PM:Okay folks, over to you.
JOURNALIST: (inaudible)
PM: What we put forward is three strategic options for the future. We've said that we will frame a final proposal to the States and Territories by early 2010, and if the States and Territories don't like that, we'll take it to the people. That's our process.
The second reason for doing it that way is as follows. We have had twelve years of inaction on health policy reform. We received this report three weeks ago. For all Australians, this has big implications.
Secondly, there are also profound revenue implications. Which is why we need to see the content and the Henry Commission, which is due by the end of this year.
Another reason is that we are waiting for new demographic data which will be obtained in the next version of the intergenerational report.
And the final thing is this: it's more than 20, or about 20 years, since there was a root and branch look at the Australian health and hospital system. And therefore, all Australians have a huge stake in this.
Australians want to make sure that we get these decisions right. Therefore the ability of Australians to participate in this debate, based on concrete proposals for reform as outlined in the Commission's report, is the right way to go. That's why we're doing it in the way in which we're proposing.
JOURNALIST: (inaudible)
PM: We keep both those options of a plebiscite or referendum available. And we would clarify that at that time, once we'd been through the process that I have just described.
JOURNALIST: (inaudible)
PM:As we've indicated prior to the election, it would be by either of those two mechanisms.
JOURNALIST:(inaudible)
PM:First of all, in the case of Denticare, you'll notice from my remarks today and the content of the Commission's report that it specifically flags one possible funding source for that, which is an increase in the Medicare levy by 0.75 per cent, that's one point.
Second, more broadly, the Secretary of the Treasury is acutely aware of this process which is underway, and I'm sure will be entirely mindful of it, in the framing of the long term recommendations of his inquiry into the future of the Australian taxation system.
I think that's a proper and sober way to go, because if you're serious about long term health reform, let's cut to the chase here - people want better, and better-funded services in the future, which help produce better health outcomes. They also want to know whether it's financially sustainable in the future as well.
These are the two tensions that we're going to be working with, in the debate in the period ahead, we think it's the right way to go.
Just one addition by the way to the earlier point about consultation ahead. Our major public hospitals are at the front line of so much of this debate and the actual delivery of the services. And as I said, the Minister and I will be engaging in direct consultation with these hospitals, starting with Royal North Shore in Sydney tomorrow. Testing their response as people in the front line, the recommendations contained in Christine Bennett's report is very important. We need to make sure from their perspective, quite apart from the rest of the health profession, quite apart from the general community, that these are the right way to go.
JOURNALIST: (inaudible)
PM: Well let's just be absolutely bottom-line about this: every Australian depends on their hospitals. Every Australian depends on their GPs. And after twelve years of total policy neglect under the Liberals, we're getting on with the business of comprehensive national health and hospital reform.
Secondly, can I just go to the assumption which underpins what you seem to be referring to today, if I go to the New Directions for Australian Health document of August 2007. We say: “if necessary, federal Labor will also consider the possibility of conducting a national plebiscite or referendum following the federal election on the question of any proposed Commonwealth takeover”.
Earlier this year when asked about this on a radio program I said: “what I said before on the future of the hospital system was that we would get to about midterm and we would review the outcome of the National Health and Hospital Reform Commission's Report”, that's what we're doing, “on the future allocation of responsibilities in health and hospitals between Canberra and the states. We'd look at the options they'd put forward and then we'd frame our decision on that. And if we decide based on that we need to move forward and take responsibility for the funding of the hospital system in the future, then as I said we would seek to get that support by way of going to the people directly.” That's what I've said. These are the stages that we've talked about.
The report was, the Commission was established in the very early days of the Government. It reported about midterm. We've received their recommendations. We will now engage directly on the hospitals and the rest of the health sector and the community on that. Put a considered and final position to the states with which they will agree or disagree. And as I said, if they disagree for the program of national reform, then, we'd proceed to the option that I've just referred to in my answer to Michelle.
And if I could just conclude on this question in this regard. On the timetable which was this, taking a question to the Australian people at the next election, that is completely on track. That's why we have outlined the process we've done so. But there are so many fundamental elements in these big decisions which are relevant to so many in the Australian community, we've got to get it right.
JOURNALIST: (inaudible)
PM: Well after twelve years of absolute neglect on this front Mark, under the Liberals, we've commissions this report, the first fundamental root and branch look at the system for nearly 20 years, and we've said that as of when we get to early 2010, concrete plans to the state and territories. They accept it, fine, we'll do it cooperatively. If we don't and they reject it, we then go to the people. That's what we're talking about. That's the responsible course of action, and that's what we intend to do.
Also, let's go back to the underpinnings, which I think is, your legitimate representation of.-
JOURNALIST: (inaudible)
PM: - no, hang on, your question goes to the question of people's expectations of what they want in the hospitals. When can my access to elective surgery be improved? When will I have my waiting times for accident/emergency made better? When will I be sure that there enough aged care beds so that when a person is finished in a hospital that they have somewhere to go? These are the big ones. That lies at the absolute core of the three strategic options we are now working with the sector on, and will reach conclusion on, by early next year.
Decisions will then be taken, either cooperatively or not, and if they're rejected by the states and territories at that time, we go to the people, and then implementation begins subsequent to that. And that is entirely consistent with the timetable we put prior to the last election.
Can I take this one here, this one, then I'll come back to yours.
JOURNALIST: (inaudible)
PM: We need to improve access targets fundamentally, and that I think underpins the wisdom of what is contained in the report's recommendations there. But can I also re-emphasise what I said in my prepared remarks before. That is, that we want to have a mature national debate about this report in its totality, rather than engage in rule in/rule out any one element of it prior to that debate concluding. And as I said, going to the coalface with 24 or 25 hospitals in the period ahead is part of that process.
Sorry, you had a question.
JOURNALIST: (inaudible)
PM: Can I draw your attention to what I said in my remarks about the brace of health policy reforms that the Government has implemented, notwithstanding the fact that we hadn't received this Commission's report by then.
Firstly, on preventative healthcare, you now have the single largest investment by the Commonwealth, some $872 million.
On primary healthcare, investment by the Commonwealth to establish some 35 plus GP Superclinics in order to extend the fabric of primary healthcare services across the country.
And thirdly, through the Australian Healthcare Agreement which was framed last year, that we now have specific agreements with the States and Territories on accident/emergency and/or elective surgery which will be measured in terms of clinically acceptable times against the inputs of the dollars which we delivered.
They are just three areas where the Government has already acted. As I said in my earlier remarks, we were mindful of earlier advice which was provided to us the Reform Commision about the likely future direction of their recommendations so we were very mindful of where we put the dollars in before they came up with their final report. So therefore to go to the crux of your question, we've been at this from day one. But we've also got to the second stage, which is this comprehensive, systemic reform. And the process we've outlined, we think, is the right way to go.
Sorry, this one here then I'll come to you.
JOURNALIST: (inaudible)
PM:Nice try. Can I just say that our intention, as I've always said, is to serve a full term. Secondly, the process that I've outlined is I think the right way to go, given the complexity of the decisions which have to be made, which are both of a policy nature and of a funding nature. And also, remember our pre-election commitment was to, with the states, either do it cooperatively, or, if the states didn't agree, to let it go to the people. For that to occur, the Government has to provide the states with a concluded, final position in terms of the pattern of reform we want for the future. That's why we've outlined the COAG process that we have.
My preference, as I've said right from the beginning, is to do these reforms cooperatively. But, if they're not accepted in the way in which we the Commonwealth judge to be appropriate to the long term health needs of the country, then we reserve the option of going to the people.
JOURNALIST: (inaudible)
PM: As I said in my remarks before, it is quite plain from the data, that health outcomes of regional and remote Australia are in many cases worse than for the metropolitan areas, the metropolitan areas of the country. And therefore, we are quite plain about the fact that additional resources, and new and better ways of doing things, are going to be important.
On Saturday, in Tasmania, together with the Premier, I help lay the first optical fibre cable for the National Broadband Network. That will be one of the mechanisms available to the system in the future for the better delivery of healthcare assistance to those in rural and regional areas. But, as I said in response to the question before about the question of the national access targets, we'll work our way through the debate with the health system over the next six months or so, and we'll reach conclusions come that COAG to which I've referred to.
JOURNALIST:(inaudible)
PM: Look, consistent with what we said prior to the election, on your second question first, consistent with what we said to the people prior to the last election, our plan in those circumstances would be for a plebiscite or a referendum.
Secondly, on the question of future funding sources, can I say the Commission has indicated its assessment of what the costs associated with these reforms would be. A further reason for the consideration of this over the second half of this year is as follows: we need to have all this tested of course by the Treasury, and gone through thoroughly. And on the possible sources of funding, we are entirely mindful, therefore, of where the Henry Commission lies. So we're not in the business of ruling in or ruling out particular forms of funding underpinning these reforms.
But what do Australians want? They want a better healthcare system. They want to make sure that waiting times for elective surgery are reduced. They want to make sure that when you front up with your kid whose had an accident or emergency they can be seen in a reasonable period of time. And that if you're discharged from hospital having had an acute piece of surgery that the post-hospital services help you get better as quickly as possible. These are the policy goals. The actual form of governance between Commonwealth and States is the next set of considerations under that. We've got to be confident that we get those results which matter to people, as I said in the speech before, that's where the rubber hits the road with real Australians in the real conditions, before we reach a final landing point in governance.
JOURNALIST: (inaudible)
PM: Well, your question before went to implementation. And consistent with what we said prior to the last election is that implementation for this full set of reforms would flow subsequent to the next election. That's broadly consistent with what we said before, and therefore that'll take some time to work through.
As of when those policy decisions are taken, as they flow through to real funding commitments, and new changes on the ground, then of course I become responsible for the system. I accept that. And I've never tried to walk away from it.
In my remarks today I began by reminding everybody what I had said. I don't walk away from one of those things, nor will I.
Too many people have advised us politically in the past ‘don't go near this with a bargepole - it's too hard, it's too complex, it's too expensive.' But you know something? If you're serious about the time that you have allotted to you in Government, this is something that you've got to grasp with both hands, and get it done, and then people will judge whether you've done it effectively or not. We intend to do that.
There will be bumps and twists in the road. There will be complaints and objections to the way in which it's done. That's inevitable. The alternative is to say ‘all too hard, blame the States and Territories; it's always worked as a political script in the past.'
I don't buy that, and I don't think, if you look at the content of the report, when they describe a new tipping point in the system, that galvanises my mind. There's too many things that are backing up on us.
Therefore, if you don't act now for the next 10 or 20 years, there's a great danger that the system will start to fall apart.
JOURNALIST: (inaudible)
PM: No, I'm just stating the facts for what they are. We've got a global economic recession which has delivered a $210 billion hit on the pocket revenue. That's just a fact and we can't wish that away. It's just there.
Secondly, however, it should not get in the road of a considered implementation of the reform recommendations which have been put forward by Christine Bennett and her fellow commissioners, and to do so in a way which puts two things together. And that is, the best policy possible with the funding envelope which is deliverable over time.
We've got to get this right. It's hard, it's complex, but when we look back on our time in Government, however long that might be, and it lies within the purchase of the Australian people, I want them to have concluded that we have had a go at this, rather than just turned to one side and say: ‘all too hard'.
JOURNALIST: (inaudible)
BENNETT: Well, actually, action is starting tomorrow with the continuing of the conversation with the Australian people and taking our proposals to people working in the frontline for their response. So I consider the action as starting tomorrow.
JOURNALIST: (inaudible)
BENNETT:This was always a long-term health reform plan, and it's going to take time to actually work out how it's going to be implemented and executed, because there can be great policy, but poor execution. We're interested in great policy being well executed, so that will take time.
JOURNALIST:(inaudible)
PM: No, I said that Ken Henry, consistent with the terms of reference of the future revenue structure of the Commonwealth, and also as part and parcel of that, that we be very mindful of the long-term funding needs of this system, which are big and huge.
Remember, I said in my remarks, in terms of total national investment in health and hospital care, running at about 8.7 per cent of GDP now, running out to 12.4 per cent of GDP in the future. This is a big slice of the national income, it's a very big slice of the national budget. We've got to get it right.
By the way, can I get back to your earlier question as well about so-called delay. I mean, we were very clear what we said beforehand - commission reports, we receive the report, Government then frames its policy decision, we then go to the States and Territories, States and Territories accept or reject, if they reject we go to the people. We have said that from the beginning. We're consistent with the process we originally outlined.
JOURNALIST:(inaudible)
PM:What I think I'll draw to your attention is, we in the measures which have been introduced since the nation building for recovery plan included some $3.2 billion worth of investment in hospital and medical research related infrastructure, from memory, Nicola, across about 32 projects in the nation.
The second largest killer in Australia today is cancer. What you've got by us is the single largest investment in cancer physical infrastructure ever undertaken by an Australian government, $1.2 billion. The Chris O'Brien Centre in Sydney, which you'd be familiar with, attached to RPA, the MacCallum Institute in Melbourne, together with a proposed network of integrated cancer centres across the country.
That's just one category.
Looks at the other categories of physical and medical research, and physical hospitals. For example, our investment in Nepean Hospital in Sydney which is for extreme depression.
In answer to your question, Mark, there is $3.2 billion worth of investment there.
Prior to that, there is a large investment also in the primary care sector with, from memory, Nicola (inaudible) $275 million for GP Superclinics.
If you're looking at future directions of primary health care, what are we on about here?
In the world described by the Commission, it's that when people go to a GP and need a GP-related service, whether it's for physio, whether it's occupational therapy, whether it's podiatry, all those outlying services, that they are more and more accessible to people in their localities so they can be accessed early and more cost-effectively as well. That's better for health and better for the health budget. Rather than people fronting with an accumulation of these problems (inaudible) in an emergency.
So, mindful of where we needed to go with that long-term, it's why Nicola has been so strong on rolling out these GP Superclinics across the country. It's quite a large number, because the whole rationale there was so our investment in GPs around the country is to aggregate those services into these integrated community health care centres that are so much described in (inaudible) report.
JOURNALIST: (inaudible)
PM:Both Nicola and I are big on teeth.
That is, if you're from our tradition in politics, you meet so many working people across Australia who have real problems affording basic health care. This really sticks in your craw that we've not dealt with this effectively as a nation so far.
What'll be our final landing point on the policy? I can't answer that at this stage. I've described the process by which we'll get there.
But we've actually got to lift our game here. In the historical data quoted in the Commission's report, about 650,000 Australians, as of I think a couple of years ago the data comes from, waiting on public dental waiting lists, is unacceptable.
Remember also the Minister has already introduced a dental care program through earlier policy announcements which the Government would (inaudible)
ROXON: Yeah, I mean, the teen dental program has actually been very successful. Of course, remember that one of our election commitments has been repeatedly blocked in the Senate, not just by the Liberal Party but the Liberal Party and the minors. So this is an area where we want to act, we have been able to enact part of our program. Where the Senate has blocked further action.
But of course Dr Bennett's report takes it further, recommending that we take over all of dental care with an increase in the Medicare Levy, and of course, that will be, I think, one of the very topical discussions as we kick off this process tomorrow, because we know that as the Prime Minister has said, dental health is becoming an indicator of wealth or poverty in Australia, something that the Labor Government, obviously, isn't happy about.
JOURNALIST:(inaudible)
PM:Well, one part relates to the whole of this entire proposed reform of the hospital and health care system.
You see, the problem is dental care has often been seen as existing to the side. The health professionals advise us that the incidence of broader infections arising from inadequate treatment of dental problems translate into the entire system, so we actually prefer to see this as an integrated (inaudible).
Nicola's brought in some great stuff on this so far, against some opposition. There's a lot more to be done and the proposal for Denticare is a big one, and it actually costs a lot of money, too. So it's good to be out here today.
JOURNALIST: (inaudible)
PM: Could I say that the previous Liberal government abolished the Commonwealth Dental Agreement. We have sought to act in response to that abolition. I go back to my response to the earlier question about it being integrated, not separated.
The third point I'd make in response to your question is this: it's expensive, and we therefore will integrate this with the rest of the health policy proposals on the back of the receipt of the Henry Commission report as well. That, we think, is the right way to go. But also, it's cleaning up lines of responsibility in the system as well.
JOURNALIST: (inaudible)
PM: Well, we believe that health and hospital reform has been waiting for a long, long time. We want to land results from this as early as possible. We've outlined the reasons for the process that we have embraced. But if there is a no-go from the states and territories on the decisions that we land as a Commonwealth Government, then we would not seek to waste a whole lot of time before we actually took it to the people, bearing in mind this is most efficiently done, of course, as I've said before, on the back of a general election. Just in terms of cost in the process.
JOURNALIST: (inaudible)
PM: Well, you work with what you've got, Michelle, which is nothing done on health care reform for 12 years. We say not good enough, let's have a Commission to tell us what they're blueprint for the future is. We've got that.
Secondly, we frame what decisions we think are appropriate for the nation in response to that, mindful of the funding dimensions of it as well.
Thirdly, seek to do it cooperatively.
Fourthly, if the States don't buy it, we've told you what we'll do about that.
I think that constitutes sufficient forward planning.
If the people were to say no under those circumstances, then of course you back to the drawing board, but our business, whether it's on climate change or anything else, is to get on with the business of making a difference.
Just to conclude on that also. I think someone before, I think it was Daniel Street, was quoting some criticism from the Liberals on this. I don't know what the Liberals position on climate change is, waiting for that to become clear for quite some time. I certainly don't know what the Liberals' position is on this area of reform either. Having looked this morning at the statements from Peter Dutton - calling for a takeover. Joe Hockey - cannot back a takeover without seeing the detail. Nick Minchin - takeover won't fix anything. Peter Dutton, again - open to radical reform. Tony Abbott - wants local hospital boards. I have no idea where they stand in response.
We are now working our way calmly, systematically, methodically through what I think is one of the hardest areas of public policy in our nation. We intend to get on with the business.
We'll be criticised on the way for not getting it perfectly right. That doesn't bother us. We intend to do as best we can and have a real go at fixing this problem.
And can I just conclude on this: the commissioners have warned us about a tipping point in the system. That is, the slow accumulation of aging of the population, the cost of medical interventions, the emergence of the two-tiered health system.
You can either just push it off, or you can lay out a program and timetable of reform. We've done so, and I repeat again, we've done so consistent, absolutely consistently, with our pre-election commitments in terms of how we go about this.
Thanks for your attention.
[ends]