Friday, 30 November 2012

AUSTRALIA, THE UN SECURITY COUNCIL AND FUTURE FOREIGN POLICY CHALLENGES IN THE MIDDLE EAST

Opening Address at the Change and Continuity in the Middle East and Central Asia Graduate Conference

Centre for Arab & Islamic Studies, The Australian National University


Australia is a middle power with both regional and global interests: the maintenance of our national security, the enhancement of our national economic prosperity, as well as the protection of the global commons on which we all rely.

Our foreign policy is also animated by universal values of freedom, fairness and international law.

We seek to give expression to these interests and values through the medium of what I have long-described as creative middle power diplomacy – a means of building, consolidating and enhancing the regional and global rules-based order.

Such an order not only benefits the world.

It also benefits Australia because we rely on the stability and predictability of the order to advance our own interests as well.

Australia has a credible voice in the councils of the region and the world.

Australia brings considerable assets to the table. 

We are one of the oldest continuing democracies in the world. 

We are a significant economy – the fourth largest in Asia and the twelfth largest in the world and now a member of the G20.

We have a stable and cohesive society based on the rule of law, the independence of the courts and a vibrant, multicultural society anchored in our national ethos of tolerance, diversity and a fair go for all.

We have a sophisticated global diplomatic network and one of the most active diplomacies in Asia.

We also have a modern, sophisticated defence force by both regional and global standards.
 
We are founding members of the United Nations and have been active members of its subsidiary institutions from the outset, as well as the IMF, the World Bank, the WTO and the ILO.

Our aid budget, in dollar terms, is now among the top ten OECD donors in the world.

We are active in practically all of the regional institutions of the Asia-Pacific and Asia-Indian Ocean regions including the East Asia Summit, APEC, the ASEAN Regional Forum, and the nascent Indian Ocean Regional Association. 

We are founding members of the Commonwealth which brings together 54 nation states, both developed and developing.

We are one of the oldest continuing allies of the United States.

We also have long-standing security relationships with the United Kingdom, New Zealand, Singapore and Malaysia.

Over the last five years, we also have developed strategic partnerships, strategic dialogues or enhanced diplomatic engagements with ASEAN, the European Union, NATO, the African Union, the Gulf Cooperation Council, the Arab League, the Organisation of Islamic Cooperation, Mercosur and SICA in Latin America, ASEAN, the Pacific Island Forum and Caricom. 

We have also enhanced our strategic partnerships and relationships with major countries in the region, including China, Japan, Korea, India and Indonesia.

Therefore we do not come to the international table with empty hands.

Nor do we believe we are uniquely capable of solving the problems of the world.

Nonetheless we are committed to the principles of good international citizenship above and beyond our own narrowly defined national interests.

In fact we believe that it is important for middle powers around the world, in addition to pursuing their own national interests, to also lend their collective hand to making the international order work as effectively as possible, given that so many parts of the order at present are not working at all.

UN Security Council

These are the broad principles, I believe, which will guide our upcoming two-year tenure on the UN Security Council where Australia received a near-record vote in the first round of voting in the UN General Assembly last month.

This is no mean feat for a country such as Australia, given we were competing against two European states and given that they had the solidarity of the 27‑member European Union behind them.

In the field of diplomacy, this was a gold medal performance for Australia, of which the government, the nation and our diplomatic service are justifiably proud.

The next two years will be an important period for the Security Council.

And much of the agenda will be taken up by a range of crises and continuing challenges occurring across the wider Middle East.

Transition in Afghanistan. 

Civil war in Syria and the associated humanitarian crisis flowing to Turkey and Jordan in particular. 

The Iranian nuclear program and the continuation of Iranian-sponsored terrorism across the region.

Together with the continuing problem of the last two-thirds of a century – the challenge of bringing about a conclusion to a two-state solution for the Israeli and Palestinian peoples.

For the two years ahead, this will therefore be a most challenging time for Australian diplomacy, particularly in these theatres.

Therefore, the national expertise represented at this conference looms as an important asset for us all. 

I therefore encourage you to bear in mind in your research programs the foreign policy needs of the nation as well.

Last week I attended the Sir Bani Yas Forum in the United Arab Emirates which brought together current and former Foreign Ministers and policy specialists from across the wider region.

And next week I will be attending The Manama Dialogue in Bahrain organised by the International Institute for Strategic Studies.

There is formidable international expertise available on the critical challenges facing this region.

We in Australia will need to continue to lift our national expertise on the Middle East both in the academy and beyond given the region’s intrinsic volatility, its capacity to generate millions of refugees in the face of insecurity, as well as its central place on the UN Security Council agenda.

Fault lines across the wider region

The wider Middle East is in a greater state of political flux today than at any time since the arbitrary determination of national boundaries by the former colonial powers after the First World War. 

The fault lines now running across the region are deep, inter-connected and widening. 

There are fault lines between authoritarian states (secular or theocratic) and the rising tide of popular democracy through what we now call the Arab Spring.

Fault lines between secular states on the one hand and various forms of political Islamism on the other.

Within political Islam, there is the widening gulf between the Sunni and Shia worlds: the former grounded in Egypt, Saudi and the Gulf; the latter in Iran.

New fault lines are also emerging between the forces of globalising modernity on the one hand, against long-entrenched forces of socially conservative traditionalism on the other.

There are fault lines between those states in the Middle East with oil and gas reserves, and those without, as well as the strategic impact of the rapidly emerging shale gas industry worldwide on the future economic stability of the region.

Then there are fault lines between competing Egyptian, Turkish, Saudi and Iranian spheres of strategic influence.

And last, but not least, the continuing fault line over Israel and Palestine, and the quest for a future Palestinian state.

For the non-Arabists among us, this is a complex melee of cross currents which makes clear analysis for policy makers a difficult task.

And for those of us who are professional Sinologists, suddenly China seems almost straightforward by comparison.

But in analysing any of the individual crises and conflict points which currently are so liberally scattered across the region, it is critical that policy makers are mindful of these overarching historical, political and sectarian drivers and where they may take the region over the decade ahead.

None of these crises exist in isolation.

Understanding context will therefore be critical in framing coherent and effective policy responses.

It is not my purpose today to attempt an amateur “grand theory” as to what is happening in the Middle East, and why, and what should we be doing about it.

The beginning of wisdom is to know what you don’t know.

But I am finding myself increasingly concerned by the emerging commentary that the aggregation of the various dynamics described above could, over time, lead to a fracturing of the post-1919 political order altogether, and its replacement by an even more chaotic secular/sectarian or Sunni/Shia divide across the Middle East.

That’s why I am interested in the collective reflections of this conference on the strategic trajectory of the Middle East over the next decade – around the core question of what will the region look like in a decade’s time, and what should our collective engagement policy be, in order to maximise the prospects for peace and economic development in this most troubled part of the world.

Syria

On the question of Syria, we should be clear that for Iran, Syria is a zero sum game. 

It represents the crown jewels of Iran’s penetration of the wider region and Iran’s base for the operations of Hezbollah, both in Lebanon and beyond.

Syria is Iran’s only regional and global ally. 

Nonetheless, the Iranian regime does not have any sentimental attachment to Bashar Al Assad.

It is entirely conceivable that Iran has already concluded that Assad’s days are numbered – although how many days that may be remains a moot point.

Iranian strategic planning is in fact likely to assume the collapse of Assad’s regime and how Iran could instead optimise its continued strategic influence through a failed Syrian state.

In other words, to use Syria in the same sort of way as the Taliban and Al Qaeda used Afghanistan prior to 2001.  Others have agreed that Syria could become the next Somalia.

Of course, not all analysts would share these conclusions.

But reasonable contingency planning by the international community, including NATO, the European Union, the Arab League and the UN, is now a critical necessity in preventing a post-conflict political, security and humanitarian disaster should Assad fall.

The UN’s history of managing post conflict fragile states is at best mixed. 

It is time now radically to draw on the lessons of the past (from Kosovo to Libya) on how to bring together the complex tasks of peacekeeping, post conflict stabilisation, humanitarian intervention, economic development (given the destruction of much of Syria’s infrastructure) and the sensitive task of truth and reconciliation given the fratricidal potential of Syria’s various political and sectarian constituencies.

These tasks will in turn hang on the nature of any transitional authority which takes over in Damascus in the event of the fall of the Assad regime. 

And this in turn will hang on the construction of a robust UN Security Council resolution where all necessary security, humanitarian and economic powers are vested in a transitional authority until a legitimate domestic political process can be put in place.

Furthermore, for this to work, preparations for a properly constituted and trained UN force that could be rapidly deployed on the ground.

None of this is easy.  But unless the work is done now, a political vacuum in Damascus is not likely to be long term, particularly given Iranian strategic interests and the internal dynamics of retributional politics.

Prospects for post conflict political and sectarian violence at this stage are high. 

Again, this means that planning for an effective international intervention if and when the regime collapses is now critical.

Of course all this assumes that the regime does in fact collapse.

Everyone is familiar with the impact of Russian and Chinese vetoes (both real and threatened) at the Security Council preventing agreement on a robust Security Council resolution which would hasten political change in Damascus.

The Russian position in my view is not dissimilar to Iran’s: Syria has been a long-standing supporter of both the Russians and prior to that the Soviets.

Russia has also been a major military supplier of the regime.

But Russia, like Iran, does not necessarily have any sentimental attachment to Bashar Al Assad. 

Moscow itself is also undoubtedly anticipating what happens in a post-Assad Syria.

To speed this process, a constructive contribution from the Russians would be to offer Bashar Al Assad and his family long term political asylum, just as the Qataris have done most recently.

Had this sort of option been exercised by Gaddafi, the war in Libya would have ended much earlier.

As for the Chinese, they are bound by their global foreign policy over half a century anchored in the principle of mutual non-interference. 

Nonetheless, it’s important to note that China recently put forward a modest proposal of its own in Beijing for dealing with the Syrian crisis.

China is mindful of its global reputation.  Its foreign ministry in particular will be acutely conscious of the international political odium China will attract if it continues to support a brutal Syrian regime, particularly given its recent history in relation to the Sudanese regime’s actions in Darfur.

Neither Syria nor Sudan have been helpful in China’s efforts to acquire great power status globally – not just as a natural consequence of China’s emerging political, economic and strategic strength, but also China’s quest for international respect as a nation capable of making an ethical contribution to the international order as a whole.

Therefore, international pressure on Beijing should continue on the Syrian question.

On the more immediate challenge in the battlefields of Syria, the critical question is whether the recently formed Syrian National Coalition will be to unite all opposition elements within Syria, deal with non-FSA security forces in Syria supported by other external powers as well as build its international legitimacy.  

A further question is whether and to what extent the international community will begin to arm the Syrian National Coalition in order to deal with the range of military contingencies Syrian opposition forces now face.

The truth is, humanitarian aid has become virtually useless with Syria because the security situation does not effectively permit it.

2.5 million Syrians are now in need of humanitarian assistance.

2.5 million have been internally displaced.

At least 400,000 have fled the country to Turkey, Jordan, Iraq, Lebanon and North Africa.

2000 are leaving each day – 60% of whom are women and children.

Two thirds of Syria’s hospitals have been destroyed.

50 per cent of doctors and medical specialists have left the country.

Production of drugs and essential medical supplies has virtually ceased.

This is turning into a humanitarian crisis of epic proportions as the world looks helplessly on.

Assad’s air force is still intact and the FSA does not have the benefit of either a no-fly zone or, for that matter, effective anti-aircraft weapons.

Given the fact that there are now hundreds of thousands of Syrian refugees who have flooded into Turkey, and given the dimensions of the political and military tensions which now exist between Ankara and Damascus, it is possible that Turkey and NATO may begin considering no-fly zones along the Turkish/Syrian border regions in order to maintain reasonable safe havens for internally displaced persons.

Consideration is also being given to what defensive weapons the FSA may need in order to protect themselves from the Syrian armed forces – in particular, the air force.

The truth is, Assad will not seek to negotiate unless and until the military circumstances on the ground begin to tip decisively in the direction of the Syrian National Coalition /FSA.

In the meantime, the work continues under Lakhdar Brahimi, Joint Special Representative of the United Nations and the League of Arab States on the Syrian crisis, and earlier Kofi Annan, which has been reflected in the recently concluded Geneva communique on Syria which outlines an action plan to facilitate and support a Syrian-led political process and transition.

For Australia, as an incoming member of the UN Security Council, preparations for post conflict stabilisation in Syria, underpinned by the necessary UN resolution, will be a high priority.

Iran

Elsewhere in the wider region, the Iranian nuclear program looms as a continuing strategic threat. 

Let us never forget that Ahmadinejad has threatened to wipe Israel off the map.

Let us also remember clearly that the Iranian regime is currently in violation of the Nuclear Non-Proliferation Treaty, resulting in six UN Security Council resolutions against Iran, four of which have imposed sanctions.

Complicating the above are the considerable internal tensions within the Iranian regime. 

Iran is already involved in a continuing cold war against much of the Sunni Arab world – and of course with the United States.

Apart from its own nuclear program and its continued strategic presence in Syria, and through Syria, Hezbollah in Lebanon, the Iranian presence is also being felt in Gaza.

Quite apart from its support for Hamas against Israel, Iran is simultaneously engaged in a political war against Fatah and the Palestinian Authority to delegitimise the moderate leadership of both president Mahmoud Abbas and Prime Minister Fayyad; and to legitimise Hamas as the alternative Palestinian leadership.

Iran however does not have it its own way.

Saudi Arabia represents Iran’s principal strategic adversary.

As do most of the other Gulf states.

And increasingly so does Turkey.

Iran for its part sees its strategic assets as lying increasingly in Iraq, of course in Syria, and through Syria, Lebanon, and through Hamas into Gaza itself.

Egypt under the Muslim Brotherhood is also seen by some in Tehran as a strategic opportunity although Egyptian politics are more complex than this. 

It is critical as we approach the challenges ahead from Iran that we are mindful not just of Israeli interests but also those of the wider region, including the GCC states.

Given Australia’s new strategic dialogue with the GCC, initiated in 2011, Australia will need in particular to be mindful of Gulf views in addition to other regional views on the most effective policy response to the Iranian threat.

Let none of us forget that the Iranian nuclear program continues to roll on.

Israel-Palestine

Of course in the midst of all the above lies the continued quest for a Palestinian state.

My view has been clearly stated on many occasions – that is, that the Netanyahu government should seize what is left of the strategic opportunity presented by the moderate Palestinian leadership of Abbas and Fayyad to conclude a permanent peace settlement leading to the creation of a Palestinian state.

Everyone familiar with this debate knows the parameters for the resolution of the outstanding final status issues: 67 borders with appropriate land swaps; the right of return; the future status of Jerusalem; the protection of the holy sites; as well as appropriate international security guarantees for the Israeli state once an independent Palestine is established.

These final status issues came close to conclusion both at Camp David II in 2001 and in the Olmert Plan in 2008.

It is also a framework consistent with the Arab Peace Proposal of 2002.

Were such an agreement to be reached, the benefits that would flow to Israel and the rest of the region would be as follows:

·         Automatic diplomatic recognition of Israel by the Arab world;

·         The opening of the Arab world to the Israeli economy as a massive growth market; and

·         A combined Sunni Arab, Israeli (and for that matter, probably Turkish) strategic front against Iran – the ultimate enemy of strategic stability in the region.
 
Failure to negotiate such a peace settlement is likely soon to have the reverse effect:

·         The de-legitimisation of the moderate Palestinian leadership and instead the re-legitimisation of Hamas as an alternative political force both in Gaza and the West Bank;

·         Hamas in turn becoming a more direct funnel for Iranian influence directly on Israel’s borders;

·         The growing possibility of a third Intifada within Israel itself as longstanding Palestinian frustration ultimately yields to re-radicalisation by Hamas, Islamic Jihad and Hezbollah;

·         The fracturing of the peace treaties with Egypt as democratic Egypt with a Muslim Brotherhood majority finds itself increasingly incapable of supporting the status quo on the question of Palestinian statehood; and

·         In turn, the loss of the peace treaty with Jordan on Israel’s eastern flank, coupled with increasing internal political destabilisation within Jordan, including against the monarchy itself.

In other words, we are very much looking at a quantum degradation of Israel’s strategic circumstances of an order of magnitude not seen since 1973 unless a two-state solution is agreed now.

That is why Australia strongly supports the early conclusion of a two-state solution.

It won’t solve everything for Israel, Palestine and the region.
 
But it will significantly improve the future strategic environment for Israel against the alternative environment which is beginning to emerge.

That is why I also strongly support both the Prime Minister’s and the Foreign Minister’s decision concerning UN General Assembly observer status for the Palestinian Authority.
 
This too will loom large in Australia’s UN Security Council in-tray from January next year, in view of the upcoming Israeli and Palestinian general elections next year and continuing security tensions over Gaza which has seen hundreds of rockets rain down on Israeli communities and cities, and Palestinian women and children killed in Israeli response attacks.

As a longstanding friend of Israel and with strong relations across the Arab world, Australia stands ready to assist in whatever practical way it could.

One possibility may be that if US funding for the Palestinian Authority through the UN trust fund is withdrawn as a result of a positive vote on Palestinian observer status in the UN General Assembly today (Australian time), then Australia should consider taking a positive lead in working with other western countries, countries of the Asia Pacific, as well as the Arab states themselves on filling that funding gap.

We have no interest in the Palestinian Authority being incapable of governing its people.

US Policy

There are many missing elements to the analysis that I have outlined above, including the future political trajectory and foreign policy of Egypt.

Nonetheless, the bottom line is that the volatility of the region is likely to place more demands on US foreign and strategic policy than before.

There is no such thing as a strategic vacuum either in international relations theory or in international relations practice.

If vacuums are created, the truth is they are quickly filled by others.

That’s why the world expects new US leadership on the future direction of the Israeli-Palestinian peace process.

The Iranian nuclear challenge is fraught with difficulties but we must all candidly conclude that current multilateral diplomatic efforts through the Six-Party Talks have not resulted in any retardation of the Iranian nuclear program.

However the impact of economic sanctions on Iran has been significant and is possibly becoming a new dynamic in Iran’s internal politics, including popular unrest and tensions within the regime.

These sanctions need to be given more time to take effect and it is critical that all states comply with the sanctions regime under the UN Security Council resolutions – 1737 (2006), 1747 (2007), 1803 (2008) and 1929 (2010).

The United States must remain fully engaged with Israel on all dimensions of the Iranian threat as well – including the rolling and even public discussion within Israel itself of the desirability of some type of pre-emptive Israeli strike against Iranian nuclear facilities; including full consideration of the consequences that would follow.

US strategic assurances to the Gulf states are also important given Iran’s physical proximity, its aggressive behaviour within the Gulf and its attempted incursions into the internal politics in various Gulf states.

An Iranian incursion among the Gulf states, political and military, would fundamentally undermine the geopolitics of the Middle East.

On Syria, US policy leadership will also be called upon given the absence so far of an effective UNSC resolution on a no-fly zone and/or related measures means that devolving operational policy to NATO, as occurred in the case of Libya, is not at this stage feasible.

US relations with the Arab League and with the Gulf states in particular will become increasingly critical as the Syrian crisis continues.

Conclusion

There will come a point, which I believe should have already been passed, when the international community’s tolerance for the mounting Syrian death toll will expire.

The international community must never forget the principle of international humanitarian intervention and the lessons post Srebrenica and post Rwanda – lessons which finally forced the international community to act in agreeing to a no-fly zone over Libya to prevent Gaddafi from carrying out the butchering of Benghazi.

In the meantime, within the constraints of international law, action must be considered by various states on the question of appropriate defensive weaponry for the Syrian opposition and the Syrian people.

In all these areas, the Middle East will continue to require strong American leadership.

And in all these areas, Australia will also be reflecting its own independent views in the UN Security Council on how to deal with these and the other challenges to global security that we’ll face in the coming years.

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.