PM: First of all, it's good to be back in South Australia, good to be here again at Murray Bridge. So I'm told it's the first time an Australian Prime Minister has visited Murray Bridge. At least, that's what the Mayor told me earlier today.
The reason we are is to continue our consultations nationwide on future directions in health and hospitals reform. This is fundamentally important for the nation, not just to tinker at the edges but to look at what reforms we need for the next quarter of a century. In fact, so far we've had too much tinkering at the edges, to many bandages applied, too many band-aids applied. What we need for the nation is root and branch reform.
That's why the Government commissioned the National Health Reform Commission report, and what we've been doing is road-testing its 123 recommendations around the nation. This is the 15th direct consultation around Australia that I've been engaged in myself, and Warren, the Minister, together with Nicola, the Health Minister, together with other Ministerial colleagues, have conducted between a total of 58 consultations around the country.
We're road-testing these recommendations with various health communities with different challenges around Australia, and of course when we come to a community like that of Murray Bridge, we are confronting the particular challenges of delivery of services to rural communities. The Rural Doctors Association have assisted us in these deliberations today, and plainly there are challenges to make sure that you've got a proper supply of medical staff and other health professionals coming to rural centres, rural and regional Australia as well.
That's one of the reasons why the Government has been forthright in its reforms through the rural and remote workforce package which was announced in this year's Budget which significantly increases the incentives available to GPs to relocate from metropolitan Australia to rural Australia, and depending on the degree of remoteness, so do the incentive packages vary.
So as a consequence of changes to the system, there is in the past, under the Howard Government, what GPs were entitled to by way of relocation was a $5,000 payment after six years of continuous service in a rural area. What we have brought about is a radical change to that which provides a $15,000 one-off relocation incentive and then subsequent to that annual incentive payments for retention ranging from $2,500 for one year up to $12,000 after five years and continuing into the future.
That represents, for someone out there in the field an incentive package worth somewhere north of $30,000, and potentially up to $50,000. We're determined to make a difference with this new set of incentive arrangements so that young medical graduates coming through metropolitan training have a real financial incentive to serve in rural areas as well.
However, that's just one part of reform for long-term health delivery in rural and regional Australia. Today, together with the health professionals here at the Bridge Clinic we've been talking about other support mechanisms which have been put to us a necessary for the future, including helping with the expansion of primary health care capital facilities as well. As you know, the Government's rolling out GP superclinics across the country and one of the discussions we've had today is how do we tailor a program like that to the expansion of existing GP superclinic-type facilities which already exist in rural and regional areas in particular.
The last thing I'd say about that is this new system that we have brought in now makes 40 different rural communities around South Australia eligible for this range of incentive payments that we have brought in. We are determined to improve the delivery of health and hospital care for rural and regional Australia. This is one practical step in that direction.
The last thing I'd say before taking your questions is the AMA has put out its report card on public hospitals across Australia, and its report card on the state of public hospitals is almost universally bleak. Can I say this about the AMA's report - I basically agree with them. There is a real problem out there, and therefore the Australian Government, rather than simply pushing this problem under the carpet, believes it's time we had a fully fledged national debate about how fix the system for the long term.
You can't do that by cutting here and cutting there or putting a band-aid here or putting a band-aid there - it is root-and-branch reform that is necessary. So therefore what this Government's determined to do is provide national leadership to bring focus to the long-term reforms that are necessary for our health and hospital system for the next quarter of a century.
Then - then - we will start to see a turnaround in the system because what we are dealing with now is the record of a decade of plus neglect, of the Australian dis-investing in the nation's public hospital system. We've turned that around with the Australian health care agreement of the end of 2008. That deals with the current five years, but beyond that there is a long-term reform program which is necessary. Health and hospitals, the delivery of health services to the Australian community, is one of the fundamental responsibilities of Government.
Over to you, folks.
JOURNALIST: Prime Minister, what went wrong, then, with the $600 million boost to elective surgery (inaudible)
PM: Well, that investment has provided for 41,000 elective surgeries which would otherwise not have occurred. We have said consistently that that, of itself, is not going to reduce waiting lists for elective surgeries. Do you know why? As soon as you move through the list of those currently registered on elective surgery waiting lists others who had not put their names onto the waiting list rapidly emerge onto it for the first time.
So this has been, for us, simply an interim measure - we've always said that, an interim measure - to assist state and territory governments on the way through, but if you were to say to those 41,000 Australians that have been the direct beneficiaries of those elective surgery procedures around the country, that is better than nothing, that is an improvement on what was, but it doesn't deal with the long-term, structural problem which underpins elective surgery waiting lists nation-wide.
The other thing I'd say is this: until you fix primary health care, until you've fixed aged care, and you've fixed the other pressures which are bearing down the system you are constantly going to have a problem with bed blocking within the system, and as a result you're constantly going to have surgical beds which are occupied by folk preventing those in need of elective surgery to obtain the surgery they need.
Furthermore, long-term, you'll see in the Health Reform Commission's report specific recommendations which go to the separation of elective surgery from emergency surgery in the way in which hospitals conduct their business in the future, and that's one of the recommendations we've been road testing with hospitals around the country.
JOURNALIST: Prime Minister, are you going to penalise the states for not meeting these targets?
PM: Well, we have a hardline approach to improving the health and hospital system nationwide. If you look at the detail of the statement we made at the end of 2008 when we negotiated a 50 percent increase in the Australian Healthcare Agreement with the states and territories, we at that time insisted on a range of performance benchmarks being met. This data is now being collected and will be published over a period of time.
We intend to hold the states and territories accountable against that data. That's why we're in the reform business. This is tough, and remember we are also dealing with a history of the previous Australian Government pulling a billion dollars out of the Australian public hospital system. We are re-investing back into a hospital system, but one which has suffered from a decade plus of neglect.
JOURNALIST: Should there be a single funding source for hospitals?
PM: One of the things we're obviously road-testing with the states and territories is how we structure roles and responsibilities for the future, funding responsibilities being one, and how that's delivered, and the actual delivery of services on the other, and how that is done. That's why we're seeking views from the various health regions and hospitals that we've spoken to so far. There are a range of different views. We haven't reached a landing point ourselves on that yet and won't do so for some time.
JOURNALIST: The AMA (inaudible) benchmarks which encourage hospitals to hide the people who are waiting for elective surgery by not putting them on the official waiting list. How do you respond?
PM: Well, we will take a very dim view indeed of any attempt by any state government, whatever their political persuasion, of somehow being cute with critical data on emergency surgery or on elective surgery or on emergency department presentations. We want real data. We want to know the absolute facts of what's happening out there.
We want to know what's working and what's not and how you can fix that. We're in the long-term reform business, but to inform that you need to have absolute confidence in the data. That's why we agreed on those performance benchmarks in the Australian Healthcare Agreement of December 2008. We intend to collect that data and to analyse it, and we'll take a very dim view indeed of any data that is cooked by anybody.
JOURNALIST: Prime Minister, there's news today that Defence and Immigration are in talks about possibly re-opening Baxter to house potential asylum seekers. Can you please clarify your view on whether Baxter should be re-opened?
PM: I've already answered that in a radio interview this morning, that we have no such plan.
JOURNALIST: Will there be any consideration of bringing anyone on to mainland Australia?
PM: The Government's current operation is to use Christmas Island. That's what it's there for. It has a large detention facility. And that's where the processing occurs. The Minister has already indicated that he has contingency plans for the expansion of the operation on Christmas Island, and beyond that, the Minister has already indicated also, further contingency arrangements in terms of facilities in and around Darwin. This is a challenge which all countries around the region are dealing with. Huge push factors coming out of political instability in Afghanistan. A civil war in Sri Lanka. Other instabilities across the Middle East. Countries around the world are dealing with the same challenge. Our job, and I make no apology for it, is to take a hard-line approach in dealing with the challenge of illegal immigration. That's why we've deployed our naval assets, our customs assets, and our other resources into the region, in partnership with the Indonesians and others, to deal with the challenge for us all.
JOURNALIST: What happens when Christmas Island fills up? You're putting tents and other accommodation there. What happens when you-
PM: I am absolutely confident that the Minister has in hand a range of contingency planning to deal with challenges across the region. Let me just go to, also, the successes which have been delivered by the Minister and his agency, and others so far in dealing with this challenge. There have been 81 successful interruptions or disruptions of illegal immigration movements to Australia.
There have been already, I think, some 44 charges or prosecutions. We are currently working on a range of others with the Indonesian and other authorities. This is what our men and women in uniform, out there on the high seas, out there in this difficult zone are doing at present. This is a challenge facing all of us. And it's going to be tough into the future. I accept that. Other Governments are finding this challenge tough as well.
JOURNALIST: Would you give Indonesia access to satellite imagery and surveillance to help them play a part in this?
PM: How we engage diplomatically with the Indonesians is a matter for the Indonesian Government and ourselves using confidential diplomatic communications. On the questions of security intelligence and information, the longstanding convention of Australian Governments is that we do not comment, and I don't intend to change that practice.
JOURNALIST: In dealing with Indonesia and boatpeople being turned around and sent back, your pledge has to been to treat them with dignity, care and fairness in the name of humanity. Number one, is that treating them with care? And number two, is that your idea of your own Pacific solution?
PM: I make no apology whatsoever for adopting a hardline approach when it comes to illegal immigration activity, and I make no apology whatsoever having a hardline and humane approach to dealing with asylum seekers. That's the balance the Australian community expects of us. You see, when it comes to dealing with this challenge, this is not a unique problem for this Government.
We've had vessels arriving in Australia with asylum seekers on for each year for the last 20 years. In the period of the Howard Government, there were nearly 250 vessels that arrived here in Australia, carrying nearly 15,000 asylum seekers. And I'm advised that some 90% of those ended up settling in Australia.
Let's just put all of this into some historical context. In the period this Government's been in, we've had something like, I think, 38 vessels arrive, probably with about 1800 people. It's a challenge. But it's consistent with the challenges we've faced in the past as well. We make no apology for hardline measures in dealing with the challenge of illegal immigration. No apologies whatsoever in dealing with, also, the vermin who are people smugglers.
We will take the harshest and hardest measures possible in dealing with that. And on top of that, ensuring that when we are processing asylum seekers, we do so humanely. If they are not bona fide asylum seekers, then we send them back. And guess what? We've already started sending some back, including to Sri Lanka.
I notice there's some criticism also on this question from Mr Turnbull and the Liberal party today. Well, can I just say this- Mr Turnbull's recommended course of action to deal with illegal immigration is to hold an inquiry. Can I say that if you're dealing with the challenge of illegal immigration, holding an inquiry doesn't help one bit. What is required is action.
Action of the type that we are taking out there in the zone at present. Secondly, it's very easy for someone like Mr Turnbull and the Liberals to shout from the sidelines, rather than coming up with practical courses of action as we have done in dealing with the problem at hand. The third thing is this- ask yourself this question- what is the unified position of the Liberal party on illegal immigration, on the future of TPVs, on the future of the Pacific solution? Mr Turnbull's Liberal party on this, as on other things, is split right down the middle. And frankly, I do not know where they stand on this.
Given that, when the Government abolished TPVs, the Liberal party did not oppose that in the Senate. When the Government abolished the Pacific solution, the now Shadow Immigration Minister fully supported the Government's action. This is a Government- this is a political party- the liberal party, which is playing politics with this.
JOURNALIST: With the change in international circumstances as you've described in the past 18 months, does that not require perhaps a rethink and change of policy?
PM: Well, we believe we've got the balance right in a hardline approach to illegal immigration, and treating the people who we are required to process in a humane fashion. You can do this if you intelligently deploy the assets of your Government. As I said, this is not a problem which is unique to this Government. Previous Australian Governments have had to deal with this.
Governments around the world are now dealing with the same sort of challenge, including in Malaysia and Indonesia, and those in Europe, particularly coming out of the political instability recently in Sri Lanka. We are deploying not just more Naval and Customs assets into the area than the previous Government did, but on top of that, courtesy of the last budget, an additional $625 million investment in additional security cooperation, in additional Police cooperation, in additional intelligence cooperation with our friends and partners in the region to make a difference.
We believe this is the right balance, and we will always, always, continue to fine-tune our response based on new and emerging challenges. That's what all Governments do around the world. We believe we've got the balance right. And I've got to zip because I'm due in Adelaide.
JOURNALIST: We have- some local media- would like to ask a couple of questions on the rural health issue.
PM: If you've got one question on that- I'm sorry, I should've asked you that.
JOURNALIST: Yes, yes.
PM: Can I get set one question for you please, locally, then I've got to zip.
JOURNALIST: We're just wondering if the Federal Government takes over the health system, how you plan to help the smaller rural hospitals that are faltering at the moment. They have a lack of doctors. Money's not always the issue. Are they going to become viable under your takeover, or will they become glorified aged care facilities?
PM: Look, can I just say this to you- the single biggest change when it comes to rural doctors and the incentives which apply to them have been taken by this Government in the package of measures I referred to about 10 or 15 minutes ago. In the past, if you wanted to be a GP relocating from metropolitan Adelaide to communities like this, at best you could hope for after 6 years continued service is an additional $5,000.
JOURNALIST: These are communities that-
PM: Can I just finish my answer to your question? And secondly, what we have now done is create a series of incentive payments, which as I said aggregate up to $30,000, as much as $50,000 over a period of time, to encourage GPs to come here, and to stay here. Furthermore, can I say in response to the last part of your question, the more remote you are from the capital city, the greater the set of incentives we offer. We are acutely mindful of small rural health practices and services which need extra support in terms of people coming there and staying there.
That's why we are here today speaking with the rural doctors and rural health association because this set of reforms is important. As I said in meeting with the community here at Murray Bridge earlier today, as Prime Minister of Australia I am responsible for the entire health system. That means big cities, small country towns. It means indigenous communities. It means the spectrum of services in between. And rural Australia is just as important as the rest of Australia. And having said that, I've got to zip.