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

There is a reform debate on right now, and it is an important debate on a range of topics—none more important at this moment than health reform in this country. It is my understanding that over the past few years it has been largely a bipartisan exercise—or a multipartisan exercise—and I would hope that with this first reform bill—the National Health and Hospitals Network Bill 2010that multipartisan reform agenda can continue.

For a region such as mine—a growth region that has for too long suffered from inequity of funding and inequity of health service delivery, and therefore the secondary consequences of less productivity, less participation in the economy and the greater impacts on an ageing community—this is critical to the reform agenda. It is critical for a growing region like the mid-North Coast of New South Wales, and, I would have thought, more generally for the productivity and participation interests of the reform agenda of Australia.

I have previously described the concepts and the theory around health and hospital reform as a slam dunk for the growth regions of Australia. While there have been some incursions by the states into this reform agenda through various COAG meetings, I still fundamentally believe that this reform is important and must happen quickly. We pitched to the previous Prime Minister the importance of two reform agendas in this broad concept of more Commonwealth funding and more local command and control in clinical services. There must be two Es included in this process that will either make or break the successful reform of health services. The first E is equity of funding. For too long, growth regions in this country have been funded for health services in an inequitable way. I think that can also be said for regional Australia generally.

At a recent meeting, the National Rural Health Alliance said they are underfunded under the various state government funding formulas by up to $1 billion per annum. That is an outrageous reflection of how the resource distribution formulas used by the states do not deliver in the interests of all Australians. Over time there seems to have been an acceptance of inefficient overfunding in metropolitan locations at the direct expense of underfunded and efficient regional and rural services. This has led to chronic workforce shortages in rural and regional Australia and to health indicators that clearly demonstrate that sometimes it is a health risk to live in regional and rural areas. The obvious example comes from figures relating to cancer and cancer services, where there are higher death rates in rural and regional areas than in metro areas. So, reform matters and equity of funding matters.

In New South Wales, the Garling report was done in 2007. Specifically for the North Coast, it identified the growing region missing out on up to $70 million per annum based on the state’s own resource distribution formula. For some reason governments have been unwilling to treat the issue of equity as an important part of their brief and they have chosen what I consider to be the lazy option of continuing to overfund some areas and underfund others, and not make the difficult political decisions that would match people movement in this country.

This legislation will hopefully help on the equity front, but it is an ongoing discussion and I will raise it when every single relevant bill about health and hospital reform comes through. The Commonwealth must tie the principle of equity to the flow of Commonwealth dollars to drive this reform process. If that equity principle is not tied to the Commonwealth dollar, we are potentially just going to spin the wheels and fall into the trap of a government once again not making hard decisions when cutting deals on service agreements with all these new local health networks. We will just have a different version of what we had before. I continue to advocate for that equity principle to be included. I know the previous Prime Minister, the now Minister for Foreign Affairs, got it in regards to equity and I hope the current Prime Minister and executive also get it, because that is the key driver of broad reform and it will make these changes to the way health is delivered in this country more significant.

The other E that those of us from growth regions continue to lobby and advocate for is efficiency. One of the original concepts behind the reform agenda was that if a local health and hospital network comes in under benchmark then that money should be returned to that local health network as a way of encouraging efficiency within the system. A criticism up to now is that those that are efficient are not rewarded and therefore there is no incentive to be efficient in the system. This is why comparisons of the costs per bed between private and public hospitals quite often raise alarm bells about why the costs at certain hospitals are so much higher than in other similar hospitals.

Again, I will continue to advocate and lobby for efficiency to be a critical part of this health reform agenda. It will drive efficiency not only on the ground but also within local health and hospital networks. Along with the principle of equity, it will make this reform agenda matter. I would hope those two Es—the principles of equity and efficiency—are front and centre in all thinking as we see these bills come through. I do not see it in writing. I certainly hear plenty of words about it and I continue to seek feedback from the minister and the government about the details of how we are going to see those two Es survive this process and make it valuable.

I think there are quite genuine concerns within the community and health sectors about the final COAG meeting that sealed the deal on this health reform agenda and saw Western Australia fall out and various state agencies somehow slot back into the organisational structure. There are quite genuine concerns about what happened in that last COAG meeting and the implications of that for the reform agenda. I am told, and I hope it is true, that slotting the states back into the organisational chart is nothing more than a mailbox for the flow of money to the ground. But I am certainly watching it closely, and I would hope everyone watches it closely. As soon as a state has the discretion to start making decisions again that are akin to choices about resource distribution, growth regions like the North Coast will again bear the brunt of those decisions. Rather than making the hard decision to take something away from one area, it is easier in politics and policymaking to deny a growing area much-needed capital and recurrent funding. In raw politics that is the way decisions can be made.

I flag as an important issue that that element of human discretion at a state level must not be there. If it is, I will fight it. I will also continue to seek those two key principles—equity and efficiency—as the drivers within important reform. If we can achieve that, I will continue to think this reform process is a slam dunk for growth regions, a slam dunk for this nation on reform and a bit of an answer to today’s media that are asking what the government’s reform agenda is. As everyone is pointing the finger at each other on reform in the last 24 hours, I would hope that this is one of those reform agendas where there is bipartisan and multipartisan support and that through this process that continues over the next critical six to nine months.

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