Mike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

Unfortunately, it is. Australia's health system post the Second World War has been acknowledged as amongst the best in the world. I think there are three pillars of that. At the present time, one pillar is Medicare, initially introduced by Gough Whitlam as Medibank. Of course, it was destroyed by the Fraser Liberal-National government but reincarnated by the Hawke Labor government as Medicare. Another pillar is the PBS system, the Pharmaceutical Benefits Scheme, which was initially conceived by Ben Chifley when he was Treasurer in the Curtin wartime government and developed fully by Chifley as Prime Minister in 1949. The third pillar is of course the National Health Reform Agreement, negotiated in 2011 by Julia Gillard to provide financial support for our hospital system. Those three pillars were introduced by Labor governments, and it's a part of our DNA that we provide the best and most equitable health services to all Australians.

Unfortunately, in the last seven or eight years, there's been a gradual deterioration in the equity of our health system so that people are now finding it very difficult to afford appropriate treatments, even in terms of doctors' appointments. In outer metropolitan, rural and regional areas there's been enormous difficulty in attracting general practitioners. I've approached the present health minister on numerous occasions about this, and nothing has been done. It's leading to very inequitable care, with people not being able to access primary care and falling back on our hospital emergency departments as their primary carers. That's one issue.

The other issue is that there have been supply chain shortages for medications in Australia for a number of years, long before the pandemic, and this government has not addressed them. I'm talking about, for example, some of the common antibiotics. There was a severe shortage of the third generation cephalosporins, which are not manufactured in Australia, in 2018, to the point where, as doctors working in hospitals, we were told to restrict use of them; and common penicillin-based antibiotics like ampicillin were very difficult to access because of supply chain problems. And for a number of years there have been shortages of adrenaline for auto-injectors, which are used to treat severe anaphylaxis. This was not addressed by the government until very, very recently, and, even now, there are still shortages. So supply chain difficulties have existed for a long period of time.

The PBS system is a cornerstone, one of the pillars of our health system, and we must make sure that it's fit for purpose. This bill will partly address that issue, but it doesn't fully address the issue. It has been a major concern of mine that the ability of Australians to access the best medications, the 21st-century-type medications, has been falling behind because of the difficulties in approval for these medications in Australia with a system that has not been reviewed for some time.

To his credit, the minister did ask the Standing Committee on Health, Aged Care and Sport to undertake an inquiry into how we assess medication availability in the 21st century, and we've come up with a number of recommendations. My concern is that those recommendations will be sitting on a shelf for another six, seven or eight years if this government is re-elected. They have been very slow to respond to previous requests for improvements. I mentioned the GP access scheme. The Medicare review has led to even more difficulties in people accessing primary care. I am very worried that our recommendations for precision medicine and access to the best treatments for Australians will be left in a cupboard for far too long.

We already heard mention of Trikafta. Trikafta is a medication for cystic fibrosis which is used for people who have the most common gene mutation—the delta F508 mutation; at least one copy of that with cystic fibrosis—and it is life changing. It is absolutely remarkable. Patients who have been placed on the heart-lung transplant list because their lung function is so poor have been put on Trikafta and the improvement in their lung function has been remarkable—sometimes from as low as 15 or 16 per cent up to 40 per cent, which is a really remarkable improvement. We are now seeing patients with cystic fibrosis, with these newer treatments like Trikafta, living normal or near-normal life expectancy. When I started my training, most people with cystic fibrosis were dead by their late teens or early 20s. These are remarkable 21st century genetic treatments, and we must approve them for Australians with cystic fibrosis and other genetic disorders so that we get equitable access around Australia.

There are other medical interventions—not necessarily medications—that we have been very slow to access. There's a new one—when I say 'new', it has been used overseas for a long time—called the Omnipod, which is a treatment for type 1 diabetes. It is attached to the skin, usually of the abdomen, and acts as an automatic artificial pancreas. The settings can be changed remotely, there is no external tubing or visible pump involved, and it's all in a small pod attached to the abdomen. It's a remarkable treatment that's been used overseas for a number of years. It's really good for adolescents, and anyone who has a child with type 1 diabetes knows that adolescence can be a real difficult time because kids get very self-conscious about having attached tubing when doing things like playing sport or going out with friends. This is a terrific advancement for those adolescent kids with type 1 diabetes. For very young children with type 1 diabetes it's great because it can be set remotely, it doesn't require skin pricks to measure blood glucose and it doesn't require external tubing that can be tangled in toys and things like that. So it's a really great treatment, yet Australia has been very slow to approve it. We must do better.

During the pandemic, we have had a pretty good response from the TGA, I think. They have been pretty remarkable in how hard they have worked to approve vaccines and new treatments, but we still have a number of difficulties in approval for a range of 21st century medicines. I think that it is time that the government really had a vision statement about where they see our PBS heading in the next 20 or 30 years. I recommend the standing committee's report to the minister again. I really encourage him to let us know how the government is going to respond to our recommendations.

We as a parliament have a duty of care to Australians. Our bipartisan report, involving members of the government and members of the opposition, pretty clearly outlines a vision for the PBS system and approval process in the future. We've made a total of 31 different recommendations, a couple of which are really important to me. The one talking about the establishment of a centre for precision medicine is a really important one. I would like to see it expanded even further to have a properly funded institute for precision medicine that is Australia-wide. The other one that is very important to me is the establishment of a national newborn screening program with a regular review process that is instituted all around Australia so that everyone gets equitable access to the best possible treatments.

As an example, there is a condition, spinal muscular atrophy, that many people have heard me speak about. It's a genetic condition in which a child is born normal but whose muscles gradually waste away after birth. Those children previously have died by the time they were two or three years of age because of muscle weakness and respiratory failure. There are new genetic treatments available for this that we feel are likely to be curative, and we have certainly seen some very positive results. That condition is only screened for in a number of Australian states, not in all states. Some children are being missed, and the longer the diagnosis is missed the more damage occurs. It is very important that the medication is made available as soon as possible after birth. It's also very important that children who have a milder form of spinal muscular atrophy who survive into adulthood are given access to the genetic treatments through the PBS. At the present time it's only available for people 18 years and under. It should be extended to those over 18 to try and prolong their lives.

In summary, Labor strongly believes in an equitable health system for all Australians. The pillars of our health system, including the PBS, are always supported by Labor. We commend the bill to the House, and I hope that, as I said, the government can go even further and provide a vision for their view of the PBS system for the next 20 years.

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