Tell me again why the Turnbull Government is insisting My Health Record will become mandatory by the end of October 2018?

It is not just ordinary health care consumers who have concerns about the My Health Record database, system design, privacy issues and ethical considerations.

It is not just the Turnbull Government which has not sufficiently prepared public and private health care organisations for the nationwide rollout of mass personal and health information collection - the organisations themselves are not ready.

Lewis Ryan (Academic GP Registrar)

* 91 % of GP Registrars have never used My Health Record in a clinical context

* 65% of GP Registrars have never discussed My Health Record with a patient

* 78%  of GP Registrars have never received training in how to use My Health Record

* 73% of GP Registrars say lack of training is a barrier to using My Health Record

* 71% of  GP Registrars who have used the My Health Record system say that the user interface is a barrier

* Only 21% of  GP Registrars believe privacy is well protected in the My Health Record system

In fact Australia-wide only 6,510 general practice organisations to date have registered to use My Health Record and these would only represent a fraction of the 35,982 GPs practicing across the country in 2016-17.

UPDATE

Healthcare IT News, 3 August 2018:

The Federal Government’s Health Care Homes is forcing patients to have a My Health Record to receive chronic care management through the program, raising ethical questions and concerns about discrimination.

The government’s Health Care Homes trial provides coordinated care for those with chronic and complex diseases through more than 200 GP practices and Aboriginal Community Controlled Health Services nationally, and enrolment in the program requires patients to have a My Health Record or be willing to get one.

But GP and former AMA president Dr Kerryn Phelps claimed the demand for patients to sign up to the national health database to access Health Care Homes support is unethical.

“I have massive ethical concerns about that, particularly given the concerns around privacy and security of My Health Record. It is discriminatory and it should be removed,” Phelps told Healthcare IT News Australia.

Under a two-year trial beginning in late 2017, up to 65,000 people are eligible to become Health Care Homes patients as part of a government-funded initiative to improve care for those with long-term conditions including diabetes, arthritis, and heart and lung diseases.

Patients in the program receive coordinated care from a team including their GP, specialists and allied health professionals and according to the Department of Health: “All Health Care Homes’ patients need to have a My Health Record. If you don’t have a My Health Record, your care team will sign you up.”

Phelps said as such patients who don’t want a My Health Record have been unable to access a health service they would otherwise be entitled to.

“When you speak to doctors who are in involved in the Heath Care Homes trial, their experience is that some patients are refusing to sign up because they don’t want a My Health Record. So it is a discriminatory requirement.”

It has also raised concerns about possible future government efforts to compel Australians to have My Health Records.

“The general feedback I’m getting is that the Health Care Homes trial is very disappointing to say the least but, nonetheless, what this shows is that signing up to My Health Record could just be made a prerequisite to sign up for other things like Centrelink payments or workers compensation.”

Human rights lawyer and Digital Rights Watch board member Lizzie O’Shea claims patients should have a right to choose whether they are signed up to the government’s online medical record without it affecting their healthcare.

“It is deeply concerning to see health services force their patients to use what has clearly been shown to be a flawed and invasive system. My Health Record has had sustained criticism from privacy advocates, academics and health professionals, and questions still remain to be answered on the privacy and security of how individual's data will be stored, accessed and protected,” O’Shea said. [my yellow highlighting]

AUSTRALIA 2018: Turnbull Government continues to hammer the vulnerable

Remember when reading this that the Turnbull Government is still intending to proceed with its planned further corporate tax cuts reportedly worth an est. $65 billion. Compare this policy with the National Disability Insurance Scheme (NDIS) funding in Budget 2018-19 which is $43 billion over four years and no dedicated NDIS funding stream established as had been previously promised.

Australian Federation of Disability Organisations & Summer Foundation, media release, 14 May 2018:

JOINT STATEMENT ON THE NDIA’S SPECIALIST DISABILITY ACCOMMODATION PROVIDER AND INVESTOR BRIEF

The National Disability Insurance Agency (NDIA) presented its latest policy position for Specialist Disability Accommodation (SDA) in a statement to the provider and investor market on 24 April.

People with disabilities and developers of innovative housing for people with disabilities are pleased the NDIA has reiterated the government’s commitment to SDA in its SDA Provider and Investor Brief. The NDIA has confirmed that the SDA funding model is here to stay.

However, the NDIA’s SDA Brief expresses a vision for SDA housing with a clear bias toward shared models of housing for people with disability, presumably to reduce support costs. This is unacceptable. You can read our joint statement here (A Rich text format is available here).

You can read the Summer Foundation’s summary of the SDA Brief here.

The Australian, 16 May 2018:

The executives of the flagship ­National Disability Insurance Scheme, which received guaranteed funding worth tens of billions of dollars in last week’s budget, have launched a crackdown on support funding to keep a lid on ballooning costs.

The razor is being taken to hundreds, possibly thousands, of ­annual support plans as they come up for review, demonstrating a new hawkish approach from ­National Disability Insurance Agency bosses but resulting in the loss of funding and support for vulnerable families. In many cases, support packages for families have been cut by half.

The early years of the $22 billion program’s rollout saw wild variability in the value and type of support being granted to participants, forcing executives to come up with a way to claw back funding that has “an impact on sustainability”. In the process, people with disabilities and their families have been shocked by sudden reversals of fortune….

In its quarterly report, the NDIA noted there was a “mismatch” between reference packages — rough cookie-cutter guides for how much packages ought to be in normal circumstances — and the value of annual support packages which affected the financial sustainability of the scheme.

“The management’s response to this is to closely ensure that significant variations away from reference amounts (above and below) are closely monitored and justified,” a spokesman said.

“Reference packages are not used as a tool to reduce package amounts to below what is reasonable and necessary. Individual circumstances are considered in determining budgets, including goals and aspirations.

“A reference package does not restrict the amount or range of support provided to a participant, but acts as a starting point for planners to use for similar cohorts. It provides amounts that are suitable for a given level of support needs that has been adjusted for individual circumstances.”

The agency has claimed the implementation of this process has started to reduce funding blowouts and a hearing into the scheme by federal parliament’s Joint Standing Committee on the NDIS last Friday heard startling evidence about how widespread the new approach is.

Donna Law, whose 21-year-old son has severe disabilities, was told by an NDIS planner: “Donna, watch out because your son’s next plan is going to be cut by about half.”

Clare Steve had funding cut in half by the NDIA and wanted to do another review.

“I spoke to multiple people, because no one would actually give me the paperwork to do the next lot of reviewing,” Ms Steve told the hearing.

“I was told by multiple people that it was a mistake: ‘Do not go for another review.

“If you go for another review, you could get your funding cut again’.”

ABC News, 19 May 2018:

Bureaucrats are reportedly working on a strategy to curb costs by tightening up the eligibility requirements after a blowout in the number families seeking NDIS support packages for people with autism.

ABC News, 19 May 2018:

Last December, Sam's case was one of about 14,000 sitting in the NDIS's review backlog, according to a damning ombudsman's report this week. Then, about 140,000 participants were in the scheme.

The review queue has since shrunk, but the agency in charge of the world-first scheme — a Commonwealth department known as the National Disability Insurance Agency (NDIA) — still receives about 640 review requests each week.

Some of those requests do not reflect badly on the NDIA. People can request an unscheduled review if their circumstances change, for example if their condition improves.

But the agency often is culpable when it comes to another type of review, known as an internal review. People ask for these when they disagree with the plan and funding package they are given.

Some reviews come from people who feel short-changed, given the state government support they previously received, or because of the high expectations associated with the scheme.

But the Government is also to blame. The NDIS's full-scheme launch in mid-2016 was a disaster. The computer system failed. A backlog of NDIS applications quickly emerged.

Plans were then often completed over the phone and rushed. Key staff lacked training and experience. There was little consistency in the decisions being made.

The scheme's IT system remains hopeless, and elements of its bureaucracy are not much better, according to the watchdog's report.

The agency accepted all 20 of the ombudsman's recommendations, and Social Services Minister Dan Tehan said work was underway to bust the backlog "over coming months".

Administration of reviews under the National Disability Insurance Scheme Act 2013 REPORT ON THE NATIONAL DISABILITY INSURANCE AGENCY’S HANDLING OF REVIEWS May 2018, excerpts:

* In February 2018, the NDIA advised around 8,100 reviews remained in the backlog and the national backlog team was clearing around 200 reviews each week. The NDIA also advised it continues to receive around 620 new review requests each week, which are handled by regional review staff.

* We have received complaints about the NDIA’s handling of participant-initiated requests for review. In particular, these complaints concern the NDIA: (1) not acknowledging requests for review; (2) not responding to enquiries about the status of a request; or (3) actioning requests for an internal review as requests for a plan review.

*Participants also complained they had sought updates on the receipt and/or progress of their requests by calling the Contact Centre and by telephoning or emailing local staff. They reported not receiving a response, leaving messages that were not returned and being told someone would contact them—but no one did.

* In our view, the absence of clear guidance to staff about the need to acknowledge receipt of review requests is concerning. Indeed, the large number of complaints to our Office where complainants are unclear about the status of their review indicates the lack of a standardised approach to acknowledgements is driving additional, unnecessary contact with both the NDIA and our Office.

* Our Office monitors and reports on complaint themes each quarter. Review delays was the top complaint issue for all four quarters in 2017.

* Some participants have told us they have been waiting for up to eight or nine months for a decision on their review request, without any update on its progress or explanation of the time taken.

In some instances, the participant’s existing plan has expired before the NDIA has made a decision on their request for review. As review decisions can only be made prospectively, it can mean a participant must go through the whole process for the new (routinely reviewed) plan if they remain unhappy.

An insider has finally admitted what any digital native would be well aware of - your personal health information entered into a national database will be no safer that having it up on Facebook

Remembering that a federal government national screening program, working with with a private entity, has already accessed personal information from Medicare without consent of registered individuals and entered these persons into a research program - again without consent - and these individuals apparently could not easily opt out of being listed as a research subject but were often only verbally offered  the option of declining to take part in testing, which presumably meant that health data from other sources was still capable of being collected about them by the program. One has to wonder what the Turnbull Government and medical establishment actually consider patient rights to be in practice when it comes to "My Health Record".

Healthcare IT News, 4 May 2018:

Weeks before the anticipated announcement of the My Health Record opt out period, an insider’s leak has claimed the Australian Digital Health Agency has decided associated risks for consumers “will not be explicitly discussed on the website”.

As the ADHA heads towards the imminent announcement of the three-month window in which Australians will be able to opt out of My Health Record before being signed up to the online health information repository, the agency was caught by surprise today when details emerged in a blog post by GP and member of the steering group for the national expansion of MHR, Dr Edwin Kruys.

Kruys wrote that MHR offers “clear benefits” to healthcare through providing clinicians with greater access to discharge summaries, pathology and diagnostic reports, prescription records and more, but said “every digital solution has its pros and cons” and behind-the-scenes risk mitigation has been one of the priorities of the ADHA. However, he claimed Australians may not be made aware of the risks involved in allowing their private medical information to be shared via the Federal Government’s system.

“It has been decided that the risks associated with the MyHR will not be explicitly discussed on the website,” Kruys wrote.

“This obviously includes the risk of cyber attacks and public confidence in the security of the data.”

The most contentious contribution in the post related to the secondary use of Australians’ health information, the framework of which has yet to be announced by Health Minister Greg Hunt.

Contacted by HITNA, the agency moved swiftly to have Kruys delete the paragraph relating to secondary use.

In the comment that has since been removed, Kruys wrote, “Many consumers and clinicians regard secondary use of the MyHR data as a risk. The MyHR will contain a ‘toggle’, giving consumers the option to switch secondary use of their own data on or off.”

Under the My Health Records Act 2012, health information in MHR may be collected, used and disclosed “for any purpose” with the consent of the healthcare recipient. One of the functions of the system operator is “to prepare and provide de-identified data for research and public health purposes”. 

Before these provisions of the act will be implemented, a framework for secondary use of MHR systems data must be established. 

HealthConsult was engaged to assist the Federal Government in developing a draft framework and implementation plan for the process and within its public consultation process in 2017 received supportive submissions from the Australasian College of Health Informatics, the Australian Bureau of Statistics and numerous research institutes, universities, and clinicians’ groups.

Computerworld, 14 May 2018:

Use of both de-identified data and, in some circumstances, identifiable data will be permitted under a new government framework for so-called “secondary use” of data derived from the national eHealth record system. Linking data from the My Health Record system to other datasets is also allowed under some circumstances.

The Department of Health last year commissioned the development of the framework for using My Health Record data for purposes other than its primary purpose of providing healthcare to an individual.

Secondary use can include research, policy analysis and work on improving health services.

Under the new framework, individuals who don’t want their data used for secondary purposes will be required to opt-out. The opt-out process is separate from the procedure necessary for individuals who don’t want an eHealth record automatically created for them (the government last year decided to shift to an opt-out approach for My Health Record)……

Access to the data will be overseen by an MHR Secondary Use of Data Governance Board, which will approve applications to access the system.

Any Australian-based entity with the exception of insurance agencies will be permitted to apply for access the MHR data. Overseas-based applicants “must be working in collaboration with an Australian applicant” for a project and will not have direct access to MHR data.

The data drawn from the records may not leave Australia, but under the framework there is scope for data analyses and reports produced using the data to be shared internationally……

The Department of Health came under fire in 2016 after it released for download supposedly anonymised health data. Melbourne University researchers were able to successfully re-identify a range of data.

Last month the Office of the Australian Information Commissioner revealed that health service providers accounted for almost a quarter of the breaches reported in the first six weeks of operation of the Notifiable Data Breach (NDB) scheme.

The Sydney Morning Herald, 14 May 2018:

Australians who don't want a personal electronic health record will have from July 16 to October 15 to opt-out of the national scheme the federal government announced on Monday.

Every Australian will have a My Health Record unless they choose to opt-out during the three-month period, according to the Australian Digital Health Agency.

The announcement follows the release of the government’s secondary use of data rules earlier this month that inflamed concerns of patient privacy and data use.

Under the framework, medical information would be made available to third parties from 2020 - including some identifying data for public health and research purposes - unless individuals opted out.

In other news....... 

The Sydney Morning Herald, 14 May 2018:

A cyber attack on Family Planning NSW's website has exposed the personal information of up to 8000 clients, including women who have booked appointments or sought advice about abortion, contraception and other services.

Clients received an email from FPNSW on Monday alerting them that their website had been hacked on Anzac Day.

The compromised data contained information from roughly 8000 clients who had contacted FPNSW via its website in the past 2½ years to make appointments or give feedback.

It included the personal details clients entered via an online form, including names, contact details, dates of birth and the reason for their enquiries….

The website was secured by 10am on April 26, 2018 and all web database information has been secure since that time

SBS News, 14 May 2018:

Clients were told Family Planning NSW was one of several agencies targeted by cybercriminals who requested a bitcoin ransom on April 25…..

The not-for-profit has five clinics in NSW, with more than 28,000 people visiting every year.

The most recent Digital Rights Watch State of Digital Rights (May 2018) report can be found here.

The report’s 8 recommendations include:

Repeal of the mandatory metadata retention scheme

Introduction of a Commonwealth statutory civil cause of action for serious invasions of privacy

A complete cessation of commercial espionage conducted by the Australian Signals Directorate

Changes to copyright laws so they are flexible, transparent and provide due process to users

Support for nation states to uphold the United Nations Convention on the Rights of the Child in the digital age

Expand the definition of sensitive information under the Privacy Act to specifically include behavioural biometrics

Increase measures to educate private businesses and other entities of their responsibilities under the Privacy Act regarding behavioural biometrics, and the right to pseudonymity

Introduce a compulsory register of entities that collect static and behavioural biometric data, to provide the public with information about the entities that are collecting biometric data and for what purpose

The loopholes opened with the 2011 reform of the FOI laws should be closed by returning ASD, ASIO, ASIS and other intelligence agencies to the ambit of the FOI Act, with the interpretation of national security as a ground for refusal of FOI requests being reviewed and narrowed

Telecommunications providers and internet platforms must develop processes to increase transparency in content moderation and, make known what content was removed or triggered an account suspension.

This highlighted health statistic would come as no surprise to people living in rural and regional Australia

The Sydney Moring Herald, 18 January 2018:

NSW has been ranked the worst for healthcare affordability among older patients in the latest survey that pits Australia's most populous state against international health systems.

The results released on Thursday showed a larger proportion of NSW patients 65 and older struggled with their medical costs than their counterparts in Australia overall and 10 other OECD countries.

NSW fared worst when it came to the percentage of respondent who said they had problems paying their medical bills (15 per cent), compared to just 1 per cent in Sweden and 10 per cent in the US, found the survey of 24,000 people including 1175 in NSW.

More than one in five (22 per cent) reported spending $1000 or more in out-of-pocket healthcare costs, the third largest proportion after Switzerland (53 per cent) and the US (37 per cent), and well behind the top performer France (3 per cent), according to the 2017 Commonwealth Fund International Health survey findings released by the Bureau of Health Information (BHI)…..

Over 20 per cent of older people in NSW said they had skipped a dentist visit when they needed it due to the cost, tying with the US for the poorest result after Australia (23 per cent).

A total of 14 per cent of NSW respondents said they had skipped prescriptions, consultations or treatments due to cost in the previous year, the second lowest score after the US.

One in four NSW respondents said they found it "very difficult" to access medical care after hours without going to a hospital emergency department, trailing the US and seven other countries. [my yellow highlighting]

Have our expectations in relation to medical treatment risen steadily or is NSW health service delivery getting worse?

The Sydney Morning Herald, 24 November 2017:

The Health Care Complaints Commission's annual report shows it was hit with 6319 complaints, which largely related to questionable treatments, misconduct and poor communication…..

Complaints surge

The NSW Health Care Complaints Commission was hit with 6,319 complaints in 2016-17 - leading to a 132 per cent growth in complaints over the past decade.

Health Care Complaints Commission Annual Report 2016-17:

Prosecuting complaints

The Commission referred 198 investigations to its Legal Division, compared with 139 in the previous year. This is an increase of 42.4%.

In the same period, the Director of Proceedings made 104 determinations whether or not to prosecute a complaint, 76 of which recommended prosecution before NCAT and 20 before a Professional Standards Committee. In eight complaints, the Director of Proceedings determined not to prosecute…..

The overall success rate of prosecutions before Professional Standards Committees and NCAT was 96.2%.

In 2016-17, the registration of 38 health practitioners was cancelled or disqualified. Three practitioners were suspended and had conditions placed on their registration. A further 31 health practitioners had conditions placed on their registration and were reprimanded or cautioned……

The proportions of complaints for each category of health service provider have remained consistent during the period. Individual health practitioners continue to make up the highest proportion of all complaints. Over the period 2012-13 to 2016-17 an average of 62.5% were about registered health practitioners, 35.1% of complaints received were about health organisations, and 2.4% were about non-registered health practitioners and practitioners whose registration status was unknown…..

The American Resistance has many faces and this is just one of them (13)

They travelled to D.C.
They slept outside in wheelchairs.
They were arrested.
They never lost faith.
They saved Medicaid. @NationalADAPT pic.twitter.com/1Fl34iduUd

— John Nichols (@NicholsUprising) July 28, 2017

Regional health divide stroke treatment a cruel lottery says Stroke Foundation

“Regional Australians are 19 percent more likely to suffer a stroke than those in metropolitan areas.”  
“Australia’s stroke hotspot North Coast, NSW” 
[No postcode untouched: Stroke in Australia 2017, Key Insights]

[https://strokefoundation.org.au/-/media/78B6CE278AB247F3A7C7B27FF459845B.ashx]

The Richmond, and Page federal electorates which cover most of the Northern Rivers region are expected to have a combined total of 18,312 stroke survivors in 2050.

Combined with Cowper and Lyne federal electorates, this brings the total number on the NSW Coast in 2050 to an est. 36,605 people living with the effects of stroke.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Stroke Foundation media release, 21 June 2017:

Regional and rural communities are bearing the brunt of Australia’s stroke burden, according to an updated Stroke Foundation report released today.

“No Postcode Untouched: Stroke in Australia 2017”, found 12 of the country’s top 20 hotspots for stroke incidence were located in regional Australia and people living in country areas were 19 percent more likely to suffer a stroke than those living in metropolitan areas.

Stroke Foundation Chief Executive Officer Sharon McGowan said due to limited access to best practice treatment, regional Australians were also more likely to die or be left with a significant disability as a result a stroke.

“In 2017, Australians will suffer more than 56,000 strokes and many of these will be experienced by people living in regional Australia,’’ Ms McGowan said.
“Advancements in stroke treatment and care mean stroke is no longer a death sentence for many, however patient outcomes vary widely across the country depending on where people live.

“Stroke can be treated and it can be beaten. It is a tragedy that only a small percentage of Australian stroke patients are getting access to the latest treatments and ongoing specialist care that we know saves lives.”

Stroke Foundation Clinical Council Chair Associate Processor Bruce Campbell said Australian clinicians were leading the way internationally in advancements in acute stroke treatment, such as endovascular clot retrieval. However, the health system was not designed to support and deliver these innovations in treatment and care nationally.

“It is not fair that our health system forces patients into this cruel lottery,’’ A/Professor Campbell said.

“There are pockets of the country where targeted investment and coordination of services is resulting in improved outcomes for stroke patients.

“Consistent lack of stroke-specific funding and poor resourcing is costing us lives and money. For the most part, doctors and nurses are doing what they can in a system that is fragmented, under-resourced and overwhelmed.”

No Postcode Untouched: Stroke in Australia 2017 report and website uses data compiled and analysed by Deloitte Access Economics to reveal how big the stroke challenge is in each Australian federal electorate. This data includes estimates of the number of strokes, survivors and the death rate, as well as those living with key stroke risk factors. It is an update of a Stroke Foundation report released in 2014.

The report shows the cities and towns where stroke is having its biggest impact and pinpoints future hotspots where there is an increased need for support. 

Ms McGowan said stroke is a leading cause of death and disability in Australia, having a huge impact on the community and the economy.

“Currently, there is one stroke in Australia every nine minutes, by 2050 - without action - this number is set to increase to one stroke every four minutes,’’ she said.

“Stroke doesn’t discriminate, it impacts people of all ages and while more people are surviving stroke, its impact on survivors and their families is far reaching. “It doesn’t have to be this way. Federal and state governments have the opportunity to invest in proven measures to change the state of stroke in this country.”

In the wake of the report Stroke Foundation is calling for a funded national action plan to address the prevention and treatment of stroke, and support for stroke survivors living in the community. Key elements include:

A national action campaign to ensure every Australian household has someone who knows FAST - the signs of stroke and to call 000. Stroke is a time critical medical condition. Time saved in getting people to hospital and treatments = brain saved.

Nationally coordinated telemedicine network – breaking down the barriers to acute stroke treatment.

Ensuring all stroke patients have access to stroke unit care, and spend enough time on the stroke unit accessing the services and supports they need to live well after stroke.

Further information

Stroke in Australia: No postcode untouched report

No postcode untouched website with electorate by electorate data

Top 20 stroke hotspots – incidence of stroke in 2017

Top 20 stroke survivor hotspots – stroke survivors living in the community

Top 10 facts about stroke

The No Postcode Untouched: Stroke in Australia 2017 report was funded by an unrestricted educational grant from Boehringer Ingelheim.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Turnbull Government has been offering half-truths to voters once gain

In its 2017-18 Budget the Turnbull Government announced it would commence the phased re-introduction of Medicare Benefits Schedule rebates indexation.

Treasurer and Liberal MP for Cook Scott Morrison stated in his Budget Night speech that “We are lifting the freeze on the indexation of the Medicare Benefits Schedule. We are also reversing the removal of the bulk-billing incentive for diagnostic imaging and pathology services and the increase in the PBS co-payment and related changes.”

It now appears that it was premature to expect that out-of-pocket expenses for a number of radiology and diagnostic imaging services might be contained after the rebate freeze was lifted for these services in three years time.

The Sydney Morning Herald, 16 May 2017:

The Medicare rebate thaw will not apply to 93 per cent of scans, including the X-rays, MRIs and ultrasounds used to diagnose some of the most common forms of cancer.

Health Minister Greg Hunt's staged four-year thaw has been widely welcomed by doctors' groups such as the Australian Medical Association and the Royal Australian College of GPs. Under the plan, indexation will gradually be reapplied to bulk-billing incentives, visits to the doctor and allied health services.

On budget night, the Turnbull government said the final stage of the thaw, due in July 2020, would lift the freeze on "targeted" radiology and diagnostic imaging services - the first indexation since 2004.

Prime Minister Turnbull puts pressure on the Senate to back the increase to the Medicare levy after the release of two new opinion polls. Vision courtesy Seven News Melbourne.

But new Department of Health figures reveal precisely how "targeted" the changes will be: the freeze will be lifted on 59 of the 891 radiology items listed on the Medicare Benefits Schedule - just 7 per cent.

While mammograms and a number of CT scans will be indexed under the plan, X-rays, MRIs, PETs and ultrasounds for such common conditions as brain, lung, breast and ovarian cancer will not. The rebate on common scans for arthritis and nuclear medicine will also remain frozen. [my yellow highlighting]

As for the promised reversing of the increase in the Pharmaceutical Benefits Scheme (PBS), this is only the potential for a flow-on effect from other changes in the PBS and is in no way guaranteed to occur.

How the NSW public hospital system still fails those with mental health issues

“To see a mentally ill person in 2014 at a public hospital in NSW treated in such an appalling manner is really beyond comprehension. The sight of the deceased wandering the corridor naked and covered in excrement while the senior nurse is seen to mop the floor apparently oblivious to her is horrific. While this appears not to be a system failure it is clearly a serious human failure. It is for another place to take such disciplinary proceedings as appear necessary.” [Excerpt from a NSW coronial inquest judgment delivered on 7 September 2016]

ABC News, 12  May 2017:

The daughter of a woman who died after she was left to wander the halls of a New South Wales hospital while naked and covered in faeces says nurses there lied to her about what happened.

Miriam Merten died in 2014 from a brain injury after she fell over more than 20 times at the Mental Health Unit of Lismore Base Hospital, on the state's north coast.

A coronial inquest heard she was locked in a seclusion room for hours, and when the two nurses supervising her unlocked the door they allowed her to wander around naked, covered in faeces.

She continued to fall over outside the seclusion room.

Coroner Jeff Linden found she died from "traumatic brain injury caused by numerous falls and the self-beating of her head on various surfaces, the latter not done with the intention of taking her life".

"The sight of the deceased wandering the corridor naked and covered in excrement while the senior nurse is seen to mop the floor, apparently oblivious to her is horrific," he said.

The state's chief psychiatrist Murray Wright said he was equally shocked.

"I can't speak for what was happening in the minds of those nurses but I think it's an absolutely appalling incident," he said.

Ms Merten's daughter, Corina Leigh Merten, said she only found out exactly how her mother died when a journalist contacted her recently.

She said that at the time of her mother's death, nurses gave her a different version of how her mother died.

"I was in school, in Year 12, my dad came and picked me up and we went straight to the hospital," she said.

"At the time they told me she slipped and fell in the shower."

Now 20, Corina Merten said she did not know the coronial inquest was on.

"I'm so disappointed that it took a reporter for me to know what actually happened to my mum," she said.

ABC News, 13 April 2017:

The New South Wales Health Care Complaints Commission said it had found that two nurses caring for a patient who later died from a brain injury kept no record of about 20 falls captured on CCTV.

The woman, known as Patient A, was filmed wandering naked and covered in faeces in Lismore's Adult Mental Health Unit in mid-2014.

CCTV footage showed that in the seven hours before she was transferred to intensive care she fell 24 times.

For most of that time she was alone in a locked room, but nursing records of her confinement made no mention of any falls.

During a five-hour period in the seclusion room, no-one entered to check the patient's temperature, pulse, respiration or blood pressure.

Patient A was not offered any food or water and had no access to a toilet.

The woman died from a brain injury the following day.

The HCCC found the two nurses charged with her care guilty of professional misconduct.

Far too late to benefit Miriam Merten, Health Minister Brad Hazzard said the State's Chief Psychiatrist and a parliamentary committee would review whether failures in mental health care persist.

See: Civil and Administrative Tribunal New South Wales, Health Care Complaints Commission v Borthistle [2017] NSWCATOD 56 decision concerning “Patient A” and Health Care Complaints Commission v Burton [2017] NSWCATOD 57 decision concerning “Patient A” .

NSW Health Care Complaints Commission (HCCC), Annual Report 2015-16:

Each year complaints relating to mental health make up around 12% of all complaints received by the Commission.

In 2015-16, there were 759 complaints in this category.

This means that over the five years from 2011 to 2015-16 the Commission has received 3,051 complaints concerning mental health….

Over the last five years the Commission received:

807 complaints about medical practitioners;

647 complaints about psychologists;

438 about mental health services in a public hospital and 299 about psychiatric hospitals;

302 about nurses; and,

220 about community health services.

In addition to the 12% of all health complaints being listed as complaints concerning mental health providers, another 5.4% of all health complaints are complaints concerning psychiatry providers.

This annual report also stated that 21% of all mental health complaints between 2011-12 to 2015-16 related to professional conduct and 31.9% related to treatment.

Of the mental health complaints received in 2015-16 there were:

46 referred to professional council;

40 resolved during assessment;

55 referred for local resolution;

23 investigation conducted by the HCCC;

46 referred to the HCCC's Resolution Service;

12 discontinued with comments;

7 referred to another body/person; and

226 discontinued with no reasons stated.

Case study included in HCCC Annual Report 2015-16 at page 58:

The Commission investigated a complaint against a mental health inpatient unit in a regional public hospital. The key facts were that:

* Patient A was scheduled under the Mental Health Act 2007 (NSW) with a dual diagnosis of schizophrenia and alcohol abuse

* The patient was difficult to manage due to lack of insight, non-compliance with medication and high level aggression.

* The decision to co-locate the patient in a double room with Patient B – both unpredictable and potentially violent patients – without any a risk assessment.

* On a night shift, required observations either not carried out at all or were not carried out in the manner required, but staff signed off that all care level checks were completed

* Overnight Patient B was killed by Patient A.

The investigation found that care and treatment of Patient A was inadequate. His care plan was ineffective, rigid and failed to improve his condition. There were lost opportunities in terms of appropriate, alternative ways to manage and treat him. Furthermore, his safety and that of others was put at risk through the decision to co-locate him with patient B and because staff failed to carry out the required observations.

SANE Australia 2013 report:

A Mental Health Council of Australia study (2011) found that people with mental illness reported similar levels of stigma from health professionals as from the general community.

Some of the study’s key findings are that:

* Almost 29% reported that a health professional had ‘shunned’ them. These figures rose to over 50% for people with post-traumatic stress disorder and borderline personality disorder.

* Over 34% had been advised by a health professional to lower their expectations for accomplishment in life.

* Over 44% agreed that health professionals treating them for a physical disorder behaved differently when they discovered their history of a mental illness.

NSW Health Care Complaints Commission decisions recorded in 2016 & 2017 re other nursing staff complaints relating to treatment of patients with a psychiatric illness:

RNs Haridavan Pandya and Sumintra Prasad – Unsatisfactory professional conduct, 2 February 2017, concerning their care of a mental health patient at Bungarribee House mental health unit in Blacktown hospital on 28 February 2014.

RNs Abraham Thomas and Donna Hayden, and Ms Julie Rumble – Unsatisfactory professional conduct, 11 May 2017,concerning the death of a mental health inpatient at Dubbo Mental Health Inpatient Unit on 28 February 2014.

Mr Stephen Woods – disqualified from being registered as an enrolled nurse for a period of 12 months, 16 May 2016, concerning a physical and verbal attack of a patient in the Mental Health Intensive Care Unit at Hornsby Hospital on 9 April 2014.

Mr Neil Mullen (RN) – Unsatisfactory professional conduct – Reprimand and conditions imposed, 18 July 2016, concerning care of care of nine patients in the Shellharbour Hospital mental health unit on 30 and 31 July 2014. 

Mr Mike Siebe Greive - Registered Nurse - Disqualified for 18 months, 30 March 2016, concerning a female mental health patient at the Hornsby Hospital Adult Mental Health Unit between October and December 2013. 

Registered Nurses Wendy Kennedy, Christopher Parker and Jisnu Dowsett cautioned and Stewart Thompson reprimanded by a Nursing and Midwifery Professional Standards Committee, 1 June 2015, concerning care of a patient at Lismore Adult Mental Health Unit’s eight bed High Dependency Unit on 19 and 20 February 2013.  The patient was found deceased in his room on the morning of 20 February 2013.

Mr Ronnie Obusan - finding of unsatisfactory professional conduct – reprimand and conditions, 19 January 2016, concerning the nurse’s interactions with a patient in the mental health unit at Nepean Hospital in 2012. 

I'm sure NSW residents would all like to believe that each and every time they present at a public hospital they will be treated with professional care and respect.

Unfortunately that is not always the case as prejudice, discrimination and racism are rarely acknowleged by government as existing within the state health care system and are therefore tolerated by default.

“Stigma against people who have experienced a mental illness is deeply entrenched in our culture. It finds expression everywhere from the Parliament to the front bar. From courtrooms and pulpits to playgrounds it is possible to hear people who experience mental illness cast in an unfair light.”  [National Survey of Mental Health and Wellbeing Bulletin 6, Carr & Halpirin 2002, Stigma and discrimination]