Radio interview with Minister Butler and Gary Adshead, 6PR Mornings - 20 February 2023

Read the transcript of Minister Butler and Gary Adshead on nurse practitioners; alcohol abuse; cashless debit card; GP shortages; vaping.

The Hon Mark Butler MP
Minister for Health and Aged Care

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GARY ADSHEAD, HOST: Now, as I said, there's a flood of politicians, federal politicians here in WA, and one of them, of course, for a Cabinet Meeting, Health Minister Mark Butler, and he joins me now. Thanks very much for your time, Minister.

BUTLER: My pleasure.

ADSHEAD: Ok. You’re holding a Cabinet meeting in Port Hedland this week. Alcohol abuse and all the misery that comes with that is the biggest health problem in our regional towns like Carnarvon, Halls Creek, Kununurra, Laverton. Will you be offering any help with that, while you're here?

BUTLER: Well, we're here to listen, frankly, and we're in the process of going through all of our alcohol and drug programs that we inherited from the former government, working out ways in which we need to build on them across the country. So, that's the great thing about being able to come to Western Australia and go and visit communities outside of the major cities to hear directly from them what a new federal government could be doing to deal with some of those challenges. We know how deep they are.

ADSHEAD: Can I ask you whether you have a view on the cashless debit card? Obviously, Peter Dutton is talking about the need to return to that, and people in Laverton, some of the leaders in Laverton are definitely saying that since it's been scrapped, they've noticed an increase in problems.

BUTLER: This isn't my portfolio area, and I'm, you know, I'm reluctant to talk about a portfolio area that another Minister is dealing with. But we took a very clear commitment to the last election to abolish a card that a number of reports had said wasn't working. The report of the National Audit Office and a number of other pieces of research demonstrated it wasn't doing the job it was intended to do. Now we don't pretend that we don't need to back in this decision with services, including alcohol and drug services, and the Minister responsible, Amanda Rishworth and I only met last week to talk about that again: to make sure that those communities that are seeing this card abolished do have the backup services in place.

ADSHEAD: Can I ask you now, obviously something more close to your heart is obviously GP shortages. Well, in your opinion, why has it happened, why have we seen a shortage of GPs around the country?

BUTLER: A couple of reasons: one, demand for health is climbing and it's climbing pretty steeply, not just here in Australia but around the developed world. As a population gets older, we get more and more chronic disease, there's just more demand to see a doctor. At the same time, though, over the last several years, we've seen a shocking decline in the number of young medical graduates choosing general practice as their career. You know, it used to be about 1 in 2 medical graduates went into general practice and the rest went into the other hospital-based specialties, really. That figure is now down to 1 in 7, so from 1 in 2 down to 1 in 7. I've described that as probably the most terrifying statistic I've got in health in Australia right now. It means that all of those older GPs who have worked hard for decades and are thinking now about hanging up their hat and retiring, aren't being replaced by young GPs in the numbers we saw only 10, 20 years ago. So, we've got soaring demand for health care and we just don't have a pipeline – a sufficient pipeline - of new GPs. That's what I’ve really tried to identify as a major challenge for us.

ADSHEAD: Can you do anything with the May Budget to incentivise those people you're talking about that are coming out of uni, and then perhaps not taking the GP path, but sort of heading into other areas, can you do anything about that in a Budget?

BUTLER: We have to. We absolutely have to. It's why we put strengthening Medicare as the centrepiece of our health policy at the last election. Part of the reason why young medical graduates aren’t seeing general practice as an attractive career is that they’ve watched 10 years of cuts and neglect really hollow out a system that is the backbone of healthcare in Australia. I mean, if general practice fails you start to see it just turn up at the emergency departments of hospitals, because people find themselves unable to get the care they need when and where they need it in the community. So young medical graduates as they cast their eye across the healthcare system have seen general practice become a harder and harder job as you see the cuts and neglect of the last 10 years - particularly a freeze on the Medicare rebate that Peter Dutton kicked off in 2014 that went for 6 long years, I mean, effectively freezing the income of GPs, so we've got to restore some vibrancy back into general practice and convince those young medical graduates that that’s a career that they'll enjoy, find rewarding for the next 30, 40, 50 years.

ADSHEAD: Now I know you're gonna be talking about nurse practitioners, is this one of the stopgaps? Is this a measure that you think could help alleviate the sort of the pressure that's on GP clinics?

BUTLER: Yes it can. I think one of the things we need to do is use the full range of our healthcare workers much more effectively, much smarter than we do here in Australia. There are too many artificial limits on the work that specialist nurses, for example are able to do. These are highly specialised people who have done their basic nursing degrees but in addition to that, they’ve done a master's degree, got very substantial clinical experience, but aren’t able to use those skills, aren’t able to use their training and their experience because of limits at state level, there are limits on the Medicare system at a federal level. So, this really clever proposal from Amber-Jade Sanderson, the Health Minister here in WA, seeks to really explore the ways in which we can use these specialist nurses much more effectively out in the community, that will mean people get the care they need when and where they need it, it will take pressure off the GP system, and it will take pressure off the hospital system.

ADSHEAD: Can I just ask you something that I've been sort of following, and no doubt you've been watching closely, too. And it's the issue of vaping, can you just explain to me why something that's illegal, as a vape, with nicotine it, are able to flood into Australia and not be stopped at the boarder?  I don't understand it.

BUTLER: I think broadly it's a question of resourcing, and of will. You know, the former Minister, my predecessor, Greg Hunt, to his credit, really did try to put some controls in place in this area, he put what's called an import control regulation in place to try and stop these things at the border. Unfortunately though there was a revolt in his party room. There was a petition of his party room members, and that regulation was overturned within two weeks. So there hasn't really been strong enough controls at the border. And then state policing authorities and state ministers, quite understandably, say: “well why should we be devoting huge police resources to going out, going into convenience stores, or petrol stations, when you're letting them flood in at the border.” So, when I talk about this with my Health Minister colleagues, and we're meeting again about this later this week, I think we recognise we've all got to take action together. It can’t just be border control if there's also not policing on the ground to reflect the fact that there's this huge black market. Frankly, it’s become a huge black market. And It's an absolute menace, particularly to our children. These things are being marketed - they've got pink unicorns on them and their bubble gum flavoured some of them – I mean, who do you think that's being marketed to? It’s not being marketed to a 25-year-old, it is clearly being marketed, not just high school kids, but primary school kids. And school principals tell others – Ministers - this is now the number one behavioural issue confronting schools across the country. So we are determined to take action on this. I've said that publicly, I've had the TGA - the Therapeutic Goods Administration - out doing a very broad consult over summer, that’s finished now, so they are in the process of preparing their report to me, but we are going to have to have concerted action, not just the federal government, state governments as well, willing to devote some resources to stamping out this really substantial problem, particularly for young kids and adolescents.

ADSHEAD: But it isn't, it can't be that hard though, Minister, surely the TGA and Border Force just need to get their act together because they seem to argue about it, you know, the prohibition level on the products coming in, but surely you know one good bust and publicising that, is going to sort of make all those people that are out there enjoying this black market - the convenience stores etc. you talked about - get very worried.

BUTLER: My understanding is they're not coming in in big shipping containers full of them, they’re coming in very small boxes not properly labelled, obviously it is lawful to import nicotine-based vapes if they're going to be used for therapeutic purposes.

ADSHEAD: With a prescription.

BUTLER: So if they’re prescribed by, yes, if they're prescribed by doctors as a quit smoking tool then that’s legal, that's permissible. But the trouble is they're coming in very small boxes, often able to just to evade the detection of customs authorities, and as I say, customs authorities haven't been given the tools because when the former government tried to do that, they were effectively withdrawn within a couple of weeks, so we are looking at all of those options as well.

ADSHEAD: Alright, and can you see a solution or certainly a new way of dealing with it in the next coming weeks, as well? Because like you just said you know it's becoming a bit of an epidemic with young people, we've got to jump in now.

BUTLER: Yeah, we do. It's exploded, frankly, over the course of the pandemic. The numbers of vapes and the number of people vaping, is now now close to the number of people actually smoking cigarettes. This is no longer a sort of a niche, fringe issue this is right through, particularly younger teenagers and even kids younger than that and it’s causing really significant health issues for them, as well as all of the behavioural issues, teachers and principals complain about, quite understandably, is causing really significant health issues amongst our youngest people. So for all the hard work we did as a country to tackle smoking, this thing has frankly got under the radar of governments over the last few years, and it's going to take a lot of work to catch up.

ADSHEAD: Can I just ask you finally then what do you think of people in the medical profession that say that that vaping is the best way to stop people from smoking and that you need to adapt to that policy?

BUTLER: I mean that policy’s already in place here in Australia, we have the ability for doctors to prescribe vaping. The research, frankly, is pretty mixed about that, it helps in a very, very small number of cases, probably less than 5% of smokers will quit because of the use of vaping. So that's not nothing, but it's also not the sort of nirvana that some people - particularly backed often by the tobacco industry - make it out to be.

ADSHEAD: Alright, well, enjoy your visit to Western Australian, do appreciate your time today.

BUTLER: Thanks very much.  

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