Among national recommendations for improving healthcare for First Nations people in prison is this: health and justice ministers should pilot alternative, therapeutic models of custody for First Nations people, prioritising mothers and young people.
State and territory health ministers discussed the National Review of First Nations Health Care in Prisons, carried out by Nous and completed in July, at their recent meeting in Hobart, and agreed to “partner with the Aboriginal Community Controlled Health Services sector, Aboriginal Justice advocates in each jurisdiction, and Ministers responsible for corrections and youth justice to develop an implementation strategy”.
The column this week also digs into new data about Aboriginal and Torres Strait Islander people’s use of primary healthcare, marks the one millionth attendance at an Urgent Care Clinic, and reports on health workforce developments, action on dementia, the NSW Drug Summit, palliative care, and mental healthcare.
Don’t miss Mark Butler’s Ministerial moves at the #NACCHOconf2024 Karaoke Dinner – “he did it again”.
The quotable?
The Australian Private Hospitals Association released a paper setting out a proposal for an immediate response to the private hospital viability crisis.
Spoiler alert: it involves the Government stepping in with an open cheque book.”
Charles Maskell Knight writes:
Health Minister Mark Butler met with his state and territory counterparts on 6 December.
One of the topics for discussion was expedited pathways for Australian registration for Specialist International Medical Graduates (SIMGs), which began to operate in October for general practice, and will shortly be extended to anaesthesia and psychiatry, and obstetrics and gynaecology by the end of February 2025.
This was one of the recommendations of the Kruk review, accepted by National Cabinet at the end of 2023.
A number of organisations offered advice to Ministers before the meeting on this issue.
The Council of Presidents of Medical Colleges (CPMC) issued a statement “warning that the proposed fast-track registration of Specialist International Medical Graduates risks exacerbating a two-tier healthcare system in which the quality of specialist care Australians receive could be determined by their postcode”.
The Royal Australasian College of Surgeons (RACS) echoed the CPMC, warning that “the proposed fast-track registration of overseas-trained doctors compromises the safety of patients living outside of urban centres and creates a two-tier system which risks eroding professional standards of care”.
RACS called for “a more thoughtful and strategic approach to solving the workforce crisis”, including pausing the implementation of the expedited pathways “for further consultation and review”, and the introduction of “targeted initiatives to recruit and retain surgeons in regions with the greatest need, both geographically and by specialty”.
How such initiatives would grow rather than redistribute the workforce is not clear.
The Royal Australian College of GPs (RACGP) said that “Ahpra’s expedited pathway started on October 21, but the information they have provided has not eased our concerns about how Ahpra will identify unsuitable candidates, or how they’ll ensure these doctors are supervised to the required standard”.
“We also still don’t know how Ahpra will ensure doctors will be placed in areas of greatest need, or how they’ll encourage them to remain in these communities – we urgently need clarity,” Ahpra said.
In the event Ministers ignored the advice, and simply noted that the next priority specialties were general medicine, general paediatrics, and diagnostic radiology.
The Ministers also discussed the findings and recommendations of the National Review of First Nations Health Care in Prisons carried out by Nous and completed in July, and agreed that they “will partner with the Aboriginal Community Controlled Health Services sector, Aboriginal Justice advocates in each jurisdiction, and Ministers responsible for corrections and youth justice to develop an implementation strategy”.
The Nous report and associated documentation is available on the Department of Health and Aged Care website, as is the response from Ministers.
Nous made six detailed recommendations, summarised as:
- Health and justice ministers agree to a set of national reform principles to drive action
- Health and justice ministers investigate evidence provided to the review and take steps to cease any practices that violate prisoners’ rights
- Establish a National Partnership Agreement to govern the reform of First Nations health services in places of detention
- Implement a national program of work for First Nations healthcare in places of detention, led by the National Partnership Agreement
- Facilitate the leadership of the Aboriginal community-controlled health sector in the policy, design and delivery of health services in partnership
- Health and justice ministers pilot alternative, therapeutic models of custody for First Nations people, prioritising mothers and young people.
Ministers and government
Minister Butler announced the release of the National Dementia Action Plan 2024-2034, outlining “eight high-level actions for implementation over the next decade… [with a] focus on increasing dementia awareness, reducing the population’s risk of dementia, and driving better coordinated dementia services”.
The Australian Institute of Health and Welfare (AIHW) will track and report annually on progress against the Plan through an online dashboard with 50 indicators. Presumably this work will be carried out by the AIHW’s National Centre for Monitoring Dementia, established in 2021.
Dementia Australia welcomed the Plan, with CEO Professor Tanya Buchanan saying that it “provides a clear vision for the future, where all Australians understand dementia and all people living with all forms of dementia and their carers have quality of life”.
Minister Butler and Assistant Minister for Indigenous Health Ged Kearney both spoke at the National Aboriginal Community Controlled Health Organisation (NACCHO) conference in Canberra.
The conference acknowledged 27 ACCHOs with anniversaries ranging from 25 to 50 years, “a testament to community-led health initiatives’ enduring strength and resilience”.
NACCHO Chair Donnella Mills said: “Aboriginal Community Controlled Health Services are more than health providers – they are the heartbeat of our communities.
“These services have served as pillars of strength for decades, providing culturally appropriate, comprehensive primary health care. Today, we celebrate their longevity and the dedication of the communities and health professionals who sustain them”.
In his speech Butler announced the extension of a number of First Nations health programs, including: Culture, Care, Connect (an additional $21 million), health infrastructure ($70 million); trachoma ($15 million); and NACCHO’s Rheumatic Heart Disease program ($15 million).
Kearney emphasised the importance of Birthing on Country, and the support the Government is providing for services delivering this model of care.
Butler joined Victorian Premier Jacinta Allan at the opening of Moderna’s mRNA manufacturing facility in Victoria, which will be able “to produce up to 100 million vaccine doses each year for respiratory diseases including influenza, Respiratory Syncytial Virus, and COVID-19”.
Butler also issued a statement marking the one millionth attendance at an Urgent Care Clinic, saying that “nearly half the patients say they would have gone to the local emergency department if the Medicare Urgent Care Clinic was not there” – unfortunately without giving a source for the statistic.
He also cited a recent survey of GPs (carried out by Healthed with 795 respondents), which found “over 70 percent of GPs support the work of Medicare Urgent Care Clinics and over 80 percent of GPs think they’re having a positive impact on hospital emergency departments”.
Butler also announced that the Government in partnership with the Cancer Council Australia was spending $15 million on skin cancer prevention messages for at risk groups: the End the Trend campaign for young people; and Save Your Skin messaging for men over 40, especially those who live in the bush, tradies, and others who work outdoors.
The Department of Health and Aged Care announced on 3 December that “submissions are now open for feedback on the draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia”.
Submissions are due by 16 December – perhaps the Department intends to release the final guidelines before the holiday feasting begins?
The AIHW released the National Cervical Screening Program monitoring report 2024, the sixth report since the screening program was changed from biannual Pap smears to quinquennial human papillomavirus tests in late 2017.
The AIHW also released a report on Aboriginal and Torres Strait Islander people and primary health care: patterns of service use, preferences, and access to services.
It found that:
- Service availability is good at a national level, but there are significant local gaps
- While most people have a usual source of care, they are not always able to use the type of primary healthcare service they prefer
- People still have unmet needs for primary healthcare services, especially dental care
- ACCHOs play a very important role in the provision of primary care services.
The AIHW released a number of other reports on First Nations health, including ear and hearing health of First Nations children; acute rheumatic fever and rheumatic heart disease; and updates to datasets in the Indigenous Mental Health and Suicide Prevention Clearinghouse.
Finally, the AIHW released 2023-24 data on public hospital elective surgery and emergency department activity for all jurisdictions except the NT.
This showed that the volume of elective surgery admissions increased by five percent from 2022-23 to 771,600, the highest number on record. The ACT recorded a 19 percent increase, while Victoria had an increase of 10 percent.
The median patient admitted from the waiting list had waited 46 days, down from 49 in the previous year; while the 90th percentile waited 329 days, down from 361. Only 6.4 percent waited more than a year, down from 9.6 percent.
Emergency department presentations increased by only 0.4 percent, a reduction in the long-term trend, and 67 percent of patients were seen on time, an increase on 65 percent the previous year.
Ahpra released the results of the Medical Training Survey for 2024, which found that “Aboriginal and Torres Strait Islander medical trainees report experiencing and/or witnessing racism at more than double the rate of colleagues”.
Chair of the Medical Board of Australia, Dr Anne Tonkin, said she was “appalled by what Aboriginal and Torres Strait Islander trainees report”.
“Clearly, our efforts to strengthen cultural safety in medicine and the health system more widely are urgent and well targeted,” she said.
Almost 30 percent of Aboriginal and Torres Strait Islander trainees were considering a career outside medicine, compared with about 19 percent of all trainees.
More positive results suggested that the national quality of trainee supervision, orientation, teaching, education and training on patient safety remained high.
Australian Medical Association (AMA) President Dr Danielle McMullen said the results were “disappointing and unacceptable”, and the survey “should be a major wake-up call to tackle the systemic issues that impact the training experience and wellbeing of doctors in training”.
The Independent Health and Aged Care Pricing Authority (IHACPA) released the Pricing Framework for Australian Public Hospital Services 2025–26.
The framework includes pricing community mental health care services on an activity basis, following four years of shadow pricing.
IHACPA said “this milestone represents the first patient service category transitioned from block funding to activity-based funding since IHACPA’s inception”.
The Australian Bureau of Statistics released microdata from the Patient Experiences Survey for use in its DataLab application.
Consumer and public health groups
The Consumers Health Forum welcomed the Government’s decision to list Visanne on the PBS for the treatment of endometriosis.
However, CEO Dr Elizabeth Deveny said that the “announcement underscores the critical need for greater investment in women’s health, particularly in improving early diagnosis and management of not only endometriosis but also other conditions disproportionately affecting women [such as] polycystic ovary syndrome, fibroids, and pelvic pain syndromes [which] often go undiagnosed for years, with devastating impacts on women’s physical and mental health”.
Palliative Care Australia (PCA) launched its “Better access to palliative care – worth voting for” campaign ahead of the forthcoming federal election.
CEO Camilla Rowland said that “Every day, around 400 people die of a terminal illness, yet 62 percent do not receive specialist palliative care at any stage”.
PCA is calling for “a new quarterly payment to primary care practices for each palliative patient to recognise the costs of delivering services not billable to Medicare; free palliative care medicines for people at the end of life; palliative care training for nurses working in aged care; and an interim program to provide basic at home living supports for people under 65 with disabilities who are dying”.
Trade unions
The Australian Association of Psychologists (AAPi) responded to a survey carried out by Deakin University’s Associate Professor Melissa O’Shea of 90 postgraduate psychology students undertaking placements, which found that over 90 percent experienced financial stress, “with the burden of paid work impacting their ability to engage with the course”.
AAPi reiterated its call for the “Paid prac” scheme to be extended to psychology students. AAPi Executive Director Tegan Carrison said “psychologists are only meeting 35 percent of the Federal Government’s psychology workforce goal, so we need to significantly boost the pipeline into the profession by recognising that government-funded paid placements for our future psychologists are an absolute necessity”.
The AMA released a position statement on mental health and wellbeing “advocating that all levels of governments, and non-governmental organisations, need to work cooperatively to design a mental healthcare system that is patient centred, and needs based, informed by evidence and research, with adequate investment and sustainable funding”.
The AMA also released its submission to the review of the Medicare safety nets. One very sensible suggestion it makes is “introducing continuous eligibility assessments based on recent healthcare visits rather than just out-of-pocket expenses per calendar year”.
“This may effectively target those requiring support without those patients having to commit considerable funds to be captured by the safety net.”
The RACGP issued a statement on International Day of People with Disability (3 December) saying that “access to more funding for essential GP care is key to improve health and wellbeing for Australians with disability”.
Dr Melita Cullen, a Queensland GP living with autism and dyslexia who sees many patients with disability, said that “to provide optimal care for people with disabilities we need more inclusive funding strategies, including more funding for longer consults, non-face-to-face patient care and longer telephone consultations which ensure access for people with mobility issues”.
The RACGP also issued a statement claiming that “funding Australians to get GP care after unplanned hospital visits will improve health and reduce costs”.
While there is a clear case for much better information flows from hospitals to GPs following hospital admissions, there is nothing to stop a patient attending a GP for a follow-up visit and submitting a claim for a Medicare rebate.
The Royal Australasian College of Physicians (RACP) was active commenting on state politics.
It said the Queensland Government’s Making Queensland Safer Bill “will significantly worsen health outcomes for children across Queensland… [and] is likely to worsen the overrepresentation of First Nations children in detention, deepening psychological, social, and cultural harm, and perpetuating trauma and disconnection from their communities”.
The RACP also issued a position statement ahead of the NSW Drug Summit “focusing on the need to have a comprehensive approach to drug policy that is evidence-based and includes education, harm prevention and reduction, and treatment”.
RACP President Professor Jennifer Martin said that governments “need to listen to evidence-based advice that will actually improve health outcomes, address inequity and reduce harm”.
If only.
NSW Health Minister Ryan Park didn’t even wait for the Summit to end before ruling out decriminalisation as an option.
Industry groups
The Aged and Community Care Providers Association welcomed the Government’s announcement of additional funding for meals-on-wheels providers, but said it “highlights that further action is needed to address rising costs and ensure the sustainability of Commonwealth Home Support Program services… [during the transition] to the Support at Home program”.
The Australian Hospitals and Healthcare Association marked the release of the final issue of the Australian Health Review for 2024, including articles on the integration of innovative care models, the role of digital technologies, and strategies for workforce sustainability.
The Australian Private Hospitals Association released a paper setting out a proposal for an immediate response to the private hospital viability crisis.
Spoiler alert: it involves the Government stepping in with an open cheque book.
The paper presents a great deal of material supporting its view that there is a crisis, and that the analysis in the recent Private Hospital Financial Viability Health Check carried out by the Department of Health and Aged Care should not be relied upon.
It argues that the sector is facing a revenue shortfall of $1 billion to $1.2 billion a year, and that the Government should provide funding direct to private hospitals of $150 per day-only patient and $250 per overnight patient, for a total annual cost of a little under $600 million.
The paper suggests a number of other policy responses, including:
- An incentive payment for private hospitals to digitise paper-based records
- A government private hospital nursing wage subsidy
- A Memorandum of Understanding with insurers to increase benefit payout ratios to 88 percent of premium revenue
- Doubling the psychiatrist inpatient consultation Medicare benefit, and allowing nurse practitioners to be eligible for Medicare benefits for inpatient mental health consults
- Amending public hospital funding arrangements so that the Commonwealth funds 60 percent of the cost of public patients treated in the private sector
- Requiring “silver” insurance products to cover maternity services, and including maternity benefits in the risk equalisation pool
- Introducing maximum reserve limits for insurers
- A regional private hospital grant of at least $10,000 per overnight bed/day hospital theatre
- Introducing a Medicare Benefit Schedule regional loading for anaesthetists and surgeons.
Nobody can fault their creativity!
And as Professor Stephen Duckett AM wryly observed, “surprised to see health sector vested interest group arguing world will fall in unless their members given more money”.
Medicines Australia issued a statement urging a hurry-up on implementing the recommendations of the Health Technology Assessment review.
It also issued a statement on data from the latest Mood of the Nation survey carried out by SEC Newgate, seizing on the findings that 68 percent of respondents “believe the Government should be investing more to ensure quality affordable healthcare for all Australians” and 74 percent “believe the Government should subside the best medicines available, even if it means more of a cost to taxpayers”.
The survey unfortunately does not appear to have asked which taxes should be increased to pay for the new medicines.
Private Healthcare Australia (the private health insurers’ lobby group) said the NSW Government had informed health insurers that “in return for them agreeing to pay the state’s preferred rate for privately insured patient stays in public hospital single rooms, it will not raise the Health Insurance Levy”.
Politicians and parliamentary committees
The Senate community affairs committee has begun an inquiry into the Health Legislation Amendment (Modernising My Health Record—Sharing by Default) Bill 2024.
Submissions are due by 10 January 2025, ahead of a reporting date of 30 January.
International
One of the recurrent themes of proposals for health service reform in Australia is that care should be moved out of acute hospitals and into community services.
We are not alone – the new Labour Government in the UK is proposing a similar shift as part of its strategy to “fix the National Health Service”.
The Nuffield Trust published a paper by senior fellow Sarah Reed and CEO Thea Stein setting out three fundamental questions that need to be addressed in considering such proposals:
- What does shifting care into the community actually mean?
- What is moving care out of hospital likely to improve, and what is it unlikely to improve? (Contrary to the assertions of most advocates, the evidence suggests that it does not generate cost savings at a systemic level.)
- Why have previous efforts failed, and what needs to be different this time?
It is a long read, but it should be compulsory reading for those advocating similar proposals in Australia.
In other international news, an outbreak of a so far unidentified disease with flu-like symptoms in the Democratic Republic of the Congo is creating headlines around the world.
So far well over hundred people appear to have died from the disease, and the World Health Organization has now sent staff to the region to investigate.
Finally
Minister Butler’s speech to the NACCHO conference on 4 December contained references to a karaoke performance at the dinner following last year’s event, and hints of a repeat performance.
Here is his latest performance – courtesy of NACCHO’s Instagram account.
I don’t think he should give up his day job yet!
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.
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
Aged Care Reforms Sector Pulse Survey
13 December
Department of Health and Aged Care
Draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia
16 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
National Lung Cancer Screening Program Guidelines
5 January 2025
Senate Community Affairs Committee
Health Legislation Amendment (Modernising My Health Record—Sharing by Default) Bill 2024
10 January 2025
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January 2025
Therapeutic Goods Administration
Adoption of International Scientific Guidelines in Australia
16 January 2025
Senate Community Affairs Committee
Access to diagnosis and treatment for people in Australia with tick-borne diseases
17 January 2025
Department of Health and Aged Care
Healthy Food Partnership Reformulation Program: Wave 3 Category Definitions and Targets
17 January 2025 (extended from 3 January 2025)
Department of Health and Aged Care
Residential Care Service List (explaining what care and services aged care homes must provide to all permanent residents and residential respite recipients).
20 January 2025
Department of Health and Aged Care
Review of Primary Health Network Business Model and Mental Health Flexible Funding Model
22 January 2025
The Treasury
Pre-budget submissions
31 January 2025
Department of Health and Aged Care
National Health and Medical Research Strategy – Webinar Survey
28 February 2025
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.
