Robert Oakeshott (Lyne, Independent) Share this | Hansard source

Fifty to 60, thank you, Member for Page. That is in dollar terms a substantial amount of money that an area that is growing and is already under pressure is not accessing based on the government’s own funding formula and based on the principle of fairness and equity. I do not think it is too much for members like me to come to this place and ask for nothing more or nothing less than fairness and equity.

At the moment in the delivery of health care in a region such as the North Coast of New South Wales we do not get fairness and we do not get equity. We do not have a state government that is following its own funding formula. Therefore, the role of the Commonwealth in this new environment of health and hospital reform—hopefully the greatest change that we have seen since the introduction of Medicare—is to place a value on the money trail through the system and to make sure equity and fairness is delivered on the ground. It involves hard decisions; populations move, governments have to move with them. It means taking away at times from areas where those populations move from, but that is the work of government. We may as well not be here unless we are willing to make those decisions. Sadly, in New South Wales today those decisions are not being made and, as a consequence, high-growth regions such as the North Coast suffer. That is unfair, that is unjust and I would hope, over the coming months when we see the health mandate of the Commonwealth revealed, that there is a strong element that says equity, justice and equal funding per head of population wherever they may live is a critical part of health reform for the future.

I also mentioned the upcoming cancer funding. We are sweating on the Minister for Health and Ageing, the government and the minister at the table to be serious about that regional cancer funding. For example, in a community such as ours a second linear accelerator would be of enormous value to people’s lives where there are still, despite one linear accelerator being in operation, way too many people going outside of the community for radiotherapy services and way too many demands on families and social networks as a consequence. This would be one of those situations where you save money in the long term by spending a bit of sensible money upfront and trying to get clinical services delivered as close to home as possible. In this regional cancer package that we are hopefully going to see sometime soon, again, I would urge the government to look at the high-growth regions, the ones with the high elderly populations, the lower socioeconomic communities—I have just summed up my region—and to make sure that we are part of the mix of the future because it will provide savings to the health service by doing so.

Another point I want to make is about efficiencies in the system. We have not had much to start with and have therefore learnt to do things in our region pretty efficiently. In Port Macquarie in particular, we have a legacy of going through a period of being a privately run public hospital where there was a buck to be made at the end of the process if you were efficient in the delivery of clinical excellence. The consequence of that was that the cost per bed, now that the hospital has been returned back to the public system, stands out as being significantly less than the seven peer review hospitals around New South Wales. The question is: why? Where are the inefficiencies in the other peer review hospitals and does that reflect inefficiencies in the system more generally?

We have an excellent standard of clinical care at Port Macquarie Base Hospital. It can be done; therefore to some degree it exposes the inefficiencies in the system at other locations that were supposed to be there to peer review the privately run public hospital. It is worth government looking at that because if we are going to have a sustainable health system into the future, efficiency needs to be an important part of it. At the moment, at the end of the financial year—there was something in the paper today about it—there is no rewarding those who are efficient in their clinical delivery. At the moment there is an attempt to either spend it or run over budget so that you do not get money taken back to consolidated revenue in the future. There has to be a better way of building in the efficient delivery of clinical excellence.

A final point is again directed to the duplication in the system where on the North Coast of New South Wales we have an infrastructure list and again Port Macquarie Base Hospital is the No. 1 priority capital works project on that list—despite the hospital at Grafton getting some Commonwealth money and getting some work at the moment. The frustration is that there is also a state infrastructure list that is at complete odds to what the list, which has been put together by local administrators and local clinicians, is saying is their priority. When I was elected I was on the back end of a government promise about the $10 billion Health and Hospital Fund and it was enormously frustrating trying to get the area health services capital works list, the regional list, treated as a priority in that process. Unfortunately, the fix was in or the deal was done between the Commonwealth and the state and the state infrastructure list was treated as a priority; therefore, what the region wanted and what the region was asking for was totally ignored.

This builds into the general theme from our region that we are pitching to government—that is, the idea of place based thinking. There is not a lot of care, compassion or ears for the views of people on the ground who are delivering—whether they be in health or in education. I ask for a better process for bottom-up views to get through to the bureaucracies in the big cities like Sydney, Brisbane or Melbourne, and for place based thinking to have a place in the healthcare mix of the future. On the North Coast we have a priority on the ground and it is the Port Macquarie Base Hospital, but it is not a priority for New South Wales Health. I would have thought that the clinicians and administrators on the ground are worth listening to on the subject of future funding models. At the moment they are not being heard. It is a critical step if we are going to see the proper and consistent delivery of health care into the future.

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