Radio interview with Minister Butler and Matthew Pantelis, FIVEaa - 10 October 2023

Read the transcript of Minister Butler's interview with Matthew Pantelis on taking pressure off hospitals; Medicare Urgent Care Clinics; Ozempic; shingles vaccine free for 5 million Australians; veterans and My Aged Care.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MATTHEW PANTELIS, HOST: Minister, good morning.




PANTELIS: Let's talk about federal funding. As you heard me say, you were hanging on there. Thank you for that. The Premier saying “well, we can't do it with one hand tied behind our back. We need more federal assistance.” Is there any forthcoming?


BUTLER: We've been having a really good discussion with all state and territory governments. The National Cabinet, which your listeners will probably know is a meeting that happens pretty regularly between the Prime Minister and all of the Premiers and Chief Ministers, decided that their priority for 2023 was health reform and health funding. Because after a decade of pretty serious pressure on Medicare, then followed by a three and a half year pandemic, our health system is really under pressure. We're seeing that through all elements of it. We're seeing it in our hospital emergency departments, we're seeing it on the hospital wards, but we're also seeing it out in the community in general practice. I think there's a really high level of goodwill between all governments working together. What we've seen in the past, and I've been involved in health for a long time, sometimes what we've seen in the past is, claims for more money and a bit of the blame game between state and federal governments. We're not seeing that now. We're seeing a really mature level of discussion about problem solving because I think we all understand that Australia is not unique. Health systems right around the world after the COVID pandemic are under enormous pressure. There's struggles to find the proper workforce we need. The workforce who are still working in the hospitals and general practice are exhausted. Many of them are taking early retirement. I think we all recognise we've got a job of work together and we're committed to doing this cooperatively and that will mean negotiating a new hospital funding agreement over the next little while. Currently, there's a five-year agreement that all of the states signed on to with Scott Morrison back in 2020 that runs to 2025. We've got a review of that underway that all of the states and the Commonwealth agreed to and we'll receive that report over the next few weeks.


We're also, in the meantime doing things like opening Urgent Care Clinics here in Australia. What they're designed to do is to give people access to emergency care that doesn't necessarily need a fully equipped hospital. So, you need care urgently, but you don't need to go to a fully equipped emergency department. We'll give you an option to receive that care, fully bulk billed, seven days a week, and those Urgent Care Clinics are opening over the coming weeks in South Australia as they are across the country.


PANTELIS: They're behind schedule, though, aren't they? The Urgent Care Clinics and you've got some flak for that. So how far behind, when will they all be open? Are they they're not on track, are they, by the completion date?


BUTLER: That's not right. During the election campaign, I made it very clear that they would be open during the course of the 2023-24 financial year. That's from the 1st of July 23 up until the end of June 2024. Then what I said after talking to state governments, when we actually won that election last year, that we were confident we'd be able to get them all open by the end of calendar 2023. So, before the end of this year. I've said only over the last week or two: that will be achieved. 58 urgent care clinics across the country will be open and operating by the end of this year. Dozens of them already are open. And over the coming couple of weeks, the South Australian clinics will be open.


PANTELIS: All right. Ozempic the diabetes drug, which is hard to find now, type two diabetes, people needing that and doctors also prescribing it to help with weight loss. Should that stop? Should it be reserved for people with type two who really need it so they don't have to scale down to the lower level Ozempic and then try and build the insulin levels back up by when it becomes available, the proper dosage becomes available down the track?


BUTLER: Some of your listeners will be aware of this issue, which is again, a worldwide issue. You saw an explosion, frankly, of people using Ozempic and a couple of other drugs like it essentially for weight loss and the prescription of that drug for weight loss by doctors right across the world, including here in Australia. What that led to was a shortage of availability of that drug for people with diabetes, as you say. That's been a huge concern for us as it has been for authorities right across the world. We've been doing a couple of things. Firstly, talking to the company, Novo Nordisk, which is a Scandinavian medicines company, about ways in which we can secure those supplies. We're much better off than we were last year on that, although we're remaining vigilant about the potential for shortages continuing. We're working very hard to make sure we've got the supply. We've also had our medicines authority, the Therapeutic Goods Administration, communicating with doctors to be careful about the way in which they prescribe this drug. The prescription of Ozempic for weight loss is what they call an off script or off label prescription. It's not actually authorised on the PBS for weight loss but that doesn't mean doctors can't prescribe it if they think the patient would benefit from it. What we've said to doctors is be careful about making sure that your patients with diabetes have priority here. It is a crucial part of their treatment. We think we've seen a good response by doctors to that but, as with authorities and governments right across the world, we're remaining very vigilant about securing supplies of Ozempic for diabetes. This issue, Matthew, is not going away. What we're seeing is more and more clinical trials and results showing that this type of medicine, which was designed as a diabetes treatment, is showing very substantial results on weight loss. This is going to continue in the future and we have to find a way to manage the availability of this for weight loss if that's where you know, trials go while also preserving supply for people who really need this treatment for their diabetes.


PANTELIS: Michael's called in from Banksia Park with a question for you, Minister. Good morning, Michael.


MICHAEL, CALLER: Good day, fellas. Mark, you mentioned that the hospital system's at capacity, overloaded. Last week, SA Health sacked 150 nurses who refused to get the injection, the COVID injection, the experimental COVID injection. And those nurses could have all gone back to work now because the so-called pandemic is over. The other issue I've got was we've got a housing and rental crisis in South Australia or actually around Australia, but in South Australia it's critical homelessness. There's a crisis as well, and yet we've got Federal Labor wanting up to a million more migrants coming in and Malinauskas has called for up to 200,000 more migrants in South Australia So who's paying for this? And the schools are overloaded, the hospitals are overloaded, the roads are crowded, peak hour traffic, regardless of how many more roads they build, everything is just at breaking point and they want to flood the country and this state with more migrants?


BUTLER: We're very concerned about housing supply. This is an issue right across the country but you're right, rental rates in Adelaide are very low here as well. That's why we've been working so hard to get our Housing Australia Future Fund through the Parliament to unlock money as quickly as possible to start building new supply. I mean the issue really is we're not building enough houses right across the country, including here in Adelaide, and we've been working very hard with all of the state governments to ensure that once we got that legislation through the Parliament, which we were finally able to do a few weeks ago, we can unlock some serious money and start getting those houses built. In terms of the migration numbers, I think everyone has seen that those numbers have taken a big climb over the last 12 or 18 months as the borders started to open after COVID. What you've seen is a whole lot of students return to Australian universities, which is good for the universities and drives our economy and sees people doing a lot of the work we need done in aged care, hospitality, and a range of other areas. For a couple of years you'll see those numbers have jumped because, you know, essentially people haven't been here leaving. All you've got is people coming in after the border has opened again. In actual fact, the Australian population today is smaller still in spite of that, influx of students and tourists that we've seen since the borders opened. The population today is still smaller than was predicted in the year before COVID under the former government. So, there's a bit of catch up happening, particularly around student numbers and some of the skilled migrant visas but we're very conscious of the need to make sure that housing supply keeps up with those numbers. Those numbers will level off because you've really just seen a bit of catch up, particularly around our universities but we're very conscious of the pressure that's placing on our housing market, Michael.


PANTELIS: All right. Thank you, Michael, for the call. Look, diabetes is the sleeper issue. Wayne says, “I'm diabetic, haven't been able to access Ozempic on the Yorke Peninsula for the last three months.” Todd has called in from Ingle Farm on a diabetes medication related question I understand.


TODD, CALLER: Matthew, Minister good morning. I know there's a shortage around the world and in Australia of Ozempic medication. Why can't the actual chemists only give the actual person Ozempic medication if they see on their computers or that that person is purchasing diabetes medication?


BUTLER: That's an interesting suggestion. I think what we've decided as governments and the medicines authorities, the responsibility really lies with doctors here, not with pharmacists. The job of pharmacists, if they are provided with a legitimate script or prescription signed by a doctor, that their job is essentially to fill it unless they really think something's wrong with it. The responsibility for prescribing Ozempic, particularly in a way that meets the need of needs of people with diabetes first and foremost, I think rests with doctors, not with pharmacists, which is why we've been working so hard with them. If more needs to be done as we continue to monitor the supply from overseas and the demand for people from Australia with diabetes, then we'll look at what more needs to be done.


TODD: Isn’t there a saying two is better than one?


BUTLER: We will continue to look at what needs to be done if we don't think that the measures we're taking with doctors is doing the job. We'll continue to monitor this, I’m particularly concerned about the other caller who said that there was a long term shortage in the Yorke Peninsula. I'll follow that up after I've finished this interview as well.


PANTELIS: Just quickly, a couple of other things. Federal government funding, free shingles, vaccinations now for older Australians?


BUTLER: This is going to mean we have the most comprehensive shingles vaccination program anywhere in the world, perhaps with the exception of Germany, but certainly one of the most comprehensive vaccine programs. We've received really strong advice over the last several months of the benefits that this will give, particularly to older Australians. From the 1st of November, this cutting edge new vaccine, Shingrix, will be available free of charge to people over the age of 65, plus a couple of other vulnerable groups that have been identified by the authorities. That's about 5 million Australians who, at the moment, I know a number of them are very keen to get this vaccine and avoid the awful disease of shingles. At the moment they're paying $560 for this cutting-edge new vaccine. There has been a shingles vaccine on the market for some time on the National Immunisation Program but this new one, Shingrix is much more effective. For a 70 year old, for example, it's about 90 per cent effective against the old vaccine that was only 40 per cent effective. That's a huge difference. It also is longer lasting and has fewer side effects. This is going to be a terrific thing for older Australians. They know if they've had shingles, it's very, very painful. But more importantly, more worryingly, it can have very long-lasting effects as well and some complications that leads a number to end up in hospital. This is good for the health system, but it's also good for the wellbeing of older Australians. It's a very big $800 million investment by our Government in our commitment to cheaper medicines and a stronger Medicare.


PANTELIS: Just finally, I had a caller some time ago who just rang in and said, you know, going to a private hospital, if you want to try and avoid the six, ten, 12 hour wait in the RAH or wherever else you might be. So you rock up at a private hospital and the first thing they say is $600, please. He was saying, well, surely the extensive premiums we already pay to health funds should soak up some of that. I suppose if that happened, that would only force premiums up even further. But $600 does seem excessive when it's to help alleviate the crush in an in a public health hospital. You're looking at that at all? Is there room for movement there somehow?


BUTLER: We'll continue to look at what the private hospitals can do to provide support across the health system. I think really what we've been trying to do instead in terms of relieving pressure on the public hospital emergency departments, is these urgent care clinics. Open seven days a week, they're fully bulk billed and you can walk into them. So, you don't need to be on the books of the particular practise that would be operating the urgent care clinic seven days a week, fully free of charge, available for walk ins for those emergencies that need urgent care but aren't life threatening, not the sorts of things you need to go to a hospital for. If your kid or your grandkid falls off the skateboard and busts their arm, you can't wait six to eight days to get into your local GP. You need care immediately, but you don't necessarily need to go to a fully equipped hospital. That's what I think we're doing to try and take that pressure off the hospital emergency departments and all of the ramping issues and so on that are a real concern, not just here in South Australia. They are happening everywhere across Australia.


PANTELIS: I can tell you, Catherine will make this interview very worthwhile for you, Minister, she says on the text line, My son fractured his wrist 5 pm Friday playing volleyball, went to the Urgent Care Clinic at Marion: x-ray, cast, home in 90 minutes. She says they're amazing.


BUTLER: Fantastic.


PANTELIS: Now, just very quickly to payroll tax, the decision that could see GPs paying payroll tax where previously staff in a clinic might have been a contractor, now they have to be classed as an employee, putting up costs, potentially putting up prices for people visiting a GP and potentially also fewer GPs around. That's the last thing you want. Is this going to be reviewed at all? The ATOs made the call, as I understand it, or certainly GPs looking to pay that once the exemption period ends. That's not going to bode well for anyone, GP's or patients or EDS where people will end up.


BUTLER: I'm very worried about this and it's important to say this is not an ATO issue, not an Australian Tax Office issue. Payroll tax is a state issue and this came out of New South Wales. That's where it started. The New South Wales Supreme Court handed down a decision a while ago that changed the way in which the state tax office over there had been treating general practice. Slowly it spread through all of the states as they've started to review the implications of that Supreme Court decision. Now I'm talking to them - ultimately how the state governments, including the South Australian Government, manage their tax arrangements is a matter for them. But I'm really concerned that on the 1st of November, for example, so in just a few weeks’ time, our new bulk billing arrangements start to take effect. That's the biggest investment in bulk billing in the history of Medicare, tripling the bulk billing incentive which the College of GPs described as a real game changer, to use their words, really to turn around the decline in bulk billing we've seen over the last few years. The last thing I want to see is those billions of dollars of investment that we announced in the May Budget into bulk billing ends up going to state treasury offices because of some change to payroll tax arrangements. I know we're working very hard with the College of GPs, but having discussions obviously with state governments to try and find that balance between them having to operate their tax systems in a proper way, but also not placing even more pressure on general practice that I think everyone understands is already under enormous pressure.


PANTELIS: Absolutely, which will only lead to more pressure in EDs and allied health services affected to, as I understand, a dentist and, you know, potentially all the way through physio and everything else?


BUTLER: We're still examining because every state is dealing with this a little bit differently. We're trying to get a clear picture of what every different state is doing and try to see whether we can get a level of consistency and appropriate application to the health system across the country.


PANTELIS: Moss has called in from Willunga in the meantime, G'day, Moss.


MOSS, CALLER: I would just like to talk to the Minister in regards to senior veterans and My Aged Care. I'm just wondering why older veterans with gold and white cards are dying before they receive essential treatment to keep them safe at home or in residential aged care? Because the My Aged Care system has taken over their care from DVA?


BUTLER: Moss, I don't have an answer to that question off the top of my head. I will take it away and I'll talk to my department and also to my colleague, the Veterans Affairs Minister. As the grandson and the son of veterans this is obviously a particular concern to me personally as well.


MOSS: The over 65s who are veterans are actually discriminated against now because the younger veterans receive much better care in complex situations. With the older act that the older veterans come under, they are transferred once they there needs to become more complex to My Aged Care. My Aged Care does not prioritise the gold card or the white card, and some veterans have had to wait 14 months before they even get an assessment and even if they were level four in regards to their disability. In fact people are dying in the meantime waiting for My Aged Care to give more domestic assistance in the home and outside the home.


PANTELIS: Concerning, absolutely.


BUTLER: We've worked very hard to get those waiting times for home care packages generally across the system right down. I think the last time I looked, which was only a few days ago, the waiting time for a level four home care package was down to very, very short, like 1 or 2 weeks. I'll have a look back at that. Thank you, Moss, for raising that issue, particularly for older veterans.


PANTELIS: All right, Moss, thank you for the call. Minister, thank you for your time this morning. Really appreciate it.


BUTLER: Thanks, Matthew

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