People in western Queensland are far more likely to experience a potentially preventable hospitalisation than people living in the north Sydney region, according to new data highlighting stark health inequalities.
The column this week also examines the laws governing organ and tissue donation, aged care matters, a vision for hospital pharmacy, calls to action for the next Northern Territory Government, and suggests that Health and Mental Health Ministers have failed to address the sector’s call for serious action to improve access to suports and care.
The quotable?
The Health Ministers Meeting was also long on rhetoric and short on deliverable action.”
Charles Maskell-Knight writes:
Friday 16 August saw a meeting of Health Ministers, as well as a joint meeting of Health and Mental Health Ministers.
In advance of the meetings, Mental Health Australia (MHA) issued a statement on behalf of 80 mental health organisations calling on Ministers to “take serious action” to improve access to mental health supports.
MHA CEO Carolyn Nikoloski expanded on the statement in an article in Croakey, highlighting the need for intergovernmental collaboration to address the problems. She concluded that “the mental health sector stands ready and willing to work with governments, if governments are only willing to work with each other first”.
The communique from the meeting records that “Minsters discussed the current mental health reform landscape and agreed an approach for reforms, focussed on achieving an effective and equitable mental health system”.
They also committed to working together “to improve access to mental health services across Australia through a re-affirmed commitment to delivering on the National Mental Health and Suicide Prevention Agreement”, and to working with “mental health stakeholders, including lived experience and First Nations, to develop a robust plan for future psychosocial support arrangements”.
I don’t think this amounts to the “serious action” the sector is seeking.
The Health Ministers Meeting was also long on rhetoric and short on deliverable action.
In relation to the ongoing shortage of IV fluids, Ministers issued a statement noting that “shortages of IV fluids, while easing, are expected to continue through 2024”.
An intergovernmental Response Group, including representation from private hospitals and primary care, is meeting regularly to address the issue. Ministers directed the group to “consider options to maintain supply of IV fluids within Australia”.
While the development of the National Health Reform Agreement remains paused to allow disability reform to develop, “Ministers are committed to finalising as soon as possible a national agreement to commence from 1 July 2025”.
Health Ministers discussed progress on reforms and improvements for the medical specialist workforce, together with representatives of all 16 specialist medical colleges, the Australian Medical Council, Ahpra, the Medical Board of Australia, and the National Health Practitioner Ombudsman.
They agreed on five “actions”, all of which involved the continuation of something that is already happening – for example, “specialist medical colleges will continue to work with jurisdictions, and other key stakeholders, on strategies to deliver the medical workforce in the right numbers and in the right locations, particularly in rural and regional areas”.
Ministers and government
Assistant Minister Ged Kearney joined with Attorney-General Mark Dreyfus KC in announcing that the Government would establish an Australian Law Reform Commission (ALRC) inquiry into the laws governing organ and tissue donation “to determine whether legislative reform is required to harmonise laws across the nation”.
The current potpourri of state laws was enacted following an ALRC report in 1977, and while I am sure that consistency was an objective at the time, the vagaries of state parliamentary counsel and legislatures resulted in inconsistencies in how fundamental concepts such as consent were expressed in laws enacted between 1978 and 1985.
Given two years for an ALRC inquiry to be completed, and an (optimistic) half a dozen years for states to legislate, we can look forward to an up-to-date consistent legal framework early in the next decade.
The Australian Institute of Health and Welfare (AIHW) released data on potentially preventable hospitalisations for 2020-21 and 2021-22 by Primary Health Network and Statistical Area Level 3.
The data show a threefold difference between the age-adjusted rate of potentially preventable hospitalisations in the North Sydney PHN (1,600 per 100,000 people) and the rate in the Western Queensland PHN (4,800 per 100,000 people).
The National Rural Health Alliance commented on the data, saying they highlighted the need for better primary care in regional, rural and remote areas.
CEO Susi Tegen said that “we often see rural communities neglecting or putting off their health issues due to limited access to primary care, exacerbated by the tyranny of distance and cost of services”.
“This leads to a cascade of problems, including overwhelming an already strained hospital and emergency system,” she said.
Tegen urged governments to adopt the NHRA’s Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) model, “designed to meet the specific health needs of communities [and] promote the preventative aspect of health”.
The AIHW also released an updated report on Cancer data in Australia, estimating that there will be almost 170,000 people diagnosed with cancer in 2024, and that cancer deaths will account for about a third of total deaths.
As reported in Croakey, the Australian Commission for Safety and Quality in Health Care released an updated clinical care standard for osteoarthritis of the knee. As well as hosting a webinar on the subject, Croakey also published an article by surgeon Dr Nigel Hartnett on why he works to avoid knee surgery on his patients.
Ahpra announced that founding CEO Martin Fletcher was resigning after 15 years in the role, and that a global search for a replacement was under way.
The National Health and Medical Research Council (NHMRC) released Staying healthy: Preventing infectious diseases in early childhood education and care services – 6th edition, “a best-practice resource that provides simple and effective ways for education and care services to help limit the spread of infectious diseases among children”.
Consumer and public health groups
COTA issued a statement on behalf of a number of groups urging MPs to “stop dithering on older people’s rights”, saying that “the Aged Care Act needs to be introduced into Federal Parliament this sitting fortnight if laws are to be passed this year that address the neglect in aged care and stop putting the rights of older people at risk”.
COTA joined the Older Persons Advocacy Network (OPAN) and the Maggie Beer Foundation in hosting an event in Parliament House about “the critical importance of food and dining in aged care and the issues and opportunities presented by the new Aged Care Act”.
OPAN CEO Craig Gear said the event was intended to help parliamentarians “to understand the importance of continuing to invest in the training of aged care cooks and chefs and improve standards across the board but particularly in relation to food”.
He concluded “we have said it time and time again, but the Government must introduce the new [Aged Care] Act this year – we cannot afford to wait any longer for this important reform”.
The National Rural Health Alliance welcomed the announcement of a delay in the shutdown of the 3G mobile network.
CEO Susi Tegen said “we have highlighted on many occasions that the impact of the 3G network shutdown is amplified for people living in rural, regional and remote areas due to the limited availability of healthcare services and the heavy reliance of 3G-enabled medical and other devices”.
“Many would risk losing access to triple-zero due to the use of older mobile phones that only support 3G networks,” she said.
The Public Health Association of Australia was one of many organisations signing an open letter to the Prime Minister urging “a three-year, phased-in ban on all gambling advertising and the banning of inducements and promotions especially around sports betting which are unethically used to ensnare people who want to stop gambling”.
First Nations health
In the lead-up to the Northern Territory election on 24 August, Croakey published an article by Aboriginal Medical Services Alliance Northern Territory (AMSANT) reporting on a survey of ACCHOs which found that nine out of 11 lacked the resources to maintain safe and fit-for-purpose facilities.
The ACCHOs said that “the poor conditions had impacted their ability to recruit and retain qualified staff, and [that they] are concerned they will not be equipped to meet demand in future if the condition of their facilities doesn’t improve”.
Trade unions
Before the Health and Mental Health Ministers meeting, the Australian Association of Psychologists called for the Government to adopt a range of measures. These included:
- increasing the Medicare rebate for all psychologist clients to $150
- removing the cap of 10 Better Access sessions a year
- providing more financial incentives to regional, rural and remote psychologists
- providing government-funded, paid placements for psychology students, interns and registrars
- allowing services provided by provisional psychologists to attract a Medicare rebate.
The Australian Psychological Society (APS) republished an article from The Australian quoting a survey carried out by the APS which found that more than 40 percent of psychologists reported “cost as the main barrier for patient access”, and that 55 percent of practitioners were reporting a reduction in waiting lists.
APS President Dr Catriona Davis-McCabe said shortening waiting lists were the result of “patients simply not accessing their services … patients are currently faced with putting food on the table and paying rent rather than dealing with their mental health”.
Meanwhile, on 16 August the Government released its response to the final report of an independent evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative (Better Access).
The Australian College of Nursing (ACN) announced the appointment of Dr Kathryn Zeitz as the organisation’s new CEO. Zeitz is presently the Deputy CEO of the Central Adelaide Local Health Network, incorporating the Royal Adelaide Hospital and The Queen Elizabeth Hospital.
Australian Dental Association President Dr Scott Davis warned of the risks of going overseas to seek dental treatment in an ABC story.
He said that “if the government funded dentistry properly in Australia so it targeted vulnerable Australians like seniors and those on low incomes, then many Australians who head overseas every year to get dental treatments done supposedly for less money would not need to”.
The Australian Nursing and Midwifery Federation (ANMF) issued a statement marking the introduction into Parliament of the Universities Accord (Student Support and Other Measures) Bill 2024, which will provide support payments for student nurses and midwives undertaking mandatory clinical placement training.
ANMF Federal Secretary Annie Butler said the means-tested weekly payments of up to $319.50 would better assist student nurses and midwives struggling with “placement poverty” as they worked toward completing their qualifications.
The Australian Physiotherapy Association (APA) released a statement setting out its policy priorities for the NT election. APA President and Palawa man Scott Willis “emphasised the importance of investing in community-led, culturally responsive physiotherapy services”.
The APA called for:
- better access to primary and community care physiotherapy
- investment in culturally safe physiotherapy for First Nations people
- support for physiotherapy positions in hospitals and urgent care settings
- investment in multidisciplinary team care and sustainable workforce
- funding for advanced practice physiotherapists.
The RACGP issued a media release warning that “over 2.2 million heart health tests were not delivered by GPs due to Federal Government funding cuts in [the period 2020 to 2022], creating a ticking time bomb for millions of Australians”.
This is a reference to the decision by the previous Government to adopt a recommendation from the MBS Review Taskforce to remove funding for GPs interpreting 12-lead electrocardiograms.
To be clear, the fact that a Medicare benefit isn’t paid for something doesn’t mean it didn’t happen. The College in the past has argued that GPs provide lots of services that don’t attract a Medicare benefit or other payment, such as following up with the families of aged care residents, or completing NDIS paperwork.
But in the case of ECGs, the College is assuming that the lack of an MBS benefit means that the service is not being provided.
I have personally observed GPs providing ECGs if they considered it necessary, regardless of the lack of an MBS item, and I would be surprised if this practice was not common.
The RACGP also released guidance on the use of AI scribes – software that can “convert a conversation with a patient into a clinical note, summary, or letter that can be incorporated into the patient’s health record”.
After canvassing the pros and cons, College President Dr Nicole Higgins concluded that “everyone deserves the quality care that comes from having a GP who knows you, and your health history – AI can never replace this relationship. But it can help with administrative tasks, and this will help GPs focus more on our patients, which is what we want”.
The RACGP also called on the Government “to reverse its decision to cut funding for chronic disease management in general practice”.
According to the College, the Government announced plans to reform Chronic Disease Management (CDM) Medicare items in the Budget, but while the changes are due to take effect in November details have not yet been released.
President Dr Nicole Higgins said the changes “must not result in a funding cut for patients seeking care from their GP” and said the absence of information was “unacceptable”.
The Department last released information on the changes in mid-July, indicating that rebates for developing and reviewing plans would be “equalised”, to encourage management plan reviews. Unless equalisation involves increasing the review rebate to the level of the development rebate, I’m sure the RACGP will portray the change as a cut – even though that is not the intention, and aggregate funding is not expected to change.
The Society of Hospital Pharmacists of Australia (SHPA) released a vision for the future of hospital pharmacy. SHPA President Tom Simpson said the Statement on Advanced Pharmacy in practice will mean:
“More collaborative prescribing models: preferred by pharmacists, embraced by our medical colleagues, increasing health system capacity and improving care outcomes across every measure; [and] more stewardship models: applying pharmacy expertise not only to individual care episodes, but in the management of medicines at a national level as we balance their benefits with their high potencies and risks”.
Industry groups
Catholic Health Australia (CHA) continued its battle with the private health insurance industry by releasing a paper that claimed to include “new analysis that exposes private health insurers’ soaring profits while many private hospitals struggle to remain viable”.
CHA’s preferred solution is reform of the private health insurance premium round process, including:
- entrusting the process to an independent body such as the Independent Health and Aged Care Pricing Authority, with a formalised approach to incorporating hospital cost data;
- linking premium increases with the level of benefits paid in order to incentivise insurers to give back more to patients; and
- implementing a national private price, which would align price growth with the real costs of delivering care — similar to what occurs in the public sector.
The Pharmacy Guild welcomed the announcement by the WA Minister for Health that “patients would be able to access treatment for a broad range of acute conditions through appropriately trained and authorised pharmacists prescribing within a framework which is based on existing models of care”.
(I reported in last week’s column on the RACGP’s criticism of the policy.)
The Guild said that “where a pharmacist considers that high-quality primary healthcare cannot safely and appropriately be provided within a community pharmacy, patients will be referred to their GP for further review or ongoing care”.
Somehow, I don’t think this will assuage the RACGP’s concerns.
Ramsay Health Care (Australia’s largest private hospitals operator) announced the appointment of Natalie Davis as its next Global CEO. Davis, who will take up the position later this year, has been Managing Director of Woolworths supermarkets division for the past three years, leading 130,000 employees across 1,000 sites.
Politicians and parliamentary committees
Greens Older People spokesperson, Senator Penny Allman-Payne, said that “Labor is keeping older Australians in the dark on its new Aged Care Act, with the community growing increasingly anxious about secrecy and delays”.
She added that “the Greens took a policy to the last election of guaranteeing a human rights based approach to aged care, and stand more than willing to deliver one with Labor”.
Shadow Minister Anne Ruston criticised the Government for inactivity on mental health and healthcare affordability.
International organisations
The OECD published a working paper on Digital and innovative tools for better health and productivity at the workplace. The paper included case studies on “wearables, mobile applications for female health, AI-driven lifestyle management applications, and health insurance engagement platforms”.
It said that while “these technologies present avenues for enhancing the efficacy, efficiency, and customization of health promotion interventions… they also pose challenges such as privacy issues, the requirement for digital proficiency, the necessity for conducive organisational practices for healthier work environments, and the assurance of safety and clinical suitability of the proliferating health applications and tools in the market”.
Finally
Finally this week, a story about bananas.
Cavendish bananas make up the vast majority of internationally traded banana crops across the world, including 97 percent of the Australian crop. Because bananas are propagated vegetatively, they have very low genetic diversity.
Since the turn of the century a fungal infection called Panama disease, which effectively destroys banana plants, has been spreading across different producing areas, and is now affecting South American countries producing fruit for the United States market.
This week a joint media release from the Minister for Agriculture, Fisheries and Forestry, the Assistant Minister for Agriculture, Fisheries and Forestry, and Assistant Minister for Health Ged Kearney announced that Food Standards Australia and New Zealand had approved the genetically modified QCAV-4 variety of the Cavendish banana, developed by the Queensland University of Technology (QUT) to counteract the effects of Panama Disease.
The Ministers said that with Panama Disease “estimated to have the potential to impact 80 percent of global banana production, Australian researchers have made a world-first breakthrough to protect local banana farms and secure our food production systems”.
Details of the work of the QUT Banana Biotechnology Program can be found here.
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.
Therapeutic Goods Administration
Reforming Australia’s Therapeutic Goods Testing Regulations
18 August
Australian Technical Advisory Group on Immunisation
Removal of information about Zostavax in the Australian Immunisation Handbook
27 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
National Health and Medical Research Council
Australian Drinking Water Guidelines – public consultation on draft guidance for lead replacements in plumbing products
6 September
Food Standards Australia and New Zealand
Amend the definitions in the Australia New Zealand Food Standards Code (the Code) for ‘food produced using gene technology’ and ‘gene technology’
10 September
Department of Health and Aged Care
Improving commercial foods for infants and young children
13 September
Therapeutic Goods Administration
Proposed changes to the Permissible Ingredients Determination
13 September
Department of Health and Aged Care
Prostheses list – General Use Items utilisation, expenditure and integrity
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 2024.
Department of Health and Aged Care
Review of MBS health assessment items
30 September
The Medical Board of Australia
Introduction of health checks for late career doctors
4 October
Therapeutic Goods Administration
Future regulation of assistive technologies
13 October
Therapeutic Goods Administration
Proposed changes to the Australian Essential Principles for Safety and Performance of medical devices
16 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.
