Health is a big issue in just about every Federal election... but it's shaping up as more important than ever in the poll that may now be only weeks away.

Labor has flagged a plan to take over State hospitals if necessary to improve the delivery of health services to patients... At the very least it will inject an extra $2 billion into public hospitals through agreements that will require the States to lift their game.

Flush with a massive Budget surplus, John Howard has countered by promising his government will spend even more on health .

But he's scorned the idea of a full Federal takeover of State hospitals ... even though it was something his own Health Minister Tony Abbott put on the agenda just a few years ago.

Mr Abbott talks to SUNDAY's political editor, Laurie Oakes.

Transcript

LAURIE OAKES: Mr Abbott, welcome to SUNDAY.

TONY ABBOTT: Morning, Laurie.

LAURIE OAKES: Now in this talk of postponing or cancelling the Melbourne Cup, things are serious. Is there any further action that can be taken to deal with this outbreak of horse flu?

TONY ABBOTT: My understanding, Laurie, is that the Federal Government, the state governments and the industry are working very cooperatively together and this 72-hour horse standstill order is certainly unprecedented and it is a sign of just how seriously it is being taken.

LAURIE OAKES: What about APEC, what are the implications there? I mean would our mounted police be unmounted?

TONY ABBOTT: Look, that is something to be decided nearer the time but obviously security is very important at APEC and I accept that mounted police have an important role to play.

LAURIE OAKES: I mean, can the security of these leaders be guaranteed without mounted police?

TONY ABBOTT: I think … I'm sure it can be, but I suspect it will be slightly more difficult to ensure crowd control. Maybe this will be an incentive for any protestors to behave rather better than might have otherwise been the case.

LAURIE OAKES: Now is this purely a problem for horses or are there wider health implications?

TONY ABBOTT: My understanding is this is purely a problem for horses, I don't believe that there is any significant risk of this thing doing a jump from species to species. That is more of a problem with influenza in animals like birds and pigs.

LAURIE OAKES: Do we know yet how the virus got into the country?

TONY ABBOTT: No, that's … it is too early to say but believe me this is all being investigated as quickly as possible.

LAURIE OAKES: Alright, well the big story in your area is the Labor Party's hospital plan. It is proving pretty popular, isn't it?

TONY ABBOTT: Again, it is too early to say, Laurie. If you go back to last election Medicare Gold was very popular initially, but it turned out to be an absolute turkey in the longer run. The issue, Laurie, is not who runs hospitals, it is how they are run and the problem with public hospitals is that they are very complex, difficult, important institutions and the last thing you want to see is upheaval in a system which is so important for so many people.

LAURIE OAKES: I will deal with that in a minute. But the co-founder of Medicare, Professor John Deval, says the Rudd plan offers the best plan chance for reform of the health system in years. Now that is a pretty endorsement.

TONY ABBOTT: Well what exactly is the Rudd plan? That's the mute point. I mean all he has really promised is to have a talk fest, a health reform commission and that is actually a recycled Latham policy, then he said we will have two years of cooperative federalism, then we'll have the ultimate uncooperative federalism with a holus bolus federal takeover. So there is something in there for everyone but I suspect in the end nothing for anyone for because he is essentially going to make it up as he goes along.

LAURIE OAKES: You are pretty critical but apart from a tin pot little plan to buy votes by propping up one little hospital in a marginal seat — what is the Coalitions' policy?

TONY ABBOTT: Well this is quite a significant plan Laurie because we …

LAURIE OAKES: The Rudd plan or your plan for one little hospital?

TONY ABBOTT: Well our plan is to see just how well this can be done, you see as I said it is not who runs the hospitals but how they are run and I think that a community controlled public hospital is going to work much better than a hospital which is run by bureaucrats, whether they are federal bureaucrats or state bureaucrats.

LAURIE OAKES: Can you name one expert in running hospitals who thinks it is a good ideal to have two intensive care units 50 kilometres apart?

TONY ABBOTT: Well the important thing is to deliver good services to the population and certainly in the central west of New South Wales you have got two hospitals, Bathurst and Orange, 60 kilometres apart, they've both got intensive care, they've both got coronary care, and if it is good enough for New South Wales why can't it be good enough for Tasmania?

LAURIE OAKES: But the experts devised the plan that would give northern Tasmania one good hospital with everything, that is the kind of planning that the Howard Government normally advocate?

TONY ABBOTT: But their plan effectively deprived one community of a comprehensive public hospital and a plan which suits the experts isn't necessarily a good plan, Laurie, if it effectively rips off the local community, and that is what happened.

LAURIE OAKES: So are you guaranteeing that the Mersey Hospital will have a high-class intensive care unit under the new plan?

TONY ABBOTT: There are different categories of intensive unit ranging from a high dependency unit to a category one intensive care unit.

LAURIE OAKES: What will the Mersey Hospital have?

TONY ABBOTT: Well, the Mersey Hospital will have the same level of services, at least the same level of services under this new model of ownership than as it had under the previous state government control.

LAURIE OAKES: But there is no intensive care unit there now is there?

TONY ABBOTT: Well there was until May, as I understand it, and what there was until May will be what they have once the Federal Government's plan is put in place.

LAURIE OAKES: But that will not be of the same standard as the hospital 50 kilometres away. Is that what you are saying?

TONY ABBOTT: Well, my understanding is that it was supposed to be a level three intensive care unit, the lowest level at the Mersey and an intermediate level intensive care unit at Burnie. My understanding is that under the state government's plan there is gong to be a lower grade of intensive care unit at Burnie and no intensive care unit at all at the Mersey. Now what we've said is that the Mersey will have in the future at least the same level of services as it had in the past. And that is the whole point, Laurie, it's not who owns the public hospitals, it is not who runs them, it's the level of services and the Rudd plan for public hospitals, apart from the potential for chaos, is not going to deliver a single extra bed, a single extra doctor, a single extra nurse or a single extra service.

LAURIE OAKES: Well he says it will produce extra beds but …

TONY ABBOTT: But he can't explain now. He has no detail.

LAURIE OAKES: He can. He says a large part of the problem in our hospitals is that there are patients occupying hospital beds who should be in aged care facilities. They're not because the Federal Government doesn't fund them, does fund enough. He's put it right back on you and your policies.

TONY ABBOTT: And he can't actually explain whether the $2 billion that he has allocated last week is over and above the extra money that he's already promised for aged care beds. But the point is this, Laurie, the number of aged care places has increased from 145,000 in 1996 to 210,000 today. There has been a massive expansion in aged care places. There's also been the step-down program to build extra facilities for people who are not sick enough to stay in hospitals but are too sick to go home and the transition care program to fund extra places for people in that category.

LAURIE OAKES: But isn't it true there is an estimated 2,300 public hospital beds occupied by elderly patient who have been assessed suitable for aged care?

TONY ABBOTT: Yes, and that was the figure that was bandied around five years ago before these federal measures were put in place. The problem is not lack of federal beds ...

LAURIE OAKES: Is that figure accurate now?

TONY ABBOTT: Well, I can't vouch for it because it is Kevin Rudd's figure, not mine, but the problem is not lack of federal programs. The problem is poor management of the public hospitals and Federal Labor would be no better at running public hospitals than State Labor because Federal Labor is going to have the same kind of ACTU-driven big government agenda as State Labor has.

LAURIE OAKES: Well Kevin Rudd has promised another 2000 additional aged care beds to free up 2000 acute care beds in hospitals. That seems sensible, doesn't it?

TONY ABBOTT: But, but this is something that has already been done by the Federal Government.

LAURIE OAKES: In that case why are there 2300 elderly patients in hospital that shouldn't be there?

TONY ABBOTT: Well I think what the States are doing is reclassifying people and I think it doesn't matter how many aged care places the Federal Government provides, there is still going to be a transitional period when people are assessed as needing aged care, but in public hospital. A certain amount of transitioning is inevitable and I think that you can make all the promises in the world here, but you are never going to entirely eliminate the problem.

LAURIE OAKES: Isn't a national policy for hospitals throughout the country better than a few one-off deals in shaky seats?

TONY ABBOTT: Well in a sense, yes, but what is Rudd's national policy? He can't give us any detail and as I said, Laurie, in the end, why do you think Federal Labor is going to be better at running public hospitals than State Labor which has created this mess and the reason why it has created the mess is because there are ... there's too much bureaucracy, there's too much politics, there has been the abolition of local hospital boards, the clinicians, the nurses, the doctors don't get listened to any more and that is the Labor mindset and that's not going to go. That's going to get worse.

LAURIE OAKES: I'm sorry, I had a forgotten all those perfect hospitals under Liberal State governments.

TONY ABBOTT: Well that's a fair point and there is no perfect way to run public hospitals because public hospitals, Laurie, are difficult things to manage, but the last thing you need is someone waltzing in thinking he knows everything, but really making it up on the run and suddenly turning the administration of 750 public hospitals on their heads.

LAURIE OAKES: How do you make it up on the run when he says that through the COAG process, in other words in consultation with the states, a national plan will be worked out.

TONY ABBOTT: But he can't tell us the national plan.

LAURIE OAKES: Because it is to be worked out in the first 100 days of the Labor Government.

TONY ABBOTT: It is a 'trust me' policy.

LAURIE OAKES: But he has set out the goals to be achieved by that and how he would do that, carrot and stick, financial incentives to get state cooperation and a threat of a takeover if they don't. You don't have any process at all, do you?

TONY ABBOTT: But Laurie, you say he set the goals. He hasn't actually set the goals. He has said lower waiting times. How much lower? He said more care in the community? What care in the community? And how is he going to deliver it? I mean this is completely devoid of any detail.

LAURIE OAKES: And 2300 more beds. I mean what's your policy. I've asked you three times now. We haven't got there yet.

TONY ABBOTT: Our policy is to continue to run well federally run programs and there aren't anything like the same complaints about federally run programs as there are about state run programs, and to try to effectively manage the interface between federally run programs out of the hospitals and state run programs in the hospitals. Now we've already significantly expanded co-located GP clinics in consultation and cooperation with the States. In consultation and cooperation with the States, we've got this step-down care program in place, we've got the transition care program in place and we've massively expanded the aged care sector and this sudden problem is basically something that has been cooked up by the States in conjunction with Kevin Rudd to manage something that was being managed quite well.

LAURIE OAKES: So your hospital systems were being managed quite well. You just said they were a disaster.

TONY ABBOTT: No, I'm just saying that the transitions into hospitals and out of hospitals are being managed much better than they were.

LAURIE OAKES: But let's look at the overall problem, which you saying is that we have dreadful hospital systems throughout the States. Your government has got no plan to fix that or to change it?

TONY ABBOTT: Well what we want to do Laurie, before we rush in is to say can we be confident that a different model of public hospital governance will work and that's why at the Mersey we are proposing a Commonwealth-funded community-controlled public hospital. Now if that works well, fine, it may well be expanded, quite significantly, the States might decide that they want to see community-controlled public hospitals again, but public hospitals are too important to play silly games with them, particularly silly games that are designed, that are cooked up on the run a few weeks before an election.

LAURIE OAKES: You see it's only a year or so ago you were confident you knew what model we should have. You were saying why don't the States vacate the field and let the Federal Government run the system altogether. You said what could not plausibly be argued is the existence of some fundamentally imperative that only state governments may ever run public hospitals. You said the current arrangements with the Federal Government helps to fund the public hospital system, that has no role in running the system is clearly unsatisfactory. Now you say you are talking nonsense.

TONY ABBOTT: No, no, I'm not saying that. I'm just saying that the reaction to those comments …

LAURIE OAKES: From the Prime Minister ...

TONY ABBOTT: … including from a lot of Labor premiers and Labor health ministers has caused me to think that this kind of thing needs to be done very carefully and cautiously because people's lives are potentially at stake. I mean if hospitals don't work, it's not like the trains not working, people might be late for school or work, if hospitals don't work, people potentially die.

LAURIE OAKES: So when you made those statements you hadn't thought it through?

TONY ABBOTT: No, I was putting things on the table for discussion. The result of the discussion, Laurie, and I'm quite capable of learning from discussion, the result of the discussion is that this is a very complex field and if you're going to move forward you should do it cautiously and incrementally and that's what the Howard Government is doing. The Mersey is the first step. It's not necessarily the last step.

LAURIE OAKES: So that could lead to a Federal takeover of the state hospital systems. That hasn't been abandoned?

TONY ABBOTT: Well what we want to do is see how this goes, see how this goes. But we're certainly not going to turn the system upside down in pursuit of power or in pursuit of a theory.

LAURIE OAKES: So how long will it take to see how this goes before you develop a national policy?

TONY ABBOTT: Well, we're still having trouble with the State Government. I mean getting details out of the State Government as to how this hospital actually works is like pulling teeth without anaesthetic and that's the kind of difficulty that Kevin Rudd would face if he was actually in government as opposed to being an Opposition Leader who in the eyes of some can do no wrong.

LAURIE OAKES: Mr Abbott, we're out of time. We thank you.

TONY ABBOTT: Thanks, Laurie.

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