16 Oct 2020
(See Translation in Arabic section)
The Budget included a number of necessary health measures, and I want to begin by welcoming them:
● confirmed ongoing support for telehealth consultations, COVID testing, GP respiratory clinics, public and private hospitals, and other elements of the COVID-19 health response and their almost inevitable extension into next year;
● recognition of the mental health impacts of the pandemic. Since May, we’ve been arguing that those impacts don’t stop at the Murray River, and that Medicare mental health consultations need to be doubled nationally. We were glad to see that happen in this Budget;
● long-overdue support for Australia’s thalidomide survivors. Until the Senate inquiry that reported 18 months ago, we as a nation had not focussed on the ongoing needs of these survivors.
In general, though, I think the health budget was more notable for what it omitted than what it contained – and so do the experts.
The Australian Medical Association said the Budget “left most other challenges in health care for another day”. The Public Health Association said it was “a huge disappointment, bordering on disastrous”.
Kicking necessary reform perennially into the long grass is no way to handle the health system.
In my mind, there were three broad omissions in the health budget – and they’re the three things that would provide a framework for my approach as Health Minister.
First, recognition of the social determinants of health, and of the benefits of prevention.
Second, an acknowledgment of record costs and waits for care, and an effort to restore the universality of Medicare.
And third, the resolve to tackle big challenges and pursue necessary reforms. Or to put it more simply: equity, access and reform.
When we talk of health, the conversation moves quickly to health care. But any serious effort to improve Australians’ health must begin outside the health care system.
I once posed the question: “whether we, as a nation, will continue to tolerate a situation in which less well-off people … live sicker and shorter lives than the wealthy”?
Unfortunately, in this Budget, and under this Government, the answer appears to be yes.
Because we have taken no serious action on the social determinants of health. Those forces have their strongest and most tragic impact on First Nations peoples.
The Australian Institute of Health and Welfare says more than half of the First Nations health gap is due to the social determinants and health risk factors like smoking.
The Institute also tells us that one in two Australians have a chronic disease – but that 38 per cent of that burden is totally avoidable.
Yet the Government is just now developing a National Preventive Health Strategy.
Now of course, even if we get all those things right, even if we start to make real progress on prevention and the social determinants of health, Australians will always need health care.
One of the striking lessons of COVID-19 is that Australians still expect universal access to health care. In February and March, we looked around the world and saw health systems overwhelmed, and clinicians making impossible decisions.
The community rejected that rationing here, rightly demanding testing and treatment for everyone who needed it.
And governments listened. Notwithstanding some delays and failures, they dramatically expanded the capacity of our health care system to cope with COVID.
We took measures to bend the curve like lockdowns and quarantine, but we also took action to expand capacity like the laudable expansion in intensive care beds across the country from 2,000 to 7,000.
That’s not just a matter of investment. Which brings me to my third point.
It’s also a matter of reform – of a willingness to tackle the big challenges head on.
As of last Estimates, there were 55 action plans in some stage of development or implementation in the Health portfolio _ 55.
What of delivery? What of the big, complex, sometimes contentious discussions we need to have to improve our health system?
If First Nations health was the worst omission from this Budget, mental health was a close second.
One in two Australians experience mental ill-health. One in four doesn’t access services. It costs our economy up to $180 billion a year.
That demands comprehensive reform, across portfolios and across levels of government.
The Government ordered the Productivity Commission inquiry into mental health more than two years ago, and the report has been with them for almost four months.
Yet it hasn’t even been released. And we’re told not to expect a response until the 2021 Budget next May.
Similarly, the Children’s Mental Health and Wellbeing Strategy – the Government’s promised response to the fact that half of all serious mental health issues begin before the age of 14 – has also been delayed by months and months.
We have no time to waste on mental health reform, and this Budget was a massive missed opportunity.
And under this third point of reform, I of course have not forgotten about medicines.
I welcome the announcement that the Government and Medicines Australia are working towards an extension of the Strategic Agreement.
But at this stage, the Government has only agreed to do what it already does – to list new medicines within the average fiscal envelope of recent years.
It’s good those listings won’t have to be offset. But nor will $481 billion in deficit spending on other programs.
I wish Medicines Australia luck in its negotiations over the coming months. You’ll have my attention and my support.