Minister for Health and Aged Care - press conference - 14 March 2024

SOUTH AUSTRALIAN MINISTER FOR HEALTH AND WELLBEING, CHRIS PICTON: Today I'm joined by the Federal Health Minister Mark Butler, and also by some very important people as well behind us. Elizabeth Dabars, who's the Secretary and CEO of the Australian Nursing and Midwifery Federation of South Australia. We’re joined by Cassie, who is one of our nurse practitioners across the state and who works at the QEH. We’re joined by Toni who is a nurse practitioner in the community and also works in the university sector as well and by Therese who is a patient and has been seeing Toni for many years.
 
We know how important it is to make sure that we are getting the full benefit of all our health practitioners right across the state and right across the country. That's why we're really excited today to be announcing a partnership with the Federal Government, in fact I want to thank the Federal Government for their support in providing funding for this initiative to expand some innovative primary care models here in South Australia. Primary care is so important to make sure that people can stay healthy in the community and ultimately don't have to end up in a hospital. We know that primary care has been under strain for a long time, particularly after the 10 years of neglect from the Federal Liberal Government previously that has seen primary care in a real crisis right across the country. We're very appreciative of the steps Minister Butler is making to address that. And one of those steps is to help South Australia with this new pilot of using nurse practitioners in the community, providing those primary care services in GP practices. This is going to help the availability of people to see an experienced trained health practitioner when they need it. Nurse practitioners are the most highly trained of our nurses, they go through extensive training. The pathway to become a nurse practitioner usually takes at least three years. A nurse practitioner comes with immense experience to be able to provide care for patients. For about 20 years we've had nurse practitioners providing care in South Australia, but we're seeing that grow and grow. We want to see that grow and grow more in primary care by working with GPs. This grants program is going to help GP practices to employ additional nurse practitioners across the state. It is going to be services that people will get for free – services provided free with that nurse practitioner.
 
The other element that the Federal Government is helping to support is additional work with Healthdirect. Many people will be familiar with Healthdirect, which is 1800 022 222. This is a phone number that you can call 24 hours a day to get help, support and advice. The problem with that is that a lot of the time when you call Healthdirect with a health problem you'll get the advice saying to go and see a GP within 6-12-24 hours. And, of course for many people that's very difficult to see the GP within that time. The additional funding that the Federal Government is helping us with is enabling us to put in place additional services to Healthdirect, so additional telehealth services and services to help navigate people to care. Because if you just get that advice that says to go see your GP, and then you can't see them, then a lot of those people will go to emergency departments unnecessarily. This has been running for a few months now. We're seeing some early success in terms of helping many people with that program and we're hoping that it is going to lead to more and more success.
 
Ultimately, we know how central primary care is because people need to get that care in the community. It doesn't always mean that people aren’t getting into the GP practice and ultimately drive off to the nearest emergency, but if people don't get primary care and they get sicker, then they've got no choice but to go to the emergency room. That's really what we're trying to work towards avoiding. I'll pass over to Mark and then to the rest of our team to explain the benefits of what we're now seeing and particularly the benefits of nurse practitioners.
 
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks, Chris. It's been a real pleasure to work with Chris Picton and the South Australian Government on some really innovative models that Minister Picton is introducing here in South Australia to deal with what the whole country, indeed the whole world, is facing right now in their health systems. That is health systems that are dealing with a population that is getting older, that is getting a little sicker with more complex chronic disease in the community, and also dealing with the legacy of a once in a century pandemic. On top of that, as Chris said, this country faced 10 years of cuts and neglect from a Federal Liberal Government, particularly cuts to Medicare with a six year long freeze in the Medicare rebate that put enormous financial pressure on primary care and general practice in particular. Here in South Australia Minister Picton is leading some of the most innovative models around the country to first of all, give South Australians Access to care in the community when and where they need it, but also take pressure off hospital systems, which right around the world are dealing with unprecedented pressure because of those population trends that are talked about but also the legacy of this once in a century COVID pandemic.
 
Today, I'm delighted that we're able to announce another chapter in our partnership, the partnership between the Commonwealth and the South Australian Government to deliver better care to the South Australians. In the National Cabinet last year in December, we built on the $100 million Primary Care Pilot we're rolling out today with another $1.2 billion of investment to strengthen Medicare working with state governments like South Australia. And also an historic hospital funding agreement that will deliver South Australia $129 million additional funds just in the first year - additional to what they would have got under the former government's hospital funding agreement. I'm delighted about the level of partnership we've been able to demonstrate to the South Australian community between the two levels of government to deliver better healthcare.
 
Today is a great example of that, as Minister Picton said, nurse practitioners have so much to offer their community, they are one of the most highly trained nursing workforces in the world. When I left the health portfolio last time I was a health minister 11 years ago, there were around 2,000 nurse practitioners around Australia, and I was pretty disappointed to discover when I came back to the portfolio a decade later, there were still only 2,000 nurse practitioners in the whole of Australia. And about 500-600 of them are not even working as nurse practitioners because there aren’t the jobs available. We are determined to change that.
 
We know, and we're going to hear today, just how extraordinary the skills of Australia's nurse practitioners are and the level of care they can give to Australian patients whether it is out in primary care settings like this, in hospitals or in aged care and mental health settings. We are determined to build that workforce. Which is why in the Budget last year, we put in place 1,800 funded scholarships for postgraduate training for nurses to become nurse practitioners or endorsed midwives. This will open up enormous opportunities to build that workforce. But we also know we need to send a very clear message to nurses who are considering that extra couple of years of education, that there's going to be a meaningful career there for them. So, we increased the Medicare rebate that nurse practitioners received by 30 per cent. Next week, when I return to Canberra, I'll be introducing legislation to remove the so-called “collaborative arrangements requirement”. That means that nurse practitioners can only work under the direct supervision of a doctor, effectively having a doctor look over their shoulder when they're delivering care that they're fully qualified to deliver. We'll remove that so that nurse practitioners will be able to work with the autonomy that their qualifications and their experience deserve. We'll also be finishing, as Chris said, the Unleashing the Potential of our Health Workforce – Scope of Practice Review, that we've been leading in partnership with state governments like South Australia, to ensure that all of our health workforce can work to the full extent of their skills, their training and their experience. It simply doesn't make sense when we have almost a million health workers in Australia, half of whom are nurses - about 450,000 nurses - not to have them working all of them to the top of their skills and their experience and their training. We are determined particularly to see nurses have that glass ceiling lifted off which too often hampers their ability to use their extraordinary skills and experience and training to the fullest.
 
Today is a great example of that. We're working with the state government providing funding to ensure that we're demonstrating time and time again just what a nurse practitioner can deliver to their patients but also the primary care practices they're working. It's been a delight to work with the South Australian Government and I’ll hand over to Liz Dabars.
 
ELIZABETH DABARS, AUSTRALIAN NURSING AND MIDWIFERY FOUNDATION SA BRANCH CEO/SECRETARY: Thank you Minister. It's an absolute delight to be here today because we have been advocating for recognition of advanced practice nurse practitioners for a very long time. We're absolutely delighted that both Ministers, both state and federal, have really taken that on board and have taken decisive action. It's been a long discussion; I think the results will ultimately speak for themselves. I really do want to commend both Minister Picton and Minister Butler for their foresight and their fortitude because I'm quite sure that it hasn't been easy from their end of the spectrum to be able to move these initiatives forward. I really do think that this is a fantastic initiative, one that is ultimately going to benefit the South Australian community and I dare say will operate as a model for other jurisdictions both nationally and internationally. It's wonderful to see their sense of innovation, their sense of dedication and appreciation for the valuable role that nurses and advanced nurse practitioners take in this jurisdiction and elsewhere and that it has been recognised. I think that's really important they do recognise that, that they've had the fortitude and foresight to move this proposal forward, and to put it into practice.
 
I think that the real winners in all of this is the South Australian community. They should see a better outcome in terms of accessible, affordable and quality care. All of that really is an absolute win for them as individuals but also for the system as a whole. We know every day of the week that we have problems getting in to see a health practitioner. We know every day of the week we have problems with the hospital system being overcrowded. We think that this is a fantastic initiative to make sure that people can get the help and care they need before their issue turns into a crisis that needs hospital admission. This is a fantastic initiative and an absolute commendation to both Ministers and the partnership approach that they are taking. I would also like to absolutely acknowledge, who will be speaking next, a fantastic nurse practitioner from our state. The work that they do is second to none. Their commitment and dedication to their patients and their client cohorts is absolutely astounding. They really do make a significant and profound difference to the health and wellbeing of our South Australian community. We're delighted that there is this recognition both at a state and federal level and a partnership approach to making sure these initiatives can get up and can get moving. And again, absolute thanks and gratitude to all the nurse practitioners of this state and elsewhere.
 
CASSIE RYAN, NURSE PRACTITIONER: Good morning. My name is Cassie Ryan. I come to you today wearing two hats. I'm currently the acting executive director for integrated care systems in the Department for Health and Wellbeing. Our team have been asked to manage and lead the three elements of the primary care pilot, but I'm also a nurse practitioner currently working in our acute care services. I'm really delighted with all of these pilots. The first element is the nurse practitioner pilots. We are working in partnership with the Adelaide Primary Health Network, and we value their expertise and connections in the Primary Health Network. We have two other elements where we're working with Healthdirect. One of those is providing a GP telehealth service and the other element is for those that require more urgent needs that don't necessarily need an emergency department, they will be redirected through to two of our existing services which is the SA virtual care service and the child and adolescent urgent care service. We've seen great results from those two elements with a high percentage of hospital avoidance keeping people in the community closer to home to receive their high-quality care closer to home. The nurse practitioner pilot Expression of Interest went out last Thursday to nurse practitioners across South Australia and to targeted practices in areas of high need, and practices that we know will help make this pilot a success. Those expressions of interest are closing on the 21st of March. We've already seen great interest and we're really happy about that. We will be starting with four nurse practitioner positions in metro Adelaide with a further two planned for regional areas. We've commenced those sessions with the regional health services and primary care practices in those areas of need. We'll be providing an update about when they over the coming weeks.
 
JOURNALIST: Just before we switch to Therese, are they particularly in the north or south or where are they? Just as a target region to start with?
 
RYAN: Across north and south, 89 practices have been approached to see their interest.
 
JOURNALIST: And the key regional areas?
 
RYAN: We don't know as yet we've just started those conversations about where the needs are but also where there's capacity.
 
JOURNALIST: What is the scope of a nurse practitioner versus a GP so that the average person knows what they're looking for?
 
RYAN: A nurse practitioner can have a varied scope. We have nurse practitioners in palliative care. We have nurse practitioners in heart failure. I'm an emergency nurse practitioner. The scope is really determined by the needs and by the preparation of the nurse practitioner. When I first started, you became endorsed in one specialty field and that was easy. Now we have the ability like doctors to change our scope, to do further study and develop expertise in a variety of scopes.
 
JOURNALIST: But these six, if you're someone in the community and needs to see a doctor and can’t, what things can you go to another practitioner for versus what you should leave to your doctor?
 
RYAN: That'll be decided when we determine who the nurse practitioners are for this pilot. That will be a conversation, but there's nurse practitioners like Toni working in primary care and the delineation between what a nurse practitioner can do and a GP in a medical office can do is often very discreet.
 
JOURNALIST: So, people will know what they can go for?
 
RYAN: Absolutely. I will defer to Toni.
 
TONI O’BRIEN, SENIOR LECTURER UNIVERSITY OF SOUTH AUSTRALIA MENTAL HEALTH AND NURSE PRACTITIONER: My name is Toni O'Brien. I am a senior lecturer at the University of South Australia teaching the mental health nurse practitioner program. At the same time I've been working in primary care for over 10 years. I think this is a great announcement because nurse practitioners are a blend of a caring of a nurse, but we also have a master's level of education, so we can do advanced assessment, we can diagnose, we can prescribe, we can order pathology, we can refer out to other allied health members as well. We can essentially manage the entire episode of patient care from the start of the assessment, management, and after care as well, depending on our specialty area. I’m focused on chronic illness a lot, so I work as a team with everyone in the clinic around me. And team-based care is really evidence based. I will have the experience and knowledge to know who to refer to as well and when things are out of our scope of practice. I think this is a win for nurse practitioners but also for the South Australian community -access to care in a timely manner rather than waiting so long to access healthcare.
 
JOURNALIST: A simple question might be what wouldn't someone come to you for that they would need to go to a GP instead?
 
O’BRIEN: It depends on everybody's specialty. My specialty is in primary care. I deal with chronic illness and basically, I can see every single patient but I know exactly who to refer out to. So, if somebody came to me for palliative care services, I have a knowledge to refer to specialists in this area. We're a bit like navigators for people in healthcare as well. We listen to people and we add something to what they want and we deliver that person centred care.
 
JOURNALIST: So, in the first instance they can come to you for anything?
 
O’BRIEN: Yep.
 
THERESE RUBBERT, PATIENT: Good morning, my name is Therese Rubbert. I’m a patient of Toni’s. I’ve been a patient of Toni’s for about 10 years, I’ve been actually following her around Adelaide for about 10 years to the different places where she’s been. I find her very patient, very helpful, and she has a lot of skills of showing you with your insulin and other various equipment that you need as a diabetic. And yes, I would highly recommend her.
 
JOURNALIST: Can you give us a bit of a range of the things that you've seen her for over the years? Maybe something small, something bigger?
 
RUBBERT: I’ve seen Toni for general things: with dieting to lose some weight for a start, and also when you get new insulin or new medication, or the testing of your sugar levels in the morning, you have little machines for that. Just all things in general. And it’s quite an ongoing thing, a life thing with diabetes.
 
JOURNALIST: And you've never had any worries that you might need to see a GP instead. It's always been that you're happy with this care at this level?
 
RUBBERT: Absolutely. And I think it's a really great idea to have this input from the Ministers, and I congratulate both of you for doing so because I think it is really badly needed. And I hope to see in the future that perhaps there might be some other things coming for other people with ongoing illnesses to help them. And there's a lot of people that have diabetes – a lot of young people that have Type 1 diabetes whereas I'm older and I've got Type 2 diabetes, which is age diabetes. Usually, a lot of children have got Type 1 diabetes and they have a pump inserted and it’s a lot harder for them.
 
JOURNALIST: How would you describe what your care has been like? How would explain how well she's helped you manage all your conditions?
 
RUBBERT: Yeah, it's been managed very well by her. I don't know what I would do with her.
 
JOURNALIST: Therese, have you found it difficult to make appointments?
 
RUBBERT: I’ve found it very difficult to make doctor’s appointments in the past and you've got to wait so long to get in.
 
JOURNALIST: And it's easy to make appointments with the nurse practitioners?
 
RUBBERT: Yes.
 
JOURNALIST: Minister, we just heard the difficulty of trying to get doctor’s appointments, how much will this free up availability for GPs for members of the public to get an appointment shorter than a week and a half, or trying to schedule in when they're going to be sick?
 
PICTON: I think that there's huge scope for nurse practitioners to play a bigger role in primary care and improve access for patients who find it more and more difficult to see a GP. I’m sure Mark will want to talk about the broader things that he’s done in relation to GPs across the board as well. But we think that nurse practitioners, who are incredibly skilled practitioners who go through all of this advanced training and experience, can play more of a role in helping people in primary care. Many people can see a nurse practitioner faster than they otherwise would, they can be on top of their chronic health conditions and ultimately have less chance of the need to go to hospital.
 
The answer to the earlier question of what are some of the things a nurse practitioner can help with, I think one of the biggest things is management of chronic disease. And we know that we have really spiralling incidents of chronic diseases like diabetes in the community. And nurse practitioners can play a pivotal role in helping people to stay on top of those conditions, stay healthier, and ultimately less incidences that they have to go to hospital.
 
The other one that we were just talking about before we started was mental health. Mental health has seen a lot more pressure on our primary care practices as well, and a lot of nurse practitioners have undertaken advanced training in mental health as well. So, we can see the ability for nurse practitioners to be able to step in and provide more assistance in primary care for mental health for people as well.
 
JOURNALIST: Just on that matter. Obviously, when you're putting this out to the community that this is the option now. How would you get the message out clearly to them on what they should be doing in which scenario?
 
PICTON: These are going to be embedded in practices working with GPs as well. And so, the practices will be able to communicate in terms of what to go to people for as well. On the ground with GPs and nurse practitioners and other practice nurses, they generally work together really well. There’s a good understanding in terms of everybody's scope of practice. It’s not complicated for the patient; they'll be able to get readily available access to this help. And we can see from the example just before, a patient who is following a nurse practitioner across town, how much there is a great connection between the patients and the nurse practitioners. And we think that that's going to grow and grow as we see more being delivered on the ground.
 
JOURNALIST: If the pilot goes well, what's the scope to expand this further?
 
PICTON: That might be a question for Mark. But we think that there's huge scope for this to expand further. I think part of that is the workforce. And as Mark said, it was disappointing that we saw a decade with no expansion in the number of nurse practitioners. As we see those federal scholarships come into place and also as we see more career pipelines, both in the public system, but also in the primary care system as well, that’s going to lead to more and more nurse practitioners. And we have some incredibly trained, hardworking, experienced nurses, more of which will be able to become nurse practitioners with efficient training and will be able to deliver even more care.
 
JOURNALIST: In picking those six locations, how would you like to prioritise?
 
PICTION: It is obviously going to go through a proper tender and assessment process between the departments and the Primary Healthcare Network as well. But we've been very clear that we're targeting areas where there's high need. I think that we know that there's particular areas both in regional South Australia and also in the northern and southern suburbs, where it is really difficult to get access to primary care and GPs. And so obviously they're the first places that are looking in terms of deploying these additional resources.
 
JOURNALIST: You mentioned regional South Australia, there's been quite a few clinic closures and services close. Do you think these two nurse practitioners are going to be enough? Do we need to invest more in the region?
 
PICTON: Certainly there's a lot more that needs to happen. I mean, one of the very exciting things as well that the Federal Government announced a few months ago, and Mark might elaborate on, is South Australia has been successful in winning a new Flinders University Regional Medical School. So, this is going to be training that is going to happen for doctors based entirely in regional South Australia. Not just doing a stint of their degree in regional South Australia, but the entirety of their degree. That's more doctor places that we're getting in South Australia and ultimately, we need to increase that supply. And that's going to help. But also having a regional focus on that to help address the regional doctor issues.
 
Then after that, we're doing more and more in terms of training doctors in regional hospitals working with regional primary care as well. And we're currently working with the Federal Government in negotiations of expanding what's called a “single employer model.” So, we can hire those doctors, they work for SA Health in their training, and then they can work in hospitals and GP practices to become real specialists. And that is showing a lot of promise already in the Riverlands where we’ve seen that running for the past two years. We think that expanding that across the regions is going to have a big help.
 
JOURNALIST: Will there be incentives for the regional health practitioners?
 
PICTON: Obviously, the whole element has been funded through this program. So there certainly are incentives in the fact that through the Federal Government it has been paid for. So, we're confident that we will be able to achieve success here in terms of getting these nurse practitioners out on the ground. And I think that by demonstrating their success, by getting them happening, that will lead to more and more, and obviously we hope that that's going to lead to a national expansion of these sorts of programs.
 
BUTLER: As Chris said, we've been working terrifically well together to try and make it more attractive for young doctors and nurses to train in rural and regional Australia because we know if they train there, they're more likely to build a life and build a career there as well. One of the things that we're doing - we passed legislation last year to implement this at a Commonwealth level - is we have a program effectively to pay the university debt for doctors and nurse practitioners who will do that additional training at university, provided they go and work in a regional community as well.
 
We feel the need to build a suite of measures that build the nurse practitioner workforce, first of all, from 2000, because 2000 out of 450,000 is just not a big enough workforce for nurse practitioners. Going back to that scholarships program we funded in last year's Budget, an additional 1,800 scholarships for young nurses and young midwives who want to take that next step and get additional qualifications to become nurse practitioners and endorsed midwives. We've got rural incentives in place, and we want to send them a very clear signal that there's a meaningful career out there. So, you can become a nurse practitioner in primary care with increased Medicare rebates - a 30 per cent increase in their Medicare rebates kicks off on the 1st of July - you can work autonomously with the removal of those collaborative arrangements. You’re working to the full extent of your scope and there is a manner of exciting careers in acute care. You'll see a lot of nurse practitioners playing really critical roles in public hospitals in South Australia as well.
 
JOURNALIST: Metro doctors are also obviously talking about increase to the rebate, is that going to be part of the suite of measures as well?
 
BUTLER: We put about $6 billion into strengthening Medicare in our Budget last year, the biggest part of which was to triple the bulk billing incentives for general practice. That's a very substantial increase in the income of general practitioners who are bulk billing pensioners, concession cardholders and children under the age of 16. What we found when that came into effect on the first of November last year, not only did it stop the very steep sliding bulk billing rates that we inherited when we came to government, but it's actually turned it around in a number of communities as well. In addition to that the increase across the board to the Medicare rebate last year because of our additional funding was the largest increase in the Medicare rebate in more than 30 years since Paul Keating was Prime Minister.
 
We recognise we need to pump more money into the primary care system after a decade of cuts and neglect. But we also need to think creatively about regearing the Medicare system to be one that responds to the needs of patients today. Which as Therese said, is really about ongoing chronic conditions. It's not the episodic care that was the bread and butter of primary care back in the 1980s when Bob Hawke and Neal Blewett were building it. We need to inject more funds into it, but we also need to regear the system to respond to the needs of patients who have ongoing complex chronic conditions.
 
JOURNALIST: A report from last year found that there was a huge lack of investment in rural mental health. And South Australia has the lowest number of psychiatrists per person. Do the state and federal governments need to work together on this to fix this?
 
BUTLER: There are workforce challenges right through the healthcare system. There's no doubt about that and the further and further away you get from the General Post Office or the GPO of every major city, the worse it is. Mental health is a challenge and it is a challenge in a whole range of other areas of the health sector as well. This is why so much of the work that we do together as states and the Commonwealth is focused on building that workforce. There is a shortage of psychiatrists out in regional Australia. There is no question of that. When we came to government we were determined to make sure that telehealth opportunities which, frankly, we introduced more than a decade ago as Minister Picton will recall -   telehealth opportunities which had been defunded by the former government - were put back in place so that psychiatrists if they weren't out in the community, at least could undertake telehealth consultations with rural patients, not just here in South Australia, but right around the country. So, putting in place a 50% bulk billing loading for that has lifted the ability for people to get high quality telehealth appointments with psychiatrists. But there is no question that of the specialties in medical practice, GPs are probably the most significant shortfall that we find. Psychiatrists are a very significant area of focus for Minister Picton, his colleagues of state and territory level, and the Commonwealth as well.
 
JOURNALIST: Flu cases are starting to pick up now. I understand pharmacies have immunisations, when will GPs get them?
 
BUTLER: We're in a position now - Chris might want to talk about his preparations here in South Australia – but we're in the period now where we're building for the flu vaccination season. You’re right, flu cases are on the rise. I’m not sure about the experience here in South Australia, but RSV cases are particularly an issue for very, very young infants and babies, and they are on the rise around the country. We're in the process now of finalising our flu campaign. I have been worried and I'm sure Minister Picton is as well that we've seen a decline in flu vaccination rates, particularly for under five-year-olds over the last couple of years. I can't stress enough to parents that not only is flu particularly dangerous for older Australians, it's also a dangerous illness for babies and infants under the age of five. So, parents of children under that age I encourage you as we move into flu season to think carefully about vaccinating your child for flu. We introduced a new program: the National Immunisation Program for pharmacists on the first of January. This gives them a very wide range and that will, particularly for over 65-year-olds, give a whole lot of convenience to them to get that flu shot as they become available. We'll have more to say about that next couple of weeks and Chris might have something to say about South Australia.
 
PICTON: We take public health advice in terms of the rollout of that vaccine to GPs and pharmacies through the National Immunisation Program. And as Mark said, there'll be more to say in the next couple of weeks, but it's about timing that to make sure that it's going to have the best possible impact in terms of when the expected spike of flu cases will be. But the message is very clear for people to make sure they roll up their sleeves and get vaccinated, whether it's somebody who's eligible for one of those key priority group programs for many people through their workplaces etcetera as well. But you're going to have more convenience to do that this year through pharmacies than has otherwise been the case through the National Immunisation Program. And we're going to be particularly targeting a lot of our campaigns and work here in South Australia to try to target parents to make sure that those young kids are vaccinated. Because we know that while we are really pleased with the rates that we're seeing comparatively to other states and South Australia - South Australia did really well last year compared to other states - but we are worried about some of that decline that we've seen in terms of the zero-to-five-year-olds in particular. So, we'll be targeting specific campaigns and parents to make sure that they can get their kids vaccinated.
 
JOURNALIST: Because it’s so prevalent, there's been some suggestion that perhaps we should have them twice a year, just to make sure we're getting enough coverage.
 
BUTLER: I haven’t heard that suggestion. Certainly not any advice that I've received, I don’t know whether Chris has received any such advice. As Chris says we have a very well-established system in place to provide government with advice about the immunisation program, particularly through the National Immunisation Program for priority groups funded by the Commonwealth and delivered through states and we monitor that advice and reflect very closely.
 
JOURNALIST: WA is introducing RSV vaccine for babies and eight-month-olds from April. Should SA be getting this, why aren’t we getting this?
 
BUTLER: I’ll see if Chris wants to respond from a South Australian point of view. I will just come back again to the very long-standing position of our National Immunisation Program that reflects a very careful analysis of the clinical and cost effectiveness of different vaccines for different groups in the community. There is not currently advice at a federal level that the National Immunisation Program should be extended to RSV for that cohort. I'm aware obviously of what the WA Government has decided to do effectively off its own back. Our medicines and vaccines experts monitor all of this very, very closely. If we were to receive advice to change the National Immunisation Program guidelines in relation to RSV obviously of course we'll follow.
 
PICTON: Similarly to Mark, no we don't have public health advice suggesting that we go down that path. Our clear intention is to work with the Federal Government who lead this program across the country and work with the leading experts in terms of vaccination. Obviously, I think those experts will continue to monitor the efficiency and effectiveness and efficacy in terms of other vaccines, but that's not something that we have advice to do at this stage.