Press conference with Minister Butler, Adelaide – 18 June 2025

MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Thanks for coming along this morning. Great to be here at the UniSA Health Campus to make a really exciting announcement that’s going to make such a difference for thousands of patients who experience chronic wounds. I'm really excited to be here with Peta and Caitlin, who will take all the difficult questions about how this Chronic Wounds Consumable Scheme will work, but more importantly, will outline what a difference it's going to make for their patients and also for them as highly qualified allied health professionals who deliver terrific care to Australians, particularly Australians with diabetes every single year.
 
We said a couple of years ago that one of our major focuses was going to be strengthening Medicare as a government, and that was about focusing on getting more doctors and nurses and allied health professionals into the system, getting more bulk billing into the system, and rolling out Urgent Care Clinics as well. But I also said at the time, I wanted to see Medicare brought up to date with the needs of 21st century patients rather than structured around the needs of patients in the 1980s when Medicare was being introduced. Of course, we've invested billions and billions of additional dollars into Medicare to make care more accessible and more affordable, but I also want to see some reform in the system that sees us delivering care in different ways.
 
At about that time, Wounds Australia and the AMA came to see me and said that one of the pressing needs in our healthcare system was good care for people with chronic wounds. These are wounds that last for more than 4 weeks, are often associated with high risk of infection, even sepsis, and in very dire cases, even amputation of limbs. They're a big driver of hospitalisation if chronic wounds aren't able to be cared for. The thing that was really brought home to me was that they are very expensive. We, in Medicare, fund the consultation sessions that people will receive in primary care or general practice settings, but the consumables, the things used to treat the wound itself, which can run to thousands of dollars a year, is a cost either borne by the patient or often by the practice itself. Wounds Australia and the AMA had pressed upon the Commonwealth for some time to introduce a consumable scheme that would see patients, eligible patients, receive support for the consumables as well as the Medicare funding obviously for the consultation with terrific allied health professionals, practice nurses, and GPs.
 
In the 2023 Budget, we committed $50 million to do just that, and over the course of the intervening period, Wounds Australia, the College of Nursing, have been preparing training sessions for allied health professionals and practice nurses, and in some cases, Aboriginal health practitioners as well to access this scheme on behalf of their patients. Today, this scheme starts to take effect. It will deliver support to, we think, around 20,000 patients every single year and mean they get support as much as $4000 in the cost of the consumables that they need for their chronic wound to be treated. The eligible patient cohort in this scheme will be diabetic patients or patients with diabetes over the age of 65, or in the case of First Nations Australians, over the age of 50. As I said, about 20,000 patients.
 
We're in the process also of evaluating this program. This is a new program and I think is the way in which we want to see Medicare go into the future. It's going to enliven really the scope of practice for allied health professionals like podiatrists I'm joined by today but also practice nurses who are working in general practice settings, who often do the bulk of the work in this area instead of the GPs themselves. This is a terrific scheme. We're really excited about seeing the results of the evaluation into the second half of next year, and I think it's a type of funding program by the Commonwealth that has a really strong future. I'm going to hand over to Peta and Caitlin now to say a few words about what it means for their work and for their patients.
 
PETA TEHAN, BOARD DIRECTOR, WOUNDS AUSTRALIA: Thank you so much. That was incredible. I have notes. Chronic wounds impact up to half a million Australians, and it has a huge impact on themselves personally but also on society. A lot of these people are unable to work and care for themselves. Being able to have access to the right consumables at the right time will improve outcomes today. I have patients personally that will really benefit from this scheme, and as a health practitioner, I'll be able to do my job to the best of my capability to assist them in their wounds to heal.
 
Wounds Australia is the peak body for wounds in this country, and we're very proud to have had a really important role in getting this scheme up and running. We are also proud to launch our Be Wound Aware campaign, which is focused on educating consumers and the public on best care for wounds. I will hand over to Caitlin now, who's got some further thoughts. Thank you.
 
CAITLIN JEFFRIES, PODIATRIST: Thank you. I have some notes too. I'm really humbled to stand alongside everyone here and talk about this really important cause. I'd like to reiterate obviously what the previous speakers have said. It's something I'm super passionate about. It's a very simple concept but has really life-changing implications.
 
I've spent 15 years working within the podiatry industry. I thought to sort of illustrate the benefit of this new scheme, I'd share with you one of my own personal experiences with a patient. Obviously, for privacy sake, I won't name the patient, but let's just call him Frank. Frank was a 73-year-old retired bus driver living in suburban Adelaide, living alone. He has type 2 diabetes and peripheral neuropathy, which is loss of sensation in his feet. Type 2 diabetes, as we know, is super, super common, and often peripheral neuropathy accompanies that. This is not an uncommon sort of presentation. Otherwise, Frank was a very active, engaged member of the community and very really independent.
 
Last year, Frank developed a small blister on the ball of his foot just from a pair of shoes that didn't fit quite right. But unfortunately, because of his nerve damage, he didn't feel it, so there wasn't any pain and he couldn't see it. By the time that he actually noticed the blister, it had become quite a significant ulcer under the bottom of his foot. He came along to me as his podiatrist to see me at my clinic, and we began aggressive offloading and wound debridement. But Frank had a lot of trouble affording the dressings. The advanced wound care that I recommended as per all the clinical guidelines were just an expense that he couldn't really accommodate. Each week, the out-of-pocket costs of the silver dressings, foam dressings, it really added up for him.
 
To give you some context, it's not uncommon. A dressing might be $30 to $40. And when you're talking wounds, particularly with diabetes on the feet, you might need to have that changed 2, 3 times a week. As a result, Frank actually began rationing his dressings, which meant that he was reusing some dressings, skipping some of the changes, and even sometimes, he actually wasn't changing them at all. He wasn't being non-compliant. He was just, poor Frank, was kind of making them last. Unfortunately, despite all of our best efforts the wound became infected, and given his diabetes, that infection spread quite quickly, and within months Frank was actually admitted to the hospital and eventually underwent a below knee amputation. For the record, statistics show if you have a below knee amputation you’ve often got a five-year mortality rate associated with that. It was really devastating, not just physically, but emotionally, financially for Frank. He lost his independence, his mobility, and his confidence, all because he just couldn’t afford basic dressing and wound care products to support him in the home.
 
The reason I just wanted to share this story with you is I think it just highlights how this really can affect the average Australian. The cost of dressings became the cost of not only Frank's foot but ultimately actually his life. More than 300 Australians develop diabetes every day, so that's one person every 5 minutes, and it's even more prevalent in the population over 65. And peripheral neuropathy with diabetes is also very common, so people can't feel these wounds. It could be your mum, your dad, your grandpa. I just really applaud the government for this initiative. I'm really super glad to see podiatrists being acknowledged as a key provider in this scheme.
 
And I'd love to thank Wounds Australia and also the Podiatry Association. Wounds Australia have played an integral role of making this all happen. As podiatrists, alongside GPs and nurses, we can hopefully get better health care outcomes. And thank you for UniSA for hosting us today. Thank you.
 
BUTLER: Any questions on this?
 
JOURNALIST: I was just going to ask who's eligible, if we could run through that?
 
BUTLER: Eligibility for this program is people with diabetes over the age of 65 and for First Nations Australians with diabetes over the age of 50, obviously with chronic wounds, as I said which are wounds that persist for over 4 weeks.
 
JOURNALIST: And I think, Caitlin, you've already explained it quite succinctly, but for someone, excuse my ignorance here, are you more susceptible to chronic wounds with diabetes? Is that something we can just spell out?
 
JEFFRIES: Yeah, absolutely. People with diabetes are at a higher risk of developing neuropathy, which is a loss of protective sensation, and also arterial disease, which is reduced blood flow. Any small friction or pressure in the foot can result in an ulceration. They're the population that are at the greatest risk of severe complications like amputation and subsequent death.
 
JOURNALIST: A new report from the Grattan Institute says specialists charging excessive fees should be named, shamed and stripped of their Medicare rebate. Is that something you’d consider doing?
 
BUTLER: This is an important report but I think most Australians have been talking for some time now about the huge growth in out-of-pocket costs visiting their local specialists. I said before the election that we intended to update the so-called Medical Costs Finder to make it mandatory. This was a website that was designed to have specialists upload the fees that they charged their patients, whether they're surgeons or anaesthetists, so that patients could make an informed choice about who they'd use. It was intended to be used on a voluntary basis and we found that over a few years, literally only a few dozen specialists uploaded their fees out of many, many, many thousands.
 
Clearly, it's been a terrible failure as a system and so we've decided to mandate the uploading of those fees. We will collect the fees, and we will upload them so that patients have much better transparency around the fees that are being charged by specialists in their community. But that's not enough, I don't think. I've asked my department for advice on options to start to get this huge growth in out-of-pocket costs back under control. It's causing real harm to Australian patients, not only their pockets in terms of the costs they're having to pay, but we know that lots of Australians simply now can't afford to visit their specialist. It's having a huge impact on their health.
 
I think this report is a really important contribution to this debate. I made it clear before the publication of this report to doctors’ groups that this would be a focus of our second term in government. We focused very heavily in our first term on trying to turn around the plummeting rates of bulk billing in general practice and that's worked. There's more to do but we have turned around bulk billing for general practice. A significant focus of my time as Health Minister in the second term of this government is getting a better deal for patients in specialist areas.
 
JOURNALIST: You just touched on a bit improving the specialist fee transparency website. Will that website help someone who only gets in to see one specialist in 12 months?
 
BUTLER: What it will do is allow patients to get online and work out what the different fees are being charged by, for example, an orthopaedic surgeon or some other type of specialist in their area. We know that out-of-pocket costs vary enormously. The Grattan report confirms this. The out-of-pocket costs charged by, for example, a number of different surgeons in an area can vary dramatically, and in a way that has no bearing on the different quality of those surgeons. But at the moment, patients are often flying blind in terms of making that choice about who they visit, making that choice when they talk to their GP about who their GP is referring them to. It’s not everything, but transparency, some sunlight on these pretty exorbitant out-of-pocket costs being charged in some areas, is I think a really important tool in the toolbox.
 
But I do want to know what other options are out there because I think this has become a barbecue stopper for the Australian public. It is becoming more and more a topic of discussion because it's causing real harm to Australian patients.
 
JOURNALIST: Just with wait times, what are you doing to reduce those for specialists?
 
BUTLER: This is really largely a question of the supply of specialists that we have. I talked in my opening remarks about wanting more doctors in the system. We've expanded medical school places over the last 3 years, particularly in rural and regional Australia. We've also got a commitment to expand medical school places that I announced in the last election campaign for urban communities, more doctors being trained here in Australia.
 
We're also making it easier to bring in overseas trained specialists, particularly from countries where we have a lot of confidence in their training system, so-called comparable jurisdictions. That started late last year in response to a report that was delivered to the National Cabinet about ways in which we could streamline the access that overseas trained doctors have to the Australian system. Already, we only received a report last Friday as a group of health ministers. That is making a difference with more overseas trained doctors from countries like the UK, Ireland, Canada, New Zealand where we have high confidence in their training systems, more applications to come and work here in Australia.
 
JOURNALIST: The state Opposition's out today making a policy announcement for the election next year that GPs will be working after hours, outside of 9 till 5. Is that something that you'd consider federally?
 
BUTLER: I'd be interested to read the detail of that and how a state Opposition proposes to shift the lever on that, or shift the dial. We've obviously been working on this for some considerable time now. As a federal government, we've rolled out 87 Medicare Urgent Care Clinics. We're committed to rolling out another 50, which will mean that 4 in 5 Australians live within 20 minutes of an Urgent Care Clinic. This is really when people need after hours care. They're fully bulk billed. They've already seen more than one and a half million Australians, a third of them under the age of 15.
 
We are actually delivering on the need to provide people with care in the community when and where they need it. We also rolled out during the last election campaign a commitment to a universal triage system, 1800-MEDICARE. A free number where every Australian could ring and get good-quality nurse advice free of charge, pretty much at any time of the day 365 days a year. And if the nurse thought they required it, would also get a free telehealth appointment after 6.00 pm, right through the evening, anywhere through the country as well. We’ve got the runs on the board. We know there’s more to do, but we know that getting care out in the community when and where people need it, free of charge on a bulk billed basis, is central to delivering the promise of Medicare.
 
JOURNALIST: On the topic of bulk billing again, 7 News has been given data by Cleanbill that says just over 20% of GP clinics nationally still provide bulk billing for adults with non-concessions. They’re also calling for, similar to the specialist fees, that there be a little bit more transparency when you’re looking on their website. Should that be looked into?
 
BUTLER: I’d take the data published by this private company with a grain of salt. It does a phone survey of general practices. What we do as the government for the first time, former governments didn’t do this, but what we do as the government on a quarterly basis is we publish comprehensive bulk billing data that will tell you exactly the percentage of GP visits across the country, by state, by federal electorate, bulk billed. What we know is that that number was plummeting when we came to government. It started to turn around when we tripled the bulk billing incentive for pensioners and kids, so that bulk billing for those Australians, about 11 million Australians with a concession card or who are under the age of 16, is now back over 90%.
 
But what I said during the last election campaign is we’re still very concerned that bulk billing for Australians without a concession card, so about 60 per cent of the population, is still dropping. It’s down about 60%, so about 40% of GP visits for those adults without a concession card, many of them on relatively low income still, they’re being charged a gap fee. We want to turn that around, and that’s why we announced the biggest investment in bulk billing at the last election campaign to get the bulk billing rate for those Australians up to 90% by the end of this decade as well.
 
We’re very focused on this. For a Labor government, there’s nothing more important in the health sector than bulk billing, because bulk billing is the beating heart of Medicare.
 
JOURNALIST: Is it sad that patients are now being asked to shop around for a cheaper GP clinic as well, and look further afield for cheaper suburbs that provide it?
 
BUTLER: We think the fees that are charged by general practice are obviously one factor that patients will think about when they decide which practice to go to, which GP to use. Obviously, the relationship between a GP or a practice and the patient is a really important one, and I want to see people strengthen their relationship with their practice, and vice versa, practices strengthen their relationship with the patients that they are there to serve. We want to make a virtue out of clinics that choose to bulk bill. That's why in that election campaign commitment we announced that we would reward bulk billing practices with an additional payment, equivalent to 12.5% of their Medicare billings. That's a huge benefit to practices that choose to bulk bill their patients. We know that around three-quarters of practices would be better off if they took up the government's offer that we announced in the campaign and bulk billed all of their patients, whether they have a concession card or not.
 
JOURNALIST: Just on the topic of the proton therapy unit, why has the federal and state governments failed to deliver a proton machine? The Auditor-General identified significant gaps in the way the SA Labor government managed its involvement in the project.
 
BUTLER: I haven't read the full report yet, but I'm not sure that is the right characterisation of the Auditor-General's report. I think what the South Australian Auditor-General's report found was that some very poor decisions were made by the former Liberal state government, the former Liberal treasurer, Rob Lucas, and the former Liberal government led by Malcolm Turnbull at the time. Very clearly when we came to government, it was pretty clear that a project that was decided by those 2 former Liberal governments to be delivered here in Adelaide, just down the road at North Terrace by a company called ProTom, was in serious trouble. This was a company that I think had only delivered one proton therapy unit anywhere on the planet, and that was a research-based unit at the Massachusetts Institute of Technology, I think, in the US. I think questions are there as to why those 2 Liberal governments decided upon that company, and what level of due diligence both governments did before committing huge amounts of taxpayer funds. About $68 million of Commonwealth taxpayer funds to purchase a unit that's never arrived and that will never arrive. It's quite clear this company is incapable of delivering on the commitments that it signed up to with that former Liberal government.
 
This is obviously a very serious issue for both governments that have committed money on behalf of taxpayers, but I'm more worried about the impact it's having on patients and their families. This was to be an incredibly important national capability, not just a South Australian capability, but that it would treat patients, particularly children, with cancer, from across the country and indeed elsewhere in our own region, particularly countries that are never going to be able to afford a proton therapy unit themselves. This has been a very serious failing on the part of those 2 former governments. We and the Malinauskas government now have to see about ways in which we can get this project back on track because we need this national capability.
 
When I came to government, I commissioned Cancer Australia to look at proton therapy across the country and what we would need over the coming 10 to 20 years. It's clear we need one unit for the next several years, and probably a second unit some time into the 2030s, given the growth in the number of conditions that we think will be treatable by proton therapy. We're now some years behind where we should be because of the failure of the project signed onto by the Marshall Liberal government here in South Australia and the Turnbull Liberal government at a national level. I've said that obviously there's a lot of sunk capital here in South Australia. There's a bunker across the road on North Terrace, and there's a lot of clinical capability that has built up here in Adelaide, and it would be a shame to lose those investments that sunk human and concrete capital, if you like. I want South Australia to see whether there is a way to resurrect a project here in South Australia. Obviously, it would have to be with a different company and if they have a proposal to put it to us, and they're doing that hard work.
 
But again, I say the thing I'm most distressed about with this very serious failure is for patients and their families, because often these patients are very young children who, until there is a proton therapy unit here in Australia, are only able to access treatment overseas. And in the interim, what I've asked my department to do is to look at the program that does support patients going overseas, at the moment usually to the United States, to make it more streamlined and more responsive to the needs of patients with these paediatric cancers that, until we have our own unit, are only treatable overseas.
 
JOURNALIST: So can you clarify how much money has actually been paid to ProTom International and its suppliers? And how much of that are we likely to recoup?
 
BUTLER: I can't talk for South Australia. The commitment from the Commonwealth was essentially the purchase of the unit. South Australia would then take on responsibility for the place, if you like, which was to be at the Bragg Centre across the road in North Terrace. I've asked my department some time ago to do everything it could to recover as much of the $68 million as is possible. I don't think that request or that direction from me is yet complete. This is a company that I think is in serious trouble globally, so we are trying to work out really how much of that money is going to be able to be recouped, if at all. But it seems quite clear to me, on the best advice I have from the department, that there is going to be a significant taxpayer loss here. I think there are questions about the degree of due diligence that was done by the former Liberal government, at a federal level as much as South Australia, on putting such faith and such an investment into a company that, frankly, had a pretty skinny record when it came to delivering these units across the world.
 
JOURNALIST: So if you were to put a timeline on it, when do you realistically think Australia will have a proton machine?
 
BUTLER: Unfortunately it's going to be measured in years. Even if there were to be a new supplier and a new arrangement concluded by South Australia with broad support, and we don't have that proposal before us yet, these things take some time to build and install. But look, I don't have that precise detail in front of me because we don’t have a proposal yet from South Australia. Thanks a lot.