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SATURDAY, 31 JULY 2021
Thank you so much for the invitation to be with you this Saturday morning.
At the outset, before I move to talk about the role your organisation and its members are playing, I’d like to pay credit to the work of Greg Hunt. I’ve worked with Greg over a number of different portfolios, over many years. While obviously I would prefer that there was a Labor Government in power right now - and while it's no secret we've certainly got some quarrels with the Prime Minister about the quality of his work this year - when I look across the aisle in Parliament there is no person I would rather see as the Health Minister from the Government benches. Greg is hardworking, he's intelligent, he's experienced and he has really worked his guts out over the last 18 months. He's been very generous with the offer of briefings from the CMO, from the heads of department and from the various other advisory groups that are guiding our response through this pandemic. So I do want to pay credit to the work that Greg does, in spite of our often substantial political differences and reasonable debates about how best to deal not only with the pandemic but with the other health challenges facing this country.
Can I also thank members of the AMA for the work that you do on the front line every single day. I want to particularly thank the AMA for its advocacy, notably the President Omar Khorshid and Vice President Chris Moy, a fellow South Australian. I know this advocacy is sometimes not easy. It's a pretty contested and fast-moving environment, particularly in a pandemic. But it’s an incredibly important role that the AMA has played over the last 18 months. The work of your President and Vice President has been a real credit to the profession.
I was a member of the health portfolio under Kevin Rudd and then under Julia Gillard for four years, appointed around the day that Christine Bennett delivered her Health and Hospitals Reform Commission report back in 2009. I held a number of different roles in that portfolio while Nicola Roxon was the Health Minister and then Tanya Plibersek. I'm absolutely delighted, after eight years experiencing the joys of climate and energy policy, to be back in the health portfolio.
After spending six months casting an eye across this portfolio, it seems to me that some things have changed for the better, some things have changed for the worse and, I have to say, there is a depressing number of long term challenges in healthcare that remain stubbornly unresolved. I hope I'll get a chance over the course of my remarks this morning to say a few things about some of those ongoing challenges.
On COVID, I think it's fair to say that Australians feel that Australia is in a very disappointing position right now - particularly given how magnificently the Australian people, healthcare professionals and governments at a number of different levels performed over the course of 2020 in the face of that first challenge of suppressing the virus throughout our community.
I think Australians feel that Australia entered 2021 better placed than perhaps any other nation, certainly any other nation to which we usually compare ourselves. And we should have been able to lead the world as well through this second phase of the fight against this pandemic - the vaccination phase. But that phase required the Prime Minister to do two jobs. I think you may have heard me say over the last few months that it's been very disappointing that he has failed on both.
This year’s poor performance, although I don’t intend to go into it in detail, essentially stems from some poor decision-making and complacency on the part of the Federal Government last year, when decisions needed to be made to set us up for this vaccination phase. We’ve heard revelations over the course of this week that there was a deliberate “wait and see” strategy on vaccine procurement decided upon within the Department, while the rest of the world's nations, certainly those to which we usually compare ourselves, were racing to sign deals with companies like Pfizer for early vaccine supply.
And the ongoing reliance on a system of quarantine in hotels that were built for tourists, not for medical quarantine, as a wholesale, long-term response is simply unsustainable. Time and time again, we see leaks from the hotel quarantine system causing the sorts of outbreaks that drive lockdown after lockdown.
I think we were all pleased that yesterday the National Cabinet decided in principle on a four phase plan that will start to see us move towards something like life returning to normal - over a still to be decided timeframe. Labor intends to take a constructive approach to this. This is an incredibly important development for the nation with so many millions of Australians yet again living in lockdown - a particularly important moment to lift the nation’s spirit that there will actually be light at the end of the tunnel.
But again, I do call on the Prime Minister to release the modelling that apparently has driven the key elements of the plan that was decided upon in principle yesterday - both the Doherty Institute modelling and Treasury’s economic modelling. If we’re going to get to a plan which has the broadest possible political and community support, and I think that's something we all want to see, then we need that detail. And we deserve that detail. Because, according to the documents I've been able to read this morning at least, there are still very important questions that are fundamental to the success of this plan.
Are those the right vaccination targets - 70 and 80 per cent of the eligible population? The Grattan Institute modelling that was released over the last 48 hours suggests it needs to be more like 80 per cent of the whole population, not just the population aged over 16. The Grattan Institute’s central transmissibility scenario suggests 70 per cent of the whole population vaccinated would see about 27,000 daily cases, more than 4,000 people in the ICU at the peak, and as many as 6,000 deaths. The targets that were released last night would see only somewhere between 56 and 64 per cent of the total population vaccinated before we start to move to those 3rd and 4th phases of lifting restrictions, assuming eligibility remains tied to age 16 .
We also need to know what the plan is for under 16 year-olds. As you know, a week or so ago the TGA approved the Pfizer vaccine for 12 to 15 year-olds. I know there's been a substantial discussion, as there should be, within your organisation about what to do with younger Australians. We're already seeing clinical trials underway in the US on children under the age of 12. This is a critical issue, as we see through the Sydney outbreak younger and younger people being infected with COVID with 200 cases already in children aged nine years or under in the current outbreak.
It’s also important that we know whether there are discrete targets for older Australians, the most vulnerable age cohort. In the UK, well more than 95 per cent of over 70s in that country are fully vaccinated.
So again I say, we want a full debate about this. There is no more important decision for the country right now than getting this plan right. But we all deserve to see the modelling that grounded the discussion and in-principle decision by the National Cabinet yesterday.
Then we are going to have a complex discussion in the community about the risk appetite for the potential of more cases, more hospitalisations, and more deaths as restrictions ease. We are seeing that play out in the United Kingdom. It will undoubtedly play out in a number of other countries. We can learn from that, as we move forward into the process of setting a clear, well-informed and science-based plan. I'm sure the AMA intends to be a central participant in that as well.
On broader health policy, I’ve developed two very deep impressions about what's happening in healthcare as I've been able to engage with health professionals, with patient groups and move around the country. Those two deepest impressions are, firstly, the parlous state of general practice and, secondly, the depth of the crisis in aged care.
Now, that's not to say that there aren't many other substantial pressures on the healthcare system. The ramping rates and other pressures on our hospitals is something like I've not seen since the latter part of the first decade of this century. Mental health is still a very substantial concern in our community and part of the reason for the pressure on emergency departments - a pressure that's simply not being dealt with where it should be, as your members well understand.
I heard Greg talk about the importance of the sustainability of private health insurance. That is obviously a key pressure on our healthcare system, and leading to very heavily contested positions about solutions to that sustainability challenge - for example, debates about reform of the prosthesis list. And I've noted the position that the AMA has taken on the review that's currently taking place.
And, against all of those challenges, you've got the background of the inexorable rise in complexity of healthcare demands, particularly the increasing incidence of complex chronic disease and the impacts of population ageing. Now, time won’t allow me to address all of those challenges. I want to indicate, though, that they're very apparent to me. I know they're important to the AMA. I look forward over coming months as we develop our election platform to engaging with your organisation about possible solutions that should be part of an election that I think will be more focused on healthcare than perhaps any in our living memory.
I did say that I was particularly alarmed about general practice and aged care. At the heart of the parlous state of general practice is very substantial financial pressure, much of which has been aggravated by the freeze on the MBS rebate over the last several years. I know that freeze has thankfully been lifted, but it is baked into the system and results in an ongoing reduction or cut of more than $500 million every year in MBS funding that otherwise would be there if the MBS rebates had not been frozen.
There is also a crisis in the GP workforce. Now, this is a recurring theme right through the healthcare system - I still think that the abolition of Health Workforce Australia was a deep mistake by Tony Abbott when he came to Government. But as you know, it is particularly acute in general practice with the interest among medical graduates in training in general practice in freefall - down as I understand it to as low as 14 or 15 per cent of medical graduates choosing that career path. The Modified Monash Model has exacerbated very deep supply problems that we have in some of the regional parts of Australia, as well as some outer suburbs that were previously classed as districts of workforce shortage. These general practice issues, I can tell you, are at the top of my list of things that I think we need to be focusing on.
I'm also very keen to engage the AMA more deeply about aged care. I had the privilege of being the Minister for Ageing when the last very substantial reforms to the aged care system took place. Martin Laverty, your Chief Executive, was a key player in that as he led the Catholic Healthcare system at the time. Those reforms were intended to be a foundational set of changes that would lead to an ongoing reform process through the course of the last decade. That's why we built in a legislated review five years after the 2012 reforms. David Tune, a very highly respected public servant, undertook that review - but, unfortunately, none of his recommendations were taken up. Instead, we saw large Budget cuts that weren't distributed elsewhere through the aged care system but, instead, were returned to Budget - a $2.5 billion cut in 2016 and 2017, when the current Prime Minister was Treasurer. Those cuts drove a system that was already under serious pressure to the point of crisis that we saw played out so vividly in the Royal Commission.
The window to act on aged care is starting to close. That's why, 10 years ago, we set up that long term reform process - not only to deliver the sort of care and support to older Australians right now that they deserve and have earned over a lifetime of building this community - but, also to make sure we are ready by the time of a very big demographic shift when the oldest of the baby boomers start to need homecare, and then move into residential care. I have to say, I'm sure all of you agree, the system currently is nowhere near ready for that challenge.
The Budget funds into aged care were no doubt welcome, but there are still very substantial gaps in the Government’s response to the Royal Commission. There was nothing to address the substantial wages gap for aged care workers when compared, for example, to the acute sector. There was nothing, or not enough at least, to deal with the recommendations from the Royal Commission around staffing ratios. Only the first phase of staffing ratios was picked up by the Government and that was deferred by quite a substantial period of time. We think there needs to be more accountability by providers for the additional money, frankly all of the money, but particularly the additional money that they received from the Budget – the increase in the basic daily fee of $10. I look forward over the coming months to engaging with the AMA along with all of the other substantial groups who are involved in the aged care sector about a better response in the lead up to the election.
We have a great health care system in this country. It won't be a particular surprise to you that the Labor Party takes great pride in the fact that the key pillars of that system - Medicare, the PBS, public hospital funding - were pillars put in place by Labor governments. But we can't take the greatness of Australia’s health care system for granted. It must be dynamic, because the needs of patients are dynamic. Technology and models of care are dynamic. And government policy settings and funding arrangements must also be dynamic.
Thank you again for the invitation to speak with you today. I wish you all the very best for your conference and thank you so much for the important work that your members do, day in and day out.