FAINE: Kevin Rudd, good morning.
PM: Good morning, Jon. Thanks for having me on the program.
FAINE: 123 recommendations, I yesterday said this is a bit like a trade union with an ambit claim to an employer.
PM: (laughter)
FAINE: There's no explanation of priorities amidst the 123. Do you think you can do all of them, or are some more important than others?
PM: I think the reason why the report is first of all so long, the recommendations so comprehensive, is that the report is based on the assumption that if you're going to reform the health and hospital system, it needs to be an integrated set of reforms. That is, the part relates to the whole. What we do in preventative health care relates to what you do in primary health care, that is, with GP and GP-related services, which in turn affects how we manage the resources for our overstretched public hospital system in the number of admissions.
What do you do for outpatient services to take further pressure off acute hospital beds? Are you properly resourcing aged care beds so that people don't remain in acute hospital beds longer than they need and prevent other people from getting there? All these things, one relates to the other, together with, do we plan properly at present for our long-term needs for the workforce for our health and hospital system as well.
And the reason why, therefore, this report has been done in the way it's been done by this independent commission, is that it said overall, the system is reaching a tipping point because of the ageing of the population, the increasing cost of the provision of individual healthcare services, the fact that we have such a large number of people who are not seen within clinically acceptable times in accident and emergency, who are not getting elective surgery within clinically acceptable times.
FAINE: Yep.
PM: But the time has come for a root and branch look, and that's why this is the biggest set of proposed reforms since the introduction of Medicare, and we'll work our way through it as systematically as we can.
FAINE: But my question specifically was, do you think you can implement all of them, or are some more important than others?
PM: Well Jon, what I said when I launched this with the Health Minister two days ago is that the Government will not inevitably be implementing each and every one of these recommendations. The other thing I've said is that fundamental root and branch reform for the long term of the health and hospital system is expensive, it costs money.
Therefore there will be a question of prioritisation in terms of how we go about it. But also, it's time for Australia to have a mature debate about the state of our health and hospital system, where we want it to be over the next ten to twenty years, and therefore we don't intend to be in the business of an immediate rule in or rule out of individual recommendations.
The Health Minister and I are working our way around the country, and she and I, depending on which city we're in, will be working our way through the major public hospitals of the country, as well as other healthcare providers, as we were in Sydney at Royal North Shore yesterday, the Flinders Medical Centre here in Adelaide today, and we'll be in Melbourne before long.
FAINE: If I can prioritise, if I can paraphrase what the Victorian Premier John Brumby said yesterday, show us the money, and then we'll talk.
PM: Well, on the question of funding to the system, when we reached the Australian Healthcare Agreement with the States and Territories in November last year, it contained within it a 50% increase in the overall funding to the states, a record $64 billion. And for the first time, you have the Australian Government investing in emergency departments. That is, a $750 million program to take some of the pressure off emergency departments.
For the first time also, the Australian Government investing $600 million in seeking to slash elective surgery times.
So on the question of the Australian Government's action, I think Premier Brumby would recognise that there were significant advances in our resourcing to the states and territories in that agreement at the end of last year, together with what we've done on health infrastructure: the MacCallum Institute, for example, in Melbourne, a huge investment by the Australian Government on cancer, as well as what we've done on the rollout of GP Superclinics out there in the area of community health and medicine.
So we've begun this process last year, but we've commissioned at the same time this independent group of experts under Dr. Christine Bennett to look at a root and branch reform for the system for the very long term.
FAINE: Yes.
PM: And that's what we want to have a mature discussion and debate about now.
FAINE: Are you comfortable with physiotherapists or chiropractors making referrals to surgeons instead of a patient having to see a GP first?
PM: You know something Jon, fools rush in where angels fear to tread.
FAINE: Which one are you?
PM: (laughter) Well I'm not about to tell you what a chiropractor or a physio should do with an individual patient in an individual surgery. That ain't my field of expertise. Nice try.
But what I am concerned about is do we have, for example, GPs in the community in sufficient number and sufficiently co-located with other community health services like physiotherapists, like podiatrists, etcetera, so that we can provide the best integrated care for patients outside the hospital environment. Better for the hospitals, but also better in terms of the long-term health of patients themselves.
FAINE: But if you have a relationship with a GP, the GP has overall conduct or supervision of your health, ideally people do have relationships through GPs, and if you in fact start to fragment that by allowing a physio, for instance, or a chiropractor to send someone direct to a surgeon, obviously you're reducing the benefit of a relationship with a primary provider like a GP, a gatekeeper.
PM: Look, can I say our view about the importance of GPs is very much reflected in the way in which the report is constructed. If there is an overall strategic emphasis in this report's recommendations, it's this - one, boost preventative healthcare.
Apparently, two percent of the entire health budget is spent on preventative measures, whereas we know for the long term if you're going to act on chronic diseases, that has to be lifted.
Second, boost what is called a primary or frontline care, and that's primarily delivered by GPs, because we are having too many people presenting themselves to accident and emergency, who if we had a better-resourced system at the GP level, and with greater allied services associated with GPs, and with better possibilities for GPs to have more flexible hours, then you have a greater ability for people in fact to use that primary frontline care rather than having to go to accident and emergency.
That's why for example Nicola Roxon, the Health Minister, has been rolling out a series of GP Superclinics to which we committed ourselves as a Government prior to the last election. This would build on that, but we've got to work our way through this together with all the other recommendations, in a systematic way, because they are all expensive, nothing comes cost-free.
FAINE: I could keep asking you questions about the detail of this scheme pretty much all morning Kevin Rudd, and it's of such breadth that there are people coming up, jumping up out of the woodwork from everywhere complaining or supporting particular aspects of it. Just pick one of them if we could please - you've managed to upset both dentists and also advocates for change in dental care by your proposal for a Denticare scheme. Are you going to take on the dentists?
PM: Well, if you look at dental care at present, here's a stunning fact for us all - that across the nation at present, we still have a system which is based on the last data that I've seen, which is admittedly a year or two ago, had 650,000 people on the public dental waiting list. Therefore, we must have a system whereby we attend to those things better.
Now, you talk about various groups being, reacting to this report, I emphasise this: we commissioned this independent commission of experts, under Dr. Christine Bennett, with 10 prominent Australians with expertise in the health field, with a set of terms of reference to look at how the system should be reformed for the long term. They've come up with their independent recommendations.
Inevitably, there are going to be people out there in the professions who will either love it or hate it or be lukewarm towards it, and the reason I want a mature national debate about this is that we tease all this out over the next six months or so, and rather than just having a, you know, an attitude as a nation which says rule in, rule out, yes, no, right, wrong, let's work it through.
And that's why we're going through each capital city, the Health Minister, myself in most circumstances, talking to major public hospitals and health providers as we did at Royal North Shore Hospital in Sydney yesterday, which has been the subject of some controversy over the years.
FAINE: The timing though, it's no coincidence that you're building up to making announcements within the electoral cycle for next year's federal election. There is a certain amount of politics no matter which way you describe the consultation process, isn't there?
PM: Yeah but Jon, this is a massive set of reforms. This would be the biggest set of reforms since the introduction of Medicare. What we said prior to the last election was that if we were elected to Government we would commission a National Health and Hospitals Reform Commission to undertake a root and branch review of the entire system.
One of these hasn't been done for a long, long, long time. That took 16 months. It reported as of the end of June and three weeks later we've put it out there, which if your listeners want to read the whole report is up on www.yourhealth.gov.au. And we invite the public to respond directly to it in terms of their attitude to individual recommendations.
And we have said that once we have worked our way through the report systematically, consulted directly the community, we'd then frame a final proposal for the states and territories, and put it to them in terms of whether they would embrace that cooperatively or not, and then we would take our course of action for the future - either to implement it cooperatively, or as I've said repeatedly, take it to the people for a mandate for the decisions which need to be taken for the future.
FAINE: Alright, last question on health before we move to other things. You can't do all this without increasing taxes, or introducing some levy to pay for it, can you?
PM: Well, you're right to absolutely say this, Jon, nothing in this report comes inexpensively.
It has all got a bottom-line figure attached to it, and as a result, if you look at the numbers which are contained within the report, for example, it would result in a recurrent set of expenditures of between $2.8 billion and $5.7 billion a year, and that's excluding the Denticare proposal.
Secondly, a capital addition to the entire system which is significant as well.
Thirdly, you have, also, the proposed additional cost for Denticare through the Medicare Levy increase of 0.75%.
How are these monies raised? Well, there are three sources of revenue for the future. If there is a transfer of any responsibilities from the states to the Commonwealth, then there will be a transfer of funding associated with that as well. Secondly, if you bring about, for the first time, an integrated health system for the nation, then efficiencies will be created.
One of which would come through creating, for the first time, a decent e-health system, whereby you have online, accessible, computerised data containing individual patient records. Thirdly, apart from those efficiencies, you're right, there are also implications for the revenue.
Let's work our way through it systematically, but I think you're absolutely correct to point out that nothing by way of fundamental reform comes cost-free, and it won't.
FAINE: Seven minutes to nine on 774 ABC Melbourne. Jon Faine with you through to twelve, and Kevin Rudd, the Prime Minister, with me, speaking from Adelaide.
Tony Fitzgerald, corruption reformer, investigator in your home state of Queensland, broke a long silence last night in a speech at a university and said that he thinks there's still a culture of corruption in your home town and in your home state. Kevin Rudd?
PM: Well, I haven't seen Tony's speech. I have enormous respect for him. I have known him well over the years and I think he is a first-class Australian. I also am very familiar with the recommendations he made 20 years ago in the Fitzgerald report, so I'll wait ‘til I've actually worked my way through his speech, I haven't seen a copy of it.
FAINE: I can tell you that he blasts the ethics of current and former Labor Governments, which may include the one of Wayne Goss in which you served. He says secrecy was established by sham claims, through Freedom of Information documents being run through Cabinet for no reason other than to keep them secret, and quote: “access can now be purchased, patronage is dispensed, mates and supporters are appointed and retired politicians exploit their connections to obtain success fees for deals between business and Government.” He could also be talking about the federal level of Government, couldn't he, not just the states.
PM: Well, as I said before Jon, I've not read his speech and I intend to do so, because I've known him over the years I've known him to be a considered individual, I also know him to have exercised and reflected great courage in the recommendations he made back then to bring about some fundamental reforms in Queensland, one of which was a recommendation to establish what was then the Criminal Justice Commission, now called the Crime and Misconduct Commission, and it's that body which, of course, has made recent findings in relation to aspects of the Queensland Police Force.
Many of the institutional reforms which Tony Fitzgerald recommended back then, of course, continue to play a fundamental role in Queensland today. The Crime and Misconduct Commission is one of them, although there is legitimate debate about its current operations and powers.
More broadly on the question of, you referred there to donations reform and things like that, and the way in which political business is conducted. Can I just draw your attention to the fact that we have currently blocked in the Senate, political donation reforms of our own, which would reduce the threshold for declarable amounts of money from $10,000 - which is where the Howard Government took it to - to $1,000, because we thought that was simply right out of the ballpark. That's been blocked by the Liberals in the Senate.
Prior to that, it used to be $1,500. Mr Howard increased it to $10,000, which would enable you to, I think, conduct fundraising activities which were largely unknown to the Australian public through the declarations process.
FAINE: Small beer, though, Prime Minister. The main issue here is that major developers, industrialists, investors, can buy access through sponsored lunches, $10,000 tables at dinners and all of these sorts of things in order to get around those rules just by signing a cheque.
PM: Can I just say one of the important reforms in response to that is to make sure that you have a threshold for campaign donations which become completely declarable to the Australian Electoral Commission. The previous Liberal Government increased that from $1,500 to $10,000, whereby you could have a fundraising function with 10 people paying $10,000 each, $100,000, and no-one would ever know about it.
We have legislation in the Senate currently blocked by the Liberals which reduces that down to $1,000.
The second thing we have is proposed ban on foreign political donations to Australian political parties. That's also been blocked by the Liberals in the Senate -
FAINE: So you don't think you need to do any more?
PM: The third thing we've introduced, which goes to the absolute core also of what you've just asked, is about the activities of, for example, people acting on behalf of companies, for the first time the Australian Government has introduced a lobbyist register, whereby a full list of all third-party lobbyists for Australian companies must be provided to the Department of Prime Minister and Cabinet -
FAINE: So you don't think you need to do any more?
PM: No, I'm about to go on to what else we have in mind here. And secondly, for the first time, the Australian Government has therefore required these lobbyists to list those companies for whom they are lobbying. That is the first time that has occurred at the level of the Australian Government.
On top of that, John Faulkner, as Special Minister for State, issued a Green Paper on further areas of reform in these areas concerning caps , further caps on donations, further caps on campaign expenses, etcetera.
These things are out there, but the reason I emphasise the matters which are currently blocked in the Senate, is that we've been determined at the Australian Government level to get on with the business of reform.
FAINE: Yes.
PM: I note, however, they are being blocked by the Liberals.
FAINE: Prime Minister, my time with you is up. I'm grateful to you for taking our call and fitting it in to your busy schedule from Adelaide this morning.
PM: Thanks Jon. Thanks for having me on the program.
(ends)