Health budget has a “gaping hole”, but also heralds “new era in prevention”

Herewith a wrap of some reactions to the health budget, covering areas such as dental policy (or the lack of it), primary health care, alcohol policy and prevention. (Based on extracts from press releases and comments to Croakey):

Dental policy needs urgent attention

The gaping hole in dental care remains after the Federal Budget failed to include any funding for public dental services, according to the Australian Healthcare and Hospitals Association.

“The AHHA welcomes COAG’s commitment to a universal and equitable health system however this commitment is undermined by the failure of successive Governments to ensure better access to dental care for all Australians. The result is that Australia is a country where the poor and disadvantaged can be identified by the state of their teeth,” Ms Prue Power, Executive Director, said today.

“The AHHA is appalled that the Government and Opposition have failed to reach agreement on even the most basic program to help at least 300,000 people in desperate need of oral health care.  The Commonwealth Dental Health Program (CDHP) would have seen well over half a million pensioners and low income earners gain timely access to dental treatment and restoration. This program was part of the Rudd Government’s election platform in 2007 and it has never seen the light of day.

“It has been convenient for the Federal Government to treat the Senate stalemate over dental care as an apparent budget-saving measure.  The CDHP is a relatively small amount of money ($290 million over three years).  But the Government made its implementation contingent on closure of the previous Coalition Government’s Medicare Chronic Disease Dental Plan.

“In this same period, however, due to the Rudd Government’s failure to even attempt resolution of the conflict, the Medicare program has continued unabated which has ended up costing significantly more than the CDHP would have.  The stubbornness in resisting negotiation has made this a budget blow-out.

Ultimately, AHHA supports the proposal from the National Health and Hospitals Reform Commission  for a universal dental program, such as Denticare, which focuses on providing preventive care and is integrated with other components of our health system.  The Government should work towards this aim through incremental steps which initially focus on ensuring better access to affordable and timely oral health care for those who need it most.  Implementing a public dental health program immediately will build the foundations of a Denticare-like program.”

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It’s a “new era” for prevention, says PHAA

The Public Health Association of Australian (PHAA) has welcomed the Government’s response to the National Preventative Health Taskforce report and funding outlined in the Federal Budget as a landmark in action to support prevention.

PHAA President Professor Mike Daube said, “For the first time, we have a comprehensive approach to reducing our massive toll of preventable ill health and death, with substantial commitments in the Budget to funding for prevention”.

“The Government’s response to the Prevention Taskforce Report demonstrates a strong commitment to action on tobacco, obesity and alcohol problems, with a special focus on binge drinking.”

The allocation of $50m for action on alcohol, including funds to offer alternatives for sports sponsored by alcohol is also an important development, allied to strong public education programs on both alcohol and obesity. We also welcome the allocation of $54m to a National Health Survey as well as the substantial funding promised through COAG.”

“Of course there are other measures we would like to see accepted – such as alcohol tax reform, and legislated controls on alcohol and junk food promotion, but this is a very encouraging start, and we note that the Government has not closed the door on some of the tough measures proposed in the Taskforce Report.”

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What about bowel cancer screening?

Cancer control advocate Terry Slevin:

“Not a sausage for the National Bowel Cancer Screening Program. If run properly (the current version is woefully inadequately funded) this can be the most effective next step in reducing deaths from cancer.  Proven by five randomised control trials, a well funded well run bowel cancer screening program is a rolled gold investment in public heath.

I guess we are just going to have to get a clear commitment, one way or the other, from both sides of politics before the next election.  Who will make this happen and in so doing cut the unnecessary bowel cancer death toll in Australia ? Is it because bowels just ain’t sexy ?”

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Does the Government get the difference between primary health care and primary care?

A health policy expert:

“Got excited when I saw reference to the on-line getting it right by calling it a Primary Care Strategy – but, as ever, the hard copy materials are
misleading, announcing ‘Australia’s First National Primary Health Care Strategy’.  And guess how many references there are in that document to food (0); employment (0), income (0), housing (0), community development (0)  – – – and so it goes.”

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Doctors Reform Society is chuffed

“The new funding for health in the federal budget is a step in the right direction,” said Dr Tim Woodruff , President, Doctors Reform Society.

“Putting money into front line care, especially when it is directed towards the frail elderly and those with complex care needs, is a welcome change of direction in government policy. It begins to address a glaring gap in health provision badly needed by the most vulnerable in our society and, if policy reform continues to be expanded in this direction in the future, will take considerable pressure off our heavily strained public hospitals, making them more sustainable,” said Dr Woodruff.

“Measures in the budget include an expansion of nurses in GP clinics in urban areas  –  rather than just rural areas as previously, is very welcome and will be a significant boost to GPs struggling with the increasingly complex demands of treating chronic diseases,” said Dr Woodruff,. However, the Government must ensure that taxpayer subsidy of nurses in primary care does not end up only boosting GP rapid turnstile medicine for the worried well.  There must also be a benefit to those patients currently missing out on a lot of  necessary care e.g the frail elderly and those with complicated care needs that are currently generally ignored by over taxed and under supported GPs”.

“Funding for the previously announced primary health care organisations now called Locals, is also welcome,” said Dr Woodruff. “Their tasks of co-ordinating care and improving after hours access  while laudable, will be very challenging without structural changes to how general practice and the GP are funded,  i.e. a change from episodic fee for service payment. Such changes have been almost ignored by the reform proposals to date, although new funding of diabetic care is a notable but small step in the right direction.”

“Funding for ehealth is necessary but the biggest challenge is in its implementation,” said Dr Woodruff. “It is worth noting however that neither ehealth nor increased nurses in GP clinics will necessarily do anything to address the barriers to access suffered by our patients in areas of GP shortage or in areas where GPs require copayments which patients cannot afford”

“Finally, after all the politics of hospital funding, we can see some very welcome increased support for primary care”, said Dr Woodruff. “Whilst helpful, it is not major reform, and will have little effect on the unfairness of our health system, which will remain plagued by patients unable to find or afford a doctor in many poorer and/or country areas. In addition dental care continues to be ignored.”

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More work needed on alcohol policy

The Alcohol Education and Rehabilitation Foundation (AER) acknowledged the Federal Government’s commitment of $50 million over 4 years towards an extension of the National Binge Drinking Strategy.

AER Director Professor Ian Webster says it’s a long way from the comprehensive alcohol reforms needed to minimise the impact of alcohol misuse on the Australian community.

“Alcohol is second only to smoking in the number of deaths from substance misuse in Australia. Alcohol misuse causes too much harm in our communities for this issue to continue to be treated lightly.

“Logic tells us that the Federal Government’s $50 million commitment will not go far in addressing the $15 billion cost of alcohol-related harm to the community.

“Comprehensive alcohol reform must be implemented to produce generational change in our attitude and behavior towards alcohol. As part of this holistic strategy, AER supports Ken Henry’s recommendations to introduce volumetric taxation, as well as strategies relating to licensing and regulation, marketing and promotion, child and maternal health and initiatives to support young people.

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Still some critical public health issues that need sorting

Margo Saunders, Public Health Policy Consultant in Canberra, writes:

“Many in the public health sector are jubilant about receiving a few things that they have battled long and hard for and are optimistic about the door being open to further initiatives (especially if they don’t bite the hand that feeds them).

It is worth keeping things in perspective, however.  While $50m over four years may be allocated for anti-alcohol abuse initiatives, this must be viewed in the context of $30m in a single year spent by Carlton and United Breweries to revive its VB brand.

I might have missed it, but there didn’t seem to be a strong commitment to addressing the drivers of obesity, for which sensible policies and regulation are as important as hard cash.

Again, the context is important when the Government talks about funding for campaigns and programs, and the need for those to hit the mark is made all the more apparent when you consider, as Todd Harper has pointed out (in what sound like under-estimates): ‘In 2008, $109 million was spent on alcohol advertising and $375 million on food advertising. Almost one-third of food ads were for confectionery, snacks and biscuits. …As with cigarettes, alcohol and junk food is increasingly marketed in more covert ways, such as free merchandise, toys and clever web marketing, which research shows are particularly popular with young people.’

It also remains to be seen how much more will be done to address the demand-side of tobacco use, in terms of the complex personal and social factors responsible for the initiation and continuation of smoking.”

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Rural doctors not impressed

The Rural Doctors Association of Australia (RDAA) says it is “very frustrated” with the glaring absence of serious measures to boost the rural doctor workforce in the federal budget.

“When it comes to real measures to improve access to healthcare in the bush and entice more doctors and other health professionals to rural and remote Australia, this budget is in serious need of a doctor…literally” RDAA President, Dr Nola Maxfield, said.

“While a number of initiatives in this year’s federal budget are positive for Australia’s health system, the Rudd Government is still not focusing on the main game in fixing the rural health crisis—the need for more realistic measures to entice more doctors to work in the bush.

“Instead of trying to paper over poor access to after-hours medical care with the Medicare Local national health telephone service, why not put in place real measures to get more Doctor Locals into the bush? After all, if there is no doctor in a rural town anyway, where is Medicare Local going to direct those after-hours patients needing serious care…Sydney, Melbourne or Perth?

… it is again disappointing that the Government has not funded the much-needed Rural Rescue Package called for by RDAA, the AMA and the Australian Medical Students Association to entice more doctors to the bush, and to better support rural practices as the small businesses that they are.

“We welcome the new funding to recruit practice nurses, as this will better support rural practices in employing these health professionals and widen the scope of services they can provide to their patients. We are pleased that the Government will be applying rural loadings to this program. We also welcome the increased locum support to enable rural nurses to take a break or undertake upskilling, and encourage the Government to expand this to midwives as well.

….“Some of the $7.3 billion package in health funding announced by the Government as part of its health reform negotiations will benefit rural and remote Australia, but given that over 30% of Australians live in rural areas at least one-third of this additional funding should be allocated to rural and remote hospitals and health services—particularly given there is already a Medicare underspend of around $1 billion annually in the bush.

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There are some pluses for rural health

Rural Health Workforce Australia applauds the latest Budget initiatives which expand support for primary health care, particularly general practice.

However, RHWA says there needs to be careful focus on implementation of these reforms so they actually deliver better service to rural and remote communities.

“It is imperative that we support general practice in rural and remote Australia as a priority, otherwise it will result in even more of a gap in access to health services for rural and remote people,” says RHWA Chief Executive Officer, Dr Kim Webber.

“For example, the increases in incentives to employ practice nurses are based on the number of GPs per clinic – so the more GPs you have, the greater the payment. How does this apply to a solo GP in a small town who is in desperate need of extra help? We need to look at a rural loading in cases like this.”

Similarly, Dr Webber says it is critical that the bush receives a significant portion of the $355 million allocated to build new GP super clinics and upgrade 425 primary care facilities. She says that to address existing health inequities the infrastructure investment should be weighted towards rural areas where unmet needs are greatest.

“Better infrastructure will make it easier to recruit and attract health professionals into rural and remote areas – so it’s vital that rural and remote Australia gets its fair share of this money,” she says.

“The new nursing and allied health locum programs are a further step in the right direction. They should help attract more health professionals to the bush, because people know they will get support for short-term breaks.”

Dr Webber says the new after-hours Medicare Local service could potentially be an opportunity for rural and remote communities. “Some of these places don’t even have access to health workers during the day because of workforce shortages,” she says. “This initiative could focus on the needs of rural and remote people during the day and night, rather than just providing after-hours services for city people.”

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Aboriginal health missed out

There were no frills and no clear strategy to embrace the opportunities in Aboriginal health in last night’s budget says Mr Justin Mohamed, Chair of National Aboriginal Community Controlled Health Organisation (NACCHO).

“The budget’s largest overall health investment has been chewed up in the hospitals deal. Much less was allocated for primary health care and out of that our medical services have to compete piecemeal with mainstream GP services,” Mr Mohamed said.

“From the budget announcements, there is still no clear capacity building plan agreed between our services as a whole and the government recognising our expertise built up over 35 years of providing frontline primary health care in our communities.

“The Federal Government, COAG, the National Health and Hospital Reform Commission, the Productivity Commission and the Health Department etcetera all say Aboriginal health is front and centre of the health reform agenda.

“Yet for the health reform agenda to be meaningful the role and experience of the community controlled Aboriginal medical services and NACCHO, as their peak body, must be valued rather than treated as an afterthought.

“The budget is essentially business as usual in Aboriginal health with a few incremental improvements.

“Our 150 services nationwide in urban, rural and remote areas will have to chase grants out of the budget’s mainstream bucket for improvements.

“However NACCHO will continue pushing for a significant boost to the sector and support for new community controlled Aboriginal medical services in communities that need them.

“At this stage there is no assistance for Aboriginal communities to develop their own new medical services, instead the government is investing Aboriginal health dollars in the new “Medicare Locals” and mainstream GP services,” Mr Mohamed said.

The only specific new “Indigenous” expenditure announced in the health budget was for the further roll out of Opal petrol in remote communities, costing $38m, $6m for Aboriginal Male Health programs focusing on the family, announced last week, and $10m for changing 50 CDEP jobs in the Torres Strait Islands to aged care and sport positions.

There was a welcome extension of the Quality Use of Medicines programs in Aboriginal communities under the Fifth Pharmacy Agreement.

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Many questions remain for rural and remote residents, says National Rural Health Alliance

<The> Federal Budget has provided clarification of some of the key elements of health reform, but a great deal is still unclear or unknown as far as people in rural and remote areas are concerned.

Jenny May, Chairperson of the Alliance, said that the key issue still remains whether people in rural and remote areas can be assured of their fair share of the big ticket items in the health reform agenda such as additional hospital beds, subacute care, and investments in emergencydepartments and elective surgery.

“It’s also vital for rural people to see how the local hospital networks and the new primary care organisations will work together for better health,” Dr May said.

The Budget has allocated substantial funds for these new regionalised primary care organisations, to be known as Medicare Locals.  “Given the importance of a very close working relationship between these agencies and the Local Hospital Networks, we wait with interest to see whether they have common boundaries and are based on communities of interest,” she said.

“We are pleased to have confirmation that rural and remote areas will be prioritised in the additional training and training places for GPs and specialists,” Dr May said.  “There are also welcome new investments in locum programs and clinical training scholarships for nursing and allied health professionals, and some increases in the number andcapacity of Multi-Purpose Services (MPSs).

The introduction of an opt-in “personally controlled electronic health record‟ will be of benefit to people such as those in rural and remote Australians who have to travel to access health care services.

However people in rural and remote areas will be disappointed at the lack of action on the dental health workforce, maternity services and on patients’ accommodation and travel.  “We will continue to argue that the Commonwealth’s newly-agreed responsibility for primary care brings with it responsibility for the supply and distribution of dentists and oral therapists, and for a uniform national patients‟ assisted travel scheme,” Dr May said.