Transcript:     AMA President, Dr Andrew Pesce, with David Speers and panel,  Australian Agenda, SKY News,  Sunday 1 August 2010

[Transcript courtesy of SKY News]

David Speers:  Let’s get back to some policy in this election campaign, if we can, and welcome our next guest, Dr. Andrew Pesce, the President of the Australian Medical Association.  Thank you for joining us. 

Dr. Andrew Pesce:  Thank you, David.

David Speers:  Health hasn’t exactly dominated in this campaign so far, but it’s always listed by voters as the number one issue for them when they’re asked about their priorities.  Why do you think we’re not seeing a great debate over health?

Dr. Andrew Pesce:  There’s been a lot of diversion.  Initially, even in the leaders’ debate, the president of Nauru was discussed more than health policy in Australia, which is an indictment maybe of the opportunities that the debate presents.  But there’s obviously been a focus on these internal political issues.  I think the divisions within a party, they’re always mesmerising in the electorate.

David Speers:  When you look at what the two parties do have on the table so far in terms of health and health reform, we’re yet to hear details really from Tony Abbott in particular on what he has in mind when he talks about local boards running hospitals.  Which side has the better plan for our health system?

Dr. Andrew Pesce:  At this stage there’s a lot more detail from Labor.  You have to remember, they have the advantage, because they had 12 months to progressively announce the health reform agenda that they’d promised over some time.  So there’s been a lot of work done, a lot of consultation, and response to that.  So there has been, with qualification, a comprehensive response from the Government, and now the Labor Party in the election campaign I think probably thinks it’s done enough because of that process to not have to do too much more.

David Speers:  But it’s not a done deal yet, either, is it?

Dr. Andrew Pesce:  It isn’t.  There are still major gaps and major policy announcements that are required, which we haven’t seen.  I think from the Opposition, the Liberals and National parties have chosen to keep a small target.  They’ve made an announcement on governance in the hospitals on the board issue, but there’s still much more detail that needs to be fleshed out on that.

David Speers:  There’s a big mental health policy, though.

Dr. Andrew Pesce:  I was going to say, yes, they’ve made a very, very good and I think, at this stage, a substantially greater commitment to improving funding of mental health, along the lines that a lot of the mental health advocates have been calling for, that goes to supporting community mental health, while still funding inpatient services as required.  So at the moment on that one issue, their mental health announcement seems to have been much more positive, and the Government’s [announcement], which is still much more modest, has been very targeted at very specific small parts like suicide prevention.  Now that’s very important, but between depression and suicide prevention there’s a lot of space that needs to be filled.

David Penberthy:  Doctor, is it frustrating to you, and I imagine to a lot of people who are involved in pressure groups, interest groups, that this election so far, both sides seem to be more interested in stage managing their messages, over-workshopped glib lines, that there’s not more talk about policy?

Dr. Andrew Pesce:  It is, but on the other hand, I must say I spent the last six months encouraging parties to discuss this outside of an election campaign, because I recognised election campaigns are not great forums for policy development and discussion.

David Penberthy:  Seems like you got your wish!

Dr. Andrew Pesce:  Well, that wasn’t what my wish was.  My wish was that both sides would make more announcements ahead of an election campaign, that would allow us, and yes, we’re not the only peak groups who have an interest in health, to sort of talk about it, to feed back, possibly modify it.  Once you announce it in the election campaign, it’s there in stone.  So I think that they’re very, very careful and there is less real discussion of health policy within the context of an election campaign than could happen outside it.  But here we are, and we still have significant holes and gaps.

Matthew Franklin:  Going back to six months ago, how good a job do you think this Government, even though there’s been a significant personnel change at the top, but how good a job do you think the Government did at explaining, say, the health takeover, which is ostensibly the biggest reform since Medicare?

Dr. Andrew Pesce:  I think it was a very hard task to reconcile the public expectation of major reform in the health system with the political realities of the interaction between the Commonwealth Government and State Governments, and the way in which health is divided.  The AMA has always called for a single funding solution to the public hospital system because, until we get that, we will see and we continue to see the ‘blame game’.  I’m now involved in discussions with State health ministers to try and bed down a lot of the detail of the announced intentions of the reform.  There’s still a whole lot between now and December when the IGA, the intergovernmental agreement, and the COAG agreement has to be finalised with all of the plans.  It’s very difficult to reconcile the high public expectations with the very difficult politics of the blame shifting that occurs between the Commonwealth and the States.  I think that there have been some major re-castings, which are very important going forward.  The creation of a national system for quality measurement, so that all the States will be measured by the same yardstick, rather than deciding whether they’re succeeding or failing in their own backyard.  The activity-based funding which, for the first time, has a national approach to say that funding for public hospital services follows clinical activity.  So, if patients choose to go to this hospital, that’s where the funding goes, rather than the hospital being funded historically.  These are actually quite significant reforms, but it is difficult sometimes to see how that fits in with the bigger picture.

David Speers:  We’ve only got 30 seconds left.  A final question?

Jennifer Hewett:  What would you like to see from the Liberals in this campaign?

Dr. Andrew Pesce:  We’d like to see a commitment to increase the number of hospital beds.  So much about emergency department waiting lists focuses on the number of beds and capacity in the system, so we need to see that.  From the Coalition we’d still like to see much more support for general practice in primary care.  We’ve got 27,000 general practitioners out there that are the fundamental lynchpin of the primary care system.  Although that system needs some reform, we need to see finally that our GPs are better supported to be the major deliverers of healthcare in the primary care system, which they are.

David Speers:  We’ll have to leave it there, unfortunately.  Dr Andrew Pesce, thank you very much for joining us with some input on the health front today.  Thanks for that.  And Matthew Franklin from The Australian, David Penberthy from The Punch and Jennifer Hewett from The Australian, thank you for joining us as well.  That’s all for this edition of Australian Agenda.  We’ll see you next time.  For now, I’m David Speers, thanks for your company.