The Zap is a newish column at Croakey, compiled by health policy analyst Charles Maskell-Knight. It provides a weekly summary of health-related reports, announcements and media releases from Commonwealth government agencies, Health and Aged Care Ministers and other politicians, national health sector organisations, and some international bodies.
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The quotable?
…there is an urgent need for comprehensive reform of the mental health system and significant investment to address key issues of early intervention, service access, social determinants and youth participation.”
Charles Maskell-Knight writes:
Parliament resumed on 6 February, collecting MPs all in one place for ease of lobbying, as well as creating a backdrop for lobby groups making announcements.
While it would be amusing to report on Parliament’s consideration of health and aged care issues, I have decided not to do so in The Zap. Parliamentary shenanigans are reported widely in mainstream media; this column is intended to summarise material that doesn’t get much media attention.
Ministers and government
Health Minister Mark Butler made a series of announcements about new PBS listings, grants for innovative models of care in rural areas, and research programs under the Medical Research Future Fund (here, here and here). He wrote an op-ed for the The Advertiser on vaping, and carried out an interview with ABC Radio Sydney on future anti-vaping legislation.
Butler also joined with the Prime Minister to launch a 40 Years of Medicare pop-up display at Australian Parliament House in Canberra. In his speech Butler asserted that “when you measure healthcare systems across the world, overall, we are the number three performing healthcare system”. I don’t know where he got that from: a quick Google search shows that our system is ranked well by many commentators, but not on the podium.
The Department of Health and Aged Care opened a consultation on a feasibility study on options to limit unhealthy food marketing to children. Submissions close on 15 March.
According to the Department, this work is “supported by the National Preventive Health Strategy 2021-2030, National Obesity Strategy 2022-2032 and the National Diabetes Strategy 2021-2030, which all include restricting unhealthy food marketing to children as a policy goal”. If strategies were any use, the problem would have been solved by now.
Last November the Department of Health and Aged Care released the final draft of new quality and safety standards to apply under the proposed new Aged Care Act (don’t hold your breath waiting for it). The Aged Care Quality and Safety Commission is now consulting on the guidance material it will issue to assist providers in meeting the standards. The consultation closes on 30 April.
Closing the Gap
However, the big story in terms of government reports last week was the release by the Productivity Commission of its Closing the Gap report, with the scathing summary:
governments have largely not fulfilled their commitments under the National Agreement on Closing the Gap… [they] have failed to fully grasp the nature and scale of change required to meet the obligations they signed up to under the agreement…
Most government actions and plans to implement the agreement relabel business-as-usual, or simply tweak existing ways of working… Governments will need to move beyond business as usual and address the entrenched attitudes, assumptions and ways of working that are preventing progress.”
The report cites the COVID-19 response as an example of governments being compelled to work in genuine partnerships with Aboriginal and Torres Strait Islander organisations to meet an essential need, and noted that this reversed the gap, with “Aboriginal and Torres Strait Islander people [having] better outcomes than non-Indigenous people and better outcomes than Indigenous peoples globally”. But “as the urgency of the COVID-19 pandemic receded, there was a return to business-as-usual”.
Catherine Liddle, acting CEO of The Coalition of Peaks, which represents more than 80 Aboriginal and Torres Strait Islander peak organisations, said the review “confirms what our own countless conversations have told us – that governments still don’t understand that Aboriginal and Torres Strait Islander people know what is best for our communities”. She called for “a dedicated Closing the Gap fund, enshrined in legislation, and directed to Aboriginal community-controlled organisations and our organisations to support our self-determination”.
AMSANT CEO Dr John Paterson responded to the report, saying “the health gap is closing in the Northern Territory, but too slowly. Our people are still living their lives much sicker and dying much earlier than non-Indigenous Territorians. More needs to be done.”
He also said that further progress in improving health status requires some of the drivers of ill-health – such as poverty, inequality, poor housing, and poor education – to be taken much more seriously by government.
“Unfortunately, even the partial progress we have seen in the health system has not been matched in other sectors,” he said.
The Public Health Association Australia also responded to the report, stating: “Sadly, the review provides evidence that the socio-economic targets outlined in the Agreement are not likely to be met without… fundamental changes, and risks becoming yet another a broken promise to Aboriginal and Torres Strait Islander peoples.
“We cannot stand back and let that happen. We must embrace the challenge set out in the review by confronting the need for real change. We must take decisive and courageous action to fulfil the recommendations to effectively close the gap for Aboriginal and Torres Strait Islander peoples.”
The Department of Infrastructure, Transport, Regional Development, Communications and the Arts (the switchboard operators receive regular training to prevent repetitive strain injury of the vocal chords) released the State of the Regions report. It sets out the problem (“accessibility to high-quality health and community services across regions is an ongoing challenge – particularly as remoteness of a region increases”), and then presents a list of Things the Government is Doing.
The National Rural Health Alliance responded, calling for funding “to be directed for place-based responses for medical, allied health, nursing, dental and pharmacies who are currently underserved, under-supported and not able to meet the minimum level of primary health care compared to urban Australia”.
CEO Susanne Tegen said that “current funding models still don’t reach the grassroots, resulting in the worst health conditions for rural Australians. Medicare is not covering costs of delivery of services in rural Australia, with bulk billing never developed to cover the whole of delivery cost of service to patients”.
Consumer and public health groups
The Rethink Sugary Drink coalition (including the Australian Medical Association and Australian Dental Association, as well as the Cancer Council, National Heart Foundation, Diabetes Australia and many other groups) launched a new position statement calling for a tax on drinks with added sugar.
At a launch in Parliament House AMA President Steve Robson said a 20 percent levy could raise about a billion dollars a year, and over 25 years could avert 4,400 cases of heart disease, 16,000 cases of type 2 diabetes, and 1,100 strokes.
Cancer Council Australia CEO, Professor Tanya Buchanan, said “the Australian Government must put the community first, following in the footsteps of more than 100 countries and jurisdictions that already have a health levy on sugary drinks”.
An unconnected (but timely) article published by the Australian Dental Association described a Colombian initiative to impose a tax on ultra-processed foods. According to The Lancet (free article), “the tax is being implemented gradually, beginning at 10%, before rising to 15% in 2024 and 20% in 2025, and targets foods that are high in salt and saturated fat, as well as industrially manufactured prepackaged foods”.
The Brotherhood of St Laurence released Making Ends Meet, a report based on the experience of 40 low income people or families over ten weeks in late 2022. One participant said “sometimes I’m not able to afford my medication and it gets really down to the wire… I’d extend it by only taking half my dose just so that I had something and that’s dangerous, I know, but it was dire straits”.
The Academy of Social Sciences released its pre-budget submission, pointing out that “the mental health of young Australians is rapidly declining… [due to factors such as] social media exposure, increased concerns about climate change, financial stress, [and] pressure to achieve”, and concluding “there is an urgent need for comprehensive reform of the mental health system and significant investment to address key issues of early intervention, service access, social determinants and youth participation”.
Trade unions
The AMA released its submission to a Treasury consultation on the use of genetic testing by life insurers, arguing that “genetic testing and genomic research can identify a need for potentially life-saving treatment, but consumers are discouraged from participating out of fear of being frozen out of insurance cover if a genetic risk is uncovered”. The community rating regime applying to private health insurance precludes insurers from discriminating on the basis of genetic make-up, and there appears to be good reason to impose a similar constraint on life insurers.
In a classic case of invent a story and then give it legs, the RACGP, which in its pre-budget submission called for a funded annual health check for children for the first 2000 days, reported on a poll of (self-selected) GPs showing enthusiastic support for the measure.
The Australian Practice Nurses Association “launched the first annual Primary Health Care Nurses Day (PHCNDay) at Parliament House in Canberra [on 7 February], meeting with numerous government ministers and politicians to highlight the Scope of Practice Review, the challenges facing PHC nurses, and to celebrate #PHCNDay”.
Someone at the Australian College of Nursing must have returned from leave last week, because the College issued two statements, one releasing the College’s October 2023 submission to the NSW Special Commission of Inquiry into Healthcare Funding, and one releasing the December 2023 submission to the Commonwealth Department consultation on the development of a National Nursing Workforce Strategy.
The Australian Nursing and Midwifery Federation (ANMF) announced that it had filed an application with the Fair Work Commission to increase award wages for nurses, midwives and assistants in nursing by up to 35 percent, on the basis that the work of nurses and midwives has never been properly valued.
Federal Secretary Annie Butler said that if it was successful, the application would “ensure that the recognition of work value given to nurses and AINs in the Aged Care Work value case, will be extended to all award covered nurses, midwives and AINs”. My back of the envelope calculation suggests that a pay rise of this scale would cost the public hospital system of the order of $5 billion a year.
The Pharmaceutical Society of Australia issued a release marking the opening of the first 24/7 community pharmacy in Adelaide by SA Health Minister Chris Picton, and the announcement that SA pharmacists (after additional training) would join counterparts in some other states in offering treatment for uncomplicated urinary tract infections.
The ACTU released the report it had commissioned from Professor Alan Fels AO into price gouging and unfair business practices. Fels devoted a page to out-of-pocket charges by medical specialists, noting that “many specialists charge more than double the scheduled fee. There is no evidence that they provide a better service. There is also great variation in out of pocket charges for the same services by different specialists… patients are often left to navigate a very complex healthcare system and bear much of the burden of seeking out information and financial risk that public and private health insurance is supposed to remove”.
Private Healthcare Australia (the private health insurers lobby group) responded with a call for price-gouging doctors to be named and shamed, with “all specialist doctors’ fees… published on the Government’s Medical Cost Finder website so consumers know who is charging egregiously”.
- Pre-budget submissions were released by:
- The Australian Psychology Society, calling for “the creation of an in-school evidence-based resilience building program, delivered by psychologists; [and] the addition of a youth safety net to Medicare, which would enable young people to access psychology services more affordably”;
- The Society of Hospital Pharmacists of Australia, calling for “cost-effective solutions that enhance the efficiency and capacity of Australia’s healthcare system” including expanding medicines access, scope of practice, and improving workforce development and sustainability; and
- Australian College of Rural and Remote Medicine (ACCRM), calling for “increased investment in rural generalism as a key strategy to improve access to healthcare services and better outcomes for rural, remote and First Nations communities”.
Politicians and parliamentary committees
The Senate Community Affairs Committee inquiry into the extent and nature of poverty received its fourth extension to its completion date, and is now due to report on 26 February, 18 months after the referral, and four months after the original reporting date.
International organisations
The Kings Fund (UK health policy think tank) published a summary of NHS workforce statistics and an article discussing the trends. There are widespread staff shortages across many parts of the English health and care sectors, and many geographic areas – sounds like a familiar problem?
But unlike Australia, where the problem is worst in rural areas, the relatively sparsely populated English southwest and northeast have the lowest vacancy rates. If only we could make Deniliquin more like Dorset or the Dales, there would be no problem in attracting staff from England.
• Have we missed anything? Let Charles Maskell-Knight know using ‘The Zap’ in the subject line: info@croakey.org
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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The idea of publishing specialists’ fees on the Government’s Medical Cost Finder website or anywhere else won’t make a damn bit of difference for those of us in places like Canberra where you wait month and month for an appointment and are in no position to go elsewhere if you don’t like the fees.