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

I'm delighted to be talking about the importance of Vision Australia's work. We've got many passionate colleagues here that are looking at a particular service provided by Vision Australia Radio and those who rely on that service. Before we consider how we fix a problem, we need to, as the member for Monash pointed out, understand what actually brought us to this point. What we've seen increasingly with the arrival of the NDIS is a scurrying, predominantly by state governments, to find ways to throw into the overall NDIS as many services as possible, as briefly related to disability as possible, as a way of making sure that half of them get funded by Canberra. And you can understand that the government would do that if it possibly could.

The second question is to look at the direction of Vision Australia and whether they're the only group that can provide this service or whether there can be support through normal channels, like community radio and other services that should be looking after those who have poor vision. In this parliament we've got the Parliamentary Friends Group for Eye Health and Vision Care, and I really encourage every one of my colleagues to come along and support what are some of the largest events held in this building by a friendship group—that is, eye health and vision care. Enough of that advertisement!

If we're going to be investing more money—the extra dollar—into health care, the question is going to be, at the margins: where is it best spent? If we're going to step back and take a health lens to this, the question really will be: is the money best spent in radio by Vision Australia or in early intervention and picking up vision problems with kids? Giving some credit to the other side of the chamber, we know that the early preschool checks that were implemented by then Prime Minister Kevin Rudd had the problem that the healthy kids with worried mums turned up for the checks and we couldn't get the high-risk kids to be checked. The question with eye health, of course, is that the sooner we find a problem, like most forms of early intervention, the better the prospects are of success. Those who are most likely to benefit from the service are least likely to attend for a lot of reason that we collectively refer to as complex. But in New South Wales they actually did try to do this. Eight LHDs in metro Sydney and seven in regional New South Wales got together and said, 'Look, of the 90,000 children that are going to need some form of preschool screening for vision, let's set up a true universal vision test and just see how it goes,' and it's now famously known as the StEPS program. Let's remember that in the state-Commonwealth arrangement that we have here one jurisdiction is stepping out and trialling what has not been found to be cost effective in the rest of the world. Sure, New Zealand has trialled it—New Zealand does a lot of stuff that we don't do—and some provinces in Canada do universal screening. But most of the rest of the world doesn't do it, so we need to have the answers.

What they found when they offered screening to everyone and used a universal approach was that with the 90,000 children they found that 80,000 of them managed to be screened. That is an impressive achievement. Of those that got a full assessment, around 9.7 per cent were referred on for second checks and 9.6 per cent had definitive pathology that needed follow-up. When they broke up that group of four-year-olds in New South Wales, we found that there were those with amblyopia, which of course is a cause of vision loss in one or both eyes; those that needed refraction; then a small category with other conditions.

When you're going to do any form of additional expenditure, I'm encouraging the mover of this motion to take a more global view. It is not just a matter of harassing a level of government about whether a service is delivered. Asking where the dollar is best spent is a really responsible element of evidence based policy that we should be adhering to. What we have seen in the Steps program is an assiduous effort to do it. They have identified how many cases were picked up, how many staff were required to do it. You work on what's called positive and negative predictive value. That's basically saying that if you have a positive finding using a clinician, how many of that proportion genuinely had the condition? In negative prediction you're looking at those who were cleared. This is an even more important point when talking about vision care. Among those whom you've examined and determined are clear of conditions, how many genuinely don't have a condition? Because, clearly, telling someone that they're well when they're not is a big concern.

The cost economics are fairly complex. We want states, like Victoria for instance, to make the case financially that this is where money in eye health and vision care should be spent. I trust that Vision Australia is coming to us and saying that they would like to continue the radio service. I would go straight back to Vision Australia and ask for the evidence.

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