Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

I think people in the gallery must be getting quite used to health debates where both sides of politics just complain about cuts by the other side. It is simply unsatisfying, I think, for people listening to this debate. More tragically, Australia really is one of the few nations where we have this deep partisan political divide over health care. We are almost unable to talk about significant improvements in the quality of health care because there is an abject fixation on the quantity of funding. I think that may seem, quite superficially, a reasonable place to start—how much money we are spending on health—but ultimately, when you are talking about the user experience in health, it is about the quality of the money spent and whether it is directed appropriately. It would be very helpful if we could rely on both sides of this chamber, at some point in this three-year term, to engage meaningfully in that debate. I could spend my next four minutes talking about how they cut money and how they froze stuff. Of course, there is a litany of these descriptions that can be attributed to both sides of politics, but that is not going to help us get anywhere.

Ultimately, we need to turn to the smartest minds in health policy and say to them, 'What will take us forward?' As a former GP, with respect, I would certainly appreciate it if my payments were indexed every year; I would be very happy for that to occur. But some greater good needs to be considered, and that is the sustainability of the system that provides those services.

Now, both sides are guilty of this, so before we get into simply regurgitating the ministerial talking points let's just remember that ultimately the fee-for-service approach is increasingly becoming difficult to sustain high-quality care with. If it is simply focusing on how many item 3s, 23s, 36s and 44s you can bill in eight hours in a cowboy practice in an inner city where you are seeing 80 patients a day then, honestly, time is a very significant proxy—an inverse proxy—of quality of care. I want to see the GPs who are doing the serious work with chronic disease, seeing 20 or 30 patients a day, acknowledged and rewarded. But you cannot if you simply let Medicare rip with overservicing in areas where it is all about the speed. Unless you have an honest conversation about that—me and you—an honest conversation about rewarding quality, then we will simply have these debates forever and a day.

It was Francis Peabody back in 1920 addressing the Harvard Medical School who said that the key to caring for patients is quite simply the care of the patient. So how do we penetrate and say what the best possible user experience is? I would have to say that even you over there across the political partisan divide have to confess that we need to look at the new models that are going to deliver quality—the healthcare outcomes start there. There are 360,000 nurses enrolled, 200 practices across seven PHNs and we are just going to say, 'Enough of the alphabet soup of health authorities!' We do not measure ourselves simply on how much money we spend—how many pot plants we can put into multi-high-rise buildings full of non-service-providing bureaucrats providing data we never use! That is not improving health, although it is spending more money. It is not just about the quantum. It is about the effectiveness of the spend.

With respect, it was Kevin Rudd, with so much promise, who talked about running the show nationally but controlling it locally. But in the end it was funded by debt and completely out of control. He came to the states and said, 'Look, we'll swap the 40-60 federal-state funding split to 60-40, but we are going to do a smash and grab,'—or should I say, 'A grab-and-smash tactic'—GST and take 30 per cent of your GST to do that change,' meaning the Feds put just one disappointing per cent more into the hospital mix. They smelled that a mile away and that is why at the end Catholic Health Australia and the COAG reform council said, 'Look, you made barely two per cent difference in the rate of people being seen in A&E in a reasonable period of time but you let the OR rates blow-out.' The chance of seeing a GP blew out. Stephen Duckett, your age-old ally said it himself. He said it was an alphabet soup of new authorities, tonnes of data and no changes in access to community care—no changes. In fact, a blowout in residential aged care.

Just be honest with yourselves: you were no better at running the show. But we can together work to make sure money is spent better. That has to be the objective here. Sure, we do not control many levers here in the federal government but we need to work with states to do it better. Stop funding corporate health and start devolving responsibility; let the regions of our great states have more say in how they employ, how they fund and how they deliver health services. Call it a Medicare Local, call it a PHN—the future is giving support to general practitioners and private direct primary healthcare providers to do their job better. It is not about buying more three-by-three tents. It is not about standing outside fairs and saying, 'Please, grab an apple or come for a walk.' Ultimately it is about taking the sickest, most stratified, high-need patients and giving them the care they need—the wraparound care they need. Together, I secretly believe both sides of this chamber can achieve that noble goal.

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