Transcript - Staff the key to health system challenges

Transcript: AMA Queensland President, Dr Maria Boulton, ABC Brisbane, Mornings with Rebecca Levingston, Wednesday 14 June 2023

Subject: State budget

REBECCA LEVINGSTON:   You've heard about the healthy budget surplus, $12.3 billion, from the Treasurer Cameron Dick. But if the surplus is healthy, what is in the Queensland budget when it comes to health? Another record spend - an increase of nearly $3 billion - promises to address ambulance ramping. What is going to change for you or your family if you do need to go to hospital? Dr Maria Boulton is president of the Australian Medical Association Queensland. Dr Boulton, good morning.

DR MARIA BOULTON:   Good morning Rebecca.

REBECCA LEVINGSTON:   Health has been under extraordinary pressure of late. Will this budget relieve that pressure?

DR MARIA BOULTON:   All aspects of health have been under extraordinary pressure - hospitals, aged care, NDIS and also general practice – and there is some good news in the budget for health. At the end of the day, it'll be how it's implemented, the extra funding. It's positive that the actual operating funding in health has increased by 9.6 per cent. It's good to see that they recognise that increase in health spending needs to be greater than the cost of CPI and inflation. Whether or not it's going to be enough to undo the decades of neglect of funding of our hospitals and primary care system remains to be seen. But it's a good step.

It was also really good to see some funding go toward areas that are in the most crisis, which is maternity services and ambulance ramping. We're a little bit disappointed that there wasn't more to try and boost GP numbers because we know that that's an issue at the moment as well. But at the end of the day, it's great to see extra money go into health. The biggest challenge moving forward is going to be workforce. Where is the workforce going to come from to man all those services that are being funded?

REBECCA LEVINGSTON:   Yeah, interesting that you said that because there is that record promise to spend on reducing ambulance ramping. That includes six new ambulance stations, 144 new ambulances, 200 more paramedics. But I guess the hope in terms of health care is you don't get to that crisis point, that you are able to see your GP or those services in the community. So when you say you're disappointed there's not more money there to boost GP numbers to boost that workforce, what more can the government do?

DR MARIA BOULTON:   The government has announced some workforce incentives to bring healthcare workers to Queensland, and the incentives are greater if those healthcare workers work in rural and remote areas. We know that they are desperate for healthcare workers. But those incentives only apply to Queensland Health employees and we would have liked to have seen some incentives also to attract GPs and also to boost the number of medical doctors training to be GPs in a similar fashion to what's happening in Victoria. In Victoria, there was an incentive announced and what we hear is that the numbers of doctors wanting to go into GP training have risen a lot. This is crucial because at the moment what we're seeing is only 15 per cent of medical students want to become GPs, whereas when I went to university 20 years ago it was 50 per cent. Victoria has managed to turn that around with the incentives that they have offered and we would have liked to see something similar happen in Queensland.

REBECCA LEVINGSTON:   Wow, that is a huge shift for Victoria. So what's the incentive? Is it straight up cash?

DR MARIA BOULTON:   It is financial incentives, but also some assistance with one of their exams as well. And that's because when doctors do start GP training, their salary does drop a fair bit. That's to make up for that and also to attract more GPs to the regions as well. It could have been used to incentivise medical doctors who want to do GP training if they want to go to rural and remote areas. Rural and remote areas are desperate for any healthcare worker, be it nurses, allied health pharmacist, GPs and we know that they need that extra boost. GPs are so needed because we know that GPs keep people healthy and out of hospital. Investing in general practice definitely pays dividends by reducing the strain on our hospital system.

REBECCA LEVINGSTON:   I might put that query about the comparison to Victoria to the Health Minister, Shannon Fentiman, who will be on the phone after 9 o’clock this morning on ABC Radio Brisbane. Right now you're listening to Dr Maria Boulton, President of the Australian Medical Association of Queensland. Dr Boulton, the government saying they will open those seven satellite hospitals, are you confident they will also relieve pressure on the health system? How do you think they will play out?

DR MARIA BOULTON:   Once again, it remains to be seen and they're not going to be fully functioning hospitals, as we understand. Some of them will be able to deliver some minor help to patients who have, for example, a fractured arm. But they're not going to be like a fully functioning hospital as maybe your listeners may understand a hospital to be.

We are concerned once again about where the workforce is going to come from. We know Queensland Health is working on a workforce plan that encompasses public hospitals, but in reality that workforce plan needs to also include private hospitals, primary care and aged care. Because what happens is that if we're pulling workforce from one area to the other, then that area goes into crisis. Workforce is a huge issue and we need to ensure Queensland Health understands exactly how many staff members it needs, but also how many it needs to train and how many need to be recruited from overseas, and make projections of how many we are going to need in five and 10 years, so we're not in this same situation again.

REBECCA LEVINGSTON:   There's also money for a business plan for the Princess Alexandra Hospital's spinal unit upgrade that's going to focus on patient care. I don't know if you've had a chance to look at that. Is it going to make a difference? I guess one of the questions people are asking in that instance is how was that able to disintegrate to such a point where the care wasn't to the standard you would expect?

DR MARIA BOULTON:   I have had conversations with Dr Dinesh Palipana, who's been behind the advocacy there. The thing about spinal units is that many of their patients are there for prolonged periods of time - sometimes six months, sometimes 12 months. They do need the best care possible and everything must be done to ensure that every patient has the care they deserve and that the environment is where it needs to be as well. It's quite tragic when you see people who are in the prime in their lives who perhaps have a fractured back, who end up in the spinal unit for a prolonged period of time, and they need all the care possible. It's really important that, with that funding, they also talk to people who have that lived experience of being patients in that unit, but also the staff who work in that unit to ensure that funding goes to where it needs to go.

REBECCA LEVINGSTON:   Dr Boulton, this budget, as I feel like every state budget, it's a record health spend, but as you pointed out, close to a 10 per cent increase, the largest jump in health spending in Queensland's history. Is that a meaningful increase or is that inflation? I'm just trying to get a handle on some of the hyperbole around health announcements.

DR MARIA BOULTON:   Yeah. I'm not a health economist. We know that 9.6 per cent is certainly above CPI and inflation currently. But we also know that health costs are actually higher than inflation and we know there's a lot of people moving to Queensland - and why wouldn't you? But that will also put extra pressure. So it had to be a record spend because it had to cover CPI, inflation, but it also must cover the increase in presentations to hospitals.

The other thing is that we have an ageing population and a lot of people come to Queensland to retire. Along with age come chronic diseases and that requires more specialised care. Will it be enough? I don't know that it will be, considering we're coming from a crisis point and a lot of funding needs to go to health to make up for the decades of neglect that have gotten us to the position that we're in. But it's certainly a positive step, and it's certainly a better increase in expenditure than we saw last year. Of course, we're still waiting on the delivery of the new hospital beds. That's a work in progress. And once again, workforce is going to be really important there as well.

REBECCA LEVINGSTON:   Yes. Beds without nurses beside them can't really help. Just finally, Maria Boulton, the payroll tax amnesty finishes in 2025. What does that mean for GPs and patients?

DR MARIA BOULTON:   We have to acknowledge the Queensland Treasurer here because Queensland is the only state thus far that has provided us with an amnesty for this payroll tax. Basically there's been a change in interpretation of payroll tax law for tenant GPs. So now when you're a patient and you go see your GP, that consultation is liable for payroll tax in most circumstances. And that's been a change in the interpretation of the law. We were seeing practices that were getting these huge retrospective tax bills. What the Treasurer did, with the help of the Queensland Revenue Office, was provide an amnesty on that payment. But that amnesty runs out in 2025 and also it doesn't apply to new GP practices. So if you want to build a new GP practice, then those patients will be liable for that consultation to be taxed, which increases the cost of that service.

Next year is an election year and we will make this an election issue because it's really important that patients continue to have access to their GP and, with the cost of living pressures, that access cannot be more expensive. So we will be pushing for an exemption and we hope that once again Queensland leads the way and recognises how important it is for patients to continue to have that access to their GP, particularly in rural and remote areas where GPs do so much. They deliver babies, they provide emergency care, GPs are so integral to the health care system.

REBECCA LEVINGSTON:   Dr Boulton, appreciate your time as always.