Minister for Health and Aged Care - press conference - 12 December 2022

Read the transcript for Minister Butler's press conference in Adelaide on COVID-19 and the Better Access Initiative

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks very much for coming today. I just want to provide an update on the Commonwealth’s COVID measures going forward into 2023. National Cabinet on Friday - the Prime Minister, Premiers and Chief Ministers of the Territories – agreed and published a strategic framework for transitioning COVID-19 measures. That framework reflects the range of principles that were agreed by the National Cabinet back in September to guide the transition particularly of government programs and public health orders out of the emergency phase of the pandemic, which has been wound back over the course of this year. The key priorities and key principles of those documents agreed by the National Cabinet will firstly, protect vulnerable and at risk members of the community, particularly from severe disease and death. Secondly, ensure that our health system and hospital system have the capacity to respond to future waves of COVID. And thirdly, provide effective information and access by the community to vaccines and treatments.


And today, I'm releasing the Government's COVID Health Management Plan for 2023. A Plan that involves the investment of an additional $2.9 billion dollars in special COVID measures over the course of that year. From the first of January, as has been indicated some months ago out of National Cabinet, COVID admissions to Australia's hospitals will be funded in the standard way under the National Health Reform Agreement, which divides or allocates funding for our hospital system between the Commonwealth and State Governments and that was something agreed and announced out of the first National Cabinet meeting after the election of the Albanese Government.


For 2023, however, the Commonwealth will continue and extend the 50/50 funding arrangements for state PCR testing clinics, where states choose to continue those clinics or other PCR testing services, and also for state vaccine administration services as well. The Commonwealth is also extending special Medicare or MBS items for PCR testing in pathology clinics, GP consults for COVID-positive patients and for people who are seeking a prescription for oral antiviral medicines for COVID. We're also extending existing arrangements to ensure that vulnerable groups in particular in the community are protected. They particularly relate to residential aged care, to residential disability care, and First Nations communities. We're also announcing the extension of GP respiratory clinics, the vast bulk of them will continue to operate throughout the remainder of summer, and from the first of March will be put on to a retainer arrangement where that can be agreed so that they're able to scale up in the event of future waves. This Plan strikes the right balance, we're confident, to protect vulnerable Australians, to protect the integrity of our health and hospital system while transitioning safely out of the emergency phase of the pandemic.


Today, I'm also releasing the Independent Evaluation of the Commonwealth’s Better Access for Mental Health program. This program has been operating for more than 15 years now. It is the largest allocation of a particular program in mental health, and it funds through Medicare services by GPs, by psychiatrists and psychology services as well. This is the first comprehensive evaluation of this significant program for more than 10 years and it was received by me on Friday. I considered it over the weekend, and I've decided to release it immediately given how eager the anticipation of this evaluation has been.


Broadly speaking, the evaluation finds that this program is very widely used, and outcomes from the program are largely positive. It also finds that lower income Australians have a much greater need for mental health services in the community: finding that the lowest income Australians have more than twice the levels of high or very high mental distress as the highest income Australians have. The evaluation finds though - and these are the words from the evaluation - that those on lowest incomes are least likely to access services under this program and that all of those indicators have worsened over time. The evaluation finds that the location of provider services - so where particularly psychology clinics set up their operations - contributes to poor access by Australians living and living in rural areas, and also lower socioeconomic areas in our major cities. The evaluation also finds that the poor access for lower income Australians means that they are more likely to be prescribed medication, instead of being referred to a psychology service than the highest income Australians.


Now at the height of the COVID lockdowns, particularly in the eastern states, the former government provided access for 10 additional psychology sessions under Better Access, on top of the existing 10 that have been funded for many years under the MBS. And under the former government's arrangements, those additional 10 sessions were funded to the end of 2022. And the evaluation I’m publishing today considered the impact of those additional 10 sessions and found that they drove a very big increase in the number of services in this sector generally. But it found that those additional 10 aggravated existing waitlists and aggravated barriers to access, particularly by the groups that I've mentioned.


The evaluation found that all of the additional services went to existing patients, and that the number of new patients who are able to get into the system and get access to psychology service actually declined by 7% over the course of that period. It also found that all of the growth - all of the growth – in services went to the highest income Australians, with the lowest income Australians actually receiving fewer services over this period than they had before the introduction of the additional 10. Wait times blew out for everyone over the course of this period. But again, wait times blew out more so for lowest income Australians. On the clinical impact, the additional sessions the evaluation found that those additional services were not particularly targeted to Australians with more complex needs. And although they found that the patients who were able to receive additional services appreciated them, it also found – and I've used their words on this – that “self-reported baseline mental health was almost identical for those who did and did not receive the additional sessions.”

In light of these findings, the additional 10 sessions will come to an end in line with funding arrangements that were put in place by the former government at the end of this year. More broadly, in the new year, I will be bringing together key stakeholders, importantly, including people with lived experience to discuss this evaluation, its conclusions broadly, and the impact going forward. The evaluation reinforces the importance, going forward, of making sure that there is more equitable access to this important program for those groups who the evaluation found have been largely missing out. In early 2023 though, we will be proceeding with two new additions to the Better Access program to expand the involvement by families and carers in those services, which will be particularly important where the patient is a child or a teenager, obviously with their consent, and also to allow more case conferencing between a patient and their different service providers, which will often, for example, be a general practitioner and their psychologist. Apologies for that long preamble, but happy to take questions.


JOURNALIST: So why would you cut the sessions now at a time when people are recovering from the pandemic and also facing economic pain amid sky-high living costs?

BUTLER: Well, the evaluation found that these additional sessions had not had an appreciable clinical impact. As I said, the baseline mental health reported in the evaluation was almost identical between those who have received the additional services and those who had not. Now that's not to say that those patients didn't appreciate the additional services, but there was no finding of actual objective clinical impact. On the other hand, though, what we do know from the evaluations that the additional services aggravated waitlists, aggravated barriers to access particularly for lowest income Australians, who actually saw their access which was already inequitable before the introduction of these services, saw their access to services actually deteriorate over the course of this period. And we're committed to continuing this important program. It's widely used, it largely provides positive outcomes. But the evaluation quite starkly sets out the degree to which this program is highly inequitable across the Australian community, whether you're talking geographical impact, because it finds that rural Australians have a much lower access to these services, or socio-economic impact, which again, it finds that the lowest income Australians had the poorest access to the services in spite of having the highest need.


JOURNALIST: So how quickly will the government be acting to implement the measures for those vulnerable groups that you mentioned?


BUTLER: As I said, early in the year, obviously, I've only received this evaluation on Friday, it runs to about 300 pages. Instead of taking time to mull it over, we've decided to get it out as quickly as we possibly can. We know that those in the sector: lived experience groups, psychologist groups, others, are very keen to consider this evaluation. It's been a long time coming. It's more than a decade since we had an independent evaluation of this program. I know they'll want to consider it over the course of summer. I haven't fixed a date yet. But I'll make this commitment that very early in the new year, I'll be bringing together those groups to have a very frank discussion about what we can do going forward to continue to preserve the benefits of this program because they are significant, but ensure that those benefits more equitably flow through the community.

JOURNALIST: And what happens to those people that still have those additional visits that they haven't accessed yet, will they be extended or are they no longer able to?


BUTLER: People have been approved for the additional 10 sessions before the end of this year, they will continue to be able to access those services early next year.


JOURNALIST: Who are the main beneficiaries from this, and who are currently missing out?


BUTLER: The evaluation sets out quite stark terms. And frankly, it's not dissimilar to the first evaluation of this program back in 2011, which I received when I was Mental Health Minister. Again, back then, more than a decade ago, it showed that these services were disproportionately being accessed by the highest income Australians, lowest income Australians were missing out on these services, in spite of the fact that they have the highest levels of need. This evaluation found that 22% of the lowest income Australians have experienced high or very high levels of mental distress compared to just 9% - which is still a large figure – but less than half the number of the highest income Australians experienced that level of mental distress. Now, it also found that because lowest income Australians weren't able to access these psychology services: they’re services that by and large don't set up in those areas of Australia, they're much more likely to be prescribed medication. They're using antidepressants and other medication much more than highest income Australians - the evaluation finds – because they don't get access to psychology services.

Thanks, everyone.

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