Q&A with Minister Butler, National Press Club – 22 April 2026

TOM CONNELL, HOST: Thank you Minister. A lot there. I might start with a broad question, because you've been speaking about a lot of these issues and even, sort of, the solutions for quite a while as well. Is it fair to say that you were hoping you could convince a lot of people, whether it be providers, people doing diagnoses and so on to do the right thing, and now it's just time to make them do the right thing?
 
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: I've tried to be honest about what I think are some genuine flaws in the design of this scheme. This scheme was designed with the very best of intentions and with so much enormous buy-in from the community, from states and territories, and obviously a Labor government and two Labor Prime Ministers in Kevin and Julia who wanted this to be a serious legacy of their time in Government. But I think as time has gone on, we've found that some of those design features aren't working well. They're not working well for government, but more importantly, they're not working well for people with a disability.
 
Now, I've tried to take a sequenced approach to this. I came here, as you said, Tom, in August last year to outline our plans for children under the age of nine, Thriving Kids reforms that are in the process of now starting to be rolled out. And I said back then that I thought the eight per cent target that National Cabinet had agreed needed to be built upon with a lower, more sustainable target, and essentially, said that was something that National Cabinet had to discuss, and they did that earlier this year. From that decision of National Cabinet a couple of months ago, I've taken it as, effectively, a tasking from National Cabinet to work out a plan to deliver that growth target and to achieve what every government wants, Liberal, Labor, State or Federal, and that is to secure the NDIS for the future, for the long-term future.
 
Yes, this has been a process that started with the NDIS review that we commissioned when we came to Government by Bruce Bonyhady and Lisa Poole, a review accepted by all governments back in 2023, and it will take some time to work through. But frankly, some of the well-intentioned measures that were put in place by us in our first term that we thought would start to control spending, just aren't gripping. They're not gripping because of some of these system flaws, some of these uncertainties in the legislation that we need to clear up. And frankly, some real problems in a chaotic free-for-all market that was allowed to build up over the last 10 years that's not spending taxpayer money well and not serving the interests of participants.

JOURNALIST: Thank you. NDIS will come in at about $50 billion this year. You've just signposted you only want it to be $55 billion in five years' time. That's growing at about $1 billion a year from growing at about $5 billion a year at this point. It suggests these changes will need to be made very quickly. So, when will you expect the eligibility changes in these coming laws to come into effect? Will that see a, kind of, a mass progression of people outside the scheme? And then, how will you cut back on that $12 billion figure for community and social participation will that also involve overnight changes to people's plans and restricting what people spend money on?
 
BUTLER: This is what people were saying in no one asking one question, wasn't it? 
What I've tried to set out is a two-stage process. The first is we need urgent financial controls put into this scheme. That is why I'll be introducing legislation as soon as budget resumes in budget week, and seeking the passage of that legislation during that session. That will allow us to deal with some of the growth in spending that we've had reported to us from the Actuary, the $13 billion blowout that I referred to, and also some of the other areas of uncontrolled growth that we're continuing to see. This is just about good management.
 
We want to see that passed by 30 June, and many of those measures will start to take effect immediately, start to take effect immediately. For example, cutting down on unscheduled reassessments, which is a big driver of growth. In terms of eligibility, that is something obviously we need to work through much more carefully with the community and with states. We want to have that work supported by a technical advisory group, and that will happen over coming months. I'd like to see that work done by the end of this calendar year so that we can then start putting in place new eligibility rules that people all understand in building that assessment tool. I'd see that starting on 1 January, 2028, for new entrants or new applicants for the scheme, and then would be the subject of ongoing reassessment for existing participants over a period of time as their plans came up for renewal.

JOURNALIST: Hi. So, in the current cost of living crisis, why have you decided to cut the supports of NDIS participants? Will there be additional supports to help us cover the cost of living?
 
BUTLER: Thank you for those questions. We've worked very carefully to identify where we think we can control spending growth, and areas where we think we need to, essentially, preserve existing support. Those areas of support that are essential for daily living, accommodation, supports, personal care, transport, hygiene, continence, medication management and all the rest, will not be subject to any of the controls that I have talked about.
 
The areas where we think there is spending growth that we need to constrain are things like unscheduled plan reassessments. There will still be the capacity for those reassessments, but they should only happen in exceptional circumstances where there has been a significant change in circumstance for the participant. Social and community participation, I understand, will have a material impact on existing participants. Getting that spending back to where it was a few years ago is going to mean a reduction in the number of hours that participants have to spend on that. Now, for people who are SIL or supported independent living participants, they'll be able to reallocate some of their activities of daily living budgets to fill that gap. But for others, that will have an impact and I understand that.
 
We haven't done that lightly, but an area that has tripled in the last five years alone and is projected to grow to $20 billion in itself is not something we think we can continue to sustain. But it's not just about the spending, it's the quality of those supports, which is why alongside that we are building this inclusive communities fund. Because we want to rebuild the capability of community organisations whether they're traditional disability organisations or sporting clubs, arts groups and so on and so forth, to host NDIS participants in them. That was the original vision of the social and community participation element of the NDIS.

JOURNALIST: Thanks, Minister. Wow, there was a lot in that. Two per cent growth over the next four years, that's below where inflation is at the moment - it's about half of inflation and we're only expected to get higher. Isn't this a cut in real terms?
 
BUTLER: I've tried to be honest about this with people. It was a deliberate decision of Government to pull this out of Budget, and not just announce this in budget night, which you all know is a pretty mad week, there's a lot happening. Because we want to have an honest conversation with people about this. To reset this scheme, both those areas where spending is growing out of control and to return the scheme to its original intent in terms of the scope of its coverage, there is going to be a period of very low growth. Resetting the scheme means that, over that forward estimates, on average, growth will be, across those four years, just two per cent a year, that's as we reset it to its original intent. Now, once that job is done at the end of the decade, you'll see it returned at more like five per cent, which I identified last year as the proper rate of growth for a social program which is mature - that's, essentially, population growth plus inflation.
 
But I wanted to be honest with people. I wanted to allow a bit of conversation about this package, this plan, separate from the budget week, which will take place in two or three weeks, so that people can chew over this and really understand it. I also wanted to be honest about the fact that there will be some areas where there is a material impact on participants, particularly in that area of social and community participation. It's a hard decision but it's the responsible, the right decision for us to take as a Government. Because we cannot see this scheme continue on its current path. It will be unsustainable from a taxpayer point of view, but much more importantly, its community support, its social licence is slipping away, and we can't let that continue to happen.
 
CONNELL: You spoke about an honest conversation there in terms of real dollars and number of people. In the short term it's not growing, it's shrinking. That's the honest take, isn't it?
 
BUTLER: It will continue to grow. Now, you can match this against inflation, which is jumping around a bit, but if it, Katina is right, if inflation is significantly higher. But we need to recognise this four-year period as a reset period. It really is going to change the nature of the scheme in some areas of expenditure and also in terms of the coverage. The number of participants that is covered will, I've tried to be honest, will change over the course of the next four years, so that will have an impact on the total spend of the NDIS.
 
But once that reset is done and it’s absolutely the right reset, I’m convinced of that. Then of course the scheme will continue to grow in an appropriate way, like other social programs. That 5 per cent growth is what you will see in areas like Medicare and childcare and such like, and that's where the NDIS should be as well.

JOURNALIST: Sarah Ison. Thank you for your speech. Can we take from your speech that you'll be looking to expand that effort of diverting kids under nine with autism, you'll expand it out to people over that age group and more adults with autism and so on? And if I can just ask, the PM says he doesn't see the NDIS as a fiscal position. Jim Chalmers says it's central to the savings of this budget. Which do you agree with?
 
BUTLER: I always agree with my Prime Minister and my Treasurer, so I’ll agree with both of them.

JOURNALIST: It's a fiscal position?
 
BUTLER: I've been around long enough to know that's a very wise course of action, and with my Finance Minister as well. But let me say, because I've seen some coverage about mental health potentially being an area that we seek to move away from the NDIS, and there's just no basis for these reports. What I tried to say in my speech is I want to get away from the diagnosis list, the diagnosis gateway. We need to return the scheme back to a question of functional capacity. That's what it was built on, the idea of people with significantly reduced functional capacity that impacts their day-to-day living needs. There's no particular area of diagnosis that will be treated differently to others. What it will it will mean, though, is that Australians with lower support needs or higher functional capacity, depending on your perspective, will be moved out of the scheme.
 
JOURNALIST: So adults with autism would fall into that?
 
BUTLER: Depending on their support needs. But adults with other disabilities or other diagnoses will be assessed according to their functional needs, not according to the label that a particular doctor has given them.
 
On the other question, I just want to be really clear about this. Obviously, the NDIS is important for the Budget because it is such a large social program now. But I want to be really clear, this is exactly the package I would have taken to the Expenditure Review Committee, no matter what the budget context, because this is the right package for the NDIS and it's the right package for participants.

JOURNALIST: Thank you. Minister, Mark Riley from Seven. I just want, a bit of overlap with Sarah's question, but I just want to investigate the reduction in participants from 760,000 to 600,000. I know it's not pure maths, but who are these 160,000 people? Are they primarily kids with autism? Are kids with autism on the NDIS now going to be reassessed, and could they be diverted away from the scheme towards Thriving Kids? Or is it only for future applicants who might be diverted that way?
 
BUTLER: Thriving Kids was built for under-nines and that work is underway. They've been the subject of agreements with states and territories. We've had great discussion about the design of that model. That's sort of off and running, if you like, for under nine-year-olds. For people over nine, what I'm announcing today is that their functional capacity will determine whether they stay on the scheme or whether they enter the scheme in the first place. And if they have lower support needs, they won't be on the scheme in the long term and they will return to the sorts of support systems that were in place before the NDIS, and frankly, were always intended to continue to support those people.
 
Now, just because of the numbers of people with autism on the NDIS, the biggest area or the biggest cohort on the NDIS, that will impact adults and older children with autism if they have those lower support needs, if they're objectively assessed as having lower support needs. But it equally will impact people with other diagnoses or other disabilities. It's not about singling any particular area out. The important thing though is that we rebuild those other support systems. They were always in place. The NDIS review that Bruce Bonyhady and Lisa Paul recommended, we rebuild them. All state governments agreed with us about that in 2023. We've allocated $10 billion in total for that work, $4 billion has been essentially allocated to Thriving Kids, $6 billion is still there, allocated by all governments to start to rebuild those local community supports, whether it's for older children or whether it's for adults with low support needs. Obviously, we can't leave people between two stools. The rewrite of eligibility systems has to happen in tandem with the rebuild of those local community support systems.
 
JOURNALIST: At the risk of breaking the rules and asking another question.
 
BUTLER: Everyone else has.

JOURNALIST: Yeah, I know.
 
BUTLER: In for a penny, in for a pound.
 
JOURNALIST: You know me, I'm such a follower, Minister. But have you just said that each person under the NDIS will be reassessed for their suitability to the scheme? If they're not suitable, they may be shifted off?
 
BUTLER: Yes, I said that in my speech. And frankly, reassessment is a part of the NDIS currently. Yes, over a period of time, we will. Over the coming months, we will work on an objective assessment tool. That's been clearly the expectation of the NDIS. It's just work that hasn't happened, with the support of a technical advisor group, with the participation of the community and with states. And I would expect that to be in place for 2028. Now, that will govern entry to the scheme, in my expectation, from 1 January 2028, and will be the tool that governs reassessment of people, which happens at the end of their plans.
 
JOURNALIST: Thank you.
 
JOURNALIST: Okay. Just back to the Thriving Kids thing and the current negotiation with the states which began back in 2023, by my calculation you've now given them $25 billion extra in hospital funding between now and 2030 and an extra $10.5 billion in GST top-ups. How much or if any of that money won't be handed over if the states don't sign up? I know you're doing it on a bilateral basis, but, for example, Queensland, which is the most recalcitrant at the moment, are you prepared to say to David Crisafulli you're not getting that dough if you don't sign on?
 
BUTLER: I think everyone, let's leave aside the fact that there's always politics played here. You've been around long enough, Phil, to know that states and state and federal governments -
 
JOURNALIST: You've wafted a lot of money after them, yeah.
 
BUTLER: There's a bit of political posturing here. But there have been moments over the last three years where state governments could have said to the Commonwealth, you do NDIS, you do foundational supports, and we'll look after the hospital system. We don't need any extra money from you. They didn't do that. They said, we need extra hospital funding and we'll do some heavy lifting with you on the NDIS. We'll sign on to foundational supports. We'll deliver the Thriving Kids program. Now, there was an opportunity for Queensland or any other state to say they didn't want to do the package deal that was done a few months ago, but they didn't take that opportunity. They all signed on to what is a package deal. It wasn't a buffet that they can pick and choose from. I like this bit. I love the $25 billion extra funding for hospitals. This was a package deal. And of course, we expect states and territories to implement it, but much more importantly, the community expects them to deliver it. I think community members, people out there, just want government to get on with it, build the Thriving Kids program, get the NDIS back on track, make sure there's enough funding in our hospitals for them to operate properly.
 
This has gone on for two and a half years. We can't have more political arm-wrestling between jurisdictions. We've done the deal. Governments now have to abide by the deal and get on with the hard work of building better supports for their communities.
 
CONNELL: And if they don't, will money be withheld?
 
BUTLER: I've seen a bit of coverage from one jurisdiction. I've not got any indication from the Queensland Government. I don't think the Queensland Premier has said that Queensland wants to withdraw from the National Cabinet deal that would see them receive, I think, about $5.7 billion in additional hospital funding. I take this as the usual sort of arm-wrestling that happens between governments in these challenging areas. Budgets are growing. We know that in hospitals, in disabilities, in aged care. There's a lot of pressure on all levels of government. That's why we worked so hard since 2023 to come to a sensible deal that divided responsibilities appropriately, but shared responsibility for making sure that people out there got the best possible support.

JOURNALIST: Thank you, Tom. Thank you, Minister. You mentioned scammers and shonks but also organised crime being involved in some of the rip-offs that are going on. Serious operators on the criminal side. Is this blended Fraud Fusion Taskforce that currently looks into the scam and the fraud enough, or does this need to be placed solely in the hands of law enforcement to save money, save the system and ultimately save the reputation of the scheme?
 
BUTLER: We haven't been able to just flick a switch and move from a completely unregulated market that we inherited four years ago into something where we have a line of sight over everything and can send the cops in if something's not going right. But we've been building very steadily. We now assess the same number of claims every single day that were assessed in an entire year under the former government. We've got this taskforce operating. There are more prosecutions. There are more people being banned. But as I've said today, we need to build out our registration system so we're confident that particularly providers of really close services are registered and comply with a whole range of quality indicators. And the measures I announced today mean that 90 per cent of all payments will go to registered providers. But the really critical thing that we announced today is to move to a digital payment system. That means that everyone receiving a payment through the NDIS will have to basically declare themselves, and we’ll be able to compare data between government agencies. We’ll be able to trace where payments are going. It’s about building, really, a series of measures that together will give taxpayers and participants more confidence that the money from taxpayers is going to where it actually needs to be.
 
The Criminal Intelligence Commission evidence though to the NDIS integrity inquiry that I talked about is pretty sobering. It’s not just some sort of fly-by-nighters that are making a bit of money out of the NDIS. They have been attracted to this honeypot as well, and it is, as the involvement of the Intelligence Commission indicates, requiring a whole range of resources across government to combat.

JOURNALIST: Thanks Minister. A lot of governments around the world are struggling to balance social welfare spending, defence spending and all the other things that governments think they need to spend money on. And you've spoken about the NDIS as being something the Labor Party and the government is very proud of, also a model for other countries. When you speak to other countries or when you talk about this, what are the lessons that people should draw about what they should not do? You spoke about a number of design flaws in the scheme itself. Looking back over the 10 years or so that it's been in place, what are the things that were mistakes that other places could learn from what Australia did wrong?
 
BUTLER: This is a unique scheme. It's not really something necessarily that we compare to other countries because there aren't many systems like this. This is a unique scheme in the sense that it covers people every day, usually for their entire lives, people with lifelong disability. Very different to the episodic support people might get from the healthcare system. Very different to aged care where people will get that same level of intensive support but for a relatively short period of time at the end of their lives. The philosophical underpinnings for a lifelong scheme of support are necessarily different. They involve much more choice, much more control, much more individualisation of support needs than you'd see in other health and social care systems. I think that was the right philosophy that the designers of this scheme had in mind 10 or 15 years ago.
 
But it also would have benefited through its implementation through applying some of the core design features of a good social program. Eligibility, who's in? What do they get? A good service list so that we know what they're actually getting once they are in. What are the pricing regimes? A disciplined pricing regime. And fourthly, what are the quality assurance mechanisms in place? These are the four pillars of any well-functioning social program.
 
Yes, you have to overlay that in the NDIS with the unique philosophy of a scheme for lifelong support. But I think what I've tried to outline today is the need to get back to those basic design pillars of a well-functioning social program that's working for participants but also is effective for taxpayers.

JOURNALIST: Minister, thank you for your speech. You mentioned a few times during that speech your intention to return the NDIS to its original purpose, its original intent. The changes you're announcing today will reduce choice of providers, they'll reduce the abilities of what plan managers can do, they'll reduce social participation, at least in hours, if not in what people can do, but certainly that builds on those reforms of last term that also restricted the options for NDIS participants. When the NDIS was first formed, it was based on control, individual, individualised plans, the freedom for NDIS participants to choose their own lives. Is the government accepting that it can no longer meet the original promise of the NDIS?
 
BUTLER: As I said in response to the last question, choice and control has got to be at the centre of this scheme. To ensure that it delivers what people with disability and their families want and need and deserve, choice and control has got to be that core philosophy. What I have announced today, though, is a move away from the let it rip market that I think has built up over the last 10 years, where there's very little oversight or line of sight about the quality and the qualifications of providers of essentially taxpayer-funded services. In some areas, particularly in really critical areas like supported independent living where people are getting very close personal supports that goes to the core of their wellbeing, we want to commission those services.
 
People, organisations have to apply and demonstrate their compliance with certain performance measures or qualifications, and then from that panel, yes, people can choose. We're not going to say to individual participants, you have to deal with this provider. There will be a panel, there will be still choice and control, but it won't be this free-for-all market that has developed over the last 10 years and is serving no-one's interest.

JOURNALIST: Minister, in the lead-up to this announcement, you didn't want to rule in any ideas. You wanted this to be a big debate. You were asked at the time about co-contributions and means-testing. Have the changes you announced today mean that a future government won’t need to go down that path? Are you still open to those ideas?
 
BUTLER: Means-testing and co-contributions won't be a part of this plan. Going back a bit to what I just said, there are unique elements to a scheme that supports people with lifelong disability and the design of this scheme was always premised on universal access. There was never any means testing in the scheme in its design or its implementation. And I still think that's the right approach to a scheme for lifelong supports philosophically. More practically as well, if you think about how means-testing would work for people who need lifelong support, who overwhelmingly have pretty limited financial means, it wouldn't deliver much anyway. Whether you think about this philosophically or practically, it doesn't really add up. It's why the Prime Minister ruled it out and it's not a part of this plan.

JOURNALIST: Rayane Tamer, SBS News. Thanks, Minister. On the scrapping of subsidising private health cover, how will you ensure thousands of older and sometimes vulnerable Australians don't fall through the cracks, those who relied on those subsidies during especially a cost-of-living living crisis but also not so reliant that they required aged care system assistance?
 
BUTLER: Look, as I said in my speech, this is the decision that Howard made to pay a higher rebate for over 65s compared to the general population. It makes no policy sense. If you're trying to use the rebate to shift behaviour, this is the cohort that would have the least behavioural response to an additional rebate. We know that. The number of people that we project will leave private health insurance because of this change is about 0.4 per cent in a market that is growing by about 2 per cent a year. It will have a very, very minimal impact and had no policy merit.
 
But from our point of view, it's more about equity. Like it's just, to me, it makes no sense from an equity point of view for government to pay a higher level of support to one household than they do on the other, where they have exactly the same income, but happen to be of different ages.
 
Now, I know this will be a hard decision for households with private health insurance over these ages but I think at a time where the budget is constrained and where we have to find more funds for aged care, we have to do more heavy lifting in aged care because of that demand trajectory I talked about in my opening, we just have to take these hard decisions. I don't want to take them, but we have to take these hard decisions.
 
CONNELL: And it won't be means-tested? Did you consider a later sum?
 
BUTLER: The two elements of the rebate that I think, from a policy and equity point of view, that were poorly designed by Howard was firstly that everyone got the same. There was no means-testing. You'll remember, Tom, when we were last in government we did introduce means-testing for the rebate. It was a struggle to get it through the parliament but we got it through the Parliament. We've done that. The second inequity really of Howard's model or legacy was this intergenerational inequity, and we're dealing with that in this budget.

JOURNALIST: Thanks Minister. What you've outlined today will require a lot of cooperation from the states, but as you've mentioned Queensland still isn't on board with Thriving Kids. So how can you be sure that they and all the other states and territories will agree with what you've said today? And just back to the National Cabinet meeting you were talking about before, states told you and the Prime Minister that they would agree to increase their cap on contributions to 8 per cent from 2028. What assurances have you got that they remain committed to that?
 
BUTLER: They signed a deal. I've got their signature.
 
JOURNALIST: Didn't they sign a deal on the Thriving Kids though?
 
BUTLER: I tried to make that point earlier too. Call me old-fashioned. You sign a deal, you stick to it. They signed a deal twice. Back in 2023 when I conceded, Premier Crisafulli wasn't in the chair. But earlier this year again, that their escalation rates would increase to 8 per cent. Currently they're only paying growth of 4 per cent or lower. For state and territory governments, it's in their interest as well that we get this spending growth under control. There'll be a benefit to their budget as well.
 
But I know that in their hearts they also share that interest in getting the NDIS back on track. They've signed this deal. They signed a deal that committed to implementing Thriving Kids. We haven't yet got them to sign the bilateral deal that sets up the design of the model effectively that every other state and territory, Labor and Liberal, have signed. But I expect they'll do that because I know their community will be asking, their Queensland families will be asking, well, what's going to happen to us when these changes take effect? Where are the local supports for Queensland families going to be when every other state and territory is just getting on with it, just getting busy building those supports, and Queensland seems to be willing to sit on its hands? I just don't think that's a sustainable position for them.
 
JOURNALIST: So you're confident that they will get on board with these reforms?
 
BUTLER: I'm always an optimist.

JOURNALIST: Thanks for taking our questions, Minister. Last year, you said that participants with psychosocial disorders were the next big cohort of work. Where are you up to with that, and do they face a higher bar under the assessment tools that you've talked about today for 2028 and beyond?
 
BUTLER: The second question, no. As I've tried to indicate, there's no different bar, to use your language, for particular diagnoses. This will depend upon people's functional capacity. And as we think about who we expect would likely be shifted from the scheme now onto one of these systems of community supports, it's a very small number of people with psychosocial disability. We're pretty confident the people on the scheme now with psychosocial disability have very high support needs. It's not easy for someone with mental health needs to get on to the scheme. If anything, there's probably some unmet need outside of the scheme, which has been identified in discussions between state and territory governments.
 
Rachel Stephen-Smith is here. Health ministers have had a number of discussions about this cohort, including with mental health ministers in those jurisdictions where they exist. We only did that a couple of months ago and we're determined to have that as the next cohort. That will be part of the negotiation process that will happen next year in our mental health and suicide prevention agreements.

JOURNALIST: Thank you, Minister, for your speech. You've mentioned the hospital funding agreement. The ACT hospital system has been under so much pressure that the Territory Labor Government has imposed a health levy on ratepayers. They argue that the ACT hospital system is underfunded relative to the cost of providing care in a smaller jurisdiction.
 
JOURNALIST: You've given the Territory a short-term boost of $150 million over two years while the way that the efficient price is calculated is reviewed. Some say that, while it is more expensive to deliver care here, that the ACT system needs to be more efficient. Do you agree with that criticism? Do you support a special loading being applied to smaller jurisdictions? And should the ACT be more efficient in running its health system?
 
BUTLER: Particularly with Rachel here, I’m not going to tell her how to operate their hospital system. In our agreements, we try to ensure that there are certain quality indicators in those agreements, and I don't intend to add to that for the ACT or any other particular jurisdiction. We did though, as you can see, put in place some additional funding for the three small jurisdictions. We also substantially lifted the base funding, for example, for the NT, the Northern Territory, which was receiving the lowest level of hospital funding support of all jurisdictions, in spite of the very significant demands on that jurisdiction. We've done a lot for those three small jurisdictions.
 
I support the process of the financing authority now analysing whether there should be an ongoing loading. I want to wait, obviously, to the outcome of that, but I think that's important work.
 
JOURNALIST: Will there be another top up in the budget next month?
 
BUTLER: I think I've given enough away about the Budget, Katy Gallagher is giving me a look and I think I've said all that I'm authorised to say. Anyway, we are waiting for the work of that agency, the pricing agency.

JOURNALIST: Minister, thank you for being here. The national gender pay gap is at a record low, and this has happened under Labor. How does it square with you that initiatives under Labor, the triple bulk billing incentive, Urgent Care Clinics being expanded and the loss of certain mental health item numbers have increased the gender pay gap for female GP’s. Should longer consultations receive a higher rate so that women's work is more valued?
 
BUTLER: Look, Karen, I've never seen any hard data on this, it may exist. But anecdotally, I very much accept that female GP’s tend to do longer consults. I've just seen enough anecdotal evidence about that to accept that as a general proposition without necessarily seeing the hard data. They do a lot more mental health work; they do a lot more multiple condition work, particularly with female patients; and that's why we put in place what we call a Level E consult after the Strengthening Medicare Taskforce very much recommended that back in 2023, so that GPs would be paid for a consult of 60 minutes or more. That was something that female GP’s talked to us very much about, domestic violence, family and domestic violence groups talked about in particular because often victims of violence need to talk with their GP for extended periods. And we were very careful not to nickel and dime that consult. It is a relatively generous consult level which, with bulk billing incentives on top of it, is working very well as I understand it.
 
Now, we'll continue to work with the AMA and with the College of GPs about the way in which the rebates are both tiered and recompensed, I recognise that is ongoing work we have to do. But I make no apology for the fact that we had an affordability crisis, it was a burning platform in general practice that we had to deal with in our first term, to deal with the plummeting rates of bulk billing that was creating huge inequity in terms of access to healthcare.
 
I do accept though, that the broader reform work, the deeper reform work that I wish I'd been able to spend more time on in our first term instead of just dealing with that affordability crisis is still work to do.

CONNELL: Alright. Short and sharp if we can please. Matthew Franklin from Capital Brief.
 
JOURNALIST: Hey, Minister. Matthew Franklin from Capital Brief. The Australian Medical Council says that 31 per cent of doctors working in our system are trained overseas, including 56 per cent of GP’s, and I've seen figures of nurses up to about 40 per cent. At the same time, your political opponents are demanding an end to mass migration. I'd like to ask you two things. One, what would happen to the health system in this country without foreign workers? And two, could you guarantee that whatever the Labor Party is doing on its next immigration targets or migration targets, that it won't be cutting more income of skilled workers for the health sector?
 
BUTLER: Well again, more than one question, this seems to be catching. But I'm not the Immigration Minister.  I'm not in a position to give some sort of expression of immigration policy. But what I will say, from my portfolio perspective, is that whether it's health or aged care or disabilities, there is a huge reliance on overseas workers. In particularly the care, the social care portfolios, people on often temporary visas, student visas for example, partners of skilled migrants, you will find in pretty much every aged care facility and disability home that you visit, they are a very important part of our workforce at a time when we have quite low unemployment in comparable terms.
 
In health, we've always relied on overseas trained doctors, particularly in rural communities. We're certainly working very hard to expand the number of Australian trained doctors. There are a lot of Australian trained nurses coming out of our universities, keeping them in nursing is really the bigger challenge. But we're not training enough doctors in Australia and that's why, over the last couple of years, we've been expanding medical schools for the first time, really, in a decade. But to take up your full toss on leg stump, very much our health, aged care and disabilities system rely heavily on overseas trained workers, overseas trained doctors, and overseas trained nurses. I think anyone who’s in this room has worked in those sectors know that they’re an incredibly important backbone of our health workforce.

JOURNALIST: Hi, Minister. Thank you for your speech. On the development of extra foundational supports that you’ve flagged, are there certain kinds of support that you’re preparing to work on first? And do the states have a point when they say this really just shifts the cost to taxpayers from the NDIS budget to other areas of the budget?
 
BUTLER: The first point to make is the NDIS was set up to support people with significant impairment or disability. To the extent it is expanded to support other people, that was never the deal, that was never the original intent, it was never what all state and territory and Commonwealth Government signed on to 10 or 15 years ago. We’ve got to reset it back to that.
 
The other point we’ve made, though, and this goes back to the 2023 National Cabinet Agreement, is we understand that it is a shared responsibility. That where people will need those local community supports rebuilt, then we should share the funding of that, 50/50 between the Commonwealth and the group of state and territory governments. We remain committed to that. Last year, I confirmed that we were extending that funding in the long term, not just for five years, we remain committed to that.
 
What they look like will really depend on the cohort. They're obviously going to look very different for kids under nine compared to middle-aged adults with severe and chronic mental illness. But for that cohort, for example, we don't have to get a blank sheet of paper out. Before the NDIS, those supports were there, they were operating really well, providing curated congregate settings in which people with severe psychosocial disability could, programs like personal helpers and mentors, day-to-day living, organisations that have been delivering those services for many years.
 
The problem has been that, as the NDIS has taken in so much of the Government funding in this space, those services have been either wound back or in some cases dismantled. And all state and territory and Commonwealth governments have a responsibility to rebuild them.
 
JOURNALIST: Thank you.

JOURNALIST: Following up that, you talked about functional care, what people need. Do you eventually see a situation that we might be moving towards where, whether you're over 65 or under 65, you'll still get the same degree of care? Whether you're under nine or over nine, you'll still get the same degree? So that, effectively, age will be not a worry, and the care will be dependant upon what your functional capacity is?
 
BUTLER: To some degree, yes, Nick. I'm not sure what you're getting at, I think I do, to some degree, yes, we want to see the scheme, the NDIS, determined upon functional capacity, but we still do have age barriers for aged care compared to NDIS. As you know, it was an original design feature of the NDIS, we have no plan to change that. If that's what you're getting at, that age delineation will remain in place.
 
CONNELL: I think I've figured out why you're back after eight months. Maybe your last guest speaker membership was about to expire, so we do have a new one for you. We do appreciate your time on weighty matters today, Minister. Ladies and gentlemen, please thank Mark Butler.