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The Health Wrap: Federal Budget, looking for wellbeing and equity, COVID-19 funding, public service reform – and a hiking holiday

In her latest column, Adjunct Associate Professor Lesley Russell has cast her expert eye over the Federal Budget, measuring what matters (in Treasury’s stead) and looking for the nasties.

The quotable?

Russell discusses the Federal Government’s commitment to produce a stand-alone “Measuring What Matters Statement” in 2023 that will lay out the government’s proposed wellbeing measures…..

That work seems to be lagging.”


Lesley Russell writes:

The 2023-24 Federal Budget is the big news this week.

My Croakey colleagues have done a sterling job in presenting the issues in the lead-up to the Budget, in analysing what is in the Budget for health, healthcare, climate change, social justice and for Aboriginal and Torres Strait Islander people, and in collating the responses of stakeholders.

All this work can be found on the Croakey Health Media website here.

The Guardian also has excellent coverage of the Budget, available here.

Budget articles at The Conversation are available here.

Here is a selection of other Budget summaries which you might find interesting and useful:

Professor Stephen Duckett: Health budget has big changes – reviving our worn-out Medicare fee-for-service system and boosting bulk billing.

Tim Colebatch: Chalmers’s devils in the detail.

Ross Gittins and Rachel Clun for the Sydney Morning Herald: Your top budget questions answered: Our experts explain the details.

ABC News: Federal budget 2023: Winners and Losers.

Ian Dunlop: The Budget and climate change: getting our priorities right.

Sydney Morning Herald: The five plans to shave $15 billion from ballooning NDIS costs in four years.

The Guardian: Indigenous groups say ‘mixed bag’ federal budget gives boost to health but neglects legal services.

Lin Hatfield Dodds writing in The Mandarin: Budget 2023: The shot in the arm Australia’s care economy badly needed.

There really wasn’t anything directly related to rural health in the Budget. I think this article published in MJA InSight just a couple of days before the Budget was released has some useful pointers for the way to tackle needed reforms in rural health.

And I’m going to let my political leanings show here and say that there was nothing related to health and healthcare worth reporting in Opposition Leader Peter Dutton’s Budget response.

Where is wellbeing in the Budget?

When the Albanese Government brought down their first budget in October last year, just a few months after it was elected, much was made of a focus on national wellbeing, including how it will be measured going forward and what parts of society will be tracked over time to determine if government policy is working (see October 2022-23 Budget Paper No 1, page 119).

The first step was outlined as “measuring what matters”:

“Indicators that measure broader quality of life factors should be considered in addition to, not instead of, traditional macroeconomic measures. When policy processes consider these outcomes, they facilitate more holistic discussions of the type of economy and society Australians want to build together.”

There was a commitment to produce a stand-alone “Measuring What Matters Statement” in 2023 that will lay out the government’s proposed wellbeing measures, drawing on the OECD Framework for Measuring Wellbeing and Progress and other international efforts, but unique to the Australian context.

That work seems to be lagging.

As part of an initial consultation Treasury received over 160 submissions from community groups, peak bodies, businesses, individuals, academics, research institutes, unions and governments. It seems that Treasury feels these submissions were not as representative as they might be. A second round of consultations is now underway “in an effort to engage even more broadly with the Australian public”.

From the first submissions and a review of international and domestic approaches, five broad themes have emerged for consideration: prosperous, inclusive, sustainable, cohesive and healthy. These are included in a consultation pack that was released in April.

Community groups, members of parliament and other organisations are invited to hold their own feedback meetings about the emerging themes (and other possible themes) to help guide the development of the Statement. The closing date for the second round of submissions is 26 May.

The Albanese Government’s rhetoric around the 2023-24 Budget is almost devoid of references to this ongoing work. Treasurer Jim Chalmers talked about “stronger foundations for a better future” (and there’s a separate Budget Paper devoted to this) but wellbeing is not mentioned in this paper or in his Budget night speech. The only reference I could find to wellbeing was in the Women’s Budget Statement.

The only discernible funding allocated to realising the Statement in this year’s Budget is $10 million for a new evaluation function within Treasury. The new unit will work with other federal agencies to evaluate key programs, rebuild lost internal evaluation capability, and save millions of dollars on consultancy fees. This is due to the long-term efforts of Senator Andrew Leigh, the Assistant Minister for Competition, Charities and Treasury.

A variety of measures in the Budget could fall under the rubric of “wellbeing” – for example, the $199.8 million package to address entrenched and concentrated community disadvantage and the $136 million for mental health services for the survivors of torture and trauma.

Even in the absence of a Statement and baseline data, these could have been presented as evidence of the Government’s commitment to a Wellbeing Budget.

I was somewhat relieved that, in his post-Budget address before the National Press Club, Chalmers said that renovating and revitalising national institutions to ensure that the government was “measuring what mattered” was a huge priority.

Where is inclusion and equity in the Budget?

In a related topic, I have been looking specifically at the Budget measures that will help with improving inclusion and equity in Australia society.

It’s encouraging that the growing socio-economic disparities and entrenched disadvantage are now topics for public discussion in the political arena. And there is growing recognition that people are not poor, unemployed, homeless or discouraged from fully engaging in society by choice: for many, the barriers are just too hard to overcome.

Budget Paper No 1 outlines how the Albanese Government is planning to set Australia up for the future:

  • Targeted cost-of-living relief.
  • Strengthening Medicare.
  • Broadening opportunities.
  • Investing in a stronger, more secure economy.
  • Managing the Budget responsibly.

At least the first three of these issues (and possibly all of them), if implemented well, could address inclusion and equity.

In a very interesting essay for The Mandarin, Robert Breunig brings the concept of “equity” (which he defines as “the principle of fairness and justice in the distribution of resources, opportunities and privileges among individuals or groups, taking into account their different backgrounds, needs and abilities”) to bear on the 2023 Budget. He finds that “Equity is hard to achieve when unfairness is baked into the system.”

There is a perfect example in the Budget of how advice to Government from a body specifically established to address equity and inclusion was ignored.

The Economic Inclusion Advisory Committee was secured by ACT Independent Senator David Pocock during negotiations over industrial relations legislation last November. It’s chaired by former Labor Minister Jenny Macklin.

The committee’s first report, with expert advice about how the most vulnerable are faring and what needs to be done to ensure they are not left behind, was released ahead of the Budget. The report’s highest priority was for a large enough increase in JobSeeker to significantly reduce poverty for the unemployed. The report finds that the current JobSeeker payment is, in and of itself, a barrier to finding work.

It suggested that the right amount would be 90 percent of the age pension — an increase of $128 a week. As we now know the Government responded with an increase of just $20 a week.

Mike Steketee, writing for Inside Story, is scathing about this, but he also makes the point that the report’s message cut through and generated support from the public and an unusually broad political spectrum. So maybe there is hope for the next budget?

If all this seems pessimistic, here’s a list (not complete) of the Budget initiatives that I think have the potential to improve inclusion and equity:

Reforming the Australian Public Service

During the last federal election campaign and since taking office, the Albanese Government has been very direct about its intentions to reform the Australian Public Service. It has pledged to revitalise a public service gutted by staffing cuts over the past decade and increasingly forced to rely on consultants and labour-hire firms.

“We’ll be valuing public servants and respecting them,” Albanese said.

“Part of [Labor’s] plan to trim spending on outsourcing in the public service is to invest in the capacity of the public service in key areas where it’s been especially hollowed out,” Chalmers told a Press Club audience last May.

And Katy Gallagher, the Minister for Finance, Women and the Public Service, has also said that the Government was looking at investments to produce a workforce that is stronger, more inclusive and more capable.

“The government is committed to an APS that embodies integrity in everything that it does, through increasing transparency and engaging with the public on issues of trust.

“The government is also focused on a culture of service delivery and policy development based on genuine partnership and co-design with the Australian public,” Gallagher said.

The Budget highlights four APS reform areas (see Budget Paper No 4):

  • An APS that embodies integrity in everything that it does.
  • An APS that puts people and businesses at the centre of policy and services.
  • An APS that is a model employer.
  • An APS that has the capability to do its job well.

The Public Service Act 1999 will be updated to reflect these values.

Various departments have received a total of $8.4 million from the APS Capability Reinvestment Fund (this was part of the $72.9 million APS Reform Package included in the October 2022 Budget), for “cultural competency, gender impact analysis and futures analysis skills for APS staff and enhancing the quality of data to inform policy analysis”.

Gallagher has also highlighted that $2 billion is investing in digital and information and communication technologies (ICT) in the 2023–24 Budget. This includes new digital solutions to improve service delivery and actions to modernise outdated legacy platforms and IT systems.

Anyone who has struggled with MyGov will appreciate how important it is to have government IT services functioning optimally. As the Department of Health looks to implement MyMedicare, this updating will be critically important for acceptance by patients and healthcare workers.

It’s good to see that this Budget provides $10.9 million for the establishment of an in-house consulting service within the Department of Prime Minister and Cabinet to provide “high-quality strategic consulting services to the APS”.

The development of an in-house consulting model aims to reduce the reliance of the federal public service on consultancies. Given the revelations of what looked at times like a takeover of the APS by the big consultancy firms during the Morrison Government, this is an important step in restoring APS competencies and public trust in government decision-making.

Hopefully these changes will also help to restore public trust after the Robodebt debacle.

There is also $3.4 million in the Budget to improve APS recruitment and employment of Indigenous Australians.

What’s in the Budget to address COVID-19 and its consequences?

The week before the Budget, the World Health Organization declared an end to the COVID-19 pubic health emergency, while stressing that this does not mean the disease is no longer a global threat

Meanwhile, here in Australia, an average of 27 people have died of COVID-19 every day of 2023 so far.

A number of experts have spoken out, concerned that the WHO announcement will generate even more complacency and urging greater progress towards being better prepared for future health emergencies.

This comes as a new COVID-19 subvariant of Omicron (XBB.1.16) is circulating in Australia among us.

Ahead of the UNGA High-Level Meeting on Pandemic Prevention, Preparedness and Response, scheduled for 20 September 2023, Helen Clark and Ellen Johnson Sirleaf have released A roadmap for a world protected from pandemic threats.

What is in the 2023-24 Budget to address the ongoing impact of COVID-19 and long COVID and to ensure Australia’s preparedness for the next pandemic (or a resurgence of the current pandemic)?

Here’s what I found. It’s instructive to compare my list of government funding initiatives with the National COVID-19 Health Management Plan for 2023.

Budget Paper No 3 indicates that, under the National Partnership for Priority Groups COVID-19 Testing and Vaccination, the Government will provide the States and Territories with $3.3 billion in 2022-23 and $142.6 million in 2023-24.

Budget Paper No 2 indicates the following under the Health portfolio:

  • At page 126: $591.3 million over two years (2022-23 – 2023-24) to continue the COVID-19 aged care response measures in the October Budget.
  • At page 127: More than $1669.9 million over five years to expand the COVID-19 vaccine strategy and provide Australians with COVID-19 treatments.

While the costs of the various measures covered are spelt out (with the exception of the costs of purchasing vaccines and providing medicines on the PBS for COVID-19 treatment — not provided due to commercial sensitivities) the Budget Papers detail only the expenditure by departments other than Health and Aged Care. This totals $319.4 million, almost all of which is in 2022-23 and 2023-24. It looks like this is for 50 percent of the cost of PCR tests and vaccines for the States and Territories.

There are two small provisions here that relate to long COVID:

  • $14.3 million over two years from 2022–23 to extend Commonwealth funding for Healthdirect’s Living with COVID service to 31 December 2023.
  • $0.8 million over two years from 2022–23 to support cardiac magnetic resonance imaging for mRNA COVID-19 vaccine-associated myocarditis.

Additionally the Government could argue that the new MBS items for long consultations, in person and by telehealth, will benefit patients with long COVID.

  • At page 131: $91.1 million over two years from 2023–24 (including $0.2 million in capital) to commence the establishment of the Australian Centre for Disease Control.
  • At page 141: Additional funding of $1.4 million over two years from 2022– 23 to ensure the National Medical Stockpile can sustain its stock and procure additional chemical, biological, radioactive and nuclear countermeasures, store surplus consumables and develop long term strategies.

Where are the Budget nasties?

If you spend as much time as I do poring through Budget Papers, then you know that the devil is always in the detail, and there are always some hidden nasties.

This year, I think that the Albanese Government has done a pretty admirable job in addressing all the urgent needs, beginning the implementation of some long-term visions, being cognisant of budget restraints and the push for budget sustainability, and tackling the task of reform and repair of the damage and neglect of past Coalition Governments.

Of course, not everyone will agree with that assessment, and I can certainly point to where things might have been done better or differently. And I must say that Budget Papers under this Government do not make it any easier to track and identify funding than in the past.

First on my list of problem Budget issues is not so much a nasty as a short-term (and therefore short-sighted) investment: $33.6 million over two years from 2023–24 to improve health outcomes through extending existing alcohol and drug programs in the community.

Given the seriousness of problems in these two areas and the implications for things like family violence, why is this funding for just two years?

The Department of Health Portfolio Budget Statement shows that the targets for progressive decrease of harmful alcohol and drug consumption do not change over the forward estimates (in contrast to those for smoking) – a sure sign that the bean counters know this effort is minimal and will achieve nothing.

It’s a sign of how deprived the sector is of resources that the Australian Alcohol and Other Drugs Council has welcomed this funding, even as I am being critical about how limited it is.

Budget Paper No 2 shows, under the heading ‘Reinvesting in Health and Aged Care Programs’ (just love these euphemisms!), that savings of $1.7 billion over 4 years from 2023–24 (and $422.9 million ongoing) will be taken from health and aged care programs.

There is no indication of what these programs are (hopefully that will be teased out in Senate Estimates), only the consolation that these funds “will be reinvested in new or expanded health and aged care services”.

Also in Budget Paper No 2, under the heading ‘A Modern and Clinically Appropriate Medicare Benefits Schedule’ there are a number of issues – many arising from the work of the MBS Review Taskforce  —  that will surely become controversial as they are implemented.

These include:

  • Savings of $301.9 million over 3 years from 2024–25 by streamlining and modernising Chronic Disease Management planning items.
  • Amendment of selected MBS Plastic and Reconstructive Surgery items and hospital requirements
  • Clarification of MBS co-claiming restrictions.

The necessary ongoing work of MBS reform remains precarious as, once again, funding for this work ($10.9 million) is provided only for 2023-24.

The best of Croakey

News on the opening of a new Mental Health and Wellbeing Local in Melbourne’s west, a response to the Royal Commission into Victoria’s Mental Health System which condemned systemic failures that had inflicted a “profound human, societal and economic toll” over many years.

Read: Transforming mental healthcare through lived experience and community engagement


The good news story

This week the good news is personal. I’m heading off to the United Kingdom for a hiking holiday.

First a solo trek along the Thames Path from the source of the Thames near Cirencester in the Cotswolds (actually the spring has dried up and I’ll have to walk a couple of days to find the river!) to Windsor. I will be staying at inns, pubs and b&b’s along the way.

And then Bruce is joining me for a train/hiking trip in the Scottish Highlands, including the Isle of Skye.

I’m hoping the weather is kind and spring-like.

This means there will be a hiatus for The Health Wrap, but there will be tweeting and photos.

This photo (via Liz Dax) from my 2018 Cotswold Way walk


Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.

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