Australia is going backwards when it comes to the proportion of health funds being allocated to public health, according to data recently released by the Australian Institute of Health and Welfare.
Aged care and Medicare reforms are also in focus this week, along with concerns about the impact on reproductive health services of the Calvary Health Care takeover of 14 former Healthscope hospitals.
The Australian Commission on Safety and Quality in Health Care is seeking comment on draft national safety and quality standards for virtual care, and on draft artificial intelligence (AI) guidance for health services. And the Australian Medical Research and Innovation Strategy 2026-2031 has been released.
The quotable?
It’s time for all Governments to consider whether a deadly product that kills 66 Australians every day should be more available than daily essentials like milk, bread or fruit and vegetables.”
Charles Maskell-Knight writes:
The Department of Health, Disability and Ageing (DHDA) issued a statement marking the 12-month anniversary of the Aged Care Act 2024 taking effect, saying that “implementation of the aged care reforms continue [sic]”.
“The Australian Government and department agencies are continuing to work with older people, aged care providers and workers and the broad sector to identify opportunities and make improvements.”
The Department said recent changes include:
moving the Support at Home personal care contribution into the clinical category
extending the Commonwealth Home Support Program
providing a second block of End-of-Life Pathway funding.
(All of these changes followed sustained pressure from older people and their advocates, including providers, and involved overturning decisions after some time which were heavily criticised as soon as they were announced.)
DHDA did admit “there is more work to do”, saying that “Assessment wait times remain a significant concern and improving access is a key focus”.
Ageing Australia (the aged care provider lobby group) gave a more realistic assessment.
CEO Tom Symondson said “older Australians have been promised rights-based care”.
“But that promise means little if the care simply isn’t available,” he said.
“The Government must now work with the sector to address the growing crisis in access to care. More than 200,000 older Australians are waiting for an aged care assessment or the care they have been approved for, the average wait for a Support at Home package has reached 300 days, and almost 4,000 older people remain stuck in hospital because they cannot access the care they need in the community.
“The right to quality care once you get through the door rings hollow if an older person waits months to be assessed and months more for the approved funding to arrive or they cannot find a residential care bed anywhere near their family and community.
“Care delayed is care denied. And rationing care does not make a person’s needs disappear. It simply shifts the responsibility and the cost onto an older person, their partner, their children or the hospital system.”
Ageing Australia called on the Government to:
Address immediate funding pressures on residential aged care providers, following a 2.55 percent indexation increase that fell well short of both CPI and the independently modelled 5.17 percent required
Establish a national aged care investment plan to support the development of around 10,000 additional residential aged care places each year
End the rationing of home care by clearing Support at Home waitlists and ensuring older Australians can access the care they have been assessed as needing.
National Seniors Australia also marked the anniversary, arguing that “increasing the availability of Support at Home places is essential to reducing delays and ensuring older Australians receive care when they need it, rather than waiting until their circumstances deteriorate”.
Unfortunately the Government appears incapable of accepting this proposition.
I wrote earlier in the year that Aged Care Minister Sam Rae had emerged from the witness protection program, after a period of almost four months with only one media interview.
After his performance in this interview with Raf Epstein on ABC Melbourne radio, he may well be applying to re-enter the program.
Ministers and government
Health Minister Mark Butler issued a statement on the 12-month anniversary of the introduction of universal Medicare GP bulk billing incentives, saying half of all general practices now exclusively bulk bill, compared with 30 percent before the incentives began.
Butler said “the biggest jump has been in rural areas, where the percentage of bulk billing practices has lifted by 27 percentage point to 59 percent”.
The percentage of bulk billing practices has more than doubled in the ACT as well – from 10 percent to 21 percent. Excitement among the locals is muted.
1 November this year saw the introduction of the three-year-old Medicare Healthy Kids check.
Butler said the check “was recommended by the Thriving Kids Advisory Group to support interventions prior to children starting primary school and help them to achieve their potential when they do start school”.
The Royal Australian College of GPs (RACGP) encouraged parents and carers of three-year-olds to speak with their GP about the check.
DHDA released the Australian Medical Research and Innovation Strategy 2026-2031 prepared by the Australian Medical Research Advisory Board.
It said the strategy “sets a vision of transforming health through research excellence and lasting impact”.
“It positions the Medical Research Future Fund to deliver world-leading research that improves health outcomes and health equity through prevention, intervention, and research translation.”
The Australian Institute of Health and Welfare (AIHW) released Government expenditure on public health activities in Australia 2024–25, reporting estimated total government expenditure on public health activities as $5.7 billion in 2024–25, a decline in real terms of one percent over the previous year.
The public health share of total government health expenditure was 2.8 percent, 0.2 percentage points lower than 2023–24, and moving away from the target of five percent by 2030 set in the National Preventive Health Strategy.
Just under half of the total (46 percent) was spent on immunisation.
The Public Health Association of Australia (PHAA) said the report showed governments “continue to underinvest in stopping people from getting sick”, adding it is “disappointing” that Governments collectively are failing to make meaningful progress toward the National Preventive Health Strategy target.
The PHAA urged all political candidates at the forthcoming Victorian and NSW elections “to invest more in programs which keep people well so they don’t add to pressures on hospital emergency departments and ambulance services”.
The Australian Bureau of Statistics released Births Australia 2025, showing a 2.6 percent increase in registered births, and a marginal increase in the fertility rate from 1.481 babies per woman in 2024 to 1.497.
However, the fertility rate remained historically low, and well down from the 1.8 babies per woman seen a decade earlier.
The Australian Commission on Safety and Quality in Health Care opened consultation on the draft national safety and quality standards for virtual care, with submissions due by 13 December.
It also is seeking feedback on draft artificial intelligence (AI) guidance for health services, with submissions due by 30 November.
The Australian Taxation Office (ATO) said it had executed a search warrant at a Melbourne dental practice linked to a former health practitioner suspected of supporting individuals to illegally access their superannuation early by falsely claiming to have compassionate grounds.
ATO acting Deputy Commissioner Pennie Snowden said “this wasn’t a misunderstanding of the rules”.
“These allegations point to a deliberate attempt to take advantage of a system designed to help Australians in genuine need.”
The ATO is alleging the health practitioner “supplied fraudulent medical reports to support compassionate release of super applications for dental treatment where applicants were ineligible or the dental work was never provided”.
Consumer and public health groups
The Lung Foundation released the results of YouGov polling it had commissioned, which found 79 percent of adults agree that people who use tobacco, e-cigarettes or other nicotine products should be better supported to quit through free access to evidence-based treatments and professional support.
Three-quarters ( 74 percent) agreed that combining tobacco control measures with better quit support is more effective at reducing smoking rates than relying on restrictions alone.
Lung Foundation Australia CEO Mark Brooke called for “free nicotine replacement therapy and evidence-based smoking cessation medicines for people taking part in cessation counselling, and more accessible quit support services”.
Professor Michelle Jongenelis of the University of Melbourne said “quitting smoking should not cost more than cigarettes”.
“Someone can be highly motivated to quit, but if the cost of evidence-based support is too high, this will act as a deterrent,” she said.
“The vast majority of people who smoke want to quit – we need to make it easier for them to do so.”
The PHAA said two studies in the Australian and New Zealand Journal of Public Health “provide complementary evidence for Governments considering the future of tobacco retailing: one shows what the community wants, while the other demonstrates how reducing tobacco availability could work in practice”.
Cancer Council WA Research Fellow Dr Natalia Lizama led a survey of more than 1,100 people which found 70 percent of WA residents thought tobacco should be less available or not available at all, while 81 percent believed it should not be sold within 500 metres of a school.
Professor Lisa Wood from the University of Notre Dame Australia led research modelling potential restrictions on the number of outlets permitted to sell tobacco.
This found “that allowing tobacco sales only at supermarkets could reduce the number of licensed tobacco retailers in WA by 82 percent, while prohibiting tobacco sales within 500 metres of schools could lower retailer numbers by 41 percent”.
PHAA CEO Adjunct Professor Terry Slevins said smoking rates are at a record low – 5.6 percent.
“Yet it is estimated cigarettes are available to purchase in around 40,000 retailers across the country,” he said. “It’s time for all Governments to consider whether a deadly product that kills 66 Australians every day should be more available than daily essentials like milk, bread or fruit and vegetables.”
PHAA also said it supported the NSW Government’s announcement of a gun buyback, joining the federal, WA, and ACT Governments in efforts to reduce the number of guns in the community.
The PHAA said it was “disappointed the Governments of the other jurisdictions are refusing to keep their communities safe”.
First Nations
The First Nations Eye Health Alliance welcomed the Government’s commitment at the Global Eye Health Summit, held this week in Antigua and Barbuda alongside CHOGM, “to improving eye health outcomes for Aboriginal and Torres Strait Islander peoples and advancing Australia’s Closing the Gap agenda by 2035”.
The Alliance urged the Government to put its money where its mouth is, and “back the commitment with a funded pathway to implement the next National Aboriginal and Torres Strait Islander Eye Health Plan 2027-36, and to invest in practical measures such as free prescription glasses for children”.
Trade unions
Allied Health Professions Australia (AHPA) said a roundtable with Minister Butler was “an important opportunity to bring the sector together and discuss allied health’s contribution to a stronger, more accessible and sustainable healthcare system”.
AHPA CEO Bronwyn Morris-Donovan said the discussion “reflected valuable recognition of Australia’s second-largest health workforce and its role in improving Australians’ health, wellbeing and independence, and supporting participation in work, education and community life”.
AHPA also released its submission to the parliamentary inquiry into access to and affordability of medical specialists, calling for “reforms to how patients reach specialist care, including direct referral pathways from allied health, longer referral validity, and better digital information sharing to cut delays and duplication”.
The Australian Medical Association (AMA), Australian Salaried Medical Officers Federation, RACGP, Royal Australasian College of Physicians (RACP), and Royal Australasian College of Surgeons wrote a joint letter to NSW Premier Chris Minns asking the NSW Government to “pause its planned expansion of pharmacist prescribing into complex conditions, warning the move risks outpacing the evidence and undermining patient safety”.
The letter called on the NSW Government to pause further expansion of pharmacist prescribing until an independent evaluation of the Queensland pilot is completed and publicly released.
It also urged the Government to “consult meaningfully with the medical profession and other stakeholders before future scope-of-practice decisions are made”.
The organisations also sought a meeting with Minns to “discuss a pathway forward that places patient safety and evidence at the centre of reform”.
The RACGP then issued a separate statement, “challenging NSW Premier Chris Minns to produce evidence supporting his expansion of pharmacy prescribing into complex conditions and disclose the Pharmacy Guild’s role in shaping the policy”.
The RACGP pointed to evidence suggesting access to GPs was improving, and to studies highlighting the absence of “robust independent evidence demonstrating that pharmacist prescribing for complex conditions is safe, delivers better patient outcomes, or reduces pressure on the health system”.
The College statement concluded “Premier Minns announced these reforms at a Pharmacy Guild conference”.
“From the outside, this looks like lobbyist-led health policy, plain and simple.
“We are calling on the Premier to release the full details of every meeting, communication and exchange of policy advice involving the Pharmacy Guild about these reforms. The public deserves to know whose advice is shaping their healthcare.
“Without the evidence, Premier Minns should pause further expansion into chronic and complex conditions. Patient safety must come before political interests and the demands of donors and lobbyists.”
The AMA media team posted on X that “an investigation by Australian Doctor (AusDoc) has uncovered the concerns shared by [NSW] state departmental officials about pharmacy prescribing and warnings of serious clinical risks”.
The AusDoc article is based on documents obtained under freedom of information, which included a briefing to the NSW Minister for Health warning “at this time, there is little evidence that there is a need for pharmacist initiation of hormonal contraceptive services, and there is a significant body of consultation and literature suggesting such a step may put consumers’ health at risk”.
The AMA also released its submission to the Tasmanian Government, calling on it “to stop its expansion of independent pharmacist diagnosis and prescribing to additional conditions and invest instead in collaborative models that bring doctors and pharmacists together”.
The AMA Tasmania President Dr Meg Creely said “there was never a convincing clinical case for the policy and the Government’s principal justification for it is becoming even harder to sustain”.
The RACP Board told members and trainees it had held a meeting on 30 October, which inter alia “received an update from the Governance Reform Working Group, which met to discuss a program to include rank and file doctor-members in the decision making”.
The Board noted “this work is particularly important in light of recent interventions by three of the College’s key regulators, the Australian Charities and Not-for-profits Commission, SafeWork NSW and the Australian Medical Council, which have mandated strengthening aspects of the College’s governance, accountability and ways of working”.
The working group is considering “governance structure, Board composition, College council, Extraordinary General Meetings, and decision-making and accountability”.
The RACP also issued a statement on the Victorian election, “calling on all political parties to commit to practical reforms that strengthen Victoria’s medical workforce, improve access to healthcare, and address growing inequity across metropolitan, regional and rural communities”.
As far as I can see, the problems apply across the country, not just to Victoria, and the suggested solutions – strengthening the healthcare workforce, particularly in regional and rural areas, and improving the healthcare workforce experience – are also generally applicable.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) was one of a number of organisations raising concerns about the impact on reproductive health services of the takeover by Calvary Health Care of 14 former Healthscope hospitals.
The issue came to a head in the Hunter region of NSW, as Calvary confirmed it would cease IVF, elective abortions, voluntary assisted dying, and gender reassignment procedures at the Newcastle and Hunter Valley Private hospitals when the transfer process is completed later this month (subject to regulatory approvals).
Health Services Daily reported RANZCOG president Dr Nisha Khot saying the Calvary acquisition raises broader questions about the accessibility of healthcare.
“We know that many of these hospitals are in regional locations. So these are even more important because it’s not like you’re in a big metropolitan city where there are many other options.
“In regional places, there’s often only one option, or perhaps no options at all.”
Khot said “the growing reliance on private healthcare, driven partly by public hospital waiting times, meant Governments needed to consider the consequences of changes in [private] hospital ownership”.
SARRAH (Services for Australian Rural and Remote Allied Health) welcomed the draft report on MBS-referred chronic condition management services from the MBS Review Advisory Committee, and its recommendations to increase the number of individual allied health services available to eligible patients from five to twelve (or ten to 17 for First Nations patients), introduce new longer consultation items, expand group programs beyond diabetes, and support delivery through telehealth.
SARRAH said any changes needed to be accompanied by “broader investment in the rural allied health workforce, measures to improve service sustainability, and innovative models of care that reflect the realities of service delivery outside metropolitan centres”.
Industry groups
The Pharmacy Guild said “patients in every state and territory can now see a specially trained pharmacist for more of their everyday health needs”.
This “follows two years of progress since Scope of Practice Review, Unleashing the Potential of our Health Workforce, was published”.
The premise of the Scope of Practice Review was that health workers should be allowed to work to the full scope of their training – not that groups should receive additional special training to allow them to expand their scope.
Still, the Guild deserves credit for pointing out that it is now two years since the Review report was released, and there is still no sign of a Government response.
The Guild statement provides a helpful summary of the “patchwork” of jurisdictional expansions to pharmacists’ scope of practice and prescribing rights, and argues “it’s hard for patients to know what’s available in which state”.
It said the Federal Government “needs to introduce a nationally consistent set of rules to end the postcode lottery and make sure patients can access safe and timely care wherever they live”.
This overlooks the fact that the Commonwealth (much to the relief of successive Health Ministers) does not have the power to regulate professional health practice.
Politicians
Shadow Minister Anne Ruston said: “Health Department officials told Senate Estimates last week that $517 million budgeted for residential aged care in 2025-26 was never spent.”
“Mark Butler told the states there was no money [to ease bed block]. His own Department has now confirmed Labor took $517 million out of residential aged care. Instead of using it to get older Australians out of hospital, Minister Butler handed it back to Jim Chalmers”.
Ruston is confusing estimation with appropriation.
At the time of the 2026 Budget in May, the Government overestimated expenditure on residential aged care for 2025-26 by $517 million.
However, that money was never provided to DHDA, and was not available to be “handed back”.
This is because the Aged Care Act contained a special appropriation, meaning funding is made available on an individual basis when the conditions in the Act are met.
The $517 million was not sitting in a DHDA bank account waiting to be spent: it was in the Commonwealth Consolidated Revenue Fund waiting for a claim to be made under the Act.
Rather than lambasting the Minister for “handing back” money, Ruston should be inquiring into why his Department provided such wildly inaccurate estimates on annual expenditure seven weeks out from the end of the year.
I guess that wouldn’t be such a good story.
International organisations
The World Health Organization (WHO) said a new report demonstrated “six proven climate and health measures could save 1.6 million lives a year while delivering trillions of dollars in economic and fiscal gains”.
The report “presents a global assessment of the health, environmental and economic benefits and costs of scaling up six prioritised climate-health actions… heat-health warning systems, climate-resilient drinking-water, basic sanitation and hand hygiene, cleaner household energy sources, and fiscal policies to efficiently price fossil fuels”.
WHO said that “countries around the world are facing record-breaking climate shocks” in 2026.
“Protecting people and the planet from the impacts of climate change is one of the defining challenges of our time. [We] call on Governments, development partners, and financing institutions to act on this economic evidence and invest in these proven actions for health, climate and economies.”
WHO also released new estimates showing one in four adolescents (aged 11-17 years) worldwide reported not getting at least 60 minutes of physical activity on any day in the previous week.
It said on average adolescents reported being active for just 2.7 days a week, while only 14 percent reported being active on all seven days.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said “for 15 years, the world has made almost no progress in getting young people moving, and girls are being left furthest behind”.
“The answer is not to tell adolescents to try harder. It is to build schools, streets and communities where moving, playing and being active is safe, easy and normal.”
Finally
Finally this week, another quiz.
Who said this, and in what context?
“Europe is navigating a period of profound change that creates opportunities to rethink, adapt, and choose the future we want to build. This study provides fresh evidence of the contribution our business continues to make across the European Union. Behind the billions of economic value there are people. Farmers, manufacturers, scientists, entrepreneurs, retailers and employees whose work strengthens Europe’s economic foundation every day.”
Elon Musk
Mark Zuckerberg
Peter Thiel
Marco Hannapel.
Answer at the end of the column.
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.
Independent Health and Aged Care Pricing Authority
Consultation on ICD-10-AM/ACHI/ACS Fourteenth Edition and AR-DRG V13.0 Development
13 November
Office of the Gene Technology Regulator
Cost Recovery Implementation Statement
13 November
Australian College of Rural and Remote Medicine
Draft Practice Standard for the Quality and Safety of Virtual Care in Rural, Remote and First Nations Communities
15 November
Department of Health, Disability and Ageing
In-home aged care service list review
16 November
Therapeutic Goods Administration
Changes to permissible ingredients – Vitamin B6 (pyridoxine hydrochloride, pyridoxal 5-phosphate, and pyridoxal 5-phosphate monohydrate)
25 November
House of Representatives Standing Committee on Health, Aged Care and Disability
Inquiry into access to and affordability of medical specialists in Australia
27 November (extended from 16 October)
Senate Community Affairs Committee
2025 National Health Reform Agreement with Western Australia
27 November
Australian Commission on Safety and Quality in Health Care
Draft Artificial Intelligence (AI) Guidance for Health Services
30 November
Office of the Gene Technology Regulator
Fermentation of straw-derived sugars using genetically modified bacterium for hydrogen production
7 December
Therapeutic Goods Administration
Reviewing the exclusion for certain digital mental health tools
7 December
Department of Health, Disability and Ageing
Medicare Benefits Schedule Review Advisory Committee Referred Chronic Condition Management Services Draft Report
9 December
Office of the Gene Technology Regulator
Fermentation of plant material-derived sugars using genetically modified yeast for ethanol production
11 December
Australian Commission on Safety and Quality in Health Care
Draft national safety and quality standards for virtual care
13 December
Department of Health, Disability and Ageing
“We want to hear about your experience with aged care assessments and the Support at Home program”
14 December
National Health and Medical Research Council
Updated National Statement on Ethical Conduct in Human Research
16 December
Ahpra Accreditation Committee
Feedback on the draft National Scheme Professional Capability Framework and pilot set of common professional capabilities on responding to family, domestic and sexual violence and safely using digital health
18 December
Food Standards Australia New Zealand
Mandatory application of the Health Star Rating System to packaged foods sold in Australia and New Zealand
23 December
Inspector-General of Aged Care
Review of the Commonwealth’s implementation of the 148 recommendations of the Royal Commission into Aged Care Quality and Safety
29 January 2027
Medicare Services Advisory Committee
177 Lutetium PSMA-617 for prostate specific membrane antigen-positive, taxane-naïve patients with metastatic castrate resistant prostate cancer
Genetic testing for the detection of germline variants in cancer predisposition genes in people with prostate cancer and their relatives
KT-pathway altered tumour testing in patients with HR+/HER2- advanced metastatic breast cancer
Ciltacabtagene autoleucel therapy to treat patients with refractory or relapsed multiple myeloma after at least 1 prior therapy
12 February 2027
Quiz answer
This was Marco Hannapel, President, Europe Region, Philip Morris International (PMI), releasing a report claiming PMI made a “total contribution to the EU economy between 2021 and 2025” of nearly €343 billion.
The report, prepared by EY-Parthenon, Ernst & Young’s global strategy consulting arm, includes a disclaimer on the last page:
“…as the nature of the report focuses on the economic, social, and cognitive impacts associated with PMI’s activities, it does not consider all potential forms of impact. In particular, the report does not assess the public health implications associated with tobacco and nicotine consumption, nor does it seek to evaluate PMI’s products or business activities from a public health perspective. These potential externalities, while outside the scope of this report, are nevertheless important considerations in understanding the broader societal costs and benefits associated with PMI’s activities.”
The economic burden of smoking in Europe has been estimated at 2.5 percent of the region’s annual GDP, or over €800 billion.
Given PMI’s European market share of around 40 percent, the annual “potential externalities” are likely to be in the region of €320 billion – almost equal to the claimed five-year total economic contribution €343 billion.
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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