With the Federal Budget hogging headlines, The Zap this week puts a focus on news you might have missed, including a call from the Department of Health and Ageing for nominations from people interested in serving on a new First Nations Health Governance Group (applications are due by midnight on Friday, 7 June).
Columnist Charles Maskell-Knight also reports new data on the use of emergency departments for lower urgency care, a new consultation about “good institutional practice to promote open, honest, supportive and respectful institutional cultures conducive to the conduct of high-quality research”, and the Federal Opposition’s plans for healthcare.
The quotable?
…with the large number of reviews undertaken in the past 12 months or about to be completed, we had anticipated a clearer indication from the Government that they would be getting things in order for some big ticket future reforms – but there is little, if any, evidence of this in tonight’s Budget.”
Charles Maskell-Knight writes:
For those readers whose only source of news is The Zap, I should begin by saying that the Commonwealth Budget was delivered on Tuesday.
It was preceded by strategic pre-announcements, accompanied with the usual hyperbolic spin, and followed by an outpouring of reaction from every lobby group I’d ever heard of – and some I hadn’t.
Croakey covered the immediate response to the Budget extensively (overview, key health issues, First Nations issues, social determinants of health, climate and health, income support, trends in spending, mental health, and the post-Budget Ministerial webinar. Bookmark this link for ongoing coverage).
Rather than repeat news about the Budget from these articles, this edition of The Zap focuses on reactions from groups that Croakey has not yet covered, as well as non-Budget news.
One of the most interesting pieces of non-Budget news was the lack of any announcement in the Budget about increasing personal contributions for aged care.
The Aged & Community Care Providers Association (ACCPA, the peak aged care provider lobby group) said it was “disappointed the Aged Care Taskforce was not mentioned in the budget [as] funding to ensure a stable and viable sector is the number one challenge facing aged care in Australia”.
Catholic Health Australia warned that the “Government’s decision to delay its essential aged care reforms in this budget threatens access to quality and dignified care for older Australians today and for the future”, and said that “the decision to neglect the Aged Care Taskforce recommendations in this budget is incredibly disappointing and frustrating”.
DCM Group CEO Chris Baynes wrote that “it is now apparent that politics do matter. Mentioning any new initiative that would increase costs for any members of the public approximately 12 months out from the next election appears to have been rejected”.
Turning away from the Budget completely, 12 May was the anniversary of Florence Nightingale’s birth in 1820, and International Nurses Day. The Australian College of Nursing marked the day with an optimistic statement, saying that the “Government’s current suite of reforms and reviews provide an unprecedented opportunity for the nation to benefit from the unlimited potential of our highly skilled and dedicated nursing workforce”.
The Australian Nursing and Midwifery Federation (ANMF) also acknowledged the day, “calling for greater recognition, investment and support of the nursing workforce so nurses are better utilised to work to their full scope of practice and deliver improved healthcare and economic outcomes for all Australians”.
The Australian Primary Health Care Nurses Association (APNA) called on the Government (and Opposition) to “acknowledge the critical work of primary health care (PHC) nurses and the economic contributions they provide to our communities”.
It asked the Government (and Opposition) to “correct the historical gender undervaluation of the nursing profession which holds back our largest health workforce from earning and working to their full potential”.
Meanwhile, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) has released this video profiling the work of its members.
In an accompanying statement timed for International Nurses Day and International Day of the Midwife, CATSINaM CEO Dr Ali Drummond and CATSINaM Elder, RN and RM Aunty Dulcie Flower highlight the importance of cultural safety and eliminating racism in workplaces.
Ministers and government
Announcements and media appearances by the Health Ministerial team were generally associated with the Budget.
The exception to the Budget focus was a statement by Aged Care Minister Anika Wells, announcing the winners of a design competition for innovative residential aged care accommodation meeting the requirements of the draft National Aged Care Design Principles and Guidelines.
The Department of Health and Ageing called for nominations from people interested in serving on a new First Nations Health Governance Group.
The Department said: “The group has been co-designed with First Nations health sector leaders [and] will be in place until 2031 to align with the lifespan of the Health Plan… [It] will share decision-making on implementing the Health Plan and areas for reform to improve health outcomes”.
It will also advise the Department and Ministers on health priorities, decisions and progress. Perhaps it could begin by addressing the reduction in spending on First Nations Health programs over the next four years included in the Budget?
In other government news, the Australian Institute of Health and Welfare (AIHW) released a report based on census data on how social determinants of health influence associations between cultural and linguistic diversity and reported long-term health conditions. It found that “many of the differences [between CALD groups] observed in the odds of reporting long-term health conditions are associated with age and the social determinants of health”.
The Institute also released a series of reports and updates on hospital activity including Hospitals at a glance, Admitted patient care, Non-admitted patient care, Bloodstream infections, and Use of emergency departments for lower urgency care.
Utilisation data for 2022-23 showed 12.1 million admissions, an increase of six percent on the previous year, and 41.1 million “non-admitted patient care service events”, up over five percent on pre-pandemic levels.
From a policy perspective, the most interesting report is that on the use of emergency departments for lower urgency care, which includes data from the ABS Patient Experience Survey on why people visit emergency departments.
In 2022-23 almost half of people aged over 15 who attended an emergency department did so because they were taken there by ambulance or their condition was serious; almost 22 percent because a GP was not available; 16 percent because the patient thought the GP would not have the required equipment or facilities; and almost nine percent because a GP had referred them. Less than one percent said the cost of GP services was an issue.
The National Health and Medical Research Council (NHMRC) announced it was opening consultation on a document “to provide guidance to NHMRC-funded institutions and NHMRC-funded researchers about good institutional practice to promote open, honest, supportive and respectful institutional cultures conducive to the conduct of high-quality research”. The consultation closes on 10 July.
Consumer and public health groups
The Consumers Health Forum described the Budget as “a placeholder in what could have been a landmark year for health reforms”.
CHF welcomed the freeze on indexation of PBS co-payments, and acknowledged the increase in the number of urgent care clinics, while “mindful that they are not the entire solution to consumers having better access to primary care”. It was disappointed there was no support for increased health literacy, and that nothing was done to improve access to and affordability of dental services.
COTA generally supported the Budget, but criticised the limited additional number of home care places announced, saying “older people are often waiting over a year for support they’re assessed as needing and end up in hospital, or residential aged care before they need to be there, or in the worst cases they die waiting for support that never comes”.
In relation to the announcement that the new Aged Care Act would now not commence until 1 July 2025 (two years after the Aged Care Royal Commission recommended and Aged Care Minister Wells promised) COTA said “we need the Government to introduce the Act into Parliament as a priority to allow proper scrutiny and community conversation, and we need the support of the whole Parliament to ensure it is passed by the end of this calendar year, so the sector is ready to implement it from 1 July 2025”.
OPAN (Older Persons Advocacy Network) also expressed disappointment in the delay in the new Aged Care Act.
The Grattan Institute response to the Budget (republished by Croakey) identified a number of holes, including limited spending on prevention; the lack of any sign of funding for a strong Centre for Disease Control; and the absence of any measures to improve access to dental and medical specialist care. While the Commonwealth and the states have agreed in principle on a deal to increase Commonwealth public hospital funding, additional funding is not included in the Budget.
Grattan also picked up on the decision to eliminate the ability for pharmacies to discount PBS co-payments by up to a dollar, saying that this will “further dampen price competition, which is already limited in the highly regulated community pharmacy sector”.
Trade unions
ACCRM (the Australian College of Rural and Remote Medicine) welcomed the report of the Medical Schools Outcomes Database showing Rural Generalism was now the sixth most popular career choice for Australian final-year medical students.
According to the ABC, the Australian College of Nursing terminated the appointment of Professor Kylie Ward as CEO and Ms Karoline Dawe as National Director of Partnerships following an investigation into financial irregularities.
The Australian Dental Association issued a statement saying that the Budget was “a double whammy of disappointment for the dental profession” – but as the statement is only available to ADA members, the rest of us can only muse about what exactly dentists were expecting, and why they are disappointed.
The ANMF and the Australian College of Midwives welcomed the passage through Parliament of legislation allowing nurse practitioners and endorsed midwives to bill Medicare and prescribe under the PBS by removing the requirement for them to work in a “collaborative arrangement” with a medical practitioner.
The Pharmaceutical Society of Australia commended the NSW Government on extending eligibility to suitably trained pharmacists across the State to provide treatment for simple urinary tract infections.
The Royal Australian College of General Practitioners (RACGP) issued a statement foreshadowing World Family Doctor Day on 19 May. College president Dr Nicole Higgins said “many people don’t realise GPs are specialists. We do the same eight years medical training as any other medical specialist, plus at least three years training in a practice to specialise as a GP”. ACCRM also acknowledged the day.
The Rural Doctors Association of Australia (RDAA) described the Budget as a “Breadcrumbs Budget” and “a missed opportunity for long-term, big picture measures that would deliver a sustainable medical workforce to the bush and a viable rural health system into the future”.
RDAA President Dr RT Lewandowski said “with the large number of reviews undertaken in the past 12 months or about to be completed, we had anticipated a clearer indication from the Government that they would be getting things in order for some big ticket future reforms – but there is little, if any, evidence of this in tonight’s Budget”.
“There are a myriad of small funding packages here and there that will be welcomed by rural doctors and rural patients, but there is nothing in this Budget that will underpin a holistic, full-scale approach to improving access to healthcare in the bush, or to growing the rural health workforce”.
Industry groups
The Australian Private Hospitals Association welcomed a Budget decision to trial telehealth for psychiatric inpatient consultations. CEO Michael Roff said that “we are pleased the Health Minister has recognised the need to address the significant barriers to accessing care in the private psychiatric hospital sector, with up to 17,000 people unable to be admitted, not because of lack of beds, but lack of an admission pathway”.
Catholic Health Australia responded to the Leader of the Opposition’s budget reply, pointing out that: “only two years ago, the Coalition Government noted its desire to see more migration to fill aged care workforce shortages, not less. Although we remain open to alternative pathways to attract and retain the number of skilled professionals needed for our sector, blanket cuts to immigration of 25 per cent to address housing shortages in the short term risks creating one problem in an attempt to solve another”.
The Pharmacy Guild welcomed the Budget measure to freeze PBS co-payments, as well as a miscellany of other measures including increased funding for the provision of dose administration aids (aka Webster-paks). It also took credit for removing the scope for pharmacies to discount patient co-payments by up to a dollar.
Private Healthcare Australia (the private health insurers’ lobby group) posted to LinkedIn on Budget day repeating its call for a “‘surprise billing law’ to protect consumers from unexpected bills in the private health system”, including civil and criminal penalties for breaches.
Despite Budget distractions, a number of doctors responded to the post. Perhaps the most pointed was this one: “can we allow for civil and criminal penalties for insurance executives in Australia who try to bring over the worst aspect of the American health system?”.
Politicians and parliamentary committees
In his Budget reply Leader of the Opposition Peter Dutton reiterated the Liberal Party’s commitment to restoring the number of MBS-subsidised psychology sessions to 20.
He also committed a future Coalition Government to “invest[ing] $400 million to provide junior doctors who train in general practice with incentive payments, assistance with leave entitlements, and support for pre-vocational training”. The Australian Medical Association (AMA) welcomed this commitment.
The Senate inquiry into “equitable access to diagnosis and treatment for individuals with rare and less common cancers, including neuroendocrine cancer” was due to report on 16 May. However, its report was not tabled, and there is no record in the Senate Hansard of an extension to the reporting date.
The Government has still not responded to the Senate inquiry into dental services, and did not make any Budget announcement about dental policy. Budget Paper No. 3 shows that Commonwealth funding to support state public dental services expires in 2024-25, and there is no provision for funding for future years.
International organisations
The OECD released a report based on the Programme for International Student Assessment (PISA) survey showing that “the interest of 15-year-old students in pursuing careers as nurses has decreased in at least half of OECD countries between 2018 and 2022”.
In good news for Australia, the proportion is relatively high (almost four percent compared with an OECD average of a little over two percent), and did not change over the four-year period.
Finally
When I worked in the section in the Department of Finance that coordinated the preparation of the outlays side of the Budget in the second half of the 1980s, Budget secrecy was taken very seriously.
Measures were hardly ever announced before 7.30pm on Budget night, and key parameters such as estimates of inflation or economic growth and the deficit (or surplus) were held very tightly because they were “market-sensitive”.
Fast-forward 35 years and the world has changed.
The media on Budget eve and Budget day was full of discussion about Treasury’s estimates of price and economic growth, the 2023-24 surplus, and the 2024-25 deficit to be announced by the Treasurer later that evening.
Minister Butler tweeted on Tuesday that:
Which begs the question, is there any point to all the razzamatazz of Budget night if everything significant is announced beforehand?
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.
Aged Care Quality and Safety Commission
Aged Care Quality Standards draft guidance documents
19 May (yes, I know it’s a Sunday, so presumably responses received on Monday 20 May will be considered).
TGA
Amendments to the Poisons Schedule
22 May
Scope of Practice review
Issues paper 2
26 May (another Sunday!)
TGA
Instructions for Use for Medical Devices
28 May
NHMRC and CHF
Review of the 2016 Statement on Consumer and Community Involvement in Health and Medical Research
31 May
Prostate Cancer Foundation of Australia
Review of the Clinical Practice Guidelines for PSA Testing
31 May
Office of the National Rural Health Commissioner
Awareness of the National Rural and Remote Nursing Generalist Framework 2023-2027
31 May
Department of Social Services
Developing the National Autism Strategy
31 May
Chinese Medicine Board of Australia
Patient health records guidelines
5 June
Independent Hospital and Aged Care Pricing Authority
Pricing Framework for Australian Hospital Services 2025–26
7 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
Department of Health and Aged Care
Overseas student health cover
24 June
NHMRC
Good institutional practice guide
10 July
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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