In the latest edition of The Zap, health policy analyst Charles Maskell-Knight provides an overview of key developments in health and aged care, including new data raising concerns about the mental health and wellbeing of LGBTQ+ Australians.
The benefits of an Indigenous-led model of maternity care are highlighted, while Diabetes Australia pushes for emergency research funding, and authorities are urged to address the excessive use of painkillers in aged care facilities.
The quotable (which comes from the UK but is no doubt more widely relevant):
Ask a clinician about waste in their service – the things that waste their time, that waste their patients’ time, and that waste taxpayers’ pounds – and you will see them light up with ideas on ways to improve how services are run.”
Charles Maskell-Knight writes:
The release of the National Drug Strategy Household Survey last week generated comments from the Foundation for Alcohol Research & Education (FARE) – about alcohol industry marketing targeting younger women – and the Royal Australian College of General Practitioners (RACGP), calling for more support for GPs treating people with problematic alcohol and other drug use, while the Alcohol and Drug Foundation published this helpful guide.
The survey’s findings on the rise in vaping emphasised the need for Government action, such as the “new influencer-led youth [anti-]vaping campaign, to spark a conversation with the next generation of Australians about the harms of vaping and nicotine addiction”, announced by Minister Mark Butler. (Read more in my report, Greater efforts are needed to tackle a “staggering” increase in vaping rates.)
Butler said that “social media is awash with pro-vaping content: misinformation cynically promoted and stoked by the vaping and tobacco industry. TikTok is home to more than 18 billion posts with the hashtag #vape and Instagram is home to more than 18,000 ‘vaping influencer’ profiles solely dedicated to promoting vaping”.
The campaign will feature Ellyse Perry; Ella Watkins; JackBuzza; Fairbairn Brothers; Zahlia and Shyla Short; Sam Fricker; Lottie Dalziel; HeyImZed. Although I am 45 years older than the target audience, even I confidently recognise one of these names…
In an associated media conference, Butler was asked about an article in The Australian claiming that the Government was in a war of words with the private health insurance sector because he had not yet announced his decision on premium increases to apply from 1 April.
He responded that the insurers had said the story was a beat-up, and that he was focussed on getting the best deal for consumers. The article prompted an amusing duel by press release between the insurers, the hospitals, and the prostheses sector, of which more later.
Other ministerial and government announcements
Apparently Leap Day is also Rare Disease Day, prompting Butler to announce that “the Medical Services Advisory Committee has recommended the addition of X-linked adrenoleukodystrophy (X-ALD) and sickle cell disease to Australian Newborn Bloodspot Screening programs”. The states and territories now need to agree to implement the recommendation.
The Minister also announced that the Government had accepted the Australian Technical Advisory Group on Immunisation (ATAGI) recommendations for COVID-19 vaccinations for 2024: biannual for over 65s and severely immunocompromised adults; and annual for other adult and severely immunocompromised children.
Assistant Minister Ged Kearney issued a media release marking the publication of the 2023 Australian Donation and Transplantation Activity Report, showing that the number of deceased organ donations increased by 13 percent over the previous year, and that 1,400 people received a donated organ.
However, “only 55 percent of families said yes to donation in the hospital last year, down from 59 percent pre-pandemic”. Kearney called on Australians to register as organ donors, and tell their family of their wishes.
Aged Care Minister Anika Wells announced that “older Australians and their families can now see how much aged care services are spending on their care, food, wages and more”. The data is available on a home-by-home basis through the incredibly clunky MyAgedCare platform.
It is a start, but there are two issues: it is only home-by-home, so aggregating results for a provider (or a sector, or nationally) requires a lot of manual work; and it still suffers from the GIGO problem, because the raw data is not adjusted for third party transactions.
As I mentioned earlier, the Australian Institute of Health and Welfare (AIHW) released the results of the National Drug Strategy Household Survey for 2022-23. Headline results included:
- a reduction in the overall smoking rate to less than 10 percent for the first time;
- an (almost) tripling in the vaping rate since 2019 (2.5 percent to 7.0 percent), with rates for cohorts aged under 25 increasing four- or five-fold;
- almost a third of Australians drank alcohol in ways that endangered their health in the last twelve months;
- 2.5 million people (11.5 percent of the over-14 population) had used cannabis in the last twelve months.
The Alcohol and Drug Foundation published a helpful guide to the survey results, noting in particular increasing support for health-based policies aimed at reducing drug-related harm, including pill testing (64 percent in favour) and supervised injection rooms (53 percent in favour).
The consultation period for the Working Better for Medicare Review closed on 1 March. The review is being carried out by Professor Sabina Knight and Adjunct Professor Mick Reid, and is examining the effectiveness of the laws and policies that the Government uses to encourage or require health professionals to work in areas of workforce shortage. It is due to report in July.
Despite the importance of this project, the request for public input did not appear on the Department of Health and Aged Care “consultation hub”. Perhaps the Department thinks that people living in areas of workforce shortage can’t access the internet, so there was no point including it on the list of public consultations?
The TGA announced it was beginning a targeted consultation on a proposal to prevent pharmacists from extemporaneously compounding medicines containing glucagon-like-peptide 1 receptor agonist (GLP-1 RAs) analogues.
Apparently extemporaneous compounders are producing Ozempic-like medications for weight loss. The TGA states that “public health and safety concerns have emerged around the complexity and commercial scale of some compounding of extemporaneously prepared GLP-1 RAs, which are sterile medicines containing high-risk active substances”. It intends to make a decision on amendments to the law by June.
On Friday 1 March the TGA announced that it had executed a search warrant at a compounding pharmacy in South Yarra and seized a number of items, including a large amount of semaglutide (the active ingredient in Ozempic) which it will allege had been illegally manufactured.
The Australian Bureau of Statistics (ABS) released an article reporting on data from the National Study of Mental Health and Wellbeing 2020-22 relating to the mental health of LGBTQ+ Australians. Among LGB+ people, just under 60 percent had a mental disorder in the past 12 months, compared with just under 20 percent of heterosexual people. The pattern was similar for non-binary people (over 80 percent experiencing a mental disorder in the past 12 months), but different for trans people (33 percent). The article also included data on suicidal ideation, self-harm, psychological distress, and service utilisation.
The ABS also released the monthly consumer price indicator for January. Compared with an overall increase in the twelve months to January of 3.4 percent, health prices increased by 3.9 percent, far behind insurance and financial services (8.2 percent) and rents (7.4 percent). This may reflect some of the Government’s measures such as increased bulk-billing incentives and 60-day prescribing.
APRA (the financial regulator, not the performing right association) released the December 2023 quarterly statistics for the PHI sector, showing 55,000 people took up hospital insurance during the quarter. Despite this increase, the proportion of the population covered declined by 0.1 percentage point. The two PHI lobby groups welcomed the increase (here and here).
First Nations peoples’ health
The National Indigenous Times reported on research showing that “women who receive support through an Indigenous-led model of maternity care are three times less likely to have Indigenous newborn children removed by child protection services”.
The research was carried out by the Institute for Urban Indigenous Health, and followed almost 2,000 women with children born from 2013 to 2019.
Kristie Watego, service development manager for the Birthing in Our Community (BiOC) program, said that “existing maternity care models, and child protection systems, lack preventative measures and fail to prioritise family preservation”.
By contrast, the BiOC care improved family outcomes, reduced child protection intervention, and significantly reduced related costs for the health system.
Consumer and public health groups
Rare Voices Australia (the peak body for Australians living with a rare disease) used Rare Disease Day to launch a set of national recommendations to help health professionals provide quality care for people living with rare disease. The recommendations were developed by a collaboration between Rare Voices Australia, UNSW, Macquarie University, and UWA, and funded by the Australian Government.
Diabetes Australia released its pre-budget submission, asking for a Government contribution of $10 million in emergency research funding to offset a decline of 35 percent in NHMRC research funding over the last decade.
The organisation also called for a diabetes and obesity mission under the MRFF, and a range of other measures including expanded access to continuous glucose monitoring, a funded implementation plan for the National Diabetes Strategy, and MBS funding for a number of services provided by credentialed diabetes educators.
Trade unions
The RACGP used its submission to the Senate inquiry into menopause and perimenopause to argue for better funding for longer consultations, as well as better funding for hormone therapies, research into “culturally appropriate best practice menopausal care for Aboriginal and Torres Strait Islanders, the LGBTQIA+ community, and culturally and linguistically diverse people”, and funding for GPs to undertake refresher training in menopause care.
Following the release of the National Drug Strategy Household Survey, the College also called for “the government to help GPs and practice teams help more people with alcohol and other drug issues, including opioid drugs”. It wasn’t made clear exactly what form this help should take.
The RACGP also called on the Government to “invest in general practice-based research to improve the evidence base for GPs caring for patients and helping people live healthier”.
President Dr Nicole Higgins said that “the pandemic exposed a gap in Australia’s health system; a major underinvestment in general practice-based research. We don’t have a national network like the UK or Canada, so we couldn’t run large-scale trials of COVID treatment in general practice”.
The Australian Dental Association released its pre-budget submission calling for:
- establishing a Senior Dental Benefits Scheme, as recommended by the Aged Care Royal Commission;
- expanding the Child Dental Benefits Scheme to cover the costs or children with more extensive treatment requirements, and assessing the costs and benefits of adding payments for hospital treatments and custom-made mouthguards;
- putting Commonwealth support for public dental service on a multi-year basis, and increasing the quantum of funding; and
- consideration of health savings accounts supported by tax incentives to allow Australians to save for their own future dental and other health care spending.
I think every second Health Minister I served under during 30 years in the health department called for a briefing on health savings accounts, and after receiving it they all dropped the idea. I can’t imagine Mark Butler will be any more receptive than his predecessors after he has received a proper briefing.
Industry groups
Following the article in The Australian suggesting the PHI industry was in a war of words with Minister Butler, Private Healthcare Australia (the PHI lobby group) issued a scathing media release, saying the article was false.
“The ‘health insurance row’ referred to in the report is a fiction and ‘six of the nation’s largest health funds’ have not commented publicly on the premium setting round as reported. Our industry has not accused the Government of anything as suggested in the header.”
CEO Dr Rachel David went on to say that insurers had “to ensure our health providers are appropriately remunerated for increases in recruitment, power and food because like the rest of the economy, they have been impacted by inflation”.
This prompted a response from the Australian Private Hospitals Association, claiming that while “this is true, yet there is little evidence of private health insurance companies increasing their payments to private hospitals. We have already seen private hospital beds, services, and indeed entire hospitals close and the current funding arrangements need to change if we want this to stop.”
The Medical Technology Association of Australia then joined the fray, calling for “greater transparency and controls on corporate health insurers to ensure savings are passed on to consumers”.
CEO Ian Burgess said “the real cost pressure for corporate health insurers is the $3 billion they spend on themselves in management expenses”.
Politicians and parliamentary committees
Following a less than satisfactory answer by Minister Butler to a question about the Government’s response to the Long-COVID inquiry, Dr Monique Ryan MP issued a statement about the importance of clean air in mitigating COVID-19 transmission. (Croakey subsequently published the exchange here.)
Butler referred to a symposium of experts on the subject to be held later this month. Ryan responded “those same professionals told our Committee last year that we need these clean air standards. We already know what they’ll say in three weeks. The Government needs to listen to expert medical advice and act on it to protect our kids and help keep them safe at school”. Action does not come easily to this Government.
The House of Representatives inquiry into diabetes took evidence in Canberra on 1 March from the Departments of Education and Health and Aged Care, and announced that it had decided to hold further public hearings in March.
The Senate inquiry into rare cancers also held a Canberra hearing on 1 March. Its reporting date was extended by two months to 16 May 2024.
Shadow Health Minister Anne Ruston issued her regular release on the decline of bulkbilling.
International organisations
The World Health Organization reported on a quadripartite meeting with the UN Food and Agriculture Organization, the UN Environment Programme, and the World Organisation for Animal Health.
The four organisations agreed that “adopting a One Health approach that recognises the health of people is closely connected to the health of animals and our shared environment offers promising solutions for addressing unprecedented challenges”.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said: “we need sustained political will to ensure One Health principles are embedded in national and international policies. Implementation in countries; resource mobilization; science and evidence; and political will. These are the four priorities that we must pursue together in the year ahead.”
The Kings Fund (UK-based health policy think-tank) published an article on the search for productivity in the National Health Service. It concluded that:
“Finally, it might be time to rebrand NHS productivity drives. I have rarely met anyone in the NHS who was inspired by pleas to improve productivity. Productivity is cold. It is equations. It is more for less. It is something that is done for a taskmaster.
“Waste, on the other hand, is visceral. Ask a clinician about waste in their service – the things that waste their time, that waste their patients’ time, and that waste taxpayers’ pounds – and you will see them light up with ideas on ways to improve how services are run.”
Finally
A research team with members from Monash University and Japan’s Institute for Health Economics and Policy released a paper finding that “only 11 percent of Japanese aged care facility residents are prescribed regular painkiller medications, compared to nearly three-quarters (74 percent) of Australia’s aged care facility population”.
In addition, it found that the rate of use of opioid painkillers in Australia in aged care was 30 times (no, that’s not a typo, thirty times) higher than the rate in Japan.
What is going on?
Qualitative data derived from focus groups with health professionals showed that the therapeutic goal in Australia was to alleviate pain, meaning painkillers were prescribed regularly, while in Japan the goal was to “minimise impacts of pain on daily activities”, with drugs prescribed for short-term use during episodes of pain. In addition, Japanese regulations restrict opioid use in nursing homes for non-cancer related pain.
Given the widespread use of polypharmacy in Australian nursing homes, and the strong association between opioid analgesic use and falls (see, for example, here), the Department of Health and Aged Care and the aged care regulator should be working vigorously on changing the culture around analgesic use in the Australian aged care sector. Don’t hold your breath.
Have we missed anything? Let Charles Maskell-Knight know using ‘The Zap’ in the subject line: info@croakey.org
The Zap column launched in early 2024, to provide a weekly summary of health-related reports, announcements and media releases from Commonwealth government agencies, Health and Aged Care Ministers and other politicians, national health sector organisations, and some international bodies.
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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