Transforming The Nation's Healthcare 2015

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TRANSFORMING THE NATION’S

HEALTHCARE HEALTH & AGEING AUSTRALIA 2015

PUBLIC HEALTH PRESSURES The failure to address the impact of

junk food will be the biggest threat to Australia’s public health system

THE NEED FOR REFORM

Minister for Health and Sport Sussan Ley writes about how the health system needs a total overhaul

PATHWAYS FOR THE YOUNG

The Minister for Social Services, Scott Morrison, interviewed on creating opportunities for young Australians

PLUS:

TECHNOLOGY

INDIGENOUS

MENTAL HEALTH

DISABILITY


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EDITOR’S FOREWORD

PREPARING FOR THE FUTURE

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ealth remains one of the key pillars of Australia’s future, and Transforming the Nation’s Healthcare remains the leading industry title providing insight into the issues that matter. Global epidemics and pandemics may turn people’s attention to public health and its ability to cope under pressure, but the public health system is under a far more sustained assault at home, all the time, from the sharp rise in lifestyle-related issues emerging among the population. Aged care also remains a serious consideration for those responsible for managing our futures, but perhaps the most important thing will be ensuring that people are financially prepared for their retirement as they live longer, and healthier. We invited leaders from the mental health, public health and indigenous health spaces to write, and they delve into some of the challenges in their respective spaces. We also look at some niche industries and explore their unique challenges, including pharmaceuticals and radiology. Australia is currently building the world’s third most expensive building – the new Royal Adelaide Hospital in South Australia, with a price tag of $2.1 billion. Infrastructure remains a key consideration in the health debate and we delve into both the bricks and mortar, and the finance that funds it. For the first time, both the Minister for Health and Sport Sussan Ley, and the Minister for Social Services Scott Morrison are featured, and we welcome both to our pages. We hope you enjoy reading the content we have assembled, and you can continue to follow us online at transformingthenation.com.au

Keith Barrett Editor


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CONTENTS HEALTH MINISTER SUSSAN LEY....... 10 The Minister for Health Sussan Ley writes about how genuine reform is required to build a health system for the future.

MINISTER SCOTT MORRISON Q&A.... 14 The Minister for Social Services answers questions on how the social system is being adjusted to better meet the needs of Australians.

THE PRESSURES ON PUBLIC HEALTH............................... 18 Global events like the African Ebola outbreak may turn attention to public health capability, but it will be the far less exciting junk food and lifestyle choices that will cause the most problems.

A PART OF THE SYSTEM................... 38 Until the health system considers factors like homelessness, substance abuse and other social issues, there can never be a truly comprehensive system to support mental health.

NURSES UNDERDEPLOYED.............. 42 Any debate on the furthering of pharmacist responsibilities should be put on hold until we successfully manage the skilled nursing workforce.

GENERAL PRACTICE......................... 46

As small business owners, GPs are under the same pressure as everyone else – and then some.

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EDUCATION...................................... 27 Cathy Wever speaks to leading health figures on the current state of play in bringing the next generation of healthcare professionals through.

INDIGENOUS INSIGHT...................... 36

Neil Drew and Jane Burns from the Healthinfonet indigenous resource write on the growing challenge in closing the gap in health.

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CONTENTS 50

68

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E-HEALTH REVOLUTION................... 50 The extending reach of e-health initiatives doesn’t just mean better care for remote communities and rural locations, but better daily health for everyone.

THE NEED FOR COORDINATION........ 58 In further reading from our main story, Frank Quinlan of Mental Health Australia explains why better coordination is needed to raise the level of mental health care in Australia.

NDIS, ONE YEAR ON......................... 60 The National Disability Insurance Scheme is well established, and has quickly become a critical part of the health system for the millions of people who need it.

BRICKS AND MORTAR REMAIN IMPORTANT........................ 64 With the third most expensive building in the world currently being developed in Adelaide, health infrastructure is still key.

THE FUTURE ECONOMY................... 68 Pharmaceuticals has the potential to become an important part of Australia’s economic future.

PAYING FOR OUR HEALTH................ 72 The network of funding for health is complex, and complicated.

FINANCING AGED CARE................... 76 As people live longer, and healthier, they need to prepare for the longer time in retirement, and the potential for longer aged care support.

SEEING TOMORROW........................ 88 Insight into Australia’s research sector.

RADIOLOGY...................................... 90 How radiology is most expensive, for those who need it most. And why this must change.

PRODUCTS & SERVICES................... 92 ADVERTISER INDEX......................... 97

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MINISTER FOR HEALTH ARTICLE

THE NEED FOR GENUINE REFORM

The Minister for Health and Minister for Sport the Hon. Sussan Ley MP writes about the challenges facing Australia’s healthcare system, and what is being done to prepare for it. A clear understanding of the health landscape is fundamental to this work.

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ince my appointment as Minister for Health and Minister for Sport, I’ve been travelling the country talking to a wide variety of health professionals and patients to discuss their views and ideas about how best to ensure our health system remains world-class for generations to come. I am a strong believer in the essential role preventative health plays in keeping us happy and healthy in our daily lives, as well as the importance of being able to access high-quality care and treatment when we need it. I also believe the fact we’re living longer as a result of these ongoing health advancements should be celebrated, rather than seen as a negative burden on the health system. However, as we all understand from running our own budgets – whether it’s a small practice, a large hospital or the nation’s finances – we also need to ensure we spend wisely to ensure we get maximum benefit for patients and health professionals from our investment. This can be a difficult balancing act to get right, particularly in such an important public policy area like health that interacts with the daily lives of all Australians. It is certainly something that I

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the disadvantaged, Indigenous Australians, and people in rural and remote regions, but it is also an area where the system can enhance the health of all Australians, while reducing pressure on future governments’ budgets. There are real risks to standing still as a nation on necessary health reforms. The Government is prepared to make difficult decisions, and will be listening to and working with state and territory governments, health professionals, the community and patients as part of the broad process of change to

receiving high quality and appropriate care. A core Government commitment is to improve the health outcomes for people living with chronic and/or complex conditions. Australia’s primary health care system works well for most people. However, there is increasing evidence that it is not as effective for people with complex needs, such as those with multiple chronic conditions, and there remain challenges associated with access to services in rural and remote Australia.

MINISTER FOR HEALTH ARTICLE

come across regularly as a regional member of parliament representing a third of NSW, where health issues vary as widely as the size of the cities and small rural and remote communities throughout my electorate. That’s why I’m determined to deliver on my promise to be a consultative Minister for both Health and Sport and get out there on the ground talking to people at the coalface. I want to ensure the Government has a clear understanding of the challenges currently facing the health system and how we can improve on them for the benefit of health professionals and patients alike. The Government will, through its Federation and Tax Reform White Papers, examine options for the sustainable funding of the health system, and consider major reform across governments. We need to look at how health roles and responsibilities are allocated to enhance the system’s performance to deliver better health and wellbeing outcomes. As part of this process, I would like to see the enhanced integration of the public, private and not-for-profit health sectors to better harness the strengths of each, and to take advantage of opportunities to expand best practice and innovative models of care. Always at the centre of these discussions will be how can we provide the best possible services for patients. It is essential the health system works around the patients, not the patient working around the health system. I am particularly committed to see improvement in the management of chronic conditions and the complex interactions between primary and acute care. This is an issue of equity because we know that chronic illness is more likely to affect

THE GOVERNMENT WILL, THROUGH ITS FEDERATION AND TAX REFORM WHITE PAPERS, EXAMINE OPTIONS FOR THE SUSTAINABLE FUNDING OF THE HEALTH SYSTEM, AND CONSIDER MAJOR REFORM ACROSS GOVERNMENTS. maintain the best health system we possibly can. These initiatives include the crucial areas of Medicare reform, primary health-care delivery and funding, health workforce, Indigenous health, mental health, e-Health and reforms to pharmacy and the Pharmaceutical Benefits Scheme. Together, they will help define Australia’s health system for the 21st century. MEDICARE REFORMS Pivotal to the Government’s plans are reforms to Medicare and primary health care. We need a Medicare that more effectively improves people’s health, including reducing the impact of chronic disease, while achieving maximum value for taxpayers’ health dollars. The Government is working hand-in-hand with health professionals and patients to deliver a healthier Medicare to ensure Australians continue

Within the current system, services are generally not as well aligned as they need to be to support integrated care and to avoid unnecessary hospitalisations, and existing payment models may not be appropriately designed to support service improvement. To this end, we have launched a three-part action plan, reviewing three priority areas – the Medicare Benefits Schedule, how primary health care can be better funded and delivered, and how we can help the profession to better comply with Medicare. The most comprehensive review ever of the MBS is being undertaken by an expert taskforce. The MBS Review Taskforce is considering how items and services can be aligned with contemporary clinical evidence and improve health outcomes for patients. It is independent and being conducted at arm’s length from government by clinicians and is being led by Professor Bruce Robinson, Dean of the Sydney Medical School.

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MINISTER FOR HEALTH ARTICLE 12

A new Primary Health Care Advisory Group, led by former Australian Medical Association President, and practising GP, Dr Steve Hambleton, will comprise clinicians, academics, health economists and consumers. The new Advisory Group is looking at new ways to fund and deliver primary care, particularly for people with chronic and complex conditions – a necessary shift from a fragmented system based on individual transactions to a more integrated system that considers a person’s whole health care needs. It is also investigating options to better recognise and treat people living with mental health conditions; and better connect primary health care with hospital care. The Primary Health Care Advisory Group recently released an options and discussion paper ‘Better outcomes for people with chronic and complex health conditions through primary health care’. Targeted stakeholder consultations are being held to get a wide range of views on the discussion paper and I encourage all Australians to provide their thoughts on this discussion paper through public consultations being held across metropolitan and rural Australia or through an online website. More information can be found at www.health.gov.au Under the third part of the action plan, the Government will establish through the MBS Review process a pipeline of refinements, developed with clinical leaders, medical organisations and consumers, that will clarify and improve Medicare compliance rules and benchmarks. The reviews program will also consider how to better use Medicare information to improve compliance and education activities as part of the broader

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move to reduce waste within the system. Better use of Medicare information will empower patients and practitioners and provide a greater understanding and more efficient use of the health system. PRIMARY HEALTH NETWORKS Alongside these reforms, Primary Health Networks (PHNs) have rolled out across the country. Evidence indicates that health systems with strong integrated primary health care at their core are both effective in improving patient outcomes and experiences, and efficient at delivering appropriate services where they are needed most. A total of 31 PHNs began operating on 1 July 2015 to increase the efficiency and effectiveness of medical services, particularly for patients at risk of poor health outcomes, and to better coordinate care to ensure patients receive the right care in the right place at the right time. The focus of the Primary Health Networks will be on the patient and how the health dollar can land as close to the patient as possible. We know the closer that is, the better the patient’s experience. Primary Health Networks will be more focussed on outcomes and less on backroom bureaucracy and administration. PHNs will work directly with general practitioners, other primary health care providers, secondary care providers and hospitals to ensure improved outcomes for patients. Engagement with GPs is critical for success and will be achieved through practice support programs targeting a range of areas including, but not limited to, accreditation, clinical support, quality improvement and immunisation.

PBS AND PHARMACY REFORMS In negotiating the recent Sixth Community Pharmacy Agreement, for the first time I brought all stakeholders across the whole of the pharmaceutical supply chain to the table, including consumers. The result is an agreement that gives new certainty to the sector, introduces efficiencies across the medicines supply chain and offers cheaper medicines and improved value for consumers. For example, the agreement will result in the price of more than 2,000 brands of common medicines falling by up to half. The Abbott Government has now more than doubled the number of new and amended drug listings on the PBS to over 660 – worth almost $3 billion in total since September 2013 – when compared to Labor’s 331 listings during their last threeyear term in office. We have restored the independence of the Pharmaceutical Benefits Advisory Committee and the integrity of the PBS listing process to provide faster listing times for some medicines and improved patient access to important new treatments. E-HEALTH In this year’s Budget the Abbott Government committed $485 million to get e-health reform back on the agenda. E-health is critical to the future of the patient experience and improved patient health outcomes will come from a fully functioning e-health system. This will include new governance arrangements for eHealth; a new name – My Health Record; improved useability and clinical content and trials of participation arrangements including an


MENTAL HEALTH The Abbott Government is committed to building a genuinely national mental health plan. We tasked the Mental Health Commission to undertake a review of programs and services and its final report presents an ambitious plan for broad, longterm reform. The Abbott Government is working hand-in-hand with the mental health sector to take the National Mental Health Commission’s landmark review from paper to policy, We consulted closely with the mental health sector about their views on the Review’s final recommendations and the most appropriate and practical ways to implement them to bring about real change for patients. A 13-person Expert Reference Group – led by respected business leader and former Beyond Blue CEO Kate Carnell AO – has been appointed and will engage with the wider mental health sector directly and allow them to provide real-time, face-to-face feedback

as they finalise an implementation action plan by October this year. COLLABORATION In actioning changes to health care delivery, it’s not just up to government to mandate or any single group to bring them about. It must be a collaborative effort – which is why, from the moment I became Health Minister, I have seen consultation, communication and cooperation with the health industry and with consumers, as the key to change. This approach is informing several key policy areas.

work together to address long-term funding pressures, and also look at structural reforms to ensure services can be delivered in the most efficient way. Change is never easy, but I am confident that with a good relationship with the states and territories, we will have the basis to achieve fundamental reform. We must not drop the ball. In my portfolios of Health and Sport, the 2015/16 Budget increased spending to a total of $69.7 billion – a sensible and moderate net increase of $2.3 billion on the 2014/15 year.

MINISTER FOR HEALTH ARTICLE

opt-out system. Training and education resources will be developed for GPs and other healthcare providers. For those GPs who need it, we’ll also support face-to-face training to enable them to confidently use the system and embed it as part of their normal clinical and business processes. We will ensure that the system is improved to be useable and clinically relevant and tested by real users of the system. We will also make changes to the eligibility requirements for the Practice Incentive Programme eHealth incentive, so that GPs continue to qualify for payments only if they’re using the eHealth records system as part of their daily practice.

OUR HEALTH AND HOSPITAL SYSTEM NEEDS TO BE MORE EFFICIENT TO CONTINUE DELIVERING THE SERVICES REQUIRED. AS THE MANAGERS OF OUR PUBLIC HOSPITALS, THE STATES AND TERRITORIES HAVE A FUNDAMENTAL STAKE IN BOTH THE FUNDING AND DELIVERY OF HEALTH SERVICES, AND ARE CRITICAL TO ANY SUCCESSFUL REFORM PROCESS. The states and territories are major players – and I am genuinely committed to working with their respective governments positively and constructively. It is only through collaboration that the reform necessary to ensure affordable health care access and optimised outcomes for patients into the future will be achieved. Our health and hospital system needs to be more efficient and effective to continue delivering the services required by Australians. As the system managers of our public hospitals, the states and territories have a fundamental stake in both the funding and delivery of health services, and are critical to any successful reform process. The Government’s Federation and Tax Reform White Papers provide the opportunity to rethink how the system works and how services are funded and delivered. Any reform will need the states, territories and Commonwealth to

A healthy nation is a productive nation and the Budget sees an increased focus on improving and protecting the health of Australians, whilst also laying the foundations for sensible long-term reform. We will use the next year to tackle long standing health issues such as: primary care and mental health outcomes; better management of chronic illness; affordable access to medicines when and where people need them; supporting regional, rural and indigenous health services; and delivering a more efficient health system. Overall I continue to be impressed and spurred on by the general understanding and optimism about the need for genuine reform of the way health services are funded in this country. Rest assured my consultative approach as Minister will continue across the broader Health and Sport portfolios and I hope to work closely with you over the next year. 

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MINISTER FOR SOCIAL SERVICES INTERVIEW

PROVIDING PATHWAYS FOR THE YOUNG The Hon Scott Morrison MP, Minister for Social Services, explains how the Government is helping build a more efficient and effective platform to streamline the social services system, and encourage the young to find work.

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ustralia is one of the wealthiest countries in the world and yet there is a perception of growing inequality. A report from ACOSS last year said our poverty rate had hit just under 14 per cent; meaning one in seven Australians are living in poverty. With the Commonwealth budget under pressure what can our social security system do to cope, and does it require a new approach? The Government is determined to address the issues around disadvantage in the Australian community. Entrenched welfare dependence is highly likely to produce entrenched disadvantage and this can have some profoundly negative outcomes for Australian families. The best way we can assist is to help people move away from welfare dependence into a position of selfsufficiency. The best form of welfare is a job. We know that moving away from welfare dependence to self-sufficiency not only increases people’s opportunities, it helps their long-term health and happiness. The best form of welfare is giving people the independence of a job and the security of a job and the ability to have more choices in their own lives and that’s what we are seeking to achieve. Our $3.5 billion Jobs for Families package is an integral aspect of

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When you released the findings of the McClure Review into Australia’s welfare system you said ‘the Government’s focus is to acknowledge those who need our help while respecting those who pay for it.’ What are the recommendations you will implement which will deliver on that? The Coalition recognises that the challenges we face in the social services sector are bigger than Government alone. Success in this area will require enlisting and empowering communities and the private sector to work collaboratively with Government to respond to social challenges. We cannot continue to rely only on the taxpayer. In 2015–16, the Government will spend $154 billion on welfare, which is around 35 per cent of total Government expenditure. The changes proposed in the McClure Review continue to be considered by the Government. The review highlighted the need to simplify and streamline a system which has become complex, inflexible and costly to maintain. In response to a recommendation of the McClure Review the 2015 Budget delivers over $20 million over four years towards the

implementation of a new Investment Approach to welfare, focused on creating a better targeted and designed welfare system to assist people to move into work. The Investment Approach will identify groups of people at risk of welfare dependence and will enable the Government to better target early interventions. This model uses evidence, research and data to target funds towards policies that are workfocused and improve outcomes. It will examine how individuals interact with the welfare system and the characteristics of people currently

piece of legislation in that it reduces access to part pensions for people who many consider to be relatively affluent. Are there other measures planned which replicate this approach, of targeting savings at wealthier welfare recipients so they can be distributed to poorer Australians? Is this likely to become a key theme for policy?

MINISTER FOR SOCIAL SERVICES INTERVIEW

the Government’s plan to assist disadvantaged and vulnerable families. The new Child Care Safety Net recognises that, in addition to the mainstream Child Care Subsidy, additional support is necessary for disadvantaged or vulnerable children, whether they be children with disabilities, children at risk of abuse, children from families on incomes under $60,000 or families facing financial risk. Importantly, getting children into early childhood learning improves a family’s ability to break a cycle of poverty and intergenerational welfare dependence. This is one of the most effective early intervention strategies available.

The Abbott Government is committed to getting on with the job of implementing our ‘have a go’ budget. We continue to have discussions with the major parties

MORE THAN 90 PER CENT OF PENSIONERS AND OTHER AUSTRALIANS WHO RECEIVE PENSION LINKED PAYMENTS WILL EITHER BE BETTER OFF OR HAVE NO CHANGE TO THEIR ARRANGEMENTS UNDER THIS NEW MEASURE. receiving welfare to understand who is most likely to have an extensive reliance on welfare over their lifetime. We are also exploring the application of Social Impact Bonds (SIB) at a federal level, which was also a McClure recommendation. SIBs have great potential for helping improve people’s lives while increasing public sector accountability. Social Impact Bonds allow us to extend the financial risk of funding and delivering social services from the public sector to include the private sector. Taxpayers’ money is spent only on successful programs and outcomes, as it should be. This will form part of the broader work being done by the Prime Minister’s Community Business Partnership that brings together leaders from the business and community sectors to promote philanthropic giving and investment in Australia. The Pensions Assets Test was passed after a rare alliance between the Government and the Greens in the Senate. It is a significant

and the crossbenchers on a range of policy matters. More than 90 per cent of pensioners and other Australians who receive pension linked payments will either be better off or have no change to their arrangements under this new measure. It is estimated that the changes to the pension assets test will result in more than 170,000 pensioners with low and modest levels of assets seeing their pension increased by around $30 a fortnight from January 2017, when these changes take effect. The Government recognised after last year’s Budget that we had to change the way we approached the task of fixing the debt and deficit disaster left by six years of Labor Government. In developing our new policies this year we listened to the feedback and suggestions from the community, stakeholders, the crossbench and the Parliament to ensure fair and sustainable measures were proposed. The support of the Australian Greens on the pension measure demonstrated the success that can be achieved through constructive

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MINISTER FOR SOCIAL SERVICES INTERVIEW

engagement on practical and positive policy. An equitable welfare system is not just about giving out money; it is also linked to education, training and taxation in a holistic whole of Government approach. Are you engaging with your colleagues in these areas to take a coordinated approach to social services, on issues such as youth unemployment, for example? The measures in this year’s budget are important to support the sustainability of the social security system and get more people into work and help them stay there. As a Government we are committed to thinking innovatively about how we can address the challenges facing Australia both now and into the future. Central to this is making sure that young people can make better choices in life. Recent statistics reveal that around one in five young Australians is not fully engaged in work or study. Particularly worrying are figures that show young people account for around 30 per cent of long-term unemployed. The Government recognises the need to combat these rising trends. We know that the best form of welfare is work and we need to do everything we can to try and encourage people along that pathway. Our new measure to encourage young people into work or study breaks this debilitating cycle. Under this policy job ready young people, under the age of 25, will not be permitted to receive unemployment payments within a four-week period. During this time they will be required to put together a job plan, finalise their CV and go out and apply for jobs. Young people should choose work, not welfare. They deserve the chance to get off on the right foot as they leave school. Importantly this measure will not affect those who are experiencing significant barriers to

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Patrick McClure and Scott Morrison

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employment, be that due to disability or an inability to live at home, parents who are their child’s primary carer, humanitarian entrants or those with mental illness. This measure is not stand-alone. We have taken a holistic view in the policies we have developed to invest in employment and education supports for under 25s. Australians need the right assistance and encouragement to learn new skills, become job ready, get a job, and stay in a job. The Government will provide over $330 million to implement a Youth Employment Strategy including the $212 million Youth Transition to Work program assisting young people who have disengaged from work and study and are at risk of long-term welfare dependence. Community based organisations will provide flexible and holistic support to help these young people find and maintain employment, including through work experience and wage subsidies, or take up an apprenticeship or traineeship. $106 million will be provided for intensive support for key groups of vulnerable job seekers. This will be delivered through four key trials focusing on vulnerable job seekers, support for youth with

mental health conditions, support for young migrants and vulnerable youth and assisting young parents overcome their barriers to employment. What exactly is the Welfare Payment Infrastructure Transformation? How important is it? And what work is being done around it? The Welfare Payments Infrastructure Transformation (WPIT) Programme will replace the ageing Centrelink ICT system. The Department of Human Services is supported in its responsibility to deliver welfare payments by a large information technology system which was developed in 1983. This system consists of 30 million lines of code and undertakes more than 50 million daily transactions. It is tasked to deliver around $100 billion in payments to 7.3 million people every year. Since its original installation over 30 years ago the system has undergone continued modifications to meet Government policy changes. This has resulted in a complex and inflexible system which is costly to maintain. The Government will take action


The Government has removed the Family Asset Test and Family Actual Means Test from the Youth Allowance Parental Income Test. What’s the purpose of that? What do you hope it will achieve? This change is integral to our commitment to provide Australia’s young people with greater choice once they leave school. The introduction of more generous means testing arrangements for youth payments will base the assessment of a young person’s

access to Youth Allowance on a fairer measure of family income than the current system. Removing the asset test will enable around 4,100 additional dependent Youth Allowance recipients to qualify for the first time, accessing average annual payments of more than $7,000 a year. The removal of the means test will see a further 1,200 people receive Youth Allowance for the first time as well as increase payments for around 4,860 existing students by approximately $2,000 a year. This measure will particularly assist farming families and families with a small business who may be exempt from having their farm or small business assets count toward the Family Asset Test for assessing Youth Allowance under these changes. We will also be changing the Youth Allowance parental income testing arrangements to include all Family Tax Benefit children in the family pool. The current test only includes children over 16. Counting all children will soften reductions in Youth Allowance as the family’s income increases. This will see around 13,700 families with dependent children in both the Family Tax Benefit Part A and youth systems eligible for an average increase in payment of $43 per fortnight. Furthermore, around 5,800 families, who currently miss out on payments due to higher taper rates will be eligible for an average payment of around $50 per fortnight ($1,300 per annum). Simplifying the parental means tests will provide additional assistance for working families to support their children make the transition from school to further study. We want to ensure that our policies encourage more young people into study to build their careers, develop economic opportunities, and contribute to our economy.

How is the Government responding to the demographic challenges of our ageing population, and how is that impacting on social services planning now and into the future? The Government views our ageing population as an opportunity which can and should be embraced, just as demographic shifts have in the past. We may be living longer but we are also living healthier and we want to want to give older Australians greater choice and flexibility in their lives. The Growing Jobs and Small Business package will help employers to employ more mature workers. The Government is investing $6.8 billion in jobactive to help more job seekers into work and to make it easier for employers to offer an opportunity. This includes $10,000 wage subsidies available for hiring mature age job seekers through the Restart program. The Government is investing $73.7 million over four years to improve the way home care services are delivered to older Australians. This investment will ensure that Australians choose their own service provider and select the services that they need to be able to remain in their own home for longer. The Government also intends to establish a single integrated care at home program, combining the Commonwealth Home Support Programme and Home Care Packages from July 2018. We will be consulting with stakeholders on potential program and funding models, as well as options for implementation and transition. This will make the aged care system easier for older people and their families to understand as well as reduce red tape for providers. We are committed to building a sustainable, affordable and equitable aged care system for Australia’s future. It is a system that will nurture strong, viable businesses, attract a strong workforce, and deliver choice and flexibility for consumers. 

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MINISTER FOR SOCIAL SERVICES INTERVIEW

to replace this now outdated system with a modern platform capable of meeting the demands of the system. The new welfare payment system will save customers time and effort by offering smarter and easier online end-to-end services. It will also reduce the costs of administering welfare payments and save taxpayers money in the long run. Investing in a new system will boost efficiencies and help advance many welfare reforms – you can’t fix the system if you can’t change the engine which drives the system and makes it work. The efficiencies it creates will also mean the new system will pay for itself over time. Investing in this new system will also help us stop the rorts by giving our welfare cops the tools they need on the beat to collar those who are stealing from taxpayers by seeking to defraud the system. If we want a flexible and modern social security system that meets the needs of those who rely on it, then we need flexible and modern infrastructure. Further, Government will benefit from faster, less costly implementation of social policy changes and better data analytics to inform policy decisions. Improvements to real-time data sharing between agencies will mean that, with customer consent, their information won’t have to be provided twice.

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PUBLIC HEALTH IS A FUNDAMENTAL PILLAR OF SOCIETY

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he process of transforming the nation’s health care is likely to focus on hospitals. We should have learnt better by now. In 1978 the Declaration of Alma Ata (now the city of Almaty in Kazakhstan) at the International Conference on Primary Health Care pointed out that primary health care ‘addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services’. Public health incorporates a comprehensive primary health care approach and is fundamentally underlined by principles of equity.

PUBLIC HEALTH ASSOCIATION OF AUSTRALIA

Governments must realise that their reluctance to tackle issues like advertising junk food to kids will create an Australia that suffers from a chronically challenged public health system. By Michael Moore

PUBLIC HEALTH IS INTEGRALLY INVOLVED IN EQUITY. THIS IS BECAUSE THERE IS A LINEAL RELATIONSHIP BETWEEN WEALTH AND HEALTH. IN A NUTSHELL: THE WEALTHIER, THE HEALTHIER. The Ebola outbreak in Western Africa is illustrative of why equity is so fundamental to health care. The lack of hospitals for treatment was one factor in the spread of the disease. However, it was a minor factor compared to the poverty that meant even simple hand washing was difficult as running water and soap were not readily available in many homes. There were also issues such as governance, nutrition and education that made control of the outbreak difficult. The conditions in which people were living provided the foundations for the outbreak. In Australia, while appropriate precautions were taken, it was highly unlikely that the disease

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would have spread to more than a few people had it arrived. Indeed this was the case in the United States. However, our living conditions including education and nutrition are also not equitable – remote Indigenous communities, for example, would have been much more susceptible to the spread of the disease. These communities are already susceptible to other diseases – not because of any genetic differences, but because they are more vulnerable through poverty, lower levels of education, lack of employment, poor/ crowded housing and other socioenvironmental factors. Public health is integrally involved in equity. This is because, as revealed in the report of the WHO Commission on the Social Determinants of Health chaired by Sir Michael Marmot, there is a lineal relationship between wealth and health. In a nutshell: the wealthier, the healthier. The Health Values Statement that forms part of the Public Health Association of Australia (PHAA) Constitution states: ‘Health is a human right,

a vital resource for everyday life, and a key factor in sustainability. Health equity and inequity do not exist in isolation from the conditions of society that underpin people’s health. The health status of all people is impacted by the

HEALTH IS A HUMAN RIGHT, A VITAL RESOURCE FOR EVERYDAY LIFE, AND A KEY FACTOR IN SUSTAINABILITY. HEALTH EQUITY AND INEQUITY DO NOT EXIST IN ISOLATION FROM THE CONDITIONS OF SOCIETY THAT UNDERPIN PEOPLE’S HEALTH. social, political, environmental and economic determinants of health’. The costs of health care that has also been attributed to noncommunicable disease needs to be addressed with an understanding of social and environmental determinants and a focus on prevention at a structural as well as personal level. Tobacco remains a major factor. Two-thirds of people who smoke tobacco will have their lives considerably shortened and

place a considerable further burden on the health system. Similarly, being obese or overweight are indicators of ill-health to come. Taxpayers of tomorrow will wear the burden of the profits made by junk food and other unhealthy commodity companies that are consumed today. Despite growing obesity rates, governments are reluctant to regulate even the marketing of junk food to children. Instead, governments are reluctant to interfere with businesses. The bottom line being that public health initiatives facilitated by governments (such as road trauma, smoking rates, food labelling) lead to a healthier, more productive society. This can only be achieved if governments take action to ensure choices made by the individual are not ones that have been blanketed by the sales pitch of conglomerates. Lip service on public health and prevention is part and parcel of the tools of election campaigns. ‘It is time to stop sending the ambulance to the bottom of the cliff and time to build the fence at the top’. Such clichés demonstrate one important part of public health. However, if we are truly to have a healthier Australia we need to do much more. Lip service is one thing, but according to the Australian Institute of Health and Welfare (AIHW,) spending on public health and prevention still remains at below 2% of health budgets across Australia. The World Federation of Public Health Associations (WFPHA) working in concert with the World Health Organisation (WHO) has prepared a Global Charter for the Public’s Health which is in the final stages of consideration. The motivation for a new Charter of this kind is summarised by a statement from Dr Margaret Chan, the WHO Director-General who said, ‘The challenges facing public health, Continued on page 24 >>

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INDUSTRY PROFILE

IMPROVING PATIENT HEALTH OUTCOMES WITH POPULATION HEALTH MANAGEMENT As healthcare providers struggle to improve services while maintaining costs, many turn to the concept of Population Health Management for help.

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ealthcare is undergoing a transformation globally to reduce costs and improve outcomes with many healthcare providers turning to Population Health Management (PHM) and the opportunity to use aggregated and data analysis to deliver targeted valuebased care to individuals and groups. However, true PHM means much more than simply applying advanced analytics to achieve lower costs and improve outcomes. It also means providing secure access to accurate, complete health records, and coordinating care to ensure the best possible outcomes for patients. Orion Health has conceived the “Six As” as a guideline for any organisation wishing to implement an effective PHM strategy.

1. Acquisition: Today, key health data resides in a wide range of source systems – primary care facilities, hospitals, specialist clinics, and others. This data must be acquired and integrated in a single location. 2. Aggregation: Each of the systems contributing data to a healthcare network has particular characteristics and conventions for formatting and sharing data. Having an effective data aggregation structure in place is key to ensuring the correct information is associated with correct individuals and organisations.

3. Analytics: Analytics is where the real value of a

of the data contained within the centralised PHM system to access the most relevant information in order to complete required tasks.

5. Action: Collecting and analysing data is important, however the most critical step is using the insights gained to take action. A robust infrastructure that supports effective data-driven actions is crucial. This can be achieved by providing care providers with the tools to make collaboration and communication easy. 6. Adoption: If clinicians and care coordinators fail to adopt an IT system, key information will not be used for decision-making and outcomes will suffer. The issue of adoption is both a technical and behavioural one and also one of ‘chicken and egg’. If clinicians and care coordinators fail to adopt the new systems, key information will not be used for decision-making and outcomes will suffer.

4. Access: Multiple stakeholders are involved in the

Although most easily explained in a linear fashion, the path to population health management need not be linear. Orion Health has been working with stakeholders across the healthcare sector to develop and deliver the integrated clinical integrated systems and infrastructure that underpin PHM. Built on a robust and scalable architecture, Orion Health is dedicated to providing solutions that ensure the full promise of PHM is realised.

management and operation of any healthcare system and each will require secure access to various portions

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PHM system lies. Mining data for views into population health and finding the actionable insights that deliver improvements to quality and efficiency drive the need for analytics as a fundamental component of a successful integrated health network.

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>> Continued from page 20

and the broader world context in which we struggle, have become too numerous and too complex for a business-as-usual approach’. Health does not sit in isolation. The Charter begins by pointing out that health is ‘crucial to achieving growth, development, equity and stability throughout the world’. It goes on to argue ‘Health is now understood as a product of complex and dynamic relations generated by numerous determinants at different levels of governance. Governments need to take into account the impact of social, environmental and behavioural health determinants, including economic constraints, living conditions, demographic changes and unhealthy lifestyles’. The Global Charter for the Public’s Health sets out core services for public health as information, protection, prevention

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THE COSTS OF HEALTH CARE THAT HAVE ALSO BEEN ATTRIBUTED TO NON-COMMUNICABLE DISEASE NEED TO BE ADDRESSED WITH AN UNDERSTANDING OF SOCIAL AND ENVIRONMENTAL DETERMINANTS AND A FOCUS ON PREVENTION AT A STRUCTURAL AS WELL AS PERSONAL LEVEL. and promotion. It then adds a group of enabler functions including governance, advocacy and capacity building. These are the fundamentals of public health. In more detail they explain the umbrella nature of public health goes well beyond simple concepts of self-care, medical assistance or tertiary care that is the dominant suction for health finances in Australia. The complexities of public health may be summarised by the following: Governance: public health legislation; health and cross-

sector policy; strategy; financing; organisation; assurance: transparency, accountability and audit. Information: surveillance, monitoring and evaluation; monitoring of health determinants; research and evidence; risk and innovation; dissemination and uptake. Protection: international health regulation and coordination; health impact assessment; communicable disease control; emergency preparedness; occupational health; environmental health; climate change and sustainability.

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PUBLIC HEALTH ASSOCIATION OF AUSTRALIA

Prevention: primary prevention: vaccination; secondary prevention: screening; tertiary prevention: evidence-based, community-based, integrated, person-centred quality healthcare and rehabilitation; healthcare management and planning. Promotion: inequalities; environmental determinants; social and economic determinants; resilience; behaviour and health literacy; life-course; healthy settings. Advocacy: leadership and ethics; health equity; social mobilisation and solidarity; education of the public; people-centred approach; voluntary community sector engagement; communications; sustainable development. Capacity: workforce development for public health, health workers and

wider workforce; workforce planning: numbers, resources, infrastructure; standards, curriculum, accreditation; capabilities, teaching and training. This is why the PHAA works hard to ‘strengthen prevention and health promotion to focus on social deprivation and health inequities’. We have a tag line that helps explain: ‘public health: it’s everyone, it’s

everywhere’. Public health investment is core to any genuine transformation of the Australian health system. It makes good sense for productivity, good sense for a healthier community and good sense for individuals. 

Michael Moore is the CEO of the Public Health Association of Australia.

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As our population ages and medical technologies advance at an unprecedented rate, training the next generation of healthcare professionals has never been more crucial. Yet across the industry challenges abound, from clinical placement pressures to workforce planning, to effectively translating the latest research into clinical practice. By Cathy Wever

EDUCATION

THE CHALLENGES OF THE HEALTH EDUCATION SYSTEM

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ead of the School of Health Sciences at the University of Melbourne, Prof Elizabeth Patterson says enormous changes to the healthcare sector continue to challenge the educators of tomorrow’s health workforce. “We are seeing a move towards far more integrated care and changing models of care that involve a lot more teamwork and collaboration between disciplines. Across all healthcare professions, the patient is now at the centre of the care, not the discipline as once was the case.” “The boundaries between professions are increasingly blurred – what does this mean for individual professions and the way we prepare graduates to join those professions?” Prof Patterson says while research shows multi-disciplinary teams provide the best outcomes for patients, timetabling constraints mean undergraduate education in particular is delivered with little or no crossover between disciplines. “One of the ways we’ve tried to facilitate inter-professional training is via simulated scenarios where students from different disciplines work together. This provides effective learning opportunities, however, it’s quite costly. While there has been funding in many universities to set up simulation programs, there’s often not the ongoing funding Continued on page 31 >>

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CQUniversity can now offer the local Rockhampton community access to a health clinic led by students enrolled in allied and oral health and nursing, under close supervision of accredited practitioners. Community members will be able to make appointments for treatment and rehabilitation, drawing on students specialising in oral health, speech pathology, podiatry, physiotherapy, occupational therapy and nursing. The wider regional community benefits in the longer-term too, as the clinic’s educational role addresses a broader shortage of health professionals in regional Australia. This ‘Stage 2’ Health Clinic – with 14 clinical consultation spaces and a glass-wall observation room – has been constructed in tandem with a comprehensive refurbishment of a nearby academic building to incorporate purpose-built teaching spaces. The $14 million Stage 2 Health Clinic and building refurbishment project was entirely funded from $73.8 million in Commonwealth Government ‘SAF/EIF’ funding associated with the merger between CQUniversity and CQ TAFE. The latest developments complement the $12 million Stage 1 facility, built with funding from the Commonwealth Government (around $9 million via Health Workforce Australia) and CQUniversity, where students are gaining clinical experience working alongside professionals who are treating and rehabilitating patients of Central Queensland Hospital and Health Services. Since 2012, Stage 1 has already been catering for up to 15,000 service occasions per year, while hosting around 120 students each day alongside Queensland Health professionals. These major projects together mean that students can gain a healthy dose of clinical experience in a regional setting and across a broad suite of health disciplines. CQUniversity Vice-Chancellor Professor Scott Bowman said students who gained professional experience in a regional setting would be more likely

to seek work in rural and regional communities after graduation, helping to alleviate workforce shortages. Increased multi-disciplinary pathways for students will also allow the region’s aspiring health practitioners to take full advantage of CQUniversity’s industry partnerships, with more opportunities for practical experience and placements within their chosen sector. Health education has become a key focus of the new comprehensive university which came into being on July 1, 2014. CQUniversity now offers nearly 40 programs relating to health and wellbeing, from Certificate to Master, across its regional and metropolitan campuses and by distance education. For example, it offers chiropratic science at its Mackay Campus and at its CBD campuses in Sydney and Brisbane. The University offers medical imaging at Mackay and medical sonography at Mackay, Brisbane, Melbourne and Sydney. It is initiatives like this which show that CQUniversity is emerging as one of Australia’s truly Great Universities.

CRICOS Provider Code: 00219C

AD_150053

PUBLIC HEALTH

A NEW ‘STAGE 2’ STUDENT-LED HEALTH CLINIC OPENS AT CQUNIVERSITY


entirely funded from $73.8 million in Commonwealth Government ‘SAF/EIF’ funding associated with the merger between CQUniversity and CQ TAFE. The latest developments complement the $12 million Stage 1 facility, built with funding from the Commonwealth Government (around $9 million via Health Workforce Australia) and CQUniversity, where students are gaining clinical experience working alongside professionals who are treating and rehabilitating patients of Central Queensland Hospital and Health Services.

Melbourne and Sydney. It is initiatives like this which show that CQUniversity is emerging as one of Australia’s truly Great Universities.

Since 2012, Stage 1 has already been catering for up to 15,000 service occasions per year, while hosting around 120 students each day alongside Queensland Health professionals.

CQUniversity Vice-Chancellor Professor Scott Bowman said students who gained professional experience in a regional setting would be more likely

A NEW ‘STAGE 2’ STUDENT-LED HEALTH CLINIC OPENS AT CQUNIVERSITY AD_150053_TransfHealthcare.indd 1

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INDUSTRY PROFILE

These major projects together mean that students can gain a healthy dose of clinical experience in a regional setting and across a broad suite of health disciplines.

C

QUniversity can now offer the local Rockhampton community access to a health clinic led by students enrolled in allied and oral health and nursing, under close supervision of accredited practitioners. Community members will be able to make appointments for treatment and rehabilitation, drawing on students specialising in oral health, speech pathology, podiatry, physiotherapy, occupational therapy and nursing. The wider regional community benefits in the longer term too, as the clinic’s educational role addresses a broader shortage of health professionals in regional Australia. This Stage 2 Health Clinic – with 14 clinical consultation spaces and a glass-wall observation room – has been constructed in tandem with a comprehensive refurbishment of a nearby academic building to incorporate purpose-built teaching spaces. The $14 million Stage 2 Health Clinic and building refurbishment project was entirely funded from $73.8 million in Commonwealth Government ‘SAF/EIF’ funding associated with the merger between CQUniversity and CQ TAFE. The latest developments complement the $12 million Stage 1 facility, built with funding from the Commonwealth Government (around $9 million via Health Workforce Australia) and CQUniversity, where students are gaining clinical experience working alongside professionals who are treating and rehabilitating patients of Central Queensland Hospital and Health Services. Since 2012, Stage 1 has already been catering for up to 15,000 service occasions per year, while hosting around 120 students each day alongside Queensland Health professionals. These major projects together mean that students can gain a healthy dose of clinical experience in a regional setting and across a broad suite of health disciplines. CQUniversity Vice-Chancellor Professor Scott Bowman said students who gained professional

experience in a regional setting would be more likely to seek work in rural and regional communities after graduation, helping to alleviate workforce shortages. Increased multi-disciplinary pathways for students will also allow the region’s aspiring health practitioners to take full advantage of CQUniversity’s industry partnerships, with more opportunities for practical experience and placements within their chosen sector. Health education has become a key focus of the new comprehensive university which came into being on July 1, 2014. CQUniversity now offers nearly 40 programs relating to health and wellbeing, from Certificate to Master, across its regional and metropolitan campuses and by distance education. For example, it offers chiropratic science at its Mackay Campus and at its CBD campuses in Sydney and Brisbane. The university offers medical imaging at Mackay and medical sonography at Mackay, Brisbane, Melbourne and Sydney. It is initiatives like this which show that CQUniversity is emerging as one of Australia’s truly great universities.

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COMMUNICATION CENTRAL TO NURSING PRACTICE

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igh quality communication is central to nursing practice and therefore to nurse education. The quality of interaction between service users/ patients and inter-professional teams has a profound impact on perception of quality of care and positive outcomes. Creating spaces where reflective practice is encouraged allows students to be curious, experiment safely, make mistakes and try new ways of doing things. Didactic approaches impart knowledge and provide students with declarative knowledge but don’t always provide the opportunity to practice communication techniques or to explore in depth the attitudes and behaviours that influence their own knowledge. Drama and theatre are increasingly being used to create dynamic simulated learning environments where students can try out different communication techniques in a safe setting where there are multiple ways of communicating. A problem based learning focus allows students to reflect on their own experiences and to arrive at their own solutions, promoting deep learning as students use their own experiences and knowledge to problem solve. In 2015 a unit is being offered for the first time for students at Monash University, School of Nursing and Midwifery in their third year. The unit is largely being delivered online but there is a special workshop using Forum theatre developed by Augusto Boal. Forum theatre is focused on promoting dialogue between actors and audience members; it promotes transformation for social justice in the broader world and differs from traditional theatre which involves monologue. Simulated practices like Forum theatre allow students to address topics from practice within an educational setting, where they can safely develop self-awareness and knowledge to make sense of the difficult personal and professional issues encountered in complex health care environments. This is particularly important when it comes to intercultural issues and power relations. Such experiential techniques can help students to gain emotional competence, which in turn assists them to communicate effectively in a range of situations. Forum theatre has been used in nursing and

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health education to facilitate deeper and more critical reflective thinking, stimulate discussion and exploratory debate among student groups. It is used to facilitate high quality communication skills, critical reflective practice, emotional intelligence and empathy and appeals to a range of learning styles. Being able to engage in interactive workshops allows students to engage in complex issues increasing selfawareness using techniques include physical exercises and improvisations. The Forum theatre experience was made possible by the following people: Monash unit leader Dr Ruth DeSouza, who has a wide range of expertise in nursing, counselling, education and research, is working with two Forum theatre artists: Azja Kulpiska is a Master of Ethnolinguistics currently enrolled in Bachelor of Arts – Community Development. Tania Cañas has a Bachelor of Contemporary Arts – Drama and Psychology, Master of Communications, by Coursework and currently a PhD student at the Centre for Cultural Partnerships, in the Faculty of the VCA and MCM, University of Melbourne. References: McClimens, A., & Scott, R. (2007). Lights, camera, education! The potentials of forum theatre in a learning disability nursing program. Nurse Education Today, 27(3), 203-9. doi:10.1016/j.nedt.2006.04.009 Middlewick, Y., Kettle, T. J., & Wilson, J. J. (2012). Curtains up! Using forum theatre to rehearse the art of communication in healthcare education. Nurse Education in Practice, 12(3), 139-42. doi:10.1016/j. nepr.2011.10.010 Wasylko, Y., & Stickley, T. (2003). Theatre and pedagogy: Using drama in mental health nurse education. Nurse Education Today, 23(6), 443-448. doi:10.1016/s0260-6917(03)00046-7


>> Continued from page 27

evidence-based practice is a priority for educators across the healthcare spectrum, says Prof Patterson. “In the 21st century, research is constantly changing the way we should be doing things. Universities

Government and the states and territories, to address urgent issues in the training pipeline.” “We’ve gone from 1400 doctors graduating from medical school in 2004 to 3700 in 2015 – a 250 per

SOME UNIVERSITIES HAVE OF A MINIMUM SCORE BELOW WHICH THEY WON’T ACCEPT STUDENTS, BUT MANY DON’T – IT’S NOT UNUSUAL TO HEAR OF ATARS FOR ALLIED HEALTH COURSES FALLING DOWN INTO THE 50s. need to instill a lifelong love of learning in their students, so they have the mindset to identify and apply new standards of best practice care throughout their careers.” EDUCATING THE NEXT GENERATION OF DOCTORS Training of new doctors to meet projected community need remains a key issue in the medical education space, according to vice president of the AMA, Dr Stephen Parnis. Parnis says the current state of affairs – which includes the federal government’s decision to open a new medical school in WA despite a projected oversupply of doctors – is being hampered by poor data collection, planning and resource allocation at both state and national level. According to the Australian Future Health Workforce Report, Australia is looking at a modest oversupply of doctors by 2030. At the same time, current issues in the medical training pipeline mean a shortfall of training places for junior doctors in as little as two and a half years. “Already, Australia is failing to provide enough internships for medical school graduates. In 2015, 336 graduates missed out on an internship,” says Parnis. “We’re failing to get the balance right. What’s required is a coordinated approach and cooperation between the Federal

EDUCATION

required to maintain these high tech environments.” Despite the high order skills required of the modern healthcare professional, Prof Patterson says a small number of universities continue to lower their healthcare course ATAR scores to attract enrolments. “I am aware of ATARs being very low in some instances, because institutions are pushing faculties to take on more and more students.” “This can only be negative – not only in terms of the challenges academics face in teaching students who will struggle to master the coursework, but also in terms of producing low quality graduates.” Escalating healthcare costs and the sharp rise in the number of Australians battling chronic diseases present both challenges and opportunities for healthcare educators, says Prof Patterson. “It’s vital that healthcare professionals are equipped to help patients improve their health literacy so that they can – where practical – manage chronic conditions in their own homes. Technology can play an important role here, but only with the right educational support for both healthcare professionals and patients.” As healthcare becomes more complex, Prof Patterson says patients also require more help than ever to traverse the system. “There are more and more vulnerable groups and individuals who struggle to access health services and understand what they mean,” she says. Within the University of Melbourne’s School of Nursing, the current research focus is around how the patient experience can be enhanced across the illness trajectory. “We want to help people understand how the system works, so that they can make better decisions about their healthcare.” Translating such research into

cent increase. At the moment, we cannot train all of those graduates to independent practice.” “These graduates are already the beneficiaries of significant public investment, but to realise that investment fully, they need to go on to practise independently – and they can’t do this unless the issue of training places is addressed.” Parnis acknowledges that entry into medical specialisations may require increased management. “The days of doctors being able to pursue whatever specialty they choose are numbered. What we want is for the relevant health and workforce data to be collated and presented by government so that junior doctors can make informed career choices that meet the needs of the population.” Parnis says strong demand in some specialties, such as surgery, has resulted in limits being placed on the number of training positions available. In less popular specialties such as gerontology, there aren’t enough graduates coming through to meet projected community need. Parnis cites the Federal Government’s decision to open a new medical school at Curtin University as misguided. While the university claims the new school will help address the health and workforce needs of West Australians, the AMA believes it’s a poor allocation of resources. Continued on page 34 >>

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A GENERATION OF INTERNET JUNKIES 0972_0615_Transforming nation healthcare_fa.indd 1

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he days of riding bicycles around the neighbourhood, playing in the local park or building a cubby house in the backyard is a childhood memory for most of us, well, that is if you were born prior to the 1990s. Those born in the early 1990s – 2010s, otherwise known as Generation Z, are more likely to have grown up playing video games, engaging on social media or browsing the internet. Born into the ‘digital era’, Gen Z’s digitally savvy lifestyles are predicted to lead to adverse health effects as they reach adulthood. The two most prominent health issues facing this younger generation is mental health and obesity. Increased screen-time, sedentary lifestyles and a high intake of fast foods are contributing to alarmingly statistics that show three out of four Gen Zs will be overweight or obese by the time they reach adulthood. Gen Zs exposure to screen time since toddlers has also made them vulnerable to mental health disorders with internet addiction being a major concern. This is the first generation to be born into a fully ‘connected’ society with ever advancing digital technologies accessible 24/7. This is a generation of digital natives that has never known life without social media, mobile phones, and the internet. This in itself creates constant life pressures with everything they consume, need and benefit from all at the touch of a button. Industry experts suggest Gen Zs are turning into internet junkies who suffer from an addiction similar to that of a drug or alcohol addiction, with most unable to function without their vice. Additionally there are issues of increased cyber bullying and online stalking. According to McCrindle research, nearly a third of all students have been bullied outside of the playground via social media, text and email. For this generation, the digital world is unrelenting and there is no safe haven from bullying, which can occur anytime anywhere and by anyone. Health organisations predict that in the next five years one in four families globally will have a family member affected by a mental health

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disorder. Gen Zs will be exposed to mental illnesses at a greater rate than that of previous generations. This increased demand on mental health services will put added pressure on a health system that is already stretched to its limits. The Australia Health Reform Institute – Addressing Workforce Challenges for Youth Mental Health Reform Report called for immediate action to ensure there are enough mental health practitioners to meet increasing demand in youth mental health without weakening capacity elsewhere in the mental health system. Chisholm Institute offers a Bachelor Degree in Community Mental Health, Alcohol and Other Drugs (AOD), which is a unique course that has been designed to meet the growing demand for highly trained practitioners with appropriate knowledge, skills and attitudes to work across the spectrum of community-based mental health and alcohol and other drugs (AOD) treatment services. Chisholm Institute has been awarded ‘The Victorian and Australian Large Training Provider of the Year 2014’. The Institute has grown significantly and has become a multisectoral Institute delivering a broad range of education and training programs and services in higher education, Vocational Education and Training (VET) and school sectors across its campuses, online, in the workplace and overseas with partnering educational and government organisations.

INDUSTRY PROFILE

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THE BEST

Chisholm offers over 500 certificate, diploma, advanced diploma, graduate certificate and short courses to approximately 40,000 students annually. We serve one of the state’s most culturally diverse and growing regions in south-east Victoria, with modern training facilities in Bass Coast, Berwick, Cranbourne, Dandenong, Frankston and Mornington Peninsula. For more information visit chisholm.edu.au

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“What we need is to fix the training pipeline, not flood it. It’s a huge waste to ‘half train’ a doctor.” The AMA also remains concerned about professionals without medical training performing the work of doctors, including pharmacists and independent nurse practitioners prescribing medicines to patients. “While we know and value enormously the positive work done

facing an oversupply of graduates, while others – including prosthetists and orthotists and perfusionists – are experiencing shortages. “Take dietitians. With no restrictions on the number of tertiary courses available across the country, we are actually graduating more dietitians than we need. Quite aside from the obvious waste of resources, it’s soul destroying for

IT’S VITAL THAT HEALTHCARE PROFESSIONALS ARE EQUIPPED TO HELP PATIENTS IMPROVE THEIR HEALTH LITERACY SO THAT THEY CAN – WHERE PRACTICAL – MANAGE CHRONIC CONDITIONS IN THEIR OWN HOMES. TECHNOLOGY CAN PLAY AN IMPORTANT ROLE HERE. by multidisciplinary teams, unless you have undertaken the significant medical and specialist training that a doctor has, you will be compromising patient safety if you try to perform the role of a doctor without the training.” “People want to expand their scope of practice, but completing a weekend course just doesn’t cut it.” BETTER PLANNING ESSENTIAL IN ALLIED HEALTH Allied health continues to play an increasingly important role in the effective treatment of a wide range of conditions. Many allied health practitioners are highly regarded specialists in their field, yet educating the next generation of practitioners is being hampered by poor planning and lack of coordination, according to Allied Health Professionals Australia (AHPA) executive officer, Lin Oke. “What we’ve currently got is an education system that isn’t in any way tailored to the needs of health consumers. There’s no commitment to coordinating supply and demand.” Oke wants to see greater Australian government involvement in planning and supporting tertiary allied health courses. She and her AHPA colleagues say some allied health professions – such as dietetics and optometry – are

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graduates to complete their training, only to go out into a saturated workforce where they will find it difficult to gain employment.” “Another factor is the lack of academics to teach across the large number of allied health courses now available in Australian universities. Many AHPA members are concerned the difficulty in staffing courses with suitably qualified and experienced teachers will impact on the breadth and quality of specialist teaching.” Oke says allied health practitioners are also worried about falling ATARs for some courses, which further impacts the calibre of graduates. “Some universities have of a minimum score below which they won’t accept students, but many don’t – it’s not unusual to hear of ATARs for allied health courses falling down into the 50s.” Meanwhile, an oversupply of certain allied health courses is creating clinical placement headaches for practitioners. “In areas such as physiotherapy and osteopathy, the number of students is putting pressure particularly on private providers, who don’t necessarily have the time or incentives to provide quality clinical placements,” says Oke.

“It’s also challenging in hospital settings, where an activity-based funding model means practitioners have to focus on seeing a certain quota of patients per day. It doesn’t leave them much time to supervise the next generation of practitioners.” Oke says most allied health practitioners would like students to have more access to multidisciplinary education opportunities, as well as the chance to experience a country placement in an effort to address allied health shortages in rural and regional Australia. “Most allied health courses are city-based. Students come to the city from the country, love the lifestyle and decide to stay. Meanwhile, there are no incentive programs to attract allied health professionals to rural and regional areas, as there are with GPs.” “We know that multi-disciplinary teams can deliver enormous benefits in terms of improved patient outcomes, but especially in rural and regional areas, a quality multidisciplinary approach is impacted if you’re missing an allied health component of the team.” MARRYING NURSING EDUCATION WITH WORKFORCE DEMANDS CEO of the Australian College of Nursing (ACN), Debra Thoms, says workforce planning and accurately aligning education with projected workforce needs remains a constant and ongoing issue. “In some states this year we’ve seen underemployment of first year registered nurses, which is a concern,” says Thoms. “We want to ensure we bring our first year graduates into the profession otherwise the investment in their education may be wasted as they pursue employment in other sectors.” Providing good quality clinical placements for nursing students is also an enormous challenge, right across the health system, Thoms says. “Undergraduate placements are


about the benefits of living and working in country areas. “Some regions find it hard to attract nurses, and while locating clinical schools and academic centres in country towns has been a great step forward, we need to continue to spread the positive message around the lifestyle opportunities of pursuing a nursing career outside a capital city.” Attracting nurses to specialities such as mental health and aged care remains an ongoing challenge, says Thoms. “Aged care is particularly fraught. In some settings there is only one registered nurse leading a team of care workers with limited qualifications, which is a huge

responsibility. Yet these professionals receive lower wages than other nurses, making it hard to attract nursing professionals to the sector.” Thoms says educating the community about the role of nurses remains an important priority. “There are still challenges around the perception of nurses as ‘ministering angels’ versus the very deep clinical knowledge nurses have and the crucial role they play in identifying and escalating problems to achieve optimum patient outcomes.” “In some settings, the skills of nurses could be better utilised, especially in the management of chronic conditions, which is one of our health system’s biggest challenges.”

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a key issue. Increasingly, universities are looking to all parts of the health system to give nursing and other healthcare students a variety of experiences and spread the load a bit. Yet coordinating the volume of students is difficult, as is having the right supports for them once they are on a placement.” “Universities provide a level of supervision, but in hospitals for example, a lot of the responsibility still falls to the ward staff even if they don’t have direct responsibility for the students who are there completing a placement.” Thoms says many parts of rural and regional Australia still struggle to attract nurses, and more could be done to educate health professionals

TURNING RESEARCH INTO EVIDENCE-BASED PRACTICE THROUGH EDUCATION At the Royal District Nursing Service (RDNS) there is a deliberate link between research and practice via the organisation’s very own research institute and education centre. Senior research fellow, Dr Di Goeman, says this accessible opportunity to translate evidence into practice is vital in the aged and community care setting. “Our Institute is very active. We conduct our own trials and research and translate the latest findings into education programs, both for our clinicians and also the wider community.” One example is the Institute’s recent research into leg ulcer prevention. RDNS researchers’ findings around how to best identify and treat this common condition were translated into an education program for staff, which has helped them to deliver better care and better outcomes for clients. “Another recent example is our research into maximising the capacity of our workforce. RDNS Institute identified instances where community care assistants (CCAs) could help clients take lowrisk medications such as vitamin supplements, or apply simple lubricant eye-drops, thus freeing up a registered nurse to provide more specialised care.” “Because RDNS is a registered training organisation, we were able to use this research to create an education program for CCAs. This has helped free up our registered nurses and helped resolve the issue of sending a highly qualified

clinician out to supervise clients taking very low risk medications.” RDNS Institute is currently working on a Department of Human Services-funded research project, which is refining a training workshop for community aged care workers to address the diversity characteristics of older people. “The project is based on our own findings about what works best for these clients, which we are now translating into a bigger program designed for national roll out.” The results of many RDNS research projects are published online, giving them the potential to reach a global audience. “In conjunction with Alzheimer’s Australia and the Vietnamese Women’s Association, we recently produced a series of talking books about dementia and diabetes, in Vietnamese. We’ve also produced talking books about diabetes in Italian, Greek and Macedonian. These resources are available free via our website, and can be used by any patient or health practitioner in the world.” Goeman says she feels lucky to see research applied to achieve improved outcomes for RDNS clients. “In a university you might spend years doing research and never see it translated into new models of care. Working in a community setting and seeing your research applied is very rewarding.” 

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WORKING TO DELIVER POSITIVE OUTCOMES IN ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH Moving forward in Aboriginal and Torres Strait Islander health depends on a continued shift in thinking towards strengths-based approaches, and fasttracking the appropriate and relevant exchange of information among all those working in the Aboriginal and Torres Strait Islander health sector. By Neil Drew and Jane Burns

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here is no doubt that on most headline indicators of health, Aboriginal and Torres Strait Islander people fare worse than other Australians. In its annual overview of Indigenous health status, the Australian Indigenous HealthInfoNet reported that, while the health status of Australia’s Aboriginal and Torres Strait Islander people continues to improve slowly, it is clear that they remain the least healthy sub-population in Australia. There have been small but significant gains in both health outcomes and in national efforts to close the gap between the health of Aboriginal and Torres Strait Islander people and other Australians. With respect to life expectancy, while there has been a decrease in overall death rates between 1998 and 2013 of 16%, this apparent good news is tempered by the fact that there has been no significant decrease between 2006 and 2013. The Closing the Gap Steering Committee though has welcomed the gains as an ‘on the ground’ improvement that has tangible meaning for Aboriginal and Torres Strait Islander families and communities. However, the most recent estimates in 2010–12, of life expectancy at birth for Indigenous people indicate a life expectancy of 69.1 years for males and 73.7

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that characterise an enduring and resilient culture with many inherently positive attributes which have the capacity to contribute to positive outcomes. A number of initiatives and commitments offer promise of contributing to continued efforts to close the gap. There is increased recognition of the importance of strong cultural foundations to sustainable improvements in health and well being; a shift in the discourse about Aboriginal and Torres Strait Islander health from deficit to strengths-based approaches is a powerful and empowering development. An increased focus on ‘what works’ provides signposts for positive pathways forward. years for females, which is 10 years less than other Australians. These statistics, while accurate, are also a limited perspective on the health of Aboriginal and Torres Strait Islander people. Focusing solely on statistics may further marginalise and pathologise Aboriginal and Torres Strait Islander people in public debates about health. This also diverts much needed attention away from the small but significant health gains and national efforts to close the gap in Aboriginal and Torres Strait Islander health outcomes. It is important to showcase the many strengths-based approaches

AN EMERGENCE OF ETHICS The shift to strengths-based approaches is marked by the emergence of the ethics and principles of Aboriginal and Torres Strait leadership in health, exemplified by the Aboriginal community controlled health sector (ACCHO); the buffering effects of culture; culturally appropriate and safe approaches to holistic health care; an appreciation of the social and cultural determinants of health; acknowledgment of historical contexts, and the increased acceptance of empowerment models. On the national stage, constitutional


THE CHALLENGE OF TRAINING The challenge is how to deliver training and support to a burgeoning workforce given the wealth of research available in the contemporary information age. Aboriginal and Torres Strait Islander health workers are overburdened and, on that account, time poor. It is becoming more and more difficult

to stay abreast of developments in all fields of endeavour, including health. These days, there is so much research being produced that most busy workers find it difficult to keep up-to-date with the latest developments in their field. Translational research is the process of taking the research produced by researchers at universities and other research organisations and summarising, or ‘translating’, it into a form that is easily understood and can be more easily applied in the workplace. In 2005, Bernard Choi, from the Public Health Agency of Canada estimated that, in order to keep up-to-date in the biomedical field alone, you would need to read 19 original articles a day, growing at the rate of 7% per year. A simple extrapolation indicates that in 2015 that number would be in excess of 30 per day. This is clearly beyond the capacity of most health workers. Also, much of the research work is produced within disciplinary communities in language that often makes the material inaccessible to those from outside those communities. This is the realm of translational research. While there are a number of associated terms such as knowledge translation, knowledge transfer and research into practice, often incorrectly used interchangeably, the fundamental goal is to make the results of research, at both the project and population health levels, available in ways that have immediate practical use in the everyday lives of people at the coalface of health practice, policy and decision making. The Australian Indigenous HealthInfoNet is one example of a national resource with a demonstrated track record over almost two decades of producing high quality, evidence-based translational research outputs to meet the needs of the Aboriginal and Torres Strait Islander health

workforce (www.healthinfonet.ecu. edu.au). Its web resource receives over 900,000 visits per year and hosts 16 online blog facilities known as Yarning Places with a total membership of over 4,500 people. Use of the resource has grown exponentially over the past decade. Relative to the size of the workforce, this suggests that there is a huge appetite for translational research among Aboriginal and Torres Strait Islander health workers and others in the sector. The clear imperative is to continue to invest in the process of ensuring that we get the research ‘rubber on the road’ in ways that make an immediate and tangible contribution to efficient and effective practice. As noted by the Australian Chief Scientist, Professor Ian Chubb, in his 2012 address to the BioMelbourne Network: “We need to ask whether… Australia can afford ‘not’ to fund translational research.” Long-term solutions to resolve the health concerns and challenges facing Aboriginal and Torres Strait Islander people in Australia will depend on an authentic commitment to Aboriginal and Torres Strait Islander ownership, leadership and stewardship of empowering, strengths-based approaches. That commitment will be substantially advanced by a well-trained workforce supported by high quality evidence-based translational research that delivers significant productivity and efficiency dividends. 

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recognition of Aboriginal and Torres Strait Islander peoples has been linked to positive health and wellbeing outcomes. One crucial key to the effectiveness of strengths-based approaches is investment in the training and support of the Aboriginal and Torres Strait Islander health workforce. As reported by Health Workforce Australia in 2014, this workforce has grown significantly in recent years, with an estimated 1,256 Aboriginal and Torres Strait Islander health workers in 2011, an increase of 87% since 1996. In 2012, there were a further 252 registered Aboriginal and Torres Strait Islander health practitioners and an estimated 3,016 Aboriginal and Torres Strait Islander people in the Australian health workforce. Of course, this is an underestimation given the complexity of identifying the full range of health worker roles in the sector and the number of non-Indigenous health workers contributing to Aboriginal and Torres Strait Islander health. What is beyond question though is the high priority given to the importance of providing training and support to the workforce. The link between a well-trained and supported workforce and positive health outcomes is irrefutable. The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework 2011–2015 sets the agenda for a productive, efficient and well-trained workforce with professional development and training as central elements.

Neil Drew (top) is director, HealthInfoNet; Jane Burns (right) is research team leader, HealthInfoNet.

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MENTAL HEALTH

THE NEED FOR NATIONAL LEADERSHIP ON MENTAL HEALTH REFORM

When the founders of our nation designed the Australian Federation, they could not have imagined the complex way our society would evolve. Among many modern concepts that would have been alien to them would have been notions of mental health and mental illness. By Frank Quinlan

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care, and other clinical care”, yet it does not separately address mental health, or the complex interactions with other portfolios or levels of government. This is disappointing, but not surprising. Mental health has for too long been regarded as simply a subset of the broader health system, sharing the same essential features. The paper briefly acknowledges the same problems that the National Mental Health Commission has described at length, citing a “lack of coordination [that] makes it hard for patients with chronic and complex conditions to get the care they need, when they need it. This is particularly evident in areas like mental health, where patients are required to navigate an overly complicated system.” WHY SHOULD MENTAL HEALTH BE CONSIDERED SEPARATELY? While it may not be evident in the Federation discussion paper, mental health is an example of intergovernmental arrangements that have over time become increasingly dysfunctional. And while our health system has certain deficiencies, the dysfunction in the mental health arena takes a very different form. For this reason, Mental Health Australia argues that the white paper process should treat mental health as a special case. Mental health is different and its complexity requires holistic thinking beyond the traditional scope of health departments and clinical ways of thinking. Factors surrounding employment, housing, income, the criminal justice system, and education all play a substantial role in determining whether mental

illness not only manifests in individuals, but also how a person will recover. The breakdown of roles and responsibilities of Commonwealth, state and territory governments varies depending on which service system is involved. Worse, cost-shifting and buck-passing is apparent in all of these systems to some degree. Take homelessness for example. Mental health is very closely linked with homelessness. Over the past 12 months more than half the people who were homeless also

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t is an accident of history that our ability as a nation to meet the needs of people who experience mental illness now depends on successfully adapting the Federation to suit the 21st century environment. This is nothing that the founders could have foreseen, but it is the reality that the mental health sector now faces. Australia’s mental health system is certainly in need of major reform. The system is complex, fragmented, and negatively impacts on vulnerable Australians every day. As described in the National Mental Health Commission’s Review of Mental Health Programmes and Services, the system is compromised by “poor planning, coordination and operation between the Commonwealth and states and territories, resulting in duplication, overlap and gaps in services.” There have been many reports, inquiries, reviews and evaluations regarding the mental health system. None have resulted in comprehensive, lasting reform. To improve mental health outcomes in the long term, all levels of government need to agree on how they are going to work towards a unified goal. The Department of the Prime Minister and Cabinet recently released a discussion white paper on options for reform of the Federation. This paper examines the roles and responsibilities of the different levels of government, discusses issues of overlap and duplication, and gaps in policy and services. While health itself is one of the three major focus areas, mental health barely rates a mention. The paper acknowledges the focus is on the various “clinical parts of the health system – hospitals, primary

MENTAL HEALTH AUSTRALIA ARGUES THAT THE WHITE PAPER PROCESS SHOULD TREAT MENTAL HEALTH AS A SPECIAL CASE. MENTAL HEALTH IS DIFFERENT AND ITS COMPLEXITY REQUIRES HOLISTIC THINKING BEYOND THE TRADITIONAL SCOPE OF HEALTH DEPARTMENTS AND CLINICAL WAYS OF THINKING.

Frank Quinlan

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FACTORS SUCH AS POVERTY, SOCIAL EXCLUSION, DISADVANTAGE, AND DISCRIMINATION CAN STRONGLY IMPACT ON MENTAL HEALTH, YET WE SEVERELY LIMIT OURSELVES IF THEY ARE NOT CONSIDERED, SIMPLY BECAUSE THEY FALL OUTSIDE THE ‘HEALTH’ SYSTEM. experienced mental illness. We also know that many people who become homeless subsequently experience mental illness as a result of their situation. Housing and homelessness is largely a state issue and is not administered at the Commonwealth level. However, if we are to improve mental health outcomes, decisions around housing should not be made in isolation on individual state levels, but must be considered within the context of broad agreed national targets, with systems that are cohesive and unified. Something that must be driven by the Commonwealth This type of disconnect extends across many areas. Another example of this disconnect is when prevention and early intervention is examined. While the white paper process recognises the incentives

within the health system associated with prevention and early intervention, it doesn’t recognise the incentives and impacts outside the health system, which is particularly relevant for mental health. Factors such as poverty, social exclusion, disadvantage, and discrimination can strongly impact on mental health, yet we severely limit ourselves if they are not considered, simply because they fall outside the ‘health’ system. If truly effective mental health reform is to be achieved nationally, a national agreement must be reached to outline who is responsible for what. Otherwise any changes achieved will be piecemeal, short-lived, and will do little to combat the root of the problem. CURRENT OPTIONS FOR REFORM At the time of writing, the Federation white paper process is at the ‘discussion and debate’ stage. In the health system, five options for reform are presented. Some options are mutually exclusive, however, combinations between other options are possible. They are as follows: 1. States and territories are fully responsible for public hospitals. The paper notes this option risks entrenching the existing incentives for cost and blame shifting, and won’t improve access to primary care, or address the existing fragmentation. 2. The Commonwealth establishes a hospital benefit. This option would see the re-introduction of a consistent activity-based funding mechanism, across both public and private hospitals. The paper notes while this is likely to have some benefits in driving efficiencies in the hospital system, it does not address the fragmentation across the system, or provide appropriate incentives for prevention or early intervention. 3. The Commonwealth, states and territories fund individualised care packages for patients with, or at risk of developing, chronic or complex conditions. The paper suggests this should provide appropriate incentives to help ensure patients are receiving the right care across the spectrum of health services, including mental health, allied health and specialist services. 4. The Commonwealth, states and territories share responsibility for all health care through ‘regional purchasing agencies’. The paper suggests this should reduce system fragmentation, reduce incentives for cost shifting and increase incentives for investment in prevention and early intervention.

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Given the importance of prevention, early intervention and reduced fragmentation for the mental health system, we would expect that options 3, 4 and 5 are most likely to improve outcomes in mental health. Options 1 and 2 are focussed solely on hospital funding and are therefore unlikely to have much of an impact on the broader mental health system. Â A LONG ROAD AHEAD Mental health reform is possible, and from the range of options suggested we can see that governments are considering approaches which could be effective and workable. To do this however, the green paper (the next part of the discussion) should explicitly consider mental health as a standalone issue, including how it interacts with other systems and who should be responsible for what, within the Federation.

History clearly demonstrates that agreements developed within health departments alone have failed to improve the whole-of-life outcomes that, as COAG acknowledged in 2012, are the true test of mental health reform. This is why Commonwealth and state and territory governments need to agree on their respective roles and how they will work together. The reforms to health services discussed in the paper are necessary, but are only one piece of the puzzle in regards to effected mental health reform. More importantly for mental health, roles need to be defined to include the other systems people who experience mental illness (and their carers) encounter and interact with. By properly defining roles and responsibilities, including for governments, non-government organisations and clinicians, we can ensure that people living with mental illness, and those who care for them, access the help they need, where and when they need it. The economic and social benefits of whole-ofgovernment, whole of community, action on mental health will be profound, but they can only be realised through collective leadership at the COAG level. ď‚&#x;

Frank Quinlan is CEO of Mental Health Australia.

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5. The Commonwealth establishes a health purchasing agency. The paper suggests consolidating funding responsibility with one level of government should increase incentives to provide services in a costeffective manner, reduce fragmentation, reduce cost and blame shifting and provide an incentive for investment in prevention and early intervention.


NURSING

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As the health system evolves, there is one clear need: to make more use of the abundance of nurses in society. Talk of making pharmacists take on more roles should wait until the nursing profession has been deployed more effectively. By Sean Causebrook

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o other health professional is closer to the patient than the nurse. At the very beginning of life, it is nurses who deliver the first critical days of care to the newborn baby. At the other end of the journey, it is nurses who provide much of the comfort to the aged and the terminally ill. And in the years in between, nurses deliver a wide range of care from road trauma to disability care to mental health services. Nurses work independently or as collaborative members of a health care team in settings which include hospitals, mental health facilities, rural and remote nursing posts, Indigenous communities, schools, prisons, and residential aged care facilities. They are in the armed forces, universities, TAFE colleges, statutory authorities, general practice offices, businesses, schools, professional organisations and people’s homes. They also comprise more than 60 per cent of all health professionals working in the Australian health system.

NURSES WORK INDEPENDENTLY OR AS MEMBERS OF A HEALTH CARE TEAM IN SETTINGS WHICH INCLUDE HOSPITALS, MENTAL HEALTH FACILITIES, INDIGENOUS COMMUNITIES, AND SCHOOLS. It is little wonder then that nurses regularly top the list of the most admired and trusted professions. According to the latest Roy Morgan Image of Professions Survey, dated July 2015, 92 per cent of Australians aged 14 and over consider nurses to be the most highly regarded occupation, up 1 per cent on the previous year’s poll, for the 21st year in a row.

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“Our members are working hard each and every day and night as advocates for safe patient care, ensuring their communities receive the best possible health care,” says Brett Holmes, the general secretary of the NSW Nurses and Midwives’ Association. “The unsociable hours of shift work require many of them to sacrifice a great deal of the lifestyle choices other workers take for granted. “Nurses and midwives are often intertwined into some of the most intimate moments in a patient’s life and as a result take their ethical and professional responsibilities very seriously.” While some things about nursing, such as “unsociable hours” haven’t changed, the profession has continually evolved, both in terms of its philosophies and the technologies. In 2015, around 10 per cent of nurses are male, and the term “sister” has long been replaced with the all-encompassing “nurse.” UNDERSTANDING THE POSITIONS Australia has two levels of regulated

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nurse – registered nurses and enrolled nurses. The four titles for nurses under Australian legislation are: registered nurse, enrolled nurse, registered midwife and nurse practitioner. Registered nurses, who comprise around 80 per cent of the 300,000-strong nursing population, must complete a threeyear bachelor degree at university before they are eligible to register with the Nursing and Midwifery Board of Australia (NWBA). After tertiary study, they undertake a period of postregistration graduate support, often in a health or aged care setting. Usually this transition period is 12 months and they can also undertake postgraduate study to specialise in one of many clinical practice areas. Registered nurses working at an advanced level and holding a recognised postgraduate qualification are also eligible to seek endorsement as a nurse practitioner. Enrolled nurses are educated in the vocational education and training (VET) sector for one year

to eighteen months to diploma level, before being qualified to enrol with the NMBA. They may also undertake additional study to work at a more advanced level. The diploma qualification also enables enrolled nurses to administer some medicines to patients. MAKING BETTER USE OF THE SKILLS Another group of health care workers, assistants in nursing (AINs), also deliver aspects of nursing care, largely in aged care facilities. There are currently around 75,000 AINs working in the Australian health system. The growth of the AINs underlines the wider responsibilities that nurses are being asked to take on, as pressure mounts on health services. In NSW, for example, there is a debate on whether registered nurses should staff new clinics based in Western Sydney, Wollongong and the Central Coast, designed to treat patients with minor illnesses and injuries. Based on clinics in the UK


would be the creation of “nurseled clinics” which would work closely and in collaboration with pharmacists to improve care and management of chronic conditions in the community. UNDEREMPLOYED Despite the call for greater responsibility for nurses and forecasts of a nursing shortage for Australia, particularly in the area of aged care, newly graduated nurses also

significantly lower in hospitals with fewer patients per nurse. Every patient added to a nurse’s workload was associated with a 7 per cent increase in hospital deaths following common surgery. But every 10 per cent increase in university-educated nurses is associated with 7 per cent lower mortality. The research, published in The Lancet, was led by Dr Linda Aiken, professor of nursing and head of the

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and also in the Australian Capital Territory, the so-called “nurse walk-in centres” are designed to relieve the pressure on hospital emergency departments. Lee Thomas, the federal secretary of the Australian Nursing and Midwife Federation (ANMF), weighed into this debate after the Federal Government suggested that pharmacists be trained to treat patient wounds. “The ANMF has been trying to negotiate with governments on the need for expanded roles for health practitioners for years,” Thomas said. “This is because we know that health care for Australians is at its best when our highly qualified and skilled health practitioners are able to work to their full scope of practice in a coordinated and consultative way. “However, one group of health professionals should not have to undergo additional training and education to take on roles which currently fall within the expertise of another group of health professionals. “While we agree that pharmacists are currently underutilised, it is ludicrous to expect pharmacists to undertake the education necessary to be competent in wound care while there are thousands of nurses, who are already expert in this area, available. “We must remember that wound care does not simply involve putting a Band-Aid over a cut but can be, for example in the case of a diabetic ulcer, chronic, complex and very difficult to treat requiring significant clinical expertise. “Nurses come prepared with this expertise; wound care and management is an integrated component of all nursing degrees. And many nurses, most particularly nurse practitioners, undertake postgraduate education to become highly specialised wound management experts.” A better solution, she urged,

NURSES COME PREPARED WITH THIS EXPERTISE; WOUND CARE AND MANAGEMENT IS AN INTEGRATED COMPONENT OF ALL NURSING DEGREES. AND MANY NURSES, MOST PARTICULARLY NURSE PRACTITIONERS, UNDERTAKE POSTGRADUATE EDUCATION TO BECOME HIGHLY SPECIALISED WOUND MANAGEMENT EXPERTS. report they are finding it hard to find employment as hospitals turn to skilled migrants. In a recent parliamentary submission, the ANWF claimed that as many as 33 per cent of nurses and midwives who finished their training last year were jobless, while many were employed as casuals and wanted more hours, the report found. Only 15 per cent of graduate respondents had found secure employment in the industry. The ANMF’s Lee Thomas said more nurse and midwife graduates were walking away from the profession because they could not find work. “This is not only throwing away public investment in their training and education, but it’s also contributing to the country’s overall increasing shortage of nurses,” she said. Increasing nurse to patient ratios doesn’t just make for better care, international studies have shown that that it will save patients’ lives. A recent European study of 617 hospitals found that deaths following common surgical procedures were

Center for Health Outcomes and Policy Research at the University of Pennsylvania. All this is occurring in the context of rapid change in the health system, and in the roles performed by health professionals. As visiting US health writer Atul Gawande told an ABC Radio National forum in June, healthcare is being transformed and “what it takes to be good in medicine is changing drastically.” “The volume of knowledge and the volume of skill has exceeded the capabilities of any one individual to know it all and do it all,” he said. “And so it’s become a team sport. We all have pieces of care, even the general practitioner only has a piece of the care. “My mother had a knee replacement, and I counted the number of people involved in her care during her hospital stay, and it was 63 different people.” It is certain that a large percentage of those 63 carers were nurses, highly trained in a variety of fields and doing what they do best: delivery quality care to their patients. 

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GP NUMBERS DECLINE, PRESSURE RAMPS UP The Medicare co-payment issue was a painful process for Government, but beneath all the public outcry, one fact remains: the Medicare system is flawed and places pressure on GPs. With their numbers in decline, where to for the profession? By Brian Davidson


in primary healthcare saves billions. “For example, a half-hour consultation in a general practice might be valued at say $70. The same sort of consultation in a public hospital could be $480 or even $580. If we invest in primary care and especially general practice then the so-called crisis would be alleviated. “The way AMA sees it is that its team care is actually providing the tools for the GP to help patients access those services.”

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or general practitioners, the front-line troops in the health care system, it’s becoming tougher. The viability of practices are now under more pressure. Chronic diseases such as diabetes, cardiovascular disease and depression are placing a greater burden on Australia’s healthcare system, especially in general practice. At the same time, the Medicare rebate has been frozen, putting GPs under financial pressures. Dr Brian Morton, who chairs the Australian Medical Association’s council of general practice, says the big issues facing GPs and the healthcare system involve the viability of the GP’s practice, quality care and the value that both government and the public place on general practice and the part it plays in our health system. What people have to remember, he says, is that GPs are running a small business. “The first thing is the freeze on Medicate rebates that holds the rebate at the same level as it has been for the past few years, because the Labor government also put in a freeze,’’ Dr Morton says. “GP’s practices are like any other small business in that they have rents to pay, staff to pay. As one GP said to me, the whole push has been to team care and to bring other services into your practice and now the government is pushing virtually the opposite. He says indexing the rebate would not only be good for GPs, it would also produce massive savings for the healthcare system by taking pressure off hospitals and putting GPs and primary health care teams front and centre. “They have frozen it and not indexed it properly,’’ he says. “If it was indexed properly, we would have rebates probably 50 per cent higher and if you look at the evidence from overseas, investment

FEWER GPS COMING THROUGH The problem, he says, is that fewer medical graduates are now becoming GPs. There just isn’t the money in it. “To get into university to do medicine, you need a score right at the top, so you’re looking at graduates or school leavers who are

THE BIG ISSUES FACING GPs AND THE HEALTHCARE SYSTEM INVOLVE THE VIABILITY OF THE GP’S PRACTICE, QUALITY CARE, AND THE VALUE THAT BOTH GOVERNMENT AND THE PUBLIC PLACE ON GENERAL PRACTICE. choosing it for the challenge, some maybe for the money,’’ he says. “There is an expectation that they will be adequately recompensed, otherwise, they could have gone anywhere else. “So there is a minimum of four years doing postgraduate, then you add another four years of medicine, then you do your specialist training and you’re looking at someone who has spent probably 13 years in eduction. If the HECS fees are going to go up, they’re going to be choosing other specialties rather than general practice where there is greater remuneration.”

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The numbers, he says, speak for themselves. “This year was the first year we’re we saw a greater number of graduates choosing to enrol in other specialties other than general practice. I think it was 46 per cent going into general practice whereas it used to be 64 per cent.” Part of the problem is that general practice is a lot more difficult these days. GPs are now more likely to have to deal with an “undifferentiated patient” with an “undifferentiated problem” which creates issues for diagnosis with the GP facing time and financial constraints. In many cases, the GP ends up just becoming a referral agency. “So a patient comes in with abdominal pains,’’ he says. “It could be constipation, appendicitis, cancer of the pancreas or bowel. The GP has to make the diagnosis and to direct the patient on the right pathway to get it managed. Or it could be diffuse symptoms like anxiety or depression right down to a physical illness. “General practice is becoming harder and if you squeeze the general practitioner into a low fee

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because that’s what the Government has done, it makes it very difficult for the GP to make an accurate diagnosis because the more time you spend, the less money you get and there is a squeeze on the business.” He says the large corporate model is built around primary health care, where GPs spend less time with the patient. “So you do an investigation and send the patient off to a speciality area. That is predicated on high throughput and getting more money from the higher paying remunerated specialties, whether its pathology or x-ray.” “Patients say to us when I know what’s wrong with me, I go to the quick throughput place. When I have a real problem I come to you. So the traditional GP spends time getting a lot more of the difficult stuff to handle.” He says the Abbott Government’s failed attempt to introduce a co-payment highlighted an issue with the Medicare system that needs addressing, and that would change the ways GPs would be remunerated. The AMA still opposes the concept of a co-payment but

a solution needs to be found for a system under enormous pressures. “My view is that a compulsory co-payment is wrong. It harms the vulnerable,’’ he says. “But there might be a co-payment that is discretionary. We shouldn’t call it a co-payment, we should call it a patient contribution.” That can only be done through legislation. Dr Morton says people need to recognise the limitations of Medicare. “Whilst Medicare is a fantastic system and gives access to everyone, it also takes some of the responsibility away from the patient for being responsible for their own healthcare,’’ he says. He believes the Government won’t revisit co-payments, but there is a problem with the system that needs attending. “Stop and think about where the money is going to come from,’’ he says. “The Government’s projections are that there is not enough money in revenue to fund the demands of an ageing population with technology advancements. “That’s why they are pushing a GST increase and I personally think


psychologists, physiotherapists and podiatrists. Exactly how much connection there should be comes down to the kind of practice they’re running. “It depends how you interpret it,’’ he says. “For example, my practice is in Northbridge in a high socioeconomic area. We have a high incidence of people being privately insured as well. And because the North Shore of Sydney is a great place to live in and work, there is an adequate number of service

some sort of plan which in turn puts pressure on the system. “Some people who don’t really have a problem come in and try to heavy you to do a plan,’’ Dr Sherman says. “So you tell them they don’t have a chronic condition and if they want to see a certain person, they can do it independently and pay for it.” “The huge change has been the whole understanding of depression. Now they come in and say ‘I am depressed Doc, what can you do?’

GENERAL PRACTICE

that’s the right way to go. But if we want good care, we’ve got to be prepared to pay for it. “The other issue is where the sources of revenue are going to come from. Government is one, patients obviously is the other, private health insurers are the other source. I think we ought to recognise that Medicare wasn’t designed for free access. What it was designed for was equitable access but it wasn’t meant as a doctor subsidy or patriarchal method of supporting people. “It’s the Government’s responsibility to find that source of extra revenue but it’s also for the patient to recognise. If you can afford it, and if you want your taxes not to be raised to a terrible level, then you will have to contribute, and to be honest, what that says to the self-provider and the patient is if that’s the cost, do I really need it? It makes us much more aware and much more honest about how we use technology and we access the services.” Say for example, someone is suicidal. The GP could see them and charge them a private fee, and a few days later, see them again and maybe bulk bill them. But the patient would have to make some sort of contribution. And the GP would be in the best position to know whether or not to bill that patient. And it would only apply to a certain section of the population. “In other words, the GP knows the problem. The GP knows the patient, knows the economic circumstances as well so they could choose to bill or not bill,’’ he says. “So we are talking about those who don’t have a concession card and who can afford some sort of payment.”

THE GOVERNMENT’S PROJECTIONS ARE THAT THERE IS NOT ENOUGH MONEY IN REVENUE TO FUND THE DEMANDS OF AN AGEING POPULATION WITH TECHNOLOGY ADVANCEMENTS. providers so it’s not necessarily appropriate for us to have them all in the one place whereas it might be in a rural or regional area, or even south-western Sydney. We could do it as a virtual home for primary care and we have good relationships with all those people around us.” Joseph Sherman, a GP in Melbourne, says he regards being a GP a tremendous privilege. But he’s noticed new pressures coming in with more people coming to the GP with issues of depression, or demanding the GP puts them on

whereas in the old days they would come in with all these different ailments and you had to tease it out of them.” All of which potentially places enormous pressures on the system. And the GPs, as Dr Morton says, are at the cutting edge. The trends suggest there will be fewer of them to deal with the problem, unless the Government indexes Medicare rebates, and invests more in primary care. 

WORKING WITH PRIMARY HEALTH CARE Dr Morton says it’s critical for GPs these days to work with primary health care providers such as

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E-HEALTH 50

CONNECTIVITY DRIVING E-HEALTH

Australians are becoming more connected online than ever before, and one of the major impacts will be the rapid development of e-health services across the country, writes Sean Causebrook

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E-HEALTH

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hether it is the ready access to lifetime medical records through cloud based storage services, or the ability to consult a health professional from a remote location, e-health has the potential to revolutionise the delivery of health services in the coming decade, both in terms of improving access to care and creating more sustainable business models. By definition, e-health is more than tele-medicine, which is the ability of doctors to connect with patients remotely. E-health is the delivery of health information online, the power of IT and e-commerce to improve the education and training of health professionals, and the use of e-business practices in health system management. A significant initiative from the Federal Government has been around e-health records, with the implementation of the Personally Controlled Electronic Health Records (PCEHR) system, with legislation passed in Parliament in 2012. Since then, Australians have been able to choose to register for their own personally controlled electronic health record. With appropriate privacy and disclosure provisions, the PCEHR links patients and healthcare providers, enabling the sharing of medical history and treatments, diagnoses, medications Continued on page 55 >>

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Patient Flow Management 20 years experience.

sales@jayex.com.au

1300 330 611 sales@jayex.com.au

sales@jayex.com.au

includes:

6,500 solutions deployed 20 years experience. Self Arrival 20 years experience. 45,000,000 patients checking includes: Wayfinding 6,500 solutions deployed includes: in or being called by Jayex 6,500 solutions deployed Self Arrival Surveys, Questionnaires& consents solutions annually. Self Arrival 45,000,000 patients checking Patient Calling 45,000,000 patients checking Wayfinding Wayfinding in beingwith called by Jayex Anor entity a direct presence in or being called by Jayex Surveys, Questionnaires& consents Patient tracking solutions Surveys, Questionnaires& consents in the UK annually. and Australia with solutions annually. Patient Calling Fast Check-in partners in many countries Patient Calling An entity with a direct presence Patient tracking An entity with a direct presence 51 languages available in theMember UK and Australia with Patient tracking HL7 in the UK and Australia with Fast Check-in partners in many countries Update details ISO 27001 Accredited Fast demographic Check-in partners in many countries ITK2 accredited 51 languages Detailed Auditavailable andavailable Reports HL7 Member 51 languages HIPPA compliant HL7 Member Update demographic details ISO 27001 Accredited Integration to nearly all PAS Update demographic details ISO 27001 Accredited ITK2 accredited Detailed Audit and Reports ITK2 accredited Detailed Audit and Reports HIPPA compliant HIPPA compliant Integration to nearly all PAS Integration to nearly all PAS


efficiencies as check in processes are captured and handled by the kiosks. Improved clinic flow as the tracking of patient pre appointment activities provides clinical and administration staff with patient readiness status and location. Patient queues have reduced by close to 60% Demographic and Medicare data accuracy has improved with demographic and GP details now being updated ‘real time’, a notification flag from the kiosk to the administration staff ensure that these updates are collected and updated, ensuring that future appointments and correspondence are sent to the correct patient address. Collection of patient DVA, TAC and Workcover includes: 6,500 solutions deployed via a check in Selfsurvey Arrival has resulted in increased Wayfinding accuracy and reporting THE PROCESS 45,000,000 patients checking in or being called by Jayex of data that Surveys, is historically difficult to To ensure that the most appropriate Questionnaires& consents solutions annually. manage andPatient report. solution was selected, Western Calling Built in reportstracking provides Western Health followed a tender process An entity with a direct presence in the UK and AustraliaHealth with with Patient a valuable reporting and to review current market offerings Fast Check-in partners in many countries auditing tool. against set evaluation criteria. The 51 languages available HL7 Member With check in times now reduced tender working party attended various details ISO 27001 Accredited from close toUpdate threedemographic minutes (presites to observe working solutions ITK2 accredited Detailed Audit and Reports kiosk) to under 50 seconds patient and the completed a risk analysis of HIPPA compliant Integration to nearlyhas all PAS flow and patient experience each of the submissions. In awarding THE CHALLENGE improved with patients seated sooner the project to Jayex, Western Health For Western Health the and increased staff capacity to better believed that they had selected the implementation of a patient check in sales@jayex.com.au assist ‘high needs’ patients. With vendor that would achieve the stated solution was as much about patient 1300 330 611best functional fit and total reduced check in and shorter queues, benefits, flow and reducing patient queues, staff wellbeing has improved with the cost of ownership (TCO). as it was about getting a check in alleviation of stress points associated solution intuitive enough to manage with patients arriving much earlier THE SOLUTION time consuming administration than necessary for their appointments To achieve the Western Health vision workflow tasks such as patient By following an industry of improved patient flow and reduced arrival, Medicare card verification, standards based project management queues in the ASB, Jayex deployed confirmation of demographic and GP framework and keeping benefits the Enlighten self-service platform, details and DVA, TAC and Workcover realisation firmly in focus, the Jayex kiosk units - ticket, calling status and then direct patients to the partnership of Western Health and screens (across four pods), Jayex appropriate area. Jayex were able to achieve project web media and Jayex services. The The physical challenge outcomes on schedule. The Enlighten platform deployed included check associated with this implementation solution has now been deployed for in, check in surveys, maps, calling, was not unlike most construction nine months and the key stakeholders patient appointment processing (iPM projects, where the technology at Western Health are pleased that integration), and check out. The footprint, to a certain extent, is the selected Jayex solution is meeting user interface is written in 51 unknown at the time of the design. all expectations. languages of which all of those In the case of the ASB the areas set required by Western Health are on aside for the kiosks was to ensure the To learn more about Jayex Patient the Enlighten platform. placement was both appropriate and Management and Patient Flow accessible by patients. solutions contact Jayex at sales@ SOLUTION BENEFITS Covering such a large jayex.com.au or on 1300 330 611 Improved operational and workflow demographically diverse population a

estern Health is the largest public health Services provider in Western Metropolitan Melbourne. It has three acute public hospitals as well as a Day Hospital, and a Transition Care Program facility. A wide range of community based services are also managed by Western Health, along with a large Drug and Alcohol Service. Western Health is in one of the fastest growth corridors in Australia with a catchment area of 800,000 speaking more than 100 different languages/dialects. With the growing demand in the West, a new $90.5M Hospital Redevelopment project was proposed to construct a new four-level Acute Services Building (ASB) on the Sunshine Campus. The state of the art building was purposely designed with a limited footprint for patient booking and waiting capacity with the intent to enhance the patient experience by reducing crowded waiting areas and utilising state of the art technology to manage patient flow.

key requirement of a patient check in solution was to present kiosk screen instructions in multiple languages, the Sunshine implementation required 11, including Dinka (Southern Sudanese dialect). Importantly the project needed to ensure that key patient demographic decision points were translated correctly. The biggest technological challenge was to ensure that the Patient Queuing system was integrated with Western Health’s patient administration system (PAS) iPM. With all outpatient appointments booked in iPM it was crucial that bi-directional HL7 communications between the check 20 years experience. in solution and iPM were integrated.

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INDUSTRY PROFILE

IMPLEMENTING CHANGE TO MANAGE GROWTH AT WESTERN HEALTH W

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BEYOND THE BUTTON : THE EVOLUTION OF NURSE CALL

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et’s face it. To most, Nurse Call systems are just about the button on a cord. Nothing much has really changed– or has it? We speak with Stephen Brown, National R&D Manager at Hills Health Solutions about developments in the last 15 years and what lies ahead. TTNH: Stephen, talk us through the early beginnings of Nurse Call systems. SB: Well going right back the earliest call systems were literally bells placed on patient bedside tables! So probably the biggest step back then was to a powered button system. These were very basic analogue, hardwired systems. And you are right, back then it really just was a wired button, lights, buzzers and simple mimic panel. But having the single Call button plus a Cancel button had its limitations. For example, What if the nurse needed extra assistance? Or what if it was an emergency? So systems started catering for these situations too. After a while, a number of different systems appeared on the market some deemed as substandard and not aligned with their life-support function. Realising this, the government decided to create a minimum and consistent standard. This happened in 1998 with the Australian Standard AS3811 – Hardwired Patient Alarm Systems. This standard specified a whole raft of recommendations around system design including colour coding and chime tones, performance, and reports.

TTNH: What other major developments have taken place? SB: Probably the biggest was the advent of IP Nurse Call Systems. For Hills, this happened eight years ago and created a kind of digital revolution. No longer did Nurse Call systems have to operate on their own dedicated wiring; they could standardise on ICT/LAN cabling infrastructure. It essentially future-proofed Nurse Call systems. As a result, customised workflows and call types

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could be created and managed and reports could be generated for analysing these new workflows. Furthermore, Nurse Call systems could then tightly integrate with other incumbent and future systems such as phones, fire panels, security systems, building management systems, RTLS and wireless duress to name a few. TTNH: And what can we expect to see going forward? SB: You can expect to see a lot more innovation, at least from us. We believe that for too long, the Nurse Call has been a cottage industry in dire need of a shakeup. Hills Health Solutions is serious about leading this space. Alongside major acquisitions in Nurse Call, we have built a strong portfolio in Patient Entertainment and have developed significant partnerships with leading RTLS and other vendors. We are also working on intelligent consolidation between our existing Nurse Call systems, new Nurse Call systems and other digital health services. In addition, we are extending workflow functionality and analytics to improve todays and future delivery of healthcare. Finally, we are extremely excited to be launching a world first with our Hills Arthritis Pendant. Inspired by feedback from several Aged Care clients, this was a joint development with Industrial Design students at the University of South Australia. It is the first major product to come out of the Hills Innovation Centre. Above all, it will help many arthritis sufferers and those with low dexterity and finger strength who previously struggled to use traditional button systems to now get the timely attention they need. In short, Hills Health Solutions is firmly committed to innovation in the Hospital and Aged Care sectors across Australia and the region so stay tuned. For more information, visit Hills.com.au or call 1300 44 55 74.


and allergies. It gives health professionals accurate information about patient’s pre-existing conditions, medical treatment history and family details, information which can increase the appropriateness of care, and also speed up decision making. While individuals control their own records, healthcare providers are able to add a consumer’s health records to their e-health record system, in accordance with preset access controls. So far, there have been more than 2.3 million individual registrations under the PCEHR (at of July 2015), with over 7800 healthcare providers also using the system. These include general practices, hospital organisations, retail pharmacies, aged care services and allied health facilities. TELSTRA ROLL-OUT In the area of telemedicine, national carrier Telstra has earmarked this as a priority market and recently rolled out Telstra Health, which delivers the ReadyCare service in partners with Swiss company Medgate, now active in Australia. Telstra has consolidated telemedicine assets through recent acquisitions, with Telstra Health aggregating Medibank’s Anywhere Healthcare platform, and adding UK analytics company Dr Foster, IP Health, and e-health software provider Database Consultants Australia. Telstra Health also has travel insurance provider Cover More Group as a corporate customer, with an offer to customers traveling overseas to access Australian doctors through video and phone links, a move which it believes could slash the amount spent on expensive foreign hospitals.

Medibank’s Anywhere Healthcare had established a reputation for high quality clinical care through a network of more than 1600 GPs and aged care referral partners, also working with a panel of specialists. Through ReadyCare, Telstra Health now offers 24/7 remote

access to care,” said Solomon. “Ultimately we want it to be a platform that will enable GPs to provide convenient and accessible telemedicine services for their own patients.” Telemedicine is also likely to cut down on the transmission of infections in hospital and waiting

THERE HAVE BEEN MORE THAN 2.3 MILLION REGISTRATIONS UNDER THE PCEHR, WITH OVER 7800 HEALTHCARE PROVIDERS ALSO USING THE SYSTEM. THESE INCLUDE GPs, HOSPITAL ORGANISATIONS, RETAIL PHARMACIES, AGED CARE SERVICES AND ALLIED HEALTH FACILITIES. consultations with general practitioners through a hotline or through a smartphone app. “ReadyCare is based on technology and processes used by Medgate, who currently conduct more than 4300 telemedicine consultations daily (in Europe),” said Shane Solomon, Telstra Health’s managing director. ReadyCare employs a number of in-house doctors, but Solomon said that Telstra Health wanted to make services available to any GP. “We’re introducing and operating ReadyCare in the first instance to demonstrate how telemedicine services can be provided safely and address issues such as timely

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rooms, or through contact with unsterilised equipment. “Services like this will decrease the risk of infection because if somebody has got the flu and they are sitting there waiting in the GP’s waiting room they’re coughing and spreading it; the same goes for hospital emergency departments,” says Dr Amandeep Hansra, chief medical officer at Telstra ReadyCare. One of the members of the clinical advisory panel, Dr Chris Mitchell, said examples such as the “swine flu” crisis showed that sending people to hospitals and clinics, where they would have contact with each other was a “dangerous honeypot situation for spreading infectious diseases.” “Having a structure where you can deliver care to people in their home will be really important with a whole lot of evolving

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uploaded to the cloud, where metropolitan-based specialists then view them on tablet devices, laptop or desktop computers. Up until now, the pace of e-health adoption in Australia has lagged behind mature markets such as the United States, where it has been driven by private health providers intent on finding cost efficiencies.

OVER 1000 PATIENTS IN REMOTE AREAS WERE SCREENED FOR A RANGE OF CONDITIONS SUCH AS DIABETIC RETINOPATHY AND GLAUCOMA. 68 OF THESE PATIENTS WERE IDENTIFIED AS BEING AT RISK OF GOING BLIND, A DIAGNOSIS THEY WOULD OTHERWISE HAVE BEEN UNLIKELY TO HAVE RECEIVED. viruses,” said Dr Mitchell. “It’s about doing the triaging process in a safe environment.” CSIRO INVOLVEMENT National science organisation CSIRO is also involved in telemedicine, with the successful recent completion of trials using its Remote-I tele-opthalmology service over satellite broadband. Over 1000 patients in remote areas were screened for a range of conditions such as diabetic retinopathy and glaucoma. 68 of these patients were identified as being at risk of going blind, a diagnosis they would otherwise have been unlikely to have received. The pilot project was the result

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of a $2 million grant under the National Broadband Network’s telehealth pilots program to screen patients in remote Western Australia, Queensland and the Torres Strait. The award-winning Remote-I has been developed over several years by a team at CSIROs Australian E-Health Research Centre. It delivers early screening to patients living and working in remote areas through a mixture of advanced imaging, video conferencing and store and forward technologies. Remote-I captures highresolution images of a patient’s retina with a low cost retinal camera, taken by a local health worker. The images are then

BROADBAND AN ENABLER In Australia, the main driver has been Federal Government policy but this has also been slowed by the maturity of broadband infrastructure, a situation which has been addressed this decade. The challenge of e-health in Australia was set out in a 2014 whitepaper entitled One in Four Lives sponsored by Anywhere Healthcare, BT, Philips, the University of Western Sydney and the Australian Information Industry Association. The report title refers to the fact that one in four Australians – or around seven million people – are impacted by chronic health conditions. The report says that the chief issue for e-health is in the creation of “sustainable, profitable business models that can meet the needs of governments, services operators, clinical practice and patients.” “These models are likely to be leveraged from government funding pools such as National Disability Insurance Scheme (NDIS), Aged Care, Department of Social Services (DSS) and/or Medicare,” the white paper says. “Any new model will need to utilise a hybrid of government and user pays funding for Telehealth to be sustainable and scalable. “It is thus increasingly important that governments and industry work together to ensure that information is shared transparently to create informed


2. Eligibility for existing Medicare items should be broadened to allow for coordinated care through multidisciplinary teams delivering care through different channels. 3. Home care packages should be provided on a consumer directed care basis and allow for appropriate provision of

further clinical services where requested. 4. Medicare listed video consultation items should continue to be supported for telemedicine consultations provided by GPs, specialist practitioners and residential aged care facilities, with the introduction of a co-payment capability. 5. The acute sector should be funded through Diagnosis Related Group (DRG) codes that are not dependent on the care being delivered within a hospital setting for specific programs – early discharge programs, hospital in the home, step-down care. 6. The current funding structure for Health in Australia – covering the Medicare

Benefits Schedule, activity based funding and private contributions – should be reviewed in light of the National Telehealth Strategy, with a view to encouraging telehealth as an option to support the long-term sustainability of the health system. In 2015, Australia is at the beginning of a new wave of e-health implementations as policy, technology and business models ultimately align. The arrival of Telstra as a major player in the market and continued Government commitment has the potential to engage with public and private health providers and insurers to leverage technology and the cost base on which e-health initiatives can successful be rolled out. 

E-HEALTH

policy decisions around healthcare funding.” The white paper says that the potential exists for e-health to “play a major role in enabling changes to the service models and delivery required to respond to the growing demand for healthcare in Australia.” Six recommendations were made: 1. The Australian Government should develop a National Telehealth Strategy for a sustainable market.


MENTAL HEALTH OVERVIEW

COORDINATION IS KEY FOR MENTAL HEALTH

Greater integration of services and programs and coordination between state and Commonwealth governments is urgently needed to improve mental health services. By Ben Hosking

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ith the recent National Mental Health Commission’s (NMHC) report claiming that mental health issues currently cost the Australian economy up to $40 billion a year in direct and indirect costs as well as lost productivity and job turnover, it’s little wonder mental health has been a hot button topic in recent years. However, a fragmented funding system coupled with poor service integration and the ongoing stigma associated with mental illness is combining to create

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a crisis, according to Mental Health Australia (MHA) CEO Frank Quinlan. “I seldom use the word ‘crisis’, but it really is fair to describe this as a crisis,” Quinlan says, referring to the fragmented manner in which mental health services and programs have been receiving funding over the last three years. “We’ve had many services that have been on the ground, delivering services who have not had a longer term future for longer than 12 months for something like three years or more – since 2012. We’ve

had 12-month extensions here and six-month extensions there. This, in the midst of some very substantial reforms that have been introduced. I just don’t think it’s good enough.” Part of this frustration comes from the Council of Australian Governments (COAG) gathering in late 2012 where various heads of state government made several commitments to improve the mental health system. “[They] agreed that what they needed to do was to set some targets and indicators so that we could have a better way


“Sadly it takes time to get the state and territory governments to the table. One of the things that the national mental health commission recommends is that state and territory governments and the Commonwealth Government do sit down and actually work out who’s responsible for what, who’s providing which services and who has responsibility for which funding arrangements. That’s something that’s going to take time.” MHA had two key recommendations for the first ministers attending the July COAG meetings, which included the

I THINK ONE OF THE FUNDAMENTAL THINGS WE NEED TO DO IS JUST TALK ABOUT MENTAL HEALTH MORE – PARTICULARLY THE SUCCESS OF MANY OF THE TREATMENT OPTIONS AND INTERVENTIONS THAT PEOPLE CAN EXPERIENCE. urgent implementation of “national, whole-of-life targets for improving mental health outcomes” as per their commitments at the 2012 discussions. The second was to urgently “develop and agree on a fully funded National Health Agreement” which would include specific responsibilities across portfolios, a boost to investment in early intervention and prevention, an expansion and streamlining of services and a guarantee of acceptable service standards for patients and carers. “I think we can do a much better job of ensuring that [mental health] systems are working in harmony and are well integrated so we end up with a situation that we describe as ‘no wrong door’, which is to say that anywhere somebody turns up in the system, they should get the

sort of support and assistance that they need – even if it’s provided in a different part of the system,” Quinlan says. Quinlan says that the fragmented nature of funding is also hurting the future of the mental health sector in other ways, like the professionals working in it. “We want expert people with good skill levels to build a career in mental health services and programs and have long-term employment prospects. This kind of ‘shorttermism’ that we’re seeing [with regard to funding] wouldn’t be accepted in education or in other parts of the health sector and there’s no reason why it should be accepted here.” When asked what an ideal mental health sector looks like, Quinlan had no hesitation, stating, “An ideal mental health sector is one that provides efficient and effective services to the people who need it and is a sector that provides a country with a significant social and economic platform in good mental health. So, it’s a service system that focused not just on fixing severe mental illness when it occurs, but a system that becomes increasingly focused on intervening early and preventing mental illness before it has a substantial cost to the individual and also to society more broadly and I think that’s how we should be measuring the success of our reforms. “I think one of the fundamental things we need to do is just talk about mental health more – particularly the success of many of the treatment options and interventions that people can experience. Because, I think that’s much more likely to give people the hope that’s appropriate. Most people make very happy recoveries from mental health issues when they encounter them and there’s no reason to be pessimistic about that.” 

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of ensuring that the system was actually performing as we hope and anticipate,” Quinlan says. “They also agreed that they needed to change governance arrangements, so there was a new national agreement on mental health. We are yet to see any of those things implemented, even though those first ministers agreed on this in 2012. However, we’ve had the Commonwealth Government recently re-commit to addressing those issues and we’re hoping that they’ll do that urgently.” So urgent is this need for reform that MHA, in conjunction with 96 other mental health organisations and services, recently issued an open letter to the first ministers attending the latest round of COAG meetings in July this year. In an accompanying press release, Quinlan states, “Federal Health Minister the Hon. Sussan Ley MP has indicated that Australia needs an agreement on mental health that is national, coordinated and binding. We have waited too long for such an agreement. The system is in crisis right now, and we need action; not after the next budget, not after the next election, but starting now with a commitment from our leaders. “From the recent report by the National Mental Health Commission and the subsequent announcement of a Mental Health Expert Reference Group (ERG), to the National Disability Insurance Scheme (NDIS) and the Federation White Paper process, the case for action between governments and across various government departments is clear. The time for talk is over, it’s time for action.” Despite the three year delay already suffered by the mental health sector since the last COAG discussions, Quinlan admits that more time will be needed to reach nationwide agreements on funding arrangements and more integrated services and programs.

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THE NDIS AND ITS IMPORTANCE TO AUSTRALIA Australia’s disability sector is huge. More than 4 million Australians have disabilities, and that includes 2.1 million people of working age between 15 and 64. This is why the National Disability Insurance Scheme is so important to Australia. By Leon Gettler

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he figures from the Australian Bureau of Statistics show that 3.4 million Australians have a physical disability, two million of them have dyslexia and one in six suffer from hearing loss. Around 668,100 have intellectual or developmental disorders. According to Vision Australia, there are 357,000 people who are either blind or who have low vision. And in what is the probably the most alarming statistic, nearly half the population, or 45 per cent, will suffer a mental health disorder. And here is the rub: 90 per cent of disabilities are not visible. It is because it is so widespread that the former Gillard government introduced the National Disability Insurance Scheme (NDIS). This is a plan that seeks to give disabled people greater control over the care they receive. Because it’s such an enormous scheme, the NDIS has to be progressively rolled out across the country. At this stage,

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the NDIS is supporting 10,000 Australians. By the time it’s rolled out completely in 2018–19, it will be supporting 460,000 people. Right now however, it’s being introduced at select sites at specifically selected trial locations and for particular groups. These

[ONE] BIG ISSUE IS THAT PEOPLE OVER THE AGE OF 65 CAN’T BY LAW GO ON TO THE NDIS. IF THEY CONTRACT A SEVERE DISABILITY, THEY ARE TAKEN CARE OF BY THE AGED CARE SECTOR. include Tasmania for 15 to 24 year olds, South Australia for children under the age of 14, in the Barwon area of Victoria and in the Hunter in New South Wales for people up to the age of 65. It is also operating in the Blue Mountains in

New South Wales for children and young people aged under 18 and in the Australian Capital Territory, the Barkly region of the Northern Territory and in the Perth Hills area of Western Australia The plan is to roll it out nationally in New South Wales, Victoria, Queensland, South Australia, Tasmania, the ACT and the Northern Territory. That will commence progressively from July 2016. NDIS disability support is universal: it is not means tested and has zero impact on income support. In other words, it will not affect anyone’s disability support pension and carer’s allowance. To pay for the NDIS, the Medicare levy was increased from 1.5 per cent to 2 per cent. And this is where the question of costs come in. The NDIS, when it was conceived, was a popular policy that was supported by both main parties. But the costs have blown out. There are now estimates that


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it will make up almost one-sixth of the Commonwealth’s departmental expenses by 2017–18. In one sense, there were warnings about this right from the start. In 2014, the National Commission of Audit, led by businessman Tony Shepherd, warned the Government that demand for what he called an “ambitious” scheme was uncertain. He said its costs could prove “highly volatile”. He recommended a slower roll-out. He even questioned whether the Government needed to set up a separate agency to run the scheme. So the Government is more than aware of the issues of costs. But it has thrown its weight behind the scheme. It has given its support fully knowing what the costs are. Indeed, the 2014–15 Budget allocated $695 million for the NDIS in the next financial year while preparing for the full roll-out of the scheme. It set aside $143 million for a new information and communications technology system to support full delivery of the NDIS and $17 million for business development initiatives to make Australian Disability Enterprises (ADEs) more sustainable. These will be delivered up until June 2019 to ensure the ADEs are ready for the full roll-out in 2019.

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It also allocated $25 million over four years to shape Disability Employment. That package includes $9 million over three years to create the JobAccess Gateway for both employers and people with disabilities. The Abbott Government has also extended funding for the six Autism Specific Early Learning

HOW DOES THE NDIS AFFECT HEALTH PROFESSIONALS? IF THEY HAVE A PATIENT WITH A PERMANENT AND SIGNIFICANT DISABILITY THAT AFFECTS THEIR ABILITY TO TAKE PART IN EVERYDAY ACTIVITIES, THEY SHOULD ENCOURAGE THE PATIENT TO USE THE NDIS CHECKLIST TO SEE IF THEY CAN ACCESS THE SCHEME. and Care Centres (ASELCCs) until the end of 2015, and will also develop new, individualised funding agreements with each centre for the next three years to the end of 2018. The investment in the new three year agreements is estimated to be more than $16 million dollars and provides the centres with

certainty in the transition to the full roll-out. Other measures include a $2.2 million investment from July 2015 over four years allowing young people with a disability to receive up to six months of Disability Employment Services (DES) support while they participate in post-school employment or transition-to-work programs, smoothing the way for their entry into the workforce. The Budget also allocated funding for carers looking after people with disabilities, providing them with easier access to information about support and services. It has allocated $33.7 million towards the Integrated Plan for Carer Support Services (ICPSS) which seeks to streamline and coordinate services for carers. The funding package in effect acknowledges that carers are in a difficult position. Searching for support and services, they are often confronted with a bunch of confusing pathways criss-crossing the disability, community mental health and aged care sectors. This will provide them with a telephone contact centre and a website providing them with critical information about support and services, regardless of the need and the age of the person they are looking after. How does the NDIS affect health professionals? If they have a patient with a permanent and significant disability that affects their ability to take part in everyday activities, they should encourage the patient to use the NDIS Checklist to see if they can access the scheme. Once the patient makes an access request, the health professional needs to provide them with information about their diagnosis, its functional impact and treatment and the expected duration of their impairment. Allied Health Professionals Australia (AHPA) says health


“Beyond the uncertainty surrounding the future role of the NDIS in the disability sector, there is also confusion relating to the scope of the scheme – who will it cover, what schemes will it replace, and what schemes will it work alongside? While the recently released NDIS rules give some indication, these aspects are still not fully described. Given the importance of maintaining access to services for our most vulnerable members of the community, AHPA believes it is crucial to ensure that the introduction of the NDIS is not impeded by any unintended consequences. In particular, transition arrangements must demonstrate continuity of care for participants currently accessing services through one of the many disability schemes. We strongly support recent indications that the NDIS will provide some transitional support to people currently accessing services but who are not otherwise eligible for NDIS. However, the specifics of these arrangements are needed urgently, so that vulnerable people and their families are not left wondering whether or not they will be able to access help in the near future. Further, adequate funding

for schemes that will continue to provide services to people with disability outside of the NDIS needs to be guaranteed. Processes are required to ensure clear lines of responsibility for funding and continuity of care must be established, and there must be an assurance that these participants will not be disadvantaged due to lack of clarity or cost-shifting across schemes within the disability sector.” Another big issue is that people over the age of 65 can’t by law go on to the NDIS. If they contract a severe disability, they are taken care of by the aged care sector. Two different beasts. The Gillard government responded by issuing a clarification to the law when it was going through Parliament, giving NDIS participants the freedom to choose to remain in the scheme after they turn 65. That was an improvement on the passage in the original legislation which cancelled people’s disability benefits after they turned 65 and moved them to the aged care system. There is still a lot of concern about the 65 year cut-off point. As National Seniors chief executive, Michael O’Neill put it, acquire a disability at the age of 64 and you’re looked after for life, get one at 65 and you are treated as a second class citizen. He has argued that this basically amounts to age discrimination, particularly at a time when today’s 65-year-olds are in good health and, increasingly, in full-time employment. They’re still paying taxes, raising and supporting families, volunteering. The NDIS is now running with bipartisan support. Clearly there are still issues to be sorted out in the lead-up to the full rollout. It’s all part of the evolution of an important government initiative. 

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professionals can play a critical role here because they have the skills, knowledge and abilities to support participants to exercise their rights in control and choice of support, by providing appropriate information and advice to enable them to make informed and supported decisions. AHPA has expressed big concerns that the transition will not go smoothly. “AHPA remains concerned that, to date, insufficient definition has been provided about the anticipated structure, future transition arrangements and proposed timelines. Services across disability, health and education settings are currently available to people with disability through a number of federal and jurisdictionbased schemes. It is critical that funding of these schemes continues to ensure all people accessing services through existing schemes receive continuity of care during this period of substantial reform in the disability sector. In the lead-up to the election, we call upon the major political parties to commit to completing transition to the NDIS and to clarify their vision for the NDIS and the disability sector as a whole to enable key stakeholders to commence planning without delay.

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he buildings in which health services are delivered and which also accommodate patients continually need refurbishment, and older facilities are constantly being replaced with new greenfield sites. Health planners must strike the right balance between creating new hospital and healthcare infrastructure, and funding the jobs of the people who work in them and the equipment they will use. Telemedicine and e-health are enabling remote communication with health professionals, but infrastructure remains a constant priority. Australia spends just under 10 per cent of the nation’s annual GDP of $1.5 trillion on health. This equates to national healthcare spend of just under $150 billion,

INFRASTRUCTURE

While much of the healthcare spend is directed at prevention so that people stay healthy and need minimal contact with the system, the reality is that physical infrastructure remains a crucial component in Australia’s healthcare budget. By Jacqueline Fox

HEALTH PLANNERS MUST STRIKE THE RIGHT BALANCE BETWEEN CREATING NEW HOSPITAL AND HEALTHCARE INFRASTRUCTURE, AND FUNDING THE JOBS OF THE PEOPLE WHO WORK IN THEM AND THE EQUIPMENT THEY WILL USE. of which – according to the Australian Institute of Health and Welfare – capital expenditure comprises 7.9 per cent, or $11.8 billion each year. Not all of this is infrastructure, of course, as a large percentage is equipment, but the breakdown does show the scale

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Artrist’s impression of the new Royal Adelaide Hospital

of health spending, and the funds which are available. State and territory governments hold the prime responsibilities for delivering health infrastructure, accessing Federal Government financial assistance for priority projects and involving the private sector where appropriate in Public Private Partnerships (PPPs), particularly around supplementary commercial projects such as hospital car parks. The Commonwealth, which has a broad policy leadership and financing role, does have its own dedicated infrastructure budget lines, such as the National Rural and Remote Health Infrastructure Fund, established in 2008. This is a competitive grants program which aims to improve access to health services through funding infrastructure and equipment in remote rural communities. To assist in the planning of new

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facilities, the Australasian Health Infrastructure Alliance has created a set of guidelines to help deliver faster and more efficient project briefs for capital projects. The guidelines comprise suggested standards on access, mobility and security, in addition to infection prevention and control, all of which flow from good environmental design. The cost of compliance means that hospitals are among the most expensive infrastructure projects to deliver. In the private sector, the chief of Ramsay Heath Care, Chris Rex, told a Business Leaders Forum in Sydney this year that building a hospital in France, where the company is also active, could be 40 per cent less than in Australia due to regulation. In South Australia, the new $2.1 billion Royal Adelaide Hospital was recently ranked as the world’s third most expensive

building, beaten only by New York’s One World Trade Centre and the Palace of Parliament in Bucharest, Romania. It will, however, be one of the nation’s most advanced hospitals, and most significant piece of health infrastructure, when it opens its beds for patients in April 2016. In the case of the RAH, the site of the original hospital – built in the 1840s soon after South Australia was settled – will be abandoned for a new site less than two kilometres away down the North Terrace thoroughfare in the city’s central business district. “Within two or three years we’re going to have a fantastic health precinct that will be the envy of many places in the world,” says David Swan, the chief executive of SA Health. “What we’re building is one of the largest hospitals in Australia. It’s 800 beds and it’s designed in a way that maximises


The new Royal Adelaide Hospital under construction

INFRASTRUCTURE

the care for all patients and we’re very confident that it’s going to be internationally recognised as a high level, professional health facility.” The new RAH is not a standalone facility either. It is situated right next to the already completed and highly distinctive $200 million South Australian Health and Medical Research Institute, home to around 700 of the nation’s elite medical scientists who conduct interdisciplinary research with the state’s three universities and the soon to be completed RAH in a new health and biomedical precinct. Given that the old RAH has served the state for more than 170 years, the new complex is health infrastructure designed to serve several generations. In other states, governments are also delivering major new health infrastructure projects to cater for the needs of changing communities. In Queensland, the Palaszczuk Government earmarked an additional $180 million in its

said Queensland Health Minister Cameron Dick. The program includes the expansion of the Hervey Bay Hospital’s Emergency Department, the upgrading of Gladstone Hospital and refurbishment at Caloundra to accommodate service delivery changes associated with the commissioning of the Sunshine Coast Public University Hospital.

IN SOUTH AUSTRALIA, THE NEW $2.1 BILLION ROYAL ADELAIDE HOSPITAL WAS RECENTLY RANKED AS THE WORLD’S THIRD MOST EXPENSIVE BUILDING, BEATEN ONLY BY NEW YORK’S ONE WORLD TRADE CENTRE AND THE PALACE OF PARLIAMENT IN BUCHAREST, ROMANIA. July 2015 budget to address the state’s most urgent health infrastructure through a new Enhancing Regional Hospitals program. The program will fund vital upgrades and repairs at the Roma, Hervey Bay, Gladstone and Caloundra Hospitals. “The Enhancing Regional Hospitals program will provide funding to refurbish and modernise ageing and outdated hospitals in regional Queensland,”

Due to open in 2016 with 450 beds, Sunshine Coast is a new $1.8 billion greenfields hospital being built as part of the 20 hectare Kawana Health Campus. Sunshine Coast can be expanded to 900 beds beyond 2021. South of Brisbane, Queenslanders are already being served by a new public hospital, the Gold Coast University Hospital, which welcomed its first patients in

September 2013. Also built at a cost of $1.8 billion, the 750 bed facility is built on a site adjacent to the Griffith University Gold Coast Hospital. New South Wales is also upgrading its health infrastructure, with $1.4 billion allocated in the 2015–6 budget to rebuild hospital and health facilities, funds dedicated to health infrastructure. “In our first four year term, the NSW Liberals and Nationals invested $4.8 billion to upgrade hospitals and health facilities across the state,” said NSW Health Minister Jillian Skinner. If re-elected, the government has pledged another $5 billion on health, a significant percentage of which is earmarked for infrastructure. Australia is entering a period of significant demographic change, and this will be reflected in health infrastructure needs. According to a recent global study by Polycom, Australian health professionals have nominated health services infrastructure as the greatest healthcare challenge of the next 10 years. 

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HOW PHARMACEUTICALS CAN BE PART OF AUSTRALIA’S FUTURE ECONOMY The Australian pharmaceutical industry is facing challenging times. Data from the Department of Industry and Science shows the industry’s turnover has been flatlining at around $23.4 billion since 2011–12. Leon Gettler asks why.

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t the same time, it has enormous growth potential. It generates close to $4 billion in exports, more than the auto parts industry and, according to the industry’s peak body Medicines Australia, it invested over $1 billion in research and development. This is why the Government appointed Dr Bronwyn Evans, CEO of Standards Australia, to chair the Medical Technologies

and Pharmaceuticals Growth Centre. The Growth Centre’s role is to work with successful Australian businesses and boost Australia’s low rate of collaboration between businesses and research institutions. Industry minister Ian Macfarlane sees them helping Australia move from traditional manufacturing to higher valueadded and export-focused production. In its submission to Mr

Macfarlane’s “Securing Australia’s Manufacturing Future” Review, Medicines Australia says the industry could be positioned for strong growth with the right policy settings. “The global pharmaceutical market, which is currently worth around $900 billion, is expected to nearly double by 2020,’’ the submission said. “With its growing population, rising living standards and an increasing incidence of

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chronic disease, the Asia-Pacific region will be one of the main drivers of this growth. This represents a unique and significant opportunity for pharmaceutical manufacturing in Australia, which is not only conveniently located but also has a wellestablished reputation in our region – in fact around the world – for manufacturing safe, highquality medicines. “Since 1999, Australia’s pharmaceutical exports to Asia have grown by more than 200 per cent. In 2012, Australia exported nearly $2 billion worth of medicines and vaccines to over 20 Asian countries, including South Korea ($322 million), Taiwan ($317 million) and China ($401 million). “Despite several recent plant closures, pharmaceutical products are likely to remain one of

Australia’s most significant hightech exports. This has occurred against the backdrop of the high Australian dollar, difficult business environment and challenging policy environment over recent years.” Medicines Australia has recommended looking at Australia playing a more active role in biomanufacturing, where drugs are made out of living cells and tissues, as well as providing more tax incentives, co-investment and clinical trials. On the question of the industry turnover and investment, Stuart Babbage, a PricewaterhouseCoopers partner specialising in health, said investment in research and development to develop new drugs is risky. At the same time, the market is changing which could affect turnover. However, he does not believe this will hurt the industry’s profitability. “What we have seen over recent years is that more and more drugs that have been identified may not

necessarily have broad population applicability,’’ Babbage said. “They may not necessarily be addressing something with very large return. They might be highly specialised drugs and so hence one of the things that becomes a challenge when choosing to continue to invest is to say: ‘If I invest in those areas, will I get a good return?’ That’s one of the challenges we face across a range of treatments in our markets. “What I would say is that a lot of the innovations are highly specialised so therefore whilst some of them are incredibly exciting, the number of people for which they are highly efficacious is very small. “There is a question mark of whether the return on investment is appropriate for the investment. I’m not sure it would necessarily be negative. But it’s certainly more challenging.” This is why the pharmaceutical industry has welcomed the Government’s Medical Research Future Fund to create new and innovative drugs. Ultimately, it can only improve industry turnover. Medicines Australia has tabled a submission urging the Parliament to pass legislation to create it. Medicines Australia CEO Tim James said the MRRF could potentially double Australia’s share of the global pharmaceutical market over the next decade. “The MRFF will help to assist growth in Australian exports through commercialisation of new therapies and meet global health needs, including generating economy wide dividends for Australia,” James said. “The MRFF Bills if passed will provide a unique chance to reinvigorate investment to conduct R&D and to manufacture medicines in Australia. It could also bolster the Australian innovative medicines industry as a dynamic, vital part of the Australian economy and society.”


BMW might be released in Europe before it comes here, that same thing can also apply to any product which might include medicines.” He said the Trans Pacific Partnership Agreement which the Government has championed might actually change that and provide better access. Both Babbage and Medicines Australia say there is an issue of getting drugs listed on the Pharmaceutical Benefits Scheme. Medicines Australia cites the COMPARE report showing that

AUSTRALIANS ARE MISSING OUT ON TOO MANY NEW AND INNOVATIVE MEDICINES, AND WAIT FAR TOO LONG FOR THOSE WE EVENTUALLY GET ACCESS TO THROUGH THE PBS. Australian patients have to wait, on average, more than a year between the medicines being deemed safe and effective and then being made available on the PBS. It compares that to many other countries which provide access to their population immediately, or within 3–6 months of the medicine being authorised for sale. Babbage says it’s also becoming more challenging for local drug makers. “In recent years, however, that has become less automatic because the drugs, certainly the new innovative drugs, are becoming highly focused around special genetic circumstances or specialised diagnoses and are of very high cost. “Potentially listing them goes beyond the Government’s appetite for continued growth of the PBS spend, hence the final step of it being approved and then asking will the Government agree to list it on the PBS doesn’t necessarily flow. So that has been where the challenges have sat.”

He says that is inevitable with healthcare costs coming under increased scrutiny. “Just like all costs in our healthcare system are coming under scrutiny, the additional step has been added where it’s not necessarily clear how decisions are made putting it on the PBS,’’ Babbage says. “Once the PBAC processes were done, it used to be the final step. That’s no longer the case as a greater level of scrutiny of healthcare expenditure has come into the scene. Like anything that happens in our healthcare economy, as economies grow, the healthcare spend grows and obviously we spend a lot of money on our healthcare economy. “There are lots of demands on the budget so by definition we put a lot more scrutiny now on what’s the right sort of investment to be making in healthcare and quite rightly, we should always ask: ‘Is this an appropriate investment for the benefits this gives Australians?’”He says the Government’s recent changes to the PBS, where for example it has provided almost $3 billion worth of drug listings added to the PBS, vowed to go ahead with the introduction of less costly biosimilar drugs in Australia and imposed a 5 per cent discount on cutting edge patented drugs, are significant. “If we are honest about this sort of stuff, some of the recent reforms the Government has announced are positive steps forward,’’ Babbage says. He says this could lead to a more “holistic” look at innovation in medicine which might also consider a drug’s flow-on benefits for hospitals and clinics. All up, the industry faces some challenging times. But initiatives like the growth centres and continued focus on developing the PBS could ensure it moves into a new growth phase. 

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At the same time, however, Medicines Australia has expressed concern about the findings of a COMPARE report – Comparison of Access and Reimbursement Environments – which benchmarked Australia’s access to new medicines. It found that Australia is now ranked 18th out of 20 comparable OECD countries, above only New Zealand and Portugal. Medicines Australia chairman Martin Cross said it was disappointing that Australia, known for its international health care system, was now lagging behind other OECD countries. “It means Australians are missing out on too many new and innovative medicines, and wait far too long for those we eventually get access to through the PBS,’’ Dr Cross said. “These are medicines which improve health outcomes, quality of life, and the population’s ability to participate as productive members of the workforce.” “Australians have access to less than 40 per cent of new medicines considered safe and effective since 2009. Patients in many other OECD countries have 75 per cent or more of the new medicines reimbursed and readily available through government funding. For his part, Babbage questioned the data but in any case, he said, it came down to a simple question of economics. “There is no one simple part of that solution,’’ Babbage said. “Just as often film companies and others don’t necessarily release things in a smaller market like Australia, we have to remember that we are not the world’s biggest economy so when you are launching a drug and going through a process of approval for an economy, the drug company may not prioritise a smaller economy over a bigger economy. “We have to recognise in all things there is a commercial reality for any business. Just as the latest

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THE FUNDING CHALLENGES OF LIVING LONGER Funding for healthcare is an issue in Australia – as it is everywhere else. By Leon Gettler

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ealthcare spending in Australia continues to increase, driven by a growing and ageing population, advances in medical technology and treatments, and consumers’ increasing awareness of healthrelated issues. In 2013, healthcare

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spending was an estimated 11.4 per cent of GDP, or $172 billion, with two-thirds of the funding coming from public sources. What’s creating the challenge for the funding system is that Australians have one of the highest life expectancies in the world. A boy born between 2010 and 2012 can expect to live to 79.9 years and a girl can expect to live to 84.3 years. Adding to the costs is Australia’s population growth, or more particularly, the parts of the population that are growing. That is

creating a challenge for funding it. In recent decades, Australia’s population growth has been stronger among older age groups compared with younger groups. According to the latest stats, people aged 65 and over in 2013 comprised 14 per cent of the population, well up on the 9 per cent in 1973. And it’s increasing. At the same time, people aged under 25 comprised 32 per cent of the population compared with almost half (45 per cent) 40 years earlier. The country’s ageing population brings all sorts of health issues that


those without disabilities. All of this adds to the funding costs. The funding operates in a complex system, a network of public and private providers, settings, participants, and supporting mechanisms. Healthcare providers include medical practitioners, nurses, allied and other health professionals, hospitals, clinics and government and non-government agencies. Public sector health

THIS COMPLEX WEB OF FUNDING HAS BEEN CREATED TO ENSURE THAT ALL AUSTRALIANS, REGARDLESS OF THEIR PERSONAL CIRCUMSTANCES, WILL GET HEALTHCARE AT A COST THEY CAN AFFORD OR EVEN AT NO COST. PRIVATE SECTOR INVOLVEMENT IN DELIVERY AND FINANCING GIVES INDIVIDUALS CHOICE. services are provided by all levels of government: local, state, territory, and national. They are all funded by the Federal Government. Then there are private sector health service providers which include private hospitals, medical practices, and pharmacies. Under Australia’s national healthcare funding system, Medicare, contributions are funded through taxes and a levy based on taxable income. The standard Medicare levy is set at 2 per cent of an individual’s taxable income. Medicare provides free hospital care, including medicines, at public hospitals. It also provides 75 per cent of the Medicare Schedule fee for services and procedures for private patients in a public or private hospital. And it subsidises spending on non-hospital services, such as doctor consultations and drugs. While taxpayers fund Medicare, it is administered by the Australian

Government which also runs the Pharmaceutical Benefits Scheme, which provides Medicare-eligible people with affordable access to a wide range of necessary and costeffective prescription medicines and the 30 per cent Private Health Insurance Rebate. Medicare and the PBS cover all Australians. They subsidise payments for private medical services, not to mention prescription medicines. Public hospital services are funded by federal and state governments under the Medicare scheme. As a result, these services are provided free of charge to anyone who chooses to be treated as a public patient. In addition to paying the Medicare levy, people can also take out private health insurance which can cover private and public hospital charges and a portion of medical fees for inpatient services. Private health insurance can also be used to cover paramedical services such as physiotherapy and podiatry services and some aids and appliances such as spectacles. This complex web of funding has been created to ensure that all Australians, regardless of their personal circumstances, will get healthcare at a cost they can afford or even at no cost. Private sector involvement in delivery and financing gives individuals choice. In addition, there are 36 private healthcare plans in Australia. The largest is Medibank Private, which has around 3.4 million members and accounts for about one-third of the private health insurance market. Medibank became a for-profit company in 2009, and remained wholly owned by the Federal Government until 2014 when it was privatised. Its subsequent IPO raised $5.679 billion in proceeds. The big challenge is to change care delivery models to increase efficiency, and develop effective recruitment, retention and upskilling

FINANCE

drive up care demand and costs, creating an issue for funding. The reality is that when the population is ageing, there will be more people with heart disease, diabetes, strokes, cancers and dementia that will need caring. That will put pressure on the healthcare system. Coronary heart disease was identified as the leading underlying cause of death for both males and females in Australia in 2011. It accounted or 15 per cent of all deaths. Three-quarters of these were deaths in people aged 75 and over. Cerebrovascular disease, otherwise known as stroke, is the second most common killer. It accounted for 8 per cent of all deaths in 2011. Stroke deaths increase greatly with age, with 82 per cent of deaths occurring in people aged 75 or over in 2011. Dementia (including Alzheimer’s disease) and lung cancer were the third and fourth most common underlying causes of death. Then there are chronic diseases, health conditions, health risks and disability, which, in terms of health burden, have largely replaced the infectious diseases of 50–100 years ago such as pneumonia and tuberculosis. One example is diabetes. About one million Australians had this condition in 2011–12. At the same time, nearly two out of three people aged 18 or over are overweight or obese, compared with about 56 per cent in 1995. Adding even more to the costs is the fact that some population groups in Australia experience marked health inequalities compared with the general population. Indigenous Australians, for instance, are less healthy than the rest of the population. Similarly, people living in rural and remote areas tend to have higher levels of disease risk factors and illness than their counterparts in major cities. People with disabilities tend to have poorer health than

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A NEW AUSTRALIAN HEALTH ECOSYSTEM

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ver the next two decades, no market is likely to see better growth in Australia than health and wellness services. We’re living longer but we also want to keep living better. In healthcare, funding challenges are part and parcel of every facet of the sector. Ask any healthcare professional about the greatest challenge (and opportunity) facing the sector over the next two decades and it’s highly likely that funding will be at or very near the top of any list. Governments are, of course, the biggest funders of healthcare but with Federal and state budgets becoming increasingly tight the capacity for governments to continue to pay the burgeoning healthcare tab seems constrained. It seems the future of healthcare funding will increasingly rely on a mix of public, private and consumer money. Today the health system works to fit the funding model, rather than the funding model suiting the system and with the ageing population the current model is unsustainable. We are seeing the collision of health costs and ageing and the need for private sector investment. Are there alternatives to sustainable long term funding? Funders will increasingly demand quantification of outcomes to justify ongoing investment or payment and how do operators quantify and measure success? When we look at understanding the problem we firstly need to consider the supply and demand sides of health. If we look at the demand side, the figures tell the story: in 1984 there were 120,862 Australians aged over 85; today there are five times as many and by 2045 there will be 14 times as many. The supply side, we have an ageing workforce in Australia. The median age of workers is now 40. How do we support people to stay in the workforce longer? As leaders in the provision of financial services to the Australian Healthcare sector, NAB Health is seeing attempts by health operators to increase user contributions and to incentivise risk/reward sharing particularly with health insurers. In order for different funding models to be developed, data needs to show the true cost – or, in fact, the cost savings - to the system of preventative health.

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With technology evolving in healthcare we are seeing an increase drive towards an Individual centric environment. The patient is demanding more from the health system – particularly those that can afford to contribute to their care costs. What does individual centric mean? In light of key trends and challenges, we believe that leveraging data for insights is critical to rebalance the asymmetries of health and healthcare, and move towards a patient-centred service model. Information asymmetries in the patient-practitioner relationship often result in the inability of patients to take ownership of their health journey, and data isn’t always recorded or readily accessible to facilitate decision-making. We at NAB Health have conducted extensive market research which has assisted us to formulate a number of fundamental design principles which we believe could underpin a future Australian health ecosystem. These design principles have been based on an individual’s view of health care, which includes; • Make life easier and more convenient for me • Include and respect me in the relationship • Provide me with confidence along my journey • Transparent access to my information • Give me the best care you can • Let me take ownership and empower me • Simplify my experience • Keep me informed • Reduce my costs As connectedness and data sharing increase over time, concerns around practitioner-patient confidentiality and data privacy will need to be addressed as a high priority. The aim is to connect and strengthen the ties between each and every player of the Australian Health Ecosystem for the benefits of individuals, Health Service providers, Health Service businesses and the community. Technology allows collaboration not just nationally but internationally, and we are seeing this as overseas healthcare technology players enter the Australian market. As the largest and most connected banking player in the health sector, NAB Health is working to connect the various facets of the sector in order to help drive the knowledge, collaboration and connection necessary for the sector to operate as an integrated whole.


strategies to ensure an adequate number of healthcare workers in the coming years. That would drive the healthcare dollar further. Technology can play an important role. Increasing use of health information technology (HIT) might improve the patient experience, and reduce costs. And then there is the possibility of digital wearables and other patient management tools. Data analytics can also be used to segment and target care, particularly at specific moments like end of life care and admissions. All of this is aimed to create a more efficient system that is easier to finance. The Centre for Independent Studies last year released a blueprint to make the system easier to finance by reducing the size of the Government’s role, while improving public services and reducing fiscal burdens on future generations. It has suggested doing this by cutting Medicare “down to size” by boosting the efficiency of public health services, better targeting public health spending and expanding the role played by private healthcare financing. It has recommended a dual funding system that sets up “health savings accounts” that people can use to pay for their own low-cost health care. If they face high costs with for example operations, there would be government-issued vouchers. The idea is that these accounts would work like superannuation accounts where the individual has to make a contribution and help fund it. It’s a system used in the Netherlands where half the money comes from employers, 45 per cent comes from the individual and 5 per cent from the government. At the same time, the private health insurance industry is going through financing challenges. Data collected by Private Healthcare Australia reveals that more than 2.5 million health insurance policies have been

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TECHNOLOGY CAN PLAY AN IMPORTANT ROLE. INCREASING USE OF HEALTH INFORMATION TECHNOLOGY (HIT) MIGHT IMPROVE THE PATIENT EXPERIENCE, AND REDUCE COSTS. scrapped or downgraded over the past three years because of premium rises and erosion of the government rebate. At the same time however, the proportion of the population with insurance has remained steady – the industry regulator recorded just over 5.4 million policies with hospital cover at the end of December – but the data shows an alarming increase in the number of policies lapsing as Australians cut costs. The latest data was collected before Health Minister Sussan Ley approved premium increases of 6.2 per cent, for the second consecutive year, Australians with private health cover face premium rises of 6.18 per cent on average, about the same as last year’s increase. Still, according to IBISWorld,

health insurance is expected to grow alongside families to help provide medical benefits when necessary. With family policies forming 51.3 per cent of private health insurance revenues, IBISWorld forecasts that the industry as a whole will grow by 36.2 per cent over the same fiveyear time period to keep up with the baby boom. The researchers also noted that “an ageing population and government policy aimed at weaning patients off the public health care system are also expected to drive demand for health insurance”, one of the key funders of Australia’s health care system. And then, households also provide some of the funding. Government data shows that households spent an average of $65.60 per week on medical care and health expenses. This was approximately 5 per cent of an average household’s expenditure on goods and services each week. All up, the financing of Australia’s health care system operates in a complex web. But it creates one of the best health care systems in the world. 

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The challenges and expected strains of an ageing population on the health system are well known, but changes to aged care provisions means the public would be well advised to have a plan for the future. By Leon Gettler

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he rules for aged care are changing with the ageing population. Preparing for the future has become complex and confusing, something that’s difficult for the elderly, and for their families. The previous Labor government introduced a much-needed change creating a system where users would have to contribute to their care, instead of it coming out of the public purse. The scheme was broadly agreed to by the Abbott Government, recognising the issues around an ageing population. From 1 July 2014, the old accommodation charge and accommodation bond was replaced by a new system based on the resident’s assessable income assets. These comprise a lump-sum refundable accommodation deposit (RAD) – usually up to $550,000 with anything higher needing to be approved by the aged care pricing commissioner – paying for a room at the aged care facility. There is also a basic daily fee covering meals, power and laundry, which at this stage is $47.49 per day, or 85 per cent of the single rate of the basic age pension. The RAD can be paid in a lump or as a Daily Accommodation Payment (DAP). To fund their aged care, people might have to sell their homes or draw down from their superannuation. There is also a means tested care fee. To calculate this, the government targets 50 cents per dollar of income above $25,316 and then 17.5 per cent of value of assets between $46,000 and $157,051 plus 1 per

cent of value of assets between $157,051 to $379,154 plus 2 per cent of assets above $379,154. The means tested care fee cannot exceed the cost of care and is capped at $25,528 per year. Once you reach a cap of $61,268.92 in your lifetime, you don’t have to pay any more. If all of that sounds complex and confusing, it is. This creates real conundrums and can cause a lot of confusion for elderly people and their families suddenly thrust into a crisis situation.

SOMEONE WILL FALL AND BREAK THEIR HIP AND THE DOCTOR WILL SAY ‘YOU’RE NOT GOING HOME’. THIS CREATES REAL CONUNDRUMS AND CAN CAUSE A LOT OF CONFUSION FOR ELDERLY PEOPLE AND THEIR FAMILIES SUDDENLY THRUST INTO A CRISIS SITUATION. Claudia Rigoni-Brazzale, managing director and financial planner of Rigale Financial Solutions and director of Aged Care Specialists Victoria, says part of the problem is that many don’t plan to end up in an aged care facility. It just happens. Someone will fall and break their hip and the doctor will say ‘you’re not going home’. Someone who is at home with Alzheimer’s will start bleeding, be sent to hospital and the doctors will recommend they go into aged care.

AGED CARE

PROMOTING FINANCIAL PREP FOR MANAGING AGED CARE

A crisis situation does not lend itself to easy decision making about financials. “They have never thought of an alternative and suddenly there are questions like who has power of attorney, do they have wills?,’’ Rigoni-Brazzale says. “It’s a mental adjustment because there are so many changes. “ What makes it even more confusing is that the rules are always changing. At the moment, for example, if someone has a house, they can rent it out and the income is not assessed. Rigoni-Brazzale points out that as of 1 January, that rental will be assessed as part of your income. “It’s going to be even harder to keep your house,’’ she says, “There are only a few legal ways to reduce your assets so that you can get benefits. In the past you could do things, these days you can’t.” On the positive side, she says residents who are assessed as not having sufficient means are fully funded at Government–backed residential care facilities. They don’t have to pay to get in. All they pay is the basic daily fee which comes out of their pension. “Most facilities need to have up to a certain percentage of fully funded people to maximise their Government funding which means if you can’t afford the RAD, you can still get accommodation in an aged care facility,’’ she says. “You just have to find one.” But it comes at a price. “Fully funded means you might have to share a room with someone as well,’’ she Continued on page 81 >>

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A journey shared a richer OF journey THEisFUTURE COMMUNITY-

BASED AGED CARE IS ALREADY HERE

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he provision of aged care services in Australia is undergoing what is arguably the most radical transformation in our nation’s history. Driven by the unstoppable baby boomers – that influential generation which redefines every life stage it enters – the way we receive care as we age is changing, in particular the way older people are cared for in their own home. Consumer Directed Care (CDC), the mandated approach to the delivery of government-funded home care packages is the acronym of our times, and it underpins the way all home-based care providers now deliver their services. For an organisation such as RDNS (Royal District Nursing Service) – Australia’s oldest provider of home nursing – a customer-centric approach to home-based care is nothing new. Yet as this industry-leader is proving, it takes more than just a retrofit of existing approaches to deliver outstanding home-based health and associated services to the next wave of older Australians and their parents.

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RDNS SHOWING THE WAY IN CDC DELIVERY

According to RDNS executive general manager Dan Woods understanding CDC is the easy part. “The Federal Government has been very clear. We know CDC is about handing over control and choice to consumers of aged care services. CDC means consumers have moved from being fairly passive recipients of care to being key influencers around the type and delivery of the services they receive,” says Woods. “At RDNS we have embraced this key shift by providing consultative guidance and advice to our clients, tailoring the best possible suite of services to meet their needs, both within and beyond the traditional parameters of home healthcare.” While being customer-centric might seem new to many home care service providers, it in fact describes the approach that RDNS has taken across several decades. “RDNS nurses have always listened to our clients with the goal of providing individualised care. A holistic approach is built into the RDNS operating system and it’s what our staff do – historically that’s what’s made RDNS special.” “The RDNS Active Service Model already places empowered consumers at the centre of our model of care. What we are focusing on now is how we create and maintain real value for our clients in the new environment,” says Woods. “Moving forward, our focus is on enhancing what we already do well through innovation, research and a reaffirming of our consumer-focused approach.”

TUNING IN TO THE MARKET

“RDNS offers a wonderful palette of services”, says

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Since 1885, RDNS has worked with individuals, families, healthcare providers, governments and others to helpFiona people live“We their best life. RDNS general manager Hearn. have a strong reputation as outstanding care providers Our services include:within the communities we serve. Yet CDC requires more.” • General and specialised home As it’s a collaborative approach to care, community nursing communication andand consultation are essential. In response, RDNS has ramped up its commitment to tuning in to its market. • Home care, including domestic andarepersonal “By listening toassistance what our clients telling us, care we have been able to complement our traditional healthcare • Education, training and coaching for offering with other services that meet our clients’ needs, carers, nurses, administration such as cleaning and gardening services, community andstaff and management leisure activities and support with meals.” “We provide our clients with a skilled and professional • Research, including collaborations case manager, and offer 24 hour support,” says Hearn. and customand designed studies. “Plus our clinical governance safety frameworks are based on the Australian Commission on Safety and Our journey continues. Quality in Healthcare. Our work is evidence-based, consumer-focused and delivered with safety as a priority – for both our clients and our staff.” Hearn, a highly experienced nurse who is widely respected for her clinical leadership, says communication with families is also vital to effectively delivering care under the CDC model. “While older people are the consumers of home care packages, their adult children are increasingly involved as key influencers. Communicating and consulting with our clients’ partners and children helps us build trust and ensures we deliver the best possible suite of services.”

GETTING SOCIAL

As is the case in virtually every industry and sector, the impact of social media is being felt across the home care industry. Woods says: “Over 55s are hugely active online, including on social media. They’re using Facebook and consulting ratings sites and forums to help them make decisions in every facet of their lives, including their choices around aged care for either themselves or their family members. “At RDNS we know that consumers will increasingly share their experiences of our care and services online. We would hope that, given all the systems we have in place to deliver high quality, individualised care, our clients will have only good things to say. But irrespective of the feedback, we’re ready to listen, engage and act.”

EAGER TO INNOVATE

Woods says CDC represents a complete shift in the market requiring organisations to be more flexible and responsive. “At RDNS we are continually reviewing the services we deliver to ensure they are relevant and meet our clients’ needs. We’re also committed to making the best use of technological innovations and advances.


THE VITAL ROLE OF RESEARCH

RDNS is highly committed to the role that primary and community care research plays in improving health services for both clients and the wider community. With its very own research arm – the RDNS Institute – the organisation is gaining an international reputation in several areas including dementia, wound management, medications management, telehealth, and more recently, positive ageing.

RDNS RESEARCH ALSO INFORMS ITS MODEL OF CARE

“It gives us an academic and research underpinning to our practice and enables us to test our theories robustly, and with research rigour,” explains Hearn. “We also engage with government and industry partners, which helps keep the RDNS nimble and informed. “In particular, we are committed to research around chronic disease, with a view to raising the standard of our care on a continuous basis as well as sharing our findings to benefit broader communities.”

EXPORTING RDNS

RDNS’s track record of delivering world-class consumer-

focused care has seen it expand to serve wider local and also overseas markets. The organisation now operates in all Australian states, as well as across both islands of New Zealand and in China. Meanwhile, RDNS’s expansion into Asia began three years ago. China in particular faces unprecedented challenges associated with both an ageing population and the burden of chronic disease. (Twenty per cent of the world’s aged currently live in China, and this aged population is expected to grow from 200 million to 437 million by 2050). “With encouragement from both federal and state governments, we investigated Chinese markets. What became evident was the desire of Chinese governments to explore what RDNS products, services or skills could be imported from Australia to help them deal with these issues,” says Woods. Investigation and business development in south-east Asia has seen RDNS establish active operations on mainland China and also in Hong Kong, where it is helping up skill an existing domestic workforce to provide home care services that help older people stay at home longer. “As far as we are aware, we are the only provider utilising Australian expertise to truly develop a new model of community care in this part of the world,” says Woods. RDNS has been nominated for a number of awards for its work in Asia and recently won the Best Home Care Operator category in the Asia Pacific Eldercare Innovation Awards 2015 in Singapore. With so much experience and expertise to offer, it’s no wonder the RDNS approach is succeeding throughout Australia and beyond. Reflecting on its achievements, Woods says, “You learn a lot over 130 years.”

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“Telehealth is a good example, whereby RDNS embraced an opportunity to deliver healthcare remotely, via videoconference link-up. A thorough research, development and evaluation process saw us roll out our telehealth service in 2013 and in 2014. More than 24,000 episodes of care were delivered through this innovative new service.”

A journey shared is a richer journey Since 1885, RDNS has worked with individuals, families, healthcare providers, governments and others to help people live their best life. Our services include: • General and specialised home and community nursing • Home care, including domestic assistance and personal care • Education, training and coaching for carers, nurses, administration staff and management

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• Research, including collaborations and custom designed studies. Our journey continues.


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AGED CARE – A SECTOR IN TRANSFORMATION

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he Australian aged care industry is a sector in transformation; the industry we see today will be very different in decades to come. That transformation is being driven by a number of powerful factors which impact the demand and supply side of aged care. If we look at the demand side this is growing, based upon an ageing population as well as increased longevity or life expectancy. On the supply side we see this decreasing, given we have an ageing and reduced workforce. For example, if we looked at the aged care workforce, half of this current workforce will be of retirement age in 15 years. Along with the demand and supply impacts, the transformation is also being driven by technological and regulatory change. This is enabling a stronger consumer voice. Transitioning to a consumer focused and funded model drives the need for aged care business operators to address culture, business processes as well as providing different care and lifestyle choices for their clients. With this consumer empowerment brings increased competition. NAB Health has noticed that some of its aged care operator clients are adapting their business models in order to differentiate their services from their competitors. For example, some services are seeing a skew towards high and palliative care needs with people entering the system much older and frailer than previously. This change has brought about the need to offer more acute care services. Whilst other providers are focused on providing a differentiated lifestyle model based upon providing consumer choice including gyms, pools, retail outlets, cinemas, flexible dining options, etc. With the change in business models also comes the need to better understand financial reporting, key performance indicators as well as benchmarking data. Previously, it was difficult to obtain public information on aged care operators in Australia. With a number of recent ASX aged care operators listing, this provides the industry and sector with some really valuable insights that they have never previously had access to. For example, the treatment of aged care bed licences on the balance sheet as well as valuing an aged care facility – land, buildings & bed licences versus going concern. This will ultimately provide a more consistent

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approach to the provision of business advice by valuers and auditors for aged care operators across the sector. Another area of growing interest to operators is that of home care. From 1st of July, 2015 all home care packages were to be delivered on a consumer directed care basis. The aim of consumer directed care is to provide more choice and flexibility to those people when selecting care services. With the consumer having control of the financial funding this has also driven the need for consumers to be more informed and then as a consequence, become more empowered. Increasingly they are demanding to know just what is being offered in return for their outlay, with a growing likelihood of the disaffected making their displease known via social media, thus placing more pressure on providers. Technology will continue to prove an enabler of in-home care, with innovations like wearable devices, which will be able to take observations of a patient remotely, without them actually feeling they are being observed, or the use of television monitors to enable carers and healthcare practitioners to contact and assess aged people remotely, without the need for the patient to leave their home.


says. She says that while rooms at the top end cost $550,000, there are many available for as low as $350,000. As she puts it, it’s a whole new ball game for aged care. For the elderly, the world has changed. “They are making it more and more difficult,’’ she says. “I understand that the Government doesn’t have a lot to splash around. If you are of means, you have to sell your assets to get into an aged care facility. Your beneficiaries will still get the money at the end. Once you pass away, they get the money you put into the aged care facility. Whereas in the past, the aged care facility would get some.” Of course, you could always use your super, provided you have saved enough and keep the house. But as Rigoni-Brazzale says, that has limitations as well. “It depends on who is living in the house and if it’s rented out, that will be assessed.” Michael O’Neill, chief executive of National Seniors Australia, says the new rules have thrust senior citizens into a completely different world. “There is enormous change,’’ O’Neill says. “The enormous complexity continues, there’s the complexity of arrangements and then there’s the complexity of the system you have to work your way through. “Accompanying all this complexity are the financial implications for people who suddenly have to manage the financial contribution towards residential aged care.” He says the complexity of the issue has created a whole new industry of financial advisors specialising in aged care. “Because of the complexity, people are turning around and looking toward someone to advise them in this space,’’ he says. “And part of the caution is that we’re increasingly seeing financial advisors who are becoming aged care financial advisors and providing financial advice in that space.

“Given the history of what we have seen happening in the market, it really is an area of caution. With end-of-life kind of decisions that are involved, people should be careful if they structure their funds to pay for their aged care into the future. They might put them into funds that might go belly up over time and not contribute to what they need at the end of their life.” His advice: be very choosy when picking an advisor. Check them out first, see what their record is. “They might be advisors who have simply just rebadged part of their business to be aged care advisors,’’ he says. “You have to go

ACCOMPANYING ALL THIS COMPLEXITY ARE THE FINANCIAL IMPLICATIONS FOR PEOPLE WHO SUDDENLY HAVE TO MANAGE THE FINANCIAL CONTRIBUTION TOWARDS RESIDENTIAL AGED CARE. through that very careful process of which one you pick and rely upon. That’s about not grabbing the first one you see. You have to talk to a few of them, briefing yourself up before you actually go out to start to do it. “And don’t be rushed into decisions. That’s difficult because often the decisions are being made at a time of family crisis where mum and dad have to go into residential care quickly and the family are involved.” He says only 10 per cent of people end up going into a residential care facility. The rest stay at home. “Primarily the big lumps are for residential aged care,’’ he says. “But equally the pressure will be on them to use their superannuation if they’re remaining at home where the costs are substantially less for everybody. “Certainly your super will have

to pay for that or whatever your retirement income generally is. It will be drawn down. Presumably if you’re accessing some form of pension, it will go to that as well so the pressure will be there for people to co-contribute. “We would say that the home, for the 80 per cent who do have a home, provides your best form of longevity insurance but there is no simple answer. And increasingly the need for the money to become sustainable will become the question.” So what’s the answer? How should people prepare for this? O’Neill says it all comes down to what he calls “longevity planning”. “It’s become increasingly an issue with the change in the way we age,’’ he says. “Added to that is the general increase in the number of folk who will end up living into the 80s and 90s and beyond and with that the increased costs come in at the finish. “It’s about people maximising their retirement income, that’s the starting point. It certainly is about being aware of the longevity issue and being able to prepare for it.” Ideally, he says, that should start when someone is planning their retirement. They should be looking at their home and making sure it’s as age-friendly as possible, taking care of issues like steep walks and staircases and making sure all their financial arrangements are in place. They are best doing this, he says, when they are in their 60s and early 70s, while their health is good. And that will require a completely different mindset. “We are increasingly coming to grips with the issue of planning for retirement but we stop planning. The next stage has to be that preparatory stage,’’ he says. “You’re better off preparing for it when you have all your faculties rather than being in a circumstance late in life when it’s a crisis decision and you’re not on top of your game.” 

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CONSUMER RATINGS FOR RETIREMENT VILLAGES: A WISE CALL FROM NRMA HELPING AUSTRALIANS AGE WELL

Would you pay $3,500 a future vision where consumers could have even more control in directing their to reach 1.6 million housing and support services. potential customers?

Within a rapidly changing world, global and local trends have occurred that are influencing our future and challenging organisations like the National Roads and Motorists’ Association (NRMA) to remain relevant to its Members. Many of these trends are about technology. And it is technology that is providing a range of new and exciting opportunities for the retirement and aged care sectors that have not been possible before. Connect with a large, trusted audience database and differentiate yourself from the competition with an Owl Rating, part of NRMA’s Living Well Navigator.

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hree years ago the National Roads and Motorists’ Association made strategic decisions that have laid the foundations for future success. It gathered creative thinkers, including members, NRMA people and thought leaders from around the globe to begin the process of mapping out a future for the organisation. It developed the Transformation 2020 team. Team 2020 had a simple mandate: develop big ideas that continue our heritage of serving its Members and the community. Out of the Transformation 2020 team the Living Well Navigator digital platform and Owl Ratings were developed.

MORE CHOICE MORE CONTROL The Baby Boomer generation is redefining ageing. NRMA’s older Members have told us very clearly they want to live as independently as possible with more choice and control so they can continue to live good lives. There are many issues important to them. At the top of the list is being able to stay mobile and get around, and making it easier to find good aged care and retirement living easier. “With over 65 per cent of our Membership base over 45 the NRMA wanted to create an online resource that was relevant to them,” says Rene van der Loos, General Manager, Living Well Navigator. “Research from

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An Owl Rating is Australia’s only independent, scientifically validated, customer engagement rating for aged care and the retirement industry. It’s your opportunity to differentiate yourself from the competition and show 1.6 million NRMA Members over 45, and tens of thousands of other visitors to the Living Well Navigator website what you have to offer. An Owl Rating is the perfect way to get your organisation noticed.

Australia and overseas showed that people are seeking more 1300 138 462 information on how to navigate life as they get providers@livingwellnavigator.com.au older and interestingly children wanted this information to help their parents too.” Currently within NRMA, there are 1,600,000 Members over 45 and of those, 750,000 Members are over 60. This is a diverse and growing segment. By 2020, the over 60 Member segment is forecast to grow to more than 1 million.

LIVING LONGER, LIVING BETTER In November 2014, the Commonwealth Assistant Minister for Social Services, Senator Mitch Fifield, who is responsible for aged care, outlined a vision to further reform of Australia’s aged care system, building on the Living Longer Living Better reforms currently underway. The Minister referred to the legislated review of aged care in 2016/17 which will examine whether in addition to changes underway in home support, if “further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model”. The Minister suggested that it might be possible to move faster in this direction. The Living Longer Living Better reforms have improved consumer control, however the Minister has described

OWL RATINGS: INDEPENDENT AND SCIENTIFIC

Currently, there are few platforms and no independent Australiawide ratings guides that are scientifically validated, where consumers can rate aged care and retirement villages on their personal experience with a service. The introduction of Living Well Navigator’s nationwide listings and Owl Ratings hopes to address this. Results from the first wave of assessments of 35 retirement villages have been released in March on the Living Well Navigator website. The second Owl Rating wave of retirement villages is currently being assessed for an October release and the third assessment wave is close to reaching capacity. Successful retirement living and aged care operators will be the ones who find ways to exceed customer expectations and make it easy for people to find out what is special and unique about their service. Living Well Navigator with its Owl Ratings provides a virtual marketplace that connects consumers with providers. Gillian McFee Aged Care - Adviser and Subject Matter Expert says “It is important to position what the NRMA is doing within the broader context of the current aged care reform agenda announced in November by the Assistant Minister for Social Services, Senator Mitch Fifield. It represents an entire rethink of the regulations that involves moving gradually to more consumer-driven systems where consumers can have more influence


WHAT MATTERS MOST TO CONSUMERS Owl Ratings help people navigate aged care and retirement living services Australia-wide to assist them to live independently, or with a little support if needed. The Owl Rating is designed to aid those searching for and using retirement living options and rates how the providers of these services drive high levels of customer engagement. Based on Gallup’s Customer Engagement methodology it measures the level of customer loyalty and emotional connection people have with a service. Unlike government accreditation and industry certification, Owl Ratings are about what matters most to customers and what drives them to want to do more business with an organisation, and then refer others. • One Owl Rating indicates quality service and a lifestyle that people enjoy. • Two Owl Rating indicates high quality service and a lifestyle that people really enjoy.

• Three Owl Rating indicates excellent service and a lifestyle that people love. Van der Loos explains “Service providers who meet Gallup’s Customer Engagement benchmark may receive one, two or three Owls. Receiving a Living Well Navigator Owl Rating is prestigious recognition of the quality of service, similar to receiving a ‘Chef Hat’ in a great restaurant. If you receive an Owl Rating your customers are highly engaged and connected to you and this translates into improved business outcomes.”

LIVING WELL NAVIGATOR: YOUR MARKETING PLATFORM For NRMA Members and the wider Australian community, Living Well Navigator is an online information source and social community, where people who share common attitudes and life events, with different needs and lifestyles, can discover a wide range of information, tools, products, services and find end-to-end solutions. It is an online resource designed to help empower people to live independently for longer, make more informed decisions, connect with like-minded people, and stay active doing the things they love. Van der Loos mentions that “This is a national site and a national initiative and it is important that we reach out to the national audience; 60 per cent of the NRMA Living Well Navigator’s audience is outside New South Wales,” Members and consumers will be able to search for operators through Basic and Enhanced Listings. These are available for all retirement living and aged care services and enable people to compare and contrast services on a range of factors like location, price, services offered and whether or not they have an official Owl Rating. NRMA Members can also post individual feedback and reviews about their experience in using a service. “Living Well Navigator is a strong marketing platform for retirement

village providers. It is a daily information service and an online marketing platform for retirement village and aged care Gillian McFee service providers. With access to the 1.6 million over 45s from the NRMA Membership network, plus tens of thousands Rene van der Loos of other visitors, Living Well Navigator is a gateway to a whole new customer base,” Van der Loos continued. “It is the perfect platform to get your organisation noticed, with a nationwide database of searchable listings and enhanced listings featuring images and more detailed profiles for retirement villages, residential care and home support services.”

INDUSTRY PROFILE

about who provides their services, the setting and the location” Owl Ratings is Australia’s only independent, scientifically validated and benchmarked customer engagement rating tool for aged care and the retirement living industry. The Owl Ratings system was created by the NRMA in partnership with research company Gallup and Council on The Ageing (COTA) Australia. McFee also says “In terms of the navigation for retirement living and aged care, Owl Ratings will make it easier for people using the Living Well Navigator to find the best services. Those providers who are Owl rated will go to the top of the search listings when someone is looking for a service. It is a win-win, not just for the consumer but for aged care and the retirement village industry.” “The NRMA is not a service or funding provider and is completely independent. With the partnership of Gallup and COTA, it brings credibility and trust to what we are trying to do.”

THE FUTURE: CONSUMER DIRECTED CARE The changes to Consumer Directed Care are profound for the aged care industry. In the past, regulation enabled providers to be awarded aged care places from the government in an environment where demand exceeds supply. This meant that providers did not have to compete for customers. Providers who understand the cultural and commercial shift involved in these new reforms know they will now have to pay more attention to marketing and understanding their unique competitive advantage. We are recruiting for Owl Rating wave 3 for retirement villages now. An Owl Rating is the perfect way to get your organisation noticed. Contact Janine Fuller via email: providers@livingwellnavigator.com. au or call: 1300 138 462 Our Owl Ratings into Home Care pilot is underway which we plan to bring to market in the New Year.

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Look who’s giving pre-prepared egg dishes a good name.

Fritters

Scrambled Egg Mix

Egg Bakes

Sunny Queen Meal Solutions. Delicious, nutritious, convenient and safe. Prepared with care in our state-of-the-art kitchen, every dish in the Meal Solutions range is made with fresh eggs from our farms and is fully cooked or pasteurised, to keep your diners nourished and happy. For more information call Sunny Queen Customer Service on 1300 834 703.

Omelettes


With health, safety and cost key focuses for many in the aged care and food services industry, Sunny Queen Australia has launched a great new range of ready to serve egg products that make putting eggs back on the menu really easy.

INDUSTRY PROFILE

SUNNY QUEEN PUTS EGGS SAFELY AND EFFORTLESSLY BACK ONTO THE MENU

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unny Queen Meal Solutions is the latest innovation from Sunny Queen Australia that has been delivering fresh shell eggs to caterers for decades. One of these caterers includes aged care specialists, Whiddon, which has worked with Sunny Queen for over seven years and helps provide residential and in-home care for older Australians across regional, rural and remote New South Wales. Whiddon offers quality nursing care and enables their clients to stay connected to the people, interests and communities they love by allowing them to be as independent as possible. Whiddon has been increasing and improving positive health outcomes for older Australians for more than 60 years. Decreasing appetites, impaired cognitive function, diminished nutrient absorption, chewing and swallowing difficulties and the challenge of packing enough nutrition into a meal are all things Whiddon has great experience in addressing. Referred to as Mother Nature’s vitamin and mineral capsule, eggs can provide a nutrient rich, well-tolerated quality protein that is tasty and adds essential nutrients important for the health of older Australians. The protein found in eggs is often referred to as the ‘perfect protein’, by which all other proteins are measured against. With time, money, health and safety such crucial issues for catering outlets today, Sunny Queen Australia wanted to ensure eggs would still be central on every menu by making it as easy as possible to prepare and deliver them. The organisation has gone to great lengths to ensure all Sunny Queen Meal Solutions’ products are made with high quality ingredients, taste great, and are safe for all to eat, especially the elderly. Sunny Queen understands the need for commercial

outlets in the aged care industry to be able to provide nutritious products, such as eggs, but to feel confident all quality control standards have been met without sacrificing the look, taste and nutrition of the end result. Whiddon’s Food and Beverage Manager, Maryanne Kerin, explains Whiddon has found the Sunny Queen Meal Solutions products easy to incorporate into meal plans and diets and currently uses the scrambled egg mix, poached egg and gourmet omelettes. All Sunny Queen Meal Solutions products can be prepared in a microwave, grill, combi or conventional oven and are free of gluten, artificial colours, flavours, as well as being HACCP certified. They are all made from fresh farm eggs and then either pasteurised or fully cooked for consistency and food safety before being snap frozen. New products are also developed on a regular basis which helps Whiddon to provide variety to its clients, with Maryanne explaining the overall quality of the products has been outstanding, and crucial to enriching the lives of clients and ensuring they have a choice in meals which are high in quality and nutrition. Find out more at www.sunnyqueenmealsolutions.com.au

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AGED CARE TECHNOLOGY

AGED TECHNOLOGY INSIGHT T

walking around independently and going about their daily life, the data from their heart and system is wirelessly delivered to the cloud-based Preventice Care Platform. It’s then passed on to physicians.

Bed turned wheelchair: Panasonic has developed a robotic bed that converts into a wheelchair. Think of elderly people who have trouble getting in and out of bed. It also comes with a built-in LCD screen and medical sensors to monitor health.

Alarms: These will send out automatic calls for help if someone falls, or feels sick. Usually, these devices are worn around the neck or clipped to a belt and have a button that’s pressed whenever help is required. Also, an alarm button can be put near the toilet or shower in case someone falls.

here is no shortage of technology designed for older people these days. And with a rapidly ageing population, many families will turn to technology to take care of seniors. Here are some handy tools and gadgets.

BodyGuardian: This is a sensor developed by American firm Preventice. Worn on the body, it conducts cardiac ECG and rhythm monitoring. While the older person is

TeleXHealth: This is a system that confidentially shares key health with the patient, doctor, family or carer through a mobile application. The data includes details like weight, blood sugar and blood pressure. All this is digitally recorded and put on an electronic dashboard which can then be shared with the relevant parties. Olive: A system that tracks elderly driver behaviour, monitoring activity like braking, location, speed and distance from other vehicles. It not only ensures their safety, it also enables them to retain their licence for as long as possible. Heston: An online personalised meal application. Used by dietitians, it enables the monitoring of medical information and history, food likes and dislikes and weight goals.

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Hapifork: This is a good device to encourage older people to maintain healthy eating habits. Looking almost like a regular fork, but with a wider base, the Hapifork will monitor eating habits and will light up and turn red and vibrate when people are eating too quickly. If you are eating at a good speed, the light stays green. Just plug it into your computer to charge it up. Passive Infra-Red Sensor: This will actually detect movement. It will send an alert when it detects that there’s no movement in the house. No alert is sent of course when the person is walking around. But when there’s no sign, it’s a sign that the senior citizen has fallen or not gotten out of bed. Families need to know that.

Robots: Australia now has a technology robotics lab that is investigating how robots can assist the lives of senior citizens. The Social Robotics and Assistive Technology Laboratory at Griffith University is the first lab of its kind in Australia. Professor Wendy Moyle from Griffith Health Institute’s Centre for Health Practice Innovation has been looking at how robots can interact and provide some comfort for people with dementia. We can expect robots to come out of the lab. It’s already a trend happening overseas. For example, some nursing homes in Japan, Europe and the United States provide some of their more lonely a seal called Paro. The seal is quite a character and responds to them. Hold him and he purrs. It will even cry if you drop it. Paro is just the start. The plan is to eventually have robots that will eventually help senior citizens with bathing, dressing and even entertaining them. It’s very much a case of watch this space. We can expect similar sorts of robots to be produced in Australia. 

AGED CARE TECHNOLOGY

watch, reminder watches, pill timers, automatic pill dispensers and pill reminders. They are perfect for people afflicted with Alzheimer’s, diabetes, deafness, epilepsy, schizophrenia or Parkinson’s disease. They can come with alarms.

Automatic night lighting bed sensor: This piece of technology basically enables lights to come on when the senior citizen gets out of bed. This is important because it reduces the likelihood of the person falling and hurting themselves. My Health Clinic At Home: Feros Care has developed a great system that allows people to monitor their health at home. It comes with a touch-screen computer and measuring devices. Using that sort of easy-toaccess technology, people can record vital signs like blood pressure, oxygen levels and blood sugars each day, These are then transmitted to a specially trained Telehealth Registered Nurse for review. The senior citizen can discuss the data with the nurse via video conference or, if they prefer old technology, by phone any day of the week. Medication reminders: These reminders come in many different forms and include vibrating clocks (that can shake your bed), the vibrating

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RESEARCH

FUNDING THE FUTURE OF HEALTH The medical research sector has been hamstrung by poor and inconsistent funding for years, but that may be about to change thanks to the recently announced Medical Research Future Fund. Ben Hosking talks to Association of Australian Medical Research Institutes president Professor Doug Hilton about what the future holds.

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ustralia boasts a wealth of scientific brainpower that’s up there with the best creative minds in the world. However, thanks to insufficient funding and low grant application success, we’re losing talent to other fields and to overseas institutes, according to Association of Australian Medical Research Institutes (AAMRI) president Professor Doug Hilton. Thankfully, that situation may be about to change with the introduction of the Medical Research Future Fund (MRFF) bill to the Senate, and a raft of recommendations that could herald a new, more efficient and streamlined era for the sector.

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“The thing that worries me – probably more for the longer-term – is that there’s a group of younger researchers who are growing up realising that they have a one in 10 or one in eight chance of getting their grant funded,” Hilton says. “They’re spending three or four months of the year putting together the application for funding and they’re not getting funding. They get disenfranchised and have the creative juices sucked out of them and they’re walking away. They find out in October or November that they don’t have funding and they’re not likely to have a job come first of January and don’t want to be part of a sector

that treats their employees that way. That’s really tough and that probably worries me more than the speed at which discoveries are being made.” This is being compounded by an increasing number of graduates seeking full-time employment in the research sector. According to a February, 2015 piece written by then-CEO of the NHMRC (National Health and Medical Research Council) Warwick Anderson, “...the number of applicants for NHMRC’s Early Career Fellowships has grown from 393 in 2009 to 567 in 2014, just five years later. The number of fellowships available in contrast increased from 129 to just 135”. The McKeon Strategic Review of Health and Medical Research – published in 2013 – placed the Australian health sector value at $135 billion a year, with medicines and health products generating around $4 billion in annual exports, making it one of the nation’s biggest high-technology export industries. Thankfully, it seems the Commonwealth Government agrees on the value of medical research and its MRFF bill, currently facing the Senate, stands to bring Australia in line with the rest of OECD countries when it comes to research funding. As proposed, the MRFF promises to deliver a $20 billion perpetual fund over the next decade which, Hilton says, would potentially make Australia “above average” in research funding against other OECD nations. “We (Australia) are at about 60


A RICH PAST Past Australian research discoveries have included such groundbreaking technologies as the Cochlear implant and the recombinant human papillomavirus vaccine against cervical cancer. Less tangibly moneysaving, profit-making discoveries that have proven no less important have included the link between prone sleeping and SIDS (sudden infant death syndrome). However, the McKeon Review identified that we are failing to make the most of our research discoveries, which is why the AAMRI and Professor Hilton are so keen to see the MRFF support ‘translational’ research. It is a subject that Simon McKeon, for whom the McKeon Review is named, reinforces in the foreword of the Review. “We must strive to develop new interventions and procedures that alleviate sickness and enhance wellbeing as well as reducing the costs of delivering healthcare,” he says. “HMR (health and medical research), as the R&D arm of this major sector of the economy, must be at the heart of the efforts to achieve this aspiration. “The Australian Government

is determined to ensure that its research investment is used wisely and equitably so that all Australians benefit through better health outcomes, and so that it delivers the greatest economic value for the nation.” The McKeon Review also offered some estimates on what the committee believes could be achieved over the next decade should something like the MRFF and sector reforms be put into place. Perhaps the most significant figures the report proposed was a 5 per cent increase in national productivity due to reduced illness and better

WE MUST STRIVE TO DEVELOP NEW INTERVENTIONS AND PROCEDURES THAT ALLEVIATE SICKNESS AND ENHANCE WELLBEING AS WELL AS REDUCING THE COSTS OF DELIVERING HEALTHCARE. chronic disease management, a biotechnology sector generating wealth worth over $60 billion, a doubling of the existing $4 billion export business, over 80,000 jobs and greater engagement with international research partners. GREATER INTEGRATION However, this success is dependent upon greater integration of research with the rest of the health sector and via a streamlining of the research sector itself. Warwick Anderson says there are more than 50 research institutes in Australia but that “... almost two-thirds of medical research is conducted at just seven universities and a further 17 per cent at the sixth-largest medical research institutes. The remaining 20 per cent or so is spread around more than three dozen other independent medical research institutes and more than 30 universities”.

McKeon agrees, stating, “... an overarching message that emerged during this review was the lack of a sufficiently strong connection between HMR and the delivery of healthcare services... I call on researchers, healthcare professionals, governments and the community to work together with strengthened partnerships”. “I think we still have a real obligation to make the system a little more efficient,” Prof. Hilton says. “We need to make the grant system more efficient and we need to do that whether or not the MRFF gets up or not in the Senate. Both the opposition and the Government hold Simon McKeon in high regard and really do believe his review is a blueprint for the sector for the next 10 years. We would follow what McKeon said and we were really pleased with the contents of that review. “What we would ideally see would be the success rates [of grants] within the NHMRC go up to about 20 per cent again and that would be very good. But more importantly we would see greater investment into translation of the discoveries into applications. I think in the end, that’s what the public demands from the medical research sector.” With the MRFF close to reaching a vote in the senate, the face of the national medical research sector could be about to change, for the better, and put Australian research right back up at the top of the international list when it comes to groundbreaking discoveries and cures. “I am feeling cautiously optimistic,” concludes Hilton. “The Government, the opposition and the crossbenchers all understand that the principle of the fund is a good idea. They may disagree about how to capitalise it, but I think they would see that the fund would be in the national interest and is something that would be good for the country.” 

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RESEARCH

per cent of the OECD average for investment in medical research and having the MRFF will take us to average or just above average, which is a good thing,” Prof. Hilton says. “We think it’s a really great idea to have [the MRFF] focused on the translational end – the ability to fund the application and the translation of the discoveries from the lab to something that’s going to be beneficial for health care that could also create jobs. We think that’s a really good focus. What that then does is free the NHMRC to fund the earlier stages of research in the lab and early-stage research in the clinic. Having two organisations with a slightly differentiated aim is a really good thing, I think.”

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RADIOLOGY

MIND THE GAP –

HOW RADIOLOGY IS BECOMING MORE EXPENSIVE FOR THOSE WHO NEED IT MOST Outdated indexing for Medicare rebates is costing patients more each year and deterring some from seeking proper medical care altogether, president of the Australian Diagnostic Imaging Association, Dr Christian Wriedt tells Ben Hosking.

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ith the Commonwealth Government suspending indexation of Medicare Benefits Schedule fees in two successive budgets, indexation has become a big issue for health care providers and patients alike as the gaps between Medicare rebates and the actual cost of services grow. However, for two particular sectors of the healthcare industry – namely radiology and pathology – indexation of Medicare rebates has been non-

existent for as long as 17 years. “Medical imaging has not been indexed since 1998 as a cost saving measure by the government,” says the president of the Australian Diagnostic Imaging Association, Dr Christian Wriedt. “However, the costs for providing the service are increasing and it is the patient who makes up the shortfall. This hits vulnerable patients the hardest because it is the most complex services,

required by the sickest patients, which have the highest gaps. For example, patients are now paying an average gap of $138 for CT services and $164 for MRI services, and these gaps continue to rise.” ADIA (which represents the private diagnostic imaging sector – responsible for more than 80 per cent of all Medicare-funded diagnostic imaging services nationally) claims the average outof-pocket cost to patients has risen 44 per cent in six years and the cost is even greater where services are not bulk-billed, Wriedt says. “When a service is privately billed (not bulk billed), patients are forced to pay the full cost of the service upfront – they are not allowed to pay just the gap. So patients are also being hit with large upfront costs.” A FALSE ECONOMY Dr Wriedt believes the decision to not index Medicare Schedule fees for medical imaging is a false economy, with additional costs affecting the economy further down the line. He’s also concerned that up to 6 per cent of patients aren’t undertaking the necessary imaging procedures due to the upfront costs. “The Council of Australian Governments (COAG) Reform

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INCLUSION REQUIRED Since indexation was stopped, average rebates per service have declined by between 22 per cent (for a CT scan) and 40 per cent (MRI), compared to average rebates for GP services which have actually increased by 15 per cent over the same period. Obviously, ADIA and Dr. Wriedt want to see the

ADIA’S QUALITY FRAMEWORK The Australian Diagnostic Imaging Association (ADIA) created a recommended Quality Framework in 2012 in conjunction with the Royal Australian and New Zealand College of Radiologists that it believes is key to ensuring better diagnostic outcomes for patients and includes four key proposals (below). ADIA president Dr. Christian Wriedt hopes that the Department of Health will implement their proposed reforms soon: 1. Patients will always access Medicare funded CT services in radiologist-supervised practices offering a minimum range of imaging modalities. 2. Patients will have access to radiologist supervised Diagnostic Mammography and MSK Ultrasound Services. 3. All remote reporting of images will meet quality protocols to preserve the clinical chain of responsibility. 4. All Medicare funded diagnostic ultrasound services will be performed by practitioners with accepted minimum professional qualifications.

RADIOLOGY

Council reported in Healthcare in Australia 2012–13 report that 5.8 per cent of Australians delayed or did not see a GP because of cost,” he says. “ADIA is concerned that this may be replicated in diagnostic imaging, because the average gap for diagnostic imaging is $92 and the average upfront cost is over $200. This is significantly more than that of seeing a GP and therefore much more likely to deter if not prohibit patients from essential diagnostic imaging services that their GP or specialist refers them for. Those who do miss important scans are likely to get sicker, require even more extensive treatment, and end up costing the health system much, much more.” While most medical imaging procedures attract some form of rebate, there are a number of critical MRI scans that aren’t covered by Medicare at all, meaning the full cost is passed onto the patient. “Many MRI services are funded by Medicare, but there are still a large number of indications which are not funded, such as MRI of the kidney, to identify and characterise malignant growths to allow tailored treatments,” Wriedt says. “When an MRI service is not covered by Medicare patients must fund the full cost themselves – anything between $250 and $1000 or more, which is out of reach for many patients. The increased cost to the health system of delayed treatments is significant, not to mention the impact on patients.”

Visit ADIA for more info: www.adia.asn.au/policy-priorities/qualityframework/ immediate reinstatement of regular indexation of medical imaging services, with the inclusion of MRI procedures. “After seventeen years without indexation the effects on patients are becoming too serious for the Government to ignore,” he says. “From 1 July 2014, indexation of Medicare Benefits Schedule fees for GPs and specialists were frozen for four years, and the Minister for Health has indicated that this pause could be reviewed as part of the outcomes of the Medicare Benefits Schedule Review. Diagnostic imaging rebates should be included in this review.” On top of the urgent reinstatement of indexation, ADIA is also pushing for the implementation of its proposed Quality Framework (see breakout), that makes four key recommendations to Government on the operation and review of the medical imaging sector – both public and private. “ADIA released the Quality Framework recommendations jointly with the

Royal Australian and New Zealand College of Radiologists in late 2012”, Wriedt says. “ADIA was pleased that the Department of Health, in its recently circulated Regulation Impact Statement, discussed options for implementation of the framework. But it is now crucial that this is taken forward by the Department and that these important reforms to support quality and safety of diagnostic imaging are not delayed. “ADIA believes that our recommendations regarding current policies in the diagnostic imaging sector can make a significant contribution to the Government’s $1 billion red tape reduction target.” With the current freeze on any Medicare Schedule fee indexation due to continue until at least 2018, it remains to be seen if the longoverdue review of medical imaging payment gaps will be undertaken any time soon. And as hardware costs and labour rates continue to climb, the cost to patients will continue to rise. 

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PRODUCTS & SERVICES

EVERLIGHT It’s impossible to predict when you’ll need radiologists – and how many of them you’ll need – at any given moment. So you need to have access to comprehensive radiology expertise at every moment. That’s why we’re here. Everlight Radiology provides tele-radiology services in Australia and the UK – 24 hours a day, 365 days a year. And we do it from reporting centres and hubs on both sides of the globe – so there’s always a sharp, focused radiologist operating in their daylight hours ready to respond. Whatever your site’s radiology needs, we can scale our services to seamlessly fit into your current operations. Whether you just need after-hours or specialist services, or you’d like us to work with your team around-the-clock, we’ll tailor our services to compliment yours. After-hours at every hour. We believe quality, affordable, on-demand reporting should be available whenever needed – which is why we’ve developed our Radiology After-Hours service. It’s designed to turn around accurate results in minimal time. Once your on-site radiographer/MIT conducts the scan, they send the images securely to an Everlight hub. From there, the next available credentialed radiologist reviews the images and dictates the report. After the report is finalised and sample-allocated for peer review, the report is signed and sent directly back to your referring clinician. The whole process is finished in less than 60 minutes. Time is critical. But so is quality. We know your reputation is staked on the professionals you work with – so ceaseless quality and reliability are our highest priorities. We’re fully ISO 27001:2013, RANZCR/NATA and IANZ (by reciprocation) accredited in our Australian operations, of course – but our highest and most important standards of work are the Key Performance Indicators and Client Level Agreements we set with you. These binding agreements are assurances of consistently high standards of work, as well as

locked-in turn-around times that seamlessly integrate into your workflow. Sector-leading technology for sector-leading experts. A guarantee of quality work must be underpinned by both talent and technology. Our dedicated reporting centres are fitted with high quality radiologist reporting workstations, paired with leading software. Our radiologists are connected to a global network allowing for collegiate support and second opinions whenever needed. And our systems are kept perpetually running by high levels of IT redundancy and comprehensive IT support. This extensive investment in resources is our acknowledgement that being able to respond to all critical situations means never being offline – even for a moment. Empowering your existing team. Your department’s performance in key metrics is dependent on the availability and focus of your onstaff radiologists. By taking them off night rosters that sap their morale, you free them up for tasks that will have measurable impacts on your business. They’ll have more time for consultations, which makes for increased clinical effectiveness. They’ll have more time for education and teaching obligations, which improves the performance of your registrars, your standing in the industry and your ability to meet NEAT targets (and other funding eligibility criteria). And they’ll have more time working during daylight hours – reducing fatigue, improving staff satisfaction and lowering error and medicolegal complication rates. And of course there’s the obvious benefit – you’ll eliminate on-call costs, freeing resources for other high-priority projects. Ready when you are. You can never predict the demands that will be placed on your radiology staff. But with Everlight supporting your team, you’ll never have to. Speak to us today about implementing a work agreement that will markedly improve your site’s performance.


PRODUCTS & SERVICES

FIRST STATE SUPER Never too young or too old for financial advice Financial advice isn’t just for people thinking about retirement. The earlier you start budgeting, saving and setting financial goals, the easier it is to build wealth. A financial planner can explain:  How to manage debt  Invest money to build wealth  Save for a home or a car  Establish an emergency fund  Arrange cost-effective insurance  Maximise social security entitlements, and  Take advantage of superannuation options We provide simple financial advice¹ on matters related to your account with First State Super through to comprehensive advice² covering a broad range of financial topics.

For more information about our financial planning service call 1300 650 873 or visit firststatesuper.com.au ¹ The fee for simple advice is covered in our member administration fee. ² A financial planning fee is payable on a fee-forservice arrangement. This is general information only. Please see our Product Disclosure Statement available on our website before making a decision. Financial planning advice is provided by First State Super Financial Services Pty Ltd ABN 37 096 452 318, AFSL 240019. FSS Trustee Corporation ABN 11 118 202 672 AFSL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365.

FOXTEL Foxtel is one of Australia’s most progressive and dynamic media companies. We offer a better entertainment experience through the delivery of exclusive and inspired programming from some of the world’s most popular channel brands. We offer a flexible range of recommended channel packages for hospitals and aged care customers. For hospitals, customers can choose from a wide range of channels to create a tailor-made package that will suit patients of all ages. And for aged care facilities, a Foxtel Aged Care Standard or Platinum package provides premium entertainment - similar to an at-home

experience - that will keep your residents happy and stimulated. See your patients and residents settle-in and enjoy some of the biggest live sporting events, new and all-time favourite movies plus an outstanding range of documentaries and lifestyle programs. Visit Foxtel.com.au/business or call 1300 364 217 Foxtel and some services not available in all buildings/premises. Foxtel marks are used under license by Foxtel Management Pty Ltd.


PRODUCTS & SERVICES

JAYEX 20 plus years of experience. 6,500 solutions deployed into Hospitals and General Practices in the UK and Australia, 45,000,000 patients self-arriving and being called by Jayex solutions per annum. Jayex specializes in patient flow management solutions and has discovered ways to increase efficiencies within your Hospital or Practice and are leading the way in innovative solutions for the Health industry. Jayex has a range of solutions that can be easily configured and customised to suit your Hospital or Practice and would welcome a call to discuss your particular requirements. JAYEX Contact Details Web: www.jayex.com.au E-Mail: sales@jayex.com.au Tel: 1300 330 611

Self Arrival Solution

Reduce queues at reception with our self-arrival touch screen solution utilizing the Jayex Enlighten Platform. Jayex are an authorized integration partner with most of the leading PAS and PMS providers allowing your patients to ‘self-check in’, with updated demographic data and answers to surveys/questionnaires and consents which are all date and time stamped and securely sent back to your database, saving you administration time and costs.

Patient Calling Solution & Digital Media Solution

The Jayex Calling system allows you to call patients to the appropriate consulting room via multimedia screens, allowing clinicians to spend more time with patients. Up to 3 minutes of Clinician time can be wasted walking to collect each patient from a waiting area. When the screen is not being used to call patients, messages can be displayed relevant to your particular clinic utilising the Jayex content management solution.

Improved Patient Flow

Manage patient flow by enabling patients to self-check-in and reduce congestion at reception area as well as directing patients to waiting areas via Jayex’s way finding module.

Redeploy Labour

Reduce double handling of data, reduce print costs and allow admin staff to focus on those patients that need it the most and on higher value add tasks.

Accurate and Current Patient information

By the patient taking control of ensuring their demographic data is correct we are able to reduce the 73% of patients that are missing or have a piece of incorrect data especially with our arrivals solution being written in 51 languages (enabling patients to understand the questions being asked in their native language). Also customisable patient survey, patient questionnaires and patient consents are available for a hospital or practice to easily produce and responses are all date and time stamped.

Security and Privacy compliance

HL7 Member ISO 27001 accredited ITK2 accredited and; HIPAA compliant

DrShop™ by MediSecure® is a free real-­‐time prescription monitoring system designed to address prescription shopping. This electronic tool is needed at the point of care, the most effective time to address addictive behaviours in DrShop™ by MediSecure® is a free real-­time prescription patients. monitoring system designed to address prescription shopping. This electronic tool is needed at the point Prescription overdose a public health of care, medication the most effective time to is address addictive epidemic. behaviours in patients. Prescription medication overdose is a public health In 2014 in Victoria more than 80% of drug overdose deaths epidemic. were linked to prescription medicines, such as opioid analgesics and benzodiazepines. If national statistics were In 2014 in Victoria more than 80% of drug overdose available it would e recognised as a catastrophe. deaths wereblinked to prescription medicines, such as opioid analgesics and benzodiazepines. If national statistics Medical professionals and the Victorian Coroner continue were available it would be recognised as a catastrophe. Medical professionals and introduction the Victorian Coroner continue to lead national calls for the of a real-­‐time to It lead national for theto introduction a real-time system. is the only calls solution this public ofhealth crisis. system. It is the only solution to this public health crisis. There have been recomendations to create such a system There have been recommendations to create such a system from 19 separate Victorian Coronial inquests. from 19 separate Victorian Coronial inquests. The Australian Medical Association argues argues that a “that modest The Australian Medical Association a “modest investment in real-­time monitoring would investment in real-­‐time monitoring would go a long way to go tahe long way to the[overdoses]." number of deaths reducing number of reducing deaths and As and [overdoses]." As primary care providers, doctors are in primary care providers, doctors are in an ideal position to an ideal position to help patients coping with addiction, help patients coping ith right addiction, they just needwthe tools. they just need the right tools.

DR SHOP BY MEDISECURE

Prescription medicine addiction is hidden. ‘Typical doctor shoppers’ are difficult to detect and often appear as high functioning professionals. Doctors do not have access to a patient’s medical history, only what a patient chooses to Prescription medicine addiction is hidden. ‘Typical doctor disclose. DrShop is the solution. shoppers’ are difficult to detect and often appear as high functioning professionals. Doctors do not have access to a DrShop™ the only system that conforms the multiple patient’sis medical history, only what a patientto chooses to recommendations from Coroners and other experts. disclose. DrShop is the solution. Importantly, DrShop™ provides information at the point of DrShop™ only system conformspto the multiple care, without isdthe isruption to the that prescribing rocess. recommendations from Coroners and other experts. Importantly, DrShop™ provides information at the point DrShop™ is integrated with most clinical software programs of care, without disruption to the prescribing process. and is now for with registration for software doctors around DrShop™ is open integrated most clinical Australia. and is now open for registration for doctors programs around Australia. To find visit www.drshop.com.au. To out findmore out more visit www.drshop.com.au.

by


PRODUCTS & SERVICES

SILVER CHAIN Silver Chain Group is one of the largest in-home health and aged care providers in Australia, comprising Silver Chain in Western Australia, Queensland and New South Wales and RDNS SA in South Australia. Together, we care for more than 80,000 people every year supporting them to remain happy and healthy at home for as long as possible.

a daily commitment to making a difference to the health and wellbeing of Australians. Silver Chain Group assists over 83,000* clients each year to live independently in their own home and community.

We partner with governments and other healthcare organisations to provide innovative solutions to today’s health care challenges, ensuring that we meet the changing needs of local communities. Our solutions include the latest technology and innovations, and are all backed by research. It’s our vision for all Australians to be able to control and manage their own health and wellbeing. We will bring this vision to life through

About Silver Chain Group Silver Chain Group comprises of Silver Chain in Western Australia, New South Wales and Queensland and Royal District Nursing Service (RDNS) in South Australia. Together, we are one of the largest in-home health and care providers in Australia.

For further details please visit silverchain.org.au or call 1300 650 803.

*Correct as of July 2015


PRODUCTS & SERVICES

UNIVERSITY OF THE SUNSHINE COAST Are you searching for a career where you make a difference? Working in public health, you can improve the wellbeing of communities and individuals by promoting health and assisting with the prevention of disease. The future of health is in top shape at USC, with a range of exciting new degrees on offer to prepare you for a rewarding career. In 2015, USC launched four new Health Science programs to complement the popular suite of over 20 health-related undergraduate and postgraduate programs already on offer. The new Health Science degrees introduced this year cater to students’ specific areas of interest, with majors in Epidemiology and Public Health; Applied Environmental Health; Health Communication; and Applied Health Promotion. Students study the relationship between the health and wellbeing of people and the social, economic, cultural, political and physical environments they live in, leading to a range of occupations for graduates. Discipline Leader and Lecturer in Public Health Dr Jane Taylor said health promotion graduates were currently in great demand. “Career opportunities include working on health campaigns, health policy development, disease prevention, project development and management, community and international health, with jobs in government, hospitals, private health care and not-for-profit organisations. “Some of our students are securing great jobs before they even graduate.” Final-year student Natalie Glasgow of Morayfield has recently started work as Moreton Bay Region Project Officer for Good Sports, an Australian Drug Foundation initiative. “I’m looking forward to working within my local community and introducing the Good Sports program to local sporting clubs to encourage responsible drinking practices as well as healthy eating,” said Natalie. Join USC’s successful health graduates and start a public health career at USC with the three-year Bachelor of Health Science and choose to specialise in one of four areas: Epidemiology and public health – learn about disease patterns, causes of disease, and data collection and analysis for the prevention and treatment of disease and other health problems. Get the specialised skills to shine with the first epidemiology program in Queensland, and the second in Australia. Health promotion – learn how to work with communities to design, implement and evaluate policies and programs that increase the control people have over their health. Environmental health – learn how to improve the health of our communities by understanding the environmental factors that can potentially impact human health and wellbeing.

USC Master of Health Promotion students Nicole Cool of Mudjimba and Kristel Alla of Maroochydore.

Health communication – learn about health messages and strategies and how to use new technologies and media to promote public health and the delivery of health care. Our program is one of only a few in Australia offering a Health Communication specialisation. In the final year of these programs, students gain valuable industry experience and networks through a supervised professional placement. All programs meet relevant industry national and/or international competency standards. Looking for a flexible postgraduate study option to take your health career to a new level? Suitable for students embarking on a new career in health and those looking to develop deeper knowledge and skills in health promotion, USC’s two year Master of Health Promotion provides the flexibility to study courses on campus, online or both and offers great outcomes for graduates. Nicole Cool of Mudjimba and Kristel Alla of Maroochydore (pictured) are both studying for a Master of Health Promotion at USC and are both already working at Sunshine Coast Medicare Local. Nicole has been with SCML for more than a year and is now the Community Events Project Officer, working on events such as Mental Health Week, Men’s Health Week, Heart Week and Healthy Weight Week. Kristel began a three-month work placement there in November and is now employed as the Project Officer, Monitoring and Evaluation, currently working on a program to enhance primary health care in general practice by developing better practice processes around chronic disease management. Former Buderim nurse Loral Courtney recently completed USC’s Master of Health Promotion after deciding that she wanted to concentrate on illness prevention. Loral now works at Lives Lived Well, a leading state-wide drug and alcohol support organisation based in Brisbane where she is the community development officer working in alcohol harm prevention. For more information on USC’s Health Science programs, visit usc.edu.au or contact us on 07 5430 2890.


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