Developments in the First Nations health workforce, aged care, pharmacy and nursing are covered in the latest edition of The Zap.
Policy analyst Charles Maskell-Knight also hopes that the impending “refresh” of the 2017 National Strategic Framework for Chronic Conditions brings less verbiage, fewer platitudes and greater impact.
And he sounds a note of caution about the COVID-induced rush on pet ownership.
The quotable?
Fido and Felix may be good for your wellbeing, but make sure you don’t fall over them.”
Charles Maskell-Knight writes:
Last week saw two major aged care stories emerging from government.
The first was the release – three months after completion – of the report of the Aged Care Taskforce. However, despite the fact the Aged Care Minister chaired it, and despite having had three months to think about it, the Government is still considering its response to the 23 recommendations from the Taskforce.
For non-paywalled commentary on the report, see Michelle Grattan in The Conversation, Anne Connolly at the ABC, and my article in Croakey.
Professor Kathy Eagar summed up the situation in a pithy tweet: “Aged Care Taskforce, chaired by the Minister Anika Wells and composed of aged care sector representatives with vested interests, wants older people to pay more. No surprises there. Where are proposals to improve transparency, improve quality & regulate profit?”
The second major aged care story was the decision by the Fair Work Commission in the latest stage of the work value case for the aged care sector. It awarded a further wage increase for direct care workers of an average 23 percent, including the 15 percent awarded in an interim decision in late 2022. Support staff who regularly deal with residents received an increase of almost seven percent.
In a brief statement Ministers Mark Butler and Anika Wells joined Workplace Relations Minister Tony Burke in welcoming the decision, and reiterating the Government’s commitment to “provide funding to support increases to award wages made by the Fair Work Commission in this matter and… help deliver a higher standard of care for older Australians”.
Health Services Union National President Gerard Hayes said the decision was an historic improvement: “Most of the aged care workforce itself can now imagine and plan for fully fledged careers, where people can plan a life around their work and really commit to it. Many workers have subjected themselves to the edges of poverty and homelessness to work in this industry. Now they can care for the elderly and also provide for themselves and their family.”
Ministers and government
As I foreshadowed in The Zap for last week, Assistant Minister Ged Kearney convened a Women’s Health Summit on 14 March. Dr Lesley Russell will be reporting on the summit as part of a wider report on women’s health in the next edition of The Health Wrap.
Assistant Minister Malarndirri McCarthy attended the launch by the National Aboriginal Community Controlled Health Organisation (NACCHO) of the First Nations Health Worker Traineeship program, which aims to certify up to 500 First Nations individuals as either Aboriginal Health Workers or Aboriginal Health Practitioners by 2027.
NACCHO said that “the program has been developed and designed by Aboriginal and Torres Strait Islander organisations and is being delivered in genuine partnership with government”.
NACCHO Chair Donnella Mills said that the program would “not only strengthen pathways for our existing workforce but also open doors for individuals in local communities to embark on careers as Health Workers and Health Practitioners”.
Minister Butler and Pharmacy Guild President Trent Twomey both announced that the Government and the Guild had signed a Heads of Agreement for the 8th Community Pharmacy Agreement (8CPA).
Butler said that “the Agreement will deliver cheaper medicines, improve patient health outcomes and secure a strong community pharmacy sector… and provide up to an additional $3 billion for community pharmacy and cheaper medicines”. The parties will work to finalise the deal by 1 July.
Butler also announced a trial of six nurse practitioners in general practices in SA. The nurse practitioner service will be free of charge, and “increase the capacity of GP clinics and other primary care providers to see and treat more patients”. The announcement did not include any details of an evaluation process.
In the associated media conference, Butler said that next week he will be “introducing legislation to remove the so-called ‘collaborative arrangements requirement’ [which] means that nurse practitioners can only work under the direct supervision of a doctor, effectively having a doctor look over their shoulder when they’re delivering care that they’re fully qualified to deliver. We’ll remove that so that nurse practitioners will be able to work with the autonomy that their qualifications and their experience deserve”.
This legislation appears to be the culmination of the Collaborative Arrangements Project described on the Department’s website.
Assistant Minister Emma McBride announced that she would be attending the “High-Level Segment” of the UN Commission on Narcotic Drugs in Vienna on 14-15 March to discuss “a diverse range of drug-related matters”.
Her announcement coincided with the release by the Australian Criminal Intelligence Commission of its 21st report on Wastewater Drug Monitoring, covering the year to August 2022. It estimated that more than 30 tonnes of methamphetamine, cocaine, heroin, MDMA and THC (cannabis) were consumed across Australia during that time.
Methamphetamine consumption increased from about nine tonnes to 10.5 tonnes, which the Commission described as a “considerable concern, due to the significant community harms caused by the drug”. On this basis the seizure of 106 kilograms announced by Border Force recently only reduced supply by one percent.
The Department of Health and Ageing opened consultation on a “refresh” of the 2017 National Strategic Framework for Chronic Conditions, which “is the overarching policy for chronic conditions in Australia and provides guidance for the development and implementation of relevant policies, strategies, actions and services”. Reading the existing framework is like wading through a trough of regurgitated buzzword salad.
The first objective of the existing framework is focusing on prevention, and the first measure of success is that “the proportion of Australians living with preventable chronic conditions or associated risk factors is reduced”.
Given that the proportion of Australians who are overweight or obese continues to increase, the framework has fallen at the first hurdle. Perhaps a refreshed version with less verbiage and fewer platitudes will be more successful?
The consultation closes on 19 April.
Consumer and public health groups
The Public Health Association of Australia, in Partnership with Beyond Blue, held a Preventive Mental Health Symposium on Tuesday 12 March 2024.
Advertising the event, the organisers said “The situation is urgent. The prevalence and impact of mental health conditions continues to rise and the demand for mental healthcare services is exceeding their availability… A growing number of evidence-based programs are available to promote people’s mental wellbeing and reduce their risk of experience a mental health condition but there remains a substantial gap between ‘what works’ and what is happening in practice and policy”.
COTA, OPAN, and National Seniors Australia joined nine other organisations in making a joint submission to the consultation process on the new Aged Care Act, highlighting the need for:
- enforceable rights of older people that address the current power imbalance
- a robust, independent complaints system
- transparency of timelines and funding
- strong regulation and penalties for those found guilty of not upholding the rights of older people
- a guaranteed right to aged care visitors at all times.
COTA issued a delightfully noncommittal statement about the Aged Care Taskforce report, supporting the process but avoiding endorsement of any particular recommendation. COTA is “looking forward to seeing the Federal Government’s response to the Taskforce report”. Aren’t we all?
National Seniors Australia CEO Chris Grice took a broadly similar approach in an interview with the ABC, while Dementia Australia issued a media release supporting the recommendations.
The Consumers Health Forum welcomed the release of the End Gender Bias report at the Women’s Health Summit. CEO Dr Elizabeth Deveny said “when consumers can advocate their needs in the health system, we know it results in better service design, delivery and update. We need women who have experienced gender bias involved in healthcare policy decision making and program design”.
Trade unions
The Royal Australian College of General Practitioners (RACGP) issued a heated media release headed “Patients must come ahead of incumbent pharmacy owner profits”, occasioned by a bill introduced to the Queensland Parliament to replace the Pharmacy Ownership Act 2001. The bill preserves the current limitations in section 139B of the Act on anyone but a pharmacist owning a pharmacy.
RACGP Queensland Chair, Dr Cathryn Hester, said that “review after review after review has recommended the removal of pharmacy location and ownership rules… the Productivity Commission has called out that existing ownership rules clearly have harmful consequences for consumers in terms of reduced access to medicines, reduced competition, and innovation”.
The Queensland branch of the Australian Medical Association (AMA) joined in, with branch president Dr Maria Boulton saying that “removing pharmacy ownership restrictions to enable Aboriginal health services to own and operate pharmacies would support commitments made by all governments in the National Agreement on Closing the Gap. It is outrageous that the Queensland Government is completely disregarding its own Closing the Gap commitments with these unnecessary, anti-competitive regulations that only serve to entrench the power of existing pharmacy owners”.
While I agree that pharmacy ownership restrictions are a nonsense, unless the Commonwealth also amends its rules around the PBS, changes to state law are nugatory.
The RACGP called on the Queensland Government to match the WA one in introducing a free infant immunisation program for RSV (respiratory syncytial virus). It also called for a similar commitment from parties in the Tasmanian election.
The AMA released its submission to the MBS Review Advisory Committee’s working group on ECG MBS items, calling for the Medicare rebate for GPs to perform electrocardiogram tests (ECGs) to be restored to the level applying before 2020. That was when the then Government reduced the rebate for GPs, as part of implementing the recommendations of the 12-Lead Electrocardiogram Working Group of the Cardiac Services Clinical Committee of the MBS Review Taskforce.
Allied Health Professionals Australia commented on the Aged Care Taskforce report, highlighting the importance of allied health services to maintaining health, and the ambiguity in the report about whether or not these services would be funded. AHPA called on the Government “to fully implement the recommendations of the Royal Commission and ensure that allied health is provided to all older consumers who are assessed to need it”.
The NSW Nurses and Midwives Association also issued a statement on the Aged Care Taskforce report. General Secretary Shaye Candish said “until providers come clean and show transparency, the federal government and residents in these facilities should not be topping up their bank accounts. These recommendations will not improve the workforce shortages being felt across aged care, nor will it address the quality of care being received within the facilities”.
The Australian College of Nursing released its pre-budget submission, calling for a “major positive image of nursing campaign to help drive health workforce reforms”.
CEO Adjunct Professor Kylie Ward said “it is estimated that there are more than 75,000 qualified nurses who are presently not working as nurses. They are doing other things. They are a health workforce in hiding. We must get them back to nursing”.
During my time in the Department of Health I worked with many ex-nurses; most of them would have needed a massive pay rise and transformational changes in work practices before they would have considered returning to the profession.
The ACN also said “nurses and nurse practitioners must have greater access to the MBS… [because] the outdated GP-led fee for service model is broken”, but did not put forward any specific proposals.
The Pharmaceutical Society of Australia issued a media release foreshadowing “Thank Your Pharmacist Day” on 21 March. It also acknowledged the signing of the Heads of Agreement for 8CPA, commenting that “while there is still work to be done on the substance of the 8CPA, PSA remains committed to growth in funded professional services and continues to approach negotiations with this intent”.
Industry groups
A number of industry groups welcomed the Aged Care Taskforce report, and urged the Government to implement its recommendations. These included ACCPA (the peak aged care provider lobby group) and Catholic Health Australia. Even CEDA joined the party.
ACCPA CEO Tom Symondson said “every Australian should have access to high-quality aged care, regardless of their location, income or financial means”. Perhaps he can persuade Minister Anika Wells that high quality care should be one of the objects of the new Aged Care Act?
The ACCPA also welcomed the decision on the aged care work value case, while noting the disappointment many non-direct care workers would experience in receiving much lower pay increases than their direct care colleagues. Symondson said “there is an ever-widening chasm between what we pay some workers in aged care and what we pay others. Without our laundry staff, kitchen staff, cleaners, gardeners, maintenance, and administrative staff, our direct care workers couldn’t do what they do”.
For several weeks now I have been noticing advertisements like this from Australian Pathology in my X feed, urging people to tell their MP that pathology funding needs to be increased to maintain bulkbilling.
In the media release at the start of the campaign, the organisation said that MBS pathology rebates had been frozen since 1999, saving the Government an estimated $13.8 billion. It called for indexation to be restored in the budget, to ensure services continued to be bulkbilled, at very modest cost total of $650 million over four years.
Politicians and parliamentary committees
Greens spokesperson on aged care, Senator Janet Rice, responded to the release of the Aged Care Taskforce saying: “If more emphasis on user-pays approaches is the answer, then we’re asking the wrong questions. The Government needs to be responsible for funding an accessible system for all Australians who need it.”
Shadow Minister Anne Ruston also responded, bemoaning the absence of a Government response to the recommendations, and stating that “the Coalition genuinely wants to work with the Government to ensure our aged care system remains sustainable into the future. We will not stand in the way of sensible reform that seeks to strengthen the systems [sic] sustainability”.
International organisations
The World Health Organization (WHO) released a report finding that “underinvestment in health systems results in a vicious cycle of unpaid health and care work, lowering women’s participation in paid labour markets, harming women’s economic empowerment and hampering gender equality”.
Finally
Finally this week, a word of caution. During the depths of the COVID-19 pandemic Australian pet ownership increased substantially, with one in five families acquiring a new pet.
The Australian Institute of Health and Welfare (AIHW) has now released data on hospitalisations resulting from animal contact, showing that the crude rate of injuries resulting from common pets increased from 18.9 per 100,000 people in 2012-13 to 47.5 in 2021-22.
Fido and Felix may be good for your wellbeing, but make sure you don’t fall over them.
Have we missed anything? Let Charles Maskell-Knight know using ‘The Zap’ in the subject line: info@croakey.org
The Zap column launched in early 2024, to provide 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.
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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