HOST: Prime Minister, welcome to Melbourne.
PM: Good morning Steve, and congratulations on the new program.
HOST: Well, you'll be happy, we've created 30 new jobs down here on Melbourne Talk Radio, so that'll go to the bottom line on the unemployment numbers.
PM: I'm impressed. I'll be monitoring your performance, and I'll get the tax department to do it as well.
HOST: Thanks a lot. The new deal, when will we see a difference?
PM: Starting from 1 July this year, you'll start to see funding flow through to the states and territories to build 1300 new hospital beds. Also, the funding to deliver 2500 new aged care beds as well. These are fundamental changes. People have often asked also Steve about accident and emergency and about elective surgery. What we're doing with accident and emergency is that we are implementing what's called a four hour cap. That is, four hours- within four hours of presentation, patients will be treated or admitted, unless there is some clinically appropriate reason not to do so.
HOST: Aren't you setting yourself up for a fall there? I mean, you will be criticised now, not the individual states if- and you know what will happen, talkback radio will be full of people saying it oh wasn't four hours, it was six, seven, eight, ten.
PM: I think unless we establish a target here Steve it'll just get worse. We've actually got to make the system work, because long-suffering patients are sick and tired of this. It becomes- this will be implemented progressively, and I'm just being up front about that. I can't wave a magic wand overnight, because we've got to get more doctors into the system to make it work. So, what happens is, for the more urgent patients, this will commence from 1 January 2011. It will gradually roll out so that all patients will be subject to the four hour target by 1 January 2015. That's our position on the four hour cap when it comes to accident and emergency. The other one that people often ask about, Steve, is elective surgery. And on elective surgery access targets, that'll be staged so that we have a gradual improvement every year, with interim annual targets to be developed between the Commonwealth, each state, and clinicians.
But here is what we intend to do- by 2015, 95% of patients will be treated in clinically recommended times, and that will be progressively rolled out from 2012 on. So, it's important that we get these targets right, we make the system conform to them, because otherwise, it's just going to get worse and worse.
HOST: Real money, real beds, more doctors, more nurses. A real change in hospitals, and before the end of the year?
PM: We start from 1 July. As I was saying to you and to others today, Steve, I can't wave a magic wand and say it will all be fixed as of 1 July. It won't be. But unless we do these fundamental changes, guess what, it'll get worse and worse. And what the system needs is fundamental reform, so that we get rid of duplication, waste and overlap between the two levels of Government. That's what yesterday's reform plan was all about. And secondly, to invest in the new growth that the system needs. 1300 new hospital beds, 2500 new aged care places, 20,000 extra young people getting access to mental health services, 6000 new doctors.
And we've just spoken about emergency departments and elective surgery. This is a comprehensive reform plan, the biggest since the introduction of Medicare. I'm sure there'll be glitches in the implementation of this. That's just life. But unless we turn this thing around, and start to turn it around, it'll get worse and worse.
HOST: What was the deal maker that got Victoria over the line? Was it giving John Brumby continued control of his own money?
PM: Well what happens on the ground is this- and I would acknowledge John's core role in making this agreement come about yesterday.
HOST: Well he held out longer than the others, didn't he?
PM: Yeah, but John actually has had a lot of experience in running local hospital networks in Victoria, and it is no secret that we have looked very hard at what reforms Victoria has brought in, in recent years, and learned as much as possible.
HOST: So you think it's better here than elsewhere?
PM: Ah, I won't make that comparison, because it differs from category to category. Look at the recent Australian hospitals report. But I pay a lot of attention to what John has to say to these questions, because he's got a lot of experience. Second point, though, is in terms of this new system, what's it all about- the National Health and Hospitals network, funded nationally with the Australian Government for the first time being the dominant funder of the public hospital system of Australia.
This is a huge change from the past. In the past, we at best picked up 35% of their running costs. This is why we had to have that change in the GST, with one third of the GST now being retained directly into a national hospitals fund. But secondly, run locally, so that local hospital networks will be able to have more say in making sure they make the best decisions for the people in their area. On the funding mechanism, what we now have is a joint statutory funding authority between the Australian Government and the State Governments across Australia which brings together our funding for the system, the states' funding for the system, and through that payment authority, it is then made direct of course to the local hospital networks. This is a good reform for the future.
HOST: I talked to Nicola Roxon the other day- can you guarantee me this is not another layer of bureaucracy, not another bunch of people sitting around computers that aren't actually on a ward, fixing people up who are sick?
PM: Absolutely not. I mean, this is the nonsense I hear-
HOST: So no more bureaucrats?
PM: I said before that in terms of the overall implementation of these reforms- and I was adamant about this when I introduced this reform plan of ours at the National Press Club about six weeks ago- that there would be no net increase in bureaucracy. What we need to do is in fact dedicate more funding to frontline services. Therefore, what's happening with the introduction of activity-based funding, whereby hospitals are paid for the actual services they deliver right across the country, we are making sure that the lion's share of this funding is delivered to doctors, nurses, and those who are already under great pressure in the system.
Part of making it work also, Steve, is to make sure that we've got enough doctors coming through. That's why we've invested in 6000 new medical training places for the country. That will take some time to flow through in terms of doctors fully emerging. But that's- doctors and nurses are the engine room, the arteries, which make the whole system work.
HOST: It's complicated financially, but you're going to take a third of the GST revenue- but is there another impact elsewhere on the budget bottom line?
PM: We believe- we have costed this very carefully- I said when I launched this-
HOST: It's difficult for people to understand-
PM: No, I understand that. When I launched this new plan of ours prior to the last election, I said there'd be no blank cheque to the states. I said that if we did this, that there'd have to be a transfer of certain payments from the states to the Commonwealth. That's what the transfer of the one third of the GST is all about. And it's now dedicated directly to a national hospitals fund. The second part of it is the growth in the system over the next three to four years. And you've rightly asked about the changes which start rolling out now- and the long term growth, we will meet that within the fiscal disciplines of the Commonwealth budget. But we could not have done so unless we had that one third of the GST being brought over.
HOST: What are you doing about WA, Western Australia?
PM: Oh well, we'll-
HOST: You seem to be trying to play that down. I think you said oh, our friends over there haven't agreed.
PM: Oh well, let's just be blunt about this. We got agreement from five of the six states, both of the territories, that's seven of the eight State and Territory Governments of Australia, representing 90% of the country's population. I think your listeners want us to get on with the job of delivering comprehensive reform and better health and better hospital services now. As for the West Australians, we'll work our way through that in the period ahead. This will take a bit of time. I'm sure we will find an outcome, because I think the good people of Western Australia are waiting for better health and better hospital services.
HOST: You upset the WA Premier didn't come across?
PM: Well, of course we're all disappointed we couldn't bring about, you know, a 100% arrangement on day one. But we're not Robinson Crusoe here. We currently have several intergovernmental agreements where West Australia has not signed up. This is not the first, there have been others as well. However, my job- and for your listeners in Melbourne- is to make sure that we get on with the business of delivering better health and hospital services, whether it's at hospitals like I've visited recently in Melbourne at Maroondah, whether it's the other big hospitals, St Vincent's, look at the Austin- these places actually need help now, as well as your big regional hospitals as well.
HOST: Does this mean I can now stop playing 'the buck stops with me'?
PM: That's a matter for you, it's a free country Steve- but I'm very blunt about-
HOST: Does this deliver on that promise?
PM: That's what I said. Why do you think I've been doing this, basically non-stop for the last two years. We had to get- we didn't just pull something out of the air here. After the Government was elected and I made that comment, and prior to the last election- what we then did was set up a National Health and Hospital Reform Commission, that took 18 months. It had representatives from right across the country, clinical experts who went through the entire system, gave us 123 different recommendations.
In the last six to nine months, Nicola Roxon, the Health Minister, who's done a fantastic job on this whole reform, together with myself, we've visited 104 hospitals across the country. I did 21 or 25 of them myself, road testing these recommendations with each of them. And that formed the basis of the plan we put out six weeks ago, and as I said, 90% of the country is now signed on to it. I reckon what people want is to just get on with making these changes on the ground. It won't be perfect. It won't happen overnight. That's why I've been candid about the implementation timetables for the changes in accident and emergency and elective surgery. But Steve, if we didn't do this, if we didn't start this process now, I really worry that the system would just reach tipping point, and one day, fall over.
HOST: As usual Prime Minister, thank you, and thank you for your first interview on Melbourne Talk Radio.
PM: Appreciate it very much Steve, and happy to talk on the program.