Not alarmist, just the boring truth

DR JOHN ZORBAS, CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING

The truth is often incredibly boring. It doesn’t sell papers. It doesn’t get people tuning in. It doesn’t win votes. And thus it follows that when things don’t make sense, one should assume incompetence before malice. But I’m finding it incredibly hard to suspend my disbelief when I stand back and take a look at the medical training system that we have in front of us today.

I’m not trying to be alarmist. I’m not here to tell you all that medical training is broken, and we should burn the books, burn the witches and behead Ned Stark. But I hope that I can convince you at the very least that the current progression to Fellowship is entirely unnatural and is fertile ground for unhealthy professional culture. To really understand this progression, I want you to pair up with each other, junior and senior doctors alike, and I want you to compare your respective paths through your medical journey. I find that often people have no idea what is or was on the other side of the fence. Let’s begin.

We finish medical school as the ultimate in medical pluripotency: the intern. We complete a year of heavily regulated and supervised training where we meander through medicine, surgery, emergency and whatever else might lie in our path that year. We then transition to residency, where without the pressure of training progression, we expand our medical buffet of specialisation and become more attuned to our final path in the journey. Armed with the knowledge of our experiences in areas such as general practice, ICU and plastics, and well rested from the safe hours worked, we apply for a training college. We get onto a program and begin to complete the pathway to specialty. Along the way, we have kids, and we do this by working part time at points along the way to balance the load. We complete our final exams and we become a Fellow of our chosen College, and apply for jobs in what is a reasonably well-balanced workplace. Right? Wrong. The truth is boring, but the truth is the truth, and this picture definitely isn’t the truth.

We finish medical school as the ultimate in medical pluripotency: the intern. We apply for internships, and a number of us will fail to get them as State governments are defaulting on their COAG agreement to provide medical graduates with internships. Without an internship, a number of doctors are unable to progress to general registration and are out before they begin. Those who remain become residents. With no national body to oversee PGY2+ terms, and with health services hungry to provide services to increasing populations with shrinking budgets, these residents work terms that don’t provide any meaningful experience. This veritable army of night cover and discharge summary monkeys are forced to scrounge around for the breadcrumbs falling off the training table. The smart ones quit, locum and complete further study, but not without further financial and temporal penalty. We’ve built a system in which the best way to advance your career is to quit the system for a while; a perverse incentive. This of course leaves behind fewer residents to fill the gaps in the roster, who are already at breaking point due to being denied leave for three years.

Nevertheless, you move towards a College. You identify the entry requirements and you undertake the extra mile to become a candidate with a chance. In some instances, that means completing a $5000 exam before you’re even a trainee. Once in, you work full-time and then the rest of it. You complete graduate diplomas, Masters and PhDs to progress. You fill your CV with publications and courses that cost thousands of dollars to progress. But you do it anyway. Because at this point you’re the blackjack player with a hard twelve. You’ve sunk enough cost into this game that you can’t quit, and there’s a glimmer of a nine sitting on top of that deck. But there are many more face cards, and maybe it’s just me, but I swear I’m seeing more and more doctors folding and busting around me.

So, you make it through. With everyone else. You’ve completed a number of extra qualifications and courses. With everyone else. You’ve participated in the medical arms race, and you’re surrounded by tens of thousands of other nuclear nations who’ll do anything for that job. The fat has been trimmed and now we’ve hit muscle. Welcome to exit block; a nation of Australian Fellows who can’t move on to consultant positions because we’re doing more with less, in every sense of the phrase. Competition is one thing, but when you’ve got multiples of trainees to every consultant position, you don’t have a competition. You’ve got a war.

I told you I wasn’t going to be alarmist and I stand by that. My examples above are all based on real life cases. I believe firmly in having a competitive workplace. I believe that smart hard work should be rewarded in the workplace. But this is not the system we currently have. We have a system that rewards the single-minded.

This is nobody’s fault. But it’s definitely our problem. It’s up to us as a profession to recognise that this isn’t about doctors eschewing hard work. It isn’t about people wanting an easy life. This is about a culture that has not kept up with the times and it’s important for those working in well-run institutions to recognise that this is not the norm anymore.

Public Hospital Doctors gearing up for a productive meeting

DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

As part of our busy schedule, the Council of Public Hospital Doctors will be meeting on 20 April. As always, there are many issues to discuss and we can’t cover them all, but a couple of the more topical ones we’ll be looking at are:

Private patients in public hospitals

Whilst private health insurance is a topic unto itself, patients can be lawfully treated privately in a public hospital by a doctor who has private practice privileges as a workplace employment condition. They may be admitted through the ED, referred from a GP’s or a specialist’s rooms, or be eligible for third party payments.

In March, the Independent Hospital Pricing Authority released its report: Private Patient Public Hospital Service Utilisation.

Key findings of the report include:

the number of separations in public hospitals funded by private health insurance has almost doubled from 451,591 in 2008–09 to 814,702 in 2014–15 (i.e. an average increase of 10.3 per cent per annum);

there is considerable variation in the proportion of public hospital separations funded by private health insurance between jurisdictions from 2007–08 to 2014–15 with QLD (an 8.1 per cent increase) and TAS (a 5.1 per cent increase) experiencing larger growth; and

a number of practices have developed encouraging patients in public hospitals “to elect” to use their private health insurance if it happens they possess it, including job descriptions for private patient liaison officers, and websites promoting the savings to the public hospital from patients electing to be treated as private patients.

The report concludes that there is sufficient evidence that the national Activity Based Funding model has not been a significant driver in the upward trend in privately funded public hospital separations.

It’s an interesting trend and we’ll be looking at this issue with a view to developing a position on it, as it now appears such patient elections are a major revenue line for all public hospitals.

Public/Private Partnerships in Hospitals

This is another growing issue, with a chequered history and many implications for public hospital doctors.

Public-private partnerships are gaining some traction in Australia, with recent developments such as Sydney’s new Northern Beaches Hospital developed under such arrangements.

Public/private partnerships can have a variety of forms, including:

a private company takes responsibility for both building a hospital and providing maintenance on the building for a 20 – 50 year period. The jurisdictional government saves paying the full capital costs up front and it reduces the immediate debt burden on the State’s balance sheet; and

private-sector management takes responsibility for all aspects of service provision in the hospital, including clinical care.

The stated benefit is usually that private management will more thoroughly drive efficiency because of the desire to generate its profits.

A main issue for both the AMA and ASMOF is that of identifying the employer, which has profound industrial implications, including accountability of government as an employer, the award under which staff will work, and the transferability of entitlements from previous State Government employment.

Public-private partnerships are typically long-term, with complex contractual arrangements setting out the responsibilities of the parties. They have regularly attracted criticism from Auditors General in several States. Some have been returned to public control, code for being a failure.

Facts we know are that this is a growing phenomenon, and it doesn’t always work. We will be taking a careful look at both the industrial implications but also the clinical care implications, of these partnerships and discussing how they have affected, and are likely to affect, public hospital doctors all around the country.

I look forward to engaging with as many public hospital doctors as possible on these and other important issues as they arise. I also look forward to seeing as many of you as possible at National Conference in Melbourne in May.

“Digital Disruption” – Taxis versus Ride-sharing

DOCTOR CLIVE FRASER

Uber ride-sharing arrived in Australia five years ago.

Undoubtedly, it has been popular and a great commercial success, much to the detriment of the established taxi industry.

There were initial issues about the legality of private drivers taking fare-paying passengers, but Governments have bowed to public pressure and have allowed Uber to blossom, and left the taxi industry to wither on the vine.

But I’m right behind the taxi lobby, which is understandably furious about livelihoods being trashed by Uber.

Just a quick look at the economics before driving off shows that taxi owners were paying up to $500,000 for a taxi plate in a highly regulated industry.

Owners of the taxi plates then forked out $50,000 for a Toyota Camry Hybrid with the GPS and cameras for security along with regular safety checks and expensive insurances.

I’ve just spent some time in Melbourne sampling various ways of getting around.

A trip from Richmond to the Tullamarine Airport cost me $75 in a cab.

The driver who owned the cab had no kind words for Uber.

He said the cab would gross about $300 in a 12 hour shift.

The driver kept $165 or 55 per cent of the fares, and with most drivers doing five 12 hour shifts (60 hours per week) the drivers would gross about $825 per week.

After paying for fuel and running costs the Taxi owner kept $80 to $90 per shift.

That’s not a great return for anyone considering the hours worked by the driver and the capital outlay by the owner.

He told me that the cab did about 10,000 kilometres per month and had an annual mechanical inspection.

It was also inspected for safety every time it was serviced every month.

The same trip in an Uber would have cost me $44 to $57, or much, much more if there was surge-pricing in peak demand times.

The Uber owner’s only outlay was $32,000 for a Hyundai i40 diesel and a few dollars per week for an iPhone.

The Uber driver also told me that he worked 60 hours per week, broken up into five hour shifts each morning and five hours each evening, six days per week.

He liked the fact that he could spend most of the day-time at home with his family and he would only drive for Uber when the demand was high.

He told me that he was happy to pick me up because I rated very highly with Uber!

I didn’t have the courage to tell him that my Uber rating was based on an N=1 because I’d only taken a single trip with Uber Black before in Sydney which cost me a small fortune to go from Potts Point to Coogee Beach.

The Uber driver told me that he was driving about 8,000 kilometres per month and that he’d done over 200,000 kilometres in the Hyundai i40 in the past two years.

He’d bought the Hyundai because it had a five-year unlimited kilometre warranty and he was fairly sure he wouldn’t be spending anything on the car other than basic service items.

He told me that he made about $2,000 per week doing Uber (minus $120 for fuel plus other vehicle running costs).

At this point in the chaotic world of digital disruption I decided to take a reality check and Google the fine print of Hyundai’s five-year warranty which said that: “Hyundai warrants against defects arising in materials or manufacture for all vehicles other than vehicles used at any time during the warranty period for commercial application.”

I wondered whether the good people at Hyundai would regard an Uber ride-share (aka taxi) as a “commercial application”.

I also thought it was best not to ask about insurance as I was a fare-paying passenger in a private vehicle.

I was after all trusting my safety/livelihood/career into the hands of a total stranger.

I decided definitely not to raise any of these concerns with the Uber driver lest he gave me a bad review which would immediately halve my rating as N would then equal 2 and I might be left by the road-side from now on.

Whilst I’m all for the free-market and competition, unlike many of my colleagues I haven’t fallen in love with Uber.

Safe motoring,

Doctor Clive Fraser

doctorclivefraser@hotmail.com

Do homework before choosing private health insurance

AMA President Dr Michael Gannon has urged health insurance consumers to shop around.

Before buying private health insurance (PHI) or changing insurers, he said, consumers need to be assured they will get value for money.

“Too many Australians aren’t getting value for money,” he said following the release of the AMA Private Health Insurance Report Card 2017.

“A lot are. Private patients admitted to private hospitals around Australia have normally got a very positive story to tell about the care they’ve received.

“But for too many people, when they get sick, when one of their loved ones gets sick, they either find they’re not entitled to treatment in a private hospital, they’re shipped off to the public hospital, or they’re told that there’s going to be a significant delay in treatment or significant out of pocket expenses.

“What the Report Card tries to do is give people an idea about which policies might suit them and their family best.”

Dr Gannon said people should thoroughly research and compare the various and varied policies on offer to ensure they are getting value for money.

More importantly, he said, they should know exactly what they are covered for in the event of accident, illness, or injury.

“Australian families now contribute a substantial proportion of their household income towards private health insurance, so it is important they know exactly what they are getting from their investment,” Dr Gannon said.

“Family budgets are under pressure with cost of living increases, which have been added to with the recent annual increase in PHI premiums.

“The AMA Private Health Insurance Report Card 2017 provides consumers with clear, simple information about how health insurance really works.

“It shows that there are a lot of policies on offer, which provide significantly varying levels of cover, gaps, and management expenses. There are a lot of policies on the market that do not provide the cover patients expect when they need it.

“If people have one of these ‘junk policies’, the AMA encourages them to check their policy matches their current and anticipated health care needs. And, if not, dump it for better cover.

“Our Report Card will help people to understand their product, and allow them to make changes to get better cover and better value for money.

“We show what insurance policies may or may not cover, what the Medicare Benefits Schedule (MBS) covers, and what an out-of-pocket fee may be under different scenarios.

“The Report Card also highlights that private health insurer benefits vary significantly between policies and insurance companies.

“Benefits vary State by State, so this year we’ve highlighted the percentage of hospital charges covered by funds in each State to help consumers better understand what they are buying.

“The percentage of services with no-gap are detailed State by State, and we reveal what each of the PHI funds has reported they spend on management and administration compared to what they pay out as benefits to patients.

“There is data on the level of complaints each fund receives, and we’ve also warned people about the dangers of doctor rating sites.”

Although it is understandable that people are looking to save money, the AMA advises they should not be deceived into downgrading to a junk policy.

From the AMA’s perspective, junk policies should not exist at all.

Dr Gannon said PHI needed to be simplified, more transparent, able to cover the real costs of treatment – including theatre fees, equipment, consumables, hospital costs, and staff time.

“The funds must put the interests of their policyholders first and foremost, and stop pointing the finger at doctors or pushing increased out of pocket costs onto patients when their products do not deliver what patients expect,” he said.

“Benefits for doctors represent less than 10 per cent of the money paid out by Australia’s biggest health insurer.

“We need to ensure that patients retain the right to choose the doctor that is right for them, and to have their treatment at a facility that suits them.

“Equally, we need to ensure that doctors can refer patients to the right specialist – not just the one that an insurer deems appropriate. Insurers do not know the difference between specialist and sub-specialist treatment.

“We must not end up with US-style managed care where a clerk in an office on the other side of the country, not the patient and their doctor, decides what care is affordable.

“Sometimes, preserving that choice might mean treatment in a public hospital. Products must preserve flexibility. Some of our best, most highly-trained doctors work in public hospitals.

“And for those in rural areas, it is often only the public hospital that is available. They should be able to use their insurance product as they need to.

“These decisions – these patient rights – are far too important to be taken away by insurers in an effort to further bolster their profits.

“The AMA wants this Report Card to be a catalyst for greater transparency and clarity from the private health insurers about their products, and a signal to consumers to thoroughly know their PHI product before signing up.”

Since the release of the inaugural AMA Private Health Insurance Report Card in March 2016, the Government has established the Private Health Ministerial Advisory Committee to examine all aspects of private health insurance.

The AMA Private Health Insurance Report Card 2017 is at ama-private-health-insurance-report-card-2017

Chris Johnson

Latest submission to Senate on private health insurance

The following is an edited and condensed extract of the AMA’s submission to the ACCC report to the Senate on private health insurance.

In Australia, the public and private systems work together as a part of a health system that provides patients with universal access to affordable health care. The balance between the private and public system cannot be overlooked.

The private health sector is a large contributor to the system. In 2014-15, 42 per cent of all hospital separations were funded by private health insurance; where 50 per cent were public patients and the remainder were self-funded. Not only is it a large contribution, but it is a cost effective one. In 2014-15, there were 4.1 million privately insured hospital separations for approximately $12 billion in outlays, or around $3000 per separation, compared to 5.9 million separations in the public sector for a combined government outlay of $48.1 billion (or $8,100 per separation). While the service mix and complexity may differ between the sectors, the private sector very efficiently complements the public sector. If consumers withdraw from the private sector, these services will need to be provided by the public sector. Under current capacity, the public sector will either not meet the additional demand, or will only do so at a higher cost to governments.

We need to ensure that as private health insurers interact with patients and hospitals, the underpinning regulation promotes the efficient supply of health services. Private Health Insurance (PHI) has specific features that make the design of efficient regulation especially complex. This is further compounded by the specific historical development and place of PHI in the Australian context – as a form of supplementary insurance to Medicare, with the primary purpose of providing private hospital cover. Current regulation, as well as defining the scope of the cover PHI provides, includes restrictions on premiums through Community Rating and Lifetime Cover, means-tested subsidies for PHI take-up (the PHI rebate which is among the top 20 most expensive Federal Government programs), along with means tested tax penalties (the Medicare Levy Surcharge) for the failure to take out cover, and price controls over increases in PHI premiums.

Managed care

Australians can choose to obtain their health care solely from Medicare or use a combination of Medicare and PHI to meet their medical needs.

PHI offers several advantages over the public system: a patient has the option of being treated by their own doctor, they have more control over when and where they receive medical care, and the waiting times for elective surgery tend to be considerably shorter. In short, PHI provides choice for the patient and, without that choice, its value is diminished.

Yet there is a subtle, and defined, shift from a system of patient control to managed care occurring in Australia. Australians do not want US-style managed care imposed on a system that currently produces superior health outcomes at lower cost (USD$4420 here compared with $9451 in the United States). Managed care, in terms of health care, means a person agrees to only visit certain doctors and specialists within their health care plan – limiting their choice of practitioner. Australia and Australians have not had a public conversation about whether they agree to relinquish control over their health and their health system to the private health insurers. (This change has occurred through the change to the contracting with hospitals with no-pay clauses; publication of practitioner details; establishing closed shop referral databases; and demanding pre-approvals prior to surgery.)

Competition in the sector

The level of competition along the supply side of private health services impacts upon the competition between private health insurers. Both insurers and providers (hospitals and practitioners) have indicated that competition is not as effective as it might be.

Some of the inputs to the provision of health can be influenced or controlled by the private health insurer. These are generally limited to hospital contracts, but do stretch to the pre-approving of surgery. As a result, contracting between the insurers and hospitals (large groups through to day surgeries) has become more vexed and publicly acrimonious at times.

Contracting is a voluntary, deliberate, and legally binding agreement between two or more competent parties. However, it can be argued that firms are not operating in a competitive market and the factors at play are such that agreements are not voluntary. Hospitals need to have a contract with the major private health insurance funds (suppliers). Some insurers have such a strong market position that they would be considered price makers, where others are considered to be smaller, and thus price takers. Smaller insurers are beginning to contract as a collective to improve market power, and the Australian Health Service Alliance now represents 28 of the 36 registered health funds, creating what they claim is the third largest buying group.

Furthermore, a small day surgery that may be practitioner-led may not have an equal power relationship when entering a contracting arrangement, nor the ability to undertake the detailed financial modelling that insurers can use to gain a more attractive contracting outcome – this can effectively provide the ability for insurers to determine what small day practices remain viable. This is problematic as small day surgeries can remove cases from the higher cost environment of overnight hospitals, as well as be areas where innovation can flourish.

As a result of this imbalance, the AMA is beginning to see variations in contracts that shift the nexus of control from the provider/patient to the private health insurance fund – managed care.

Publication of a practitioner’s details

Private health insurers offer gap cover schemes to provide their members with certainty about out-of-pocket expenses for their privately insured medical care. Medical practitioners electing to participate in a gap cover scheme must agree to the terms and conditions that are set by the insurer. One of the common terms and conditions is that the medical practitioner agrees to information about them being published including their name, practice address, contact details, gap agreement usage and participation rate, and average gap charges.

Bupa has a ‘Find a Healthcare Provider’ section of its website. It provides information on the gap payment that may apply with providers it is contracted with, as well as information on the percentage of services, roughly, under which providers participate in its gap scheme.

Nib, Bupa and HBF are major shareholders of a system called Whitecoat, which owns a database that provides information on practitioner charging patterns using data gleamed from the HICAPS system. Under the Whitecoat system, a provider’s agreement with the payment processing system (HICAPS) will lead to publication in the directory. The directory is segmented by insurer, and only a customer of Nib can find Nib data about a practitioner’s billing practices or percentage of services provided under a no-gap or known gap scheme.

Not unlike Trip Advisor, the Whitecoat site also allows consumers to search, find and book a clinical provider as well as review and share their experience. Whitecoat has stated that the customer reviews are vetted to ensure they do not contain clinical details, however, members have raised concerns that the vetting process is not foolproof.

Already it hosts over 40,000 providers (thus far, mainly allied providers such as dentists) and shares 250,000 patient reviews. Around six million private health insurance members will have access to this information.

However, these types of websites have the potential for significant unintended consequences. Far from helping health consumers, posting outcomes of treatment online could lead to reduced access to care, particularly for patients with chronic and complex health problems.

Referrals databases for consumers and general practitioners

Medibank has announced it is providing information to the referrals database Healthshare that will allow general practitioners to identify specialists who charge gap fees.

This initiative will provide information to approximately 85 per cent of general practitioners as to which doctors are part of Medibank’s ‘no-gap’ or ‘known gap’ schemes. The converse of this is that general practitioners will therefore know which doctors are not part of Medibank’s ‘no-gap’ or ‘known gap’ schemes as they will not be on the Medibank list.

Effectively this action by Medibank (which will undoubtedly be followed by the other large funds) could have a detrimental impact upon the referrals received by practitioners who are not part of Medibank’s ‘no-gap’ or ‘known gap’ schemes, as patients are increasingly weighing gap charges into their decision on which specialist they choose. It is a closed shop, and it means that who is the most appropriate clinician for the referral, based on medical advice, may not be the consumer’s driving motivation.

Again, this is a private health insurer influencing the provision of services and determining who may provide a service and, since they set the ‘no-gap’ or ‘known gap’ amounts, at what price.

Setting of premiums

The regulation of PHI premiums sits on top of this complex regulatory environment. It has a dual goal of protecting consumers from excessive pricing and the Commonwealth from fiscal risk. However, it has been argued by the PHI sector that this regulation provides an inefficient outcome.

Many stakeholders are of the view that the compliance costs of the premium setting process are out of proportion to the benefits that are obtained. These concerns tended to focus on the process being too long, the amount of information required, and claims that outcomes would be the same even if the requests for increases in insurance were not reviewed.

A relevant consideration to the process and its ongoing appropriateness is whether market failures exist in the PHI market that justify the current suite of regulations. There are 36 PHI entities competing in the market. However, the Australian industry is highly concentrated. The two largest insurers, Medibank and Bupa, have 55.4 per cent of the market. The Private Health Insurance Administrative Council in 2013 indicated that there does not appear to be ‘unbridled competition’.

Premiums are a key driver in the choice of insurance for consumers. The increase in exclusionary products has not been at the expense of growth in excesses and co-payments that are also used to mitigate premium costs.This indicates that consumers are purchasing products with excesses, co-payments and exclusions to minimise their premiums. Therefore any methodology to set premiums must ensure that this product remains viable and attractive to consumers.

PHI used to be run mainly by not-for-profit funds. However, around 70 per cent of the insured population are now covered by ‘for-profit’ funds. The shift to a for-profit industry has created a greater need to ensure that there are sufficient profits to allow a respectable return to shareholders. It would appear that the private health insurers are not averse to increasing premiums in order to ensure a sufficient return for their shareholders. APRA data show an industry surplus (before tax) of $1.56 billion for the 2015-16 financial year (up from $1.45 billion for the previous year). Nib’s 2017 half-year results showed a sizable return on equity of 31.7 per cent.

The Federal Government has a decided stake in ensuring participation in PHI. The Government’s regulatory environment of incentives and penalties all but guarantees customers to private health insurers and has ensured that the PHI industry is one of the Australian economy’s more protected industries. However, it also has the effect of undermining consumer confidence in the product. Allowing an industry with limited competition to set its own premiums may contribute to a further decline in confidence.

The full submission can be found at: submission/ama-submission-accc-report-senate-private-health-insurance

Jodette Kotz

AMA Senior Policy Advisor

[Editorial] The high cost of unpaid mental health care

Informal carers for people with mental illness, such as spouses, parents, or even children, are often underappreciated, unpaid, and invisible to the wider community. A new report from Mind Australia and the University of Queensland—The Economic Value of Informal Mental Health Caring in Australia—brings visibility to this sector of the health-care workforce and puts a price on the value of their services by estimating the cost of replacing informal support with government services.

New mental health advisory panel formed

A new mental health advisory panel has been established by the Federal Government.

It will be co-chaired by National Mental Health Commission CEO Dr Peggy Brown and Mental Health Australia CEO Frank Quinlan.

To be known as the Primary Health Network Advisory Panel on Mental Health, the body will examine how the Government’s 31 Primary Health Networks (PHN) facilitate mental health services across the country.

Health Minister Greg Hunt said the panel would work closely with the Government on its plan to deliver more frontline mental health services.

“I have met with many organisations active in the mental health field to discuss the progress of our significant reforms,” Mr Hunt said.

“All agree that targeting mental health support, care and funding at a regional level through the PHNs is the right approach. But like any major reform, the scale and pace of change presents challenges.

“Both Mr Quinlan and Dr Brown will ensure our significant funding of mental health services, through the 31 Primary Health Networks across Australia, delivers support where it is needed.

“They are both extremely well qualified and have played a significant role in creating awareness and understanding around mental health issues and the type of services needed to treat them.”

Four million Australians have a chronic or episodic mental health episode each year, which effectively means almost every family has been touched by mental health challenges.

The Primary Health Network Advisory Panel on Mental Health will serve four main functions:

to review and provide guidance regarding the mental health plans developed by the 31 PHNs nationally;
to review and provide advice on the guidelines for mental health commissioning provided to the PHNs;
provide advice on strategies to support the PHNs to effectively carry out their commissioning responsibilities in mental health; and
provide recommendations on ongoing governance and coordination of PHN’s commissioning of mental health services.

Chris Johnson

Health COAG meets

The Federal and State and Territory Health Ministers met in Melbourne recently at the Council of Australian Governments (COAG) Health Council to discuss a range of national health issues.

The meeting was chaired by the Victorian Health Minister Jill Hennessy and welcomed New Zealand Health Minister Dr Jonathan Coleman as a participant.

The Ministers considered a draft of the Health Practitioner Regulation National Law Amendment Bill 2017.

Once enacted, the Bill will make a number of important reforms to the operation of the National Registration and Accreditation Scheme and the powers of National Boards and the Australian Health Practitioner Regulation Agency. The Bill responds to recommendations arising from the Independent Review of the National Scheme undertaken in 2014–15.

All Health Ministers also endorsed a revitalised agenda to streamline the conduct of clinical trials in Australia. Clinical trials are an important driver in improving health outcomes through access to new drugs, devices and treatment.

Under this directive, all Governments have agreed to redesign trial operating systems around central coordinating units that will make it easier to conduct and participate in safe, high quality clinical trials. The Commonwealth has committed funding of $7 million over four years to support jurisdictional clinical trial reform.

The Ministers noted that timely negotiation of expiring National Partnership Agreements (NPA) was important for each jurisdictions’ planning and delivery of services. They agreed to continue a cooperative dialogue to progress discussions about a range of expiring funding arrangements to ensure current care and timely preventative services can continue to be delivered to the community.

Medical research at Commonwealth and State levels; re-exposure prophylaxis for the prevention of HIV; meningococcal W; ear disease and hearing loss in Aboriginal and Torres Strait Islander children; digital health, childhood obesity, the implementation of the Health Care Homes program; end of life care; and the medicinal cannabis were all also discussed at the Health COAG.

In addition, the Ministers agreed that the Fifth National Mental Health Plan will re-emphasise its objective of suicide prevention and will therefore become the Fifth National Mental Health and Suicide Prevention Plan.

They also agreed to a national opt-out model for long-term participation arrangements in the My Health Record system.

Chris Johnson

Turnbull does a Trump

Prime Minister Malcolm Turnbull tried channelling his US counterpart recently when in true Donald Trump fashion he embarked on a Twitter-fest to shout down news reports he claimed to be false.

News Limited newspapers had reported the Government was looking to scrap certain aged pensioner concession cards and welfare payments in the May Budget.

But just like the US President, Mr Turnbull didn’t issue a statement or wait for a press conference to deny the reports – he blasted it across the Twittersphere.

“I can assure all aged pensioners the measure reported will NOT be in the budget,” the PM tweeted.

He then subsequently tweeted that the reporter “insisted on writing the story” even though he had told her she was wrong.

The word ‘false” was tweeted, as was his “outright” rejection of the story.

Mr Turnbull saved his best Twitter attack on the subject for Opposition Leader Bill Shorten.

Using one of President Trump’s favourite words (“sadly”), the Prime Minister tweeted: “And sadly, I can assure you that you can always rely on Bill Shorten to lie.”

The Prime Minister would have been called on to withdraw such a remark if he had said it in Parliament but, sadly, it seems that in Twitter-land just like in Trump-land almost anything goes.

Chris Johnson

Prime Minister has prizes for our best scientists

The search is on again.

Each year the Federal Government honours Australia’s best scientists, innovators, and science teachers through the Prime Minister’s Prizes for Science.

The call has gone out for nominations for this year’s humble science heroes, promising early-career researchers, media-shy innovators, and modest teachers who deserve to have their work recognised on the national stage.

This is what they’re looking for:

· heroes of Australian science who have made a significant contribution to the advancement of knowledge through science — people like Rick Shine, Graham Farquhar and Ingrid Scheffer:

· exceptional innovators from both industry and research who have translated scientific knowledge into substantial commercial impact — like Michael Aitken, Colin Hall, Graeme Jameson, John O’Sullivan and Ian Frazer:

· early to mid-career scientists whose research is already making, and will continue to have, an impact on our lives — like Kerrie Wilson, Jane Elith, Ryan Lister, Andrea Morello, Angela Moles, Matthew Hill and Tanya Monro: and

· science teachers—primary and secondary — like Suzy Urbaniak, Ken Silburn, Richard Johnson and Rebecca Johnson, who are inspiring the next generation with a love of science and exploration.

The prize recipients will receive national recognition and meet leaders in science, industry, education and government at the prize dinner in the Great Hall of Parliament House, Canberra.

The prizes are:

· $250 000 Prime Minister’s Prize for Science;

· $250 000 Prime Minister’s Prize for Innovation;

· $50 000 Prize for New Innovators;

· $50 000 Frank Fenner Prize for Life Scientist of the Year;

· $50 000 Malcolm McIntosh Prize for Physical Scientist of the Year;

· Prime Minister’s Prize for Excellence in Science Teaching in Primary Schools ($50 000 shared between the recipient and their school); and

· Prime Minister’s Prize for Excellence in Science Teaching in Secondary Schools ($50 000 shared between the recipient and their school).

Nominations close at 5.00 pm Canberra time, Wednesday 12 April 2017.

It’s simple to nominate in the first (shortlisting) stage, with an online form that requires:

· details of the nominator, nominee(s), two supporters;

· for the five science prizes: three external referees (two of whom must be based overseas);

· an achievement summary of no more than 1 000 words;

· a two-page curriculum vitae;

· proof of Australian citizenship or permanent residency; and

· for the early to mid-career awards: evidence that their research career spans no more than 10 years (or full time equivalent) from completion of their highest relevant tertiary qualification.

If a nomination is shortlisted, further material will be required in the final stage.

For eligibility, selection criteria, nomination guidelines and forms, visit: www.business.gov.au/scienceprizes or contact 13 28 46

For more examples of past recipients, visit: www.science.gov.au/pmscienceprizes

Chris Johnson