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Now, you’d think it’s a level playing field, but according to Doctor David Manners, it is not. Now he’s a private respiratory physician in Midland and he is getting quite frustrated at what he sees as a terrible inequity based on where people live and Dr Manners is here. Good morning.

Dr David Manners: Good morning, Nadia.

Nadia Mitsopoulos: And with him today is Elizabeth Collett, a survivor of multiple breast cancers who lives in Kalamunda. Good morning to you and thank you for coming in.

Elizabeth Collett: Pleasure.

Nadia Mitsopoulos: To you first, Dr Manners. What sort of patients do you see and what sort of treatment usually do they need?

Dr Manners: I am a respiratory specialist and a big part of my job is to meet people who are suspected of having lung cancer. They may have had a scan organised by a hospital or a GP, and then they come and meet a respiratory physician and we organise biopsy tests and other tests to stage the cancer, and coordinate treatment. So, it’s a relatively common part of my practice where patients will return after having a biopsy, and I tell them that they have lung cancer and that they will be offered radiation treatment as part of their treatment plan.

Nadia Mitsopoulos: And how often would they have to have that radiation treatment again, roughly.

Dr Manners: Well, it depends a little bit on the type and indication, but in the lung cancer space, it’s usually every day for about a week. There are some situations where it can be up to six weeks; every day for six weeks.

Nadia Mitsopoulos: OK. So then tell me about the disparity as you see it. What’s the problem here?

Dr Manners: Well, in approximately 2021/2022, there was an arrangement that was made with private radiation oncology practices that operate in Rockingham and Mandurah, and the arrangement happened that those patients would be able to have their treatment subsidised by the state government at no out-of-pocket cost.

Nadia Mitsopoulos: So still free.

Dr Manners: So, for those patients, instead of having to travel to Fiona Stanley Hospital in Murdoch to access the State Centre there, they were able to have treatment locally without having to pay a gap, and that has been very successful for the patients down there and has been going on for a few years.

In Midland where I work, there is also a private radiation oncology facility. It’s run actually by one of the same practices that operate down south. But that arrangement doesn’t exist for the Midland patients so, when I tell them that they need to have radiation treatment, it’s followed up by a question of, well, you’ve got two options here. You can have free state government-funded treatment at Sir Charles Gairdner Hospital, and you have to travel from Ellenbrook or Mundaring or Kalamunda or Midland to Charlie’s every day, or you can have treatment locally, but you may have to pay a cost of several hundred dollars.

Nadia Mitsopoulos: How is that fair?

Dr Manners: I don’t think it is. I think it is absolutely unfair and I think that if more people found out about it, they would be very, very upset.

Nadia Mitsopoulos: How long have you been having to tell your patients that? How long has this been going on for?

Dr Manners: Well, since approximately the precedent started in the south metro area around about 2021/2022, so it has been going on for several years

Nadia Mitsopoulos: And unfair. It isn’t a level playing field.

Dr Manners: No. And the same could be applied to patients who live in the northern suburbs as well, because there is a private radiation oncology facility at Joondalup but those patients may have to pay a gap there or travel to Charlie’s.

Nadia Mitsopoulos: And travelling to Charlie’s, I guess, when you’re having this sort of treatment is maybe not as easy as it sounds.

Dr Manners: Well, you have to if you have to do that every day for six weeks, and if you have to follow Great Eastern Highway from Mundaring all the way down to Nedlands, you would want a better alternative, and that’s why most of my patients will actually pay for their treatment locally. Because it’s better for them, it’s better for their caregivers. Sometimes their radiation treatment happens at the same time as other cancer treatments like chemotherapy, and they can have free chemotherapy through the state government-funded system at Midland as well. They just can’t have radiation oncology there without paying a gap.

Nadia Mitsopoulos: Elizabeth, tell me about your story. Is this something that you’ve experienced?

Elizabeth Collett: Actually yes, because I got my breast cancers, both of them, in 2021 and it was in 2021 that I started to hear that I was paying full price — the gap — and we’re pensioners, and it was very stressful for my husband, my family. It was just difficult, and I didn’t think it was fair.

Nadia Mitsopoulos: It doesn’t sound fair, that’s for sure. Can I ask how much you were paying? Do you know the financial burden?

Elizabeth Collett: I don’t know off the top of my head.

Nadia Mitsopoulos: But it adds up, right?

Elizabeth Collett: Hundreds, absolutely, because radiation on the first breast, it was three weeks and on the second breast it was three weeks again. But I also had chemo and that was, I’ve forgotten how many weeks.

Nadia Mitsopoulos: Yeah. And so how did you make that choice? I mean, how hard is it to make that choice about paying for it locally or making the trek, you know, pretty much to the other side of the city?

Elizabeth Collett: I had had experience previously with the public system, as a carer of a family member, and I knew what I was going to be facing, and I saw the sign and I said in the afternoon, I said I’ll ring them up and I rang up the people I went to for the radiation therapy. And they were wonderful. And the parking was great. A train came through if we needed it. Everything was free, apart from the fact that we had to pay and my husband would pay in the morning and would you believe, the radiation only took 15-20 minutes and we live in Kalamunda, so just up the hill and down the hill, and I was home within the hour from woe to go and it was just great.

Nadia Mitsopoulos: Can I ask how your treatment went and how you are now?

Elizabeth Collett:. I’m in remission.

Nadia Mitsopoulos: Great to hear.

Elizabeth Collett: And they were wonderful and I highly recommend not having the anxiety for your carer and the travelling and the parking. No, I can’t imagine it anywhere else and I want everybody that lives in our area to have the same.

Nadia Mitsopoulos: Elizabeth Collett is my guest this morning, a breast cancer survivor from Kalamunda and Dr David Manners, a private respiratory physician in Midland. Now you talked about the fact that it’s a similar situation in Joondalup and beyond. So, what’s the solution here?

Dr Manners: It’s a very complex situation.

Nadia Mitsopoulos: A complex situation, but I can’t help but feel it might be a simple solution.

Dr Manners: Well, we’re really looking for the new health ministry team, so (Health and Mental Health Minister) Meredith Hammat and her team to really come up with a solution that extends the precedent that is happening down at Rockingham and Mandurah to other parts of Perth.

Nadia Mitsopoulos: So, provide the same level of funding.

Dr Manners: Yeah, unfortunately I don’t think it’s going to be an easy decision for them. And this probably gets to a more complex discussion about the nature of health funding in Australia. Yourself and many of your listeners will be aware that it’s very complex and some of it is provided by the federal government, some of it is provided by state government and things that are specialist care but operate in the community like radiation treatment that are not necessarily hospital-based, it’s a real overlap between those two. And so often there needs to be discussion, compromise and agreement between our two levels of funders, the federal government and the state government to come to a solution.

Nadia Mitsopoulos: OK, so this may not be as easy as I thought to fix.

Dr Manners: We’ve been trying with a variety of other key stakeholders to fix this for about a year and a half. And you would think that it would be easy because the precedent exists down south, but it certainly, for a variety of different reasons that, well, that I’m not necessarily privy to, it hasn’t gotten over the line. So we’re just hoping that some people will become aware of the issue, maybe express their concerns if they think that this is not fair, and that the new health ministry team can come up with a solution.

Nadia Mitsopoulos: And it’s interesting because a couple of people are saying, well, what about just expanding the public health system to be able to provide this service. That’s not as easy as it sounds though.

Dr Manners: Well, if you say the public health service, you’re probably referring to state-funded, hospital-based care. Look, that’s relatively easy to do. The Department of Health produces a thing called the Clinical Services Framework, which tells hospitals what they can and cannot provide. Radiation oncology is not part of the East Metropolitan Hospital Service. So, somebody could say, yes, radiation treatment should be provided in the east. And then somebody could say, you can outsource that to a private practice who’s already operating in Midland to provide that. So, it can be done.

Nadia Mitsopoulos: Because we need that diversity in the health system.

Dr Manners: So it can be done.

Nadia Mitsopoulos: It’s already being done.

Dr Manners: It always comes at a cost. I think that that’s probably one of the big issues is who’s going to pay for it.