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Community Affairs Legislation Committee
19/10/2011
Estimates
HEALTH AND AGEING PORTFOLIO
Health Workforce Australia

Health Workforce Australia

[21:33]

Senator FIERRAVANTI-WELLS: Mr Cormack, how is the agency going? Is it well and truly up and running? Have you filled all the position you have advertised?

Mr Cormack : Yes, the organisation is established. We are running at our targeted establishment of 120. We have established virtually all of our services. We are based in Adelaide and all of our principal programs are being rolled out and the funding that has been allocated to the agency has been committed to those programs.

Senator FIERRAVANTI-WELLS: Earlier we were talking about mental health with regard to the workforce and the big picture. Are you now in a position to better provide information in terms of a snapshot of the mental health workforce in Australia and the aged care workforce? Do you have some statistics around that?

Mr Cormack : Health Workforce Australia is completing the national training plan. Ministers asked us to undertake that in November last year, and we are coming to the end of that process. It focuses on the health workforce requirements out to 2025 for doctors, nurses and midwives, specifically, but it identifies the specific requirements of specialty groups and service groups, such as mental health and aged care, across those three disciplines. We will be providing the report to the Australian Health Ministers Conference at the end of 2012, and that will contain a consolidated set of information about workforce projections, by specialty, and in some cases by service grouping, such as mental health and aged care, for the consideration of ministers.

Senator FIERRAVANTI-WELLS: In the interim, are you putting up data on your website in preparation for that work and the work that you are doing towards that report or are you just going to release it all in one hit?

Mr Cormack : We have been putting up a series of technical papers that describe the methodology and how we are consulting with groups to get the best information. But we have not released any of the preliminary figures because they have not been finalised at this stage.

Senator FIERRAVANTI-WELLS: But you will be releasing information as you complete it rather than waiting until the end of 2012?

Mr Cormack : The report will not be finalised until the end of 2012.

Senator FIERRAVANTI-WELLS: Sure, but you will be releasing information and statistics?

Mr Cormack : We will be providing the national training plan report to the Australian Health Ministers Conference, as we were requested to, by the end of the financial year. Its publication will be after it has been considered by ministers.

Senator FIERRAVANTI-WELLS: In other words, you will do two years worth of work, which will include the gathering of information and statistics which will all go towards a report. There are statistics that may relate to the mental health and aged care workforces, but you are not going to release that raw information; you will be waiting and that raw information will be released as part of the report process? That is the question I am asking.

Mr Cormack : We will not be releasing any information about the national training plan until it is finalised and considered by health ministers.

Senator FIERRAVANTI-WELLS: That does not answer my question. Ms Halton, I appreciate the plan, but, I am sorry, I just cannot understand why the statistics and a lot of that information gathering is not going to be released beforehand.

Mr Cormack : What we are doing is using the available information that we get from public domain sources such as the AIHW—and more recently from data sources from the new national boards and APRA—to consult with different service groups, such as those involved in mental health, those involved in aged care. On the basis of working through those numbers with those groups, we will develop the final plan for the end of the year. But it is unlikely that we will be releasing bits and pieces of information until the plan is complete, because it has to be considered by a board and then it has to be considered by ministers and we envisage it will be released shortly thereafter.

Senator FIERRAVANTI-WELLS: Thank you.

Senator McKENZIE: I have a question in relation to the Medical Specialist Outreach Assistance Program.

Ms Halton : That is outcome 6.

Senator McKENZIE: Thank you. Apologies.

CHAIR: Rural health.

Senator ADAMS: No, I am doing health workforce.

CHAIR: Yes, but I have just been told by Ms Halton that the question belongs in outcome 6.

Ms Halton : So we should have dealt with it earlier in the day. At five o'clock.

CHAIR: Any others?

Senator ADAMS: I understand that Health Workforce Australia is undertaking consultations to develop a rural and remote workforce strategy and implementation plan. What funding is available for the implementation of such a plan, and when can rural and remote people expect to see a lessening of the disparity between their areas and major cities in relation to the workforce supply?

Mr Cormack : As part of our 2011-12 work plan, which was approved by ministers last month—this is part of the $70 million workforce innovation reform program—there is an allocation for rural health, and I will get that figure for you in just a minute. There is an allocation to implement that. I am happy to take another question while we look for that information.

Senator ADAMS: Well, I was ducking and diving with my workforce questions; I thought some might have been yours but I think they have all been answered. It gets a bit tricky. I do have another question here. Health Workforce Australia and the Medicare Locals, do you have a lot to do with them or some interaction with them?

Mr Cormack : At this stage, we do not have a lot to do with Medicare Locals. Obviously, they are in the formative stage. But clearly they would have a very significant view, I would imagine, on the health service needs of the particular geographical area that they serve. That relates to workforce, and we will be wanting to work closely with them to better inform our workforce planning.

Senator ADAMS: With the divisions at the moment, are you working with them, as they are going through their transition?

Mr Cormack : Not specifically. Our focus of work has not been heavily concentrated on individual divisions. We have certainly had dealings with the AGPN at a national level, and some of them have been involved in our consultations around our various programs, but we have not got a structured, ongoing dialogue going with them. If I could just give you an indication, there is $5.5 million allocated for that strategy.

Senator ADAMS: Thank you very much for that.

CHAIR: Are we now finished with outcome 12?

Senator ADAMS: I have finished with Health Workforce Australia.

CHAIR: On that basis, I believe we have finished with outcome 12. Thank you very much to those officers.

[21:43]

CHAIR: We will move on to outcome 10—health system capacity and quality. Senator Furner, to which program do your questions relate?

Senator FURNER: 10.2.

CHAIR: Do we have anyone in 10.1, chronic disease?

Senator ADAMS: I am wondering if—since I missed out on asking about bowel cancer screening in population health—I can sneak in here.

CHAIR: Ms Halton, it was my suggestion that Senator Adams may be able to put her questions about the bowel cancer screening in this one, in case there is an officer who can help, if that is okay.

Ms Halton : Here he is: 'Mr Bowel Cancer'.

Mr Smyth : Thank you!

CHAIR: We are in outcome 10.1, which is chronic disease, and Senator Adams is going to lead off on it.

Senator ADAMS: I have three questions and I will be as quick as I can. Given the failure to expand the National Bowel Cancer Screening Program in the 2011-12 budget, is the department developing any lower-cost strategies to increase participation among the limited target age range, such as communication strategies or working more closely with the primary care sector to involve GPs in program promotion?

Mr Smyth : Yes, we will be working collaboratively with Medicare Locals and the like. I think that one of their remits is around prevention. Once Medicare Locals start to get established we certainly will be working collaboratively with them to promote the program.

Senator ADAMS: Does the department have any contact with the Rotary bowel cancer screening program? It is confusing people quite a lot.

Mr Smyth : I am aware of the program, but I would have to take that question on notice.

Senator ADAMS: I just wonder if there was any funding that went there—

Mr Smyth : Not under this program.

Senator ADAMS: Has the department put up a funding proposal for the program's expansion? If so, would it be available under FOI?

Mr Smyth : I think I answered this question last estimates. Any consideration of expansion of a program would have been, if it had occurred, considered as budget-in-confidence and would have been advice to government. I am not in a position to answer that question.

Senator ADAMS: The previous screening program experienced data collection problems, as data collection is based on a usual care pathway with few incentives for health professionals to return information about the screened patients to Medicare. What are the department's plans for improving data collection in the next phase?

Mr Smyth : In the next phase, I really cannot give away the specifications at the moment for the open tender process that we are going to be going through. Suffice to say we are looking at electronic data capture, and we have been doing electronic forms for pathologists and general practitioners, so we are looking at it from the user's point of view and trying to make it easier for them and for them to be able to provide us with that information, which will then get captured into the register.

In the next phase, and with some of the e-health initiatives that are rolling out, we would look to streamline some of those processes and make it less burdensome for medical professionals to be able to provide us with that data.

Senator ADAMS: Thank you.

CHAIR: Senator Fierravanti-Wells, do you have questions on 10.1?

Senator FIERRAVANTI-WELLS: No, not 10.1. My questions relate to the health and hospital funds—the regional priority round which I was told could come into 10.6.

CHAIR: We will start with Senator Furner.

Senator FURNER: Starting with the IHIs, the individual health identifiers, how many layers have been either downloaded or accepted as being sole identities in the e-health system?

Ms Granger : It is a million all together, or a little over a million—830,000 in GP practices and e-health sites and 430,000 in Tasmania and ACT administrative systems as part of their data cleansing projects.

Senator FURNER: As I understand it, that is administered by Medicare? Can you run through the process of how someone gets on the system?

Ms Granger : How they download into their system?

Senator FURNER: How they get onto the system, yes.

Ms Granger : To get IHI identifiers?

Senator FURNER: Yes.

Ms Granger : They apply to Medicare and have to provide identity and their name. Do you want to add some more depth?

Ms McCarter : They ring Medicare and provide their name and date of birth by phone, and a form is sent out. They are able to receive an IHI identifier at that point.

Senator FURNER: Medicare has already got that material, hasn't it? They have all that data—it is just a case of being identified as IHI.

Ms McCarter : Correct—based on the date of birth and the name.

Senator FURNER: Is there any other information that is stored as an IHI, as opposed to being on the Medicare system, other than the typical identification of name, address, sex, date of birth and those sorts of things? Is there anything in addition to those?

Ms Halton : The question is not completely clear, Senator. If your question is: is that number stored separately and securely, yes.

Senator FURNER: Is it separate from the Medicare system?

Ms Halton : Yes.

Senator FURNER: Because there have in the past during estimates been some concerns about privacy and security, can you run through the protections that are available as an IHI?

Ms Halton : Is this in terms of the privacy legislation?

Ms Granger : Or the proposed PCEHR?

Senator FURNER: Maybe do both.

Ms Forman : There are quite strong controls in the Healthcare Identifiers Act to protect access to and use of identifiers. Those protections limit the use of individual health care identifiers to the delivery of health care and the use of health care information in the normal health care provider organisations.

Senator FURNER: Just going to the infrastructure partner arrangements, can you explain what the process was in respect to the choice of the national infrastructure partner, and whether that was a rigorous exercise in terms of identifying and achieving that?

Mr Madden : Their selection of the national infrastructure partner was based on a two-pass process, where we went to the market to select systems integrators and providers of particular services. The processes used there were the usual procurement processes we use for the Commonwealth for procurement of infrastructure of that kind. They certainly followed all of the procurement guidelines. We had probity advisers and independent representatives on the committee in both of those places.

Senator FURNER: How has industry as a whole embraced the eHealth system?

Mr Madden : Industry being the IT industry?

Senator FURNER: Yes.

Mr Madden : There is certainly a groundswell of support there from the IT industry to be involved in eHealth. I think the expectations of reaching a set of specifications and standards that will allow interoperability is what they have been waiting for. We are certainly reaching that point now. But the level of interest is certainly high. Those who wish to participate in providing infrastructure support and those who are looking to provide services to GPs, consultant physicians, specialists in hospitals, are certainly there.

Senator McKENZIE: I would like to know what will have been achieved by 30 June 2012 with regard to eHealth and the PCEHR in Australia?

Ms Granger : By 30 June 2012 the infrastructure will be in place for all Australians to register for a personally controlled electronic health record. They will be able to set their access controls for the record and enter data that they choose to share with their clinicians. We will be able to approach a provider to create a shared health summary for them.

Senator McKENZIE: Can you provide the benchmarks for the PCEHR on notice?

Ms Halton : Certainly.

Senator McKENZIE: When the minister was first notified that the usual standard-setting process would have to be bypassed to meet the 1 July 2012 deadline—

Ms Halton : This would be a certain newspaper article.

Senator McKENZIE: It is.

Ms Halton : I think I have a copy of it.

Senator McKENZIE: I would appreciate clarification.

Mr Madden : The article depicts that we have changed the standard-setting process in order to meet a time frame, but we have not actually changed the standard-setting process at all. We are committed to using the Standards Australia process through the IT-14 committee. We have been working collaboratively with that committee to work out the time frames, program and plan to develop the standards.

The first step in the setting of standards is the development of specifications and guidance material on how to use these things. We are publishing those specifications in October and November such that software vendors who want to get involved and start providing those services to their users early—as in somewhere between February and July 2012—have the guidance, material and information to do so. But it is the complete expectation that those specifications will continue the normal track through the standard-setting process and they will emerge sometime around July 2012.

To make that possible for the software vendors, we have offered a change control process which will give them certainty and stability that building systems based on those specifications will be guaranteed to continue working and will continue to support those specifications for a two-year period. The expectation from the software vendors is that standards give you stability; they do not change very quickly over time. So we need to keep that same guarantee in relation to the specifications.

Senator McKENZIE: Thank you for that clarification. Is it the case that a patient may have registered for PCEHR by 1 July 2012 but their doctor, pharmacist or clinician may not yet be capable of entering the data onto the patient's electronic record? Essentially, what provisions are in place to encourage medical professionals to upgrade not only their own software but also their skill sets as well?

Mr Madden : The expectation is that the infrastructure and the registration process will be there for the patients. We are doing what we can around software vendors to provide them with the instruction material, guidance and testing facilities for them to get the products to the users, being GPs and hospitals. We also have a change in adoption partner who is working with the healthcare professional community to look at change and adoption and how it is we get them to a point where they want to demand those services and use them. We have software vendors in the wave sites. We also have software vendors who wish to get engaged in this. While they might put the products in the hands of the health professionals, getting them to use them is the next step. So we are doing all of those things at the same time to get the software in place, to get the demand and the ability and willingness to use that and also to get the understanding of the things they need to do to get their data quality lifted up to a standard where they can transact electronically to share their records with other clinicians.

Senator McKENZIE: Excellent. Is it also the case that the PCEHR audit trail will only be able to identify which organisation has accessed the PCEHR and not the individual within the organisation who has accessed it, unlike similar systems, for instance, in police forces et cetera?

Ms Granger : It will log access at the individual level.

Senator McKENZIE: It will log at the individual level?

Ms Granger : Yes. So there will be an audit trail.

Senator McKENZIE: Okay, thank you. I just wanted that clarified. The draft legislation says:

A nominated healthcare provider will be responsible for creating and managing a consumer’s shared health summary …

This is surely going to increase the time burden on the healthcare provider. Is there an estimate of how much extra time the nominated healthcare provider will spend maintaining a consumer's shared health summary? Will they be compensated financially for this extra time? And any comments you have around those sorts of issues would be good.

Ms Huxtable : Senator, we are sharing things a bit here—

Senator McKENZIE: Everyone is getting a go!

Ms Huxtable : Yes. Mr Madden spoke earlier about the wave sites, and we have not really discussed those, but there are 12 lead sites that have been funded as part of the measure and which are on foot already. Those lead sites are enabling us to better understand what the processes are around putting a PCEHR into the field, so they are a very important part of the learning. One of the things that we are interested in in that context is what the benefits of a PCEHR are, not just from a consumer perspective but also from a provider perspective. I think that we need to keep in mind, when talking about what this means for a general practitioner or a specialist, the amount of time that is already spent in practices basically searching for the right bit of paper—for example, trying to connect the pathology test that came in with the right patient. I think we are already developing some of this anecdotal evidence that there are many business benefits to PCEHR, and we are working with our change-and-adoption partner around explaining and broadcasting some of those benefits. It has to be a balanced proposition in this regard. We would anticipate that, in developing a shared health summary, a nominated provider will gather information that is readily available and accessible in their patient information systems. Certainly, we are looking on the wave sites at how some of that information can be streamlined and uploaded into the PCEHR.

As for what supports there might be going forward, no decisions have been taken in respect of how workflows might be managed. I think we still have a lot to learn about what is happening in the lead sites and how that gets translated into broader practice.

Senator McKENZIE: Yes. I guess, when you think about your normal general practice, that sort of paper-chasing is done as a back-office function, or a front-of-office function, really, and the GP is not doing that level of paper-trailing, whereas with this the onus is on the health professional themselves rather than on some of their support staff in terms of taking on that administrative task.

Ms Huxtable : I am not sure that is entirely correct. I think often practitioners do get involved in trying to marry up information. Certainly, that is some of the anecdotal advice that we have been provided with.

Senator McKENZIE: I want to follow up on something you just said about the wave sites—that you have got these happening and you are collecting data about how this is going to work and, obviously, that is going to be feeding back into your processes over the coming months. I am just wondering about the relationship between the wave sites and the specs that Mr Madden was talking about being developed for the ICT software providers: how is that being fed back in, given that we want the specs sooner rather than later, to get it all tidied up?

Mr Madden : The wave sites were dealing with some of the early versions of those specifications and guidance materials. So the benefit of them having tried to implement some of those and going through the testing processes has been fed into the next level that are going to be produced. But, on the wave sites themselves, there are some specifications for the PCEHR which have been published already and they are already using those. Others that will be published on 31 October are being consumed and reviewed by those wave sites as well, with the background that we have seen the earlier versions of those and we understand some of the pitfalls. We are also bringing some of the software vendors who are not in those wave sites into that process as well, so it gets a broad review. But we fully expect that the wave sites will be the first adopters of those specifications that come out in October and then November—and, if there are things that change as a result of their implementation, then we will upgrade those as we go. But that would only be if they create system errors, as opposed to 'we thought of a better idea'.

Senator McKENZIE: Yes, because we want to give the ICT software providers security to develop.

Mr Madden : The specification process has matured quite well. The feedback and the loop to the software vendors has got us to the level where what we produce is at a high level of quality and meets their needs in comparison to where we were maybe two years ago. So I think, with the experience we have had in iterating and reviewing those, it has a level of maturity now.

Senator McKENZIE: Thank you. I have a few more questions that I will put on notice.

Senator ADAMS: Have allocations been made in this and the out years to support doctors, remote area nurses and allied health professionals in rural and remote areas to become involved in the priority rollout of the personally controlled electronic health records? Are there any plans to support allied health professionals and nurses in the use of electronic health records for clinical management so they are equipped to contribute to the PCEHR when it starts?

Ms Huxtable : There are probably two elements to that question. Included in the work that is being conducted now in respect of the investment that has been made leading up to 30 June 2012 is money around change and adoption. As part of that, there has been work done about the readiness of various sectors to pick up and run with PCEHR related material and money to support them in this period through change and adoption. So our change and adoption partner is out consulting with various groups, analysing their particular circumstances and advising us about how materials can be prepared to support them.

In respect of beyond 30 June 2012, there has basically been no decision by government on funding beyond that period, so I think the question you are asking is probably a little premature because it does relate to something that might happen in a period for which there has not yet been a funding decision.

Senator ADAMS: I was just trying to highlight the fact that often rural and remote get forgotten. Our allied health people out there and, once again, our nurse practitioners and remote area nurses sometimes do get forgotten.

Ms Huxtable : With regard to those wave sites, there are a few operating in rural and remote areas. There is one, for example, that is covering the whole of the Northern Territory, so we are learning about things from that. There is another on the Cradle Coast that is looking at advanced care directives. So quite a variety of activity is occurring around the country. The consumer population covered by those 12 sites is up around the 500,000 mark, so we have quite a lot of activity occurring across some quite diverse areas.

Senator ADAMS: That is good. It is just something I had not caught up with. What funding has been made available to allied health and nursing professional organisations to ensure that standards and practice guidelines are available for their members' involvement in various facets of e-health? Is any funding or are any grants available for them to apply for?

Ms Huxtable : We might have to take that on notice. There might be moneys that have been available over the period, but we are talking about quite a long development period here, so we should it take notice.

Senator ADAMS: Thank you very much.

[22:08]

CHAIR: We will move to 10.6, Health infrastructure.

Senator FIERRAVANTI-WELLS: Senator Boyce left us with a multitude of questions and traipsed off into the great blue yonder and left us to decipher them!

Ms Halton : I am not sure that you should indulge her by asking every single one of her questions; I think there should be some price paid!

Senator FIERRAVANTI-WELLS: We will not indulge her further. I cannot believe we have had an estimates without a multitude of e-health questions. I have questions about the Health and Hospitals Fund. My questions relate to HHF funding rounds 3 and 4. They are based on information taken out of the annual report. How much money is left in the fund? I am just going to refer to it as 'the fund', rather than HHF.

Mr Thomann : There is $4.35 billion as of 30 June 2011 left in the HHF—in the fund itself.

Senator FIERRAVANTI-WELLS: Could you take on notice the expenditure to date?

Mr Thomann : I can give you the expenditure to date now if you so wish. As of 30 September 2011, expenditure was $1.271 billion.

Senator FIERRAVANTI-WELLS: Could you take that on notice and give it to me by year and project, and the projected expenditure by year and project until the end of completion of each project?

Mr Thomann : It can be done. That will be quite a large table.

Senator FIERRAVANTI-WELLS: Do you want me to refine that request?

Ms Halton : It would be better if you could.

Mr Thomann : I think it would be better if you could do that.

Senator FIERRAVANTI-WELLS: I am asking questions on behalf of someone else, so I will get those refined. So, after this funding round, the $5 billion allocated will not be fully allocated because there will be some money left over?

Mr Thomann : The interest accumulated in the fund will be left over.

Senator FIERRAVANTI-WELLS: The annual report for 2010-11 notes that 88 per cent of the progress reports from the contracted projects met agreed requirements. In relation to those reports which were not accepted, which were the main reasons for the reports not meeting the agreed requirements? Do you want to take that on notice?

Mr Thomann : No, I think we can answer the question. I will just hand that to Ms Hancock.

Ms Hancock : The main reasons were essentially insufficient information in the report provided.

Senator FIERRAVANTI-WELLS: Paperwork not in order?

Ms Hancock : Yes.

Senator FIERRAVANTI-WELLS: So there is a time frame for these reports to be resubmitted—they were allowed to do that?

Ms Hancock : Yes. As a milestone report is submitted, it is assessed by officers of the department. If further information is required then we seek it straight away and it is always provided.

Senator FIERRAVANTI-WELLS: So have any projects had payments withheld as a result of non-compliance with reporting requirements?

Ms Hancock : Some payments have been delayed while we sort out the additional information.

Senator FIERRAVANTI-WELLS: I have some questions in relation to resources in the department for managing the contracts awarded. I will put some questions on notice about the staff and the sorts of levels and that sort of detailed information. The annual report also notes that the department implemented recommendations by the fund's advisory board to establish a strengthened compliance and monitoring framework for the fund projects. What changes were required, and have those changes been fully implemented?

Mr Thomann : Those changes are being implemented. One of the recommendations was the establishment of a centre of excellence and the appointment of a senior adviser, and that has been achieved. Mr Paul Carmody, who is with us today, has been appointed. He has significant experience in the construction industry and is advising us on the rollout of the HHF rounds and in our negotiations with project proponents. The WorleyParsons report also recommended quarterly reporting against key indicators such as project expenditure, scope, time frames, milestones and compliance with state and federal legislation. The department has implemented a portal to enable HHF project proponents to report against those areas of risk on a regular basis. That portal is up and running and people are reporting.

Senator FIERRAVANTI-WELLS: This is like an evaluation, effectively, of the contract management?

Mr Thomann : No, it is really a project reporting system to enable the department to have visibility of the projects against some key dimensions of project risk.

Senator FIERRAVANTI-WELLS: Will you be doing an evaluation of the contract management processes with the fund at some stage?

Mr Thomann : At the moment we are focused very much on managing round 4—it closed today—and negotiating with the 63 successful applicants in round 3 to get their projects to the agreement finalisation stage.

Senator FIERRAVANTI-WELLS: I am going to put further questions on notice in relation to more specific detail around this. Just going back to monitoring, given that these are 20-year periods for these contracts, what is now being looked at to examine how the department will monitor over a 20-year period?

Ms Hancock : Once the project goes into what is called the designated use period, which is after the construction is complete, the standard project agreement requires an annual report from the funding recipient which certifies that the construction is being used for its required use.

Senator FIERRAVANTI-WELLS: All right. I have more detailed questions in relation to that I will put on notice.