Spike in mandatory reporting of doctors

As stakeholders get ready for mooted changes to mandatory reporting procedures, AHPRA has announced a dramatic increase in the number of doctors reported in 2016/2017.

In its newly released annual report, the regulatory authority records a 32.1% increase in the number of mandatory notifications of health practitioners, totalling 1,142 notifications, compared with 980 the previous year.

Just under 300 doctors were on the wrong end of a mandatory notification, up from 272 the previous year.

On investigation, around half of those cases required no further action. Forty-three doctors received a caution or reprimand, 15 accepted a specific undertaking, and 32 had conditions imposed on their practice.

Six doctors agreed to surrender their registration, five had their registration suspended and two had their registration cancelled.

The majority of doctors were reported for poor standard of clinical care, with a further 57 reported for impairment, 11 for drug or alcohol misuse and 29 for sexual misconduct.

In its report, AHPRA said that this year it had received the highest number of general notifications overall in any financial year since the national scheme was set up.

Nearly 6,000 complaints were logged against doctors, up considerably from 5,371 the previous year. Around three-quarters of these were about significant departures from standards of clinical care.

Around 5% of all doctors were subject to a notification in 2016/2017.

Immediate action was taken in 259 cases. No further action was taken in two thirds of cases, while 2% of cases ended in a surrendering or cancellation of registration.

The top three reasons for notification of a health practitioner were clinical care (43%), pharmacy or medication (12%) and health impairment (8%).

Nearly 30% of health, performance and conduct matters resulted in regulatory action, and over 90% of matters decided by tribunal resulted in regulatory action.

AHPRA monitored over 3,000 practitioners for health, performance and/or conduct during the year.

You can access the full AHPRA report here.

[Comment] Humanitarian medicine is more than a technical exercise

What a sad indictment of our times that the Turkey Hub of the Health Cluster, a UN-activated humanitarian health coordination body, has begun to calculate the confirmed number of attacks against hospitals in Syria. Mohamed Elamein and colleagues,1 as part of the Lancet Series on health in humanitarian crises,2–5 present evidence on the use of the Monitoring Violence against Health Care tool to detect and verify attacks on health-care services and describe their effect in Syria. The tragic story these statistics tell highlights the need for action to stop attacks against health-care settings and workers in Syria and elsewhere in the world.

[Correspondence] Patients are denied care because of corruption in Romania

On Sept 1, 2017, the prosecutors of the Romanian National Anticorruption Directorate detained 14 people on charges of corruption, with the president of the National Health Insurance House (NHIH), the head of the NHIH’s Antifraud Department, and the director of the Bucharest Health Insurance House among them.1 They are accused of having orchestrated reimbursement of home care services for fictional patients to the detriment of real patients on waiting lists, who had been denied services. Initial estimates indicate damage of at least €3 million to the NHIH budget between January, 2016, and August, 2017.

Fearmongering with doctors in training

BY DR KATE KEARNEY, CO-CHAIR AMA COUNCIL OF DOCTORS IN TRAINING

Over the past decade, there’s been a remarkable development of companies and offerings for doctors in training (DITs) to help them pass their exams, get selected onto a program or generally get ahead in an increasingly competitive environment. The range of companies putting forward these type of services has developed from opportunistic small businesses to, now, prestigious universities looking for their piece of the DIT panic money pie. These courses have a significant logistical impact on service provision within hospitals as well as financial and stress impacts on trainees.

What is the appeal of pursuing these type of extracurricular activities? DITs are afraid, of not passing exams, not getting onto a training program, not getting a job at the end of many years training. Fear about the state of the Australian medical workforce is drilled into us from the first year of medical school.

As students, we hear about it from stressed interns and residents. As interns and residents, we hear about it from panicked registrars and fellows. Ceding control over how, where and in what capacity we’ll be able to practise medicine – and live and raise our families – to the whims of medical system that isn’t investing meaningfully in medical workforce planning would raise the heckles of most in the community. Getting a little self-direction back is pitched as, as easy as signing up to our course, which will definitely get you through your exam, or improve your chances of selection.

Exams are challenging and in an uber-competitive job market, failure appears untenable. It seems insurmountable, career-defining, and not enough of those on the other side talk about their own challenges and how they faced them on the journey of their medical careers. If everyone else is doing it, and it purports to be necessary to pass – you don’t want to be the only one left behind.

Aside from the monetary cost, which is reaching new heights especially for exam years beyond even the expense of college annual and exam fees, the message that DITs allow in their mind is that this is legitimately necessary. My education provided by my hospital, my supervisors and my College aren’t enough. I have to spend significant chunks of my own hard-earned income to be able to do this. This feeds impostor syndrome – that little voice that says I’m not good enough to do this, I’m not meant to be here. Separately, it drives the CV arms race where a Masters Degree is rapidly becoming a necessity, not a standout.

So, what can be done? We can take notice. Colleges and hospitals and supervisors can take notice. We can look at our curricula and educational strategies. Are they really effective if this is happening? Are we testing the right knowledge and the right skills if it has to be delivered at such cost and outside of the workplace? The RACP advocates for both fellows and trainees to follow the 70:20:10 model of learning – where 70 per cent is experiential, 20 per cent social and 10 per cent formal learning. This is the type of sensible approach that DITs need to reinforce in their own thinking and see demonstrated in the workplace. Supervisors and mentors are an important part of modelling realistic behaviour.

There’s a place for some of these courses, as complementary educational strategies, but which are truly beneficial and which are exploiting trainee fear, under a guise of empowerment? I would ask DITs to consider how any course aligns with their educational aims and assess as objectively as possible the cost-benefit in terms of time, money and stress.

What will the next health reform agreement bring?

BY ASSOCIATE PROFESSOR SUSAN NEUHAUS, CHAIR, HEALTH FINANCING AND ECONOMICS COMMITTEE

The Health Financing and Economics Committee (HFE) has a very keen interest in the likely direction and detail of the next public hospital funding agreement that will take effect from 2020.

Negotiations between the commonwealth and State Health Ministers will begin in earnest in 2018 but early signs of the likely reform agenda are emerging, with some consistent themes coming to the fore. Unsurprisingly, most of these themes are a continuation of the changes to public hospital financing agreed by all Australian Governments in June 2017 as documented in the National Health Reform Addendum.[1] Whether States and Territories agree is hard to predict and will likely depend on how much new funding, and over what period, the Commonwealth Government is prepared to offer it.

The themes in the Addendum we would expect to see considered as part of a 2020 agreement are:

i. improve patient outcomes;

ii. decrease avoidable demand for public hospital services;

iii. improve the coordination of care for patients with chronic and complex conditions to reduce avoidable demand for hospital admissions for this group;

iv. incentives to reduce preventable, poor quality patient care; and

v. incorporate quality and safety into hospital pricing and funding to reduce poor quality patient care: sentinel events, hospital acquired complications and avoidable readmissions.

Recent media speculation[2] [3] suggests Minister Hunt will seek COAG agreement to reward jurisdictions that can demonstrate improved patient outcomes, with the goal of readmissions over the short term being avoided.

Such a move may also represent the first step towards ‘outcome based’ hospital funding. Media speculation[4] also suggests the government will frame the push as a reduction in ‘low value care’. It is likely not coincidental that the Productivity Commission released a report on 24 October 2017 that recommends low value care in public hospitals should not be funded[5]. Of course, what is finally argued by the Commonwealth in the lead-up to the negotiations with State Ministers is yet to be seen – but it is clear they are laying the groundwork.

On the topic of coordinated care, it is worth noting that jurisdictions already have the ability to enter bilateral agreements to trial coordinated care initiatives, for the 2017-2020 period. These are intended to inform the development of an evidence-based national approach in the 2020 funding agreement – but clearly we are also in early days of this work.

The National Health Reform Addendum reforms might be worthy in the abstract – it is hard to argue against improved patient outcomes, a reduction in preventable poor quality patient care, better care coordination across the boundary of admitted/non-admitted care – especially for patients with one or more chronic conditions.

But whether they are they worthy in practice depends entirely on how they are implemented. For example, shifting public hospital funding away from payments based on cost and quantity to a formula based on patient outcomes represents a massive organisational change for the public hospitals delivering the care. They will require substantial additional funding to build the necessary organisational capacity. And this will take time.

Outcome-based funding will also require substantial new government investment in data infrastructure to collect and measure robust clinical patient outcome data – not just patient reported outcomes, which may or may not be clinically relevant. It must include patient outcomes in the non-admitted setting. This capacity does not yet exist. We first need robust, consistent primary healthcare data definitions used and recorded by all primary healthcare providers. The primary and tertiary outcomes data must be linked. And if the Government is serious about linking outcomes to funding and ‘quality’ then it would need to develop an entire framework of quality-adjusted life year (QaLYs) per episode of care. Overcoming the constraints and barriers inherent in a health system that is structured within a federated system of government is no small feat, nor will it be cheap.

So far, the AMA has been bitterly disappointed in the Government’s opportunistic use of the ‘improved safety and quality’ agenda to do little more than reduce the Commonwealth’s share of public hospital funding. My Australian Medicine article published on the September 18, 2017 summarises this. The AMA will be carefully examining the detail of the 2020 health care agreement to ensure it is a genuine effort to empower public hospitals, including in providing them with the resources they will need to successfully transition to outcomes based funding with improved care-coordination. These are massive reforms that will require time, a clearly articulated evidence-based pathway and substantial new Commonwealth investment, not less.

[1] Schedule I – Addendum to the National health Reform Agreement: Revised Public Hospital Arrangements, p1, 2017.

[2] Parnell S GP Patient Incentives – Rewards to reduce crush in hospitals Weekend Australian 29/7/2017 p10-11

[3] Avoiding hospital admissions a priority, The Pharmacy Guild of Australia, 27 September 2017

[4] Martin P Education, health face shake-up, The Age, 23 October 2017 p 4

[5] Shifting the Dial:5 Year Productivity Review, Productivity Commission, 2017

Close the clean drinking water gap

BY AMA PRESIDENT DR MICHAEL GANNON

Safe drinking water is an indispensable human right. The leading national and international health bodies, such as the World Health Organization and the United Nations, all agree that safe drinking water is essential to sustain life, and a prequisite for the realisation of other human rights. The UN General Assembly explicitly recognises the human right to clean drinking water.

Having access to sufficient, safe, accessible and affordable drinking water is an important public health issue.

In developed nations such as Australia, it is often assumed that safe drinking water is accessible to all. However, this is not the case, particularly in many remote or very remote communities where artesian (bore) water is often the primary source of drinking and household water.

According to the Bureau of Statistics (2007), for discrete Indigenous communities the majority accessed bore water (58 per cent), while other sources of water included: town supply (19 per cent), river or reservoir (5 per cent), rain water tank (3 per cent), well or spring water (3 per cent), and other sources of water (2 per cent).

While the supply of potable water (defined as waterthat is safe to drink or to use for food preparation, without risk of health problems) impacts on all people living in remote areas of Australia, Aboriginal and Torres Strait Islander people are disproportionately affected.

Many Aboriginal and Torres Strait Islander people living remotely find it challenging to obtain water that is of sufficient quantity (and quality) to meet their needs.

In 2012, the Australian Bureau of Statistics estimated that there were more than 400 discrete Aboriginal communities across Australia, with the largest number in Western Australia. Data collected on over 270 remote WA communities indicated that the quality of drinking water did not meet the Australian standards, as outlined in the Australian Drinking Water Guidelines (ADWG), approximately 30 per cent of the time.

While the National Health and Medical Research Council (NHMRC) has responsibility for the ADWG, this is not a mandatory standard, with State and Territory Governments and local councils responsible for the implementation and monitoring of water quality and safety. Yet during the two year period 2012-2014, 80 per cent of remote Aboriginal communities in Western Australia failed to meet quality standard testing at least once.

There are obvious health consequences from drinking poor quality water. Some Aboriginal communities are known to have unsafe levels of chemical contaminants such as nitrates and uranium in the water. Nitrates and uranium occur naturally, and are common in the Goldfields and Pilbara regions.

‘Blue Baby Syndrome’ – where an infant’s skin shows a bluish colour and they can have trouble breathing – can be caused by excessive nitrates in the diet, which reduce the blood’s ability to carry oxygen. It can occur where prepared baby formula is made with well water. Water tested in over 270 remote communities in WA showed nitrate levels 10 times the recommended levels.

It is concerning that Aboriginal and Torres Strait Islander people living remotely often have no choice but to pay for safe drinking water. While the majority of us enjoy free, safe drinking water from the tap, those who can least afford it often have to pay just to ensure they are not drinking water sourced from rivers, streams, rivers, cisterns, poorly constructed wells, or water from an unsafe catchment.

The AMA is a member of the Close the Gap steering committee and the Public Health team has raised potable water as a Close the Gap target.

The solution may not just be in more bottled water. In communities without adequate recycling and waste disposal services, thousands of extra plastic water bottles create additional environmental problems.

Governments must invest in infrastructure, such as proper treatment facilities, water storage facilities and distribution systems to meet the changing demands of communities.

All Australians must have permanent and free access to safe water. It is a basic human right and it is difficult to understand how this hasn’t already been implemented and addressed.

Encouraging times for rural health

BY AMA VICE PRESIDENT DR TONY BARTONE

Readers of this column will know that improving access to health care for rural Australians is one of my chief motivating passions.

We know there are many indicators that show people living in the bush generally suffer worse health outcomes than those in major cities.

Regrettably, many of the initiatives put in place to increase training places in rural Australia and expand the local medical workforce have not improved these discrepancies, kept pace with the demand for rural medical services, nor resulted in a better distribution of suitably qualified doctors.

The challenge remains – we need to get doctors to rural communities, and give them the opportunity to experience rural and remote medicine and make it an attractive and valuable career option.

Some may feel achieving real change is a truly Sisyphean task.

But with the recent appointment of Professor Paul Worley as the nation’s new Rural Health Commissioner, there is perhaps some cause for optimism. Professor Worley has made a substantial contribution to rural health over many years; all of his experience will be needed for this welcome opportunity to build a strong health care workforce in regional, rural and remote Australia.

One of Professor Worley’s important tasks is to help the Government design and roll out a national rural generalist pathway. The pathway will try to address the lack of access to training for rural generalists with the ultimate aim of improving the supply of doctors to rural and regional communities.

Many people have been waiting for the announcement on the Rural Health Commissioner for a long time; we are not alone in believing that Australia’s medical workforce needs more generalists to meet the healthcare needs of rural (and metropolitan) communities as the demographics of the population shift and the numbers of patients with long-term chronic conditions and co-morbidities rises.

The AMA has been championing for a long time an improved and expanded advanced training pathway for rural generalists, with the proper resources to attract and train the appropriate number of doctors with the right skills mix necessary for rural practice.

The Queensland Rural Generalist Pathway is often put forward as the model for vocational training that could increase the numbers of doctors training and staying in rural locations, and able to deliver a broad range of hospital and community-based medical services, as well as the much-needed specialised services.

The Queensland model is a good starting point, and there is the potential to apply its principles to a national pathway that can be adapted to suit the geography and demographics of different regions.

Nonetheless, there are some contentious and vexing issues that will need to be addressed as the national rural generalist pathway is conceived and put into effect. For example, should there be quarantined procedural training places for rural generalist trainees? Should some thought be given to extending the training pathway beyond general practice as a strategy for ensuring a balanced rural workforce with the right skills mix?

Concerns around accreditation, training and recognition will need serious collaboration between the Colleges and health services.

Several AMA committees are considering the design principles for the national rural generalist pathway.

We look forward with great purpose to meeting with Professor Worley soon to discuss our ideas. Overall, the signs are positive for rural health.

Progress and barriers to a digital health upgrade

In collaboration with Harvard Business Review Analytic Services, Microsoft has published a briefing paper that highlights the progress being made in digital-enabled health care, the barriers to progress, and how a digitally augmented system can improve the lives of all Australians.

Microsoft sought input from Australian experts on the current and future state of our health care system and has released Embracing the Change Mandate: The 2020 Digital Transformation Agenda for Australia’s Health Care Sector.

Establishing a new digital health care system is complex.

“We need to deliver care; reduce errors, waste, and duplication of services; and create a sustainable system amid growing expectations and financial constraints,” says Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research (CHSSR) at Macquarie University in Sydney.

The report states there are key steps for leveraging digital technologies: working towards full digital transformation; localising international technology options; collaborating with technology providers and IT staff; sharing lessons learned within the sector; promoting digital success; and developing digital health skills.

With Australian healthcare organisations clearly moving down the track to digital health initiatives, many have seen positive results.

Richard Royle at PricewaterhouseCoopers Australia believes the evidence supports electronic records leading to improved length of stay and clinical outcomes.

“The ability to document, in an electronic record, the clinical pathways to follow for diagnoses produces greater consistencies of clinical outcomes and reduces readmissions,” he says.

However, there are still digital challenges needed to be overcome.

Dr Andrew Hugman of South East Sydney Local Health District, part of NSW Health, also contributed to the report and believes there needs to be greater engagement across all stakeholders.

“Many clinicians believe health IT projects create barriers to patient care as opposed to being the crucial tools for delivering the potential for massive gains,” he says.

“Once there is a better awareness from both the public and clinicians of how we can use the huge amount of health data we are collecting, there will be more drive for greater transparency to interrogate and analyse the data.”

The AMA provided a submission earlier this year to the Joint Standing Committee’s inquiry into the rollout of the National Broadband Network (NBN). The submission focused on broadband access for regional, rural and remote health services, while centred around the principle that all Australians, regardless of where they live or work, should have equitable access to high-speed and reliable internet services.

The submission highlights that the NBN is a necessary and worthy investment that is needed to enhance the important contribution made by regional areas to Australia’s economy. It notes that the economic and social benefits of advances in information and communications technology can only be fully realised through access to fast, reliable and affordable broadband services.

However, the submission notes there are many regional rural and remote areas that have very poor broadband connection. Internet services delivered via satellite only make available relatively small download allowances and these come at a much higher cost and slower speed than those services available via fibre or fixed wireless in metropolitan areas. The submission stresses that this ‘data drought’ must be addressed as a matter of priority.

Among other things, the AMA has urged the Government to find ways to extend the boundaries of the NBN’s fibre and fixed wireless footprints into the satellite footprint wherever possible to lessen the reliance on satellite for those living in rural and remote Australia and to address the increase in internet usage over time.

A copy of Microsoft’s report can be found here: https://sendto.stwgroup.com.au/message/JNd9m1h4J9MGnIf0yE9CDo/YBqDGbzcKslfYjQVos48fE/xHupsBS0HNo4x2VyBLPkhH/20624_HBR_Briefing%20Paper_Microsoft_Health.pdf

The AMA’s response to the Joint Standing Committee’s inquiry into the rollout of the National Broadband Network (NBN) can be found here: https://ama.com.au/system/tdf/documents/AMA%20submission%20to%20Joint%20Standing%20Committee%20on%20the%20NBN.pdf?file=1&type=node&id=46166

MEREDITH HORNE

Senate Committee hears AMA on private health insurance

AMA President Dr Michael Gannon appeared before the Standing Committee for Community Affairs Senate Inquiry into the Value of Private Health Insurance on 31 October, supplementing the AMA submission lodged with the Committee in July.

Dr Gannon told the Committee that the private system is an essential part of the health system and working with the public system to deliver the care Australians expect and deserve.

But he also began dispelling a few myths about the causes of consumer discontent with private health insurance.

Out-of-pocket medical costs are not the cause of discontent among consumers with their health insurance, he said.

“Most consumers understand that they may need to contribute to the cost of their care,” Dr Gannon said.

“The problem facing consumers is that they believe they are covered, but have inadvertently purchased a product that is, unfortunately, useless. If a policy does nothing more than avoid the tax penalty, it is a junk policy.

Out-of-pockets costs are not growing. The proportion of health expenditure funded by individuals, not Government or insurers, has remained relatively static at 17 per cent over the decade to 2015-16.

Importantly, of that 17 per cent of health expenditure funded by individuals, only 10 per cent is spent on medical services. The majority of individual expenditure is on dental services and pharmaceutical products. Out-of-pocket medical expenses are a small proportion of what patients pay for their healthcare.

“The second myth is that medical expenses are the cause of increased premiums,” Dr Gannon told the Committee.

“Medical expenses are a small proportion of total benefit outlays for private health insurers. Medical expenses, as a proportion of benefits, have remained static at around 16 per cent since 2007.

“In fact, administration expenditure by private health insurers is around 10 per cent. So it is costing insurers almost as much to run their business as it is to pay for the practitioners who treat their customers.”

With regard to individual out-of-pocket costs, the AMA has a clear position that it does not support exorbitant charges or egregious fee setting, i.e. fees that the majority of a practitioner’s peers would consider to be unacceptable.

Further AMA position statements maintain that providing informed financial consent is not only best practice, it is demanded by medical ethics.

The clear majority of practitioners charge a reasonable amount. The vast majority of health care provided in Australia is provided at no direct cost to the patient. 88.1 per cent of services are provided at no-gap and a further 6.9 per cent have a known-gap charge of less than $500.

A major source of gaps is the extended freeze on Medicare Benefits Schedule rebates, which has led to insurers also freezing payments to doctors or indexing well below inflation.

The MBS continues to fall behind. Health inflation has sat between 3.6 per cent and 6.6 per cent per annum over the past seven years. Over the same period of time, PHI premium increases have been between 4.8 per cent and 6.2 per cent. Even when it was not frozen, MBS rebates have increased at best by 2 per cent, meaning that the MBS rebate is far removed from the cost of providing a quality specialist service.

Dr Gannon then turned to the next challenge for this inquiry. It is an issue of social policy – what is the role of the private health insurer?

From the AMA’s perspective, he said, it is a payer for medical services, not a manager of clinical care.

“Private health insurers are moving private health care in Australia towards a system similar to that of the United States – a ‘managed care’ system,” Dr Gannon said.

“Health insurers in Australia are focused on minimising their expenditure and are creating barriers for patients accessing care. These are the same patients that have paid substantial premiums for top cover.

“Who is running the health system? The shift to a for-profit industry has created the need to ensure that there are sufficient profits to allow a return to shareholders. APRA data show an industry surplus (before tax) of $1.56 billion for the 2015-16 financial year, up from $1.45 billion for the previous year.”

This inquiry has come at a crucial time. Insurers are understandably concerned about the viability of the sector.

Insurers need to improve their offerings. Insurance products should be easy to understand, payments should be made on clinical need, and the ‘de facto’ risk rating system created through products with incomprehensible exclusions and ‘carve-outs’ needs to cease.

The AMA supports a system of Bronze, Silver and Gold product standards. All policies should cover maternity services and mental health services.

The policies must be based upon an agreed set of standard understandable clinical definitions, Dr Gannon stressed, saying the categories must be more than labels. “The review into private health and the Government needs to deliver on removing the policy confusion from the 20,000-plus policies,” he said.

CHRIS JOHNSON

Diabetes data linked to double death rates

The Australian Institute of Health and Welfare (AIHW) has examined data from National Diabetes Services Scheme and the National Death Index to provide a more complete understanding of deaths among people with diagnosed diabetes.

With 280 Australians developing diabetes every day, the bearing of the disease and its complications have a major personal cost to the individual and their family as well the health system.

The AIHW believes their comprehensive picture of diabetes-related deaths is important for population-based prevention strategies and could help to improve care for all people with diabetes.

The report found that overall death rates among people with diabetes were almost twice as high as the general population. And, with around 1.7 million Australians having diabetes, the numbers are significant.

“Overall in Australia, there is a trend toward lower death rates, but for people with type 2 diabetes, these improvements have not been seen,” AIHW spokeswoman Dr Lynelle Moon said.

“In fact, death rates among people with type 2 diabetes increased by 10 per cent between 2009 and 2014, mainly driven by the increase among the very old (85 and over).”

The disparity in death rates between people with diabetes and the general population was highest at younger ages – death rates were 4.5 times as high for people aged under 45 with type 1 diabetes and almost 6 times as high for those with type 2 diabetes, compared with the Australian population of the same age.

“Overall, diabetes, coronary heart disease and stroke were the most common underlying causes of death among people with type 1 or type 2 diabetes,” Dr Moon said.

“Kidney failure was also a leading cause of death for people with type 1 diabetes, while dementia was a common cause of death in those with type 2 diabetes.”

The report also shows that death rates among people with diabetes increased with socioeconomic disadvantage and remoteness.

People with diabetes living in the lowest socioeconomic areas experienced higher death rates than those in the highest socioeconomic areas. Among people with type 2 diabetes, the highest death rates were in remote and very remote areas.

Diabetes is the fastest growing chronic condition in Australia; increasing at a faster rate than other chronic diseases such as heart disease and cancer, according to figures from Diabetes Australia.

The total annual cost impact of diabetes in Australia is estimated to be at $14.6 billion. This includes a cost to the Australian health system of around $875 million per year in amputations. Diabetes Australia estimates that 4,400 amputations are performed in Australian hospitals every year, with up to 85 per cent of these preventable.

Diabetes Australia believes that awareness and early detection is incredibly important to address this growing concern and has called on the Australian Government to implement a Diabetes Amputation Prevention Initiative to ensure systematic early detection of foot problems, and early treatment to prevent amputations.

“Most people in the community have no idea that diabetes causes so many amputations. We need to raise awareness within the community and with key political leaders about the scale of the problem, its impact and what we need to do to fix it,” Diabetes Australia CEO Professor Greg Johnson said.

“Every year thousands of Australians are not so lucky and have to undergo traumatic and debilitating amputations. The sad truth is that health outcomes for people undergoing major amputations are poor. Many people will die in the first five years after a major amputation.”

MEREDITH HORNE