AMA National Conference - President's Address - Hobart

The President's report is meant to capture the last 12 months and deliver the current setting.... difficult in some 10 minutes.

It has been a busy and crucial year from an internal perspective with restructuring the AMA, building better communications and relationships with our essential State and Territory AMA's, appointing a new Sec Gen and so on.

From a broader perspective it has been a year with the first 5 months leading up to a Federal Election, and subsequently dealing with a new government with new directions, philosophies and ideology... and wanting to make its mark and contain costs.

The AMA held health as a focus leading up to the election, and certainly health is a major focus of the new Federal government and COAG.

In October 2007 the AMA released its Public Hospital Report Card.

This put clearly the picture of public hospital occupancy rates running consistently way over safe occupancy of 85%, sometimes up to 110% along with wait list data and the inability to fulfil clinically appropriate waiting times.

We called for more beds. A conservative estimate based on State and Territory needs of some 3750 beds across the country to attempt to meet patient needs and ease bed block and emergency department pressures.

The call for beds continues to be ignored in the belief that "health reform" will keep people out of hospitals.

"Health reform" is in fact the "catch cry" and "commissions, task forces and committees" have been developed to review existing systems and consider change implementation.

I understand that in the department of health there is a "coordination taskforce" to assist with "all these" measures.

The AMA and doctors are NOT AFRAID of change when it is for the better of our patients. But, reform just for the sake of change or with hidden agendas will be exposed by the AMA, also WITHOUT FEAR.

It is clear that with the projected reforms emerging, every craft group and every patient will be affected.

Reform has to be doctor-driven; patient-centred. Not dominated by political ideologies and bureaucratic arrangements.

It is up to the AMA to stand in defence of patient care. To be well informed; and inform well, others in the health arena. To put forward our options, lead the debate and declare when we see a policy that is harmful to the standards and quality of patient care in this country.

With your help and your work at the coalface, the AMA will continue to do this work in what will be the busiest and most difficult of times.

It is our connection with patients and the delivery of care, which gives us a unique understanding of what is needed.

The AMA had for a long time pointed to the doctor shortage. A product of previous government's policy to contain costs by controlling doctor numbers in spite of increasing patient need.

At last we have double the number of Australian trained medical graduates being delivered into the work force by 2012, with increasing numbers along the way. These young doctors will provide valuable service to patients and to the system, from graduation and while they are training.

The drought is being broken, but this government and COAG now have a "health work force" reform agenda which is about blurring the quality of care that patients will receive by blurring the expertise of health workers.

It seems that a "good health experience for a patient is more important than the clinical outcome."

We do not deny that patients need to be empowered.

That patients must have choice, and information. But as doctors we have an ethical duty to respect the patient and understand that they can be and are vulnerable when they are seeking health care. They may be sick, or afraid, they trust, they seek information;

We must make sure that they are not "conned" into false reassurance or exploited with anxiety in their encounters with "other health providers". This will be costly in dollar terms and in health outcomes.

Australia can afford to deliver the best quality and standard of health care to Australians. Australians should be able to access doctors.

Also, the principle underpinning the COAG proposal for National Registration and Accreditation in the IGA is " to deal with work force shortages " and that is not just about the portability concept that The AMA advocates.

We support a system of Medical Registration to facilitate doctors working from State to State, but COAG's concept of "portability" is task substitution.

COAG's concept of National Registration is for control of accreditation and standards in a work force agenda.

Last year, we stopped John Howard from signing the IGA, knowing that we had only put it off to live to fight it another day.

This year, the AMA flanked with the Colleges had the courage to stand alone on the principles of independence of accreditation for the medical profession to maintain standards and quality and safety of patient care, as well as international recognition of our medical training.

Nowhere in the western world do governments set standardsin accreditation and training.

That has always been - and always should be - a role for the Colleges.

Those standards have been, and should be, independently assessed by a body such as the Australian Medical Council.

We will continue to influence this process of National Registration and maintain the independence of the AMC and the role of the Colleges.

We have established a task force specifically focussed on National Registration and Accreditation to work with the implementation so that it delivers what we believe is best for the future.

We must "hold the fort" of the doctor workforce till our younger colleagues swell the ranks, and we must ensure that they have high quality training and valuable employment.... not just for their sake, but also for our patients.

Task referral or delegation and doctor led patient care is not new to us... we do it every day when we work with our nurses, refer to allied health providers, discuss with the pharmacist and consult our colleagues. The "team" is a reality, and we can work it efficiently without compromise of care.

Preventative medicine is not a new revelation, and an investment in it is welcome. Prevention is a responsibility of primary and secondary medical care, and also of government and public health campaigns.

We as doctors will do what we can in patient care to avoid "clinically inappropriate" emergency department presentations or hospital admissions if and where they exist.

Give us access to the resources to enable this, BUT do not believe that all can be solved without more public hospital beds and investment in human and capital infrastructure.

The very fact that we recognise the growth in population, in longevity and age, and in obesity and chronic disease, means that that government MUST acknowledge the need for greater evidence based investment in health.

When a patient needs to be in hospital we are not going to tell them to go home and hope for the best.

We're going to send them to hospital.

In the budget over all health funding was relatively spared... there was a paring of some programs that was disappointing and painful.

Negative impact on prevocational GP places, a sideswipe again at pathology, and absolute absence of significant care about rural medicine..... These amongst others all hurt.

BUT the biggest blow is the impact that the change in Medicare Surcharge Levy threshold will have on Private Health Insurance rates and subsequently back on the public hospitals.

I fear the damage has been done. The message is out to many Australians that it is ok to drop private cover.

Even the "young and healthy" will create demand and this group "makes babies" so that public maternity services will be hit.

The snowball begins; with a smaller insured pool premiums will rise, the price will become more unaffordable to those who currently save to have the security of private cover. They too will fall out and into the public sector... with even greater and more recurrent needs than the "young and healthy".

Private health insurers will introduce managed care in order to hold premiums to a marketable level. ..... I do not need to go on.

This issue is another that is front and central to the AMA right now and for the future.

Indigenous health has finally achieved a new respect after the previous governments NT initiative. This has been strongly followed by the Rudd Government with the apology and the Closing the Gap commitment.

The AMA has been in front leading, and behind pushing... and we now need to ensure the delivery in better health outcomes for our indigenous people.

The AMA Indigenous Health Report Card will be launched soon and it focuses on indigenous children and the discrepancies in their outcomes. It is a multi factorial equation involving families, communities, education, nutrition, employment, public health issues such as smoking, housing and all the elements of medical care that need to appropriately accessed and delivered.

So many already do and have done precious work in the area of indigenous health and we must recognise these successes and build on them.

The AMA has made a submission on "GP Super Clinics" and we will discuss them further tomorrow in the policy session.

Now, correct me if I'm wrong, but I thought the government was supposed to be about encouraging more GPs to set up shop in the community - not about pricing them out of the market.

We continue to fend off fund holding agendas and the "measure and share" concepts where money for patient care is siphoned into beaurocratic empires with perverse drivers intervening in the doctor patient relationship.

The profession needs to be distinct and stand on the ethical responsibility of the doctor to the patient. The AMA needs to uphold professionalism, and we, as individuals need to continue to live it.

Professionalism, flanked by our knowledge and skill, is the cornerstone of the trust in the doctor patient relationship.

The message to Government is that the AMA will engage, will inform, will work positively but will stand firm when it must.

This National Conference is about the collective voice of the profession.

The government must listen and follow our lead.

ENDS