Radio interview with Minister Butler and Neil Mitchell, 3AW - 10 February 2023

Read the transcript of Minister Butler's interview with Neil Mitchell on Babies in parliament; long COVID; strengthening Medicare; general practice; bulk-billing; Urgent Care Clinics; Centre for Disease Control; AHPRA; aged care; vaping.

The Hon Mark Butler MP
Minister for Health and Aged Care

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NEIL MITCHELL, HOST: On the line is the Federal Health Minister Mark Butler. Good morning.


MITCHELL: Now just out of left field first, do you think babies should be banned from Parliament?

BUTLER: Oh, nice, easy question to start our interview with thanks Neil.

MITCHELL: That's the idea. What do you think? I mean, the UK’s banned them and It's becoming the fashion here. We've had them in the State Parliament and the Federal Parliament.

BUTLER: We've had them in the Federal Parliament when babies need to be fed by their mother. I think, having a family friendly, including breastfeeding friendly workplace in the Parliament gives a whole lot of extra opportunity for women to rise to be Parliamentarians. So, no, I think we've got the balance right. I don't think people overdo it. I think they bring their babies in when they need to feed. Otherwise, babies are usually in the childcare centre at Parliament House if they're over in Canberra or being cared for by a family member who might have travelled with them. But I think we've got the balance right. I think it's a much friendlier, certainly family friendly workplace now than it was when I first came.

MITCHELL: Okay, onto health issues - long COVID. The State Minister here says it's up to you to provide the funding to keep long COVID clinics open. Will you?

BUTLER: We do provide funding for all sorts of outpatient clinics run by state hospital systems. They are covered by the hospital funding agreements that have been in place for many, many years. There are long COVID clinics around the country, most of them in New South Wales, but they're in every state and we continue to fund them.

We're also going through a process with the states, with the Independent Hospital Pricing Authority, to make sure we get the pricing right for long COVID because it is a new condition as you know, you talk about this a lot on your program, which is great. It's very complex. It's complex to diagnose, difficult to treat. So we want to make sure we've got the pricing right so states are getting funded for it correctly. But there's no question that these outpatient clinics that states might be setting up to deal with increasing numbers of long COVID are covered by the hospital funding agreement. So, yes, we cost share them. Most people, frankly, with long COVID are going to see their doctor and so the vast bulk of treatment of long COVID, which, as you know, is very widespread in the community, is happening under the Medicare system, fully funded by the Commonwealth.

MITCHELL: But we're going to have long COVID for a long time, aren't we? It's going to get worse because more people will get COVID and we've got about an estimated 10 per cent getting long COVID. It is more common with women – 75 per cent of the cases, we're told anecdotally, are female. Are we not going to need specialist long COVID clinics? And the states - New South Wales has been putting off staff, the Victorian Government says ‘well, it’s all up to the Feds.’ I'm getting calls from patients saying, ‘we can't even get in to see anybody in a long COVID clinic?'

BUTLER: I think the honest truth is we're still understanding the precise extent of long COVID, but we do know it's huge. Some estimates are 5 per cent, some are 10 per cent. In some populations it's even a little higher. And my advice, for example, for your listeners is that over the summer wave we've had, which started in late October and is starting to peter out now - probably 3 to 4 million people were infected with COVID, now, the official numbers say that's 1 million. But given reporting of tests is not mandatory anymore and a whole range of other changes, we know that probably the multiple is three or four. So if it is 5 per cent of even 3 million, you’re talking 150,000 people, potentially if it's 10 per cent - double that - are impacted by long COVID.

MITCHELL: Well GPs can’t handle all that. GPs are stressed enough, they’re not going to be able to handle all that?

BUTLER: It's going to place even more burden on an already deeply stressed health care system. You know, all of the usual cases that were going to GPs, a lot of them were deferred over the course, particularly the lockdowns in Victoria and New South Wales and the ACT, so now people are going to their doctor later or after they probably should have been because of all of that understandable response to COVID. And they're sicker. They're turning up at emergency departments with more acute illness as well. We're aware, I think all of the Health Ministers are aware - we meet very regularly - just what pressure the healthcare system is under. It's COVID itself, it's the impact of long COVID, and it's all of the built-up pressure on the health care system delivered by health professionals who are frankly exhausted. They're just exhausted after a few years of this pandemic.

MITCHELL: And it's massive underfunding for 40 years.

BUTLER: That's certainly what we've been trying to sort of bring to the public attention. You say there wasn't much discussion during the election campaign - I was trying to talk as much as I could about the pressure, particularly Medicare was under, I know there’s pressure in the hospital system, in mental health, in aged care and we wanted to talk about that as well, but general practice right now, you mentioned it in your introduction, is in the most parlous state it's been in in the 40-year history of Medicare. That's my view. It's the view of every single GP.

MITCHELL: You told me it was the last time we spoke it was terrifying. Is it still terrifying?

BUTLER: I think I used the word terrifying in relation to the pipeline of new GPs. I think I was saying that not too long ago - about 50 per cent of medical graduates, so one in two people coming out of medical school went into general practice. That's now down to 14 per cent. So instead of one in two, you've got one in seven going to general practice. So if we think it's hard to get into see a GP now, if you think five or ten years down the track, if we don't turn that figure around, make general practice more attractive to young doctors, young medical graduates, the thing is really going to become unsustainable.

MITCHELL: Are you putting new money into Medicare or not?

BUTLER: Yes, we are. We put it aside in the October Budget. What I said at the election was that we were going to put extra investment into Medicare but we wanted to talk with doctors and nurses and patient groups and the like about how best to spend it.

MITCHELL: So how much extra?

BUTLER: $750 million we put aside.

MITCHELL: And that's not being reshuffled from somewhere else in the Health Budget. That is brand new money, is it?

BUTLER: That's additional money. On top of that, we put additional money in the October Budget particularly into rural general practice, which is under even more pressure than in our cities. There’s pressure right across Australia, but it's more acute in rural communities. So we put a big package of additional money, so new money in the October Budget to bolster rural general practice. And only last week I announced the first tranche of our Urgent Care Clinics. Now, since we made that announcement in the election, I know Premier Andrews and Premier Perrottet, north of the border, have also joined us in starting to build these urgent care clinics that are somewhere between a sort of standard general practice and a full emergency department in a hospital, bulk billed, extended hours seven days a week available for people to walk in, we will be opening them over the course of this year.

MITCHELL: Obviously a key part of the problem, the GPs told me they can't afford to bulk bill because they don't get enough back. When will that be fixed?

BUTLER: That was obviously a very big part of our discussion. And I've said very clearly the pressure general practice – well Medicare generally is, but general practice particularly is under - as a result of six years of freezing of the Medicare rebate. Their income froze while their costs were going up. It's not viable.

MITCHELL: So, when will there finally be relief?

BUTLER: I have said there's additional money coming in May – it's set aside. It will be targeted in May, so people will learn exactly what that additional money is going to be spent on.

MITCHELL: So, will it be more money for the GPs, in a rebate, from May? Will it be more money for GPs and rebates, and other purposes?

BUTLER: It's going into Medicare; so it will go into rebates. But what I've said clearly is, it's clear to everyone that we can't just put more money into the existing system because the existing system isn't working for people now. The existing system was designed back in the 1980s when people had very different care needs, they generally went to their doctor for a short episode of illness, they got fixed, they got some medicine or some other treatment, they went away and didn't come back until they had another illness. That's not the profile today. So we need to reform the whole basis of Medicare as well as put more money into it. We can’t just throw more money into an existing system that's not meeting the care needs of people today.

MITCHELL: Well, it needs both. It needs money and it needs reform, does it not?

BUTLER: Exactly and that's the point I've made. That's why we sat down with what I called the Strengthening Medicare Taskforce. I didn't do it through the bureaucrats. I sat down directly with them. I chaired the meeting. We had six meetings, 3-4 hours each over the course of the last several months of last year, and we've released the report and we'll fund it in May.

MITCHELL: We're focusing on GPs, what about specialists?

BUTLER: The out-of-pocket cost to see a specialist has risen even more than for GPs. For GPs the average gap fee, the fee that many Australians have to pay the see the doctor is now more than the Medicare rebate itself for a standard GP consult - the first time in the history of Medicare. But over the last decade, specialist out-of-pocket costs climbed even higher. They actually doubled over the course of the last decade.

MITCHELL: Yeah, and medicine is increasingly specialised, I mean it’s often you’re at your GP and it’s ‘you’ve got to go see a specialist’. I'll give an example I got from one specialist: 1983, it was $100 to see him, it was a 95 per cent rebate, now it's $146 for the same visit with an 85 per cent rebate. He's worked out that the rebates gone up $1 a year over 40 years, that's absurd.

BUTLER: Well, that is absurd and that’s surprising I have to say. I'd want to look at what particular item in the MBS that was, because the MBS has continued to increase over the last decade – it hasn’t increased enough. But that's not a general picture you'd find in the Medicare schedule, a $1 increase over 40 years.

MITCHELL: No, $1 a year over 40 years.

BUTLER: Yeah, $1 a year over 40 years. I've been saying as loudly as anyone else is over the last couple of years, Medicare is in the worst shape it's been in for 40 years. But I want to be clear with people, I'm not going to throw additional money at the existing system because the existing system is not working for -

MITCHELL: But you are, you are throwing additional money - $750 million, aren't you?

BUTLER: Yes, but not at the existing system -

MITCHELL: Well, when will we get it?

BUTLER: It will come in May. But it will come in a package that responds to the needs of people today and what doctors and nurses and allied health professionals and most importantly, patient groups on that taskforce told me, is they need something different than what was sort of behind the design of Medicare in the 1980s. They need more wraparound care that’s not delivered just by a doctor - if you've got diabetes, has a diabetes educator in there, podiatrist in there, an exercise physiologist, a nurse.

MITCHELL: Do you accept that the problems with GPs in particular where people - some people tell me they just can't afford to go so they don't. Do you accept it's costing lives?

BUTLER: Yes, I suspect it is costing lives. We don't measure that. But it is very, very clear - the states report this to us all the time that people are turning up to the already overcrowded emergency departments with conditions that should and could be treated out in primary care – so in general practice or in community health centres, because either they can't get in to see a doctor or they can't afford one. The states think, or the independent authorities report there's about 8 million presentations to emergency departments every year, about half of them around the country are what are described as non-urgent or semi-urgent. So, the challenge for us - and this is why the Premiers and the Prime Minister have been talking about this issue so much – is to take pressure off an already strained hospital system. We need to divert those people who really don't need to be in an ED, when they get there, they always shuffle to the back of the queue because heart attacks coming in obviously need priority and they might end up waiting 6, 8, 10 hours to get care that they should be getting in a general practice.

MITCHELL: How much money? Just in general, how much do we put into the health system? Billions or many millions?

BUTLER: It’s sort of close to 10 per cent of our entire economy.

MITCHELL: And people are dying because it's not working properly?

BUTLER: I think that's right and that's always been the case. The health care system has never been perfect, has never saved every single life, and that's the case all over the world. Let's not pretend health care has ever been completely perfect.

MITCHELL: But you've just told us it’s never been this bad?

BUTLER: I think it's never been this bad. Certainly not been this bad in the era of Medicare. I've been saying that over the last 18 months, no one's challenged me, no one has stood up and said that's not right -

MITCHELL: No, I agree.

BUTLER: - And said, ‘it's worse in 1988, or it was worse in 1997’. It’s a product of the financial pressure that came from that Medicare rebate added to the fact we're getting older, there's much more chronic disease. And on top of that, you've got the impact of a once in a century pandemic. It's a perfect storm hitting an exhausted health care system.

MITCHELL: The changes and the improvements you're talking about long term. What do you say to people now who can't get hope if they're suffering from long COVID without hope or if they're suffering from something else, without hope, what do they do? Because there's a lot of them out there.

BUTLER: My approach to this is to be honest with people, that we can't turn around the health care system overnight, that we are putting additional investment in now that was invested in the October Budget. The Parliament is looking right now through a very well-represented committee that's going to advise us on changes to the health system, particularly focused on long COVID. That will be reporting to me in coming weeks, I expect. And we're trying to build and we're working closely with states who are also doing this, an intermediary system, intermediate system that makes it easier to see a doctor and takes pressure off hospital at the same time. Nothing in health happens overnight.

MITCHELL: I want to ask about that, you talk about pharmacists possibly diagnosing and prescribing, and specially trained nurses possibly being involved. Would they be part of integrated GP clinics or are you going to have the local pharmacist on the street corner who's selling hair dye, are they going to do it there?

BUTLER: Pharmacists being involved in prescribing medicine wasn't a part of our discussion at a federal level. I know some states are looking at trials that have pharmacists actually prescribing medicine.

MITCHELL: So, good idea or not?

BUTLER: But that's not something we're looking at.

MITCHELL: So is it a good idea or not?

BUTLER: Well let's see how those trials roll out and see what the product is. It's a pretty highly contested issue. But they're not, they’re not trials I'm dealing with right now. General practice that is delivering good wraparound care that is also employing highly qualified nurses, allied health professionals, some - not many - some also would employ a non-dispensing pharmacist, so not someone who dispenses medicine, but can do medicines reviews and make sure people are on the right Medicines. It's the idea of a very broad team.

MITCHELL: A couple of other things. Aged care is a mess, we've got Medicare is a mess, the whole system. Aged care is a mess and we are certainly losing lives there we shouldn't lose, when can you offer hope on fixing the aged care system? And getting elderly people out of hospital back into care?

BUTLER: Aged care was in real strife before the pandemic, again there had been too many funding cuts under the previous 10 years - staffing levels were right down, nurses - qualified nurses - were walking away from aged care because the conditions were so tough, and because they get paid more in hospital. So COVID then just piled on top of that - a range of additional pressures. We've got a strong agenda in aged care. We went to the election promising that every nursing home would have a nurse in it 24/7. Often when I say that to people in the community, they’re shocked that that’s not already a rule, that a nursing home actually has to have a registered nurse in at all times. Those rules come into effect this year. We funded that last year. We’re increasing the staffing levels generally, not just nurses, but carers as well, that's coming over this year and next. And, finally, we're increasing the wages of aged care workers because we know that's not only the right thing to do, I mean they get paid appallingly for some of the most important work in the community, but that’s actually becoming a difficult challenge in recruiting enough staff and keeping them if they are paid less than they are at Woolies.

MITCHELL: I really know, I really must let you go. But a couple of quick ones - the subsidised mental health - the reduction number of mental health consultations which have reduced from 20 to 10. There has been outrage and outcry about that, will you change it?

BUTLER: No, I don't intend to change it. I want to be clear that that was a measure that was put in place by the last government for two years directly related to COVID -

MITCHELL: But it’s still needed?

BUTLER: It was a clear COVID measure -

MITCHELL: There’s no question it’s still needed.

BUTLER: And I did that after considering a lengthy evaluation of the program by the University of Melbourne and that evaluation showed that far from - the program's called ‘Better Access’ - far from making access better it actually cut out tens and tens of thousands of people who weren't able to get into the system at all. 


BUTLER: And overwhelmingly those people were in poorer communities, who the evaluation found tend to have higher levels of mental distress. And so because they can't get access to these services, they’re much more likely to be medicated. So when I look at a program like this. I also look at it through a lens of equity and frankly that program just wasn't delivering enough equity across our outer suburbs, than big cities like Melbourne, certainly in regional Australia. So those additional ten had made equity worse.

MITCHELL: So it's not being reviewed, another one quickly, avian flu - are you concerned about it coming here?

BUTLER: We're concerned about the fact that all of the experts tell us that these zoonotic diseases - diseases that might jump from animals, birds to humans are likely to become more frequent in the future. That's why we're committed to a Centre for Disease Control that will frankly improve our pandemic preparedness in the future. Of course, I'm concerned about that, every health expert, every researcher, including in Melbourne, which is one of the world's best centres of research excellence. Everyone I talk to is concerned about next pandemic, as well as getting through this current one.

MITCHELL: Vaping, anything you can do about it? Will you control it further?

BUTLER: I'm determined to take strong action on vaping. I just think this is an absolute menace to our children.

MITCHELL: It's not going away, it's not going away.

BUTLER: It needs strong action and Mary-Anne Thomas, and the other state health ministers and I are talking about what action we can take in partnership, we can take action at the border, they can take action on the ground with policing, but this enormous black market has just spread. You know, these vapes, their marketed with pink unicorns on them and bubble gum flavour. I mean who are they marketed to? They are marketed to primary school aged children who now talk about getting ‘nic sick,’ sick on nicotine. It’s just appalling. School principals tell us it is now the number one behavioural issue they have, not just in high schools, in primary schools. The TGA has been working over summer on ideas to help stamp this out. I've talked about the fact we will take strong action, but we want to make sure it's evidence-based.

MITCHELL: Speaking of the authorities, there's a report in The Age today that if you like - the main - AHPRA's investigations team has been so inadequate as to lead to death and injury amongst patients. Is that right? Is that a case there?

BUTLER: I’ve read the report, the only thing I’ve read is the report in The Age, this morning, Neil. I haven't had a chance yet to follow that up, there are other things frankly I'm following up in relation to APHRA, particularly after a very disturbing Four Corners report about health practitioners practising after quite substantial offences, including sexual offences. I’ve ordered a rapid review into that. I want to know how that’s happening, and why range of other reviews earlier about how to deal with those people haven't been implemented over the last 10 years.

MITCHELL: I don't know if this is an area that you cover, but you might have advice on, there’s a family in Bali - Australian people but they're living in Bali - their little baby, 7 weeks old is in serious health trouble, they are trying to get the child back to Australia - $90,000 to medivac them back and they can't pay for it. Is that an area where the government sort of has a fund that they can look at to help them?

BUTLER: I have to be honest I don't know the answer to that question, Neil.

MITCHELL: Fair enough.

BUTLER: But I’m more than happy, actually, I’d be pleased if we could get the details from your program after the interview and I'll follow that up.

MITCHELL: We’ll do that, we will give it to your office. And just finally the COVID figures just in this week for Victoria, just on 3000 new cases, 118 in hospital, 70 in ICU but still 52 deaths in the past week. It has not away, it has not gone away has it?

BUTLER: No, it hasn’t gone away. We are certainly in the sort of downward end of this particular wave, but it's been much longer. It hasn't been as sharp, but it has been much longer than certainly any of us were advised. We thought it was going to be a short, sharp wave, as it had been in Singapore a couple of months earlier but, you know, there's been a lot of cases, huge pressure on the hospital system, more than about 2,600 people across the country have died, this thing has not gone away. Which is why, you know, again I urge your listeners to listen to the advice that I published earlier this week: from the week after next, you will be able to get an additional dose of vaccine provided it's more than 6 months since either you've had your earlier dose, or you’ve actually had a COVID infection itself. So a new round of vaccine will provide much better protection over the course of coming months, particularly against severe disease.

MITCHELL: Thank you so much for your time. I really appreciate you staying with us so long. Mark Butler, the Federal Health Minister. 


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