An historic public health campaign, a funding announcement for Aboriginal Community Controlled Health Organisations (ACCHOs), and national health reform negotiations are covered in the latest edition of The Zap.
Columnist Charles Maskell-Knight also reports on wide-ranging health workforce matters, and shares his own experience with delays in obtaining the second dose of the Shingrix vaccine.
The quotable?
Given the experience with Shingrix and with the COVID-19 vaccine stroll-out, the Department of Health and Aged Care needs to reflect on how it manages the acquisition and supply of vaccines for mass campaigns to get it right before the next pandemic strikes.”
Charles Maskell-Knight writes:
Minister Mark Butler announced expanded measures to support Australians to quit vaping and smoking, with a new government advertising campaign and updated quit support services. The package included four streams of content targeted at young people who vape, adults who vape, adults who smoke, and First Nations people who smoke.
The announcement claimed that the campaign was historic, in that it was “the first time that the Australian Government has advertised to the public about the risks and harms of vaping, the first time in nearly 10 years that it has produced a national population-wide smoking campaign, and the first time that TikTok will be used in an Australian Government campaign”.
The additional support services include “funding to expand and ensure nationally equitable access to Quitline services; development of an online cessation hub that is now live at quit.org.au; redevelopment of the My QuitBuddy app to provide new features and support; dedicated resources to support parents and carers; and updated clinical guidance for health practitioners”.
Butler concluded by saying “all Senators now have the once-in-a-generation opportunity and responsibility to act to safeguard the health of young Australians for generations to come”.
“The best time to have done this would have been five years ago, but the second-best time is now,” he said.
Ministers and government
Minister Butler announced that from 1 July 2024 Aboriginal Community Controlled Health Organisations (ACCHOs) would be funded through four-year rolling funding agreements, supported by a $300 million increase in funding.
As he said, “over the last ten years ACCHOs have had grant funding agreement terms of one to three years. Their future funding was often only advised in the six months prior to their grant expiring”.
“From 1 July 2024 the uncertainty ends,” he said.
Dr Dawn Casey, Acting CEO of NACCHO, said that “the new rolling funding arrangements, coupled with the Government’s ongoing commitment to expanding the Indigenous Australians’ Health Programmes’ comprehensive primary healthcare funding, provide crucial financial stability for the Aboriginal Community Controlled Health sector”.
As long as the funding is indexed for price movements and population increases, the current decline in nominal terms in First Nations health funding might be reversed.
We note a media release from the Morrison Government in February 2022 announcing the move to four-year rolling funding agreements. The Health Minister at the time, Greg Hunt, said the new arrangement “will ensure greater certainty and stability for the sector”. The then Minister for Indigenous Affairs, Ken Wyatt, said the move would give the sector “greater confidence to employ, plan and grow”.
While Minister Butler was in Geneva at the World Health Assembly, he announced spending of $5 million over the next four years to help prevent rheumatic heart disease across the Pacific. The funding will support a partnership between the University of Western Australia, Telethon Kids Institute, Pacific governments and experts, which will collaborate with Champions4Change, an advocacy and leadership program for Aboriginal and Torres Islander peoples with lived experience of rheumatic heart disease.
Assistant Ministers Ged Kearney and Malarndirri McCarthy announced that the Government would be funding NACCHO to distribute free pads and tampons to women and girls living in remote First Nations communities to help address period poverty and reduce cost-of-living pressure (also read more on these measures here).
A number of media reports drew attention to a statement on paediatric care issued by the Chiropractic Board in November last year, which replaced the Interim policy – spinal manipulation for infants and young children issued in June 2019. That policy “clearly outlined the Board’s expectation that chiropractors not use spinal manipulation to treat children under two years of age, pending the recommendations arising from [an expert] review”.
The new statement allows such treatment, and was made “after considering the recommendations made by the Safer Care Victoria independent review into chiropractic spinal manipulation of children under 12 years [and] community needs and expectations and, specifically, the strong support for consumer choice voiced in the public consultation of the independent review”.
The ABC and SBS reported that doctor groups had condemned the return of the practice, and that Minister Butler had asked the Board for an “urgent explanation” of its decision, and would be raising the issue with state health ministers at a meeting on Friday 14 June.
The communique from that meeting records that “the Chair of the Health Ministers’ Meeting will write to the Chiropractic Board requesting it to immediately reinstate the interim ban [on the spinal manipulation of children under two years of age] and provide urgent advice on its recent decision to allow a resumption of this practice”.
Health Ministers also discussed negotiations on the new National Health Reform Agreement.
While the communique “noted that the Prime Minister and state and territory First Ministers had agreed that the combined health and disability reforms will be progressed in tandem… [to] ensure greater alignment of reform and that all states and territories are better off following the endorsement of the new Addendum”, state and territory Health Ministers did not seem to have received the memo.
They reportedly sent a “a furious demand to Anthony Albanese, calling on him to fix the health system in Australia as it buckles under pressure”.
The communique blandly noted that Health Ministers remained “committed to finalising as soon as possible a national agreement to commence from 1 July 2025”.
The Department of Health and Aged Care announced a number of consultations.
One was on the development of a national standard for counsellors and psychotherapists, to cover the experience, capabilities and behaviours expected of the two professions, including education, supervision, CPD and oversight requirements. While it was announced on 10 June to close on 5 July, no other details were announced on 10 June, and were not made available until 13 June.
Another was to expand the list of health professionals for which private health insurance benefits under Chronic Disease Management Programs (CDMPs) will be eligible for risk equalisation to include practice nurses, nurse practitioners, and mental health nurses. It opened on 7 June, with the release of a discussion paper, and is due to close on 2 August.
I am sure that decisions about the relative timelines for these two consultations were made in good faith – but by two separate decision makers in the absence of any central departmental guidance on what is reasonable.
Why else would interested people be given a little over three weeks to comment on an entirely new professional framework for two hitherto unregulated professional groups, and over seven weeks to comment on relatively minor amendments to an existing regulatory framework?
The Department could mitigate criticism by adopting a set of standardised timelines for consultations, dependent on the complexity of the issues involved.
And while I am handing out free advice, the Department should also remove from the Consultation Hub links to administrative forms associated with the Hearing Services Program.
The Therapeutic Goods Administration (TGA) announced that Ryan Gregory McTeigue, the sole director of the Australian company Elite Labs Pty Ltd, which traded under the name Elite SARMS, had been sentenced to two years imprisonment for his role in the unlawful manufacture, supply, advertising and export of performance and image enhancing therapeutic goods.
However, the sentence was suspended for two years provided McTeigue was of good behaviour and did not “export from, manufacture, advertise or supply therapeutic goods in Australia or import or offer to import therapeutic goods into Australia”.
Despite the successful prosecution, an EliteSARMS website is still operating, ostensibly from an address in Texas.
The Australian Institute of Health and Welfare (AIHW) released updated data on Aboriginal and Torres Strait Islander specific primary health care drawn from the Online Services Collection (OSR) and the national Key Performance Indicators (nKPI) collection.
Of the 23 performance indicators reported, there were trend improvements in seven, including rates of smoking during pregnancy and cervical cancer screening. However, ten indicators showed a decline, including the rate of influenza immunisation.
The AIHW also released reports on the National Bowel Cancer Screening program for the 2021 and 2022 calendar years; alcohol and other drug treatment services for 2022-23; and the health of veterans.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) released a Women’s Health Focus Report and an updated Heavy Menstrual Bleeding Clinical Care Standard.
The report examined the rates of hysterectomy and endometrial ablation, which are both used to treat non-cancer gynaecological conditions such as heavy menstrual bleeding, which affects one in four women.
It found that for hysterectomy in 2020-21 there was a five-fold difference between the local area with the highest rate and the local area with the lowest rate; while for endometrial ablation in 2019–22 there was a 20-fold difference between the local area with the highest rate and the local area with the lowest rate.
Consumer and public health groups
The Older Persons Advocacy Network published an article encouraging people to “become your own expert: ask questions about your medical condition(s) and the medications you are being prescribed – find out what they are for and possible side effects”.
“Be persistent: if you are uncertain about the medication you have been prescribed, book another appointment,” the article advised. “Don’t have your prescription filled until you are sure the medication is right for you.”
Trade unions
Allied Health Professions Australia (AHPA) released its response to the Scope of Practice Review second issues paper.
While broadly supporting the direction of the review, AHPA raised concerns that “the key policy options may exacerbate rather than minimise existing barriers experienced by allied health professions without a firmer commitment to allied health-focused funding reform”.
As well as the standard suggestion that “for allied health practitioners to practise at their full scope, Medicare funding for allied health services must be expanded”, AHPA called for “an additional dedicated review of self-regulation focused on legislative enablement of the regulatory role of self-regulating health professions as well as title protection based on enrolment of all clinicians in regulatory schemes”.
In other words, Government protection without Government control. I wish them luck.
The Australian College of Nursing (ACN) marked International Archives Day (the end of International Archives Week) by announcing “valuable additions to the National Nursing Archives of Australia, including a new website”.
The Archives are curated by the ACN, and “preserve the countless stories of dedication, compassion, and resilience in Australian nursing history”.
The Royal Australian College of General Practitioners (RACGP) and other doctor groups have been advocating for some time for Government action to ensure that GP trainees are not disadvantaged relative to specialist trainees working in a hospital setting.
The College welcomed the announcement in the Queensland Budget of incentive payments to address the issue, with Queensland chair Dr Cathryn Hester saying that “unfortunately, doctors leaving the hospital system to their GP training usually take a hit to earnings that can be in the tens of thousands of dollars, and they also lose the parental and other leave they have earned”.
“That doesn’t happen with other specialisations. Australia needs a solution to this, and the Queensland Government has stepped up to help to fill that gap.”
The RACGP also issued a media release calling for “changes to after-hours care so that more patients across Australia can get the care they need, when they need it”. This follows the College’s submission to the Government’s Review of after hours primary care policies and programs.
The Rural Doctors Association of Australia marked the start of Men’s Health Week with a media release encouraging men to get physical with exercises they enjoy; eat well, adding extra greens, and limiting portions and foods with saturated fat, or added salt and sugars; stay socially connected; get enough sleep; avoid risks by not smoking, moderating alcohol, and speaking up about workplace safety; and getting checked and dealing with health niggles before they become major problems.
All probably just as good advice for the 50.2 percent of the population who aren’t men.
The Australian College of Rural and Remote Medicine (ACCRM) also marked the week, with a media release “raising awareness about the importance of proactive healthcare, emphasising both physical and mental wellbeing”.
Industry groups
AHHA’s Deeble Institute for Health Policy Research released a policy brief examining the collection, reporting and use of data about hospital-acquired complications (HACs).
It concluded that “there are substantial delays in the publication of data for HACs, [and] as of 2024, the national data is out-of-date and published across multiple websites”.
“As a result of this lack of standardisation, outdated data and fractured publication, clinicians and hospitals are currently unable to effectively evaluate and compare performance or identify specific areas in need of improvement.”
The brief made a series of recommendations including “standardisation of reporting requirements, improving timeliness and streamlining publication by using fewer platforms, legislative reforms and developing co-designed approaches to publication with consumers”.
The Pharmacy Guild issued a media release responding to the ACCC’s statement outlining “preliminary competition concerns with Sigma Healthcare Limited’s proposed acquisition of Chemist Warehouse Group Holdings”.
Having used the negotiation of the 8th Community Pharmacy Agreement to eliminate the ability of pharmacies to compete by discounting the cost to patients of PBS scripts, the Guild is now concerned at the “reduction in competition in pharmacy retailing” that might arise from the Sigma-Chemist Warehouse deal. Cry me a river!
The Guild also suggested that “the ACCC’s statement that ‘Chemist Warehouse appears to exert significant control or influence over its banner stores, including through high levels of executive ownership of Chemist Warehouse stores’ warrants urgent attention from State and Territory regulators” to ensure compliance with pharmacy ownership laws.
We could all take the Guild’s claim that the pharmacy ownership laws protect consumers a little more seriously if they prevented pharmacists from owning more pharmacies than they can personally supervise, and if they prevented pharmacists in one jurisdiction from owning pharmacies in another thousands of kilometres away.
Politicians and parliamentary committees
The House of Representatives committee inquiry into food and beverage manufacturing in Australia held a public hearing in Brisbane, including witnesses from the organic food sector and End Food Waste Australia.
The Senate committee inquiry into excess mortality held a hearing on Thursday, previewed by Alison Barrett in this article for Croakey.
The Senate committee inquiry into menopause and perimenopause will hold hearings in Sydney and Melbourne on June 17 and 18, before moving on to Brisbane, Canberra and Adelaide in late July and early August. It Is due to report by 10 September.
International organisations
The British general election is in full swing, with just over two weeks to the election on 4 July. Unless there is a major turnaround in voter sentiment, the Labour Party will be elected with a substantial majority in the House of Commons.
The Kings Fund has been following the campaign closely, and published a statement by CEO Sarah Woolnough setting out her reaction to Labour’s policies. She said:
“The broad ambitions for health and care set out in Labour’s manifesto tick many of the right boxes. Bolstering out-of-hospital care and focusing on preventing illness as well as treating it would lead to a healthier population and a sustainable health service.
“But the individual pledges in the manifesto are, at best, only a policy down-payment on achieving those longer-term reforms. In and of themselves, the specific commitments set out by Labour lack some concrete detail and are unlikely to deliver the scale of change the party is promising.
“The manifesto also makes a number of key commitments without clarity on the spending implications for health and care budgets.”
Finally
The first edition of this column in January this year reported on the difficulties general practices were facing in obtaining doses of the Shingrix vaccine. Demand for the vaccine had soared after the Commonwealth Government announced in October last year that it would be made available free to people aged 65 and over.
As a relatively newly-minted member of that class I received my first dose in January, at which stage the practice hoped to provide the second dose in April. However, it was not until last Thursday that I was able to receive the second dose.
The practice I attend (in common with most others, I am sure) is doing a great job in balancing demand for initial doses with the requirement to provide the second dose within six months of the first.
However, it shouldn’t be this hard.
Given the experience with Shingrix and with the COVID-19 vaccine stroll-out, the Department of Health and Aged Care needs to reflect on how it manages the acquisition and supply of vaccines for mass campaigns to get it right before the next pandemic strikes.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
TGA
Companion diagnostics guidance update
17 June
Department of Health and Aged Care
National Immunisation Strategy
19 June (previously 5 June)
Department of Health and Aged Care
Culturally safe aged care for First Nations people
21 June
Department of Health and Aged Care
Overseas student health cover
24 June
Medical Board of Australia
Revised registration standard for overseas specialists|
3 July
Department of Infrastructure, Transport, Regional Development and Local Government
National Urban Policy for Australia
4 July
Department of Health and Aged Care
Development of a national standard for counsellors and psychotherapists|
5 July
Department of Health and Aged Care
Establishment of a National Aged Care Mandatory Quality Indicator Program (QI Program) for in-home aged care services
9 July
Department of Health and Aged Care
Outline of the National Allied Health Workforce Strategy
9 July
NHMRC
Good institutional practice guide
10 July
TGA
Update to medicine labelling rules
11 July
Department of Health and Aged Care
Post-implementation review of changes to MBS electrocardiogram items
25 July
AHPRA and national registration boards
Criminal history registration standard
30 July
Department of Health and Aged Care
Health professionals included in private health insurance Chronic Disease Management Programs
2 August
Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August
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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