Croakey
A comprehensive update on the latest developments and resources in palliative care is provided in the column this week, as well as wide-ranging news in cancer control, including some key recommendations from a Senate inquiry into rare cancers.
Following Budget week, the Health Ministerial team embarked on a series of doorstops and media interviews announcing new Urgent Care Clinics and mental health services, and extolling the virtues of other Budget measures.
Post-Budget week was also National Palliative Care Week. The Department of Health and Aged Care issued a media release marking the week, and referring people to the Palliative Care Australia (PCA) website.
PCA invited people involved in palliative care to complete a survey covering workforce pressures; demand for services; the National Palliative Care Standards; after-hours care; wellbeing at work; voluntary assisted dying; and palliative care in primary care and aged care.
It also issued a new edition of the National Palliative Care Standards, including “simplified, more user-friendly self-assessment tools that services can work through as they embed the… standards into their ways of working”.
PCA also released a series of videos, fact sheets, and check lists co-designed with bereaved parents and health professionals to “assist parents, families, caregivers, and healthcare professionals in making informed and compassionate decisions that support quality of life for children and young people who are dying”.
PCA and the National Rural Health Alliance supported the Australia New Zealand Palliative Care Society in advocating for better access to end of life supports for rural and regional communities, including establishment of a Rural and Remote Institute of Palliative Medicine to oversee and support specific rural and regional training initiatives.
The Department of Health and Aged Care issued a media release reminding health and aged care workers of the availability of free palliative care training and other resources.
The Australian Institute of Health and Welfare (AIHW) released a series of reports on palliative care services, measures, and utilisation based on 2019-20 data. PCA summarised the findings as:
- 80 percent of all expected deaths in Australia each year need palliative care… almost 110,000 people per year, or 2,000 people a week
- 62 percent of all people who need palliative care did not receive specialist palliative care
- people with dementia and heart disease are least likely to receive specialist palliative care, while people with cancer are most likely.
- those in major cities are more likely to receive timely specialist palliative care than those in rural and remote areas. In some of these communities only around 15% of people with a life limiting illness received timely palliative care.
Ministers and government
On 29 February the Therapeutic Goods Administration (TGA) announced a “targeted consultation” on a regulatory change to prevent compounding pharmacies from producing medicines containing GLP-1 receptor agonist analogues (GLP-1 RAs), including semaglutide-like medicine. The move was intended to address pharmacies effectively becoming manufacturers for Ozempic-like medicines.
Minister Mark Butler announced on 22 May that the Government would implement the change from October “to protect Australians from the clear risk to human health posed by the large-scale manufacture of compounded injections”.
He said in a media conference that “everyone – except the pharmacy business owners who are conducting this business – the doctors’ groups, the pharmacy groups, the Pharmacy Board and Medical Board, consumer groups like Diabetes Australia and the Eating Disorders Alliance, they all say this is an unacceptable risk to public safety and it should be shut down”.
Butler also tweeted that he had “signed Australia up to the U=U principles”, joining the US, Canada, and Vietnam. A media release from the Australasian Society for HIV Medicine shed some light on this somewhat cryptic announcement: U=U means “Undetectable=Untransmissible”, and “refers to the fact that when a person living with HIV is on effective antiretroviral treatment for HIV, they will reach an ‘undetectable’ viral load and will be unable to transmit the virus to sexual partners”.
Butler said that “we are confident that embedding U=U into our approach to HIV will accelerate progress towards national and global goals to end the HIV epidemic”.
The Department of Health and Aged Care announced on 22 May it was opening consultation on a new National Immunisation Strategy for 2025-2030, with responses due by 5 June.
Given the significance of the issue, a turnaround of a fortnight seems unduly hasty – especially given the new strategy doesn’t begin until next year.
The short time for response looks even more odd, given that people are being given a week longer to respond to several consultations on niche issues around the private health insurance prostheses arrangements.
In an exemplary display of transparency, the Department released the results of a grant round for “projects focused on maintaining or improving access to quality aged care services, primarily in small rural towns, remote and very remote communities”. While $135 million was available for allocation, applicants sought a total of over $1 billion.
The AIHW issued a technical report which “describes approaches for diabetes case definitions using markers of diabetes status including diabetes specific prescriptions, pathology tests and Medicare Benefits Schedule service items recorded in general practice data”. It’s useful work, but unlikely to make the AIHW most-downloaded hall of fame.
As well as its reports on palliative care, the Institute also released reports on suicide and self-harm, including deaths by suicide among Centrelink income support recipients.
The report on suicides among Centrelink recipients showed that during 2011-21 the age-specific suicide rate for the 36-45 age cohort for disability support pensioners was 78.7 per 100,000 and for JobSeeker recipients was 48.3, compared with the rate in the general population of 17.2. The same broad pattern applies across other age cohorts for these income support programs.
Associate Professor Ben Phillips from the ANU highlighted the decline in the JobSeeker suicide rate coinciding with the massive temporary increase in the payment rate during the worst of the COVID-19 pandemic – while noting that the composition of the recipient population also changed.
Greg Jericho responded “almost like keeping people out of poverty and treating them with dignity saves lives”. Indeed.
Cancer Australia announced the launch of the Australian Comprehensive Cancer Network (ACCN). It said that “there are significant disparities in cancer outcomes for some populations, particularly affecting those in rural and remote regions, as well as Aboriginal and Torres Strait Islander communities”.
The ACCN is intended to “to address these disparities, emphasising coordinated and equitable access to comprehensive cancer services irrespective of where a person lives”. It will be “anchored” by a set of Comprehensive Cancer Centres which will “collaborate with other cancer care centres, academic institutions, Aboriginal Community Controlled Health Services, regional hospitals and allied health services, among others”.
The Aged Care Quality and Safety Commission released a report on complaints about home care providers for the second half of 2023. The number of complaints resolved exceeded the number received, meaning the backlog is being reduced. A third of providers were the subject of at least one complaint, and the most common reasons for a complaint were a lack of communication or consultation, and fees and charges.
AHPRA announced that the WA parliament had adopted amendments to the Health Practitioner Regulation National Law which had come into force in most other states and territories in October 2022. (The National Law is a Queensland law, with amendments adopted automatically in Victoria, Tasmania, and the territories, and following a regulation in NSW and SA, but requiring an Act of Parliament to be adopted in WA.)
APRA released statistics for the private health insurance sector for the March quarter.
The Australian Bureau of Statistics (ABS) reported on progress under the Partnership Reformulation Program (an initiative under the Healthy Food Partnership), which “aims to reduce the Australian population’s consumption of sodium, saturated fat and sugar from processed food products”.
While the system of participating products and targets is complex, the bottom lines are:
- “consumption of sodium for the Australian population fell by 0.3 mg per capita per day between June 2021 and June 2023. This is equivalent to a 0.01 percent decrease in the estimated total consumption of 3,093 mg of sodium per capita per day in June 2021”
- “the reformulation of participating products [to reduce sugar content] resulted in a 1.3 percent decrease in total sugars between June 2021 and June 2023. In per capita terms this amounted to a decrease of less than 0.1 gram per day from the estimated total sugar consumption of 109 grams per capita, per day”.
Given NHMRC advice that maximum daily sodium consumption should be 2,000 mg, and WHO advice that total daily sugar consumption should not exceed 50 g, it will be hundreds of years (sugar) and thousands of years (salt) before we reach healthy levels, if current rates of reduction in consumption continue.
First Nations health
The Department of Health and Aged Care for the first time added to the consultation page on its website an invitation from the Interim First Nations Aged Care Commissioner, Andrea Kelly, to present views on:
- the changes needed to support culturally safe, trauma aware and healing informed access to the aged care system for older First Nations people, carers, families and communities; and
- the statutory First Nations Aged Care Commissioner role and their functions and authority.
Apparently the process opened on 5 February; submissions close on 21 June.
Consumer and public health groups
The Consumers Health Forum welcomed the Government’s ban on compounding replica Ozempic, but expressed concern about the possible impact on patients with a genuine need for the drug.
The CHF strongly encouraged the Australian Government “to do what it can to ensure supply” after the ban takes effect in October.
Trade unions
The Australian Medical Association (AMA) joined with 11 peak education lobby groups in “a joint letter to all Senators and MPs… warn[ing] of the growing crisis of vaping in Australian schoolyards, where teachers, principals and parents are facing a difficult battle to protect the health and wellbeing of children”.
The letter urged Senators to “stand up for the wellbeing of young Australians”, and pass the Government’s anti-vaping legislation.
The Australian Psychological Society (APS) claimed credit for the rapid modification of a Government decision to change the referral requirements for mental health treatment plans under the Better Access program. The profession’s concerns about the change were cogently set out by the Australian Association of Psychologists in its post-Budget release.
The Royal Australian College of General Practitioners (RACGP) called on “all state and territory governments to save the future of general practice care so that no patients miss out”.
A big call – but it turns out it is only about continuing the previous exemption from payroll tax for GP remuneration. So far the Victorian, Queensland and SA Governments have taken action to ensure that payroll tax does not apply, but the issue is still to be resolved elsewhere.
The College also launched a new Advocacy Plan which will deliver “stronger, more focused advocacy from Australia’s peak general practice body”.
The Royal Australasian College of Physicians released its March submission to a TGA consultation on medicine shortages, calling for medicine manufacturers and sponsors to advise the TGA of a shortage or discontinuation and expected end date well in advance; minimum stock levels of critical, life sustaining medications; local production of medications to be encouraged; international suppliers of critical medicines to be encouraged to enter and remain within the Australian market through “TGA-driven incentives”; and a “system-wide and nationally coordinated approach among supply chain partners and the Government to reduce the risk of medicine shortages through the use of artificial intelligence technologies such as big data analytics”.
The College also released its response to the Budget, saying that Urgent Care Clinics should have access to specialist physician care to improve their effectiveness in reducing pressure on hospitals. It also “expressed disappointment at the Budget’s lack of initiatives to address significant health workforce pressures and burnout, to expand telehealth services for people living in regional and remote Australia and to adequately fund the Australian Centre for Disease Control”.
The Society of Hospital Pharmacists of Australia welcomed the release of the report of the Senate rare cancer inquiry (see below in this column) and the announcement of the Australian Comprehensive Cancer Network. It also released the Standard of Practice in Palliative Care for Pharmacy Services as part of National Palliative Care week.
Industry groups
Catholic Health Australia welcomed the unheralded decision by the Government to allow aged care providers to meet up to 10 percent of target minutes for RN care with enrolled nurses. Yet another watering-down of a clear recommendation by the Aged Care Royal Commission.
Private Healthcare Australia (the main private health insurance lobby group) used the release of the latest Australian Prudential Regulation Authority (APRA) quarterly statistics on the sector as the background for another complaint about the regulatory regime governing prostheses benefits.
PHA said that “APRA data shows that over the past five years, the number of medical devices funded by health insurers increased by 20.5 percent compared with a 4.6 percent increase in hospital treatment medical services and a 5.9 percent increase in hospital episodes over the same time. This is not sustainable and has not been associated with an improvement in patient outcomes over this time”.
Members Health Fund Alliance (the peak body for private health insurers that do not distribute profits) also welcomed the APRA release, with CEO Matthew Koce stating that “the more than 14.8 million Australians who are members of a health fund receive fast access to high-quality care with doctor of choice, while also helping to alleviating pressure on our overstretched public health system”.
Just to be clear, the 14.8 million is the number of people with general treatment insurance. Only 12.2 million have hospital insurance, which may allow doctor of choice, and less than half of those have policies covering them for the full range of hospital services.
Private Healthcare Australia also called “for the Government to tighten rules for early access to superannuation so people can only use it for terminal and life threatening medical conditions”. This was a response to data showing an increasing number of people obtaining early access to superannuation to pay for dental treatment.
Politicians and parliamentary committees
The report of the Senate inquiry into rare cancers appeared on the committee’s website, with no fewer than 41 recommendations.
Some we have seen before: “the committee recommends that state and territory governments reform patient assisted travel schemes with a view to create more consistency in scheme offerings across all jurisdictions; increase financial assistance; and expand schemes to include travel and accommodation costs for clinical trial participants”.
Some require an upheaval of the TGA application and approval process: “the committee recommends that the Australian Government adjust regulatory processes to broaden indication coverage for medicines that treat rare and less common cancers, including neuroendocrine cancer”.
Some are welcome, albeit not only relevant to rare cancers: “the committee recommends that, as a matter of priority, the Australian Government legislate a complete ban on genetic discrimination in life insurance”.
Now we need to see how long it takes for a Government response – which under Senate rules is due by mid-August.
Which of course reminds me that the Government response to the Senate dental inquiry is now 13 weeks late.
International organisations
The World Health Organization (WHO) reported that COVID-19 had “wiped out nearly a decade of progress in improving life expectancy within just two years”.
“Between 2019 and 2021, global life expectancy dropped by 1.8 years to 71.4 years (back to the level of 2012). Similarly, global healthy life expectancy dropped by 1.5 years to 61.9 years in 2021 (back to the level of 2012)”.
Finally
This column reported recently on the passage through the British House of Commons of a Bill to make it illegal to sell tobacco to anyone born in or after 2009. Unfortunately, the Bill was not introduced to the House of Lords before PM Rishi Sunak announced an election on 4 July, and was not prioritised for introduction and passage before Parliament was prorogued.
However, the public health movement should not lose heart. According to the BBC, Labour has promised to proceed with the ban if elected, and Sunak remains committed to the ban, which is “likely to feature in the Conservative manifesto”.