*** Aboriginal and Torres Strait Islander readers are warned that this article contains a reference to a deceased person ***
The Pharmacy Guild’s fascinating reaction to the Government’s vaping reforms, recommendations for tackling diabetes, shortages of pain relief medicines, innovation in rural healthcare, and the latest excess mortality data are covered in this week’s edition of The Zap.
The column also links to tributes to the late Cleveland Fagan and his significant contributions to the Aboriginal and Torres Strait Islander community controlled health sector.
Charles Maskell-Knight also highlights the 10th edition of the Guidelines for preventive activities in general practice, the so-called Red Book, providing “recommendations on evidence-based screening, prevention of chronic disease, early detection of disease, and empowering patients through health education and promotion”.
The quotable?
I am just waiting for the Guild to press for an amendment to the Community Pharmacy Agreement to receive Government reimbursement for distributing vapes.”
Charles Maskell-Knight writes:
The big national health story last week was the fate of the Government’s anti-vaping legislation.
Croakey has provided extensive coverage of developments, including this open letter from dozens of health groups supporting the original legislation; this article from Associate Professor Becky Freeman (expert adviser to the Cancer Council Tobacco Issues Committee); and this summary by Croakey Managing Editor Alison Barrett of the response to the final version of the legislation from the public health community.
To keep this column a reasonable length, I won’t repeat this reporting here, but I will add two points.
Firstly, the Pharmacy Guild’s reaction has been fascinating. The Guild, which has been taking every opportunity to expand the role of pharmacists to include prescribing Schedule 4 drugs at the expense of doctors, is now complaining vociferously that they may be asked to supply non-prescription smoking cessation aids.
According to the Guild, “pharmacists are healthcare professionals who dispense medication that provides a proven therapeutic benefit”. I can only assume that those pharmacies I visit that sell homoeopathic “medicines” with no measurable active ingredients and no possible therapeutic benefit are not Guild members.
The Guild also claims that “no guidance or protocol exists for pharmacies to stock unregulated substances with no established therapeutic benefit”. The lack of guidance or protocols doesn’t appear to prevent pharmacies from stocking and profiting from a huge range of cosmetic and beauty products with no established therapeutic benefit.
I am just waiting for the Guild to press for an amendment to the Community Pharmacy Agreement to receive Government reimbursement for distributing vapes.
And secondly, a special shout-out to the media team at the Australian Medical Association (AMA) for their media release headline “Nationals have little to be proud of on vaping reforms”.
Readers after a plain, spin-free summary of exactly what is involved in the new regime should read the Therapeutic Goods Administration’s media release issued on 28 June.
A consequential health story that was largely lost in the vaping brouhaha was the launch by Diabetes Australia of its 2024 State of the Nation report, showing that “the diabetes epidemic shows no sign of abating, with alarming rates of type 2 diabetes diagnosis in younger people”.
Data shows First Nations communities have “the world’s highest rates of youth-onset type 2 diabetes, with the prevalence in 15 – 24-year-olds doubling over the past five years”.
CEO of Diabetes Australia, Justine Cain, said that “for decades there have been calls for a national diabetes prevention plan, and today – with an estimated two million Australians living with the condition – we still don’t have one”.
The State of the Nation includes 25 recommendations including:
- the introduction of a 20 percent health levy on sugar-sweetened beverages as a population-wide diabetes prevention measure
- the promotion of type 2 diabetes remission
- the introduction of a national diabetes kidney screening program
- an increase in funding for diabetes research
- introduction of a new training program for aged care staff supporting residents living with diabetes
- the development of a strategic plan to grow the diabetes health workforce
- Medicare Benefits Schedule (MBS) rebates for general practice visits that are focused on diabetes prevention and screening.
It will be interesting to see whether the protracted House of Representatives committee inquiry into diabetes (established in May last year) adopts any of these ideas when it finally releases its report.
Ministers and government
Health and Aged Care Minister Mark Butler announced that “record numbers of doctors, nurses, midwives and other health professionals are moving to Australia and working in the health system”.
In the ten months to April 2024 almost 4,700 overseas doctors registered to practise, 50 percent more than in the full 2018-19 financial year.
As a result of the increase, half of all new doctors registering for the first time in 2022-24 were overseas trained.
Butler also said that since July 2022, more than 42,000 other overseas educated health professionals had registered to practise in Australia.
These movements are definitely assisting to address workforce shortages in Australia, and the Government’s ability to civilly conscript overseas medical graduates to work in regional and rural areas for ten years is crucial to ensuring some sort of medical workforce in those areas.
But what does it say about Australia’s education and training system and the incentives for working in the health sector if we are reliant on importing healthcare workers from overseas?
And as Dr Hilary Bowman-Smart from the University of South Australia wrote in The Conversation, “importing doctors from overseas… has significant ethical implications”.
“If we do import doctors, especially from other countries with doctor shortages, we should give back to those countries and their healthcare systems. This could be by increasing foreign aid, or providing further training for healthcare professionals who can then take those skills back to their country of origin.”
Butler also announced funding of “$16 million to support 11 innovative healthcare projects in rural and remote Australia that aim to provide a range of innovative models of care”. (His press secretary needs to consult a thesaurus and find a synonym for “innovative”.) Some further details on the program are available from the Departmental website – although as of 29 June this had not been updated to reflect the latest announcement.
Assistant Minster Malarndirri McCarthy announced that “more First Nations families now have access to culturally safe maternal healthcare in North East Arnhem Land thanks to a growing workforce of Djäkamirr – First Nations skilled companions and caretakers of pregnancy and birth, who use Yolŋu and western knowledges to support women in Birthing on Country”.
In a column several weeks ago I discussed the timelines the Department of Health and Aged Care applied to various consultation processes. On 24 June the Department sought comments on a proposal to reclassify Sports and Exercise Medicine Physicians as consultant physicians.
Comments are due by 5 August – 11 days after the request. The consultation paper states that the proposal was put forward by the Australasian College of Sport and Exercise Physicians in February 2023.
So, 16 months for the Government to ponder it, and 11 days for the public to respond.
The Department also released a statement urging increased COVID-19 vaccination to help protect older Australians. It said: “If you have a family member, friend or loved one living or working in an aged care home, please help them to get their COVID-19 vaccine now.”
The Australian Bureau of Statistics (ABS) released data from the 2022 National Health Survey broken down by state and territory. According to the Bureau’s media release, the key insights were:
- Australians are breathing a little easier! Over the last 20 years, the proportion of adult daily smokers has fallen in every state and territory.
- Adults in the ACT are more likely to have never smoked (67.6 percent) and less likely to be daily smokers (5.9 percent) than any other state and territory.
- Northern Territorians are getting fitter. One in four, or 24.6 per cent of, people aged 15 years and over in the Northern Territory got enough exercise in 2022, up from 15.5 per cent in 2017–18.
- Almost one in three adults are drinking more than recommended in the Australian Adult Alcohol Guidelines in the NT (31.1 percent), WA (29.9 percent), Queensland (29.4 percent), and SA (29.3 percent).
- Tasmanians are more likely to have at least one chronic condition (58.4 percent) than any other state or territory. They were also more likely to have self-reported hypertension (16.2 percent) than any other state or territory.
- Almost two thirds of Aussies are overweight. More than 60 percent of all adults were overweight or obese in each state and territory in 2022.
- Most of us are still not getting enough fruit and veggies. Less than half (45.5 percent) of NSW adults had enough fruit in their diet, and one in ten (10.5 percent) Tasmanians had enough vegetables.
The ABS also released data on excess mortality during the COVID-19 pandemic through to the end of 2023. It estimated that at a national level, deaths in 2023 were 5.1 percent higher than expected, but that excess mortality had decreased across all jurisdictions except Tasmania in 2023 when compared with 2022.
First Nations health
A number of health organisations, including the Apunipima Cape York Health Council, the Queensland Aboriginal and Islander Health Council, the Lowitja Institute, and Public Health Association of Australia, paid tribute to Cleveland Fagan, who died suddenly several weeks ago. He was a proud Djabugay man from Kuranda, with connections to Cairns, Yarrabah, Kuranda, Mareeba and Cape York.
Apunipima said that Fagan served as CEO “for 12 years from 2005 to April 2017 and oversaw Apunipima’s transition from an advocacy organisation to primary healthcare service provider. This was a period of incredible growth as the organisation increased its staff numbers from 20 staff to over 200, and expanded into many of the services and programs that we see as core health services today.
“Cleveland was a champion of change for the Aboriginal and Torres Strait Islander community controlled health sector, sharing his wealth of knowledge and experience to build capacity and develop our local and regional organisations to be leaders of primary healthcare in our communities”.
Consumer and public health groups
The National Rural Health Alliance welcomed Minister Butler’s announcement of funding for innovative models of care, especially the trial in Mareeba in far north Queensland of the Primary care Rural Integrated Multidisciplinary Health Service (PRIM-HS) model developed by the Alliance.
The model is “community-led and co-designed”, and involves “community-based, not-for-profit organisations deliver[ing] multidisciplinary primary healthcare services that meet the specific health and wellbeing needs of communities”.
CEO Susi Tegen said: “We are committed to putting all our strength and expertise into this trial program by mentoring and providing support at a local level.”
“We will be working with Mareeba Community Family Health Care in the overarching PRIM-HS implementation and evaluation, facilitate the governance model and background planning, as well as sharing learnings and findings with other primary healthcare entities across Australia.”
The Neurological Alliance Australia held a summit in Canberra as part of its Count Us In campaign, calling for “the establishment of a Taskforce for Neurological Conditions, to urgently address the needs of millions of forgotten Australians”.
The Alliance comprises 27 disease lobby groups, such as MS Australia, Parkinson’s Australia, MND Australia, and the Stroke Foundation, and also receives support from a number of major pharmaceutical companies.
It is seeking: greater investment in medical research; a stronger NDIS; equal access to assistive technology; establishment of a national neurological dataset; an end to NDIS age discrimination; and improved aged care, health and disability sector integration.
Palliative Care Australia (PCA) issued a statement concerning shortages of pain relief medicines. After Mundipharma announced it was removing oral liquid morphine (Ordine) from the Australian market, the TGA approved a range of alternative medicines under section 19A of the Act to fill the gap, pending a new manufacturer of Ordine entering the market. However, there are now shortages in the alternative medicines which require week to week management of stocks.
PCA deputy chair Dr Peter Allcroft said that “PCA and the sector more broadly would welcome the opportunity to work collaboratively with government to ensure that Australia has a stable supply of this critical medicine into the future”.
The shortage in Australia is particularly ironic, given the Tasmanian opium poppy industry grows about half of the world’s supply of legally sourced raw material for morphine production.
Perhaps there is room in the Government’s Made in Australia initiative for developing an industry to convert Australian raw material into morphine?
Trade unions
The Australian Association of Psychologists published an article by Associate Professor Bridianne O’Dea, Adolescent Mental Health Researcher at the Black Dog Institute, about the ClearlyMe® app developed by the Institute.
It is “a free, self-directed CBT app for teens with mild to moderate depressive symptoms [such as] low mood, negative thinking, relaxation difficulties, and motivation loss”.
The app was co-designed with teens, and “has been evaluated through a rigorous randomised controlled trial”.
The Australian Physiotherapy Association released a report it had commissioned from the Nous Group on the potential savings from allowing physiotherapists to refer patients directly to orthopaedic specialists and for medical imaging. The report concluded that these policy changes could save the health system and patients a little over $160 million annually.
APA President Scott Wilson said the changes would “streamline the patient journey, eliminating unnecessary GP visits, cutting down wait times for diagnoses and treatments, reducing out-of-pocket expenses for patients, and providing savings for the health system as a whole”.
The Royal Australian College of General Practitioners (RACGP) has “thrown its support behind including mental health and wellbeing in early childhood health checks” in a response to the National Mental Health Commission’s draft National Guidelines for inclusion of wellbeing in early childhood checks.
The College repeated its call for “funding for universal annual children’s health checks for the first 2,000 days – this is a critical period which sets a child up for life”.
The College launched the 10th edition of the Guidelines for preventive activities in general practice, the so-called Red Book, providing “recommendations on evidence-based screening, prevention of chronic disease, early detection of disease, and empowering patients through health education and promotion”.
New topics in the tenth edition included “developmental delay and autism; child and elder abuse; anxiety; gambling; sleep; eating disorders; several new women’s health topics in relation to preventive care during and after pregnancy; and post menopause”.
Finally, the College “warmly welcomed” the announcement by the Victorian Government of a pill-testing trial.
RACGP Victoria Chair, Dr Anita Munoz, said “drug testing has been proven to work in other jurisdictions, it makes sense, and it saves lives”.
“This is a victory for common sense and sound policy over tired rhetoric and a ‘war-on-drugs’ mentality that gets us nowhere. Alcohol and other drug use, whether it be illicit drug use at music festivals or people experiencing severe opioid dependence on drugs such as heroin, is a health issue.”
The Alcohol and Drug Foundation also issued a statement strongly supporting the Victorian announcement.
Industry groups
ACCPA (the aged care provider lobby group) released its submission to the Aged Care Inspector-General’s review of My Aged Care. (Submissions closed on 28 June – apologies to our readers for missing this consultation process.)
ACCPA made nine generally sensible recommendations to improve the operation of My Aged Care in relation to address “access and navigation challenges, assessment and referral issues, client experience, and operational inefficiencies between My Aged Care and approved providers”.
The Members Health Fund Alliance issued a statement that its member private health insurers had “returned over $1.3 billion back to policyholders” since the beginning of the COVID-19 pandemic. CEO Mathew Koce said that “Members Health funds understand the current cost of living pressures Australians are experiencing, and we hope these payments help”.
The insurers could have helped even more by not applying for unnecessary premium increases to collect the money that they clearly didn’t need.
On a related topic, Catholic Health Australia called for significant reform of the annual private health insurance premium round process “to protect private healthcare access for patients as funding issues continue to threaten services”. It envisages a system under which insurers with low payout ratios receive approval for lower premium increases, while those with higher payout ratios can increase premiums more.
Politicians and parliamentary committees
The Government response to the report of the Senate dental inquiry is now a neat three months overdue. Will we see any reaction before the next election?
Shadow Minister Anne Ruston issued a statement promising to adopt a licensing regime for vapes, rather than “Labor’s prohibition-style approach [which] plays straight into the hands of organised crime syndicates, who are massively profiting from the sale of illegal vapes”.
As Annabel Crabb wrote, “valid to wonder… whether this new-found disdain for prohibition as a failed system will be extended by the Coalition to any drugs that are not walked into the political arena on the leash of a donor: Heroin? Cocaine? Unlikely”.
International organisations
The World Health Organization (WHO) released a study of global, regional, and nations trends in insufficient physical activity from 2000 to 2022.
At a global level the study shows that “nearly one third (31 percent) of adults worldwide, approximately 1.8 billion people, did not meet the recommended levels of physical activity in 2022. The findings point to a worrying trend of physical inactivity among adults, which has increased by about 5 percentage points between 2010 and 2022”.
Finally
Ever since the success of the 2003 film Calendar Girls, there has been a steady stream of nude fundraising calendars unveiled in Australian communities.
A Google search (NSFW) reveals South Arm in Tasmania, Tuart Lakes in WA, and Crookwell in NSW, as well as various sporting teams (for example, the Perth Pythons) and university groups (for example, vet students at University of Sydney).
The latest disclosure is from Bombala in the NSW high country, where Southern Cross Care shuttered the town’s aged care home in early 2022.
The ABC reports that a group of Bombala residents have successfully re-opened the facility as an assisted living service under the NSW Boarding House Act, with residents able to access Commonwealth home care packages. The exposure gained from the nude calendar helped raise $340,000 from a town with a population of 2,000.
While this is a good news story of a sort, it highlights the problems in delivering aged care in small rural communities. Providing high quality residential aged care is an expensive business and requires a pool of skilled staff, which can be hard to source in many areas.
The workaround in Bombala is unlikely to provide the high levels of care that some residents require, and they will still be forced to relocate out of their community.
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.
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
South Australia Preventive Health
Preventive Health Bill
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
Reclassification of Sports and Exercise Medicine Physicians as consultant physicians
5 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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