DAVID SPEERS, HOST: Calls have also been growing to expand access to Medicare funded IVF services for single mothers and gay couples. And as mentioned earlier, my ABC colleague Steph Dalzell, is reporting this morning that doctors are still being told to conserve IV fluids in major hospitals, despite the government saying more than enough had been secured to overcome a severe shortage. Mark Butler, welcome to the program.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Morning, David.
SPEERS: So, let's start on the IV fluids. Three weeks ago, you announced that you’ve secured supply for the next six months of over 22 million additional bags, IV fluid bags. Is it more accurate to say normally we would get 19 million over that six months, and you've secured an extra 3 million bags?
BUTLER: We'll have millions more than we need. The group that we've pulled together to monitor what's happening through the healthcare system, they met again last week. They have said although the situation has very much stabilised, they want health systems to be using these bags judiciously and cautiously. We're not through the woods yet, David, but we're certainly in a much better position than we were a few months ago. To be honest, this got under the radar of healthcare systems, whether it was state governments or private hospitals, because we've always just assumed there would always be a surplus of IV fluids or saline bags. When there was a bit of a supply interruption, it became clear that, first of all, there was no obligation to notify that shortage, which there is for medicines, for example, we're now treating IV fluid as a medicine but also there wasn't much coordination between different parts of the system. Some state governments that had one procurement arrangement were doing quite well with their IV supply other state governments who decided upon another procurement direction were coming up pretty short. That's why we've pulled all of the jurisdictions together, private hospital operators, the primary care part of the system through the AMA, to make sure that very regularly, we have a much better line of sight, than the system did have before.
SPEERS: Okay, but just for accuracy sake, you've really only got a few million more bags than we'd normally get over the next six months?
BUTLER: That's right, we'll have more than we need.
SPEERS: Are you sure of that?
BUTLER: Yes, and we're looking at longer term security of supply as well. For example, our major manufacturer here in Australia will be opening an additional production line in coming weeks. I've been down to have a look at that over the last few weeks as well. But we need to think in the more medium to long term, about how we can avoid getting into this position again. It's part of a broader question about our sovereign capability in the area of medicines and medical technology.
SPEERS: Okay, but what do you say to those doctors right now who are saying they're having to gatekeep, conserve, not give patients all that they need. What do you say to them?
BUTLER: We're working to remedy this situation. We've pulled all of the systems together, they've looked at this very carefully. They've been doing this on a weekly basis, and said, although the situation has stabilised, we can't be wasteful about this. We need to, I think the words of the latest report from last week were to be judicious about the way which we're using this.
SPEERS: This morning, you're announcing expanded access to the shingles vaccine. Who will now be eligible for it?
BUTLER: This is a little bit more than 200,000 additional Australians with moderate compromise to their immunity. They might have HIV, they might be in an advanced stage of kidney disease, on dialysis. They're about twice as likely as the general population to contract shingles, which can be a very, very serious illness indeed. It expands what is already the most comprehensive shingles vaccine program on the planet. Since we announced it in November, already, one and a half million Australians have accessed free vaccines. They would have been paying $560 for the two doses of the vaccine that they need already that saved $800 million in out-of-pocket costs. This is one of more than 200 new or expanded listings we've made to the PBS and the National Immunisation Program in just two years. It’s a very big part of our chief of medicines policy David.
SPEERS: A unanimous Senate inquiry mentioned during the week found women going through menopause are being let down by the health system. Some doctors receive only one hour of training on menopause and perimenopause. The committees call on you to urgently fund better training for doctors and also do something about the shortage of MHT the menopause hormonal therapy. Will you respond to this?
BUTLER: We will, and this is now one of two really important inquiry reports the Senate has delivered to us around women's health, and together, they tell a pretty shameful story of women not being taken seriously in the health system about their symptoms. Women taking far too long to receive a proper diagnosis in some areas, like endometriosis, for example, can be up to seven, eight or even nine years to get that diagnosis. Also our treatment regimes, our PBS medicines, you mentioned that the hormone replacement therapy just not keeping pace with best practice. We now have a couple of very important reports -
SPEERS: So what will you do?
BUTLER: We've made modest investment, I'd have to say, in the last Budget to lift the capability, particularly of our GPs, to support women in perimenopause and menopause. We've got the review underway, for example, of the Medicare items for IUDs and longer acting contraception. But there's much more I think we need to do in this area. I'm working with the Minister for Women, Katy Gallagher. Ged Kearney, is leading some work with the women's health sector to examine these reports and look at what we can do to better support women. I'd also make the point, though, David, the best thing we can do for women, given that they use about 60 per cent of all of our Medicare services, is strengthened Medicare. Over the last four months, our bulk billing changes have delivered more than 3 million additional free visits to the GP –
SPEERS: Okay, sticking with this issue, appreciate that. Sticking with this issue. And this committee found there's all sorts of misdiagnosis, mistreatment going on, women going through mental health issues as a result, family breakdown. It's pretty harrowing stuff. One of their other ideas is flexible work arrangements for women, is that something the government would contemplate?
BUTLER: Look, the report was only delivered in recent days, so we're going to go through it carefully, but it's been a really important inquiry. I've been hearing from the health system and from consumer groups, they've taken it seriously, they've invested a lot of time and energy into it. Some of the conclusions of the inquiry, I found really quite shocking –
SPEERS: So, are you open to the idea the recommendation of a right for women going through menopause to work flexibly?
BUTLER: I'm not going to respond to the report today, David, but I want to say that in the area it’s helped, these two reports now are really important foundation for us to do more and do better for women. I think some of these findings were shocking. I'm astounded that medical students over a long degree would maybe spend one hour on perimenopause and menopause. About half of their patients are going to be dealing with this. They are complex conditions that need really complex support –
SPEERS: Okay we’ll see what comes of that. On access to abortions. It's not just a few days, it's more than a year since another Senate inquiry into reproductive health recommended, amongst other things, all public hospitals within Australia be equipped to provide surgical pregnancy terminations for timely, affordable pathways to other local providers. This used to be Labor policy, what is your position now on public hospitals providing abortions?
BUTLER: We want women right across Australia, particularly in regional communities, to have equitable and safe access to all health services, including termination services. Ged Kearney and I have briefed state and territory health ministers on that report, and I really hope that our state and territory colleagues are taking that one recommendation very seriously. I know that was a long discussion we had with health ministers. There are also medical termination services through the MS-2 step medications that that we've sought in conjunction with the Therapeutic Goods Administration we have made it easier to access for women, including women in regional communities. That was also a very important report that we're taking very seriously. We're working through the recommendations, particularly those that are Commonwealth responsibilities. Together with this latest report on menopause, some of the work we've been doing around endometriosis and pelvic pain, on top of the broader strengthening Medicare agenda that we can do much better for women in the health space, and I'm committed to doing that.
SPEERS: Okay but on this issue of public hospitals providing abortion services, will you make that a requirement under Commonwealth funding agreements?
BUTLER: We don’t have plans to do that –
SPEERS: Why not?
BUTLER: We're currently negotiating public hospitals agreements. State and Territory ministers are accountable to their electorates for the way in which they operate their hospital systems. We've briefed them on the Senate inquiry report and made it very clear that –
SPEERS: This used to be Labor’s policy, is it too politically sensitive now?
BUTLER: We take the view that state and territories are accountable to their electorates for the way in which they run hospital systems –
SPEERS: Why the change?
BUTLER: We've briefed them on this report and we're negotiating a hospital funding agreement right now.
SPEERS: Why aren't you insisting it anymore?
BUTLER: We've taken the view that the state and territory governments are accountable to their people for the way in which they do that and we're accountable to people for the way in which we run the medicine systems. For example, we’ve broadened access to medical terminations, surgical terminations are a matter for state and territories -
SPEERS: So it depends on where you live. On IVF, there was an inquiry that also recommended the government look at extending care and IVF services to cohorts that aren't currently eligible, so that includes gay couples, single parents as well. Are you willing to do this?
BUTLER: Again, this was another report delivered last week by Greg Hunt. I'm glad to see he's still contributing –
SPEERS: But there was a Senate inquiry last year that did this as well.
BUTLER: This is an active area of debate, and I have to say this technology has been extraordinary over the last several decades in giving families who can't conceive access to the joy of having children. Anything we can do to broaden access to that treatment and give even more families the joy of having children if they can't conceive naturally, we're very open to. The latest report from Greg Hunt and Rachel Swift has a range of very sweeping recommendations, including, for example, the Commonwealth taking responsibility that states and territories have held since the introduction of IVF technology for regulating this area. Obviously, we'd have to have a pretty deep discussion with them about that –
SPEERS: What about the idea of Medicare funded IVF services –
BUTLER: And the definition of infertility –
SPEERS: Would this be available to gay couples and single mums?
BUTLER: This is only a report that we've received over the last several days. I haven't been formally briefed –
SPEERS: Well, there was one a year ago but –
BUTLER: I know this has been an active area of debate, but –
SPEERS: So, will you do it?
BUTLER: But I'm not going to make a decision on your program about this. We will work through all of these recommendations carefully –
SPEERS: Are the rules discriminatory though against gay couples?
BUTLER: My starting position is that this has been extraordinary technology for families who can't conceive naturally, and if we can give more families the joy of having children, that's a great place to start. But we're going to work through these recommendations carefully, as I imagine your viewers would expect.
SPEERS: Alright you’ve got a bit to work through by the sounds of it Minister.
BUTLER: I receive a report about every week about how we can improve the healthcare system, David.
SPEERS: We'll see where you land on some of these things. Vapes, your ban on vapes, at least sales not through pharmacies, took effect nearly three months ago. According to the Nine newspapers, they're still widely available. Tobacconist and convenience stores still selling them, but at a higher price. What do you make of this is the ban working as you intended or not?
BUTLER: I never pretended that this would shut down overnight, but let's remember why we're doing this. Vapes were presented as a therapeutic good to help hardened smokers kick the habit, but we learned very quickly that was not what it was about. It was actually about recruiting a new generation to nicotine addiction. You look at the vapes the way in which they're presented their flavourings, where the vape stores set up. Nine in 10 of them were set up within walking distance of schools and tragically, it was working, one in six high school students were vaping. We were determined to crack down on this. We introduced the border control on the first of January. Already, we've seized more than 5 million vapes at the border, and we introduced the retail ban on the first of July. That is starting to have an effect in my own electorate there were six or seven vape stores operating in my electorate, every single one is now shut, and I'm seeing that around the country. But it's quite clear that some convenience and tobacconist stores are breaking the law –
SPEERS: And what's happening to them? Have you got any data on, are many being fined or shut down?
BUTLER: We've taken the approach in the first few months to try to get businesses to surrender their vapes, and many businesses have done that to the TGA. We've been conducting inspections in conjunction with state authorities to hundreds of premises to inform them of the new laws and warn them of the consequences in the longer term, but we are going to have to switch to a far more assertive approach. There are very serious penalties in the federal laws now up to seven years in prison –
SPEERS: So, you’re going to get tough now?
BUTLER: And fines of more than $2 million and pretty soon, I want to see prosecution starting to be prepared by authorities, because this is too important to the health of our young people. Only last week we saw new research that shows that high school students who vape are five times more likely to take up cigarettes. 12-year-olds who are vaping as well are 29 times more likely to take up cigarettes. With all of the health consequences we've been fighting for decades from Big Tobacco, and that was their strategy all along. It's not going to happen overnight. And a whole lot of people say, “Oh, it's too hard”, including the Liberal Party and the industry itself, but I'm determined to keep fighting this and protect the health of our younger Australians.
SPEERS: A couple of other issues. Just quickly, the shortage of GPs, you have increased Medicare rebates, but there was a report from your own department last month that looked at the trajectory that we're hitting on there's a shortfall still. There's going to be a worsening shortfall over the years and decades ahead. Can you, will you do more to get more medical graduates into general practice?
BUTLER: I'm desperately worried about this. We don't have enough GPs that's just going to get worse. One in two medical graduates used to choose general practice a decade ago, it's now about one in seven. We need a lot more medical graduates choosing general practice. This year, about 20 per cent more medical graduates have chosen general practice than did last year. So that's maybe some green shoots of recovery. We're bringing more GPs in from overseas than we were before COVID. We're plugging the gap to a degree, but not enough. We have made some changes to make general practice study more attractive to deal with some of the industrial disadvantages they face compared to hospital based specialties. But we've got to do more. I'm speaking closely with the AMA and with the College of General Practice about their idea. National Cabinet has directed all health ministers to come up with a GP attraction strategy, because they recognise general practice is the backbone of our healthcare system. And if we can't fix this over the coming years, we're going to be in very deep trouble.
SPEERS: And a final one, mental health. We saw another report during the week, crisis in youth mental health in particular, I know Pat McGorry has been raising these issues for a long time as well teenage girls, particularly in crisis. Do you really think the system is working at the moment?
BUTLER: Demand has been increasing for 20 years. I think it's pretty clear that increase in demand has been amplified by social media, which is why there's such a vigorous debate about social media. But when I talk to people like Pat McGorry, just this extraordinary Australian who's given us so much in youth mental health, we also take the view that it's time to have a good look at the models of care we have for youth mental health right now. We rolled them out, I was involved in much of that as mental health minister 15 years ago, in a way that really led the world, but I think Professor McGorry and many others think it's time for us to have a look at whether those models of care are right today and we're doing that. But this is a this is an area that parents and school communities are very, very worried about. The demand for mental health services by young people just continues to increase. We want to go upstream and look at some of the impacts that social media and other things like that are having. But there is more demand on the system than there is service right now, and we've got to do better.
SPEERS: Health Minister Mark Butler you had a lot on your plate. Thank you for joining us this morning.
BUTLER: Thanks David.
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