Budget 2018-19: How did nurses fair?

The 2018-19 Budget has been released and Minister for Health Greg Hunt says it’s guaranteeing the essential health services that Australians rely on.

While key industry stakeholders continue to pick through the Budget with a fine-tooth comb, Nursing Review canvasses their early reactions. So, how did nurses fair in the Budget?

Nursing workforce investment

The Australian College of Nursing (ACN) was pleased to see investments designed to strengthen Australia’s nursing workforce.

Some key initiatives funded include 3,000 extra nurses to improve the health of people living in rural, regional and remote areas, and funding for frontline service delivery by nurse practitioners.

Adjunct Professor Kylie Ward, chief executive of ACN, said by investing in and supporting the nursing workforce, the Australian community can feel confident that nurses will be available to provide care now and into the future.

Nurses need to be at the table where all decisions will be made regarding new funding announcements to ensure they will be successful, Ward said, adding: “The aged care promises in particular are ones that will be closely examined to ensure the changes are creating better outcomes for older Australians.”

The College was pleased to see that aged care reform is a major topic in the Budget announcement. It held that this needs to remain front and centre as a Government priority.

“Care for older Australians is a priority for the Australian College of Nursing and so is meeting the needs of ageing Australians, particularly with a focus on healthy ageing.

“ACN will be looking to see funding support for gerontological nursing to provide safe and appropriate care for the complex needs of the elderly,” Ward said.

The Australian Nursing and Midwifery Federation (ANMF) voiced its disappointment that nothing was done to ensure that aged care providers are employing enough nurses and carers.

Acting federal secretary Annie Butler said: “We know that from 2003 to 2016, there’s been a 13 per cent reduction in qualified nursing staff working full-time in aged care.

“This chronic staffing crisis has led to dangerous workloads for nurses and carers resulting, too often, in missed care for vulnerable nursing home residents, yet the Government is still not prepared to guarantee safe staffing levels in residential aged care.”

What else for aged care? ($1.6b for 14,000 additional high-level home care packages + 6000 already announced in the second half of 2017.)

One of the star players in the $5 billion announced for aged care in the Budget was the announcement of more home care packages.

With over 100,000 Australians on waiting lists, Aged & Community Services Australia said the additional home care packages are urgently needed to address some of that demand.

The ANMF said funding to meet the ever-growing demand for in-home aged care services was long overdue.

“It’s simply unacceptable that waiting lists have blown out to this point, with thousands and thousands of people waiting more than a year for the care services they need to remain in their home,” Butler said.

The additional home care packages, along with a raft of other measures, were tied up in the More Choices For a Longer Life package.

Other announcements included making available 13,500 residential aged care places and 775 short-term restorative care places, with $60 million capital investment to support new places, and providing increased flexibility of funding for residential beds or home care packages by combining both programs from July 1, 2018.

Mental health ($338.1 million in mental health funding, including $102.5 million for mental health services for older Australians)

The Budget included $338.1 million in mental health funding, with a focus on suicide prevention, research and older Australians, as well as advancing the Fifth National Mental Health and Suicide Prevention Plan.

This funding included over $82 million for older Australians in residential care and $20 million for a mental health nurse-led service focused on reducing mental health impacts of social isolation for Australians aged over 75 years.

Preventive health

Australian Healthcare and Hospitals Association (AHHA) chief executive Alison Verhoeven said the lack of any concrete action on preventive health is concerning. “It has been allowed to slip down health budget priorities, despite its proven benefits in preventing big health bills later.”

Public Health Association Australia (PHAA) chief executive Michael Moore agreed, saying despite repeated advice and “repeated commitments in principle”, the Government is still not developing a preventative health focus for Australia's health system.

“It’s true there are a few modest measures tonight – including additional vaccinations funded, very welcome measures to promote mental wellbeing, and the Good Sports Program to reduce alcohol consumption in sporting contexts," Moore said. "But Australia’s people will continue to experience avoidable chronic disease in the years ahead.

“People who should be destined to live healthy lives will not because of the preventable diseases they will suffer.

“The inevitable cost to Budgets far into the future will be greater than the investments that might have been funded.”

Palliative care ($32.8 million over 3 years for extra palliative care in residential aged care)

Liz Callaghan, chief executive of Palliative Care Australia (PCA), said the funding shows the Commonwealth’s commitment to ensure palliative care is included in aged care service provision and not just end-of-life care.

“Like the Productivity Commission, we call on cross jurisdiction cooperation to avoid problems resulting from poor stewardship, which ultimately leads to aged care services not responding as they should to users’ palliative care needs and choices.

“Australian studies have shown that when specialist palliative care services are brought into residential aged care settings, there is a reduction in unnecessary hospitalisations and an improvement in symptom and pain management,” Callaghan said.

Callaghan added PCA would like to see specific palliative care quality indicators across residential and community aged care. “For example, all staff need to be trained and equipped to recognise the need for appropriate end-of-life or palliative care, including appropriate pain management and the signs of approaching death.”

Healthcare data ($30 million over 4 years to the Australian Institute of Health and Welfare (AIHW) to improve accessibility to health information and statistics)

AHHA’s Verhoeven called the boost in funding for better health data “a great building block for much-needed reform of the system”.

The funding for AIHW aims to improve accessibility to health information and statistics, including better data sharing capability and information and communications technology upgrades.

“While the news on data is good, it’s disappointing that there have been no major announcements boosting the capacity of public hospitals to cater for what is now overwhelming demand, nor to better coordinate the two-way divide between primary care and hospital care,” Verhoeven added.

A snapshot of other measures

• $3.9 billion from 2018-19 to 2021-22 for indigenous health, including $33.4 million for Aboriginal and Torres Strait Islander health workforce
• $77.9 million in infant and maternal health and for the first 2,000 days of a child’s life
• $40 million to support aged care providers in regional, rural and remote Australia for urgent building and maintenance works
• $5.3 million allocated for dementia innovation
• $105 million for culturally safe aged care services in remote Indigenous communities

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