Missed chances in federal budget
The federal budget did not answer the AMA's four main requests, but there are some wins, AMA Queensland Committee of General Practice Chair Dr Maria Boulton has told ABC Sunshine Coast.
Transcript: AMA Queensland Committee of General Practice Chair Dr Maria Boulton, ABC Sunshine Coast, Mornings with Alex Easton, Thursday 31 March 2021
Subjects: Federal Budget, North Queensland Pharmacy Trial
ALEX EASTON: Before the Federal Government released its pre-election budget this week, the Australian Medical Association sent it a series of ideas to improve the delivery of health services in Australia, and basically make us all healthier and ultimately, potentially save the government some money, maybe even make it some cash.
Maria Boulton is a board member of the Australian Medical Association Queensland. Maria, your title's actually a little bit more extensive than that. It's quite long, so I've just tried to boil it down there. Now there were four key ideas that the AMA proposed and we might sort of work through them, starting with the proposal for a 50/50 funding split between the States and the Commonwealth on health funding. That's a call that was also made by Queensland Health Minister, Yvette D'Ath, and that hasn't happened. So, why is that important?
MARIA BOULTON: Good morning, Alex. Hospital funding is slightly tricky because hospitals are funded by both the State and the Federal Government, and they are administered by the State Government. And what we've seen in Queensland is that our hospitals are working at over-capacity. So, our ambulances are getting ramped, people are waiting a long time to get a bed once they're in emergency, and elective surgeries have been delayed. We have a few proposals for both Governments. Starting with the Federal Government, AMA Federal proposed an increase in funding from the Feds up from 45 per cent to 50 per cent. Currently the split is the Feds fund 45 per cent and the State Government fund 55 per cent. And we were hoping that the Feds would increase their funding by 5 per cent, and we were hoping that the State would keep the funding as is, not go down of course, to try and alleviate some of these issues. That's basically at a federal level.
But at a state level, we need more beds. So, AMA Queensland calculates that we need at least 1,500 new beds, and when you look at hospitals in Australia over the years, there's been a decrease in the number of beds per population, which doesn't make sense when we're seeing an increase in chronic illness and we're seeing an increase in the use of hospitals, and COVID has just made that so much worse.
ALEX EASTON: Is that because there's been the development of ideas in how beds are treated? So they're not looking as a bed as in, is someone in that bed today? It's like, is someone in that bed for the next 10 minutes, kind of thing? So they're cycling through, which is why you see wards with capacities of 200 per cent sometimes.
MARIA BOULTON: Yeah, that's right. There is no capacity for surges. We would like to see hospitals running at 90 per cent capacity to allow for those surges. We're coming into winter. Winter is a really busy season in hospitals and we need that leeway, so that the hospitals can cope if there's increased demand.
The other thing we're seeing is that there are people who are waiting to go into aged care, who are sitting in a hospital bed waiting for that aged care to become available. We're also seeing that hospitals, you know hospitals need to also function seven days, so admin staff need to be there seven days, so that if somebody needs to be discharged on the weekend, they can be discharged and that bed can be used by somebody else.
There's a lot of reform that needs to happen, both that State and Federal level, and as a GP it doesn't really matter really who does it, but at the end of the day, it's the patient that suffers if A, they can't get seen in emergency in time, and B, if their elective surgeries are delayed. I've got a patient who's going to wait now for 12 months to have her gallbladder out, and she's a mum with young kids, and every month she ends up in emergency department in severe pain from her gallstones, and she ends up there for a few hours getting pain relief and who looks after her kids, right? So elective surgery, it's not a choice, it's essential, and there are people in pain that need them and think about those people like, oh my God, we need urgent reform.
ALEX EASTON: Yeah, that whole tag ‘elective surgery’ is so misleading because it makes it sound like it's a surgery you might want, but you don't necessarily need. But that's not actually the case.
MARIA BOULTON: That's right. It should be called semi-urgent because it's still essential. It may not be urgent, you may not need to have it in the next 24 hours.
ALEX EASTON: Yeah, or you'll die, kind of thing?
MARIA BOULTON: Yeah, or you'll die. But it's still affecting someone's quality of life. People who have gallstones, for example, a gallstone can dislodge and block your pancreatic duct and you end up with pancreatitis. So, it's not pleasant, and gallbladder surgery can be done, you're in hospital overnight, and then you go home, that's it.
ALEX EASTON: Yeah. The AMA was also calling for a tax on soft drinks essentially, and the idea was that would reduce consumption by 41 per cent, and reduce community health issues like obesity, type 2 diabetes, heart disease, and stroke. And at the same time would raise something like $2.8 billion in revenue for the government. That seems like it would tick a lot of boxes. Did that get any love at all?
MARIA BOULTON: No, it got no love and that's a real shame because we see sweet drinks creeping in everywhere and you see ads for them all the time. The worst thing I've ever seen is a child had Coke in a milk bottle. It not only affects all those conditions that you just said, but also their teeth as well, and we know that good dental health is conducive to good health. If we tax these drinks, hopefully they'll go up in price and hopefully people won't buy them, they'll go for the water instead. Then all that tax can be used to solve all those chronic issues that those drinks cause. That was the hope, but sadly it didn't get up, didn't get any love from the Feds.
ALEX EASTON: I mean, apart from generating revenue through the taxes, which I think the AMA had said that they hope that would be used for more health spending, but reducing type 2 diabetes, heart disease, and stroke presumably would save a lot of money in the health budget just by itself.
MARIA BOULTON: Yeah, a can of Coke or a sugary drink has about 10 teaspoons of sugar in it, and over time that equates to a lot of kilos that somebody carries, which increases your risk of diabetes, knee issues and people eventually end up with knee replacements, et cetera. If we could avoid that from happening, you know it's a lot cheaper to prevent illness from happening, than to treat it at the other end.
ALEX EASTON: Yeah. It's funny, isn't it? Because if you put 10 teaspoons of sugar in a bowl and just put that in front of someone and said, "Here, eat this." They’d go "Are you insane? Why would I do that?"
MARIA BOULTON: Yeah, that's right and these drinks are quite addictive, you know it's sugary. Sometimes when I have a parent who's trying to stop drinking sugary drinks, I'll say to them, "You know, just imagine you have your kids in the car with you and they're sitting in the back seat, and they're watching you just eating 10 teaspoons of sugar because that's what's happening when you're picking up a soft drink." That's what sometimes they use to try and stop.
ALEX EASTON: Private health cover has been becoming a bigger and bigger issue over the last few years, and the AMA’s asked for an independent authority to oversee the sector. What would that achieve?
MARIA BOULTON: Private health cover, what we're seeing is that a lot of young people aren't taking it up because it costs money and at the moment cost pressures are high, fuel is expensive, groceries are getting more expensive. You know, the mum I was talking about with the gallstones, she can't afford private health cover. If she could, she would be able to get that surgery a lot quicker through the private system. But in reality it needs to be affordable, so that people are able to take it up and so that people are able to get those semi-urgent surgeries done quicker.
ALEX EASTON: Isn't it just flat out wrong though, that you should have people who can get that kind of semi-urgent surgery relatively quickly because they've got private health insurance versus people who are using Medicare, which is supposed to be universal health coverage? Isn't it unfair they can't get it in the same kind of time? It used to be that private health just meant you got a few more frills.
MARIA BOULTON: Yeah, look, I completely agree and that is the truth. That's the idea of living in Australia, that we do have universal health cover. But in reality, at the moment with the wait lists being what they are, it's just not happening.
ALEX EASTON: If we had an independent authority, how would that improve things?
MARIA BOULTON: Look, I'm not an economist, but it's just looking at the economies, right? Once again, if someone is waiting for medical care and they get that medical care, they can return to being really productive people in society, right? They can return to work et cetera, and contribute to the economy. I guess it just needs the economists to have a look and see where improvements can be made, how those private health insurance... You know, I get an invoice every month, how that money's being used, and my making sure that it's a fair amount so that people are paying fair premiums.
ALEX EASTON: Okay. And that also didn't get up. And the final one, which I'm just going to go straight up, this also I'm pretty sure didn't get up, was a request for more funding for general practice. We've heard a lot over the years about GPs being underfunded, but we are seeing some consequences of that in Queensland at the moment, particularly with, there's the pharmacy trial up in North Queensland and I gather the AMA's done a survey of GPs, not just members of AMA, and it doesn't sound like it's going very well.
MARIA BOULTON: No. I'm a GP, so this is a topic close to my heart and my patients’ hearts. What we've seen over the years is the rebate for patients for seeing a GP not keep up with the cost of living. So when you look at what a Medicare rebate should be, it's less than half of what it should be. So basically general practice care has been underfunded throughout the years and we're getting to the point where once again, there's an increase in chronic illness, we're also managing a lot of people with mental health issues on the back end of the COVID pandemic and now the floods, and Medicare tends to reward short consultations, and we need more funding so that we can spend more time with our patients. General practice is extremely complex. Mental health issues take a lot longer. There's also the problem with domestic and family violence. Those consultations are a lot longer and patients deserve the funding to be able to talk to their GPs for longer to solve those issues.
I have worked in regional Queensland and I know that there are pressures in getting doctors to those areas, but the solution is not to swap those doctors with allied health professionals who don't have a medical degree. It's to get more doctors. The mining industry manages to get FIFO workers to mines all over Queensland. I don't see it as being that hard to be able to get doctors to those areas, but we need resources to be able to do that.
And you mentioned the North Queensland pharmacy trial. So in this trial, it's proposed that pharmacists will be able to diagnose and treat diseases such as diabetes, high blood pressure, ear infections, psoriasis, acne, and they're meant to be able to do this after doing an online training of 120 hours.
Now, a GP on average does 12 years of training at university and they want to replace that with somebody who does 120 hours online tutorial. When we look at pharmacists who go on to train and do a medical degree and then train and become a GP, the thing that they tell you is that they didn't know what they didn't know. That's what the survey has shown basically. So we surveyed 1,300 doctors in Queensland and most of the doctors have deep concerns about this trial because one in five doctors have seen issues with a previous trial, which was the one where pharmacists were able to prescribe antibiotics for urinary tract infections. So one in five doctors have seen pharmacists fail to recognise illnesses or prescribe the wrong antibiotic or not treat the patient the way that they should have been treated through that trial. And this is extremely concerning because above all our patients, our Queensland patients, especially those in remote regions, and sometimes these are our most vulnerable communities, deserve medical care by somebody who has a medical degree.
ALEX EASTON: You're hearing from Dr Maria Boulton from the Australian Medical Association Queensland. So we've been talking about the Federal Budget, but this specific issue with the pharmacy trial is a Queensland Government thing. So, there's issues that you've got obviously with both those levels of government. But in terms of what has come through or not come through from the Budget, it must be disappointing that, of all of those suggestions, you've got nothing. Is that surprising though?
MARIA BOULTON: Look, we were hoping for more. It is an election year and we know that health care is important and we saw that in the State Election in South Australia. There were a few things that we did get. For example, we got a promise to fund more regional training places for medical doctors, which is really good news. And there is some funding going towards the diagnosis and care of patients with endometriosis, which affects many women and it is a disease that requires a lot of time and team collaboration, which is really, really great.
But what we really wanted was real reform because we just can't keep functioning on the goodwill and altruism of health care workers, who have done an amazing job through COVID. But even before COVID, our systems were stressed, and if we want to keep enjoying the quality health outcomes that we have enjoyed in the past, we need to make sure that the funding is there to allow that.
ALEX EASTON: Yeah and I mean, I don't know, did you have any consultation with the Commonwealth before the Budget? Was there any indication they were even listening?
MARIA BOULTON: So our federal counterparts in AMA and our state counterparts as well have regular meetings with all levels of government and they do listen. But what we do need is action. We are disappointed, we feel that Australians deserve more. As a GP, we're the ones that care for patients as they wait to have that semi-urgent surgery. We're the ones who look after people with mental health issues who can't get in to see more specialised services, because there's a logjam there too. We're the ones that ring the patient to see whether or not they have been through emergency yet. So we're the ones that pick up the pieces and it's a sad state of affairs at the moment. And I mean, don't get me started on aged care and we need some real change.
ALEX EASTON: All right, Dr Maria Boulton, thank you for giving us so much your time this morning.
31 March 2022