Government's move against NPS MedicineWise is causing concern. Photo by Markus Spiske on Pexels.com

Health consumers give thumbs down to Government’s move against NPS MedicineWise

Melissa Sweet
Darlene Cox
Wednesday, September 28, 2022

Consumer health matters, Choosing Wisely, Safety and quality of healthcare and aged care, Evidence-based issues

Introduction by Croakey: An informal survey of about 20 healthcare consumers and clinicians has revealed considerable disappointment about the impending closure of NPS MedicineWise in the wake of Federal Government funding discontinuation.

Darlene Cox, Executive Director of the Health Care Consumers’ Association, the peak health consumer organisation in the ACT, says there is a widespread concern that health consumers, prescribers, and pharmacists will be worse off due to these changes.

She joins other health leaders in calling on Health and Aged Care Minister Mark Butler to reverse his decision.

Darlene Cox writes:

The cost and potential harms of medicines and other health technologies are key issues of concern for policy makers, funders, healthcare workers, consumers and carers.

Medicines are one of the most used healthcare treatments, and appropriate use can have significant benefits for our health. Diagnostic services and other health technologies are also highly valued, and use is increasing. It is important that our national policy and systems ensure the safe and wise use of medicines and other health technologies.

In recent weeks, I have discussed the recent changes to the Government’s approach to the quality use of diagnostics, therapeutics and pathology with about 20 consumers and clinicians and there is clearly a lack of support for these changes.

I asked experienced consumer representatives to share their thoughts with me. They are included in this article. Most people have asked not to be identified as they have a range of roles with leading national organisations and do not want to have their comments politicised.

The Health Care Consumers’ Association has a long-standing role in supporting consumer voices on local and national health policy. We have been advocating for consumer interests in health care since 1978.

We are disappointed and deeply concerned about this decision to remove uncontested funding to NPS MedicineWise. We are not alone. NPS has existed for nearly 25 years and has done exceptional work in progressing the Quality Use of Medicines (QUM) agenda. We feared that the loss of an uncontested funding stream would directly challenge the viability of NPS MedicineWise, and this has turned out to be the case with the NPS Board decision to cease operations at the end of the year.

In May 2022 I was a signatory to an open letter regarding the future of NPS MedicineWise to Hon Greg Hunt MP and Hon Mark Butler MP. Around 70 senior health care leaders signed the letter expressing our deep concerns about this decision to remove uncontested funding for NPS MedicineWise.

In June 2022, HCCA President, Dr Alan Thomas wrote to the Hon Mark Butler MP, the Health Minister, to express our opposition to the decision and ask for the decision to be reversed.

Minister Butler opposed the decision in Opposition, but once in Government he engaged Deloitte to undertake a rapid review. Based on this review it is difficult see how the decision to remove uncontested funding is justified.

One of our members, who has been involved in medicines police for over 20 years, considered the recommendations of the 2019 Review of the NPS MedicineWise QUM Programs by Professor Lloyd Sansom as well as the recent rapid review. They suggested that as the Government had supported all recommendations of the review and changes had been made to the Grant with NPS, it would be wise to give these “a chance to settle in”.

Medication errors can result in preventable adverse drug events with a significant effect on patient safety, and health outcomes. Information about medicines is important for consumers to make informed decisions about our treatment. Written information, including Consumer Medicine Information (CMI), complements good verbal communication between consumers, prescribers and pharmacists. The material developed by NPS MedicineWise, with consumers, helps address the inherent power imbalance between consumers and healthcare practitioners in both communication and decision making.

With the increasing prevalence of chronic conditions, the complexity of therapeutic management for both health professionals and patients will increase. The risk of harm also increases. The Royal Commissions into the aged care and disability sectors identify significant QUM issues. The National Medicines Policy is also currently under review. This is not the time to change the structure supporting QUM in Australia.

One consumer rep who has been involved in national health policy for over decade shared with me their thoughts:

This appears to be a nonsensical decision ignoring the expertise, leading practice and documented savings that NPS MedicineWise has delivered over the past 24 years. It is a decision taken during the review of the National Medicines Policy, but there was no reference to such a significant change in arrangements, despite an extensive consultation process being undertaken in the latter half of 2021 [as part of the review of the National Medicines Policy]”.

We have reviewed the Rapid Review by Deloitte and have a number of observations:

While the recommendations in the Report are useful considerations we cannot see that they justify the outcome of removing uncontested funding to NPS.
Broader consultation was seen as out of scope, with very limited consultation. The report does not reflect the voices of health professionals or consumers. There was very limited consultation. Any policy development and review must involve consumers to ensure it meets our needs. Leadership from health consumers has been integral to the QUM movement in Australia. HCCA members were instrumental in this, as was the Consumers Health Forum of Australia (CHF).
The report recommendations fail to adequately consider and manage the risks associated with dismantling the collective QUM assets of NPS MedicineWise. A critical risk is the loss of key personnel and expertise during any transition.
Another risk is increasing fragmentation with the move away from an integrated QUM delivery model. The NPS is focused on QUM and that singular focus has power. We are concerned that this change could dilute this focus. NPS is an example of the whole being greater than the sum of its parts. There is collaboration between the various activities of NPS MedicineWise, including national QUM stewardship, the evidence-based NPS MedicineWise website and its content, the Medicine Insight dataset, the MedicineWise consumer apps, National Medicines Symposium, Practice Reviews, Choosing Wisely Australia, and the Australian Prescriber journal. These activities support each other and the educational programs of the organisation. This collaboration would be lost with transfer of some activities to Australian Commission on Safety and Quality in Health Care (ACQSHC) and other providers.
The transition arrangements are crucial and the timing of the competitive tendering needs to be communicated as soon as possible. One consumer rep expressed their concern that “It is not known when these programs are to be tendered, but it will most likely be after the closure of NPS MedicineWise, hindering the transfer of resources and knowledge to the new organisations”. Most consumers I spoke with expressed concern that competitive tendering tends to result in a race to the bottom for quality and pricing.

NPS MedicineWise plays a key role in the implementation of the National Medicines Policy and also in addressing medication safety issues identified in the final reports of Royal Commissions into both disability and aged care. The National Medicines Policy is currently under review. That the decision to remove uncontested funding from NPS was taken before the review of National Medicines Policy has been finalised simply does not make sense.

Another consumer rep shared with me a very considered critique of the situation. They wrote: “Continuing professional education, consumer education, health promotion and health literacy, Choosing Wisely, and the Medicines Line will move to contestable funding/competitive tendering arrangements. This will likely reduce the ability and opportunity for a coordinated campaign approach, with coordinated interventions targeting consumers, prescribers, and pharmacists.”

Karin Calford is a member of HCCA and has been a consumer rep involved with NPS for many years. Most recently Karin has been a member of the NPS Consumer Advisory Group. Karin shared with me her disappointment at the decision to defund NPS. Karin recognises “there is increasing tension between access, affordability, safety and use of medications. The need for a strong national focus on the quality use of medications is more important now than ever.”

HCCA is part of the Choosing Wisely Australia movement which NPS MedicineWise has championed since 2015. It is not clear who will now lead this work. This work is important and needs to continue. I was pleased to be a member of the Choosing Wisely Advisory Group in the early stages. HCCA has been a strong supporter and worked hard to get this on the radar of ACT health services, including primary care. We also share these with the many consumer groups we work with.

Karin Calford was also a member of the NPS Advisory Group and is a self-confessed ‘fan’ of the Choosing Wisely initiative. For many consumers, the Choosing Wisely 5 Questions are valuable. Karin summed this up nicely when she told me the questions “are simple. Yet powerful. Asking these questions can result in a proper conversation with the doctor, where the patient feels heard. The patient’s ideas, concerns and expectations can be discussed, and any misunderstandings addressed. Utilising The 5 Questions engenders patient centred care, and an opportunity to improve patients’ health literacy.”

NPS has played a leading role in improving health literacy and contributed to making available high quality, accessible information about the safe and wise use of medicines and other health technologies. They have understood to importance of building health literacy of consumers and carers. NPS has promoted health literacy to healthcare workers and this has been valued by consumers. As one consumer rep shared with me: “We live in a world where many clinicians (still) adopt a ‘just don’t Google it’ approach to shaming and trying to control consumers seeking access to health information. This is not a sustainable, nor ethical, approach… NPS provides a credible, high-quality and reliable place for clinicians to point consumers for information.”

There is more work to do for consumers to ensure safe and wise use of medicines and other health technologies. One consumer rep shared with me their concerns about “increasing moves by pharmaceutical companies to hijack the consumer movement in pursuit of their own ends”. They are concerned that pharmaceutical companies are using consumers to lobby government regarding PBS listings and direct advertising of pharmaceutical products to consumers.

This underscores the importance of an independent and evidence-based organisation to provide information for consumers. NPS is an established organisation with a strong brand and expertise and the cessation of operations is a significant loss.

The NPS MedicinesLine is a useful resource for consumers. When it was first established it provided consumers access to pharmacists. It is now delivered in partnership with Healthdirect.

While the service is now staffed by Registered Nurses it is still a valuable service for consumers. One consumer rep shared that this service has “great potential to reduce many healthcare problems like high demand on GPs, ED presentations and hospital admissions from medication issues, and people ending up acting on misinformation/disinformation”. It is important for consumers that this service is promoted and funded adequately to achieve good outcomes.

I want to be very clear that our opposition to this decision of Government is in no way a comment on our respect for and confidence in the work of the ACSQHC to improve the quality and safety of health care. HCCA has a strong relationship with the Commission – we respect the work they do and value their role in the health system.

The intent of this decision is to enhance the ability of the Commission to co-ordinate and drive quality and safety improvements related to use of medicines and diagnostics. This is a significant undertaking. The time and resources needed for the Commission to establish the working relationships and trust with primary care and aged care is substantial.

While this is a good goal, the loss of momentum around QUM while the transition to the Commission occurs is a concern. We cannot afford to lose ground at a time of critical reforms in mental health, aged care and primary care more broadly.

One consumer advocate articulated the issue perfectly: “Ultimately the quality use of medicines will be diminished in Australia, with the loss of a unique, evidence-based, high performing organisation. Health consumers, prescribers, and pharmacists will be worse off due to these changes”.

It’s not too late. This is a decision that can be reversed.

We urge the Government to review the decision to discontinue NPS MedicineWise core funding and instead to enable the organisation to continue its ongoing role in leading and supporting QUM in Australia.

• Darlene Cox is Executive Director, Health Care Consumers’ Association, the peak health consumer organisation in the ACT. We work to improve the quality and safety of health services and advocate for health equity for people living in the Canberra region. We provide a voice for consumers on health issues and provide opportunities for consumers to participate in all levels of health service planning, policy development and decision making.