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Secretary's Review
Australia’s health system has evolved and expanded greatly since the nation was formed at federation in 1901, as the needs and expectations of the Australian people have changed. Despite the extent of this evolution in terms of both health service provision and medical knowledge and technology, there have been only a few occasions on which major changes have been made to the system as a whole.
This financial year, 2009-10, has been one of those occasions. The agreement by the Council of Australian Governments (COAG) except Western Australia on 20 April 2010 to establish a new National Health and Hospitals Network, signalled the start of the biggest reforms in health since the introduction of Medicare almost 25 years ago.
Implementation of the reforms began quickly. The first payments to support public hospital (emergency departments and elective surgery) investments started flowing to states and territories (with the exception of Western Australia) before 30 June 2010.
Assisting the Australian Government in drawing up these reforms was a major achievement for the department in 2009-10. Implementing the reforms – across the breadth and depth of the health sector – will be the major task over the next few years.
When they are fully in place, the reforms will equip the health system for the demands of today and, importantly, future years and decades. All parts of the health system will benefit.
Another major achievement of this financial year was the department’s efficient and effective response to pandemic influenza 2009 (H1N1), which had first been described in Mexico in April 2009. The department’s response to the crisis included conduct of the largest vaccination program in Australia’s history, which reduced the impact of the pandemic.
The department also worked hard to deliver the Government’s current investments in better health and health services. One of these was the development of innovative GP Super Clinics in areas with shortages of doctors and other health professionals.
Highlights of 2009-10 in detail
Health Reform
The National Health and Hospitals Network and associated changes are designed to equip the health and hospital system to meet the health challenges of today and the future.
They are based heavily on the three major reports commissioned by the Australian Government and released early in 2009-10. These were the report of the National Health and Hospitals Reform Commission; the draft National Primary Health Care Strategy; and the report of the Preventive Health Taskforce.
Despite the extensive work behind these reports, there remained a great deal to be done to translate their findings into a working plan. A Health Reform Taskforce was established within the department in July 2009 to manage the consultations and advise the Government on detailed policy development, with assistance from most areas of the department.
This huge task included organising a total of 103 community consultation forums on health reform nationwide, all attended by at least one member of the department’s ministerial team and some attended by the then-Prime Minister. Members of the public, health professionals, state and territory governments and other key stakeholders took part.
Following this extensive consultation process, the Commonwealth’s reform plan was put to COAG and received historic agreement (excluding Western Australia) on 20 April 2010. The department then helped the Government to commit funding for the reforms in the 2010-11 Budget announced in May. Active negotiations with Western Australia continued into the new financial year.
Given the complexity of the reform agenda, in May 2010 I established a Transition Office to lead and coordinate the department’s responsibilities in implementing the reforms, and to manage its reform dialogue with other Australian Government agencies, the states and territories and key stakeholders. The Transition Office will operate until the new authorities for the National Health and Hospitals Network are established and fully operational.
The reforms aim to provide a new, sustainable system of health funding and governance; and to change the way that health services are delivered, with a greater focus on prevention and early intervention, and greater provision of care outside of hospitals.
The Australian Government will become the majority funder of public hospitals in Australia, providing 60 per cent of the efficient price of all public hospital services delivered to public patients. The Australian Government will have funding and policy responsibility for general practice and primary health care. New organisations, Medicare Locals, will work closely with Local Hospital Networks to support more integrated care and help ensure patients experience smooth transitions between sectors of the health system.
The Australian Government will also take funding and policy responsibility for all aged care services. This will allow the development of a consistent aged care system covering basic care at home, through to high level residential care, and much better integration between aged care and the health and hospital system.
Improving Hospital Services
In 2009-10, the department continued to work with the states and territories to implement the third and final stage of the Elective Surgery Waiting List Reduction Plan to improve access to elective surgery within clinically recommended times. The third stage of the plan provides additional funding of up to $300 million to states and territories that meet specific performance targets.
The plan has been successful in increasing elective surgeries to reduce waiting times. Latest figures1 show that there were 35,000 more elective surgery procedures in January to September 2009 than in the same period of 2007.
The department also worked with states and territories to increase the number, mix and regional availability of subacute care services. Improving this level of care is another theme of the major national health reforms, as they will improve patient care, allow people to avoid unnecessary hospitalisation and improve the transition between acute hospital care and the community.
The first payments to support public hospital capital and recurrent costs were made to the states and territories (with the exception of Western Australia) in June 2010 to enhance the capacity and performance of public hospital emergency departments and elective surgery as well as to enable investment in areas of greatest need, such as subacute care. Projects will commence from 2010-11.
Promoting Good Heath and Preventing Disease
A key element of the National Health and Hospitals Network is greater use of early intervention and prevention to take pressure off other parts of the health system, especially hospitals. Over the past year the department has worked hard to promote action on preventative health in line with the Government’s reform strategy.
The three priority areas for prevention set by the Government are tobacco, excessive consumption of alcohol and obesity. These areas were the focus of the final report of the Preventative Health Taskforce, Australia: the Healthiest Country by 2020, released in September 2009. The report recommended a phased response across all governments as well as communities, workplaces, families and individuals and was considered along with other reform issues in the health reform consultations in 2009-10.
The Government released its strategic response, Taking Preventative Action, in May 2010, summarising action already under way as well as future plans.
This financial year also saw progress on the COAG National Partnership Agreement on Preventive Health. The Australian Government’s contribution of $872.1 million over six years began in 2009-10. A National Implementation Plan for the partnership agreement was agreed by all Health Ministers in April 2010.
In May 2010, the department reached agreement with the Australian Bureau of Statistics for the conduct of the Australian Health Survey. For the first time, the survey will gather information on what Australians are eating, how physically active they are, as well as other health information such as whether they have a chronic disease. Pilot surveys for both a general population and an Aboriginal and Torres Strait Islander component of the Australian Health Survey, began in 2009-10.
In relation to smoking, the department assisted in developing the comprehensive package of reforms which were announced by the Government in April 2010. This package included a 25 per cent increase in tobacco excise, a world-first commitment to plain packaging of tobacco products by 2012, restriction of Australian internet advertising of tobacco products, and further media and information campaigns to encourage people to quit. These commitments will help Australia reach the targets agreed by COAG of reducing daily smoking prevalence among Australians to 10 per cent and halving smoking rates among Aboriginal and Torres Strait Islander people by 2018.
The department continued the roll out of the National Binge Drinking Strategy to change the culture of alcohol abuse particularly among young people including funding for community projects and the multimedia campaign "Don’t Turn a Night Out Into a Nightmare". After some delays, the ‘alcopops’ legislation was passed by the Senate in August 2009, ratifying the excise increase in April 2008 which has resulted in a marked and ongoing drop in consumption of ready-mixed drinks.
Good progress was also made on national efforts against blood borne and sexually transmitted infections. The department worked with community based organisations, state and territory governments and health professionals to develop five new national strategies to combat these infections. The new strategies for the period 2010-2013 were endorsed by the Australian Health Ministers’ Conference in April 2010.
Other significant areas of progress on health promotion to which the department contributed were development of the Australian National Breastfeeding Strategy 2010-2015, development of Australia’s first National Male Health Policy, launched in May 2010, and COAG agreement to a National Partnership Agreement on Essential Vaccines. Under this agreement the Australian Government will provide financial rewards and incentives to states and territories which reach and maintain high immunisation rates.
Primary Care
The National Primary Health Care Strategy was released by the Minister for Health and Ageing in May 2010, and is the first comprehensive national policy statement for primary health care in Australia. Extensive direction for the strategy came from the Health Reform consultations undertaken during 2009-10. The department also received advice from the External References Group and from written submissions. The recommendations from the strategy have helped inform the development of the Government’s 2010-11 primary health care reforms.
The National Health and Hospitals Reform Commission Report and the National Primary Health Care Strategy both identified infrastructure as a key building block for primary health care reform in Australia. It is an important catalyst for new models of primary health care delivery that provide a more extensive array of services in a single location. Appropriate infrastructure enables and supports integrated services delivered by teams of health professionals and improved training opportunities for GPs, nurses and allied health care professionals.
GP Super Clinics are a key element of the Government’s plans to improve GP and primary health care, including a greater focus on prevention. In 2009-10, the department worked to establish GP Super Clinics around the country, collaborating with state, territory and local governments and funding recipients.
A total of 21 GP Super Clinics were either completed, provided early services or were under construction by 30 June 2010. This included nine GP Super Clinic funding recipients providing early services while the construction of the new clinic is being completed. This included the GP Super Clinics in Ballan, Strathpine and Port Stephens becoming operational.
GP Super Clinics in these communities are now providing better access to multidisciplinary team based primary health care services tailored to their needs, focused on improving the management of chronic disease and promoting better preventative health care.
In June 2010, the department advertised the Primary Care Infrastructure Grants announced in the 2010-11 Budget. Together with a further round of grants in 2011-12, these grants are intended to provide upgrades to around 425 general practices, primary care and community health services, and Aboriginal Medical Services.
Pandemic Influenza Response
The H1N1 influenza officially arrived in Australia in late May 2009. The department led Australia’s response to the pandemic over the following days, weeks and months. This entailed the longest single continuous activation of the National Incident Room to date – from 24 April to 26 November 2009 – and involved more than 300 staff from throughout the department.
The National Incident Room again proved to be highly effective in enabling the department to share and exchange information with other parts of the Commonwealth as well as the states and territories, and to prepare and coordinate information for the media and general public.
The national response was guided by the Australian Health Management Plan for Pandemic Influenza. The department showed initiative and flexibility in adapting the plan by devising a new phase – PROTECT – which recognised that the H1N1 virus was mild in most patients and moderate overall, although it was severe for some people. It put greater focus on treating and caring for people who were more vulnerable to severe outcomes, rather than trying to prevent the further spread of the disease, and was very effective in directing effort and resources to achieve the best outcomes.
The national response to the pandemic required a cooperative effort at all levels and across all governments and community stakeholders. This was achieved due to the solid foundations built during the process of developing and maintaining the Australian Health Management Plan for Pandemic Influenza, and by Exercise Cumpston and other exercises. The pandemic preparations made in recent years were also vital to the national response - including the National Medical Stockpile, improved capacity for disease surveillance and laboratory testing, and a good communications framework.
In partnership with the states and territories, the department rolled out the largest vaccination program in Australia’s history within a very short time starting in September 2009. By 15 July 2010, 9.16 million doses of pandemic (H1N1) vaccine had been delivered to immunisation providers across the country.
Although the pandemic was not as severe in its health impact as had been expected, it was a testing period for Australia’s health authorities including the department. The extensive preparations which the department had made over a number of years were invaluable and allowed the department to meet the needs of the Australian people in terms of practical protection, monitoring of developments, deployment of resources and providing accurate and helpful information on the pandemic.
Mental Health
In 2009-10, funding under the National Perinatal Depression Initiative was provided to Divisions of General Practice through Access to Allied Psychological Services (ATAPS) to improve access to psychological support for women experiencing perinatal depression and build links with child and maternal health units and mental health care providers.
Extension of the Mental Health Support for Drought Affected Communities Initiative allowed for early intervention services to those most affected by the impact of drought, and aims to increase awareness in these communities of mental disorders and their effective treatment.
To improve its effectiveness, a new governance arrangement was devised and put in place for headspace National Youth Mental Health Foundation Ltd, which targets services to 12 to 25 year olds with mental health and/or drug and alcohol problems.
In May 2010, funding was announced for an additional 30 headspace sites, taking the total number of sites to 60.
A departmental review of ATAPS was completed in March 2010. To implement the outcomes of the review, the department commenced new funding arrangements which enable all Divisions of General Practice to target psychological services for hard to reach, vulnerable groups within their areas, in order to supplement Medicare-based service delivery. In addition, the department has provided an additional flexible pool of funding to encourage innovative service delivery to specified groups with priority needs which cannot be met through traditional ATAPS service delivery approaches.
As part of significant mental health reform, the department also developed the Fourth National Mental Health Plan in partnership with states and territories which was endorsed by Australian Health Ministers in September 2009. The work of the Mental Health Nurse Incentive program, which provides incentive payments to community-based general practices, private psychiatrist services, Divisions of General Practice and Aboriginal and Torres Strait Islander Primary Health Care Services who engage mental health nurses to help coordinate care for people with severe mental disorders, also continued.
Indigenous Health
This year has seen a focus across the department on improving the responsiveness of the health system to Aboriginal and Torres Strait Islander people across Australia, including implementation of the $805.5 million Indigenous Chronic Disease Package.
The department funded 293 new health workforce positions in Indigenous health services and the Divisions of General Practice Network to improve primary health care. In addition, funding for increased services has enabled an additional 237 primary health care staff to be employed in remote primary health care services.
A new Indigenous Health Incentive through the Practice Incentives Program (PIP) began in May 2010. The Incentive supported around 850 general practices and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease. Around 2,900 eligible patients have been registered. The department developed the requirements of the PIP Indigenous Health Incentive in close consultation with the medical profession, including representatives from Indigenous health peak bodies.
Another new program under the COAG Closing the Gap Indigenous Chronic Disease package which began this year was the Urban Specialist Outreach Program in New South Wales. It supports private specialists to provide outreach services to Indigenous patients in urban areas.
In 2009-10 the department continued implementation of the Expanding Health Service Delivery Initiative to increase and improve primary health care services in remote communities of the Northern Territory. Achievements included a new territory-wide hearing health and audiology service, implementation of a Continuous Quality Improvement Framework and agreement to introduce primary health care service planning in 2010-11 using an agreed suite of core or essential services.
Follow-up to the Northern Territory Emergency Response continued, requiring delivery of specialist and allied health care to thousands of people in remote communities, most of them children. This was a major challenge. Special mention should be made of the many health practitioners from the Northern Territory and across Australia who responded to the challenge, especially in relation to Ear, Nose and Throat and dentistry services. With a heightened focus on preventing avoidable disease in future, services included provision of preventative oral health services to 500 children in 2009-10.
In addition a national coordination unit, RHDAustralia, was established as part of the Rheumatic Fever Strategy to promote consistency in clinical responses, including preventative care, and in providing data for national monitoring.
Pharmaceutical Benefits
Pharmaceuticals are a vital area of medicine and ensuring a sustainable footing for the Pharmaceutical Benefits Scheme is a crucial element of our future health planning. This financial year the department worked hard to successfully negotiate the Fifth Community Pharmacy Agreement with the Pharmacy Guild of Australia, and a Memorandum of Understanding with Medicines Australia. The new pharmacy agreement begins on 1 July 2010 and will save taxpayers money while supporting better pharmacy services for consumers, and a viable community pharmacy network.
Implementation of price disclosure for multi-brand medicines continued. By 30 June 2010 price disclosure had been applied to 42 multi-brand medicines with 173 brands, resulting in consumer price cuts of between 13 and 71 per cent.
E-health Advances
Widespread use of information technology in health services was identified by the National Health and Hospitals Reform Commission as an essential tool for significant improvement in Australian health. This financial year, a major advance was made in this direction with development of a legislative and regulatory framework to support the use of healthcare identifiers in health services.
The department undertook three rounds of public consultation and received 197 submissions from stakeholders to develop the Healthcare Identifiers Bill 2010, the Healthcare Identifiers (Consequential Amendments) Bill 2010 and the supporting regulations. The legislation will improve the transfer of essential health information and patient safety, and will reduce errors and limit the mismatching of patient information. The Bills were passed by Parliament on 24 June 2010 and the Healthcare Identifiers Service began one week later, on 1 July 2010.
Rural Health
The department continued its work to improve access to health services for people living in rural, regional and remote Australia by supporting targeted rural health programs, strengthening health infrastructure and increasing access to the health workforce.
The department continued to improve rural health planning by phasing in the Australian Standard Geographical Classification - Remoteness Areas system to better target programs and funding. As a result, almost 500 communities have been classified as regional and will benefit from the Government’s programs to improve rural health services.
The department also worked to implement the Rural Health Workforce Strategy which aims to tackle the health workforce shortages in regional and remote areas across the country by introducing a package of financial and non-financial incentives for doctors who relocate to rural areas.
The department also supported 1,399 medical specialist services through the Medical Specialist Outreach Assistance Program and improved access to specialist health services for Aboriginal and Torres Strait Islander people in rural and remote areas through support for 148 services under the Medical Specialist Outreach Assistance Program – Indigenous Chronic Disease measure.
Three funding rounds were conducted under the National Rural and Remote Health Infrastructure Program for equipment and infrastructure projects in rural and remote communities.
Regional Cancer Centres
The department assisted the independent Health and Hospitals Fund Advisory Board and the Government to select 21 projects to receive funding totalling about $540 million under the Regional Cancer Centres initiative. This initiative will increase essential cancer services in rural, regional and remote Australia, and improve the outcomes for people with cancer from these areas.
To implement this initiative, the department also developed the Regional Cancer Centres Guiding Principles to define the key features of a viable regional cancer centre. The department continues to negotiate with the successful applicants, including state and territory governments and private organisations, and will finalise funding in 2010-11.
Health Workforce
Developing an adequate and sustainable health workforce is a priority for the department. This financial year the department continued to implement the Government’s strategy to respond to medical workforce shortages by substantially increasing the number of general practice training places. The Australian General Practice Training program was increased to 700 places in 2010 (up from 675 in 2009) and all of these places were filled. The program will continue to increase to 1200 in 2014.
In concert with this growth, the number of places for junior doctors to train in general practice, through the Prevocational General Practice Placements program, has been increased to 380 in 2010.
The department facilitated the Council of Australian Governments commitment to a single national registration and accreditation scheme through collaboration with the states and territories. The National Registration and Accreditation Scheme (NRAS) for health professions was established to provide consistent registration standards across states and territories. This enables health professionals to move around the country more easily, reduces red tape, and promotes a more flexible, responsive and sustainable health workforce. Under the NRAS, health professionals are registered with one National Board, providing greater safeguards for the public against negligent practitioners.
A major achievement for the department was the implementation of the COAG Health Workforce National Partnership Agreement, through collaboration with states and territories. The aim of this agreement is to increase the supply of health professionals, providing them with individual support and assisting them to work together, and improve the care people receive. A new agency, Health Workforce Australia, was established to oversee this national agenda and commenced operations in January 2010.
As part of the COAG agreement, the department administered grants totalling $67.48 million for innovative clinical teaching and training. It also allocated funding of $33 million from the Rural Educational Infrastructure Development (REID) Pool capital grant round, and continued support for 17 Rural Clinical Schools and 11 University Departments of Rural Health (UDRH).
National Healthcare Agreement
The National Healthcare Agreement (NHCA) came into effect on 1 July 2009, replacing the previous Australian Health Care Agreements between the Commonwealth and each state and territory. The NHCA (agreed by COAG in November 2008) locks in annual increases in funding to reflect the increasing cost of providing hospital services. It also defines the objectives, outcomes, outputs and performance measures and clarifies the roles and responsibilities that will guide the Commonwealth and states and territories in the delivery of services across the health sector.
During 2009-10, the department worked co-operatively with states and territories to address the current challenges faced by public hospitals through the NHCA, such as expanding subacute care and taking pressure off emergency departments. It also worked with other jurisdictions on priority reform areas identified in the NHCA including a move to a national approach to activity-based funding for public hospital services, and better data on non-admitted hospital patient services.
The NHCA will be superseded by the new health financial arrangements under the National Health and Hospitals Network.
Sport
The department assisted the Independent Sport Panel in completing and publishing its report The Future of Sport in Australia, and supported the Government’s response to the report Australian Sport: the pathways to success.
The response was backed by $195.2 million in new funding in the 2010-11 Budget, the biggest funding injection to sport in our nation’s history.
As part of this response, the department began work on a national framework on sport and active recreation, which will realign the national sport institutes system and establish a collaborative approach to the delivery of sport and active recreation outcomes by the Commonwealth and state and territory governments.
The department also assisted the Government to act on the key recommendations of an independent review of the Australian Sports Anti-Doping Authority. This included changes to the structure of the authority, which came into force on 1 January 2010.
Ageing
At the request of the Minister for Ageing, an independent review of the Aged Care Complaints Investigation Scheme was set up in 2009. The review reported to the department in October 2009 and a number of changes are being implemented to improve the experience of its clients, including aged care recipients.
In December 2009, the Better Health in Residential Aged Care training commenced. The initiative is designed to strengthen dental and oral care in aged care facilities. By the end of June 2010, more than 300 train-the-trainer workshops were held, with 4,000 registered nurses and trainers receiving training. Representatives from over 2,000 aged care facilities attended the training, which is expected to be completed by December 2010.
Changes to the Government scheme to assist people needing continence aids were announced in June 2009. Preparation for the new Continence Aids Payment Scheme (CAPS) to begin in July 2010, involved transitioning 75,000 existing clients to ensure that they were not disadvantaged, and holding information sessions across Australia. The department’s CAPS policy phone line fielded close to 19,000 calls regarding the new scheme.
Two new palliative care programs worth $14 million were developed and implemented by the department to improve palliative care support and services for patients with mental illness and dementia, and to patients in rural and regional areas, and their families and carers.
The Department
As in all years, all of these achievements could not have been reached without the hard work and dedication of our staff working in partnership with our stakeholders and the Ministerial team. I would like to acknowledge their service.
Recognising the Contributions of Staff
Length of Service Awards were introduced in the department to recognise and celebrate the dedication of our long-serving team members. In October 2009, hundreds of staff were presented with certificates for 15, 20, 25 and more than 30 years of service. Collating service histories was a major effort given the changes in the department, the government and the personnel system over time.
Awards were also given to staff to recognise their contributions to the department or to the wider community, as part of the national Australia Day Achievement Awards. Twenty-two high-quality entries were received, with nine staff members presented with certificates and medallions.
The NAIDOC Awards were presented to nominated staff, to recognise the contribution and commitment of individual staff members to our work in improving services and outcomes for Aboriginal and Torres Strait Islander people.
Staff Survey 2009
Eighty per cent of staff responded to the annual staff survey – the department’s seventh, and the second delivered electronically. This high participation is evidence of the desire of our people to engage with the organisation. I am very encouraged by the results which suggest we have significantly improved our performance across six of the seven drivers which motivate staff, as well as the measures of staff interest and commitment. I am also pleased to report that the department is now above the Public Sector mean on all seven motivation drivers – job, alignment, employer, development, influence, leadership, manager – and significantly above the Public Sector mean on all three outcome measures of motivation – interest, satisfaction and commitment.
In response to staff survey feedback, and with input from all staff across Australia, the department has developed a new "People Strategy" for 2010-2015, outlining our approach to attracting, retaining, building capability, and motivating our people to deliver outstanding performance.
Workplace Generosity
The generosity of staff continues to take many forms. From individual monetary contributions to charities nominated by staff, or by donation of time and effort through volunteer activities, staff contributions to corporate philanthropy continue to be impressive. This financial year the Workplace Giving Program (staff donations to charities through the payroll system) was expanded to include an additional 15 charities, taking the total number of charities to 31. Since the inception of the Workplace Giving Program in 2006, staff have donated over $250,000 which is a tremendous achievement.
In November 2009, 41 cyclists drawn from the department and from sponsors Fujitsu and iSoft participated in the Hartley Lifecare Ability Cycle Challenge. This 10th anniversary staging of the challenge involved a 450 km cycle from Canberra to Charlotte Pass and return over three days. The team raised more than $102,000 to support the work of Hartley Lifecare, a not-for-profit organisation that provides full-time accommodation and care, respite and community services to children and adults in the ACT with physical or complex disabilities. This was the third year running the team was the leading fundraiser.
Disability
Significant achievements have been made in listening to and supporting staff with disability during the year. A member of the department’s Senior Executive Service was appointed Disability Champion, and representatives of staff with disability were invited to join a range of consultative and governance committees. Activities to improve understanding and awareness of disabilities increased across the department. A national meeting of staff with disability was held and resulted in establishment of a network for these staff.
Public Service Reforms
March 2010 also saw the release of Ahead of the Game: a Blueprint for Reform of Australian Government Administration which will increase the Australian Public Service focus on citizens. Part of the reform was the establishment of a new Secretaries Board as well as a senior leadership group, the APS 200, to lead cultural change in the Australian Public Service.
Outlook for 2010-11
In the year to come the department will continue to progress health reform by implementing the National Health and Hospitals Agreement and associated primary health care reforms, working with the states and territories.
This will include administering additional funding for public hospitals and health infrastructure. Improving access to elective surgery and reducing elective surgery waiting lists will be priorities. New targets for each of these areas including the four hour emergency department access target are due to commence in January 2011.
In 2010-11, the department will also offer additional GP Super Clinic grants. These grants will establish new medium and large GP Super Clinics, which will deliver an extensive range of health services and provide clinical training placements.
The department will work closely with Medicare Australia and the National E-Health Transition Authority to ensure that communication and implementation strategies are used to support the rollout of healthcare identifiers into healthcare provider systems.
Increased efforts to support all Australians to lead healthy and active lives will also be a key focus. Work under the National Partnership Agreement on Preventive Health will step up in 2010-11, with the next phase of the Measure Up anti-obesity campaign as well as a new anti-smoking campaign. The department will also continue to manage the work of the proposed Australian National Preventive Health Agency until debate resumes in the Senate.
Increasing the health and aged care workforce, closing the gap in life expectancy and health outcomes for Indigenous Australians, and maintaining our vigilance against a national biosecurity threat, will remain priorities.
Reform of how we do our business will also continue with a strategic review of the department and portfolio. This will ensure that we are well positioned for the challenges of the future and ensure that tax payer funding is used efficiently and effectively. It will also ensure that we remain a work place of choice for our staff.
[Signed in Hard Copy and PDF versions.]
Jane Halton PSM
Secretary
Department of Health and Ageing
yourHealth: www.yourhealth.gov.au
The yourHealth website
www.yourhealth.gov.au was developed in July 2009 as an online consultation channel supporting national health reform by a dedicated team of communication and web development professionals.
yourHealth allowed the Australian community to comment online on the recommendations in the National Health and Hospitals Reform Commission Final Report, share their experience of Australia’s health system and provide views on how this system could be reformed. Community submissions were reviewed and published in the website daily based on a publicly available moderation policy.
At launch on 27 July 2009 yourHealth contained core content such as the National Health and Hospitals Reform Commission Final Report, fact sheets and a consultation calendar. It included consultation tools such as ‘share my story’ and ‘feedback’ and engagement tools such as quick polls. A Twitter account, email newsletter and RSS feed allowed the community to stay informed about health reform developments and visitors could share yourHealth information via the major social networking sites.
New functionality was released regularly to prompt ongoing engagement and participation. In particular a weekly blog and consultation map were added in September 2009 and a public video submission tool, submissions map and the ability to ‘Agree’ with video and comments was added in October.
The website also featured ‘voxpop’ videos, impromptu interviews with health professionals and members of the Australian community discussing their health views and experiences, as well as a consultation calendar and summaries of the 103 consultation events held across Australia.
Since the end of the consultation process, yourHealth has been repurposed to provide information on the Australian Government’s health reform program. It also continues to host the department’s online consultations, such as feedback on potential boundaries for Medicare Locals and Local Hospital Networks.
Between launch and August 2010 yourHealth attracted roughly 1.2 million visits and more than 1,800 consultation submissions.
Chief Medical Officer’s Report
This year marks the 30th anniversary of the world wide elimination of small pox through vaccination. Also this year, Australia successfully managed the threat of pandemic influenza A (H1N1) 2009 epidemic. These events highlight the ever-present threat of infectious disease epidemics and the importance of vaccination in preventing them. These important issues will be discussed later in my report, but first I would like to touch on the current health of the nation.
The Health of the Nation
Australia’s life expectancy increased substantially over the last 20 years, and is now one of the highest in the world behind Japan and Switzerland with 84 years for females and 79 years for males. As shown in Figure 1, females at 65 years of age can expect to live another 22 years and males another 18 years. More than 85 per cent of Australians assess their own health as either good or excellent.
Figure 1: Australia's ranking of health outcomes among Organisation for Economic Cooperation and Development countries, 1987-20061
Figure 2: Health expenditure per capita, public and private expenditure, Organisation for Economic Cooperation and Development countries, 2008 ($US PPP)
For a range of health outcomes, Australia generally ranks in the top third of countries in the Organisation for Economic Cooperation and Development (Figure 1). Over the last 20 years, Australia’s outcomes improved markedly for coronary heart disease, stroke, lung cancer and colon cancer. In this time, death rates also fell for chronic obstructive pulmonary disease, infant mortality, diabetes and accidental falls, although Australia’s ranking dropped for these outcomes.
Whilst Australia’s health outcomes are better than average for countries in the Organisation for Economic Cooperation and Development, our health expenditure is close to average (Figure 2).
Over 80 per cent of the burden of disease in our community is caused by seven diseases (Figure 3). Burden of disease is measured by disability-adjusted life years (DALYs), which take account of years of life lost due to premature mortality (YLL) and years of ‘healthy’ life lost due to living with illness and disability (YLD). The leading causes of disease burden in Australia are: cancers, cardiovascular diseases, nervous system and sense disorders, mental disorders, chronic respiratory diseases, diabetes and injuries.
The main contribution of cancers and cardiovascular diseases to the burden of disease is through premature mortality, however death rates for these diseases have declined considerably over recent decades (Figure 1). For those with cancer, the likelihood of dying from cancer is now the lowest it has ever been.
Figure 3: Projected burden of major disease groups in Australia, 20103
Mental disorders make a significant contribution to disease burden. Unlike the larger burdens of cancer and cardiovascular disease, mental disorders manifest with substantial disability rather than deaths, and often affect younger people.
Current surveys suggest around 17 per cent of our population experience some mental health problems in a year, with 14 per cent experiencing mild to moderate disorders and 3 per cent experiencing more severe illness (Figure 4). Anxiety and depression are the major mental health conditions affecting the Australian population.
People with mental health conditions report spending more days ‘out of role’ – unable to work or carry out normal activities. Those with a mental health condition spend three times as many days out of role than people with no health problems, and those with both mental and physical health conditions spend five times as many days out of role as people without health problems.
Figure 4: 12-month prevalence estimates of mental illness in the Australian population by severity level3
It is estimated that around eight per cent of our population accessed health services for mental health issues in the last 12 months. General practitioners remain the major providers of mental health services. While state mental health services cater for a smaller proportion, patients treated by these services are frequently more severely affected and may require more intensive care.
The Council of Australia Governments at its meeting in April 2010 identified mental health as a major priority for work in 2011.
Future trends in the major disease burdens in Australia are broadly favourable for coronary heart disease, anxiety and depression, and stroke (Figure 5). However, it is expected that the burden of disease due to dementia and diabetes will increase over the next 20 years.
Cancer incidence is also projected to increase over the next 20 years. In 2009-10, the department implemented a number of initiatives in cancer control. These included funding for comprehensive cancer centres in Sydney and Melbourne. Through the Health and Hospitals Fund, the department is also funding 21 new Regional Cancer Centre projects, which will provide further support and access to rural and regional cancer patients.
Figure 5: Trends in leading causes of disease burden, 2003-20234
Around one-third of the disease in our community is potentially preventable by changes in lifestyle including decreasing tobacco smoking, blood cholesterol and obesity, increasing physical activity, and controlling blood pressure (Figure 6). The importance of these five risk factors provides an opportunity to substantially control the burden of disease in our community. The remaining two-thirds of factors leading to disease are less well understood. Over the next several decades it is expected that medical research discoveries will identify key genetic susceptibilities to disease and other factors, to enable us to improve the future health response to our burden of disease.
This year the Government responded to the Preventative Health Taskforce report, which offered recommendations to reduce tobacco use, obesity and alcohol misuse in Australia.
Tobacco remains the major cause of preventable illness in Australia. Australia’s achievements in tobacco control have been good by international standards, with only 17 per cent of our adult population smoking daily in 2007. This puts Australia towards the top of the Organisation for Economic Cooperation and Development countries in tobacco control. However, differences remain between states and territories in tobacco consumption, as well as disparities within states and between socioeconomic groups, which will require further work.
Figure 6: The keys to prevention5
As part of its response to the Preventative Health Taskforce report, the Australian Government announced a 25 per cent increase in the excise tax on tobacco products effective on 1 July 2010. The Government has also committed to introduce plain packaging for tobacco products, restrict internet advertising of tobacco and fund additional anti-tobacco social marketing measures.
The Australian Health Survey has been established by the department and the Australian Bureau of Statistics, with funding assistance from the National Heart Foundation. The aim of this survey is to provide a greater depth of knowledge on our population’s health and predisposition to disease, particularly obesity, diet and physical activity, and includes a voluntary blood collection. The survey will also provide an important insight on the health needs of Indigenous Australians. Such detailed knowledge will enable key policies to be developed to support prevention and better plan health services.
The increased number of medical and other health professionals graduating from our universities will provide greater depth and support for our health sector in the next few years. In 2009-10, several initiatives have been put in place to support our expanding health workforce, including a single national registration system and additional funding for clinical training of doctors, nurses and allied health professionals. Health Workforce Australia was established in early 2010 by the Council of Australian Governments to deliver programs in workforce planning, workforce research, support clinical training and education, support innovation in the health workforce and aid recruitment and retention of health professionals.
The Pandemic Influenza A (H1N1) 2009 Epidemic
Australia’s health system is well-placed to manage the challenges posed by the major burden of chronic disease, in terms of both prevention of risk factors and the treatment and management of ill-health. Although infectious diseases currently make a relatively small contribution to the overall disease burden (Figure 3), they always pose a potentially significant danger to the health of the population. Australia averted such a threat this year in managing the pandemic influenza A (H1N1) 2009 epidemic.
Figure 7: The spread of influenza A (H1N1) 2009 in Australia5
Australia experienced a first wave of a pandemic influenza in the winter of 2009, following the declaration of a "public health emergency of international concern" by the World Health Organization on 25 April 2009. Australia was one of the few countries in the world to first experience this virus in its winter season with an unprotected population.
There was a four week period between world-wide identification of this emerging pandemic virus and the first clinical cases identified in Australia in May 2009. This provided time to start to understand the clinical course of the illness, its degree of virulence, and which groups were most vulnerable to poor outcomes following an infection.
Australia’s well rehearsed plan, the Australian Health Management Plan for Pandemic Influenza6, provided a valuable evidence based platform for the Australian emergency health response. The response included information to travellers, provision of health staff at the international borders, public awareness campaigns to reduce droplet spread, initial containment and testing of cases and the treatment of such cases and their contacts with anti-viral treatment. Coordination of our national effort was focused at the department’s Aileen Plant National Incident Room with leadership from the Australian Health Protection Committee.
When more clinical information was available, Australia’s health response and pandemic plan was substantially modified to appropriately reflect the virulence of the virus. The new PROTECT phase of our national response focused on testing and antiviral therapy for those with severe deteriorating influenza, and those most at risk with underlying medical conditions, pregnancy, obesity or Indigenous Australians. Media and government campaigns alerted the public early in the epidemic about vulnerable groups most at risk of a poor outcome.
The pandemic influenza A (H1N1) 2009 epidemic ran its course in Australia over around 16 weeks peaking in late July 2009 (Figure 7). 7 For the four to five weeks at its peak, emergency departments and intensive care units around Australia were in some cases severely stretched but overall the Australian health system coped well with the epidemic.
The clinical picture of the 2009 epidemic is now quite clear and differs from the usual seasonal influenza experience in several important ways. Pandemic influenza A (H1N1) 2009 in Australia was characterised overall as a mild disease not requiring medical care for the majority of those infected. It preferentially caused severe infections in the young, while sparing the elderly (Figure 8). The hospitalisation rate was higher than for seasonal influenza, with 13 per cent of confirmed cases or 4,992 persons hospitalised. For those who were hospitalised, the proportion admitted to intensive care units was also higher. Around 700 patients were admitted to intensive care units in Australia during the epidemic in 2009, predominantly for severe viral pneumonia, compared with 50 to 60 in an average year from seasonal influenza.8
While 37,636 individuals could be identified who tested positive for pandemic influenza A (H1N1) 2009, and 191 died during 2009 with the virus, these figures are likely to significantly under represent the true extent of the epidemic in Australia in 2009. Sero-surveys have been conducted to ascertain how many Australians developed natural immunity following infection with the winter pandemic wave. It is estimated around 20 per cent of our population, or around 4.4 million Australians, may have been infected. The proportion infected was higher in school-age children and much lower in toddlers and the elderly. It is likely that there were geographical differences in infection rates.
The death rates from the pandemic influenza A (H1N1) 2009 epidemic in Australia appear lower than seasonal flu death rates. However, the median age of those who died was also lower, at 53 years compared to 83 years in a normal flu season. It is also likely that in a year dominated by the pandemic virus, the community death rate, while lower than other seasons, may be closer to the usual annual mortality rate than previously identified.
It is likely that death rates and complications were kept relatively low in Australia due to a combination of public awareness, early anti-viral therapy and hospitalisation for severely affected cases, a high quality health system and a coordinated public health response to the epidemic, including the delivery of a major vaccination program.
Figure 8: Age-specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 to 3 October 2009, compared with average annual age specific rates of hospitalisations from seasonal influenza 2004-05 to 2006-07, Australia8
Vaccination and the Pandemic
Australia was the second country to start a vaccination program in response to pandemic influenza A (H1N1) 2009. The Australian Government activated a deed in June 2009 to provide a specific monovalent vaccine for a pandemic virus. Clinical trials of the pandemic influenza A (H1N1) 2009 vaccine reported high efficacy in mid-September 2009, resulting in Therapeutic Goods Administration registration. The general vaccination program began on 30 September 2009. During 2009-10, over 9 million doses were distributed. The safety record of this vaccine, now well documented in Australia and in the United States, was very good.
In September 2009, the World Health Organization recommended the composition of the seasonal influenza vaccine for the Southern Hemisphere for 2010. It recommended that the pandemic influenza A (H1N1) 2009 strain be included along with influenza B and an updated influenza A (H3N2) strain. This vaccine was available in Australia from March 2010. Again, there was a high level of interest and uptake in the vaccine by our population, with the Therapeutic Goods Administration approving distribution of nearly 6.5 million doses.
On 15 April 2010 the Therapeutic Goods Administration was alerted that increased reports of febrile convulsions in children under five years of age had been reported to the Western Australia Health Department. The Therapeutic Goods Administration immediately requested full documentation from all states and territories. On 20 April 2010, the first documentation was received from Western Australia of a higher than expected level of febrile convulsions in children under five years. Within 72 hours of receiving these reports, the Australian Government suspended the use of the seasonal influenza vaccine program in young children.
Subsequent investigations by the Therapeutic Goods Administration and the Australian Technical Advisory Group on Immunisation revealed 100 cases nationally of febrile convulsions in children under five years of age. The rate was one in 100 for the vaccine Fluvax for children under 3 years, with expected rates of less than one in 1,000 seen for other seasonal influenza vaccines Influvac and Vaxigrip. The department recommended that vaccination continue with the latter seasonal flu vaccines for all age groups, but that Fluvax only be used for those five years and over. Otherwise, the vaccines had a low level of adverse effects and were well tolerated as in previous years.
Following the rollout of around 15 million doses of vaccine, plus population immunity following infection in the first wave of the epidemic, it is estimated that between half and two-thirds of our population have some immunity to pandemic influenza A (H1N1) 2009, with a smaller proportion also immune to other influenza strains for the winter of 2010.
Further follow up is needed before the extent of winter influenza for 2010 is known. The Australian Technical Advisory Group on Immunisation has modelled the likely infection rates based on the extent of vaccination in our community. Following an effective vaccination program, this modelling suggests there may be a large reduction in influenza infections in 2010, substantially relieving pressure on emergency departments and intensive care units this winter.
Vaccinating Against Other Diseases
The important role of vaccination in managing the influenza pandemic served as a useful reminder to the community of the value of vaccination in controlling a range of illnesses across the community. Vaccination is a simple, safe and effective way to protect individuals before they come into contact with particular infections. The Therapeutic Goods Administration approves all vaccines available in Australia only after they pass stringent safety testing.
The National Immunisation Program schedule currently includes vaccines against 16 harmful and sometimes life-threatening infections including polio, measles, mumps, rubella, meningitis and whooping cough (Table 1). Measles, mumps, rubella, tetanus, polio and Hib vaccines protect more than 95% of children who have completed the course. One dose of meningococcal C vaccine at 12 months protects over 90% of children. Three doses of whooping cough (pertussis) vaccine protects about 85% of children who have been immunised, and will reduce the severity of the disease in the other 15% if they do catch whooping cough. All vaccines provided according to the National Immunisation Program schedule can be provided free.
If enough people in the community are vaccinated, some diseases can be eradicated altogether, as for smallpox. On the 30th anniversary of the worldwide elimination of smallpox, and in the wake of an averted threat from an influenza pandemic, it is timely to reflect on the importance of vaccination in maintaining the internationally high standards of health enjoyed by Australians.
Table 1: Diseases with vaccination recommended under the National Immunisation Program
- Hepatitis B
- Hepatitis A (recommended for Aboriginal and Torres Strait Islanders)
- Diptheria
- Tetnus
- Pertussis (Whooping cough)
- Poliomyelitis
- Pneumococcal pneumonia
- Rotovirus induced diarrhoea
- Haemophilus pneumonia and ear infection
- Measles
- Mumps
- Rubella
- Varicella (Chicken pox)
- Influenza (A & B)
- Meningococcal C
- Cervical cancer (human papillomavirus)
[Signed in Hard Copy and PDF versions.]
Professor Jim Bishop AO
MD MMED MBBS FRACP FRCPA
Chief Medical Officer
Social Inclusion
The Australian Government has a vision for social inclusion, to ensure every Australian has the opportunity and support they need to participate fully in the nation’s economic and community life. Ill-health and disability can reduce a person’s capacity to work and participate in education or social activities, both through physical and mental health conditions as well as time spent receiving health care or caring for others, and all of these can exacerbate financial strain in households.
Groups who are at risk of, or experience, social exclusion generally experience the highest rates of illness and disability, have most trouble navigating health care, and therefore particularly rely on a well-functioning health system.
The department contributed to social inclusion outcomes this year in many ways. Some examples include:
- Delivering Australia’s universal health care platform to ensure that all Australians can access a high standard of affordable health care. In 2009-10, Medicare rebates were provided for 308 million services and almost 184 million pharmaceutical prescriptions were subsidised.
- Reaching agreement with states and territories (except Western Australia) to establish the National Health and Hospitals Network. Health reforms seek to secure a sound basis for funding public hospitals into the future, with additional investment in preventive and primary care approaches to help avoid, reduce or manage illness in the community.
- A range of preventive measures to reduce lifestyle health risks such as smoking, obesity, poor nutrition, and physical inactivity, all of which disproportionately affect socially disadvantaged groups.
- A youth-friendly holistic model of mental health, alcohol and drug services was delivered in 30 headspace sites and up to 30 new headspace sites will be established commencing in 2010-11.
- The Indigenous Chronic Disease Package addresses the high rates of chronic disease, and associated risk factors, which contribute to the life expectancy gap between Indigenous and non-Indigenous Australians. Some 293 new health workforce positions were funded in Aboriginal community controlled health services and the Divisions of General Practice Network. A new Indigenous Health Incentive began, supporting 850 general practices and Indigenous health services to provide better health care for Indigenous Australians, with around 2,900 eligible patients registered.
- Through the Assistance with Care and Housing for the Aged program, the department helped frail older people living in insecure housing to access secure accommodation and appropriate support services. The department also funded 157 community-based organisations to recruit, train and match volunteers to visit residents of aged care homes at risk of being socially or culturally isolated.
Chief Financial Officer's Report
I am pleased to provide this first Chief Financial Officer Report, an overview of the department’s 2009-10 financial results and financial improvement in recent years.
2009-10 Financial Results
During the 2009-10 financial year, the department continued to build on a sound financial position. The department successfully delivered its business plan activity and reported a modest departmental operating surplus, $2.723 million (the eighth surplus in the past nine years), and in doing so, met the requirements of Government to manage within the resources provided. The 2009-10 departmental operating result has improved the net asset position and maintained respectable levels of cash liquidity.
In 2009-10, the department oversaw 48 programs on behalf of Government. Major administered items for 2009-10 included:
- Administered expenses of $41.4 billion primarily related to the payment of subsidies of $7.1 billion for residential, aged care and community programs; personal benefits of $29.1 billion for Medicare services, pharmaceutical services and affordability and choice of health care initiatives. The department also paid grants of $4.3 billion with the majority of these made to non-profit organisations ($3.3 billion).
- Administered assets of $1.1 billion incorporating investments in other portfolio entities of $0.4 billion including two new organisations, the Australian Sports Foundation Ltd and Health Workforce Australia and $0.4 billion in inventories predominantly being the National Medical Stockpile.
- Administered liabilities of $2.8 billion principally related to personal benefits of $1.9 billion.
Figure 1: Revenue / Expenses
Figure 2: Operating Result
The Auditor-General provided the department with an unqualified audit opinion for the 2009-10 financial statements. In conducting the 2009-10 financial statement audit, the Auditor-General advised that the department has in place appropriate financial controls which operate effectively.
The achievement of a positive 2009-10 departmental operating result demonstrates the department’s effective management of Budget appropriations and cost pressures. The department’s business planning and budgeting framework operated effectively to ensure departmental resources were allocated to meet the Government’s priorities.
The department’s continued strong financial performance enabled it to meet its longer term staff accommodation strategies through the completion of several leasehold improvement projects. One major accomplishment in February 2010 was the completion of the Sirius building project with 3,100 staff moving into the new accommodation.
The department’s cash management position remained solid with an excess of current assets over current liabilities at 30 June 2010 of $44.6 million, providing a strong financial position to meet future Budget appropriation and cost pressures.
Improving Financial Position
Over the last 10 years the department has proven its ability to support and respond effectively to a number of significant policy reforms while continuing to meet its financial obligations and improve on past performance. Key trends for the department’s financial position for the past 10 years are illustrated at figures 1, 2, 3 and 4.
Figure 3: Assets, Liabilities and Net Equity Trend
Figure 4: Current Assets and Liabilities
Challenges Ahead
Financial challenges facing the department in 2010-11 and future years include the implementation of the net cash appropriation framework and establishment and reporting of departmental Capital Plans.
Health reform activity is anticipated to continue to increase the challenge to ensure departmental funding provided by Government is appropriately prioritised to support administered program activities.
The department is well positioned to meet these and other future financial challenges through the existing governance framework which includes a proven internal business planning and budgeting model and a delegation framework supporting sound financial decision making.
2009-10 Financial Statements
Further information on the department’s financial result can be obtained in Part 5 of this annual report including an analysis of the department’s current year financial performance.
[Signed in Hard Copy and PDF versions.]
Malcolm Bowditch, CA
Acting Chief Financial Officer
August 2010
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