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The Zap: don’t miss the latest in health and aged care news – and check all the consultations now open

An urgent need to build the nursing workforce in the face of a looming undersupply of nurses in acute care, primary care, aged care and mental healthcare is highlighted in this week’s column.

Columnist Charles Maskell-Knight also covers announcements about new independent peak bodies to represent people with lived experience of mental ill-health, funding for Indigenous health infrastructure, and expanding roles for pharmacists.

Meanwhile, palliative care workers across health and aged care settings are encouraged to contribute to an online survey – it is open to those working in specialist palliative care as well as GP clinics, community health centres, allied health, and aged care.

And a big congratulations to Aunty Dulcie Flower AM, a Meriam woman and trailblazing nurse, for winning the 2024 NAIDOC Lifetime Achievement Award.

The quotable?

Aged care is just one of the many issues facing older Australians.

Many also experience ageism, barriers to mature age employment, elder abuse, poverty, and homelessness.”


Charles Maskell-Knight writes:

The Australian Institute of Health and Welfare (AIHW) released the 19th edition of its biennial Australia’s Health report on 2 July.

According to Health Minister Mark Butler, “the Albanese Government’s comprehensive health reform agenda is enabling Australia to meet key health challenges highlighted in the [report]”.

Several health interest groups thought the report highlighted opportunities for more action by the Government.

Australian Medical Association (AMA) President Professor Steve Robson said that the report showed that while life expectancy is increasing, “the burdens of chronic disease and mental illness are on the rise”.

“We must treat health spending as an investment, rather than a cost,” he said. “Placing a greater focus on preventive health, mental health and increasing support for general practice would help Australians live healthier lives and would save taxpayer dollars in the long run by reducing pressure on the health system.”

Robson also called for “immediate action from all governments to address the public hospital logjam crisis”.

Dementia Australia noted that the report identified dementia as “the second leading cause of death in Australia, the leading cause of death of women, the second leading cause of disease burden overall, and the leading cause of burden for people aged 65”.

It said that the data “provides compelling evidence of the need for further funding commitments to dementia research, increasing community awareness and a strategic public health approach to dementia prevention”.

The Australian Association of Psychologists said the report was a reminder that “mental healthcare is still woefully underfunded”, and argued for more Medicare rebated psychology sessions, increased rebates, “funding for the 8,000 plus provisional psychologists to allow them to offer their clients Medicare rebates and to extend rural and regional incentives, currently available to GPs and psychiatrists to psychologists so that people can stop playing the postcode lottery”.

Ministers and government

Minister Butler announced the establishment of “two new independent peak bodies to represent people with lived experience of mental ill-health”.

The bodies will “work closely with the Government to ensure people with lived experience are included in decision making at the national level”, he said.

After a competitive grants process, the National Mental Health Consumer Alliance was chosen to establish a new National Mental Health Consumer Peak Body; and Mental Health Carers Australia was chosen to establish a new National Mental Health Carers, Family and Kin Peak Body.

Butler also announced that there had been over two million additional bulk billed visits since the bulk billing incentive was tripled in November last year, with close to a million additional free visits in May, and that Australians had also saved more than $414 million on the cost of their medicines due to 60-day prescriptions reforms and the cut to the maximum patient copayment.

Minister for Indigenous Australians Linda Burney, Assistant Minister Malarndirri McCarthy and the Lead Convener of the Coalition of the Peaks, Pat Turner, announced $100 million in funding for Indigenous health infrastructure including constructing new clinics, renovating existing clinics, and building staff housing for workers.

The Department of Health and Aged Care announced that funding to support on-site pharmacists to work in aged care homes began from 1 July. Aged care providers wishing to engage a pharmacist “must first attempt to access an on-site pharmacist through a community pharmacy of their choice”.

“If the community pharmacy chooses not to participate, is unable to participate, or the residential aged care home is unable to come to a suitable agreement with the community pharmacy, the residential aged care home will be eligible to access funds directly to engage an on-site pharmacist,” the Department said.

Minister Anika Wells announced, and the Department released, the Aged Care Data and Digital Strategy and Action Plan, which “respond to the increasing and potential use of data and digital technology to enhance care and wellbeing”.

The Department is apparently working with a range of groups including older people, families and carers, providers and workers, and IT vendors “to innovate for the future”.

There is no truth to the rumour that the Medical Research Future Fund (MRFF) is being used to develop a time machine to allow the Department to innovate for the past.

The Department also quietly released the Nursing Supply and Demand Study 2023-2035, concluding that the baseline projections across all sectors show an undersupply of 70,707 FTE by 2035 with around 79,473 nurses needed to fill the gap.

  • For the acute care sector, the projections show an undersupply of 26,665 FTE by 2035.
  • In the primary healthcare sector, the projections show an undersupply of 21,765 FTE by 2035.
  • For the aged care sector, a projected undersupply of 17,551 FTE by 2035. These projections include 24/7 RN staffing and mandatory care minutes in residential aged care homes.
  • In the mental health sector, a projected undersupply of 1,918 FTE by 2035.

The Australian College of Nursing interim CEO, Emeritus Professor Leanne Boyd, said that the study “reflects ACN’s concerns about the nursing and broader health workforce, and reinforces ACN’s recommendations to Federal and State/Territory governments on how to support nursing to build the necessary workforce”.

The Australian Digital Health Agency announced it had published the National Healthcare Identifiers Roadmap 2023-2028, “a strategic plan… to drive uptake of the Healthcare Identifiers Service”.

Simon Cleverley, Assistant Secretary of the Digital Health Branch in the Department, said that “increased adoption of the national healthcare identifiers will mean Australians will avoid having to retell their story as they move across the health system”.

“Access to information in real time will also support healthcare providers to make well informed clinical decisions and care plans.”

The Australian Bureau of Statistics (ABS) released the summary findings of the 2022 Disability, Ageing and Carers, Australia survey (DACA). The headline finding was that “more than one in five people (21.4 per cent) had disability in 2022, up 3.7 percentage points from 2018”.

The rate increased across all age groups except for people aged 90 and over, where it fell from 84.6 percent to 81.1 percent (probably not significant given confidence intervals).

The survey showed that there were three million unpaid carers across Australia, and that 40 percent of these carers had disability themselves. There were 391,300 young carers under the age of 25.

First Nations groups

Aboriginal and Torres Strait Islander people who have worked tirelessly for the health of communities and Country have been recognised in the 2024 NAIDOC awards. 

The 2024 Lifetime Achievement Award was presented to Aunty Dulcie Flower AM, a foundation member and Elder of the Congress of Aboriginal and Torres Strait Island Nurses and Midwives (CATSINaM), who was profiled in this 2022 article, Celebrating the many achievements of Aboriginal and Torres Strait Islander nurses and midwives in Aboriginal Community Controlled Health Organisations.

Read her full NAIDOC profile and the details of the other award winners here. The theme of this year’s NAIDOC Week is Keep The Fire Burning! Blak, Loud and Proud.

Consumer and public health groups

National Seniors Australia thanked MP Rebekah Sharkie for introducing a motion in Parliament on 26 June calling on the Government to appoint a Minister for Older Australians.

CEO Chris Grice said “aged care is just one of the many issues facing older Australians. Many also experience ageism, barriers to mature age employment, elder abuse, poverty, and homelessness”.

Palliative Care Australia urged health workers involved in providing palliative care to complete the Survey of the National Palliative Care Workforce Across Health and Aged Care Settings launched six weeks ago.

CEO Camilla Rowland said “those working in specialist palliative care have responded strongly, and we are very grateful for the insights they have shared, but we also need to hear from those working in GP clinics, community health centres, allied health, and aged care”.

The survey will remain open until a statistically valid number of responses have been received from across the country.

Trade unions

The AMA released its submission to the Government’s consultation on the 2025-30 National Immunisation Strategy, calling for childhood immunisation to remain in general practice.

President Professor Steve Robson said general practice “is the safest environment for childhood vaccinations, which are considered an important milestone in establishing a relationship with a usual GP, which leads to better long-term health outcomes”.

The Australian Nursing & Midwifery Federation (ANMF) issued a statement noting that the Fair Work Commission had made a final decision on the date of effect of wage increases for aged care workers, with direct care workers receiving half of the increase from 1 January 2025 and the remaining half from October 2025.

The union also condemned aged care providers for reclassifying lifestyle staff as personal care workers in order to meet the current requirement of 200 minutes of direct care per resident per day.

Federal Secretary Annie Butler said the Aged Care Quality and Safety Commission “must keep aged care providers accountable by ensuring they meet mandated care minutes as intended, instead of taking away essential elements of care to tick other boxes”.

“We call upon aged care providers to use additional taxpayer funding provided to the sector as it was intended, on direct, daily care,” she said.

The Pharmaceutical Society of Australia noted that in Tasmania trained pharmacists could now extend prescriptions for oral contraceptives for 12 months.

Following a report from the Australian Institute of Family Studies and the Australian Human Rights Commission on Improving the safety and wellbeing of vulnerable children, the Royal Australasian College of Physicians urged the Government to “rethink child protection and youth justice”.

The College noted that the report was based on more than 3,000 recommendations from 61 Royal Commissions and inquiries over the course of 12 years, and that this is “more than enough evidence to tell the story of the child protection system”.

Last year the College released a position statement on the healthcare of children in care and protection services, with 28 recommendations for action.

Professor Nitin Kapur, President of the RACP Paediatrics and Child Health Division, said “according to the report, existing evidence suggests that focusing on preventing children from interacting with the protection and youth justice system is the best way to improve outcomes”.

“We need to invest in our most vulnerable children to ensure they have the support they need to help reduce these poor outcomes and break the cycle of health and social disadvantage.”

He said that “despite being an identified target in Closing the Gap, First Nations children continue to be over-represented in care and protection services”.

“The need for culturally safe, trauma informed care is fundamental to improving health outcomes for First Nations children.”

Yet still state governments drag the chain on increasing the age of criminal responsibility.

As reported in last week’s column, the Royal Australian College of General Practitioners (RACGP) released a new edition of its Red Book Guidelines for preventive activities in general practice. This week it issued a statement, noting that sleep is one of the new topics included in the guidelines.

Chair of the Red Book Committee Professor Danielle Mazza AM said “nearly half of Australians experience at least two sleep-related problems [including] inadequate sleep… [and] chronic conditions like insomnia and obstructive sleep apnoea that seriously affect sleep quality, our overall health, and our ability to function at our best… If you have had trouble falling or staying asleep, or you find yourself tired throughout the day, you should speak to your GP to receive advice to help you get back on track”.

The Red Book also included new material on “pregnancy, interconception, perinatal mental health, and post-menopause care”, and the College used this as the occasion for a statement on women’s health.

RACGP President Dr Nicole Higgins said “on the women’s health front, Australia has come a long way, but we also have a long way to go… addressing health inequalities for women and girls in Australia is something I’m especially passionate about. There are so many areas where we can and should do better”.

Higgins also called for “a fair go” for female GPs, who “are more likely to conduct longer consults covering complex issues including post-natal depression and other mental health issues, domestic violence, and childhood behavioural problems”.

“The inequity of Medicare rebates effectively penalising those GPs who take on a greater share of longer consults is something that I will continue fighting for,” she said.

Finally, the Red Book’s new material on mental health related issues (anxiety, eating disorders, perinatal mental health, and issues such as gambling) led to a media release calling for greater support from the Government for GPs providing mental health services.

Higgins said: “We know that mental health consults cannot be rushed, and that’s why we are continuing our calls for a 20 percent increase to patient rebates for longer consults and consults concerning mental health, with extra support for rural patients.”

The RACGP also welcomed the passage by the Senate of the Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Bill 2024, “modernising the process for GPs to document patient consent for bulk billing benefits to be paid to their health provider”.

Industry groups

A contract dispute between nib and the St Vincent’s hospital group made the news, and prompted releases from both sides of the dispute, and from Catholic Health Australia (CHA).

CHA director of health policy Dr Katherine Bassett said: “This year nib had one of the highest premium increases at 4.1 percent, yet in 2022–23 only returned 79 percent of premiums back to patients – well short of the industry’s 90 percent gold standard and the lowest of the major insurers.”

“It is totally unacceptable for insurers to put the squeeze on patients and hospitals while increasing their large profit margins and bank balances.”

The AMA also weighed in on the issue, urging “St Vincent’s and nib to get back to the negotiating table to strike a deal that puts the needs of patients first, while also delivering a reasonable return for all parties and recognising the rising costs of providing quality care”.

The ACCPA (peak aged care lobby group) released its submission to the evaluation of the aged care star ratings system commissioned by the Department of Health and Aged Care. I thought I must have missed a call for public consultation on this – but the project page on the Department’s website shows that there hasn’t been one.

One of the focuses of the evaluation is “how Star Ratings have improved care quality and outcomes”. I am one of many commentators who would argue that a better question would be “is there any evidence that the system of Star Ratings the Government has implemented have improved care quality and outcomes”.

Politicians and parliamentary committees

The House of Representatives diabetes inquiry tabled its report, with 23 (largely sensible) recommendations, as detailed in this Croakey article.

Chair Dr Michael Freelander said “the fundamental aim of the Committee’s report is to improve health outcomes for Australians affected by all forms of diabetes. By placing particular emphasis on prevention, the Committee is also seeking to raise awareness of major risk factors associated with the disease, such as obesity”.

However, Coalition members of the committee did not support the recommendation for a tax on sugar sweetened beverages because of its impact on low-income households. I’m pretty sure the financial impact on those households of a family member with diabetes would be worse.

Dr Sophie Scamps, who joined the committee as a supplementary member for the inquiry, urged the Government to act quickly to implement the recommendations to apply a tax on sugar sweetened beverages and to restrict marketing and advertising of junk food to children.

Diabetes Australia CEO Justine Cain welcomed the report and its recommendations, saying that they made up “a comprehensive package of measures that can really make a difference, and we need to see them implemented together”.

She was pleased that the committee had responded to DA’s calls for “investment in access to healthy food; a levy on sugary drinks; and a ban on junk food advertising to children”.

The Public Health Association of Australia welcomed the report, and encouraged the Government to “stand firm against the push from big business to again dilute action on harmful, sugary products”.

The Australian Chronic Disease Prevention Alliance also welcomed the report, observing that “a common theme in the report is that the food industry’s voluntary and self-regulatory approaches are consistently insufficient to drive the improvements needed in the food system to reduce the impact of diet related conditions like type 2 diabetes and obesity”.

Other groups used the report as an occasion to repeat earlier arguments.

So the RACGP used the report to argue yet again for increased funding for GP consultations; and Private Healthcare Australia (the private health insurers’ lobby group) used the report as an occasion to complain yet again about the prostheses list arrangements, and the inflated prices it requires insurers to pay for medical devices.

The Royal Australasian College of Physicians welcomed the report, noting that it supported the College’s position on “more accurate food labels, a tax on sugary drinks and a total ban on junk food advertising for children”, as well as funding for longer MBS consultations, telehealth, and broader case coordination models for people with obesity and diabetes.

The AMA strongly supported the proposal to tax sugar sweetened beverages. President Professor Steve Robson said “we are 100 percent behind this sugar tax on sugar-sweetened beverages because we know it could help reduce the prevalence of type 2 diabetes in Australia, as well as reducing other chronic diseases”.

“Prevention is better than cure and this inquiry has realised we need to be ahead of what is a national health crisis.”

International

As was generally predicted, the Labour Party won the UK election.

New Health Secretary Wes Streeting said the NHS is “going through the biggest crisis in its history” and it could not be fixed overnight.

“From today, the policy of this department is that the NHS is broken,” he said.

Finally

The Department of Health and Aged Care announced on 4 July the appointment of Professor Jenny May AM as the National Rural Health Commissioner.

“Wait,” I hear you say, “isn’t that old news?”

Well yes, it is. Health Minister Mark Butler and Assistant Minister Emma McBride announced May’s appointment on 19 June.

I’m not sure why the news took two weeks to travel the seven kilometres from Parliament House to the Department’s headquarters in Woden – any suggestions from readers will be gratefully received, and the most convincing (or amusing) will be published.


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.

Department of Health and Aged Care
Establishment of a National Aged Care Mandatory Quality Indicator Program (QI Program) for in-home aged care services
9 July

Department of Health and Aged Care
Outline of the National Allied Health Workforce Strategy
9 July

NHMRC
Good institutional practice guide
10 July

TGA
Update to medicine labelling rules
11 July

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

Department of Health and Aged Care
Reclassification of Sports and Exercise Medicine Physicians as consultant physicians
5 August 

Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August


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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