Whether we’re talking mental health reform, tackling gambling harms, or responding to the Senate inquiry into dental services, or the Disability Royal Commission, it’s looking increasingly like this Federal Government has a pattern of “waiting a long while for an unsatisfactory response to inquiry or review reports”.
That’s according to columnist Charles Maskell-Knight, who this week also covers the national shortage of IV fluids, rural medical training news, aged care reform, the regulation of dangerous and ineffective medical devices, and health implications of the NT election result.
The quotable?
It appears nothing is as politically successful as a law and order campaign demonising children.”
Charles Maskell-Knight writes:
After I submitted last week’s column, my eagle-eyed editor Dr Melissa Sweet noticed that the Government had released a response to the evaluation of the Better Access program, and added a brief reference to it.
The evaluation of the Better Access program was carried out by the University of Melbourne in the second half of 2022, and released on 12 December 2022. The Government used its findings to justify not extending the temporary pandemic-related annual cap of 20 Better Access-funded sessions, and allowed the cap to revert to 10.
At that time, Minister Mark Butler announced that “in early 2023, the Government will convene a forum of key experts and people with lived experience of mental illness to assess the recommendations of the independent evaluation and provide reform advice on how to improve Better Access, so all Australians have access to the same level of evidence-based care”.
And now, over 18 months later, we have the Government’s response, quietly added to the Departmental website on a Friday.
Mental health academic Dr Sebastian Rosenberg and Dr Catriona Davis-McCabe, President of the Australian Psychological Society, have both provided a detailed analysis of the response in Croakey.
The Australian Psychological Society also issued a statement about the response, and the Australian Association of Psychologists covered the subject in Executive Director Tegan Carrison’s weekly update.
At a high level, it is worth noting that of the 16 recommendations made by the review, the Government has accepted seven, accepted two “in principle”, noted six, and rejected one.
Two of the “noted” recommendations related to affordability: independent fee setting, and amendments to the Extended Medicare Safety Net.
In these cases at least I am sure that “noting” is a way station on the path to the dustbin of history. (As Tegan Carrison observed, “noted” is “government slang for ‘yeah, nah’”.)
Waiting a long while for an unsatisfactory response to inquiry or review reports seems to be a theme of this Government – think of the Senate inquiry into dental services, or the Disability Royal Commission.
And I don’t think anybody is expecting a useful response to the recommendations of the House of Representative inquiry into gambling, released in June last year.
Ministers and government
Health Minister Mark Butler asked the House of Representatives Standing Committee on Health, Aged Care and Sport to inquire into “the health impacts of alcohol and other drugs in Australia”.
The terms of reference for the inquiry can be found here, and submissions are due by 30 September.
Let’s hope the Government does more than “note” the recommendations when they eventually emerge.
The Australian Institute of Health and Welfare released a report on hospital use by children as a result of family domestic violence. Based on linked data for the period 2010-11 to 2020-21, it found that just over 5,000 young people had at least one hospital stay related to family domestic violence – an average of one a day.
Over a third of the children were aged under five, and 28 percent had a fracture of the head (compared with 10 percent in a set of control cases).
The AIHW also released the latest version of the COVID-19 Register, “a linked data asset that enables evidence-based research, and public health and health system planning for current and future pandemics”. The register now contains almost 9.5 million linked records.
Ahpra announced that it has been contracted by the Department of Health and Aged Care to review the Prescribing Competencies Framework, previously prepared by NPS MedicineWise, to ensure it remains fit for purpose and “continues to describe competencies required to contribute to safe and person-centred prescribing”.
Ahpra also issued a statement on the growing use of artificial intelligence (AI) in healthcare, saying that it “recognis[ed] the significant potential [for AI] to improve health outcomes and create a more person-centred health system”. However, it cautioned that there were “unique practical and ethical issues” associated with the use of AI in healthcare.
It released a guidance document Meeting your professional obligations when using Artificial Intelligence in healthcare to assist practitioners is using AI within existing obligations in practitioner codes of conduct.
The Australian Commission for Safety and Quality in Health Care released the Aged Care Infection Prevention and Control Guide, which will support implementation of the strengthened Aged Care Quality Standards. It also released a Guide for Healthcare Services to support healthcare services to implement the Primary and Community Healthcare Standards.
The Australian Bureau of Statistics announced that responsibility for reporting annual updates of the Measuring What Matters dashboard has been transferred to it from the Treasury.
The Measuring What Matters framework includes indicators in five health areas, including unmet need for services, delayed access to services, life expectancy, psychological distress, and chronic conditions.
Consumer and public health groups
Mental Health Australia released a “glass half full” response to the joint meeting of Health and Mental Health Ministers on 16 August, commending Ministers for agreeing to regular biannual meetings and releasing data on unmet need for psychosocial support.
The Australian Association of Psychologists had a more robust view of the meeting, with Executive Director Tegan Carrison suggesting to members “while many of you will share my frustrations with the lack of tangible actions, meetings such as these help to put mental health care back on the agenda as a priority for our country”.
Croakey’s managing editor Alison Barrett discusses the issues in more detail in this article.
National Seniors Association CEO Chris Grice and other senior staff held a series of meetings in Parliament House with a number of MPs and advisers covering a wide range of issues, including private health insurance, regulation of independent retirement villages, the new Aged Care Act, and NSA’s Keep Cash campaign.
The Northern Territory election
The Country Liberal Party won the NT election held on 24 August.
Apart from its policy to expand the role of community pharmacies in providing primary care, the CLP promised that “families will get easier access to cheaper medicines and vaccines” – but did not provide any further detail.
The CLP also promised to “fix the broken hospital system”, relieving the pressure on hospital emergency departments by “tackling alcohol-related harm that is increasingly rising in emergency wards with stronger laws and rehabilitation”, and working with the Federal Government to increase aged care facilities to help free up hospital beds.
However, the CLP campaign was largely focused on reducing crime, starting with youth crime. This included commitments to “ensure kids are raised in safe environments away from alcohol abuse and harm… building two youth boot camps in Alice Springs and Darwin… School based constables will keep our students and teachers safe by being present to intervene and stop crime… If parents are not caring for their children’s basic needs, they will be referred to Commonwealth income management like the basics card… We’re putting youth justice back in Corrections where it belongs because Corrections is best placed to change the criminal behaviour we are seeing across the Territory”.
In 2022 the Labor NT Government became the first state or territory to raise the minimum age of criminal responsibility from 10 to 12 years. The CLP has promised to introduce legislation in the first week of parliament to reverse the change.
It appears nothing is as politically successful as a law and order campaign demonising children.
Trade unions
The Australian Medical Association (AMA) issued a statement saying it was “reassured” by national and state government efforts to address the shortage of IV fluids.
President Professor Steve Robson said that “responsible and measured steps are being taken to conserve supply when necessary and we are now seeing real coordination of efforts to ensure that we not only have enough supply, but it also gets to where it is needed”.
The AMA also weighed into the gambling advertising debate, stating that “anything less than a total ban on all advertisements for online gambling would be a public health policy failure that would allow betting companies to continue causing harm to Australians”.
President Professor Steve Robson said that “we have waited more than 12 months for a response to the 31 recommendations contained in the You win some, you lose more parliamentary inquiry report and it is now time for the Government to take the same principled approach it took with vaping and agree to implement these recommendations in full”.
The AMA joined with the Law Council of Australia in welcoming the recommendations of an Australian Human Rights Commission report into Youth Justice, which included raising the minimum age of criminal responsibility from 10 to 14 years.
AMA President Professor Steve Robson said “criminalising the behaviour of young and vulnerable children creates a vicious cycle of disadvantage and increases the likelihood of ongoing experiences within the legal system”.
Law Council President, Greg McIntyre SC, said “governments need to take meaningful steps towards raising the minimum age of criminal responsibility to ensure all children in Australia have the best start to life with equal opportunities to grow and thrive”.
Somebody should alert the new NT Government to these views.
The Australian Primary Health Care Nurses Association released an online handbook (available to members only) to support school nurses, including best practice guidelines, evidence-based practices, and other resources.
The Pharmaceutical Society of Australia (PSA) called for “the removal of vaccination red tape and for national harmonisation of pharmacist vaccination scope to ensure all Australians have equitable access to vaccination services”. The PSA said that pharmacists and all other immunisers should be governed by the Australian Immunisation Handbook, rather than “relying on complex regulatory instruments unique to each state and territory”.
The Royal Australian College of GPs (RACGP) announced that this year it had “successfully placed 177 GPs in training in rural communities that had not had a registrar in years”, with the uptake assisted by College incentives of up to $45,000 to help cover relocation and training costs.
President Dr Nicole Higgins said because the RACGP trains 90 percent of Australia’s GPs, “we know what works to get GPs into communities”.
“The research shows GPs who train in a rural community are far more likely to work there – so this is growing our future rural GP workforce,” she said.
Higgins repeated the College’s call for the Government to “ensure GPs in training receive equal pay to their colleagues in other specialisations”.
In other rural medical training news, the Australian College of Rural and Remote Medicine (ACCRM) welcomed the Victorian Government’s commitment to trial a Single Employer Model for Rural Generalist registrars. The model allows registrars to be employed by a single health service while undertaking their primary care placements at different locations, and is already in place in NSW, Queensland, Tasmania, and SA.
The RACGP said on 23 August that “the Northern Territory’s political parties must commit to firm action to improve access to essential general practice care across the NT before the election on Saturday [24 August]”.
College NT Chair Dr Sam Heard said “access to healthcare is essential and it should be right up there with policing as a priority for NT politicians. We need to ensure our communities are safe and healthy”.
Finally, the RACGP announced that Dr Michael Wright had been elected as the new President of the College, and will succeed Dr Nicole Higgins in November. As Wright completed a PhD in health economics in 2019, it will be interesting to see if the College adopts a more nuanced approach to these issues in the future.
The Rural Doctors Association of Victoria joined the Australian College of Midwives and the Maternity Consumer Network in expressing outrage “at the immediate downgrading – and effective closure” – of the maternity service at the Camperdown Hospital, west of Melbourne), “reducing it from low-risk birthing to nil-birthing, with no notice given and for no good reason”.
Industry groups
The Aged and Community Care Providers Association (ACCPA) expressed disappointment that bipartisan support has not yet been achieved for the introduction into Parliament of a bill for a new Aged Care Act.
While there has been a lot of chatter across the sector that introduction of the bill is imminent, it has not yet emerged.
ACCPA CEO Tom Symondson said “if the new Act isn’t introduced immediately after Parliament resumes in a fortnight, the chances of it passing before the next election are near zero”.
ACCPA joined with Anglicare Australia, Baptist Care Australia, Catholic Health Australia, and UnitingCare Australia in a joint statement on the issue, which claimed that “the importance of the new rights-based Aged Care Act cannot be overstated”.
“If action is delayed any further, older people and the dedicated providers who support them, cannot be assured of the future of aged care in Australia,” they said.
The Australian Private Hospitals Association (APHA) announced that Brett Heffernan will succeed Michael Roff as its CEO. Heffernan was APHA’s Public Affairs Manager from 2002 to 2006, but has most recently worked as head of peak industry body Gas Energy Australia, and before that the Brewers Association of Australia.
On 1 August the Therapeutic Goods Administration removed 12 spinal cord stimulator devices from the Australian Register of Therapeutic Goods (ARTG), and imposed conditions of supply on another 70.
Following an ABC report on the decision, Private Healthcare Australia (the peak private health insurer lobby group) issued a statement calling for doctors to be “legally obliged to report adverse events involving medical devices to the TGA”.
This requirement was put forward by the Greens during consideration of legislation requiring hospitals to report adverse events, but the AMA successfully lobbied against it “due to the additional compliance burden for doctors and the lack of additional patient benefit if hospitals were already required to make these reports”.
PHA also suggested that “the definition of an adverse event should also be made clearer, and not left up to device manufacturers to determine”, citing the example of one manufacturer which “was of the view that unplanned surgeries to fix faulty leads did not qualify as an adverse event”.
PHA said that the “Government should also introduce tougher measures to ensure dangerous and ineffective medical devices are swiftly taken off the Medicare Benefits Schedule and [private health insurance prostheses list]”.
The Medical Technology Association of Australia has so far maintained a dignified silence.
PHA also issued a self-congratulatory statement on the fact that insurers had returned $4.3 billion to policy holders since 2020 because claims had fallen as a result of COVID-19.
I’m sure policy holders welcomed the return of their money. But they might have been even happier if insurers had not collected the money from them in the first place by imposing unnecessary premium increases.
Politicians and parliamentary committees
Following reports that PFAS (per and polyfluoroalkyl substances, aka “forever chemicals”) had been detected in the Sydney water supply, the Senate established a select committee to “inquire into the extent, regulation and management of PFAS”, with a reporting date of 5 August next year.
This will be the second parliamentary inquiry into the issue, following a 2018 inquiry by the joint committee on foreign affairs, defence and trade into the management of PFAS contamination in and around Defence bases.
International organisations
On 14 August the Director-General of the World Health Organization (WHO) determined that the ongoing upsurge of mpox in the Democratic Republic of the Congo and in a growing number of countries in Africa constitutes a public health emergency of international concern under the provisions of the International Health Regulations (IHR).
This week WHO released the record of the meeting of the IHR Emergency Committee that led to that decision.
Despite the declaration, The New York Times reported that vaccines are not available in the African countries at the heart of the epidemic because the WHO has “neither officially approved the vaccines… nor issued an emergency use license that would speed access”.
Finally
The ongoing extension of the role of community pharmacies into primary healthcare means that pharmacists are now diagnosing conditions, prescribing medicine, and then dispensing the medicine.
I am old enough to remember the Pharmacy Guild’s objections to allowing doctors to dispense medicines they had prescribed, on the basis that dispensing through a pharmacy allowed for independent scrutiny of the prescription, and that carrying out both functions generated a conflict of interest.
Now pharmacists are writing scripts, independent scrutiny appears to be no longer necessary, and the conflict of interest has disappeared.
In a March 2022 speech, Guild President Trent Twomey said that preventing pharmacists from both prescribing and dispensing medications is “a truly ancient notion” and assumes they don’t put the needs of their patients first.
Of course, exactly the same argument can be made for doctors. In a world where pharmacists are allowed to diagnose, perhaps doctors should be allowed to dispense?
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.
Australian Technical Advisory Group on Immunisation
Removal of information about Zostavax in the Australian Immunisation Handbook
27 August
Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August
Department of Health and Aged Care
Multi-Purpose Service trial sites direct care targets
30 August
Department of Health and Aged Care
How to implement the MSAC advice about the cost of technical support services for cardiac implantable electronic devices
6 September
National Health and Medical Research Council
Australian Drinking Water Guidelines – public consultation on draft guidance for lead replacements in plumbing products
6 September
Food Standards Australia and New Zealand
Amend the definitions in the Australia New Zealand Food Standards Code (the Code) for ‘food produced using gene technology’ and ‘gene technology’
10 September
Department of Health and Aged Care
Improving commercial foods for infants and young children
13 September
Therapeutic Goods Administration
Proposed changes to the Permissible Ingredients Determination
13 September
Independent Hospital and Aged Care Pricing Authority
Pricing Framework for Australian Residential Aged Care Services
20 September
Department of Health and Aged Care
Prostheses list – General Use Items utilisation, expenditure and integrity
20 September
Australian Commission on Safety and Quality in Health Care
National Safety and Quality Medical Imaging Standards (to replace the Diagnostic Imaging Accreditation Scheme Standards)
27 September
Department of Health and Aged Care
Draft of the National Roadmap to Improve the Health and Mental Health of Autistic People
27 September 2024
Department of Health and Aged Care
Review of MBS health assessment items
30 September
House of Representatives Standing Committee on Health, Aged Care and Sport
The health impacts of alcohol and other drugs in Australia
30 September
The Medical Board of Australia
Introduction of health checks for late career doctors
4 October
Therapeutic Goods Administration
Future regulation of assistive technologies
13 October
Therapeutic Goods Administration
Proposed changes to the Australian Essential Principles for Safety and Performance of medical devices
16 October
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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