Cubism – Cube Blog

By Jody Fassina, Independent Political Consultant, JF Consulting 

The Federal Budget has done nothing to allay fears of further PBS deferrals for the pharmaceutical industry, or indeed if there is any chance at all that the Government would reconsider these listings.  The deferment of PBS listings has become a key Government management tool to contain PBS costs and the absence of any budget guidance basically confirms this, now and into the future.

The Budget provides the following forward estimate costs for the PBS.

• 2010/11 – $10,337m
• 2011/12 – $10,794m
• 2012/13 – $11,245m
• 2013/14 – $12,070m
• 2014/15 – $12,882m

Year-on-year this results in percentage increases of 4.4%, 4.2%, 7.3% and 6.7%.  This enables the Government to perpetuate the myth, for as long as possible, that the PBS is growing faster than the rate of inflation and hence maintain pressure on industry in terms of PBS expenditure. Most importantly, it allows the Minister for Health to dismiss industry claims, supported by Medicare data, that the PBS is in fact growing at a rate less than inflation and therefore allow for new approved medicines to be placed on the PBS.

What this also demonstrates is that, with the year-on-year increases being greater than inflation, the February deferrals have not resulted in major savings over the forward estimates; however, the policy of deferrals has certainly become a fiscal management tool for Government to wheel out when required to prevent future PBS listings. The precedent is now firmly in place.

These costs also fail to take into account the impending patent cliff, which could result in savings to the PBS of anywhere up to $2 billion.  The Government clearly and strategically has decided not to factor in the patent cliff so it can maintain its political rhetoric that PBS costs are still growing at an unsustainable rate.

This is a key challenge for the pharma industry – convincing Government and the community at large that the PBS is in fact a sustainable, vital public health program supported by $1.9 billion in savings offered up in the MoU, and the impending patent cliff which will see savings of up to $2 billion. 

It is clear that funds exist to support the ongoing listing of new and innovative medicines for the Australian community; however, as it stands the Government has been relatively successful in demonstrating the need for PBS costs to continue to be reined in.

This Budget confirms by its silence that Government will maintain a tough political stance on the PBS.

The ‘fight’ is most definitely on and the pharmaceutical industry, as well as professional medical groups and patient advocacy, will need to convince the public and the media that Government has got its estimates wrong! This will be vital if there are to be any substantive PBS subsidies in the next few years.

Jody Fassina specialises in providing strategic counsel to both corporate and non-profit organisations requiring high level advice on public policy issues of paramount importance to their organisation. Jody has worked as a senior public affairs manager in the corporate sector with Macquarie Bank, a political consultant with a boutique Sydney firm and as a senior policy advisor to federal MPs. He is currently an independent political consultant, having established JF Consulting.

 For more information contact Jody Fassina at fassinaconsulting@bigpond.com

By Jody Fassina, Independent Political Consultant, JF Consulting

Against the backdrop of recently released treasury documents under FOI and subsequent media reports claiming they demonstrated Treasurer Wayne Swan had no idea how to implement the mining resource rent tax, next Tuesday will be the Treasurers’ 4th and most difficult Budget – with the pharmaceutical industry at the forefront of the Government’s near manic commitment to bring the Federal Budget back into surplus by 2012/13.

The $1.9b in savings Government secured from industry via the MoU was followed by the announcement in February, by Minister Nicola Roxon, that Cabinet had decided to defer listing of six new drugs that had received positive recommendation by the PBAC. And that in future all PBAC recommendations would be decided by Cabinet.  This has established a totally new political environment for the pharma industry.

The Budget next week is unlikely to offer any joy for the industry.  There is no sign of a reversal in regards to the Government deferring future drug approvals or providing guidance on when past deferrals will be reconsidered, other than the Minister’s statements that they will be reconsidered when ‘fiscal circumstances allow’.

What the Budget will provide however, is the Government’s estimate over the next four years of what it believes the cost of the PBS will be to Australian taxpayers.  This will be interesting as only last Friday, at a gathering of industry and consumer health groups, the Health Minister claimed the PBS was continuing to grow at an unsustainable 6% per annum, and was totally dismissive of industry claims, derived from Medicare data, that the PBS was in fact growing at less than the inflation rate of 3.3.

Given the concern and uncertainty created by Cabinet’s decision to defer the listing of new drugs, it will be interesting to see whether the Budget forward estimates for PBS expenditure provide some insight into the savings this decision is meant to have delivered for Government. 

Will there be more pain for the pharma industry in the Budget?  While crystal ball gazing is always fraught with difficulty, the Government has belatedly ruled out any change to the patient co-payment, but would look at other measures such as expanding pre-existing therapeutic groups.  Given the Government’s actions to date, nothing can be ruled out.

Who would have thought that under the MoU with the Government committing to use best endeavours to consider PBAC recommendations within six months that its response would be to do just that, and indeed announce the deferral of multiple drugs to a time not yet committed to!!

Jody Fassina specialises in providing strategic counsel to both corporate and non-profit organisations requiring high level advice on public policy issues of paramount importance to their organisation. Jody has worked as a senior public affairs manager in the corporate sector with Macquarie Bank, a political consultant with a boutique Sydney firm and as a senior policy advisor to federal MPs . He is currently an independent political consultant, having established JF Consulting.

 For more information contact Jody Fassina at fassinaconsulting@bigpond.com 

By: Rachael Randal

Within the toolbox of PR research and measurement, there is a no more contentious utensil than the Advertising Value Equivalent (AVE). Its use has long been condemned by the Public Relations Institute of Australia (PRIA) and countless PR societies worldwide. By definition, it places media space or time purchased as advertising in parity with that earned through PR, but even if the cost and quantity of the space or time is equivalent, control over content and placement, as well as credibility and influence, are most certainly not.

Despite its significant flaws, the AVE still gets a substantial amount of air time within serious conversation on PR measurement, disproportionate to its value. According to a UK PR Consultants Association survey in May this year, over a third of respondents admitted to continuing to use this evaluation model. It is relatively inexpensive and simple to calculate, and many argue that there is no accessible alternative.

But now, we are decidedly moving along the path toward another option – a new validated metrics matrix that is the result of a five-month review by the International Association for Measurement and Evaluation of Communication (AMEC). This new approach, which was previewed recently at a conference in London, is not just another industry fad that over simplifies the contribution of PR by implying instant results. It takes into account not only OUTPUTS – how the messages are distributed through a third party in a way that could impact the target audiences – but also OUTTAKES and OUTCOMES – how the messages are consumed by the target audiences and the impact they have on awareness, understanding, interest, support and action. A complex web of parameters can be used depending on the type and objective of PR activity being evaluated– from number, frequency and prominence of media articles, to key message alignment and accuracy of fact, to expressed opinions online, to Likes/retweets and Linkbacks to progress against initial outcome targets. The key underlying principles for best practice in evaluation remain the same as always: plan fro

m the outset what measurements you will do and conduct baseline research so you have clear benchmark data against which you can assess change.

This is an important milestone in the evolution of communications and so

mething agencies and in-house PR teams have been aiming towards for a long time. The new set of metrics provides the reassurance we all need to continue our commitment to demonstrating the true value of PR for achieving business results.

The PR industry needs to move away from measurement as a media analysis tool to something more, as business decision support. - Report International’s director Mike Daniels argued at the AMEC conference

This week marks a landmark moment in Australia’s healthcare system when a key item in the Government’s health reform plans is fully realised.  In a major change that will affect nurses – but also GPs, patients and the pharmaceutical industry – nurse practitioners and midwives will now have the power to access specific Medicare Benefits Schedule (MBS) items and prescribe certain medicines subsidised on the Pharmaceutical Benefits Scheme (PBS).

The change in legislation recognises the highly-skilled and capable Australian nursing and midwifery workforce, providing a new framework to enhance and expand their role in providing quality healthcare.

Nurse prescribing is common practice overseas. The UK has seen a significant shift in the last two decades in nurse prescribing – which started in the 1990s when community based nurses were able to prescribe independently from a limited formulary. Since May 2006 independent nurse prescribers have been given the ability to “prescribe any licensed medicine for any medical condition within their competence.”

With this local shift in prescribing power now happening in Australia’s healthcare system, divisions in opinion and the murmur of a ‘turf war’ were always going to be inevitable. Great effort has been made to ensure the change in legislation preserved the requirement for nurse practitioners and midwives to work in collaboration with medical practitioners to access the MBS and PBS – essentially ensuring GPs are ‘kept in the loop’.  The AMA has gone to considerable lengths to help GPs prepare for the changes asking them to ‘embrace the changes’ or risk the possibility of jeopardising the mandated collaborative arrangements.

Importantly everyday Aussies are reportedly supportive of the Government’s move. Research just released by the Australian Primary Health Care Research Institute (APHCRI) has shown Australians know the difference between being sick and needing a doctor and those “everyday health concerns” when a nurse practitioner would suffice.

Responses to the ongoing APHCRI survey has stated nurses are “good listeners” and could cater for “everyday health concerns, such as repeat prescriptions and minor illnesses, to free up GPs to manage more complex conditions.”  Shorter waiting times and better access to primary care has been identified as important advantages.

There is no doubt this represents a major milestone in Australia’s healthcare system. Ensuring this significant move enhances the delivery of best possible healthcare to Australians will be critical.  Time will tell whether or not we can indeed reach the levels of contribution nurse practitioners are making in the UK.

Last week’s departure of former PM Kevin Rudd and Julia Gillard’s ascent into leadership broke Australian news site traffic records. And with every other media outlet in the country still running red hot with Gillard news, it would seem almost unfair not to mention our new PM’s impact on health policy.
 
As a start, Julia Gillard has proficient experience in the area, serving for three years as the Opposition health spokeswoman during Abbott’s tenure as Federal Health Minister. She has also been involved in Rudd’s own ‘health revolution’.
 
A recent Galaxy poll shows nearly a quarter of us want to see a fast-track of the health reforms as a first priority. But what do the various industry bodies have to say about whether or not health policy will be given the red light by the new leadership?
 
The doctors
 
The AMA says that a leadership change is not likely to change the track of health policy. The group is also of the belief that Rudd’s National Health and Hospitals Network will remain in place.
 
The nurses
 
The ANF believes Gillard has what it takes to win the election – ‘Australians want a hospital, aged care and primary health care system that works and Labor has demonstrated a keen understanding of this’. The group also welcomes the first female PM into the fold.

The e-health experts
 
…say Gillard gets it and they look forward to see how the e-health agenda progresses.

The mental health advocates
 
Mental health experts are hopeful that our new leader will put mental health higher on the agenda. A great deal of momentum developed in the lead up to the leadership shake up, with over 60 organisations delivering nearly 100,000 signatories calling for an urgent focus on mental health – but this was unfortunately delivered to the wrong PM.

Professor Patrick McGorry sees this momentum as an incredible opportunity for the Gillard Government to take action and score some ‘brownie points’ in the lead up to the election.

But watch out Julia – Tony Abbott just pledged $1.5b to improve front-line mental health services if the Coalition is elected.
 
Health got a mention in Julia Gillard’s acceptance speech (video below, in case you missed it). Will this enthusiasm translate into action?

At the Pharmacy Expo held in Sydney from 4-6 June there was much discussion about the evolving role of the Pharmacy Assistant in the modern pharmacy environment.

The Footy Show in Melbourne leads in with their theme “It’s more than a Game”, but in Community Pharmacy land, the role of the Pharmacy Assistant is certainly “more than a name”. They come into the pharmacy industry with wide-eyed enthusiasm, but is their title really appropriate – one which reflects their status in their role in the Pharmacy healthcare team?

Pharmacy Assistants are fundamentally important to the survival of Community Pharmacy as we know it. As the ‘coalface’ representatives, they offer the caring perspective with which the pharmacy industry is entrusted and must multi-task every day. An average day in Pharmacy sees the whole spectrum of humanity – from those with minor illnesses, to impatient individuals and drug-dependent people with accompanying overt behaviour. Being passionate, understanding, knowledgeable, structured and organised are elementary requirements for a career in this challenging environment.

As an increasing number of Australians look to the pharmacy for ‘everyday’ management of their health concerns, the Pharmacy Assistant will become an increasingly important entity within the business. Pharmacists do expect Pharmacy Assistants to keep abreast of the latest information on treatments and disease areas, but are they encouraged and rewarded for this ongoing career development? There are a number of ways we can do this:

• Consider initiating a specialised pathway which allows career development in a particular area – diabetes, natural medicines, wound care or cardiovascular health -  complementing the role of the Pharmacist
• Encourage improvement of their professional skills by providing relevant courses and seminars
• Provide the opportunity for online study/learning, and incentivise with appropriate rewards
• Ensure they are kept informed of the latest product news and launches via the pharmacy media, particularly PostScript and Contact
• Always consider the messages and language appropriate to this audience and focus on helping them to have the confidence to conduct a consultation with customers that offers real solutions
• Highlight great work – showcase ‘stars’ through appropriate communications channels so all Pharmacy Assistants recognise what ‘the best in the business’ is all about.

Now is the time for the role of Pharmacy Assistants to be recognised and re-branded. What’s in a name? Let us know your thoughts below…

This blog has been co-authored by Gerald Quigley, practicing Community Pharmacist & Accredited Herbalist & Lisa Burling from Cube

The healthcare landscape is constantly changing, and this can be a lot to keep on top of for any busy health professional. So it’s no wonder that ongoing education needs to be such an important element of their roles. Important, but not necessarily mandatory. Not until now, that is…

Enter the National Registration and Accreditation Scheme, a new system coming into effect in Australia from 1^st July 2010.

What is it?

The National Registration and Accreditation Scheme is being introduced to create a unified national registration system for medical doctors, nurses/midwives, pharmacists and practitioners in seven other health occupations. It will ensure that consistent standards of practice are upheld by all health professions in Australia. As part of this, the new scheme will make it compulsory for health practitioners to partake in continuing professional development (CPD) and meet specified targets for educational credits accumulated over the course of a year.

Why is it important?

CPD has long been available to health practitioners in the form of training modules, certification courses and sponsored events, such as seminars and symposia; however participation was often reliant on two things: professional interest and personal initiative. By introducing national standards and making CPD mandatory, participation in accredited activities will become a medical mainstay and practitioners will be looking to professional bodies, teaching institutions and commercial purveyors of healthcare education to provide the learning opportunities they require.

But with great power comes great responsibility and educators must always be mindful of their responsibility to provide the highest standards of quality and value to the health professionals who will be relying on them.

For more information on the new system and how to get a pharmacist CPD module accredited visit website of the Pharmaceutical Society of Australia.

Over the coming weeks, additional information will be made available about accreditation procedures for other professions including GPs, specialists, nurses, opticians, dentists, osteopaths, psychologists and the like, so keep your notebooks open  and your pencils at ready – there will be a quiz!

By Mitzi Saitzyk

Health literacy in Australia... as easy as ABC? Cube PR blog

For all of us working in the healthcare industry, it is easy to focus all our attention on the development and delivery of information to patients and the general public at large. However, it is becoming increasingly apparent that we must also pay attention to how that information will be received and understood – a process referred to as ‘health literacy’. At last week’s FROCOMM Health Communications, Marketing & Media Conference, the topic took centre stage – what it is, how Australia is fairing and ways to improve it.

Search the internet and you will find a plethora of information on health literacy, ranging from official Government-funded reports to blogs which ask why Australia, a nation obsessed with health, lags behind, albeit slightly, other first-world countries such as Canada.

Health literacy is described as a person’s ability to use health information effectively. The Australian Bureau of Statistics (ABS) provides a more detailed definition - “the knowledge and skills required to understand and use information relating to health issues such as drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies and staying healthy”.

Health literacy has become an increasing focus in recent years amongst Government and academics. The latest version of the ABS ‘Health Literacy, Australia’ report delves deep into demographic distinctions and, whilst it’s not hugely surprising that people with higher formal education attainment achieve higher levels of health literacy, age does have a significant impact. Health literacy it increases from 15 to 39 years, then decreases for those ages 40 and over. The ABS report surmises this is because aging causes physical, psychological and social change.

Just last year, two reports into health literacy were released, both unveiling worrying findings. The National Health and Hospitals Reform Commission (NHHRC) report found six out of every 10 Australians would experience difficulty in understanding or making the choices necessary to stay healthy, or to find their way round the health system. Similarly, a study by Australian doctors at the University of Adelaide stated many people do not understand basic health information.

That is enough of the problem – what are the potential solutions? At the FROCOMM conference a number of people representing universities and industry associations offered their views. Peter Waterman from the Pharmaceutical Society of Australia encourages people to search through the society’s Pharmacy Self Care program online, which has over 80 separate factsheets on topics as diverse as Alzheimer’s, antibiotics and alcohol. The Society also recently set up a Facebook page in an attempt to have as more direct dialogue with consumers.

Deon Schoombie from the Australian Self-Medication Industry (ASMI) agrees consumers should seek to have a direct dialogue with their healthcare professional. He also highlighted social media as the ideal way to engage publicly and directly with people as it is about them and allows the health system to offer a tailored message, bringing the system closer to a real conversation/interaction. ASMI recently launched a Facebook page, Twitter profile and regular blog, demonstrating their tangible belief in this viewpoint.

All FROCOMM panellists agreed that better education in schools is critical as is making the health system more accessible. (Backing up this viewpoint, the NHHRC report also recommends health literacy be included as a core element in the curriculum for both primary and secondary schools).

The provision of information in a consumer-friendly and engaging manner and connecting consumers with HCPs quickly was also discussed. Professor Clare Collins from the Dietitians Association of Australia believes flexibility of information delivery will help ensure it captures the attention of the target population – for example, SMS texting for younger populations.

Is getting Australia’s health literacy levels to the standard they should be as easy as ABC? Not quite, but addressing the issue must remain a priority to ensure Australia remains a truly healthy nation. As part of Australia’s healthcare industry, we have a unique opportunity to help in a tangible way  by ensuring we focus on the 3 d’s with all communications materials – developing, delivering and perhaps most importantly, deciphering.

New reforms proposed by the Therapeutic Goods Administration (TGA) could see future prescription medicines approved in less than 300 days.

For Australians waiting for medicines which could potentially lead to better health outcomes and improved quality of life, it’s still a long wait. But the reduced timeframe (down from an average of 500 days) represents a significant development in facilitating earlier access to novel therapies in Australia.

The TGA believes a new pre-submission phase, to be conducted over 90 days, will ensure companies are clear on core requirements for an effective submission. This in turn should encourage higher quality submissions and eliminate unnecessary queues and delays in the evaluation process.

For the pharmaceutical industry, the proposed reforms are a positive outcome but it is clear that many challenges lie ahead.

In a recent information session held in Sydney, the TGA opened the floor to a few hundred regulatory specialists whose questions related to the underlying requirements which will underpin the new process.

Although pleased with the prospect of reduced timeframes, many expressed concern that 30 days does not provide enough time for companies to respond to a consolidated set of questions (a requirement in the 1st round assessment) – especially when consultation with overseas head offices and external stakeholders is required.

TGA cuts waiting times - industry to consider timelines

Other questions revolved around the TGA’s ability to manage the backlog of existing applications and how this will impact on new applications and the process which needs to be followed during the transition stage.

The TGA appreciate the proposed reforms involve a commitment from both the TGA and industry. The TGA must be able to offer effective resource planning, while companies will need to have processes in place to ensure overseas stakeholders can contribute to the company’s response to the TGA’s consolidated set of questions in a timely manner.

Will industry be able to deliver on this core requirement? And will the TGA be able to reassure Australians that standards for safety and efficacy of new prescription medicines will not be compromised with the shorter timelines?

The TGA is inviting external stakeholders to review the proposed changes and provide comment on its consultation paper by 22 March 2010.

2010 marks 50 years since Medicines Australia first introduced the Code of Conduct. In five decades the Code has evolved dramatically. From a small booklet in the 1960s that could practically fit in a back pocket and scrutinised use of telegrams as a communications channel – to Edition 16 now two A4 manuscripts holding almost 300 pages with Facebook, Twitter and YouTube under the microscope!

Edition 16 now provides the pharmaceutical industry with even tighter and more specific standards for the marketing and promotion of prescription products and engagement with healthcare professionals, patients and the general public.

When it comes to communicating with the general public what was once quite ‘grey’ and open to interpretation, has become far more lucid.

New Code now in play

For the first time there is clarity on previously debated areas. When a company can issue a product-specific media release and what can and can’t be included is now qualified. How a company can respond to journalists requesting internationally released data on unregistered or ‘off-label’ products is also specified.

Edition 16 also features a sub-section on social media, recognising that while industry is still a little cautious with this new sphere of communication, it cannot be ignored.

At first glance Edition 16 may come across as more restrictive when it comes to industry’s relationship with the general public and media. And no doubt, it has prompted many a communications professional to consider how to convey a balanced, Code-compliant message that also piques the interest of one of its primary conduits of communication – the media.

However, on closer assessment, clarification of ‘grey’ areas and the setting of very clear parameters to work within can only be seen as a positive step. Greater alignment and consistency among each company’s approach to marketing and communications is important – and may assist in minimising the public scrutiny the industry has been forced to face in recent years.