The 'Dispatched' Week in Review - 1 May

Tokenistic characterisations of patient engagement are no substitute for listening and empowering. The risk of government funding for organisations and how it can impact what they do, primarily because the government is just another vested interest. 

Transcript

Paul 0:08

Hello and welcome to the Dispatched Podcast, week in review, focused on healthcare. It's 1 May, it's May Day. My name is Paul Cross. I'm delighted to be joined by my co-host, Felicity McNeil, PSM, Chair of Better Access Australia, amongst other things. How are you, Felicity?

Felicity 0:25

Uh look, having a good week. I'm I'm really grateful that as a patient representative, you've filled our studio with hearts to just make me feel welcomed and at the centre of everything you do.

Paul 0:39

Well, yeah. Well, you've got to do it, right?

Felicity 0:42

I know. If there's no heart emoji, how do I know it's real?

Paul 0:45

Yeah. Uh you know I saw that and uh I just burst out laughing.

Felicity 0:54

I think the term is lost your nanny.

Paul 0:56

And then my inner rage built. Lost your nanny. Yes, like I was like to spent five minutes on LinkedIn. And my inner rage generally bubbles over.

Felicity 1:06

Yes.

Paul 1:07

But uh this was an this is an interesting one. This is an interesting one. It's an appalling document. It's appalling because everything in that document the health department would would would claim to be doing. In all seriousness, they would claim to to be doing all of those things today. And they would be able to get away with that argument because the three-page framework is just full of vague banalities. There's actually nothing specific in there. And I I find that really offensive because its intent its intent is to be able to go to a Senate hearing or speak to someone and say, well, we we we've got a framework that we consult it on. Oh, you mean like a flow chart for Yeah, yes, like a postmarket review flow chart which you put together in the ante-room outside that.

Felicity 2:04

No, I did not it was in full consultation. Don't you dare, I did it in full consultation with the industry. There were multiple meetings.

Paul 2:10

I have to say, well, I will, in all fairness to the Health Department, things have made it calling out David Heard to support me. Things have moved on since then because you didn't have the benefit of graphic design and emojis. So your post-market review flow chart was done in Word with boxes and arrows.

Felicity 2:28

Couldn't possibly come.

Paul 2:30

So the only design question was the font and the nature of the arrowhead. You know how you used to be able to choose the you know the arrowhead?

Felicity 2:36

But I listened to my stakeholders and asked that they wanted a clear flow chart on how it worked, so we did. But yeah. Well getting back to this one, which is is far more important. And I think as I said to you, I look at this and say, well, hang on a minute, didn't the gut government give the department 16.6 million under the MRFF for five years worth of consultation and clinical analysis of how patients and consumer input could be incorporated into HTA and that it would take five years, and that none of those applications necessarily had to be headed by or included a consumer. So I wondered if this is the fifth 16.6 million, in which case, like, wow, that's like five million a page. I assume it's not, but there's a lot going on here with how we make people feel that they are being consulted and incorporated in something. And yeah, it's it it is of considerable concern because it's becomes a distraction, and you and I have talked about this many a time in the past, which is while you're busy looking at something that I gave you and threw over here, I bring something else up and put it out over here. And really saying which lane you can stay in and which lane let we will let you contribute to is really concerning. So yeah, it it's hugely it is offensive.

Paul 4:03

The other reason it's concerning will become apparent to people in the next 72 hours.

Felicity 4:07

Yeah.

Paul 4:08

Because of the timing of its of its release and some other things that we're gonna talk about not today, but later.

Felicity 4:17

But a breaking news podcast.

Paul 4:22

I upset some people with my comments on it yesterday, and that's fine, you're entitled to be upset.

Felicity 4:31

Yeah, but if you're actually gonna come out and say, Well, I was consulted on that and I thought it was a good thing, then you better own your alcohol.

Paul 4:38

You've got to own it. And and and I and I have to tell you, if you're offended, well you can be offended. I mean, I did have someone say to me that I'm really offended, and I just said, You can be offended.

Felicity 4:48

You know, that's you're taking the money and you're taking the decision under status, so take the criticism.

Paul 4:53

Am I sorry that you're offended? Uh well, I don't like you to be upset. But if you endorse this, then you've made a terrible mistake. And and I know a lot a lot of people read these documents and and they see the adjectives and think, well, that's that's quite good. But they're all passive. They're all incredibly passive. As and as I said, everything everything in that document, the Department of Health would claim that they are doing today.

Felicity 5:24

Absolutely, and they are. And I reflect on we got in trouble in a podcast, was it last year, when you were a speaker at another consumer forum where you call we people were talking about how great it was that finally after years and just before Christmas, they were asked to consult on the HDA review and put together a consumer engagement response on that over the January break when everybody else got to rest, and that the greatest impact they'd had is that someone who started fighting for this and was dead. And so we should be really proud of their legacy. And you sat on that panel and deconstructed that and said, We're kind of looking at the wrong thing here, that as a patient, as a consumer, you're so um set aside, so taken for granted by a system that they can throw you something on Christmas Eve and say, you should be grateful, and you all jump and say, Yes, we should definitely do this. Like, thank heaven someone finally spoke to us, you all rushed to it, and you think it's a good thing that someone who died fighting for better access got some of their words into a publication. So it's it's a bit more of what you've been talking about, which is the lip service and the tokenism that the HTA system places on the patient, and it is the only part of the health system, and we say it all the time, that really does see the patient as an afterthought because we talk about the population level, Paul, not the individual. But no doctor gets to sit in front of me and say, Look, I appreciate it's your health and your blood test results and your scan results and you know your concerns. But let me talk to you about how I will let that fit into what I'm about to do.

Paul 7:08

Yeah, there's a lot of passivity around advocacy. And I did say to someone yesterday about they asked me, Well, you know, who's who who who is really good at achieving change? I said, Well, the people who argue for it. And and most people don't actually argue for change. Clearly, it's very passive. And one might describe our environment on those things as unusually polite. There's nothing wrong with courtesy. But if politeness if politeness means acquiescence to bad outcomes, that's a that's a problem. There is also an insider-outsider aspect to this environment, to the policy discussions. And we'll get we'll get to that in the next 72 hours because we have un uncovered a brutal and frankly disgusting example of it.

Felicity 8:01

Yeah, and it's it's probably one of the worst I've seen in university. Yeah, it's one of things. As you know, I've I I argued it back in the National Medicines Policy Review terms of reference and the way that was handled, and the people on the inside and the people on the outside, and those that got to be part of designing those terms of reference, and who then had access to them for two years while the rest of us were told to wait for COVID and then give them three weeks to respond.

Paul 8:25

So this is what this is the example we'll be talking about in the next few days is worse than that.

Felicity 8:30

No, I know it is worse than that. But this is a system that has a history of it, and the problem is like you said, everyone is so busy being polite as opposed to actually standing up for what is needed. And it is also a system that when an individual or a group dare to call out behavior or dare to call out a process that is negatively impacting them as patients or as a collective, they are shunned. They are told, you know, oh, you've got to play nice. I mean, I had a conversation yesterday with an organization that said, yeah, but we don't want to we we don't want to upset the government. I'm like, well, literally patients are missing out. So who are you happy with being upset right now? The patient that doesn't get access to a treatment, the patients that die, the patients who are permanently uh disabled by these decisions, or you just want a minister who's on 350,000 bucks a year and his ministerial advisors and the departmental officials who are on a couple of hundred thousand bucks a year to feel good about themselves. Because that's actually not your job as an advocate for patients. It is to have the difficult conversations, even though that makes us as ourselves feel very uncomfortable. You feel uncomfortable, I feel uncomfortable about the conversations we have at times, but that is the responsibility we have for raising issues that allow the patient to be at the centre of what we're supposed to be doing.

Paul 9:51

I've I well, we know they're at the centre, Felicity. Come on, because there's a love heart emoji in the new framework.

Felicity 9:56

Yeah, in a circle. Definitely that.

Paul 9:58

That's it. So Yeah, I think people advising organizations not to upset the government on a particular issue are doing their clients or their organizations or their partners a huge disservice. If you think about and and often I think that advice is provided by people who don't really have any real experience, or they're trying to protect their own relationships with all due respect to them. Uh the reality is that when you are a health minister and you are in a health minister's office, you are dealing with 100 rolling disasters on a daily basis, and the 95 to 99 organizations involved in those rolling disasters are not being nice. They're not being nice. And sometimes ministers, in fact, often ministers need to be dragged kicking and screaming to deliver certain outcomes and to make certain decisions, partly because there is a limited bandwidth. They can't do everything. So they have to deal with the things that are immediately in front of them. And sometimes that's the things that make them angry. I also say to people is that you don't help the minister by not telling them that there's a problem coming down the track. Now they mightn't like to hear it, but they're going to prefer to hear it today than they will a month down the track when it's a real problem.

Felicity 11:17

Yeah, and health is a very different beast, and we've talked about it before. I've seen it in the social services sector versus the health sector. And in the social services sector, there is a lot of groups that are r in receipt of grants funding from the government. And in fact, a lot of the time when they are awarded those grants, the government knows absolutely that that money is going to be used to literally beat them with a two by four to get the best outcome for the the area of the the community that they represent. And do you think that's a good thing and they're fine with it. And they don't shy away from the emotive and the sometimes combative or direct arguments in the social services sector. That is taken as a granted. And that's okay because it's the robust discourse that you need to actually work out where a policy and a program should go. You're starting to see it now again with the NDIS and the statements the minister has made. And you know, the NDIS and the policy is now within his broader portfolio, but it used to sit in social services. He will be seeing the marked difference between what it is to engage in the health system with the advocates there for patients versus the disability sector and the advocacy for participants. And the health sector should learn a lot from the disability sector. I'm not talking about the rights and wrongs of what's going on with the allegations of fraud, etc., or or how we're costing things, but I am talking about the comfort with saying, this is my life, this is people that we were entrusted, and I am paid to represent and to get the best outcomes for in their life. And I'm supposed to be assertive about that. I can be polite about it at times, and sometimes I can be cranky. But it's I don't know what it is about federal health, because I also don't see this in state health. But in federal health, everyone just feels that the only way to do this is to just everyone be nice and no one complain and just be grateful for what we've got. And I don't know if that is also representative of the funding part of the federal system, which is predominantly a purchase or provider relationship, as opposed to most other areas of health, particularly in the state system, which is services, which are more directly uh impacting a patient. And so we get caught in the whole, who am I transacting with? I'm actually transacting with the pharmaceutical company or the device company or the diagnostic company or the research company. And maybe that is what distorts this sector and why we have so much um complicit acquiescence from those who are actually already in the system because they're scared of being out of it. I mean, I I'm open to the debate on it and the discussion, but having spent now 15 years on all the various sides of this, it continues to amaze me. And I have great much greater faith in the social services disability sector for representing those who will be participants or non-participants in the MDS than I do in health.

Paul 14:16

Yeah, well the reality reality is this system explicitly pits one stakeholder group against another because it rewards acquiescence, it rewards timidity. Groups groups go from being patient advocates to uh being service providers to government. And I'm sorry that once once the bulk of your revenue as a patient organization and your focus is derived and and primarily focused on the service provision on behalf of the Commonwealth, you cease to be a patient group, in my view. And I'm sorry if that upsets people, well let it upset you. That that that's that's the reality. You've really got to understand your own pathway and your own course here. And you know, people are really defensive about it and they don't like the criticism. People don't like the criticism in this system is because they're not used to it. You know, this is a system where everyone cheers everyone for every stupid idea and dumb action. Everyone cheers you, you've only got to go to LinkedIn to see that they're cheering really bad things, things that I would consider bad. And I'm in a very bad mood today because of what we're going to be talking about in 72 hours. Uh there's some appalling stuff going on in this system, and it needs to be called out. And there are some people, some organizations, some companies that that have to make some difficult decisions in the next in the next week or so that might involve them uh uh taking some in-principle stances on issues. But we won't focus too much on that. I do want to talk about I want to talk about the Consumers Health Forum.

Felicity 16:00

Okay.

Paul 16:01

I want to talk about the Consumers Health Forum, a body that I've been very close to and very fond of for such a long time.

Felicity 16:08

I see you get invited to every function.

Paul 16:10

I know, I know. You know, I'm partially responsible for the CHF.

Felicity 16:14

Because You were partially responsible for the NPS medicine.

Paul 16:18

Yes, because back in the day, when you asked for patient or consumer nominations, it was done by regulation, and the regulation required choice. And because choice was so antagonistic towards the coalition, we said, Yeah, we're not gonna do that. Well, who can we do? I will do the consumer's health forum. What a mistake that was. But so that was like 30 years ago now, which I'm showing my age, but I was a very young advisor.

Felicity 16:45

But at 12, apparently.

Paul 16:47

Yeah, very 12, yeah, very much so. I was a teenager, I was like the doogie houser of advisors. But but but uh so the minister, fresh from his uh you know announcement on the NDIS, has now he's gonna he's gonna test the limits of the section 51 of the constitution. So for those of you who don't know, uh section 51 lists all of the Commonwealth's responsibilities, and some of them I mean, this were mostly written in the 1890s, and so some of them don't make sense in Postmaster General and stuff like that, but some of it does make perfect sense with defence and trade and all of that sort of stuff, and some of it has has naturally been redefined over the years. So in the post-war referendum on section 51, they added the the power on pharmaceutical and health services. Now, for those of you who think that this is a very descriptive part of the constitution, it's not, it's maybe eight words. It's very brief, it's very brief, and has been pretty narrowly interpreted over the years in the sense that uh MBS and PBS are set up the way they are because of section 51. So the government doesn't directly procure medicines, it reimburses them.

Felicity 18:05

Yeah, the subsidy that sorry, the benefit goes to the patient, not to the provider.

Paul 18:09

Yeah, so this is this is really a really important delineation. And so I overlay that with the civil conscription clause that that has always meant that the government can't allocate Medicare provider numbers by postcode because it would be conscription, and it can't um cap medical fees. So the minister has decided that he's gonna test the limit of that. Now, you and I both know because of a certain person that used to work for you who did a thesis on the expanded interpretation of section fifty one. Maybe the health department should give me a call and ask, try and get a copy of it, because it's it's a brilliant document. And and how the High Court has expanded its interpretation of Section 51 over the decades. It's a very, very good document. Very good thesis. I remember she asked me to prove it, didn't like to check it, and I just thought, you know, we can do that, but I don't think I'm gonna add much value. I pretended to. But that's that's gonna be really, really interesting because I think anything that even maybe it's just a leverage point is trying to seek some leverage, but obviously the AML will be in the high court tomorrow.

Felicity 19:23

We'd hope so.

Paul 19:24

Yes, if the government tries to do anything, because it's a price control, and I think we've got to be really really cautious about uh allowing governments to impose price controls, but maybe it's a negotiating tactic. The day after he says this, the Consumers Health Field Forum essentially issues a press release supporting it. And I went, okay, that's interesting. It also described itself as Australia's peak health consumer body. Well, it's the peak government funded health consumer body.

Felicity 19:54

Yes.

Paul 19:55

It it is it is mostly funded by the the government refuses to take money from the pharmaceutical industry, which is interesting. So, how would the CHF respond to a patient group who issued a press release supporting the PBS listing of a medicine? Well, we know how they would respond. They'd be critical, they'd see it as a conflict of interest. And it just seems to me intellectually, as a service provider to the government, which they are, because they're mostly a recruitment panel. As a service provider to the government, I think they've got to be really careful here about what they do. And intellectually, what's the difference? What's the difference? Government is just another vested interest. There's nothing pure about the government. In fact, they come to these things with pretty dirty hands, in in my view. So I just I just read and I thought this is just a huge double standard. A huge double standard. And I found it very, very irritating, decided I wanted to talk about it.

Felicity 20:52

Well, I think it is important. And as someone, as a patient group who has been a recipient of, like I said, constitutionally we can't accept money from the government. We said we found it was too much of a corrupting influence. It it tends to colour um your uh ability to say what needs to be said as opposed to a pharmaceutical or a device company that basically looks us and says, when we give you the money, please don't talk to us, please don't tell us anything you're going to do. We don't want to look like we're consulted on anything. And uh it it it is quite a different way of being. But it is a it is a common you know, it's a bit like the grant funding for peak bodies. So who proves that they are the peak body for which particular issue? We create this um competition between patient groups and you know, and we were going to talk about that in respect of diabetes. We create this competition and government likes that tension of who do we go to, who has our ear, who what do you have to do? And that also perpetuates this is why we have to be nice, because if we're nice, we might get money, or if we're nice, we might get a season. Table for a night who might get to put things down and be invited to things, as opposed to what really is the issue here. So I know CHF always comes out against our private health insurance. Like it's the third leg on a stool. Like it is so important. You you you need to to step away from that. But I we uh I think also as patient groups have to learn when we come out and w when we will challenge and be uh unbiased in that. And I'm I'm curious as to what consultation occurred that is the peak body for representing consumers in consumers in health in Australia. I like to think patients, that all those who are members and contributors said yes, I 100% agree with this, as opposed to the complexity of the issue which you and I talk about, which is the colleges refusing to expand the number of um places for people to train for the specialist positions. I mean, there there is an issue there with RSAP and others about how are you controlling the throughput of uh a workforce. So our workforce in health and our care workforce more generally, which we've previously talked about, has a huge like crisis coming at it. But if you're not letting people come in, perhaps that's the issue we should be addressing, not how much you charge. So I know you went to the UCB uh opening yesterday, which uh looked fantastic, and you talked quite passionately about the patient experience and the clinical experience in Queensland. That's not just by price price. That pricing is a pricing point because there are insufficient specialists available in the areas that we all need treatment. And why isn't CHF coming out about that? Why aren't they attacking, not attacking, but challenging the colleges to say, what are you doing?

Paul 23:54

Yeah, this issue, remember Graham Samuel took it on in the 1990s and was defeated. Because a lot of these colleges only approve two or three training positions a year. And so that's naturally that's not a problem that can be fixed in a couple of years. That's a very significant issue that would involve the colleges losing responsibility over training positions. Now you could argue that it's obvious well, it's probably in the best interest of the system to do that. But what are all the drivers of these higher fees? It might also be government imposed costs and all sorts of things, the cost of doing business, because obviously they are businesses.

SPEAKER_03 24:38

Yeah.

Paul 24:38

These specialists are finishing their training with vast swathes of debt.

Felicity 24:43

Yes.

Paul 24:44

Which particularly now, so I I imagine that a neurologist or an ophthalmologist finishing their training now is finishing with a level of debt much greater than someone finishing that training 20 years ago. Yes. I don't and I don't know that for sure, but I'm gonna guess that's probably the case.

Felicity 25:01

It is some of the discussions I've had with older specialists and them talking about the focus of their younger colleagues coming in saying, Well, I need to charge. This is actually what it costs me to join the business. Um I'm I'm not a salaried employee. And yeah, if you're a neurologist that went f uh, you know, a new neurological surgeon, and you go from you know, Mr. to doctor to mister, that's 12 years.

Paul 25:26

Yeah, so I just I just think you know, whenever I get a report, whenever I get a study, a commission report, I always like to know who's funded it. Not for any other reason that it informs my judgment of the report. So what's behind this? And that's that's important. And so when I Australia's peak health consumer body issues a press release supporting the government the day after their primary funder, the day after the government proposes a very controversial fix. Uh then you know you've got to think, well, they're government funded, right? So I'm gonna discount that in the same way I discount anything. But that's that's that's an interesting and and on the on the UCB event, that was an excellent event. I had a fantastic conversation with Selena, the general manager there, and Predit Philip, who for people our age has been around governments in Australia for a very long time, about the push for a more holistic view of the life sciences sector. It's fantastic. The event itself, the 25th year since their launch in Australia. I think their first general manager is Dieter Torhydent. Do you remember Dieter? No, yeah, yeah, yeah. He was he was around for a long time. Uh, really nice guy, really nice guy, and Selena's really nice and very smart and quite strategic in her understanding of the drivers of the system, but the program was excellent. The patient story was just so sad. Uh, but there was also a uh professor there talking about clinical trials, and that was just just really, really interesting. So, congratulations uh to to to them for doing that. So it was it was really, really enjoyable. And you know, there's just so much, generally, there's just so much happening at the moment. We've got the budget in a week and a bit.

Felicity 27:22

Ten sleeps.

Paul 27:23

Ten sleeps, and so the leaves are turning in Canberra. Starting to get a bit chilly, which means it's almost budget time. And uh what are you expecting?

Felicity 27:35

Oh, look at a lot of people in town. Oh, look, a lot of the things have already come out, you know. You can see what's happening at the NDIS, you can see what's going on with tax. I mean, obviously, in respect of the PBS, the Minister's already staked his claim about, you know, fully expect things, the decisions taken but not announced, as everyone is uh corraled into a certain point hit to 1 July. I you know it it's gonna be another budget. What does the government have the courage to actually make some difficult decisions in expenditure versus um being happy to tax more of they're very happy to spend everybody's money?

Paul 28:14

So um Yeah, lodging estimates variations of savings.

Felicity 28:19

Yeah.

Paul 28:19

Which has not historically been allowed.

Felicity 28:23

No, no, it hasn't. But look, I think it will be you know, this is the last if you we always talk about election cycles, this is the budget where you can actually do something difficult and hope that the community will forgive you in sufficient time to actually go to the next election. We've obviously got the Farrah election this weekend. Oh yeah. So I'm sure they'll take that as a bit of a bellwether. Um but yeah.

Paul 28:46

Did you see the uh Pauline Hansen's plane?

Felicity 28:49

Yeah, well I'm assuming that you know, with your impending license, you're gonna apply for a job.

Paul 28:56

Yes, but that'll be kind of a commercial pilot. Uh well the the last plane. Yeah, oh it's beautiful. Cirrus G7, that's top of the range. That's like the that's like the Mercedes S class of general aviation planes.

Felicity 29:11

Yeah, for your listeners, um does tend to look at plates.

Paul 29:14

It's got air, it's got air conditioning, it's got autopilot. It's still not going to be very comfortable for more than a couple of people. So I don't know, I know they're talking about it as you know, she can fly around regional Australia, but I don't know, I don't know what his max speed would be, about a hundred and maybe a hundred and fifty knots or something. So it's not it's not a golf stream.

Felicity 29:37

No, and I know as um colleagues who used to work in um actually Minister Lee's office, and this is her final weekend as the member for Farrah.

Paul 29:46

So um Yeah, she's got a Cessna 102.

Felicity 29:48

Yeah, but she used to not always fly that, and every now and then advisers would have to fly with her on in the small planes to go somewhere and they're like, I think I'll just drive. If you think it's luxury travel having your own plane to travel between it it's a lovely plane, but I'm just saying I don't think people understand what it is to small to fly in a a light aircraft. It's not a quantas dash, it's a small quantity.

Paul 30:12

No, you're not you're not much more You're not bumping over turbulence at 500 knots.

Felicity 30:18

If you've got a bit of a um dodgy tummy or not a huge flying fan, it does take a little bit of getting used to.

Paul 30:24

When you hit severe turbulence, it's like a giant grabs it and just shakes it around. So you know you hit your head on the roof of the plane and it's why you have sick bags.

Felicity 30:34

Uh yeah, and you still need them in small planes, but you still need them.

Paul 30:38

So our plan is to record another episode.

Felicity 30:43

In the coming few days.

Paul 30:44

In the coming few days, because of an issue that we're just trying to piece together. Uh we're not going to we're alluding to it, but we're not gonna go into any detail because we don't have all the detail, but I think it's something that is gonna be highly relevant and historically relevant to the to the audience. And so we're gonna try and explain why.

Felicity 31:06

Yeah, and look, I'm gonna make two political comments before you sign us off. And one is a beautiful little girl lost her life this week, and there is a community raging, and we as a country need to have the grown-up conversations about what allows these things to happen in the first place and the responses that happen to them, irrespective of race or culture. Our women and our children, regardless of where they live and regardless of how they identify, need the better protection and we need to uh violence after the fact does not solve the problem of before the fact. And well done to uh Senator Price, who is trying to call these things out and continues to, and set aside your politics and listen to the lived experience of women and children in these areas. We regularly call out the number of women and children killed in domestic violence situations in this country, and there is no excuse for it, and we cannot let culture get in the way of that. The second thing I want to talk about is obviously we had the interim report from the Royal Commission into anti-Semitism basically called uh delivered this week. I don't think it was delivered particularly well. I have concerns about the way our Prime Minister talked about the actions of a terrorist organization as if it's it was a terrorist attack.

SPEAKER_00 32:27

Uh let's say you called it the actions of Hamas.

Felicity 32:31

Yeah, we need we need to use language properly and we need to call it out. And then when we see it at the same time, what's happening to the Jewish community in uh England, and again the silence, and and you and I have talked a little bit about this, and you know, I'm one of the more outspoken people over the last few years. But I always worry that we as a society are so used to our beloved friends in the Jewish community being attacked, we're almost desensitized to it. That's what worries me. It worries me that we take that this is just the way it should be, and I never understood that it could be that way, and I think we need to be calling it out over and over and over again, and our language needs to be stronger. We need to absolutely say that there this is not just about anti-Semitism, this is about other cultures and other religions who have violent tendencies, and when they are perpetrating acts against us or against the Jewish community or others, we need to call it out. And I I am very concerned at the way that you you said you hoped the Prime Minister just had a poor use of language, but nomenclature matters and this Royal Commission matters, and we need to actually take the the advice of that lovely footballer, Harry Sheesel, who said you need to make a submission because we and also non-Jews in the community need to make a submission too, because we need to express and defend and protect and explain what it's like to care about Jewish people in Australia and watch them suffer and how it is completely unacceptable.

SPEAKER_00 34:09

Yeah, thank you for saying that. It's well said.

Paul 34:11

You know, I tried to give the Prime Minister the benefit of the of the doubt just because I can't emotionally deal with the alternative at the moment. I know. And I think a lot of people in the Jewish community are the same, where it's just it's peak, and and so it's exhausting. It's exhausting, and as I say to people all the time, bollards and security guards and razor wire are not a new factor at synagogues or Jewish schools. It has been the case since I was a child that that that that going into a Jewish school like Mount Scopus in Melbourne is like crossing Checkpoint Charlie. It was into into West Berlin, right? And and that that is not a recent thing, that is not since October 7th. That has been the case since I was a child that it has been like that. And the sad thing is Scopus is leaving its eastern suburbs home where it has been for decades and going deep into the heart of Melbourne's Jewish community because that's where people feel safe. And and that sort of breaks my heart. It breaks my heart that the community is turning in. But and and it's far worse in it's well it's it's worse in its in its consistency in England. It's murderous in Australia, it's murderous in England too. But we had the stabbing this week at Goldersgrain, which for those of you who don't know is in northwest London and is is uh you know, you would liken it to the Australian uh Jewish community where it's quite focused there. But it's it's not new, and I hadn't really thought about it the way you have, and you mentioned it to me, and I thought, yeah, I just wonder if people have just become somewhat immune to it, where oh, it's another it's another attack, it's it's another it's another attack, and so it's almost normalized and and expected. Now, the problem Australia has is the Jews are already leaving this country. People that you and I both know of effectively already left, and these were people that were making a huge contribution to Australia healthcare system. And look, they might come back at some point, but it's it's incredibly distressing, and everyone I know says the right thing. You know, everyone, you know, I walk through the airport and see some idiot we're in a cafe you know, and I pretend not to be silent.

Felicity 36:52

No, anyway, you say you can I I know even when we're walking the mouth to the local shop.

Paul 36:59

But it's it's it's really people have to understand the signal that sends.

Felicity 37:12

Yeah.

Paul 37:13

That's you know, and so when people say globalised into fada, well it's been globalized, people. It was globalized in Bondi, it's been globalized in Gold is Groin This Week in London, it's globalized at Jewish and in and Israeli restaurants and and bakeries around Australia. It's the fact that you know you go to the local synagogue here and there's four AFP and ten security guards.

Felicity 37:36

Yeah.

Paul 37:38

Tomorrow.

Felicity 37:39

So And I really encourage people to just think about how much they are becoming normalized and accepting or desensitized of it. And I I I highlight again also the attack on President Trump this week on the weekend. You think about how actually quickly people have adjusted and moved on to that too, as if like, oh yeah, well, that's to be expected. We we need to be careful in that there is so much violence and extreme behaviour in society at the moment. And so we kind of just accept it. And I don't mean we accept it and we think it's a good thing, we just accept that that happens. And yet actually it's really beholden upon those of us who are not at the receiving end of these horrific events to actually stand up and call it out. It's and like I said, it's why I'm talking about that beautiful little girl in Alice Springs, because it's actually not acceptable to let a cultural debate get in the way of what happened, and we actually need to say that these are our laws and this is what we do, and we need to have very we need to call out how what do we do that at times allows for a level of behaviour and acceptance of risk that we would not tolerate elsewhere, and more broadly for women and children in Australia there is still a big battle going on. Um continues to fight for that.

SPEAKER_00 39:07

These are our fellow citizens. They are okay, and and we need they need to be protected. If they need to be protected, they need to be protected.

Felicity 39:15

Exactly. So before the facts, not after.

Paul 39:19

Alright, so people are gonna hear from us uh Monday morning, I suspect. Uh there will be a few dozen people who I think know what we're talking about. But unfortunately, the vast majority of people won't be privy to this information, and therein lies the problem. Yeah. And this is not about confidentiality obligations. This is about something far more pernicious. So we we we will come back to that.

Felicity 39:50

Because we're just trying to get all our information together before we get it.

Paul 39:54

Yes, we yeah, we want to get we want to get it right because it's quite complex. But so thank you, everyone. Thank you, Felicity. Thank you for your words today. They're very heartfelt, and I know you really mean them, and uh yeah, it's uh terrible thing that happened in Alice Springs, and uh there's a certain righteousness in in what you say that we've got to care for our fellow Australians here.

Felicity 40:19

Thanks, Paul.

Paul 40:20

Thanks, everyone.