Thank you, Steve so much for that warm, warm welcome.
And first of all, I want to acknowledge that we’re meeting on the traditional lands of the Yagumbeh people and pay my respects to their Elders, past, present and emerging – as Steve and the birthday boy, Hash, have already done.
And can I thank Justine and Coby for that really warm Welcome to Country.
And today of all days, as Steve has said, only the day after receiving that latest confronting, and in ways depressing, report from the Productivity Commission on Closing the Gap data, but also, more hopefully, as Garma Festival gets underway up in the Top End, we recommit ourselves to the work that we in the health sector have to do, perhaps more than any other part of our society, to close the appalling gap in health outcomes, life expectations and life expectancy between Indigenous and non-Indigenous Australians.
Thank you, Steve, for that very kind welcome.
You’re right: it was a shaky start.
But we have developed, I think, a really open and constructive relationship as Health Minister and President of the AMA – two incredibly important positions to which people working in the health sector look to get a sense of how health policy is going in this country.
But people more broadly in the community see the mouthpiece of the AMA President and the way in which they are interacting with governments of the day, but particularly the Commonwealth, as a really important barometer about how things are going in a system that is just so important to every single Australian man, woman and child.
So I’ve really appreciated that.
And I’ve come to know Steve pretty well in the past couple of years, and he really does care very deeply about public health.
And importantly, from my perspective, health reform as well.
And while we haven’t agreed on absolutely everything – and it would be weird, frankly, if the Health Minister and – yes Danielle’s nodding – it would be weird if the Health Minister and the AMA President agreed on absolutely everything.
I think we do share, in so many respects, a vision for what a health system in the 21st century in Australia should look like.
And I have deep, deep respect for the advocacy that he’s shown.
I also want to acknowledge the Vice President and now the President-elect – cleared away all of the candidates, sorted it out, no ballot – Danielle McMullan!
I got to know Danielle very well, too, on the Strengthening Medicare Taskforce.
I thought she was from New South Wales, but Maria Boulton says that they’ve claimed her now as a Queenslander.
Usually you have to live in Queensland for two to three decades at least, as I understand it, to be called a Queenslander.
But Danielle’s managed it in just 18 months, so congratulations on that as well. I know that Danielle will be an outstanding President for the AMA, and I look forward to continuing to build on the constructive relationship I think we’ve developed in that important Taskforce.
The thing is, though, as Steve politely alluded to: when it comes to health reform, the relationship between the AMA and Labor Governments has not historically always been, I think, as constructive as I think it is right now.
In the distant past, as you know as well as I do, anytime that a Labor government has tried to implement a really serious, big reform to health, we’ve generally had to battle with the AMA or its predecessor, the BMA, in doing that.
Whether it was Chifley with the PBS in the 40s, or Whitlam with Medibank in the 70s, or indeed, Hawke’s Medicare in the 1980s.
Indeed, a little bit more than 40 years ago, when Prime Minister Bob Hawke and – I think – the nation’s most outstanding Health Minister in its history, Dr Neal Blewett, were introducing Medicare, the so-called “Doctors’ Dispute” at the time was pretty significant: full page newspapers ads, the threat of a strike in our hospitals, and a direction from the AMA to doctors not to bulk bill.
Dr Blewett was never one to mince words – and I can tell you, as someone who is on the phone to him every now and then, is still not one to mince words – described these as “bully tactics”.
This might surprise you, but I don’t think Dr Blewett was ever invited to address an AMA Conference. Or if he was invited, he didn’t accept the invitation.
Which is why I’m just so grateful that our Government, and I as the Health Minister, don’t have that same combative relationship that, too often, has dogged interactions and engagement between this most important of health organisations and the federal government.
Instead of warring words and ‘press releases at 20 paces’ between the AMA and the government, I come to you today as a partner in reform.
And I’m also really pleased to come to you to say that we’ve achieved a lot together in two short years.
But as the front page of the Australian indicated this morning, we still have so much to do, we really do.
Today I gather is going to see the launch of the second edition of the AMA’s key policy document “Vision for Australia’s Health”. It’s already been previewed in some of the media and it charts a course to what a modern health system will look like.
I’ve only had a chance to look at the key features briefly, but it is clear that there is a hell of a lot of good policy in there, and I’m looking forward to reading it, at length.
And I’m hopeful that it will continue to shape the public debate and the understanding among other leaders of our country, beyond the health portfolio, about what we need to do to continue our performance in health.
Because as your Report points out, as significant as the challenges are that we face, Australians do have a lot to be proud of in our health system.
And Australia’s doctors and nurses and other health professionals have a lot to be proud of.
In the prestigious Commonwealth Fund rankings, Australiaconsistently ranks in the top three for overall health performance of the system.
And importantly, in health care outcomes, we rank number one.
And in health equity, we rank number one as well.
We can put a lot of that down to our universal health insurance system Medicare, particularly when it comes to health equity.
As Steve and I talked about when we were celebrating the 40th birthday of Medicare in February, before the 1st of February 1984, 1 in 7 Australians did not have health insurance coverage.
Before Medicare, before that date, the leading cause of personal bankruptcies in this country was unpaid health and hospital bills.
After the 1st of February , literally within a day, we simply stopped measuring health and hospital bills as a cause of bankruptcy, because it disappeared overnight as a cause. It simply disappeared overnight.
Because the core principle of Medicare was that it didn’t matter what your bank balance or income was, every Australian was entitled to the best possible health care a country as wealthy and as clever as ours could muster.
But almost 40 years on, when we came to government in 2022, it was clear to us and clear to everyone in this room, I know, that Medicare was under very real pressure.
Ten years of cuts and neglect, including a six-year freeze on Medicare rebates, as well as three years of a once-in-a-century pandemic, had left Medicare really struggling and ill-suited to deal with the demographic challenges faced by 21st century Australia.
Almost half of Australians, as you know, now live with at least one chronic disease, and one in five live with two or more diseases.
The sharpest growth, particularly as GPs understand, has been in mental health conditions like anxiety and mood disorders.
And while Australia’s life expectancy is the third longest in the OECD, the past 12 years have barely moved the needle at all.
Twelve years of progress in medicine, in health care, in pharmaceutical technology, delivered a net gain of just an additional two months of good life lived without disability – and that was only for men.
If we are to meet the needs of modern Australia, then we must strengthen Medicare for a patient profile that is really quite profoundly different to the one that Hawke, Blewett and the AMA hand in mind 40 years ago, at the time we were introducing Medicare.
And to do that, we have to work together.
The first step was to begin to address the funding shortfall that was caused by a six-year freeze to the Medicare rebate.
The indexation boost across the board to Medicare rebates that our Government has delivered in the past two years has been historic.
The second biggest increase to the Medicare rebate since Paul Keating was Prime Minister was delivered in this year’s Budget.
And the first biggest was delivered in last year’s Budget.
In just two years we’ve increased the Medicare rebate overall by more than the former government did in nine long years.
That is on top of around $11 billion in new measures to strengthen Medicare across the three Budgets the Treasurer Jim Chalmers has delivered, including obviously the largest investment in bulk billing incentives in the history of Medicare.
Alongside the immediate cash injection, we have also begun the deliberate and the iterative work of reform.
When I was last in the Health Portfolio for four years under Kevin and then Julia Gillard, I remember being in the audience at an AMA Parliamentary Dinner in 2012, when then president Dr Steve Hambleton – who I think is in the room today, or certainly in the corridor, so he might not have come into the room to listen to me, but if you’re here, Steve, welcome.
I remember when Steve – who was also someone who I was so pleased to work with on the Strengthening Medicare Taskforce alongside Danielle – said these words that really stuck with me then and still stick with me today.
He said: “Announcing health reforms is easy. Implementing them is hard work.”
And by Lord, we learned that lesson when we were last in government, because good health reform takes time.
But already in two short years, as a Government and as an organisation and as a sector more broadly, I think we have achieved a lot together.
The Strengthening Medicare Taskforce did help to set the direction for that reform.
Out of it, just as one small example, came the $48 million Chronic Wound Consumables Scheme that the AMA has been advocating for, for a very long time. It will provide fully subsidised wound consumables for people aged 65 and over and for First Nations people 50 and over, who have chronic wound conditions and diabetes.
Greg Hunt promised wound care at the AMA ³Ô¹ÏÍøÕ¾ Conference in 2018.
We actually delivered it in last year’s Budget and the program begins next year.
2018 was also the year that the independent experts at the PBAC first recommended 60-day prescriptions for Australians with a stable, chronic condition.
Yet 60-day were another reform left on the shelf, costing Australians millions of dollars in copayments that they simple didn’t need to pay if the PBAC advice had been followed, harming both their hip pocket obviously, but also their health, given how many Australians we know simply don’t get their script filled because of household affordability.
With your principled support – I have to say – and really strong advocacy for that reform, our government has implemented 60-day scripts, with the final tranche of around 100 medicines joining the 200 already on the 60-day script list, in just a few weeks.
Even now, before it has been fully implemented, and as it is still ramping up, close to nine million prescriptions have already been issued for 60 days, not for 30.
This has saved Australians more than $50 million on their medicines costs, on top of another $400 million saved through other cheaper medicines reforms, like the historic cut to the general patient copayment in January last year.
Then, of course, there is the public health menace that just snuck up on our country and on so many more besides: that of recreational vaping, particularly among young people.
Something that in 2017 Greg declared was – QUOTE – “not going to happen on his watch”.
And I have on many, many occasions acknowledged that – to his credit – Greg Hunt did try to take action on vaping, by putting in place an import control to stop candy and bubblegum flavoured vapes flooding in at the border and onto shelves in shops that are deliberately being set up across the road from, or down the road from, our primary and our high schools.
But Greg was rolled by his Party room, but particularly by the ³Ô¹ÏÍøÕ¾ Party – the only party to still accept donations from the tobacco industry.
And he had to overturn that import ban in just a matter of a few days.
After decades of some of the world’s best tobacco control, reform led in Australia, led by an alliance of public health advocates including the AMA and – it must be said – by Labor Governments, parents, school communities – like the principal that Steve talked about – and policymakers alike could only watch as Big Tobacco had free rein to quite successfully start to hook another generation to nicotine.
With the support and advocacy of the AMA and many other public health groups, we have taken world leading action to stamp out recreational vaping, passing legislation only in recent weeks to outlaw the manufacture, the import, the sale and the supply of all vapes, outside of a therapeutic pharmacy setting.
I really want to acknowledge the AMA’s support on this.
You quite easily could have sat this out or provided some reasonably gentle support.
But your advocacy was full-throated.
And I particularly want to thank Steve for the really enthusiastic, energetic way in which he participated in this – at times – quite difficult public debate.
Since January, already we’ve seized more than 3.5 million vapes at the border, literally taking them out of the hands of Australian children.
And in just the first month of the supply and sale ban, already we are seeing dozens and dozens and dozens of vape shops closing.
Nine out of ten of them was set up down the road of schools.
Not accidentally, quite deliberately, because that was their target market.
Convenience stores that were once flagrantly selling vapes right next to chocolate bars, are now surrendering their stock, under our surrender scheme, to the TGA.
There is more to do. There are still vape stores – I noticed one around the corner from this convention centre when I was walking last night.
There is still more to do on enforcement and on education.
But thanks to the advocacy and support of groups like the AMA, Australia right now finally has the proper legal framework for this product in place.
It’s something that many other countries are looking to, as so often they have in the area of tobacco and nicotine control.
These are just three pieces of health reform that our government has delivered in just two years.
And, I have to say, we could not have done any of them without the advice, the advocacy and the support of Australia’s health practitioners and professionals.
But also: peak bodies. And in particular, I want to say, the support of the AMA.
If we are to strengthen Medicare for the chronic disease and ageing patient profile of the 21st century, then we need to put coordinated multidisciplinary team-based care at the heart of patient care, harnessing the full strengths and skills of the diverse health workforce, including obviously through the leadership of general practitioners.
That is why in the 2023 Budget, we invested close to half a billion dollars to give GPs the support that they need to grow their nursing and allied health teams, by increasing the Workforce Incentive Payment by up to 30% for practices and, for the first time, indexing it.
Smaller practices will be able to draw on $77 million which we have provided to PHN’s to commissioning a range of different supports for GP practices.
In the same vein, in this year’s Budget, we invested $72 million for PHNs to work with GPs to commission mental health nurses, counsellors and social workers to provide ongoing care coordination for people with high mental health needs.
Report after report confirms that GPs increasingly are the frontline for mental health care in Australia, and we’re determined to provide them with the support that they need to deliver that care well.
More than 6,000 practices, or around three-quarters of all general practices, have already registered for MyMedicare, registering 1.4 million of their patients.
We want MyMedicare to become the base upon which we build a stronger and more personalised Medicare, built around multidisciplinary teams that are led by general practice.
We want to strengthen that relationship between individual patients and their general practice.
But we know that to realise this promise, broader MyMedicare funding packages will be needed.
We’re building this – very deliberately – slowly, but steadily.
No one wants another chronic condition pilot that fails to get off the ground – what Grattan Institute described, memorably, as having “more pilots than Qantas”.
So we will monitor and evaluate MyMedicare as we continue to strengthen it.
We want to make sure we have the right value proposition for patients, but importantly, as a value proposition that is compelling to practitioners.
There’s no doubt that our Budget last year, in 2023, with $6 billion in strengthening Medicare, was something of a blockbuster.
But health reform is the work of more than one Budget.
I’ve been around in the health portfolio for long enough to know that if a health reform starts with a bang, it often ends with a whimper.
Reforms like MyMedicare that build multidisciplinary collaboration, not to mention the digital systems that have to underpin them, will take time to develop.
That is as it should be: better to build and build, than have a quick bang that ends with a whimper.
And behind the scenes of this Budget, as I think is pointed out by the coverage of the AMA’s Report in The Australian this morning, a lot of work was underway to secure a new five-year agreement with states and territories for hospital funding.
We want that agreement to be much more than its predecessors – going back to when we were last in government – very technical documents that set out the basis for activity-based funding and how that financing system would work.
We want it to live up to its name and be a genuine ³Ô¹ÏÍøÕ¾ Health Reform Agreement, which takes a whole-of-system perspective, as the former Dep Sec of Health and Secretary of Finance Rosemary Huxtable certainly recommended, in her very fine midterm review of the existing agreement.
The final agreement will deliver further integration of our – too often – fragmented health system: ensuring that hospitals, aged care, disability care and general practices are working much more effectively together to get better outcomes.
The new hospital funding agreement will see more than $13 billion of additional Commonwealth funds – at least – flow to states beyond what they otherwise would have agreed under the existing agreements framework.
While negotiations are currently paused, we look forward to them rapidly progressing, once the NDIS and disability reforms – which are also on the front page of The Australian this morning – finally catch up with the progress we have already made in health.
Two other reforms that have already had an enormous impact in primary care, though, are Medicare Urgent Care Clinics and the tripling of the bulk billing incentive.
We promised 50 Urgent Care Clinics at the last election. We delivered them in the first year, and we delivered 58 of them.
In the May Budget we committed to expand the network to 87 Clinics, to provide that urgent, non-life threatening care that patients need, while taking pressure off our busy emergency departments.
Only a few weeks ago, I announced a second Medicare Urgent Care Clinic for this region in the Gold Coast, given it has the busiest emergency department in the country.
Now I know that our Urgent Care Clinics are a very significant area of health reform on which the AMA and the Government has not really agreed much.
But there have already been more than 600,000 presentations to these clinics, with around a third of visits for patients under the age of 15, and around a third occurring on weekends, often just after weekend sport times, when it can be especially hard to get in to see your usual GP.
When asked, well more than half of the patients that receive treatment at an Urgent Care Clinic tell us that they would’ve gone to a hospital ED, if the clinic was not available to them.
We’re going to fully evaluate the program as it rolls out, of course, but you only have to speak to patients – as I do – as well as to practitioners, even briefly, to recognise that these clinics are making a difference.
I see Urgent Care Clinics as a key part of reforms to primary care.
And importantly, they extend the scope of practice for GPs and contribute to the sustainability of that profession.
They’re open seven days a week, they’re open extended hours, and importantly – for us, particularly – they are fully bulk billed.
Because for Labor, bulk billing is the beating heart of Medicare.
And when we came to government, as you know better than me, it was in very steep decline.
That’s why we tripled the bulk billing incentive for 11 million children under the age of 16, pensioners and concession cardholders on the 1st of November last year – a group that is a minority of the population, but accounts for around 60% of general practice activity.
Since then, there have been an additional three million bulk billed GP visits.
In May alone, there was an additional 900,000 bulk billed visits to the GP.
And in June, another 900,000 additional bulk billed visits.
³Ô¹ÏÍøÕ¾ly, the GP bulk billing rate has grown from a bit over 75% to just under 79% in June.
Encouragingly, the strongest growth has been in the states and regions that have historically had the lowest rates of bulk billing – smaller states like Tasmania have seen the highest rates of bulk billing increase, as well as rural and regional Australia which, as you know, have really struggled in this respect.
We know it is still early days. It isn’t yet clear to me whether or not this is sustained or even if we’re going to see more growth, which is why we will be monitoring this so carefully.
As you know, again, as we’ve been talking about, Steve, quite a bit over the last several months: health systems everywhere are facing a global health workforce crunch that was made significantly worse by three years of a once-in-a-century pandemic.
Thankfully though, record numbers of doctors, nurses and other health professionals are moving to Australia and are working in the Australian health system.
Every single one of the British health ministers – and I’ve spoken to a number of them in two short years – complain to me about the number of NHS doctors and nurses that are coming to Australia.
Around 5,000 doctors from overseas have registered to practice in 10 months of the last financial year – not even a full year.
5,000.
That’s 75% more doctors than registered in the final full year before the COVID pandemic.
75%.
This year’s Budget allocated $90 million to further streamline the process for overseas-trained doctors and health professionals to join the Australian workforce, in line with recommendations from the independent Review overseen by Robyn Kruk.
But we also need to ensure we have the right domestic pipeline.
Which is why we are doing things like investing in GP and Rural Generalist training programs, doubling rural pre-vocational placements in primary care to 1,000, and funding eight new medical school programs in rural communities to support an extra 140 medical students every year.
This includes – finally – a new medical school in Darwin to attract and retain more doctors to meet the specific health care needs in the Top End.
Innovations like the Single Employer Model will attract and retain more doctors in regional and rural areas, by providing GP and RG registrars with guaranteed income and entitlements like annual leave and parental leave while they train.
As we build a strong and sustainable workforce for medical practitioners and the broader heath workforce, we will continue our strong engagement with the AMA, to seek out your advice, your experience and the wisdom of your members about how we deal with these really, really difficult challenges.
The great Dr Sidney Sax, who was arguably Australia’s first health planner, published a book 40 years ago, in Medicare’s birth year, entitled ‘A Strife of Interests’.
He was referring to Ambrose Bierce’s quote about politics generally, which Dr Sax was applying to the politics of health, as being ‘a strife of interests masquerading as a contest of principles’.
That book, not to mention the loud and bruising battle with the AMA at the time, led Neal Blewett to say that “the scope for change and speedy action is always difficult where established interest groups are well entrenched”.
As all of us in this room know, the scope for change is indeed difficult.
As I have often said, health is a sector that is full of well-intentioned stakeholders with loud voices and sharp elbows.
But perhaps now, when the need is greatest, I believe and I hope that we may finally have relegated that “strife of interests” to the pages of history.
When I chaired that Strengthening Medicare Taskforce and spent hours and hours and hours together – didn’t we, Danielle? – I witnessed firsthand remarkable agreement and collaboration amongst Australia’s many and varied health practitioners and peak groups.
As such a significant player, the AMA has played a key role in setting a tone of compromise, of collaboration, and of concern.
Concern obviously for your own professional interests – you’re a members-based organisation, that’s your job – but also, obviously, for the interest of your patients and for the country.
Just as an individual patient’s interests are best served by health practitioners working as a team, so too are the interests of all patients served by the representative bodies of those same practitioners doing the same.
We will need that cooperation in the months and years ahead, particularly as a number of independent reviews near completion and are handed to Government and released publicly, with recommendations that I expect will drive further change.
The Working Better for Medicare review is looking at the levers that we currently have to distribute the workforce across the country, like the Modified Monash Model or Distribution Priority Area, to figure out – frankly – if they’re still fit for purpose.
The Effectiveness Review is looking at general practice incentives, including the PIPs and the SIPs and WIPs, and any other ‘IPs’ that I might have missed.
And the independent Scope of Practice Review is examining how we unleash our workforce to its fullest potential.
As I have said on a number of occasions – at a time when our population is ageing, becoming sicker, and demand for good quality health care is rising, in a way that I don’t think is going to end in any of our careers – it doesn’t make sense not to have every single health care worker working to the fullest extent of their skills and their training, in a properly coordinated way.
I expect to receive, particularly, that scope of practice review in October from Professor Cormack.
Throw in the other two reviews, and we will have before us a series of recommendations on how practitioners are paid for their work, what work they are allowed to perform, and where they are encouraged to work in our big country.
If ever there was a risk that the health sector would fall back into some of those old habits of loud voices and sharp elbows being deployed, of ‘a strife of interests masquerading as a contest of principles’, then these three reviews may well test our collective resolve.
But if we are to strengthen Medicare for the needs of a modern Australia, with very different needs to those that confronted people 40 years ago, then we are going to need to resist that urge.
Just as it has in these past two years that I have had the privilege and honour of working with you, I really hope the AMA will continue to set that tone and leadership of compromise, collaboration, and concern for patient interests.
Let us prove that we need not be bound by some of historical contests, as we strengthen Medicare and reform the health system for the next 40 years.
Thank you very much. I hope you enjoy the rest of your conference and some of the sunshine here in the Gold Coast.
Thank you.
