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Closed captions by CSI

This program is not subtitled

VOICE-OVER: Today at the

National Press Club, the head

of the Australian Medical

Association, Dr Andrew Pesce,

the obstetrician and

gynaecologist was recently elected President of the peak

outline doctors' group. Dr Pesce will

outline his priorities, including influencing

Government policy. Here's Dr

Andrew Pesce, with today's

National Press Club address. This Program is Captioned

Live. Ladies and gentlemen,

welcome to the National Press

Club and today's National

Australia Bank address. It's a

great pleasure today to welcome

Dr Andrew Pesce, the President

who was elected President, in fact, of the Australian Medical who was elected President, in

Association just a couple of

months ago. He's still getting

used to the idea. He's an obs

gynaecologist who practices in industrial relations and

both the private and the public

health sectors and in 2006 he

was awarded the AMA's

President's Award for his work

representing the profession

during the medical indemnity crisis that was so prominent

that year.

that year. He's also served on

a range of advisory committees

to Government and the

profession and he serves as

chair of the national

association of specialist

obstetricians and

gynaecologists until the end of

this week. When he was elected

he said his priorities would

include engaging with the

national health Government to influence

national health policy debate

for the benefit of patients,

the medical profession and the

broader community. A timely statement, given the report of

the National and Hospitals

Reform Commission could be

published as early as next

week. To tell you more, please welcome, Andrew Pesce. APPLAUSE

Good afternoon ladies and OK, thank you very much.

gentlemen. I wish to first

acknowledge the traditional

owners of the land we are

meeting on today, in

recognising the nunna wall

people let me add to the AMA was disappointed in was disappointed in the

findings of the recent productivity report overcoming

Indigenous disadvantage. The

report which was considered by

COAG, shows the lack of progress in improving the

circumstances, the health and

the prosperity of Indigenous

Australians. I know we weren't

alone in feeling a sense of

failure and even hopelessness.

Despite that, our challenge is

not to wallow in despair and

give in to a sense of futility.

Reconciliation is a word used a

lot in the context of our

relationship with Indigenous

people, and as a doctor, I

believe there is no more important reconciliation

required than to reconcile our

desire to improve the health of

Indigenous Australians with our

historical failure to achieve

our ambition in this regard.

We need to believe in the

creativity and passion of our

communities, which has successfully risen to other challenge. We must work

together to garner the resolve

to meet this, our most

fundamental challenge. And I

say this very mindful of the

burden it will place on the

medical profession. Doctors

have a clear role and

responsibility to contribute to

what must become a national

plan to improve the health, living conditions

living conditions and life expectancy of Indigenous

Australians. We need a

national plan with clear

targets and benchmarks for

conceit action. It's a

national tragedy that requires

a coordinated national

response. It's our number one

national priority. I call on

others who rightly recognise

the land on which we live to do

more than just tasitly

recognise the gap that recognise the gap that exists,

Indigenous Australians. I'd to make real the aspirations of

also like to inform you that

this week is GP Week, a week

set aside by the AMA every year

to pay tribute to Australia's

hard-working and dedicated

general practitioners. It is

worth noting that two recent

reports have endorsed the

important role of GPs in

primary care. The OECD has

confirmed that GP-led primary

care is a cost effective way to

promote good health. This has

been a core message to

governments from the AMA for

many years. The OECD also

stresses the need to promote

general practice as a career.

As GP numbers are growing at a

much slower rate than specialist numbers. This

Government has made a good Government has made a good

start by supporting training

for junior doctors to gain

experience in general practice

before they make a final

decision on which career path

they will choose, and we need

to continue to build on this.

A fortnight ago, the Australian

Institute of Health and Welfare

reported and GPs are playing an

increasingly important role in

treating older patients and

managing chronic medical

conditions and that they need

to be supported in this role.

With our rapidly ageing

population and the increasing

incidence of chronic illness in

report from the institute. the community, this is a timely

Again, the AMA has lobbied

strongly for greater support

for GPs, as the number of

patients with chronic and complex conditions grows

markedly. I will talk further

about the role of GPs a little

later. But first I'd like to

talk about how I see the AMA

working for its members, their

patients and the community

under my presidency. It is an

important time in health. We

have a Government determined to

instegate reforms. Australians

do not receive equal

opportunities to access health

care. Access is determined by

where you live, by your level of education and by of education and by your

income. Now, that is not the

promise of Medicare. It is

time to bring fairness into the

system and to use scarce

resources better, to make real

improvements in areas of social

disadvantages. We must

remember that Medicare must

first and foremost be about

access to health services for

all. Unfortunately, access can

be compromised by an

overemphasis on cost control.

What doctors see every day is

that there is not equal opportunity to essential health

care in Australia. There are

too many scarce health dollars

caught up in the games that

governments play. The system

is still confusing and uncoordinated for people coping

with chronic conditions, severe

disabilities and very tenuous

social support. The safety nets

for frail, elderly Australians

are frail and at times illusive

and there is a lack of

attention and concerted effort

given to people with mental

illness. This is increasingly

becoming a national disgrace.

So no wonder governments are

looking at reform. Medicare is

25 years old and starting to

show its age. Rumour has it that serious structural change

may be put on the agenda and

not since the heady days of the introduction of Medibank and

then Medicare have we seen such

bold plans for structural

change in our health system

being mooted. Today, as it was

back then, the AMA will be actively promoting the key

leadership role of doctors in

the health system and how this

role must be reflected in the

change process. For the

public, health care is about

going to the doctor and getting

diagnosies, advice and treatment. treatment. The patients of

Australia trust us and we

expect, and expect us to do

this for them. Similarly, the

Government needs to trust and

seek our advice on health

reform. Doctors are integral

to the health system. Doctors

must be consulted closely about

changes in health care. The

imput of doctors is vital if

the Government wants to make

its health reform real.

its health reform real. Real

for patients through better access to quality affordable

health services, real for health professionals to use

their skills and have rewarding

skills, and real for the

national interest through a

healthier population and greater productivity. I could

add another one here, real for

governments who want to be

re-elected. It's my job to

ensure the AMA is engaged with ensure the AMA is engaged with Government throughout the

reform process and I intend to

be a strong advocate for

doctors and their patients and

the communities they serve.

Health reforms must be

responsible and affordable.

The only health reforms we will

support are those that make

health service delivery better

for people, and which recognise

the importance of doctors as the foundation of quality

health care teams. We expect

to see a number of major to see a number of major

reports released in coming

weeks. One, the report of the

national primary health care strategy external reference

group. Two, the report of the

preventative health task force

and three, the final report of

the national health and reform

commission. These reports will

have significant impact on how

health care services will be

delivered in this country. They will have

They will have an impact on all

the health professions, but it

is likely they will have the

greatest impact on the medical

profession. Hence, the need

for AMA engagement with the

Government. I was elected AMA

President on a platform of

engagement. Gant doesn't mean

rolling over, nor does it mean

going for the jugular at every

opportunity. I plan to deal

openly and honestly with the

Government. I will highlight problems with their problems with their policy and

bring solutions to the table.

It is my preference to have

healthy dialogue with

Government over the issues that concern my members and my

profession and our patients. I

do not intend to engage in media

media skirmishes

Apology apology As AMA

President I have productive

meetings with Nicola Roxon and

her staff. I am confident we

can work well together. The

health debate can't be run by

ideology, it must be about the best possible health outcomes

for all Australians, no matter which political party is in

power. Evidence must be the

basis of sound health policy

and the medical profession is

very good at providing and

using evidence to achieve

positive health outcomes. So

my message is to Government is

"Hi, I'm Andrew Pesce, I'm from

the AMA, and I'm here to help".

The health reform agenda is huge, and I don't have huge, and I don't have the time

today to comment on every item

that is bound to emerge from

the imminent reports. I will

speak briefly on some of the

major issues, but I would also

like to raise a couple of

matters which I want the AMA to

lead a debate on during my

presidency. Perhaps the most

anticipated aspect of the

national health and hospitals

reform commission report is

what they will recommend on who

should run the health system,

and how, and who pays. Much

has been made of the Prime

Minister's election pledge to

take over public hospitals if

the States don't lift their

game. Whether or not the

States have lifted their game,

the States are showing little

enthusiasm for a Commonwealth

takeover and if the truth be

known, I think the Prime

Minister and the Health

Minister are less enthusiastic

about takeover than the States.

So the focus is very much on the the commission's

recommendations in this area.

Not having access to a crystal

ball, I will not try to guess

what the commission has come up

with. Instead, I will outline

the AMA's preferred path. From our perspective and the

public's perspective, the major

governance issues are around

public hospitals. The major

problems in the public hospital system are the practical

difficulties of better

resourcing and better results

resourcing and better results

for patients. For people like

me who have been around public

hospitals for many years, there

is growing frustrations with

the levels and styles of bureaucracy that run the

system. There is frustration

at the litany of undelivered

promises from government of all persuasions, and there is

frustration at the failure to

deliver on promises is always

blamed on the other arm of

Government. These undelivered

promises transform into the

problems, the deaths, the

mistakes, the queues, the

problems that make their way

onto the front pages of our

newspapers every couple of

months. Indeed, the Prime

Minister himself was clearly

aware back in 2007 when he said

that he had a long-term plan to

fix our nation's hospitals, and

we all remember " the buck stops with

stops with me". As the AMA

President, my only plea before

we have seen any of the reform

options is that we hear

Government's commit to act and

commit with action.

Australians need governments to

take responsibility, not merely

to posture. Inaction leads to

the increasingly level of

cynicism that unfortunately

bedevils the culture of many

hospitals as decent people struggle to struggle to provide

high-quality health care to

very needy people within a

system that is grossly

underfunded and manifestly

overmanaged. We at the AMA

have grappled with this issue

for many years. The AMA told

the inquiry into health funding "Commonwealth-State

arrangements in health care are

difficult to unravel because

the cost and blame shifting potential of that system

potential of that system is

appealing to all politicians".

The inertia against change is

immense. Whilst that remains

the case, improvements in

accountability by governments

will remain illusive. Were it

possible to resolve some of the

areas of shared responsibility

so that one level of Government

was fully accountable for

outcomes, this would be a

significant step forward.

However, we are not holding our

collective breath. That was collective breath. That was

the AMA in May, 2005. In July

2009, as we await the NHNRC

report, let me set out the

sorts of things we would support in reform

recommendations. Any proposal

would need to genuinely and

clearly improve access to

health and hospital services.

There must be good integration

across all related health

services. Changes must result

in high-quality health services

and health care. There must be

minimum levels of bureaucracy. Administration, performance

reporting and accountability

requirements must not take

precedence in terms of time or

funding over the delivery of

patient care. Services must be

organised and administered as

close as possible to the actual

delivery of the service to the

bedside, to the clinic. Reform

must enable more decision making by health professionals

at the local and institutional

levels. Reform must encourage

a move to national standards.

There must be clear political accountability and

responsibility for performance.

The reforms must be clearly

understood by and accepted by

the public. Reform must maximise individual choice as to the quantity and to the quantity and location of

desired health services. And

the reform package must be

affordable, both for the nation

and for Australian families,

and our bottom line as outlined

by my predecessor in our

response to the commission's

interim report earlier this

year is how to improve patient

care at the bedside, not at

which level Government well.

We will be looking at the commission's recommendations

through this prism and respond

accordingly. So we watch this

space. Another area being

pursued by the Government is

the health workforce. We have

already seen legislation tabled

in Parliament that allows nurse

practitioners and midwives to

write PBS prescriptions for

patients and claim benefits

which can be claimed under the

medical benefits schedule. This legislation This legislation is risky. At

best, it may assist in meeting

unmet needs in some areas of

our health system by

introducing more flexibility

into the health force. It can

fragment care, increase risk of

poor outcomes and increase

costs through lack of

continuity. We've always been concerned about it and our

concerns are based on the hard evidence that is available

about how good health care should should be provided. Our

medical duty of care obliges us

to help mitigate the risks of

these measures and that's why we're engaging with the

Government to ensure there is proper collaboration with the

patient's usual doctor and

there are always clear roles

and lines of responsibility for

that patient's care. Doctors

have been working in teams with other health professionals for

generations. It is not a new

concept. We all have the

greatest respect for the skills of other health professionals of other health professionals

and we don't see this measure

as a panacea to improve access

to health care. There are only

370 nurse practitioners across

the country, compared to 23,000

GPs. We don't have enough

nurses to meet existing nursing

workloads. The minister has

made it known that she has

plans for workforce reform.

And we know from its interim

report that the commission

supports elements of these

reforms in certain locations reforms in certain locations

and situations. There may be

more in the commission's final

report and we'll know soon.

Much of the work in this area

is in its early stages and

clarification is needed around

the implementation of the changes. Further discussion

and debate is needed around the

concepts of team care, as

opposed to independent care, as

opposed to autonomous care, as

opposed to clinical leadership. opposed to clinical leadership.

These are all very different

concepts, but they are used interchangeably by the Government at different times

to different audiences. More

information is needed on how

the proposed collaborative care

models that are supposed to be

in place soon will work. And I

will make one point very clear.

The AMA will continue to

promote the central role of the

GP and patient care. And I'm

pleased that as recently as pleased that as recently as a

fortnight ago, minister Roxon

acknowledged the central role

of the GP and patient care.

The GP-led system works. When

people are sick, they want to

and have a right to see a

doctor. That is why the AMA must be involved in developing

and implementing any changes to

ensure that any new

arrangements result in safe, quality outcomes and that

patient care is not fragmented.

So I am pleased to So I am pleased to report that

the Prime Minister's office has

invited the AMA to be part of

the implementation process. We

will be involved in consultation and providing

advice in developing the

regulations that will underpin

the new legislation on

Thursday, practitioners and

midwives. We certainly have

strong views about the

safeguards that are required to

protect the quality and safety

of health care and we'll be

making sure that these views

are put clearly to the Government.

Government. Looking ahead, the Government must factor in that

there are a lot of new doctors

in the medical schools at the

moment who will soon find

themselves ready to work in the health system, including in

general practice. This influx

of new graduates in greater

numbers is a result of earlier

dialogue between the AMA and

Government, engagement delivers

results. I want to seriously results. I want to seriously

engage the Government on rural

health, as well. Australians

who live in country areas

deserve and are entitled to

access to quality affordable

health services, just like city

people, but they don't always

get it. Patients do it tougher

out there and the doctors in other health professionals who

work in rural areas do it

tough, too. Recruitment of

Australian-trained GPs to rural

Australia has almost come to a

stop. Communities seeking a

new GP are relying almost

totally on overseas-trained

doctors. Of all the OECD countries, Australia now has

the second highest reliance on

overseas-trained doctors. Such

that today more than 40% of

rural GPs are overseas-trained

doctors and they are there

because they are required to

spend 10 years working in

country areas. At the same

time, we are losing our time, we are losing our rural

proceduralists at an alarming

rate. These are our rural GPs

who maintain skills and

training in areas such as

aesthetics anaesthesia,

emergency care and surgery.

And more than 130 rural

maternity units have been shut

down in recent years. We need

to revamp the incentive system

to attract GPs, especially some

of the big batch of new

graduates soon to emerge, to

work in rural and remote

Australia. Just as we must

promote general practice as a

rewarding career, we must

promote rural general practice

as a rewarding career

experience. Getting more

doctors into the country will

undoubtedly help patients and

communities. The Government

made a downpayment on rural

health incentives in the last

Federal Budget and while we

welcome this, a lot more is

needed. In the meantime, we

must do more to help patients

get the quality health care, if

it is not locally available. A

good start would be to overrecall patient assistance

travel schemes to make financially assistance properly

reflect the cost of travel and

accommodation. And while all

Australians will benefit from

E-Health initiatives, rural

Australia is where new and

innovative technology and information systems will pay

off big-time . Until we see

dramatic improvements in rural

health workforce and attraction

retention, patients' access to

health care can be improved

through tele medicine. It must

be a priority for all

governments. More generally on

E-Health, the AMA strongly

supports moves to make

electronic health records a

reality. Electronic health

records will bring wide-ranging

benefits to the Australian

community, particularly for

patient safety and quality care

health outcomes. We are

looking at the proposals for a person-controlled electronic

health record very closely. I believe patients should have

control over who has access to

their information. We must

ensure, however, that this

control does not inadvertently cause limitations to access, especially in the case of

emergency physicians for

instance. Rigourous privacy

safeguards must be in place.

There is a lot happening in the E-Health sector at the moment

through COAG, NITA and the Health Reform Commission. But

fundamentally, this is an issue

on which governments must show

leadership to ensure progress.

The AMA will be an active

commentator and adviser on

developments in E-Health. I'd

like to turn now to a couple of

important areas where the AMA

intends to lead community and

political debate. The first political debate. The first is re-establishing the case for

the Government to introduce a national long-term care scheme

for people catastrophically

injured in accidents, including

medical accidents. For those

who remember me from the AMA's

campaign throughout the medical

indemnity crisis a few years

ago, you will know that this is

an issue close to my heart.

The AMA has a policy on the

establishment of a long-term

care scheme. It reads, "The

AMA supports the establishment

of a long-term care scheme for provision of benefits and

services on a no-fault basis to

all children with permanent

disability diagnosed before 18

years of age requiring at least

2 hours of person care per day

for their lifetime and all

adults catastrophically injured

through an accident or from a

serious and rare outcome

arising from medical treatment

requiring at least two hours of

person care a day in their

lifetime". These long-term care

services should include support for accommodation appropriate

to age , needs and

circumstances, case management

and coordination, attendant

care needs, domestic support

and home maintenance and

counselling and social support.

The previous government

abandoned plans or at least

ceased discussions for a

national long-term care scheme

in 2005. They put it off for

another day, Prime Minister,

the day has arrived. I make

one thing perfectly clear. The

doctors got their support

package in 2005, now it is the

time to look after disabled

Australians and their families.

Currently, about 50% of catastrophically injured

Australians are already covered

by statutory schemes. I

believe that the cost of expanding the expanding the current scheme is

affordable, and the social

benefit would far outweigh the

cost to the Government in any

case. A properly-structured

long-term care scheme would

make more effective use of

taxpayer money and more importantly, provide better

lives and quality of life for

the disabled. The scheme would

take place at the existing adversarial court-based system

that results in one-off

compensation payments which are

not structured for lifetime

care and are only available to

some people who need

assistance. A national scheme

would provide justice, fairness

and com passion for those who

need it the most and over time

provider greater affordability for governments and the

community. It would also

underpin the medical indemnity

system. The AMA will put

together a compelling case and

seek community support for a

long-term care scheme. The

Government should support the

AMA work on a long-term care

scheme because it fits in well

with a national disability

strategy. Minister Roxon is

showing interest in significant

structural reform of the health

system for our severely

disabled Australians no reform

is more important than a scheme

which provides assistance based

on need, not the outcome of a on need, not the outcome of a legal lottery. The Government

is consulting widely on

disability services and we are

sure they are hearing that the current system is not too

flash, and that's the AMA's

view too. It is a system that

kicks in when there is a crisis

and is based on a welfare

mentality, but it doesn't

provide adequate ongoing support and the assistance that

is needed over the lifetime of

a person with a disability.

You'd be surprised to realise You'd be surprised to realise how many Australian families

are left to their own devices

to support children with a

disability, even into adulthood

and what it costs them, both

financially and emotionally.

It brings me to tears when I

see elderly parents

accompanying their disabled

child with the love and

patience that only a parent can

give, but with uncertainty in their eyes their eyes that asks the

question, who will look after

my child when I'm gone? Our

support to them as a community

shouldn't be about patching up

the gaps when families can't

cope so that people with a

disability in their family can

just get by. We need to introduce an entitlement scheme

that goes beyond a mere safety

net to ensure they can have sustainable and productive

lives. Doctors care about this issue issue for many reasons, including social justice and equity. People with disability

and their families have a right

to participate in our community

and be supported. Doctors see

the downstream impact of

inadequate early support and

assistance because they treat

people with a disability, and

doctors are frustrated that

their inability to get

assistance, care coordination

and support services in the

community for their patients

who have a disability. The AMA

will work closely with the

Government and with groups such

as the national disability and

care alliance in this important

area. I'd like now to speak

briefly about the issue of professional responsibility

within the medical profession.

It is an important matter,

especially in this era of

comprehensive health reform.

The medical profession in

consultation with community is

best placed to lean on the

development and monitoring of

its own standards and ethics

rather than have them opposed

from governments or outside regulators. Profession-led

regulation and monitoring will

always ensure that the

patients' needs come first.

This is central to our

professional sense of duty to

society. Doctors have a high

expectation of themselves and

their colleagues, but it's

necessary for the public to

have confidence in our high

standards. Being a

professional to me means accepting the standards of my colleagues

colleagues and placing our

obligations to our patients

above our own individual legal

rights. The medical profession

recognises its limitations and

sets very high standards and

codes on guidelines on what is

and what isn't suitable

behaviour in practice. The AMA

has been actively involved in

writing what could become the

first national code of medical

practice in Australia. For

those of you who doubt the strength of our strength of our own standards,

I should tell you the planned

introduction of national code

of conduct has been substantially strengthened by

input from the AMA and as AMA

President I commit us to

helping us implement and

educate the doctors of Australia about the fundamentals of the code and

how it should be applied in

daily practice. In saying

that, it is important to be

reminded that doctors already

contribute many voluntary hours

to the development of their profession and assessment profession and assessment of

their peers. For example, they

sit on medical boards, they sit

on ethics and research

committees, they sit on professional development

standard panels and they're actively engaged in the

activities of their learned

colleges in the pursuit of

professional excellence. They do this because they believe it

is important to contribute to

the growth and development of

the profession in all its areas of responsibility. of responsibility. My

profession has on occasions

been accused of being an old

boys' club, looking after its

own. If this has happened in

the past, I believe it's an

exception. But I remind my

colleagues to take seriously

the obligations placed on us by

our profession. If we don't

lead in this governments will

do the job, much less

satisfactorily. Without going

into all of the details I will

provide you with a very

practical and personal example practical and personal example

of this responsibility. I am

currently working with the NSW

police as the expert adviser in the investigations of

complaints and allegations made

against Dr Graeme Reeves. As a

senior obstetrician and gien

Coles's I'm obviously

well-placed to provide advice

on the specifics of the case

made against Dr Reeves. I made

a deliberate and carefully

considered decision to take on a significant

a significant extra workload.

I believed it was necessary for

a recognised senior specialist

. I was at the time President

of our national specialist

organisation to take on the

task of assisting in an

investigation of serious

complaints against one of my

colleagues. I'm not at liberty

to discuss further the details

of the case, but I present my

involvement as an involvement as an example of

professional responsibility

which I and my colleagues take

very seriously. I can take

questions on professional

responsibility, but obviously

not on the details of the

Reeve's case. In closing, I

return to my theme of

engagement, the importance of

being at the table to put your

arguments to Government at the

time of unprecedented health

reform. I will refer to a

major speech in another place just a

just a month ago. The speaker

on that occasion said "My view

is that health care reform

should be guided by a simple

principle - fix what's broken

and build on what works". He

also said "There's already

widespread agreement on the

steps necessary to make our

health care system work better.

First, we need to upgrade our

medical records from a paper to

animatronic system of record

keeping. The second step keeping. The second step that

we can all agree on is to

invest more in preventative

care so we can avoid illness

and disease in the first place,

and we need to rethink the cost

of a medical education and do

more to reward medical students

who choose a career as a

primary care physician. Who

choose to work in underserved

areas instead of the more

lucrative paths". Sound lucrative paths". Sound

familiar? The speaker was

President Barack Obama. He was

speaking at the annual

conference of the American

medical association. At the

opening of his speech, the

President said "And we also

know one essential step on our journey is to control the spiralling cost of health care

in America and in order to do

that, we need the help of the

AMA". Several times during his AMA". Several times during his speech, President Obama called

on the AMA for help in his

health reform agenda. This was a speech about engagement in

the political process. Today,

I formally invite Prime

Minister Rudd to address the

2010 AMA national conference,

to discuss his health reform

agenda with our members. Prime

Minister, my name is Minister, my name is an drew

Pesce, I'm from the AMA and I'm

here to help. Thank you. APPLAUSE

Thank you very much, Dr Pesce. We have our usual

period of media questions. Dr,

Danielle from the 'Canberra

Times'. You mentioned the state

state of Indigenous health is a

national tragedy, how would you

rate Government efforts to

close the gap? Can you nominate

three practical steps that

could be done right now to

improve the situation? I think

the governments have been, like

a lot of us, noble in their

intention. The difficulty's

always been translating and

reconciling that intention with

the outcomes. I think they all

mean well, but I think we need

to look at what works and we

need to assess what works and

what we see in terms of

practical steps. The three

steps are consultation with

local communities. No matter

what you do if the local

community isn't engaged, they

don't turn up. Secondly, we

need to assess the

effectiveness of the various

programs out there. There have

been a myriad of programs. We

need to assess what's worked.

We need to see what hasn't

worked and we need to focus on the strategies that do appear the strategies that do appear

to work. And finally, we need

to really find ways to deliver

services out to remote areas,

because some of it is tied up

not only with the Indigenous question but the remote

question. And that really comes

down to finding options for

incentives to attract workforce

to the areas at need. Dr Pesce, Julian Pesce, Julian Drape from

Australian Associated Press.

You said in your speech that

you thought the Prime Minister

and the Health Minister were

less enthusiastic about a Federal takeover than the

States were. Does that mean

that you'd agree with the

Opposition which says that

Kevin Rudd's threat to take

over the hospitals was an

election stunt before the 2007 election? No, I don't think

things are done as stunts. I

think it just shows that it's a lot easier

lot easier to make a promise

than to actually work on the

response to that promise. I

think Kevin Rudd at the time

very, very correctly identified

a major concern in the

community, and everybody is

acutely aware of the

deterioration of public

hospital services in this

country. I think that was a

very insightful thing that was

picked up. Of course, the big picked up. Of course, the big

difficulty is translating the

acknowledgement of the problem

with a solution in what's been

a very complex area, and one of

the complexities is, of course,

the fact that the

responsibilities are divided,

so it becomes a very difficult

political issue and I'm not

here to teach the Prime

Minister how to solve political

issues. Mark Metherell from

issues. Mark Metherell from

the 'Sun-Herald' and the 'Age'.

You say the public hospitals

are underfunded and

overmanaged. Would you prefer

to see a Federal takeover of

the public hospitals, or a

Federal takeover of non-hospital operations in

health? I think we need to look

at the whole package of reforms

that's going to come from the

Government's response to the national health and hospital national health and hospital

reform commission. It's just

too difficult to say whether

one thing on its own is going

to solve a problem. It may

solve a problem in one area and

shift it to another area.

That's been the big problem in

health all the time, that by

dividing it up into little

pockets and silos, there's been

a temptation to just solve a

small problem here which

doesn't solve the big problem.

The AMA will look at any The AMA will look at any

proposals which deliver

funding, which is locally

responsive and allows doctors

and nurses to look after the

patients at the bedside, in the

clinic, in the rooms. That's

what we need. We need to see

the plan and then we'll be able

to comment on it. John Bruce.

John Bruce at the 'Financial

Review'. I'm asking about

hospitals again. In hospitals again. In your

principles you said you want more administration and more

decision making that's as close

to the bedside as possible. At

the same time, you want clearer

political accountability, how

do you do those two things at

once? Well, I think you have to

measure and decide what

decisions are best made at the

coalface under a template of

overarching funding

responsibility, and

responsibility, and I graduated

from medical school in 1984, so

I've been in the hospital

system for 25 years. In that

time I've seen six or seven

generations of expansion of

hospitals, expansion of Area

Health Services, contraction of

Area Health Services,

reamalgamation of Area Health

Services, and the problem is that people haven't focussed

on, what is it that has done best at that

best at that high level, and

what's done best at a local

level? And I can tell you that

doctors and nurses know how to

solve problems for their

individual patients. The

problem has been for the last

few years our administrators

are not helping us solve those

problems. They're giving us

all the reasons we can't solve

the problems, because there

isn't funds, it's got to be

approved by this body, it's got

to go to that minister, and so

we need our administrations to we need our administrations to

help us, not be obstacles to

what we can do. Naomi Woodley

from ABC Radio. On Indigenous

health, has enough been done to

recognise the problems that the

swine flu or H1N1 poses to Indigenous communities in

particular, and more broadly,

has the issue of swine flu been

overtly sensationalised, or has overtly sensationalised, or has

the level of response to it

been appropriate? The swine flu

has probably been the best

documented and reported

epidemic in our time and that's

raised a lot of issues. Look, I honestly think the Government

has done a great job at recognising the potential threat of the swine flu

pandemic. It had to make

decisions at a time when it was

unclear whether it was going to

be a very virulent virus that be a very virulent virus that

had up to 40% mortality rates

like the SARS virus, or whether

it was just going to be another

flu. It wasn't going to get

presence for overreacting or

underreacting if it got it

wrong, I think it made the

right call. It was very

cautious, it however didn't want to overreact until there

was evidence of where the

problems were. Now we now have good evidence that the swine flu in the general flu in the general population

of healthy people tends not to

be any worse than the seasonal

flu that has afflicted us every

year. We do, however, now see

that at risk patients may be

more at risk of developing life-threatening complications

and they need to be a) aggressively identified and aggressively treated and

pregnant women are one of those

at-risk groups, even though

they're generally healthy otherwise.

otherwise. So I think in terms

of the Indigenous question, it

was always recognised that Indigenous communities were

probably going to be at risk,

because they do have a higher

level of underlying chronic

conditions and the problem, of

course, is always once again,

translating the decision to say

"Yes, Indigenous communities

are an at-risk population, but

then getting the resources to

those communities what we would see

see as optimal health responses

to the outbreak. And often

that's failed. And I think one

of the things we have to

acknowledge is we need to learn

the lessons that have come out

of our response to the swine

flu pandemic. As I said, I'm

not being critical. We've done

a lot of good things, but we've

made some mistakes. We need to

learn from those mistakes so

that in future if the big one

does come. If there is a

SARS-like infection that comes in

in the next few years, we're

better-placed to respond to

that effectively. Dr Pesce,

Sue Dunn-Leavy from the 'Daily

Telegraph'. You're the first

AMA President to have direct

hospital experience, you're at

the coalface in the hospital system, do you think that system, do you think that the

Federal Government should take

over the hospital system? A

poll yesterday of 800 residents

in Sydney found 67% of them wanted the Federal Government

to take over the NSW health

system. Do you agree with

them? They've obviously identified it as a big

problem. You're right, I've

been working in the health

system for a long time and I

know and my patients know and

my colleagues who have the

misfortune of coming into the hospital system as hospital system as patients

know things are getting worse.

We need things to get better.

Should the Federal Government

take over the hospitals? We

need to see a proposal for me

to say is that going to help.

The AMA will not comment on a

policy before it's released. I

have no doubt that serious

changes, serious change is needed and we

needed and we need to see what

proposals there are. Thank you

Ken. John mill ard. I'm here

to help. Dr Pesce, the cost of

medicine in Australia is

increasing due to the ageing

population, the increased cost

of medical science of medical science and

technology and to some extent,

some people have suggested to

the cost of paying doctors. I don't talk about the

hard-working or dedicated GP or

your consultant physician, but

some of the fees that are

demanded and received by some

medical specialists, procedural specialists have been

criticised even by members of

your own profession. Do you

think the cost of providing medical services could medical services could be

reduced significantly if some

of these surgeons and others

could reduce their incomes to

perhaps three or four times the

Prime Minister's salary? If you're suggesting the problems

in the health system are due to

overpaid doctors, then there's

no evidence of that at all. If

you compare the incomes of

doctors in Australia to

comparable countries, I think

you'll find that we're not you'll find that we're not

doing badly. I think that I

fully support improving the

payment to our underpaid GPs

and non-procedural specialists.

There was a very significant

process that the AMA agreed to

and was involved with the value

study a number of years ago,

where the AMA undertook to

implement the findings. It was

overseen by an arm's length overseen by an arm's length

actuarial firm, it was done

according to the rules and what

did it show? It showed that

yes, we needed to show the

procedural, problem-solving

doctors that didn't do

procedures much better and

surprise, surprise, this meant it was going to increase the

cost to the Government and it

got dropped like a hot potato.

The AMA would still support the

principle of a relative value

result for payment of doctors,

but that's not the major but that's not the major issue

facing our health system.

What's your view on pathology

companies approaching doctors

to ask them to reduce their

bulk-billing of requests to

labs for patients? That's my

first question. And the second

is, I mean doctors

is, I mean doctors do have a

major influence on out of

pocket costs for patients. I

mean, where do you see the

bulk-billing figures heading?

Are they going to stay at the

comparatively high level

they're at now? Which

direction, basically up or down? The answer to the first question is that doctors make a decision, because they know the

patient, the patients that need

to be bulk-billed because they to be bulk-billed because they

can't afford out of pocket

expenses and those that might

be able to afford it. So

that's how they determine their

charges and when they order a

pathology test, they can

request the provider to make

the same concession to the

patient. They don't direct the

pathology provider to do that,

I think most pathology

providers would usually follow

that recommendation. It's not

possible for a doctor to determine determine whether a patient is

bulk-billed for a service by

another provider, but I think

that the GP or the doctor

that's organising the test is

probably best placed to make

that call and I would support

that the doctor is the one who

continues to make that call.

The second question on the

bulk-billing. Sorry, can you

complete it

complete it please? Which way

is it going? Look, I think

there has to be a recognition

that this is a question of two

interests, and I refer to it in

my speech. The principle of

Medicare is that there is

access to medical services, and

when Medicare was when Medicare was introduced

the fee structure supported

pretty universal access with

minimal out of pocket expenses

for medical services. Since

the introduction of Medicare,

the decision to save costs and

decrease in real terms the

rebates for services has meant

that it's been impossible to

deliver services at that

rebate. When I graduated, I rebate. When I graduated, I

came from a non-medical family.

I didn't know what Medicare,

whether it was a good

remuneration or not. I

bulk-billed all my patients for

two years. After two years my

practice was still not making

money. So for those of you who

think that the Medicare rebate

can provide a realistic income

level and cover practice costs

as well, it just doesn't work.

So if the Government is serious

about the

about the Medicare rebate funding medical care for

patients of Australia, it has

to be serious about setting

that rebate at an appropriate

level, and you can go back to

the RBS, the relative value study, you can consult with the profession, there's lots of

ways you can do that. But you

can't have it both ways - you

either want to save Government

money and increase cost to

patients or you say "No, we're

going to have to invest in going to have to invest in

this, because we believe it's

in the public interest that the

Medicare rebate pays for

care". Simon Grouse from

Science Media. I've got a queery about the professional

representation of GPs. Just

before I came this morning I

got an email released from the Australian General Australian General Practice

Network in which their head is

having a go at you over what he

sees as your judgment that the

Government's push to prioritise

primary health care won't take

pressure off hospitals. His

and your group are members of United General Practice

Australia which was just formed

just October last year. Other

members are the Royal Australasian

Australasian College of General

Practitioners the Rural Doctors

Association of Australia and

the Australian College of Rural

and Remote Doctors. The whole

impression is of a profession

wrought by conflict and

internal fractions, unable to

talk in one voice. Why is this

so? Are you reconciled to that?

Do you think there's a chance for it to

for it to change? I think

you're right, I think that

Australians don't want doctors

to be divided. I think that the profession prefers not to be divided and it's interesting

to ask the question. I'll be

meeting with Am iel later

today. It's a pity he's chosen

to something I've been reported

to say. I don't know how much

of it was reported, whether

some of it was taken out of context. context. Look, I work in the

public hospital system and I

was asked on whether or not

these reforms would help the

public hospital system and I

gave an honest answer saying

that even though it was good

for primary care, it wasn't

going to see solve the

immediate problems I see every

day in the public hospital

system. I'll have a chat to Am

iel and see what he says. I

think it's in everybody's

interests that we talk amongst

ourselves rather than fire

broadsides in the media. David

Spears from Sky News. I'm

interested in your call for a

long-term care scheme for the

disabled. What services practical would

practical would you like to... We apologise for this break

in caption transmission.

Whenever you set the threshold determines threshold determines the cost,

so we're talking about in the

grand scheme of things, you remember the Australian health

budget is $60 billion plus a

year, we're talking if

implementing the

recommendations of the price

Waterhouse costings about $300

million a year to expand it to

include all of the seriously

disabled Australians we treat

as doctors. So it sounds like

a big number, but, in fact, a a big number, but, in fact, a

lot it's being spent already.

As I said, I think the

advantages will come through

the quality of life that we can

provide, not just for the

disabled Australians, but their

families. Can I take you back

to one of the central point s

that you've been making, which

is the dysfunction as you see

it between management and

delivery. You said earlier on

that the current system is manifestly overmanaged and manifestly overmanaged and you'd like to see one where

there was minimal levels of

bureaucracy, and you've

acknowledged that the costs of

medicine if we use all the

tools that were available would

go up and that scares

politicians out of their pants.

So do you have, does the

profession have a concept of

the best management model

that's possible? I think that the the costs relate to efficiency

of delivery, but also the

expectation in the community.

In a sense, we're also caught

up in the bind between

community expectations of

ever-improving access to

improving health care services

and the cost of delivering that

and we understand that it's not

sustainable to have several

percentage points growth every

year ad infinitum. So to a

certain extent I think we need to to consult the communities

about where they see a reasonable invest - because

it's their taxpayer dollars.

But in terms of answering your

question as directly as I can,

I think doctors and nurses who

look after patients can clearly

articulate the priorities. I

think it's a question of the

funders to come in and say

"These are our priorities" ,

and they have to get together

and work out how the dollars

are spent. The problem is are spent. The problem is because that's a complicated

process and doctors and nurses

can be quite difficult

customers to deal with

themselves, that it's easy to

make a decision at the level

here and just expect it to be

implemented down there, and the

end result is that continuous

tension between the service

providers and the service

payers. Now, it's inevitable there is going to be some

tension, but I think we have to

pick, we have to pick those pick, we have to pick those

decisions which must be made at

that upper level and then have

those bureaucrats understand

that local decision-making,

local priori