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Transcript of doorstop interview: Port Macquarie: 25 August 2009: Health funding; Health reform; ageing, population growth; aviation infrastructure; Jodie Campbell.

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25 August 2009

Transcript of doorstop interview Port Macquarie

Subject(s): Health funding; Health reform; Ageing, Population growth; Aviation infrastructure; Jodie Campbell

PM: Firstly, thanks to, it’s good to be here with Rob Oakeshott, and of course, Justine Elliott. Rob’s the local Member and Justine’s the Federal Minister for Aged Care. And what we’ve been doing is talking to the health

professionals here at Port Macquarie Base Hospital.

The reason I’m doing that is that the local Member has asked me, in fact, he asked me in Parliament to do that. And so I thought I’d better say yes.

But the second reason is this is a major regional hospital in Australia, and the Government is currently engaged in consultations nation-wide on the recommendations of the Health Reform Commission, on how we build the health and hospital system Australia needs for the 21st century.

This is full of challenges. It goes to what we’re going to do for the future of preventative care to deal with the challenge in the explosion of chronic diseases. How we enhance primary care, or GP related services, in communities such as this around Australia. Because that’s so important to keep some of the pressure off the emergency departments of hospitals like this as well.

What do we do to boost the overall capacity of acute hospitals, and their ability to conduct surgery, and acute hospital interventions? And certainly one of the representations here at Port is that they’ve got some real challenges when it comes to surgery.

Then beyond that, the need for greater investment in sub-acute services, of course, the range of other services as well, which goes to elective surgery, which goes to aged care, as well as mental health services and dental care as well.

I’d like to thank all the health professionals who spent some time with Rob and myself this morning, together with the State Member as well, who is with us.

We had a good discussion. Many points of view were put to me about the particular needs here at this hospital, particularly in the area of surgery. Particularly in terms of areas of cardiology, integrated cancer care, as well as needs in the primary health care department as well. Namely, better GP related services as well.

The Government, as I explained to those here, will be spending the rest of this year consulting around the nation major metropolitan hospitals, major regional hospitals and some rural hospitals to test the recommendations which have been put forward by the Health and Hospital Reform Commission against local community and regional reactions from the health professionals here.

So I’d thank each of those who spent time with us here this morning on their particular representations.

Obviously in this region, there is a desire to see expanded services at this hospital. Obviously in this region there is a desire to see greater emphasis on integrated cancer care. The Government has made an allocation of

some $500 million plus for a regional network of integrated cancer care services, and the Government therefore will be considering in due course the application which will be received from this health region, and this particular area.

Now also, the future of primary care out there in the community is important, and Rob Oakeshott has been keen to obtain support in time for expanded GP services in this area as well.

So we will work our way through all of those. But the primary point today has been here to test the reaction from the locals to the recommendations contained in the Commission’s report.

One of the things that we have done in the interim, as of the end of last year, was increase the Australian Healthcare Agreement between the Australian Government and the State and Territory Governments by 50 per cent.

This is a $64 billion investment nationwide, and of course it goes through State Government systems, through area health services such as the one which services this region as well. Part of that has been an investment that we have made for elective surgery. Part of that has also been an investment that we’ve made also to assist with emergency departments. $750 million in investment nationwide for the first time by the Australian Government for emergency departments, $600 million for elective surgery waiting lists.

Part of that latter amount, we’ve also confirmed today an allocation of some additional $217,000 here at Port Macquarie Base Hospital, to enable the hospital to purchase much needed additional surgical equipment, to help reduce waiting times for elective surgery.

This comes on top of some recent changes we’ve made also to the Government’s rural and remote workforce package in the ‘09/10 Budget, which we discussed this morning, which has seen previously ineligible communities such as Port Macquarie, Camden Haven and Taree, become eligible for a number of workforce incentives to help tackle workforce shortages in the region as well. Also, the medical specialist outreach assistance program supports ten specialist services at Port Macquarie.

These however, are very much interim forms of assistance. We as a national community have got to get on with the business of integrated long-term reform for the health and hospital system, and that means the future of important regional hospitals like this. The truth is in regions like this the population is going through the roof. The truth is in regions like this you see an ageing of the population as well. You see a lot of people making the sea change move from Sydney and elsewhere to have their retirement, in communities like this. And also, there are young people, like the ones I’ve just mentioned veer there, with the usual range of health challenges as well.

Therefore, our challenge is not just to focus on ‘how do we fix this bit and that bit of the system’, it is how do we take an overall view about proper funding, investment and allocation of responsibilities between the State and the Australian Governments for the long-term reform of this system for the 21st century. That’s why we’re here in Port Macquarie today, and I’d thank Rob Oakeshott for organising the visit here to the hospital, it’s been for me a very useful exchange.

And then, before we take questions, do you want to say something? Over to you Rob.

OAKESHOTT: Firstly, it is to say a very big thank you to the Prime Minister, coming to Port Macquarie and the mid North Coast generally, and in particular, coming to Port Macquarie Hospital to look at growth pressures of a particular nature here in Port Macquarie. But also, hopefully, some food for thought in regard to growth regions and the pressures on infrastructure that growth regions are under, right around Australia.

It was a fruitful discussion, and it was a genuine discussion. For anyone who is in any doubt that this is some sort of just process of consultation for consultation’s sake, can I confirm what was a meeting that was

supposed to go for forty five minutes I think nearly went for two hours, at the Prime Minister’s request. And it was an open discussion on the full range of issues faced by the clinical staff at the hospital, the nursing staff, and also the primary care and the division of GPs for example, throughout our community.

So it is greatly appreciated that the Prime Minister has taken the time to come to Port Macquarie, to look at the hospital in particular, to look at health services generally and in the region, and also to hold Community

Cabinet here.

There would be 1000, at least, postcodes throughout Australia, and the Prime Minister could choose to go to any one of those throughout this country. To choose this area, and to genuinely take the time to listen and consult, to meet with patients and to meet with community members, is certainly greatly appreciated.

From the discussion we had, I do believe it was fruitful, and hopefully left Government with some food for thought.

We tried to leave a message that was shaped around two Es. One is about efficiency. I think the Port Macquarie Hospital and the Mid North Coast generally delivers efficient health services. Governments don’t recognise

that within existing funding formulas. And so we tried to get a message across about supporting the principle of efficiency within the health service.

Also, the issue of equity. For too long now, this region has, due to the high growth, and the demographics in the region, has been under equity. About at least two to five per cent on the State Government’s own funding formulas. Whilst it doesn’t sound like much as percentage, that equates to anywhere between $20 and $50 million every year that the North Coast region is missing out on.

So if we only got our own fairness and equity within the funding formulas of the health system generally, we would be doing a lot better, and would be able to do a lot better, and would be able to deliver a lot more

efficiency and better healthcare generally for the community.

So we tried to leave those messages, I think the Prime Minister heard them, and Hopefully they are food for thought in considerations about the overhaul health and hospitals reform package.

We are supportive, I think generally, of the reform agenda. We do in this region live and breathe the need for reform within the health system, and

certainly hope from this round of consultations that good decisions are made. Either the Commonwealth playing a greater role, or the Commonwealth forcing and demanding better outcomes through the State and area health service funding formulas.

So, thank you Prime Minister, thank you for visiting our community, and hopefully the rest of the day is as fruitful as the last two hours.

PM: Thanks for that. Over to you folks for any questions.

JOURNALIST: (inaudible). I know that the local Member there has left you with no doubt how the community feels with (inaudible)

PM: Can I just say, our blueprint for the future has been in two parts. First, through the Australian Healthcare Agreement which we signed at the end of last year, a 50 per cent increase in Australian Government funding for the States and Territories for health and hospitals.

Secondly, the internal distribution of that, which has been the subject of some of Rob’s comments just now, has come through the various State and Territory Governments. So that is what has happened so far.

Secondly, the second phase of our reform process is the one we’re here to consult on today. And that is long-term reform. And that also goes to the proper resourcing of hospitals in regional Australia as well, including Port Macquarie.

What’s our timeframe for making those decisions? They’re outlined in the Health Commission’s report, sorry, not in the Health Commission’s report, but in our response to it. We’ll convene a meeting of the States and Territories come the end of this year, and one early part of next year for putting a final proposal to the States and Territories.

So, obviously there are high degrees of local frustration about elements of delivery here. I understand that. All I can say though is that our blueprint for handling the future has been absolutely clear, absolutely upfront. We’ve honoured every element of what we said we would do. And furthermore, we have also provided a 50 per cent increase in funding to all States and Territories as of the end of last year.

JOURNALIST: There’s double the number patients here (inaudible).

PM: I heard that this morning too. 14,030, have I got it right?


PM: I do listen.

JOURNALIST: As you’ve probably also heard, there’s a number of staff cuts that are happening across this area health service. How do the needs here, from other hospitals that you’ve seen around the country, how do our needs really compare here?

PM: Yeah, that’s actually a really good question, because you may be surprised to know that everywhere I go in Australia, nobody tells me their population is shrinking. And nobody tells me their population isn’t ageing, either. So, just in the last few weeks I’ve been to far North Queensland, I’ve been to North Queensland, I’ve been to the northern suburbs of Melbourne, I was at Nepean Hospital in Western Sydney the other day, Lismore yesterday, and here today.

The stories have some common themes, but also some important differences as well.

What are the big drivers? Population is increasing, which means that we, by the time we get to the mid century, are going to have between 25 and 30 million Australians.

Secondly, the population is ageing. The proportion of people who are going to be above 85, or between 65 and 84, is increasing rapidly.

Thirdly, we’ve also got this real challenge in terms of properly planning for our health workforces, there have been some great changes which have occurred here, but there are still challenges in getting enough people to GPs, specialists, cardiologists, as well as surgeons in regional areas.

So in regional Australia there is a common theme that they need to receive more support than they have in the past, and that’s often in areas like this and other parts of Australia where you have a real sea change phenomenon occurring as well. Three patients I saw this morning all told me they came to live here 21 years ago. I presume it wasn’t coordinated. And Fred from Wauchope, and two from elsewhere - what was that town?

OAKESHOTT: Laurieton.

PM: And, these three really good folk, one of whom had a particularly strong view on the future direction of the reforms, symptomatic of what’s happening nationwide. That is a lot of people are reaching the retirement age and going to sea change centres like this. That, therefore, is

something we can either stick our head under the blanket and hope it goes away, or we can address as a nation.

But I say this to every community. If we’re going to embark upon long term reform here, including better resourcing for major regional hospitals like this one, then it will cost, and people need to know that. It’s not just a question of shaking some money tree and hoping that money will fall down. It doesn’t. And therefore we’ve got to reform the healthcare system, provide better healthcare services in critical regions like this where you’ve got such a boost in population. We’re also going to have to find, be very upfront and frank with the Australian people, about the funding of that long term as well.

PM: And, these three really good folk, one of whom had a particularly strong view on the future direction of the reforms, symptomatic of what’s happening nationwide. That is a lot of people are reaching the retirement age and going to sea change centres like this. That, therefore, is something we can either stick our head under the blanket and hope it goes away, or we can address as a nation. But I say this to every community.

If we’re going to embark upon long term reform here, including better resourcing for major regional hospitals like this one, then it will cost, and people need to know that. It’s not just a question of shaking some money tree and hoping that money will fall down- it doesn’t. Therefore we’ve got

to reform the healthcare system, provide better healthcare services in critical regions like this where you’ve got such a boost in population, we’re also going to have to find, be very upfront and frank with the Australian people, about the funding of that long term as well.

JOURNALIST: (inaudible). Do see that by joining with Taree and Kempsey we’re going to have a better chance of getting a federal (inaudible)?

PM: Fools rush in where angels fear to tread -

JOURNALIST: They fly in.

PM: And the particular relationship between Port Macquarie, Taree and Kempsey I will leave to the locals to resolve. What I do know however, in terms of patient transport, and the way in which that’s coordinated within an area health service or coordinated more generally is one of the areas of recommendation in this national report.

People in regional and rural areas obviously do not have the same concentration of medical services as those in the larger cities in the country. Therefore, one of the ways in which you try and offset that is to

have a properly funded patient transport system. The Health Reform Commission is very upfront about the fact that this needs to change for the future, because it’s really stretched and people are finding it very,

very difficult.

Of course, the other part of that, and this is part of the recommendations put to me this morning by many of the health professionals at this hospital, is that the more of the, shall I say, do-able specialisation which can be done and performed here in major regional hospitals reduces the overall patient transport needs to capital cities. But it’s an area of reform, but on the specific application between those three centres, I’ll leave that to be sorted out among the locals.

JOURNALIST: (inaudible) regional airport strategy, I know that Rob Oakeshott is keen to raise that with you. Is that a good idea (inaudible)

PM: My understanding is, this evening when we have Community Cabinet, Albo is here, the Minister for Infrastructure and Transport, and my discussions with him, I think last week in Canberra, was that he intended to meet with all the relevant local authorities on that while he was here for that. So I’ll defer that one to the Transport Minister, but

certainly the more rational use we can make of regional airport services the better, but I’ll defer to his judgement. I am sure Rob, as ever, will be in his ear big time.

JOURNALIST: Do you see a solution to the long-term health care needs of the country in the Federal Government taking over health care?

PM: As you know, we’ve outlined three strategic options, or should I say, the Health Reform Commission has. One is what is called a partial take-over of the system by the Australian Government - all preventative health care going to the Federal Government, all primary health care going to Federal Government, 40 per cent of acute hospital funding going to the Federal Government, 60 per cent to the states, Federal Government will responsible for sub-acute services, Federal Government being responsible for all mental health services, all dental health services and all aged care, as well as person-controlled electronic health records.

Second strategic option is all of the above, plus, over time, in a two-step process, the Australian Government taking responsibility also for the remaining 60 percent of the funding.

Third option, which we described as the Full Monty, is doing everything upfront at once, and that is - you’ve obviously seen the Full Monty, have you?

JOURNALIST: Just hoping I’m not going to see one now.

PM: So am I. I’ve lost my train of thought.

JOURNALIST: The third option.

PM: Is not recommended, neither that nor the one in the Health Commission’s Report by the actual Commissioners themselves, because they believe that if we were to move in that direction, we should do it in a staged way.

The Government has an open mind on which of these strategic options to embrace, and we have deliberately decided to embark upon a process of consulting major regional and metro hospitals like this and other health communities and health professionals to road test these recommendations right across the country. Then, to being to reach conclusions and recommendations that we put to the states and territories in the early part of next year.

That’s our decision-making framework, so that’s why we want to, as I said, road test as much as possible with major regional centres like this.

JOURNALIST: You made the point earlier about ageing and health care going to cost so much over the future - does it concern you about going into so much debt now, at this stage, when it is going to cost us a hell of a lot to deal out ageing population and our health care issues going into

the future?

PM: Well, thing I’d say to you right now that as of the end of the first quarter 2009, Australia had the fastest growing economy in the OECD with the second lowest unemployment of the major advanced economies with the lowest net debt and the lowest deficit of all the major advanced economies, and also the only not to have gone into recession. So, that’s my partial answer to your first point.

The second is, in terms of the long-term needs of the health and hospital system. We’re very clear in our presentations to communities here and elsewhere there are three potential sources of funding for this. One is if the Australian Government tales over responsibility of funding for

particular services from the states, then we’d also take that revenue stream to the states.

Second is, efficiencies in the system. What’s one of the big gaps in system right now? It’s the absence of a person or patient controlled electronic health record, so the systems can’t effectively talk to each other. I was just talking to Kevin the cardiologist a little bit before - not Kevin the Prime Minister, Kevin the cardiologist.

JOURNALIST: Do you earn more than him?

PM: Ask Kevin the cardiologist, mine’s on the public record. But he’s a really good bloke who knows what he’s talking about. But, for example, if you’ve got folk who are making the sea change move from Sydney to here who may have had an emerging cardiac condition, it’s far better to be able to quickly, through electronic data records, immediately transfer all their diagnostics in the flick of a hand than re-diagnose him, because it’s, A hugely expensive, B it wastes time, particularly if something acute is unfolding.

You multiply that across the entire nation. So, one of the efficiencies in the system to be delivered in terms of cost is getting that in place.

The third source of funding is, of course, the Commonwealth’s revenue, and that is why we have decided that we should also ensure that our decision on the future of health and hospital reform is informed by the conclusions and the options put forward by the Henry Commission of inquiry into the future of the taxation system in Australia, which is due by year’s end.

So, we are taking a balanced approach as to how we would, A design the best policy for the health and hospital system for the future and, B how you would best fund it. But we’ll do so always on the basis of a prudent and conservative and cautious approach to the long-term management of the nation’s public finances.

JOURNALIST: Can you tell me, Prime Minister, if you think there’s any benefit in the long-term of actually getting rid of the states all together and going to a two-tier government (inaudible)

PM: That’s a good, provocative question for five to twelve on a Tuesday here in Port Macquarie. First response to that is - by instinct I’m a federalist and I want to make sure the federation works cooperatively. That is why, whether it’s in education, through the Australian School Agreement, Australian Education Agreement which we concluded at the end of last year - large increase in investment in our schools, matched by a whole new set of reporting responsibilities by states for schools, transparent reporting on the performance of individual schools, plus

quality reporting on other aspects of, shall I say, outcomes measures of the education system.

Similarly, with the Australian Healthcare Agreement. Also, we’re doing the same thing in Indigenous policy. We’re also seeking to do the same in areas of climate change and environment policy. So that’s the cooperative framework which we’ve evolved so far. We’ve got this huge program of microeconomic reform and regulatory harmonisation - 27 different areas between the states and Commonwealth at the moment in business regulation large and small. We’re doing all of that cooperatively, so that’s my instinct.

However, if you can’t get there cooperatively in critical areas like health and hospitals long-term, then, as I’ve said constantly, the Commonwealth reserves its right to seek a mandate from the Australian people to move ahead with its reforms, and that has always been my position, but is very much, having gone through a process of consultation first before resorting

to that option second. And I’d much rather solve problems in a practical way along these lines than go more broadly than that in the direction that your question suggested.

JOURNALIST: (inaudible) independent state MP and an independent federal MP. First time we’ve had that. A lot of talk from other major parties that independents aren’t effective. Rob Oakeshott somehow managed to get you here. Do you believe that they do have a role to play in parliament (inaudible)

PM: Oh, I think at various, across Australia, it’s always horses for courses, and my experience of Rob so far is he’s always up front in getting into the ear of federal ministers on x, y and z, a, b and c, and delivering as best he can for his community. And we try and respond on the merits of the argument, and we won’t always agree with everything Rob wants, but we’ll try and deal with him as constrictively as we can and do what we can.

I think I’ve said on a number of occasions before when he’s asked question in the parliament that I take it as a given that he is acting in the best interests of his local community and putting forward proposal x, y and z, a, b and c. So when has asked the other day whether I’d come up, ‘yep, fine, we’ll do that.’

JOURNALIST: (inaudible)

PM: We’ll work our way through all of those things. So I think, in terms of the role of independents, it always depends on how independent MPs, and any member of parliament, conduct themselves to try and work

things out in a practical way. If the policy and the needs of the community comes first and the politics comes last, then we will always work well with individual members.

JOURNALIST: Bringing it back to just to why you are here today, you spent a considerable amount of time chatting to the doctors, more than was on the agenda. Was that-

PM: Oh, I needed a consultation actually (inaudible)

JOURNALIST: Was that because of the huge amount of needs that you’ve seen here or is it because the doctors here are smarter than the average doctor (inaudible) why so long chatting to doctors here in Port Macquarie?

PM: Each of those is a loaded question, which you were all trained to ask in journalism school. No, when I go to a community, I think I stayed longer than I was scheduled to in Lismore yesterday as well. I actually just prefer to let people have a say. I mean the truth is, I will not get

back here for another consultation with this hospital or this community before we reach our decision for the long-term, so I’d much rather let people have a yak.

And if you are, I think you’re not doing your job as Prime Minister if you go through a day and don’t learn something new, and therefore it’s important to listen carefully to what people have got to say and we had a long, long discussion about how things are operating on the ground here in quite a detailed way, so I benefitted from that.

OK, any other questions?

JOURNALIST: (inaudible) domestic violence? (inaudible)

PM: You’re referring to our Member in Tasmania?

This is about Jodie Campbell. Jodie Campbell is a very, very hard-working Member for Bass. She is a very, very good person. I’ve got to know her very well in the period that she’s been in Parliament, and prior to that as well.

The reports obviously, in today’s media are deeply disturbing, and deeply troubling. I spoke to her last night and had a long chat with her. She is in good spirits, despite the great trauma that she’s been through. And I was keen to say to her very clearly that not just myself but all members of the

Parliamentary Labor Party were in complete and absolute support of her at this very, very difficult time.

As you know, this matter is now the subject of a police investigation, so I’m reluctant to comment further on any details concerning it.

I will say this more broadly, though, about domestic violence. Acts of violence against women, in my view, are cowardly acts by men. Acts of violence against women are cowardly acts by men and have no place - no place - in modern Australia.

That’s why I have said, time and time and time and time again, that the only attitude that we can have to this sort of violence is a policy of zero tolerance. And as a nation we need to embrace that.

Okay folks, having said all that, I might zip. Thanks very much