Latest News National Accreditation and Registration 8th September 2008 The APodC continues to be concerned regarding a number of issues associated with the concept of national registration and accreditation. The Scheme, as it has become known, is to take effect from 2010. Currently, the legal and legislative framework is being developed with the first piece of this work the creation a parliamentary Bill (know as Bill A: which is one of three bills). This Bill is to be introduced into the Queensland parliament in December. Bill A is designed to facilitate the functioning and/or the operational aspects of the Intergovernmental Agreement (IGA). The APodC has been invited to participate in various stakeholder forums over the last 6 weeks: Professions Reference Groups – representing ‘health peak bodies’ and the Forum of Australian Health Professions Councils – representing ‘health bodies’ accrediting schools and clinicians. Last week in Canberra the APodC made the following recommendations at the stakeholder forum of the Health Workforce Principal Committee in relation to the drafting of Bill A: That the professional National Boards must control resources derived from the specific profession to enable a clear and transparent funding process Failure to do so will result in loss of control over registration fees Loss of control of the roles and management of staff The importance of maintaining the independence of accreditation and standards It was recommended that the profession develop the standards and sign-off comes from a professional accreditation body, rather than a Minister as stated in the IGA Check and balances need to be included into legalisation to prevent future changes without professional involvement Potential risk of Ministers imposing decisions without advice from National Boards The profession wants input defined by legalisation Concern that the Scheme will provide the Government with a vehicle for work force reform The profession wants roles and responsibilities detailed in the legalisation to ensure checks and balances to protect our professional status Bill A needs to ensure there is sufficient funds to manage the transition of continuing tasks around registration and accreditation Kelli Cheales CEO APodC Ministerial Statement by the Australian Health Ministers’ Conference Issued in Canberra on 4th September 2008 Health Ministers Outline Consultation Arrangements For National Registration and Accreditation Scheme For Health Professionals Australian Health Ministers last week announced the arrangements they will put in place to ensure that health professions, consumers, registration boards and education providers, as well as members of the general public, will have the opportunity to contribute to the implementation of the new national registration and accreditation scheme. The new scheme was agreed by the Council of Australian Governments at its meeting on March 26 2008. The Health Ministers say they will use as their guiding principles in developing the scheme legislation that public safety is paramount, that high quality health care must be protected and advanced and that the governments should be accountable and their processes transparent. The implementation arrangements and the new scheme itself are designed to ensure consultation on key matters. In announcing the consultation arrangements at a national forum convened in Canberra early September, Ministers noted that the national forum, and forums in each State and Territory being held in August and September, are just the beginning of the process of consultation and engagement. To implement the scheme, national legislation will be introduced into the Queensland Parliament in two stages. The first stage will cover the provisions of the COAG Agreement and will be introduced into the Queensland Parliament in October 2008. The second stage, to be introduced into the Queensland Parliament during August 2009, will cover matters where further work and discussion is required beyond the terms of the COAG Agreement. These includes: details of registration and accreditation arrangements, complaints and enforcement arrangements, and privacy and information sharing arrangements as well as other matters. The Health Ministers have given a commitment that consultation papers on all these issues will be available over the next three months, with the opportunity for anyone to provide a submission should they so wish. All submissions will be due before the end of 2008 with different closing dates for different topics. In the case of two issues - complaints and enforcement arrangements and privacy and information sharing arrangements - two national public consultation meetings will be held, one in October and one in November 2008. When the feedback and submissions have been analysed, Health Ministers will develop a final set of proposals for the overall policy directions for the second piece of legislation. Ministers have already made public commitments that these proposals will also be made available for public comment. According to the Australian Health Ministers’ Conference media release, a national forum – and State and Territory forums – will be held during March 2009 to discuss the proposals and public/stakeholder submissions will reportedly be accepted on any further adjustments required. Health Ministers noted that a public call for submissions has already been made on the question of whether professions currently regulated in only some States and Territories should be included in the new national scheme. Submissions on this matter are due by Friday October 3. Ministers are also committed to consultation on matters not covered in the legislation. They are committed to involving professions, the existing registration boards, accreditation bodies and education providers in designing the transition arrangements for the new scheme. To ensure the full engagement of the existing State and Territory boards in the 10 professions to be covered by the scheme from July 1 2010, a national Registration Reference Group has been set up to provide advice. There will also be a Transition Coordination Group in each State and territory, comprising the 10 boards and the local health department. A transition coordinator will be funded by governments in each State and Territory to assist the process of planning for the transition. Ministers also noted that the website www.nhwt.gov.au/natreg.asp will carry all policy papers as they are issued as well as calls for submissions and information sheets on the new accreditation scheme and its accompanying implementation process. Overweight Aussies Risk Losing Their Feet Foot Health Week 2008 It’s easy to take the two feet we are born with for granted but just try living life without them! Our feet are incredibly complex body parts. Each pair of feet is made up of 52 bones, 66 joints, 19 muscles and a network of more than 100 tendons, ligaments, muscles, blood vessels and nerves that support our feet and help to absorb the shocks of walking and running. To remind us of how important it is to maintain healthy feet, the Australasian Podiatry Council stages Foot Health Week each year to underline the strong links between foot health and individual well being and mobility. Foot Health Week 2008 runs from Sunday October 12 to Saturday October 18 and the theme for this year’s event is how Obesity Can Damage Your Feet. Being obese puts people at greater risk of developing diabetes and long-term foot, leg and back problems as carrying extra weight negatively affects every part of the body. At its worst, obesity creates diabetic complications that can lead to foot and toe amputations. Obesity Obesity is a growing problem for our society. In 2008 around 7.4 million Australians, almost half of all adults, are over weight. Almost one in three of these are obese, according to the Australian Institute of Health and Welfare’s biennial national Australia’s Health 2008 snapshot. The same report also noted that around 3 in 10 young Australians are overweight or obese. The Australian Bureau of Statistics 2005 National Health Survey found that in middle-aged groups as many as 72% of men and 58% of women were overweight or obese. The economic costs of obesity in Australia today are estimated to total around $58 billion each year, according to Access Economics. Obesity can put people at risk of long-term foot, leg, back and other chronic health problems – including type 2 Diabetes, certain cancers, cardiovascular disease and high blood pressure - as carrying extra weight negatively affects every part of the body. The physical state of becoming over weight or obese arises through a prolonged energy imbalance. Although many factors may influence a person’s weight, according to the Australian Institute of Health and Welfare (AIHW), a sustained energy imbalance need only be minor for weight gain to occur. According to the World Health Organisation, some people may be more likely to gain weight than others because of genetic and biological factors. High body weight was estimated by the AIHW to be responsible for 7.6% of the total disease burden in Australia during 2003. Obesity Linked to Foot Development Problems According to Australian podiatrists, being obese or over weight has a negative impact on the way the foot and lower limb functions during walking, running and other physical activities. Obesity can also put extra pressure on the joints in the foot, leading to problems in the way the foot aligns and functions. Excess weight can damage the delicate and immature nature of children’s feet, leaving them at particular risk of developing foot deformities and abnormalities. Obese children have wider and longer feet than normal, according to research by British Podiatrists. They also found that obese children have problems balancing and tended to walk at a slower pace. The International Journal of Obesity found in a 2001 study that foot problems in obese children could prevent them from participating in sports and other desirable forms of physical activity. Australia’s podiatrists, our foot care professionals, say this finding underlines the importance of focusing on the prevention of obesity, not trying to cure the problem after it has occurred. Excess weight in older age impairs mobility, participation in social activities and often reduces quality of life. It is estimated by the Australian Institute of Health and Welfare that Australian females aged 30 to 34 in 1980, gained 12kg as they aged to 50 to 54 years of age by 2000, while the average Australian male in the same age group gained over 8kg during the same 20 year period. Obesity and Diabetes Diabetes is becoming more common in Australia with its prevalence at least doubling during the past two decades, according to the Australian Institute of Health and Welfare’s Australia’s Health 2008 report. The inter-relationship between diabetes and obesity is clear: being obese or over weight and having poor nutritional habits are key drivers of the onset of Type-2 Diabetes. The food we eat produces sugar, which is absorbed into the cells with the help of insulin to give us energy. When sugar does not get absorbed into the cells – because not enough insulin is produced by our pancreas, or because insulin is not used effectively by the body - it remains in the blood and causes high blood sugar levels. Diabetic foot problems can result in significant social, medical and economic consequences. Diabetes can lead to damage to blood vessels and nerves, reduced blood flow to the feet, a reduction in the ability of sufferers to feel their feet and the increased risk of developing foot ulcers and infections. Sometimes, amputation of the affected foot or toe becomes unavoidable. However, with early care by their podiatrist, most patients can avoid amputation. The proportion of adults with diabetes reporting they were overweight or obese - and undertaking little or no regular exercise - was notably higher than for other non-afflicted adults, according to the Australian Bureau of Statistics 2005 National Health Survey. Registered Clinical Trials have demonstrated that regular podiatric care of patients with high risk diabetic feet significantly reduces infection rates, hospital admission days, re-ulceration, foot amputations and mortalities. Type 1 Diabetes Type 1 Diabetes mostly arises in children or young adults, although it can occur at any age. Accounting for between 10 and 15% of all diabetes cases, Type 1 Diabetes occurs because of the failure of the pancreas to produce enough insulin or because insulin is not effectively used by the body. People suffering Type 1 Diabetes need insulin replacement for survival. Type 2 Diabetes Type 2 Diabetes is not common amongst people under the age of 40. Type 2 diabetes occurs when not enough insulin is produced by our pancreas or because insulin is not used effectively by the body. Reducing The Impacts of Obesity on Feet Changing dietary habits to reduce sugar intake and increase the consumption of fibre and vitamins can help reduce weight. Increase the amount of physical exercises undertaken, including walking for at least 45 minutes each day, to reduce weight. Consult your podiatrist if you experience tingling, numbness or burning sensation in your feet. Consult your podiatrist if you have to rest because of leg pain when you walk. Consult your podiatrist if you experience any aches or pains in the ball, arch or heel of your foot. Only wear well-fitting shoes. People with diabetes should visit their local doctor for an annual foot screening. Don’t smoke. Have corns, calluses and other foot problems treated by your podiatrist as soon as they emerge. Feet Facts and Stats Our feet are incredibly complex body parts. Each pair of feet is made up of 52 bones, 66 joints, 19 muscles and a network of more than 100 tendons, ligaments, muscles, blood vessels and nerves that support our feet and help to absorb the shocks of walking and running. Children’s feet are mostly cartilage when they are born and the bones will keep growing and developing throughout childhood and adolescence. Feet grow most rapidly during childhood, as many parents already know kids can change their shoe size every few months. Children’s feet will reach half the average adult size by the age of 18 months. By the time the average person reaches an age of 50, they will have lost up to half of the shock-absorbing capacity of the natural foot pad. A person will walk around 128,000 kms in the average lifetime – equivalent to walking around the world more than three times. Our feet absorb 1.5 to 2 times our body weight during normal walking and up to four times body weight when we are jogging. General Foot Care Hints When shopping for new foot wear, you should consider: Always having both feet measured for length and width. The shoe should fit the natural shape of the foot especially around the toes. The top of the shoe should allow toes to move freely and not be squashed from the top or the sides. Make sure there is about 10mm growing room for children between the end of the longest toe and the end of the shoe. Properly fitted shoes are essential for foot health. A significant number of people wear poor-fitting shoes that can and do cause serious foot problems. Shoes should fit comfortably around the heel and not be too loose or too tight. Shop for shoes in the afternoon as feet tend to swell during the day. Washing feet and keeping them dry and clean helps to avoid irritation and minimise infection. Wear cotton socks, change them daily and air your shoes overnight to help reduce skin problems. Pantyhose or stockings should be of the correct size and preferably free of seams. A visit to your local podiatrist is recommended if: You notice uneven shoe wear. If you notice skin rashes, hard skin lumps or bumps on your feet. Your feet suffer in-grown toe nails, athlete’s foot or verrucas. You suffer recurrent pain in feet or legs. You are unexpectedly tripping or falling. If you have any other concerns about your feet. National Accreditation & Registration Scheme 2nd September 2008 The Council of Australian Governments has decided to introduce a National Registration and Accreditation Scheme (known as the Scheme) for a number of health professions, including podiatry. What this means for podiatry is that a single national agency encompassing both the registration and accreditation functions will be developed. As a result, the functions of independent state podiatry registration boards and accreditation agencies will be covered by national profession-specific boards from 2010. These boards will oversee the accreditation and registration functions now managed at state and territory level. This raises a number of questions, including will the Australasian Podiatry Council continue to manage the accreditation process as it has since 1994? With the new scheme due to begin operations during July 2010, COAG has established an implementation secretariat under the direction of Dr Louise Morauta, a former senior official from the Department of Prime Minister & Cabinet. The implementation of the national scheme will commence with uniform enabling legislation being passed by state and territory parliaments, the creation of a ministerial council to oversee the scheme together with an advisory council to assist Ministerial deliberations, the creation of 10 national professional boards to manage accreditation and registration within each of the health professions that are part of these reforms and a national peak agency to support these professional boards. The Queensland Parliament will take the lead in passing legislation to enable the national scheme. All other states and territories apart from WA will then enact the legislation in their jurisdictions, applying Queensland’s template legislation as law. WA will then enact its own similar legislation to achieve a uniform legislative framework. The first group of medical and allied health clinicians selected to enter the new accreditation Scheme learnt 12 months ago about their involvement in the process. However podiatry was seen as a special case – given registration currently does not exist in all states/territories – and it was not until mid June 2008 that the podiatry profession learnt it would be included in the first tranche of professions moving to national accreditation and registration. Accordingly, the pace of implementation is running very fast for podiatry. There are several reasons for this. Firstly, the urgent need to develop the legislation to accommodate a national framework within the government’s allocated timelines. Secondly, to change or realign all existing state legislation to ensure the scheme operates effectively. We will keep you posted. For more information on this news alert, you can contact Kelli Cheales, Australasian Podiatry Council CEO on 0411 741 815. Government Rural Podiatry Scholarships Available 11th August 2008 Applications are now open for podiatrists and other rural health care professionals to apply for Services for Australian Rural and Remote Allied Health professional scholarships. The Australian Rural and Remote Health Professionals Scholarship (ARRHPS) scheme is a Federal Government initiative designed to support the rural and remote allied health workforce. The ARRHPS scholarship program assists allied health professionals such as podiatrists living in rural areas to undertake continuing professional development activities. Relevant postgraduate study might include: Short courses Individual clinical placements to enhance and expand on clinical skills Formal tertiary postgraduate qualifications; and Attendance at relevant professional conferences. The Primary focus of SARRAH is established is to develop and provide services to enable those living and working in remote Australia to confidently and competently carry out their professional duties. Applications for SARRAH’s scholarships close on September 29 2008. For more information, and to apply for a scholarship, you can visit www.sarrah.org.au or phone 02 6285 4960. APodC Communiqué 6th August 2008 The Australasian Podiatry Council (APodC) president and vice president, on Friday 1 August convened a meeting with Australasian & New Zealand Podiatry Accreditation Council (ANZPAC) representatives to open communications between the two groups in relation to the implementation of the national accreditation and registration scheme (the Scheme) for Australian health care professionals. The meeting discussed a range of relevant issues arising from the implementation of the Australian Intergovernmental Agreement on a National Registration and Accreditation Scheme for the Health Professions. Implementation of the Scheme, for which legislation is currently being drafted, is moving rapidly and will go to the Queensland Parliament by the end of this year. Both APodC and ANZPAC agreed to ongoing consultations on all areas where professional input is required. Scott Leslie President APodC Pharmacy Guild Calls For Prescription Reform 28th July 2008 The Australian Medical Association has cautiously supported a Pharmacy Guild proposal to relax prescription rules and shift some of the associated responsibilities from doctors to allied health professionals. Pharmacy Guild President Kos Sclavos told the National Press Club at the end of July that just 20 medicines used to treat a number of chronic conditions make up 45 million prescriptions - around 25% of all claimed PBS items - each year. "For these (20) medicines, once a Doctor has initiated therapy it is our view that a pharmacist should be able to continue that therapy for up to 12 months," Mr Sclavos said. "The patient would continue to see their doctor as regularly as the doctor required under this proposal and the Doctor would remain the key coordinator of care under such an approach, Mr Sclavos said. Allowing pharmacists to continue providing a patient with, for example, the contraceptive pill without a repeat script could eliminate 4.4 million annual doctor visits and save Medicare money, having the equivalent effect of adding 450 full time GPs to the national health system, according to the Pharmacy Guild. Mr Sclavos said there were seven allied health professions, including physiotherapists and podiatrists, who were vying for the right to prescribe a limited number of medications to patients for short periods of time. The proposed changes fit with Federal Health Minister Nicola Roxon’s plan to optimise national healthcare systems by shifting a limited number of responsibilities from doctors to allied health professionals. Minister Roxon said publicly she would be happy to consider plans for prescription reform as part of the Rudd Government’s National Primary Health Care strategy. The President of the AMA, Rosanna Capolingua, told Sydney’s Daily Telegraph newspaper there were certain areas where doctors were prepared to agree to extend current prescribing rights arrangements. "Continuance for 12 months would be a sensible and convenient thing. I think we have to be mindful of convenience (and) at the same time be mindful of what’s best for patient care," Dr Capolingua said. National Primary Health Care Partnership Launched 27th June 2008 The National Primary Health Care Partnership was officially launched in Canberra by the Minister for Health, Nicola Roxon, yesterday. The NPHCP is advocating reform to the Australian health system, pointing out that it is essential for our community that we invest in building a strong and viable primary heath care sector. A national health system founded on a robust primary care sector will deliver improved population health outcomes as well as improvements in equity, access and continuity of care while lowering costs, according to APodC CEO Kelli Cheales. The NPHCP is a collaboration of 19 peak organisations representing over 100,000 primary care professionals and consumers and provides an advocacy body and communications platform for the Australian Primary Health Care sector. For more information, you can visit the NPHCP website at www.nphcp.com.au. Statement Re Surgery by Podiatrists 23rd June 2008 Podiatrists Board of Queensland Podiatric surgery is a legitimate specialty recognised and practised in most western countries including Australia, the United Kingdom and the United States, the Podiatrists Board of Queensland said today. Board Chair Jason Warnock said podiatrists have been performing surgery in Australia since 1975. "The Board is concerned people are confused over surgery by podiatrists. We want to make sure people know podiatric surgery is a legitimate specialty, practised internationally, and managed in this country by Federal and State agencies so the public interest and safety is protected," Mr Warnock said. Qualified, registered podiatrists are able to diagnose and treat pathology of the foot and lower limb and are legally able to use local anaesthesia to perform skin and nail surgical procedures. To perform surgery, podiatrists undertake extensive specialised postgraduate training and education in podiatric medicine and surgery and are qualified to care for bone, joint, ligament, muscle and tendon pathology of the foot and ankle. The Board requires Fellows of the Australasian College of Podiatric Surgeons (ACPS) to report annually to demonstrate ongoing professional competence. "The public can be confident of the international standing of surgery of podiatrists and the Board’s commitment to protecting the public interest and maintaining standards of practice and public confidence in the profession," Mr Warnock said. Australasian Podiatry Council News Alert 16th June 2008 An effective APodC lobbying campaign has delivered new opportunities for members of the podiatry profession. The Australasian Diabetes Educators Association has recently accepted the Australasian Podiatry Council’s submission arguing that podiatrists should be eligible for recognition as ADEA Credentialled Diabetes Educators. As a result, podiatrists will in future be eligible for CDE status, subject to the usual requirements. Going forward, ADEA has informed APodC it will be amending its current credentialing information and advising ADEA members of this important change. ADEA CDEs are recognised by the Health Insurance Commission, the Department of Veterans Affairs and by the National Diabetes Services Scheme. APodC will provide member updates on CDE as they come to hand. In the meantime, you can get more information by visiting www.adea.com.au and clicking on the Credentialing menu.