The latest in food policy news, a new initiative to encourage community-driven activities to improve the delivery of cancer care for Aboriginal and Torres Strait Islander people, and an awareness campaign drawing attention to elder abuse are covered in the column this week.
Columnist Charles Maskell-Knight also reports on claims by Private Healthcare Australia (the private health insurance lobby group) that obstetricians are charging some of the highest out of pocket fees of all doctors in Australia – up to $10,000 in major cities – and that this is the major barrier to people choosing private maternity services.
The quotable?
What will it take for a national government to take dental health seriously?
The track record of both major political parties over the last decade suggests that this will only happen if the Australian Greens win an unexpected majority at the next election.”
Charles Maskell-Knight writes:
Last week saw a number of stories about health and food.
The Food Ministers Council met to consider a range of issues including regulation of infant formula products, the Health Star Rating system (HSR), and the FSANZ Act Review.
The Council did not call for any further amendment to the proposal regarding infant formula products – a process that appears to have been running so long that children who were infants when it started will soon be entering high school.
In relation to HSR, Council asked to FSANZ “to work with FRSC [Food Regulation Standing Committee] to commence preparatory work to inform ministers’ future decision-making on mandating the HSR system [so as to] facilitate an efficient process to mandate the system if the final results do not reach the target”.
The target is that 70 percent of products in scope include a HSR by November next year; so far only 32 percent of products are complying.
While Council did not request a full review of the HSR system or algorithm, it directed that the work would proceed in parallel with “the scoping of a holistic review of the Nutrition Information Panel (NIP)”.
The Public Health Association of Australia (PHAA) said the decision would “shift oversight from the food industry in the Health Star Ratings Advisory Committee, to government regulators”. This was “a welcome and necessary step in… ensuring that food labelling in Australia better serves people in Australia”.
Food Ministers also noted the progress of the FSANZ Act review, and agreed that the Australian Government would progress the review to the next steps in the legislative process.
There was no sign that Ministers had heeded the call in this Croakey article to strengthen public health protections in a new regime.
Food in aged care was also an issue.
Monash University published an article, Tackling malnutrition in the aged care sector, which highlighted recently published research showing that 40 percent of a sample 700 aged care residents in NSW, Queensland and SA were malnourished, including six percent who were severely malnourished.
Lead researcher Dr Jonathon Foo from Monash said that while the existing weight loss performance indicators used in aged care fail to detect the majority of malnourished residents, accurate routine screening is a challenge given limited resources.
The Older Persons Advocacy Network (OPAN) said that “food was one of the top five care/service delivery issues raised with OPAN advocates in the last financial year by older people living in residential aged care”.
OPAN National Older Persons Reference Group member Rosemary Seam said she had seen “a marked deterioration in the quality of the food” over the four years she has been living in aged care.
She emphasised that the environment in which food is served is just as important as the food itself.
Ministers and government
Assistant Minister Malarndirri McCarthy (who has since been promoted to Minister for Indigenous Australians) announced a grants program to be overseen by Cancer Australia to support to support partnerships between cancer services and Aboriginal and Torres Strait Islander community-controlled organisations.
The partnerships are to “focus on innovative, community-driven local activities designed to improve the delivery of cancer care for Aboriginal and Torres Strait Islander people”.
Cancer Australia CEO Professor Dorothy Keefe said that the partnership model will “foster strengthened and sustained relationships between cancer services and community-controlled organisations to improve cultural safety and equity of access”.
McCarthy joined with Aboriginal Medical Services Alliance Northern Territory (AMSANT) CEO John Paterson to announce six new Urgent Care Clinics across the Northern Territory in Ali Curung, Galiwinku, Alyangula, Wurrumiyanga, Lajamanu and Maningrida.
McCarthy said she was confident the remote clinics could be staffed, because of the high take-up of the First Nations Health Worker Traineeship Program.
Paterson said the clinics would be co-located with existing services, so that “as one shift finishes for the day, the other shift will obviously come in and undertake the appropriate healthcare for community members that require them after hours”.
Attorney-General Mark Dreyfus KC announced the launch of an awareness campaign drawing attention to elder abuse. He said that a 2021 study had found that one in six older Australians had experienced abuse in the previous year, and that over 60 percent of victims did not seek help or advice.
COTA welcomed the announcement, with CEO Pat Sparrow saying that under-reporting meant that the rate of abuse was likely much higher.
She also said that “systemic issues like ageism mean that all too often elder abuse is overlooked or dismissed. Anything that helps bring the issue to the forefront of people’s minds and provides practical tools to address it is very welcome”.
Aged Care Minister Anika Wells issued media releases on the increase in care minutes and RN availability in residential aged care, and re-announcing funding for nursing homes to employ on-site pharmacists.
The Australian Institute of Health and Welfare (AIHW) released updated data on mental health, including the physical health of people with mental illness. The Institute summed up the last report as “people living with mental illness, and in particular severe mental illness, are more likely to experience comorbidity of physical conditions, more likely to be hospitalised for potentially preventable reasons and tend to die earlier than the general population”.
The AIHW also released a series of reports under the general heading of Regional Insights for Indigenous Communities, including a Regional overview dashboard, a Closing the Gap dashboard, and a Life stages dashboard. The dashboards allow searching for a wide variety of statistics by community or by area.
The Institute also released a paper on the development of three area-based indices relating to local primary healthcare access across Australia: the first modelling the underlying need for primary healthcare; the second the spatial accessibility of general practitioners; and the third combining access and need.
It found (unsurprisingly) that “generally, access to GPs worsens with increasing remoteness, particularly affecting First Nations Australians with relatively high needs”.
The paper foreshadows future work to “conduct separate modelling of how First Nations people’s access to Aboriginal Community Controlled Health Services varies geographically; [and to] investigate whether the interaction between access and need can be calibrated in a meaningful way with respect to its effect on health outcomes”.
Finally, the Institute published a report on the use of hospitals and homelessness services by refugees and humanitarian entrants.
The Australian Bureau of Statistics released updated estimates and projections of the First Nations population, which is now estimated at one million people, an increase of almost 60,000 since 2021. It is projected to increase to close to 1.2 million people by 2031. Areas with the highest projected growth are Perth and Brisbane.
First Nations health
The National Aboriginal Community Controlled Health Organisation (NACCHO) will deliver one-hour webinars on supporting cervical collection self-screening for staff from ACCHOs and AMSs, as well as other healthcare workers who work with First Nations patients.
Consumer and public health groups
Chronic Pain Australia (CPA) marked National Pain Week (with an almost illegible web page featuring white text on a pale blue background – I hope the money CPA is saving on graphic design is being used wisely).
It reported on the results of a (self-selecting) survey of almost 2,600 people living with chronic pain, which found that pain had led half the respondents to stop working, and two-thirds to experience strained family relationships. Only 20 percent of respondents had been referred to a multidisciplinary pain management program or clinic.
CPA Chair, Nicolette Ellis said that “we know the well-evidenced solution: multidisciplinary pain management programs must be made widely available in primary care settings, eliminating the one to three year wait for tertiary pain management”.
“This should be a priority for any government that wants to increase productivity and promote the well-being of its citizens.”
The Australian Physiotherapy Association supported the CPA, with President Scott Willis saying that the survey results showed “many respondents also reported having to forego essential household items just to be able afford medicine and healthcare, which is an incredibly concerning factor for Australians in this current economy and cost-of-living climate”.
Willis said the Government needed to “fund high-value multidisciplinary care in a patient’s local region so they can receive and afford the right care when they need it most”.
The PHAA highlighted publication in the Australian and New Zealand Journal of Public Health of research on the exposure of welders to carcinogenic fumes.
A survey of over 600 welders found that “about 90 percent were being exposed to ‘welding fume’, a mixture of very fine particles and gases produced when a metal is heated above its boiling point”.
PHAA CEO Adjunct Professor Terry Slevin said: “We have seen strong action to reduce the health problems linked to asbestos and silica; this is another example where Australia’s health and safety legislation must be put to work to protect our tens of thousands of welders… every professional welder in Australia be supplied with upgraded protective equipment to make their work as safe as humanly possible”.
Trade unions
The Australian Association of Psychologists has been vocal in arguing that the Government should increase the annual cap on the number of psychology sessions funded under Medicare from 10 to 20.
It is now calling for up to 40 sessions for “survivors of sexual abuse, childhood trauma and complex mental health needs”, as well as an increase in rebates to $150, bulk-billing incentives, and rural and remote loadings.
The Australian College of Nursing released a position statement on the use of Standardised Nursing Terminology to improve data collection around nursing activity.
The Australian Medical Association announced that NSW GP Dr Danielle McMullen had been elected unopposed as the next national president.
McMullen said that “some of the areas I will focusing on in my presidency include getting waiting lists down and improving the value proposition of private health insurance… [but] our first priority needs to be boosting investment in general practice”.
Australian Primary Health Care Nurses Association (APNA) held its Essential Health Summit in Adelaide. President Karen Booth welcomed the Albanese Government’s investment in the APNA National Nursing Clinical Placements Program (NNCPP), which she said “will help to grow the next generation of primary healthcare nurses and combat the workforce shortage”.
The program is intended to place 6,000 nursing students over the next three years in primary healthcare settings.
The Royal Australian College of General Practitioners (RACGP) warned against a proposal by the NT Country Liberal Party “to allow pharmacists to provide drugs for 21 conditions without a GP diagnosing and prescribing them to a patient”. The conditions include urinary tract infection (UTIs), school sores, shingles, wound management, asthma, swimmer’s ear, travel vaccines and hypertension.
RACGP NT Chair Dr Sam Heard said that “making prescription medicines easier to access should not be prioritised over access to high quality general practice care for NT patients and families… [We are] keen to discuss real solutions to improve access to GPs in the NT with the Country Liberals”.
The Pharmaceutical Society of Australia (PSA) welcomed the policy proposal, with Northern Territory and South Australia Vice-President Colleen Niland saying that “allowing pharmacists to treat uncomplicated UTIs, deliver more vaccines, or provide antivirals for COVID-19 and influenza would mean more time available for GPs to spend on more complex health needs”.
The Pharmacy Guild also backed the proposal.
The PSA also marked International Self-Care Day by encouraging Australians to “leave behind the advice of unverified websites and online influencers and instead visit their local pharmacist for accurate health information”.
The Rural Doctors Association of Australia (RDAA) jumped the gun on DonateLife Week (starting on 28 July) with a media release urging rural and remote Australians to make it the week they register to be an organ and tissue donor, and discuss their decision to donate with their family.
Industry groups
The peak aged care sector lobby group, the Aged and Community Care Providers Association (ACCPA), said it was “calling on our elected politicians to end the political impasse and back the recommendations of the Aged Care Taskforce for the sake of older Australians now and in the future”.
CEO Tom Symondson said “we need urgent action to land these reforms before the next election. That means the new Aged Care Act must be introduced to Parliament in August”.
Tell him he’s dreaming.
The Australian Healthcare and Hospitals Association (AHHA) issued a statement on the consequences of the health system’s underinvestment in prevention, using diabetes as an example.
AHHA said that the recent House of Representatives diabetes inquiry found that “despite being mostly avoidable, diabetes is the fastest-growing non-communicable disease in Australia, with around 1.5 million Australians living with diabetes and around 500,000 more cases being undiagnosed, [and accounting] for 10 per cent of all hospitalisations”.
CEO Kylie Woolcock said that Australia is spending more on dealing with the impacts of diabetes than all governments in Australia spend on childcare, and that “this demonstrates why we need a health system that places far greater value on prevention and on health outcomes”.
“Future investments in health must be optimised and directed towards wellness and away from crisis-driven demand,” she said.
AHHA also released a brief from the Deeble Institute for Health Policy Research on the importance of accurate and timely workforce data in projecting oral health workforce requirements. I would add that these findings extend across the health workforce as a whole.
Private Healthcare Australia (the private health insurance lobby group) issued a media release claiming that “obstetricians are charging some of the highest out of pocket fees of all doctors in Australia [and that] this is the major barrier to people choosing private maternity services”.
CEO Dr Rachel David said that “research shows the number one reason people don’t choose a private hospital to give birth is the out of pocket fees charged by obstetricians, which can be up to $10,000 in major cities”.
While David didn’t provide details of the research, it sounds plausible.
A recent ABC report listed a number of private maternity services that have closed in recent years, and while workforce issues have had a role in regional areas, falling profitability due to decreasing demand is clearly an important factor.
The National Association of Specialist Obstetricians and Gynaecologists (NASOG) issued a lengthy response to the PHA statement. In his president’s blog, A/Professor Gino Pecararo OAM began by opining that “it’s a bit rich of Rachel David to point out that obstetricians have amongst the highest out of pocket expenses without acknowledging that health funds CEOs and health funds generally have enormous salaries and profits far beyond what any doctor can ever hope to make”.
I’m not sure that comments like those help the policy debate.
Pecararo said that the Government should commit to:
- indexation of Medicare rebates
- the mandating of inclusion of pregnancy in all insurance policies in line with its own community rating system
- allowing private health insurers to contribute to out-of-hospital health expenses.
The problem with the first part of the proposal is that any increase in MBS fees to alleviate the burden of obstetric out of pocket costs would make those fees completely out of kilter with the fees for other specialties, potentially leading to further specialist fee inflation.
The problem with the second part of the proposal is that insurance is designed to provide indemnification against costs caused by chance. Given the widespread use of contraception and assisted conception, most pregnancies are now the result of choice rather than chance. Requiring insurers to offer obstetrics cover in low-cost policies would expose them to “hit and run” purchases, resulting in further increases in premiums.
And the problem with the third part is that allowing insurers to contribute to out of pocket costs for services provided in the community without any element of hospital substitution would lead to a two-tier health system – and also push up premiums.
Politicians and parliamentary committees
The Senate committee inquiry into menopause and perimenopause will be holding public hearings in Brisbane and Canberra on 29 and 30 July respectively.
Witnesses will include the AMA, RACGP, ACCRM, and RDAA; the Pharmaceutical Society of Australia and the Society of Hospital Pharmacists of Australia; and the ACTU and other unions.
International organisations
Several weeks ago the OECD released a Comparative assessment of patient safety culture performance in OECD countries.
Based on survey responses from almost 650,000 hospital staff across the OECD, less than half of respondents felt that there were safe staffing and work pace levels in their work environment, and about half felt that there were high levels of perceived punitive response to error in hospital work environments.
Finally
Last week I reported that the Government response to the Senate dental inquiry had “noted” 24 of the 35 recommendations. This week the Consumers Health Forum “noted” the Government’s response, describing it as “disappointing and inadequate”.
CEO Dr Elizabeth Deveny said “there is a lack of commitment to any immediate actions or funding that will address the dental care access and affordability issues faced by consumers and a lack of clear prioritisation or timeframe for next steps”.
Deveny concluded that “Australians being able to better afford to access dental care must be something that the next parliament deals with as a priority”.
The last recommendation of the Senate dental inquiry, which reported last November, was that the Government should “work with the states and territories to achieve universal access to dental and oral health care, which expands coverage under Medicare or a similar scheme for essential oral health care, over time, in stages”.
The Government response “noted” this recommendation, and said that “governments are working together to progress dental reform priorities including long-term funding options which would offer funding stability, enhance service accessibility, and assist state and territory governments in achieving oral health outcomes by means of improved service design, implementation, and workforce recruitment and retention”.
I now understand that discussions between the Commonwealth and the states were suspended several months ago.
Commonwealth assistance to the states for public dental services expires at the end of this financial year – there is every sign that there will be yet another last-minute short-term extension of these arrangements, with the amount of assistance remaining frozen at 2014-15 levels.
What will it take for a national government to take dental health seriously?
The track record of both major political parties over the last decade suggests that this will only happen if the Australian Greens win an unexpected majority at the next election.
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
Reclassification of Sports and Exercise Medicine Physicians as consultant physicians
5 August
Therapeutic Goods Administration
Legislating regulatory categories for some boundary and combination products
6 August
National Indigenous Australians Agency
National strategy for food security in remote First Nations communities
11 August
Therapeutic Goods Administration
Proposed exposure model for assessing the safety of sunscreen ingredients in Australia
13 August
Therapeutic Goods Administration
Revised TGA Instructions for Disinfectant Testing
16 August
Therapeutic Goods Administration
Reforming Australia’s Therapeutic Goods Testing Regulations
18 August
Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August
Department of Health and Aged Care
Multi-Purpose Service trial sites direct care targets
30 August
Department of Health and Aged Care
How to implement the MSAC advice about the cost of technical support services for cardiac implantable electronic devices
6 September
Department of Health and Aged Care
Review of MBS health assessment items
30 September
Therapeutic Goods Administration
Future regulation of assistive technologies
13 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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