KEY STRATEGIC DIRECTIONS FOR 2004-05
Improved Quality of Care
The Department provided secretariat support to the National Health Priority Action Council which is chaired by the Chief Medical Officer, with the development of the overarching National Chronic Disease Strategy and the disease specific National Service Improvement Frameworks progressed in 2004-05. Consultative workshops in each State and Territory were held in June 2005. By promoting an integrated evidence-based approach to health care service delivery for people with complex care needs, more effective prevention and management strategies can be put in place, with improved outcomes for individuals, clinical practitioners and jurisdictional level service delivery planners.
Diabetes constitutes a major health risk to Australians, particularly in those who are overweight or obese. In addition to the personal health costs, the disease imposes a large public health burden, with the estimated annual cost to the nation exceeding $1.2 billion.
The Department continues to support general practice doctors (GPs) to improve the care of people with diabetes through the National Integrated Diabetes Program. The program provides a national, integrated approach to improving detection and management of diabetes by providing incentives to GPs through the Medicare Benefits Schedule, providing infrastructure and support for the Divisions of General Practice network, consumer engagement and changes to the practice of health professionals. In the 2005-06 Budget, the Government allocated $44.2 million to continue the program for a further four years.
In meeting the goals of the National Diabetes Strategy, the Department in 2004-05 made further progress administering the development of clinical practice guidelines for the management of Type 2 diabetes with six in a set of nine guidelines now endorsed by the National Health and Medical Research Council (NHMRC). In addition, guidelines for the management of Type 1 diabetes for children and adolescents were endorsed by the NHMRC in February 2005. In August 2004 the Department commissioned the development of a National Service Improvement Framework (NSIF) for Diabetes which identifies the best opportunities to improve health system delivery, based on evidence and consumer opinion. The Department has consulted widely in the development of the NSIF which will be presented to the Australian Health Ministers’ Advisory Conference in October 2005 along with an overarching National Chronic Disease Strategy.
To complement the NSIF, the Department is developing an Aboriginal and Torres Strait Islander Advocacy Brief to address the chronic conditions of diabetes, cardiovascular disease and asthma. This document is being developed in consultation with an advisory group including Indigenous health experts and a separate group of representatives from State and Territory Health Departments. This brief, which is scheduled for completion by the end of September 2005, will identify the best opportunities for improvements in the health system affecting Indigenous communities that can be pursued within the context of the National Diabetes Strategy, the National Strategy for Heart Stroke and Vascular Disease and the National Asthma Strategy.
Heart, stroke and vascular diseases kill more Australians than any other disease group. The total burden of these diseases is expected to increase over the coming decades due to the increasing number of older people, among whom these diseases are most common.
The NSIF for Heart, Stroke and Vascular Disease was commissioned in August 2004. In July 2005 the Department consulted widely to finalise a draft which will be considered by the Australian Health Ministers’ Advisory Conference in October 2005.
The Department progressed the National Strategy for Heart, Stroke and Vascular Health through its work with St John Ambulance on the use of automated external defibrillators which have been shown to prevent death and disability following sudden cardiac arrest.
Under the National Strategy, the Department also progressed work with the National Stroke Foundation on the development of evidence-based Clinical Guidelines for Stroke Rehabilitation and Recovery
covering the post acute phase of stroke care and completing a suite of stroke care guidelines. The Department expects to provide a draft document, which is the result of wide consultation, to the NHMRC for full council endorsement in September 2005.
In 2003, the Department also provided funding to a project for improving cardiovascular risk assessment over 5 years. A final report has now been received and the Department is considering the potential application.
Asthma Management Program
Implementation of the Medicare Benefits Schedule GP Initiative 3+ Visit Plan continued to be supported through the National Asthma 3+ Community Support Program delivered by State and Territory Asthma Foundations with funding administered by the Department. This continued to be funded by the Department to encourage uptake of the 3+ Visit Plan and effective self management by people with moderate to severe asthma. Education on asthma and the 3+ Visit Plan for health professionals was delivered by the National Asthma Council with funding administered by the Department.
The Asthma Friendly Schools Program is delivered by the asthma foundations with support from the Department, achieving full recognition of up to 50 per cent of all schools in Australia as ‘Asthma Friendly’ and registration of 80 per cent of all schools in the program by June 2005.
The Department administered funding to the asthma foundations to undertake a fourth round of Asthma Community Grants designed to increase community awareness of asthma and promote a team approach to asthma management. The grants targeted Indigenous communities, culturally and linguistically diverse groups and asthma education. Additional activities supported by the Department included a pilot of best-practice hospital discharge practices for asthma patients in 30 emergency departments across Australia; GP Decision Support Materials to assist in the diagnosis of asthma in older Australians; a 3+ Visit Plan communication strategy for pharmacists; and publication of eight evidence-based information brochures on asthma topics for health professionals and consumers.
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Better Arthritis Care
The Department referred the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis to Health Ministers which was endorsed in July 2005. An Arthritis and Musculoskeletal Conditions Quality Improvement Program addressing the key clinical focus areas of the national action plan was supported by the Department and managed by the Royal Australasian College of Physicians.
National monitoring of cancer is particularly important as one in three men and one in four women can be expected to be diagnosed with a cancer before the age of 75 years.
During the period 1991 to 2001 there was a 34 per cent increase in new cancer cases compared with population growth of 12.3 per cent over the same period. Much of this difference is due to the ageing of the population and improved screening and early diagnoses.
Each year, an estimated 460,000 people are diagnosed with cancer. Approximately 374,000 (80 per cent) of these cancers are less threatening types of skin cancer – namely non-melanocytic skin cancers. Excluding nonmelanocytic skin cancer, there were 88,398 new cases of cancers in 2001 compared to 65,966 in 1991. Prostate cancer was the most common registrable cancer in males, with 11,191 new cases diagnosed in 2001, followed by colorectal cancer (6,961), lung cancer (5,384) and melanoma (5,024). These four cancers account for 60 per cent of all registrable cancers in males. In females, breast cancer was the most common registrable cancer with 11,791 cases, followed by colorectal cancer (5,883), melanoma (3,861) and lung cancer (2,891), which in total account for 60 per cent of all registrable cancers in females.
Key activities undertaken by the Department in 2004-05 include:
- the Supporting Women in Rural Areas Diagnosed with Breast Cancer initiative implemented across all States and Territories;
- the first round of the Building Cancer Support Groups initiative was conducted in which 15 projects were funded; and
- funding delivered to Camp Quality and Make-A-Wish to assist them in continuing to provide support to children with cancer and their families.
The Department works collectively with all State and Territory governments to improve the safety and quality of health care through support for the Australian Council for Safety and Quality in Health Care (the Council) which was established in 2000. The Office of the Safety and Quality Council, housed in the Department, manages Council activities and facilitates the implementation of Health Ministers’ decisions.
Improving safety and quality is a major focus of Australian Health Ministers’ health reform agenda and in January 2005 they agreed to an implementation plan to progress four priority areas in safety and quality in public hospitals including:
- open disclosure: open communication in public and private hospitals following an adverse event in health care (based on a national Open Disclose Standard);
- performance management: ensuring clinicians have the knowledge, skills and local resources to deliver safe health care (based on a national Standard for Credentialling);
- development of improved information collection to assess the safety and quality of our health care system; and
- external review: ensuring accreditation and review systems in hospitals are robust, and are integrated and streamlined where possible.
The Council’s programs have been extended from a focus on the acute public sector to incorporate aged care and general practice settings. A number of Council tools and strategies are being adapted for use in these sectors in the future. However, considerably more progress is needed in other areas and the Government is also keen that the private health sector is engaged effectively as the quality and safety agenda progresses.
A recent focus for the Department was the coordination of input to the Review of Future Governance Arrangements for Safety and Quality and Health Care
which Ministers agreed to in July 2004. The Review Team reported to Health Ministers in July 2005 and Ministers agreed that the Australian Council for Safety and Quality in Health Care will be succeeded in 2006 by a national body, the Australian Commission on Safety and Quality in Health Care, which will be closely linked to both government and non-government bodies. The Review noted the importance of engaging with the private sector to coordinate safety and quality initiatives across the health system.
Medical Workforce Initiatives
In 2004-05, the Department progressed three medical workforce initiatives announced in the Strengthening Medicare package. The initiatives target overseas trained doctors, bonded medical school places, and medical specialists:
- the number of appropriately qualified overseas trained doctors working in areas of workforce shortage in Australia has increased as a result of medical recruitment activities managed by the Department through international recruitment agencies. During 2004-05, an additional 160 doctors were recruited and had commenced work in areas of workforce shortage, resulting in an increase of 139 doctors over the previous year. This overseas trained doctor initiative was supported by improved training and support for overseas trained doctors, and simplified processes for overseas trained doctors entering and working in Australia;
- the Bonded Medical Places Scheme, managed by the Department, provided an additional 246 publicly funded medical school places in 2005. Students taking up a place under this Scheme are required to work for a minimum of six years in a district of workforce shortage on completion of their training; and
- the Department’s Specialist Re-Entry Program is supporting specialists who want to resume clinical practice after taking a career break. The program provides training and mentoring assistance and training placements for this group.
National Health and Medical Research
Investment Review of Health and Medical Research
The Investment Review was announced by the former Minister for Health and Ageing, the Hon Kay Patterson on 2 October 2003 to assess the impact on Australia’s health and medical research outcomes resulting from the 1999-2000 Budget initiative to double funding for research over six years.
The Investment Review team chaired by Mr John Grant AC was asked to report on the effectiveness and efficiency of NHMRC funding in meeting its objectives and its response to changed priorities and emerging issues in the Australian research environment. The NHMRC made a significant contribution during the course of this review including presenting a detailed submission and providing the Review Secretariat with explanatory information and responses to supplementary questions.
The final report Sustaining the Virtuous Cycle For a Healthy Competitive Australia: Investment Review of Health and Medical Research
was officially released by the Minister for Health and Ageing, the Hon Tony Abbott MP on 9 December 2004. The Australian Government is currently considering the report and its recommendations.
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High Impact Research
Strategic Research Initiatives in areas of National Priority and Aboriginal and Torres Strait Islander Health
The NHMRC was involved in setting and implementing national research priorities, and has taken a lead agency role in the strategic development and support of research in the priority area of Promoting and Maintaining Good Health. The type of support NHMRC provides ranges from grants for investigator initiated or targeted priority driven research projects and programs, as well as to grants for multi-disciplinary collaborations that explore innovative approaches to understanding and improving health.
The NHMRC and the Australian Research Council (ARC) have worked together to actively promote the establishment of multi-disciplinary research in national research priority areas. This has included the joint development and funding of:
- the coordination of leading edge research. In August 2004, $9.3 million was awarded to five networks of researchers that work on: the development of biotechnology tools and new health diagnostics; ways of improving childhood health and the quality of life for older Australians; the control and eradication of parasites; and better understanding the relationship between genes and the environment. A total of $2.5 million has been committed to this initiative; and
- research projects to establish a body of evidence to inform policy makers, industry, practitioners and individuals on health and continuing participation in economic and social life with increasing age. Expressions of interest in competing for grants of up to $500,000 were invited in June 2005. A total of $10.0 million over five years has been set aside for this initiative.
In May 2005 the NHMRC awarded $6.5 million for research under its Healthy Start to Life for Indigenous Children program. This program addresses priorities for action identified by the Ministerial Taskforce on Indigenous Affairs. The taskforce called for early childhood intervention, a key focus of which will be improved mental and physical health, and in particular primary health, and early educational outcomes, as a priority area for action. Research investment was also guided by the NHMRC Road Map: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research which promotes a research focus on the factors and processes that promote resilience and wellbeing during the periods of pregnancy, infancy, childhood and adolescence and form the basis for good health throughout.
Aboriginal and Torres Strait Islander health research is a NHMRC priority for 2003-2006. Expenditure on Indigenous health research was $4.6 million in 2001 and will increase to $14.7 million (almost 3.5 per cent of the total NHMRC research expenditure) in 2005. Activity in this area spans a number of NHMRC Principal Committees. The Health Advisory Committee undertook projects dealing with cardiac rehabilitation in Aboriginal and Torres Strait Islander patients and management of drinking water in remote communities. In addition, Australian Health Ethics Committee continues to promote the implementation of its guidelines for the ethical conduct of Aboriginal and Torres Strait Islander health research.
With the investment of $115 million in 20 new grants in 2005 (60 per cent more than in 2004), the total commitments to the NHMRC Program Grants scheme, introduced in 2002 which address the issue of providing funding vehicles that were of greater size, scope and duration, has now exceeded $500 million.
The NHMRC’s research grants initiatives also included funding to enable Australian researchers to develop closer links with industry and to gain experience in the commercial development of research findings. Expenditure in this area increased from $1.8 million at the end of the last triennium (2000-2003) to more than $3.7 million by June 2005.
To support the future of health related research in Australia, the NHMRC provides funding to a number of projects which support the training of postgraduate students. Support for our brightest scientists and clinicians from starting out to early career development and beyond has always been a component of research expenditure by the NHMRC. While research grants account for almost half of total funding, career related funding is also significant. Support for people in 2005 increased by 19 per cent over that for 2004 (from 862 to 1,054).
The NHMRC issued Ethical guidelines on the use of assisted reproductive technology in clinical practice and research
(the guidelines) in September 2004 following a revision of the 1996 guidelines. The guidelines address complex ethical issues in the area of assisted reproductive technology such as pre-implantation genetic diagnosis and surrogacy. They also form part of the legislative framework to regulate research involving excess embryos from assisted reproductive technology under the Research Involving Human Embryos Act 2002 (RIHE Act 2002).
In collaboration with the Australian Vice- Chancellors’ Committee and the ARC, the NHMRC continued revision of the National Statement on Ethical Conduct in Research Involving Humans
. The National Statement
sets national standards to guide institutions, researchers and Human Research Ethics Committees (HRECs) in the ethical review and conduct of research involving humans, and sets out their respective responsibilities.
Annual compliance reporting by the 220 registered HRECs found that 218 HRECs were compliant with the National Statement
. The compliance status of the remaining two HRECs is dependent on consideration of further information which has been sought from these committees.
In May 2005, the NHMRC hosted the second National Ethics in Human Research Conference. Opened by the Minister for Health and Ageing and attended by more than 400 registrants, the conference provided a national forum for researchers, members of HRECs, ethicists, research and institutional administrators, sponsors of research, students and community members to discuss a range of ethical and practice issues pertaining to research involving humans. The theme of the 2005 conference was ‘Conflicts of interest in human research’.
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High Quality Advice on Health Issues
During 2004-05, the NHMRC developed health advice for the Australian community including best practice clinical practice guidelines for clinicians and information for consumers as well as broader public health advice on issues as diverse as hormone replacement therapy and managing bodies of recreational water.
The NHMRC also continued its program of encouraging development of clinical practice guidelines by other organisations and approved, as meeting the NHMRC standards, guidelines in diabetes, immunisation, acute pain management, and the management of asymptomatic women with screen detected abnormalities.
To maintain the currency of its advice, the NHMRC continued a program of reviewing its publications. In 2004-05, the NHMRC rescinded 56 publications and recommended the review of 11 others.
In addition to the above, and following a request from the Minister for Health and Ageing, the NHMRC, in September 2004, initiated a review of the therapeutic effectiveness and safety of microwave (UHF radiowave) cancer therapy. An interim report was provided to the Minister in April 2005 and a final report is expected in August 2005.
Human Cloning and Licensing of Embryo Research
The NHMRC Licensing Committee was established under the Research Involving Human Embryos Act 2002
(RIHE Act 2002) which was passed by Parliament in December 2002. The Committee is responsible for administering the national regulatory system described by the RIHE Act 2002 and the Prohibition of the Human Cloning Act 2002 (PHC Act 2002).
Under Section 21 of the RIHE Act 2002 there are strict criteria that the Licensing Committee must consider before it decides to issue a licence authorising the use of excess assisted reproductive technology embryos. A total of nine licences have been issued including three during this reporting period.
Under Section 29 of the RIHE Act 2002, the Licensing Committee is required to maintain a public database containing details about each licence issued.
Reporting, Monitoring and Compliance
Under Section 19(3) of the RIHE Act 2002, the NHMRC is required to table a report to Parliament on or before 30 June and 31 December each year, and at any other time required by either House of Parliament. Biannual Reports include information about the operation of the Act and licences issued under the Act. In 2004-05, reports were tabled for the periods 1 April 2004 to September 2004 and 1 October 2004 to 31 March 2005.