Health services administration

Maximising the availability of trained staff and coordinated matching of ICU capacity with demand are urgently needed

Edward Litton · Sue Huckson · Shaila Chavan · Tamara Bucci · Anthony Holley · Evan Everest · Sean Kelly · Steven McGloughlin · Johnny Millar · Nhi Nguyen · Mark Nicholls · Paule Secombe · David Pilcher

An approach for reframing palliative care has been designed to help improve the wellbeing of people with serious illness

Peter Hudson · Anna Collins · Mark Boughey · Jennifer Philip

Widespread adoption of high value cancer care practices during the pandemic will benefit cancer care delivery into the future

Vivienne Milch · Rhona Wang · Carolyn Der Vartanian · Melissa Austen · Debra Hector · Cleola Anderiesz · Dorothy Keefe

The fourth annual assessment of Australia’s exposure, vulnerability and response to climate change finds us continuing to lag behind the rest of the world

Paul J Beggs · Ying Zhang · Alice McGushin · Stefan Trueck · Martina K Linnenluecke · Hilary Bambrick · Helen L Berry · Ollie Jay · Lucie Rychetnik · Ivan C Hanigan · Geoffrey G Morgan · Yuming Guo · Arunima Malik · Mark Stevenson · Donna Green · Fay H Johnston · Celia McMichael · Ian Hamilton · Anthony G Capon

An ongoing pandemic response, beyond mass vaccination, will be required of political and health systems throughout 2022

Mark J Hanly · Timothy Churches · Oisin Fitzgerald · Jeffrey J Post · C Raina MacIntyre · Louisa Jorm

With rising expenditure, growing chronic disease burden, and widening inequalities, the health system is in urgent need of redesign

Elizabeth Koff · Susan Pearce · David P Peiris

The health reform imperative is clear; it now requires national courage and leadership to implement it

Claire L Jackson · Diana O’Halloran

About one in five “exception” colonoscopies detect and excise advanced pre-cancerous polyps

Michelle Lee See · Antonio Lee · Roderick Roberts · Richard A Friedman · David G Hewett · Daniel L Worthley

The time for actively recommending the screening of asymptomatic men has passed

Justin J Coleman

Removing MBS rebate restrictions for telehealth consultations would enhance sexual and reproductive health services access

Yan Cheng · Clare Boerma · Lucy Peck · Jessica R Botfield · Jane Estoesta · Kevin McGeechan

Australian public hospitals’ energy choices are at odds with “first, do no harm”

Hayden Burch · Matthew H Anstey · Forbes McGain

We need to consider offering vaccination to adolescents and young adults

Mary‐Louise McLaws

To the Editor: Recruitment and retention of a sustainable rural health workforce was one of four issues highlighted by Osborne in a recent MJA supplement.1 Chapter 4 of the Supplement describes a need for longitudinal methods to evaluate recruitment and retention of nursing and allied health professionals, noting challenges around scale and links to policy.2 Comparative efforts examining the medical workforce in Australia are more advanced (eg, the Medical Schools Outcomes Database). Chapter 5 concludes there is a need for a longitudinal, linked database to address rural workforce planning that utilises public data sources, noting medicine was covered by all primary data sources identified, yet only three covered all health professions.3 The Nursing and Allied Health Graduate Outcome Tracking (NAHGOT) study is a research collaboration between the University of Newcastle, Monash University and Deakin University that addresses issues of scale and relevance to national health workforce policy. NAHGOT links Australian Health Practitioner Regulation Agency practice location data (the outcome) with university administrative records (explanatory variables including placement location and duration), and is complemented by the national Student Experience and Graduate Outcomes Surveys. Further complementing the NAHGOT database are the publicly available Socio‐Economic Indexes for Areas at varying spatial resolutions (eg, Statistical Areas Level 1 to Level 4), a general measure of spatial access (Australian Statistical Geography Standard — Remoteness Areas), and a workforce specific model used to define Distribution Priority Areas (Modified Monash Model). Across the nursing and allied health disciplines offered by the three universities, data from a new cohort of about 2000 first year students are captured annually and securely stored in a central, de‐identified repository. Database access is currently restricted to participating institutions, with the longer term intent to permit external data extractions based upon predefined study protocols through a formal process. To our knowledge, NAHGOT is the largest tracking study of this type and growing, with three other universities soon to join the collaboration, enabling expansion into Queensland and South Australia. All participating universities are funded by the Rural Health Multidisciplinary Training Program, with the study design reflecting the objectives of the federal Department of Health. Universities are the logical choice to undertake tracking of graduate outcomes at scale. Unlike other data sources, universities hold admission and professional placement data not available elsewhere. The protocol will soon be available4 and the first peer reviewed publications from NAHGOT have now been published,5,6 and as the project expands it is anticipated it will become a major contributor to workforce planning and augment established efforts in medicine.

Vincent L Versace · Tony Smith · Keith Sutton

To the Editor: Victoria introduced voluntary assisted dying in June 2019, historic legislation which aimed to enable terminally ill people in limited circumstances to end their life with autonomy, compassion and support. The Voluntary Assisted Dying Act 20171 is considered the most conservative and safe legislation in the world, with 68 safeguards. We compared recent Victorian reporting data2,3 with a 12‐month period of data on Oregon’s Death with Dignity Act (1997),4 as the jurisdictions have similar population sizes and there is no comparable jurisdiction currently operating in Australia. To access voluntary assisted dying in Victoria a person must: have an incurable and advanced disease, illness or medical condition that is expected to cause death within 6 months (or within 12 months for a neurodegenerative condition); be experiencing suffering, which the person considers intolerable; have decision‐making capacity in relation to voluntary assisted dying; be an adult, aged 18 years or older; and be an Australian citizen or permanent resident who has lived in Victoria for at least the past 12 months. Eligibility requirements for Oregonians are comparable; however, there is no requirement to demonstrate intolerable suffering. Based on a total number of 46 581 deaths in Victoria during the 2019–2020 period, 0.3% of deaths can be attributed to voluntary assisted dying.5 In both Victoria and Oregon, the most frequently reported reasons for requesting voluntary assisted dying and dying with dignity were loss of autonomy and losing control of body functions; additionally, loss of dignity and being unable to engage in activities that make life enjoyable were also cited. Data show that: Victorian applicants were aged between 32 and 100 years, with an average age of 71 years.2,3 In comparison, the average age in Oregon was 74 years, with a range of applicants from 18 to over 85 years.4 In Victoria, 44% of applicants were female, 55% were male and 1% selected “self‐described” as their gender,2,3 comparable to Oregon (41% female and 59% male).4 Between 19 June 2019 and 30 June 2020, 231 permits were issued. Of these, 104 (45%) self‐administered the medication, while another 20 (9%) had the medication administered by a medical practitioner (Box).2,3 Oregon data from 2019 (population, 4.2 million) revealed that 290 applicants were prescribed medication, with 150 (59%) self‐administering;4 in Victoria (population, 6.3 million), 54% self‐administered, while another 61 (21%) did not take the medication and died of other causes. In addition to the first 12 months of Victorian data, we also included the cumulative totals to February 2021 (Box). The Victorian Act requires three requests be made to a registered medical practitioner for an individual to access voluntary assisted dying. Medical practitioners can apply for either a self‐administration or practitioner administration permit at any one time. Time from first to last request occurred within 11 days for 25% of applicants and 19 days for 50% of applicants.2 Voluntary assisted dying and dying with dignity represent an option for individuals to choose the manner and timing of their death during the terminal phase of illness. Continued community awareness and conversations about end of life options are essential to ensuring that voluntary assisted dying is available to eligible Victorians who seek access. Box – Victorian voluntary assisted dying data snapshot4,5 Total Stage Status 19 June 2019–30 June 2020 To February 2021 Eligibility First assessment by coordinating medical practitioner Eligible 341 562 Ineligible 7 19 Second assessment by consulting medical practitioner Eligible 297 483 Ineligible 4 8 Permit applications Self‐administration permit Issued 201 350 Not issued 32 44 Practitioner administration permit Issued 30 55 Not issued 9 16 Withdrawn: case withdrawn from portal by medical practitioner or upon notification of death of the applicant 134 239 Medications dispensed For self‐administration 154 281 Confirmed deaths Medication administered Self‐administered 104 184 Administered by practitioner 20 40

Kate Furness · Donna Markham · Tamica Sturgess · Margaret O’Connor

To the Editor: The Medical Research Future Fund (MRFF) should be a policy triumph for the Australian Government, tackling unmet clinical needs through transformative research that saves lives, creates jobs and strengthens the industry.1 However, to deliver these objectives, medical research findings must be translated from the laboratory and library to achieve impact on the clinic, community and companies. The capacity for efficient health research translation has been limited in Australia.2 The MRFF provided $20 million per year, finishing in 2021, to pump‐prime Australia’s ten health research translation centres designated by the National Health and Medical Research Council, in which we work. The Translation Centres bring health services and consumers together with health researchers from universities and medical research institutes. Distributed across the nation, the Centres have come together to form the Australian Health Research Alliance (AHRA), providing a “go to” destination for those seeking expertise in health research translation.3 We want to see that research‐ and translation‐trained practitioners in medicine, nursing, allied health disciplines, clinical laboratories, pharmacy, health informatics and other frontline services have time stably funded to deploy their skills in a role we describe as “research translators”.4 Alongside conventional health care duties, such staff will have dedicated time to engage consumers, recruit participants to clinical research, partner with industry, prove the relevance of research to their service, promote best evidenced practice, and champion the adoption of innovation. While overseas governments invest heavily in such roles, funding time for frontline clinical staff to deliver research and translation alongside their clinical work, Australia does not. For example, the National Institute of Health Research in the United Kingdom commits approximately $20 per citizen per year, with an impressive impact on lives saved, jobs created and industry invigorated.5 Australia should address this translational workforce gap or risk failure to achieve full beneficial impact from the MRFF. About $65 million per year (about 10% of the MRFF investment income) would support a cadre of research translators broadly proportional to the provision from comparable research budgets overseas, with AHRA’s Centres best placed to provide efficient coordination. Thus, the MRFF would be powered for success by investing in research translators through AHRA, ensuring the triumph of an exciting new policy that promises benefit to all Australians.

John Savill · Christopher Levi · Gary Geelhoed

Objectives: To describe the population characteristics of people with intellectual disability in New South Wales; to quantify and compare public mental health service use and costs for people with and without intellectual disability in NSW during 2014‒15. Design: Retrospective cohort data linkage analysis. Setting, participants: People using publicly funded in‐ or outpatient (admitted or non‐admitted) mental health services in NSW, 2014‒15. Main outcome measures: Numbers of bed days (inpatient mental health services), and treatment days (ambulatory mental health); costs of publicly funded mental health services. Results: People with intellectual disability comprised 1.1% of the NSW population, but 6.3% of people who used public mental health services; 12% of public mental health costs during 2014–15 were for people with intellectual disability. Compared with metropolitan local health districts (LHDs), overall public mental health service costs were lower for rural and regional LHDs (adjusted incidence rate ratio [aIRR], 0.8; 95% CI, 0.8–0.9) and higher for specialty networks (aIRR, 1.2; 95% CI, 1.1–1.3). Per person costs for people with intellectual disability were higher than for those without intellectual disability (aIRR, 2.6; 95% CI, 2.2–3.0). Conclusion: People with intellectual disability use public mental health services to a greater degree than other people. They should be explicitly considered by all tiers of mental health policy and service planning in Australia. Population health planning for the needs of people with disabilities would be assisted by including disability identifiers in all health administrative data sets.

Preeyaporn Srasuebkul · Rachael Cvejic · Theresa Heintze · Simone Reppermund · Julian N Trollor