Alan Cadman (Mitchell, Liberal Party) Share this | Hansard source

I was not as heavily involved with this committee inquiry as I could have been due to having a number of committees meeting at the same time, but I am delighted with the report. I think it is extremely well written and comes with practical management solutions to what is a most difficult problem in Australia—probably the most difficult management problem for Australian governments, both federal and state, and even local.

One of the things that struck me about the report was how well Australia comes out compared with the rest of the world on most of the things relating to health. In ‘Health expenditure per person, Australia and other selected OECD countries’, for instance, Australia in 1993 spent slightly over $2,000 per person. The OECD average was $2,400. In 2003 Australia spent $3,855, and the OECD average was $4,000. We spend slightly less than Canada, more than France, a lot more than Japan, more than New Zealand, more than the UK and less than the US. I think that is not a bad place for us to be, but it means that we need to be very careful.

When we examine the funding flows for hospital and medical services, it looks like that famous Barry Jones concoction which looks like spaghetti junction. It was supposed to be a process of projecting what the future for Australia was going to be like. The health funding process is looking exactly like that. There are arrows and lines going in all directions, and that is part of the management difficulties identified by the committee which need cleaning up.

In examining the funding costs and the capacity to shift blame and costs, the committee went into a whole lot of detail about how this is occurring and can occur. Some people say it is a matter of good management to make somebody else pay; others say it is a matter of complexity. Both answers are right; however, where it can be avoided it will save costs. The estimated costs of cleaning up the management system are somewhere between $1 billion and $4 billion. So there is much to be gained if we just clean up the system and make it more efficient and are prepared to work together so that we get adequate and good results for the benefit of those seeking to use the health system.

On selected health indicators, taking Australia’s ranking among OECD countries on life expectancy, morbidity, mortality, health, labour force and risk factors, Australia works out very well compared with the rest of the world. I am very conscious that Australia is often criticised for having a poor health system. I think our health system is about as good as anybody else’s, if not better. It is better than most, and we should be proud of it. It does not mean to say that every citizen is satisfied with it. I know in Western Sydney there are a lot of people unhappy with the current health system and the way in which it operates, and a lot more can be done to make sure that it works more effectively and that some of the management practices are changed.

When one comes to look at the variation between the states and public hospitals, however, it is very interesting to note the way in which management has occurred. For instance, in Victoria, administrative staff number about 9,000 and diagnostic and other health professionals number about 11,000. In New South Wales, it is round the other way: there are more administrative staff than there are health professionals, and that does not surprise any of us who live in New South Wales. They are so busy managing they do not look after the people who are crook. That is a great shame because the system suffers from being overbureaucratic and it suffers from being unable to deliver the expectation of the people of that state.

One aspect of the report that I found particularly interesting was about investment in prevention and early detection, an emphasis that is now being given by state and federal governments in, for instance, kidney health. The report says:

Chronic kidney disease is a common, under-recognized, progressive, preventable and treatable condition. Over the last 25 years, while the Australian population has grown less than 40 per cent, the numbers of Australians being treated with dialysis or a kidney transplant has grown by more than 400 per cent.

That indicates that we are into the system far too late. Kidney failure and other problems have increased greatly, but we are not into the system in a way that will stop these preventable traumatic occurrences.

Osteoporosis is another one. It is a preventable skeletal disorder. In 2001, two million people had osteoporosis. Attributable direct costs are about $1.9 billion per annum. The disease affects women in particular but it also affects men. Bone density testing, medication and diet and can make a big difference. Chronic obstructive pulmonary disease is another disease where early intervention and better lifestyles can make a real difference to the health and cost outcomes. Multiple sclerosis is a random, chronic and disabling disease, the cost of which is approximately $1.3 billion per year. All of these things can be dealt with more effectively.

I refer the House to the recommendations in the early part of the report. I agree with previous speakers about some of the significant recommendations relating to the coordination of the existing jurisdiction based recruitment of overseas trainees. I think most Aussies would prefer to have locally trained staff, and the Commonwealth should take a role in the identification of appropriate staff and their coming to Australia.

Another committee of which I was a member found that a tradition has grown in the area of adoption such that the states have taken charge of adoption but are not doing it particularly well. This is another area where a committee has identified a need for effective Commonwealth leadership.

Another recommendation is about providing an adequate number of health professional graduates to meet the projected demands. The committee recommended that the government have a strategy to produce enough medical professionals by 2021 to meet Australia’s needs. That seems a long way off—it seems a long lead time—but, when one examines the number of doctors, specialists and nurses needed to fulfil our projected needs, 2021 is a reasonable target. It is absolutely essential that the necessary funding to expand the training system is forthcoming. It is no good stealing other people’s graduates and hoping that they will fit into Australian conditions and go to the bush or to remote areas. It just will not happen.

When my wife and I lived in outback New South Wales, we were most thankful to have the services of Dr Paul Retter, a refugee from Czechoslovakia. He was a wonderful doctor. He moved to the city and now lives in my electorate. He is now in his nineties. Paul Retter and his wife, Irene, were a godsend to the people in those remote areas. They were frequently asked out to dinner, and they were highly regarded. Whether it was for mothers with little kids, elderly people with chronic disease, or accidents which occur on farms and in rural areas frequently, their services were absolutely critical to the survival of that community.

There are not too many Paul Retters in the world. Doctors who are used to living in urban areas in other countries come to Australia and expect to fit straight into an urban environment. That should not be their expectation. They should be trained to serve the whole of Australia. Nothing is better than the home-grown doctor or medical professional, and that is the focus that we need to give.

I commend this report. It is a very interesting and sensible report, as you would expect. The committee was extremely well led by Alex Somlyay, who is a man of great experience and has great skill in producing terrific reports. This will make a difference to Australia and I look forward to the government’s response to it.

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