Health and Ageing

Audit strategy overview

The Health and Ageing portfolio has a broad objective of working to achieve a health care system that meets the health care and ageing needs of all Australians. Achievement of this objective relies upon a large number of portfolio agencies delivering programs and initiatives both directly to health practitioners and health consumers, and through a range of intermediaries, including state and territory governments.

The Department of Health and Ageing (DoHA) is the lead agency in the portfolio and is responsible for achieving the Australian Government’s priorities by developing evidence-based policy, managing programs and undertaking research and regulation activities. In the 2009–10 Federal Budget, DoHA was appropriated $41.2 billion for 15 department-specific outcomes reflecting the Australian Government’s desired results for health and ageing. Recent ANAO audit coverage has focused on portfolio outcomes involving population health, aged care and population ageing, primary care, and health workforce capacity.

The ANAO’s 2010–11 audit program for the Health and Ageing portfolio has been developed within the context of the ANAO’s audit strategy. This strategy recognises the broad range of DoHA outcomes and targets the key risks to their achievement. The strategic areas of the ANAO’s planned audit coverage include:

• meeting the needs of older Australians—quality aged care comprising high-quality community and residential aged care;
• healthy communities—health system capability including a skilled general practitioner workforce;
• protecting the health of consumers—regulatory effectiveness including safe therapeutic goods and safe food;
• achieving program outcomes—effective program delivery including mental wellbeing; and
• addressing major cost drivers and finding efficiencies.

Subject to the passage of legislation from July 2010, the Australian Government will begin to provide $5.3 billion in additional funding to support health and hospital reforms over the next four years. The National Health and Hospitals Network Agreement sets out the shared intention of the Commonwealth and state and territory governments to implement a National Health and Hospitals Network (NHHN) for Australia. To inform its future audit coverage, the ANAO will monitor the Commonwealth–state/territory developments with respect to the health and hospital reforms.

Audits in progress at 1 July 2010

Practice Incentives Program

The Practice Incentives Program (PIP) aims to recognise and provide financial incentives to General Practices that provide comprehensive quality care and that are either accredited or working towards meeting the Royal Australian College of General Practitioners Standards for General Practices. Some $298 million was paid to General Practices and GPs under PIP in 2008–09.

Responsibility for program delivery is shared; DoHA is responsible for program policy development, including eligibility criteria, and Medicare Australia is responsible for assessing all applications from General Practices for participation in the program.

The audit is assessing DoHA’s effectiveness in undertaking PIP program planning, program monitoring and review; and with Medicare Australia, in ensuring PIP program delivery to General Practices and their medical practitioners.

The audit report is expected to be tabled in the Spring 2010 Parliamentary Sittings.

Food Standards Regulation

The Australian and New Zealand governments established Food Standards Australia New Zealand (FSANZ) as an independent statutory agency under the Food Standards Australia New Zealand Act 1991. FSANZ is responsible for setting food standards within an integrated food regulatory system involving the governments of Australia and New Zealand, and the Australian states and territories. The food regulatory system is complex in terms of bi-national, government, state, territory and local government relationships.

The audit forms part of the ANAO’s strategic focus on regulation. It examines the effectiveness of FSANZ as a regulator of food standards and focuses on its compliance with legislation, risk management approaches, stakeholder engagement, and standard-setting. The audit also includes an assessment of FSANZ’s internal and external reporting.

The audit report is expected to be tabled in the Spring 2010 Parliamentary Sittings.

National Blood Supply

The National Blood Authority is the national coordinating agency for supply and demand planning and the purchase of blood and blood products from suppliers on behalf of the Australian Government. In 2009–10, the Authority’s total resources are estimated at $1.1 billion. The Authority commenced operation on 1 July 2003 as an independent statutory agency under the National Blood Authority Act 2003. It was established as part of government reforms, to improve management of Australia’s blood supply; the Australian Government (63 per cent) and the state and territory governments (37 per cent collectively) jointly fund its operations. The Authority manages contracts with several major suppliers of blood, blood products and diagnostic reagents. The largest contract is with the Australian Red Cross Blood Service—$1.7 billion from 2006 to 2010.

The audit is assessing whether the National Blood Authority’s governance and contractual arrangements are effective in ensuring sufficient blood supply and services.

The audit is expected to be tabled in the Autumn 2011 Parliamentary Sittings.

General Practice Training

The Australian Government supports vocational training for doctors wanting to pursue general practice as a career. The General Practice Education and Training Limited (GPET) manages training programs on behalf of the government. As at May 2010, GPET’s estimated expenses for 2009–10 are $114 million. It plans to deliver 700 general practice vocational training places in 2010.

Against the backdrop of the Department of Health and Ageing-GPET funding agreement, the audit is examining aspects of GPET’s administration. The audit objective is to assess the effectiveness of GPET’s management of its two main programs: the Australian General Practice Training and Pre-vocational General Practice Placement programs. These programs aim to improve quality and access to primary care across Australia, including through general practitioner vocational education and training for medical graduates.

The audit is expected to be tabled in the Autumn 2011 Parliamentary Sittings.

Potential audits

Aged Care Standards and Accreditation

Government expenditure on aged care places is expected to continue to increase in line with the ageing of the Australian population. The Australian Government, through the Aged Care Standards and Accreditation Agency (appointed by DoHA under the Aged Care Act 1997), assesses the performance of residential aged care homes against established accreditation standards.

ANAO Audit Report No.42 2002–03, Managing Residential Aged Care Accreditation, identified six recommendations for improvement. Since then, the Agency has experienced a significant increase in funding and expansion of its compliance program. For example, in 2004–05, the Agency received an additional $36.3 million over four years and the 2006–07 Federal Budget provided a further $8.6 million for increased ‘spot checks’ of aged care homes.

An audit would align with the ANAO’s strategic coverage of the quality assurance framework established under the Aged Care Act 1997 and examine the Agency’s management of monitoring activities within the accreditation cycle and the related compliance role of DoHA. Implementation of the recommendations of the earlier audit would also be examined.

Access to Allied Psychological Services

In response to the high burden of mental illness in Australia, the Government announced the Better Outcomes in Mental Health Care (BOiMHC) Initiative in the 2001–02 Federal Budget, allocating $120.4 million over four years. This initiative consisted of five interrelated components aimed at improving community access to quality primary mental health care. At present, two components remain, including Access to Allied Psychological Services (ATAPS) and GP Psychological Support.

ATAPS is a key feature of the initiative, consuming the majority of the funding allocation, with a budget of approximately $27 million per year. ATAPS is a capped program and since its inception in 2003, has received a total of $80.7 million in funding.

An audit would examine the effectiveness of DoHA’s administration of the ATAPS program.

Therapeutic Goods Regulation

The Australian Government has identified as a priority the Australian community’s access to high-quality, safe, and effective therapeutic goods. The Therapeutic Goods Administration (TGA)—a division of DoHA—regulates the quality, safety and efficacy or performance of therapeutic goods, including medicines and medical devices. TGA’s operations are funded, in part, by cost recovery from industry through charges and fees for service. In 2008–09, the Government signalled its intention to pursue a reform agenda to update and streamline the existing regulatory framework for therapeutic goods in Australia.

The ANAO has undertaken performance audits on therapeutic goods regulation in the past and has identified significant opportunities for improvements in the administration of the regulatory framework.

An audit would form part of the ANAO’s strategic focus on regulators within the Health and Ageing portfolio. It would examine TGA’s effectiveness as a regulator, stakeholder engagement, implementation of proposed government reforms and, where relevant, progress against previous ANAO recommendations.

Mental Health Nurse Incentive Program

The Mental Health Nurse Incentive Program provides a non-Medicare Benefit Schedule (MBS) incentive payment to community-based general practices, private psychiatrist services and other appropriate organisations (such as Divisions of General Practice) who engage mental health nurses to assist in the provision of coordinated clinical care for people with severe mental disorders. The program forms part of the Australian Government's component of the COAG’s  National Action Plan on Mental Health 2006–11.

The program commenced on 1 July 2007 and funds nursing work in collaboration with psychiatrists and general practitioners to provide services such as monitoring a patient’s mental state, medication management and improving links to other health professionals and clinical service providers.

An audit would examine aspects of the planning, implementation and management of the Mental Health Nurse Incentive Program.

Improving Palliative Care

It has been estimated that terminal illness affects around half a million Australians as patients, carers, family members or friends every year. Palliative care seeks to maintain quality of life for these people, by addressing their distinctly different physical, psychological and spiritual needs.

The Australian Government's National Palliative Care Program aims to improve access to and the quality of palliative care. Working closely with state governments to ensure that Australian Government activities are complementary, DoHA manages its Palliative Care and Community Assistance Program (PCCA). With an annual budget of $30 million, the PCCA Program aims to improve access to the quality of palliative care for people with a terminal illness.

An audit would examine DoHA’s management of the PCCA Program to improve the standards of palliative care.

Aged Care Complaints

In July 2006, the Australian Government announced measures to strengthen the complaints- handling powers under the Aged Care Act 1997, including establishing an Office of Aged Care Quality and Compliance (the Office), an Aged Care Complaints Investigation Scheme (CIS), and an Aged Care Commissioner. These measures were legislated in April 2007.

The Office manages the CIS and has the power to investigate all ‘in scope’ complaints and reported information relating to an approved provider’s responsibilities under the Act. The Aged Care Commissioner has a role to, among other things, examine on appeal certain decisions made by the CIS under the Investigation Principles 2007, examine complaints received about the Secretary’s processes for handling matters under the Investigation Principles 2007 and examine complaints about aspects of the application of the Accreditation Grant Principles 1999.

An audit would, as part of an ongoing review of the quality assurance framework under the Aged Care Act 1997, examine the effectiveness of DoHA’s administration of aged care complaints.

GP Super Clinics

The Australian Government has committed $275 million over five years, starting in 2007–08, to establish GP Super Clinics in 31 localities across Australia. GP Super Clinics were designed to bring together general practitioners (GP), nurses, visiting medical specialists, allied health professionals and other health care providers, to deliver care that is tailored to the needs and priorities of local communities, and they are a key element in the government’s drive to build a stronger primary care system. They are expected to provide a greater focus on health promotion and illness prevention and better coordination between privately provided GP and allied health services, community health and other state and territory government-funded services than the traditional model of GP practices.

An audit would examine aspects of DoHA’s planning and implementation of GP Super Clinics.

National E-Health Implementation

In the 2009-10 budget, the Australian Government committed $57 million to E-Health to facilitate the transition of paper-based clinical record keeping to electronic means for better information exchange to deliver safer, more efficient, better quality healthcare.

Over the period July 2009 to June 2012, the National E-Health Transition Authority (NEHTA) will deliver key components of the National E-Health Strategy, endorsed by Australian Health Ministers in late 2008. The Council of Australian Governments (COAG) has agreed to provide $208 million to NEHTA, with 50 per cent funded by the Commonwealth and the remainder by the states and territories under the COAG funding formula.

An audit would examine DoHA’s management and co-ordination of E-Health developments within DoHA and with state/territory governments.

Investing in Health Infrastructure

In the 2009–10 Budget, the Australian Government announced that it would invest $3.2 billion to fund health projects across Australia, including upgrading and delivering major new health infrastructure, modernising Australia’s cancer services, and improving medical research infrastructure to improve Australia’s health system collectively. Funding for this investment would be sourced from the Health and Hospitals Fund (HHF), which was established by the Government on 1 January 2009 under the Nation-building Funds Act 2008 to provide a financing source for health infrastructure priorities. Under the Act, all health infrastructure spending proposals must be assessed by an independent, expert advisory board using established evaluation criteria and in accordance with guidelines issued by the Minister for Health and Ageing.

An audit would examine DoHA’s assessment and approval practices for the HHF-funded Budget measures against the requirements of the Nation-building Funds Act 2008.

Preventative Health

Well-planned prevention programs have made enormous contributions to improving the quality and duration of our lives. The public health revolutions of the 19th century led the way, and in recent years we have seen major improvements in areas such as tobacco control, road trauma and drink driving, skin cancers, immunisation, cardiovascular disease, childhood infectious diseases, Sudden Infant Death Syndrome and HIV/AIDS control.

The National Preventative Health Taskforce has developed the National Preventative Health Strategy focusing initially on obesity, tobacco and excessive consumption of alcohol. The strategy has a number of targets which have been aligned with a further set of interim targets set by the COAG. The strategy recommends the creation of a National Preventative Health Agency to ‘provide a unique opportunity to provide strong leadership and coordination of the preventative reform agenda’. While the strategy has a phased and long-term approach to preventative health, the department and its portfolio agencies have, for some time, been focusing on preventative health measures across the range of portfolio outcomes.

The strategy’s conceptual framework links directly to four elements: ensuring a well-informed public; keeping people and families at the centre of action; responsive regulation; and supporting vulnerable groups.

An audit would examine how DoHA and relevant portfolio agencies are implementing the coordinated and more structured focus in these areas of preventative health.

 

Previous: Finance and Deregulation

Next: Human Services