PM: Thank you very much and clearly COAG has had a long day talking about issues of importance to the nation and I do thanks Premiers and Chief Ministers for their patience and resolve in working through so many long hours and I do want to thank the members of the federal parliamentary press gallery for attending a very late press conference, thank you for that.
Today I want to advise you of two of the important topics COAG has talked about today: first, natural disaster preparedness and then second, health.
On natural disaster preparedness, after the summer of disasters that we have lived through it was important for the nation's leaders to gather together and to reflect on that summer and what lessons could be learned from it. I thank very much Premier Bligh and Premier Baillieu for leading the Council of Australian Governments in that discussion. As a group we want to take this opportunity to record our very sincere thanks to every emergency services worker, to every police officer, to every ADF officer, to every health worker, to every volunteer who made such a difference during this time of natural disaster.
We did share experiences and we have determined that we will ask our ministers for emergency services to review what can be learned from the events of this very, very difficult summer, to provide some advice to COAG on emergency management on the way that disaster payments work, on disaster resilience and the like.
We have also agreed that we will work on the question of gift deductible status for the various charitable funds that have been set up following these natural disasters. As people would be well aware the Premier's relief appeal in Queensland now has I think around $200 million in it, a very substantial amount of money and in other states, including the state of Victoria, there are charitable funds that have been fundraising to give that extra helping hand. We want to make sure that our taxation system is working in the right way with those funds, we learned some lessons about that from bushfire relief in Victoria following the tragedy of Black Saturday and we want to make sure that those lessons continue to be learned and to apply to these funds.
So I'd thank my colleagues for that discussion, it was very important that as a group we have it at this time.
The other substantial issue on the agenda today was of course the question of health, and we came here today with three objectives: to deliver health reform that would stand the test of time, that was genuine reform that would last; to deal with the structural funding problem facing our health system; and to make sure that we were delivering a better deal for patients.
I can advise that we have secured an agreement which meets these three aims and I thank my colleagues for their patience and diligence in working through that agreement.
My bottom line was that we saw a better deal for patients and my colleagues agreed with me on that bottom line. My bottom line was that I wasn't going to let politics get in the way of entering a truly national agreement that would last over time and we have secured that agreement.
I want to be clear that in securing this agreement we have held true to the principle that new money should only flow when there is reform and reforms will be made to our health system as a result of the agreement today.
This new deal will deliver unprecedented transparency in our healthcare arrangements. If you want to summarise what we've achieved today, we've achieved more money, more beds, more local control and more transparency, and we have achieved an agreement which will mean less bureaucracy, less waste and less waiting.
I want to take you through the five elements of what we have agreed today. First, in terms of funding, we have agreed that there will be a guaranteed $16.4 billion in new money from the Federal Government to state and territory governments from now to 2020. This comes on top of what has been agreed to in the Australian Healthcare Agreements, and on top of the $3.4 billion that is being used for elective surgery and emergency departments.
Under this agreement, the Commonwealth will step up to a fair share of growth; 50 per cent of every new dollar coming from the Commonwealth. Over time, my state and territory colleagues have faced a circumstance where the Commonwealth's share of funding has been declining as a percentage of what they need to run their public hospitals and the Commonwealth was not stepping up to its fair share of growth. Now, as a result of today's agreement, the Commonwealth will become a 50 per cent partner in growth for the future, that's important for the long term stability and quality of our healthcare system.
Second, we are boosting transparency. People want to know what is happening with the money that goes in to fund health. They do not want it beyond their line of sight; they do not want to wonder whether when one level of government is stepping up to putting more in, perhaps another level of government is taking some out. As Education Minister I was driven by the principle of transparency, not only because people have a right to know what is happening with funds that are being spent for public purposes like education and health, but because the very transparency itself can drive change. That is if you identify underperformance, you can step in a rectify it, if you identify best practice then you can share that best practice.
So today I can announce that we have agreed that there will be a national funding body which will be a pooled arrangement making transparent funding flows in health. This is a huge step forward and I thank my colleagues for the discussions today. Through this national funding body, we will be able to ensure that hospitals around the nation are transparently and fairly funded, we will also be able to ensure that information between states is truly comparable.
I said the third element, the five elements of this package: funding, transparency - thirdly we are taking a giant axe through red tape and unnecessary bureaucracy. Under the former deal there was an agreement which would have created eight separate bureaucracies that would have risked over time, eight separate approaches to funding and it would have risked over time that information was not truly comparable nationally. As a result of today's agreement we are sweeping away those eight separate bureaucracies for one national funding body.
Fourth, I have agreed with my colleagues that we will, as a Federal Government, step up in primary care, particularly bringing Medicare locals on stream more quickly than initially envisaged and we will step up to ensure that we are delivering extra assistance for after-hours more quickly than envisaged.
And finally we, through today's reforms, are dealing with greater community say and local control through the national hospital networks structure. Pivotal to these reforms remains having an efficient price for services that are provided in hospitals because that efficient price will drive change in our hospital system.
Today with my colleagues we have signed a Heads of Agreement on each of these areas, the in detail worked will now happen to bring this Heads of Agreement to a full agreement, but I thank them for signing the Heads of Agreement today.
We have also jointly signed today a national partnership agreement, dealing with targets in emergency departments and elective surgery, and I thank my colleagues for signing that agreement today too.
All in all, I think whilst this has been a very long day, it's been a very successful outcome.
When we walked into the COAG room we did not have a national agreement on health reform. When we walked into the COAG room there was reason to fear that as time went on the agreements between the Commonwealth and those states that had signed would become increasingly unsustainable in the absence of a national agreement. When we walked into that room today, we didn't have the benefit of one national funding body for the kind of transparency that I have outlined.
We have walked out of the room having ensured we've got one national agreement, transparency, proper funding, local control, new investments in primary care, and less bureaucracy.
For people around the country, this does mean more money, more beds, less waiting time, more access to the healthcare that they want now and into the future.
With those words, I'll turn to the chair of the Council of the Australian Federation, CAF, and Paul Henderson from the Northern Territory.
CHIEF MINISTER HENDERSON: Thank you, Prime Minister.
I will be brief, but certainly on behalf of all the premiers my colleague the ACT Chief Minister, it was our first time to come together and catch up with the Premier of Queensland and demonstrate out support and commitment as Australians across all levels of government to assist with the rebuilding of Queensland and affected areas.
It's been a really horrific time across the nation, just watching the impact of the floods unfold, the impact on people's life, on communities, and certainly, as Australians, we all know people in Queensland directly, indirectly, businesspeople. It has been a tragic, horrific, extraordinary time and today we've all come together as leaders from across our nation and said to the Premier of Queensland ‘We are with you. We will work with you and do everything we can to assist in the rebuilding of Queensland and affected areas', and also, importantly, to learn those lessons.
And, just briefly, as the Chief Minister of the Northern Territory, the one comfort that I take out of the extraordinary devastation from Tropical Cyclone Yasi, talking with the Premier of Queensland, it does look as though that the cyclone codes that we actually build to in the northern Australia certainly have stood up very well in terms of homes and businesses that have been built to those codes, and certainly that should give some comfort to people who live in northern Australia, that living in a home that has been built to those codes that have been in place since '84 or '85. We wish we'd never had this test, but the fact that we have had the test should give some comfort.
In regards to the historic health reform agreement we have today, as the Prime Minister said, when we walked into that room this morning we did not have an agreement on the table, and at times today it looked as though it was going to be difficult to reach agreement, but I would like to thank all of my colleagues, the Premiers and the ACT Chief Minister, that when we stood back from the issues around the detail, we focussed on patients.
At the end of the day, what we have today is a better deal for patients in our hospital system. It means more beds right across Australia. It means reduced waiting times in emergency departments across Australia. It means reduced waiting times for elective surgery, and importantly for our community, transparency and a line of sight in regards to every dollar that goes into our hospital system - how that relates and reflects on the ground in terms of the care of patients and people in our system.
So, I'd like to thank all of the Premiers and Prime Minister today. My first meeting as the Chair of CAF, but it has been a sign, I believe, that even though that CAF now reflects different political stripes sitting around the table, we can all sit around the table in the national interest and reach agreement, and we've done that on health today.
PM: Thank you.
So, we're happy to take questions. I should have said, of course, that apart from being my first COAG meeting it's the first COAG meeting for Premier Baillieu, for Premier Giddens, and for Genia McCaffery, representing local government, so this is the Canberra press gallery. They're not too bad.
Matthew?
JOURNALIST: Prime Minister, all the messages that we heard during the day was that the bone of contention, if they're was one, was your single pool. Were the Premiers simply trying to avoid scrutiny, or what was their reasonable concern, and when you say that you've got a heads of agreement rather than an iron-clad deal, what concession have you made?
PM: See what I mean about them?
A heads of agreement is a signed deal. We will now do all of the technical work that needs to be done, all of the work that needs to follow it through. We will be distributing the signed heads of agreement so you can see it yourself.
So, we've walked into that room with no national health agreement and we've walked out with a national health agreement.
You would expect, when I have been proposing considerable changes to the agreements that a number of States had signed onto, and a new way of thinking about health compared with the proposals of last year, that Premiers and Chief Ministers would want to analyse that, hold it up to the light, ask all of the questions, have all of the debates. I think that absolutely appropriate. That's what leaders should do and that's what we've been doing in the room today.
But I'm very pleased that we have been able to work through, with a lot of hard work, a lot of respectful dialogue, and get the agreement, a signed agreement on which we will build with a full, detailed agreement when officials have done all of their work.
JOURNALIST: (inaudible) measures that you nominated on Friday, as you nominated?
PM: The transparency measures I nominated on Friday are in the signed agreement. I want, and have been very clear with my colleagues, I'm a big believer in transparency. I believe in it because I believe Australians have got a right to the information. I believe in it because transparency drives change, and if you look in this country today, we spend tens of billions of dollars each year on our public hospitals, but we do not have good, real-time information that people can see, and we do not have good line of sight on dollars in and dollars out. We will now have that line of sight. That is a really important reform.
Of course, from the point of view of people in emergency departments and people waiting for surgery, people who want to see a doctor, they are going to say to themselves ‘what is different for me?' Well, what is different for them is a national agreement, so right round the nation, whether you're in Perth or Brisbane or Darwin or Launceston or in Sydney, any part of the nation, there's a national agreement that is applying to your healthcare that's got more funding, more beds, more transparency and more local control than people have had before.
Yes, we'll go there and come across. Yes?
JOURNALIST: Prime Minister, does that mean that all major elements of the agreement will be ready to roll July 1?
PM: What that means is people will start to see real changes on July 1. Many of the elements of this agreement, building, as they do, on the shoulders of the agreement that went before, do have a July 1 start date.
JOURNALIST: Prime Minister, on that, you say more beds, exactly how many more hospital beds will there be, including in the next 12 months, and how many extra people will have elective surgery who weren't going to have it?
PM: Well, we are working at the moment through the additional $3.4 billion that we provided to assist elective surgery around the country, and that has literally resulted in tens of thousands of additional procedures, and we are able to give people the details of that.
What this agreement means for the long term is there's more money and growth is not capped. So, in this country, because of the approach of the Federal Government, and this has been a problem a long time in the making, and it was certainly there under the former government, in this country we've seen a declining share from the Federal Government. We've seen a capped amount of funds. If States and Territories were in a position to lift activity beyond the cap they had to pay for it. There was no more extra Federal money.
Now, we are moving to a system where we are partners in growth - 50 per cent, 50 per cent, the system growing as it needs to. That's a transformational change.
JOURNALIST: How many more beds?
PM: As the agreement is implemented, obviously, beds will come on line. What I can give you is I can give you the statistics about what the money to date, the difference has made, and it has literally been in tens of thousands of additional procedures in elective surgery.
JOURNALIST: Prime Minister, we were told 10 months ago, with great fanfare, that there was an agreement when in fact there was none. There was a lot of hyperbole. We're being told that there's an agreement today, but we're also being told that it's not a full agreement. If I could ask you to allow the Premiers and Chief Ministers to talk, what are the caveats and or conditions that have been placed on signing a final agreement?
PM: Well, it's not a question of caveats and conditions, and you will have in your hand as soon as the photocopying can be done, a signed agreement. You'll be able to read it for yourself, and what you will see is that some further work needs to be done by officials in various areas, and that's appropriate.
I said on Friday that what I wanted to do at this meeting was sign a heads of agreement, sign up the principles for reform and change. I did not envisage we would walk into this room and walk out with the comprehensive, technical detail of every level of these reforms.
What we've walked out with is a signed agreement which outlines all of the key elements of the reforms that we've agreed to.
JOURNALIST: (inaudible) Premier Keneally as well, did you have to offer anything extra to get the Premiers and Chief Ministers over the line today, separate to what you had on Friday? And Premier Keneally your government's already implemented the original package of reforms, does changing to the new system going to present any problem for you bureaucratically or anything else?
PREMIER KENEALLY: Thank you Phillip for the question, you're right New South Wales has already rolled out 369 beds of the 488 that we secured last April, we've also implemented our local health networks, we've got the boards in place, the chairs in place and we've passed the legislation. We had made arrangements, as per the COAG agreement in April, to put the state funding authority in place as was agreed in April, but we have no qualms about the national funding arrangements that the Commonwealth have proposed in this agreement, we see the transparency initiatives that the Prime Minister has put on the table as ones that are good for the health system, not just in New South Wales but indeed nationally as we were very pleased to be able to come here today and achieve what is truly national health reform for New South Wales. The health reform has meant a significant boost in funding, that's what last April represented, that's why my bottom line was to keep the beds, the money and the growth money, and what put that at risk was the risk that over time, without all the States signed up and all the Territories, that that agreement would start to unravel. What we've done today is secured the future of health reform, national health reform, in Australia.
JOURNALIST: (inaudible) sweeten the deal at all?
PM: The envelope of money is as I announced it on Friday, so it's the $16.4 billion and that is specified as the minimum, as I specified it on Friday in this health reform agreement. We also have entered a second agreement; the second agreement is about the targets in elective surgery and in emergency departments. I have agreed with my colleagues that to facilitate the best possible progress towards those targets, that we will bring forward some $200 million and make that available earlier than it otherwise would have been available, so that's a movement across two financial years.
We'll come across the front, yes?
JOURNALIST: What details still need to be finalised, and is there a timeline for finalising those details?
PM: Well you will see when you see the agreement the kind of work that needs to be done now, and we will be signing this agreement in the coming months, it's my intention that COAG will meet in the middle of the year, and we will obviously be finalising the agreement at that time.
JOURNALIST: Prime Minister a year after you originally promised to have an independent pricing authority, you still haven't introduced legislation to set it up, it's going to have less than 12 months to work out the, one of the key aspects of this reform, the national efficient price, can that be done within 12 months?
PM: Yes.
JOURNALIST: Prime Minister did you get agreement from the Premiers today to narrow the scope of COAG, and in particular those four key areas that you announced last week that you really want to focus on a get a renewed commitment from the Premiers for the COAG vehicle?
PM: Yes we have had some discussions today about this being a meeting of the nation's leaders, that it's our job to be focussed on the most important strategic challenges for the nation, and we've talked about what those priorities should be. We have agreed five priorities, we have decided that it is very important that First Ministers continue to oversight our Closing the Gap agenda. In the priorities I announced, we talked about Closing the Gap under the heading of participation, and of course making sure that Indigenous Australians get what I refer to as the benefits and dignity of work is so important to ensuring life time equality and opportunity including for the children of those Indigenous Australians, but First Ministers decided we wanted to put even more oversight on it than that and so we have nominated it as its own priority.
JOURNALIST: On transparency-
PM: Sorry, we'll go here, I did wave there, so that's fair and then I'll come across.
JOURNALIST: Prime Minister on transparency the money will flow from the national pool to the hospitals via State based accounts, what Federal oversight will there be of those State based accounts? Are you worried about double handling with that State based money? And Premier Barnett do you feel vindicated on your position about resisting the GST clawback?
PM: The main thing with transparency is that we know where money comes from and where it's going. We will obviously work on arrangements to minimise double handling, no one around the COAG table wants to see unnecessary double handling, what we do want to see is transparency so that we've got a clear line of sight on money being provided by the Federal Government, money being provided by the State government, and the purposes and activities for which it is used in hospitals, that's the transparency that the agreement deals with.
JOURNALIST: (inaudible) national pool?
PM: Well you can be transparent across all of the national pool, including the State based expenditure.
I'll turn to Colin for comment.
PREMIER BARNETT: Well for Western Australia the issue of surrendering the GST revenues to the Commonwealth was a show-stopper. We would simply never agree to that and that was a bi-partisan position in Western Australia. Once the Prime Minister took the GST matter off the table that did open the door for an agreement, we've had over 12 hours of meetings and negotiations today, there has been, in my opinion, a fair degree of goodwill and give and take on all sides. The work that's to be done now is the detailed mechanics of the structure of the body to be established, and how the funds will flow and how the hospital system will be managed. Now that is detailed work this is probably best undertaken by respective Commonwealth and state health officials and that's what we're relying on.
Hopefully after that we can stay where we are at the moment, and that is talking about health, not GST, and that we can look at other issues like mental health, aged care and I think everyone agrees in front of you today, that it is about health and improving health services and value for money and the vast amounts of money that are spent collectively on health.
JOURNALIST: (inaudible) Heads of Agreement will proceed more smoothly that the previous Heads of Agreement on the mining tax Mr Barnett?
BARNETT: I don't think we're going to proceed smoothly on the mining tax.
JOURNALIST: Prime Minister can you guarantee that this will end the so-called blame game between the Commonwealth and the States?
PM: I think that's a really good question and what I can absolutely say to you is the following: first and foremost one thing that has caused a blame game, or at least a round of recriminations between the two levels of government, one thing that's caused that round of recriminations is the absence of transparency. So there have been fears, and perhaps sometimes they've been very unjustified, but there have been fears that one level of government is adding money in, as another level of government is taking it out, so many in health would tell you they fear that money is being tipped into the top of the bucket, but money is coming out the bottom of the bucket and they can't even see where the hole is. The arrangements we've struck today will end all of that.
Then the other blame game that people worry about is a blame game about pressures on public hospitals as those pressures have grown, States and Territories have rightly said to the Commonwealth ‘you don't fund us properly', and sometimes the Commonwealth has turned to States and Territories and tried to put blame on their shoulders. That is over now because we are going to be equal partners in growth.
And then the other end of the blame game is pressure between the various sectors of our healthcare system, so the States and Territories have right said at various parts of Australian history, that the Federal Government has been under investing in primary care, not training enough doctors, and under investing in aged care, and all of that burden has ended up in their public hospitals. As a result of the arrangements we've struck today, because we're equal partners in growth, the Federal Government as the main funder of first instance care, primary care, and aged care, now has a structural incentive to make sure people get cared for in the right place at the right time by the right person. It's not in my interests as Prime Minister to have someone in an acute hospital bed when they could be in an aged care bed, because we're going to be partners in the growth, that will come 50 cents onto the Commonwealth account. It's not in my interests for primary care to fail an Australian who then ends up in hospital, whereas they wouldn't have needed to be there if they'd got proper primary care, because we're going to paying 50 per cent of the growth. So those incentives to get primary care and aged care right will be there and that's been a big part of the blame game.
JOURNALIST: Prime Minister you said that 2011 was going to be your year of delivery and decision, is this the first delivery, is that how we read this?
PM: Well I would hope, I would hope Australians would recognise this for what it is, I think it's a very major achievement. We've struggled with health reform, the nation has struggled with the prospect that if you left it all un-reformed, that the growth in health costs would overwhelm State budgets. We would have woken up in a future where State governments, Territory governments, would have rightly said we cannot afford to run the hospital system anymore, we would have seen declining quality; that's where we were headed.
Today, we're sitting here with a national agreement that avoids that. It stands on the shoulders of what's gone before in health reform, but it is a health reform agreement, we have got away from all of the politics around the GST and financing transactions, and we've got on with the business of improving health. I think that's a very big achievement, it is shared with my colleagues sitting in front of you; we're only sitting here now because we worked on this together in a spirit of goodwill and respect and co-operation and I thank them for that.
JOURNALIST: Prime Minister in your decision to cut the bureaucracy was there any discussion about whether that means a loss of jobs and how many?
PM: These are entities not yet created, so we have swept the need to create all of those new entities aside.
JOURNALIST: (inaudible) maybe Premier Rann, do you envisage that this single pool could eventually be expanded to cover more than just hospital funding, that more things could be brought into the umbrella?
PM: I'm very happy to turn to Premier Rann, but I should say to my colleagues gathered here I have the constant dialogue with the press gallery that they would have been those kids trying to run down the stairs at 2 o'clock in the morning on Christmas Day to rip open their presents.
Yes, Phil, I'm sure you're going to start writing very learned pieces about the future of health, but perhaps where we get there we could digest this major health reform that's been delivered today.
Mike?
PREMIER RANN: Can I just say the transparency's important for us because since I was elected Premier, South Australia's Government has more than doubled its expenditure on health and hospitals, and we did that in the context of as we were putting more money in we saw the Howard Government taking more out, and that's at the nub of transparency, and let's make sure that can't happen either way.
So, we're very pleased that we have reached a deal.
For me, it was very important that having signed a deal at the end of last year that there was not one single cent less, and that's guaranteed in the heads of agreement that we've signed.
I have to say there's one area that I'm very pleased that COAG has agreed upon, and that is that I've proposed that we have a special session of COAG in the future on mental health, and I'd like to see eminent people like Patrick McGorry, Monsignor David Cappo and others address us as national leaders on that very important area of mental health, and that's been agreed today as well.
JOURNALIST: Mr Baillieu, you were one of the States resisting the original agreement put forward by Kevin Rudd. Are you happier with today's outcome, and do you believe an agreement has been reached between the Premiers and the Commonwealth?
PREMIER BAILLIEU: I do, but bear in mind that our predecessors signed up to the 2010 version. We expressed some reservations about that in terms of the funding model, and I'm pleased that the new agreement has dealt with those issues, and I think it's been very constructive in that respect.
We did have concerns about some aspects of the NPA, and I think a lot of those issues have been addressed, and we're pleased to have signed up. I think this will be a substantial gain for Victoria and Victorian patients in particular, but obviously a substantial gain for Australia.
To have everybody on board, I think, is significant in itself, and can I say on the issue of transparency, each of the Premiers and the Territory leaders, if I can dare to repeat was said, we were explicit in our desire to see transparency in resolving these issues. I think that's going to be an important development as well, to ensure that we do share the growth in funding and we do share the responsibilities.
PM: Sorry, we'll take this as the last question. I'm moderately concerned you'll be selling tomorrow's morning newspapers tomorrow afternoon if we keep going.
JOURNALIST: Just on transparency, you talk about how everyone's going to find out all the details, how to use the jargon, how much in real time will we get these statistics? Will the figures on how hospitals are performing and how the money's being pasted between them be two years after the fact? Three months after the fact? How regularly will the transparency be reported, and how out of date will it be when we get it?
PM: Well, we are talking about transparency that basically is in real time. It's transparency about the funding flows. We're dealing with monthly accounts and those kind of things, so in terms of a data collect for Australian hospitals, we're talking about more transparency than we've ever had before.
JOURNALIST: How often will the public see these figures?
PM: Well, the aim of this and the aim of a transparency agenda is that it is there not only for levels of government to have, but it is there for the public to see.
I've brought into this position the same kind of reformist drive I showed about transparency in the education portfolio. That data transforms because the public has it, so I'm bringing the same reform drive here.
Thank you.