Secretary's Review

Highlights of 2011-12

2011-12 was a very busy year with numerous significant achievements and milestones across a wide range of areas. A stand out, internationally recognised achievement was the introduction of the world’s first plain packaging legislation for tobacco products.

Building on the Australian Government’s National Health Reforms, the Department also developed significant reforms in mental health and aged care, and took major steps forward in modernising the health system through eHealth.

During 2011-12, the Government announced significant reforms focusing on areas in need. As part of the 2011-12 Budget, a long-term plan was announced to reform mental health services. These reforms will deliver a system that gives Australians with mental illness timely access to clinical and non-clinical support, and the best chance to recover, stabilise and stay well in the community.

The Living Longer Living Better package is a ten year aged care reform program aimed at providing older Australians with more choice, control and easier access to a full range of services, where they want it and when they need it. The Government also responded to the National Advisory Council on Dental Health’s final report by announcing a $515.3 million dental health package to treat around 400,000 people on public waiting lists, boost the dental workforce and provide incentives for dentists to work in rural and regional areas.

The year also included the appointment of a new Health Minister, the Hon Tanya Plibersek MP.

The National Health Reform Agreement (NHRA), signed by the Australian Government and all states and territories in August 2011, is the culmination of consultation and negotiations over several years, and will bring about the largest change to our health, hospital and aged care systems since the introduction of Medicare in 1984.

The Department continues to focus on keeping people well and out of hospital, bolstering our health workforce to ensure we have enough doctors, nurses and allied health professionals, and leveraging new technology to deliver more coordinated and flexible health care through the establishment of Personally Controlled Electronic Health Records and telehealth initiatives.

To position ourselves to deliver these reforms, while still continuing to conduct the normal business of the Department, we are implementing a number of internal reforms under the DoHA National Alignment (DNA) banner. These reforms will help us to become better at the way we do business, becoming a more capable and flexible organisation.

As part of the DNA program, the Department consolidated 159 programs into 18 flexible Funds. These changes took effect on 1 July 2011, and during the year we have worked with stakeholders to develop program guidelines and transition to the new Funds. The flexible Funds are intended, over time, to reduce red-tape, provide increased flexibility to respond to emerging issues and deliver better value for money with quality and evidence-based funding.

Preventive Health

During 2011-12, Australia introduced the world’s first plain packaging legislation for tobacco products. The Tobacco Plain Packaging Act 2011 and the associated Trade Marks Amendment (Tobacco Plain Packaging) Act 2011 received royal assent on 1 December 2011. The plain packaging legislation removes one of the last forms of tobacco advertising by prohibiting the use of logos, brand imagery, symbols, other images, colours and promotional text on tobacco packaging and products.

All tobacco products manufactured or packaged in Australia from 1 October 2012 for domestic consumption will be required to be in plain packaging of a drab dark brown colour, and all tobacco products will be required to be sold in plain packaging by 1 December 2012. Tobacco product packaging will also be required to be labelled with new, larger graphic health warnings from 1 December 2012. The Department is currently in the process of finalising a compliance and enforcement framework for plain packaging.

Another highlight of the year was the continuation of the successful National Bowel Cancer Screening Program. Approximately 1 million eligible Australians aged 50, 55 and 65 were invited to participate in the program during the year. The program continues to demonstrate that using faecal occult blood tests for screening can detect cancers and pre-cancerous lesions. Under phase two (2008-2011) of the program, more than 1,100 suspected or confirmed cancers and more than 3,300 pre-cancerous lesions were detected and removed from program participants. Almost 80 per cent of bowel cancers removed were in the two earliest stages when the cancer is most readily treatable.

In the 2012-13 Budget, the Australian Government committed funding of $49.7 million over four years to expand the National Bowel Cancer Screening Program to include 60 and 70 year olds. The Government also announced that biennial screening for all Australians aged from 50 to 74 years will be phased in from 2017-18.

Mental Health

During 2011-12, the Department began implementation of the Delivering National Mental Health Reform Budget package. Over the five years from 2011-12, the Australian Government has committed to a reform package totalling $2.2 billion. The reforms are improving the lives of thousands of Australians experiencing mental illness through better access to services, better and earlier detection, better targeting and better coordination.

The Department has focused on the roll-out of a further 15 headspace sites and more than 600 schools are participating in the KidsMatter Primary initiative. 2011-12 also saw the commencement of additional funding for psychological services under the Access to Allied Psychological Services (ATAPS) program, targeted at hard to reach groups, including children and Indigenous peoples.

Projects under the National Partnership Agreement Supporting National Mental Health Reform, focusing on admission and discharge planning from hospitals, and supported accommodation, have been agreed and are now being implemented. These projects will help move Australia’s mental health system away from crisis-driven activity towards prevention, early intervention and care in the community. It will particularly benefit people with severe and persistent mental illness who are frequent users of emergency departments and who need stable accommodation to keep well and break the cycle of hospitalisation and homelessness.

Ageing

A major focus for the Department in 2011-12 was advising the Australian Government on a response to the Productivity Commission’s Report Caring for Older Australians. The Department supported the Minister for Mental Health and Ageing, the Hon Mark Butler MP, in his ‘Conversations on Ageing’ tour which included 31 events in capital cities and regional towns across Australia.

The $3.7 billion Living Longer Living Better aged care reform package announced in April 2012 includes measures aimed at delivering more choice, easier access and better care for older Australians and their families.

A major achievement for the Department in 2011-12 has been the successful transition of over 1,000 Home and Community Care (HACC) service providers to funding arrangements with the Commonwealth. Under the Commonwealth HACC Program from 1 July 2012, the Commonwealth has full responsibility for basic maintenance, support and care services for older people (people aged 65 years and over and Aboriginal and Torres Strait Islander people aged 50 years or over) in most states and territories. This is an important achievement under the NHRA.

During the transition, the Department worked collaboratively with participating state and territory governments, the sector and other stakeholders to ensure they were fully informed and that continuity of services for HACC clients was supported during this process.

Acute Care

A key feature of the NHRA is the introduction of a national activity based funding system for public hospitals. This system will fund public hospitals based on the number and types of services they provide, and drive improvements
in efficiency.

The Department, with the cooperation of states and territories, Treasury and the Department of Prime Minister and Cabinet, managed the drafting of legislation, and the development and implementation of a national health funding pool and associated payment arrangements, to enable activity based funding to commence on 1 July 2012.

2011-12 also saw the establishment of several other key agencies set out within the NHRA – the Independent Hospital Pricing Authority, the National Health Performance Authority and the Australian Commission on Safety and Quality in Health Care. The Department supported these new organisations as they commenced operations. In 2012-13, the Department will continue to work with the new statutory authorities and states and territories to ensure the terms of the NHRA are met.

The National Lead Clinicians Group (LCG) membership was announced in September 2011 by the former Minister for Health and Ageing (the Hon Nicola Roxon MP). The National LCG is a multidisciplinary group, consisting of 16 members from a range of healthcare sectors. The group provides a focal point for the engagement of senior clinicians and provides advice to the Minister for Health on clinical matters of national significance and opportunities to reinforce the safety, quality, effectiveness and efficiency of the Australian health system.

In 2011-12, the Department continued its progress under the National Partnership Agreement on Improving Public Hospital Services (NPA IPHS). At 30 June 2012, $1.76 billion was expended under the NPA IPHS, contributing to improved public patient access for elective surgery, emergency department services and subacute care services.

The Department also supported the revision of the NPA IPHS, in line with the recommendations of the COAG Expert Panel Review of Elective Surgery and Emergency Access Targets. This included developing a nationally consistent approach to reporting performance against the National Emergency Access Target (NEAT) and the National Elective Surgery Target (NEST), prior to the commencement of the targets on 1 January 2012.

Primary Health Care

Stronger primary health care which can better prevent and manage chronic disease is another major element of the national health reform agenda. The Department delivered on a key element of the NHRA by establishing 19 Medicare Locals on 1 July 2011 and an additional 18 Medicare Locals by 1 January 2012. The remaining 24 Medicare Locals commenced on 1 July 2012.

Medicare Locals are a nation-wide network of primary health care organisations that will make it easier for patients to navigate the health system. They will improve the planning and coordination of services at the local level, support the delivery of a range of primary health care initiatives, including addressing service gaps and inequities, and improve collaboration between practitioners and service providers across the health system.

On 1 July 2011, the after hours GP helpline commenced operation as an add-on service to the healthdirect Australia 24/7 nurse triage service (1800 022 222). During 2012, the helpline was extended to residents of Queensland and Victoria through their 13HEALTH and NURSE-ON-CALL services. The helpline exceeded its target of 150,000 calls in the first year of operation. All Australians now have access to after-hours medical advice from a GP on the telephone.

The Department also continued to manage the GP Super Clinic program and a total of 38 clinics are either completed, providing early services or under construction as at 30 June 2012. To date, around 1.9 million clinical services have been delivered to patients across Australia and this number is expected to grow quickly as additional Clinics commence operations over the coming year.

Funding for Health and Hospitals Infrastructure

In 2011-12, the Department continued its role for overseeing the allocation of funds for hospital infrastructure projects. The Department assisted the independent Health and Hospitals Fund (HHF) Advisory Board to consider applications in the Round Four - Regional Priority Round. The Government subsequently selected 76 projects to receive funding of $468.5 million over five years. This brings the total funding committed to developing health infrastructure under HHF Rural and Regional Rounds to $1.8 billion. The projects funded under this stream will enable improved access to health care services for people living in regional and remote communities across Australia. Over 100 projects from the first three HHF rounds have now commenced or been completed. These projects include research infrastructure, hospital extensions and redevelopments as well as a range of projects that have focused on mobile dental clinics, dental chairs and equipment.

Regional and Rural Health

In 2011-12, the Department established Rural and Regional Health Australia to provide information on rural and remote health and aged care programs, policies and services in local areas. Rural and remote communities now benefit from having improved access to information about Government programs and services available outside metropolitan areas.

The Department also finalised a new four year funding agreement with the Royal Flying Doctor Service (RFDS). The agreement articulates the important role of the RFDS in continuing to provide essential primary health care services within a multidisciplinary context to rural, remote and very remote communities.

Throughout the year, the Department also sought to improve rural and remote health infrastructure. Under the National Rural and Remote Health Infrastructure Program, 42 projects were delivered under round five and a further 50 projects were approved for funding under round six. These projects establish and refurbish health facilities, which provide a range of primary care services, including privately insurable health services such as podiatry, physiotherapy, speech pathology and dental health services. The program also supports facilities to provide training for medical students and registrars in rural and remote communities.

Indigenous Health

Implementation of the Indigenous Chronic Disease Package, the Australian Government’s contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, continued in 2011-12. Risk factors for chronic disease were targeted through the roll out of 16 Regional Tackling Smoking and Healthy Lifestyle Teams in 2011-12 taking the total to 37 teams across Australia. The uptake of Medicare-funded primary health care items for Aboriginal and Torres Strait Islander peoples continues to increase. There were 52,426 Aboriginal and Torres Strait Islander health assessments provided in the period 1 July 2011 to 30 April 2012, an increase of 32.8 per cent over the same period in 2010-11. The Department also commenced a national evaluation of the Package which will be reported in 2012-13.

In 2011-12, the Live Longer!, Health Heroes, Do Something Real, and Care for Kids’ Ears social marketing campaigns commenced. These campaigns, which are largely implemented at a community level, contribute towards efforts in tackling chronic disease and otitis media within Aboriginal and Torres Strait Islander communities.

The Department participated in negotiations with the Northern Territory Government to develop the National Partnership Agreement on Stronger Futures in the Northern Territory. This agreement includes $713.5 million over 10 years for better primary health care and better access to allied health services. Beginning in 2012-13, it will replace the Closing the Gap in the Northern Territory National Partnership Agreement and will deliver primary health care services, hearing and oral health services, child abuse trauma counselling services and increase the number of alcohol misuse workers.

MBS and PBS

The key pillars of the Australian health system – the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) – have continued to ensure that all Australians have access to high quality and cost-effective medical services and medicines. The focus continues on ensuring sustainability of these programs so that universal access can be continued into the future.

As a result of the PBS Pricing Reforms, the prices of 75 medicines were reduced on 1 April 2012, delivering savings to Government and reducing the prices paid for medicines by taxpayers and consumers. This was the major component of $1.9 billion in savings to Government and taxpayers as forecasted in the 2010-11 Further PBS Reforms Budget measure.Expanded and Accelerated Price Disclosure has directly impacted consumers with the price of nearly 1,000 brands of over 60 medicines becoming cheaper for general (non-concessional) patients. Future reductions will occur in August, December and April each year, with a further 13 medicines taking reductions in August 2012.

Throughout the last financial year, the Department also implemented the Diagnostic Imaging Reform Package, which expands patient access and service provision of Medicare funded magnetic resonance imaging (MRI) services, to support faster diagnosis and earlier detection of disease. In May 2012 the operating arrangements for all current 125 Medicare eligible MRI units were standardised and bulk-billing incentives for MRI services increased to 100 per cent of the Medicare schedule fee.

eHealth

To underpin the patient-centred health system that national health reform aims to facilitate, work has continued on eHealth and the Personally Controlled Electronic Health Record (PCEHR). eHealth has the capacity to change the way practitioners interact with each other and with patients, leading to improved health care safety and more efficient and effective patient-centred health care. Significant work took place in 2011-12 to prepare for the launch of the PCEHR on 1 July 2012.

The last financial year also saw the introduction of new MBS items and financial incentives to encourage health professionals and aged care services to help patients have a video consultation with a specialist, consultant physician or consultant psychiatrist. By the end of June 2012, more than 26,000 MBS claims had been processed for telehealth services provided to nearly 14,000 patients, and more than 5,000 practitioners had become eligible for financial incentives.

Health Workforce

The Department has worked to ensure Australia is well positioned to deliver a high quality, safe and well distributed health workforce.

The Department continued to work closely with General Practice Education and Training Limited and the Remote Vocational Training Scheme Limited to train our future general practice workforce. The number of general practice training places increased to 1,000 in the 2012 training year with at least 50 per cent of general practice training being undertaken in rural and remote locations across Australia. Placements on the General Practice Procedural Training Support Program were also filled for the 2012 training year, including 25 obstetric training grants and 15 anaesthetic training grants for rurally-based GPs.

In 2011-12, the Department also continued to support specialist training through the funding of medical specialist training posts situated beyond the traditional public teaching hospitals including private, community and rural/regional sectors.

Further, the Department has successfully implemented the Nursing and Allied Health Rural Locum Scheme providing locum placements to enable rural nursing and allied health professionals to take leave and undertake professional development activities without impacting on vital service delivery. The scheme allows interested nursing and allied health professionals to experience rural-based practice through a rural locum placement.

On 1 January 2012, the Department also commenced the Practice Nurse Incentive Program which provides incentive payments to general practices to support an enhanced and expanded role for nurses working in general practice and allowing GPs to focus on more clinically complex care.

Managing the Department

Staff Survey 2012

Eighty per cent of staff participated in the 2012 Staff Survey, the ninth survey conducted in the Department and the second using a new methodology that was initially employed in 2010.

The survey again provided a largely positive view of our work environment. Whilst the Department continued to achieve results above the Australian Public Service average in some areas, the survey also identified some key areas for improvement that will be addressed as part of departmental and local area action planning.

The annual staff survey complements the Department’s People Strategy. This Strategy outlines the Department’s five year approach to attracting and retaining staff, building capability and motivating our staff to deliver outstanding performance, and evaluating our success to continually improve.

Workplace Generosity

As we work towards better health and ageing for all Australians, we have also played an important role in actively supporting fundraising initiatives in the community, including those based on physical challenges. Together we have walked, run and cycled to raise vital funds for key charities.

I am proud to acknowledge the contribution that we make to the community through individual and corporate philanthropy. Our Workplace Giving Program has been in place since 2006 and staff continue to give generously through our payroll system, including to appeals such as the Red Cross East Africa Drought Appeal. For the fifth year running, our team was the leading fundraiser in the annual Hartley Lifecare Ability Cycle Challenge. Over $126,000 was raised to support the work of Hartley Lifecare within the Canberra community.

Workforce Diversity

The Department has maintained its commitment to building the diversity of its workforce, with a range of initiatives and strategies aimed at the attraction and retention of staff from diverse backgrounds being delivered through targeted action plans.

The Department continues to be an active member of Pride in Diversity – Australia’s first and only not-for-profit workplace program designed specifically to assist Australian employers with the inclusion of lesbian, gay, bisexual, and transgender employees – and also maintains its gold membership with the Australian Network on Disability (AND). The Department’s Disability Champion, a role performed by a member of the Department’s senior executive team, remains a member of the AND Board.

The Department is also participating in the Business Administration Traineeship for People with an Intellectual Disability, engaging seven people with an intellectual disability for a period of 18 months from June 2012, more than any other APS agency.

The Department conducted its third annual Conference of staff with disability in June 2012, giving staff who identify with disability an opportunity to listen to a range of guest speakers and participate in forums and discuss issues affecting them. The Department’s Staff with Disability Network has been operating for two years, with network membership open to all interested staff members, whether or not they identify as having a disability.

As a large government department, we want to continue to be an employer of choice for Aboriginal and Torres Strait Islander staff. Our Reconciliation Action Plan commits the Department to actively nurture an inclusive culture that values the contribution, skills and knowledge of all staff and promotes values embraced by, and significant to, Aboriginal and Torres Strait Islander employees.

During 2011-12, the Department successfully delivered a number of key actions through the Reconciliation Action Plan including: recognition of national celebrations of cultural significance; facilitating a National Aboriginal and Torres Strait Islander Staff Network Conference; and participating in the Indigenous Graduate program and encouraging Aboriginal and Torres Strait Islander graduates to apply for the Department’s graduate scheme.

This year the Department launched two e-learning modules to raise Aboriginal and Torres Strait Islander cultural awareness within the Department and provide a comprehensive summary of relevant health policy initiatives.

These resources provide an important source of learning for all staff, and demonstrate our commitment to improving health services and outcomes for all Aboriginal and Torres Strait Islander people to achieve health equality, and to nurturing a diverse and inclusive workplace culture that values the contribution, skills and knowledge of all staff.

Enterprise Agreement

During 2011-12, the Department negotiated with staff and union representatives on the development of a new enterprise agreement. The aim of the negotiations was to agree on an affordable and competitive employment package of salary and flexible conditions which would also continue to build a supportive work environment within the Department. A three year agreement, with a nominal expiry date of 30 June 2014, was accepted by 89 per cent of staff following a vote in November 2011.

Improving Wellness and Motivation in the Workplace Initiative

The Improving Wellness and Motivation in the Workplace Initiative was launched during 2011-12 to help reduce workplace factors that may reduce people’s ability to attend work. As part of the launch, a range of tools to support managers and staff were rolled out including a dedicated intranet site, training, seminars and improved reporting.

The initiative complements actions previously implemented, such as the HR Dashboards and the Early Intervention Reporting and Leave Management Protocols, to create a positive people management culture. As a result of these initiatives, the average annual rate of absence per employee is trending down and by the end of June 2012 had decreased by 0.9 days per employee.

Graduate Development Program

The Department continued to actively promote its Graduate Development Program (GDP) to ensure that a pool of highly skilled candidates is developed from which the Department can recruit on an annual basis. The GDP is a 12 month program incorporating three structured rotations in key areas of policy development, program management and corporate management. The program ensures that graduates develop the skills, knowledge and networks to achieve their full potential.

Outlook for 2012-13

The next 12 months present a number of challenges for the Department. There remains room for improvement with regard to ensuring staff are recognised and feeling valued for their contribution, ensuring roles are appropriately classified and staff are provided access to interesting, fulfilling roles and career paths. We will also aim to enhance our learning and development programs, and look to maintain respectful workplace behaviours by providing a range of training, educational and support materials and guidance.

2012-13 will see the introduction of activity based funding for public hospitals, the commencement of the Commonwealth HACC program and the establishment of Personally Controlled Electronic Health Records. Medicare Locals and Local Hospital Networks will ensure that health care systems are responsive to local needs. And new mental health initiatives such as Early Psychosis Prevention and Intervention Centres and the Partners in Recovery program will be implemented to provide a more integrated system of support for vulnerable Australians.

On the international front, the Department continues to contribute to regional and global health cooperation through the World Health Organization. In recognition of Australia’s strong contribution to the organisation, in May 2012 I was elected to the Executive Board, which will be overseeing a vital period of reform to better position the World Health Organization to meet contemporary health challenges.

By investing in improved systems and processes, the Department will continue to transform into a contemporary best practice organisation, contributing internationally as well as domestically, so that we are positioned to best respond to current and emerging health and ageing challenges. We look forward to another busy and productive year.
Jane Halton signature

Professor Jane Halton PSM
Secretary

September 2012

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