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Insurers won’t run PHNs Apr 13th, 2015
This article appeared in Medical Observer written by Julie Lambert

PRIVATE health insurers will not take roles in running new Primary Health Networks despite reports describing them as partners in successful PHN consortiums.

Health Minister Sussan Ley (pictured) on Saturday announced the successful tenderers for 28 of the 31 PHNs, which are to replace Labor’s 60 Medicare Locals as of 1 July.

Ms Ley’s media release said many of the successful PHNs were “consortiums harnessing the best skills and knowledge from a range of sources, including allied health providers, universities, private health insurers and some of the more successful former Medicare Locals”.

Adding to the impression that the insurers had managed something of a coup, a weekend news report said the Abbott government had “handed control” to a range of groups including the two major health insurers HCF and Bupa.

Giving a specific example, the News Ltd report said the North Brisbane PHN would be “run” by Metro North Brisbane Medicare Local (MNBML), together with Metro North Hospital and Health Service, Children’s Health Queensland Hospital and Health Service, Telstra Health, AMA Queensland, UnitingCare Health, and the two insurers.

However, Medical Observer has confirmed that only four of the 28 successful bids had any involvement with private health insurers, and their roles are strictly as support players.

MNBML CEO Abbe Anderson said HCF and BUPA were just two of many groups that had backed the successful application from her organisation.

“While MNBML has the support of a wide range of key participants – including those listed – I think we had over 30 organisations that provided us with letters of support and endorsement in our application,” Ms Anderson toldMedical Observer.

“But the PHN itself will be governed and managed by the same organisation that has been running the ML since its inception.

That organisation – Partners 4 Health, the registered trading name of MNBML – has been in place for four years and is very much a “grassroots” outfit, she said.  

“It has a local membership structure of over 20 organisations, all of which represent local clinicians and community groups, and that will be complemented by the formation of new clinical councils and community adviser groups,” Ms Anderson said.

She said private insurers shared the same imperatives as hospitals and primary care groups - trying to keeping people well and out of hospitals - adding they were in conversation “about the types or program we want to see".

“In our experience, private health insurers are very willing to look at chronic disease programs that benefit everyone, that aren’t just aimed at their members,” she said.

But Ms Anderson did not see any risk of a push for preferential treatment of private health fund members.

“I honestly see everyone working very collaboratively together, and I guess that’s one of the key reasons why we need the voices of GPs and other clinicians in the planning of these models, to ensure we don’t end up with systems that somebody will lose out on.”

Dr Marcus Tan, a director of WA Primary Health Alliance, which has landed contracts for three WA PHNs, said his organisation saw a similar need to take “a very collaborative approach” including input from the same two insurers.

“This is recognition of the need for an integrated healthcare system to have government, non-government and private involvement,” he said.

“The private health insurers have signalled their interest in chronic care, for example – but they are not formally part of the organisation.”

The Alliance was formed from Perth Central & East Metro ML, Goldfields-Midwest ML, Perth South Coastal ML and Fremantle ML, with endorsement from Bupa and HCF among others.

Dr Tan said he thought the Perth North, Perth South and Country WA PHNs would make the 1 July start date because much of the established resources and infrastructure of the Medicare Locals would be transitioned into the new networks.

In Victoria, the Grampians and Barwon South West PHN was also named as having a private health-fund partner aboard.  

But Jason Trethowan, CEO of Barwon Medicare Local, which will manage the new PHN covering western Victoria, said the association with locally based private health insurer GMHBA was entirely without conflict.

“Our Medicare Local is the company that will change its name and constitution to establish the PHN for western Victoria,” Mr Trethowan said, adding GMHBA and the four local hospital networks would all be critical in the rollout.

“But there’s no deals, no role in governance, no seats on boards, no interference with the running of the PHN,” he said.

“Where there are areas where [GMHBA] can support us or work with us, then we would do so.

“It was important in our submission to show we had a strong buy-on from Deakin University, four major hospital networks and also a health fund that has most of its members in our footprint.”

South Eastern NSW PHN is the fourth new entity identified by the minister’s office as having private-insurer backing.

The managing organisation is Coordinare Limited, formed by the Illawarra Shoalhaven ML, supported by the University of Wollongong and Peoplecare, a member-owned, not-for-profit health fund based in Wollongong. 

Australian Doctor - Axed preventive health program showed promise Apr 2nd, 2015
This appeared in todays Australian Doctor written by 

Australia’s national preventive health program was showing promising results before it was scrapped in last year’s budget, according to a belatedly released Department of Health report.

The National Partnership Agreement on Preventative Health (NPAPH) was introduced as a COAG initiative under Labor in 2008 with programs to reduce smoking rates, combat excess alcohol intake, boost physical activity and improve diet.

The Coalition axed the program in the 2014 federal budget and diverted the savings of $368 million over four years to the Medical Research Future Fund.

However, an independent evaluation report released under a Freedom of Information request showed that six months before the partnership agreement was abandoned, the government was told the program "appears to be a sound, evidence-based and highly appropriate investment in preventive health".

"Overall, approaches have been based on effective health promotion principles and best-available evidence, and there is a judicious mix of innovative and evidence-based strategy," the report authors said.

"Available evidence indicates that implementation is on track, and that some states and territories are achieving a good level of reach into target groups."

The programs funded by the NPAPH included the Healthy Children Initiative, the Healthy Workers initiative, the Measure Up campaign, the National Tobacco campaign, and the Healthy Communities Initiative.

The report was finalised in January 2014, when the future of the NPAPH still looked bright.

"While it is too early to reach conclusions on the likely extent that the NPAPH will achieve its longer term outcomes ... the current evidence of reasonably effective partnership processes and successful implementation of initiatives indicates that considerable progress is being made in the right direction," it concluded.

This week, 11 peak health groups raised concerns about the axing of a wide range of preventive health programs.

"We are particularly concerned about the future of the Close the Gap Indigenous Chronic Disease package, which aims to prevent chronic disease including GP services, medications and tackling smoking. The new Primary Health Networks will not be able to pick these critical programs up as they have barely been established yet," said Lisa Briggs, CEO of the National Aboriginal Community Controlled Health Organisation.

Federal Minister for Health Sussan Ley could not be reached for comment.

Realising the Health Benefits of Work for all Australians Mar 31st, 2015
Realising the health benefits of work for all Australians requires a paradigm shift in thinking and practice. It necessitates cooperation between many stakeholders, including government, employers, unions, insurance companies, legal practitioners, advocacy groups, and the medical, nursing and allied health professions.

The family doctor is best placed to advise and educate patients that, in most cases, a focus on return to work is in the best interest of the patient – for both their future and quality of life and that of their family.

Return to work is not possible for everyone, but certifying time off work – particularly when absence is long term – can have significant side effects, including increased rates of overall mortality, poorer physical health and poorer mental health and psychological wellbeing.

The following document is a consensus statement from the Australian Faculty of Occupational and Environmental Medicine. It highlights the importance of a trusted GP in assisting employee's to return to work.

Despite all of the above, research continues to show that many GPs are unlikely to recommend alternate duties for injured workers, and many GP’s who suggest a ‘special interest’ don’t always follow these best practice guidelines.

I hope that the above highlights the significant benefits to be gained from offering employees a 'trusted' GP and Injury Management Service.


Reassuring Employees About Low Back Pain Mar 28th, 2015
Back pain is one of the most commonly encountered conditions in Australian workplaces.

In the 2012-2013 Australian Workers Compensation Statistics 22% of serious claims were due to back pain and some 33% of serious claims were caused by muscular strain while lifting or handling objects.

Despite trends showing increasing use of advanced imaging tests, opioids, and invasive surgical and interventional procedures, with attendant increases in costs, the prevalence and burdens associated with back pain appear to be on the rise.

In fact, there is growing evidence that those who suggest a ‘special interest’ in managing back pain often provide less appropriate treatment recommendations. These providers often hold alternative beliefs regarding the association of pain and activity that influence their practice behaviour.

For example, the presence of common degenerative findings on spinal imaging poorly correlates with the presence of and severity of back pain or the likelihood of developing chronic disabling symptoms. Rather, predictors of chronicity are primarily psychosocial.

For this reason back pain is best understood as a complex biopsychosocial condition. Many other factors besides the employee's medical condition (e.g. acute back pain) affect outcomes– e.g. organizational, work-environmental, and social.

Most acute back pain improves substantially within the first 4 weeks. However, a small proportion of patients with acute back pain go on to develop chronic disabling symptoms. Such patients often are refractory to treatments and account for the majority of the costs associated with back pain. Preventing the transition from acute to chronic low back pain is therefore an important goal of current evaluation and management strategies.

The above paper provides a 2 page summary of evidence regards how best to approach the employee with acute back pain to alleviate patient worries and fears. This along with evidence based acute injury management assist in preventing the transition from acute to chronic low back pain.

Medical Observer - Better use of healthcare professionals is vital for a sustainable Medicare Mar 28th, 2015
WHILE welcoming the Abbott government’s abandonment of the GP co-payment, to ensure a sustainable Medicare system the Australian Physiotherapy Association (APA) would like to see an improvement to the use and scope of practice of existing healthcare professionals.

Removing barriers to physiotherapists referring patients directly to medical specialists with a Medicare rebate, instead of requiring a GP referral, would achieve better patient-centred care, as well as over $13 million in savings to Medicare each year. This would also reduce out-of-pocket payments for patients by more than $2 million per year.

Other sustainable measures that would improve healthcare for patients and save money include: 

  • Physiotherapists leading screening clinics to triage surgery patients. 

  • Better supporting advanced scope physiotherapists in emergency departments to deal with patients with simple but urgent musculoskeletal injuries that are currently contributing to the burden on ED doctors. This has been shown to reduce patient waits, and helps move patients out of hospital more quickly.

  • Enabling physiotherapists with additional qualifications and endorsement to prescribe medications within their scope of practice. The Medicare co-payment would have made access to primary care even more difficult for people who could least afford it.

The APA’s solution to improve the use of physiotherapists who are highly qualified and experienced primary health professionals to undertake these practices will ensure better patient-centred care and relieve pressure on the healthcare system.

The APA’s pre-budget submission for 2015–16 details APA’s recommendations on the referral to specialist issue. It is available online Click here.

The APA is the peak body representing the interests of Australian physiotherapists and their patients. It is a national organisation.

Cris Massis is CEO of the Australian Physiotherapy Association.

Click here to read other ideas submitted so far

Many Reap Rewards in Wellness at Work! Mar 27th, 2015
Australia’s working population is becoming sedentary and workers are being asked to put off retirement and work longer hours.

TWO out of every three Australian adults have at least three or more risk factors for cardiovascular disease, diabetes and chronic kidney disease, according to a new AIHW report.

Employees with a cluster of seven heart disease risk factors have an average annual cost of ~$2640.00 more than employees with no modifiable risk factors.

Employers have a choice, proactively promote health promotion programs or expect to pay more in direct and indirect health related costs.

Workers spend a large proportion of their waking lives at the workplace and are a captive audience for any health promotion intervention.

We recognise that you, the employer, have extensive experience in ensuring the wellbeing and health of your staff. However there are times when it could be helpful to access the insight and expertise of a trusted partner to tailor services to your organisation and employee's needs.

Click to download copy

Our team of allied health professionals from a wide range of backgrounds give the perfect know-how and skills base to provide such an intervention in a proficient and energetic manner.

Medical Observer - Nine reasons why Australia needs to improve preventive health! Mar 25th, 2015
This appeared in today's Medical Observer, Written by Ruby Prosser Scully

TWO out of every three Australian adults have at least three or more risk factors for cardiovascular disease, diabetes and chronic kidney disease, according to a new AIHW report.

Multiple risk factors were also prevalent among Australians who already had one of the conditions. 

“For people with diabetes, nearly all adults (94%) had three or more risk factors, and for CVD and CKD, 84% and 77%, respectively, had three or more risk factors,” AIHW spokesperson Sushma Mathur said.


1. Just under a third of all adults have hypertension (including 22% with uncontrolled hypertension).

2. Almost two-thirds are overweight or obese, and 3% have impaired fasting glucose. 

3. Over half the population is not active at all or insufficiently active. 

4. One in six people smoke daily and one in five surpass guidelines for lifetime alcohol risk. 

5. A third of Australian adults have high LDL-cholesterol, and 63% have dyslipidaemia.

6. People with cardiovascular disease are more likely to have uncontrolled hypertension (2.1 times), be overweight or obese (1.3 times), have dyslipidaemia (1.3 times) and be inactive or insufficiently active (1.2 times) than those without CVD.

7. Almost all adults (95%) do not eat the daily recommended two serves of fruit and five serves of vegetables.

8. People with type 2 diabetes are twice as likely to have uncontrolled hypertension, be overweight or obese (1.5 times), and have uncontrolled dyslipidaemia (1.2 times) than adults without the disease.

9. People with CKD are more likely to have uncontrolled hypertension (1.9 times), or have blood glucose levels ≥6.1 mmol/L (2.8 times) than adults without CKD.


Source: Australian Institute of Health and Welfare report, Cardiovascular Disease, Diabetes and Chronic Kidney Disease

Australian Doctor - Legal fallout follows hike in bariatric surgery Mar 23rd, 2015
 This article, written by 

The rise in bariatric surgery has seen it become a 'medicolegal hotspot' with many patients harbouring unrealistic expectations and little understanding of the high complication rates for the procedure.

The majority of claims now being made focused on informed consent, negligent performance of the surgery and inadequate post-management and follow-up, Janine McIlwraith (pictured), principal lawyer at Slater and Gordon, told last week's Medico Legal Congress in Sydney.

Patients also needed to know the surgery was "not a panacea and just part of a solution to weight loss", she said.

"They need to be committed to lifestyle modifications after surgery, and they need to be aware of complications and their frequency."

Patients tended to be well-educated and financially well-off but expected unrealistic outcomes, so consent procedures needed to be robust, she said.

The number of procedures has increased dramatically - from just 500 in 1998/99 to over 17,000 in 2008/9. About four in 10 procedures resulted in complications, Ms McIlwraith said.

A Medical Services Advisory Committee report in 2012 said bariatric surgery should be performed as part of a multidisciplinary effort to improve long-term outcomes.

However, very few patients were receiving that kind of care, Ms McIlwraith said, with most patients visiting solo practitioners.

The spike in claim numbers for bariatric surgery could simply be the result of a rise in procedure rates, she said, "but there may be other causes worth investigating".

For successful RTW timing is everything! Mar 21st, 2015
Evidence suggests the longer the delay to rehabilitation and RTW planning following a workplace injury, the smaller the chances of a successful return to work outcome become. The following posts continue our focus on providing information to allow injury management co-ordinators to feel comfortable taking greater control of RTW processes.


AIA Australia is a life insurance specialist trusted to protect more than 2.5 million Australian lives. AIA Australia is committed to helping people improve their health and therefore is a strong believer in workplace rehabilitation and the power it has, where health conditions permit, in getting people back to work – and therefore a full life – faster.

In August 2013 AIA produced a paper titled “A critical equation: balancing Australian worker health and company wealth” that noted in terms of physical conditions, as the number of days off work increases, the chances of successful return to work significantly decreases:

These are fairly sobering figures and are cause for alarm given a number of employers continue to take a ‘return when you are fully fit attitude’ to work related illness and injury.


Work is a determinant of health, both physical and psychological.  The longer a person is away from work for an unplanned (or unmanaged) absence the more their health can potentially suffer.

Comcare engaged a consultant to conduct research into delays in providing rehabilitation or return to work assistance for their injured employees, after they identified a trend for employees injured at work to stay off work for long periods (6-12 weeks in majoity of cases)

The results were published in the paper “BODY STRESSING INJURIES: Key messages for rehabilitation providers”.  One of the things the Consultant found in their analysis was in most cases, RTW assistance was not provided until after the normal recovery period for the injury.  Consequently by the time assistance was offered it was often no longer appropriate.

The issue here is once a body stressing injury progresses beyond 12 weeks of incapacity it becomes a ‘chronic’ injury that is much harder to manage and rehabilitate due to numerous psychosocial issues.  Equally with psychological injury claims there is often deterioration in the person’s mental status the longer they are away from work.

Amongst other findings, this report promoted that early recovery and return to work involves effective management of an injured employee by their employer and needs to commence as soon as practicable after the injury occurs and preferably before any claim for compensation is made.

Next - Timing in RTW is everthing - What Next

Timing in RTW is everthing - What Next Mar 21st, 2015
Following on from the AIA paper, evidence from industry experts overwhelmingly supports early rehabilitation and RTW programs are a winning combination for all involved. 

Concord General Hospital, Sydney is a self insurer, who in 2003-4 found themselves with a huge number of open claims (~300), and a spate of very difficult cases who went on to have chronic pain syndromes. The organisation felt they were failing injured workers and that something needed to change.

After significant internal investigation, the consensus was that the first 4 weeks after an incident/injury was the answer, – after that you start to lose control! They instigated a rapid assessment and early intervention process, which included an assessment psychosocial risk (i.e. Yellow Flags). The idea was that high risk individuals needed to be identified in the first week/s. Nothing different needed to be done; only it needed to be done earlier. It was also important that a trusted GP was in control of the whole process through consultation and approval.

Along with aggressive acute injury/illness management, return to work planning for high risk individuals was commenced from the day of injury in the form of planning, discussion and communication between injury management co-ordinators, health professionals (GP and Physiotherapist) and employee supervisors.

Key Points of Concord Case Study:

  1. There is a significant difference between the 20% in the “high risk” category and the other 80% who manage pretty well with ‘usual care’.

  2. Psychosocial risk factors (i.e. ‘Yellow Flags’) predict the cost of a workers compensation claim within 48 hours regardless of what or where the injury occurs.

  3. The provision of an early and aggressive assessment and intervention, lead by a trusted GP can reduce costs in high risk claims.

 Next - Strategies to Help Employees Return to Work

Video - Diabetes Australia Healthy Eating Mar 20th, 2015

High Performance Jump Program Mar 10th, 2015

Day- Tuesday

Location – Central West Health and Rehab

Time – 4:00pm

Training focus – Jump Strength

Maximal strength determines jumping height. When trying to improve jump height athletes should focus on maximising strength development.


Day – Friday

Location – Central West Health and Rehab

Time – 4:00pm

Training focus – Jump Plyometrics

Plyometrics include performance of various types of body weight jumping-type exercise, like drop jumps (DJs), countermovement jumps (CMJs), alternate-leg bounding, hopping and other SSC jumping exercises. Plyometrics are a powerful tool for improving jumping performance.

Start Date: Tuesday; 21st of April 2015

Click for Registration Form

Payment required at initial physical assessment

Registration Form Mar 10th, 2015

Infographic - Calories Burned in 10 minutes! Mar 9th, 2015

Dietitian - 3 Day Food Diary Mar 9th, 2015

Test - Google Forms Mar 8th, 2015

This post is a test run of embedded Google Form data in News Post.

Medical Observer - Allied health keeps patients out of hospital Mar 7th, 2015

6th Mar 2015

Declan Bowring

STROKE, diabetes and osteoarthritis patients could avoid unnecessary hospital treatment with greater investment in allied health professionals, a new report says.

The report, produced for Services for Australian Rural and Remote Allied Health (SARRAH), found evidence that hip and knee replacements and diabetic limb amputations could be avoided and thousands of hospital beds freed up with targeted care by allied health teams.

“This report the first of its kind in Australia, has demonstrated the huge cost savings and patient benefits that Australia could achieve,” SARRAH CEO Rod Wellington said.

“It exposes the myth that allied health is an optional extra in healthcare.”

The report cited cases including:

  • A 64% drop in diabetic limb amputations and a 24% decrease in hospital stays after treatment by podiatrists under the Queensland Diabetic Foot Innovation project.

  • A 15-month reduction in the waiting list for joint replacement surgery at Melbourne’s Alfred hospital after triaging by physiotherapists.

  • Fifteen per cent of osteoarthritis patients removed from the joint-replacement waiting list at a Sydney hospital after treatment by a multidisciplinary team. 

  • A 37% prevention rate in the incidence of diabetes among 2241 high-risk participants in eight international trials after intervention by dietitians, physiotherapists and exercise physiologists.

  • Stroke care focusing on speech pathology in the NSW Illawarra region prevented 45 emergency presentations, 49 hospital admissions, 188 readmissions and saved 2808 bed days.

The report emphasised the value of physiotherapists, occupational therapists and speech pathologists in improving the function and independence of stroke patients.

Executive officer of Allied Health Professions Australia, Lin Oke, said affordability was a problem, noting Medicare Chronic Disease Management rebates for allied health services were “extremely limited”.

“The rebate of approximately $50 is based on a 20-minute service, regardless of the required length of the appointment with the allied health professional,” Ms Oke said.

“So many Australians just cannot afford the services which would keep them away from hospitals and surgical procedures.”

The report found a significant lack of access to allied health for rural patients, with only 14% of registered allied health professionals working in rural areas. 

More than 1000 deaths from diabetes in rural areas could have been prevented if the mortality rate matched that of urban areas. In very remote areas, diabetes was the second-highest cause of death.

Independent MP for Denison, Andrew Wilkie, used the report’s findings to blast the Tasmanian government for cutting allied health staff in the state.

“To sack these vital front-line workers who can get people home from hospital sooner and prevent elective surgery is complete madness,” Mr Wilkie said.

“These workers are worth their weight in gold because they save hospitals money.”


Click here to view the report.



Infographic - Coffee Vs Tea, What is healthier? Mar 4th, 2015

Medical Observer - We’re not all the same Feb 26th, 2015

‘One size fits all’ is doomed to failure, so weight loss strategies must be tailored.

IN THE classic 1979 Monty Python movie, The Life of Brian, the lead character, Brian, tells the swarming masses, “You’re all individuals”, to which the group responds as one, “Yes, we’re all individuals”.

The fact is, we are indeed all individuals and respond differently to different pharmaceutical and lifestyle prescriptions —  weight loss being a great example.

But does this mean we need a separate program for all three million overweight or obese adult Australians? And if not, how do we individualise without over-individualising?

The first law of thermodynamics states that energy is neither gained nor lost, it just changes form.

We’re told that this is immutable. And yet change the energy balance (food in/exercise out) of 1000 people in exactly the same way and you’ll get a variation in weight loss from nothing to more than the loss predicted through any calorific formula. The question is, why?

The simple answer is that the first law is based on a physics formula, which is linear (e.g. weight = energy in — energy out).

This only works approximately in a biological system.


Feedback in a living organism, such as through changes in metabolic rate, hunger levels and a range of other factors, makes generic lifestyle prescriptions such as diet and exercise, just that — generic, with huge variations around the mean.

The implications of this are profound: “A calorie is no longer a calorie.”

As the actual value of heat energy can be influenced differently by feedback in individuals, any attempt to prescribe or measure weight gain or loss by counting calories is bound to be flawed.

Using a systems theory model can complicate the issue but may be necessary.


In the UK, the Foresight Commission, a body set up to examine the future, published a complex diagram of known drivers of obesity1 which has come to be used by obesity lecturers around the world to draw a laugh. You can see it at http://www.foresight.gov.uk/Obesity/12.pdf.

Prescribing a set diet and exercise program alone to help a patient lose weight may work brilliantly for some, for whom these are the immediate divers, but it may not work at all for others.

What’s the alternative? Ultimately, a computer program including genetic analysis might reduce the variability in response. But this is some way off. So what to do in the meantime?


American obesity researcher and clinician Dr Robert Kushner has had a crack at this by looking at different personality types based on types of eaters, exercisers and stress managers.

In his book, Dr Kushner’s Personality Type Diet2 — which would normally be discarded as a ‘fad’ book on the basis of its title — Kushner developed a screening system to categorise people into six different types of eaters, exercisers and stress responders.

Kushner’s eating personality types are classified in such non-scientific categories as ‘unguided grazer’, ‘night-time nibbler’, ‘convenient consumer’, ‘fruitless feaster’, ‘mindless muncher’ and so on. Despite the appeal to a public audience, each does have some scientific basis, which is added to by Kushner’s respectability as a world-class obesity researcher.


Breaking the weight loss responder into different groups like this, according to Kushner, can help increase the prospects of success on a weight loss program.

This is not rocket science — yet! But individual targeting in prescription, just as in marketing of consumer products, points to the way of the future.

A good clinician might do this intuitively but the increasing complexities of the modern world make it more and more difficult to do so.

Kushner’s approach is a possible way of narrowing down the individual differences in weight loss response.

But, given that there are a number of other drivers that can influence lifestyle, including sleep, the environment and relationships, don’t expect any major breakthroughs in the clinical response to weight loss. 


Reference: http://www.medicalobserver.com.au/news/were-not-all-the-same#.VO6CvF1aUxA

Next Dietitian Talk Friday 6th March 2015 Feb 23rd, 2015

Catherine Dumont's next Dietitian Talk is on Friday 6th March, 12 noon at Central West Health & Rehabilitation in Geraldton. This talk is free for gym members and people who are completing Central West Health & Rehab's Diabetes Management and Chronic Disease Prevention programs.

This talk covers:

  • Healthy Eating Habits

  • Glycemic Index

  • Fat Types and Cholesterol

  • Recipe Modification Label Reading

A 'Real and Substantial' Connection to Employment Feb 21st, 2015

Kathleen Kay v Woolworths Limited [2014] NSWWCC 365 (1 October 2014)

In the following case, a Woolworths Customer Services Manager, who worked predominately daytime and afternoon shifts, bought proceedings to the NSW Arbitrator. She suggested that the insurer’s decision to reject her claim was inappropriate as while her injuries did not happen at work, they were ‘substantially connected’ to her employment.

On the week of the workers accident, the shop’s floors were being stripped and resealed by cleaners. The works took place overnight, and required a manger to be present. In the afternoon of Wednesday 17 October 2012, the worker was told by her employer that she was required to work the following Thursday night to supervise the cleaners. The worker was unable to sleep before the shift due to a dentist appointment.

Upon completion of her shift at 8am on Friday, the worker had been awake for over 24 hours. On her journey home, she fell asleep at the wheel, causing her to veer onto the wrong side of the road and collide with an oncoming vehicle.

The medical evidence confirmed sleep deprivation was as a significant causal factor in the accident. The worker subsequently made a claim for workers compensation, which was declined by the insurer on the basis that there was no ‘real and substantial’ connection between her employment and the accident.

Considering a case where it was held that a ‘real and substantial’ connection does not necessarily require a worker’s employment to have caused the accident, the Arbitrator rejected the insurer’s submissions, and held that the worker satisfied the requirement set out in section 10(3A).

The Arbitrator highlighted that this section merely requires that there be a ‘real and substantial’ connection between the employment and the accident; meaning that there can be several factors involved.

The worker was required by her employer, at short notice, to complete the night shift. Her inability to properly prepare herself physically and mentally beforehand meant she was sleep deprived, which the Arbitrator accepted to be a significant factor in her accident.

Importantly, the Arbitrator held that in the circumstances, the worker’s risk of injury “was not outside the control of the employer.” The employer did not conduct any risk assessment as to whether it was safe for the worker to work the night shift, at short notice, without any substantial prior experience working the shift, and without having slept beforehand.

It was held that the employer, despite observing the worker’s tiredness at the completion of her shift, failed to determine how much sleep the worker had gotten in the preceding 24 hours. Arbitrator suggested that the employer, in order to avoid the risk, could have simply asked how the worker was feeling and offered the worker a taxi voucher.

Mal Chronique - Chronic Pain and Exercise; Evidence and Benefits Feb 19th, 2015
click to enlarge

Chronic pain involves symptoms of prolonged pain and fatigue, leading to an inactive lifestyle. However being inactive can increase your levels of pain and fatigue, leading to deconditioning of the body. Deconditioning can make you more prone to injury and put you at risk of more severe health problems.

Breaking the pain cycle can be difficult, especially if your body has been in pain for quite some time. Sometimes people feel their attempts at exercise cause more pain and lead to flare ups, avoiding exercise and turning to rest. Even if there is discomfort in the beginning, retraining your body and remaining active will be beneficial for your health and wellbeing in the long term. 

Best Evidence for Chronic Pain and Exercise

Exercise works best when delivered as part of a multi-factorial approach. This includes sound knowledge and education about your condition, physical activity and the pain experience. The body and mind love movement, where gradually becoming more active is essential for treating and managing chronic pain.  Recent evidence shows people with chronic pain reported moderate exercise decreases pain, fatigue, stress and symptoms. It also improved perceptions of health, physical function and aerobic fitness. Other studies have shown low intensity exercises such as walking and pool exercises improved joint and muscle pain, improving the ability to carry out daily activities.

Exercise-induced Hypoalgesia

Recent studies have shown exercise inhibits descending pathways. Descending pathways can inhibit or facilitate transmission of noxious (painful) information, and are therefore of major importance in pain modulation. Studies demonstrate a reduction in pain sensitivity during and following exercise, in both the healthy and chronic pain population.

Aerobic exercises (running, cycling etc) produce exercise-induced hypoalgesia, particularly when performed at moderate to high intensities for longer periods. This is also true for isometric exercises (static muscle contraction), when performed at either low or high intensities.

Benefits of Exercise

  • Joints become better lubricated and glide easier

  • Nerves and discs of the spine get their required nutrients

  • Muscles become stronger and fatigue less quickly

  • The nervous system winds down promoting relaxation

  • Increased levels of energy, improving mood and helping with anxiety and depression

  • Your body produces Endorphins - your own pain relieving medication!

  • Improves efficiency of the heart, controls blood sugar levels, and improves your ability to burn fat


Rhianne Turner (Physiotherapist)

Next - 7 exercise tips for people with chronic pain

5 Steps to a Better Back Feb 19th, 2015

Mal Chronique - 7 exercise tips for people with chronic pain Feb 19th, 2015

  1. Incorporate exercises in everyday life – take the stairs whenever you can, get up more often and do tasks around the home

  2. Choose exercises that you enjoy, whether its swimming, yoga, walking, or weights

  3. Add a component of aerobic exercise to your programs (swimming, walking, stationary bike)

  4. Stretching and breathing exercises are great additions to your program as they improve blood supply and nutrients to the joints, reduce your risk of injury, improve your balance, and reduce stress in muscles

  5. Avoid exercises which cause pain, though some discomfort is okay

  6. Avoid the boom-bust approach, start slowly and gradually increase your program (increasing volume before intensity)

  7. Be consistent from day to day, avoid good day and bad day behaviour

A Foundational Model for Good Work Design Jan 20th, 2015
Principles of good work design are a key element of the Safe Work Australia members collaborative project Good Work through Effective Design. This project contributes to the Australian Work Health and Safety Strategy 2012-2022 and the national action area Healthy and Safe by Design. Particular focus has been placed on achieving the strategic outcome of 'eliminating or minimizing risks and hazards by ensuring all work, work processes and systems are well designed'.

Comcare and Workplace Health and Safety Queensland have been tasked with phase one of the Good Work through Effective Design project, to produce a set of principles for good work design. Phase two of the project is to promote good work and effective design, through case studies, education and other guidance materials.


‘Good work’ is healthy and safe work where the hazards and risks from the work have been eliminated or minimised, as far as reasonably practicable, through the process of design. Good work is designed to manage the structure of tasks, demands, supports, and work processes to optimise human performance, organisational productivity and job satisfaction.


When making decision about work tasks, activities, and responsibilities, there are typically four interrelated elements that are important. These are:

  • physical elements—aspects of the work environment or context that creates physical or physiological demands on the human body, for example physical hazards, chemical hazards and biological hazards.

  • biomechanical elements—aspects of the work that include hazardous manual tasks and the biomechanical risk factors that leads to musculoskeletal disorders, for example force, vibration and movement.

  • cognitive elements—aspects of the work that create demands on the human mental capacity, for example attention, mental workload and complexity.

  • psychosocial elements—social, psychological, and organisational aspects of work that place demands on human capacities, for example work demands, job control, supervisor/peer support, role variables, managing relationships, rewards and recognition, management of change an organisational justice.

Risk factors are interrelated and interdependent so focusing on one or two factors in isolation will likely be ineffective as a strategy. The interaction amongst elements, and their co-occurrence, means that a holistic approach should be adopted when evaluating work, and when designing solutions.

There are many models that are applied in the context of designing good work. The report reviewed the following key approaches and perspectives from the research evidence:

  • Work Design-Specific

  • Risk Management

  • Continual Improvement Process

  • Health Promotion

  • Change Management

  • Human Factors Engineering