*Please note, this is the full version of the transcript, not all was aired*
Laura Jayes: Minister, thanks so much for your time. Mental health is something that I’ve spoken about a lot on my show and the last statistic that came out showed that Australia at a ten-year high when it comes to suicide. For Indigenous people it’s six times the rate of the national rate. Lifeline says they need a national summit. Will the Government agree to that?
Sussan Ley: We don’t need a national summit in my view but we do need, perhaps for the first time, a really national approach. I’m quite conscious that when we all sit down and call something a summit it looks a bit as though we’re here on the hill having yet another talk fest. But, look, Lifeline have a great understanding of the needs of the community when it comes to things like prevention so I will be sitting down with them and other suicide prevention organisations in a less formal round table setting so that we can all talk about the next steps, talk about what needs to happen and what needs to change, but also so that I can explain what we’re already implementing. Because we aren’t sitting on our hands as a government, we have done a lot, we have added from during the campaign alone $192 million in new money for mental health. There is all sorts of activity and I do want to make sure I get that message out to the sector as well.
Laura Jayes: Why do you think it is getting worse, though? Maybe it’s marginally worse but it’s certainly not getting better. I know it’s not an easy- and it’s multifaceted but when you have statistics like 3000 people killing themselves and, you know, supposedly we live in the best country in the world and we have- one of the richest countries as well but people are still killing themselves. Have you got some answers on that; do you know, can you put your finger on it?
Sussan Ley: I ask myself that question all the time and, of course, Indigenous Australia if it’s treated as a separate country is much higher up that table in the world, probably around number six and I think that Australia, non-Indigenous, is about number 64 so that alarms me especially because of that disparity between Indigenous and non-Indigenous Australia. That’s why I’m really interested in the outcomes of the suicide prevention trial in the Kimberly and [indistinct] talk about that, I guess. But, generally, as I said, it is a question I ask myself all the time because in one sense we live in the best country in the world in the best time life, when you look at wars, particularly, the past and what our grandparents and great grandparents survived through, we have to conclude that proclivity towards suicide has some other factors underpinning it that have nothing to do with how, for example, tough life is as it was, particularly in the wars in Australia. So, I’m hoping to find some answers when I talk to the [indistinct] that I am, but I guess in one sense we need to address the problem and we need to do it in a systemic way and focussing on the cause is a part of that but these are statistics that we live with and that we must respond to.
Laura Jayes: The statistics are shocking and you can go through so many, Australia’s place in the world when it comes to suicide statistics is bad enough, but one that really shocks me is that around 40 per cent of people who die by suicide, haven’t had contact with the health system. The most vulnerable group in that are those with previous attempts and most of them have come out of wards, emergency departments. Are you doing something specific to look at that, to look at frontline services?
Sussan Ley: This is a key component of our reform to suicide prevention and mental health more broadly and I should say that suicide strikes more in people who have mental illness but it also strikes across the board in people who are quite well. So, we have to be aware of that, it’s not just found with mental illness. But our reforms to mental illness generally were absolutely focussed on a regional approach and a joining up between the primary and acute care systems because too often I heard this story. People are discharged from the acute facilities effectively into a vacuum. The acute facilities managed by state governments, they have some level of community engagement but not enough. I was in a major hospital where people were in confinement essentially because their psychosis was so bad and when they left, I asked the staff where do they go and they said they were referred to the community facility which you can actually see out of this window. I said, do you know that they actually get there? Well, no, we don’t because that’s not us, that’s them. So, maybe [indistinct] but the connections aren’t there and too often the most vulnerable, we know who they are. I mean, we know who they are so out reforms are saying those individuals need targeted, integrated- an integrated package of care that starts in primary care. We don’t want to identify people when they’ve crashed through the doors of an emergency department or been brought in in a terrible state. You know, we don’t want that to be the first time that the system knows who they are. So, our Primary Health Networks are commissioning funding but most importantly they’re joining the primary care with the state hospital systems. That’s vital.
Laura Jayes: What about the COAG agenda? Shouldn’t this be a priority in COAG? I mean, when we had a blackout in South Australia, we have an emergency meeting of energy ministers; this should be an emergency of the COAG, shouldn’t it?
Sussan Ley: This was talked about when I met COAG ministers last Friday, so we are working on that fifth National Mental Health Plan. And I know these things seem incredibly slow and bureaucratic and, hey, they do to me as well but I also recognise that if you’re going Local Health District by Local Health District across the country, joining that up, mapping where the services are, making it happen, you know, it’s taking time but it is happening. If you look out across Australia, you will see those connections being made and most importantly, you’ll see them in rural and regional Australia because when you talk about people who haven’t been in the health system, they’re often rural and regional. And what this will do is allow the services to leave the capital cities and set up there because they as services will have a critical mass of activity and patients and consumers and families and carers to work with. Previously we had this one size fits all approach, so Medicare funded a number of visits to a clinical psychologist and doctors who- GPs, who should be the centre of your care, would say, would see a patient coming into see them, they’d be carrying this little black box saying anxiety and they would think I don’t want to open that box, I don’t know what to do to refer (*) the patient. All they had was the clinical psychologist intervention. That’s not necessarily where we want to go. We may want that but we may want something low-intensity and we may want that [indistinct] care. What we’ve done is say that our funding will cover the spectrum: low, medium, and high intensity. A stepped care model that the experts tell us is the right one.
Laura Jayes: Okay, and if I could look at your portfolio more broadly given the election campaign we’ve just had, on 5 July, Medicare campaign all behind us on that date, Malcolm Turnbull said it’s very clear that me and my colleagues have to work harder to rebuild or strengthen the trust of the Australian people in our side of politics when it comes to health, there is no question about that. What has the Government done to strengthen that trust in the last hundred days?
Sussan Ley: We’ve continued with the reforms that were in place before the election which haven’t come out of nowhere. Trust with the medical profession, so our MBS review being done by clinicians; trust with general practice being done through our Health Care Homes model which they are participating in. That’s the new way of looking after people with chronic disease but it’s bringing the doctors to the table to help us design exactly what the new system of payments will look like. It’s talking about mental health and reminding people that only with careful management of our health portfolio could we in fact add $192 million of new money just for …
Laura Jayes: [Interrupts] Have you seen that rebuild of trust? Are you seeing those policies have an effect?
Sussan Ley: Look, I believe they are. I’m not going to stand- sit here and say, you know, I know what people are thinking. I’ve certainly been out and about, my colleagues as backbenchers are certainly armed with the information that they may need to address the concerns. For example, Labor keeps talking about so-called cuts to blood tests and scans. This is just a complete lie. I mean, this is- this is fraudulent misrepresentation of our position, and it’s very hard to fight what is, you know – and I’ll call it a lie. I’ll call it out for what it is. But the truth surfaces and we’re quietly, persistently explaining to people what we’re doing with Medicare, why we’re doing it, and why sensible, calm, measured reform is what we need to do. When you point to …
Laura Jayes: [Talks over] Now, the reforms that you put in place before the election, that you said just then that you’re continuing with. Are there any lessons to learn out of the election, any at all?
Sussan Ley: There were lessons around campaigning, because when I …
Laura Jayes: [Interrupts] Isn’t it around policy, though?
Sussan Ley: The policy settings are correct. The policy settings are where they need to be, and when I talk to people about where our policies are, they accept and understand that. Remember, we’ve got a huge reformist agenda in place. It’s big. There’s lots of things happening.
Laura Jayes: But when Malcolm Turnbull said we need to rebuild or strengthen trust, all you’re saying you’ve done is continue with the reforms you had before – before the election.
Sussan Ley: Well, some of those – some of those reforms are landing. They’re landing in a place where it’s clear what they’re doing. For example, medicines, medical devices, access to new treatments, clinical trials, and so on. So as reforms happen, you see more of the results on the ground. I’ve visited a lot of electorates since the election campaign, and we were the victims of a very clever campaign. But it was built on falsehoods. It really was, and we know this, because when the Leader of the Opposition was asked to say well hang on, is the Government privatising Medicare, he just wouldn’t answer the question, because he knew it was not true. But my colleagues reported to me that at the polling booth, people were absolutely- they had believed those lies. They said, you’re going to privatise Medicare. They repeated those lies when they went into vote. So look, it was a clever campaign. And it was a dishonest one.
Laura Jayes: The freeze of the Medicare rebate has been obviously a hot issue, and Malcolm Turnbull used the last day of the election campaign to say that he quote unquote absolutely guarantees that the extended freeze on rebates would not result in patients paying more to see a doctor. How long can you maintain that promise? Because at least anecdotally the AMA is saying that GPs are shouldering increasing costs, and also – you would have heard it during the election campaign – they’ve called it a co-payment by stealth, that rebate.
Sussan Ley: It’s – the pause which was originally introduced by Labor has been kept in place because of our fiscal circumstances. When I talked to doctors, I explained that I don’t want it to be there one day longer than necessary.
Laura Jayes: [Interrupts] No, and you said during the campaign that it was Treasury and the Treasurer and the Finance Minister not allowing you to do that. Is that …
Sussan Ley: [Talks over] That was – that was a misrepresentation of what I said then.
Laura Jayes: [Talks over] Oh, okay. But is that still the case if the budget can’t afford it?
Sussan Ley: I’m a minister who signs up to the agenda of a Government that needs budget repair and strong, stable economic management, so I’m absolutely not walking away from our responsibilities. So I know that we can- you know, that we need to leave the pause in place. But I know that we need to lift it for the benefit of general practitioners as soon as possible.
Laura Jayes: When’s that, do you think?
Sussan Ley: Well, that’s some time in the future, but meanwhile …
Laura Jayes: [Interrupts] Do you think this term?
Sussan Ley: Look, these are decisions that are made through the MYEFO and Budget process, and I’m not going to forecast what they might be.
Laura Jayes: You obviously have a big say because you’re the Health Minister. When would you see this as a reasonable time? Before the next term? Surely that would help rebuild the trust in the system that Malcolm Turnbull was talking about on 5 July.
Sussan Ley: The point that I want to make is it’s not just about effectively lazy policy as Labor would have, saying we’ll just reverse the freeze and we’ll put it on the credit card. We’re reforming primary care. Our Health Care Homes model is actually about paying GPs quarterly in bundle payments for 25 per cent of their patients who have chronic and complex conditions. So it’s a completely new model of remuneration. Yes, it will sit side by side with Medicare, but it is a new model, and no-one has to do it. So we’re implementing something that we’re not forcing on doctors, that they are helping us design, and that in the long term will be in the interests of their patients. And I always say, if the dollars aren’t right for them, they actually won’t sign up to Health Care Homes.
Laura Jayes: [Interrupts] But there is a – there’s a looming problem, though, isn’t there? Doctors are shouldering more of the costs because of the ongoing freeze which is continuing, and you don’t – you can’t really say whether that freeze will be lifted in this next term. So is there a perfect storm brewing here that you’re very aware of?
Sussan Ley: I make the point that bulk-billing rates have never been higher. Never been higher. So the access …
Laura Jayes: [Interrupts] How long can that last?
Sussan Ley: Well, the last bulk-billing rates were holding up very well, and we can- we’ve said for quite a while now that they’ve never been higher. And I appreciate the fact that doctors do a lot for their patients. But remember, when you bulk-bill your patients, you get $6 something if you’re in the city, and $9 something if you’re in the country. So there’s a strong incentive that Government’s providing in terms of the dollars to support that high bulk-billing rate. We want to work with general practice. I don’t want it to be all about us and them. I have, I believe, a strong relationship. You know, naturally there’s tension in that relationship, because we’re the funder and they’re providing the service. But above and beyond that, we want to build models of care that look after their patients. They want that; we want that. There’s huge areas of common ground.
Laura Jayes: One final question to you, minister. Labor, during the election campaign, was able to muddy the waters on privatisation. It was always going to be the back office, and that was part of the problem, as well. Just to be patently clear here: the Government is not going ahead, even with the privatisation of the back office in that direction. Have you now disbanded the taskforce that was looking at that?
Sussan Ley: The department brings together groups of people, and I think they were described at one stage as a taskforce. That wasn’t my taskforce. I [indistinct] repeat the Prime Minister’s promise. Every element of Medicare that is delivered by Government now will continue to delivered by Government into the future.
Laura Jayes: So you’re not looking at privatising the back office?
Sussan Ley: No. Every element will be delivered by Government into the future. There is no privatisation whatsoever. Not that I think people really believed that in the first place, after they were told the facts.
Laura Jayes: I think that’s patently clear now. Minister, thank you for your time.
Sussan Ley: Thank you.