Welcome to the 2018-19 Department of Health Annual Report. I am privileged to continue leading a Department with a highly engaged workforce, committed to fulfilling our vision – better health and wellbeing for all Australians, now and for future generations.
In this financial year, the Australian Government has invested more than one in five dollars of its expenditure budget in the health, aged care and sports portfolio. We have a substantial responsibility for implementing and regulating very large programs and reform initiatives in partnership with many organisations, clinicians and consumer representatives.
Highlights over the past 12 months
We continued to ensure a clinically and cost effective Medicare program and improved access to essential services, medicines and health products with:
Completion of the initial reviews of 5,700 items on the Medicare Benefits Schedule (MBS), oversighted by the MBS Review Taskforce;
additional services approved to be added to the MBS during 2018-19 included: life-saving services for cancer/stroke; management plans for eating disorders; services for bladder cancer, liver cancer and obstetrics; dialysis x-ray services in aged care homes; and expanded services for GPs including telehealth, after-hours and aged care home services; and
bulk billing rates at record levels, with 86 per cent of GP services bulk billed in 2018-19.
Reforms to Aged Care and the Royal Commission into Aged Care Quality and Safety
In 2018-19, we continued to progress quality and safety reforms for aged care which included establishing the Aged Care Quality and Safety Commission from 1 January 2019; developing new quality standards; and further enhancements were made to My Aged Care to improve access to information about aged care services. The Government provided additional funding for aged care services and released an additional 25,187 Home Care Packages in 2018-19, a 25.2 per cent increase since 2017-18.
In the second half of the year, in addition to delivering reforms across aged care services, a significant focus of our work has been supporting the Royal Commission into Aged Care Quality and Safety (Royal Commission) established by the Government in October 2018. As at 30 June 2019, eight officers of the Department had appeared before the Royal Commission with the Department providing a significant amount of information, including providing more than 20,000 documents.
Focus on Mental Health
During 2018-19, the Department established a dedicated Mental Health Division to focus our efforts on expanding and improving support and services for Australians experiencing mental health issues. A number of key initiatives were implemented over the year including launching ‘Be You’ for early childhood and school students and supporting 110 headspace centres around Australia.
We also worked to improve access through the MBS to affordable and comprehensive treatment for the estimated one million people affected by eating disorders.
The Million Minds Mental Health Research Mission was launched in October 2018, providing investment of $125 million over 10 years for innovative and ground breaking research into mental health and suicide prevention.
The 2019-20 Budget included an additional $461 million for a national action plan to prevent suicide and promote the mental wellbeing of young and Indigenous Australians. The Prime Minister also appointed Ms Christine Morgan a National Suicide Prevention Adviser to support the Government’s ‘towards zero’ suicide plan.
Workplace mental health is also crucial and I am committed to improving mental health and wellbeing in our workplace, encouraging healthy minds and bodies for all Health staff.
Improved access to new medicines and treatments
The Department worked to support the Government’s commitment to deliver more life-saving, life changing and cheaper medicines for Australians through the Pharmaceutical Benefits Scheme (PBS).
Some key medicines listed this financial year, which without PBS subsidy would be extremely expensive, included: ribociclib for metastatic breast cancer; lumacaftor with ivacaftor for cystic fibrosis; golimumab for spondyloarthritis; and avelumab for metastatic merkel cell carcinoma. Price changes from 1 April 2019 will save Australian patients and taxpayers more than $270 million on 242 medicine brands. Meningococcal A, C, W, and Y vaccine was added to the National Immunisation Program.
In 2018-19, the Medical Services Advisory Committee recommended public funding for Australia’s first CAR T-cell therapy tisagenlecleuce, to treat refractory or relapsed acute lymphoblastic leukaemia in children and young adults. The Department negotiated new funding arrangements with the sponsor and state and territory governments to make this frontier treatment available free of charge to young Australians with no other treatment options.
During 2018-19, the Department commenced implementation of the $6 billion package for medical research announced in the 2018-19 Budget. This included a $1.3 billion National Health and Medical Industry Growth Plan (the Plan) with $500 million for the Genomics Health Futures Mission. Funding is dispersed from the capital preserved Medical Research Future Fund (MRFF).
The Plan will drive a new era of better health care together with jobs and growth in new firms and industries, based on research and innovation. It will inject an estimated $18 billion into the Australian economy, create an estimated 28,000 new jobs, deliver a minimum of 130 new clinical trials and a 50 per cent increase in Australian exports of biotechnology, medical devices and pharmaceuticals.
The second set of MRFF priorities for 2018–20 was released and included antimicrobial resistance, ageing and aged care including dementia research, primary care, public health and Aboriginal and Torres Strait Islander health.
Hospital funding and private health insurance reforms
In December 2018, the Council of Australian Governments (COAG) agreed to Health Ministers continuing negotiations for a National Health Reform Agreement (NHRA) 2020–25. The Australian Government increased funding for public hospitals by $31.3 billion in 2018-19, bringing the overall contribution to $131.4 billion between 2020-21 and 2024-25. All states except Queensland and Victoria have signed a Heads of Agreement for progressing the NHRA.
In April 2019, the new private health insurance four-tier system of Gold, Silver, Bronze and Basic hospital insurance was introduced to make it simpler for consumers to choose the cover best suited to their needs. A number of other reforms were implemented in 2018-19 to reduce costs, including allowing insurers to offer aged based discounts and increasing maximum voluntary excess levels and improve value to consumers, including improving access to travel and accommodation benefits.
The Department made regulations implementing benefit reductions for prostheses, reducing insurers’ costs and contributing to the lowest average premium increase in 18 years.
To provide further support to hospitals and community health, the Government provided $1.25 billion in the 2019-20 Budget for a new Community Health and Hospitals Program announced at the COAG meeting in December 2018. This program will be rolled out progressively over the forward estimates and includes infrastructure for cancer treatment, rural health, drug and alcohol treatment, mental health and chronic disease management.
Chronic diseases are the leading cause of ill health and death in Australia. Almost one in four Australians have more than one chronic disease, usually developing over time and sharing many of the same risk factors as one another, including tobacco use, obesity, lack of physical activity and poor diet. The Department is working with stakeholders on the development of the 10 year National Preventive Health Strategy to keep people well and will include strategies such as: increase screening and immunisation rates; increase health checks; stopping the growth rate in type 2 diabetes amongst children; and reduce smoking rates.
In 2018-19, the Department implemented a range of maternal, infant and preventive health programs to support children and parents which included extending the Child Immunisation Education campaign. Working with states and territories and consumers, the Department developed a high level strategy to support higher rates of breastfeeding. The Australian National Breastfeeding Strategy: 2019 and beyond seeks to provide an enabling environment for breastfeeding to provide children with the best start in life.
Improving health outcomes for Indigenous Australians
In 2018-19, the Department continued to support improved primary care for all Aboriginal and Torres Strait Islander Australians.
Ending avoidable vision and hearing loss in Aboriginal and Torres Strait Islander children remained a priority during the year. To help achieve this goal, a new program for annual hearing assessments and follow-up treatment in rural and remote communities commenced for children before they start school.
A funding boost of more than $12.4 million, bringing total funding to $21.2 million, was announced to help curb syphilis outbreaks among Aboriginal and Torres Strait Islander communities in northern and central Australia.
The Australian-first Optimal Care Pathway for Aboriginal and Torres Strait Islander Australians with cancer was developed through the National Cancer Expert Reference Group to tackle the growing gap in cancer outcomes and support the delivery of tailored, culturally safe and responsive care.
Sport and physical activity
The Department assisted in the development of Australia’s first national sport plan, Sport 2030, launched in August 2018. Sport 2030 provided a vision and a plan for sport and physical activity over the next 12 years, to make us an active and healthy sporting nation, known for our integrity and sporting success. Sport 2030 will be delivered in partnership with Australia’s sporting, physical activity, technology, education and corporate community. Participation in sport and physical activity helps bring communities together and helps Australians enjoy healthier, happier and more productive lives.
In February 2019, the Government responded to the Wood Review of Australia’s Sports Integrity Arrangements, announcing landmark reforms which will ensure Australia is a world leader in clean, safe and fair sport. This included the announcement of a new body, Sports Integrity Australia, which is expected to begin operating in July 2020.
In 2018-19, the Government invested an additional $201.5 million over four years for the Sporting Schools Program, Community Sport Infrastructure grants and high performance.
Protecting public health and safety through regulation
The Therapeutic Goods Administration (TGA) regulates the quality and safety of therapeutic goods. On 1 January 2019, the TGA implemented a new mandatory reporting scheme for medicines shortages to address concerns raised by patients, their carers and health professionals seeking information about the shortage of a critical medicine. A clearer and more concise code for advertising of therapeutic goods also commenced on 1 January 2019.
Key performance outcomes
In 2018-19, the majority of our program performance criteria were successfully met within our budget and staffing targets. The 2018-19 Budget and Mid-Year Economic and Fiscal Outlook, delivered an increase in funding of $20 billion for the Health portfolio over the forward estimates bringing the Budget to $115 billion in 2022-23.
In addition to key performance information contained in this Annual Report, over the year the Department actioned 20,979 items of ministerial correspondence including responses to letter campaigns related to My Health Record, natural therapies and private health insurance and Medicare rebates for psychological services.
To help inform the community, the Department responds daily to media queries and requests from the general public and other stakeholders. In 2018-19, our staff responded to 1,822 media enquiries and developed 953 media releases, speaking notes and speeches. The Department also prepared about 6,300 submissions for our ministers. We responded to 26 Parliamentary questions on notice, 774 Senate Estimates questions on notice, 434 Freedom of Information applications and made submissions to eight Parliamentary Inquiries.
The Department will continue to support the Government’s Long Term National Health Plan1. Our focus will be on delivering the Government’s plan to make Australia’s health system the world’s number one. We will focus on even greater engagement with stakeholders and consumers to ensure policies are implemented and sustainable.
In 2019-20, priority areas for action include:
strengthening primary care to make health services more patient-centred, support more flexible care models and focus on prevention and integrated management of chronic conditions;
providing continued access to a modern, high quality Medicare system based on best clinical evidence, delivery of the Government’s response to the MBS Review Taskforce, and supporting access to the latest and most effective medicines through the PBS;
finalising the NHRA; embedding reforms to private health insurance and more transparency in out-of-pocket costs will be areas of priority over the next year;
finalising negotiations for the Seventh Community Pharmacy Agreement;
continuing to deliver aged care reforms with a focus on quality and safety and more support for independently living in the home; and ongoing support to the Royal Commission into Aged Care Quality and Safety;
improving access to mental health services, by implementing the national strategy to prevent suicide and promote the mental wellbeing of young and Indigenous Australians and other measures from the 2019-20 Budget; working closely with the National Mental Health Commission and the Prime Minister’s National Suicide Prevention Adviser; and funding research to develop new approaches to prevention, diagnosis, treatment and recovery;
improving preventive health for Aboriginal and Torres Strait Islander Australians, driving to increase the number of people having at least one health check, ensure more pregnant women receive an early antenatal health check, halt the growth in type 2 diabetes among children and young people, reduce the proportion of Indigenous adults who are daily smokers, eradicating rheumatic heart disease and ending avoidable blindness;
developing and implementing a National Preventive Health Strategy to address and prevent chronic disease. Addressing risk factors such as diet, obesity, smoking, lack of physical activity and the misuse of alcohol and drugs will be important in this strategy;
improving health workforce capability across the health and aged care sector and continuing to implement the $550 million Stronger Rural Health Strategy to deliver an extra 3,000 doctors and 3,000 nurses to regional, rural and remote communities over 10 years; and
encouraging more exercise and physical activity at all ages and stages of life and our high performance sport system will be enhanced by implementing stronger integrity arrangements.
We have a highly engaged workforce and we deliver health outcomes for our community each day. Maintaining our high performance will be a priority and our organisational priorities over the next 12 months include:
strengthened governance arrangements to manage our large programs;
strengthening our project management practices to ensure effective and timely delivery of government initiatives and programs;
improving data collection and analysis, and performance information and reporting;
a focus on more evaluations of our programs;
capability improvements and providing necessary learning and development opportunities for staff. The executive will focus on improved workforce planning to build our capability; and
putting in place our New Ways of Working program to modernise our workplace over the next three to five years to support a more flexible, accessible and healthy workplace into the future.
It was great to see significant improvements in this year’s Australian Public Service Staff Survey. Since 2018, we have improved significantly with our staff recommending Health as a good place to work, believing in the purpose and objectives of the Department, and feeling the Department inspires staff to their best work every day.
The overall perception of the Department’s leadership group has improved since 2018 and is significantly above the APS average.
On behalf of the executive I would like to thank our staff for their commitment and hard work as we move to strengthen our health and aged care systems. I would also like to thank our many stakeholders, clinicians, peak bodies, academia, representative consumer groups and consumers we partner with to jointly deliver a world class health system.