Joint press conference at the Health Ministers' Meeting - 19 April 2024

Read the transcript from the joint press conference which covered vaping and hospitals.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE MARK BUTLER: First of all, can I thank Minister Fentiman for hosting another meeting of the health ministers here in Brisbane. We've all gathered here today, with the exception of the Northern Territory health minister who isn’t able to join us, here in Brisbane for another important meeting of the Health Ministers group.

We've got a big agenda dealing with a range of pressures and opportunities in our healthcare system, most important of which is the negotiation of a new health funding agreement, some work that was essentially allocated to us by meeting of National Cabinet in December where the Commonwealth committed to at least an additional $13 billion in hospital funding over the next five years from 2025 to 2030. We'll be getting about that work over the course of this morning.

In the last 24 hours, health ministers have reaffirmed our collective commitment to stamp out the public health menace of vaping. Vaping was a product that was sold to our community here in Australia and communities around the world over the last several years as a therapeutic good. A therapeutic good that would help hardened smokers most of whom had been smoking cigarettes for many, many years, finally, to kick the habit. It was never sold to Australia or any other country for that matter as a recreational product, and especially not one that would be targeted towards our kids but that is what it has become. You only have to look at the products that are brightly coloured often with cartoon characters on them, sometimes disguised as USBs, or highlighter pens to be able to be hidden in pencil cases, and bubblegum flavoured and other flavours that are clearly, clearly marketed towards children. You also only have to look at where they're being sold: nine out of 10 vaping stores have been deliberately set up within walking distance at our schools, because that is the target market. This is clearly nothing more and nothing less than an insidious device from big tobacco to recruit a new generation to nicotine addiction and the tragedy here in Australia and in so many other countries around the world is it's working. We know that about one in six high school students are vaping. We know that young vapers are three times more likely to take up cigarettes than non-vapers and we know the only age group in the community where smoking rates are actually rising rather than continuing to come down are the youngest members of our community, in the late teens in the very early 20s.
Health Ministers as a group, state, territory and the Commonwealth, have all been determined over the last little while to stamp this out and take collective action to lead the world in a in a series of reforms to stamp out vaping. On the 1st of January, we introduced an import ban on disposable vapes. We increased the resources to the Australian Border Force to clamp down on those vapes that have been flooding into Australia over the last several years because of the lack of an effective import ban. And there are now laws in the Federal Parliament that will be able to be enforced at the state and territory level to ban the sale and the supply of any vape that has not been pre-approved and is not being sold on prescription through a pharmacy. There's still some debate to go in the House of Representatives when we return to Canberra in coming weeks. There's a Senate inquiry underway that will report in the next few weeks as well. There will then be a Senate debate.

And again, I call on all of my parliamentary colleagues to back up the work of health ministers and public health groups, the Therapeutic Goods Administration, Border Force and so many health authorities at state and territory level as well, to back us up and to allow us to put in place this regulation that returns vapes to their original intention which is a therapeutic good. If that's what it's supposed to be, then it should be regulated therapeutic good available only on prescription from pharmacy. I'm really, really pleased with the level of support and cooperation that the Commonwealth has received from all state and territory governments. We've been working as a group of health ministers for this world leading reform that will really make the difference to the health of the youngest Australians.

We've also been working with other parts of government as well. Late last year, we had a joint meeting with police ministers and police commissioners to work out ways in which we can cooperate across portfolios to enforce these laws once they are passed, as I hope they will be through the Australian Parliament. I want to thank my health minister colleagues, and I think we're happy to take any questions.
JOURNALIST: If these vape bans are introduced won’t this see the emergence of more of the black market?
BUTLER: Our job is to is to regulate these things in a way that returns them to being a therapeutic good. What we see now is vape stores, as I said, opening up down the road from our schools, nine in 10 of them are within walking distance of our schools. School communities are complaining right across the country that they can almost see the front of these vape stores from the school gate and we are determined to stamp that out. I've never pretended that this was going to be easy. This has really exploded as a market over the last several years, there's been no control on them coming in from overseas through the borders. And there's been precious little ability for authorities to enforce arrangements at the federal level that had more loopholes than you could poke a stick at. I've never pretended this was going to be easy. But we as a health ministers’ group, as we work through this issue, recognise that we have a responsibility to do everything that we can to shut down the supply of these vapes to the youngest members of our community and that is what we are determined to do. Not only is this a public health menace to our youngest Australians, not only is it an environment menace, particularly the disposable vapes are causing huge environmental problems as they're disposed of, we also know now that this increasingly is a lucrative source of revenue for organized criminal gangs. This is a source of revenue that is funding the other criminal activities like drug trafficking, and sex trafficking and we're determined to choke off that source of revenue as well.
JOURNALIST: The Greens say they’re concerned about prohibition model and the individual shouldn't be punished for vaping. Are you willing to negotiate with them to get them on board?
BUTLER: Obviously, we'll have sensible discussions with any members of the parliament as we see these laws progress through the Federal Parliament, as we see the response from the Senate committee that has been inquiring into these laws. I'd say a couple of things, firstly, there is nothing in these laws that seeks to punish users. These laws go after the suppliers, the vendors of these products that are making a profit off a public health menace. There's nothing in these laws that will seek to punish users and we've deliberately framed it that way. That was the subject of quite considerable discussion among health ministers as we were framing this response.
The second thing I'd say is this is not prohibition. What we are saying is this was presented as a therapeutic good and it should be regulated as such. It should be available only on prescription and only through a pharmacy. I mean, it's no more prohibition than the reforms that took place around the availability of codeine, for example, in recent years, was not prohibition. What that did was returned codeine to its regulation as a therapeutic good, and that's what we're doing with e-cigarettes and vapes.
JOURNALIST: How much pressure do you think needs to be put on social media companies when it comes to regulating videos and posts about vaping?
BUTLER: There was clearly a loophole in federal laws around advertising of vapes. For a very, very long time been quite strict regulations around the advertising of cigarettes, which apply also to social media. And late last year, we updated those laws in the federal parliament to apply them to e-cigarettes and vapes as well as traditional cigarettes. There are strong laws in place but we do know that through influencers on a range of social media platforms like TikTok, we are seeing literally hundreds and hundreds and hundreds of millions of posts that seek to promote vapes. That's why the Commonwealth has put money into social media campaigns that seek to counter that. We have to get onto the playing field where young people are getting their messages. And increasingly, those are, as you say, social media platforms. We're out there now. We've got we've got campaigns on platforms, including TikTok, that seek, through influencers, to present messages about the health harms of vaping and other reasons why you shouldn't vape, but we recognise that this has become very widespread. The pro vaping message, Big Tobacco getting onto those platforms and seeking to use them to influence the minds of young people, has been going on for too long.
JOURNALIST: Just on elective surgeries. The AMA’s latest report card says hospitals are breaking point with elective surgery waiting times. The longest on record. What do you make of those figures?
BUTLER: I think that there is nothing new in that report card that doesn't add to what I and my colleagues have been saying. Hospital systems across Australia indeed across the world are under enormous pressure after a more than four-year long pandemic. If you look at any health system across the world you're seeing two things that flow from the pandemic. One is an increase in demand because there was a lot of deferred care, through the course of the pandemic, where people weren't getting the surgery, weren't seeing their doctor, weren't getting cancer screenings because of the restrictions that were put in place, understandably, in response to the pandemic. There is pent up demand, not just in the Australian hospital system, but in every hospital system across the world. And on the supply side, you're also seeing again, right across the world, a real challenge in getting the workforce to deal with just usual activity, that alone the increased activity that flows from the pandemic.
We're working together very much as a group of health ministers to do what we can to alleviate pressure on hospital system, you see that through measures like urgent care clinics and such like. We're also working as I said on a new hospital funding agreement that will see more than $13 billion of additional Commonwealth funds flow to states beyond what they would otherwise have expected. But it's not just extra dollars that you'll see in this new agreement, as the report card says, and as the statements of the AMA that I've read this morning say, it can't just be business as usual. And when we are talking, we'll talk today about ways in which we can reform the delivery of services, see more services, as far as possible, delivered outside the four walls of our major hospitals. This is work that we are very much focused on as a group of ministers.
JOURNALIST: Why is the bar getting worse every single year for elective surgeries?
BUTLER: I’ve just talked about the reasons for that. I'm not sure whether any of my colleagues want to add, given they're closer to the operations of hospital systems than the Commonwealth. I think none of us are under any illusions about the pressure on our hospital systems beyond the immediate impact of the pandemic, which is substantial. Obviously, we are dealing with the background demographic trends of a population that's getting older, a population that is seeing a greater incidence of chronic disease. That inexorably rising pressure in demand on hospital systems is something that we very much need to deal with in the negotiation of a new modern hospital funding agreement and we're determined to do that.
JOURNALIST: The AMA wants an injection of more than $4 billion from state and federal governments into the public hospitals until new national funding agreement is reached. Is that Is that feasible? Is that possible?
BUTLER: At the National Cabinet meeting in December, there was a really constructive, positive discussion about the new hospital funding agreement. We had commissioned a midterm review of the existing hospital funding agreement that looked at the actual dollars that would be flowing to states from the Commonwealth, which is, as my colleagues will attest, always been a matter of contention between Commonwealth states and territories. But it is also looked at the way in which we can have a modern agreement that delivers services in a different way, in a more effective way. We are working on that right now. We're determined to do everything we can to meet the objectives that were set to us by, by our leaders - by our Premiers and Prime Ministers and Chief Ministers - to get that agreement in place by the 30th of June. And in addition to that, the Prime Minister put on the table $1.2 billion of a commitment for short term funding to be delivered in ways that would alleviate pressure on our hospital system in the immediate term. We've been working through that funding with state territory colleagues as they put propositions to us about ways in which that money can be most effectively spent. We'll have more to say about that in the coming weeks.
JOURNALIST: Obviously, the report says that Queensland’s performance fell between 21-22 and 2022-23 periods across most elective surgery and emergency department indicators. Also pointing to the regions being left in the dark essentially, when it comes to patient access to care. Are you worried about the current status?
QUEENSLAND MINISTER FOR HEALTH, SHANNON FENTIMAN: As our federal health minister has outlined, this report card tells us what we already know. Our hospital system is under pressure, as is every hospital system across the globe. We have seen a record number of presentations to our emergency departments - 2.3 million, and we are also seeing an extraordinary increase in the most urgent cases. We've seen a 65% increase in those most urgent cases presenting to our emergency departments as category ones and twos. We know that there is absolutely more to do, but as Maria Boulton, AMA Queensland President outlined in the report card, there has been a disproportionate level of investment into our hospitals by the Queensland Government and the former federal government. The former federal government absolutely gutted Medicare. And if you talk to Queenslanders, one of the biggest issues when it comes to health is the lack of availability of a GP or finding one that bulk bills. People are waiting and deferring their care and they are getting sicker and they are presenting to our hospitals. I'm really pleased to be able to stand here in front of my ministerial health colleagues to say that Queensland is actually doing well above the average on most of these measures. And when it comes to elective surgery, being seen on time, Queensland is actually leading the nation. And that is because coming out of COVID we have had a dedicated effort on getting through that elective surgery. So Brendon, as you know, in the latest quarterly data that outlines how our health system is doing, Queensland is doing more elective surgeries than ever before in our history. And we are getting through more elective surgeries within the clinically recommended timeframes than any other state. I'm really proud of the efforts of our frontline doctors and nurses and health staff for really doing the heavy lifting. But we do need more support. And I'm really pleased about that the now federal government and now, national Cabinet colleagues have identified that Medicare and helping discharge older Australians from hospitals will help take the pressure off our very busy hospitals. We're really looking forward to seeing that 1.2 billion allocated as soon as possible. We're working together on that. And we do think that that will really help make a difference, not only for planned care and elective surgeries, but just getting through the huge amount of people that are presenting to our busy hospitals.
JOURNALIST: The New South Wales Health Minister, what is your take on the AMA's Report? Your state has the longest median lifetime for planned surgery, patients waiting twice as long for planned surgery as they were 20 years ago. What do you think is missing in your state's health approach?
NSW MINISTER FOR HEALTH, RYAN PARK: We've got some challenges in the health system, as have health systems, as Minister Bulter said, right around the world. But let's be very clear, on a couple of factors. When we took over there are around 14,000 people waiting longer than clinically recommended for their surgery. We established from day one, the surgical care taskforce. We got the very, very best clinicians from across the hospital system in New South Wales and started to work on what we could do as a system and what we could do to make surgeries quicker and be able to get them faster for people in the community. What has that resulted in? 14,000 from day one, now down to 2,000 in the recent report. We are continuing to track downwards. That is a massive improvement in the space of a 12-month period come about because we as a government have prioritised this. We wanted to make sure that people across New South Wales got access to surgery as quickly as possible, particularly those who are waiting longer than clinically recommended. And that is the group that we are focusing on. That is the group that I will continue to have New South Wales Health and our local health districts focus on, because they're the people who should have already had access to their surgery.
JOURNALIST: Is it disheartening that New South Wales has fallen in four key metrics?
PARK: No, we're continuing to work really, really hard. We are continuing to see improvement, slight improvement in our emergency department responses, that's pleasing. We've established an emergency department Task Force designed to have a look at what we can do across our emergency departments. It is pleasing that we are continuing in a federal and ministerial level today and previously around what we can do about moving older patients out of our health system. At the moment we have the equivalent of a Prince of Wales Hospital of elderly people and those needing NDIS support stuck in our hospitals. Now, that makes throughput difficult. And we are working very closely with the Commonwealth and our state and territories around what we can do to try and get those people into the appropriate care. What is not appropriate is for those people to be stuck in a hospital bed. It's not good for them. It's not good for their family, but it's certainly also not good for the system because it essentially clogs up an already very busy system and we are seeing increases in demand for our emergency departments. And that's why we've also been working very closely with the Commonwealth around rolling out Urgent Care Services. We've invested around $124 million into 25 Urgent Care Services. We are continuing to see improvements in those. Some of those are seeing over 1000 people a month now. It'll take some time to transfer into reductions in time in our ED. But we're starting to see the first green shoots. And that is a program that we're very, very keen to continue to work with the Commonwealth, to roll out as fast and as quickly and as thoroughly across New South Wales as we can.
JOURNALIST: Just what we saw in Bondi Junction - the horrible event. Is mental health going to be something that's going to be discussed today and dealing with mental health?
BUTLER: Mental health is something that's discussed at most health ministers’ meetings. This is obviously an area of huge challenge in the community, at a range of different levels. From mild to moderate needs, where people need psychological therapy, and more acute needs, where state and territory systems have tended to operate this area. I'm sure we'll have a discussion about the tragic events in Sydney that Minister Park has been responding to so thoughtfully, along with his colleagues in New South Wales, and the rest of the New South Wales community. Australians right around the country who watched the events of the last week or so in New South Wales, who have been deeply, deeply affected and feel deeply about our New South Wales colleagues.
JOURNALIST: Do you believe there's a mental health crisis?
BUTLER: I think even before the recent events in New South Wales there has been deep concern in the community and among health minister colleagues I know about the rising incidence of mental distress in the community. As I said, that's a range of levels we are doing work as a group of governments to work through the level of support for people with particularly acute mental health needs as part of the NDIS reforms that were determined at the National Cabinet meeting in December. There's a process that had been agreed under the former Commonwealth Government with state governments to undertake an analysis state by state of the unmet need for mental health services for people with particularly severe and chronic mental health. Those analyses will be delivered over the coming weeks and couple of months that will help inform the work that governments are doing around foundational supports that was determined that the December national Cabinet meeting to try and work out where those gaps are for people with severe needs who might not be currently in the NDIS.
JOURNALIST: To the Victorian Minister, in terms of the category three emergency wait times, that that is a strong performer for your state, but then, lacking in the four-hour rule and category two scheduled surgery close to the worst in the nation. What do you put that down to? And what do you say to your Victorian constituents?
VICTORIAN MINISTER FOR HEALTH, MARY-ANNE THOMAS: Ask any healthcare worker and they will tell you that COVID has changed everything. It's why our government continues to invest record funding into our health system - $24.8 billion this year alone. And it's why I'm here negotiating a fairer share of funding under the National Health Reform agreement with the Commonwealth. As we've heard, all the states and territories are challenged with our planned surgery, waitlists but this is not a problem that is unique to Australia. What we've seen is that these challenges are being experienced all around the world. Now we have a dedicated strategy to drive down our waitlist. But most importantly, we are looking at ways in which we can continue to support patients to receive their treatment in time. I'm really pleased that throughout the peak of the pandemic, and beyond, those most urgent needs, category one patients, 99.9% have continued to receive the treatment they need within the clinically recommended time of 30 days. We have a dedicated focus on strengthening the number of planned surgeries that are delivered, and indeed in Victoria, just like Queensland, in the last year, we've delivered more surgeries, more planned surgeries, than ever before. This is something that we're very proud of, and I thank our dedicated healthcare workforce for all that they have done. There's obviously more to do but we're committed to seeing it through.
JOURNALIST: To the South Australian Minister, what is your take on the opening remarks from Dr. John Williams saying that South Australians continue to suffer the health ramifications of living in one of the worst performing hospital jurisdictions in this country?
SOUTH AUSTRALIAN MINISTER FOR HEALTH, CHRIS PICTON: I think very similar to all the other health ministers that you've asked questions to, right across the country health systems are under pressure and right across the country state governments are putting more and more resources in to try to address that. Certainly in South Australia, we've got an agenda of $4.4 billion extra going into our health system. That's a bucketload of money that the state government is putting in to build more beds, to hire more doctors and nurses, to make sure we've got the capacity to see the additional people that are coming through our hospital system. But this meeting is critical. Because while the state governments are putting in more and more money, we obviously want a fair deal from the Commonwealth Government as well. And that's what some of those critical negotiations will be happening today are about. And similarly, as well, the other parts of the healthcare system impact upon that just as equally, so people can't get access to a GP, they get sicker and have to go to hospital, and people can't get out of hospital, because they can't get into aged care. That impacts upon flow in our hospital system as well. It is a critical piece of our agenda that we're discussing this, and the states will obviously be trying to work with the Commonwealth to get a fair funding agreement going forward.
JOURNALIST: Obviously, Western Australia was different in its approach to COVID, it was relatively COVID free. The report states that WA is actually the second-best performer in the four-hour rule category, but performance fell across all four metrics. Given COVID isn’t the main factor what is the reason for that?
WESTERN AUSTRALIA MINISTER FOR HEALTH, AMBER-JADE SANDERSON: Western Australia was not untouched by the pandemic. During that period, we obviously have very strict border controls, and that was one of the most important tools that the West Australian government had to maintain the safety of the community and protect the health system. With that came a range of challenges. That is that obviously impacted the system. With the opening of the borders we're very much in lockstep with other states and managing the impacts of the pandemic on our workforce. What is what the focus of this government has been is on the post pandemic recovery and the recovery is strong. We have seen a record amount of elective surgery performed in our system over the last six months, we're seeing improvements in the transfer of care. We're seeing significant reduction in ramping hours - on average 30% consistently over the last 12 months – a reduction month on month in ramping hours, people are getting better access to emergency care. We've been obviously improving our elective surgery waiting times, employing more staff - 4000 extra nurses in our system since 2022. We've seen around 1600 increase in medical staff, 1700 increase in allied health staff, 550 beds in the last 18 months, and all of those really important investments and programs have helped to provide better access for the community to elective surgery and emergency.
TASMANIAN MINISTER FOR HEALTH, GUY BARNETT: I'll just kick off and to say thank you to the Federal Minister and my ministerial colleagues across the country for the initiatives to combat vaping and particularly the scourge of vaping on children. This is an excellent initiative and as far as Tasmania is concerned, we have been proactive, and will continue to be proactive. I look forward to collaborating with my colleagues across the parliament to develop and to progress these very important initiatives.

With respect to obviously hospital funding and also the challenges in primary health. It seems that we've been on a very, very slow boat to China, it's time for the federal government to step up and act. We need that support in Tasmania we've been delivering record funding. You've just seen that commitment now in the recent state election where we've committed even further funding support not just to our hospitals, but in primary health care. It's time for the federal government to take on its responsibilities when it comes to primary health care. When four out of 10 Tasmanians who present in the emergency department are not emergency, most of those can be seen by the doctor, bulk billing rates and support for primary health care needs to be improved. It's excellent to work with the federal government with respect to urgent care clinics and piloting single employment training models, and we want to work with the federal government and collaborate with them. But it's time to step up and to act. And that's why we're here to negotiate with the national agreement. And as far as Tasmania is concerned, we want our fair share to ensure that we can deliver better health care outcomes for all Tasmanians. And to conclude, in terms of the hospital space, as the Minister for New South Wales mentioned earlier, we have serious bedblock, where you have an entire ward that are ready to be discharged to an aged care facility or for disability care and support in the community. They cannot be. And they are clearly responsibilities of the federal government. We look forward to working with the federal government to get better solutions faster.
JOURNALIST: There was mention of improving morale, doctors and other frontline health staff. How can you do that?
BARNETT: I say our frontline health care workers are awesome. I say that day in day out in the last few days since being elected, I've been at every major hospital thanking our health care workers for what they do. And they're awesome workers. They know that we're dedicated to delivering better care and improving health care system in Tasmania. I look forward to working with the unions and healthcare professionals and my department to deliver better health care outcomes for all Tasmanians.
JOURNALIST: Just for the ACT, how do you find that balance in improving that four-hour rule that’s been lagging for the past five years?
ACT MINISTER FOR HEALTH, RACHEL STEPHEN-SMITH: As others have said, and I want to start by thanking Shannon and the Queensland team for having us here today. As others have said, data that's in the most recent AMA report is not new data. We've known about this data for some time. But the ACT the pleasing thing is that the more recent reports that I've been able to release using our operational data indicate that we've continued to see a significant improvement, both in emergency departments seen on time and in the four hour rule over the course of 2023. So we've seen quarter on quarter improvements. And that's a result of the significant investments that we've made into our emergency departments, as well as the work that the teams have done to change and improve the models of care. And of course, emergency department performance is a whole of hospital issue. There's also been substantial work to reduce bed blocks across our two hospitals. The ACT is quite unique in its hospital system. And I know that when we hear the National Forum, people often say Canberra as being some kind of privileged bubble. But the reality is we have the lowest bulk billing rates in the country, we have the lowest number of GPs per 100,000 population, we have the highest number of people who are putting off seeing a primary care practitioner, because of the cost of care. And we have the highest state and/or territory contribution to our public health system as a proportion. We are doing the heavy lifting on our health system. That's why it's great to be here to talk to Mark and with our federal colleagues about how we can improve the National Health Reform agreement. We know that Federal Labor commenced the National Health Reform agreement process with an objective of getting the Commonwealth Government to 45% of hospital funding over time. We are nowhere near that. And 10 years of neglect of the primary care system alongside an inability to get to that 45% has really held back the Australian health system generally, and in the ACT. We were very pleased to see that commitment and national cabinet to getting to 45% over time, a clear path to that. We are looking forward to continuing negotiations about how that's achieved. But we also know that the National Health Reform agreement needs to deliver genuine reform, we need to have an integrated system across primary care, across our hospitals, and across the caring community. We need to be investing in innovation and ensuring people are getting the right care at the right time to take the pressure off our hospital systems. Because as everybody has said, all of our health systems around the country, just as health systems around the world, are facing significant pressure post the COVID-19 pandemic.
JOURNALIST: Just back to the Queensland Health Minister, in terms of hospital admissions for young people or further treatment, has the government seen a spike in those who vape and secondly we know a lot of vapes that are manufactured overseas don't meet Australian standards and many explode, cause burns, eye injuries. What's the government saying about that?
FENTIMAN: We have seen an increase in hospital presentations for young people who have been vaping which is why we are working together - state and the Commonwealth - to take really strong action on making sure the next generation aren't hooked on these very dangerous products. And you know, through the parliamentary inquiry that we had in Queensland, not only are these vapes full of nicotine when they are advertised as nicotine free, they're also full of really dangerous metals like formaldehyde, lead and arsenic. We are doing everything we can to make sure that the next generation are not hooked on these very dangerous products. And I would urge the Greens and the LNP to not stand in our way to take this very strong action to protect the health of young Australians. I'm really proud to be part of a group of health ministers that are taking really strong action to protect the health of young Australians. And I would urge other parties. I mean, it's too late for the National Party, we know they take big donations from Big Tobacco, but I would urge the Greens and the LNP to please get on board to protect the health of the next generation.

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