CHF’s submission to the draft report of the Review of Accreditation Systems within the National Registration and Accreditation Scheme has called for greater interprofessional collaboration, training in settings other than hospitals and the need to improve efficiency, consistency and commonality within the accreditation system. This submission builds on our previous submissions to the review.
CHF Response to the Independent Review of Accreditation Systems
Engaging Patients in Decision-making - PharmAus17
Delivered by CEO Leanne Wells at PharmAus17 this presentation offers a few brief consumer perspectives on whether or not we have a 21st century national medicines policy. You can read a summary of PharmAus17 here.
Scheduling of Codeine
What we support
We support the role of Therapeutic Goods Administration (TGA) as the independent regulator and accept its decision to make all codeine products prescription only from 1 February 2018.
We are participating in the work of the Nationally Coordinated Codeine Implementation Working Group to ensure consumers are aware of the change and have information about alternate pain management strategies and services.
We also support the need for more education for prescribers on the dangers of codeine to reduce its use. Over-the-counter access to codeine is only part of the problem and without measures to change prescribing habits the problems associated with over use and addiction will continue.
There also needs to be more services available for people with a codeine addiction to help move them away from using codeine and to help them manage any pain issues more effectively.
We join with painAustralia and the Australian Pain Management Association in supporting the full implementation of the National Pain Strategy.
What we do not support
We do not support the proposal from the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia to allow pharmacists to dispense codeine products without a prescription for people with one- off acute pain under certain conditions.
Why we believe this
When the proposal to reschedule all codeine products to be prescription-only medicines was first mooted CHF opposed it. We acknowledged that there was a problem with misuse but believed that most people used codeine products responsibly. We argued for other measurers to be implemented including: introduction of real time monitoring of sales of codeine through pharmacy e.g the Guild MedAssist program; more education for consumers about potential issue around dependency and addiction; more services for people with addiction and dependency issues to help them move away from codeine and more education for doctors on prescribing codeine products. We acknowledged that if these did not work then the next option would probably be moving to prescription-only.
CHF believes that the scheduling framework which looks at access to medicines in terms of potential risks to consumers and has ensuring consumer safety as its key principle serves Australian consumers well overall. The Therapeutic Goods Administration looked at all the evidence and made the decision that the harms outweighed the benefits and so codeine should be made prescription only.
CHF supports the role of TGA as the regulator; we believe overall it does an excellent job of ensuring Australians have access to safety and high-quality medicines. We also note that this decision brings Australia into line with most other developed countries. As recently as July 2017 France has moved to make codeine products prescription only. The evidence for harm from codeine and other opioids is growing and their efficacy in assisting with pain management is coming under more and more scrutiny.
The proposal to allow controlled supply by pharmacists without a prescription could be seen to undermine the scheduling framework. Whilst CHF acknowledges there may be a place for looking at ways to improve access to medicines through measures like controlled supply we think this needs to be done in a rigorous and systematic way not just applying it to a specific medicine. The work on this needs to develop a sound evidence base for the need for such a model, look at possible ways it could be implemented and develop some criteria for deciding which medicines might be suitable to be accessed in this way. The review needs to involve all the stakeholders including pharmacists, consumers and doctors.
Much of the messaging around the changes for codeine concentrate on the potential harm it causes and that it is an ineffective pain management tool. Consumers would become very confused after seeing these messages to then hear that codeine products are the way to deal with acute pain. It may also undermine the moves to get consumers to look at a range of pain management approaches, not just medicines.
September 2017
Summary of Tipping the Scales - Australian Obesity Prevention Consensus
This is a summary of the Tipping the Scales - Australian Obesity Prevention Consensus report that outlines eight actions for the Australian federal government to take, established by a comprehensive consensus process as agreed elements to underpin a national obesity prevention plan.
Tipping the Scales - Australian Obesity Prevention Consensus
Australia’s health, wellbeing and productivity is being threatened by an epidemic of weight-related illness. Most Australian adults (63.4%) are above a healthy weight with 27.9% obese and 35.5% overweight. More than a quarter (27%) of Australian children are overweight or obese. If current trends continue, there will be approximately 1.75 million deaths in people over the age of 20 years caused by overweight and obesity between 2011 and 2050, with an average loss of 12 years of life for each Australian who dies before the age of 75 years. If obesity rates could be halted in this period, half a million premature deaths could be prevented.
Here the Obesity Policy Coalition go into detail on eight actions for the Australian federal government to take, established by a comprehensive consensus process as agreed elements to underpin a national obesity prevention plan.
Options to reduce pressure on private health insurance premiums by addressing the growth of private patients in public hospitals discussion paper
First and foremost, we would like to remind the government and policy makers that consumers, the people who use the health system and for whom it was created, should be at the centre of all of decisions. As advocates for consumers, who do not have a financial stake in this, we offer suggestions which are based on the reality of consumers’ use of their PHI and how the health system can best serve them. Our key principles in this area are:
- That consumers’ ability to choose to be private patients in public hospitals be maintained
- That PHI policies that are public hospital only should still attract government incentives particularly given their importance for rural consumers
- That patients should be treated according to clinical need, not ability to pay. This needs to be strengthened by improved monitoring and data collection on this issue.
As our submission highlights, most of the options presented in this paper and the broader discussion around PHI do not currently have consumers at the centre and may be seen to penalise consumers, instead of supporting them. While we acknowledge the importance of equitable sharing of funding between the commonwealth and states and territories, changes should not be made which would limit patient choice and potentially increase confusion or costs for individual consumers. We suggest that while this issue is not unimportant, that changes in this area are unlikely to have substantial or wide-ranging affects in the areas of value or affordability for consumers.
The discussion paper has many assumptions and conclusions that we suggest are not clearly substantiated with the evidence offered. For example, the paper argues that “(i)f the number of private patients in the public sector had grown at the same rate as private patients in private hospitals since 2010-11, premiums in 2015-16 would have been about 2.5% lower than they actually were” (page 4). It is unclear how these figures were derived.
Webinar - Accreditation Systems Review: What’s in the draft report?
Watch it here: https://youtu.be/c3eliNq_jsc. Professor Woods provides a synopsis of the draft report and outlines the impact of proposed options for health consumers. It was also be an opportunity for participants to provide feedback and comment on the anticipated reforms.
Submission to the Independent Review of Health Providers' Access to Medicare Card Numbers
This is a response to the discussion paper released 18 August 2017.
CHF agrees with the Discussion Paper that there is a balance to be struck between security protections surrounding health professionals’ access to patients’ Medicare card numbers to avoid unauthorised, inappropriate or fraudulent use, and timely access to Medicare benefits for patients who are unable to present their Medicare card at the time of service.
Particular considerations for CHF are as follows:
- The July 2017 media reports of illegal selling of Medicare card numbers on the Dark Web suggest that current controls for access to others’ Medicare card numbers need to be tightened, and possible weaknesses rectified, within the Health Professional Online Services (HPOS) system and the arrangements for the Medicare provider enquiries line.
- Individuals who are unable to present their Medicare card at the time of service typically have understandable reasons for being in this situation, while possibly also being financially unable to meet the whole cost of the service provided out of their own pocket at the time of the service. For example, these individuals may be acutely or chronically unwell, homeless, escaping family violence, or under other significant stress for whatever reason. As the Discussion Paper notes, Medicare is Australia’s universal healthcare system, providing all Australians with access to timely and affordable healthcare. It is important that individuals who are unable to present their Medicare card at the time of service are not disadvantaged by changes to the HPOS system.
- CHF supports the move to a national opt-out approach to the implementation of My Health Record, as well as measures which genuinely address consumers’ legitimate security concerns in relation to the My Health Record system. It would be unfortunate if inappropriate access to Medicare card numbers, as highlighted by the July 2017 media reports, reduced public confidence in the My Health Record system.
Consumers Shaping Health, vol 11, Issue 2, September 2017
CHF is proud be part of the push to build a consumer-centred health system in Australia.
Consumer Priorities for a National Health Plan - Summary
The Consumers Health Forum has presented Health Minister Greg Hunt with consumer priorities for a National Health Plan, setting out what’s needed to bring 21st Century consumer-centred care to our poorly-coordinated system.
Consumer priorities for the Plan centre on two essential starting points:
- Reforms to strengthen Australia’s primary health care system to make it more consumer-centred, prevention-oriented, and better integrated with hospital and social care and with more capacity to support transitions of care;
- Boosts to investment in health systems research, shaped by consumer and community priorities to stimulate services that reflect advances in health sciences.
CHF outlines reforms in seven key areas:
- PRIMARY HEALTH CARE: to expand the focus on new models of care to include children, families and others at risk of chronic illness, and to enhance the role of Primary Health Networks.
- PREVENTION: pre-empt chronic diseases like obesity with effective public health measures
- RETHINK FUNDING: to better link hospitals with coordinated community-based services
- INTEGRATE MENTAL HEALTH SERVICES: with physical health, education and employment.
- FLEXIBLE WORKFORCE: incentives, education and services to put consumers at the centre of care.
- DIGITAL HEALTH FUTURE: support efficient care, more consumer choice and transparency.
- CONSUMER ORIENTED RESEARCH: to ensure consumer say in setting research priorities and translating research into practical improvements to services.
Please read the PDF for the full summary.