Content
Strategic Plan 1991-1993
Published year: 1991 |
Reference No: NH3 |
The NHMRC Strategy is shaping the Council's activities in the present triennium.
Substantial consultation and wide-ranging input have contributed greatly to the Strategy and have assisted its evolution into its current form.
To maintain its relevance a strategic plan must promote public discussion and feedback.
This plan sets the broad directions for the NHMRC for the remainder of the current triennium (1991-93), identifies linkages with other key elements in the health field and indicates the major health issues NHMRC would like to address.
Feedback on the Strategy is welcome, and should be directed to:
The Secretary
NHMRC
GPO Box 9848
CANBERRA ACT 2601
Appendix B to the Strategy sets out guidelines for NHMRC's approach to consultation. I have made specific comment on consultation as an introduction to those guidelines.
It should be noted that the strategy for the health and medical research program is substantially expanded in a separate NHMRC document 'Strategy for Health and Medical Research'.
Dr Diana Horvath
Chairman of Council
The Council's Broad Approach
Consultation and Communication
1. HEALTH CARE PROGRAM
2. PUBLIC HEALTH PROGRAM
3. HEALTH AND MEDICAL RESEARCH PROGRAM
4. ETHICS PROGRAM
Appendix A- NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL 1991-93
Appendix B - GUIDELINES FOR CONSULTATION
Attachment 1 - NHMRC GUIDELINES FOR CONSULTATION
Attachment 2 - GUIDELINES FOR CONSULTATION - AUSTRALIAN HEALTH ETHICS COMMITTEE
Attachment 3 - GUIDELINES FOR CONSULTATION - PUBLIC HEALTH COMMITTEE
NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL
The National Health and Medical Research Council was established in 1936 to advise governments on matters relating to health and on funding for health and medical research.
Members of the Council are drawn from various walks of life and serve on a part-time basis. The composition and membership of the Council are shown at Appendix A.
The Council operates through a network of expert committees, the members of which also serve on a part-time basis.
The secretariat to the Council and its committees is provided by the Department of Health, Housing and Community Services.
The charter for the NHMRC is set out in the Order in Council which establishes the NHMRC as follows:
(a) To inquire into, and to advise and make recommendations to the Commonwealth, the States and Territories and the Australian community on matters relating to:
(i) the improvement of health (including legislation, administration and practice in that field);
(ii) the prevention of disease (including the merits of methods of disease prevention, diagnosis and treatment);
(iii) health care, medical care, dental care, health research and medical research; and
(iv) ethical issues in relation to health,
(b) to advise and make recommendations to the Commonwealth on expenditure of money on health research and medical research and in connection with projects of health research and medical research generally; and
(c) to advise the Minister on the application, and on matters connected with the application, of the Medical Research Endowment Fund for the purposes of the Medical Research Endowment Act 1937.
In the performance of its functions, the Council shall, in particular -
(a) sponsor and support investigations and recommend priorities (including priorities in the matter of funding) in the fields of health care, health services, health research and medical research;
(b) co-ordinate the work, and assess the recommendations, of NHMRC committees (including the principal committees); and
(c) review, at intervals of not more than 3 years, the effectiveness of the Council's activities in the performance of its functions.
The Council views 'health' in the same light as the World Health Organization: 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infinnity'.
Knowledge of 'best practice' in health (i.e. health activities that are appropriate, effective, efficient and equitable) - both personal health and public health interventions - derives from health and medical research. NHMRC inspires and funds research, distilling this knowledge into consensus statements which answer questions of 'best practice' and guidelines for a healthy environment. Collection and analysis of health data, such as that undertaken by the Australian Institute of Health, provides information about Australia's health.
In order to fulfil its role, NHMRC is required to:
- develop and maintain a national network of expertise,
- contribute to and have access to relevant knowledge around the world;
- maintain the trust and respect of the health care community and the Australian people in order to be able to work as an honest broker.
In so doing NHMRC recognises that there are many professions engaged in the delivery of personal health care, whether in institutions or in the community. They all may engage in research activities pertinent to their respective areas of practice. Hence, phrases such as 'service providers', 'clinical practice' and 'clinically-based research' are intended to include reference to doctors, nurses, dentists, and allied health and scientific professionals and their related areas of health practice and research.
Consultation and Communication
The NHMRC places great emphasis on appropriate consultation in its processes. Committees, working parties and expert panels are constituted to ensure that relevant professional and community interests are represented. As well, the processes of formulating guidelines, standards and advice, themselves involve consultation as widely as possible and as relevant to the issue. Processes for NHMRC public consultation are being developed.
Equally important is appropriate communication of the outcome of NHMRC deliberations. A Communications Committee has been established and has prepared a communications strategy for NHMRC.
Guidelines for consultation and for representation of public interest perspectives on NHMRC Committees working groups etc. are attached. (Appendixes B and C)
NHMRC has responsibilities for advising on issues across the total spectrum of health and provides a national focus for dealing with the major issues affecting the health of the Australian people. Over the 1991-93 Triennium particular attention will be paid to:
- Inequalities in health status - as and between different population groups (particularly Aboriginal people) ~ with a view to identifying ways of reducing inequalities. This involves identifying ways of taking further steps to changing behaviour (of both professionals and communities) to effect best practice.
- Improved understanding of chronic conditions - both causality and means of influencing outcomes. The particular focus will be on diseases for which there is currently neither cure, nor satisfactory treatment.
- Ageing - improved understanding of the ageing process, impact on population health of the nation, and means of re-orienting health services and individuals to ensuring healthy lifestyles for older people and for changing approaches to care.
- Environmental health - develop a range of strategies to understand better the links between ecologically sustainable development and human health, including the effects of environmental contamination and to intervene where appropriate to prevent adverse effects on human health. A particular concern will be to understand better the effects on health of the urban environment and how a better urban environment might be healthier. Inter-sectoral issues will need to be assessed carefully.
- Research - assess the needs for and means of providing improved infrastructural support for the nation's medical and health research. In addressing these priority issues, NHMRC will be mindful of the social circumstances of the 1990s and hence provide advice relative to:
- defining the relationships between the different service providers.
- defining the relationships between providers and consumers of health services (both at an individual and group level).
These involve matters of law, ethics and social practice.
The NHMRC resources which include a range of professionals involved in health care delivery, representatives of consumers. the community and industry and health and medical researchers, enable NHMRC to deal with these and other issues in a unique way. It is the only national organisation with access to such a broad range of health expertise.
NHMRC closely co-ordinates its work with other national bodies in relevant areas including the National Occupational Health and Safety Commission and the Australian Institute of Health.
NHMRC operates at two broad levels:
- the Council which provides general direction and advises on major issues,
- committees which provide expert advice on a range of issues and which generally make use of sub-committees, working parties and expert panels.
There are four programs of activity within the NHMRC, as follows:
- health care
- public health
- health and medical research
- ethics
The health care program advises on 'best practice' in health care delivery and is managed through the Health Care Committee (HCC). Its focus is clinical practice and the patient.
The functions of HCC are as follows:
(i) To inquire into and advise the Council on matters relating to health care and the provision of health services;
(ii) to inquire into and advise the Council on the merits of methods of disease prevention, diagnosis and treatment:
(iii) to receive, and make recommendations to the Council in relation to appropriate reports of expert groups and specialist working parties and community groups.
(iv) to prepare reports, submissions and any other documents relating to the functions of the committee for distribution by the Council: and
(v) to advise the Council on means of providing information to the Australian community on matters relating to the functions of the Committee.
Major Themes
- NHMRC has a major national role in the development of standards of provision of health care.
- NHMRC is uniquely placed to develop guidelines for clinical practice in areas such as diagnostic imaging, birthing options, mental health practice, and informed decisions about medical interventions.
- This work will be undertaken jointly with relevant professional organisations and involve community and consumer groups.
- Work on the development of guidelines for informed consent to a range of procedures will continue. This is an important area of public concern and relates to research, health practice and public health. Whilst the NHMRC will focus on the health and ethical concerns there will be legal, social and administrative implications.
- In the context of the better management of chronic conditions, a national action plan is being developed to address the complications of diabetes.
- As part of developing an improved understanding of the ageing process, mental and dental health issues facing the elderly are to be considered.
- The introduction of health technologies and provision of advice on their most appropriate distribution nationally will be undertaken through the Australian Health Technology Advisory Committee. This concentrates national expertise in best practice, evaluation methodology and economics.
- Preventive measures including screening and periodic health cheeks are of increasing importance as the community accepts the need for a greater emphasis on preventive health care. NHMRC is well placed to recommend guidelines for the scope of various screening programs, their frequency and best practice in their conduct, analysis and evaluation.
- The development and maintenance of networks of health care experts, service deliverers and users of health services is a major continuing requirement.
- NHMRC will encourage the most rigorous methodologies in evaluating all aspects of health care.
- The Public Health Program develops policies, guidelines and standards to minimise the harm to the community through environmental health hazards. In meeting this objective the Public Health Committee (PHC) provides the mechanism to promote uniform action by all jurisdictions to implement the advice and recommendations which come from its detailed scientific assessment of issues of public health concern.
The functions of PHC are as follows:
(i) To inquire into and advise the Council on matters of public health, preventive medicine and the improvement of health, including environmental factors on health, and the health of minority groups including Aboriginal people;
(ii) to advise the Council on the legislation and administrative procedures that should be introduced by the Commonwealth, the States or the Territories to implement the matters referred to in paragraph (i);
(iii) to receive, and to make recommendations to the Council on reports of expert groups and working parties in matters relating to the Committee's functions;
(iv) to prepare reports, submissions and any other documents relating to the functions of PHC for distribution by the Council; and
(v) to advise the Council on means of providing information to the Australian community on matters relating to the functions of the Committee.
Major Themes
Chemicals Safety
- The safety of chemicals used in agriculture and in veterinary practice is the immediate responsibility of NHMRC. Measures to increase the efficiency of the clearance and review process for these chemicals and to improve the availability of information to the public are planned for the triennium, along with the development of a national policy to reduce harm to the community through the use of domestic chemicals.
Food and Health
- NHMRC will continue to study the longer term relationship of food and health and provide input to the National Food Authority inquiries as necessary.
Environmental Influences
- Air, water and soil quality, the 'sick building syndrome', disposal of wastes, radiation protection standards and improvement in understanding and reporting of communicable disease are all high on PHC's agenda for the triennium. The development of national standards and guidelines is the highest priority. More effective coordination with other relevant agencies (particularly the Australian and New Zealand Environment Council) with the aim of more timely introduction of nationally accepted standards is a high priority initiative.
Ecologically Sustainable Development
- The development of a national strategy on ecologically sustainable development, health impacts of longer term climatic change and international developments including the 1992 UN Conference on the Environment and Development, provide a basis to promote the intersectoral impacts of the environment and human health. Securing recognition of the importance of the direct and indirect effects on human health within the environment debate (and inclusion of health in such processes as environmental impact assessment) is a key priority for PHC during this triennium.
Disease Control and Prevention
NHMRC will contribute to upgrading the national surveillance and
response systems for communicable diseases and examine the national immunisation strategy.
3. HEALTH AND MEDICAL RESEARCH PROGRAM
The health and medical research program advises on the research that should be funded to ensure broadly-based, scientifically sound research into health issues and the maintenance of a highly skilled health and medical research workforce in Australia.
The program is managed through the Medical Research Committee (MRC) and Public Health Research and Development Committee (PHRDC) whose functions are set out below:
(a) Functions of MRC
(i) To advise and make recommendations to the Council on the application of the Medical Research Endowment Fund;
(ii) to monitor for the Council the utilisation of assistance provided by that Fund:
(iii) to assess on behalf of the Council the quality and scope of medical and dental research in Australia and to develop plans to advance such research;
(iv) to advise the Council and the Commonwealth with regard to research undertaken, or to be undertaken, in relation to the improvement of health or the prevention of disease, in institutes and laboratories administered by the Department of Health, Housing and Community Services*, and
(v) to provide to the Council advice on research matters relevant to the functions of the other principal committees of Council.
(b) Functions of PHRDC
(i) To develop guidelines for the funding of research in the field of public health;
(ii) to advise the Council on recommendations to be made by the Council to the Commonwealth in respect of research in the field of public health;
(iii) to advise and make recommendations to the Council on the allocation of funds for the conduct and promotion of research in the field of public health: and
(iv) to advise the Council on means of providing information to the Australian community on matters relating to the functions of the Committee.
Major Themes
- All research funded through NHMRC is ultimately directed towards improved human health. In order to achieve this strategic objective, it is necessary to ensure nationally that there is a broadly-based research capacity involving basic biomedical research, clinicallybased research programs and research focussed around populations. A crucial component of this strategy is ensuring that Australia has a highly skilled research work-force. This is achieved through training and career initiatives.
- Broadly, health and medical research is directed towards meeting the health needs of the community. Currently some 46% of medical research funding is in the areas which are the major killers and disablers of the Australian population - cardiovascular disease, cancer, diabetes, musculos- skeletal disorders, respiratory disease and mental ill-health. The research focus will shift over time and care needs to be taken that its broad direction is appropriate to known and anticipated health problems. Additionally, the particular health needs of disadvantaged groups, especially Aboriginal people, and some major health problems affecting women, need to be investigated. Special mechanisms are required to ensure that these needs are met.
- While the major economic purpose of medical research is to reduce the direct costs of medical expenditure, and indirect losses to the economy from decreased productivity due to ill health, opportunities for returns to Australia from commercial development of discoveries can also arise. Initiatives will be undertaken to improve liaison between researchers and Australian industry and to support development of research results of potential commercial significance.
- With the increasing sophistication of research techniques involving expensive equipment and consumable items, there is a need to ensure that the research infrastructure is maintained appropriately to enable Australian medical science to remain internationally competitive. The allocation of funds for equipment will need to be rationalised to ensure that major items are provided in such a way as to ensure their most effective use.
- There are issues to be dealt with over the forthcoming trienniumrelating to the best mix of research funding, e.g. between clinical, biomedical and public health research, between support for large institutes and individual researchers in small teams, and between research proposed by research experts and that which might be commissioned to meet particular objectives.
The NHMRC ethics program provides advice on ethical issues in health care, public health and health and medical research. This is a new program and will be managed through the Australian Health Ethics Committee, (AHEC) with the following functions:
- (i) To inquire into, advise and recommend on ethical, legal and social matters which arise in relation to public health, health care practice and health and medical research involving humans.
- (ii) To develop guidelines where appropriate to assist in suitable ethical conduct in the health field and to meet the requirements of the Commonwealth Privacy Act 1988.
- (iii) To promote community debate, and consult with individuals, community organisations, the health professions and governments on health ethical issues.
- (iv) To monitor the workings of Institutional Ethics Committees and advise on these.
- (v) To monitor international developments in relation to health ethical issues and liaise with relevant international organisations and individuals as appropriate.
The ethics program will consolidate work in the ethics of health and medical research formerly undertaken by the Medical Research Ethics Committee. Ethical issues arising in health care practice were formerly dealt with through HCC. Bioethical issues were the responsibility of the National Bioethics Consultative Committee which will become part of the NHMRC ethics program. While being formed from these elements, the ethics program will provide fresh perspectives on each and consider ethical issues which arise in public health.
The program will be developed through a wide and intensive process of consultation with governments, health and medical researchers, community groups and individuals.
Major Themes
- The increasing demand for and cost of health services require that greater attention be paid to questions about the ethical implications of the allocation of available health resources. Some of the major ethical issues arising from this have already been identified by NHMRC. AHEC will address these issues and give detailed consideration through a working group which will undertake tasks which include facilitating informed public debate and consultation with the community. Enquiry into this topic will be dealt with at a number of levels and over the triennium a number of papers and reports will become available for public discussion.
- The Institutional Ethics Committees (IECS) are important mechanisms to ensure that the highest ethical standards are maintained in health and medical research. A high priority for AHEC will be to support the work of IECs and to strengthen the network. Strategies will be devised and implemented through a standing subcommittee of AHEC which will specifically focus on IEC related issues. These will include the operation of the Clinical Trials Notification Scheme, guidelines and reporting procedures for the protection of privacy in medical research, and methods for informing and supporting IEC work.
- There is increasing public concern about the protection of privacy in modern society where information is gathered for a range of purposes but can be manipulated and used for different purposes. The Commonwealth through the Privacy Act 1988 has strict rules concerning the use and release of information gathered by Commonwealth agencies. NHMRC guidelines issued under that Act enableaccess to information in the conduct of medical research. AHEC will monitor the continuing relevance and effectiveness of these guidelines in concert with the Privacy Commissioner.
- Guidelines for the conduct of research involving Aboriginal people are being developed and this process will continue well into the triennium.
- Guidelines already developed in the use of genetic registers for research, will continue to be monitored and further developed as issues emerge.
- As awareness and concerns about ethical issues and ethical implications in health care practice become more widespread and sophisticated, institutions in particular have perceived a need for ethics committees to be set up and available to assist in the resolution of ethical dilemmas. Sometimes IECs have been approached to provide such advice. Specific consideration needs to be given to the roles of IEC and ethics committees and methodologies for providing assistance in the identification and resolution of ethical dilemmas in health care practice. This matter will also be addressed by AHEC in the course of the triennium.
- The success of AHEC will depend to a significant degree upon its capacity to consult effectively and flexibly with a wide range of audiences within and outside NHMRC structures. Consultation about ethical issues is highly complex in a pluralist society. It is often impossible to gain consensus on ethical matters which include moral and social issues as well as individual value judgements. AHEC has produced guidelines to assist with its consultation and will monitor their practice and efficiency over the triennium. The committee recognises that consultation should not be aimed at achieving a single agreed position on matters where significant diversity exists.
NHMRC will facemany challenges over the coming triennium. It must retain its traditional values of excellence and continue to identify and respond to emerging issues.NHMRC is one contributor to an increasingly complex health scene. It is uniquely placed to provide expert advice in the health arena through its considerable network of resources.A particular challenge will be to develop or maintain effective relationships with other bodies including
- professional colleges, representative associations and the scientific academies,- national science and technology advisory bodies such as the Prime Minister's Science Council,, and the Australian Science and Technology Council,- the proposed Council for Aboriginal Health, - peak community, union and industry bodies. A major influence on NHMRC strategic direction will be the development of the National Health Strategy. In particular, it is envisaged that NHMRC will be responding to the development of that Strategy in such areas as equity and health, prevention and health promotion, the effectiveness of health research and delivery to meet the needs of targetted groups and the health workforce.Finally, NHMRC faces special challenges in ensuring that its advice is timely and relevant to the Australian population. It will strive to ensure that its messages are received and understood by those to whom they, are directed, including the professions and the broader community.