Extra home care packages welcome, but more needed urgently

The AMA has welcomed the Government’s announcement of 6,000 extra high-need home care packages, following the release of the Legislated Review of Aged Care 2017 Report, but says more packages are desperately needed.

Health Minister Greg Hunt and Aged Care Minister Ken Wyatt announced the extra packages, along with the long-overdue announcement of $20 million to go towards fixing the inefficient My Aged Care information system last month.

AMA Vice President Dr Tony Bartone said he was pleased that the Review, led by retired senior public servant David Tune, had adopted a number of the AMA’s recommendations, particularly around improving the My Aged Care information technology system.

But he said that the 6,000 extra home care packages, while welcome, fell well short of demand.

“The Home Care Packages Program Data Report released today notes that at 30 June 2017, there were 53,750 people seeking home care who had not yet been assigned a home care package,” Dr Bartone said.

“While the extra places are welcome, they won’t go far in tackling the enormous backlog of applications.

“These are for people who are being cared for in the community, and their carers are doing it tough. It’s one thing to improve the IT system, but we still need beds and packages.”

Dr Bartone said the AMA was a strong supporter of digital health for the delivery of better health care, but the IT technology has to work.

“In its submission to the Review, the AMA outlined the multiple inefficiencies with My Aged Care,” he said.

“In its current form, My Aged Care cannot satisfactorily handle electronic referrals from GPs, forcing them to resort to outdated methods like fax machines.

“The online form for an ACAT referral is not linked with clinical software, so it can’t be auto-populated with the GP’s clinical records, or be directly saved to the patient record.

“Instead, it has to be saved as an external document and attached, creating a significant administrative burden for already time-limited GPs.

“The AMA has repeatedly raised these concerns with the Department of Health, both through the Review, and through direct communication with the Department.

“Improving communication with My Aged Care contact centre staff is essential to avoid missing vital information on a patient’s application form, which has considerably delayed care in the past. The Tune Report recommends that the National Screening and Assessment Form should be revised.

“The Government has predicted that the proportion of Australians aged 65 years of age and older will increase to 18 per cent by 2026.

“The aged care workforce needs to be properly equipped with the appropriate tools to deal with the challenges that this ageing population will bring.”

The AMA’s submission to the Review is available here: submission/ama-submission-department-aged-care-legislated-review-2016-17

The Legislated Review of Aged Care 2017 Report is available here: https://agedcare.health.gov.au/legislated-review-of-aged-care-2017-report

CHRIS JOHNSON

Patients’ ability to use private cover in public hospitals must not be curtailed

The AMA is advising the Federal Government to reject any policy proposals that limit patients’ ability to use their private health insurance for treatment in a public hospital, warning that such a move would restrict patient choice and further disadvantage public hospitals.

In its submission to the Government’s paper, Options to reduce pressure on private health insurance premiums by addressing the growth in private patients in public hospitals, the AMA strongly rejects all of the options proposed.

AMA President Dr Michael Gannon said the options would have a negative impact on the health system and should be dismissed out of hand.

“The options raised in this paper would simply reduce the level of funding available to public hospitals in favour of private health insurers, and significantly reduce the health care choices available to privately insured patients,” Dr Gannon said.

“Patient choice is a fundamental feature of our health system, which includes the option for patients to use their private health insurance in a public hospital.

“There are very good reasons why a patient may choose to use their private health insurance for treatment in a public hospital.

“In regional and rural areas, there may be no other option available due to the lack of private sector services.

“Public hospitals are also equipped to handle the most complex of cases and, in many cases, may represent the most appropriate clinical setting for treatment.

“It may also be the most cost effective option for a patient, particularly in light of the growing number of private health insurance policies with exclusionary features or excesses and co-payments.

“A patient may also wish to be able choose to be treated by a doctor who they have previously seen or know.

“There are also significant benefits that flow to public hospitals.

“In a constrained funding environment, the supplementary revenue generated from private patients makes an important contribution towards the recruitment and retention of medical practitioners, improved staffing, teaching, training, and research, and the purchase of modern new equipment.

“All these resources support and enhance the delivery of high quality care to public and private patients alike.”

Dr Gannon said the private health insurance lobby was guilty of blatant hypocrisy.

“On the one hand, the industry is offering and promoting public hospital-only private insurance policies, but at the same time objecting to more and more of their members opting to use their insurance in a public hospital,” he said.

“Insurers and governments only have themselves to blame for patients increasingly choosing to be treated as a private patient in a public hospital.

“The private health insurers offer a bewildering array of products, with varying levels of cover and many exclusions, which often leave patients confused and shocked when they find out that common medical procedures are not covered by their expensive insurance policy.

“This is compounded by the stagnation of the indexation of the Commonwealth Medicare Benefits Schedule (MBS) and medical fee schedules offered by the private health insurers.

“On top of this, public hospital funding has failed to keep up with community demand for services, with the Commonwealth and the States and Territories guilty of under-delivering in this area for many years.

“If the Government and the private health insurers want to see fewer patients opt to use their private health insurance in a public hospital, we will need to see significantly improved long-term funding for public hospitals, private health insurance policies that meet the common medical needs of consumers, and clear articulation of the different levels of coverage so that they are easily understood by consumers.

“If there is evidence of cost shifting, or concerns that private patients are jumping the queue in public hospitals, this needs to be addressed through stronger provisions and improved compliance arrangements in future COAG Hospital Funding Agreements.

“The development of a durable solution to this issue needs to be proportionate, and considered in the context of broader private health insurance reforms and future public hospital funding arrangements.

“This will require extensive consultation, including with the States and Territories which, in relation to private patients in public hospitals, appear to have had very limited input to date.”

The AMA submission is as submission/private-patients-public-hospitals

MARIA HAWTHORNE

Nation-first pill testing trial at Canberra music festival

Australia’s first pill testing trial will be held at a music festival in Canberra later this year, prompting applause from drug reform advocates but concern from the Federal Government.

Revellers at the Spilt Milk festival in November will be able to have their illicit substances tested for purity and authenticity, and will have the option of safely disposing of the pills if they turn out to be not what they thought they had purchased.

ACT Health Minister Meegan Fitzharris said the testing would be provided free by the Safety Testing and Advisory Service at Festivals and Events (STA-SAFE), which is led by Harm Reduction Australia, Australian Drug Observatory, Noffs Foundation, DanceWize and Students for Sensible Drug Policy.

A similar proposal for another festival in May was denied.

Ms Fitzharris said the decision had been made after careful assessment of the STA-SAFE proposal, and of pill testing schemes in New Zealand and Canada.

“We need to find the right balance between letting young people know it’s illegal to take drugs, they can be very harmful, but also being realistic because we’ve seen deaths at festivals, five in 2015 alone, so if that helps to keep people safe, it’s worth doing,” Ms Fitzharris said.

“Pill testing means young people who are considering taking drugs can be informed about what’s really in their pills, and how potent they are, and it creates an opportunity to remind them of the risks before they make the final decision to take a drug.”

While the AMA has always supported a range of drug harm minimisation measures, AMA President Dr Michael Gannon raised concerns that the trial might send the wrong message.

“We do need to do better but we also need real evidence that something works,” Dr Gannon told The Project.

“And the last thing we would want to do is give people a false sense of security about taking illegal drugs cooked up in someone’s bath tub.”

The AMA is concerned that pill testing does not entirely remove the risks associated with taking illicit drugs, as people react to drugs differently, and may also be influenced by the amount of drug consumed, gender, age, weight and other substances consumed such as alcohol.

The announcement coincided with the launch of a new national TV and online advertising campaign cracking down on ice and party drugs, aimed at school leavers who are preparing to celebrate the end of their school education.

Federal Health Minister Greg Hunt said while the pill testing trial was a matter for the ACT Government, the Federal Government did not support it “as a matter of principle”.

“Saying that any drug is okay is not okay,” Mr Hunt told Weekend Sunrise.

“People can have a reaction to any drug. There are no safe illicit drugs, and I think that’s a very important message.”

Festival goers will be able to attend a medical tent and provide a sample of a drug to be tested using laboratory grade equipment for free.

After receiving the results, the person will have the option of keeping the pill or discarding it in an amnesty bin containing bleach.

Regardless of the test outcome, trained drug counsellors will warn festival goers about the health risks of illegal drugs.

Dr David Caldicott, an emergency medicine specialist and advocate for Harm Reduction Australia, said the move would stop people taking drugs and prevent deaths.

Research from overseas programs showed up to 60 per cent of people who had their pills tested went on to throw them away, he said.

ACT Chief Police Officer Justine Saunders said ACT Policing supported the program and had been actively working with ACT Government and stakeholders.

“ACT Policing will be patrolling the festival to ensure patrons enjoy the event in a safe environment,” she said.

“Police will not enter the health facility that contains the pill testing station unless requested to do so by festival organisers, security staff or emergency services or in response to an emergency situation.”

MARIA HAWTHORNE

Greater recognition and response for treating eating disorders

Federal Health Minister Greg Hunt has launched the Butterfly Foundation’s National Agenda for Eating Disorders.

The Butterfly Foundation will receive an additional $1.2 million over the next two years to roll this out nationally through the National Eating Disorders Collaboration.

The goal of the National Agenda is to ensure Australia has a national approach to help people with eating disorders and to establish a bank of information around what works, so people suffering from this disease can access the best treatment for their needs.

The Agenda was developed in consultation with Australia’s eating disorders experts and those with a lived experience of an eating disorder.

Launching the National Agenda in September, Mr Hunt said that the Federal Government was committed to bringing together State and Territory governments and industry to deliver a consistent response in treating and supporting people with eating disorders.

The Government in the Budget this year announced it will provide almost $3 million for more support and better treatment for people suffering from eating disorders.

Eating disorders not only affect an individual’s relationship with food, but also body image, confidence, mental health, and overall health.

In May, Minister Hunt requested the Medical Benefits Schedule Review Taskforce investigate options for Medicare coverage for the treatment needs of those people with an eating disorder, including physical, psychological, behavioural, nutritional, occupational and social needs. The aim is to increase the skills of health professionals to identify and respond to eating disorders through a nationally consistent approach.

The Butterfly Foundation’s Chief Executive Christine Morgan believes this is critical because currently the foundation believes that only 25 per cent of Australians with an eating disorder currently seek treatment.

“The Agenda addresses critical areas of health system reform and identifies the priorities needed to provide access to evidence-based multi-disciplinary treatment and dosages to any Australian with or at risk of an eating order,” Ms Morgan said.

Mr Hunt also announced funding of $1.7 million to support expansion of the 1800 ED HOPE national helpline, allowing 1800 ED HOPE’s hours to be increased so it remains open from 8am to midnight seven days a week. This expansion will happen by February, 2018.

The telephone helpline is the only of its kind in Australia.

The Butterfly Foundation welcomed the support for the hotline saying they are committed to: “Ensuring there is no divide between those who can afford treatment and those who can’t.”

Ms Morgan said the announcement marked a milestone in Australia’s recognition and response to people living with an eating disorder.

“The launch of the first National Agenda for Eating Disorders, coupled with the Minister’s restated commitment to a review of Medicare to more comprehensively cover the needs of those with eating disorders, constitutes the policy realignment that has been sadly lacking to date,” she said.

The Butterfly Foundation has also recently launched an Australian-first Youth Intensive Outpatient Program in Sydney, a low cost program, costing families $120 per patient per week over the 10-week program.

The AMA expressed support for a nationally coordinated approach in order to develop effective and consistent practices in preventing and addressing the incidence of unhealthy body image and eating disorders. The AMA’s position paper Body Image and Health can be found here: position-statement/body-image-and-health-2002-revised…

Anyone needing support with eating disorders or body image issues is encouraged to contact Butterfly’s National Helpline on 1800 33 4673 or support@thebutterflyfoundation.org.au

MEREDITH HORNE

[Editorial] Accountability is key for protecting health workers

On Sept 22, 2017, during the 72nd Session of the UN General Assembly, experts and representatives from international non-governmental organisations (NGOs) and UN member states convened for Protecting Health Care in Armed Conflict. The high-level side event was a collaboration between the Permanent Missions of Canada, the Netherlands, Spain, and UK, and The Lancet–American University of Beirut Commission and the Safeguarding Health in Conflict Coalition.

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

Emergency department use in developed countries

A global study undertaken by George Washington University has evaluated the use of emergency departments in seven developed countries and has identified areas where efficiencies are needed.

The study, conducted with Royal Philips researchers, found that Australia has a low use of emergency departments when compared to Canada, the US, the UK, the Netherlands, Switzerland and Germany.

This finding points to Australia’s strong access to primary care resulting in less frequent use of emergency resources.

The paper, Acute unscheduled care in seven developed nations: a cross-country comparison, compares the similarities and differences across nations with a focus on care delivery and the impact of socio-economic factors.

The research from Philips and the GWU School of Medicine and Health Sciences reveals unsustainable ED use in some developed nations.

Better access to primary care can result in lower ED use.

The findings of the report show Germany (22 per cent) and Australia (22 per cent) as having the lowest ED use, likely resulting from better and faster access to primary care — nearly two-thirds of Australians (58 per cent) and three-quarters of Germans (72 per cent) were able to make same or next day appointments with their primary care physicians (PCPs) compared to less than half of Americans (48 per cent) and Canadians (41 per cent).

“In looking at the way emergency departments are used around the world, we were able to obtain valuable new insights to help improve care delivery,” said Jesse Pines, from GWU.

“Because of research findings presented in this report, all emergency departments, no matter their location, have the opportunity to efficiently improve the way care is delivered in emergency department settings.”

Kevin Barrow, managing director of Philips Australia and New Zealand said the research shows Australia ranked relatively well when it comes to hospital emergency department admissions.

“And (for) the cost of health care for both government and individuals, in comparison to other countries surveyed, reflecting the relative ease of access to primary care in our country,” he said

“However, the findings also identified a need to improve departmental efficiencies and increase activities to minimise the burden on acute care facilities, by continuing to focus on preventive care, chronic disease management and the education of patients on the appropriate care for their health needs.”

Data has been formulated into a list of key areas researchers say impact the way care is delivered in emergency settings, and the broad differences in available treatments across countries.

They include:

• Social determinants (smoking, eating, violence, substance abuse and poverty) have a strong impact on the use of EDs;

• Reduced access to health insurance results in poorer population health; placing a greater strain on emergency departments;

• Sick patients do not make the most efficient decisions about when and where to seek medical care;

• Extensive provider training is mandatory for effective delivery of acute unscheduled care; and

• Quality measures for EDs are immature and not standardised.

“There’s a belief that easy access to primary care can result in lower emergency department use,” said Mark Feinberg of Philips North America.

“However, as a result of this report, it is clear that even if people have easy access to primary care and full healthcare coverage, there is no guarantee the patients will make economically prudent decisions to seek the most appropriate medical care setting.”

The complete report can be accessed at: www.healthsystems.philips.com/acute-unscheduled-care

CHRIS JOHNSON