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The Zap: don’t miss the latest on health and aged care, including long COVID, mental health – and a common policy failure

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.

Bookmark this link to follow the series.

The quotable?

Discrimination against patients based on race, ethnicity, or language is a serious problem that impacts care delivery and workforce morale.

Health systems can take steps to facilitate reporting and tracking of discrimination, review treatment of non-English-speaking patients, measure equity in outcomes and experiences, and train workers to identify and respond to racism.”


Charles Maskell-Knight writes:

I know I said this column wouldn’t report on Parliament, but I was expecting an announcement this week about a program to respond to alcohol misuse by members of parliament. It was not to be. Instead, there was the release of the Closing the Gap report, and the Government’s response to the Long COVID parliamentary inquiry.

Ministers and government

The big news item from the Government last week was the release by the Prime Minister of the Commonwealth Closing the Gap 2023 Annual Report and 2024 Implementation Plan. Drawing on Productivity Commission data released last July, the report showed that there was improvement in performance against Outcome 1 Everyone lives long and healthy lives and Outcome 2 Children are born healthy and strong, but they are not on track. Performance against Outcome 14 People enjoy high levels of social and emotional wellbeing was worsening.

A number of new health initiatives were announced, including funding to improve First Nations cancer outcomes, increase take-up of health assessments, establish 30 dialysis units in regional and remote locations, place a suicide prevention coordinator in each Primary Health Network, and expand the Tackling Indigenous Smoking Program.

All very well, but absent action to deal with the issues identified by the Productivity Commission last week on how governments address the issues, will anything really change?

The major health sector story emerging from the Government was the release by Health and Aged Care Minister Mark Butler announcing the Government’s response to the report of the House of Representatives inquiry into Long COVID. That inquiry took less than eight months (including the summer holidays) to conduct: the Government then took ten months to respond.

Has it been worth the wait? Probably not – the response includes quite a few “accept in principles”, which is the bureaucratic death knell for any prospect of actual action. The delay in releasing the response emerges comically in the statement that “the PBAC will again consider the PBS listings of both COVID-19 oral antiviral treatments in 2023” [emphasis added].

Leaving the timing aside, the response to the recommendation that pharmacists should be able to initiate antiviral treatment for COVID is bizarre. It has rejected the recommendation, saying that “the Government must comply with current legislation, which does not support pharmacists dispensing COVID-19 oral antivirals without a prescription or prescribing these medicines as pharmaceutical benefits”.

The point of the recommendation was that the Government should change the legislation to allow more timely access to antivirals without the need to secure a GP consultation.

Professor Kathy Eagar summed up the Government response in a tweet:

This response is a work of art. 20 pages full of bureaucratic buzz words like ‘consider’, ‘note’ & ‘monitor’. Plus some other weasel words.

What does the government actually commit to do? Well, nothing actually. Just BAU.”

Minister for Aged Care Anika Wells announced that the consultation period on the exposure draft of the new Aged Care Act had been extended to 8 March. She said that “the new Act is the next step in the Government’s improvements to aged care and it is essential the rights of older people are placed in the centre”. Just as long as it isn’t a right to high quality care or equitable access to services.

The Department of Health and Aged Care announced a consultation process on an impact analysis of options for updating the Food Standards Australia New Zealand Act 1991. This is the latest stage in a saga that began in 2019, when Ministers “endorsed an ambitious plan to reform the Bi-national Food Regulation System to ensure it remains strong, robust and agile into the future”.

Since then there has been “public consultation on a Scoping Paper across October and November 2020, draft Regulatory Impact Statement in April to May 2021, and targeted workshops with key government, industry, public health and consumer bodies in 2021 and 2023”. You just can’t rush these things.

The Australian Institute of Health and Welfare (AIHW) released or updated a number of reports on various aspect of mental health, including mental health services, the prevalence and impact of mental illness, mental illness and substance use, the physical health of people with mental illness, and stress and trauma. Taken together, the reports paint a depressing picture of our national mental health.

The AIHW also released a report on residential aged care quality indicators for the September 2023 quarter. While the headline figures show a welcome improvement in some indicators over time (the proportion of residents subjected to polypharmacy has declined from 41.0 percent to 34.4 percent over the last two years), other indicators have not changed much (the proportion of residents with pressure injuries is still just under six percent). And while there have been improvements in relation to physical restraint and use of anti-psychotics, over 17 percent of residents are still subject to each of these abuses.

The AIHW released a report on access to breast screening services which found that in 2021 over 90 percent of women lived within a 20-minute drive of a permanent or visiting BreastScreen Australia screening service.

The Australian Bureau of Statistics (ABS) has been trialling an experimental measure of household spending using bank transactions data. The latest release for December 2023 showed a year-on-year increase in spending on health of 10.2 percent, the highest of the nine expenditure categories included in the measure.

There is clearly lots of scope for further health measures to address the cost of living – capping specialist fees, anybody?

 Consumer and public health groups

The Melbourne Institute released the latest report on the Household, Income and Labour Dynamics in Australia (HILDA) survey, a nationally representative longitudinal study of Australian households. The report covers the period ending in 2021. The chapter on health by Professor Roger Wilkins is full of interesting information, including trends in serious illnesses among participants based on data collected every four years.

In relation to mental health, the report found “in 2021, females aged 15 to 34 had by far the highest proportion – 29.3 percent – diagnosed with depression or anxiety. In terms of changes between 2009 and 2021, most alarming is the rise in diagnosed depression and anxiety, which increased for males and females in all age groups but was especially pronounced among females aged 15 to 34, among whom it rose from 12.7 percent to 29.3 percent”.

Just under three-quarters of people suffering from depression or anxiety in 2021 were in regular contact with a doctor to manage their condition, a marginal decline from 2009.

Stephen Bates MP, the Greens spokesperson for youth, responded to the report, noting that the trend to worsening mental health began well before the COVID-19  pandemic and was because “young people feel disconnected, alienated and insecure in their work, relationships and home life”. Bates pointed to the Australian Greens’ “fully costed plan to tackle the mental health crisis in Australia by making mental healthcare free and unlimited for everyone who needs it as part of Medicare”.

CHOICE issued a media release with the results of its analysis of recent private health insurance premium increases, showing that insurers were increasing the premiums for gold cover at rates far higher than the average increase announced by the Government. We are still waiting for Minister Butler’s decision on the permitted increase to apply from 1 April.

COTA Australia announced that former Liberal Minister Christopher Pyne would replace Jane Halton AO, who has served as chair since 2017.

Australians for Mental Health released its pre-budget submission to the Federal Government, calling for the creation of a new Mental Health and Wellbeing Commissioner within the Australian Human Rights Commission. “The newly formed role would have the power to initiate investigations, compel witnesses, and refer matters for prosecution in a bid to drive more accountability from governments on their mental health performance.”

Trade unions

The Australian Medical Association (AMA) released a position statement on healthcare for people who identify as Lesbian, Gay, Bisexual, Trans and/or Gender Diverse, Queer, Intersex, Asexual, Sistergirl, and Brotherboy (LGBTQIASB+).

Among other things, the AMA called for the Government to “urgently enhance access to beneficial gender-affirming treatment… through appropriate avenues under the PBS and MBS; ensure that medical practitioners who provide gender affirming care to patients are protected and supported; and ensure that gender affirming care is treated no differently to other areas of care covered by medical defence organisations”.

The AMA’s position was welcomed by Equality Australia.

The Royal Australian College of General Practitioners (RACGP) had a busy week. It weighed into the payroll tax dispute in Victoria, claiming that a requirement to pay a 4.85 percent payroll tax would lead to 30 percent increases in GP fees. Returning to planet Earth, it announced that it was taking over responsibility for GP training in north Queensland from James Cook University.

The College supported moves to make Cytisine available in Australia as a smoking cessation aid. The drug has been widely used in eastern Europe for over 40 years, but has not been used much outside that region. The RACGP is concerned that sponsors will remove nicotine patches from the PBS later this year, once a further reduction to the wholesale price under the generic drugs policy takes effect.

The College also called for a new MBS item to pay for GPs delivering iron infusions. It is clearly not sensible for the system to be paying for same-day hospital admissions for this treatment, but before agreeing to pay GPs for this pro