This Is Really Bad News Indeed And An Ongoing Worry!

This appeared last week:

Drug resistance

Rise of almost untreatable superbug linked to a common antibiotic

‘Surprising’ finding by Australian-led study is first recorded instance of one antibiotic causing resistance to another in a different class

Sharlotte Thou

Thu 24 Oct 2024 07.30 AEDT

The rise of an almost untreatable superbug has been linked to a common antibiotic, an Australian-led study has found.

The study – published in Nature – found that rifaximin, an antibiotic used to treat liver disease, causes resistance to another antibiotic, daptomycin.

Daptomycin is one of the few drugs that is effective against vancomycin-resistant enterococcus (VRE), a contagious bacterial infection that can cause serious reactions in hospitalised patients.

Dr Adrianna Turner, the study’s lead author, said the “really surprising” finding was the first recorded instance of an antibiotic causing resistance to one in a different class. It was previously thought that the risk of antibiotic resistance only applied to the one antibiotic.

Superbugs explained: what they are and what a post-antibiotic future could look like – video

The findings also overturned the widely held idea that rifaximin was a low-risk antibiotic.

Last month international leaders committed to decisive action on antimicrobial resistance – the development of bacteria to resist treatment. This included the aim of reducing the estimated global 4.95m deaths associated with antimicrobial resistance annually by 10 percentage points by 2030.

Turner said when bacteria became resistant to an antibiotic, “it’s a bit like gaining a new ability in a video game”.

“But when exposed to rifaximin, the VRE bacteria don’t just get one boost – they gain multiple abilities, like super-speed and super-strength, allowing them to easily defeat even the final boss, which in this case is the antibiotic daptomycin.”

Rifaximin use triggers changes in an enzyme within the bacteria, which then leads to changes in the VRE’s cell membrane, causing cross-resistance, researchers from the Doherty Institute and Austin Health found.

Turner did not rule out the possibility that other antibiotics could create resistance to antibiotics in different classes.

Researchers are now investigating whether daptomycin-resistant strains of VRE may be transmitted to other patients within the hospital.

The eight-year study involved genomic analyses of isolates from patients from Australia and Germany, and used animal models to support the hypotheses.

Turner said the findings highlighted the need for surveillance and investigation into how bacteria become antibiotic-resistant, allowing researchers to create diagnostic tests and genomic surveillance to understand the prevalence of such bacteria.

Prof Jason Kwong, from Austin Health, emphasised that rifaximin is still effective when used appropriately and those taking it to treat advanced liver disease should continue to do so.

“But we need to understand the implications going forward both when treating individual patients and from a public health perspective,” he said.

He advised clinicians treating patients with VRE who have taken rifaximin to confirm that daptomycin is working via a lab test, as its efficacy may be affected.

Kwong emphasised the importance of drug regulators considering whether the use of one drug makes another less effective when approving new drugs.

Prof Martina Sanderson-Smith, a molecular bacteriologist at the University of Wollongong, said the finding that antibiotic resistance can affect different types of antibiotics was “really concerning and interesting”.

She said the findings highlighted the difficulties in the responsible use and prescription of antibiotics, and the need to balance safety with clinical need.

“We need to better understand the possible sort of consequences of prescribing all classes of antibiotics on this idea of shared resistance across antibiotic classes, so that clinicians can make more informed decisions,” she said.

Here is the link:

https://www.theguardian.com/society/2024/oct/24/antibiotic-resistance-daptomycin-superbug-study

It is clear that some-time soon we are going to need better regulation and supervision of anti-biotic prescribing. Can’t happen soon enough I reckon!

David.

It Looks Like All Is Not OK In The Private Hospital Sector!

This appeared last week:

Ramsay calls for insurance shake-up as hospital bailout hopes sink

Michael Smith Health editor

Oct 24, 2024 – 5.37pm

Ramsay Health Care has called for health insurance funding to be automatically linked to cost inflation. The head of its Australian hospital operations said the company was prepared for a “fight” if insurers did not agree to do more to cover unexpected surges in staff wages.

Ramsay, the country’s largest private hospital group, also said it was not expecting the Albanese government to bail out struggling facilities or deliver any solutions to the sector’s crisis as it prepares to release the findings of a Department of Health review into the $22 billion sector.

The closure of a private maternity ward in Gosford on the NSW Central Coast announced this week triggered warnings on Thursday of more hospital closures unless insurers tipped more money into the system or Health Minister Mark Butler takes action to prop up loss-making facilities.

“I am not expecting solutions from the government, but I think there is a bit of pressure on [them] from the closure of maternity services like Gosford. You would imagine there would be MP pressure in some of those regions which will necessitate some thought,” Ramsay’s Australia boss Carmel Monaghan told analysts on Thursday.

“I don’t think there is a bailout coming for hospitals that aren’t doing so well. I can’t see that happening.”

While Ramsay is more profitable than other big private hospital groups, its margins are under pressure from soaring wages. Ms Monaghan told investors the company was in talks with a number of health insurers to address funding shortfalls from cost inflation. She said while there had been “some recent success” she would not rule out further disputes with insurers if they did not come to the party.

“There are quite a number of negotiations underway. I hope we don’t have to bash them up but if we have to, we will. I can’t say there won’t be a fight but if that’s what it comes to...,” she told analysts after a site inspection of Ramsay facilities in Perth.

She said Ramsay wanted “automated indexation” when health inflation was higher than expected. That model would automatically link future funding to cost inflation compared to the current system, where funding is negotiated in contract talks with each insurer.

However, health insurers said a tax hike on NSW health insurance passed by parliament on Thursday meant there was no money left to increase funding for hospitals.

“To date, health funds have provided multiple voluntary payments to private hospitals to help them survive tough financial conditions. However, the Minns government’s tax hike will cannibalise any reserves to do this in future. There is nothing left,” Rachel David, chief executive of Private Healthcare Australia, which represents health insurers, said.

Ramsay on Thursday outlined plans to expand its hospital network and invest in emergency departments and other outpatient services despite the pressure on the sector due to inflation and lacklustre patient numbers. It also said it was confident of getting more work from state governments paying for public patients to use private hospitals, although company data showed this had dropped off in the last two years.

“New South Wales have turned off the tap for a while, but they have a big waiting list … there will be pressure at some point and the pressure valve will have to be released,” Ms Monaghan said.

Ramsay is under pressure to improve its operational performance with the value of its shares down 20 per cent so far this year. The company has appointed Woolworths’ former head of supermarkets Natalie Davis as its new chief executive. She is expected to formally take on the role at the end of this year.

Some investors are disgruntled with the company’s rejection of a $20 billion takeover bid from private equity firm KKR in 2022 of $88 a share. Ramsay shares closed down 4¢ at $41.77 on Thursday, valuing the company at $9.7 billion. The stock has lost 20 per cent of its value so far this year.

“I do think the company is undervalued, given no market value being placed for Ramsay Sante, but for the market to get confident, Ramsay needs to improve operational performance,” said Blackwattle Investment Partners portfolio manager Ray David, an investor who has been calling for a change of strategy at Ramsay. Sante is the company’s European operations.

Preliminary findings of the Butler hospital review obtained by The Australian Financial Review in July revealed a government warning that some hospitals would close in the next 12 months with a shift from overnight stays to same-day procedures harming profit margins. It said the private sector was “uninvestable”.

Insurers and hospital groups had been expecting a summary of the report to be released this week, two months later than originally expected.

Michael Smith is the Health Editor for The Australian Financial Review. He is based in Sydney. Connect with Michael on Twitter. Email Michael at michael.smith@afr.com

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/ramsay-calls-for-insurance-shake-up-as-hospital-bailout-hopes-sink-20241024-p5kkzu

This is more useful information on the Private Hospital sector which, I suspect, is really struggling and needs a proper plan for co-existence with the public sector. It seems clear that both mental health and acute care are in some difficulty.

The system has always been a bit ‘Micky Mouse’ and the time has come to get it back on a sustainable footing.

A good few hard heads need to give this some careful thought! If Ramsay is struggling there will be some smaller entities in deep 'do-do'!

David.

It Will Be Interesting To See Just How Well This Key Recommendation Flies With The Docs.

This appeared last week:

25 October 2024

Here’s what’s in the scope of practice report

By

Holly Payne

The controversial review has now signed and sealed its final report, which is on its way to Health Minister Mark Butler.

Patient registration will be central to the reforms recommended by the scope of practice review in its final report, according to committee lead Professor Mark Cormack.

Speaking on a workforce panel at Rural Medicine Australia 2024, ACRRM and the RDAA’s annual conference, Professor Cormack disputed the notion that the review would promote a fragmented system.

“Our review will strongly recommend the centrality of the Strengthening Medicare policy framework and the centrality of patient registration with a [GP] practice,” he said.

“The funding, payment and other reforms that we’re proposing – and of course, we’re proposing others that have got nothing to do with payment – will be built around the centrality of Strengthening Medicare and MyMedicare.

“[It will] in many ways provide a forcing function for multidisciplinary approaches to care in the primary care sector.”

The most significant ask in the report will be on payment models.

“Payment mechanisms drive and restrict scope unnecessarily, more than any other policy setting,” Professor Cormack said.

“The work that the [Department of Health and Aged Care] … has done through the GP Incentives Review is absolutely fundamental, not only to achieving the 2032 vision for primary care, but also for enabling health professionals to work to their full scope of practice.

“Put simply: if there’s not a payment available for a healthcare worker to work at their full scope of practice … they won’t do it.”

The review of WIP and PIP payments caused a stir earlier this year, when its draft report recommended that the payments be phased out in favour of a simplified GP architecture, which itself required practices to participate in MyMedicare.

While some of the more controversial aspects were ultimately walked back in the final report, it still recommended that non-fee-for-service Commonwealth payments to general practice (i.e. block funding) should increase from 10% to 40%.

“Health professionals are far more likely to be working at full scope of practice in the context of a multidisciplinary care team in a blended payment, block payment or salaried environment than they are in fee-for-service arrangement,” Professor Cormack said.

“It’s absolutely clear cut.

“The payment mechanism drives behaviour, and there needs to be a concerted focus on addressing that.”

Professor Cormack said Aboriginal Community Controlled Healthcare Organisations were the “stand out model” for primary care.

The second consultation paper from the review, which was released in April, put forward reform options like allowing allied health professionals to write referrals to non-GP specialists directly and opening up the MBS to non-doctors.

Professor Cormack said the report will recommend a harmonisation of legislation and regulatory arrangements.

“Many of the reforms that are happening at a state-by-state level are enabled by virtue of the states having their own Drugs and Poisons Act, and the same for the Radiation Safety Act and Mental Health Act,” he said.

“At system level, we need to focus on harmonising where it makes sense and where there’s a common goal of health professionals working at full scope of practice in the context of a multidisciplinary care team.”

He also said the report would propose a formal mechanism be put in place to assess and evaluate significant changes to workforce models and scope of practice, in the same way that the PBS considers requests for new drug listings.

Rural Medicine Australia 2024 was held at Darwin Convention Centre between 24-26 October.

Here is the link:

https://www.medicalrepublic.com.au/heres-whats-in-the-scope-of-practice-report/111956

I will be interested to see just how far they (The Federal Government) get with these changes – which really look rather like a form of creeping nationalization to me – and a move to practice operation rather like that found in the NHS.

I will keep an eye out for reaction!

David.

There Might Be Big Trouble Coming Over The Next Few Years I Fear….

This appeared a few days ago:

The mental health crisis gripping Australia’s private hospitals

Some health insurers say stand-alone mental health hospitals are unlikely to exist in 10 years’ time given the challenges they face.

Empty mental health wards are at the heart of the financial challenges facing the struggling $22 billion sector. Robert Duong

Jemima Whyte and Michael Smith

Oct 25, 2024 – 9.48am

Psychiatrist Angelo Virgona is grappling with a paradox in the Australian health system.

Demand for mental health treatment is at a record high. It is the top reason for patients to visit a GP and is the top reason for people aged under 60 to end up in hospital, insurance data shows. Staff at public hospital emergency wards say they are overwhelmed with cases.

But Virgona says, despite the mental health crisis in Australia, particularly among younger people, private hospital psychiatric wards are empty. He says they have been forced to turn patients away for years because they cannot find the staff willing to work on the wards.

Now, Virgona, who is a director of the Royal Australian and New Zealand College of Psychiatrists and has run rural and city clinics, says no one even calls him any more looking for mental health admissions in private hospitals because they know it’s an impossible task.

“People just give up on ringing you up for admissions, we don’t have a doctor who can admit you,” he says. This means the psychiatric wards in private hospitals are sitting empty, leaving Virgona to question how long hospitals can keep the wards open.

“We don’t have enough psychiatrists who want to work in the private hospital system now,” he says.

Empty mental health wards are at the heart of the financial challenges facing the struggling $22 billion private hospital sector, which is the subject of an Albanese government review. The private hospital health check, ordered by Health Minister Mark Butler in June, which collated data from hundreds of hospitals around the country has been completed, but it has not been made public.

However, a summary of the findings from the Department of Health review obtained by The Australian Financial Review singled out declining mental health and maternity services as two key problems for the nation’s 650 private hospitals. While the data on maternity makes sense given the decline in the nation’s birth rate, the opposite is true for mental health.

Soaring healthcare costs are shaping up as a key headache for the Albanese government ahead of the next election. The latest The Australian Financial Review/Freshwater Strategy poll shows health was the third-highest rated concern, with 27 per cent saying it should be a focus for the government. Insurers are also preparing to ask for a big hike in premiums from April next year.

While rising demand for healthcare as the population ages is putting a strain on all parts of the system, the surge in mental health is the area most concerning medical practitioners.

Demand for treatment has never been higher, but wards are closing because psychiatrists do not want to work there. They earn more by treating patients in their own clinics or online. They also blame insufficient rebates from private health insurers.

The Albanese government says more than 3000 lives are lost to suicide each year with demand for treatment higher than ever. Mental illness is also topping private health insurance claims and was the main reason people under 60 spent time in hospital last year, industry data shows.

Beds but no staff

Private hospital operators such as Ramsay Health Care and Brookfield-owned Healthscope say they have the facilities to treat patients but not the staff.

“The maximum hourly earning capacity of psychiatrists treating outpatient and low complexity patients is much greater than those psychiatrists treating the most acute and high-risk patients admitted to hospitals,” says Carmel Monaghan, the head of Ramsay Health Care’s Australian private hospital network, which is the largest in the country.

She says there are patients who are “unable to access the necessary care or languishing in emergency departments and medical wards” because psychiatrists are financially incentivised to assess and treat patients as outpatients, especially for enrolment in the National Disability Insurance Scheme (NDIS).

Treating hospital patients, who are usually admitted for at least 21 days, is also harder work. The psychiatrists in those cases are on call 24 hours a day, seven days a week.

“Psychiatrists appear financially incentivised to favour telehealth and rooms-based work over work in hospital-based settings,” the preliminary findings of the Butler review says. It also says doctors have “limited ability” to charge out-of-pocket fees in hospitals, which was also driving them away.

Department of Health data shows the number of people receiving Medicare-subsidised psychiatric sessions has increased 18.9 per cent from 2019 to 2022. But over the same period, the number of services delivered in private hospitals has fallen 15 per cent.

Pay disparity

Virgona says he earns up to 30 per cent more in his own rooms than when he works at a private hospital.

In the hospital, the doctors aren’t paid for time spent travelling to and from hospitals, talking to nurses, a patient’s family or for taking calls in the middle of the night.

“It’s the worst remunerated role in all of psychiatry. As an in-patient, it’s almost uneconomical,” he says. “But it’s also wonderful, challenging work, providing continuity of care to people in ways not seen in other parts of the mental health sector.”

Many in the industry believe staffing is not the only problem, but that it is time to rethink the old model of care centred around long hospital stays. More people are being treated online or at home.

Patrick McGorry, a former Australian of the Year and mental health expert says home-based care can be managed safely with teams of experts visiting patients two or three times a week, making it a less traumatic experience than staying in hospital.

“You end up getting things like medication reviews which could easily be done on an outpatient basis if there was better infrastructure between the isolated private psychiatrist and the hospital, like a team-based community mental health model. Maybe the insurers and the hospitals need to be wrangled by the government around that,” McGorry says.

Private health insurers, which fund the hospitals, also argue the old model is flawed, with one executive saying there is no future for stand-alone medical facilities. In February, the 75-bed Bethesda mental health facility in Perth shut down after a year of operation. The West Australian government took over the lease.

“We will always need hospitals for people experiencing severe illness and those needing medical support to detox from alcohol and other drugs,” says Rachel David, the chief executive of Private Healthcare Australia, which represents the major health insurers.

“But the evidence is increasingly showing that people recovering from alcohol and drug addiction do better if they receive ongoing treatment at home and in the community so they can continue to live a productive life and overcome environmental triggers for their condition.”

“For these reasons, stand-alone mental health hospitals are unlikely to exist in 10 years’ time,” she says.

The insurance question

Australian Institute of Health and Welfare data shows health insurance funded 54 per cent of all mental health hospital admissions in 2022-23.

Mental health hospital admissions are expensive for health funds because the average length of stay is 27 days, which means admissions can cost more than $10,000.

Ramsay says both mental health and maternity are only included by health funds in gold cover policies which are increasingly unaffordable for young people who are the largest users of these services.

However, insurers dispute this saying a government mental health waiver means a person with basic cover can be upgraded to gold cover if they are admitted to a mental health facility where they will be covered during their stay.

An annual survey released by the Royal Australian College of GPs (RACGP) showed a sharp rise in the number of patients seeing a GP with mental health concerns. About 71 per cent of GPs report mental health as the top reason for patient consults, up from 61 per cent when the survey started in 2017.

“GPs from across Australia have told us that they’re seeing more patients with multiple, complex health issues including mental health, and that many can’t afford to see specialists or allied health professionals privately,” RACGP president Nicole Higgins says.

“After decades of underfunding and the Medicare freeze, we need meaningful investment in patients’ rebates to make essential healthcare affordable for all Australians. With the current cost-of-living crisis, this is more important than ever,” she says.

Some healthcare providers are looking at new models that combine hospital care with more out-patient services.

IMH Deakin Private Hospital is a joint venture between insurer Medibank and Aurora Healthcare that has a model of shorter stays, 14 days instead of 21 days, for young people seeking mental health treatment.

Anna Smith, the hospital group’s director of clinical services, says the model which seeks to get people home sooner and into out-reach programs has led to reduced readmissions.

As the private sector is forced to close down unprofitable operations and reassess the way it treats one of the country’s fastest-growing illnesses, many believe home and online care is the way forward although some GPs are concerned as patients still need supervision and the experts to help them remain in short supply.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/the-mental-health-crisis-gripping-australia-s-private-hospitals-20240906-p5k8hp

I have to say this all paints the picture of a system that is on the edge and is struggling to meet the demand it is faced with while knowing there is a a large backlog of unmet need.

This is surely not a stable and satisfactory situation – and so it seems likely we will see problems break out all over in the next few years.

I wonder what solutions will emerge. We sure need some smart thinking to bolster this aspect of the system! Right now it all sounds petty grim!

Any clever ideas?

David.

I Hope People Have Taken Steps To Move Forward To 4G Etc. By Now!

This reminder appeared a day or so ago:

Warnings for older mobile phones, medical devices as 3G shuts down

By Mary Ward

October 27, 2024 — 5.00am

Tens of thousands of older mobile phones and other devices will cease to work from Monday, when the nation’s 3G network is shuttered.

Australians are being urged to help older family members or neighbours check devices, amid concerns about people losing access to triple-zero services and medical monitoring equipment.

When will Australia’s 3G network be turned off?

Telstra and Optus will switch off their 3G coverage from Monday, affecting mobile phones, tablets and medical devices that still use the older network.

The telcos had intended to start their 3G shutdown earlier this year, but concerns about hundreds of thousands of users still on the network led both to delay the change.

Which devices will be affected by the 3G shutdown?

As of last week, there were 18,000 3G and 70,000 4G non-VoLTE Telstra mobile phones, both of which use 3G for calls, representing 0.3 per cent of the telco’s handsets.

A further 58,000 4G VoLTE phones that use 3G for triple-zero calls will be blocked when the network is shut down, as a safety measure. These phones are older devices often purchased overseas.

Telstra and Optus users can text “3” to 3498 to see if their handset will be affected. Affected Telstra customers have heard a pre-recorded message before outgoing calls, and both telcos have sent warning text messages and emails.

Federal Communications Minister Michelle Rowland urged people to “check their tech now”.

“This is a commercial decision taken by the network providers and industry has undertaken significant efforts to identify and contact potentially affected customers and share critical public information about the 3G switchover,” she said.

“Our focus is that the switchover takes place in a safe way.”

The Therapeutic Goods Administration has said the shutdown may affect medical devices including personal medical alarms, glucose data transmitters, pacemakers, fall monitors and telehealth devices.

It said some devices imported from overseas suppliers or bought online may not work as promised once the 3G network is switched off.

“Even if they claim [to use] 4G, some of these devices may not work on Australian networks,” it said.

Who may be left offline by the 3G shutdown?

Advocates for older Australians have expressed concern about the impact of the 3G shutdown on the elderly, who are more likely to rely on home medical devices or own older mobile phones.

Council of the Ageing (COTA) Australia chief executive Patricia Sparrow urged people to ask older family members or friends about whether they knew if the shutdown would affect their devices.

“If you have an older neighbour or someone you think may need assistance with working out what the switch away from 3G will mean for them, please help them out,” she said.

“Changes of this scale can be anxiety-inducing for many people; it’s crucial people are given the support they need.”

Why is the 3G network being shut down?

First announced in 2019, the 3G shutdown is designed to free up the radio spectrum for higher speed 5G networks.

Here is the link:

https://www.smh.com.au/national/warnings-for-older-mobile-phones-medical-devices-as-3g-shuts-down-20241025-p5klc6.html

Its rather a situation of “Coming Ready Or Not!” at this point!

David.

AusHealthIT Poll Number 770 – Results – 27 October 2024.

Here are the results of the poll.

Are You Noticing More Usage Of myHealthRecord Information In General Practice These Days?

Yes                                                                               4 (13%)

No                                                                              27 (87%)

I Have No Idea                                                            0 (0%)

Total No. Of Votes: 31

A very clear vote, with the feeling being that we are seeing little more use of the myHR over the last few months than previously.

Any insights on the poll are welcome, as a comment, as usual!

A better voting turnout. 

0 of 31 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many special thanks to all those who voted! 

David.

I Hope This Will Be Seen As A Step Forward Towards An Australian Health Information Exchange

This popped up last week:

16 October 2024

ADHA releases draft HIE architecture and roadmap

By Jeremy Knibbs

Software vendors across the country just got sent quite a bit of weekend homework: the ADHA’s updated take on the national HIE architecture.

Software vendors around the country who have been crying out for a little bit more guidance on how they might better prepare to get involved in what is shaping up  as the country’s largest digital health infrastructure project since the My Health Record, will likely be spending this weekend poring over today’s release of a Draft of the Australian Digital Health Agency’s Health Information Exchange Architecture and Roadmap.

Announcing the release of the draft document earlier today, ADHA Chief Digital Officer Peter O’Halloran said that the agency was releasing the draft document early with the intent of better engaging stakeholders in helping “craft the vision of the HIE into a final state”.

The agency is seeking immediate feedback via an online survey HERE (last day to participate is 8 November ) and a free webinar on the topic on 28 October from 11.30am, which you can register for HERE.

O’Halloran neatly summarises what the agency is trying for with HIE the project as follows:

“The HIE will play a central role in facilitating person-centred, connected healthcare across the country by ensuring seamless information flow between various healthcare settings.
 
“[It] will deliver a set of national capabilities using a consistent approach, based on agreed standards, to facilitate the sharing of health information across existing systems such as My Health Record and other data sources. It will evolve and deliver new functions over time to meet the continuous changing needs of clinicians and consumers.”

Which doesn’t tell us a lot given that if you substituted HIE for My Health Record in the first sentence, you might have read the same sentence 10 years ago.

Notwithstanding, there is a lot of detail in this document which confirms we are witnessing a pretty significant pivot from the agency towards trying to introduce a significant new capability for the system to poll distributed data in real time as a means of facilitating data sharing.

This is of course on top of our current centralised infrastructure in the My Health Record.

That the My Health Record looks like it is going to become a subset of the HIE capability in that as well as talking to every other meaningful health provider database distributed across the country, it will also be talking to the My Health Record, feels like the nub of the change we are witnessing.

Reading between the lines?

The HIE is the main game from here on in for data sharing, so vendors best get their head around what the agency is thinking fast, both so they can participate going forward in any related upcoming contracts (some vendors already believe that the recent My Health Record FHIR upgrade tender is setting parameters for the HIE work), and so the agency doesn’t do anything silly from a technical perspective as far as local vendors are concerned.

Excited vendors wanting to get into the gory detail on actual architecture will probably just want to turn to page 38 of the draft document and start reading furiously (or you could try to interpret the diagram below which isn’t a bad attempt at showing vendors everything they are thinking in colour pictures).

As far as hardcore architecture ideas go, the document starts by softly outlining key philosophical shifts across the system the project is going to attempt. These are summarised pretty well in the diagram below.

In one way it’s a good way to create a framework for the changes coming, but it’s also a pretty classic piece of consultant work (good work) dealing mostly largely with the political PR framing the project as opposed to the actual technical architectural issues in play.

The document does get to some of those real structural issues too to an extent – more for sure than the Agency has let go up until now.

Under section 5.2 in Conceptual Future State, the agency outlines the broad view of what the key technical capabilities in play will likely be and how they should be interacting as the project unfolds. The chart below summarises the Agency position.

In what is a pretty comprehensive approach to helping everyone understand how the Agency got to the above position the document also outlines what current technology they feel is play that is most relevant in achieving the HIE goals and what assumptions and decisions they are making around that technology.

Key among these elements include:

• That the project expects to follow the Platform as a Service (PaaS) model, with new application(s) deployed on top of the platform (if appropriate). 
• Integration will play a major component, to ensure that there is a clear separation between the systems with a view to insulating the project against technology changes that will inevitably occur during the life of the project. 
• That health information and how we manage it, which might normally be considered separately from a project like this, and which is currently being spearheaded by the CSIRO through its Sparked program, will be tightly aligned into the project.
• Security is critical (okay so LOL on this point, but obviously very important and needs to be said).
• The whole project will be tightly aligned with standards around technology which everyone already understands is in play, and which may have to be mandated at some point by government.
• The project must continually contemplate the acquisition, development and maintenance of comprehensive information about stakeholders, including providers, consumers, and vendors.

In this last respect the Agency has already started on aligned information and directory infrastructure projects.

Importantly, the document says that the HIE will be actively involved in supporting the management of the information of all these stakeholders and the relationship between each stakeholder. The document goes on to outline its wish list of technical capabilities for the HIE, all 23 of them, and by the time you get to number 23 you do start to wonder whether the timeline that the document provides for the project early on – seven years all up – might be a bit ambitious.

Some aspects of the document do feel a tad deja vu certainly, but overall, it’s a very comprehensive attempt at putting some meat on the bones of what so far has been a pretty bold vision.

It’s worth the weekend read.

Here is the link:

https://www.dermatologyrepublic.com.au/adha-releases-draft-hie-architecture-and-roadmap/3048

What is clear is that this is a very small step – only getting the HIE specification to Version 0.2!

It really feels like a repeat of much I have seen before so I am not sure how much progress is represented here.

Will look forward to comments on this rather long document!

David.

The Australian Population Seems To Be Heading For A Slide – Saved Only By Migration!

This appeared last week:

Australia’s baby drought is driven by housing and cost-of-living worries

Stephen Lunn and David Tanner

16 October,2024

KPMG urban economist Terry Rawnsley puts the baby drought down to cost-of-living and housing pressures.

Cost-of-living pressures and unaffordable housing have been blamed for driving Australia’s fertility rate down to 1.5 births per woman in 2023, its lowest level since records began in 1935.

The falling birthrate will leave the nation increasingly reliant on migration to deliver population growth, experts say.

New Australian Bureau of Statistic data reveals the national fertility rate dropped from 1.63 births a woman in 2022 to 1.5 last year, putting Australia right at the average of OECD countries and sitting alongside Germany, Sweden and The Netherlands.

The total number of babies registered as born in Australia in 2023 – 286,998 – was the lowest in 17 years, almost 14,000 fewer than in 2022.

A jump in births during 2021, in the midst of Covid lockdowns, has been wiped out, with last year’s fall continuing a trend since 2008, the last year when the fertility rate was above 2.

With 2.1 births a woman required to maintain a natural population balance through births alone, declining fertility feeds into the current migration debate. Migration is the only other lever available to influence population, a key pillar of economic growth.

The ABS data shows women are having children later, with the fertility rate of women aged 40 to 44 years almost doubling over the past 30 years.

“The long-term decline in fertility of younger mums as well as the continued increase in fertility of older mums reflects a shift towards later child-bearing,” ABS head of demography statistics Beidar Cho said.

“Together, this has resulted in a rise in median age of mothers to 31.9 years, and a fall in Australia’s total fertility rate.” (The median age for fathers is 33.8 years.)

KPMG urban economist Terry Rawnsley puts this down to cost-of-living and housing pressures.

“The cost-of-living crunch is coming through in these numbers,” he said. “People finding it hard to pay their rent or their mortgage are delaying having that first child, which in turn delays subsequent children.

Australia experiencing its biggest baby recession since 1970s

A new analysis of population and birth data by KPMG has found Australia is in a baby recession not seen since the 1970s.

“With the extra government investment in childcare and paid parental leave over the past two or three years, you’d have hoped that this might have started to shift that fertility rate but clearly cost-of-living pressures are outweighing the impact of those benefits.

“Housing affordability issues over the last 10 years are also having an impact on couple ­decision-making around having babies. Where they previously could have afforded a three-­bedroom home, allowing space for two children, now it’s a two-bedroom apartment and one child.”

Demographer Simon Kuestenmacher said despite the downward trend of the fertility rate, it wasn’t time for radical policy steps. “I’m afraid people will now call for baby bonuses. They don’t work,” Dr Kuestenmacher said.

“The small increase in total fertility rate after the Costello baby bonus (a one-off payment to parents brought in by former treasurer Peter Costello) had nothing to do with the handout but was the result of the mining boom.

“To increase the fertility rate, we must give young people a sense of optimism, a confidence they can financially handle a family,” he said, adding that part of this would revolve around “making housing cheaper”.

Demographer Peter McDonald said Australia was not facing population declines like some other countries “because births will remain above deaths due to the impact of migration”.

“Keeping net migration at around 200,000 a year, similar to recent history, is easily enough to compensate for falling fertility.”

Professor McDonald said if the federal government wanted levers to try to stabilise the birthrate, childcare and affordable housing should be considered.

“It doesn’t have too many levers around affordable housing, but it does for affordable childcare, so it wouldn’t surprise me to see some announcement in this regard ahead of the next election.”

The ABS data shows Western Australia had the highest total fertility rate in 2023 (1.57 babies per woman) closely followed by NSW and the Northern Territory (1.55 babies per woman).

The ACT had the lowest total fertility rate with 1.31 babies per woman. Only Tasmania saw an increase, growing from 1.49 to 1.51 babies per woman.

Here is the link:

https://www.theaustralian.com.au/nation/australias-baby-drought-is-driven-by-housing-and-costofliving-worries/news-story/75dbc5c18dff41d335f2b8c024619db7

The bottom line seems to be that we are so busy with life we are forgetting what causes it to go forward and grow!

I wonder what has to change to reverse the trend we are now seeing?

David.