Minister for Health and Aged Care - Melbourne press conference - 5 January 2023

Read the transcript for Minister Butler's press conference on COVID-19; travel arrangements; Medicare; bulk-billing; Strengthening Medicare Taskforce; Better Access; mental health; and Medicare compliance.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: As most people are aware the Government requirements for travellers from China, including the Special Administrative Regions of Hong Kong and Macau, to show evidence of a negative COVID test before boarding flights to Australia took effect earlier this morning, one minute past midnight Australian Eastern Daylight-Saving Time. I’m advised that several flights governed by that requirement have already landed in Australia and the advice I've received from the Department of Home Affairs is that there have been no issues identified with compliance with those measures. I want to thank the airlines which, since the first time we made contact about introduction of this requirement, have shown a high degree of cooperation with the government to put in place this modest, sensible measure very quickly.


And I also want to thank the passengers who have travelled to Australia and who have shown a very high degree of compliance with this measure. Obviously, passengers leaving China, Hong Kong and Macau for most destinations, frankly, around the world, are governed by this requirement. But it has proved to be no barrier to the resumption of travel between China and Australia, which I and other members of the Government have indicated we so warmly welcome. We know on a personal level this is going to be a joyous thing for many hundreds of thousands of Australians, particularly Australians of Chinese descent who have not been able to have personal contact with their friends and their relatives for months or even years.


It is just not the same, seeing your friends and relatives over a computer screen. So we warmly welcome that resumption of travel. But we know also that universities and university communities are very keen to see Chinese students return to study on-campus rather than studying remotely, as well. The tourism industry, I know, is relishing the chance to show Australia’s wonderful tourism assets to Chinese tourists returning to Australia. And I am confident that this modest, sensible measure taken out of an abundance of caution, will prove no hindrance, no barrier to the resumption of travel at all.


As people are aware, I think, this is a widely shared position around the rest of the world. The United States and Canada announced their intention to put in place a predeparture COVID testing from China, Hong Kong and Macau a couple of days before I made that announcement on behalf of the Australian Government. The United Kingdom and a number of European countries also made that announcement. And in the past 24 hours, the European Commission has “strongly encouraged” - to use their words - strongly encouraged all 27 members of the European Union to put in place exactly the same arrangements for pre-departure COVID testing. In our own region: India, Japan, South Korea and Malaysia have also put in place pre-departure testing requirements for travellers from China, Hong Kong and Macau. And again, in the past 24 hours, the World Health Organisation – the head of the WHO – has reiterated their view that these measures are to use their words, again, “understandable”, in light of “the lack of comprehensive information” about the situation in China. It's really important that the rest of the world have as much information as we possibly can get about this fast developing COVID wave in China. Happy to take questions.


JOURNALIST: Why did you go against the advice of the CMO on these test requirements?


BUTLER: The four recommendations from the Chief Medical Officer that was contained in the advice that I decided to publish on the same day I made this announcement - on New Year's Day on the 1st of January - are all being implemented by the Government. To look at the feasibility of wastewater testing from aeroplanes arriving from China: we started a pilot of that on the 3rd of January. We're getting great buy-in, great cooperation from the airlines and from state governments to do that wastewater testing off aeroplanes. You will also have seen, in recent days, European nations and the US look at that as well. We also accepted the recommendation from the CMO to look at strengthening community wastewater testing - so wastewater testing here in Australia. And we've had again really good cooperation from state governments with several new community wastewater testing sites, agreed only in the past couple of days.


Other recommendations from the Chief Medical Officer in the advice that I took the decision to publish at the same time that we made this announcement have all been accepted, and are all being implemented. But I was also clear at the time that in light of what was happening around the rest of the world: pretty much every country to which we would usually compare ourselves is putting in place these requirements, in light of the World Health Organisation advice that was being released at the time that the Chief Medical Officers advice was being sent to me that these were “understandable” measures, I also took the decision to put in place the pre-departure testing arrangements.


JOURNALIST: The Chief Medical Officer said that he didn't believe that there was sufficient public health rationale for this decision, your Government has made much of following the health advice. When your own Chief Health bureaucrat is telling you that there's not sufficient rationale for this decision. Why do you ignore him?


BUTLER: I've accepted every positive recommendation contained in the advice. We value transparency, that's why I took the decision to publish the advice in full on the day that I made these announcements. Of the four recommendations made by Professor Kelly, I'm implementing all four. If I decided not to implement some of those recommendations, which he had said were important in terms of getting better understanding of what's happening here in Australia, there would have been a valid criticism. But I have accepted all four recommendations from Professor Kelly. Now in addition to that, I as the relevant Minister, and the Government more broadly have taken the decision as has been taken by pretty much every government to which we would usually compare ourselves - a decision described by the World Health Organisation as “understandable” - out of an abundance of caution, to put in place pre-departure testing.


JOURNALIST: Given how common it is for other governments and similar governments have taken this decision, to health authorities around the world who have advocated this position, is the CMO’s attitude on COVID mitigation too conservative for this government?


BUTLER: You've also seen the European Union CDC – the Centre for Disease Control – take of take a view that there was no public health imperative to put in place this, in the sense there was no imminent public health risk. Now, I said very openly at the time I made this announcement that the consensus view of the Chief Health Officers was that there was no imminent public health threat posed by the resumption of travel between China and Australia. But that I was, out of an abundance of caution, putting in place this pre-departure testing in light of what the World Health Organisation described as “an absence of comprehensive information” about the situation in China. A very similar situation is emerging in Europe, as the European Commission governments coming together recommend that all 27 members of the EU put in place these similar pre-departure testing arrangements out of an abundance of caution, out of what they describe as a “precautionary approach” to a fast-evolving COVID wave in the largest country on the planet, with very little information about exactly what is happening on the ground. This is what governments are responding to. This is what the World Health Organisation has talked about on a number of occasions over the last five days.


JOURNALIST Some experts are expecting three peaks over the next three months in China. If they don't start providing better data on their outbreak, is it likely that these measures will continue?


BUTLER: We want these measures to be temporary. They are modest measures. I think, as you're seeing with flights landing today, they are not proving to be a barrier to all of those people here in Australia who want to travel back to China, and people from China wanting to travel to Australia. It is a modest requirement to have a PCR or a supervised rapid antigen test. And I do make the point that to travel to China, you need to show a pre-departure PCR test, as well. So we're confident this will prove no barrier to the resumption of travel. What it will do is provide us with a higher level of confidence about the transmission of COVID from that country to this. And of course, we are hoping, particularly from the regular discussions that are happening between the World Health Organisation and China, that we will start to see more sharing of information of the type you see around the rest of the world, particularly sharing of genomic sequencing of COVID cases that are increasing very fast in China.


I've also asked my department to reach out to their equivalents in China to stress our view that it would be valuable for information to be shared more comprehensively by China, not just with Australia, but with the rest of the world, in the way in which other countries are doing - real time uploading of their genomic sequencing of COVID cases. This is what governments including Australia, are calling for. This is why we've put in place these modest measures sensible measures out of out of an abundance of caution This is why you've seen very strong language from the World Health Organisation, not just once, but on two occasions now over the last five days.


JOURNALIST: I know it's very early. But do you have any data on how many people have been turned back on flights in China or anything around operation of the protocol so far?


BUTLER: You're right, it is very early. But the Department of Home Affairs advice to me is that there have been no issues with compliance. There's only been obviously, several flights, given we're only in the first 12 or 13 hours of this, but that there have been no issues with compliance. I make the point again - I don't want to run through the list of countries, again, because it's a very long list - but you know, there aren't many significant destinations you would be flying to from China, that don't require this pre-departure testing arrangement. All of North America, all of Europe, all the big destinations in our own region in Asia. So this is something obviously that all passengers seeking to leave China, Hong Kong or Macau are having to deal with - not just travellers to Australia. And the advice I have right now is that there have been no issues with compliance


JOURNALIST: Do we have any idea how many people may have not travelled as a result of a positive test?


BUTLER: No, I don't have that advice.


JOURNALIST: Minister on another topic, Victoria and New South Wales Premiers have formed a bit of an alliance calling for an overhaul of Medicare, do you concede that the health system is broken? And if so, will the Government commit to changes?


BUTLER: I welcome the intervention from Premiers of the two largest states. It's not the first time they've made this intervention. And it reflects the position that Federal Labor has been making right back until quite a time before the May 2022 election. We said at the election that there was no higher priority for Labor in the Health portfolio than strengthening Medicare and rebuilding general practice in particular, because the constant advice we have received across the country is that after nine years of cuts and neglect to Medicare, it has never been harder to see a doctor, and never more expensive - with bulk billing rates in decline, and gap fees constantly going up - than it is right now. And that's obviously seriously impacting the ability of people to get the care they need, when they need it, in the community from a GP, and practice nurses and other allied health personnel working with them.


But it's also placing real pressure on our hospital systems. And I think that's the particular perspective that the state governments bring to this. Too many people are having to end up in a hospital emergency department because they can't get the care they need in the community when and where they need it. So that's why the centrepiece of our health policy at the last election was strengthening Medicare. And I've been working over the last several months with a range of doctors nursing, allied health, and obviously patient groups in the Strengthening Medicare Taskforce to help guide the Government's investment of Strengthening Medicare Fund that we promised at the last election. That work’s largely complete. The report is in the process of being finalised and will be published over coming weeks, in order to allow us to make decisions in the May Budget about the investment of that Fund.

I value the contributions from Premiers and from state Health Ministers. This is something that I've talked with my state Health Minister colleagues about very, very regularly. Obviously, they're interested in a primary care system working well for the health of their own citizens. But I say again, state governments are very worried about the impact that the parlous state of general practice is having on their own hospital systems. There is no higher priority in the health portfolio for Labor than strengthening Medicare.


JOURNALIST: Can you promise that this will be a priority at the National Cabinet meeting on February 1st?


BUTLER: The National Cabinet agenda is set by the Prime Minister, in consultation with the Premiers and the Chief Ministers, not by me. I know though, from the time we were elected after that first National Cabinet meeting that health has been a significant topic of discussion at every National Cabinet, as far as I'm aware, since the Albanese Government was elected. It’s something that the Prime Minister and his Premier and Chief Minister colleagues are deeply engaged in. And can I say as a Health Minister, I think my state colleagues agree with this, that is a significant thing. To have the First Ministers of the nations focused on this issue is something that I welcome as a Health Minister, because we - all parliamentarians I think - receive a constant level of feedback from a community that they're deeply worried about the state of general practice in this country.


JOURNALIST: So should all GP’s [inaudible]


BUTLER: There's no question that the level of bulk billing is in decline. And I was making that argument before the last election. Gap fees have increased very dramatically. For the first time in the history of Medicare, the average gap fee for a standard GP consult is more than the Medicare rebate itself. So people are paying more out of their own pocket to see a GP, if they're paying a gap, than they're receiving through a Medicare rebate. And that's having a real impact on the general operation of our health system.


JOURNALIST: Minister, how did we get to this state?


BUTLER: Nine years of cuts and neglect. The Medicare rebate was frozen for six years under the former government. When the former government, particularly Peter Dutton, as the Health Minister was unable to get his GP tax through the Senate in 2014, which would have required every single Australian, every pensioner, every child or parent on behalf of children, every concession card holder to pay a gap fee. Now that was opposed by the Labor Party: it would have ended bulk billing forever for every single Australian patient. We opposed it. And so when the Liberal Party under Health Minister Peter Dutton was unable to get that GP tax through, instead they froze the Medicare rebate. So effectively, the income of general practice was frozen, while the costs of delivering general practice continued to increase. No wonder really, that bulk billing rates were declining, and no one to get fees were increasing to their highest level on record.


JOURNALIST: The Taskforce has looked at heaps of reform ideas, rebates is only one of them. But you've mentioned that it’s one people talk about regularly, do you think it's highly likely that the Government will move to increase rebates, particularly, as part of this reform?


BUTLER: I don't want to speculate about what the recommendations of the Taskforce will be and what the response of Government will be in the May budget. I'll say a couple of things, though, about the real focus of that Taskforce. The first thing that we really focused on was the need to improve team-based care: so care not just from doctors, but also from practice nurses, from allied health professionals. Because what we know, beyond the pandemic, is that increasingly, Australia's healthcare system is grappling with much more chronic disease, much more complex disease, which requires multidisciplinary care. And our system is not working well to deliver that multidisciplinary care, with health professionals working as teams. And I think you'll see that as a real focus of the Report from the Strengthening Medicare Taskforce.


Also, digital health is not working well, in a connected way. There are lots of different digital health systems at state level, in primary care. They're not well connected, which means your health team that you use as a patient, that you that you work with as a patient, is not seeing the same information. We need to do better on digital health, that really has been an area where there's not been enough progress over the last decade. I don't want to speculate on what the recommendations will be there was a high level of cooperation, a high level of consensus between groups, that don't always see eye to eye, on that Taskforce about the desperate need to rebuild general practice and strengthen Medicare.


JOURNALIST: You set aside $750 million to act on Medicare Taskforce recommendations, GPs and Premiers are saying that's not going to be nearly enough. Do you expect that it will cost a lot more than that?


BUTLER: I've said publicly, and we've talked very frankly about this within the Strengthening Medicare Taskforce, that this is not going to be a simple thing to turn around. This is not going to be something we can fix in one budget. This is going to require a determined long-term effort. I think every stakeholder in the system, patient groups, doctors, groups, nurses, groups, the sort of academic experts we called on, they all agree with that. This is going to require long term determined effort, not just the decisions included in one Budget. And our Government, and certainly I as Health Minister, am committed to doing that.


JOURNALIST: The communique that came out on the 13th of December from the Strengthening Medicare Taskforce said that they expected to deliver this report by the end of 2022. You're now saying it will be out by the end of January. What's causing the delay? Why is it taking so long?


BUTLER: We had a face-to-face meeting that I think you've referred to, with the communique there. There was a high degree of consensus about the areas that the members of the Taskforce wanted to focus on in their report. But we also agreed to continue to work offline, if you like, not face to face, with finalising the terms of the report and that's been happening over the last several weeks.


JOURNALIST: As of this week, subsidised psychology visits has been cut from 20 to 10. A lot of mental health groups are saying this is not good enough. Do you acknowledge that this will have a detrimental emotional and financial impact?


BUTLER: The measure you refer to was a temporary measure introduced at the height of the COVID lockdowns. It was a part of the COVID response package put in place by the former government that was scheduled to come to an end on 31st of December, so several days ago, and we did decide not to extend that. And we did that on the basis of information that that I received through an evaluation of this programme: a programme called Better Access, which provides Medicare support for psychology visits. That evaluation reflected modelling and advice a number of people talked about when this measure was first introduced by the former government, which suggested that this measure would actually make access worse, not better. And that's what the evaluation showed. It showed that as a result of some people receiving additional services, tens of thousands of people went without any support whatsoever.


It also showed that those people who were missing out were overwhelmingly in poorer areas of our cities and rural and regional Australia - communities, which the evaluation said, have much higher levels of mental distress, and therefore actually higher levels of need for this psychology support.


This is a good program: Better Access. I've said that over the many years, I've been involved in mental health, including three years as the Mental Health Minister under the former Gillard Government. But it is also a program that too often operates inequitably and does not provide enough support to those communities I just talked about. The evaluation found that because those communities have difficulty accessing psychological support under this programme, they are much more often medicated by their GPs because they have no alternative therapy. This is something I'm determined to fix. This is something I'm determined to focus on to improve the equity of this programme.


And that's why I've pulled together a range of different groups - obviously including the psychology businesses who are impacted directly by this decision - but a range of other mental health experts, many of whom have expressed support for the decision we took. Because they know that it actually had a negative impact on access to psychology support for too many communities in the country.

JOURNALIST: Last year, there were allegations of over servicing and fraud within Medicare and the government ordered a review. Is that complete?


BUTLER: It's not complete. As I indicated at the time that we appointed Pradeep Philip, who's a former Secretary of the Victorian Department of Health here to conduct that review, I indicated it would be available and delivered to government in the early part of 2023. So it's not complete yet.


Thanks, everyone.


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