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The Zap: all the essential health and aged care news, plus consultations now open

More reform has been underway over the past week on vaping regulations in Australia, while the Federal Government has called to account residential aged care homes on mandatory care minute requirements that were introduced a year ago.

Also in the news, a report on ageism in the Australia media, a climate health framework underway, calls for full funding for a permanent Centre for Disease Control, the launch of the Greens health policy, private health claims, and enviable leadership from the US Centers for Medicare and Medicaid Services.

And finally, frustration involved in getting details on public policy from the Department of Health and Aged Care.

The quotable?

I am still waiting for a reply.”


Charles Maskell-Knight writes:

As reported at Croakey last week, the Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Act 2024 provided that from 1 October vaping products were only to be available over the counter from pharmacies with the direct involvement of a pharmacist. (This reflected a compromise between the Government and the Greens which was needed to ensure passage of the Act through the Senate.)

The Act achieved this outcome by amending the Poisons Schedule – a piece of subordinate legislation usually amended by officers in the Therapeutic Goods Administration.

However, the Poisons Schedule only has legal effect because it is adopted and enforced by state and territory governments.

Several months ago the Tasmanian Government announced it would legislate to require that vapes could only be supplied on prescription, and now the Western Australian Government has followed suit.

While public health groups have supported these moves, they should remember that it is equally possible for states to override the Poisons Schedule and allow vapes to be sold without any legal restrictions.

Health Minister Mark Butler marked 1 October with a media release emphasising that “the only lawful way to purchase a vape is through a pharmacy”. He said that the Pharmaceutical Association of Australia had “worked with the Government to develop updated guidelines, education and training for pharmacists to support the government’s tobacco and vaping reforms”.

Also last week, the Therapeutic Goods Administration announced that it was introducing “strengthened product standards for therapeutic vapes including vaping substances, vaping substance accessories, vaping devices and vaping device accessories”. From 1 March next year it will be illegal to import or manufacture products that do not meet these standards, and from 1 July it will be illegal to supply them.

On the dispensing front, the Pharmacy Guild is making available resources to assist pharmacies which do not wish to sell vapes, arguing that “pharmacists are healthcare professionals, dedicated to the safe and quality use of medicines”.

Just remember that next time you walk through aisles full of perfumes, cosmetics, hair care products and other toiletries, dietary supplements and homeopathic medicines on your way to the dispensing counter hidden at the back of a pharmacy.

Ministers and government

Minister Butler announced that the Government was managing a shortage in the supply of Pre-exposure prophylaxis (PrEP, an anti-viral medicine taken to lower the chance for someone of contracting HIV), by listing a USA-registered brand of the medicine on the Pharmaceutical Benefits Scheme from 1 October.

Aged Care Minister Anika Wells released an open letter to aged care providers concerning their delivery of care minutes,  mandating the amount of direct care that older people living in residential care receive from registered nurses, enrolled nurses and personal care workers.

Writing a year after the requirement first took effect, she said that analysis by the Department of Health and Aged Care had “found compliance with care minutes is disproportionally low in metropolitan areas, even though it is understood that workforce constraints are generally greater in regional, rural and remote areas”.

The findings “also showed compliance rates of aged care homes run by for-profit providers are much lower than those run by not-for-profit providers”, she wrote.

Wells said, “this is disappointing given the Government’s record investment of over $15.1 billion to lift wages in aged care…  to ensure aged care providers are able to employ sufficient care workers. From 1 October 2024, average care funding will be around 58 percent higher than it was in September 2022. A significant part of this increase has been to fund providers to increase their care minutes to an average of 215 minutes per resident per day… The Australian Government expects that you are spending your increased care funding on meeting your mandatory care minutes”.

It is almost as if the for-profit sector is saving on care minutes to maintain profits.

Who would have thought it?

Wells’ letter may have been inspired by the June 2024 quarter data on aged care minutes of care released by the Department of Health and Aged Care on 3 October.

This shows that while just under 60 percent of homes met the total care minutes target or the registered nurse care minutes target, only 41 percent of homes met both targets. Only 23 percent of for-profit homes met both targets, compared with 44 percent of not-for profit homes.

But remember, under the star ratings system, over 95 percent of homes are receiving three or more stars for delivering an acceptable level of care!

Talking of aged care star ratings, the Department’s website revealed that a media campaign is to run from 6 October to 28 December 2024 nationally across free-to-air television, digital video, digital search and in medical centres and pharmacies to “build awareness, trust, and use of Star Ratings nationally with older people and their support networks”.

Research underlying the campaign found that “there is an opportunity to promote Star Ratings as a helpful tool for people to use in the early stages of planning for residential aged care”.

Until star ratings differentiate between homes that comply with quality standards and those that do not, and those that meet care time targets and those that do not, they will not be helpful! Unless these flaws are fixed, money spent on promoting the use of star ratings is wasted.

Meanwhile, the Senate inquiry into the Aged Care Bill released submissions from the Office of the Inspector General of Aged Care (OIGAC) and the Aged Care Quality and Safety Commission.

The OIGAC’s submission heavily criticised various elements of the Bill, including ongoing rationing of care and an “aspirational” approach to user rights and high quality care.

It concluded “the retention of an aged care system based on the rationing of aged care rather than assessed need is of concern to the Office, as it negates the core intentions of a rights-based system envisioned and recommended by the Royal Commission. The Office reiterates its position that a universal rights driven system is achievable and would create a sustainable, strengthened aged care system in which people could have confidence”.

If the Government agency responsible for monitoring the aged care system does not believe the legislation gives effect to a rights-based regime, why should anybody else believe the Minister’s explanatory memorandum which says “the Bill establishes a modern rights-based legislative framework”?

Also as Croakey reported last week, Assistant Minister Ged Kearney announced that 19 major health organisations had signed on to a statement agreeing to “work together to deliver a framework for action on climate and health… including supporting a workforce-led health system response to climate change”.

The statement appears on the Australian Commission for Safety and Quality in Health Care (ACSQHC) site, and is endorsed by the ACSQHC, the interim Centre for Disease Control, the Australian Indigenous Doctors Association, and all medical colleges.

Kearney said “to address climate change we need everyone at the table”. Unfortunately her colleague the Minister for Environment appears to be sitting at a completely different table where she continues to approve new and expanded fossil fuel developments.

The Australian Institute of Health and Welfare (AIHW) released the latest data on ten general practice Practice Incentives Program Quality Improvement measures. However, it is hard to discern whether or not there has been any care quality improvement, as the measures are mainly focused on data recording rather than service delivery outcomes.

The AIHW also released its latest report on breast cancer screening. Since the program of free biennial mammograms was introduced in 1991, breast cancer mortality has decreased from 74 deaths per 100,000 women aged 50–74 to 37 deaths per 100,000 women in 2022.

The AIHW released an updated report on Oral health and dental care, with findings repeating the dismal pattern of similar reports for the last three decades.

Low-income groups have worse oral health and find it difficult to afford private dental services, while those eligible for public dental services face long waits from services that are forced to spend most of their time treating acute episodes rather than providing preventative care.

The Consumers Health Forum (CHF) reacted to the report, with CEO Dr Elizabeth Deveny saying “it’s really quite shocking to see these statistics in today’s updated report… So today, I’m saying, enough is enough. We need real action now. Not after the election, not in five years’ time, not sometime in the next decade – now”.

Minister Butler has ruled out any measures to improve the situation.

The Independent review of the regulation of podiatric surgeons in Australia released in March recommended among other things that the title ‘podiatric surgeon’ should be changed to ‘surgical podiatrist’. The Podiatry Board of Australia is now consulting on that proposal, with submissions due by 8 November.

Consumer and public health groups

COTA Australia marked the International Day of Older Persons on 1 October with a statement referring to the Australia Human Rights Commission’s report Shaping perceptions: How Australian media reports on ageing.

Patricia Sparrow, CEO of COTA, said that the report “confirmed what we have all known for a while – that ageism is a scourge that continues to persist in all aspects of life in Australia… we’re seeing too much media representation which exploits negative stereotypes of older adults, using sensationalist headlines that stoke intergenerational tensions. This practice is not only misguided but deeply harmful”.

The theme for this year’s International Day is “Ageing with dignity: the importance of strengthening care and support systems for older persons worldwide”. Perhaps it will inspire the Government to accept that high quality care should be one of the objectives of its proposed new Aged Care Act?

COTA also commented on the latest aged care minutes of care data released by the Department. CEO Pat Sparrow said “the fact that too many older people are still not getting the mandated minutes of care is a real concern…basic direct care isn’t a ‘nice to have’, it’s crucial and the absolute minimum we should expect for older Australians in aged care”.

She went on “we shouldn’t have a situation where aged care homes are making profits off government funding while falling short of their mandatory care targets”.

The Public Health Association of Australia (PHAA) joined with the Australasian Society for Infectious Diseases, the Climate and Health Alliance, and the Royal Australasian College of Physicians in a joint statement calling for the Government to “act decisively now to formally establish the much-anticipated Australian CDC [Centre for Disease Control] to ensure better co-ordinated and more strategic public health leadership”.

Funding for the interim CDC, established on 1 January, expires on 30 June 2025, and as yet there has been no sign of the legislation to establish a permanent body.

PHAA CEO Adjunct Professor Terry Slevin said “it is vital [that the CDC] has a sound base, clarity of purpose and the funds to take a leadership role, joining all other members of the OECD who have established a Centre for Disease Control. We are looking forward to a definitive and substantial financial commitment to the establishment of the permanent CDC before the end of 2024, before an election is called”.

Trade unions

The new leadership team at the Australian Medical Association has taken  office. The new President is Dr Danielle McMullen, a Brisbane-based general practitioner, and the new Vice President is Associate Professor Julian Rait, a specialist ophthalmologist.

The Royal Australian College of GPs (RACGP) continued to trickle out early results from its annual “Health of the Nation” survey of GPs. It reported that a quarter of GPs have bulk billed more consultations since the incentive payments for bulk billing were tripled, but average out-of-pockets costs for a 20 minute consultation increased to $36.86 from $34.91 a year earlier.

RACGP President Dr Nicole Higgins said the increase in the bulk billing incentives were only “the first steps” in the rebuilding of Medicare, and the Government should now move to “a 20 percent increase to all Medicare rebates for 20-minute and longer consults, with additional increases for rural and remote communities. Increasing Medicare rebates is the most direct and cost-efficient way to increase bulk billing rates”.

The RACGP also welcomed an announcement by the Victorian Government that it would fund immunisation against respiratory syncytial virus (RSV) for unprotected newborns and eligible infants.

Industry groups

The Australian Healthcare and Hospitals Association issued a statement marking the release of the October edition of the Australian Health Review, focused on health workforce issues including hospital CEO retention, anti-bullying training, and staffing ratios.

One of the many oddities in the private health insurance world is the fact that private health insurers pay nothing like the full cost of treatment for insured patients in public hospitals. Since 1994 insurers have been required to pay the minimum default benefit, which has been indexed by CPI rather than health inflation, and now meets under half of the cost of these patients.

In other words, governments are subsidising private health insurers by meeting a substantial proportion of the cost of public hospital treatment for privately insured patients. Australian Prudential Regulation Authority  (APRA) data show that in 2022-23 the average hospital benefits per episode paid by insurers in public hospitals were $1,567, compared with $3,208 in private hospitals.

In the lead-up to the New South Wales budget, the State Government said it would “work with private health insurers to ensure the correct payments are being made to public hospitals” – code for increasing charges.

Private Healthcare Australia (PHA, the private health insurers lobby group) issued a statement characterising the increased charges as a “health tax”, and asserting it could cause 60,000 people to drop their health insurance.

As I have written before, if the private health insurers were really concerned about the impact of premiums on policy holders, they could stop asking for premium increases they don’t need, and bring their burgeoning management expenses under control.

National shadow health minister Anne Ruston commented on the issue, calling on the Albanese government to intervene.

PHA also issued a statement claiming that patients opting to use their private health insurance in NSW hospitals were facing unexpected out-of-pocket costs of thousands of dollars for medical services.

This is surprising – the standard spiel from the ward clerk designed to encourage private patient election for non-elective surgery admissions promises that the patient will not face any direct costs, and in the half dozen admissions I have been involved with over the last few years this promise has been honoured.

Politicians and parliamentary committees

The Greens launched their health policy, “an ambitious plan to enable all Australians to go to the GP for free, as well as get free appointments with other primary healthcare professionals, at new Free Local Healthcare Clinics to be established in every electorate”.

Under the policy there will be 1,000 Free Local Healthcare Clinics with employed staff including a GP, a dentist, a registered nurse or a psychologist, providing care with no out-of-pocket costs. The Greens will also support provide bulk-billing incentives for all patients, increase Medicare rebates for longer consultations, and ensure that GP trainees receive equal pay to their hospital trainee counterparts.

The RACGP welcomed the policy, while the Australian Dental Association (ADA) questioned how practical the plan would be. ADA President Dr Scott Davis said “to staff the proposed clinics with existing dentists would require attracting them away from existing clinics, or training a very significant number of new dentists, which takes time and is subject to constraints. So it might be a challenge to make strong headway on this within the term of the next government”.

The House of Representatives inquiry into the health impacts of alcohol and other drugs announced that it would accept submissions until Tuesday 31 December 2024.

International organisations

The US Centers for Medicare and Medicaid Services (CMS), responsible for overseeing health programs for around 170 million Americans, released an updated framework for health equity.

It identified five priorities for the next decade:

  • improving data collection, reporting and analysis
  • assessing the causes of disparities and addressing policy and operational inequities
  • building workforce capacity to address inequity
  • improving practical access through improving language and health literacy and providing culturally appropriate services
  • increase all forms of accessibility to healthcare services and coverage.

In relation to addressing the causes of inequity, the CMS said it intended to “assess our programs and policies for unintended consequences and make concrete, actionable decisions about our policies, investments, and resource allocations. Our goals are to explicitly measure the impact of our policies on health equity, to develop sustainable solutions that close gaps in health and health care access, quality, and outcomes and to invest in solutions that address health disparities”.

If only we had an Australian body with the same objectives.

Finally….

Before the last election Prime Minister Anthony Albanese said he wanted to “change the way that politics operates in this country” by avoiding soundbites and “actually answering questions”.

This week I had another frustrating interaction with the Department of Health and Aged Care, which appears incapable of actually answering questions.

Regular readers of this column will recall that in June the Department began a Private Hospital Sector Financial Health Check, which was due to be completed in “late August”.

Having not heard anything about an outcome from this process, on 30 September I asked the Department “as it is now (very) late September, are you able to indicate when the process will conclude? When will the results be made available? What has caused the delay?”

I received this response: “the Private Hospital Sector Financial Health Check is still being finalised. The Minister has not received the Health Check”.

I replied: “just to clarify, I asked as it is now (very) late September, are you able to indicate when the process will conclude? When will the results be made available? What has caused the delay? The answer you provided does not answer any of these questions. Would you like to try again?”

I am still waiting for a reply.


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.

Therapeutic Goods Administration
Draft guidance on the new regulatory requirements and transition arrangements for medical devices containing medicinal substances or materials of animal, microbial, or recombinant origin
9 October

Department of Health and Aged Care
Survey on the functionality and user experience of MBS Online
11 October

Therapeutic Goods Administration
Future regulation of assistive technologies
13 October

Therapeutic Goods Administration
Clarifying and strengthening the regulation of Artificial Intelligence (AI)
13 October

Department of Health and Aged Care
Safe and Responsible Artificial Intelligence in Health Care – Legislation and Regulation Review (See also the Joint Committee on Public Accounts and Audit Inquiry into the use and governance of artificial intelligence systems by public sector entities)
14 October

Independent review of complexity in the National Registration and Accreditation Scheme (NRAS)
Consultation paper
14 October

Therapeutic Goods Administration
Proposed changes to the Australian Essential Principles for Safety and Performance of medical devices
16 October

Ahpra Accreditation Committee
Guidance on developing professional capabilities
18 October

Department of Health and Aged Care
Draft 24-hour movement recommendations for adults and older Australians
18 October

Therapeutic Goods Administration
Public consultation on interim decisions to amend the Poisons Standard 
18 October

Department of Health and Aged Care
Draft National Nursing Workforce Strategy
20 October

Therapeutic Goods Administration
Proposed amendments to the Poisons Standard
22 October

Independent Health and Aged Care Pricing Authority
Pricing Approach for the Support at Home Service List
25 October

National Mental Health Commission (National Suicide Prevention Office)
Draft National Suicide Prevention Strategy
27 October

Australian Commission on Safety and Quality in Health Care
Draft Medication Management at Transitions of Care Stewardship Framework
27 October

National Health and Medical Research Council
Draft Procedures and Requirements for Meeting the NHMRC Standards for Clinical Practice Guidelines
27 October

Food Standards Australia and New Zealand
Varying maximum residue limits (MRLs) for residues of specific agricultural and veterinary chemicals that may occur in food commodities
29 October

Department of Health and Aged Care
Proposed amendments to the Gene Technology Act 2000
8 November

Podiatry Board of Australia
Proposed change to the protected title for the specialty of podiatric surgery
8 November

Department of Health and Aged Care
Reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office
11 November

Independent Health and Aged Care Pricing Authority
NDIS pricing reform
15 November

House of Representatives Standing Committee on Health, Aged Care and Sport
Inquiry into the health impacts of alcohol and other drugs in Australia
31 December (extended from 30 September)


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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