DAVID BEVAN, HOST: Good morning, Federal Health Minister Mark Butler.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning, David, you're about to start a very long holiday.
BEVAN: Yes.
BUTLER: Just making me a bit emotional as well. The sheer relief that the end of 30 years of probing questions from you.
BEVAN: We have had a few interviews.
BUTLER: I think you were my first interview.
BEVAN: Really?
BUTLER: When I was very young -
BEVAN: I was your first?
BUTLER: You were my first. It was a mixed experience, as I recall it. But you were outside the Bishop Auditorium with your cassette player hanging over your shoulder. Yeah, and I'd like to say it's been an unadulterated joy these last 30 years, being grilled by you.
BEVAN: Do you remember the Rooty Hill interview?
BUTLER: I do.
BEVAN: Yes.
BUTLER: I'm surprised I still have a career after that one.
BEVAN: We've got the giggles asking you about the Rooty Hill gaming pubs.
BUTLER: This is very triggering for me. I've sort of developed a twitch just talking about it again.
BEVAN: Yeah, because, well, we thought it was, all very ‘carry on’ here in, Adelaide. I don't think it went down that well in the eastern states.
BUTLER: It didn't go down well anywhere else really anywhere. I think you and Matt and Christopher Pyne and I thought it was hilarious, but we were the only four.
BEVAN: And I remember you giving a very good impersonation of Elvis Presley down at Moseley Square during one outside broadcast for, I think it was the federal election before last, was it?
BUTLER: Yeah, I think it was the 2019 election. And that was really just an omen, really.
BEVAN: Yes. Yeah, but it was fun.
BUTLER: It was fun.
BEVAN: By the way, Mark Butler does an exceptional Elvis Presley. You really do. Would you like to before we go?
BUTLER: No.
BEVAN: Alright. That's for another time. Now, in a moment. Hannah from Yankalilla. Your old friend Hannah from Yankalilla. Who has really been pushing the buttons on aged care. She wants to talk to you. Kathleen wants to ask you about over 65’s not getting access to disability care. Joe from Semaphore wants to talk about the COVID vaccine. But this question about the, was it, Visanne?
BUTLER: Yes, Visanne.
BEVAN: Alright. What's Visanne?
BUTLER: So Visanne is the first new listing on the PBS for endometriosis in 30 years, which is extraordinary, given one in seven women suffer from endometriosis. And the fact that there's not been a new drug has been a really serious challenge for those women. This takes a long time to get a diagnosis. I think it's really clear that the experience of many, many women - far too many women for too long - has been to have to suffer in silence and to be doubted, frankly, by the system about whether they're really experiencing pain to be told it's normal to suck it up. This new drug is going to be a real life changer for many, tens of thousands of women. And I announced it yesterday with a terrific clinician, Neisha Wratten, a gynaecologist who was probably the first Australian gynaecologist to prescribe this drug in a private script way, because it's not been on the PBS. And she's seen over the years just an extraordinary impact on patients.
BEVAN: So Anna asks, when will it be available on the PBS?
BUTLER: As of yesterday.
BEVAN: So you can go today and it'll be cheaper?
BUTLER: Yep. Go to your GP and get a script. And it is now on the PBS, available at affordable PBS prices. Until now it's been $700 - $800. Before then, it was over $1,000 a year to be on it, now it will be available at PBS prices. We announced that at the St Andrew's Hospital yesterday with, as I said, Dr Wratten, but also a couple of patients, including Syl Freedman, who ten years ago started this terrific organisation with her mum - she was 21 at the time - called EndoActive and it has been a really powerful advocacy organisation which, among other things, started a petition to get Visanne onto the PBS.
BEVAN: Okay. Hannah from Yankalilla. Good morning, Hannah.
HANNAH, CALLER: Good morning, David. Good morning, Minister.
BUTLER: Good morning, Hannah.
BEVAN: Hannah, your question?
HANNAH: This relates not only to health but to aged care. I think we had a bit of a pyrrhic victory on having the caps removed because we're going to be hit with co-payments.
BEVAN: Now, these are caps being removed on the cleaning and on the gardening?
HANNAH: Yes, but it goes further, David. There were caps on those. But the co-payments are going to affect gardening, shopping, cleaning, cooking assistance and anything linked to what they call domestic assistance. Now that's going to be charged at 17.5 per cent. I've done the maths and under the agreement by the government last year, we have to employ our support workers for a minimum of two hours. So if you have two hours of cleaning, two of gardening, two of shopping and showers three times a week, which wouldn't be unreasonable to expect, you're going to be out of pocket as a pensioner for about $100. And that's on conservative costs.
BEVAN: $100, what?
HANNAH: Out of your pension to co-pay to your care provider for the services you receive under your My Aged Care Package under Support at Home.
BEVAN: What's that, a year or a month or what?
HANNAH: That is a week, David.
BEVAN: $100 a week?
HANNAH: Yes. If you want those services of two hours of cleaning, two of gardening, two of shopping and two of showering. So what are people going to do? They're going to choose between going shopping or having a shower and having food or medication. It's going to affect their mental health, their general health, their skin integrity.
BEVAN: Okay, well Minister is Hannah, right?
BUTLER: I haven't brought the tables in with me. If you're in the aged care system now, if you have a home care package now and then transfer into residential aged care, which many do at some point in the future, you will remain under existing arrangements.
If you are in the system from next year, there is a new set of financing arrangements that help to underpin the sustainability of the aged care system, which is something that we've been looking at since the Royal Commission made some recommendations about this several years ago. We have a very large increase coming down the pipeline of older Australians who will need support in their home or will need residential care, and we need to make sure that they get the type of care that they deserve after many years of contributing to the sort of society we live in now. But also one that is sustainable given the taxpayer base. There are some contributions that people will be making to their own care at home or in residential aged care. But the taxpayer will continue to pay the vast bulk, like around 75 per cent, of all aged care costs right across the system. The contributions are also calibrated or tiered, depending on whether you are a full pensioner or a part pensioner or a fully self-funded retiree. They're graded according to your assets and your income. And they're also different depending on whether they are the sorts of things that you would have to pay for anyway, like your meals, everyone pays for their own meals, for example, or whether it is clinical care. Clinical care is completely free of charge for everyone on the Medicare principles.
BEVAN: If you are a fully self-funded retiree, you would pay the maximum amount, the maximum contribution?
BUTLER: That's right.
BEVAN: Is that capped at 17.5 per cent?
BUTLER: I haven't got the tables in front of me. They're very complicated because they first depend on whether you're a self-funded retiree, a Seniors Health Card holder, a part pensioner or a pensioner. And they're then different according to whether it is clinical care or whether it's services like showering, on the one hand, or whether it's things like meals that you would pay for in the ordinary course of your life anyway. It is quite complicated, but it's been thought through very carefully, firstly by a taskforce that included providers and consumer groups that made recommendations to government and then over long negotiations that the government had with the Opposition, which I think we've talked about before on this programme, largely involving Anne Ruston, the Shadow Health and Aged Care person, but with Peter Dutton, very, very heavily involved.
BEVAN: So the Coalition signed up on all this as well?
BUTLER: Yeah.
BEVAN: And so both sides have said you're going to have to pay more if you're coming onto the system from the middle of next year?
BUTLER: But I will make the point that the change is pretty marginal in the overall system point of view. Up until now, I think taxpayers pay around 77 or 78 per cent of the total cost, and we get down to about 74 or 75 per cent -
BEVAN: Hannah says it’s about a hundred bucks a week?
BUTLER: It's about a 2 or 3 per cent difference that taxpayers make compared to the contributions of older Australians over time, into the future.
BEVAN: Hannah, thank you for your call. I mean, we could spend the rest of this session just talking about aged care. But Hannah, thank you very much for flagging that. We'll look at that in more detail. I'm sure, over the next couple of weeks. Kathleen's next from the Adelaide CBD. Hello, Kathleen.
KATHLEEN, CALLER: Oh, good morning, David and Mark. One of the things that really concerns me about Labor is that it represents the people and is supposed to be fair. So I'm really upset by inequity, which is a form of iniquity, which is in the case of age and accidents. If you have an accident over the age of 65, a serious accident that might sort of cripple you for life, you don't get the care that normally you would as a disabled person in the rest of your life. You only get the normal My Aged Care payments. Now, I've got a couple of friends who've been affected by this, and I find age discrimination absolutely abhorrent, particularly in this case. I'd like the Minister to explain why nothing has been done about this, despite many letters being written about it by these people.
BUTLER: Thanks, Kathleen, for that question. When the NDIS was first being contemplated, probably 15 years ago now, we had a situation where essentially, we had two care systems; we had an aged care system for older Australians, and we had a disability care system for children and adults with disability. We were doing a whole lot of work to improve the aged care system, which we just talked about then. We're continuing to do to improve the level of care, the number of home care packages and things like that for older Australians. Then at the same time, we wanted to build a National Disability Insurance Scheme which would provide better care for children and adults with disability. This was not intended to supplant or replace the aged care system. It was meant to complement it. Like the disability care system that preceded it, it was targeted at children and adults with disability. Now, if you have a disability that might be from your birth or acquired during adulthood and you reach the age of 65, you will continue on the NDIS, on the National Disability Insurance Scheme. But if you acquire some sort of disability, which might be through an accident or through a neurodegenerative condition, or something like that, in aged care age, then you will be cared for in the aged care system. And that was really the arrangement that pre-existed the NDIS, and that age breakdown was not changed by the introduction of the NDIS.
BEVAN: Are you happy with that? Oh no, we've lost our caller. Alright, well we don't know if she's happy with your answer.
BUTLER: This is something that is raised with me from time to time. And this was a design principle when the NDIS was introduced 15 years or so ago. But really, there'd always been that separation between the disability system and the aged care system. And that remained in place after the NDIS It's just that the disability system was replaced by the NDIS.
BEVAN: Kathleen, are you happy with that response?
KATHLEEN: No, I'm not happy because I believe that it's still inequitable and I’ve seen people have drawn the Minister’s attention to this many times with personal letters and so on, and protested this and it is still a matter of age discrimination. Because what you get in aged care is nothing like what you would get as a disabled person. And these people are disabled.
BEVAN: Kathleen, thank you very much for your call. Let’s go to Jo from Semaphore. Hello, Jo.
CALLER, JO: Hi, Mark I’m just wondering, many of my family members have had a reaction to the Pfizer vaccine. And so we’ve basically all been sticking to the Moderna and that’s been okay. I understand the JN1, the vaccine that’s going to be available from December 9 is only Pfizer. I was wondering if you can let me know what’s happening with the Moderna vaccine?
BUTLER: Thanks, Jo, for the question. We had stocks of the Moderna vaccine and I've not been told that they're exhausted yet. They should run for quite a while yet. I'll actually be down in Melbourne this week opening the Moderna factory, which was a decision the former government made to establish our own mRNA vaccine manufacturing facility here in Australia. That is going to be a huge addition to our sovereign security or sovereign capability to have in addition to the work that CSL has done for decades in manufacturing vaccines, to have our own mRNA manufacturing capability here in Australia, which is a Moderna capability. I think we have still quite substantial stocks last time I was advised as well as the Pfizer vaccine. That should be fine. If you're having trouble, I'd encourage you, particularly given you're in Semaphore and a constituent of mine Jo, contact my office and we can follow that up for you. I'll be down there later today.
BEVAN: Jo, thank you for your call. Let's go from Semaphore to Coromandel Valley. If you've just joined us, we're talking to Mark Butler, the Member for Hindmarsh. It was Port Adelaide, and for a couple of elections now it's been the seat of Hindmarsh, and he's Minister for Health and Aged Care. Good morning, Simon from Coromandel Valley.
SIMON, CALLER: Hi. Good morning, gentlemen. How are you?
BEVAN: Good. What's your question?
SIMON: Look, earlier in the year, I was down, diagnosed with a cancer. It was May - June and put on the list for, you know, to have it removed. It’s supposed to be removed later this year but I've rung a couple of times and no one can give an answer to roughly when it would be whether you know you're on the list. I can't tell you where you're on the list, whether you're 20, 30, 500. I just wondered how that works?
BUTLER: I hope you're feeling okay and this must be really sort of stressful, period for you not to know exactly when you're going to be able to get whatever it is removed. I assume you're talking about the state hospital system?
SIMON: Yeah, this is, I’m on the list in the RAH.
BEVAN: Can you tell us what the cancer is, Simon?
SIMON: It's prostate cancer.
BEVAN: Prostate?
SIMON: Yeah. It's not super aggressive, but obviously the specialist said, you know, if you leave it for a long period of time, well, then it can expand.
BEVAN: Well actually, in ‘what ails you’ today we're talking about prostate cancer. So we might you might want to listen to that after 10:00am, Simon. But, Minister, he's been waiting since the new year is –
SIMON: What I’m curious is why, You know, they might say you're number 20 on the list or 30 so you've got some idea where you actually are, but no one can give you anything at all?
BUTLER: Yeah. The hospital systems have waiting lists for every type of procedure, it might be a knee replacement, a hip replacement. But for the oncology or cancer area, there are there's obviously a different level of urgency to the waiting list compared to a knee. I would advise you to contact your local Member of Parliament if you're getting very concerned about this, your state Member of Parliament. I'm not sure what electorate Coromandel Valley is in, but I would encourage you to if you're getting worried about this and I understand that you might be and not feeling you have enough information, I would contact your local state Member to ask them to follow it up for you.
BEVAN: Alright, Simon, I'm very sorry you're going through that. And thank you for your call. The Saturday Advertiser headline was ‘six year wait for elective surgery waiting times’. Brad Crouch writes, “for key specialist outpatient appointments at public hospitals have blown out with the maximum wait for 11 consultations now more than five years, including two of more than six years.” Then the very next day in the Sunday Mail, the story was more than a third of Australians say they have delayed medical treatment because of the tough economic conditions. People are going to go to the election in the next six months. Do you think Australians believe that the health system has improved in the last three years?
BUTLER: They’re two separate issues, but for people are the same experience. One is how the state hospital system, like we just discussed with Simon, is dealing with their elective surgery waiting lists, you should talk to Chris Picton about that. Although, obviously the states and the Commonwealth are talking about the adequacy of funding arrangements for state hospital systems, and I will be grilled by all of my eight state and territory health ministers at a meeting later this week about that. We've got our regular catch up for a full day, so that is obviously an issue. We have skin in the game on, but the operation of the system is really a matter for South Australia.
The broader question though, that was in the papers on the weekend is really about the huge pressure household budgets are under generally and the really difficult choices households are making. And some of them are ‘do I go to the doctor, do I get all my scripts filled?’ Particularly for a house that might have several scripts for medicine when they add them all up. And that is absolutely a high priority for us. It's why, over the last two and a half years we've been in government, so much of our time and my time as Health Minister has been getting more bulk billed doctor appointments and getting cheaper medicines so that people aren't left with this really difficult situation about choosing between something in their household budget and their health, on the other hand.
BEVAN: But do you think Australians believe that their health system is better now than it was three years ago?
BUTLER: I think that what we have done has made a meaningful difference. We have saved Australians over $1 billion in two years in out-of-pocket costs at the pharmacy because of our cheaper medicines policies. In just the last 12 months, there have been more than 5 million additional bulk billed visits, almost a million -
BEVAN: So you think it is better than it was three years ago?
BUTLER: Almost a million Australians have been through Urgent Care Clinics free of charge.
BEVAN: So you think it's better now than it was three years ago?
BUTLER: I think what we've done is made a meaningful difference to a system that was under huge pressure when we came to government, but I will say this: it is still incredibly tough to get bulk billed -
BEVAN: But if you've made a meaningful difference, what exactly does that mean?
BUTLER: That things are turning around. We have –
BEVAN: Oh, you think it's better?
BUTLER: We have more doctors, we have more bulk billing, we have cheaper medicines. Last week I opened our 83rd Urgent Care Clinic, providing fully bulk billed care, seven days a week for urgent care. But does that mean ‘job done’? Absolutely not. No, there is so much, so more to do.
BEVAN: But you think it's better? And you say, yes.
BUTLER: I think things are turning around. We've got more junior doctors choosing general practice as their career. Now they are the green shoots of recovery. And we've got years more work to strengthen Medicare and make sure it's delivering what particularly patients need today rather than what they might have needed in the 1980s, when Bob Hawke and Neil Blewett introduced it.
BEVAN: So you'd rather be turning up to an emergency department today than three years ago?
BUTLER: I'm talking really about general practice and urgent care -
BEVAN: Well, you'd rather be trying to get in to see a GP today than three years ago?
BUTLER: Yes, I would. Now does that mean it's easy to find a GP or a bulk billed GP? It is still tough, but things are turning around. There are more doctors bulk billing, the doctors’ College says that and the statistics say it. As I said, in the last 12 months, more than 5 million additional bulk billed visits to the GP. Medicines are cheaper, there's more urgent care. Now, the impact that is having on the hospital system is that what they call semi-urgent or non-urgent presentations to the emergency department – think of your kid falling off a skateboard and breaking their wrist, they need urgent care, but they don't necessarily need a fully equipped hospital. So those presentations are starting to reduce because more and more, those cases are now going to our Urgent Care Clinics, of which we have several here in Adelaide.
BEVAN: Now people are just given up.
BUTLER: No, you don't give up if your kid falls off a skateboard and breaks their arm.
BEVAN: They've given up going to emergency departments because there's no point.
BUTLER: They know they would have to wait 6 or 8 hours there, because obviously priority is given to someone coming through the front door having a heart attack. What we have done, what many other countries do, which is to give an alternative option to people, and that is a general practice that is better equipped to deal with urgent care, including fractures and all those sorts of things, open seven days a week and fully bulk billed. And we know that's having an impact, a positive impact on hospital emergency departments in those areas. But I stress, I hasten to say, things are still very tough in the health care system as they are right around the world after a decade of cuts to Medicare, the fact we are a population getting older and sicker, and the impact of COVID is still felt in our health care system.
BEVAN: Now it's just gone 9:30 and we've only got time for one more call. Can we go to Doctor Kenneth Joy? I see from my screen, Doctor Kenneth Joy is a GP with district priority areas. I'm not sure exactly what that means, but good morning, Doctor.
CALLER, DOCTOR KENNETH JOY: Good morning. Thank you for taking my call. I just would like to ask the Minister if he could comment on the status of the DPA, the district priority areas review that has been taking place for the last 18 months, I believe. The Minister is aware that the current DPA restrictions place many metro practices like mine in Old Reynella at a disadvantage where we are considered inner metro, even though there are many practices much closer to Flinders and the CBD is considered outer metro. This restriction prevents us from being able to backfill retired doctors or GPs who elect to leave community practice in favour of the more lucrative reimbursements found in the Urgent Care Centres.
BUTLER: Thank you for that question, Doctor Joy. For your listeners benefit, David, the DPA - Distribution Priority Area - status allows practices in particular to recruit overseas trained doctors. We've got a lot of in this case general practitioners coming in from overseas. We've made it easier for them to come in from the UK, Ireland and New Zealand in particular systems that we're very confident in. But they can only work and bill Medicare in certain areas. So particularly we prioritise rural communities that find it very difficult to get Australian trained doctors -
BEVAN: But Doctor Joy is saying if they move on, you can't backfill them?
DOCTOR JOY: Correct.
BUTLER: That's right. There is a live debate now and I know including in areas like the south of Adelaide, but equivalent areas right across the country about whether we should expand those rights to recruit overseas, trained doctors to some parts of our bigger cities that are having real trouble getting enough GPs. And as the doctor said, I've had a review commissioned about that. I've received the report, which is public, for doctors to have a look at it. It frankly doesn't give me probably the range of recommendations I was hoping for, particularly to deal with some real deserts in the system in some of our cities. Adelaide and Perth are the two big cities I'm most worried about not having enough GPs in them. We're having another look at that report. If you've got some ideas, you can send them direct to me or through your local Member, Amanda Rishworth. I'm sure she'll forward them to me because she's been talking to me about this issue as well. But there is no easy fix. I will say that. Because if we make it too easy for metro areas to recruit overseas, trained doctors we’ll create knock-on problems in rural communities. But it is something I'm deeply concerned about and committed to trying to find a fix for.
BEVAN: Minister, thank you for coming in.
BUTLER: Thank you David.
Media event date:
Date published:
Media type:
Transcript
Audience:
General public
Minister: