Well, not any more. With the rollout struggling and half the country in lockdown, Scott Morrison is now encouraging younger people to get the AstraZeneca vaccine, despite the Australian Technical Advisory Group on Immunisation (ATAGI) not recommending it for the under 60s.
Morrison’s Monday night announcement of the government’s new position was quite a significant moment.
It marked a break with the experts in a move that, if it were to backfire, would leave the government facing the heat without the “shield” of its advisers.
One can understand why Morrison is going down this path. The government needs to get the population vaccinated much more quickly. We are at the bottom of the OECD with our rollout. There is plenty of AstraZeneca, which is home made at CSL, and limited amounts of the imported Pfizer, the vaccine ATAGI recommends for the under 60s.
The hugely infectious Delta strain is putting the fear of god into federal and state governments, and many in the public. The current lockdowns show how quickly activity can be semi-crippled even by small numbers of cases.
All this when the younger part of the adult population, the under 40s, aren’t yet even in the current vaccination queue.
However, the contradiction is obvious. After AstraZeneca was associated with rare blood clots, the government took ATAGI advice on who should receive which vaccine – AstraZeneca for over 50s, Pfizer for those under.
In embracing the ATAGI advice it knew it would be contributing to hesitancy about vaccination generally and AstraZeneca in particular, but it said it felt it had no option.
Then ATAGI became even more cautious and recommended AstraZeneca be given only to those 60 and above. The government accepted the revised advice, which was likely to make people even more suspicious of AstraZeneca.
When Morrison in effect parks his attachment to the experts and says to younger people, if you are so inclined just talk to your doctor and make your own decision about taking an AstraZeneca jab, the danger is the public become confused or cynical or both.
Heath Minister Greg Hunt on Tuesday explained things this way: “So the advice is very clear on two fronts. One is the medical advice; two is the access.
“AstraZeneca remains the preferred vaccine for people 60 years and over. That has not changed, the advice of ATAGI, and Pfizer is the preferred for people under 60. And the clinical advice of ATAGI, again, has not changed.
“However, as has always been the case … on the basis of informed consent, individual patients and their doctors have been able to make a decision to take up the AstraZeneca on the basis of their individual circumstances and their own judgement,” Hunt said.
“Some GPs have reported that they have excess supply [of AstraZeneca]. And so if there are people who wish to access it, via informed consent, via the existing ATAGI rules, then that’s simply being enabled.”
It might have “always been the case”, but now people are being actively encouraged by the government towards this independent position. Australian Medical Association President Omar Khorshid described the PM’s announcement as “a really significant change in the vaccine program”.
So a 30-year-old woman may find herself weighing the ATAGI advice and the advice of her doctor (who, incidentally, is being provided with a professional indemnity giving “additional certainty” to those advising on vaccination).
Who knows where she will land if the two sets of advice differ?
The AMA and the Royal Australian College of General Practitioners both said on Tuesday they hadn’t received advance notice of the government move.
Karen Price, President of the RACGP, tweeted: “Phones are ringing off the hook at GP clinics. We had no warning of last night’s announcements and this isn’t the first time this has happened to general practice. It’s vital that government provides significant support to GPs to implement these changes to the vaccine rollout.”
She said on 2GB if doctors were to operate outside the ATAGI guidelines “we need to be super clear about what that means”.
Khorshid told The Guardian, “It took us by surprise”.
“Our recommendation is still really for patients to follow the ATAGI advice. Be patient and have the ATAGI-recommended vaccine when it’s available. I am certainly still backing the expert advice at this stage.”
Khorshid said he thought the government had taken this step because it wanted “to provide nervous Australians who are going into lockdown this week with something that they can actually do to improve their chances of getting through this and to push the nation’s vaccination program forward”.
It will be interesting to see how ATAGI now reacts.
Meanwhile there must be questions about how the officials let the doctors apparently be caught on the hop.
Just as the “medical advice” has stopped (at least in this case) being sacrosanct, so criticism of federal health officialdom continues to sharpen over its operations in the rollout. It’s no coincidence that a military man, Lieutenant General “JJ” Frewen has been put in charge of trying to get the program on track.
The official medical and health experts are finding themselves a good deal more challenged by their federal political masters than a year ago.
Additional findings testing looks for variants in patients’ genes that aren’t relevant to their current health, but may be later on. For example, it can reveal if someone has an above-average chance of developing a hereditary heart condition.
But these tests can have major implications for patients and their families. Thus, individuals deciding whether they want such a test need support — which Edna can provide.
A range of medical conditions have underlying genetic causes. Historically, this has been tested with genetic testing, by looking at either a single gene or a panel of genes related to one particular condition.
In genomic testing, however, almost all the genes in a patient’s DNA are analysed using a biological sample (such as blood).
In Australia, genomic testing is done for patients with certain medical conditions, to provide more information about the condition and medical care required.
But genomic data can be analysed further in an additional findings test, to report on potential gene variants responsible for other preventable and/or treatable conditions.
Although available in the United States, additional findings tests are currently beyond immediate medical need in Australia and are only carried out in research settings. That said, conversations have started about them becoming mainstream here, too.
If additional findings tests were offered in Australia, genetic counsellors would have to spend a large proportion of their time helping patients decide whether they want one. This is where chatbots come in.
Edna the chatbot in training
For chatbots to accurately recognise human speech and provide a meaningful response, their “brain” needs to draw on a large body of data.
Many chatbot brains are developed from open source data, but this is inadequate for highly specialised fields. We developed Edna by analysing transcripts of actual counselling sessions that discussed additional findings analysis.
Edna can emulate the flow of a real patient-counsellor session, explaining various conditions, terms, concepts and the key factors patients should consider when making their decision.
For example, it prompts them to consider the personal and familial implications of undergoing an additional findings analysis. As we all share genes with our family, results from genomic testing can lead to serious conversations.
Edna has several other capabilities, such as:
knowing when to connect a patient with a genetic counsellor, if needed
providing general information covered in most genetic counselling sessions, allowing counsellors more time to focus on patients with complex needs
collecting a patient’s family history
detecting various forms of common language, such as “nan” instead of “grandmother” and “heart attack” instead of “myocardial infarct” (the medical term for heart attack)
recognising certain temporal markers. For instance, if a patient says “my mother died around Anzac Day two years ago”, Edna will know their mother died around April 25, 2018.
Edna is currently undergoing a feasibility trial with patients who have already had additional findings analysis done in a research setting, as well as genetic counsellors and students.
Past research has suggested people prefer chatbots that interact with empathy and sympathy, rather than unemotionally giving advice. This is called the “Eliza effect” — named after the first ever chatbot. Eliza was able to elicit an emotional response from humans.
Edna is quite advanced on this front. It can detect negative sentiment and even some forms of sarcasm. Still, this isn’t the same as true empathy.
Since Edna provides generic information, it can’t discuss the implications of a future or previous genomic test for a specific patient. It also can’t link the patient with a support group, or provide expert medical advice.
Still, Edna represents a significant move towards a digital health solution that could take some pressure off genetic counsellors.
Edna’s main advantage is accessibility. It can support people living remotely, or who are otherwise unable to attend face-to-face genetic counselling.
It can also be accessed at a patient’s home, where family members may be present. They can then share in the information provided and engage Edna themselves, potentially improving the chances of an accurate history capture.
As a digital interface, Edna is almost endlessly modifiable. It can be updated continuously with data compiled during interactions with patients — whether this be information on new topics, or a new way to respond to a question.
A larger-scale patient trial is planned for the near future.
Last month, scientists uncovered a mineral called Edscottite. Minerals are solid, naturally occurring substances that are not living, such as quartz or haematite. This new mineral was discovered after an examination of the Wedderburn Meteorite, a metallic-looking rock found in Central Victoria back in 1951.
Edscottite is made of iron and carbon, and was likely formed within the core of another planet. It’s a “true” mineral, meaning one which is naturally occurring and formed by geological processes either on Earth or in outer-space.
But while the Wedderburn Meteorite held the first-known discovery of Edscottite, other new mineral discoveries have been made on Earth, of substances formed as a result of human activities such as mining and mineral processing. These are called anthropogenic minerals.
While true minerals comprise the majority of the approximately 5,200 known minerals, there are about 208 human-made minerals which have been approved as minerals by the International Mineralogical Association.
Some are made on purpose and others are by-products. Either way, the ability to manufacture minerals has vast implications for the future of our rapidly growing population.
Climate change is one of the biggest challenges we face. While governments debate the future of coal-burning power stations, carbon dioxide continues to be released into the atmosphere. We need innovative strategies to capture it.
Actively manufacturing minerals such as nesquehonite is one possible approach. It has applications in building and construction, and making it requires removing carbon dioxide from the atmosphere.
You could say this is a kind of “modern-day alchemy” which, if taken advantage of, could be an effective way to suck carbon dioxide from the air at a large scale.
Meeting society’s metal demands
Mining and mineral processing is designed to recover metals from ore, which is a natural occurrence of rock or sediment containing sufficient minerals with economically important elements. But through mining and mineral processing, new minerals can also be created.
Smelting is used to produce a range of commodities such as lead, zinc and copper, by heating ore to high temperatures to produce pure metals.
The process also produces a glass-like waste product called slag, which is deposited as molten liquid, resembling lava.
Once cooled, the textural and mineralogical similarities between lava and slag are crystal-clear.
Micro-scale inspection shows human-made minerals in slag have a unique ability to accommodate metals into their crystal lattice that would not be possible in nature.
This means metal recovery from mine waste (a potential secondary resource) could be an effective way to supplement society’s growing metal demands. The challenge lies in developing processes which are cost effective.
Our increasing knowledge on how to manufacture minerals may also have a major impact on the growing synthetic gem manufacturing industry.
In 2010, the world was awestruck by the engagement ring given to Duchess of Cambridge Kate Middleton, valued at about £300,000 (AUD$558,429).
The ring has a 12-carat blue sapphire, surrounded by 14 solitaire diamonds, with a setting made from 18-carat white gold.
Replicas of it have been acquired by people across the globe, but for only a fraction of the price. How?
In 1837, Marc Antoine Gardin demonstrated that sapphires (mineralogically known as corundum or aluminium oxide) can be replicated by reacting metals with other substances such as chromium or boric acid. This produces a range of seemingly identical coloured stones.
On close examination, some properties may vary such as the presence of flaws and air bubbles and the stone’s hardness. But only a gemologist or gem enthusiast would likely notice this.
Diamonds can also be synthetically made, through either a high pressure, high temperature, or chemical vapour deposition process.
Creating synthetic gems is increasingly important as natural stones are becoming more difficult and expensive to source. In some countries, the rights of miners are also violated and this poses ethical concerns.
Medical and industrial applications
Synthetic gems have industrial applications too. They can be used in window manufacturing, semi-conducting circuits and cutting tools.
One example of an entirely manufactured mineral is something called yttrium aluminum garnet (or YAG) which can be used as a laser.
In medicine, these lasers are used to correct glaucoma. In dental surgery, they allow soft gum and tissues to be cut away.
The move to develop new minerals will also support technologies enabling deep space exploration through the creation of ‘quantum materials’.
Quantum materials have unique properties and will help us create a new generation of electronic products, which could have a significant impact on space travel technologies. Maybe this will allow us to one day visit the birthplace of Edscottite?
The recent case of paper medical files from a Brisbane hospital found on a busy street highlights the need for secure, controlled disposal of medical records.
The files were said to be from out-patient clinics and contained patient names and their appointments, but not medical details. Now Queensland Health is investigating the circumstances of how the files came to be found in public, rather than being safely destroyed by a contractor.
So how are hospitals and clinics handling their old paper records as they move to electronic systems? How are they dealing with the tsunami of files that need to be safely disposed of?
Your medical records, whether paper or electronic, need to be kept while they’re relevant to your care, with restricted access to protect your privacy. But who decides when medical records are no longer needed? What happens then?
Governments at all levels have legislation for this. For instance, the Queensland health department specifies what is destroyed and when, according to a schedule from Queensland State Archives. This covers medical records in the public health care system in physical form (paper, photographs, film), in electronic form or a mixture of the two.
This, for example, says “records displaying evidence of clinical care to an individual or groups of adult patients/clients” should be kept “for ten years after last patient/client service provision or medico-legal action”. There are a number of exceptions relating to, for example, clinical trials, mental health and communicable diseases. For each exception, there is a specific time period of how long the file needs to be kept.
Hospitals can contract commercial services to destroy paper files. But the document owner, in this case the hospital, is ultimately responsible for ensuring this is carried out legally.
The Royal Australian College of General Practitioners (RACGP) has established practice standards for GP clinics. These require the secure destruction (for instance, by shredding) of paper records before disposal.
So, hospitals and GP clinics need to develop and implement policies and procedures that state explicitly when and how medical records should be disposed of, and also keep a record of when that happens.
However, to determine whether an individual medical record among the vast quantities held has passed its “use by date” can be extremely resource-intensive for administrative staff.
This means the ultimate driver of paper record destruction is more likely to be the need to free up expensive office or storage space. It’s this sort of scenario that might eventually play out into records being accidentally or deliberately dumped wherever, whenever.
The move towards digital records
The Brisbane situation highlights the limitations of “business as usual” in relation to medical records, which includes paper records held in multiple locations, in hospitals, in GP clinics and with specialists.
Consider your own medical record “paper trail”, which may include files from hospital admissions, records held by your local doctor or other specialist, and results of blood tests and x-rays performed elsewhere.
At both a personal and whole-of-population level, there are clearly numerous opportunities for unintended access to these physical documents. Centrally and securely stored electronic records can address this risk, and also carry a number of other advantages.
Like all transitions of this scale, there are a range of costs involved in moving from paper to electronic medical records, one of which is the prospect of further paper record data breaches as mountains of redundant records are destroyed. However these transition costs need to be balanced against the ultimate benefit of electronic records.
Even accepting these benefits doesn’t necessarily mean people will automatically become more comfortable with electronic medical records, like My Health Record. For that to occur, people also have to overcome a general lack of trust in government.
However, our research shows it is possible to encourage people to use online government services. By harnessing behavioural science, we have shown that providing customer support and promoting the benefits and ease of online services helps the transition from queuing and paper forms to using online services.
Hope for the future
In the rush to drag people to shiny new online platforms, this illustrates the simple act of talking people through the advantages and supporting their transition can address many of the psychological barriers to change.
Then, hopefully, we can see the end of paper medical records and services, and fewer paper records being dumped on the side of the road. As long as paper records exist they will be vulnerable to unauthorised access – either within a storage facility or in transit to destruction. However, each case of unauthorised access is dwarfed by the number of paper records successfully and securely destroyed, never able to be physically accessed again.
The government goes into the resumption of parliament this week
trailing Labor 47-53% on the two-party vote in Newspoll, unchanged
from a fortnight ago.
The poll comes as Labor’s stand on the legislation to facilitate
medical evacuations hangs in the balance, with Bill Shorten having
indicated he would like to find a compromise and speculation about a Labor retreat from its earlier support.
Shorten receives a briefing on the implications of the bill from the secretary of the Home Affairs Department, Mike Pezzullo on Monday. Shadow cabinet and caucus will discuss Labor’s position.
The opposition has been under concerted attack from the government
over its backing for the legislation, which passed the Senate last
year with ALP support.
Shorten is worried about Labor being wedged, because border protection is always a politically vulnerable area for the ALP.
Scott Morrison says the government will not shift from outright
opposition to the bill, which is based on a proposal originally coming from independent Kerryn Phelps but subsequently refined.
Newspoll, published in The Australian, has Labor’s primary vote up a point to 39%; the Coalition’s vote remains on 37%. The Greens are on 9%; One Nation is polling 5%, down a point.
Morrison has increased his lead over Shorten as better prime minister by 2 points to 44-35%.
Morrison’s satisfaction rating is up 3 points to 43%; his
dissatisfaction rating has fallen 2 points to 45%. Shorten has a net approval rating of minus 15, a worsening by 2 points.
The tactical battle over the medical transfer amendments will dominate the run up to Tuesday’s first day of the sitting. On another front, the opposition is trying to muster the numbers for extra sitting days to consider measures from the banking royal commission.
In comments on the medical transfer bill Opposition spokesman Shayne Neumann said on Sunday: “Labor has always had two clear objectives – making sure sick people can get medical care, and making sure the minister has final discretion over medical transfers.”
The bill provides that where there a dispute between the two doctors recommending a transfer and the minister, the final say on medical grounds would be in the hands of a medical panel.
The minister could override medical decisions only on security grounds (“security” is as defined in the ASIO act).
Passage of the legislation, which would require support from Labor and all but one of the crossbench, would be a big rebuff for the
But the government has managed to turn the heat onto Labor, claiming the legislation would undermine Australia’s border protection.
The briefing Shorten will receive will put more pressure on the
opposition, because Home Affairs will presumably reinforce the
argument it advanced in advice to the government.
The government has now declassified this advice – which last week it provided more informally to The Australian.
The advice, which has some sections blacked out, says: “The
effect of the Bill will undermine the Australian Government’s regional processing arrangements.
“Conduct which would come within the security exception to transfer
based on the minister’s reasonable belief that the transfer would be prejudicial to security, does not include all criminal conduct”.
“Ultimately, the amendments provide that the approximate 1000
transferees currently located in Papua New Guinea (PNG) and Nauru
could have access to a transfer to Australia within weeks of any Royal Assent,” the advice says.
“It is not expected that the Minister’s ability to refuse transfer on security grounds will significantly reduce the number of potential transfers”.
Neumann said on Sunday: “Labor has great respect for our national
security agencies and we’ve always worked cooperatively with them.”
As the battle escalates ahead of next week’s vote on legislation to
facilitate medical transfers from Manus and Nauru, Scott Morrison is playing up the dangers if the bill passes while downplaying the
Morrison declares the amendments, based on a proposal from independent Kerryn Phelps, would leave the government powerless to stop the entry of a paedophile, rapist or murderer.
“It doesn’t provide for the usual arrangements which would enable us to reject someone coming to Australia because they have a criminal history.
“They may be a paedophile, they may be a rapist, they may be a
murderer and this bill would mean that we would just have to take
them,” he said on Wednesday while campaigning in Melbourne.
Morrison raised the spectre of “hundreds upon hundreds upon hundreds of single males being transferred … at the directive of doctors, not the government.
“This will mean we will have to reopen detention centres that we
closed, like Christmas Island.”
But the Prime Minister has been anxious over the last two days to hose down talk that a government defeat on the bill could lead to an election.
“If we lose that vote next week, so be it. We won’t be going off to
the polls. The election is in May. I will simply ignore it and we’ll get on with business,” he told Sky on Tuesday.
Asked on Wednesday whether a loss would be a trigger for an election Morrison said: “Of course not. Why would it be?”
The government is firmly locked into the May election timetable and
its April 2 budget that it will use to frame the poll. Passage of the medical evacuation measure would not amount to a vote of no
Meanwhile Labor on Wednesday released its legal advice, from barrister Matthew Albert, arguing that the legislation would add to, rather than detract from, present security protections.
“The minister’s power to exclude a person from transfer to Australia is expanded beyond the security protections of the existing law,” the December advice says.
“The expansion empowers the minister to have regard to questions of
both public safety ‘and border integrity’ before a person is
The measure, passed by the Senate last year, would allow the transfer on the advice of two doctors but the minister could intervene on security grounds.
At central issue is the adequacy of the definition of “security” – the bill draws this from the ASIO act.
The government maintains this definition, with its focus on national security, is too narrow, while the ALP’s advice argues it is broad.
Under the ASIO act, “security” means:
“(a) the protection of, and of the people of, the Commonwealth and the several States and
(iii) politically motivated violence;
(iv) promotion of communal violence;
(v) attacks on Australia’s defence system; or
(vi) acts of foreign interference;
whether directed from, or committed within, Australia or not; and
(aa) the protection of Australia’s territorial and border integrity
from serious threats; and
(b) the carrying out of Australia’s responsibilities to any foreign
country in relation to a matter mentioned in any of the subparagraphs of paragraph (a) or the matter mentioned in paragraph (aa).”
As in present arrangements, under the bill transferees would be
immediately detained and only released from detention if the minister determined this was in the “public interest”.
“This is a broad test which allows the minister to have regard to any issues of security or character relating to that person,” the advice says.
On the last sitting day of 2018 the legislation potentially had the
required crossbench support to be carried in the House but a
government filibuster prevented it reaching there for a vote.
The government is lobbying crossbenchers intensively, while keeping the public heat on Labor. It has also undertaken to set up a medical panel to review transfers from Manus and Nauru.
In his Tuesday Sky interview Morrison played down the significance of this gesture.
“All that I have done is made sure that the Australian people have got an assurance about how well that [present] process works. They can’t change the decisions, they can’t reverse the decisions, the decisions all remain with the Department of Home Affairs”.
But Bill Shorten said he thought the government was “starting to do a backflip”.
“They may be doing it because they don’t want to lose a vote in
Parliament, but I’m not going to be a purist, if they get to an
acceptable outcome I’m not going to judge their motivation.”
Labor would have a look at the government’s position “but this stage we’re still supporting the Phelps amendments,” Shorten said.
Replying to Morrison, Phelps said:“The large majority of people on Manus Island and Nauru have been assessed as genuine refugees. Under the Refugee Convention, they cannot be granted that status if they have committed a serious crime, a hate crime or a war crime in their country of origin.”
The government faces pressure of another front next week, as Labor
tries to muster the numbers for its call for parliament to have extra sitting days to consider recommendations from the banking royal commission. It would need the support of all the crossbenchers to pass its motion but the stand of Bob Katter is not clear.
In response to the public outcry against the potential for My Health Record data to be shared with police and other government agencies, Health Minister Greg Hunt recently announced moves to change the legislation.
The laws underpinning the My Health Record as well as records kept by GPs and private hospitals currently allow those records to be shared with the police, Centrelink, the Tax Office and other government departments if it’s “reasonably necessary” for a criminal investigation or to protect tax revenue.
If passed, the policy of the Digital Health Agency (which runs the My Health Record) not to release information without a court order will become law. This would mean the My Health Record has greater privacy protections in this respect than other medical records, which doesn’t make much sense.
Under the proposed new bill, state and federal government departments and agencies would have to apply for a court order to obtain information stored in the My Health Record.
The court would need to be satisfied that sharing the information is “reasonably necessary”, and that there is no other effective way for the person requesting it to access the information. The court would also need to weigh up whether the disclosure would “unreasonably interfere” with the person’s privacy.
If granted, a court order to release the information would require the Digital Health Agency to provide information from a person’s My Health Record without the person’s consent, and even if they objected.
If a warrant is issued for a person’s health records, the police can sift through them as they look for relevant information. They could uncover personally sensitive material that is not relevant to the current proceedings. Since the My Health Record allows the collection of information across health providers, there could be an increased risk of non-relevant information being disclosed.
Although we share all sorts of personal information online, we like to think of our medical records as sacrosanct. But the law underpinning My Health Record came from the wording of the Commonwealth Privacy Act 1988, which applies to all medical records held by GPs, specialists and private hospitals.
Under the Act, doctors don’t need to see a warrant before they’re allowed to share health information with enforcement agencies. The Privacy Act principles mean doctors only need a “reasonable belief” that sharing the information is “reasonably necessary” for the enforcement activity.
Although public hospital records do not fall under the Privacy Act, they are covered by state laws that have similar provisions. In Victoria, for instance, the Health Records Act 2001 permits disclosure if the record holder “reasonably believes” that the disclosure is “reasonably necessary” for a law enforcement function and it would not be a breach of confidence.
In practice, health care providers are trained on the utmost importance of protecting the patient’s privacy. Their systems of registration and accreditation mean they must follow a professional code of ethical conduct that includes observing confidentiality and privacy.
Although the law doesn’t require it, it is considered good practice for health professionals to insist on seeing a warrant before disclosing a patient’s health records.
In a 2014 case, the federal court considered whether a psychiatrist had breached the privacy of his patient. The psychiatrist had given some of his patient’s records to Queensland police in response to a warrant. The court said the existence of a warrant was evidence the doctor had acted appropriately.
In a 2015 case, it was decided a doctor had interfered with a patient’s privacy when disclosing the patient’s health information to police. In this case, there no was warrant and no formal criminal investigation.
Unfortunately, there are recent examples of medical records being shared with government departments in worrying ways. In Australia, it has been alleged the immigration department tried, for political reasons, to obtain access to the medical records of people held in immigration detention.
We can’t change the fact different laws at state and federal level apply to our paper and electronic medical records stored in different locations. But we can try to change these laws to be consistent in protecting our privacy.
If it’s so important to change the My Health Records Act to ensure our records can only be “unlocked” by a court order, the same should apply to the Privacy Act as well as state-based laws. Doing so might help to address public concerns about privacy and the My Health Record, and further inform decisions about opting out or staying in the system.
The winners of this year’s health budget are aged care, rural health and medical research.
The government has announced A$1.6 billion over four years to allow 14,000 more older Australians to remain in their home for longer through more high-level home care places. For those in aged care, an additional A$82.5 million will be directed to improve mental health services in the facilities.
The budget includes A$83.3 million over five years for a rural health strategy, which aims to place more doctors and nurses in the bush and train 100 additional GPs.
There’s A$1.3 billion over ten years for a National Health and Medical Industry Growth Plan, which includes A$500 million for new research in the field of genomics.
Other key announcements include:
– A$1.4 billion for new and amended listings on PBS – A$302.6 million in savings over forward estimates by encouraging greater use of generic and bio similar medicines – A$253.8 million for a new Aged Care Quality and Safety Commission.
Helen Dickinson, Associate Professor, Public Service Research Group at UNSW
It was well foreshadowed that this budget would bring with it significant provisions for aged care. It has been widely reported that reforms to pension and superannuation tax have resulted in disaffection in the Coalition within older age groups.
Making older Australians the cornerstone of budget measures is a calculated political tactic in a budget that in the short term makes only limited tax cuts for low- and middle-income earners.
The A$1.6 billion for 14,000 new places for home-care recipients will be welcome, but are a drop in the ocean, given there are currently more than 100,000 people on the national priority list for support.
Additional commitments around trials for physical activities for older people, initiatives to improve connections to communities and protections for older people against abuse will bolster those remaining in homes and communities.
Commitments made for specific initiatives for Aboriginal and Torres Strait Islander people and aged care facilities in rural and remote Australia will be welcomed, although their size and scope will likely result in little to address older age groups with complex needs.
While investment in aged care services will be welcome, it remains to be seen whether this multi-million-dollar commitment will succeed in clawing back support from older voters.
Recent years have seen around A$2 billion of cuts made to the sector through adjustments to the residential care funding formula. The current financial commitments go some way to restoring spending, but do not significantly advance spending beyond previous levels in an area of the population we know is expanding substantially in volume and level of need and expectation.
A number of new budget commitments have been announced in relation to mental health services for older people in residential aged care facilities, for a national mental health commission, and for Lifeline Australia.
However, given the current turbulence in mental health services, it’s unclear whether these will impact on the types of issues that are being felt currently or whether this will further disaggregate an already complex and often unconnected system.
Equity, prevention and Indigenous health
Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy at the University of Sydney
The government states its desire for a stronger economy and to limit economic imposts on future generations, but this budget highlights a continued failure to invest in the areas that will deliver more sustainable health care spending, reduce health disparities, and improve health outcomes and productivity for all Australians.
There is nothing new to address the harms caused by excessive alcohol use or opioid abuse.
The crackdown on illegal tobacco is about lost taxes rather than smoking prevention.
There is A$20.9 million over five years to improve the health of women and children – an assorted collection of small programs which could conceivably be claimed as preventive health.
There is nothing in this budget to address growing out-of-pocket costs that limit the ability of many to access needed care.
Additional funding (given in budget papers as A$83.3 million over five years but more accurately described as A$122.4 million over 2018-19 and 2019-20, with savings of A$55.6 million taken in 2020-21 and 2021-22) is provided for rural health that should help improve health equity for country Australians.
Continued funding is provided for the Indigenous Australians’ Health Program (A$3.9 billion over four years); there is new money for ear, eye and scabies programs and also for a new Medicare item for remote dialysis services.
There are promises for a new funding model for primary care provided through Aboriginal Community Controlled Health Services (but no details) and better access for Indigenous people to aged care.
The renewal of the Remote Indigenous Housing Agreement with the Northern Territory will assist with improved health outcomes for those communities.
PBS, medicines and research
Rosalie Viney, Professor of Health Economics at the University of Technology Sydney
The budget includes a notable increase in net expenditure on the Pharmaceutical Benefits Scheme (PBS) of A$1.4 billion for new and amended listings of drugs, although most of these have already been anticipated by positive recommendations by the Pharmaceutical Benefits Advisory Committee (PBAC).
Access to a number of new medicines has been announced. The new and amended medicine listings are clearly funded through savings in PBS expenditure from greater use of generic and bio-similar medicines, given the net increase in expenditure over the five year outlook is around A$0.7 billion.
In terms of medical research, there is an encouraging announcement of significant further investments through the Medical Research Futures Fund. This will be welcomed by health and medical researchers across Australia.
What is notable is the focus on the capacity of health and medical research to generate new jobs through new technology. While this is certainly important, it is as much about boosting the local medical technology and innovation industry than on improving health system performance. And the announcements in the budget are as much about the potential job growth from medical innovation as on providing more or improved health services.
There is new funding for medical research, development of diagnostic tools and medical technologies, and clinical trials of new drugs. The focus on a 21st century medical industry plan recognises that health is big business as well as being important for all Australians.
All of this is welcome, but it will be absolutely critical that there are rigorous processes for evaluating this research and ensuring the funding is allocated based on scientific merit. This can represent a major challenge when industry development objectives are given similar standing in determining priorities as health outcomes and scientific quality.
Andrew Wilson, Co-Director, Menzies Centre for Health Policy at the University of Sydney
Rural Australians experience a range of health disadvantages including higher rates of smoking and obesity, poorer survival rates from cancer and lower life expectancy, and this is not solely due to the poor health of the Aboriginal community.
The government has committed to improving rural health services through the Stronger Rural Health Strategy and the budget has some funding to underpin this.
The pressure to fund another medical school in rural NSW and Victoria has been sensibly addressed by enhancing and networking existing rural clinical schools through the Murray Darling Medical Schools network. This will provide more opportunities for all medical students to spend a large proportion of their studentship in a rural setting while not increasing the number of Commonwealth supported places.
There is a major need to match this increased student capacity with a greater investment in specialist training positions in regional hospitals to ensure the retention of that workforce in country areas. Hopefully the new workforce incentive program will start to address this.
Hospitals and private health insurance
Peter Sivey, Associate Professor, School of Economics, Finance and Marketing, RMIT University
Maher El-Gohary and daughter apply for asylum in France.
ISTANBUL, April 21 (CDN) — A father and daughter who fled Egypt to Syria after spending two and a half years in hiding for becoming Christians have arrived in France and yesterday applied for asylum there, human rights advocates said.
Maher Ahmad El-Mo’otahssem Bellah El-Gohary, 58, had become the target of Islamic ill will in Egypt after he tried to change the religious affiliation on his national identification card from Muslim to Christian. He and his daughter, 17-year-old Dina Mo’otahssem, arrived in Paris from Syria on March 30 after having fled to Damascus on Feb. 22 in the wake of the revolution in Egypt that deposed then-President Hosni Mubarak.
The Jan. 25-Feb. 11 protests in Egypt also weakened the Ministry of the Interior, an agency that had harassed El-Gohary and prevented him from leaving the country.
El-Gohary had fled to Syria because it was both the fastest and the easiest way to get out of Egypt, but he said he also feared Islamic opposition to converts in Syria and growing political unrest in Damascus.
“When we got to the French embassy in Syria, we were so scared because of what was happening in Syria at the time,” he said.
It took him more than a month to secure a visa to leave Syria. Previously in Egypt, he had been able to leave because he had received a court decision ordering the Ministry of the Interior to allow him to leave the country; taking advantage of the confusion gripping Egyptian government agencies in the wake of the anti-Mubarak protests, he left with his daughter.
Eventually El-Gohary and his daughter hope to gain a visa to the United States and then immigrate.
Despite their newfound safety, El-Gohary and Dina are still shaken by their ordeal. They said they are afraid that a Muslim extremist in France could seek them out and attack them. They also have unresolved medical issues from the physical stress of two years of hiding and from not being able to receive proper medical care during that time.
On Monday (April 18), El-Gohary went to the Embassy of the United States in Paris to apply for U.S. asylum as well. According to a Coptic activist who requested anonymity, the embassy advised El-Gohary that his best option was for his wife, who lives in the United States, to apply for a visa to allow him to enter the country. El-Gohary is also applying for a tourist visa to the United States. Human rights activists have advised El-Gohary to stay in France while he applies for asylum rather than go to the United States on a tourist visa, which may leave him financially exposed and hinder his immigration efforts.
Meantime, El-Gohary’s application for asylum in France qualifies him for an automatic three-month extension on his visa to France, which was set to expire at the end of the month. The extension can be renewed as long as his case is unresolved. It also qualifies him for certain government benefits.
‘Miracle from God’
El-Gohary and his daughter were forced into hiding in August 2008 immediately after he filed his lawsuit to change his ID card’s religious designation. The suit caused uproar in a country where, according to a recent Pew Research Center poll, 84 percent of Muslims in Egypt believe those who leave Islam should be executed.
El-Gohary filed the suit, he said, because he wanted to spare his daughter the persecution he suffered when he became a Christian in his 20s. In theory, the religion listed on his ID card would be used to determine the religion listed on Dina’s.
In Egypt, it is illegal for adults not to have a national ID card, and it is nearly impossible to survive without one. It is necessary for opening a bank account, renting an apartment and obtaining medical care. Also, being identified as a Muslim in Egypt makes one subject to Islamic civil law, which would have prevented Dina from marrying someone identified as a Christian.
Freedom of religion, including the right to change one’s religion, is guaranteed in Egypt by law. But in practice, while it is easy for Christian converts to Islam to change the religion listed on their ID cards, it is impossible for a Muslim convert to Christianity to do the same.
For the time that El-Gohary and his daughter were on the run, they lived a marginal existence, moving from one safe house to another about once every month. On different occasions, he and Dina were attacked. On one occasion, El-Gohary said, Dina had acid thrown on her. On another, he said someone came at him with a knife.
El-Gohary called his escape from Egypt a “miracle from God,” but when he arrived in Syria he was quickly faced with the reality that he was alone in a country in which he had no support network and felt almost as unsafe as he did in Egypt. Also, his expectation that he would be able to quickly obtain a visa to the United States proved false. Frustrated by what he described as a cold reception at the U.S. Embassy in Damascus, he began to look for any country in Europe that would give him an
On advice of the Vatican Embassy in Syria, El-Gohary went to the French Embassy in Damascus, which issued a short-term visa the same day.
“I really appreciate what the French ambassador did for us,” El-Gohary said. “The French saved us.”
El-Gohary was able to get to France with the support of Egyptian Christians and advocacy groups, most notably the United Copts of Great Britain. Dr. Ibrahim Habib, a Copt and the chairman of the group, said his organization arranged accommodation for El-Gohary and Dina with an Egyptian Christian in France. Habib said El-Gohary, motivated by fear, left for France unprepared.
“He was going to France without knowing anybody at all,” Habib said. “He was just going to land in the airport and start thinking, ‘What are we going to do?’”
After painful effort to change ID card, Christians flee – to similar fate.
CAIRO, Egypt, March 21 (CDN) — When the plane carrying Maher El-Gohary and his daughter, Dina Mo’otahssem, took off from Cairo International Airport last month, they both wept with joy. After spending two-and-a-half years in hiding for leaving Islam to become Christians, they were elated by their newfound freedom.
They also felt secure that once they arrived in Syria, they would quickly obtain visas to the United States and start a new life. That hope soon proved unfounded.
After spending more than a week and a half unable to obtain a visa to the United States or to any country in Europe, they realized they may have traded in the reality of being prisoners in their own country for being refugees in another. And as El-Gohary watches the weeks pass and his resources dwindle, he said the stress is almost unbearable.
“I feel like we’ve stepped out of a prison cell and into a fire,” he said. “We are in very, very bad conditions … My daughter and I divide the bottles of water to live, because there is no income.”
Maher Ahmad El-Mo’otahssem Bellah El-Gohary, 58, gained notoriety in Egypt after he sued the government in August 2008 to gain the right to change the religion listed on his state-issued ID card from Islam to Christianity. In Egypt, ID cards play a critical role in a person’s life, being used for everything from opening a bank account and renting an apartment to receiving medical care.
The listed religious affiliation, whether a card-holder subscribes to it or not, also determines whether the person is subject to Islamic civil law. The listed religious designation determines what state-mandated religion classes minors are required to take in school. El-Gohary said he filed the suit so his daughter, then 15, could opt out of the religious classes and would not be subject to the persecution he suffered when he became a Christian in his 20s.
It is a crime punishable by imprisonment to have no ID card in Egypt.
The suit sparked outrage throughout Egypt. Both El-Gohary and his daughter were publicly branded apostates in a country where 84 percent of Muslims think those who leave Islam should be executed, according to a study released by the Pew Research Center in December. The same month the suit was filed in 2008, El-Gohary and his daughter were forced into hiding.
For two-and-a-half years, El-Gohary shifted back and forth among several apartments in Cairo and Alexandria, usually once every month. Even in hiding, the two were harassed regularly by Egypt’s dreaded State Security Intelligence service (SSI) and assaulted repeatedly by others, including someone pouring acid on Dina, El-Gohary said.
While in hiding, El-Gohary tried repeatedly to leave Egypt, but officials at the Ministry of the Interior blocked him at every attempt. On at least one occasion, they seized his passport. In December 2010, after a long legal battle, El-Gohary got a court decision ordering the Ministry of the Interior to allow him to travel, but he said it still took several weeks for the government to comply with the order; the Jan. 25-Feb. 11 revolution didn’t hurt, El-Gohary said.
Out of Egypt
After the national demonstrations that led to the removal of both President Hosni Mubarak and Minister of Interior Habib Al-Adly, El-Gohary and his daughter went to Cairo International Airport on Feb. 22 to leave the county. They came prepared with their newly issued passports, the court order and myriad documents to prove they had the right to leave the country. Even so, authorities took the two aside for interrogation at the airport.
“My daughter and I went to the counter of the airport to the manager, then they took us to the SSI,” El-Gohary said. “We spent an hour talking to an officer trying to tell him, ‘We spent ages during Habib Al-Adly’s time, and even now after the revolution, we don’t have the right to leave?’”
According to El-Gohary, the guard asked him if he really wanted to leave the country.
“Yes,” El-Gohary replied. “I have a court order against Al-Adly, and I have the right to leave and the freedom to travel outside the country.” As if to add insult to more than two years of injury, the SSI officers told El-Gohary that Egypt was “their country” and to “come back anytime you want to.”
El-Gohary credits the revolution as the reason he was allowed to leave Egypt, saying it was a miracle “from God.”
They chose to go to Syria because Egyptian citizens are not required to have visas to visit there. After contact with a U.S. organization that concentrates on religious freedom, El-Gohary expected it would be easy to get a visa to the United States, where his wife lives. But he said he has been unable to obtain an entry visa there or to any country where he will feel safe. He went to a U.N. office in Syria seeking assistance; he was given an appointment to come back on April 20.
“I wasn’t expecting, after all this suffering and all these years, that…” El-Gohary said, cutting himself off. “The series of persecution is not finished.”
Although they don’t live under the same type of threats as they did in Egypt, El-Gohary and Dina now live in an apartment where they still watch everything they say and everyone with whom they talk. They still spend much of their time trapped between the four walls of their apartment because Syria, El-Gohary said, is a country where converts to Christianity from Islam are persecuted.
“The danger is still there,” El-Gohary said. “We don’t get out of the house. We don’t meet people. We don’t tell people what we are doing or talk to them about our situation. Because we don’t want someone to say, ‘Why are you applying to the U.N.?’ There are still a lot of enemies.”
Dina, now 17, said that although leaving Egypt was “like a miracle,” she is devastated by the prospect of having to spend more time with her life on hold. She said she is just as scared in Syria as she was in Egypt.
“We’re really, really tired of all this suffering,” she said. “I’ve lost two years of my life. I want to finish school.”
Muslim converts to Christianity in Syria were sometimes forced to leave their place of residence due to societal pressure last year, according to the U.S. Department of State’s 2010 International Religious Freedom Report. While there is no official state religion in Syria, the constitution requires that the president be Muslim and stipulates that Islamic law is a principal source of legislation.
With strict monitoring and curtailing of militant Islam, the government in Syria has long been considered a moderate regime. The government’s fear of violent responses by Islamic extremists to increasing conversions to Christianity, however, was at least partially responsible for the closing of six buildings where Christians were meeting last year, according to Christian support organization Open Doors. Noting that several Christians were arrested and interrogated in 2010, the organization’s World Watch List bumped Syria’s ranking up to 38th place among nations in which persecution of Christians takes place, from position 41 the previous year.
Syria is 90 percent Muslim, and 6.34 percent of its 22.5 million population is Christian, according to Operation World.
Though El-Gohary and his daughter have a dark outlook on their current situation, they are still grateful.
“Without God’s love, we would have been dead by now,” El-Gohary said. “Getting out of Egypt itself was a victory from God.”
Dina said she also is thankful, but that as she gets older she is becoming increasingly preoccupied by one wish.
“I want to get out so I can finish my studies,” she said. “I want to go into a church and out of a church without being scared of being killed.”