Thursday, 22 November 2012

Address to the Queensland Media Club

There is nothing more fundamental to Queensland's future than having a world class health and hospital system.

Nor is there anything more fundamental than the radical difference between the Australian government's commitment to the long term funding and reform of the health and hospital system on the one hand, and the approach we have seen from the Queensland Liberal National Party Government on the other.

This difference is manifest across the board in virtually every sector of healthcare delivery in this state.

We the Australian Government deliver record funding to a radically over-stretched system, the Liberal National Party response is to de-fund the system.

We the Australian Government fund thousands of new healthcare workers in Queensland, the Liberal National Party sacks more than 4000 healthcare workers in Queensland.

We the Australian Government train 40 per cent more young doctors in Queensland than have ever been trained before, while the Liberal National Party refuses to provide these critical healthcare professionals, who are desperately needed across the state, with the required internship positions in Queensland hospitals for 2013 (at least until last week when they were dragged kicking and screaming to the table and with the Federal government having to provide additional funding to get them to discharge their own responsibilities in this critical area).

And we the Australian Government have invested more than $78 million for new and upgraded TAFE facilities in 50 separate projects across Queensland (where many of our allied and preventative healthcare professionals are trained), while the Liberal National Party have withdrawn $78.8 million from the tertiary, TAFE and training sectors.

And now it is reported that the Liberal National Party is threatening to close up to half of all Queensland’s TAFE campuses, including those that we the Australian Government have already provided new investment in.

And so this sorry saga rolls on as the Australian Government builds things up, only to see the Liberal National Party tear things down.

We plan for the future, while they walk away from the future.

And most critically, we fund the future, while they de-fund the future.

The assault on the Queensland health and hospital system by the Liberal National Party Government has become a scandal of national proportions.

Our friends here in the media know this because you have reported on it. Often.

But the core problem is this - what the Queensland Liberal National Party has done to health and hospital funding is just the entree.

Tony Abbott's Liberal National Party at the federal level represents the main course.

This is not an idle political observation.

This is based on Tony Abbott's stated policy positions on the part of the alternative Government of Australia.

To slash and burn funding by abolishing Medicare Local.

By withdrawing funding for GP Super Clinics.

And most significantly of all, by refusing to endorse the National Health and Hospitals Agreement with the States.

This agreement which has delivered the Queensland health and hospital system record funding of $13.56 billion over the last 5 years.

This represents a 17 per cent real increase on the previous government.

And over the next four years, federal funding for Queensland health and hospitals will continue to increase – by a further 21% - to a record $3.76 billion in the 2015-16 financial year.

To put this in its starkest contrast, under the Keating government, federal funding as a proportion of overall public hospital expenditure was 46.1 per cent, under the Howard government it collapsed to 42 per cent and under the current Australian Government as a direct result of the National Health and Hospital Agreements signed with the states will rise to 45 per cent from 1 July 2014 rising to 50 per cent in 2017-18.

In other words, under the federal Liberal National Party when Mr Abbott was health Minister the states had to shoulder 58 per cent of the burden – in the future they will have to sustain 50 per cent of the burden.

And this is fundamentally significant to the financial future of the states and the federation given the ballooning nature of the costs of hospital care into the future, diverting resources from other critical state government priorities such as education, police and emergency services.

Queenslanders may have been caught by surprise by what the state Liberal National Party has done to health.

Nobody should be caught by surprise by what the federal Liberal National Party has said it will do to health.
Not only has Mr Abbott promised slash and burn for the future.

Mr Abbott has a history as Federal Health Minister of delivering slash and burn in the past when his government withdrew $1 billion from the health agreement with the states.

And let nobody forget that John Howard had to overrule Health Minister Abbott to ensure that Australia adopted a mass immunisation campaign to prevent cervical cancer using the Australian discovery of Gardasil – from Queensland’s own Professor Ian Frazer.

Therefore, given that I have had a significant role in the years following the 2007 election in driving health and hospital reform nationally, as well as having seen Queensland benefit significantly from these funding and policy reforms, as well as seeing new services delivered on the ground in my own local community on Brisbane's Southside, I do not intend to stand idly by while Mr Abbott's Liberal National Party launch a new slash and burn crusade against the Queensland health and hospitals system.

And my specific challenge to Mr Abbott, the Shadow Health Minister Mr Dutton, himself a Queenslander, and Dr Glasson, a former head of the AMA and now a Liberal National Party Candidate, is to identify the precise list of Queensland health and hospital services that will be cut should Mr Abbott become Prime Minister next year.

After the experience of the March state election, Queenslanders refuse to take this on trust.

·         How much of the $297 million currently being invested in 18 Queensland emergency departments will be cut?
·         How much of the $275.4 million currently being invested in elective surgery services (including new capital funding) will be cut?
·         How much of the $425 million for Queensland’s new sub-acute hospital beds will be cut?
·         How many of the 16 GP Super Clinics we have opened or are building across Queensland will remain financially viable once Mr Abbott implements his undertaking to abolish funding for this program?
·         Will any of the services delivered by the 7 new regional cancer care centres be cut?
·         Will Mr Abbott continue the increased number of GPs in training (635 today versus 453 in 2007)?
·         And will Mr Abbott commit to concluding the rollout of the personally controlled electronic health record for all Queenslanders – a critical reform to improve patient care, reduce wrong prescriptions and to reduce costly duplicative diagnostic services?

When I last debated Mr Abbott on specific questions concerning his proposals for health policies in 2010 – he refused to provide any details whatsoever as to what he would do to the health and hospitals system.

With the federal election now less than 12 months away, the time has come for Mr Abbott to come out of hiding.

My challenge to Mr Abbott is to provide a written guarantee to the people of Queensland that no federally funded health services or health jobs will be lost in Queensland if he is elected Prime Minister.

Mr Abbott places great store in written guarantees.

He has already provided one saying if elected he would repeal the carbon price legislation.

Therefore it should not be difficult to provide a comparable written guarantee on such a critical area of service delivery as health.

I would also ask Mr Abbott to provide a written guarantee to all states that the federal contribution to the health funding would be maintained at 50 per cent from 2017-18 as opposed to the collapse in federal effort during his tenure as health minister which dumped health funding into the lap of the states, effectively saying ‘not my problem’.

National Health and Hospital Reform

Over the last 5 years, the Australian Government has brought about the most significant reforms to the health and hospital system since the introduction of Medicare a quarter of a century ago.

The government has done so in a comprehensive manner which recognises the interconnection of all the elements of the health system – from preventative healthcare, to primary healthcare to acute hospital care, to subacute care, to aged care, to mental health, to health workforce planning and reform as well as e-health.

The core policy objective with these reforms was to maximise health outcomes for the Australian people while also maximising the efficiency of the system which delivers those outcomes.

In the absence of such reforms, the risk to Australia and to the federation as a whole is an uncontained explosion in health and hospital costs to the Australian taxpayer and consumer, and with health budgets eventually consuming the entirety of state government revenues to the exclusion of all other functions.

This phenomenon is common across the western world because we are all living longer, the number and cost of healthcare interventions in a person’s life is radically increasing, and within our federation the perverse health economics of cost-shift and blame-shift between the Commonwealth and the states was structurally undermining the efficiency and effectiveness of the overall healthcare system.

That’s why the government commissioned the Bennett Review in 2008.

That’s why the government negotiated a National Health and Hospital Network (NHHN) Agreement with the states in April 2010 and, following further objections from Victoria and Western Australia in particular, the revisions to that national agreement that were finally agreed in 2011.

That’s why the government agreed on the establishment of the National Preventive Health Agency with the states in 2008.

The relevant national agreement also provides a record investment of nearly $1 billion dollars over nine years from 2009 in preventative health programs.

This agreement recognises that unless real preventative action occurs across the community in critical areas such as obesity, smoking, exercise and nutrition, that the explosion in chronic diseases such as type two diabetes will financially cripple the health system of the future.

The core function of the agency is to provide continuing, evidence based policy advice to all health ministers on the most effective on the ground programs in the community.

A second area of fundamental reform is in the area of primary healthcare, most critically through the establishment of Medicare Local.

61 Medicare Locals have been established across Australia.

Their critical function is to keep people out of hospital by linking them to the range of non-hospital based services that can provide their healthcare needs in a non-institutional setting.
Medicare Local seeks to join the dots of the healthcare system by linking local GPs, allied health professionals, aged care services as well as Local Hospital Networks in personal health plans to ensure that the full range of healthcare needs for an individual patient are being met.

Medicare Locals also provide a 24/ 7 telephone service to link people with local healthcare providers out-of-hours, rather than simply have patients present at accident and emergency when more effective and less expensive healthcare options are available.

Medicare Locals will also support the rollout of the patient-controlled electronic health record in close collaboration with other healthcare services providers so that when a patient presents for a consultation with any part of the healthcare system, that patient’s health records (including diagnostic records) can be accessed across the system, thereby reducing the risk of bad diagnosis, erroneous prescriptions or duplication of diagnostics which also costs the system enormously.

One of the areas where Medicare Locals will also be supported in their community-based medicine approach is the rollout of more than 60 GP Super Clinics across the country, with 16 of those in Queensland.

These Super Clinics are designed to provide flexible, out of hours, integrated healthcare services to patients – including GPs and the range of allied health professionals form podiatrists to psychologists. 

Together with other forms of support to other GP clinics – once again the purpose of the system is to help provide integrated patient care plans, better health outcomes for patients and to keep those patients out of hospitals.

A related reform in non-hospital based primary care has been the rollout of 24 regional cancer care centres across the country, with 7 in regional Queensland.

Again the purpose of these centres is to keep patients as close to home as possible, by delivering as many chemotherapy and radiotherapy services in the region in which they live.

This also reduces the need for all such patients to present to major metropolitan hospitals, reducing travel costs as well as social isolation during what is always a very difficult treatment.

Within the acute hospital system, local hospital networks (referred to by different names in different parts of Australia) have been established across the country.

The purposes of these networks is to ensure that hospital-based services can be planned on a regional basis so that we reduce duplication and increase the availability of a full range of health services within every region.

Prior to the introduction of this reform, there was a grave danger that individual hospitals would simply be run as independent fiefdoms in ignorance of the services provided by proximate hospitals or, for that matter, in non-hospital environments in the primary healthcare sector and aged care sectors as well.

Part and parcel of hospitals reforms within these local hospital networks has been the agreement between the Commonwealth and states to introduce casemix funding across the hospital system.

Casemix funding is designed to establish efficient national pricing for individual hospital based services.

As a result, the Independent Hospital Pricing Authority (IHPA) was established under legislation last December which will determine the national efficient price for public hospital services allowing for the national introduction of activity-based funding.
Its first determination was released in June of this year.

The government has also expanded hospital capacity across Australia through an unprecedented $8.75 billion in additional hospital infrastructure across the nation in the last five years.

This is the single largest national investment in the capital needs of the nation’s hospitals in history by a country mile.

This has also been accompanied by unprecedented investment in hospital based health and medical research institutions, facilities and services designed to improve clinical outcomes within hospitals.

Many of these are based on the critical concept of “translational medicine” whereby the colocation of clinical and research expertise means that there is an effective inter-relationship between clinical needs of patients, supervised clinical trials and laboratory based research.

The Australian government is also investing in an additional 1316 sub-acute beds across the health and hospital system in order to free up acute beds as rapidly as possible, while patients recover from intensive surgical and medical interventions.

And investments of $1.5 billion have been made by the Australian government into emergency services so that as many patients as possible can be seen quickly and effectively within ED while keeping admission to acute beds to a minimum.

Once again the rationale has been to improve patient outcomes and where possible to keep the as many patients as possible out of acute hospital beds which are massively expensive to the taxpayer and which should be free for the patients who are in absolute need of such services.

The government has also introduced a range of reforms in mental health and aged care – both of which are also core parts of an integrated healthcare system.

None of the above would work unless the government was also making proper provision for the training of healthcare professionals – in medicine, nursing as well as the allied health professions.

On doctors in particular the government has increased by working to double the number of training places nationally with 1100 training places available in 2013 – up from 600 in 2006.

This is critical if we are to fill the gap in various communities who are not being serviced effectively by an aging workforce.

Finally, in the broader domain of e-health (beyond the domain of personally controlled electronic health records) the government has launched a large-scale national investment, in partnership with the rollout of the National Broadband Network to deliver e-health services across the internet to Australians who do not have ready physical access to specialist services.

The NBN-related applications of e-health are potentially revolutionary in terms of the reach of the system to regional and remote areas, and in terms of the savings to the overall system.

Be it in preventative healthcare, GP related services, specialist services and even assisted surgery.

But all this requires massive bandwidth and band speed so that both high resolution vision and data can be delivered across the range of clinical applications.

So when I refer to the Australian government’s approach to health and hospital reform as “comprehensive”, I mean it. It has embraced every arm of the system.

And therefore it is entirely legitimate to ask whether Mr Abbott is offering an alternative system to the Australian people.

Or does he intend to defund parts of the system, therefore making the system as a whole dysfunctional.

If Mr Abbott is proposing any changes to the system as we have reformed it, then he has a responsibility to explain how the rest of the system will be impacted by those changes.

The health and hospital system is too important simply to be the subject of political game-playing in the absence of proper policy analysis and the application of proper costings disciplines on any alternative health and hospitals system planned by the Liberal National Party. 

From Mr Abbott we are yet to see either.

How Queensland has benefited from health and hospital reform

So what has changed over the last five years here in Queensland and here in my own local community here on Brisbane’s Southside?

Three of Queensland’s largest hospitals (the PA, Mater and Greenslopes) are located in my local community.

Thousands of healthcare professionals live in my electorate.

My electorate is very much health and hospital central.

Five years ago we had a severe shortage of doctors and other health professionals in Australia – and because it takes time to train them, we still have a shortage particular in rural areas.

That’s why we the Australian Government have increased in Queensland alone the number of commencing training places to more than 200 – up from 126 in 2007.

A fair few of them are trained at the UQ Medical Training Centre at Greenslopes Hospital in my electorate in which we invested $13 million in.

In health infrastructure we the Australian Government have rebuilt hospital facilities across the state:

·         $250m to expand the Townsville Hospital;
·         $76m to expand the Rockhampton Hospital; and
·         $25.9m for new beds at St. Stephen’s Regional Hospital in Hervey Bay.

And that is just three of more than 50 infrastructure investments for regional health in Queensland since 2007.

And again here on the Southside it has meant that our local community now has access to new theatre and surgical equipment at the PA Hospital ($5.8m).

As noted above, we the Australian Government have established 11 Medicare Locals across Queensland – ensuring every region has a public coordinating centre for their integrated healthcare needs, as well as an agency responsible for driving the rollout of the personally-controlled electronic health records in each region.
Here on the Southside we have a 75 person team based at Mt Gravatt who are doing a fantastic job – their representatives come along to my local seniors forums and you can see the change in people’s faces as they realise there is someone who can help them navigate an often highly complex health system and not just pass the buck to someone else.

We the Australian Government have invested $119.7m for 16 GP Super Clinics as part of a $149 million investment in primary care infrastructure.

Here on Brisbane’s Southside this has meant a new GP Super Clinic in Annerley to take the pressure off the nearby emergency departments and make it more possible for people to get in to see a GP and other allied health professionals when they need to.

We the Australian Government have lifted Australia’s organ donation rates across the country to their highest levels on record through the Australian Organ and Tissue Donation and Transplantation Authority.

And some of this work is being driven out of the DonateLife team at the PA Hospital – resulting in the Queensland rate or organ donation rising from 9 donors per million of the population in 2005, 2006 and 2007 to 14.6 donors per million of the population in 2011.

As someone who has benefited from an aortic valve transplant – these numbers mean a lot.

For some they represent the difference between life and death – and I have spoken to a number of the patients and their families whose lives have been transformed through this program.

Since 2007 the Australian government have invested $213.8m in building 7 new Regional Cancer Centres across the state.

And while you won’t be surprised that there is no Regional Cancer Centre here in Brisbane – we have funded a new prostate cancer research centre at PA ($7.5m).

And the list of what has changed on the ground here in Queensland over the last 5 years goes on:

·         5928 elective surgeries to help clear the backlog;
·         $4.9m in grants to help GPs stay open after hours;
·         A new Translational Research Institute led by Professor Ian Frazer;
·         Support for new facilities, accommodation and aircraft for the Royal Flying Doctor Service totalling $13.2m;

There is not one electorate in Queensland (Liberal, Labor, National or independent) that has not benefited from our investments in health services.

Good health is also good economics

So if you aren’t convinced of the need for government to address the practical challenges of the growing healthcare needs of the Australian community, then think of the economic challenges of not acting.

In 2010 the intergenerational report estimated that whereas currently health expenditure represents 15 per cent of all Commonwealth Government spending (4.0 per cent of GDP) to that this would increase to 26 per cent by 2050 (7.1 per cent of GDP).

This is the cost of an aging population and the projections are similar across the world.
Therefore Australia is faced with the choice of being an importer or an exporter or health services, expertise, training and products.

I believe we are good at healthcare in this country and we also need to be directly engaged in the economic opportunities represented by the healthcare industry worldwide.

It is part of how we diversity the Australian economy beyond being China’s quarry and Japan’s beach – new services industries and exports in health, education, engineering, financial services, as well as new opportunities in agribusiness and manufacturing.

There is a huge and growing market for us to export our health training services, our management expertise, our research findings, products, treatments and technologies that come from all of these.

Just think of this fact for one minute – the 2009 KPMG report commissioned by the Australian government Health Workforce in Australia and Factors estimated “that there is currently an absolute shortage of 2.3 million physicians, nurses and midwives across 57 countries”.

And the opportunities this provides increases with the NBN allowing us to fill this gap at low cost and high convenience.

Let’s take just one example in our region – one I am familiar with – China. The health services market in China is going through the roof:

·         The number of private hospitals has increased 20.6% in the last year alone to a total of 8,947 as of May 2012;
·         We are seeing record highs in the amount of investment in china’s healthcare industry tripling over the last three years to $4.14 billion in 2011;
·         The Chinese government this year revised its guidelines and is now actively encouraging foreign investment in the health sector; and
·         Deloitte estimate that China’s growth in the medical services market is currently growing at 18 per cent – more than twice the general growth rate in China;

Therefore to slash and burn our health system in Queensland makes even less sense – we will lose talented staff, we will lose international reputation and we will lose the opportunity to be able to export health services as we cripple under the weight of an under-resourced health sector at home.

The world recognises that Australia’s healthcare system is one of the best performing systems in the world.

If we can get it right for Australia then there are huge opportunities for us to help other countries get it right and make full advantage of exporting our expertise.

And to do that we must maintain, reform and invest in a continued world class system at home providing also a first class platform for exporting health services abroad.

The Liberal National Party record on Queensland health

I am proud therefore of what we have delivered in through national health and hospital and funding for the country, our state of Queensland, and my community on the Southside.

And therefore I take seriously any threat to the foundation of this and the services they support should Mr Abbott become Prime Minister next year.

As I said at the outset, we in Queensland have every right to be concerned about what it means for the people of Queensland should the federal Liberal National Party be elected on the question of health.

Because we know they already have form in Queensland based on the following reports:

·         Closing the emergency centre at Wynnum hospital;
·         Cutting 220 aged care beds including 80 at Eventide Aged Care Campus;
·         108 full-time health jobs cut on the Sunshine Coast and Gympie;
·         Two locum positions slashed from Hervey Bay Hospital;
·         Some 100 staff to go from Pathology Queensland including 7 pathology jobs on the Gold Coast, closing the lab at Mareeba Hospital, 6 staff from Maryborough Hospital
·         Two to six jobs to go at Ayr Hospital;
·         18 emergency department staff and 16 surgeries staff to go from Gold Coast hospitals;
·         Five of seven health promotion workers in Mt Isa to be sacked;
·         The closure of the PA Hospital TB clinic, which the Queensland government then reversed, deciding to instead sack almost half the workforce;
·         Up to 50 jobs to go at Darling Downs Hospital and Health Service;
·         Up to 200 jobs to go at Charters Towers;
·         Townsville Hospital to lose 131 positions, including 45 nurses;
·         Cuts to free Whooping Cough vaccine for new parents;
·         They have even cut the flu vaccination for staff working in our hospitals; and
·         74 jobs to go at the John Tonge forensic centre (even the dead, it seems, are not safe from the reach of the Liberal National Party).

And when federal Liberal and National Party candidates are asked to defend their slash and burn of their state Liberal National colleagues we end up with answers like this one, and I quote:

 “Well, um, ah, I know that, um, Can I say that Can Do has to do”

And:

“It’s my job to get out there and explain to people why Can Do, Campbell Can Do, had to do what he had to do...”

If that’s the response of the former head of the AMA, Dr Glasson, who seems to be channelling Joh in this response, then God help Queensland health.

Conclusion

It is five years since the election of this Australian Government.

We are proud of what the Government has achieved.

But we also recognise those areas where we have fallen short, including the period of my own Prime Ministership.

We are nonetheless proud of our core achievement navigating Australia through the Global Financial Crisis and worst global recession since the 1930s.

We are proud of the fact that we emerged as the only major advanced economy not to go into recession, the only one to avoid mass unemployment, and doing so with the lowest debt and lowest deficit of all the major advanced economies.

We are proud of the fact that we secured for Australia for the first time in its history a place at the top global negotiating table - the G20 - where we now contribute core global economic decisions rather than just respond to the decisions taken by others.

We are proud of the fact we have taken major steps to building an Asia Pacific community by securing American membership of the East Asia Summit.

We are proud of the fact that we have secured a position on the UN Security Council for the first time in twenty-six years.

We are proud of the fact that we are implementing an Education Revolution including Australia’s first national curriculum, the first system of nationally consistent testing of literacy and numeracy and state of the art capital injection into the Australian school system including:

  • more than 3,000 new state of the art libraries
  • new state of the art classrooms with interactive whiteboards
  • hundreds of new language centres, science centres, trades training centres
  • as well as over a million new computers to ensure that every kid from Year 9 and above has access to their own computer at school, building the digital divide between rich kids and poor kids.

We are proud of our record of comprehensive reform and funding with the new national health and hospital system.

We are proud of our ratification of Kyoto, our introduction of a 20% mandatory renewable energy target and a price on carbon.

We are proud of our Apology to Indigenous Australians and our strategy of closing the gap through Australia’s first Commonwealth State agreement within that framework.

We are proud of the fact that we have delivered the biggest single Age Pension increase in Australia’s history, increased the Child Care Rebate from 30% to 50% and introduced Australia’s first Paid Parental Leave scheme.

We are proud of the fact that we have helped build new Common Ground facilities (like the one here on the Southside) in Australia’s capital cities to provide secure, supported places for people to go who would otherwise be sleeping on the streets.

And I’m proud of the fact that each of these major national reforms has had an impact here for the people of Queensland and with people who live in my own community here on Brisbane’s Southside.

Much more remains to be done as we seek to build together a stronger Australia, a fairer Australia, a more sustainable Australia, an Australia confident of its voice and place in the region and in the world, as well as an Australia which intelligently plans to meet the challenges we will face in the future.

And I am privileged to remain a member of the Government team in this great enterprise of ours for Australia’s future.


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