Dr Hambleton, AMA Parliamentary Dinner Speech, 22 August 2012

22 Aug 2012






***Check Against Delivery

Ladies and gentlemen, as President of the AMA it is very pleasing for me to see such a diverse and influential group of people in this marvellous Great Hall tonight.

On the occasion of our 50th Anniversary, the Prime Minister chose to visit us.  That is fantastic.

I want to congratulate the Prime Minister and her Government – especially Attorney-General and former Health Minister Nicola Roxon – on the plain packaging legislation and last week’s High Court victory.

This is public health policy at its best.

We have Ministers and Parliamentary Secretaries.  Welcome to Tanya Plibersek, Mark Butler, Warren Snowdon, David Bradbury, and Catherine King.

We have Shadow Ministers and Shadow Parliamentary Secretaries.  Welcome to Peter Dutton, George Brandis, Eric Abetz, Concetta Fierravanti-Wells and Teresa Gambaro.

We have MPs and Senators from all Parties.

I note the presence of former Prime Minister, Kevin Rudd.  Mr Rudd is no stranger to health reform and consultation.  Welcome, Kevin.

We have key Independents.

There are Department Heads, Deputy Secretaries and senior bureaucrats.

There are heads of Medical College and leaders of associations, federations, societies that represent just about all the health professions.

We have my colleagues, the AMA Federal Council – representing the medical specialties and all the States and Territories.

These are some of the finest minds in health and medicine in the country.

I acknowledge two well-known former AMA Presidents, Dr Bill Glasson and Dr Mukesh Haikerwal.  Welcome to you both.

Bill, you might like to have a chat with Kevin after the speeches.  I can arrange an introduction.

We have political advisers and AMA staff.

Last, but not least, we have members of the Parliamentary Press Gallery – here to note our every move.

I welcome you all.  What a fitting group to help the Federal AMA celebrate its 50th Anniversary.

The AMA has a proud history – much longer than 50 years.

We operated under a different banner prior to that as a branch of the British Medical Association.

Whatever the name and whatever the era, we have a strong and proud history of advocacy and a strong and proud history of engagement with Governments of all persuasions.

We recently sent all our politicians a copy of our publication – More than Just A Union: A History of the AMA.

I recommend it to you.  It traces our humble origins right through to our part in the health policy debates of recent years.

The AMA has always been a strong voice in health.

All too often it is the AMA that is out there bellowing the messages that Governments don’t want to hear.

They are messages and opinions that we genuinely believe in.

They are the messages and opinions that our patients want heard.

They are the messages and opinions that other groups want to say, but often can’t or won’t.

That is our lot at the AMA.

We don’t always get our way.  That is political reality.

But the media provides us with an audience because our views are based on evidence from the coalface of delivering health services.

We tend to generate broad public support, and this gives us political influence.

And, while Governments don’t always act on what we say, they give us a hearing – most of the time anyway.

Good health policy is never produced with the first draft.  And thank goodness for that.

Policymakers need to hear all sides of the story as they shape good health policy.

That is a core strength of our democracy and our political processes.

Many of you in this room have served on Parliamentary Committees or presented to them.

Some of you have appeared at Senate Estimates.  I know Jane Halton has.

Strong debate and the airing of competing views is a good thing when determining how valuable health dollars are spent.

As n advocate, you have to always be on the front foot.

That is what the AMA does best.

Tonight we have seen a good example of how constructive consultation can and should work.

The Government’s announcements on e-Health are very positive outcomes.

In recent years, we have seen similar results – in full or incrementally - through good faith negotiations over hospital funding, medical training places, diabetes care, and national registration, to name a few.

There was more – much more – to come but the change in the national political landscape has put ‘big bang’ health reform on hold for now.

It will be a while before the moon and the stars are back in alignment to allow genuine significant reform.

The Government, meanwhile, must push on with the implementation of those parts of the health reform agenda that have survived.

Announcing health reforms is easy.  Implementing them is hard work.

Governments come under a lot of pressure from a whole range of competing interest groups as they bed down new or revised policies.

And we are seeing that happen now.

We were surprised to see the communiqué from the most recent meeting of the Standing Council on Health.

The communiqué stated that: “The Commonwealth agreed to vary the determination on collaborative arrangements to enable agreements between midwives and hospital and health services.”

That one sentence undermined months, even years, of good faith negotiations between the AMA and the Commonwealth.

It is a change that brings big risks to patients and quality health care.

The AMA takes this change very seriously.

At its meeting in Canberra today, the AMA Federal Council passed the following urgency motions:

1. That Federal Council, in recognising that collaborative models of care between midwives and medical practitioners are an essential element of a high quality and safe maternity services system in Australia, calls on the Commonwealth Government to immediately abandon its proposed changes to the National Health (Collaborative arrangements for midwives) Determination 2010 which would permit midwives to enter directly into collaborative arrangements with a hospital or health service.

2.  That Federal Council condemns the Government's proposed changes to the National Health (Collaborative arrangements for midwives) Determination 2010 as they:

  • are contrary to original policy intent of the Government to promote collaboration between midwives and medical practitioners;
  • fail to recognise the significant consultation involved in the development of the existing determination;
  • will fragment patient care;
  • will transfer the responsibility for patient care from medical practitioners to non-medical bureaucrats; and
  • will undermine the safety and quality of Australian maternity services.

The AMA resolves to campaign against the proposed changes.

Minister, please don’t let the States and Territories railroad good policy.

We did not expect this change.  Let’s please talk about it before a final decision is made.

We want to ensure the best possible care – collaborative care – for mothers and babies.

I want to close tonight with an impassioned plea to all the Federal politicians here tonight – and all of those who are not here tonight.

This time last year I called for urgent action from the Parliament on mandatory detention of asylum seekers, which is inherently harmful to the physical and mental health of detainees, especially for children.

There was some action.

Immigration Minister Bowen and his office and his Department gave us briefings on how they were responding to the health needs of detainees, and granted me a tour of a facility in the Northern Territory.

However, according to the most recent figures released from the Department of Immigration and Citizenship, over half of all asylum seekers who are children are still in closed detention facilities:

  • 591 are in closed detention facilities;
  • 489 are in community detention (i.e. living in the community under strict conditions while they await the assessment of their claim); and
  • 81 have been granted bridging visas (i.e. living in the community while they await the assessment of their claim, with very limited access to supports, including health care).

These figures are from June 30.

There have also been a large number of boats which have since arrived, and which have a significant proportion of minors.

So the figures are now probably much higher than this. 

Despite some well-intentioned improvements, the long term detention of desperate people seeking a better life is not good for health and wellbeing of detainees of any age.

It is a defeat for social justice and fairness.

But the contemporary political debate around asylum seekers is far removed from social justice and fairness.

So, in light of recent policy from this Parliament – namely the use of Nauru and Manus Island for offshore processing – the AMA is making another call on you all tonight.

We want to see the urgent establishment of a truly independent expert medical Panel to oversee the quality of health services available to all immigration detainees in all locations – onshore and offshore.

Detainees have a lack of access to health facilities.

Indeterminate detention has a serious mental health impact.

There are currently no specific guidelines for dealing with the health needs of children in detention.

But there is plenty of research evidence of the harm that detention causes to a child’s development.

We must do the right thing.

We want this Panel to report directly to the Parliament, the Prime Minister, and Ministers.

Part of its brief would be to monitor the health services available to the local communities outside the detention facilities on Nauru and Manus Island.

It has to be above the bureaucracy.

The current advisory group – Immigration Health Advisory Group or IHAG – reports to the Immigration Department.

It is limited.  Its members are constrained.  It is toothless.

I urge you – as a Party or as an individual politician – to bring a Bill before the Parliament to establish this Medical Panel.

The AMA will help you draft it and we offer to provide suitably qualified doctors to serve on the Panel.

It will add some humanity to an otherwise inhumane policy.

So, I close on that note.  I urge you to add some compassion to this policy.

Thank you for being with us tonight.

Enjoy the rest of the evening.  Make contacts and talk health.

22 August 2012

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