A failure of logic in aged care reform, a call for submissions for the 2025–26 Federal Budget, a proposal for advancing preventative health agendas, and the release of the 9th National HIV Strategy are among topics covered in this week’s column.
Columnist Charles Maskell-Knight also covers “the undignified legislative conveyor belt” of 28 November, food insecurity, the injustices of the ‘justice system’, and has a query about Public Health Thank You Day.
The quotable?
…as long as the Government does nothing to restrict fossil fuel extraction and export, worrying about the climate impact of the health sector, which accounts for seven percent of our total carbon emissions, feels a little like fiddling while Rome burns.”
Charles Maskell-Knight writes:
One of the most dangerous syllogisms of public life goes “something must be done; this is something; therefore this must be done”.
Aged Care Minister Anika Wells issued a statement on the passage through Parliament of the Aged Care Bill, saying “the Albanese Labor Government has now addressed the number one recommendation of the Royal Commission… through the passing of the Bill”.
The Minister’s logic seems to go: the Royal Commission said there should be a new Aged Care Act; this will be a new Aged Care Act; therefore, the recommendation has been met.
However, in many important respects the new Act falls far short of the new Act recommended by the Royal Commission.
For example, high quality care is not an object of the new Act, and it does not establish a right to timely access to care. Those rights that are included are unenforceable.
After the Government-appointed Inspector-General of Aged Care told the Senate inquiry that “the approach taken in the Bill to safeguard individuals’ rights [is] largely aspirational”, and it “retains the rationed approach that has always been a feature of Australia’s aged care system”, the true nature of the legislation should have been obvious – much the same pig, but a different shade of lipstick.
COTA issued a statement highlighting the benefits of the new legislation. While these are important, the package as a whole still falls far short of what the Royal Commission envisaged and what older Australians deserve.
Other groups issuing statements about the new Act included the Older Persons Advocacy Network, the Aged and Community Care Providers Association, Catholic Health Australia, and Palliative Care Australia.
Ministers and government
In advance of World AIDS Day on 1 December, Health Minister Mark Butler released the 9th National HIV Strategy, which aims to virtually eliminate HIV transmission in Australia by 2030.
He said the strategy was developed in partnership with key HIV organisations, health professionals, academics, and state governments, and “focuses on reducing new and late diagnoses, improving HIV outcomes for priority populations, implementing new models for testing and treatment, and addressing ongoing stigma and discrimination”.
Assistant Minister Ged Kearney announced the publication of the Systematic Mapping Review of Australian Research on Climate Change and Health Interventions, which summarises current Australian research on interventions and policies “to support health system decarbonisation; health system adaptation, vulnerability and resilience; and achieving health benefits from emissions reduction and adaptation activities in all sectors”.
The review was carried out in collaboration with the Healthy Environment and Lives (HEAL) Network, which recently guest-curated Croakey’s X account @WePublicHealth. (Croakey is also reporting on HEAL’s annual conference held on 26-28 November.)
However, as long as the Government does nothing to restrict fossil fuel extraction and export, worrying about the climate impact of the health sector, which accounts for seven percent of our total carbon emissions, feels a little like fiddling while Rome burns.
The Assistant Treasurer and Minister for Financial Services Stephen Jones called for submissions from individuals, businesses and community groups on their views regarding priorities for the 2025–26 Budget by 31 January.
Submissions can be provided through the portal.
The Department of Health and Aged Care released a new Understanding Medicare: Provider Handbook, “designed to help healthcare professionals, medical practice staff or anyone involved in Medicare billing and claiming, to navigate the Medicare system”.
Recent media reports of fraudulent billing by specialists suggest there is a definite need for the handbook.
The Australian Institute of Health and Welfare released updated data on chronic respiratory conditions, as well as monthly Medicare and PBS statistics.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) released fact sheets to support the implementation of the Australian Framework for National Clinical Quality Registries 2024. The framework was recently covered in an article in MJAInSight.
The ACSQHC also marked the ten-year anniversary of the release of the first Clinical Care Standard (which covered antimicrobial stewardship). There are now 19 standards covering a wide range of conditions.
Ahpra and the National Boards issued a joint statement on family violence, warning practitioners that family violence “is a gross departure from the ethical standards of behaviour expected of health practitioners”.
“Health practitioners who are perpetrators of family violence could face suspension, cancellation, the imposition of conditions, or refusal of registration,” they said.
As foreshadowed last week, the Psychology Board of Australia released the new Code of conduct for psychologists, which will come into effect on 1 December next year.
The Australian Bureau of Statistics released the National Aboriginal and Torres Strait Islander Health Survey for 2022-23, including data on health, use of health services, health risk factors, and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples.
According to the ABS, the main findings included that 41 percent of households experienced food insecurity due to a lack of money for food at some time in the last 12 months; and 31 percent of people aged 18 years and over living in non-remote areas experienced high or very high levels of psychological distress in the last four weeks, compared with 24 percent of people living in remote areas.
The ABS also released the latest data on persons in custody. The 44,316 people incarcerated in the September quarter this year was the highest since the 44,159 in March 2020 as the pandemic began. The average growth rate for the last two years is almost 4.1 percent per year, far in excess of population growth.
The Aboriginal and Torres Strait Islander imprisonment rate was 2,701 persons per 100,000 adult Aboriginal and Torres Strait Islander population, up over eight percent from the September quarter 2023. (If that rate of increase is sustained, 10 percent of the adult Aboriginal and Torres Strait Islander population will be imprisoned by 2040.)
The recent actions of the new governments in the Northern Territory and Queensland are set to exacerbate this trend, and undermine action on the justice targets in the National Agreement on Closing the Gap, despite the warnings of many organisations and experts that the evidence does not support these governments’ ’tough on crime’ policies.
The Australian Prudential Regulatory Authority (APRA) released private health insurance statistics for the September quarter, showing 45 percent of the population now have hospital insurance. The data were welcomed by Private Healthcare Australia and the Members Health Fund Alliance.
Consumer and public health groups
On behalf of almost 20 other health organisations, the Consumers Health Forum (CHF) announced the launch of the Coalition for Preventative Health Funding (CPHF), which “called on the 48th Parliament to invest more on Australia’s preventative health”.
CHF CEO Dr Elizabeth Deveny said “our members and sector partners have consistently highlighted the urgent need for greater funding in preventive health”.
“While many politicians express agreement during our discussions in Parliament, this support rarely translates into substantial investment in community-based preventive health measures on Budget night,” she said.
The CPHF agreed that:
- the Government and the 48th parliament commit to five percent of the health Budget being spent on prevention
- the CPHF is engaged in a co-design/advisory capacity about how the funding should be spent
- the five percent funding flows through to CPHF members to do prevention work with their communities
- The Government fund a Secretariat component to help administer the CPHF.
Given five percent of health spending is about $13 billion or 0.5 percent of GDP, I think that even if a government was to commit to spending that amount on prevention, hell would freeze over before it would provide that amount to a group of organisations with combined current revenues of a few hundred million dollars at most.
If the Government really cared about preventive health it could reanimate the Australian National Preventive Health Agency, established in 2010 under an eponymous piece of legislation.
Its functions included building an evidence base in relation to preventive health strategies, facilitating a national health prevention research infrastructure, generating new partnerships for workplace, community and school interventions, assisting in the development of the health prevention workforce, and implementing a national approach to social marketing for preventive health programs.
While the Agency was defunded and quietly throttled by the Abbott Government, the Act has not been repealed.
National Seniors Australia reacted to claims of fraudulent billing by some medical specialists, arguing that this strengthened the organisation’s case for a “head to tail” review of the private health system “to find out what’s wrong and fix it”.
The Public Health Association of Australia (PHAA) put forward a plan to break the political deadlock on gambling advertising. It proposed a four-step solution:
- A comprehensive ban on gambling advertising
- Impose a one percent levy on gambling companies’ gross revenue
- Distribute that revenue among the media and the sporting codes, for the next three years, during the transition to an Australia without gambling advertising revenue
- Both Labor and the Coalition must support the deal, so that neither of them gets targeted by media or sporting organisations at the next election.
PHAA CEO Adjunct Professor Terry Slevin described it as “a rational transition plan out of the present deadlock, and better still, neither the punters nor taxpayers have to pay for it… it shifts one percent of the nation’s current gambling revenue from a predatory, mostly transnational, industry sector over to two other business sectors which serve a variety of other purposes”.
As Slevin said, “we’ve seen in Parliament this fortnight that sudden bipartisan agreements are possible, when the parties have the will for it”.
First Nations health
The Aboriginal Medical Services Alliance Northern Territory (AMSANT) called on the Northern Territory Government to step up and fulfil its $180 million commitment to tackling the domestic and family violence crisis in the Territory.
AMSANT CEO, Dr John Paterson, said “before the election, both major parties recognised the desperate need and committed to $180 million over five years to support specialist services”.
“Yet, since taking office, the CLP Government has provided no details on how this critical funding will be delivered,” he said.
Trade unions
Advanced Pharmacy Australia (AdPha) released a new Standard of practice for pharmacy services specialising in transitions of care.
The Australian Medical Association (AMA) announced its Dirty Ashtray and Exploding Vape awards (see more in this previous Croakey article).
The Dirty Ashtray went to the Australian Association of Convenience Stores (AACS) “for refusing to disclose their industry funding to a Senate Inquiry consultation on new tobacco laws… [even though] AACS members include three transnational tobacco companies”. The AMA said that AACS had “campaigned against world leading public health measures on smoking and vaping for over two decades”.
The Exploding Vape went to “the Australian Taxpayers Alliance for their ‘Bust the Black-Market’ campaign, which pushed an industry agenda for regulating consumer sales of vapes ‘just like cigarettes and alcohol’ while ignoring public health recommendations and claiming to be grassroots campaigners (astroturfing)”.
Newly installed Royal Australian College of GPs President Dr Michael Wright spent several days visiting MPs in Canberra during the last sitting week of the year.
Wright also co-authored an article published in The Medical Journal of Australia, arguing that while “bulk-billing has been a term associated with the success of Medicare, [it] no longer provides an agreed or meaningful estimate of access to health services”.
“The successful implementation of an effective model of care for the complex nature of 21st century general practice requires the use of modern and more meaningful metrics, and this involves relegating the term bulk-billing for such purposes to history,” he said.
The Rural Doctors Association of Australia (RDAA) acknowledged the introduction into the House of Representatives of the Doctors for the Bush Bill by independent MP Andrew Gee.
The bill purports to prevent the Government from classifying outer metropolitan and large regional centres as “Distribution Priority Areas” where International Medical Graduates and Foreign Graduates of Accredited Medical Schools can access Medicare.
RDAA President Dr Sarah Chalmers said that the expansion of Distribution Priority Areas to outer metropolitan and large regional centres “had resulted in rural and remote areas having basically no relative assistance when it comes to attracting and retaining medical staff”.
Commenting on the numerous reviews of primary healthcare reporting over the last year, Chalmers said “the main issue for rural is that there simply are not enough healthcare professionals, of any variety from nurses to midwives, allied health practitioners or doctors, out there to meet the needs of the rural population”.
“We need a National Rural Health Strategy that coordinates the relevant recommendations across all the reports, and brings them all together into a workable solution… [with] additional investment – not just the repurposing of the existing funding,” she said.
Industry groups
The Association of Australian Medical Research Institutes (AAMRI) released its pre-budget submission, calling on the Government “to take urgent action in the next Budget to safeguard the future of the nation’s health and medical research sector”.
It asked for increasing the NHMRC budget to cover “real salary costs”; meeting the indirect costs of research; and “ensuring the new National Health and Medical Research Strategy supports the growth and security of the sector”.
Parliamentary shenanigans
One of the bills rushed through the Senate on the undignified legislative conveyor belt on Thursday evening (28 November) was the Aged Care (Consequential and Transitional Provisions) Bill 2024 (the C&T bill).
These sorts of bills accompany many major legislative packages amending or replacing existing legislation, and are intended to fix up the rest of the statute book by updating or replacing references to the main Act, as well as setting out how the new Act will take over from the old one.
The C&T bill was only introduced on 21 November, a number of weeks after the main Aged Care Bill.
Rather than identify every reference to provisions of the Aged Care Act 1997 in other legislation and replace it with a reference to the corresponding provisions in the Aged Care Act 2024, the C&T bill provides that any reference to the old legislation “is taken to be” a reference to the Aged Care Act 2024 and “an equivalent, or nearly equivalent, provision of that Act”.
This may have saved on legislative drafting time but is likely to provide future employment for administrative lawyers and the Administrative Review Tribunal working out whether two provisions are “equivalent, or nearly equivalent”.
On a more positive note, the C&T bill finally gave effect to the Aged Care Royal Commission’s recommendation to remove the blanket exemption from release under the Freedom of Information (FOI) Act applying to documents containing information about aged care providers.
FOI decisionmakers considering a request for access to such documents will now need to apply the standard section 47G test, balancing the public interest against the risk that the disclosure might “unreasonably affect that person adversely in respect of his or her lawful business or professional affairs or that organisation or undertaking in respect of its lawful business, commercial or financial affairs”.
International
The United Kingdom House of Commons passed the second reading of the Tobacco and Vapes Bill 2024.
Section 1 of the bill provides that “it is an offence to sell any of the following to a person born on or after 1 January 2009: a tobacco product; a herbal smoking product; cigarette papers”.
If the bill gets through the remaining stages, it is likely to have a profound impact on public health into the future.
Finally
The Monday before Thanksgiving in the United States is Public Health Thank You Day, when the American Public Health Association, Research!America and other leading public health organisations “take time to recognise public health professionals who work tirelessly to protect the health of all people and all communities”.
Many US state health departments acknowledged the day, as did some counties and cities.
Is it time for an equivalent (or nearly equivalent) day here?
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.
National Health and Medical Research Council
Proposed updates to the Investigator and Synergy Grant assessment framework
4 December
Office of the Gene Technology Regulator
Proposed minor and technical amendments to the Gene Technology Regulations 2001
8 December
Department of Health and Aged Care
Draft national standards for counsellors and psychotherapists
13 December
Department of Health and Aged Care
Star Ratings for residential aged care – design changes
13 December
Department of Health and Aged Care
Aged Care Reforms Sector Pulse Survey
13 December
Department of Health and Aged Care
Draft National STI Strategy
18 December
Department of Health and Aged Care
Medical Research Future Fund Australian Brain Cancer Mission – consultation on the refreshed Roadmap and Implementation Plan
20 December
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
Department of Health and Aged Care
Healthy Food Partnership Reformulation Program: Wave 3 Category Definitions and Targets
3 January 2025
Department of Health and Aged Care
National Lung Cancer Screening Program Guidelines
5 January 2025
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January 2025
Senate Community Affairs Committee
Access to diagnosis and treatment for people in Australia with tick-borne diseases
17 January 2025
The Treasury
Pre-budget submissions
31 January 2025
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, and on Bluesky at: @charlesmk.bsky.social.
