NACCHO Aboriginal Health News Alert: @AMAPresident releases its vision for the future – Delivering Better Care for Patients: The AMA 10-Year Framework for Primary Care Reform

AMA President, Dr Tony Bartone has released its vision for the future of primary health care and general practice in post-COVID Australia – Delivering Better Care for Patients: The AMA 10-Year Framework for Primary Care Reform.

General practice is the cornerstone of successful primary health care and the foundation of Australia’s world-class healthcare system.

However, despite agreeing with the rhetoric of the importance of properly funded general practice, successive Governments have overseen a rate of investment in general practice that has not matched the increase in the cost of providing high-quality patient care.

The AMA 10-Year Framework identifies immediate funding goals to ease the financial pressures on general practice, and long-term reforms that should be implemented as part of the Federal Government’s 10-year Primary Health Care Plan.”

Download the AMA 10-Year Framework for Primary Care Reform HERE

Read over 50 NACCHO Aboriginal Health and AMA articles published over the past 8 years HERE

“Government spending on GP services is about $391 per person annually, down from $395 in 2017–2018.

The Australian population is growing, ageing, and developing more complex health needs as chronic disease and mental ill-health continue to increase. General practice funding models must change to meet the needs of the community.

COVID-19 has highlighted the under-funding of general practice for decades. Large financial incentives were needed to keep many practices viable.

Teleheath – an innovation that the AMA has long advocated for – was implemented in the midst of the pandemic to assist access and connection of patients with their usual GP at this time of critical challenge.

The AMA is calling for Federal Government spending on general practice services to be increased to at least a mandated 16 per cent of total health spending as part of a range of reforms to support general practice and improve access to GP care for all patients.

The AMA has made four key recommendations:

  • Primary care reforms to build on the existing GP-led model of primary health care, which deliver high-quality, cost-effective outcomes for patients;
  • The Government to work closely with the AMA and medical profession to develop and implement a suitable funding model to enable the transformation of general practice into a medical home;
  • General practice to be adequately funded to reach its full potential and meet the increasingly complex healthcare needs of the community, involving a mandated 16 per cent of total health spending; and
  • Continued investment in long-term strategies to ensure a sustainable medical workforce.

NACCHO welcomes the new AMA President, Dr Omar Khorshid and Vice President, Dr Chris Moy.

The election of Dr Khorshid and Dr Moy at the AMA’s National Conference, follows the conclusion of the two-year term of President Dr Tony Bartone and Vice President Dr Chris Zappala.

Dr Khorshid, an orthopaedic surgeon in Perth and a former AMA WA President, said governments should increase medical, health, and aged care expenditure to combat both COVID-19 and help the economy avoid prolonged recession. “State and Federal Governments have rightly funded the response effort to COVID-19,” Dr Khorshid said.

NACCHO Chair and the NACCHO team congratulate Dr Khorshid and Dr Moy on their election. We look forward to working closely with you on Closing the Gap in Aboriginal and Torres Strait Islander health.

Image credit: ABC News

Aboriginal and Torres Strait Islander Elder Care News : Read or download both NACCHO’s 15 Recommendations and @AMAPresident 42 Recommendations in submissions to the Royal Commission into Aged Care Quality and Safety

” Older Aboriginal and Torres Strait Islander people are being let down by the aged care system.

 They are significantly underrepresented in residential aged care services, at under one per cent, and their uptake of dementia services is very poor.

Yet older Aboriginal and Torres Strait Islander peoples experience at least 2.3 times the burden of disease as other Australians and are also 3-5 times more likely to experience dementia.i

 It is a sad indictment of the system that the care needs of our ageing First Peoples are not being met.

The needs of older Aboriginal and Torres Strait Islander peoples require urgent attention by the Australian Government and the health and aged care systems.

NACCHO Submission to the Royal Commission into Aged Care Quality and Safety 30 September 

Download the full NACCHO Submission HERE

NACCHO submission_Royal Commission Aged Care Quality and Safety_September 2019_FINAL (1)

Read previous NACCHO Aboriginal and Torres Strait Islander Elder Care articles

 ” The Royal Commission, we know, has been extended to 2020, November 2020.

And they’re having to encounter and deal with an enormous number of submissions, of stories that we see making the front pages of our papers and the headlines on our evening news day after day after day.

They’re stories of neglect, they’re stories of lack of care, of stories of lack of access at the appropriate and necessary time of their life.

The Aged Care Commission will deliver its findings in November 2020 and they need that additional time – it’s just been announced that their findings will be delayed another six months, because they’ve got to deal with all the necessary work and all the submissions they’re receiving.

But the message I want to leave with you today is that we can’t wait for the findings of the Royal Commission to start investing in aged care.

AMA President, Dr Tony Bartone, and ANMF President, Annie Butler, Doorstop, Parliament House, Monday, 30 September 2019 Pictured above :

Aboriginal and Torres Strait Islander people living in regional, rural and remote Australia experience particular challenges in accessing culturally and linguistically appropriate aged care services and supports.

Ongoing investment into programs such as the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) is essential in supporting the growth and development of aged care services for Indigenous Australians. ” 

AMA Recommendation 40 of 42 see in full Part 2 below or Download 

As the Commissioners will be aware, the population of First Peoples aged 65 and over is projected to grow by 200 per cent between 2011 -2031.ii

This unprecedented population growth combined with the complex health issues that our people experience as they age presents major challenges for providers of both aged care and primary health care to respond to increased service needs from Aboriginal and Torres Strait Islander elders.

We believe it is imperative that the Australian Government commits to resourcing more innovative, efficient and effective solutions that address the barriers to accessing aged care solutions for older Aboriginal and Torres Strait Islander peoples.

NACCHO welcomes the opportunity to provide this submission to the Royal Commission into Aged Care Quality and Safety.

We wish to acknowledge the comprehensive nature of this inquiry, including the different ways in which members of the public, aged care providers and other interested agencies have been invited to contribute.

The Royal Commission hearings have provided ample evidence of the key components and conditions that make up best practice aged care for older Aboriginal and Torres Strait Islander peoples.

They have also provided evidence of systemic failures to provide culturally safe, accessible care. It is also evident from the hearings, however, that there is a genuine interest among all participants to better understand the needs of older Aboriginal and Torres Strait Islander people in order to inform recommendations on how to improve their health and aged care outcomes.

NACCHO’s vision is that all Aboriginal and Torres Strait Islander peoples be able to enjoy quality of life through whole-of-community self-determination and individual spiritual, cultural, physical, social and emotional well-being.

To enable this vision, our people must be granted agency in the development and implementation of policies and programs that impact on their lives, as enshrined in the Aboriginal and Torres Strait Islander Act 2005 (Cth) and the UN Declaration on the Rights of Indigenous Peoples 2007.iii

We believe the next step forward in addressing the needs of older Aboriginal and Torres Strait Islander peoples as outlined in this submission, is a genuine commitment from the Australian Government to work in partnership with Aboriginal and Torres Strait Islander peoples and their representatives to develop solutions and oversee their implementation in services on the ground.

This submission addresses the Royal Commission’s Terms of Reference in relation to the criteria of:

  • Person-centred aged care;
  • Challenges and opportunities for delivering accessible, affordable and high quality aged care services; and
  • How best to deliver aged care services in a sustainable way, including through innovative models of care and investment in the aged care

NACCHO’s response to the Terms of Reference includes feedback received from our member services, Aboriginal Community Controlled Health Organisations (ACCHOs), who deliver a range of services in urban, rural and remote communities across Australia.

NACCHO Concluding comments and recommendations

It is imperative that, given the population projections of older Aboriginal and Torres Strait Islander peoples, the burden of disease they carry, and their underrepresentation in the aged care system, that their needs and preferences are given urgent priority.

NACCHO believes the next step forward is for the Australian Government and providers to deliver on what works, in genuine consultation with Aboriginal and Torres Strait Islander peoples and their representatives.

Aboriginal and Torres Strait Islander peoples need to be decision makers on what a culturally safe aged care system looks like.

NACCHO is strongly committed to and interested in being part of the solutions to address the care needs of our people and is confident that, with adequate resourcing, the Aboriginal community controlled health sector has the knowledge and experience to make a positive difference to older First Peoples’ health and aged care outcomes.

The following list of recommendations are based on our consultations with Aboriginal and Torres Strait Islander representatives, including our member services.

NACCHO recommends that:

  1. Cultural safety be embedded across all areas of aged care services, compliant with what is outlined in the Aged Care Diversity Framework and Action xxxvi
  2. Cultural safety be a mandatory part of accreditation
  3. As part of their accreditation requirements, mainstream aged care services commit to work collaboratively with local ACCHOs, including seeking their advice on issues relating to cultural safety and trauma-informed
  4. Aboriginal community controlled organisations be funded to deliver regular cultural competency training, tailored to local protocol, to mainstream aged care
  5. Regular cultural safety training be mandatory for all aged care assessors and call centre staff.
  6. There must be a concerted effort to increase the numbers of Aboriginal and Torres Strait Islander peoples who receive higher levels of package care (levels 3 and 4).
  7. That the Australian Government commit to undertaking feasibility studies on the need for additional residential aged care services in remote and very remote locations in close consultation with Aboriginal local communities, including exploring options for:
    1. additional National Aboriginal and Torres Strait Islander Flexible Aged Care Services; and
    2. establishing Aboriginal and Torres Strait Islander specific, community-based, small scale hostels with formal ties to local ACCHOs and/or residential aged care services.
  8. Funding for interpreters be available for Aboriginal and Torres Strait Islander language speakers as it is for other
  9. Aboriginal and Torres Strait Islander run aged care services become eligible to access block
  10. Aboriginal Community Controlled Health Organisations receive an increase in their baseline funding in recognition of:
    1. the vital roles they play in keeping older Aboriginal and Torres Strait Islander peoples healthy and well in community and residential aged care settings;
    2. the projected population growth of this age group; and
    3. the significant burden of disease and complex health conditions experienced by older Aboriginal and Torres Strait Islander
  11. ACCHOs are designated as preferred providers of aged care navigation services for older Aboriginal and Torres Strait Islander peoples, through the aged care application and assessment
  12. ACCHOs are designated as preferred providers of primary health care for all Aboriginal and Torres Strait Islander residents of aged care
  13. The Australian Government increase its investment in integrated primary health and aged care exemplified by
  14. The Australian Government, at a minimum, reinstate aged care workforce funding to the same level prior to the 2015
  15. Aged care services are funded to employ Aboriginal liaison

PART 2 The AMA makes the following recommendations to the Royal Commission and looks forward to further working with the Royal Commission and the Australian Government to further improve the aged and health care systems.

Aged care workforce

Recommendation 1: Retaining and increasing the number of doctors interested in working in the aged care space should be the focus of any future reforms in aged care if appropriate clinical care is to be provided. Investing in primary care particularly for patients in aged care settings will save on public hospital expenditures.

Recommendation 2: Further investigation and research is needed into the demographics and movements of GPs in the aged care sector due to the decreasing trend in GP aged care visits and an ageing medical workforce. The research needs to take into consideration the forward-looking trends of expenditures related to Australia’s ageing population and the projected need for the medical workforce.

Recommendation 3: Medicare rebates need to increase in excess of 50 per cent to begin to adequately compensate for the additional time and complexity involved in comparison to a GP attendance in their own consulting rooms.

Recommendation 4: Introduce an MBS telehealth item for phone calls between the GP, RACF staff and relatives. This may reduce some barriers to accessing medical services after hours. The Government should consider introducing telehealth for RACFs for afterhours consultations as a pilot. Outcomes of such a pilot program will help inform government policy and provide an evidence base for informed decision making.

Recommendation 5: The Royal Commission should investigate the absence of routine roles for geriatricians and psychogeriatricians and how this should be addressed to better support GPs.

Recommendation 6: Further research is needed into improved funding and workforce models for medical care of older people.

Recommendation 7: Aged care providers need to provide basic equipment and facilities to support doctors to carry out their services in aged care settings. This includes access to a consulting room, a computer and appropriate clinical software.

Recommendation 8: Education and training for Doctors in Training and medical students on caring for older people should be increased.

Recommendation 9: Registered nurses should be available on site, 24 hours a day in RACFs to ensure older peoples’ medical needs are adequately met, including the appropriate administration of medicines.

Recommendation 10: There should be a mandatory minimum qualification for personal care attendants that includes basic health care.

Recommendation 11: Government should provide additional funding for specialised training of the aged care workforce, primarily personal care attendants. This should include a professional development leave option for those wanting to further develop their skills.

Recommendation 12: Implement a streamlined process to improve access to respite care for people who have not yet been assessed by an ACAT/RAS or who have not yet entered the aged care system.

Recommendation 13: Minimum mandatory staff-resident ratios should be researched and then introduced in RACFs that reflect the level of care need of older people and ensure 24 hour on site registered nurse availability.

Recommendation 14: The Aged Care Safety and Quality Commission should investigate staff turnover when assessing and auditing aged care providers.

Recommendation 15: The effectiveness of the aged care assessment process should be improve by including the patient’s usual doctor in the assessment arrangements.

Fragmentation between health and aged care systems

Recommendation 16: Communication between doctors, hospitals and aged care providers must be improved through minimum standards and guidelines.

Recommendation 17: Government must make more home care packages available to older people to address their care needs and to prevent the need for more complex care in RACFs and hospitals.

Aged care regulation

Recommendation 18: More specific Aged Care Quality Standards, including a Medical Access Standard should be developed for RACFs that helps to facilitate access to doctor services and high-quality clinical care.

Recommendation 19: Quality Indicator data should be made an integral part of the accreditation/audit reports conducted by the Aged Care Quality and Safety Commission.

Quality of care in aged care settings

Recommendation 20: Palliative care must be built into any aged care model, by defining the skills and staff requirements and recognising that palliative management is a basic RACF service. The funding model must be flexible enough to account for increased needs at the end of life and be responsive enough to allow for reassessment when required.

Recommendation 21: AMA members support mandating the requirement that all RACFs residents should have a current up to date ACD. AMA members also contend that there should be an MBS item/fee available for GPs to complete ACDs with their patients living in RACFs or their SDMs.

Recommendation 22: Further work is needed to raise awareness among aged care service providers on advance care planning, the role of aged care providers in ensuring the development and implementation of advance care plans, directives and communication around hospital transfers and the person’s usual GP, the need for caring staff to be aware of existence of ACDs, My Health Record and advance care planning, as well as the role of ACDs in clinical care.

Recommendation 23: Expand the Better Access to Mental Health Initiative to ensure older people living in RACFs receive the same access to mental health services as the rest of the population.

Recommendation 24: Improve dementia management and behavioural training for nursing and personal care staff attendants to reduce prescription of antipsychotic medication.

Recommendation 25: Doctors must be able to maintain clinical independence in order to make the best treatment recommendations for patients, based on current evidence, preserving their own clinical judgments regarding treatment recommendations.

Recommendation 26: Medication reviews should occur annually, and when there is a significant change in an older person’s medication and/or medical condition.

Recommendation 27: A National strategy on polypharmacy should be developed, along with evidence-based guidelines for prescribing to the elderly. Having a strategy and guidelines may reduce adverse events, hospitalisation and PBS costs.

Recommendation 28: Develop and implement national nutrition standards for aged care facilities, ensuring menus are varied and food is appealing and palatable.

Recommendation 29: Continuing education on elder abuse and neglect of the profession, including doctors, nursing aged care staff and personal care staff is essential to evaluate and mitigate medical and psychiatric consequences for the victims.

Recommendation 30: Introduce relevant safeguards for whistle-blowers in aged care, along with regulation for urgent mandatory investigations into their revelations.

Recommendation 31: Older people should maintain the choice of their preferred medical practitioner in residential care.

Recommendation 32: Simplify the aged care navigation process and ensure access to more information on aged care provider performance against the Aged Care Quality Standards.

The use of technology in aged care

Recommendation 33: Greater transparency for GPs and patients to be able view the progress of aged care assessments. This will provide GPs with confidence that their patients are being provided with the necessary care in a reasonable timeframe, as well as enable GPs to take action if this is not occurring.

Recommendation 34: More investment in innovation, digital technologies and telehealth in aged care.

Recommendation 35: Use of digital technologies in aged care in the future should be planned now by the Government and in coordination with relevant stakeholders.

Aged care in regional, rural, and remote Australia

Recommendation 36: Government needs to develop comprehensive plans to better support the provision of health and aged care in regional, rural, and remote Australia, and to commit to significant funding increases to bridge the gap between city and country.

Recommendation 37: Multi-purpose model of services for rural and remote communities should be further supported by the Government, particularly with the implementation of new Aged Care Quality Standards and accreditation under those standards for multi-purpose providers.

Young people living in residential aged care facilities

Recommendation 38: Options other than residential aged care facilities should be explored and implemented by the Government for younger people with disabilities who are currently serviced by residential aged care facilities.

Recommendation 39: Better coordination between disability and aged care systems is required to enable seamless transition between different services for people living with disability. Coordination with primary care in the process is crucial as well as other service sectors including allied health.

Aged care for special needs groups

Recommendation 40: The AMA calls for more research into health and aged care needs of special needs groups, including but not limited to CALD, ATSI and LGBTQI. These groups have particular needs around culturally appropriate and culturally safe services, which should be further documented and enable equity in accessing services and service provision.

The need for research on the care of older people

Recommendation 41: More research into care of older people in the future, including appropriate aged care and health care data collection to inform future policy and regulation.

Recommendation 42: Conduct a scientific evaluation of the impact of government policies on the wellbeing of older Australians. This will lead to proper policy adjustments and revisions as needed.

Have your say about Elder Care what is needed to make real change in the lives of Aboriginal and Torres Strait Islander people #HaveYourSay about #closingthegap

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:

https://www.naccho.org.au/programmes/coalition-of-peaks/have-your-say/

 

NACCHO Aboriginal Health #amafdw19 #Prevention #Smoking : At #NPC @AMApresident says the Federal Government must commit adequate resources to its proposed long-term national preventive health strategy :

“ Preventive health measures reduce the rate of chronic ill health and improve the health and wellbeing of all Australians, leading to better and healthier lives.

As a nation, we spend woefully too little on preventive health – around two per cent of the overall health budget.

A properly resourced preventive health strategy, including national public education campaigns on issues such as smoking and obesity, is vital to helping Australians improve their lifestyles and quality of life.

The Australian Government must commit adequate resources to its proposed long-term national preventive health strategy, and work with GPs to help improve the health of all Australians.

AMA President, Dr Tony Bartone, who addressed the National Press Club as part of Family Doctor Week, said the AMA is looking forward to working on the strategy, which Health Minister, Greg Hunt, first announced in a video message to the AMA National Conference in May.

Download full speech HERE

AMA President Press Club Address

” The Northern Territory Government has been judged to have been the worst-performing Australian government on tobacco control measures over the last 12 months, and shamed with the Dirty Ashtray Award for 2019.

This year is the 25th anniversary of the National Tobacco Control Scoreboard – run by the AMA and the Australian Council on Smoking and Health (ACOSH) – and the Northern Territory has managed to collect the dubious Dirty Ashtray Award 13 times.”

SEE Part 2 below NATIONAL TOBACCO CONTROL SCOREBOARD 2019

Read over 130 Aboriginal Health and Smoking articles published by NACCHO in the last 7 years 

Part 1 AMA President, Dr Tony Bartone Prevention Press Release

“Family doctors – GPs – are best placed to manage preventive health, and can assist their patients in managing issues such as weight, alcohol consumption, physical activity, stress, substance use, and quitting smoking.

“Managing weight is a vital part of preventive health. Carrying excess weight contributes to cancers, high blood pressure, and musculoskeletal disorders like bad backs and neck pain. It also affects general health and wellbeing.

“Too many Australians drink at harmful levels, and this is dangerous to their health. Drinking in moderation, and within the guidelines, is a message all Australians should be aware of, and if you are worried about alcohol consumption, talk to your GP.

“Tobacco kills. There is no way to sugar coat the dangers of smoking. If you smoke, you increase your risk of coronary heart disease and cancer.

“Smoking can cause cancer of the lung, oesophagus, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum.

“If you want to quit smoking, start by seeing your family doctor.”

Dr Bartone will also announced the recipient of the 2019 Dirty Ashtray Award, which is presented to the government – Federal, State, or Territory – that has done the least over the past year to combat smoking.

AMA Family Doctor Week runs from 21 to 27 July 2019.

Background

  • In 2017-18, two-thirds of Australian adults and almost one-quarter of Australian children were overweight or obese.
  • Coronary heart disease is the nation’s leading single cause of death.
  • It is estimated that more than 1.2 million Australians have diabetes. The majority (85 per cent) have type 2 diabetes, which is largely preventable.
  • In 2013, diabetes contributed to 10 per cent of all deaths in Australia.
  • Tobacco is the leading cause of cancer in Australia.
  • In 2014-15, more than 1.6 million Australian males aged 15 years and over smoked, 90 per cent of whom smoked daily.
  • More than 1.2 million Australian females aged 15 years and over smoked, 91 per cent of whom smoked daily.
  • About one in 10 mothers smoked in the first 20 weeks of pregnancy.
  • In 2016, 57 per cent of daily smokers were aged over 40, and 20 per cent of daily smokers lived in remote and very remote areas of Australia.
  • Daily tobacco smoking has been trending downward since 1991, from 24 per cent to 12 per cent in 2016.
  • The proportion of people choosing never to take up smoking has increased to 62 per cent in 2016, from 51 per cent in 2001.
  • In 2016, almost one in three (31 per cent) current smokers aged 14 and over have used e-cigarettes.
  • Of current smokers in secondary school aged 16-17, more than one-quarter (26 per cent) smoked daily.

Sources: Australian Bureau of Statistics’ National Health Survey, Australian Institute of Health and Welfare, Heart Foundation.

 

Part 2 NATIONAL TOBACCO CONTROL SCOREBOARD 2019

To read all the states an Territories scores CLICK HERE

The Northern Territory Government has been judged to have been the worst-performing Australian government on tobacco control measures over the last 12 months, and shamed with the Dirty Ashtray Award for 2019.

This year is the 25th anniversary of the National Tobacco Control Scoreboard – run by the AMA and the Australian Council on Smoking and Health (ACOSH) – and the Northern Territory has managed to collect the dubious Dirty Ashtray Award 13 times.

In contrast, the Queensland Government has achieved a remarkable hat trick by topping the scoring to win the coveted National Tobacco Control Scoreboard Achievement Award for leading the nation in tobacco control measures.

AMA President, Dr Tony Bartone, today released the results of the AMA/Australian Council on Smoking and Health (ACOSH) National Tobacco Control Scoreboard 2019 at the National Press Club in Canberra.

Dr Bartone congratulated Queensland on its strong consistent record in stopping people from smoking, and urged the Northern Territory to build momentum with its efforts on tobacco control, while noting the NT Government had amended and strengthened its tobacco control legislation earlier this year.

“The Queensland Government has continued to protect its community from second-hand smoke in a range of outdoor public areas including public transport, outdoor shopping malls, and sports and recreation facilities,” Dr Bartone said.

“Queensland Health is well ahead of other health services in recording smoking status, delivering brief intervention, and referring patients to evidence-based smoking cessation support such as Quitline.

“The Making Tracks – toward closing the gap in health outcomes for Indigenous Queenslanders by 2033 – Policy and Accountability Framework indicates a commitment to reducing smoking among Indigenous communities.

“Funding continues for the B.Strong Brief Intervention training program to strengthen primary healthcare services for Indigenous smokers by increasing the brief intervention skills of health professionals, access to culturally effective resources, and referral to Quitline.

“A dedicated smoking cessation website – QuitHQ – has been developed for the Queensland community, which includes quit support, information for health professionals, and smoking laws. Promotion of QuitHQ includes on-line messages and billboards.”

Dr Bartone said that the Northern Territory is showing signs of moving ahead with stronger tobacco control programs, but we are yet to see solid action and proper funding.

“The NT Government has  published a new Tobacco Action Plan 2019-2023 stressing the need for  media campaigns, smoke-free spaces, sustaining quit attempts and preventing relapse, and identifying priority populations,” Dr Bartone said.

“But these good intentions are yet to be backed with the necessary funding.”

Dr Bartone said the AMA would like to see the Federal Government take on a greater leadership role to drive stronger nationally coordinated tobacco control to stop people smoking and stop people taking up the killer habit.

“The Federal Government has not run a major, national media campaign against smoking since 2012-13, when plain packaging was introduced,” Dr Bartone said.

“Nor has it implemented any further product regulation or constraints on tobacco marketing in that time.

“We would like to see the National Tobacco Campaign reinstated with additional and sustained funding.

“The $20 million announced during the Federal election health debate is a welcome start, but falls well short of the $40 million a year that is needed for a sustained public education program.

“That is a mere 0.24 per cent of the $17 billion the Government expects to reap from tobacco taxes in 2019-20.

“The Government should also implement a systemic approach to providing support for all smokers to quit when they come into contact with health services.

“These key ingredients should be part of the Minister’s commitment, first announced at the AMA National Conference in May, to develop a National Preventive Health Strategy in consultation with the AMA and other health and medical bodies.

“Smoking remains the leading cause of preventable death and disease in Australia, causing 19,000 premature deaths each year.

“Two-thirds of all current Australian smokers are likely to be killed by their smoking. That is a staggering 1.8 million people.

“While Australia is a world leader in tobacco control, more needs to be done to help people quit smoking, or not take it up in the first place.

“Big Tobacco is attempting to distract attention from evidence-based measures that will reduce smoking, while promoting itself as being concerned about health.

“This is particularly outrageous from an industry whose products kill more than seven million people each year.

“It is crucial that Australia maintains its strong evidence-based policies and avoids being diverted by Big Tobacco’s new distraction strategies, particularly following disturbing evidence from the US and Canada about the epidemic of youth e-cigarette use.

“We must remain vigilant against any attempts to normalise smoking, or make it appealing to young people.

“This includes following the advice of the National Health and Medical Research Council and the Therapeutic Goods Administration in regulating e-cigarettes, and not allowing them to be marketed as quit smoking aids until such time as there is scientific evidence that they are safe and effective.”

The AMA/ACOSH National Tobacco Control Scoreboard is compiled annually to measure performance in combating smoking.

Judges from the Australian Council on Smoking and Health (ACOSH), the Cancer Councils, and the National Heart Foundation allocate points to the State, Territory, and Australian Governments in various categories, including legislation, to track how effective each has been at combating smoking in the previous 12 months.

No jurisdiction received an A or B rating this year or last year.

AMA/ACOSH Award – Judges’ Comments

This year is the Silver Anniversary of the AMA/ACOSH National Tobacco Control Scoreboard. 

Since the introduction of the Award in 1994, daily smoking in Australia has halved from 26.1% in 1993 to 12.8% in 2016.

Importantly, the proportion of 12 to 17-year-old school students who have never smoked in their life has increased significantly from 33% in 1984 to 82% in 2017.

Australia has led the world in its implementation of a comprehensive approach to reduce smoking.

Since the early 1990s, Australia has implemented the following strategies to reduce smoking, many of which have been duplicated in other countries around the globe:

We call on the Australian, State and Territory Governments to implement the following recommendations:

  • allocate adequate funding from tobacco revenue (predicted to be $17 billion in 2019/2020) to ensure strong media campaigns at evidence-based levels;
  • ban all remaining forms of tobacco marketing and promotion and legislate to keep up with innovative tobacco industry strategies;
  • implement tobacco product regulation to decrease the palatability and appeal of tobacco products;
  • implement comprehensive action, including legislation, in line with Article 5.3 of the Framework Convention on Tobacco Control (FCTC) to protect public health policy from direct and indirect tobacco industry interference, and ban tobacco industry political donations;
  • implement positive retail licensing schemes for all jurisdictions;
  • implement best practice support for smoking cessation across all health care settings;
  • ensure consistent funding for programs that will decrease smoking among Aboriginal and Torres Strait Islanders and other groups with a high prevalence of smoking; and
  • ensure further protection for the community from the harms of second-hand smoke.

Results

NACCHO Aboriginal Health #refreshtheCTGRefresh : @NACCHOchair Welcomes the release of the @AMAPresident 2018 Report Card on Indigenous Health and joins its call for rebuilding the #ClosingtheGap health strategy from the ground up

It’s been a decade since the Council of Australian Governments (COAG) launched the Closing the Gap Strategy, with a target of achieving life expectancy equality by 2031

But 10 years on, progress is limited, mixed, and disappointing. If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.

The Strategy has all but unravelled, and efforts underway now to refresh the Strategy run the risk of simply perpetuating the current implementation failures.

The Strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”

The Closing the Gap Strategy is unravelling, and must be rebuilt from the ground up to have any chance of closing the life expectancy gap between Indigenous and non-Indigenous Australians, AMA President, Dr Tony Bartone said today at the launch of the AMA report at the ATSICHS ACCHO in Brisbane : Interview with The Guardian Part 3 Below 

Download the 24 Page AMA Report 

AMA Indigenous Health Report Card 2018 (2)

Dr Tony Bartone (left ) and Ms Donnella Mills ( Second left ) on tour of ATSICHS

We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the report.”

The report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.

Urgent and systematic action is needed to reverse these failures and to have any prospect of meeting the Council of Australian Governments’ goal to Close the Gap in life expectancy by 2031

NACCHO calls for the immediate adoption of the Report Card’s recommendations.

We are seeking a formal partnership between Aboriginal and Torres Strait Islander peoples and governments to be included in the Closing the Gap Refresh policy , Aboriginal people need to be at the centre of Closing the Gap strategies; the gap won’t close without our full engagement and involvement.

The Chairperson of the peak body for Aboriginal controlled health services Ms Donnella Mills today welcomed the release of the AMA’s 2018 Report Card on Indigenous Health and joined its call for rebuilding the Closing the Gap from the ground up. See full NACCHO Press Release HERE 

It doesn’t mean that things aren’t improving, because health outcomes for our people are improving

The challenge is that we’re trying to actually improve the pace of that improvement faster than some of the healthiest people in the world, which is what Australians enjoy – one of the healthiest countries on the globe.

So you’re trying to actually close the gap between some of the sickest people in the world to some of the healthiest people in the world – it was always an ambitious target.”

Adrian Carson, CEO of the Urban Institute of Indigenous Health, said while national outcomes lagged behind, he had seen “significant” health improvements at a local level in south-east Queensland. see Part 3 below or in full here 

Busting the myth that Indigenous-led organisations ‘don’t deliver’

Dr Bartone today launched the AMA Indigenous Health Report Card 2018, the AMA’s annual analysis of an area of Aboriginal and Torres Strait Islander health across the nation.

This year’s Report Card scrutinises the 10-year-old Closing the Gap Strategy, and recent efforts to “refresh” the Strategy.

“It’s been a decade since the Council of Australian Governments (COAG) launched the Closing the Gap Strategy, with a target of achieving life expectancy equality by 2031,” Dr Bartone said.

“But 10 years on, progress is limited, mixed, and disappointing. If anything, the gap is widening as Aboriginal and Torres Strait Islander health gains are outpaced by improvement in non-Indigenous health outcomes.

“The Strategy has all but unravelled, and efforts underway now to refresh the Strategy run the risk of simply perpetuating the current implementation failures.

“The Strategy needs to be rebuilt from the ground up, not simply refreshed without adequate funding and commitment from all governments to a national approach.”

The Report Card outlines six targets to rebuild the Strategy:

  • committing to equitable, needs-based expenditure;
  • systematically costing, funding, and implementing the Closing the Gap health and mental health plans;
  • identifying and filling primary health care service gaps;
  • addressing environmental health and housing;
  • addressing the social determinants of health inequality; and
  • placing Aboriginal health in Aboriginal hands.

“It is time to address the myth that it is some form of special treatment to provide additional health funding to address additional health needs in the Aboriginal and Torres Strait Islander population,” Dr Bartone said.

“Government spend proportionally more on the health of older Australians when compared to young Australians, simply because elderly people’s health needs are proportionally greater.

“The same principle should be applied when assessing what equitable Indigenous health spending is, relative to non-Indigenous health expenditure.

“The Australian Institute of Health and Welfare estimates that the Aboriginal and Torres Strait Islander burden of disease is 2.3 times greater than the non-Indigenous burden, meaning that the Indigenous population has 2.3 times the health needs of the non-Indigenous population.

“This means that for every $1 spent on health care for a non-Indigenous person, $2.30 should be spent on care for an Indigenous person.

“But this is not the case. For every $1 spent by the Commonwealth on primary health care, including Medicare, for a non-Indigenous person, only 90 cents is spent on an Indigenous person – a 61 per cent shortfall.

“For the Pharmaceutical Benefits Scheme, the gap is even greater – 63 cents for every dollar, or a 73 per cent shortfall from the equitable spend.

“Spending less per capita on those with worse health, and particularly on their primary health care services, is dysfunctional national policy. It leads to us spending six times more on hospital care for Indigenous Australians than we do on prevention-oriented care from GPs and other doctors.

“We will not close the gap until we provide equitable levels of health funding. We need our political leaders and commentators to tackle the irresponsible equating of equitable expenditure with ‘special treatment’ that has hindered efforts to secure the level of funding needed to close the health and life expectancy gap.”

AMA Media Coverage 

The AMA 2018 Indigenous Health Report Card is at https://ama.com.au/article/2018-ama-report-card-indigenous-health-rebuilding-closing-gap-health-strategy-and-review

Part 2 : The Chairperson of the peak body for Aboriginal controlled health services Ms Donnella Mills today welcomed the release of the AMA’s 2018 Report Card on Indigenous Health and joined its call for rebuilding the Closing the Gap from the ground up.

Download the full NACCHO Press Release HERE

National Aboriginal Community Controlled Health Organisation (NACCHO) Chairperson, Ms Donnella Mills said, “We congratulate the AMA on their work to support closing the gap and endorse the recommendations in the report.”

The report highlights research which indicates the mortality gaps between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are widening, not narrowing.

The AMA estimate that the Commonwealth government spend on Aboriginal and Torres Strait Islander health is only 53% of needs-based requirements. Aboriginal and Torres Strait Islander peoples have at least twice the per capita need of the rest of the population because of much higher levels of illness and burden of disease.

“This underspend represents a significant failure” Ms Mills said. “Genuine commitment by Australian governments to Closing the Gap requires equitable funding.”

The funding shortfall is particularly important for primary health care services where big gains could be made in improving health, keeping people out of hospital and preventing premature deaths. Funding for Aboriginal Community Controlled Health Services, which deliver accessible, culturally safe, comprehensive primary health care across Australia, is not keeping up with need.

Alongside the increased funding for Aboriginal Community Controlled Health Service there is an urgent need for government to address the environmental health, housing and other social determinants of health inequality.

NACCHO, its Affiliates and members will continue to work with the AMA to urge the adoption of the Report Card’s recommendations by Australian governments.

Part 3 Busting the myth that Indigenous-led organisations ‘don’t deliver’

From NITV

Adrian Carson, CEO of the Urban Institute of Indigenous Health, said while national outcomes lagged behind, he had seen “significant” health improvements at a local level in south-east Queensland.

He urged governments to place more trust in Indigenous-led organisations to deliver services.

“This country’s still got a crisis in terms of its relationship with the First People,” Mr Carson told NITV News.

“The narrative’s a negative one, it’s always deficit-based, but we turn around and look at what parts of our sector are doing… we’re actually coming up with improved health outcomes within our community – they’re actually solutions that could benefit the whole country.

So this whole idea that somehow our communities can’t be trusted, or that we don’t have the capacity to deliver, is a myth.”

Mr Carson said while he welcomed the AMA’s report, it was important to take a proactive approach rather than dwelling on negative statistics.

“It doesn’t mean that things aren’t improving, because health outcomes for our people are improving,” he said.

“The challenge is that we’re trying to actually improve the pace of that improvement faster than some of the healthiest people in the world, which is what Australians enjoy – one of the healthiest countries on the globe.

“So you’re trying to actually close the gap between some of the sickest people in the world to some of the healthiest people in the world – it was always an ambitious target.”

Part 4 The Guardian Interview

The Australian Medical Association says the Closing the Gap strategy has “all but unravelled” and insists that the policy needs to be rebuilt from the ground up, starting with boosting health expenditure on Indigenous Australians and putting Aboriginal healthcare in Aboriginal hands.

A refresh of the program is expected to be considered at the December meeting of the Council of Australian Governments, but the AMA president, Tony Bartone, says Closing the Gap needs root-and-branch reform, not changes “without adequate funding and commitment from all governments to a national approach”.

Read in full 

 

 

NACCHO Aboriginal Health celebrates #AMAFDW18 AMA Family Doctor Week : @amapresident Speech to @PressClubAust #NPC Includes support #ulurustatement #prevention investment #obesity #Chronic Disease funding #MentalHealth

 

” I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.”

AMA President Dr Tony Bartone speaking at the National Press Club 25 July 2018

 ” This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

GPs of Australia, I salute you. We all salute you.

Your hard work and dedication is highly valued. The AMA will always support you and promote you.

Your GP – your family doctor – will ensure that your health needs are met throughout all stages of your life.

Be it immunisation, preventative health care, age specific medical checks, chronic disease management, or aged care, the life long relationship with your GP underpins continuous and appropriate care.

This is especially the case for patients who are from culturally or linguistically diverse backgrounds. For them, GPs truly are their trusted health advocates.”

 ” The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese. ”

Full Speech : Health reform: Improving the patient journey

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

It is a humbling experience to be elected President of such a proud and respected organisation as the AMA.

It is an equally humbling experience to speak here at the National Press Club in Canberra. I thank the Press Club for this opportunity.

I am a GP, and I have been in practice in the northern suburbs of Melbourne for more than 30 years.

Some of you may know that I was inspired to become a GP by watching my own family doctor, who cared for my ill father when I was growing up.

Even now, my mother reflects on the care and dedication my family GP displayed in caring for her family. It’s no surprise that he became an early mentor in my professional life.

I have seen it all as I have looked after the health of my community and my patients, including generations of the same families.

I like to think that my experience has given me some credibility in knowing what works and what doesn’t work in the health system, especially in primary care.

My overarching concern has always been the patient journey – ensuring that people get the right care at the right time in the right place by the right practitioner.

The priorities for me are always universal access to care, and affordability.

Today, I will share my views on what can be done to make our great health system even better – how to improve the patient journey.

I will also introduce you to some of my patients, and reflect on the barriers in their access to timely care, to further illustrate our concerns.

General practice and primary care reform

On the day I was elected, I made it very clear that one of the hallmarks of my Presidency would be stridently advocating for significant investment in general practice.

This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

see intro for text

However, there is something really crook about how GPs have been treated by successive Governments.

They have paid lip service to the critical role GPs play in our health system, often borne out of ignorance and often in a misguided attempt to control costs.

General practice has been the target of continual funding cuts over many years. These cuts have systematically eaten away at the capacity of general practice to deliver the highest quality care for our patients.

They threaten the viability of many practices.

I talk to my GP members regularly, both metropolitan and rural.

The message is simple – some are at a tipping point and have a very bleak view of the future.

They see general practice becoming increasingly corporatised, burdened with more red tape, and GPs are less able to spend the necessary time with patients.

This is not the future that GPs want to see.

This is not the future that our patients want to see.

We can and must avoid these bleak predictions, but it requires significant real and immediate investment from the Government with a clear pathway to long-term reform.

Let me be very clear about this: we must put general practice front and centre in future health policy development.

We have seen too many mistakes. Too many poor policy decisions.

Despite the Government’s best intentions – and lots of goodwill within the profession – the Health Care Homes trial and implementation failed to win the support of GPs or patients.

Instead of real investment, the Trial largely shifted existing buckets of money around.

It has fallen well short of its practice enrolment targets, and it looks like only a small fraction of the targeted 65,000 patients will sign up.

There is no doubt that the challenge of transforming general practice was severely underestimated by policy makers. At least with this model.

But general practice still needs transformation and rejuvenation to meet growing patient demand and to keep GPs working in general practice.

The AMA has a plan for reform of general practice and primary care.

It is patient-centred and focuses on better access to long-term continuous quality care and managing patients more effectively in the community.

It takes the best elements of the ‘medical home’ concept and adapts them to the Australian context.

It is a plan that will require upfront and meaningful new investment, in anticipation of long-term savings in downstream health costs.

In the short term, the AMA plan for general practice will involve:

  • significant changes to Chronic Disease funding, including a process that strengthens the relationship between a patient and their usual GP, and encourages continuity of care;
  • cutting the bureaucracy that makes it difficult for GPs to refer patients to allied health services;
  • formal recognition in GP funding arrangements of the significant non-face-to-face workload involved in caring for patients with complex and chronic disease;
  • additional funding to support enhanced care coordination for those patients with chronic disease who are at risk of unplanned hospital admission – a similar model to the Coordinated Veterans Care Program funded by the Department of Veterans Affairs;
  • a properly funded Quality Improvement Incentive under the Practice Incentive Program – the PIP;
  • changes to Medicare that improve access to after-hours GP care through a patient’s usual general practice;
  • support for patients with chronic wounds to access best practice wound care through their general practice;
  • better access to GP care for patients in residential aged care; and
  • annual indexation of current block funding streams that have not changed for many years … including those that provide funding to support the employment of nursing and allied health professionals in general practice.

In the longer term, we need to look at moving to a more blended model of funding for general practice.

While retaining our proven fee-for-service model at its core, the new funding model must have an increased emphasis on other funding streams, which are designed to support a high performing primary care system.

This will allow for increasing the capability and improving the infrastructure supporting general practice to allow it to become the real engine room of our health system.

It is about scaling up our GP-led patient-centred multidisciplinary practice teams to better provide the envelope of health care around the patient in their journey through the health system.

A good example is the Blacktown Hospital Diabetes Outpatient Clinic in New South Wales.

This Clinic has a waiting time of less than a week because the service is distributed to its catchment GPs with the appropriate funding and support for both personnel and infrastructure.

This is a small example, but a significant one when you consider the scale and prevalence of diabetes across Australia, let alone the western suburbs of Sydney, and the average access times for outpatient hospital clinics.

We cannot continue to do things the way we always have.

The bulk-billing rate should not be the metric by which we judge the performance of general practice.

Chronic conditions have become more prevalent in Australia. The ones causing most concern are:

  • arthritis;
  • asthma;
  • back pain and problems;
  • cancer;
  • cardiovascular disease;
  • chronic obstructive pulmonary disease;
  • diabetes; and
  • mental health conditions.

One in two people now report having at least one of these eight common chronic conditions.

These conditions account for around 60 per cent of the total disease burden, and they contribute to nearly 90 per cent of deaths in Australia.

We must reshape our primary care system to meet these challenges.

We must put in place the funding support that general practice needs to better manage patients in the community – and keep people out of hospital.

Our plan is a smarter and more sustainable blueprint … a better plan for general practice. A better plan for Australians.

Public hospitals

We also need a better plan for public hospitals.

In an election year, voters tend to focus very closely on public hospitals when they are comparing health policies.

Public hospitals are a critical part of our health system. They are highly visible. They are greatly loved institutions in the community. They are vote changers.

The doctors, nurses, and other staff who work in our public hospitals are some of the most skilled in the world.

In 2016-17, public hospitals provided more than six and a half million episodes of admitted patient care. They managed 92 per cent of emergency admissions.

If the state of general practice is crook, then our public hospitals are on permanent code yellow.

Despite their importance, and despite our reliance on our hospitals to save lives and improve quality of life, they have been chronically underfunded for too long.

Between 2010-11 and 2015-16, average annual real growth in Federal Government recurrent funding for public hospitals has been virtually stagnant – a mere 2.8 per cent.

The AMA welcomes that, between 2014-15 and 2015-16, the Federal Government boosted its recurrent public hospital expenditure by 8.4 per cent.

But a one-off modest boost from a very low base is not enough.

I deal with the results of stressed public hospitals every day and manage the impact it has on my patients.

Ollie is a patient with well-controlled Parkinson’s disease. He now also has a recently diagnosed lung cancer, which has been caught early, resected, and appropriately managed.

But he has been denied care for his resulting poor control of his Parkinson’s disease in the same hospital’s neurology outpatient department and referred back to me.

I have been advised that I must source an alternative option for his neurological care.

Another of my patients, Carlo, is a victim of the never ending Federal-State buck passing when it comes to health.

Having developed poorly controlled reflux and having been referred to the local hospital outpatient department for a gastro consult, Carlo was referred back to me.

I was advised that I had to arrange a referral at the same hospital’s diagnostic imaging service for a possible coordination and swallowing problem, which ultimately proved correct.

He was then referred back to the gastroenterology department to manage his newly diagnosed oesophageal condition.

Barbara is another very common example of the funding chaos.

She is a very active 68-year-old lady who was troubled by severe osteoarthritis of the knee for many years. She was placed on a waiting list for surgery two years ago.

She has had to attend our practice regularly for pain management and supportive referrals for physiotherapy, while I continued to manage the consequences of her inability to lose weight due to her exercise restrictions and worsening diabetes and blood pressure profile.

She has just finally had her knee joint replaced.

These are the experiences of everyday patients.

They underpin the troubling headlines that came from the AMA’s 2018 Public Hospital Report Card. Our hospitals are stretched to the limit.

Likewise, the AMA’s Safe Hours Audit is a window into the lived experience of dedicated doctors, struggling to deliver quality care in over-crowded, under-funded hospitals.

But instead of helping the hospitals improve safety and quality, governments decided to financially punish hospitals for poor safety events.

There is no evidence to show that financial penalties work.

Health care is complex. Not all patient complications can be avoided.

The 2020-25 hospital funding agreement does little to improve the situation.

Funding levels stay the same, but public hospitals will have to do more with it to help coordinate patient care post-discharge.

The AMA supports better discharge planning and integrated care, especially for patients with complex and chronic disease.

But this will cost money – and public hospitals need extra funding.

The AMA calls on the major parties to boost funding for public hospitals beyond that outlined in the next agreement.

There must be a plan to lift public hospitals out of their current funding crisis, which is putting doctors and patients at risk.

Governments must stop penalising hospitals for adverse patient safety events.

We need policies to fully fund hospitals. We must help them improve patient safety and build their internal capacity to deliver high value care in the medium to long term.

They must link up and work with primary care to deliver better coordinated care.

I note that Labor has pledged an extra $2.8 billion for public hospitals.

I expect that the Coalition will match that as the election draws nearer.

They do not want another Medi-scare style campaign.

Medical care for older Australians

Older Australians are voters, too.

Aged care was, until very recently, one of the highest profile segments of the health system – but for all the wrong reasons.

It is now emerging as an area in need of significant reform as the population ages and lives longer.

Older Australians all too frequently do not have the same access to medical care as other age groups – a longstanding result of inadequate funding in the aged care system.

This inequity will likely only grow as the Australian population ages with more complex, chronic medical conditions requiring more medical attention than ever before.

We have witnessed numerous consultations and reviews.

Enough! Now is the time for action.

There is already sufficient information to underpin the final recommendations. It is simply unfair and unjust to delay this any further.

An increase in funding for GP visits to aged care facilities would result in many savings, including from reduced ambulance transfers to hospital emergency departments.

Changes to after-hours care remuneration must consider services that are currently provided under ‘urgent’ item numbers to patients in aged care facilities.

We also need to ensure that the critical role that nurses play in caring for older Australians is recognised in those facilities.

The AMA wants to see Medicare rebates that adequately cover the time that doctors spend with the patient assessing and diagnosing their condition and providing medical care.

We want new telehealth Medicare items that compensate GPs, and other medical specialists, for the time spent organising and coordinating services for the patient.

This includes the time that they spend with the patient’s family and carers to plan and manage the patient’s care and treatment.

There must be funding for the recruitment and retention of quality, appropriately trained aged care staff.

And we must reverse the decline in the proportion of Registered Nurses in aged care.

The AMA Aged Care Survey, released today, shows that AMA members who work in aged care have identified the shortage of Registered Nurses – who should be available 24 hours a day – as the biggest priority for aged care reform.

The survey also shows that one in three doctors are planning to cut back on, or completely end, their visits to patients in aged care facilities over the next two years.

This is largely because the Medicare rebates are inadequate for the amount of time and work involved.

The AMA will ensure that aged care gets the attention and profile it deserves in the election campaign.

Private health insurance:

Private health insurance has been in the headlines for much of the past year – again, for all the wrong reasons.

The AMA has always called for a simpler and fairer private health insurance system.

Without the private system, the public system would likely collapse.

But we cannot expect the private system to thrive – or even survive – if there is not value in insurance policies.

Patients are smart – they know there is no point outlaying thousands of dollars every year if the coverage isn’t there.

Affordability means very little without value.

We are clearly at a crisis point in private health insurance. And the Government knows it.

Hence the latest Review, and the recent announcement by the Minister of new categories of policies … and greater transparency.

We support the concept of developing Gold, Silver, and Bronze insurance categories.

We can’t expect consumers to understand the many different definitions, the carve outs, and exclusions of some 70,000 policy variations.

Australians want reasonable and simple things from their insurance.

They want coverage.

They want a choice of the practitioner, and a choice of the hospital.

They want treatment when they need it.

We can’t have patients finding out they aren’t covered after the event, or when they require treatment and it’s all too late.

To that end, we have been very clear – we don’t support the use of restrictions in Gold, Silver, and Bronze.

Restrictions lead people to believe they are covered, when in reality they are exposed to additional costs.

We don’t support junk policies. If a Basic policy category doesn’t provide much coverage, that should be made crystal clear.

We don’t support dismantling community rating. This must be protected to maintain equity of access to private health treatment.

When the objective is to support a strong private health sector to take pressure off the public sector, it makes no sense to financially discourage the patients who are most likely to need access to private health.

We support standard clinical definitions. Whatever is involved for coverage for heart conditions should not vary between insurers and policies.

I urge the Government to continue to work with the Colleges to ensure that these definitions are robust.

There is increasing corporatisation of private health and the market power is shifting in favour of private health insurers.

Insurers, whether private or via Medicare, cannot determine the provision of treatment in Australia.

They cannot and must not interfere with the clinical judgement of medical practitioners.

Australians do not support a US-style managed care health system. Neither does the AMA.

One area we are disappointed with in the recent announcements is pregnancy cover.

It does not make sense to us, as clinicians, to have pregnancy cover in a higher level of insurance only.

Many pregnancies are unplanned – meaning people are caught out underinsured when pregnancy is restricted to high-end policies.

Pregnancy is a major reason that the younger population considers taking up private health insurance.

They are less likely to be able to afford the higher-level policies. We need to make sure it is within reach.

I having female reproductive services at a different level to pregnancy coverage is, to us, problematic, and will leave a lot of people caught out.

There will be much more to talk about as the private health reforms are finalised and bedded down.

Mental Health

As a suburban GP who sees the whole range of health ailments and conditions, an area of special interest to me is mental health.

I do not think the unique role and special skills of GPs are used enough at the front line of mental health care.

The AMA earlier this year called for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults – that is more than seven million people – will experience a mental health condition in their lifetime.

Almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague.

The statistics are startling. For example:

  • More than half a million children and adolescents, aged four to 17, experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.

And yet mental health and psychiatric care are grossly underfunded.

Strategic leadership is needed to integrate all components of mental health prevention and care.

For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

There is no vision of what the mental health system will look like in the future.

Poor access to acute beds for major illness leads to extended delays in emergency departments.

Poor access to community care leads to delayed or failed discharges from hospitals.

And poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

We have repeatedly called for support for carers of people with mental illness, which is often the result of necessity, not choice.

Access to respite care is vital for many people with mental illness and their families, who are the ones who bear the largest burden of care.

Indigenous health

I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.

Prevention

There is not enough time today to cover all the issues I would like to cover in one speech.

I could deliver a whole speech on each of the following topics – medical workforce, rural health, medical research, genetic testing, e-cigarettes and vaping, opioids, medicinal cannabis, scope of practice, asylum seeker health, the NDIS, or palliative care, to name just a few.

I could probably manage a few words about the My Health Record, too. No doubt there will be questions about that.

But I have to talk to you about prevention, if only briefly.

The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

This amounts to a measly 1.34 per cent of all health spending. This is considerably less than comparable countries such as Canada, the United Kingdom, and New Zealand.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese.

The evidence shows that advice to lose weight given by a doctor increases the motivation to lose weight. It also increases engagement in weight loss behaviours.

But the support and advice from doctors can only achieve so much.

Population level measures are needed. We need to see action on a sugar tax, banning junk food advertising to kids, and improving urban planning to help get people moving and active.

Governments have the tools to implement these measures. A sugar tax would be a good start.

In closing, I know the challenges ahead for the health system.

I will dedicate my Presidency to improving health policy so that we have a system that delivers the best possible care to our patients.

The AMA will be a very strong and loud advocate.

There is nothing like a Federal election to help our political leaders share the public’s interest in good health policy.

The election will happen within twelve months, possibly this year.

Along with the members of the National Press Club, the AMA will be watching the political events of this weekend and the coming months with very close interest.

NACCHO Aboriginal Health and the #UluruStatement promoted during #NRW18 and @TheLongWalkOz Thanks to @AMAPresident @EssendonFC @VAHS1972 @quitvic @DeadlyChoices

” What you (Victorian Premier Daniel Andrews ) said about Aboriginal and Torres Strait Islander advancement being led by Aboriginal and Torres Strait Islander people is absolutely right,

The great Australian Chris Sarra said very wisely … governments have got to stop doing things to Aboriginal people and start doing things with them and that is my commitment.”

Prime Minister Malcolm Turnbull has told a Reconciliation event The Long Walk he is committed to following the lead of Indigenous people, less than a year after rejecting their call for an enshrined voice in parliament.

After Premier Daniel Andrews spoke of his government’s efforts to create a state Treaty at the Long Walk event at Melbourne’s Federation Square, Mr Turnbull said the two leaders were “starting to agree on more things all the time”.

During a summit at Uluru in May 2017, Indigenous leaders rejected symbolic constitutional recognition in favour of an elected parliamentary advisory body and a treaty.

But in October, Mr Turnbull said a new representative body was not desirable or capable of winning acceptance at a referendum

NACCHO Aboriginal Health #treaty : #Uluru Summit calls for the establishment of a First Nations Voice enshrined in the Constitution

Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart: It was a fairly clear-cut decision for us to make.

We recognise the issue regarding the will to want to have the right to self-determination. We recognise the health inequities, the social justice inequities, the wellness inequities that confront our Indigenous population.

And this Statement is just another way of trying to ensure that we can continue to work and get all governments, both State, Federal, and Territory, to work towards closing the gap, improving the social determinants of health, and recognising the need and the required improvements that are necessary to address the gap that currently exists.

The ACCHOs, or Aboriginal Community Controlled Health Organisations, are a very important part of the health delivery process. It recognises that the usual relationships, when it comes to health facilities in a different way, it’s a different connectivity. “

The recently elected Australian Medical Association’s President, Tony Bartone, who participated in the Long Walk spoke with ABC Radio reporter, Dan Conifer . See full interview and AMA press release Part 1 and 2 below

 

 ” Politicians, footballers and campaigners have joined thousands of Australians in the Long Walk event to support moves to improve Indigenous health and celebrate Aboriginal and Torres Strait Islander culture.

It has been 14 years since AFL champion Michael Long’s momentous journey from his home in Melbourne to the Prime Minister to get the lives of Aboriginal and Torres Strait Islander people back on the national agenda.

Indigenous health is focal point of this year’s walk, with the Victorian Aboriginal Health Service Australian Medical Association (AMA) and Quit Victoria both throwing their support behind the event.

Ill health forced Essendon great Michael Long to miss this year’s Long Walk.

Part 1 : Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart

The AMA Federal Council has endorsed the Uluru Statement from the Heart, which calls for a First Nations’ voice in the Australian Constitution.

AMA President, Dr Tony Bartone, said today that the AMA has for many years supported Indigenous recognition in the Australian Constitution, and that the Uluru Statement is another significant step in making that recognition a reality.

“The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people in regard to self-determination and status in their own country,” Dr Bartone said.

“The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

“Closing the gap in health services and outcomes requires a multi-faceted approach.

“Cooperation and unity of purpose from all Australian governments is needed if we are to achieve meaningful and lasting improvements.

“This will involve addressing the social determinants of health – the conditions in which people are born, grow, live, work, and age.

“Constitutional recognition can underpin all these endeavours, as we work to improve the physical and mental health of Indigenous Australians.”

Dr Bartone said the AMA was proud to announce its endorsement of the Uluru Statement during National Reconciliation Week.

Part 2 :The recently elected Australian Medical Association’s President, Tony Bartone, who participated in the Long Walk spoke with ABC Radio reporter, Dan Conifer

ELIZABETH JACKSON: Within the next couple of years, your local doctor’s surgery could be adorned with posters supporting Indigenous Constitutional change. The highly influential

Australian Medical Association has thrown its support behind last year’s Uluru Statement from the Heart. The peak body says including Aboriginal and Torres Strait Islander people in the nation’s founding document could help make Indigenous patients healthier. The AMA’s President Tony Bartone has told our political reporter Dan Conifer the organisation is unequivocal in its support.

TONY BARTONE: It was a fairly clear-cut decision for us to make. We recognise the issue regarding the will to want to have the right to self-determination. We recognise the health inequities, the social justice inequities, the wellness inequities that confront our Indigenous population. And this Statement is just another way of trying to ensure that we can continue to work and get all governments, both State, Federal, and Territory, to work towards closing the gap, improving the social determinants of health, and recognising the need and the required improvements that are necessary to address the gap that currently exists.

DAN CONIFER: Can you just explain for us how something like the Uluru Statement from the Heart, and the changes that it calls for, would support health outcomes, would improve life expectancy and so on?

TONY BARTONE: They’re fairly fundamental aspirations that are part of the Uluru Statement, and those aspirations and recognitions really speak to a number of emotional, physical, and broader social, environmental issues that really will address, as we say, the social determinants of health. We can’t really seek to close the gap when it comes to health outcomes until we address the fundamental building blocks.

DAN CONIFER: Now, one of the key elements of the Uluru Statement is about involving Aboriginal and Torres Strait Islander Australians in decision-making processes. In the medical profession, how has involving Indigenous Australians driven improvements?

TONY BARTONE: The ACCHOs, or Aboriginal Community Controlled Health Organisations, are a very important part of the health delivery process. It recognises that the usual relationships, when it comes to health facilities in a different way, it’s a different connectivity. Put another way, it recognises the inherent qualities and behavioural patterns of our Indigenous population, and that is different from a traditional Western-type setting which we’ve become experienced with.

DAN CONIFER: And if a referendum were to be held on any of the elements of the Uluru Statement, how would the AMA, individual doctors and specialists around the country, take part or be involved in that campaign?

TONY BARTONE: We would use all avenues open to us, both in terms of our advocacy and communication with our members, to ensure that the information and the sharing of that information, in terms of the wider community, patients who come to our surgery, the access points that we do have, are used to the fullest in terms of ensuring a proper address of the Statement’s initiatives.

DAN CONIFER: So we could see Vote Yes posters or pamphlets or badges in GP surgeries when this, or if this comes to a vote?

TONY BARTONE: What we’d see is the Association taking a front foot in our communication and advocacy on behalf of members. Of course, each individual member is free and would be wanting to participate to perhaps even a fuller extent, which would lead to putting up of posters and sharing that material in a surgery environment. But we would take a front foot more at an Association level to ensure that we communicate with our stakeholders, with our leaders in Parliament, and with the community in general through our media connectivity to communicate that wish and desire.

Part 3 The Long Walk ,VAHS and Quit Victoria promotes Indigenous health

Smoking rates among Aboriginal and Torres Strait Islander people are almost three times the national average of non-Indigenous people, although the prevalence in Indigenous communities is falling steadily.

In Victoria, 41 per cent of the Aboriginal and Torres Strait Islander population are smokers.

Quit Victoria’s Aboriginal Tobacco Control Program Coordinator Jethro Pumirri Calma-Holt told SBS News the health of Indigenous Australians should be kept at the top of the agenda.

“Indigenous health is something that needs to be invested in by everyone and that’s part of national reconciliation week.”

“What Michael Long did all those years ago has created a really big legacy for everyone to follow in his footsteps,” he said

Check it out the legend himself Anthony McDonald-Tipungwuti wearing the VAHS Deadly Choices Shirt out during the warm up for Dream Time at the G. The other players also wore the shirts as well… What a moment !

If you want your very own VAHS Deadly Choices Shirt just like Tippa the only way you can get one is to complete a health check at VAHS. So call us and book your health check on 03 9419 3000

 

 

 

NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

 

 ” It is unacceptable that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting Aboriginal and Torres Strait Islander people, who comprise just three per cent of the population. Funding for Aboriginal and Torres Strait Islander Health is inadequate to meet the burden of illness.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health ”

Extract from

AMA Budget Submission 2018-19

AMA President, Dr Michael Gannon, said today that the culmination of key reviews, under the guidance of Health Minister Greg Hunt, provides the Government with a rare opportunity to embark on a new era of ‘big picture’ health reform – but it will need significant long-term investment.

Releasing the AMA’s Pre-Budget Submission 2018-19, Dr Gannon said the key for the Government is to look at all health policies as investments in a healthier and more productive population.

“The conditions are ripe for a new round of significant and meaningful health reform, underpinned by secure, stable, and sufficient long-term funding to ensure the best possible health outcomes for the Australian population,” Dr Gannon said.

“The next Budget provides the Government with the perfect opportunity to reveal its health reform vision, and articulate clearly how it will be funded.

“We have seen years of major reviews of some of the pillars of our world class health system.

“The review of the Medicare Benefits Schedule (MBS) is an ambitious project.

“Its methods and outcomes are becoming clearer. Its best chance of success is if the changes are evidence-based and clinician-led and approved.

“A new direction for private health insurance (PHI) has been determined following the PHI Review.

“We must maintain flexibility and put patients at the centre of the system, but recognise the fundamental importance of the private system to universal health care.

“The Medicare freeze will be lifted gradually over the next few years.

“There is now a greater focus on the core health issues that will form the health policy battleground at the next election.

“There is no doubt, as shown at the last Federal election, that health policy is a guaranteed vote winner … or vote loser.

“Our Submission sets out a range of policies and recommendations that are practical, achievable, and affordable.

“They will make a difference. We urge the Government to adopt them in the Budget process.

“Health should never be considered an expensive line item in the Budget.

“It is an investment in the welfare, wellbeing, and productivity of the Australian people.

“Health is the best investment that governments can make,” Dr Gannon said.

The AMA Pre-Budget Submission 2018-19 covers:

·         General Practice and Primary Care;

·         Public Hospitals;

·         Private Health Insurance;

·         Medicare Benefits Schedule (MBS) Review;

·         Preventive Health;

·         Diagnostic Imaging;

·         Pathology;

·         Mental Health and the NDIS;

·         Medical Care for Older Australians;

·         My Health Record;

·         Rural Health;

·         Indigenous Health;

·         Medical Workforce;

·         Climate Change and Health; and

·         Veterans’ Health.

 The AMA Pre-Budget Submission 2018-19 is at https://ama.com.au/ama-pre-budget-submission

This Submission was lodged with Treasury ahead of the Friday, 15 December 2017 deadline.

Part 2 The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite a decade of commitments to closing the gap.

NACCHO Aboriginal #EarHealthforLife @KenWyattMP and @AMAPresident Launch AMA Indigenous Health Report Card 2017:

The AMA values the progress being made in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. But if the Government is serious about building on this early but slow progress, it must create sustainable, long-term improvements by increasing funding and resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people. It must also increase and properly resource the health workforce.

Many of the chronic health conditions experienced by Aboriginal and Torres Strait Islander people should not be endemic in a highly-developed country like Australia. Chronic diseases are known to be the main cause of the life expectancy gap between Indigenous and non- Indigenous Australians.

Despite some recent health gains for Aboriginal and Torres Strait Islander people, awareness and political will is frustratingly slow-moving. There is an urgent need for the Commonwealth to deliver on the well-documented research and national strategies showing how to tackle health inequalities and the social determinants of health.

Closing the gap in health outcomes means addressing: poverty; unhygienic, overcrowded conditions; poor food security and access to potable drinking water; lack of transport; and an absence of health services.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health.

AMA POSITION

The AMA calls on the Government to:

• prioritise Indigenous health funding in the 2018-19 Budget and fund Aboriginal and Torres Strait Islander health services according to need;

• support measures to increase the uptake of MBS and PBS items;

• fund and implement the National Aboriginal and Torres Strait Islander Health Plan;

• adopt the recommendations in the AMA’s Report Cards on Indigenous Health, in particular the recommendations in the 2016 Report Card calling for a target to eradicate new cases of Rheumatic Heart Disease (RHD); and the recommendations in the 2017 Report Card to address ear health (otitis media);

• given the strong link between health and incarceration, support the justice reinvestment approach to health by appropriately funding services that divert Aboriginal and Torres Strait Islander people from prison;

• commit to the principles of the Redfern Statement, which calls on all political parties to make Aboriginal and Torres Strait Islander affairs a key election priority;

• meaningfully address the disadvantage experienced by Aboriginal and Torres Strait Islander people by reversing cuts to the Indigenous Affairs portfolio;

• reinvest in health, justice, early childhood, and disability services, as well as services to prevent violence;

• increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations to build their capacity to be sustainable over the long term;

• recognise that chronic disease in Indigenous communities is inextricably connected to the social determinants of health such as: poverty; inappropriately designed, unhygienic, overcrowded housing conditions; inadequate access to affordable food and potable water supplies; and an absence of health services;

• acknowledge the wealth of existing reports, Parliamentary inquiries, strategies, and plans to improve Indigenous health and close the gap, and start to fund and implement them; and

• fund national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce.

 

NACCHO Aboriginal Health News Alert @AMApresident speech National Press Club -Time for heavy lifting in Health

 

” Aboriginal & Torres Strait Islander Health

So too, the AMA takes Indigenous health very seriously.

Last year, I travelled to Darwin to launch our annual Indigenous Health Report card, which focused on Rheumatic Heart Disease.

In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure.

It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

RHD is perhaps the classic example of a Social Determinant of Health.

It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

Smart policy. Saving money. Preventing heartache. The right thing to do.

I remain committed to partnering with other health professionals and champions of Indigenous health like Ken Wyatt and Warren Snowdon to continue to Close the Gap.

Dr Michael Gannon  : Pictured above after speaking at the National Press Club , meeting two new members of the NACCHO Communications and Digital Team Wendy Brookman and Oliver Tye

Beyond the Medicare freeze – Time for heavy lifting in Health

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

Good afternoon. It is a great honour to address the National Press Club for a second time as AMA President.

There have been many changes over the last twelve months.

There is no more talk of co-payments.

The cuts to pathology and diagnostic imaging bulk billing incentives have been reversed.

The general practice pathology rents issue has, for the most part, been resolved.

The Medicare freeze has a ‘use by date’. It can’t come soon enough.

The AMA wanted an immediate end to the freeze right across the Medicare Benefits Schedule. We did not get it.

But in 300 days’ time we will see a return to annual indexation of patient rebates to see GPs and other specialists.

The extended freeze has been a major contributor to out-of-pocket expenses when patients see doctors.

We have a new Health Minister – Greg Hunt. He has been consultative and highly engaged with the health sector. He and I speak most weeks. He is a good listener.

He genuinely wants to be across the complexities of his portfolio.

The same can be said of Shadow Minister Catherine King and Greens Leader Richard Di Natale. They get health. They know how health policy affects people’s lives.

This is why Greg Hunt has played a key role in repairing the Government’s relationship with the major stakeholders in health – with the backing of the Prime Minister.

The health policy environment is much calmer, but this does not mean that everything has been fixed. Far from it. There is plenty of heavy lifting to do.

The lifting of the freeze has raised the curtain to allow a greater focus on the other health priorities that require Government action ahead of the next election. 2

These include long-standing structural issues around public hospital funding, private health insurance, the Review of the Medicare Benefits Schedule, and the My Health Record.

The AMA’s priorities extend to Indigenous Health, medical training and workforce, the Pharmaceutical Benefits Scheme, and the many public health issues facing the Australian community – most notably tobacco, immunisation, obesity, and alcohol abuse.

I have called for the establishment of a no-fault compensation scheme for the very small number of individuals injured by vaccines.

I have called on the other States and Territories to mirror the Western Australian law, which exempts treating doctors from mandatory reporting and stops them getting help.

We also need to deal with ongoing problems in aged care, palliative care, mental health, euthanasia, and the scope of practice of other health professions.

In the past 12 months, the AMA has released statements on infant nutrition, female genital mutilation, and addiction.

In coming months, we will have more to say on cost of living, homelessness, elder abuse, and road safety, to name but a few.

Then there are the prominent highly political and social issues that have a health dimension, and require an AMA position and AMA comment.

All these things have health impacts.

As the peak health and medical advocacy group in the country, the community expects us to have a view and to make public comment. And we do.

Not everybody agrees with us. But our positions are based on evidence, in medical science, and our unique knowledge and experience of medicine and human health.

Health policy is ever-evolving. Health reform never sleeps.

I cannot and will not cover all these issues in my prepared speech today. There is not time. I will highlight a few of the most pressing.

Health Economics

As I have stated many times, health is the best investment that governments can make.

Health should never be considered just an expensive line item in a budget – it is an investment in the welfare, wellbeing, and productivity of the Australian people.

Despite constant claims to the contrary, often from governments, Australia’s health budget is not experiencing an expenditure crisis.

Commonwealth health expenditure is actually reducing as a percentage of the total Commonwealth Budget. 3

In the 2016-17 Budget, health was 15.8 per cent of the total, down from 18 per cent in 2006-07.

While health spending has reached a 10 per cent share of GDP, this is less than comparable countries.

France, Sweden, Germany, and Switzerland all spend 11 per cent.

The United States, with their managed care system of private medicine demands more than 17 per cent of GDP to provide worse health outcomes.

Our system may be the envy of many other countries, but that doesn’t mean we can’t or shouldn’t seek to improve it.

Public Hospitals

Our health system cannot improve without properly-resourced public hospitals.

The doctors, nurses, and other staff who work in them are some of the most skilled in the world.

In 2015-16, there were more than 6 million episodes of admitted patient care in Australia’s public hospitals.

Between 2011-12 and 2015-16, the number of separations rose by 3.3 per cent on average each year.

This was greater than the average growth in population over this period, which was 1.6 per cent.

In 2015-16, public hospitals managed 92 per cent of emergency admissions.

They provide services in a time of need. But they need support.

We are not meeting critical targets.

Against key measures, the performance of our hospitals is stagnant or declining.

Bed number ratios have remained static despite the celebrated opening of multiple shiny new hospitals.

Emergency Department waiting times have worsened and, in most cases, they remain well below the target set by governments to be achieved by 2012-13.

The percentage of ED patients treated in four hours has not moved over the past three years.

It is well below our target of 90 per cent. Elective surgery waiting times have worsened.

So when we talk about the need for secure, long-term, and adequate funding, we need to remember what that funding is for. 4

Only last month, it was suggested that there wasn’t enough ‘competition’ between public hospitals.

Competition? I can’t imagine the mother of a young child with suspected meningitis checking the internet at midnight to see which hospital might provide the most competitive offer.

No, that family would be rushing that child to the nearest ED.

We hear more and more about the idea of ‘docking’ funding to hospitals for what are deemed ‘avoidable readmissions’ and ‘acquired complications’.

Doctors take an oath to look after patients. They take it seriously.

They train their entire careers with the primary purpose to heal people. To make them better.

The idea that a financial disincentive, applied against the hospital, will somehow ‘encourage’ doctors to take better care of patients than they already do is ludicrous.

Unfortunately, some complications are unavoidable.

Where there are errors, or where targets are not met, these are almost always due to not having the resources, the staff, or the time.

Taking funding away from hospitals would make things worse.

We need greater certainty and an increase in funding.

We call on the Federal Government and the States and Territories to listen to doctors in the lead-up to 2018 negotiations.

The concept of a 10-year funding agreement sounds attractive. But it must not become a plan to simply lock in chronic underfunding.

Private Health

Our public hospitals would not survive without the support of our private health system.

As a private practitioner who works in the public system, I am well placed to comment on the relationship between these two pillars of our health system.

Australia’s health system relies on the dual system of public and private health. The two complement each other.

Nearly 70 per cent of elective surgery occurs in private hospitals.

We often talk about private health offering choice – choice of doctor, choice of hospital. It’s why people take out insurance policies.

We talk about private health offering shorter waiting times – it’s a major benefit of the system. 5

But we also need to talk about private health as a critical component of taking pressure off the public system.

As a forceful advocate for public hospitals and those Australians who do not have the luxury of a choice, I am therefore an advocate for private health.

However, I am concerned. Very concerned.

If we do not get reforms to private health insurance right – and soon – we may see essential parts of health care disappear from the private sector.

Doctors have a complicated relationship with private health insurance. Indeed, private health insurance itself is complicated.

There are more than 20,000 policy variations around the country.

They are littered with inconsistent terminology and a bewildering array of exclusions, caveats, carve-outs, and excesses.

There are policies out there that offer inappropriate cover.

There are cases where removal of metal is not covered. So, you have had your head caved in. A surgeon repairs the fracture and inserts a plate at midnight on a Saturday night. All covered by health insurance.

But they do not cover removal of that plate at a later date.

We have seen cases where mothers covered for pregnancy have been told their newborn baby cannot be looked after in the special care nursery.

We are calling for pregnancy cover to be included in all levels of policies, adding it to the risk equalisation pool.

It’s a natural part of life. Two thirds of pregnancies are unplanned. So let’s cover it properly, spread the cost appropriately, and make it affordable for more people.

The same applies to mental health services. Suffering anxiety, depression, or a situational crisis are all too common ‘speed bumps’ in life. They are not predictable. This is why we need insurance.

We need to put the concept of value back into private health insurance.

Market power has dramatically shifted in favour of the private health insurers.

They are deciding who can provide what treatment, and where they can provide it.

We have situations where clinical decision-making is being questioned, and overridden, in some cases, by insurers.

If this shift is allowed to flourish, it will undermine both the private and public systems. 6

Insurers are also insisting practitioners agree to the publication of their details, their fees, and allowing customer testimonials that they do not get to verify.

This is dangerous territory.

The consideration of clinical performance and the years of training to improve safety and quality cannot be captured in a customer ‘star rating system’.

Joint replacement surgery is a bit more nuanced and complicated than an Uber ride.

We note also that contracting arrangements with hospitals have ‘no pay’ clauses for adverse events.

Insurers should not interfere with the established safety and quality system that is achieved via the independent accreditation agencies.

The AMA will fight this deliberate drift towards United States style managed care – a system that performs worse than ours according to nearly every metric.

In the last decade we have seen the PHI industry move from one that was dominated by Mutual insurers, who have members, to for-profits, who have policy-holders and, of course, shareholders.

Private health insurance should serve the needs of health consumers who have paid for it.

Patients should not have health care options available to them curtailed for profits.

We see premiums rise five to six per cent every year, at the same time that people are facing increasing cost of living pressures.

It is no surprise that we see people downgrading or dropping their cover.

This has to stop. It requires careful Government action.

Doctors are not the affordability problem.

Too often we hear misguided and misinformed claims – usually from the very big, very powerful health funds – that doctors’ fees are the reason that premiums are rising. This is an appalling and deliberate lie.

As soon as a doctor charges one cent above the insurers’ scheduled fee or, where it exists, their known gap arrangement, the insurer reverts to paying only 25 per cent of the MBS scheduled fee.

That’s about $330 for a hip replacement, $170 for delivering a baby. The insurers actually save money!

In an admission to hospital that might cost $30,000, do you really think the doctor’s fee is the affordability problem in PHI?

The other argument is that doctor fees are creating out-of-pockets – and a disincentive to private health insurance. 7

But the statistics again disprove it. Doctors’ fees are only 16 per cent of insurer outlays.

Australian Prudential Regulation Authority (APRA) statistics show that 88.1 per cent of services are charged at no gap. That is, nothing to pay – zero dollars. The patient’s health insurance covers it.

A further 6.9 per cent are at a known gap of $500 or less.

Now reflect on the fact that the MBS hasn’t been indexed since 2013. Nor have the insurers indexed their payment schedules anywhere near health inflation, if at all.

APRA recently reported that insurers’ profits were up 17 per cent to $1.8 billion before tax for the 2016-17 financial year.

So governments and insurers set the underlying price for a service – and that price has largely been stagnant.

As a private practitioner, I can promise you that my insurance, my rent, my electricity, my staff wages, my supplies, are all increasing in cost.

Doctors have absorbed these costs. Just look at the combined no-gap and known-gap rate of 95 per cent.

Let’s have a look at the out-of-pockets.

The average known-gap cost for Anaesthesia is $96. So, a specialist doctor with 10 years of training and potentially 30 years of experience comes in to help out with an emergency Caesarean Section at 3.00am in the morning. Try getting your plumbing fixed for that price.

Look at the bulk billing rates in general practice. They too have held firm.

The medical profession has done its utmost best to protect patient access to affordable care.

But unless the ‘payers’ in the system start to work with us, it is simply not sustainable.

When we get instability, patients suffer. They lose access. They lose supply. They lose the quality of care they have a right to.

We will continue to participate in the Ministerial Advisory Committee.

But our patients need and deserve certainty. And so do doctors.

Medical Indemnity

An area of great concern to the medical profession has recently re-emerged.

I am talking about medical indemnity. Some of you may remember the indemnity crisis more than a decade ago. 8

The reforms and protections put in place by then Health Minister Tony Abbott are showing signs of stress.

While back in the UK recently, I saw what could happen here again without intelligent policy.

Medical indemnity in the UK is becoming unstable. The two major providers have pulled out of private Obstetrics. There is talk of pulling out of coverage in other high risk areas.

More than a decade ago, the AMA advocated tirelessly, brought together the profession, and worked with the Government to design a series of schemes that have been a resounding policy success.

They promote stability. They provide affordable insurance, which flows through to affordable care.

That has been the AMA’s strong message heading into the current review of indemnity insurance.

Thankfully, the Government has been receptive to our advice, and I am grateful to Minister Hunt for listening.

He was surprised to hear that annual premiums got as high as $126,000 a few years ago. And that’s after the support schemes’ contributions are taken into account.

We now have a review that is focussed on improving and building on the current policy success. It is not a savings exercise.

It removes a threat to a stable medical workforce.

Medical Workforce

For many Australians, access to a doctor remains a problem. People in rural Australia often find it difficult to access care in a timely fashion.

But the problem is not that we don’t have enough doctors. We have more doctors per head of population than the OECD average.

We are graduating record numbers of medical students, putting us well above the OECD average. But we are not providing enough prevocational and specialist training places for our medical graduates.

We must address workforce shortages in particular specialty areas.

Many people think that medical training finishes at the medical school gates. However, medical training is a much longer journey.

It requires an internship, a period of prevocational training and, ultimately, specialist training, which can last upwards of seven years.

I wrote recently that my training took seventeen and a half years, half my life when I opened my practice on my 35th birthday. 9

With record medical graduate numbers, the pressure this is placing on the medical training pipeline is widely acknowledged.

Next year we face a shortage of 569 first year advanced specialist training places.

The bottleneck of doctors in training waiting to get on to a specialist training program is growing, and the projections suggest it will only get worse.

This has implications for the community’s access to services, and the career aspirations of our best and brightest.

We do not need more medical school places. The focus needs to be further downstream.

Unfortunately, we are seeing Universities continuing to ignore community need and lobbying for new medical schools or extra places.

This is a totally arrogant and irresponsible approach, fuelled by a desire for the prestige of a medical school and their bottom line.

Macquarie University is just the latest case in point.

With a looming oversupply of doctors, they have developed a $250,000 medical degree for those who are wealthy enough to be able to afford it.

With that kind of debt, their graduates will not work in areas where they are needed.

They will opt for more lucrative specialties in major metropolitan locations – assuming they can get a job at all.

It’s an example of greed trumping need, and governments need to work with the AMA to stop this from happening.

The evidence clearly shows that, if you select doctors from a rural background, or provide them with opportunities to train in rural areas, they are much more likely to work in a rural area.

We support Minister Gillespie and his idea for training hubs in the regions.

We will keep arguing about the problems with Bonding. We hope that more graduates will choose general practice or rural practice, or both. We will continue to argue for measures that will work.

General Practice

General practice is under pressure, yet it continues to deliver great outcomes for patients.

GPs are delivering high quality care, and remain the most cost effective part of our health system. But they still work long and hard, often under enormous pressure. 10

The decision to progressively lift the Medicare freeze on GP services is a step in the right direction.

But the Government needs to do much more to recognise and reward quality general practice.

The Government is proceeding with its Health Care Homes trial and, while we share the vision of the trial, it is not without problems.

Significant questions also remain over the adequacy of funding for the trial, given the Government is asking GPs to do more for patients, but with no additional investment.

It will be a number of years before we learn what impact the trial has had for patients, health costs, and whether it relieves pressure on our hospital system.

General practice can’t wait that long. It is already under pressure and needs new investment now.

We must have everything funded and connected – strong primary care, led by general practice; properly resourced public hospitals; and a complementary private hospital sector underpinned by a stable private health insurance industry.

This is a handy ‘to do’ list for the Government.

I turn now to a couple of topics that have put the AMA is a different sort of spotlight.

Marriage Equality

The AMA gets accused of being too conservative.

So, it was not totally surprising to see the reaction to the launch of our new Position Statement on Marriage Equality a few months back.

The AMA position generated significant coverage in both mainstream and social media.

It also generated interest within our membership, the medical profession more broadly, and with the general public.

We received overwhelming support – in line with public opinion polls which indicate the majority of Australians support marriage equality.

Our Position Statement outlines the health implications of excluding LGBTIQ individuals from the institution of marriage.

Things like bullying, harassment, victimisation, depression, fear, exclusion, and discrimination, all impact on physical and mental health.

I received correspondence from AMA members and the general public. The overwhelming majority applauded the AMA position.

Those who opposed the AMA stance said that we were being too progressive, and wading into areas of social policy. 11

The AMA will from time to time weigh in on social issues. We should call out discrimination and inequity in all forms, especially when their consequences affect people’s health and wellbeing.

It is not our place to determine how we achieve marriage equality. That is for our legislators.

We hope this process goes ahead with honesty and respect.

Euthanasia and Physician Assisted Suicide

Last year, we released an updated Position Statement on Euthanasia and Physician Assisted Suicide.

It came at a time when a number of States, most notably South Australia and Victoria, were considering voluntary euthanasia legislation.

There was an expectation in some quarters that the AMA would come out with a radical new direction. We didn’t.

The AMA maintains its position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life.

This does not include the discontinuation of treatments that are of no medical benefit to a dying patient. This is not euthanasia.

Doctors have an ethical duty to care for dying patients so that they can die in comfort and with dignity.

We are always there to provide compassionate care for each of our dying patients so they can end the last chapter of their lives without suffering.

We believe that governments must do all they can to improve end of life care for all Australians.

They must properly resource palliative care services and advance care planning, and produce clear legislation to protect doctors who are providing good end of life care in accordance with the law.

Of course, euthanasia is a matter for society and its Parliaments.

However, if new legislation does come into effect, doctors must be involved in the development of the legislation, regulations, and guidelines.

We must protect doctors acting within the law, vulnerable patients, those who do not want to participate, and the wider health system.

The AMA recognises that good quality end of life care can alleviate pain and other causes of suffering for the overwhelming majority of people. 12

There is already a lot that doctors can ethically and legally do to care for dying patients experiencing pain or other causes of suffering.

This includes giving treatment with the intention of stopping pain and suffering, but which may have the secondary effect of hastening death.

I reiterated all of this yesterday in an address to 40 MPs in Victoria, imploring them to legislate protections according to this ‘doctrine of double effect’.

Bills in South Australia and Tasmania have been defeated. I encourage politicians in Victoria to ‘put the horse before the cart’ and focus on the everyday issues in end of life care.

Our position does not appeal to everyone, least of all high profile euthanasia campaigners and their enthusiastic supporters in the media.

We also have members who differ in their view.

But our position, supported by the overwhelming majority of our Federal Council, is supported by the bulk of the medical profession.

There are medical, ethical, and moral responsibilities at the heart of the doctor-patient relationship, and we all take them and our oath, the Declaration of Geneva, very seriously indeed.

Aboriginal & Torres Strait Islander Health

So too, the AMA takes Indigenous health very seriously.

Last year, I travelled to Darwin to launch our annual Indigenous Health Report card, which focused on Rheumatic Heart Disease.

In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure.

It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

RHD is perhaps the classic example of a Social Determinant of Health.

It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

Smart policy. Saving money. Preventing heartache. The right thing to do.

I remain committed to partnering with other health professionals and champions of Indigenous health like Ken Wyatt and Warren Snowdon to continue to Close the Gap.

The significance of challenging social issues like Indigenous health, marriage equality, and euthanasia is that they highlight the unique position and strengths of the AMA.

We are completely independent of governments. 13

We rely near totally on member subscription income to survive. I can promise you, as a Board member, it is often a concern.

But unlike many other lobby groups, inside and outside the health industry, this gives us a total legitimacy to speak honestly, robustly, and without fear or favour in line with our mission – to lead Australia’s doctors, to promote the health of all Australians.

We have strong public support and respect as the peak medical organisation.

The AMA was recently ranked the most ethical organisation in the country in the Ethics Index produced by the Governance Institute of Australia.

People want and expect us to have a view, an opinion. Sometimes a second opinion.

The media demand that we have an opinion. And not just on bread and butter health issues. But also on social issues that have an impact on health.

Our view is never knee-jerk.

We consult our members and the broader medical profession. Often we encourage feedback from other health professionals – the ones who provide quality health care with us in teams.

We attract public feedback whether we like it or not. I can promise you that social media has taken this to a whole new level.

In the last year I have been criticised by the Pharmacy Guild, the College of Midwives, the Greens, One Nation, the ALP, the Coalition, pro-Euthanasia campaigners, E-cigarette enthusiasts, Anti-Vaccination campaigners, shareholders in Medicinal Cannabis enterprises, and the occasional celebrity chef.

And that is before I get home to my 13 year old daughter.

All of our consultation and engagement informs our policies, our views, our opinions.

Our opinions are not designed to be popular.

Many feel uncomfortable when we talk about healthcare standards for asylum seekers and refugees on Nauru and Manus Island.

We make Australians feel uncomfortable when we ask them to reflect on the amount they drink and the fact that licit drugs like tobacco and alcohol cause far more carnage than Ice ever will.

People might not like it when we use scientific evidence to inform our views on the limitations on the usefulness of Medicinal Cannabis, climate change and health, air quality, expanding adult and child vaccination programs, restricting Codeine use, or call for a tax on sugar-sweetened beverages.

But we believe we get it right most of the time. 14

We are the only body that can possibly represent the whole medical profession – from medical student to retired doctor, from Psychiatrist to Vascular Surgeon to Paediatrician, whether trained in Mumbai or at Monash.

From Busselton to Bundaberg, we will continue to fight for the health of our patients and their communities.

That is why governments take notice of our policies. They are informed by what our patients and what our members tell us, based on what is happening at the front line of health service delivery.

Conclusion

I want to finish today with a message to our political leaders.

Last year we had a very close election, and health policy was a major factor in the closeness of the result.

The Coalition very nearly ended up in Opposition because of its poor health policies.

Labor ran a very effective Mediscare campaign.

As I have noted, the Government appears to have learnt its lesson on health, and is now more engaged and consultative – with the AMA and other health groups.

The next election is due in two years. There could possibly be one earlier. A lot earlier.

As we head to the next election, I ask that we try to take some of the ideology and hard-nosed politicking out of health.

I talked today about some of the structural pillars of our health system – public hospitals, private health, the balance between the two systems, primary care, the need to invest in health prevention.

Let’s make these bipartisan. Let’s take the point scoring out of them.

Both sides should publicly commit to supporting and funding these foundations.

The public – our patients – expect no less.

 

NACCHO Aboriginal Health @amapresident says Treat Dependence And Addiction As Chronic Brain Disease

Behavioural addictions – such as pathological gambling, compulsive buying, or being addicted to exercise or the internet – and substance dependence are recognised as chronic diseases of the brain’s reward, motivation, memory, and related circuitry,

Substance abuse is widespread in Australia. Almost one in seven Australians over the age of 14 have used an illicit substance in the past 12 months, and about the same number report drinking 11 or more standard alcoholic drinks in a single session.

Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.”

AMA President, Dr Michael Gannon pictured above with NACCHO Chair on a recent visit to NT ACCHO Danila Dilba

Read view over 170 Articles last 5 years NACCHO Alcohol and other drugs

Substance dependence and behavioural addictions are chronic brain diseases, and people affected by them should be treated like any other patient with a serious illness, the AMA says.

Releasing the AMA’s Harmful Substance Use, Dependence, and Behavioural Addiction (Addiction) 2017 Position Statement today, AMA President, Dr Michael Gannon, said that dependence and addiction often led to death or disability in patients, yet support and treatment services were severely under-resourced.

Download copy Harmful Substance Use, Dependence and Behavioural Addiction (Addiction) – 2017 – AMA position statement

“Substance use does not inevitably lead to dependence or addiction. A patient’s progression can be influenced by many factors – genetic and biological factors, the age at which the use first started, psychological history, family and peer dynamics, stress, and access to support.

“The costs of untreated dependence and addictions are staggering. Alcohol-related harm alone is estimated to cost $36 billion a year.

“Those affected by dependence and addictions are more likely to have physical and mental health concerns, and their finances, careers, education, and personal relationships can be severely disrupted.

“Left unaddressed, the broader community impacts include reduced employment and productivity, increased health care costs, reliance on social welfare, increased criminal activity, and higher rates of incarceration.

“About one in 10 people in our jails is there because of a drug-related crime.

“Given the consequences of substance dependence and behavioural addictions, the AMA believes it is time for a mature and open discussion about policies and responses that reduce consumption, and that also prevent and reduce the harms associated with drug use and control.

“Services for people with substance dependence and behavioural addiction are severely under-resourced. Being able to access treatment at the right time is vital, yet the demand for services outweighs availability in most instances.

“Waiting for extended periods of time to access treatment can reduce an individual’s motivation to engage in treatment.

“While the Government responded quickly to concerns about crystal methamphetamine use with the National Ice Action Strategy, broader drug policy appears to be a lower priority.

“The recently-released National Drug Strategy 2017-2026 again lists methamphetamine as the highest priority substance for Australia, despite the Strategy noting that only 1.4 per cent of Australians over the age of 14 had ever tried the drug.

“The Strategy also notes that alcohol is associated with 5,000 deaths and more than 150,000 hospitalisations each year, yet the Strategy puts it as a lower priority than ice.

“The updated National Drug Strategy is disappointing. The fact that no additional funding has been allocated to the Strategy to date means that any measures that require funding support are unlikely to occur in the short to medium term.

“The Government must focus on those dependencies and addictions that cause the greatest harm, including alcohol, regardless of whether some substances are more socially acceptable than others.

“General practitioners are a highly trusted source of advice, and they play an important role in the prevention, detection, and management of substance dependence and behavioural addictions. Unfortunately, limited access to suitable treatment can undermine GPs’ efforts in these areas.”

 

NACCHO #WeAreIndigenous on International Day of the World’s Indigenous Peoples AMA calls for a whole-of- Government approach to close our health inequalities

AMA 1

“Aboriginal and Torres Strait Islander people will not achieve equal health outcomes until their educational, economic, and social disadvantages have been eliminated.

“We still have much work to do as a nation to close the gap in life expectancy and the overall health of Indigenous Australians compared with the rest of the community.

“The AMA remains committed to improving the health outcomes for Indigenous people by working in partnership with Aboriginal and Torres Strait Islander groups to advocate for greater Government investment and cohesive coordinated strategies.”

AMA President, Dr Michael Gannon

On International Day of the World’s Indigenous Peoples, the AMA is calling for a whole-of- Government approach to close the health inequalities that exist for Aboriginal and Torres Strait Islander peoples.

This year’s International Day of the World’s Indigenous Peoples is dedicated to supporting the right to education.

AMA President, Dr Michael Gannon, said today that we need genuine collaborative action to improve health and education outcomes for Aboriginal and Torres Strait Islander people.

“There are clear links between education and health,” Dr Gannon said.

“We know closing the gap and improving the health outcomes for Aboriginal and Torres Strait Islander people also means closing the gap in education and literacy.

“Now is the time to develop a whole-of-Government approach to improve access to education and provide health services in culturally appropriate ways to improve the physical and mental wellbeing of Aboriginal and Torres Strait Islander peoples.

“All current and future policies addressing education, employment, poverty, housing, taxation, transport, the environment, and social security should be assessed according to their impact on health and equity.

The AMA strongly endorses the UN Declaration on the Rights of Indigenous People and the goal of equal access to all education and training for Indigenous peoples.