AMA Speech - AMA President Dr Steve Hambleton - President's Statement

***Check Against Delivery

Health Reform – The AMA is a Key Agent for Change

Good morning friends and colleagues, you are one and the same.

You have heard me talking a lot the last few days.

I promise you – this is my last speech.  My last speech as AMA President anyway.

A quiet note for future reference - never ever get between an AMA President and a microphone or a TV Camera.

I am on the verge of becoming a feather duster.

Worse, I may soon be suffering from ‘relevance deprivation syndrome’ – a debilitating condition made famous by Gareth Evans.

So, it is fitting that I deliver my final speech as AMA President while vote counting is conducted to decide my successor.

How fitting also that the new AMA President will start his term at a time of radical change in health policy.

It is change that is possibly more radical and far-reaching than the Rudd reforms that I confronted when elected Vice President five years ago.

The Rudd and Abbott reform agendas may be very different, but they had and will have a significant impact on doctors and their patients.

The AMA was a key agent of change during the last big era of health reform.

We were consulted, and we influenced Government to bring about positive changes.

The reform agenda of the current Government poses significant risks and challenges for Medicare and the health system – and we are talking about the very structure of Medicare – our universal health system.

The current agenda also offers opportunities for the profession.

The AMA – with its new President, its new Executive, and its new Federal Council - must be a key agent for change in the current health environment.

There will be much work to do – and it is work that only the AMA can do.

So much dwelling on the present and the future.

I want to talk now about the past, especially this last year of my Presidency.

You saw some of our highlights in the video.

The AMA was very busy on behalf of its members and the Australian community in 2013 and what we have seen of 2014 so far.

It was a Federal Election year last year.

The AMA appointed a new Secretary General.

We embarked on a voyage of governance reform to make the AMA stronger and smarter in the years ahead – and we reached our destination this weekend, thanks to you all.

The new look Federal AMA will continue to deliver good old-fashioned policy, lobbying, and member benefits.

It was another great year for AMA advocacy.

If the AMA is not happy, the population will hear about it. We are out there. We are available. And we will comment. We will pass judgement.

And we have made many high-class intellectual comments on health policy in my time.

Some will go down in history.

Who will ever forget:

·        Podiatrists creeping up the leg;

·        Not a shred of credible scientific evidence for chiropractic treatment of children.  It is simply biologically implausible that jiggling a baby or making a clicky noise behind its back does anything;

·        If treatment is only backed up by mumbo jumbo, there is an opportunity cost for treatment with credible scientific evidence;

·        Scrap the cap;

·        The “Coke and Fries” for pharmacy;

·        Giving vaccinations in the pharmacy aisle between the toothpaste and the toilet paper;

·        The Four Horsemen of the Apocalypse;

·        It’s a health system designed by bean counters for bean counters;

·        I challenged the press to make preventive health desirable. So I suggested they might try to make an apple sexy. Flanners suggested they make it hard core.

We were prominent in politics and the media as we sought to shape health policy to deliver the best possible health services to the Australian population, and the best possible working conditions for the medical profession.

Our message was that everybody in politics had to get smarter about health policy, especially about how we spend health funding.

And it was going pretty well until Budget night. People just got very dumb all of a sudden.

But you have heard and talked about that at length already. There is a new challenge already defined for us.

The AMA consistently called for health policies that were based on smarter spending of valuable health funding.

We stressed the need to concentrate on programs and services that worked.

This meant a greater focus on general practice as the cornerstone of primary care.

This GP focus faced its usual challenges.

Pharmacists, nurse practitioners, optometrists, chiropractors, podiatrists, and others all made claims to take on roles that are the natural and safe domain of doctors – and we actively opposed those claims.

And there are the unusual challenges.

I have already mentioned the Budget.

But perhaps the biggest other threat to the profession came from an unexpected and unlikely source – the Treasury.

As the former Government looked desperately to make Budget savings in an election year, Treasury proposed a $2000 cap on work-related self-education expenses for professionals.

The Labor Government, foolishly, took it on as a policy proposal.

So, the Scrap the Cap movement was born.

Led by the AMA, this campaign amalgamated doctors and other professions in an unprecedented show of unity, which ultimately won the day.

There was plenty of action on other fronts.

It was a year in which the AMA took a stand and showed leadership on new and emerging issues that won us great support from the community.

We highlighted the potential catastrophic effects of changing weather patterns, and suggested primary care response strategies.

We made a submission on the need for health assessments on proposed new mining activities, including coal seam gas and traditional coal mining.

We made a submission on air quality and health.

We called for an independent expert panel to oversee the health of asylum seekers in detention.

We also had our campaign in support of Queensland hospital doctors, who were being coerced into signing unfair, one-sided contracts that stripped workplace rights and conditions they had worked for over many years.

This campaign raged on from 2013 into 2014.

This was genuine trench warfare.

The Queensland Government – led by the Premier and the Health Minister – and fuelled by an overwhelming political majority – were determined to not take a backward step.

They underestimated the profession.

They underestimated the AMA.

They did not anticipate the united front between the Federal AMA, AMAQ, ASMOF, and the unions.

We built a compelling message and we won the support of the public and the media.

Our cause was the right one – and we won.

This was a truly great moment for the AMA, and I was proud to be a part of it.

I was proud to lead the AMA in a political battle that delivered a great outcome for doctors, patients, and Queensland.

There were other battles.

The AMA lobbied hard on our long-running concerns over Medicare Locals and GP Super Clinics.

This brought favourable responses from the new Coalition Government.

Similarly, the new Government heeded our calls to review the implementation of the Personally Controlled Electronic Health Record (PCEHR).

We also achieved significant wins on medical training and medical research.

The AMA Public Hospital Report Card attracted huge media coverage and political reaction following its launch by all AMA Presidents, Federal and State.

Each President gave personal and passionate pleas for ‘smarter’ public hospital funding and policy, based on their own experiences in the system.

The AMA continued its leading role in promoting immunisation in the community.

We circulated evidence-based educational material to thousands of general practices around the country and made quality information available to the community through our website and publications.

And, as you are aware, we reformed the governance of the Federal AMA.

It is only fair that as we call on the Government to get ‘smarter’ with its operations that we do the same.

The AMA is the leading health lobby in the country.

We lead. Others follow. Others look to us for leadership and example.

It is vital – always – for the AMA to be in a position where its views are heard and seriously considered by the Government of the day.

And a constant strong media presence is necessary to carry and support our advocacy.

More importantly, our media presence must at all times be positive and informed if we are to be seen as a serious contributor to the health reform debate.

If we oppose something, we must explain why, and offer a better alternative.

This is how we build the support of the profession and the community.

This is part of the way we influence the Government.

If we are going to tear something down, we need to propose something better to go in its place.

That is advocacy.  That is engagement.  That is a unique AMA skill.

Before I leave you, I would like to talk briefly about health reform.

How do we know that we have arrived? 

The Health and Hospital Reform Commission tried to set the vision and the goals and, as I said, in the session on the Budget that vision and goals still apply - and I will go over them again.

The vision was for a sustainable high quality responsive health system for all Australians now and into the future.

The goals were:

·        To tackle the major access and equity issues that affect people now; 

·        To redesign our health system to meet emerging challenges;

·        To create an agile and self-improving health system for future generations.

Unless we know where we are going, how will we know if we have arrived?

We need to move from:

·        intervention after a problem occurs to health promotion;

·        acute care to chronic care;

·        hospital-centric to patient-centric, with primary care being the hub for most patients;

·        silos to a coordinated continuum;

·        Extraordinary intervention at the end of life to patient-driven palliative care.

·        drawing patients to hospitals to assisting patients to stay out;

·        from centralized management to regional management;

·        under-funded poorly integrated primary care to properly funded team-based primary care;

·        working alone to working in teams;

·        public-private divide to a blend of public and private care.

·        poor use of IT to extensive use that is key to coordination across the system and that provides accountability;

·        doctors’ office-based information to multi-source, multi-location information; and

·        poorly-planned workforce numbers and roles to coordinated and responsive planning to deliver the workforce that Australia needs.

But enough rambling from me.  In minutes you will have a new AMA talking head.

Conclusion

It has been an absolute honour to serve the AMA and the medical profession as President for the last three years and as Vice President in the two years prior to that.

I thank you all for your support, confidence, and friendship.

The AMA is a wonderful organisation that does many good things for many people.

I encourage you to maintain your support and your energy as the AMA goes through much-needed changes to make it even smarter.

I would like to thank a few people for helping me get through a hectic five years.

My Vice President, Geoff Dobb.

My predecessor, Andrew Pesce.

I thank Ann Trimmer and Francis Sullivan and the AMA Secretariat for providing me with excellent back-up.

I thank my Executive members - Liz Feeney, Iain Dunlop, Brian Owler, and Stephen Parnis – for their advice, their friendship, their support, and their hard work.

I thank the engine room of ideas and debate – the Federal Council.

Thank you to the State and Territory AMAs for their teamwork.

And thanks to my wife, Deb, and the kids for letting me do this job – for so long. 

It is a great honour to be AMA President.  It is not easy. There are many challenges but, if we stand together, we can achieve many things.

As President I have been able to do things that I would never have believed.

I have had dinner with three Prime Ministers.

I visited an Asian country for the first time.

I have met the health minister of China in Beijing.

I gave the father-daughter address at my daughter’s school – that was special.

I have met some of the brightest doctors in the country.

Two of them have offered themselves to be your new President today.

I have met doctors who care about their profession, doctors who are prepared to give up their time freely and without question for their profession.  

Doctors who give up much time with their families, not to mention a fair bit of sleep.

Doctors who come together to advocate for their colleagues, to advocate for a better health system to advocate for the future.

Medicine has had a long history of altruism and advocacy.

I see it alive and well in the AMA and that alone makes all the sacrifices worthwhile.

I can see that this Federal Council has contributed to that history, and has set up the AMA for a strong future.

I am proud to have known you. I am proud to have served with you.

Thank you, ladies and gentlemen.  Thank you, colleagues. Thank you, friends.

Thank you.