The Federal Government’s failure to properly respond to a Senate inquiry’s report into mental health and suicide prevention – which was published in late 2021, before the Albanese Government’s election – has been described as “distressing and disrespectful”, and “an absolute waste of time and effort” for all who contributed.
The column this week also reports on important concerns for the midwifery workforce, the less-than-optimal experiences of specialist medical trainees, moves to tighten regulation of infant formula marketing, and some rare good news about aged care.
Our columnist also highlights questions arising from the Queensland election outcome about a number of health matters, including whether the Liberal National Party will go ahead with ditching the Police Drug Diversion Program.
This program – which health, medical and legal groups support – allows people found with small amounts of drugs for personal use to be given a warning or referral to a health intervention, rather than a criminal penalty.
The quotable?
Unfortunately, there has been only a tenuous relationship between evidence and policy in the Queensland election campaign.”
Charles Maskell-Knight writes:
The centenary of the establishment of the Australian Nursing and Midwifery Federation (ANMF) was on 23 October. In a statement the union said that it had grown from an initial membership of 700 to now covering over 326,000 nurses, midwives, personal carers and students.
Federal Secretary Annie Butler said that the ANMF had “fought hard for, and won vital nurse-to-patient ratios, penalty rates, and better pay and conditions for our members”.
She said the union had been “instrumental in lobbying for and supporting national registration and the establishment of the Australian Nursing Council (ANC) in the late 1980s and early 90s; and later the establishment of the National Registration and Accreditation Scheme (NRAS), Ahpra and the Nursing and Midwifery Board of Australia (NMBA)”.
Also on 23 October, the NMBA released a report on the midwifery workforce, carried out by the Burnet Institute. The report concluded that the midwifery workforce “is in crisis and there are not enough midwives or current midwifery students in the pipeline to meet future needs”.
It also found that there are widespread localised staffing shortfalls, particularly in non-metropolitan areas. A third of midwifes who responded to a survey were considering leaving the profession, many before retirement age.
As well, the impact and ongoing presence of racism, intergenerational trauma, vicarious trauma, and colonisation present significant challenges” to addressing the underrepresentation of First Nations people in the profession.
The report made 32 recommendations, including:
- increasing the number of midwifery students as soon as possible by at least 20 percent, and quarantining places for First Nations students; leading to around 1,560 students graduating in the next 2-4 years
- ensuring that leadership of maternity services is provided by midwives at government, employers, executive and clinical levels
- strengthening workplace flexibility, improving working conditions, and ensuring more career pathway options.
It also recommended that “the Commonwealth Government develop and implement midwifery continuity of care models as a defined care pathway, and fund midwives to work to their full scope”.
The ANMF commented on the report, saying “it is imperative that the midwifery profession remains a strong, equipped workforce that reflects the Australian community”.
It identified immediate responses to the crisis as including “safe midwifery-specific staffing ratios”, as well as “flexible rostering, subsidised education, culturally appropriate trauma-informed care education, paid clinical supervision, utilisation of midwifery in primary care, removal of barriers to midwives practising to their full scope, and competitive remuneration”.
Also last week, the Gosford Private Hospital on the NSW central coast, operated by Healthe Care, announced that maternity services at the hospital would cease next March.
Hospital CEO Dr Stephen Johnston said that “over the past 10 years we have seen a steady decline in the number of local families choosing to have their birth privately, with births falling by close to 40 percent during that time and forecasts for less private births in the years to come”.
“We have now reached the point where it is no longer sustainable for us to continue to operate this service.”
Ministers and government
Health Minister Mark Butler announced funding to “accelerate the development of a national targeted skin cancer screening roadmap”. (I think that is code for working out how to run a skin cancer screening program.)
The work will be led by the Melanoma Institute Australia, and will also involve skin cancer data collection for the Australian Cancer Database.
At the associated media conference, Butler also revealed that he has received the long-awaited Private Hospital Sector Financial Health Check, and would soon be releasing “some information that is appropriate and gives Australians, but also people in the health sector, a sense of what conclusions that health check reached”.
Assistant Minister for Health Ged Kearney made a submission to the Australian Competition and Consumer Commission’s (ACCC) consideration of re-authorisation of the Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement (MAIF Agreement) as an industry code of practice.
She wrote that “the Government is committed to mandating the MAIF Agreement and acknowledges that a stronger regulatory framework is required”.
“However, time to transition to a mandated MAIF Agreement is needed. It is anticipated that this will take two years, noting that enabling legislation via amendments to the Food Standards Australia New Zealand Act 1991 will be required before the development of a mandatory Code can proceed.”
The Government’s commitment drew praise from the Australian Medical Association (AMA) and a group including the Public Health Association of Australia (PHAA).
PHAA vice-president Professor Kathryn Backholer described the current voluntary agreement as “ineffective, unenforceable and limited in scope”, and AMA President Dr Danielle McMullen said it had allowed manufacturers and retailers to irresponsibly market their products to parents and carers.
Details of the Government’s proposed mandatory code are yet to be revealed.
The Office of the National Rural Health Commissioner released its annual report for 2023-24, identifying highlights including establishing a consumer advisory group, “working towards progressing the second edition of the National Consensus Framework for Rural Maternity Services”, and co-hosting a webinar with an award-winning First Nations Alaskan health service.
The Therapeutic Goods Administration warned the long-delayed final switch-off of the 3G network by Telstra and Optus from 28 October might affect some medical devices.
The Australian Institute of Health and Welfare released data on residential aged care performance indicators for the June 2024 quarter.
The good news is that since September 2021 there has been a statistically significant decrease in the proportion of residents experiencing polypharmacy, antipsychotic medication use, falls that resulted in major injury, one or more pressure injuries, use of physical restraint, physical restraint exclusively through the use of a secure area, significant unplanned weight loss and consecutive unplanned weight loss.
The not-so-good news is that the proportion of residents experiencing many of these undesirable outcomes remains high.
The National Health and Medical Research Council released for consultation draft updated Australian Drinking Water Guidelines, including new limits for PFAS ( per- and polyfluoroalkyl substances) concentrations. Submissions close on 22 November, and the final guidelines are expected to be released in April next year.
The Australian Bureau of Statistics released updated microdata on sun protection behaviours.
Consumer and public health groups
The Alcohol and Drug Foundation joined a number of other organisations calling on the Queensland LNP to maintain the Police Drug Diversion Program that allows people found with small amounts of drugs for personal use to be given a warning or referral to a health intervention, rather than a criminal penalty.
The LNP promised to scrap the program if elected.
AMA Queensland President Dr Nick Yim said the program was supported by “health and medical experts, legal groups and the Queensland Police Service and has been in place for more than a year”.
“The LNP must listen to doctors, police and legal experts and retain the laws,” Yim said.
Unfortunately, there has been only a tenuous relationship between evidence and policy in the Queensland election campaign (for more on this, see Adjunct Professor John Mendoza’s Croakey article).
The Consumers Health Forum issued a statement warning of the risks of “using a one-off telehealth consultation to access a particular medicine”. This followed reports of an individual practitioner issuing as many as 12,000 scripts for medicinal cannabis in a six-month period.
In an article in Croakey, the Grattan Institute’s Peter Breadon explored vaccination rates in residential aged care for COVID-19 and other diseases. Government data shows that just over half of residents have a current vaccination for COVID, despite the Aged Care Quality and Safety Commissioner’s minatory statement in June.
Breadon suggested four steps to improve the situation: monthly reporting of aged care-home vaccination rates for flu, shingles, and pneumococcal vaccines; targets for aged care vaccination, covering all adult vaccines; greater flexibility in the rules governing vaccine timing to allow all residents to be vaccinated at the same time (as is the case in the UK); and including vaccination rates in the aged care star-rating system.
The PHAA issued a joint statement with the Australasian Society for Infectious Diseases, the Climate and Health Alliance, and the Royal Australian College of Physicians calling for the Government “to urgently commit funds to establish a permanent Australian Centre for Disease Control (CDC)”.
While the ALP promised during the 2022 election to establish a CDC in its first term in Government, it has only established an interim body with funding that expires at the end of this financial year.
PHAA CEO, Adjunct Professor Terry Slevin, said “Australia is the only country in the OECD who doesn’t have a Centre for Disease Control”.
“The Australian CDC could be the most important and impactful change in the Australian public health landscape in our lifetime,” he said.
“It is critical it is set up effectively from the start with the right legislation and funding to deliver on its potential. We are looking forward to a definitive and substantial financial commitment to the establishment of the permanent CDC before the end of 2024, before an election is called”.
Trade unions
The Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA) jointly held the Rural Medicine Australia 2024 conference in Darwin from 23 to 26 October.
The ABC reported that the NT Government tried to gag employed doctors attending the conference from protesting against the new CLP Government’s policies including lowering the age of criminal responsibility and criminalising public drinking.
The head of NT Health, Chris Hosking, wrote to the AMA’s NT president, Dr Robert Parker, asking him to help ensure the event ran without “any disruptions”. Parker replied that the AMA had not endorsed any protests, but had no power over members wishing to protest.
Croakey’s Dr Melissa Sweet also shared the full letter on X/Twitter.
The national AMA released its latest Specialist Trainee Experience Health Check report, based on 11,500 responses to the 2023 Medical Training Survey.
Compared with 2021 results, there were some areas of improvement.
There was a reduction of 11 percentage points in the prevalence of unpaid overtime to 39 percent, and the number of respondents receiving timely feedback from examinations and assessments increased from 39 percent to 43 percent. The proportion receiving support from their college when needed increased from 44 percent to 48 percent.
However, the highest overall rating any training program received was a “C+”– achieved by both the Royal Australian College of GPs and ACRRM. At the other end of the scale, the College of Intensive Care Medicine and the RACP could only manage a “D+”.
The AMA said it encouraged specialist medical colleges and health services “to reflect on how trainees perceive the quality of their training experience; review compliance with the Australian Medical Council standards for specialty education and training; and internally review education and training policies, with a particular focus on the areas for improvement”.
The RACGP joined with a number of other organisations in “a unified response to dangerous discussions around the potential recriminalisation of abortion in Queensland… calling for immediate action to safeguard the rights, health, and safety of Queensland’s women and pregnant people”.
The organisations said that “recriminalising abortion would disproportionately impact vulnerable communities and those already facing barriers to healthcare, pushing them toward unsafe and dangerous alternatives”.
Industry groups
The Aged and Community Care Providers Association announced the appointment of Mick Reid AM as its new independent chair.
While the statement highlighted Reid’s experience as head of two State health departments and his academic links, it did not mention his service as a director of aged care provider Bolton Clarke.
Private Healthcare Australia (PHA, the private health insurers’ lobby group) maintained its rage against the NSW Government’s increased levy on private health insurance policies with no fewer than three increasingly strident media releases (here, here, and here).
On 15 October the PHA was claiming that the increased levy would lead to 60,000 people dropping their private health insurance, but by 25 October that number had increased to 75,000 – a rate of increase even faster than the increase in private health insurance management expenses.
According to the latest media release, the increased levy will not only drive up premiums, but it will also “decimate health fund reserves to assist private hospitals in areas of need in acute financial distress”.
Reserves would only be reduced if insurers decided to absorb the cost of the increased levy – in which case premiums would not increase.
Politicians and parliamentary committees
The Liberal Party made a rare health policy commitment, with Shadow Health Minister Anne Ruston promising to provide funding of $265,000 “to progress the next two stages of critical research into Creutzfeldt–Jakob disease”.
The Senate inquiry into the Aged Care Bill completed its hearings on 24 October, and also appears to have completed the task of posting submissions to its website. It is due to report on 31 October.
The House of Representatives committee inquiry into the health impact of alcohol and other drugs will hold its first hearings on 28-30 October.
International organisations
The UK Government has launched the Change NHS process, seeking public contributions to “help build a health service fit for the future”.
The Kings Fund published an article by Dan Wellings, Senior Policy Fellow, setting out the characteristics of a successful public engagement process. He suggests these are:
- the process does not limit itself to what the system wants to hear
- there is equality of voice
- it achieves the right balance between local and national
- it is clear how decisions are made based on what has been learnt, and
- it drives a cultural change that prioritises the voices of the people and communities served by the system.
Australian policymakers should bear these ideas in mind as they embark on consultation processes.
Finally
In December 2020 the Senate established a select committee on mental health and suicide prevention, which produced its final report in late 2021, including 44 recommendations.
A Senate resolution requires the Government to respond to recommendations from a Senate committee inquiry within three months – although this requirement is often ignored.
The then Morrison Government did not respond to the recommendations before the 2022 election, so the task fell to the current Government.
On 17 October it finally acted, posting a response on the Department of Health and Aged Care website. Here is the response in its entirety:
“The Government notes this recommendation. However, given the passage of time since this report was tabled, in November 2021, a substantive Government response is no longer appropriate.”
In other words, it is using its unconscionable delay in complying with the requirement to respond as a justification for never responding. It is treating with contempt the people who provided submissions and gave evidence to the inquiry in good faith.
In a statement on 23 October, the Australian Association of Psychologists (AAP) described the “non-response” as “distressing and disrespectful”.
AAP Executive Director Tegan Carrison said: “This pivotal inquiry resulted in 232 submissions, 17 days of public hearings and expert witness presentations from over 100 organisations and individuals who gave their time and experiences to this inquiry in the hope of making a difference.
“The fact the Government has used the passage of time as an excuse not to give a substantive response to the recommendations is irrelevant, regardless of which party was in power then.
“The report was delivered in November 2021 and although it provided meaningful solutions to help ease the mental health crisis, these have been ignored.
“We have waited almost three years for nothing. What an absolute waste of time and effort for all the invested stakeholders, and what a waste of taxpayer dollars”.
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.
Food Standards Australia and New Zealand
Varying maximum residue limits (MRLs) for residues of specific agricultural and veterinary chemicals that may occur in food commodities
29 October
Department of Health and Aged Care
Proposed amendments to the Gene Technology Act 2000
8 November
Podiatry Board of Australia
Proposed change to the protected title for the specialty of podiatric surgery
8 November
Department of Health and Aged Care
Medical Research Future Fund Genomic Health Futures Mission – National Consultation on the refreshed Roadmap and Implementation Plan
8 November
Department of Health and Aged Care
Reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office
11 November
Therapeutic Goods Administration
Medical Devices – Essential Principles for Safety and Performance
13 November (extended from 16 October)
Independent Health and Aged Care Pricing Authority
NDIS pricing reform
15 November
Department of Health and Aged Care
Potential reforms to the Medicare safety nets
15 November
Australian Commission on Safety and Quality in Health Care
Updated Falls Guidelines Consultation
20 November
Office of the Gene Technology Regulator
Online Services Portal Survey
22 November
National Health and Medical Research Council
Updated Australian Drinking Water Guidelines
22 November
House of Representatives Standing Committee on Health, Aged Care and Sport
Inquiry into the health impacts of alcohol and other drugs in Australia
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.
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