Transcript: AMA President, A/Prof Brian Owler, Doorstop, 5 June 2014

BRIAN OWLER: Thanks everyone for coming out. I'm here to talk about the Bureau of Health Information. Obviously there was some figures put out in relation to the emergency department performance and elective surgery performance in NSW.

We're pleased that there has been an improvement in elective surgery and emergency department performance in these figures. It does show the hard work that doctors and nurses are doing in our emergency departments to treat the numbers of people coming through, but also the increased acuity of the patients that are actually presenting to our emergency departments.

So what we're seeing is an increase in the category one patients, and the category two patients, which are actually the sickest and most life-threatening problems, and a reduction in the - as a percentage at least - in the numbers of GP-type issues that are coming through our emergency departments. Elective surgery has also maintained a good performance.

There are issues, obviously, in the Budget around these needs and these targets, particularly around the reward funding. We have concerns that $100 million in reward funding has been removed from the Federal Budget that drives these targets, and whether or not that reward funding is there, it's important that focus is maintained to try and achieve these targets because, at the end of the day, they are about patient safety and quality.  I'm also happy to talk about the co-payment issues and any other Budget issues that you might like.

JOURNALIST: So there has been some improvements in the?

BRIAN OWLER:  There are a number of things that we need to work through and the disappointing thing about this proposal that has clearly come out of Treasury and Finance without reference to health policy.

The AMA is now doing the work with the key stakeholders in pathology and diagnostic imaging, and I'm meeting with those people again today. That needs to be done to work through the health policy, to come up with a solution that protects those most vulnerable in our society, make sure we continue to manage chronic disease.

We encourage preventive health care, but also make sure that our members, our doctors of our practices, are able to be viable, and they're actually able to continue to provide the care that this society needs. And so we are doing that policy work, which really should have been done way in advance before this Budget announcement was made.

JOURNALIST:  But is there a price? Or in terms of either a price issue or exemption – it seems like you're leaning more towards exemptions.

BRIAN OWLER:  It's, I think, more complex than that. There are a number of issues that really haven't been aired, I think, in terms of the co-payment debate, particularly around pathology and diagnostic imaging. The loss of the 10 per cent bulk billing incentive, the fact that they have had a freeze on their rebates for 16 years, and the implications that it's going to have for some practices in terms of their viability.

So it's not just about the co-payment, it's about whether it's going to be $7, for instance, per item number for diagnostic imaging, or whether it's going to be per visit. How that then gets back to whether it's $5 reduction per item number, which is what the Health Department is now saying.

I mean, there is so much detail to work through on these proposals, and there is a lot of scope for improving the proposal that may see a co-payment maintained, but with the protections that are there for those most vulnerable to make sure we look after people with chronic diseases and that we encourage preventative health care.

JOURNALIST: What do you think about the worst hospitals being in Sydney's west, like in Liverpool?

BRIAN OWLER:  I think it just shows the demand that there is, particularly in western and south-western Sydney, for health care services. We know that those hospitals historically, over years haven't received the, I think, infrastructure that they need.

Westmead Hospital, where I previously worked, was 30 years old and hasn't received the makeover that it really needs. It really needs a rebuild of that hospital. And we're still working out of wards with large four-bedded bays where we really should be going to much more modern-type facilities. You know, it's an issue in quality but also capacity of our public hospitals.

JOURNALIST: Do you think it's more of an infrastructure problem than a staffing problem?

BRIAN OWLER:  I think it's somewhat of both. I mean, we're training large numbers of doctors coming through now. We've got these medical graduates that are coming out of our medical schools in the orders of 3000 or more per year, and there's been a significant increase. There's not going to be a shortage of people to fill the positions. What we do need to have is the infrastructure, but then the recurrent funding to make sure that we're actually able to staff the beds and provide the services.

Now, that obviously does cost money, and under this Budget, we've seen significant reductions in funding for public hospitals compared to what was previously agreed to under the National Health Reform Agreement. We have a system of activity-based funding, which many doctors and nurses in the hospitals have put an enormous amount of effort into coming to fruition and it's only now being enacted, and now we've gone back to a situation where we're going to fund our public hospital system on Consumer Price Index and population growth, which is going to be a lot less than what was going to be promised under the National Health Reform Agreement.

So, it's not just about building hospitals. It's not just about beds. But we've got to be able to fund the public hospital system as well to provide those sorts of services.

JOURNALIST: Any encouraging signs for elective surgery?

BRIAN OWLER:  As far as New South Wales is concerned, they've always been performing well. Well, at least over the past four years, and I know before that there was a lot of effort put in and a lot of focus on elective surgery targets.

Still, people do wait to get into some surgeries and we understand that, but in terms of the recommended clinical time frames and the categories that are there, New South Wales is actually very close to achieving most of those targets being in the high 90 per cent range. Around the country, most other jurisdictions have not performed as well in terms of elective surgery and there's still a lot of work to do there.

And what we know is that the National Emergency Access Target, emergency department, and elective surgery targets go together; that you need the capacity in the hospital system to be able to drive performance in both targets. You pay attention to one, the other often then lags behind. So it is about whole hospital reform, but you need the capacity and you need the beds in our public hospital system to be able to do that.

JOURNALIST:  Just on co-payments, Labor and the Greens have both said they won't support this legislation, but are you lobbying them to reconsider their position and perhaps to look at a compromise?

This morning, Joe Hockey said he was disappointed no one had put any options on the table to consider. Do you think that Labor and the Greens should be more open to considering a compromise?

BRIAN OWLER:  I think if we can come up with a solution that addresses everyone's concerns, I would hope that would be supported. But, at the end of the day, it's the Government. And the onus is on the Government, on Mr Hockey, to actually look at the policy and come up with the solutions and address people's concerns if they want to get this through the Senate. So, we will be happy to work with them, but we need to be able to see that there is room for negotiation; that those protections for those most vulnerable, but also the concerns that we have for our doctors and their practices are also going to be addressed. Thanks everyone.

5 June 2014

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