DAVID BEVAN, HOST: Mark Butler, federal Minister for Health and Aged Care. Good morning to you.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Morning, David.
BEVAN: Just before 9:00, we were talking to Peter Malinauskas. Good mate of yours. And we said, we've got the federal health minister in anything you'd like to put to him? He pointed out that right now in South Australian hospitals, there are about 200 people who have in terms of their medical treatment, they've been fixed up. There's nothing more the hospital can do. But they're sitting there, lying there because there is not an aged care home for them to go into. So these things are they're all linked together, aren't they? What are you going to do about those 200 people who are languishing in hospital beds?
BUTLER: It is all linked, and I think increasingly the discussions not just that I have with my health minister colleagues, but that the Prime Minister and the premiers are having is how those linkages between hospitals, aged care, primary care - so your GPs - the NDIS (and I heard a bit of the conversation you were having with Paul there) how do those linkages work? Because generally the individual bits of our system might work really well. But if the linkages aren't working well, people get stuck in one system or they fall between the gaps. So what we call “longer stay older patients” - it's a bit of a technical term - people who are in hospital, older patients who've been clinically discharged, so the doctor has said “you no longer need to be in a hospital”. How do we ensure they're able to move into something else, either back to their own home or to an aged care facility as quickly as possible? It's obviously good for them, because no one really wants to stay in hospital, but it's also good for the hospital system. Now, the first challenge we've had, and you talked about the aged care reforms we announced last week, is no one's been building aged care facilities now for some years. It just hasn't been what they describe as “investable”, where they've wanted to do it. The banks have said we're not willing to lend money to you on these policy settings. So already we've had aged care operators, after the announcements we made last week say, “great, we've had homes we want to build, we've got development approval from the local council, we just haven't been able to get the money. Now you've announced these reforms, we're going to start building again.” That's been absolutely critical.
BEVAN: You talk about there aren't the linkages there. It's not that there aren't the linkages there. There's nothing to link to.
BUTLER: And that's the point. My point the first point is we have to build more beds. We've got a huge increase in demand for aged care coming our way very shortly. The baby boomer generation, the oldest of the baby boomers born in the mid 40s, are now at Home Care age, on average. So they're that's why we're seeing such a big increase in demand for Home Care Packages. And within 3 or 4 years, the oldest of them, which includes my dad, for example, will hit the average age of entry into a residential aged care - so about 82 - and then, there's a big step up in the number of beds we need. And the problem has been, for some years: they haven't been building the beds because the policy hasn't been right.
BEVAN: How many beds do we need? How many beds or beds are we short now and how many beds will we need in? I don't know, five, ten years?
BUTLER: It's in the many thousands. It's in the many thousands.
BEVAN: Right now?
BUTLER: Over the next few years, we need to build many thousands. I mean, I was looking at one operator who announced - literally the day of our announcement - that they had homes ready to go, with development approvals from their local councils. They're going to build 1600 beds, just off the back of our announcement across the country, not just here in South Australia. A number of other providers have been telling me the same: they've got the plans ready to go, they're approved by council, the banks just aren't letting the money go until they heard the announcement. So that is a big that's going to be a big relief. But one of the things that Chris Picton - the South Australian Health Minister - and I and our colleagues have been talking about is: there are also people, though, in the hospital system who have more complex needs than they might have had 10 or 15 years ago, and who would struggle to be properly cared for in a standard aged care facility. So they might have very complex medical needs that require laryngectomy - so they require quite complex care for throat wounds and all those sorts of things. So we are also trying to develop ways in which people with higher care needs don't just languish in hospital, literally for months and months. Some of them are high level dementia needs. And Chris Picton and I announced some packages only a couple of months ago here in South Australia for people with very high-level dementia who would struggle to go into a standard aged care facility, being able to move out of hospital into something else.
BEVAN: Now you might have a question or a comment or an experience that you would like to put directly to the federal Minister for Health and Aged Care, Mark Butler. Now's your opportunity. 1300222891 is the number to call. You say “at the moment we put this bill into the Parliament” - so you cut a deal with Anne Ruston from the Coalition who was also a South Australian. The moment you did that, the private sector said, “yep, we're ready to go. This will be enough. If this can get through.” What does that mean? What that means is that you have put a bill up for discussion, which unlocks money. That's what this is about, isn't it? Because the private sector wouldn't do it because, well, we're not going to you can't make money out of this. You'll go bankrupt building a nursing home now. So it's unlocking money now. Are there unforeseen consequences for unlocking this big bucket of money that you can see, which is basically people's homes?
BUTLER: What we've tried to do is make sure we get reform of this sector, which has really not seen much reform for the best part of a decade, in the right sequence. The first thing we needed to do was get more staff in. So we went to the last election promising that there would be a registered nurse in nursing homes 24/7. And usually when I spoke to people in the community about that, they were just completely bamboozled. They said, “well, you're saying there are no nurses in nursing homes right now? How is that not a requirement already?” But it wasn't. It was a recommendation of the Royal Commission. We've delivered it. 99% of the time. Now there is an RN - a registered nurse - in every nursing home in the country, 24/7.
BEVAN: You say, you have delivered on that 99% of time. And what was it before?
BUTLER: Way lower than that. I can't remember the exact percentage. And look, many facilities had RN's on all the time, but many didn't. So we've paid them to do that. But the former government didn't do it, because they said there weren't enough nurses. You couldn't get it done. Which comes to my second point, which is: we had to pay aged care workers better because we just weren't able to recruit and then retain, particularly nurses, because they were earning a couple of hundred dollars a week more at the local hospital. So we've paid them more. That's cost quite a bit, but it's already meant that aged care providers are able to recruit the workers they need, not just nurses, but also the care workers who do the bulk of the day-to-day care of aged care residents. We've now got almost 4,000,000 minutes of care every day being delivered that were not being delivered two years ago. So you've got more staff, they're delivering better care. That's already resulting in fewer pressure sores, fewer falls, fewer restraints. So all of the things that Royal Commission into Aged Care really lifted the lid on that shocked people so much. We've got that right.
BEVAN: But what you need to do is, have more homes doing that. You need more homes.
BUTLER: That's right –
BEVAN: And so which gets us back to –
BUTLER: But we weren't willing to unlock the investment in new homes, before we got the existing system in better shape. So more and better paid staff, more transparency around where the money was going, which you'll see in the “Dollars to Care” program - every facility now has to report how much of their money is going into food, how much is going into staffing.
BEVAN: Yeah, but it's all about the money. And you're unlocking a big bucket of money with this new Bill. And what I'm putting to you is: will you – you've opened up a trickle of revenue. I think it's going to save you something like $12 billion over 11 years. It's a trickle of revenue which will be irresistible for governments, and in a decade, you will have eroded a transfer of wealth to the next generation, leaving the middle class that much weaker. It starts off with a trickle. Governments can't help themselves. It'll just be like HECS. And in a decade, it won't be a trickle. It will be a raging river of money. Where's that money coming from? It's coming from the middle class. Are you aware of the if of the unforeseen consequences of opening up this bucket of money?
BUTLER: There are already contributions that people make to their aged care costs, so it's not like this is the first time we've asked people who have the capacity to pay to contribute to the cost of their aged care. For decades that’s been the case. We're certainly tweaking it –
BEVAN: It's not going to hurt you. It's not going to hurt you. You're a federal minister. You've got a pretty good wicket. It’s not going to hurt the Prime Minister. You're not going to hurt the people who manage and massage these policies. And it's not going to hurt poor people, because poor people haven't got any money. It's going – you are opening up a precedent which will get bigger and bigger.
BUTLER: First of all, we're not opening up a precedent. People have been, for a very long time, been asked to contribute to the cost of their aged care. They did decades ago. They did when Peter Dutton and I agreed aged care reforms 12 or 13 years ago, people were being asked to contribute to the cost of their care. So there's certainly a change to the nature of the system. But I'll make this point, just to give you a sense of the numbers. Currently, taxpayers fund about 95% of the cost of home care. 95%. Once these changes are in place, taxpayers will still fund 89% of the costs of home care. So still, the vast bulk of the system is funded from the Budget, so from existing taxpayers who are working right now.
BEVAN: This is just what your lot said about HECS.
BUTLER: I don't follow the HECS example.
BEVAN: You know exactly what I'm saying. That is: you introduced HECS and it was a Labor Government introduced HECS, saying “we're just asking a little contribution, guys. You're all going to be incredibly well set up by the degrees you get. And this is all perfectly reasonable.” Now fast forward 20-30 years later, and we have kids who are leaving university with debts of $40-50,000 a year, which are indexed to inflation. And they've discovered they've got huge bills. Now, at the same time, these people are trying to buy houses. Which, by the way, the housing crisis has got away from us. And so they can't afford to put together a deposit, because what started off as a reform of just a modest contribution to something that will look after you in your future years, has now turned into a noose around their necks. Why should our listeners be any more confident that you're not going to do exactly the same thing with aged care?
BUTLER: Because we've done this very, very carefully –
BEVAN: That's what you said 30 years ago!
BUTLER: You're talking about HECS again? This is reminding me of the Trump debate, where he was asked about immigration and he went into student loans. We're talking about aged care, David -
BEVAN: No, this is not a false equivalency. This is absolutely equivalent. That is, that it was an issue of where do we get money to fund universities. Now you're asking the same question: where do we get money for aged care?
BUTLER: But HECS was from a system where the government - which Whitlam had introduced, as you remember - funded the entirety of university fees. That is not the case with aged care. What I was trying to illustrate to you and to your listeners with those numbers, is that the actual percentage of taxpayer contribution to aged care is going to change by a few points. So instead of –
BEVAN: From 95% to 89%
BUTLER: 95% to 89%. And in residential care, taxpayers currently pay 76% of the system and they will pay 73% of the system. So, it is a shift. And I don't minimise the impact of the shift on some people, but it has been very carefully calibrated. And what it does is not only make the system more sustainable for the Budget in the long term, but it actually delivers a much better system.
BEVAN: Is this to save the government $11 billion over 12 years, or will it, uh, are you going to maintain your contribution and it'll bring in another $11 billion on top of that?
BUTLER: I think it is actually $12 billion over a decade that would be saved is a net figure. And what that doesn't account for is the fact that we're piling in a whole lot of money. So, yes, there will be some changes to the way in which people contribute to the cost of their care, particularly some of those everyday expenses like meals and cleaning and gardening and shopping, the sorts of things that people pay for usually in their lives. There will be some change to that. But importantly, what we're doing is we're delivering hundreds of thousands of more home care places. There'll be better packages, particularly for people with high level needs. There’ll be much more fulsome packages delivering more care to people in their home. Waiting lists will be shorter. For the first time, people will be able to receive packages for palliative care in their home in their final 12 weeks, rather than living at home and then having to go to hospital for their final moments on this earth. So we're delivering a much better system. So that figure is a net figure. It doesn't account for the fact we're piling investment in to deliver a much better system of support at home, which is what people have told us is their number one priority.
BEVAN: That's the voice of Mark Butler, South Australian federal MP. He's the Minister for Health and Aged Care. Big changes are being debated by the federal Parliament. By the way, the Coalition have said “yes, we agree for this legislation to go forward doesn't mean they're going to agree with it.” And if they don't get agreement before the next election the wheels fall off. And I wonder whether we'll get any progress at all. But can we just quickly go to the calls?
BUTLER: Just to that point, what the Coalition have said is that Chapter Four of the Bill, which is the one that deals with the financing of the system, is agreed between us. The rest of the Bill - and there's a lot in this Bill about the sort of aged care system we have in the future – yeah, they want to test that. They want to have a Senate inquiry. There may be debates and amendments about that. But the financing of the system is agreed between us and the Opposition might depend on which opposition MP you're talking to on that. Well, I talk to Anne Ruston, who's the Shadow Health Minister, and we talked to the Leader of the Opposition.
BEVAN: You might want to talk to some of the other MPs. Chris from Heathfield has called. Hello, Chris.
CALLER: Good morning, David. I've been in home support and the home support work for a long time. And there's more and more providers coming into the market to offer services. Is it possible that they could all be on the same level of what they provide, their costings, what they charge the clients? Because I think there's a lot of variation in what providers do when they have a client with a package. Can that be standardised, or is that something that he's thought of, that there's a need for providers that come in - there's more and more coming into the market – um, to have a standardised rate of charging and things like that? Is that possible, Minister?
BUTLER: Thanks, Chris, and for your work in the system. We're pretty careful to make sure that any provider of aged care has to be registered. You know, for example, that's been a debate over the last several days in the NDIS that there's a whole lot of unregistered providers. But you have to be registered. So you have to demonstrate compliance with a whole bunch of standards. And the system in aged care has prices set by an independent pricing authority, which has been a development over the last sort of 10 to 12 years, as well. So look, it is a very diverse system. There's a lot of providers in it. Um, so there is some difference in the sort of, uh, services and products you get delivered to older people. But we are pretty determined to make sure that standards operate right across the system, apply to all providers. And as I said in my introductory remarks to David, that there is also much more transparency in the system -
BEVAN: There's a lot of rip off in these home care packages. You talk to Rebekha Sharkie, she'll tell you how worried she is. And her concerns reflect the concerns of a lot of our listeners.
BUTLER: Rebekha’s been very hot on the admin fees.
BEVAN: The admin fees are outrageous!
BUTLER: Her advocacy has been terrific on that. It's something we were very strong about coming into government. We've capped those admin fees.
BEVAN: I know a couple, an elderly couple, both of them ended up in hospital. And the home care provider was still charging them for a service that was not being delivered. And this family got in touch with the provider and said, well, hang on, why, are they being charged full tote odds? Oh, well, you know, there's a lot of there's a lot of admin that has to be done here. You're not providing a service and you are charging them the same amount of money while they're in hospital than when you did provide the service and said, oh no, that's because of all the admin. I mean, this is a rip off.
BUTLER: I'd be interested in how long they did that for –
BEVAN: Weeks.
BUTLER: I get charged childcare when my kid is sick and, you know, you still get charged a school fee, if your kid's off sick as well. I mean, to some degree, you have to keep the service operating, but there's got to be a limit to that.
BEVAN: So this was for weeks. I know of this couple. I was told about it that they went into, um, they had both ended up in hospital for a couple of months at least. And the aged care provider, the home care package provider, said, no, they weren't cleaning the house. They weren't sending anyone around to do the cleaning, as in the laundry or mow the lawns or anything like that. None of the services were being provided. The family got in touch and said, look why Mum and dad are in hospital, is there a reduced rate? Oh no, there's no reduced rate. So they the family ended up cancelling the service and they said, oh well, you know, if you cancel the service you could be, you know, have to get back on cargo to get back on. Well, the family called their bluff and said forget it. Good on them. So we go to Roman. Roman from Mallala. Hello, Roman.
CALLER: Hello, David, how are you? I had a similar experience with my mum. I think it was back in about 2011, 2012 where she was having in home care, and an incident happened and she ended up in hospital, and then they wouldn't discharge her back to her home. So she was actually sort of stuck in the Royal Adelaide Hospital for, I think it was nearly three weeks until we found her a nursing home. Um, and in that process, I felt quite pressured trying to find her a nursing home. And in the end, we made the wrong decision and had to move her again about a year later. But my thought or suggestion would be, why couldn't the government build like a short-term nursing home? Um, aligned with each hospital so that those patients could actually stay in a nursing home for a short period of time, say, for example, three months, which then gives the family a bit of time to find an appropriate place. And it also takes those people out of the hospitals?
BUTLER: We do actually have a programme called the Transition Care Program which does precisely that. We operate it in conjunction with state governments. It's 12 weeks. So people are able to go into a residential aged care facility for 12 weeks. They're supposed to receive, not just obviously respite care, but also some rehabilitation care as well, so allied healthcare there. So that maybe they'll be able to go back to their own home, or it gives families time to try and find an aged care facility. I'm not quite sure why your family wasn't able to access that at the time, or why it wasn't made clear to you that was available. We're trying to expand that program because it is a terrific way for families to just have some time to make those really important decisions, and they are hard decisions. You want to make sure that you get the choice of the facility for your mom or your dad or your partner, right. And that is also another human element to the point you raised with me at the start, David, that Peter Malinauskas and other premiers raise sometimes, people aren't leaving hospital because the family just hasn't yet made the necessary arrangements that they're comfortable with to find them an aged care facility or to, you know, get the finances to together and all of that –
BEVAN: Or maybe convincing Mum or Dad, you need to go into an aged care home.
BUTLER: They're really difficult conversations, as I'm sure many of your listeners know. And you can't just click your finger no and move from hospital into an aged care facility when you've spent decades living in your own home.
BEVAN: Yeah, and I think there's a new facility at the Repat, which is sort of a halfway house, um, for people in that position. So they'd been discharged from hospital and for whatever reason, they're not able to move into an aged care home, and they're in this building on the old Repat site. It's a new building. Uh, I forget what it's called. Um, and they can be there for weeks and weeks waiting for either a place to come up or waiting for the person who's in there to accept that yes, they need to go into an aged care.
BUTLER: Right. And aged care facilities usually allocate a number of beds to this program, the Transition Care Program. So the state government and the Commonwealth will pay that aged care facility to house a person for 12 weeks, hopefully to sort of get them rehabilitated a bit. Maybe they can go home, but probably more likely they'll have to use that time to find an aged care facility.
BEVAN: Somebody says use the Womens and Childrens Hospital, the existing one, when the new one is built, use that as a holding place. Um, look, we're going to quickly run out of time. And we do have Bruce Lee coming to brunch, which I'm sure you'll be very excited about. You would have been a martial arts fan. I'm sure all those enter the Dragon. You would have been watching that in the 1970s.
BUTLER: I'm a child of the 1980s, David. You know, I was watching it, always debating whether Chuck Norris or Bruce Lee would win in a fight.
BEVAN: Apparently, Bruce Lee taught Chuck Norris.
BUTLER: Really?
BEVAN: I did not know that until the other day. We do a lot of research on this show. Uh, now, before you leave us two things, okay? The measures that you have proposed for aged care, whether or not they work, even if they work, they will still take two, three, four, five years to come online. You can't just snap your finger and get a nursing home built. So what will you do to fix help Peter Malinauskas fix ramping in the next few months?
BUTLER: We've got a program that I think I've mentioned, that Chris Picton and I announced a couple of months ago, where we are funding a range of activities here in South Australia. We're doing it in every state, to try and ease that path for people out of hospital, but also, frankly, try to stop them going to hospital in the first place –
BEVAN: Whatever you're doing is not working. If you announced it a few months ago.
BUTLER: It's only rolling out now, and I don't pretend that it's going to solve everything. Look at the thing about this - I try to be honest with people about around the country, is that none of this can be switched on and off overnight. Like these are hard challenges in the system that require a whole range of things to work. We need to build more nursing homes. I mean, we have nursing homes with vacant beds now in South Australia -
BEVAN: Are you going to are you going to give him anything that can fix ramping by the next election? Because he said he'd do it?
BUTLER: We're rolling out Urgent Care Clinics. Already that is reducing presentations to hospitals, because the bulk of people who are going to our Urgent Care Clinics around the country say that if that was not available, they would be rocking up to the local emergency department. You know, we are looking at ways in which we can help fund state government services, particularly reaching into nursing homes to stop people being transferred from nursing homes to hospitals in the first place. Often they can be quite adequately cared for in the nursing home with geriatric flying squads, which we're helping the state government fund, to stop those.
BEVAN: Geriatric flying squads!
BUTLER: I didn't come up with a name, David.
BEVAN: These are not flying squads manned by geriatrics.
BUTLER: These are flying squads that go to help geriatrics. They've got geriatricians, they've got nurses, they've got mobile x-ray machines. And they are reducing admissions from aged care facilities into hospitals. Because we know once people end up in a hospital, it's very hard to get them out again. So it's not just about the back door. It's also about the front door of the hospitals and trying to minimise the admissions.
BEVAN: Do you reckon ramping will be fixed in South Australia by the next state election?
BUTLER: I think you've got a Premier who, because he's a former health minister, has some of the best literacy of health policy in the country and you’ve got a really dedicated –
BEVAN: Oh, this is as good as it gets?
BUTLER: You’ve got a very dedicated, committed health minister as well. We are working together to do everything we can to reduce those admissions in the first place and to move people –
BEVAN: Do you think it will be fixed by the next election?
BUTLER: That's a matter for the state government. My job -
BEVAN: It is a matter for you.
BUTLER: My job, as the Commonwealth, is to do everything I can to provide support to state governments running hospital systems, but also to discharge my responsibilities, which is to run the Medicare system, to bolster general practice which we’re working hard on to build new models of care like Urgent Care Clinics –
BEVAN: Well, I hope you're doing your job. But do you think you doing your job, combined with Peter Malinauskas, who's apparently the best in the country, will be enough to fix ramping by the next election?
BUTLER: I think it's making a real difference already. It doesn't mean there's not more to do. We're reducing admissions through Urgent Care Clinics. We're coming up with innovative ways to help older patients avoid going to hospital. But it doesn’t mean there isn’t more you can do in the health system -
BEVAN: Everybody heard you not answer the question.
BUTLER: I think anyone out there listening to this programme knows that there is always more you can do in the health system. What we're doing now is making a meaningful difference, but we know it's still tough in the health care system now.
BEVAN: And just quickly, you're going to make another announcement today with Chris Picton a little later about vaping. Is there anything you haven't done to crack down on vaping? You seem to make up vaping announcements every week.
BUTLER: This is another job that is just hard work because, you know, we've clamped down on these things flooding in the border, but we've already seized more than 5 million of them at the border just since January. These are 5 million vapes taken out of the hands, largely of school children and very young adults. But we've also got the ban now on the sale in retail premises and South Australia, through Chris Picton and Andrea Michaels have been doing a terrific job getting out into retail premises, making sure they're not still selling vapes. As I drive around my own part of Adelaide in the West, those vape stores that were open, they're shut now. Today, we'll be able to provide some new advice about the progress we're making on taking these vapes out of the hands of kids.
BEVAN: Okay. Thank you very much, Mark. Good to come in. Mark Butler, thank you very much. He is the federal Minister for Health and Aged Care, local MP for the seat of Hindmarsh.
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