Author: gg@gordongregory.net

Do the Government’s claims about its rural health strategy stack up?

Note: This piece was first published in Croakey, 9 July 2018.

In the Federal Budget in May, the Government announced what it called a Stronger Rural Health Strategy.

It would be very useful to have a national strategy to guide and inform governments and other agencies concerned with the status of health and health services in rural and remote areas.

But this Budget document is not it.

It is a package of programs for rural medical education, many of them reshaped versions of programs that already exist – and with some questions needing to be clarified about exactly what is intended (for instance, how much money will be allocated).

A Federal Budget program cannot, by definition, be a longer-term, national strategic document: the Budget looks forward over only four years; is about the allocation of funds rather than goals and principles; and is not something that can be endorsed by States/Territories and by both sides of politics.

For much of the period between 1991 and 2007, there was a real National Rural Health Strategy, issued by the Health Ministers’ Conference and jointly approved by all health jurisdictions and the sector itself, represented by the National Rural Health Alliance. The most comprehensive and longest-lasting of these was called Healthy Horizons and was in place from 1999 until 2007.

In the first of three pieces for Croakey, I unpack the current Stronger Rural Health Strategy package, make the case for a new bipartisan National Rural Health Strategy, describe its place vis-a-vis health sector ‘road maps’, ‘plans’ and programs, and illustrate what such a document would contain.

Unpacking the Stronger Rural Health Strategy

Senator Bridget McKenzie, Minister for Rural Health, has described the Stronger Rural Health Strategy announced in the May Budget as “the most comprehensive workforce reform package ever produced in Australia” and as “a comprehensive and transformational rural health package over the next 10 years”.

She continued by saying that The Stronger Rural Health Strategy “resets 29 years of incremental regulatory build-up at every stage of the medical workforce supply, including teaching, training and retention”.

Are these claims reasonable, or is the lily being somewhat gilded?

Close scrutiny of publicly available materials about that Strategy suggests that these claims may be exaggerated.

The first thing to say is that where rural and remote health issues are concerned, the Stronger Rural Health Strategy (hereafter SRHS) is not comprehensive. It concerns only health workforce issues. And in almost all respects it concerns medical workforce issues only.

The fact that all of the Department of Health’s workforce programs now fall under the aegis of the Chief Medical Officer is significant. There are now only vague but fond recollections of the time when there was an Office of Rural Health.

In what way the SRHS is ‘transformational’ is not clear to me. The Minister’s emphasis in her Senate speech on the “resetting” of regulation or red tape is curious. The medical workforce is one of the most heavily regulated there is, and neither the profession itself nor the general public seem to have any objection.

The centrepiece of Australia’s medical system for years has been a regulated market and price for the services of GPs. Through the Medicare Benefits Schedule (Medicare, essentially) a floor price is set for their services, irrespective of clinical need, effectiveness or general quality. Competition between increased numbers of vocationally registered GPs does not reduce the price they charge below the level set by the Schedule.

And the public have a strong interest in regulation. Without it there would be no Medicare.

Let’s not forget too that it is the regulation of overseas trained doctors that prevents them for a period from competing with Australian trained clinicians in the cities, and which provides the mainstay (40-60%) of GP services in many rural and remote areas.

Regulation also plays a critical role in establishing and preserving specific rural programs such as those funded through the universities and the Rural (Health) Workforce Agencies.

The next thing to note is that a Budget commitment over 10 years is meaningless given the uncertainties about who will be in government in that period, what their view will be about the importance of rural health, and what their capacity will be to fund essential services like health. Governments will always face the trap of spending too many of the fruits of economic growth for political purposes, mainly through unwise tax cuts.

The Government’s consistent messaging about the SRHS is that it is “a $550 million investment to support improved rural health services”.

Questions abound

Where the $550m comes from is a mystery – and is likely to remain so, given that the Budget papers only deal with the period until 2021-22.

One thing that can be said is that, over 10 years, that’s an average of $55m a year. Given that the primary health care deficit with which people in rural and remote areas have to live has been estimated at over $2 billion each and every year, $55m a year is really not a lot.

It is to be hoped that current and future Australian Governments give more priority to rural and remote health workforce issues than is indicated by $55m a year.

The Budget papers show that the SRHS will be provided with $83.3 million over the five years 2017-18 to 2021-22. The funding over those five years is concentrated in the second and third years (2018-19 and 2019-20) and valued at $150m. In the other three years there are savings against the program, valued in total at about $70m. This surely needs explaining. It would be good to know which of the programs will have reduced funding in the fourth and fifth years.

Of the $150m allocated in total for 2018-19 and 2019-20, only $122m is current expenditure for the Department of Health.

Several elements of the package are augmentations or re-arrangements of existing programs, such as extension of the Rural Health Multidisciplinary Training Program, updating the geographic eligibility criteria for rural bulk billing incentives, amending return of service obligations under bonded medical training programs, and streamlining the GP training arrangements provided through the two Colleges.

From 1 July 2019 the General Practice Rural Incentives Program and the Practice Nurse Incentive Program will be combined and re-named the Workforce Incentive Program. This is just the latest iteration of general practice incentive programs that have existed for at least 25 years. Extension of the program to support nurses, Aboriginal and Torres Strait Islander health professionals and allied health workers is welcome.

Incrementalism

One of the higher profile initiatives in the package is establishment of the Murray-Darling Medical Schools Network, credited with “creating end-to-end medical school programs that take school leavers straight to rural medical schools”.

This is an incremental addition to what has been happening in medical education and training for twenty years, but is not ‘transformational’. The Integrated Rural Training Pipeline for medicine (IRTP) was announced in December 2015.

The Murray-Darling Medical Schools Network will receive $95.4 million over a period not specified in the Budget papers. There will be no additional medical Commonwealth Supported Places (CSPs) in the universities. Rather, 2 percent of the existing CSPs (up to 60) will be subject to competition between university providers, including the new Murray-Darling Network.

The amount allocated to the SRHS includes an extra $84.1m for the Royal Flying Doctor Service, bringing total Commonwealth funding of the RFDS to $327 million over the next four years. (Inclusion of this $84.1 and its extrapolation through to year ten may help explain the difference between the Budget paper’s five-year $83.3m and the headline $550m over ten.)

The continued seriousness of the bottleneck at the Registrar stage of training for general practice is recognised by a couple of means.

From 2021 there will be an additional 100 places for junior doctors in training for rural generalist practice. To provide more registrar positions away from the metropolitan hospitals, the pathways through the RACGP and ACRRM will be ‘rationalised’. There will be a Rural Primary Care Stream and a Private Hospital Stream. Both will be very welcome, with the latter providing salary support for junior doctors working in private hospitals.

Further additions to the number of doctors working in rural areas will come from encouragement to those who currently do not have Vocational Registration (VR) to obtain it by enabling them to directly bill Medicare if they work in a place classified 2-7 in the Modified Monash Model.

Moves are foreshadowed towards the situation in which all bonded medical students will have a three-year bonding period, and there will be some changes to the regulation of their return of service obligation.

Presumably the key selling point of the SRHS – that it “will deliver 3,000 specialist GPs to the regions over the next 10 years” – is based on an estimate of the extra number who will adopt rural practice in order to obtain VR, to acquit return of service obligations, to train in the Rural Generalist Pathway, and/or in response to more closely targeted place-based incentives.

Partly as a response to Health Workforce Australia’s 2014 report that projected health workforce supply and demand through to 2025, there will be a new planning tool for health workforce and services data. It will help the Department to anticipate workforce shortages among professions registered with the Australian Health Practitioner Regulation Agency and tweak incentives and training funding as appropriate.

Overall the SRHS continues the Australian Government’s positive engagement with an issue that is top of the mind for many people: having access to a doctor. It includes some incremental moves down a familiar track but is no more than a partial treatment for the ills of people and communities in rural and remote Australia.

Further explanation needed

However, some of its elements warrant further explanation. For example, one of the SRHS Fact Sheets informs readers that there is to be continued funding for the Australian Primary Health Care Nurses Association and “an independent review of nursing preparation and education”.

Both of these initiatives are welcome but the particular Fact Sheet includes no mention of the words ‘rural’ or ‘remote’ so that inclusion of these elements in the SRHS may be bogus.

Medicine is still front and centre where the Federal Government’s consideration of rural health is concerned, and strong advocacy must continue to try to extend its role to other disciplines, health care settings and health-related sectors, and to topics other than the workforce.

A centrepiece of this advocacy should be work on a new, real National Rural Health Strategy that would be approved by both sides of politics, governments at all levels, and the rural and remote health sector itself.

 

123 years of argument for primary prevention in healthcare

Here’s a new take on the better sense of trying to prevent ill health rather than merely treating it. It’s from a speech last week by a Conservative member of the House of Lords, Lord Prior of Brampton, a former UK Minister for NHS Productivity:

“Simply putting more money into the NHS and hoping for the best will not work. With funding must come radical reform. We need a shift from ‘diagnose and treat’ to ‘predict and prevent’. Care must be joined up around - and tailored to - the patient.”

And here’s the take on the issue from 1895 – 123 years ago – with which everyone is familiar.

The Fence or The Ambulance
by Joseph Malines, "an American physician"

‘Twas a dangerous cliff, as they freely confessed,
 Though to walk near its crest was so pleasant:
 But over its terrible edge there had slipped
 A duke and many a peasant;
 So the people said something would have to be done.
 But their projects did not at all tally:
 Some said, “Put a fence around the edge of the cliff”
 Some, “An ambulance down in the valley.”

But the cry for the ambulance carried the day.
 For it spread to the neighbouring city:
 A fence may be useful or not, it is true,
 But each heart became brimful of pity
 For those who had slipped o’er that dangerous cliff,
 And the dwellers in highway and alley
 Gave pounds or gave pence, not to put up a fence,
 But an ambulance down in the valley.

“For the cliff is alright if your careful,” they said,
 “And if folks even slip or are dropping,
 It isn’t the slipping that hurts them so much
 As the shock down below - when they’re stopping,”
 So day after day when these mishaps occurred,
 Quick forth would the rescuers sally
 To pick up the victims who fell off the cliff,
 With their ambulance down in the valley.

Then an old man remarked, “It’s a marvel to me
 That people give far more attention
 To repairing results than to stopping the cause,
 When they’d much better aim at prevention.
 Let us stop at its source all this mischief, cried he.
 “Come neighbours and friends, let us rally :
 If the cliff we will fence, we might almost dispense
 With the ambulance down in the valley.

“Oh, he’s a fanatic.” the others rejoined:
 “Dispense with the ambulance Never!
 He’d dispense with all charities, too, if he could:
 No, no! We’ll support them forever.
 Aren’t we picking up folks just as fast as they fall?
 And shall this man dictate to us? Shall he?
 Why would people of sense stop to put up a fence?
 While their ambulance works in the valley?”

But a sensible few who are practical too,
 Will not bear with such nonsense much longer
 They believe that prevention is better than cure
 And their party will soon be the stronger
 Encourage them, then with your purse, voice and pen
 And (while other philanthropists dally)
 They will scorn all pretence, and put up a stout fence
 On the cliff that hangs over the valley.

PPS (Post Poem Script): When Bruce Harris sent me a copy of this poem in 1997 as part of my training for work in the health sector he commented – with his usual wit and wisdom – as follows:

“From the parable:

– choose to live in a place with no cliffs – ideal but unlikely;
– don’t go near the cliff – education, expects too much;
– build a fence – authoritarian, expensive.

Until these happen, some of us have to man the ambulances!”

 

Solstice and Sunlight

The Winter Solstice in Canberra is on Thursday, 21 June 2018 at 8:07pm AEST.

After the Winter solstice the days get longer, and the day has therefore been celebrated in many cultures as a time of rebirth.

“In the Southern Hemisphere the Winter solstice, also called Hibernal solstice, is the moment when the path of the Sun in the sky is farthest north. At the Winter solstice the Sun travels the shortest path through the sky, and that day therefore has the least daylight and the longest night.”

“When the Winter solstice happens in the Southern Hemisphere, the South Pole is inclined about 23.4° away from the Sun, with its vertical rays are overhead at their northernmost position, the Tropic of Cancer (23°27′ N).”

“According to the astronomical definition of the seasons, the Winter solstice marks the beginning of the season of winter, which lasts until the vernal equinox (September 22 or 23).”

On the shortest day

on the shortest day i lie in the sun
 but feel the shade sweep over me
 hoping the dark will turn to light
 and that chance might four-leaf-clover me

this sun through glass has kept me here
 and belief in tasks worth doing
 but suppose that jobs are over now
 the agendas changed or going

suppose a canker is really inside
 not cured by sunshine at all
 where will we be – my friends and i
 when the long summer evenings call

it’s not in a bottle, not in a pill
 and not in these fears of mine:
 it’s on the breath and in the soul
 where even the sun can’t shine

if contentment comes but once a year
 when the shortest day is now over
 it might after all be just enough
 – and time will grow the clover



gg    21/6/2008

 

Bob Carr, Anthony Powell and me

Apart from sundry genes, the most important thing I have given my children has been a full set of Anthony Powell’s A dance to the music of time.

The first in this 12-volume novel was published in 1951, the last in 1975. The stories, the writing style and the humour have fascinated and entertained me ever since I came across the first volume, A question of upbringing, around 1970.

At some random stage in the young life of each of my four children they have been presented with a set of the books and given the understanding that it is my favourite work. There is no other rite of this sort to which they have been subject. This makes Anthony Powell and these 12 books matters of great significance to me and, I hope, to them.

Family gatherings have occasionally been regaled with a reading of the opening scene of the first book, which sets the tone for both subject and style of the whole work.

"The men at work at the corner of the street had made a kind of camp for themselves, where, marked out by tripods hung with red hurricane-lamps, an abyss in the road led down to a network of subterranean drain-pipes. Gathered round the bucket of coke that burned in front of the shelter, several figures were swinging arms against bodies and rubbing hands together with large, pantomimic gestures: like comedians giving formal expression to the concept of extreme cold."

The works of Anthony Dymoke Powell (1905 – 2000) have remained in print continuously and have been the subject of TV and radio dramatisations. In 2008, The Times named Powell among their list of “The 50 greatest British writers since 1945”.

Some of the key facts of his life serve almost as a synopsis of the subjects of A Dance to the Music of Time. His father was an officer in the Welsh Regiment and his mother “came from a land-owning family in Lincolnshire”.  He went to Eton and Balliol College, Oxford, where he “was awarded a third-class degree at the end of his academic years”. He married Lady Violet Pakenham in 1934. During the second war he served in the Welch Regiment and later the Intelligence Corps. In 1973 he declined an offer of knighthood.

Anthony Powell died near Frome, in Somerset, in March 2000.

One of the characteristics of Powell’s novel is the occurrence of coincidence at what might be regarded as an unlikely rate. People keep meeting in unexpected circumstances with those with whom they have had previous contact; newly-introduced characters turn out to have links with people and events that have gone before.

I have often defended the notion that ‘coincidence’ is more of a reality of life than is connoted by a normal understanding of the word, which goes to its rarity and surprise. Events do seem to recur, albeit with different personnel, and certain people encountered years ago seem incapable of escaping the ebb and flow of one’s own life.

This of course is the dance to which Anthony Powell refers. Often life has a kind of circularity which eventually brings back the partner with whom one traced figures around the floor when the music began.

One of the latest of such coincidences to affect me occurred three weekends ago. Having just read a biography of Paul Keating gave me an appetite for more Australian political biography. Browsing in the splendid Canty’s second-hand bookshop in Fyshwick I selected four titles without too much consideration, one of which is Bob Carr’s My Reading Life –  Adventures in the World of Books. Flicking the pages, what attracted me in the Introduction was Carr’s wish that his choice of reading had been informed by what he calls ‘How to Read’ books:

"I needed someone, in effect, to place a comforting arm on my shoulder and say, now Tolstoy isn't that hard. Persist with the Russian names in the first 50 pages. Remember that there are two key characters, Andrey and Pierre.' A bit of guidance, a few clues. That would have been enough. A reader needs a handful of notions so they don't think they're going to drown, some idea of 'Where is this writer taking me?' And that's enough to start."

It wasn’t until I was browsing the book a little more carefully at home that I came across the second chapter entitled Laughing out loud – the best comic writing. Carr begins the chapter with: “This twelve-volume novel may be the best I have ever read. I’ve reread some volumes and felt confirmed in that view.” Later on:

“Powell’s is the major postwar achievement in the English novel. While his work has been described as a combination of Proust and Wodehouse, Powell is consistently funny in a way Proust is not, and his story has none of the roadblocks that sit like indigestible lumps in the middle of Proust’s volumes.”

In order to compile the necessary collections for family members I have frequently made a beeline for “po” on the shelves of the better second-hand bookshops. If they have authors shelved in alphabetical order they almost certainly have also recognised the value and popularity of Anthony Powell’s books.

In the 28 May 1998 issue of the New York Review of Books there is a long essay by the redoubtable Christopher Hitchens (1949-2011)** about Powell and his major work https://bit.ly/2I1tPdw. In typical Hitchens style he provides a strongly intellectual analysis of the politics of the work and its relationship to real political developments of the period. (Incidentally, Hitchens makes half a dozen references to the use of coincidence in Pwell’s work.)

Hitchens is clearly impressed and intrigued with the novels and, like Bob Carr, laments the weakness of the TV production of the work. And rather in the same way as Carr, Hitchens is ultimately unsatisfied, particularly with the closing volume:

"To invert, in fact, what has been so often and unfairly said against Powell, the verdict here [about the last volume] must be that events are random and unstrung rather than intricately coincidental. The series does not end or conclude, still less achieve a resolution. It just stops."

I have been unable to feel dissatisfaction of this  type. I kept collecting – perhaps against the possibility of there being yet more members of my immediate family still to come.

Despite the care with which I collected it has been difficult to make collections of all twelve volumes in a single publishing edition. When I began collecting, the titles were in Penguin with that familiar orange livery and some with cover drawings by Osbert Lancaster.

The books were in fact first published by Heinemann in 1960 and then by Penguin in 1964. Once Penguins had become rarer the commonest version was the black-covered series produced by Fontana from 1967. Later editions in Fontana had cover caricatures by Mars.

There followed Flamingo editions (still Fontana) from 1983  – my favourites –  with cover drawings by Mark Boxer and, from 1991, Mandarin paperbacks with artwork by the same person.

There is a biography of Anthony Powell by Hilary Spurling. I am yet to find a copy.

** re Christopher Hitchens, from Wikipedia: "Having long described himself as a socialist, Marxist and an anti-totalitarian, he broke from the political left after what he called the "tepid reaction" of the Western left to the Satanic Verses controversy, followed by the left's embrace of Bill Clinton and the antiwar movement's opposition to NATO intervention in Bosnia and Herzegovina in the 1990s. His support of the Iraq War separated him further. - - he regarded concepts of a god or supreme being as a totalitarian belief that impedes individual freedom. He argued that free expression and scientific discovery would eventually replace religion as an ethical code of conduct for human civilization. The dictum "What can be asserted without evidence can be dismissed without evidence" has become known as Hitchens's razor."

 

Progress on UN’s Sustainable Development Agenda

Artwork by Jordana Angus

The Government has just released a report on the progress made in Australia on implementation of the UN’s 17 Sustainable Development Goals (SDGs) (https://bit.ly/2JV66Rj). Together the 17  constitute the 2030 Agenda for Sustainable Development, to which Australia is one of 193 signatories.

The first four SDGs are:

  1. No Poverty
  2. Zero Hunger
  3. Good Health and Well-Being, and
  4. Quality Education.

Together, the 17 are described as a “global blueprint for a sustainable future for our planet, our communities, our families and our economies”.

The Report ( a “Voluntary National Review”) is a ‘whole of Australia’ document, providing evidence of what the business sector, civil society, academia, communities and individuals are contributing to achievement of the SDGs, as well as governments.

It is the result of a range of activity, including outreach events, expert analysis, case studies and the 2018 SDG Summit.

It lists the Departments that have had the lead responsibility for Commonwealth Government input to the Report relating to each SDG. So, for example, the Department of Health led on input about SDG 3, for which the tagline is “Ensure healthy lives and promote well-being for all at all ages”.

What’s important now is to be assured that those lead Departments will continue to promote active engagement of governments and other entities in the SDG for which they have special responsibility. For further progress to be made, responsible departments and other entities need to give the SDGs priority as frameworks within which their ongoing policy development and program management activity will sit.

The Report makes the point that being faithful to two mantras that are of particular resonance in Australia – ‘Caring for Country’ and ‘A fair go for all’ –  would result in good progress towards several of the Goals.

This progress can be assisted through a range of means, including businesses adopting the SDGs into their operations; supporting the work of volunteers, youth, community and business networks; and through application of the expertise of national organisations like universities, libraries and scientific institutions.

The recently-released Report will be presented at a United Nations Forum in New York in July.

The Report is at https://bit.ly/2JV66Rj

The website is Australia SDGs website

Enquiries can be directed to 2030Agenda@dfat.gov.au

Bloggs 1-63 with direct URL links

No. Title Cat.* Date published
1 How did rural people vote in the (2016) Federal Election? Pol 6 July 2016
2 English rugby: no longer Down Under Rem 15 July 2016
3 Does the Brexit vote mean an end to the not-keeping-sheep industry under the CAP? Pol 16 July 2016
4 For Leanne Coleman’s birthday (17 July) P 17 July 2016
5 Quad bike safety RH 20 July 2016
6 The tale of a cowslip Rem 24 July 2016
7 Tour Defiance 2016 P 1 Aug. 2016
8 Marriage equality and greyhounds Pol 9 Aug. 2016
9 Dear Dr Gillespie: Don’t narrow the rural health agenda RH 10 Aug. 2016
10 Submarines and greyhounds: industry policy with a heart PWE 13 Aug. 2016
11 An agenda for the Minister for Rural Health RH 17 Aug. 2016
12 The language of ‘health promotion’ RH 19 Sept. 2016
13 Fields of Gold: the 2016 AFL Grand Final P 6 Oct. 2016
14 Rolling over P 6 Oct. 2016
15 “Look at the tyres!” Rem 2 Nov. 2016
16 On electoral ‘mandates’ and furphies Pol 2 Nov. 2016
17 For good rural health we need good rural jobs RH 2 Nov. 2016
18 On holiday with Anne Cahill-Lambert and (photogenic) Rod P 2 Nov. 2016
19 Parliamentarians and the plebiscite Pol 4 Nov. 2016
20 Pounds, shillings and common sense Rem 4 Nov. 2016
21 Structural change in the economy: a real life and political issue PWE 4 Nov. 2016
22 Dreams of home: Beardy Street, Armidale P 21 Nov. 2016
23 To market, to market, to buy a fat pig…two case studies of economic change PWE 14 Dec. 2016
24 A jogger’s diary P 17 Jan. 2017
25 parkrun: healthy movement P 24 Jan. 2017
26 The Art of Professional House Cleaning F 24 Feb. 2017
27 Health advocacy needs to be more specific, less ‘motherhood’ Pol 9 March 2017
28 Comments on accepting Louis Ariotti Award for Excellence, 6 March 2001. RH 9 March 2017
29 Quad bike accidents: “It’ll never happen to me” RH 17 March 2017
30 Extracts from debate in House of Representatives on Bill to establish a National Rural Health Commissioner (NRHC) RH 21 March 2017
31 Adelaide Crows Women: next year can we police have the chorus too? F 4 April 2017
32 “Julia Gillard is not a liar” – written in April 2012 Pol 12 April 2017
33 Reflections on retirement P 19 April 2017
34 Surfing the ‘waves of health reform’ in Australia Pol 31 May 2017
35 Drones: workers of the future? P 1 June 2017
36 The challenge for the National Rural Health Commissioner RH 8 June 2017
37 Lines in the Trouser – Introduction and Part One P 12 June 2017
38 Lines in the Trouser – Part Two P 18 June 2017
39 Rural Generalism: One of the best games in town for rural health? RH 20 June 2017
40 A poem for the Winter Solstice P 22 June 2017
41 Lines in the trouser – Part Three P 23 June 2017
42 For Bev Glover P 2 July 2017
43 On politics, paramedics and the Sunburnt Country Pol 30 July 2017
44 ‘Reasonable expectations’ of human services in remote communities RH 3 Aug. 2017
45 “This was the most unkindest cut of all.” (Julius Caesar, Act 3, Scene 2)[1] P 14 Aug. 2017
46 Dual citizenship explained – by Duncan Kerr – in 1989!! Pol 1 Sept. 2017
47 Rural people face high, unmeasured and increasing out-of-pocket health care costs RH 29 Oct. 2017
48 Dear Scott, So you want to clearly understand about split infinitives? P 10 Nov. 2017
49 Lawrence’s daffodils P 15 Nov. 2017
50 Marriage equality – a case study in too much democracy Pol 18 Nov. 2017
51 Obstructing the field – Alex Ross is out P 11 Jan. 2018
52 How Green Was My Lily & other terrible Fotopuns F 14 Jan. 2018
53 Much to report – September 2008 P 30 Jan. 2018
54 Two-wheeler Kate: in praise of speech recognition software P 16 Feb. 2018
55 Retiring slowly – Match report for Saturday 20 January 2018 P 19 Feb. 2018
56 Command and control F 13 March 2018
57 Rural and remote gaps in NDIS rollout RH 15 March 2018
58 NRL: a bird in the hand is worth 30% of what’s in the bush P 19 March 2018
59 Just Loving It (Our theatrical holiday in the UK) P 19 May 2018
60 Stalking George Gently P 19 May 2018
61 ANZAC Day in Knaresborough, North Yorkshire P 19 May 2018
62 Paddling his own canoe: for Dane P 24 May 2018 (re-posted)
63 Australia’s health research effort RH 5 June 2018

Cat* = Category: P is Personal; RH Rural health; F Fantasy; Pol Politics; Rem Reminiscence; and PWE People’s wellbeing and the economy.

Australia’s health research effort

A recent article in the Australian Journal of Rural Health (Vol 26, Issue 2, April 2018) makes the case that, at 2.4 per cent by value of the National Health and Medical Research Council total in 2014, the amount of research aimed specifically to deliver health benefits to Australians living in rural and remote areas is low given the health status and health service deficits faced by the 30 per cent of the population who live there.

Issues relating to health research in Australia were the subject of discussion at Senate Estimates on Tuesday 29 May 2018. This bloggpiece consists of a summary of some of the numbers and other facts from that discussion, sourced from the Hansard record.

In the period 2018-19 to 2021-22, the four years of forward estimates, some $6 billion is to be committed by the Australian Government for health and medical research. The main programs through which this money will be allocated are the National Health and Medical Research Council (NHMRC) (around $800m per year), the Medical Research Future Fund (c.$500m a year), and the Biomedical Translation Fund (c. $60m a year).

It would be interesting to compare this amount funded directly through the Federal health budget with the total through the private sector – dominated, presumably, by the pharmaceutical companies – and through other sources such as hospitals, State budgets and specific health condition interest groups (the Heart Foundation, for example).

The discussion at Estimates referred to the fact that many people in the research community are unclear about how funds in the Medical Research Future Fund (MRFF) are being disbursed.

Historically there has been a considerable amount of investigator-driven research funded by the NHMRC. The MRFF, on the other hand, is “priority setting research” and can fill gaps that are identified. The priorities are determined by the Government, through the Minister of the day and advice received by them. The Act requires the MRFF Board to consult with the community and the sector about its priorities.

"The Australian Medical Research and Innovation Strategy 2016–2021 was prepared by Australian Medical Research Advisory Board. It sets out the vision, aims, objectives, impact measurement and strategic platforms of the MRFF. The strategic platforms provide a framework for identifying MRFF priorities."

The first disbursements from MRFF were in 2016-17 and were for one year only. The next batch, announced in the 2018-19 Budget, are for four to five years.

There has been criticism of the relatively small amount allocated to research related to illness prevention, both within the MRFF envelope and in the overall health research effort. It has been suggested that as little as one per cent of the total health research allocation has been directed at prevention which, if true, would reflect poorly on the priorities in place.

At Estimates the Health Department referred to a number of grants for what could be considered ‘illness prevention’, including to the Australian Prevention Partnership Centre, some mental health research, Keeping Australians out of Hospital, Maternal Health in the First 2,000 days, the Advanced Health Research and Translation Centres, and the Centres for Innovation in Regional Health. These last are obviously of particular interest to the rural health sector.

"The aim of the Centres for Innovation in Regional Health (CIRH) initiative is to encourage leadership in health research and translation of direct relevance and benefit to regional and remote areas of Australia."

"To achieve recognition as a CIRH, groups are required to demonstrate competitiveness at the highest international levels across all relevant areas of health care."

In 2017 the NHMRC recognised two groups in the CIRH program: the Central Australia Academic Health Science Centre and NSW Regional Health Partners.

Departmental officers spoke at Estimates of there being two main problems along the research pipeline. One is where a researcher or a team has a great idea but does not have the funds or the resources to prove the idea, to bring it to ‘proof of concept’ and start it down the pathway to trials. The other is where the idea has been proven through trials and the need is commercial energy and capital to bring the concept to market.

This second is where the Biomedical Translation Fund (BTF) fits in: it is designed to stimulate the venture capital sector and increase Australia’s ability to invest in good-quality late-stage research.

The BTF is leveraged 50:50 with private capital. It was announced in December 2015 under the National Innovation and Science Strategy and, after the identification of three fund managers, began operation in January 2017. The fund managers search out deals for advanced commercial-ready health and medical research innovations. To date there have been nine deals at a total value of about $42 million.

It has been suggested that if all goes well the health and medical sector could be the source of 28,000 new jobs, 130 new clinical trials, and a 50 per cent increase in exports. To hit all the desirable targets will require a suitably trained health research workforce and the MRFF is helping with this. It is working with the NHMRC to ensure there are more fellowships available to attract Australians into health and medical research.

Let’s hope the individuals and agencies involved have at least a third of an eye on the special opportunities and challenges in rural Australia.

Paddling his own canoe: for Dane

The Alliance saw more movement – for the word had passed around

That the colt from in our midst had paddled off

To join the Health Department – with his pay a thousand pound –

Enough to satisfy most any Toff

 

He got up every morning in the cruel winter frost

All rigged out in his gold and in his green

And only he knew secretly the trouble and the cost:

His sorest point remained below unseen

 

He paddled hard with Russians and he met them stroke for stroke

In countries to the east and to the west

And Canada was where he went with hardened motley blokes

To put their training to the final test

 

The tried and noted paddlers from their clubs both near and far

Had gathered at the jetty overnight,

For the boatmen love the challenge where the coldest waters are

The competition starts with great delight.

 

Our muscled Dane was off the grog for many endless days

And ate up porridge oats and lots of gruel

To see him pine for beer and wine was tough enough I’d say

But think of his sore backside: seems so cruel

 

His paddle-ing was paralleled by toils with us at work

On mental health and PHNs and such

He’d come at nine and work til five and never ever shirk

His humour pleased us all so very much.

 

With Helen first he toiled away and was by duty bound

They jointly shaped up policies and stuff

When Helen left he seemed bereft and obviously found

The work on Fact Sheets was a little tough.

 

With Anne-Marie he formed a bond – his wit and wisdom grew

Their vigour never ever seemed to flag

But once again his partner went, and when we made a brew

We fell back from tea-leaves to use tea-bag

 

Then Andrew with his tested figures came to lend a hand,

No stats man ever made of him an ass;

For never puzzle threw him while his formulae did stand

He came with numbers strong from Sassafras

 

Fiona then did join him and she leapt into the fray

She valued him as much as any chum

She’ll miss him in the pod they share when he has gone away –

We hope he finds a new de facto mum

 

He’s hard and tough and wiry – just the sort that won’t say die –

Recall the many funnies that he’s said;

He bears the badge of fitness in his enigmatic eye,

His witty words can often knock one dead.

 

And down by Burley Griffin, where the pine-clad ridges raise

Their torn and rugged battlements on high,

Where the air is clear as crystal, and the white stars fairly blaze

At midnight in the cold and frosty sky,

 

Just near the Murrumbidgee where the reed beds sweep and sway

In breezes and the stunted trees are clipped,

The man who paddles his canoe’s a household word today,

This doggerel tells the story of his trip

 

As he strokes into the sunset with his yet untested crew

We’ll toast him once and toast him once again.

His sore bit’s healed – that’s such relief – his bottom is like new –

We’re one seat down: farewell our paddling Dane.

 

ANZAC Day in Knaresborough, North Yorkshire

We were talking with Knaresborough’s Town Crier (Roger Hewitt, who used to work with Peter G.) when a local man came up to suggest three things for inclusion in the Crier’s next proclamation.

First, he informed the TC that it was ANZAC Day.

Secondly, he said it was the anniversary of Oliver Cromwell’s birth – the person responsible for the destruction of Knaresborough castle (lying just a stone’s throw away from the Market Cross where we were standing).

Knaresborough castle

And third – this is way random – he said that it was also Monty Panesar’s 36th birthday!!

Much to his credit, and reading from the scroll removed with ceremony from his tipstaff, the Town Crier began his next proclamation with reference to ANZAC Day. Good on him – and the local man who was so aware.

 

 

Stalking George Gently

Two of my favourite English TV shows are Foyle’s War and George Gently. Both have seaside connections, the first with the Sussex Coast – all busy and pebbled – the second with the rather bleak, windswept and extensive sandy beaches of the North East of England.

In three years at university in Durham, the beaches of the North East remained completely unknown to me.

In more recent tv viewing George Gently has become conflated in my mind with the principled but unlikely Judge John Deed – both of them wonderfully portrayed by Martin Shaw.

I’ve always thought that Michael Kitchen does the best close up ‘face work’ on television: so nuanced and expressive, with minimalist twitches and other small facial movements. Foyle also has the best and nicest tv driver, played by Honeysuckle Weeks.

Honeysuckle Weeks as Sam and Michael KItchen as Foyle. Copyright: ITV

Imagine, then, my delight when Pella and I discovered that The Best Man, currently showing in the West End, stars both Mr Shaw and Ms Weeks. We hastened to the Playhouse to see them portraying a 1960 struggle for democratic Presidential candidature between ‘good’ and ‘evil’, both (no spoiler alert is required, I think) seeking support for their nomination from a previous President.

After the show we joined 5 others in stalking Martin Shaw, with a bare majority of the 7 being Australian. Ms Weeks made her way out of the gated basement before Mr Shaw, and I now believe that it must have been shyness caused by a frisson of a sort of admiration not felt for Mr Shaw, that explains why we (I) let her pass with no more than congratulations: no molestation for photograph or conversation.

Martin Shaw did not get off so lightly.

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