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Transcript 17134

Prime Minister Minister for Health Transcript of joint doorstop interview Queanbeyan Hospital 15 March 2010

Photo of Rudd, Kevin

Rudd, Kevin

Period of Service: 03/12/2007 to 24/06/2010

More information about Rudd, Kevin on The National Archive website.

Release Date: 15/03/2010

Release Type: Interview

Transcript ID: 17134

PM: It's good to be here with Mike and with Nicola today to talk about an important step forward in health and hospitals reform.

The Australian Government is committed to a strong economy, protecting the jobs of hundreds of thousands of working families, keeping Australia out of recession when most of the world, the rest of the world, has gone into recession.

We're also committed to delivering on the basics for working families. Basics in education, basics in health and hospital reform as well. And there is nothing more basic in health and hospital reform than making sure that we have enough doctors, nurses, specialists, and the allied health professionals to keep our hospital system and our health system functioning.

If you talk to working families right across the country - doesn't matter what hospital you go to or which GP practice you go to, country, city - the constant story is this; there are not enough doctors, there are not enough specialists, there are not enough nurses. We hear this right across the country.

Furthermore, in an examination undertaken by the primary healthcare taskforce, we found that six in 10 Australians live in an area where there are shortages of available doctors. Six in 10 Australians living in areas where there is a shortage of available doctors.

That's why the Government, today, will be delivering more than 6,000 new GP and medical specialists to deliver better health and hospital services for working families. We believe the time for action has come

Let me go to GPs. The Department of Health estimates that to maintain current levels of GP and primary care services alone, we will need a further 3,000 GPs out over the next decade. However, we have to do better than simply fill that gap. We have actually got to improve the level of services that we provide through GPs.

One of the reasons why Australia has one of the highest hospitalisation rates among the developed economies is because we don't have enough GPs out there. And therefore, if you've got GPs, more GPs in the community, it means that patients have more, and different places to go. If they don't, they present at accident and emergency, and often end up in acute hospital settings. Therefore, fixing the GP problem is critical.

Secondly, let me go to specialists. Estimates from the Australian Medical Workforce Advisory Committee and the medical colleges tell us that there'll be a shortage of around 1,280 specialists over the course of the decade ahead. These are big numbers. A projected shortage of 3,000 GPs over the decade ahead. A projected shortage of 1,280 medical specialists over the decade ahead. And that's just to keep things going as they are, before you talk about the growth of the system in the future.

So what are we going to do about this?

Firstly on GPs - the Government will invest $339 million to increase GP training places to 1,200 students per year, starting with increasing it to 900 per year next year. This is double the number of GP training places that existed under Mr Abbott's time as Health Minister. In total, our investments will deliver an extra 5,500 GPs working in the community over the course of the decade ahead. That is, we will fill the estimated gap of 3,000 just to keep services running at their current levels, but we will be going beyond that as well, to make sure that there are further services provided by GPs out there for working families.

Let me turn to what we propose to do on specialists. We'll be investing a further $145 million to train more specialist doctors. This will expand specialist training into private hospitals, into community settings, and into, critically, rural hospitals, and deliver an additional 680 specialists into the health system over the course of the decade. That is within those particular training settings. Of course, beyond that, the Government, through its Health and Hospitals Network plan, will be for the first time taking on the dominant responsibility in the public hospital system for the teaching and training of specialists as well.

So on the one hand, we are adding another 680 specialists across the decade ahead, through these other training settings - private hospitals, community settings, as well as regional and rural hospitals - as well as for the first time the Australian Government becoming the dominant funder for expanded specialist training within the major public hospitals as well. These are the essence of the reforms that we have planned for doctors, for GPs, for specialists. In total, this plan to deal with the shortages in our medical workforce comes to some $632 million. This plan will be fully offset and the details associated with its funding will be outlined fully in the Budget which is due in May.

This represents new money for the system. This is a new investment for the future. We begin expanding these places as of next year.

This is a necessary reform for Australia. We've proposed a new health and hospital network for Australia, funded nationally, run locally, for the first time the Australian Government taking on the dominant funding responsibility for the future of the public hospital system. The exclusive funding responsibility for the primary care system. Exclusive responsibility also for the aged care system.

Can I ask Nicola to add to my remarks, given that she has been integrally involved in this and all other elements of our health reform plan.

MINISTER ROXON: Thank you Prime Minister. I just want to add a couple of extra comments, because today is a very significant announcement, appropriate that we're here with Mike Kelly, someone who deals both with the larger regional hospitals like Queanbeyan Hospital that we're at today, but also deals with the needs of GPs in smaller communities, and has been a very strong advocate for us getting this plan right, in addition to the rural incentives that of course were in last year's budget and commence on the first of July for GPs.

What we're doing today is investing in the lifeblood of our health and hospital system. We know that we cannot fix the imbalances in our system if we don't have a strong primary care system, and GPs are absolutely critical to that. So these extra training places not only will help meet the needs of the community, but will help meet the needs of our hospitals as well.

Of course, Queanbeyan Hospital is run significantly with its medical workforce as visiting medical officers, local GPs come in to the local hospital to provide services. So as well as fixing our primary care system, we're making sure that we're helping fix our hospital system as well.

We're providing more GP training places. We want young graduates, the numbers of which will be increasing over coming years, to see that General Practice is the place to be. It's where they can provide support for the community. It's where they can do a lot of the good work that they're trained for. And up until now there's been a cap on the places that has prevented some of those young students going into General Practice where they're desperately needed by the community.

We're also going to provide more support to doctors in training. For those in the health sector, the PGPPP program is a very important program. It provides young students and new graduates with experience in General Practice, rather than simply training them always in hospitals, exposure to General Practice as a vital part of our health system. And of course, importantly, training for specialists. We know that increasingly, as services are provided in private and community settings, and we want to encourage that, it helps the balance in our system, we need to provide more training in those other components of the system too.

And that's why our specialist program is targeted to rural and regional settings. It's targeted to private settings, and community settings. Of course, the public hospitals have done the lion's share of training before. But both they and our private hospitals and our general practices are calling out for the support that we are providing today to allow specialists to be trained in a better variety of settings, and we'll be working very closely with the colleges to ensure that the specialties that are in high demand and where there are shortages and the communities that are experiencing shortages are those that get the first priority for these new training places.

So I'm very excited about this announcement today, because we know we have to get the workforce right, the lifeblood of the system, if we're going to get health and hospital reform right. So I'm very pleased to be here with the Prime Minister to make this announcement, and we're of course happy to take any questions.

JOURNALIST: The specialist colleges have stood in the way in the past. Are they going to be on-side here? (inaudible)

MINISTER ROXON: Look, I think we've seen a significant change in the approach that many of the colleges are taking, and the virtue of course of us funding more of these places is the conditions that can be attached, whether it's for the specialties where there are shortages like obstetrics and gynaecology or pathology, general surgery can be prioritised, but also making sure that these training places can increasingly be undertaken for example in our major regional hospitals, not just in the CBDs where a lot of training will still be done, but needs to be enhanced in those areas where there are shortages.

JOURNALIST: But the ACCC has made clear as Bonge says - was talking about - that in the past, some specialist colleges have actively sought to limit their own numbers to keep their appointment book full. Are you prepared to take them on if that happens to make this happen? And secondly, you're providing a lot of new doctors, but how do you make sure that they don't all settle within, you know, five kilometres of the GPO rather than going rural?

MINISTER ROXON: Well this is why it's such a carefully designed announcement, and why it complements the initiatives that were announced in last year's Budget in terms of the incentives for rural and regional GPs. It's why we are prepared to put money on the table for specialist training places, and with that will come conditions. And my discussions with the colleges to date have been very supportive of this.

You'll of course - I don't want to put words in their mouth - you'll need to talk to them directly, but if we see any misuse or abuse of these programs, of course we would act strongly. But I'm actually very optimistic that there is a realisation from our community of doctors that some services are not being provided in the community because of a poor distribution of specialists, and a poor distribution of GPs. We can pull our weight, that's what this announcement's doing, and we certainly will be expecting and encouraging the colleges to pull their weight.

JOURNALIST: And if they don't?

MINISTER ROXON: Well, we're making this announcement today and I'm very optimistic that they will be very positive about it.

JOURNALIST: Will you make the places bonded so that people who get (inaudible)

MINISTER ROXON: Well, as I think any one of a number of specialists who are here or working at other hospitals will already tell you, the training period is a long period for specialties. These services can be provided while people are in training. That, in itself, makes a significant difference to the services that can be provided in rural and regional communities, and, of course, when you then balance that with, for example, in general practice incentives that are very generous now being offered, I am confident that we can make a significant difference to the shortages, both in terms of specialties and in terms of regions where there have been shortfalls.

JOURNALIST: Mr Rudd, (inaudible) Victoria, what do you do next - do you override Victoria or do you go to the next election?

PM: All I'd say in response to that, Michelle, is one step at a time. We've had some good discussions with the premiers of NSW, Queensland and Victoria so far. We've got a few weeks to go yet between now and when the Council of Australian Governments meets, but our bottom line hasn't changed one bit.

Can I add also to Nicola's answer concerning rural and regional areas, which was raised, I think, just before?

You know, what's the big problem out there in rural and regional areas? I grew up in a small town in country Queensland. I think we had a visiting doctor once a month for half a day. This pattern across rural and regional Australia, frankly, has not been getting better. It's probably been getting worse. So what can you do about it?

The first thing is to make sure your overall supply of trained GPs increases. This is a very big step forward. We're talking about 5,500 GPs.

The second is this - the distribution of both those GP training places and the distribution of the specialist training places will be very mindful of the needs of regional and rural Australia.

Thirdly, what I find when I go to communities in the bush and elsewhere is that if a GP is trained in a local area and begins to establish roots in that local area, they tend to stay in that local area. The key thing is to make sure that you've properly distributed GP training places out there in regional and rural centres which make it possible, and similarly for specialists as well.

This is an important reform, not just in terms of the overall need for more doctors in our system, and more GPs and more specialists - it's also to deal with what is a chronic shortage of those services out in rural and regional Australia.

JOURNALIST: When will you be talking to Jon Stanhope (inaudible)

PM: Pretty soon. We've had a quick chat on the phone already, and it's less of a commute than it is to Perth, so I'll probably head to Perth before too much longer.

MINISTER ROXON: Can I just add onto that, too, because I've had several conversations with Katie Gallagher, and those of you who cover ACT politics will know that this announcement for GPs is absolutely critical - in fact, their top-order request in terms of health reform - because, surprisingly, there is actually a severe problem with GPs in the ACT, both in terms of numbers and lack of bulk billing. So I am sure that when that conversation is had that these announcements today will be very much welcomed by the ACT Government.

PM: Where the rubber hits the road with a lot of this, it's been useful talking to the health experts here in Queanbeyan this morning, and listening to Mike and his comments about this community and health care services here over a long period of time. I've just been through this hospital, which I'm advised has 32 beds, not many of which are occupied at the moment. That's just the truth. Part of that lies in the fact that we have some real workforce challenges here.

Secondly, we have an operating theatres capacity - three theatres I'm advised by one of the docs this morning, capable of doing, I think, if I can recall correctly, about 120 a procedures a month presently operating with about 20 or 30 procedures a month. Therefore, we've got a problem there.

Thirdly, as Nicola has just said and Mike has certainly been saying to me for a long time, the adequacy of GP services in the community as well, which is why, down the road here, a GP Super Clinic is being put together and I understand will be open sometime in the early part of 2011 so that you've got enough doctors, more flexible hours, operating out there in the community, but also there's enough doctors operating within hospitals like this to actually use them to their proper capacity.

JOURNALIST: (inaudible)

PM: You know something? Hospitals like this have a huge future under the National Health and Hospitals Network of Australia, because what we're dealing with is one - how do we fund the system properly for the long term? Two - how do we make sure we have enough doctors, GPs and specialists to run the system in the future? And three - how do we also make sure that the other necessary reforms are embraced by the states and territories as well.

One footnote on that - again, the locals tell me today that here we are in Queanbeyan, which is part of a health region which is, I think, called Greater Southern Area, which starts up somewhere near Goulburn, goes to the Victorian border, east to the coast and west to somewhere.

Now, can I just say that's a fair bit of turf, OK? And in this part of the world, while I am very reluctant to engage in the business of where you should draw lines around communities of interest, surely we should start thinking about why a local hospital network in this area doesn't bring together hospitals in Canberra, in Queanbeyan, in Yass and Cooma and to make some sensible, local, community-of-interest decisions for the future.

JOURNALIST: Back to this hospital then, there's three or however many operating theatres idle at the moment. Doesn't the real problem, again, get back to the behaviour of doctors? They won't get off their tails in Sydney inner city or perhaps in Canberra, although the customer can't get a doctor there either, and come out here and work? Don't you have to compel them or do something?

PM: Two key things that we're doing here - one-

JOURNALIST: - Well, you know, I'm not joking, you're from Queensland, you can't get a doctor north of Nambour?

PM: Just listening for command and control and civil conscription. Can I just say this? Key problem, key challenge, is where do you physically fund and provide enough GP training places for the future? And what we are doing across this very large increase in the GP workforce is to make sure that they are going adequately out to rural and regional hospitals as well.

And secondly for specialists, this package concerning 680 specialists is focussed on rural settings, it's focussed on community settings, so that we can make it possible for people to become well grounded, well entrenched, well integrated with these local communities, where they want to stay, have their families, grow up, have their kids go to school. You've got to do things that way. Command and control? Well, let's see how this one works.

JOURNALIST: (inaudible) provider numbers on a geographic basis?

MINISTER ROXON: Can I just add one comment to that, which I think really does go to the core of that issue?

One of the most significant shortages in specialties is for general surgery - general surgery that would actually be used in hospitals like Queanbeyan Hospital, so we have to actually deal with the pipeline as well. We have to make sure we are training people in the right specialties and encouraging them to work in the places where there are shortages. We can't just do one or the other.

If we made some rule, as you're suggesting, there would simply not be enough bodies in a number of these specialties to meet the needs across the country. So we have to enhance the training places in specialties where there are shortages and lots of them are the ones that are critically felt in rural and regional Australia.

And we have to get the mix of our other funding right, as the network plan that was released about 10 days ago seeks to do, to get our rural incentives right, so what you see is this jigsaw coming together to meet the demands of the community, the correct demands of the community to have proper services closer to home.

JOURNALIST: (inaudible) suggestion you'll need to pay remote hospitals 55 per cent more than a city hospital to keep it open and regional hospitals will need up to 22 per cent more. Are they going to get that much?

PM: Well, we said very plainly the other day in response to a fear campaign being launched elsewhere that there will be not a single hospital in rural and regional Australia which will be required to close as a result of the introduction of the new National Health and Hospital Network - not one. We've been very plain about that.

Secondly, therefore, we will be designing the way in which hospitals are funded for the future to take into account the different costs of delivering services in rural and regional Australia. That's just a fact. People live out there. Therefore, you've got to make sure that they have decent access to healthcare services. You can't provide those services on the same cost structure as apply in the inner suburbs of Brisbane or the inner suburbs of Sydney. It's just different.

And when you get to Indigenous health, it gets even more of a challenge.

Sorry, you had a question as well.

JOURNALIST: Mr Rudd, you're sympathetic to the problems Barack Obama's facing on health reform. Given the real difficulties he's facing, do you think there is a chance he won't make it to Australia, and given that Hillary Clinton's already had to pull out, what does it say about the nature of the relationship?

PM: Oh, the relationship with the United States is in pretty good working order. I deal with the President a lot, as does Stephen with Hillary, as does Senator Faulkner with his counterpart in the United States.

Barack Obama has challenges when it comes to getting health reform through a troublesome senate. I have a lot of sympathy for Barack Obama because that's part of the democracy that we have to deal with.

JOURNALIST: Do you think he'll still make it to Australia?

PM: Look, our most recent advice is that the visit will be delayed and shortened a bit, but look, we're pretty relaxed about all this. It's a great relationship. I catch up with the President quite regularly, certainly on the phone, and we are meeting constantly at international conferences, and our officials are working together the whole time.

He's a welcome guest in Australia, whenever he can get here and for how long.

And having said all that, folks, we've got to zip and get back to Canberra. See you.

Transcript 17134