Tommy thrills at the Opera House

BY CHRIS JOHNSON

Australia has no greater guitarist than Tommy Emmanuel. Full stop. End of story.

In fact, he is probably the best the guitarist in the world.

In his hands, he can make a single acoustic six-string sound like an orchestra.

And he can make an entire audience stop breathing.

So it is only fitting that one of the world’s finest musicians should perform on the stage of one of the world’s finest concert halls.

Tommy Emmanuel and the Sydney Opera House belong together.

It is not the first time Tommy has played the Opera House and hopefully it won’t be his last.

But, as he said during his September 30 concert, he always knew that was where he wanted to be.

“I couldn’t have imagined how it would be possible that I would one day play in the Opera House,” he said.

“But I did imagine it. As a ten-year-old boy I saw myself here.”

The guitar has been Tommy Emmanuel’s life and his dedication to the instrument has certainly been rewarded.

If the long gone Mississippi bluesman Robert Johnson really did sell his soul to the devil in the 1930s in exchange for better guitar skills, then Tommy Emmanuel must have done a deal with a more powerful entity – because his prowess on the instrument is truly out of this world.

Tommy has thrilled audiences across Australia and around the globe with his fast and furious picking, his gentle meanderings over the fret board and his sheer brilliant musicianship.

These days he resides in Nashville, Tennessee but he regularly returns to Australian shores to the delight of home grown audiences.

His most recent appearance at the Sydney Opera House was Tommy Emmanuel at his outstanding best.

His blend of classy instrumentals and the occasional song he put his voice to (he doesn’t sing a lot but he sings really well), worked a treat.

So did the mix of styles he chose to perform.

From the traditional old-world Deep River Blues, to Guitar Boogie, to a jaw-dropping Beatles medley, to a wealth of his original tunes, the concert was mesmerising from start to finish.

Tommy uses the whole guitar, to make it percussive as well as melodic. The sounds he draws out of his instrument are amazing.

As always, Tommy gave more than a passing nod to his hero the late Chet Atkins.

He played a few of Atkins’ numbers to honour the man who gave Tommy one of his own greatest honours.

In the 1990s, Chet Atkins named Tommy Emmanuel a Certified Guitar Player – a formal recognition Atkins gave to only five people.

Tommy uses the CGP honorific with pride. He earned it.

He is as proud of that as he is the other letters after his name – AM, for being named a Member of the Order of Australia in 2010 for services to music.

On this tour, Tommy brought with him another CGP, Nashville’s Steve Wariner, who not only opened the show but returned to join Tommy onstage for a few numbers during the main act.

Together, the duo played a chillingly beautiful rendition of Wichita Lineman, in tribute to the recently passed Glen Campbell.

But for more than two hours it was Tommy Emmanuel standing (and sometimes sitting) alone on the stage of the Opera House.

Alone with his guitar. The world at his fingers.

Indigenous health, an AMA priority

The Federal Government needs to broaden its thinking when it comes to addressing the healthcare needs of Aboriginal and Torres Strait Islanders, because the current situation is unacceptable, according to AMA President Dr Michael Gannon.

Addressing the Australian Indigenous Doctors’ Association (AIDA) conference in the Hunter Valley in September, Dr Gannon said Indigenous doctors were vital to the health of Indigenous Australians.

“The AMA has said time and again that it is simply unacceptable that Australia cannot manage the health care of the first peoples, who make up just three per cent of our population,” Dr Gannon said.

“When it comes to Indigenous health, the Federal Government needs to broaden its thinking.

“For too long now, people working in Indigenous health have called for action to address the social issues that affect the health of Aboriginal and Torres Strait Islander people.

“Education, housing, employment, sanitation, clean water, and transport – these all affect health too.

“This is clearly recognised in the Government’s own National Aboriginal and Torres Strait Health Plan 2013-2023, yet we continue to see insufficient action on addressing social determinants.

“One message is clear – the evidence of what needs to be done is with us. There is a huge volume of research, frameworks, strategies, action plans and the like sitting with governments – and yet we are not seeing these being properly resourced and funded. We do not need more paper documents. We need action.

“The AMA recognises that Indigenous doctors are critical to improving health outcomes for their Aboriginal and Torres Strait Islander patients.

“Aboriginal and Torres Strait Islander doctors have a unique ability to align their clinical and cultural expertise to improve access to services, and provide culturally appropriate care for Indigenous patients.

“But there are too few Aboriginal and Torres Strait Islander doctors and medical students in Australia.”

AIDA used its conference to celebrate the organisation’s 20^th anniversary and had a conference theme of Family – Unity – Success.

Dr Gannon congratulated AIDA on the anniversary, noting that it had “come a long way”.

He said Aboriginal and Torres Strait Islander people face adversity in many aspects of their lives.

“There is arguably no greater indicator of disadvantage than the appalling state of Indigenous health,” he said.

“Aboriginal and Torres Strait Islander people are needlessly sicker, and are dying much younger than their non-Indigenous peers.

“What is even more disturbing is that many of these health problems and deaths stem from preventable causes.

“The battle to gain meaningful and lasting improvements has been long and hard, and it continues.

“I am proud to be President of an organisation that has for decades highlighted the deficiencies in Indigenous health services and advocated for improvements.

“While there has been some success in reducing childhood mortality and smoking rates, the high levels of chronic disease among Indigenous people continue to be of considerable concern.

“For the AMA, Aboriginal and Torres Strait Islander health is a key priority. It is core business.

“It is a responsibility of the entire medical profession to ensure that Aboriginal and Torres Strait Islander people have the best possible health.

“It is the responsibility of doctors to ensure that patients – all patients – are able to live their lives to the fullest.”

This year, the AMA’s Report Card on Indigenous Health – to be released in November – will focus on ear health and hearing loss.

Aboriginal and Torres Strait Islander people in Australia suffer from some of the highest levels of ear disease in the world, and experience hearing problems at up to 10 times the rate of non-Indigenous people across nearly all age groups.

Hearing loss has health and social implications, particularly in relation to educational difficulties, low self-esteem, and contact with the criminal justice system.

The report card will be a catalyst for Government action to improve ear health among Aboriginal and Torres Strait Islander people.

Dr Gannon told the conference that at every opportunity, the AMA highlights the issues of housing, clean water, transport, food security, access to allied medical services, and other social determinants that contribute to chronic disease and act as barriers to treatment and prevention.

And he said the AMA will continue advocating for an increase in the number of Indigenous doctors in Australia.

“The AMA has been a persistent, sustained, and powerful voice on Indigenous health for decades,” he said.

CHRIS JOHNSON

PIC: Dr Jeff McMullen, Dr Michael Gannon, Charles Davison, and Karl Briscoe

Remote NT patients at risk due to high staff turnover

Half the staff working in a remote Northern Territory healthcare clinic leave after four months on the job, two-thirds leave remote work altogether every year and any one clinic can see a 128 per cent turnover of staff each year, putting patient health at risk, new research shows.

Released on the 10^th anniversary of the United Nations Declaration on the Rights of Indigenous Peoples, the study raises concerns about how the rights to health of Aboriginal and Torres Strait Islander people living in remote communities are compromised by an unstable remote health workforce.

The study’s chief investigator Professor John Wakerman, Associate Dean Flinders Northern Territory, said there was no one simple solution to this issue.

“The work to date suggests a number of possible strategies. These include increased investment in recruiting and retaining local Aboriginal Health Practitioners and consideration of utilising remote nurse practitioners where there are no doctors to provide higher level care and to stabilise the nursing workforce,” Professor Wakerman said.

“We can also learn from successful strategies used for training and retaining doctors and apply them to nursing and allied health professionals.

“This would entail prioritising remote and rural origin and Aboriginal students in undergraduate courses, early exposure and training in remote areas and developing clear career pathways for these remote area health professionals.”

Lead author of the report, Dr Deborah Russell of Monash University, said there was considerable anecdotal evidence about the difficulties remote communities faced attracting and retaining suitably skilled health staff and their increasing reliance on agency nurses.

“This is a landmark study that actually measures turnover from the perspective of a particular remote health service,” Dr Russell said.

“It shows extreme fragility of the remote workforce, confirming that there is a heavy reliance on agency nurses to provide primary health care in Northern Territory remote communities.

“Lack of continuity of care has serious implications for both patient health and staff safety in remote communities across Australia.”

“Constantly having to recruit and orient new staff is also a serious drain on resources and can make it very difficult for these health services to participate in quality improvement.”

The study was a collaboration between Flinders University, Monash University, Macquarie University, the University of Adelaide, the University of Sydney and the NT Department of Health. It is part of a larger program of research investigating the impact and cost of short-term health staffing in remote communities to determine whether fly-in, fly-out is the cure or the curse.

The study looked at data provided by the NT Government payroll and account system from 2013 to 2015 covering 53 remote clinics.

While the study looked specifically at NT health services, the authors say that extremely high turnover and heavy reliance on short-term agency nurses for supply has important implications for remote health services anywhere in Australia.

“There’s good evidence that primary health care is critically important for achieving equitable population health outcomes,” said Dr Russell.

A chronic lack of continuity of care sees people less likely to access primary health care in a timely way and to disengage from their health care altogether.

“And, ultimately, that results in poorer health outcomes.”

The paper Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013-2015 published in Human Resources for Health is available at: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-017-0229-9

CHRIS JOHNSON

New boss for Health Department

Prime Minister Malcolm Turnbull has appointed career public servant Glenys Beauchamp the new Secretary of the Department of Health.

She took up the post on September 18, following the resignation of former Health Department chief Martin Bowles.

Ms Beauchamp has had an extensive senior-level career in the Australian Public Service and was most recently the Department of Industry, Innovation and Science Secretary.

Her roles before that included: Secretary of the Department of Regional Australia, Local Government, Arts and Sport (2010–2013); Deputy Secretary in the Department of the Prime Minister and Cabinet (2009–2010); and Deputy Secretary in the Department of Families, Housing, Community Services and Indigenous Affairs (2002–2009).

She has more than 25 years’ experience in the public sector and began her career as a graduate in the Industry Commission.

Ms Beauchamp has also held a number of executive positions in the ACT Government, including Deputy Chief Executive, Department of Disability, Housing and Community Services and Deputy CEO, Department of Health. She also held senior positions in housing, energy and utilities functions with the ACT Government.

In 2010, she was awarded a Public Service Medal for coordinating Australian Government support during the 2009 Victorian bushfires.

She has an economics degree from the Australian National University and an MBA from the University of Canberra.

Mr Turnbull described Ms Beauchamp as a highly experienced departmental Secretary.

CHRIS JOHNSON

Hearing health for Indigenous Australians a crisis

The Still Waiting to be Heard: Hearing Health Report has been presented to Federal Parliament and provides sobering reading – particularly in relation to Indigenous children.

The Australian Parliament’s Health, Aged Care and Sport Committee received more than 100 written submissions and held over 11 public hearings around the country to examine the hearing health and wellbeing of Australia.

The report found improving hearing health across the whole Australian community required greater prioritisation by Government.

Implementing the actions recommended in the report, it found, would improve the hearing health and wellbeing of Australians across all demographics.

Hearing loss is estimated to cost the Australian economy $33 billion per year.

Chair of the Committee Trent Zimmerman MP said: “For those who experience hearing loss, the most profound impact can be the effect on their everyday lives and relationships with family, friends, and work colleagues.

“Among working age Australians hearing loss can make it difficult to find or retain a job, and among older people hearing loss may lead to social isolation and has been linked to an increased risk of cognitive decline and dementia.”

One point stressed in the report was that it is “no exaggeration” to describe the level of hearing loss among Aboriginal and Torres Strait Islander children as at a crisis.

The report made 22 recommendations including the development of a national strategy to address hearing health in Aboriginal and Torres Strait Island communities and a significant increase in the provision of hearing services to remote Aboriginal and Torres Strait Islander communities.

Also recommended was increased support to hearing impaired Australians of working age who are unemployed or earning a low income.

A prohibition on the use of sales commissions in hearing aid clinics taking part in the Australian Government’s Hearing Services Program was another recommendation.

The implementation of a universal hearing screening program for children in their first year of school was also seen as beneficial by the committee.

The Report is available at:

http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/HearingHealth/Report_1

The AMA urged the Committee to examine the existing, and expert, evidence on Indigenous hearing loss and hearing health problems and to support the evidence-based recommendations on best-practice responses. The AMA’s submission to the inquiry can be found here:

http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/HearingHealth/Submissions

MEREDITH HORNE

[Comment] Health inequality across prefectures in Japan

Japan has exemplary records in human development as measured by a human development index of 0·903 in 2016 (ranked 17th in the world).1 Universal access to health services with no financial barrier for every citizen in Japan launched in 1961 and has contributed to nearly equitable access and relatively small gaps in health status across regions and socioeconomic groups in the country.2 Ageing is homogeneously distributed across all communities,3 which has led to high demand for health care in all prefectures (provinces).

[Global Health Metrics] Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000.

[Global Health Metrics] Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults.

No place for photo ID checks in General Practice

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

Universal access to health care is highly valued by Australians. The furore caused when a badly designed co-payment model was proposed provided strong evidence that Australians will not tolerate any threat to their right to access medical care when needed. The AMA strongly advocated to protect vulnerable patients’ access to care at the time.

Following the sale of a small number of Medicare numbers on the dark web, AMA advocacy is needed to ensure the Government’s response is proportionate and that attempts to improve the security of Medicare numbers do not diminish patient access to care.

To the Government’s credit, it was quick to react to security concerns raised by the alleged breach, commissioning an independent review of the accessibility by health providers of Medicare card numbers. The Review is being led by Professor Peter Shergold, with the AMA represented on the review panel. The panel recently released a discussion paper, giving stakeholders the opportunity to provide submissions, with a final report due by the end of this month.

The AMA President has met with both the Ministers for Health and Human Services on this issue and the AMA has also provided a submission in response to the discussion paper.

This is a good opportunity for the Government to assess the risks to its systems. However, the AMA has made it very clear that an excessive response could impact adversely on patients and practitioners.

The Department of Human Services’ Health Professional Online Services (HPOS) is a valued service for health care providers and their delegates, enabling streamlined and secure access to Medicare Australia and Department of Human Services programs, services, tools and resources. Every day there are around 45,000 interactions with HPOS.

HPOS has continuously evolved since its introduction to ensure it increasingly enables secure and streamlined transfer of data between providers and Government entities and timely access to information. Nevertheless, there are still some clunky aspects to using HPOS, particularly when it comes to the use of PKI certificates.

The introduction of PRODA has made it much simpler for individual health care providers or delegates to securely access HPOS. However, PRODA is yet to provide the same secure business to business functionality of the PKI site certificate.

The AMA believes that introducing this functionality in PRODA as soon as possible would make it easier for providers to interact with HPOS. It would ensure provider systems flexibility by removing the need for a physical certificate tied to a physical machine, retain secure capability, and streamline provider access. We need to keep up with technological developments in an increasingly mobile, digital, online and cloud based world.

What we don’t want to see as an outcome of this Review is over-the-top security measures that go well beyond the problem that has been identified. Ideas like requiring photo ID to see a GP are heavy handed and simply add to a practice’s administrative burden. It could also see patients unable to access care and place reception staff in a very difficult environment, facing sick and often distressed people who will not be able to understand why their Medicare card is no longer sufficient enough evidence to access a basic right – health care.

Paying the piper. So what’s the tune (and how good is it)?

BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR PUBLIC HEALTH, UNIVERSITY OF SYDNEY

Healthcare funding challenges us as a nation on three levels. The most obvious and basic is: Where does the money come from? The second is: How can we be certain that the money is being well spent on health gain? The third is: How does our funding of health care match our values as a society? While these challenges interlock, looking at each separately can help us determine if we are on the right track. Let’s look at values first.

How much do we value health care?

Most advanced economies agree that funding health care should be a major call on public money and hence paid for through taxation. This is a political response to social attitudes that see illness as capricious and accidental and hence not something for which the individual can be held to be responsible. Even when groups engage in risky behaviour – smoking or drinking for example – what happens to an individual remains very much a matter of chance.

Who pays? The individual or all of us?

Which smoker develops lung cancer is currently unpredictable. You cannot hold the sufferer responsible for their illness. As a reflection of social solidarity, most societies like ours choose to defray costs for health care by spreading them across all of us.

This approach is not universal: when money is scarce health care costs are sheeted home to the individual. The proportion of government expenditure going to health care is lower as a proportion of GDP in low- and middle-income countries.

The slow slide to privatising health care

Gradually, since the inception of Medicare in 1984, a decade after Medibank, successive Australian governments have sought to contain health care costs by shifting more of them to the individual. This matters – for equity and fairness.

The New York-based Commonwealth Fund ranks health care in eleven economically advanced nations every two years.

It compares health care on 72 indicators in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Australian health care comes second overall but has lost its top-ranking on the dimension of equity. This is because of rising co-payments that now rival those of the US.

Although this “privatisation” was not the focus of the Mediscare furore before the 2016 federal election, it could have been. Rather, it passes almost without comment.

The latest survey can be found here: http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017

Funding for activity and outcome

Other strategies to ring-fence the amount of public spending employed in Australia include payments made by the Commonwealth to the States and Territories based on hospital activity as measured by the volume of services they provide.

Efforts put into this approach were mentioned recently in an article in The Australian by Sean Parnell. Parnell wrote that: “Before the last federal election, Prime Minister Malcolm Turnbull struck a deal with the States that the Commonwealth would fund 45 per cent of the growth in activity-based funding, capped at 6.5 per cent nationally each year.” The problem, of course, will be whether growth can be limited to this figure.

This move has liberated us from complete ignorance of what it is that we are paying for and opens the door for the next step – to find out not just what we are doing but what it is achieving. This requires better information about clinical outcomes and this may follow from improved IT systems.

Getting more value for what we spend is a necessary corollary of capping activity. We must rearrange our processes of care to match the decades-long needs of people with chronic problems in the community rather than in hospital.

We can do better with programs of prevention – directed at nutrition, activity, alcohol and tobacco use for example and the commercial forces that determine these. We should continue our efforts to sort through the lengthy Medical Benefits Schedule to remove those items we now know do not work. We are fortunate to live in a country that enjoys good health and high-grade health care. Ensuring that this remains the case for the future would be fine legacy.