The Australian Nursing and Midwifery Federation has called on the Albanese Government to do more to address the “escalating humanitarian catastrophe” in Gaza and to work toward a just and sustainable peace, reports The Zap this week.
The column also covers global health developments, including the world-first Pandemic Agreement and a new paper investigating inequalities in mental health.
Diverse perspectives on a range of contentious health and aged care reforms are also highlighted.
As well as writing The Zap each week, our columnist recently co-authored a new publication on peoples’ lived experiences of out-of-pocket costs of healthcare and medicines.
The quotable?
…the fact that some Australians with chronic conditions are having to make choices between basic necessities, such as food, and healthcare is more than surprising considering Australia’s ranking amongst the best healthcare systems in the world.”
Charles Maskell-Knight writes:
The 78th World Health Assembly meeting in Geneva adopted the world’s first Pandemic Agreement.
The World Health Organization (WHO) said that the decision “culminated more than three years of intensive negotiations launched by governments in response to the devastating impacts of the COVID-19 pandemic, and driven by the goal of making the world safer from – and more equitable in response to – future pandemics”.
WHO said the agreement “sets out the principles, approaches and tools for better international coordination across a range of areas, in order to strengthen the global health architecture for pandemic prevention, preparedness and response”.
“This includes through the equitable and timely access to vaccines, therapeutics and diagnostics.”
In an effort to head off the international conspiracy theorists (see Senator Malcolm Roberts), the agreement explicitly states that:
“nothing in the WHO Pandemic Agreement shall be interpreted as providing the Secretariat of the World Health Organization, including the Director-General of the World Health Organization, any authority to direct, order, alter or otherwise prescribe the national and/or domestic law, as appropriate, or policies of any Party, or to mandate or otherwise impose any requirements that Parties take specific actions, such as ban or accept travellers, impose vaccination mandates or therapeutic or diagnostic measures or implement lockdowns”.
Health Minister Mark Butler said Australia welcomed the adoption of the agreement, and described it as “a significant step towards strengthening pandemic prevention, preparedness and response”.
He added that Australia was proud to have served as Vice-Chair of the Intergovernmental Negotiating Body for the Pandemic Agreement, representing the diverse Western Pacific region.
Ministers and government
Assistant Minister for Mental Health and Suicide Prevention Emma McBride gave a largely boilerplate speech at the National Suicide Prevention Conference.
She claimed that the Government had been addressing the drivers of suicidal distress by:
- improving access to free healthcare
- strengthening the social safety net
- bringing down inflation and easing the cost of living
- reducing unemployment and increasing wages
- addressing housing insecurity and homelessness.
There is a long way to go in strengthening the social safety net.
In bringing down the 2025 Budget, the Government for the third successive year ignored a recommendation from its Economic Inclusion Advisory Committee (chaired by Jenny Macklin AC) that it “commit to a substantial increase in the base rates of JobSeeker Payment and related working age payments as a first priority”.
Minister Butler held a media conference in Adelaide to mark the fact Urgent Care Clinics have now treated 1.5 million patients.
Asked how long until we see a new five-year public hospital funding deal?, Butler said the Government was committed to reaching agreements on public hospital funding, NDIS reform, and foundational supports by the end of the year.
He was also asked if there would be an MBS rebate rise to address out-of-pocket fees for specialist appointments.
The short answer is no; the Government will focus on adding all specialists’ fees to the Medical Cost Finder website.
This is next to useless in areas like Canberra, where every specialist charges multiples of the schedule fee.
Through 2023 and 2024 the Government commissioned a series of policy reviews covering general practice and primary care more broadly, which all identified potential improvements to existing arrangements.
The Department of Health, Disability and Ageing has now released in response to a freedom of information request a draft of a “review of reviews” prepared late last year which summarises the policy opportunities or recommendations and challenges found in the various reviews, identifies areas of overlap and conflict, and considers how agreed recommendations could be pursued and conflicts resolved.
There is nothing remarkable in the fact that the Department decided such a document was required, given the overlap between the various reviews.
What is remarkable is that the document was prepared by Monash University under a consultancy contract. The Department apparently no longer has the capability to synthesise the results from five reviews and come up with a coherent path forward.
With a little over a month before the new Aged Care Act comes into force, the Department released resources and training materials about the Act and the new Support at Home program.
It also announced it was “sending letters to older people who currently receive a Home Care Package to help them prepare for the new Support at Home program that starts on 1 July”.
I think the general view among providers it that this is too little, too late.
The Australian Institute of Health and Welfare (AIHW) released a series of reports and updates on mental health, including the physical health of people with mental illness; mental health services; suicide, self-harm and mental health; ADHD medications dispensed over the last twenty years; and new mental health patients in 2018 using linked data from the National Health Data Hub.
The AIHW also released a report on endometriosis, which found sustained increases in diagnoses, hospitalisations, and the burden of disease.
Finally, the AIHW issued the Essential vaccines: performance report 2023–24, assessing state and territory performance against the benchmarks outlined in the Essential Vaccines Schedule.
It found that SA, Tasmania and the ACT met all the benchmarks, while NSW, Victoria, WA, and Queensland met four out of five benchmarks.
The good news is that all jurisdictions met the benchmark for vaccine coverage for Aboriginal and Torres Strait Islander people in 2023–24.
Ahpra said that the Accreditation Committees for Aboriginal and Torres Strait Islander health practice, Chinese medicine, medical radiation practice and podiatry were all inviting feedback on their draft updated accreditation standards. The consultations close on 25 June.
The Productivity Commission is investigating how to deliver quality care services more efficiently, and is consulting on a range of options with submissions closing on 6 June. Dr Lesley Russell has explored the issues for Croakey here.
First Nations
The National Health and Medical Research Council (NHMRC) highlighted the work of Ngiyampaa/Wongaibon social epidemiologist Professor Raymond Lovett, Associate Director of Yardhura Walani (Australian National University) and Director of Mayi Kuwayu: The national study of Aboriginal and Torres Strait Islander wellbeing,
The NHMRC said: “Professor Lovett’s research has influenced policy at state and national levels, as well as empowered communities at the local level.
“He is now aiming to take this to the global stage through the development of a world-first Indigenous wellbeing index.”
Professor Lovett said “health and wellbeing are influenced by many factors, yet globally, Western developed quality of life measurements focuses almost exclusively on physical health”.
“For Indigenous peoples, social, emotional and cultural wellbeing of community, and health of country are known to impact quality of life.”
He is working to develop, validate and apply an Indigenous quality of wellbeing (IQoW) utility index to “inform policy, services and programs that meet Aboriginal and Torres Strait Islanders’ wellbeing needs”.
Trade unions
The Australian College of Rural and Remote Medicine (ACCRM) said it was “continuing to monitor the establishment and operation” of urgent care clinics (UCCs).
ACCRM representatives met with the Department of Health, Disability and Ageing to discuss opportunities to clarify existing requirements within the UCC Operational Guidance.
The Australian Medical Association (AMA) marked IDAHOBIT (International Day against Homophobia, Transphobia, and Biphobia) on 17 May.
AMA President Dr Danielle McMullen said it was “a day to recognise the great advances in LGBTQIASB+ healthcare, while also noting members of the LGBTQIASB+ community are still unfairly marginalised in some areas of society”.
McMullen reminded the Government of the importance of implementing the National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025–2035 released last December.
She said the AMA “supports the provision of appropriate, respectful and culturally safe healthcare for people who are LGBTQIASB+ across the healthcare system [and] strongly advocates for the Australian health care system to be a safe place for all LGBTQIASB+ health workers as well as people seeking care”.
The Pharmaceutical Society of Australia (PSA) also marked the day.
The AMA also released its submission to a targeted consultation by the Therapeutic Goods Administration (TGA) on a proposal to change the law to allow Special Access Scheme information to be shared with other regulators.
The TGA is concerned at the pattern of prescriptions for medicinal cannabis written by some providers under the Special Access Scheme.
The AMA said its members had been “appalled” by the behaviour of some prescribers highlighted by the TGA, such as the doctor who treated more than 31,000 patients with medicinal cannabis within six months.
Dr McMullen said “the TGA has no role in regulating health professional behaviour and this must not change”.
“But it’s reasonable to expect that a practitioner applying to provide patients with access to unapproved therapeutic goods would be subject to appropriate scrutiny, and that the TGA can share that information with the appropriate regulator when there is genuine concern about their behaviour.”
The Australian Nursing and Midwifery Federation issued a statement on the “escalating humanitarian catastrophe” in Gaza calling on the Government to:
- condemn the blockade and push for immediate, unrestricted humanitarian access to Gaza
- join international calls for an immediate and lasting ceasefire
- recognise the State of Palestine and work toward a just and sustainable peace
- support the United Nations and humanitarian agencies to deliver aid based on the principles of neutrality, impartiality, and independence.
The Royal Australian College of GPs (RACGP) marked World Family Doctor Day 2025, “recognising GPs around Australia for their vital work nurturing mental wellness in their patients through preventive care, early and effective diagnosis, and holistic, person-centred support”.
RACGP President Dr Michael Wright said mental health was one of the top three reasons for people seeing their GP, and that GPs were often the first port of call regarding mental health issues.
He said “alongside higher patient rebates for longer consults to address chronic, complex healthcare needs, the RACGP has advocated for an increase to mental health rebates to make care more accessible and affordable for every patient”.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists published the Australian Living Evidence Guideline: Endometriosis.
The Royal Australasian College of Physicians called for the NT Government to follow the ACT, New South Wales and Victoria and “introduce pill testing at music festivals to help reduce drug related harm” following news that nitazene had been found in the NT for the first time.
Industry groups
Ageing Australia (the aged care providers lobby group) issued a Request for Information (RFI) for vendors able to provide the data and technology requirements for an Aged Care Data Roundtable. The RFI closes on 9 June.
The RFI said “Ageing Australia is exploring the feasibility of creating a national Aged Care Data Roundtable… [which] would enable aged care providers to safely and voluntarily contribute data that supports continuous improvement, real-time benchmarking and performance insights across residential, home and community aged care settings”.
Given the Government is spending over $30 billion a year on aged care services, benchmarking and continuous improvement should be priorities for the Government – but they do not appear to be.
The Association of Australian Medical Research Institutes welcomed the Victorian Government’s decision as part of the state Budget to spend $24.6 million over two years “to support independent medical research institutes to meet the full costs of delivering life-saving medical research”. (For more reaction to the Victorian Budget, see this Croakey round-up.)
Bupa announced it was opening its first Mindplace mental health clinic, with plans for a further eight by the end of the year and about 60 by the end of 2027.
Bupa said: “Mindplace will offer a safe, empathetic space with introductory psychologist matching consultations, integrated telehealth options and practical digital resources. Every Mindplace clinic and the services they provide will be open to all Australians, not just Bupa customers.”
Local Bupa CEO Nick Stone said “by launching an extensive network of Mindplace mental health clinics, Bupa intends to play a pivotal role in meeting the ballooning demand for mental health support in our community”.
“Our ambition is to work in partnership with the services already provided by the public system to ensure all Australians can access the mental health support they need.”
The announcement did not include information on charging arrangements.
The AMA said Bupa’s “aggressive plans to expand its own network of medical centres by a further 130 and create 60 of its own mental health clinics is a major red flag for Australia’s private health system, which is now at risk of being plunged into a US-style model”.
McMullen said “it is crucial that we avoid a scenario where profits are put before patients, like we have seen happen in the US with disastrous results”.
“Clinical decisions must remain in the hands of doctors and their patients – not influenced by insurers or corporate ownership – so that care is guided by need, not by financial incentives.”
Publicity around the Bupa announcement may have led Private Healthcare Australia (the private health insurance lobby group) to set out six reasons why Australia is not heading towards a US-style health system:
- in Australia, only you and your doctor can make decisions about your medical treatment
- health insurers cannot direct doctors or other health professionals such as psychologists or dentists to act against a patients’ best interests
- your health insurer cannot pre-authorise treatment or make you go to a narrow network of hospitals
- when Medicare pays for a hospital service, your health insurer must pay too, regardless of whether clinical guidelines were followed
- in Australia, there is no link between your insurance and your employer. If you don’t like what your insurer is doing, it is quick and easy to swap
- health insurers cannot determine what private doctors charge or force them into employee arrangements. This protection is enshrined in the Constitution.
Of course, the fundamental difference between Australia and the US is that Australia has a universal system of Government-funded healthcare, meaning that all patients can receive care without dealing with private health insurers.
The Pharmacy Guild and the PSA respectively welcomed and applauded the announcement in the Victorian Budget that the state would spend $18 million to make the Victorian Community Pharmacist Statewide Pilot (the Pilot) permanent and expand the conditions for which pharmacists can treat patients in Victoria.
The RACGP warned the move would threaten patient safety and compromise patient care.
RACGP Victoria Chair, Dr Anita Muñoz, said “expanding pharmacy prescribing powers also fragments care”.
“This is particularly risky for patients with multiple, chronic conditions that need to be carefully managed by a regular GP who has precisely one priority in mind – the health and wellbeing of their patient.”
Muñoz also raised the issue of conflicts of interest, saying “there is a reason why we have, until this ‘trial’, separated prescribing and dispensing responsibilities and that is to avoid a conflict of interest”.
“Pharmacists will be selling patients medicines that they have just prescribed.”
I am old enough to remember the Pharmacy Guild’s strong objections to doctors being allowed to dispense drugs they had prescribed – the Guild clearly does not believe the same considerations apply to pharmacists.
International organisations
The Organisation for Economic Cooperation and Development (OECD) released a working paper on Understanding and addressing inequalities in mental health.
The paper found:
- inequalities in mental health are marked across all OECD countries. Groups with poorer mental health also have higher unmet needs and worse experiences and outcomes of care
- three-quarters of OECD countries have policies and strategies to tackle inequalities in mental health, but certain groups receive less attention, and policies are poorly evaluated
- efforts to increase access to mental healthcare are widespread but do not always work for all population groups
- culturally and linguistically tailored interventions and peer-based support are key strategies to reduce inequalities in experiences and outcomes of care.
Finally
This week the Health Policy journal published an article, ‘Lived experience of out-of-pocket costs of health care and medicines by people with chronic conditions and their families in Australia’.
The team behind the article was led by Associate Professor Jane Desborough at ANU, and included the now Chief Medical Officer Professor Michael Kidd and me.
The article concluded that “a number of policy mechanisms are intended to protect at-risk populations [from out-of-pocket costs]… current mechanisms of subsidising consultations with providers and offering incentives for bulk-billing of at-risk populations are effectively reaching some of these groups”.
“However, the evidence clearly also indicates that these policies are not reaching everyone who needs financial support to adhere to recommended healthcare regimens.”
There are major issues in access to specialist consultations, allied health services, and dental care, and the PBS safety net thresholds are also an issue.
Private health insurance for out-of-hospital services has low benefits and limits on service volumes.
For people in rural areas receiving services in cities, the patient accommodation and travel schemes provide inadequate (and often delayed) payments.
Patients and their carers needing to drive to receive hospital services can face exorbitant parking charges. The article says that “while many hospitals have policies to subsidise parking for people with chronic conditions, their reach is clearly insufficient and needs to be improved”. (Coincidentally the cost of parking was the subject of this column in The Guardian by Dr Ranjana Srivastava.)
The article argues that “the fact that some Australians with chronic conditions are having to make choices between basic necessities, such as food, and healthcare is more than surprising considering Australia’s ranking amongst the best healthcare systems in the world”.
“It is critical to explore the experiences of people with chronic conditions further.”
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.
Medical Radiation Practice Board of Australia
Professional capabilities for medical radiation practice
28 May
Prostate Cancer Foundation of Australia
Clinical Guidelines for the Early Detection of Prostate Cancer
28 May
Ahpra
Revised National Prescribing Competencies Framework
30 May
Independent review of the National Registration and Accreditation Scheme
Second consultation paper
6 June
Productivity Commission
How to deliver quality care services more efficiently
6 June
Independent Health and Aged Care Pricing Authority
Consultation Paper on the Pricing Framework for Australian Public Hospital Services 2026–27
13 June
Therapeutic Goods Administration
Proposed amendments to the Poisons Standard
13 June
Paramedicine Board of Australia
Proposal to regulate advanced practice paramedics
20 June
Aboriginal and Torres Strait Islander Health Practice Board
Accreditation Consultations
25 June
Chinese Medicine Board of Australia
Accreditation Consultations
25 June
Medical Radiation Practice Board of Australia
Accreditation Consultation
25 June
Podiatry Board of Australia
Accreditation consultations
25 June
Therapeutic Goods Administration
Adoption of International Scientific Guidelines in Australia
30 June
Office of the Gene Technology Regulator
Risk Assessment and Risk Management Plan for a commercial release of a genetically modified (GM) mosquito strain to help prevent dengue outbreaks.
7 July
Australian Commission on Safety and Quality in Health Care
Australian Safety and Quality Medical Imaging Accreditation Scheme
18 July
Department of Health and Aged Care
Updating clinical guidelines for dementia care
31 December
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, and on Bluesky at: @charlesmk.bsky.social.
