Three prominent medical organisations have joined forces in urging governments to do more to prevent young people ending up in the criminal justice system, including through raising the minimum age of criminal responsibility to 14 years nationally.
Also covered in this edition of The Zap are Commonwealth Prac Payments, various regulatory concerns, the ALP National Conference, pharmacy policy matters, and seven, evidence-based strategies from the World Health Organization for preventing drowning.
There are two quotables this week:
The FDA used to be a gold standard regulator. Judged on this performance, the Trump Administration and Robert F Kennedy Jr have reduced it to pinchbeck.”
And:
Occupational violence and aggression in the workplace is causing significant physical and psychological harm and trauma, which is impacting health workers and their capacity to deliver care.”
Charles Maskell-Knight writes:
Ever since the 2024 Budget announcement of the Commonwealth Prac Payment to provide assistance to teaching, nursing, midwifery and social work students while they are undertaking mandatory placements, there have been calls to expand the range of students eligible for the payment.
On 23 July, Prime Minister Anthony Albanese and Health Minister Mark Butler announced the scheme would be expanded to cover clinical psychology, physiotherapy, occupational therapy, speech pathology, paramedicine, radiography, pharmacy, rehabilitation therapies, audiology, and podiatry.
Needless to say, the announcement was welcomed with enthusiasm by the groups representing the professions covered by the expansion, including Advanced Pharmacy Australia, Audiology Australia, Advanced Pharmacy Australia, the Australian College of Paramedicine, the Australian Physiotherapy Association, the Australian Psychological Society, Australian Society for Medical Imaging and Radiation Therapy, Occupational Therapy Australia, the Pharmaceutical Society of Australia, the Pharmacy Guild, and Speech Pathology Australia.
The National Rural Health Alliance (NRHA) also welcomed the decision, describing it as “an important investment in the future health workforce, especially for rural Australia”.
NRHA Chief Executive Susi Tegen said “this is not a rural-only payment, but it has significant potential to remove some of the financial barriers that prevent students from accepting rural and remote placements”.
Allied Health Professions Australia (AHPA) said the announcement “reflects months of coordinated advocacy by AHPA and its member organisations, together with Independent Senator David Pocock and Independent MP Dr Helen Haines who campaigned to keep placement poverty on the national agenda”.
AHPA Chief Executive Officer Bronwyn Morris-Donovan said the expansion “was a hard-won and welcome step forward for the allied health workforce”.
However, AHPA also called on the Government to extend the same support to the remaining allied health professions, including dietetics, osteopathy and optometry.
Health Services Union National Secretary Dustin Halse welcomed the announcement, but added “the HSU will continue campaigning until every allied health student undertaking a mandatory placement receives proper financial support”.
A number of groups who missed out expressed their disappointment, including the Australian Medical Association (AMA), the Australian Medical Students Association, Dieticians Australia, the Psychotherapy and Counselling Federation of Australia, and the Rural Doctors Association of Australia (RDAA).
It is unfortunate that the Government did not set out explicit criteria for inclusion in the scheme when it was originally introduced, and has not taken the opportunity to do so when expanding it.
In the absence of clear criteria, decisions such as that to include audiology but not optometry (both involving measurement of sensory capability and prescription of remedial devices to address shortfalls) appear arbitrary and capricious.
ALP National Conference
The ALP National Conference held from 23-25 July adopted a number of resolutions relevant to health, including dental health and voluntary assisted dying (VAD)
In relation to dental services, the 2023 party platform says “Labor sees oral health as the missing element of Medicare. Our goal is to provide universal access to affordable dental services for all Australians. Labor will engage a consultative process with all relevant stakeholders to begin this work”.
Conference replaced the reference to a consultative process with a commitment to “develop a roadmap towards improved access to dental services… prioritising those with the greatest need, such as children who are eligible but not accessing the Child Dental Benefits Schedule, older people and other priority populations”.
Given it is now over half-way through 2026, and the Government has still not managed to replace the National Oral Health Plan 2016-25, I am not going to hold my breath waiting for a roadmap.
The ABC reported that conference “backed a conscience vote on lifting the ban on using telehealth to access VAD”, and said Labor “would remove barriers that exist in federal law to the provision of end-of-life care (including via telehealth) as part of lawful access to voluntary assisted dying in the states and territories, while maintaining appropriate clinical safeguards”.
The issue here is that VAD is a matter for state legislation, and all states and the ACT have now passed VAD laws which either explicitly or implicitly contemplate consultations with medical professionals being undertaken via telehealth. (Legislation in the NT is expected to pass soon.)
In 2005 then Attorney-General Phillip Ruddock obtained parliamentary approval for a bill to amend the Criminal Code to insert sections 474.29A and 474.29B creating offences for using a carriage service (for example, any form of electronic communication) to directly or indirectly counsel or incite committing or attempting to commit suicide.
These amendments were intended to address internet influencers trying to persuade or individuals to consider suicide or instruct them in how to do so. They were not intended to prevent or hinder telehealth being used as part of a VAD process.
While there has been some ambiguity about whether the offence provisions extend to action taken under VAD laws, a Federal Court decision in 2023 held that they do.
As a result terminally-ill patients (especially outside metropolitan areas) are being required either to undertake expensive and painful travel to attend in-person consultations, or to pay the travel costs for doctors to attend their homes.
The problem would be fixed by a simple amendment to the Criminal Code to make it clear that the offences did not apply to doctors acting under state or territory VAD law.
Attorney-General Michelle Rowland said at conference: “I am personally not convinced that a person confronting an end-of-life decision shouldn’t be afforded the dignity of a personal face-to-face consultation with a medical practitioner.”
With all due respect to the Attorney, this isn’t the Commonwealth’s business. State legislatures have undertaken exhaustive debates to develop and enact a system of VAD for their jurisdiction, and if they are prepared to countenance telehealth as part of the process, that should be a matter for them, and is nothing to do with a Commonwealth MP.
Rowland should also consider that “a personal face-to-face consultation with a medical practitioner” might be a lot harder in most of NSW than in her electorate based on Blacktown, 30 kms west of the Sydney CBD.
Government
I have written before about the baffling curation of the news page on the Department of Health, Disability and Ageing (DHDA) website. Important and long-awaited reports or responses to inquiries are posted on obscure corners of the website without any reference on the news page, while trivial issues are posted as news.
This week the news page included this gem: a reminder from DHDA to hearing service providers that “signed claim forms are critical program records supporting all Hearing Services Program claims”.
“Providers must ensure forms are retained, transferred with client records where required, and remain accessible after any software or records system changes,” said the note.
First, this is not news – it is restating an existing obligation.
Second, organisations must register to become hearing service program providers. DHDA knows who they are, where they live, and what their email addresses are. There is no need for DHDA to post this reminder on the news page of the website if it could just send an email (or even a letter) directly to the 300 organisations who need reminding.
In early May this year, the Therapeutic Goods Administration (TGA) issued a warning about the risks of importing and using unapproved peptide products that are promoted online.
Following the ABC’s Four Corners program on 20 July on the “race to reverse ageing” including the use of peptides, the TGA issued another statement warning “unapproved peptide products are being advertised as delivering fast health results, but they can pose serious health risks to consumers”.
The TGA said “the message is simple”:
- If you are buying unapproved peptide products, understand the risks
- If you are advertising, importing, supplying, manufacturing or exporting them, know your legal obligations
- If you are unlawfully advertising, importing, supplying, manufacturing or exporting them, expect the TGA to take action.
Later in the week, in the US a Food and Drug Administration (FDA) advisory panel recommended lifting restrictions on the ability of compounding pharmacies to prepare a range of peptides which had not been subject to usual FDA scrutiny processes.
The Guardian reported “across several votes, the panellists voted 8-6, with one abstention, in favour of putting the peptides on FDA’s list of substances considered safe for pharmacy compounding”.
It went on to say the “vote tally reflected the unusual makeup of the panel”.
“Before the meeting, more than a half-dozen people with connections to the peptide industry were added to the panel, including doctors, pharmacists or consultants who work in the field.”
The New York Times reported that non-industry panel member Dr Elizabeth Rebello, a medicine professor at the University of Texas MD Anderson Cancer Center, asked “has the FDA approved a medication delivered in this form that’s not been studied in humans previously?”
An FDA official responded: “No.”
The FDA used to be a gold standard regulator. Judged on this performance, the Trump Administration and Robert F Kennedy Jr have reduced it to pinchbeck.
The Australian Institute of Health and Welfare (AIHW) released an article on injury hospitalisations among healthcare workers, citing Australian Bureau of Statistics data showing “healthcare and social assistance workers experience some of the highest rates of work-related injuries in Australia, particularly for women”.
The article found the leading causes of injury hospitalisations among healthcare workers in 2024-25 were falls (36 percent of 819 hospitalisations) and assaults (15 percent of hospitalisations).
The AIHW noted while “falls are also the top cause of injury hospitalisations in the general population”.
“However, assaults rank as the second most common cause for healthcare workers, compared with seventh for the general population.”
Over the decade to 2024-25, assaults moved from the fourth most common cause to the second.
The Australasian College for Emergency Medicine (ACEM) said the data on assaults “reflect the daily reality reported by emergency department (ED) staff”.
ACEM President Dr Peter Allely said “emergency doctors and nurses go to work to care for people, not to be hospitalised themselves. When assaults on healthcare workers that require hospitalisation double in a decade, that is a sign the systems meant to protect staff and patients are falling short”.
Alley said ACEM’s report Breaking Point: An Urgent Call to Action on Emergency Department Safety released last year “sets out what needs to change: better reporting of violent incidents, a properly resourced ED security officer role, and a whole-of-system approach that reduces wait times in EDs and reduces avoidable presentations through stronger primary care, mental health and aged care”.
The Australian College of Nursing (ACN) and the Australian Nursing and Midwifery Federation (ANMF) issued a joint statement, saying the data “confirms years of warnings about worsening safety of healthcare workers”.
ACN CEO Adjunct Professor Kathryn Zeitz said: “Health services need to act now to rein in this epidemic of occupational violence [and]… make addressing occupational violence a priority.
“[Boards] need to closely monitor and respond to incidents against their staff and ensure that anti-occupational violence measures are being enforced and working.”
ANMF Federal Secretary Annie Butler said “occupational violence and aggression in the workplace is causing significant physical and psychological harm and trauma, which is impacting health workers and their capacity to deliver care”.
Butler added “urgent action, including improved staffing levels, and additional security measures, is needed, so nurses, midwives and personal care workers are safe on the job”.
The AIHW also released a report on injuries occurring among admitted patients, finding that “from 2015–16 to 2019–20, the hospital-onset injury rate fell from 64 to 50 per 10,000 separations and has remained stable up to 2024–25”.
- Falls accounted for just over half of the injuries, and generally resulted in open wounds or superficial injuries.
- The rate of hospital-onset injury increased with longer periods of hospitalisation, and the occurrence of a hospital-onset injury was associated with a longer length of stay.
The AIHW also released a report on reducing preterm birth among Aboriginal and Torres Strait Islander women, finding “preterm birth rates among First Nations babies have hardly changed in two decades, fluctuating between 13.9 percent in 2005 and 13.8 percent in 2023”.
By way of comparison, the preterm birth rate among all babies born in Australia was 8.1 percent in 2004, increasing marginally to 8.4 percent in 2023.
The report expatiates on potential strategies to reduce the incidence of pre-term births, but does not provide much analysis of the causes of the existing differential.
The ABS published an article on Completed Cohort Fertility Rates (the number of children born to cohorts of women up to age 49). The rate peaked at over three for women born in 1930 and 1935, but has since fallen to just over two for women born in 1970 and 1975.
The Independent Health and Aged Care Pricing Authority released its 2026-27 Work Program, with major projects including starting multi-year reviews into the costs and pricing of care for First Nations peoples and services delivered in rural and remote areas and smaller jurisdictions, and assessing the funding model and providing advice on the Multi-Purpose Services Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) released the initial draft of the National Safety and Quality Health Service (NSQHS) Standards (third edition) and invited feedback by 25 September.
The ACSQHC said the draft:
- responds to known system pressures and gaps identified since earlier editions of the Standards
- reflects a shift in focus from specifying clinical processes to prioritising how patients experience care
- has streamlined the number of Standards to encourage greater integration within health services and practical application at the point of care.
The ACSQHC also issued a specific invitation to Aboriginal and Torres Strait Islander health organisations to have their say on the requirements in the draft standards to improve the cultural safety and quality of care for Aboriginal and Torres Strait Islander peoples.
That process closes on 2 October.
Ahpra said it had reviewed its handling of 477 notifications relating to racism and discrimination between July 2023 and February this year, finding that nearly half (44 percent) of the notifications arose from practitioner conduct on social media, particularly in relation to alleged antisemitism and Islamophobia.
Ahpra said it is implementing a range of actions to strengthen its response, and has already reduced the average time taken to finalise these notifications from 132 days to 53 days.
It will publish data every six months to track progress.
Ahpra added it has commissioned a dedicated Cultural Safety Evaluation to examine how its notifications system responds to racism affecting Aboriginal and Torres Strait Islander Peoples.
Consumer and public health groups
Peter Breadon, director of the health program at the Grattan Institute, responded to what he called “supermarket scaremongering” – criticism of the Institute’s paper on pharmacy remuneration and ownership arrangements focussing solely on the idea that supermarkets could own pharmacies.
Breadon wrote “it’s been called ‘absurd’ for pharmacy services to be offered in supermarkets, and an ‘Americanisation’ of our system”.
“That’s a stretch for something that’s routine in the UK, the US, Canada and New Zealand,” he said.
He went on “the supermarket scaremongers have been silent on the real scandal: not who might own pharmacies in the future, but who owns pharmacy policy today – and what it’s costing you”.
Lung Foundation Australia said “comments made at the National Press Club [by a panel including Liberal MP Mary Aldred, Rohan Pike, and Dr Nick Coatsworth] on Wednesday 22 July did not accurately reflect [its] position on vaping and smoking cessation”.
The Foundation said it “believes therapeutic nicotine e-cigarettes should only be considered as a last-line smoking cessation option for people who want to quit smoking… only after evidence-based treatments, including NRT, approved cessation medicines and behavioural counselling, have been tried without success”.
MS Australia welcomed the Government’s announced rapid review of MS medicines, and said the review should:
- recognise that MS is a complex and highly individual disease, and no single therapy is right for every person or at every stage of disease
- prioritise first-line access to a broad range of PBS-listed treatments, including high-efficacy treatments, as essential to giving each person the best chance of maintaining their health, independence, workforce participation and quality of life
- ensure that decisions regarding continued access to MS medications on the PBS today and into the future, are informed by the evidence, the science, and the clinical needs of the people dependant on these medications.
First Nations
The Australian Indigenous Doctors’ Association (AIDA) issued a statement on its appearance with the Royal Australasian College of Physicians (RACP) and the Royal Australian College of General Practitioners (RACGP) before the Senate inquiry into Australia’s Youth Justice and Incarceration System on 3 July.
AIDA CEO Dr Peter Malouf told the inquiry: “Australia does not suffer from a lack of evidence, it suffers from a lack of political courage.
“If governments are serious about reducing youth offending and improving community safety, we must intervene before children are criminalised, not after the damage has already been done.”
AIDA, RACP and RACGP called on the Parliament to:
- Raise the minimum age of criminal responsibility to 14 years nationally
- Implement the Australian Human Rights Commission’s Help Way Earlier! recommendations
- Establish a national health-first legislative framework that addresses children’s health, disability, developmental, family and cultural needs before criminalisation
- Invest in Aboriginal and Torres Strait Islander community-controlled organisations and culturally safe early intervention
- Embed the principles of restorative justice in reform of youth justice pathways
- Embed the Closing the Gap Priority Reforms across youth justice
- Ensure the National Commissioner has a strong role in monitoring accountability.
(Croakey published an article on 24 July on the NT Government ignoring the evidence and expert advice in introducing child protection reforms.)
Trade unions
The RACGP called for “targeted reform of pharmacy ownership rules” following a report by Monash University, published in the Australian Journal of Rural Health, “showing the current ownership restrictions are not working as claimed – particularly in rural and remote communities and outer suburban areas”.
RACGP Rural Chair Associate Professor Michael Clements said “where communities cannot attract a pharmacist willing or able to purchase a pharmacy business, the current rules can leave patients with limited or no local dispensing services”.
The RACGP called on Government to explore exemptions or alternative ownership models for rural and remote communities where pharmacy services are at risk or unavailable.
Clements said “many rural GPs choose to work in practices without wanting to own the business themselves”.
“The same flexible thinking should be applied to pharmacy services where communities are at risk of missing out.”
The Pharmacy Guild position paper on pharmacy ownership states: “The Guild believes the public is best served when pharmaceutical services are provided from a practice which is owned and controlled by pharmacists who are personally responsible for its conduct. This protects the health and safety of the public by positioning healthcare providers at the centre of the provision of care rather than corporations, and ensures that safe, high quality and effective professional services are available at all times.”
Given pharmacists can own multiple pharmacies in multiple states, “personal responsibility” for the conduct of the business is often highly diluted.
The Guild position would be more credible if it argued for numerical and geographic limitations on the number of pharmacies an individual can own.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) said its Child and Adolescent Psychiatry Workforce Report “shows that while Australia’s shortage of child and adolescent psychiatrists is a national problem, its causes look different in every state and territory”.
Psychiatrists consulted during the development of the report “described routinely having to decline five to ten new referrals each week, and said public services have been forced to stop seeing children under 12 so they can prioritise the most acutely unwell adolescents”.
Chair of the RANZCP’s Faculty of Child and Adolescent Psychiatry, Scientia Professor Valsamma Eapen AO, said “some states are training psychiatrists and still losing the fight to keep them”.
“Others can’t get enough doctors into training in the first place. Every state and territory needs a different response, but every state needs to act for its children who need specialist support for their mental health needs.”
The RDAA marked the start of National Pain Week by “encouraging Australians living with ongoing pain to seek help early, reminding people that persistent pain is not something they simply have to live with”.
RDAA President Professor Sarah Chalmers said “chronic pain affects millions of Australians, and people living in rural and remote communities often face additional barriers to getting the care they need”.
Industry groups
The Australian Private Hospitals Association (APHA) called on the Australian Competition and Consumer Commission (ACCC) to reject an application from Honeysuckle Health (a subsidiary of private health insurer nib) to allow it to “collectively negotiate hospital contracts on behalf of multiple health insurers”.
APHA said “the application would give nib’s insurer group unmatched bargaining power at the expense of financially struggling private hospitals, jeopardising patient access to timely, high-quality care”.
It should be noted Honeysuckle Health already has an ACCC authorisation, and the application as described by the ACCC is “seeking to maintain operation of the Buying Group, and to engage in the same conduct, for an additional ten years”.
The AMA said the ACCC must maintain previously agreed safeguards in any reauthorisation of Honeysuckle Health.
The Medical Technology Association of Australia (MTAA) said it was “deeply concerned” that the reporting by Nine Publishing and 60 Minutes on regulation of medical devices, on 18 and 19 July “will needlessly cause some patients to question or delay the use of medical technologies that may be essential to their health and quality of life”.
MTAA went on to say it “strongly rejects the underlying premise of this reporting”.
“The conclusions presented are highly predicated on inappropriate interpretation of data, go far beyond what the actual data can demonstrate, and oversimplify highly complex clinical issues.”
The TGA provided 60 Minutes with a lengthy statement explaining how medical device regulation works.
Medicines Australia said “only 25 percent of medicines launched globally over the past decade have been listed for government subsidised access in Australia – leaving Australian patients with the ‘bitter pill’ of the three-quarters that are missing”.
“The paltry approval rate compares with 88 percent in the United States and 46 percent in the United Kingdom.”
Medicines Australia called on the Government to act on two priorities: real, sustained growth in PBS investment in future budgets; and the timely, transparent implementation of the Health Technology Assessment Review completed in May 2024.
Parliamentary committees
The Senate inquiry into the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026 will hold a one-hour hearing on 29 July attended by DHDA.
International organisations
Ahead of World Drowning Prevention Day on 25 July, the World Health Organization (WHO) launched a new “technical package to help governments and communities implement seven proven measures to reduce drowning deaths”.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said “every drowning is a tragedy, and most are preventable”.
“The seven PROTECT strategies give countries practical, evidence-based approaches to prevent these tragedies… Drowning prevention isn’t the job of one ministry; it belongs to everyone, and the lives it saves are the reward”.
The seven strategies are:
- Physical infrastructure that promotes safe interaction with water
- Rescue and resuscitation capability for bystanders and professional responders
- Occupational safety for work around water
- Transport safety standards for water travel
- Education in basic swimming and water safety
- Child‑care systems and ensure safeguarding
- Threat preparedness for floods and other multi‑hazard emergencies.
Finally
Shortsightedness about the benefits of spending money on services to assist older people to stay at home rather than enter residential care is apparently not restricted to Australia.
The New York Times reported the Trump Administration is withholding Medicaid funds due to California and Minnesota because of suspicions of fraud.
In the case of California, the “evidence” cited by Dr Mehmet Oz, the federal official who oversees Medicaid and Medicare, included rapid growth in spending on in-home support services.
California Governor Gavin Newsom defended the additional spending on in-home care, tweeting “Dr Oz doesn’t understand that we are *SAVING* taxpayers money by keeping seniors and people with disabilities out of far more expensive nursing homes!”.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Australian Commission on Safety and Quality in Health Care
Help shape culturally safe hospital care for First Nations people – expressions of interest
30 July
Therapeutic Goods Administration
Radiopharmaceutical regulation in Australia
31 July
Senate Community Affairs Committee
Support at Home Program
31 July
Australian Commission on Safety and Quality in Health Care
Provide feedback on the Standard for VTE prevention
31 July
Department of Health, Disability and Ageing
Fee Transparency in Health Care: Informed Financial Consent and Split Billing Practices
5 August
Therapeutic Goods Administration
Changes to the Permissible Indications Determination
12 August
Australian Commission on Safety and Quality in Health Care
Updated pathology Standard
12 August
Australian Commission on Safety and Quality in Health Care
Requirements for Haemopoietic Cellular Therapy
12 August
Department of Health, Disability and Ageing
Private Health Reforms – Consultation Paper 1
13 August
Department of Health, Disability and Ageing
Consultation on the Medical Research Future Fund Australian Medical Research and Innovation Strategy and Priorities
16 August
Food Standards Australia New Zealand
Common commencement date for labelling changes
18 August
Independent Health and Aged Care Pricing Authority
The development of residential aged care pricing and costing advice to the Government for 2027-28
21 August
Senate Community Affairs Committee
Private Health Insurance Amendment (Modernising the Private Health Insurance Rebate) Bill 2026
21 August
Department of Health, Disability and Ageing
Co-design the future of aged care Application Programming Interfaces
29 August
Therapeutic Goods Administration
Improvements to the Therapeutic Goods Advertising Code
3 September
Department of Health, Disability and Ageing
Public consultation on items to be considered by the PBAC
16 September
Australian Commission on Safety and Quality in Health Care
Draft National Safety and Quality Health Service Standards (third edition)
25 September
Australian Commission on Safety and Quality in Health Care
Requirements in the draft National Safety and Quality Health Service Standards to improve the cultural safety and quality of care for Aboriginal and Torres Strait Islander peoples
2 October
Medical Services Advisory Committee
- Surgical Procedures for Gender Affirmation in Adults with Gender Incongruence
- Breyanzi (lisocabtagene maraleucel) for the treatment of large B-cell lymphoma
- Implantation of an active middle ear implant (Vibroplasty) for treatment of mixed and conductive hearing loss
- Supervised oral food challenge in patients with suspected food allergy
- Genomic testing for the diagnosis of primary immunodeficiency
9 October
House of Representatives Standing Committee on Health, Aged Care and Disability
Inquiry into the access to and affordability of medical specialists
16 October
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
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