ANDREW COHEN, FORHEALTH CEO: Good morning, everyone my name is Andrew Cohen, I'm the CEO of ForHealth. I'm joined by Dr Carolyn Roesler, our Clinical Director here. And we warmly welcome the Honourable Mark Butler, Minister for Health, Aged Care and now NDIS who is also our local member here in Hindmarsh. ForHealth is the largest bulk biller in the country. We see more than 7 million patient visits every year. Our mission is universal health care, and we really focus on low socio-economic and more regional areas.
And before we turn to urgent care, I just want to take the moment to say thank you to the Albanese government for what is a historic $8.5 billion investment into Medicare, and in particular bulk billing. You know, we take this as a real vote of confidence in the Medicare system but also a shot in the arm to bulk billing. And to give you some perspective on that for our clinics, we have about a hundred clinics. One in ten are currently bulk billing only, and we think that from 1 November the vast majority of our clinics will become bulk billing, so it’s really transformational to our business, but it’s also incredible transformational to the communities that we serve in terms of healthcare access.
Complementary to that is urgent care, and urgent care is really a safety net. It's a safety net of access for patients that need episodic urgent care that doesn't fit into an appointment-based system in general practice. Most of those are afterhours, and they’re not only giving people access but they’re taking pressure off emergency departments. For us to give you some sense of what that looks like, for every clinic that we have there’s more than 50 patients a day, and that number continues to grow as people become aware of the service. Of those people, 9 out of 10 that come into our practices highly recommend the service, so they mark it 5 out of 5 stars. And the average time between when they come in and are triaged to when they commence care is generally 30 minutes or under. Half of those patients say that they would have otherwise have gone to the hospital. So that gives you a sense for some of the statistics. But I suppose the stats only really tell you part of the story. Really what tells you how this impacts community are the patient stories. And I'm going to ask Dr Roesler to kind of tell you one patient story, one out of the 1.5 million patient stories delivered to date. I just asked her for a story here in Adelaide in the last week. Thank you.
DR CAROLYN ROESLER, FORHEALTH SA CLINICAL DIRECTOR: Thank you. As Andrew said, the stories often make the staff and myself feel very humbled and very grateful for the work that we can do in urgent care. And it's these letters of sincerity of the appreciation of the care that are quite touching. I'm going to share and highlight some feedback that we received last week and use the patient's own words. However, I obviously for confidentiality will not name the patient.
The patient says: Honestly, I can’t thank these guys enough. I ended up in a really bad state with an abscess exploded on my upper thigh. I attended urgent care, and there was an angel of a nurse who saw how bad I was. I was struggling, but she got me triaged and into the doctor immediately. The doctor made me his first priority to get me pain relief. He then removed the abscess right there, saving me a dreaded hospital visit. The nurse checked in on me every step of the way, and ensured that I was safe. One day later, I feel so much better. I can actually walk without crying. The doctors, the nurses, the whole team have gone above and beyond, and if it wasn't for them I'd likely be in hospital right now. So, thank you.
That obviously is a really lovely piece of feedback and echoes and resonates on what other consumers are feeling. But I will now hand over to the Honourable Mark Butler.
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Thank you Dr Roesler, and to Andrew. ForHealth has been a huge supporter of our Urgent Care Clinic model. It was only this week three years ago that the Albanese Government was elected and at that time a Medicare Urgent Care Clinic model simply didn't exist in this country. Very common in other countries to which we usually compare ourselves, but we promised at the 2022 election to establish that model to open 50 Urgent Care Clinics during our first term, and we've opened 87. They started opening in the middle of 2023, they've been operating a little less than two years, opening progressively over the period of that time, and have already seen one and a half million patients. Every single patient, including the one that Dr Roesler just talked about, has been fully bulk billed. A third of them are seen on weekends. A very significant number of the rest of them who are seen on weekdays are seen after 5pm or 6pm, when their usual GP will usually be closed. And interestingly, a third of them are under the age of 15. Kids getting injured at sport or playing on their skateboard, or kids who wake up in the morning with a respiratory illness that is really worrying, or a fever that's worrying to their parents. They're able to be seen quickly, effectively and as I said completely free of charge because it's fully bulk billed.
The last election campaign a few weeks ago we promised that we would open another 50 clinics. Over the course of the coming 12 months or so, we will have 137 Medicare Urgent Care Clinics operating across Australia. Four in five Australians will live within 20 minutes’ drive of a Medicare Urgent Care Clinic that is open seven days a week, 365 days a year, extended hours and fully bulk billed. We think that once the network is fully up and running, it will see about 2 million patients every single year. As Andrew said, about half of those patients say that they would otherwise have had to go to a hospital ED. Not only is this providing high quality care, free of charge, in a person's local community, it's also taking much needed pressure off our busy hospital emergency departments.
This is all part of our strengthening Medicare agenda. We started it three years ago. An agenda that was focused on more doctors and nurses, more bulk billing, more Urgent Care Clinics and cheaper medicines. And that is exactly the agenda of delivery that will focus our time and energy over our second term in government. Happy to take questions.
JOURNALIST: Minister, how do you think the literacy is of people that might think they want to go to the ED but have to come to an Urgent Care Clinic as well? Do enough Australians know that this is an option?
BUTLER: Dr Roesler might want to comment on this as well. We've focused very hard on advertising that it’s targeted to communities that have a Medicare Urgent Care Clinic, to educate people about what this new model of care is designed for. It’s designed for urgent care, as the name suggests, so you need care urgently, but not the sort of life-threatening emergency that hospital emergency departments are set up for. There are some cases where people are presenting to Urgent Care Clinics for cases that aren’t really in scope for this model, but they’re very few. Actually, I’ve been surprised at how few number of people who are presenting to a clinic like this for a matter that’s either not urgent or should be dealt with by a hospital.
As we were opening these clinics, we worked very closely with state governments and with ambulance services to ensure that there were clear protocols agreed between local hospitals and Urgent Care Clinics like this. The local Queen Elizabeth Hospital for example, if you go up to the QEH you'll see advertising and signage very clearly explaining to people if they should be coming to the ED at the QEH, or whether instead they should consider coming to the Urgent Care Clinic here down the road at Royal Park. There's bunting still right across the front of the QEH trying to give people in the Western Suburbs that sort of information, so they make the right choice about where to go.
But I know if someone presents here at the Urgent Care Clinic or any of the other 87 Urgent Care Clinics, and it's clear to the triage nurse or the doctor they should be at a hospital, there are very clear protocols in place for an ambulance to come and get them immediately. I'm not sure that Dr Roesler wants to add to that.
ROESLER: No, that's right. There's been a lot of work with stakeholders, as you've mentioned - the PHN, the ambulance, the emergency departments and consumers themselves. We don't see ourselves as a wrong door and, in fact, we feel that we can expedite care of those that may be arriving and they should be in a hospital, we make sure that their transit is smooth. And for others we will obviously utilise, navigate, and educate through health pathways. The education piece is something probably undervalued on what the urgent care can provide – so, giving parents some education on flu or cold management et cetera so that everyone gets the help that they need to be at - whether it's in the centre or it might be through another healthcare provider.
JOURNALIST: You mentioned that making people avoid waiting hours at the hospital. How long is the average wait here? Would people still be waiting hours or is it significantly less than there would be in ED?
BUTLER: Like any service there are busy times that all of the Urgent Care Clinics are facing. But I think Andrew talked about the fact that - I can't remember the percentage but maybe you can answer this question?
COHEN: My understanding from the report is that the medium wait time is about 35 minutes.
JOURNALIST: Fantastic. And just on a local level, Minister. I mean, we know that these urgent clinics are designed to keep people away from the ED but we're still seeing, you know, the ED is quite full, we're still seeing ramping uncomfortably high. Is it working here in Adelaide?
BUTLER: I think we know it's working in all of those catchments where there are Urgent Care Clinics. Different states report in different ways, but where states are reporting on their local hospital activity, where there is an Urgent Care Clinic there's a significant reduction in what we call category four and five presentations. They are the non-urgent, semi-urgent presentations that account for about half of the ED activity in the country – about four million out of the eight and a half or nine million ED presentations that happen every single year. There’s no doubt that it’s taking some pressure of local ED’s. That doesn’t mean they aren’t still busy. We’re a growing population, we’re getting older, we’re a little sicker. There’s still some deferred care in systems from the COVID pandemic.
In addition to this we’re working very closely with state governments to help and support them in the operations of their public hospitals. Here in South Australia, for example, there will be a 15 per cent increase next financial year, so in a few weeks’ time, in the Commonwealth's contribution to the operation of the South Australian public hospital system - the biggest increase in anyone's memory I think from the Commonwealth to support the hard-working doctors and nurses and staff at hospitals like the QEH and elsewhere across SA.
JOURNALIST: Speaking of hospital funding, now that you are back in government how long is it until we see a new five-year public hospital funding deal, and have negotiations begun there?
BUTLER: We're still getting our knees back under the desk. I'm taking briefings about that and other issues within my portfolio across health and ageing and disability. You'll recall that we struck a one-year deal with states and territories for funding for the financial year 2025-26, that kicks in, as I said, in a few weeks' time. And there was an agreement across the governments, between First Ministers, to work very hard over the course of the rest of this calendar year to strive to reach an agreement for a five year funding deal for hospitals by the end of the year, so by Christmas. But also, the associated deals that are being negotiated in disabilities; NDIS reform and also the development of foundational supports for people outside, people with disability outside of the National Disability Insurance Scheme.
We're now working through our briefings on that but we remain committed to that target to get those agreements all done by the end of this year.
JOURNALIST: Minister, will the new Alzheimer's drug be put on the PBS?
BUTLER: It's obviously very exciting news to see the TGA has approved Donanemab, which is a new treatment for early stage Alzheimer's from Eli Lilly. There's been a lot of coverage and commentary about this drug over the last couple of years. Because we've known now for, pretty much, 40 years the role that the amyloid protein plays in the development of Alzheimer's in particular, but we haven't seen a therapy that would target and reduce the presence of amyloid on the brain. This does that.
It’s not uncomplicated, there are pretty challenging issues about scanning, particularly using PET scans to detect the amyloid to determine which patients would be eligible or would benefit from this medicine. And also, some side effects that we need to be very conscious of as a patient goes through a course of therapy for the Donanemab and well known that be well canvassed across the world.
I welcome the approval for Donanemab by the Therapeutic Goods Administration. There is still a fair way to go, though, to determine whether or not this will be reimbursed by the Federal Government and, if so, for which patients. The Pharmaceutical Benefits Advisory Committee, which essentially determines the advice to Government about which medicines do end up on the PBS, is considering this drug in July. There will also though, need to be consideration of the associated scanning that needs to take place for patients. First of all the PET scans to determine eligibility, but also pretty regular MRI scans over the course of treatment to determine whether or not there is any associated brain bleeding and whether the drug is having the desired effect in terms of the presence of amyloid on the brain. A bit of a way to go but very exciting news for the Alzheimer's community.
JOURNALIST: You have flagged that you would like to do more to address out-of-pocket fees for specialist appointments. Might we see a rebate rise?
BUTLER: That's not on the table right now. The first thing that we want to do is provide patients with better information. The former government, under former Minister Greg Hunt, tried to do that through a voluntary opt-in scheme called Medical Costs Finder, where a specialist would upload the gap fees that they charge their patients. I think of the tens of thousands of specialists covered by that, I think we had a few dozen specialists who had uploaded their fees. Not a very successful foray by a former government into transparency and information sharing.
I made an announcement before the election that we will collect the information, the gap fees that every non-GP specialist is charging whether they're an anaesthetist or a surgeon. And we will upload that to the Medical Costs Finder so that patients, when they're considering, for example, a knee operation, will have the best possible information about the range of gap fees, for example, that are charged in the western suburbs of Adelaide. And they can make an informed choice about who they end up going with or seeing and having an operation by.