Remarks to the Australian Medical Association (AMA) National Conference
Remarks by Minister for Health, Greg Hunt to the Australian Medical Association (AMA) National Conference on 25 May 2018.
The Hon Greg Hunt MP
Minister for Health
Thank you very much to Michael, and congratulations not just on a beautiful and moving speech about the role of the AMA and our doctors, but also on what you’ve achieved leading the AMA in your time and your period. I’ll come back to that in a moment.
To everybody here today involved with the AMA, to Tina, who gave such a powerful welcome to country and reminded us and reminded me of the great tasks we still have ahead in dealing with Indigenous health in Australia. To my federal colleague Catherine King and to all of those who are simply seeking a very simple goal and that is better outcomes for patients and better outcomes for those within the health profession around Australia.
So let me begin with a simple proposition. I was reflecting yesterday that, in my view, Australia has the best doctors and best medical workforce in the world, and only recently I was looking at the Commonwealth fund out of New York's assessment of OECD health systems. Within that assessment, they judged Australia to have the best clinical outcomes of any of the countries. And that's hard data and hard testament to the work of all of those in this room and to all of those doctors and nurses and allied health professionals around the country.
And that's the basis for my judgment, which is not just anecdotal but backed by international assessment. It said that we have the second best health system in the world, and I think that we can aspire to achieve, legitimately, the world's best health system as our goal.
The missing part is access. That's where we were lower down the rankings, and one of the things that Michael and I have been very focused on is Indigenous health and Indigenous health access. So as we continue to work forward with the AMA that will be one of my significant themes over the course of the next year.
Now, Michael was right. I think the first call that I made after the Prime Minister gave me a call was to him. There was one difference though, the Prime Minister didn't ask me whom I thought should be the health minister of the country. But having been offered what to me is just one of the great privileges in public life, to have responsibility for health, I called Michael and we talked about ourselves and each other, but also the great task of building a national partnership between the medical community and the government of the day.
And I thought that was an extremely productive start to our working relationship. He finished, though, by putting in a cautionary note. He said there are two things you have to know about me. One is I'm a working doctor and two is I’m a West Coast Eagles supporter.
And I was reminded of the working doctor comment looking at the video. During one of our conversations, we’d speak pretty much every week, and sometimes once a day depending on the circumstances, and he would call me or I would call him, and I called Michael on this occasion. He said, just hold one sec, I’m with a patient, and it’s no problem.
And then the conversation continued. He said could you just hold on? And I heard the question: so, is the baby crowning yet? And I said Michael, are you okay? He said yeah, no, the mids got it all under control. I said, I think you’ve got a slightly more important and urgent task than talking to me. And he really is a working doctor, as are all of you here, and that’s a very important point.
On the West Coast Eagles front, he didn’t talk about it as much last year, but he does remind me almost every day, every time we speak, that he's a West Coast Eagles supporter, as is my eight-year-old son whom I love dearly but will miss. And this was presented to me on Sunday night when we spoke, at his final victory after his West Coast Eagles beat my Richmond Tigers. He felt vindication for his period in the office.
But the most important thing we’ve been able to do is work together to create a partnership. Last year, a year ago, we struck the compact, which was the basis of the contemporary relationship between the Government and the AMA. That included $1.5 billion over the period to the end of the current budget of additional investment in Medicare through re-indexation.
It included the agreement to work on the MBS reviews, and now more than 90 different recommendations have been adopted by the Government for reviewing practice based on the expertise of those who are involved in the profession and it included an agreement to work together towards the implementation of the My Health Record, and that is proceeding.
We are moving together, with the agreement of all of the states and territories, the AMA and the different colleges, to the opt-out model in the period between mid-July forward for the next three months after that. And by the end of this year, approximately 75 per cent of GP practices are expected to be engaged and enrolled in uplifting data to the My Health Record service, 75 per cent of hospitals and I would encourage all of the other specialists in the room to engage in that process as well.
Ultimately, it is about the data that can help save and protect lives for patients and to give the clinicians the opportunity to make earlier and better diagnoses. So it’s a national tool of national significance which has had bipartisan support, first announced in 2010 and progressed over the course of this decade. It’s a major national undertaking.
In addition to those that work though, we’ve been able to work together in particular on private health insurance reform and the changes that were made were about affordability, whilst retaining an absolute commitment to the hybrid model of a public system and a private system.
It’s only with real structural reform to the cost drivers of that system that we can make it sustainable. But by adding mental health coverage in such a way so as there is no delay for those seeking to upgrade their mental health coverage, improvement in coverage for rural Australians, and now working towards an absolutely crystal clear system, where people will know what's in and what's out of their coverage, then we can put this on a much more stable long term basis.
So moving forwards from there, what I really want to address is three things today. One is the third wave of reform that’s contained within the Budget. The second is the workforce reforms, to which Michael referred, that we have cooperated on through multiple discussions, not just with the AMA but with all parts of the medical profession, which will make a profound difference to opportunities for junior doctors, for nurses, for those in medical schools, and therefore to patient outcomes in rural Australia.
As Professor Brendan Murphy said to me, the Chief Medical Officer, his view is that this was the most significant workforce reform in 30 years in Australia. And then, finally, to look to the future, to look at the next steps in relation to primary care and quality outcomes, medical indemnity and the mental health of doctors and the medical profession.
In terms of the Budget, the overview is a simple concept. We set out to improve quality and to improve support across all of the different areas of the Australian health and medical sector. All up, there was an addition of $12.4 billion to the health budget in this in this Budget. That takes it to approximately $414 billion over the course of the next four years.
What it does also is to provide areas of profound reform within workforce, which I’ve mentioned, within medical research, very, very significant new primary care and other items added under Medicare. New medicines added under the PBS and mental health initiatives, coupled with the aged care outcomes.
So to look briefly at how we frame this, the Long Term National Health Plan that we’ve developed jointly over the last year and more is built around the four pillars, and the first of those pillars is guaranteeing access to doctors and nurses and medicines through the primary care system and through Medicare and the PBS in particular. The Budget added $4.8 billion all up over the course of the next four years to Medicare.
In particular items, we saw new tests added for cystic fibrosis for preconception screening, just an incredibly important thing that is part of a much broader plan and practice that we're seeking to introduce over the course of the next decade to give all Australians access to preconception screening.
Secondly, we saw new tests added in relation to the capacity for enhanced cataract surgery options, which will help thousands of Australians in rural areas, particularly Indigenous Australians. New MRI screening for prostate cancer for over 20,000 men who are likely to benefit from that and new 3D mammogram testing, which will help over 200,000 women in Australia. So these are profoundly important steps forward which have come out of the work of the Medical Services Advisory Committee and the MBS Taskforce, to which so many of you have contributed.
Moving forwards, we also see that there was a major addition to the Pharmaceutical Benefits Scheme. One of the most important things that I've been able to do, in addition to working with the AMA on the compact with them and the College of GPs and the pharmacists, was to take steps to put the PBS on a sound basis. Back in 2010, the contingency for new listings was stripped out.
That was one of the elements that had a long term impact on the health budget, not just within medicines but outside. So dealing with that was, in many ways, a cornerstone of our ability to do all of the reforms together.
Off the back of that, now, in this Budget, we were able to list 1.4 billion of new medicines, and very importantly, create an additional billion dollar contingency going forward. And those new medicines included things such as $700 million for advanced metastatic breast cancer through the listing of Kisqali, a drug that virtually no woman could ever afford, but for over 3000 women it will be profoundly important in its access.
Listing of Spinraza, a medicine which would have cost over $367,000 per family for children with spinal muscular atrophy, an impossible ask for virtually every family in Australia, but for them it will be a lifesaving or life-preserving or life-improving drug. And when you meet these families, you understand why your work is so incredibly important. And along with that, a new compact on the Life Saving Drugs Program to increase access and to increase speed under that program to medicines that are exactly that - lifesaving.
That then brings me to the second pillar of what we're focusing on, which is our hospital system, and that involves the public hospitals, the private hospitals and private health. The steps we've taken to put a foundation under private health, after average rises over many years of 6 per cent, have led to a 3.95 per cent change.
Still too high, but only possible because of sustainable changes which were able to reduce costs in that sector by a billion dollars, and that was passed through to the patients. And what we’ve seen is a 47,000 person increase in private health insurance numbers in the last quarter, and a decrease in complaints in the last quarter. So two very important steps.
Now it's about ensuring that we have sustainable private hospitals by having that private health insurance, and also we've just now reached agreement with six of the eight states for what will be a $30 billion injection into the public hospital system and in this Budget we'll see public hospital funding climb from $21 billion to $22 billion to $23 billion to $24 billion.
So a very, very significant injection of new funds and Commonwealth funding is increasing at the present period, over the last three or four years, of 32 per cent, as opposed to state funding of about 11 per cent. So our investment is significant and growing and fundamental and sustained.
Now, that brings me to mental health, an issue of immense importance. I know, for every single working doctor, for every single family member, whether it's themselves or their patients or their families. This is an issue of fundamental and profound meaning. So in this Budget we’ve built on three things in relation to mental health.
Firstly, suicide prevention, with support both for Lifeline and significantly expanded services but in working with Julia Gillard for beyondblue and the creation and expansion of the current pilot for aftercare once somebody is discharged from hospital. That's the moment when people are most vulnerable if they have attempted suicide or they had been in the hospital for suicidality, and the lack of support subsequently was one of the major surprises to me in coming to this job.
So we are dealing with that, with a $37 million program which I hope states will match and I'm confident that they will, and that will be about a major investment in working together to provide patients with better support in that period after they've been discharged from hospital.
Something that Michael and many of you have championed is a major investment in mental health care within aged care facilities, but also within the community for older Australians.
And there's $102 million in that space and a $125 million medical research Million Minds program to look out over the course of the decade to try to provide up to a million Australians with access to treatment which they would otherwise not receive and access to outcomes which will significantly improve their own mental health journey.
That also leads me to the fourth pillar, which is the investment in medical research. Medical research is fundamental to your ability to deliver better outcomes to patients. The medical research budget this year has grown to $6 billion over the course of the next four years and the Medical Research Future Fund has expanded very significantly. So we have a $1.3 billion new program, a health and medical sector growth plan.
And that's about the genomics revolution, which will assist with a half a billion dollar investment over the course of the next year to ensure that patients and doctors and researchers are able to see Australia as the global centre for the precision medicine revolution through the use of genomics. A quarter of a billion dollars for the Rare Cancers Rare Diseases program and additional funding for Frontier Science research and for the Brain Cancer Mission. So all of these things come together.
Perhaps, though, the most significant element was the workforce reform to which Michael referred. That's built around a simple concept of more opportunities for doctors and nurses, and assisting 3000 additional doctors and 3000 additional nurses to take up places in rural and regional Australia. The approach that we took together, which was a co-designed program with the AMA and the College of GPs and the College of Rural and Remote Medicine and many other stakeholders, was to build up teaching, training and retention incentives.
The teaching was where we adopted the Murray Darling Basin Medical School Network structure, which we'd worked on and agreed upon with the AMA and others, where there would be no new CSPs created. There would be, instead, the establishment of end to end clinical schools, end to end clinical schools right across the Murray Darling Basin, funds injected into that, as well as training opportunities for nurses. So people will come from the bush, be able to stay in the bush and then go on to do their post-medical school training in the bush.
Related to that is the junior doctors training program. This is about 100 extra places, exactly as Michael was discussing. It's about ensuring that we have incentives through a rural provider number for junior doctors to be able to advance their careers and their training, as well as to provide additional workforce, as well as to have, above all else, better outcomes for rural patients. And then the incentives to recruit and to increase retention in our rural areas through the workforce incentive program, the Bonded Medical Places program, which has been reformed and support for nurses.
That's the vision and that's what we're working on now. And then, when you look to the future, let us begin with the notion of improved quality and that’s improved quality in our primary care and improved quality in our hospitals. Fundamental to that is the fact that we've taken the advice of the medical profession and we're now working with Bruce Robinson, with the AMA, with the College of GPs, on the lessons from the Health Care Homes program and advancing that to have an additional focus on a quality structure, on an opt-in basis.
It's an idea which has three partners as a starting point but the whole of the medical profession, the AMA, the College of GPs and the government, working to create an option for a quality payment framework that general practices may seek to be a part of. And I think that that is a very exciting model that's being developed now and is under consideration.
Related to that, though, is wound management and this is something that’s been a personal passion of many of you. I'm delighted to announce today that, in relation to wound management, we will, in particular, embark upon a comprehensive program.
I am referring wound management to the Medicare Taskforce for consideration. Secondly, there will be $1 million in relation to a wound management pilot program under the primary healthcare system. And thirdly, it will be the first priority of the new health system’s translation program under the MRFF, and I think, Michael, that was one thing you were looking for from us before you finished.
Further, in regards to medical indemnity, I am delighted to announce today that we will legislate over the coming months to ensure universal coverage and a level playing field. Universal coverage and a level playing field.
And then finally, I want to deal with both Indigenous health and mental health. In terms of Indigenous health, one thing that is an unacceptable national shame is the level of transmissible sexual diseases. So the STIs and infections are at an unacceptable level. We will be investing $8 million to ensure that there is a response to the HTLV-1 virus. That’s working with Indigenous communities, under the leadership of the Chief Medical Officer and Ken Wyatt.
But then that brings us to our own - to the health of our doctors, And our doctors in particular, as Michael acknowledges, are under stress, under challenge and always facing difficult issues that affect their own mental health. We will continue to work, and I am utterly committed, to ending the mandatory reporting practice.
We have worked together. There are one or two states who still have some issues, but on our watch, in our time, that will become a reality that every doctor who wants and needs help will be able to seek that help without fear and I think that that is (inaudible).
Thank you. And to back that reality, we will commit $1 million today to support the doctors and health services program, which is overseen by the AMA — $500,000 over each of the next two years, so as doctors in rural and remote areas can seek help when they need it from the people they trust.
Ultimately, Michael, I will finish by acknowledging you. At a personal level, you’ve been a guide, an amanuensis and a friend. I don’t think, with the greatest respect, Beverly, a 400-metres runner is the best way to describe him. More a decathlete meets Greco-Roman wrestler. He is skilled at close quarters grappling and he usually ends up pinning his opponent, but at the end of the day, he's a fine doctor, a fine leader, and above all else, a fine person. Thank you.