PART 1 OVERVIEW SECRETARY’S REVIEW

PART 1 OVERVIEW

SECRETARY’S REVIEW

Secretary

Department of Health and Ageing

INTRODUCTION

Health and aged care systems around the world are also responding to increasingly complex challenges. These include budget constraints; workforce availability, quality and distribution; and social, demographic and security issues. With 2002-03 projected expenditure of $32 billion (a 9 per cent increase from 2001-02), the health and ageing portfolio now accounts for about one dollar in every five spent by the Australian Government. Australia has continued to perform well in health and ageing compared with other developed countries. We continue to maintain services and health outcomes well above Organisation for Economic Cooperation and Development (OECD) averages.

We currently have one of the lowest mortality rates in the OECD, improving from 16th in 1969 to third in recent years. Australia also ranks fourth in the OECD on quality of life indicators published by the World Health Organization.

In responding to all the challenges of maintaining a world class health system, a key strength of the Department has been the dedicated and skilled people who work in it. Throughout 2002-03, the Department continued to improve its people and business management and assisted the Government in implementing its policy agenda. We continue to attract people with passion and a commitment to better health and healthier ageing for all Australians.

During the year the Department worked to maintain and enhance productive partnerships across the health and ageing sectors. We also responded to a large number of sensitive and complex policy issues, while maintaining a high quality of service to Ministers and the Parliament. Our main challenges nevertheless remain to ensure the delivery of better health outcomes for a better quality of life and to drive health care budgets as far and efficiently as possible.

CHALLENGES FOR THE DEPARTMENT

Our People Moving Forward Together

The successful negotiation of the Department's Certified Agreement was another highlight of the year. Through it, the Department remains competitive in employment remuneration and conditions while continuing to strengthen an organisational culture that actively supports the health and well being of its people. I was encouraged to see, for example, how quickly the Department embraced the ‘10k a day’ exercise initiative, which encourages staff to engage in an appropriate amount of physical activity each day.

We see the management of our people as the key to the effective delivery of our outcomes. To that end, the Department conducted a comprehensive staff survey in April as a means of better understanding the important issues for our people. The survey has proven to be very useful in identifying the main areas that we will need to focus on in the future. I was very happy with the extremely high level of people's commitment to the survey, displayed through the 91 per cent participation rate. The survey also provided comparison with other public and private sector employers, against whom we compare favourably, particularly with regard to the performance of managers.

The devastating Canberra bushfires in January 2003 affected a large part of the Canberra community in what were a terrible few days for many people. Several staff members in the Canberra area had homes lost or damaged. I was pleased to see our staff rally to support those who lost so much at this time. I would like again to thank all of those members of the Department who donated goods, helped raise funds, or gave their time to support those in need. I would particularly like to acknowledge the departmental members of volunteer emergency services who put themselves at personal risk to help fight the fires or to support those who were.

Better Business Management

The first stage of implementation delivered a more effective Department structure to align more closely with program outcomes and to provide better matrix management and focus on key priorities.

A range of other management initiatives also undertaken during the year included revising and streamlining our corporate decision-making processes with an Executive Committee and two supporting committees (Policy Outcomes Committee and Business Management Committee) replacing the Departmental Management Committee and its five supporting committees. In addition, the first phase of the Financial Services Review reforms were completed. These included introducing on-line workflow approval for financial transactions and increasing functionality in our computer systems to assist overall financial control.

The Department continued to support Australian Government initiatives to promote the more efficient functioning of government arrangements, through its participation in the More Accessible Government working group and the Red Tape Task Force. This agenda mirrors the continued focus in the Department on driving efficiencies in the way we work.

Policy Challenges for the Portfolio

2002-03 will long be remembered for the challenges we faced as a result of SARS and the Bali bombing.

The global outbreak and rapid spread of SARS was a potent reminder of the risks to public health from the emergence of new infectious diseases. By reacting quickly, including screening incoming travellers for illness and preparing the health system to manage cases of SARS, the Department helped to prevent a local outbreak of the disease.

The response of the Australian Government and States and Territories to the Bali bombing of October 2002 ensured necessary health and support services were available to those affected by this tragic event. The Department and the Health Insurance Commission developed mechanisms to ensure that victims did not face out-of-pocket costs for health care for conditions caused by the bombing.

Other notable policy challenges and achievements are highlighted below.

The ‘Focus on Prevention’ package announced in the 2003-04 Budget provided a range of initiatives for the Department to implement as the next instalment in making disease prevention and health promotion a fundamental pillar of the health system.

The Returns on Investment in Public Health report was commissioned by the Department and released in 2003. It showed that spending on illness prevention measures such as public health interventions against tobacco consumption, heart disease and immunisation against measles, has resulted in significant savings. The Report reinforced the Department's research into the burden of disease, the effectiveness of interventions and investing in workforce capacity.

In April 2003 the Therapeutic Goods Administration (TGA) took regulatory action to suspend the licence to manufacture therapeutic goods held by Pan Pharmaceuticals Limited. Following regulatory action against Pan, the TGA developed a number of legislative amendments which now strengthen the requirements placed on manufacturers and sponsors of therapeutic goods to ensure the quality, safety and efficacy of therapeutic goods supplied in, or exported from, Australia.

The Intergenerational Report identified the Pharmaceutical Benefits Scheme (PBS) as a key part of Medicare for which increased expenditure is placing pressure on the sustainability of the health system. The Department implemented a range of measures from the 2002-03 Budget such as restricting prescription shopping and facilitating the use of generic medicines.

Following the release of the National Strategy for an Ageing Australia in 2002, the Department began the implementation phase. The strategy is designed to deal with the short, medium and long-term impacts of population ageing. The challenge is for a more coordinated approach to these issues across all levels of government including a strategy for engaging local government.

The Department in conjunction with State and Territory governments and other key stakeholders, established the National Blood Authority (NBA) on 1 July 2003, which introduces consistent national arrangements for the supply of blood and plasma products.

Providing flexible and sustainable health and aged care services for small rural and remote communities remained a priority for the Department. The Multipurpose Services Program continued to enhance service integration for these communities with a 27 per cent increase in the number of operational sites in 2002-03.

An increasing number of people are accessing hearing services via the Commonwealth Hearing Services Program’s voucher system with growth of 12 per cent in 2002-03. The Department is working towards making it easier for people with hearing loss to access specialist services; for example, by simplifying application processes.

Work was completed on the National Strategic Framework for Aboriginal and Torres Strait Islander Health achieving agreement amongst all levels of Government in July 2003. The framework outlines agreed principles and nine key result areas to be achieved over the next decade.

The Department drove a comprehensive review of the private health insurance industry and ongoing implementation of reforms designed to make private health insurance more efficient, competitive and attractive to consumers.

Rigorous feasibility testing of HealthConnect commenced in 2002-03. HealthConnect is a project aimed at achieving a national system of electronic health records in order to better inform decisions at the patient’s point of care and improve the delivery of health care services.

LOOKING AHEAD

I would like to thank all staff for their commitment and hard work in implementing the Government’s reform agenda over the year and their contribution to producing better health care and a better quality of life for all Australians.

Jane Halton

Secretary

Department of Health and Ageing

CHIEF MEDICAL OFFICERS REPORT

‘PROTECTING AND ENHANCING AUSTRALIA’S STATE OF HEALTH’

Understandings from Recent History

The cigarette smoking epidemic, following both World Wars, has driven epidemics of lung cancer and contributed to other cancers, cardiovascular and lung diseases. Rates of smoking-related cancer are now falling in men, but still rising in women where smoking has continued to spread.

Understanding the Burden of Disease

The Current Scope for Prevention

With a much greater disease burden, Aboriginal communities have more immediate scope for prevention. Life expectancies for Indigenous Australians are cut short by as much as 20 years. Inadequate living conditions, nutrition and education have contributed to infectious disease and death in childhood and added to the chronic burden in later life from diabetes and diseases of kidneys, lungs and heart. The disruption of traditional culture, and the difficulties of translation between cultures⁵ have contributed to ‘diseases of the spirit’⁶ for Aboriginal people; loss of self-esteem, depression, substance abuse, violence and crime have added to their burden from physical diseases. The tragedy for Indigenous people has been compounded by unemployment and lost productivity. Fortunately, there is now greater awareness by governments, industry and Indigenous people themselves, about what should be done. Solutions are being implemented through cross-cultural education and employment programs, through initiatives in sport, art and business, and through improved health services.

The Economics of Prevention

Economic returns varied widely (Table 3). However, all programs led to significant health gains and some showed exceptionally high returns. HIV/AIDS programs were estimated to have prevented 6,973 new infections between 1980 and 2010. Measles programs were estimated to save the Government $155 for every dollar invested, with net savings of $8.5 billion over the last 30 years. For every $1 invested in public health programs to prevent smoking, the government recouped $2. However, coronary health disease, components of the HIV/AIDS program, and road trauma programs all cost the Government more for prevention than they averted in treatment costs. However, all were justified by the significant health benefits to the community. This ground- breaking report validates our investment in public health. Prevention has now been recognised as a fundamental pillar of the Australian health system.

Notes:

2. Capital cities and urban areas only.

3. Error bars indicate 95 per cent confidence intervals for the prevalence of abdominal overweight and obesity. The apparent downturn in 1999 is within the bounds of measurement error.

Source: AIHW: Dixon T & Waters A-M 2003. A growing problem: trends and patterns on overweight and obesity among adults in Australia, 1980 to 2001. Bulletin No. 8. AIHW Cat. No. AUS 36. Canberra: AIHW.

The Challenges from Overweight and Obesity

Australians are not alone in putting on weight. Globally, there are more than one billion adults overweight and at least 300 million obese. Urbanisation and changes in the food industry have affected physical activity levels and dietary habits in developing countries as well as industrialised societies, driving the obesity epidemic in both.

The impact of excess weight on disease and disability is well established. Mortality rates for non-smoking obese men are about double those of their non-obese counterparts, with an average loss of life of 3-6 years. The risk is greatest at an early age. Severe obesity at age 25-35 increases mortality by 12 fold. Obesity predisposes to hypertension, Type 2 diabetes, raised serum cholesterol and to death from cardiovascular disease. Around 58 per cent of Type 2 diabetes, 21 per cent of heart disease and 8 per cent to 42 per cent of certain cancers are attributable to excess weight. In addition, obesity leads to gall- stones, breathing difficulties, osteoarthritis, social discrimination, isolation, and physical inactivity; the latter makes obesity worse. Obesity also contributes to health disparities as excess weight is more common in disadvantaged and Indigenous groups.

As well as the personal harm to those affected, obesity impacts on the entire community. The direct costs of obesity have been estimated as 7.8 per cent of total health expenditure in the USA, with additional costs from lost productivity and sectors other than health. If no action is taken, WHO estimates a one third increase in loss of healthy life over the next 20 years in countries such as Australia.

The epidemic of obesity has followed changes in urban living, transport, family structure, work- habits, food practices and leisure activities. These have favoured physical inactivity (cars, TV, computer games and labour saving devices) and intake of energy-dense foods (fast and refined foods rich with sugar or saturated fat). In Australia between the mid-1980s and 1990s, average energy intake in the diet increased by 10 per cent for those aged 10-15 years, and by 4 per cent for adults. Physical activity levels have declined. Children who drink more sweetened soft drinks and spend more time watching TV have been shown to put on more weight.

Excess weight is not inevitable, although, some people put on weight more easily than others. However, all Australians can be best protected by social and educational strategies to encourage exercise and good food habits. As excess weight gain in childhood predicts obesity in later life, the best strategy is to teach healthy habits in childhood. Lifestyle change in adult life to modify diet and foster physical activity, while simple and effective in principle, is more difficult to achieve and sustain. The size of the weight loss industry in Australia attests to this difficulty. For persons who are grossly obese, it may be necessary to resort to gastro-intestinal surgery to reduce food intake and achieve permanent weight loss, as no other strategies have been shown to be as effective. In future there is hope that natural appetite control might be achieved by applying knowledge about peptide-YY, the natural appetite suppressor hormone, or through other research advances.

Australia has responded to the obesity problem promptly. In 1997 NHMRC released a plan for Acting on Australia’s Weight to raise professional awareness and Guidelines for Weight Control and Obesity Management were recently adopted. Following a series of Obesity Summits across Australia, a National Obesity Taskforce was established by the Australian Health Ministers’ Conference to look at factors contributing to obesity and ill-health in both adults and children, and to develop a National Action Plan.

The obesity problem is complex. Yet there are precedents for achieving major social change. For example, the attitudinal changes to reduce smoking were almost unimagined forty years ago. Australia should be able to trade on its sporting image and capture the hearts and minds of families and teachers in responding to the obesity epidemic. For example, we could point to the Netherlands as a country where obesity levels are low, and physical activity levels are high, and set national ‘sporting’ targets to ‘catch up’. To succeed, we will also need the cooperation of industry and of all sectors of government, as well as regular surveys to monitor the impact of our community responses.

Emerging Infectious Diseases - the Warning from SARS

Annual winter outbreaks of influenza are usual, and influenza vaccine is cost-effective in preventing severe disease and hospitalisations, particularly in the elderly. However, experts have long been predicting a global pandemic of influenza, as seen in 1918-19. Effective vaccines may not be available in time for any new and dangerous influenza strain.

Until 2003, the world had been spared any such outbreak. When it appeared, the disease was not influenza, but SARS (Severe Acute Respiratory Syndrome). This new virus apparently jumped from infected market animals to infect people in Southern China in late 2002. On the night of 21 February 2003, a doctor infected in China visited Hong Kong. He was unwell in room 911 of Hotel M. Something happened on that ninth floor to infect eight other hotel guests, who then took SARS to other countries, as travellers, in subsequent days. There were many hundreds of cases of SARS in Singapore, Canada, Taiwan, Hong Kong and China, with more limited outbreaks in Vietnam, Philippines and other countries.

Australia was lucky. A foreign tourist, present on the 9^th floor of Hotel M on the relevant night, subsequently came to Australia and became unwell, with unusual symptoms. However, she was not hospitalised, and left Australia before 12 March when the World Health Organization issued a global alert about SARS. The tourist was subsequently diagnosed as mild SARS after an international follow-up of guests in Hotel M on that fateful night. Fortunately, she did not spread the disease to anyone else in Australia.

The warning from WHO to look for cases of severe respiratory infection in all travellers was unprecedented, but undoubtedly effective, as much of the international spread of SARS preceded the WHO alert. Travellers at national borders were screened; those with fever were refused carriage and referred for diagnosis and treatment. People on aircraft, in ambulances, and in general practices with any symptoms suggestive of SARS also needed to be carefully managed.

The worst affected countries, Singapore, Hong Kong and Canada, struggled initially as SARS spread to health care workers, threatening morale and the very integrity of the hospital system. People watched as infected colleagues died, and infection control precautions were seen to be inadequate as SARS continued to spread. Infection control measures were rapidly improved, and high-risk medical procedures were avoided.

By 5 July SARS had been contained by breaking person-to-person transmission in all affected countries. The effort was enormous. Many thousands of contacts of cases were quarantined under emergency regulations, usually at home; those with possible symptoms were isolated, either in hospital or at home; suspect patients were ‘barrier nursed’. Airline passenger manifests were scrutinised to find travellers who could have been exposed in-flight. International cooperation was unparalleled. When the epidemic ceased there had been 8,422 cases reported to WHO, with 916 deaths world-wide.

SARS has taught us much. The global costs in terms of lives lost and health costs were high. Even with no local transmission in Australia, the precautionary health and border control measures had direct costs of millions of dollars. However, because SARS led to great public anxiety and a dramatic downturn in travel and tourism, the indirect economic costs were very much higher for Australia, the region, and the world at large.

The lessons are clear. SARS was contained through international cooperation involving experts from Australia and many other countries. Australia escaped serious consequences, through luck, through prompt responses overseas, and through the concerted efforts of public health experts, clinicians, and border control staff here in Australia. Australian preparedness for disease control must be sustained and enhanced to protect our health and our economy, to support international efforts and to provide regional leadership in disease surveillance and responsiveness.

Public Safety in the Age of Terrorism

Australia responded effectively to its own white powder incidents, which all proved to be false alarms. Health responses were coordinated with States and Territories through the Communicable Diseases Network, and the Public Health Laboratory Network. The Department also worked behind the scenes, with other agencies of government, to strengthen its preparations to deal with bio-terrorism. The emergency stockpile of antibiotics and antivirals has been enhanced, supplies of smallpox vaccine have been acquired, and surveillance and response plans developed for smallpox, anthrax and other potential threats.

Following Bali, much was learnt from a debrief involving health authorities, Defence and other agencies. Coordination arrangements have been strengthened, and plans to deal with trauma and burns casualties enhanced. In any future incident, the Department will activate its Emergency Incident Room to coordinate health responses, including communication with the public. This room was first activated in March 2003 as part of the national response to the SARS emergency.

Better use of Health Information to Enhance Public Safety and Quality of Care

Despite the greater expectations of a modern health care system, there are major challenges in storing, retrieving, and interpreting health information to improve quality and safety through efficient and effective decision-making. Health information systems, many still paper- based, are fragmented, reflecting the piecemeal development of private and public health-care in our federal system. Records for an individual patient can still be distributed across the country in different surgeries, hospitals or aged-care facilities. Because of the difficulty of sending physical records from one place to another, carers may either act in ignorance of important past information, or be forced to duplicate past procedures. At best, this is inefficient; at worst, it places patients at unnecessary risk.

Doctors also need electronic help to deliver on their commitment to quality care and evidence- based decision-making. Improved record systems will improve their access to comprehensive information about each patient.

Improved electronic prompts and communication will facilitate timely and effective referrals to specialists and allied health professionals. Electronic decision-support systems, currently under development,¹¹ can provide doctors and health care workers with desk-top access to the most appropriate evidence to support each individual patient decision. Patients will also have electronic access to quality information about their own condition, to support the information provided by health-care workers, and to assist them in self-management when appropriate.

In partnership with health professionals, State and Territory health agencies, data custodians, and community representatives, the Department is providing leadership to deliver on these IT solutions to improve the efficiency and effectiveness of patient care. Protection of individual privacy is fundamental. For each individual, there will be a secure electronic patient record to ‘follow’ the patient from place to place. HealthConnect will for the first time allow the patient to control access to their own electronic medical records. Electronic patient records will complement and enhance the present provider-centred paper-based records, and in time supersede them.

At another level, there are inefficiencies in the use of aggregated health information to address questions about quality and safety, to evaluate disease outcomes and to look at long-term health trends. For example, Australia spends hundreds of millions of dollars each year to treat patients with antibiotics, and to detect antibiotic resistance in bacteria infecting individual patients. Yet it is currently impossible to use aggregated data to count the antibiotic resistant infections across the country for prevention purposes, even though the public has already paid for the basic data which are largely available in electronic form.

The analysis of integrated, de-identified health and administrative data sets, bringing together information currently collected in many separate administrative units, can inform strategies for improving the efficiency and effectiveness of the health system and individual patient outcomes. The utility of bringing data sets together cannot be overestimated. Techniques developed in

Western Australia enable this work to be undertaken without any risk of patient privacy being breached. Anonymous population-level data sets are created which can be used to evaluate treatments, to improve knowledge of effectiveness and to detect and respond to adverse or unexpected events in the health system. Such routine analyses will support quality assurance programs. Likewise, enhanced surveillance by systematic interrogation of data sets from pathology, pharmacy or general practice could provide an early warning of a new disease outbreak, or a bio-terrorist attack.

Future work will complete an information network for Australia to bring health care delivery into the 21^st century. Much can be achieved at relatively low cost, through changes in culture and motivation and through the adoption of standards and protocols to protect privacy and to ensure consistency and security of data management. Much of this work has been successfully trialed.

Early benefits from the use of integrated health data should include:

Monitoring of outcomes of interventions and treatments at the state, institutional and provider level. (If there are any Dr Shipmans in Australia, we must detect them early)

Early detection of adverse events from drugs and surgical interventions;

Cost-effectiveness analysis of interventions to support rational choices in funding;

Assessment and monitoring of individual quality initiatives such as accreditation;

Detection of population sub-groups requiring additional health care services;

Device, disease and intervention registers created as a by-product of a linked health information resource; and

Improved surveillance and early detection of new diseases and bio-terrorism events.

Questions for the Public

The public is more aware of lifestyle change to prevent sexually transmitted and chronic diseases, of immunisation, and of measures taken by government to reduce cigarette smoking. Yet the public, and many in government, may not know that public health interventions are so cost-effective. Public health expenditure on tobacco control saves $2 for every $1 invested. Measles vaccine returns health care savings, although newer vaccines, directed at less threatening or rarer diseases, are more expensive, and less cost-effective.

What about public opinion, and public expectations of the health system? Most of us would see the availability of a GP, a prescription, or a hospital bed as the major criterion of success in the health system. Yet some consumption of primary and acute care services is inefficient, because of a mismatch between patient expectations and medical need. How can the public come to place a greater value on prevention, and to take greater responsibility for their own health, through lifestyle change, more self-management, and a more discriminatory approach to the consumption of expensive services?

These are difficult questions. However, there are some clues about what the public wants. At least $2.3 billion of personal money is spent annually on complementary or alternative medicine; this shows that people want the reassurance of something that they believe will do them good, even if there is little evidence of efficacy. It also shows that we want attention as individuals as well as attention to our illnesses. Modern medicine, evidence-based as it is, does not have much time to spare for talking to people and providing reassurance. How many unnecessary prescriptions are given to terminate the consultation and to trigger a placebo response? Yet at another level, does talking and counselling always provide the best use of medical time? How do we find more cost- effective solutions to meet people’s needs? How do we better help people to find fulfilment through physical activity and lifestyle activities?

How big a role should there be for psychologists and other professionals?

The proposed electronic health record, controlled by the patient, has the potential to greatly improve the efficiency, quality and safety in our health system. Privacy is paramount, but it can be protected. The community interest will suffer if we have to forego the very great health benefits of the information revolution because of unjustified concerns about loss of privacy. These matters would benefit from wider public discussion.

In the light of such public discussions, this Health portfolio will provide continuing leadership to further improve our health system, which is already delivering excellent outcomes, by international standards, for the majority of Australians.

DEPARTMENTAL OVERVIEW

GENERAL OVERVIEW

identifying the key areas where overlaps, duplication and/or shortcomings in coordination and communication are perceived to jeopardise our effectiveness in program delivery;

identifying good practices in alignment and coordination within and across Divisions and State and Territory Offices (STOs);

recommending options for structures and processes to improve alignment, coordination and communication within and across Divisions and STOs; and

examining the effectiveness and recommending options for improving our interactions with stakeholders.

The first stage of implementation aimed to deliver a more effective Department structure to align with departmental programs and provide better coordination and focus on key activities. Other recommendations included improvements in business planning and other processes and development of a stakeholder charter. A range of other management initiatives also undertaken during the year included:

revision and streamlining of our corporate decision-making processes with an Executive Committee and two supporting committees (Policy Outcomes Committee and Business Management Committee) replacing the Departmental Management Committee and its five supporting committees;

delivery of phase one of the Financial Services Review reforms, including introduction of on-line workflow approval for financial transactions and increased functionality in our computer systems to assist overall financial control;

development and acceptance of a Departmental IT architecture and strategic plan which delivered a roadmap for efficient and effective future investment in IT systems and infrastructure;

completion of the outsourcing of property services, office services and warehousing and distribution services;

completion of a comprehensive staff survey to inform the directions and progress of our reform strategies and to assist managers in focusing attention on staff concerns;

commencement of the development of a stakeholder charter; and

initial scoping of a rationalisation of all of the Department’s grants and entitlements processes and IT systems.

There were also changes to the portfolio structure of the Department. CRS Australia was transferred from the Department of Family and Community Services to the Department of Health and Ageing on 1 July 2002. The National Industrial Chemicals Notifications and Assessment Scheme (NICNAS) also transferred to the Department on 3 July 2002. The Department also prepared for the development of a National Blood Authority, with the bill passed by Parliament to establish the new authority from 1 July 2003.

The Department has continued to support Australian Government initiatives to promote the more efficient functioning of government arrangements, through its participation in the More Accessible Government working group and the Red Tape Task Force. This agenda mirrors the continued focus in the Department to drive efficiencies in the way we work. Our challenge for 2003-04 will be to build on the Program Management Review outcomes to deliver tangible improvements in the way we manage common activities across the Portfolio.

THE DEPARTMENT’S ROLE AND FUNCTION

population health;

Medicare and the Pharmaceutical Benefits Scheme;

indigenous health;

rural health services;

the Health Insurance Commission;

private health insurance; and

corporate leadership and resource management.

A list of ministerial responsibilities is set out in Appendix Four. Details of the Department’s responsibilities are set out in the Administrative Arrangements Orders, with the main legislation administered by the Department at Appendix Five.

The Department’s vision is for better health and healthier ageing for all Australians through a world class system which:

meets people’s needs, throughout their life;

is responsive, affordable and sustainable;

provides accessible, high quality service including preventative, curative, rehabilitative maintenance and palliative care; and

seeks to prevent disease and promote health.

The Department’s mission is to make a difference by:

looking outwards to listen and respond to consumers and engage constructively with professionals, providers, government and industry;

looking forwards to respond effectively to emerging challenges including an ageing population and improve services and care by strategic planning, benefiting from emerging knowledge and technologies; and

looking after the health and wellbeing of the community; the funds entrusted to the Department by the Australian people and the priorities of the Ministerial team and the Government.

ORGANISATION STRUCTURE

The Review also noted that there are many important, cross-cutting functions that are relevant across all or most of the sectors and service areas in the health and ageing system. The Review recommended that we group these functions more clearly into divisions with cross- portfolio responsibilities.

As well as their specific program responsibilities, these divisions have important roles to play in identifying the links and interdependencies between the various sectors of the Australian health and ageing system and therefore help manage our work on these issues in a more strategic and integrated way. These divisions are:

Information and Communications Division

Health Services Improvement Division

Office of Aboriginal and Torres Strait Islander Health

Portfolio Strategies Division

In addition two areas provide support for managing our business environment:

The Therapeutic Goods Administration (TGA) and CRS Australia also form part of the Department.

A detailed structure chart is provided at the end of this section.

Outcomes and Outputs Structure

CRS Australia

CRS Australia operates as a business unit within the Department and contributes to Outcome 4. It operates its own corporate business planning, financial management, information technology and certified agreement with staff. Where the operations of CRS Australia are distinct from the rest of the Department they are reported on separately within the report, for example in Part 3 (Management and Accountability).

Internet: www.crsrehab.gov.au

Telephone: (02) 6212 2900

State and Territory Offices

In particular, State and Territory Offices contribute uniquely to the integration agenda of the Department as they are in a good position to identify policy links between programs and to identify overlaps and gaps. They are also able to ensure appropriate integration of services on the ground with those of State and Territory Government agencies.

CRS Australia also has offices in all States and Territories. The national services delivery network consists of 163 permanent offices, covering urban, rural and remote areas. CRS Australia seeks to locate its offices conveniently for clients in relation to Centrelink offices, transport systems and other community facilities.

PORTFOLIO AGENCIES

OUTCOME ONE: POPULATION HEALTH AND SAFETY

Food Standards Australia New Zealand

Function

coordinating the surveillance of activities relating to food available in Australia in consultation with State and Territory Governments;

conducting research and surveys in consultation with State and Territory Governments;

coordinating the recall of food by States and Territories;

setting policy on the assessment of imported food;

developing codes of practice;

food education initiatives in cooperation with the States and Territories; and

providing advice to the Minister on matters related to food.

Internet: www.foodstandards.gov.au www.foodstandards.govt.nz

Telephone (02) 6271 2222

Australian Radiation Protection and Nuclear Safety Agency

Function

Internet www.arpansa.gov.au

Telephone (02) 9545 8333

OUTCOME TWO: ACCESS TO MEDICARE

Health Insurance Commission

As a decentralised organisation, the HIC operates from 226 Medicare offices, and from state offices, processing centres, and a national office in Canberra. The HIC employs around 4,000 staff and processes payments of approximately $16 billion annually.

Function

Medicare;

the Pharmaceutical Benefits Scheme;

the Australian Childhood Immunisation Register;

the Australian Organ Donor Register;

the Private Health Insurance Rebate/Incentive Scheme;

the Practice Incentive Scheme;

the General Practice Immunisation Incentives;

the Hearing Services voucher system;

the Compensation Recovery Scheme; and

the Veterans’ Treatment Accounts.

In each of these programs, the HIC processes and pays claims and benefits and records data. The HIC also participates in the operation of the Family Assistance Office in conjunction with Centrelink and the Australian Taxation Office.

The HIC is increasingly making information available to help indicate Australian health patterns and trends, and enable health professionals and consumers to base their decisions on better information and evidence.

Through a Strategic Partnership Agreement, the HIC and the Department of Health and Ageing work together to achieve the Government’s health policy objectives.

Internet www.hic.gov.au

Telephone (02) 6124 6333

Professional Services Review

Function

The Director investigates the referrals and may inquire into services and conduct not specifically included in the HIC’s reasons for referral. After investigation, the Director may dismiss a referral, negotiate an agreement, or establish a committee of peers to review the practitioner’s conduct.

If a committee finds inappropriate practice, the Determining Authority (DA) comprising three independent persons, decides the sanctions to be imposed. The DA must ratify any negotiated agreement between the Director and practitioner under review, for it to become effective.

Internet www.psr.gov.au

Telephone (02) 6281 9100

OUTCOME THREE: ENHANCED QUALITY OF LIFE FOR OLDER AUSTRALIANS

Aged Care Standards and Accreditation Agency Ltd

Function

The main functions of the Agency are to:

manage the residential aged care accreditation process using the Accreditation Standards;

promote high quality care and help industry to improve service quality by identifying best practice and providing information, education and training to industry;

monitor ongoing compliance within the Accreditation Standards; and

liaise with the Department about homes that do not meet the Standards.

Internet www.accreditation.aust.com

Telephone (02) 9633 1711

OUTCOME EIGHT: CHOICE THROUGH PRIVATE HEALTH

Private Health Insurance Administration Council

Function

develop, implement, and monitor compliance with the solvency and capital adequacy standards, to ensure that Registered Health Benefits Organisations (RHBOs) remain prudentially sound;

administer the Health Benefits Reinsurance Trust Fund;

undertake the supervisory functions in relation to RHBOs, including the appointment of inspectors and administrators;

approve registration, de-registration and merger of RHBOs;

approve voluntary winding up of an RHBO;

collect and disseminate financial and statistical data, including tabling of an annual report to Parliament on the operations of RHBOs; and

levy RHBOs for the general administrative costs of PHIAC and the Acute Care Advisory Committee.

The Council collects and disseminates information about private health insurance to allow consumers to make informed choices about the product.

Internet www.phiac.gov.au

Telephone (02) 6215 7900

Private Health Insurance Ombudsman

Function

Internet www.phio.org.au

Telephone (02) 9261 5855

OUTCOME NINE: HEALTH INVESTMENT

Australian Institute of Health and Welfare

Functions

identifies and meets the information needs of governments and the community to enable them to make informed decisions to improve the health and welfare of Australians;

provides authoritative and timely information and analysis to the Australian Government State and Territory governments and non- government clients through the collection, analysis and dissemination of national health data, community services and housing assistance data; and

develops, maintains and promotes, in conjunction with stakeholders, information standards for health, community services and housing assistance.

The Institute publishes the results of all its work.

Internet www.aihw.gov.au

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MANAGEMENT STRUCTURE CHART

It notes the members of the Executive, First Assistant Secretaries and other Senior Executive Service officers.

The names of State and Territory Office Managers are also included.

From left to right:

Executive

Chief Medical Officer - Prof Richard Smallwood

Deputy Secretary - Mary Murnane

Deputy Secretary - Philip Davies

State and Territory Offices

Victoria - Maree Bowman

Queensland - Elizabeth Cain

Australian Capital Territory - Joseph Murphy

Western Australia - Michael O'Kane

South Australia - Phillip Jones

Tasmania - Angela Reddy

Northern Territory - Leonie Young