Radio interview with Minister Butler and Matthew Pantelis, FIVEaa Mornings - 27 April 2023

Read the transcript of Minister Butler's interview with Matthew Pantelis on cheaper medicines; nurses in nursing homes; Urgent Care Clinics.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MATTHEW PANTELIS, HOST: Mark Butler, good morning.


PANTELIS: All right, let's start with prescriptions and pharmacies particularly. They're not happy - the pharmacists - and I don't really understand why, it's the same business at the end of the day, isn't it?

BUTLER: What it will mean is that for the 6 million patients who are on chronic disease medicines and many of them have been on these medicines not only for years, some of them for decades, for blood pressure, for cholesterol, for particular diseases like Crohn's disease, asthma, and the like. Many, many millions of Australian patients, instead of only being able to be given one month's supply of medicines and having to go back to the same pharmacist the next month. The advice I received from the expert group that oversees our entire medicine system, a group called the Pharmaceutical Benefits Advisory Committee, was that for a certain group of medicines - those sorts of things I just talked about: blood pressure, heart disease - sort of stable medicines people are on for an extended period of time, you should be able to get two months’ supply at once.

Now, this is very common across the world. New Zealand has had this system for 20 years, UK for years, Canada, France, Germany, America. So, we're really the outlier, the idea that you can only get one months' supply. If obviously you're getting two months’ supply, you only have to go to a pharmacist six times a year, not 12, and it means you only pay 12 co-payments. So, every time you get a medicine, if you're a general patient, you're paying maybe $30. If you're a pensioner, you're paying $7. It will halve the cost of these medicines for 6 million Australians. Huge cost of living relief. We also know though cheaper medicines are good for people's health. There are almost a million Australians every year, the Bureau of Statistics tells me, almost a million Australians go without a medicine that their doctor has prescribed for them because they can't afford it. They're making choices between groceries, rent, energy bills and medicines. Making medicines cheaper, making it more likely people will actually get their scripts filled is good for their health. But we also know from overseas evidence that if you've got two months’ supply of medicine rather than just one month, you've got better compliance because one of the biggest causes of people going off their tablets is that they run out. Or their script runs out and they're having difficulty getting into a GP, and your listeners know how hard it is to get into a GP right now. Halving that number of GP visits is good for obviously convenience. People have got busy lives, it's good for their hip pocket. They're not paying those gap fees that some GPs are charging now, and it halves the number of fees they're paying their local pharmacist.

PANTELIS: Is the safety net unaffected then for people who are on that?

BUTLER: The safety net stays as it is. We cut the safety net for pensioners last year by 25 per cent, so now for pensioners and concession card holders, the most that they will pay for all of their medicine needs no matter how many medicines they're taking across the whole year will be $5 per week. We cut that by 25 per cent, a very big reduction to the maximum amount a pensioner would pay for all of their medicines needs across a given year. We did that last year. We're not making any other changes to that.

PANTELIS: And claims of supplies running out or people hoarding medication. That just seems very fanciful to me.

BUTLER: You don't have to think about it for more than a few minutes to realise that the change we're making doesn't actually have any impact on the number of tablets for cholesterol, or for asthma, or for diabetes that are being dispensed between now and Christmas, or now and the end of next year. It will make a little bit of a change to the delivery schedules to pharmacists, but that's not beyond the width of our system to do that. I think this is frankly a bit of a scare campaign being run by the pharmacy lobby group. The experts that are set up by law to advise government on this have said this is the right thing to do. It's safe. They're charged with monitoring supply of medicines to the Australian community. They're the ones who recommended it. I notice that the medicines industry, which actually makes the stuff and delivers it, they’ve supported this change and it's long overdue, Matthew. It was recommended to the former government five years ago and they decided not to follow that recommendation, and as a result those 6 million Australians have been shelling out payments that the experts said are unnecessary, hundreds and hundreds of millions of dollars of payments they didn't need to make. I'm determined to follow that advice, because I think it will be good for the hip pocket of millions of Australians and ultimately good for their health as well.

PANTELIS: You've talked about how hard it is to get into a GP at the moment. You've said previously that the GP system is in the worst shape it's been in for decades. A key part of this is Medicare and the urgent reform it seems to need. You have the AMA saying indexation needs to be brought up to speed and maybe that's part of it. What are the answers here? We know also as part of this, from a study done only a week or so ago, it's very hard to find a GP clinic that bulk bills. So we've got some real problems in health. How are we going to address them?

BUTLER: General practice is in, I think, the worst shape it's been in in the 40-year history of Medicare. That's not just making it hard for people to get in to see a GP, which in itself is a real problem. It's also placing real pressure on our hospitals because if people can't get the care they need out in the community, at a general practice when they need it, too often they end up at hospital emergency departments, which is placing real pressure on our hospital system across the country, not just here in South Australia, in our home state, Matthew. So, rebuilding general practice is my highest priority as the Health Minister and we've got the Budget not next week but the week after next, where we'll be issuing our response to some work that I did with doctors’ groups, nursing groups, patient groups - something called the Strengthening Medicare Taskforce. I met with them over a six-month period last year in the lead up into Christmas, and we've been considering that report and will be issuing our response to it over the next couple of weeks. We've got to rebuild general practice. We've got to use all of the skills of other health professionals, including nurses particularly, the biggest group of health professionals in the country, 400,000 of them. Too often we're not using their skills fully enough, and that's not just a message I get from nurses, it's the message I get from doctors as well. They know the nurses who are working in their practice. They value their skills. They know that they can do more if the system allows them to do that. So, strengthening Medicare, rebuilding general practice is my highest priority as the Federal Health Minister. It will be good for general practice, obviously, but the flow on impacts for our hospital system are also going to be really important.

PANTELIS: GPs: we need more of them. So, recruiting and then keeping them in that general practice system is key and that's just been lacking too. Is Medicare part of the problem there that the rebates, the charges, everything else. Doctors not being paid for their efforts as they would see it appropriately, and so they go?

BUTLER: That's a really big problem. The Medicare rebate was frozen under the last government for six years. So that really squeezed the finances of general practice. It means that the financial attractiveness of general practice compared to working as an anaesthetist or a surgeon in a hospital is now becoming a real issue. We're now in a position where, when you and I were young, about half of medical graduates chose to become GP. So about 50%, or one in two medical graduates went into general practice. We're now down to just one in seven, but used to be one in two. Now only one in seven medical graduates are saying they want to be a GP. If we don't turn that around, you think it's hard to get into a GP right now, five or ten years when the current generation of GPs is frankly pretty exhausted after the three year pandemic that we've all been through, when they start hanging up their hats and retiring, I'm absolutely terrified about the fact we just don't have enough new GPs being trained to replace. So that is a very strong focus not just of mine and my Health Minister colleagues like Chris Picton here in SA, but I know it's also a focus of the National Cabinet, the Prime Minister, the Premiers, the Chief Ministers of the Territory. This is desperately important because you can't just pluck a GP off the tree. They take years to grow, to train and to supervise in general practice. So, we've got to get moving right now. This has been let go, frankly, for a decade. And if we don't turn it around soon, we're going to have a very real crisis on our hands.

PANTELIS: The other issue I wanted to bring up today was I see from July 1, residential aged care providers will have to have a registered nurse on site 24/7. Do we have enough nurses? When we talk about GPs, are there enough nurses out there to meet that demand?

BUTLER: We've got enough nurses in Australia, as I said, we've got 400,000 nurses in Australia. We have got to get them back into aged care. I think many of your listeners will be gobsmacked to hear that there's not already a legal requirement to have a nurse in a nursing home. We call them nursing homes, but there's been no requirement to have a registered nurse in them, which I think to most people is gobsmacking, particularly given that I've been involved in aged care for 30 years. I've seen it change so substantially over that time. People in aged care now are much more frail, much more unwell, much more dependent than they ever have been. But we have fewer nurses working in aged care than we had when I started dealing with the sector 30 years ago. It just doesn't make sense, which is why the Royal Commission into Aged Care a couple of years ago recommended that there be a legal requirement for every aged care facility to have a registered nurse on site 24/7, 365 days a year, and we unashamedly went to the last election making that commitment. Now, for some reason the former government did not accept that recommendation, which I never really quite understood. But we made a commitment to put nurses back into nursing homes.

For most aged care facilities, that's not a big leap. But most of them already have a registered nurse on site, if not 24/7, pretty much 24/7. So, they might have to tweak their arrangements. For some others, particularly some of the smaller facilities in more rural communities it will be more of a challenge and we're going to work with them to help them do that. We've got to make aged care more attractive as a place to work in, which is why we supported a wage claim to lift the wages of aged care workers. From the 1st of July aged care workers will receive a 15 per cent wage increase awarded to them by the Fair Work Commission, the old Industrial Relations Commission, and funded by the Commonwealth Government, given that we fund aged care. For so many years there's been a massive gap in the wages you receive as a nurse working in an aged care facility compared to what your colleagues earn at the QAH or at the Royal Adelaide. That means there is a challenge frankly attracting nurses to work in aged care when there's such a wage difference. So, for that wage increase that comes in July will certainly help, but there's more we need to do to give all of those nurses out there who once used to work in aged care or might only be working part time in aged care and would be willing to work additional hours, give them confidence that we will lift the standards in aged care, will lift the wages in aged care and give that work the value that I think all of your listeners agree it should have.

PANTELIS: And just finally, I want to just raise this with you, because I see information this morning that every metro hospital yesterday, and this is a state government issue, let's make that clear at the start. But as the Federal Minister, I'm sure you're getting this from your Health Ministers right around the country, from different governments that last night every hospital was code white, which means there was no beds available, so any patients going to a hospital anywhere in metro Adelaide, just no room, no beds. That's the key problem with our health system, well, right across the country, including particularly I think here in South Australia, where we've just seen the ramping issues, the lack of beds, the lack of staff for the beds to be created for a start, because every bed, needs a doctor, a nurse, etc. We've got this perennial problem now it seems that we just can't get on top.

BUTLER: I don't say this as an excuse, but this is not just an issue in South Australia and it's not just an issue in Australia. Right across the world, in the western world, developed countries, every hospital system, every health system is under the most extraordinary pressure after three years of this pandemic. The workforce is exhausted. In so many cases, people were not able to get out and get the care that they needed for different conditions. Some of them as serious as cancer, which means that now they are getting the care after lockdowns and all of the other impacts of COVID. Now they are able to get care, their conditions are much worse. The acuity has increased really substantially. Health systems are under very real pressure. Generally when there's a problem in the health system, whether it's in general practice or mental health or in the aged care system, it all ends up at the hospital emergency department. The hospital emergency department ends up as the lightning rod, but for every challenge we've got in the health system. The best contribution I can make to this problem, this challenge that everyone is having across Australia, not just here in SA, is to try and take pressure off the hospitals. We're building Urgent Care Clinics here in Australia which people can visit fully bulk billed for those sort of urgent emergencies that are not life threatening. At the moment so many people are going to the hospital emergency department because they can't get care anywhere else. We want to give them an opportunity to go and visit somewhere where they can get high quality, urgent care, fully bulk billed, extended hours, seven days a week, and take that pressure off the hospital emergency department. There are no other ways I think we can cooperate with Health Ministers like Chris Picton as a Commonwealth to take that pressure off hospitals and allow hospitals to get back to the business that they're really built for, which is the really, really high acute needs, those sort of life threatening emergencies that should be the bread and butter of emergency department.

PANTELIS: Minister, just again, a state issue, but I've got a text here. Please ask about unvaccinated nurses for COVID getting back to work like other states. Should they come back to work, should they be allowed back?

BUTLER: Look, I'm going to be honest and say I'm not entirely clear what the current arrangements in South Australia are as we've moved into a very different phase of the pandemic. A lot of those vaccination mandates have been unwound at a different government level. I don't pretend to understand exactly where the South Australian health system is up to. I’m sorry you're going to have to ask someone from the state government that question.

PANTELIS: I appreciate your time. Look forward to maybe having a chat with your GP report out in a few weeks’ time.

BUTLER: Terrific. Thanks Matthew.

PANTELIS: Thank you. Mark Butler, the Federal Health and Aged Care Minister on a few issues there.

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