Australian Labor Party Senators' Dissenting Report
Labor Senators do not
see merit in these bills and oppose them in their entirety without amendment.
The costs to Australia’s healthcare
system due to preventable disease continue to rise, and without coordinated
action by government will continue to do so.
Labor established the Australian
National Preventive Health Agency (ANPHA) to ensure the nation’s effort to curb
the rise in preventable illness was coordinated, properly resourced and a
priority of the Australian government.
Health Workforce Australia (HWA) was established by Labor to ensure that
for the first time since Federation an independent statutory agency existed to
provide advice and ensure Australia’s future health workforce needs were properly
planned and distributed.
The best way of ensuring Australia’s future health workforce is most
properly distributed and appropriately resourced is through an independent
agency tasked explicitly with that role.
Coalition Senators delayed the commencement of ANPHA and HWA and
prevented even more achievements being realised because of these delays.
The bills are unnecessary and
political in nature
The Coalition Government has failed to realise the role of ANPHA nor has
it acknowledged its work to date in making the decision to abolish the Agency.
In his second reading speech the Minister for Health stated that ANPHA was
established to 'focus on the prevention of the harmful use of alcohol, on
obesity and on tobacco'.
As noted by the Consumers Health Forum , this is a limited understanding
of the role ANPHA was established to fulfil, and indeed it was established
[To support] all Australians in reducing their risk of
chronic disease by embedding health behaviours in the settings of their
pre-schools, schools, workplaces and communities, by instituting programs
across smoking, nutrition, alcohol, and physical activity (SNAP) risk factors
which mobilise the resources of the private, public and non-government sectors.
ANPHA was established to:
- provide evidence based advice to federal, state and territory health
support the development of evidence and data
on the state of preventive health in Australia and the effectiveness of
preventative health interventions; and
put in place national guidelines and standards
to guide preventative health activities.
Labor Senators note that the Coalition Government has abandoned the National
Partnership Agreement on Preventive Health and the associated $367 million
in Commonwealth funding without establishing any policy rationale for having
The abolition of ANPHA removes the independence with which governments
receive advice on evidence based policy and the development of evidence to
develop national guidelines and standards to develop and guide preventive
The Coalition Government is not properly resourcing the Department of
Health to ensure that the functions of ANPHA and HWA can continue
Department of Health officials gave evidence that the Department has
resourcing to employ approximately half the number employed at ANPHA.
The health sector including most organisations directly affected by the
abolition of HWA have almost universally expressed opposition to the decision
and concern about the important role the agency has played being continued by
the Department of Health.
Australian National Preventive Health Agency (Abolition) Bill 2014
The abolition of ANPHA will cost
the health system more in the long run
The policy drivers for the establishment of ANPHA have not changed. As
the Queensland Government’s Department of Health noted 'ANPHA’s vision – A
healthy Australian society, where the promotion of health is embraced by every
sector, valued by every individual, and includes everybody – remains relevant'.
Over the past decade the incidence of almost all preventable illnesses
has continued to increase. According to the ABS 2011–13 Australian Health
Survey, nearly two-thirds of Australians aged 18 or over are now overweight or
obese (63%—comprised of 35% overweight and 28% obese), compared with about 56%
Chronic disease continues to be the leading cause of death in Australia:
Coronary heart disease was an associated cause of death for
51% of deaths due to diabetes, 28% of deaths due to chronic and unspecified
kidney failure and 19% of deaths due to chronic obstructive pulmonary disease
Hypertensive disease was an associated cause of death for 35%
of deaths due to diabetes, 28% of deaths due to cerebrovascular diseases (which
include stroke) and 21% of deaths due to coronary heart disease.
Kidney failure was an associated cause of death for 26% of
deaths due to diabetes.
Labor is concerned that taken with the Coalition Government’s decision
to abandon the $367 million National Partnership Agreement on Preventive
Health the Commonwealth will have no role in funding or developing
preventive health policy and that this will add an unnecessary burden and cost
to the health system in the future due to even higher rates of chronic disease
such as diabetes and heart disease.
Labor Senators are encouraged by the fact that smoking rates continue to
decline but note this is only the result of increased disincentives to smoke
and reforms introduced to remove tobacco companies’ capacity to market their
products through world leading plain packaging laws.
The Royal Australasian College of Physicians highlighted the potential
ANPHA had to prioritise preventive health and the impact the failure to invest
in preventive health will have on the health system:
The RACP is concerned that the repeal of the Australian
National Preventive Health Agency (ANPHA) sends a very negative signal to the
community about the value of preventive health, especially as it comes on top
of the discontinuation of the National Partnership Agreement on Preventive
Health. The abolition of ANPHA has the potential to reduce Australia’s capacity
to develop a national, strategic direction for preventive health and to inform
a consistent approach to prevention across all levels of government, as there
will no longer be that independent body working across jurisdictions.
Long-term and well-planned preventive health measures are
highly effective investments, and necessary to address many of the chronic
health issues exacerbated by lifestyle related behaviours and choices. Chronic
disease is rising in incidence in Australia and is placing increasing pressures
on our healthcare system – both from a patient care and a cost perspective –
and needs to be addressed.
The Public Health Association of
Australia pointed out the bill 'simply flies in the face of an agreement
by all governments in Australia. It is a unilateral action by a single
government to do away with an agreement reached between governments. It is one
of a series of moves that undermine the actions that have been taken to promote
preventive health in Australia'.
The National Rural Health Alliance likewise pointed out:
Preventive action costs relatively little but has been at the
heart of Australia’s status as one of the world’s longest-lived and healthiest
countries. Despite its undoubted benefit-cost ratio, only around three per cent
of Australia's health dollar is currently spent on health promotion and illness
prevention. It is to be hoped that the value of this three per cent will be
monitored and that there will be a sustained effort to increase it...
To be effective, health promotion efforts need to be
sustained through time. The experience with skin cancer prevention campaigns,
for example, has shown that benefits can take many years to come to fruition.
Work to tackle issues such as high levels of alcohol consumption and smoking,
diabetes and obesity should have the benefit of being sustained.
Labor members of the committee recommend that the Australian National
Preventive Health Agency (Abolition) Bill 2014 be opposed.
Health Workforce Australia (Abolition) Bill 2014 [Provisions]
Abolishing Health Workforce
Australia will undermine Australia’s capacity to plan for future health
The policy drivers surrounding the establishment of Health Workforce
Australia are as important today as they were when the Agency was established
In 2004 COAG asked the Productivity Commission to investigate
Australia’s health workforce. In its report released in 2006 the Productivity
Commission concluded a more responsive and sustainable health workforce was
Labor acted on these recommendations in 2009 and established HWA to
ensure more streamlined and integrated clinical training arrangements were in
place and to support health workforce reform initiatives, health workforce
research, as well as new health workforce models and reforms.
This decision was made due to 'chronic shortages in general practice,
various medical specialties, dentistry, nursing and certain allied health
The abolition of Health Workforce Australia brings with it a $142
million reduction in funding for health workforce reform projects and health
workforce planning. The reduced funding will mean much of the expertise and
work HWA has been undertaking to date will come to an end.
The decision by the Coalition Government to abolish HWA was made without
reference to the Standing Council on Health which had already endorsed HWA’s
Strategic Plan 2013–16.
The decision by the Coalition Government to abolish HWA will mean there
is no independent body advising State, Territory and Commonwealth Health Ministers
on the distribution of Australia’s health workforce or on their state or
territory’s future health workforce requirements and distribution.
The lack of consultation and haste with which the decision to abolish
HWA was made has left the Department without the resources or ability to absorb
the clinical training programs undertaken by HWA to develop Australia’s future
doctors, nurses and allied health professionals. This includes a cut of $10.5
million to expand the capacity of the university sector to provide clinical
placements to 22 different health professions. This will impact on
Australians’ access to the nation’s health workforce.
The abolition of HWA also sees the loss of its work agenda agreed by the
Australian Health Ministers Advisory Council including 'improving coordination
of medical training by working with trainees, employers, educators and governments
through a new National Medical Training Advisory Network; analysing state and
territory health workforce industrial arrangements to identify barriers and
enablers to workforce reform; investigating the implications of increasing
self-sufficiency in the medical workforce; streamlining clinical training
funding through the development of nationally consistent approaches to clinical
training placements in the public, non-government and private sectors and
focusing work on the retention and productivity of nurses'.
The work to improve the equity of access to general practitioners,
medical specialists, nurses and allied health workers in rural and regional
Australia will be undermined because of the decision to abolish HWA and the
funding cuts to programs.
The work HWA has been undertaking since 2009 has almost universal
support from the health sector.
The Australian Medical Association (AMA) noted in its submission:
The AMA has strongly supported the medical workforce planning
and coordination activities of Health Workforce Australia (HWA) since it was
established in 2009. HWA has undertaken substantial long-term national
workforce planning projections for the medical profession and established
programs to expand the capacity of our health system to train the next
generation including funding for additional clinical training capacity and
Australia cannot afford to waste the significant investment
it has made in boosting medical student numbers. For the community to benefit
from this investment, there needs to be robust workforce planning to ensure
that medical graduates can access quality training positions and that the
future medical workforce is better matched to community need. This must be
backed by well-informed policy advice and funding to expand our training
After a long hiatus, we are now in a position where that
information, advice and capacity enhancement is being delivered by HWA and we
must not lose this momentum. Clearly, the NMTAN also has the potential to
improve the available medical workforce data as well as the coordination and
planning of the medical training pipeline. Its work is taking on an increasing
urgency due to the shortage of vocational training posts highlighted earlier
and the fact that the advertising of posts and applications for entry to
vocational training in 2016 will occur in mid- 2015. This leaves only a year
for substantial work to be done that can inform vocational training numbers and
guide doctors’ career choices.
The Australian and New Zealand College of Anaesthetists (ANZCA) concur
that the reasons for establishing HWA in 2009 are just as important today,
These arguments for a unique entity to undertake this role
still apply to this day.
ANZCA is concerned that subsuming these activities within the
Department of Health may result in health workforce matters not receiving the
high priority that they deserve. Such an outcome would be unacceptable to
ANZCA. This is particularly so when the imperative to create a health workforce
able to meet the current and future healthcare needs of all communities has
never been greater.
During the four years that HWA has been in operation there
has been a marked improvement in the understanding of workforce issues within
the overall Australian healthcare environment. Meaningful data have been more
freely available and shared within the sector, leading to greater capacity for
policy makers and clinicians to have robust discussions about critical
It is vital that a national coordinated approach to the
collection and analysis of workforce data continues. This must include
iterative workforce model updating as new data come to hand. HWA has highly
skilled staff working in this area and it is important that any proposed new
workforce unit within the Department of Health is funded at a level that
ensures personnel of this calibre can be employed. It is clear that failure to
adequately plan for the transition of this key function could harm the capacity
of the health sector to undertake workforce planning for years to come.
ANZCA has greatly appreciated the opportunity to engage with
HWA during its brief history on a range of issues of strategic importance to
the College in helping to meet the healthcare needs for Australia into the future.
This was particularly so over the past year with respect to the proposal for a
National Medical Training Advisory Network (NMTAN), and prior to this in
relation to health workforce modelling for the medical workforce generally and
anaesthesia and pain medicine specifically. The College has anticipated an
ongoing role, providing input to future workforce modelling and policy
Health Ministers agreed that HWA should establish the NMTAN
in response to the findings of Health Workforce 2025, Doctors, Nurses and
Midwives (HW2025) which found that:
Poor co-ordination of medical training was contributing to a
lengthening of the time taken to produce independently practicing specialists,
as well as projected oversupply in some areas and undersupply in others.
There was a reduction in the number of generalists due to a
growing trend towards specialisation and sub-specialisation. There were lost
opportunities to rectify the geographical maldistribution of the workforce.
There was an over-reliance on overseas trained doctors.
ANZCA supports a coordinated national effort to bring
together all relevant stakeholders to improve medical training and provide a
more planned approach to medical workforce across the country. ANZCA recognises
that NMTAN is an ambitious concept. However, we welcome this initiative as a
necessary mechanism to balance the needs of the community for quality
healthcare with the training requirements of doctors to meet these needs.
Universities Australia highlighted:
[M]uch of the work undertaken by HWA had been identified by
governments and agencies such as the Productivity Commission as inadequate
prior to its formation ... Health workforce planning and development is not just
essential for ensuring an adequate and capable workforce, but helps to deliver
cost effectiveness and containment. Workforce shortages typically result in
service and wage cost blowouts without necessarily leading to productivity
It is critical that as a nation we do not undermine our
capacity to meet future health care demand. Ensuring Australia has a highly
skilled and distributed workforce to meet growing and changing population needs
is and should remain a central strategy for effective health care provision
while containing expenditure.
The need to act on these issues is immediate. The abolition
of HWA potentially diminishes our capacity to identify systemic issues and act
coherently to deal with them.
The Australian Medical Students Association (AMSA) similarly noted:
HWA established the National Medical Training Advisory
Network (NMTAN). It is the objective of NMTAN to provide advice to government
on addressing training bottlenecks. The NMTAN is also aiming to produce a
National Medical Training Plan. These objectives represent a significant step
forward in health workforce planning, and contrast to the haphazard manner in
which medical training has been addressed in the past, resulting in the
bottlenecks we face today.
AMSA has also engaged with other subsidiaries of Health
Workforce Australia. The Future Health Leaders organisation is an HWA
initiative. It provides a valuable forum for young people who will be involved
in Australia’s healthcare system in the future – allowing them to discuss
important healthcare issues. We encourage the Committee to ensure this
initiative is not lost during the transition to the Department of Health..
Australia must retain its Australian-trained doctors. Health
Workforce Australia has been instrumental in highlighting this fact, and in
addressing barriers to achieving this goal. HWA was also set to make important
contributions in addressing issues including the geographic workforce
maldistribution, trends towards subspecialisation, and the use of
overseas-trained doctors to fill workforce gaps. HWA brought together numerous
stakeholders and created an independent space for them to collaborate in order
to deliver the best health outcomes from Australia.
AMSA is concerned that the disruption caused by moving Health
Workforce Australia’s functions to the Department of Health will come at a
critical juncture in addressing Australia’s health workforce needs. Beyond the
predicted shortage in medical internships in 2014, there is only about one year
for the broader postgraduate training bottleneck to be resolved before this too
hits a crisis point. It is therefore important that any disruption does not
impede upon the process being made by HWA and, in particular, by the NMTAN.
AMSA would encourage the Committee to ensure this is not the case.
The Royal Australasian College of Physicians (RACP) was similarly
supportive of the role HWA has played and expressed ‘concerns regarding the
full implications of the Health Workforce Australia (Abolition) Bill 2014 (the
Bill) and its effective transition to the Commonwealth Department of Health. RACP argued:
The core functions currently performed by HWA are becoming
more rather than less important. Driven by Australia’s aging population,
increasing levels of chronic disease and the emergence of new healthcare
technologies, there will be a need for changing models of healthcare which in
turn dictates changing workforce needs. Hence, there is a significant
imperative for the timely collection and analysis of detailed and accurate
health workforce data. This data needs to be able to be considered at a
national, State and local level. HWA’s health workforce data collection and
analysis functions also need to be seen in the broader context of its role in
facilitating and developing new models of care. The two functions are allied as
the workforce data collected and analysed by HWA can and should also be used by
State and Federal jurisdictions to drive workforce policy and coordinated
development of new models of care. The continuation of these related functions needs
to be assured following the abolition of HWA.
Labor members of the committee recommend that the Health Workforce
Australia (Abolition) Bill 2014 be opposed.
Senator Carol Brown Senator
Nova Peris OAM
Senator Jan McLucas Senator
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