Minister for Health and Aged Care – press conference in Adelaide – 25 September 2023

Read the transcript of Minister Butler's press conference in Adelaide about 125 major health organisations supporting a 'yes' vote for the Voice, the COVID-19 inquiry, and payroll tax for general practice.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks everyone for coming out to this morning. It's great to be here with Tanya Hosch. She'll say a few words in a second. Also with Chris Moy, who promised himself and those around him he was retiring from public life, but he's back in the media today. We're here at Chris’s practice to talk about the impact that a constitutionally enshrined Voice to Parliament would have on the health of First Nations people in this country. Today, more than 125 health organisations representing the length and breadth of this incredibly diverse sector of health have come out and published a public letter in support of the referendum on October 14. That is, if I can discern their reasons, because working in health, you understand more than any other sector perhaps, the entrenched disadvantage, being experienced day in and day out by First Nations people.

There is no area of policy, I don't think, more important than health where a Voice to the Parliament and to the executive from Aboriginal and Torres Strait Islander people would be more valuable than in health. With the best of intentions and many billions of dollars of investment year after year, the Parliament receives report after report that sets out in awful detail the yawning gap in health outcomes and life expectancy between Indigenous and non-Indigenous Australians. We have to be honest that with the current approach, that gap is not closing. Indeed, in too many areas, the gap is actually getting worse. We need a new approach. Doctors and health professional know that to get the best outcomes they have to listen to their patient carefully. They have to listen carefully to what their patient says about what they're experiencing, if they are going to get the best outcome and prescribe the best treatment.

I really want to thank those organisations for stepping out and indicating their view about this referendum. We only get one of these referenda every 25 years or so: a chance to have a say and have a vote on an important idea and important concept for the nation's future. Closing the gap and recognising the place of First Nations people in this country as the oldest continuously surviving culture on the face of the planet is an incredibly important thing for the Australian people to vote on in about 19 days time. I'd like to hand over to Tanya to see if she wants to say a few words and then to Dr Moy.

TANYA HOSCH, YES23: Thank you, Minister. We're so pleased to have your support. I acknowledge we’re on Kaurna land today. The Yes campaign feels really strongly about this work, because we believe that Australians are tired of the separation between us as indigenous and non-Indigenous Australians. This is an opportunity to bring us all together under the Constitution. But additionally, this constitutional amendment, which will recognise the first peoples in the Constitution for the first time – a Constitution that recognises lighthouses and coinage, but says nothing about the first peoples of the country – has a practical element to it through the Voice to Parliament.

As the Minister has outlined, one of the things that we know – without dispute – is that Aboriginal and Torres Strait Islander peoples have some of the worst health conditions in the country. And that is something that I experienced myself, and so as a consumer of the health system, as someone who has sat on hospital boards and community health centre boards and advocated for family members in the health system, as a consumer of the health system, I still experience difficulties.

The Voice to Parliament is a way to help us improve the outcomes for First Australians. It is not a lobby group. It will be there to give advice. Advice that is, you know, based in strong lived experience. Advice from years and years of expertise about what makes a difference and improves the quality of life of First Australians. And advice that comes with cultural insights. All of those things, put together, is just going to make our health system stronger, and better results for people on the ground, better results for people, no matter where they are, whether they be in a remote community, or living in the suburbs of Adelaide, like I do.

What we really need to do through this opportunity, as the Minister said, this rare opportunity is to say 'Yes' because we need change. To stay as we are means that we maintain the status quo or things get worse. In 2023, I really believe Australians can come together on this really simple request. We really urge you to make sure that you're informed, so that you can see that this is actually a really positive opportunity for the country and one that we shouldn't squander.

FORMER VICE PRESIDENT, AUSTRALIAN MEDICAL ASSOCIATION, DR CHRIS MOY: The AMA is really pleased to have been invited by the Minister to speak on behalf of 125 of the largest health organisations in support of the Voice. I think the thing is: the fact that so many health organisations have come out, representing health professionals across Australia, indicates that health and the problems in health for our Indigenous community is essentially the epicentre of the crisis that hopefully the Voice can help alleviate. The Minister has talked about us being able to listen.

As doctors we need to listen. The problem is, and this is, you know, I've just faced this, even in the last few days, is that the patients that I have that are the most vulnerable, the sickest, have the greatest trouble actually being heard, because they're often the quietest. They have the greatest trouble being seen. Now the thing is on a wider level that is the situation for which the Indigenous community suffers. They are the community that are the sickest and most vulnerable and the least heard. This is why we need the Voice, so that they have a chance to be heard in wider policy. And I think the thing is, for many people – people will talk about examples, I'm not sure you've got the time to listen to examples – but we've seen many examples where really good Aboriginal Community Controlled Health Centres, who listen to the communities locally, have made such a big difference to their communities and the health of their communities. And in fact, have often made a difference because they have listened. And because those communities have the chance to be able to tell the health system what they need. It has changed their destiny. When we're talking about children, many children who, for example, suffer – Indigenous children suffer eight to nine times the ear disease and deafness of the rest of the population. Those children are disadvantaged as far as things like development, education, then employment, and then they suffer great social disadvantage. And then, you know, that is why we see great, high proportion of those individuals suffering from things like alcohol abuse and social disadvantage.

This is a great chance on a wider level. So, as I said, from my point of view, our patients that are the most vulnerable and the sickest have the greatest trouble being heard. This is a great chance to be able to increase the ability of the Indigenous populations who are the most vulnerable and sickest to be heard, and to be able to influence health policy, on a wider level. It can change their destiny.

JOURNALIST: Doctor, would you suggest the 125, that sounds like a large number. Is that a sizable amount of support?

DR MOY: That is pretty much every major health organisation that's anybody. Just go look at the list. Basically, any organisation that's anybody is pretty much on that list and that's because we know what the problem is. We're at the frontline, we see what the situation is. I think the thing to keep in mind is that a lot of the problem is that for the population that we're talking about – First Nations communities – they have the greatest trouble seeing us, they have the greatest trouble actually getting health care. They have the greatest trouble accessing it, because of whole number of reasons, distance, discrimination, a whole number of issues. I mean, if you've got the time, I'm not sure you guys have got the sort of attention span for me to actually be able to give an example.

But, see the work of Professor Kelvin Kong from New South Wales. He's the first Indigenous surgeon in Australia and I think it's actually pretty disgraceful, it took so long to get one, but his work is amazing. He epitomises what should happen. He's worked in childhood ear disease, trying to alleviate that problem that I just explained. What they found, for example, is that they were getting only about 50 per cent of patients being able to get to the outpatient clinics, for the children to be seen. What they did is they listened to the community, and they moved the clinic down the road to an Aboriginal Community Controlled Health Centre, where that community felt welcomed and more comfortable. They more than doubled the number of children who attended the clinic. Now, that is a micro example of where you can make a difference and change the destiny of these children. The thing is, what we need to do is do this on a macro level. That is this practical example of where the Voice may be useful to providing change.

JOURNALIST: Minister, the New South Wales Premier, he's called on the federal government to ban vapes at retail outlets. Does the Federal Government have any plans to do this?

BUTLER: We've got a comprehensive plan that has been agreed with all state governments. I’ve said that I'll be aiming to put in place an import control regulation by the end of this year, which will ban the import of vapes into this country, other than through a very narrow therapeutic pathway. This has been the problem for the last several years. To his credit, Greg Hunt tried to put in place an import ban. But it was only in effect for a few days before he was rolled by the Coalition party room.

We've just had open borders with a steady flow of these insidious devices that have been marketed to Australia's kids. I saw reports of the New South Wales raid, and every raid that's conducted by a state government shows even more awful detail about these terrible devices. These contain chemicals that are used for anti-freeze on airport runways, chemicals used for nail polish remover, paint stripper – all these things are chemicals that our children are ingesting into their lungs through a device that cynically has been marketed by the tobacco industry to recruit a new generation of nicotine addicts.

So yes, a comprehensive – one of the toughest in the world – comprehensive plan to get rid of these things and return them to what they were intended to be, which was a narrow therapeutic tool for hardened smokers who are having trouble kicking the habit, not a not a recreational product for our kids to learn how to smoke,

JOURNALIST: The notion that that should be a prescription only for people that are trying to quit smoking, do you support that?

BUTLER: That's the plan that all health ministers have agreed. Vapes will be allowed to continue as a therapeutic good prescribed for a patient, a hardened smoker who is having difficulty kicking the habit that will only be available on script, through pharmacies. They will have to be in pharmaceutical style packaging, so none of these sort of fancy colours with pink unicorns on them. They have to be plain flavoured, not bubble gum flavoured or all the other flavours that are so obviously directed at kids.

They will not be available through the sort of retail settings that you now see them available, as the New South Wales Premier has referred to. Some of these stores are deliberately opened just down the road from schools because they know that is their target market. All governments – territories, states and our Commonwealth Government – are agreed on a plan, on a mission to get rid of these things that are changing the lives of our children for the worse, making school communities deeply worried because that is now the number one behavioural issue of schools confront. We're going to start that work this year.

JOURNALIST: On the COVID Inquiry, the Human Rights Commissioner says the COVID Inquiry needs to review the severe pandemic restrictions Australia has suffered such as border closures and curfews. She says it affected that disadvantaged and vulnerable disproportionately and that Australians deserve to have those stories told to restore trust in institutions. What do you say to that?

BUTLER: Those stories will be told. I want them to be told. I've been very clear that the terms of reference in the Inquiry, make it clear that we want that group of experts to look at all of the health response measures, which includes the public health and social measures, so-called. That covers social distancing arrangements, density requirements, school closures, business closures, border closures, lockdowns, all of those things that were put in place at the time by state governments managing an emergency will be in scope of the Inquiry. I also saw some reports, where people have some concerns about whether or not the mental health impacts would be in scope for this Inquiry will be in scope for this Inquiry. Well of course, they will be. The Prime Minister and I have made it clear the purpose of this Inquiry is to set up next time – because there will be a next time – in the best possible way and that it would be extraordinary not to have an Inquiry, given the distress and the dislocation and the death that our country – along with every other country on the planet – has faced.

We have deliberately put in place as the Chair of this inquiry, an esteemed public servant whom people should note, I appointed as the inaugural Chief Executive Officer of the National Mental Health Commission more than a decade ago. She obviously will be very keen to understand the psychological and mental health impacts of this pandemic on our community. It would be extraordinary to think otherwise.

JOURNALIST: And if I might jump back to the referendum, it's looking increasingly difficult to get the Yes campaign to succeed. Do you think announcements such as this one we've heard today are going to get through to people?

BUTLER: This referendum is about a few things. It's about recognising the place of First Nations people in our countries, as Tanya said. A very significant gap in our founding document. It was only 30 years ago that the High Court finally swept away that legal fiction that this was somehow vacant land when Europeans arrived. But we know that simply wasn't the case. It was a continent occupied by the oldest continuously surviving culture on the face of the planet. What we have before the Australian people, is a question to change our Constitution and reflect that reality. Reflect it with pride.

We should be so proud that we live in a continent with the oldest continuously surviving culture on the face of the planet. It's also about listening, which is what the health organisations have been talking about because listening to a community is not just an important exercise for a doctor and a health professional. It's important for Parliaments and for governments. We know that by listening to the voices of a group that is so marginalised in our community, we will get better outcomes, get better value for taxpayer money, but most importantly, we will help Aboriginal and Torres Strait Islander people live longer, healthier, happier lives.

JOURNALIST: I might ask Dr Moy a question. How effective do you think it'll be all of these groups come together to support a 'Yes' vote in influencing how Australians vote?

DR MOY: Basically, every major health organisation is coming out in support of this. And the reason why is because we’re at the frontline. We see the disadvantage, but also we see the outcomes. People are very getting caught up in mind games about yes or no. We’re thinking about our patients, often the most vulnerable patients, the ones who can't see us, they often cannot see us, or they don't have the option of health care.

And think about it, I mean the headline of that open letter said they have a life expectancy – the First Nations community has a life expectancy eight years less than the rest of the population. I think if anybody else was thinking that they were going to be robbed of eight years because of the terrible system that exists out in the world, there wouldn't just be a Royal Commission, there would be far wider change in the system.

I think we've actually got to open our eyes, and this is why these organisations have come out and tried to cut through the noise and get into the real problem, rather than get into these mind games which seem to be occurring at the moment. And a lot of the games are being played at the moment right throughout to try and sort of influence the thinking. This is about real people who are suffering who need help. That is why the Voice is a way to increase the ability of people who are the most vulnerable to be able to say what they need and talk about the problem directly to Parliament to supercharge that needs to be made.

JOURNALIST: Can I ask just quickly, also on the payroll tax issue. Got the Minister here, what's your message to Chris Picton in how GPs are treated?

DR MOY: The Federal Health Minister, Minister Butler, has acknowledged the huge problems in general practice at the moment. We're trying to build great multidisciplinary practices like this here, where we have doctors and we have every other service here. The problem is that this payroll tax is essentially going to actually destroy that and actually put general practice in disarray. Potentially by next year in South Australia. The irony is that we worked with the Minister for this Government to inject somewhere in the order of about a billion dollars, federally, into general practice because they understand the level of problems in terms of general practices at the moment. I think we've done a sort of a rough estimate, and essentially, the states are going to take out about the same amount. Really, if you think about it, this is pretty much Utopia stuff, Yes, Minister stuff, that federal government is giving a certain amount of money which is going to get taken straight out by the state governments. Crazy stuff which needs to be killed, right now.

JOURNALIST: Would you say crazy stuff, Minister?

BUTLER: The only thing I disagree with Dr Moy on is it's significantly more than a billion dollars that we've put in to strengthen Medicare. We had a $6.1 billion strengthening Medicare package in the last Budget, particularly focused on general practice, because I've said I'm so concerned in the state of general practice after a decade, essentially, of cuts and neglect to Medicare.

I've also been very frank: I don't want to say that additional investment by taxpayers at the federal level, simply end up in state treasury coffers. At the end of the day, payroll tax arrangements are a matter for state governments. I know state premiers have been coming to National Cabinet urging the Prime Minister, urging me and the rest of the Government to strengthen general practice, because they know that any problem in general practice ends up at their hospital emergency department. I do urge all state governments to take a measured approach to payroll tax arrangements. We're just in the process of starting to get general practice back up on its feet again, a substantial package from the May Budget. We want to see that go into general practices, not into state treasury.

JOURNALIST: Do you think Stephen Mulligan's moved appropriately on this?

BUTLER: My comments have been very broad about all state governments because different states are taking essentially the same approach to payroll tax arrangements after the decision of the Supreme Court in New South Wales. My position has been one generally for all state and territory governments: as you consider your payroll tax arrangements, consider the impact on the backbone of our healthcare system, which is general practice. I think all states have acknowledged general practices in a very, very difficult situation now. They've been urging us as a Commonwealth to put more money in. We did that in the May Budget. We just want to see that money stay in general practice and allow them to deliver the care that they desperately wanted to deliver to their patients out in the community, when and where their needs are. Thanks, everyone.

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