Ken Wyatt (Hasluck, Liberal Party) Share this | Hansard source

I rise to speak against the National Health Reform Amendment (National Health Performance Authority) Bill 2011. I do so on the basis that I am part of the Standing Committee on Health and Ageing, which looked at this. After reflecting on the legislation, revisiting the Council of Australian Governments website and casting my mind back to three significant bodies that exist at the national level and that work in concert with state and territory jurisdictions, I came to the view that we are duplicating an area which, if it were tweaked within the three bodies that currently exist, would be a much more effective use of taxpayers' money.

The proposed bill will amend the National Health and Hospitals Network Act, which established the Australian Commission on Safety and Quality in Health Care as an independent statutory committee. I listened to the member for Hindmarsh's comments, which in a number of areas were important. But I think there are elements within the health arena that we have to seriously consider when we establish bodies to take on the national role of collecting data, reporting and monitoring. We have to consider how that information is used. Often the complexity of health is not considered in its fullest context because each state and territory implements its services differently. Their priorities are based on state and territory needs. The other element that we can never capture in data is the human element, which is absolutely critical in the role of the health workforce in improving health outcomes.

This bill will establish the authority which will monitor and report on the performance of the local hospital networks, which are still evolving; public and private hospitals; primary healthcare organisations and other bodies that provide healthcare services. What I found fascinating is that when you go to the COAG website you find a list of those agreements that have been developed under the Council of Australian Governments with the involvement of health ministers from each of jurisdictions. We have the National Health Reform Agreement, the National Partnership Agreement on Improving Public Hospital Services, the expert panel report, the National Healthcare Agreement, the Intergovernmental Agreement on Federal Financial Relations and a brief summary of the Commonwealth investments in public hospitals.

If you look at these NPAs, or national partnership agreements, you will see the structure of them. They talk about the focus of the work and the outcomes to be achieved. They also identify the reporting elements within each of the agreements. Within states and territories—through the COAG process and the reform under the Rudd government, and through the Australian Health Ministers Conference and the Australian Health Ministers Advisory Council made up of the directors-general—there is broad agreement on what the measures should be. There was rigorous debate through the Australian Health Ministers Advisory Council on the types of data that needed to be collected and how it was to be used, and what reforms would take place and how the data would underpin that. But the emphasis was on the states and territories. When you read through these—and I invite any member who has spoken today not to restrict themselves to the proposed bill alone—you can look at those other elements that have been negotiated over a period of time in reaching directional-setting objectives for the reform of the healthcare system and the delivery of services, policies and programs.

Another point I want to make is that the data that is collected is produced in reports. There are something like 28 reports from a number of minimal data collections. These data collections are reports that are released biannually or within an arranged time period when they are investigated, the data is collected and a report is done. I know for Aboriginal health a jurisdiction can pay additional money to the relevant agency—I will come that agency shortly—to get a particular state slant on the data. So they can receive a WA-emphasised report, or a report based on that jurisdiction.

I find it fascinating that we have so many datasets, collections and reports and yet we are not using those. In a sense, they have a historical basis. Why do we need to establish another authority to collect data when that authority does not tell me what is going to do with it? We talk about reform, but when I consider the burden of collecting data I realise that you are taking people away from frontline services. You are taking them away from delivery of health care that is needed at the various levels within each of the state and territory jurisdictions, including the primary healthcare providers. It is a cumbersome process. If we want a healthcare system that works, do not tie people in frontline services to collecting data that feeds a beast that has been established in Canberra. To me this is a centrist approach and what we will see again is a grab for the control of the health agenda. To me the Australian parliament sits at the heart of Australian federalism. The Australian parliament continuously positions itself as a dominant player in the national political deliberations but does not have exclusive responsibility. We have state and territory governments who are the front-end providers. Professor Brian Galligan, in a paper from the Politics and Public Administration Group on 26 June 2011, titled Parliament's development of federalism, states:

The National Government was given defined powers—either exclusive or concurrent—whereas the States retained the residual. Where there is overlap, Commonwealth laws prevail to the extent of any inconsistency.

It is my view that this bill will provide the Commonwealth with authority over the state and territory governments and this will be extended by practice through the implementation of public sector erosion of the responsibility of the states and territories. When you work in that sector you protect the area in which you work. If you have a leadership role then you certainly identify those very key things that you want to achieve within this framework. To me it is control by stealth.

By adopting a written constitution we confined notions of parliamentary sovereignty by the terms of the Constitution itself. Support for a federal rather than a unitary constitution was unanimous amongst the delegates in the 1891, 1897 and 1898 conventions because the states wanted to protect their responsibility for the provision of front-line services. Health is a key area where states and territories consistently deliver at the local level. Those programs and services are often shaped by the recipients. Certainly we use data about elective surgery waiting lists and about time spent in emergency departments but we also have to consider the drain and the pressure on health-care systems. Both parliament and federalism are core features of the Australian Constitution which created an indissoluble federal commonwealth based on the consent of the people of the Australian colonies.

The bill will change the title of the act to be the National Health Reform Act 2011. It amends the current act to distinguish between the two new authorities and introduces provisions relating to secrecy and disclosure of information. Why would you want secrecy if we are being transparent? Why wouldn't we want to make sure that everybody had the information that is being collected so it is relevant and seen by all?

These authorities came from the first set of commitments made under the Rudd health reforms and outcomes of the COAG meeting that was held in April 2010. I spoke against the original bill and questioned the need to establish three new authorities given the existence of the Department of Health and Ageing, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. I turn to these bodies. In the Australian Bureau of Statistics Act 1975 it states:

ABS is one of many providers of statistics (albeit the largest) that are used to inform research, discussion and decision making within governments and the community. The organisations and arrangements, formal and informal, which together provide such statistics, form Australia’s national statistical system.

Section 6(1) of the act outlines the function of the ABS, and I want to cite two of these:

(a) to constitute the central statistical authority for the Australian Government and, by arrangements with the Governments of the States, provide statistical services for those Governments;

(b) to collect, compile, analyse and disseminate statistics and related information;

Why wouldn't you use the ABS and extend its role and function without having to create another layer of bureaucracy?

Secondly, the Australian Institute of Health and Welfare informs community discussion and decision-making through national leadership and collaboration in developing and providing health and welfare statistics and information. The Australian government, through AIHW, collects health and welfare statistics related to the information they seek and then develops specialised statistics standards and classifications relevant to health, health services and welfare services in conjunction with the ABS. The AIHW is prescribed as a Commonwealth authority under the Commonwealth Authorities and Companies Act 1997, and it has a leading role in supplying national data for reporting on a range of performance indicators and output measures for the national agreements adopted by the Council of Australian Governments. The institute develops, collects, analyses and reports high-quality national health information, and I have been a user of those reports. The information contained in those reports is very informative and publicly available and it helps with some of the planning directions that need to be set. AIHW works with the Australian government, state and territory governments and other stakeholders to ensure that high-quality and consistent data and information are available to underpin the COAG reform agenda and the health reform agenda.

Finally, we have the Department of Health and Ageing, which has a broad functional role but is still one of the key Commonwealth bodies. So we have three significant bodies and if I were in the position of determining whether we needed another one, I would determine that we did not. I would argue that we should use those bodies effectively, sending the money and funding to front-line health services that are badly needed in rural and regional Australia, and then through the hospital networks. It is a pity that we become consumed with the establishment of additional bodies that collect and report data, and certainly the Senate inquiry had its own findings with respect to the legislation.

Western Australia, in correspondence signed off by the Premier of Western Australia, made the following point:

Firstly, in relation to the scope and functions of the NHPA, the Bill as currently drafted allows for the possibility that the real work of the NHPA could be broadened in scope beyond that contemplated by the HoA.

In other words, there is a capacity to extend its role and function. There is not a requirement, as the WA letter goes on to say, to go back and deal with those issues. In a major rebuff, the health ministers in a communique stated:

Health Ministers agreed that States and Territories are the system managers and as such the performance managers of public hospitals in Australia. The Performance Authority will report on the performance of hospitals and health networks, and these reports will be provided to State and Territory Health Ministers, as the system managers, prior to public release;

Then they go on and talk about the watering down of powers, the role of the NHPA, empowering state ministers and requiring the Commonwealth minister to seek state ministerial and, in some instances, COAG approval for the role of the authority. This is not a bill that I would support. I would certainly support its referral to a Senate committee to have a look at the issues within the bill, to identify and look at how the roles and functions of those three existing Commonwealth authorities operate and provide that service now, and also to look at the cost-effectiveness of the use of taxpayers' money, which could be better directed to frontline services that would see the reduction of elective surgery lists, see better health care being delivered at the point of need and the underpinning and support of the local Medicare networks that will come into place.

I believe that we do need real action and real reform, but there is also a reality in this day and age that we do not have an endless bucket from which we can pull all of the initiatives that are being announced and all of the bodies that are being established under various pieces of legislation. I ask the government to be much more considered in the establishment of this authority, be more frugal in expenditure and utilise the resources that are currently in place that have served health systems at the state and territory level and at the Commonwealth level. There are also the COAG processes that complement the work that they do.

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