April 13, 2022


MARY GEARIN, HOST: We're joined now by Mark Butler, the Shadow Minister for Health and Ageing. Thank you very much for joining me. 


GEARIN: Is it a reheated old Rudd policy?

BUTLER: I don't think Greg has read it very closely because what we've clearly said is this is not a program to build a series of new clinics. This is a program to tap into the existing GP practice network and in some cases, maybe community health centres, which are well known to people in Victoria, and use their skills, use their resources, to deliver this enhanced urgent care Service. So we're not building a series of new clinics, we're going to provide resources to existing GP practices, who want to take their practice to the next level and provide this really important level of what I described as intermediate care, something between your standard GP practice on the one hand, and your typical hospital emergency department on the other. 

This is a model that works really well in countries overseas, New Zealand is probably the best practice example. As a result of having this urgent care service available to people who don't then need to go to hospital. Their level of emergency department presentation is the lowest in the developed world, which obviously has a whole lot of benefits for the system.

GEARIN: There was some analysis today from Dr Stephen Duckett, who's a former Health Department Secretary, he’s an economist, and he said, yes, there is some evidence from New Zealand that urgent care clinics like this do reduce emergency department presentations, but it's not going to fix the entire problem. He says the issue for emergency departments is it's not just these patients who are taking up beds. The AMA has said that this policy only tinkers around the edges. Does this go far enough as a health solution?

BUTLER: I don’t pretend any single solution is going to deal with the enormous pressure on our hospital system. We know across the country, just how overburdened our hospitals are at the moment. In many ways our local emergency departments are the lightning rod for every other failing in the health system. It's never been harder to see a GP than it is right now. It's never been more expensive because of ten years of cuts and neglect to Medicare.

GEARIN: Pardon me for interrupting, will you give the hospital system more funding too?

BUTLER: The hospital system is subject to an existing five-year agreement that all of the states and territories in the Commonwealth signed a couple of years ago. That runs till 2025. There are obviously some separate arrangements in place to deal with COVID issues, which are important as well. But right now the best thing that Commonwealth Government can do to relieve pressure on hospitals, is to strengthen Medicare. To ensure that people are able to see a doctor as easily and as cheaply as possible because if they can't they always end up in an emergency department. That also means fixing the crisis in aged care so we don't see as many older Australians removed from aged care facilities because there aren't the staff there to care for them, and put into hospitals in some cases for weeks, or even months. So Stephen Duckett is spot on, there are a range of measures that are needed to address really several years of cuts and neglect to the aged care and Medicare systems from this Government.

GEARIN: I hear what you're saying in terms of aged care and the GPs and so forth and all of this does seem to come back for so many experts to hospital system capacity. You talk about a five-year agreement though. Are there going to be no more promises in the next five or six weeks that would be Labor saying that actually we will be chucking in more, we will change that agreement, we can and should bolster the hospital system from the Commonwealth Government perspective?

BUTLER: We've got a range of commitments still to roll out in our health policy area all focused on strengthening Medicare, taking pressure off the hospital system, making it easier to see a doctor. This is a really important measure we've announced today. There are 4 million presentations to hospital emergency departments every year, which are described by the hospital systems as either 'non-urgent' or 'semi-urgent'. Many of them could be dealt with, quite often appropriately, in care settings outside of a hospital if those settings existed. And today's announcement is about giving people a choice. Instead of going to the hospital, taking their kid who's fallen off a skateboard or busted their arm, to a service that's free of charge, open seven days a week, staffed by specialised training doctors and nurses and open well into the evenings. This is an important measure to take pressure off hospitals, and ensure hospitals are doing what they're built for, which is dealing with those once in a lifetime emergencies like heart attacks and strokes and very serious car accidents.

GEARIN: You're listening to Mark Butler, Shadow Minister for Health and Ageing. Do these clinics depend on more migrant workers coming in as well? You're talking about them being all staffed but we've already got such an overstretched system?

BUTLER: There’s no question, we really do have a challenge in terms of getting enough GPs now and particularly into the future. The most startling statistic I think I've heard over the last four months is, the College of GPs tells me, only 15 per cent of medical graduates are intending to go into general practice. That's an enormous drop in the traditional number, which is over 50 per cent. So I'm very worried about our ability to get enough GPs into the system to make sure that people can see a doctor when they need. 

GEARIN: So what will Labor be doing about that? 

BUTLER: We’ll have a range of things to say about our approach to GP training. But one of the things that we know, and this is an issue in aged care as well, is you've got to support a system, you've got to pay a system respect and put the resources into it, if people are going to want to work there. So we think this is a really important model to bolster general practice, to bolster primary care, make general practice a more attractive place to work for medical graduates. It's the sort of thing that's going to improve our ability to attract and keep the young medical graduates that traditionally have gone into general practice.

GEARIN: But will it rely on getting more skilled migrants coming in? Will this plan rely on that in short term? I mean, you're not going to be able to retrain, there'll be sort of a drip feed, will you will you need to get people from overseas?

BUTLER: No, I don't think particularly that we will in this area. This is 50 services across the country. The number of general practitioners or doctors working this will run to the you know, maybe some hundreds of general practitioners, in a group of you know, 25 or 30,000 around the country. In some regional areas they might be able to attract overseas trained doctors under existing systems. 

As for nurses, I know talking to nurses groups, that there are a number of our 400,000 nurses across the country who'd love to work in primary care. In these sorts of services outside of the hospital system. It’s exciting work. It's interesting work. We think this is a model that's going to improve the ability to bring doctors and nurses into primary care, after 10 years of cuts and neglect, and really running down of the system by the Morison Government.

GEARIN: Mark Butler, the Greens announced a policy today to give free dental care. What do you think of that policy? Will you match that?

BUTLER: Well, of course, this is a policy from a party that's never going to have to actually deliver a policy.

GEARIN: Has it got no merit?

BUTLER: We've had a long standing commitment as a Labor Party to try and bring more dental care into the Medicare system. It’s the one part of the body that's not covered by Medicare. When we were last in government, we put in place a measure that does provide Medicare funded services for children of working families, of lower-middle income families. That's had a huge impact on that cohort right now that is going to pay dividends for decades. We have a long standing commitment to that. We're going to have more to say about our health policy. But these sorts of policies by minor parties, like the Greens, they never actually have to deliver them and make the budget add up, I give it some passing interest but not much more than that.

GEARIN: Mark Butler, Adam Bandt did come up with a line that I suspect might be envied now by your party, “Google it, mate.” Would you see this as a turning point in the dance between politicians and media and those gotcha moments? Or do you expect the next one to come around the corner?

BUTLER: Gotcha politics is deeply ingrained in the media in my long experience of it. I don't expect the gotcha questions from our good friends in the media are going disappear anytime soon.

GEARIN: Do you think that Adam Bandt should have been able to get the, I think it was the wage price index definition, up off the top of his head?

BUTLER: Look, there's any number of statistics that that you know can be asked by journalists. All of us make mistakes about numbers. Adam is a person who cares deeply about his country and thinks deeply about policy. I think everyone in the Parliament does. I don't agree with everyone in the Parliament but we all do our best to think carefully about policy, whether that's wages policy, or health policy. And, you know, all of us make mistakes from time to time about these numbers. The trick is to own up to them, to take responsibility and to move on.

GEARIN: Mark Butler, thank you for joining us today.