Simon Crean (Hotham, Australian Labor Party, Shadow Minister for Regional Development) Share this | Hansard source

The Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 puts into legislation the provisions of the fourth pharmacy agreement, reached late last year, between the government and the Pharmacy Guild. The provisions themselves are non-controversial, and Labor supports them. As shadow minister for regional development I particularly support the new arrangements that will improve access to pharmacies and to pharmaceutical services for people in rural and regional areas and in the developing suburban areas.

In this and in so many other areas of service delivery in our regions we do need innovative solutions. This bill presents a small but nevertheless important demonstration of that innovation. The truth is that one size does not fit all as far as service delivery is concerned in the regions. My experience as minister has been that regions left to apply flexibility to available resource allocations do innovate in creative ways, and government needs to find more creative and innovative solutions and it needs to encourage them. It needs to reward those regions that come up with those solutions and it needs to present something of a best-practice list for others to adopt. I am going to ensure that this approach of encouraging and rewarding creative and innovative solutions to service delivery generally in our regions forms an integral part of Labor’s regional policy in the development of sustainable economic, social and environmental growth in our regions.

The bill also raises aspects of the government’s health policies with which the opposition strongly disagrees and which have disadvantaged many Australians. It is on that basis that we have moved a second reading amendment which identifies a number of the government’s failings. It identifies the failure to investigate the impact of the government’s copayment increase and its implication for people’s access to medicines, particularly for pensioners. This copayment would have been unnecessary if the government had been prepared in the last term to work with Labor on identifying a list of savings measures to the PBS.

We know we have to find savings to make this scheme viable, but it is far better for the government, especially if it has got the cooperation of the opposition—and we were offering it—to find those savings through government activity rather than having to slug people for their medicines. We invited the government to work with us in a bipartisan way to obviate these increases. It refused. Pensioners are now paying the price. Our amendment also condemns the recent changes to the Pharmaceutical Benefits Scheme safety net which have also burdened Australians who need medication by increasing their out-of-pocket costs. Our amendment also condemns the confusion that the government has created for patients, doctors and pharmacists—it is a rare trifecta to have all of them complaining—by the new 20-day rule on repeat prescriptions. In the broader field, not specifically in the narrowness of this bill, this is another example of and another reflection on a government that just does not get it right. It ignores cost savings which are in its purview and control and which we would assist it with, it slugs patients more for their medicines, it mangles new procedures and it delays dealing with issues and changes to further improve affordable access in regional areas.

The bill extends the operation of pharmacy location rules and their administration by the Australian Community Pharmacy Authority until 30 June 2010. The bill gives the minister discretion to approve a pharmacy not otherwise approved. The bill simplifies the process for approving changes to pharmacies that are already approved and makes some other minor technical amendments. As I said at the outset, these are not controversial in themselves, but the measures in the bill should actually go further in the way that I have already identified.

There is another aspect of the pharmacy agreement, one that is outside the scope of this bill but which the government has to act on quickly. It is the community service obligation on pharmaceutical wholesalers to make medicines available promptly and affordably all over Australia, with availability at affordable prices in the regions as in the cities. I am particularly aware of this issue not only because of my responsibility for regional development and affordable access to medicines in the regions but also because one of the major medicine wholesalers, Sigma Pharmaceuticals, has its distribution and dispatch centre in my electorate. It is also a major employer in my electorate. It is a significant participant in the growing biotechnology industry sector based around Monash University in the south-east corridor of Melbourne.

Anyone who visits Sigma’s distribution centre in Clayton would be impressed by this highly efficient operation. The business model is working. What is failing is the government, in identifying and agreeing on its contribution to the community service obligation. In discussions with Sigma the matter of remuneration of wholesalers for meeting that obligation to the community, particularly in high-cost rural and remote areas, still has to be determined. This was an agreement that was reached at the end of last year. But here we are at the end of March with the government saying it is concerned about affordable access in the regions yet it still has not kept its side of the bargain for a major distributor of pharmaceuticals. This applies not just to Sigma but to every other distributor of pharmaceuticals.

This is another example of the government’s failure to follow through. It talks the talk but does not undertake the actions. So I call on the government to bring this to a conclusion, to determine with industry the level of remuneration on a fair and equitable basis. This is not a question about business getting its act right. It is not a question about business efficiency. It is another example of where markets fail, given the distance and the costs associated with getting products out there. Governments have a role to play if they are committed to affordable access in the regions. That is what is called a community service obligation. It requires a contribution by government. They are the basics, but the government has not secured and finalised the detail. I urge it to do so, and I will keep on its hammer, on behalf of constituents of mine and the people that work for them, to ensure that it does.

This bill basically continues current arrangements relating to pharmacy locations. These arrangements have in themselves been the subject of some discussion and controversy. They seek to balance what can be in some cases conflicting goals: on the one hand community access to pharmacy services; on the other hand ensuring the continued viability of existing pharmacies—and we all know of the debate about the big supermarkets wanting to get into this area of activity. In a sense, they are two sides of the same coin: access to pharmacy services for communities. The arrangements have been criticised on the grounds that they are anti-competitive and protect a monopoly service. This was the argument for the inclusion of pharmacies in those supermarkets that I have just alluded to. It is not a problem in many areas. Indeed, I note with interest, again drawing on the circumstances of my constituency, that a new pharmacy is about to open next door to my electorate office in Clayton when there are already four other pharmacies within 200 metres of it. I understand that the new entrant’s pharmacy approval has been moved in effect from a smaller shopping centre—one at Westall, which is also in my electorate—two kilometres away. It means that people in Westall will be disadvantaged by having to travel further for their pharmacy needs. I am not certain what a fifth pharmacy in Clayton is going to add to the availability of services in that shopping strip.

However, access to a pharmacy and to PBS medicines is a real issue for many Australians living in rural and regional Australia. The local pharmacy is a critical part of a town’s health and social infrastructure. For many people, particularly older people or those without cars, it is very difficult to travel to get access to prescription medicines, and then there are issues of privacy if someone else does the errand for them. So better and affordable access to health services and to the advice and assistance of a pharmacist are significant issues for people living in rural areas.

Regional development is a key Labor priority. Regional development is good for our regions and it is good for the nation. Australian regions are the powerhouse of this economy. Most of our GDP is created in the regions—in mining, agriculture and industry. A federal Labor government will harness the potential of the regions; it will reduce disparity between regions for economic, social and environmental sustainability. Federal Labor is committed to regional development, and it has three main priorities to deliver successful regional policy.

Firstly, Labor will develop location based responses to regional challenges. We cannot continue to ask regions to just respond to programs. A one-size-fits-all approach will not work. I have mentioned this in the context of the flexibility that this bill demonstrates in relation to pharmacy locations. So, if the one-size-fits-all approach does not work, we have to make the programs more flexible to what does work—that is, the innovative solution that the regions themselves come up with. Labor will encourage locally-driven approaches to respond to the challenges which vary from region to region.

Secondly, federal Labor will revitalise current regional structures to empower local communities—creative and innovative solutions are best developed by working with local communities, not imposing solutions from the top down—and to take up the examples of best practice, including capitalising on regional specific resources, their know-how and developing location based strategies to encourage local investment.

In tandem with working with local communities, Labor will revitalise regional Australia’s structures to deliver those local solutions. Area Consultative Committees, which were established under the Labor government—in fact, by me when I was the Minister for Employment, Education and Training—should be given the capacity to develop strategic economic plans and good outcomes, innovative outcomes, that suit the region’s needs for that particular area.

I and many colleagues in the Labor Party have been consulting with these Area Consultative Committees across Australia over past months. They are saying to us that they want to be able to develop the strategic plans. They then want to be able to deliver long-term economic and social development in a sustainable way. I think that we have to tap into the leadership that these Area Consultative Committees provide. I know they work, because when I was employment minister and gave them the task of helping us put the long-term unemployed back into work they responded magnificently—300,000 jobs were created by the Area Consultative Committees in the last six months of Labor’s term. That is really saying to the regions: ‘We will make the resources work responsively to your needs. We want you to give the leadership. You know best what suits your region, the skill needs of your region, and what you need to get local industries going. What we want to do is to give you the capacity to develop responses that meet those needs.’ It has been demonstrated that, if you empower regions, ask them for leadership and resource them, you will get the results. That will be a vital plank in Labor’s approach to regional development as well.

Thirdly, a federal Labor government will restore Commonwealth leadership in regional development. A location based response must be supported by strong Commonwealth leadership. I am reminded that, when this government first came to power in 1996, the first statement it made in relation to regional development was: ‘There was no constitutional role for the Commonwealth in regional development.’ It gave up. It buck-passed. It said that it was the responsibility of the states and the responsibility of local government. Of course it is, but it is also the responsibility of this government. If you simply get to this exercise of saying that it is someone else’s jurisdiction rather than fixing the problem, it is no wonder that voters turn off you. Labor are saying, ‘We have to provide the leadership in a way that facilitates all levels of government in responding to those location developed agendas that stack up.’

There is an area of health policy of particular concern for people living in regional areas, and that is mental health. It is another area where I believe the government has failed the regions. People are suffering in isolation and loneliness, far from appropriate diagnosis and treatment. Recently, we have seen the grand announcement by the Minister for Health and Ageing of $1½ billion for mental health but no details of how it is going to be spent. Certainly no strategy is being developed for rural and regional areas, and this at a time when the Better Outcomes for Mental Health program funding has been reduced by the government and the number of prescriptions being filled for medicines to treat mental illness is declining.

The funds in regional programs could also be better spent on addressing issues in regional areas. I was interested to learn yesterday, in a very informative meeting I had with Mission Australia, that they have been funded by the Macquarie Bank to undertake a significant study of social research into the needs of the regions. I see the Parliamentary Secretary to the Minister for Education, Science and Training at the table nodding with interest. I urge him to read this report because it is very revealing.

It is probably not understood that 36 per cent of people, more than one-third of our population, live outside the capital cities. That is a huge population base. They suffer the same problems as people living in the cities but they experience them in circumstances of greater isolation and with less access to the range of available, affordable services. The report is entitled Rural and regional Australia: change, challenge and capacity. It sets out clearly the challenges that confront regional Australia in a rapidly changing social and economic environment. It identified that, while some regions are prospering, a number are struggling. For example, 72 per cent of students in metropolitan areas complete year 12 but only 62 per cent in the regions. Sixteen per cent of regional and rural households earn only $300 a week compared with less than 13 per cent of metropolitan households, so their income base is much lower. Also, people from rural and regional areas suffer higher incidences of injury, mortality, homicide, diabetes and coronary heart disease.

The report calls for more resources and services to prevent regional Australia’s vibrant population from ebbing away. I was interested and I asked them about the ways in which they were addressing the issue and they are coming up with some innovative approaches. I am keen to continue to work with them, visit them and see some of these innovative solutions because, when you think of it, it fits neatly with the sort of policy prescription that I was outlining before. If we can free up the resources, for example, and have flexibility as part of the health budget to respond to innovative solutions, creative solutions, best practice solutions and solutions that are efficient and stack up, why shouldn’t we be funding those? Why shouldn’t we be responding to the solutions that regions come up with? At the moment, we cannot because of the rigidity within the programs imposed by a program driven approach. We have to get to a location specific approach and that is what we will be arguing.

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