Aged care reforms, suicide prevention, health technology assessment, workforce regulation, prevention research, and a lack of action on dementia – these are some of the topics covered in this week’s column.
And columnist Charles Maskell-Knight suggests that the National Health and Climate Strategy Implementation Plan 2024-2028 looks more like “an enhanced list of objectives rather than a plan”.
On Donald Trump’s comment during the recent United States campaign debate that he does not have a healthcare plan so much as “concepts of a plan”, the Zap reports: “A Facebook user has now suggested that this was because Trump had a plan, but the dog ate it, and then somebody ate the dog.”
The quotable?
The financial bottom line of pharmaceutical companies and wish lists of industry cannot take precedence over the safety of the Australian community.”
Charles Maskell-Knight writes:
Last week saw a number of major events in the world of health and ageing policy.
On Monday, 9 September the Royal Commission into Defence and Veteran Suicide presented its final report to the Government, making 122 recommendations.
Defence Minister Richard Marles and Veterans Affairs’ Minister Matt Keogh said the Government would work through the recommendations and provide a formal response. Based on the Government’s dilatory response to many other reviews, don’t hold your breath.
The Conversation published an article by Professor Ben Wadham and Associate Professor James Connor summarising the background to and outcomes of the Royal Commission (also republished at Croakey).
The Consumers Health Forum responded to the report, calling on Parliament to “come together and work constructively to better the health and wellbeing of Australia’s current and ex-serving ADF members and work towards stopping veteran deaths by suicides”.
CEO Dr Elizabeth Deveny said that CHF backed stronger health services for veterans, including support for primary healthcare providers, and better information to let veterans know what services are available.
“If implemented correctly, these measures will create better health equity for our veterans and could also be looked at as a future healthcare model to benefit civilian health service delivery,” she said.
She added that the Government should ensure that any new service or programs were co-designed with veterans.
The Australian Physiotherapy Association (APA) also reacted, noting that the Commission’s report showed that “current processes for veterans to access essential physiotherapy care are overly complex and often create barriers to timely, effective treatment”.
APA committed to maintaining its advocacy for reforms to improve healthcare access and outcomes for veterans.
On Thursday, 12 September Minister for Aged Care Anika Wells introduced the long awaited and much delayed Aged Care Bill 2024 into Parliament.
Wells joined the Prime Minister and the Treasurer in a media conference and issued a media release on the proposed changes, while the Department of Health and Aged Care released a “plain language fact sheet” on the Bill.
Numerous interest groups have commented on the announcement, including the Aged and Community Care Providers Association, Catholic Health Australia, COTA, and the Older Persons Advocacy Network, and there has been extensive media coverage including the ABC, The Guardian, and The Conversation here and here.
Shadow Health Minister Anne Ruston made a commitment that “the Opposition will agree not to amend the financial sustainability framework contained in the Government’s Aged Care Bill”, and took credit for numerous changes to the package of reforms.
Greens ageing spokesperson Senator Penny Allman-Payne warned that “Labor’s aged care deal with Dutton deserves scrutiny”, and said she was concerned that “the new legislation may fall short of the recommendations from the Royal Commission into Aged Care Quality and Safety”.
The Greens will be pushing for a Senate committee inquiry into the legislation – given that the Community Affairs Committee is due to report on its only current reference on 17 September, it can’t use pressure of work as a reason not to hold one.
Perhaps the key points are that the changes are estimated to save Government over $12 billion over the next decade – that is to say, older Australians needing care will pay over a billion dollars a year more to replace Government spending, as well as extra to expand and improve services – and that the changes have received bipartisan support.
Michelle Grattan’s headline in The Conversation summarises it neatly: “Coalition backs Labor’s heavy lifting on aged care, hoping to reap the benefit down the track”.
Aged care expert Professor Kathy Eagar AM posted on X (formerly Twitter) that “the aged care announcement this week is not a true Labor reform package”.
“This is a neocon package whereby government & providers transfer their financial risks onto consumers. Consumers are now cash cows in an uncapped market, not older people in need of care and support,” she said.
I hope to write more about the new legislation shortly.
Other government news
Health Minister Mark Butler released the final report of the Health Technology Assessment (HTA) Review including 50 recommendations, and an accompanying Enhance HTA Report, “which delivers ten recommendations to elevate the consumer and patient voice in our health technology assessment processes”.
Butler said that “the Government will carefully consider the recommendations” and will establish an independent implementation group to guide the HTA reform process and provide regular updates to Government. This group will “be led by an eminent Australian and will include representation from the Commonwealth and state and territory governments, as well as industry, consumers and clinicians, as well as the expertise of a health economist”.
Medicines Australia CEO Liz de Somer was a member of the review committee, and said “the recommendations will make a significant difference to Australians once implemented as a complete package”.
“Without these changes Australians will continue to miss out on the best medicines available now and the revolutionary treatments that are on the horizon. System-wide reform will deliver a Stronger PBS for all Australians,” she said.
Advanced Pharmacy Australia (AdPha, previously the Society of Hospital Pharmacists) also welcomed the review’s recommendations, particularly those “which address under-represented patient groups and streamlined pathways for faster access to therapies”.
The Consumers Health Forum also commented, stressing that “the safety of the community and access to safe health technologies [must] be the priority of the implementation group. The financial bottom line of pharmaceutical companies and wish lists of industry cannot take precedence over the safety of the Australian community”.
As ever, the devil will be in the detail of implementation.
While Medicines Australia wants to see new medicines listed on the PBS within 60 days of market approval by the TGA, the Government will need to ensure that reimbursement continues to be based on cost-benefit analysis to support the interests of taxpayers.
Butler announced that the Government was seeking feedback on the draft National Suicide Prevention Strategy prepared by the National Suicide Prevention Office (NSPO).
He said “the Government is committed to reforming the suicide prevention system, so every Australian has access to support when and where they need it [and] the advice from the NSPO will be an important part of this process”. Responses are due by 27 October.
Butler added that the Government “is supporting Gayaa Dhuwi to develop a First Nations suicide prevention strategy. The suicide rate of Aboriginal and Torres Strait Islander people is more than double that of the broader community and the Government is committed to taking focused actions to address this”.
Assistant Minister for Health Ged Kearney announced that the Government had opened consultation on the draft National Nursing Workforce Strategy.
The Department of Health and Aged Care’s website has a home page for the Strategy here setting out the process so far, and details of the consultation can be found here. The deadline for responses is 20 October.
The National Health, Sustainability and Climate Unit, part of the interim Centre for Disease Control, released the National Health and Climate Strategy Implementation Plan 2024-2028. It appears to me to be an enhanced list of objectives rather than a plan.
The independent review of complexity in the National Registration and Accreditation Scheme (NRAS) for health professionals released a consultation paper seeking submissions by 14 October.
Over the past decade I have been a regular user of MBS Online, an electronic version of the Medicare Benefits Schedule – one of the few Department of Health and Aged Care IT initiatives that operates well.
The Department is now giving users of MBS Online “a chance to provide their views and feedback on the functionality and user experience of the website” by responding to a survey. Responses close on 11 October.
The Australian Institute of Health and Welfare released an updated report on Dementia in Australia as a precursor to Dementia Action Week. The headline story was that “the number of dementia-specific medications prescribed to Australians living with dementia, as well as hospitalisations due to the condition, continue to increase”.
Over the nine years to 2022-23, the rate of prescriptions for dementia medications increased by 24 percent to 42 scripts per 1,000 people.
While hospitalisations due to dementia increased 24 percent between 2016-17 and 2022-23, after adjusting for demographic changes, the rate of hospitalisations due to dementia remained steady at around 42 per 10,000 population.
Dementia Australia said the report reinforced the position of dementia as the chronic disease of the 21st century. CEO Professor Tanya Buchanan said that “despite the growing number of Australians diagnosed with dementia… it is not receiving the recognition it needs as a public health issue”.
Buchanan added “Dementia Australia and people living with dementia, their families and carers have contributed to the development of the National Dementia Action Plan and we eagerly await its release”.
The Department of Health and Aged Care website shows that in 2022 and early 2023 there were consultations and other work on developing the National Dementia Action Plan, “which will be finalised in 2023”. Over 18 months after public consultations closed, there has been no sign of further progress.
Ahpra announced that “action to streamline Ahpra’s registration processes has seen a surge in new international medical practitioners registered to enter the Australian workforce, with 1,205 more overseas qualified doctors registered in the 2023-24 financial year than in the previous 12 months”.
This amounted to a 27 percent increase, and coincided with a 26 percent reduction in the time taken to process applications.
Process changes implemented from December last year mean applicants can lodge identity documents offshore, rather than having to be present in Australia.
CEO Martin Fletcher said that “‘we want to do everything possible to make Australia an attractive work destination for international medical graduates by simplifying the process while not compromising on safety”.
First Nations health
The Australian Indigenous Doctors Association (AIDA) issued a statement, published in Croakey, on the new Northern Territory Government’s retrograde plan to reduce the age of criminal responsibility to 10 years from the current 12.
AIDA concluded that “if we are to reach the Closing the Gap target #11 – to reduce the rate of Aboriginal and Torres Strait Islander young people (aged 10-17) in detention by at least 30 percent by 2031, then we must listen to Aboriginal and Torres Strait Islander peoples, along with other health experts, and raise the age of criminal responsibility to 14-years-old”.
Consumer and public health groups
The Australian Academy of Health and Medical Sciences released a report on Advancing Prevention in Australia, summarising a round table held last year.
The report recommended expanding the role of the Centre for Disease Control to include prevention; more research on primary prevention; and improved partnership and engagement between policymakers, the research and industry sectors, First Nations communities and the healthcare workforce, rural and remote communities, and other individuals with lived experience.
The Public Health Association of Australia (PHAA) issued a statement on the publication of research showing that after controlling for other factors, “teenagers aged 12-17 who had vaped are five times more likely to start smoking in the future than those who had not… 12-year-olds who had vaped were 29 times more likely to go on to try smoking than 12-year-olds who had not vaped”.
It is clear that for children vaping is a pathway to smoking, not an aid to quitting.
Trade unions
Allied Health Professions Australia (AHPA) republished a media release from independent MP Rebekah Sharpie on the very low provision of allied health services in aged care.
AHPA Senior Policy and Advocacy Advisor Dr Chris Atmore said “allied health care services must be provided to meet individually assessed needs, not rationed as if they were an optional luxury… we need a nationally consistent allied health needs assessment and care planning process… supported by a fully funded multidisciplinary team approach”.
The Australian Medical Association (AMA) welcomed the announcement by Assistant Treasurer Stephen Jones that the Government would legislate to prevent life insurers from discriminating on the basis of genetic testing.
AMA President Steve Robson said that “consumers have been discouraged from participating [in genetic testing] out of fear of being frozen out of insurance cover if a genetic risk is uncovered”.
The Royal Australian College of GPs (RACGP) also supported the announcement.
In the lead-up to the Queensland election on 26 October, the RACGP “warned both sides of Queensland politics not to ignore their advice for a more accessible health system if they want better health outcomes for Queenslanders”.
The College said that the State Government needed to “grow and sustain the GP workforce, cut red tape to essential treatments, and listen to GPs for a smarter healthcare system”.
Rural Doctors Association of Australia (RDAA) President Dr RT Lewandowski visited Canberra to meet with the Government, Opposition, and Department of Health and Aged Care. His message was that “the time for tinkering around the edges with health policy is over, with a ‘big picture’ approach needed to deliver a bright future for rural healthcare in Australia”.
“We need big picture progress on health reform because micro-reform costs a ton of money but doesn’t deliver real improvements,” he said. “While whole-of-system reform takes additional investment, particularly in rural healthcare, focusing on the big picture ensures that investment is not wasted.”
The RDAA also marked R U OK? day with a media release highlighting the impact cost of living increases are having on many Australians.
Lewandowski said “if you reach out and find someone who is not doing ok, supporting them to take the first step in booking a consult with their rural GP can be difficult, but just by starting that conversation you can really assist them to open up and acknowledge that they need some help”.
The Australian College of Rural and Remote Medicine (ACRRM) urged rural doctors “to take a moment on R U OK? Day to reflect on their own mental health”.
Industry groups
The Members Health Fund Alliance (representing private health insurers which do not distribute profits) announced the launch of an advertising campaign “targeting males aged 25-35… and emphasising the benefits of private health insurance as a preventative measure, with extras tailored to their needs”.
Politicians and parliamentary committees
The Senate community affairs committee is due to deliver the report on its menopause inquiry on 17 September, after which it will have no current inquiries.
On 10 September the Senate asked its legal and constitutional affairs committee to inquire into Australia’s youth justice and incarceration system, reporting by 26 November 2024.
The terms of reference include: the outcomes and impacts of youth incarceration; the over-incarceration of First Nations children; the degree of compliance and non-compliance by prisons and detention centres with the human rights of children and young people; the Commonwealth’s international obligations in regards to youth justice including the rights of the child, freedom from torture and civil rights; and the benefits and need for enforceable national minimum standards for youth. Submissions are due by 20 October.
International
In the United States, Presidential candidate Donald Trump promised in the 2016 election that he had a plan to replace the Affordable Care Act with a far better health plan.
During his term as President the Republican Party failed to secure the repeal of the Act, but there was no sign of the Trump replacement plan.
During the debate with Vice President Kamala Harris, Trump was asked about his healthcare plan. He replied: “I have concepts of a plan.”
A Facebook user has now suggested that this was because Trump had a plan, but the dog ate it, and then somebody ate the dog.
Finally
I remember a cartoon in the West Australian newspaper from the late 1960s highlighting the disparity between the age of call-up for national service (20), the voting age (21), and the legal drinking age (also 21 in WA).
At age 20 you could be conscripted to fight for Australia, but you had no say in choosing the government, and if you were called up you couldn’t have a drink to drown your sorrows.
This was clearly ridiculous, and the laws were changed in 1973 (federal voting) and 1970 (WA drinking age).
This week the Federal Government announced it would legislate to restrict children aged under 14 (or 16) from accessing social media – yet in most jurisdictions children aged 12 and 13 (if not 10 and 11) are held to be criminally liable for their actions.
Too immature to manage social media, yet mature enough to take criminal responsibility for their actions.
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.
Independent Health and Aged Care Pricing Authority
Pricing Framework for Australian Residential Aged Care Services
20 September
Department of Health and Aged Care
Prostheses list – General Use Items utilisation, expenditure and integrity
20 September
The Joint Standing Committee on Aboriginal and Torres Strait Islander Affairs
Parliamentary inquiry into the Truth and Justice Commission Bill 2024
20 September
Australian Commission on Safety and Quality in Health Care
National Safety and Quality Medical Imaging Standards (to replace the Diagnostic Imaging Accreditation Scheme Standards).
27 September
Department of Health and Aged Care
Draft of the National Roadmap to Improve the Health and Mental Health of Autistic People
27 September
Department of Health and Aged Care
Review of MBS health assessment items
30 September
Department of Health and Aged Care
How the Australian CDC plans to use data
30 September
House of Representatives Standing Committee on Health, Aged Care and Sport
The health impacts of alcohol and other drugs in Australia
30 September
The Medical Board of Australia
Introduction of health checks for late career doctors
4 October
Department of Health and Aged Care
Review of the Stoma Appliance Scheme Schedule
6 October
Therapeutic Goods Administration
Draft guidance on the new regulatory requirements and transition arrangements for medical devices containing medicinal substances or materials of animal, microbial, or recombinant origin
9 October
Department of Health and Aged Care
Survey on the functionality and user experience of MBS Online
11 October
Therapeutic Goods Administration
Future regulation of assistive technologies
13 October
Therapeutic Goods Administration
Clarifying and strengthening the regulation of Artificial Intelligence (AI)
13 October
Department of Health and Aged Care
Safe and Responsible Artificial Intelligence in Health Care – Legislation and Regulation Review (See also the Joint Committee on Public Accounts and Audit Inquiry into the use and governance of artificial intelligence systems by public sector entities.)
14 October
Independent review of complexity in the National Registration and Accreditation Scheme (NRAS)
Consultation paper
14 October
Therapeutic Goods Administration
Proposed changes to the Australian Essential Principles for Safety and Performance of medical devices
16 October
Ahpra Accreditation Committee
Guidance on developing professional capabilities
18 October
Department of Health and Aged Care
Draft National Nursing Workforce Strategy
20 October
National Mental Health Commission (National Suicide Prevention Office)
Draft National Suicide Prevention Strategy
27 October
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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