This week brings a new feature at The Zap, in response to reader feedback: a list of consultations that we hope will be helpful for Croakey readers. Please keep us updated of any new ones to add.
Charles Maskell-Knight also reviews concerns about spinal surgery and aged care reform, brings the latest data on food consumption trends, and reports that the Australian College of Nursing has been “in the news for all the wrong reasons”.
Meanwhile, which medical organisation has been called out for using an “aeronautical oxymoron”?
The quotable?
Too often, patients are funnelled towards surgeries including spinal fusion and the insertion of spinal cord stimulators without being fully assessed and informed.
In many situations, safer, less invasive evidence-based interventions are appropriate or should be trialled before there is any consideration of these invasive procedures.”
Charles Maskell-Knight writes:
Sunday 7 April was World Health Day – the 76th anniversary of the formal establishment of the World Health Organization (WHO) when the 26th nation ratified its constitution.
The theme for this year was “My health, my right”, chosen by the WHO to “champion the right of everyone, everywhere to have access to quality health services, education, and information, as well as safe drinking water, clean air, good nutrition, quality housing, decent working and environmental conditions, and freedom from discrimination”.
While over 140 countries recognise health as a human right in their constitutions, WHO estimates that at least 4.5 billion people were not fully covered by essential health services in 2021.
Foreign Affairs Minister Penny Wong and Minister for the Pacific Pat Conroy marked the day by issuing a media release announcing aid of $45 million for six projects across the south Pacific including training for essential health workforce skills, support to improve disease surveillance and response, and funding to strengthen health information systems.
However, the day was not recognised publicly by Health Minister Mark Butler or any of his health portfolio colleagues.
The Climate and Health Alliance organised a webinar to mark the day, addressed among others by Susi Tegen, CEO of the National Rural Health Alliance. Another webinar was organised jointly by Monash University and Beyond Blue, focusing on the link between planetary health and mental health.
Spinal surgery
The really big story in Australian healthcare last week was the Four Corners program on Monday 8 April investigating spinal surgery, particularly the use of surgically implanted spinal column stimulators and spinal fusion. The report suggested poor medical practice and fraudulent billing, and prompted reactions from a wide range of groups.
The Consumers Health Forum, Arthritis Australia and Chronic Pain Australia issued a joint statement calling on “the Australian Government to launch an inquiry into the chronic pain management sector and management of musculoskeletal conditions so that all Australians can be confident that patients’ best interests and safety are prioritised when treating chronic pain. The inquiry should also examine evidence-based ways Australians can manage their pain and ensure that taxpayer money is being well spent”.
PHA (Private Healthcare Australia, the private health insurers’ lobby group) issued a statement saying that it would “immediately ask payment integrity experts within our [insurers] to investigate allegations of fraud, waste and abuse in spine surgery for back pain. We expect the Department of Health and Aged Care will launch its own investigation as a matter of urgency and we’ll be seeking confirmation of this.”
The Australian Society of Anaesthetists issued a statement criticising allegations in the program of incorrect claims by anaesthetists.
Dr Mike Selby, a spine surgeon and consultant to Stryker Spine and LifeHealthcare, posted a lengthy statement on LinkedIn responding to the program. He wrote “it must be emphasised that paralysis and death from spinal cord stimulators and spine surgery are still rarer than death or major disability from road traffic accidents over a 10-year period”.
I’m sure that is true. I’m also sure that almost 100 percent of the population is exposed to the risks of road traffic accidents, while only several-tenths of one percent of the population are exposed to the risks arising from spinal surgery.
The TGA announced a post-market review of spinal cord stimulation devices to: “reassess the safety and performance of the devices, with the current real-world evidence that is now available for the intended purposes for which they are to be used”; ensure that the devices meet the “essential principles” for medical devices; and “confirm these devices remain safe for use whilst demonstrating that their intended purpose is achieved throughout the lifecycle of the device”.
The Medical Technology Association of Australia issued a statement defending the record of spinal cord stimulation (SCS) to target chronic pain. It said: “We firmly stand behind the evidence that supports the availability of SCS (spinal cord stimulation) for Australians with chronic pain and share the concerns from pain experts and leading pain clinical and patient organisations on the limitations of the Cochrane Review…
“The methodology of [the Cochrane] meta-analysis provides a limited view of the evidence landscape for SCS and ignores several other data sources such as long-term multi-centre comparative trials, more pragmatic studies and real-world evidence. In order to truly assess long-term safety and effectiveness of a therapy the totality of the evidence must be considered”.
The following day PHA issued a further statement calling for “the immediate recall and suspension of spinal cord stimulators to protect public safety, pending an investigation by the Therapeutic Goods Administration”. It cited the Cochrane Review which concluded “for people with low back pain, we are moderately confident that, at six months, spinal cord stimulation probably does not lead to lower pain, better function, or higher quality of life compared with placebo”.
The Australian Physiotherapy Association joined the discussion, reporting on a “flash poll” of members which found “over 90 per cent of physiotherapists said they have treated patients suffering after unnecessary and potentially harmful surgeries”.
Chair of the APA’s national Pain group, Dr Tim Austin, said: “Too often, patients are funnelled towards surgeries including spinal fusion and the insertion of spinal cord stimulators without being fully assessed and informed. In many situations, safer, less invasive evidence-based interventions are appropriate or should be trialled before there is any consideration of these invasive procedures.”
Readers interested in this issue should also refer to an article in The Conversation by Professor Ian Harris and colleagues. They conclude that “if we were to remove funding for expensive, harmful and ineffective treatments, more funding could be directed towards effective ones”.
Ministers and government
Minister Mark Butler issued a media release and held a press conference with Minister for Education Jason Clare about vaping in schools and a program developed by the Matilda Centre at the University of Sydney to address the issue. The Our Futures vaping program has been trialled in 250 schools with highly successful results. (See here for a related Croakey article.)
Aged Care Minister Anika Wells announced that data from the December 2023 quarter showed aged care homes delivered an average of 201.93 care minutes per resident per day, including 38.76 minutes from a registered nurse.
This is the first quarter of data following the introduction on 1 October 2023 of a requirement to deliver an average of 200 direct care minutes per resident per day, including 40 minutes of care by a registered nurse.
The fact that the average home is failing to deliver the required 40 minutes per day of nursing time has not stopped well over ninety percent of homes receiving three or more stars under the star rating system. One could be forgiven for thinking the star rating system isn’t working properly…
Assistant Minister Malarndirri McCarthy and Minister for Indigenous Australians Linda Burney announced that Central Australian Aboriginal Congress was providing better health services to First Nations people in Central Australia with a new custom built 4WD mobile clinic to support the treatment, education and management of diabetes in remote communities.
The Government’s response to the Senate dental inquiry is now six weeks overdue. Partly to fill the gap, Croakey held a webinar on 6 April on tackling oral health inequities. Just under 100 people participated, a sign of how much interest there is in the topic.
Speakers presented their views from a number of different perspectives, and a lively discussion followed. Croakey’s managing editor Alison Barrett reported on the webinar as it took place in this X thread, and presented a fuller account in this longer article.
Ahpra announced that “just 18 months after having established its Cosmetic Surgery Enforcement Unit, the Australian Health Practitioner Regulation Agency has worked with National Boards to complete its 200th cosmetic surgery and cosmetic practices notification about practitioners”. However, only “around nine percent” of these completed notifications have led to regulatory action for the practitioners involved.
Ahpra said it was still managing 315 notifications about 127 cosmetic practitioners, including “long and highly complex investigations into 15 practitioners subject to a combined 180 notifications”.
The Australian Bureau of Statistics released statistics on Apparent Consumption of Selected Foodstuffs for 2022-23.
Australians each bought 3.9 percent less food than the previous year, a daily drop per person of 63 grams or 337kj. Vegetable consumption dropped 14 grams per person per day, fruit 12 grams, and milk products 11 grams.
However, over the last five years consumption of some foods has increased, including potato chips (up 16 percent), chocolate (up 10 percent), and cereals and convenience meals (up 9 percent).
The good news was that “people are continuing to have fewer sugar-sweetened beverages, falling from a peak of 145 mL in 2020-21 to 134 mL per person per day in 2022-23”.
But as a later item in this column shows, the bad news is that the sugar content in at least some of those drinks is increasing.
First Nations health
The Central Australian Aboriginal Congress announced the launch of the Alukura midwifery service. The design was “based on the success of the Indigenous Birthing in an Urban Setting (IBUS) prospective cohort study in South-East Queensland” reported in The Zap last month. The IBUS model showed a reduction in the odds of pre-term birth of 38 percent, as well as substantial cost savings.
Congress CEO Donna Ah Chee said “given how important a healthy birth weight it is to lifelong health and the prevention of chronic diseases we are very confident that this new [service] will help to Close the Gap in Aboriginal Life Expectancy”.
Consumer and public health groups
The week beginning 8 April was Global Public Health Week, during which the World Federation of Public Health Associations aims to “engender discussion on the best practices and missing gaps fundamental to disease prevention and the promotion of health and wellbeing”.
Croakey’s @WePublicHealth followed the action, sharing links to webinars and events around the world; a summary will be published at Croakey in coming days.
National Seniors Australia published an article by CEO Chris Grice on aged care funding. He set out a number of principles for the Government to consider:
- continued consultation on changes to funding arrangements, especially co-contributions
- changes to co-contributions should be reasonable and incremental, and not apply to current recipients
- improved transparency and accountability to ensure funding is spent wisely and efficiently, and in particular, “providers should be required to open their books to forensic auditing to restore confidence in their management of funding”
- “care services should be of the highest quality for all older people accessing aged care, regardless of their ability to co-contribute”
- multi-partisan support for funding reform.
Trade unions
The week beginning Monday 8 April was National Dietitians Week. During the week Dieticians Australia released a guide to the evidence “on how nutrition therapy can be harnessed to tackle the spectrum of mental health challenges faced nationwide”.
DA President Tara Diversi called on the Government “to create avenues through Medicare and other funding programs to support Australians with depression, mood disorders and severe mental illness to access individual and group consultations with Accredited Practising Dietitians as part of a holistic and truly multidisciplinary approach to care”.
The Royal Australian College of General Practitioners RACGP welcomed news that the NSW safe injecting room in Kings Cross would be carrying out a pilot pill-testing service, to run for one day a week for four months. The move comes ahead of a foreshadowed NSW Drug Summit to be held some time this year.
NSW College chair Dr Rebekah Hoffman called on the NSW Government to implement a much wider, ongoing program.
She said “my question to the Government is a simple one – what are you waiting for? We need action, how many more senseless deaths need to happen before widespread drug testing services are available across our state. An overdose could happen to someone in your life, whether it’s your son, daughter, or partner. This does not just happen to ‘other people’, and every person’s life matters”.
The RACGP also fired a shot across the bows of the Scope of Practice review, expected to release its second issues paper shortly. The College said “the Albanese Government’s Scope of Practice review must support the vital role of GPs at the heart of primary care and avoid repeating the abject failures of the United Kingdom’s health system”.
The RACGP also used World Health Day as the occasion for a media release reiterating its requests for the Government to fund improvements to GP registrar conditions, and subsidise training for GPs to work in regional and remote communities.
Several years ago Coca-Cola reduced the amount of sugar in Fanta, to demonstrate that a sugar tax was not needed for drinks manufacturers to reformulate their products to reduce the sugar content.
This week reports emerged that the reduced sugar had since been reintroduced, increasing sugar levels from 45 grams per litre to 72 grams per litre. This results in an extra four teaspoons of sugar in a 600 ml bottle.
The AMA responded with a media release reiterating calls for a sugar tax. AMA President Steve Robson said “this policy really is a no brainer — it would raise vital funds for preventive health and protect Australians’ health by decreasing the risk of diseases linked to excess weight like heart disease, type 2 diabetes, stroke, and some cancers”.
The sugar tax proposal is the highlight of the long-awaited Chapter 4 of the AMA’s pre-budget submission, focusing on preventive health.
The Rural Doctors Association of Australia (RDAA) released a calculator to assist doctors to calculate the government incentives and supports they would receive as for practice is a particular rural location. RDAA President Dr RT Lewandowski said: “while there are some great federal incentives and supports available to doctors who work in rural or remote Australia, you sometimes need to be a Class A detective to find out what measures are available, and what measures you are eligible for”.
The Australian Dental Association announced it was tackling the dental assistant shortage with a “dynamic new multimedia campaign” on Facebook and Instagram designed to “spark interest in the profession from potential candidates across the country”.
My favourite Facebook comment on the campaign: “when dental assistants can go and get a job in FIFO earning double what they earn in dentistry, I don’t think you can blame them. If they’re vital to the running of the practice, then they need to be treated as such”.
The Pharmaceutical Society of Australia (PSA) welcomed the latest brick to fall from the wall dividing prescribers and dispensers, with the news that South Australian community pharmacies will be able to resupply some oral contraceptive pills from May 2024.
The Australian College of Nursing was in the news for all the wrong reasons, with the ABC reporting that several executives had been stood down pending an investigation into “potential financial irregularities”. A spokesperson for the College said “the board stresses that this is an investigation only and is not at this stage alleging that any of the people who have stepped aside are responsible for any financial irregularities”.
The Royal Australasian College of Physicians was also in the news for personnel changes, as the CEO and the President stepped down with a week of each other.
Industry groups
Catholic Healthcare Australia called on the Government to require private health insurers to pay a default benefit for hospital-in-the-home services, and suggested that the Government should approve lower premium increases for insurers which returned a lower proportion of premium revenue to members.
CHA also proposed that the Government should:
- ease workforce shortages by establishing Health Workforce Australia, providing rental assistance to nurses, and creating a health and care worker passport
- improve mental health care by removing insurance waiting periods, extending default benefits, and increasing Medicare rebates
- provide funding to allow Medicare ineligible patients to access primary health networks and urgent care clinics to prevent avoidable hospitalisations
- commence reform of the private health sector towards an activity-based funding model.
Politicians and parliamentary committees
Shadow health minister Anne Ruston appeared on Sky News Sunday Agenda, lambasting the Government for the delay in the new Aged Care Act and its failure to respond to the Aged Care Taskforce report.
Submissions to the Senate inquiry into the anti-vaping legislation closed on 12 April. The Committee is yet to announce when (or if) it will hold a public hearing.
International
The British Medical Journal carried an article reporting that tobacco company Philip Morris International was funding education courses on smoking cessation on the Medscape medical information and education site.
One of the course slides states that “the health goal for all smokers should be smoke free, not tobacco/nicotine abstinent”.
The article quotes Robert Jackler, professor emeritus at the Stanford University School of Medicine in California, as saying “only purveyors of tobacco products would make such a ridiculous assertion. The health goal is not switching to another Philip Morris product line but rather to break nicotine addiction and thus halt all use of tobacco products”.
Finally
In a Croakey article on private health insurance last November I wrote that “insurers could have increased their reserves even more if they had exercised more control over management expenses, which increased by $730 million or 32 percent over the four years [to 2022-23]”.
On 12 April the AMA issued a media release criticising increasing private health insurance management expenses. (It claimed they are both soaring and skyrocketing, which I think is an aeronautical oxymoron.)
It said “new analysis by the Australian Medical Association shows management expenses for private health insurance providers skyrocketed 32 per cent over the last four years to June 2023 — an increase of $716 million”.
The AMA policy team needs to start reading Croakey.
Consultations and inquiries
From now on this column will attempt to keep track of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries. Here is our first list (in order of submission deadlines), and please let us know if there are any to add for next week’s column:
Department of Health and Aged Care (DoHAC)
Quality use of diagnostics, therapeutics and pathology
16 April
Therapeutic Goods Administration (TGA)
Poisons standard
17 April
Independent Health and Aged Care Pricing Authority (IHACPA)
Work program and corporate plan 2024-25
17 April
Department of Health and Aged Care
Review of after hours primary care policies and programs
20 April
Australian Commission on Safety and Quality in Health Care (ACSQHC)
Draft requirements for medical pathology services
26 April
Senate committee
Excess mortality
26 April
DoHAC
National strategic framework for chronic conditions
29 April
ACQSC
Strengthened Aged Care Quality Standards guidance
30 April
TGA
Clinical decision support system software regulation
6 May
Department of Social Services
Developing the National Autism Strategy
31 May
TGA
Companion diagnostics guidance update
17 June
Croakey also became aware last week that the Department of Health had consulted at least one organisation representing allied health professionals on the development of the National Allied Health Workforce Strategy.
Searching online for details of this consultation did not turn up any results, so I asked the Department for clarification. Apparently the current consultation is a sort of proto-consultation, intended to inform a draft consultation plan for the strategy.
I was assured that “following finalisation of the consultation plan, there will be broader consultation opportunities including open submissions… The department is planning to use similar consultation approaches to those used for the National Nursing Workforce Strategy”. Watch this space.
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.
