Minister for Health and Aged Care - press conference - 3 February 2023

Read the transcript of Minister Butler's press conference on the Strengthening Medicare Taskforce Report; Urgent Care Clinics; Medicare; and hospital funding.

The Hon Mark Butler MP
Minister for Health and Aged Care

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After nine long years of cuts and neglect to Medicare, most significantly a 6-year freeze on the Medicare rebate. It has never been harder to see a doctor, particularly a GP, than it is right now. And it's never been more expensive. As I've pointed out now on a number of occasions, for the first time in the 40-year history of Medicare, the average gap fee for a standard GP consult is now more than the Medicare rebate itself, for the first time in the 40-year history of Medicare. That's why strengthening Medicare and rebuilding general practice in particular was right at the centre of Labor's policy at the last election - particularly its health policy. Today, I'm delighted to release the Strengthening Medicare Taskforce Report that has been the subject of really hard work by a number of dedicated groups: doctors' groups, nurses, allied health professionals groups, importantly, patient groups. And a range of other experts that were invited to take part in the Taskforce’s work.

And I want to thank all of those members, they're busy people, they've been engaged a lot over the last several years with not much result. I want to thank them for the confidence they showed in this process and for the work that they've produced that I'm publishing today. Ours was the only party at the last election to promise additional investment in Medicare. We've put aside $750 million to the Strengthening Medicare Fund that will be used to fund the recommendations in this report. We have $220 million in infrastructure grants to strengthen general practice - practices that work so hard to keep us safe and healthy over the last few years of the pandemic, but deserve, frankly, more than just the thanks of their government - they deserve some investment to ensure that they can deliver modern healthcare, particularly in the area of modern digital health. We've got 50 Urgent Care Centres that will be rolled out over the course of this year. And as the Prime Minister I think indicated in his press conference earlier, we announced seven locations - along with the Western Australian Government only a couple of days ago in that state. And in the October Budget, we've already announced $160 million in additional investment to strengthen rural and regional - particularly remote - general practice as well.
This report and the recommendations contained in it will guide the deliberations of Government between now and Budget to frame particular investments needed to deliver our commitment to rebuild general practice and, more broadly, strengthen Medicare. The key messages from the Taskforce report, though, are very clear. The first message is we need to improve access to general practice and primary care. We need to improve access after usual office hours. The former government did not allocate a single dollar to support general practice operating beyond 6:00pm after June 30. All of the after-hours programs that for many, many years have allowed general practice to offer patients care after 6:00pm into the night all finish on June 30. Their last Budget before the election contained not an additional dollar. So we will obviously have to respond to that. The report also recommends better access for urgent care. It recommends the ability for GPs to be able to bill for longer consults - particularly reflecting the more complex, chronic nature of so many presentations from their patients. Sometimes in the area of mental health, but we know from advocates who've talked to us over so long that particularly women dealing with family violence and a whole range of associated health issues often need to spend more time with their general practitioner than just 40 minutes. Longer consults is a clear recommendation of this report. Sustainable models of care for rural and regional Australia that have really been at the pointy end - those communities have been at the pointy end of the crisis in general practice. As happens in so many government service areas, they experience those shortages and those gaps in services that are now afflicting big parts of our major cities as well. And finally in the area of access, the need to strengthen the relationship between patients and their primary care team - really strengthening and, in many ways, formalising that relationship - is a key recommendation from the Taskforce.
The second theme is to provide more wraparound care from primary healthcare teams. The needs of patients today are very different to the needs of the 1980s. Back then, most presentations to a GP were episodic, relatively short, and they were to deal with a point in time or a short period in time need from a person's healthcare perspective. Now we're dealing with much more chronic disease, ongoing need, and older Australians who tend to have more than one healthcare condition. The recommendations from this report are firstly, the critical need to use our health workforce more fully, and to allow all of our healthcare professionals who are trained - at vast community expense - to operate at the full scope of their practice, to use all of their skills and all of their training rather than being restricted by outdated regulations and, frankly, too often, turf wars between different groups within the healthcare system. The Taskforce also recommends much better support for general practices and other primary care businesses to be able to employ and use nurses and allied health professionals - a very clear, perhaps the most significant recommendation from the Taskforce report.
The third message from the Taskforce is we've got to do better on digital health in this country. We have almost countless different clinical information systems operating at state level, Commonwealth level, and in different parts of the private sector. And they generally don't talk to themselves at all or, if they do, they don't talk to themselves very well. My Health Record is now used by 23.5 million Australians. But again, the former government did not allocate a single dollar to the My Health Record system beyond June 30. If we're not able to find new money to continue the My Health Record, you'll have to dust off your fax machines, because the whole of the e-health system in Australia will fall over. This is just one of hundreds of measures that we've talked about that were only part-funded by the former government. I had 200 measures in the Health and Aged Care portfolio that were not fully funded through the forward estimates. These are not pilots. These are ongoing programs that have been operating for years and, in some cases, even decades that were simply not properly funded by the former government. My Health Record is just one obvious example of that. But we understand that, in addition to having to continue the funding for My Health Record, if genuinely it is going to be the centrepiece of a connected digital health system, we have to improve its functionality. Currently, it's a pretty outdated, clunky, pdf format system that needs to be able to underpin a real-time, fully-integrated digital health system. So we recognise that the Commonwealth has the first responsibility to move here and to upgrade the nature of the My Health Record. But we also need other health professionals to connect to it. General practitioners, pharmacies, are very good at this. About 99% of them or more are connected to My Health Record and upload to it regularly. Only 11% of specialists do. Only about 20% of diagnostic imaging - so X-rays and CT scans - are uploaded to My Health Record. So, time and time again, a patient goes to their doctor, talks about their conditions, and their tests are not available for the GP to look at and use as part of their diagnosis and treatment decisions. We've got to do better there. The report also stresses how important it is to have better connections between the systems that we fund as a Government at a Commonwealth level - particularly in primary care - and state hospital systems as well. They're not currently working well enough together.
Medicare is one of this country's shining stars, and it's the backbone of our healthcare system. But it's simply not delivering the sort of care that Australians need in the 2020s. Our government has no higher priority than strengthening Medicare and rebuilding general practice to ensure that Australians get the care they need when and where they need it in the community in order to take pressure off our deeply stressed hospital systems. After nine long years of cuts and neglect to Medicare - particularly that 6-year Medicare rebate freeze - I want to tell Australians honestly, it's not going to be quick and it's not going to be easy, and it's not going to be fixed in one Budget. But this report sets a very clear challenge to Government about how we start to turn things around in general practice and primary care more broadly. And this Government is up for that challenge. Happy to take questions.
JOURNALIST: Are you ruling out an increase to the Medicare rebate?
BUTLER: No, I'm not ruling anything out. There was a very clear discussion in the Taskforce about affordability. What I have said - and frankly, I think, a key message from the health sector more broadly - is we can't just add more money to existing systems, particularly where those systems aren't performing against the range of indicators. Most commentators - and frankly, most stakeholders in the health sector - are very clear that the current system does not fit the needs of Australians. An older population with a much, much higher incidence of complex, chronic care. As I think the National Cabinet said, it's not just about more money - it's about getting the settings right, it’s about getting the policy right. Those are the clear messages in this report. There needs to be reform. But clearly, affordability is a major challenge. I talked about the fact that that gap fee has increased above the Medicare rebate for the first time in the history of Medicare. Affordability is a clear challenge and, of course, as a Labor government, we're considering a whole range of options about the Medicare rebate as well as all of these reforms.
JOURNALIST: I guess, to follow the line of questions, I guess, on the issue of affordability - bulk-billing rates are going down, those stats are well-known. Do you expect those rates as a result of today's National Cabinet, as a result of the recommendations in the report today, to go back up? I guess I mean - you know, it sort of boils down to - if you're someone who can't find a GP, can't get an appointment, are on a waitlist for four weeks, if you’re paying an $80 gap fee - what does the report, what does today's National Cabinet mean for you?
BUTLER: As I said, the Taskforce - have a look at the report - the Taskforce is very clear on the need to address affordability. We talked about a range of options there. There are still stakeholders that are out in the public debate, as is proper, advocating different approaches to ways in which to try and turn around the clear slide in bulk-billing. You say it's well understood, but it hasn't been well understood for very long. The former government tried to pretend everything was rosy with bulk-billing. We were saying there was a clear problem after six years of Medicare rebate freeze. We've tried to be absolutely honest and transparent with the Australian people that there is a real challenge here. That is one that we will be facing up to. Urgent Care Clinics - they don't cover the whole country, but this is one, I think, innovative model to provide a free of charge, fully bulk-billed service, for people who are dealing with minor emergencies that they need dealt with urgently. Because if they're not able to get a bulk-billed service, too often they're having to go to a hospital – and that’s clearly an issue that the state Premiers and Chief Ministers talked about today as well.
JOURNALIST: Minister, a lot of these recommendations, as good as they are, are broad and fairly self-evident - need to increase access to healthcare, GPs and other primary healthcare - but it all hinges on having an adequate workforce. Can you give us specifics? How many doctors, nurses, allied health professionals, pharmacists, do we need in addition to the workforce now to achieve a better health system? How many of those will you deliver this calendar year? And where are they coming from?
BUTLER: They come out of medical school, the GP’s - Sarah's having a good giggle at that - but what I've said very clearly is perhaps the most terrifying statistic in the area of primary care is that now less than 14% of medical graduates are choosing general practice as their career. It's not too long ago, as the College will tell you, that about half of medical graduates chose to be a general practitioner, and the other half went into other specialties - usually hospital specialties. That figure is on an inexorable slide. If you think it's hard to see a GP now, look 5-10 years down the track when the current generation of GPs increasingly are retiring and there's no pipeline coming through - it will be even harder. But you don't turn that around in 12 months. To grow a cohort of general practitioners takes time. Now I know National Cabinet have been talking particularly about this workforce challenge. I had another discussion with my Health Minister colleagues last night about that. I think frankly we need to pull all of the Colleges together as a group of Health Ministers and talk about the distribution of post-university training between the different specialties - general practice being among them. That's identified in the National Medical Workforce Strategy that the former government and state governments all endorsed. But at its heart, I think the challenge is that general practice is not seen as being as attractive as an option for a young medical graduate as it used to be. And that's about all governments investing in general practice, investing in primary care, and valuing it. And that's really what we've been trying to do over the last 12 months.
JOURNALIST: If I can just ask, from New South Wales, we've heard this push for pharmacists to prescribe antibiotics and other things, they want that extended nationally. Do you have a view on that?
BUTLER: These are debates happening at a state level - in Queensland, New South Wales, and I think even Victoria to a degree are talking about expanding the scope of practice for pharmacists. That is where those regulations are set, at a state level. So it's natural that those debates will start there. And again, the Health Ministers and I had a discussion about these issues last night. What I have said as a general principle - and I'll come to the question of pharmacists - as a general principle: at a time when demand for good quality healthcare is skyrocketing and workforce is constrained, it doesn't make sense as a country not to have every healthcare professional working to the top of their scope of practice, now that is clinically determined, it’s not a decision of politicians. What is quite clear that there are a range of healthcare professionals who are currently limited in what they can do and what they can get paid for. And those limits are well beyond the extent of their skills and their training. So there is much more to do and that’s a clear message in this report. We should be having systems, including regulations at a state level, that allow all healthcare professionals to work as close as possible to the top of that scope, and to work much more connectedly.
JOURNALIST: And that includes pharmacists?
BUTLER: And that includes pharmacists. Now what that means in practice, I think, has to be stepped through. And I've read the reports that there are a number of state Premiers who see that as a way forward. I don't think there was any decision out of National Cabinet about that today. But what I'm very pleased with as a Health Minister, I can tell you, is to have the country's First Ministers so focused on the crisis in parts of the healthcare system, that they see that as a first-order priority not just for Health Ministers - as it obviously always is - but for the nation's Prime Minister, Premiers and Chief Ministers. So we'll obviously be examining and seeking reports about the discussions of National Cabinet and seeing what we as Health Ministers have to do to follow that up. But the work of pharmacists, the work of all allied health professionals, the work importantly of nurses, the biggest cohort in our healthcare workforce - there's so much more that they could be doing to deal with this shortage of access to healthcare.
JOURNALIST: The Prime Minister said that there were practical reforms in the report that have been committed to today. Could you outline what specifically those are and, in addition to that, health stakeholders have been calling for short and long-term fixes to this. The report obviously goes to long-term issues. Are we expecting any of those short-term fixes introduced between now and the May Budget, for example? If so, what?
BUTLER: So as one example - I think the Prime Minister used this - the report calls for better access for urgent care. He talked about a couple of examples where people now are really finding it very difficult to find a GP at all, particularly out of hours. And if they do, to find one that bulk-bills for your kid when they fall off a skateboard or a burn or something that needs care immediately. So instead, we know that about half of all emergency department presentations right now are classified as semi-urgent or non-urgent - about 4 million every year. And many of them could and probably should be dealt with outside of hospital settings. Instead, people end up waiting hours and hours to get attention in an overcrowded emergency department room. We've said we're delivering on those Urgent Care Clinics this year. I think the Prime Minister said that when we were in Perth a couple of days ago, we indicated the first three of them would be rolled out before June 30 - and fast-track the other four in the second half of the year. That's one example. Another example is to improve the ability for connection between state hospital systems and the Medicare system to train general practice registrars, particularly in rural and regional Australia. And we were down in Tasmania last week announcing a state-wide program to do just that. We are working on doing what we can now, implementing commitments we made at the last election. But this report is not just thematic. It has some very clear recommendations, some of which I went to, longer consultations, voluntary patient enrolment, after-hours payments for general practitioners who operate after 6:00pm, upgrading My Health Record, talking about the need for pathology providers, specialists who receive Medicare funds, paid for by taxpayers, as a quid pro quo to upload what they're doing to My Health Record so it can be used by other clinicians with the consent of those patients. There are some very concrete measures here that now will be considered in the Budget process leading into May.
JOURNALIST: Getting back to that very point, you said you were going to spend $750 million - that was your election promise. Everyone was expecting this report to explain to us how you were going to spend that money. It doesn't explain how you're going to spend that money. It's got some broad themes and, with the greatest of respect, $250 million a year is chicken feed up against what the changes that its recommending are. You're going to need billions to get general practice back on its feet. Are you prepared to get that money out of ERC?
BUTLER: The first thing I'd say is that all members of the Taskforce, and frankly everyone I've spoken to - we haven't had a talk about this, but everyone else I've spoken to - understand quite clearly that there are recommendations made to Government, the Government then needs to respond to those recommendations in a Budget process. I don't think that's any particular insight into the way in which government works. There are quite specific recommendations here, and they will now go into a Budget process to determine how we spend that $750 million. And that will become clear on Budget night. I've had no pushback from stakeholders and members of the Taskforce about that. I think they see that utterly as the natural order of things. As to whether this is enough, as I said in my introductory remarks, I want to be really frank with Australians and with people working in the health sector: I know that this is not going to fix things in and of itself. I know this is not a single Budget challenge. I know there will be more to do. As National Cabinet said, though, this is not a question of just chucking money at the existing system. The existing system needs to change to reflect the care needs of the Australian population in the 2020s. Yes, you need more investment, but you need system change happening at the same time. And the Report does talk about the need to sequence that right, to make sure that people don't fall between gaps as you're changing from a system that's overwhelmingly fee-for-service to one that delivers much more wraparound care, the possibility of blended funding models and such like that you and I are very familiar with.
JOURNALIST: You've sort of flagged all these measures for budget consideration. Is it safe to assume you won't cover the state's 50-50 hospital funding? The Prime Minister was fairly dismissive of it. Can we rule that out in the Federal Budget?
BUTLER: I didn't see those remarks from the Prime Minister. I only saw part of the press conference. I'm pretty clear about what the states' views are about this. We're into the third year, I think, of a 5-year agreement. The hospital funding agreement has to start renegotiations towards the end of this year, from recollection. We're obviously talking about this very regularly, as Health Ministers, between the Commonwealth and the other jurisdictions. I think what was quite new, though, today - having been in this health policy space for many years, and reflecting on what happened last time we were in government - what's new about today is the depth of interest by jurisdictions including Premiers and Chief Ministers not just in hospital funding, but in how the primary care system is operating. As well as, frankly, linkages to aged care and disabilities. Because they understand that those pressures are ending up on their doorstep. The emergency department ends up effectively as the lightning-rod for every failing elsewhere in the healthcare system. If you can't get care in an aged care facility or in a general practice, too often you end up in an emergency department.
JOURNALIST: Are you ruling out an increase to the Medicare levy?
BUTLER: No, I won't rule anything out. As I said in response to an earlier question, that was clearly a matter discussed in the Taskforce, and will be part of our considerations as well. All I have said is my very clear view - and frankly I think it's shared in big parts of the healthcare sector - that simply adding more money in and of itself to the existing structures, is not going to deliver better care to Australian patients.
JOURNALIST: You've talked about the need to get healthcare professionals like pharmacists and nurses working to the full extent of their abilities. As long as I can remember, there's been massive pushback for a very powerful vested interest, for example, the idea of pharmacists doing more to, for example the nurse-led walk-in clinics in the ACT, as well as your Urgent Care Clinics. How are you going to end those turf wars?
BUTLER: This is a sector - it's not the only sector in Australia – this is a sector that has a lot of loud voices and sharp elbows. I think anyone who's worked in health for a while knows that very well. I will say, though, that the task force deliberations were all respectful and were, I think, very clearly focused on the reality that people can't operate in silos anymore. That's not how the demands of Australians for health is playing out in the 2020s. Everyone - the doctors' groups, the nurses, the allied health groups and others, but most importantly the patient representatives - know that they need to bust down these silos and have all of their healthcare professionals working together genuinely as a team. I come back to the point that I think anyone with a bit of analysis of where demand and supply is in the healthcare system understand we can't continue to have people who have been trained at vast taxpayer expense, they’ve made big contributions to their training as well, have great skills and lots of experience and training, operating below their scope of practice. It's just a terrible return on the investment Australia has made to train and skill hundreds of thousands of really hardworking health professionals that could be delivering more.
JOURNALIST: Minister, can you give us a better idea of the time frames you're looking at here? Is something like longer consultations, adopting a blended funding model, are they this term kind of idea or are we looking further out than that?
BUTLER: We will respond to this report in the Budget. We might not accept every single recommendation right now, but this is a really good set of recommendations that the ERC and the Cabinet can get their teeth into, I think. And we recognise the need to deliver on this Budget with funding flowing from the 1st of July. The report makes clear - there are some things you could do very, very quickly - a longer consult is probably one example. There are other changes that are really, really quite substantial - blended funding models, for example - that are going to take time. Because it's really important you get the transition right. The report makes this clear otherwise you risk really having a system with gaps that people fall through. Some of the digital health recommendations that I think are utterly critical, they’re not going to be able to be delivered in the first week of July, and they’re going to take a significant period of time to rebuild the My Health Record, make it into a genuinely 2020 system that has the ability to underpin real-time integration and interface between patients and healthcare providers. But we will be responding to that because we know this is urgent. That's why we put this utterly at the centre of our healthcare policy at the last election.
JOURNALIST: Just to clarify expectations, then, of the public. You've got the system under strain. It will be July at the earliest that some of these measures will start ...
BUTLER: Like I said, we're delivering stuff now -
JOURNALIST: But 30 June was the Urgent Care Clinics rollout.
BUTLER: We said in 2023 and we've outlined that they're going to be rolling out through the course of 2023. We've brought some forward. The funding was only available from the July 1 on our commitment. We've brought some of that through to the first half of this year. There was the package we announced to strengthen rural and regional general practice that we'll start to roll out very soon as well. So we’re doing stuff now but the $750 million was always allocated on July 1, was put in the contingency reserve in the in the October Budget. We will respond in May. Some of those measures will be able to flow pretty quickly. Others are about rebuilding the system and you can't do that, you know, across general practice just in one way.
JOURNALIST: Minister, can I just clarify your earlier answer to Sarah's question, her question was about the Medicare levy.
BUTLER: Oh, the Medicare levy?
JOURNALIST: I think you said earlier Medicare rebate. Is the Medicare levy on the table?
BUTLER: No, it’s not. Sorry, I thought you’d asked about the Medicare rebate.
JOURNALIST: So how do you pay for it?
BUTLER: $750 million is allocated in the Budget. It was delivered in the October Budget. And obviously, you know, there is a more general process that all responsible governments will be going through. And Jim Chalmers and Katy Gallagher have talked about this more broadly across the Budget to find other ways in which money that is not being spent in the optimal way can be allocated to better use.
JOURNALIST: So obviously this is one priority, we can assume that we're getting a lot more funding in preference to other service delivery areas?
BUTLER: We've made the allocation of the funding commitment. We made it at the last election. We put it into the Budget in October and we'll be announcing in the May Budget the way in which that money will be spent.
JOURNALIST: But will there be more in the May Budget?
BUTLER: You’ll have to wait until the May Budget. Thanks everyone.

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