Pill testing programs, health workforce reform, Close the Gap Day, oral health, vaping and the new national lung cancer screening program are among issues highlighted in the latest edition of The Zap.
This week there are a few quotables because we were spoilt for choice:
I understand the Department’s new slogan is ‘More Reviews than Rotten Tomatoes’.
AND
Operating under weak and poorly enforced regulations with financially insignificant penalties, the for-profit sector fosters an environment where corners are frequently cut, compromising the quality of care and endangering patient health.”
Charles Maskell-Knight writes:
Thursday 21 March was National Close the Gap Day. As reported by Croakey, the Lowitja Institute marked the day by publishing the Close the Gap Campaign Report 2024, with a set of recommendations intended to “provide a pathway towards achieving the National Agreement’s goals”.
In relation to health, the report called for full implementation of the 2021–2031 National Aboriginal and Torres Strait Islander Health Plan and other supporting plans, including:
- a commitment to long term (10+ years) needs-based and coordinated cross-sectional funding by the Australian, state and territory governments
- a review of current government governance models and partnerships over the Health Plan and other supporting plans to assess whether they represent genuine decision-making opportunities. This review should aim to create efficiencies and maximise decision-making power for members
- investment in the urgent establishment of suitable governance mechanisms over the Health Plan to ensure Aboriginal and Torres Strait Islander leadership is fully imbedded in its implementation.
On 22 March the Government and the Lowitja Institute hosted the National Aboriginal and Torres Strait Islander Health Ministers Roundtable, bringing together all Health Ministers and CEOs, Aboriginal and Torres Strait Islander Collaboration members, and First Nations health leaders.
According to Health and Aged Care Minister Mark Butler, the meeting focussed on topics identified by the First Nations health sector: Closing the Gap; building a health system which is culturally safe and free of racism; and the National Health Reform Agreement.
Ministers agreed to develop a First Nations Schedule to the National Health Reform Agreement, co-designed with First Nations people so that it “includes the right actions and reforms that best suit the needs of Aboriginal and Torres Strait Islander people”.
Many health sector organisations marked Close the Gap Day and supported the report and its recommendations, including the Royal Australian College of General Practitioners (RACGP), the Royal Australian and New Zealand College of Ophthalmologists, Australian College of Rural and Remote Medicine (ACRRM), the Society of Hospital Pharmacists of Australia, the Pharmaceutical Society of Australia, the National Rural Health Alliance, and the Public Health Association of Australia (PHAA).
PHAA vice-president Dr Alana Gall, a Palawa woman and researcher, said “there’s overwhelming evidence that proves that health and other initiatives which are led by Aboriginal and Torres Strait Islander communities get the best results”.
It appears that governments are slowly getting the message.
Ministers and government
World Oral Health Day was Wednesday 20 March – an obvious day for the Government to release its response to the Senate dental services inquiry. It failed to do so, meaning the response is now three weeks late.
(To help fill the dental policy gap, Croakey will be holding a webinar on tackling oral health inequities on 8 April – sign up here to join the discussion.)
Assistant Minister Ged Kearney introduced the niftily titled Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill into Parliament. The Bill removes the requirement for nurse practitioners and endorsed midwives to work under the supervision of a medical practitioner, and will allow them to provide services under Medicare and prescribe under the PBS on an autonomous basis.
The Bill was welcomed by the Australian Nursing and Midwifery Federation (ANMF), the Australian College of Nurse Practitioners, and the Australian College of Midwives. In a slightly alarming trope, the Australian College of Nursing claimed that the new arrangements would “unleash” endorsed midwives and nurse practitioners.
Minister Mark Butler introduced the Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Bill 2024 into Parliament. The Bill bans the “importation, manufacture, supply, and commercial possession of disposable single use and non-therapeutic vapes”. After the legislation comes into force, vapes will only be available on prescription.
Butler said that “vapes were sold to the Australian community as therapeutic goods, to aid those seeking to quit cigarette smoking and so, it is entirely appropriate to regulate them as therapeutic goods – through controls that simultaneously ensure legitimate access and provide sound public protection”.
He held a media conference on the subject as well as giving a number of TV and radio interviews, addressing a range of issues including the “tax and regulate” option proposed by the National Party – the only political party to still accept donations from the tobacco industry.
The legislation was welcomed by many health groups, including the Australian Medical Association (AMA), Quit, the Cancer Council Victoria, VicHealth, and the RACGP.
College President Dr Nicole Higgins said: “We must do everything we can to stop a new generation of nicotine users emerging because once young people start vaping, they will have a lot of trouble stopping… our role [as GPs] is crucial, and although we do have a big job ahead of us prescribing nicotine vapes for patients who need them, I’m confident that with the right kind of support we can continue helping patients from all walks of life wean themselves off nicotine.”
Butler also introduced legislation to add lung cancer to the National Cancer Screening Register, following the decision in the 2023 Budget to introduce a new National Lung Cancer Screening Program from July 2025. The screening program will target asymptomatic individuals aged 50 to 70 years with a history of cigarette smoking of at least 30 pack-years, including ex-smokers who have quit within the past 10 years.
The Minister also announced measures to increase the number and diversity of bone marrow donors, improve chronic wound care, and expand Royal Flying Doctor services.
The Department of Health and Ageing announced it was carrying out an aged care worker survey, open until 30 April. The survey is open to anyone providing one-on-one care, regardless of their workforce status (employed, contracted, labour hire, independent professional), and can be found here.
I’m not sure how the Department will overcome the obvious difficulties in drawing conclusions from a self-selected sample, but it must have a cunning plan.
The Department also launched a consultation on after hour primary care policies and programs, due to close on 20 April. The Department notes that “the Review builds on a range of previous reviews undertaken between 2016 and 2020 and is taking place in parallel to and in close association with a separate review of general practice incentive programs and in awareness of other contemporary reviews and reform activities. It is separate and complementary to the Department’s Review of General Practice Incentives, which is taking place concurrently”.
I understand the Department’s new slogan is ‘More Reviews than Rotten Tomatoes’.
The Australian Institute of Health and Welfare (AIHW) released a number of publications, web reports, and updates, including:
- the eighth national report on the 21 Better Cardiac Care measures for Aboriginal and Torres Strait Islander people
- a report on acute rheumatic fever and rheumatic heart disease (which predominantly affect First Nations people) for 2022
- an update of the Aboriginal and Torres Strait Islander Health Performance Framework
- a report on treatment pathways for people hospitalised for acute coronary syndrome.
In relation to the cardiac care measures, there is some good news, tempered with bad news.
Between 2006 and 2021 the age-standardised mortality rate from cardiac disease for First Nations people fell 35 percent from 205 per 100,000 to 134 – but it is still 1.5 times the rate for non-Indigenous people.
The proportion of First Nations people receiving percutaneous cardiac intervention (a stent or stents) following a severe heart attack increased from 28 percent in 2006-07 to 70 percent in 2020-21 – but First Nations people are still 14 percent less likely to receive such an intervention compared with non-Indigenous people.
The Independent Hospital and Aged Care Pricing Authority (IHACPA) released its determinations of the National Efficient Price and National Efficient Cost to be used in calculating public hospital funding for 2024-25.
While IHACPA had earlier “signalled the intent” to adopt activity based funding for community mental health care from 2024-25, it has decided to defer this change to 2025-26. It has now foreshadowed reviewing the ICU eligibility criteria and adjustments for the 2025-26 pricing model, as well as the paediatric adjustment.
Ahpra announced a collaboration with the Weethunga Health Network to “co-design and develop nationally consistent standards, codes and guidelines for registered practitioners on cultural safety”.
Yawuru woman and Ahpra Board member Tanya McGregor is chair of the working group overseeing the project. She said:
There is a significant gap in cultural safety knowledge and application across regulated health practitioners, and that is putting Aboriginal and Torres Strait Islander People’s lives at risk.
By embedding cultural safety in accreditation and Continuing Professional Development requirements for all 16 regulated health professions we will ensure consistency and accountability to protect Aboriginal and Torres Strait Islander patients and health workers.”
The Aged Care Quality and Safety Commission issued a release announcing an antimicrobial stewardship (AMS) self-assessment tool for the aged care sector.
The Commission pointed to the evidence suggesting “concerning, ongoing levels of inappropriate antimicrobial use in Australian residential aged care services”, and said that the tool “is highly recommended to highlight the range of activities available for implementing AMS programs, help in conducting reviews of existing AMS programs, and for gaining greater understanding of what AMS involves”.
However, “use [of] the AMS tool is optional for providers and clinicians”.
In a sector where many participants struggle to meet mandatory quality standards, how many will make use of a voluntary tool to assess AMS?
First Nations health
The Victorian Comprehensive Cancer Centre Alliance (VCCC Alliance) hosted the third World Indigenous Cancer Conference (WICC) in Naarm in partnership with the World Health Organization’s International Agency for Research on Cancer. It was attended by 500 delegates, and is being covered by the Croakey Conference News Service.
Associate Professor Kalinda Griffiths said the conference would “shine a light on cancer disparities between Indigenous and non-Indigenous people around the world, including here in Australia”.
As reported in Croakey, Professor Gail Garvey AM said “Indigenous Australians are 14 percent more likely to be diagnosed with cancer, and 20 percent less likely to survive at least five years after diagnosis compared with non-Indigenous Australians”, and the gap in outcomes between Indigenous and non-Indigenous Australians continues to widen. [Bookmark this link for ongoing coverage.]
Consumer and public health groups
COTA marked World Oral Health day by releasing the results of polling showing about half of older people on lower incomes delaying or avoiding dental treatment due to cost, and calling for the Government to introduce a Senior Dental Benefits Scheme, as recommended by the Aged Care Royal Commission.
CEO Pat Sparrow said “the number of older Australians putting off dental care is incredibly alarming given the broader health and welling implications, especially for older people who are particularly susceptible to the overall health impacts of poor dental care”.
Trade unions
The AMA convened a meeting in Canberra of over 50 medical colleges and associations to discuss health system issues and the need for reform, and used the occasion to release several further chapters of its pre-budget submission dealing with general practice, public hospitals, and workforce issues.
Its proposals include:
- improving GP training numbers by improving pay and conditions for trainees
- restoring the BEACH general practice data collection (Bettering the Evaluation And Care of Health)
- a two-year program to address elective surgery waiting lists
- funding additional hospital discharge planners to assist in moving hospital patients out to aged care or NDIS funded supports to address “exit block”
- “the establishment and funding of an independent national health workforce planning agency to collate, analyse, and utilise health workforce data to inform evidence-based policies and strategies, enabling us to proactively and efficiently adapt to changing healthcare demands and ensure that all Australians have access to high-quality healthcare”.
We have now seen chapters 1 to 3 and chapter 5 of the submission: when will chapter 4 drop? And what will it cover?
The RACGP supported the call for better pay and conditions for GP trainees, and also suggested that the Government should subsidise international and local doctors undertaking GP training in regional and rural Australia.
The College also suggested that the Tasmanian Government should fund the cost of the Fellowship Support Program (a 24-month education and training program designed to support international medical graduates to qualify as a specialist GP) for 20 graduates annually. The Tasmanian ALP later announced it would proceed with this if it was elected, but the nature of the new minority government there is still uncertain, as are the implications for health policy.
The College was also speaking out about pill-testing – urging the Victorian Government to adopt a pill-testing trial, and welcoming an announcement from the Queensland Government.
RACGP Alcohol and Other Drug spokesperson, Dr Hester Wilson, said:
Queensland and the ACT are taking the lead, now it is time for [other states] to follow.
How many more senseless deaths do we have to witness before politicians come to their senses and introduce pill testing?
We have had so many experts come forward and so many coronial recommendations backing pill testing. We know what to do, it’s time to make it happen.”
The RDAA and ACCRM backed the call from the AMA last week for the rebates for GPs conducting ECGs to be restored to their pre-2020 levels.
RDAA President RT Lewandowski said that “patients in rural and remote areas can’t just pop out to the nearest cardiologist for these tests. A cardiologist appointment will often take months to get and require hours of travel – not at all suitable for high risk or emergency situations”.
The Australian Dental Association (ADA) marked World Oral Health Day with a media release pointing to an increase of over 10 percent in the number of children hospitalised for dental procedures over the period from 2018 to 2021-22, but then claimed that there was not enough operating theatre time to treat every child who needed it.
The Association said that high rates of dental decay were due to almost three-quarters of children aged 9-18 having too much sugar, often in the form of fruit juice and soft drinks.
Did anyone mention a sugar tax?
As the RACGP says about pill-testing, “we know what to do, it’s time to make it happen”.
Industry groups
In The Zap for last week I reported on opposition from the RACGP and AMA on a Bill before the Queensland Parliament to maintain the monopoly of pharmacy ownership by pharmacists.
The legislation duly passed this week, with the Guild claiming it “will safeguard the ownership of community pharmacies in Queensland to ensure pharmacies remain in the hands of pharmacists and not in multinational companies. The passage of this legislation is a win for Queensland patients and will ensure local community members are front and centre in community pharmacy”.
ACCPA (the peak aged care sector lobby group) released its pre-budget submission with a number of recommendations. As well as the obvious asks (funding for quality and sustainable services), it called for a system of independent pricing determinations for aged care; improved access to oral health care; relief from some state taxes; boosting the aged care workforce (and others in the health sector and care and support economy) across regional Australia through incentives and housing options; and assistance for providers to attract and retain migrant workers.
Medicines Australia held a Horizon Scanning Forum, a meeting to discuss “four therapeutic areas where innovative new classes of medicines and treatments are on the horizon for Australians: cell and gene therapies, vaccine technology, novel antimicrobial therapies to combat growing antimicrobial resistance and digital technologies such as artificial intelligence that are impacting medicine discovery, research and development processes”.
CEO Liz de Somer said the innovations “demonstrated the urgent need for system reform and investment into the PBS so that Australian patients can access the best treatments possible, when they come to Australia”.
Politicians and parliamentary committees
Dr Monique Ryan, independent MP for Kooyong, wrote an article published in The Guardian on vaping, the links between big tobacco and politics, and astroturfing. After noting that almost a fifth of the National party’s receipts in 2022-23 came from tobacco companies, she asked “is it a coincidence that Nationals leader, David Littleproud, is now calling for regulation, rather than prohibition, of vaping in Australia?”.
I think that is a rhetorical question.
Ryan calls on the Government to adopt legislation introduced by the crossbench to “put limits on lobbyists’ relationships with politicians, close the revolving door between ministerial and senior public service jobs [and positions] in the tobacco industry, and ban political donations from harmful industries”.
Finally
And finally this week, another one-question quiz: this quote about the aged care sector comes from which country?
“Operating under weak and poorly enforced regulations with financially insignificant penalties, the for-profit sector fosters an environment where corners are frequently cut, compromising the quality of care and endangering patient health.
Meanwhile, owners make the facilities look less profitable by siphoning money from the homes through byzantine networks of interconnected corporations. Regulators have neglected the problem as each year [huge amounts] are funnelled out of nursing homes through related parties and into owners’ pockets”.
Is it Australia? It certainly might be… for the answer, see here.
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK.
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