AMA President, Dr Andrew Pesce, Speech to the National Press Club, Wednesday, 21 July 2010
Health Reform Can’t Wait
Good afternoon, ladies and gentlemen.
I acknowledge the traditional owners of the land on which we are meeting today.
The AMA wants health to be the top priority in this election.
Health will make headlines this election – just as it has for the last couple of years with the Government’s reform agenda.
Now is the time for the major parties to make their case for a fresh mandate on health reform.
Labor has indicated its foundations, but much more detail is needed.
The Coalition and minor parties have to lay out how they will improve and develop the health system.
Good health policy wins votes.
Bad health policy can change votes.
In regard to good health policy, the AMA – as always – is here to help.
AMA Family Doctor Week
This week is AMA Family Doctor Week – a week when we salute hardworking family doctors all around Australia.
They are under enormous pressure as they continue to provide high quality care to their patients and their communities.
It is the AMA’s job to ensure that health reform supports family doctors.
Health reform must not threaten them or diminish their role in any way.
This is also the first week of the Federal election campaign.
Today I will launch Key Health Issues for the 2010 Federal Election – the AMA’s health policy wish list.
Health reform
A year ago, I made my first major speech as AMA President here at the National Press Club.
A lot has happened in that year.
I spoke then of the hopes that the AMA had for significant positive health reform.
The Prime Minister of the day, Kevin Rudd, had promised an ambitious agenda of significant change.
His reform plans were based on the work of high profile commissions and committees.
His stated objective was to deliver a health system redesigned to meet the challenges of changing patterns of disease and an ageing population.
To his credit, Kevin Rudd heard and understood the problems caused by the blame game and the disengagement of clinicians in our hospitals.
The stories he heard reflected the daily playing out of the problems in our hospitals and in the broader system that the AMA had described for some time.
The Rudd Government set out to address these problems by committing to centralised funding and devolving management to local hospitals.
The AMA was and is determined to give the Federal Government’s commitment to reform every chance of success.
But our patience is wearing thin.
We are hearing from doctors at the local level that some State Health Departments may be seeking to capture the momentum of the reforms.
That would be a betrayal of the spirit of the COAG agreement.
The COAG agreement is meant to codify the reform plan.
The State Governments have until the end of the year to finalise their implementation of the redesigned financing and governance arrangements.
So where are we now?
Despite the slow pace of change, we have seen some significant commitments already.
There is a commitment to uniform national standards for our hospital system – so we will better compare performance to see what works and what doesn’t.
There is a commitment to activity-based funding as a means to measure what we do and ensure that funding follows patient care.
At the same time, there is recognition that, in rural and remote areas, block funding is necessary to allow smaller hospitals to fulfil their community service obligations.
There is recognition of the importance of supporting training of the future medical workforce, and significant resources have been provided to achieve this.
However, much work still remains to translate funding into quality teaching and ensure that we are able to deliver quality training to our young doctors and nurses.
But we also see areas of significant concern in the reform process.
One State – Western Australia – remains outside the COAG Agreement until disputes about GST funding are resolved.
From our perspective, Western Australians deserve the same per capita investment in health care as all other Australians.
We don’t want to see much-needed national health reform become a political football.
It is fair to say that the States have worked very hard to retain significant control of public hospitals.
To a large extent, it appears they have not acknowledged the need for re-engaging local clinicians in the management of hospitals.
A driving motivation on reform was to re-engage locally, manage locally, and respond locally.
As I said previously, we are hearing that re-engagement at local levels is being overpowered by some State Health Departments.
We see this in their opposition to our local doctors, nurses and allied health clinicians taking their place on governing councils.
Governments entrust the care of our families – their families - to these dedicated professionals.
But these same Governments refuse to allow these trusted clinicians to take their places in the management structures - and decision-making processes - of the hospitals.
The doctors know what works and what doesn’t work.
The doctors know what changes will improve the system and they know what changes will compromise patient care.
Their input is vital.
The AMA urges the States to grasp the opportunity of working with our clinicians to build better hospitals.
If they miss this opportunity, hospital performance will continue to deteriorate, and we will revisit the same problems at our next election.
I am happy to say that the NSW Health Minister, Carmel Tebbutt, has acknowledged the importance of placing local clinicians on governing councils.
We are yet to see the same commitment from other State Health Ministers.
We have heard a lot about health reform activity over the past 12 months.
The Coalition has to date just dipped its toe in the health policy election pool.
In its 12 Point Action Plan, the Coalition says that it will protect private health and improve the public health and hospital system.
By preserving the private health rebate, the Coalition says it will help to take the strain off the public health system and reduce waiting times.
The Coalition says it will introduce local hospital boards staffed by local health experts.
They have indicated that, at this point, the hospital boards will only be in NSW and Queensland, but they may have more to say about that as the campaign unfolds.
On 30 June, the Coalition released its $1.5 billion Real Action Plan for Better Mental Health.
This policy would deliver 20 new Early Psychosis Prevention and Intervention Centres, 60 additional youth headspace sites, and 800 acute and sub-acute early intervention beds.
The AMA and the mental health sector welcomed the policy.
The downside from our perspective is that the policy would be funded in part by money diverted from e-health and GP infrastructure proposals promised by the Government.
The AMA said at the time that we hope to see strong Coalition policies in these areas ahead of the election.
The AMA looks forward to seeing comprehensive health policies from all parties over the coming weeks.
Health reform
Health reform is hard. We have seen that over the last few years.
It is difficult to turn good intentions into nationally agreed and nationally shared programs and services.
Building momentum for change necessarily requires that a case be made for the better.
The Rudd Government said it would end the blame game between the Commonwealth and the States, only to fall well short.
While acknowledging the problem, the Coalition shied away and played a ‘small target’ approach - preferring caution to ambition in the hope that heightened expectations would inevitably fail.
We all need something to strive for to improve our health system.
Elections are about choices.
The type of health system we want is one of those crucial decisions.
The next Government has to turn the promise of health reform into a reality that serves the community well into the future.
That is why this election is so important.
Whoever wins will determine the type of health system we will have for the next decade and beyond.
Whoever wins must have the right health policies.
Doctors are at the coalface of the system and constantly see the impacts of Government decisions.
Doctors know how to make the system work best for patients.
Grassroots doctors and their patients inform AMA health policy.
Our policies give voice to what works best for patients.
Health policies that do not reflect consultation with the medical profession will not work.
The AMA believes that any health system reform should satisfy the following criteria.
It must improve patient care above all else.
It must promote informed patient choice.
It must improve integration across all public and private health services.
It must result in best practice health service provision and health care.
It must significantly reduce levels of bureaucracy, waste and inefficiency in the health system.
It must not allow administration, performance reporting, and accountability to take precedence in terms of time or funding over delivery of patient care.
It must allow decision-making everywhere in the health system to involve input from medical practitioners, with decisions about local health services based on input from local medical practitioners.
It must allow transparent political accountability and responsibility for performance.
It must be affordable for individuals and for the nation.
It must support integrated team-based care led by doctors.
It must not facilitate or promote duplication and fragmentation of patient care.
It must promote continuing improvement of the health system based on evidence.
It must result in a single public funder for public hospitals that has total responsibility for fully funding the public hospital system so we can finally end the blame game.
And it must not disadvantage patients or doctors.
Key Health Issues
The AMA will today present the major political parties with a platform of good health policy.
Key Health Issues for the 2010 Federal Election is the AMA’s wish list of health policies.
Our policies are comprehensive and pragmatic and achievable.
They build on what works and suggest ways to improve what doesn’t.
They take the system forward without disruption.
And they have the added benefit of working well locally.
This is something that aspiring MPs - and aspiring PMs – should work with.
Our policy platform assumes that investing in the health care of the Australian population is not only a social obligation; it is also an investment in the productivity of the nation.
It calls for the political parties to be open and honest with the community.
It calls for them to acknowledge that real progress for the health system requires more than a re-jigging of what we have now to solve the demand pressures and improve access to the services that people need.
For too long, health bureaucracies have not seriously listened to doctors.
Just see how difficult it is to have local doctors appointed to local boards of hospitals.
Too regularly, bureaucrats and others behave as if doctors are ‘part of the problem, not the solution’.
Yet at any genuine community consultation people overwhelmingly call for better access to doctors and for more support for their family doctor.
Our policy platform provides many measures to respond to that call from the community.
Only the AMA can speak independently for better medical services on the ground.
I will now run through the policies that the AMA wants to see implemented by the next Government.
Our Key Health Issues document covers 14 major areas of the health landscape that need reform:
- General Practice;
- More time With the Doctor: Chronic Disease Management;
- Indigenous Health;
- Public Hospitals;
- Health Financing – including dental care;
- Workforce and training;
- Mental Health;
- Aged care;
- Rural Health;
- E-health;
- Priorities for Prevention;
- Climate Change and Health;
- Research; and
- Long-Term Care.
We see these as the priority areas.
We outline the concerns for patients and the concerns for the Government in each area, and we set out AMA solutions for positive reform.
Copies of the document are available here today – and you can read all the detail on all the policies in your own time.
I will concentrate on the issues that tend to take prominence during election campaigns.
The first is not a surprise.
Indigenous Health
Throughout the term of the last Government, it was heartening to see a bipartisan resolve to close the gap on Indigenous disadvantage.
At every election, the AMA calls for more concerted action, in partnership with Indigenous people, to address this national disgrace.
It pains me to have to stand here again today and admit that we still have not done enough.
Our call on all political parties today is to make capacity building a central strategy in ensuring that sustainable health and medical services are a constant feature of Indigenous communities throughout the country.
This means that new models of service delivery and community development need to be deployed.
They must involve Indigenous communities and non-government organisations working together to do what Government bureaucracies have failed to do – across all governments of all political persuasions.
Services must respond to health needs and not be delayed or denied because of State border issues.
This will require cooperation between the Commonwealth and the State and Territory Governments.
In a country as prosperous as Australia, we do not want to see the shameful reality that some Indigenous people are unable to access essential medical care because they live on the wrong side of a State border at the wrong time.
The state of Indigenous health has for too long been our national shame and continues to be a major priority for the AMA.
General Practice
Another priority is ensuring that the front line of primary care – general practice – is properly supported.
I want to be clear today with you.
General practitioners – our family doctors – expected great things from the promise of health reform.
At this stage, those expectations have not been met.
For as long as I can remember, the AMA has been calling for the heavy hand of bureaucracy to be taken off general practice.
We have called for the Medicare patient rebate system to be simplified so that doctors can spend more time with their patients and less time caught up in Government paperwork.
Access to a medical diagnosis from a general practitioner is the starting point, the lynchpin, and the real safety net of our health system.
Recent AMA research involving more than fifteen hundred GP patients confirmed the strong relationship and trust that Australians have with their family doctor.
The research, conducted by Essential Research, showed that 88 per cent of Australians have a usual family doctor to care for them, 78 per cent visit their family doctor more than twice a year, and 83 per cent of people are satisfied or very satisfied with the medical care they receive from their family doctor.
Ninety-four percent of patients believe it is important to have a long-term relationship with the one family doctor who knows their medical history.
Australians clearly want time with their family doctor.
However, the reality for a GP is that they spend nine hours a week on administrative compliance.
For every hour that a family doctor is tied up doing government paperwork, about four patients miss out on getting to see the doctor.
So, as far as we are concerned, time is running out for family medicine.
Bureaucracy is choking doctors’ surgeries.
The real needs of patients are being displaced by unnecessary Government regulation.
This week, Family Doctor Week, the AMA launched a campaign for patients to petition the major parties to properly resource and support their local family doctors.
The intention is to put the focus on general practice – to preserve one of the genuinely locally-responsive parts of the health system.
In a country that values and supports individual choice, ensuring that patients can choose their doctor and see that doctor as often as they need should be a given.
Health policy should not threaten that choice – that right.
This is a challenge for our political parties.
The AMA petition calls for:
- Support for people’s right to choose their family doctor;
- Support for their right to see their family doctor as often as they need to;
- Support for the central role of their family doctor in delivering health care and advice to them and their families;
- Support that will enable them to spend more time with their family doctor when they need it; and
- A cut in red tape to minimise the paperwork and processes that reduce the time that family doctors can spend caring for patients.
In order to achieve this, the next Government will have to deliver proper reform and simplification of the MBS structure.
There must be sufficient indexation of rebates to reflect the actual costs of providing GP services.
Red tape must be slashed.
I note that Health Minister Nicola Roxon made a start this week with changes to the PBS authority prescription process.
We know there is no clinical, safety or economic reason to retain any PBS approval requirements at all in the future.
Rather than roll out more new GP Super Clinics, the next Government must support existing general practices to expand.
Changes should not make it harder for practices to continue to provide after-hours services for their patients or employ practice nurses.
Medicare Locals or any other primary health care organisation must not become the primary care sector’s version of the bureaucracies that have stifled our public hospitals.
We must allow GPs to refer patients directly for MRI scans, and fund point-of-care pathology testing in GP practices.
These measures would significantly support general practice and support quality, cost-effective care.
Chronic care
Most prominent in the primary care reform debate is the need to improve services for people with complex and chronic conditions.
Care for people with diabetes is the issue that has been regularly in the news.
The AMA has a plan that builds on what works when providing this type of care.
The AMA plan has the overwhelming support of GPs.
Our plan calls for patients to have streamlined access to GP-referred allied health services and a range of other support services.
Our plan focuses on the patient’s clinical needs and ensures that more support is available to those patients who need it.
Our plan calls for better subsidies so that patients can more easily access the ‘other than GP’ services they need for the management of their ongoing conditions.
We are not asking for more money for GPs.
Our plan stands in stark contrast to Labor’s diabetes proposal, where patients are asked to forfeit their entitlement to Medicare rebates.
Theirs is a proposal where there is considerable uncertainty about whether patients will always be under the care of their usual family doctor.
The AMA plan extends to all patients identified by their doctor as living with chronic conditions and preserves their right to Medicare entitlements for as many services as they need.
In short, our plan is patient-centred, not budget-driven. And I repeat - we are not asking for more money for GPs.
We have asked Julia Gillard to re-examine the AMA plan if elected, or at least to trial the AMA plan to see which is most effective at providing access to care for Australians suffering a chronic condition.
We urge the Coalition to get behind the AMA plan, which has the support of both doctors and patient groups.
Mental health
In recent weeks and months, much has been said about the unacceptable state of mental health services in Australia.
The AMA has supported the Coalition’s recent announcement and hopes that Labor will likewise address this issue in the campaign.
It is vitally important to understand that mental health reform requires hospital beds, respite services, and better access to specialist medical care in the community, and other social support.
It also requires employment and housing support.
It needs to reflect the regard we have for one another, not treat one group of Australians as second-class citizens, without access to necessary care, and the consequent impact on their education and employment prospects.
The plight of those with mental illness needs to be tackled with as much, if not more, determination than the political parties are putting into the immigration debate, for example.
This is a genuine issue that affects many Australian families on a daily basis.
Aged Care
Another is aged care.
There has not been a concerted effort to improve medical and health care services for the frail elderly.
The aged care debate has too readily been reduced to the issue of the capacity or construction of aged care homes and the number of aged care beds.
We need to look closely at the human dimensions of aged care.
Australia has an ageing population.
More older Australians will be voting in this election than has been the case previously.
Under Medicare, Australians are entitled to access medical care when and where they need it.
Yet, the barriers for aged care residents to receive ongoing quality medical care and medical supervision are enormous.
Despite all the rhetoric, residents in aged care facilities are getting second-rate access to proper medical care.
Recent successive Governments have not been serious about addressing this problem.
It is time to get serious.
Governments cannot always provide for all aged care needs.
But there is no regulatory requirement for nursing homes to provide an acceptable level of medical care for their residents.
This is an area where Governments do have and must have a leading role.
The AMA is calling on political parties to establish a codified standard of medical care for all residents in aged care homes, to monitor aged care providers against this standard, and to provide sufficient funding to cover the costs of doctors providing this care.
Long-term care
I want to quickly mention and applaud the progress towards what we hope will be a universal disability insurance scheme.
The large majority of people with disability have for too long had to negotiate a complex system of fragmented and inadequate support.
Their lives and our community are diminished as a result.
The Parliamentary Secretary for Disabilities, Bill Shorten, has galvanised considerable resolve to address the needs of people with disabilities.
I sense real progress in this area.
Enhancing the autonomy for people living with a disability is as important for our society as it is for the people themselves.
AMA – health policy adviser
The AMA will continue to engage and advise the next Government on sound health policy.
We have the runs on the board.
Over the last term of Government, we contributed to improvements in the National Registration and Accreditation Scheme – but sadly not all our suggestions were taken up.
If anyone was sceptical of the AMA’s concerns, the recent explosion in the costs of the registration system and its failure to accurately and comprehensively register our health professionals demonstrates that bigger is not necessarily better.
Quality is the most important dimension of any system, and Health Ministers don’t always get things right.
We have materially improved the proposals for Medicare audits to allow responsible financial review, while protecting our patients’ privacy and not imposing an unbearable increase in red tape for our doctors.
We have ensured that expansion of access to midwives and nurse practitioners will not fragment patient care, but instead support collaborative care.
We commend Nicola Roxon for her resolve in this area.
The onus is now on us - doctors, nurses and midwives - to use the opportunity to enhance the care for our patients by making collaborative care work, and to work together for the benefit of our patients.
We supported tobacco control measures.
We supported e-health initiatives.
We advised on medical training priorities and were happy to support the medical training announcements.
The AMA participates in many committees and reviews to continually improve our health system.
We engaged with the Government to produce positive reforms and policy that benefits patients.
More than $7 billion of new funding will be pumped into the health system, and that is a very good thing.
It is now up to the AMA and those of us who work in the health system to work with the next Government to ensure that money is invested properly.
We must shape and influence the reforms to get the best results for patients.
There is momentum for productive health reform.
There is goodwill for productive health reform.
Let’s not squander it.
Our hospitals must be fixed. Our health system needs fixing.
We have to fill the gaps – mental health, aged care, dental care, and Indigenous health.
Things cannot stay as they are. No change is not an option. Health reform can’t wait.
We need real action to move forward. To move forward, we need real action.
21 July 2010
CONTACT: John Flannery 02 6270 5477 / 0419 494 761
Geraldine Kurukchi 02 6270 5467 / 0427 209 753
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