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Dutton discusses health reform plans -

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Dutton discusses health reform plans

Broadcast: 28/07/2009

Reporter: Tony Jones

The Opposition's health spokesman, Peter Dutton, joins Lateline to discuss the health reform


TONY JONES, PRESENTER: Joining us now in the Sydney studio is the Opposition's Health spokesman
Peter Dutton.

Thanks for being here.


TONY JONES: You say you're open to radical health reform, so let's start with this: should the
Federal Government take over the running of the nation's hospitals?

PETER DUTTON: Well that's certainly what the Prime Minister promised at the last election. He saw a
need for it then. And I think he tapped into a rich vein that's running deep in the Australian
public. People believe, quite properly, that the health system is broken, and that it is not
sustainable into the future to continue to pour money into a system until significant reform takes
place. So we're looking at our options at the moment. Obviously, we've had this 292-page report for
about 24 hours now. We're having a look at that and we'll announce our policies in due course. But
I think there is overwhelming support in the Australian public for significant change to take place
so that we cannot repeat the same mistakes over the next decade that we've repeated over the last

TONY JONES: Let's look at some principles from your point of view. Last night, I put Professor John
Dwyer's argument to the Health Minister. He says Australia is the only country in the developed
world which has hospitals run by one level of government and the rest of the system operated by
another. Fixing the problem, he says - that problem - is the "Holy Grail" of health reform in this
county. Do you agree with him?

PETER DUTTON: Well I think what he says makes a lot of sense. And I think the more you look at the
way in which a system operates at the moment, you've got funding arrangements which provide
incentive for cost-shifting to take place - both the Commonwealth to the states and vice versa. And
that's been inherent in the system. It's why the Prime Minister promised to end the blame game,
because he knew that people were sick of this passing of the buck between the Commonwealth and the
state. In the end, people want proper outcomes and there are health experts with many varied and
different opinions. This is not an easy area. But the Prime Minister made his first announcement
two years ago that he would fix health. And in actual fact, if he hadn't fixed the hospitals by
June, 2009, that he would seek the mandate to take them over. So that - it's an interesting debate,
but obviously one that the Prime Minister saw fit to commit to about two years ago.

TONY JONES: OK. Alright. What's your opinion, though? I mean, the Government is only talking about
potentially taking over the funding of these hospitals. Should they also take over the
administration of them? Should they get rid of the nine health bureaucracies and make one central
health bureaucracy?

PETER DUTTON: Well, Tony, we've got a population of 20 million people. We've got nine health
bureaucracies. In NSW and Queensland in particular, people on a daily basis see the fact that now
$2 out of $3 are being spent in administration, and only $1's making it onto service delivery. And
I think that funding mix has to change. We certainly have to look at the way in which we deliver
services, and if we've got a funder-provider arrangement, then it doesn't provide for an efficient
delivery of those services. And there are better examples of how it could work. I think there's a
lot of credibility in the issue of - and I'm attracted to the idea of local boards, of regional
boards, professionally managed by CEOs and chairman with the experience in the health field that
would be necessary. But we need to prioritise local needs for their medical services and demands
from their public, and I think we need to give it a sharper focus at a local level. I certainly
don't support a swelling of the bureaucracy in Canberra and a running of the health system from

TONY JONES: Well how would you do it, then? I mean, if you're serious about this, and there are
nine health bureaucracies you want to turn into one health bureaucracy, how do you do it, apart
from swelling the bureaucracy in Canberra?

PETER DUTTON: Well, Tony, the first thing you've got to do is get people over this idea of not
being able to give up any power. I mean, for John Della Bosca in NSW as a Health Minister there, he
presides over an enormous kingdom. And for him to give up that power is obviously very difficult.
And I suspect Kevin Rudd, over the last 18 months, has put the argument about the Commonwealth
taking over, but the state premiers and health ministers have beat him around the head for a while,
and he's realised how difficult it is for that proposition, for people to give up these kingdoms.
And until we get past that and we start to concentrate on putting the patient first, listening to
the doctors and nurses, I don't think we're going to get change. And that's why I've been critical
of the Prime Minister today in saying, well, you don't need another six months of consultation; the
decision time is with, Prime Minister, here and now.

TONY JONES: Well, understood. But if you were in government for 10 years and have this strong
belief that there are too many bureaucracies, that the system should be fundamentally and radically
reformed, and it wasn't done in that period, it would be difficult to expect the current government
to do it in a year and a half.

PETER DUTTON: Well, Tony, I think there's a couple of points there. First is that we tried to work
cooperatively for a number of years with the states and territories. We've seen some of the reports
now from the Auditor-General where - in different states where there's a suggestion that the
waiting lists have been doctored. And that's one of the great frustrations we had in government.
It's very difficult to tie funding to outcomes in hospitals, because if you're giving $500 million
to the Queensland Government to put into elective surgery, for argument's sake, you're taking their
word for it. Once the money's spent, it's very hard to say, "Well, close down the Royal Brisbane
Hospital, we're going to take the money back, or we're going to hold money back." I mean,
politically, it is just nigh on impossible. And that's the difficulty which compounded over a
period of time, and we find ourselves in the position now where I think Kevin Rudd rightly at the
last election said it can't continue as it is. And it's not just a case of him having been in
government for 18 months. He first made this announcement that he had a plan to fix health two
years ago, and he's had 16 months with 10 experts.

TONY JONES: But you acknowledge yourself how complicated this was when you were in government. They
appear to have discovered the same thing. Their Health Reform Commission has given them a huge
number of recommendations and they can't just implement them without trying to explain them. That's
a reasonable thing to do, is it not?

PETER DUTTON: Well, it's an interesting debate, Tony, because if you cast your mind back to the
November, 2007 election, the Prime Minister didn't give a commitment that he was going to
commission an options paper or a summit or that he would look at different ways in which we could
do it. He made a commitment that if public hospitals weren't fixed by June, 2009, he would seek a
mandate to take financial control of them. He didn't put of those caveats on them.

TONY JONES: OK, but that's your political point. I mean, we now face a reality, and the reality is
in order to fix the hospital system, you're going to have to raise taxes, it appears, and by one
estimate, $1,000 a year for people on the average wage. So, it's a big thing for a government to do
without warning people and letting them consider it. Isn't it the right thing to do to let this
process unfold, let people understand what's happening and then let them vote on it?

PETER DUTTON: Tony, I think what you saw in the last 24 hours was Nicola Roxon, who I think really
(inaudible) the cat on this, and she said, "Look, we are attracted to a financial takeover of the
hospitals, but it's very difficult for us in the current economic climate because the Government
essentially finds themself in huge debt." And so, this is what we've been talking about over the
last 18 months. This is a government that borrowed money to throw it out the door, and by doing
that, by giving all of those cash payments out, they now find themselves in a position, "Well,
maybe we should've used that money to fix our health system." And this is what happens if you have
a government that spends all of the money, rushes it out the door. The $22 billion that we left
them with when they came into government: that would have been a great starting point to fix the
health system, if Kevin Rudd was actually serious about it.

TONY JONES: OK. Getting back to the situation we're in and the reality of it. I mean, when John
Howard wanted to introduce a new tax - the GST - he spent a great deal of time explaining it to
people and then put it before the electorate in an election, so people could actually vote on the
GST. It became a central feature of that campaign, as, potentially, a tax to increase the benefits
you get from healthcare will be one of the key elements of the next campaign. So isn't that
actually an honourable way of doing it?

PETER DUTTON: Well the Prime Minister's honourable way was to commit to a mandate to take over
financial control. That was actually what he said he would take to the election. And he made that
commitment at the same time he made other commitments. He said he'd end the blame game and the buck
would stop with him on health - all of those lines that he knew cut through. So, he may well take a
package to the next election.

But what I'm most worried about is in this latest report, and elsewhere, we've seen evidence that
people are dying on waiting lists. 4,500 Australians each year die unnecessarily in our hospitals
because of the way in which the bureaucratic process works. And if the Prime Minister's saying,
"Well, I've had 18 months, I've done nothing. I've got another 18 months of this term and I'm not
going to do anything until some way through the second term of the Rudd Government," so in two
years time; I just think that is completely unacceptable, and I don't think that's what people
bought at the last election.

TONY JONES: Let's go back to the principle from your point of view. Now your former Health Minister
Tony Abbott is putting forward ideas on policy and he's basically saying what's needed is a new
federalism, and he's essentially saying the hospital crisis is a good case in point. Do you agree
with that principle and does a new federalism extend beyond hospitals to public schools and
transport - the other things he's mentioned?

PETER DUTTON: Well, Tony gifted me with a manuscript early on of his book, so I haven't seen the
final version, although I'm going to his book launch in Canberra on Thursday, so I'll get a signed
copy then, as I think all your listeners should do too. But the reality is Tony is an ideas person.
I mean, it's encouraging to see people with colour in politics in our country that is putting
forward debates and ideas. I think one of the points, the key points that Tony is making at the
moment is that, as a federal government, the Coalition was seen as being successful - not just in
managing the economy, but in other areas as well. And all of a sudden, the difficulties of the
states became the difficulties of the Commonwealth. And for us, over a period of time, that built
up. And there's no better example than in health. People thought that the Federal Government had
plenty of money, because we'd managed the economy well. They thought that we were competent
managers, and therefore if the state premiers weren't able to manage health, well what's John
Howard doing? He should take it over, or should deliver a better outcome. So, I think as this
debate matures - and we do have to have a mature debate about it - there has to be, in my mind, as
we go forward, a clear delineation between responsibilities so that bucks can't be passed one to
the other. And clearly that's the case in health at the moment.

TONY JONES: Alright. Let's have a look at what you've done with the universal health care system
proposal. You've said we certainly do need to do more in relation to dental care, but you oppose
this scheme. What's your alternative plan?

PETER DUTTON: Well my concern about the scheme, as I understand it, it's been proposed , Tony, is
that if you open up dentistry to a universal system so that 20 million Australians could access it,
those who are most in need, in particular the pensioners and low income families, would find
themselves in the same situation that they're in at the moment, and that is at the back of the
waiting list. We see it in hospitals because there's such huge demand. And I think we're better off
to target a lot more money, sure. More money in dental is what we all support, but ...

TONY JONES: Why would anyone trust your proposal when the very first thing, or one of the very
first things, your government did in 1996 was to cut a scheme which had $120-odd million allocated
for the lowest paid people to get dental care?

PETER DUTTON: Well, there are a couple of reasons for that. We probably haven't got time to go into
all of them. But let me say very briefly that part of the reason that we're in this debate at the
moment and that we had that debate then about dental when we came in in '96 is that it was a state
government responsibility. State government's still operate dental services. There are 650,000
Australians on waiting lists in state dental programs at the moment. When we were in government, we
implemented a scheme which was directly targeted, not at all comers, ...

TONY JONES: Yes, after more than 10 years, in 2007.

PETER DUTTON: Well that's right, we ...

TONY JONES: And the point is, by then, there were only half a million people who were requiring
public dental care and on long waiting lists. So, I mean, cost is the big problem here; you're
going to have to increase the pie somehow. I mean, do you simply oppose any extra money being spent
on this?

PETER DUTTON: Well, what I say is that - and the dental program is an excellent example of the fact
that it was a state responsibility, and in the end, we had to weigh in to compensate for the way in
which they weren't delivering a service - that's the core point that you need to make in relation
to some of these services. And the way in which the ...

TONY JONES: You cut a federal program, originally - that was my original point.

PETER DUTTON: Well, it was a program which was the responsibility of the state governments, and
that's exactly the sort of argument that we don't want to get into in the future. We want clear
responsibilities for different areas of health.

TONY JONES: So should there be more money spent on dental health - substantially more, as the
Government is proposing or not? They're saying you want to freeze the funding.

PETER DUTTON: There should be more money spent on dental programs, but it should be targeted to
those who most need it. You and I shouldn't be lining up in waiting lists ahead of people who are
on aged pension or on a disability support pension. You and I shouldn't be accessing those services
ahead of those in greater need, and that's what the Government's proposing, and that's why we've
got a question mark over it.

TONY JONES: Alright, let's move on. Wilson Tuckey, the so-called "mad uncle" of the Liberal Party
is at it again today, publicly criticising your leader Malcolm Turnbull. What effect is this open
disunity having on the opinion polls?

PETER DUTTON: Well I think it's abundantly clear what open disunity has by way of effect on opinion
polls, and we have to draw a line in the sand and move forward now. I mean, we have to start ...

TONY JONES: What effect does it have? It may be clear to you. Is this one of the things that's
fundamentally hitting Malcolm Turnbull's popularity, or is it something else?

PETER DUTTON: Well, Tony, I mean, anyone who's been a watcher of politics in this country for five
minutes, let alone many years, would tell you that disunity is death in politics. And for us now,
the time has come to concentrate on the failings of the Government, to highlight those, and health
is a key issue. The core election promise of the Rudd Government ...

TONY JONES: Yes, but we have talked a lot about core election promises; let's talk a little bit
about what's going on in your party while we still have a minute or so left. What can be done about
it? I mean, the problem with this disunity is that Wilson Tuckey is almost a stalking horse for
more powerful figures inside the shadow Cabinet.

PETER DUTTON: Well, what we can do is, as I say, concentrate on broken election promises, such as
in health and we can talk about ways in which we can improve the Government's ETS scheme. We can
talk about it in a constructive way, like the Labor Party, where we have disagreements, we can do
that behind closed doors. But ours now, in the run-up to the next election - our responsibility is
to make sure that we continue to focus on the Rudd Government, because this is a government which
is full of spin and hype. They are not delivering in the areas that people want them to deliver and
we should capitalise on it ...

TONY JONES: OK, that's a point you've made time and time again during the interview. Fair enough.
But history tells us there's a limit to how much people under threat of losing their seats in an
election are going to put up with bad polls and particularly the sliding popularity of a leader.
What is that limit?

PETER DUTTON: Well, Tony, my margin's 217 votes out of a population of 90,000 in my seat. They
don't come much more marginal than that. And what I'd say is that in politics, people respect
politicians who stand by their word, who stand up for what they believe in, who fight for the
issues that are important to them. They are characteristics which have dominated the Liberal Party
room for many decades. They are inherent traits in my colleagues right here and now, and they're
the traits that we need to air to the Australian public so that they can see us as a credible
alternative at the next election.

TONY JONES: Peter Dutton, we'll have to leave you there. We're definitely out of time now. We thank
you very much for coming in and talking to us tonight.

PETER DUTTON: That's a pleasure. Thanks, Tony.