encourage staff to where they are needed.
“The new health workforce tracking capacity will better inform decisions on where incentives are going to deliver the best bang for buck,” Dr Laverty said.
Rural Doctors Association of Australia
The Rural Doctors Association of Australia (RDAA) says the Federal Government has delivered for rural health this Budget, with a Stronger Rural Health Strategy worth $550 million being announced.
RDAA President, Dr Adam Coltzau, said the Budget includes a wide range of initiatives that will make a real difference to the health workforce in rural Australia and the many rural and remote communities it serves.
“This is the rural health Budget that RDAA has been waiting for” Dr Coltzau said.
“There are not just one or two initiatives here – this is a multi-pronged approach to supporting improved medical workforce distribution to rural and remote Australia.
“The Budget includes a range of supports for medical students, junior doctors, registrars and senior doctors, which will deliver the right doctors with the right skills to meet community needs into the future.
“We welcome the expansion of Australian-trained junior doctor rotations in supervised rural primary care settings, as part of the Junior Doctor Training Program.
“We have been advocating strongly for increased junior doctor rotations with supervision as they are an excellent recruitment mechanism for future rural doctors.
“These rotations provide a great opportunity for junior doctors to get a feel for rural medicine in a supported environment, and the expansion of this program will see an increase from the current 240 rural rotations to over 1,000 once it is fully implemented.
“This is great news for rural communities and we commend the Government for committing to this program.
“There will also be an additional 100 Rural Generalist training positions to commence in 2021, and we believe this demonstrates a commitment to the National Rural Generalist Pathway.
“We have been a major supporter of this Pathway, and see it as a critical initiative if we are to ensure the next generation of rural doctors have the right skills to meet their local community needs.
“We also acknowledge the commitment from the Federal Minister for Rural Health, Senator Bridget McKenzie, to provide the National Rural Health Commissioner, Emeritus Professor Paul Worley, with the required resources and support to progress the next phase of work towards implementation of the National Rural Generalist Pathway.”
Rural Medical Schools have been a contentious issue in the lead-up to the Budget, however RDAA is now satisfied that the Government has made enough commitments for junior doctor training in the post-university years that it can now support the additional Rural Medical School programs announced in this Budget.
“We thank the Government for listening to our call to only progress a rural medical school announcement if there was also investment in, and a commitment to, increasing rural junior doctor positions” Dr Coltzau said.
“We are pleased to see that there are a number of initiatives that together will help build the capacity of our rural practices and hospitals to train young doctors and provide them with a rewarding medical career in our rural communities.”
In addition to these initiatives, RDAA supports in-principle a range of other Budget announcements supporting the rural medical workforce and rural communities, including:
– changes to the bonded scholarship schemes for medical students
– supporting overseas trained doctors who are currently working in rural communities to progress towards Fellowship of a GP College
– $338.1 million for mental health
– $3.9 billion for Indigenous health
– $40 million for urgent maintenance and infrastructure for regional aged care providers
supports for rural practices in MM3-7 locations to employ nurses and allied health staff, including non-dispensing pharmacists.
“RDAA will work with the Government and Department of Health on the various initiatives to ensure the detail and implementation align with the needs of rural communities across Australia,” Dr Coltzau said.
“The National Rural Health Commissioner will also play an important role in ‘rural proofing’ the health budget initiatives.
“Finally, while the impact of the Medicare freeze on rural general practice will continue to be felt for a number of years to come, we welcome the next stage of the lifting of the freeze which will see GP consultation item numbers re-indexed from 1 July 2018.
“We greatly look forward to working with the Federal Government and Department of Health to bring the benefits of the Stronger Rural Health Strategy to fruition.”
The Australian College of Rural and Remote Medicine (ACRRM) has noted the strong package offered to support access to safe and affordable medical care in rural and remote Australia in this 2018 budget.
Australian College of Rural and Remote Medicine
The Australian College of Rural and Remote Medicine (ACRRM) has noted the strong package offered to support access to safe and affordable medical care in rural and remote Australia in this 2018 budget.
ACRRM President Associate Professor Ruth Stewart said: “This package addresses each step in the training pathway that produces doctors with the confidence and competence to be a pivotal part of the health care team in rural and remote communities.
“Each item shouldn’t be taken in isolation; instead, it should be viewed as part of the larger package that will strengthen this country’s health services.”
The College is broadly supportive of the changes in legislation and funding signalled in this budget.
“These items aim to set Australia on a path to a future where rural and remote community members will know that the doctors who care for them are trained to the highest standards,” she said.
“In addition, these doctors will know how to provide that care in remote and rural locations. They will be trained to work in small Primary Health Care Centres, small and medium sized private General Practices, in Aboriginal Community Controlled Health Organisations, and remote and regional hospitals.”
The College supports a commitment to increase opportunities for junior doctors who want to try rural practice.
“Increasing the opportunities for junior doctors to work in the community under supervision is a welcome change and should give junior doctors a good “taste and see” experience,” said A/Prof Stewart.
We are also very pleased to see that this budget strengthens incentives for doctors living and working in underserved areas of Australia to undertake and complete training for General Practice.
“Australians should have access to first rate health care wherever they live. We look forward to supporting more doctors to train for rural and remote practice and are delighted to hear Minister McKenzie’s assurances of resource support for the National Rural Generalist Program,” said A/Prof Stewart.
“We know that equipping doctors with the skills and experience to work rurally increases the recruitment and retention of doctors in rural and remote communities. 74% of doctors with a Fellowship of ACRRM are still working in rural and remote communities 5 years after Fellowing[1].
“It is really important for Australia to address our responsibilities to our rural and remote communities and to the international community.
“For the past twenty odd years, International Medical Graduates arriving in Australia have been mandated to go to rural and remote communities to provide the care that these communities need.
“They continue to be a very important part of our health teams and should be thanked and recognised as such, but Australia should no longer be draining doctors from developing countries to meet our needs when their need is greater.
“We are graduating more doctors than ever before. We need to address the current maldistribution and ensure that Australian Graduate doctors are supported to go where they are most needed – our rural and remote communities.”
Some of the highlights of this budget for the College and its members are the items that will help recruit and retain the right health care professionals, with the right training, to rural and remote communities.
“The changes to legislation for rural bonded medical education programs will benefit rural communities and give equity and reassurance to doctors in training,” said A/Prof Stewart.
“In addition, bulk billing incentives will now be focused on areas where the need in health care outcomes, in socio economic status, and in access to health care is greatest.
“It’s the combination of these items, and many others in this budget that will see us start to shape the future of rural and remote health.”
The College will be taking time in the coming days to consider the finer details of the whole budget, and will release subsequent statements regarding items of importance.
Australian Medical Association
The AMA welcomes the Budget announcement of a range of initiatives to improve access to health services for rural and regional Australians.
AMA President, Dr Michael Gannon, said that many of the initiatives – outlined in the Stronger Rural Health Strategy as part of the Health Budget – are a direct response to AMA rural health policies and the AMA Budget Submission.
“We welcome the Government’s strong focus in this Budget on improving access to doctors in underserviced communities, particularly rural Australia,” Dr Gannon said.
“The evidence shows that selecting medical students with a rural background and providing high quality training in rural areas are the most effective policy measures to address workforce maldistribution.
“With medical graduate numbers in Australia at record numbers, well above the OECD average, there is a strong emphasis in this Budget on building a rural training pipeline so that it will be possible for doctors to complete their medical degree in a rural area – and then continue to be able to work and train in these areas.
“The decision to reject the proposal for a stand-alone Murray Darling Medical School, in favour of a network, is a better approach with the Government instead pursuing a policy that builds on existing infrastructure to create end-to-end medical school programs.
“However, while the Government has made a welcome commitment not to increase Commonwealth-supported medical school places, it has taken the unnecessary step of compensating medical schools with additional overseas full-fee paying places.
“This will not address community need, and instead simply waste precious resources.
“We welcome the decision to create a pool of medical school places that can be reallocated over time, a nimble way of better responding to community need.
“The AMA has championed a Community Residency Program, focusing on rural areas, and the significant expansion of prevocational training places in general practice announced tonight delivers on that policy proposal.
“The decision to set aside funding for an extra 100 GP training places from 2021, earmarked for the proposed National Rural Generalist Pathway (NRGP), is a good first step in supporting its rollout.
“This will build on the work of the Rural Health Commissioner, who is currently consulting on the design of the NRGP.
“It is also good to see that the Government is funding support for non-vocationally registered doctors to progress to College Fellowship. Rural areas are very reliant on International Medical Graduates (IMGs) to deliver care, and this decision will help them in continuing to deliver high quality care for patients.
“The AMA is also pleased to see the Government take the decision to completely overhaul the bonded medical graduate programs, which have so far largely failed to deliver extra doctors to needy communities.
“The new arrangements will be more flexible, and provide greater career certainty for doctors who have signed up for these programs.”
RACGP Rural
Australia’s peak body for rural general practice, the Royal Australian College of General Practitioners says patients in regional and rural communities will have better access to healthcare with vital investment announced in the 2018 Budget.
Chair of RACGP Rural, Dr Ayman Shenouda welcomed the Federal Government’s support of rural specialist GPs and commitment to improving the health of Australians living in rural and remote communities.
“The Federal Government has committed to rural health in this Budget, with a Stronger Rural Health Strategy worth $550 million, to be delivered over the next 10 years,” Dr Shenouda said.
“RACGP Rural welcomes this investment to attract more doctors to rural and remote areas.
“The initiatives included in the Budget will make a real difference to the health workforce in rural Australia and the many rural and remote communities it serves.”
Dr Shenouda commended the government for its comprehensive approach, saying it would improve medical workforce distribution to rural and remote Australia. “The Government has demonstrated its commitment to addressing the challenge of ensuring Australia has the right mix of health professionals to deliver high quality healthcare to those in need, particularly those in rural and regional areas,” Dr Shenouda said.
“This will ensure people living in rural, regional and remote Australia have better access to health services.
“The RACGP supports all efforts to increase the number of doctors working in rural and remote Australia.”
AMSA Rural Health
AMSA Rural Health welcomes the rural health workforce measures outlined in the 2018-19 Federal Budget, but meets the announcement of a new medical school network with cautious optimism. The $83.3M Stronger Rural Health Strategy to address access to medical care by rural and regional Australians is an important step towards health equity in rural and regional Australia.
Murray Darling Medical School Network
The announcement of the Murray Darling Medical School Network, accompanied by $95.4M in funding, represents a welcome focus on rural medical education. However, AMSA Rural questions what the network means for overall medical student numbers, and the impact it will have on rural health workforce shortages.
“While there will be no new Commonwealth Supported Places (CSPs), the inclusion of two more universities within the network – Charles Sturt and La Trobe – means the existing universities will replace redistributed places with full fee paying places. We are concerned the introduction of a new school in Orange that has been allocated 30 of the existing CSP will open the door to future increases in student numbers,” said AMSA Rural Co-Chair Nic Batten.
“The overall number of medical students will increase as these universities will replace lost income by recruiting more international students, which will only worsen the oversupply of medical graduates and bottlenecks in further training,” said AMSA Rural Co-Chair, Gaby Bolton.
“In Victoria alone there will be 100 more graduating doctors than internship places for 2019, and most of those missing out will be Australian trained international students. It is unethical to continue to encourage international students to study in Australia if they will be unable to work here as doctors after graduation – this loophole must be closed,” said Ms Bolton.
All sites in the network – Bendigo, Albury-Wodonga, Shepparton, Wagga Wagga, Orange, and Dubbo – already teach medical students within Rural Clinical Schools. However, the funds for the network will allow expansion of existing infrastructure to enable end-to-end rural medical school training.
“We hope that the network model translates into more doctors committed to rural practice, and that the university partnerships involved will enable greater recruitment of and support for students of rural background to study medicine,” said Ms Batten.
“Whilst we welcome the network model over a large new stand-alone medical school, these funds could be better spent in addressing the issue of too few vocational training spots for doctors who want to work, train and live in rural and regional areas, and are currently forced to return to metro areas to complete specialty training,” said Ms Batten.
Junior Doctor Training Program
The Junior Doctor Training Program, which includes an increase of 300 rural places for junior doctors, represents the beginning of a clear pathway for rural practice. Details, including a possible expansion of internship rotations in rural general practice, are yet to be outlined.
“For medical students wanting to practice in rural areas, and particularly those who aim for careers in rural generalism, this is an invaluable program”, said AMSA Rural Co-Chair, Gaby Bolton.
“PGY1-3 is where many doctors who have trained in Rural Clinical Schools are lost to metro hospitals. This initiative will help stem this barrier to rural practice,” said AMSA Rural Co-Chair, Nic Batten.
Rural Generalism
AMSA Rural is pleased to see commitment to the National Rural Generalist Pathway with 100 additional vocational training places to be administered by Australian GP Training (AGPT), beginning in 2021. This comes off the back of a historical agreement between RACGP and ACRRM earlier in the year, facilitated by the Rural Health Commissioner Professor Paul Worley.
“We are excited to see this measure devoted to addressing rural training pathways. Many of our members are keen to work in this area, so this is will be a great step to increase the number of rural doctors,” said AMSA Rural Co-Chair, Gaby Bolton.
“While we would have liked to see more funding towards the National Rural Generalist Pathway, this is an important move towards increasing the number of rural GPs, and recognises the special skill-set required of doctors working in rural and remote areas,” said AMSA Rural Co-Chair Nic Batten.
Rural Specialty Training
In comparison to funding for rural generalism training places, no announcement was made of an expansion of the Specialty Training Program. AMSA Rural hopes the release of further information after the Budget will include support for specialty training within the Regional Training Hubs.
“Access to further rural opportunities for specialty training is key to retention of these doctors in rural and regional areas. This will help to address the maldistribution of certain specialities as well as provide necessary additional specialty training places,” said AMSA Rural Co-Chair Nic Batten.
Bonding
AMSA Rural Health welcomes the changes relating to rural bonding contracts.
“The return of service obligations have not been fulfilled by many rural bonding contract holders, and have only damaged perceptions of living and working within rural communities,” said AMSA Rural Co-Chair Nic Batten.
“Bonding contracts have not been administered in a way which encourages doctors to fulfill their obligations to work in a rural location,” said AMSA Rural Co-Chair, Gaby Bolton.
“The changes announced in the Budget will provide a flexibility around training that will encourage more doctors to complete their return of service and work in a rural location,” said Ms Bolton.
AMSA Rural enthusiastically supports the changes to rural bonding and the opportunities presented by the Junior Doctor Training Program and the National Rural Generalist Pathway. Whilst the MDMS network may represent an expensive mis-step in addressing rural health workforce shortages, with funds better spent on rural Specialty Training Places, the announcement of better targeting, monitoring and planning for future rural workforce need is encouraging.
Overall, AMSA Rural welcomes the government’s renewed focus on health equity for rural and regional communities and looks forward to hearing more details of the Stronger Rural Health Strategy.
NDIS
National Disability Services
The Federal Budget sees the Turnbull Government confirm its commitment to the National Disability Insurance Scheme with $43 billion funding secured over the forward estimates period.
Dr Ken Baker, Chief Executive of National Disability Services, said: “The disability community was taken aback two weeks ago when the Treasurer announced the decision to scrap the proposed increase to the Medicare levy to fully fund the NDIS. Our message to the government was clear: tell us your alternative plan to ensure the NDIS’s funding into the future is beyond doubt.
“In tonight’s budget the government has been true to its word in finding another way to fund the NDIS. This scheme is too important to hundreds of thousands of Australians not to be fully funded – and it’s clear the government agrees.
“Without a hypothecated funding source for the NDIS in the form of the Medicare Levy, we need all sides of politics to have a plan for how the scheme will be funded over the long-term.”
“Any future Treasurer should be clear that the NDIS is not a political football. It is a source of security for people with disability and their families who have enough uncertainty in their lives. Long-term certainty for the NDIS is imperative.”
Dr Baker said the Government must now turn its attention to fixing implementation problems with the scheme, including improving the quality of NDIS plans and processes and ensuring that the disability service sector is sustainable and is able to invest in growth to meet the need for services.
“The Budget’s announcement of $64 million over three years to establish an NDIS Jobs and Market Fund is welcome and will assist the sector. However, disability service organisations will not invest in growth unless they are confident that the fundamentals of the scheme are working well – including that NDIS pricing is right – and that is not the case at present,” said Dr Baker.
Dr Baker continued: “Now is the time for the government to focus on delivering the great promise of the NDIS.”
An evaluation of the NDIS released last week found that while many people with disability had benefited from the NDIS, too many Australians with disability feel worse off.
Dr Ken Baker said: “It is very concerning that some people with disability feel worse off as a result of the NDIS. The NDIS is founded on great principles, but translating those principles into practice has proved challenging. Too many people who are in the NDIS find the system confusing, there is too much paperwork, and many not-for-profit disability organisations are struggling to provide NDIS services and remain financially viable.
“None of these problems is unsolvable. The NDIS has the potential to be a world-leading system. The disability sector is ready to work with government to get it right.”
Medical research
Association of Medical Research Institutes
Significant investment in new medical research missions from the 2018-19 budget ensures Australia’s ability to delivery best health, social and economic outcomes.
Continued commitment to the Medical Research Future Fund (MRFF) will ensure Australia remains a world leader in medical research.
Multiple funding boosts from the MRFF are being used to innovative medical research fields, including genomics and precision medicine, allowing Australia to be at the forefront of turning new discoveries into the next generation of advanced patient treatments. Other key areas will also receive funding boosts including mental health, brain cancer, rare cancers, diabetes, and heart disease.
“This is a great Budget for medical research, and this is where the Australian medical research sector should be heading.” said Professor Tony Cunningham AO, President of the Association of Australian Medical Research Institutes (AAMRI).
“It’s fantastic to see the Government recognise that for Australian’s to continue to benefit from this work, we need to continue funding it,” said Professor Cunningham. “These are all areas where Australian researchers are delivering excellent results.”
The announcement will ensure better health and social outcomes for Australians, including reducing healthcare expenditure and creating thousands of new high value jobs.
The MRFF is set to reach $20 billion by 2020-21, and Professor Cunningham congratulated the Government on continuing to deliver on this promise.
“This means the medical research sector can focus on what it needs to be doing – developing new and improved treatments and medical devices to people who need it,” he said. “This is especially important during a time where we need to be capitalising on our research and commercialisation successes.”
AAMRI is looking forward to seeing competitive processes put in place to ensure the best value for money can be gained from this new investment.
Also announced in the budget was funding for the National Research Infrastructure Plan. Nearly $400M has been committed for the next four years, and close to $2 billion over the next decade to fund a Research Infrastructure Investment Plan. This will ensure in the coming decade that Australia will maintain its position as a global leader in medical research.
The Medical Technology Association of Australia
The Medical Technology Association of Australia (MTAA), the peak industry body welcomed the decision in the Budget to recognise the importance of clinical trials and research and development.
The decision to exclude R&D expenditure on clinical trials towards the $4 million refundable R&D tax offsets is been something the medical technology research community has been calling on.
MTAA aims to ensure the benefits of modern, innovative and reliable medical technology are delivered effectively to provide better health outcomes to the Australian community.
At the heart of the medical devices industry is 17,700 dedicated professionals, committed to making a positive difference to patients’ lives through medical technology.
Further, MTAA welcomes the additional $6 billion for Australia’s health and medical research sector, including $3.5 billion for the National Health and Medical Research Council, $2 billion in disbursements from the Medical Research Future Fund (MRFF) and $500 million from the Biomedical Translation Fund.
MTAA welcomes the Government’s Budget commitment to:
$1.3 billion over 10 years from 2017-18 for a National Health and Medical Industry Growth Plan to improve health outcomes and develop Australia as a global destination for medical sector jobs, research and clinical trials.
These investments, using proceeds from the Medical Research Future Fund (MRFF), will include:
$500.0 million over 10 years from 2017-18 committed to the Genomics Health Futures Mission, including $10.7 million in 2017-18 for genomics research;
$240.0 million committed to the Frontier Health and Medical Research program;
$248.0 million for expanded clinical trial programs;
$125.0 million over nine years from 2019-20 to contribute to the Targeted Translation Research Accelerator for chronic conditions focussed on diabetes and heart disease; and
$94.3 million for biomedtech programs and industry research collaborations.
$275.4 million from the Medical Research Future Fund (MRFF), including:
$125.0 million over 10 years from 2017-18 for a Million Minds Mental Health Research Mission to support priorities under the Fifth Mental Health and Suicide Prevention Plan;
$75.0 million over four years from 2017-18 to extend the Rapid Applied Research Translation program that supports Advanced Health Research Translation Centres and Centres for Innovation in Regional Health;
$18.1 million over four years from 2017-18 for a Keeping Australians Out of Hospital program to support preventive health, behavioural economics and reduce avoidable presentations to hospital;
$39.8 million over four years from 2017-18 for a Targeted Health System and Community Organisation Research program with a focus on comparative effectiveness studies and consumer-driven research; and
$17.5 million over four years from 2017-18 for research into Women’s Health and research into Maternal Health and First 2,000 Days to address the underlying social determinants of health that impact on a child’s early days of life.
Ian Burgess, Chief Executive Officer of the Medical Technology Association of Australia said:
“MTAA congratulates the Government and the Minister for Health in the budget handed down tonight.
“The announcement to carve out clinical trials from R&D expenditure is something the sector has been calling on.
“We’re pleased the Government understood the longer timeframes, due to significant scientific and regulatory hurdles to reach market and the higher expenditure on R&D, particularly in later stages with activities like clinical trials.
“Australian clinical trials industry is estimated to be worth $1 billion to the economy with the number involving medical devices having increased from 119 to over 160 in just three years.
“Global advances in medical technology over the past 20 years have resulted in a 56% reduction in hospital stays, 25% decline in disability rates, 16% decline in annual mortality and increased life expectancy of approximately 3.2 years.
“The medical technology industry makes a highly significant contribution to the quality of healthcare in Australia in helping people live longer, healthier and more productive lives.”
