Department of Health, WA

In October/November 2023, the WA Department of Health End of Life Care (EOLC) Program conducted a consultation to gain a better understanding of the current uptake of advance care planning (ACP) and use of ACP resources in WA. The survey sought feedback on the revised WA Advance Health Directive (AHD) and suite of ACP resources that were released on 4 August 2022.

69 respondents completed the survey with 76% reporting they thought the resources were very effective/ effective. Reported levels of awareness and use of the key ACP resources (Advance Health Directive and accompanying Guide, Values and Preferences Form, Your Guide to ACP in WA: Workbook) was high. Qualitative feedback on the resources was largely positive indicating the information within the resources is clear and comprehensive with a broad range of diversity represented within the images. Areas of concern that were noted included the literacy level and length of some of the resources.

The most common ACP activity reported within the last 12 months was ACP conversations with family, carers or friends.

Health professionals reported they were moderately or very confident in supporting patients with ACP. However, there were a small number of respondents to this question so the results may not be indicative of true levels of confidence across the whole workforce.

The findings informed the development of several actions that the EOLC Team is currently implementing alongside existing work plans and priorities. This includes exploring possibilities to simplify the range of ACP information, arranging targeted awareness around common misconceptions, coordinating general awareness raising of ACP and investigating further opportunities for health professional education.

The consultation was about proposed supply controls over nitrous oxide, with the aim of reducing supply patterns associated with increased health harm.

Nitrous oxide gas is used as a prescription medicine, as a food additive and in the automotive industry. It is also inhaled as a recreational substance. Changing patterns of recreational use have resulted in increasing health harm, including damage to the nervous system, behavioural changes and reduced ability to safely drive.

The consultation related to nitrous oxide when classified as a Schedule 6 poison. There will be no changes to the regulation of nitrous oxide as a prescription medicine.

The survey was set up so those supplying nitrous oxide, those using nitrous oxide in food and drink preparation and those using nitrous oxide as an inhalant were asked questions most relevant to them.

A total of 260 submissions were received in response to the online survey. The majority (85%) of responses were from individuals with the remainder from organisations and businesses.

There was variation in responses between the self-identified groups of respondents. Generally, those indicating they used nitrous oxide for home cooking or recreational use and those who identified as a member of the public, were less supportive of any restrictions. Health professionals, organisations representing health professionals and government departments were most supportive of the introduction of additional regulatory controls over supply.

Businesses selling nitrous oxide were of the opinion that additional supply controls would have an economic impact on their businesses.

Advice was also sought from an industry reference group, with representatives from the hospitality, wholesaling and retailing sectors. An expert working group convened by the Mental Health Commission also provided input.

Details of the final proposals are available in the Consultation Report February 2024.

The proposed new rules for purchasing nitrous oxide in Schedule 6 will mean:

• Businesses using nitrous oxide bulbs for food additive purposes will have ongoing access to these products. These businesses will need to provide their supplier with evidence of their food business registration or liquor licence.
• Other businesses or institutions will be able to seek approval from the Department of Health to purchase nitrous oxide bulbs.
• Individual members of the public will no longer be able to purchase nitrous oxide bulbs.
• Supply of food additive grade nitrous oxide in larger cylinders or cannisters will not be allowed.
• Anyone (aged 16 years or older) will be able to purchase nitrous oxide intended for automotive use, provided the product has added sulfur dioxide, to deter inhalation.

The consultation was about amendments to the Medicines and Poisons Regulations 2016 and the Schedule 8 Medicines Prescribing Code. A primary aim of the consultation was to seek feedback on proposals to reduce regulatory burden, particularly for prescribers.

The proposed changes follow implementation of ScriptCheckWA, Western Australia’s real-time prescription monitoring system. ScriptCheckWA provides clinicians with up-to-date information about all monitored medicines prescribed and dispensed for their patient within WA.

The survey was set up so respondents could choose to answer only those questions most relevant to them.

A total of 39 submissions were received in response to the discussion paper. Eighteen were from organisations and 21 were from individuals.

Peak bodies representing prescribers, pharmacists and consumers responded. A significant number of respondents confined their feedback to either the section about regulation of stimulant medicines or the section about regulation of medicinal cannabis.

Most respondents supported a requirement for prescribers and pharmacists to register to access ScriptCheckWA. Opinion was divided about whether use of ScriptcheckWA, at the time of prescribing or dispensing, should be mandated.

There was general support for regulating the prescribing of stimulant medicines and medicinal cannabis in a similar manner to other Schedule 8 medicines. Detailed prescribing restrictions would be included in a ‘prescribing code’ rather than in the Regulations.

Over half the respondents supported the list of Schedule 4 medicine proposed to be classified as ‘monitored medicines’. Another 26% of respondents supported most of the medicines on the list being monitored through ScriptCheckWA.

Following agreement by the Minister for Health, regulatory changes are being progressed. Details of the final proposals are available in the Consultation Report (April 2023). 

Further targeted consultation will be undertaken during development of a new prescribing code to replace the current Schedule 8 Medicines Prescribing Code.