The state of the aged care sector, misinformation about vaccination safety, rural health news, workforce controversies, and questions about the popular trend to use stand-up desks are among the topics covered in this week’s column.
The quotable?
Almost half of all respondents identified the cost of living crisis as the biggest barrier to accessing professional mental health support, with seven out of 10 people with a lived experience stating they could not afford services from a psychiatrist, psychologist, or counsellor.”
Charles Maskell-Knight writes:
14 October was International Allied Health Professions Day.
Allied Health Professions Australia marked the day by calling on the Government “to stop talking about multidisciplinary team care and bring it to fruition with appropriate funding and implementation planning”.
SARRAH (Services for Australian Rural and Remote Allied Health) also marked the day, calling for a “targeted and coordinated approach” to building a rural allied health workforce.
CEO Cath Maloney said “without specific focus and investment, there is a risk that service delivery is skewed towards what can be delivered rather than tailored to the health needs of rural Australians, which simply serves to maintain the status quo”. (Read more from SARRAH in this Croakey Conference News Service preview of their conference.)
Minister for Indigenous Health Ged Kearney released a video on LinkedIn thanking the professions for their work, as did Assistant Minister Emma McBride.
The Commonwealth Chief Allied Health Officer Anita Hobson-Powell also marked the day with a list of 29 “policies, programs and reforms that are imparting [sic] allied health professionals or access to allied health”.
It is hard to take the list seriously, as it is a grab-bag of any activity that has any tangential mention of allied health.
For example, the new Aged Care Act is included. The bill for the new Act at clause 386 includes experience or knowledge in an allied health profession as one of the qualifying criteria for appointment as a member of the Aged Care Quality and Safety Advisory Council – but is otherwise completely silent on allied health.
In a related development, the Aged Care Minister Anika Wells announced that a further three quality indicators would be added to the aged care quality indicator program from the June quarter next year to cover enrolled nurse, allied health professional, and lifestyle officer staffing.
Ministers and government
Health Minister Butler joined with other Ministers in announcing further funding for high pathogenicity avian influenza (HPAI) preparedness. Health sector funding included $22.1 million to increase the number of ready-to-use pandemic flu vaccines in the National Medical Stockpile.
Aged Care Minister Anika Wells announced the appointment of Natalie Siegel-Brown as the Inspector-General of Aged Care from January next year. Siegel-Brown is currently a member of the Productivity Commission, and has previously worked on social policy in a number of State Governments. Ian Yates AM will continue to serve as acting Inspector-General until Siegel-Brown takes up the post.
Minister for Indigenous Health Ged Kearney announced a Partnerships for Cancer Research program which will seek “to improve cancer outcomes for Aboriginal and Torres Strait Islander people by generating knowledge that informs inclusive and equitable cancer care while also building the capacity of the First Nations cancer research sector”.
The program will fund up to 12 community-based grants across “prevention and early detection, access to cancer care, and patient experiences and outcomes from diagnosis through to survivorship”.
Adjunct Professor Jacinta Elston, Cancer Australia’s Advisor on Aboriginal and Torres Strait Islander Cancer Control, said that “by investing in community-based research and strengthening partnerships between Aboriginal and Torres Strait Islander organisations and mainstream cancer services, this grant program will empower our people, honour our knowledge, and build capacity for generations to come”.
The Department of Health and Ageing opened consultation on potential reforms to the Medicare safety nets. The consultation paper seeks views on a number of issues including the effectiveness, equity, simplicity and awareness of the safety nets. Submissions close on 15 November.
The Therapeutic Goods Administration issued a statement comprehensively debunking reports of claims that the COVID-19 mRNA vaccines are contaminated with excessive levels of DNA.
The statement, titled ‘Addressing misinformation about excessive DNA in the mRNA vaccines’, said the reports “are based on studies conducted by a small number of laboratories [using methods] that currently fall short of the scientific rigor expected in pharmaceutical testing”.
Regardless of the TGA’s proactive statement, expect pointless and inane questioning on the issue to take up far too much time at the next Senate estimates hearings.
The Australian Institute of Health and Welfare (AIHW) released an updated report on the National Core Maternity Indicators.
The Australian Bureau of Statistics (ABS) released births data for 2023, showing a record low total fertility rate of 1.499 babies per woman. Apart from a blip in 2021, the total fertility rate has fallen every year since 2008, when it reached a 21st century peak of 2.023.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) released the first Chronic Obstructive Pulmonary Disease Clinical Care Standard, including ten quality statements describing safe and appropriate care and a set of indicators to support monitoring and quality improvement.
Ahpra announced that “a new fast-track pathway to specialist registration for eligible internationally qualified medical specialists will open on 21 October 2024”.
General practice will be the first specialty to be included, with Irish, New Zealand, and UK GPs able to apply directly to the Medical Board for registration, rather than being assessed by a medical college. Anaesthetics, obstetrics and gynaecology, and psychiatry will be added to the list in December 2024.
The Royal Australian College of GPs issued a statement saying that “health ministers must take all responsibility for anything that goes wrong with their rushed process to implement an expedited pathway for overseas-trained medical specialists”.
RACGP President Dr Nicole Higgins said: “Australia’s health ministers and Ahpra have pushed this through regardless of the major risks, unanswered questions, and lack of detail about how a GP’s suitability to practice will be assessed, just a week before it’s due to be implemented.
“We all hope it will work as planned, but you don’t guarantee the safety of patients and wellbeing of doctors with hope, you need appropriate processes,” she said.
First Nations health
As reported elsewhere in Croakey, the new Northern Territory Country Liberal Party Government has delivered on its election commitment to lower the age of criminal responsibility from 12 years to 10 years.
This is despite “calls by Aboriginal health leaders, medical organisations and youth justice advocates for the new Government to reconsider its plans to lower the age, with concerns over the harmful and disproportionate impact on Aboriginal and Torres Strait Islander youth”.
Consumer and public health groups
Older Persons Advocacy Network (OPAN) CEO Craig Gear gave evidence to the Senate inquiry into the Aged Care Bill.
OPAN raised five issues:
- Everybody interacting with older people must be required to uphold the Statement of Rights
- Anyone who is part of the aged care system must be required to support older people to continue to make their own decisions
- Aged care providers must not use restrictive practices without authorisation and monitoring by the regulator
- Older people must not be denied aged care services due to their inability to pay or be pushed into poverty due to aged care fees
- There should enough flexibility under the Support at Home program to ensure that older people do not have to choose between personal care and a hygienic house.
The National Rural Health Alliance (NHRA) marked the release of the latest issue of the Australian Journal of Rural Health. It includes an article from Margaret Deerain, the NHRA’s Director, Policy and Strategy Development, arguing for “a National Rural Health Strategy that… supports fairness, dignity, equality and respect for rural Australia, as a basic human right”.
Trade unions
Allied Health Professions Australia reported that the Universities Accord (National Student Ombudsman) Bill giving effect to the “paid prac” scheme had been passed with an amendment initiated by Dr Helen Haines to include a review of the scheme within three years.
The review “requires the government to consider expanding prac payments to other areas of key skills shortages, including allied health”.
The Australian Association of Psychologists (AAPi) reported on the results of a survey carried out on behalf of Wayahead (the Mental Health Association of NSW), which found that “almost half of all respondents identified the cost of living crisis as the biggest barrier to accessing professional mental health support, with seven out of 10 people with a lived experience stating they could not afford services from a psychiatrist, psychologist, or counsellor”.
AAPi Executive Director Tegan Carrison said the survey showed that the cost of living crisis is not only increasing distress, but is preventing those affected from accessing support.
She said that “to improve access to professional mental health services, we need to increase the Medicare rebate and expand the number of subsidised sessions Australians can access”.
The Australian Medical Association (AMA) said it had written to Minister for Education Jason Clare urging the Government to expand the prac payment scheme to include medical students, arguing that including them “would improve community access to health care, particularly in underserviced rural and remote communities”.
The Australian Nursing and Midwifery Federation (ANMF) said it “stands in solidarity with women and people giving birth in response to the NSW Select Committee on Birth Trauma Report”.
The report made five findings and 43 recommendations, including improved access to midwifery-led care, midwifery continuity of care models, and trauma informed care., as well as increased maternity care resources such as midwife ratios that support woman and person-centred care, ensuring competitive pay and working conditions to attract and retain midwives, and providing publicly funded homebirth services.
The ANMF said that “many of the recommendations have been previously advocated for by consumers and stakeholders”, and that, as birth trauma is not limited to NSW, the recommendations should be considered nationally.
The Pharmaceutical Society of Australia (PSA) announced it has partnered with New South Wales Health to deliver specialised training and support for pharmacists delivering services under the Opioid Treatment Program.
The PSA also welcomed the announcement by the Tasmanian Government to amend legislation to allow prescriptions written outside the State to be dispensed on the island. That creaking noise is Tasmania moving to join the 20th Century.
Representatives from the RACGP visited the South Australia Parliament to argue for better pay and conditions for GPs in training, ensuring junior doctors undertake general practice placements during training, “ruling out the expansion of programs that jeopardise patient safety by allowing health workers to provide potentially complex healthcare that should be provided by specialist GPs”, and incentives for practices to extend opening hours.
The RACGP also called for better ADHD care in Tasmania, and summarised its views on a range of ACT health issues before the election on Saturday 19 October.
The Rural Doctors Association of Australia (RDAA) previewed the Rural Medicine Australia conference to be held 23-26 October. The keynote speaker will be Dr Jillann Farmer, former medical director of the UN, and now CEO of A Better Culture.
Farmer says that “the time has come for the medical sector in Australia to ‘own and acknowledge’ a masked gender and race problem, both in the profession itself and in medical training”.
Industry groups
The Aged and Community Care Providers Association (ACCPA) released its inaugural State of the Sector report. The survey underpinning the report collected responses from 191 providers, but unfortunately there is no indication of how this sample was selected.
Key concerns were funding levels, workforce availability, and the pace of reform (too fast, rather than too slow).
ACCPA CEO Tom Symondson said the report “provides evidence-based insights about what’s happening on the ground. It is honest, and it is earnest”. That may be so, but there is no assurance that it is representative.
The Members Health Fund Alliance (lobby group for private health insurers who cannot distribute profits) released a report on The Economic and Social Impact of the Members Health Funds of Australia.
This “highlights the enormous value and contribution that the alliance of 24 Members Health funds provide to the Australian economy and society, and sets the agenda for how we can continue to support the health and wellbeing of current and future generations to come and do even better”.
It suggests restoring the premium rebate to 30 percent; mandating greater transparency of pricing and performance for hospitals and clinicians; allowing health insurers to cover out-of-pockets for GP visits; and exempting private health insurance premiums from the Fringe Benefits Tax.
The Private Healthcare Association (PHA, the private health insurer lobby group) responded with outrage to the NSW Government’s reported proposals to increase the levy on private health insurance policies, claiming that the increase of $156 for a family policy would lead to 60,000 people dropping private health insurance.
Dr Rachel David, CEO of PHA, said “people with health insurance are already paying taxes to fund public hospitals and insurance premiums to access private hospitals”.
“It is extremely unfair to make four million people in NSW pay twice for nothing in return,” she said.
The flip side of that argument is that people without insurance paying taxes to fund public hospitals should not be cross-subsidising the costs those hospitals incur when they treat privately insured patients.
PHA also commented on the latest APRA data on private health insurance, arguing that the 88 cents in the dollar of premium revenue paid out as benefits was better than any other kind of insurance. This is true, but it still does not excuse the rapid growth in management expenses and retained earnings that has characterised the sector in recent years.
Also on private health insurance, three provider lobby groups (the Australian Private Hospitals Association, Catholic Health Australia, and the Medical Technology Association of Australia) issued a joint statement calling for reform to the private health insurance premium approval process.
The statement suggested:
- Establishing an independent body to oversee insurer behaviours that are threatening the viability of the system and the value of private health insurance for consumers
- Implementing a cap on capital requirements to compel insurers to free up excessive reserves of capital to support the struggling private health system
- Incorporating the increasing cost of delivering care as well as acknowledge push factors such as insurer profits and management expenses in the 2025 premium round process.
There is certainly a strong case for capital caps. It is hard to argue that any insurer needs more than six months-worth of premium income in net reserves, yet over half of insurers hold this much or more.
Politicians and parliamentary committees
The Senate inquiry into the Aged Care Bill held hearings on four days last week, and is due to complete its hearings in Canberra and Darwin on 21 and 24 October.
Despite submissions closing on 30 September, as of Friday 18 October not all submissions had been posted to the inquiry website.
The inquiry is due to report on 31 October.
Shadow Health Minister Anne Ruston again criticised the Government for not intervening in the NSW Government’s efforts to raise more money from private health insurers.
International organisations
CEPI (the Coalition for Epidemic Preparedness Innovations) is leading the 100 Days Mission, “a global health security plan for the world to be able to develop and make available new vaccines against a future pathogen with pandemic potential within 100 days of that pandemic threat being recognised”.
It announced a study modelling the potential impact of a COVID-19 vaccine available with 100 days, concluding that it would have saved eight million lives and averted productivity losses due to illness amounting to almost $1.4 trillion, as well as $63 billion of hospitalisation costs.
CEPI’s CEO Dr Richard Hatchett said “this work shows in the starkest terms why the world needs to be prepared to move faster and more equitably when novel pandemic disease threats emerge”.
“Investing in preparedness now to make the 100 Days Mission possible for future incipient pandemics will save millions upon millions of lives and protect the global economy against catastrophic losses,” he said.
Finally
In the last few years before I left the permanent workplace, stand-up desks were growing in popularity as a way of avoiding the perceived risks of sitting at a desk all day.
Research reported in the UK Independent now suggests that standing up at a desk comes with its own risks.
The study published in the International Journal of Epidemiology found that not only does standing not reduce the risk of diseases such as stroke and heart failure, but standing for more than two hours a day “could put people at higher risk of developing problems such as deep vein thrombosis… and varicose veins”.
Author Dr Matthew Ahmadi from the University of Sydney said “the key takeaway is that standing for too long will not offset an otherwise sedentary lifestyle and could be risky for some people in terms of circulatory health”.
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.
Therapeutic Goods Administration
Proposed amendments to the Poisons Standard
22 October
Australian Commission on Safety and Quality in Health Care
Critical results management of pathology and diagnostic tests and imaging investigations
23 October
Independent Health and Aged Care Pricing Authority
Pricing Approach for the Support at Home Service List
25 October
National Mental Health Commission (National Suicide Prevention Office)
Draft National Suicide Prevention Strategy
27 October
Australian Commission on Safety and Quality in Health Care
Draft Medication Management at Transitions of Care Stewardship Framework
27 October
National Health and Medical Research Council
Draft Procedures and Requirements for Meeting the NHMRC Standards for Clinical Practice Guidelines
27 October
Food Standards Australia and New Zealand
Varying maximum residue limits (MRLs) for residues of specific agricultural and veterinary chemicals that may occur in food commodities
29 October
Department of Health and Aged Care
Proposed amendments to the Gene Technology Act 2000
8 November
Podiatry Board of Australia
Proposed change to the protected title for the specialty of podiatric surgery
8 November
Department of Health and Aged Care
Medical Research Future Fund Genomic Health Futures Mission – National Consultation on the refreshed Roadmap and Implementation Plan
8 November
Department of Health and Aged Care
Reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office
11 November
Independent Health and Aged Care Pricing Authority
NDIS pricing reform
15 November
Department of Health and Aged Care
Potential reforms to the Medicare safety nets
15 November
Office of the Gene Technology Regulator
Online Services Portal Survey
22 November
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 (extended from 30 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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