Radio interview 2SM on Labor's Hospitals Plan

MUKESH HAIKERWAL:   Good morning, how are you?

DELANEY:          Well, thanks, how are you today?  Are you pleased overall with the health and hospital policy announced by the Opposition?

HAIKERWAL:    What we have said is that it's good that the problems have been recognised and it's good that there's actually extra funding been announced to go into the system.  We certainly have concerns about the way in which that's been divvied up, if you like.  We're certainly concerned that the States need to make sure they continue their commitment to, and improve on the commitments to hospitals as well because the hospitals really are living treasures.

                            We really value our hospitals, they do such a fantastic job for the sick in our community and do such innovative work, that they need support.  So although it's good to see the Feds - the Labor Party - are going to put some money into the...it's important that the States don't feel that they can then remove their commitment from that process.

DELANEY:          You don't have to go too far to find somebody to tell you that the standards of service in public hospitals have declined and that the stresses and pressures have increased.  Whether that's right or not, that is certainly a widely held perception.  Now, the hospitals are a State responsibility, what's gone wrong?

HAIKERWAL:    Look, it's a situation where we became better at what we did, more efficient, we could move people to a system quicker, so we had less fat to cut within the system, so we're working on a very high percentage of the beds that were there being full all the time, so if you had a bit of an excess into casualty or you had a bit of blockage with people trying to leave the hospital system to go into rehabilitation or into a nursing home situation, it would completely block up the whole system, there's no leeway.

                            And that's something that really needs to be addressed, that we need to make sure not only do we do what we do well and minimise bed stays, and all the rest of it, we've got to have a bit of fat in the system so that you can actually have an opportunity to be more flexible when there's a push in the bottom end or a block at the top end.

DELANEY:          So access block is the primary cause for the logjam in accident and emergency?

HAIKERWAL:    Well, the problem in an accident emergency is that there are more people presenting, we have more people living in the community who are older, more people living in the community who've got chronic and complex care needs, and people who need more care - because we are keeping more and more people living in the community, so general practice is caring for more and more people.

                            But eventually they get unwell enough to need to go into hospital, and therefore we need to make sure that when they get into hospital that there are actually beds available for them to be looked after, and that once they are on their way out, that there are places for them to step down, which aren't hospital beds, but where they can do the rehabilitation and gently get back to being able to do the normal activities of daily living and then go back home or, if necessary, go into a residential facility.

DELANEY:          The Opposition plan for outpatient GP and specialist bulk billing clinics to be located at hospitals - is that a good step - and will that help ease pressure on accident and emergency rooms?

HAIKERWAL:    The reason for putting - if the reason for putting in a GP clinic close to a hospital is to relieve the pressure on a hospital, then the State Labor Governments joint report to the Federal Government this year says categorically no it's not going to help because the number of people going into A&E in category 2 - that's your heart attacks, and the like - is about, has gone up 45% across the country.

                            The number of people going in for GP-type cases has dropped by 11% in level 4 and gone up a little bit in level 5, so it's not the GP‑type patients that are causing the increased presentation to casualty, so you're not going to solve that problem - because if they go and see a GP they're still going to have to go and see the hospital.

                            If you're looking at if it's going to make any difference putting in a fully subsidised government service into an area where there's GPs doing some work, you're actually going to reduce the amount of access.  That's what we saw in Perth when they brought in these clinics, that the clinics in Perth are not particularly busy, but the people that were providing services out of hours on a Saturday or Sunday just said, "We can't compete with something that's free.  We have costs to provide our quality of services."

                            And that's what's been missing in the whole of this election debate so far, that the general practitioner that's responsible for looking after people in the community is looking after a much more broad-based group of people with illness, and the quality and the value of that service has just not been addressed in any of the policy we've heard so far.  We've seen money being thrown into bulk billing, we've seen money being thrown into a higher rebate for consultations.

                            All those things are somewhat positive, but the actual addressing the quality and rewarding people who are looking after people in the community who are there, who are sicker and older, and all the rest of it, just has not had a look-in, and that's what we've got to pin people down on and say, "You've got to commit to general practice to make sure that you reorganise a schedule under which we're working so that a patient who sees a doctor for a proper 15-minute consult actually isn't out of pocket."  And that's where the debate hasn't happened yet.

DELANEY:          Is the increase in the Medicare rebate enough to encourage at least some doctors back to bulk billing?

HAIKERWAL:    The increase in the Medicare rebate is one small part of the equation, and certainly will keep a few more people having services subsidised up to 50% a little bit longer.  It was good to see that the amount of money, $1.8 billion, that the Government has put into Medicare just recently was they put that on top of the money they've already put in.

                            There is enough money in the system there to address this problem of the quality agenda to make sure people out there understand that they're getting a good service and that they're getting a proper rebate for that and will general practice the confidence to keep people in the system.

                            We're in a shocking situation with 64% only of doc hours available in general practice are used.  Doctors are walking away from the service and it's just so important that they feel that their services are valued and the patients are not out of pocket for getting that good value service.

DELANEY:          The Opposition policy also announces funding for additional training places for both doctors and nurses.  Again, enough?

HAIKERWAL:    Absolutely fabulous.  We do need our own trainees, both in medicine and in nursing.  What's important is that when we do our training we need to have clinical placements for our people doing the training.  That time that it takes to do the clinical training needs to be understood and that the time and cost for that needs to be real wide, so that people aren't having to just do the - serve a commitment in the hospital and looking after people in the hospital, and not get time to do the teaching and training of the next generation.

                            That's very important as a positive step, but yet we need a bit more - 20 more is not going to make an awful lot of difference.  Same for nursing, vital, intrinsic part of our system, we've got to make sure nurses are supported, to get their training and that there are enough of them around.

DELANEY:          It's also not just enough to train more doctors and nurses, but also to encourage them to go to areas of need, isn't it?

HAIKERWAL:    We need to encourage them to areas of need, the

HAIKERWAL:    It's something that strikes a chord, that people understand what you're talking about.

DELANEY:          Oh, yes.

HAIKERWAL:    But the machines that go 'beep' are fantabulous and they save lives, but the reals are underscored by the - they're real workhorse machines and they need to be kept up to date, they need to be recalibrated, they need to be serviced regularly.  And a lot of that got run down and hospitals had to cut back on their expenditure to meet their budgetary requirements, and that's from chronic underfunding.

                            Some States started to put more dough in, the Feds are going to put more money in, but it doesn't mean the States pull out, and it means that the additional injection needs to be used, and used wisely in a co‑ordinated manner across the community - State/federal continuum, and not just seen as money to be thrown at a problem willy-nilly.

DELANEY:          Yes, of course the money is important, but at the same time, it's also important how you spend it, isn't it?

HAIKERWAL:    Exactly right, and it needs to be done in a co‑ordinated manner.  You need to involve the staff on the ground, you need to make sure that they can see benefits and point out where benefits could be most wisely used, rather than leaving it to a board that doesn't necessarily understand what's going on or even want to understand what's going on.

DELANEY:          Doctor, thanks very much for your time today.

HAIKERWAL:    You're very welcome.