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Category: Health

12/11/2021

Mental Health and Physical Health

11 November 2021

The Health system has a major divide that is not often spoken about- the divide between mental health and physical health.

Physical health tries to be a science and likes to think that its diagnoses and treatments are based on sound experimental evidence. If someone is sick and there are not enough facilities there is a fair effort from the medical profession and relatives to get more resources and they are mostly successful. There is a highly respected system and career structure.

Mental health has similar endeavours, but has less of a scientific base for its diagnoses and treatments. There has been a lot of work on neurotransmitters associated with depression and drugs that supposedly increase the good ones, but no single test is associated with a diagnosis, and diseases are defined. It gives it a lingering stigma of imprecision.

The workforces in mental and physical health have relatively little crossover, even isolated within the same hospital. When I last worked in the health system 9 years ago in a hospital that had both an active ED and a mental health facility, patients were triaged as physical or mental, different teams saw them, and neither team wanted much to do with the other stream’s patients. There was a shared waiting room, but different personnel, assessment areas, practices and wards. Getting one of the other team to assess someone was an afterthought, or only when the pathology was fairly gross.

When I was in tobacco control, there was a lot of reluctance to try to get mental health patients to stop smoking as ‘they needed it’, which was another way of saying that to add the nicotine withdrawal to their generally stressed situation was merely making trouble. But the public health statisticians said that people with mental health problems had a lot of physical problems and died about 14 years earlier (AIHW). So glossing over the physical health of mental health patients is not without consequence.

It was interesting to note recently that a COVID-19 infection in a mental health inpatient went undiagnosed for 4 days, and drew attention to the fact that mental health patients had a poor vaccination rate also.

www.smh.com.au/national/nsw/hospital-patient-s-covid-19-infection-undetected-for-four-days-20211105-p596aw.html

11/11/2021

iCare will repay 53,000 underpaid injured workers

11 November 2021

iCare, the State workers’ compensation insurer has admitted that it has underpaid thousands of workers and will now repay them, according to an article in today’s SMH.

This story has been leaking out in the media for ages. At a day to day level, my patients have always complained that they get a lot less in compo than they got before their injury. This has been even for workers on regular salaries. Those on casual work were in a worse situation as there was some argument about what their PIAWE (Pre-Injury Average Weekly Earnings) were, especially if they got variable hours from a labour-hire company.

When this scandal first broke, I tried to tell my patients to ask iCare if they had been underpaid and some did. It seemed that iCare could not work out what their PIAWEs were. It did not have the data. In that employers’ future premiums related to how much was paid out in claims, it suited both the employers and the insurers to minimise their PIAWE, so if a low amount was put in, there was little incentive to check it up. Now, a few years later, iCare would need a forensic accountant going through the employer’s books to get to the correct amount. This is unlikely to happen.

So while this promise is a start, it is hard to believe that it will be enough to see justice done.

Workers’ Compensation has always been seen as a cost for business rather than a moral obligation to pay for people injured at work. Generally it is about minimising the cost of the payout, rather than having an energetic injury prevention programme.

The Minister in charge is the Treasurer, so all of this happened on Dominic Perrottet’s watch. Matt Kean, the new Treasurer may be more sympathetic, and this will help, but we still need a lot better enforcement of safety to prevent accidents, and much more power to injured people to ensure that they are correctly paid.

It illustrates that active Unions are necessary to redress the power imbalances in the the system. Legislation without enforcement is just words on a page, just as apologies from banks and insurance companies for rip-offs are just sound vibrations in the air.

Here is the article:

‘My sincere apology’: iCare will pay back $38 million to 53,000 injured workers

Lucy Cormack SMH November 11, 2021

State insurer iCare will pay $38 million to 53,000 largely underpaid injured workers affected by historic miscalculation errors between 2012 and 2019.

An iCare review of 16,000 injured worker case files has revealed an average error rate of 3.5 per cent or an underpayment of $26 a week due to miscalculated pre-injury average weekly earnings.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error,” said ICare chief executive Richard Harding.

Among the most seriously injured and affected are 523 workers underpaid a total of more than $3.9 million, or around $7500 each.

The mass pay-out follows a joint investigation by The Sydney Morning Herald, The Age and ABC’s Four Corners which last year revealed iCare had underpaid as many as 52,000 injured workers by up to $80 million in compensation.

ICare then disputed the underpayment figures, saying it believed only 5000 to 10,000 workers had been underpaid up to $10 million in total.

Chief executive officer Richard Harding on Thursday said affected employers and employees had been unable to provide the data to accurately assess underpayments. As a result, iCare conducted a “file by file review” of 16,000 cases as a sample to assess the scale of the errors.

“We’ve been advised there is a risk of overcompensation in this approach, but the desire is to get money back as quickly as possible,” Mr Harding said.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error.”

The underpayments were caused by errors in the calculation of pre-injury average weekly earnings for injured workers dating back to 2012, when the insurance scheme was run by WorkCover.

Mr Harding said the average lump sum to be paid to the 53,000 workers will be around $700. However, some will receive thousands.

Affected workers will receive any money owed through an adjustment of their weekly benefits for the weeks already paid. Any historical overpayments caused by the same miscalculation error will not be recouped by iCare.

Revelations of financial mismanagement and widespread underpayment across the iCare stable first emerged last year, before a subsequent review into its culture and governance revealed systemic weaknesses and a failure to hold management to account.

Labor treasury spokesman Daniel Mooched said the announcement repudiated earlier claims that only a small number of people were affected.

“As always with iCare, the devil is in the detail. But today’s announcement is meaningful for the tens of thousands of people iCare underpaid”.

Mr Mookhey said the insurer must guarantee that it will not seek to recover the money from sick and injured workers through benefit cuts or employers through higher premiums.

Upper house Greens MP David Shoebridge said the pay-out to workers followed years of chasing by unions, injured workers and non-government MPs.

While he welcomed the payments, he said there was “no evidence from iCare that this payment goes anywhere near meeting their full obligation to injured workers”.

“We will continue to press iCare for a full accounting so that no injured worker is left short-changed,” he said.

Unions have described the decision to reimburse workers as a significant step but called for greater transparency about the process.

“This is hardly an organisation that can be taken at its word. iCare executives, who are better known for receiving fat bonuses, must detail their methodology,” said Mark Morey, Secretary of Unions NSW.

Last week, a budget estimates hearing heard iCare had reported a $1.4 billion underwriting loss in the past year, with the total accumulated loss of the past three years now exceeding $6 billion.

Treasurer Matt Kean, who is responsible for iCare, told the hearing new legislation following recommendations from another review prompted by the scandal would not be introduced until 2022.

03/10/2021

31% of JobKeeper recipients checked were ‘not eligible’

3 October 2021

As we all wonder at the level of corporate rather than individual fraud, a Federal review of JobKeeper found that 31% of recipients who triggered compliance checks were ‘not eligible at all’. This was after a survey of 13% of the recipient companies.

The ATO seems reluctant to say who they were or how much. 31% of the recipients may not mean 31% of the $89 billion given out.

Only $194 million has been repaid (which is around 0.2%) of the total payout.

The Government response contrasts starkly when compared to the amount of attention that went to Robodebt, where welfare recipients received relatively small amounts of money. The ATO is very concerned about the confidentiality of Tax records, but this is not tax records, it is money given out.

30/09/2021

Tasmania Wants 90% of Adults Double Vaccinated before Opening the Border

30 September 2021

Here is a realistic assessment of how to stop an epidemic if you have the choice. Liberal Premier Peter Gutwein has some modelling coming. Bear in mind that 20% of the Tasmanian population are under 16 year of age, so if no kids are vaccinated the actual rate is still only 70%, not 90%. Even you assume that kids will not get sick, which is actually not a reasonable assumption, there are 30% who can spread COVID and 10%, the adults, who are quite vulnerable.

In reality, it is hard to get vaccination rates over 90%, though Blacktown LGA has 95% with first jabs, and presumably Tasmania would also being trying to vaccinate 12-15 year olds and younger if possible.

Meanwhile Morrison is stopping welfare payments to States when they get over 70%, which is actually starving people into unlocking. Even Conservative NSW Treasurer Perrottet is adding some welfare payments from the State budget.

www.abc.net.au/news/2021-09-29/tasmania-wont-reopen-covid-border-before-90pc-vaccination/100500844?sf249931972=1&fbclid=IwAR2NqGfeDQA9rGcnm7XQ6iLiDGK7XH1PNkRsjYs3uL15J31hP7qLbDsby88

25/09/2021

Motivation and Money

25 September 2021

Some years ago, I won a Public Service Fellowship to study workplace absence and had what the Americans call a boondoggle, with a world trip to look at why people attend or do not attend work.

One outcome from that was that I stopped using the word ‘Absenteeism’ as that is a valued judgement suggesting a worker disease, and used the term ‘workplace absence’ which, as the progressive journals at the time insisted meant that an employee considered that they had a better reason not to be at work.

Unsurprisingly people who had more interesting work or control over their work were less likely to be absent, while those in boring production lines were more likely. The US car industry had absence rates of around 10% and handled this by simply rostering on excess people in the assumption that people were not going to turn up. A union OHS academic there said that the rates of what we called RSI were very high, but I did not get to examine workers and naturally no figures were available.

People who needed to be away from work also were more often absent, particularly women with families whose incomes were lower than their partners. Later I looked at age groups and health as these were measureable and confirmed the general conclusion that health did not correlate with absence. People who had a chronic illness were less likely to take sick days as they might need them later, whereas young healthy males wanted to go surfing.

The Swedish car industry let workers have quite a lot of autonomy, but this had led to the workers trying to finish early and giving themselves RSI, but the Swedes were not keen to talk about this, as they had been studied by too many itinerants like me, (and one suspected that they did not like what we had found).

The Japanese worked very long hours, and had token payments systems which kept a peer pressure to gain this respect, but the last part of their long working hours tended to be not very productive, because the peer pressure was merely not to be the first to leave. Again, this insight came from US academics; not the Japanese.

One of sillier things that I noted in some management training that I had was that some still seem to think that the only thing that motivates people is money. This seemed so simplistic to me as to almost absurd, but it was still taught.

So I was interested to see an article today by Malcolm Knox in the SMH about the motivation of the Melbourne Storm Rugby League players, who are favoured to beat Penrith in the second preliminary final this afternoon. Some of their players are paid much less than they would be if they changed clubs, but they stay there because of their respect for the coach, and for the fact that the team wins. Young fullback Ryan Papenhausen is quoted as saying that he stays while Bellamy is coach because he thinks he will improve most while coached by this man. So despite salary caps, which are designed to even up the quality of players between clubs, Melbourne have more than their share of stars.

I have not been a huge fan of Rugby League over the years as it seemed to merely have people bump into each other and lacked the subtlety and variety of Rugby Union, particularly the innovative movements of the All Blacks. But their variety and flair is improving, particularly with the work of Nathan Cleary at Penrith, which is now being watched and copied to the level that other teams have been beating them.

We can watch Melbourne Storm v. Penrith from 4pm, but I will also be thinking that if Melbourne wins, it will say something about motivation and money.

www.theage.com.au/sport/nrl/splitting-heirs-papenhuyzen-storm-s-regeneration-proves-the-cap-doesn-t-fit-anymore-20210924-p58ugx.html

22/09/2021

Victorian Government Bites the Bullet and Mandates Vaccination

22 September 2021

At last! A government that does the sensible thing. The Victorian government will only open up if people are vaccinated. Thanks to NSW the Delta variant genie is out of the bottle and spreading nationwide. Business wants to unlock, some with no care for anyone but themselves.

Victoria wants to unlock but minimise spread among those now having more interpersonal contacts. The R (Reproduction) number is the number of cases each case infects. If everyone is vaccinated, less people will get it and those who have it will get it to less people.

Reasonable medical opinion is that the risks of vaccine are massively less than the risks of getting COVID, so the case against vaccination is incredibly weak on medical grounds. The ‘right not to have your body violated’ etc sounds very dramatic, and makes vaccination equivalent to rape in a semantic sense. But in a practical sense the two concepts are as far apart as could be. One is sensible medicine and the other is a crime.

Anyone who thinks that this does not matter should look at the graph of NSW cases that has peaked and is just starting to fall. Anything that can flatten the curve or make it fall is good. Anything that makes it rise is creating deaths and misery.

I am a member of the Council for Civil Liberties and have spent years working against excess government power. But sometimes it is necessary to act for the common good. I have no time for smokers’ rights or the right to spread disease. The Morrison government is as usual missing in action when real leadership is needed. ‘Let every workplace decide’, is a nightmare for retail business owners, offices and just about every other employer. Gladys is similarly missing. Dan Andrews has stepped up, despite a motley crew in the streets spreading disease and demanding the right to continue to do so.

What of the Health System? We are going the way of the Americans by stealth, and the fact that the public system is what has helped us survive is being glossed over, hidden by subsidies to private hospitals. The Federal government has been quietly trying to kill public medicine for years. The Medicare rebate has fallen from 85% of the AMA rate to 45%, so for the same bulk-billing work doctors incomes have almost halved over 35 years, while subsidies to the inefficient Private Health Insurers continue. Being a GP is now a little-sought speciality. (I have a FB page- Fix Medicare that I spend too little time on).

The States have maintained the public hospitals at a minimal level, as all the lucrative work has been siphoned off by the private system basically doing the easy stuff. There is No slack in the system, not that counting the number of ICU beds should factor. All our efforts should be to keep people out of Hospital and ICU by prevention of infection.

Have a look at this article on the anti-discrimination aspects of mandatory vaccination, and also look at the NSW cases, just turning down, but likely to rise if anything, like opening up from lockdown, tips the balance.

www.smh.com.au/national/victoria/here-s-why-no-jab-no-entry-is-not-discrimination-20210920-p58t2v.html?fbclid=IwAR2jrbfGJsq6fD-J-unnAn12j9UyWvdk-do5BpE23bI0z0gQ8kknq5nc39c

08/09/2021

What Has Gone Wrong in Australia?

8 September 2021

John Quiggin gives a good, insightful summary in The Monthly.

www.themonthly.com.au/issue/2021/september/1630418400/john-quiggin/dismembering-government?utm_medium=email&utm_campaign=The Monthly Today – Wednesday 8 September 2021&utm_content=The Monthly Today – Wednesday 8 September 2021+CID_77319af0620e0ea97965a0e5af6e7e60&utm_source=EDM&utm_term=The Monthly#mtr

04/09/2021

Please Sign the Petition to stop the COVID Lockdown Ending Prematurely

4 September 2021

The Governments, Federal and NSW State, seem hell bent on ending the COVID lockdown.

Morrison stuffed up the vaccine and Gladys stuffed up the lock-down.

Now Morrison is talking about ‘Freedom’ and ‘One Australia’ showing that patriotism is the last refuge of a scoundrel. Gladys is talking about the need for more deaths as if it is an inevitable consequence of the Delta strain and that nothing can be done to mitigate the situation . She is talking about bed numbers and trying to conjure ICU nurses out of thin air. The fact that the State public hospital system is always at full capacity with beds in corridors in ED is well known to any health professional who has any dealings with the system and is about to bite us big time.

So what should be done? The lockdown can only buy time to improve the vaccine rollout, but this is still very much worth doing. Figures from NSW that I posted last week suggested that vaccination reduced the chance of being in ICU by about 97%. Vaccinated people can still get and transmit COVID as it seems that the antibodies are not in secretions, so it is not until the virus invades that the body starts to fight it. But as the disease is milder, vaccinated people will cough less, spread the virus for less time and be less sick themselves.

NSW has given about 7.2 million doses to a population of 8.2 million people. For everyone in NSW to have 2 doses it would take about 16 million doses. If we assume that about 4% of people are anti-vaxxers and want to take their chances, and 16% are children under 12 for whom the vaccines are not approved, then 80% of the total population should be vaccinated, which will take about 13 million doses. At the current rate of a million doses a week, that should take about 6 weeks from now.

The government already has a huge debt and will avoid a lot of future costs by prevention rather than ‘cure’. A support package for those who cannot work is naturally needed also. There was a full page ad in the SMH last week with a number of businesses urging the Government to stick to the opening up timetable of the Doherty Report. Given that the Doherty Report recommendations were based on a far lower number of cases and it was assumed that what cases there were could be traced and were not Delta variants, the report needs to be reconsidered. Perhaps because it is from a reputable research organisation and that it is a long read it has not been seriously challenged, The Government has used it to try to justify the early opening.

One of the disappointing things in my life has been the revelation that some people really do not care a fig about anyone as long as they are personally OK. I was initially shocked to find that the Tobacco industry really did not care how many people died as long as they could make money. I found that the asbestos industry was the same, and then that most businesses skimp on safety on the principle that ‘we take the money, you take the risk’ There has also been the worrying trend, which I still link to Harvard management theory in the 1980s that managers can manage anything, and just need to buy any expertise that they do not have. Often that do not even know what they do not know, so they neglect to ask, do not know who or what to ask, or find the advice inconvenient. And sometimes they put ads in the paper.

We also cannot assume that those in Government know or care or that their primary concern will be for the welfare of their constituents. Presumably their unlikely re-election is what they are focused on.

So please sign the petition to stop the early opening- it currently all we can do.

29/08/2021

Irresponsible COVID Policies will Destroy the Federal and NSW Liberals

29 August 2021

Ok. I am making a prediction. The totally irresponsible Liberal COVID policies will destroy both the Morrison government and the NSW Liberals.

Why? The strategy of unlocking with only 70% of over 16 adults vaccinated is totally irresponsible. It is true that less children will get a bad infection and die, but some will- perhaps 1 in 100,000. But if a few million children go back to school, that is still a significant number. The unvaccinated children will also get infected and go home to their families and infect them. Every parent who has had kids start at day-care knows how many more colds they got that year.

As far as the adults are concerned, if there are still 30% of them unvaccinated, that is a huge number to make an epidemic. The hospitals always manage with very slim margins of capacity. How many beds are in corridors and how many trolleys in ED normally? Quite a few. Now they are stopping non-urgent surgery, but these cases are not trivial, and cancer patients may well die of their delays.

But they key point is that the hospital system will be overwhelmed by cases and that those cases would not be necessary if the government held its nerve and continued the lockdown until all those who wanted the vaccine had it- upwards of 95% perhaps. If NSW is vaccinating a million people a week and has 8 million people needing 2 doses each, that is 16 weeks, less the fact that almost half the adult doses has been given. 12 weeks might be a realistic estimate, better if the vaccine can be hurried further. As far as the children are concerned, I recall in the 1950s when polio vaccine came- we were simply lined up in the school corridor at lunch time and everyone was done.

The cost of vaccination compared to the cost of hospitalisations does not bear thinking about. It is also probably that the cost of the hospitalisations and time lost will exceed the cost of a decent home support system- but Morrison will not even consider this, still talking about tax cuts before the election, as the national debt balloons to record levels. Do the rich really need this?

Morrison also wants to force states that have almost no COVID to open up. Qld and WA, having isolated themselves, controlled COVID and given themselves quite a remarkably normal quality of life do not want to be forced to open to NSW and Victoria, where COVID is frankly out of control. Morrison needs Qld seats to get re-elected. If he forces Qld to open and the pandemic spreads there as it will, his chances of re-election is nil.

Gladys Berejeklian is now talking about vaccinations, trying to distract attention from the number of cases and is systematically getting us used to the idea that since we now can never get to zero cases, we have to open up, and might as well do it now as later. This is not true, if now we are not vaccinated, and later we will be. She is blamed for the Delta virus escape as she did not mandate vaccination for limo drivers who ferried people from the airport to the quarantine hotels and then was slow to lock down Bondi when the infection escaped in June. So now to say it is all inevitable and unlock with what amounts to a very low vaccination rate is likely to lead to very big epidemic, the health system being overwhelmed, a lot of unnecessary deaths and yes, Gladys losing the election.

And Gladys does not like Morrison either, so she had better throw him under a bus before he does it to her.

29/08/2021

COVID Vaccine Works!

29 August 2021

An anti-vaxxer who keeps posting on my Facebook page also keeps demanding proof that the vaccine does more harm than good. I told her to do her own research as it is really too obvious.

I looked at the figures for NSW today and they made the point very clearly. There are 126 people in ICU of whom 13 have had one dose of vaccine and 1 has had 2 doses. The percentage of NSW people over 16yo unvaccinated are 37.3%, one vaccination jab 29% and two vaccinations 33.8%.

If vaccine did not work, the percentage of people in ICU would be the same in all 3 groups. This would mean unvaccinated would be 47 (37.2% of 126), one vaccine jab 37 (29% of 126) and two vaccine jabs 43 (33.8% of 126). But the numbers are: unvaccinated 113, one jab 12, two jabs 1.

So those with 2 jabs have only I person in ICU instead of 43, and those with one jab have 12 instead of 37. So the chance of being in ICU has been reduced by 42/43 (97.7%) with 2 jabs, and 25/37 (67.6%) with one jab. This is just a one day sample (yesterday in NSW), but the results are very significant. The data is from NSW Health via Juliette O’Brien’s website.

And the chance of dying due to vaccine is about 1 in a million.