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Editorial
Victoria’s new voluntary assisted dying laws—more than meets the eye
The first of our ‘Top stories’ today is about a lot more than voluntary assisted dying.
There can be no doubt that Victoria’s legislation, the first to endure in Australia, signifies a major change in our response to end-of-life.
But it also showcases that:
- parliaments are increasingly using tri-partisan (government, opposition, crossbench) Committees that consult widely when seeking solutions to complex social issues (What does this say about our ‘normal’ political processes?)
- the rise of individualism in democratic societies (fuelled by the information revolution) seeks expression in increased personal autonomy and choice
- the legislation is a watershed in the rise of the consumer voice in health
- the legislation signifies a more equal relationship than previously between consumers, the professions and governments
- development of the legislation in Victoria was cooperative rather than adversarial, with recognition of ‘deal-breakers’ on all sides and an appreciation of what was most likely to ‘get up’.
It is a fascinating case study—we link to not only the AHHA media release, but to two highly relevant papers on the legislation published in our Australian Health Review peer-reviewed journal late last year.
Latest AHHA podcast is a doozy
For our younger readers, ‘doozy’ means ‘great/unique/stylish’ and for many is a reference to the magnificent Duesenberg cars produced in the USA between WW1 and WW2.
Our latest podcast features distinguished Harvard University Professor of Public Health Practice and former politician, John McDonough. John led our recently-held series of executive workshops on ‘Leading effectively during political change periods’.
The workshops were aimed at transforming how health leaders in Australia understand, anticipate and respond to health system challenges in the context of political change, ideological shifts, and health care funding instability.
John is worth listening to, and now you can—through our podcast! (See ‘Top stories’).
Offensive conjecture is not journalism
Check out our ‘Women’s health’ section for links to the article in question, and a response from the profession that was insulted.
‘I write to question’ and ‘I write to understand’ is not journalism. Question to understand—and then write—is a better approach in this editor’s humble opinion.
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Top stories
Victoria’s ‘citizen-driven’ voluntary assisted dying laws enacted
Australia’s first enduring voluntary assisted dying laws came into effect two days ago in Victoria.
‘The laws are not only a major shift in the response to end of life—they are a watershed in the rise of the consumer voice in health’, Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven said.
‘Public support for voluntary assisted dying is very strong—it was estimated at 75% in an ABC survey back in 2016—so the movement towards legislative reform is not surprising.
‘It is likely other states will follow Victoria’s lead in due course.
‘The key to legislative change in Victoria was the approach taken in developing the new laws. It was citizen-driven and inclusive, combining evidence, science and social action’, Ms Verhoeven said.
‘Accordingly, the laws are cautious, with many safeguards—but they have been agreed on and passed.
‘In 2018 AHHA published two research papers on this topic in our peer-reviewed Australian Health Review journal—Documenting the process of developing the Victorian assisted dying legislation (author team led by Professor Margaret O’Connor, Monash University), and the Future of assisted dying reform in Australia (by Professors Ben White and Lindy Willmott, Queensland University of Technology). Professor White is an associate editor with the Australian Health Review.
‘The authors argued that the rise of individualism and personal autonomy in society has been a key factor in changing social attitudes to issues such as assisted dying’, Ms Verhoeven said.
‘They argued that “restlessness” in democratic societies can be attributed to individuals seeking to maximise their places in society through expressing their individuality and autonomy in various ways.
‘This includes making their own informed choices in healthcare, in the context of a more equal relationship between consumers, the professions and governments—and a cultural shift away from traditional “top down” communication patterns.’
(Source: AHHA)
Latest AHHA podcast released—Prof. John McDonough, Harvard University
Prof. McDonough John E. McDonough is professor of public health practice at the Harvard School of Public Health. He was also a member of the Massachusetts House of Representatives from 1985 to 1997.
In this 12th episode of The Health Advocate Podcast, Advocacy Director Krister Partel sits down with Prof McDonough to discuss opportunities and challenges in the Australian and American healthcare systems—including why they’re so hard to reform and how health leaders can anticipate and respond to health system challenges in the context of political change.
(Source: AHHA)
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Events and workshops
Health Planning and Evaluation Short Course
Block 1 (29-30 July 2019); Block 2 (9-10 September 2019)
The Health Planning and Evaluation courses offer an introduction to the principles and practice of integrated health planning, and the evaluation of health policies, planning and services. AHHA members will receive a 15 percent discount on total course costs. Registrations close on 22 July 2019.
For more information visit www.qut.edu.au/health/ph-short
IHF World Hospital Congress 2019
6–9 November 2019, Muscat, Oman
Early bird registration for the IHF World Hospital Congress in Muscat, Oman, is now open. As a member of IHF, AHHA members can access a discounted early bird rate of US$850. This rate is only available until 15 August 2019.
Register online at the Congress website here. The discount can be accessed by entering this exclusive member code: IHFCO2019
Congress registration inclusions and other information are available on the website. Add-ons such as tickets to the Gala Dinner, hospital site visits, social tours and hotel accommodations can all be purchased during registration.
(Source: IHF)
Asia-Pacific Conference on Integrated Care
11–13 November 2019, Melbourne
Registrations are now open for the 2nd Asia Pacific Conference on Integrated Care which will take place in Melbourne, Australia, from 11-13 November 2019. With the overarching theme ‘Achieving better value for people and populations’ the conference is a partnership of The University of Newcastle, Centre for Rural & Remote Mental Health, Children’s Health Queensland, Central Coast Local Health District, The Australian Healthcare and Hospitals Association and Health Justice Australia. The conference will bring together researchers, clinicians and managers from around the world who are engaged in the design and delivery of integrated health and social care.
The scientific committee for this conference has been established from international experts who are leading in the field of integrated care policy and practice, and they are now accepting paper submissions on the science, knowledge and application of integrated care and specifically relating to the conference themes until Friday, 28 June. Submission guidelines are available to download from the conference website.
For more information visit https://integratedcarefoundation.org/events/apic2-2nd-asia-pacific-conference-on-integrated-care
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Aboriginal and Torres Strait Islander health
Indigenous people believe aged care isn't 'culturally safe', and are ageing earlier
Professor Leon Flicker, a professor of geriatric medicine from the University of WA, told the Commission that Indigenous people in residential aged care were under-represented. They accounted for 1% of residential places although they constituted 3% of the population.
Like the people of Docker Creek, most Indigenous people wanted to age and die on country, the commission heard. In very small communities, it was difficult to provide cost effective care, find qualified local Indigenous staff, and overcome language and cultural barriers.
Professor Flicker said Indigenous people often shunned residential care because they did not believe it was ‘culturally safe’. Indigenous Australians exhibited disability rates and syndromes associated with ageing up to 20 years earlier than non-Aboriginal and Torres Strait Islander people, he said.
(Source: Sydney Morning Herald)
No fresh fish and no respite care: the challenges facing Indigenous aged care
Elderly Torres Strait Islanders are having to rely on family members to bring them freshly caught fish prepared from home because bureaucratic red tape is stopping traditional Indigenous foods from being served in nursing homes.
The aged care royal commission has travelled to Broome this week to hear evidence about the barriers and challenges to providing services for Indigenous Australians.
Multiple witnesses spoke about the importance of providing ‘culturally safe’ aged care services. This included ensuring residential homes serve Indigenous traditional foods so people maintain their connection to country and culture.
(Source: Guardian)
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Ageing and aged care
Elderly Victorians being treated for hypothermia as heating costs bite
Victorian pensioners anxious about turning on the heating are being treated for hypothermia in a ‘concerning’ trend that has alarmed authorities. The sad finding was contained in a study of 217 hypothermic emergency presentations between 7 July 2009 and 1 September 2016 to Alfred Health prompted by a record-breaking cold winter in 2015.
More than half of the patients who presented to a hospital with hypothermia lived alone and had few social supports, while almost three-quarters were on a pension. ‘The finding that 87% of our hypothermic elderly patients were found indoors is concerning’, author Dr Michelle Amanda-Rajah said in the study, published in the Internal Medicine Journal.
(Source: Guardian)
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Cardiovascular disease
Cardiovascular disease affects half a million Aussie women
Cardiovascular disease (CVD) is a leading cause of illness and death among Australian women, according to a new report released today by the Australian Institute of Health and Welfare (AIHW). The report, Cardiovascular disease in women—a snapshot of national statistics (in focus), shows over half a million Australian women have cardiovascular disease, and that it accounts for almost one-third of all deaths among women.
‘In 2016, more than 22,200 women died of CVD—making it the most deadly disease group for women,’ said AIHW spokesperson Miriam Lum On. CVD, which includes coronary heart disease, stroke and heart failure, is a largely preventable and treatable group of conditions.
(Source: AIHW)
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Digital health
Health records to enter digital age (ACT)
The move follows the release of the ACT’s Digital Health Strategy in May and the $41 million Budget allocation last year to position the Territory to take advantage of new technologies and advances in health care into the future.
Chief Information Officer for the Health Directorate, Peter O’Halloran said the Digital Health Record project would completely transform the health system. ‘It is not only an exciting development but a critically important one, when it comes to maintaining a modern, sustainable health system’, Mr O’Halloran said. ‘ICT systems, through innovations in medical technologies, have evolved so rapidly that over time more than 250 different systems have been established here in the ACT.’
(Source: PS News)
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End-of-life
Victorians now have a choice on dying
Go Gentle Australia, which campaigns for dignity at the end of life, said the extensive community consultation and resulting law showed democracy working at its best, and called for other states to follow suit.
Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven said the Victorian laws were ‘a watershed in the rise of the consumer voice in health’, and reflected a wider need for individual autonomy.
‘The key to legislative change in Victoria was the approach taken in developing the new laws. It was citizen-driven and inclusive, combining evidence, science and social action’, Ms Verhoeven said.
(Source: Medical Republic)
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Food and nutrition
High on iron? It stops anaemia but has a downside
People with high iron levels are not only protected against anaemia but are also less likely to have high cholesterol, according to an international study led by Imperial College London, the University of South Australia (UniSA) and University of Ioannina.
What is less known is the impact of excess iron where the body stores too much iron, which can lead to liver disease, heart problems and diabetes in extreme cases…high iron levels could also lead to a greater risk of bacterial skin infections, such as cellulitis and abscesses.
(Source: University of South Australia)
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Health funding
The rising cost of education and health care is less troubling than believed
Since 1950 the real cost of new vehicles has fallen by half, that of new clothing by 75% and that of household appliances by 90%, even as quality has improved. Tumbling prices reflect decades of improvements in technology and productivity. But the effect is not economy-wide. Cars are cheaper, but car maintenance is more expensive, and costs in education and health care have risen roughly five-fold since 1950.
The real culprit, the authors write, is a steady increase in the cost of labour—of teachers and doctors…That in turn reflects the relentless logic of Baumol’s cost disease, named after the late William Baumol, who first described the phenomenon. Productivity grows at different rates in different sectors. It takes far fewer people to make a car than it used to—where thousands of workers once filled plants, highly paid engineers now oversee factories full of robots—but roughly the same number of teachers to instruct a schoolful of children. Economists reckon that workers’ wages should vary with their productivity. But real pay has grown in high- and low-productivity industries alike. That, Baumol pointed out, is because teachers and engineers compete in the same labour market. As salaries for automotive engineers rise, more students study engineering and fewer to become teachers, unless teachers’ pay also goes up. The cost of education has thus risen because of the rising pay needed to fill teaching posts.
(Source: Economist)
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Industrial relations
Third major Sydney hospital unit banned from training junior doctors
St George Hospital's intensive care unit has been barred from training junior doctors amid protracted allegations of bullying and dysfunction among senior staff. It is the third damning case of a major Sydney hospital unit banned from supervising trainees over concerns for their welfare.
The College of Intensive Care Medicine (CICM) withdrew accreditation from the South East Sydney hospital this week, following an inspection of its ICU and multiple bullying complaints. Once the current CICM trainees finish their contract periods, the ICU will need to find ways to cover shifts vacated by the trainees, such as relying on unaccredited junior doctors, anaesthesia registrars, and locum specialists.
(Source: Age)
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Mental health
The personal and the political—why do we find it so hard to direct mental health spending to the people who most need it?
Never before have so many Australians been counselled, medicated or otherwise treated for mental health problems. If increased funding and greater access to care delivered better outcomes, then Australians would be enjoying better mental health than ever before. Yet our performance seems to be stagnating or even going backwards.
At the heart of the problem is a failure that, on the face of it, seems quite simple. Current mental health policies and programs have proved unable to target services to those with the highest level of need. While they have unquestionably helped more people get access to psychology services and reduced discrimination and stigmas, former NSW mental health commissioner John Feneley tells me, the focus has mainly been on the more common but less severe mental illnesses, such as mild depression and anxiety.
As a result, Feneley believes, and despite the enormous efforts of frontline staff and some isolated examples of improvement, most people with more severe and persistent illnesses, such as psychosis, bipolar disorder and eating disorders, have not benefited from the record increases in spending. And if we aren’t improving outcomes for this group of people then we can’t claim that our overall approach is working.
(Source: Inside Story)
$247 million for chaplains in schools, $2.8 million for mental health: What’s wrong with this picture?
On Tuesday, the Morrison government is set to announce funding to expand a mental health plan in schools around the nation. Per Fairfax, ‘The $2.8 million will go to a not-for-profit group, batyr, to offer more online services and support a program of school visits promoting youth mental health and suicide prevention. The group is named after a talking elephant.’
In 2018, the Coalition rolled out the $247 million plan to place chaplains in public schools, a plan that Scott Morrison not only supported, but wanted to see ‘significantly expanded’. The plan was uniformly panned by the Australian Human Rights Commission (in a report). Labor senator Louise Pratt said that ‘….there’s an urgent need for youth workers with professional qualifications in our schools and that would be a much better priority for the government’, a sentiment echoed by the President of the Australian Education Union, who said: ‘We do not support the chaplains program. Our schools need these funds to invest in programs such as school counsellors and student wellbeing programs in schools. We prefer to see that money invested in our schools more broadly.’
(Source: The Big Smoke)
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My Health Record
My Health Record launches Rapid Access Cardiology Clinic testing
The Australian Digital Health Agency (ADHA), in partnership with the University of Sydney, is pleased to launch a study into the use of My Health Record in Rapid Access Cardiology care.
The Agency and the University of Sydney have launched the pilot to investigate how My Health Record can support the management of low to intermediate risk chest pain patients through the Rapid Access Cardiology Clinic (RACC) model, initially based at Westmead Hospital. The pilot aims to enhance the quality, safety and efficiency of cardiology services, and if successful, may be scaled up to roll out across the country. It is expected that this study will yield lower rates of hospital readmissions and avoid a rise in major adverse cardiac events, such as heart attacks.
Furthermore, the pilot may also help to develop targeted cardiovascular disease prevention programs including lifestyle modifications to address common risk factors such as high blood pressure.
(Source: ADHA)
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Pain
At last—a national plan for better pain management
Painaustralia has today launched the new National Strategic Action Plan for Pain Management. Millions of Australians live with ongoing persistent pain. Chronic pain can have a devastating impact on individuals, their families, workplaces and the community, often contributing to problems including; opioid dependency, depression, loss of income and increased risk of suicide.
Painaustralia CEO, Carol Bennett, said ‘The Australian Government and Minister Greg Hunt funded and supported the development of the first ever National Strategic Action Plan for Pain Management (NSAPPM) in May 2018. The year of exhaustive consultation and development that followed have now culminated with the final release of the NSAPPM that sets out the key priority actions to improve access to, and knowledge of best practice pain management, in the next three years.’
(Source: Pain Australia)
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Research
Research Check: is white meat as bad for your cholesterol levels as red meat?
You’ve probably heard eating too much fatty red meat is bad for your health, while lean meat and chicken are better choices. So, recent headlines claiming white meat is just as bad for your cholesterol levels as red meat might have surprised you. The reports were triggered by a paper published in the American Journal of Clinical Nutrition earlier this month.
There are a few things to keep in mind with this study. First, the researchers used the leanest cuts of both red and white meats, and removed all visible fat and skin. If participants were eating fatty meat, we may have seen different results…The study did find lean white meat had the same effect on cholesterol levels as lean red meat. While this might be construed as good news by lovers of red meat, more research on this topic is needed for a clearer picture.
(Source: The Conversation)
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Vaccinations
Patients warned following vaccine bungle
Thousands of patients vaccinated by two Sydney GPs are being contacted after vaccines were found to have expired or not been stored properly. The Sydney Local Health District has put a call out for patients who received vaccinations at a Burwood general practice after it was found vaccines were improperly stored in the practice refrigerator—leaving some too hot or cold—while others were expired.
Patients vaccinated since 1 January 2010 by Drs Darrel and Brinda Weinman at 40 Lindsay Street, Burwood, NSW, have been recommended to get revaccinated as any vaccines given may not have been effective.
(Source: Australian Journal of Pharmacy)
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Women's health
Is it really a job for a man?
(Article paywalled)
Why do male gynaecologists and obstetricians choose their profession? What’s their motivation to specialise in this most intimate of arenas? I’ve been wondering in the light of several high profile cases involving the butchering and abuse of female patients by male medicos.
A female doctor friend had seen many male gynies and obs over her long working life, and had a harsh observation: ‘They hate women, and like to see them in pain.’ A brutal assessment, yes, but a fascinating observation from someone who’d spent decades in the profession. I always gravitate towards female gynaecologists, just as I presume many men gravitate towards male andrologists and urologists. First-hand knowledge—why wouldn’t you?
(Source: Nikki Gemmell/Australian)
Male gynaecologists—AMA Board Chair, Associate Professor Gino Pecoraro
I'm disappointed that so little research was actually done into the subject that she's writing a column about [Nikki Gemmell, The Australian]. She tried to couch it in a question, ‘trying to find more information’, but I just think that was a little bit too cute…it's really, really unacceptable, and it’s insulting not just to the thousands of gynaecologists that we've got working in Australia, but also to their patients.
To suggest in this day and age, that somebody's gender, or even sexual preference, should play a role in which careers you choose is simply not acceptable. And I think that journalists need to be held to the same level of accountability as every other professional group. And so, while I'm waiting for her to write the apology, and I look forward to reading that, I do think that something further needs to be done.
(Source: AMA)
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Announcements
ELDAC is interested in your feedback
End of Life Directions for Aged Care (ELDAC) is currently seeking people to take part in an interview/eSurvey about their experience using the ELDAC website. Your feedback will be valuable in improving the website.
Respondents will be reimbursed for their time with a $25 digital gift card of their choice from Prezzee.
If you have used the ELDAC website, and either work or previously worked in the aged care sector, you can provide feedback through either interview (email eldac.helpline@flinders.edu.au) or by completing an eSurvey.
More information is available in the Participant Information Sheet.
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Jobs
To advertise vacancies in Healthcare in Brief, please contact the AHHA at admin@ahha.asn.au.
AHHA's online jobs section provides up-to-date information about vacancies across the health sector.
To visit the AHHA online jobs section, click here.
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Australian Health Review
The AHHA is pleased to offer you early access to articles in our peer reviewed journal Australian Health Review. If you have trouble viewing these in your browser, they can be accessed via the AHHA homepage.
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Volume 43(3) 2019
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Healthcare in Brief is brought to you by the Australian Healthcare and Hospitals Association, the independent peak membership body and advocate for the Australian healthcare system and a national voice for universally accessible, high quality healthcare in Australia.
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