Judi Moylan (Pearce, Liberal Party) Share this | Hansard source

When introducing the National Health Amendment (National Health Performance Authority) Bill 2011 the Minister for Health and Ageing in her second reading speech declared that the National Health Performance Authority would form 'part of the backbone' of the government's so-called health reforms. Such a statement is very hard to assess given that scant details about the workings of the authority are contained in this bill, or in public explanations by the government about how it is to operate.

The bill will amend the National Health and Hospitals Network Act, which passed both houses on 21 March. That act established the Australian Commission on Safety and Quality in Health Care, or ACSQHC, as an independent statutory body. This body existed before that as a non-statutory body established by the Australian Health Ministers' Conference on 1 January 2006, which itself evolved from the Australian Council for Safety and Quality in Health Care, which was created in January 2000 under the former coalition government.

Throughout its various iterations the commission has led and continued to coordinate improvements in safety and quality of health care, reporting publicly on clinically relevant topics, such as patient experiences, medication safety and hygiene, against national standards. Whilst it does not report on performance data of individual health providers, the commission does supply strategic advice to health ministers, especially to drive topical performance improvement and recommend quality and safety standards. In amending the National Health and Hospitals Networks Act, this bill seeks to create a national performance authority to formulate performance standards for hospitals, collect and analyse data to determine whether hospitals are meeting those standards and advise the health minister on the performance of health service providers. The bill does not intend to enlarge the function of the ACSQH or replace it with the performance authority. Instead, the amalgamated bills, to be known as the National Health Reform Act 2011 once enacted, will create two separate bodies, one reporting on existing healthcare standards for safety and quality and advising the health minister on thematic issues and another one formulating performance standards for hospitals, collecting data on hospitals and advising the minister on particular service providers.

The cost to government is $35.2 million for the ACSQH over four years and $109 million over four years for the performance authority. Considering the similarities in purpose of the two statutory bodies and the fact that the government will amalgamate the two bills, it is incredible that the government has not simply considered amalgamating the two bodies. Continually expanding bureau­cracy has been the hallmark of this government's reforms. As outlined by my colleague the shadow minister for health during the debate on the National Health and Hospital Network Bill 2010, the bodies to be established by this government as part of the health reforms include the Independent Hospital Pricing Authority, at a cost of $91.8 million; the national performance authority, at a cost of $109 million; Medicare Locals, at a cost of $416.8 million; the national funding authority, at an unspecified cost; the state-based funding authorities, which have since been scrapped; and local hospital networks, at an unspecified cost. The final figure will be well in excess of half a billion dollars, and perhaps more towards $1 billion, to establish separate bureaucratic bodies.

Whilst the 13 February 2011 agreement of the Council of Australian Governments specifically mentions the creation of the performance authority, its apparent genesis is in recommendation 33 of the National Health and Hospital Reform Commission report published in 2009. That recommendation was:

To improve accountability, we recommend that public and private hospitals be required to report publicly on performance against a national set of indicators which measure access, efficiency and quality of care provided.

The recommendation does not call for a new government body to collect and publish reports. In fact, it places the onus on the hospitals to produce the report publicly outlining whether particular indicators have been met. Of course the government would argue that one of the functions of the performance authority, as the bill outlines, is to investigate and determine exactly what those indicators should be. However, the Australian Council on Healthcare Standards notes in its submission to the House of Representatives Standing Committee on Health and Ageing, which is currently investigating this bill:

ACHS has a well-established, substantial indicator program which holds one of the largest clinical data sets of its type in the world. ACHS is willing to collaborate with the Performance Authority to adopt or incorporate ACHS clinical indicators.

If a not-for-profit, Australian-based organisation already has the available information and is willing to work with the government, why is $109 million of taxpayers' money required to establish a new body?

In her second reading speech to this bill, the Minister for Health and Ageing stated that the government has 'listened to the advice of the National Health and Hospitals Reform Commission.' However, the final report of the reform commission, entitled A healthier future for all Australians, does not mention the creation of a performance authority. It does mention, in appendix H on page 252, that the creation of a national performance reporting and accountability framework—not body—is estimated to cost $12 million, not $109 million. Later, on page 261, the report explains its costings and expands on recommendation 33, which called for performance reporting. The passage states that the:

… Australian Institute of Health and Welfare currently exists and its funding could be increased to reflect an expanded function of national performance reporting.

The Australian Institute of Health and Welfare was established in 1987 as an independent statutory body to provide statistics and reliable information to the Australian government. It collects and analyses data, including on individual hospitals, and is accountable to the parliament through the Health and Ageing portfolio. I had the pleasure of working closely with this organisation when I was a minister and I can vouch for the incredibly good work that the Australian Institute of Health and Welfare does. Its website notes:

… in doing our work, we collaborate closely and have effective data partnerships with many experts from around Australia, including the Australian Bureau of Statistics, government at all levels, universities, research centres and non-government organisations.

The institute even currently supplies data for the government's My Hospital website.

The Australian Institute of Health and Welfare has existed for 24 years. It is an independent statutory body collecting, analysing and reporting on hospital and health statistics, with an established range of partnerships. The expert panel of the National Health and Hospitals Reform Commission appointed by the government called for a relatively modest expansion of the institute to cope with any performance reporting requirements. But instead the government believes that it is appropriate to reinvent the wheel and establish another independent body at enormous cost to the taxpayer. Had the government instead agreed to fund the expansion of the Australian Institute of Health and Welfare, the costs would have been only 11 per cent of that of the proposed performance authority.

How the proposed performance authority shall operate in conjunction with the Australian Commission on Safety and Quality in Health Care and the Australian Institute of Health and Welfare is unknown. No details are included in this bill. There is no detail on how the authority is meant to 'improve quality, increase transparency and drive value for money,' as the minister claimed it would in her second reading speech. Under this bill, the performance authority has no power to compel disclosure of statistics or information by hospitals and health providers.

In pursuing the creation of the performance authority, the government is doing exactly what its own former Minister for Finance and Deregulation, the Hon. Lindsay Tanner, expressly warned against. In a speech to the Australian Institute of Company Directors on 14 October 2009, the then minister stated:

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—

See this speech in context