Transcript: Dr Pesce, ABC News 24, 14 February 2011
Transcript: AMA President, Dr Andrew Pesce, with Virginia Trioli and Michael Rowland
Breakfast, ABC News 24
Monday 14 February 2011
Subject: COAG health deal
MICHAEL ROWLAND: The Australian Medical Association has warmly welcomed the new national health agreement.
VIRGINIA TRIOLI: Dr Andrew Pesce is the AMA president and he joins us now from Sydney.
Andrew Pesce, good morning, and thanks for joining us again.
ANDREW PESCE: Good morning Virginia, it’s always a pleasure to be here.
VIRGINIA TRIOLI: Why is this deal, as outlined by this Prime Minister, Julia Gillard, better than the previous one?
ANDREW PESCE: Well I guess because it’s a deal. It became increasingly apparent that the previous deal did not have – well it never had the support of Western Australia, and as the other wall-to-wall state Labor governments started changing – we’ve got a Liberal one in Victoria now and possibly another one in New South Wales later – it became increasingly obvious that we were further away from a real deal than we had been before. And I guess the Prime Minister realised she actually had to get them back round the table and get them to agree to something. And they have.
VIRGINIA TRIOLI: So is that all that we’ve got this morning? We’ve got agreement on something, rather than an agreement on really good health reform?
ANDREW PESCE: Yeah, look, a funding agreement is necessary but not sufficient to deliver health reform. Without a funding agreement there is always instability and an inability to have accountability and stop the blame game, the blame shifting between governments that the Prime Minister referred to last night.
So, you know, we needed to get that out of the way. But the real reforms will come from the other parts of the agreement which were struck earlier in the initial one, and which have not been changed by this one. And I presume, and assume, that the Premiers will honour their obligations under the previous deal, to devolve decision-making to the Local Hospital Networks, to make sure that they put in place the legislative changes that are required to empower local hospital networks to really make the decisions and deliver, on the ground, surface reform, which is what the patient, going to the hospital, will see will improve their services.
VIRGINIA TRIOLI: And as part of then, of working out the details of those ongoing reforms – and, as you say, the real business of health reform starts now, that you have a basic financial agreement – do we need to have absolutely specific targets in your view? For example, that the number of new hospital beds that will be open and will remain open and will be functioning; that the number of procedures per hospital that have to be completed within a certain timeframe and costing a certain amount. Do we need to get that specific?
ANDREW PESCE: I think it’s very helpful to have a level playing field. What we need to avoid is a situation where hospitals and doctors and nurses in one state believe that they’re a lot worse off just because they happen to live in that state, than some other state. So in that sense we need to have confidence that all the hospitals, no matter what state they are in, are working towards the same goals with the same amount of funding, the same amount of financial incentives if they’re tied into these targets and, if necessary, the same penalties if they don’t meet them.
So the function of those targets, if you like, is to have a nationally consistent approach across the whole country, given the funding follows performance. So I think it is important to aim for a common goal, but I don’t think we should get hung up on targets. They’re indicative. They help measure what’s happening in the system, and they may help identify what part of the system is working the best and what part is working the worst, so then we can learn the lessons from that to help us make the decisions to improve the performance where it’s most needed.
VIRGINIA TRIOLI: But are health costs consistent across the country? Is the cost of one procedure the same from one state to another?
ANDREW PESCE: No, it’s a very good point. So as you understand, we now have a national funding pool ...
VIRGINIA TRIOLI: Yeah.
ANDREW PESCE: ... where funding will be distributed according to a predetermined formula. The activity-based funding formula – and it was acknowledged in the heads of agreement last night – is there as a baseline, but has to recognise that different states have different cost structures, for a simple reason as the award for nurses or salary doctors varies from state to state. So the baseline activity base funding formula will need to be adjusted for each state to make sure that none is starting behind the eight ball, because they’re not getting a sufficient amount of funding to account for these costs.
Over time, it may well be that those differences might diminish, but whilst they’re there, it’s very important that funding for essential patient services is relatively constant and that variations that are required to meet the current differences in costs of each state aren't made up for by taking away from frontline patient clinical services.
VIRGINIA TRIOLI: Andrew Pesce, there’s some criticism about, and particularly being made by the Opposition and even those who are party to this agreement, they still have concerns about the layers of bureaucracy that will be introduced in order to coordinate and release from this pool of funding, the organisations, it will draw from the pool and then hand on and then hand on.
ANDREW PESCE: Yeah.
VIRGINIA TRIOLI: Do you have concerns about waste taking place because of the bureaucratic layers?
ANDREW PESCE: Yeah, unfortunately, I never learned of an operation where I could surgically excise bureaucrats from the health system and so we never know what’s going to happen. But, look...
VIRGINIA TRIOLI: A good dose of chemo might do that.
ANDREW PESCE: Which is exactly what we’re going to see happen if this starts to take place. Andrew Pesce, we’ll leave it there. Thanks so much.
ANDREW PESCE: Thanks a lot.
14 February 2011
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