Dick Adams (Lyons, Australian Labor Party) Share this | Hansard source

This Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010 implements changes to the federal financial arrangements. It gives effect to reforms to the financing of health and hospital services, set out in the National Health and Hospitals Network Agreement, endorsed by the states with the exception of Western Australia on 20 April 2010. The National Health and Hospitals Network agreement includes significant reform to the financing of health and the hospital system and requires modification to the current framework for the financial relationship between the federal government and the states. The current situation is set out in the Intergovernmental Agreement on Federal Financial Relations. The agreement changes the treatment of the GST general revenue assistance payments to the National Healthcare SPP. It also creates new arrangements that allow the Commonwealth to meet its financial commitments under the National Health and Hospitals Network Agreement by making additional top-up payments.

Under the agreement, the Commonwealth becomes the majority funder of the Australian public hospital system by funding: 60 per cent of the national efficient price of every public hospital service provided to public patients; 60 per cent of recurrent expenditure on research and training functions funded by states and undertaken in public hospitals; 60 per cent of block funding paid against a COAG agreed funding model, including the agreed functions and services and community service obligations required to support small regional and rural public hospitals; 60 per cent of capital expenditure on ‘user cost of capital’ basis where possible; and, over time, up to 100 per cent of the efficient price of primary health care equivalent outpatient services provided to public patients. This will be a major opportunity to give major reform to the health services of Australia.

This really does give Australia an opportunity to improve health care in our country. It is greatly in need of it. We can knock off some of the duplications and we can work towards a more practical and efficient delivery of health care. It will also mean that we can get some more sense of funding priorities into regions to focus where we need to put more resources. It will mean great improvements to Commonwealth-state relations. The reforms will lead to getting better value for all Australians from the money invested in health.

Tasmania suffers because it has to deliver primary health care to a small, scattered and decentralised population across the whole island. We also have to deal with current perceptions of what an efficient health care system is. We have many old, small country hospitals that have seen better days and need to be ‘rebadged’ for their actual role. The word ‘hospital’ is something that people can hang onto, even though their ‘hospital’ would not have been thought of as such many years ago. Today, if you are really sick you need to be in a major hospital that can give the needed services. We need to deliver primary health care in our regions in a new and better way, which is what this government is endeavouring to achieve.

We have been discussing this for some time and the change to health funding gives us an opportunity to look at the whole question of health—from primary health care delivery and prevention through to the hospital system. I believe there should be a regional approach and Tasmania has always worked best when three regions have been used as a base for any planning of delivery. This is because local people on the ground have the most experience in delivering services within their boundaries. If they know their areas they can be innovative and make sure that services are delivered in those areas. They can work more closely together and it makes sense to allow the service deliverers and their clients/patients to be able to easily access each other. Technology is going to play a bigger role in service delivery too. People seeking help will be able to use the internet to access diagnostic-type information.

We cannot talk about health without talking about aged care. The biggest problem with our health system in Tasmania, particularly as it relates to hospitals, is that our beds are overflowing with aged care patients because there is nowhere else for them to go. I believe older Australians should be able to choose the location and kind of place they live in, and they should have access to affordable care when needed. But community and residential care is underfunded and therefore the problem is thrust onto the health care system, which leads to a build up of care needs in the public hospital system.

This has to change. I believe that many of the moves this government has made in developing the health infrastructure have begun to make inroads into the waiting lists. Some of these moves include GP superclinics, developing programs that assist regional doctor services to add ancillary activities to their practices, and allowing nurse practitioners to have access to Medicare schedules. These measures will mean that fewer patients will need to go to a hospital because their care can be sorted out at a local level. We do not have to clog up areas around hospitals.

There will still be a need to do something at the other end with aged care and there have been some recent models that have come up with some plain common sense ideas. Any health plan should include an aged care package to allow many older Australians to enjoy growing old and not be parked somewhere where they cannot contribute to their community.

E-health is becoming a reality, even in outlying areas and rural pockets that have hitherto been unserviced and not represented in the health care delivery system. An article in Tasmanian Country on 19 November clarifies this very well:

Local networks are used to check on clients and nurses make phone contact when they can’t make outreach visits.

For instance, they make sure that firewood and food is available by one means or another. They can serve more people because it can take 1½ hours for a nurse to reach a client in the Central Highlands in my electorate, be with them for an hour and then spend 1½ hours on the journey back. The article went on to say:

The use of technology allows nurses to give clients health care that is the first of its kind in Tasmania.

Cars are fitted with mobiles loaded with Wi-Fi software.

Nurses consult with specialists via the phones, which send and receive data.

The Central Highlands is the only place in Tasmania where in home monitors are used to take vital observations such as blood pressure, pulse, weight and blood-sugar levels.

The information is then read and analysed by the treating doctor. No-one has to travel, more people are given fast and efficient health care and these people are allowed to live longer at home. It is a win all round, I would say and I think most people would agree. These are opportunities for the future. With the National Broadband Network this sort of technology will expand and assist us in delivery in ways beyond what we can presently imagine.

The other change that I think would improve the current system would be to use electronic technology to move each individual’s personal records. Each practice seems to have a computer in front of the doctor and records of the visits of patients, treatments, referrals, drug therapies, et cetera, are entered into that computer. Yet if you ask for an electronic copy to take with you to the specialist there is great reluctance to relinquish the information, and the paper trail starts again. I have noticed that even in hospitals one can still see orderlies wheeling around trolleys full of paper folders. These are prone to being lost or containing mistaken entries, yet they are the major information system in many hospitals.

We are well behind where we should be. Technology can help us make gains in efficiency and effectiveness, and make health delivery safer. It will help people make decisions and allow information to be passed on in an electronic format. There are real opportunities within the primary health delivery system and in the hospital system. What can be connected to a bedside situation is unlimited into the future.

The government want to provide national leadership on health and hospitals. The ministers need to be congratulated on the great work that they are doing. But while the government are doing that, we have to allow greater control at the local level. We are determined to work with state and territory governments to deliver the National Health and Hospitals Network. The reforms will include the governance of our health and hospital system and ensure funding sustainability in the future.

We need to deliver better access to high-quality integrated care that is patient-centric. We propose to deliver health care that is designed around the needs of patients, not the needs of the health system. It must be focused on the patient and it should be about outcomes. It is also vital that we focus on prevention and early intervention. It is the new way of delivering health care throughout this nation.

Hospitals should only be used if there are clinical reasons and not for the provision of aged care. There are many things throughout hospitals that can be delivered around clinics and general GPs. The roles and responsibilities between the Commonwealth and the states need to be clarified. It will help reduce duplication of activities and improve coordination. These reforms will put Australia’s financial relations on a more sustainable footing for the future and allow us to better manage health expenditure growth. I support the bill and wish the Treasurer and the health minister every success in its carriage through the parliament.

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