Welcome to the 2008 series of e-healthcare brief, the weekly e-mailed newsletter of the Australian Healthcare & Hospitals Association, the peak body representing the public health care sector. We hope you had a relaxing break and are looking forward to the full year of exciting work ahead. Through e-healthcare brief we aim to give you a succinct and lively overview of the most topical issues of importance to members and other healthcare professionals. To find out about our other products and services, such as the highly respected peer-reviewed journal, Australian Health Review, please visit our website.

NOTICES

2008 Summer School of the European Observatory on Health Systems and Policies - Venice

Hospital reengineering: new roles, tasks and structures
The European Observatory on Health Systems and Policies has announced its Summer School in collaboration with the Veneto Region of Italy which will take place on the island of San Servolo in Venice 3 -8 August, 2008. Applications are welcome from all countries across the European Region.

The Summer School will bring together a mix of policy-makers, planners and health professionals to review evidence and share experiences around hospitals and their links with other parts of the health and care systems and the community. The intention is to raise key issues, share participants’ insights (whether they are practitioners or analysts), develop a greater understanding of how evidence and context interact and build networks. The emphasis will be on participative approaches, complemented by some formal teaching (in English).

The 2008 School will look at how hospitals interact with the rest of the health and care system and with the communities around them. The course will focus on the policy rather than management dimensions of boundaries to the outside world. The implications of the relationships with other actors (including patient and consumer groups) will be addressed as well as the repercussions for the division of labour and internal organisation. It will help to understand and show how to support seamless links between services; and how to identify, plan for and manage hospitals' place in health and care systems.

The Summer School’s target groups are (i) senior to mid-level policy-makers and (ii) a limited number of junior professionals who are making careers in policy and management at a regional, national or European level. All participants should be in institutions with decision-making powers whether government or non-governmental (e.g. ministries, national health institutes, federal committees), relevant provider or payer associations (such as national insurance boards, hospitals or hospital federations, management boards, physicians’ chambers) or community stakeholder or consumer groups.

Applications with CV will be invited in a formal announcement in January 2008. A selection process will follow and a limited number of bursaries will be available. The Summer School is accredited by the European Accreditation Council for Continuing Medical Education and therefore counts towards ongoing professional development in all EU Member States. The programme will be tailored to the mix of participants. The course will be led by leading international experts and decision-makers. For more information please contact the Observatory.

AGED CARE

6,500 More Aged Care Places For Older Australians
A total of 6,525 new residential aged care beds worth $233.3 million a year in recurrent funding will be allocated across Australia to provide much-needed care for frail older Australians. The Minister for Ageing, Justine Elliot, also said capital grants of $40.5 million would be allocated to assist aged care providers build or improve residential aged care services. Of the 6,525 places allocated, there are 4,415 high care and 2,110 low care places. The new places are part of the 2007 Aged Care Approvals Round – an annual competitive assessment process that allocates new aged care places to providers who best demonstrate they can meet the needs of the ageing population within a specified region. Decisions on aged care places are made independently by the Department of Health and Ageing.

Funding Boost For Home And Community Care
Late in 2007, the Minister for Ageing Justine Elliot announced increased joint funding for Home and Community Care Programs operating in each of the states and territories. “Home and Community Care is a central element in the Government’s vision for a world-class community-care system that delivers high-quality, affordable and accessible care to meet the individual needs of older people, younger people with a disability, and their carers,” Mrs Elliot said.

DENTAL

New Alliance Formed To Fight For Better Access To Oral Health Care For All Australians
A new organisation, the Australian Oral Care Alliance (AOCA), has been formed to fight for better access to oral health care for all Australians. Spokesperson, Mr Duncan Campbell said, "We welcome the commitment by the Labor governments to invest in public dental programs. However if the government is serious about improving dental services they must put the Nation Registration of health professionals back on their agenda. Giving all oral health professionals the ability to deliver oral health services to their level of professional training and competence is a key aim of the AOCA." Mr Campbell added that "Registration recognises the high level of skill attained by members of the dental team but those skills and abilities are recognised differently from state to state. The Alliance wants uniform national recognition for all oral health professionals and direct access to patients when part of a dental team." The Alliance consists of peak bodies representing dental therapists, hygienists, prosthetists, technicians, laboratories and the industry.

GOVERNMENT

Health Minister's Staff Announced
On 8 January Nicola Roxon announced the senior appointments in the Office of the Minister for Health and Ageing. “I am pleased to announce that Michael Reid will be my new Chief of Staff” said Ms Roxon. Mick Reid has an extensive and impressive history in health reform, having overseen health reform projects across Australia. He has worked with every government in Australia in the areas of health policy, science and medical research, including a five year period as Director-General of the NSW Health Department (1997-2002) during a period of significant reform. He also brings international experience to the role, having worked with the World Health Organisation to improve health services in New Zealand, Hong Kong, Cambodia and East Timor, among others. "With an ambitious agenda ahead of us in health, including the forthcoming Australian Health Care Agreement negotiations, Mick’s experience and drive will be invaluable assets," said Ms Roxon. Dr Angela Pratt will be the new Deputy Chief of Staff. Dr Pratt has been Ms Roxon's senior health policy adviser since she took on the portfolio, and brings extensive knowledge and expertise to the role, especially in the area of Indigenous health. Sean Kelly will be Ms Roxon's senior Press Secretary and has been her media adviser since entering the health portfolio, and has worked in policy and politics across several States. "We have much to do in health. Across Australia, working families are counting on us. I am confident that with my new team in place, we will be able to deliver the broad-ranging health care reform this country needs” said Ms Roxon.

HEALTH POLICY

Healthy Horizons Offers Blueprint For New National Rural Health Plan
The peak lobby group for rural and remote health says a national rural health plan is essential if the Rudd Government is to deliver on its promise to improve health outcomes for Australia’s rural communities. Gordon Gregory, Executive Director of the National Rural Health Alliance, says many of the pieces are already in place for such a plan. “The Alliance believes the best way forward on rural and remote health will be to endorse a collaborative redesign of Healthy Horizons 2003-2007,” he said. Healthy Horizons is the current national framework for rural and remote health. It has the major advantage of having been jointly agreed by Commonwealth, State and Territory Governments and by the Alliance on behalf of rural health consumers and providers. “People in rural and remote areas have been well served by Healthy Horizons 2003-2007, but it is essentially a passive reporting template, without expenditure or outcome targets. Incorporating such targets into the new plan will be in line with the Prime Minister's call for evidence-based policy,” Mr Gregory said. The Alliance is urging Federal and State/Territory health departments to move quickly to develop and endorse a revised Healthy Horizons as the new national rural health plan.

HOSPITALS & HEALTH SERVICES

NATIONAL
The Federal Health Minister, Nicola Roxon, today announced the outcomes of the meeting between State, Territory and Commonwealth Treasurers and Ministers of Health to distribute the $150 million initial funding to reduce elective surgery waiting lists. At the meeting, issues of reforming Specific Purpose Payments and the funding of services across the board for Indigenous people. The full communiqué is available from the Department of Health and Ageing website.

NT
Senior Territorians will receive a greater level and choice of quality care and support with the development of a new federally-funded 65-single room with ensuites residential aged care home in Darwin. The Minister for Ageing, Justine Elliot, last week visited Darwin – for the first time since her appointment – to discuss the Southern Cross Care project with the Territory Government and the Federal MP for Solomon, Mr Damian Hale. Mrs Elliot said one of her first tasks as a minister had been to approve national funding for the Aged Care Approvals Round, with the Territory receiving $6.33 million for the provision of additional aged care places. The announcement also included Capital Grants comprising:

• A $6 million commitment to Southern Cross Care will help to build a new 65-bed residential aged care facility in Darwin; and
• A $334,000 commitment to The Juninga Centre in Nightcliff to upgrade its fire system.

QLD
Burns Patients To Benefit From Queensland's New Skin Bank
The State Government is establishing a Queensland Skin Bank to ensure adequate local supplies of life-saving skin tissue for burns patients and victims of civil emergencies. Health Minister Stephen Robertson said the Bligh Government is investing more than $1.4 million to establish the Queensland Skin Bank and the Queensland Skin Culture Centre. "Burns victims and patients with chronic, hard-to-heal wounds will benefit from having a locally-based supply of allograft and cultured skin in Brisbane," he said. "Each year up to 50 people with severe burns are treated in Queensland as well as patients with chronic wounds that require skin grafts. The Australian Red Cross Blood Service operated a skin bank service in Queensland between 1996-2003 in conjunction with the Royal Brisbane Hospital Foundation. Since then, Queensland has had to import skin from Australia's only skin bank in Victoria, or from overseas, which has proved costly and unreliable." Minister Robertson said "Having a reliable local supply of skin will provide a lifeboat for sick burns patients in whom skin substitutes have failed and wound infection threatens their life. It will assist in improving patient recovery time as well as reducing pain and suffering, scarring and infection rates. Importantly, it will ensure Queensland Health has a banked supply of skin available to respond in the event of a natural disaster, major industrial accident or terrorism incident."

Workforce Boost For Queensland Indigenous Nurses
The State Government will boost the ranks of Indigenous nurses in Queensland by offering 40 cadetships worth a total $600,000 to nursing students. In addition, 12 scholarships each worth up to $10,000 are also on offer for Indigenous registered nurses to undertake postgraduate studies in midwifery and child health in 2008. Stephen Robertson said the Indigenous 'nurse cadets' would each be paid $15,000 for 12 weeks work in public hospitals throughout Queensland to financially support them while they complete their university course. "The first 20 'nurse cadets' have already commenced work in Brisbane, Caboolture, Ipswich, Toowoomba, Mackay, Thursday Island, Cairns and Townsville," Mr Robertson said. "The remaining 20 will be appointed during 2008 and be placed in a hospital with close, appropriate supervision so they can gain extra on-the-job experience while completing their nursing degrees."

Graduate Doctors And Nurses Set To Start In Record Numbers
Record numbers of graduate medical and nursing students will begin work as young doctors at Queensland public hospitals this month. "Queensland Health is providing a record 412 hospital internships in 2008 for young doctors entering the health system for the first time," said Stephen Robertson. "That's 25 more clinical training positions than the 387 base establishment medical internships we provided in 2007. It also represents a significant increase on the 319 medical internships provided for 2006 prior to the start of the State Government's $10 billion Health Action Plan. The 2008 intake of interns includes a number of Rural Generalist positions plus scholarship holders through the Queensland Health Rural Scholarship Scheme. This is good news for Queensland because all these particular new doctors will be working and undergoing clinical training at major public hospitals before going on to work in rural and remote hospitals." Meanwhile Mr Robertson also announced that 911 graduate nurses have already accepted jobs as registered nurses with Queensland Health starting in January, 153 more than started in January 2006 at the beginning of the State Government's $10 billion Health Action Plan. In addition, a further 12 nurses with Queensland Health Rural Scholarship Scheme grants will also start work at rural and remote public hospitals in coming weeks.

TAS
The Australian Government and the Tasmanian Government are strongly committed to working together on improving health services for people in the north-west of Tasmania, including at the Mersey Hospital, the Commonwealth Minister for Health and Ageing, Nicola Roxon, and the Tasmanian Minister for Health and Human Services, Lara Giddings, said last week. “The Rudd Government understands how important health is to the people of North-West Tasmania. We have committed an additional $50 million to improve healthcare services in Tasmania, focused on the North and North-West. We’re also committed to honouring the Mersey Hospital Heads of Agreement signed by the previous Government. We look forward to working closely with Sid Sidebottom and the local community to provide a safe and sustainable hospital service in Devonport," said Ms Roxon. The Minister announced on Friday that the Commonwealth Government would commission an independent analysis on the feasibility and safety of providing critical care services at the hospital.

INDUSTRIAL RELATIONS & WORKFORCE

ACCC Issues Final Notice On AMA Victoria’s Proposal To Collectively Bargain With Latrobe Regional Hospital
The Australian Competition and Consumer Commission issued a final objection notice in relation to the collective bargaining notification lodged by AMA Victoria on behalf of 39 Visiting Medical Officers at Latrobe Regional Hospital on 19 December 2007. AMA Victoria proposed to collectively negotiate, on behalf of the doctors, contract terms and conditions, including fees, with Latrobe Regional Hospital, a base hospital in the Gippsland region of Victoria. ACCC Chairman, Mr Graeme Samuel, said collective bargaining notifications are assessed on a case-by-case basis. "In the Latrobe case, having considered the information before it, the ACCC considers that the public benefit to result from the arrangement would be limited. Hospitals are faced with workforce shortages and the need to engage specialists. There does not appear to be strong evidence of a disparity in bargaining positions between the group of doctors and the hospital." Mr Samuel said the presence of different specialties in the group also reduces the public interest justification for collective bargaining. "The ACCC is concerned that the coverage and composition of the group would lead to potentially anti-competitive outcomes. In particular, the ACCC considers that a potential price rise as a result of the proposed arrangements may force the hospital to operate with fewer medical practitioners, or rationalise services. Despite differences of opinion, the ACCC notes the open and constructive approach adopted by the AMA in relation to this matter and their efforts in addressing matters of interest to the ACCC," Mr Samuel said.

ACCC Allows Wangaratta Anaesthetist Group To Collectively Bargain
The Australian Competition and Consumer Commission has decided not to object to a collective bargaining notification lodged by the members of the Wangaratta Anaesthetic Group, said ACCC Chairman Mr Graeme Samuel. WAG is an associateship of anaesthetists. Its members propose to collectively negotiate with BUPA Australia Health (trading as HBA) a fee for the provision of no-gap billing to HBA members. The ACCC considers that the proposed collective bargaining arrangement may result in some public benefits in the form of increased input into contracts and some efficiency savings. The ACCC considers that the voluntary nature of the proposed arrangements would mitigate against the potential for anti-competitive impact. In particular, it is likely that the proposed collective bargaining arrangements will only lead to an agreement if it is mutually beneficial to both parties. Protection afforded by the notification commenced on 19 December 2007 and will last for three years. As with any notification, the ACCC may review the notification at a later stage should concerns arise.

INFORMATION-COMMUNICATIONS TECHNOLOGY

Federal - State Collaboration Advances Electronic Health Agenda
Minister for Human Services, Senator Joe Ludwig and Minister for Health and Ageing, Nicola Roxon have welcomed the signing of a contract between Medicare Australia and the National E-Health Transition Authority (NEHTA) for the development of a Unique Healthcare Identifier (UHI) service. The UHI service will accurately and uniquely identify people who receive healthcare in Australia and the people who provide healthcare, as well as the places where it is provided. The UHI program is being developed to support progress toward the proposed establishment of a national Shared Electronic Health Records System (SEHR), a system with the potential to save lives and reduce costs. “One of the key building blocks for the establishment of this system is the means for uniquely identifying patients and health professionals, which will ultimately reduce the possibility of information being sent to the wrong health professional or being assigned to the wrong patient,” said Ms Roxon. NEHTA is a not-for-profit company established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. Under the contract with NEHTA, Medicare Australia will be responsible for the design, building and testing of the UHI service.

ANZ Signs On To Electronic Medicare Claiming
Minister for Human Services, Senator Joe Ludwig, announced on 21 December that the ANZ bank had signed on to deliver electronic Medicare claiming, through the Medicare Easyclaim system. ANZ joins the Commonwealth Bank, NAB and Tyro as the fourth banking institution to support the system. This will give more than 70 per cent of doctors with EFTPOS the opportunity to offer Medicare Easyclaim to their patients, once the system is rolled out. Senator Ludwig welcomed ANZ’s sign-on, saying the bank would work with Medicare Australia and the medical profession in delivering on-the-spot claiming. “Electronic Medicare claiming, through either Medicare Easyclaim or the Internet-based Medicare Online, offers increased patient convenience and greater choice for medical practices,” Senator Ludwig said. “On-the-spot Medicare claiming means patients can lodge their claim electronically after they pay the doctor. Their rebate is then deposited directly into their bank account. Since June, GPs and specialists across the country have assisted more than 51 000 patients to lodge their claims through Medicare Easyclaim,” Senator Ludwig said. The Australian Government is supporting medical practices in helping their patients, with a transitional support package aimed at increasing the number of bulk bill and patient claims made electronically.

GPs Get Active With Latest Online Learning
The Royal Australian College of General Practitioners’ (RACGP) innovative online learning platform – www.gplearning.com – has teamed up with the Heart Foundation to deliver new physical activity health education to general practitioners and their practice teams across Australia. “Everyone should do at least 30 minutes of moderate intensity physical activity, such as brisk walking, on all or most days of the week,” said Dr Vasantha Preetham, RACGP President. "This physical activity can be accumulated in bouts of 10 minutes or more if it’s more convenient. Remember, something is better than nothing, but more is better than something! Even moderate amounts of exercise can contribute to great health outcomes – it’s good for your heart, good for your waistline and you will feel great,” said Dr Preetham. The physical activity module is suitable for the entire practice and is made up of three different activities:

• multi-choice questions
• physical activity in general practice including case studies and video footage
• audio/Powerpoint presentation by Dr Susan Wearne from Flinders University.

GPlearning allows general practitioners to access education activities 24 hours a day, seven days a week, making it the easiest way for doctors to update their knowledge and skills.

MENTAL HEALTH

$19 Million Awarded For New Local Youth Mental Health Centres
More than 20 communities across Australia including 14 in rural and remote areas, will soon benefit from a new local headspace youth mental health centre thanks to the National Youth Mental Health Foundation and the Commonwealth Government. Young people experiencing mental health and drug and alcohol problems in these communities will have better access to the help they need as a result of $19 million in grants announced by the Minister for Health, Nicola Roxon at the Western Melbourne headspace. Of particular importance is the unprecedented number of rural and remote services funded through headspace’s Second Funding Round to address critical shortages in these often neglected regional areas. Minister Roxon said grants of up to $1million each would be provided to 20 communities to establish local headspace youth mental health services. Minister Roxon said the 20 communities had committed to a major overhaul of their existing health services to benefit young people with mental health and associated drug and alcohol problems.

PUBLIC HEALTH

Two Million Australians Could Face Chronic Kidney Disease
Kidney Health Australia has warned Australia is losing the kidney disease battle, with deaths from kidney failure having doubled in the past twenty years. KHA states there is an urgent need to review and upgrade the previous Federal Government policies on national early detection programs. The organisation said Australia is urgently in need of an early detection program as approximately 1 in 3 Australian adults are at risk of developing Chronic Kidney Disease (CKD), which is the 7th most common cause of death exceeding diabetes, respiratory disease and suicide. Anne Wilson, CEO of Kidney Health Australia said, “Over 40 people die each and every day from kidney failure in Australia." Apart from the human suffering involved, a Report on the Economic Impact of End-Stage Kidney Disease in Australia by the George Institute for International Health commissioned by Kidney Health Australia said the cost of treating Kidney Disease in Australia will jump from $700 million to $900 million by 2010. This will provide a major challenge for the Federal and State Governments to maintain patient services in the face of an ageing population and other chronic diseases such as diabetes which acts as a trigger for Chronic Kidney Disease.

RESEARCH & REPORTS

Higher Death Rates In Rural And Remote Areas
The Rural Doctors Association of Australia (RDAA) says findings on higher death rates in rural Australia, contained in a recent Australian Institute of Health and Welfare (AIHW) report, underline why improving access to rural healthcare must be a special focus in the development of the Federal Government’s new National Primary Care Strategy and in the deliberations of the National Health and Hospitals Reform Commission. The AIHW report, Rural, regional and remote Australia: a study on mortality, found that death rates were about 10% higher in regional areas and up to 70% higher in very remote areas. RDAA has estimated from the report’s findings that around 4500 rural Australians are dying each year when they would otherwise survive if they were living in a major city. The higher death rates were particularly concentrated in people younger than 65 years, and in remote areas were mainly reflective of the relatively higher proportion of Indigenous Australians. For country people aged less than 65 years, the major causes of higher death rates included motor vehicle accidents, coronary heart disease, other circulatory disease and suicide. For males in regional areas, prostate cancer was also a large contributor to excess deaths. For females in those areas, diabetes and lung cancer were also significant contributors to excess deaths.

Pollution Shrinks Foetus Size: Brisbane Study Finds
Exposure to air pollution significantly reduced foetus size during pregnancy, according to a new study by Brisbane scientists. Queensland University of Technology senior research fellow Dr Adrian Barnett said the study compared the foetus sizes of more than 15,000 ultrasound scans in Brisbane to air pollution levels within a 14km radius of the city. "The study found that mothers with a higher exposure to air pollution had foetuses that were, on average, smaller in terms of abdominal circumference, head circumference and femur length," Dr Barnett said. The 10-year study, which was undertaken by Dr Barnett, Dr Craig Hansen (US Environmental Protection Agency) and Dr Gary Pritchard (PacUser), has been published in the international journal Environmental Health Perspectives.

What’s hanging around your neck?
Research published in the latest Medical Journal of Australia by Kotsanas et al has found that lanyards and identity badges are a common source of pathogenic bacteria in hospitals. A total of 27 lanyards were identified with pathogenic bacteria, compared with 18 badges, from a total of 71 staff sampled. Analysing lanyards and badges as a combined group, seven had methicillin-resistant Staphylococcus aureus (MRSA), 29 had methicillin-sensitive S. aureus (MSSA), four had Enterococcus spp and five had aerobic gram-negative bacilli. Lanyards were found to be contaminated with 10 times the median bacterial load per area sampled compared with identity badges. There were no significant differences between nurses and doctors in total median bacterial counts on items carried, but doctors had 4.41 times the risk of carrying MSSA on lanyards (95% CI, 1.14–13.75).