Dr Kerryn Phelps, AMA President, Meet The Press, Channel Ten

KNIGHT: Your truce with the Health Minister hasn't come easily, a lot of water under the bridge, a lot of personal insults between the two of you. How would you describe your relationship at the moment with such a bitter foundation?

PHELPS: It's far better than it was before. It had reached a ridiculous level where the AMA was being excluded from all discussions to do with health policy and you just can't really, as a Government, run a health policy without consulting the nation's doctors.

KNIGHT: Has it reached a point where it's actually progressing? Or has there been an erosion of the good will that was agreed to at that famous lunch which we saw so publicly?

PHELPS: There's still a fair bit of negotiating going on behind the scenes. But I have to say that the relationship is far better and we're also speaking on a regular basis to other ministers and also to the department of the PM and the cabinet to ensure that all MPs who have any input into the health policy debate are well informed.

KNIGHT: The wheels are pretty shaky, though. We have seen already Michael Wooldridge criticising your Victorian AMA president over anti-cholesterol drugs - the same issue that started the entire feud between the two of you - Is the problem with Michael Wooldridge himself? Or do you think that he's getting the wrong advice?

PHELPS: It may be a combination. I certainly think that the Minister expresses frustration in the ways that we've seen publicly and that's a shame. I'd like to think that we can have a relationship that is far more constructive than it has been and in order to do that you have to stay on the issue and not try and attack the person.

KNIGHT: There has been some suggestion that he is having problems within his own department in terms of communication, and that is affecting your relationship and the way that you two deal with each other professionally. Is that the case?

PHELPS: We've certainly had a lot of problems with the Department being quite obstructionist in some areas and that could well be a problem too that there might be an issue of communication between the Minister and the Department with the department running a certain agenda and I don't think it's suited some people in the Department for the AMA to be back in the game.

KNIGHT: Are there specific areas in the Department which you are having more problems with than others?

PHELPS: Seems to be a general problem at the moment. But we are working on that and we are making some progress. And it's very important for the Government to keep on top of the Department's agenda, rather than the other way around.

KNIGHT: Well the PM, obviously, wants to patch things up between you. He did intervene very publicly to get you two on speaking terms. You hadn't been speaking for about four months before that. After that meeting, John Howard said that the AMA and the Government shared a lot of common ground on health policy. Do you think that was a bit more optimism than realism overstating the commonality between the two groups?

PHELPS: No, that actually was quite realistic. The areas where there were concerns were areas that we can work on. But there are some areas where we really do have quite different opinions And that is in areas like, what are called blended payments where doctors are not remunerated on a fee-for-service basis where they provide a service and receive a fee from a patient which is rebated by Medicare or by the private health insurance funds and moving more towards a kind of flaming hoops approach where doctors are expected to jump through various hoops to access government funding through Medicare particularly in the case of general practice. And GPs have a real problem with that particular form of funding. It does create difficulties for doctors.

KNIGHT: Well, we'll have to flesh out that funding issue a bit later. But social policy is also something there seems to be a stark contrast between the Government and the AMA. Issues such as an Aboriginal treaty, which you've bought into, IVF for same-sex couples, a lot of issues where there is a real difference. Is there a risk that you as AMA leader might be taking what is traditionally a right-leaning organisation too far to the left?

PHELPS: Well, I have to say that the issue, for example, of a treaty for indigenous people between the indigenous people and the Government was discussed at the last Federal Council meeting and was passed unanimously. So, it's the entire Federal Council who are making these decisions. And, as their spokesperson, I articulate those decisions to the public. So, no, I'm not taking a traditionally right-leaning organisation and pulling it to the left. I'm articulating where the medical profession is at. And the medical profession has a long history of very strong social conscience. And the sorts of issues and policies that we are coming up with at the moment are really not out of line with previous AMA policy, it's just that perhaps they're getting a little more air than they might have had before.

KNIGHT: Now, in terms of relationships, there's a real possibility that you might be dealing with a Beazley government either next year or even earlier. What's your relationship with Kim Beazley, and the Labor Party, and his health spokesperson, Jenny Macklin?

PHELPS: We have regular meetings with Jenny Macklin I have met at some length with Kim Beazley and plan to meet again soon. I've also met the Shadow Treasurer, the Assistant Shadow Treasurer, all of the Labor backbenchers I've met with on various occasions. But I have a similar kind of communication with the Coalition backbenchers who are interested in health as well.

KNIGHT: So is it a better relationship than with the Liberal Party?

PHELPS: No, I would say that we have a very constructive relationship with both sides of government. That's very important. It doesn't matter which party is in power, which party is in opposition. Any person who is an MP or a senator who has responsibility for legislation which is going to be affecting the health of Australians needs to be very well informed about how that legislation might affect the people who are at the grass roots level. That is doctors, nurses, health care workers and patients.

KNIGHT: Well, your role is to inform your members as well. In this election year, what will you be advising your members in terms of support of parties? Who will you be advising them to vote for?

PHELPS: We're not a politically-partisan organisation. What we will be doing is looking at the issues, issue by issue And making sure that our members are very well informed, also, about where the AMA stands on policy. Giving them an opportunity to give feedback. And we have already established an extensive network of doctors around the country who will be visiting MPs and prospective MPs in the lead-up to the next election to make sure that they also know exactly where the medical profession stands on these things.

KNIGHT: So with the election campaign, will you be shying away from a party-based campaign? Will you not be doing a partisan electioneering-based strategy?

PHELPS: Yes, I think that's very important that the AMA is not a political partisan organisation. We stick to the issues, we make sure that the public is well informed and that's an incredibly critical part of the communication strategy of the medical profession because people need to know what policies are likely to affect them. And inform their voting at the next election. We can't say, "vote for one party or another." But what we can say is "this policy makes sense, and this policy is not as good as that."

KNIGHT: And just quickly on the issue of aspirations and ambitions, I suppose, nothing like an election year to focus on that. Will you be following the lead of former AMA presidents and perhaps enter a career in politics?

PHELPS: Obviously that issue is raised all the time. And it's very flattering, I suppose, when people do raise that issue. But no, I'm really very much focused on being the president of the Federal AMA and I don't have any ambitions politically beyond that.

KNIGHT: OK, time for a break. When we return with the panel - good medicine or playing with human life? We'll look at the controversial issues of heroin trials and human cloning.

KNIGHT: You're on Meet the Press with the AMA president Kerryn Phelps and welcome to the panel John Kerin from the 'Australian' newspaper and Brian Toohey from the 'Sun Herald'. US President George W. Bush this week did what's described as his most difficult decision so far in office, allowing limited research into embryonic stem cells, John Kerin.

JOHN KERIN, THE 'AUSTRALIAN': Dr Phelps, if I can just ask you, has the American President got the balance right in weighing up the medical advances versus the ethical issues with his decision on cloning and stem cell research? And is it a precedent for Australia to follow, how does it effect us?

PHELPS: I think it's a very difficult decision because there's always a balance between what we know might be able to be achieved by stem cell research balanced against the very real ethical concerns about the production of embryos for the purpose of stem cell research, and I think Mr Bush has taken a middle of the road approach to try to reach a compromise and that is to use embryos that have already been produced and to allow stem cell research on the stem cell lines that have already been produced from those embryos that are now long gone. I think that through that research, we may well be able to find directions for the future.

KERIN: We have an Italian scientist saying this week or talking about cloning the first human being in some year's time but beginning that pioneering work later this year. Should the public be alarmed or get involved in the debate at this stage?

PHELPS: The public should absolutely be involved in this debate. It effects the future of humanity as we know it and the AMA at this stage is opposed to the cloning of individuals. We have to distinguish that from the cloning of cells for harvesting for the possibility, in the future, of cures for things like spinal cord injury, Alzheimer's Disease, dementia and we do have the hope for cures for diseases such as these through stem cell research and through cloning technology. In terms of creating an individual cloned from an existing person, the AMA does have serious ethical concerns about that.

BRIAN TOOHEY, THE 'SUN HERALD': On another topic. The AMA supports trials for the legalised prescription of heroin. Why doesn't the AMA support the legalised prescription of cannabis for pain relief?

PHELPS: It is AMA policy to have cannabis for medical purposes and has been for some time. We also think the prescription of heroin in certain circumstances is a possible option for the future for the management of people who have maybe tried a number of different types of treatments for their heroin addiction and simply can't get off the heroin. Methadone hasn't worked, buprenorphine hasn't worked, other treatments have not worked. The main problem that these people have is getting hold of that heroin and the implications of illicit supply.

KNIGHT: Surely heroin isn't going to be a magic bullet either. There are different treatment options that work for different individuals. Surely you can't rule out methadone and other options and say prescribed heroin will be a better answer.

PHELPS: Absolutely. What we are talking about is not closing the door on any option. If prescribed heroin is an option, and it looks very promising from European work, then I think we should look at that as an option to people who are not successful on other forms of treatment.

KERIN: What do you say to John Howard who says this won't happen while I'm PM?

PHELPS: I think that's a regrettable statement. I would hope the Coalition and the PM would reconsider that because what we're really saying is that this is something that could work, it may well work, it's been proven to work in overseas trials. What that statement's saying is we're closing the door on that option. I would like to see the Coalition and the Opposition have a look at this as a possibility. What we're talking about is a trial. When you are talking about a prescribed heroin trial, we need to say, where would science be if we didn't investigate, if we didn't have trials. If it doesn't work, fine, then we know it's not a particular path to go down.

KNIGHT: The same can be applied to the issue of human cloning. This Italian doctor is saying we need to experiment, we need to go down that issue of trials and experimentation. Why is it right for heroin and not right for human cloning?

PHELPS: In respect to prescribed heroin trials, people are already using heroin people who have been using it for some time have been unable top get off it using other types of methods. We have a human life that is in desperate trouble with heroin addiction and we need to pull out all stops to try and figure out a way of improving the quality of life and increasing the length of life of that person. We know we can do it and we know that purified, prescribed heroin is a much better option than what people can buy in the street which is cut with God knows what chemicals and injected under all sorts of different circumstances - not knowing the dose, the risk of overdose, the risk of contamination, the risk of infection and the risk of breaking the law to get the heroin. Prescribed, purified heroin of a known dose with supervised counselling and medical treatment is, we believe, one option in managing that problem. It's a totally different situation to looking at the production of a new human being where we don't know what problems the cloning technology might create for that human being. They're already seeing problems with Dolly, the cloned sheep, with uncontrolled obesity. We're seeing other problems with cloned mammals and why do we want to transpose those problems into humans when we don't know what problems we're going to saddle ourselves with maybe for generations to come for those individuals when they are produced. Quite different than cloning technology for cells where you might be creating an organ for transplant.

TOOHEY: Another area where the AMA differs from the PM is on access for same sex couples for IVF treatment. What's the basis of the AMA's stand on that issue?

PHELPS: The basis of the AMA's stand is that it should be an issue that's non-discriminatory. That you don't say that this particular couple of people would make better parents because of their sexuality, because of their marital status. What we're saying is that if this particular technology is available to the Australian taxpayer, then all taxpayers should have access to it.

KERIN: On another issue. Doctor Philip Nitschke is talking about a suicide pill that should be available to teenagers. You've campaigned very strongly - in fact made an announcement a couple of weeks ago on teenage depression and youth health issues - what's your view on that?

PHELPS: The statements made about a suicide pill being made available to teenagers completely misses the point. If we have young people who are so desperate about their life circumstances at this present time that they want to end their lives, then what we should be doing is looking at the cause of the problem, which is the society, the family that they happen to be in, the fact that they can't get the counselling that they need to get through the problems that they're currently facing so that they can see a future. Maybe the issue is that they don't believe they can get a job, they don't believe they have a future. It could be a whole range of issues that can be dealt with with appropriate social support, community support and counselling. Giving access to a pill so that person can end their life because it's difficult right now is hardly the way to go and it just defies common sense.

KNIGHT: Time for another break. When we return with Meet the Press - are doctors contributing to the crisis in aged care?

KNIGHT: You're on Meet the Press. The closure this week of a Victorian nursing home after reports of horrific conditions has again focused debate on funding for aged care. Brian Toohey.

TOOHEY: If current trends continue, a consulting firm, Access Economics, has estimated that three decades from now, the cost of aged care will add about $45 billion to Government budgets in today's dollars. It's a massive increase. Who do you think should pay for this? Should the aged themselves pay more, or should the burden go on taxpayers in a shrinking workforce?

PHELPS: It is a difficult issue but it is one we must grapple with right now because I think we now have to be planning for 50 years ahead. It's no good planning just for one election cycle, we have to be planning for a life cycle. And we need to be looking at the issue of aged care for the next generation. Now, how that's paid for, is really of question and certainly, there needs to be a combination of people being able and assisted, perhaps, to plan for their own retirement and aged care and the taxpayer having to contribute as well. Because if we have, as I believe we have in Australia, a compassionate society, then we do need to take responsibility for our least able.

TOOHEY: What about doctors exercising more restraints on the costs by not being so willing to prescribe whatever is the latest and most expensive, but possibly only marginally better drug, which is being pedalled by the pharmaceutical companies which take doctors on overseas holidays and all the rest of it?

PHELPS: Well, I haven't been on an overseas holiday and I don't know any GPs who have at the expense of a drug company.

TOOHEY: Well some do and some go to very fancy conferences and are put up in fancy hotels and so forth.

PHELPS: I think we need to look, on that particular issue, the contribution of pharmaceutical companies to the continuing medical education of doctors. And that there is a very constructive contribution by the pharmaceutical companies there. A lot of the time, the reporting focuses on things like conferences and so forth, where there is sponsorship by pharmaceutical companies. But, at the end of the day, doctors make up their own minds based on evidence, what they're going to prescribe. Now, if you're looking at the latest and greatest clearly, if, say, you have a medical condition, and the doctor says to you, well they've got this medication here, but there is this improvement with this medication - it's a bit more expensive, which one do you want to have? Now, are you going to say, well, I'll have the one that's not so good because it's cheaper, or no, I want the best one? That's the dilemma that doctors are facing all the time with their individual patients, and saying, this particular one might give you these side effects, and this one, they say, is not going to. And so, what we try and do is the best for our patients. What does need to happen is a rethink of the Pharmaceutical Benefits Scheme just to see what, perhaps, can be done to ensure that it is affordable into the future.

KERIN: Dr Phelps, the Aged Care Minister announced 500 extra places to take pressure off public hospitals with aged care patients, residents being housed in hospitals. Is that enough, in your view?

PHELPS: It's nowhere near enough. In Victoria alone, there are enough people waiting in acute care hospitals for beds in aged care facilities to fill an entire major teaching hospital. That's the level of the problem with older people waiting in inappropriate facilities in acute care beds. We need to see a lot more funding for places. This is a really difficult issue because the amount of funding available per person is not enough for the aged care facilities to provide quality care and so those places are not actually being taken up because the aged care facilities are saying they can't actually provide that care and make a profit by taking up those packages. So, we actually need to look at the amount per person that is provided for these packages.

KNIGHT: Is there enough care actually being given by GPs to nursing home residents?

PHELPS: GPs are doing the best they can but it's extremely difficult. There's a lot of what we call non face-to-face time with nursing home patients, where you're on the phone to nursing staff, you're co-ordinating with pharmacists and community health services and hospitals and that work's not paid for at all. And when you actually go to the nursing home, you have to leave your surgery. You're actually, basically doing that service at a loss if you're accepting Medicare as the payment because most of the older people in nursing homes don't have the means to be able to pay then doctors feel a conscience about charging them any more than Medicare which is inadequate to cover the cost of providing the visit. So, the issue of remuneration for visiting nursing homes is, I think, one of the impediments to GPs visiting the nursing homes. We need to look at this whole issue again and make sure it is worth GP's while to be able to go there and that they do have appropriate levels of community support to be able to help them in that work. We also need to look at nursing staff levels in the aged care facilities because by the time you go there and you have to track down the nursing sister who might be the only one on that shift, who's running around trying to do everything that they need to do. You've already blown 15-20 minutes trying to find the nurse and the patient and the notes - there are a lot of problems with aged care that we are trying our best to try and deal with. We do have an aged care summit which the AMA will be hosting in October which will bring together all of the major players in aged care to try and address some of these issues.

KERIN: Just on the topic of public hospital funding, there's a nursing crisis in Victorian public hospitals at the moment. Is that, from you point of view, a symptom of the under funding that goes on? Or is it your concern for patient welfare?

PHELPS: I am very concerned with patient welfare with the nursing workforce shortage. The AMA is 100% behind what the nurses in Victoria are saying. We're hearing the same thing from all of the other States, so it's not isolated to Victoria. I actually met this week with the Australian Nursing Federation and we have a large number of policies that we will be working on together between now and the next election. And one of those issues is the nursing workforce shortage. It's affecting the quality of care that doctors are able to provide in hospitals. And it's affecting the care the patients are able to receive when they are in hospital and in a very vulnerable situation. And the fact that there is a shortage of nurses working in the system, is one of the reasons why they are losing nurses from the system. Because the ones that are there are having to work harder and under more difficult conditions. The Nursing Federation says there are enough trained nurses in the community - they're just not working in nursing. And so we have to address that issue of conditions, remuneration and staffing levels to attract nurses back in.

TOOHEY: You keep talking about funding, much of it comes from Governments. But do doctors, and does the AMA support cuts to the top marginal tax rate which will make it harder to fund these things?

PHELPS: I think we always have to have a balance between taxes paid and the way they are spent. I'd certainly like to see more efficiencies in some areas of Government, where I think there are some obvious areas of waste. And that money, I think, could be better spent in the public hospital system and in supporting the health system. We also, I think, need to as a community, if we are seeing our taxes well spent, health is a very good area to spend it well.

KNIGHT: Is the responsibility also for doctors to reign in their costs because funding is an issue that everybody has to embrace? Doctors constantly calling for more funding for themselves. Is that something that also needs to be reigned in?

PHELPS: I think it's important to realise that doctors are not calling for more funding for ourselves. What we're saying is that if Medicare - it is supposed to be a universal insurer - is falling well short. And when we talk about Medicare, it's not about doctor's fees, it's about the gap between the doctor's fee and what the patient has to pay. At the moment, we're seeing declines in bulk billing levels and that will continue because Medicare is hopelessly inadequate, particularly in general practice. So the gap that patients are having to pay is increasing. Unless Medicare keeps up, that gap will continue to widen and households will have to pay for it.

KNIGHT: A very complex issue with a lot of areas to canvas yet during this election year. That's all we have time for this week on Meet the Press. Thanks to our guest AMA president Kerryn Phelps and to our panel, John Kerin and Brian Toohey. Thanks for your company. Join us again next week on Meet the Press.

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