Pharmaceutical Society of Australia (PSA) breakfast
Read the transcript of Minister Coulton speaking at the Pharmaceutical Society of Australia (PSA) breakfast at Parliament House.
The Hon Mark Coulton MP
Minister for Regional Health, Regional Communications and Local Government
I'm here today to support the PSA in launching the latest in its series of reports on medicine safety and this one in particular, aged care.
Aged care is a vital part of the broad health system.
All senior Australians deserve quality, appropriate aged care that supports their dignity and respects their choices.
While the Australian Government does not provide aged care, we are responsible for regulation, planning and funding.
Medicine used in aged care was identified some years ago as an important issue for quality care. The Government has worked with the pharmacy sector, including valued contributions from the PSA, to improve the appropriate and safe use of medicines in aged care residents.
However, the Royal Commission in Aged Care, Safety and Quality’s interim report made it clear there’s more that needs to be done. One-third of submissions it received, raised concerns about medication management.
It also heard expert advice that only 10 per cent of the aged care residents who are receiving psychotropic medication should be getting it. These messages are reinforced by the PSA report which has found that 40 to 50 per cent of people living in aged care are on medicines that can cause sedation or confusion, and 50 per cent of people with dementia are taking medicines that can worsen their confusion and other symptoms of dementia. Clearly this is not acceptable.
This chemical restraint was one of the priority issues identified by the Royal Commission's interim report and its concerns are echoed by this PSA report. It found that up to one-third of aged care residents living with benzodiazepines, tranquilisers, and one-fifth are on antipsychotics. In both cases, more than half the patients are receiving these powerful drugs for extended periods.
The royal commission was right when it said the evidence it heard did not describe substandard care so much as a shocking tale of neglect.
We are all shocked and the government responded quickly. The Prime Minister announced a $537 million funding package in response to the release of the interim report last year.
We have restrictions on PBS prescribing of the antipsychotic Risperidone.
We know that many aged care residents have been given the drug for long periods, in some cases even years. The list of common side effects for the long term use of this drug is alarming. The stories coming out of the royal commissioner of families who’s elderly patients have been put on this medication for long periods are distressing.
Since the start of this year, the PBS subsidy for Risperidone for dementia is limited to 12 weeks, initial treatment.
The government has also amended aged care legislation to make it clear that the chemical or physical restraint must only be used as a last resort. The law now refers to the legal responsibility of prescribers under state and territory law to obtain informed consent for chemical restraint.
In addition, the government, with ongoing assistance from the PSA, is developing a new quality indicator on medical management. This will be added to the national mandatory quality indicator program for residential aged care in July next year. Again, I thank the PSA for its involvement.
It's clear that pharmacies have a large and growing role in ensuring medicine safety and aged care.
I represent a regional electorate, it’s actually half the land mass of New South Wales. In 2004, I had my very first council meeting after being elected to council, I was elected Mayor of a regional council in the north of the state.
With the responsibility of mayor, I was then in charge of the aged care facility of which we owned, which was funded under the umbrella of local government with community support.
I realised very quickly that we had a whole range of compliance issues, a whole range of compliance issues in that facility that was so vital for our little town. So I met with the chairman of the advisory committee, who happened to be my elderly father.
And I said, Dad, we're going to have to make some changes and I think we're going to have let the manager go, and we're going to bring a consultant in from Inverell, the town next door, to really go through all the procedures in this place because we're in danger of losing our license.
He said, where she goes, I go. I said, well Dad, nice knowing you.
On a personal note, within two years, he was a resident of the facility that he founded. And everyone would think that would be a great thing to happen, but it wasn't without its issues at the time.
On the farm next to me, the wife of the farmer is our local pharmacist.
Debbie does 100 kilometers a day to go and run her pharmacy in the little town that I live at. So, I certainly have an understanding from her of some of the issues. But that partnership in those regional areas between local government, the local doctor, and the pharmacy are vital.
The pharmacist is a very, very important part of the team in those aged care providers, and we don't talk about it enough. But it’s so important in the country town to be able to spend your final days and ultimately, your passing, amongst your family and friends.
Sadly, I’ve got some towns in my electorate now, where couples who have been together for 65 years, have spent the last 12 months of their life apart because there's not suitable care in their country town.
The challenges of providing that care and service in the country town are enormous but so, so important. So, so important.
We can’t move our residents away from their loved ones to a larger center where it might be more economical to care for them, it's certainly not the appropriate thing to do.
I'd like to acknowledge the expanded role of pharmacists in other aspects of health care and the work you undertake in local communities.
The health challenges in rural and remote areas are varied and complex and require a collaborative approach.
My focus as Rural Health Minister is to improve the quality and distribution of health services and ensure the sector receives the attention and resources that you deserve.
We are serious about addressing current health workforce challenges and we need to look at integrated and collaborative models in primary care.
Not every small town can sustain a doctor, and that’s when community look to you, as the pharmacist, as the only local medical professional for advice and care.
Quite often, with the revolving changeover of doctors, the pharmacists quite often is the one constant.
The pharmacist in Bourke tells me that residents will come in with a script and when he says: what did the doctor say, they answer that they don’t got a clue what the doctor said. You tell me what this means. And so, the pharmacy plays a vital role as a constant in these regional areas.
We're committed to supporting rural pharmacists and the broader allied health workforce.
Last November, I announced the Government would develop a new allied health rural generalist workforce and education scheme.
This will support implementation of an allied rural health generalist pathway by upskilling health professionals, including pharmacists, working in rural and remote areas and improve access to health services.
It will recognise the extra demands of pharmacists and other allied health workers in rural areas through new service models, training and upskilling.
Separate to this, the National Rural Health Commissioner is developing advice to government on improving the quality, access and distribution of allied health services in rural and regional areas. We’ll be submitting this report to the Parliament at the end of June.
This work to improve rural access and health care is underway and it’s critical that we can see that responding to aged care needs and the rollout of the NDIS in rural and remote communities.
There is a clear need for pharmacists to play an ongoing role in improving the safety and quality of health care for older Australians.
While the Aged Care Royal Commission will not deliver its final report until November, the government is acting now to stop medication issues in aged care.
The PSA’s report released today is a valuable addition to the evidence and provides further direction on our path towards better medication safety in aged care.
I sincerely thank you for the work that you do. As the Rural Health Minister, my door is always open and I look forward to collaborating with you to ensure that rural health services are accessible and sustainable in our communities over the long term.
Pharmacy is a key to achieving these objectives and it’s important to be working with you as we look at some pathways to work on pharmacy workforce.
There's been a lot of discussion around doctor shortages, but the pharmacists I speak to tell me constantly that pharmacy workforce is a big issue, and I look forward to working with your organisation as we try and overcome those issues as well.
So thank you, ladies and gentlemen. Enjoy the rest of the day.