Health inequalities, the threat of antimicrobial resistance, disappointments in aged care reform, and global trends in health workforce shortages are among the topics covered in this week’s column.
The Zap also reports on the Royal Australian College of General Practitioners launch of an Aboriginal and Torres Strait Islander Cultural and Health Training Framework, as well as the launch of the fourth edition of preventive healthcare guidelines for Aboriginal and Torres Strait Islander people.
Our columnist has compiled a long list of consultations now open, and also highlights a flawed consultation process around the bill enabling a social media ban on children.
The quotable?
The operation of Australia’s aged-care system as a market means the incentive for providers to profit always trumps the provision of high-quality care.”
Charles Maskell-Knight writes:
The week 18-24 November was World AMR (antimicrobial resistance) Awareness Week.
The Australian Medical Association (AMA) warned that Australia “faces a return to the medical dark ages” if AMR is not addressed.
AMA President Dr Danielle McMullen said “the dangers of AMR should be front of mind for all governments when considering the expansion of prescribing rights for non-medical health professionals, as this had the very real potential to result in unnecessary or inappropriate use of antibiotics, with over prescribing contributing significantly to the risk of AMR in Australia”.
The AMA has prepared a report on AMR, recommending establishment of a Centre for Disease Control, improving antimicrobial stewardship practices in Australia, and improving the antimicrobial market, including through sovereign manufacturing of antimicrobials.
The Rural Doctors Association of Australia President-elect Dr Sarah Chalmers said “please don’t feel cheated if your doctor tells you that a course of antibiotics won’t help you for your common cold, influenza or other viral illness, and you leave your appointment without a prescription – you will be thanking them in five, ten or fifty years’ time when you or your family members really do need a course of antibiotics…and those antibiotics are still working”.
The Australian Commission for Safety and Quality in Health Care (ACQSHC) issued a statement marking the week, with links to updated resources including “quizzes, presentations, web banners and ideas for engaging activities to raise AMR awareness and advocate for action”.
The Aged Care Quality and Safety Commission also acknowledged the week, in a post including quizzes for clinicians and carers.
The National Health and Medical Research Council announced it was providing $3 million to support Australian researchers participating in international collaborative projects addressing AMR.
Ministers and government
The Senate approved the Aged Care Bill 2024 with numerous amendments, which unfortunately did not address the many gaps between what the Aged Care Royal Commission recommended and what will now be legislated.
One bizarre amendment put forward by the Opposition and accepted by the Government purports to impose a duty on the Senate Community Affairs Committee to review any amendments to a wide range of subordinate legislation made under the Act and report to the Senate within three months. That should keep the Committee busy!
The Greens voted against passage of the bill. Senator Larissa Waters spoke for many aged care advocates (and this columnist) when she said:
“We are deeply concerned that the parliament is conceding the opportunity for once-in-a-generation reform to the self-interest of for-profit providers at the expense of participants…
We’ve long supported the shift to the rights-based framework, but older people, their advocates and their loved ones have been clear that those rights must be unequivocal, clear and enforceable. Aspirational rights do not go anywhere near the heart of the problem in aged care.
The operation of Australia’s aged-care system as a market means the incentive for providers to profit always trumps the provision of high-quality care.
Further, we’re worried the bill will usher in a permanent state of expanded means testing and user pays. Instead of treating aged care as health care, we’ll turn it into a marketplace. Participants and the government will continue to subsidise for-profit aged-care providers.
We cannot risk a two-tiered system that bakes in equality. The elderly are not commodities; they’re people. First and foremost, aged care must be universal.”
A number of aged care advocacy and provider groups were more supportive of the legislation, including COTA, Catholic Health Australia, and the Aged and Community Care Providers Association.
Before the bill had passed the Senate, Aged Care Minister Anika Wells had rounded up the usual suspects from the aged care sector and consumer groups and appointed them to an Aged Care Transition Taskforce “to help the sector deliver once in a generation reforms [and] help providers manage implementation of the new Aged Care Act from 1 July 2025, pending parliamentary passage”.
Wells also issued a statement saying that there would be “cap-free gardening and cleaning services under the [proposed new] Support at Home” program.
The statement did not make it clear that this was a backdown by the Government, which had earlier proposed caps on cleaning support of one hour a week and on gardening support of 18 hours a year.
In other parliamentary action Health Minister Mark Butler introduced the Health Legislation Amendment (Modernising My Health Record–Sharing by Default) Bill 2024, which will create a framework that will require key health information to be shared to My Health Record.
Beginning with pathology and diagnostic imaging, it “will establish requirements so that where Medicare rebates are claimed for key services, there will be a requirement to share information about that service to My Health Record”. Patients will be able to opt out of having information shared.
Minister Butler also announced the members of the Health Technology Assessment (HTA) Review Implementation Advisory Group, which will “help guide critical reforms in response to the findings and recommendations of the HTA Review Report which was released in September”.
The Department of Health and Aged Care opened three public consultations during the week.
One is on improvements to the aged care star ratings system, and closes on 13 December. Given the Department is acknowledging the need for improvements, the decision to launch a public campaign several weeks ago encouraging people to make use of the ratings is odd.
The second is on the development of the Fifth National Sexually Transmissible Infections Strategy, and closes on 20 December.
The last is on definitions and targets under the third wave of the Healthy Food Partnership Reformulation Program, and closes on 3 January.
Why three different closing dates?
And why on earth does the Department – which closes from midday Christmas Eve until 2 January – think any organisation responding to the healthy food consultation will be carrying out any work during that period?
The Australian Institute of Health and Welfare (AIHW) released three reports: Health expenditure Australia 2022–23, Health system spending on the response to COVID-19 in Australia 2019–20 to 2022–23, and Health system spending on disease and injury in Australia 2022–23.
The AIHW said that overall health expenditure patterns “have returned to the pre-pandemic trend”, with health expenditure in 2022-23 making up 9.9 percent of GDP, down from 10.4 percent the previous year.
Total health expenditure adjusted for inflation fell 0.3 percent compared to 2021-22, while health expenditure per capita on the same basis fell by 2.4 percent.
These results are the combination of a number of factors, including the end of COVID-19 spending and population growth resuming at pre-COVID-19 levels.
The AIHW found total COVID-19 spending over 2019-20 to 2021-22 was $55.9 billion, 98 percent of which was funded by governments. Individuals spent an estimated $1.1 billion on “COVID–19 related health goods and services such as rapid antigen tests, personal protective equipment, and sanitiser”.
Australia was ranked fourth lowest out of 36 OECD countries in terms of health expenditure above pre-COVID trends from 2020 to 2023.
The report on health spending by disease or injury is based on a highly complex modelling process which allocates health spending to one of 17 Australian Burden of Disease Study groups and 220 conditions within those groups. For the most recent year 2022-23, just under three-quarters of recurrent health spending was allocated in this way.
The headline results are not surprising: the highest spending was for cancer ($18.9 billion), followed by cardiovascular diseases ($16.2 billion), and musculoskeletal disorders ($15.9 billion), a pattern which has been constant for most of the last decade. Together these three groups account for about a third of allocated spending.
The report found that “spending on chronic conditions (often referred to as long-term health conditions), accounted for around $82 billion in 2022–23, just under half (48 percent) of all disease spending in 2022–23”.
The Psychology Board of Australia released a report on the public consultation it conducted in June-August last year on the development of a Board-authored code of conduct for psychologists to replace the existing code, based on the Australian Psychological Society’s Code of ethics, which has applied since national registration began in 2010.
The Board foreshadowed release of the new code, to apply from 1 December 2025, next week.
The Australian Bureau of Statistics (ABS) released the results of the 2023-24 Patient experience survey.
Headline findings included:
- 11 percent of people living in the areas of most socioeconomic disadvantage delayed or went without prescription medication due to cost, compared with six percent of people in the areas of least disadvantage
- 27 percent of people living in areas of most socioeconomic disadvantage also delayed or did not see a dental professional when needed due to cost, compared with 11 percent of people in the areas of least disadvantage
- people living in areas of most socioeconomic disadvantage were more likely to report waiting longer than they felt acceptable for a GP or medical specialist appointment than those living in areas of least disadvantage.
However, “people living in areas of most socio-economic disadvantage were more likely to receive coordination of their care than those living in areas of least disadvantage”.
The Royal Australian College of GPs (RACGP) seized on the data showing that the proportion of patients citing cost as a reason they have delayed or avoided seeing a GP increased to 8.8 percent from seven percent in 2022-23, arguing that the Government should “do more to make general practice care accessible and affordable for everyone, including by increasing patients’ Medicare rebates for longer consults”.
The Consumers Health Forum also reacted to the data, with CEO Dr Elizabeth Deveny saying “we are worried that the continued rising cost of healthcare is becoming the biggest factor in people accessing treatment”.
“It’s pretty simple really, if you can’t afford healthcare, then you don’t go. We know that when people delay treatment it usually results in worse health outcomes for that person,” she said.
First Nations health
The RACGP annual conference GP24 saw two announcements about First Nations peoples’ health.
The first was the launch of the RACGP’s Aboriginal and Torres Strait Islander Cultural and Health Training Framework, developed by Aboriginal and Torres Strait Islander medical education experts and leaders.
Dr Karen Nicholls, Chair of RACGP Aboriginal and Torres Strait Islander Health, said “this framework embeds Aboriginal and Torres Strait Islander values and knowledge across the College and our GP training program”.
“As part of the plan, we’re aiming for 100 percent participation in cultural and health education among GPs in training and higher numbers of practising GPs undertaking training, as well as progress to grow Australia’s Aboriginal and Torres Strait Islander GP workforce,” she said.
Outgoing RACGP President Dr Nicole Higgins said “recognising rights and sovereignty is essential to close the gap in health inequities”.
“Our framework will ensure this is visible across the College, and will enhance our GP training program, ultimately helping to improve health outcomes for Aboriginal and Torres Strait Islander people,” she said.
The RACGP also launched the fourth edition of preventive healthcare guidelines for Aboriginal and Torres Strait Islander people, produced in partnership with NACCHO. It includes new material on the health impacts of climate change, vaping and racism.
Nicholls said: “Aboriginal and Torres Strait Islander people led development of the guide, and it positively states what promotes, supports, and strengthens Aboriginal and Torres Strait Islander health and wellbeing.
“Government data shows almost two-thirds (64%) of the fatal burden of disease for those aged under 75 are deaths that could potentially have been avoided with high-quality culturally and clinically safe preventive healthcare.”
Consumer and public health groups
The Cancer Council marked National Skin Cancer Action Week, urging us all to slip, slop, slap, seek, and slide.
AMA President Dr Danielle McMullen called on Australians to follow that advice, and also encouraged “all Australians to talk to their GP about how they can get a skin check”.
Mental Health Australia (MHA) released its submission to the public consultation on reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office.
The submission proposes an “independent, standalone statutory [National Mental Health Commission] with a monitoring, reporting and advisory role embedded in enabling legislation” with a focus including “providing independent, stakeholder-informed, data-driven, and evidence-based feedback to the government and community on mental health and suicide prevention systems performance and improvements… [and] holding the government to account publicly for systems performance and the implementation of systems improvements”.
MHA also argues that the Commission should have a national focus, and that the Government should engage state governments to work out how state mental health commissions could be “reconstituted to create a harmonised, national approach to monitoring national systems performance to foster greater coordination and clearer accountability”.
Trade unions
Advanced Pharmacy Australia (AdPha) welcomed the announcement by Minister Butler that the title of Doctor of Pharmacy will be granted to graduates of Masters Degree (Extended) programs.
AdPha President Tom Simpson said the title would “provide a strong gateway to the interdisciplinary environments of advanced pharmacy in which skills and expertise can flourish”.
The Pharmacy Guild also welcomed the announcement, saying that “it elevates the profession in line with the recognition bestowed on other health professionals such as physiotherapists, podiatrists, optometrists and dentists”.
The difference is that those other professions do not aspire to provide the full range of primary care services, while the pharmacy profession appears to do so.
The Australian Nursing and Midwifery Federation joined with eight other peak nursing groups in an alliance to campaign for “significant and meaningful primary healthcare reform”.
The group held an event at Parliament House with the Parliamentary Friends of Nursing to “showcase of modern nursing with exhibitions of the diversity of nursing, practical demonstrations, and health assessments for parliamentarians and their staff”.
The alliance said it aims to “ensure significant health care reform in line with the raft of independent reviews under the Strengthening Medicare banner – including the Review of General Practice Incentives, the Review of After Hours Primary Care Programs and Policy, the Working Better for Medicare Review, and the Unleashing the Potential of our Health Workforce – Scope of Practice Review”.
It said that the “spirit of the consultation process throughout these reviews indicates that the Government recognises the growing health needs of patients and communities now and into the future – and the Government has an appetite for reform”.
Minister Butler said when releasing the first three reviews that they all “involved extensive consultation with primary care and health workforce stakeholders”.
“The Government will consult with the sector as it considers the recommendations and findings of the three reviews.”
This suggests to me that the Government has an appetite for endless consultation (which will not upset anybody) rather than actual reform (which might upset some groups).
The AMA called on governments and hospitals to introduce a range of measures to tackle workplace violence, following reports of more than 20,000 violent incidents in Victorian public health services last year.
It suggested “the implementation of risk-management systems to reduce the impact and instance of workplace violence, investment in reporting, monitoring and evaluation mechanisms to assess the effectiveness of the risk prevention and management strategies, and increased investment by hospitals and medical workplaces to support doctors affected by workplace violence”.
The AMA also released its submission to the public consultation on the draft advice on the National Suicide Prevention Strategy, highlighting the need to address workforce shortages.
President Dr Danielle McMullen said “with the shortage of psychiatrists and psychologists, the burden on GPs in managing the caseload of patients has increased”.
“We are urging the government to invest in the psychiatry workforce as well as measures to support well-designed, medically governed multi-disciplinary teams”.
The National Council of Primary Care Doctors said that it “supports and strongly advocates to increase access to general practice services for all Australians, including during after-hours periods”.
However, it said the establishment of Urgent Care Centres (UCCs) “is unfortunately not the solution”.
It said that the Government should:
- invest in additional general practice and rural generalist training to increase access to GP services as part of a comprehensive model of primary care
- reform funding for after-hours periods and appropriately invest in facilitating increased access for Australians to their own GP/GP practice, particularly from 6pm – 9pm, when the majority of after-hours GP type presentations occur
- reform the funding model for primary care to facilitate general practice based multidisciplinary care that is integrated, comprehensive and coordinated.
(For readers who, like me, had never heard of the National Council of Primary Care Doctors, it is apparently a group comprising leaders from the AMA, RACGP, RDAA, ACCRM, Australian Indigenous Doctors Association, General Practice Supervisors Australia, and General Practice Registrars Australia.)
The RACGP said that for the first time in years it had filled all its Australian GP Training (AGPT) Program places, and called on the Government to commit additional funding to address Australia’s GP shortage.
The College said that the increase in trainee numbers was the result of “close coordination between the RACGP and Department of Health and Aged Care and the flexibility of the Government’s training contract with the RACGP”.
President Dr Nicole Higgins praised “the Government’s rapid support for College requests to enable more junior doctors to take up training places, including funding for accommodation, travel, and childcare that allowed the RACGP to place 177 general GPs in training in rural communities that had not had a registrar in years”.
Higgins said the Government should:
- link the allocation of Government-subsidised medical places to a target of 50 percent of graduates training as GPs
- fund 500 more AGPT Program places for the RACGP over the next five years
- ensure GPs in training have equal pay and work entitlements to other medical specialists in training.
Industry groups
The Association of Australian Medical Research Institutes welcomed the Government’s appointment of Rosemary Huxtable AO PSM to oversee delivery of the National Health and Medical Research Strategy by end of 2025.
Medicines Australia welcomed Minister Butler’s announcement of the Health Technology Assessment Reform Implementation Advisory Group, including two industry representatives.
CEO Liz de Somer said “the independent Implementation Advisory Group announced today by Minister Butler is a step forward in progressing HTA reform, and will enable Australia to get on with fixing our broken system so patients can access new medicines without unnecessary delay”.
Minister Butler did not describe the Group as “independent” when announcing it, and it is quite a stretch to apply the adjective to a body including representatives from the industry likely to be most affected by any regulatory change.
Private Healthcare Australia (PHA, the private health insurers lobby group) said the AIHW Health expenditure report showed that “private health insurers financed $19.35 billion of Australia’s total health spending in 2022-2023”.
PHA omitted to mention that $2.2 billion or 11.5 percent of this spending was on administration rather than health services.
Insurers’ total spending on administration (including the proportion funded by the Government through premium rebates) of just under $3 billion made up over 42 percent of total health system spending on administration, even though insurers’ total spending made up under 11 percent of total health spending.
PHA also reacted to the announcement by Healthscope, which operates 38 private hospitals, that it would terminate its contracts with Bupa and the Australian Health Service Alliance in 90 days.
Healthscope announced last month that it was going to charge policyholders covered by those contracts “facility fees” of $50 for a same day admission and $100 for an overnight stay starting from 26 November.
Healthscope said it had decided to cancel the contracts after the insurers pursued legal action to stop the introduction of the facility fee.
Healthscope CEO Greg Horan said “in an environment of rising costs and private hospital closures, it is unacceptable for insurers to fail their core purpose – funding the care of their members, particularly those like Bupa who are boasting of record profits”.
Dr Rachel David, CEO of PHA, said “if Healthscope was serious about delivering patient care to Australians in a cost-of-living crisis, it would negotiate an affordable and sustainable outcome, rather than throwing its toys out of the cot”.
The AMA also issued a statement on the dispute, saying that it “highlights the urgent need for a Private Health System Authority, which can have a crucial role in helping solve disputes like those between Healthscope and Bupa and the AHSA”.
In a radio interview Minister Butler was clear that “we do not involve ourselves in commercial negotiations”.
“We do not use taxpayer funds to bail out one side or the other because they think they need more money,” he said.
The ABC report on the story includes comments from Bupa, AHSA, and the Australian Private Hospitals Association.
Politicians and parliamentary committees
On the motion of Liberal Tasmanian Senator Wendy Askew, the Senate referred to the Community Affairs Committee an inquiry into Access to diagnosis and treatment for people in Australia with tick-borne diseases. This will follow up on the committee’s 2016 report on Growing evidence of an emerging tick-borne disease that causes a Lyme-like illness for many Australian patients.
Submissions are due by 17 January, and the report is due on 26 March (assuming there is not an election in full swing at the time!).
The Senate also referred the legislation enabling the social media ban on children to a committee for an inquiry.
The referral took place on Thursday 21 November, submissions were due on Friday 22 November, a public hearing will take place on Monday 25 November, and the committee will report on 26 November.
If the Senate cannot afford the public enough time to make considered submissions to a proper review process, it should not engage in a pointless charade.
International organisations
The OECD released Health at a Glance: Europe 2024, “examining the major challenges facing European health systems in the aftermath of the COVID-19 pandemic”.
The report includes two thematic chapters on health workforce shortages and trends in health among an ageing population.
In relation to the workforce, it concludes that “attracting enough young people to meet the rising demand presents a significant challenge”.
“Optimising the skill-mix through for example greater use of advanced practice nurses, as well as harnessing digital technologies and AI, will be essential to augment health worker productivity and enable them to focus more on patient care,” it said.
On ageing, the report concludes that “effective policy action is imperative to promote healthy longevity by prioritising disease prevention, including by means of vaccination, supporting mental health at all ages and empowering individuals to manage their own health”.
“Projection models indicate that a concerted ‘healthy ageing’ scenario could slow the growth of health spending as a share of GDP in the coming decades and help contain long-term care costs, while reducing the demand for health and long-term care workers.”
These suggestions seem to apply just as much to Australia as to Europe.
Finally
Finally, this week, a question from the AMR quiz on the ACSQHC website.
True or false – It is predicted that in 2050, 1.9 million people worldwide could die from antimicrobial resistance. (Answer at the end of the column.)
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.
National Health and Medical Research Council
Proposed updates to the Investigator and Synergy Grant assessment framework
4 December
Office of the Gene Technology Regulator
Proposed minor and technical amendments to the Gene Technology Regulations 2001
8 December
Department of Health and Aged Care
Draft national standards for counsellors and psychotherapists
13 December
Department of Health and Aged Care
Star Ratings for residential aged care – design changes
13 December
Department of Health and Aged Care
Draft National STI Strategy
18 December
Department of Health and Aged Care
Medical Research Future Fund Australian Brain Cancer Mission – consultation on the refreshed Roadmap and Implementation Plan
20 December
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
Department of Health and Aged Care
Healthy Food Partnership Reformulation Program: Wave 3 Category Definitions and Targets
3 January
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January 2025
Senate Community Affairs Committee
Access to diagnosis and treatment for people in Australia with tick-borne diseases
17 January 2025
Quiz answer: True. See Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050.
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.
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