The APA released its pre-Budget submission Physiotherapy: A Path to Better Care in late January.

Every year, the Australian Government invites individuals, businesses and community groups to provide their views on priorities for the next federal budget.

On 6 December 2021, the Assistant Treasurer called for submissions to inform budget strategy and policies to be provided by 28 January 2022.

Although time was short, the APA produced a comprehensive submission outlining solutions for improving Australia’s health system and patient outcomes.

More than just a pre-Budget submission, this is a detailed paper advancing pathways to strengthen care for all Australians.

We also included three options papers, developed with National Advisory Council chairs, that offer all political parties well-developed and evidence-based solutions to improve access to quality physiotherapy.

The APA’s document represents both our 2022–23 pre-Budget submission and an election statement, developed for this moment in the election cycle but also at a critical time in healthcare reform.

It supports planning for the Budget and beyond in terms of renewal for a world after COVID-19.

Our submission demonstrates how to reorient the health system towards primary care encompassing physiotherapy.

We call for a redesign so that people can have unencumbered access to the care they need, beginning with lifting the barriers to access to streamline the patient journey.

We emphasise the need to strategically prioritise access and outcomes and send a clear and direct message that physiotherapy provides a path to better care.

Physiotherapy is a critical and essential service for all Australians and it’s time to publicly fund it.

So what happens to these submissions?

Let me step back a bit and explain that there is no template or format for telling governments (federal, state or territory) how they should expend our monies.

Some organisations provide detailed budget costings on specific programs.

There’s a trick with asking for money—never use round figures.

If you want $135 million, you ask for $134.2 million.

That way they think you’ve costed it and not just estimated an amount.

Some submissions show governments where to save money, arguing that a reduction in one area of expenditure could be used to fund another.

An example of this is the Medicare Benefits Schedule review, where the government is asked to use savings from removing certain Medicare Benefits Schedule items to fund new or expanded items.

Most submissions, including ours, highlight areas where governments should invest to improve outcomes—such as better healthcare, improving patient care, reducing waste and unnecessary expenditure and investing in innovation and new models of care.

Every year, ministers draw up their own portfolio budgets and ‘wish list’ and then take this to the dreaded Expenditure Review Committee (ERC).

Now, the federal government has a lot of money to spend.

In the last budget, total revenue was $497 billion and total expenses were $589 billion.

These are rough figures, but it gives you an idea of how enormous federal budgets are.

ERC is a subcommittee of Cabinet that meets in the months leading up to the Budget and decides on new policies and expenditure, savings proposals and what is recommended to Cabinet to be included in the Budget.

ERC usually includes the Prime Minister, Treasurer and Minister for Finance along with relevant portfolio ministers.

In my time at Federal Parliament, I only ‘fronted’ ERC once with the minister I worked for and it’s as close to a secret police interrogation as I ever want to get.

You wait outside (they make you sweat, I’m sure deliberately) before being brought before very intimidating economists to argue your case.

And this is why health reform is so frustrating—because decisions are made by finance and economic experts, not health practitioners.

They are also made earlier in the cycle, from October, in a process that is well out of sync with the community call-out for submissions.

If there were a physiotherapist in ERC, we would likely see our pre-Budget submission given the tick of approval.

I’ve worked on many of these before and this year’s APA submission is one of the best I’ve seen.

At ERC, we were grilled about our proposals and had to produce data justifying the benefits we claimed and, not surprisingly, the votes that would accrue from potential Budget announcements.

Oftentimes, especially in an election year, ERC’s eyes light up with ‘headline’ announcements designed to catch voters’ attention.

Substantial structural reforms, innovation, new models of care and better pathways for patients rarely get a run.

However, sometimes non-government parties adopt policies and proposals and then we see an election with contested ideas on improving healthcare—as opposed to talk about dollars.

Frustratingly, many worthwhile health proposals are either not adopted or adopted with minimal funding.

Those in the ‘Canberra bubble’ recognise that the ERC surgeons have cut a terrific policy to pieces but left a few bones for the sector to pick at.

I’ll conclude with an anecdote about ERC.

In the mid-2000s, Casey Bennetto wrote Keating! The Musical We Had To Have.

It was hilariously entertaining, but also full of ‘insider’ jokes.

When the musical came to Canberra (booked out every night), one of the cast told me that the audience laughed at very different parts from the audiences in Sydney and Melbourne and he didn’t understand why.

He told me the biggest laugh every night in Canberra was when [Keating] sang: ‘You want your funding for the AME? We’ll have to sneak it past ERC!’

I hope that the ERC of the Coalition and the Australian Labor Party will understand the benefits to all Australians contained in the APA’s submission.

The APA’s pre-Budget submission, Physiotherapy: A Path to Better Care, can be found here.