September 18, 2021

General

Increase our health workforce before it’s too late

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The NSW Nurses and Midwives’ Association (NSWNMA) has renewed calls for the state government to fast-track the remainder of a nursing and midwifery workforce ‘boost’, following the release of hospital data outlining the widespread pressures across public hospitals.

The latest Bureau of Health Information quarterly report shows even prior to the extraordinary strain of the current COVID-19 outbreak, public hospital emergency departments were facing record-high attendances and patients were waiting longer.

NSWNMA General Secretary, Brett Holmes, said the April to June data further reinforced the urgent need for more nurses and midwives to be recruited to deliver the level of safe care every patient required.

“Once again we’ve got record numbers of people seeking urgent medical care at their public hospitals. More patients, arriving very unwell, and longer wait times are all an unfortunate recipe for poorer health outcomes,” said Mr Holmes.

“Add to that a record number of babies delivered, and the highest number of elective surgeries ever performed for the quarter, and the unprecedented demand being placed on our health workforce is apparent.

“Our members have repeatedly called for nurse-to-patient ratios to be introduced across our health system to meet the ever-increasing demand, yet they continue to be ignored by the government.

“The government must bring forward the rest of its planned workforce ‘boost’ and better support the growing number of fatigued and burnt-out nurses and midwives who have continued to battle on under mounting pressures.

“Nurses and midwives across NSW deserve more than token acknowledgements by the government for their ongoing efforts.

“Nurses and midwives should be afforded adequate recognition for keeping our public hospitals open and deserve to be heard when raising serious patient safety or professional concerns.

“We need the right numbers of nurses and midwives, with the right skills, to be available at the right time – that includes shift-by-shift ratios across areas such as emergency departments, critical care units, maternity services and acute mental health units.”

The NSWNMA is continuing to support nurses and midwives who are confronting the ongoing pandemic, as well as pursuing the shared goal of mandated nurse-to-patient ratios in NSW.

The media contributes to vaccine hesitancy: experts

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Media reporting on COVID vaccines should be careful to contextualise the benefits alongside the risks, say experts.

Vaccine hesitancy has been a notable hurdle in Australia’s troubled vaccine rollout and the media has played a role in fuelling fears, say experts.

Two Griffith University academics – Heather Green, a senior lecturer at the School of Applied Psychology, and Joan Carlini, a lecturer from the Department of Marketing – say reporting on vaccine hesitancy must be handled carefully.

“In a global study, three of 13 national and state-level immunisation managers interviewed said negative information conveyed in the mass media contributed to vaccine hesitancy in their countries.

“On the flip side, media reports about influenza and vaccination can also increase vaccination uptake,” they wrote in the online magazine, The Conversation. 

A Griffith University survey conducted in the middle of 2020 found that 68 per cent of people would take a COVID-19 vaccine if one was available.

“Any reporting on Australians’ inclination to vaccinate should reinforce what is in fact the social norm – the intention of the majority to receive a COVID vaccine,” the academics say.

Calls for Nurse Practitioners to be utilised in COVID vaccination roll-out

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A coalition of peak nursing organisations is calling on National Cabinet today to include Australia’s highly-skilled nursing practitioner (NP) workforce in the COVID vaccination roll-out.

Nurses deliver the majority of vaccines in Australia and NPs are the most highly skilled and educated nurses in the clinical nursing workforce.  NPs have the qualifications and expertise to diagnose, order investigations and prescribe medicines. They are recognised as being able to lead a health team in exactly the same way as a doctor can and are actively engaged with a developed client base in their communities

NPs service many of the underserved and isolated populations across the country, but are blocked from supporting the COVID 19 vaccination program, after being sidelined by the Morrison Government. The coalition of peak nursing organisations is ready to immediately support government efforts to identify and recruit nurses and operationalise a nurse-practitioner-led response to the COVID-19 vaccination roll-out.

Currently, the Australian population over 18 numbers 19.01 Million. Of these 14.1% are fully vaccinated and a further 17.7% have had their first dose. As a nation, we must have at least 80% of the population vaccinated to return to ‘normal life’. This can be achieved sooner if NPs are included in the vaccination roll-out.

The peak nursing organisations have urged National Cabinet to include a NP-led vaccination model to accelerate the vaccination roll-out:

  • 250 Vaccine Strike Teams spread throughout the country – Nursing homes, stadiums, convention centres, universities, rural and remote sites;
  • Each team led by 1 Nurse Practitioner with 10 Nurses and 3 administrative staff;
  • Each nurse vaccinating 15 patients an hour approximately (based on 50% efficiency of a nurse-led school vaccination program);
  • Each strike team can vaccinate 1200 patients per day based on an 8 hr day;
  • 250 teams will vaccinate 300,000 patients per day;
  • 1,500,000 patients vaccinated every week, based on a 5 day working week.

Under the plan, the time for the entire Australian population having a first dose would be 8.9 weeks. The time for the entire Australian population having the second dose is 10.8 weeks (plus 1 month for Pfizer and 3 months for AZ).

Some pharmacies are already recruiting NPs to oversee their local vaccination programs. The use of NPs in the vaccination roll-out is vital to protect Australians from COVID-19.

In contrast to Australia’s success with hepatitis C, our response to hepatitis B is lagging

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Around one-third of Australians living with hepatitis C have been cured in the last four years.

Hepatitis means inflammation of the liver. Hepatitis C is one of five varieties of viral hepatitis (A-E), and alongside hepatitis B, is responsible for the majority of illness caused by hepatitis.

Australia’s response to hepatitis C is seen as a leading example around the world, and the elimination of the disease as a major public health threat is looking like an increasingly achievable goal.

But the situation is much less promising for Australians living with hepatitis B, which is now the most common blood-borne viral infection in Australia. It affects more people than hepatitis C and HIV combined.

In our research published today, we show Australia is falling short of its targets to reduce the burden of hepatitis B. Looking to the way we’ve responded to hepatitis C may set us on a better path.

Hepatitis C treatment

There were an estimated 182,144 people living with chronic hepatitis C in Australia at the end of 2017.

A number of important drugs were listed on the Pharmaceutical Benefits Scheme (PBS) from 2016, making curative treatments available to nearly all Australians living with hepatitis C.

The number of treatments being initiated has fallen significantly since the early peak, and significant differences exist in who has accessed the treatments across Australia. Nonetheless, Australia’s response to hepatitis C is highly regarded as an example of how to rapidly scale up hepatitis C treatment in a population, including among people who inject drugs.

Recent data from New South Wales demonstrate access to hepatitis C cures has led to a drop in the number of people with hepatitis C dying from liver cancer, with the bend in the curve coinciding with listing of these new treatments on the PBS in 2016.

Hepatitis B treatment

There were an estimated 221,420 people living with chronic hepatitis B in Australia in 2017. Along the trajectory of the disease, those who have liver disease or are at risk of developing liver disease require treatment.

Unlike hepatitis C, hepatitis B cannot be cured with current treatments, so ongoing antiviral therapy is required. This is similar to the treatment received by someone with HIV.

Although not a cure, the available treatments are effective. Current hepatitis B treatments have been associated with reducing the risk of liver cancer by around 50% in the first five years of treatment.

Scaling up such treatment and care will be a critical element in reversing the increasing tide of liver cancer deaths in Australia.

Targets

By 2030, the World Health Organisation has set out that 90% of people with hepatitis B should be diagnosed, 80% of those who meet criteria for treatment should be treated, and deaths due to hepatitis B should be reduced by 65% relative to 2015 globally.

In Australia, our Third National Hepatitis B Strategy sets targets to be achieved by 2022, including diagnosing 80% of people, engaging 50% of people in care, treating 20% of people, and reducing deaths due to hepatitis B by 30%.

Measuring progress towards these targets is complicated and requires consideration of a range of demographic and other factors. Considering most people living with hepatitis B in Australia were born overseas or are Aboriginal or Torres Strait Islander peoples, up-to-date estimates of Indigenous status and migration flows into and out of Australia are essential. Estimates of the prevalence of hepatitis B in different groups and detailed information about the natural history of hepatitis B in individuals over time is also important.

Our research

Taking these complexities into account, we’ve constructed a mathematical model simulating the burden of hepatitis B in the Australian population from 1951 to 2030. We wanted to see how Australia is faring in terms of meeting national and international targets.

By 2022, if current trends continue, the proportion of people diagnosed will reach 71% (short of the 80% goal). Some 11.2% of Australians living with hepatitis B will be on treatment (short of the 20% target). But we estimate the proportion who actually need treatment is around 30%, so we have a long way to go.

In related work mapping the burden of hepatitis B and estimating differences in treatment and care nationally we estimate only 20% of people living with hepatitis B are engaged in care (either being appropriately monitored or receiving treatment). Again, this is well short of the 50% target.

So why aren’t we meeting these targets?

Broader inequities in health access and outcomes for culturally and linguistically diverse groups and Aboriginal and Torres Strait Islander peoples play a substantial role. Together they represent over two-thirds of Australians living with hepatitis B.

Current delivery of treatment and care differs across the country. The experience and strategies used in those areas with higher levels of treatment and care should be examined and shared to address the inequities observed across Australia.

Like hepatitis C, Australia’s response to the needs of people living with HIV is viewed as being of a high standard. Two elements central to our responses to hepatitis C and HIV are currently missing for hepatitis B.

The first is strong, ongoing community engagement and leadership of the response by those affected. While organisations representing people living with HIV have existed since the 1980s and for hepatitis C since the 1990s, engagement with people living with hepatitis B has lagged well behind.

The second is treatment and care primarily being delivered in the community by primary care clinicians (especially GPs) – rather than in hospitals and by specialists, as is the case for most people living with hepatitis B. Many patients prefer seeing GPs and find this more convenient than waiting for hospital appointments and seeing specialists. This can be especially true for people living far from major hospitals, reflected in the fact hepatitis B treatment uptake is much lower than average in regional and rural areas of Australia.

Making it happen

Although both factors are priorities for action in the National Hepatitis B Strategy, progress will require ongoing funding and coordinated efforts by the Commonwealth, state and territory governments, primary health networks, and other partners.

The impact will be measured, not just in modelled estimates, but in real lives saved. While we’re not yet on track to meet our targets for hepatitis B in Australia, our modelling suggests even with the relatively low current uptake of treatment and care, 2,300 Australian lives were saved between 2000 and 2017, which otherwise would have been lost to liver cancer and liver failure caused by hepatitis B.

If we can translate what has been learned in our HIV and hepatitis C responses to increase access to essential care for Australians living with hepatitis B, thousands more lives can be saved in the next decade and beyond.The Conversation

Benjamin Cowie, Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity; Karen McCulloch, Research Fellow, University of Melbourne, and Nicole Romero, Epidemiologist, WHO Collaboating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Explainer: the A, B, C, D and E of hepatitis

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Hepatitis means inflammation of the liver. While we usually think of hepatitis A to E viruses, anything that causes inflammation or damage to the liver can be considered as a form of hepatitis.

Hepatitis A, B, C, D and E are very different viruses. Hepatitis A is genetically closer to the common cold than it is to hepatitis B, for example. Hepatitis C is closer to the virus that causes dengue fever.

The thing all five have in common is they can cause mild to very severe liver damage.

Viral hepatitis caused around 1.45 million deaths in 2013, making it the seventh leading cause of death world-wide; 96% of these were due to hepatitis B and C.

Hepatitis A

Hepatitis A is spread by contaminated food and water, and from person to person via faecal transmission, particularly in household settings.

Hippocrates first described epidemics of diarrhoea and jaundice as far back as the fifth century BCE.

Although hepatitis A can cause significant illness, the body usually recovers without treatment and becomes immune to future infections.

Vaccines can prevent hepatitis A; these are recommended for travellers and other groups at particular risk of infection. Vaccination given early after exposure can also prevent hepatitis A from developing.

Hepatitis B

This is the most prevalent form of viral hepatitis worldwide. It’s also the leading cause of liver cancer.

An estimated 250 million people live with hepatitis B worldwide. Around 220,000 Australians are thought to be living with chronic hepatitis B.

Hepatitis B can be transmitted from person to person through sex or blood-to-blood contact. But most people living with chronic (long-term) hepatitis B acquired it at birth from their mother, or early in life. Following infection, the chance of developing chronic hepatitis B in infancy is around 90%, but falls to 5% among adults.

A safe and highly effective vaccine has been available for hepatitis B since the 1980s. It has been provided for all infants born in Australia since May 2000.

In China, the proportion of children aged under five who had chronic hepatitis B fell from 9.7% in 1992 to 1% in 2006 after a vaccination program was introduced. The program has prevented millions of deaths from liver cancer and liver cirrhosis in China alone.

Effective antiviral treatments are also available for chronic hepatitis B. These can prevent liver damage and liver cancer from occurring. But even in a well-resourced country such as Australia, only a minority of people needing treatment and care for hepatitis B are receiving it.

Hepatitis C

This is the most common cause of viral hepatitis in Australia; an estimated 230,000 people live with chronic infection.

Hepatitis C is the leading cause of liver cancer and liver transplants nationally.

Most hepatitis C infections in Australia were acquired through unsafe injecting drug use. But in some low-resource countries, ongoing transmission of hepatitis C in health care settings is a major problem.

Around 80% of people infected with hepatitis C develop chronic infection; those who do clear the infection naturally remain susceptible to future infections.

No vaccine for hepatitis C is available.

On March 1, new treatments were listed on the Pharmaceutical Benefits Scheme (PBS). Although expensive, these treatments represent a huge advance and are a cost-effective way to prevent both new infections and deaths due to existing hepatitis C infections. With cure rates of the order of 90% with 8-24 weeks of tablets, and minimal side effects, these agents have the potential to drastically reduce the impact of hepatitis C.

The real key to unlocking this potential is the very liberal access criteria the Commonwealth government has applied to these treatments. As a result, uptake of treatment for hepatitis C in Australia has risen more than 20-fold.

Hepatitis D

Hepatitis D is a satellite virus that can only infect people who also have hepatitis B.

It is estimated that approximately 5% of people living with hepatitis B globally also have hepatitis D, which can lead to more severe liver disease.

Hepatitis E

Hepatitis E, like hepatitis A, is spread through contaminated food and water.

The first outbreak of hepatitis E infection acquired in Australia was reported earlier this year.

While hepatitis E is usually relatively mild, it can cause serious illness late in pregnancy, with a death rate of up to 20% among pregnant women in their third trimester.

A vaccine against hepatitis E has been developed but is currently licensed only in China.

While viral hepatitis remains a substantial public health challenge in Australia and world-wide, with political will, adequate investment and global partnerships, the world can eliminate viral hepatitis by 2030.The Conversation

Benjamin Cowie, Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Nurses and midwives reject pay offer and poor staffing

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For the first time in eight years, a resounding majority of public sector nurses and midwives have voted not to accept the NSW government’s pay offer and lack of shift-by-shift ratios.

The NSW Nurses and Midwives’ Association (NSWNMA) conveyed the decision to NSW Health officials this morning, after its branches unanimously dismissed the 1.04% pay offer as ‘pitiful’ and ‘insulting’.

NSWNMA members were furious the government had ignored their comprehensive claim for safe staffing using nurse-to-patient ratios and said the pay offer fell well short of the 4.7% increase sought by the union earlier in the year.

NSWNMA General Secretary, Brett Holmes, said members felt the government’s offer showed a ‘complete disregard’ for all they do around the clock, let alone during the pandemic, to keep essential health services running and communities safe.

“The number one priority of our members has always been to maintain safe patient care and deliver the best possible health outcomes. What more do they have to do in order for their voices to be heard by this government?” said Mr Holmes.

“This offer simply isn’t good enough. Nurses and midwives across the state have done so much this past year. Understandably, they feel more than taken for granted. They’re deeply insulted.

“To not consider any improvements to their working conditions or discuss measures that would increase patient safety inside our public hospitals and health facilities is quite frankly, reckless.

“We are willing to sit across the table and will continue to outline the overwhelming evidence from Queensland and Victoria, following their successful introduction of legislated nurse-to-patient ratios since 2016 and 2015 respectively.

“What is the NSW government so afraid of? Our public health system is bursting at the seams and increased pressure is being piled onto health workers year after year.

“The government knows we’ve got a staffing crisis in our hospitals and the failure to adopt shift-by-shift ratios is leading more nurses and midwives to leave these professions.

“Seeking safe staffing through shift-by-shift ratios and fair pay is not excessive. It’s what NSW needs and would help the workforce feel much more valued than it currently does.”

The NSWNMA confirmed it was continuing to canvass all options available in response to current negotiations with NSW Health.