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The Health Wrap: Budgets, mental health reform, rural health and patient safety

This edition of The Health Wrap is compiled by Barry Dunning, Media and Communications Manager at the Sax Institute. Enjoy the wrap and don’t forget to tweet us @SaxInstitute if you have any ideas you’d like to share.


Budgets, budgets everywhere

The Federal Treasurer Scott Morrison will hand down the Federal Budget on Tuesday 9 May and across the health, medical and research sectors, speculation is rife as to what it will contain. The Australian reports that the Government has:

Quarantined healthcare from sweeping cuts, part of a wider budget plan to end a divisive freeze on Medicare rebates, as Malcolm Turnbull tries to shake off the ghosts of an unpopular $80 billion saving in the 2014 budget…. The savings in some parts of the health portfolio, such as an increase in the use of generic pills to save spending on proprietary medicines, will be ploughed back into the portfolio to assure voters there is no threat to healthcare.

Easing of the Medicare rebate freeze has been heavily signalled in recent weeks, with News.com.au reporting that “rebates for general practitioner visits for concession patients, including pensioners and children, will rise from July this year… for general patients there will be a wait until July 2018 before their $37 Medicare rebate is adjusted for inflation after being frozen at 2014 levels for four years.” The Grattan Institute’s Stephen Duckett has called for reform of GP services as quid pro quo for ending the Medicare rebate freeze, in an article for The Conversation (an issue also covered by Croakey here):

General practice in Australia needs reform. In late 2015, the government’s own primary care advisory group called for change. Last year, a Grattan Institute report, Chronic failure in primary care, identified numerous potential improvements, notably updating the payment to GPs from fee-for-service to a system that will encourage better care of the increasing number of Australians who suffer from chronic conditions.

All will be revealed on Tuesday night, but if the Federal Health Department was looking for ways to reduce costs whilst keeping services at the same level, this Croakey article about Gold Coast Health’s success in reducing unnecessary pathology testing has some suggestions. Elsewhere on Croakey, Jennifer Doggett described the Australian Healthcare Reform Alliance’s campaign for reform of the private health insurance rebate, highlighting many options from across the healthcare sector on how to spend the $7 billion per year in direct subsidies in this article.

Daniel Andrews’ Victorian Labor Government handed down its State Budget on Tuesday 2 May. While an extra $2.9bn was announced for healthcare including for hospital upgrades, the unprecedented investment in tackling family violence was the headline grabber. Treasurer Tim Pallas announced a $1.9 billion allocated over four years to implement the recommendations of the Victorian Royal Commission into Family Violence. The ABC reported that this money will be used to fund key features of the blueprint laid out by the Royal Commission including:

  • $448.1 million to establish 17 one-stop-shop Support and Safety Hubs
  • More than $270 million for victim assistance, support and counselling
  • $269.4 million to introduce specialist Family Violence Courts and expand legal assistance for victims.

Reactions to this have been positive. Fiona McCormack, the CEO of peak body Domestic Violence Victoria commented:

To be honest I think today is a day for Victoria to be proud. God knows we’ve had enough days to be ashamed of.

According to the ABC, the Victorian coroner reported 24 family violence deaths last year — 15 women and nine children.

In the Northern Territory, the Labor Government of Michael Gunner handed down its first budget. The ABC reports that health services were a big winner, and while $27 million was committed to fund the hearings of the Royal Commission into Youth Detention, no extra money has been allocated for future recommendations.

Finally on politics, Sydney University Adjunct Professor Bill Bellew wrote about political disruption, and the ongoing challenges for public health and the CEO of the Public Health Association of Australia Michael Moore reflected on populism politics and global public health, both for Croakey.


Reforming mental health care

Issues with Australia’s mental health care system continued to make headlines. In the latest edition of Public Health Research & Practice (PHRP), guest editor Professor Ian Hickie, a commissioner on the National Mental Health Commission, wrote:

Increased funding for expanded mental health services is crucial, but unless we overhaul the system and have the courage to defund ineffective programs, we will be throwing good money after bad.

Elsewhere in the current edition of PHRP, consumer advocate and Australian Mental Health Commissioner Jackie Crowe wrote that consumers and their families are demanding changes to Australia’s mental health care system:

In recent times there has been a noticeable unrest stirring within our [mental health consumer] communities, a budding revolution. People, advocates and communities are expecting more. They are demanding an open, transparent and seamless enabled system of care and support.

Still on the topic of mental health, researchers have criticised the Australian healthcare system for ‘failing’ patients with eating disorders. They found anorexia nervosa to have the highest mortality of all mental illnesses, with one in five patients with the condition likely to die by suicide. The ABC’s Sophie Scott reported on three families who lost loved ones with anorexia nervosa to suicide, who “all struggled to get doctors to take their concerns seriously”. The families spoke about the fragmented care available and their experiences of being “bounced in and out of hospitals as their weight went up and down…but none were offered holistic care to treat their physical and mental illness”.

The Federal Health Minister Greg Hunt, who has spoken about his family experience with mental health and his commitment to improving services, responded to the ABC with a pledge to take action:

We have to do more for mental health, but specifically for anorexia, which has been such a tragic condition and so it has been, to a degree, overlooked and it’s time to put the spotlight firmly on eating disorders… It  [The Medicare Review committee] will look at whether new approaches should be made available under Medicare specifically for eating disorders, and particularly for anorexia.

Finally, The Huffington Post has been running a series of articles over recent weeks as part of their support for the #StopSuicide campaign. This short documentary, asking why men are 3 times more likely to die by suicide than women, tells a powerful story.

If you need help in a crisis, call Lifeline on 13 11 14. For further information about depression contact beyondblue on 1300224636 or talk to your GP.


Rural health challenges

The 14th National Rural Health Conference was held in Cairns from 26 to 29 April. Dr Lesley Russell made the case that investing in rural health not only improves health outcomes but brings dollar returns to local economies, in this curtain raiser piece, published originally on The Conversation. The ABC reported that safety remains a major factor in the challenge to recruit and retain remote area nurses and midwives.

Croakey editor Melissa Sweet was at the conference and even managed to take some snaps and selfies. She also reported on the challenge laid down by leading Australian health administrator Mick Reid to the rural health sector; the impact on rural Australia of the changes to the 457 visa; and what impact artificial intelligence might have on rural health.

Another presentation at the conference, covered here by Croakey, focused on the ‘triple whammy’ leading to higher risks from antibiotic resistance for rural communities.

One of the biggest responses at the conference was prompted by a speech by  Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), who asked delegates to join her on a journey forward to 2037: a year where Australia has closed the gap in health outcomes for Aboriginal and Torres Strait Islander people and non-Indigenous Australians, where cultural safety doesn’t begin in the health system but in our homes and schools and public discourse, and where recognition of the urgency of climate change has prompted a profound sea change in the way we live and do business. Read the full speech or watch it here.


Staying safe – in the hospital

The need to address patient safety in healthcare has been clear for almost two decades. While major efforts have been made globally and in Australia to address patient safety in hospitals and reduce harm to patients, research still shows about one in 10 episodes of hospital care result in harm. Despite the best of intentions, global efforts to tackle the problem have not resulted in widespread improvement. A recent seminar hosted by the Sax Institute, the Australian Institute of Health Innovation at Macquarie University and the Clinical Excellence Commission in Sydney brought together leading experts in the field of patient safety, including WHO Envoy for Patient Safety Professor Sir Liam Donaldson, to explore ways forward to ensure patients remain safe when they undergo care in our hospitals and healthcare institutions. Croakey has a full write up of the event, written by my colleague Megan Howe, which is available here.

Sticking with the issue of safety in our health services, a recent joint report issued by the Australian Nursing and Midwifery Federation and The Australia Institute documents mounting evidence of labour and human rights abuses in the overseas production of goods such as gloves, surgical instruments, clothing, footwear and electronics. The report is available here or you can read a Croakey post on the issue here.

Triple J’s Hack reports that the first legal, commercial medicinal cannabis shipment is now available in Australia. Hack reports that until now, medicinal cannabis was imported into Australia on a case-by-case basis, whereas now pharmacists are able to stockpile the drug for anyone with a prescription. If you are unsure of what the science says on the benefits of medical cannabis, this excellent explainer from The Conversation US sets out the good and the bad.


Marching for Science

In terms of sheer weight of numbers, the biggest story of the past few weeks was undoubtedly the March for Science. As the Australian branch of this global movement states on their website, “the March for Science celebrates the public discovery, distribution, and understanding of scientific knowledge as crucial to the freedom, success, health, and safety of life on this planet.”

The Guardian asked readers worldwide working in or involved in science to tell us why they were taking action, The New Yorker opined as to the Usefulness of a March for Science and the indefatigable Simon Chapman explained on Croakey why he was marching for science – as well as for planetary and public health.

If marching for science has reinvigorated your fondness for exercise and activism, read up on #CroakeyGo walk and talk, which takes place on 27 May.


Listen up to ‘Bad medicine’

Thanks to shows like Serial, S-Town and This American Life, podcasting has become an enormously popular publishing medium in recent years.

There are a variety of podcasts covering health, medicine, and research that are worth checking out, including RadioLab, The Health Report with Norman Swan and the RACP’s Pomegranate podcast. In this edition of The Health Wrap, I’d like to recommend Freakonomics Radio‘s three-part series Bad Medicine. As the show’s presenter describes it:

We tend to think of medicine as a science, but for most of human history it has been scientific-ish at best. In the first episode of a three-part series, we look at the grotesque mistakes produced by centuries of trial-and-error, and ask whether the new era of evidence-based medicine is the solution.

Happy listening.


Other Croakey reading you may have missed: