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November 18, 2025 11 mins

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Speaker 1 (00:00):
We told you about this on the show yesterday. The
States and territories are on a collision course with the
Commonwealth over public hospital funding, with health ministers expressing white
hot anger, according to the ABC Nationally over this letter
from the Prime Minister demanding that they rein in spending
if they want a funding deal honored now. In that report,

(00:22):
Anthony Albanezi made the request in September, writing to state
and territory leaders saying that they must slash growth if
they want a public hospital funding commitment. Well, if they
want it implemented now, it's pretty wild. In this letter,
it says for states and territories to realize a Commonwealth
contribution of forty two point five percent of public hospital
costs by twenty thirty to thirty one under the capped

(00:44):
glide path model, it will be necessary for your government
to work to reduce growth in hospital activity and costs
to more sustainable levels. Now, joining me on well in
the studio is a man who has been advocating for
an increase in funding when it comes to hospitals in
the Northern Territory. And I would say somebody who's got
a better idea than just about anybody. How busy our

(01:06):
hospitals are. It is doctor John's Orbis from the AMA
here in the Northern Territory. Good morning to you, Doctor's Orbis.

Speaker 2 (01:13):
Morning Katie, thanks for having us.

Speaker 1 (01:14):
Yeah, thank you so much for joining me this morning
on the show. Now John, this report it angered our
listeners yesterday. They were questioning how on earth the Prime
Minister expects a hospital to decrease demand. I mean, how
did you feel when you learned that the Prime Minister
had written to state and territory leaders essentially asking them

(01:35):
to do that.

Speaker 2 (01:36):
Yeah, the letter just induces white hot rage. And I
imagine that your text line has been blowing up with
listeners who also, I think, probably have a pretty good
handle on how funding and the lack of funding is
affecting us. Especially up here in the territory. We've got
ministers arguing over the color of the curtains or the
building's on fire and we're all inside it. It's not
a great feeling.

Speaker 1 (01:54):
No, it would not be good at all. Like I
think to myself, anyone that's been to our hospitals, whether
it's Cella Springs Hospital, whether it's Royal Darwin, you know,
whether you're at Catherine Hospital, whether you're at Palmerston, doesn't
matter where you are. We know the staff are working
so incredibly hard to deliver health services to Territorians, but

(02:14):
you know it's under real stress. Yeah.

Speaker 2 (02:17):
I mean these kinds of discussions show the complete disconnect
between the people making the decisions about our funding and
the actual state of reality inside our hospitals. You can't
cut your way to excellence in a system that is
already running on empty. And that's the big difference up here.
I'm not here to say that every decision made in
the hospital is perfect and efficient. We know where the
efficiencies are and we repeat multiple times. Just let doctors

(02:39):
and nurses be doctors and nurses and you'll find your savings.
But for that kind of letter and this kind of
idea that you can just trim the fat, well, the
fat was trimmed in the Australian healthcare system years ago.

Speaker 1 (02:48):
Yeah. I was thinking to myself, we've literally just come
out of a cold yellow like what other you know,
these no more fat to trim And.

Speaker 2 (02:54):
It's really it's a really dangerous position to take because
if you just put a cap on funding and scriminatet
cap on funding, you know you start to develop safety risks.
If you've got one doctor doing the job of two
or three, that's not efficiency or hih vague care, that's
just a safety risk. You delay care as well. Every
dollar we don't spend on a hip replacement now is
going to cost ten or more in the future, and

(03:15):
it just makes eventual care more expensive. It's got to
happen at some point, and it doesn't allow for innovation.
So there's all this talk of doing things smarter than harder,
and I agree with that, but that needs capital. You
can't just squeeze budgets because it'll make people cling to
the old, safer, well known way of doing things. So
who's going to take that risk? Which hospital manager is
going to take that risk?

Speaker 1 (03:35):
No, that's exactly right. But also when you're already sort
of operating at almost crisis level, how are you going
to take that risk? Ever, you're already you know, you're
already operating at your one hundred percent capacity.

Speaker 2 (03:45):
And the real rich part of this letter is that
the majority of where we're being let down up here
is a federal responsibility. So the four hundred million dollars
that we've banned around before, we're talking about the way
we fund our hospitals, the way we fund aged care,
the way we find retrieval medicine in the top end,
and primary care, especially remote and rural care. The hospitals
aren't the problem. This is just cost shifting. It's rich

(04:07):
of the Feds to blame the hospitals. Well, primary care
has been crumbling under their watch. The solution is to
fund GPS, not defund hospitals.

Speaker 1 (04:15):
Now tell me, John, I know that the Queensland Health
Minister Tim Nichols, when he received this letter. He seed
upon reading the letter, my immediate response was that it
was almost beyond belief that the Prime Minister would write
to us saying that we have to work to reduce
growth in hospital activity. He said, does he want us
to go out there and close the front door to

(04:35):
our emergency department so or stop taking ambulance delivering sick
patients to our emergency wards? He said, you know, like
he's obviously frustrated. I mean, we get to hear from
the Northern Territory Health minister, but I would imagine that
he feels the same. I mean, is it even possible
to reduce growth when we've got an aging population? We've

(04:56):
got quite a sick population, and we've got issues that
you probably don't even see in any other state or
territory or maybe some you know, maybe some parts of
WA or northern queensign. But we've got illnesses that, in
a lot of cases, you just don't see anywhere else.

Speaker 2 (05:11):
Yeah. Look, this letter is just this one size fits all,
you know, blaming the firefighter for using too much water.
I mean, our fire is bigger and it's different. I
think renal disease, kidney disease is a great example of
this up here. Dialysis isn't discretionary, right, Like, you can't
just efficiency your way out of renal failure on paper.
If you look at us on a spreadsheeting, Camebra, we
have double the number of admissions per person in the

(05:32):
country roughly, And that just looks like waste. It looks
like overservicing. It looks like we're admitting too many people
to hospital. But that's a misdiagnosis of the problem. Anybody
on the ground in the territory will know that what
we see is kidney disease. Almost half of those admissions
are dialysis, right, they're treated as a hospital admission on paper.
Now that happens three times a week, fifty two weeks
a year. These aren't unnecessary, right, It's chronic disease driving

(05:56):
the cost of healthcare here and the rest of the
country might not see that when you take dialoge so
out of the numbers, when you take the outlier out,
we're one of the most efficient providers in the country.
There's a standardized unit called an en wow, and it
won't bore your listeners, but essentially it's one kilo of healthcare.
And if you standardize that and you look at how
much we spend, we're actually incredibly efficient. You just can't

(06:16):
see that on the spreadsheet.

Speaker 1 (06:18):
Yeah, I mean, look, I know that. Today the Graton
Institutes released a report on hospital spending, claiming these smarter
ways to spend money in hospitals and for example, state
and territory governments set unrealistically low budgets at the start
of the year, then they bail out hospitals when they
run a deficit at the end of the year. What's
your take on that report? Is this the case in

(06:39):
your experience?

Speaker 2 (06:40):
Yeah, Look, the headline sounds bad. There's some truth here.
The way we fund hospitals on budgets that we know
are going to fail.

Speaker 1 (06:46):
Right.

Speaker 2 (06:47):
You recall at the time Minister lawl are saying we
were badly behaved for overspending on health. Well, she set
the number, so you said an unachievable number, You're going
to get a unachievable result. Welcome a conversation about value, okay.
And we can be inefficient, but often that inefficiency is
caused by underfunding. Right. So a great example again is

(07:08):
elective surgery. We don't do as much of it up
here as we could or we should, but anybody who
lives here knows we've got problems with our private system
and the private hospital which shoulders most of this elective
surgery work in the rest of the country. The Graton report,
you know, they're three headline solutions, and again they're just
looking at Australia. Let's talk about the NT. Their three
headline solutions are more age care beds.

Speaker 1 (07:29):
Well, thanks, that's no surprise.

Speaker 2 (07:33):
We have the lowest number of age care beds per
capita in the country, more than half less than anybody else. Right,
so when they talk about age care, I'd gladly welcome
a federal injection of money to fix that. That is
a federal responsibility, and the other two headlines were centralized
the costs of delivering this care, so sharing costs across
services and centralizing high level care. I mean there is
no more hospital more centralized in this country than Royal

(07:55):
duh On Hospital.

Speaker 1 (07:56):
We have to be right, exactly.

Speaker 2 (07:58):
And you know when we talk about centralizing care, it's
interesting that the report doesn't cost doesn't touch on the
cost of travel. It's obviously written by someone who can
go one suburb away to receive their care. Now, you know,
they should come and see our hospitals. Yeah, maybe they
should start their journey and what I maybe they should
start it in Ramo, you know, or go and make
their way across to the final destination is Royal Darwin

(08:20):
and just see how difficult and how different the problem is.
And then when they see how much they spend, well,
maybe people might be coming here to look at the solutions.

Speaker 1 (08:27):
Yeah, I mean, doctors orbish. You and I speak often, right,
and we have been over the last few weeks because
there's been such a spotlight on health and we've been
speaking about, you know, some of the difficult situations. So
then you know, when I see that there's this letter
coming from the Prime Minister. I think to myself, well,
maybe elbow needs to go and stand in the emergency
department for twenty four hours at Royal Dahen Hospital and

(08:49):
see how it looks. Yeah.

Speaker 2 (08:50):
I welcome every decision maker from the Prime Minister right
down to everybody in the territory. And our citizens do
it every day every day they're in the emergency department,
see feeling it. They see what our doctors and nurses
do and they know we're working as hard as we can.
I welcome absolutely any decision maker to come spend some
time with us. And so it looks like on the ground.

Speaker 1 (09:10):
And I spoke about it yesterday on air, just sort
of you know, amusing and saying, oh, you know, but
we'd probably you know, make sure things weren't looking as
busy at the hospital. And then I thought, do you
know what, No, our doctors and nurses wouldn't be able
to do that. You guys be going n You can
need to see this in all its glory, what we
deal with every single day, and it's bloody busy, there
is no doubt about it. Now. I just want to

(09:31):
ask as well, I mean, you've been pushing for increased funding,
saying that we're four hundred million dollars down. Do you
feel like we're ever going to get the increase that
we really need from the federal government.

Speaker 2 (09:42):
We could, right, the money can be there. We spend
billions and billions and billions of dollars on stuff all
the time at a federal level, and when you look
at what it would take to bring us up, it's
a drop in the ocean compared to other jurisdictions. Now,
we're not asking for something that we think is more
than we deserve. I will say we've got a higher
burden of disease in almost any category of disease across

(10:05):
the country. When you are just for sickness, when you
are just for the amount of work that needs to
be done. All we're asking for is what's fair. We
have slipped behind each year after year, successive government after government,
federal territory. You know, we're behind the starting line, well
behind it. All we're asking for is to come back
to the starting line. So if we can't do that,

(10:26):
and if we can't prioritize health, then what can we
do without health? You have nothing?

Speaker 1 (10:30):
I mean, I heard the member for Solomon on the
ABC this morning. You know, just very briefly saying that,
you know, the federal governments increase the Northern Territory funding
when it comes to health.

Speaker 2 (10:42):
Is that your take on this, Look, it's technically true,
but it still doesn't bring us to the starting line. So, yes,
there was a one off uplift that that's brought us
closer to where we need to be, but it's still
below the average. So if you take the average that
the common warthships in for all other jurisdictions, we're about
sixty seven percent below that. That's hundreds of millions of dollars.
It's not pocket change. And when we talk about waste,

(11:05):
you know there is waste in healthcare. There are things
we can do better. And the position from our doctors
is that a lot of what we're seeing as waste
is not clinical. Treating a sick patient in a bed
isn't a waste. The waste is the administrative burden that
it takes to deliver that care and navigating a very
fragmented system. I think the n DIES is a perfect
example of how fragmented things have become. The gains are

(11:27):
not going to be found at the bedside, it's just
not there. And you know, there's always quality projects that
we're doing at the bedside to make care better. There's
always new technologies we're embracing, right, but we've been doing
that for forever and that's not going to find you
four hundred million dollars. That's going to find you slight gains.

Speaker 1 (11:42):
Well. Doctor John Sawbers, the head of the AMA here
in the Northern Territory, always appreciate your time. Thanks so
much for taking the time to come into the studio
and see yesterday.

Speaker 2 (11:51):
Thanks for having us, Katie, thank you, Thanks so much.
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