As the Starmer Government signals its commitment to health reform in the United Kingdom, the latest edition of The Zap highlights many opportunities for health and aged care reformers in Australia.
These include reforms to address inequitable access to ambulance services, diabetes inequities, regulation of infant formula marketing, and to improve vaccination rates across general practice, where there is currently significant variation in performance.
Columnist Charles Maskell-Knight also brings the latest data on aged care safety and quality, highlighting the unreliability of the Aged Care Star Ratings system.
Meanwhile, It’s perhaps not surprising that the Federal Government is so low key about its response to the Senate inquiry into dental services.
The quotable?
It’s been three years since the Royal Commission into Aged Care highlighted the importance of ensuring our most vulnerable older people, including those in aged care, get access to the oral and dental care they need, yet the Government seems to still be stuck in ‘noting’ mode when it comes to those key recommendations.”
Charles Maskell-Knight writes:
Diabetes has been in the news in recent weeks: Diabetes Australia released its State of the Nation report in late June, and then in early July the House of Representatives committee inquiry into diabetes released its report.
The latest diabetes event is National Diabetes Week, which ran from 14 to 21 July. This year Diabetes Australia is highlighting inequities in access to diabetes technology, such as continuous glucose monitoring devices and insulin pumps, with the slogan “unite in the fight for tech”.
The organisation also announced funding for a Diabetes Technology Research Accelerator Grant program, “designed to fast-track the development of new diabetes technologies by connecting medical technology, biotechnology, and pharmaceutical industries with academics and clinicians”.
The Royal Australian College of General Practitioners (RACGP) joined Diabetes Australia in calling for “the Government to improve screening for diabetes and support the health of patients with or at risk of developing diabetes”. College President Dr Nicole Higgins said there was a need for “higher Medicare rebates for longer consultations and MBS rebates for patients to regularly see a GP for preventive care”.
The Rural Doctors Association of Australia backed the call for better access to technology, saying that “insulin pumps, continuous glucose monitors (CGMs) and flash glucose monitors (FGMs) [should] be subsidised for more diabetic patients – including those in rural and remote Australia…to help save lives, improve health outcomes, and deliver big savings to the health system”.
Ministers and government
Health Minister Mark Butler and Assistant Minister Emma McBride issued a series of media releases announcing Urgent Care Clinics and Mental Health Centres at various points along the east coast from Dapto to Cairns.
Assistant Minister Malarndirri McCarthy announced funding for three new renal dialysis clinics. These are to be provided by: Wakaid Tribal Council in partnership with Flinders University for Badu Island; Pilbara Aboriginal Health Alliance for Tom Price; and Ngangganawili Aboriginal Health Services for Wiluna.
In an interview with ABC News Radio, McCarthy spoke about the need for renal dialysis services in these remote areas to allow people to remain living on Country.
On 18 July the Department of Health and Aged Care quietly released the Government response to the Senate inquiry into dental services. (I say quietly, because it did not rate a mention on the Department’s news page.)
The response came almost four months after the three-month deadline for responding to Senate reports. It was not worth the wait.
Of the 35 recommendations made by the Senate committee, the Government supported three, supported in principle another eight, and noted 24.
I will provide a detailed analysis of the response for Croakey later this week.
The Australian Dental Association (ADA) lost no time in responding that “the nation’s dentists have slated as a wasted opportunity the Government’s failure to properly consider funding dental services for Australia’s most vulnerable populations”.
ADA President Dr Scott Davis said that the Association’s recommendations adopted by the Senate inquiry were “a defined and clear roadmap out of this disaster, and not taking it up is a wasted opportunity and short-termist by the Albanese administration”.
“If the Government chooses to ignore the recommendations of the Parliamentary Senate Inquiry, what’s the point of the Inquiry? Has it all been a whitewash and a show pony?”
Patricia Sparrow, CEO of COTA, said that the Federal Government’s response to the Senate Committee report and this crucial health issue is “mediocre at best”.
“It’s been three years since the Royal Commission into Aged Care highlighted the importance of ensuring our most vulnerable older people, including those in aged care, get access to the oral and dental care they need, yet the Government seems to still be stuck in ‘noting’ mode when it comes to those key recommendations,” Sparrow said.
The Australian Institute of Health and Welfare (AIHW) released aged care quality indicator data for the March 2024 quarter.
According to the Institute, the results show that “over time there has been a statistically significant decrease in the proportion of residents experiencing polypharmacy, antipsychotic medication use, falls that resulted in major injury, one or more pressure injuries, use of physical restraint, physical restraint exclusively through the use of a secure area, significant unplanned weight loss and consecutive unplanned weight loss”.
All very well, but there are still very high proportions for many of these indicators. For example, over a third of residents are subject to polypharmacy, nearly 18 percent receive antipsychotics, and about ten percent undergo unplanned weight loss.
The Institute also released a report on mental health in aged care. It found that the age-standardised suicide rate for home care package recipients was over 50 percent higher than the rate for aged care residents and the older population generally.
(If this topic has raised issues for you, please contact Lifeline on 131114.)
The data also showed that four percent of people entering residential care in 2021-22 had a psychotic condition – which begs the question why 18 percent of residents are receiving antipsychotics.
The AIHW released data on sports injuries (as well as a national sports injury data strategy).
Bearing in mind that “sports” includes individual recreation and exercise as well as organised sport, the high points identified by the Institute were that:
- people aged 15-19 had the highest rate of sports injury leading to hospitalisation (556 per 100,000 population)
- half of all hospitalisations were for fractures, most commonly of the arm or shoulder
- cycling was responsible for the greatest number of hospitalisations (8,600 out of a total of 56,000)
- about two-thirds of hospitalisations were emergencies.
The AIHW also released a set of reports and data cubes relating to hospitals, including:
- Australia’s hospitals at a glance
- Admitted patients
- Principal diagnosis, AR-DRG, and procedure data cubes.
These last three items should keep data nerds happy for weeks.
Finally, the AIHW also released reports on family, domestic and sexual violence, together with specialist homelessness services, and the child protection system.
The Aged Care Quality and Safety Commission (ACQSC) released its Sector Performance Report for the March quarter, including outcomes from residential care site audits and home services quality reviews.
In relation to residential care, the report states that Q3 audit decisions continue the trend of residential care’s relatively high compliance with the Quality Standards seen in the past four quarters. “In Q3, 84 percent of the of audits we did in fully complied with all 42 requirements of the Quality Standards. Nearly one in seven residential care services are below minimum standard in at least one area of the care they provide.”
If the regulator consistently finds that one in seven homes are not meeting the minimum standards, how is it possible that the Aged Care Star Ratings system reports that only one in 50 homes are providing one- or two-star care and need to improve?
(That was a purely rhetorical question: the answer is that the star ratings system is clearly deficient.)
Another finding from the Sector Performance Report was that only 64 percent of home care services met all the requirements of the quality standards (down from 71 percent in the June quarter 2023).
During the quarter the Commission received over 14,000 notifications of incidents in residential care under the Serious Incident Response Scheme, over half relating to unreasonable use of force, and almost a quarter to neglect. The report noted that “notifications of neglect have been increasing over time and increased again this quarter by approximately five percent”.
Yet, according to the Aged Care Star Ratings system, only two percent of homes are not providing appropriate care.
Consumer and public health groups
The Australian Alcohol and other Drugs Council joined with a number of other organisations in a statement warning about the impact on people in prison of the emergence of nitazenes in the illicit drug supply.
The statement called on state and territory governments to:
- provide training to custodial officers to recognise overdose and administer naloxone
- ensure naloxone is accessible to custodial officers to promptly and effectively respond to overdose
- ensure that naloxone and naloxone training is routinely offered to all people exiting prison.
The Consumers Health Forum (CHF) issued a media release calling on National Cabinet to “to bring harmonisation, reform and fairness to the way Australians are charged for using an ambulance”.
As this ABC report shows, the current situation is a complex mess, with many interstate travellers potentially liable for unexpected charges for ambulance use.
As CHF CEO Dr Elizabeth Deveny said: “It’s really hard to see how the current system on the whole provides a fair and balanced approach to ambulance cover for all Australians”.
Past efforts at reform have always failed as soon as one or more state governments realised that they may need to increase spending.
The Grattan Institute released a report on vaccination rates in general practice, finding large differences by practice in vaccination rates for older patients: from 40 percent to 90 percent for influenza, and 22 percent to 85 percent for shingles.
Even within areas there are large disparities – in Bankstown there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination.
The report found that “GPs with lower vaccination rates typically have more patients who are disadvantaged and struggle with English, but they get less funding because they charge their patients lower fees”.
It recommended:
- an overhaul of general practice funding, to provide more money to GPs in poorer areas with more disadvantaged patients
- Primary Health Networks (PHNs) providing data to allow GPs to monitor their vaccination rates against peer practices
- PHNs providing GPs with low vaccination rates with extra staff, extra training, and assistance in running vaccination drives or helping patient bookings.
Now to see if the new National Immunisation Strategy will adopt any of these ideas.
Trade unions
The Australian Medical Association (AMA) released its submission to the Australian Competition and Consumer Commission (ACCC) consultation on re-authorising the Marketing in Australia of Infant Formula (MAIF) Agreement.
It recommended that:
- the MAIF Agreement is not fit for purpose and should NOT be re-authorised for any period of time
- Australia must expedite the drafting, implementation, monitoring and enforcement of effective and sustainable legislation that implements the full provisions of the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions (The World Health Organization Code)
- the ACCC should be empowered to monitor and enforce the existing Australian Food Standards Code legislation to protect consumers from aggressive and inappropriate marketing of breastmilk substitutes while suitable legislation is being prepared and enacted.
The AMA also released its submission to the national parliament’s Joint Select Committee on Social Media and Australian Society.
It argued that Australia should adopt rules similar to the European Union’s General Data Protection Regulation, which “clearly stipulates that individuals are the owners of their data and they must provide specific, informed and unambiguous consent for their data to be used”.
The AMA also questioned the move to (try and) enforce age limits on social media, saying that “age verification is also rife with privacy and digital security risks, and the AMA has many questions about how such a system would be enforced effectively”.
International
The WHO and UNICEF released the latest estimates of global immunisation coverage, and said they showed “the need for ongoing catch-up, recovery and system-strengthening efforts”.
Measles vaccination rates have stalled, with only 83 percent of children receiving a first dose in 2023, far short of the 95 percent required to prevent outbreaks. Over the last five years there have been measles outbreaks in 103 countries where three-quarters of the world’s children live.
While childhood immunisation rates in Australia are high (between 92 percent and 96 percent, depending on cohort and residence), the number of measles cases is increasing (of the 53 reported for the 12 months ending 23 June, 40 occurred in the most recent six months).
In the UK, the new Labour Government set out its priorities for health in the King’s Speech:
“My Government will improve the National Health Service as a service for all, providing care on the basis of need regardless of the ability to pay. It will seek to reduce the waiting times, focus on prevention and improve mental health provision for young people.
“It will ensure mental health is given the same attention and focus as physical health. My ministers will legislate to modernise the Mental Health Act so it is fit for the twenty first century.
“A Bill will be introduced to progressively increase the age at which people can buy cigarettes and impose limits on the sale and marketing of vapes. My Ministers will also legislate to restrict advertising of junk food to children along with the sale of high caffeine energy drinks to children.
“A draft Bill will be brought forward to ban conversion practices.”
Finally
I have written before about the inconsistent approach of the Department of Health to consultation.
Major policy issues such as a new national immunisation strategy or regulation of psychotherapy have had a consultation period of two or three weeks, while amendments to relatively arcane elements of private health insurance regulation have had six weeks.
This week the Department added to its public consultation page a survey of Multi-Purpose Services who are undertaking some sort of trial of aged care staffing time.
Now the Department knows the name, email address, and phone number of each of the 180 or so Multi-Purpose Services, because it funds them. If it wants to know what they think about an issue, it could send them an email or ring them up. There is no need to ask through the public consultation page – especially as only MPSs are able to respond.
I also discovered this week – via the AMA website – that the Department is conducting a survey of doctors as part of its Private Hospital Sector Financial Health Check. There are about 130,000 registered doctors in Australia, and while many of them won’t have anything to do with private hospitals, some tens of thousands will.
Yet this survey does not appear on the Department’s public consultation page. It is not mentioned in the information about the Private Hospital Sector Financial Health Check and, as far as I can tell, it is not mentioned anywhere else on the Department’s website.
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.
NHMRC
Evidence to support dietary guidelines for older Australians
24 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
Feedback on the Addressing Critical Psychology Shortages – Postgraduate Psychology Incentive Program grants
31 July
Department of Health and Aged Care
Health professionals included in private health insurance Chronic Disease Management Programs
2 August
Inspector-General of Aged Care
2024-25 work plan
2 August
Department of Health and Aged Care
Reclassification of Sports and Exercise Medicine Physicians as consultant physicians
5 August
Therapeutic Goods Administration
Legislating regulatory categories for some boundary and combination products
6 August
National Indigenous Australians Agency
National strategy for food security in remote First Nations communities
11 August
Therapeutic Goods Administration
Proposed exposure model for assessing the safety of sunscreen ingredients in Australia
13 August
Therapeutic Goods Administration
Reforming Australia’s Therapeutic Goods Testing Regulations
18 August
Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August
Department of Health and Aged Care
Multi-Purpose Service trial sites direct care targets
30 August
Department of Health and Aged Care
How to implement the MSAC advice about the cost of technical support services for cardiac implantable electronic devices
6 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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