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The Zap: all the latest health and aged care news, and a comprehensive list of consultations not to miss

Bupa is talking up its vision for integrated healthcare, but seems reluctant to answer key questions, according to health and aged care policy analyst Charles Maskell-Knight.

His latest column also addresses the latest data on chronic illnesses, the scourge of elder abuse, claims and counter-claims about private hospitals’ financial health, and dips into statistics showing that various groups of doctors made up five of the top ten occupations by taxable income for 2021-22.

The Zap brings stern words for the Liberal and National parties “which are now committed to the catastrophic environmental vandalism associated with constructing and operating seven nuclear reactors rather than committing to renewable energy”.

The column also offers a bonus soundtrack, courtesy of The Bangles, and this quotable:

There is no excuse for any residential aged care service to be under-prepared for COVID-19.”


Charles Maskell-Knight writes:

On 17 June, Bupa Australia “signalled its vision for the future of healthcare, unveiling a roadmap to create a more connected and personalised journey across physical and digital channels with an initial focus on supporting customers with mental health, type 2 diabetes, musculoskeletal health, oral and eye health issues”.

This vision goes under the name of Connected Care, which was rolled out in the United Kingdom at the start of the year.

The local version will involve “a multi-year investment bolstering its current services…initially focused on acquiring healthcare centres that will offer integrated GP, allied health, and pathology services [and] will be open to anyone, not just Bupa Health Insurance customers”.

Other “strategic Connected Care initiatives” include “24/7 virtual doctor consultations – currently available to international Bupa health insurance customers – and almost one million of domestic health insurance customers as part of a trial where they can access up to three free consultations per year”.

I asked Bupa a series of questions about how these arrangements would work in practice, including the extent of Medicare billing, links between the doctors providing telehealth consultations and regular GPs, and out-of-pocket costs.

I was told that the three free consultations would not be billed to Medicare. However, the responses to my other questions were directions to various other Bupa webpages, which did not provide any relevant detail.

Either Bupa don’t know what they are doing, which seems unlikely, or they aren’t prepared to tell anybody about it yet.

Ministers and government

Health Minister Mark Butler announced the appointment of Professor Jenny May AM as the next National Rural Health Commissioner, charged with providing health policy advice and advocating for reforms which support better access to safe, quality and affordable health care in rural, regional and remote Australia. He also thanked outgoing Commissioner Adjunct Professor Ruth Stewart for her service over the last four years.

May’s appointment was welcomed by the RDAA, ACCRM, the National Rural Health Alliance, the RACGP, the AMA, and other rural health organisations.

Butler also announced the appointment of exercise physiologist Anita Hobson-Powell as the new Chief Allied Health Officer for the Department of Health and Aged Care. Allied Health Professions Australia and other groups welcomed the announcement.

Butler’s media release also thanked the “first Chief Allied Health Officer, Dr Anne‑marie Boxall”. In fact, Boxall was the fourth incumbent, following the appointment of David Butt by Minister Tanya Plibersek in 2013.

Butler announced that the Government was providing the NHMRC with $1.1 million to develop new clinical guidelines for treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), long COVID and related conditions.

Assistant Minister Malarndirri McCarthy announced the opening in Coober Pedy of the first renal dialysis clinic funded through the Government’s Better Renal Services for First Nations Peoples initiative. She said that “providing dialysis treatment closer to a patient’s home increases the likelihood of regular treatment, continued support and care, while remaining on Country and connected to community and family”.

Selwyn Button, Chair of the Lowitja Institute, has been appointed for a five-year term as a full time Commissioner at the Productivity Commission, in the role of Indigenous Policy Evaluation Commissioner. Romlie Mokak, who was announced as the Commission’s first full-time Indigenous Policy Evaluation Commissioner in 2018, ended his five-year term on 24 March.

The Department of Health and Aged Care announced that, as part of the transition to the Support at Home program funding model from 1 July 2025, it was asking Home Care Package providers to complete a survey and provide information on the service hours and units delivered to care recipients by service type.

At the end of March this year almost 275,000 people were receiving Home Care Packages at an annual cost of about $8 billion. It is remarkable that the Government has to establish a special data collection to find out what services were actually provided!

The Australian Institute of Health and Welfare (AIHW) had its own version of Manic Monday on 17 June. Unlike The Bangles, they made it to work by nine, in time to release no fewer than 18 reports, web articles, and updates.

The releases were all related to chronic conditions and associated risk factors (overweight and obesity, physical activity, and diet), and included one on multimorbidity.

There were then releases on:

What does it all mean?

Without reading all the reports in detail, the overarching conclusion is that Australians as a group don’t exercise enough and eat too much of the wrong food, resulting in many of us being overweight or obese, which then predisposes us to various chronic illnesses.

What is the Government doing about it? It is “refreshing” the 2017 National Strategic Framework for Chronic Conditions. We’ll have the problem licked in no time.

At the other end of the week, the AIHW released a report on injury in Australia, as well as updated monthly Medicare statistics.

The injury report found that “from 2017–18 to 2022–23, the age-standardised rate of injury hospitalisations fell marginally by an annual average of 0.7%. There was a noticeable fluctuation in hospitalisation cases seen between 2019–20 and 2021–22, possibly related to disruptions caused by COVID-19”.

While the number of deaths from injury has been increasing over time, the age-standardised death rate from injuries has remained relatively stable.

This column recently reported on a joint letter on 24 May from the Aged Care Quality and Safety Commissioner and the Department’s Chief Medical Officer to the board members of aged care providers warning that “vaccination rates [for influenza and COVID-19] in residential aged care remain disappointingly low”, and reminding them that they “are responsible for ensuring that residents have access to the recommended vaccine dose as soon as they are eligible”.

The Aged Care Quality and Safety Commission (ACQSC) has now issued a statement beginning “there is no excuse for any residential aged care service to be under-prepared for COVID-19”.

It continues: “More than four years after COVID-19 was first detected in Australia, every aged care provider should know what they need to do to reduce the risk of, prepare for, and minimise the impact of a COVID-19 outbreak. Providers are expected to have in place the necessary systems and processes to fulfil their obligations and safeguard residents’ health and wellbeing as far as possible.”

Indeed!

The statement goes on: “Residential aged care homes with low COVID-19 vaccination rates raise questions for the Commission about whether those in charge of those homes are focusing enough on protecting older people in their care from serious disease.”

Really? I think the answer is pretty clear.

Commissioner Janet Anderson PSM said that the Commission would be carrying out unannounced site visits to homes with low COVID-19 vaccination rates, and that “where we find that a provider lacks interest and/or capability to take the necessary action, and their ongoing inattention to this vital preventative measure is placing residents in harm’s way, there will be regulatory consequences”.

According to the Department’s data, at the time of the joint letter to providers, 43.2 percent of aged care residents had received a COVID-19 booster vaccination in the past six months. By 13 June, three weeks after the letter, that percentage had declined to 40.3 percent.

The time for thinking about regulatory consequences has long since passed – it is time to implement them.

The Independent Health and Aged Care Pricing Authority (IHACPA) released its work program and corporate plan for 2024–25.

As well as its business-as-usual activities, the Authority will be developing a pricing framework and pricing advice for the new Support at Home aged care program from 1 July 2025. It will also be working with the Department of Social Services and the National Disability Insurance Agency “to undertake initial work to reform the National Disability Insurance Scheme pricing arrangements, including reviewing existing pricing approaches and developing a pricing data strategy”.

The Chiropractic Board issued a brief statement announcing that, following a request from Health Ministers, it had reinstated the previous interim ban on spinal manipulation on children under two years of age.

The policy will apply “until further consultation with Health Ministers can allow for developing a final position”.

The Chair of the Board, Wayne Minter AM, was more forthcoming in an interview with the ABC, saying the Board “look[ed] forward to working with Ministers to develop an evidence-based final policy on paediatric care that balances the paramount need to protect patients, with the right for parents and other patients to have a say in the care they choose”.

The issue is whether parents have the right to choose treatment for their infant children for relatively minor conditions if the evidence suggests there is a risk of harm, but very little chance of benefit?

The NHMRC issued a statement saying it was carrying out an independent review of that part of the Australian Drinking Water Guidelines relating to per- and polyfluoroalkyl substances or PFAS. This will include an examination of international guidance and reviews, including the recommendations from the US Environmental Protection Agency.

The review is “anticipated to be completed by late 2025” and will include public consultation in late 2024 to early 2025.

The Australian Taxation Office released taxation statistics for 2021-22, showing that various groups of doctors made up five of the top ten occupations by taxable income.

Surgeons were in first place (average taxable income of $460,000 across 4,170 people), followed by anaesthetists (average taxable income of $431,000 across 3,535 people).

Other medical groups in the top ten included internal medicine specialists (fourth), psychiatrists (fifth), and “other medical practitioners” (sixth). To be clear, “other medical practitioners” does not include GPs or OMPs.

Consumer and public health groups

COTA marked World Elder Abuse Awareness Day by calling on national, state and territory governments to “take stronger action to stop the scourge of elder abuse, including urgently reforming Power of Attorney laws”.

CEO Pat Sparrow said “we’ve all heard stories of unscrupulous relatives or acquaintances using our inconsistent and weak Power of Attorney laws to get away with abusing vulnerable older Australians”.

“Everyone recognises the problem, but consecutive governments at all levels have dragged their heels on action for years.”

Trade unions

The Australian Dental Association republished an article from the FDI World Dental Federation on its work at the recent World Health Assembly, including advocacy for oral health to be included in universal health cover, and for governments “to tax sugar-sweetened beverages and other unhealthy foods and beverages, implement front-of-package nutrition labelling, and regulate the marketing of unhealthy foods, especially those targeting children and adolescents”.

The Australian Medical Association (AMA) kept up the pressure on the Senate to pass the Government’s anti-vaping legislation with a statement highlighting the environmental consequences of vaping.

President Professor Steve Robson said vapes were “an ‘environmental triple-threat’ with plastic waste in the device body and pod, electronic waste in the form of lithium-ion batteries and a heating element, and hazardous waste due to the heavy metals in the vape and nicotine in the e-juice”.

All true, but will it have any impact on senators from the Liberal and National parties which are now committed to the catastrophic environmental vandalism associated with constructing and operating seven nuclear reactors, rather than committing to renewable energy?

In response to the Government’s consultation on a new National Strategic Framework for Chronic Conditions, the Royal Australian College of General Practitioners (RACGP) called for “higher patient Medicare rebates for longer consultations to better support Australians with chronic disease”.

Industry groups

The Australian Healthcare & Hospitals Association’s Deeble Institute for Health Policy Research released an issues brief on Integrating oral health into primary healthcare for improved access to oral health care for rural and remote populations.

AHHA CEO Kylie Woolcock said: “Primary care providers are often the first point of contact for health services in rural and remote communities, and are well positioned to provide basic oral healthcare [such as] screening for risk factors, oral health education, provision of non-invasive preventative interventions, and referral.

“However, limited oral health knowledge and skills and boundaries to professional scopes of practice curb the possibility of leveraging existing primary healthcare resources for oral healthcare provision.”

Medicines Australia issued a media release on the reporting of medicine shortages (perhaps prompted by the current shortage of azithromycin). For the last five years medicine suppliers have been required to notify the TGA if “the supply of a medicine is not likely to meet the normal or projected consumer demand within Australia at any point during the next six months”, and the TGA then publishes that information.

Medicines Australia CEO Liz de Somer encouraged “caution in the interpretation and reporting of supply information that may inadvertently prompt panic buying or stockpiling and further intensify supply pressures…

“Transparency is a very important principle for the industry, prescribers and others in the supply chain. However, it is equally important this information does not cause unnecessary concerns about medicines availability for patients”.

The Government is conducting a behind-closed-doors review of the viability of the private hospital sector, which has prompted public reactions from the two private health insurer lobby groups.

CEO of Private Healthcare Australia, Dr Rachel David, was interviewed on ABC radio, and the CEO of Members Health Fund Alliance, Matthew Koce, wrote an op-ed for the AFR. Their message was fairly consistent: private hospitals need to have far greater levels of financial transparency before anybody should take their claims of financial hardship seriously.

Until 2016-17, the Australian Bureau of Statistics produced an annual publication on private hospitals, including financial data, paid for by the Department of Health. However, the series was discontinued in 2017-18, presumably because the Department no longer saw the expenditure as a priority.

As a result, the Department of Health and Aged Care now has had to resort to asking private hospital operators to submit financial data on a voluntary basis.

Call me cynical, but I am pretty sure that if you were running a profitable private hospital, you wouldn’t be rushing to submit data.

Politicians and parliamentary committees

Shadow Health Minister Anne Ruston criticised the Government for the shortfall of registered nurses in aged care in regional and rural areas in the run-up to increased care time requirements to apply from 1 October.

While acknowledging the recent decision to allow 10 percent of registered nurses care minutes to be provided by enrolled nurses, she said that “more needs to be done to give providers flexibility and support”.

International organisations

The World Health Organization issued a warning about fake semaglutide medicines such as Ozempic. It was not exactly timely, as it referred to three batches discovered in Brazil, the UK, and the US late last year.

However, WHO said that its Global Surveillance and Monitoring System had been “observing increased reports on falsified semaglutide products in all geographical regions since 2022”.

WHO suggested that “to protect themselves from falsified medicines and their harmful effects, patients who are using these products can take actions such as buying medicines with prescriptions from licensed physicians and avoid buying medicines from unfamiliar or unverified sources, such as those that may be found online”.

Finally

In last week’s column I questioned the Pharmacy Guild’s commitment to competition between pharmacies, given it had spent years working to secure the abolition of the ability of pharmacies to compete by discounting the patient contribution for PBS scripts.

This week Peter Martin, economics editor at The Conversation, published an article delving into the regulatory environment surrounding the pharmacy sector. It is well worth a read for anybody interested in the issue.

He observes that: “The peculiar rules governing pharmacies ought to make them particularly profitable, except that they don’t, because pharmacies cost so much to buy.

“The benefit is baked into the price [in a form of] the “taxi licence” phenomenon. The owners who sell get rich as a result of the rules, not the owners who buy. Which gives new owners an even greater incentive to keep startups out.”


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.

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

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
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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