It’s only the National Health Reform Agreement, guys. No pressure.
Arguably the most important job on the Department of Health, Disability and Ageing’s to-do list gets barely a mention in the department’s latest annual report, just published.
The National Health Reform Agreement – the pivotal hospital funding arrangement between the commonwealth and states – gets just three paragraphs in the 412-page document, and those pars aren’t even connected.
The NHRA was due to be renegotiated in time for the new agreement to kick in on 1 July this year, but got extended for a year. Since then it’s become a political football with the commonwealth tying hospital funding to the states taking responsibility for NDIS foundational supports.
That has driven the negotiations largely underground, at least from the commonwealth’s point of view. The states are happy to talk publicly about it because they want to pile public pressure on the federal negotiators.
The DoHDA’s annual report 2024-25 is a case in point, it seems.
In his secretary’s report, Blair Comley has this to say about the NHRA:
“Progress was also made in discussions with the states and territories on a new National Health Reform Agreement to support investment in public hospitals, ease pressure on emergency departments and help clear elective surgery backlogs.”
On page 29, in the Outcome 1 (Health Policy, Access and Support) report, there’s this:
“The department has continued to lead collaboration with states and territories on long-term health reform. The department leads administration of the Addendum to the National Health Reform Agreement 2020–2513 (NHRA) to improve health and wellbeing for all Australians.”
On page 152, there’s a couple of pars about the development of an inaugural Aboriginal and Torres Strait Islander Schedule to the NHRA as a Closing the Gap priority reform.
That’s it.
The hits
Mr Comley did detail other achievements of the DoHDA in the 2024-25 financial year, including:
- An additional 29 Medicare Urgent Care Clinics were delivered from 1 July 2024 until 30 June 2025, taking the total at the time to 87 clinics which recorded 1.1 million patient visits;
- Registrations for MyMedicare (which opened in October 2023) continued to rise during 2024–25. As at 30 June 2025, there were more than three million patients and 6600 practices registered;
- From 1 January 2025, Pharmaceutical Benefits Scheme co-payments were frozen, meaning that the cost of medicines would not increase with indexation in 2025;
- Unleashing the Potential of our Health Workforce – Scope of Practice Review was released in November 2024 and found that too many health professionals face restrictions which prevent them doing the full range of work for which they are qualified. The Department established a taskforce in January 2025 to work with stakeholders on options to respond to this and other workforce reviews;
- Public consultation was undertaken on the National Nursing Workforce Strategy and the National Allied Health Workforce Strategy. Final reports are expected later in 2025;
- Initiatives to grow the general practitioner (GP) workforce saw close to 1,800 prevocational doctors start their commonwealth-funded GP training in 2025 – a record high;
- By the end of 2024–25, 38 of the 61 Medicare Mental Health Centres announced in May 2024 were open nationally;
- Tele-psychology and tele-psychiatry services were also announced in May 2024, to boost the clinical capacity of Medicare Mental Health Centres. Rural Health Connect will commence service delivery to Medicare Mental Health Centres via a phased approach from August 2025;
- wage increases for approximately 400,000 aged care workers after the Fair Work Commission’s decisions on the Aged Care Work Value Case;
- Aged Care Act 2024 was passed by Parliament on 25 November 2024;
- extensive preparations in 2024–25 for the start of the new Support at Home aged care program which will also commence on 1 November 2025;
- Disability Strategy was updated to include three new targeted action plans as well as a revised data improvement plan. This followed a review of the strategy which was completed in late 2024;
- National Carer Strategy 2024–2034 was released on 10 December 2024, representing a 10-year commitment to the three million unpaid carers who provide vital support to family members, friends and loved ones every day;
- National Autism Strategy was launched in January 2025;
- Significant progress was made on restoring the NDIS to its original intent. Changes to the National Disability Insurance Scheme Act 2013 (NDIS Act) were passed in Parliament on 22 August 2024. The legislation enables reforms to planning based on needs assessments, more flexible budgets and clearer guidance on the supports participants can access;
- New laws came into effect on 1 July 2024, with further changes on 1 October 2024. Importation and domestic manufacture of non-therapeutic vapes were banned. Enforcement efforts by the Therapeutic Goods Administration (TGA) and Australian Border Force (ABF) have led to the seizure of more than 9.5 million vaping products, between 1 January 2024 to the end of June 2025;
- A new package of measures announced in February 2025 included funding for 11 new Endometriosis and Pelvic Pain Clinics, taking the total to 33. Changes to Medicare and the PBS also improved access to contraception and menopause care and treatments.
The misses
In 2024-25, out of the total of 44 planned performance targets for the DoHDA, 24 were achieved, five were substantially achieved, 13 were not achieved and two did not have data available.
The Annual National Report Card was published by 24 July instead of the target of 30 June.
A daily smoking prevalence target of less than 10% was not achieved – in fact the rate climbed to 10.7%, up 0.1% on the previous year.
Similarly, harmful alcohol consumption remained the same as in 2023-24 (30.7%) and missed the target of under 28.8%; and illicit drug use remained stable at 17.9%, well outside the target of under 13.94%.
Targets for improving the overall health and wellbeing of Australians by achieving healthy eating and physical activity targets were also not achieved.
Performance Measure 1.6A – the number of Primary Health Network regions in which the rate of potentially preventable hospitalisations is declining, based on the latest available Australian Institute of Health and Welfare longitudinal data – was a big miss.
The target was 28 of 31 PHNs, but only two PHNs met the criteria, down from 24 in 2023-24, and 30 in 2022-23.
Performance Measure 1.7A – maintain Australia’s access to quality GP care through the percentage of accredited general practices submitting PIP Quality Improvement Incentive data to their Primary Health Network – was also missed, with 93.2% falling short of the 95% target. It was an improvement from 2022-23’s 92.7%.
Financial performance
In 2024-25 the DoHDA recorded a consolidated operating loss of $40.8 million. After adjusting for unfunded depreciation, the net cash operating surplus was $7.9 million.
During 2024–25, revenue from government increased by 31.7% to $1.7447 billion (from $1.3251 million in 2023–24).
Revenue from other sources, including fees charged to industry by the TGA and the Australian Industrial Chemicals Introduction Scheme, increased by 13.5% to $263.9 million ($232.5 million in 2023–24).
Departmental operating expenses increased by 22.8% to $2.0609 billion (from $1.6779 billion in 2023–24).
Employee expenses increased by 18.3% to $1.0352 billion (from $875.1 million in 2023–24).
“This reflected average staffing level growth during the year as the department continued to invest in aged care reform, TGA public good activities, vaping reform and Strengthening Medicare,” said the report.
Read the full report here.
