Mr Hunt, are we there yet? Continuing the public hospital funding journey

BY DR RODERICK MCRAE, CHAIR, AMA FEDERAL COUNCIL OF PUBLIC HOSPITAL DOCTORS

By the time of this column’s publication, we may have had some further information from the Federal Minister for Health Greg Hunt, at the AMA’s National Conference, although the Budget is pretty fresh. We know public hospitals are fundamental to Australia’s overall health system, dealing with greater than six million admitted patient care episodes and around 92 per cent of emergency admissions in any one year. Nonetheless, we experience chronic under-funding partially because of near stagnant growth in financial support. This has been going on for just too long; we all feel the pressure day in, day out. We know under-funding is building to crunch point.

AMA’s 2018 Public Hospital Report Card shows bed numbers per 1000 population are static; performance, basically, is plateauing at best; waiting lists, you know the sorry truth about that and our patients are suffering! My December 2017 Australian Medicine column criticised the Council of Australian Government’s (COAG) savage imposed financial penalties where avoidable re-admissions or hospital-acquired complications are deemed to have occurred. The AMA’s 2016 Safe Hours Audit shows that in public hospitals, 53 per cent of doctors are at “significant risk” of fatigue with dangerous fatigue levels being reported across a raft of specialty groups.

So, the effect of underfunding is cumulatively adding up to seriously affecting our, and the system’s, ability to perform optimally for our patients, and our own health and wellbeing is at stake. That’s why the 2018 Budget decisions matter; it’s about what the future holds for public hospital medicine. Without vital new investment, required infrastructure, and human resource capacity, an appropriate standard of result cannot happen.

Reflecting on AMA’s pre-budget submission, what we have said is that the Budget must fully fund, for the medium to long term, internal capacity building and expansion of their integrated care responsibility. Not to penalise an already underfunded sector via that sneaky COAG device that will redirect otherwise committed funds. The AMA also says States and Territories must be fully compensated for any loss in private patient revenue and any funding decisions must not dilute support for patients electing private treatment. Mr Hunt has said he intends to look at these private patient issues so we don’t yet know where Government is headed.

Despite the known pressure on public hospitals the new 2020-25 Hospital Funding Agreement ratchets up this financial pressure on hospitals even further. Within existing levels of Federal funding, the Agreement will require public hospitals to implement new measures to cut waste, increase productivity and extend their responsibilities to engage in the care of chronically ill-patients post discharge to reduce overall admissions.

I agree integrated care is essential – but this work requires new Federal funding to pay for the hospital and primary sector resources required to deliver it. The public hospital funding in the 2018 Federal Budget was nothing more than the amount forecast over the forward estimates to maintain funding at current levels.

There are many laudable new funding initiatives out of this Budget, to name some: a rural doctor workforce/training package, increased support for aged care in the home, and mental health/suicide prevention services, new research investment and (perhaps laughable!) the “unfreezing” of Medicare indexation. However, the Budget lacks consideration of how any savings from the Government’s yet to be finished MBS reviews will be re-invested into public health, and we still wait on needed big structural reform. There must also be funds to urgently begin development of a national medical workforce strategy. On that, your Council of Public Hospital Doctors is working through the AMA to encourage all jurisdictions to cooperate more closely in their planning and coordinating of our future medical workforce to meet Australia’s future healthcare needs.

There’s an election coming; maybe this year; and Labor has promised an additional $2.8 billion ‘better hospitals’ fund to target reducing elective surgery waiting times and increasing emergency department bed numbers. Your CPHD will be looking to score both major parties as they release more health policy and keep a watching on eye on any moves to change public hospital private practice arrangements. We must push for the government to match Labor’s pledge and make Government fund for growth, not just, as it has been, keeping pace with activity. It’s matching funding with growth and having a workforce plan that really matters!

AMA ramps up its aged care advocacy

BY DR ANDREW MULCAHY, CHAIR, AMA’S MEDICAL PRACTICE COMMITTEE

It only takes a skim of the media headlines to know that the aged care system is failing older people. Many reported cases of poor quality care are a result of delayed medical care and neglect, and AMA members are deeply concerned for their older patients. There have been multiple inquiries and reviews into the system in the past couple of years. Government are well aware of the issues and, while there was a $5 billion funding increase in the aged care 2018-19 budget, more urgently needs to be done.

The AMA is responding to its members’ concerns by ramping up its aged care advocacy. In November 2017, the Medical Practice Committee (MPC) conducted a survey on AMA member experiences and perceptions of aged care to inform future AMA policy. In April 2018, a new Position Statement, Resourcing aged care was released. This Position Statement focuses on workforce and funding measures required for a good quality aged care system, and draws from the learnings of the aged care survey.

Aged care calls for adequate resourcing to ensure doctors are supported to deliver medical care to their older patients. One such measure includes appropriate remuneration to cover the opportunity cost of leaving a surgery to visit patients in Residential Aged Care Facilities (RACFs). The AMA also advocated for this policy change at the MBS Reviews’ General Practice and Primary Care Clinical Committee (GPPCCC). Dr Richard Kidd (Chair, Council of General Practice) and AMA Federal Secretariat called for increased MBS rebates for GP RACF attendances, telehealth consultation items for GPs, and for the Practice Incentive Program (PIP) Aged Care Access Incentive (ACAI) to remain.

MPC, with input from the Council of General Practice, has lodged six aged care submissions this year alone. These include:

Aged Care Workforce Strategy Taskforce – The Aged Care Workforce Strategy;
Australian Aged Care Quality Agency – Draft Standards Guidance (for the new Aged Care Quality Standards);
House of Representatives Committee on Health, Aged Care and Sport – Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia;
Medical Services Advisory Committee – New mobile imaging services for residential aged care facilities;
Aged Care Financing Authority – Respite Care; and
Department of Health – Specialist Dementia Care Units.

In addition to the House of Representatives Committee on Health, Aged Care and Sport for the Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia submission, Dr Tony Bartone and Dr Kidd gave evidence at a public hearing in May. Dr Bartone and Dr Kidd highlighted that AMA members have major concerns that the current aged care system is failing older people, and called for more appropriately trained aged care staff, especially registered nurses, in RACFs. Dr Bartone and Dr Kidd also highlighted that doctors need to be recognised and supported as a crucial part of the aged care workforce to improve medical access, care and outcomes for residents.

In addition to the Aged Care Workforce Strategy Taskforce submission, Dr Bartone recently attended both Aged Care Workforce Taskforce Summits. The summits are aimed at engaging stakeholders in developing a strategy for ensuring aged care workforce growth to meet older people’s needs. Dr Bartone highlighted that the current aged care workforce does not have the capacity, capability and connectedness to adequately meet the needs of older people.

MPC aged care advocacy efforts were also reflected in several Budget announcements, including:

the establishment of an Aged Care Quality and Safety Commission ($nil);
investment in rural aged care ($40million);
improvements to My Aged Care website access ($61.7million) and faster Aged Care Assessment Team (ACAT) assessments ($14.8million);
improved access to specialist palliative care services in RACFs ($32.8million);
a new mental health service for older people living in RACFs ($82.5million); and
14,000 additional home care packages (plus 6000 additional packages as announced in the Mid-Year Economic and Fiscal Outlook) ($1.6billion).

However, more needs to be done to ensure older people receive quality care. 20,000 additional home care packages makes a small dent in the 104,602 people currently on the waiting list. The Productivity Commission stated in 2011 that the aged care workforce must quadruple by 2050 to meet demand, but there was no mention of a workforce strategy in the budget. MPC is waiting with bated breath for the Aged Care Workforce Strategy to complete its work (by the end of June 2018).

MPC will continue advocating for a better quality aged care system. 2018 will see the introduction of four additional aged care Position Statements, covering topics such as the health of older people, palliative care, clinical care, and innovation in aged care. So watch this space.

AMA aged care Position Statements and submissions can be accessed through: advocacy/aged-care.

Federal Council communiqué

BY DR BEVERLEY ROWBOTHAM, CHAIR, AMA FEDERAL COUNCIL

The May meeting of Federal Council is condensed to one day immediately before the start of National Conference. While shorter in length, the breadth of matters brought to the Council remains significant. The meeting was the last for outgoing President, Dr Michael Gannon, and several other members – Drs Susan Neuhaus, Gary Geelhoed, Robyn Langham, Lorraine Baker, Stuart Day, Andrew Mulcahy, and John Zorbas. As a result of the election of incoming President, Dr Tony Bartone, and Vice President, Dr Chris Zappala, Drs Brad Frankum and Gino Pecoraro also completed their terms. All have been substantial contributors to the work of Federal Council, in some cases over many years.

Dr Gannon provided an overview of his last weeks in office with highlights including a tour of remote Indigenous communities with the Hon Warren Snowdon, the Federal Budget with its wins for workforce, and attendance at the Council meeting of the World Medical Association in Riga.

The Secretary General’s report highlighted several wins in the Federal Budget which were the result of AMA advocacy. Most important among these was the introduction of a comprehensive medical workforce package. This included the establishment of the Murray Darling Medical School Network with a number of participating medical schools offering end-to-end rural medical school programs; an expansion of prevocational GP places for doctors in training; additional GP training places earmarked for rural generalists; and an emphasis on supporting doctors undertaking training in rural areas.

A major win in the Budget was the overhaul of bonded medical places which will apply to all new participants from January 2020. Existing BMP and MRBS participants have the choice to opt in. The changes offer more certainty and flexibility in how return of service obligations can be satisfied. Federal Council heard that the Secretariat is receiving calls from members expressing their delight in the life-changing outcomes from these announcements.

The AMA’s sustained advocacy for workforce reform included a medical workforce and training summit held in March 2018. An important theme from the summit was the need for a whole of government approach to planning the future delivery of health care and for all governments to collaborate more effectively on workforce planning, training and coordination.

Federal Council noted AMA activity on issues impacting on practice including medical indemnity reforms, private health insurance reforms, the ongoing MBS review, and reports on the significant engagement with aged care policy reform.

The AMA’s public health advocacy remains a consistently strong area of activity. Federal Council received an advanced draft of the Position Statement on social determinants of health, and received updates from the working groups on child abuse and neglect, and health literacy.

The Ethics and Medico-Legal Committee continues its revision of the AMA’s Position Statement on Medical Practitioners’ Relationships with Industry. It has commenced a review of the Position Statement on Conscientious Objection.

Federal Council agreed with a recommendation from the AMA’s Taskforce on Indigenous Health that the AMA sign on to the joint statement by non-Indigenous Australians in support of the Uluru Statement from the Heart.

Federal Council adopted the AMA Anti-Racism Statement which addresses racism in the medical workforce, and expresses support for good medical practice that reflects the cultural needs and contexts of patients.

The Council of Doctors in Training is working on the development of standardised questions to support State and Territory AMAs to run hospital health checks which measure and report on how well health services are meeting State-based industrial agreements and/or accreditation standards for doctors in training.

The Council of Private Specialist Practice has been considering a proposed website to support transparency of doctors’ fees. The Council noted the complexities of such a site and expressed its view that the site must be government-controlled. The Council also noted its concerns that such a website would be unmanageable if its aim is to capture every fee charged by a privately-billing doctor. Council acknowledged that there is a strong desire in government, and from consumers, to improve fees transparency and support patient awareness.

The Council of General Practice reported on the success of AMA advocacy in the Government deferring the introduction of the Practice Incentives Program Quality Improvement Incentive, which would have left many practices financially worse off. Five incentives scheduled to cease on 1 May 2018 will now continue until 30 April 2019.

The MBS Review, through its general practice and primary clinical care committee, is examining funding for GP visits to residential aged care facilities, including funding for telehealth consultation items. AMA advocacy has resulted in the referral to the MBS Review of consideration of funding for wound care items in general practice.

The Council of Public Hospital Doctors reported on its consideration of the impact of technology on workplaces, and the future of work and workers. Further analysis will be undertaken to look at potential industrial implications including task substitution, medico-legal issues, obsolescence, and outsourcing.

The Council of Rural Doctors outlined additional work that the AMA should undertake in considering rural doctor health. including longer working hours, lack of access to resources and professional support, professional and geographical isolation, and limited team support. The Council noted the work underway by the AMA subsidiary, Doctors’ Health Services Pty Limited, in sponsoring a trial of telemedicine consultations for rural doctors.

At the Annual General Meeting of members held on the day following the meeting of Federal Council, members voted unanimously to create a new position on Federal Council for a representative of Australia’s Indigenous doctors, nominated by the Australian Indigenous Doctors’ Association, and who is a member of the AMA.

Cancer warnings mooted for every Canadian cigarette

The Canadian Government is considering placing health warnings directly on individual cigarettes.

Health Minister Ginette Petitpas Taylor used World No Tobacco Day to describe the idea as “bold” and said it was being looked into.

The proposed measure is being studied by Canada’s Health Department officials, she said.

“Some people have suggested the idea of putting a warning on individual cigarettes and using what we call sliding shell,” Ms Petitpas Taylor told the Tobacco Control Forum.

“I have to tell you these ideas are being studied and I also have to tell you I really like them. They are quite bold.

“When I look at the rates of tobacco use, we have certainly come a long ways, but I personally believe a lot of work needs to be done in this area.”

Canada has followed Australia’s lead in legislating for plain packaging of cigarettes. New laws there should kick in by the end of the year, the Bill having recently received royal assent.

As was the case in Australia, the new packaging rules were bitterly fought by the big tobacco lobby, but it will nonetheless be illegal for cigarette packets to carry logos, promotional information, or branding.

Placing health warnings on individual cigarettes would be a leap further, but one that is being welcomed by health groups and anti-tobacco campaigners.

The Canadian Cancer Society praised the Health Minister’s comments on the individual warnings.

“The tobacco companies place the brand name and logos on the cigarette themselves, it’s a very good way to communicate with consumers,” said the society’s Rob Cunningham

“Under plain packaging, they will no longer be able to have that, so it is a great idea to have a health warning.”

Mr Cunningham suggested a single word like “cancer” or “emphysema” printed on a cigarette could be highly effective.

CHRIS JOHNSON

[Correspondence] The Hungarian government has made national health a priority: a reply

The Lancet’s recent Editorial entitled “Orbán not delivering health for Hungary” (April 21, p 1549)1 claims that the third re-election of Prime Minister Viktor Orbán and his party offers a “preview” for western countries of impending negative health consequences. The Editorial asserts that these are the kinds of consequences that ensue when governments “value populism and economic strength over the health of their people.”

Excellent choice for Excellence in Healthcare Award

The recipient of the AMA Excellence in Healthcare Award 2018 wants to know how she can use it to build greater awareness for a very worthy cause.

Professor Elizabeth Elliott AM FAHMS was presented with her award by outgoing AMA President, Dr Michael Gannon, at the AMA National Conference in Canberra in May.

Professor Elliott is a pioneer in research, clinical care, and advocacy for Fetal Alcohol Spectrum Disorder (FASD) and was named the winner of the AMA Excellence in Healthcare Award 2018 during the opening session of the Conference.

FASD is caused by prenatal alcohol exposure and is recognised as the leading preventable cause of prenatal brain injury, birth defects, and developmental and learning disability worldwide. There are lifelong consequences for children born from alcohol-exposed pregnancies.

The AMA Excellence in Healthcare Award is for an individual, not necessarily a doctor or AMA member, who has made a significant contribution to improving health or health care in Australia. The person may be involved in health awareness, health policy, or health delivery.

Professor Elliott was nominated for the award by the National Organisation for Fetal Alcohol Spectrum Disorder (NOFASD), the first and largest organisation dedicated to FASD in Australia.

Over the past 20 years, FASD has evolved from being a little-known, poorly recognised, and misunderstood condition to becoming a major strategic focus for Commonwealth and State Health Departments.

“I am really delighted to be acknowledged, but I really accept the award on behalf of all the children and families I work with, and of course a lot of dedicated clinicians,” she told Australian Medicine.

“I guess for me it’s particularly nice that the group that nominated me was the national organisation.

“I read something that said this was an opportunity to highlight this cause so I’m very keen to find out how to use the AMA network to raise awareness.

“We need to raise awareness of (1) the fact that are still lots of women who drink during their pregnancy not knowing they might harm their unborn child, and (2) there are lots of doctors who are very reluctant to ask pregnant mothers about their drinking.

“They don’t want to upset the doctor-patient relationship, and yet women tell us they want to be asked. They want clear advice. In fact many of them tell us they want to be told not to drink during pregnancy. They want a clear message from doctors.”

Professor Elliott is a Distinguished Professor in Paediatrics and Health at The University of Sydney School of Medicine and a NHMRC Practitioner Fellow. She has been a passionate advocate for raising awareness of FASD for more than 20 years.

In presenting her the award, Dr Gannon said Professor Elliott played a significant leadership role in developing the Australian Guide to the Diagnosis of FASD and online training modules, new clinical services, a national FASD website, and a national FASD register.

“She chaired the Australian Government’s National FASD Technical Network and is Co-Chair of the NHMRC Centre of Research Excellence in FASD, and Head of the NSW FASD Assessment service,” Dr Gannon said.

“She was lead clinician in the Lililwan study on FASD prevalence in the Fitzroy Valley and has published extensively on FASD.

“She contributed to WHO, NHMRC, and RACP alcohol guidelines and has been a keynote, invited, or scientific presenter at more than 300 conferences nationally and internationally.

“Professor Elliott is a true pioneer in the FASD field and has contributed to the development of Australia’s response to FASD, through addressing aspects of health policy, health care delivery, education, and health awareness in the work she has undertaken.

“However, FASD is only one component of Professor Elliott’s work, which includes disadvantaged children in Immigration detention, with rare disorders, and living in remote Australia.

“In 2008, she was made a Member of the Order of Australia (AM) for services to paediatrics and child health and, in 2017, she received the Howard Williams Medal from the Royal Australasian College of Physicians (RACP) – its highest award – for her contribution to paediatrics in Australia and New Zealand.

“Much of her work has been undertaken voluntarily, and has strengthened Australia’s health systems and their capacity to respond to FASD.

“Her efforts have improved health care services in FASD and changed health outcomes for children and families living with, and affected by, FASD.

“She is a worthy recipient of the AMA Excellence in Healthcare Award.”

CHRIS JOHNSON

APY Lands medical student awarded scholarship

A medical student who makes patient education films in Pitjantjara language, and who plans to provide health care to the people of Central Australia, is the recipient of the 2018 AMA Indigenous Medical Scholarship.

Pirpantji Rive-Nelson, from Alice Springs, is a final-year medical student at the University of Queensland. He is attending the Rural Medical School in Toowoomba and he plans to return to Central Australia to work as a clinician.

Outgoing AMA President Dr Michael Gannon presented Mr Rive-Nelson with the scholarship at the AMA National Conference in Canberra in May.

The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is seeking further donations and sponsorships from individuals and corporations to continue this important contribution to Indigenous health.

Mr Rive-Nelson told Australian Medicine he felt honoured to receive the scholarship.

“It’s great. It serves two purposes for me,” he said.

“It is a bit of a pat on the back for my efforts, in terms of medicine being quite a gruelling degree and you’re getting constant feedback and always told to improve in many areas.

“So it’s kind of nice to get a pat on the back and know that I’m on the right track. So that’s been great.

“And also to be given the opportunity to come down here to meet some of the bigger players in the medical community. That’s a bit of a treat.

“I think people where I am from will definitely notice it, but I don’t think people will understand the gravity of it and the fact that the AMA is the peak governing body for medicine in Australia. But people will recognise it as an achievement and will be very pleased to see it.

“At the end of the day it definitely bolsters my confidence in medicine in terms of keeping me on track.”

Upon receiving the award, Mr Rive-Nelson said his aspirations included a fulfilling and challenging career practising medicine in Alice Springs Hospital, inspiring youth of Central Australia to pursue health careers, and to take on leadership and advocacy roles within Central Australia and national health care organisations.

“Many Indigenous Australians of Central Australia do not speak English as a primary language, and seeking health care from the Alice Springs Hospital is a daunting experience,” Mr Rive-Nelson said.

“Therefore, I hope to actively assist Pitjantjatjara-speaking patients, and my colleagues, by being a clinician who is able to navigate both languages and cultures competently.”

Mr Rive-Nelson is also making short patient health education material in Pitjantjara language, including a YouTube video on kidney disease, which won an award from the University of Queensland.

Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.

Dr Gannon said Mr Rive-Nelson was a deserving recipient of the $10,000 a year Scholarship.

“Pirpantji Rive-Nelson is a respected member of the University of Queensland medical school, and of the tri-State region comprising the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, the Ngaanyatjarra Lands, and the Central Lands Council lands,” Dr Gannon said.

“He grew up in communities including Irrunytju, Pipalyatjara, and Kalka, and has been exposed to a traditional life that most young Indigenous people can only dream of.

“He is a Wati – a fully-initiated man – and many of his family are Ngangkari – traditional bush doctors. Pirpantji will be the first initiated Pitjantjatjara Wati to become a doctor in the Western medical model, and he will be able to collaborate with Ngangkari to share knowledge and better outcomes for the health of the Central Australian community.

“The significant gap in life expectancy between Indigenous and non-Indigenous Australians is a national disgrace that must be tackled by all levels of Government, the private and corporate sectors, and all segments of our community.

“Indigenous people are more likely to make and keep medical appointments when they are confident that they will be treated by someone who understands their culture, their language, and their unique circumstances. Mr Rive-Nelson is that person.”

CHRIS JOHNSON

More information is available at donate-indigenous-medical-scholarship

Mr Rive-Nelson’s kidney health video can be viewed at https://www.youtube.com/watch?v=cgIjvo0oQTo

AMA mourns the passing of Dr Bruce Shepherd

The AMA mourns the loss of Dr Bruce Shepherd AM, former President of the Federal AMA and AMA NSW, who passed away on May 25, aged 85.

Outgoing AMA President, Dr Michael Gannon, speaking from the AMA National Conference in Canberra, said Australia had lost a giant of medicine and health advocacy.

“Dr Bruce Shepherd put the AMA and medical politics on the map,” Dr Gannon said.

“His tireless advocacy and campaigning for doctors and patients in the Hawke Government years were legendary.

“Bruce played politics tough and without fear, but he was a man of deep compassion and a strong will to help the disadvantaged and needy, built on the foundation of doing the best possible for his two children who were born profoundly deaf.

“Bruce continued his medico-political advocacy beyond his AMA leadership years, founding the Australian Society of Orthopaedic Surgeons and the Australian Doctors’ Fund.

“His pride was The Shepherd Centre, which specialises in early intervention to help children who are deaf and hearing-impaired develop spoken language skills.

“Under Bruce’s guidance, The Shepherd Centre has become a world leader in its field.

“Not everybody agreed with Bruce Shepherd, but everybody respected him for speaking out for what he believed was best for doctors, their patients, and the health system.

“He leaves a significant legacy. He will be missed.”

The Shepherd family has requested donations be made to The Shepherd Centre in lieu of flowers via www.shepherdcentre.org.au/dr-bruce-shepherd-memoriam

JOHN FLANNERY

An obituary for Dr Shepherd will appear in the upcoming print edition of Australian Medicine.

GPs to retain access to MBS item 30202

Following representations from the AMA, it has now been confirmed by the Department of Health that GPs will not be precluded from accessing MBS item 30202.

In response to questions from the AMA, the DoH has stated that the MBS Taskforce response to the recommendations of the Dermatology, Allergy and Immunology Clinical Committee had been misreported in the Taskforce’s finding on the website. The reported change to MBS item 30202 would have seen GPs, the predominant users, excluded from claiming the cryotherapy item for removing malignant neoplasms.

The Clinical Committee recommended that the descriptor for MBS item 30202 be amended to replace “specialist” with “Australian Medical Council (AMC) recognised dermatologist”. It was also recommended that the Department of Health should monitor high-volume users to ensure that providers were requesting the appropriate pathology tests to confirm malignancy. At no point was it recommended that GPs be excluded from claiming the item.

However, the material that was released was inconsistent with this and suggested that the MBS Taskforce had recommended to Government that the descriptor be amended to restrict the use of this item to AMC recognised dermatologists and plastic surgeons to support appropriate use of the item and improve patient safety.

The DoH has now acknowledged the concerns raised by the AMA about the potential impact of the change and has confirmed an error was made during the publication of the taskforce’s findings. This will be corrected and amendments to the item descriptors will ensure GPs retain access to this item.

Many GPs, particularly those in rural areas, will be relieved that appropriate patient treatment will not have to be delayed for an unnecessary specialist referral.

MICHELLE GRYBAITIS

National alcohol strategy please

Australia has been without a current National Alcohol Strategy since 2011. In late 2017, the current draft of the National Alcohol Strategy 2018-2026 (NAS) was released for public consultation. The AMA developed a submission expressing frustration at both the time being taken to release the document, and the absence of tangible objectives and indicators. These concerns were echoed in the submissions of a number of other stakeholders.

Much of what is contained in the current draft of the NAS has been proposed in previous iterations of the NAS and related strategies, which appear to have been all but ignored, only to be replicated in the current draft.

The most frustrating example of this discord between the Government’s rhetoric and its actions is the exploration of tax reform. Alcohol taxation has been prime for reform for over a decade.

Former Treasury Secretary Ken Henry delivered a suite of recommendations as part of his strategic plan for Australia’s Future Tax System. Pertinently, he identified volumetric taxation as an effective mechanism for taxing alcohol and outlined a framework in which the revenue of alcohol taxation could be channelled back into initiatives which address the impact of alcohol-related harm. The Henry Tax Review was intended to guide tax reforms for the next decade. We are dangerously close to the end of that decade and one of its most valuable recommendations remains entirely unimplemented.

In 2006, the previous iteration of the NAS conceded that the logic behind volumetric taxation “is difficult to refute”. This is apt; it is difficult to refute. It is equally difficult to defend the failure of consecutive Governments to deliver this reform.

The current draft of the NAS, again, makes a very convincing case for the use of volumetric taxation as a means of curtailing alcohol-related harm, although it remains unlikely that these reforms will ever see the light of the Senate floor.

What drives the reluctance to implement such a simple, affordable, and, most importantly, effective, policy?

A clue can be found halfway through the consultation draft of the latest NAS. In almost the same breath that the World Health Organization’s summation that volumetric taxation is one of the “most efficient strategies to minimise the harmful use of alcohol” is acknowledged, the NAS goes on to stress that the known public health benefits of such measures must be balanced with “conflicting needs of disparate stakeholders”.

In other words, the profit margins of commercial alcohol producers are worthy of the same protection and consideration as the health of Australians.

Perhaps the most telling indication of the effectiveness of volumetric taxation is the reaction garnered by its appearance in the latest draft of the NAS. In response to this proposal, Brett Heffernan, CEO of the Brewers Association of Australia, described the draft NAS as “bereft of scientific rigour”.

Questionable as this may be, Heffernan is given an opportunity to convey these concerns directly to Health Minister Greg Hunt, who has invited stakeholders to participate in a forum to “collaboratively and collectively” work through issues identified with the NAS. Given the makeup of these stakeholders, it is hard to view this forum as anything other than an opportunity for producers to chip away at the already underdone recommendations put forward by the NAS.

It was only very recently that the Australian Institute of Health and Welfare released a report which identified alcohol and illicit drug use as causal factors in approximately 1 in 20 deaths in Australia. The alcohol industry will tell you proudly that both alcohol-related harm and alcohol consumption more broadly are on the decline in Australia. True as this may be, that is no reason to ignore evidence-based policies with the potential to achieve further reductions in the burden of this harm.

Next time you hear an alcohol lobbyist promulgating this type of argument, simply replace the word “alcohol” with “tobacco”, and you may find that these arguments immediately lose their substance.

GEORGIA BATH
AMA PUBLIC HEALTH POLICY ADVISER