It has only been a little over two years since the last federal election, in which health policy was a key battleground.
This weekend voters in five electorates will go back to the polls in what the media has dubbed the Super Saturday by-elections – and again, health policy has been a big focus in those.
Just ask the poor staff at Caboolture Hospital, who’ve had to put up with a visiting politician every other day for the last two months.
I bet they’re counting down the days until this is all over – much like we are. Five to go!
But over the last eight weeks, as I’ve been criss-crossing the country meeting Labor’s candidates and helping their campaigns, the message has been overwhelmingly clear: voters in these five seats – just like those in the other 145 – care deeply about our health system.
That’s no surprise. Health regularly ranks as the highest priority for voters in the opinion polls.
So when the next general election rolls around – probably sooner rather than later – health will be at the core of that campaign too. Labor will make sure it is, because it’s one of our highest priorities as well; and we have genuine philosophical differences with the conservatives over how best to fund and deliver health care.
All of which is to say is it often feels like we’re in permanent campaign mode in federal politics. Barely has the last election passed before we’re preparing for the next one.
And that – as I’m sure everyone in this room keenly appreciates – can lead to short-termism – when policymaking gets hijacked by what will win votes rather than what’s best for our long-term future.
That’s why it’s refreshing to come to a place like the George Institute: you are an audience who wants to hear about Labor’s long-term vision for health care in this country.
Make no mistake, Labor is asking the big questions in health policy.
- What should our health system look like 10 or even 20 years from now?
- How do we better promote health and prevent disease so that fewer people need health care to begin with?
- How do we reshape primary care and our hospital system to truly meet the challenges of our expanding and ageing population?
- And how do we achieve true universality – so that all Australians can access timely, quality, affordable care whenever they need it regardless of socio-economic status or geographical location?
These are the sorts of questions that I grapple with every day. And today I want to give you an insight into my thinking.
First, I want to talk about prevention.
All of you know the extraordinary burden chronic disease places on our society. The cost to individuals, families, communities and to our society as a whole is enormous.
Around 7 million Australians have a chronic condition. Nearly 90 per cent of premature deaths have chronic disease as an underlying cause. The cost to the health system is many billions of dollars.
And prevention – as we all know – is the key to reducing much of that burden.
And yet – apart from some calls for a sugar tax that are starting to get traction in the media and the public consciousness – prevention has completely fallen off the political agenda.
Our spending on prevention remains a tiny proportion of our overall health budget – other similar developed nations spend five times as much.
I want prevention to be at the very forefront of our national conversation about health.
In explaining why it’s not – and why Australia is languishing so far behind on this – I’m going to strike something of a political note that some of you may find tiresome. But bear with me.
The last Labor Government took prevention seriously and tackled chronic disease head on. The fight over tobacco plain packaging was perhaps the most high-profile and contentious of our preventative measures – but it was certainly not all we did.
We established the National Preventative Health Taskforce, which developed a 10-year roadmap for action on obesity, tobacco and alcohol – much of which remains relevant now. We established the Australian National Preventive Health Agency, so that governments would receive ongoing expert advice on disease prevention.
We did so because we wanted to make sure we had the long-term policy settings right.
At the last federal election we sought to extend this proud record with a new $300 million investment in prevention. Because talk is cheap – prevention needs real investment.
I was very proud of this package but sadly – as you all know – we did not get the opportunity to implement it.
The Liberals meanwhile have spent the last five years gutting health promotion and disease prevention programs. It abandoned the National Partnership Agreement on Preventive Health and ripped the remaining $368 million out of prevention.
And it abolished the Australian National Preventive Health Agency, the best source of advice on keeping Australians healthy –for a measly saving of $1 million a year.
Since then we’ve heard barely a peep from them on prevention. They’ve been completely missing in action.
And yet they’ve suffered next to no political pain for it.
Right now, prevention is a hard sell politically. When the Budget is tight, it’s not easy for any politician to convince their colleagues that they should invest hundreds of millions of dollars in policies that that will pay only long-term dividends – and won’t win many votes.
To change that dynamic, we need a new national conversation about prevention. And that can’t just come from politicians.
We need fierce advocates for prevention.
We need strong, united stakeholders who are willing to hold the Government of the day to account when they cut prevention programs, or when they’re not taking it seriously enough.
And we need thinkers and experts like you to help as well: to talk to the voting public, to explain why prevention is so important, why it requires a significant investment of their tax dollars – and how that investment could improve and extend their lives.
Without that national conversation we will be forever mired in the status quo – where we continue to pour billions of dollars into treating diseases rather than preventing them.
Right now, the prevention agenda is stalled. I’m committed to getting it going again – but I simply cannot do it alone.
Next I want to talk about my vision for primary care and hospitals.
Primary care is the frontline of our health care system.
A strong primary care system which includes a focus on protection, health promotion, disease prevention and early detection of those at high risk is critical to addressing chronic disease.
An older population with higher rates of chronic disease means Australians will need more care and different types of it.
Labor’s ultimate vision is for primary care that is still led by GPs but much more integrated with other specialists, allied health, and other health providers. We also want much better coordination between primary care and hospitals.
This won’t be easy and we are not so arrogant as to impose a one-size-fits-all model. But it’s something that simply has to be done.
And in this space, innovation is important – but so is investment.
The Government’s Health Care Homes was conceptually a reasonable policy – emphasising integration and coordination – but it simply wasn’t backed by financial investment. As a result, I warned it wouldn’t work; so did GPs and other stakeholders.
And sure enough it’s been a spectacular failure – with only 1600 patients signing up to the trial, not even within coo-ee of the 65,000 target.
This was Malcolm Turnbull’s “signature healthcare policy” at the 2016 election – he told us it was going to revolutionise primary care. But he didn’t back it with cash. So now the Government is quietly backing away from the whole thing.
In future, we need to offer the right incentives to providers to innovate; not just expect them to do more with less.
Investment is critically important in hospitals too. Money doesn’t solve all problems; clever innovation and efficiency are important. But as the AMA notes, under our current funding formula our public hospitals will be “doomed to failure”.
On prevention, on primary care and on hospitals that’s something the Government just doesn’t seem to get.
Labor’s $2.8 billion Better Hospitals Fund will pay for more activity in our public hospitals– more emergency department presentations, more elective surgeries. It will also pay for more resources – more beds; more doctors, nurses and hospital staff.
But we also want the Fund to drive innovation.
Activity-based funding has made our public hospitals more efficient. That’s a good thing, because it allows more services to be provided within the same budgets.
But now we need to work with the states and territories to make our hospitals more effective.
We don’t pay hospitals for what they don’t do. They have no financial incentives to prevent avoidable admissions, and limited incentives to prevent avoidable readmissions.
We need to create them. That’s one of my key priorities in this space.
Another is restoring the quality and safety agenda. The Government is focussed on penalising poor safety. But we also need to think about how we reward quality care.
So how do we do all this?
Well at the last election I proposed establishing a permanent Australian Healthcare Reform Commission.
This commission would have a broad mandate to continuously monitor and improve our entire healthcare system.
It would focus on many of the innovations I’ve been talking about today: developing, trialling and evaluating new models that seek to improve quality and safety – and where possible bring down costs. New models of primary care would be a key focus.
The commission could also look at ways to ensure the future sustainability of the PBS.
Over the next decade many of the new medicines expected to become available will be more specialised and targeted – increasing pressure on government resources. We must nevertheless ensure all Australians get affordable and timely access to the drugs they need.
I envision the commission would become a key advisory body – but it would also have strong implementation capacity.
It would also be a body explicitly charged with reducing inequality and improving the universality of our health system.
There have always been challenges to Medicare’s universality – such as the difficulty of accessing services for Aboriginal and Torres Strait Island Australians and those in regional, rural and remote Australia. People with physical disabilities or mental health issues in rural and remote Australia also still face significant barriers.
But in recent years, thanks in part to the Government’s Medicare freeze, out-of-pocket costs have also become a significant barrier to access. So we need to find ways to reverse that trend.
There are particular issues with specialists, given their bulk-billing rates remain mired at around 30 per cent.
A Healthcare Reform Commission would have a standing remit to look at all those issues of access.
Again, this idea was something I was not ultimately able to implement given we lost in 2016.
But I want to make it clear today it’s not an idea I’ve given up on – I’ll have more to say about it in the months ahead.
And I think this shows Labor is committed to breaking out of the short-termism that can afflict policymaking in this country.
A Healthcare Reform Commission would not win Labor any votes – it’s not a sexy, headline-grabbing policy. But it would improve healthcare policy in this country for the long-term.
I’m sorry to say I don’t see much long-term vision from the Coalition. Theirs is a managerial approach that seeks above anything else to take the political heat out of the portfolio.
They are not asking the big questions like we are.
And now I believe you have some big questions of your own. So over to you.
24 JULY, 2018