Minister for Health and Aged Care - press conference - 2 May 2024

Read the transcript of Minister Butler's press conference on transforming health and medical research in Australia; vaping.

The Hon Mark Butler MP
Minister for Health and Aged Care

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PROFESSOR KATHRYN NORTH AC: My name is Professor Kathryn North, I’m the Director of the Murdoch Children’s Research Institute. I’ve been with the Institute for the past 11 years. Before we begin, I’d like to acknowledge the traditional owners of the lands on which we live in today: the Wurundjeri people of the Kulin nation, and I pay my respects to Elders past and present.
One in 10 children have a food allergy, and that's posing a large and growing burden on families. We're not proud to say that Melbourne is the allergy capital of the world. This is not a statistic that anyone wants to boast about but it's at the forefront of a lot of our work because it's a major problem, particularly with risks of anaphylaxis or shock when exposed to the foods like peanut and egg. At the Murdoch Children's Research Institute, we are the headquarters for a Federal Government funded national allergy centre of excellence and an NHMRC funded Centre for Food Allergy Research, which is one of the 10 NHMRC Centres for Research Excellence, that's housed here at MCRI. Dr Kirsten Perrett is here today and is directing both of these world leading allergy centre centres. This year, the National Australian Centre of Excellence in Allergy Research, established a Clinical Trials Network to fast track the startup of allergy trials across Australia, and giving families greater access to prevention and treatment options. Here at MCRI we're currently running 10 early interventional treatment clinical trials for allergies, with sites in Victoria and around Australia. We’re going to hear about two of those from Professor Mimi Tang, the Head of our Translational Allergy Group.

Clinical trials are incredibly important., They're not just research,. They're how we get the latest and the best therapies into clinical practice based on evidence. In our Melbourne Children's Clinical Trial Centre we are currently running over 390 trials focused on children. Spanning a whole range of disorders from allergy, cancer, autism and other neurodevelopmental disorders, ranging from preventative trials to genetic and advanced therapies. We're really looking forward to the Minister's announcement. Minister Butler has been a long-standing supporter for health and medical research sector and has a really wonderful understanding of the importance of the intersection between health and medical research. Minister Butler was very involved in the national sector review of health and medical research through the McKeon Review, and that subsequently led to the establishment of the Medical Research Future Fund, which we will be eternally grateful. As Director of the Murdoch and past president of the Australian Association of Medical Research Institutes, I'm so excited for the potential of our health and medical research sector, feeding a pipeline of world leading clinical trials to improve the lives of all Australians, especially our kids. Over to you Minister Butler.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thank you, Kathryn, for hosting us this morning, and to Mimi for showing us a bit about the extraordinary clinical trials and work that you and your team are doing here at Murdoch, particularly around food allergies. We're going to hear more about that in a second. I've got a series of exciting health medical research and clinical trials announcements to make today, but as we're in really one of the world's leading paediatric research institutes, I did want to reflect a bit on where we sit right now as a country in health and medical research.
It's almost 90 years since the Australian Government in around 1936 decided to establish the National Health and Medical Research Council and Billy Hughes, who was the Health Minister at the time did that with two major goals. One, was to improve clinical practice. He had what we now call translation, very much in the front of his mind. But the second, which was such a lofty ambition in the 1930s was for Australia to punch above its weight in health and medical research, which was really gaining momentum across the globe and an extraordinarily lofty ambition for a relatively small country, at the end of the world, still very much controlled by Britain in the 1930s. Now, almost 90 years on, although Australia does not rank in the top 50 nations of the world by population, we rank at about number seven in health medical research. That's a reflection of the extraordinary work that researchers at our universities, in our hospitals and in institutes like the Murdoch have been doing in the decades since Billy Hughes made that announcement. Health and medical researchers in my experience in Australia, are never content to rest on their laurels. They're constantly wanting to continue to push the envelope and today's announcement of a package of around $1.9 billion in initiatives that will be contained in the Budget the week after next, will assist health medical researchers in Australia to do exactly that.
Firstly, I want to announce $1.4 billion in funding for the Medical Research Future Fund (MRFF). $1.1 billion of that will be used to extend existing Missions, which right now are already underpinning extraordinary research right across Australia, but $300 million dollars will be redirected to two new Missions. $150 million will be directed to a new Mission for the MRFF around low survival cancers. Although, we have some of the best cancer survival rates in the world, that is not true of all tumour types. There are very common cancers which have survival rates of still well under 50 per cent, which is the definition of a low survival cancer cancers like lung, liver, and pancreatic cancer. These will be the focus of this Mission, along with a range of rare cancers that because of their small scale have also been unable to achieve the improvements we've seen in a range of other cancer types.
The second Mission will be about reducing health inequalities. Largely because, I think, of Medicare - Australia's most important social program - Australia's health system  consistently ranks as number one in the world for health equality. Because we know, in this country, it doesn't matter what your bank balance is or what your credit card says, you are entitled to get free treatment from public hospitals, no matter what your means. But we're not, again, willing to rest on our laurels here. $150 million will be available in a Mission to explore and target ways of reducing inequalities for people like First Nations Australians, culturally and linguistically diverse Australians and LGBTQIA+ plus Australians as well. A very important new Mission.
I'm also delighted to announce $411 million in new Investigator grants through the NHMRC Investigator Grant scheme, for 229 of Australia's leading researchers. These are researchers at the early career, the mid-career, and I think what we politely call the established career phase of their time doing health and medical research. This is only the second year in which this very long-standing grants program will be awarding more than half of its grants to women researchers, and that's a terrific testimony to the work the NHMRC has been doing over the last several years to improve gender equality in our health and medical research sector.
I'm also delighted to announce $54 million in new grants for three really important focus areas. The first is in women's health, and these grants will focus in particular on improving our understanding of the treatment of menopause, and also various aspects of reproductive health. As well as women's health, these grants will focus on novel treatments for chronic pain, and also novel treatments for alcohol and other drug addictions. This new $54 million grant scheme that will be contained in the Budget the week after next will be a really important way to lift out capability in these three important areas.
We're here particularly to talk about clinical trials, and I'm delighted to announce $62 million in new initiatives to support 26 cutting edge clinical trials here across Australia, the type of which we'll hear about from Professor Tang very shortly. But when I talk about clinical trials, I am really delighted today to announce that the government will be investing $19 million in this year's Budget to further the work that Ian Chubb has led to create a One Stop Shop for clinical trials in Australia. And I can't overemphasise the importance of this.
There are great things about being a Federation. Those mere mortals who live in Adelaide will watch, with some amusement, that creative tension between Sydney and Melbourne that we have in a federal state. And it really does lead to some really exciting discoveries. But there are also some great inefficiencies. And these inefficiencies are well understood over the course of our nation's history, whether it's railway gauges or licensing schemes and so much else that really hold back businesses, researchers, universities and the like. And clinical trials have been exactly that problem. To do a multi-jurisdiction clinical trial in this country - for many, many years - industry, researchers, universities have complained about the need to get approvals in every single jurisdiction. The inefficiency that that involves, it really does lead a whole lot of people to wonder whether it's worth doing a clinical trial here in Australia.
I've been associated with this challenge for some time. I chaired an action group not last decade, but the decade before last, whose number one recommendation was to create a single One Stop Shop for clinical trial approvals in this country. And we've waited a long, long time for that work to come to some level of fruition. Professor Chubb is going to talk a bit about that, because he has been able to square that circle in a way that has eluded many, many others over the last couple of decades. In particular, that means getting all of the states to sign on to this, which is not always an easy task. I'm delighted that Professor Chubb will be able to talk about this, but we're backing it in with $19 million of investment this year's Budget.
Last, but not least, can I talk about how we intend to bring all this together. The health and medical research sector, through AAMRI largely, the Association of Australian Medical Research Institutes - which Kathryn was the former chair of, and now Liz Hartland chairs - published a paper in 2021, called “Australia's Missing Link”, which pointed to the lack of a National Health and Medical Research Strategy. And I really appreciate the feedback that I had, both in opposition and since coming to government, about the work that such a strategy would do. We've been talking about ways in which we can better align the work of the MRFF and the NHMRC, we're still considering that work. But I'm really pleased to announce today that the Government has decided to really accept the advice of AAMRI and many, many others, to develop a single National Health and Medical Research Strategy for Australia. We want that to be in place by next year, and we're looking forward over the coming weeks and months to engaging  with the sector about the way in which we will develop that strategy, the way in which we'll engage obviously, with the sector around its terms of preference and its leadership. I think it's a really important signal, at a time where we are investing more money into health and medical research, that as a country, we want to make sure that money is invested in absolutely the right directions. Now, I'm going to hand over to Professor Chubb and thank him for his extraordinary work, and I'm happy after we finish with the presentations to take some questions. Thank you.
EMERITUS PROFESSOR IAN CHUBB AC: Thank you, Minister. Thank you, Kathryn, for providing this opportunity today. I've got some notes, because otherwise, I'll still be here at three o'clock telling you why this is important, and many of you know that. Thank you, Minister for your commitment to health and medical research, and particularly your continuous support for clinical trials and the translation of some of that research into better practice and better treatment options for patients. I have read your report, the pages were slightly yellow, it was that long ago that was written, but we're getting onto it now. You could well ask while I’m here, well, you've got a hidden item here, but there is one thing that I do want to say before I tell you a bit about what we've been doing, and that is that I was a beneficiary of Australian clinician researchers who did see the value in knowledge driven improvement treatment options that offer better outcomes for patients. I was one of those patients, I was diagnosed with renal cell carcinoma. It was thought to be stage one, so we were all relaxed. A little while later, an oncologist said we'll get a CT scan, and we discovered four in the lungs, so it was stage four. At that time, I was essentially symptom free, but surprised that the fact that my body was doing this to me. My prognosis was three to five months, standard chemotherapy was carefully explained to me. Then he did something that I did not expect, he said to me, “Ian, have you ever considered a clinical trial?” I had not. I wouldn't have known where to look. And that irritated me because in my early academic life when I had what some people describe as a proper job, I was actually in a medical school embedded in a hospital. We used to have lunch every day with clinicians, we talked about clinical trials quite frequently, sometimes other interesting stuff too but clinical trials quite regularly because they were deeply involved in that area. We talked about the benefits the recruitment of cohorts, and the ethics of it, because if this is not done ethically, it shouldn't be done at all. The outcomes and of course, the funding. I was later admitted to an immuno-therapy-based trial, and by that stage, I was in pretty poor shape. The symptoms were pretty profound, I was getting pleural effusions on large scale, two and a half litres at a time drained out, not very pleasant. At the end of the trial, they told me that they didn't think I'd make it, that I was too advanced, and I was pretty sick. But I responded very well. So well, eight years later, I'm still here. I am here, and I am real, and eternally grateful for the fact that that oncologist looked at me and he said, have you ever considered a clinical trial? But I've played a prominent part in it too, with the clinician, who did ask me that question, and they don't all do that. I was assigned to the experimental arm, I could have been assigned to the chemo arm. I was retired, as I still am, but I could go to Sydney. I live in Canberra, and I had to go to Sydney for a couple of days, every three weeks for two years. I was in a position to be able to do that, and there was a lot more luck involved, which I can tell you about a three o'clock if we are still here.
When I was asked whether I would get involved in policy reform specifically, with respect to clinical trials, I didn't hesitate for a second. I had skin in the game. I was lucky. I was able to get access to a clinical trial.I walked out of that trial, under a headline in a newspaper, with a journalist having to ring me up Monday when I was getting my infusion. He said, “You got a minute?” I said, I've got two hours, sitting in this chair for two hours getting an infusion. He asked me why I told him I published an article saying Ian’s cured. No clinician would ever accept that I was cured under those circumstances. Eight years on, I still see that the guy in Sydney who treated me, He's more inclined to use cured in a soft, almost aside than it would have been in those days. We've been going now for about three years. I was appointed to an Advisory Committee that would go and consult with the Minister, and the Ministers' colleagues in jurisdictions. We produced a pretty extensive report. About 1,600 people were consulted face-to-face and sometimes through surveys, and the like. During that consultation with all those people from every possible angle you can imagine, we got a lot of views, a lot of useful insights were put to us, but I don't recall anybody, there probably was one, but I don't recall anybody saying that we couldn't make a good system better.
I'd like to emphasise that when looking at making a system better, it's not saying that what we do is not very good, because there are ample examples of how it is good, but how can we make it better? How can we make it more cohesive? How can we make it more accessible? You don't have to be retired and be able to take two days every three weeks to get a facility to get your treatment, tele trials are a part of this. All of that sort of stuff builds into what people in Australia actually want, more options, more accessibility and more trials.
The rest of the world is getting its act together, the federations like the European Union, have set goals that are far in excess of ours in terms of relative ease of starting clinical trials, and getting patients recruited into across that Federation, which is at least as complicated as ours. Trials of all sorts, sponsored trials, investigator led trials, large ones, small ones, personalised ones, basket ones, all of the ones that we now know that we can do better because we know more about individual. It's not just about treating to the average, it's not just about saying well you're 100 kilograms, or 65 kilograms, you take a pill, It's actually treating the individual much more specifically and sensitively.
All of that becomes part of what we need to do here. We need to do in Australia in a way that is cohesive and brings all of us together. The report was accepted by all health ministers late last year. As a consequence, the government established the inter-governmental policy reform group, which I Chair and which is really why I’m here. I wanted to tell you why I actually bothered to turn off Netflix and actually doing some work, that I think is a benefit, and then from which I have a particular experience, but also a range of views that enable us to make a good system better. Each jurisdiction is represented on that panel along with agencies that the OGTR, NHMRC, TGA. We've met twice, and one of the really good things of that was that since we passed through the consultation stage, and we started talking about, okay, we've done that everybody wants change, now we're going to change, we all cohered remarkably well. Two meetings so far, have been very good. I did promise them post-Budget, I didn't know what the outcome would be until today. I knew something was happening, or I wouldn't be here, but I didn't know exactly what it was on. I promised them a bottle of champagne and 12 straws. We'll do that at our next meeting because we do have something to celebrate. We do actually, now have rubber on the road, we do actually have a job that requires us to do what we need to do for the benefit of everybody. After the Minister's announcement, our next phase begins, we'll be working with all the jurisdictions, we will develop a process that will make health and medical research more easily translated to treatment options, we will provide a mechanism by which individuals, so me in an earlier stage, could go somewhere and find out whether or not there are trials, trialling treatments for whatever condition I had, that would enable me to go to my primary carer and say, have you thought about referring me to a trial, which is, which is an important part of the healthcare system, not just being told what to do by somebody in a white coat. But actually going in and having a conversation, to getting the information that you need to ask the right questions, is an important part of what will come out of, what we are presently calling a One Stop Shop, and the National Front door, we will probably think of better names at some point in the future. But that's the one we have at the moment. So we're doing that, with full regard to ethics. As I said, ethics are critical to this. But to access wherever Australians live. It shouldn't be limited to people who have access to a major treatment centre. By definition, we should be exploring all of the options that allow anybody, anywhere in the country, who has a particular condition to get some form of access. I know that's not going to be 100%, I'm not arguing that it should be 100%, but it could be better than it is.
After I went through the initial immune reaction, the first two infusions, the National Gallery had an exhibition on 100 objects and civilisation. I got to number 22, and couldn't walk, I had to sit down because of all my systems were draining the energy into other better places. But after that, I could drive up to Sydney, see the oncologist, do a blood test, do a CT, get an infusion and drive back again. And then it was possible for me, but it shouldn't require that level of possibility to be able to get access, we'll be looking seriously at that. We'll be looking to make sure that patients are looked after but also researchers and the institutions that support those researchers. So that they're not locked up in bureaucratic processes, only some of which have value. There has been a tendency in Australia to add bureaucracy to a process, to make us all think it's better because of that. It's not always, sometimes it is, sometimes it's essential, but not always. We'll be looking at that too, as part of the overall reform process. So colleagues, soMinister, there's a lot for us to do, but I want to assure you that we're going to do everything we can to get the job done. thank you for your support.
PROFESSOR MIMI TANG: Thank you. I'm going to introduce myself. I’m  Mimi Tang, Director of Allergy Research Translation at the Murdoch Children's Research Institute, I also lead the Allergy Immunology Research Group here. Our group focuses on food allergy, and we have a number of streams of work, one of which is clinical trials. I'm very excited actually, to be able to share with you some of the work that we're doing, and hopefully that will support also, the Federal Government's announcement today.
Food Allergy, as Kathryn North has nicely described is a growing public health problem affecting one in 10 babies and 120 children. The issue right now is that there are no curative solutions. Patients are forced to manage their condition through avoiding the allergen, and unfortunately, this inevitably fails. Reactions to accidental exposures are common, and patients live with this constant fear, anxiety and psychological distress. Altogether this leads to a very severe reduction in quality of life, equivalent to a child living with diabetes. Now, there are a number of treatments starting that have emerged globally. These treatments do not address the underlying allergen, they induce something called desensitisation, which means that they increase the amount of the allergen a child can eat before they have a reaction. This gives protection against accidental exposure to small amounts of the allergen. But drawbacks include having to stay on maintenance dosing indefinitely, the need to still avoid your allergens. That burden isn't removed, and no surprise then that there's no improvement in quality of life.
I'm very proud of our research team here at the Murdoch Children's Research Institute. We've spent the last two decades developing treatments that can induce remission of food allergy. Our focus areas have been in peanut allergy in the first instance, and also egg, and milk allergy. We've been fortunate to run several trials now, randomised trials, all of which I'm happy to say we're funded by Federal Government, National Health Medical Research Council grants. These studies have shown that our novel treatments can induce remission of allergy somewhere in somewhere between half and three quarters of treated patients. More importantly, our treatments are the only ones in development that have led to improved quality of life.
Recently, we were fortunate to receive two research grants from the National Health Medical Research Council. The first will help us examine the long-term risks and benefits of our treatments compared to current standard care, that is allergen avoidance. Now, this piece of work is actually very important, because the available therapies, the desensitisation therapies that are referenced earlier, they have caused a lot of controversy in the field. Experts and regulatory bodies alike, unsure whether it actually offers greater benefit than allergen avoidance. What we want to do with our treatments, is to demonstrate comprehensively and clearly that taking these treatments, achieving remission does actually translate to health and economic benefits compared to standard care avoidance in the longer term, and in the real world.
The second grant that we received will allow us to run a new trial, we're going to compare our two novel peanut oral immunotherapy approaches against an available low dose approach that induces desensitisation. This is very exciting for us. I'm pleased to hear about the One Stop Shop, because the two biggest barriers to a successful trial are recruitment, and then also setting up a high-quality process and ensuring quality execution. It's clear to me that the One Stop Shop solution will actually benefit researchers and patients alike. It will certainly reduce the burden on the research teams in setting up these trials, and also hopefully improve access for patients to trials that are available. I would like to thank the Health Minister, I'm very pleased to hear about the new funding for clinical trials. I believe firmly that this is a giant step forward for researchers as well as families alike will be able to run our trials more efficiently and ultimately then patients will have faster access to effective therapies.
Now, we're very lucky today because we have one of the families that has benefited from our clinical trials, Chloe's here with her mum, Debbie Sevels. I'm sure that they're very happy to take questions. Chloe was diagnosed with peanut and egg allergy at the age of 10 months having suffered an anaphylaxis reaction. Shortly after, I was pleased to have Chloe participate in our first peanut immunotherapy trial, and then Chloe progressed and decided she'd like to do it again, with our egg allergy trial. Having gone through both of those, Chloe is actually in remission from both her egg and peanut allergy. She's able to eat both egg and peanut freely in her diet. I’ll pass now to Chloe, and Debbie to take some questions.
JOURNALIST: How scary was it the first time Chloe had a reaction?
DEBBIE SEVELS, MOTHER: Very scary, I think we knew what was happening, that it was a food allergy reaction. We went straight to emergency as a result, and then navigated the path after which is now seeing a specialist and wondering what life will be like, with a child with an allergy that can result in an anaphylactic reaction.
JOURNALIST: Obviously at 10 months old, was it a lot of looking to the future? Like what primary school is going to be like, what’s high school going to be like? Can you talk me through some of those fears as a mum that you have?
DEBBIE: Yeah, absolutely. Having a baby and going through solids and food introductions that introduces a lot of anxiety, social settings where you're sitting and eating with family and friends. How to navigate that, do you speak to family and tell them all upfront that this is what Chloe has? And can you help to manage that. Then of course, school and parties and things like that it brings along a lot of that fear and anxiety that Mimi talked about, and that certainly does affect your quality of life for everyone in the family.
JOURNALIST: How did you find out about the clinical trial?
DEBBIE: To be honest, I can't remember, I think a colleague of mine actually did some Google searching and found that  it was running here at the Murdoch and contacted the team and started screening. I think we've been coming here since Chloe was about two years old,  the staff has got to know us as a family since she was little, and now to be standing here and be able to say that Chloe can eat peanuts and egg is something we hadn't ever really thought about when she was diagnosed, absolutely not at all.
JOURNALIST: We've heard Ian talk about it as well, making sure that people know that the clinical trials are out there. Is that something that you'd like to see improve as well, just general knowledge, so parents like yourself, when they're put in that position, can quickly know I can look at these options?
DEBBIE: Absolutely. I think when Chloe was diagnosed, there was no mention at all of trials or treatment, it was a case of avoid and manage and that was it. It does leave you as a parent thinking surely there's something else we can do to manage this condition that can result in an anaphylactic reaction. Having that access available to parents and patients with other conditions is crucial to open up that knowledge, for people to know that there is this option,and not limited just to certain doctors.
JOURNALIST: Chloe, are you eating peanuts and eggs now? Can you  tell me I guess before you couldn't eat peanuts or eggs, how does it feel now being able to go out and know that you can eat it safely?
CHLOE SEVELS: I’m hoping I can eat more food now, and I don’t need to ask all the time what it contains.
JOURNALIST: What's your favourite egg dish or peanut dish?
CHLOE: I don't really have a favourite peanut dish.
JOURNALIST: Are parties more fun now?
JOURNALIST: Thank you, thanks Chloe.

JOURNALIST: How would this increase in hospital funding be paid for? Will there be other cuts to different parts of the portfolio?

BUTLER: The increase in the hospital funding that was reported in The Australian this morning was made quite clear, out of the National Cabinet meeting that the Prime Minister had with premiers and chief ministers in December. This pulled together a range of shared opportunities and challenges between states and the Commonwealth. It gave states certainty around GST arrangements - the “no worse off” guarantees for coming years. It also talked about the importance of making sure the NDIS was put on sustainable footings over the coming years. Again, a shared opportunity and responsibility between states and the Commonwealth. And really importantly, from a healthcare perspective, it had this landmark commitment from a Commonwealth to put in at least an additional $13 billion over the course of the next five years additional to what the states otherwise would have expected to receive.

We've been working so hard with our state colleagues to relieve the pressure that is there, right across the federation, on hospital systems. Whether that's by opening 58 Urgent Care Clinics, the $1.2 billion Strengthening Medicare package that was also announced by the Prime Minister at the same National Cabinet meeting. We'll have more to say about that arising out of the Budget in the next couple of weeks. And then as I said, this landmark hospital funding deal that the Prime Minister committed to in December.

JOURNALIST: So, will the amount of Commonwealth hospital funding provided to the states in the next financial year be more than double the previous 6.5 per cent cap?

BUTLER: The commitment that was made by the Prime Minister is for the next five-year funding deal, which starts in 2025/26. those new arrangements won't kick in until the 1st of July 2025. We made it clear that we would have a growth premium in that first year so that the growth cap would be very substantially increased to take account of the fact that there is quite a quite a deal of pent-up pressure in hospital systems, not just across Australia, frankly, but right across the world as a result of the legacy of the COVID pandemic. All of these details have been public since the National Cabinet meeting in December. The final agreement is still subject to negotiations between states, territories and the Commonwealth. I had a meeting with my health minister colleagues about that a week before last. Officials from all levels of government have been working very hard to try and strike that deal before the 30th of June, which was the timeframe that was set for health ministers and health department leads by the National cabinet in December.

JOURNALIST: Is it accurate report the figure will be about $4 billion in 2025/26?

BUTLER: The figures have been out there since the National Cabinet meeting, we said that the growth cap would be lifted. Now, not every state will necessarily get to that growth cap. That will depend significantly on the level of activity and in particular state hospital systems. That's a matter of really for the states. While the Commonwealth has said though, is that we will kick in our share of hospital funding up to a much-increased growth cap in 2025/26. That's our offer. We haven't yet got a final deal with states and territories. We're working hard to achieve that. it was a very significant offer. I really emphasise this was a landmark offer that the Prime Minister made to the states in December as part of a broader deal to really pull together a whole range of shared opportunities and challenges the government shared.

JOURNALIST: Will funding cap at 8 per cent for the remaining four years of the decade starting 2026/27?

BUTLER: As I said, that was the offer made to states out of the December National Cabinet meeting. It's been public for some time, it's now the subject of negotiations. We don't have a final agreement yet, but that was the Commonwealth position that we put on the table.

JOURNALIST: On domestic violence, the funding announced yesterday will be welcomed by many, but there's some criticism that there wasn't more for frontline services. Is that something that you're going to look at in the immediate future?

BUTLER: This is really a matter for Social Services Minister Amanda Rishworth. I know she's been out a lot over the last couple of days, providing a sense of the government's intentions in this area, particularly the payment that was announced from the National Cabinet meeting yesterday. A payment of almost a billion dollars to assist women and their children who are required to flee a violent partner. It's obviously one aspect of the range of supports that those women and their children need from our government and from other governments as well. I'll leave other announcements to be made by the Minister.

JOURNALIST: Are you happy with it?

BUTLER: This was a very significant announcement by the National Cabinet yesterday. It is obviously one part of a range of things that need to happen to stop women being killed by their partners. This is a horrific circumstance that I think all Australians are just so deeply worried about, obviously, women, most importantly, but also the overwhelming majority of men who love their mothers and their wives and their partners and their daughters, and they want them all to feel safe and to enjoy the sense that they can go about their lives safely, and the safety of their children. What you saw for National Cabinet yesterday was a shared commitment from all governments, not just to increase one particular type of payment, as important as that is, but to work right across right across the board, to improve those levels of protection and safety for Australia's women and their children. That will be that will involve work in the justice area by state governments and that was made clear out the National Cabinet meeting yesterday. It also means the really difficult work of dealing with these societal drivers of this violence. Amanda Rishworth has talked about some of the work that she is leading in that area, whether that's the availability of really disturbing materials online, that is being seen by really young Australians, importantly by young Australian boys, and all of the work that we need to do not just as governments but as parents, as communities, as school communities, to teach young boys and young men at the earliest possible age, the need for respect for women in our community.

JOURNALIST: How concerned are you about the rates of vaping among kids? And what more can the Government do to curb to curb this vaping?

BUTLER: Health ministers across the country, and premiers, chief ministers and the Prime Minister have agreed to a program on changes that will seek to stamp out recreational vaping in this country. We now realise, several years on from this product being introduced by Big Tobacco, not just Australia, but to countries right across the world, that far from it being what they said it was, which was a therapeutic good designed to help hardened smokers kick their habit. It is now clear this is an insidious device designed to recruit a new generation to nicotine addiction. The tragedy is it's working. We know that vast numbers of high school students are vaping. Vast numbers of young adults out of high school are vaping and increasing numbers of primary school students are vaping. This is causing real health harms directly to them. It is the number one behavioural issue that school communities right across the country report and we are determined to stamp it out.

We're also honest enough to say it's not going to be easy. This thing has got away not just from Australia, but from countries right across the world. The rates of vaping are really serious out there among young Australians. The first thing we've decided to do is try to choke off the supply from overseas. We've put in place an import ban effective from the 1st of January. Already our authorities, the Australian Border Force and the Therapeutic Goods Administration have seized more than one and a half million illegal disposable vapes taking them out of the hands of young Australians. The next phase of our reforms needs to be the Australian Parliament passing the laws that I introduced several weeks ago. Those laws would outlaw the sale, the supply, and the commercial possession of vapes, other than those that are specifically approved to be available through a pharmacy on prescription from a doctor or nurse practitioner. These vape stores, nine out of 10 of which have opened up within walking distance of our schools, need to be shut down. The convenience stores that sell these vapes to young Australians need to stop selling them. The Opposition, led by Peter Dutton, the Greens party and others on the crossbench, I implore them to support our laws and to pass them over counting week so that they can be put in place by the 1st of July, which is when health ministers, jurisdictions across the country, Liberal on Labor alike have agreed should be the case.

JOURNALIST: Doctors are saying pregnant women are unable to access blood pressure medicines, what is the Federal Government doing to improve access?

BUTLER: I've read those reports this morning and I'm pleased that the relevant College of Obstetricians and Gynaecologists is sitting down with health authorities, including I think the Therapeutic Goods Administration, to explore the supply problems that doctors and most importantly, their patients are having around this area. This is obviously a very serious concern. Reading some of these reports, though, the perspective, if you like, put by some of the researchers and the clinicians in this area is that there aren't enough clinical trials in this space testing what medicines are able to be used for pregnant women. I think that the discussion we've had this morning, a number of the initiatives that I've announced today, whether it's research into some of those reproductive health issues for women, or the clinical trials initiatives, are specifically designed to lift our performance in this area. I really look forward to hearing about the outcomes of the meeting that is being held today between RANZCOG, the relevant college, and health authorities. If there's something that they say government should be doing in the shorter term about this, I'll be very pleased to hear that.

JOURNALIST: Is an apology enough from the Immigration Minister, it was given to the grandmother, Nannette, who was allegedly attacked in her home, and she says she feels let down by the government?

BUTLER: This is a deeply distressing circumstance, obviously for the couple who had their home invaded, and were subject to such horrifying assaults by these people, allegedly. I think the whole of Australia feel terribly about this. The Minister has talked about this, other members of the government have as well, I think it's now a quite clear matter on the public record that the High Court decision late last year required the Commonwealth to release a number of people who had been in detention whom we wanted to keep in detention, including the person who was alleged to have committed this assault. The ministers are doing everything that they can to action the laws that were passed by the Parliament, modelled on the regime that the former government had in place to allow for preventative detention. We are all awfully sorry that this elderly couple in Perth, have experienced this utterly dreadful home invasion ourselves.

JOURNALIST: Thanks, Minister. Just back to the hospital agreement is the latest offer to the states 13.5 per cent in the first year and 8 per cent in the remaining years in the five-year agreement?

BUTLER: That's the position the Commonwealth put on the table last year. Those are new growth caps. Whether the funding actually got to that level would depend on principally the activity in different hospital systems, and also on the price that was recommended by the independent Pricing Authority for hospitals. I guess the important thing for states and territories, who operate our hospital system, was the indication for the first time that the Commonwealth would lift the share that it provides for hospital funding to something that reflected the midterm review of the existing hospital funding agreement, so to 42.5 per cent by the end of this decade of total hospital costs and to 45 per cent of total hospital costs by the middle of the next decade, by 2035. Those percentages you refer to Jess, were not actual percentages of funding. They were new growth cap. So, whether funding reached those caps will depend upon largely the activity undertaken in different hospital systems.

JOURNALIST: Okay, great thank you. And will this deal likely cost more than the $13 billion extra you predicted in December?

BUTLER: We've said that it would be at least an additional $13 billion. Again, the precise figure will largely turn on the activity undertaken by hospitals, and also the annual price changes put in place by the Pricing Authority, which is independent.

JOURNALIST: And lastly, just do you think this latest offer is enough to bring federal hospital funding contributions to 42.5 per cent by 2030?

BUTLER: Yes, we do. We're very confident about that. This agreement, and frankly, the scope of the negotiations that are underway right now between states, territories and the Commonwealth is not just about hospital financing, as important as that is. There's a real level of goodwill and cooperation between jurisdictions to explore ways in which we can make our hospitals more efficient, how we can streamline some of the interfaces between the hospital system on the one hand and aged care, disabilities, and primary care systems on the other. I'm feeling very confident, very optimistic about our ability to achieve a really far reaching deal by the 30th of June which will underpin a period of strong reform over the coming five years.

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