MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Thanks for coming. One of the drivers of the success of Australia’s healthcare system is its blended nature. We have universal healthcare delivered through 700 public hospitals underpinned by Medicare principles, as well as a really strong primary care system. But from the introduction of Medibank by Gough Whitlam, and certainly the introduction of Medicare by Bob Hawke, that has always been supported by a strong private hospital system, funded in large part by private health insurance payments paid by millions and millions of families. And that private hospital system is responsible for about 70% of all elective surgeries, about 1 in 4 births, and receives very significant taxpayer support amounting to about $8 billion through the private health insurance rebate. All of these parts of our system are interconnected, and there's a very strong national interest in ensuring that every part of it, including the private hospitals component of the system is functioning well.
A few hours ago, the second largest owner of private hospitals in the country, Healthscope, entered receivership and administration. Healthscope owns 37 hospitals in every single state and territory, as well as having a contract to deliver the Northern Beaches Hospital in Sydney as well. About 650,000 Australians receive a procedure and care through a Healthscope hospital every single year, and Healthscope hospitals employ about 19,000 hard-working doctors, staff, allied health professionals and support staff. This decision to place the ownership of Healthscope into receivership is not unexpected. We've been meeting as the government with Healthscope now for some considerable time as speculation about this decision has really been spreading through the community, and made very clear our expectations that the interests of patients and hard-working staff will be the highest priority through this process once it eventuated. I want to be clear that I expect to see an orderly sale process eventuate from this decision to a new owner, with no impact on patients and no impact on hard-working staff. My department over recent hours has already met with the receivers and made that exact same point to them, and we'll be engaging closely through the receivership and administration process to protect the interests of staff and patients going forward.
I say that I'm being reassured by the Healthscope statement, that's been released over the last hour or so, that makes it clear that hospitals will continue to operate as normal, and I had a conversation over the last half an hour with the CEO, Tino La Spina, and I sought an assurance from him that the thousands of Australians who right now have a birth planned or a knee reconstruction booked at a Healthscope hospital can be confident that procedure will go ahead, as planned and as booked. I received that assurance from the Healthscope CEO, and I have to say, I will be holding the company and the receivers and administrators to that commitment given to me and given to Australian patients and staff. Happy to take questions.
JOURNALIST: Does this have the potential to put more pressure on the public system? And does it complicate negotiations with the states over the next hospital funding agreement?
BUTLER: There's no question that a disorderly process would have an impact on public hospitals. As I said, about 70% of elective surgery is undertaken in private hospitals, and this is the second biggest private hospital company in the country. About 1 in 7, or 1 in 8 private hospital procedures are undertaken at a Healthscope hospital. And that's why we've been so determined – and I know my state and territory colleagues share this view – so determined to make sure that if there is a sale of Healthscope hospitals, which is now clear there will be, that it's undertaken in an orderly, stable way that protects the operations of those hospitals, and through that the interests of patients and the very hard-working 19,000 staff members.
JOURNALIST: Is there any consideration of more public funding going to support for hospitals while there is this transition, on top of the loan that’s recommended?
BUTLER: As your question indicates, there are some months of funds available, both through the funds that were held before today by Healthscope and the new funding package that the Commonwealth Bank has led and announced over recent hours, that ensure that this company now has several months of operations open to it as we go through this – what I am confident will be a stable process of sale.
JOURNALIST: Did you consider, though, jumping in?
BUTLER: I made it very clear that the owners of this company, which you'll remember was an overseas private equity firm, would not receive a taxpayer bailout to deal with this. They need to go through a proper sale process, and I've made it really clear from the time that speculation first emerged about this that we would be ensuring that that sale process took place in a way that protected the interests of patients, but also the 19,000 hard-working doctors and nurses and staff who turn up every single day, 365 days a year, to deliver those procedures and that care.
JOURNALIST: What about down the track, though? Would the federal government be open to providing public funds if it's necessary to keep some of these hospitals open?
BUTLER: They have funds available to keep these hospitals open. There’s already very significant taxpayer support that goes into the operation of the private hospital system part of our terrific healthcare system. What I am confident about is that now the process has started, now we have this assurance from the company, and we’ve made clear that we expect receivers and administrators to respect that assurance that there can be a stable process, and new owners put in place that will continue. Many of these hospitals have been operating in communities for decades. They’ve only been owned by Healthscope in its current ownership structure through Brookfield, the Canadian private equity firm, for several years since 2018 or so. But many of them, I know from my own state, have been in place for decades and are a very important part of their community, and I’m confident will remain so into the future.
JOURNALIST: Will this further delay the hospital funding agreement? It’s complicated.
BUTLER: No, I see no reason why it would delay the hospital funding agreement. We're starting to put ourselves in a position as a re-elected government to start those negotiations again. James.
JOURNALIST: Just a question on the statement that says no taxpayer bailout. How confident are you that a buyer will be found and that an orderly sale process will take place? And who are some of the potential bidders?
BUTLER: I can't answer that second question. There's obviously been speculation, including in your newspaper, about potential interest there. But that really is speculation. It's a matter for bidders to make themselves clear. This is a very significant part of our healthcare system. As I said, most of the hospitals have been operating in their community for decades, not just years. This is a substantial business, and I expect that there will be a great deal of interest in purchasing it.
JOURNALIST: Minister, do you see this as an isolated issue, or is the collapse an indictment on the system itself that it maybe can’t sustain itself?
BUTLER: This is a sale. This is a sale of an ongoing business, operations that will continue right through this process. I wouldn’t necessarily share your description of this process. But it is clear and I've been very upfront including at this podium that there are some viability challenges to private hospitals as a sector, and that's why a couple of months ago I announced my expectation to insurers that they would lift the benefit payments ratios. The amount or the percentage of their income from private health insurance members that is actually paid out to hospitals rather than going into profits or management expenses of private health insurance companies. We've put a range of other possible reforms to improve the operation of the private part of our healthcare system, including the viability of hospitals.
But I think people who observe this part of our healthcare system understand that Healthscope and its ownership structure, particularly over the last several years, is something of a unique case, something of an outlier. I wouldn't draw any sector-wide extrapolations from what's happening in this company.
JOURNALIST: Just data as well from the AEC showing that hospitals and aged care facilities, the number of informal votes has increased by almost monumentally, much more than any other election. Is this an indication in your capacity as Health Minister that these vulnerable Australians need more support when it comes to voting so they know how to vote?
BUTLER: The first thing I'd say, particularly as the minister with responsibility for aged care and disability, particularly aged care facilities that I've been visiting for decades now, it is important that every citizen enjoy the right to vote. The outreach that the AEC has conducted for a long period of time into these facilities, to ensure that residents are able to exercise their democratic right to vote, is a critical part of our democracy.
Now, I've seen the headlines. I've skimmed the articles. I've been a little bit preoccupied with this over recent hours. There's certainly a very significant increase in informality in some areas, including, frankly, I saw in my own electorate. I look forward to that being the subject of significant attention, but I don't have anything to add to it.
JOURNALIST: Minister, just on disability, obviously, yourself and your office has said you want to roll out foundational supports as soon as possible, which is great, but still hearing from advocates and peak bodies today wondering, on that July 1 date that Bill Shorten talked about, are they going to see any detail, or do you expect this to be more of a 4-, 5-, six-month proposition?
BUTLER: I think I've said before the election on a number of occasions that the conclusion of the NDIS reform to rules, the finalisation of foundational support arrangements and the finalisation of a multi-year hospital funding agreement are all tied together, and I think all governments have recognised that interconnection of those 3 processes. I have to say that, from a Commonwealth perspective, the change to machinery of government arrangements that mean that I now have responsibility, and my department has responsibility, for the NDIS and foundational supports means that states now have a single point of contact, a single portfolio of contact.
But the position I think I outlined before the election remains the case. We are working to a timeline of finalising those negotiations, all 3 of those negotiations, over the course of the rest of this year. That has been discussed between the Prime Minister and premiers and chief ministers. There's obviously quite a deal of work to go to each of those three components, let alone considering them all as a job lot, but we're very focused on getting on with that work.
JOURNALIST: Can I tell disability advocates if they ask, July 1, can I say, listen, you're probably not going to see anything then?
BUTLER: What I just said was televised, and we'll be publishing a transcript, but I'm sure you'll also tell them, Sarah. Thank you.
JOURNALIST: Would there be changes to eligibility to the NDIS as part of this process?
BUTLER: I think the position that's been articulated through this reform process is that there's no change to eligibility that's been undertaken through these changes to reforms. But consistent with the NDIS review, there is also work undertaken to develop a system of foundational supports, what previously were called tier 2 supports for people who fall outside of the formal NDIS.
JOURNALIST: Why should they be trusted to continue running the hospitals when they’ve mismanaged their finances?
BUTLER: I think the point of this decision is that there are now administrators appointed around the ownership of Healthscope. Healthscope is going to be a very different beast going forward in terms of its ownership and ultimately perhaps its operations.
JOURNALIST: I know you said you sought reassurance, but is there anything to guarantee that patients and staff won't be adversely impacted?
BUTLER: I’ve sought that reassurance. I’ve received that commitment from the company, and we’ll be making that position clear, already have, to receivers and administrators through my department. It’s been made very clear to me that the thousands of Australians who have a procedure planned and booked at a Healthscope hospital, and there are literally thousands of them out there in the community right now, can have complete confidence those procedures will go ahead. There is funding that is available to this company to continue operations for some months through that period of time there will be an orderly, stable process of sale undertaken. James.
JOURNALIST: Just a question on ADHD. New South Wales looks to be following Queensland’s lead and make it possible for some GP’s to be able to prescribe that medication now. Listening to the ABC today, they said something like 7% of all kids now have that. There’s a chronic shortage of specialist psychiatrists, paediatricians who can prescribe these meds in states where it’s not possible to get, to go to your GP. Is there a way, or would you look to bring to the next state and territory meeting with health ministers, to harmonise natural laws around access to ADHD to make it easier to clear the backlog when you’ve got a $5,000 appointment in Sydney to get this medication? Or a 2-year wait in Victoria or Canberra or wherever it might be? It's a bit of a mess at the moment, isn't it?
BUTLER: I read the reports out of New South Wales this morning with great interest. I talked with people in Western Australia, which is where an earlier decision was announced by the Western Australian Government effectively to do the same thing, to allow GPs to undertake treatment and prescriptions for patients with ADHD diagnoses.
This is part of a broader piece of work that the Commonwealth is currently considering around scope of practice that is often seen as the interface between doctors and non-doctors, so pharmacists or nurse. But also within the medical profession, I think there's a lot of opportunity for us to think about what GPs can do but are currently not permitted to do.
Without stating a particular position about this, over the course of the last several hours I've sought a briefing from our department about ways in which we can look at what different states are doing here. There was, obviously, a Senate Inquiry into ADHD that raised some of these issues as well that we're currently considering. I know it's a matter of enormous frustration and distress to many families who wait for long periods of time to often have their children or teenagers seen and assessed and diagnosed, and then to receive treatment.
I welcome the collaborative way in which it appears the New South Wales Government has gone about this work, not just with the College of GPs but also with the College of Psychiatrists and Physicians representing paediatricians. And, as I said, I think there's great opportunity for us to work together as jurisdictions on a way forward across the country, not just in particular states.
JOURNALIST: Would you be able to convince COAG? Well, not COAG anymore but whatever it‘s called now, at the next health ministers’ meeting?
BUTLER: I'm not sure whether we'll make it for the next health ministers meeting. I'll have a look at that briefing once I receive it. We've got a meeting in the next few weeks. We meet very regularly as a group of health ministers. If it doesn't make the next meeting, which is particularly focused on mental health more broadly, then I'm confident we'll have a discussion about it in due course.
JOURNALIST: Will the government consider taking over any of the Healthscope hospitals with or in partnership with state or territory governments and bringing some back into the public health system?
BUTLER: That's not on our agenda right now. As I said, of the 37 private hospitals operated by Healthscope or owned by Healthscope, many of them have been private hospitals for many, many decades. Certainly, the South Australian ones I'm familiar with have been there as long as I can remember, and that's the case in other jurisdictions as well.
There is a 38th hospital, that I think I mentioned, in Northern Beaches in Sydney, which is a public hospital that was, effectively, contracted out to Healthscope by a former Liberal government, that's a bit of an outlier again. But ultimately, what happens in the future with that is a matter for the New South Wales Government.
JOURNALIST: Would you prefer this is purchased by an Australian entity? Would that be the government's preference?
BUTLER: Right now our focus is on ensuring continuity of operations and protecting the interests of patients who have procedures booked, and those 19,000 hard-working staff I've talked about a couple of times already. This was an unusual ownership change several years ago to have ownership of such an important part of our healthcare system transferred to an overseas private equity firm.
Our party raised some questions about the wisdom or some of the questions that were considered when that sales process was approved by the Foreign Investment Review Board several years ago. And I think over time there will no doubt be a bit of reflection about the wisdom of such important assets being held in the hands of overseas private equity firms. But that's not for today. Today, really, the focus is on the interests of patients and staff who work so hard in these hospitals.
I'm going to let the sale process run its course, overseen by receivers and administrators, But I want to be really clear that we'll be looking over the shoulder of all of those bodies to make sure that the interests of staff and patients going forward are protected.
JOURNALIST: Do you believe the business plan of a single entity owning so many private hospitals can be sustainable with the rising cost of healthcare?
BUTLER: That's subject to the views of the ACCC, which has expressed views about the concentration of ownership or the potential for concentration of ownership in the private hospital sector before, I don't have a particular view about that. I just want to make sure that private hospitals are owned and operated in the interests of patients and their staff. Yes, these are private operations, but they are part of a national good.
There is a strong national interest in the operation of private hospitals, as there obviously is in the operation of public hospitals. And I make the point again that the private part of the system receives about $8 billion a year in taxpayer support through the private health insurance rebate. And with that comes some social licence that obligates operators of private parts of the system to do so in a way that benefits the interests of patients, not just their owners or their lenders or their shareholders.
JOURNALIST: You mentioned that you'll be looking over their shoulders. Do you have the power to approve or deny a potential buyer? And also just separately, another question which is not in your portfolio, just sort of asking you as a government spokesperson, an Australian’s been charged with allegedly smuggling 1.5 kilos of cocaine into Bali. What does the Australian Government know about this case and are they assisting?
BUTLER: I'm not aware of that sorry, Chloe. To your first point, though, there is, as I indicated in relation to Brookfield buying Healthscope, the jurisdiction of the Foreign Investment Review Board. If there were consideration from a foreign purchaser, a non-Australian purchaser. Thank you, everyone.