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Dr Kerryn Phelps, AMA President, with Jeremy Cordeaux, Radio 5DN

CORDEAUX: The Australian Medical Association yesterday released a report on the major parties health policies. It shows that while neither side is allocating enough funding for health, would it be possible that anybody could, huh? The Labor Party is slightly ahead in front because of a better on-going vision for reform, however President Kerryn Phelps says that even then their costings are not specific enough. She also criticises the Coalition for sticking to its past policies, which are clearly failed in certain areas. They've had some difficult times in the area of aged care, which we have touched on and no doubt we will continue to touch on. We'll see what she has to say. Doctor, how are you?

PHELPS: Good morning, Jeremy.

CORDEAUX: I really should be coming to see you for a prescription, or perhaps even a needle. But never mind.

PHELPS: Oh, you poor thing.

CORDEAUX: Yeah.

PHELPS: What's wrong?

CORDEAUX: Oh, let me see your beside manner. No, I've got the flu.

PHELPS: Oh, there's still a bit of that going around at the moment.

CORDEAUX: Have you ever noticed that men always get the flu and women get colds?

PHELPS: I think that's a very interesting study for someone's PhD.

CORDEAUX: Yeah. Now the policies. My observation is that neither could really ever spend enough money to satisfy everybody, and particularly the doctors and the health care workers. But what, essentially, is the difference between the two policies?

PHELPS: Well, I think you have to look at it really on an issue by issue basis. And I guess if we start with where there are no differences between the two parties. The areas where there are no differences would be the Medicare Benefits Schedule, with neither side really, I think, demonstrating a clear commitment to Medicare. Both sides know that Medicare rebates have to be increased to keep patient gaps down, and particularly to protect disadvantaged patients, but both sides at this stage are turning a blind eye. I think it's a big missed opportunity at this election for the two sides to actually display a clear difference.

CORDEAUX: What do you think the Medicare levy should be?

PHELPS: It's not really a matter of the levy. I think, you know, everybody knows that the levy is nowhere near going to pay for the health costs of the country. I mean…

CORDEAUX: Well, it doesn't even go to health care costs, does it?

PHELPS: No. It's just an extra tax and it's called the Medicare Levy and it's, you know, one per cent and it really doesn't go anywhere near covering the cost of health care. It just sort of, you know, goes in to consolidated revenue and gets spent on everything else. The other area where there's really no difference between the two parties is the area of private health insurance. Both have a commitment to keep the 30 per cent rebate on hospital tables and ancillary cover, and so those are two areas where they're pretty much the same. And one other area is medical indemnity. Both sides have now recognised the need for some changes to medical indemnity insurance, because we are fast heading towards a very big brick wall on medical indemnity. And the whole system is going to come collapsing down around our ears on this unless there's some urgent national leadership on that issue.

CORDEAUX: Well, what can you do when people are free to go to the courts and the courts are free to dole out telephone numbers to people?

PHELPS:: I think it's a very very difficult situation. And the problem is that it's only the people who can actually afford to go through the expense of an adversarial legal system who get any compensation, no matter what the worthiness of their case is.

CORDEAUX: Well, let's make you the Health Minister for a minute. How would you fix that up?

PHELPS: Please, don't. Well, I think that we need to pursue the Australian Health Ministers' Advisory Council's work, which is looking at a national approach to this whole problem. It will require reform of the laws that deal with medical negligence actions. It will require, I think, things like the New South Wales Government has brought in, in terms of mandatory mediation in cases, so that patients can understand if things went wrong why they went wrong. And I do think that we need to look at a national scheme that will look after the long term care costs of people who are catastrophically injured, without them having to go through years in expensive court costs and legal costs. And, you know, there are a number of areas that I think that we need to look at. We need to make sure that expert witnesses are engaged by the courts and not employed by one side or the other. And I think that we need to have judges who are virtually specialists in the area.

CORDEAUX: Yeah. Yeah. Doctor, I don't mean to be glib, but what's wrong with all of this, to me, is that it is not a health policy it's a sickness policy. We don't have a health minister, we have a sickness minister. Why isn't more money - why don't we put more resources to keeping people healthy? Why don't we put a fence at the top of the cliff instead of the ambulance at the bottom?

PHELPS: Well, I think we have to do both because there are still people who are going to jump over the fence. And they're the people who don't have healthy lifestyles for one reason or the other.

CORDEAUX: But surely there's a penalty that goes along with jumping over the fence?

PHELPS: I don't think we should adopt a punitive attitude to health care. And while it's all well and good to say that we should be looking at prevention, we are doing that more and more. But there are still people who require acute hospital care and the truth is that people are going to hospital for shorter times. They're being discharged quicker and sicker, and that a lot of the load for that is going on to the community services like general practitioners who have inadequate support in the community and for the work that they're doing. And if we actually look at the differences in policies between the two, the Coalition has really been relying on its track record for public hospital funding. And claim the GST will provide the greater funding capacity for the States with time. But that, of course, will take quite some time to come into play.

On the other hand, Labor has pledged an extra $545 million over four years, but most of that's concentrated in the fourth year when we will be past the next election. So that's a concern. But one of the other things that can be done to try and sort out the mismanagement of the health system, and that is to sort out who's responsible at Commonwealth and State levels for what. Labor's proposed a Medicare alliance. We have had sort of virtual silence on the topic from the Coalition saying what they would do to ensure that the States meet certain benchmarks for the public hospital spending and for care in those hospitals. And we do need to have, I believe, a culture of excellence continuing in our public hospitals. And they can't do that without adequate funding. We will fall behind the rest of the world, and that would be tragic. And we're also seeing, because of inadequate funding in the public sector, people of great talent who are leaving the public sector and going and working in the private sector.

CORDEAUX: Looking around the world, Doctor, do you see anybody getting it right or getting it better than we have got it at the moment?

PHELPS: I think Australia has the foundation for the best system in the world. I really do. I think that the foundation stones here and the philosophy of our health system, if it's properly funded, is pretty hard to beat. And, frankly, I think if there was a system that was working brilliantly, then other countries would adopt it. There is a lot of things said about France's health system, and I don't know that that would translate exactly to Australia, but they certainly are not afraid of spending a lot of health. And I don't think Australians should be either, because if you spend a lot on health in your country then you reap benefits in terms of improved productivity and quality of life.

CORDEAUX: But if we had a two-pronged attack that maybe went along the lines of we've got certainly resources that we can put to health care, now we will do that. But we will also try and have fewer people going in to avail themselves of that health care. Because I get the feeling that an awful lot of the problems we end up on hospital with are avoidable and they're lifestyle problems.

PHELPS: I think that's important, and we do need to look at education of the public and encouragement, as much as possible. I don't think punitive measures, so that if for example you say, 'Okay, you're a smoker so you get on the back of the queue for heart surgery or the back of the queue for vascular surgery or whatever because you brought it on yourself.' Or, you know, 'we're not going to fast track your lung cancer radiotherapy because, you know, you did it to yourself.' I don't think that any compassionate society would agree to that kind of measure. I think what we need to do it to encourage people, as much as possible, to do the best they can for their health. Given that not everybody will have the education to be able to do that. A lot of people are, for example, culturally would need to have a major cultural shift to change the way they eat. To change their exercise habits. But all those things, I think, need to be encouraged. We need to encourage people to have regular check ups, women should be regularly having their pap smears so that we don't have women dying unnecessarily of cervical cancer. Now, when you're talking about these preventive measures, the specialists in preventive care are general practitioners, because that's what we do every day. And I mean general practitioners are so well placed if, for example, someone like you comes in to the surgery and says, 'Look, I've got a cold or flu and that's what I'm here for', you take the opportunity, in general practice, to take someone's blood pressure. To talk to them about whether they smoke, how much they drink, or how well they eat, because all of these issues impact on health. And if you support general practice in being able to spend time with patients and to concentrate on this sort of preventive medicine, then I think that we will reap benefits not only for individuals in the community but for the system as a whole.

CORDEAUX: Now, the point you make here is that GPs have been largely ignored by both sides, and yet, as you rightly say, they're the front line of defence?

PHELPS: That's right. Both sides have paid lip service to support for general practice and for Medicare, but neither is really prepared to put their money where their mouth is at this stage. And frankly it does take money. The Medicare Benefits Schedule has been eroded over the last 25 years, and the general practitioner rebates have really fallen further and further behind. So what we are going to see, and are increasingly seeing in communities all over the country - and I've no doubt many of your listeners will be observing this - is that bulk billing is disappearing. We will see, I think after this election, a significant decline in the percentage of services bulk billed in general practice. Because people - doctors are saying that they aren't able to support Medicare through their own practices any longer and that patients are going to have to pay an increment that will be over and above their rebate so that general practice can work in the quality way that it ought to be able to work.

CORDEAUX: Doctor, I need to take a break. Would you mind staying on the line?

PHELPS: Okay.

CORDEAUX: Have you got the time to do that?

PHELPS: Yes, for sure.

CORDEAUX: And on the World Wide Web, my special guest is Dr Kerryn Phelps who is the President of the AMA. Doctor, thanks for waiting.

PHELPS: My pleasure.

CORDEAUX: Now tell me about aged care. The policy or the side of politics that has the best, in your opinion, solution.

PHELPS: Well aged care was a bit of a late starter in the election campaign but one that I highlighted in my Press club speech in July as one that was going to be very important to the community at this election and beyond. And I think that we really need to be planning now for the next couple of generations ahead because the way that aged care facilities are planned and the way that aged care itself in the community is planned over the next generation or two will have a great bearing on how the current crop of people in middle age will be faring in their old age. And I think it is high time that we really placed a great deal of emphasis on what happens in a humanitarian and a compassionate sense in aged care. And I do welcome the emphasis that the Coalition is now placing on community-based aged care. But you have to make sure that that is not at the expense of adequate residential aged care facilities for people with high care needs. We have assessed the aged care policies of both the Coalition and the ALP and I have to say that in terms of the overall picture, the ALP's policy seems to have got most of the directions in the right place. Most of the priority is correct because they have been listening to the major lobby groups in aged care.

CORDEAUX: Both the policies have been costed by Treasury, have they, at this stage?

PHELPS: We have seen some costings. We're concerned about the costings for both sides at this stage because…

CORDEAUX: What, too low?

PHELPS: Well yes, the announcement of 30,000 beds by June 2006 by the Coalition does seem to be quite ambitious and it would be interesting to see how that costing ultimately comes out. But we do need to see a real concentration on not just the number of beds and the amount of money going in to aged care but the way aged care facilities are designed and built. And the AMA has been working with a National Aged Care Alliance which are representatives of the major aged care groups in the country. And there is very much a united, co-ordinated effort of everybody in the aged care sector to look for solution that will serve us into the next couple of generations. And I think that it would certainly serve whoever is the next Aged Care Minister very well to work with that group to make sure that everybody is really working towards the same objective and that the expertise in that group is well utilised.

But I think anybody who has tried to get an elderly relative into a satisfactory aged care facility will know how hard it is. And it's very frustrating and people are constantly writing to me at the AMA and some of their stories that they're telling are just heart-breaking, of trying to find the most appropriate type of care and having difficulty finding it.

CORDEAUX: Well did you see the ad in The Age today placed by Mary Wilkinson's daughter. She says in part here, 'My frail 91-year-old mother's death from brain injuries sustained in one of Australia's federally accredited aged care institutions is not merely an incident; it is a national disgrace.' Apparently she suffered from dementia and she was bashed by, allegedly bashed by another patient, a male, who was also suffering from dementia and the grieving family have decided to make it very personal and political by taking out a full page advertisement in The Age. Now it's a terrible thing that that kind of thing can happen. But it strikes me that what can you do? Tragedies and accidents and incidents like this, regrettable and all as they are, do happen.

PHELPS: Look they do, and I don't think any person or Minister or institution can necessarily be held accountable for such a terrible incident happening. But what we do need to look at is what level of skilled staffing that we have in aged care facilities, what level of supervision there is; how well the facility is for example designed for people with dementia. Because people with dementia do require quite special attention and special, I suppose, architectural planning to make sure that these sorts of things, the risk of these sorts of things happening is minimised.

CORDEAUX: Would you say that putting an elderly 91-year-old woman in a ward with men who are similarly disturbed and impaired, would you say that was reckless or negligent or just common practice?

PHELPS: I don't know the actual details of that case, to be honest. I don't know whether they would have been in the same ward or just in the same facility and I don't know what the exact situation…

CORDEAUX: No, I can't glean…

PHELPS: …was so I can't really comment.

CORDEAUX: …I can't glean from the advertisement what the situation there was.

PHELPS: But there is a lot of grief and a lot of frustration by relatives about how best to care for their elderly relatives. And I think a lot of the burden does tend to fall on the females of the family to be the carers. But we also have the situation where there are elderly couples trying to look after each other where one of them is less able than the other. And that can become a tremendous strain and that's where I think the community aged care packages that have been announced by the Coalition for this election are going to be very useful, provided that there are sufficient of them to meet the need.

CORDEAUX: Doctor, good to talk to you. Thank you. I suppose you're looking forward to working one way or another with a new Minister?

PHELPS: I am. I am. We're looking forward to establishing a relationship with a new Health Minister. That is the one certainty before we get to this election, that there will be a new Health Minister before the end of the year. So, we have a great deal of positive and constructive work to do with the new Health Minister for the benefit of the Australian health system.

CORDEAUX: Thanks, doctor.

PHELPS: Thank you, Jeremy.

CORDEAUX: 'Bye.

PHELPS: Cheers.

Ends

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