We Asked, You Said, We Did

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.

We asked the following questions of all survey respondents:

• What are your biggest current strategic challenges for safety and quality in WA Health?
• How can the DoH support your S&Q initiatives and priorities?
• How can the DoH improve collaboration to drive effective safety and quality in WA Health?

We also asked a series of specific questions depending on whether respondents worked in a Health Service Provider or the Department of Health.

You said the key issues facing our safety and quality system include:

• The availability of high-quality, accessible safety and quality data, and a desire for more skills to use data effectively to support safety and quality initiatives;
• HSP and DOH awareness and ability to implement contemporary approaches to quality and quality improvement in healthcare;
• Resourcing to support a strong, positive patient safety culture, and to sustain positive safety culture long-term;
• Barriers to compliance with safety and quality measures and engagement between the Department and Health Service Providers to proactively resolve patient safety issues

Your feedback contained a mix of concrete suggestions for safety and quality activities and initiatives, and ways of working towards these within the confines of our health system.

We have used your feedback to help shape detailed goal setting for the Patient Safety and Clinical Quality Directorate’s Strategy 2022-2025. 

We will continue to refer to specific comments and feedback as we implement the Strategy.

The Office of Population Health Genomics asked stakeholders for their feedback on the draft WA Genomics Strategy and their views to inform the development of the strategy’s first implementation plan.

The strategy has one overarching vision – that all Western Australians benefit from the timely and appropriate translation of genomics, enabling precision medicine and precision public health.

A total of 66 responses were received through Citizen Space and 2 written responses were received via email. The key themes that emerged from the responses are summarised below.

Vision:

• More than 20 respondents explicitly agreed with or made positive comments about the vision.
• More than 10 respondents commented on the term “maximise the transformative potential”, suggesting that it was either too ambiguous or not beneficial to include.
• Some respondents suggested that the vision needed to be more patient focussed.

Underlying principles:

• All comments received were positive and in support of the underlying principles.
• Some additional principles were suggested for inclusion – the most mentioned ones being innovation, privacy and confidentiality, accountability, integrity, and collaboration.
• A couple of respondents suggested that seven underlying principles was too many.

Enablers of success:

• The feedback received was overall supportive of the enablers of success.
• There were mixed responses around what “governance” should encompass, indicating that this word can take on different meanings for different stakeholder groups.
• Eight respondents commented on the critical need for reliable and ongoing funding, suggesting that this should be an enabler of success.

Priority areas, goals and initiatives:

• More than 20 respondents explicitly agreed with or made positive comments about the priority areas.
• More than 10 respondents suggested including more detail on the needs, preferences and roles of various stakeholder groups relevant to genomics, i.e. carers and guardians beyond immediate family members, peer support groups, regional and remote patients and staff, allied health professionals, not-for-profit organisations, and the private sector.
• Other factors important to multiple stakeholder groups were:
  • Co-design and co-production with health consumers
  • Secure and sustainable funding of the genomics workforce and services to ensure continuation and growth
  • Improving the genomic literacy of health professionals and consumers
  • Ethical use of genomic data
  • Equity of access.

Stakeholders also provided valuable input to shape the content of the strategy’s implementation plan, particularly the key actions to complete in the first two years.

In response to the feedback, the Office of Population Health Genomics:

• Amended the vision to be clearer.
• Consolidated the number of underlying principles from seven to four and incorporated the additional principles suggested by stakeholders in the process. The only exceptions were accountability and collaboration, as they were already included as enablers of success.
• Removed governance from the enablers of success to minimise confusion. Governance is instead covered in the conclusion section with additional details on what the strategy’s governance structure will look like for additional clarity.
• Amended the content of the strategic priorities to better reflect stakeholders’ values and views, including:
  • Referring to a multi-professional genomics workforce and incorporating vignettes to acknowledge the diverse applications and many successes of genomics in WA.
  • Emphasising the critical role of health consumers in the co-creation (i.e. co-design and co-production) of genomic healthcare services and policies.
  • Elevating sustainable investment as an enabler of success to signify that this is critical to ensure the goals of all strategic priorities are met.
  • Expanding on the importance of genomic and health literacy for both health professionals and consumers.
  • Highlighting the need to protect privacy and trust with all community members.
• Considered stakeholder’s views in drafting the strategy’s first implementation plan (internal working document).

The final WA Genomics Strategy 2022-2032: Towards precision medicine and precision public health is now available to view here.

Any queries can be directed to genomics@health.wa.gov.au.

In November 2020 we launched the statutory review of the Tobacco Products Control Act 2006 (the Act) and the Tobacco Products Control Regulations 2006 (the Regulations).

We published a discussion paper which asked for views on the operation and effectiveness of the Act and the Regulations, if the legislation is achieving it’s purposes, and how it could be improved. We also sought stakeholder views on other evidence-based legislative reforms that could update and strengthen WA’s tobacco control legislation to ensure that it continues to meet its objectives.

A total of 53 submissions were received in response to the discussion paper.

Submissions were received from a wide range of respondents including members of the public, universities, industry stakeholders, nongovernment organisations and government departments. Submissions highlighted the varying perspectives and expectations that exist among different stakeholders regarding tobacco control legislation in Western Australia (WA).

A consultation report summarising the submissions was tabled in Parliament by the Minister for Health on 24 June 2021.

The consultation report can be viewed on the Parliament website.

Information gathered from this stage of the review will assist in identifying possible areas for further investigation to strengthen the operation and effectiveness of the WA Tobacco Products Control Act 2006 and the Regulations. Following the development of options for regulatory improvements further consultation will be undertaken to inform the Government’s decision making process.

The WA Health End-of-Life Care Program released draft high level strategies for Advance Care Planning (ACP) education and awareness raising amongst health professionals and the community for broad consultation in September to October 2020.

The survey asked for input on the comprehensiveness and anticipated effectiveness of the overall approach outlined by the strategies and sought to identify existing education, training and awareness raising initiatives that are of relevance to the strategies.

All members of the WA community were encouraged to have their say, with the invitation to participate circulated amongst a broad range of stakeholders including consumers and carers, community organisations, Government departments/areas, health and allied health professionals, health and legal services, and aged care providers.

Over 75 responses we received to the online survey.

Overall the feedback from the consultation was positive with 77% of respondents indicating they agreed/ strongly agreed that the strategies:

• were easy to understand
• outline an appropriate approach for advance care planning education, training and awareness in WA
• provide appropriate direction for future advance care planning education, training and awareness in WA.

As a result of the positive feedback, no strategies were removed but the following are some of the changes that were made:

• More examples of current related activities in WA and Australia were added
• The target population was clarified for some strategies where it was unclear
• The need to tailor strategies to populations and provide information in a variety of formats was emphasised
• The need to recognise existing resources and materials and adopt a coordinated approach where possible was noted
• A strong emphasis on a collaborative design approach for the development of resources and implementation planning of the strategies was supported
• The need to recognise the role that different professions play in supporting ACP varies, and education and training should reflect that.

Additional more-detailed feedback has been noted and recorded to inform the implementation phase.

Further background information was added to the document to provide clarity on the purpose, development process, and implementation (i.e. how it should be used and by who). A one-page summary has also been included. The final document is referred to as WA Health’s strategy for Advance Care Planning education and awareness raising: For health professionals and the community.

The first anniversary of the launch of the WA Men’s Health and Wellbeing Policy (the Policy) was celebrated during Men’s Health Week in June 2020.

A 12 Month Check-Up of the Policy was carried out to assist in understanding:

• the level of awareness of the Policy
• men’s health and wellbeing related activities that have been carried out in the previous 12 months
• any issues and/or opportunities regarding the Policy that have arisen.

An on-line survey was developed and was open for a period of five weeks (24 August - 25 September 2020). A total of 37 responses were received.

Overall, the feedback indicated that the majority of respondents were aware of the Policy and most people had some level of familiarity with its content. Despite the challenges of implementing the Policy (especially during the COVID-19 pandemic), a wide variety of men’s health and wellbeing events have occurred in the 12 months under review. The feedback was supportive of the purpose of the Policy as it provides a good framework to support the health and wellbeing of men and boys living in WA.

Your feedback was summarised in the WA Men’s Health and Wellbeing Policy: 12 Month Check-Up Report. A copy of the 12 Month Check-up Report is available on the WA Department of Health website.

In 2020, the WA Health End-of-Life Care Program sought feedback on the revision of the WA Advance Health Directive (AHD) template. The consultation consisted of 2 phases:

• an initial broad consultation phase in August 2020 to seek feedback on proposed content to help shape a draft template
  • included a survey and a series of open invitation face-to-face workshops, regional videoconference consultations, and targeted workshops with key clinicians as well as priority populations including people with mental illness, Aboriginal people, people with disability and people from culturally and linguistically diverse backgrounds.   
• a road-testing phase in October/November 2020 to gather comments on the usability of the draft template
  • included a survey and 3 face-to-face workshops.

All members of the WA community were encouraged to have their say, with the invitation to participate circulated amongst a broad range of stakeholders including consumers and carers, community organisations, Government departments/areas, health and allied health professionals, health and legal services, and aged care providers.

In total, 295 survey responses were received, and 217 people participated in workshops. Extensive feedback was received including useful suggestions on how to ensure the revised AHD better meets the needs of the community and health professionals: Key themes included:

• support for the inclusion of a value statement and including the value statement at the beginning of the AHD to allow the individual to consider what is important to them before making their treatment decisions
• finding a balance between keeping the form as short as possible whilst also including enough guidance and detail within the questions so people are clear on how to complete it
• need for examples and a clear guidance document to support individuals to complete the AHD
• importance of being able to express the circumstances in which certain treatment decisions apply
• the wording of the form should be simple, clear and in plain English
• overall the majority of respondents felt the proposed changes are an improvement on the current form which can be considered as too vague and open-ended.

The feedback was utilised to develop a final draft AHD template that was reviewed and refined by a working group comprised of WA Health stakeholders, key clinicians, consumers, and Office of the Public Advocate and Department of Justice representatives.

It is anticipated that WA Health will submit the finalised draft AHD template to the Department of Justice in April 2021. Once the Department of Justice have approved the final draft, they will proceed with drafting amendments to the Guardianship and Administration Act Regulations 2005 to incorporate changes to the prescribed AHD form. The revised AHD will be launched and promoted to the community once available.

The Patient Opinion™ Dashboard is intended to display a summary of Patient Opinion™ activity for all WA Health Service Providers. The dashboard displays data that is already publicly available but across several sites. Displaying data in one place as a web page on the HealthyWA website is intended to enable those interested to gain a quick snap shot of Patient Opinion™ activity in WA and guide those interested to more in depth information.

From the 29th of April to the 17th of May 2019 we invited you to provide feedback on a sample Patient Opinion™ Dashboard.

We received 114 responses to the consultation. Majority of the feedback was positive and included a range of suggestions for further adjustments to the Patient Opinion™ Dashboard.

In response to your feedback improvements have been made to: clarity of writing, definitions of the terms used by Patient Opinion and explanations of the purpose of the data provided. Patient Opinion™ Dashboard Consultation Report provides lists of all changes made in response to your feedback and areas identified for future improvement.

Your feedback about the Public Health Amendment (Immunisation Requirements for Enrolment) Bill 2019. Thank you for your input.

You provided valuable feedback.

Your feedback contributed to the Decision Regulatory Impact Statement. This document has now been completed and can be accessed at https://ww2.health.wa.gov.au/immunisationenrolment

The Bill was introduced into Parliament in May 2019.

Any queries can be directed to immunisation@health.wa.gov.au

The WA Men’s Health and Wellbeing Policy was developed to provide direction to the WA health system and its partners to deliver strategies that improve the physical, mental, social and emotional wellbeing of men and boys living in WA.

We asked for feedback on the draft Policy to inform and guide its development.

A series of community consultation forums also occurred from June to August 2018 and provided an opportunity for face-to-face feedback in addition to the online survey.

A total of 107 responses were received via the online survey from various stakeholders groups. The online survey generated nearly 500 separate comments that were accurately processed, analysed and considered.  

Seventy seven per cent of respondents provided their views in the survey as an individual, with the remainder expressing views on behalf of a group or organisation.

Feedback from respondents showed there was broad support for the Policy’s guiding principles, vision, purpose, goals, priority populations and areas for action.

The feedback highlighted a variety of other priority population groups to consider for possible inclusion in the Policy, the need for a condensed version of the document and the importance of implementation and monitoring.

Health Networks re-drafted the Policy to incorporate the consultation feedback with guidance from the WA Men’s Health and Wellbeing Policy Reference Group.

The Policy was launched in Men’s Health Week (10-16 June 2019). A copy of the Policy and a Summary Document is available from 

https://ww2.health.wa.gov.au/Articles/U_Z/WA-Mens-Health-and-Wellbeing-Policy

Thank you to everyone interested in men’s health who participated in the consultation of the draft WA Men’s Health and Wellbeing Policy.

For further information on the WA Men’s Health and Wellbeing Policy, please contact Health Networks on 9222 0200 or email  healthpolicy@health.wa.gov.au.

People were asked a series of questions about their thoughts on the health status report and objectives and policy priorities outlined in the Interim State Public Health Plan. A total of 63 responses were received from various stakeholder groups. Local government represented 33 per cent of responses received. 

Data

• A number of submissions highlighted the absence of data and information around social, economic and environmental determinants of health and wellbeing and requested stronger links on how these determinants relate to health inequities and poorer health outcomes. 
• It was suggested that, if possible, data needs to be presented by age group, Aboriginal status, Cultural and Linguistic Diversity status, region, other priority populations e.g. refugees, people with disability
• Submissions also requested easier access to data and sharing of data across departments, health profiles, preferably at the suburb or local government level, to be made available online, and a list of available data sources for local government to use when preparing their public health plans

Objectives and priorities

• There was overall support for the three priorities identified in the Interim Plan, particularly the focus on Aboriginal Health.
• Mental health was clearly identified across a number of submissions as the most notable omission. This was closely followed by drugs other than alcohol and tobacco, including use of illicit drugs and misuse of pharmaceuticals.

Partnerships and other suggestions

• Overall, respondents were positive about the Interim Plan. However a number of submissions indicated that the Interim Plan should include targets, action plan, tangible outcomes, clarification on the types of evidence based programmes and initiatives that local government can implement at a local level to support the objectives and priorities and clarification on the role and expectation of State Government and Local Government when it relates to public health interventions.
• A number of submissions discussed the need to develop WA centric health indicators in order to better measure progress on objectives implemented. 
• Numerous respondents requested a list of health services, within the State that local government may seek to partner with.
• Resourcing was identified as a concern of local government, particularly when there is uncertainty about what local government is expected to do to support the objectives and policy priorities. 
• A number of submissions suggested further workshops or information, particularly targeting elected members and local government executives, to clarify roles and responsibilities relating to the local health plans and to dispel misinformation relating to ‘cost shifting’.

The CHO will consider the feedback received and use it to inform a revised State Public Health Plan. This process will involve:

• Reviewing the health status report to include information on any new public health priorities or objectives and, where feasible, responding to other data-related suggestions raised in the submissions.
• Partnering with mental health related bodies to discuss the potential inclusion of mental health in future State Public Health Plans.
• Partnering with relevant agencies to address the potential inclusion of priorities related to use of illicit drugs use.
• Ensuring that the Plan incorporates:
  • Targets, where possible.
  • An action plan that identifies tangible and achievable outcomes.
  • Clarification on the types of programmes and initiatives that local government can implement at a local level to support the objectives and priorities. 
• Develop information on:
  • what health services are available to support and partner with local government 
  • the role and expectation of State Government and Local Government when it relates to public health.

For your feedback about the Medicines and Poisions Regulations 2015.

Thank you for your input.

You provided valuable feedback.

Your feedback contributed to the Decision Regulatory Impact Statement.

The Decision RIS has now been complete and can be accessed at: http://ww2.health.wa.gov.au/Articles/A_E/Development-of-the-Medicines-and-Poisons-Regulations

Drafting instructions are currently being completed for the Parliamentary Council Office to compile into legislation to be presented to Parliament.

Any questions can be directed to poisonsregulation@health.wa.gov.au

What you thought about cancer prevention in Western Australia

• You were surprised by the overall preventability of cancer
• You were positive about the role government can play in cancer prevention
• More needs to be done to improve awareness around risk factors and screening for bowel cancer
• There are opportunities for improving sun protection messages at high schools
• You were supportive of the HPV vaccination program and Breastscreen WA
• Keep up the good work in tobacco control
• You didn’t know much about oesophageal and stomach cancers, including who is at risk, what the symptoms are, and how to prevent these cancers
• You were confused about recommendations on prostate cancer screening

• Shared the consultation findings with the community and other organisations involved in cancer prevention
• Created an agenda for action on cancer prevention in WA

To see the full consultation findings and agenda for action, click here:

http://healthywa.wa.gov.au/~/media/Files/HealthyWA/Original/Your-say-on-cancer-wa/13009-chief-health-officer-report.ashx