Minister for Health and Aged Care - press conference - 27 January 2023

Read the transcript of Minister Butler, Prime Minister Albanese and Premier Rockliff's press conference at Latrobe University on Tasmanian General Practice; Medicare; Voice to Parliament; Macquarie Point Stadium and the Port of Darwin.

The Hon Mark Butler MP
Minister for Health and Aged Care

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ANTHONY ALBANESE, PRIME MINISTER: Look, it's fantastic to be back in Tasmania again. And great to be here for my first trip of this year with the Premier Jeremy Rockliff, with the Health Minister, Mark Butler, and with Senator Anne Urquhart, who does such great work here in the North-West. And it's great that Jeremy and I are able to come here to fulfil the first step in the commitment that came out of the National Cabinet and was put into the Budget in October. We said we would allocate $100 million around the country to make sure we worked on the way that the hospital system worked with the primary healthcare system, particularly to help workforce issues in order to address the challenges there with the healthcare system going forward. And I'm very pleased, and I congratulate Jeremy and his government, for being the first government in the country to deliver a program which is innovative here in Tasmania. This program will be Tasmania-wide. We will deliver some $8 million to make a difference here, to make sure people who are working through the hospital system can get the training that will enable them to become GPs, particularly in rural communities. This is about boosting primary care and taking pressure off the hospital system. In addition to that, Tasmania will contribute $5 million over four years to improve capital works for the Rural Medical Workforce Centre right here and $1 million a year to support mandatory rural medical officer rotations. This is a great example of the Commonwealth working with state governments to make a difference for healthcare around the country. And I look forward to this program being rolled out with state and territory governments right across the nation. This came from state leaders, from first ministers. When we met last year they said, 'How can we trial an innovative program to make a difference?' I'm convinced that this will make a difference. And with Cody and Emily, who we met with here today, one of whom, Emily, has come from WA and wants to make a difference as a GP here in Tasmania, along with Cody who came from Hobart in order to make a difference here in the North West. Being a GP is an honourable profession. They can provide care from birth right through the system of life and provide the day-to-day update which will make a difference to people's healthcare. The reason why primary healthcare is so important and GPs are so important is that if you get that knowledge of care between a doctor and their patient it's more than just a transaction, it's a relationship for life. It's a relationship which is about making sure that health issues are diagnosed early, that intervention happens as soon as possible. And, of course, we know that if that happens, it will cost less because we'll have less people who have acute health issues. And I'm very pleased that Jeremy has worked so closely with Mark Butler and the health system here.

JEREMY ROCKLIFF, PREMIER OF TASMANIA: Thank you very much, Prime Minister. To Senator Anne Urquhart, we've shared the podium a few times for positive announcements recently. And indeed, Health Minister Mark Butler. Welcome to Tasmania. It's fantastic that once again we have had cooperative relationships between federal and state government and that's what Tasmanians expect. They expect governments, irrespective of political colour, to address key challenges and there is no doubt that there are key challenges across our health system. Much of that has been due to the delayed care and disruption of the pandemic. But what we are doing is coming up with innovative solutions, working together to ensure that, in this case, all Tasmanians have greater access and reliability of access when it comes to the primary healthcare system. In Tasmania, key investments working with clinicians are working. We have a four year elective surgery plan that has demonstrated month by month over the course of the last 12 months that our elective surgery waiting lists are coming down and continue to come down. Why is that? Because we are investing, but also investing in relationships with our clinicians in having a clinician-led, patient-focused four year elective surgery plan and beyond. The missing piece is to ensure we also invest in primary healthcare services. I recognise, as Premier and as Health Minister, that there are real challenges of accessing GPs across our state. When you have those challenges, you just don't play the blame game. You sit down sensibly, as Mark and I have done and indeed the National Cabinet, and work together to find solutions. That's the expectation of each and every Tasmanian. The other thing that is very important is the transparency of data so we understand the challenges that are here. And just this week, we've released our health dashboard data, greater transparency putting greater accountability on governments, both state and federal. What the data demonstrated was that 40 per cent of people that have been attending emergency departments, in Category 4 and 5, could access their healthcare in pharmacies or GPs. And so what that means, and what is so significant about this announcement, is that we are going to ensure that through this pathway, encouraging GPs to come out of the hospitals and into the regions, we will free up greater access for people that need that healthcare and prevent them from having to attend the emergency department when their healthcare gets more complicated. And we had a great discussion with Cody and Emily just before. Emily highlighted the challenges when it comes to chronic disease within our community. When a chronic disease is not supported in our community, then people get sicker and are forced to come into the emergency department. We need to ensure that people with specific circumstances and challenges with their health get sooner access to their local GP and establish that relationship, as Anthony has said, for the longer term, have confidence in the primary healthcare system and alleviate the pressures in our acute care system. This is a fantastic initiative. This is a $30 million investment over the course of the next four years, of which we are grateful that Tasmania can have some $8 million of that almost $100 million investment. We are contributing $5 million. This is a great partnership in action between Federal and State Government that will deliver results.

MARK BUTLER, MINISTER FOR HEALTH: We said at the last election that we had no higher priority in healthcare than strengthening Medicare and rebuilding general practice. And this announcement today, a level of co-operation between the Commonwealth and the Tasmanian Government, is another indication of us delivering on that promise. We know how hard it is to see a GP right now across Australia, but particularly here in Tasmania, where there has always been a slightly lower number of GPs per head of population than the national average and where bulk-billing is substantially lower than the national average as well. We are about securing the ability to see a doctor right now. We have a range of policies across the country to strengthen Medicare, to deliver urgent care services, including three of them here in Tasmania that will be rolled out this year, to secure practices as well with $220 million of infrastructure grants going to general practice, and a range of other measures as well. But it's not just the problems of today that we are focused on. We are also focused on the challenges of tomorrow. The fact is, we know that fewer and fewer medical graduates are choosing general practice as their preferred career. It used to be about 50 per cent of young people coming out of medical school would choose general practice as their lifelong career instead of one of the other specialities. That figure now is less than 14 per cent. That is just not enough to secure a sustainable workforce in general practice for the future. So what we are also seeking to do, working with states and with the sector, is to make general practice more attractive those young medical graduates. The announcement today, the agreement that we've struck with the Tasmanian Government, breaks down some of those traditional silos between the Commonwealth system and the state systems. Now, as a medical graduate, you have to take a choice between either working in the hospital system or choosing to work in the Commonwealth Medicare system. You haven't been able to do both. That's meant, for a young GP registrar who might be doing five years of postgraduate training, you might end up working for five, six different employers in that short period of time. You don't accrue leave entitlements. It makes it hard to plan a family despite being at that childbearing age. You don't have the same wages and entitlements that your equivalents working in the hospital system has and it doesn't make general practice attractive as a training opportunity for young people like Emily and Cody. What we have been able to agree with Premier Rockliff is that GP registrars, working in rural communities here in Tasmania, the future workforce of general practice here in Tasmania, will be employed by the Tasmanian health system but still be able to access Medicare. This is a level of cooperation between the Tasmanian State Government and our government at a national level that you have not seen in the past. It will significantly lift the attractiveness of general practice to those medical graduates who want to come and work in a beautiful part of Australia like Northwest Tasmania, but they want to enjoy the same conditions that you see in the hospital system as well. I really congratulate Premier Rockliff for having the vision to make this a statewide system. We've had a pilot in one very small part of NSW, in Murrumbidgee, operating for a couple of years. But to take this to a statewide level really required a level of vision and ambition and commitment by Premier Rockliff. When he wrote to me late in November we had a draft Memorandum of Understanding back to his office and department within a week. He and I met within two weeks and our officials, at a state and federal level, have been working right through the Christmas and New Year to make this a reality, something we could announce before the end of January. So I want to thank the Premier for this and I want to thank the Prime Minister for putting that extra funding on the table at National Cabinet so we could lift this to a statewide level that I think will be a real beacon for the rest of the country.

JOURNALIST: Where else in the country are you hoping to roll out this model? And when will that happen?

PRIME MINISTER: We want this to be rolled out in every state and territory. This was something that we discussed around the National Cabinet table when we met in Canberra. It arose out of, how do we stop the silo approach? We know that, in so many areas, the pressure on emergency departments in particular are because there are people who are in hospital who go to emergency departments who are aged care residents. Part of what we are doing with getting a nurse in every nursing home, putting the nurses back in the nursing home, is to make sure they get that care available where they are rather than getting transported to an ED at much greater cost and at, more importantly as well, not getting the healthcare that people need. We are looking at a range of measures that will take pressure off the hospital system. This is just one of them but this is innovative. The National Cabinet is meeting next week. We will be using this as an example of the first projects that will be rolled out in every state and territory.

BUTLER: This idea of a single employer, so GP registrars, trainee GPs, being able to have just a single employer, the state hospital system for their entire period of training, has been piloted in Murrumbidgee over the last couple of years. We started another pilot in country New South Wales in December. And in the October budget, we committed to 10 additional pilots across the country and in the last few days I've written to all of the state health ministers inviting proposals to expand this model across the country. But I didn't have to write to the Tasmanian Premier. He wrote to me as soon as he read the budget and saw our commitment because he had the idea that he wanted not a pilot but a statewide system, and wanted not just to have the system changed that meant that hospital employed trainees could access the Medicare system, which is an important change for us to make, but he wanted to put money on the table to scale this up and he wanted us to co-invest in that. And we have done that through that $100 million fund. So yes, there are other proposals that I am seeking from other states. But no other state has had this level of ambition to make it a statewide scheme, putting $5 million on the table and asking us to add $8 million to fund practice upgrades, to fund accommodation if that's needed in some of the very small rural towns. So there will be proposals from the mainland but I'm not sure they will match the ambition that the Premier here has put on the table.

JOURNALIST: You mentioned a bit about some of those larger structural problems we have had to get students into the GP area. What extra funding will be needed to fix some of those structural problems?

BUTLER: I've been pretty clear that we're not going to turn a decade-long decline around in one year. This is a big structural decline. It follows ten years of cuts and neglect to Medicare, particularly the big six-year freeze on the Medicare rebate, which has really strangled the financial capability of many general practices and you've seen that play out right across the country. As I said, though, there is no higher priority for our government than strengthening Medicare and rebuilding general practice. It has been a very strong focus already in the last eight months, and over the next couple of weeks we will be releasing the report of the Strengthening Medicare taskforce to modernise the Medicare system, to deal with the sort of disease profile that Emily and Cody were talking to us about, which is so different from the 1980s and 1990s. I think young medical practices talking about the career choices want to know that the Federal Government and the local state government sees value in general practice, sees value in primary care and certainly that's our commitment, to make sure that we bring primary care, general practice to its rightful place because it is the backbone of our healthcare system. So things like this will make, I think, a practical difference to the choices that young medical graduates make. But at the end of the day, our real challenge is to strengthen Medicare again after ten years of cuts and neglect.

JOURNALIST: You mentioned the urgent care clinics will be rolled out in the next year. There is one promised for North West Tasmania. Has a site been identified? And when do you expect to break ground on that?

BUTLER: As I said we committed 50 of these services across the country and they will be rolled out this year. We are on track for that. There's been an extraordinary level of interest by all state governments, including the Tasmanian Government, to work with us to get the location right but also to get some of the details right. These services are going to have to work hand in glove with the local hospital systems, with strong protocols with local emergency departments and stronger protocols with local ambulance services so people are taken to the right place. We've had a terrific level of cooperation between all state governments and the Commonwealth to ensure, not just that we can get them out the door this year, which we will, but also to make sure they are in the best possible location and we really are working very cooperatively with each state government and their hospital system. So I think there's been some expressions of interest sought. We said there would be one in the North West here, probably in the Devonport-Latrobe area, because we are conscious that the purpose of this is not only making it easier to see a doctor for those minor emergencies, your kid falls off a skateboard or you get a deep cut, for example - that's important in and of itself - but also it's important to take the pressure off the emergency department. The Premier talked about those Category 4, Category 5 emergency department presentations that could quite properly be dealt with in a community or general practice setting if people could get in to see a doctor.

ROCKLIFF: We welcomed and embraced the commitment from the Federal Labor Government when it was made and of course we are working together with the Minister for Health and our respective officials right now. The commitment was for an urgent care centre in each of the three key regions around Tasmania. We are working through the detail and location of that now. It's important that we get that right because any investment in healthcare has to make a difference and support alleviating pressures on our emergency departments, but ensuring that every Tasmanian gets the right care at the right place at the right time. And when it comes to urgent care centres, we have been supporting urgent care centres in Northern Tasmania, in Launceston, with an after hours investment. That appears, through the evaluation, to be working in terms of alleviating some of those pressures of the Launceston General Hospital. So urgent care centres, if done right and if invested in correctly, can work, can alleviate the pressures in our emergency departments to ensure that the patient at the centre gets the right care at the right place at the right time. And look forward to an announcement in the not-too-distant future.

PRIME MINISTER: I will be announcing one of the locations on the north island just next week, so we are on track for this to be rolled out right around the country.

JOURNALIST: What does this announcement today actually mean for an everyday Tasmanian who may be struggling to find a GP or get healthcare? What does it mean for them?

PRIME MINISTER: What it means is simply this: that we are putting in place structures that will make it easier in the future for you to access a GP. It's as simple as that. It won't happen overnight. But what it will do is change the whole structure of the way that the health system is working here, so that you get the primary healthcare system working with the hospital system to make sure that it's more efficient, that it is more accessible, that it is more affordable as well. This is a really commonsense solution which has looked at what are the disincentives to becoming a GP. We heard from Emily and Cody, two fine young Australians who want to be GPs. That's what they want to do. But GPs, as well, with particular expertise. One of the things about this is the Tasmanian support is to have rotations in paediatrics and anaesthetics but other issues as well, so you will get a level of expertise as well as having the general healthcare role in GPs. And that will make such an enormous difference. I think this is an incredibly positive announcement. I was very excited, Jeremy and I spoke about me coming down here a couple of weeks ago, very early in the new year. This was the first big announcement that I wanted to make here in Tasmania for this year because there is nothing more important than healthcare.

JOURNALIST: Do you think the messages from Indigenous voices at Invasion Day rallies calling on people to vote no in the referendum will harm the campaign?

PRIME MINISTER: People will have different views on this. And just like any section of society, to think that it is homogeneous is, I think, just not realistic. Now, I very firmly believe that the Uluru Statement from the Heart was very clear about the priority that Indigenous people, after hundreds of consultations, came together and they said they wanted Voice as the first thing. Now, what people will vote for in the referendum, if they decide to support it, is they will vote for recognition of Indigenous Australians in our constitution and they will vote for consultation with Indigenous people on matters that affect them. That is simply the principle that is there. I put forward draft wording in July at the Garma Festival. I have not had one suggestion come forward from anyone, across the political spectrum, of a proposed change to the wording that has been put forward. Last night, I was with the New South Wales Premier who, once again, reaffirmed his government's support for the constitutional change, for recognition. Across the country, every state Premier, every Chief Minister, is supporting yes at this referendum because this is about progress going forward. It is about reconciliation. It's not a radical proposition. So I'm not surprised that some radicals are opposed to it. Because this is a mainstream proposition. This is a modest and gracious request for reconciliation by Aboriginal and Torres Strait Islander peoples. Now, if we don't recognise Aboriginal and Torres Strait Islander peoples in our Constitution this year, when Australians will have the opportunity to do so, when will we?

ROCKLIFF: I was one of the Premiers in Anthony's first National Cabinet, along with every other Premier and Chief Minister, that said yes, absolutely. We support the Voice. And I will be voting yes in the referendum for very good reasons, in bringing this country closer together, unity of purpose, acknowledging the Uluru Statement from the Heart and ensuring that not only we recognise Indigenous Australians in our Constitution but also listen to their concerns, their ideas of how we can support First Nations people right across the country in living a better life, Closing the Gap on all of those areas. For generations we have failed Indigenous Australians in so many areas. This is about bringing the country together. Every state and territory is supporting the referendum, unity in purpose, to ensure that we, as a country, support and listen to our Indigenous people, Aboriginal people across the nation, First Nations people to ensure that they are involved in the decision-making process. By governments listening to First Nations people on how we can support them to live a better life, better access to education, better access to healthcare and better access to all the initiatives we need to for a greater sense of well being and belonging.

JOURNALIST: Michael Mansell from the Tasmanian Aboriginal Corporation said that you would like to discuss their views with you and said that you are not welcome in Tasmania until you do that. Is that a group that you are intending to consult with before the referendum?

PRIME MINISTER: We are consulting very widely. We have a Referendum Working Group. There has been an extensive consultation process, five years of consultation from 2012-17, before the Uluru Statement from the Heart was made. And then six years since then. There will be a process this year where there will be a parliamentary committee examining the legislation that will go forward. That is required under the referendum. There will be extensive, continued, ongoing consultation with people. It doesn't mean that everyone will agree. But it does mean that overwhelmingly, Aboriginal and Torres Strait Islander peoples have come together and have said, overwhelmingly, this is the direction. The what is Constitutional Recognition. The how this through a Voice to Parliament.

JOURNALIST: You have dismissed calls for more information on the referendum as politically motivated, but we're also these calls from non-political Indigenous leaders. Do they have a point?

PRIME MINISTER: You are paraphrasing me there. What I have said is that what is before the Australian people in the draft wording of the referendum is very clear. There is a clear question that in recognition of Aboriginal and Torres Strait Islanders as Australia's first peoples, that's the recognition bit. And there are three points: one, there shall be an Aboriginal and Torres Strait Islander voice; two, the Voice will advise on matters that affect Aboriginal and Torres Strait Islander peoples and the third is the Parliament will legislate for the structure and other processes, the detail of the operation of the Voice. That is what is before the Australian people. It is very clear. I made that announcement, put that forward last July in response to people saying what is the question going to be. That was made seven months ago now. In that seven months, there has not been a proposed alteration. We have a Referendum Working Group, we have a group of constitutional experts - including former High Court Justices, Professor Anne Twomey and others - looking at the detail of legal issues as well, convened through the Attorney-General's Department. There will be further detail, but part of the detail is that it will be legislated because it is subservient to the Parliament. It is not on top of the Parliament. And everyone will have the opportunity to have input to this.

JOURNALIST: When can Australians expect to vote in this referendum?

PRIME MINISTER: I made that clear as well, they will vote into the second half of this year. There is a timetable that is required in terms of the consultation processes which are there. The clear timetable which is required under the law is that you will have the passage of the referendum machinery legislation, which will occur in the coming session, and then you will have an introduction of a Constitution Alteration Bill. There will be a Parliamentary inquiry into that legislation where people have the opportunity to put forward their views. There will be a debate on that legislation in the House of Representatives and the Senate that will involve all Members and Senators. And then, after the passage of that legislation, a referendum can only be held on a Saturday between two months and 33 days, a bit over three months, and six months after the Bill is carried. So there is a timeframe there for when this can occur: a clear process of engagement and involvement and consultation, on top of the consultation for an idea that was first raised last century and that begun the process in 2012 leading to the Uluru Statement from the Heart into 2017. So for those who say there has not been detail - one of our major parties has already determined they will vote no without looking at any of that - the Referendum Working Group will provide further detail. They have already put out the principles which are there. And those include: no veto over legislation, it will not be a funding body, it will not run programs, it is an advisory body. Recognition and consultation, that is what this is about and that is what Australians will have the opportunity to vote for, to advance reconciliation, during the last half of this year.

JOURNALIST: Any progress on the Macquarie Point Stadium business case? Do you see it as an effective form of investment?

PRIME MINISTER: I am working cooperatively with the Premier. Today, we are here talking about healthcare and that is our priority today, but the Department has received the report. If I am asked 'should Tasmania have an AFL team?' I say yes, because Tasmania is an important part of our nation. The Macquarie Point plan, though, is about urban redevelopment. It is not just about a stadium, and that is the basis of the consideration that we will be giving. We take the expenditure of taxpayer funds seriously. We will be examining it as part of our budget process.

JOURNALIST: What is the current status of the review into Darwin Port? What are the terms of reference and timeframe?

PRIME MINISTER: The Darwin Port is being examined. We will report on that. Given the nature of the report, we will report when it is finalised.

JOURNALIST: Ukraine is calling for more support, would Australia consider sending tanks over as well as more Bushmasters?

PRIME MINISTER: I will be in Bendigo later today and I will be in Bendigo looking at the Bushmasters which Australia has provided, which have made an enormous difference, a practical difference on the ground, making a difference for the people of Ukraine in their struggle, which is not just for them. They are struggling and fighting for the rule of law. They are fighting for national sovereignty. They are fighting for the right of a smaller country to not be invaded by a larger country. We have a land war in Europe. Australia is providing Bushmasters and, what's more, we are providing the support by Australian defence personnel currently who have travelled to the United Kingdom to provide that support on the ground.



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