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Preference: Government and politics

Excerpts from Treasurer Scott Morrison’s Budget Speech 2018-19

Our national economy is strengthening, but it is also true that the benefits are yet to reach everyone. This will take more time. That is why it is important to stick to our plan. There is more to do. We cannot take a stronger economy for granted. We live in a very competitive world. If we make the wrong calls, other countries will ‘cut our lunch’. There is a lot to gain and much to lose. We can’t ease off.

***

In this year’s Budget there are five things we must to do to further strengthen our economy to guarantee the essentials Australians rely on.

  1. Provide tax relief to encourage and reward working Australians and reduce cost pressures on households, including lowering electricity prices,
  2. Keep backing business to invest and create more jobs, especially small and medium sized businesses,
  3. Guarantee the essential services that Australians rely on, like Medicare, hospitals, schools and caring for older Australians,
  4. Keep Australians safe, with new investments to secure our borders, and, as always,
  5. Ensure that the Government lives within its means, keeping spending and taxes under control.

That’s our plan.

***

Tonight we announce a new 21st century medical industry plan to create more jobs in this fast growing sector of our economy. The health sector represents 7 per cent of our economy and 14 per cent of jobs. Our plan will provide more support for medical research projects, new diagnostic tools, clinical trials of new drugs, scientific collaboration, and development of new medical technologies that can be sold overseas. In particular we will back in Australian medical scientists through the largest single investment of the Medical Research Future Fund to date of $500 million over ten years for Australia to become a world leader in genomic research. This is about building another strong and competitive industry in Australia that will generate income and jobs, from the white coats in the labs to the workers making new medical devices on the shop floor.

***

In rural and regional areas we have funded a plan to get more doctors to where they are needed through a new workforce incentive program. This plan includes the establishment of a new network of five regional medical schools within the broader Murray Darling Region. And we have moved to guarantee rural and remote access to dental, mental health and emergency medical services through increased financial support for the Royal Flying Doctor Service. Indigenous Australians also benefit from our $550 million commitment to address remote housing needs in the Northern Territory and $1.7 billion through our primary health care model. Our veteran centric reform package will continue with a planned additional $112 million in this Budget, as will our support for ongoing veterans’ mental health and employment initiatives. Finally, every dollar and every cent committed to delivering the National Disability Insurance Scheme remains in place and always will.

***

Our new five year hospitals agreement, which is being signed onto by the States and Territories, will deliver $30 billion in additional funding, a one third increase over the previous five years. And following last year’s Budget, funding for Medicare and the Pharmaceutical Benefits Scheme or PBS has been guaranteed in legislation. This Budget includes an extra $1.4 billion for listings on the PBS, including medicines to treat spinal muscular atrophy, breast cancer, refractory multiple myeloma, and relapsing-remitting multiple sclerosis, as well as a new medicine to prevent HIV. Lifeline Australia will receive additional support as will funding for Mental Health Research, with $125 million over 10 years from the Medical Research Future Fund.

The Government will also provide $20.9 million to support parents and infants by funding tests for new conditions and ensure that debilitating conditions are picked up at the earliest opportunity. The Government will provide $154 million to promote active and healthy living, including $83 million to improve existing community sport facilities, and to expand support for the Sporting Schools and Local Sporting Champions programs.

***

Just because you are getting older does not mean you should have to surrender your dignity or your choices. We’re living longer. It’s a good thing. We want to preserve and increase the choices of older Australians. To support the choice of older Australians who wish to stay at home and avoid going into residential aged care the Government will be increasing the number of home care places by 14,000 over 4 years at a cost of $1.6 billion. By 2021-22, over 74,000 high level home care places will be available, an increase of 86 per cent on 2017-18. We will also be providing $146 million to improve access to aged care services in rural, regional and remote Australia. We will also provide $83 million for increased support for mental health services in residential aged care facilities, especially to combat depression and loneliness.

 

Budget’s rural health initiatives from medical students’ viewpoint

AMSA Rural Health (Australian Medical Students’ Association rural health division) welcomes the rural health workforce measures outlined in the 2018-19 Federal Budget, but meets the announcement of a new medical school network with cautious optimism.  

The $83.3 million Stronger Rural Health Strategy to address access to medical care by rural and regional Australians is an important step towards health equity in rural and regional Australia.

Murray Darling Medical School Network

The announcement of the Murray Darling Medical School Network, accompanied by $95.4M in funding, represents a welcome focus on rural medical education. However, AMSA Rural questions what the network means for overall medical student numbers, and the impact it will have on rural health workforce shortages.

“While there will be no new Commonwealth Supported Places (CSPs), the inclusion of two more universities within the network – Charles Sturt and La Trobe – means the existing universities will replace redistributed places with full fee-paying places. We are concerned the introduction of a new school in Orange that has been allocated 30 of the existing CSP will open the door to future increases in student numbers,” said AMSA Rural Co-Chair Nic Batten.

“The overall number of medical students will increase as these universities will replace lost income by recruiting more international students, which will only worsen the oversupply of medical graduates and bottlenecks in further training,” said AMSA Rural Co-Chair, Gaby Bolton.

“In Victoria alone there will be 100 more graduating doctors than internship places for 2019, and most of those missing out will be Australian trained international students. It is unethical to continue to encourage international students to study in Australia if they will be unable to work here as doctors after graduation – this loophole must be closed,” said Ms Bolton.

All sites in the network – Bendigo, Albury-Wodonga, Shepparton, Wagga Wagga, Orange, and Dubbo – already teach medical students within Rural Clinical Schools. However, the funds for the network will allow expansion of existing infrastructure to enable end-to-end rural medical school training.

“We hope that the network model translates into more doctors committed to rural practice, and that the university partnerships involved will enable greater recruitment of and support for students of rural background to study medicine,” said Ms Batten.

“While we welcome the network model over a large new stand-alone medical school, these funds could be better spent in addressing the issue of too few vocational training spots for doctors who want to work, train and live in rural and regional areas, and are currently forced to return to metro areas to complete specialty training.”

Junior Doctor Training Program

The Junior Doctor Training Program, which includes an increase of 300 rural places for junior doctors, represents the beginning of a clear pathway for rural practice. Details, including a possible expansion of internship rotations in rural general practice, are yet to be outlined.

“For medical students wanting to practice in rural areas, and particularly those who aim for careers in rural generalism, this is an invaluable program,” Ms Bolton said.  

Ms Batten said: “PGY1-3 is where many doctors who have trained in Rural Clinical Schools are lost to metro hospitals. This initiative will help stem this barrier to rural practice.”

Rural Generalism

AMSA Rural is pleased to see commitment to the National Rural Generalist Pathway with 100 additional vocational training places to be administered by Australian GP Training (AGPT), beginning in 2021. This comes off the back of a historical agreement between RACGP and ACRRM earlier in the year, facilitated by the Rural Health Commissioner Professor Paul Worley.

“We are excited to see this measure devoted to addressing rural training pathways.  Many of our members are keen to work in this area, so this is will be a great step to increase the number of rural doctors,” said Ms Bolton.  

“While we would have liked to see more funding towards the National Rural Generalist Pathway, this is an important move towards increasing the number of rural GPs, and recognises the special skill-set required of doctors working in rural and remote areas,” said Ms Batten.

Rural Specialty Training

In comparison to funding for rural generalism training places, no announcement was made of an expansion of the Specialty Training Program. AMSA Rural hopes the release of further information after the Budget will include support for specialty training within the Regional Training Hubs.

“Access to further rural opportunities for specialty training is key to retention of these doctors in rural and regional areas. This will help to address the maldistribution of certain specialities as well as provide necessary additional specialty training places,” Ms Batten said.

Bonding

AMSA Rural Health welcomes the changes relating to rural bonding contracts.

“The return of service obligations have not been fulfilled by many rural bonding contract holders, and have only damaged perceptions of living and working within rural communities,” said Ms Batten.

“Bonding contracts have not been administered in a way which encourages doctors to fulfil their obligations to work in a rural location,” Ms Bolton said.

“The changes announced in the Budget will provide a flexibility around training that will encourage more doctors to complete their return of service and work in a rural location.”

Summary

AMSA Rural enthusiastically supports the changes to rural bonding and the opportunities presented by the Junior Doctor Training Program and the National Rural Generalist Pathway. Whilst the MDMS network may represent an expensive mis-step in addressing rural health workforce shortages, with funds better spent on rural Specialty Training Places, the announcement of better targeting, monitoring and planning for future rural workforce needs is encouraging. Overall, AMSA Rural welcomes the government’s renewed focus on health equity for rural and regional communities, and looks forward to hearing more details of the Stronger Rural Health Strategy.

CANDICE DAY
VICE CHAIR AMSA RURAL HEALTH

 

PIC: AMSA’s Candice Day, Joel Selby, Alex Farrell (Pres) and Victoria Cook (Vice Pres) with Dr Bill Glasson (former AMA Pres), Dr Michael Gannon (AMA Pres) and Dr Tony Bartone (AMA Vice Pres) on Budget night.

Budget 2018: who are the winners in health?

 

The federal budget was a mixed bag for the health sector, but it delivered significant wins for aged care, rural health and medical research.

Treasurer Scott Morrison announced $1.6 billion over four years to allow 14,000 more elderly Australians to continue living in their home with extra in-home care places. This follows the 6,000 extra places already announced in December. However, given that there are more than 100,000 people on the waiting list for in-home care, the new places are “welcome, but are a drop in the ocean”, according to Associate Professor Helen Dickinson of the Public Research Group at UNSW.

Morrison also announced a $146 million plan to improve access to aged care service in rural areas and $83 million to support mental health services in residential care.

Meanwhile, an $83.3 million rural health strategy aims to place more doctors and healthcare professionals in rural areas, and includes a project to train an extra 100 GPs for work in rural areas.

The other big winner in terms of funding is medical research. The government has allocated $1.3 billion over ten years for a National Health and Medical Industry Growth Plan, including $500 for genomics research.

Here are some other health takeaways from the 2018 Budget:

  • No rise in the Medicare levy

An $8 billion rise in the Medicare levy to fund the NDIS had been originally pencilled in, but Scott Morrison backed away from the plan last month.

  • Fewer IMGs allowed to work in Australia

The government will allow 200 fewer international medical graduates into the country than previously planned, capping the yearly intake at 2,100 new IMGs. The government says this will save money, as Australian junior doctors who will take the place of the IMGs are paid at a lower rate.

IMGs will also be hit by a reduction in MBS fees paid to them, in order to fund a network of new rural medical schools in the Murray-Darling basin.

  • Extra money for PBS listings

The government is providing an additional $2.4 billion for new PBS listings and there will also be several new Medicare rebate numbers. These include a $400 rebate for prostate MRI, which urologists have been calling for for some time. There will also be a $114 rebate for 3D breast cancer scans. Around $700 million has been budgeted for the breast cancer drug ribociclib and the spinal muscular atrophy treatment nusinersen will also be subsidised for the first time.

On the other hand, there will no longer be rebates for MRI knee scans for patients over 55, for some sleep studies, or for spinal fusion to treat chronic low back pain.

  • Extra money for WA hospitals

Western Australian hospitals will get a $180 million funding boost, which will be directed to the Joondalup health campus, an expansion for the Osborne Park Hospital and the refurbishment of Royal Perth Hospital.

But there will be no new money for public hospitals in other states.

  • Free whooping cough vaccines for mums

The pertussis vaccine will be added to the National Immunisation Schedule for all expectant mothers, a measure expected to cost around $40 million.

  • Funds for Flying Doctors mental health outreach

The government will provide $84 million in funding to provide mental health nurses for remote and rural areas.

  • New funds for rare diseases

An extra $240 million will be allocated for clinical trials for rare cancers, rare diseases and diseases with unmet needs.

  • Measures to encourage use of generic drugs

New prescription software will enable prescribing of generics by default, with doctors having to manually override the system if they want to prescribe a branded drug. The measure is expected to shave $335 million from the budget.

Health Budget safe and steady

The AMA has labelled the 2018-19 Health Budget as “safe and steady”, but adds that it is notable as much for what is not to be found in it as it is for what is included.

Treasurer Scott Morrison has delivered a Federal Budget with an eye on the next federal election, promising tax relief for middle Australia, significant infrastructure investment and more funding for aged care.

On the health front, the establishment of a new 21st century medical industry plan to create more jobs and support more medical research projects is a major commitment.

This Budget includes an extra $1.4 billion for listings on the PBS, including medicines to treat spinal muscular atrophy, breast cancer, refractory multiple myeloma, and relapsing-remitting multiple sclerosis, as well as a new medicine to prevent HIV.

The Government will also provide $154 million to promote active and healthy living, including $83 million to improve existing community sport facilities, and to expand support for the Sporting Schools and Local Sporting Champions programs.

It has dismissed a proposal for a single and separate Murray Darling Medical School, in favour of a network, in what Dr Gannon has described as a better approach 

Mr Morrison said the plan was to get more doctors to where they are needed through a new workforce incentive program.

“This plan includes the establishment of a new network of five regional medical schools within the broader Murray Darling Region,” Mr Morrison said when delivering his Budget Address to Parliament on Tuesday.

Dr Gannon said many of the rural health initiatives outlined Budget are a direct response to AMA rural health policies and the AMA Budget Submission.

“We welcome the Government’s strong focus in this Budget on improving access to doctors in underserviced communities, particularly rural Australia,” Dr Gannon said.

“The evidence shows that selecting medical students with a rural background and providing high quality training in rural areas are the most effective policy measures to address workforce maldistribution.

“The decision to reject the proposal for a stand-alone Murray Darling Medical School, in favour of a network, is a better approach with the Government instead pursuing a policy that builds on existing infrastructure to create end-to-end medical school programs.

“However, while the Government has made a welcome commitment not to increase Commonwealth-supported medical school places, it has taken the unnecessary step of compensating medical schools with additional overseas full-fee paying places.

“This will not address community need, and instead simply waste precious resources.”

Dr Gannon said overall, the Government had delivered a safe and steady Health Budget, which outlines a broad range of initiatives across the health portfolio.

Necessary funding to aged care, mental health, rural health, the PBS, and medical research, were all welcome commitments.

“But some of the bigger reforms and the biggest challenges are yet to come,” he said.

“Due to a number of ongoing major reviews, this Budget is notable as much for what is not in it as for what is in it.

“The major reviews of the Medicare Benefits Schedule (MBS) and private health are not yet finalised, and the ensuing policies will be significant.

“We are pleased that indexation has been restored to general practice and other specialty consultations, but new and considerable investment in general practice is missing.

“Also, the signature primary care reform – Health Care Homes – did not rate a mention.”

Dr Gannon said the AMA supports the establishment of the Workforce Incentive Program, which will incorporate and expand on the existing Practice Nurse Incentive Program and the GP Rural Incentive Program.

“This new funding program will increase the support available for general practices to employ other health professionals, including non-dispensing pharmacists, as part of a GP-led team-based approach to care,” he said

“Good health policy is an investment, not a cost,” Dr Gannon said.

“We look forward to the finalisation of the private health and MBS reviews, and the reforms that will flow from those processes.

“We anticipate more significant health policy funding announcements ahead of the next election.”

CHRIS JOHNSON

 

 

 

 

 

 

 

[Comment] Offline: A Caribbean consciousness

The word Windrush now defines the shame of a nation, a nation that once courted, welcomed, and put to work Caribbean migrants to fill shortages in Britain’s labour market after World War 2. The cold expediency of modern British politics, the racist nationalism of today’s England, and the angry isolationism of Brexiteers have combined to foster a bitterly hostile environment for anyone with a skin colour or accent deemed outside populist boundaries of acceptability. The British colonialist state expropriated riches from those it occupied to build an inglorious Empire.

New Secretary General announced

The AMA has appointed Dr Michael Schaper as its next Secretary General.

Dr Schaper will take up the position in late July. He will replace Anne Trimmer, who will leave the AMA in August at the completion of her five-year term.

Dr Schaper will join the AMA from his current position as Deputy Chairman of the Australian Competition and Consumer Commission (ACCC), a position he has held since 2008.

AMA President Dr Michael Gannon said the AMA Federal Council and AMA Board were delighted to secure the services of Dr Schaper, who has considerable background and experience in business, government, and academia.

“Dr Schaper is exceptionally qualified and very highly regarded across a number of peak sectors in the Australian community,” Dr Gannon said.

“His intimate knowledge of the workings of government, business, and the tertiary education sector makes him the ideal leader for our talented and hardworking Secretariat in Canberra.

“The interests and concerns of AMA members, the medical profession, and every Australian who has contact with the health system will remain in very capable hands,” Dr Gannon said.

Chair of the AMA Board Dr Iain Dunlop, who oversaw the national recruitment process, said Dr Schaper’s business background will be invaluable for the Association.

“Like all member organisations, the AMA needs a solid financial base upon which to embark on its vital policy and advocacy activities,” Dr Dunlop said.

“Michael’s impeccable inside knowledge of politics, government, regulation, and the business world will ensure that the AMA’s reputation as one of the nation’s most successful lobby groups is preserved.”

Dr Schaper has a PhD in Management and a Master in Commerce, both from Curtin University. 

He has chaired or served on a number of Ministerial advisory committees, and been an adviser to various State and Federal Ministers and Members of Parliament, including the Cabinet Office of the Western Australian Government and the office of a previous Federal Treasurer.

As a manager, he has been the head of both the Bond University and Murdoch University business schools, CEO of a community business advisory centre, and was the Small Business Commissioner for the Australian Capital Territory.

JOHN FLANNERY

AMA House a perfect location for headquarters

AMA House was constructed throughout 1990 on a special 99-year lease block on the edge of what is known as the Parliamentary Triangle in Canberra.

The Parliamentary Triangle is the largely ceremonial precinct in the nation’s capital and straddles the part of Lake Burley Griffin where some of Australia’s most significant institutional buildings find their home on its banks.

The High Court, the National Gallery, the National Library, the National Science and Technology Centre (Questacon), the National Archives, the Treasury, Old Parliament House and, of course, Parliament House are all located in the Triangle – as is the Aboriginal Tent Embassy and Reconciliation Place.

Other Federal Government departments are also located either inside or close to the Triangle, with a smaller triangle within the precinct known as the Parliamentary Zone on the lake’s southern shore.

AMA House is located on the edges of the Triangle’s official boundary and within close walking distance to Parliament House.

It was a longstanding ambition of the AMA to have a national headquarters in Canberra.

The Federal Secretariat at that time had been working out of a building in Sydney owned since 1924 by the Australasian Medical Publishing Company (AMPCo, publisher of the MJA), but which was sold in 1989 to The University of Sydney.

During the construction period, Federal Secretariat staff occupied an office in Queanbeyan, on the NSW-ACT border just a few kilometres from where the organisation’s new home was being built.

During this period, the AMA also adopted a new national logo and launched a new national journal, Australian Medicine (this publication).

On March 7, 1991, AMA House was officially opened in Canberra by the highly esteemed biologist Professor Sir Gustav Nossal, who was/is also an AMA member.

At the time of its opening, Dr Bruce Shepherd was the AMA Federal President and Allan Passmore the Secretary General.

Once in its new home, the Federal Secretariat quickly created AMA departments with expertise in general practice, medical fees and medical insurance, public relations and communications, public health and hospital and health funding.

Staff for the most part were all located on the third and fourth (top) floors of the building.

In recent years, housing of staff was reduced exclusively to the fourth floor, with the third floor used for membership workshops and meetings of the Federal Council.

Offices were leased out to other organisations and businesses on the remaining floors.

With the sale of AMA House, the organisation retains naming rights and the exclusive lease of the fourth floor.

CHRIS JOHNSON

Pic: AMA House under construction. 

 

 

[Comment] Canada’s efforts to ensure the health and wellbeing of Indigenous peoples

In September, 2017, Prime Minister Justin Trudeau stood before the UN General Assembly and acknowledged that the “failure of successive Canadian governments to respect the rights of Indigenous peoples in Canada is our great shame.”1 For generations, First Nations, Inuit, and Métis peoples in Canada were denied the right to self-determination and subjected to laws, policies, and practices based on domination and assimilation. Indigenous peoples lost control over their own lives.

[Department of Error] Department of Error

Das P, Horton R. Pollution, health, and the planet: time for decisive action. Lancet 2018; 391: 407–08—In the acknowledgments section of this Comment (published online first on Oct 19, 2017), the Governments of Germany, Norway, and Sweden should have been thanked for their “funding of the report, input, or both”. This correction has been made to the online version as of April 10, 2018.