Radio interview with Minister Butler and Patricia Karvelas, ABC RN Breakfast - 31 January 2023

Read the transcript of Minister Butler and Patricia Karvelas' radio interview on Mental Health Equity and Access Forum; Medicare; Strengthening Medicare Taskforce.

The Hon Mark Butler MP
Minister for Health and Aged Care

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PATRICIA KARVELAS, HOST: The Minister for Health, Mark Butler, joins me now. Minister, welcome back to Breakfast.


KARVELAS: You've announced two new national peak bodies on mental health. One is going to be representing people experiencing mental health disorders and the other one is for carers and families. What difference will they make?

BUTLER: It gives patients a voice, it also gives carers a voice who play such a critical role in the recovery of their loved ones, particularly who are experiencing more severe mental illness. This is frankly something that should have happened many years ago. When I was the Mental Health Minister more than a decade ago, we allocated funds to set up an organisation that would support the capability of patients or consumers having a voice in the development of mental health policy. But unfortunately, that wasn't implemented. Nothing happened over the last decade. And so this, I think, will play a really important role in helping consumers build the skills they need to come to the table and participate and contribute to the development of policy, along with, obviously, all of the service providers, the doctors, the psychiatrists, psychologists, and so many others who are very good at coming to the table and participating in these debates.

KARVELAS: We know Australia is facing a mental health crisis right now. At the beginning of this year, you announced those cuts to subsidised psychology sessions from 20 to 10. You promised an alternative solution so more people could access a psychologist. And you made a case actually on this program, too, explaining that you didn't think that was the best way to actually get people help. So what will replace those sessions?

BUTLER: I think the discussion yesterday - which was a really important discussion that I was involved in for several hours - just reinforced, as you said in your introduction, the pressure that the mental health system is under and the diversity of that pressure. I mean, there are some really significant problems in the system that are longstanding, that don't relate to the natural disasters and the pandemic that you talked about. But undoubtedly the experience of Australians lives over the last three years have aggravated all of those pressures. We don't have enough workforce in the right place. People in parts of Australia, particularly in the outer suburbs of our cities and rural and regional Australians just don't have access to services that are taken for granted in some of the wealthier suburbs in inner cities. And there are real problems with bits of the system being able to talk to other bits of the system. I think the message from yesterday was there are some immediate pressures that we need to work on. There are some services, for example, that aren’t funded beyond the 30th of June, that weren't funded by the former government that we're having to work on right now. But the longer-term response to some of those really deep systemic pressures are not easy, they're not going to be quick. There was no easy solution presented to me by the sector yesterday. They recognise as much as anyone does that this is hard work, and we committed to them, to working with them very deeply - myself, my Assistant Minister Emma McBride, who works day to day mental health to start to respond to these needs.

KARVELAS: Okay. You mentioned two things - that one thing is long term, and one is immediate - 30th of June, what runs out and what are you considering extending?

BUTLER: There are about 200 measures in the health portfolio. Some of them are related to mental health, there are measures in Indigenous health and a range of other areas that just weren't fully funded by the former government. I think Katy Gallagher has talked about this across government, that there were just many, many, many terminating measures. These are ongoing programs. They're not pilots that were only supposed to be funded for a couple of years to see how that went. In many cases, these are programs that have been in place for many years or even decades. So we're having to find the money, go through the process and the Expenditure Review Committee to make sure that those really important ongoing programs don't fall off a cliff on the 30th of June. And some of those programs were mentioned to me yesterday.

KARVELAS: So can you give any specific examples of them in the mental health space of programs that you've guaranteed will continue past June 30?

BUTLER: I've said we're working on all of them. One of them, for example, was in the Northern Territory, working in Indigenous communities that don't have access to the sort of program we talked about last time on your show, Patricia. A program that really predominates in the major cities. This is a terrific organisation that's been working in the Territory for many, many years that's only funded to the 30th of June. Now that's just one example that was raised with me yesterday that are now having gone through this process with Katy Gallagher, with my department on the ERC, there are a range of them across the portfolio, not just in mental health.

KARVELAS: So were all 200 to be saved or will some go?

BUTLER: Well, you'll see that in the Budget.

KARVELAS: Can you give me an indication of what you're funding?

BUTLER: We're trying to make sure that all of the services that that people have relied upon for many years, good services, services that there's no question mark on in terms of their quality, the evidence base, their ability to deliver service in an equitable way. Often, they are plugging gaps that otherwise would exist in a system where there's more demand driven service through Medicare. These are critically important services we're working really hard on to make sure that Australians can continue to rely upon them. One of the challenges is when a government only part funds them and sees that funding drop off on the 30th of June when you're delivering a Budget in May, that contributes to enormous uncertainty to the service and for their staff. So we're having to work with all of those services on that issue as well.

KARVELAS: One of the biggest issues is the shortage of psychologists, particularly in outer suburban and regional areas. How are you going to address that supply problem? I've got lots of texts, different suggestions. One is that you need to increase places at universities. Is that on the table?

BUTLER: I had a terrific conversation with some of the people from the APS, the Psychology Society yesterday about some of the issues in universities. Traditionally, the psychology degree has been treated a bit like an English literature degree because it started really to emerge from the  Bachelor of Arts many years ago but it was actually much more intensive than a traditional arts degree in terms of the resources required by university. So there is an issue there, I think, about the way in which this degree is treated and funded. We'll have further discussions about that. But the bigger issue, other than just the sheer numbers of psychologists in the system, which is a challenge, is their distribution - as I've said on your program before. When you set up a demand driven system that really depends upon decisions by private businesses about where they locate, you will see gaps in the market, and that's the job of government to plug those gaps. This is not new. We did this when we were last in government. We had to fund psychology services in outer suburbs, particularly poorer suburbs and in rural and regional Australia because private psychology businesses weren't setting up there, they weren't setting up, they weren't delivering services to communities that the recent evaluations showed actually have much higher levels of need, more than twice the levels of high or very high mental distress you see in poorer parts of Australia than in richer parts of Australia. So higher levels have made much poorer levels of access and as the evaluation said, those levels of access have actually got worse over time, not better.

KARVELAS: I want to move to Medicare and there is a, you know, growing consensus that Medicare is in crisis. And, of course, Medicare is well-loved in our country. The Strengthening Medicare Taskforce is due to hand its report to the government imminently. When will that be released?

BUTLER: It'll be released in coming days. We've worked really hard. The work that was done by all of those groups that I participated in the Taskforce with, I chaired all of those meetings. They're busy people and they devoted hours and hours to the discussions we had and to the finalisation of the report that we'll be able to release very, very shortly.

KARVELAS: Okay, so it'll be publicly released, the whole report? And when you say coming days, I'm thinking this week?

BUTLER: Coming days won't necessarily be this week, but in very short time indeed. We know that there's a huge thirst out there for this, because people recognise that this cherished institution, as you described it often, Patricia, is in real strife. I've said it’s in the worst shape it's been in the 40-year history of Medicare, particularly general practice, which is the backbone of our health care system, is in a truly parlous state that if we don't turn it around, it’ll get much worse before it gets better. Because not enough medical graduates, young doctors are choosing general practice as their career because they see the difficulty of working as a general practitioner. We've got to turn this around.

KARVELAS: Yes. So one of those issues, of course, is bulk billing. And we know that bulk billing rates are in freefall. It's pretty confronting. I mean, if you're in Canberra, good luck to you trying to find any doctor that can bulk bill you. But it's also becoming a growing issue across the country. Now, last week you said the average gap fee is now more than the Medicare rebate fee itself. Why don't you increase the rebate?

BUTLER: That’s one option that has been put on the table by at least one of the doctor organisations, probably both of them and it’s something that we’ll be looking through. But what I really wanted to be clear about with people, as I've talked about this, is that simply putting more money into the existing structures is not going to deliver the type of care modern Australia needs. We don’t just need to add more money to the existing systems, we need to change the existing system because the consensus from doctors, from nurses, from patient groups and many others is that the Medicare designed 40 years ago with a completely different disease profile to the one we see today, is not delivering the wraparound, multi-disciplinary care that modern Australia needs, an older Australia with much higher levels of complex chronic disease. So yes, there is financial pressure on general practice after a six-year freeze on the Medicare rebates, effectively a freeze on their income, there is undoubtably real financial pressure on general practice and we’re very cognisant of that. But we can’t just add more money to the existing system. We have to reform the system. People have known this for years.

KARVELAS: So what does reform look like? Because obviously the actual rate that GPs are getting they’re saying is just too low. Do you accept their premise? 

BUTLER: As I said, six years of freezing the rebate obviously has meant there’s enormous cost pressure on doctors. Their costs were continuing to go up while their income was staying flat. So unsurprisingly for those people who they charge a gap fee, which is about a third of the Australian community, their gap has been skyrocketing. That’s no surprise and that’s been a big part of our discussions and that’s certainly going to be factored into our deliberations. But they’ve also said that Medicare was designed really as a fee for service. You’d go and see a doctor, they’d prescribe a particular treatment or a medicine and you’d go away and hopefully you’d get better. And you’d come back later with something different. Complex chronic disease requires a very different relationship with your doctor and other allied health professionals and nurses working with them. You need a team working with you, a team that talks to each other with different digital systems that are connected as well. And we just don’t have that in Australia right now because there hasn’t been enough attention paid to keeping Medicare up to date with the changing disease profile, the changing needs of the Australian community.  

KARVELAS: Minister, many thanks for joining us, and given it’s coming days, I expect I’ll speak to you in coming days again. 

BUTLER: I look forward to it, thank you Patricia.  

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