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Speech to the AMA National Conference, Melbourne

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The traditional custodians of the land on which we meet and pay my respects to their Elders, both past and present Dr Steve Hambleton, President of the AMA Francis Sullivan, Secretary General of the AMA

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

This is my first AMA National Conference, having been Health Minister now for six months.

The AMA has been around for considerably longer than that - 50 years, in fact. Since your inception in 1962, the AMA has been a strong and effective advocate for doctors and, more broadly, Australia’s health system.

I acknowledge the strong role the AMA has played in supporting major public health reforms throughout its history.

For example, we are now implementing world leading reforms to discourage smoking - and the support of medical experts and groups like the AMA has helped to make this happen.

We are making investments to close the life expectancy gap between Indigenous and non-Indigenous Australians - and the advocacy of groups such as the AMA has been important in highlighting this issue.

I also acknowledge your willingness to work with governments to contribute to the debate and to improve health policy outcomes.

Your President, Dr Steve Hambleton, has argued that in hard times it is important for governments to strengthen those parts of the health system that will provide the greatest benefit to patients and the community.

That is a priority shared by the Australian Government.

It’s the priority that has helped to drive national health reform.

And it’s the priority that underpinned the 2012-13 Budget, our next instalment in our investment in health reform.

While many of you may be familiar with some of the headline initiatives, I would like to provide you some insight into our thinking in shaping the health Budget.

In economic circumstances where the Government’s key priority has been a return to surplus, it has been a difficult task to develop the health Budget.

It was a task that we approached thoughtfully, logically and carefully.

It was a task that needed to be informed by broader health priorities: priorities driven by where the greatest need is, and what will provide the greatest benefit.

And in determining our priorities, we have been strongly informed by clinical advice and the evidence of what works.

We have made some important investments in areas where there is clear evidence of clinical need. And in order to make those investments, we have had to reprioritise spending away from areas which are less effective.

I know that there will always be debate about savings measures, but I ask that you look at the broader perspective, at how carefully targeted savings enable us to make some important, evidence based investments to improve the health system.

Bowel cancer

A key example of the Gillard Government’s commitment to evidence-based policy is the expansion of the National Bowel Cancer Screening Program.

The Program will be extended to provide regular five yearly screening for people between 50 and 70 years of age.

And, consistent with the NHMRC guidelines, the program will be further extended in 2017-18, when a phased implementation of biennial screening will commence.

Bowel screening saves lives - screening at regular intervals will pick up around 12,000 positive tests and save between 300 and 500 lives annually.

Dental health

It is a fact - sad but true - that around 400,000 people on public waiting lists, together with a range of people with limited means, have poorer dental health than their fellow Australians.

Not only does this affect their health, poor dental health can also affect people in many other ways: their confidence and ability to get a job, or to engage in many community activities the rest of us take for granted.

In the Budget, the Gillard Government is investing $515 million in foundation measures to support reform of dental care. An estimated 400,000 adults will benefit from a blitz on public dental waiting lists.

This initiative is clearly focused on Australians most in need - lower income Australians who have waited months, possibly years for dental treatment - unlike Mr Abbott’s poorly targeted Chronic Disease Dental Scheme.

The dental workforce will also get a boost with 50 extra voluntary dental graduate placements, and 50 new oral health therapist graduate placements. A new grants program will encourage and help dentists to relocate to regional, rural and remote areas.

In addition, the Gillard Government has allocated $10.5 million for national oral health promotion activities.

The Government has also invested $8.2 million through the Health and Hospitals Fund for projects that will support new dental chairs and mobile dental clinics in regional areas.

New and improved facilities in regional Australia

Many people in rural and regional Australia have poorer access to health services than other Australians. And, unfortunately, this results in poorer health outcomes.

The Gillard Government will seek to address this by building on our record investments in health facilities and buildings.

Those living in rural and regional areas will benefit from 76 new projects under the Health and Hospital Fund, including hospital redevelopments, community health centres, multi-purpose services and dental facilities.

To attract, train and retain permanent health professionals in the bush, accommodation for students and health professionals including locums, will also be built and improved.

I have recently visited a range of project sites across Australia. I visited Yamba NSW, where we are funding a new Community Health Centre that will improve local access to contemporary health care services.

Earlier this month I visited the Royal Flying Doctor Service in Cairns, and travelled with the service to visit remote communities in Western Cape York.

The RFDS will be receiving funding under the Health and Hospital Fund to expand their services. This includes the purchase a mobile dental unit that will provide services to people in remote Australia, who we know currently have inadequate access to oral health care.

I also visited Moruya, Bega and Cooma in Southern NSW where the General

Practice Network has been funded to develop new clinical training facilities. These will be co-located with local hospitals and provide clinical consultation spaces, student clinics, simulated learning labs and residential accommodation for clinical trainees.

These projects are among 76 HHF projects, valued at $475 million, announced in the recent Budget.

These build on the $1.3 billion allocated to 63 regional health projects in last year’s Budget and brings total Health and Hospital Fund investments in improving health facilities to $5 billion.


You probably won’t be surprised that in any one week, one in three Australian GPs see a patient for whom they have no current information. More than one in five GPs face this situation every day.

We know that about two to three per cent of all Australian hospital admissions are medication-related. This represents about 190,000 hospital admissions each year, costing $660 million…of which about 15,000 are due to inadequate patient information

The practical benefits of eHealth are obvious.

As I’ve mentioned before, soon after I became health minister I heard the story of an elderly man who collapsed in a shopping centre. He collapsed from a perfectly preventable interaction between medicines. The incident occurred after the man’s GP, and his specialist, changed his medication independently of each other — without knowing what the other had done.

With eHealth, stories like these will eventually become a thing of the past. Doctors will have access to a patient’s medical information at the click of a button, including medication.

But the eHealth journey isn’t one that’ll be complete overnight. It’s not just a matter of ‘flick a switch’ and away you go.

During the last two years, the Government has been building the foundations for the national eHealth records system. And progress has been strong.

We’ve been working hard to build the essential digital infrastructure - the virtual poles and wires for the national eHealth records system; uniting the common language that will allow the different parts of our health system to talk to each other; connecting up our medical records, and connecting the computers of our hospitals, GPs, specialists and allied health professionals to each other.

Over the last two years, the Government has also provided more than $160 million to general practices across Australia (up to $50,000 per practice) to upgrade their computer systems for eHealth.

Government support has helped more than 96% of Australian practices to get the IT they need for eHealth - more than two times better than practices in the United States. That makes our GP workforce the fifth most computerised in the world.

Now many practices have most of the IT in place, we want to make sure government focuses its investment on the roll-out and take up of the eHealth record.

In the Budget, the Gillard Government is investing $233.7 million to continue the rollout of a national, secure eHealth system.

Once the digital infrastructure is in place, patients will be able to register for their own eHealth record through Medicare shopfronts and over the phone. And mums and dads will be able to register for their kids.

When they’re registered, patients will be able to go online to view their record and add a range of their basic health information. This will include things like emergency contact details, the location of advanced care directives, allergies, and medication.

We’ve always said the rollout of the national eHealth system would be in gradual, carefully managed phases. That is the sensible, responsible way to deliver the reform.

Over time, as patients and doctors register, more detailed and sophisticated features will be available as part of an eHealth record.

Eventually things like immunisation records, Medicare and pharmaceutical benefits information, organ donation details, and hospital discharge papers will be able to be added.

Evidence based savings

As I said at the outset of my speech, we have only been able to make these investments to improve our health system through also making targeted, evidence-based savings.

If I am to convince my Cabinet colleagues to invest in dental health or bowel cancer screening, I also have to show them that we are using every health dollar as efficiently as possible.

For instance, the Government will better target the Private Health Insurance Rebate so that it is paid for insurance products that cover ‘natural therapy’ services only where the Chief Medical Officer concludes they are clinically effective.

This is a sensible, evidence based approach - and I am pleased that AMA President Steve Hambleton has supported this measure.

The Government will also discourage health providers who are using the Extended Medicare Safety Net inappropriately. We will put a cap on selected Medicare items from 1 November this year where excessive fees are being charged or where

Medicare may be being used inappropriately for cosmetic purposes.

Again, this is a carefully designed policy that will only target excessive or inappropriate behaviour, not the vast majority of patients or doctors.

By targeting inappropriate behaviour, we will save the taxpayer money - some $95.2 million over four years - and I would like to acknowledge the medical groups that are supporting this sensible saving.

The Government will also tighten regulations around diagnostic radiology services so that those taking the images hold minimum qualifications. This measure is about improving the safety and quality of care - and it will produce savings of $45.8 million over four years.

Health reform

The Budget should not be seen in isolation but rather as the next instalment in our investment in health reform - and health reform has been strongly focused on delivering a more evidence-based, well-targeted health system.

As many of you would know, the Commonwealth is investing about $20 billion up to 2019-20 to improve public hospital services.

What I would like to highlight today, is how we have targeted that additional funding so that it doesn’t simply arrive as a large cheque with no strings attached to state treasuries.

Rather, it is targeted to encourage better performance and greater efficiency.

Significant funding will be paid to states where they have met targets for elective surgery and emergency department performance. These targets were developed with close consultation with medical experts, chaired by the Chief Medical Officer.

We are also introducing Activity Based Funding from 1 July this year, to ensure all hospitals are paid in the same way, based on the services they actually deliver.

Another key element of our reforms has been increasing transparency and accountability of funding arrangements. As I am sure you are aware, it has been historically difficult to track the flow of funding to the actual services delivered by the states.

The new arrangements will provide unprecedented transparency of Commonwealth and state contributions to our health and hospital system.

All Commonwealth funds for public hospital services will flow through a new Funding Pool, enabling us to track where the funds go, and how they are spent.

All state and territory activity based funding for public hospital services will also flow through the Funding Pool. We will therefore know the relative contributions of the Commonwealth and state governments.

Improved transparency of the performance of services at the local level is another critical element of the reforms. As you know the National Health Performance Authority will use the measures and standards identified in the Performance and Accountability Framework to assess the performance of health and hospital services.

As well as ensuring that innovative and effective practices are shared between Local Hospital Networks and between Medicare Locals, the reports produced by the Authority will help identify those that are under performing to enable effective performance management.

The final plank of the national reforms is safety and quality. The newly formed Australian Commission on Safety and Quality in Health Care is already developing, implementing and monitoring National Clinical Safety and Quality Standards. These standards cover safety, quality and appropriateness of clinical care.

These structural reforms will provide the opportunity for greater clinician engagement in our health and hospital system through new devolved governance structures in local hospital networks and Medicare Locals.

This will put greater control about health care into the hands of the experts - the clinicians who practise in those communities - rather than the bureaucrats.

Together, these reforms will help clinicians do their jobs better, by cutting red tape, reducing pressure on hospitals and promoting best practice.


In conclusion, the recent health Budget and the Government’s health reforms are underpinned by a common philosophy - of improving the health system through drawing on the evidence and the advice of clinical experts, and strengthening transparency and accountability.

This means addressing the gap in our nation’s teeth.

It means better screening for bowel cancer in line with what our medical experts say is the best approach.

It means paying for natural therapy services through private health insurance only when they have been demonstrated to work.

And it means paying for hospital services in a consistent, transparent way, only when we know what services are being delivered.

Delivering an evidence-based, transparent health system is a challenge - but it is a challenge worth grappling with if we are to provide all Australians with high quality care into the future.

It is a challenge which I hope you, as medical experts and clinicians, join me in tackling for the future.

Thank you.