Health groups have raised concerns about the Federal Budget’s lack of action on climate change and prevention, and also welcomed investment in areas ranging from allied health to health and medical research.
This post wraps Budget reaction from the Australian Medical Students Association, National Health and Medical Research Council, and Allied Health Professions Australia, as well as linking to a detailed analysis by Macquarie University’s Centre for the Health Economy.
See Croakey’s #Budget2021Health coverage here, and download the Department of Health Budget Briefing Pack here.
Young Australians’ future on the back-burner
Australian Medical Students Association
Australian medical students implore all sides of Parliament to make stronger commitments to Australia’s future.
“It was disappointing to observe a lack of leadership from the major parties on some of the biggest issues faced by young Australians,” said Ms Sophie Keen, President of the Australian Medical Students’ Association (AMSA).
“Heavily publicised budget items such as mental health, climate change, and women’s health failed to include measures addressing the key factors driving issues in these domains. Funding appears to have been superficially allocated, just like slapping on a band aid, this only temporarily addresses the issue. The Government needs to treat the cause not the symptom.
“Neither the Government nor the Opposition committed to a 2030 greenhouse emissions target of 45-65%. This goal was recommended by the Intergovernmental Panel on Climate Change to limit global surface temperature increases to 1.5 degrees Celsius. It is unfortunate to see the major parties have ignored calls for stronger climate action.
Following the Opposition’s budget reply, Australian medical students reacted positively to the prospect of introducing previously ignored recommendations from the Respect@Work report.
“AMSA welcomes the Opposition’s proposal of legislating ‘positive duty’. The implementation of positive duty would be instrumental in addressing sexual harassment in the workplace by ensuring that employers are taking every opportunity to prioritise women’s safety.”
John Flynn Placement Program
Meanwhile AMSA also issued a statement urging the Australian Government to reinstate funding for the John Flynn Placement Program, which was suspended following the Federal Budget announcements last week.
The Program, named after the founder of the Royal Flying Doctor Service, has provided thousands of students a taste of rural medicine through four funded fortnight-long placements in rural Australia since 1997.
“This Program has fostered an interest in rural medicine among students who wouldn’t have otherwise had the opportunity to immerse themselves in rural life,” AMSA President, Sophie Keen, said.
“While we commend the investment into prevocational training in rural and remote areas, this leaves a hole in medical student experiences that cannot be filled by university-led programs through the Rural Health Multidisciplinary Training.”
Jasmine Elliott, Chair of AMSA Rural Health, said positive experiences during medical school are a primary determinant of rural workforce retention.
“We have plenty of students who go through the JFPP loving rural medicine. JFPP’s longitudinal model is unique, and it is a shame to lose this repeated exposure to a community,” Ms Elliott said.
Research by Dr Louise Young found that overall, JFPP Scholars rate their clinical and community experiences highly, with a positive impact on rural practice and career intentions.
Contrastingly, schemes such as the Bonded Medical program, which saw more doctors withdrawing from their rural service obligations than completing them, continue to attract more funding from the Federal Government.
“We have to ask ourselves, is it the carrot or the stick that addresses the rural doctor shortage? Is the Federal Government serious about supporting rural Australia with evidence-based solutions?” Ms Elliott said.
AMSA Rural Health Vice Chair Alastair Weng, a JFPP scholar in Stanthorpe, said the program provided positive experiences through the sense of community, with a dedicated clinical mentor and non-clinical contact.
Disappointment over neglect of preventive health
Royal Australasian College of Physicians
The Royal Australasian College of Physicians says it’s disappointed the Australian Government has overlooked the need to invest in preventive health – and that $250 million over four years is not enough.
This is much lower than preventive health expenditure in Canada and the UK for example, where expenditure is over 5% of the health budget.
The College says significant investment in preventive health is critical for better preparing Australia for future health challenges by reducing risk factors causing chronic disease.
The budget only allocated $1.9 million for the next year to operational costs to ‘kick start’ the National Preventive Health Strategy 2021-2030
This is out of a total of $250.9 million over four years.
RACP President Professor John Wilson says “The pandemic has taught us many things – one of them is the importance of having a strong robust health system that is prepared for major health crises.
“This budget allocation is welcome, but is well short of being able to sustain preventative health across our national system.”
Most of the $250 million over four years committed to prevention will go to cancer screening and continuation of existing alcohol and drug initiatives.
Whilst these are worthy initiatives and recognised as such in the National Preventive Health Strategy, the Strategy encompasses other elements such as obesity, social determinants of health and climate change and health. Spending less than $2 million to develop an operational plan for the Strategy is short-sighted.
“Now is the time to be proactive and invest in protecting the Australian population against future pandemics and other health crises, which are inevitably in our future.
“COVID has highlighted that people with chronic health conditions are often at greater risk of disease from infection. Many chronic health conditions can be prevented by investing in the right preventative health measures.
“By expanding preventative healthcare initiatives we can reduce the burden of disease in Australia and better protect our community against the challenges of the future – not to mention the benefits of easing the financial strain on our healthcare system.”
Further detail about the RACP’s preventive health priorities for the budget can be found in the RACP Pre-budget submission, detailing all 48 recommendations to Government:
https://www.racp.edu.au//docs/default-source/advocacy-library/equitable-effective-and-efficient-pre–budget-submissions-2021-2022.pdf?sfvrsn=32bdfc1a_6
Support for research
Professor Anne Kelso, CEO of the NHRMC (see statement)
Current projections indicate that new commitments from the Medical Research Endowment Account (MREA) will reach $1 billion for the 2021 NHMRC grant round.
The Government’s funding of the MREA will continue to grow with indexation over the Budget and forward years.
With $863.26 million allocated to the MREA through the Budget in 2021-22 and funds carried over from 2020-21 due in part to the impacts of COVID-19, NHMRC expects to deliver substantially more funding through its 2021 grant round than ever before.
This support is in addition to the significant funding that will be provided from the Medical Research Future Fund (MRFF), projected to grow to $650 million per annum in 2022–23 and beyond.
With the disruption of research activities by the COVID-19 pandemic, this increased support will be critical to ensuring the resilience of Australia’s outstanding health and medical research sector as it works to address our major health challenges.
Among Budget announcements are grant outcomes that demonstrate NHMRC’s commitment to:
- improving the health of Australia’s Aboriginal and Torres Strait Islander people and communities by building the capability and capacity of Aboriginal and Torres Strait Islander health researchers
- advancing Australian research through international collaboration, and
- supporting research in areas where there is a gap in critical knowledge needed to address important health problems.
Grant outcomes announced in the 2021-22 Budget:
NHMRC National Network for Aboriginal and Torres Strait Islander Health Researchers
A National Network of Aboriginal and Torres Strait Islander health researchers has been established that will bring together unique skills across culture, knowledge and health research to address the health priorities of Indigenous communities.
The NHMRC National Network has been established with $10 million funding from the Australian Government as a major new initiative in NHMRC’s 10-year strategy to improve the health of Australia’s Aboriginal and Torres Strait Islander population (Road Map 3).
NHMRC–NIHR Collaborative Research Grant scheme
International collaboration is essential for tackling shared challenges in health and medicine.
More than $1.8 million has been awarded to support collaborative health and medical research between Australia and the United Kingdom. The collaborative research grant scheme brings together researchers through NHMRC in Australia and the National Institute for Health Research (NIHR) in the UK.
The $1.8 million awarded in this round supports two research projects examining ways to improve patients’ quality of life:
Professor Catherine Hill at the University of Adelaide has received funding to test a new protocol to reduce the use and side effects of steroid treatment in people with polymyalgia rheumatica (PMR). About half those on steroid treatment relapse and often suffer from steroid side effects such as diabetes and bone fracture. This clinical trial will determine whether adding an immunosuppressive treatment can reduce steroid use in people with relapsing PMR.
Professor Manuela Ferreira at the University of Sydney has received funding to compare the outcomes of two different approaches to rehabilitation and pain relief for people who have had the meniscus cartilage removed from the knee – meniscus transplant versus exercise and physiotherapy.
NHMRC’s partnership with the UK’s NIHR is an effective way to bring researchers in our two countries together to solve practical issues in patient care.
NHMRC Co-funding of the MRFF – Emerging Priorities and Consumer Driven Research Initiative (EPCDRI) – 2020 Silicosis Research Grant Opportunity
Recognising the large gaps in knowledge about the current rise of accelerated silicosis in Australians caused by engineered stone, NHMRC is contributing $1 million to this grant opportunity to fund a Silicosis Research grant awarded to researchers at Monash University who will investigate emerging techniques for earlier diagnosis and assessment of the severity and progression of artificial stone silicosis.
Stonemasons who have worked with engineered stone have been shown to develop a rapidly progressive and potentially fatal form of silicosis. This research will use data from affected workers from Victoria, Western Australia and Queensland. The research will comprise a suite of projects to investigate many uncertainties in radiological screening methods, as well as investigating new methods to assess disease severity and identify indicators of progression to inform future practice.
MRFF is funding several other grants under this grant opportunity.
Mitochondrial Donation Regulation and Clinical Trial
The 2021-22 Budget includes new funding of $2.4 million over four years for NHMRC to establish and maintain the regulatory and licensing framework for mitochondrial donation in Australia as proposed under the Mitochondrial Donation Law Reform (Maeve’s Law) Bill 2021.
In 2019-20, NHMRC examined the scientific, social and ethical issues associated with mitochondrial donation, consulting widely with the public.
Earlier this year, further Government consultation was conducted on a staged approach to the introduction of mitochondrial donation into Australian clinical practice.
This Budget funding is being provided to support the implementation of a regulatory and licensing framework for a clinical research trial, as proposed under Stage 1 of Maeve’s Law. The introduction of mitochondrial donation would be subject to oversight by NHMRC’s Embryo Research Licensing Committee and include research and training licences and a clinical research trial licence to introduce mitochondrial donation in Australia.
Cautious welcome
Allied Health Professions Australia
Allied Health Professions Australia and its members have cautiously welcomed the 2021 Federal Budget’s acknowledgement of allied health and investments in some key areas in which allied health plays crucial roles.
However, there are significant aspects of the budget that fail to acknowledge the multi-disciplinary nature of allied health and its critical role in healthcare and aged care.
We welcome the $700,000 funding for a gap analysis of allied health data. CEO Claire Hewat states ‘Effective provision of allied health services cannot be achieved without comprehensive data which has been sadly lacking.’
AHPA will be working closely with the Australian government and the Department of Health to clarify the allied health impacts of the Budget measures and to ensure that the allied health sector is involved in their implementation.
Aged care
AHPA welcomes the government’s commitment to making changes to aged care in response to the Aged Care Royal Commission, including the replacement of the Aged Care Funding Instrument, the formation of an Aged Care Advisory Group, which will include allied health, and a Council of Elders and, and the investment in reducing the waiting list for residential home care.
The Royal Commission identified the crucial role of allied health care in both home care and residential aged care facilities, but found that currently there is limited access to such services. Lack of funding was an important factor in the gap in allied health provision.
CEO Claire Hewat says ‘ Understanding the gaps in access to allied health in aged care is an important step in improving aged care for all. But to actually fill these gaps requires federal Budgets to reflect these strong recommendations from the Royal Commission and at this stage it is not at all clear that this is the case.’
The Budget also lacks the recognition that allied health is a sector which provides multi-dimensional care across all areas. Older people require a holistic approach to their health and wellbeing which addresses all facets of living. They often need allied health providers such as: exercise physiologists, social workers, occupational therapists, physiotherapists, podiatrists, psychologists, and speech pathologists.
Primary healthcare
After many years of campaigning, AHPA is glad to see the 14.2 million dollar investment into MBS case-conferencing for allied health.
This is a significant step forward in creating an integrated approach to healthcare, but must be followed by improved access to allied health through Medicare and other primary care funding in the near future so that comprehensive care can be provided, especially to those least able to afford it, and not just talked about.
$2 million dollars of funding has also been dedicated to primary care model trials. AHPA expects to be a part of this development and will update members accordingly.
Rural and remote
Positively, this budget has included investment into allied health professional training and staffing in rural and remote areas, including $9.6 million to extend the National Rural Generalist Pathway. There will be 90 packages of funding for workers in rural
and remote areas, including 30 packages for allied health assistants. However, while this is significant, it does not come close to meeting the current demands for allied healthcare provision in rural and remote areas.
AHPA acknowledges the Federal Government’s commitment and funding toward other aspects of the healthcare sector, including improving services and support for those with cognitive disabilities, and mental health reforms. We look forward to engaging in these initiatives.
In order for healthcare to be truly beneficial to the Australian public, all providers, including allied health, must be considered as a connected network of care, rather than remote individual providers, and the related budget should reflect this holistic approach.
Further reading
See also this detailed 41-page analysis of the Budget and health by Professor Henry Cutler, Macquarie University Centre for the Health Economy.
While the Budget has attempted to address some long standing problems within aged care and mental health, this report says that “handing over buckets of money and planning for change is the easy part,” and that implementation and evaluation are the hard part.
The report says:
This Budget has not addressed many grand challenges permeating the Australian healthcare system.
The Government closed down all unnecessary elective surgery last year in response to COVID-19. That blew out public hospital elective surgery waiting times when many people were already waiting more than a year. Nobody should have to wait this long when suffering.
Our public hospital system must do better. The Government should work with state and territory governments to substantially reduce public hospital waiting times, by spending more on infrastructure and workforce.
That should include building on private hospital partnerships established within the National Partnership Agreement (NPA) on COVID-19 Response to undertake more public patient elective surgery in private hospitals.”
See Croakey’s articles on #Budget2021Health.
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