Martin Ferguson (Batman, Australian Labor Party, Shadow Minister for Primary Industries, Resources, Forestry and Tourism) Share this | Hansard source

Perhaps the member for Ryan should listen to this: it is the result of secret and difficult negotiations that reflect poorly on how this government does business and how it regards pharmacy services to Australians. The incompetence of the health minister throughout these negotiations can be illustrated by the fact that this is the third time in less than 12 months that the parliament has been required to act on these rules. It is important for the House to acknowledge and welcome the changes but it is also important that we highlight and hold the government accountable for the drawn-out tortuous process that created uncertainty in the pharmacy industry and uncertainty in the minds of many Australian consumers.

Those negotiations did not do justice, in terms of the performance of the minister for health, to the needs of the frail and elderly who do not have ready access to pharmacies. It also created uncertainties in their minds about whether or not supermarkets such as Coles and Woollies would be able to win the ear of government and take away from their local community shopping strips the pharmacist that they so much depend on, because those pharmacists—unlike the major retail chains such as Coles and Woollies—are part of the local community. All too often these people cannot afford to go to doctors because of the decline in bulk-billing, so they go down to the local pharmacy. They have often known the pharmacist for many years. The pharmacist has known the family and has been able to give medical assistance over and above filling prescriptions. The handling of this bill by the Howard government was an utter disgrace, because it created uncertainty and insecurity in the minds of many frail and elderly people who rely on their local pharmacists on a regular basis.

Moreover, the legislation neglects the fact that the agreement covers some 22 per cent of PBS spending. The real concern is that these beneficial changes are being seriously undermined by the Howard government’s attack on the Pharmaceutical Benefits Scheme. Next to Medicare, the PBS is a vital part of our health care system. We should not forget that it has now been in operation for 50 years. The scheme means that potentially life-saving drugs are accessible to all through a critical government subsidy system which has been among the best in the world—something we as a nation have always prided ourselves on and something that other nations such as the United States of America are envious of.

In the early days of the PBS, this meant that parliament legislated to supply free medicines to immunise against diphtheria and whooping cough. In the 1970s, the emergency supply of medicines after the devastation of Cyclone Tracey in Darwin was critical to minimising the risk of a public health disaster through immunisation against cholera, typhoid and tetanus. These are some examples of the success of this scheme and its great benefit to Australia. These examples further illustrate the crucial role that a government plays through publicly supported access to vital medicines through a scheme known as the Pharmaceutical Benefits Scheme and its importance to public health. Since those days it has broadened to include access to more than 590 generic drugs.

Around 80 per cent of medicines are funded under the PBS, and around 170 million prescriptions were covered by the scheme in the year to June 2005. These are important medicines that we all depend on and that help us all to lead healthier lives. This effectively means that the PBS is a great investment in terms of taxpayers’ scarce dollars. I therefore argue that, given the value of this program and its history, it is disturbing to witness the way in which the government is undermining the PBS.

Yes, providing subsidised medicines is not a cheap exercise for governments but the reality is that prescriptions are falling. Moreover, the data generally indicates that the proportion of funding Australia devotes to pharmaceutical subsidies is lower than that of other OECD countries. Despite this, there has been a 21 per cent increase on PBS copayments—that is, the amount that patients have to pay for accessing medicines. Since the increase was introduced last January, the PBS growth rate has now fallen to 2.5 per cent and is expected, unfortunately, to drop even lower. According to recent Medicare Australia data, the potential savings to the PBS could amount to $1.38 billion for the next financial year, with 11.4 million fewer prescriptions. I wonder whether that is a good investment in the overall wellbeing and health of the Australian community.

The reduction in prescriptions follows the increase faced by patients and reflects the government’s willingness to cut costs at any expense, including the health of Australians. Like other areas of policy, this government is content to allow the Americanisation of health care and medicines. We all know what that means—a sick and desperate underclass, penalised simply for the fact that medicines are extraordinarily expensive.

The PBS, I contend, goes to the heart of the difference between the opposition, represented by the Labor Party, and the coalition government. Increased PBS copayments are increasingly raising out-of-pocket health care costs and hitting the sickest and neediest Australians. Some 80 per cent of PBS beneficiaries are patients already receiving concessions. They depend on the system. Moreover—and we should never forget this—Indigenous Australians get dramatically less access to the PBS than any other Australians—and just look at the problems of health care confronting the Indigenous community.

The government has also deliberately undermined the PBS safety net through the introduction of the 20-day rule. Under this rule, a repeat supply of the same medicine within 20 days on certain medicines will not be covered by the safety net. So, under this government, access to the PBS is being restricted, drugs are being delisted and copayments are rising—facts which are pushing Australians to make critical decisions about how they spend their money.

How can we as a nation, in the 21st century, force Australians to choose between buying their medicines or the other necessities of life? Yet the figures clearly show beyond any doubt that fewer prescriptions are being filled for serious health conditions such as cardiovascular conditions, anaemia, blood clotting problems and mental illness—all fundamental, critical health care issues that need government assistance and leadership.

Let us take the issue of mental illness, a major and growing problem in Australia. It is hard to believe that drugs for this major health problem are being restricted when, only recently, mental health was right at the centre of the COAG announcements. The government simply cannot have its cake and eat it too. It is either committed to doing something about mental health, including assistance through the PBS system, or it is not making that fundamental commitment. It is a problem that we, as a community, have correctly realised that we have to front up to. We have to invest in trying to assist these people—often very desperate families trying to manage the problems of mental health.

This contradiction, I believe, reflects the difference between government rhetoric and policy. The bottom line, especially when it is in the black, should not be pursued as an end in itself and certainly not at the expense of the health of Australians in need of medicines. This is a fundamental right of all Australians and something that we expect in any decent society, especially in a nation such as Australia which prides itself on its capacity to play above its weight, not only in assisting people at home but also in appropriate overseas aid for more needy nations beyond Australia’s shores.

To top it off, the health minister, Mr Abbott, takes it upon himself to remove, for example, calcium tablets, without any expert advice. He saved $9 million. But will this result in the deterioration of health outcomes as a result of that short-sighted decision? I would also point out to the House that people left without access to PBS calcium tablets are people with osteoporosis—a disease that costs Australia $1.9 billion per annum in health care costs. One can only say that that decision by the minister for health was not a good investment because enabling people to try and care for themselves, if properly done, represents a long-term saving to the Australian taxpayer by avoiding far more difficult personal health challenges. The minister for health therefore simply would not know, I suggest to the House, because he did not bother to get that advice. He, as always, took it upon himself, without proper advice, to basically impose his opinion on the Australian community. In essence, it was about simply cutting costs today at the expense of better health tomorrow, in complete disregard for expert opinion and good policy. Yet, as a minister, he is expected to be committed to proper public policy rather than short-term savings decisions which, in the long term, are to the detriment of a lot of individuals’ health, their families, their communities and the nation at large.

This means that the cost, for example, to concession card holders who are accessing calcium from the PBS has gone from $4.60 to around $13 a bottle. For those people that is a big personal hit. They live from week to week. They are finding it very difficult to make ends meet at the moment. To go from $4.60 to around $13 a bottle might not appear much to a minister on an especially generous salary, if he or she had the same problem, but for the ordinary pensioner that is a huge slug which many of them just cannot meet financially. But I am pleased to say that, after this knee-jerk cost cutting by the minister for health, he had to back off and to back-flip. That effectively meant that calcium was put back on the PBS for people with kidney conditions—the result of failing to seek sound advice before making a hasty decision.

The question must therefore be asked: just how is the government’s PBS policy reducing access to much needed medicines? How, in turn, is this policy acting to increase costs in other areas of health care? The reality is that this policy neglects the importance of the role of medicines in preventative health care. Yet that has got to be the No. 1 objective of government policy: how do we lift our game in terms of preventative health care?

Ultimately, the issue is not simply about capping costs; it is about ensuring that money is well spent towards producing good health outcomes and good public policy. If the health minister spent more time understanding the long-term preventative benefits of the PBS rather than slashing costs—if he took better advice—Australian health would be better now and for future generations.

As I said at the outset, the opposition supports the bill before the House. The bill is, appropriately, about the introduction of greater flexibility in the location of pharmacies, which is especially important for regional Australia and growing suburbs.

I stress once again that the decision by the Howard government to back away from its intention to extend pharmacies to major retail chains such as Woolies and Coles is the right decision. I am pleased that the Prime Minister was forced to acknowledge the commitment given to the Pharmacy Guild during the last election in the form of an exchange of letters which committed to that policy position but which the minister for health and others on the other side of the House sought to undermine.

We should never forget that these community pharmacies are part of the fabric of the community. Out in the suburbs and in rural, remote and regional Australia, pharmacies are part of the leadership of our local community. We all depend on the community pharmacist. We should never forget that they are essential in our local metropolitan and regional communities. They give crucial advice. They often make sure that people properly attend to safe medical and medicinal practice. This is about the better health of all Australians. As far as I am concerned, the professional services provided by pharmacists are vital to a decent Australia in the 21st century.

In conclusion, I make one point. We have major skilling problems in every other sphere of Australian life at the moment. The Australian government also has to do more with the Pharmacy Guild and associated entities to train more pharmacists. Our neglect of training for Australians, be they in traditional trades or the professions, effectively means that we are in serious trouble as a nation. I know that from my own responsibilities as shadow minister for resources, energy, forestry and tourism.

We are now losing investment because we do not have the skills base to enable capital decisions to be delivered on time and on budget in Australia. When you ask the major resource companies and hospitality providers to identify the key issue or challenge that they confront at the moment, they speak of a shortage of trained Australians to actually do the work. Skilled migration might be of assistance in the short term, but it is not the long-term solution. In the same way as we have had to rely on overseas doctors, we are now relying on overseas pharmacists.

I simply make a plea to the government. Having got in place a new pharmacy location arrangements bill that has the support of both sides of the House, please start paying more attention to the issue of how we train Australians to succeed the current generation of pharmacists that we depend on as a community. If you do not, we will not only see pharmacy shops close in the local community shopping strips in the suburbs and in rural, remote and regional Australia, but also see associated neglect and a decline in the health of the Australian community.

I commend the bill to the House but also say to the government: please start getting your head around what is probably the biggest priority in Australia at the moment—how we invest in the skilling of Australians, be it in a trade or a profession. If we do not do that, we are going to effectively reduce the size of Australia’s economic cake for future generations.

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