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

Reform of this bill follows a classic Labor path: reform means creating yet another bureaucracy. The National Health Performa­nce Authority is to be charged with monitoring and reporting on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services. It was to be an incredibly wide-ranging brief. Unfortunately, though, the bill provides absolutely no performance indicat­ors that the proposed authority would monitor and report upon. The government controlled House of Representatives Stand­ing Committee on Health and Ageing held an inquiry into this bill. There was one extremely brief public hearing for the Department of Health and Ageing to answer, seemingly, one question, and a report from the committee was then tabled, with just one recommendation, that being for the House to pass the bill with a minor amendment requiring an annual report to the parliament. Given submissions to the inquiry outlined serious reservations regarding this legisla­tion, coalition members presented a dissenting report that it would be unwise for the House to pass legislation until stakeholder concerns were addressed.

The dissenting report noted:

… there are far too many unanswered questions about the National Health Performance Authority … . The House should not debate this bill until the Government clarifies this matter.

It also noted:

… a number of stakeholders that wanted to contribute to the Inquiry were unable to due to the haste with which the Inquiry was conducted.

So it is worth looking in some detail at what some of the stakeholders said about this legislation. The Australian Medical Associ­ation, for one, has called for the legislation to be deferred, wanting an assessment of the impact of the legislation and detail of what data must be provided to the authority by health provider organisations.

The explanatory memorandum to this legislation states that its measures will have no regulatory impact on business or individuals. The AMA bluntly responds: 'We do not believe this is a true statement.' The AMA is also concerned that smaller private hospitals and medical practices will not be able to cope with some as yet unidentified data collections. It wants the data that is to be provided to the new authority to be included in a disallowable instrument and made publicly available prior to the passage of this bill through parliament. The AMA expresses concern that the legislation does not provide any information on the interaction between this proposed authority and the Australian Commission on Safety and Quality in Health Care, established in the prior legislation, or the proposed independent hospital pricing authority. This stakeholder wants consultation about what this authority will do, it wants open and transparent processes and it wants account­ability to parliament. Passing strange is the claim from the government that the authority is all about enhancing transparency in the healthcare system, yet it does not intend that there be transparency in this legislation.

The Consumers Health Forum of Australia is another stakeholder wanting more information on the areas of perform­ance to be assessed by this proposed authority. In its submission its states:

… we consider that it is appropriate, and indeed necessary, for the legislation to outline at least a minimum scope for the areas of performance to be assessed by the Performance Authority.

Among other numerous concerns, at another point Consumers Health Forum says they 'would like to see more detail about the functions of the Performance Authority'. The forum also wants greater safeguards for patients in relation to information the authority may gather and release.

Clarity, transparency and scrutiny are aspects that recur throughout stakeholders' submissions. The Australian Private Hospi­tals Association has concerns that this new authority will simply add 'yet another layer of compliance burden for both the public and private hospital sectors'. Its submissions to the House committee inquiry stated that 'any national data collection must replace the current system of multiple reports' to multiple government agencies, which it says places a 'significant regulatory compliance burden' on private hospitals. Again, it adds to the cost of delivery to patients. The association argues for real reform but it, too, wants scrutiny of the data that hospitals may have to provide to this proposed authority. And, when decided upon, that data set, the association says, 'should be presented to the Parliament as a Regulation, so that it may be properly and publicly considered'.

The bill was also the subject of a Senate committee inquiry. Submissions to the Senate inquiry raise even greater concerns about this bill. The Royal Australian College of General Practitioners warns that the provisions of this bill hold long-term threats to 'harm the current high standard of medical services, and consequently health services, delivered to the community'.

Catholic Health Australia held similar worries. In its submission to the Senate it stated:

The legislation as currently drafted is very broad – indeed vague – on the scope, range and detail of data that will be required to be submitted.

CHA wanted to see that detail set out in regulations, which would enable the parliament to exercise oversight. It said that such details needed to avoid 'unintended consequences' and that the authority should 'not result in health services unduly focusing on particular performance indicators to the detriment of their overall performance.' CHA issues this warning:

We need, for example, to learn from the recent experience of the Mid‐Staffordshire NHS Trust in the United Kingdom, where it has been reported that between 400 and 1200 excess deaths together with appalling lapses of patient care and hygiene occurred between 2005 and 2009 as a result of the local board and hospital management focusing more on meeting performance and cost cutting targets than on actual patient care.

Apart from those overriding issues, stakeholders found a myriad problems with this bill. The Royal Australian College of General Practitioners was concerned about virtually every aspect of the proposed performance authority from its composition to its functions and powers, its independence and its relationship to the other authorities this government has established and is proposing to establish. A body with such wide-ranging reach over every aspect of health care, the college submitted, should draw on expertise from all sectors, yet the only specification for the make-up of the authority in this legislation is that one of its members must have experience in rural health. The college pointed out that it was unclear whether general practice will be monitored by the authority, and clarity is needed on the issue. It fears that if general practice is to be monitored then onerous data collection and reporting requirements could be imposed on already overworked and overstretched GPs and could subtract from their capacity to deliver services to communities.

Finally, it noted that 'there is a significant overlap between the roles and functions of' this authority 'and the Australian Commi­ssion on Safety and Quality in Healthcare.' Catholic Health Australia echoed many of those points in calling for clarity on the role of the authority, noting that the Australian Commission on Safety and Quality in Healthcare, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics already collect data on hospitals and health services. CHA also wanted the legislation drafted in such a way that the governance arrangements of the authority would reflect the make-up of Australia's health system and therefore would have members with knowledge of public and private hospitals, primary health care and private or non-government healthcare provision.

The Australian Institute for Primary Care and Ageing also raised significant issues with the functional overlap between this authority and the already-operating commi­ssion for safety and quality that would 'place a substantial administrative burden on individual health services'. Its criticisms noted that there was no objective for the performance authority itself and the bill provides only a list of its functions. In response to the minister's past rhetoric about the importance of this new bureaucracy, the institute stated this:

It is difficult to see how the bill will create the "backbone of a modern, integrated, high-performing health system" when the bill itself does not appear to be integrated.

A submission to the Senate inquiry from the Council of Procedural Specialists queried the very need for the authority proposed by this bill. It said it could find 'no justification or compelling case' as to why it is needed. It submitted that Australia already has an independent major national agency to provide reliable, regular and relevant information and statistics on Australia's health and welfare: that is, the Australian Institute of Health and Welfare. The submission said the council had 'concerns about the agenda, nature and ultimate purpose of this new agency'. It went on to say, 'The establishment of a new authority may have a wider purpose than that which is currently being outlined.'

So it is true to say that there were recurring themes throughout many of the submissions to the House and Senate committees, namely that there is a lack of clarity about this legislation and the authority it will establish, a vagueness about what it will do, a lack of goals and objectives, a concern about duplication with other existing and new agencies this government is establishing, worries about the administrative burden being placed on health service providers and concern about the composition of the authority board.

In assessing stakeholder commentary on Labor's so-called health reform, researchers in the Parliamentary Library found that many of the concerns raised by stakeholders were pertinent. In fact, the Bills Digest raises more questions than it answers. Let me just take some of the points and issues raised in the Digest in relation to this bill. It points out, firstly, that it is unlikely that the authority as a single entity will be able to achieve its objectives and, secondly, that the bill does not provide any details on how the three national governance agencies, the safety and quality commission, the performance auth­ority and the pricing authority, will work together to deliver improvements in the Australian health system. The next point is that it is not yet clear how the upstream National Health Performance Authority proposed in this bill will connect with downstream factors, namely, healthcare providers. The fourth point is that this bill does not give the authority any enforcement powers; it cannot compel state and territory governments or private and non-government organisations to provide performance data, and it cannot compel individual providers to make changes that will lead to better performance. Next it is stated that it is unclear how many primary healthcare providers will be monitored directly by the National Health Performance Authority. The frequency of reporting by the national performance authority is not specified in the legislation. It went on to say that the authority is reliant on the goodwill of organisations to provide information; next, that currently the proposed legislation is silent on arrangements for private hospitals; and, finally, that the lack of any specific provision regarding private hospitals in the bill highlights jurisdictional limits on the Commonwealth.

There are some further interesting points from the Digest that I think need to be highlighted, and they relate to the concerns of stakeholders. It summarises them in this way: that this legislation does not appear to reflect the initial remit of the authority except in very broad terms, that there is a lack of clarity about the role and function of the authority and that what the Minister for Health and Ageing outlined as that role in her second reading speech differs to what has been previously outlined by the government. The Digest concludes:

This lack of detail combined with the lack of power attributed to the Authority raises questions about the extent to which the Authority can achieve its objectives as set out in the Bill … or as articulated by Government.

In other words, this was a totally flawed piece of legislation which should not be before this parliament, and the amount of amendments presented today clearly highlights that fact. The Australian Healthcare and Hospitals Association publicly expressed concern in March of this year about the lack of consultation by the federal government with stakeholders. In its submission to the Senate the association stated:

It is clear that the legislation fails to recognise the formal role of state and territory Governments as majority funders and system managers of public health services including overall responsibility (statutory and political) for the performance of LHNs, public hospitals and state/territory primary health care services.

The Western Australian Premier, Colin Barnett, made exactly that point in a submission to the Senate. He said:

… I believe the Commonwealth has gone beyond what is contemplated as the role and function of the NHPA in the HoA I signed at the COAG meeting on 13 February, 2011.

He further wrote this:

… the Bill undermines the States' and Territories' role as system managers of the public hospital system with the potential to significantly disrupt and destabilise the on-the-ground operations of the State's hospitals and health services.

The Premier points out that the authority is being established on the basis of a joint agreement at COAG, and yet the provisions of the bill would allow the Commonwealth minister, without consultation with the states, to extend the functions of the authority. That, the Premier said, was unacceptable to Western Australia. The Victorian minister apparently expressed similar concerns in a letter to Minister Roxon, which brought up the multitude of amendments now before us.

Given those views—and it is my understanding that it was not just the two states I have mentioned; several other Labor states expressed a similar view—ultimately Minister Roxon realised that she needed to consult with the states overall on her so-called historic reform and consequently was forced to convene a special meeting of the Australian Health Ministers' Conference at an airport lounge in early June. As the communique from that meeting stated, the ministers agreed that the states and territories are the system managers and, as such, the performance managers of public hospitals in our country. That is now reflected in the amendments before the House. New clauses spelling out the role of state and territory health ministers as health system managers form a key amendment stating that this parliament will acknowledge that role and that the parliament intends that the national performance authority in performing its functions will have regard to that role. The Council of Australian Governments will be able to set policy principles for the authority rather than this minister being able to simply impose her view on the world and ride roughshod over what are rightly state functions.

Other amendments which this minister now puts forward will limit her actions in relation to this national performance authority. The minister will need the state and territory ministers to approve her specifying which bodies and organisations are local hospital networks or hospitals for the performance authority to report on. The authority's function to monitor and prepare reports on healthcare services other than hospitals, hospital networks and primary care will need approval in writing from COAG. The minister will need approval from COAG if she intends to widen or change the functions of the performance authority. The scope of the authority's reporting will be changed totally by these amendments. The authority will not have the right to directly consult and seek responses from individual hospital networks or hospitals where reports of poor performance are being prepared. Under these amendments, it will provide the reports to and seek responses from state ministers. The authority's strategic plan will also need agreement from the states.

So change has been forced upon this hapless minister. States' concerns have been addressed. The minister has been sanctioned and duly embarrassed. But not all of the significant concerns and issues voiced by stakeholders in their submissions to the House and Senate committee inquiries have been addressed. In particular the private sector of health is no clearer about what the establishment of this new bureaucracy will mean for it and whether it will face a new and increased burden in reporting to yet another arm of government.

This remains an unnecessary and flawed piece of legislation. I would remind the House that, at the time the government introduced the National Health and Hospitals Network Bill that this bill now seeks to substantially amend, the coalition called on the government to introduce all of the provisions for all of the new bureaucracies it sought to establish in one piece of legislation so that the parliament, the stakeholders and the public could see exactly what this government proposed with these authorities and their operations. I repeat that call again today. I call on the Independent members of the House to note the serious issues that have been brought to the fore and the widespread deficiencies pointed out in this legislation. I call on them to support the opposition in refusing to give this bill a second reading and to put a halt to this piecemeal approach and growth of bureaucracy.

In summary, it has to be said, particularly with the developments of the last 24 hours, that this is a government that are completely shambolic. They promised as far back as 2007 that they would fix public hospitals. They promised to become the major funder. They promised that they would work in a collaborative way with the states. They have promised amendment after amendment and reform after reform. I think on three or four occasions different iterations of the reform have been described as historic by this government. Nothing is further from the truth. They have walked away from, backflipped on, compromised on and ultimately given up on every piece of reform that they have had on the table for the last four years.

This Prime Minister said four months ago that she had an agreement. It turned out to be a heads of agreement to agree at a later date. Four months down the track what we find is that they have had to delay the COAG process, not because some sort of result is pending and they need to tick off on a couple of additional points, as the minister pointed out, but because, as the minister loosely let slip yesterday in a press conference—embarrassingly, she later had to have her press secretary call up and say, 'This is under embargo until tomorrow'—this government have basically given up on health reform. It is patients around the country who are suffering as a result. It is clear that this minister has no capacity to negotiate.

As we have seen during the course of the last few years on every issue that they have put before the Senate, the government have either compromised or let it go. They have no capacity to negotiate and it has been seen clearly over the last 24 hours that the states have completely outmanoeuvred and outnegotiated what is a desperate govern­ment. The problem for this government is that they are a buyer in distress. The Indonesians know it in relation to other debates at the moment. The Malaysians know it in relation to other debates. The Australian business industry knows it in relation to other debates that are underway at the moment. The Australian premiers and health ministers know it as well. This is a government on the ropes because of their own incompetence. They have not been able to put forward a coherent package.

We warned on a number of occasions that this eventuality would be arrived at in the health portfolio. We said to the government, 'Do not bring forward this piecemeal approach of additional bureaucracy.' That was the formula that New South Wales Labor had for health. That is the formula that Queensland Health still has in place because of the Labor government in Queensland. Increasing the bureaucracy and increasing the burden of bureaucracy in the health system is not the way to fix our health system at all. In fact, what Labor is enacting at a federal level is the completely failed model of New South Wales, Victoria and Queensland Labor over the last decade that has led to disastrous outcomes. This govern­ment now seeks to try and apply that same failed formula, not just to this aspect but also to the private health insurance arrangements that are proposed at the moment, which I think would put into ultimate decline the private health insurance numbers in this country and increase the burden on the public health sector at a time when Australian families cannot tolerate another increase in their out-of-pocket expenses as proposed by this government.

Throughout the period of this Labor government, first under Kevin Rudd and now under Julia Gillard, there has been constant talk about health reform—but, as I say, very little in the way of concrete results. Despite the pages, the multitude of press releases, the communiques, the agreements and the numerous volumes of publications produced on health reform, many are left shaking their heads at the lack of actual detail about how most elements of this so-called reform are actually supposed to fit together and operate in the real world. The reality is that the government do not know what they are doing in every area of their responsibility, and that is sadly the case for health as well. I think Australian patients right around the country, and the whole public, want to make sure that we see improvements to our health system—but this government just do not have the capacity to deliver on that which they promise. They may well be full of good intent but they have no ability whatsoever to deliver what reform is desperately needed. This government have squandered four years of opportunity, and there is no light at the end of the tunnel. Accordingly, I move:

That all words after “That” be omitted with a view to substituting the following words: “the House declines to give the bill a second reading until provisions establishing the Independent Hospital Pricing Authority, including its functions and responsibilities, are presented to the House for its consideration.”

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