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Speech to the AMA National Conference, Brisbane



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THE HON NICOLA ROXON MP

Minister for Health and Ageing

Speech to the AMA National Conference, Brisbane

27 May 2011

E&EO

Acknowledgements: x Traditional owners x Dr Andrew Pesce, outgoing President of the AMA x Dr Steve Hambleton, current Vice-President and incoming President x Dr Geoffrey Dobbs, incoming Vice-President x Mr Francis Sullivan, Secretary-General x AMA members

It’s a great pleasure to be in here in Brisbane to officially open your national conference.

I’d like to start by paying tribute to your outgoing President, Andrew Pesce. Andrew, it’s been a great pleasure working with you over the last two years. You have been a fierce and persuasive advocate for the interests of your profession. We haven’t always agreed, but we have found in you a constructive partner— willing to engage in the debate and work with the Government on the issues that matter, and I think that shows in the outcomes that have been delivered over the last few years. I wish you well in returning to the quiet life of an obstetrician…

Can I also say that I look forward to working with your incoming leadership team, Steve and Geoff. I hope that we can continue working constructively together, because I firmly believe that its when we are doing that that we are delivering better outcomes for patients.

The interests of patients and the community, of course, are at the centre of the Government’s national health reform agenda. As you know, our agenda is an expansive one, but it has one fundamentally important goal at its heart—providing better health and care to patients, close to where they live, now and into the future. I know it’s a goal that the AMA shares with us.

So it’s a good time to be working in health—and an interesting time for Steve and Geoff to be taking the reigns—because, as I seem to say each year, there is an awful lot going on. This year, all of the activity is on the implementation and delivery of our reforms.

I won’t give you chapter and verse on health reform today— I know you’ll all be broadly familiar with the historic agreement reached by all governments in February which we’re now working to fine tune with the States and Territories.

Today I want instead to update you on important implementation news as we work towards our health reform goals and some of the new policies we’ve recently announced. I’ll focus on three areas: 1. Our investments in the Budget, in particular in mental health and

regional health 2. The rollout of some key components of our national health reforms, especially in primary care and workforce, and 3. The latest in our fight against big tobacco.

The Budget

The recent federal Budget included some very important new investments in health —despite the Government putting the Budget together in extremely difficult fiscal circumstances.

I’m delighted that we were able to secure very significant investments in two areas in particular where there have been major service gaps and unmet need, despite investments our Government has made over the last three years.

The first of these, of course, is mental health. The Budget included approximately $1.5 billion in new investments over five years for significant reforms of mental health care. When combined with our 2010-11 Budget and election commitments, this brings our total additional investment in mental health reforms to around $2.2 billion over this coming five years. The total is even higher—around $2.5 billion— when you add in recent investments in mental health from other areas such as sub-acute beds, the Health and Hospitals Fund, and specialist training.

Minister Butler did a great job putting this package together—with important investments in children and youth mental health, but also in emphasising the importance of better care and support to people with severe mental illness, the Government is delivering a truly comprehensive approach to mental health reform.

Our package recognises the diverse impact of mental illness throughout a person’s lifetime and will build resilient kids, support teenagers dealing with the challenge of mental illness, improve access to primary care, and target more services to hard to reach groups and to people living with severe mental illness. Importantly, for the severely mentally ill, for the first time we are putting a very significant amount of resources into improving the way often disparate mental health services work together for the patient, particularly in clinical and non-clinical areas. We know that

this is especially what is needed if we are ever going to stop the 60,000 or so people with severe mental illness falling through the cracks.

Now before the elephant in the room starts rumbling too loudly, let me address directly the part of the mental health package that I know many of you have concerns about.

I know with your union hat on you will want to disagree with the changes to GP rebates under the Better Access program. I understand that. But these changes are based on good data and sound reasoning. They are a sensible recalibration of the rebates which GPs receive, designed to better reflect time spent by GPs and bring them in line with other time-based Medicare items - while importantly, maintaining a premium if GPs have undertaken mental health skills training.

With your broader health stakeholder hat on, though, I imagine you’ll welcome the increased support for areas that are least well serviced, and for patients with the greatest needs. Changes such as those we’ve made to Better Access are necessary to enable investments in important areas like mental health—which I know you will all agree is a priority.

It simply isn’t sustainable for the Government to keep pouring more money into health—and the AMA has never been afraid to ask us to do that, your ask on mental health alone was $5 billion—without also looking at areas where we can make sensible savings. There is an endless range of areas where you can invest to do good in health—but not a bottomless bucket of money with which to do that. The AMA’s total requests to the Government before the Budget reached $20 billion, without a single save proposed.

Despite the tough Budget circumstances, our Government also found room to invest in rural and regional health. The Government committed $1.8 billion in the Budget to upgrade health infrastructure in rural and regional Australia. $1.33 billion in 63 projects were announced in this Budget, and an additional $475 million set aside for a further regional priority round later this year. These projects will deliver real and lasting benefits to communities around Australia—from Tennant Creek to Townsville, and Wagga to Warrnambool.

In addition to the very significant investments in these two areas, we’ve also been able to commit significant funding to improve access to diagnostic imaging services, continue the bowel cancer screening program, and fund $600 million worth of new drugs for the PBS.

Rolling out national health reform

These new investments build on all of the important investments and changes we are already delivering through the national health reform agenda. We don’t believe, as our political opponents do, that we needed to make a choice between national health reform and mental health reform. We believe we need to do both—in fact, we believe you can’t really have one without the other.

For example, our mental health reforms will be more effective, more quickly, with our broader primary care reforms in place.

The investments we are already rolling out through the reforms announced during the Government’s first term include: x more investments in hospitals - including in sub-acute beds, elective surgery and emergency departments

x important investments and reforms to primary care x harnessing the power of technology to connect the health system to the future, through e-health and telehealth, and x massive investments in the health workforce - including in expanding

clinical training capacity outside hospitals, to help address the growing problem of clinical training capacity.

In fact, just this morning I was at the Wesley Hospital announcing the latest tranche of this funding: $ 51 million allocated through Health Workforce Australia going to support 35 clinical training infrastructure here in projects in Queensland.

Underpinning all of these reforms is a very strong commitment to transparency and accountability. On this point, it’s been disappointing to see some state governments indicating they might recant on the important principles of transparency and accountability agreed by COAG earlier this year.

These principles are the cornerstones of reform—because it is only through strong transparency and accountability measures that we can know how our precious health dollars are being spent, and more importantly, whether they are improving health outcomes for the community. I know we’re on a unity ticket here.

As I said at the outset I’m not going to talk in detail about each and every component of national health reform, I do want to take a moment to talk to you about an area of our agenda which I know has led to some queries in this room: Medicare Locals.

Medicare Locals are a fundamentally important part of our primary care strategy. These organisations, operating at local and regional level, are being set up to help coordinate and integrate services, address service gaps in local areas and regions, and help bring GPs and other health professionals together.

In saying Medicare Locals are fundamental, I do want to reassure you and perhaps dispel some of the myths that have unfortunately taken hold about what Medicare Locals will (and will not) do.

Medicare Locals will support and assist GPs to provide better care for their patients. They’ll continue the valuable practice support and other roles that the Divisions already provide to many of you, but they’ll expand on this by working with GPs and other health professionals to address the broader health needs of their communities and regions.

For example, in consultation with local GPs, a Medicare Local might identify that there are a large number of diabetics in a particular area, and organise a roster of allied health professionals such as nutritionists and diabetes educators to provide sessional services to GP clinics in that area.

When we talk about identifying and filling gaps in local services, supplementing and complementing the work of local GPs—this is the sort of thing we mean.

Medicare Locals are not intended to and will not displace the central role of the GP in the primary care system. They will need to include local GPs in their governance and board structures—we are crystal clear on this. And we have absolutely no plans to cash out Medicare benefits and have these funds held by Medicare Locals.

We don’t want to usurp the role of the GP. But we do want GPs to be able to work together and link with other health professionals in their areas, so that patients— especially patients with chronic conditions and complex care needs—get better access to all of the services they might need.

My message to the AMA, and in particular to Steve as your new President, is to work with us on these changes. Ultimately, as a new President, the choice of how we engage is yours. But my suggestion to you is this: if you’re not sure you like what you see, come and talk to us about it. Stay inside the tent—because that is a much more effective strategy than sitting outside throwing pot shots. We both know that reforming and strengthening the primary care system is fundamental to the future of our health system—and it’s important that together we get it right.

Big tobacco

Lastly today, I want to talk to you about the latest on our efforts to tackle smoking.

Some of you were in attendance at the World Medical Association conference in Sydney last month when I released a draft for consultation of the Government’s legislation to mandate plain packaging of cigarettes. The consultation period will close this fortnight and I intend to introduce the Tobacco Plain Packaging Bill 2011 into the Federal Parliament as soon as possible after that.

By taking this step, we want to take away the last tool Big Tobacco has to entice people, including young people to their killer product.

As you will have seen over the last couple of weeks, Big Tobacco has taken to the airwaves to warn about the dangers of our world first move to introduce plain packaging. We’ve heard them bleating before that it won’t work. Now they’re complaining that it will be so successful in stopping them from promoting their killer products that they’ll have to slash the prices of their products.

Their ridiculous tactics would be laughable if the issue at hand was not so serious: as all of you in this room know, because you see every day the effects of their killer products.

I said to your international colleagues when I addressed them last month: the Government knows Big Tobacco will fight these steps tooth and nail. They are already doing everything in their power to fight the Government politically and legally, and the plain packaging legislation will be no exception.

So I issue an invitation today: join with us in this fight. And in particular, I urge you to take one very specific step, here at your conference today.

When my Opposition counterpart addresses you later this morning, urge him and his Liberal Party colleagues to support our plain packaging measures when they come before the Parliament.

I think that it’s time for members from all political parties to stand up and be counted.

Tony Abbott and Peter Dutton have spent a week in Canberra ducking and weaving from the calls from health experts to stop taking donations and support plain packaging.

The Nationals are missing in action—where are Warren Truss and his team when it comes to acting in the best interest of the health of their community?

We are seeing support from their side of politics at State Level for Plain Packaging: Health Minister Skinner in NSW and Health Minister Davis in Victoria have both supported it and Premier Barnett in WA opposes donations from Big Tobacco.

Where are the LNP? Will they follow the lead of their State counterparts or are they too in the pocket of Big Tobacco.

Big Tobacco is desperate to stop these measures in Australia, because they know that if Australia is the first, we will not be the last. Currently, they seem to be banking on the Liberal Party’s support to topple the plain packaging measures when they come before the Parliament.

I cannot for the life of me understand why the Liberal Party would put themselves in this position—but I do know that this gathering here today is very well placed to do something about it.

If there is one thing that I’ve spoken about today that we can agree on, surely this is it.

Conclusion

As doctors, you all take an oath to ‘do no harm’. My predecessor once said that should be the guiding principle of his reform agenda as the Health Minister.

It’s a powerful principle—but ultimately I think it falls short as a framework for health reform.

For starters, its a principle that is expressed as a negative. I think in health policy we should be aiming to do more—I believe that we should be positive.

We should look to do the most good that we can—the most good that we can to protect the health of our community and to promote its well-being.

As doctors you have responsibility to your individual patients, but as an association of doctors you also have a responsibility to the whole community.

Thank you for having me here today. I’m delighted to officially declare your conference open, and I wish you well in your deliberations over the next few days.