Health and medical announcements and statements have been flowing in the lead-up to the 14 May Federal Budget, reports Charles Maskell-Knight.
His latest column also brings updates on public health, aged care and medical research, as well as the World Health Organization’s most recent achievements.
And he shares some personal reflections from the frontlines of rural healthcare, about the kindness and care he has witnessed, as well as the intense demands upon a system that “is only just coping”.
Don’t miss the list of consultations that may be of interest for Croakey readers.
The quotable?
Possum skin cloaks have been integral to storytelling and have also protected and helped Aboriginal Communities heal for tens of thousands of years.
The launch of the Men’s cloak is a celebration of the healing power of 65,000 years of Aboriginal culture and Aboriginal ways of knowing, being, and doing.”
Charles Maskell-Knight writes:
The last few weeks have seen a number of pre-Budget announcements, including the “once in a generation” medical research spending announced by Health Minister Mark Butler on 2 May.
Another took place last week, when Education Minister Jason Clare announced the Commonwealth Prac Payment “to support students undertaking mandatory workplace placements required for university and vocational education and training qualifications [and covering] Australians studying to be a teacher, a nurse, a midwife or a social worker”.
Unsurprisingly, groups representing students eligible for the payment were supportive.
Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Annie Butler said “the ANMF has been making the case for clinical placement reform as a platform to address workforce retention and recruitment and we commend the Albanese Government for helping the nurses and midwives of tomorrow”.
Just as unsurprisingly, there was a chorus of criticism from groups that missed out, including psychologists, paramedics, and pharmacists (both the Guild and the Pharmaceutical Society of Australia, PSA).
Allied Health Professions Australia (AHPA) welcomed the announcement as it applied to social workers, but pointed out that “‘placement poverty’ is real for many students of other allied health disciplines where mandatory placements are just as extensive, if not more”.
AHPA said that the 2023 Skills Priority List had identified shortages of audiologists, occupational therapists, optometrists, orthotists/prosthetists, physiotherapists, podiatrists, psychologists, speech therapists, and sonographers, and called for “an expansion of this ‘placement payment’ to ensure the supply of qualified allied health professionals matches demand for services”.
Asked by the Medical Republic to justify the exclusion of medical students, Clare said “the Universities Accord team recommended we focus the Commonwealth Prac Payment first on teaching, nursing, midwifery, early education teachers and social work, and that’s what we’re doing”.
Let’s hope that the Government’s slavish obedience to expert advice extends to the Economic Inclusion Advisory Committee, which again recommended increases to social security payments in its 2024 report (released on 26 April when nobody was paying attention).
Ministers and government
In another pre-Budget announcement, Minister Mark Butler released details of new Medicare items covering consultation with gynaecologists of 45 minutes or more, intended to support better care for women with endometriosis.
Butler also announced that the Government would provide $24.6 million to Charles Darwin University to establish and operate a medical school from 2026, with an intake of 40 students a year.
At a press conference in Adelaide today, Butler announced another 29 Urgent Care Clinics would be established, in addition to the 58 already in operation.
It’s not surprising that journalists have in recent days asked Ministers ButIer and Ged Kearney for their views on the Government’s Future Gas Strategy, given the health impacts of fossil fuel industry expansion. Both Ministers strongly expressed their support for renewable energy.
In non-Budget news, Butler also announced that “the Australian Medical Association (AMA), the Royal Australian College of General Practitioners (RACGP), and the Pharmacy Guild of Australia are backing the Albanese Government’s world-leading legislation to protect children, young people and all Australians from the harms of vaping and are urging all Parliamentarians to support the legislation currently before the Australian Parliament”.
The TGA announced that the Dolphins NRL team had agreed to remove Alternaleaf branding from its jerseys from stadium signage displayed during games. (Alternaleaf is a medical cannabis clinic, and the TGA was concerned that the branding amounted to illegal advertising under the Therapeutic Goods Act.)
The Australian Health Protection Principal Committee (essentially the Chief Medical, or Health Officers from the Commonwealth and every state and territory) issued a statement on the dangers of vaping, concluding that “we are at a pivotal moment in the response to vaping”. “Tackling this public health crisis requires a collective, concerted, and bold response to prevent current and future generations developing nicotine-addiction,” they said.
The Australian Institute of Health and Welfare (AIHW) released a report on maternal and perinatal outcomes during the 2020 and 2021 COVID-19 pandemic. Compared with previous years, fewer babies were born pre-term, fewer mothers had induced labour, fewer first-time mothers attended 10 or more antenatal visits, and both mothers and babies had shorter hospital stays.
The Institute also released a very timely update to its data on family, domestic and sexual violence.
Meanwhile, Dr Zoran Bolevich has been announced as the Institute’s new leader. He was previously Chief Executive of eHealth NSW and Chief Information Officer for NSW Health, and has been a member of the AIHW board since 2016.
The Independent Hospital and Aged Care Pricing Authority released for public consultation the pricing framework for public hospital services for 2025-26.
The Authority is particularly seeking feedback on its proposal “to transition community mental health from block funding to activity based funding”, as well as feedback “to address any potentially enduring impacts of the COVID-19 pandemic response and the need to prepare for future system disruptions… includ[ing] variations in public hospital activity and costs that have endured since the onset of COVID-19, and principles and processes, that could guide an appropriate pricing response to significant disruptions to the health system”.
Responses are due by 7 June.
The Dental Board of Australia responded to reports of a surge in people accessing superannuation pre-retirement to pay for dental procedures with a statement that it “is concerned by this sudden rise and sees this as an emerging issue that may lead to more complaints in the near future”.
The Board reminded dentists that it could consider disciplinary action against a dentist providing misleading information to the Australian Taxation Office (ATO), and that advertising “must not directly or indirectly encourage the indiscriminate or unnecessary use of a regulated health service [or] provide information that is false, misleading or deceptive or likely to be misleading or deceptive”.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) launched its national standard to improve the care of people with cognitive disability or impairment by reducing the use of psychotropic medication.
The Productivity Commission released a paper on the role digital technology can play in improving patient outcomes and enhancing productivity in health care. It concluded that “drawing on case studies… better integrating digital technology into everyday practice could save more than $5 billion a year”.
There is a long way to go. For example, despite the ongoing and significant patient flow between southern NSW and The Canberra Hospital, patient records are transferred via folders of papers stuffed under a patient’s pillow in an ambulance.
First Nations health
The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) announced the launch of a special Men’s possum skin cloak, developed in collaboration with the Royal Melbourne Hospital and Peter MacCullum Cancer Centre.
The cloak will be available to all Aboriginal men to wear or place over their beds while receiving treatment at those services.
VACCHO Acting CEO Jim O’Shea said “possum skin cloaks have been integral to storytelling and have also protected and helped Aboriginal Communities heal for tens of thousands of years”.
“The launch of the Men’s cloak is a celebration of the healing power of 65,000 years of Aboriginal culture and Aboriginal ways of knowing, being, and doing.”
Consumer and public health groups
The Alcohol and Drug Foundation commented on data released by the Pennington Institute showing that the number of number of drug-induced deaths reported in Australia increased to 2,356 in 2022, almost double the road toll.
Foundation CEO Dr Erin Lalor said “a suite of measures is needed to prevent and reduce drug-related harms, including targeted education campaigns in populations at greater risk of unintentional overdose, addressing stigma, and stronger investments in harm reduction and prevention initiatives, and treatment services”.
The Consumers Health Forum said “the Budget must make it cheaper and easier for Australians to access healthcare”.
It asked for funding for health literacy; acceleration of the next tranche of medicines scheduled for 60-day scripts; an electronic PBS safety net system; and increased funding for public dental services.
The Grattan Institute released a report with a detailed proposal for a sugar tax on sweetened drinks, including modelling of implications for the sugar industry. It cited studies showing that “sugary drink taxes in Australia could lead to tens of thousands of extra years of life, hundreds fewer people developing diabetes each year, and tens of thousands of avoided cases of dental decay”.
The Institute estimates that given 80 percent of Australian sugar production is exported, the reduction in sugar consumption arising from the tax would only amount to half a percent of total Australian production – and this could easily be made up with increased exports to meet growing global demand for sugar.
The Australian Medical Association (AMA) welcomed the report, saying its own modelling showed a tax could prevent thousands of cases of diabetes.
The Australian Dental Association also welcomed the report, saying that “as long as our government drags its feet, Australia will remain behind the 100 plus countries around the world which have taken the step to combat sugar consumption via sugar-sweetened beverages”.
Trade unions
The Australian College of Midwives marked International Day of the Midwife.
This year a rose called ‘Lucina- the midwives rose’ was planted in rose garden at The Lodge in Canberra. Prime Minister Anthony Albanese said he was “proud to acknowledge the profession of midwifery on International Day of the Midwife and thank them for their hard work, dedication and commitment”.
On the local front in Yuin country, inclement weather didn’t curb the enthusiasm of a group of 50 or so midwives and their supporters who walked from Batehaven to Bateman Bay.
The Australian College of Rural and Remote Medicine (ACCRM) issued a media release calling for the Budget to include “additional funding to train 500 registrars each year, for the next five years”.
Ahead of the Budget, the AMA called for further urgent investment in the health system to address immediate concerns.
Re-releasing the Association’s pre-Budget submission, President Professor Steve Robson highlighted a number of priorities including equitable remuneration for GP trainees; establishment of health workforce planning agency; introduction of a sugar tax; a mandatory benefit: premium ratio of 90 percent for private health insurers; and establishment of an independent authority to regulate the private health sector.
The AMA also released its response to the Department of Health and Aged Care’s consultation on a new National Strategic Framework for Chronic Conditions. It is calling for “improved arrangements to support GP led well-coordinated multidisciplinary care for patients with chronic and complex disease”.
The PSA backed calls from other health groups for the Parliament to pass the Government’s anti-vaping legislation.
The RACGP criticised the Victorian state budget for failing to resolve the “GP payroll tax fiasco”, and called on the ACT Government to resolve the issue in the ACT.
The Rural Doctors Association of Australia asked the Government to provide additional support in the Budget for rural general practice, including a central credential register to assist doctors working across multiple sites; simplification of the Medicare after-hours incentives; a new funding model for rural and remote general practices; and better systems to track patients’ diagnostic test referrals.
Industry groups
The Association of Australian Medical Research Institutes (AAMRI) unveiled a cunning plan to address the issue that “when researchers are awarded grants, additional costs are incurred that are not covered by the funds received… [such as] HR, finance, research commercialisation, legal costs, business development, data storage, cyber security and costs for laboratories and research facilities”.
AAMRI’s solution is to use some of the difference between the amount of Medical Research Future Fund (MRFF) funds available for distribution ($973 million in 2024-25) and MRFF grants awarded ($650 million) to meet these on-costs.
I don’t know why the system doesn’t automatically fund the full costs of research, including on-costs.
Catholic Healthcare Australia responded to reports that the Budget would not include changes to aged care contributions with a statement urging action.
CEO Jason Kara said “with most aged care facilities running at a loss, the government must urgently enact funding reforms to ensure older Australians have access to the quality care they deserve”.
CHA also called for the Government to act to meet surging demand for home care services.
Politicians and parliamentary committees
The Senate committee inquiry into the Government’s anti-vaping legislation published its report, with a majority recommendation that the bill be passed, and dissenting views from Coalition senators that the bill not be passed.
The Greens dissenting report highlighted a number of concerns, including in relation to exemption for personal use; reversal of the burden of proof; the availability of other support for people seeking to quit; recycling of vapes; and restrictions on advertising vapes to medical practitioners.
The Government will clearly need to entertain some amendments to the bill to win Greens and potentially other cross-bench support if the bill is to pass.
Shadow Minister Anne Ruston appeared on Sky News and reiterated her party’s commitment to restoring the 20-session cap on MBS-funded psychology services.
International organisations
The World Health Organization (WHO) released its Results Report for 2023, “showcas[ing] achievement of key public health milestones, even amid greater global humanitarian health needs driven by conflict, climate change and disease outbreaks”.
Notable achievements for the 2022 and 2023 biennium included:
- administration of the world’s first malaria vaccine to more than two million children in Ghana, Kenya, and Malawi
- 14 countries eliminating at least one “neglected tropical disease”
- the highest number of people with tuberculosis to get treatment since monitoring began almost 30 years ago
- an additional 13 countries implemented best-practice policies to eliminate industrially-produced trans-fatty acids from the food supply
- more than 75% of people living with HIV are receiving antiretroviral therapy, with most achieving viral suppression
- declining tobacco use in 150 countries
- an additional 29 countries developed national action plans on antimicrobial resistance
- another 25 countries introduced the human papillomavirus vaccine.
However, the report also “acknowledges significant disparities in health outcomes, disruptions caused by the COVID-19 pandemic, and that persistent health workforce shortages require investments in education and employment”.
Finally
Finally this week, some personal reflections on rural healthcare.
For the last ten days I have been accompanying a patient receiving care in two hospitals on Yuin country on the NSW south coast.
As a result, much of this column has been written in the Sub-acute Rehabilitation Unit lounge at Moruya District Hospital, which enjoys a panoramic view of the Moruya river.
The hospitals have delivered excellent care. With only a couple of exceptions, the nursing staff have been skilful, knowledgeable, and caring. The doctors have not only been professional, but have explained what they are doing, while showing great empathy and compassion.
The culture of looking after people runs through the organisations. One of the cleaners worked out I had missed lunch one day, and went to the kitchen and scrounged a sandwich for me.
However, from talking to the staff and listening to the nurse station and corridor conversations, you realise the system is only just coping.
It is being held together by staff like the veteran nurse who had worked 16 of the last 18 days (including a couple of double shifts), the Irish nurses and physios out to see the world, and the doctors on a round Australia trip stopping for a few months in a seaside town.
I met several nurses who worked a shift, had a shift off, and then worked the next shift.
On the upside, there were many great younger nurses who had graduated from the University of Wollongong’s outreach campuses scattered down the NSW south coast. They deserve to work in a system that is properly resourced and doesn’t burn them out.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Australian Commission on Safety and Quality in Health Care (ACSQHC)
Aged Care Infection Prevention and Control Guide
15 May
Senate Community Affairs References Committee
Inquiry into Excess Mortality in 2021, 2022, and 2023.
17 May
Department of Health and Aged Care
Minimum stockholding requirements for PBS drugs
17 May
Aged Care Quality and Safety Commission
Aged Care Quality Standards draft guidance documents
19 May (previously 30 April)
TGA
Amendments to the Poisons Schedule
22 May
Scope of Practice review
Issues paper 2
26 May
TGA
Instructions for Use for Medical Devices
28 May
NHMRC and CHF
Review of the 2016 Statement on Consumer and Community Involvement in Health and Medical Research
31 May
Prostate Cancer Foundation of Australia
Review of the Clinical Practice Guidelines for PSA Testing
31 May
Office of the National Rural Health Commissioner
Awareness of the National Rural and Remote Nursing Generalist Framework 2023-2027
31 May
Department of Social Services
Developing the National Autism Strategy
31 May
Chinese Medicine Board of Australia
Patient health records guidelines
5 June
Independent Hospital and Aged Care Pricing Authority
Pricing Framework for Australian Hospital Services 2025–26
7 June
TGA
Proposed changes to the regulation of exempt medical devices and exempt other therapeutic goods
9 June
TGA
Companion diagnostics guidance update
17 June
Department of Health and Aged Care
Overseas student health cover
24 June
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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