Croakey readers who are planning submissions to the national health workforce scope of practice review will find some useful leads in the column below, as well as in previous editions of The Health Wrap, and our extensive archive of articles on workforce matters.
Deadline for submissions is 16 October and an interim report is due with the Government by December.
In her latest column Adjunct Associate Professor Lesley Russell also provides an update on COVID-19, links readers into a host of recent publications, and reports on the benefits of giving homeless people a significant cash injection.
The quotable?
Perhaps, finally, we can move from seeing health, disability and aged care as budget imposts and seen them as investments in productivity, quality of life and equality.”
Lesley Russell writes:
My apologies for the brief hiatus between the last edition of The Health Wrap and this edition.
My excuse is that I was enjoying the mountain hiking life – it’s a great way to refresh the body, mind and soul.
A lot has been happening on the health policy front – not all of it in the public arena. When I delve into the issues of the day – COVID-19 vaccines, health workforce policies, private health insurance reforms, the review of the Medical Research Future Fund – I am always amazed at how much information is not readily available.
I learn something about this every day. Recently I learned that the Australian Government has a Transparency Portal. For the Department of Health and Aged Care and related agencies, it contains only the Portfolio Budget Statement, the Corporate Plan and the Annual Report – so nothing very revealing.
At a time when public distrust of government and of scientific and medical expertise is at an all-time low, transparency in the policy-making process and in the evaluation of programs is essential.
This raises the question for me: what else would you like to see in the portal from the Department of Health and Aged care et al?
COVID-19 update
New SARS-CoV-2 strains are emerging and an increase in COVID-19 cases is being reported in the northern hemisphere.
In early August, the World Health Organization (WHO) warned of an Omicron variant, EG.5.1 – also known as Eris – which is now the most prevalent variant in the United States, and is spreading quickly around the world. It has been reported in Australia since April. This strain is related to XBB.1.5, which has been circulating in Australia since the beginning of the year.
The WHO has stated that, based on the available evidence, “the public health risk posed by EG.5 is evaluated as low at the global level”.
However, there is considerable concern about a highly mutated strain designated BA.2.86, which was first spotted by virus trackers in July in Denmark; every day brings news that it has been found in another country and it has now spread across four continents.
The mutations in BA.2.86 represent an evolutionary jump similar in size to the changes in the first Omicron variant compared to the original coronavirus strain. There are fears that the vaccines currently in production will not be very effective against it, although lab studies suggest that BA.2.86 may be less infectious than other variants and perhaps less immune-evasive than feared.
Recent studies from Sweden show that antibodies produced by people who had a recent COVID infection did provide some protection against BA.2.86 when tested in the lab, suggesting that current vaccines might also provide protection.
This finding is supported by Australian research that found breakthrough SARS-CoV-2 infection in vaccinated individuals provides long-lasting immunity against similar strains of the virus, but immunity from newer variants is significantly reduced.
On August 23, the US Centers for Disease Control and Prevention issued a risk assessment for BA.2.86, and UK Health Security issued a risk assessment on September 1.
The CDC assessment states: “Notably, the amount of genomic sequencing of SARS-CoV-2 globally has declined substantially from previous years, meaning more variants may emerge and spread undetected for longer periods of time.”
COVID-19 cases are increasing in both countries. In the United States hospitalisations, deaths and waste water data are all increasing; in the United Kingdom there is an uptick in hospitalisations. It seems COVID-19 did not take a summer break, although to date the increase in cases is not attributable to BA.2.85.
What will winter bring for the northern hemisphere?
Pfizer, Moderna and Novavax are all working on vaccines which are all formulated to target the Omicron XBB.1.5 variant (which is genetically similar to EG.5). The US Food and Drug Administration has just approved the Pfizer and Moderna boosters for everyone aged six months and over. These now go to the CDC for approval, but the new vaccines could begin to be rolled out imminently. It appears that in the United States the costs of these booster shots (expected to be in the range of US$100) will not be covered by government. 
It appears that both the United States and the United Kingdom are planning on providing this vaccine only to those at most risk from infection.
A CDC official recently told the media: “The general public should not expect to need to receive the latest COVID booster… It’s for people in high-risk groups – those who are age 75 or older, pregnant or immunocompromised.”
Update on 13 September: The CDC has released a statement recommending that everyone six months and older get an updated COVID-19 vaccine to protect against the potentially serious outcomes of COVID-19 illness this fall and winter. Updated COVID-19 vaccines from Pfizer-BioNTech and Moderna will be available later this week.
What is happening in Australia?
In short, it seems not much. True, we are about to head into summer and life outdoors, but the absence of COVID-19 from political and policy discussions is disconcerting. There is no evidence of any planning for problems with new variants.
In the last week of August, Australia had 5,733 reported cases (up 330 from the previous week), there were 910 people in hospital (up 1) and 28 in ICU (up 5) and there were 74 deaths. The COVIDLive website is handy for up-to-date data.
See the Twitter thread by Professor Brendan Crabb.
The Variants of Concern Working Group of the Communicable Diseases Genomics Network (CDGN) at the Peter Doherty Institute for Infection and Immunity is responsible for ongoing monitoring and surveillance of SARS-CoV-2 variants to inform Australia’s national approach in detecting and reporting of variants of concern. It looks like the relevant CDGN webpage has not been updated since May.
Dare we even ask about vaccines?
More than 80 percent of vaccinated adults, including more than half of people aged over 65, haven’t had a COVID-19 booster shot in the past six months, despite newer bivalent vaccines delivering significantly higher protection against severe disease and hospitalisation.
An update on COVID-19 boosters from the Australian Technical Advisory Group on Immunisation was issued on September 1. The focus is on boosters for older and immunocompromised people.
The only reference to new vaccines is this: “ATAGI notes that XBB.1.5-based vaccines have been developed, but these are not yet approved for use by any country and updates will be provided as information is available. Ongoing surveillance of COVID-19 infection rates and clinical outcomes, new variants, and vaccine availability and effectiveness will inform future recommendations for additional COVID-19 vaccine doses from ATAGI.”
As pointed out in a recent article in The Saturday Paper, the Albanese Government is apparently ignoring the advice from its own commissioned report in terms of vaccine planning and capabilities. The report’s author, Professor Jane Halton, highlighted that, “[i]n the event a new and significantly different variant with severe health outcomes emerges, the capacity to respond rapidly and at scale should remain a policy and delivery priority”.
Next Community Pharmacy Agreement
Within days of the Pharmacy Guild announcing that it would suspend its controversial campaign against 60-day dispensing (which came into effect on September 1 ) – presumably because Health Minister Mark Butler has said that negotiations over a new Community Pharmacy Agreement will begin early (the current CPA is not due to expire until June 30, 2025) – this past week saw the unedifying spectacle of some 200 white-coated pharmacists disrupting Question Time in the federal Parliament with jeering and obscenities.
That puts the spotlight clearly on the negotiations over the 8th CPA and the funding involved. Sadly, at a time when the focus should be an expanding the role of pharmacists in primary care and their better integration into primary care and aged care teams, the focus will be on the dollars. Expect plenty of noise from organised medicine around this.
The current (7th ) CPA provides approximately $18.3 billion over five years to over 6,000 community pharmacies for dispensing PBS medicines ($16 billion), professional pharmacy programs and services ($1.2 billion), and for the Community Service Obligation arrangements with pharmaceutical wholesalers (these ensure the timely availability of prescription medicines across Australia) and the National Diabetes Services Scheme ($1.15 billion).
Additional funding is provided separately, outside of the CPA, for administration of COVID-19 vaccines and National Immunisation Program vaccines.
Particular scrutiny is required over the $1.2 billion allocated to funding patient-focused professional programs such as Home and Aged Care Medicines Reviews, Diabetes MedsCheck and the Indigenous Dose Administration Aids Program (see the full list of such programs, with further information, here). Data about the number of services provided and the cost is available here.
I am a supporter for a greater role for pharmacists in primary care, but have long been concerned about the way these programs have received ongoing support over several CPAs despite evaluation studies that are unable to say if they deliver any benefits.
I wrote about this for Pearls and Irritations in the lead-up to the 7th CPA. Around the same time, my colleague Jennifer Doggett raised concerns in an article which outlined the findings of previous reviews of the CPA and the urgent need for reform of the retail pharmacy sector.
In January this year the Office of Prime Minister and Cabinet submitted a Post-Implementation Review (PIR) of the 7th CPA – required because a Reguatory Impact Statement was not finalised by the Department of Health and Aged Care and assessed by the Office of Best Practice Regulation before the signing of the 7th CPA on 11 June 2020. The PIR is thus limited to activities undertaken under the 7CPA prior to 1 July 2022.
This review concurred with Jennifer Doggett and me about the patient programs, stating: “Key issues for the 7CPA, in common with previous CPAs, appear to be a lack of successful evaluation and assessment mechanisms in relation to the operation of programs and related activities funded through the agreement. In particular, the scarcity and quality of available data for robust and meaningful analysis of health outcomes is a continuing concern.”
The PIR also noted that – aside from the recognised benefits of the CPA to the sector and the community – “concerns have been raised amongst stakeholders regarding governance, transparency and accountability”.
A recent paper evaluated the CPAs from a public policy perspective. It noted the longstanding influence of the Pharmacy Guild on the development and implementation of CPAs and characterised the Agreements as predominately industry policy benefiting pharmacy owners rather than health policy.
The authors conclude: “The incremental changes negotiated every five years to the core elements of the Agreements have supported the public’s access to medication, provided stability for the government, and security for existing pharmacy owners. Their impact on the evolution of pharmacists’ scope of practice and through that, on the public’s safe and appropriate use of medication, has been less clear.”
Health workforce review
The need to restore Health Workforce Australia (HWA) has been a catchcry of mine since it was abolished by the Abbott Government in the 2014-2015 Budget.
So it was great to see the announcement on August 24 from the Health Minister of the “Unleashing the Potential of our Health Workforce Review” – a recommendation of the Strengthening Medicare Taskforce.
This is not the reinstatement of a health workforce planning agency – the review is tasked with looking at how to ensure health practitioners work to the full extent of their skills and training – but it represents progress towards that goal.
There’s considerable irony in the appointment of Professor Mark Cormack – previously CEO of HWA – to lead the review, which is due for completion in the second half of 2024.
Consultations for the review opened on 11 September, with submissions due by 16 October. The terms of reference are available here.
Work has been underway from both the previous and current governments on a swathe of strategies and plans aimed at addressing the health workforce.
These include:
• National Medical Workforce Strategy 2021-2031
This was released in January 2022 – the first such strategy to be released since the National Health Workforce Strategic Framework, released in 2004.
There were generally favourable opinions from the medical colleges, although the AMA (which took credit for the new strategy) cautioned that “the devil will be in the detail of the implementation”.
There is no publicly available information about efforts to implement this strategy.
This was released in March 2022. The plan aims to lift the rate of Aboriginal and Torres Strait Islander people working in the sector from the current 1.8 percent to 3.43 percent by 2031, better reflecting overall population numbers.
The accompanying media release from Indigenous.gov.au states: “The Morrison Government has committed $53.1 million from 2022-23 to 2025-26. This includes $11.9 million for the Australian Indigenous Doctors’ Association, $12.7 million for the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, $18.9 million for Indigenous Allied Health Australia and $9.3 million for the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, $0.3 million in support for the National Health Leadership Forum (NHLF).”
However, the website of the National Indigenous Australians Agency states that: “Costs are to be absorbed within existing resources.”
• National Strategy for the Care and Support economy
This work, which encompasses paid care and support services in aged care, disability and support care, veterans’ care and early childhood education and care, is being undertaken by the Department of Prime Minister and Cabinet.
• A draft National Care and Support Economy Strategy was released for consultation in May; the consultation closed on 26 June 2023.
• National Nursing Workforce Strategy
A Strategy Steering Committee and a Strategy Advisory Group have been established, with representatives from nurse practitioners and midwifery. There is also a separate Nurse Practitioner Steering Committee which has been meeting since August 2021 (it is not clear if the current aim is for a separate Strategic Plan for nurse practitioners).
One meeting of the Advisory Group has been held, on June 8, 2023. To date there has been no public consultation.
• National Mental Health Workforce Strategy
There is a webpage for this, not updated since 2021, so presumably this work is no longer underway.
Aside from meeting communiques, none of the work products from the National Mental Health Workforce Strategy Taskforce or its several working groups are available on the website.
• Allied health workforce
The allied health webpage on the Department of Health and Aged Care website refers to a range of programs “related to” allied health workforce. None of these is specifically about allied health.
• Oral health/dental workforce
This was last looked at by HWA in 2014 (yet another reason for me to bemoan the loss of HWA).
A recent report on oral health and dental care from the Australian Institute of Health and Welfare has a section on workforce.
A fact sheet on health workforce from the Parliamentary Library provides some additional information on health workforce numbers and the issues confronting future workforce planning.
The three issues that are most pertinent are: maldistribution of the workforce; the aging of the current workforce; and the additional (and ongoing) pressures on the current workforce due to COVID-19, lack of resources and burnout. While much is made of the possibilities of telehealth and artificial intelligence, these are tools that do not replace healthcare professionals and carers.
The review announced by Butler refers to the “health workforce” but the scope of the review indicates that (with the possible exception of Aboriginal Health Workers), it is not looking beyond the clinical aspects of the “healthcare workforce”.
To be honest, given the current state of internecine warfare between the clinical professions, if progress is made in getting these various groups to work better together and for everyone to work at full scope of practice (especially in under-served areas) then that will be real progress.
Having said that, let’s hope McCormack and his colleagues look to the pockets of innovation around the country where this is already happening.
Back in 2005 Professor Stephen Duckett predicted what was needed, stating that “the roles of health professionals will need to change and workforce planning needs to place a stronger emphasis on issues of workforce substitution, that is, a different mix of responsibilities. This will also require changes in educational preparation, in particular an increased emphasis on interprofessional work and common foundation learning.”
In case you missed it
An Office of the Chief Health Economist
The recently released Corporate Plan 2023-2024 for the Department of Health and Aged Care indicates the establishment of “an Office of the Chief Health Economist to provide leadership on economic issues and engage in the public discourse on … system reform.”
This is excellent news: perhaps, finally, we can move from seeing health, disability and aged care as budget imposts and seen them as investments in productivity, quality of life and equality.
Australia’s burden of disease
A recent paper in The Lancet provides detailed information about the burden and trend of diseases and their risk factors in Australia. It looks at trends from 1990 through to 2019 – its absolute usefulness is undermined because there is no information about the impact of the COVID-19 pandemic.
It finds that non-communicable diseases remain a substantial cause of mortality, contributing to 90.8 percent of all deaths in 2019 and so should remain a key target of healthcare policy and practice. Additionally, trends for falls, drug-use disorders, and liver cancer have shown increases that are concerning and warrant further investigation.
More up-to-date data is available from the Australian Institute of Health and Welfare report on the Australian Burden of Disease Study 2022.
Report card on the wellbeing of Australians
The Australian Institute of Health and Welfare has just released Australia’s Welfare 2023 with a report card that addresses the wellbeing of Australians since the pandemic began. It describes COVID-19 as having a “massive impact” on the welfare and wellbeing of Australians.
Since the pandemic began there have been 10,176 excess deaths in Australia; and in 2022 COVID-19 accounted for 151,400 years of healthy life lost and was the eighth leading cause of total disease burden in Australia.
More on the Medical Research Future Fund
If you follow my writings and analyses for Croakey Health Media, then you will be aware that since 2019 I have been investigating how the MRFF has been managed.
A review of the MRFF is currently underway and in that light I recently did a deep dive into yet more questions for the MRFF.
I highlight four key issues for the review:
- The need for meaningful public consultation and for ministerial justification when expert advice is not followed.
- Management of the MRFF investments and disbursements.
- MRFF funding to industry and translational research.
- Where are the required reports?
The MRFF funding principles are supposed to consider initiatives will reduce burden of disease and provide practical benefits. Yet to date there is little MRFF spending on research to address the treatment of COVID-19 and long COVID and on vaccine research.
At the time the parliamentary report on long COVID Sick and tired: Casting a long shadow was released last April, the Health Minister committed to $50 million in MRFF funds for research in this area.
This funding was due for release in August. Grant applications opened on 6 September (details are here). Note that this notice indicates that the total funding available is $14 million (with up to $5 million per grant).
On 30 August the Minister announced $31.5 million for 14 COVID-19 research projects. None of these projects relates specifically to long COVID. I assume this funding is not part of the $50 million commitment.
Best of Croakey
Please check in regularly to Croakey’s special portal on the Voice, to find updated articles and resources, with a focus on health issues and health sector perspectives.
The good news story
Researchers in British Columbia studied how 65 homeless people spent a (Canadian) $7,500 handout. They tracked the spending of the recipients for a year after they received the cash. They also followed a control group of 65 homeless people who did not get the handout.
The recipients did not spend their windfall on “temptation goods,” such as alcohol, drugs or cigarettes; they spent it on rent, clothing and food. They spent 99 fewer days homeless, and spent 55 more days in stable housing.
The handout actually generated net savings of almost $800 per recipient, taking into account the costs that would have been involved in providing shelter accommodation.
The research was published in the Proceedings of the National Academy of Science.
It found recipients spent 99 fewer days homeless, and spent 55 more days in stable housing. They also retained $1,160 more savings.
You can read more about the benefits and limitations of giving people unconditional financial support here.
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.
