Thank you very much to Michael. I have to say my first call after the Prime Minister rang me and offered me the current role was in fact to Michael Gannon.
I didn’t realise how he dressed in his private time and he hasn’t taught me the secret handshake yet. But ever since that moment, Michael and I have spoken perhaps every week and often once or twice a day.
From time to time I may not have been immediately available because of parliamentary duties and from time to time he may not have been immediately available, and I’ve remembered on a couple of occasions he’s got back to me and said look I’m sorry about that, I was delivering a baby, and I said that’s fine.
At the end of the day, whilst he’s the president of the AMA, he said to me that his most important roles are as a dad and husband on the one hand, and as a working doctor helping mothers bring new babies into the world.
And it puts all our roles into perspective that the role of the doctor, whether it’s the GP or the specialist, is ultimately and fundamentally about giving people the best chance at a healthier life, a longer life, a better life, a more confident life.
And when I talk to my wife and, in earlier days when my mother was with us when I talked to my mother, although each of them is convinced that they are in charge of operating theatres in their time and not the doctors, they had immense and deep and profound respect for the doctors for whom they had worked over so many years.
So I want to just acknowledge, Michael, you and your work both as president of the AMA, but above all else as a doctor involved in the great task of life, and then all of the members of the AMA here for your commitment to your profession, but the general community in particular.
I also want to acknowledge Tony Bartone, I’ve dealt with Tony on many matters, and his work, and Beverley Rowbotham, who’s here and chairing the council, Anne Trimmer, who’s secretary general, who’s been a tremendous partner for engagement on policy issues on a day-to-day basis.
Previous presidents, I understand I think, at least I’m aware that Dr Brian Owler is here and Mukesh Haikerwal. We, along with Michael Gannon, have been discussing initiatives I’ll come back to later, which is mental health and support for the medical workforce themselves.
Because too often, the care is not there for the carers and I think that’s an extremely important (inaudible) partnership and your reference to Chloe’s tragedy is something that I need to address.
And then I also want to acknowledge Dr Anthony Dedea. Anthony is my local GP when I’m in Canberra. He does make house calls I’ve discovered.
When I had an issue with a mysterious sort of leg and illness issue after coming back from China in December, he discovered and interpreted that I’d picked up a little golden staph infection through cutting a toe and had to be admitted. And I want to say Anthony, you are an outstanding doctor. Thank you very much.
But I understand doctors are not allowed to advertise, so that is not a paid advertisement.
Let me begin in a different place. I want to go back to where I was a week ago at almost exactly this time.
I was in the intensive care unit of the neonatal ward at the Royal Prince Alfred Hospital in Sydney. And there we were introduced to the parents, to the doctors, the nurses, and the little premature 28 and 29-week-olds that were the subject of this amazing unit.
And these children would not have been there but for the extraordinary capacity of the medical profession. And in fact, the whole notion, in my view, of society comes together in an ICU, in a neonatal ward, in a major public hospital.
Our family was touched, Michael, in a similar way a decade ago. My now 10-year-old nephew was born at 28-weeks, and he was cared for by doctors here in Melbourne at the Women’s and then at Royal Children’s, and they saw him through his early journey.
And so there would be doctors in this room, and doctors in other rooms, who helped to take care of my little nephew, Alessandro.
And again I saw those learnings being translated a decade on, last week, where new life was being given new hope. And you should, every day, stop and have a little moment to think that what I’m engaged in as a doctor is the most noble of professions.
And I should acknowledge that before looking at the policy issues, that what I saw last week and what our family saw a decade ago is the absolute definition of society at its best. So I thank you for that in particular.
Now looking forwards in terms of the health profession, my view, and our view as a Government – is that we have one of the best health systems in the world.
But our vision is that we can take it to be unequivocally, with all of the resources, human, capital and societal that we have in Australia, the best health system in the world.
That is the vision. So in order to do that, the fundamental thing that we want to set out is a Long-Term National Health Plan and to work together towards that outcome.
The AMA, along with the GPs, the pharmacists, and the medicines, the pharmaceutical sector, have been a fundamental partner in that process.
So what we have set out in the Long-Term National Health Plan is four critical pillars. Firstly, guaranteeing and supporting Medicare and the Pharmaceutical Benefits Scheme and strengthening it, in particular through working with our medical workforce.
Secondly, is the focus, as Michael set out, of supporting the hospital system, the public hospitals, the private hospitals and the private health insurance system.
I think that hybrid combination is a fundamental part of the success, but also the challenges that the Australian system faces.
Thirdly, is prioritising mental health and preventive health. And fourthly, is medical research. And only yesterday, along with Professor Anne Kelso and Professor Bruce Robinson and Dean Fraser and so many Australian luminaries, we announced the new guidelines developed by the medical research profession for the medical research sector, for the MH and MRC going forward.
So let me begin with, in particular, the guaranteeing and supporting of Medicare and the Pharmaceutical Benefits Scheme, which was such a fundamental part of the overall Budget package, which was a new investment of more than $10 billion in the health system.
It’s not the number, it’s the partnerships we struck and the agreed priorities. Central to those partnerships was what we did with the AMA, and I know that Michael and many others worked exceptionally hard on this.
The shared vision statement which we jointly issued sets out a commitment to transparency in health, to re-indexation, to support for reforms, and then to the fundamental independence and role of the AMA.
As part of that, the achievements, which we were able to deliver and I’ve got to say that Michael and Ann together are very, very tough negotiators, they took us to places that I never thought we’d get to when we started.
But in that context, you are very well represented no question about it. Firstly, obviously there’s the billion dollars that we were able to add for re-indexation over the next four years.
Secondly, as part of that, something that Michael made clear I think from the very first conversation, was the notion that controlling of doctors’ rents was not an acceptable proposition, that there had to be a better way to support both pathology and the medical community, or specialists and GPs.
And so we worked hard and we found a solution to that. The solution was that we would support the continued bulk billing incentive for pathology and diagnostic imaging, in return for not controlling doctors’ rents, and personally I have to say that at a philosophical level I was very happy with that outcome.
I think it was the right balance and the right outcome to make sure that there’s compliance against the law. But that this notion that we could have, in some way, shape or form, controlled rents for doctors has been now put aside, and I would say it’s been put aside forever.
At the same time, we were able to protect the Medicare safety net, to abandon some of those initiatives which had been put forward in 2014.
I think they had been tried and, in my time, on my watch, it was our view that now was the moment to put them behind us. The same with the attempts to make changes to the bulk billing incentive for pathology and diagnostic imaging.
They have been rejected. And so all of that has meant that we’ve had a reinvestment in Medicare more generally of $2.4 billion, and that has allowed us to work with the AMA and with the GPs on a much broader package of reform and reinvestment.
Michael has talked at length about the MBS review, and my approach there is we have the medical experts, work with the medical experts on finding what are the ways forward to ensure that we are always looking to improve the list of items to make sure that they are relevant and there are no surprises, that everything we do is a process of continuing consultation and that it’s done by the professionals, with the professionals.
Similarly, we were able to strike agreement not just with the AMA, but with every state on an opt-out procedure for the first time for the My Health Record.
Now, why does this matter? It means that we will go from about 4.7 million records currently to 23 million records. It’s roughly the number where I think it will land within about 24 months. What does that mean?
It means that we will have the capacity for some of the best health data analytics in the world, and that means that we’ll be able to do preventive health on a national basis in an utterly informed way.
But the great challenge is the issue of ensuring it works for the medical workforce. And so now we’re going to a strong, clear, consultative period over the next few months on real incentives to assist the medical workforce in their work, whether it’s in the hospitals or the specialists, whether it’s for the GPs, in the right incentive and the right design to ensure that the record actually serves your purposes.
So I want it to be designed by doctors, for doctors, so as to assist patients with their lifetime records, but also to assist against adverse drug reactions, to assist in emergency situations where time is so critical, so as it becomes fundamental to the ability of doctors to conduct their work in a timely fashion and get better health outcomes.
That’s the only test of success, Is it being used and is it providing better health outcomes? And so our task now is to assist with the right incentives to do that.
The next thing going forwards is, Michael has also mentioned the Health Care Homes trial. We had more than 400 applications for 200 places.
We listened to the AMA on the right timing. I want to look at this as a trial, but I am aware, and I think what you said to me, Michael, in private as well as public, is this in theory it’s an outcomes payment, but perhaps we can and should be moving to a much more genuine outcomes payment into the Health Care Homes model.
And contained within that, I am flexible and willing to look at those items. I think that this is a trial. I’m not saying it’s the end of it, I think we can improve the model that is there, which is exactly what the AMA and the GPs have been saying to us.
Going forwards, one of the fundamental elements is what we’ve also been able to do with the Medicines Australia agreement and the support for the Pharmaceutical Benefits Scheme.
If you look at the challenges in health over successive governments, over many, many years, much of it emanates from the epicentre of the PBS. The great trend of history is that new medicines are being developed all of the time to deal with extraordinary conditions.
Now, I know in my time we’ve been able to extend the listing of Kalydeco for cystic fibrosis for these beautiful young children, ages two to six, with transformative benefits, something, though, which would’ve cost families $300,000 or more per year, something completely beyond the reach of any but the very, very few in society.
We’ve been able to assist with drugs for lung cancer and for ovarian cancer and so many other life-threatening conditions, but these drugs have come at a huge cost to the system.
That’s what we should be doing, and historically much of the space for that has been made in other areas. That’s, of course, how ultimately the indexation pause made it down in early 2013. It came about because of making space for new drugs.
The agreement with Medicines Australia addresses that problem for the first time. They were willing to accept lower prices for the listed formula one drugs and lower prices in the transition from formula one to formula two of $1.8 billion over five years.
So a very significant reduction in return for the guarantee, for the first time, we would create genuine headroom, a space for new listings, and what that does is it’s very important for the drugs, but in particular it protects the rest of the health budget in Australia.
So we see that the Medicare budget will go from $23 billion to $24 billion to $26 billion to $28 billion over the next four years, and we’ve been able to protect that by the changes that have been made of the Medicines Australia agreement.
And similarly, the agreement with the Pharmacy Guild, which in particular is predicated on the ability to make savings through their dispensing processes, has also allowed us to reinvest in that sector.
So anything that we’ve done is allowing for the full reinvestment. That’s the theory behind the four critical areas of agreements with the specialists, with the doctors, with the pharmacists, and with the medicines providers in the country.
So it’s the first time that there’s been simultaneous agreements, I’m advised, ever, and it’s a real tribute to the work of the AMA in helping to lead that process.
That then leads me to the second of our pillars which is the support for hospitals, in this Budget we were fortunate to be able to invest an additional $2.8 billion in supporting the public hospital network in Australia and that brings, in just the last 16 months, the total additional support to $7.7 billion.
So what we can see is that the public hospital funding grows from 19 to 20 to 21 to 22 billion dollars over the course of the next four years and that allows for new treatments and, in particular, for work on reducing waiting lists.
At the same time, we also want to be working on the private health insurers and the way in which we can help take pressures out of the costs.
We’ve just had the lowest cost increase in 10 years, however it’s still too high. And one of the major tasks that I have over the next 12 months is helping to reduce pressures on private health insurance premiums, I think that that’s a fundamental and joint role that we will work on together.
Then, beyond the hospitals, there’s the critical work of mental health and preventive health. One of the main things we introduced in the Budget was prioritising mental health.
For the first time, this has been raised to the top level as one of the four pillars of the Long Term National Health Plan. And we were able to invest significantly in mental health, both in the election, but in particular, in the Budget as well.
There’s a very strong focus on suicide prevention with support for suicide prevention hotspots and an $11 million initiative, but also complementing that with the rural telehealth initiative for psychological services.
Much of this is deeply important preventive health work on the mental health side and it goes with what has to happen in, I think, the medical work force.
The case of Chloe Abbott was outlined and I’m aware that many people have been affected by Chloe’s loss, as well as others.
And Michael and I have been speaking this week, and also been speaking in recent weeks with Mukesh Haikerwal, and I am determined, Michael, to offer a partnership with the Government and the AMA for us to provide new investment directly into caring for carers.
And so I want to announce that we will offer a partnership going forward and we will develop the suicide prevention, mental health programs with the AMA and the broader medical work force for suicide prevention and mental health support, specifically for doctors and other medical work force professionals.
One of the critical roles that you have is psycho-social services, there’s the clinical work with those with mental health issues, but then there is the support services.
The NDIS it’s a wonderful national initiative. It’s got great bipartisan support. One of the gaps within it, though, is that as services were being passed into the NDIS, the psycho-social support, there was an emerging risk that outside would be left without adequate support, so we’ve invested $80 million in this Budget.
And it’s something that I’ve been fortunate to work on with Pat McGorry, with Jackie Crowe, with Ian Hickie, with Lucy Brogden and so many of the others in the sector. That, I think, is critical. We’ve made it contingent on matching funding from the states.
I’ve written to all of the states, but I am very confident that they will match it. And so instead of a gap we will have our 80 plus 80 from the states which will really help strengthen up this area going forwards.
Moving from mental health to preventive health, the obesity epidemic is real and undeniable. It’s in all areas of society, but it starts in childhood. So it’s something which is a real passion for both the Prime Minister and myself, we have provided funding to get people moving for physical activity, as well as to ensure that the GPs have a national healthy weight partnership.
The physical activity is a partnership of $10 million with the Heart Foundation and that’s to get 300,000 people who otherwise might be at risk of diabetes, obesity, walking both at school, at youth and at all ages level.
So that’s a new initiative which we’ve just launched, we launched that also at St Vincent’s in Sydney a couple of weeks ago with the Prime Minister.
But there’s a much broader range of activities on that front, sports participation, both exercise and competitive, cancer screening where there’s a $150 million initiative, in particular breast cancer screening as well as cervical cancer, support for prostate cancer nurses, and support for mental health nurses. So these are some of the things that we’re doing on the preventive front.
All of that leads me to the last of the areas, which is medical research. As I mentioned at the outset, yesterday we were able to announce the new National Health and Medical Research Council program structures, developed by the medical research community.
All up, we’re now on track to double medical research over the next five years. This is the golden moment in Australian medical research funding. The Medical Research Future Fund will match the National Health and Medical Research Council’s work in funding, we have just announced that it will be a total of $1.4 billion over the next four years.
We’ve grown from $60 to $120 to $220 to $380 to $640 million, so growing on an annual basis at a very rapid rate. Importantly, as part of that in our first round of announcements, one of the issues which the medical profession has raised with us is antimicrobial resistance.
It’s not just a concern for us, but in the current discussions before the World Health Organisation we know that it’s a global concern.
As we’ve been successful in our antimicrobial work, we’ve also seen resistance and the prescription of drugs to achieve things has meant that nature has responded with a counter-reaction. So that’s a real battle.
Today, I’m announcing $5.9 million to be made available for research, under the Medical Research Future Fund, for combating antimicrobial resistance. We have to find ways of identifying, addressing, and responding to the emerging superbugs.
This risk is an enormous risk for population health, not just in Australia, but in the developed and the developing world. So we are part of a global push which is coming out of the World Health Organisation and something that I’ve discussed with them and with the AMA.
Going forwards, there are three waves that we are trying to deliver these reforms. Firstly, this Budget has delivered on the first wave, the fundamental agreements on Medicare and the PBS with the profession.
The partnership with the AMA in the form of a shared vision, as well as with the GPs, the Medicines Australia members, and with the Pharmacy Guild, the mental health investments that are part of that as well.
The second wave now is about the work force issues which Michael’s outlined. We’re now going into 12 months of very careful design which can only be done in complete consultation with the profession about the right understanding of the challenges and the right mechanisms to ensure that there is a very healthy GP, rural generalist pathway, but that we have the right balance of future work force in terms of GPs and specialists, urban and rural.
At the same time, we’ll be focusing on the sustainability of private health insurance and the aged care system and delivering on the fifth National Mental Health and Suicide Prevention Plan.
Then the third wave of what we want to do, which we will deliver over the next two years, is the great challenge of turning avoidable hospital admissions into avoided hospital admissions. This is preventive healthcare in its deepest sense.
It’s probably the most fundamental challenge for us to work on and it’s ensuring that we provide the right incentives, the real incentives, so as doctors are provided with incentives and rewards for delivering the outcomes that keep people out of our hospitals, that’s important for sustainability, but above all else, it’s important for the health of individuals and the population at large.
And with that, looking at the extraordinary challenge going forwards and the opportunity provided by genomics and precision medicine which will continue to transform medicine and health in Australia.
Ultimately, I want to thank you, I want to honour, and I want to congratulate you on your contribution as doctors, as carers, and as people who make a profound difference to the lives of Australians every single day. Thank you.
Topics: Budget; bulk-billing; Medicare; Pharmaceutical Benefits Scheme; Bill Shorten; gay marriage.
I think there’s a lot of resentment amongst GPs around what’s happened the last few years with the freeze on bulk billing, the indexation’s really not going to make much difference.
Well the indexation is what’s been sought, and I’ve got to say that I can only refer to the comments of the Royal Australian College of GPs.
I think they’ve been overwhelmingly welcoming. The release from Bastian Seidel, his comments, the comments of Michael Gannon at the time of the Budget, the written partnerships, they’re all evidence that this is fundamentally important.
We’re investing $550 million in GP support through the Budget, and that’s over four years. It represents about $2.2 billion over 10 years. So it’s a very significant increase and it’s been backed by the written agreement with the GPs and it’s been backed by the comments of the GPs.
You don’t feel that there is resentment amongst grassroots GPs around the lack of funding this government’s offered them?
Look, I’ll let individual GPs speak for themselves. I can only go on the comments of the Royal Australian College of GPs, which have been extraordinarily positive, both in their press release and in the many, many interviews that Bastian Seidel’s done.
Now, this indexation doesn’t actually bring up the value of a patient’s rebates and the cost of living, so it’s still a slow erosion of the rebate’s value. So when are you actually going to put additional money to general practice to keep people out of hospitals? Because that, as you’ve just said, is your declaration.
With respect, we’ve just invested $550 million in GP services and $2.2 billion over 10 years. Those figures are not just unequivocal but they’ve been welcomed by the College of GPs. So I understand and respect you may have a different view, but I also respect the fact that the president of the College of GPs has a different view.
So what do you make of Margaret Court’s comments, particularly in light of the fact that the AMA’s now said that not legalising same sex marriage is a significant health issue?
Look, my view is very clear, and let me talk both about the issue itself, the issue of speech and the way of delivering a mechanism.
Firstly, I think that every Australian has a right to speak on this issue and I welcome and endorse the AMA’s right to speak on this issue.
That means that people with all different views have the capacity. We could have resolved it by now if we had had the plebiscite.
I suspect that the plebiscite would have been passed and this issue could well have been addressed. But my view is that every Australian not only has a right, but that that’s why we should have a national free vote.
I strongly support, I deeply believe in a plebiscite on this issue. That would allow the issue to be resolved and for all Australians to have a part.
Now, I have a disagreement on substance with those who oppose same sex marriage. I happen to believe in it and support it.
So I’ve said that before and I’ll continue to say it, that is my view on the substance. On the mechanism, though, I think that the best way to deal with it is a plebiscite and then it could be done, dusted forever.
Greg, part of the problem with that the AMA’s talking about the divisive public debate about same sex marriage and the deleterious effect that that has on peoples’ mental health. Wouldn’t a plebiscite exacerbate that?
Look, in my judgement this issue will be debated no matter what we do, because at the moment the elite get to speak out, the general public doesn’t.
So the debate will occur whatever the mechanism, but what will be most successful in delivering public support from those who oppose or those who support same sex marriage is allowing a genuine national free vote.
And that’s what a free vote does. It allows everybody to have their say, both those who have access to the media, because it’s being debated every day. I’ve been in the situation where if you’re on Q&A, if you’re in a forum, those who are fortunate to have access to the media are always debating it.
What would happen though, through a plebiscite is it would legitimise the result for the vast majority of Australians.
If they feel they’ve had a say they are much more likely to accept the result, and ultimately I can’t see a stronger, clearer, better way to removing pressure around this issue where everyone feels they’ve had a say. Australians are very fair minded.
If the national umpire in terms of a national vote lands one way the vast, the vast, vast, vast majority of people will accept it.
Greg, in his speech Bill Shorten is going to call the Medicare rebate freeze-lifting as cash for no comment and hush money. What’s your response to that?
I think the AMA couldn’t be stronger and more independent. And if he wants to attack the AMA, I think that that is a vile thing for him to do.
Could you give us a little bit of background about the compact that you’ve worked out with the College of GPs? How long was that in the making, and when was it finalised?
So all four of the pillars, or the areas, being the specialists, the GPs, Medicines Australia and the Pharmacy Guild, and within the medicines area there were two, there was Medicines Australia and the Generic and Biosimilar Medicines Association, began soon after I came in to office.
I spoke to a lot of people, beginning with my first two calls were Michael Gannon and Bastian Seidel. And from those and then other calls over the early days, discussions with people right across the health sector, my view is that we needed a fresh start.
There were a few things that had to happen in order to have that fresh start, one is to strike compacts with all of the sectors, two is to ensure that there was indexation, three was to ensure that there was stability in terms of the Pharmaceutical Benefits Scheme, and four was to ensure that the unlegislated measures, which in my view were never going to pass, were dropped forever.
And so we started literally in the days after coming into office, and so we worked on those agreements over a period of three months, and I think they were all signed and the letters with signatures were published on Budget night, about two to three weeks prior to the Budget.
There was $16 million budgeted in the Federal Budget for compliance at pathology (inaudible). How is that money being spent?
Sure. So that’s going to be focussed on ensuring that, through investigation, and we’ll do that in conjunction with the AMA and the GPs, but both of them in their compacts actually strongly endorse that practice as opposed to the idea of controlling rents.
And so that will be done through the Department of Health and that’s to ensure that there’s adequate support for compliance there, and that’s using the existing laws, rather than creating a new law, which had been a proposal.
But that proposal, of course, was always on the basis that either the Government took the bulk billing incentive away for pathology and diagnostic, in which case there would be different changes in terms of other payments to them and the controlling the rents, or we kept the bulk billing incentive.
In fact, we kept the bulk billing incentive. The total reinvestment in pathology and diagnostic over ten years is about $3.4 billion, so that’s been a very significant area of reinvestment.
I don’t think you’ve had a question so if you have anything.
I was just wanting you to explain a little bit more about the mental health doctors, because that’s been a big issue for doctors.
Yes, it has been. There have been some terrible tragedies in the sector. Michael Gannon and other doctors, Mukesh Haikerwal, have talked to me about that.
What we’ll be doing is developing a caring for carers package which will be assisting with specialist channels, because sometimes, and this is what’s been explained to me, those who are doctors or nurses A.) will feel that they shouldn’t be seeking help even though they’re just the same as everybody, and B.) they might feel professionally uncomfortable, even though they might be in the depths of despair they’ll still feel that professional discomfort at reaching out.
And so if they have some specialised services for them then they will feel more comfortable, we hope, and that’s what’s been proposed by the profession.
Are you going to change the mandatory reporting lines? Because that’s the big fear the doctors have, that they get reported and they go to the medical board when they seek help.
Look, there’s been no proposal put to me yet, but as I’ve said, in designing of this, what I really want to do is work with the AMA and the GPs. One last question.
I was just going to say, on that question, what do you mean by partnership? Are you going to put money into that, or?
Is there any amount?
No, what we’re doing is we’re designing together, and from that we’ll have the outcome.
Just back on gay marriage. Now that the AMA has identified that as a significant health issue, are you going to have discussions about that within government or progress that issue again? It’s kind of fallen off the agenda.
When I was asked about this a week ago, I strongly endorsed their role and their right to speak on this and made the point then, as I make the point now, that that’s precisely why we need a national plebiscite so as every Australian gets a free vote. Okay, thanks.