more_vertThe UK Government has an ambitious plan to reduce deficits in the UK’s economy. However, this quest for recovery might be at the expense of the poorest and most vulnerable groups in society. Last week, the UK All-Party Parliamentary Group (APPG) on Health in All Policies released the findings from their inquiry into the effects of the proposed Welfare Reform and Work Bill 2015–16 on child poverty and child health. The Bill sets out several changes to the UK welfare system, including reducing the benefit cap, freezing some benefits for 4 years, and restricting the amount of support provided by child tax credits—changes that will hit the poorest people the hardest.
Preference: Government and politics
MBS Review progress
Last week the AMA convened its second meeting of medical profession leaders to discuss the progress of, and concerns about, the MBS Review.
AMA President Professor Brian Owler said all in attendance wanted to achieve an MBS that reflected modern medical practice, and which benefited patients, but warned delays in listing new MBS items to replace scrapped items could create an incomplete Schedule, with serious implications for patient care.
Professor Owler said it was clear that the Government was aiming to make savings from the MBS Review. He said that where savings could be made without adversely affecting patient access to services or clinical practice, they would have AMA support, but it was vital that any savings be reinvested in health.
Professor Bruce Robinson, Chair of the MBS Review Taskforce, told the forum that the Taskforce did not have a savings target, and its aim was to align the MBS with current clinical practice.
“My task is not to save money. The Government may make savings, but I hope that the money is reinvested in health,” Professor Robinson said.
[Perspectives] Serpent spirits in perspex
Circumambulation, walking a ritual path around a sacred object or space, is important in Tibetan Buddhist ritual. The Wellcome Collection’s exhibition, Tibet’s Secret Temple: Body, Mind and Meditation in Tantric Buddhism (video), has been designed as a subtle circumambulation, winding clockwise as it contextualises the history, politics, medicine, and spirituality in which “Tibet’s Secret Temple” was built.
Let them out
Picture: paintings / Shutterstock.com
The Federal Government’s refugee policies will come under attack at a forum being organised by the AMA to highlight the enormous harm caused by indefinite detention.
As doctors at Brisbane’s Lady Cilento Children’s Hospital stand steadfast in their refusal to discharge a one-year-old girl who faces being sent back to the immigration detention centre on Nauru, hundreds are expected to attend an AMA forum in Sydney on 21 February condemning the treatmernt of asylum seekers.
AMA President Professor Brian Owler, who will address the forum, is expected to highlight concerns about the standard of health care provided to asylum seekers, particularly those held in offshore facilities, and to call for the immediate release of all children currently being detained.
The forum, which is expected to be attended by leading clinicians, entertainers, commentators, jurists and religious leaders, comes as the Government advances plans to deport 267 asylum seekers, including 72 children, to Nauru after seeing off a High Court challenge to the legality of its offshore detention regime.
In a landmark decision, the High Court rejected the claim by a Bangladeshi woman detained by immigration authorities that the Government’s arrangement with Nauru breached the Constitution.
The nation’s highest court ruled that the Commonwealth’s memorandum of understanding with the Nauruan Government was authorised by section 61 of the Constitution, and its move to hire Transfield to operate the detention centre on the island was “a valid law”.
Releasing an AMA Position Statement on the health care of asylum seekers late last year, Professor Owler said that although the number of children being held in detention had declined dramatically under the Coalition Government, the practise needed to end completely.
“Detention has severe adverse effects on the health of all asylum seekers, but the harms in children are more serious,” Professor Owler said late last year. “Some of the children have spent half their lives in detention, which is inhumane and totally unacceptable.
“These children are suffering extreme physical and mental health issues, including severe anxiety and depression. Many of these conditions will stay with them throughout their lives.”
The forum, which will be held at the Ionic Room, SMC Conference and Function Centre, 66 Goulburn Street, Sydney on Sunday, 21 February from 11am, will also hear from leading child health experts from the Children’s Hospital at Westmead, including Consultant PaediatricianProfessor Elizabeth Elliott; Clinical Professor, Paediatrics and Child Health, Professor David Isaacs; and Paediatric Nurse Alanna Maycock.
Meanwhile, the Government is being frustrated by the action of doctors, nurses and hospital administrators in refusing to discharge children who face being returned to detention.
Since 12 February, doctors at the Lady Cilento Children’s Hospital have refused to release baby Asha, who was evacuated there from Nauru after being badly burnt by boiling water.
A hospital spokesman told the ABC that the child would not be discharged until a “suitable home environment is identified, as is the case with every child who presents at hospital”.
The spokesman said decisions relating to treatment and discharge were made by qualified clinical staff “with the goal of delivering the best outcome”.
The decision is a rebuke to the Government over the quality of care it provides for detainees, particularly those held offshore.
It echoes similar action taken by doctors at Melbourne’s Royal Children’s Hospital late last year.
The AMA said all asylum seekers and refugees should have universal access to basic health care, something that was “clearly not happening.”
The AMA Position Statement on the Health Care of Asylum Seekers and Refugees can be viewed at: position-statement/health-care-asylum-seekers-and-refugees-2011-revised-2015
The details of the AMA forum on asylum seeker health are:
| Date: Sunday, 21st February 2016
Venue: Ionic Room, SMC Conference and Function Centre, 66 Goulburn St, Sydney Time: 11:00am – 1:00pm RSVP: By COB Thursday, 18th February 2016 to amaforum@ama.com.au |
Adrian Rollins
Of politicians and rectal probes
Despite it being summer and the mercury hitting the 40s in many rural areas, Medicare rebates remain frozen.
It is time all practitioners got active in stirring their electorates up to resolve this bloody-minded impasse. Please talk to your colleges, and get them to get down and get their hands dirty doing some political pushing in this election year.
See your local MP, put up signs in your place of practice informing patients that bulk billing is going to have to end if the freeze continues, and ask patients to get involved to save Medicare as we know it. Universal access for all is under severe threat.
It is well and truly time the people sought honest answers from their politicians as to what the Government’s real plans are for Medicare. It cannot be left to slowly and sneakily strangle it by shrinking patient rebates. As the election draws closer, ramp up your actions.
The Australian Competition and Consumer Commission has a strict embargo on collusion and price fixing so act independently and, if you have any doubts, check your planned actions with the Federal AMA.
You will shortly receive a Rural Medicine Issues Rating Survey, the result of which will be used to guide the AMA in its lobbying on your behalf. Please devote a few minutes to filling it out and telling us what most needs fixing.
The Rural Classification Working Group meets on 25 February, so if you have concerns regarding the Modified Monash formula as it affects you, please let me know now.
I am about to purchase a basic ultrasound with a 40 centimetre rectal probe for the farm to let me know which cows have failed to conceive. I only continue to feed the productive members of the herd.
It is a pity a similar device cannot be used to scientifically sort our politicians into the “keepers” and the “oxygen thieves”.
The annual revelation of the small number of doctors rorting the Medicare system by the Professional Services Review should be accompanied by a similar release of data on politicians rorting the taxpayer, billing us for useless overseas junkets, trips to sporting events and family travel, with the odd helicopter flight and over-the-top entertainment expenses tossed in.
Before the political pot calls the medical kettle black, it needs to get its own house in order.
Thoughtless largesse by our political masters does not engender a culture of thrift in the community, let alone encourage respect.
Change aplenty looms in 2016
Last year was a busy one, with many issues arising that affected salaried doctors, including Rights of Private Practice, workplace wellbeing (such as bullying and harassment), personal safety and the implications of the Border Force Act.
Salaried doctors are always in the front line of public health matters, and the expectations placed on them continue to build, increasing the pressure on terms and conditions.
It is hard to know which issues we will need to focus on as the year progresses, but there are several key issues that are likely to take up much of our time in the year ahead.
Workplace wellbeing
Issues of harassment are of continuing significance. Late last year a report revealed that junior doctors at Canberra Hospital continued to experience bullying, harassment and sexist treatment, leading to concerns about patient care. Lessons for many there.
This comes as no surprise to those who have been following the results of junior doctor surveys around the country. In December, the AMA released its updated Position Statement on Workplace Bullying and Harassment, which outlines the AMA’s commitment to work with the whole of the medical profession to banish bullying and harassment from all medical workplaces.
Salary packaging limits
In its 2015-16 Budget, the Government announced a $5000 cap for salary sacrificed meal entertainment allowances would come into effect from April this year. Currently, in addition to FBT exemptions, employees of public benevolent institutions and health promotion charities can salary sacrifice meal entertainment benefits with no FBT payable by the employer and without it being reported. The ensuing consultation saw many submissions received, including from the AMA. We expressed concern at the potential effect on attraction and retention of staff, especially in struggling rural hospitals.
Despite many voices raised in protest, from 1 April 2016, a separate single grossed up cap of $5000 will apply for salary sacrificed meal and venue hire benefits for employees. Meal entertainment benefits exceeding the separate grossed up cap of $5000 can also be counted in calculating whether an employee exceeds their existing fringe benefits tax (FBT) exemption or rebate cap. All use of meal entertainment benefits will become reportable.
This is yet another erosion of benefits for public hospital doctors and effectively equates to a pay cut by stealth. However, you must comply. Please ensure your affairs are in order for the new regime from 1 April this year.
Rights of Private practice (RoPP)
Our industrial colleagues within the AMA/ASMOF family are continuing their work on a national strategy for RoPP, to bring some consistency to policy in this area. The benefits of RoPP far outweigh any perceived disadvantages, and we hope to make this clear in the policy that is in development. Also in development is a handy information booklet that can be used as a reference for those considering entering into RoPP arrangements.
Medicare Benefits Schedule (MBS) reviews
The MBS Review Taskforce released its consultation papers last September, setting out the background and context for the MBS reviews, as well as the process for undertaking them.
While it is arguably true that the MBS is outdated in many respects, any suggestion by those in the political arena that doctors have been using it to perform unnecessary procedures for financial gain is a pure insult to the profession. AMA policy is that this must not end up being a mere cost-cutting exercise. Clinical input, including from salaried doctors, is absolutely vital to keeping it transparent and relevant.
The consultation process closed on 9 November and the final results are yet to be published. So far, 23 items have been announced for removal.
With a federal election coming up in 2016, we hope that the incoming Government, whatever its political colours, will value the work of public hospitals, their doctors and other staff. I wish you a successful year ahead and look forward to working with you on these and many other issues.
Gender diversity matters
2015 was perhaps a seminal year for the issue of gender inequity in the medical profession.
The year started with comments about sexual harassment in surgery.
To its credit, the Royal Australasian College of Surgeons resisted the urge to deny there was a problem, and instead commissioned an independent Expert Advisory Group (EAG) to investigate its extent. The Group’s report gave a sobering picture of the high prevalence of bullying, discrimination, and sexual harassment in the surgical workforce. I have no doubt that there are implications for the wider medical profession.
It was pleasing that the EAG responded to a number of points put forward by the AMA in its submission, including recognising that commitment to change needs to come from the top, and the importance of increasing gender diversity in senior roles in the College.
A scan of the leadership across the colleges, societies and employers shows limited gender diversity. My own college, the Australasian College for Emergency Medicine, is a case in point – currently, there are no women on its board. This under-representation exists despite the dramatic increase in female participation in the medical workforce in recent decades, to the extent that women now outnumber men as graduates of Australian medical schools.
To be sure, the medical profession is not alone in having a small number of women in senior leadership and management roles. According to the Australian Government’s Workplace Gender Equality Agency, last year only 9.2 per cent of ASX 500 company directors were women; they comprised 9.2 per cent of ASX 500 executive management personnel; and 23 per cent of Australian university vice-chancellors.
Why does this matter?
A healthier gender balance is essential if the medical profession is to harness the potential of all its members, and reflect the realities of modern medicine in policy and practice.
Like many, I believe that determined leadership is the key to accomplishing lasting change in the culture of our profession. This includes the upper tiers of the colleges and associations, the employers of doctors and, indeed, the AMA itself.
At times the pace of change may seem slow, and the task too difficult; however, the changes that have been demonstrated recently within the culture of the Australian Army show what can be achieved with a determined effort.
There has been considerable debate, and no consensus, as to whether an increase in gender diversity is best accomplished by using mandated targets or quotas. In our submission to the EAG, the AMA expressed support for a voluntary code of practice or a similar document, that includes voluntary targets and timeframes.
I believe this approach is worthy of consideration.
Our goal is clear – to achieve timely and substantial progress towards a leadership of the medical profession that reflects its composition. In turn, we are then more likely to realise the full potential of our abilities as doctors, and to promote a healthier professional culture.
AMA acts to hold insurers to account
This time last year I wrote about the AMA’s position on various private health insurance issues in response to increasingly aggressive activities by insurers that were affecting patient care.
In late 2014, the privatisation of Medibank Private saw the market share of for-profit health insurers rise from 34 per cent to more than 63 per cent of health fund members. This has been a game-changer. We now have an industry dominated by the interests of for-profit health insurers rather than not-for-profits, with a subsequent shift of focus from providing patient benefits to increasing profits for shareholders. Medibank announced higher than expected profits this year.
The effects of this are becoming clear. In the second half of 2015, the Australian Competition and Consumer Commission issued a damning report on the quality and accuracy of information provided by private health insurers about their products, and the impact this was having on the ability of consumers to make informed decisions about which policy best suited their needs, and to understand exactly what they were covered for.
The AMA is working to help address this problem. The Medical Practice Committee is developing the AMA’s first annual report card on private health insurance, which will provide consumers with clear, simple information about how health insurance works and encourage them to examine their policy more carefully.
The report card will include a table of all primary products offered by private health insurers to highlight those that have exclusions or restrictions. Consumers can check whether a particular policy provides ‘public hospital only’ cover and should therefore be considered junk.
The report card will also provide information on the level of benefits paid by different insurers for a sample of common procedures. Insurers vary significantly in how much they pay for the same procedure, and therefore how likely it is consumers will face out-of-pocket costs. The report card will also help doctors identify which are the better paying insurers when considering gap arrangements. The cost of a product’s premium is not necessarily a good indicator of how well it will cover health costs.
The regulation of premium increases is one of many regulatory controls over private health insurers that is currently being examined by a review of the industry commissioned by Health Minister Sussan Ley.
The review is examining all aspects of government regulation of private health insurance, including issues such as: expanding its scope to primary health care; relaxing community rating principles; and shifting government subsidies to private hospitals payments for patient care rather than via health insurance premium rebates.
In its submission to the review, which can be viewed at submission/ama-submission-private-health-insurance-consultations-2015-16, the AMA reaffirmed its support for community rating principles, in order to maintain the balance between the public and private hospital sectors. We would strongly oppose any moves to set premiums according to an individual’s risk of ill health.
The AMA also called for junk policies – those with significant exclusions or that provide cover only for treatment in public hospitals – to be banned. Private health insurance policies should meet consumer expectations by covering them for those procedures most likely to be needed, and by providing them with a level of choice about the timing of their care and their medical practitioner.
It will be interesting to see whether the Government will announce any new policies on private health insurance as a result of this review, prior to the election later this year.
I encourage you to email any views or suggestions regarding these issues to president@ama.com.au.
Government faces ballot box pain if no policy shift
The Federal Government could pay a hefty price at the ballot box unless it changes course on health policy, the AMA President Professor Brian Owler has warned.
As senior Ministers thrash out details of the all-important pre-election Budget behind closed doors, Professor Owler cautioned that how the Government responds to the many reviews it has commissioned across health, particularly regarding Medicare, primary health and private health insurance, “may well have a significant electoral impact, especially if key health stakeholders are not properly engaged”.
Professor Owler called for a fundamental shift away from the Government’s current emphasis on cutting spending and offloading the funding burden onto patients and the states and territories.
“The Government is on a path of funding cuts and shifting costs to patients,” the AMA President said. “This is not good for the Australian health system or the health of Australians.
He urged it to “change tack…before it is too late”, warning the Government its current approach might m.
Professor Owler’s comments framed the AMA’s Pre-Budget Submission, which includes detailed recommendations across 18 areas of health policy, from Medicare indexation and reform of hospital funding to GP infrastructure grants, palliative care, alcohol and tobacco policy and immunisation.
The AMA President said the submission gave the Government a guide on how to recalibrate its policy to end the current retreat from core responsibilities in funding and delivering health services.
“There is an urgent need to put the focus back on the strong foundations of the health system,” Professor Owler said. “We need a strong balance between the public and private system, properly funded public hospitals, strong investment in general practice, and a priority put on prevention.”
There are already signs that Government decisions are having an adverse effect on health services.
The AMA Public Hospital Report Card released in late January showed that improvements in hospital performance have stalled, and in some instances have gone backwards, since the Government’s decision to 2014 to rip hundreds of millions of extra funding out of the system.
Professor Owler said the cuts, combined with a downshift in the indexation of Commonwealth hospital funding from next year, showed the Government’s preoccupation with funding cuts came at the expense of good health policy.
The Government’s response to the mental health review provided more worrying signs of how it might approach other areas of reform, he said.
Under the new approach, Primary Health Networks will be paid by the Commonwealth to provide tailored “integrated care packages” for patients with mental health problems.
Professor Owler said there was no commitment to a key role for GPs in providing care, and the Government had provided scant other detail.
“The worry is that the mental health approach may be a signal for what is to come with the Primary Health Review,” he said, and added that a proposal for hospital funding to be replaced by a Medicare-style “hospital benefit payment” that would follow patients was also a worrying sign.
The AMA President said the Government had actively demonised doctors in its MBS review process, had encouraged private health funds to play a more active role in all areas of health despite concerns over inappropriate behaviour and poor value products, and showed signs of pursuing a US-style managed care system.
He warned that “this is not a health policy platform to take to a Federal election”.
In its 27-page Budget submission, the AMA proposed the Government immediately reinstate indexation of Medicare rebates; increase indexation of public hospital funding to a rate that reflects growth in the cost of health goods and services; recognise the both the Commonwealth and the state and territories all have a role in funding and providing health services; explicitly address the role of the private sector in delivering care; and give patients the right to assign their Medicare benefit direct to the provider.
Professor Owler said the nation needed a health system built on “modern health policies, not outdated economic policies designed only to improve the bottom line”.
Adrian Rollins
Govt wants ‘friendly rivalry’ in organ donation
Hospitals will come under pressure to disclose organ donation rates and ensure more staff are trained in discussing the issue with distressed families, as part of changes to organ donor arrangements announced by the Federal Government.
In its long-awaited response to an independent review of the Government-funded Organ Tissue and Donor Authority (OTDA), the Government did not adopt suggestions the country move to an opt-out system for donors.
Instead, Rural Health Minister Fiona Nash announced the establishment of a one-step online registration process for organ donors, the publication of hospital by hospital and State by State donor data, and the automation of a nationwide organ-matching system.
“Almost all Australians would like to be able to receive a donated organ themselves to save their life, or for their child or parent…yet the vast majority are not registered as organ donors,” Senator Nash said. “If we increase the number of registered organ donors, we will save more lives. I look forward to fostering a friendly rivalry between states and hospitals as to who has the better organ donation rate.”
The Government aims to achieve a deceased organ donor rate of 25 per million by 2018, a major jump from the current rate of 16 per million.
Senator Nash commissioned the review last year amid dissatisfaction with the rate of progress in boosting the donor rate.
But the decision was heavily criticised by television personality David Koch, who quit his position as Chair of the OTDA’s Advisory Council live on air in protest at not being consulted over the decision.
The Ernst and Young review partially vindicated the Authority, finding that its strategy to boost donor rates was “sound”. But it added there was “significant room for improvement” if there was effective national implementation and monitoring.
The review found that the OTDA lacked effective oversight, and recommended the appointment of a new Board of Governance to strengthen accountability – advice the Government has adopted.
Senator Nash said that, combined with easier online registration, targeted hospital improvement, better donor and recipient matching and greater transparency over donation rates by hospital and State, would boost donation rates.
Adrian Rollins