Media Transcript - Q & A National Press Club with Dr Andrew Pesce

Question and Answer Session

National Press Club Address

AMA President Dr Andrew Pesce

Wednesday 21 July 2010

 

KEN RANDALL: As usual we have a period of questions, first one today is from Sue Dunlevy.

QUESTION: Dr Pesce, this was billed as the health election. We're five days into it and neither leader has yet mentioned the subject, and isn't that partly your organisation's fault?

In 2004, when you were facing spiralling medical fees - indemnity fees, you - doctors threatened to walk out of hospitals. You made that a political problem, the government had to cave in and provide hundreds of millions of dollars of subsidies for your medical insurance.

Have you lost your mojo since then? If you really think that health reform needs to be tackled in this country, why won't you use your industrial muscle in the same way on this issue, or is it just that you use it when your incomes are threatened rather than the health system?

ANDREW PESCE: Thanks very much Sue.

Yeah look, you were here last year and we sort of have the same discussion. When the Medicare rebate was introduced, it was a great social policy decision which focused on giving access to the public and gave them access to medical care, and basically covered the cost of that care.

Because of the failure to adequately index that rebate - it's not that it's happened overnight, it's just been gradually happening, we've been gradually talking about it and consistently talking about it over many years - the value of that rebate has fallen so far away that now the largest growing single part of the health economy is patient out-of-pocket expenses. That's a fact.

Now, this is a political question that our politicians have to think about and they have to make a decision. Do you want the Medicare system to, once again, be a vehicle for universal access to quality health care, or do you want it to be a vehicle to restrict the Government's exposure to medical costs and transfer the costs to - at patients' out of pocket expenses? It's a pretty simple question, it's a very complex deliberation, but that's something that I'd like to hear answers during the election campaign.

KEN RANDALL: Simon Grose.

QUESTION: Simon Grose. I met you just four months ago but - then Prime Minister Kevin Rudd introduced the health reforms that are currently the political agenda. And he said it's going to end the blame game.

Now, you've had a few goes at the bureaucracy today and we're moving from a system where we had two sources of funding and two layers of administration, to a system where we're going to have two sources of funding and three layers of administration. So what hope do you see that the health blame game is going to end?

ANDREW PESCE: One of those layers of administration is purely a financial vehicle to deliver money so, you know, I don't think you need to over-emphasise that layer.

But we've talked about doctors and their reluctance to change. Well, I tell you what, get in between a state department of health and devolution of its powers, and you're in for a torrid time.

Look, I've been on public record and - I don't hammer the bureaucrats. They are doing their job that they're asked to do by the governments of the day.

The governments have to realise that the pendulum which led them to say, if we're taking the political responsibility for health outcomes, well, bloody hell, we're going to keep control of all the decision-making because we're not going to be vulnerable based on the unpredictable idiosyncrasies of decisions being made at the local hospital network.

It's very intuitive; it makes sense. But the problem is those decisions end up not improving the picture, especially when you need to make change, for two reasons. You're too far removed from the point of care, so you don't really understand. Unless you've got a very, very good information system, you don't really understand what's needed and the impact of your decisions.

And the second thing is that if the doctors and the nurses and the allied health professionals who have to implement those changes don't have some sense of ownership over the decisions to make those changes, surprise, surprise, we complain rather than make the change.

So it ends up becoming a dysfunctional system and you just cannot run a system where those decisions are being made centrally rather than locally.

Now, overall resource allocation, sure; that's a central decision. State governments have to decide how many hospitals they're going to have, how many are going to treat cancer because not every hospital can do everything all the time. They have a decision to say here is - in consultation with the doctors and nurses who understand, here is where we're going to have the services.

Activity-based funding is a formula which is going to, in a very rough sense, deliver funding to the volume of work that's being provided there. But then get out of the way. Let the doctors and nurses manage it. They need help. They're going to need people - I don't want to sit at my desk, you know, filling in accounting books. But ask my opinion then implement the decisions to say, you know, this is the money you've got to spend, these are the patients you've got to look after, how do you think you can look after them. That's the way we're going to get forward progress and we're going to get engagement of the clinical workforce that will have ownership of the decisions and work hard to implement them, rather than complain about perceived or real inadequacies.

KEN RANDALL: Let's go back to Sue for her last question today.

QUESTION: Sue Dunlevy, Daily Telegraph.

The maternity reforms introduced by the Federal Government require collaboration between obstetricians and midwives. A study in Queensland this year found that doctors thought they should have the final say in the care of pregnant women, and midwives thought they were capable of doing that.

In such an environment, how can collaboration work? And is there a danger that under these reforms some midwives could be shut out of caring for pregnant women because doctors won't collaborate with them?

You're an obstetrician, a leader of your profession. What are you going to do to make sure that doesn't happen?

ANDREW PESCE: Well, the first thing I did was involve myself in the process to set up the framework. And this was done with a very open and honest and objective intent to improve the access of our women to maternity services, and to provide continuity of care by the people that they want to look after them. Been through a whole lot of effort and work to translate that intention into the structures that are being implemented with the Maternity Services Review.

And I'll tell you right now that if it doesn't result in an improvement in the access to services, then the Government is going to revisit its decision-making.

So I'm very, very happy with what's happened. I think that the framework has been set up for very, very good and constructive collaboration. Probably the only part that's missing at the moment, and which I would encourage the organisations involved to finalise, is a consensus guide between the obstetricians and - the College of Obstetricians and Gynaecologists, and the College of Midwives, in saying, this is a consensus statement on evidence-based collaborative framework, consultation referral guidelines.

So when a midwife approaches me saying, Andrew, I'd like you to collaborate with me in provision of care, my patient has actually said she'd like you to be the obstetrician if there's a problem, I'll say, that's good, you know the document, don't you. Yes. You're going to work according to that document. I therefore know what to expect from you and you know what to expect from me. Fantastic. We can go ahead and do that.

If we can get that going I think this is a great step forward.

I referred to it in my speech and I'll say it even more clearly now, I will be telling my colleagues that I believe they have a very strong obligation to make this work. We are, I think, setting the gold standard for collaborative maternity care in this country if we get this right. It will be better than any other country in the world by far, and this is something which you should be proud of and work towards.

So I'll be giving a very clear message to my colleagues and I've already started doing it. I've addressed the graduating class, if you like, of this year's obstetric registrars saying they really should be very happy about this, work very, very strongly to support it. And I'll be giving that message very, very clearly.

And if they seem to be grudging and not wanting to do it, I'll say, well, if you don't like this, if you don't make this work, I'm sure that this will be revisited and whatever comes up you'll be even less happy with. So let's make it work.

We work with midwives all the time. In a sense, this is a bit of a sad discussion to have because 99 per cent of my working life, I've worked with midwives and we've worked really, really well together. So there should be no reason that we can't do that.

KEN RANDALL: Thank you very much.

 

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21 July 2010

 

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