Yet more criticism of Federal Opposition and One Nation tobacco policies, what’s on the (public) agenda of the nation’s health ministers, the first National Health Literacy Framework, and ongoing concerns about the inappropriate use of psychotropic medicines in aged care are among the topics covered this week.
The Zap also reports on “a growing realisation that the Government’s ‘aged care reforms’ have largely missed the mark in terms of improving timely access to quality care”.
And congratulations to the winner of the inaugural Uncle Louis Peachey Lifetime Achievement Award, announced at the Australian Indigenous Doctors Association 2026 Conference Gala Dinner on Whadjuk Noongar Boodjar.
The quotable?
Australia now has the lowest smoking rates we’ve ever seen. This is not the time to abandon the measures that have delivered those results.”
Charles Maskell-Knight writes:
Commonwealth, state and territory Health Ministers met on 4 September. The official communiqué is here. Topics discussed by Ministers included:
- National Mental Health and Suicide Prevention Agreement (effectively deferred until December)
- Hospital discharge (Ministers agree a definition for “Delayed Discharge of an Older Person”)
- 2026 Aboriginal and Torres Strait Islander Health Roundtable (Ministers reaffirmed their commitment to continue to work together to achieve real improvements to the health and wellbeing of First Nations people in places of detention and upon their release)
- Oral Health and Dental Reform (Health Ministers agreed to establish a National Oral Health and Dental Reform Senior Officials Group to progress dental health reform as a national priority.)
The separate media conferences held by state and territory Ministers, and then by Health Minister Mark Butler suggests the meeting was a little livelier than the communiqué suggests.
At his media conference, Butler was asked: “You can hear the frustration from the state and territory ministers about the aged care bed problem, and you have reflected that yourself in your comments. What are you doing? What can you do?”
He replied: “I’ve tried to be honest with the Australian community and my colleagues that there is no easy fix to this challenge of demand.
“The numbers are simply unprecedented – the number of older Australians needing and deserving support, whether that’s support through the healthcare system or support through the aged care system.
“I said to [Ministers] again this morning, we increased the number of home care packages last year by 25 percent. Even with that increase, there’s still more and more demand. But frankly, it is difficult for us to increase the number of packages by more than that level and essentially run into labour supply constraints.”
Of course, this upsurge in demand was not unforeseeable.
In 2008, then Aged Care Minister Justine Elliot regularly quoted the factoid that the number of people aged over 70 was going to increase from two million to four million over the next 20 years.
This does not appear to have been reflected in projections of demand or expenditure – or in labour market planning.
Asked about state and territory Ministers’ comments on the impact of the proposed private health insurance premium rebate changes, Butler pointed out that the Government’s modelling and modelling from the University of Melbourne both suggested fewer than 50,000 people would drop their insurance.
“The insurance industry unsurprisingly has put out very different numbers, and it appears that the state governments are simply reflecting the insurance industry modelling about what they think will happen,” he said.
“I made the point to my health minister colleagues today, if you go to the private health insurance website, they still have modelling on their website that says that when we means-tested health insurance some years ago, 1.6 million people would leave health insurance, 850,000 additional people would end up in public hospitals. None of it happened.”
Tobacco control
This column reported last week on the release of the report of the Coalition-chaired Senate inquiry into illicit tobacco on 28 August, including recommendations to reduce tobacco excise and legalise wider distribution of vapes.
On 3 September, the Coalition announced “a major law and order policy to crush the organised crime gangs that are making billions from illegal cigarettes and vapes” by reducing tobacco excise by 80 percent and legalising the wider distribution of vapes and other tobacco products.
This followed an announcement by One Nation two days earlier that it would “cut tobacco excise by 75 percent, pause indexation for three years and pair the cut with far tougher action on organised crime”.
Croakey has already reported on reaction to these developments from a number of groups, including the Australian Council on Smoking and Health, the Public Health Association of Australia, the Australian Medical Association (AMA), and the Australian College of Nursing (ACN).
At his 4 September media conference Minister Butler also commented, saying: “What we’re seeing on the conservative side of politics increasingly is One Nation yelling jump to the Liberal party, and Angus Taylor simply asking how high.
“You saw that yesterday again around tobacco excise. This was a grossly irresponsible policy announcement from an alternative party of government. What we’ve seen is a policy with no modelling behind it, no plan around the way in which it will roll out in the retail sector.”
Other groups to react included Lung Foundation Australia and the Thoracic Society of Australia and New Zealand (TSANZ), which issued a joint statement on the Senate inquiry report, “reiterating the need for a comprehensive national approach to reducing the harms caused by legal and illicit tobacco and nicotine products”.
Lung Foundation CEO Mark Brooke said illicit tobacco must be addressed through coordinated enforcement and continued investment in proven tobacco control measures; TSANZ CEO Vincent So said addressing illicit tobacco should be accompanied by continued investment in the evidence-based measures that reduce smoking and prevent lung disease.
They agreed on the need for nationally consistent tobacco retail licensing and penalty frameworks, continued coordinated enforcement, and measures to reduce tobacco retail availability.
They said: “Weakening or removing established tobacco control levers would risk undermining these reforms and the protections they provide for lung health and public health more broadly.”
They called for “expanded access to free nicotine replacement therapy, Quitline and behavioural counselling services, MBS-funded cessation support and other evidence-based treatments through primary care”, and said they supported the pharmacy-only pathway for therapeutic nicotine vaping products that meet Therapeutic Goods Administration requirements, where clinically appropriate for smoking cessation and with guidance from a healthcare professional.
The Cancer Council and Quit issued a joint statement responding to the Senate report and the Coalition-One Nation policy, without explicitly mentioning either.
The statement said “proposals to legalise vaping products and dramatically reduce tobacco excise would undermine decades of progress in reducing smoking and preventing cancer”.
Cancer Council Director of Cancer Control Policy David Martin said: “Australia now has the lowest smoking rates we’ve ever seen. This is not the time to abandon the measures that have delivered those results.”
“Sixty-six people will die today from smoking. We should be asking how we further drive down smoking, not how we make cigarettes and nicotine products more available and socially acceptable.”
Martin added: “We know that the illicit trade is a serious problem but making tobacco cheaper or creating a commercial vape market will not address it. The answer to illicit tobacco is stronger enforcement – tighter control of supply, better policing, tougher penalties and disrupting organised crime.”
Quit Medical Lead Dr Liam Egan said: “Quitline receives calls from young people addicted to vaping and pouches, and struggling to quit. We don’t want to make these harmful, addictive nicotine products easier to access at the very moment we should be doing everything possible to prevent another generation becoming hooked.”
The Guardian reported on reaction from other public health experts to the Coalition and One Nation policies.
Also on tobacco control, Deepcut News reported that: “Big Four consulting firm Deloitte has been handed a $2.1 million contract to provide ‘management advisory services’ to the Illicit Tobacco and E-Cigarette (ITEC) Commissioner despite a decades-long relationship with the tobacco industry and its contribution to campaigns against plain-packaging laws.”
Presumably the tender evaluation committee concluded Deloitte’s experience in working for poachers would be relevant to assisting the gamekeeper.
Ministers and government
Assistant Minister for Health Rebecca White launched Australia’s first National Health Literacy Framework.
White said “people shouldn’t have to be health experts to understand their own health”.
“This framework provides a national roadmap to help all people in Australia make informed health decisions and make sure health information is communicated clearly in a way that is easy to understand.”
White also announced the engagement of the Living Evidence Collaboration (ALEC) at Monash University to lead the development of Australia’s first national clinical guidelines for perimenopause and menopause.
There is a growing realisation that the Government’s “aged care reforms” have largely missed the mark in terms of improving timely access to quality care. Increasing workers’ pay and mandating care minutes in residential care have both been important and valuable, but otherwise the picture is bleak.
There are long waits for assessment and access to care at home, and poor access is exacerbated by increased costs.
There is a growing undersupply of residential places, and the cost of access to them is also increasing.
The rights underpinning the so-called “rights-based system” are deficient (for example, no right to timely access) and unenforceable.
The star-ratings system designed to assist people finding a quality provider is a bad joke – every provider passes with flying colours, even if their performance on one of the domains is manifestly inadequate.
This hasn’t stopped the Department of Health, Disability and Ageing (DHDA) from uploading videos to its Instagram account extolling the new system.
I’m not sure how many people needing aged care have Insta accounts (and follow healthgovau), but those who do deserve better than this pap.
The Centre for Disease Control (CDC) said “there have been ongoing detections of H5 bird flu (influenza A H5N1 clade 2.3.4.4b) in birds in Australia”.
“Bird flu has also been detected in other wildlife in Australia for the first time. The risk to people in Australia remains low.”
The CDC urged people seeing sick or dead birds or animals to:
- avoid contact
- record what they see
- report it to the Emergency Animal Disease Hotline on 1800 675 888 from anywhere in Australia.
The Australian Institute of Health and Welfare released the First Nations Burden of Disease Study, finding Injuries (22 percent), cancer (21 percent) and cardiovascular diseases (19 percent) caused most of the fatal burden for First Nations people in 2022.
It said at the individual disease level, the leading causes of fatal burden were coronary heart disease (11 percent), suicide and self-inflicted injuries (9 percent) and lung cancer (5.5 percent).
While there was a 6.3 percent decrease in the age-standardised rate of total burden between 2011 and 2022, from 457 to 429 Disability Adjusted Life Years per 1,000 people, this was driven by a reduction in the age-standardised rate of fatal burden between 2011 and 2022.
The age-standardised rate of non-fatal burden remained largely unchanged.
The Independent Health and Aged Care Pricing Authority (IHACPA) released the Residential Aged Care Pricing Advice 2026–27, including:
- the recommended Australian National Aged Care Classification (AN-ACC) price to apply from 1 October
- the recommended price weights for each AN-ACC class, respite class and base care tariff category
- the estimated gap between the costs of delivering everyday living services and related revenue received by residential care homes.
The AN-ACC price of $303.19 is 2.55 percent more than the $295.64 IHACPA recommended for 2025-26.
Aged Care Minister Sam Rae promptly announced the Government had accepted the advice, saying the “Government is continuing to support the aged care sector to deliver better quality care for older Australians, with increases to vital funding taking effect in the coming weeks”.
Ageing Australia (the aged care provider lobby group) said the price was “unacceptable”, and providers would not be able to make ends meet, let alone build new beds.
Ageing Australia CEO Tom Symondson said “this is an extremely disappointing outcome”.
“It does not reflect the major financial challenges the sector is facing, or the massive increase in costs for fuel and clinical supplies driven by an unpredictable international environment,” he said.
“Put very simply, this decision is not good enough and lets down both providers and the older people who rely on them every day.”
Catholic Health Australia (CHA) said the decision amounted to “a real-terms funding cut on aged care providers across the country, poses a serious risk to quality care for older Australians and must be revisited immediately”.
CHA Director of Aged Care Alex Lynch said “the Government has made significant decisions to support the aged care system but this funding cut is a major step in the wrong direction”.
“It goes directly against the Government’s aim to ensure Australians have access to a quality, affordable and safe aged care system and must be reconsidered.”
It is perhaps a little ironic that CHA, which has been leading the campaign for a national price for private hospital services set by the IHACPA, is now complaining about a national price for aged care services recommended by the IHACPA.
Ahpra invited applications from registered Aboriginal and/or Torres Strait Islander health practitioners for appointment to the Aboriginal and Torres Strait Islander Health Practice Accreditation Committee.
Ahpra joined with the Medical Board in a statement reporting on an evaluation of the first eighteen months operation of the Expedited Specialist pathway introduced in October 2024, which made it easier for Specialist International Medical Graduates (SIMGs) to obtain Australian registration.
It found a 29 percent increase in applications, with 476 SIMGs granted registration.
It also found:
- most applicants are new entrants to the Australian health system
- the pathway is attracting a cohort of recently qualified specialists which may contribute to longer-term workforce sustainability if they remain in Australia
- 88 percent of specialists are practising in defined areas of workforce shortage including designated metropolitan priority areas
- 11 percent are practising in regional, rural and remote areas.
It concluded “the pathway is achieving its intended objective of providing a more streamlined registration process for eligible internationally qualified specialists while maintaining the standards expected by the Australian community”.
The Medical Board opened applications for specialist registration in rural generalist medicine for doctors with Australian College of Rural and Remote Medicine (ACRRM) or Royal Australian College of GP (RACGP) qualifications.
Both ACCRM and RACGP welcomed the announcement, describing it as an important milestone.
The Aged Care Quality and Safety Commission released a Progress Report on the Joint Statement on the Inappropriate Use of Psychotropic Medicines to Manage the Behaviours of People with Disability and Older People.
The ACQSC joined with the NDIS Quality and Safeguards Commission (NDIS Commission) and the Australian Commission on Safety and Quality in Health Care (ACSQHC) in issuing the Joint Statement in March 2022.
The three commissions “committed to working together to reduce the inappropriate use of psychotropic medicines wherever people received care and support”.
While the report “highlights the range of activities undertaken to specifically support aged care providers”, it does not report outcomes.
In relation to antipsychotics, AIHW data shows that after falling from 21.6 percent of aged care residents receiving the drugs in the September quarter 2021 to 18.4 percent in the June quarter 2023, the rate has since stabilised between 17.3 and 18.0 percent.
Perhaps it is now time to stop “supporting” providers, and start penalising them for continuing to use drugs with no clinical benefit for many residents.
It might even be time to implement the Aged Care Royal Commission recommendation that “only a psychiatrist or a geriatrician can initially prescribe antipsychotics as a pharmaceutical benefit for people receiving residential aged care”.
First Nations
The inaugural Uncle Louis Peachey Lifetime Achievement Award was presented to the man who inspired it at the Australian Indigenous Doctors Association (AIDA) 2026 Conference Gala Dinner on Whadjuk Noongar Boodjar.
“The new accolade recognises an individual whose lifelong leadership, advocacy and commitment have helped shape AIDA’s mission, vision and values, while advancing equity and recognition for Aboriginal and Torres Strait Islander peoples in health,” AIDA posted on Facebook.
“Thank you, Uncle Louis, for your enduring legacy that continue to guide us today and into the future.”
AIDA also announced the appointment of Phillip Saunders as our Chief Executive Officer for the next 12 months. He began in the role on 24 August.
Indigenous Allied Health Australia (IAHA) announced applications for Puggy Hunter Memorial Scholarship applications were open until 31 October.
The scholarships are intended to empower Aboriginal and Torres Strait Islander students to succeed in their undergraduate studies, and “provide access to financial, cultural, mentoring, and other supports for Aboriginal and Torres Strait Islander students studying in health, including access to up to $15,000 per annum (full time) for the normal duration of the course”.
They are administered through IAHA and the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, in partnership with Rural Doctors Network.
Trade unions
The ACN released a new report, which “reveals Australia’s nurses are calling out for structured nursing career support and guidance to keep them working as nurses and making nursing their lifelong career”.
Based on “direct national consultation with nearly 800 nurses from all corners of the country”, the ACN called for:
- Embedding wellbeing as a core component of career development
- Improving the visibility of enrolled nurses as essential members of the nursing workforce
- Strengthening career pathways and career development resources for nurses
- Improving national data on graduate program availability and early-career transition
- Strengthening structured transition programs at both ends of the career
- Embedding nursing career infrastructure into national workforce strategies.
The AMA announced the election of Sydney GP Dr Michael Bonning as the next President of the federal Australian Medical Association and Melbourne emergency medicine specialist Dr Sarah Whitelaw as the next Vice President. They will take up the positions on 2 November.
The AMA also released its submission to the DHDA consultation on private health insurance reform, “welcoming several promising proposals on private health sector reform but warning meaningful reform will require action on underlying funding pressures threatening the viability of private hospitals, particularly in mental health and maternity care”.
It advocated for increased MBS rebates for psychiatrists providing inpatient care, and “greater flexibility for women who unexpectedly become pregnant to access appropriate private health insurance cover, and better Medicare support for clinicians involved in maternity care”.
The Australian Physiotherapy Association (APA) released a position paper on direct referral by physiotherapists to orthopaedic surgeons, and called on governments allow such referral for defined musculoskeletal presentations when established clinical criteria are met.
APA National President Dr Rik Dawson said modernising referral pathways would help ensure patients receive care from the right healthcare professional at the right time.
He said “the proposed reform would not create a new scope of practice or change the role of other health care professionals”.
“Instead, it would update referral pathways so patients can access specialist assessment when clinically indicated, while maintaining physiotherapy-led conservative management as the first step for most non-urgent musculoskeletal conditions.”
The Pharmaceutical Society of Australia (PSA) said it had endorsed the International Pharmaceutical Federation’s Montreal Declaration on Non-Communicable Diseases (NCDs), which “calls for action to ensure pharmacists are fully enabled to contribute to the prevention and management of all NCDs as integral members of primary health care teams”.
The RACGP urged people who experience hay fever, allergies and asthma to be prepared and take steps early to manage their symptoms as spring begins.
Industry groups
Australian Health Service Alliance CEO Andrew Sando said the drawn-out Healthscope sale process had shown “Australia’s private hospital infrastructure is too important to leave to a rubber stamp process of highest bid wins”.
“It demands closer attention from regulators, funds, and industry leaders. There’s too much at stake, and no time or patience for history to repeat itself.”
His full article is available at Health Services Daily.
The Australian Private Hospitals Association (APHA) released a study it had commissioned from ACIL Allen, which found that the sector contributed (directly and indirectly) over $27 billion to the economy and “underpinned” the jobs of more than 229,000 Australians.
APHA CEO Brett Heffernan said “this contribution underscores the vital case for private hospital viability”.
He concluded that the sector “indirectly positively impacts the lives of all Australians, shouldering a healthcare burden and economic footprint that would otherwise see many industries and the jobs they support disappear, in addition to the collapse of the public health system”.
Of course, if the private hospital sector did not exist, all the same services would eventually be delivered by an expanded public sector making the same contribution to GDP.
Medicines Australia “released its proposed solutions to increase the number of new medicines available in Australia on the PBS for patients… including doubling the investment in innovative medicines as a proportion of GDP over ten years”.
It said the UK has already made this commitment, and matching it would ensure Australia remains competitive with the rest of the world.
Medicines Australia released a new report Access Unlocked, which identifies the current problems facing medicine access, the consequences for patients of not addressing these problems, and proposes solutions.
Health Services Daily reported the Pharmacy Guild had written a four-page letter to a financial supporter of the Grattan Institute highly critical of the Institute’s Future Pharmacy report on pharmacy policy.
The letter, from Guild executive director Gerard Benedet, went on: “Given the above failures of the Report, the Guild is urging you to rethink your organisation’s support for the Grattan Institute”.
“In some cases, your organisation actively supports the community pharmacy sector which is then incongruent with your support for a body which over more than a decade as sort [sic] to dislocate and damage the community pharmacy sector.”
The Grattan Institute told Health Services Daily it knew of a number of supporters who had received a similar letter.
Grattan health program director and Future Pharmacy report co-author Peter Breadon said “we have yet to see a definitive public response from the Guild to the report, that engages with the evidence”.
“The Guild seems to be putting all its energy into Grattan’s supporters, presumably with the intent of putting pressure on us.”
“But we follow the evidence, and stand by the report.”
Politicians and parliamentary committees
The Senate inquiry into the proposed private health insurance premium rebate changes held hearings on the Gold Coast on 3 September and in Sydney on 4 September.
While transcripts are not yet available, Professor Stephen Duckett AM allowed Croakey to publish his opening statement to the hearing on 3 September.
I’m sure the evidence of most institutional witnesses from the insurer, medical, private hospitals and older persons lobby groups will come under the heading of “Mandy Rice-Davies applies”.
International organisations
The Ebola outbreak in the Democratic Republic of Congo continues to grow, leading to warnings it could be the worst in history.
One of the contributing factors is the lack of a vaccine to address the Bundibugyo strain of the virus responsible for the outbreak.
The World Health Organization (WHO) has now released emergency guidance on the use of licensed Ebola vaccine during Bundibugyo virus disease outbreaks.
Based on evidence assessed by the Strategic Advisory Group of Experts on Immunization (SAGE) it concludes that “although some findings suggest possible cross-protection against [Bundibugyo], the available evidence remains insufficient to determine whether [the current licensed vaccine] Ervebo® provides clinically meaningful protection in humans”.
It recommends “the vaccine be used only within research protocols”.
In better news, WHO also announced:
- “a global initiative to establish a stockpile of mpox vaccines… creating a long-term mechanism to ensure countries have access to vaccines when responding to mpox outbreaks”
- the elimination of trachoma as a public health problem in Timor-Leste
- the elimination of dog-transmitted human rabies in Bhutan.
Finally
I recently decided to explore Substack, mainly so I could follow the wonderful Paul Krugman, self-described “Professor, City University of New York Graduate Centre, Nobel laureate and former columnist, New York Times. Also, according to Donald Trump, a ‘Deranged BUM’”.
While looking at other authors I came across Greg Jericho’s Grog’s Gamut, and his commentary on neoliberalism and public services. My favourite observation:
“I don’t have many maxims in life, but one of them is that the moment you privatise a public service is also the day you should set the date for the Royal Commission into the failures and abuses of the system”.
“Aged care and childcare are the prime example. The corrupted view that the free market will deliver optimal outcomes is based on a fraudulent belief that not only was the market free, but that those using aged and childcare services are able to make decisions based on equal information and power as held by the providers.”
“They don’t and so the abuses occur, both financial and personal.”
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.
Pharmaceutical Society of Australia
Clinical governance in contemporary pharmacy practice
10 September
Pharmaceutical Society of Australia
Dispensing practice guidelines
10 September
Therapeutic Goods Administration
Adoption of International Scientific Guidelines in Australia R01-2026
11 September
Department of Health, Disability and Ageing
Public consultation to help inform a possible “commissioning” approach for part of the Supported Independent Living market
13 September
Therapeutic Goods Administration
Proposed changes to support automated decision making for applications to change listed medicines
14 September
Pharmaceutical Benefits Advisory Committee
Public consultation on items to be considered by the PBAC in November 2026
16 September
Department of Health, Disability and Ageing
Public consultation on items to be considered by the PBAC
16 September
Office of the Gene Technology Regulator
Commercial supply of a genetically modified multivalent vaccine for chickens
25 September
Department of Health, Disability and Ageing
Medical Research Future Fund Reducing Health Inequities Mission – Consultation on the Roadmap and Implementation Plan
25 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
Revised Australian Guidelines for the Prevention and Control of Infection in Health Care
29 September
National Health and Medical Research Council
- Nutrient Reference Values – Public Consultation on Draft Recommendations – Vitamin B6
- Nutrient Reference Values – Public Consultation on Draft Recommendations for Sodium
30 September
Pharmaceutical Benefits Advisory Committee
Rapid Review of PBS medicines for relapsing-remitting multiple sclerosis
1 October
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
Therapeutic Goods Administration
Consultation on sharing more information about medical devices
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
- Procedures for the implantation and refill-exchange of the Port Delivery System with ranibizumab to treat neovascular age-related macular degeneration
9 October
Department of Health, Disability and Ageing
New Framework Planning and NDIS Supports
14 October
Medicare Benefits Schedule Review Advisory Committee
MBS Time Tiered Items Draft Report
15 October
House of Representatives Standing Committee on Health, Aged Care and Disability
Inquiry into the access to and affordability of medical specialists
16 October
Therapeutic Goods Administration
Additional public consultation on amending the Poisons Standard regarding ethylene oxide, propylene oxide and epichlorohydrin
Author details
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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