Pharmacy, nursing, exercise physiology, medicine, occupational therapy, dentistry, mental health, consumers and public health….. your guide to what happened in the 2018/2019 health budget. It’s a 20 minute read, so prepare your favourite cup of tea and settle in.

Pharmacy

The Society of Hospital Pharmacists of Australia (SHPA) welcomed the 2018 Health Budget’s support for sustainable access to medicines, and equity of healthcare access in rural and regional areas for the Pharmaceutical Benefits Scheme (PBS).

Chief Executive Kristin Michaels believes that the new funding scheme can sustainably offer maximum value to patients. He said,

‘The $2.4bn commitment to both currently-scoped and future new medicines on the PBS shows strong ongoing support for streamlined access to the best treatments for Australian patients, as soon as they are available.’

‘Additional loading makes this prospect particularly attractive outside major cities, which is appropriate recognition of the importance of pharmacists’ roles and the support they can provide in areas where equitable access is harder to achieve.’

Ms Michaels also expressed agreement on further consultation on management of medicines remuneration and funding for education and training modules in the prescription of generic medicines.

‘Hospital pharmacists facilitate 22 per cent of PBS expenditure – a proportion that is growing each year – and play a crucial role managing the introduction of cutting-edge medicines and, on behalf of our members, we welcome tonight’s strengthening of the Life Saving Drugs Program, including the introduction of additional listings.

The Pharmaceutical Society of Australia (PSA) welcomed of the new Workforce Incentive Program announced in the 2018/19 Federal Budget.

The program aims to support general practices to engage relevant health professionals including non-dispensing pharmacists. Dr Shane Jackson, National President of the PSA celebrates the inclusion of pharmacists in the program. He expressed that this inclusion would not have been possible if not for the continued parallel advocacy of the PSA and other organisations especially the Australian Medical Association.

“As the government-appointed peak body for pharmacists, we look forward to working with the government and our medical colleagues on the training, credentialing and standards of practice for pharmacists working in these practices; and ensuring these complement and align with the range of professional programs provided through community pharmacy,” Dr Jackson said.

PSA National Vice-President and general practice pharmacist Dr Chris Freeman said “This is a win for patients through improved quality use of medicine outcomes, a win for the pharmacy profession through a new sustainable career pathway, and a win for government through return on investment in primary care.”

Nursing 

The Australian Nursing and Midwifery Federation (ANMF) welcomed many aspects of the 2018/19 Federal Budget including: additional home care packages; funding for capital works for aged care providers in rural, regional and remote areas; and dementia and mental health programs for older Australians. However, these initiatives did not stop ANMF from strongly declaring their disappointment against the government failing to address the continuing crisis of safe staffing in nursing homes.

Annie Butler, ANMF’s A/Federal Secretary reiterated that the funding for the growing demand of in-home aged care services was long overdue.

Ms Butler said, “Our members are pleased the Government has allocated funding into additional home care packages and palliative care services, but they know that this will do nothing to ensure safe and timely care for elderly Australians already in residential care, and those who will need it soon, because the Government has done nothing to ensure that aged care providers are employing enough nurses and carers.”

She also focused the blame on large for profit aged care providers whose priority is to maximise profit instead of improving staffing.

“While small not-for-profit, particularly rural and remote, aged care providers are struggling to make ends meet, we know that the large for-profit providers have the financial capacity to improve staffing to ensure safe and effective care for residents but are choosing to focus on maximising profit rather than providing safe staffing levels.

Ms Butler said that a report released by the ANMF, prepared by the Tax Justice Network “shows that the six largest for-profit providers, some foreign entities, are benefitting from $2.17 Billion in Government subsidies, yet paying little or no tax – at the expense of residents.

“If the Government is serious about ensuring quality service provision, it needs to shift its focus from company tax cuts to company tax collection by closing the loopholes that allow large forprofit companies to profit from taxpayers’ money.

To combat this crisis, ANMF believes that mandated minimum staff ratios will guarantee safe staffing levels in aged care. Furthermore, the organisation launched a new campaign to call for making a staffing ratio law.

The Australian College of Nursing (ACN) also reflects the view that there needs to be a priority for aged care. CEO and Adjunct Professor Kylie Ward FACN said, “We are pleased to see that aged care reform is a major topic in the Budget announcement and this needs to remain front and centre as a Government priority.”

“Care for older Australians is a priority for the Australian College of Nursing and so is meeting the needs of ageing Australians, particularly with a focus on healthy ageing. ACN will be looking to see funding support for gerontological nursing to provide safe and appropriate care for the complex needs of the elderly.”

The ACN was pleased with the Federal Budget’s initiative on strengthened nursing workforce, free whooping cough vaccine for pregnant women, and especially affordable and equal healthcare access in rural and regional areas.

“According to the Commonwealth Fund’s Comparative Analysis of Health Systems, Australia’s health care system performance is a close second to the United Kingdom. Yet we rank in the bottom half when it comes to equity. This means, Aboriginal and Torres Strait Islander peoples, low income families, those who live outside our major metropolitan cities, or people who are new to Australia, do not always have the same access to best practice care that many of us take for granted,” Adjunct Professor Ward said.

Exercise and Sports Science

Chief Executive Officer of Exercise & Sports Science Australia (ESSA) Anita Hobson-Powell, discussed the effects of the Federal Budget on the exercise and sports science industry.

The Federal Budget inclusions she thought would affect the exercise and sports science industry are:

• Focus on a more active Australia in preparation for the National Sports Plan
• $230 million funding for implementation of sport and physical activity initiatives
• $10.1 million funding for the protection of the integrity of Australian sport against national anti-doping and criminal intelligence capabilities
• Hindering inappropriate practice among health professionals through the Professional Services Review (PSR)
• Improvement of My Aged Care through investment of $61.7 million

Ms Hobson-Powell said, “The Budget reflects the Government’s commitment to building a more active Australia. Participation in physical activity is vital for the health and well-being of all Australians, and is foundational to the Government’s National Sports Plan to be released this year.”

“We are particularly interested in the new participation grants that will support sporting and physical activity organisations to design and deliver initiatives that will get less active Australians moving. However, we are disappointed to see the Government only putting a target of a 1% change in participating rates.”

“The PSR reviews and investigates health practitioners who are suspected of inappropriate practice, and the scheme covers all Medicare recognised health professionals including exercise physiologists.”

“Accredited exercise physiologists should take this time to consider their clinical decision making to ensure they align with all regulatory bodies they receive funding from.”

Despite all the good news, ESSA believes that the Budget failed to address investment in future healthcare outcomes such as funding for primary prevention besides the National Sports Plan and inequity of exercise physiologists having to charge GST.

“Once again, the Budget is focusing on doctors and nurses, with funding to get only doctors out to regional and remote areas. No funding has been invested to support the allied health workforce who are needed in these regions” said Ms Hobson-Powell.

Medicine 

The Australian Medical Association described the Health Budget as safe, steady, and notable yet still incomplete.

Dr Michael Gannon, AMA President said that despite the many significant and worthy announcements, bigger health reform announcements are yet to come.

“The major reviews of the Medicare Benefits Schedule (MBS) and private health are not yet finalised, and the ensuing policies will be significant.

“We are pleased that indexation has been restored to general practice and other specialty consultations, but new and considerable investment in general practice is missing.

“Also, the signature primary care reform – Health Care Homes – did not rate a mention.

“Public hospital funding is consistent with the COAG National Health Agreement. However, as pointed out in the AMA Public Hospital Report Card, more funding will be needed over the long term.

“This will involve the States and Territories doing their bit to work with the Commonwealth to increase the funding to appropriate levels.

“The investments in aged care and mental health must be seen as down-payments with more attention needed in coming years and decades as community demand drastically increases.

“We need to see a more concerted approach from the Government in prevention. We need to keep people fitter and healthier and away from expensive hospital care.”

The AMA also firmly welcomed the range of initiatives outlined in the Stronger Rural Health Strategy to improve access to health services for rural and regional Australians, responding directly to AMA rural health policies and AMA Budget Submission.

“We welcome the Government’s strong focus in this Budget on improving access to doctors in underserviced communities, particularly rural Australia,” Dr Gannon said.

“The evidence shows that selecting medical students with a rural background and providing high quality training in rural areas are the most effective policy measures to address workforce maldistribution.

“With medical graduate numbers in Australia at record numbers, well above the OECD average, there is a strong emphasis in this Budget on building a rural training pipeline so that it will be possible for doctors to complete their medical degree in a rural area – and then continue to be able to work and train in these areas.

In line with this, AMA welcomed the following initiatives:

• decision to reject the proposal for a stand-alone Murray Darling Medical School
• create a pool of medical school places that can be reallocated over time
• setting aside of funding for an extra 100 GP training places from 2021 for the National Rural Generalist Pathway (NRGP)
• funding support for non-vocationally registered doctors to progress to College Fellowship
• complete overhaul of bonded medical graduate programs

The Royal Australian College of General Practitioners (RACGP) celebrated the federal government’s recognition of the vital role of specialist GPs in Australia’s healthcare system through unconditionally funding a postgraduate training program for medical graduates and supporting 3,000 International Medical Graduates (IMGs) to secure Fellowship as a specialist general practitioner.

RACGP President Dr Bastian Seidel said, “A commitment to unconditionally fund postgraduate GP training will ensure that all Australians have access to a doctor with specialist qualifications in general practice, and this has not always been the case.

“Far too often, doctors without any postgraduate qualifications were placed in so called ‘areas of need’ and ‘district workforce shortages’.

“They were asked to work there with little or no professional support or continuous professional training.

“The funding made available in this year’s Federal Budget will finally start to rectify this shortcoming.”

Albeit with these welcomed initiatives, the RACGP still agrees on further improvement on the indexation of general practice consultation item numbers and the need for an increased Medicare rebate for GP attendees.

“We must see coherent and cohesive funding for general practice that reflects the expertise of all specialist GPs.

“Appropriate investment in general practice has been proven, repeatedly, to be the most cost-effective way to deliver effective healthcare to the Australian population, particularly as the numbers of patients with chronic conditions continue to increase.

“Patients want to spend more time with their GP, and the evidence shows that time with your GP is good for patients,” Dr Seidel said.

“The Federal Government can really make a difference to the quality of care GPs are able to provide Australians by increasing this rebate before the Federal election and as a matter of urgency.”

The Australian Medical Students’ Association (AMSA) expressed discontent on wasted rural health invested on a new medical school and thus welcomes the Federal government’s rejection of funding in full the Murray-Darling Medical School. AMSA expressed more discontent with the announcement of a new medical school in Orange.

“We are glad to see the Government investing in Rural Clinical Schools that already exist in Dubbo, Wagga Wagga, Shepparton and Bendigo. These are not new medical schools, they are investments in existing programs that are working. But we are baffled by the decision to fund yet another new school in Orange.” AMSA President Alex Farrell commented.

“Orange already hosts a Rural Clinical School that is highly successful in creating graduates who return to Orange for intern year.

“Last year Orange had eight times the number of applicants for internship positions that available spots. Rural interest at a student level is not an issue in this area.

“This is an extravagant amount of money to spend recreating something that already exists and increasing total student numbers in the process.”

Other concerns raised by the Australian Medical Students’ Association were:

• Lack of discussion on vocational training issues
• Funding allocation decision for the Stronger Rural Health Strategy
• Rural specialist training areas to keep junior doctors rural

Occupational Therapy

Occupational Therapy Australia (OTA) have discussed areas such as aged care, the NDIS, Medicare and indigenous health:

• Disability and the NDIS
  • Additional funding to continuously support people who are not eligible for the NDIS but are currently receiving support under programs transitioning to the NDIS
  • Funding to support ongoing implementation of the NDIS by establishing an NDIS jobs and Market Fund
  • Funding for the continuity of the Disability Employment Services
  • National Disability Insurance Agency’s staffing increase
• Aged Care
  • Establishment of the three pillars of aged care reforms namely Better Access to Care, Better Quality of Care, and Better Ageing
  • Announcement of major reforms in response to the Aged Care Legislated Review and the Review of National Aged Care Quality Regulatory Processes
  • New high-level home care packages
  • Additional residential aged care and Short-Term Restorative Care places through Aged Care Approvals Round
  • Establishment of an Aged Care Quality and Safety Commission
• Medicare
  • Additional investment in Medicare
  • Modernisation of health and aged care payments system
• Mental Health
  • Funding:
    • To expand role of the National Mental Health Commission
    • For a suicide prevention package
    • For continued operation of Head to Health, the government’s digital mental health gateway
    • For tailored mental health support for people from multicultural backgrounds
• Rural, regional, and remote health care
  • Delivery of 3,000 additional GPs, 3,000 nurses, and other allied health professionals in rural and remote areas
  • Stronger Rural Health Strategy investment
  • Inclusion of Curtin University and La Trobe University in the Rural Health Multidisciplinary Training Program
  • Incentive eligibility of 5,000 practices under the Workforce Incentive Program
• Public Hospitals – increased funding for public hospitals
• Indigenous Health – more transparent primary care funding model
• Support for carers – new Integrated Carer Support Services

Dentistry

The Australian Dental Association (ADA) reports that the third budget laid out by the Turnbull Government brought little to no surprises for the dentistry profession.

Below are the relevant initiatives for the profession:

• Decrease in expenditure for the 2021-22 Budget due to stunted growth in the utilisation of the Child Dental Benefits Scheme even when there have been no cuts to the current $1000 limit or additional restrictions imposed.
• Decreased federal contribution to public dental health services
• Funding for the Royal Flying Doctor Service for improved delivery of dental services in rural and remote areas with the exception of areas with access to private services.
• Improved Medicare compliance and debt recovery
• Equal workforce distribution through the use of demand and supply planning tool
• Improvement of E-prescribing software systems
• Significant changes in funding for aged care but not for oral health care
• Increased unincorporated small business tax discount rate for practice owners

Mental Health 

The Australian Psychological Society (APS) particularly welcomed the 2018/19 Federal Budget’s investment on the mental health of people living in residential aged care facilities.

The announced $83 million allocation for new psychological and mental health services for people living in residential aged care facilities addresses one of the organisation’s long-running advocacy.

Professor Littlefield commented that, “Aged care residents have not had adequate access to mental health care and been left unsupported when dealing with conditions like depression and dementia.”

“We look forward to working with the Government to ensure residents have ready access to psychologists, as they would if they were living in the community,” she said.

APS President Anthony Cichello supported the professor’s claims saying, “We congratulate the Government on its strong investments in mental health and look forward to working with them to help deliver psychological care as part of a number of these programs.”

The same welcome of the mental health investment was expressed by the Royal Australian & New Zealand College of Psychiatrists (RANZCP).

The organisation’s president, Dr Kym Jenkins said, “We commend the budget’s focus on suicide prevention, mental health research and a commitment to build the capability of Australia’s medical workforce, particularly in rural and remote areas”.

Dr Jenkins added that, “The budget allocation of $83.3 million to align health workforce distribution to areas of greatest need is an important step towards addressing the significant shortage of psychiatrists working in rural and remote Australia.”

The RANZCP also expressed that they are looking forward to additional support to rural specialists in Australia and the development of integrated rural training pathways for psychiatrists to address undersupply.

Consumers 

The Consumers Health Forum of Australia (CHFA) considered the record funding for hospitals from 2020 and budget increase for aged care in the Federal Budget among the major contributors to a more consumer-focused scheme.

CHFA CEO Leanne Wells expressed excitement over the innovative ways of integrating primary and community health services. She said, “This is a welcome measure that will leverage co-investment from the states and recognises that hospital reform must be about so much more than simply investing in more beds,”

“The scope to look at models of care that involve specialist hospital providers working in innovative ways outside of the hospital walls and better integrating with primary and community health services is an exciting, patient-friendly prospect that should be actively pursued with this funding.

Ms Wells also reiterated that poor health literacy and difficulty understanding the health and aged care system can be a major barrier to access for man older Australians.

“There will be increases in funding for mental health services. We particularly welcome the support for the critical services provided by Lifeline and to better support people discharged from hospital after a suicide attempt. That this funding will be directed through Primary Health Networks to implement will ensure integration with the work PHNs are doing on mental health stepped care.

“While the additional funding for hospitals, Medicare, aged care and medicines is welcome, there is a strong case for greater emphasis on primary health care that focuses on local health services to respond to local need for integrated care, particularly for chronic illness.

The CHFA also expressed disappointment towards the overlooked call for a national obesity strategy as they see obesity as the number one preventable public health challenge for Australia.

“A comprehensive obesity strategy should include curbs on the exposure of children under 16 to promotion of unhealthy food and drink marketing, strengthen the healthy food star rating system and fund a comprehensive national plan to promote routine physical activity and public transport use”.

Public Health – PHAA 

The Public Health Association of Australia’s Chief Executive Michael Moore AM noted an extensive lack on preventive health measures in the recently released 2018/19 Federal Budget.

“Despite repeated advice – and repeated commitments in principle – the Government is still not developing a preventative health focus for our health system,” Mr Moore emphasized.

“It’s true there are a few modest measures tonight – including additional vaccinations funded, very welcome measures to promote mental wellbeing, and the Good Sports Program to reduce alcohol consumption in sporting contexts.”

“But Australia’s people will continue to experience avoidable chronic disease in the years ahead. People who should be destined to live healthy lives will not because of the preventable diseases they will suffer. While we need to look after the aged populations and those requiring medical treatment, we need to focus even more heavily on the younger generation we are failing,” Mr Moore added.

“Future Health Ministers and Treasurers will rue the mistakes of this generation, including tonight’s Budget, in failing to invest in preventive health.”

Other than the government’s focus on quality in aged care, PHAA also welcomed these initiatives:

• Improving physical activity with a $50.4m investment to get people moving and expanding other physical activity
• Funding to expanding four forms of vaccinations, including Pertussis, and a targeted program to address low vaccination rate areas.
• A National Injury Prevention Strategy for children and older people, including a program to prevent water and snow sport injuries
• Additional funding for suicide prevention

The Public Health Association of Australia expressed strong opinions on the issue of social inequity being promoted by the Federal Budget.

Mr Moore asserted, “A token attempt to divert attention from the Government’s substantial and ingrained support of corporations over the welfare of the general population is evident in the 2018 Budget announcement. The Low Income Tax Offset plan to ease pressure on ordinary Australians is simply a thinly-veiled political tactic.”

Mr Moore also said that the budget “is symptomatic of public policy in Australia increasingly failing anyone other than the few sitting at the top of the heap. The tax offset for low-income earners will mean some people receive an extra $300-500 dollars a year. How this matches up against significantly reduced living costs for the average Australian household remains to be seen. Wage growth continues to stagnate, house prices rise and the primary healthcare system is more and more inaccessible to low-earners. Financial sweeteners this small do not make up for continual occurrence of illness, particularly in low-income households.”

“This superficial focus on personal tax relief is an attempt to guild a thin facade over the growing wealth divide and related social and health inequalities in Australia. The offset has been presented as the best way to provide relief to the largest number of taxpayers below a certain income threshold. While objectively true – this does not translate to a markedly fairer distribution of wealth,” he continued.

“This is a fundamental health equity issue. The rebate favours the well-off in our community when the greatest need is for those who are unable to access health treatment in our public hospitals due to inadequate funding”.

Images

Budget Scrabble pieces – Photo credit: cafecredit on VisualHunt
Man reading newspaper – Photo by Sam Wheeler on Unsplash
Orange Civic Centre – Amanda Slater – flickr
Calculator – Photo on VisualHunt

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