Updates on immunisations, dementia, mental health, and anti-vaping legislation are covered in the latest edition of The Zap.
Health policy analyst Charles Maskell-Knight also examines a Productivity Commission report on healthcare productivity, as well as the benefits of being a left-handed surgeon.
Don’t miss the updated list of consultations and inquiries – please let us know of any new ones to add.
Meanwhile, the Government has still not released its response to the Provision of and Access to Dental Services in Australia inquiry – now eight weeks overdue.
The quotable?
At last, the [Productivity] Commission is focusing on value as well as cost.”
Charles Maskell-Knight writes:
Various health groups acknowledged 22 April as Earth Day.
In the United States, the Centers for Disease Control and Prevention posted on X (formerly Twitter) that protecting the environment also protects animals and people. “By caring for the Earth, we are caring for all.”
In Australia, the Australian Medical Association (AMA) posted on Facebook that “it is Earth Day today, and a timely reminder of our collective responsibility to protect and preserve the Earth for future generations”.
“Climate change is a health emergency, with clear evidence of severe health impacts for people and communities.”
Assistant Minister Ged Kearney marked the day by announcing that Australia had signed a “public statement of collaboration” with the US and the UK to decarbonise healthcare supply chains.
While the health system is currently responsible for around five percent of Australia’s carbon emissions, about three-quarters of this comes from imported medicines and health technologies.
Kearney said that “reducing carbon emissions from the production and supply of healthcare goods and services is a very effective way to make healthcare greener”.
Ministers and government
Assistant Minister for Health and Aged Care Ged Kearney spoke at the opening of the World Health Summit Regional Forum in Melbourne. Croakey’s rotated @WePublicHealth account on X followed the action using the hashtag #WHSMelbourne2024.
Kearney also attended a media conference on vaping at the Regional Forum together with World Health Organization Regional Director Dr Saia Ma’u Piukala and VicHealth CEO Dr Sandro Demaio.
VicHealth launched the UNCLOUD – Warn Others campaign, featuring warnings from young people to their peers of the dangers of vaping and vaping addiction.
Health and Aged Care Minister Mark Butler announced that pharmacists would be funded to provide free flu and other National Immunisation Program (NIP) vaccines in aged care and disability homes from 29 April.
The move was welcomed by the Pharmaceutical Society of Australia and the Pharmacy Guild.
Butler also announced that a joint operation between the Therapeutic Goods Administration and Victoria Police had “identified and detained nearly 500,000 vapes suspected of being unlawful”.
The use of telehealth services in Australia has grown from almost nothing pre-COVID to the point where 25 percent of people received a telehealth service last year.
Butler announced six grants to different groups to “to develop a solid evidence-base that can inform future health policy on telehealth”.
In non-announcement news, the Government has still not released its response to the Senate dental inquiry, which is now eight weeks overdue.
Two weeks ago (on 10 April) the Department of Health and Aged Care told Croakey:
the Government is finalising its response to the Senate Select Committee into the Provision of and Access to Dental Services in Australia. This is due to be tabled shortly”.
According to the Senate’s resolution of 14 March 1973, the response was actually due to be tabled on 29 February! Anyway, watch this space – but don’t hold your breath.
Chief Medical Officer Professor Paul Kelly used World Vaccination Week (24-30 April) to remind everyone to book their annual flu vaccination.
The Australian Institute of Health and Welfare released the results of the Dementia Awareness Survey commissioned by the Department of Health and Aged Care.
The survey found that people with higher incomes, better education, or exposure to the disease knew more about it and that increased knowledge led to reduced stigmatisation of people living with dementia.
Just as we all speak prose without knowing it, almost all (99.6%) Australians engage in one or more behaviours that reduces their risk of the dementia – including being physically, cognitively, and socially active, controlling high blood pressure, and eating a Mediterranean diet – without realising the protective effect these have.
The Therapeutics Goods Administration opened a consultation on proposed amendments to the Poisons Schedule. While these amendments are often technical in nature and attract little public attention, this round includes a proposal to down-schedule sildenafil (aka Viagra) from Schedule 4 prescription-only to Schedule 3, so it can be provided by pharmacists.
The Productivity Commission released a report on research showing that “Australia’s healthcare system delivers some of the best value for money of any in the world”.
Commissioner Catherine de Fontenay said that for the first time, quality had been considered in the assessment of productivity.
“Previous research assessed the productivity of our healthcare system by looking at how much it costs to provide a service, such as a visit to hospital. This research looks at how much it costs us to treat a particular disease and the outcomes of treatment.
“Looking at the outcomes our system creates for patients provides a much truer picture of its productivity. A healthcare system that gets people in and out of hospital quickly and cheaply isn’t much good if those patients aren’t getting better.”
At last, the Commission is focusing on value as well as cost.
The Australian Bureau of Statistics released the latest data on people in Australian prisons. In 2022-23 the total number of people in prison increased by three percent, but the imprisonment rate increased by one percent. Almost 40 percent of people in prison have not yet been sentenced.
The number of First Nations people in prison increased by seven percent, while the imprisonment rate increased by a staggering five percent. As a result, 2.4 percent of the First Nations adult population are now incarcerated, accounting for a third of the prison population.
And still the major political parties at a state level engage in “tough on crime” bidding wars, promising to lock more people up for longer (see for example here, here and here).
The ABS also released the March quarter Consumer Price Index, with an overall increase of 1.0 percent over the quarter, and an annual 3.6 percent. The health component increased 2.8 percent over the quarter, and an annual 4.1 percent.
Of course, this does not yet reflect the completely unnecessary rise of three percent in private health insurance premiums which took effect on 1 April.
First Nations health
The National Indigenous Times reported that a group of First Nations mental health groups had issued a joint call for urgent investment by governments in “social and emotional wellbeing and mental health supports for Indigenous children in state care”.
The group said that “in the 16 years since Kevin Rudd’s Apology to the Stolen Generations, removals of Indigenous children have tripled, with First Nations children now representing more than 40 percent of the total population of all children who have been removed from their parents, but only six percent of the total population of children in Australia”.
Indigenous Allied Health Australia Chief Executive Officer Donna Murray said “we don’t need another inquiry or Royal Commission – what we need is action. We need to break the cycle of injustice, and that starts with providing Indigenous children with the wellbeing support they need to live well in their communities”.
Consumer and public health groups
The Alcohol and Drug Foundation expressed disappointment at a decision by the Victorian Government not to trial a medically supervised injection room in Melbourne’s CBD, despite a report by former police commissioner Ken Lay which stated that “there is a continuing and clear need to establish a supervised injecting service trial in the City of Melbourne”.
The State Government said “it had been unable to identify a suitable site that balances the needs of people who use drugs with the needs of the broader CBD community”.
However, it announced a range of other harm reduction measures, including 20 naloxone vending machines to be trialled alongside existing needle exchanges and a hydromorphone treatment trial starting in 2026.
Mental Health Australia announced that board Chair Matthew Berriman had resigned.
Berriman said he remained “driven by a desire to ensure that one day equitable and easy access to good mental health support and services will be considered an unquestionable basic human right, and an integral part of how our society functions”.
In an interview with the ABC, Berriman was more forthcoming, saying he resigned because the Federal Government was not doing enough: “I don’t think over the last 20 years mental health has been addressed in this country and the Labor government promised that was going to happen and it hasn’t”.
Trade unions
The Australian Medical Association (AMA) issued a media release urging Australians to book their annual flu vaccination, and a COVID-19 booster shot if one was due.
President Professor Steve Robson said it would be understandable if many Australians had a sense of “vaccine fatigue” after the pandemic, but flu shots were “absolutely the best and easiest way to protect yourself and the ones you love from serious illness”. The flu vaccine and a COVID booster could be given on the same day.
The Pharmaceutical Society of Australia welcomed the announcement by Queensland Health Minister Shannon Fentiman of the start of the Community Pharmacy Scope of Practice Pilot. The Pharmacy Guild also supported the pilot.
Under the pilot, appropriately trained pharmacists will be able to carry out autonomous prescribing for a range of conditions such as gastro-oesophageal reflux; acute nausea and vomiting; rhinitis; impetigo; herpes zoster; acute wound management; and otitis media.
They will also be able to provide smoking cessation therapy, hormonal contraception, and travel health services, and carry out oral health screening and fluoride application.
Only ten pharmacists are eligible at present, but a further 290 are expected to complete their training over the next few weeks.
The Medical Republic has an excellent article on the pilot, including the predictable pushback from medical unions.
The Royal Australian College of General Practitioners warned the Government that it needed to do more in the upcoming Federal Budget to “improve access to essential care for Australians grappling with the cost-of-living crisis [by] reducing out-of-pocket medical costs for patients”.
The College wish-list for increased spending now includes:
- a 20 percent increase to rebates for longer consultations and for mental health consultations
- funding for practices to employ other health professionals
- funding to support coordinated care for older Australians requiring complex care
- new MBS items for annual health checks for children up to five-years-old, and for patients to see a GP within a week of an unplanned hospital visit.
The RACGP also issued a media release on Anzac Day calling for changes to veterans’ health programs. It wants the Coordinated Veterans’ Care (CVC) Program expanded to cover all White Card holders aged over 50 with a chronic condition, together with higher indexation for Department of Veterans Affairs (DVA) medical fees.
It also recommended that DVA “introduce a GP awareness campaign to promote the [CVC] program. Many GPs are currently unaware of DVA support to provide wrap-around care for veterans. Greater awareness of this valuable program among GPs will improve access to care for patients who need it”.
I’m sure that is all true, but I don’t see why the College can’t use its regular communications with members to lift awareness of the program.
The Rural Doctors Association of Australia announced the resumption of birthing services at Weipa Hospital, 25 years after maternity services were closed. While the physical infrastructure has been ready for some time, staffing problems had delayed the opening.
The collaboration on healthcare supply chain decarbonisation announced by Assistant Minister Ged Kearney was welcomed by the Society of Hospital Pharmacists of Australia (SHPA).
Industry groups
This column recently reported on Australian Pathology’s campaign to increase Medicare rebates for pathology services to “keep pathology bulkbilled”.
In an article in The Conversation republished by Croakey, Professor Stephen Duckett explains why this is a bad idea. He concludes “paying more to private providers under a payment system that has passed its use-by date is not good policy. That’s despite its simplistic attraction and advocacy from vested interests”.
Catholic Health Australia (CHA) published an article arguing that the Government should require private health insurers to pay a minimum level of benefits for hospital-in-the-home (HITH) treatment.
It claimed that “the insurers themselves have noted that there is $1.3 billion in potential savings for the health system being left on the table every year that HITH is not expanded. But after two decades left to expand HITH funding on their own terms, they have failed dismally to support this critical care pathway for patients”.
The problem for the insurers is that while they may save $1.3 billion on HITH patients who were previously inpatients, absent some powers of utilisation control the hospital beds that those patients were using will be filled by new patients.
Insurers will thus finish up paying for existing levels of activity, as well as the cost of expanded HITH services. And giving any sort of powers of utilisation control to insurers will see the AMA raising the bogeyman of “US-style managed care”.
Perhaps CHA member hospitals could reassure insurers by undertaking to close a bed for every thousand HITH admissions they provide?
Medicines Australia issued a media release claiming that the Productivity Commission report on productivity in healthcare offered “irrefutable evidence” that faster access to new medicines is needed.
Now it is true that the Commission identified improvements in pharmaceuticals as a major contributor to better outcome for many diseases, particularly cancer.
And it is also true that the Commission said “more timely approval processes for pharmaceuticals and other medical technologies would help ensure that the diffusion of new treatments remains a positive contributor to productivity growth”.
However, the evidentiary basis for this claim is inductive rather than empirical. The report does not examine or discuss at any point the current approval processes and any problems they may have.
According to the Government, “the average time to listing [on the PBS] in 2021-22 was 101.8 days (3.4 months)”.
How much faster can it get, while still allowing time for a proper consideration of cost-effectiveness and a price negotiation process that protects the interests of taxpayers?
Politicians and parliamentary committees
Shadow Health Minister Anne Ruston used the resignation of Matthew Berriman as chair of Mental Health Australia to attack the Government for its record on mental health.
Pointing out that Budget night will mark 500 days since the Government cut the maximum number of psychologist sessions under the Better Access initiative from 20 to 10, she said:
since then, Labor has failed to introduce a single new measure to directly improve Australian’s affordable access to mental health support. It is a serious concern that Labor’s next Budget will continue this harmful trend”.
In a rare example of policy specificity, Ruston committed to “re-establishing the full 20 Medicare-subsidised psychology sessions that were cut by Labor if elected”.
Senator Jordan Steel-John also issued media releases referring to Matthew Berriman’s resignation as chair of Mental Health Australia, but going on to attack the Government for spending money on weapons systems rather than mental health services.
The Senate committee inquiry into the Government’s anti-vaping legislation has now received 101 submissions. It announced it would hold public hearings in Canberra on 1 and 2 May. At the time of finalising this column, a program for the two days had not been disclosed.
International organisations
The World Health Organization foreshadowed an article in The Lancet estimating that over the past 50 years global immunisation efforts have saved an estimated 154 million lives, including the lives of 101 million infants.
The measles vaccine alone saved almost 94 million lives, while polio vaccinations have saved about 20 million people from partial paralysis.
Finally
Have you ever noticed whether a health professional treating you is right- or left-handed?
The BMJ this week published an article by medical student Chloe Milton, claiming that Medicine is designed for righthanded people.
After battling for four years with a training environment designed for the right-handed, Milton spoke to a left-handed surgeon who said that “being left-handed was in fact an advantage in medicine and… that left-handed individuals may show a greater degree of ambidexterity than their right-handed peers, from having had to use their non-dominant hand regularly”.
It turns out that there is a considerable literature on the subject of handedness, medical training, and specialisation, including one study showing 64 percent of a (small) sample of plastic surgeons were left-handed.
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
National strategic framework for chronic conditions
29 April
Aged Care Quality and Safety Commission
Strengthened Aged Care Quality Standards guidance
30 April
Therapeutics Goods Administration
Clinical decision support system software regulation
6 May
Australian Commission on Safety and Quality in Health Care (ACSQHC)
Aged Care Infection Prevention and Control Guide
15 May
Department of Health and Aged Care
Minimum stockholding requirements for PBS drugs
17 May
Therapeutics Goods Administration
Amendments to the Poisons Schedule
22 May
Scope of Practice review
Issues paper 2
26 May
Therapeutics Goods Administration
Instructions for Use for Medical Devices
28 May
NHMRC and CHF
Review of the 2016 Statement on Consumer and Community Involvement in Health and Medical Research
31 May
Department of Social Services
Developing the National Autism Strategy
31 May
Chinese Medicine Board of Australia
Patient health records guidelines
5 June
Therapeutics Goods Administration
Proposed changes to the regulation of exempt medical devices and exempt other therapeutic goods
9 June
Therapeutics Goods Administration
Companion diagnostics guidance update
17 June
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.
