Radio interview with Minister Butler and Patricia Karvelas, ABC RN Breakfast - 14 December 2022

Read the transcript of the radio interview with Minister Butler and Patricia Karvelas, ABC RN Breakfast on Better Access; Medicare; Strengthening Medicare Taskforce; bulk-billing; mental health.

The Hon Mark Butler MP
Minister for Health and Aged Care

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ABC RADIO NATIONAL BREAKFAST HOST, PATRICIA KARVELAS: Bushfires, floods, COVID: for many of you the past 3 years have been really tough. It's led to a spike in demand for mental health support and now for some of you that's about to get harder to access, with the Federal Government cutting the number of subsidised psychology sessions from 20 to 10. The Minister for Health and Aged Care is Mark Butler and he's our guest this morning. Minister, welcome.


KARVELAS: Your decision means that from 1 January next year, people will only be able to access 10 rather than 20 Medicare-funded psychology sessions. Why have you made this decision?

BUTLER: This program has been around for a number of years and it's for many years had a limit of 10 sessions for people to access, generally for mild to moderate mental health disorders. That's why it was set up. And over that long period, the average person has used 4 to 5 of those sessions. Now as your intro said, the former government as part of the COVID response introduced an additional 10 sessions: so took it from a maximum of 10 to 20 to respond to increased demand during the emergency phase of the pandemic when we all know, there were high levels of distress, particularly during the lockdowns and that was introduced as a temporary measure to end this year. And I understand people who are able to access those additional sessions appreciated that and got a benefit from it, but people like Professor Ian Hickie said at the time, and modelled at the time, that those additional sessions, in a limited sector frankly - a sector with limited workforce - was going to have the effect of cutting out other people, meaning that other people couldn't get any support whatsoever. And the evaluation I received on Friday and released on Monday showed exactly that. Showed that it had the impact of cutting more people out of the system: fewer people were able to get any support whatsoever. And most of those people were in some of the poorest communities in Australia where the evaluation said there is the highest need.

KARVELAS: It also told you to keep the extra 10 sessions didn't it?

BUTLER: What it said was that people with more complex needs to benefit from additional support. I don't think that's a surprising conclusion.

KARVELAS: It said not to scrap the extra 10 sessions, that was the recommendation of the report.

BUTLER: No, the recommendation of the report was that we would consider additional sessions for people with complex needs. And this system was not designed to focus on people with complex needs and the evaluation found very clearly that the additional sessions had not been targeted at that group. Indeed, the needs of the people who are receiving the additional sessions - the evaluation found – were almost identical to those who didn't. So yes, the evaluation said additional sessions are a good thing for complex people with complex needs. But it found that that's not who was getting it. It actually found, as well, that people with significant needs in lower income communities received substantially fewer services because of the change the former government put in place. The number of new patients able to get any psychological support actually went backwards by 7%. So a whole lot of existing patients got more service, even though they didn't necessarily have more complex needs. People trying to get into the system had barriers to getting it. They weren't able to get into the scheme and that's exactly what Professor Ian Hickie predicted would happen.

KARVELAS: Okay, so how much money are you saving from going back to the 10 sessions, rather than the 20?

BUTLER: What I hope and frankly what I expect is that all of the psychologists out there working in the system will take on new patients. What the evaluation found is that fewer new patients were taken on so waiting lists blew out.

KARVELAS: With respect, I didn't ask that I said how much money are you saving from cutting it to 10?

BUTLER: It's a demand-driven program, Patricia.

KARVELAS: You would have estimates of how much money it would save?

BUTLER: Let me just finish this point, really important point. Every person who goes to their GP and has a mental health plan is entitled to up to 10 sessions. What the evaluation found there is a whole, whole bunch of people, tens of thousands of people who were doing that were not able to get a single, a single episode of treatment. What I hope is that this will open up opportunities for people who are getting no support whatsoever to get that support. That's what the evaluation found.

KARVELAS: So does that mean that the money that you save will be invested into those high needs areas that there will be no net saving from this cut?

BUTLER: Well that depends on what psychologists do. As I said this is a demand-driven program. Basically, if you go to a GP, get a mental health plan, then you’re entitled to up to 10 sessions. The problem we found in the evaluation is the whole lot of people who needed that support weren't getting it, they were overwhelmingly in poorer and rural communities. The evaluation found as a result of their inability to get psychological support, those people were far more likely to be medicated because they weren't able to get good quality, psychological therapy.

KARVELAS: So you're saying, because it's not capped, you're saying psychologists go get new patients so they can get the 10 free sessions and, you know, you might spend the same amount. Is that what you're saying, like the Commonwealth might end up expending the same amount?

BUTLER: That's how the scheme has always worked.

KARVELAS: Okay so how do psychologists do that? Because I don't - I'm just been really, honestly, I don't understand how that model works. It sounds great to say it, but how is a psychologist going to start trying to get these high-needs people through the door? Isn't that partly your responsibility as a government to try and make those doors open more easily?

BUTLER: We have other programs where we direct funding towards particular communities. But this program was set up like usual Medicare programs, so that patients go and seek support. If they can get support from a health professional, whether that's a doctor or psychologist, then Medicare will help pay the cost of that. The problem that I think many of your listeners will be familiar with is people who need some mental health support are ringing around to psychologists in their area - or psychiatrists, for that matter - and finding their books are closed. They're not able to get an appointment because the system is overwhelmed. And people predicted at the time these additional sessions were put in place that situation would be made worse and fewer people would be able to get in the door in the first place, and the evaluation found that's exactly what happened. And frankly, it's not surprising really: you add additional sessions to existing patients and it will mean, in a limited workforce, that fewer new patients were able to get in the door.

KARVELAS: Do you agree that there is a mental health crisis in our country?

BUTLER: I think it's very clear and the evidence, the data shows this, that COVID led to a very big increase in mental distress among Australians, particularly among young Australians. That's probably the most alarming increase in the data. But across the population, there was a substantial increase in mental health disorders because of COVID. And what we know from previous experience, what I know from having dealt with natural disasters and other big traumas in the community is that these things have a long tail. The mental health impacts of these traumas on our community can last for years. They don't switch off at the time the flood recedes, or the bushfire ends or the pandemic stops.

KARVELAS: So is this the right time now to switch it off, the extra support? Because your right: it's the long tail is absolutely right. That's what we're hearing from the people on the front line so wouldn't you extend it for that tail?

BUTLER: That's why I was so concerned about the fact that fewer people are getting in the door. Fewer people are getting in the door, that's having the most dramatic impact – the evaluation found – on poor communities and rural communities. The evaluation found that the lowest income communities have more than twice the levels of mental distress as the highest income communities but they get the lowest level of support under this program and that inequity was substantially worsened by these additional 10 sessions. The evaluation found that the number of low-income Australians getting support under this program actually went backwards, at a time it was expanded.

KARVELAS: Minister I know people on your side of politics are really concerned about this, they're distressed. Members of the community who are approaching MPs saying this isn't good enough. This is happening at a pretty difficult time of the year. As you know when Christmas happens this brings up a lot of issues for many people. Are you willing to extend it or revisit the decision?

BUTLER: Firstly, can I say in terms of where people are situated right now. If you are part way through a series of these sessions, they will continue beyond the first of January. So if you've been approved for 20 sessions and you're up to number 11 or 12 they will continue over the course of the summer. The first of January changes is for a new a new course of additional 10 sessions. I've also said that there's a whole range of recommendations in this evaluation about how we can make Better Access more equitable. And that's the key message out of the evaluation: this is a good program, I've been familiar with it for many years, but its problem has always been one of equity.

KARVELAS: So when is that going to be addressed? When will that be announced by the government, all of the new help you'll be providing if that's your argument?

BUTLER: We've been trying to deal with issues of equity in this program, which is one of the biggest spends the Commonwealth makes in mental health for many years. We tried to deal with that when we were first in government, this evaluation shows it's still a very big issue. I have said that I want to bring all of the key players, patient groups, as well as obviously the providers together very early in the year and work through this evaluation. To the extent the evaluation says there should be additional services for a smaller group of people with particularly complex needs, then we would need to work out how that is delivered. Because the additional 10 sessions that were put in place during the COVID emergency, the evaluation found did not deliver to that group. It delivered additional services to a whole bunch of other people and I know they appreciated that.

KARVELAS: A six-month extension, which I know Anne Ruston in opposition and others have called for, are you actively considering it?

BUTLER: This decision has been taken by the Government. But we've also said that we would have a look at the evaluation very closely with the sector and work out how we can improve this program. The problem, Patricia, is that those additional services weren't having a benign effect, they weren't having a neutral effect on the scheme, they were having the effect of cutting tens of thousands of Australians out from getting any support whatsoever in a highly inequitable way across the community. So I couldn't stand by and let something that was clearly distorting the system in a way that meant a whole lot of people who needed any support were getting none, while the evaluation said very clearly that had been impact. 

KARVELAS: Okay, on another issue new Medicare data shows bulk-billing rates have dropped again in the last quarter, from 87% to just over 83%. Many clinics are saying they'll have to hike up their fees again or close their doors, if nothing is done about the rate. Will you commit to increasing the Medicare rebate?

BUTLER: We went to the election, the only party that went to the election with substantial additional money into Medicare. And over the last 6 months, indeed, as recently as yesterday, I have been sitting down with the College of GPs, the AMA, nursing groups, other health groups, importantly the Consumers' Health Forum and a range of other experts to work through the best way in which we can spend and invest that money. We said right through the election campaign, I've said since the election that I think general practice is in crisis. It is in the worst shape it's being in the 40-year history of Medicare. The Medicare rebate was frozen for 6 years and that's had a substantial financial impact on the viability of the sector. So we've got no higher priority in the health portfolio than rebuilding general practice, because if general practice continues to decline and we see the declines in the bulk-billing rates, that's going to reverberate right through the health system. Health Ministers at a state level tell me they're deeply concerned about this, because they know the impact it's having on their on their hospital system. People are turning up to the emergency department who could quite adequately be cared for in the community, but they can't find a GP to see. So we will have more to say. As I said in the election campaign, we wanted to work with the sector to find the best way to invest that money. It's been a terrific process, I've chaired it, so I’ve been involved directly in those discussions with the College, the AMA, nursing groups and others. We're close to delivering our report and we’ll action that report in the Budget next year.

KARVELAS: Thank you so much for joining us this morning, Minister. 

BUTLER: Thanks Patricia. 

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