Some extracts from the Address to the National Press Club – Canberra

Sussan Ley addresses the national Press Club ABC Video online

Sussan Ley addressed the national Press Club that was full of journalists and not a single voice of analysis or dissent appeared anywhere in any form of media in the following days or since.

Here is my analysis and commentary.

I believe we need a health system where the patient is centre of everything.

I would like to start today by reading a real-life example about inefficiencies in emergency departments that a GP wrote to me about this week:

“We are becoming rather a “scans on” profession rather than a “hands on” profession. Patients clutter the Emergency Department and they have an excessive amount of investigations because nobody takes the time to take a history or to do a physical examination. Emergency Departments can also have the attitude that they are the front line diagnostic unit of the hospital and they cannot discharge a patient without leaving any stone unturned. This is just one aspect of care and one aspect of ways in which our health dollar could be spent more efficiently.”

This is a good example of quoting one individual who supposedly wrote a letter with real-life example about inefficiencies in emergency departments. This supposed, and most likely concocted, GP doesn’t even work in an Emergency Department but is concerned about ‘clutter’ because in some particular Emergency Department they ‘cannot discharge a patient without leaving any stone unturned’ – supposedly. The most surprising thing about the opening to her speech is it implies that she reads letters from individuals.

Just about every politician will say that they receive 500 emails/letters a day and cannot read them all or even any of them.

It’s also amazing that she said she wanted a ‘health system where the patient is centre of everything’ and continued immediately by reading a letter complaining about how the ‘Patients clutter the Emergency Department’. The reality is sick people are just cluttering up everything according to Sussan Ley.

At a simple level, consider the example of hip replacements. Thirty years ago they were performed to keep patients out of residential aged care.

Thirty years ago she was 23 years old and I’m sure not that interested in what hip surgery was for. Her degrees are in taxation and accountancy.

‘At a simple level’, you can see here the logic of putting a tax accountant in charge of health.

One person who's no stranger to surgery is former 'Sale of The Century' quizmaster Tony Barber. Tony has undergone three hip replacements – the first back in 1989, when he was around 50 years old.

It was not to keep him out of residential aged care but to keep him working.

The 75-year-old is still fit and active.

He is showing that three hip replacements, a knee replacement and a toe reconstruction are no barriers to fitness and work.

There were professional young squash players having hip replacements 30 years ago and that wasn’t to keep them out of aged care. They continued to have long term coaching careers in Australia and overseas as a result of the medical interventions.

Now they’re done to keep you on the tennis court.

And as for that observation about keeping you on the tennis court, I pass a set of four tennis courts daily that are open to the public and I have never seen a player on them except occasionally kids on school days for sport. I have to conclude that there are not many hip replacements being done for Gold Coast residences.

I did meet a man walking with a stick one day this year and he said he had just had a hip replacement so he could continue his physical work as a builder. He had been unable to climb ladders and stand on roofs etc.

He didn’t actually say it but he would have to finish his commitment to the Davis Cup team first I presume.

Some 13,000 deaths annually in Australia are attributed to physical inactivity, while one-in-four children are now considered overweight or obese. Too many Australians, young and old, are living sedentary lives and, frankly, it’s killing us.

So are the tennis and the hip replacements good or bad?

Her take on hip replacement and tennis is truly odd seeing that she is the Health Minister and the Sports Minister.

Hip replacement was performed when people were disabled by pain. There was never a connection with aged care. There was never criterion that it would only be performed to keep someone out of residential aged care.  A painful hip doesn’t just bother someone when they are about to go into aged care, or on the tennis court.  It means they have difficulty getting around at work and are unable to do everyday jobs. The tennis court remark is meant to be half-smart but the funny thing is all the tennis courts are empty. Maybe private ones someplace has all the hip-replaced tennis-fanatics lined up to play.

We currently spend about $100 million a year through our Play.Sport.Australia program on various initiatives building stronger grassroots sports participation. Essentially, we need more people up off the couch, putting down the remote and getting active. Not just early in life, but the millions of adults who think their sporting days are behind them.

Still not sure if the tennis playing hipster socio-economic class is a good or a bad thing.

It is obvious she has no health care background but it is hard to imagine anyone could be so ignorant.  Worse, it is possible that someone wrote part or all of this speech for her.

Perhaps Joe or Tony?  Those sentiments were trotted out before they went.

Not that anything has changed.

As such, our health system now seems to be suffering from an identity crisis – unsure whether its focus is on making a person well or improving their wellbeing.

What does that even mean and since when did it become an ‘identity crises’ to focus on the ‘wellbeing’ (A contented state of being happy and healthy.) of a patient?

And like one in two Australians, our health system is also struggling under the added burden of chronic disease. No longer are we dealing with heart and stroke issues as just episodic incidents. Instead they are now on-going clinical management issues; or in other words ‘chronic conditions’.

What does ‘And like one in two Australians, our health system is also struggling under the added burden of chronic disease’ mean.

Half of all Australians have risk factors for the development of Chronic Disease. Which is not the same thing: These are: lifestyle and biomedical risk factors. Foremost in Australia are daily smoking, lack of physical exercise, poor nutrition, overweight and obesity, hypertension and hypercholesterolaemia.

Thirty years ago when we talked about Diabetes, it was all about Insulin Dependent Diabetes an auto-immune disease. Very rarely did we talk about Type II Diabetes, yet it’s now one of our most common and costly chronic lifestyle diseases.

She feels she should only be talking about insulin dependent diabetes not ‘type II diabetes’ as they were 30 years ago etc.

How does she know what ‘we’ talked about 30 years ago? Does she mean what she talked about? And why would she be talking about diabetes anyway 30 years ago?

There has been an outbreak of blood testing rather than an outbreak of Type II Diabetes.

Also many studies show that Type II Diabetes is also an autoimmune disease.

But for the sake of the budget people should just have an episode or two and die and be done with it.  They have no right to front up for ‘chronic’ care apparently.

I believe we need a health system where the patient is centre of everything.

Australia’s health system was built for the patient and it’s important they remain at the centre of everything.

The patient was the centre of nothing, well except veiled criticism, in this speech. 

Thirty years ago mental illness was the unspoken health issue or the hidden institutionalised family member. Nowadays the ABC devotes a week of its airtime to bringing mental health out in the open.

Everything happened thirty years ago apparently. That’s a time that nobody in her audience remembers. It seems that thirty years ago was year zero according to Sussan Ley. From then on everything went haywire. But everything's gone straight to Hell since Sinatra played Juarez. Lyrics

Did the ABC do a good thing or a bad thing there? She made it sound like a bad thing. Perhaps a funding cut is in order if they can waste a week on mental health. They have too much time of their hands.

And medical researchers have done such wonderful work that in many cases cancer is no longer a death sentence; but a chronic disease to manage, which is a positive, but presents its own set of unique challenges.

The unique challenges are that the government doesn’t want to pay for them.

In a perfect world money wouldn’t be an issue. But it is.

You can say that again if you live long enough.

So, what if we, as government, got out of the way and gave consumers full access to their own personalised health data and full control over how they choose to use it?

I didn’t even know they were in the way.

What if you, as a consumer, were able to take your personal Medicare and Pharmaceutical Benefit Scheme data to a health care service; to an app developer; to a dietician; to a retailer and say how can you deliver the best health services for my individual needs?

What if you did take your personal information to an app developer or your local retailer, what then? The placebo effect and Cured perhaps?

On what planet is an app developer going to help anybody’s health? There isn’t even an app where you can read a smart phone in the Australian sun, or any other sun, an d how hard would that be? We had at least a notion of a low-power paper-like display since the 1970s but it’s still not a reality.

I think perhaps she needs an appendectomy.

To put it in perspective, total expenditure on health in Australia for the 2014 financial year was $154.6 billion. Governments collectively provide around 70 per cent of this. And it adds up, with 1 in every 4 dollars Governments raised through taxes now going towards supporting our health nation’s spend.

The federal (Out) budget numbers do not correspond with the above figures and the Graph doesn’t bear that excessive spending either. It shows health at 16 percent of the budget. It’s a long way down the list of countries spending on health care.

Treasury’s March 2015 Intergenerational Report in particular highlights some of the challenges we face: – a population that is getting older, Australians are now living 11 years longer than they were 50 years ago, a workforce as a proportion of the total population that is shrinking and technology that allows us to do so much more but also comes with a hefty price tag.

The Intergenerational Report and life expectancy

The Intergenerational Report, which was initially meant to look into the future as much as is possible to help with economic forecasts, has been turned into a partisan report and consequently has no credibility whatsoever.

The scaremongering that the baby boomers are going to live to one-hundred, one-hundred-and-twenty and even one-hundred-and-fifty has, without a voice being raised in opposition to the opprobrium of the elderly, now become a new ‘fact’.

No, unfortunately, our life expectancy has not increased, except statistically – our average life-span in a graph does make it look like eventually we will all live forever...

However, most of the gains in ‘average’ life span are due to the reduction in infant mortality and those people live normal lives and pay their taxes. They don’t just arrive at pension age to be a burden on society in general and a particular burden on the treasurer and the health minister.

Using these figures is similar to taking a set of twins and saying that if one twin died at birth and the other lived to be 100 then statistically their average age at death is 50. That’s not telling the story of either of them. That’s what statistics are good at; not telling the story.

That’s why politicians love them. That’s what politicians are good at too; not telling the story.

John Quiggin, author of Zombie Economics had this to say on the subject: ‘It’s worth pointing out that, with pension age eligibility rising from 65/60 when the age pension was introduced around 1910 to 70/70 by 2035, men will have lost half of the extra retirement years gained from higher life expectancy and women the whole gain. The big problem we face is underemployment of prime-age workers, not the fact that we aren’t dying early enough.’

A concept Hockey and now Morrison seem totally unable to grasp, most likely because they don’t want to grasp it, (also stupidity should never be dismisses. “If it looks like a duck, quacks like a duck, it's a duck!”) is that life expectancy will show a significantly increase if more young people survive child birth and young adulthood, rather than just actually extending older people's lives.

Take as an example a sample in around 1900. In the sample of 10 kids – 2 die at birth 3 die before the age of 10 years and 5 live to be nearly 80 years old. Life expectancy is somewhere around 42 years. Now today take a sample of 10 kids. All survive child birth and live into their 70’s. Life expectancy is around 75. That’s an Increase of 33 years in life expectancy, even though many people were living just as long or even longer in the past. Put that in a graph and you have Hockey living to 150 years.

(In Russia the life expectancy for a male is still 60 years. Luckily the state pension kicks in at the same age. That’s the aim of the Australian Treasurer too. Kick in the pension at ‘life expectancy’ – around 150 years according to economic guru Joe Hockey.

Another statistic trotted out is that Australians are living longer because ‘in 1901, there were only 50 people in the country aged 100 or over. At last count, in 2014, there were more than 4,000.’

This is a completely meaningless figure considering that a person would have to have been in Australia from around 1800 to be an Australian living to 100 in 1901. In 1800 there were only around 5,000 Europeans in Australia. Even in 1841 there were only 178,000 people and many of those would be too young to be 100 in 1901. Very few elderly people were making the perilous journey to the antipodes. In reality the pool of people living in Australia with the opportunity to reach 100 by 1901 was very small. The biggest surprise, considering the conditions of the early settlers, is that any of them made it to 70 never mind 100.

(Data for the 19th century did not include the number of Aborigines in Australia of any age. At that time, as far as Britain was concerned, the Aborigines still did not exist as human beings, the term ‘terra nullius’ — empty land — had conveniently got rid of them.)

So, the biggest gains in life expectancy came from things like child vaccinations, improved care around births etc. Even workplace health and safety has made a big impact. To this can be added that after 1945 there have not been large percentages of the younger generations of males who have either died, or experienced life-shortening injuries or illnesses, as a result of wars.

Both Hockey and Morrison and now Health Minister Lea seem disappointed with that.

It is true that there have been very modest increased in what is known as ‘maximum life expectancy’ which only requires one person in the world to live longer than everyone else. Historical detail is too sketchy for this to be reliable and it’s not worth mentioning anyhow.

Animal studies suggest that lengthening of human lifespan could be achieved through reducing food consumption. Although calorie restriction has not been proven to extend the maximum human life span in countries where food is scarce – as in famine or near famine. Hockey didn’t seem to show any interest in this research for his welling and longevity.

So initiatives on preventing young people's deaths have a greater statistical impact than any observation you can make on the health of older people. That's why obesity has a lesser relative impact on life expectancy than advances in medicine for children.

So why not target that area (medicine for children) in the budget reforms. That’s where the increase in longevity is coming from.

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