Speech by Shadow Minister for Health the Hon. Catherine King MP to the Australian Healthcare and Hospitals Association 70th Anniversary Dinner

Tuesday, April 19, 2016

I start by acknowledging the traditional custodians of the lands upon which we are gathered.

Thank you to the Australian Health and Hospitals Association for your invitation to speak here tonight at your 70th anniversary dinner.

  • Alison Verhoeven who for many years now has been a respected and valued voice in health policy, and who I’m always happy to hear from
  • and AHHA Board Members Deborah Cole, Walter Kmet and Nigel Fidgeon.

70 years is an amazing length of time for an organisation to have been advocating for high quality healthcare in Australia.

It’s essential that we continue to have organisations like the Australian Health and Hospitals Association putting forward high quality, respected and representative advocacy for universally accessible, high quality healthcare in Australia.

This is especially true at a time when so many voices in the health sector are under so much pressure.

As many of you are aware, the Department has now isolated from the existing Flexible Funds the funding it provides to run peak organisations to, in the words of its Secretary “focus on who are the peaks that we fund to do broad consultation and broad activities.”

Just last week, in answer to a question on notice at Senate Estimates, we received the deeply concerning news that 79 of the 103 organisation who applied for funding under this new health peak and advisory bodies fund were knocked back.

This includes Arthritis Australia, the Women’s Health Network, the Cancer Council, the Federation of Ethnic Communities Councils, the Medical Deans, the Stroke Foundation, Parkinson’s Australia and Ovarian Cancer Australia.

Many of these organisations will continue to receive funding to run their activities, but not their advocacy.

That highlights why, now more than ever, a strong and respected voice such as yours must continue to be heard in the health space, advocating on behalf of all Australians, for fair and universally accessible healthcare.

This is doubly so when we are likely to be just weeks out from an election, an election that most commentators now tell us will be extremely tight, and where health is among the top issues.

Indeed, an Essential Research poll taken just last month found health was rated the top election issue by 43 per cent of Australians, six points clear of the next issue – managing the economy, and more than twice as important as terrorism and security.

It was, of course, the number one issue for Labor and Greens voters. But even among Coalition supporters health rated the second behind economic management.

So, there is a lot at stake in this election, and health will play a crucial role in deciding who forms Government in the coming weeks or months.

ELECTION 2016

Looking Over the Horizon. Where to next for the Australian health system?” could not be more timely, or appropriate just days out from a parliamentary sitting that appears likely to send us into an election within the next month.

When 2015 ended, the polls all indicated the result of that election was a foregone conclusion.

The fact we now have a contest, with polls showing the two parties to be roughly even, is entirely due to the hard work of the Labor team united under Bill Shorten.

As my colleague Jenny Macklin put it recently:

After an election loss, new oppositions have a choice to make.

They can linger in their gloom –

Or they can dust themselves off and get back to work.

Under Bill Shorten’s leadership, this Labor opposition got back to work.

The evidence of that was spectacularly demonstrated when we started this year with a fully funded schools policy, and bold ideas on how to make our tax system fairer and more efficient.

This was not a brief flowering of ideas, but the result of two years of dedicated hard work by a Labor team focussed on developing good policy. It will provide not only a platform to take us back into Government, but an honest platform for that Government.

In the coming weeks and months you will see this pattern repeated across the board in all portfolios, and, I’m proud to say, especially in health.

Much of the campaign debate on health will be focussed on public hospital funding. That is appropriate – hospitals are where we go when we are mostly sick or injured. And there is a stark difference between the parties on hospital funding and policy.

Labor will have more to say on hospitals soon. For now, suffice to say that Labor does not believe that reversing a fraction of the Coalition’s cuts will reverse the damage that the Coalition has done to our hospitals. And I can assure you, as Bill Shorten has assured all Australians, that our public hospitals will always be better off under Labor.

Tonight, though, I want to focus on two topics that are not getting as much airtime in right now, but are just as important: Primary Care and Prevention. In doing so, I hope to set out the context for our health policy – how Labor sees our healthcare system as it stands, and the broad reforms that Labor thinks are needed.

Medicare for 2016 and beyond

In his parliamentary speech introducing Medicare in September 1983, Dr Neal Blewett described the legislation as 'a major social reform' that would 'embody a health insurance system that is simple, fair and affordable'.

He also emphasised the 'universality of cover' as being 'desirable from an equity point of view' and 'in terms of efficiency and reduced administrative costs'.

The principles that guided Labor then are the principles that guide us today - that every Australian should have access to the best quality healthcare regardless of where they live and regardless of their capacity to pay.

But healthcare reform is never complete. The Medicare that was introduced in 1984 is not the Medicare we have today, and is not the Medicare that best suits the healthcare needs of Australians in 2016 and beyond.

Primary Care

In my mind, one of the key challenges we face is reforming primary care to meet the changing needs of an aging population with rising rates of chronic disease.

As Martin Bowles noted in a recent speech:

Our biggest concern is undoubtedly the growing burden of chronic disease.  There are also the challenges — but also opportunities — posed by rapid uptake of technology and our need to keep up, our ageing population and increasing consumer expectations.

This is an area where Labor started work when we were last in Government. And we welcome the work of the Primary Health Care Advisory Group, whose final report was released last month.

The Group’s core recommendation is a good but not surprising one. We have been thinking about the Patient Centred Medical Home model for a long time. The idea has been around since the 1960s, having originated among paediatricians caring for children with chronic illness.

All evidence from overseas suggests it is a very promising model for the future. And of course, there are Australian precedents too – like diabetes management plans, and DVA’s Coordinated Veterans Care program.

Australian practitioners and experts have been calling for an expansion of the model for some time. The RACGP’s ‘Vision for a Sustainable Health System’ is premised on the idea. And I was interested to note that the national review of mental health programs recommended the staged implementation of medical homes for mental health.

So the concept of a Patient Centred Medical Home is an idea Labor has been actively exploring in our discussions with the health community.

Of course, an Australian Patient Centred Medical Home model would differ from what is available in New Zealand or the United States. We need to think about how the model would work in our unique system.

But the model is not actually radically different from what happens as a matter of course in many practices – the lifelong journey of the GP looking after their patients, and managing and coordinating their care.

One example that comes to mind is of a practice I visited in Western Sydney. It was working with its then, Medicare Local, to identify populations most in need of treatment for chronic disease. The GPs had also expanded their clinic using a government infrastructure grant that has allowed space for an exercise physiologist, as well as a diabetes educator to be co-located within their practice.

The GPs at this clinic now run regular diabetes workshops. They spend one morning a week with a parents group teaching them about nutrition and exercise for under 5s. And inspired by their example, a number of their patients have started a walking group.

Two things strike me about the practice. The first is that GPs want to provide the kind of care envisaged by the Patient Centred Medical Home model. They know that’s best for their patients.

But the second thing that strikes me is that we need to enable GPs to deliver that kind of care. This particular practice had been supported by the diabetes reforms Labor introduced in Government. And, as I’ve said, their physical expansion – and the expanded services that flowed from it – was enabled by a government infrastructure grant.

In general, though, our system does not encourage or reward this sort of activity, nor does it reward outcomes. There is not really an MBS item for much of what we want GPs and other providers to do.

‘Healthier Medicare’

This is my key concern with the Government’s underwhelming response to the Advisory Group’s work. The Government says it will ‘revolutionise’ Medicare. But the change we need can’t be achieved with a grand total of $21 million for two years of care for 65,000 patients, or just $300 each. And, we won’t even know until the Budget if this is new money, or simply funded by even more cuts to health.

Of course, that marginal new money comes against the backdrop of billions of dollars cut from primary care. The Medical Journal of Australia says that the MBS freeze – the fourth iteration of the Government’s GP Tax – will cost the average GP $30,000 by 2017-18.

The transition to a Patient Centred Medical Home – and indeed other new models of care – is a complex, long term project. It can only succeed with the active support of GPs and other providers. I for one don’t think we can expect that support while the Government squeezes GPs’ revenue and forces them to perform more fee-for-service medicine.

MBS Review

Similarly, we cannot expect real reform if the MBS Review is just a front for a savings exercise, not an opportunity for new investment.

Labor is all for making sure that Medicare is modern and sustainable. In fact, it was us who introduced the independent, systematic review of MBS items via an MBS Quality Framework.

From Labor’s perspective, potential savings from the MBS Review should be reinvested back into Medicare to fund innovation in primary care and hospitals. This should be a continuous cycle, a part and parcel of healthcare reform, not an end in and of itself.

This is good, and smart healthcare reform, based on evidence, quality and safety in healthcare. It is not about rationing healthcare but exploring opportunities for reform.

BEACH Program

As we try to move toward the health care system of the future, those informed decisions are key. But over the weekend, news broke that the respected BEACH (Bettering the Evaluation and Care of Health) program is to be wound up. After 18 years of commitment by both political parties, as well as industry partners, there will be no further funding from the Department of Health.

Disturbingly, this is a far from isolated decision, with the department also defunding the Australian Primary Health Care Research Institute and the Primary Health Care Research and Information Service.

I’m relieved to hear that the University of Sydney is now offering a short term lifeline for BEACH, while it searches for alternative funding, that will prevent what was looking like the almost immediate collapse of this program.

BEACH is the longest continuous dataset for general practice in the world. It is also the only one that relies on random samples of GPs, links management actions to the exact problem being managed, and provides extensive measurement of prevalence of diseases, multimorbidity and adverse medication events.

BEACH has been an invaluable source of data, attracting the support of over 11,000 GPs during its time - which is a magnificent testament to how highly it is regarded. Its independent voice has been important and I believe the Government would be well advised to reverse its decision and give BEACH the support it has earned.

PREVENTION

Turning to prevention, no one in this room needs me to explain the chronic disease crisis, or the importance of preventive health in addressing it. But I think it is instructive to recap the approach that successive governments have taken to prevention.

The last Labor Government tackled chronic disease head on. As part of our historic health reforms, we established the National Preventative Health Taskforce, which recommended a 10 year roadmap for action on obesity, tobacco and alcohol. My personal view is that much of that work remains relevant today, and could help guide a future Labor Government. Labor also established the Australian National Preventive Health Agency, so that governments would receive ongoing expert advice on promoting health and preventing disease.

Of course, we also put our money where our mouth was. Under our National Partnership Agreement with the states, we committed $872 million to help children, adults and communities stay healthy.

We in this room know that investments like the NPA on Preventive Health make economic sense. You have probably heard the figure from the Trust for America’s Health, with whom I was pleased to meet last year – every $1 spent on increasing physical activity, improving nutrition and reducing smoking lowers health care spending by $5.60.

In contrast to our approach, the Abbott-Turnbull Government has gutted health promotion and disease prevention for savings. In its first Budget, the Coalition abandoned the NPA on Preventive Health and ripped the remaining $368 million out of prevention. This forced an end to important prevention programs across Australia, like:

  • Healthy Communities, which supported community-based healthy lifestyle programs like the Heart Foundation's walking groups and the Diabetes Council's BEAT IT program;
  • Healthy Children, which provided funding to states and territories to run physical activity and healthy eating programs for children in schools, early childhood centres and preschools; and
  • Healthy Workers, which funded workplace programs on healthy eating, physical activity, smoking cessation and reducing harmful levels of alcohol consumption.

The 2014-15 Budget also abolished the Australian National Preventive Health Agency. For a small saving of around $1 million a year, the Coalition got rid of its own best source of advice on keeping Australians healthy.

Labor will have more to say on prevention in the lead up to the election. For now, I can say that our approach will be more like the one we took in Government and less like that one that Tony Abbott and Malcolm Turnbull have taken.

HEALTHCARE REFORM

In closing, I want to say some words about healthcare reform in general.

To put it mildly, our recent reform journey has been marked by cycles of boom and bust. Too often we have taken two steps forward, only to take one or two back. Hospital funding deals done and undone. Medicare Locals established, abolished, and in essence re-established as Primary Health Networks. Significant time and expense taken to re-badge the Personally Controlled Electronic Health Record as My Health Record – and so on.

There are huge differences between us and the Coalition on health policy. In talking about primary care and prevention tonight, I have highlighted some of those. We are proud of our record, and will continue to hold the Government to account for theirs.

But ultimately, Labor believes that there should be a long-term commitment to healthcare reform in Australia, and that reform should be embedded in our healthcare system.

Healthcare reform shouldn’t be something the last Labor Government did. And healthcare reform requires much more than an announcement and some funding. It should be an ongoing process that ensures our healthcare system continues to meet the changing needs of all Australians. This requires a continuing process of policy and program development, implementation, monitoring, evaluation, communication and feedback.

I believe that governments – federal and state – can do more to embed reform in our health care system. Again, Labor will have more to say on this before the election.

But governments and politicians can’t do it alone – and in fact, we shouldn’t try. Reform should be driven by the people who know our system best – consumers, practitioners and experts.

So organisations like the AHHA, and events like today’s Think Tank, play a crucial role. Thank you for all the work you do, and again for inviting me to join you tonight. I look forward to continuing to work with you all as we move towards the health care system that is just ‘over the horizon’.

This speech was given by Shadow Minister for Health the Hon. Catherine King MP at AHHA's 70th anniversary dinner in Melbourne on 12 April, 2016.