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Senate estimates: a summary of health evidence

Hotel quarantine, the COVID-19 vaccine and mental health were all on the agenda when the Department of Health faced the Senate Community Affairs Committee at the estimates hearings in Canberra last week.

A summary of the key issues raised in the hearings is provided below – see here for a full transcript.


Jennifer Doggett writes:

COVIDSafe app

Key point: 17 unique individuals have been identified using the app out of a total of 80 close contacts.

Additional details: Departmental officials stated that Victoria has fully integrated the COVIDSafe app into its contact tracing and there have been a total of 1,851 individuals who’ve identified they’ve had the app and been contacted by contact tracing.

COVID-19 Vaccine

Key point: Australia is pursuing a ‘diversified’ vaccine strategy, including participating in international alliances for global allocation of vaccines and exploring advance purchasing agreements with individual companies.

Additional details: The federal government has signed an agreement with (international vaccine alliance) Gavi to join the Covax Facility and committed $80m which entitles Australia to enough doses of a vaccine (when available) for 50% of our population.

It has also entered into two advanced purchasing agreements in relation to the AstraZeneca Oxford vaccine and the University of Queensland vaccine, both of which will be in large part manufactured in Australia and is also having ‘active and very sensitive discussions’ with other companies.

These advanced purchasing agreements allow Australia to on-sell or donate excess doses to other parts of the world if there is a surplus.

The Department confirmed that Australia has the capacity to store and transport vaccines at minus 70 and minus 80 degrees, if required.

Two companies have sought and been provided with provisional designation for their vaccines in development: AstroZeneca and Pfizer.  This will expedite the approval processes of these vaccines once finalised.

Homelessness and domestic violence

Key point:  The Department of Health is undertaking work on domestic violence presentations to hospital emergency departments

Additional details: The Department is consulting with the College for Emergency Medicine and the National Health Data and Information Standards Health Committee on this issue.  There are a number of barriers to collecting this type of information in an emergency department, including avoiding placing a greater burden on emergency medicine specialists.

Currently the Department is working through the detail to see whether there’s data that’s already been collected that we might be able to use, assessing whether it’s collected in a standardised way.

This work is not likely to be finalised in the short term in order to be included within the national minimum datasets and our core national collections.

Aged and disability care

Key point:  The Department is working to improve the transition of care between care setting and on the treatment of challenging behaviours.

Additional details: Transitions between care settings, for example, a person going from a home care situation or residential aged care up to a hospital and back, are where many mistakes and adverse events occur.

The government is working with stakeholders to improve transitions between care settings.

The government is also working very closely with the aged-care commission and the disability commission on work around the care of people with behavioural disturbances, in particular on the use of chemical restraints and inappropriate use of anti-psychotic to sedate people.

The plan is, within six to 12 months, to have one standard across all settings to appropriately care for people with behavioural disturbances rather than just turning to an anti-psychotic.

Productivity Commission inquiry into mental health

Key point:  The report of the Productivity Commission’s inquiry on mental health is with the government and no decision has been made about when it will be released.

Additional details: The final report of the Productivity Commission’s inquiry on mental health was provided to the government on 30 June 2020.

Productivity Commission reports generally go to the Treasurer in the first instance because the Productivity Commission sits under the Treasury portfolio.

The Treasurer has not indicated when it will be released.

Suicide report

Key point:  The National Suicide Prevention Adviser’s interim report has been provided to government but has not been released.

Additional details: The National Suicide Prevention Adviser’s interim report has been provided to government. As the National Suicide Prevention Adviser reports to the Prime Minister, he makes the decision about whether and when to make it publicly available.

The Department of Health anticipates that the final report will be delivered in December. Details of its release and the government’s response are a matter for the Prime Minister and the National Suicide Prevention Adviser.

Better Access to mental health

Key point:  The MBS Mental Health Reference Group has provided a report to the MBS Review Taskforce which has made recommendations about mental health funding to government.

Additional details: The government is considering these recommendations. They have not been made public at this stage but it is likely that they will be in the future.  No decisions have been made about the timing of this.

Hotel quarantine

Key point:  The government is working with states and territories on a response to the recommendations of the Halton report.

Additional details: The Department understands that hotel quarantine is stressful and it impacts on people’s mental health.

The Commonwealth has provided some support for people affected by quarantine and the lockdown. For example, during the Victorian towers incident earlier with the pandemic and the lockdown the department worked with beyondblue to make sure that there was in-reach provided to the towers.

However overall the government believes that supporting people in quarantine is predominantly the responsibility of various states and territories.

The Department is considering what the Commonwealth can do to help simplify and standardise the information that’s provided to people in quarantine to make sure that their mental health and wellbeing are taken care of.

It does not yet have a position on specific recommendations such as the development of a website similar to New Zealand’s Managed Isolation and Quarantine website or the provision of information to all international arrivals on commercial aircraft.

Rural health

Key point:  The Department has a number of different programs aiming to increase the GP rural workforce but there are still shortages in many areas of Australia.

Additional details: The Department said that rural general practice is ‘probably the single biggest health workforce focus of the department’.

Initiatives in this area include: the Stronger Rural Health strategy, the Medical Workforce Strategy, efforts to make the training programs in rural general practice more attractive and to make them better funded, loadings to general practice supports and workforce incentive programs, the transition of general practice training to the colleges, and  the medical school strategy.

One issue has been that overseas trained doctors haven’t felt the capacity to get their specialist GP qualifications but that is now being address through the Stronger Rural Health Strategy.

The government also recently significantly expanded the Workforce Incentive Program that funds allied health positions in primary care and provides a significant rural loading.   This includes funding for practice nurses, physiotherapists, occupational therapists, and pharmacists.

In remote areas, where there is not a viable Medicare fee-for-service funded general practice, the Department is exploring different models, for example, three or four towns pooling their Medicare money and employing salaried professionals.

The Rural Health Multidisciplinary Training Program is being expanded to support university departments of rural health which provide rural, long-term clinical training opportunities for allied health practitioners.

This is a longstanding program approach which has been evaluated as building more rural workforce because people get the opportunity to practice in a rural area and are more likely to remain working in that area once they’ve finished their clinical training.

The telehealth measures also provide support for allied health practitioners in regional and rural areas.

Preventive health strategy

Key point:  The National Preventive Health Strategy will include a focus on climate change after feedback from stakeholders on the consultation paper indicated that this was a major area of concern.

Additional details: The federal government accepts that climate change is an issue in health.

The Health Protection Principal Committee, which has been very focused on COVID this year, has commissioned some work from the Environmental Health Standing Committee or the national health emergency management committee on preparation for heat and heat management.

The Department has also commissioned a lot of national work on bushfire smoke issues and vector-borne diseases.

Stakeholders responding to the Preventative Health Strategy consultation paper felt that the issue of climate change hadn’t come through strongly enough.

The Department acknowledges that there are many determinants outside of the health sector that impact on prevention or impact on good health outcomes and that there is work they need to do with other parts of government, other portfolios, and that’s in relation to climate change, infrastructure, healthy environments and other factors.

The Department noted that ‘there was also a bit of a campaign in relation to climate change and health’ with 238 submissions specifically focussing on this issue

The draft preventive health strategy will be released before Christmas.

Telehealth

Key point:  The government is developing a long term plan for telehealth with input from stakeholder groups.

Additional details: There are some exemptions from this condition but no request has been made by rural communities for an exemption.

The Government introduced the requirement that people have a an existing and continuous relationship with the GP in order to access Medicare funding for telehealth after consultation with peak bodies, including the RACGP and the AMA, who were concerned about loss of continuity of care.

There have been reports that city-based GP practices were attempting to attract patients from rural areas via telehealth but these have not been verified by the government.

The government is not undertaking a formal evaluation of telehealth but is looking at data on its uptake and following academic and other research in this area.

Medical costs finder website

Key point:  The government is working to upgrade the costs finder website to include individual practitioners’ fees.

Additional details: The budget commitment of 17 million is to support the inclusion of individual specialists’ fees on the site.

The government is not undertaking a formal evaluation of the site but is using analytics to inform design decisions and upgrades.

The government is currently preparing and workshopping a number of prototypes for collecting and publishing medical specialist’s individual fee data on the site and continues to engage with different stakeholder groups around the design.

To 23 September 2020 there have been 19,134 unique users and 28,426 site visits in total.

There is no evidence that people have used the information on the site to inform their decision making.

It is difficult for the Department to give a launch date for the site given that it relies on different craft groups to provide the information.

Private health insurance – mental health

Key point:  A new budget measure will support access to PHI funded mental health services in the community.

Additional details: The government is considering which mental health services would be eligible for PHI subsidies under the budget measure to expand PHI coverage of home and community based care.

Specific mental health services being considered mental health nurses and mental health apps.

Consultations have taken place with insurers and some healthcare providers.

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