RORY MCCLAREN, HOST: Minister for Health, Ageing and Minister for Disability and the NDIS, Mark Butler, welcome.
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Thank you, Rory. It is a pleasure to be home, I can tell you, after a fortnight in Canberra.
MCCLAREN: It has been a long week, and there is a lot to work through with you. Yesterday though, we heard from the state’s Health Minister, Blair Boyer, who says this week there are more than 470 people stuck in South Australian hospitals who need an aged care bed. For years, bed block and the lack of aged care placements has put pressure on state and territory hospital systems. When will this change?
BUTLER: We have an enormous job to build enough aged care supply for what I heard you talking about with your colleagues before nine o'clock is a very, very sharp increase in demand for aged care services. Those baby boomers who were born in the second half of the 1940s after soldiers like my grandfathers both came home are hitting their early 80s now, and we know that is the age where demand for aged care services really starts to climb. And we don’t have enough. We don't have enough aged care facilities. We're increasing the number of packages for care at home very sharply. It would be very hard for us to increase them any more than we are now. We just wouldn't have enough workers to deliver. But for nursing homes particularly, we just didn't see enough investment over the last 10 years to deal with what we always knew was going to be a big increase in supply.
Instead, we had a sector that had fallen into crisis. People might remember the Royal Commission some years ago that had a title with one word, “neglect”, some terrible stories about what was happening in the sector. We've had to put an enormous amount of energy and, frankly, taxpayer money into getting that sector back on track and staffing it properly.
Now what we need to do is to build a huge number of new aged care facilities.
MCCLAREN: So when are you hoping to see meaningful change in hospitals and alleviation of the pressure that hospitals are facing here in South Australia and across the country?
BUTLER: I have to be honest and say it's going to take a little time yet. We're working with state governments to find ways to encourage that new investment in aged care facilities. We need to see a new facility open every three days, not just for a little while, but for 20 years, consistently open a new facility every three days for 20 years. It's sort of jaw-dropping in terms of its ambition. We're working with state governments here and around the country. We've just announced a number of capital grants, including in South Australia to fund the building of new facilities or the expansion of existing facilities. But it's the thing I most worry about in my portfolio, a very big portfolio of health and aged care and disabilities. A lot of pressure on all elements of that portfolio but having enough aged care supply to give older Australians the care that they deserve and need is the biggest job I think we have right now as a country. And I know the fact that we don't have enough supply right now is putting pressure on every other part of the system.
Now, state health ministers tend to talk about hospitals, it's the most obvious one, but you're seeing it right through the health and social care system.
MCCLAREN: So what more can the Commonwealth do, given what you've just said there about the time it also takes to add supply to age care in a short to medium term basis to improve the flow of patients out of hospitals? What are you actively considering beyond what you're already doing?
BUTLER: Let me first say what we're doing to try and encourage more building of aged care facilities. Over the last couple of budgets, we've increased the funding that aged care providers receive to build new facilities, and that's starting to yield some results. But as your listeners would know, if they wanted to build a home or something, you can't just magic these things up overnight. We've got pretty good planning arrangements here in South Australia, but frankly, there are other parts of the country where even when we grant new bed licenses that are ready to go, we're finding local councils blocking the building of new aged care facilities. Frankly, we don't have, particularly in our big cities, we don't have vast tracts of land where we can build big aged care facilities of one or two storeys. A lot of these new aged care facilities are going to go up, or we just won't have or we just won't have enough beds to care for older Australians, and local councils need to recognise that. It's not a huge problem here in Adelaide. It is in some of the other parts of the country.
What we're also doing though is trying to work with state governments to relieve pressure broadly in hospitals. Your listeners might be familiar with the Urgent Care Clinics that we have opened over the last few years. There's now 137 of them open around the country. They'll see about 2 million patients every year now, most of whom would have otherwise gone to hospital. And given there’s about eight or nine million ED presentations every year, that's a relief. We're also working with state governments to try and get older people out of hospitals when clinically they're able to leave, but more quickly, more smoothly.
MCCLAREN: What about something like the announcement that came yesterday regarding the Commonwealth Home Support Program and the extension of that scheme? It was set to end next year, but you've now decided to continue it out until the middle of 2029.
BUTLER: Yeah, the former government had decided to sort of roll it into another program which is more about delivering personal care and nursing care in a person’s home. I never really loved that decision. I set up the Home Support Program 15 years ago when I was Aged Care Minister, and it brought together a range of services. Again, your listeners will be familiar with things like Meals on Wheels, which I'm so proud was actually started here in Adelaide, down in Port Adelaide, is now familiar right across the country; community transport, respite services, those sorts of things that aren't really about personal or nursing care, but they are important services for people to be able to continue to live in independently. And those organisations like Meals on Wheels, for example, were telling me if we rolled that into the care program, they'd lose their ability to continue operating. We've been reviewing that for a little while.
And yesterday, you're right, I announced that we would continue that as a standalone program. I've seen comments from Meals on Wheels this morning, enormous relief that that will allow them to continue. This has been running since the 1950s, delivers millions of meals every year to people, and us continuing to fund that, to encourage the work of volunteers, all the social capital that that creates, I think is really important.
MCCLAREN: That is the voice of Mark Butler. He's the Federal Health Minister at 9:13AM on 891 ABC Adelaide Mornings with me, Rory McClaren. Let's take a call here. Mark has rung in to share his experience at the Queen Elizabeth Hospital last week. Hello, Mark.
CALLER: Yes, hello, how are you?
MCCLAREN: Mark, what happened?
CALLER: I was, I'm just going to just say that I wasn't aware. I heard what ramping sort of was, and I've heard it obviously as a buzzword, but I'd never sort of experienced it until my 83-year-old dad had to actually go to hospital after an emergency. And this is no blight on the ambos. Like, the ambos are 100 per cent, they're awesome. But basically, I feel that ramping is just, if everyone hears that as a buzzword, I think that ramping now is just using ambulances as a hospital bed in a car park until a bed comes ready. But unfortunately, because this happened after hours, there's no admin staff at the hospital to actually clear those beds out and for people to leave. So that's why it takes so long.
MCCLAREN: How long were you outside for, Mark?
CALLER: My dad was in the ambulance for sort of four-four and a half hours. Now, and like I said, basically, to me, I run a business myself. And you've got an ambulance with three people on there, and like I said, this is no blight on the ambos. The ambos are awesome people, do an awesome job. And you've got a full crew of three people sitting in an ambulance with a guy, with my dad, waiting for a bed to come free. They can't leave. The ambulance can't go. And basically, if they're halfway through a 12-hour shift at that six-hour mark, well, they've got to spend another six hours there, or if there's still a bed not ready, they have to come, change over ambulance, they go home and another ambulance and another three ambos have got to sit there with a patient until the bed comes ready.
MCCLAREN: Mark, thank you for sharing your perspective and experience. Back to you, Minister.
BUTLER: Yeah, Mark, thank you for your story. I hope your dad is recovering from whatever emergency happened there. And thank you for calling out the ambos. As Health Minister, I'm constantly inspired by the work, not just ambos, but health professionals right through the system do every day they get up and they deliver frankly the best healthcare anywhere on the planet.
But you're right, getting patients flowing through these hospitals is incredibly complex. They do do this after hours. It's not something that's a nine to five, Monday to Friday thing. But across our 750 public hospitals, and the QEH is my local hospital as well, they are improving their patient flow systems, there's no question about that. And we also know, frankly, in every hospital system in the world, at times of the year like this, when respiratory illnesses really peak, flu, RSV, COVID and the like, hospitals are under enormous pressure. And the staff who try to keep them operating, in a way they may be able to in other parts of the year, just do magnificently well.
MCCLAREN: I want to move on, if we can, to the NDIS reforms which cleared Parliament this week. How do you know you’ll be able to achieve the intent of the reforms, that is capping spending growth and also cracking down on unscrupulous operators, without leaving some participants worse off?
BUTLER: That really is the balance that we’ve been thinking about so carefully, so deeply, talking to states about, but importantly talking to the disability community itself about. We’ve had a lot of advice from disability advocates, participants, their families, people who provide these services about how to get the NDIS back on track. It’s this most extraordinary social program that has transformed the lives of hundreds of thousands.
MCCLAREN: So why should participants have confidence in what passed this week will actually stop the fraudsters?
BUTLER: Because we’re introducing systems that just haven’t been there. When we came to office four years ago, the National Audit Office said that the NDIS essentially had no controls on fraud. Today, Rory, we will check the same number of payments in just one day that used to be checked in an entire year. It is just far too loose, and it's been too loose for too long. It doesn't have the controls that we have in Medicare, that we have in aged care, for example, the requirement for people providing care and receiving taxpayer money to do that, to be registered, to be able to demonstrate to participants, their families, but also to taxpayers that they've got the right qualifications, they've got the right character.
Putting in place pretty fundamental things like digital payment arrangements so we know who's receiving money, because the Criminal Intelligence Commission tells us some very, very bad people are receiving money through the NDIS. They're pretty basic controls and I think taxpayers will have confidence and should have confidence that we are going to get this thing back on track.
MCCLAREN: Can we bring it back to people though, Minister, because this is just one small example of the feedback we've had this week from NDIS. participants. Sudhashree Somers, she is an NDIS participant. She's also a university student studying disability and community inclusion. This is what she told us a little earlier this week.
[Excerpt]
CALLER: Because of my disability at the moment, I need someone with me pretty much every single time I step out of my front door. It's for my own safety, so things don't go horrendously wrong, so I don't keep ending up in the emergency department or having police called to section me. It keeps me safe and, so I've got my support worker standing next to me right now. Then on top of that, I have extra therapies who have helped improve my disability and improve my life to a point now that I'm not continuously ending up in the emergency department like I was last year, and I feel like I'm able to live a life again before having all these supports when my plan wasn't enough. I was stuck at home and really, really struggling and my family were really, really struggling.
These supports allow me to live the life that my peers do. They allow my family to do things outside of caring for me. They allow me to be kept out of the hospital system, out of a medical system that doesn't actually have any supports for my disabilities. We're going to have to start making some really hard decisions. Is my volunteering important to me? Is my job important to me? Which of those do I choose? Am I able to do any of them at all? This bill is going to hurt and kill some people, and that's not ok. We agree that the NDIS needs to be better, but it needs to be better for every single person in that system, not just the budget.
[End of excerpt]
MCCLAREN: That was Sudhashree speaking on Mornings earlier this week. Minister, what do you say to participants like her?
BUTLER: First of all, I'd say that's exactly what the NDIS has delivered to people like Sudhashree, the ability to study, to work, to participate in community activity. And frankly, far too often that didn't exist as an opportunity for people with disability before the NDIS. And we are utterly determined to preserve that opportunity that the scheme has given. I mean, we created the scheme as a government, I was a Minister at the time -
MCCLAREN: But you are, at the same time, you’re cutting it at the same time.
BUTLER: We are getting its growth under control. The NDIS will continue to grow. It will continue to be the biggest social program we have outside the age pension. It will continue to be the centrepiece every independent observer accepts of the most comprehensive system of supports for people with disability you will find anywhere on the planet. But we simply had to get some of these areas of uncontrolled growth back under control. Now, the very constructive debate, I think, we’ve had in the Parliament over the last little while, a detailed inquiry, a debate again this week, 63 amendments that we moved to the bill, pick up a lot of the concerns that your listener just indicated to make sure that people with high complex needs, high support needs were protected as these changes roll out, to make sure that they didn't interrupt their ability to participate in employment, to attend disability related health sessions, all those sorts of things I think have meant this bill is the best version of itself it possibly could be.
MCCLAREN: Now, given the size of the reforms, and lots of this is linked to getting thousands of children with autism off the NDIS and then on to Thriving Kids. How can you be confident that will be delivered in just under 18 months' time in 2028?
BUTLER: First of all, let's deal with why we had to do this. The NDIS was set up as a scheme to support people with significant and permanent disability. And what I think everyone understands is it's gone well beyond that remit. There are hundreds of thousands more people on the scheme that was originally envisaged, and what that means is we’ve got a position around the country where if you go to a junior primary school, as many as 1 in 4 boys are on the NDIS, 1 in 4 boys on a scheme set up for significant and permanent disability. I don't think anyone thinks that is the right position for society or for those young boys. Young girls are on in big numbers too, but nothing like young boys.
MCCLAREN: But this is also major structural reform that you're going to try and achieve in less than 18 months' time. Can you understand the apprehension and the anxiety out there at the moment, considering how limited information has been made available?
BUTLER: Absolutely. I do. And for those kids who are under the age of nine, I announced that 12 months ago, we have been working on it since then. We've developed the model in a terrific group that I co-chaired with Frank Oberklaid, probably the country's leading paediatrician. And we have implementation plans with all states, except Queensland, which is another issue, but certainly South Australia and all of the others, Labor and Liberal alike, have been thinking about this carefully, have designed the sorts of services that will be put in place. We've allocated money, they've allocated money, and they will start rolling out over the next 16 or 17 months before the start-up date of 1 January.
I know people are anxious about these reforms. I know they are hard reforms, but I am utterly convinced they are essential if we are to get this scheme back on track and secure its future for the long term to deliver the sort of opportunity we were just talking about. And that includes putting in place supports that are appropriate for children with more low to moderate support needs.
The sort of market that the NDIS set up for people with profound lifelong disabilities just doesn't suit these kids, just doesn't suit the families who before the NDIS would have got a group supports in the communities where they live and they learn and they play, mixing with other parents who are going through the same issues. I'm really confident, first of all, we'll have these in place when we need to, but secondly, they'll be far more appropriate needs for the children we're talking about.
MCCLAREN: It's 9:25AM. That is the voice of Mark Butler. He's the Federal Health Minister. Let's go now to Mary. She has a question. Hey, Mary.
CALLER: Hi. I just wondered why the federal government is reducing the rebate for over 65s for private health. Isn't that just going to make it worse? Now, could it be that one's a federal government and one's a state government, but it will just make the queues to public hospitals worse, because it doesn't apply to everyone, but a lot of older people cannot afford private health cover anymore and this reduction in rebate will make it worse.
MCCLAREN: Mary, thank you. We've had lots of texts on this as well, Mark Butler.
BUTLER: Thanks, Mary, for the call, and there's frankly a lot of I think misinformation around this largely put out there by the insurance industry. When we means tested the private health insurance rebate 15 years ago or so, the insurance industry said 1.6 million people would leave insurance. Actually, it kept growing. We didn’t see that many people- we didn’t see people leave.
MCCLAREN: So what's your modelling telling you about who is going to drop off as a result of the changes?
BUTLER: Our modelling from government indicated that maybe around 40,000 people out of some millions would leave. More independent modelling came out from the University of Melbourne the week before -
MCCLAREN: You sure that's right? That seems like a low number given how many Australians and South Australians have private health and are aged over 65.
BUTLER: Yeah. That's our modelling. The University of Melbourne released more independent modelling, so not from the industry, not from government. But an independent modelling outfit said that 40,000 figure was at the high end. They think fewer people will do that because frankly older Australians get a lot out of their insurance. They use it more than they pay for it, if you like. What we're doing though is returning to the original position, which was that everyone received a taxpayer subsidy for their private health insurance based on their income, not their age.
At the moment, you have a position where there are two households living next door to each other both with private health insurance, both on the same household income, but one's over 65 and one might be in their 40s or 50s with kids, and the over-65s are receiving a higher subsidy. We're going back to the original design when Howard introduced this 25 years ago to make sure everyone gets the same subsidy. For most people who we're talking about, taxpayers will continue to pay about a quarter of their private health insurance bill. This is not something I wanted to do, but we were talking about aged care -
MCCLAREN: But you also acknowledge that you're taking something away that people have enjoyed for many years.
BUTLER: Yes. And I want to be clear, we've got a lot of coverage about the debt this morning. We've talked about the need to find more money in aged care. Every single dollar from this decision, which is about $3 billion over the next four years, every single dollar goes into doing what we talked about at the beginning, which is expand aged care services. I just don't think I was in a position to maintain a subsidy that was paid at different rates depending on age rather than income when we have to lean so heavily into finding new aged care services.
Now, I could have put it on the debt, but people don't want us to do that either. We've had to make hard choices in this budget. I wish I didn’t have to, but this is one of them.
MCCLAREN: Now before you leave, Mark Butler, the long-running saga of the Australian Bragg Centre for Proton Therapy and Research. It was back in the news yesterday. We had a petition handed to the state opposition. We had families meeting with the Premier. Will Adelaide be home to Australia's first proton therapy cancer unit or not? It's a yes or no.
BUTLER: It's not a yes or no, Rory. It was going to be, and the contract that was signed by previous governments unfortunately didn't come to pass, tragically didn't come to pass because the company that was supposed to deliver this to South Australia has effectively gone bust. We've lost a lot of money, the Commonwealth, taxpayers that is, by handing money over to a company that was relying upon Russian parts that's only delivered one of these machines anywhere else in the world. And I think both levels of government recognise that this is lost money. We're not going to be able to do it through this company.
We've been working very hard. I've been working hard with all jurisdictions because we have to have this capability in the country. It delivers significantly better cancer care, particularly for children -
MCCLAREN: How soon will you make a decision?
BUTLER: I've said to the South Australian Government that because this is a national capability, this was going to be the only one in the country, so it would have cared for particularly children from all states, not just from Adelaide or from South Australia. I've said I think as the National Health Minister, I've got a responsibility to go to other jurisdictions, given this one has fallen over effectively.
MCCLAREN: So you’re hoping to make a decision this calendar year? Are we that close to it?
BUTLER: I essentially have two indications of serious interest. One is South Australia, another is Victoria. They're different types of service, different types of machine. I think because we've lost these years, unfortunately, because of this company falling over, I think it's not an either-or now, it's not either Victoria or South Australia. It may well be we need both, given the numbers we're probably talking about here.
I've been talking with some of the clinicians here in Adelaide, some of whom moved to Adelaide from overseas because of this exciting project. They've been giving me advice, and I thank them for that. I mean, in discussions not only with the South Australian Government and the Victorian, we're going to have to find new money. We've basically lost the money we allocated to this because it was a failed project. And I’m very keen to do that and do it in partnership with governments like South Australia.
MCCLAREN: Now Linda has called in, we've got time for one call before you leave, and she wants to talk about the challenges around private health. Linda?
CALLER: Right. Mark, with the deepest respect, I am so offended with what you're saying at the moment. You're using that analogy of two people living next door to each other and one paying less for private health and one paying more. Well, do you know, Mark, there is also people like me that are living with a hell of a low income. I get $600 a week, and the person next door to me is probably getting $6,000 a week. But I can't- I'm paying my private health. I was told that if I went public, I would be four years before I saw a specialist. I went private health, still had to fork out $5,000 in gaps, and you're telling me that I should be just paying the same as next door who's getting a hell of a lot more money than I am. Mark, you don't know what the real world is. This is absolutely disgusting.
MCCLAREN: Linda, I can tell you're emotional. Thank you for sharing your thoughts. To you, Minister.
BUTLER: Thank you, Linda. I'm sorry if I wasn't clear. I was talking about two households next to each other on exactly the same income. Certainly, if there's someone on a much higher income next door to you, they won't be receiving that level of subsidy, whatever their age is, because we means test this subsidy. I'm sorry if I wasn't clear, Linda, I can hear your distress. I was talking about two households next to each other on exactly the income, whatever that income is.
MCCLAREN: Health Minister Mark Butler, thank you for being available this morning.
BUTLER: Thank you, Rory. Thank you to the listeners.
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