The Zap this week examines inaction on mental health policy, recommendations to improve access to primary care across rural and remote Australia, and the Scope of Practice Review.
It also covers new efforts to address the widespread misuse and overuse of psychotropic medicines in the aged care and disability sectors, and a recommendation for the terminology of “podiatric surgeon” to be replaced by “surgical podiatrist”.
Columnist Charles Maskell-Knight notes some colourful language among lobby groups, and indulges in some wishful thinking on chocolate.
The quotable?
Despite all these meetings, there have as yet been no policy outcomes. Little wonder the Assistant Minister for Mental Health and Suicide Prevention can’t find anything substantive to put in a speech.”
Charles Maskell-Knight writes:
For many Australians, last week was a four-day working week because of the Good Friday public holiday. Parliament went one better and sat for only three days, rising on Wednesday to allow members time to get home for the Easter weekend. It will not meet again until the Budget on 14 May.
While the bureaucracy kept producing reports and releasing statistics, many health and aged care groups had a quiet week.
Ministers and government
Assistant Minister Ged Kearney announced that the National Health and Medical Research Council would be making available $5 million for research into climate-related health impacts and effective interventions to improve health outcomes. As Kearney said, the World Health Organization (WHO) has described climate change as the greatest threat to global health this century.
Perhaps rather more than $5 million would be justified?
Assistant Minister Emma McBride gave a banal speech to the Sydney Mental Health Policy Forum. She said “more work needs to be done so that all Australians can access the mental healthcare they need, when they need it. This has been the central focus of the Mental Health Advisory Committee, bringing together leaders from across the mental health policy and service delivery spheres”.
It is now well over a year since the evaluation of the Better Access program was completed. Following its release, the Government convened a Mental Health Access and Equity Forum on 30 January last year (attended by McBride, Minister Mark Butler and 80 other people from across the mental health sector), “focused on how to make mental health services more affordable and accessible to those that need them”.
While the 2023 Budget announced $556 million in additional mental health funding, Budget Paper 2 makes it clear that only $36 million a year is ongoing funding, and that is to “support the mental health of survivors of torture and trauma before moving to Australia on humanitarian grounds”.
In other words, there was no additional ongoing funding for mainstream services.
Then the Mental Health Advisory Committee, chaired by Minister Mark Butler, held its first meeting in September last year “to discuss what needs to be done to improve the mental health system and respond to the Better Access evaluation”. The Committee met three more times last year, with the minutes of the November meeting stating that “the advisory committee is expected to meet early in 2024 to continue discussions”.
Despite all these meetings, there have as yet been no policy outcomes. Little wonder the Assistant Minister for Mental Health and Suicide Prevention can’t find anything substantive to put in a speech.
Wearing her other hat (an Akubra?) as Minister for Rural and Regional Heath, McBride received the Best for the Bush, Rural and Remote Health Base Line report from the Royal Flying Doctor Service (RFDS).
As well as setting out the all too familiar statistics about the worse health status and service access in regional and remote Australia, the RFDS made a series of recommendations:
- the Government should establish an agreed definition of reasonable access to primary care and develop a detailed plan to deliver across rural and remote Australia
- work with the states to substantially expand funding to provide more adequate and equitable levels of primary healthcare to rural and remote communities
- allocate dedicated funding for health promotion initiatives and activities for rural and remote Australians.
It also called for “a National Compact on Rural and Remote Health [serving] as a transparent inter-governmental agreement between the Commonwealth, States and Territories that ensures the agreed level of reasonable access to primary healthcare, oversees the rural and remote primary healthcare care plan and commits necessary funding to improve health outcomes for those living in rural and remote Australia”.
McBride didn’t respond to any of these ideas.
The Scope of Practice review led by Professor Mark Cormack released a two-page update on progress. (While this is a welcome sign of transparency by the Department of Health, it could have done even better by posting the statement on the news page, rather than requiring interested readers to traverse the trackless wastes of the health.gov.au website to find it.)
Following release of the first Issues Paper in January, Cormack has been holding discussions and consultations with a wide range of groups across the country.
The review intends to release a second issues paper with potential policy solutions in April, to be followed by further engagement with the sector through June and July, leading up to a final report.
Nobody will be able to complain that they didn’t have an opportunity to be heard – but that won’t stop people complaining about the recommendations when they emerge.
In the first few months of last year the TGA undertook a public consultation process on improvements to the therapeutic goods recall process. It has now released a new version of the Uniform Recall Procedure for Therapeutic Goods, with improvements designed to reduce unnecessary regulatory burden and improve clarity.
Recalls are relatively rare, and of the dozen or so carried out in the last six months, none have involved prescription medicines. Several have involved bacterial contamination in ostensibly sterile eyewash and wound irrigation products, one involved lead in a Chinese medicine, and one involved high pyridoxine levels in a magnesium supplement.
It is important for public health and safety that the recall process work expeditiously and effectively, and the new procedures should assist in this.
The Australian Institute of Health and Welfare (AIHW) released the monthly Medicare Benefits Schedule (MBS) statistics, now including February 2024 data. Despite the substantial increase in bulkbilling incentives for GP services in the 2023 Budget, the proportion of GP fees met by Medicare has now declined to 83 percent, the lowest since Medicare began. The proportion of fees for specialist attendances paid by Medicare has now declined to 50 percent – again, the lowest ever.
The AIHW also released its bi-annual update of Dementia in Australia, largely confirming past trends.
The Australian Bureau of Statistics (ABS) released provisional mortality statistics for 2023, showing deaths registered to the end of February this year were 4.6 percent lower than the previous year. ABS noted that the monthly mortality rates were lower for every month compared with the previous year, with the “difference [being] particularly noticeable in January, July and August, which coincide with peaks in Omicron waves in 2022”.
Deaths due to COVID-19 declined from 9,840 in 2022 to 4,387 in 2023.
Ahpra announced the results of a review of the regulation of podiatric surgeons by Professor Ron Paterson ONZM. Podiatric surgeons are podiatrists who have undergone training in the surgical management of conditions such as bunions, hammertoes, flat or high arched foot deformity, bone spurs, and arthrosis of the foot and ankle.
The review found that “there was no evidence of a need to reduce or regulate the scope of practice for podiatric surgeons, but recommended measures to align some aspects of the accreditation assessment of podiatric surgery education programs and ongoing training more closely with that of medical practitioners”.
It also recommended that the term “podiatric surgeon” be replaced by “surgical podiatrist”, to make it clearer to consumers that practitioners are podiatrists and not medical practitioners. The Australian Medical Association (AMA) supported this proposal, claiming it came after years of advocacy by the organisation.
The Podiatry Board will now begin a consultation process about the recommendations.
The Australian Commission on Safety and Quality in Healthcare (ACSQHC) is undertaking a public consultation on an update to the Requirements for Medical Pathology Services. The draft of the proposed updated requirements is here, and comments are due by 26 April.
The ACSQHC also announced the launch to take place on 9 May of a “clinical care standard to reduce the inappropriate use of psychotropic medicines in people with cognitive disability or impairment, particularly when used for managing changed behaviours or behaviours of concern”.
Following the Aged Care Royal Commission and the Disability Royal Commission, which both found widespread misuse and overuse of psychotropic medicines in the sectors they examined, the ACSQHC together with the aged care and NDIS regulators announced in March 2022 that they would work together to “to reduce the inappropriate use of psychotropic medicines as a form of restrictive practice”.
Register here for the event on 9 May.
First Nations health
In his media release following the National Aboriginal and Torres Strait Islander Health Ministers Round Table on 22 March, Minister Mark Butler said that the administration of the Puggy Hunter Memorial Scholarship Scheme was to be transferred to First Nations control.
Indigenous Allied Health Australia (IAHA) will partner with the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners and the Rural Doctors Network to lead the program from the middle of the year.
Kamilaroi woman and IAHA Chairperson, Nicole Turner, said “many of our members have benefited in their studies as Puggy Hunter Memorial Scholarship recipients and IAHA is excited to work in partnership to support the next generation of the Aboriginal and Torres Strait Islander health workforce”.
Consumer and public health groups
CEO of the National Rural Health Alliance Susi Tegen spoke to the National Indigenous Radio Service (Bumma Bippera Media) in support of the Close the Gap Campaign Report 2024.
She also backed the RFDS Best for the Bush report, saying “we stand with the RFDS in its recommendations for expanded health funding that would help remove barriers to healthcare access. It’s important to agree on a definition for ‘reasonable access’ to health care. The Alliance and others are working to develop minimum standards for healthcare access and we’re keen on taking this project forward with the Government”.
Trade unions
It is always hard to make a media release stand out, and perhaps that explains why the health unions have been resorting to colourful language recently. The week before last the Australian College of Nursing welcomed the “unleashing” of nurse practitioners and endorsed midwives; and last week the Royal Australian College of General Practitioners (RACGP) announced that a delegation of 20 GPs had “descended” on Parliament House.
According to the College, the GPs were going to “meet with Ministers, Senators and parliamentarians of all political stripes [and] attend Question Time, a briefing with the House Committee on Health, Aged Care and Sport, breakfast with the Parliamentary Friends of General Practice group, and a roundtable on climate change… among other activities”.
The College supported the announcements by the NSW and Queensland governments to offer free RSV (respiratory syncytial virus) vaccination for all infants (Queensland) and at-risk groups (NSW).
The College also released a set of statistics on GP training, showing that 80 to 90 percent of GP registrars were satisfied with various aspects of their training, and that over 80 percent of GPs training as rural generalists said they intended to remain in rural practice. The College also said that incentives to attract doctors to train in mainly rural areas of need were also working, with 114 “incentivised” placements filled in those areas.
Sixty members of the Australian Nursing and Midwifery Federation (ANMF) also went to Canberra (they did not “descend”) to tell parliamentarians about the failure of aged care providers to comply with the minutes of care regime recommended by the Aged Care Royal Commission and introduced last year. Secretary Annie Butler said many providers were cutting corners while failing to meet the standards, replacing enrolled nurses with less qualified staff, and asking care work to perform non-care tasks such as serving meals and washing up.
I wish I could say that the Minister, the Department, and the regulator were all over this – but there have been no signs of action in any of those quarters yet.
The Canberra Times published an op-ed (paywalled) from AMA President Professor Steve Robson strongly supporting the Government’s anti-vaping legislation. He concluded:
I urge Australia’s political leaders to heed the evidence and the advice from your health leaders.
We have a chance to protect young Australians and stop this unhealthy profit-driven scourge. Let’s see this important and world-leading legislation passed so we can truly claim a public health success.”
The Rural Doctors Association of Australia issued a media release with tips on driving “egg-stra safe” this Easter.
The Pharmaceutical Society of Australia (PSA) called on governments to make permanent the continued dispensing measures, which are due to expire on 31 March. The measures allow pharmacists to “issue a single supply of a medicine when a patient cannot get in contact with their usual prescriber”, and can assist patients in circumstances ranging from “personal emergencies to natural disasters”.
Industry groups and providers
The Members Health Fund Alliance (the lobby group for private health insurers which can’t distribute profits) announced that the latest State of the Health Funds Report 2023 from the Commonwealth Ombudsman showed customer retention among Alliance members at 87 percent, compared with 84 percent for the rest of the industry.
The report is available from the Ombudsman’s website.
Politicians and parliamentary committees
The Greens announced a reshuffle, necessitated by Senator Janet Rice’s imminent resignation from the Senate. (Croakey published her valedictory speech here.) Her responsibilities for aged care will be taken over by Queensland Senator Penny Allman-Payne. Health remains with Senator Jordon Steele-John, whose most recent media release on a health issue came out four months ago.
On 19 October last year the Senate agreed to a motion from Senator Malcolm Roberts directing the Senate Legal and Constitutional Affairs Committee to inquire into and report by 31 March 2024 on “the appropriate terms of reference for a COVID-19 Royal Commission that would allow all affected stakeholders to be heard”. The inquiry received 79 submissions, and the committee conducted two hearings.
This week the light finally dawned that the nominated reporting date was not only a Sunday, but Easter Sunday, and the reporting date was changed to 19 April.
International organisations
The WHO marked World Tuberculosis Day on 24 March (the 142nd anniversary of the day on which German doctor Robert Koch announced his discovery of the tuberculosis bacterium). The theme for the day “Yes! We can end TB!” is intended to “convey a message of hope that getting back-on-track to turn the tide against the TB epidemic is possible through high level leadership, increased investments and faster uptake of new WHO recommendations”.
While Australia has a relatively low incidence of TB, the most recent report I can locate from the Communicable Disease Network Australia observed that due to our migration pathways “it is likely that the greatest reduction in Australia’s TB incidence rates will be achieved through the improvement of TB control globally, in particular in the Western Pacific and South-East Asian regions”.
On 24 March, Foreign Affairs Minister Penny Wong and Minister for International Development and the Pacific Pat Conroy announced that Australia would contribute $17 million to the Global Alliance for Tuberculosis to develop more effective treatments for tuberculosis and help deliver them in countries including Indonesia, Philippines, Vietnam, and Papua New Guinea.
Government action following expert advice? Well, I never!
Finally
For people who haven’t finished their Easter eggs yet, this 2021 meta-analysis of the health effects of chocolate and cocoa consumption published in Nutrients by Tan et al. might offer a little encouragement. The study found that “compared to controls, chocolate or cocoa product consumption significantly improved lipid profiles (triglycerides)”.
Unfortunately, that’s all the good news, as the analysis found “no significant difference between the effects of chocolate and control groups on parameters related to skin, blood pressure, lipid profile, cognitive function, anthropometry, blood glucose, and quality of life regardless of form, dose, and duration among healthy individuals”.
So chocolate won’t help you think better – but I’m sure many of us think we are thinking better after a couple of squares of the dark stuff.
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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