From July 12 2012
The five key values that I, and our conservative side of politics, bring to my department are: We do believe in smaller government, we do believe in lower taxation, we do believe in better management, we do believe in individual enterprise and reward for effort and we do believe in individual responsibility. They are five key values which are in many ways different to our predecessors. I’m not saying that my predecessors were not hoping and wishing they would be doing a good job – but everyone who enters politics and public administration has their own personal motivations and values to do a particular job.
Our department (Queensland Health) on the whole does a pretty good job, but there are some managerial issues that need to be dealt with and some structural issues that need to be dealt with. We’ve got some 84,000 staff that is our head count, basically fortnight on fortnight. What we’re doing is seeing millions of people in our emergency departments. We’ve got hundreds of thousands of in-patient days and a whole range of other contacts in the various fields that we deal with in Queensland Health.
And indeed the greatest majority of those people who have contact with Queensland Health have a very, very good experience. Unfortunately when you are treating millions of people a year, even if a very small portion of those people have a negative experience, it adds up to thousands of people. Unfortunately also the good work gets overshadowed by some of that. So what I want to be able to do is to contain and to be able to deal with some of the negative issues that we have on a daily basis far more effectively and proactively in order to allow us to be able to get the positive messages out there.
Because there are some enormous positives that are happening within Queensland Health and our people who work out in the field and we need to tell all those stories because at the moment we have had an absolute bunker mentality where we’ve been under siege and not been prepared to share those stories with the community at large and particularly through the media. So we need to address that.
I want to also take this opportunity to set some of the backdrop of the issues that we are dealing with. At this rate of expenditure growth, Queensland Health will consume the entire Queensland budget by the year 2030. That’s quite enormous and is something that is unsustainable and I’m not sure my colleagues, the Minister for Education, the Minister for Transport or Child Safety or Police would be very happy about that. So we cannot continue on with this particular rate of growth and not do something about the outcomes, which we need to improve along the way. Nationally, there are some very interesting figures that I’ve heard recently that the Australian Society of Medical Research and some of you may have been there, the projections to date explicitly show, based on what we know, that by the year 2060 that will $3.3 trillion dollars. Of course we know that that is not necessarily comparative to $3.3 trillion dollars today, but it’s still a lot of money in the future, and that is against the backdrop currently of the entire economy of Australia which generates the wealth of about $1.3 -$1.4 trillion dollars. So it’s unsustainable and we need to do something about addressing that.
When I became Minister for Health in the first week of April my departmental budget was about $130 million in the red. Now frankly that is also unsustainable and the days of running back to Treasury and saying, “please give us some more money because we can’t control and deliver on our expenditures” are over. Now Treasury tipped $300 million in last year to bail out Queensland Health last year. We cannot afford to do that so we have to look at ways we deliver things into the future and what our core responsibilities are. And I will speak about some of those in a moment.
One of the other priorities of our government has been devolution of care and authority as well. And what we need to do is break Queensland Health down and we have picked up on where the previous government was at with regards to their local, hospital and health networks, which were part of commonwealth and state agreement. We’ve actually built on that and have refocused them around hospital and health wards in Queensland with the view of further devolution of responsibility and community engagement further down the track.
Now it is true, I believe, and most people in the community feel that if you are making those decisions closer to the community where the decisions impact most, with people who actually understand what the local dynamics are and you’ve got the ability to cast the microscope over 16 very defined sub-sets of Queensland Health you have a greater ability to be able to deliver, get those efficiencies and to be able to break down the management of Queensland Health where it can be efficiently and effectively delivered at that particular level. We are already starting to see some of those examples in regard to enthusiasm from our board chairs and the members that have been appointed to this moment.
With regards to other opportunities, government is historically partnered with the non-government sector, our NGOs and we will continue to do that, but as I’ll mention later on, we are going to change the way we are going to do that with regards to efficiencies that we expect from the organisations as we expect the same thing from ourselves and I’ll touch on that in a moment.
We will also be engaging more with the private sector in the delivery of health services in Queensland and we also will be partnering more with the private sector with regards to the construction and provision of health facilities in Queensland. So opportunities where we can lever money out of the private sector to deliver our key responsibilities, we would be more than happy to do that. And when you have more than 200,000 people on the waiting list to get on the waiting list – I know some people say it’s technically a waiting list to get on the waiting list because only about 40 per cent of people that are ultimately assessed by a specialist need to have surgery. But everyone knows there is a waiting list to get on a waiting list and I’m not going to try to tart it up to make it sound something different, because that is what it is. If you are waiting to see a specialist, it is a particularly difficult experience for you when you have to wait years to see someone. So if we can engage and be more innovative in those sorts of areas, then we will be doing that. And if we can engage more in a process of the training and appointment of nurses who have advanced qualifications in certain areas, such as endoscopy, we will be doing that to address some of the challenges with our patients.
We will certainly be doing more with regards to physiotherapists who have advanced skills in the area of musculo-skeletal issues. We have got to change the way that we deliver. Areas where we have trialled that in the past, the previous government, it has been enormously successful. We can stream off and you can actually collapse that time enormously of getting people in to get their core issues that are dealt with.
On the issue of partnering with the private sector we will be driving the provision of construction facilities more and more through that and I think people out there in the community don’t really care if its delivered through an efficient public sector model or a model of external engagement with the private sector. All they want is to have their health care need dealt with promptly assessed and have surgery if they need that particular surgery. And we do believe in those sorts of partnerships.
The other thing of course is that we have to have a far greater demarcation and this comes to the issue of chronic disease and preventable disease, and I don’t think we engage very well with the primary care sector and we’ve got a whole range of work that needs to be done with regards to the establishment of the Medicare Locals and the way that they interface, and that’s one of the objectives of the new Hospital and Health Services Act in Queensland, as it was with regards to the previous Act for the networks. But a lot of things that I’ve found in recent times, in my short period of time as Minister for Health, is that you’ve got these objectives, mission statements, but they’re not necessarily translated. So we need to do far more to make sure that we translate those particular outcomes. For example the other day I was in Weipa, now if you listen to what the Commonwealth Government says, they say Medicare Local will actually fix up some of the issues that we have with the primary care sector in community. No that’s closed down. It’s unsustainable. Queensland Health has now stepped in to take over the primary care facility hopefully just on the interim basis. So basically we’ve got those particular issues and if we can get more people effectively dealt with and streamed in the primary care sector then what we will do is to reduce our expenditure on health care enormously in the future. There’s an old saying about, “a stitch in time saves nine” and I think that is probably a clear indication of where its best. Because the figures are basically – if you can properly assess one, make those changes early on, then you can basically save $8 further down the track. So we need to actually get those particular linkages worked out even more into the future.
We will be moving more towards evidence-based medicine and we don’t do that enough. A lot of the treatments which we, working with individuals, aren’t necessarily giving them any demonstrable outcomes, and sometimes, arguably, they may be making their conditions worse. Research which is being done around the world indicates quite clearly, the more you personalise the treatment plan around an individual, understanding their genetic makeup and all the other issues that go with that, you get far better outcomes. That’s the encouragement I have from our government about where we will be looking in the future.
Research and the translation of that research is vitally important to us. If you look at the great advances that have come in health care over the last few decades, and indeed even century, a lot of that has been based around research. What has been observed, what has been used more formally and forensically, if I can use that term, then scrutinised and the ability to have people be able to take that up and translate it. There is an enormous amount of great research that is being done in Queensland in the area of medical research. Probably second to none in Australia, but some of our challenge is to make sure that we translate that. And that translation’s not just in research, it’s translating our preventable disease messages and I don’t think that we are doing that well enough.
Hospital in the home will become far more substantial way of us operating our health system in Queensland because it is absolutely stupid for us to have so many people taking up our acute care beds in this state who could be treated more effectively, with just as good results, if not even better results at home, because the longer you spend in hospital there are a whole lot more challenges which are associated with regards to that.
Remote area of monitoring, or remote monitoring of people with chronic diseases. We know that we’ve got a lot of people out there with co-morbidities, very serious chronic disease, and what often happens with those people is of course they have an incident, they end up in an ED (emergency department), very serious with a second heart-attack or whatever the case may be, they’ll spend a fair degree of time in the acute ward and they may never come out. So if we can actually work as they’re doing overseas, in Europe, and it may be happening in other areas of Australia that I’m not aware of, that remote monitoring of people with chronic disease in their own home, that allows suitably qualified people monitoring them to detect if something’s going haywire in regards to their vital signs to intervene at a much earlier stage.
Investment in sub-acute care is very important as well to make sure that we can free-up the amount of hospital beds taken up by sub-acute patients. There will be a dramatic investment over a period of time in that particular area.
Palliative care is an area that’s gone right under the radar and I will be putting a major focus through my Assistant Minister Dr Davis with regards to this particular issue because I don’t believe people in the community have confronted this issue, or understand this issue. There are enormous investments that are actually being made in people with regards to international medicine towards the latter stage of people’s lives, costing tens of thousands of dollars, sometimes with actually debatable outcomes. Sometimes they are making their quality of life, worse not better because of the recovery in that stage of their life. So the options for patients with regards to being able to be aware of and sign up to advanced health directives, and more access to palliative care in our community is something which we need to focus on and very much invest in, in the future.
The Mental Health Commission will be happening in Queensland sometime in the next few months and that will take key responsibility for the co-ordination of and also advising government with regards to expenditure of mental health funds here in Queensland. We are going almost beyond this particular stage of what is an epidemically fast-approaching pandemic, when it comes to mental health. If you’re looking at any one year, the figures say this, 1 in 5 people have a mental health incident in their life. 1 in 2 have a serious mental health incident and we are not necessarily getting the outcomes for the funding we are putting into those areas. Sometimes what we are finding, I think, is something that’s more self-serving and not necessarily being able to be measured in positive outcomes. I am very keen on the model of New South Wales which is based around the New Zealand model which is very much about community care options, limiting the institutionalisation of people, and of course we do need to have along the way the right amount of acute in-patient beds as well.
Now the Mums and Bubs policy is a key part in delivering a preventative health message because if you can actually make that message more effectively to mums, particularly at the early stage of looking after a child, it can really have some great outcomes as well.
A lot of system challenges: Obesity in 2007/8 in Queensland the figures were 800 000 Queenslanders overweight and about half a million people fit into the obese category, and that contributed to about 21 per cent of heart disease in Queensland.
Currently the figures indicate that 57.4 per cent of Queenslanders have some form of a weight issue and the negative contribution in cost on the Queensland economy of obesity is $11.6 billion dollars, now that’s a lot of money. In future those rates of people who have got a weight issue are going to increase in the future to 63 per cent. Diabetes, 24 per cent is directly attributable to obesity and if we look at another area of health intervention, we want to get our prevention message out a bit better home in the area of smoking. We’re still behind the national average but we are making up significant ground in that particular area and I think that at this stage we are around four per cent behind where the national average is.
One third of our deaths are preventable. It is quite remarkable, one-third of our deaths are preventable. Who would actually think about that – there’s an old saying, “One death’s a tragedy, a million’s a statistic”. It’s very, very tragic when you actually look at it in the context of those particular deaths. And the overall cost of chronic disease is very, very serious with an aging population to boot as well.
Now from our perspective, are we committed to health prevention campaigns and preventable health, and preventing chronic disease in Queensland? Absolutely. That is a key motivation and responsibility that we actually have. I think there are a range of messages that are being delivered effectively and efficiently in Queensland in the past, and I think we can really learn from them. I remember when I was a child and probably a little bit later on, being subjected to the slip, slop, slap and I think we’ve got a slide on the end of that message. Whilst we’ve still got very, very high rates of skin cancer, of course above the national average, I think we’ve actually seen a significant change in the attitude of people and the prevention campaign has worked in that area. Now a lot of that actually happens through our education system. If you go to schools you actually see children not being able to go out to play unless they’ve got a hat on and suitable clothing and I think that’s very, very important. The image of the bronzed Aussie in the context of Queensland is not what it was when I was a child. Now that’s an example of where something has effectively worked because we have been able to take a message, construct the argument around it and translate a significant amount of success. Similarly we’ve been able to do something with the HIV AIDs campaign in the 1980s. That was enormously successful. The Grim Reaper ads were enormously successful in actually raising awareness and also putting the curb on what was a very, very serious public health issue at the time. And I think in regards to ‘Quit Smoking’ we’ve had some degree of success as well.
But if we look at obesity, and we look at some of the other lifestyle diseases I don’t think we’ve been anywhere near as successful. I don’t think we’ve been able to, proportionately, translate the investment into outcomes. Indeed if we look at obesity and the other contributory health effects that actually flow on, now we’ve got heart disease, we’ve got diabetes, we really do have a serious issue where we’re investing in it, trying to get the message out but we’re not actually changing the behaviours and habits of people in the community. Now I remember last week, I was speaking to a doctor in one of the Cape communities and this was an Indigenous community and I said to this particular doctor, “are you really making much difference?” and she said “No, not really. I still see the same people with the same problems getting worse” And I said, “why’s that?” and she said “well actually because people need to have a life-changing event to change the way they live”. And that really brought it home to me. So if we look at it as a successful proportional translation of results from the funds that we actually invest, we’re not doing a very good job in that area and we need to a far better job in that area. Now that applies to my organisation, Queensland Health, that applies to those involved in the primary health care area, that applies to our non-governmental organisations as well, that we actually fund. So we’re going to make sure that as part of our review of our grant system in Queensland that we have a process which is accountable, which actually people understand what the application criteria are, they are actually properly assessed based on what they have to offer. We will also be looking at tendering the opportunity for people to actually be able to deliver messages and be able to get better results as well. But at the end of the process we are going to put in place key performance indicators and measurables. Key performance indicators and measurables are not people turning up with a folio of material which basically are ‘I love you’ letters saying we really like what you do, it’s basically ‘what are our outcomes, what have we done to actually address obesity levels in this community, what have we actually done to reduce type 2 diabetes in this community, what have we done to effectively reduce smoking rates in the community’. Now this is taxpayers money, I’m the custodian for it, and I think that we need to do a little bit better with what we do, all the way around, Queensland Health down.
Now the other day I also saw in the Cape, while there are also some remarkable initiatives there as well, that incident that I pointed out with that doctor, that’s the same with a lot of communities, it’s not just indigenous. Until a person has a life-changing event, and they’ve got it up here (points to head), we really are, currently, in many ways wasting our time. We’re just trying to put a band-aid on the problem. So we’ve got to get better at how we deal with those sorts of issues right across the state. But also one thing that I’ve noticed through the process of what we do with funding is an enormous duplication and triplication. I saw that in the Cape the other day, where we had a multitude of organisations in communities who are seeking to be doing similar things. You have Queensland Health there, you have (inaudible) there, you’ll have the Royal Flying Doctors Service there, you’ll have some program that’s being funded by the Commonwealth. And guess what? We don’t actually have much coordination. In some cases we’ve got people in there doing the exact same thing. Is it actually sensible for us to actually send a Queensland Health maternal child welfare nurse out into a remote community when we’ve got an organisation that’s being funded over here that’s actually sending someone into the same community. That doesn’t make sense, so we have in Queensland Health an enormous grants pool, and as a part of that we want to make sure the discretionary amounts of those grants that are actually focused towards delivering key health messages and outcomes are actually better targeted to getting results and we will be doing that. We will be reducing duplication, reducing triplication and we will also be making sure that organisations clearly understand what our key outcomes are. I wish that I had the money to be able to fund purely for advocacy. I don’t have that. I have to fund for outcomes. That’s the important thing people need to understand with regards to that. So I’m very happy to work with any non-government organisation to change the way that we deliver our health messages and the outcomes within the community.
Preventative health care is the area that we can make the most serious difference, quickly. Yet believe it or not, it’s the area we’re not really making much difference. And so there’s a definition of insanity and that’s basically doing the same thing over and thinking you’re going to get a different result. That’s not going to happen. We just can’t afford to go down that particular track so we have to look at successful programs interstate, overseas, where it works let’s pick it up. Let’s not reinvent the wheel, because nothing’s new under the sun generally and we’ll be taking that, we’ll be adopting that and we’ll be expecting these particular outcomes. It comes back to those key values I outlined earlier on and that is people taking responsibility. If we are going to invest money and put the resources there that we need to actually continue reinforcing the message that people are in charge of their own health care.
But Jenny, and ladies and gentlemen, thank you very much for the opportunity to be here today. We have an appetite for preventative health measures in Queensland and we look forward to working with a whole range of organisations to deliver that.
Q: (Peter McCutcheon ABC 7:30) I was unclear about what you were saying about obesity campaigns. Were you saying that because they haven’t been effective enough you want to cut funding until you can prove otherwise that they were? Or are you suggesting spending more money on it. Are we talking more about individual responsibility does that mean that you are naturally suspicious of government regulation public health, things like AMA’s call to reduce junk food advertising.
A: No I’m not necessarily reluctant to support those sorts of suggestions, Peter. I think that advertising done the right way can really seriously deliver a good message and a positive health outcome. I think that we’ve had some examples with regards to that. We’ve also had some examples when I don’t think it’s actually worked as well. I think with regards to people’s calorific intake and issues with types of food that they eat, I don’t think we’ve necessarily been as successful with that as we have been with some of the other campaigns such as sun safety and skin cancer, all those sorts of things. What I’m saying with regards to obesity campaigns is that we need to look at the success of what we are doing and how we can get more bang for our buck and better outcomes for the money we are allocating in those areas. That is what I am saying. We fund significantly for the area of nutrition education, lifestyle choices, we actually outsource some of that. Our data around it doesn’t necessarily measure very positive outcomes, so we’ve got to look at the way that we deliver those messages. Sometimes we need to, also in the delivery of that messages, need to look like we ourselves practice what we are preaching to the people. Now I’ve seen some examples of where we’re trying to take messages in some communities with regards to smoking and obesity and the person who is taking the message themselves has an issue with smoking and weight. That can really have a serious effect on whether people take notice. But that is only one small part of it. So it’s the effectiveness of it, it’s measuring it, so we’re not going to shirk from significant allocation of funds, but we want to make sure we get better results from the funds we are allocating. It is one area we are not able to measure demonstrable, proportional increase in outcomes for the money we are putting in, and we need to look at our outcomes.
Q: Just a follow up – what was your view regarding junk food advertising for AMA calls to restrict junk food advertising?
I’m happy to consider that around a range of other options. The previous Premier in Queensland had indicated she would consider going it alone and introducing into Queensland even though she preferred it to be dealt with at a national level. But it is something that I would be very keen to properly consider but again, we’ve got to make sure we have got evidence for its effect. If people don’t have access to that encouragement to adopt a negative lifestyle choice, or a food intake choice, then you have a chance to quarantine the problem. I’m happy to consider that.
[More of the Q and A transcript will be available shortly.]