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Transcripts from the Prime Ministers of Australia

Transcript 18043

Transcript of joint press conference, Canberra

Photo of Gillard, Julia

Gillard, Julia

Period of Service: 24/06/2010 to 27/06/2013

More information about Gillard, Julia on The National Archive website.

Release Date: 02/08/2011

Release Type: Interview

Transcript ID: 18043

PM: I am joined by the Minister for Health and Ageing Nicola Roxon. In February this year I sat in this building with premiers and chief ministers from around the country and we entered an agreement to fundamentally reform our health system, an agreement to deliver better services to patients and an agreement which meant over the months to come we would work on the details and get the details right.

Today I'm in a position to announce that I have entered a health reform agreement with every state and territory in the nation. What this new agreement means, put simply, is more money, more beds, more services, more local control, greater accountability, less waste and less waiting times around the nation.

Today we are able to publish that agreement so the nation can see the health reform that has been struck. It's got three major components, first looking at proper funding. This agreement places an obligation on the Commonwealth to properly fund its share of hospital services. When we came to Government the Federal Government was funding nationally less than 40 per cent of hospital services and of course there were periodic meetings where people would see health ministers storm in and out of rooms as the then Federal Government, state and territory governments, blued about what should go into health.

In this agreement we have agreed that we will properly fund hospitals, we will become an equal partner in the growth costs of hospitals, funding firstly 45 per cent of growth and ultimately moving to 50 per cent of growth. This is a commitment of $16.4 billion extra between now and the end of this decade. It's a commitment of $175 billion extra by 2030 over the next decade and a half. What that means is that states and hospitals can reliably plan knowing that the Federal Government will be there and will be an equal partner in growth.

What we've also agreed is that this funding will be transparent and accountable. Australians have rightly feared when they've heard about health agreements in the past that one level of government has been putting more money in at the top of the bucket but there's a hole at the bottom of the bucket as the other level of government takes funding away and people have not known in a transparent and accountable way where extra money was going. This agreement changes all of that. As a result of this agreement money will go into a transparent pool. Federal money and state money, there will be clear transparency and accountability about where that money goes to and how it is spent. People will be able to see the Federal Government's contribution and state government contributions. The days of the blank cheque are also gone. This money is being devoted to get major reforms to our hospital system. Indeed this agreement delivers the most fundamental change to health care in this country since Medicare. It comes with clear transparency and accountability, it comes with more local control through local hospital networks and through Medicare locals. And those local hospital networks and Medicare locals will work with local clinicians who know what is happening on the ground and can help best direct services in their locality.

But also at the centre of this agreement is less waste because money will be dispersed in accordance with an efficient price. People have rightly feared that money in health has gone on administration, money in health has gone to services but services have been delivered with more or less efficiency around the country. And of course there is evidence that in some hospitals work is done much more efficiently than in other hospitals. So money will follow an efficient price, set by a national authority, set independently and enabling us to see where the best and most efficient hospital practice is being pursued and then to spread that best practice.

It won't just be government that can see all of these things, Australians themselves will have their own window on what is happening in the hospital sector. They will be able to see where the money goes, they'll also be able to see what is being delivered at their local hospital through the My Hospital website.

Then there is less waiting for patients as a result of this agreement and this is very important, for people to experience change on the ground, what they want to see is less time spent waiting in emergency departments and less time spent on elective surgery waiting lists. In February this year we decided that the best way of ensuring that we had targets in the system that could be met and achieved and were meaningful for patients was to ask the experts. So we asked the Chief Medical Officer together with an expert panel to go and work and provide advice back to the Council of Australian Governments on what the appropriate targets should be. They have provided that advice and it has been accepted.

What it means for emergency departments is that the appropriate target will be 90 per cent of all patients seen within a four hour period. Now that is a change from a target that has been discussed earlier. But there's a substantial difference here. The earlier target of 95 per cent applied to a selected group of patients. That 95 per cent target applied to a group of patients when you had already removed people who it was determined were clinically appropriate to not be in that group. We've got away from all of that complexity to make the system more transparent, more understandable and more meaningful. So the 90 per cent target is for all patients who go to emergency departments.

We understand that there are some patients for whom it is clinically appropriate that they are not admitted to a hospital bed or discharged within a four hour period. To give a common sense example of that, if someone for example had taken a drug overdose it may be appropriate to keep them under observation in the emergency department for longer than a four hour period whilst that drug overdose wore off. Recognising that, the experts have said to us the appropriate target is 90 per cent of all patients recognising that there will always be around 10 per cent of patients for whom it is clinically appropriate to be in emergency departments for a longer period of time.

The target for elective surgery is now a 100 per cent target. People would be aware that the earlier target under discussion was to say that 95 per cent of patients would get their surgery on time in the public hospital system and 5 per cent would be referred to private hospital beds. The experts have advised us that that could have perverse and unforeseen outcomes. In particular it would not enable public hospitals to make long term reliable arrangements with private hospitals they want to have work with them. So the target has been changed from 95 per cent to 100 per cent of patients on elective surgery waiting lists getting their surgery on time.

Around the country this is a very different way for our hospitals to work. What it means is that the political blues people have got used to seeing every few years between federal governments and state governments are over. They're over because funding is certain into the future. We will be an equal partner in growth. For the system it means more efficiency, transparency and accountability than ever before and for patients it means less waiting time for the services that they and their families need.

I'll turn now to the Minister for Health for some comments and then we'll be happy to take questions.

MINISTER ROXON: Oh, thank you very much.

I'm delighted to be here with the Prime Minister today to announce the finalisation of this health reform agreement. And I thought, in addition to the comments that the Prime Minister has made, it might just be worth taking you briefly through, of course, the benefits that are already flowing to patients from the agreements that have been struck and that this agreement, finalised today, is standing on the shoulders of services that our Government is already delivering to the community.

For example, as part of this agreement, 1300 new sub-acute beds are being delivered across the country. A significant number of those are already up and running and providing services. For example, you could look in New South Wales at ten new beds at Mt Druitt Hospital. You could look at 16 new sub-acute mental health beds at St George Hospital. We can look in Victoria and have examples in South Australia similarly. So it is already, while some of the detail needed to be finalised, starting to deliver to patients in communities across the country.

Similarly of course people would know that our health and hospitals fund has now allocated four and a half billion dollars to 148 projects across the country. These infrastructure investments complement the ongoing funding that has now been negotiated by the Prime Minister with every premier and state and territory leader.

Of course, it is also building on the investments that we committed to the states that we would deliver in the area of primary care. So you have seen, for example, in the last month, our new GP after hours service open. In the first month, that GP after hours service has taken 10,000 calls from across the country, showing that there is a great need to provide good advice and reliable advice to patients across the country, particularly at a time when their GP might be closed, that otherwise would mean they would be presenting at our emergency departments across the country.

These are all complementary investments and reforms that are coming to fruition through some pretty dogged determination of our Government and certainly some very dogged determination and negotiation by the Prime Minister in delivering this final outcome that we can announce today.

Of course, you also are aware that other investments like our e-health investments, our tele-health consultations have come online from the 1 July. This modernisation of the health system is a critical part of being able to deliver better services to patients across the country. And now, with the finalisation of the emergency department targets, the elective surgery commitments, patients can see the plan that we will work on with the states and territories, over the next few years, to deliver constant improvements as we work our way to those targets over the coming years. And that's good news for patients as well as good news, I think for all governments that we have a clear partnership outlined that is delivering to patients as we speak today and has enormous potential for the future.

JOURNALIST: Prime Minister, I don't understand something you said so I was hoping you could (inaudible) it. You said that in regard to the 95 per cent target for elective surgery, the experts advised it could have perverse and unforeseen outcomes and this is part of, you said that they believed that this could somehow prevent them entering into the long term arrangements with private hospitals that they want to enter into. Have I understood that correctly? Can you just - I don't understand it. And also, sorry, the reason I'm asking you is that Catholic Health Australia say they've got, they're ready to go right now - they've got beds right now, so why not use them?

PM: Yes, absolutely, so I'm happy to explain it and I think when I do explain it you'll see the beds that are there ready to go can be used. The way the old target was talked about was that you would get, if you weren't meeting your target, then you would scramble around and get someone a private hospital bed. Now it's that scrambling around that we were told by experts could have perverse and unforeseen consequences. So if you imagine the old system, the old way of thinking about it, could have put a public hospital in a situation where it says to itself, gee, we're not going to hit targets we've got to quickly make arrangements with the private hospital down the road, let's run down, let's try and get them to admit Matthew and get his surgery done. That was the kind of conception about thinking about it.

With the new target, what we're saying is we are not going to mandate from here the best set of arrangements for meeting the 100 per cent target. But certainly the expert advice is some hospitals will enter long term contracts with nearby private hospitals to help them with their case load. So it won't be a question of scrambling around for an individual case in the face of being concerned about your target, you'll enter long term arrangements to deal with case load so you know you can acquit 100 per cent of people being dealt with in clinically appropriate time.

JOURNALIST: Why not just mandate the arrangement?

PM: Because we - all of this, when you look at it, is us not saying standing here in Canberra, I can absolutely tell you the best way for a hospital in Perth to work, it's actually saying local hospital networks, local control, local clinicians involved in the process, making the right arrangements so that patients get seen on time. The outcome for patients is getting seen on time, the best way of doing it, there will be different arrangements in different parts of the country, it's the outcome that matters and we received and I'll use the words, ‘the expert panel found that the national access guarantee flagged in 2010 may have unintended consequences and perverse incentives and that it was not appropriate'. Once you've received advice like that, clearly you have to think about a better way of doing it and the expert panel gave us advice on a better way of doing it.

MINISTER ROXON: Prime Minister, I might just briefly also comment. That report from the expert panel is being released today. That will be available on the website. Chris Bagggoley is here, who chaired that group. He's happy to talk with you at any point during the day if people have questions.

There is another important commitment that flowed from that recommendation and that is that we're not just looking at who tips over clinically recommended time and there needs to be, as the PM says, you know, a scramble to find a bed to provide that surgery. We're also looking at those people who have - are on the waiting list and have been waiting too long. So the recommendation is actually now that we need to have both an emphasis on those who have been waiting for too long, and clearing those lists, as well as looking at anyone that from tomorrow or, you know, in the future, tips over to having waited too long for their surgery.

So it's actually a much more ambitious target, but it's been prepared now with the clinical advice about what is realistic to be able to be delivered and I think it's very good news for patients that you won't tip over. Once you're on the list, you don't just get forgotten about so that the next lot of people get their surgery. You need to actually look at those on the list now, as well as those who might wait longer into the future.

JOURNALISTS: (inaudible)

PM: We'll just go one at a time, Paul.

JOURNALIST: Prime Minister the states have kept their GST, where does this extra funding come from and how critical is the health insurance rebate change that you want?

PM: We've made provision in the forward estimates for this agreement, so that's already been done. Separately to that we continue to pursue the Private Health Insurance Rebate savings that Minister Roxon's brought to the Parliament. So Paul it's not right to say that one depends on the other, we've already made provision for this in the forward estimates. But what we continue to say to the Parliament about the Private Health Insurance Rebate savings is that they are appropriate savings, we're talking about the fastest growing area of health expenditure is my understanding and we believe that we can make savings there which free up money for other parts of the health system. It's not necessary to fund this but there are other parts of the health system that obviously need new resources and we believe in a saving which means people aren't subsidising my private health insurance for example, is an appropriate saving to make.

Yes, Lyndal.

JOURNALIST: Prime Minister, this is at least the third time that the Labor Government has announced a historic agreement on health, each time it's announced it's been a little bit less ambitious if you look at the original plan which (inaudible) have the Commonwealth as the dominant funder of health, or of hospitals, what's to say we won't be back in two years time if the states are unhappy, that there's another historic agreement that waters it down a little more?

PM: Well this is signed, this is done and it's agreed to by all states and territories, we've never been in a position to say that to you before, we're in that position now. And this isn't a block of funds, you know, a cheque here, have this for five years and then come back in another five years and we'll have another ding dong blue and then we'll wander around talking about health agreements again, this is embedding into the system for the future how funding shares will work between the Federal Government and State Governments-

JOURNALIST: Does it end the blame game?

PM: Absolutely, if you look at the blame game, let's go back. You would have reported on meetings in this building under the Howard Government where health ministers stormed out halfway through. You would have reported on COAGs in this building, ones overseen by Prime Minister Howard, I remember one particularly clearly, I was Shadow Minister for Health at the time, where the premiers stormed out mid-morning because of health. You would recall all of that, what was that blame game and those blues about? They were about money. What does this solve? It solves into the future, the shares of money. So what we've seen is the states rightly objecting to the fact that under the Howard Government the percentage of funding of our hospital system from the Federal Government was going down and down and down, what this agreement says is we will be an equal partner in growth, we will get there in two steps: 45 per cent first, equal partner second, 50 per cent. And because it's activity based funding, it's not a capped cheque, only do so much activity and once you've spent the money it's gone and let's start fighting again. Because it's activity based funding, decisions will be made about the services that need to be provided in order to meet the targets that we outlined and funding will flow to the provision of those services.

So activity will match demand, we will be funding activity and we will be an equal partner in growth, that's what's difference about this agreement.

JOURNALIST: Prime Minister it does resemble a much diminished package of the model that was announced by Kevin Rudd a year and a half ago. Is there a lesson in this that you need to better consult first on these types of reforms, not just with the state but with the expert groups such as that which advised you on elective surgery? Looking back, should there have been better upfront consultation on this to avoid the last 18 months?

PM: Well if I can invite you to look through the eyes of patients who use hospitals and I know people in this room have had cause to use hospitals for themselves and their family. When you walk into the emergency department what do you want? Well you're pretty anxious, you want to be seen quickly, you want to know what's going on with your health or with the health of the family member you've taken to the emergency department because they're unwell.

What this agreement means is that 90 per cent of patients will be seen within a four hour period, yes there are times when it's clinically appropriate to keep people for longer, but people will experience less waiting. And then looking through the eyes of patients, if you need elective surgery, so you're on a list and you're waiting for that surgery that can transform a lot of your life - the hip replacement, we met a young man at Canberra Hospital this morning who was talking about how his hip replacement had made a big difference for him. You want to know that you are going to get that in a clinically recommended time. This agreement has in it the target of 100 per cent of people getting that surgery in the appropriate time.

So if you look through the eyes of patients, that's what's been achieved. Of course when you look at the arrangements that then Prime Minister Kevin Rudd talked about, they had with them a set of transactions in relation to the Goods and Services Tax, and that set of transactions was not agreed with state governments and in my estimation was never going to be agreed right around the nation. So I have taken a different approach but at every step of the way have held true to the reform agenda that makes a difference to the long term and held true to the objectives that Australian patients want to see when they go to the hospital. Less waiting time, less waste, more local control, delivered through this agreement and then the reform drivers here, efficient price, incredibly important, transparency - I fought long and hard for transparency in the schooling system because it makes a difference. Transparency in health will make a difference and it is here, fully delivered, and then a key understanding of quality and monitoring it, not in reports that just I get to see or Nicola gets to see or even you get to see, but quality benchmarks that people around the country in their lounge rooms can get online and have a good look at, so they get to see them about their local hospital.

JOURNALIST: Prime Minister you stood here last year and said that 60 per cent of the funding was the foundation stone of the agreement, so how can you move the foundation stone and you're actually saying that the states and the Commonwealth will never argue over health funding again, given they may well argue over what constitutes an efficient price?

PM: Well what is an efficient price will be decided by experts through the pricing authority and I'll get Minister Roxon to comment in a second about that process of setting up the authority and striking the efficient price for various sorts of activities. On the structuring of this health reform agreement, this has got the reform drivers in it, the GST transaction was not agreed and it wasn't going to be agreed, this will drive reform in healthcare, make a difference for patients, more money, more beds, more services, greater transparency, more local control, less waste, less waiting times, all in this agreement, that's what we wanted to achieve to make a difference for Australian patients and we've achieved it in this agreement.

On the efficient price determination I'll turn to Nicola.

MINISTER ROXON: Chris, you're right to zero in on the efficient price being a very big change, something that we negotiated long and hard to have delivered - because without a national efficient price, the confidence that taxpayers expect that every health dollar is being spent sensibly, I don't think, can be met. With this agreement we now will be able to have that confidence.

We've negotiated in the period from February to now the details of the legislation establishing the hospital pricing authority. It will be introduced into the Parliament when we return. We have the support of every state and territory including the Liberal state and territories to the terms of that legislation. And I am very confident that all of the background work that's being done in the meantime will be able to be quickly transferred to that new authority, with one exception.

There is actually something that potentially stands in our way - and that is if Mr Abbott is determined to be a wrecker when this legislation that has the support of all the Liberal Premiers, not just all the Labor Premiers, if Mr Abbott wants to play silly buggers with it and object to the legislation, that of course has some potential to delay the establishment of the pricing authority.

JOURNALISTS: (inaudible)

MINISTER ROXON: But I would hope-

JOURNALIST: You're confident that in two years time as the states have the lived experience of their efficient prices, there'll be no arguments over what constitutes a-

MINISTER ROXON: Well I'm confident that every state and territory has now agreed that it is right for taxpayers and patients to expect that an efficient price will be paid for services and the growth in services. That's the big benefit for the states and territories. We are not going to back away from our view, and every state premier has agreed to this, that an efficient price should be the foundation. That is a very big reform. It's a technical one. It's one that patients don't necessarily talk to us about when we walk to our hospitals. But it is one of the foundations for delivering a more efficient health system, and for us being able to be confident that extra investments in health are going to deliver extra services - not be absorbed into the system.

JOURNALISTS: (inaudible)

PM: We'll take them one at a time and I'll just add a comment to Chris' and then we'll go here, I'm happy to make this prediction: that just like we see on the days that we release the national testing results in schools, you see premiers hunting down a TV camera in order to say ‘we won, we're better than the other state, we're more efficient that the other state, we're doing it better than everybody else' you'll see the same outcome in health.

David.

JOURNALIST: If this does end the blame game, who is to blame if something's going wrong in a hospital?

PM: Well hospitals will be properly funded, that's our role, to step up to 50 per cent of growth and we will. States are the system managers of their hospital systems and they will take that responsibility, local hospital networks will drive arrangements in their locality. So what you will do is if you have experienced a problem in your local hospital, people will in the first instance raise that complaint with their local hospital, it would be dealt with immediately for them or if it wasn't dealt with they may choose to pursue it at the local hospital network level, or they may choose to pursue it with their state government because they're the systems managers. What we won't see is the cycle that we've seen in the past where something goes wrong in hospitals, premiers say it's because the Federal Government doesn't fund them properly, the Federal Government says ‘no it's because the States don't do a good job managing them' and on and on and on it goes because this agreement delivers certainty about funding for the future.

JOURNALIST: Prime Minister will there an advertising campaign to sell this reform and on a totally unrelated matter, are you meeting News Limited editors and executives today and if so what will you tell them?

PM: Right, on this reform obviously the reform is before you today, we do raise with the public and we'll continue to do so the ways in which they can access services for example the afterhours hotline and other things that people need to know in order to navigate their healthcare system and understand what's happening with their healthcare system are things we'll continue to bring to public attention, it's important that Australians understand how the system works, how they fit into it, where they can get information, where they can get services. So in terms of public communications we'll continue to do that kind of work.

Yes I am meeting this evening with News Limited editors, I was invited the do so by John Hartigan who brought his editors across the group together as I understand they periodically do, such meetings have been addressed by Prime Ministers and Opposition Leaders in the past so when I was invited by Mr Hartigan I accepted the invitation.

JOURNALIST: What will be your message to those editors Ms Gillard?

PM: We'll I'll be happy to have a discussion in the room with people, it's a private meeting, but you would expect me to be talking about the Government's reform agenda and my vision for the nation's future.

JOURNALIST: Just following up from David's question, what will happen to hospitals if they're not meeting their targets, what will happen and I'd also like to ask why are riot police needed to help transfer 54 asylum seekers to Malaysia?

PM: Well they're two quite different questions.

On the first of them, people will be able to transparently see who is not meeting targets and to demand that it be addressed, so the force of transparency is it always keeps before decision makers and the public what's going well and what's going badly and it always informs a will for change because what's going badly is transparent to everyone.

On the question of Australian Federal Police and the movement of asylum seekers, I dealt with this matter yesterday, yes we do have security personnel and Australian Federal Police available to assist with the transfer of asylum seekers to Malaysia, my view is that people will be given instructions to board a plane and they should obey those instructions. As for operational matters and requirements for the Australian Federal Police including training exercises they're a matter for the police itself.

JOURNALIST: Further to Joe's question-

PM: Yeah we'll go and then we'll come to Mr Farr.

JOURNALIST: Ok, so me first?

PM: Yes.

JOURNALIST: Sorry Malcolm-

PM: But I just know out of the respect that you would show, you'll now keep your question very brief because you know Mr Farr-

JOURNALIST: Further to Joe's question, there is a single child on the latest boat that's been intercepted, now I understand that he's part of a family group. What will decide as to whether he is sent to Malaysia or whether he's allowed to stay, is it the fact that he's in a family group, the fact that he's not unaccompanied, what will be the kicker?

PM: In terms of who is on the boat I think that is best finally ascertained and dealt with when people get to Christmas Island and disembark the boat. On any details in between I'd refer you to Minister for Immigration.

Yes.

JOURNALIST: You've nominated this as the year of delivery, are you open to the charge now that you've downgraded your ambitions in health, and in asylum seekers simply to make it the year of delivery, to deliver something?

PM: Just explain your question to me Malcolm, what do you say has been downgraded?

JOURNALIST: Well there's huge differences between what your predecessor said should be done in the health area and what you've just outlined now.

PM: But from the point of view of patients what do you say has been downgraded?

JOURNALIST: Well, certainly the Federal Government is not going to be taking up 60 per cent of funding-

PM: But when I go to hospitals people don't talk to me about financing transactions, they sit in emergency departments and say when do you reckon someone's going to come and see me, when I talk to patients in hospitals they don't talk about financing transactions, they say my mum's on a waiting list for a new hip, how long do you reckon she'll have to wait. So looking at it through the eyes-

JOURNALISTS: (Inaudible)

PM: Well I'm challenging the premise of your question and if it's got a-

JOURNALISTS: (Inaudible)

PM: Well hang on, we'll deal with Malcolm's question first. So rather than just make an assumption I'm asking you from the point of view of Australians who use hospital services where does your question take us?

JOURNALIST: Well I return to what the original program of the Government of which you were Deputy Prime Minister, there is a vast difference between what was proposed then and what you've just announced.

JOURNALIST: What was promised during an election campaign.

PM: Well let's go through this and let's be really practical about it. What was promised was at least $16.4 billion of new funding, what's being delivered? Precisely that. What was promised was reform, accountability, transparency, efficient price, more local control, what's being delivered? Precisely that. What was promised was that people would wait less time in emergency departments or on elective surgery waiting lists, we've asked the experts, there's no point having a view about targets sitting in a room here in Canberra, we wanted to know that the targets we struck could live and breathe in Australian hospitals, they could be delivered, and we asked the experts and the experts came back with their advice and we've accepted their advice. Their advice is go for 100 per cent of elective surgery, go for 90 per cent of the entire patient group going into emergency departments rather than chopping up that patient group and then applying targets to a section of it, that's what we've done.

We'll go to Sue's question and then come back through.

JOURNALIST: The difference between your agreement and Kevin Rudd's is he gave a guarantee that you would get your elective surgery, you seem to have got a target. If you were to be treated on time under his system you have to have found a bed within five days if you were a category one patient. Under your agreement there is no guarantee that you will get treated within five days of passing the deadline, can you tell us why that isn't a difference to the patient outcome?

PM: It's a difference that has been struck on expert advice, because let me refer you to the words: that access guarantee by the experts was seen as having, may have unintended consequences and perverse incentives and that it was not appropriate. Having received advice like that from an expert panel, I believed it appropriate as Prime Minister to accept that advice.

JOURNALIST: Prime Minister, on page four there's a reference to reward payments to the states being brought forward as facilitation happens. I thought the overall objective here was to give the states a big incentive to improve efficiency and performance and then they would get reward payments, but here it looks like some of the reward payments are being paid in advance. Does that not represent a weakening of the pressure on the states to get results?

PM: No, I think we've got to be clear about the time sequence, and you may be just juxtaposing those words against a different notion of the time sequence. We've got a national partnership agreement that has been signed again. So, we had national partnership agreements, we've got a new national partnership that we've struck with states and territories. It is about getting change into the system, lifting the system up so it is doing better, before these new arrangements which apply from 2014-15 come into effect.

Most particularly, that national partnership money is about sort of turbo-charging change around the 4 hours in emergency departments and around 100 per cent in elective surgery. What we've agreed with the states is that there is reward money payable off those targets under the national partnership, we want people to move up, to step up and then they step into the new system off that higher and better base.

In that agreement, and the details are before you, you've got the 4 hour target, as described in the emergency department, we've got the 100 per cent target, as described in the elective surgery. We've agreed with the states that reward money will be paid at a 98 per cent achievement level, against the 100 per cent target, because we do recognise you can have a completely random event that can make a very marginal difference to hospital performance.

To give you an example of that, if we had a big emergency in one part of the country, and asked a lot of specialists from other parts of the country to go to the emergency site, that would make a modest difference to elective surgery performance and so we've recognised that. So, national partnership agreement is there before you. It's not correct to say that reward money is being paid in advance of change.

JOURNALIST: Prime Minister, under the initial, not even Kevin Rudd's proposal, but as I understood your post-February COAG meeting, and the initial legislation establishing the new health authority, it was going to be answerable to Commonwealth. As I understand now that's been changed, so that the states have greater input, I think, through COAG. What is the specialist advised reason to do that, or is it the case that the states wanted to have a greater say in how that was run, who runs it, how much they get paid and the setting of the targets?

PM: No, no, the targets are set and they are as described to you today.

JOURNALIST: Sorry, (inaudible)?

PM: I'll go to Nicola on the details of the legislation and discussions there, but I want to be very clear - this agreement today delivers on the Heads of Agreement I entered into in February. It delivers on it in full, so any suggestion that there's been concessions made between February and now is simply not right.

Yes, we have worked through new levels of detail and with all the details in front of you today, you can see the full agreement. On the structuring of the Performance Authority I'll go to Nicola.

MINISTER ROXON: Yeah, look, I think you're confusing two different things. There is the National Health Performance Authority which was always going to be a body which had accountability to both the Commonwealth and the states. The negotiations and the public coverage of changes to that legislation all turned around how that was delivered.

It was agreed in February that there would be an independent National Performance Authority. There was to-ing and fro-ing over what the legislation would say in order to deliver that, but it is now agreed and it was announced more than a month ago that that National Health Performance Authority would have certain accountabilities that provided reporting to the states and the Commonwealth and to the public.

The commitment made in February has been delivered upon, and I think if you ever understood that that was just a Commonwealth-only body, that was a misunderstanding because it's always been agreed that that was a body that would provide performance information to the states, to the local hospital networks, to the Commonwealth and to the public. And separately, the Hospital Pricing Authority, that legislation has not been introduced into the Parliament. It's been being negotiated in detail before it was introduced into the Parliament. It is now agreed to in detail and is ready for introduction when we return.

JOURNALIST: Minister, can I just draw you out on what the consequences or penalties may be for hospitals that don't meet the targets?

MINISTER ROXON: Well, I think the Prime Minister made absolutely clear that one of the big drivers of change is the accountability and transparency, so a hospital that is not performing is going to very quickly and very publicly know that it's not and its community will know that it's not. Similarly, a hospital that is performing very well is going to very publicly be recognised, and for the first time we'll be able to say, that hospital's performing really well, what is it doing that we want to be able to deliver in this hospital that's not performing well and will drive the changes in process, the changes in clinical practice, the changes in administration that improve those services.

Ultimately, the penalty is whether or not the states will get their reward payments, but every hospital will be paid its efficient price for the provision of services. If it is operating inefficiently, it will have a bigger burden to find the costs and funds elsewhere. So it is the driver that we've never had before that says if your hospital is not performing well, you need to be able to improve your performance to make sure that you can make the most of the money that's available through this new system.

JOURNALIST: Prime Minister, (inaudible) the local hospital networks, I mean are they answerable to the states, or to the Federal Government. It does seem that the states have been the really big winners here, you've conceded much to them-

PM: Once again Paul, what? What do you say we've conceded to them?

JOURNALIST: Well, it did seem that one of the crutches of the reform was that local hospital boards, especially in New South Wales, or networks as they were called, would have more autonomy, more say and it would be a way of delivering real needs. Now the states, in a sense, were seen as the villains of the piece here previously, but it would seem that they have still got the major say in the way in which these boards may even be set up?

PM: I'll go to Nicola for an in detail answer, but once again before we get to the analysis, let's actually just digest facts, because maybe they might inform the analysis. On local hospital networks what we've said is we will deliver structures that would give better partnership arrangements for health care in communities, so metropolitan communities in particular have a number of hospitals within their reach, they can better collaborate, better co-operate, to meet community needs and they need to be answerable to their community, they need to be transparent and they need to involve the best of local advice, including clinicians advice.

That was what we set out for local hospital networks and what is going to be achieved through this agreement.

On the technical structuring of them, I'll turn to Nicola.

MINISTER ROXON: Well, just to make the point, you've chosen a good example. In New South Wales, the area health services, I think you've rightly said, were not popular. But in New South Wales, the local hospital network legislation has been passed. The new local hospital networks are up and running. The new independent chairs are established and in place. This actually occurred under the previous state government with the support of Mr O'Farrell who was then the Leader of the Opposition.

This is actually a reform that has already started delivering in New South Wales, one of the states where there was the most common complaints about the area health service being too distant from local service providers.

So those changes are already starting to deliver very significant change to the way services are structured and delivered and supported. And in New South Wales, that reform is already done and dusted.

PM: So, it's perhaps Paul a little hard to suggest it's somehow been watered down.

JOURNALISTS: (inaudible).

PM: We'll go to the last three, we'll go to Chris first, then to Katherine up the back and call it a day.

JOURNALIST: (inaudible) local hospital networks were accountable to, more to the dominant funder, which was going to be 60 per cent funded by the Commonwealth, so how are they accountable (inaudible)?

MINISTER ROXON: Well, the mechanism is that they are creatures of the state. We have been-

JOURNALIST: (inaudible)

PM: That's not true. That's not true, let's just deal with the facts. The local hospital network structure that Nicola has described, for example in New South Wales, the one that applies now was the one that was always going to apply.

So, any suggestion you're trying to weave into this change in the operation of those networks, I think you've got to test against the facts.

MINISTER ROXON: I think that's right. I mean, it was always explicit that they were creatures of the state. Yes, we have a say and we negotiated with the states and territories boundaries to try to make the Medicare local boundaries and the local hospital network boundaries as complementary as they could be. But the Medicare locals has always been ultimately our responsibility and the local hospital networks have always been ultimately the states' responsibilities.

I think the point that you're making is that is now clearer, it is clear, and the Prime Minister made clear and this was made clear in February, that we acknowledge that the states are the system managers. We don't resile from that. What the Commonwealth is delivering is appropriate and proper funding for the system into the future and demanding more transparency and accountability. But the states ultimately are responsible for hospital services, and that's something that we have made public since the February agreement was struck.

PM: And if I can, we'll take some other questions, but if I can just invite some comparisons here, because there was the discussion before about targets. I'd invite people to reflect on the differences that have been made in education - we don't run schools, states run schools, catholic system runs schools, independent bodies run schools, the independent schools around the country. We introduced better funding, better quality standards, better transparency and it has catalysed change.

Now, look at this reform together with things like the efficient price, big drivers, it will cause change. There's no reason to be sceptical about that, you've actually seen that happen before your very eyes with Australian schooling, transparency made a difference, it's made a difference to performance, the schools that came up with a sea of red, people scrambled around, including state governments to make a difference to performance in those schools. I've had conversations with people in this room about change programs in the school that their children go to, because of bad results on My School. So, transparency, accountability, quality, efficiency, price, pooled arrangements, no mystery about where Federal money goes, where state money goes, clear standards for patients to rely on and to track delivery against. That's what these reforms are about.

Katherine.

JOURNALIST: Prime Minister, given your meeting this evening with News Limited executives, have any of the major media companies made representations either formally or informally to the Government about the privacy reforms, or about the desirability or otherwise of a Senate or other inquiry into the media?

PM: Not to me personally. On the privacy reforms you would have to check with Minister O'Connor, whether he's had direct discussions with newspaper editors on the announcements he made the other week. I can't help you with that. So, he's obviously in charge of the consultation process.

JOURNALISTS: (Inaudible)

PM: I think we did say one here and then we'll come - and that's it. Yes up the back.

JOURNALIST: Thank you. This will start in 2014, seven years after Labor was elected, it's a long time for patients to be waiting for the blame game to end, isn't it?

PM: You're not going to hear Nicola Roxon go through the list of what's been achieved in the meantime. Settle in.

MINISTER ROXON:Despite those threats, I won't take you through each and every one of the hundreds of projects that are already having an impact across the country. But I do need to challenge the assertion the targets, the ultimate targets come into force, as you say, in 2015 and 2016 in some of the smaller states for the elective surgery targets.

But just for example - and this is released in all of the materials that are being provided today - the emergency department targets that are being introduced as we go to lead up to 2015, in New South Wales, for example, only 62 per cent of patients in emergency departments are currently seen within four hours. By next year, that target will be 70 per cent, and each year after those targets increase, so the patient will see a benefit straight away. And I can take you through each of those figures in each state, but I fear that many of you won't want to stay here for the 20 minutes or so that that will take me. But that is publicly available.

So not only are the investments that we've already made starting to deliver a difference across the country, you also have a phase-in of the targets which commences straight away, which patients will see the benefit from as each and every one of those targets is implemented.

And from Western Australia you will know, where there is experience in implementing the four-hour rule, as soon as that was introduced there was massive change immediately in hospitals. The target wasn't reached in the timeframe that the West Australian Government had set but there was, you know, a 20 and 30 per cent increase in some hospitals over a period of just 12 months.

So I don't accept that patients will be waiting to see change. There are already 70,000 patients across the country who have had their elective surgery that they wouldn't have had if our reforms were not introduced. There are already GP super clinics providing services across the country that wouldn't have been delivered if we weren't already implementing our reforms. There are sub-acute beds that are operating across the country in different parts of the country that are already treating patients as we speak, and that will continue to grow over the coming years. There won't be a sitting around waiting until 2015, although the ultimate targets kick in at that time.

PM: And of course once the agreement, 2014-15 to the end of the decade, two million more admitted to patient episodes of care, 2.9 million more services in emergency departments, 19 million more outpatient consultations. That's what the funding will enable.

Now, we said last question before. Mr Riley.

JOURNALIST: Thank you very much. What's the Government's response to Dr Philip Nitschke's plan to bring Nembutal into Australia and prescribe it to patients with terminal illnesses?

PM: I'll turn to the Minister for that comment.

MINISTER ROXON: I haven't seen reports of that. Obviously Dr Nitschke has been a public figure for some time. I would have to take it on notice, Mark. I haven't seen the current reports of what he is planning to do.

Obviously there are very tight restrictions about what sorts of medications can be imported. We have a tightly regulated system here for what is legal and what is not. But I'll have to take it on notice and get back to you, which I'm happy to do. Thank you.

PM: Thank you.

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