Tony Zappia (Makin, Australian Labor Party, Shadow Assistant Minister for Medicare) Share this | Hansard source

I speak in support of the amendment moved by Labor to the motion for the second reading of the My Health Records Amendment (Strengthening Privacy) Bill 2018. Since coming to office, the coalition government has resorted to every crafty trick to cut health spending across the country. It's done so firstly by freezing the Medicare Benefits Schedule payments to doctors—with out-of-pocket costs now rising, I understand, to something like on average $38 if you want to see a GP or $88 if you want to see a specialist—and then by negotiating dud deals with pathology centres with respect to their rent payments; three different attempts at co-payments by patients; cutting hospital funding to the tune of $715 million between 2017 and 2020, and more after that; cutting public dental services; cutting Indigenous health programs; and refusing to increase payments to GPs when they visit people in aged care. Bear in mind that the aged-care access incentive payment, I understand, ends in April of next year, and that in effect means that we will see fewer GPs visiting our aged-care centres. We just had a matter of public importance discussion with respect to the care of people in aged-care facilities across Australia, and one of the real concerns that arise from this government's cut to health expenditure is that the AMA has predicted that, over the next two years, one in three doctors who visit a patient in an aged-care centre will either scale down their visits or cut them out altogether. Again, this is all because of cost cutting by this government.

I accept that, in a budget that stands at something like $78 billion of health expenditure, the government would be responsible in looking to make efficiencies in that expenditure. Every government should be constantly trying to go through its outlays and seeing where money can be saved if it can be, and I have no criticism of governments trying to do that. But I have criticism of governments doing it when the savings result in a diminution of patient care for people across this country. If a saving can be made without diminishing service and without diminishing patient care, by all means we should look at it. That's exactly what the My Health Record was expected to do when it was proposed by Labor in 2012.

If properly administered, the My Health Record system was going to have the dual objective of providing better patient care and lower health costs, and I will explain why. Patients benefited because the treating health professionals would have had access to all patient records, not just some, regardless of where the patient went to see a doctor. That meant the doctor could make a decision based on the best interests of the patient and do so quickly, so there is the benefit to the patient right there and then. It also meant that, from the public purse point of view, where the government is constantly saying we need to make savings and find efficiencies, there would be no reason to duplicate the many unnecessary tests that doctors call for when they don't have access to all the records that they need of a patient. That's because those records are being held somewhere else. It's not necessarily that the tests have not been carried out; it is more the case that the information from those tests might have been held somewhere else and therefore are not available to the treating doctor.

That's particularly the case when a patient presents to the outpatient's department of a hospital, where it is usually an emergency situation where immediate care is required,. The outpatient's staff and medical professionals need whatever information is important to them to make the right decision for that patient, and quite often that means sending the patient immediately in for X-rays or diagnostic imaging and the like. Again, a lot of that could have been avoided and time could have been saved in the treatment of that patient if we had a good My Health Record system in place. That's exactly why it would have benefited both the patients and the public purse.

Unfortunately, because of this government's incompetence, the public has understandably lost confidence in the government's My Health Record system, and they are opting out in large numbers. We see in the latest figures, only in the last 24 hours, that some 900,000 Australians—since the opt-out period was brought in, which was only a couple of months ago—have already opted out of the My Health Record system. By the time the opt-out period ends on 15 November, it is likely that over one million Australians would have opted out. They do so for a good reason: because they have lost confidence in the government's management of their records. The damage being done is not only being done to both the public's benefit and the government public purse right here and now; the damage is being done because when people lose confidence in the government's management of a system it will take a long time for them to have that confidence restored.

We've already had, to date, the AMA, the RACGP, the Law Council of Australia, a member of the government's backbench and others all criticise the government's administration of this program. But then one shouldn't be surprised about that. When one looks at the this government's management of a number of government programs, including the robo-debt debacle; the census of 2016, with the confusion and lack of confidence that caused with people not having the confidence to provide accurate information; and the Medicare and PBS data leaks that occurred under this government, we can understand why people would say, 'I don't mind the government setting up a My Health Record if I can have confidence in it being confidential. But if it is going to be either abused or accessed by those who have no right to access it, then of course I don't have confidence in it and I will not have my record placed within it.'

The minister comes into the chamber every day in question time and talks about how this government is committed to an excellent health system for this country and relies on the work of the PBS to do that. That is work that, quite frankly, has little to do with the government's administration and has been ongoing for decades. Both sides of parliament have supported the work of the Pharmaceutical Benefits Advisory Committee in terms of the medications that they recommend. Then we also have the government coming into the parliament every day and saying things like, 'Under our government, health expenditure has increased every year,' forgetting to mention that, quite logically, health expenditure would increase because the population is increasing, if nothing else, and that we have an ageing population, which again, as the records would show, always incurs additional costs to our health system.

The reality is that this government has mismanaged the health record system of the country. The government has bungled it. Whilst this bill seeks to address some of the mistakes within the act, regrettably it doesn't go far enough. Yes, it extends the opt-out period to 15 November. That is in some respects a good thing, because it gives people more time to opt out. I'm not sure what happens after that if people are determined to opt out, but nevertheless it gives people more time to opt out. Yes, it has brought in a provision which ensures law enforcement agencies will require a court order if they want to access health records of a person of this country.

However, it doesn't address the issues raised by others on this side of the parliament and by many of the people out there in the community about matters such as access to records of children in this country, particularly those aged between 14 and 18, who, in many cases, don't want their records accessed by anyone, including their own parents, for various reasons. They believe that they are old enough that only themselves and their health professionals should have access, and nobody else. With respect to children who come from families that have separated, one parent may well not want their address disclosed to the former husband or wife. Through access to the health records of the children, one party to the failed marriage can get access to the living address of the other person. Those concerns are not addressed by these changes, and they need to be.

We then have concerns about workers in this country who may have to do a work medical of some sort. The work medical is usually done by a health professional that works for their employer. That means their employer's doctor gets access to their health records through this system, but they don't know—and neither does anyone else—just what of that information is then relayed back to the employer by that doctor. It is a concern. We now hear that big pharma—that is, big pharmaceutical companies—might also have access to some of the health record information if they apply to use the information for research purposes and the like. It creates another element of uncertainty about who might have access to this information and how they will use it once they get it.

Because of the uncertainty, the benefits that the My Health Record system was likely to accrue will be lost for a long time. It is more so than ever the case today that people are moving away from their normal residential address. It could be simply for travel. People travel a lot more than they ever used to. Work opportunities have people moving from one location to another. People then change their living address through early retirement, or for other reasons in addition to that. Perhaps they just want to move. The reality is that the population moves more so than ever before. When they move, it's very likely that they then change their doctor and go to a different doctor's practice. That means that, if they can't take their health records with them—and they can't always do that—their whole health record system has to start again. Again that comes at an incredible additional public cost. As I said earlier, the X-rays, blood tests, diagnostic imaging and the like that are needed in an emergency situation may also be needed when you change doctor.

Some of the people that are going to be worst affected by all of this are people that live in country Australia, because people that live in country Australia, for a whole raft of other reasons, are also very likely to need to see a health professional away from their normal place of residence. Again, it would seem to me that the bungling of this service by this government is going to make it more difficult for those people as well. If they are away from home and they have to see a doctor or go to the emergency department of a hospital outside of their normal address, then all of their medical information that would have been absolutely vital to the best treatment that they require would not be with them, because the system itself doesn't provide it. That's why we supported a My Health Record system in this place five or six years ago, because it was in the public interest to do so. What I see now through this government's bungling is a system that was well intended, and still is, that is likely to be undermined not just for a temporary period whilst we sort out the problems but for a long time to come. With that, the benefits that were hoped for as a result of it will be lost.

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