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The Election Wrap: focus on accountability and why the next Health Minister has a long to-do list

Each Wednesday during the election campaign, Croakey is publishing a rolling wrap of health and election news. We welcome submissions and suggestions.

In this wrap, Associate Professor Lesley Russell launches The Accountability Report, which could also be sub-titled, ‘The long list of tasks that Health Minister Greg Hunt has left for his successor’.

This wrap also updates the detailed #AusVotesHealth2022 Election Report Card, which now includes the Independents’ policies.

Don’t miss our selection of tweets-not-to-miss, and the listing of health and community stakeholder election policies.

ICYMI, here are part one (13 April), part two (20 April) and part three (27 April) of this series.


Lesley Russell writes:

Last Sunday evening Croakey ran the first of three Zoom discussions on the election issues (reported in more detail here).

It was a lively session and there was a surprising level of agreement on how disappointing the major parties’ campaigns have been. I suspect there is little chance things will improve.

Why don’t you tune in to the next discussion on Sunday, from 7pm AEST, with a focus on rural health.

This week, we launch The Accountability Report – a new compilation of all the reports, reviews, inquiries, evaluations, plans, strategies and advisory groups that retiring Health Minister Greg Hunt is leaving behind for his successor – it’s a long To Do list for the new Minister.

The #AusVotesHealth2022 election report card has been updated with the new policies that have emerged in the past week. And don’t forget to check out the key Independents at the end of the document.


Campaign progress report

Sadly, despite voter concerns about the cost of living and affordable healthcare, it seems health and  healthcare is rarely on the agenda.

The major parties want voters to believe that they are rock solid in their support of Medicare, but no-one has acknowledged the continuing erosion of the universality of Medicare and of the public hospital system.

There’s plenty of rhetoric but no statements about what will be done to make Australia’s healthcare system more accessible, affordable and equitable.

The Conversation asked five experts (including me) to rate the Coalition and Labor on Medicare issues (although some of the experts caste their gaze well beyond Medicare in making their assessments, which might explain why they were so generous!).

There’s plenty of rhetoric but no statements about what will be done to make Australia’s healthcare system more accessible, affordable and equitable.

It is also shocking, given the looming threats to health, the environment and quality of life, that we hear so little about climate change. When we do, it’s almost always in the context of jobs and taxes.

And the other issue that rarely rates a mention is how to manage the ongoing impacts of the pandemic and be better prepared for the next one.

Thank goodness for the Teal Independents who are talking about these key issues!

As the campaign proceeds we are getting a better sense of the handful of seats where women described as Teal Independents stand a good chance of getting elected.

Dr Monique Ryan is a very real threat to Treasurer (and would-be Prime Minister down the road) Josh Frydenberg in Kooyong – and that would be a real upset.

Apparently Kooyong is awash with “Keep Josh” billboards. I thought there was something prophetic about Frydenberg’s campaign materials on a boarded-up bank.The Coalition and the Murdoch media are clearly worried, and their diatribes are increasingly partisan and nasty.

In the once-safe Liberal seat of Goldstein, polling shows incumbent Liberal Tim Wilson and his independent challenger Zoe Daniel tied at 33 percent each on the primary vote.

Wilson wrote in an opinion piece for The Australian (paywalled) that “‘Independents’ want to override our democracy”.

Greg Sheridan, also writing in The Australian, was positively apoplectic about the Teal Independents, calling them “extremists”, “a direct threat to our national security” and arguing that they are “playing the electoral system for a sucker”.

No wonder then that an assessment by ABC’s Media Watch of coverage of these candidates in the Daily Telegraph and The Australian found that the vast majority of the stories were negative.

But this Independent movement is bigger than potential upsets in well-off, urban seats. It demonstrates the dangers of ignoring the very cogent need of voters to feel that they are being listened to and that government is working to help them and their communities. (Do the Liberal candidates who are not turning up for debates and not taking questions realise that this doesn’t help their cause?)

This is exemplified in the Queensland seat of Hinkler, which encompasses Bundaberg. A Coalition stronghold for several decades, it is currently held by Resources Minister Keith Pitt.

But an Independent challenger has emerged: former Bundaberg Mayor and State LNP minister Jack Dempsey (I’m sure he would not describe himself as a Teal Independent!). He is gaining traction because Hinkler voters feel ignored and that no-one is addressing their concerns around affordable housing, the cost of living and the cost of healthcare.

He seems to be cutting through in ways that the local United Australia Party (UAP) and Pauline Hanson One Nation (PHON) candidates are not.


Labor’s campaign launch

I was heartened by the messages coming out from Labor’s campaign launch. You can read Anthony Albanese’s speech here, and also see some rather entertaining comments in the speech from the Premier hosting the event, Mark McGowan.

There was clearly strong support in the room for Labor’s commitment to work with First Nations people to implement the Uluru Statement from the Heart in full.

There were new commitments in a number of areas:

  • A “Made in Australia” industry policy
  • A policy to reduce the out-of-pocket costs for prescription medicines that bested the policy recent announced by the Coalition
  • Addressing the gender pay gap
  • A national charging network for electric vehicles
  • A government equity scheme for first-time home buyers.

And I thought the Opposition leader’s rhetoric – delivered sincerely, if not rousingly, worked well.

“Australia: if we stand still we will be left behind. If we don’t shape the future, the future will shape us,” he said.

“Because, make no mistake, climate change is here now. Our region is changing now. The jobs and skills and infrastructure that will grow our economy are needed now. There is a crisis in aged care, right now. Families need lasting help with rising costs, right now. Australia does not have three more years to waste.”

Albanese promised to lead a government that “holds no-one back – and leaves no-one behind”.

The media are reporting that the Coalition won’t do their launch until the last week of the campaign. Somehow that seems symbolic – they are always late to the issue of the day.


Competing policies on reducing PBS co-payments

A bright moment in the election campaign has been the policy competition between the Coalition and Labor to reduce co-payments for prescriptions on the Pharmaceutical Benefits Scheme (PBS).

Voters are absolutely the winners with this sort of one-upmanship to address a serious healthcare cost barrier.

On April 30 the Morrison Government announced that it would cut the PBS co-payment for general patients by $10, meaning the maximum price for a PBS script would be reduced to $32.50.  This proposal was originally, mistakenly, announced during Budget week.

This is a seriously significant policy proposal, the first time the PBS co-payment has ever been cut and it will make a real difference for many people who do not have a concession card and need multiple medications. It potentially benefits some 19 million Australians.

As part of the 2022-2023 Budget, the Morrison Government has said it will reduce the threshold for the PBS safety net, a move that will primarily benefit concession cardholders.

It was not long before Labor upped the ante, with the announcement (as part of Albanese’ election launch) that Labor would drop the general co-payment by $12.50. (I have been unable to determine if Labor has said it will take up the Budget safety net changes.)

What was the Coalition to do in a bidding war?

They responded on May 2 with an announcement that they would change the thresholds so almost 50,000 more Australians will be eligible for Commonwealth Seniors Concession Cards.

This eligibility means the PBS co-payment is $6.80 and drops to zero once the safety net threshold is reached. Concession card holders can also attract a bulk billing incentive for GP visits (at the discretion of the doctor) and receive a reduction in the cost of out-of-hospital medical expenses, once the lower, concession card threshold for the Extended Medicare Safety Net is reached.

Labor said “We’re not interested in playing politics when we see a good idea”, and adopted the proposal.

This year the election policy announcements are very short and sharp and lack any of the details that are usually provided (and that must ultimately be provided so the policies can be costed). So – as I always say – the devil is in the detail. But the PBS announcements are seriously good news for many Australians.

Now if only they would deal with the out-of-pocket costs to see a GP and specialists.Tweet by Grattan Institute

 


The Health Minister’s legacy – unfinished business that awaits his successor

In a recent article for Croakey Health Media commenting on the announcement by Health Minister Greg Hunt that he was retiring from federal politics, I referred to him as the Minister for Unfinished Business.

Put bluntly, that translates as someone who has too often been able to find an excuse for delaying decision-making and who has endlessly resorted to the need for further advice, committees and taskforces, even in the face of mountains of reports, evidence and recommendations.

I have provided further evidence for this assertion with The Accountability Report, launched today by Croakey. This is a compilation of reports, inquiries, evaluations, plans strategies and advisory groups that have delivered information and recommendations and imperatives for action over the life of the 46th Parliament.

In doing this work I ignored the accumulation of such paperwork from previous parliaments that (at least figuratively) must languish – unseen, ignored, forgotten – in the Department of Health archives.

This is just one indication of what is waiting for the next Minister for Health and Ageing on the day they are sworn in. The Accountability Report surely serves as a signal that, with very few exceptions, there is little need for further reports and recommendations – there is plenty of evidence to inform the actions that are needed in critical areas of the health and healthcare system.

All that is missing is a Health Minister with a vision of improving the health of all Australian and the political willingness to act.

Mental health serves as a classic example here.

There were 32 reports and inquiries into mental health between 2006 and 2012. In the years since:

  • the National Mental Health Commission has delivered annual reports to the Australian Government on the mental health and suicide prevention system in Australia and in 2014 handed down a major report “Contributing lives, thriving communities”
  • the Australian Institute of Health and Welfare has issued a series of reports on the use of mental health services
  • there has been a report from the Royal Commission  into Victoria’s Mental Health System
  • there has been a recent report from a select committee of the Australian Parliament on mental health and suicide prevention.

All these reports said the mental health system was in crisis and not delivering services to those most in need – but they had minimal political impact. Sussan Ley, the Health Minister at the time, rejected the key recommendations of the ‘Contributing Lives’ report out of hand.

In a recent article for Croakey Health Media, Dr Sebastian Rosenberg summed up thirty years and mental health policy and plans as a series of lost opportunities.

Finally, the Productivity Commission’s findings could not be ignored. But there is very real concern that the Morrison Government’s response to date is about doing more of the same rather than reforming the system around patients’ needs.

The situation is just as bad for aged care. At least 20 aged care reviews have been conducted in the past 20 years; the Aged Care Royal Commission presented a background paper on these.

It’s over 20 years since the kerosene baths incident was reported, yet today’s media still has stories of neglect and abuse and staffing issue that have been aggravated by the pandemic.

All these reports delivered basically the same recommendations for improvement. We know what should be done, now it’s time for what must be done.

In implementing the agreed strategies, plans and frameworks there will always be a need for ongoing advice, assessment and evaluations.

There is little point in setting outcomes, targets and Key Performance Indicators if these can’t be measured or if the results of those measurements are ignored. And the increasing commitments from governments and bureaucracies to work with patients, carers, community groups, and First Nations communities and experts demand regular and ongoing committee and/or advisory group meetings.

Back in 2008, Dr Ann-marie Boxall, Professor Stephen Leeder and I published a paper in the Medical Journal of Australia entitled Seeking a Horse and Finding a Camel, looking at the advisory groups and committees in the Health portfolio  during the Rudd Government.

We made the point that advisory groups are only as effective as political leaders allow them to be: “An expansive and devolved advisory system could improve the health policy-making process, but only if it is integrated into the processes of government.”

The paper then outlines eight simple and practical measures that, if implemented, would make Australia’s health advisory system more transparent and effective.

My colleagues Charles Maskell-Knight and Jennifer Doggett have outlined the factors that contribute to a successful tenure as Health Minister. Their list includes luck but does not include the ability to juggle multiple balls in the air, managing multiple difficult and complex issues simultaneously. I think The Accountability Report reinforces that point very effectively.


Fact check – Morrison Government’s PBS listings

The Morrison Government makes much of the new and amended listings on the Pharmaceutical Benefits Scheme under their watch.

These days they cite 2,900 new and amended listings since 2013.

That number has increased since March 2022 when it was cited as 2,800.

“Since 2013, the Coalition Government had approved more than 2,800 new or amended listings on the PBS. This represents an average of around 30 listings or amendments per month ­– or one each day – at an overall investment by the Government of $14.3 billion.” (media release, 1 March 2022)

The Pharmaceutical Benefits Advisory Committee, which approves medicines for listing on the PBS, sits three times a year. From the July 2021 PBAC outcomes, there werecpositive recommendations for 30 medicines: 11 were for new listings and 19 were for changes to listings. If we assume this is typical, then about 1,680 new medicines (or new uses for previously listed medicines) were added to the PBS.

Hunt regularly brings up a Labor decision in the 2011-12 Budget to defer the listing of some medicines on the PBS (see this Twitter thread).

The requirement for Cabinet consideration of products that cost more than $10 million in any of the first four financial years of being listed on the PBS was first introduced in 2001. This has led to many examples of delays in the listing of products on the PBS.

A classic case came in 2002 when the then Minister for Health (Senator Kay Patterson) declined to list Viagra on the PBS, despite a positive recommendation from the PBAC. The advice from the PBAC contained a clear warning that the listing of this product on the PBS might have a significant budgetary impact.

Perhaps a more egregious example is the refusal of Prime Minister John Howard’s Cabinet “razor gang” to add pneumococcal vaccine for infants to the list of free vaccines, despite recommendations from both the Australian Technical Advisory Group on Immunisation and the National Health and Medical Research Council. The listing of this vaccine was delayed by two years and only occurred after a campaign by Labor.

In the circumstances cited by Hunt, the Gillard Government, working to bring the 2012-13 Budget back into surplus, announced in February 2011 that it would defer the listing of seven products (six medicines and a vaccine), while proceeding with the listing of several other PBAC recommendations. The justification given was that existing treatments were already available on the PBS in lieu of these products.

There was of course considerable outrage from the pharmaceutical industry, patient groups and consumers, and it was not a good look for the Labor Government.

All of the deferred medicines were listed on the PBS by September 2011, after a delay of up to seven months.

There’s a good explanation of this issue from the Parliamentary Library here. A paper published in the Australian Health Review in 2012 takes a more detailed looked at the issues.


Upcoming


Campaign shockers


Media-related


Selection of tweets



Links to election policies

ACOSS response to Greens climate policies

Australian Academy of Health and Medical Sciences

Australasian College for Emergency Medicine

Australian College of Mental Health Nurses election priorities

Australian College of Rural and Remote Medicine

Australian Healthcare & Hospitals Association

Change the Record Election Platform

Climate and Health Alliance election scorecard

cohealth election priorities

Council on the Ageing (COTA) Australia agenda for the next Government and Parliament

Every Australian Counts

Joint statement by Australia’s suicide prevention sector, representing 40-plus organisations

Lowitja Institute

National Rural Health Alliance election priorities

Obesity Coalition – 2022 election priorities

Public Health Association of Australia priorities

Refugee Council of Australia scorecard

Royal Australasian College of Physicians

The Latch: Vote for disability rights

Women’s Electoral Lobby

Women with Disabilities Australia


Join the conversation

Bookmark this link to stay in touch with our election coverage.

See the #AusVotesHealth2022 Election Report Card, updated each week.

Follow this Twitter list (65 members & counting) for health and election news and commentary. We will continue building the list over time.

Please use and share this hashtag – #AusVotesHealth2022 – on related content to help build a collective platform to amplify diverse voices with a focus on health equity. The Public Health Association of Australia is also encouraging use of the hashtag, #VoteForPublicHealth.

Join members of the Croakey team at open news conferences on Sunday, May 8 and 15, 7-8pm AEST.

Register for each one separately: https://www.eventbrite.com.au/e/croakey-health-media-ausvoteshealth2022-registration-318361386477


We thank and acknowledge contributors to this compilation, including Dr Anny Huang.

 

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