Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Hansard source

I should place on the record clarification in relation to some of the comments made by the Minister for Health and Ageing in her summing up of the last debate. She completely misrepresented what I had to say as part of that debate. It is a clear method of operation of this minister to try to misrepresent, but I will let others draw their own conclusions.

The key amendments in the Health Legislation Amendment (Australian Community Pharmacy Authority and Private Health Insurance) Bill 2010 are the result of the agreed negotiations arising from the Fifth Community Pharmacy Agreement between the Minister for Health and Ageing and the Pharmacy Guild of Australia. The bill proposes amendments to the National Health Act 1953 relating to these arrangements for approving pharmacists to supply pharmaceutical benefits subsidised by the Commonwealth. It is intended that the Fifth Community Pharmacy Agreement will commence on 1 July 2010 and expire on 30 June 2015. The National Health Act 1953 currently gives effect to the pharmacy location rules and the operation of the Australian Community Pharmacy Authority only until 30 June 2010, the expiry date of the existing Fourth Community Pharmacy Agreement. These amendments are required to extend the location rules and the operation of the ACPA for the term of the fifth agreement, to end on 30 June 2015. In so doing, they enable the implementation of the Fifth Community Pharmacy Agreement, signed on 3 May this year.

Pharmacy services are a key component of primary health care. They are important to all Australians, for there would be few who would not enter a pharmacy at some time every year to have a script filled or as a first point of call for advice on minor injuries or ailments. This Fifth Community Pharmacy Agreement will provide spending of more than $15.4 billion over the next five years for delivery of pharmaceuticals and pharmacy services to the Australian community while providing around $1 billion of savings on forecast spending, according to the government. The expenditure will go to more than 5,000 community pharmacies across the country to dispense PBS medicines and provide other professional services and to meet the community service obligation arrangements with pharmaceutical wholesalers to ensure timely delivery of pharmaceutical products to those pharmacies and, in turn, to the consumer.

Medicare Australia’s latest annual report showed that almost 200 million prescriptions were filled in Australia in the 2008-09 financial year—almost 10 for every man, woman and child, a six per cent increase on the previous year and a figure that is sure to continue rising over the years of the Fifth Community Pharmacy Agreement. It shows the integral role community pharmacy plays in the nation’s healthcare system. It is one of the foundations of the system. The Pharmaceutical Benefits Scheme could not operate without it.

The Fifth Community Pharmacy Agreement does not differ greatly from past agreements put in place by the coalition, which shows that the Rudd government realises the efficacy of those past arrangements. Key features of previous agreements have been retained, in particular the retention of the community pharmacy location rules and the prohibition on a community pharmacy being co-located in a supermarket as well as continuation of the wholesaler community service obligation payments. The coalition introduced the location rules in a past agreement to ensure provision of widespread community access to pharmaceutical services. They were later amended to prohibit co-location of pharmacies in supermarkets to maintain that access.

The coalition supports free market principles, and we want to see competition in the pharmacy sector, but we recognise that the supply of pharmaceuticals which include dangerous drugs is very different from the retailing of other products. Retailing is about maximising sales and that is not the culture that suits the supply of pharmaceuticals, which should be provided on a needs basis, professionally supervised and professionally monitored. So, as a government, we were prepared to take the decisions that would keep pharmacy apart from the big supermarkets and their retail chains. We did not then, and do not now, believe that replacing focused, often family oriented, businesses with departments of major retail chains would be an improvement on existing arrangements. Delivery of effective, efficient and professional pharmacy services to consumers through a unique community pharmacy model are arrangements that have served Australians well. They are the pedestal on which community pharmacy rests and are necessary to maintain a system that remains among the very best in the world. In negotiating past agreements, the coalition has sought savings from the Commonwealth, but it has also been prepared to introduce other measures to boost community pharmacy and the quality of service it provides to consumers and to ensure the provision of those services across our geographically dispersed nation.

The third agreement covering the period 2000-05 introduced the location rules but, importantly, it included incentives for the pharmacy networks in rural and remote areas to continue to provide quality services and to expand services. It also provided further recognition of the wider and growing role of the pharmacy sector in the provision of health care. The fourth agreement in 2005 established the community service obligation funding pool to ensure that it was commercially viable for pharmaceutical wholesalers to supply the full range of PBS medicines to pharmacies across Australia regardless of location. It also funded a continuation of a greater role for pharmacists to deliver new programs to improve health outcomes in the community in areas such as asthma, diabetes and communicable diseases, and it provided funding for improved access to community pharmacy services for Indigenous Australians. In the main the Fifth Community Pharmacy Agreement recently signed by the Minister for Health and Ageing continues to build upon those core measures.

There are two further matters regarding the fifth CPA that I will comment briefly upon tonight. Under the fourth CPA a review of the location rules, among other matters, was carried out. I note that the results of that review are due to be provided to the government and to a consultative committee established under the new agreement in the very near future. As the agreement says, these are ‘complex issues with significant impact on community pharmacy’. Care will be needed in dealing with them. Secondly, there is one change in this agreement that has drawn criticism, and that is a move to allow pharmacists to dispense some medicines without a doctor’s prescription. The coalition notes the agreement allows for such dispensing only under specific circumstances such as a patient not being able to get to their doctor to obtain a timely prescription renewal. The coalition has been informed that further details surrounding this change are yet to be finalised and that appropriate consultations with all stakeholders are still to take place. It is also understood that these changes will require legislative change at a state level and therefore will provide an opportunity for further scrutiny.

The coalition will not oppose the amendment which will bring the Fifth Community Pharmacy Agreement into operation. It is worth noting, though, that this health minister does not have a proud legislative track record. Her record in bringing health before this parliament is particularly poor, as is this government’s record in actually achieving results with its promises in health like fixing hospitals by mid-last year and having more than a score of so-called GP superclinics opened around the country by next month. Where are we at? The Prime Minister now says he has a plan for hospitals, but he said he had one at the last election. He has promised at the forthcoming election to achieve with that plan what he promised at the last election—that it will fix hospitals, although the word ‘fix’ of course has dropped off his website. No-one will know until some undetermined date in the future exactly when that fix will come, but we know that Mr Rudd’s fix—the one he said that he would complete in 2009—will not be completed now until at least 2020. And what a fix it is: a noodle nation plan of federal and state bureaucracies with money churning around between them before at some point it gets offloaded to a local hospital network where—and I stress this—local clinicians are explicitly barred from serving on governing councils, another broken promise from Mr Rudd who says this plan is all about federal funding and local management.

Mr Rudd told doctors and nurses they would have a say under his plan in the running of local hospital networks, yet clause A10-b-ii on page 14 of the National Health and Hospitals Network agreement signed with the states clearly says that clinical expertise on network-governing councils should be external to the particular network. Our health system is a massive, complex, $100-billion-a-year enterprise, and Kevin Rudd—the Prime Minister who could not even oversee a program to put pink batts into ceilings for free—is going to fix it! I very much doubt that. The Prime Minister’s plan has disaster written all over it.

What of that other big health promise—to deliver superclinics around the country? There are not many of them, and those that do exist are not all that super. After 2½ years in office, just three are open and considered to be fully operational—three out of a promised 31. What a track record this health minister has! Can anyone really believe that this government, this health minister, will deliver the 59 of these clinics now being promised? Mr Rudd and Minister Roxon are good at making promises; they just cannot keep them. They cannot deliver on their promises.

They promised they were not going to change private health insurance. The Prime Minister put it in writing before the last election. But that promise meant nothing. The government tried, twice, to cut rebates to those who choose to take out insurance, to take responsibility for their healthcare costs. The government’s determination to press on and introduce a means test on the rebates remains. There were commitments not to change the Medicare safety net. Those commitments were dumped in a series of callous attacks on patients: a decision to slash Medicare rebates for cataract surgery in half, forcing elderly Australians to abandon treatment or pay hundreds of dollars more for it; a decision to drastically cut rebates for macular degeneration treatment, which left some sufferers with the frightening alternative of blindness; and a decision to cap safety net support for IVF and, likewise, for many obstetric services. The health minister was forced to back down from most of those ill-thought-through attempts to claw back costs at the expense of patients. And now this government want Australians to trust them to spend billions of dollars to ‘reform’ health. It is a so-called ‘reform’ that even the states baulked at until Mr Rudd bought their support with billions of extra dollars. For all that, Victorian Premier John Brumby assessed that under Mr Rudd’s reforms there would be ‘no big changes’.

I turn to the other matter in this bill, amending the Private Health Insurance Act 2007 in relation to the Lifetime Health Cover provisions of that act. The bill amends the legislation to ensure it is consistent for all new migrants to Australia. It removes an anomaly that allowed some migrants extended periods of time—unavailable to Australian citizens and most migrants—before the Lifetime Health Cover provisions applied to them. The change will make the Lifetime Health Cover provisions consistent for all. The Lifetime Health Cover provisions were part of several measures the coalition introduced to strengthen private health after it had been trashed by the Keating Labor government. When the Keating government was thrown from office private health insurance levels had fallen to a calamitous 30 per cent of the population. The introduction of the Medicare levy surcharge for higher income earners who did not take out private health insurance, 30 per cent rebates for those who did take responsibility for their health care by taking out private insurance cover and the lifetime cover provisions, which encourage people to join and maintain health insurance, have seen health insurance coverage levels rise to around 45 per cent of the population. Around 11 million Australians now insure themselves and, in doing so, relieve pressure on our overstretched public hospitals.

Since the Rudd government came to power these important pillars of the health system have been under attack—none more so than the rebates for private health insurance. As I said earlier, this minister and her government appear determined to attack the rebates. Their attacks are ideologically driven with no thought for the consequences. We have warned that the consequences of those attacks, should they succeed, will be serious—a departure from insurance and more people seeking treatment in the public hospital system, with all the attendant problems that will cause. We remain steadfast in our opposition to the government’s attempts to change the rebates for private health insurance. That said, the coalition does not oppose this bill.

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