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Estimates: Mental Health Nurses Incentive Program

Estimates & Committees
Penny Wright 7 Jun 2012

Senator WRIGHT: I have some questions regarding the funding of mental health nurses and, in particular, the Mental Health Nurse Incentive Program. The budget allocates an additional $17.6 million to the Mental Health Nurse Incentive Program to maintain existing service levels. While this funding is described in the budget as additional funding, it appears actually to be a freeze or cap in funding of the program. So I have some questions about the program and the implications flowing from this year's budget. Firstly, can you please provide details of the total amount of base level funding that is allocated to the MHNIP for the next financial year, 2012-13? That is, what the base level of funding of the program is that the $17.6 million is in addition to?

Ms Campion: The level of funding in 2012-13 prior to the additional funding at budget-I do not have the exact figures-was around $19 million. I do not know whether Ms Nicholls knows the exact figure.

Ms Nicholls: It was approximately $19 million.

Senator WRIGHT: How close is that approximation?

Ms Nicholls: Within a few hundred thousand.

Senator WRIGHT: So you will you take on notice for me the exact amount, then?

Ms Nicholls: Yes.

Senator WRIGHT: What was the total funding for the program in 2011-12 and what will be the total funding of the program in 2012-13?

Ms Campion: The appropriation for the program in 2011-12 was $26.3 million, but the department expects to allocate around another $9 million to meet the actual costs of the program. It is a demand-driven program, so predicting the exact cost is a little bit difficult to do. This year we expect to spend about $35 million or so.

Senator WRIGHT: I think I understand. What you are saying is that for the previous year, 2011-12, that is nearly finished, it was $26.3 million; and you are predicting that the total amount for the next financial year will be-how much; sorry?

Ms Campion: This year the allocation is actually $26 million, but we expect that the cost will be about $35.5 million. The level of funding for next year, the $19 million that was in the allocation and the additional funding provided at budget, will bring the total allocation to $35.5 million.

Senator WRIGHT: I think I need to go back to what the base level of funding for the program was in the last financial year, 2011-12-I do not think I asked that one?

Ms Huxtable: I think the base level for 2011-12 was $26.32 million; that was the base level of allocation. But, as Ms Campion said, there was an additional amount allocated of a further $9 million to that figure. So it is a little bit confusing. That brought the actual amount of money that we expect to spend on the program this financial year closer to $35.5 million.

Senator WRIGHT: I see. So that $35.5 million is for the financial year ending at the end of June this year?

Ms Huxtable: That is correct.

Senator WRIGHT: So let me ask again then-I am a bit unclear.

Ms Nicholls: Perhaps I could clarify? I think what is confusing in the figures is that, in the 2010-11 budget, additional funding over two years was provided to the program and that funding was running out at the end of this financial year. So the additional funding in 2010-11 was $5.29 million and in 2011-12 was $7.6 million. So that brought the funding available in 2011-12 to $26.3 million. But the base funding was essentially approximately $19 million. That is why we have $19 million in the base plus another approximately $17 million-or $16.5 million-in 2012-13, which brings the total to $35.5 million.

Senator WRIGHT: So is that the amount that you are predicting will be spent in 2012-13-$35.5 million?

Ms Campion: Yes.

Senator WRIGHT: I now would like to have details of the total annual funding of the program since its inception in 2006, so the total funding in 2007-08, 2008-09, 2009-10 and 2010-11, which I think you have already provided. Do you have those details available today?

Ms Campion: Just to clarify: do you want expenditure-what we spent on the program in those years?

Senator WRIGHT: Yes, what was actually spent in total?

Ms Nicholls: In 2007-08 there was $10.75 million; in 2008-09 there was $12.95 million; and in 2009-10 there was $12.175 million-well, there was a $12.175 million allocation but the actual expenditure was $22.097 million. Then in 2010-11 it was $28 million and in 2011-12 we are anticipating that we will spend $35.5 million.

Senator WRIGHT: So, in 2009-10 the allocation was $12.175 million but, in fact, the expenditure was $22.097 million?

Ms Nicholls: Yes.

Senator WRIGHT: The other figures that you gave are in relation to the actual expenditure, is that right?

Ms Nicholls: I think so, but I need to take that on notice.

Senator WRIGHT: I need clarification then. Thank you for that.

Ms Huxtable: Whether we come back on that, they will be down to several decimal points-

Senator WRIGHT: Thank you. I would also like details of the projected base funding for the program over the forward estimates periods 2013-14, 2014-15 and 2015-16.

Ms Nicholls: I can give you 2013-14 and 2014-15. The estimates are $19.457 million and $19.865 million in 2014-15.

Senator WRIGHT: And you cannot give me an estimate for 2015-16 at this stage?

Ms Nicholls: No.

Senator WRIGHT: Predictions have not been made that far out, is that right?

Ms Nicholls: I do not have them with me.

Ms Campion: We could take that on notice.

Senator WRIGHT: Thank you for that. What is the average yearly amount that organisations registered in the program have received over the past five years from 2007 through to 2011-12?

Ms Nicholls: I do not think I have an average yearly amount. I think the issue that we are looking at here is that this is a program where the majority of organisations employ on average one or two nurses. There are a small number of organisations that employ more than that. So what you will see is variance in the expenditure depending on both the number of nurses that an organisation will employ and also the number of sessions that a nurse will deliver, and the number of sessions that nurses deliver varies from service to service.

Senator WRIGHT: It is highly variable; I understand that.

Ms Nicholls: Yes.

Senator WRIGHT: I understand that over 700 organisations are registered with the program. Am I correct in that figure?

Ms Nicholls: I think that the over-700 figure relates to the total number who have been registered at any point in time across the program and not the total number who might be registered at this point in time.

Senator WRIGHT: Could I ask you to take on notice then that I am interested in the average yearly amount that organisations registered in the program have received over the past five years-and I fully appreciate that for some of them it will be a very small average annual amount and that, obviously, for those who employ a greater number of nurses and who provide more services it will be a larger amount. But I imagine that those details would be available. You would need to know, would you not, over the period of time who is using this program and what amount is being paid out to them? So could you take that on notice for me?

Ms Huxtable: I am sorry; can I just clarify exactly what you mean by that? I think there are probably two ways that we could interpret that. One would be the average that every participating organisation is receiving; obviously there are many, many hundreds of organisations. The other is what the average is that an organisation-a typical organisation, I suppose-receives? I presume that you mean the latter rather than the former?

Senator WRIGHT: Actually I am more interested, I think, in differentiating between the small users and the larger users.

Ms Huxtable: It would be a significant amount of work, I would say, to do every organisation, but it might be possible to provide some bands to divide organisations into small, medium or large and give a sense of what the average is across organisations of this type.

Senator WRIGHT: That would be good, and it would give us a sense of the scope and the nature of the use of the program by the various organisations that have been registered with the program over the last five years. Thank you. I am interested in knowing how many individual patients received services under the program over the past five years. So I would like to know how many individuals accessed the program in each year.

Ms Nicholls: I have some information for the most recent years, but going back five years we would need to take on notice.

Senator WRIGHT: Thank you. I understand that. If you could tell me what you have now, that would be good.

Ms Nicholls: When the program was started in July 2007, it was estimated, and the target was, that more than 36,000 patients with severe mental illness would be receiving mental health nurse services by 2010-11. The actual number of people that received services under the program in 2011 was just over 40,000. Based on the current program uptake, we estimate that the number of people receiving a service in the 2011-12 financial year could exceed 47,000. To go back earlier than that, I would need to take it on notice.

Senator WRIGHT: I am really interested in looking at the growth of the program over those five years and ascertaining how many individuals are using it and potentially, or presumably, benefiting from it; but obviously that is subject to evaluation and monitoring.

Senator FIERRAVANTI-WELLS: Could you please include, as information in that answer, what the actual cost was?

Senator WRIGHT: I was going to ask how many sessions Medicare paid for on an annual basis over the past five years-so figures of program sessions paid for in 2007-08 right through to 2011-12.

Ms Campion: Just to clarify-I think we will have to take that on notice-do you mean the average number of sessions per person?

Senator WRIGHT: No; just the number of sessions that Medicare paid for in each of those financial years.

Ms Campion: Okay; that is fine.

Senator WRIGHT: That is at this stage. I may have more questions in line with what you have asked there. My next question is: how many mental health nurses were registered with Medicare under the Mental Health Nurse Incentive Program on an annual basis over the past five years? Do you have those figures with you today or at least some of the more recent years?

Ms Nicholls: What I can tell you is that, as at 31 December 2011, just over 1,200 nurses had registered with the program since the program's inception and 119 nurses registered in 2011. However, the total number of nurses in 2011 that actually were involved in delivering MHNIP services was approximately 650.

Senator WRIGHT: Is it possible then to go back and ascertain over those five years how many nurses were registered each particular year?

Ms Nicholls: We would have to approach the Department of Human Services to find out what data they could provide us; but we could take that on notice.

Senator WRIGHT: Thank you for that. How many general practitioners have used the Mental Health Nurse Incentive Program on an annual basis over the past five years? Under the various organisations that are registered I am interested in breaking down what organisations used the program and to what extent. I presume you will need to take these on notice-correct me if I am wrong.

Ms Nicholls: I could not give the figures over five years without taking it on notice.

Senator WRIGHT: That is what I am assuming. I will ask the same question then in relation to psychiatrists. How many psychiatrists have used the program on an annual basis over the past five years? How many divisions of general practice were registered in the Mental Health Nurse Incentive Program on an annual basis over the past five years? You will jump in if you have any of these answers, I presume?

Ms Nicholls: Yes.

Senator WRIGHT: I am interested-and you may be able to answer this one for me-in how many Medicare Locals are currently registered in the Mental Health Nurse Incentive Program? Ms Nicholls: We can certainly take that on notice. As divisions of general practice are transitioning across to Medicare Locals, obviously they are eligible to continue the delivery of the service. So that figure will change as the transition occurs.

Senator WRIGHT: You do not have a ballpark figure at this stage that you could provide to me?

Ms Nicholls: No.

Senator WRIGHT: How many headspace centres are currently registered in the program?

Ms Nicholls: I would clarify that headspace is not an eligible organisation under the program, as I understand it, so we would need to look into that. As you have identified, divisions of general practice, private psychiatrists, general practices and Medicare Locals are eligible organisations, but-

Senator WRIGHT: You do not think headspace is an eligible organisation?

Ms Nicholls: I do not think they have been defined as an eligible organisation, so I would need to look into that.

Senator WRIGHT: Perhaps you could clarify that for me then. I understand that with the funding cap there is a requirement that no new organisations or nurses can join the program unless existing participants leave. Is that correct?

Ms Nicholls: That is certainly the approach that is being taken in relation to ensuring that organisations can maintain existing service levels. The Department of Human Services has written to all of the organisations that are currently approved and registered with them to deliver these services. The purpose was to advise them of the changes and to identify that in order to maintain existing service levels we will be ensuring that new services are not approved unless existing services have dropped off the program, and that existing services are being asked to maintain current nurse service levels so that we can maintain program funding.

Senator WRIGHT: Back to the headspace issue, I was operating under the, I suppose, understanding that headspace is able to use the program in some way or another. I am not sure whether that is through some other mechanism, not being a registered organisation as such. Are you aware as to whether entities operating such as headspace have actually been able to use the Mental Health Nurse Incentive Program at all?

Ms Nicholls: There are probably two things I would say. One is that I know of at least one Division of General Practice that is approved to operate a headspace service-so there could be confusion in terms of eligibility relating to that. The other is that, where headspace services are utilising the services of GPs or psychiatrists, it may be that the headspace service is utilising the mental health nurses through that process. But my understanding is that headspace itself is not an eligible organisation to employ mental health nurses in that way.

Senator WRIGHT: So if there is a capacity through some mechanism for GPs working with headspace, for instance, to use the program, I am concerned that with the cap-with the requirement that no new nurses be able to be enrolled or used in relation to the program, as was set out in the letter of 9 May-the 30 new headspace centres that are to be announced by the end of June would presumably not be able to access the use of this program because they will be newly organised entities. What would you say to that? Am I misunderstanding that situation?

Ms Nicholls: I would probably go back to the fact that we have approved eligible organisations and they are as we have already identified, and that it is up to those eligible organisations to employ mental health nurses. We would not know what that might look like in the context of headspace, and that would have to be considered into the future. In terms of the things that we have asked the evaluation to consider, it has been asked to consider the Mental Health Nurse Incentive Program in the context of all of the developments in the mental health program. So we would anticipate that looking at issues in relation to headspace would be one of the matters that the evaluation would pick up on, just as it would look at expansion in other services and other areas of the mental health system.

Senator WRIGHT: When is the evaluation due to be completed?

Ms Nicholls: September.

Senator WRIGHT: It sounds to me from the answer that you are giving at the moment that, subject to whatever may roll out after the evaluation is completed, unless entities associated with new headspace centres that are announced are already eligible organisations they would not have the capacity to then become involved in this program at this stage because no new eligible organisation is going to be allowed at this stage. Is that correct?

Ms Nicholls: Yes; unless existing organisations step out of the program.

Senator WRIGHT: As previously mentioned, stakeholders informed us that as of 9 May they were advised that no new organisations or nurses can join the program unless existing participants leave, and organisations and nurses will need to maintain client services and sessions at existing levels. I am interested in unpacking how that can work practically. For example, if a nurse has worked on a part-time basis this financial year but was intending or wishing to increase their workload next financial year to full-time hours, that particular nurse would not be able to do so-is that right?

Ms Nicholls: I think the issue is that it is the eligible organisations that employ the mental health nurses identify what the client loads are that they think need the mental health nurse services for. It is appreciated that the nature of service delivery will mean that some clients with severe and persistent mental illness will need ongoing treatment and some clients will have episodic levels of care, which will mean that they need higher and lower levels of service throughout the period, and that is provided for in the guidelines. So we would be looking at the organisations employing the mental health nurses to be looking at the service levels they provided over the previous period and managing the service delivery in relation to that.

Senator WRIGHT: It sounds highly difficult to me, given the variable nature of, as you say, treating people with mental illnesses, where some people have fairly predictable, I suppose, care needs and others have episodic illnesses where they will need more intensive care or attention at some particular points and not at others. If this is demand driven, essentially the demand will be subject, in fact, to this cap-this requirement that organisations do not go beyond their existing care levels. So, will new patients experience limited access to these services as a result of the funding cap and the requirement that client services must be maintained at existing levels? It sounds as though if there is not a big change in the current service that is being provided by a registered organisation, they will not be able to take on new patients and they will not necessarily be able to meet the needs of their existing clients if their patient needs increase. Is that right?

Ms Campion: As Ms Nicholls said earlier, the organisations that are registered currently will need to manage their client loads based on current patterns of service and to manage their patients over the year according to current levels of service. As patients leave, no longer needing the services or for other reasons, new patients will be able to be brought into the program-but only under those circumstances.

Senator WRIGHT: So there might be waiting lists? If they have patients that all require more hours or more needs at a particular point because they happen to have illnesses that become exacerbated at that same time, I am interested in how an organisation will manage those requirements over the course of a financial year. It sounds difficult practically. Can you indicate how you think that would work?

Ms Campion: It is a bit hard to speculate because we are trying to work out what the situation might be and how an organisation might respond, and there could be any number of different scenarios there. So I think it is actually quite hard for us to provide you with one answer to-

Senator WRIGHT: I think that is my point, really. If it is hard for you to speculate presumably it is really hard for the organisations to speculate as well, given the somewhat unpredictable nature of the care needs that their patients will have. It is by virtue of the fact of their needs that this program has been demand driven, essentially-so that it can be responsive to the needs of the patients that the organisations are seeing. So, to extend what I am trying to get to, if an organisation were to maintain the same number of mental health nurses-so no nurse were to leave or reduce their hours-over the next financial year, and all patients continue to access sessions in the next financial year at the same rate and frequency that they accessed them in the last financial year, then the organisation would not be able to employ new nurses to respond to demand for additional services. They would not be able to meet the demand for additional services, it seems to me, and the organisation cannot offer assistance to new clients in need of services provided by mental health nurses. So if they have existing patients who have greater needs, they will not be able to respond to those and they will not be able to take on new patients either. That is the logical consequence of what is meant by managing, I suppose, this pre-existing level of service delivery.

Ms Huxtable: Obviously, individual organisations-as Ms Campion has said-may have different ways of addressing this. But you could imagine in the scenario that you painted that there may also be clients who no longer require the service, or clients who in the future have less need for the service than they have had. So it is obviously a bit of a management exercise, not unlike where we have services that are delivered under grant management arrangements and where there is an expectation about the level of funding that is available. Organisations, as they enter into arrangements with us, are expected to manage to that level of funding. This is really not dissimilar.

I think the important point to make here is that the program has provided services year on year-I think 40,000 last financial year and 47,000 this financial year. When this program was initially announced back in 2006-07, the expectation was that when fully functional, that was the order of services it would be providing. In fact, I think it was less than that. I think we were looking then at around 36,000 services a year. So it has grown beyond what the original expectation was. This decision is an opportunity to pause while the evaluation is going on and to maintain the program at what is a higher than anticipated level in any event, but then to look at the evaluation and come to a view about what that might mean for the program in the future.

Senator WRIGHT: I understand that. Obviously, it would be a happy situation if, for some reason, an organisation were juggling a situation where, indeed, their patients were in a state of recovery where they did not need as much. That would be an easy thing for them to manage, and they could then take on more nurses or more hours of care. Obviously, it is the other side of the equation, given that it is demand driven. I am interested in what happens to those new patients who need the services and who are not going to be able to access them. Given that it is demand driven, of course it is somewhat unpredictable.

Ms Huxtable: Although it is demand driven within a capped allocation. So it is an odd beast, I know, and we have a few programs that are like this. But from the beginning an allocation has been made available in respect of this program, so it is what we call a capped demand-driven program-I know that seems odd-and that is one of the things that need to be looked at in the evaluation: what is the best way of continuing this program into the future? There are often fluctuating needs within this population. So, yes, needs at times may be greater, but needs at times may be less as well. I think that within organisations there will be some capacity to manage within that environment, knowing the services they have provided in the past and so what they need to be pitching for in next financial year.

Senator WRIGHT: Again, I say in terms of reduced services that it is not a problem if there is fluctuation down, but if there is fluctuation up it ultimately means that someone will not be getting the care that they may need. The program started running in 2007. Is this the first evaluation that has been done of the program?

Ms Huxtable: I am not sure I know the answer to that, to be honest. One of my colleagues may know.

Ms Nicholls: It is the first external overall evaluation, yes.

Senator WRIGHT: On what basis was the decision made to apply this particular cap and require these changes? I understand it may have been nominally capped previously but, in fact, as we have seen, demand has increased and demand has been met as it has increased. Now we have this cap which essentially means that there will be a reduction in services for some people. Why is it that this has now been instituted before apparently an evaluation has been done about the efficacy of the program?

Ms Halton: Senator, as has been discussed already in this committee today, we are in constrained financial circumstances. We are having constraints put on us in a number of places in the portfolio and this is one of them. You are quite right; the review is very important. We have had to trim our cloth in a number of areas and this is one of them.

Senator WRIGHT: I guess I am suggesting that a review to evaluate the efficacy of the service and to ascertain what will happen to those people who need the care and are not going to receive it would have been sensible before implementing this change. That is the next course of questions that I am asking. What is going to happen to the people who have the need and their needs are not going to be met? It seems to me that the program provides assistance to people, as we have acknowledged, experiencing severe and persistent mental illness. There are case studies that I am aware of where that has been particularly effective in keeping people as well as possible in the community. The potential is that if they are not getting that care, they will end up needing a more acute intervention such as hospitalisation. If new clients with severe and persistent illnesses cannot access the service because, for instance, an organisation is at capacity-and that may well be the case in rural areas-and cannot increase service levels, where will they go to receive assistance and treatment for their severe mental illness? What will happen to them? What predictions have been made about the flow-on costs of that kind of exacerbation of illness?

Ms Huxtable: There are a number of issues there. The first thing I would say is that in the current environment there has been $17-odd million made available for this program. It is important to note that is the case. I might get some of these figures wrong, but the base allocation would have been $19 million in respect of next financial year and money has been available to lift it up to that $35-odd million, providing services to more people than were anticipated would be using those services.

The other point to make is that there is also other work afoot as part of the mental health reform package from last year. It is important that a program like this is put in the context of broader mental health reform work, some of which is very much targeted to a similar population-those with severe and persistent mental illness. One of those measures is the Partners in Recovery measure, which is a very significant investment. We may well get questions about that here today. Another is the work that has occurred with states and territories around the National Partnership Agreement on Mental Health. A number of measures have been successfully negotiated with the states around providing services to this group. It is a changing landscape in which the Mental Health Nurse Incentive Program operated. It would seem to me quite timely to consider it in the context of those broader matters and in the context of the evaluation going forward.

I would not want to leave the impression that there has been a reduction in funding to this program-$17 million has been made available in 2012-13 for this program to maintain service levels in an environment where other things are also coming on stream. I think that is important.

Ms Halton: To re-emphasise the point, we are doing a review in this overall context. No, there will not be an extension, exactly as I have said, because we have all had to cut our cloth a bit. But there are a number of other ways in which people's service needs are going to be able to be met.

Senator WRIGHT: How will they be met? That is what I am interested in. Where will these people go? The predictions are that there will not be sufficient being able to meet need beyond this year. So where will those people go, in terms of the clients who need services?

Ms Huxtable: I do not think that people should assume from the budget announcement that this program will cease to exist. That is certainly not the intention. Money has been made available for a year while that evaluation is conducted. I think Ms Nicholls referred to the out years-the $19 million a year figure in the out years. The intention of this allocation and the evaluation is that there be consideration of what is an appropriate amount in the out years, noting that the initial estimates of how many people this would provide services to have well been passed. More than 10,000 more people have accessed services. It needs to be seen in that context, rather than a reduction in service. I feel that we are a little at cross purposes on that. I am trying to draw the broader context.

Senator WRIGHT: Am I understanding you to say that, depending on the outcome of the evaluation, if it is seen that this is actually good value for money, that it is meeting need and that it is actually providing services that would otherwise be unavailable to people in the community, particularly people with persistent severe mental illnesses-it is enabling them to stay out of hospital-the forward estimate for the next financial year may be revised? Is that what you are suggesting?

Ms Huxtable: The government has already been quite clear in this announcement that the evaluation that is being undertaken is assessing the effectiveness and the appropriateness of the program and that evaluation will guide consideration of funding in 2013-14 and future years. Obviously that would be a matter for the government in the budget context, and we are a long way away from the next budget. The government has been very clear in the announcement that its intention is very much to review this program and how it best fits in the long term in terms of that broader fabric of services that are available, but also what is the expectation around future demand and how do you best meet that demand.

Senator WRIGHT: I might come, again, to some more specifics about how, practically, this essential cap-the requirement that existing service levels be maintained but not increased-is actually going to work on the ground. The number of sessions a mental health nurse delivers each week often fluctuates due to clients' needs. How will Medicare, or anyone, decide what an organisation's existing level of activity is?

Ms Nicholls: As I said before, the Department of Human Services has written out and provided initial information to all organisations-

Senator WRIGHT: Was that the letter of 9 May? Excuse me for interrupting. I just wanted to be clear on whether there was any other documentation.

Ms Nicholls: It was of 22 May. These are, of course, in part, issues for the Department of Human Services. They have also identified where public inquiries can be directed so that organisations that have concerns about how they will manage this can ring the Department of Human Services.

Senator WRIGHT: You cannot give me any more specific information about how that will work? It is a matter for the Department of Human Services to advise affected organisations or nurses?

Ms Halton: We should take it on notice. The reality is that the policy is ours. We will take it on notice and give you some quite specific answers to that question.

Ms Campion: We have been working with the Department of Human Services to design the implementation of the measure.

Senator WRIGHT: The Department of Health and Ageing has indicated that the decision is effective from 9 May. That was the letter that I was referring to that I think was signed by you, Ms Nicholls. If an organisation has increased its level of activity since that date-for example, a new nurse is engaged or an existing nurse works for longer-will Medicare pay for that activity?

Ms Nicholls: The estimates in terms of the additional funding available have predicted service usage up until 30 June this financial year, recognising that there is often a time lag between when a service is delivered and when claims are made. As I said, this has been factored into the costings. The reason why we put the letter out so quickly and flagged this with providers was that it was important to provide early advice to the sector so they did not start developing new services or expanding existing services. Obviously, this is provided for where that was already in train before this advice.

Senator WRIGHT: I would just clarify what information has been provided to services or organisations at this stage. Was your letter of 9 May sent out to all registered organisations?

Ms Nicholls: No, my letter of 9 May was to the key stakeholder groups that we had identified in relation to that. It was for DHS, who administers the programs, with the details of the organisations currently claiming funding, to write out to all providers, which they have done.

Senator WRIGHT: That was dated 22 May?

Ms Nicholls: Yes. My understanding is that that letter was of 22 May. They have identified where people can make inquiries and they have also put information on their website.

CHAIR: Senator Wright, your time is just about up.

Senator WRIGHT: Thank you very much, Chair. I have just a couple more then. Was that information also sent to the mental health nurses, as well as the organisations, from the Department of Human Services?

Ms Nicholls: I would need to check that.

Senator WRIGHT: If you could take that on notice, please, and if you could clarify who that documentation on 22 May went out to.

Ms Campion: Do you mean the actual nurses who are providing the services or the peak body?

Senator WRIGHT: No; I mean the nurses who are actually providing the services.

Ms Campion: Okay.

Senator WRIGHT: That brings me to my final questions, which go to how the identity of the nurses involved is actually ascertained. If there is no current requirement for mental health nurses to apply to enter the incentive program or to notify Medicare if they discontinue working with the program, how will the department monitor the number of nurses in the program?

Ms Nicholls: It is the organisations who employ the nurses. The relationship is between those organisations and the nurses and those organisations and the Department of Human Services in terms of funding and payments. When those organisations claim for funding they provide a range of information to DHS. It would be up to DHS to identify information in relation to that.

Senator WRIGHT: What notice will Medicare give to organisations if they will not be paid for sessions above a particular level? If they have gone above their existing service level, however that is identified, what notice will be given to organisations in that case?

Ms Campion: We need to take that on notice and talk to DHS about that.

Senator WRIGHT: It is an important issue to have the organisations involved.

Ms Campion: Yes.

Senator WRIGHT: Can you tell me-and you might need to take this on notice-how much on average per hour is the cost of mental health nurses under this program?

Ms Nicholls: A session is defined as 3½ hours and the sessional rate is $240 per session. Then there is a loading.

Senator WRIGHT: So it is $240 for a 3½-hour session?

Ms Nicholls: And then there is a loading for rural and remote as well.

Senator WRIGHT: How does that compare to the average hourly rate of doctors, psychologists and psychiatrists? If you are not sure, perhaps you need to take that on notice. In the sense of value for money or the cost of the program, I am interested in comparing $240 for a session of 3½ hours with the average hourly cost of doctors, psychologists and psychiatrists. Do you have those figures available for me at this stage?

Ms Huxtable: Could we take that on notice and see what we can provide you? I am not sure that the session rate is going to compare. We will have a look and talk to our colleagues in Medicare benefits and see what we can come up with.

Senator WRIGHT: Thank you very much.

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