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On the COAG health omnibus: mandatory reporting, National Energy Guarantee, smoking age, organ donation…

Mandatory reporting laws for doctors. Real-time prescription monitoring. Streamlining medical cannabis access. Lifting the minimum age for tobacco purchase (brought to you by mining magnate Andrew ‘Twiggy’ Forrest). Big health worries about the National Energy Guarantee target.

This omnibus post looks at some of the many issues being debated and agreed at recent and upcoming Council of Australian Government (COAG) Health and Energy meetings.

See also below re research commissioned by the Australian Health Practitioner Regulation Agency (AHPRA) on vexatious complaints, which has found there is more risk from people not reporting concerns than from making dubious complaints.


National Energy Guarantee “fails health”

As David Blowers, Energy Fellow at the Grattan Institute writes at The Conversation today, the finer policy details of the of the Federal Government’s proposed National Energy Guarantee (NEG) have begun to leak onto newspaper front pages and websites, ahead of Friday’s Energy Council Ministerial meeting.

Last weekend’s Doctors for the Environment Australia national conference (see here for a Twitter wrap of the event) issued a joint statement to state and territory Energy Ministers from 150 concerned GPs, emergency doctors, public health physicians, paediatricians, physicians, surgeons, medical students and other health specialists. It said:

As doctors, we call on the energy ministers to enact energy policy that protects public health as a matter of priority.

The National Energy Guarantee proposed by the Coalition Government fails health on the following points:

  • Australia’s emissions are rising.
  • The overall emissions reduction target, 26 per cent for the electricity sector by 2030, is woefully inadequate in meeting the Paris Agreement to curb global warming, a looming health disaster.
  • Doctors are already dealing with the human face of climate chaos in their clinics and hospitals as a result of extreme weather events including heatwaves, thunderstorm asthma, drought, cyclones and more.
  • The NEG doesn’t address the direct health impacts of coal, a major cause of air pollution and driver of climate change. Poor air quality is costing lives and causing multiple health problems.
  • The NEG does not provide a clear plan to transition towards renewable energy, nor for coal-workers to face a secure future.

Cautious welcome but significant concerns still on mandatory reporting

Australian medical organisations have cautiously welcomed the proposed revision of mandatory reporting laws that compel treating doctors to report the ill-health of other health professionals, but said the changes agreed by last week’s Council of Australian Governments (COAG) Health Council meeting still leave “significant room for doubt and confusion”.

According to the Health Council’s communique, the meeting of state and territory Health Ministers agreed unanimously to a nationally  consistent  approach  to  mandatory  reporting  which proposes exemptions from the reporting of notifiable conduct by treating practitioners.

The Ministers said: “The legislation will include strong protection for patients and will remove barriers for registered health professionals to seek appropriate treatment.”

However there was concern among doctors’ groups with the news that the legislation will specifically include a requirement to report “past, present and the risk of future sexual misconduct” and  “current and the risk of future instances of intoxication at work and practice outside of accepted standards”.

In a statement, Australian Medical Association (AMA) President Dr Michael Gannon said it was clear that acceptable nationally consistent mandatory reporting laws were within reach that would remove barriers for doctors seeking help about mental health or stress-related conditions.

But he said the AMA was particularly worried about wording referring to ‘future misconduct’ of health professionals:

“It is unreasonable and unworkable to expect treating doctors to predict the future behaviour of any patients, including their colleagues.”

The Royal Australian College of GPs said it was particularly concerned about the retention of requirements for reporting a health professional “practising at a lower standard’.

“Much of the conduct identified as grounds for mandatory reporting is subjective, open to interpretation by both the health professional and their treating practitioner,” said RACGP President Dr Bastian Seidel. “If there is room for doubt on what should or shouldn’t be reported, the fundamental issue of there being barriers to healthcare for all health professionals remains.”

Seidel said health professionals must be exempt from reporting health professionals under their care, in line with the model adopted by Western Australia.


Also on the agenda at the COAG Health Council

Real time prescription monitoring:

The Ministers said they had agreed to progress national real time prescription monitoring as a federated model.

The agreement was welcomed by the Pharmacy Guild which said:

“With unanimous support across all States and Territories, there is every reason to expect a national real time prescription monitoring system can be achieved as soon as possible so that lives can be saved.

“The solution must be nationally consistent to be fit for purpose – namely to connect prescribers and dispensers in real time so that clinicians can be informed and make decisions to minimise the risk of drug abuse and death.”

Increasing the minimum legal age of tobacco purchase

The Ministers referred a proposal to increase the minimum legal age of tobacco purchase from 18 to 21 years to the Australian Health Ministers’ Advisory Council with input from the Australian Institute for Health and Welfare for advice.

The move is in response to a high profile campaign from billionaire mining magnate Andrew ‘Twiggy’ Forrest, who says raising the age would stop young people getting hooked, save lives and save government coffers up to $3.1 billion a year.

A recent study of New York’s decision to boost the legal age to 21 suggested that tough enforcement is the key to success: it found that adolescent tobacco use declined slightly after he policy change, though was larger in control locations, and that increased use of e-cigarettes and unchanged reported purchases of loose cigarettes suggested uneven policy implementation, enforcement, or compliance.

Streamlining the process for unregistered medical cannabis products.

The Health Ministers all signed up to new streamlined access to medicinal cannabis, which reports said aimed to make medicinal cannabis available to patients within two days.

The Health Council said the development of a single national online application pathway would avoid duplication of decisions regarding clinical appropriateness.

Federal Health Minister Greg Hunt said the agreement would establish a “one-stop-shop” for patients seeking the treatment with doctors placed at the centre of the process.

Greens campaign material

The news came as The Greens this week released a new policy for cannabis to be legalised and sold in plain packaging, with its wholesale distribution monopolised by a new government agency. The policy would  ban sale of cannabis to people under 18, prohibit advertising, and use tax revenue collected for drug treatment and education programs. Greens leader Richard Di Natale said:

“Prohibition has failed. As a drug and alcohol doctor, I’ve seen that the ‘tough on drugs’ approach causes enormous harm. It drives people away from getting help when they need it and exposes them to a dangerous black market”.

Read the policy in detail here: http://drugs.org.au/

More from COAG Health Council

Read the full communique here, also for news on a further review of the organ donation, retrieval and transplant system; streamlining visa arrangements to support pathways for overseas students; and further inquiry into improving the primary care response to family violence.

The communique says the Health Ministers next meeting will be in Alice Springs, and will include a significant focus on Aboriginal and Torres Strait Islander health issues.


Vexing not vexatious, report finds more risk in not reporting

The Australian Health Practitioner Regulation Agency (AHPRA) also this week announced independent research on reducing, identifying and managing vexatious complaints commissioned from the School of Population and Global Health, University of Melbourne. AHPRA said it initiated the work in line with its commitment to the Senate Affairs Reference Committee inquiry into the medical complaints process in Australia.

The AHPRA statement quotes researcher Associate Professor Marie Bismark, saying that being on the receiving end of a complaint is a distressing experience for any health practitioner, and regulators need to have good processes for dealing with unfounded complaints quickly and fairly. She said:

“Our research found that the term “vexatious” is often loosely used in debate to refer to complaints that may simply have been the result of a miscommunication or a misunderstanding. A truly vexatious complaint is a complaint that is groundless and made with the intent of causing distress or harm to the subject of the complaint.

‘There is a common misconception that a complaint must have been vexatious if it resulted in no regulatory action. However, a decision by a National Board not to take regulatory action does not mean that the complaint was unfounded or made in bad faith. For example, a risk to the public may have been adequately addressed between the time the complaint was made and when the investigation concluded,’ she says.

‘This is not an issue that is unique to healthcare. Around the world, regulators from different sectors are occasionally faced with people who make repeated, unreasonable and fervent complaints or intentionally misuse complaints processes. Our research identified some helpful processes for identifying and responding to this type of complaint in a timely way. Efforts to better prevent and manage vexatious complaints must be carefully designed so they don’t discourage those with legitimate concerns from coming forward,’ she added.