Outcome 10 - Health System Capacity and Quality

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Improved long-term capacity, quality and safety of Australia’s health care system to meet future health needs, including through investment in health infrastructure, international engagement, consistent performance reporting and research

Major Achievements

• Progressed implementation of 148 projects funded under the Health and Hospitals Fund across the first three funding rounds.
• Successful transition of the Australian Commission on Safety and Quality in Health Care (ACSQHC) as a permanent, independent authority.
• Australia was appointed to the World Health Organization Executive Board.
• Delivered the national Personally Controlled Electronic Health Record (PCEHR) system for launch on 1 July 2012.

Challenges

• Managing the large and diverse portfolio of capital works projects funded by the Health and Hospitals Fund.
• Managing an accelerating program of incoming visits from international delegations seeking to learn from aspects of Australia’s health system.
• The increasing volume of unwanted medicines being returned is a challenge to meet within existing funding and service levels.
• Driving uptake of the PCEHR, managing the introduction of future releases to sustain the stability and ongoing uptake of the system, and working with states and territories on the future funding and governance of the system.

Outcome Strategy

Outcome 10 aims to improve the long-term capacity and the quality and safety of Australia’s health care system by a range of measures. These include improving the management of chronic disease, including: supporting the fight against cancer; supporting electronic health system reform; improving health information programs; engaging in international forums; improving access to palliative care, supporting health and medical research; and improving infrastructure through the Health and Hospitals Fund. The Department worked to achieve this Outcome by managing initiatives under the programs outlined below.

Program 10.1: Chronic disease – treatment

Program 10.1 aims to improve detection, treatment and survival outcomes for people with cancer.

Improving Detection, Treatment and Survival Outcomes for People with Cancer

Cancer Centres

The Department continued to work with states and territories, through the National Cancer Expert Reference Group, to prepare and finalise the COAG National Cancer Work Plan. The plan aims to ensure that people with cancer have access to best practice prevention, diagnosis, assessment, treatment and follow-up care in the right place at the right time. Achieving this vision involves all governments and cancer teams working together to agree clinical pathways and protocols; improve integration of cancer services across sectors; establish designated regional cancer centres with referral pathways to specialist centres; and improve patient access and information.

The Department continued to monitor the construction of a network of 21 regional cancer centres funded under Round Two of the Health and Hospitals Fund. This Australia-wide network will dramatically improve access and support for cancer patients and their carers and families in rural and regional Australia. Funding arrangements for two projects were finalised in 2011-12 and two projects were completed: the Toowoomba and South Western Queensland Integrated Cancer Service; and the Stage 2 Accommodation project at the Gippsland Cancer Care Centre.

The Department also monitored the progress of two important cancer centre projects that promise to improve cancer outcomes for all Australians. These include Lifehouse at Royal Prince Alfred Hospital (RPA), which will be an Australian centre of excellence as an integrated cancer research and treatment facility, and the Garvan St Vincent’s Campus Cancer Centre, which will focus on rapidly translating research findings into clinical application for the prevention, diagnosis and treatment of individual cancer patients.

The COAG National Work Plan was approved by COAG on 16 July 2012. The National Cancer Expert Reference Group, established by COAG to prepare the National Cancer Work Plan, reports directly to COAG.

All of the progress reports submitted during 2011-12 from contracted projects met the agreed requirements.

In 2011-12, the Department continued to support CanTeen to implement the Youth Cancer Networks Program. CanTeen works with each jurisdiction to enhance treatment and support services for adolescent and young adult cancer patients and implement new models of care, including referral pathways, networks and multidisciplinary care teams.

Working with national project partners, CanTeen progressed the development of a national web portal which will provide: easy access to information about youth cancer services; a minimum dataset of key information to be collected and analysed to facilitate learning about national trends in youth cancer; increased awareness of, and access to, clinical trials for young people with cancer; a national network of health professionals interested in youth cancer; and professional development including a postgraduate certificate course for health professionals.

In 2011-12, the Department continued to support the McGrath Foundation to maintain the ongoing recruitment, placement and professional development of Commonwealth supported breast care nurses, who are currently placed in 44 communities around Australia. Approximately 90 per cent of these positions are located in rural and remote areas.

These nurses provide information, care, and practical and emotional support to women diagnosed with breast cancer, their families and carers.

The Department will continue to monitor the progress of the breast care nurse initiative in 2012-13, which will include receiving and assessing an independent evaluation of the Program.

The target of employing 30 Commonwealth supported McGrath Foundation breast care nurses was reached.

Whole of Program Performance Information

The Department funded the Australian Institute of Health and Welfare to operate five centres to monitor and report on the level, burden, and trends in chronic diseases. These centres provide reliable and up-to-date data to support evidence-based policy and advice. The Department also continued to support cancer research to improve detection and treatment through a number of projects, including the construction of cutting edge facilities funded through the Health and Hospitals Fund such as the Chris O’Brien Lifehouse at RPA and the Kinghorn Cancer Centre. Both of these facilities will be completed in 2012-13.

The Department consulted stakeholders widely through projects including the construction of facilities such as the Chris O’Brien Lifehouse at RPA and the Kinghorn Cancer Centre.

During 2011-12, the Department managed Program 10.1 funds effectively and achieved a variance of 0.3%.

Program 10.2: eHealth Implementation

Program 10.2 aims to provide national leadership in electronic health (eHealth) to: improve health system standards and infrastructure; promote the use of Healthcare Identifiers and Authentication Services to improve safety and quality outcomes for patients and support improved management of health information by health care providers; and support the design and development of a personally controlled electronic health record system to increase the availability of health care information for consumers and health care providers when and where it is needed across the health care system.

National eHealth Leadership

During the year, the Department (in conjunction with state and territory governments) continued to support the National E-Health Transition Authority (NEHTA) to develop and maintain the specifications, infrastructure, software and systems required to support electronic health systems nationally. NEHTA’s responsibilities encompass the delivery of key eHealth components, including the Healthcare Identifiers (HI) service, the National Authentication Service for Health (NASH), standard clinical terminologies and secure messaging to support the safe and secure electronic exchange of patient information.

The Department participated in stakeholder discussions, led by NEHTA and Standards Australia, to inform the development of these national eHealth standards and focused on the promotion and use of eHealth standards, particularly the foundation standards for clinical terminology and secure messaging, to ensure efficient, effective and consistent implementation of eHealth nationally.

The NEHTA Board approved the 2011-12 COAG funded work program. The Board includes heads from the Department and state and territory health departments, representing their respective Ministers. The Commonwealth’s funding agreement linked deliverables to the work program for those deliverables supported by the Commonwealth.

The Department continued throughout 2011-12 to provide incentives to general practices, through the Practice Incentives Program, to promote the uptake and use of eHealth tools and systems. The Department, through the Fifth Community Pharmacy Agreement, provided funding to pharmacies for dispensing prescriptions that are generated electronically by prescribers. Through these activities, general practitioners and pharmacists are able to send and receive crucial information faster and more securely.

The number of general practices provided with incentives to promote the use and uptake of eHealth tools and systems exceeded the 2011-12 target.

National eHealth standard specifications for electronic transfer of prescriptions required additional input from stakeholders which has delayed publication by Standards Australia. The six draft documents have now been reviewed by the Department and are in an advanced stage of development. The standards are expected to be completed and published early in 2013.

Software vendors were unwilling to trial standard clinical terminology software upgrades in a limited number of emergency departments because it did not fit in with their corporate business objectives or align with their overall software deployment strategies. Vendors were prepared to participate in a national software roll out to all emergency departments but this was outside the scope of the project. Presently on hold.

Promote the Use of Healthcare Identifiers and Authentication Services

In 2011-12, the Department continued to promote the use of Healthcare Identifiers (HI). HIs are unique reference numbers allocated to individuals receiving health care, individual health care providers and health care provider organisations involved in providing patient care. HIs ensure that individuals and providers can have confidence that health information accessed through eHealth technologies is linked with the correct individual at the point of care.

The Department worked with NEHTA and the Department of Human Services (DHS), as the HI service operator, to support the adoption of HIs in health care provider information management systems.

The Department, through DHS, NEHTA and the Office of the Australian Information Commissioner, provided consumers and health care providers with information and assistance about the benefits of HIs, legal compliance and how the HI service works. Further information was available from the DHS website.

A key outcome for the Department was to build public confidence in the use of the HIs. To help achieve this, lead sites implemented eHealth infrastructure and standards in real world settings. These sites provided a foundation for secure electronic communications such as referrals and sharing of summary health information to support continuity of care between health care providers.

DHS has been providing assistance to healthcare providers to download Individual Healthcare Identifiers (IHIs) into local systems.

Over 2 million HIs have been downloaded and incorporated into local systems within the 12 lead implementation sites.

There are 24,555,487 IHIs assigned to individuals.

The deliverable was affected by a pause in the development of the specifications for the Primary Care desktop software developed by NEHTA for the eHealth lead sites. The lead sites were funded to implement regional eHealth capability and were not part of the national infrastructure for the PCEHR system. The assessment processes used for the specifications highlighted some technical incompatibilities in November 2011 across versions which were rectified in March 2012.

The deliverable was affected by the pause in the development of the specifications for the Primary Care desktop software developed by NEHTA for the eHealth lead sites. The lead sites were funded to implement regional eHealth capability and were not part of the national infrastructure for the PCEHR system. The assessment processes used for the specifications highlighted some technical incompatibilities in November 2011 across versions which were rectified in March 2012.

Support the Design and Development of a Personally Controlled Electronic Health Record System

The PCEHR system was delivered for launch on 1 July 2012. The system will encourage greater support and participation by individuals in their own health care and will improve the efficiency of the health care system by reducing the time taken to locate relevant information, reducing duplication of services, and reducing inappropriate treatments.

All Australians could register for a PCEHR from 1 July 2012. The PCEHR system will enable participating Australians and their authorised health care providers to securely access PCEHRs via the internet. The PCEHR system is supported by the national HIs for individuals, health care providers and health care organisations, as well as authentication services and standard clinical terminologies.

The PCEHR system was developed in consultation with health care providers and consumers. The Department worked with the National Infrastructure Partner, NEHTA, and with industry to develop the IT architecture and national infrastructure components, to enable patients to register for the PCEHR system from 1 July 2012. eHealth lead implementation sites were used to implement elements of the system in health care settings.

The Department developed with NEHTA and the National Change and Adoption Partner (a consortium led by McKinsey and Company) a Change and Adoption Strategy for the eHealth record system to encourage the widespread and effective adoption of the PCEHR system by health consumers and health care providers. The Strategy was directed at communication, education and public awareness, with communications focusing on six priority consumer groups: Aboriginal and Torres Strait Islander people, mothers and their newborns, older Australians, people with chronic or complex conditions, people with mental health conditions, and people living in rural or remote communities. The Strategy saw the Department engage with consumers, clinicians, industry and state and territory governments throughout the year.

The Department launched on 11 May 2012 an eHealth information website¹²⁰ which includes a Learning Centre, where consumers and health care professionals can complete training modules on using the eHealth record system.

The Department contracted consumer and provider organisations to undertake communications campaigns and other activities to encourage adoption of eHealth records and managed the production of a large suite of information resources for the PCEHR system.

As for above deliverable.

A key component for the implementation of lead eHealth sites has been facilitating healthcare providers gain Healthcare Provider Identifiers-Organisation status, the collecting of Healthcare Provider Identifiers-Individuals for practices, and the downloading and incorporating into local systems of IHIs.

Over 100,000 consumers have consented to participate in local systems across the lead eHealth sites. The deliverable was affected by a pause in the development of the specifications for the Primary Care desktop software developed by NEHTA for the eHealth lead sites. The lead sites were funded to implement regional eHealth capability and were not part of the national infrastructure for the PCEHR system. The assessment processes used for the specifications highlighted some technical incompatibilities in November 2011 across versions which were rectified in March 2012. The PCEHR rollout will be staged throughout 2012-13.

Whole of Program Performance Information

In 2011-12 the Department funded the Consumer and the General Practitioners’ (GPs) surveys to determine these groups’ readiness to adopt the eHealth record system. The surveys were a critical component in developing a Change and Adoption strategy for the eHealth record system.

During 2011-12, the Department consulted nationally with stakeholders on design, governance and implementation of the PCEHR system. The Department conducted three public consultations on the PCEHR system legislation, receiving over 140 submissions, and consulted 1,240 organisations and individuals on the legislation and the proposals for the PCEHR system rules and regulations.

In April 2012, the Department commenced delivery of a monthly eNewsletter titled ‘On The Record’, updating stakeholders on the progress of the eHealth record system.

During 2011-12, the Department managed Program 10.2 funds effectively and achieved a variance of -0.3%.

Program 10.3: Health Information

Program 10.3 aims to undertake activities through the Health System Capacity Development Fund and contribute to the strategic development of health and ageing policies and programs, to benefit the Australian health system and the population.

Health System Capacity Development Fund

The Health System Capacity Development Fund (the Fund)¹²¹ was established on 1 July 2011 consolidating ten full or part programs¹²² providing a larger, flexible funding pool for a variety of means that may include, annual grant funding rounds, unsolicited or one-off activity funding and procurement.

The primary objective of the Fund is to build an understanding of the health needs of population groups and approaches to addressing those needs that strengthen primary prevention in Australia. The Fund aims to support community health including public health, professional, community and consumer involvement in health advocacy, breastfeeding, gender specific health activities and the Primary Health Care Research, Evaluation and Development Strategy (PHCRED). The Fund also aims to support health, consumer and community organisations.

In 2011-12, the Department opened two rounds of funding. The first was an open competitive process, advertised publicly in November 2011. The second round was targeted at organisations already receiving grant funding. Applications under the open and targeted grant rounds closed on 24 December 2011.

On 26 April 2012, the successful grant recipients were approved by the Minister for Health following a rigorous assessment process conducted by the Department. The new activities to be funded will support health, consumer and community organisations to promote and advocate policy development; research and health care programs to meet identified population needs; and research in the field of primary health care through the Bettering the Evaluation and Care of Health (BEACH) initiative. Funding will also support specific population health improvements, including breastfeeding promotion and support, and male sexual and reproductive health.

A further grant round is expected to be conducted in 2012-13.

On 13 September 2011, a discussion paper on the proposed objectives and priorities of the Fund was released for comment. Twenty submissions were received from stakeholders. Submissions were incorporated in the development of the Fund guidelines where appropriate.

The Department released operational guidelines for the Fund on 14 November 2011 which coincided with the advertising of the first open grant funding round. The guidelines are available on the Department’s website.

The Department extended all relevant contracts to 30 June 2012 for funding recipients whose grants were for an ongoing service, if that grant was due to expire prior to that date.

Future grant funding round time frames will be advertised annually on the Department’s website.

Male health promotion materials were developed by the Department in consultation with the Male Health Reference Group. Key to this was the Health Toolbox that contains items such as tape measures, carpenter’s pencils, magnetic clips and note books featuring positive health messages and referral pathways. During 2011-12, hundreds of toolboxes were distributed through the Australian Men’s Shed Association, Men’s Sheds Australia and through other related health initiatives, such as the national Healthy Communities Program, managed by local government areas. Some toolboxes and other male health reference and promotion material were also distributed to health professionals managing programs and projects targeting men’s health.

The Helpline exceeded expectations receiving 84,769 calls in 2011-12. The 24 hour peer support Helpline continues to provide peer to peer support for breastfeeding mothers and their families.

Maternity Services

Throughout 2011-12, the Department continued to work in consultation with state and territory governments to implement action items under the National Maternity Services Plan (the Plan), with the first annual report being provided on time to the Standing Council on Health in November 2011. The second annual report on the Plan’s implementation will be provided to the Standing Council on Health in November 2012.

As a key action item under the Plan, the Department also continued work with the Australian Institute of Health and Welfare to develop a comprehensive, nationally consistent maternity and perinatal mortality data collection. During 2011-12, the National Maternity Information Matrix, a tool designed to provide a stocktake of maternity related data collection practices across Australia, was made available online. This tool will facilitate the identification of gaps in maternity-related data collection practices and allow for improvements to be made.

The Department also continued work on a comprehensive evaluation to assess the appropriateness, effectiveness and efficiency of the Improving Maternity Services Budget Package (2009-10). The evaluation will be completed by 30 June 2013 as anticipated, and is expected to identify opportunities and recommendations to assist future policy and program development for maternity services.

The Department’s action items under year one (2010-11) of the Plan have been implemented and actioned in a timely manner.

This includes the Australian Institute of Health and Welfare’s data collection described earlier.

An implementation plan for the middle-years (2012-13) of the National Maternity Services Plan was developed by the Department with the assistance of states and territories and endorsed by Health Ministers on 27 April 2012. A separate implementation plan is to be developed for the later years (2014-15) and submitted to Health Ministers in late 2013.

The Department continued to work with states and territories to implement the National Maternity Services Plan, a strategic national document providing a framework for consistent and coordinated planning and policy making for maternity services in the five year period 2010-2015.

Primary Health Care Research

The Australian Government has continued its commitment to building a strong research capacity to support evidence-based health reform in the primary health care sector through the PHCRED.

The Department supported the establishment of the first five Centres for Research Excellence (CRE) in primary health care through the Australian Primary Health Care Research Institute (APHCRI). The CREs is a collaborative model bringing together researchers and institutes across Australia, and in some cases internationally, to conduct research focusing on key priority areas identified under the National Primary Health Care Strategy.

The Department will support more research activity in primary health care through APHCRI, including funding for the establishment of at least three new CREs in 2012-13.

The Department funded the APHCRI to establish five CREs which commenced operations at the beginning of the 2012 academic year, focusing on a range of key priority areas such as ensuring accessible and equitable primary health care service provisions in rural and remote Australia and Indigenous primary health care intervention research in chronic disease.

The Department is supporting the establishment of CREs in Primary Health Care through funding to APHCRI. Five CREs were awarded funding following two independently assessed funding rounds.

APHCRI conducted a third funding application round in late 2011 to broaden the range of research collaborations and partnerships in primary health care. Assessment of third round applications was completed in June 2012. The Department anticipates the additional CREs will commence operations in 2012-13.

The CREs in Primary Health Care are formed by collaborations of key partners in primary health care research, including researchers and institutions from across metropolitan, regional, rural and remote Australia, and with international partners in some cases.

The five established CREs cover a range of primary health care reform priority areas which will actively contribute to the broad network of primary health care research including: accessible and equitable primary health care service provision in rural and remote Australia; building quality, governance, performance and sustainability in primary health care; Indigenous primary health care intervention research in chronic disease; urban Aboriginal child health; and prevention of chronic conditions in rural and remote high risk populations.

The Department also increased funding to enhance the knowledge exchange activities conducted by the Primary Health Care Research and Information Service (PHC RIS). PHC RIS provide a range of resources and networking opportunities for researchers and stakeholders in the primary health care sector to access and share information and knowledge to improve policy, planning and service delivery in primary health care.

The Department established a PHCRED Liaison Officer position in March 2011. Initially, the role focused on promoting the PHCRED Strategy, developing skills and expertise in knowledge brokering, and building relationships within the research and policy sectors.

Throughout 2011-12, the Liaison Officer has undertaken a wide range of activities aimed at increasing researchers’ understanding of the policy development process and disseminating knowledge and research to policy makers. Key activities include: presentations and workshops to researchers and policy makers; building relationships and linkages with researchers, CREs, key stakeholder organisations and policy makers; engaging with PHCRED governance and advisory committees; and participating in key conferences and relevant knowledge exchange events.

Primary health care researchers and key PHCRED stakeholders are routinely invited to present on research projects and related activities to promote knowledge exchange between researchers and the Department. In 2011-12, the Department conducted 15 seminar events.

The Department engaged the APHCRI to administer funding under the PHCRED Strategy to develop targeted research projects that address key priority areas identified under the National Primary Health Care Strategy.

During 2011-12, the APHCRI funded four studies to investigate ways of improving interdisciplinary team arrangements and access to allied health services in primary health care for people with chronic conditions. Addressing the needs of specific population subgroups is a key element of improving access and reducing equity under the National Primary Health Care Strategy. Six new research projects were awarded funding in early 2012 under the Coordination and the Vulnerable Consumer Health Care Research stream.

Strategic Development of Health and Ageing Policies

Australian Health Ministers’ Advisory Council

The Australian Health Ministers’ Advisory Council (AHMAC) provides support to the Standing Council on Health (SCoH) by advising it on strategic issues relating to the coordination of health services across the nation and, as applicable, with New Zealand. AHMAC also operates as a national forum for planning, information sharing and innovation in these areas.

Throughout 2011-12, AHMAC has continued its focus on implementing the National Health Reform Agreement and on health workforce reform with finalisation of the Health Workforce 2025 Report. AHMAC also worked to resolve transitional and implementation issues for the National Registration and Accreditation Scheme including the addition of four new National Registration Boards (for the professions of Aboriginal and Torres Strait Islander health practice, Chinese medicine, medical radiation practice and occupational therapy), and finalisation of the appointments process for the ten existing national registration boards.

The COAG Ministerial Councils were reformed by 30 June 2011 and the SCoH held its first meeting on 11 November 2011.

The Australian Government provided input to the 2011-12 AHMAC/SCoH work plan that was approved by SCoH at its meeting on 11 November 2011 and then provided to COAG.

The Department’s contribution to AHMAC cost shared budget of $1.8m was within the agreed parameters.

Whole of Program Performance Information

The Centres for Research Excellence (CREs) supported by the Department bring together researchers and institutes to conduct research focusing on the key priority areas under the National Primary Health Care Strategy. Five CREs were established at the beginning of 2012.

The Health System Capacity Development Fund is designed to support activities that strengthen the capacity and understanding of the Australian health care system. The objective of the Fund is to build an understanding of the health needs of population groups and approaches to addressing those needs that strengthen primary prevention in Australia. In September 2011, a discussion paper on the proposed Fund objectives and priorities was released for comment and 20 submissions were received from stakeholders. These submissions were incorporated into the development of the Fund guidelines. Fund activities support health, consumer and community organisations to promote and advocate policy development.

The small surplus from the Health System Capacity Development Fund is attributable to some funding recipients not achieving deliverables under the Research Capacity Building initiative, and to some ‘capacity development’ projects not proceeding.

Program 10.4: International Policy Engagement

Program 10.4 aims to improve health outcomes in Australia by contributing strategically and effectively as a member of the global community to international health and ageing issues and to bilateral and regional initiatives.

Facilitate International Engagement on Global Health Issues

A significant achievement for the Department in 2012 was managing Australia’s successful candidacy for a position on the World Health Organization (WHO) Executive Board. Australia was elected to the Executive Board by the World Health Assembly (WHA) and is one of only 34 nations represented. The main role of the Executive Board is to provide advice to the WHA and action its decisions and policies. Australia’s three year term (2012-15) is an excellent opportunity to make a major contribution to international health policy decisions.

Engagement in multilateral, regional and bilateral international health policy discussions is a major aspect of the Department’s international work. This work is undertaken to promote and protect the health of the Australian population and to ensure Australia’s health system is responsive to international best practice.

The Department made a significant contribution to multilateral organisations, such as the WHO, Organisation for Economic Cooperation and Development (OECD) and Asia-Pacific Economic Cooperation (APEC), on international health policy issues, chairing the OECD Health Committee and the 2011 annual Pacific Senior Health Officials Meeting.

The Department attended the key WHO governing body meetings for 2011-12. These were the: 2012 WHA; two Executive Board meetings; two Programme, Budget and Administration Committee meetings; IARC Governing Council meeting; and the 2011 Western Pacific Regional Committee meeting. The Department also attended WHO technical meetings.

In 2011-12, the Department chaired two OECD Health Committee meetings.

In 2011-12, the Department participated in two APEC Health Working Group meetings.

The Department was represented at the major international health meetings (WHO, OECD and APEC). The Department was also represented at WHO technical meetings by relevant departmental technical experts.

In 2011-12, the Department contributed to debates on global health policy priorities and showcased Australia’s world leading tobacco control initiatives. The Department participated in the United Nations General Assembly High Level Meeting on Non Communicable Disease (NCD), which resulted in major commitments by member states to improve NCD prevention, treatment and care. At the meeting, Leaders called on the WHO to progress and coordinate the global response to NCDs, including developing a comprehensive global monitoring framework.

As well as the Department’s international engagement through organisations such as the WHO, International Agency for Research on Cancer (IARC), OECD and the APEC, the Department also works with other Australian Government agencies to promote Australia’s strategic interests and development goals. This cooperation helps the Department strengthen bilateral relationships and our engagement in the region.

For example, the Department in cooperation with AusAID, facilitated the Pacific Senior Health Officials Network to foster cooperative links and promote good governance in Pacific health systems, and continued its strong working relationship with other regional health ministries, notably with China’s Ministry of Health. Such relationships are important to Australia because of the increasingly cross-border nature of diseases and disease control.

In 2011-12, the Department hosted and provided secretariat support for the 2011 annual Pacific Senior Health Officials Network meeting held in Cairns, Queensland. The Department also chaired the annual network steering committee meeting by teleconference in 2012. This meeting provided strategic direction for the network.

The Department hosted some 35 visits from overseas delegations interested in learning about aspects of Australia’s health system, a significant increase on previous years. Managing the accelerated increase in delegations was at times a logistical challenge due to short notice for some visits. The Department tailors agendas, information materials, site visits and expert speakers to suit each delegation. Incoming visits from overseas delegations are an important means of engaging with other countries to build networks and professional linkages between individuals and organisations, and to share technical information and experiences in different aspects of health systems development.

The Department regularly hosted visits of overseas delegations interested in learning more about Australia’s health system. The Department also worked with key agencies, such as the Department of Foreign Affairs and Trade and AusAID, to facilitate meetings with the Department for overseas delegates.

As at June 2012, cooperative agreements are in place with China, Indonesia, Iraq, and Japan. Health is also identified as a specific area for technical cooperation in whole-of-government agreements, for example with Mexico and the European Union. Resource reductions in 2011-12 meant no new agreements were developed.

Whole of Program Performance Information

The Department facilitates high quality, targeted and timely advice for international meetings and incoming and outgoing delegations on international health and ageing issues.

The Department coordinated across agencies and met with non-government stakeholders on request ahead of, and in the margins of, major international meetings. For example, the Department met with the non-government organisation grouping the NCD Alliance ahead of, and in the margins of, the 2012 WHA to discuss non-communicable diseases. An independent evaluation of the Pacific Senior Health Officials Network was conducted, with input from Network members and other stakeholders. The results of this evaluation will assist the Department in ensuring the Network continues to meet the needs of its members.

In response to a request from the World Health Organization, the Department made an additional voluntary contribution of $125,000 to support the WHO’s role in implementing the Pandemic Influenza Preparedness Framework to advance global health security. This was within the administered allocation for Program 10.4.

Program 10.5: Research Capacity and Quality

Program 10.5 aims to: undertake activities through the Health Surveillance Fund; undertake activities through the Quality Use of Diagnostics, Therapeutics and Pathology Fund; improve research capacity; and improve coordination of safety and quality in health care through national collaboration.

Health Surveillance Fund

The Health Surveillance Fund (the Fund)¹²⁴ was established on 1 July 2011, consolidating the activities of eight programs¹²⁵ to provide a flexible funding pool for surveillance and monitoring initiatives.

The objectives of the Fund are to support a quality health system through: enhanced surveillance and public health data collection; social, clinical and translational research; and reporting on priority communicable and chronic diseases. This flexible funding pool will provide information to support evidence-based preventive health policy development in Australia and supplement the National Notifiable Diseases Surveillance System.

In 2011-12, the Department undertook consultations with Fund stakeholders, and developed guidelines for the Fund.

Major Health Surveillance Fund activities included: the 2010 National Drug Strategy Household Survey published by the AIHW in July 2011; two annual surveillance and monitoring reports on HIV, viral hepatitis and sexually transmissible infections in Australia in September 2011; an annual surveillance report specific to Aboriginal and Torres Strait Islander Peoples in September 2011; and a Surveillance and Monitoring report in May 2012 which measured progress against meeting the goals of the National Blood Borne Viruses and Sexually Transmissible Infections Subcommittee.

The Health Surveillance Fund also supported the education of consumers in safe food handling, including Food Safety Week in November 2011. Food Safety Week 2011 focused on the food safety practices for vulnerable populations – the young, the old, pregnant and immunocompromised.

The Department commenced consultations on the new flexible Fund arrangements with Health Surveillance Fund stakeholders in May 2011. Consultations in September and October 2011 included the Discussion Paper on the Development of the Fund Guidelines.

The Department released operational guidelines for the Fund in March 2012. The guidelines are available on the Department’s website.

The Department received the chronic disease surveillance information in accordance with agreed work plans.

Communicable Disease Surveillance, Analysis and Reporting

The communicable disease issues facing Australia are diverse and involve foodborne diseases, antimicrobial resistant bacteria, sexually transmissible infections, vector borne diseases, and vaccine preventable diseases. New and emerging diseases, such as Hendra virus and avian influenza, also pose potential threats to public health. In 2011-12, the Department continued to support the ongoing and systematic collection, analysis and reporting of surveillance data related to domestic and international incidences of communicable and foodborne diseases. The Department used relevant data sources, including the National Notifiable Diseases Surveillance System and links with the World Health Organization, to identify outbreaks and predict communicable disease trends.

There is a growing concern around the world about the emergence of antimicrobial resistance as clinicians are forced to use broader spectrum and usually more expensive agents to treat seriously ill patients. In 2011–12, the Department facilitated the establishment of the Antimicrobial Resistance Subcommittee, under the Australian Health Protection Principal Committee, to oversee coordination of a national strategy on antimicrobial resistance. The Australian Commission on Safety and Quality in Health Care will lead initial work on a strategy to integrate a national monitoring and audit system, education and stewardship programs, infection prevention and control, research into antimicrobial resistance, review of current regulatory systems and community and consumer campaigns.

In 2011-12, the Department continued to improve existing influenza surveillance systems in response to gaps identified during the 2009 pandemic, including developing systems to monitor the burden and severity of influenza in the community. Leading into the 2012 influenza season, the Department also provided funding for a nationally representative system monitoring influenza associated hospitalisations and intensive care admissions.

Ongoing seasonal and pandemic surveillance activities continued to provide crucial data on the timing and severity of the influenza season and circulating virus strains. Data from these systems were analysed and reported by the Department on a fortnightly basis during the 2011 influenza season. This report acts as an essential early warning on influenza activity in the community and plays a role in informing appropriate and targeted public health interventions, including influenza vaccination policies.

Following the Australian Health Ministers’ Conference endorsement of the 2010-13 national strategies for blood borne viruses and sexually transmissible infections, a supporting surveillance and monitoring plan was developed. In 2011-12, the Department provided notification surveillance data to inform progress towards reaching the goals of the national strategies.

The overall rate of tuberculosis in Australia remained low in 2011-12 by global standards with incidence mainly in people born overseas. The National Tuberculosis Advisory Committee used surveillance data in identifying priority populations in developing the Strategic Plan for Control of Tuberculosis in Australia: 2011-15.

A small number of communicable diseases surveillance annual reports were funded under the Health Surveillance Fund. The annual reports will be published in Communicable Diseases Intelligence and will contain supplementary information to the data provided to the National Notifiable Diseases Surveillance System under the National Health Security Agreement.

In 2011-12, the Department provided timely surveillance data and reports to the Communicable Diseases Network Australia and other relevant committees for enhanced monitoring. By working with states and territories, a number of communicable disease outbreaks were detected and contained including measles, Murray Valley encephalitis and salmonellosis.

During the Shiga-toxin producing Escherichia coli/Haemolytic Uraemic Syndrome outbreak in Europe during May-July 2011, the Department liaised with the Communicable Diseases Network of Australia, OzFoodNet, Food Standards Australia New Zealand, and the Department of Agriculture, Fisheries and Forestry to provide health advice to health professionals and consumers. National and international Escherichia coli/Haemolytic Uraemic Syndrome surveillance data were monitored continually during the outbreak.

In 2011-12, the Department continued active participation in a number of surveillance fora with other Australian government departments including AusAID, the Department of Agriculture, Fisheries and Forestry, the Department of Immigration and Citizenship and the Department of Foreign Affairs and Trade. For example the Department, in collaboration with the Department of Agriculture, Fisheries and Forestry and working with the states and territories through the Communicable Diseases Network Australia, provided national coordination and leadership for the public health aspects of Hendra virus outbreaks in Queensland and New South Wales.

The Department continued to work closely with the Australian Health Protection Principal Committee and its subcommittees, particularly the Communicable Diseases Network Australia and the Public Health Laboratory Network, to promote a nationally consistent approach to communicable disease management through development and revision of national communicable disease guidelines, case definitions and surveillance practice.

Internationally, the Department was actively involved in regional disease elimination and control goals. The Regional Committee for the Western Pacific’s ‘Regional Verification Commission for Measles Elimination’ was established in 2012, which includes an Australian member nominated by the Department. The Department is currently reviewing the criteria and gathering the surveillance data required to verify measles elimination in Australia.

Western Pacific region countries, including Australia, agreed to reduce the prevalence of chronic hepatitis B infection to less than 2% in children aged at least five years of age by 2012. In 2012, Australia submitted evidence of meeting this target to the World Health Organization’s Western Pacific Regional Office Hepatitis B Expert Resource Panel for verification.

The Department facilitated a restructure of the Australian Health Protection Principal Committee with the establishment of the Antimicrobial Resistance Subcommittee and the incorporation of the Blood Borne Virus and Sexually Transmissible Infections Subcommittee. The Australian Health Protection Principal Committee is chaired by the Chief Medical Officer and membership comprises state and territory Chief Health Officers, subcommittee chairs and technical experts. Together with its existing subcommittees – the Public Health Laboratory Network, National Health Emergency Management Subcommittee, the Communicable Diseases Network Australia and Environmental Health Subcommittee – the Australian Health Protection Principal Committee’s new structure will improve national leadership through cross-jurisdictional collaboration on policy development to mitigate emerging threats from infectious diseases.

In 2011–12, the Department supported the Australian Health Protection Principal Committee’s major activities. The Department led a working group to develop a Communicable Disease Control Framework. With contributions from state and territory public health units and technical experts, the Department supported the development, revision and publication of the Communicable Diseases Network Australia’s Series of National Guidelines for public health management of infectious diseases. The Department also continues to support the development of a business case for a coordinated and efficient national approach to the surveillance of antimicrobial resistance and usage in human health.

The Department coordinated and provided support for meetings and teleconferences for the Communicable Diseases Network Australia, Blood Borne Virus and Sexually Transmissible Infections Subcommittee, Public Health Laboratory Network and Communicable Diseases Network Australia’s specialist working groups, such as the National Arbovirus and Malaria Advisory Committee, National Immunisation Committee, National Surveillance Committee, and the National Tuberculosis Advisory Committee and its subcommittees, and the expert advisory body, the Australian Technical Advisory Group on Immunisation.

In 2011-12, the Department conducted national surveillance on 65 communicable diseases through the National Notifiable Diseases Surveillance System which enabled health authorities to respond to outbreaks in a timely manner. Additional surveillance data were also collected through the National Influenza Surveillance Scheme and OzFoodNet. Surveillance data showed the decline of many communicable diseases. Notifications of some communicable diseases increased over this period which may have reflected an increasing incidence of the disease in the community for example, pertussis (whooping cough) or targeted screening programs and/or changes in testing practice resulting in improved case ascertainment (for example, chlamydia).

OzFoodNet conducted a multi-jurisdictional investigation following an outbreak of gastroenteritis in Australian passengers and crew on a cruise ship with passengers who flew from Cairns to board in Papua New Guinea. Of the 31 passengers and crew interviewed, three were confirmed cases of Salmonella Typhimurium phage type 135a and a further 11 suspected cases of salmonellosis were identified. While the epidemiological investigation indicated a point source outbreak, the cohort study and environmental investigation did not identify a particular food item as the source of infection.

In 2011-12, syndromic surveillance for influenza-like illness and gastroenteritis continued to be conducted through a national sentinel network of GPs. At the end of March 2012, there were 295 GPs across all states and territories reporting data to the network; an increase from 112 in March 2010.

Weekly information on presentations of influenza-like illness act as an early alert indicator of influenza activity in the community. Data from this system were analysed and reported by the Department.

In 2011-12, 100% of nationally notifiable diseases were reported to the National Notifiable Diseases Surveillance System. According to the National Health Security Agreement, states and territories are to provide data on the 65 communicable diseases that are listed on the National Notifiable Diseases List and are reported within their jurisdiction. A small number of diseases are not reported within specific jurisdictions. The Department and jurisdictional health authorities made collaborative and continuous efforts to improve the collection, timeliness and quality of communicable disease surveillance data.

The data from non-mandatory data fields are used to profile how disease spreads in Australia, who is most at risk, and to inform policy. Overall, data completeness for the priority fields was 79% for the cases of tuberculosis, invasive pneumococcal disease, newly acquired hepatitis B and C, gonococcal infection and infectious syphilis notified in 2011-12, where those priority fields are applicable. Due to the nature of the diseases and the complex enhanced data that are required for each case of tuberculosis and invasive pneumococcal disease, states and territories work towards finalising these data by August the year following the reporting year. The Department anticipates an improvement in data completeness for these diseases. States and territories follow-up gonococcal infection cases to determine a case’s Indigenous status as resources permit. The Department worked with states and territories throughout the year to improve the completeness of these and other fields.

Most communicable disease surveillance reports were completed and disseminated according to schedule in 2011-12. These included National Notifiable Diseases Surveillance System and National Arbovirus and Malaria Advisory Committee annual reports, fortnightly reports to the Communicable Diseases Network Australia, seasonal influenza reports during the 2011 influenza season and monthly measles and annual tuberculosis reports to the World Health Organization.

Three of the four quarterly issues of the journal Communicable Disease Intelligence were published in 2011-12. The final quarter was delayed due to competing priorities. Annual reports for influenza, invasive pneumococcal disease and tuberculosis and the quarterly OzFoodNet publications were similarly delayed.

In collaboration with states and territories, in 2011-12, the Department worked through the National Surveillance Committee to improve the quality, timeliness and completeness of national surveillance data. States and territories also collaborated with the Department on the Case Definition Working Group to ensure that nationally agreed case definitions were used by all jurisdictions for consistent case notification.

Improve Research Capacity

Improve Safety and Quality in Health Care

On 1 July 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) became a permanent and independent statutory authority, established under the Commonwealth Authorities and Companies Act 1997 and National Health Reform Act 2011.

The Department continues to support the ACSQHC in leading and coordinating improvements in safety and quality in Australian health care by assisting in identifying issues and policy directions, and recommending priorities for action.

The Department assisted in developing ten National Safety and Quality Health Service Standards to form the basis of the Australian Health Service Safety and Quality Accreditation (AHSSQA) Scheme. The AHSSQA Scheme, which is to commence in January 2013, aims to enhance safety and quality through a nationally consistent approach to health care accreditation.

Health and Hospitals Fund

Supporting medical research is the $430 million investment in 12 medical research infrastructure projects that commenced in 2009-10 under the Health and Hospitals Fund (HHF). Of the 12 projects, two are completed with the remainder expected to be finalised before 2015. These projects will contribute to improved community health through translating new findings into improved treatment and enabling the discovery of new treatments.

In 2011-12, the Department met all procedural and process deadlines to ensure that all payments were progressed within the agreed timelines.

The Department received and accepted the progress reports from contracted parties during 2011-12, the majority of which met agreed requirements. Where reports were not received within the required time frames or were received but were not accepted as adequate by the Department, follow-up action was taken and in consultation with the organisations involved, the outstanding reports were able to be finalised.

Quality Use of Diagnostics, Therapeutics and Pathology Fund

The Quality Use of Diagnostics, Therapeutics and Pathology Fund (the Fund)¹²⁷ was established on 1 July 2011, consolidating the activities of six existing programs.¹²⁸

The objective of the Fund is to continue to implement and manage initiatives, aimed at improving the quality use of medicines and medical services by health professionals and consumers.

In 2011-12, the Australian Government continued to fund the National Prescribing Service (NPS) through this new fund to provide information to consumers to increase their understanding that generic medicines are of equivalent quality, safety and efficacy compared to popular brand medicines. The NPS continued to run the ‘Generic Medicines are an Equal Choice’ campaign as one component of its broader ‘Be Medicinewise’ campaign, designed to educate and support consumers across a range of medicines issues.

The NPS also launched its five-year program to address antibiotic resistance in Australia. This involved a campaign targeted at health professionals to provide the latest evidence and equip them with tools to encourage more informed clinical decisions when they are deciding whether to prescribe antibiotics. It also involved a campaign aimed at consumers to help consumers understand issues surrounding antibiotic resistance.

The NPS continued important work through the Rational Assessment of Drugs and Research (RADAR) and Australian Prescriber publications to provide independent, evidence-based information to health professionals and consumers for new therapeutics, including expert advice and intervention design. The NPS also assisted the Department to implement the Post-Market Monitoring Program which commenced in June 2011. The program monitors medicines use in clinical practice through research and evidence-based assessment of utilisation and aims to improve patient safety, the quality use and the cost-effectiveness of medicines.

The Department also continued to promote evidenced-based pathology and diagnostic imaging services, through the ongoing funding of the NPS. The NPS was funded to undertake a range of projects to improve pathology and diagnostic imaging referral quality and consistency. This included the introduction of education and quality assurance programs for health professionals and consumers and the introduction of peer feedback programs amongst practitioners. This additional support and information will help doctors ensure that the services they request are the most beneficial for patients. Activities will contribute to the sustainability of Medicare-funded services through more appropriate use of pathology and diagnostic imaging services.

These activities provide independent, evidence-based advice and support to assist clinical management decisions and to improve the quality of prescribing, dispensing and disposal of medicines, and the use of diagnostic and pathology services. The Department worked closely with these organisations to ensure the benefits of this consolidation are realised, and the policy objectives of Government continue to be met.

The volume of unwanted medicines collected under the NatRUM program has increased steadily since the program commenced in 1998. In 2000-01, the collection was 235,267 kilos and in 2011-12, the collection was 429,094 kilos, almost doubling in growth (collection data not available prior to 2000-01).

Through a number of meetings over 2011-12, the Department consulted with the NPS and NatRUM to facilitate the establishment of the Quality Use of Diagnostics, Therapeutics and Pathology Fund and to inform the implementation of the new arrangements.

In 2011-12, the Department established the administrative arrangements for the Fund, including consolidating the reporting for the Fund.

In 2011-12, NPS reported that approximately 13,000 general practitioners participate in education activities provided by NPS.

In 2011-12, the National Prescribing Service implemented three therapeutic topics recommended to provide increased support for health professionals, and improve patient safety and the quality use of medicines in Australia.

Whole of Program Performance Information

In 2011-12, the Department produced and disseminated accurate communicable disease surveillance data, reports and public health resources. The Department reported national notifiable diseases data fortnightly to the Communicable Diseases Network Australia so that outbreaks and trends in disease notifications were identified and acted upon by jurisdictions. Data were also summarised and published on the Department’s website and in the journal Communicable Diseases Intelligence.

The Department funded research and data gathering activities in a range of areas. For example, through OzFoodNet, the Department provided information to Food Standards Australia New Zealand about outbreaks of foodborne illnesses to inform the development of primary production and to process standards for fresh horticulture produce.

The Department strengthened communicable disease partnerships through the Australian Health Protection Principal Committee and its subcommittees, in particular its existing Communicable Diseases Network Australia and the Public Health Laboratory Network and the incorporation of the Blood Borne Virus and Sexually Transmissible Infections Subcommittee and establishment of the Antimicrobial Resistance Subcommittee.

During 2011-12, the Department managed Program 10.5 funds effectively and achieved a variance of 0.2%.

Program 10.6: Health infrastructure

Program 10.6 aims to invest in major health infrastructure programs that will support the objectives of reform of the Australian health and hospital system.

Health and Hospitals Fund

The Department worked with the funding recipients of the Health and Hospitals Fund (HHF) to provide ongoing support to progress the strategic capital investment projects in health infrastructure. The HHF was established on 1 January 2009 under the Nation-building Funds Act 2008 and forms part of the Australian Government’s broader nation-building infrastructure program. These investments deliver major improvements in health infrastructure through renewal and refurbishment of a cute and primary care facilities, medical technology equipment and major medical research facilities and projects.

The Government provided funding for 85 health infrastructure projects in the first two funding rounds of the HHF. These projects span three critical areas: the fight against cancer; translational research and research workforce infrastructure; and the improvement and modernisation of the hospital system. 25 of these 85 projects have now been completed: 23 from the first round of the HHF and two from the second round.

Under the regional priority round of the HHF, the Government provided funding for 63 health infrastructure projects to target infrastructure development in regional communities. The successful projects will establish new or improved health facilities in regional communities and aim to close the gap in health outcomes between major metropolitan and regional areas of Australia. A list of the funded projects is located on the Department’s website. The Department has finalised the agreements for 22 projects with the state and territory governments. Funding agreements have also been finalised with non-government organisations for a further 10 projects.

The Department monitored and reported on the progress of projects using the online Capital Funding Portal and supported the independent HHF Advisory Board.

The Department supported the HHF Board by ensuring all members received the papers in a timely and professional manner.

In 2011-12, the Department met all procedural and process deadlines to ensure that all payments were progressed within the agreed timelines.

Delays in finalising funding arrangements were due to longer than anticipated negotiations with funding recipients. The Department will continue to work with state and territory governments and non-government organisations to ensure the funding arrangements will be finalised early in 2012-13.

All funded organisations submitted progress reports within the time frames specified in their agreements or, where circumstances warranted, as agreed with HHF project managers and senior officers.

The majority of progress reports submitted during 2011-12 from contracted projects met the agreed requirements. Where this did not occur the Department followed up in a timely manner.

Whole of Program Performance Information

The Department progressed analysis of the implementation of the program during 2011-12 and the benefits of completed projects were documented.

During 2011-12, stakeholders provided input to the Department about how to continue to develop and effectively manage the program. However, this input was received in an ad-hoc manner.

A number of project milestones were achieved and paid ahead of schedule.

Outcome 10 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ’Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

1. Following passage of HI legislation in June 2010, HIs were issued to all eligible Australians.
2. Available at: www.ehealth.gov.au
3. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Health System Capacity Development Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
4. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
5. Number of agreements excludes licenses, funding agreements for specific activities under other programs and reciprocal health care agreements.
6. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Health Surveillance Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
7. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
8. Mandatory data fields include: date of birth, sex, Indigenous status, death and serogroup / subtype. Select key indicators include: tuberculosis, invasive pneumococcal disease, sexually transmitted infections, Hepatitis C and Hepatitis B.
9. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Quality Use of Diagnostics, Therapeutics and Pathology Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
10. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.

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