LABOR’S “dud’’ Medicare Locals will be rebadged and redesigned after GPs complained that the $1.8 billion bureaucracy is failing to deliver real services to patients.

See previous NACCHO reports here

NACCHO Aboriginal healthly debate: Medicare Locals (MLs) their future is unclear ?

Also below Croakey Health WRAP

Senior government sources have revealed that a review into the system has confirmed some sites underperforming. Staff working at Medicare Locals also hate the name, complaining patients think they can claim Medicare refund there or actually see a doctor.

But the review has come with a hefty $550,000 price tag according to tender documents obtained by the Sunday Telegraph. Despite the contract running for just three months, it comes with a $550,000 contract for accounting services awarded to Deloitte.

Medicare Locals were established by the Rudd-Gillard government and were designed to better integrate GP and primate health care services. Unlike GP superclinics, they are not a shopfront with doctors.

Doctors have also labelled the program a dud, with the Australian Medical Association releasing a survey stating that 75 per cent of GPs believed the program had “not resulted in any improvement in access to, or deliver of primary healthcare, and should be scrapped.”

Health Minister Peter Dutton confirmed he would announce changes to Medicare locals when he had considered the findings of the review.

“Labor wasted billions in health and we have to get the system back on track so we can pay for cancer drugs, the ageing population and the massive onset of dementia and obesity,’’ he said.

But Labor health spokeswoman Catherine King said any moves to scrap Medicare locals, reduce funding or close some down would represent a broken election promise.

“Any cut to Medicare Locals would be a clear broken promise by the Prime Minister.

Medicare Locals are transforming the way primary care is delivered across Australia and making it easier for all Australians to get to doctors, psychologists, nurses and other allied health professionals,’’ she said.

During the election, the Prime Minister announced he would review Medicare locals if elected, admitting he cannot guarantee they will stay “exactly the same.”

“I don’t guarantee they’re all going to stay exactly the same. Our focus is on trying to move the money from the back office to frontline services,’’ he said.

“Now, can I say that absolutely no Medicare Local will close? I can’t say that.”

But a week later, during a leaders’ debate on August 27, Mr Abbott also pledged: “we are not shutting any Medicare Locals.”

By Melissa Davey

Welcome back to the fortnightly Health Wrap, and the first for 2014.  We hope your start to the year has been a healthy one. There have been some hot health topics in the headlines for the past couple of weeks, and they have particularly focussed on alcohol and cancer.

World Cancer Day reveals some sombre projections

A cancer tidal-wave is on the horizon, the BBC reports, leaving World Health Organisation (WHO) scientists warning that that much tougher restriction on alcohol and sugar intake is needed. The BBC also reports the World Cancer Fund as saying that the public still has a huge level of naivety about the importance of diet and alcohol intake in cancer prevention.

Alcohol is an attributable factor in nearly 2000 new cancer diagnoses a year in Scotland, with an increased risk of developing breast, head, neck, oesophagus, bowel and liver cancers, the Herald Scotland reports. The article says that even drinking alcohol within sensible limits may lead to an increase in cancer risk.

The success of the program has prompted some Australian health experts to call for cigarette-style warning labels to be placed on alcohol packaging warning of cancer and other risks, news.com.au reports.

World Cancer Day on February 4 coincided with the release of the WHO’s World Cancer Report, which found cancer had surpassed heart disease as the biggest killer in Australia. In 2011 there were 7.87 million cancer deaths compared to 7.02 million from heart disease (stroke deaths were considered separately), the report found.

Also concerning was the release of Cancer Council NSW data  that revealed NSW men over 50 are three times as likely to die from melanoma as women the same age, partly because more than half of men in that age bracket are not aware of the high risk associated with skin cancer.

Meanwhile the New York Times asks if we are giving ourselves cancer, in this piece examining the link between radiation – particularly from CT scans– and the disease.

Finally, The European Cancer Patient’s Bill of Rights was unveiled this week to address the differences in care received by cancer patients across Europe. Some 1000 medical organisations and cancer groups from 17 European countries collaborated to produce the Bill.

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A mixed response to alcohol law reforms

The NSW government has revealed its latest plan to curb alcohol-related violence which will see an eight-year minimum sentence for alcohol or drug-fuelled assaults that result in death, while bottle shops will close at 10pm across the state and licensed premises in the centre of Sydney won’t be allowed to let new patrons in after 1.30am. The laws have civil liberties groups up-in-arms, the ABC’s PM reports.

But NSW Opposition leader John Robertson believes the plans don’t go far enough, telling SBS that the announcement is rife with loopholes. “We have lock-outs with loopholes where small bars will be exempt from lock-outs,” Mr Robertson said to SBS. “Backpacker bars will be exempt from lock-outs and hotels with bars will also be exempt from lock-outs.”

The family of alcohol-related violence victim Thomas Kelly, the teenager who died in 2012 after being punched once in the head, spoke to the media following the reform announcements, describing them as “bittersweet” but “amazing”.

However, the SBS reports legal experts have raised concerns about plans that have been rushed through the State Parliament, fearing they will result in a large increase in the number of Indigenous people jailed. Fines for some drunken violence offences will result in people who are unable to pay being jailed, they report.

While the Australian Medical Association (AMA) welcomed the proposed measures, they also say measures should be tougher. The AMA called on the federal government to convene a national summit bringing together government, councils, police, health experts, teachers, victims and industry to come up with solutions to the alcohol misuse epidemic.

Finally, Croakey reports that The Alcohol and other Drugs Council of Australia – the national peak body for the alcohol and other drugs sector for nearly 50 years – has put in a heartfelt request to present to the Abbott Government’s National Commission of Audit on the impact of its unexpected defunding last November.

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Vaccines, fluoride and vitamins – pushing for best practice

Prominent public health expert and anti-pseudoscience campaigner Dr Ken Harvey quit his job as an adjunct professor with Victoria’s La Trobe University after the University struck a $15 million, six-year deal with vitamins manufacturer Swisse.

The ABC reports the University described the memorandum of understanding with Swisse as an important step towards establishing a complementary medicine centre, which Dr Harvey described as a conflict of interest.

Dr Harvey’s move has been supported by Friends of Science and Medicine, an association that lobbies for evidence-based medicine, The Conversation reports. The organisation has called on La Trobe University to abandon the planned research into Swisse supplements.  In his resignation letter, Professor Harvey said he was concerned La Trobe University would be pressured to “produce results that will justify the company’s investment”.

GP and medical writer Dr Justin Coleman has also backed Dr Harvey’s  “brave stance”, writing:

“ I am a senior lecturer at two Australian universities and I would also be very troubled if one of them compromised its independence in this way.”

To vaccines, and The West Australian reports more WA doctors are refusing to endorse parents who object to their children being vaccinated, but who need a letter from their GP to get government benefit payments.

New Federal Human Services Department figures reveal an extra 479 WA children were added to the conscientious objectors’ database last year – a 13% increase on the previous year, the piece says.

Meanwhile, experts fear public confidence in vaccination programs could be undermined after dozens of young children were given a flu vaccine despite it being banned for under five-year-olds. The Therapeutic Goods Administration says across the country, 43 children under the age of five were injected with Fluvax last year, the ABC reports.

This excellent map from Mother Jones reveals the high cost of vaccine hysteria across the world, with measles and mumps making a comeback thanks to anti-vaxxers claiming an autism link – a link that has been utterly and thoroughly debunked thanks to evidence and science.

We’ll let Slate have the final say on anti-vaxx nonsense, in this piece which explores what creationists and anti-vaxxers have in common. “Ignorance is curable by education, but wilfully ignoring the facts can be contagious — and even fatal,” they write.

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E-cigarettes – ban or regulate?

In a world where there are one billion smokers and smoking kills almost six million people a year, the regulation of e-cigarettes is a high-stakes debate, writes health journalist Andre Picard for the Globe and Mail.

While research on e-cigarettes and their potential harms and potential benefits is in its infancy, and data on long-term risks and benefits are lacking, he writes that with tobacco causing so many deaths around the world e-cigarettes may be a step in the right direction.

But as this piece for OPB says, a major barrier to policy making on e-cigarettes is the lack of scientific knowledge about the products. A report released this month by the US Surgeon General called for research and regulations on e-cigarettes, as well as other new nicotine-based products being introduced to the market, the piece says.

Meanwhile, tobacco giant Philip Morris has been taken-to-task by the ABC’s Fact Check Unit for saying “the data is clear” that plain packaging has not stopped people smoking. Public health experts and even Philip Morris competitor Imperial Tobacco say it’s too soon to draw conclusions about the long-term impact of plain packaging on smoking, the ABC reports.

Meanwhile,  Dr Melissa Stoneham reports for Croakey on research that investigated smoking cessation apps and whether they adhered to evidence-based practice. The researchers found that of the more than 400 apps available, most were missing basic evidence-based practices, such as referral to a Quit line or providing information on approved medications.

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Experts are arguing for a cultural approach to health spending in light of high costs and poor outcomes, this piece for Al Jazeera says. According to the World Health Organization, Australia’s 670,000 Aboriginal and Torres Strait Islander people suffer from diseases found nowhere else in the developed world – such as trachoma, a form of preventable blindness.

Meanwhile the National Aboriginal Community Controlled Health Organisation (NACCHO) reports that during the past three years, Aboriginal and Torres Strait Islander suicides reached nearly 400.

Commenting on the crisis, NACCHO chair Justin Mohamed said: “Aboriginal and Torres Strait Islander people experience suicide at around twice the rate of the rest of the population. Aboriginal teenage men and women are up to 5.9 times more likely to take their own lives than non-Aboriginal people.”

Psychiatrist Professor Alan Rosen writes for Croakey that the impact of sustained heatwaves or drought on Aboriginal communities needs further investigation. He referred to this study; ‘The impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales’, published in the Australian Journal of Rural Health in 2011.

It found drought was affecting Aboriginal wellbeing by damaging traditional culture; skewing the population profile in smaller centres; exacerbating underlying grief and trauma; and undermining livelihoods and participation, amongst other things.

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Australians nutritional guidelines need to be tougher

Australian researchers have found controls on food manufacturers are being weakly implemented, as foods continue to contain too many unhealthy ingredients like sugar and fat. Professor Bruce Neal, at The George Institute and The University of Sydney, led a team that evaluated the Federal Government’s Food and Health Dialogue, Health Canal reports. The evaluation was published in the Medical Journal of Australia.

As director of Health Strategies for the Cancer Council NSW, Kathy Chapman, writes in a piece published by Croakey and originally appearing in The Conversation; “most people doing their grocery shopping are blissfully unaware of the industry lobbying and backroom politics that determines what information appears on food labels”.

But attempts to treat obesity are being hampered by flaws in clinical guidelines as well, with the head of clinical obesity research at the Baker IDI Heart and Diabetes Institute, John Dixon, saying Australian obesity guidelines contain inadequate advice on monitoring nutritional deficiencies after bariatric surgery.

National Health and Medical Research Council guidelines released in June last year contained the “potentially dangerous” implication that nutritional problems should only be assessed after symptoms developed, including muscle wastage and bone pain, Professor Dixon tells Fairfax.

However, Australia must be getting at least something right in the war on obesity. New Zealand Prime Minister John Key has announced that Australia‘s obesity prevention program will be adopted there , International Business Times reports. New Zealand Health Minister Tony Ryall visited Victoria and said the children who were part of the obesity prevention program had become more active and lost weight.

Meanwhile, academics and policy experts specialising in medicine and nutrition in the UK have formed a campaign group, Action on Sugar, to convince manufacturers to gradually lower the amount of sugar added to foods – so slowly that it isn’t missed by consumers.

But this piece in New Scientist says using initiatives that have successfully reduced the amount of salt in manufactured foods may not work when it comes to sugar.

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Health sector reforms and health policy

In this piece for Croakey, Australian Healthcare and Hospitals Association CEO Alison Verhoeven reports on a round-table meeting held in Canberra to celebrate Medicare’s 30^th birthday. She asks whether consumer expectations for access to free public hospital services and bulk-billed consultations with doctors are realistic in a time when healthcare costs are increasing.  Some thoughtful wishes for a 30^th birthday makeover for Medicare were also shared in this Croakey piece.

Sydney Morning Herald Economics Editor Ross Gittins writes that while therising cost of healthcare is the greatest reason for increasing in budget deficits, it is rarely made clear that this assumes a limit on the growth in healthcare taxation.

And Drs Gemma Carey from the Centre of Excellence in Intervention and Prevention Science and Pauline McLoughlin from the LightHouse Foundation examine the Victorian Government’s recently launched  ‘Roadmap for Community and Human Services Reform’, lead by Dr Peter Shergold. Their article for Croakey covers some of the challenges for reformers hoping to tackle ‘top-down’ relationships, service silos, overly complex funding arrangements and legacies of mistrust.

The policy head of Research Assets at the Sax Institute*, Bob Wells, says health policy analysts have spent the first weeks of the year vigorously debating ways to rein in Australia’s rising health budget and to make the system more efficient. His  piece for The Conversation examines a couple of the proposals on the table.

Meanwhile Professor Peter Brooks argues in a piece for Croakey that reform of the fee-for-service payment system must be considered as part of a broader discussion about the future sustainability of the health system.

Also for Croakey, a health policy analyst writing anonymously  examines what might be expected from the National Commission of Audit when it comes to health policy. Looking back might help us look to the future, the writer says, speculating about what the Commission might recommend and implement including removing regulatory duplication, and pricing blood products.

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Healthy bloggers

The health blog featured in this Health Wrap comes from NPR. Their comprehensive public health blog includes news about health from around the globe including the latest on prevention, disease outbreaks and the world’s response to health crises.

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Other Croakey reading you may have missed this fortnight:

REVIEWING THE LOCALS Last year, Health Minister Peter Dutton appointed Professor John Horvath, a former Commonwealth chief medical officer to head the review. The terms of reference include an investigation into whether the program is actually delivering clinical services and whether it has increased the co-ordination of after hours care. Nearly half of all GPs surveyed by the AMA last year found the bureaucracy employing 3,000 people was “duplicating existing GP services. “The starting point for the Review is to change the name — ‘Medicare Locals’ means nothing to the people who need access to quality primary health care services in their communities,’’ Australian Medical Association President Steve Hambleton said in a statement. “It sounds like another layer of bureaucracy. The name should project an active role in looking after people’s health.”