CHECK AGAINST DELIVERY
I acknowledge the First Australians on whose land we meet, and whose cultures we celebrate as among the oldest continuing cultures in human history.
The Australian Government values the role of the Australian Medical Association in representing the interests of Australian doctors - in general practice and other specialties, medical students and doctors in training. We especially value the AMA's constructive engagement in the national debate on the future of our health and hospitals system.
In particular, tonight I want to acknowledge the hard work of Andrew Pesce as President of the AMA. I've appreciated Andrew's input and his engagement with the health reform agenda in the meetings that we have had together in recent weeks.
The Government and the AMA are both committed to tackling the long-term challenge of health reform, and we are both committed on the direction we need to take to tackle this challenge - in particular, on the need for stronger clinician leadership within our health system.
In July last year, the AMA told us about the sorts of things that they would like to see in health reform. In a speech to the National Press Club, Andrew said, and I quote:
"Services must be organised and administered as close as possible to the actual delivery of the service (to the bedside)."
He also said:
"Reform must enable more decision-making by health professionals at the local and institutional levels."
"Reform must encourage a move to national standards."
Andrew, we heard you.
What I am going to talk about tonight is what the National Health and Hospitals Network means to you, how you have helped shape this reform and the critical role that you have to play in the future.
In framing this reform, the Government conducted more than 100 consultations with clinicians, health professionals and patients across the country, from major tertiary hospitals through to small primary care centres providing the entire clinical support for several towns.
I have heard firsthand about:
* the need to provide clinicians with leadership and flexibility to determine what works best for their patients;
* the need to recognise that general practitioners are the backbone of our health system - and to properly support and train them;
* the need to train more doctors and to ensure that our next generation of doctors are equipped with a world class education;
* the shortage of health professionals in our rural and remote communities and the demands placed on our dedicated rural doctors, who are often the single practitioner servicing the full spectrum of needs of several small communities;
* the future information technology needs to support our health system;
* the major differences in quality and standards across the nation; and
* the need to support training and research in both our hospitals and in health services in the community.
Again, we have heard you, and as a Government, we are determined to act, after so many years when health reform was considered just too hard to undertake.
The Australian Government believes that now is the time for action on health and hospitals. The health system we have today - though it has served us well - has come to a tipping point.
The current system is fragmented.
Its structure encourages cost shifting and blame shifting between different levels of government.
It wastes resources.
It leaves too many patients waiting at the end of long queues.
It is increasingly unable to cope with the strains under which it operates.
It often leaves key decisions in the hands of bureaucrats far too remote from the communities that health professionals serve.
And it is unprepared for the challenges of the future - an ageing population, rising chronic disease rates, workforce shortages and the rising cost of medical care.
The scale of the challenge is reflected in Treasury's conclusion that without action, State government budgets by 2045-46 will be completely overwhelmed, with health spending consuming their entire revenue.
In other words, as a nation we cannot afford to delay action any longer.
Within our first year in office, we signed a National Health Care Agreement that delivered $64 billion - a 50% increase in on the previous agreement, and last week we announced the most significant reforms to health and hospitals since the introduction of Medicare.
The National Health and Hospitals Network will be nationally funded and locally run.
The Australian Government will become the dominant funder of our public hospital system.
We will devolve responsibility for managing our public hospitals to Local Hospital Networks.
We will take over all funding and policy responsibility for GP and Primary Health Care services.
But we know that much more is needed - and we will have more to say over the coming weeks and months ahead.
We will be addressing the reform of primary care in greater detail because if we are to take pressure off our hospital system, that is going to happen through providing better primary care in the community.
General Practitioners will be very important to those changes.
We will also tackle the long-term shortage of doctors, nurses and allied health professionals, building on the record $1.1 billion investment in training more health professionals and the expansion of GP training places that are already being delivered.
We will take the National Health and Hospitals Network to the States at next month's meeting of the Council of Australian Governments and if the States and Territories do not sign up to fundamental reform, we will take this reform plan to the people at the next election - to give the Australian Government all the power it needs to reform the health system.
What I want to talk about with you tonight is what these reforms mean for you as doctors.
First, what a nationally funded network means for you.
Second, what national standards mean for you.
And third, what Local Hospital Networks and clinical leadership mean for you.
Under our plan, for the first time, the Australian Government will permanently fund 60 per cent of the efficient price of all public hospital services. It will also shoulder the burden of rising hospitals costs into the future.
As the dominant funder of the hospital system, the Government will pay for hospital services differently. Instead of providing States with a blank cheque, the Government will pay hospitals directly for each service they provide.
It has not only been patients who have been short changed by jurisdictional buck-passing and system-wide inefficiencies. It has been medicos who have been left to turn patients away from hospital wards due to a lack of available beds. It has been doctors who have had to work in often rundown buildings, without state-of-the-art equipment, as the number of administrative and clerical staff has ballooned to more than 36,000.
Under a National Health and Hospitals Network, things will change - from service provision to the delivery of operating capital and large scale capital works, hospitals will be better resourced into the future.
The level of government with the strongest financial position will foot a dominant share of all hospital costs and it will do so on a permanent basis.
For the first time, we will provide clinicians with the certainty of knowing that when you admit a patient, the hospital is being paid a fair price for the services that you directly deliver. This fair price will be set by an independent national umpire. The umpire will be free from the clutches of either level of Government.
This means no more finger-pointing between governments about the rate of indexation for hospital funding and it means no more arbitrary cuts to the indexation rate - which undermine funding for public hospital services.
Instead, funding will reflect an independent assessment that takes into account clinical advice about what is needed to deliver services properly and efficiently. And, in line with the AMA's recommendations, the efficient price will reflect the varying cost of service delivery across different hospitals in rural and remote locations, and for patients with more complicated conditions.
As the majority funder of the health and hospitals system, the Australian Government will require strong national standards and transparent reporting in the health system. These national standards will reflect the high expectations that patients and clinicians should rightly have of health and hospital services. These national standards will apply across the health system, including:
* Access to hospital care;
* Access to GPs and other local health professionals;
* Safety and quality in the health system; and
* Financial performance.
Today, there is significant variation in waiting times for emergency departments and elective surgery across our eight state and territory health systems.
Last week I said that a national network would for the first time mean tough national standards. For the first time, patients - no matter which hospital they attend, no matter where it is - will know that their hospital is subject to the same strict standards as every other hospital.
This week, I can announce that we will put money on the line to drive those standards.
We must improve waiting times for emergency services. We must improve waiting times for elective surgery.
But consistent with the move to activity-based funding, we won't be handing over blank cheques.
Today I can reveal that we will make additional investments, based on reaching and exceeding those tough national standards. In other words - performance incentives for local hospitals.
This will not be the whole of our extra investments - not by a long shot - but we believe it is crucial to recognise concrete improvements in a concrete way.
This will give local hospitals more funds to deliver essential health services, and drive innovation and improvements across our hospitals.
National standards will also drive better health and hospital outcomes, but to achieve better outcomes, the pursuit of these standards needs to be informed by clinical practice, and that's where clinicians will play a critical role.
The national standards are our destination. It is clinicians, and their expertise, that will provide us with the quickest and surest route of reaching these standards.
Part of reaching the destination is ensuring clinicians have sufficient scope and authority to adapt best practices at the local level. I will return this important matter shortly.
But an equally important part is ensuring that clinicians have sufficient voice to tell decision makers what national best practices are.
The Government will support clinicians in ensuring we have ways of disseminating their experience and their research, and putting it into practice nationally. We will do so by supporting the development of national clinical guidelines, and we will do so by enhancing the role of the Australian Commission on Safety and Quality in Health Care, to expand its range of functions to drive evidence based medicine.
And we will underpin our commitment with a new role as the dominant funder of teaching and research in our public hospitals.
Local Hospital Networks are another key element of our reform agenda. As I have made clear, these are not the hospital boards of old, which pitted hospitals against each other in a fight for funding.
Networks will be made up of small groups of public hospitals which will work together to deliver patient care, manage their budgets and answer for their performance.
I know how important this is for clinicians. Across the nation, clinicians tell me they feel locked out of decisions on the delivery of health services in their communities. Everyone in this room knows this damages staff morale, increases turnover and disrupts patient care.
Under our reforms, Local Hospital Networks will have Governing Councils made up of clinicians, and finance and management professionals, who are in touch with local needs. These Governing Councils will work with local clinicians to ensure their expertise - especially on quality and safety - is incorporated in the day to day operation of hospitals.
I know many of you in this room will be members of the various forms of clinical advisory councils that exist today, and I suspect that the same number of you will be frustrated at the constant talk and lack of action arising from these bodies that you devote your precious time and energy to.
Our reform plan will bring a fundamental change to the relationship between clinicians and the CEO of the local hospital. The strings will no longer be pulled by unseen bureaucrats.
Imagine the situation I outlined last week where two clinicians at a regional hospital pioneered the development of new services for elderly patients which decreased their admission rate and provided them with better care in the community.
Instead of spending time putting together business cases that end up in the bottom drawer of a bureaucrat hundreds of miles away, the clinicians will be able to deal directly with the Governing Council, and the Governing Council will have the authority to act.
Let me be clear - clinical leadership will be an integral part of Local Hospital Networks and will be built in at every layer across the National Health and Hospital Network.
The Australian Government will establish Lead Clinician Groups so doctors - who know patients best - will be able to improve service planning and the allocation of clinical services in their area.
Lead Clinician Groups will also be drawn upon to provide solutions to national clinical standards.
These groups will complement the corporate governance of Local Hospital networks - giving local clinicians a voice.
We will make sure that clinicians and representative bodies like the AMA are involved in the development and implementation of lead clinicians groups across the Network.
Reforming the Australian health system will be tough, but if we get the structural reforms in place now, we can build a health network that is sustainable, and fair and efficient; one able to navigate the challenges that lie ahead; and one that reflects the excellence of the medical professionals who serve the needs of patients in Australia every day.
We value the AMA's partnership and valuable contribution to building better health and better hospitals for all Australians.
I thank you.