Love it or lose it

Health care holds an enormous slice of Australia’s budgetary pie, a proportion that only stands to increase as our population continues to age.

A constant struggle for health care advocates and a persistent area of focus for successive governments is: how can we hold onto the things that work, improve the things that have potential and decide when to drop the things that are failing?

Political ideology aside, ensuring the right balance is struck remains a struggle, so it is in the best interests of the system, the workforce and, most importantly, Australian patients, that we cut through the noise and protect ongoing investment in the elements of our healthcare that are — or that should be — the envy of the world.

PBS — a long history

One such area is ensuring equitable access to new (and therefore costly) medicines through the Pharmaceutical Benefits Scheme (PBS). While the PBS has been a common point of pride for Commonwealth governments since 1948, its younger and more complex cousin — the PBS Medicines in Public Hospitals Pharmaceutical Reforms agreement (aka the PBS Medicines in Hospitals program) — is largely unknown outside pharmacy circles.

Commencing in 1998, the PBS Medicines in Hospitals program was an innovative, early attempt to resolve problems caused by the Commonwealth and jurisdictional divide in healthcare service delivery and the associated supply of medicines. Private hospitals already had a similar agreement, which funded PBS medicines for inpatient use and at patient discharge.

The program saw public hospitals receive funding from the federal government for using their staff and infrastructure to treat people with PBS medicines for key conditions and encouraged hospitals to supply 30 days of medicines for patients being discharged, a far longer supply than had previously been supported. This reduced inconvenience to patients, improved medicine adherence and prevented urgent and unnecessary GP appointments related to hospital-initiated medicines.

As part of a commitment to high-quality care, the original agreements also mandated each participating state and territory government achieve the Australian Pharmaceutical Advisory Council’s guiding principles that aim to improve medication safety, specifically across high-risk transitions of care such as between hospital and home. In a great demonstration of collaboration and commitment to patient-centred care, between 2001 and 2011 all states and territories, except ACT and NSW, signed up.

Unlike other federal health funding, PBS remuneration was paid directly to pharmacy departments, which enabled the employment of clinical pharmacists to counsel patients, advise doctors and nurses, dispense medicines and coordinate clinics using PBS medicines.

Impact of budget cuts

Over the ensuing years, this PBS funding became an essential component of public hospital operations, yet at the same time it is clear Commonwealth Government understanding and appreciation of the program has decreased: the 2019 Federal Budget included a discreet $44 million cut of annual funding for public and private hospitals dispensing PBS medicines. Despite great enthusiasm for listing new medicines, support for hospitals to use them is fading.

Beyond this funding cut, it is clear hospital pharmacy remains an under-funded and under-utilised clinical service in many hospitals. Despite hospital pharmacies’ best efforts, medication-related incidents after hospital discharge continue to climb — 90% of patients experience at least one problem — and across Australia there are 250,000 hospital admissions each year as a result of these issues.

As the professional partner of Australia’s leading community of hospital pharmacists and pharmacy technicians, SHPA is determined to ensure the PBS Medicines in Public Hospitals Pharmaceutical Reforms program is not a victim of its quiet success. On behalf of all hospital pharmacists, SHPA will continue to push for adequate PBS funding for public and private hospitals, recommitment to the reforms program (including NSW and ACT agreements) and engagement in collaborative discussion and data sharing with relevant jurisdictional governments.

Investing in complex medicines without investing in hospital pharmacy is like investing in a new aeroplane without a flight crew: great visuals but not going anywhere.

PBS-listed medicines are not available in the supermarket or ‘off the shelf’ for good reason. They are complex medicines requiring careful consultation and attention to quality and safety by pharmacists as key members of Australia’s healthcare workforce.

 

*Kristin Michaels is the Chief Executive Officer of The Society of Hospital Pharmacists of Australia, with a keen interest and experience in health system design. She is a seasoned board director in the primary, acute and aged-care sectors. Kristin holds qualifications in arts, organisational leadership, governance and health service management. She is a Fellow of the Australian Institute of Company Directors and is accredited as an international partnership broker.

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