*** Aboriginal and Torres Strait Islander readers are cautioned that this article mentions someone who has passed ***
Recent traumatic events are covered by the Zap this week, with a focus on mental health and calls for the Federal Government to implement the 1997 report, ‘Bringing them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families’.
Columnist Charles Maskell-Knight also covers the latest on the Scope of Practice Review, vaping, aged care, public hospitals, cancer care and environmental sustainability within healthcare.
Don’t miss the column’s new feature: a list of consultations that we hope will be helpful for Croakey readers. Please keep us updated of any new ones to add.
The quotable?
[Shadow Health Minister Anne Ruston’s] solution is ‘a national and comprehensive workforce strategy for the entire care sector’.
Perhaps if the Abbott Government hadn’t abolished the agency dedicated to strategic workforce planning, we wouldn’t need a completely new strategy?”
Charles Maskell-Knight writes:
The after effects of the shocking mass murder and assault at Westfield Bondi Junction in Sydney on 13 April will be felt for years to come.
On the Monday after the incident SANE, the national organisation representing Australians impacted by severe, long term or complex mental ill health, issued a statement recognising the devastating impact on all those involved.
The statement went on to make two important points.
First, “extensive public speculation placing the blame entirely on mental illness is not only inaccurate, it’s extremely harmful for those living with long term or complex mental health conditions”. While the evidence shows that people with schizophrenia are far more likely to be the victims than the perpetrators of violent crime, they are often “automatically (and incorrectly) blamed by the media”.
Second, “it is clear from statements made by police and his family that this person was in need of mental health support and it was not made available to him… There is an enormous need for increased investment and better coordination of mental health services at a state and federal level. Our current mental health system is filled with gaps and it appears this person has fallen through”.
An article in The Guardian by Dr Kamran Ahmed, a psychiatrist working in the Bondi area, concluded that “while police are still looking into the motives of this attack and the investigation continues, a renewed focus on adequate treatment for people with serious mental illness is imperative. This should be a wake-up call for decision makers to fund mental health services adequately”.
Croakey also republished an article from The Conversation by Professor James Ogloff on the lack of a link between mental illness and violent crime.
(If this subject has raised issues for you, call Lifeline on 131114 or BeyondBlue on 1300 224636.)
Ministers and government
Assistant Minister for Mental Health and Suicide Prevention Emma McBride gave an interview on ABC Central Victoria which inevitably turned from the local Headspace to mental health funding more generally.
McBride said: “As a former mental health worker myself who worked in adult acute inpatient units for most of my working life, I really want to acknowledge the dedication and the contribution of our healthcare workers and including frontline workers, but also to recognise that there was problems that existed before the COVID-19 pandemic.
“They’ve then been exacerbated through that. And as a Government and as a society, we are committed to doing more.”
At a meeting in Brisbane all state and territory health ministers joined Minister Butler in a strongly-worded statement backing the Government’s anti-vaping legislation.
They said: “Vapes were sold to governments and communities around the world as a therapeutic good: a product that could help hardened smokers kick the habit… It’s now clear vapes are being used to recruit a new generation to nicotine addiction, and it’s working…
“Before the Federal Parliament there is currently world leading legislation to ban the sale, supply, manufacture and commercial possession of non-therapeutic vapes…All Health Ministers have today urged the Australian Parliament to pass the Albanese Government legislation, to ensure consistency and coordinated action to protect the future generations of Australians”.
The Scope of Practice review led by Professor Mark Cormack released its second issues paper, setting out a range of options for enhancing the ability of primary care health professionals to work to the top of their scope of practice.
I have written about the paper and the acute adverse reaction from the Royal Australian College of General Practitioners (RACGP) to the options for Croakey here.
Since that article was posted, the Australian Primary Health Care Nurses Association has also reacted. It believes that the review is “shaping a clear vision for primary healthcare” and “welcomes the considered approach from Mark Cormack and his team”. I expect many other non-medical groups are also likely to support the options put forward by the review.
The review is seeking submissions on the options paper by 26 May.
The TGA issued a media release “to confirm that regardless of whether cannabis oil or cannabis flower medicine comes from overseas or here in Australia, it must comply with the relevant quality standard”. Anybody involved in the supply chain of non-compliant products may face prosecution.
This follows TGA pursuing action in the Federal Court against Montu Group Pty Ltd, its subsidiary Alternaleaf Pty Ltd and their common director Christopher Strauch, for alleged unlawful advertising of medicinal cannabis on websites and social media.
Earlier in the week it was also reported that the TGA was investigating the sponsorship deal between Alternaleaf and the Dolphins NRL team to see if it involved illegal advertising of therapeutic goods.
Staying with cannabis a little longer, the Australian Institute of Health and Welfare (AIHW) updated its report Trends in cannabis availability, use, and treatment in Australia, 2013–14 to 2021–22 to include some 2022-23 data. The headline figure is that “between 2019 and 2022-23, daily cannabis use increased from 14 percent to 18 percent of people in Australia aged 14 and over”.
Yes, I was astounded too!
It transpires that those proportions are of people who have used cannabis in the last 12 months, not of the whole population. Given about 11 percent of the population have used the drug in the last year, the proportion of the population who are daily users is only about two percent.
The report also presents data on use of drug treatment services.
The AIHW also released a report on injuries in children and adolescents leading to attendance at an emergency department or admission to hospital in 2021-22. There were about 600,000 emergency department presentations and almost 90,000 admissions. Boys were about 50 percent more likely than girls to present at a hospital as the result of an injury.
I think the most concerning result was that “adolescents aged 13–18 are 3.4 times more likely than adults to be hospitalised for injuries caused by intentional self-harm. Over 4 in 5 of these hospitalisations were for girls”.
The Aged Care Quality and Safety Commission announced it was collaborating with the Department in delivering a voluntary Menu and Mealtime Review Program for nursing homes, which will include “independent feedback and recommendations from Accredited Practising Dietitians specific to each service”. Applications from homes interested in participating close on 10 May.
The Osteopathy Board of Australia announced that it was “celebrating 45 years of statutory regulation for osteopaths in Australia as part of World Osteopathic Healthcare Week [running from] 15-21 April”. According to the Board, Australia was the first country in the world to fully regulate osteopathic practitioners.
First Nations health
Following the suicide of a ten-year-old First Nations boy in state care in WA, independent Senator Lidia Thorpe called on the Government to show leadership and move to implement the many recommendations of the 1997 Bringing Them Home report that have yet to be actioned.
Thorpe said “the recommendations of the Bringing Them Home report clearly point to the need for federal leadership… that report is sitting on [Minister Linda] Burney’s shelf – she should read it and implement its recommendations urgently”.
Consumer and public health groups
Palliative Care Australia announced that it was partnering with the Australian College of Nurse Practitioners to deliver scholarships funded by the family of Heather May Herrick.
The scholarships will “support Nurse Practitioners and Advanced Practice Nurses in the delivery of palliative care, end-of-life pain management, aged care, oncology, and intensive care – with a focus on Aboriginal and Torres Strait Islander health, rural and remote communities”.
Trade unions
Allied Health Professions Australia (APHA) held a roundtable with aged care recipients and allied health professionals, attended by Aged Care Inspector-General Ian Yates AM.
AHPA reported that “while consumers spoke highly of their experiences with allied health professionals, it was sobering how often they are not receiving the tailored healthcare needed to maintain function and quality of life”.
AHPA also responded to last week’s announcement by Aged Care Minister Anika Wells about increases in aged care direct care time, claiming that the rise in total care time and nursing care time has occurred at the same time as a decline in allied health care time.
In an AHPA survey last year “half of respondents said their role had changed since introduction of the Australian National Aged Care Classification mechanism (AN-ACC). Of those respondents, almost one in five had lost their role and 48 percent had their hours decreased”.
AHPA concluded “simply focusing on nursing and personal care minutes is insufficient if we are to achieve accessible, high-quality, comprehensive health care to older people in residential aged care. Allied health service provision according to need must be funded, in the same way as nursing and personal care”.
Ahead of International Nurses Day (12 May, Florence Nightingale’s birthday), the Australian College of Nursing suggested five ways for nurses to celebrate the day.
The Australian College of Rural and Remote Medicine (ACCRM) called on the Government to “recognise the training and clinical consultancy roles of Rural Generalist and rural General Practitioner supervisors”, and create “new MBS item numbers and/or other mechanisms which acknowledge the clinical consultant services provided by RG and GP supervisors, with indexed loadings for rural and procedural practice supervision”.
The Australian Medical Association (AMA) released its Public Hospital Report Card, saying it showed the longest elective surgery waiting times on record, while emergency departments remain strangled by access block.
President Professor Steve Robson wrote to health ministers urging them “to agree to a $4.12 billion plan to address the planned surgery backlog, split between the commonwealth and the states and territories… to ease the immediate backlog while a new NHRA [National Health Reform Agreement] is negotiated”.
President of the Australian Physiotherapy Association Scott Willis wrote an article for Croakey outlining how the re-elected Tasmanian Government should make better use of the physiotherapy workforce in addressing the island’s persistent health care problems.
While the recommendations were designed for Tasmania, they apply just as well to the rest of the country: for example, investing in physiotherapy services in rural health settings, or integrating physiotherapy into Urgent Care Clinics.
Willis also said that the Scope of Practice review would be “key to driving the deeper structural reform required in primary care [and] an important step forward in a reform process that can bring us close to a value-based healthcare system”.
Ahead of the release of the Scope of Practice review’s second issues paper, the Pharmaceutical Society of Australian (PSA) released its position statement on pharmacist prescribing, arguing pharmacists should be allowed to prescribe a wider range of medicines.
National President Associate Professor Fei Sim FPS said “pharmacists can prescribe medicines within their scope of practice. The red tape and regulation that gets in the way of pharmacists helping patients needs to go… We need to remove the out-of-date regulatory barriers that get in the way of delivering timely, effective healthcare”.
He said that the various trials and pilots of pharmacist prescribing across Australia suggested that “pharmacist prescribing is driven by real demand on the ground, and serves to address a gap to improve overall health system capability and capacity”.
The RACGP issued a statement “urging the federal Government to help GPs and patients take full advantage of the Hospital in the Home program”. President Dr Nicole Higgins said that the Government should “issue clear and nationally consistent guidance to all state and territory health departments and hospitals [to] clear up confusion across jurisdictions regarding communicating with GPs once their patient has been admitted, GP referrals, and billing practice”.
The Royal Australian and New Zealand College of Radiologists (RANZCR) called on the Government to resume capital grants for brachytherapy equipment, which ceased as part of major reforms to radiation oncology health program grants in 2017.
The College said that its research had shown a decrease in brachytherapy courses since 2017 and it is now ‘critical’ that funding is restored in the Budget.
In 2017 the Targeting Cancer radiation oncology group warned that “Cancer patients requiring brachytherapy, a special type of radiation therapy, stand to lose access to this cancer treatment if proposed changes from a government funding scheme are implemented”.
Industry groups
The Australian Healthcare and Hospitals Association announced that it was working with the International Hospital Federation (IHF)’s Geneva Sustainability Centre to “drive environmental sustainability within Australian hospitals and healthcare delivery settings” by adopting the Sustainability Accelerator Tool developed by the IHF and Deloitte Switzerland.
The Sustainability Accelerator Tool provides “a digital solution for strategic planning and performance benchmarking”.
The Australian Private Hospitals Association announced that CEO Michael Roff had resigned effective 5 July, after 24 years in the role (and a further six years as public affairs manager). As they say in the classics, you get less time for murder.
Politicians and parliamentary committees
Shadow Health Minister Anne Ruston criticised the Government for failing to address the severe workforce crisis affecting aged care. She claimed there was a shortfall of almost 6,000 nurses across the sector before the 40 minutes a day nursing care time requirement was introduced last October.
Ruston also seized on the release of the AMA Public Hospital Report Card to attack the Government. She said that the AMA data “has further reaffirmed that Australians’ access to critical healthcare has never been worse than under the Albanese Labor Government”.
Her solution is “a national and comprehensive workforce strategy for the entire care sector”.
Perhaps if the Abbott Government hadn’t abolished the agency dedicated to strategic workforce planning, we wouldn’t need a completely new strategy?
The Senate community affairs committee inquiry into the Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Bill has now received 35 submissions, but still not set a date for a public hearing. It is scheduled to report by 8 May.
International
At the UK Tory party conference last October, Prime Minister Rishi Sunak promised to introduce legislation to ban the sale of tobacco products to anyone born after 2008. The Bill passed the House of Commons on Wednesday by 383 votes to 67, and now proceeds to the House of Lords, where it is also expected to pass.
As the Labour Party supported the Bill, the opposing votes were mainly dissident Conservatives, including former Prime Minister Liz Truss and leadership hopeful Kemi Badenoch. Another senior Conservative and leadership hopeful Penny Mordaunt abstained from the vote.
Minister Mark Butler was asked on Adelaide radio what he thought of the issue. He said he had consulted widely on tobacco control, and that “no one really recommended to me that we do this age-based changes so it wasn’t included in our laws last year… We’ll obviously follow it closely and look at how it goes”.
Finally
Regular Croakey readers will know I have been a strong critic of the Government’s implementation of the aged care star ratings system – see this Croakey article and this article in The Mandarin. I am not alone – others including Professor Kathy Eagar and Dr Rodney Jilek – have also been highly critical.
For a brief moment last week I thought the Government may have finally taken on board criticisms of the system, when I found a references to a survey of people’s opinions of the ratings in a LinkedIn post.
It turns out that the survey is on the “news” section of the MyAgedCare website – but it is not mentioned in the section dealing with star ratings, so people using the ratings are unlikely to find out about the survey.
It is not mentioned on the Department’s consultation hub, nor on the Department’s web pages dealing with the star ratings, nor on the Aged Care Quality and Safety Commission’s website.
Even Minister Anika Wells, who is always ready to tell the world how good the ratings are and how well nursing homes are doing, has not said a word about the survey.
It is almost as if the Government doesn’t want anybody to know about it…
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.
Australian Commission on Safety and Quality in Health Care (ACSQHC)
Draft requirements for medical pathology services
26 April
Senate community affairs committee
Excess mortality
26 April
Department of Health and Aged Care
National strategic framework for chronic conditions
29 April
Aged Care Quality and Safety Commission
Strengthened Aged Care Quality Standards guidance
30 April
TGA
Clinical decision support system software regulation
6 May
Australian Commission on Safety and Quality in Health Care (ACSQHC)
Aged Care Infection Prevention and Control Guide
15 May
Department of Health and Aged Care
Minimum stockholding requirements for PBS drugs
17 May
Scope of Practice review
Issues paper 2
26 May
TGA
Instructions for Use for Medical Devices
28 May
Department of Social Services
Developing the National Autism Strategy
31 May
Chinese Medicine Board of Australia
Patient health records guidelines
5 June
TGA
Proposed changes to the regulation of exempt medical devices and exempt other therapeutic goods
9 June
TGA
Companion diagnostics guidance update
17 June
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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