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

The bill before us today, the National Health and Hospitals Network Bill 2010, establishes the Australian Commission on Safety and Quality in Health Care as an independent statutory body and provides for the establishment of the National Performance Authority and Independent Hospital Pricing Authority under the proposed National Health and Hospitals Network reforms.

The commission was established under the previous coalition government by Australian health ministers on 1 January 2006. It evolved out of what was known as the Australian Council for Safety and Quality in Health Care, which had itself been established in January 2000. It has developed an important role in the Australian health system to, firstly, lead and coordinate improvements in safety and quality in health care by identifying issues and policy directions and recommending priorities for action. It disseminates knowledge and advocates for safety and quality. It reports publicly on the state of safety and quality, including performance against national standards. It recommends national datasets for safety and quality, working within multilateral government arrangements for data development, standards, collection and reporting. It provides strategic advice to health ministers on best practice thinking to drive quality improvement, including implementation strategies. And, finally, it recommends nationally agreed standards for safety and quality improvement.

There have been advances made in areas such as clinical handover and infection control as a result of the work of the commission. The commission is currently resourced through the Department of Health and Ageing by means of a cooperative agreement and funding from state and territory governments. The coalition does support an ongoing role for the commission within existing resources, but we hold serious concerns about this government’s capacity to efficiently and effectively implement its supposed health reform agenda.

There are reports in some jurisdictions that there have been signatories to the agreement who are now reconsidering their positions and have raised concerns about a number of aspects of this government’s proposed reforms. It was reported in the Age on 11 August this year that leaked emails show ‘a long list of concerns raised by executives from Victoria’s health department during a meeting with Commonwealth representatives last month’. The leaked emails, between Commonwealth and Victorian officials, reportedly went on to claim that it was extremely difficult to examine aspects of the reform package because it was ‘hard to tell what the Commonwealth was trying to do’. Some of the additional concerns specifically include how the new funding arrangements would work, Victoria not being included in discussions about the draft boundaries for Medicare Locals, how specialist hospitals would fit with local hospital networks and whether Medicare Locals would be private companies or statutory bodies.

The agreement establishing the National Health and Hospitals Network was motivated by urgent political need, rather than as genuine and considered policy response. This was evident very early with the scrapping of the National Funding Authority just after it had been announced. The authority was central to the National Health and Hospitals Network Agreement as ‘a joint payment authority which makes it absolutely transparent that the money actually goes through to the service providers’. That was the then Prime Minister, Kevin Rudd, on Sky News on 21 April 2010. To quote Kevin Rudd again:

What we’ve agreed to with the states and territories is not a state delivery agency; what we’ve agreed to is a joint state-Commonwealth statutory body which becomes the payment authority. There’ll be full transparency, therefore, about how the money is being delivered to each of the local hospital networks.

That was again on 21 April.

The minister’s response to the scrapping of the funding authority showed that the reforms were being driven as a political strategy out of the then Prime Minister’s office, particularly as he became more desperate day by day to cling on to power, and it was certainly not based in a sound health policy perspective:

I’m afraid you’d have to put the question to PM&C about why they decided to release it at a particular time last night, that’s not something that was in our remit.

That was not from a junior minister; that was actually from the Minister for Health and Ageing, Nicola Roxon, at a press conference on 17 June 2010. It demonstrated the dysfunction within the government of the day. It demonstrated that decisions were being made purely based on political outcome, not on good policy outcome. That was the approach of the then Prime Minister, Kevin Rudd. It is why the Labor Party got rid of the Prime Minister and it is why the health minister was completely excluded from deliberations which ultimately resulted in a compromise proposal, not one worthy of the much-needed health reform in this country.

In responding to questions as to why the funding authority had been so essential only weeks earlier, the minister stated:

… it’s not appropriate for us to establish an authority where there is not a need to do so.

Unfortunately, bureaucracy was not one of this government’s reforms. The bodies to be established include the Independent Hospital Pricing Authority, at a cost of $91.8 million; the National Performance Authority, at a cost of just under $110 million; Medicare Locals, at $416.8 million; National Funding Authority, cost unspecified and, of course, since scrapped; the state based funding authorities, cost unspecified; and local hospital networks, cost unspecified.

The scrapping of the National Funding Authority and Victoria’s leaked concerns about Medicare Locals and other elements of the proposed network show that there is a lack of coordination and huge scope for waste and mismanagement in the government’s approach to these reforms. The claims of the Commonwealth being the so-called dominant funder, as mentioned in the minister’s second reading speech, were never credible. John Brumby said at the time:

I object strenuously to the fact that these funds are being taken from our state and from other states and then being recycled back as “New Commonwealth money”. What our analysis shows absolutely conclusively is that there is no new money in this for Victoria.

That was on 8 April on the 7.30 Report. Rather than 30 per cent of GST being quarantined by the Commonwealth, as was first proposed, the budget estimates show that for some jurisdictions in 2011-12 it will be up to 49 per cent. We already know that taxpayers in states such as Western Australia receive far less back from GST than they pay. According to the COAG agreement, the amount of states’ GST dedicated to funding the federal government’s supposed 60 per cent hospital costs will not be fixed until 2014-15. It remains to be seen how many jurisdictions will remain a party to the agreement at that time.

I also take the opportunity to address the comments in the minister’s second reading speech regarding after hours care. Under the government’s health reform proposals, GP surgeries will lose $58 million in practice incentive payments for after hours patient care. The President of the Royal Australian College of General Practitioners, Dr Chris Mitchell, was reported on 15 July 2010 as saying that removal of the incentive payment of up to $6,000 a year per doctor will have ‘enormous implications for the role of the GP’ and ‘has the potential to have an impact on the viability of general practice to deliver the services outside normal opening hours’. In fact, Dr Mitchell went further and said the removal would:

… jeopardise the fragile availability of after-hours services in some areas, and potentially increase the burden on ambulance call-outs and emergency department presentations.

What becomes very clear about this government’s so-called plan is that it has adopted the same failed approach as the state and territory Labor governments—that is, to increase bureaucracy at every turn, to drag money away from frontline services. It is not a formula that has worked at a state or territory level. In fact, it has compounded much of what we see that is wrong in the health system today and this government, for ideological purposes, has decided to go down the same failed path. These incentive payments are to be withdrawn from 1 July next year, with Medicare Locals not operational for another two years—that is, until July 2013. This supports the concerns raised by the Victorian government and is further evidence of the inability of this government to competently implement policy. It is a matter the minister is yet to resolve.

The Labor government’s National Health and Hospitals Network reforms purport to localise control of the health system. Unfortunately, the evidence suggests that these changes will result in centralisation and bureaucratisation. The partnership agreement states that local clinicians are not to directly participate in their local hospital network. Of course, lead clinician groups were proposed in response to criticism of the government on this issue, but it is still unclear what practical role they will have in decision making and resource allocation. The coalition believes it is important that local clinicians have an active role in the running of local hospitals. Doctors and nurses who know their hospitals are better placed to respond to on-the-ground needs than bureaucrats in a central office.

A single local hospital network for all of Tasmania has previously been proposed. Clearly, this could lead only to a greater centralisation of health and hospital services. If local clinicians are not to participate in the local hospital network in which they work, what happens if ultimately one network covers an entire state? Only the coalition’s proposal for community controlled hospital boards would provide for genuine local and clinical control and better management of our health and hospital systems. I note that the minister made mention of the government’s 1,300 promised beds in her second reading speech. I remind the minister that the coalition promised more than double that number—in fact, 2,800 beds—which is what is really needed to address access-block and reduce elective surgery waiting times. The government’s Medicare Locals are themselves anything but local. Once again, it has been suggested that only one is to cover all of Tasmania and only one is to cover all of the Northern Territory. General practice needs more flexibility, not more red tape. Again, it has been difficult for the minister to articulate in practical terms how Medicare Locals will interact or coordinate with local hospital networks.

The minister also made mention in her second reading speech of the role of GP superclinics. The coalition strongly supports general practice as the cornerstone of primary health care. The coalition’s plan to invest significantly in longer GP consultations, after hours care, practice nurse services, MRI referrals, infrastructure grants and rural bonded scholarships would greatly enhance access to GP services and build on existing infrastructure. The coalition shares the concerns of many health and medical professionals about Labor’s policies that undermine the doctor-patient relationship and the viability of existing family GP services. In addition to the changes to after hours care proposed under these reforms, the bungled implementation of the GP superclinics program represents another policy delivery failure of the Labor government. In particular, with only four of the original 36 fully operational after the Labor Party’s entire first term of government, it underscores the ineffectiveness of this Prime Minister.

Many patients, doctors and other health professionals are concerned that the viability of existing family GP practices will be jeopardised by Labor’s poor implementation of this program. There is evidence that an unfair regulatory environment has been created for existing family GPs. GP superclinics not in districts of workforce shortage have been able to employ overseas trained doctors when established practices in the same area are not permitted to do so. The withdrawal of services by established family GPs will be detrimental to patients who have grown to trust and rely on the dedicated services of their family GP over many years. The minister must guarantee that no existing general practice services will be reduced or closed as a result of the government’s GP superclinics program which she referred to as part of her comments on this bill.

I was sorry, I must say, to hear the minister only make a passing comment on mental health care as part of her contribution. Access to specialised mental health services is vital in alleviating pressure on health and hospital services, especially in regional and rural areas, and it is an enormous failure of this government to exclude it as part of its proposed health reforms. The coalition has provided a comprehensive $1.5 billion plan to greatly improve access to services through 800 additional mental health beds, 60 new Headspace sites and 20 early psychosis prevention and intervention centres. If this minister were serious about genuine reform of the health system, she would listen to the support amongst health experts, within this parliament and in the wider community for this policy and act to implement it.

The bill before us does state that the act will be amended to include provisions to establish the Independent Hospital Pricing Authority and the National Performance Authority. Whilst the coalition supports the work that has been done and can continue to be done by the Commission on Safety and Quality in Health Care, we hold serious concerns about this government’s ability to establish new, stand-alone bureaucracies that have a tendency for blow-outs. That ability should be questioned because this is a government that has at every opportunity increased numbers within the bureaucracy, and this is no exception. As I said before, people need to cast their minds back to when this particular policy was formulated. It was formulated by a Prime Minister who at the time knew that the public tide was turning against him, who knew that his own colleagues were not supporting him. Over the course of the weekend I read Barrie Cassidy’s book, and it just underscored the dysfunction that took place in the government at the time. The public should never forget that this policy was formulated by a desperate Prime Minister at a time when he was trying to detract attention away from the debates about insulation and about the school halls rip-offs. This was not a policy which was developed to try and fix the problems that exist in health care today. This was not a sincere government in its approach to policy at that time.

The scrapping of the National Funding Authority did ring alarm bells about a general lack of coordination and forethought in the establishment of new bureaucracies. It is unclear how the function of the commission will coordinate or interact with the functions of the Independent Hospital Pricing Authority or the National Performance Authority. The government should have introduced provisions for all the proposed bureaucracies together. It remains unclear why the minister has delayed legislation for the National Performance Authority and Independent Hospital Pricing Authority.

I would like to draw the House’s attention to the comments of the former Minister for Finance and Deregulation, Lindsay Tanner, from his speech to the Australian Institute of Company Directors’ Public Sector Governance Conference on 14 October last year. He said:

The indiscriminate creation of new bodies, or the failure to adapt old bodies as their circumstances change, increases the risk of having inappropriate governance structures.

This in turn jeopardises policy outcomes and poses financial risks to the taxpayer.

He went on to say:

Incorporating a new function within a department is almost always the preferred option because of the difficulties a small body faces in meeting its own needs.

The coalition supports the role of the commission but, consistent with Mr Tanner’s views, believes that this can be achieved within the resources of the department. The coalition calls on the government to provide all provisions to establish all bodies intended under this bill.

This is a government that has turned a $20 billion surplus into a $41 billion deficit and is paying around $4.2 billion in interest on net debt this year alone. The coalition maintains scarce resources should be focused on front-line clinical care and will not support the creation of new bureaucracies without a strong and reasoned justification. At the very least, the minister should allow the parliament to scrutinise the complementary functions of the proposed bureaucracies together. Accordingly, I move the following amendment:

That all the words after “That” be omitted with a view to substituting the following words:“the House declines to give the bill a second reading until the following provisions are presented to the House for its consideration:

(1)

provisions establishing the Independent Hospital Pricing Authority, including its full functions and responsibilities; and

(2)

provisions establishing the National Performance Authority, including its full functions and responsibilities”.

This is a government that needs to be held to account. It has—and not just in this program but in a number of others—created additional bureaucracies by at the same time distracting and taking away valuable and scarce resources to front-line services. The government should be called for this stunt. This was set up as a political distraction and it really lets down the doctors, nurses and patients right across the country, all of those people working in health care who were desperate for the reform that they thought Kevin Rudd had promised in the 2007 election when he said that he would fix public hospitals. But this is a government that has failed and this is why the coalition takes a principled stance in relation to this matter. We will not tolerate Labor’s additional bureaucracies. Billions of dollars have been wasted at a state level and that same formula is now being applied at a federal level. We want to provide support to doctors and nurses at the front line. The coalition stands for a more practical, purposeful outcome, and we will continue to fight until we achieve such an outcome.

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