AMA rebuffs Deputy PM’s call for more regional medical schools

The AMA has again stressed to the Federal Government that establishing more regional medical schools is not the answer to attracting doctors to rural Australia.

It follows Deputy Prime Minister and Nationals Leader Michael McCormack’s comments (while serving as the Acting Prime Minister) that a new regional medical school would help address the doctor shortage in the bush.

He urged his parliamentary colleagues, and especially those in the Nationals Party, to continue fighting for more regional doctors and medical schools.

“I am a big believer in rural medical schools, which will address the maldistribution of doctors,” Mr McCormack said during an address to the National Press Club in April.

“As the Nationals leader, I believe medical schools should happen.”

But AMA Vice President Dr Tony Bartone said the message didn’t seem to be getting through to the Government that regional medical schools were not the answer.

“This is not the way you try and get good-quality doctors into rural and regional Australia,” Dr Bartone said.

“We continue to pour out doctors, but we don’t have a sustainable, robust training solution to allow them to develop their capabilities.

“It’s those postgraduate training positions which are the bottlenecks, the major barrier.”

Dr Bartone said accepting more medical students from rural backgrounds and then giving those graduates rural training places was the key to the issue.

“You need to have students from a rural background, trained in a rural background and given the opportunity to develop their career in a rural background,” he said.

“The ball is firmly in the Government’s court and it is not a question of simply shifting a gear and hoping that if we produce enough medical students eventually some will sift through to rural and regional.”

CHRIS JOHNSON

Government orders nursing homes to offer staff flu shots

Aged-care homes must offer their staff a flu vaccination this year, following orders from the Federal Government.

Aged Care Minister Ken Wyatt announced the new immunisation policy late in April, in the lead-up to what is expected to be another dangerous flu season this winter.

Last year, more than 1000 people, mostly aged over 65, died from influenza-related complications.

In announcing the new move, Mr Wyatt said only 91 of 2600 aged-care facilities provided the acceptable level of vaccination rates last year.

He said the Government has had to step in with stricter rules in order to try and prevent a repeat in nursing home flu deaths this year.

Workers in aged-care facilities can’t be forced to be vaccinated, but it will be compulsory for their employers to offer the shots.

“What right does a senior, frail Australian have to be protected from someone who chooses not to (get vaccinated) and then ends up with a virulent flu that then causes their death?” Mr Wyatt said.

“There will be some individuals who will take a stand but, then again, that is up to the provider to make a decision in respect to that individual. They can move staff to other locations.”

The Government’s stipulation is that a vaccination rate of 95 per cent is needed among nursing home staff, but very few maintain that level.

The Minister also asked family and friends visiting nursing homes to get flu shots as well.

CHRIS JOHNSON

Mapping the cost of health-related work incapacity

A Federal Government statutory authority is releasing new research that estimates the scale and cost of health-related work incapacity in Australia. And it looks at opportunities to improve the situation.

Comcare, the Government’s compensation insurer and work health and safety regulator, late last year established an innovative public-private initiative known as the Collaborative Partnership to Improve Work Participation.

It is focused on aligning the various sectors of Australia’s work disability system to deliver better outcomes for people with temporary or permanent physical or mental health conditions.

The Partnership includes the Australasian Faculty of Occupational and Environmental Medicine (AFOEM), the Departments of Social Services and Jobs and Small Business, the ACTU, the Insurance Council of Australia, insurer EML and experts Lucy Brogden, Chair of the National Mental Health Commission, and consulting Professor Niki Ellis.

AFOEM is leading work to strengthen the role of GPs in improving return to work outcomes for injured and ill workers – including helping GPs prescribe work as part of recovery.

Through a range of projects, the Partnership is working across sectors including workers’ compensation, life insurance, superannuation, disability support and employment services to improve disability employment and return to work rates for people experiencing work incapacity through illness and injury.

It is also the first time all the major compensation and benefit systems have been examined together to identify the flow of people through them, how the systems interact, and where they can be improved to deliver better health and productivity outcomes.

The Partnership commissioned Monash University to undertake the research. The resulting report The Cross Sector Project Mapping Australian Systems of Income Support for People with Health-Related Work Incapacity is now being released.

The study considered data and services across the systems that support people to work – workers’ compensation, disability support, veterans’ compensation, superannuation, life insurance and motor accident compensation.

Among other things, the study found that 786,000 Australians who were unable to work due to ill health, injury or disability received some form of income support in 2015-16.

Also, about $18 billion was spent on some form of income support in that year.

This research sheds new light on how many Australians have health conditions that impact their ability to work, and the cost for employers, Government and insurers. The numbers include 155,000 people in workers’ compensation and 469,000 people in social security.

Researchers also produced a conceptual map of Australia’s income support systems, showing the volumes of people, the types of income support they receive and how they might move through the various systems.

“These findings mark the first step in establishing an evidence base in a critical area of public health and social policy,” Comcare CEO Jennifer Taylor said.

“It gives us a basis for improving Australia’s service delivery model for supporting people with work-related injury or disability in their return to work.

“Australia’s benefit and compensation systems are siloed and operate with little reference to each other. There’s growing recognition that what happens in one system impacts others, and the costs often just shift between the systems.

“Considering the sectors as a whole rather than as independent systems will lead to a better understanding of how they operate in relation to each other, how they connect and where gaps or tensions exist.

“It’s clear that taking a cross-system view and a collaborative approach gives us a platform to design and trial new service offerings. We have significant opportunities to improve health and productivity for a very large number of working age Australians.”

Monash University’s Insurance Work and Health Group, led by Professor Alex Collie, was asked to develop a high-level system map of the current Australian service delivery model for supporting people with a work-related injury or disability in their return to work. The project also analysed and mapped system-related data and data gaps.

The project scope included investigating five categories of services: return to work services; healthcare and treatment; job finding or employment services; functional support services; and case management services.

The Monash team mapped 10 major systems of income support in Australia: employer provided entitlements; workers’ compensation (short tail and long tail schemes); motor vehicle accident compensation (lump sum and statutory benefits); life insurance (income protection and total and permanent disability schemes); defence and veterans’ compensation and pensions; superannuation; and social security.

The report estimated the number of people accessing income support and associated costs from each of the systems during 2015-16 and identified opportunities for improvements in the various systems.

Potential improvements include information and data sharing to provide greater understanding of the systems of income support; and better aligning service models – particularly through reforming GP certification and work capacity assessment – to reduce overlap and improve service delivery.

The Collaborative Partnership is considering these recommendations and working towards addressing the opportunities for change. Members are already examining ways to improve data sharing between the various compensation and benefit systems to get a better understanding of how they interact and how they can work together more effectively.

CHRIS JOHNSON

The Cross Sector Project report can be found on the Partnership’s website: http://www.comcare.gov.au/collaborativepartnership

PICTURE: Comcare CEO Jennifer Taylor launching the Collaborative Partnership to Improve Work Participation.

Doctors and nurses not happy in Zimbabwe

Doctors and nurses are involved in a drawn out and ugly industrial dispute in Zimbabwe, resulting in more than 16,000 nurses being sacked by the African nation’s new Government.

The nurses were striking over pay and conditions. Junior doctors had only just finished their month-long walk-out over the same issues.

But as the Government tries to hush up the dispute while it heads into its first elections since the ousting of Robert Mugagbe, reports have leaked that the striking nurses were sacked on mass.

Vice President Constantino Chiwenga subsequently confirmed the sackings, accusing the nurses of staging a politically motivated strike. While he said they would be replaced, the nurses’ union has described the Government’s move as a stunt and is considering its response.

Doctors there are now also considering their next move.

CHRIS JOHNSON

Government drops Medicare levy rise ahead of Federal Budget

The Government has scrapped its plans to increase the Medicare levy 0.5 per cent, despite having earlier said it needed the extra money it would raise in order to fully fund the National Disability Insurance Scheme.

Following last year’s budget, legislation was introduced in August for the levy hike, with the Government insisting it was needed in order to fund a $57 billion NDIS shortfall.

But on April 26 this year, just 12 days before handing down the Federal Budget in May, Treasurer Scott Morrison announced a reversal and explained the reasoning behind the decision.

He said the Australian economy was in a better than anticipated position.

“Our economy is finally shaking off the dulling effects of the downturn in the mining investment boom,” Mr Morrison told a business conference.

He suggested the Government was now confident that more revenue from economic growth will fund the NDIS and pay for the assistance scheme 440,000 disabled Australians are depending on.

The move adds to rising speculation that the budget is going to be kind to taxpayers and therefore an election primer.

“Over the last 15 months or so we have seen the economy improving,” Mr Morrison told Network Nine.

“Over the early part of this year and the latter part of last year we started to see the tax collections that were coming from companies doing better, come into the coffers, we could have greater confidence about revenues into the future.

“As this continued to confirm as we prepared the budget, it’s clear we no longer have to do this. I’m pleased as punch we don’t have to do it and pleased as punch for people with disabilities.”

The Opposition has claimed a win, saying the Government was only dropping the levy hike due to pressure from Labor.

But it will now scrap plans of its own to impose the increase on Australians earning more than $87,000.

Shadow Treasurer Chris Bowen said it was Labor’s refusal to support the Government’s intended rise that has killed it.

“I welcome the fact that finally Malcolm Turnbull and Scott Morrison are dropping this tax increase on Australians,” Mr Bowen said.
“They never should have proposed it in the first place.
“The Government now having dropped the Medicare levy increase, of course we no longer need to proceed with that effort of compromise for those above $87,000.
“It was simply the Labor Party proposing to meet the Government in the middle.”
AMA President Dr Michael Gannon said he didn’t care where the money came from, but wants to see bipartisan political support for the NDIS funding model.
“Australians with a disability don’t deserve to be political footballs,” Dr Gannon said.
“Australians with a disability are deserving of this ambitious scheme, but if it’s not fully funded, then there’s concerns about its future.
“We want this ambitious, fabulous program fully funded and reliably funded. It’s not our job to tell Governments how to fund it, but what we will say is Australian families need that certainty.”

CHRIS JOHNSON

[Editorial] Orban not delivering health for Hungary

Viktor Orban’s re-election to a third consecutive term in Hungary offers a preview for western countries of what the health consequences could be for governments that value populism and economic strength over the health of their people. The controversial populist was swept back into power by a wave of support, with a manifesto that included a crackdown on liberal non-governmental organisations. Orban said before the election that his opponents will face “moral, political, and legal revenge”, in the aftermath.

[Comment] The social sciences, humanities, and health

Humanities and social sciences have had many positive influences on health experiences, care, and expenditure. These include on self-management for diabetes, provision of psychological therapy, handwashing, hospital checklists, the Scottish Government’s stroke guidelines, England’s tobacco control strategy, the response to the Ebola outbreak in west Africa and Zika virus in Brazil, and many more.1 Researchers have shown time and time again the political, practical, economic, and civic value of education and research in disciplines like anthropology, history, and philosophy.

AMA welcomes ice inquiry report

The Joint Parliamentary Committee Inquiry on Law Enforcement has released its Inquiry into Crystal Methamphetamine (ice) Report.

It has recognised drug and alcohol addiction to be a serious illness and should be treated as such.

The AMA has welcomed the findings, which also state that demand for drug and alcohol treatment services often outweighs capacity.

And there is a need to tailor services to suit a variety of needs, including post care services.

The importance of accountability for those bodies who fund alcohol and drug treatment services was also stressed, as was the need to rebalance funding across the National Drug Strategy.

AMA President Dr Michael Gannon said the AMA believes that any substance dependence is a serious health condition, and that those impacted should be treated like other patients with serious illness and be offered the best available treatments and supports to recover.

“We welcome the recommendations that recognise the stigma associated with addiction, and seek to increase compassionate responses, including media reporting,” Dr Gannon said.

“This is essential if we are going to encourage people to seek treatment.”

The release of the report also serves as a timely reminder of the statement made by the Head of the National Ice Taskforce, Ken Ley: “That we cannot arrest our way out of the problem.”

The AMA supports the recommendations to monitor and ultimately reduce the time take for people to access appropriate treatment. It is also great that the importance of pre- and post- care is recognised.

“The AMA is particularly pleased to see the recommendation that the Department of Health work with Primary Health Networks (PHNs) to improve their tender processes for drug and alcohol treatment,” Dr Gannon said.

“We believe that the PHNs must be accountable for the services, wait times and the quality of the drug and alcohol treatment services provided in their jurisdictions.”

The approach (established under the National Ice Action Plan) is new and the capacity of PHNs to oversee the effective and equitable delivery of drug and alcohol treatment services is yet to be fully established.

The report recognises the importance of culturally and linguistically appropriate drug and alcohol treatment for Aboriginal and Torres Strait Islander people. This work should include efforts to increase the Aboriginal and Torres Strait Islander drug and alcohol workforce, it noted.

The report contains a recommendation to collect data on the use of illicit drugs in correctional facilities which will provide some valuable insights, but it is vitally important that rehabilitation and treatment services are available to those people who are in the corrections system noting drug and alcohol addiction is often a key contributor to incarceration.

“We must also recognise the link between mental health and addiction, and the report misses an important opportunity reiterate this and advocate for increased linkages between the sectors,” Dr Gannon said.

“The Inquiry Report is certainly on the right track in many areas relating to drug and alcohol addiction.

“This is in stark contrast to the Government’s current efforts to pass legislation (Social Services Legislation Amendment Drug Testing Trial Bill 2018) that will drug test welfare recipients.

“This punitive measure will increase the stigma associated with drug addiction, and is not supported by evidence. The reality is that it will increase the demand for drug treatment services that are clearly under significant pressure. Throwing money at the trial sites won’t fix the problem.”

The AMA encourages Social Services Minister Dan Tehan to read the Inquiry report to better understand the problems in the sector, and withdraw the random drug testing proposal until such time that we can improve the capacity of the sector to meet demand for drug treatment.

“We must not do anything to increase the delays for those individuals actively seeking treatment,” Dr Gannon said.

“Referring those who test positive under the welfare trial will do this.”

The AMA Submission to the Joint Parliamentary Committee on Law Enforcement Inquiry into crystal methamphetamine can be found at: submission/ama-submission-joint-parliamentary-committee-law-enforcement-%E2%80%93-inquiry-crystal

The AMA Submission to the Senate Community Affairs Legislation Committee’s Inquiry into the Social Services Legislation Amendment (Welfare Reform) Bill 2017 can be found at: submission/ama-submission-senate-community-affairs-legislation-committees-inquiry-social-services

AMA Position Statement on Methamphetamine can be found at: position-statement/methamphetamine-2015

AMA Position Statement on Harmful substance abuse, dependence and behavioural addiction can be found at: position-statement/harmful-substance-use-dependence-and-behavioural-addiction-addiction-2017

CHRIS JOHNSON

Tuberculosis continues to threaten regional health security

During a World Tuberculosis Day speech delivered in the Senate in March, International Development Minister Concetta Fierravanti-Wells sought to highlight the devastating outcomes tuberculosis is still having globally, including in Australia’s region.

TB is the world’s top infectious disease killer. In 2016, 1.7 million people died from TB – almost 4,700 each day.

Twelve of the world’s 30 highest TB burden countries are located in our region, accounting for nearly half of all cases of drug-resistant TB and TB deaths worldwide.

“Turning the page on TB – once and for all” is a Federal Government priority, Senator Fierravanti-Wells said.

In the 12 months to December last year, there were 10 million movements out of Australia. Two million Australians visited Pacific island countries and Oceania and another 3.1 million Australians visited South-East Asian countries.

“Thirty highest TB-burden countries are located in our region and account for nearly half of all cases of drug-resistant TB and TB deaths worldwide,” the Minister said.

“Papua New Guinea, which is four kilometres to our north, has a major TB problem and, in particular, a drug-resistant TB problem. That not only puts PNG at risk; it also puts Australians at risk.”

In 2014, Australia’s National Notifiable Diseases Surveillance System received 1,339 TB notifications, representing a rate of 5.7 per 100,000 population

However, the Department of Health notes Australia’s overseas-born population continued to represent the majority (86 per cent) of TB notifications and Australia’s Aboriginal and Torres Strait Islander population continue to record TB rates about six times higher than the Australian born non-Indigenous population.

The Department estimates the cost of treating a single patient with drug resistant TB can be up to $260,000 in Australia.

“TB not only affects individuals, but it also cripples communities; disrupts tourism, trade and investment and sets back regional economic growth and development,” Senator Fierravanti-Wells said.

The Minister said that in June last year, the Government announced a new partnership with the World Bank, targeting drug resistant TB in vulnerable communities in PNG.

Another way that Australia is contributing to the fight to end TB is through research.

With one in four people with TB not getting treatment through public health programs, WHO Regional Director for the Western Pacific, Dr Shin Young-soo, continues to urge Governments to do more.

“The TB rate is coming down in the region, but it’s not happening fast enough. We need to do much more to achieve our goal of ending the epidemic once and for all,” he said

MEREDITH HORNE

Research suggests Australians confused about sun protection

Fewer than one in 10 Australians understand that sun protection is required when UV levels are three or above, according to research by the Cancer Council and QIMR Berghofer Medical Research Institute.

Melanoma is the third most common cancer in Australian men and women. Australia and New Zealand have the highest melanoma rates in the world with Queensland incidence rate of 71 cases per 100,000 people (for the years 2009-2013), vastly exceeding rates in all other jurisdictions nationally and internationally.

Melanoma is the most common cancer in young Australians (15–39 year olds) making up 20 per cent of all their cancer cases.

Heather Walker, Chair of Cancer Council Australia’s National Skin Cancer Committee, said the latest National Sun Protection Survey results showed a clear gap in Australians’ knowledge. Forty per cent of Australians are still confused about which weather factors cause sunburn.

“This new research shows that Australians are still very confused about what causes sunburn, which means people aren’t protected when they need to be,” she said.

“In summer 2016-17, 24 per cent of Australian adults surveyed incorrectly believed that sunburn risk was related to temperature, while 23 percent incorrectly cited conditions such as cloud cover, wind or humidity.

“It’s important for us to reinforce the message that it’s ultraviolet radiation that is the major cause of skin cancer – and that UV can’t be seen or felt. It’s a particularly important message this time of year. In autumn, temperatures in some parts of the country are cooling, but UV levels right across Australia are still high enough to cause serious sunburn and the skin damage that leads to cancer.”

Professor David Whiteman, Head of the Cancer Control group at QIMR Berghofer Medical Research Institute, said despite years of public education, encouraging Australians to protect their skin was an ongoing challenge.

“These findings show that very few Australians know when to protect their skin from the sun’s harmful rays,” he said.

“This is clearly a concern as it’s likely that Australians are relying on other factors, like the temperature or clouds, to determine when they need to slip, slop, slap, seek shade and slide on sunglasses.

“There is overwhelming evidence that, if used correctly, sunscreen prevents skin cancer – yet at the moment many Australians don’t even really understand when it’s required, and many are neglecting to use it altogether. We also know from previous research that 85 per cent of Australians don’t apply it correctly.”

Late last year, the Cancer Council National Sun Protection Survey showed that overall the proportion of adults slipping on clothing to protect themselves from the sun has decreased from 19 per cent to 17 per cent in the last three years.

The Cancer Council believes there is a need for Government to continue to invest in skin cancer campaigns to ensure adults remain vigilant about reducing their UV exposure.

“Australia hasn’t had Federal funding for a skin cancer prevention campaign since 2007 – this latest data suggests adults are becoming complacent about UV and demonstrates the urgent need for a refreshed national campaign,” Professor Sanchia Aranda, Cancer Council Australia Chief Executive Officer said.

Cancer Council’s SunSmart app provides local UV alerts and sun protection times and can be downloaded free on the App Store or Google Play.

MEREDITH HORNE