DEPARTMENT OF HEALTH AND AGEING Section 1: Agency Overview and Resources 1.1 STRATEGIC DIRECTION Since the 2011-12 Budget the Government has announced more than $494 million over four years of spending initiatives to improve critical health and aged care services, including new and amended listings under the Pharmaceutical Benefits Scheme which include: Xgeva® (denosumab), for the treatment of bone metastases from breast cancer and hormone resistant prostrate cancer; Mabthera® (rituximab), for the treatment of a specific form of chronic lymphocytic leukaemia; Erbitux® (cetuximab), for the treatment of metastatic colorectal cancer; and Gilenya® (fingolimod), for the treatment of relapsing-remitting multiple sclerosis. The department is currently working to implement an extensive efficiency program announced as part of the 2011-12 Budget. This will result in a portfolio with a flexible approach to the funding of health priorities and staff that are better enabled and supported to deliver on the Government’s agenda effectively and efficiently. Following the Government's decision to increase the Efficiency Dividend from 1.5% to 4% in 2012-13, the department is positioning itself to achieve further efficiencies in the second half of 2011-12. In conjunction with a reduction in staffing, the department is looking at the way it delivers some core programs so effort can be focussed on delivering legislative and regulatory responsibilities and the Government's priorities, including health reform. 1.2 AGENCY RESOURCE STATEMENT The Agency Resource Statement details the resourcing for the Department of Health and Ageing at Additional Estimates. Table 1.1 outlines the total resourcing available from all sources for the 2011-12 Budget year, including variations through Appropriation Bills No.3 and No.4, special appropriations and special accounts. 11 Department of Health and Ageing Table 1.1: Health and Ageing resource statement — Additional estimates for 2011-12 as at Additional Estimates February 2012 Estim ate as at budget Proposed additional estim ates 2011-12 2011-12 $'000 $'000 Total Total estim ate available at AEs appropriation 2011-12 2010-11 $'000 $'000 Departm ental resources Ordinary annual services Estimates of prior year amounts available in 2011-121,2 Departmental appropriation3,4 s31 Relevant agency receipts Total ordinary annual services Other Services 5 Non-operating Equity injections Total Other Services Departm ental special accounts 6 Opening balance3 Appropriation receipts Non-appropriation receipts to Special accounts Total special accounts Total departm ental resourcing Less appropriations draw n from annual or special appropriations above and credited to Special Accounts and/or CAC Act bodies through annual appropriations Total net departm ental resourcing for Health and Ageing 227,957 600,236 20,010 848,203 29,023 29,023 227,957 629,259 20,010 877,226 178,250 607,884 23,349 809,483 24,613 24,613 (12,324) (12,324) 12,289 12,289 100,311 100,311 58,228 10,775 - 58,228 10,775 58,030 9,998 126,060 195,063 457 457 126,517 195,520 112,513 180,541 1,067,879 17,156 1,085,035 1,090,335 (10,775) - (10,775) (9,998) 1,057,104 17,156 1,074,260 1,080,337 12 Section 1 – Agency Overview and Resources Table 1.1: Health and Ageing resource statement — Additional estimates for 2011-12 as at Additional Estimates February 2012 (cont.) Estim ate as at budget Proposed additional estim ates 2011-12 2011-12 $'000 $'000 Total Total estim ate available at AEs appropriation 2011-12 2010-11 $'000 $'000 Adm inistered resources Ordinary annual services 3 Outcome 1: Population Health7 Outcome 2: Access to Pharmaceutical Services Outcome 3: Access to Medical Services Outcome 4: Aged Care and Population Ageing Outcome 5: Primary Care Outcome 6: Rural Health Outcome 7: Hearing Services Outcome 8: Indigenous Health Outcome 9: Private Health Outcome 10: Health System Capacity and Quality Outcome 11: Mental Health Outcome 12: Health Workforce Capacity Outcome 13: Acute Care Outcome 14: Biosecurity and Emergency Response Outcome 15: Sport Performance and Participation8 Payments to CAC Act Bodies Total ordinary annual services Other services 5 Paym ents to States, ACT, NT and local governm ent Outcome 1: Population Health Outcome 15: Sport Performance and Participation8 Total paym ents 367,868 (7,765) 360,103 262,032 657,638 (4,545) 653,093 617,840 107,374 500 107,874 109,617 800,052 892,228 92,437 410,660 722,824 3,913 (115,938) (37,383) (14) (23,886) (9,279) - 684,114 854,845 92,423 386,774 713,545 3,913 847,603 815,349 184,610 363,368 641,131 14,624 554,285 292,920 (8,179) 12 546,106 292,932 260,288 186,660 1,120,888 155,232 585 1,120,888 155,817 711,619 140,242 26,279 (600) 25,679 26,991 37,325 6,241,923 (781) (207,273) 36,544 6,034,650 22,974 40,704 5,245,652 25,793 - 25,793 7,841 25,793 - 25,793 2,150 9,991 535 - 535 27,910 535 - 535 300 28,210 26,328 - 26,328 38,201 Adm inistered non-operating Administered assets and liabilities Payments to CAC Act Bodies - non-operating Total non-operating Total other services 13 Department of Health and Ageing Table 1.1: Health and Ageing resource statement — Additional estimates for 2011-12 as at Additional Estimates February 2012 (cont.) Proposed additional estim ates 2011-12 2011-12 $'000 $'000 Estim ate as at budget Special appropriations lim ited by criteria/entitlem ent National Health Act 1953 Essential vaccines Total Total available estim ate at AEs appropriation 2010-11 2011-12 $'000 $'000 19,110 31,826 50,936 39,927 National Health Act 1953 Pharmaceutical benefits 9,646,858 (230,278) 9,416,580 8,774,856 National Health Act 1953 Aids and appliances 266,319 (558) 265,761 244,738 16,901,499 192,714 17,094,213 16,266,209 75,306 - 75,306 57,509 815,653 17,282 832,935 . 628,321 7,006,144 443,950 7,450,094 6,721,389 587,069 (12,403) 574,666 531,715 44,269 4,000 48,269 39,541 Health Insurance Act 1973 Medical benefits Dental Benefits Act 2008 Aged Care Act 1997 - Flexible care subsidies Aged Care Act 1997 - Residential care subsidies Aged Care Act 1997 Community care subsidies National Health Act 1953 Continence aids payment scheme - - - 5,585 3,753,656 973,747 4,727,403 4,727,601 Aged Care (Bond Security) Act 2006 Private Health Insurance Act 2007 National Health Act 1953 - Blood fractionation, products and blood related products to National Blood Authority 646,003 - 646,003 608,868 Medical Indemnity Act 2002 117,200 (9,700) 107,500 58,610 3,244 (1,992) 1,252 - - - - - 345,000 - 345,000 316,053 Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2010 Paym ents to CAC Act Bodies Private Health Insurance Act 2007 - Risk Equalisation Trust Fund Private Health Insurance Act 2007 - Council Administration Levy Total special appropriations 5,366 - 5,366 5,235 40,232,696 1,408,588 41,641,284 39,026,157 14 Section 1 – Agency Overview and Resources Table 1.1: Health and Ageing resource statement — Additional estimates for 2011-12 as at Additional Estimates February 2012 (cont.) Estim ate as at budget Proposed additional estim ates 2011-12 2011-12 $'000 $'000 Adm inistered special accounts 6 Opening balance3 Appropriation receipts Non-appropriation receipts to special accounts Total special accounts Total adm inistered resourcing Total Total estim ate available at AEs appropriation 2011-12 2010-11 $'000 $'000 13,799 4,595 - 13,799 4,595 11,877 12,299 1,290,865 1,309,259 212,888 212,888 1,503,753 1,522,147 698,542 722,718 47,810,206 1,414,203 49,224,409 45,032,728 Less appropriations draw n from annual or special appropriations above and credited to Special Accounts and/or CAC Act bodies through annual appropriations (392,286) Total net adm inistered resourcing for Health and Ageing 47,417,920 781 (391,505) (374,591) 1,414,984 48,832,904 44,658,137 Total net resourcing for Health and Ageing 1,432,140 49,907,164 45,738,474 48,475,024 All figures are GST exclusive 1 The estimate of prior year amounts available constitutes opening balance at bank and appropriation receivable for the core department (excluding special accounts). 2 The estimate at Budget has been revised to reflect the 2010-11 Annual Report. 3 Appropriation Bill (No 1 & 3) 2011-12. 4 Includes an amount of $9.942m in 2011-12 for the Departmental Capital Budget (refer to table 3.2.5 for further details). For accounting purposes this amount has been designated as 'contributions by owners'. 5 Appropriation Bill (No 2 & 4) 2011-12. 6 Estimated balances for special accounts (less 'Special Public Money' held in accounts like Other Trust Monies accounts (OTM) and Services for other Government and Non-agency Bodies). For further information on special accounts see Table 3.1.1. 7 The proposed additional estimates for Outcome 1 includes a reduction of $11.823 million for a transfer under s32 of the FMA Act to the Australian National Preventive Agency for the National Binge Drinking Strategy. 8 The sports function transferred to the Department of Prime Minister and Cabinet as a result of the revised Administrative Arrangement Orders of 14 September 2010. 15 Department of Health and Ageing 1.3 AGENCY MEASURES TABLE Table 1.2 summarises new Government measures taken since the 2011-12 Budget. Table 1.2: Agency 2011-12 Measures since Budget Program 2011-12 $'000 2012-13 $'000 2013-14 $'000 2014-15 $'000 National Im m unisation Program - listing of Fluarix Department of Health and Ageing Administered expenses 1.5 (167) Total (167) (173) (173) (178) (178) (183) (183) National Im m unisation Program - Q fever vaccine - revised arrangem ents Department of Health and Ageing Administered expenses 1.5 (1,426) (1,426) Total (1,426) (1,426) (1,426) (1,426) Outcome 1: Population Health Therapeutic Products - establishm ent of the Australia New Zealand Therapeutic Products Agency Department of Health and Ageing Departmental expenses 1.4 nfp Departmental capital nfp Total - - Outcome 2: Access to Pharmaceutical Services Herceptin® Program - additional vial size Department of Health and Ageing Administered expenses 2.3 (4,545) (5,137) (5,315) (5,494) Department of Human Services Departmental expenses Departmental capital Total 575 434 (3,536) (5,137) (5,315) (5,494) Pharm aceutical Benefits Schem e - new and am ended listings Department of Health and Ageing Administered expenses 2.2 66,476 112,898 3.1 941 (1,217) 128,082 (841) 135,120 (560) Department of Veterans' Affairs Administered expenses Department of Human Services Departmental expenses Departmental capital Total expenses Department of Health and Ageing Administered revenue Total revenue 814 669 737 645 354 227 68,812 422 634 662 - - - 112,772 128,612 135,867 nfp nfp 16 nfp nfp nfp nfp nfp nfp Section 1 – Agency Overview and Resources Table 1.2: Agency 2011-12 Measures since Budget (cont.) Program 2011-12 $'000 2012-13 $'000 2013-14 $'000 2014-15 $'000 Pharm aceutical Benefits Schem e - price am endm ents Department of Health and Ageing Administered expenses 2.2 (17,794) (38,658) (38,823) (40,993) (1,780) (3,793) (3,743) (3,804) (19,574) (42,451) (42,566) (44,797) Medicare Benefits Schedule - new and revised listings Department of Health and Ageing Administered expenses 3.1 (105) Departmental expenses - (177) - (385) - (611) - Department of Veterans' Affairs Administered expenses (192) (646) (673) (722) Department of Human Services Departmental expenses Total expenses (5) (302) (23) (846) (26) (1,084) (29) (1,362) Department of Veterans' Affairs Administered expenses Total expenses Outcome 3: Access to Medicare Services Positron Em ission Tom ography (PET) services at Westm ead Hospital Department of Health and Ageing Administered expenses 3.3 Departmental expenses - - - (1,300) (1,300) (1,300) (1,300) Clean Energy Future - Helping Households - residential aged care Department of Health and Ageing Administered expenses 4.6 542 418 321 Department of Veterans' Affairs Administered expenses Total 76 494 58 379 Treasury Departmental expenses Total (1,300) (1,300) (1,300) (1,300) Outcome 4: Aged Care and Population Ageing - 17 99 641 Department of Health and Ageing Table 1.2: Agency 2011-12 Measures since Budget (cont.) Program 2011-12 $'000 2012-13 $'000 2013-14 $'000 2014-15 $'000 Outcome 10: Health System Capacity and Quality Health and Hospitals Fund - Royal Hobart Hospital - bring forw ard of funding Department of Health and Ageing Administered expenses 10.6 Department of Treasury Administered expenses Total (16) (16) (38,606) (38,606) (50,000) (50,000) - (50,000) (50,000) Health and Hospitals Fund - Northern Territory BreastScreen Australia project Department of Health and Ageing Administered expenses 10.6 Department of Treasury Administered expenses Total (1,200) (1,200) (600) (600) - 1,200 1,200 600 600 National Health Reform Agreem ent - revised funding arrangem ents Department of Health and Ageing Administered expenses 13.3 - - - Department of the Treasury Administered expenses Total - - 21,000 21,000 Mersey Com m unity Hospital Tasm ania - ongoing com m itm ent Department of Health and Ageing Administered expenses 13.3 2,226 Total 2,226 4,530 4,530 - Outcome 13: Acute Care - Outcome 14: Biosecurity and Emergency Response Delivery of Hum an Quarantine Services Department of Health and Ageing Administered expenses 14.1 Department of the Treasury Administered expenses Total 18 (600) - - - 600 - - - - Section 1 – Agency Overview and Resources Table 1.2: Agency 2011-12 Measures since Budget (cont.) Program 2011-12 $'000 2012-13 $'000 2013-14 $'000 2014-15 $'000 Whole of Government Measures1 Reducing the cost of Governm ent adm inistration - one-off efficiency dividend Departmental expenses Health and Ageing (14,063) (13,688) (13,095) Australian Institute of Health and Welfare (410) (412) (415) Australian National Preventive Health Agency (140) (144) (136) Australian Organ and Tissue Donation and Transplantation Authority (151) (152) (153) Australian Radiation Protection and Nuclear Safety Agency (347) (347) (352) Cancer Australia (324) (299) (300) Food Standards Australia New Zealand (483) (479) (483) National Blood Authority (124) (123) (125) National Health and Medical Research Council (1,038) (1,043) (1,052) Private Health Insurance Ombudsman (48) (48) (49) Professional Services Review (148) (149) (151) Total (17,276) (16,884) (16,311) Departm ental Capital Budgets - savings Departmental expenses Health and Ageing Australian Radiation Protection and Nuclear Safety Agency National Blood Authority National Health and Medical Research Council Private Health Insurance Ombudsman Professional Services Review Total - (897) (905) (2,148) - (485) (100) (489) (97) (511) (163) - (20) (15) (8) (1,525) (20) (15) (8) (1,534) (47) (21) (8) (2,898) Other Portfolio Measures1 Digital Productivity - Expansion of telehealth services through trials 2 (Department of Broadband, Communications and the Digital Economy) Department of Health and Ageing Administered expenses 10.2 nfp nfp Departmental expenses nfp nfp Total nfp nfp Better Targeting of Im m unisation Incentives (Families, Housing, Community Services and Indigenous Affairs) Department of Health and Ageing Administered expenses 1.5 1,175 2,479 Departmental expenses 274 383 Total 1,449 2,862 19 np nfp nfp - 6,583 85 6,668 7,191 37 7,228 Department of Health and Ageing Table 1.2: Agency 2011-12 Measures since Budget (cont.) Program 2011-12 $'000 2012-13 $'000 2013-14 $'000 Clean Energy Future - Helping Households - tax cuts and increased paym ents (Treasury) Department of Health and Ageing Departmental expenses 4.6 174 Total 174 Fam ily Tax Benefit - Cease fortnightly paym ents to fam ilies w ho have zero entitlem ent for tw o consecutive years (Families, Housing, Community Services and Indigenous Affairs) Department of Health and Ageing Administered expenses 3.1 (287) (969) Total (287) (969) National Carer Strategy (Families, Housing, Community Services and Indigenous Affairs) Department of Health and Ageing Administered expenses 2.2 61 2.4 107 3.1 8 Total 176 66 103 7 176 71 111 8 190 2014-15 $'000 - (706) (706) 78 114 8 200 Personal incom e tax - 50 percent tax discount for interest incom e - deferral 3 (Treasury) Department of Health and Ageing Administered expenses 2.2 (2) (778) 3.1 (547) (1,212) Total (549) (1,990) Personal incom e tax - standard deduction for w ork related expenses and the cost of m anaging tax affairs - deferral 3 (Treasury) Department of Health and Ageing Administered expenses 2.2 (200) 3.1 (537) (1,463) Total (537) (1,663) Tasm anian Forest Industry - adjustm ent package (Department of Agriculture, Fisheries and Forestry) Department of Health and Ageing Administered expenses 11.1 Total - 500 500 - - Prepared on a Government Financial Statistics (fiscal) basis. 1 The Department is not the lead agency for these measures. Health & Ageing portfolio impacts only are shown in this table. 2 Funding included as a decision taken but not yet announced in the 2011-12 Budget. 3 Numbers for this measure have been revised since the 2011-12 MYEFO 20 Section 1 – Agency Overview and Resources 1.4 ADDITIONAL ESTIMATES AND VARIATIONS The following tables detail the changes to the resourcing for the Department of Health and Ageing at Additional Estimates, by outcome. Table 1.3 details the Additional Estimates and variations resulting from new measures since the 2011-12 Budget in Appropriation Bills No.3 and No.4. Table 1.4 details Additional Estimates or variations through other factors, such as parameter adjustments. Table 1.3: Additional estimates and variations to outcomes from measures since 2011-12 Budget For details to the changes to the resourcing for the Department of Health and Ageing at Additional Estimates from measures please refer to each outcome chapter in Section 2. Table 1.4: Additional estimates and variations to outcomes from other variations For details to the changes to the resourcing for the Department of Health and Ageing at Additional Estimates from other variations please refer to each outcome chapter in Section 2. 21 Department of Health and Ageing 1.5 BREAKDOWN OF ADDITIONAL ESTIMATES BY APPROPRIATION BILL The following tables detail the Additional Estimates sought for the Department of Health and Ageing through Appropriation Bills No.3 and No.4. Table 1.5: Appropriation Bill (No. 3) 2011-12 2010-11 Available 1 $'000 2011-12 Budget $'000 2011-12 Additional Reduced Revised estim ates estim ates $'000 $'000 $'000 262,032 367,868 360,103 4,058 (11,823) 617,840 657,638 653,093 - (4,545) 109,617 107,374 107,874 500 - 847,603 800,052 684,114 - (115,938) 815,349 892,228 854,845 - (37,383) 184,610 92,437 92,423 - (14) 363,368 410,660 386,774 - (23,886) 641,131 722,824 713,545 - (9,279) 14,624 3,913 3,913 - - 260,288 554,285 546,106 - (8,179) 186,660 292,920 292,932 12 - 711,619 1,120,888 1,120,888 - - 140,242 155,232 155,817 585 - 26,991 26,279 25,679 - (600) Administered Items Outcom e 12 Population Health Outcom e 2 Access to Pharmaceutical Services Outcom e 3 Access to Medical Services Outcom e 4 Aged Care and Population Ageing Outcom e 5 Primary Care Outcom e 6 Rural Health Outcom e 7 Hearing Services Outcom e 8 Indigenous Health Outcom e 9 Private Health Outcom e 10 Health System Capacity and Quality Outcom e 11 Mental Health Outcom e 12 Health Workforce Capacity Outcom e 13 Acute Care Outcom e 14 Biosecurity and Emergency Response Outcom e 153 Sport Performance and Participation Total adm inistered item s 22,974 - - - - 5,204,948 6,204,598 5,998,106 5,155 (211,647) 22 Section 1 – Agency Overview and Resources Table 1.5: Appropriation Bill (No. 3) 2011-12 (cont.) 2010-11 Available 1 $'000 2011-12 Budget $'000 2011-12 Additional Reduced Revised estim ates estim ates $'000 $'000 $'000 58,867 67,825 78,582 10,757 - 52,935 46,431 46,431 - - 42,306 37,963 37,963 - - 194,491 198,646 205,943 7,297 - 37,670 29,818 29,818 - - 10,732 5,227 5,227 - - 8,144 11,550 11,550 - - 59,979 55,693 55,693 - - 11,565 12,172 12,172 - - 24,466 24,500 24,951 451 11,574 17,776 17,776 - - 24,831 26,867 26,867 - - 39,499 42,139 52,657 10,518 - 28,307 23,629 23,629 - - 2,518 - - - - 607,884 600,236 629,259 29,023 - Total Appropriation Adm inistered and Departm ental Bill No. 3 5,812,832 6,804,834 6,627,365 34,178 (211,647) Departmental Programs Outcom e 1 Population Health Outcom e 2 Access to Pharmaceutical Services Outcom e 3 Access to Medical Services Outcom e 4 Aged Care and Population Ageing Outcom e 5 Primary Care Outcom e 6 Rural Health Outcom e 7 Hearing Services Outcom e 8 Indigenous Health Outcom e 9 Private Health Outcom e 10 Health System Capacity and Quality Outcom e 11 Mental Health Outcom e 12 Health Workforce Capacity Outcom e 13 Acute Care Outcom e 14 Biosecurity and Emergency Response Outcom e 153 Sport Performance and Participation Total departm ental appropriation 1 The 2010-11 available appropriation is included to allow a comparison of this year's appropriation with what was made available for use in the previous year. Available appropriation is the amount available to be drawn down, and is equal to: Budget Appropriation + Additional Estimates Appropriation + DIAB + AFM – Savings - Rephasings - Other Reductions +/Section 32. 2 The reduced estimate of $11.823 under Outcome 1 (administered) represents a transfer under section 32 of the FMA Act to the Australian National Preventive Agency for the National Binge Drinking Strategy. 3 The Sports function transferred to the Department of the Prime Minister and Cabinet as a result of the revised Administrative Arrangement Orders of 14 September 2010. 23 Department of Health and Ageing Table 1.6: Appropriation Bill (No. 4) 2011-12 2010-11 Available 1 $'000 2011-12 Budget $'000 2011-12 Additional Reduced Revised estim ates estim ates $'000 $'000 $'000 Payments to States, ACT, NT and Local Government Outcom e 1 Population Health Outcom e 152 Sport Performance and 7,841 25,793 25,793 - - 2,150 - - - - 9,991 25,793 25,793 - - Non-operating Equity injections Loans Administered assets and liabilities 100,311 27,910 24,613 535 12,289 535 - 12,324 - Total non-operating 128,221 25,148 12,824 - 12,324 Total Appropriation Bill No. 4 138,212 50,941 38,617 - 12,324 Total 1 The 2010-11 available appropriation is included to allow a comparison of this year's appropriation with what was made available for use in the previous year. Available appropriation is the amount available to be drawn down, and is equal to: Budget Appropriation + Additional Estimates Appropriation + DIAB + AFM – Savings - Rephasings - Other Reductions +/Section 32. 2 The Sports function transferred to the Department of the Prime Minister and Cabinet as a result of the revised Administrative Arrangement Orders of 14 September 2010. . 24 Section 2: Revisions to Agency Resources and Planned Performance 2.1 RESOURCES AND PERFORMANCE INFORMATION The department’s activities, resourcing and performance reporting are organised under a structure of 14 outcomes. These outcomes represent the results or impacts on the community that the Government wishes to achieve. There has been no change to the department’s outcome statements since the 2011-12 Health and Ageing Portfolio Budget Statements (PBS). Revisions to Performance Information since the 2011-12 Budget are detailed in the Outcome chapters in this section. Changes have been made to the Performance Information for Outcomes 1, 2, 3, 5, 6, 7, 8 and 12. CROSS OUTCOME VARIATIONS The table below shows variations to the departmental forward estimates not notionally allocated to an outcome. Table 2: Cross Outcome Variations 2011-12 $'000 2012-13 $'000 2013-14 $'000 2014-15 $'000 Cross-agency departm ental variations Changes in departm ental appropriations Appropriation Bill No. 3 Measure - Reducing the cost of Government administration - one-off efficiency dividend - (14,063) (13,688) (13,095) Measure - Departmental Capital Budgets - savings - (897) (905) (2,148) Price parameter adjustments - operational - 539 1,051 502 Price parameter adjustments 1 - DCB2 - 4 9 16 1 2 Movement of Funds - DCB 1 See explanation in glossary. 2 Departmental Capital Budget(DCB). 25 - 4,410 - - - (10,007) (13,533) (14,725)