National Press Club - Federal President of the AMA, Dr Kerryn Phelps

Welcome, comrades.

Good afternoon, ladies and gentlemen. It is a pleasure to be here at the National Press Club in Family Doctor Week.

I have titled my speech today 'Musings of a militant trade unionist' because it is one of many sobriquets bestowed upon me during my time as Federal AMA President. It is also one of the most polite.

I have this philosophy that the best way to deal with name-calling is to define the term and, if the cap fits, wear it. So let's look at the meaning of this term "militant trade unionist".

The Macquarie Dictionary defines "militant" as: combative, or aggressive, as in a militant reformer. "Combative" is defined as "ready or inclined to fight".

Now I will admit that there are times when putting your case to government requires a quiet, low-profile, diplomatic approach.

Then there are the other times, such as when your organisation's point of view is not being listened to, or when your organisation is actively excluded from the decision-making process - when the outcome of those decisions has far-reaching consequences for the lives of the people you represent.

Then a somewhat less diplomatic, yes, even "combative" approach may be required.

If "militant" means ready or inclined to fight for your principles, for what doctors know is best for the health system of Australia, then I can live with "militant".

The Macquarie further defines a "trade union" as: an organisation of employees for mutual aid and protection and for dealing collectively with employers.

Now, while it may be wildly inaccurate - as the AMA is a professional body - I can live with the mutual aid and protection part.

And this is why:

The AMA has more than 27,000 members.

They include GPs, physicians, surgeons, salaried doctors, researchers, doctors-in-training, and retired doctors. Employees and employers. Even a Federal Health Minister.

Our members cover virtually all aspects of the medical profession in this country - and their knowledge, skills and experience span generations.

These are just the paid-up members.

The AMA also represents a much broader and diverse group of people - the millions of patients who use or encounter the health system in Australia every day of their lives.

As President of the AMA, my advocacy on behalf of our members extends to each and every one of these patients. They are the people who are affected by the health system, and who inform the doctors who inform the AMA who informs governments what is right and what is wrong with the health system.

It is the patients and the doctors who are best placed to advise on health policy when the bureaucracy and the politicians are often removed from the everyday realities.

So, if as an advocate for better health outcomes in this country I am to be labelled a militant trade unionist, I think I will simply wear the badge with pride.

So now to muse.

I wish to muse today on what lies ahead for health policy and the health system generally, and specifically in the area of public health.

As a number of you here today reported recently, the AMA is now far better placed to provide sound advice to the federal Government.

For a considerable period of time prior to the recent highly publicised and well-catered rapprochement, the AMA had been excluded from negotiations - all negotiations - with the Minister and his Department on health policy.

That was a nonsensical situation. Where diplomacy failed, militancy became necessary. We stood ready to fight.

The fact of the matter is that Medicare - the heart of our health system - is in strife.

Something - a lot of things, in fact - needs to be done…and fast.

An efficient Medicare sets the Australian health system apart from those, say, of the United Kingdom or the United States.

We have balance, or we should have balance.

Looking at the recent GP protests in the UK over the National Health Service, my form of so-called "militancy" is a walk in the park by comparison. GPs in the United Kingdom...at least those who are left working in the NHS…have been threatening mass strike action in protest at the conditions in general practice.

Things aren't much better across the Atlantic.

If you tune in to watch Chicago Hope or any of the other popular American hospital dramas, you will get a glimpse - a frightening glimpse - of the patients' and the doctors' point of view in the managed care style of medicine.

This is the system where administrators and clerks - removed from direct contact with patients - make decisions about what treatment doctors may offer to patients, based on cost.

What is more frightening is that Health officials in this country have been examining elements of both the US and UK systems to trial here. We must not let that happen.

Do we want managed care here? No.

Do we want UK-style fundholding here? No.

What we need to do is to appreciate and strengthen the best elements of the system we have, and to identify and fix the problems that have arisen over the three decades since the introduction of Medicare.

Some of the problems can be solved by addressing funding shortfalls. Other solutions will fall into the recurring theme of "untangling the wires" between the Commonwealth and the States.

This is particularly the case in the areas of public hospitals, aged care and indigenous health.

First, to funding:

Earlier this year, the AMA presented our Health Budget Submission to the Government.

It was a responsible, professionally costed wide-ranging blueprint that addressed the areas of greatest concern in the health system.

It provided a plan for the longer term - a plan for our health and the health of the next generation of Australians.

It talked about public hospital funding.

It talked about action to address the medical indemnity crisis.

It talked about the need to properly fund and manage health programs for Indigenous Australians.

It talked about anti-smoking programs, and programs to combat alcohol and drug abuse - some of the biggest killers in our community today.

And it talked about the Relative Value Study and the need to address the deficiencies in the outdated Medicare Benefits Schedule (MBS) - the key to the revival and survival of Medicare.

Needless to say, at the time, the AMA Budget Submission was totally ignored.

And some commentators have since expressed surprise that the AMA was not out there dancing in the streets on Budget night!

The fact is, the health budget was a plan to calm the horses prior to the election. To appear to be doing something for general practice. Not only did the funding come with strings attached, it was not enough.

The AMA has genuine well-founded concerns about the contemporary Australian health system.

It is failing many who use it and many who practise in it. While it might just have its head above water now, it is not suitably equipped to serve the next generation of Australians and beyond.

Tough decisions must be made now if Australians are to have access to quality affordable health care into the future.

So, on this basis, what does the AMA want to see from the major parties over the coming months as they prepare to put out their health policies for the election?

Quite a bit, actually.

RVS

We have not given up on the Relative Value Study. Not by a long shot. Our arguments for it are well known.

The Medicare Benefits Schedule (MBS) is dangerously outdated and does not reflect the real cost or the complexities of providing quality medical care today.

If the inadequacy of the MBS is not addressed, patient gaps will get bigger, bulk billing rates will decline further, or doctors will find it harder to stay in practice - morale is already at an all time low.

I won't dwell on the RVS today.

I will have more to say about it once I have established what the Health Minister and the Government have in mind now that the AMA will be able to engage in consultations with Government.

The AMA will also be seeking more information from the Opposition about how a Labor Government would approach implementation of the RVS.

After all, it was a Labor Government that started the RVS process.

I'm sure voters would be comforted by a strong commitment to Medicare from both sides of politics.

Aged care

While the public hospital system is in a constant state of crisis, the aged care sector is in a state of despair and disrepair.

Australia's population is ageing. Projections show substantial increases in the number of people aged 85 years or more, rising from 216,000 in 1997 to reach between 1.1 and 1.2 million in 2051.

That makes aged care a very important health issue.

The number of residential aged care places has risen by less than 10,000 in the past six years…in an ageing population.

Funded aged care places and community aged care packages providing services to people in their own homes have risen but clearly not enough to cope with demand.

However, even with the increases in Residential Aged Care Facility beds and in Aged Care Packages within the community, old people are still waiting in hospitals for beds in residential facilities to become available - so there is still a high level of unmet need.

At present, older people often have to stay in hospital longer than necessary waiting for beds to become available in aged care facilities - either because they can no longer live in their own home or because they need extra support before returning to their home.

For example, if you have an 85 year old man who has just had his hip replaced, or suffered a bout of pneumonia, it might take a while before he is able to do his own shopping or prepare meals or take care of himself.

There needs to be coordination of Commonwealth and State programs for improved coordination of hospital, residential aged care facilities and community-based services, including the recognition of the need for services for older people that fall between acute hospital care and home care.

These transitional care services - could be provided by Residential Aged Care Facilities… or new types of purpose-built facilities attached to hospitals, which would cost less than acute care.

This would allow patients to be discharged from hospital to facilities where they could receive the care they need…with a focus on rehabilitation…until they are back on their feet and well enough to return to their own homes.

Aged Care Facilities should not be seen as a place where, once there, you never leave…that you have to bolt yourself to the bed because you will never get back in if you leave.

We need to see more flexible community care services, so that waiting times for beds in aged care facilities and for receiving aged care packages can be reduced.

There also needs to be improved access to aged care services for people with special needs, and older Australians in rural and remote communities.

The staff in Residential Aged Care Facilities play an essential role in the delivery of quality care to older people.

However, nurses in private aged care facilities receive lower wages than nurses working in hospitals.

The work is demanding and often demoralising. Little wonder that there is a drought of nurses prepared to work in aged care.

And to compound the problem, there is no basic skill requirement for workers in aged care.

We need to see increased wages for nurses which reflects their real worth, and a national training strategy for all workers in the aged care industry.

The AMA has suggested the introduction of Centres of Excellence where a Nursing Home is linked to a University and Hospital to provide training not only for nurses, but also for carers, doctors and students from all disciplines. They would also be the focus of research into ageing.

Nearly every day when we pick up a newspaper we read of problems associated with aged care facilities - whether it be closures, low standards or staffing problems.

The aged care sector is so concerned about existing problems that it has formed a National Aged Care Alliance (NACA).

In this forum, aged care providers sit down and work with the AMA, consumers, representatives from the nursing federation, and the Australian Society of Geriatric Medicine, and other aged care organisations, to discuss problems faced by the various stakeholders and to seek answers.

We hear from providers that with the Aged Care Reforms came a reduction of around 50% in the funds available to meet building and development costs.

There are increasing government requirements and costs within a strictly regulated and fixed funding system that have led to deteriorating viability.

One way to balance the budget is to cut staff numbers, while trying to maintain quality of care. But we know that equation was never going to work and is not fair to anyone.

With the introduction of the Reforms we saw the establishment of the Aged Care Standards and Accreditation Agency.

This Agency, whose membership was appointed by Government, was set up to ensure that the facilities provided high quality care within a framework of continuous improvement. A fine motherhood statement if ever I heard one…

But there are no benchmarks of care - no set staffing levels, no set staffing mix - included in the framework.

The Accreditation process should be owned, run and controlled by the aged care sector, not by Government. An existing alternative is the Australian Council on Healthcare Standards, which runs a successful national system for accreditation in hospitals, which has accredited nursing homes in the past.

Later this year, the AMA will host a non-partisan Aged Care Summit.

This summit will involve all of the aged care sector - including consumers, health care professionals, providers and unions - and Government - all political parties - to develop the long term strategy that will move us along the road to quality care for older people.

We are not talking about the immediate future, or even the next five years.

We need to learn the lessons of the present system, correct them, and have a proper positive vision and plan that is economically viable, practical and compassionate.

The health of older people is paramount and the AMA is striving to achieve a health care system that will provide security for every older Australian.

Entering a Residential Aged Care Facility should not be an experience to be dreaded.

It should be an experience where residents still retain their individuality and their dignity and where they can still share their thoughts and love with their partners.

Planning for aged care should answer one basic question…is this the way I would want myself, my parent or, in the more distant future…my children…to spend their final years of life?

One example of how the rules and regulations can depersonalise older people is the absence of any recognition of relationships.

On that note, can anyone here today recall ever seeing a double bed in an aged care facility?

You might have a couple who have been together for fifty or sixty years, yet when one of them is no longer able to cope at home, they are physically separated from each other at one of the most vulnerable times in their lives.

We even have the ludicrous situation of partners who both need residential care - but one has higher dependency needs than the other. So one person is admitted to one part of the facility and their partner has to live in a separate part of the facility because that's what the rules say.

The only way you qualify to stay together is if you both happen to have equal care needs.

I know that very few so-called 'low care' facilities allow double accommodation but they are rare.

You could say, "Love means never having to say you're too old."

There is no practical reason why the aged care industry could not introduce more partner accommodation with the option of double beds to their facilities - where it is possible and practical within the licensing requirements.

This would make the prospect of assisted accommodation far more appealing.

The health care of older people can no longer be considered in isolation.

Aged Care crosses many portfolio boundaries. Translated that means a lot of potential for tangled wires - it crosses community care, primary health care, the hospital sector, the residential aged care sector, and the pharmaceutical benefits scheme.

High level coordination is required and funding must be rationalised - or "untangled".

But, above all, Australia needs a sensible and compassionate aged care policy which transcends party politics.

Indigenous Health

Indigenous health is another area of desperate need.

In the past year, I have had the privilege of visiting a number of remote Aboriginal communities.

Like others before me, I was shocked at the appalling lack of basic services other Australians take for granted.

It is a national tragedy that needs a more dignified response than the argy-bargy of party politics.

Indigenous Australians have the worst health of any group in Australia, with lower life expectancy at birth. Indigenous parents can expect to lose their babies at a rate 2 to 4 times higher than the national average, and indigenous men and women can expect to live twenty years less than non-indigenous Australians.

Chronic diseases are the leading cause of premature death.

Together with injuries, they are responsible for rates of hospitalisation that are two and a half times that seen in non-Indigenous Australians.

Other countries have bitten the bullet and significantly improved the health of their indigenous populations. Australia has not.

The improvement in the health of Indigenous communities in countries such as Canada, the United States and New Zealand wipes out our excuses. Progress is achievable

It is unacceptable that Australia lags behind in ensuring the health of Indigenous people.

It is particularly damning because the priorities are obvious.

The message received by the AMA Taskforce in Indigenous Health is that there needs to be a quantum leap in funding for Indigenous Health if progress is to be achieved and the cycle of ill health broken.

It is not acceptable for the Commonwealth to spend less on health services for those whose health is the worst in the nation. This is what happens at present.

AMA-commissioned research by Professor John Deeble shows the inadequacy of Commonwealth funding, particularly through services rebated by Medicare and through the PBS.

At least an extra $245 million per year is necessary to fund Indigenous health services.

Such an increase was not forthcoming in the recent Federal budget.

There needs to be a major emphasis on primary health care (or out of hospital) services, adequately funded, and delivered by skilled staff as a basic human right.

It is essential that the Commonwealth backs and funds Aboriginal community controlled health services ensuring that these have national representation in policy matters through an adequately resourced National Aboriginal Community Controlled Health Organisation (NACCHO).

Aboriginal and Torres Strait Islander communities must be in a position to shape their health services so that they address local priorities and are culturally appropriate.

It is also essential that the basic infrastructure such as clean water, sanitation, appropriate housing and transport - taken for granted by other Australians - is available to all Aboriginal and Torres Strait Islander communities irrespective of where the communities live.

Underlying all these matters, however, is the fundamental matter of the relationship between Indigenous and non-Indigenous Australians.

The issue of a treaty is being taken forward by ATSIC and by Aboriginal Land Councils.

Today I announce the AMA's support of their efforts.

In other countries, such as New Zealand, the signing of a treaty has facilitated progress that has flowed on to many other areas.

A treaty is able to acknowledge and help resolve historical issues that are currently outstanding, ensure the rights of Indigenous Australians, and make a binding contract as to what should happen next.

There has been some talk of the need for "practical reconciliation".

But there cannot be practical reconciliation without a binding contract or, in other words, a "treaty".

We have reports up to our eyeballs but words and paper are cheap.

It is time to begin the process of ensuring that the rights of Indigenous Australians are securely protected.

A treaty is necessary to ensure accountability from State and Federal Governments to achieve measurable quality of life and health outcomes.

Such an undertaking would involve a mutual agreement between indigenous people and governments which would underpin any national Aboriginal and Torres Strait Islander health strategy, specifying what needs to occur, who is responsible for what strategies, and in what time frame.

Until there is an unassailable commitment in the form of a contract to overcome the poverty and desperation of our most disadvantaged citizens, we are not taking the issue seriously enough.

The recently released draft of the new Aboriginal and Torres Strait Islander health strategy lacks the specificity and clear direction necessary to achieve real progress.

The AMA is not entering this debate cold or uninformed.

Indigenous Health is an area in which the AMA has a long history of advocacy.

The AMA National Conference in 2000 passed a resolution reaffirming the need for an apology to Aboriginal and Torres Strait Islander people and support for the reconciliation process.

In my first year in office, I established the Taskforce in Indigenous Health.

This has representation from NACCHO, the Australian Indigenous Doctors' Association and ATSIC, as well as from AMA Federal Councillors and others with particular experience in this area.

It is essential to move beyond a piecemeal and incremental approach and show the world that Australia is, at last, able to bring about real progress in the health of Aboriginal and Torres Strait Islander communities.

Until then, Australia will maintain the shame.

Public Hospitals

A commitment to public hospitals would not go astray, either.

There can be no argument that they are under-funded and under-resourced.

At the AMA National Conference in May, we released a summary of some independent research into the state of our public hospitals across the nation.

The people surveyed were the people who work in these hospitals.

I am releasing the full report here today.

It makes interesting and disturbing reading.

The researchers were asked to look at:

the overall perceptions and ratings of the public hospital system

how the public hospital system compares to 10 years ago, and

the strengths and weaknesses of the public hospital system as they saw them.

They conducted focus groups around the country to identify the issues and then distributed 4,800 questionnaires to GPs, Specialists and hospital CEOs and received an excellent response.

It may have been higher except that some State Governments felt so threatened by it that they actively discouraged hospital staff from responding to the survey.

The findings indicate the need for some urgent Government action.

For instance:

70% of people questioned believe the current public hospital system is inferior to the way things were

10 years ago

77% are not confident that there will be a public hospital system that will adequately meet the needs of the

community in 10 years time, and

94% of respondents felt that the dual Federal and State system for funding public hospitals is a weakness,

and results in cost shifting, inefficiencies and duplication.

But wait, there's more:

80% of respondents said funding required urgent attention

73% said that long term vision and planning was lacking, and

69% said the lack of aged care residential facilities was an urgent problem.

This research adds weight to our calls for $900 million in extra funding for public hospitals over two years, as recommended by the Senate Community Affairs References Committee. I think the amount is on the conservative side.

But it also adds weight to the argument that the roles and responsibilities of the Commonwealth and the States need to be sorted out.

Ask the Commonwealth about public hospitals and they blame he States. Ask the States and they tell you the Commonwealth is not doing its bit.

The wires need to be "untangled" so that SOMEONE takes responsibility.

"Managed care" or "Restricted care"?

The AMA wants to see the doctor-patient relationship maintained.

Managed care involves replacing the medical practitioner with the insurer or third-party payer as the decision maker in patient care.

One of the great protections we have had against managed care in Australia has been the existence of a high quality alternative public system.

Yet already we are seeing signs of managed care creeping into the Australian health care system.

You may think it is only in the private sector with the growing power of the health funds. Yet we are seeing increasing government interference based on short term cost rather than long range vision.

The MRI debacle was a case in point.

In that whole debate, we heard nothing about the possible benefits of greater access to MRI for people with cancer, brain tumours, spinal problems, and joint injuries.

Not a word about whether MRI was better than CT scanning or ultrasound for particular conditions. This should have been discussed with the medical profession on the basis of evidence.

It was all about which machines would get the nod for the limited Medicare dollar.

If you had your MRI procedure on an MRI machine with the Medicare blessing, it cost you nothing. If your machine was not so anointed, you were up for $450.

Medicare is supposed to be a universal subsidy for access to high quality medical care freely chosen by the patient with the help of the GP, who is the effective gatekeeper to the health system.

This recent gap cover campaign overlooked the essential truth that the fundamental reason for gaps is a deficient government contribution. The RVS showed us that.

Instead, government and health funds have used a range of tactics, including shameless doctor bashing, as a decoy in the public relations campaign to avoid this responsibility.

The media itself has been all too willing to swallow the Government's and the health funds' rhetoric of blaming doctors for the failings of the health system when, in truth, it is the dedication of doctors and nurses working under ever-deteriorating conditions that has kept the system running until now.

Capping medical expenditure is high on the Government's priority list. While on the surface this might sound like responsible fiscal policy, it ignores the actual level of need.

We have seen it in Pathology first, then Radiology and, most recently, General Practice.

The Government, particularly Treasury, regards it as an achievement to cap outlays in these areas.

Patients and doctors take a different view … if these new capped deals bear any relationship to actual health need, then that is entirely accidental.

We seem to be rapidly moving away from a patient initiated universal medical system to one where the Government is meddling more and more in the decisions about access to medical (and pharmaceutical) services and products.

The health funds have joined the Government in this pursuit and cannot wait to get their indulged fists on the levers.

As proof, let's look again at our public hospitals.

We have had fine public institutions that have provided care to Australians and been the centres of excellence, teaching and research for each generation of medical practitioners.

Choking off adequate funding to public hospitals means that non-urgent functions - or at least things that won't be missed until after the next election - get cut back. Things like teaching and research, which should never be optional extras.

If we stopped the teaching function in public hospitals tomorrow, no-one would notice much difference the next day or the next year or even the next few years.

But we would all certainly notice the difference 10 years down the track. Health spending is like that.

It is a very big investment in the future health of the nation.

In the meantime, the unholy battle for bucks between the Commonwealth and the States continues.

Under the Australian Health Care Agreements, which would be better named the Australian Health Care Disagreements… the only obligation on the States to spend at least the level of the Commonwealth hospital contribution on public hospitals.

But given that the Commonwealth contribution is approximately 50% of total hospital expenditure, this obligation is meaningless.

The Commonwealth's decision not to claw back up to $1 billion in public hospital expenditure - which it technically could have done because of the growth in private health insurance - has to be seen in this context.

It does not mean this decision will flow through to additional public hospital funding by the States.

When it comes to our public hospitals, there must be national standards. People should expect the same level of quality care in all States and Territories.

The fact is that we do not have a national public hospital system.

What we get in terms of the number of beds, variety of services, access to services, and quality of services varies substantially from State to State.

And there is inconsistency in the level of commitment to the public hospital system across the States.

One of the most glaring inequities is the difference in access for people living in rural and remote parts of Australia.

It is impossible to take an economic rationalist view of health provision in rural Australia. The tyranny of distance and the small populations mean you are working with a completely different set of fundamentals.

We must define what are core services for every community, and ensure that those services are delivered and maintained.

We also need to get serious about realistic incentives to recruit and maintain medical practitioners in rural areas. The Government's attempts to socially engineer doctors into rural areas is not working.

The increased numbers are largely the result of temporary visa and overseas trained doctors, not a sudden awakening of Australian medical graduates to the joys of country practice.

We need to develop national standards to ensure equity for all Australians and to ensure that Governments are held accountable for the delivery of quality health services to every Australian community.

The take up of private health insurance in Australia has resulted in a substantial increase in the utilisation of private hospital services.

However, it has not yet relieved the pressure on the public hospital system - although it is expected to in the long run.

This is because when a service is rationed, you get a large unmet demand that shows itself as soon as there is a shift in demand to the private system.

The public hospital system was the great protection against managed care in Australia. The private health funds could not offer a product that was inferior to Medicare and expect to sell it on the open market.

But, given the pressure on the public hospital system and, given the not so subtle coercion for Australians to take out private health insurance, it is no longer a protection - nor do we have an open market.

The health funds have been very eager to get more involved in what they will pay for. We have seen aggressive contracting with selected hospitals, cutting other hospitals out of the game.

Legislation requires funds not to intervene in clinical decision making but there is more than one way to skin a cat.

Only offering access to fund products for patients of those doctors who bill by a certain method is one such way.

Fine print that says what the fund will pay for - for example, how many sessions of physiotherapy after an orthopaedic operation, regardless of the doctor's opinion - is another example.

The health funds' preferred provider lists based on cost rather than expertise are the first step in the process to displace the GP in the referring role. This is managed care.

The funds have an obvious and understandable commercial imperative to control their costs and it is clear that to control their costs, they feel they must control doctors.

We have seen moves to restrict admissions, to restrict high cost drugs, to discharge quicker, and to pay hospitals on the basis of an episode of care rather than on a daily basis.

These measures gradually erode the doctor's ability to advocate on behalf of the patient for the best treatment options for the patient.

The reason so many specialists are unwilling to sign on to "no-gap" schemes is because they recognise that surrendering the control of their fees to health funds, they could ultimately surrender their clinical freedom.

Conclusion

There are many issues of concern in the health sector and I have touched on just a few of them today.

The frustrating thing is that many of the problems - the entrenched problems - are the result of political differences in a system that allows governments to shift the responsibility for some of the hard issues to "someone else".

In the interests of quality affordable health care in this country, the political auction on health policy every three years has to stop.

It is time that significant elements of health policy in this country were treated as a national treasure…to be elevated as much as is practical above party politics. The "too hard basket" issues like aged care, public hospitals and indigenous health.

These issues that ultimately affect the health of all Australians - must become non-partisan.

It is time to stop the petty point-scoring between parties, between the States and the Commonwealth, and between one State and another over the health dollar.

Health policy should be about the most practical approach to saving lives and enhancing the quality of life.

Instead it has become a fight over dollars and ideologies - who gets the biggest piece of the pie and what flavour the pie should be.

It is undignified and uninspired.

I think the Australian community would welcome and support a Government initiative - by this Government or a future one - to initiate a genuine non-partisan approach to key public health issues.

Last year's Senate Community Affairs Reference Committee hearing was a good starting point.

The NSW government's model of engaging front-line clinicians in restructuring the hospital system in that state is a way of the future.

It is time to put compassion back into health policy.

It is time to put the interests of the patient first and foremost in the development and implementation of health policy.

The real health policy issues must be approached in a non-partisan way.

And the medical profession must be consulted. We must have input to policy development if it is to have any practical relevance.

And the patients must have their say.

But how do we get there?

In partnership, that's how - by sharing the knowledge and ideas of all stakeholders.

A national Health Summit would give the government after the next election a chance to display a serious commitment to Medicare and a serious commitment to the health of all Australians beyond a single electoral term.

Health will be the Number One issue for the next election and beyond.

You cannot be a Clever Country or a Knowledge Nation or an Ideas Island or a Learning Landmass or a Tax Territory unless you first take care of the health of your people.

The next Government must put in place a long -term plan for Australia's health system, for Medicare.

It is a job that is beyond politicians and bureaucrats alone. Such a plan needs the input of health professionals - the people who deal with the ill, the frail and the elderly on a daily basis.

I today call on the major parties to include a Health Summit in their Health policies for the next election - and the summit should take place in the first 100 days of the new government.

Going to the election with this policy will tell voters which party is really serious about fixing the health system, which party is really committed to Medicare.

A National Health Summit would be a positive signal from a new Government that a new cooperative approach to health policy had arrived.

I'd vote for that.

Thank you.

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18 July 2001

CONTACT: John Flannery (02) 6270 5477 / (0419) 494 761

Sarah Bucknell (02) 6270 5472 / (0419) 440 076