TV Interview with Kieran Gilbert, Sky Sunday Agenda - 5 February 2023

Read the transcript of Minister Butler and Kieran Gilbert's interview on Strengthening Medicare; Health Workforce; Mental Health; NDIS

The Hon Mark Butler MP
Minister for Health and Aged Care

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KIERAN GILBERT, HOST: First, let's go live to the Health Minister Mark, who joins me from Adelaide. Minister, thank you for your time as always. As Andrew touched on, there are some real workforce challenges for the health system first and foremost, only 14 per cent of graduates from medicine are going into general practice. How do you reverse that decline?
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: You have to make general practice much more attractive to young doctors, to medical graduates coming out of university. It's not too long ago that about 50 per cent of all medical graduates chose general practice as their career. If we think it's hard to find a GP now, and it is harder than ever before, in five or 10 years, if we haven't turned that figure around, it's going to be even harder, given the general practices the backbone of our system. I think the premiers and chief ministers recognised that last week. They're seeing the pressure on their hospital systems because of the problems in general practice. If we don't turn that around then the whole of our health care system is going to be under enormous pressure.
GILBERT: How many international doctors are here, whose qualifications aren't yet recognised?
BUTLER: I heard Andrew talk about the review that we as a group of health ministers have commissioned about those processes. Really, I want to see that review be an end-to-end review. It's about going overseas and recruiting as the Australian healthcare system. Recruiting doctors and nurses and other health care professionals to come to Australia. Frankly, it's a very competitive field now. A whole range of other countries are competing to get well qualified health care professionals come to their countries and practice. It's recruitment, its visa processing, which as you know, we've streamlined significantly in the short time we've been in government. But then once they actually land in Sydney, Melbourne or wherever else, we want them on the floor as soon as possible, delivering health care rather than, as Andrew said, sitting in an apartment or doing some Uber driving. We've got Robyn Kruk, a highly experienced, highly respected public servant looking at that because there's a real demand from all health ministers whether they're responsible for general practice and Medicare like me, or whether they're running hospital systems to make this operate much more effectively than it is right now.
GILBERT: The AMA responded to the Taskforce straight release saying, this is the President saying, “there's absolutely nothing in the report released today that will allow Australians who are struggling to see a GP see that GP any more quickly, any more affordably.” They clearly want a move on the Medicare rebate, can you reassure them that there will be an increase to the GP Medicare rebate in the budget?
BUTLER: I was a bit surprised by the attitude of the AMA President. Over a couple of days he seems determined to fight us on our Strengthening Medicare agenda, which is a bit of a surprise because his Vice President played an incredibly constructive role through that Taskforce contributing to the report. I think all healthcare groups recognise we have to work as a group to deliver the sort of reform and improvement that we need to see in Medicare - a system that's a shining jewel of our country, but just isn't delivering the care that Australians need right now.

I've said that the changes to the rebate are not off the table. Of course, affordability was a major pressure that we discussed at the Taskforce, but I've also said you can't just put more money onto the existing systems. The existing systems do not reflect the needs of Australians today. I think all health care groups who've participated in the Taskforce, frankly including the AMA, recognise that. There's got to be reform. Yes, there's got to be more money. We're the only party of government that promised more money in Medicare at the last election, we'll deliver it. But it won't be delivered on existing systems designed in the 1980s. What the report that we released last week shows is the need to change the way in which the system operates to take account of the care needs of modern Australia.

GILBERT: You chaired the Taskforce so you know what needs to be done. What do you say to the criticism that essentially, it's restating what we know needs to happen? What's being done now? What can you say to those critics that you aren't doing now in the short term as opposed to longer term reform?
BUTLER: Well right now, we're already rolling out urgent care centres. We were in Perth last week, the Prime Minister and I, the expressions of interest are out for the Western Australian urgent care centres. This will deliver extended hours of fully bulk billed service for people who experienced those non-life-threatening emergencies but can't find a GP. Because they can't find a GP when their kid falls off a skateboard and bust their arm for example, they're ending up in hospital emergency departments that are already extremely stressed, overcrowded, and they're not really built to deal with those non-life-threatening emergencies. So, we're rolling out urgent care services. We were down the week before doing some fantastic work with the Tasmanian Premier, who is also the Health Minister, to underpin much better arrangements for GP registrars, that's trainee registrars, trainee GPs in rural Tasmania.

We're getting on with the job but we were always clear that the additional money for Strengthening Medicare would flow in the May budget. What we wanted was some urgent advice. I sat down at monthly meetings for several hours at each meeting, to work with healthcare groups to make sure we got the decisions right as a new government coming in, we'd get the decisions right to invest that money in the most the most effective ways possible. And you see those ways identified quite clearly in the report.
GILBERT: Okay, so yes, indeed there are pathways. One of them that is very clear in terms of at least the description is a blended payment, but for many of our viewers, it might not be that clear what that means. Can you explain how that would work at blended payment for medical practice?
BUTLER: The central theme of this report is that our current Medicare system was designed in the 1980s on a fee for service basis, generally at a time when healthcare meant going to a doctor because you had a particular short-term illness, getting some medicine or some other treatment from a doctor going away for six months and not coming back until something else happened to you. Today, there's much more chronic disease, ongoing disease that needs wrap around ongoing care and the funding systems just don't reflect that. So that really is the key message of doctors, nurses, allied health professionals, and most importantly of patient groups who say that the current Medicare system doesn't deliver that ongoing care from not just GPs but health care teams working together. That's really the key message out a report.
GILBERT: And would that be so you have a fee for service on the one hand, but maybe some bulk payments separately so that a practice can put on a nurse, psychologist, physio, that sort of thing?
BUTLER: That's right. I think if anything, that's the most significant demand we have right now. That is the need to much better support general practice and other primary care services to have a range of health care professionals operating in their practice. There's already some of that now, but I think a key message from healthcare professionals was they're not adequate. So, workforce payments that enable a practice to employ practice nurses, allied health professionals, and the consideration of some more flexible funding arrangements. That really allow those primary health care teams to focus on the ongoing often chronic and complex needs of a very different patient group that we have in the country - an older patient group with more chronic disease than we had when Bob Hawke was designing this scheme 40 years ago.

GILBERT: Health Ministers subcommittee of National Cabinet is meeting in two weeks, what will you be asking your state colleagues to do?

BUTLER:  I already had a great discussion with them the night before National Cabinet. We distributed the report we had a good discussion about that. We've got a very full agenda as you'd imagine, Kieran. There's the ongoing pandemic response we have to consider. There are other issues that have been raised about cosmetic surgery, about workforce, about the sorts of things that Robyn Kruk is looking at to make sure we've got a good flow of GPs, nurses and other healthcare professionals coming in from overseas to buttress our system.

I think the key change over the last year or two that you've seen it National Cabinet as well, is that state premiers and chief ministers now recognise they have skin in the game of a primary care system that's operating effectively because they know when it's not operating effectively, as it isn't right now, the consequences end up in the hospital emergency departments. Nine years of cuts and neglect to Medicare have put general practice in the most parlous state I think it's been in in the 40-year history of Medicare and that is reverberating right through the health care systems including into the front doors of emergency departments. Health ministers are desperately keen to be a part of this discussion. It's not like the old days where they ran the hospital system and we ran primary care through Medicare, aged care and the like. They recognised and we recognise we've got to work together.

GILBERT: One of the things you said on Friday was that we need to have all medical practitioners working at the full scope of their practice. And I guess a lot of people read into that thing like pharmacist prescribing more it sounds like you're very open to that. I know a number of the premiers are, is that something that you would urge the states and territories to get on board with for example?

BUTLER: I know some states are looking at that. Queensland has had a pilot in place for a while now. That's not part of the Pharmaceutical Benefits Scheme it operates outside that. Pharmacist prescribing was not a part of the discussions at the Taskforce and pharmacy groups were not represented on the Taskforce. It was really about how primary care practices, aside from pharmacy, are operating. But there's no doubt in my mind that that whether it's pharmacists or paramedics allied health professionals, certainly nurses who are the largest workforce group in the system, they could be doing more than they currently are allowed to do through regulation through frankly, a history of turf wars. It just doesn't make sense, though, when we've got demand for health care, skyrocketing, the sorts of constraints on workforce supply that we've been talking about, not to have everyone operating to the full extent of their skills and their training and their experience - as we describe it in health their “scope of practice.” It's just not a good enough return on investment, if nothing else Kieran. Taxpayers spends hundreds of millions of dollars training these hundreds of thousands of hardworking health professionals, we should be allowing them to operate to their full extent of skills and training.
GILBERT: It certainly makes sense. Now a couple of other related issues. Mental health is a big one within this space. But specifically, I know you met with a number of advocates and experts in the field last week as well. The numbers are really sobering aren't they - a 50 per cent increase in adolescent young adult mental ill health since 2007. Basically, two in five young Australians need some sort of treatment for mental ill health or some professional health. What's the government's plan to try and deal with that real scourge in our nation?
BUTLER: You're right Kieran, this is a major pressure on the nation and on millions of Australians and frankly, their families. It's been a rise that we've seen for many years, but it's also been accelerated very significantly by the pressures of the pandemic, particularly in the states that experienced widespread lockdowns. Those state systems were reporting huge increases in the number of emergency department presentations, particularly by Australians under the age of 17. I know states have been under enormous pressure to deal with that mental health presentations by young people with self-harm and suicidal ideation. This is something we've been talking about a lot as health ministers as well. We did have a terrific roundtable last week to canvass the different ways in which state and federal systems should be responding to the pandemic element of this and we know that's going to have a long tail. We know from previous natural disasters and the like the mental health impacts of these massive traumas on the community can last for years and it's going to going to take a lot of effort by governments to make sure we have the supports in place for all of those years to deal with that.
GILBERT: Finally, the budget forecasts revealed the NDIS is going to cost over $50 billion by 2025/26. The IMF raised this issue again. This is going to overtake Medicare, is the Government going to look at things like a levy, potentially to help pay for these ballooning costs or a co-payment, possibly means testing it?
BUTLER: Jim Chalmers and Kathy Gallagher have been very clear that there are five strong pressures on our budget. As a member of the Expenditure Review Committee, we're looking at all of them very closely: health and aged care, the NDIS, defence and obviously the skyrocketing interest costs on a trillion dollars of debt we inherited from the former government. We are very focused on that. I think as you said, in your introduction, Bill Shorten is working terrifically hard right now to make sure that the NDIS is working as efficiently and effectively as possible. And we do have to take a step back and just reflect on the degree to which the introduction of that system under our last Labor Government has transformed the lives of hundreds of thousands of people living with a disability. But I know Bill Shorten is seized at the fact of the challenge that we've got to make sure it's working efficiently and effectively for taxpayers as well.

GILBERT: Mr Butler, appreciate your time.

BUTLER: Thanks, Kieran.

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