Well, it's a little bit like attending your own eulogy, isn't it?
To Biljana, to Maria, to Peter. And then I look out over this room and I see all of these faces, and I think my last address to you, I can really say what I think.
And what I think is that we do have here exactly as you have said: an imperfect, but arguably the best health system in the world. And there are systemic reasons. But the real reasons are in this room and in other rooms.
And I'm not going to try to single people out today, because I'd have to start over here at table five and finish at table four over there and cover everybody in between.
But when you think of the incredible Department of Health and all of those who are engaged in the public health system, when you think of the extraordinary medicine sector, primary care sector, tertiary sector, research sector, and everybody involved in the translation, commercialisation, and delivery of our health system.
And then when I think of my incredible office, I am just so moved by the work that people have put in to do exactly what Biljana was talking about in terms of saving lives and protecting lives.
And that's a national achievement, the likes of which has arguably never been paralleled over the last two years and beyond. But it's ongoing work.
So I want to thank all of you. This country could have had a very different path, and I'll come to that in a second. It could have had the path that we’ve seen overseas.
And yet, I had a text last night, a very generous text from one of the state health ministers, a Labor state health minister, and he wouldn't want me to name him. But he said: together, working across the lines, we’ve saved an enormous number of lives.
We have talked about 40,000 lives. But he said: you know what? I was with Peter Doherty, the great Peter Doherty just this week, and he said, in his view, when you look at the real number of lives, not just the recorded number that had passed in Europe, and these modern, sophisticated, and vibrant countries and economies, and if we had had just a similar figure to those, we would have lost 70,000 more lives.
And that's the view of Peter Doherty – not looking at the official figures, but what he believed to be the actual loss of life elsewhere.
And we measure all of those lives in terms of each of our families and each of our communities and in those that we don't know. And that's what this room has done, and that's what those outside of this room have done, and that's what the Australian project has done, and that's not too bad.
And that actually sets up what I will talk about today, which is the future, the health budget going forwards, and the 10-year plan in primary care, in rural health, in mental health, in medical research, and for our hospitals.
And so that's what really matters, that future, but that background, the platform that we've created, which could only have come from a strong system, but which was never inevitable given what we have seen with sophisticated countries.
When you think of Milan, Madrid, of Paris and London, of New York and the streets of New York, in February and March of 2020, it was almost impossible to believe all that, and yet we did.
And so I think that is an extraordinary testament to our system, our country, to all of you, and to the Australian people. We're a better country than I think we ever realised. I always had the highest view of who we were.
But as good as I thought we were, I was pleased that Australia was better. And that's not to do with one side or the other; it's to do with the whole Australian National Project, but that's embodied in this room.
I particularly want to acknowledge our Indigenous Australians. We have had one of the lowest rates of loss of life in the world in Indigenous Australia and amongst First Nations people. There's been extraordinary work to achieve that.
But our First Nations people have done their work. And on that front, I'm just thrilled to be able to start with an initial appointment today to make a reference.
We've been blessed with our Mental Health Commission, which is taking care of the mental health as well as supporting all of those who’ve taken care of the health of Australians. Lucy Brogden has been chair and Christine Morgan is CEO, and Lucy is following me into retirement, but she's got more work to do.
But she's being joined today by her successor, who will be co-chair with her, so a period of some months before beginning on 1 August, and that co-chair will be Professor Ngiare Brown, a proud Indigenous woman who's been on that commission, but who's an expert at national and international level in their own right, in child mental health, in Indigenous mental health.
When I think of the next task, it's about bringing down the suicide rate amongst Indigenous Australians, it's about improving the mental health of our children, and to have Ngiare Brown, who in her own right, is an extraordinary national and international leader, but to be a beacon to Indigenous Australians, to say, we can lead, we can take responsibility.
I'm really proud to be able to introduce Ngiare. Ngiare, could you stand?
That's the future, and the future’s in this room.
So let's get down to business. Except for one other thing, Peter. You talked about healthcare being about your wife, Nicole, and every person in this room has their own story. All of your families, yourselves, your friends, each person will have stories.
I see Dr Dave Gillespie, my colleague who's here today – a treating physician in his own right. He sent me to hospital with cellulitis once. And he knows all the individual stories.
But in a way, this budget was tied together by a little boy I met on Tuesday morning. His name was John. He's six weeks old, and he went through the national bloodspot screening program. It determined he had spinal muscular atrophy a week into his life.
A couple of years ago, that would have been a catastrophic, a catastrophic diagnosis.
Along the way, we worked really hard to list Spinraza, Spinraza for spinal muscular atrophy, and then we worked to bring it forward for asymptomatic treatment. And that was a big fight, and we were able to win that.
This little boy by two weeks was receiving Spinraza. One of the youngest children in the world, and we believe the youngest child in Australia. It is very, very likely that he will never go on to develop symptoms.
Biljana mentioned gene therapy, and in this budget we had the most expensive medicine that Australia has ever had on the PBS. Anna, this is your work. Anna and Louise, this is your work, coming home to deliver results for patients.
And it would otherwise be, it's a $2.5 million medicine for a one-off treatment. But it’s for children under nine months who are diagnosed early, who had spinal muscular atrophy, and it's a virtual cure using gene therapy, Zolgensma.
And this little boy will also have access to Zolgensma, so he will grow up, on all the advice that we have, to have a full, rich, symptom-free life from a condition which would otherwise have been catastrophic and almost inevitably fatal just a couple of years ago.
That's the journey we've been on. So now the journey we've got to come.
So then let me go to the budget and put all of this into context, because none of this would have been possible without those lives being saved, without the country then being able to rebound, without a four per cent unemployment rate, which has completely turned around the national finances, and then, without, as a consequence of that, being able to have a rebound with a $100 billion reduction in deficit and therefore the capacity to invest in this, the largest health budget ever.
So, what are the big things here? Obviously, the size of the budget – at least $537 billion over four years, it’s $132 billion this year.
But what’s really interesting, it’s a $34 billion growth – that includes an extra $7 billion in Medicare, $10 billion in our hospitals and $10 billion, in particular, in aged care. That’s all additional funding.
And then when you look at the things that are central. It was mentioned that in the extra $2.4 billion in newly-listed medicines right now, a $1.7 billion 10-year primary healthcare plan.
The work in terms of public hospital funding, almost $150 billion. And then the women’s health package, which I’ll address in more detail, and a $3 billion national medical health and suicide prevention plan. So all of those things are profoundly important.
When we think through the four pillars of the budget, you see that Medicare itself – we’ve come from $19 billion a year – these are just the numbers, but they allow the services, they allow the new treatments, they allow the growth and they allow the support of the sector.
Going over the course of this budget to 31, to 32, to 34, to $36 billion. It’s not the money that counts, but it’s the services that are enabled and the system that is supported. At the heart of this is the vision of a 10-year primary healthcare plan.
I’ve mentioned the funding, but what is the central element which comes in? And we'll all remember the uncertainty and the dark days of February and March and early April of 2020. And when we saw the collapse of primary health, aged care and hospital systems across southern Europe and then in the United States.
And we had a 10-year plan to deliver Telehealth. We delivered Telehealth in ten days, and I look to the department and I thank them, and I look to Jo Tester and I thank her amongst many others. It was impossible that that would be done, but that has now been enshrined and made permanent and universal in this budget.
The largest transformation in Medicare since Medicare was formed - 100 million consultations to date and climbing, it is now a fundamental and inevitable part of our health system going forwards.
Then, what’ve we also done as part of this? Critically, we've added $4 billion for COVID primary care through Medicare over the course of the next four years. That's on top of what we've already done. So it takes it to a $45 billion investment.
So those are the critical needs in terms of Medicare. But we go forwards and we see the new listings that I mentioned. One of the fundamental new listings complements what I mentioned before about little six-week-old John.
We all know now about Mackenzie's Mission and the National Carrier Screening trial, and I want to acknowledge the amazing Kylie Wright from my office who helped design this.
Mackenzie's Mission is about giving parents the option to screen for cystic fibrosis and fragile legs and spinal muscular atrophy. This budget makes McKenzie's Mission permanent and universal. We have jumped a decade and brought universal carrier screening now to be available – an $81 million plan – which will be available for every group- every family, for every set of potential parents in Australia going forward.
Obviously funding for primary healthcare, for telephone services and for dental services.
But then there is the stronger rural health strategy, and I mentioned Dr David Gillespie. One of the things that Dave and I partnered on was a cunning plan to make MRIs available on an un-licenced basis, to deregulate access to MRIs across rural and regional Australia.
It's the first step. It will inevitably lead on to a similar program, I believe, over the coming years in terms of our urban areas. But right now this is about rural health access, and that is part of the broader 10-year rural health strategy.
So it's a $300 million plan approximately. It also includes $150 million for training across the different programs and the different elements, and a 10-year commitment which of, and in itself, is nearly $1 billion for aeromedical support for the RFDS, for Little Wings and CareFlight and others.
So those things are incredibly important. And I met with the Heart of Australia just this week, Dr Rolf Gomes and others, who are taking their five trucks around Queensland into towns and working with Indigenous communities, with remote rural communities, with lower socio-economic communities to deliver not just general practice services, not just allied health services, but complex cardiology and oncology services on the road in areas that would never see that, and complementing that with the access now through Telehealth.
So all of those things come together, as I've said, in terms of the additional training, the additional clinical support. But what it really means is an extra 3000 doctors and 3000 nurses in rural and remote Australia.
And then for Indigenous Australians it's a multibillion-dollar investment over the course of the budget – an extra $133 million very specifically for Indigenous aged care scholarships for our nurses, support in particular for screening.
We know that cancer rates in Indigenous Australia are higher, in part because of circumstances relating to the communities and the way they deal with endemic health challenges, but also avoidable issues with regards to screening.
And to catch up and to have that screening is incredibly important as well as the other elements that are set out there.
And then as we move from the primary care outreach to the medicines that support- I mentioned the $2.4 billion of medicines that are specifically allocated. Right at the top of it, [indistinct] for triple negative breast cancer, Trodelvy. That’ll help 580 patients save over $80,000 a year. The work beyond that- Zolgensma, that I've mentioned, Trikafta for cystic fibrosis.
you know, I was with Ana, and we had met and talked with the patients, with Jess and with Heidi and so many others who will benefit from this. And then today, having just seen my great friend and colleague Jimmy Lloyd, I am delighted to announce that Lynparza will be extended for metastatic prostate cancer.
It's a saving, again, of approximately $80,000 for 200 patients, and that's available as of today. And so these are all real themes that translate.
It’s probably- apart from the pandemic, there’s probably nothing which I'm approached about more when I'm on the streets, and people will tell me about their family, their story and what these medicines have meant to them.
And this room is the room that helps research, trial, develop and ultimately deliver these new medicines.
But then as part of it, there's cost of living. And even with the PBS, there are challenges for some. And so I want to acknowledge all of those who’ve fought for additional action. In this budget, there’s a half a billion-dollar reduction in cost of living through the investment to reduce the safety net threshold.
It’s effectively reducing the number of scripts for concessional card holders by 25 per cent, by 12 scripts. It’s a doing a comparable thing for non-concession card holders. It simply means that people have access to free medicines earlier. And that’s one of the legacy items of which I’m most proud.
And so those are the elements there. You can see the actual costed amount – budgeted, costed, delivered.
So as we move from our first pillar to our hospitals, think of where we’ve come from. We’ve got public hospitals and private hospitals.
You know the options – an Americanised system with its emphasis on private; the UK system, which is a very fine system, with its emphasis on public. But the Australian model, which is a hybrid model, which I believe is a balanced and blended model which serves this country well and gives us- Peter, as you say, the finest health system in the world, but one that can always be better, always continuously improving.
This budget, we’ve taken that investment from $13 billion, and then over the course of the budget, we go from- to 27, to 29, to 31, to approximately $33 billion of annual investment in terms of our hospitals.
There’s an additional $10 billion for COVID-related hospital investment. And all of this sits alongside what we are doing in terms of the private side.
We were able to have private health insurance changes halved from over 6 per cent, to the lowest in 21 years, with 2.7 per cent.
But right now – and I see Ian Burgess here from the MTAA – we were able to strike an agreement for lower device prices, which in turn has been able to support our hospitals and our private health insurers, and gives us continually downwards pressure on private health insurance prices, and which has seen private health insurance uptake skyrocket. And that underpins that model.
At the start of this term, pre-pandemic, my biggest concern was the viability of the private health insurance, the private hospitals, and the device centre. The reforms that’ve been made have sustained that and built that.
When you look at what we’ve seen, over 760,000 Australians take up private health insurance over the past six years, and over 300,000 since January 2021, and these year’s numbers are looking significantly greater again. So that part of the system is strong.
But we now continue that process of bringing forward devices earlier, but of doing so in a more cost-effective way, which increases the capacity for people to take up lower cost private health insurance built on the reforms of gold, silver, bronze and basic, and better access to mental health, and better access for rural health, and better access for young people, which has changed the value proposition.
So then we turn to mental health and to preventive health - the third of our pillars.
A $3 billion investment in stages one and two of the National Mental Health and Suicide Prevention Plan, the five pillars of prevention and early intervention of suicide prevention, of treatment, of supporting the vulnerable and of strengthening workforce and governance. They've all been established and enshrined.
And in particular, what I note as part of that is that there's $206 million over the next three years for the Early Psychosis and Youth Services Program. And so many of you are engaged on this work, in this task of saving lives and protecting lives.
You remember we were told that not just would there be catastrophic outcomes with COVID, but there would be catastrophic loss of life to people taking their own lives. I think the term was a tsunami of suicide. People taking their own lives went down in 2020.
Not as much as we would ever want. The only goal can be towards zero, but the fact that lives lost went down and all those lives that would’ve been additional were saved, is a testament to all of the programs.
And I'm delighted to be able to announce as part of that, some additional appointments- which I don’t have my glasses. That's unfortunate.
Additional appointments beyond [indistinct] to the work- thank you very much. That’s a real [indistinct] It's a public-private partnership in action.
Additional appointments to the National Mental Health Commission. Kerry Hawkins is being reappointed to the board. Phoebe Ho, Christine Jones, Heather D’Antoine, Dr Mark Wenitong are all being appointed to the board of the National Mental Health Commission.
And then an appointment which has been through Christine Morgan's merit review process that particularly delights me.
The first head of the National Suicide Prevention Office will be Dr Michael Gardner. Michael will be known to many of you. He has been my mental health and suicide prevention advisor.
He went through the process independently. He's a PhD from Cambridge, so he's reasonably well qualified- as he would not be willing to say that. But he's been very up front now.
I never knew this in all the time he's served in this role, that he comes with lived experience. And to have somebody with that empathy, that compassion, who has probably saved a dozen lives over the phone, through early intervention, through people who call our office because they're at the end of their journey – people who’ve been literally on bridges, people who have been on the edge, Michael has been there.
And Michael, you’ll be a magnificent addition and you will continue to save lives and protect lives.
So then as we go forwards from here, we look at the investments – in particular, the digital programs for young people, the work in terms of suicide prevention and the support for the Office. All of those things are fundamental.
In terms of the treatment – and I especially want to acknowledge my colleague, David Coleman, here. We built the model of Head to Health. And Head to Health builds on what we have done in terms of headspace and headspace for adults. And it's headspace now for under 12s.
And so to Head to Health; last budget we talked about 40, this time it will be 80 Head to Health. Remember we’re on our way to 160 headspace. And within a few short years then we will already be at 80 Head to Health facilities for adults.
Everybody in this room will have somewhere to go. At the moment, there are options, but there's not an easy option, and that will make a difference. And it will be virtual, online, telephone, but above all else face-to-face.
It's an old railway yard in Geelong. It was chosen by the lived experienced community. They gave us somewhere that was a bit edgy, that had a design where they felt they would be comfortable going.
And they were the ones that designed it. And that's what Head to Health is about. And that's what this treatment is about. The absolute heart of the program and expanding out the services and support for Australians of all ages.
And so we then turn to, in particular, closing the gap in funding that we're providing there. The Red Dust program that Sue Martin and I were just discussing. So important for our Indigenous Australians. And then to underpin it, the investment in additional workforce.
I know that this is the challenge, the psychology workforce, the psychiatry workforce, the lived experience, peer-to-peer workforce and the carers workforce, additional funding for all of those.
And now on the preventive health, there’s something that I particularly want to acknowledge, and that's the $333 million for women's health. I mentioned before what we're doing in relation to carrier screening, but the funding for endometriosis.
I'll tell you a story and I've got two of my budget advisers here. Nick Henry, who was my budget adviser, and Belinda McEniery. And Belinda has now put together six economic updates in in three years, and she helped drive this budget. And I want to acknowledge, but for these last three budgets, these last six economic updates, Belinda. And these items would never have come without them.
But going into ERC, Expenditure Review Committee, is never easy. It's always: no, you're going to have to reduce that, or why do we really need it? That's their job, is to test the importance of things. I took the endometriosis package and they said no.
I said: why? They said: not good enough, not big enough. Prime Minister looked at me and said: I want you to triple the size of it and I want you to come back with very clear clinical treatment options for women.
Okay, we'll be back. And came back a second time, he said: no, a bit more. And all these things will help women.
But you know what's really important? The fact that you have a Prime Minister, a Treasurer, a Finance Minister, a Government that says this matters. This matters to over 800,000 women.
It's a part of the language. It's an issue that's been acknowledged. And then the $58 million in treatment, that's about the pain clinics for women all around Australia. It's about the MRIs for diagnostic work, because diagnosis has been in the dark for so long.
So all of those elements, coupled with the women's safety, coupled with the carrier screening, mean that this has been a landmark investment.
Then in terms of what we do with cancer? Peter MacCallum, but for Western Australia. Chris O'Brien, but for Western Australia. The Genomics Australia vision to create that framework to oversee the genomics mission going forward. They are incredibly important.
And then the health checks, Richard Temperly from my office, has helped to put all of this together. And these programs will also give everybody hope and treatment as we go forward. Other elements of the preventive health strategy.
There’s the National Ice Action Strategy, obviously a big number, over 300 million. But there's a smaller number there of 26.9 million, and that's to support prevention, diagnosis, treatment and management of allergic diseases and anaphylaxis. I reckon there are a lot of people in this room who know a lot of people that have suffered from severe allergies and anaphylaxis.
And Katie Allen, Dr. Katie Allen, has helped put this together with those that are in this room, with the patient groups that were identified. And so all of these elements are incredibly important and underpin the National Preventive Health Strategy.
We’ve backed that with what are we’re doing with sport. And my colleague Richard Colbeck has been a great advocate on this front. He can't be with us, because he's contracted COVID. Some people will do anything to get out of Senate Estimates, which is today, which is why some of the department are already there.
But these investments are actually about long term participation in our schools, about Australia being a global sporting venue, and therefore driving participation right across the country.
So then this brings me to medical research. The fourth of our pillars. We lay out a ten-year plan, $6.8 billion over the next four years across the four major areas of the NHMRC.
Anne Kelso, I see and acknowledge you here for all of your work. The Medical Research Future Fund and the Biomedical Translation Fund.
As part of this though, the 10-year plan, $6.3 billion. And I'm not expecting you to read this, but you will get the papers and you can take it away. The four pillars of the Medical Research Future Fund 10-year plan of clinical trials, $750 million in terms of our patients.
In 10 years, $750 million commitment to rare cancers, rare diseases, clinical trials. The work in terms of our researchers, where there's a $700 million programme in relation in particular to what's being done with the Frontier Science Program.
I am reminded of Tennyson's Ulysses: to strive, to seek, to find, but not to yield. That is what Frontiers is about.
And then we have the commercialisation, which is underpinned by a near $2 billion commitment over the coming years, and the missions. And there's one and a half billion dollars for the great eight national missions.
And those are the transforming directions; stem cells, genomics, all of the new therapies which will lead to precision medicine over the course of the coming decade; embodied in Mackenzie's mission, but delivered through the new therapies.
In particular, $303 million of new grants and new programs announced in this budget right now, which are either being delivered or open for people.
Lastly, I turn to ageing and aged care. We've expanded on the Royal Commission. We've done all of that work. Here I want to acknowledge somebody very special. I've been blessed with two extraordinary Chiefs of Staff, Jo Tester and Wendy Black. Wendy has lived and breathed the royal commission, and she has helped design and coordinate it, and done it with a passion for the lives of older Australians.
And this Budget builds on those five pillars. It's built on all of the things that we want to put in place in terms of home care - something which was ignored in another speech in another place last night.
Residential care in terms of services and sustainability and care and quality and workforce, and in governments.
But significantly, in home care, what we are seeing now is that a radical transformation of that system, we've gone from 60,000 places to now, over the course of this year and Budget, over 250,000 places that are being made available.
That is an incredible transformation, and quadrupling in the size of that system. The other elements that are there in terms of the residential aged care, quality and safety, the significant thing is $345 million for medication management through onsite pharmaceutical roles.
That will change the care and treatment. But above all else is the support for workforce, for having nurses on site, something for which we have committed. All of those are there.
And then let me round up, by thinking about where we've come from. The COVID journey. That doesn't define us, it allows us to be who we are.
The $45 billion that was invested was an enormous investment, but it builds on who we are. It has been an extraordinary challenge. The $4 billion that comes in this budget allows us to go forward with confidence that we are covered through this winter and through future winters.
The investment in bringing mRNA vaccine manufacturing to Australia is about securing us for the future, but it's about creating the ecosystem going forward with it.
There’s quite a little group from my office that I haven't mentioned: James and Julia and Mat. They've taken care of media and communications.
It's been a little bit busy during COVID. They've tallied up 45,000 media enquiries in two years.
And to imagine that any group of humans could process 45,000 enquiries in two years, but then to do it in an unflappable and utterly compassionate way, I just am in awe of my own media team, and I don't get to acknowledge them very often, but I am today.
But going forwards from all of that, they’re the two words that I have. I want to thank all of you for everything that you do.
You have saved lives and protected lives during the pandemic. You have saved lives and protected lives through your work.
But over the course of the next ten years, which is what this budget was about, built on the lives that we have saved and protected during COVID, which in turn has underpinned the national economic story, which in turn has underpinned the ten-year long-term national health plan, we will save lives and protect lives on a greater scale than we've ever done before.
I thank you, and I honour you.