Address to the Australian Medical Association National Conference - 30 July 2022

Read Minister Butler's speech at the Australian Medical Association National Conference on Saturday 30 July 2022. (Check against delivery)

The Hon Mark Butler MP
Minister for Health and Aged Care

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I'm coming to you from the lands of the Kaurna people on the banks of the Port River, a very important place for the Kaurna people for many, many millennia. I want to pay my respects to their elders past, present, and emerging.

This week the Closing the Gap Report continued to remind us of the large gap in health outcomes and life expectancy between Indigenous and non-Indigenous Australians. I'm very proud to be a Minister of a Government that is committed to implement the Uluru Statement from the Heart in full.

I note that the AMA, at an early Federal Council after that statement in 2018, also indicated its support for the implementation of that statement.

I hope a number of you have been able to read the reports this morning of the Prime Minister's statement at the Garma festival in Arnhem Land about our commitment to roll that out into a referendum over the course of this Parliament, which is incredibly exciting, and a moment I hope that will really lift the nation, if successful.  

I want to thank Omar for his introduction and for the way in which we've been able to engage over the last 18 months that I've been back in the health portfolio.

It's fair to say that over the sweep of history every Labor Health Minister has enjoyed a robust relationship with the AMA.

I know that history, I've been around for a little while myself, including almost six years in the health portfolio in one form or another. I know that relationship between the AMA and Labor governments is often one of creative tension with periods of more creativity than tension and other periods where we can be frank, It's just been pretty damn tense.

There have been moments over the last 12 months of tension between our relationship, including in the lead up to the election, but I really do think that they ended up being more creative than anything else.

They very much helped shape our election policies and that is in very large part due to the frank and forthright advice, certainly that Omar brought publicly and privately to Labor about health policy, but the utter professionalism of the way in which he approached his task, and I'm very grateful.

The advocacy of the AMA, and the sage advice of Omar and Martin and others, helped shape our policy which brought about $5.5 billion of new commitments in the health and the aged care portfolio.  

I know that these national leadership jobs are very hard to perform from Western Australia given the vagaries of time zones and Western Australia's curious opposition to the concept of daylight savings. So again, I'm sure he'll be glad to spend some time in his own time zone. I really wish Omar all the best for his release from the AMA presidency.
As you all know better than me, for the new incoming AMA president, for me as the Federal Health Minister, and most importantly, for all of you as medical practitioners, these are challenging times that we face in the pandemic and in terms of some very deep structural challenges facing our health and hospital system more broadly.

As you know, we're right in the middle of the third Omicron wave this year, and we're still only in July.

We're numbering about 330,000 cases on a seven-day average per week at the moment but we know from sampling from the positivity rates that we're getting for PCR tests, that the real number is probably at least twice that. It is an extraordinary numbers of infections with this highly infectious new subvariant.  

You know better than me how heaving the hospitals are with well over 5,000 hospital beds, about one in 12 of our public hospital beds, filled by a patient with COVID.

On the upside, if there can be an upside, ICU rates are still well below where they were in January, and flu cases, including flu hospitalizations appear to be on a very sharp downward trend. And we hope that that continues, but there's no question that our hospitals are under enormous pressure, as are the doctors, nurses and other staff that work within them.  

On coming to government, I really wanted to try and bring a new energy to some of the elements of the pandemic response that I've said in the lead up to the election had started to lose a bit of momentum.

I think the lack of a really strong public information campaign meant that we lost a very important period of months around the messaging of the importance of the third dose.

The vaccine rates for third doses have just stalled to a quite an alarming extent.

There are about 5 million Australians who effectively have tapped out of the vaccine program. These are 5 million Australians for whom it's been more than six months since they had their second dose, but still haven't had their third.

In spite of an information campaign that we've rolled out, information campaigns that the states have rolled out, some of them very clear that two doses is not fully vaccinated. That third dose rate creeps up only by about 1 per cent every week.

At the moment, we're only seeing about 50,000 third doses every single week.  

On a much more positive note, though, our ability to expand the eligibility through ATAGI advice for the fourth dose has had fantastic results.

Since that decision came into effect a few weeks ago, we've seen more than triple the number of fourth dose vaccinations that we had before the decision.

More than half a million people every week now are getting their fourth dose.

We're seeing very good percentages of fourth dose coverage, particularly in older groups over the age of 65, but increasingly also in the 50 to 65 age group as well.  

I said publicly, I was concerned that the fourth dose rate was climbing too slowly in residential aged care facilities.

I wrote to aged care providers reminding them of their obligation. But I also said to our own Department, we needed to be more energetic and more active here.

Doing repeat visits if need be, some residents who might not have been eligible at the time of the first or a second visit, for a fourth dose.

And pleasingly again, that fourth dose rate, since I made those comments has climbed - from about 50 per cent in residential aged care, which was actually running behind the rate for over 65s - to around 80 per cent now.

That vaccination rate plus the preplacement of antivirals into residential aged care facilities will be providing extra protection, particularly given that now about maybe, one-in-four, or in some areas, one-in-three residential aged care facilities have COVID outbreaks.

I know a number in the in the medical profession were saying that the eligibility criteria for antivirals was too strict.

And so, the Government, maybe for the first time, made a submission to PBAC because the relevant drug companies wouldn't do this to expand the eligibility criteria.

I'm really glad we were able to be successful in that application, and fast track the implementation of the new advice from PBAC.

And again, we've seen a very big increase in prescription rates for those antivirals- Molnupiravir and Paxlovid from about 13,000 a week - we had hundreds of thousands of these medicines sitting on warehouse shelves gathering dust - and now to over 30,000 a week.

I'd still like to see them climb further, but that's a very, very big increase, which will go a long way to preventing severe disease.  

We had a good, robust discussion about the role of phone consultations in people trying to get these scripts. I appreciate the frank dialogue I was able to have with Chris Moy representing your organisation, as well as the College of GPs.

We heard your advice, we made that change. And hopefully now there should be no barrier, particularly for older Australians, getting their hands on those highly effective antiviral treatments as soon as they're notified of a positive COVID test.  

Again, there are information blockages here, so we've rolled out - from last week - a community information campaign to make sure that particularly older Australians and others with compromised immunity or other health conditions are aware that there is this treatment that can really make the COVID journey much less serious than otherwise would be.

The Prime Minister's first National Cabinet meeting with the premiers and chief ministers had a very full discussion about hospital funding the states.

I know you’ve been trying to get that onto the agenda of National Cabinet, unsuccessfully for a very long period.

I was really glad as the line minister with responsibility for health, to see a positive outcome there, both in terms of the extension of our COVID supports for another three months at the cost of about $760 million. But more importantly for the long term, in engaging the head of Prime Minister and Cabinet, and his equivalents at state level, to start delving into these structural challenges.

Whether it's long stay patients of NDIS recipients in aged care residences, or other fundamental elements that, frankly, we've been dealing with for many, many years.

I, as the Health Minister, take the view that there's nothing better as a line portfolio minister, than when the Prime Minister, or in state level, the premier and their departments feel that an issue is sufficient importance for them to become involved. I think that's an extraordinarily positive development.  

Our focus now obviously has to be to get through this wave and get through winter.

But we're already starting to plan the next phase of the pandemic response that's got to be sufficiently flexible to reflect the fact that we don't know what this virus is going to throw at us next, but we've got to plan ahead.

One of the elements of that is I've asked Jane Halton to conduct a review of our procurement arrangements for vaccines into the future, as well as treatments.

We know that those at a global level are starting to change very quickly, great advances coming, I hope, in vaccine and treatment technology, we want to make sure that we've got priority access to those, and I look forward to her report in coming weeks.  

Beyond COVID, though, I've already talked about the pressure on the hospitals and what I think governments of the state, territory and Commonwealth levels are trying to do to start to come to grips with some of those structural challenges beyond COVID.

I've said in the lead into the election, that if I was lucky enough to be appointed the health minister of this country, my two real priorities over the course of this term, would be primary care, which I think is in worse shape than it's been in the entire Medicare era, and aged care, which I think is quite publicly documented and well understood by your members, I'm sure, to be in a state of real crisis and frankly, was in a state of crisis before COVID came along.  

Yesterday, we had our first meeting of the Strengthening Medicare Taskforce, which was attended by Chris Moy in Omar's place.

It was an incredibly positive meeting.

I'm chairing each meeting, and I'll be attending each of them, which will be for several hours each month in the lead into Christmas.

The job of this is to really draw out the priority investments from the 10-year primary care plan, a plan that that had very broad consensus support across the sector across the community, but had no funding attached to it.

The $750 million - $250 million a year - ongoing into the future that we committed at the election is intended to fund those priorities identified by the Taskforce as the most important things to put in place.

Now that doesn't mean there aren't other things we need to do to strengthen primary care, particularly in general practice.

I expect the Taskforce will come up with a range of recommendations that are longer term for us to work on together.

But the four things that that we identified as needing a deeper dive for the rest of this work of the Taskforce is the question of voluntary patient enrolment.

I've posed the question to members of the Taskforce, how do you describe the value proposition for patients?

I really think that is a crucial challenge for us. 

There was very broad consensus across the Taskforce that voluntary patient enrolment is probably the first piece of work for a deep dive.

The second is ways in which we can encourage and facilitate genuinely multidisciplinary care that will obviously involve a very deep look at the WIP, but other issues as well.

Thirdly, there was a huge appetite for a deep dive into technology.

I think that's going to be a really exciting part of our work.

Fourthly, there was a broad discussion about the models and the business model effectively for general practice and whether it's working given not just funding arrangements, but other things that are happening in the health sector more broadly.

This is exciting work and I'm really looking forward to it.

I think it's incredibly important and will have a big role in shaping the 2023-2024 budget of the Federal Government next year. 

Thank you very much for the opportunity to talk to you.

I'm sorry it's virtual and not in person. I wish you all the best for your conference.


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