NACCHO political alert: NACCHO welcomes Coalition Indigenous policy finally released

Tony
The NACCHO chair Justin Mohamed welcomes the release of the Coalition Indigenous policy  document and if successful on Saturday hopes that the Coalition will work closely with peak bodies like NACCHO to develop policy and invest in healthy futures for generational change. We look forward to more detail
You can read the full policy in the download

DOWNLOAD the COALITION INDIGENOUS POLICY BOOKLET HERE

Watch NACCHO chair Justin Mohamed and Kirstie Parker On Skynews discussing Coalition policy

Key Points

The Coalition believes indigenous Australians deserve a better future, with more job opportunities, empowered individuals and communities, and higher standards of living.

The Coalition aims to ensure that right around Australia, children go to school, adults go to work and the ordinary law of the land is observed – in indigenous communities no less than in the general community.

The Coalition will establish a Prime Minister’s Indigenous Advisory Council, to be chaired by Mr Warren Mundine. The Council will help ensure that the Indigenous programmes achieve real, positive change to the lives of Aboriginal people.

We will transfer responsibility for Indigenous programmes to the Department of the Prime Minister and Cabinet. Under a Coalition government Australia will, in effect, have a Prime Minister for Indigenous Affairs and a dedicated Indigenous Affairs Minister.

All Australian children, but particularly disadvantaged Indigenous children, need access to a proper education. Much more needs to be done in this area. The Coalition will work with the States and Territories to improve educational outcomes for Aboriginal children.

Within 12 months of taking office, the Coalition will put forward a draft amendment for constitutional recognition and establish a bipartisan process to assess its chances of success. The key objective of a referendum will be to achieve a unifying moment for the nation, similar to that achieved by the 1967 constitutional referendum.

The Coalition will provide support for Jawun’s Empowered Communities initiative, which is a new regionalised model to be applied in eight opt-in communities. Empowered Communities will give more authority to local indigenous leaders with a view to achieving Closing the Gap targets more quickly.

The Department of the Prime Minister and Cabinet will review indigenous training and employment programmes to ensure that such programmes are more effectively linked to employment outcomes. This review will be headed by Mr Andrew Forrest.

We will provide up to $45 million for GenerationOne’s demand-driven training model. This commitment, through GenerationOne’s Australian Employment Covenant, will train up to 5,000 Indigenous people for guaranteed jobs

HEALTH

The Coalition will work collaboratively with State and Territory Governments, as well as the community health sector through existing national frameworks, to ensure that our efforts to close the Indigenous health gap achieve the real and lasting outcomes that all Australians expect.
Aboriginal and Torres Strait Islander Health continues to be an urgent priority for the Coalition. We have a long and proud record of improving Indigenous health outcomes and we remain fully committed to achieving health equality between Indigenous and non-Indigenous Australians within a generation.
Despite good intent and considerable investment by successive governments, there remains a significant disparity in health outcomes for Indigenous Australians as evident by key indicators such as life expectancy, age-standardised death rates and rates of chronic disease.
Continued investment in clinical health services for all Indigenous Australians will remain a priority for the Coalition. However, the Coalition is also determined to address the social determinants of health that will be key to improving Indigenous health outcomes.
The Coalition has provided in-principle support for Closing the Gap initiatives and will maintain the funding in the Budget allocated to Closing the Gap in Health. We have also committed to a range of initiatives to improve school attendance, employment opportunities and appropriate housing options in remote and Indigenous communities.

The Choice

The ANAO reports that in 2011 there were 210 Indigenous specific Australian Government programmes and sub-programmes included in its Closing the Gap activities, administered by more than 40 agencies across 17 separate portfolios, with the best estimate of expenditure totalling $4.2 billion in 2011-12.

Unfortunately, you do not have to look very closely at the Prime Minister’s recent report on Closing the Gap to conclude that Labor’s approach to Indigenous Affairs has not worked.

While a target for access to preschool programmes appears to have been met, there is no indication that Aboriginal children are availing themselves of these places. The life expectancy gap is stuck stubbornly where it was five years ago. There has been an improvement in the infant mortality rate, but the trend was established under the Howard Government as far back as 1998 and the decline in infant mortality has not accelerated under Labor. Despite all the expenditure on job programmes, unemployment remains unacceptably high. Tragically, a number of the education or NAPLAN indicators are going backwards.

Too many young Indigenous people in remote areas are not attending school and are not able to read or write at anywhere near an acceptable standard. Labor has clearly not done enough to address this.

Economic development on Aboriginal land and land tenure reform has stalled because the Labor Government has no appetite for changing the status quo. They abandoned the Indigenous Home Ownership on Indigenous Land programme because of their complete lack of progress on land tenure reform. Indigenous people in remote areas remain dependent on welfare, have no jobs, no property rights and are over run by bureaucrats; while Labor’s priority is the protection of vested interests.

They dropped the ball on the Northern Territory intervention and have replaced it with the self-serving bureaucratic Stronger Futures programme, leaving future generations condemned to a life on welfare.

The Coalition’s Policy

The failure to properly manage the expenditure of hundreds of millions of dollars for remote Indigenous housing under their Strategic Indigenous Housing and Infrastructure programme (SIHIP) is an absolute disgrace.

In the end, despite all the money Labor has spent, it will not have achieved its objective of reducing overcrowding in remote communities.

Labor’s failure to properly monitor and evaluate Indigenous programmes has led to chronic waste and lost opportunities, a prime example of this is the mismanagement of the Strategic Indigenous Housing and Infrastructure programme.

Resources meant to improve the lives of Indigenous Australians are being squandered on overlapping and inconsistent services and bloated bureaucracies that disempower local people and their communities.

The Labor Indigenous affairs landscape is littered with bureaucratic failure and incompetence. The ANAO found that the key Australian Government agency responsible for coordination arrangements for Indigenous programmes “is failing to adequately perform its lead agency role and needs to be more proactive at monitoring and reporting on expenditure.”

Labor has shown that it has not been prepared to apply the same standards and expectations for Indigenous Australians that it would apply to other Australians. Like Labor’s approach to housing, when they set targets and as usual fail to meet them they simply reduce the standard to be achieved.

The result of all this is that after more than six years and lots of money, Labor has not made sufficient inroads into Aboriginal welfare dependency, incarceration rates, overcrowding, poverty or school attendance and achievement.

The Coalition will continue the current level of funding expended on Closing the Gap activities, but will examine these costly programmes to make sure that they are directly working to meet the Closing the Gap targets.

We will take steps to ensure that the people who the programmes and services are intended to assist take advantage of those programmes and services. We would also make sure that programmes are targeted on the basis of need, not race alone, and are delivered in the most effective way possible.

Attending school is an absolute must. Opportunities for employment must be grasped. The Coalition will operate on the principle of offering a hand up rather than a hand out.

The Coalition will make sure that the same standards and the same expectations apply to Indigenous Australians as are applied to other Australians. Importantly, we would not attempt to deny local people the opportunity to solve their own problems.

The Coalition’s Policy for Indigenous Affairs will invest $94 million over the forward estimates in a better future for indigenous Australians

NACCHO AMA political alert: Big “bang”gap in health policies to Close the Gap

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“No party has yet produced a comprehensive Indigenous health policy that would provide significant new funding and direction to build on the modest but welcome successes to date of the Closing the Gap strategy.

“The ideal health policy for this election would combine elements of each of the policies on offer from Labor, the Coalition and The Greens – topped with a ‘big bang’ Indigenous health policy and a well-articulated approach to dealing with the growing impact of chronic disease.

AMA President, Dr Steve Hambleton, (picture above left with NACCHO CEO Lisa Briggs, Chair Justin Mohamed and DoHA Department Secretary Jane Halton)

AMA PRESS RELEASE

AMA President, Dr Steve Hambleton, today urged the major parties to plug the gaps in their election health platforms before Saturday’s election.

Dr Hambleton said that there are lots of votes in positive, forward-looking health policies and there is still time for Mr Rudd and Mr Abbott to pitch more comprehensive health policies to the electorate.

“I set a health policy challenge at the National Press Club in July,” Dr Hambleton said.

“We currently have a new set of problems and challenges in meeting the health needs of the Australian community, and they require a new set of solutions – and that is the great task for the major parties.

“Any change must be tested against the reasons we need proper health reform – mainly our increasing burden of chronic disease and our ageing population.

“Proposals should be moving us toward a joined-up, strengthened primary health care system built on team-based solutions.

“The Labor emphasis to date in this campaign has been on hospital infrastructure, while the Coalition is concentrating on primary care, especially general practice.

“The Greens have focused on access to healthcare, public health and environmental health.  They have a policy that supports the AMA proposal for an independent panel to assess the health of asylum seekers.

“No party has yet produced a comprehensive Indigenous health policy that would provide significant new funding and direction to build on the modest but welcome successes to date of the Closing the Gap strategy.

“The ideal health policy for this election would combine elements of each of the policies on offer from Labor, the Coalition and The Greens – topped with a ‘big bang’ Indigenous health policy and a well-articulated approach to dealing with the growing impact of chronic disease.

“We encourage the major parties to commit to practical and affordable policies that would improve public health, help the most vulnerable and disadvantaged in the community, and ensure a strong, highly skilled medical workforce to meet the future health needs of the community.

“The AMA released a Key Health Issues plan in July, which set out achievable policies that would deliver health service improvements at the front line, directly to patients.

“Some elements have been addressed, but many haven’t.

“We remind our political leaders of what they can do to bolster their health credentials in the final days of the campaign.”

Indigenous Health No significant new funding or direction to build on the modest but welcome successes to date of the Closing the Gap strategy.

Scrap the Cap The Government deferred its ill-considered cap on the tax deductibility of self-education expenses, but no party has yet been prepared to dump this policy, which is bad for education, productivity, and the economy, as well as the safety and quality of our health services.

Medical Training The AMA remains committed to working with the next Government to come up with a long-term policy that supports medical education and training.

Despite the major parties announcing additional intern places in the private sector, which were welcomed, no party has tackled the need to better coordinate the medical training pipeline or address the looming shortage of prevocational and specialist training positions as predicted by Health Workforce Australia.

There needs to be a concerted effort through COAG processes to commit to additional prevocational and specialist training places, including in general practice, with funding to match, in order to ensure that Australia can properly address future community health needs

Chronic Disease The major parties need to do more to tackle the impact of chronic disease so that we can keep people well and out of hospital.  Current Medicare arrangements impose too much paperwork on GPs and limit access to services for patients with higher health care needs.

The major parties need to do more to support GPs in caring for these patients by streamlining current Medicare arrangements and by looking to adopt innovative approaches such as the Department of Veterans’ Affairs Coordinated Veterans Care program more broadly.

We note and welcome the proposed Australian Prevention Partnership Centre, launched today by Federal Minister for Health and Minister for Medical Research Tanya Plibersek, to research what works and what doesn’t in helping people make lifestyle changes to prevent chronic disease.

Rural Health Rural health has still missed out on the big funding boost it needs to address rural medical workforce shortages.

The AMA/RDAA Rural Rescue Package outlines the funding required to get more doctors into rural and remote Australia, with the right mix of skills to deliver services to these communities

Healthier Australian Families There has been no specific policy announcement from Labor or the Coalition on significant public health concerns around Better Environmental Health (effects of climate change, better standards for clean air, greater health monitoring of non-conventional gas mining projects), Preventing Harms of Alcohol (curbs on alcohol marketing to young people, minimum pricing for alcohol products), or Asylum Seeker Health (independent panel).

Dementia, Aged Care and Palliative Care We acknowledge and welcome recent policy announcements around palliative care and dementia, but they do not go to the key issue of access to medical care.

The major parties need to ensure that people with dementia, those who require palliative care, and older Australians with complex and multiple conditions can receive appropriate medical care.  The major parties need to do more to ensure the Medicare arrangements are geared to deal with the increasing numbers of these patients and the need to better manage these patients in the community.

Better recognition of and support for the time that doctors spend assessing patients, organising services and providing support to the patient’s family and carers would ensure that quality dementia, palliative and medical care for the elderly is provided inappropriate settings.  This would relieve the counterproductive use of acute services.

Affordable Medical Services Immediately restore indexation of MBS patient rebates.  Reverse the decision to raise the Extended Medicare Safety Net threshold from 2015.  Restore tax deductibility of out-of-pocket medical and health care gaps.

Authority Prescriptions While the major parties mention tackling red tape, no party has committed to reducing the time wasted by doctors having to telephone the Department of Human Services (DHS) to obtain an authority to write prescriptions for certain PBS medicines.  Based on DHS information, up to 25,000 patient consultations are lost while doctors wait for their calls to DHS to be answered.

AMA Key Health Issues for the 2013 Federal Election is available on the AMA website at https://ama.com.au/keyhealthissues

The AMA publication, Alcohol Marketing and Young People, is at https://ama.com.au/alcohol-marketing-and-young-people

NACCHO political alert: Complacent parties taking eye off the ball in Aboriginal health

Question Time in the House of Representatives

This time next week Tony Abbott could be the PM and Peter Dutton Health Minister but:

Closing the health gap between Indigenous and non-Indigenous Australians should be one of the highest priorities for government. Yet Indigenous health has barely been mentioned by either major party during this campaign.

healthy-futures-great

NACCHO chairman Justin Mohamed says the only thing missing is political attention, with indigenous health hardly mentioned so far in the federal election campaign. At the National Press Club Health debate last week Peter Dutton announced that Tony Abbott would be making an announcement before Saturday about Aboriginal health but so far nothing.

“I think to be honest both parties at different times do talk about Aboriginal community control, do talk about Aboriginal health, but I think what we’re seeing in the election process at the moment is that I would like to see more of the parties to let us know what their platform is or what their thoughts are around Aboriginal health, not just health in general.”

Mr Mohamed argues that Aboriginal community-controlled health bodies have proven their expertise and efficiency, and whoever wins government on September 7 must show greater faith in the sector.

Press release from Australian Healthcare Reform Alliance (AHCRA).

Health care is one of the most important issues to voters at this election but the policies of both major parties fail to deliver on key measures, according to the Australian Healthcare Reform Alliance (AHCRA). “Whilst there are some valuable initiatives from both sides, they fail to add up to a genuine effort to address the scale of the current health system problems.

There is insufficient action to address serious inequities in health and health care or longer term problems – they have taken their eye of the ball,” said Tony McBride, AHCRA chair.

“Closing the health gap between Indigenous and non-Indigenous Australians should be one of the highest priorities for government. Yet Indigenous health has barely been mentioned by either major party during this campaign.

“The current Labor Government has introduced some promising reforms, such as Medicare Locals and national funding of children’s dental services and more public adult services, a move that will address inequities. AHCRA therefore welcomes the Coalition’s broad support for these positive reforms, but is very concerned that there are too few details of how they will be progressed if they win power.

“Another major threat to our health system is the increasingly high co-payments faced by people when accessing care. Unless co-payments are addressed, they will continue to be a severe barrier that undermines the equity and universality of health programs such as Medicare and reverses any gains made by the reform process.

“Most importantly, neither major party has their eyes on the future and on how the looming health funding crisis in the next decade can be avoided as health care costs escalate. Neither party has a robust plan to keep people well and out of hospital by supporting prevention, by seriously addressing the social determinants of health that cause so much ill-health or by effectively managing chronic disease in the community. Without such action, the pressure on hospitals will simply grow to unaffordable levels and society as a whole and health care will become increasingly inequitable.

AHCRA welcomes Labor’s commitments to mental health, medical research, and better stroke care. But overall its initiatives and vision are far too modest.

AHCRA welcomes the Coalition’s significant investment in support for general practice teaching and the 500 additional nursing and allied health scholarships for students and health professionals in areas of need. AHCRA also supports the Coalition’s more detailed plans for mental health research and other initiatives to improve care, especially for young people. However it is concerned about the

Coalition’s plans to hand back hospitals to local rather than regional boards which will not serve consumers’ needs for a highly integrated system unless there is a universal commitment to consumer-centred care. Additionally the plan to restore the private health insurance rebate to the wealthiest Australians makes no financial or health policy sense given the take up of private health insurance has actually increased since the rebate was cut.

AHCRA strongly supports the Greens’ universal dental plan but disappointingly even they do not place health among their top ten policies.

Mr McBride called on both major parties to “address the holes in your health policies before the 7th September and commit to building on the early gains of the reform agenda. Deliver a world class health system for Australia’s future that is effective and financially sustainable by addressing equity and focussing much more on prevention and primary health care” he concluded.

Contacts:

Tony McBride, Chair, 0407 531 468;

Bruce Simmons

NACCHO political news: What are the Aboriginal health priorities for the next Government ?

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Call for incoming government to commit to Close the Gap

A renewed COAG National Partnership Agreement on Closing the Gap and action on the National Aboriginal and Torres Strait Islander Health Plan should be key priorities for the next government, according to an incoming government brief prepared by the Close the Gap Steering Committee.

Picture above Tanya Plibersek and Peter Dutton National Press Club Health Debate 

VIEW VIDEO on current  Peter Dutton Aboriginal Health policy NATIONAL PRESS CLUB HEALTH DEBATE

The briefing paper, to be released today, outlines the key steps needed in the next parliament to ensure progress on closing the life expectancy gap between Aboriginal and Torres Strait Islander and other Australians.

DOWLOAD THE 16 Page BUILDING ON CLOSE THE GAP document here

The paper says that within its first hundred days, a new government should:

  • Reaffirm the commitment for the Prime Minister to annually report at the beginning of Parliament on progress towards closing the gap;
  • Secure a new COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, with a minimum Commonwealth investment of $777 million over the next three years; and
  • Begin the implementation of the National Aboriginal and Torres Strait Islander Health Plan in partnership with Aboriginal and Torres Strait Islander people and their representatives.

Campaign spokesperson and Chair of National Aboriginal Community Controlled Health Organisation, Justin Mohamed said that closing the gap is literally a life or death issue for Aboriginal and Torres Strait Islander people.

Team NACCHO

TEAM NACCHO at the NATIONAL PRESS CLUB Health Debate

“We’re only at the beginning of the journey to close the gap in life expectancy by 2030.  We can’t turn back now because closing the gap needs long-term commitment and policy continuity. Aboriginal and Torres Strait Islander health in our hands is having an impact and we must keep supporting our people to deliver their own health outcomes,” Mr Mohamed said.

AMA President, Dr Steve Hambleton said that both Kevin Rudd and Tony Abbott have been strong supporters of Close the Gap.

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AMA President, Dr Steve Hambleton with Department of Health Secretary Jane Halton .NACCHO’S Lisa Briggs and Justin Mohamed

He said that Tony Abbott gave the campaign strong encouragement in its early days when he was Health Minister and Kevin Rudd committed to the targets and deadlines we proposed and secured the first National Partnership Agreement through COAG.

“It’s important that momentum towards closing the gap is maintained regardless of who wins the election.  Closing the gap is a generational effort and we are beginning to see signs of progress,” Dr Hambleton said.

Lowitja Institute Chair, Pat Anderson said the Close the Gap Steering Committee welcomed the attention given to Aboriginal and Torres Strait Islander education and employment in the election campaign.

“Along with racism, education and employment are key social determinants of health.  But action on these needs to proceed at the same time as action on health because kids can’t study and parents can’t hold down a job if they have poor health,” Ms Anderson said.

The Close the Gap Campaign was launched by Olympians Catherine Freeman and Ian Thorpe in April 2007. Since then almost 200,000 Australians have signed up to the campaign, which has also received multi party support by all Federal, State and Territory Governments.

 Close the Gap platform : https://www.humanrights.gov.au/close-gap-indigenous-health-campaign

Media contact: Gary Highland. Mobile: 0418 476 940

DOWLOAD THE 16 Page BUILDING ON CLOSE THE GAP document here

NACCHO political alert: Weighing up the Coalition’s health policy and finding it pretty light-on

Peter Dutton

Opposition spokesman Peter Dutton will be debating Health Minister Hon Tanya Plibersek MP at National Press Club  today

You can follow the debate on Twitter @NACCHOAustralia   or LIsa Briggs @NACCHO_CEO

Tanya Plibersek

What is our ACCHO sector saying about the Coalition health policy

“It is vital that responsibility for Aboriginal health remains in the health department and is not transferred into PM&C.

I have published on the success of the transfer of health administration responsibility from ATSIC to the DoHA – we cannot go back to a situation where responsibility for health is back within a non-health literate bureaucracy”

Dr John Boffa, Public Health Medical Officer, Central Australian Aboriginal Congress

NACCHO statement

Aboriginal people across the country today will be disappointed by the release of the Coalition’s health policy given the persistent appalling health gap between Aboriginal and non-Aboriginal Australians.

NACCHO Chair, Justin Mohamed said the seventeen page Coalition Health Plan dedicated only one line to Aboriginal health and provided no detail on the initiatives they would support to specifically improve Aboriginal and Torres Strait Islander health outcomes.

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“Tony Abbott has previously expressed a commitment to closing the shameful health gap between Aboriginal and non-Aboriginal Australians.

“The Coalition signed the Close the Gap Statement of Intent in 2008 and plans to elevate Aboriginal affairs directly to the Prime Ministerial office if Tony Abbott wins Government in three weeks.

“Given that, it is disappointing and somewhat surprising that he has not given a lot more focus in his Health Policy to solving the challenges in Aboriginal health.

“Focusing on bowel screening, diabetes management, dental health and building the medical workforce are welcome initiatives in the Coalition Policy but must be delivered by Aboriginal people to Aboriginal people if we are maximise their effect in Aboriginal communities.”

 REVIEWED BY

blogmasthead

When weighing up the various election policies through a health lens, some of the most important issues to consider are:

1. How do the policies address climate change, the major public health issue that we – as Australians, as the planet – are facing?

2. How are health inequalities addressed? Is there an explicit commitment to addressing the social determinants of health, and to implementing a health-in-all-policies approach?

3. What is the plan for improving Indigenous health, mental health, the situation of those living in poverty – especially children, and the health of asylum seekers (some of the most glaring areas of health inequalities).

4. How do the policies address prevention, and are they upfront about the need to tackle the vested interests that contribute to so much poor health and unhealthy environments, particularly the coal, tobacco, alcohol, gaming and junk food industries?

5. How do the policies plan to ensure the sustainability and affordability of our health system? This requires major ongoing reform, and again being prepared to take on the powerful vested interests that tend to dominate policy agenda.

As to the above, a search of the Coalition’s health policy finds:

1. No reference to climate change and no response to calls for a national policy to deal with its health impacts.

2. No reference to health inequalities, the social determinants of health or health in all policies.

3. Only passing reference to Indigenous health and mental health. Mind you, as has been pointed out by the Australian Medicare Local Alliance, neither major party distinguished itself on Indigenous health so far this election.

4. Apart from Tony Abbott’s announcement that the Liberal Party will no longer accept tobacco donations, the policy gives no signal of intent to tackle the interests that contribute to poor health. The title of the policy – The Coalition’s policy to support Australia’s health system – doesn’t inspire any sense that population health is understood, let alone a priority. The only mention of prevention is in the context of plans for a new national diabetes strategy. The policy fails to even mention the Australian National Preventive Health Agency, surely an ominous sign.

5. The policy explicitly endorses the importance of a universal health system: “strong public hospitals providing universal access to care will be a central pillar of our health system under a Coalition government”. But it leaves unanswered important questions around the fate of the architecture of national health reform that underpins this pillar, for eg does the Coalition support the National Health Performance Authority? It gives no indication that the Coalition has any plans for a reform agenda as groups like Mend Medicare would like to see. As this article at The Global Mail makes clear, the Liberal Party is heavily backed by the private hospital industry  – and Tony Abbott’s support for the private sector showed yesterday in his suggestion that private hospitals outperform public hospitals (a highly contestable statement given that less than half of the 570 private hospitals report quality and safety data to the MyHospitals website). The policy mentions hospitals 26 times, while primary care rates 15 mentions. The only mention of Medicare Locals is ominous, that there will be a review “ensure that funding is being spent as effectively as possible to support frontline services rather than administration”. Senator Richard Di Natale tweeted yesterday that he suspected the review may be “code for abolition”.

Bu perhaps it’s naive to expect that election health policies might offer a vision for the future. As the University of Sydney’s James Gillespie has written at The Conversation, the Coalition’s health policy seems mainly focused on keeping itself a small target. The policy is cautious and more focused on attacking PM Rudd than providing any visionary alternatives, he writes. Clearly it’s the politics, not the policy that is driving this policy document.

The policy will cost $340 million over the forward estimates and is structured under the headlines of supporting hospitals, timely access to medicines, and rebuilding primary care.

Its announcements include:

• The Health Minister will have the authority to list medicines recommended by the PBAC that do not cost more than $20 million in any of the first four years of listing. “We will help Australians get quicker access to new treatments.”  As one Croakey contributor notes below, it sounds like Peter Dutton and his advisors haven’t read Ben Goldacre’s book, Bad Pharma – and should.

• The Coalition will bring forward the full implementation of biennial bowel cancer screening by 14 years.

• It will invest $52.5million to expand existing general practices for teaching and supervision; invest $119 million to double the practice incentive payment for teaching in general practice/

• Provide 500 additional nursing and allied health scholarships for students and health professionals in areas of need and provide $40 million for 400 medical internships in private and non-traditional settings.

• The Coalition will work with the sector to provide a nationally coordinated approach to clinical trials, reduce complexity of ethics processes and where possible, rationalise the number of ethics committees.

• The Child Dental Benefits Schedule, which is due to commence in January 2014, is to provide access to $1,000 in Medicare dental benefits for eligible children. From 1 July 2014 funding is due to be provided to the States under the National Partnership Agreement for Adult Public Dental Services.  The Coalition will honour the arrangements under the National Partnership Agreement for Adult Public Dental Services and will continue to work with stakeholders, patient representatives and State and Territories to improve the scheme as necessary. At the expiry of the National Partnership Agreement for Adult Public Dental Services, the Coalition will seek to transition respective adult dental services to be included under Medicare.

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Responses from Croakey contributors

On public health

Professor Simon Chapman, University of Sydney (re stopping tobacco donations)

Better late than never. The Liberals now join the Greens and Labor in telling Big Tobacco “we don’t want your blood money”. That leaves only the Nationals as a major party yet to show tobacco the door.

This is certainly an announcement of important symbolic importance. But the Liberal Party has deep connections with the Institute of Public Affairs, which receives money from British American Tobacco and probably other tobacco companies.

There will be nothing stopping the IPA from laundering tobacco donations to political parties, and that’s likely to only mean the Liberals. But will it do them any good?

Tony Abbott memorably went out of his way to say publicly on the morning of the 2012 High Court decision on plain packaging that he hoped the High Court would uphold the government’s intent on plain packs and reject the tobacco industry’s case.

He also has announced that a Coalition government will be keeping the Labor-announced major tax increases over the next four years. These will drive smoking down further, while bringing in over $5billion in revenue. Abbott while health minister in the Howard Government, introduced graphic health warnings on packs, hardly the action of a poodle for Big Tobacco.

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Professor Mike Daube, Curtin University

Delighted by bipartisan approach to tobacco funding. That’s a big and important step forward.

Bowel cancer screening commitment is good.

Would have liked to see more about prevention programs: commitment to maintaining action on tobacco; firm action on alcohol; focus on obesity tsunami.

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Nutritionist Rosemary Stanton

Reading through the Coalition’s health policy, prevention of non-communicable diseases seems limited to bringing forward

(a) bowel cancer screening (a good idea – although what is the policy when the faecal occult test reveals something that requires a colonoscopy – what is the policy for this procedure, currently very costly or subject to long waiting periods for admission to a public hospital),

and

(b) some vague thoughts on trying to bring the different diabetes organisations together (bests of British on that!).

Prevention of type 2 diabetes requires looking at obesity. It’s all very well and good to use increased services of allied health professionals, but they can’t address what is basically an obesogenic environment. And obesity is one of the major problems related to diabetes, it’s also relevant to bowel cancer, cardiovascular disease (which seems to have been forgotten), osteoarthritis and many other health problems.

The two major areas of preventing obesity have not been addressed – ie making it easier for people to be physically active and to choose healthier foods. These areas need to be addressed at a structural level rather than leaving them to individual consultation with an allied health professional.

The food supply is top heavy with junk foods and drinks – all advertised extensively (through TV, radio and print advertising and increasingly through advergaming directed at children and social media campaigns – such as those run by Coca Cola). Neither individuals or industry operated codes of practice are sufficient to tackle these problems.

For physical activity, we need more emphasis on public transport and local affordable facilities. (The Coalition seems to think more roads are more important than public transport or cycling facilities.) While local facilities such as walking paths, sporting fields, playgrounds, swimming pools etc) may be a local government responsibility, this is an area where fears of litigation have made local authorities prefer to remove facilities rather than face possible legal action. This is one area where federal govt could assist by removing ‘red tape’ systems that favour lawyers and litigation over provision of public areas suitable for physical activity.

On food, where is the policy that will help individuals make healthier food choices – especially those on lower incomes? Where is the policy to stop bombarding kids with ads for junk food and drinks, and adults with ads for alcoholic beverages. Where is the policy to tax alcoholic drinks on their alcohol content? Where is the policy to ensure fresh produce is available at a reasonable price to low-income people and those in more remote communities?

The rant about private health insurance rebates being removed is absurd. How can the Coalition describe those earning high salaries (which were the only ones with a cut to the PHIR) as ‘struggling’ under cost of living pressures?

The statement that the Coalition will ‘reinvest in private health insurance “once fiscal circumstances allow” is a good example of weasel words. Why should there be a rebate for anyone taking out private health insurance. There is no rebate for people insuring their lives, cars, houses or other aspects of life. If the money spent on rebates for private health insurance were directed to public health and public hospitals, there would be no crisis in health care.

I am against giving the Health Minister sole responsibility for approving medicines where the costs is less than $20m (or any other figure). Health Ministers are not health experts and giving any one person such responsibility opens that person to persuasive tactics from those wanting their medicines approved in this way.

Where is some kind of policy on ‘shonky’ goods marketed under the TGA’s almost non-existent oversight?

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On mental health

Sebastian Rosenberg, University of Sydney

I am flabbergasted that the issue of mental health is completely ignored in the Coalition’s health policy.

How can an issue with such currency only a few years ago now seem so far off the political radar? Within the past fortnight, major reports into mental health have been issued by the Mental Health Council of Australia and by a consortium of nearly 50 organisations led by Adjunct Professor John Mendoza.

Mental health in Australia remains in crisis.  The lifespan of people with severe mental illness has not improved over the past 30 years. Neither party has so far offered any solutions or commitments to change this pitiful situation, one in which suicide and self-harm are common, daily occurrences for our young people.

Even armed with increasing evidence about what works in mental health care and treatment and a suite of articulate and high profile advocates, the issue of mental health has uniquely found a way to disappear from public view, leaving literally millions of Australian people and families isolated and unhelped.  The electorate has repeatedly indicated its concern to see mental health fixed.  It seems a bizarre and tragic case study in reverse advocacy, one worth studying carefully.

It is even more curious because many if not most politicians have some level of intimate understanding of mental illness and the impact it can have on families. What permits such a  damaging and pervasive health and social issue to go unaddressed?  What makes it ok for our politicians not to speak about mental health? To ignore it?

I am not sure of the answer but clearly mental health has failed to demonstrate the merit of continuing attention.  I think this is at the heart of enduring stigma towards mental health – that spending money on crazy people would in itself be crazy.  Sophisticated arguments about the economic and productivity benefits to be derived by assisting people with a mental illness to find work don’t stack up against this prejudice.  Crazy.

The poverty of our so-called mental health system means the nature of care and treatment vary from place to place.  People don’t trust services to be available when and where they need them. People are helped to understand the risks and have confidence in cancer treatments. Can we say the same for mental health and if not, why not?  Stigma lives here.

The past decade has seen a stop/start attitude to mental health reform in Australia.  At the moment, we are practically at full stop. Governance of and responsibility for mental health is skewered on the federal/state divide. Let’s hope that before the campaign is over, the huge task of mental health reform can at least be considered by the major parties.  Nobody is expecting miracles.  Just some ongoing attention to one of the biggest health and social challenges facing 21st century Australia.

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On Indigenous health

Dr John Boffa, Public Health Medical Officer, Central Australian Aboriginal Congress

It is vital that responsibility for Aboriginal health remains in the health department and is not transferred into PM&C.

I have published on the success of the transfer of health administration responsibility from ATSIC to the DoHA – we cannot go back to a situation where responsibility for health is back within a non-health literate bureaucracy.

It may well be useful to have PM&C responsible for some aspects of Aboriginal Affairs such as economic development and creation of employment in Aboriginal communities but not health and education these should stay out. PM&C could take over the FaHCSIA portfolio areas and this may well be useful and give these areas more clout.

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NACCHO statement

Aboriginal people across the country today will be disappointed by the release of the Coalition’s health policy given the persistent appalling health gap between Aboriginal and non-Aboriginal Australians.

NACCHO Chair, Justin Mohamed said the seventeen page Coalition Health Plan dedicated only one line to Aboriginal health and provided no detail on the initiatives they would support to specifically improve Aboriginal and Torres Strait Islander health outcomes.

“Tony Abbott has previously expressed a commitment to closing the shameful health gap between Aboriginal and non-Aboriginal Australians.

“The Coalition signed the Close the Gap Statement of Intent in 2008 and plans to elevate Aboriginal affairs directly to the Prime Ministerial office if Tony Abbott wins Government in three weeks.

“Given that, it is disappointing and somewhat surprising that he has not given a lot more focus in his Health Policy to solving the challenges in Aboriginal health.

“Focusing on bowel screening, diabetes management, dental health and building the medical workforce are welcome initiatives in the Coalition Policy but must be delivered by Aboriginal people to Aboriginal people if we are maximise their effect in Aboriginal communities.”

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On workforce and general policies

Professor Andrew Wilson, Menzies Centre for Health Policy, University of Sydney

The devil is always in the delivery but:

1. Reinstating the ministerial delegated $20m responsibility for PBAC decisions is sensible, the increased limit necessary to allow for inflation. The challenge is that pharma can usually structure their proposed listing to come under the cap by limiting the target population. The risk is whether that target population actually reflects the real prescribed population (this is not a new risk). A newer risk is that there are a lot more niche medicines, ie targeting specific conditions.

2. The need for a National Diabetes Strategy with a much stronger prevention element is self-evident. However not clear what resources will be behind strategy other than the $30 million for research on curing type 1 diabetes which represents about 15% of all diabetes cases. T1 diabetes is disproportionately costly because f younger age of onset and higher complication rates.

3. The need for the guarantee on intern places is important (declaring my COI as I have a child studying medicine). I also think the additional subsidy to general practice teaching is good news as this remains a specialty that needs to expand rapidly. Nothing wrong with the scholarship proposal although shown to have limited workforce impact. I remain concerned that there is no additional support for supporting new nurse entry. The workforce modelling shows tis is the most critical future resource shortage and while we have expanded undergraduate training numbers, there will be a short term excess of nursing graduates who will be unable to find entry level positions and who will then look elsewhere.

I am also concerned that the additional GP teaching subsidy puts yet another price signal in the clinical placement arena will bring further efforts from public hospitals to charge for clinical placements. The independent Health Pricing Authority should be directed to accelerate its work on the teaching, research and training component of ABF for hospitals so there is a consistent approach to this across sectors.

4. Not totally clear on what is proposed on dental health but at least the interim commitment to continue current arrangements hopefully won’t see us going backwards.

5. Mixed messages here about private health insurance but at least without specific commitments they have left themselves room to undertake a major review of private health insurance if they get into office.

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Professor John Dwyer, UNSW

No exciting policy announcements re our health system have been forthcoming from the Government or Coalition. They refuse to recognise the structural deficiencies that need correction if we are to give Australians the contemporary health system they need.

I stress the word health as much of the discussions centre on sickness.

Where will we find the leadership to take us on a journey to a single funder model integrating in a patient focused way Primary, community and hospital care/ $4 billion could be saved by a single funder model—9 departments of health for 23 million people?

No structure to see us focus on prevention is forthcoming despite the evidence from so many countries that having people enrol in an Integrated Primary Care model (team medicine) where patients and families are serviced to help them stay well rather than just treat illness is cost effective. It requires Medicare funding of teams of doctors, nurses and allied health practitioners in the one practice (not just physically located in separate practices but I the one building e.g..  Super GP clinics.

The only way we can afford timely quality hospital care into the future is through a reduction in the demand (need) for hospital services through better community care.

The PC remember has estimated that 700,000 plus admissions to public hospitals could be avoided by an effective community intervention in the three weeks prior to someone requiring admission.700000 x $5000 (average cost of an admission) = 350 million dollars tat could be available for the PC sector.

Where are policies to tackle the increasing inequity that sees the biggest growth in health expenditure coming from Australians’ wallets. There is much more structural change that is urgent, Inter-professional learning in universities to break down the silo mentality among health professionals, shortening medical education, speeding up entry into post graduation vocational training, establish some rural based medical schools for rural students and so much more.

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NACCHO political alert: Opposition Health spokesperson claims Labor can’t be trusted on health funding

Question Time in the House of Representatives

“Funding certainty is critical in the health sector, and only the Coalition has a plan to return certainty to Health.”

Press release Peter Dutton Opposition spokesperson Health

The recent funding announcements from Minister Plibersek was  too little, too late.

NOTE: This press release provided for the information of NACCHO members and stakeholders but not endorsed in anyway by NACCHO

More than that, they come from a Minister with a track-record of generating huge funding uncertainty in Health by making gung-ho decisions and breaking promises.

This is the Minister that slashed $1.6 billion from public hospital services without notice and without consultation. This is the Minister that cut funding retrospectively for services that had been provided, causing hospitals to cancel surgeries and close beds.

This year alone, Victoria has lost another $100 million and New South Wales $144 million compared to what was proposed in the 2012 Budget.

“Tanya Plibersek has consistently betrayed the trust of the medical profession and the Australian people when it comes to health funding,” Mr Dutton said.

“Funding certainty is critical in the health sector, and only the Coalition has a plan to return certainty to Health.”

Not content with creating chaos around hospital funding, Labor has also ripped $4 billion out of private health insurance rebates despite promising never to do so. This decision is forcing up premiums for Australians struggling to pay their cover and putting more pressure on Australia’s public hospitals.

“There is no reason for Australians to trust Labor to honour its health promises. History has shown that you cannot trust this government with Health and Australian patients have paid the price,” Mr Dutton said.

Media Contact: Christian Hayes (07) 3205 9977

NACCHO eye health news : Indigenous eye health put on Coalition’s agenda

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Pictured: Selwyn Button, Lisa Briggs, Jennifer Gersbeck, Desley Culpin and Hugh Taylor

CEOs from some of Australia’s leading eye health organisations urged the Coalition to close the gap for vision in Indigenous people at a Vision Summit in Brisbane which coincides with NAIDOC Week.

More than 40 leading eye health agencies attended the Vision Summit yesterday to meet with key members of the Coalition including Peter Dutton Shadow Minister for Health and Ageing and Andrew Laming Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health.

Jennifer Gersbeck, CEO of Vision 2020 Australia, told the Coalition there was a significant disparity between Indigenous and non-Indigenous Australians’ eye health and more funding was needed to make Aboriginal and Torres Strait Islander eye health a priority.

“Today the eye health and vision care sector called on the Coalition to commit $53.63 million* over three years to improve Indigenous eye health should they get elected at the upcoming Federal Election,” Ms Gersbeck said.

“Improving coordination and referral pathways and improving accessibility to services is the key recommendation in the sector’s Indigenous eye health pre-election policy and funding proposal to closing the eye health and vision care gap over the next three years,” she said.

“Uncorrected refractive error, cataract, diabetic retinopathy and trachoma are the main causes of vision loss in Aboriginal and Torres Strait Islander people,” she said.

The Coalition Shadow Minister told the Vision Summit the Coalition would improve Indigenous eye health by reducing red tape, utilising expertise and working with local communities.

NACCHO CEO Lisa Briggs said some 94 per cent of vision loss in Indigenous people is preventable or treatable but 35 per cent of Indigenous adults have never had an eye exam.

*This figure is sought within the context of a five-year funding requirement of $90.75 million as outlined in The Roadmap to Close the Gap for Vision, 2012 (The Roadmap).

For more information: Louise Rudzki at Vision 2020 Australia on

(03) 9656 2020, 0414 784 359 or lrudzki@vision2020australia.org.au

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