Julia Gillard (Lalor, Australian Labor Party, Shadow Minister for Health and Manager of Opposition Business in the House) Share this | Link to this | Hansard source

The amendments in the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 are the result of the fourth community pharmacy agreement between the Commonwealth and the Pharmacy Guild of Australia. I am sure, Mr Deputy Speaker, you are familiar with the arrangements that the Commonwealth makes with the Pharmacy Guild whereby it enters into an agreement for five-yearly periods.

The most recent agreement commenced on 1 December 2005 and will terminate on 30 June 2010. The agreement provides for new pharmacy location arrangements, to commence on 1 July 2006. This bill gives effect to some of the issues around those arrangements. Specifically, this bill will do the following.

Firstly, it will extend the operation of the Australian Community Pharmacy Authority until 30 June 2010. The authority’s role is to consider applications made by pharmacists for approval to supply benefits under the Pharmaceutical Benefits Scheme, to determine if such applications comply with the pharmacy location rules and to make recommendations to the Secretary of the Department of Health and Ageing as to whether such applications should be approved.

Secondly, this bill increases the membership of the Australian Community Pharmacy Authority from five to six members by including a consumer representative appointed by the minister. As I am sure the House is aware, obviously there are increasing demands for consumer representatives in various bodies in the health sector and on this occasion the demands of those representatives have been agreed to, with a consumer representative being included on the authority.

Thirdly, the bill provides the minister with a new discretionary power to overrule a decision of the secretary made in accordance with the pharmacy location rules if that decision will have the unintended or unforeseen consequence of leaving a community without reasonable access to pharmacy services. Affected parties may seek a review of any decision made by the minister under this power, under the Administrative Decisions (Judicial Review) Act 1977.

Fourthly, the bill provides for the processes associated with this discretionary power, such as how an applicant may make a request to the minister for consideration of the secretary’s decision.

Fifthly, the bill deals with clarifying the ability of the secretary to approve more than one pharmacist to supply PBS benefits from a particular premise.

Finally, the bill provides that the secretary can approve a pharmacist’s application to expand or contract their premises without prior recommendation by the Australian Community Pharmacy Authority.

The actual changes in the pharmacy location rules will ensure that the following can occur. The new rules will permit co-location of pharmacies with large medical centres that operate extended hours. The new rules will allow the location of pharmacies in small shopping centres. The new rules will allow the relocation of an additional pharmacy to one-pharmacy rural towns and one-pharmacy high-growth areas without regard to the usual distance criteria. The new rules will remove the requirement that a specified number of commercial establishments are open and trading before an approved pharmacy can relocate to a shopping centre. And the new rules will provide greater flexibility for pharmacies located in private hospitals by allowing the establishment of satellite dispensaries for hospital in-patients. It should be noted that these changes do not require legislative change, but will be put into effect by being exercised through a set of regulations authorised by ministerial determinations under section 99L of the National Health Act 1953.

The changes to the rules will have a number of benefits, especially in rural and remote areas and growing suburban communities. Obviously, it makes sense to permit the co-location of pharmacies with large medical centres that operate extended hours. I think each of us receive many complaints in our local electorates and more broadly and would be aware that the Howard government inspired crisis in the medical workforce, particularly the government’s 1996 cutback in the number of GP training places, is now showing in our communities, with many communities not having anywhere near enough GPs. That situation shows at all times of the day and night, but tends to particularly show after hours, when accessing a GP can be very difficult. If it is possible for a large medical centre to provide extended hours of operation, that clearly is a benefit to local community members and enables them to at least access a GP after hours.

However, such an arrangement is no substitute for having the right number of doctors across the country or for doing what the Howard government should be doing, which is properly investing in after-hours care. Around the country we have some very successful models for how to do that, particularly the Hunter division model of after-hours care, which has been a leader. None of the arrangements in this bill and none of the more general arrangements the government has made to date are in any way substitutes for doing the proper job, which is about that kind of investment.

As we know, the Howard government has no intention of doing the proper job. The vision of the minister for health in this area is confined to picking up from the United Kingdom a National Health Service model—NHS Direct. The minister, who in the past has railed against the National Health Service, and indeed against the British health model, is not ashamed to pick up NHS Direct entirely and put it somewhere in Australia. But, as we know, NHS Direct is just a big call centre. You can ring and get some preliminary health advice but, because it is not connected with local services, it cannot actually find you a GP. That is why it is an inadequate model and why it is no substitute for making the proper investment right round the country.

Nevertheless, with the Howard government here and largely ignoring the need for after-hours care, obviously, for those communities that do get some after-hours coverage with large medical centres that operate extended hours, it makes sense to have co-located pharmacies so that people can not only access a GP but also, effectively in the same visit, after hours, access the medications that they need.

The change to permit the location of pharmacies within small shopping centres recognises the retailing trend for smaller centres with large supermarkets. Currently the requirement for large shopping centres with at least 30 commercial establishments gives limited access to pharmacy services in many retail developments. This is a sensible change. Each of us would be aware from our experience and our own locations that there are many suburban shopping centres now that have very large supermarket developments but not necessarily many associated shops—certainly not 30 or more. Yet the shopping centre may attract considerable patronage because of the supermarket, and it makes sense for pharmacy to be available in such locations.

Then there is the change to allow the relocation of an additional pharmacy to one-pharmacy rural towns and one-pharmacy high-growth areas without regard to the usual distance criteria. That is a sensible measure to make sure that we are not left in a situation where Australians in such areas miss out on fair access to pharmacy because the usual distance criteria preclude them from having a second pharmacy in the area.

The removal of the requirement that there be a specified number of commercial establishments open and trading before an approved pharmacy can relocate to a shopping centre is once again a recognition of reality. Not all commercial establishments in a shopping centre need to be open and trading at the time of an application approval. We do note that this restriction in the past has in fact delayed access to pharmacy services in new shopping centres where shops are being progressively leased and taken up but the shopping centre as a whole is not opened, with every shop trading on a given start date. So it makes sense to have such flexibility in the arrangements. Finally, it does make some sense to have greater flexibilities for pharmacies located in private hospitals.

Given the nature of these requirements, I doubt that it will surprise you that Labor will support this bill. I do note—and I think it is a very important omission—that there is nothing in this bill that will ensure that Aboriginal and Torres Strait Islander people have better access to Pharmaceutical Benefits Scheme medicines and pharmacy services, despite the fact that PBS spending per capita on Indigenous people is only one-third of that spent on the non-Indigenous population.

I know, for example, the member for Lingiari, who is in the House, would be only too familiar with the fact that many of his Indigenous constituents do not get fair access to pharmacy services or to the PBS. The fact that this matter is being omitted yet again from this bill gives us cause for concern about the ongoing pattern of disadvantage and despair that surrounds the issue of Indigenous health in this nation. It is another lost opportunity to perhaps have made some difference in that regard. I think that that is an unfortunate oversight with this bill.

More broadly, Labor is very concerned that the Howard government is generally failing to properly manage the Pharmaceutical Benefits Scheme, and I foreshadow that at the conclusion of my speech I will move a second reading amendment that deals with some of the areas of greatest concern. However, we are here to deal with this very bill because of the fourth pharmacy agreement and the new pharmacy location rules. We should note that, in this whole process of striking the fourth pharmacy agreement and the new pharmacy location rules, the Howard government and the Minister for Health and Ageing, Tony Abbott, have not in any way, shape or form covered themselves in glory.

As we know, pharmacy services are important to all Australians. They are important to all of us. They are a vital part of our access to primary care and to medicines that not only assist us when we are unwell but help us maintain our health. The pharmacy agreement is not an insubstantial document. The pharmacy agreement covers some 22 per cent of Pharmaceutical Benefits Scheme spending. When negotiations about the pharmacy agreement go badly, that spells bad news for the PBS. Of course, what we know about the negotiations for the fourth pharmacy agreement is that the negotiations were protracted, they were sometimes acrimonious and they were always hidden behind closed doors.

The minister for health was on some days belligerent and on some days cowed during the course of these negotiations. One can track from his media statements the days on which he was belligerent and the days on which he was cowed. On a belligerent day he would say that he was intending to undermine community pharmacy by opening up the rules allowing pharmacy to go into supermarkets. This was the sort of threat that he would hold over the heads of the Pharmacy Guild and pharmacists when in a belligerent mode. But then on other days he was completely cowed, completely giving in and certainly making every sympathetic noise to pharmacists that he properly could.

I have had occasion to speak on this matter in the House before, and in a very unseemly short period one could track completely contradictory ministerial statements on the question of whether or not pharmacy should be in supermarkets. On one day the minister for health would say something entirely different from what he would say on another day. I have had occasion in the past to go through that matter in quite some detail in Hansard. That is no way to conduct a set of negotiations, when the people with whom you are negotiating cannot even tell what your position is because apparently you do not know yourself. That was the position that the Pharmacy Guild was in when dealing with the minister for health, who would have wildly different positions on different days.

The problem here is that, because of the way the minister for health dealt with this matter, it took a great deal of time to strike the new pharmacy agreement. It might surprise you to know, Mr Deputy Speaker Barresi—and I believe you should be quite shocked at this—that this is the third time in less than 12 months that the parliament has been required to deal in this House with a bill that relates to these pharmacy location rules. The negotiations were so protracted because the minister for health had so little idea of what he was doing that on three occasions he had to rush into this parliament saying: ‘I need more time. I need help with an extension of time on these pharmacy location rules. They are going to be out of date. There are going to be sunset clauses. Can you give me an extension? Can you help me out?’

This is the third time it has happened. On the two other occasions, because the Labor Party are interested in making sure people have fair access to pharmacy services, we did bail out the minister for health and we did deal with this legislation—one, by supporting it; and, two, by dealing with it in an expeditious way—but it is no way to run the health sector of this country. It reeks of incompetence. The problem for the minister for health is that he is not a competent minister on the details, and something that is about 22 per cent of PBS spending is a pretty big detail. Those other bills were dealt with in May 2005, when we extended the pharmacy location rules to 31 December 2005 through the Health Legislation Amendment (Australian Community Pharmacy Authority) Bill 2005. Then in October 2005 we had to do it all again, and the provisions were further extended until 30 June 2006 through the passage of the Health Legislation Amendment Bill.

I should note that, whilst the minister for health was dithering back and forth, rushing into this parliament to get pharmacy location rules extended and not knowing what to do next, Labor, apart from bailing him out by dealing with his legislation in a supportive and expeditious way, had a consistent position on the question of pharmacies and supermarkets. Unlike the Howard government, which did not know whether it was coming or going, whether it was Arthur or Martha on the issue, Labor had a consistent position. We consistently said that we gave an undertaking to community pharmacists before the last election and we were honouring that undertaking.

Given that the Prime Minister wrote a letter to community pharmacists across the country, giving an undertaking before the last election, one wonders why the Howard government could not be as simple and true as the word its Prime Minister had given and had a consistent position on this. I think it should be noted that, on a day on which we have had cause to debate issues about the honesty and credibility of this government, this was another issue going to honesty and credibility. What better form of promise could one have than a personally signed letter from the Prime Minister? The community pharmacists of Australia were in possession of such a letter. Even being in possession of such a letter did not matter, because that does not stop the Howard government breaking its word. It is a salutary lesson for anybody who relies on a representation from the Howard government about any area of policy during this parliament and particularly in the run-up to the next election.

We are also concerned, on the question of management and incompetence, that there is a clear incompetence in the way in which the Howard government is managing the Pharmaceutical Benefits Scheme. All of the rhetoric of the Howard government about the PBS, forever and a day, has been that the costs of the Pharmaceutical Benefits Scheme are out of control, that they are sky rocketing, that this is going to be an imposition on the community in the future and that it is particularly going to be an imposition when we deal with the challenges of an ageing society. When the Treasurer did his much vaunted—by him—Intergenerational report, the single biggest thing he said he was concerned about and going to act on was the escalating costs, the growth rates, in the Pharmaceutical Benefits Scheme. So all of the imagery was of a crisis. I believe there are real challenges in having a sustainable PBS over the longer term, but I also think there is a need for real honesty about where we are with the PBS and growth rates today. I suspect that the statistics I am going to give people now will shock them a little bit, because they are so contrary to the imagery that the Howard government seeks to create of a Pharmaceutical Benefits Scheme out of control.

Since the Howard government increased the PBS copayments by 21 per cent last January, and since it introduced its 12.5 per cent cuts in the price of generics in the middle of the year, the growth rate for PBS spending has now fallen on our calculations—and they are calculations supported by others—to around one per cent, and it is expected to drop even lower. The growth in prescription numbers, which is a good measure of whether or not people can afford to get their prescriptions filled, is already in negative territory. So, far from the crisis imagery of the Treasurer, the one year that he was dealing with all of these issues in his Intergenerational report and was shocked by a 22 per cent growth rate in PBS spending, he never actually identified the various things that the Howard government had done that contributed to that special one-off effect of a 22 per cent growth rate. There was an atmosphere of crisis, but now the Howard government has cut back and cut back and we are seeing extraordinarily low rates of growth—in fact, a reduction in the number of prescriptions.

I would like to think that that is because there has been some outbreak of wellness in our community, and fewer people need prescription medicine, but that is not the case in my estimation. The government’s own figures show clearly that fewer prescriptions are being filled in some crucial categories. In particular, fewer prescriptions are being filled for medicines that deal with cardiovascular conditions; for anaemia and blood clotting problems; for hormone replacement therapy needed because of thyroid, pituitary or pancreatic problems; and for mental illness, epilepsy, Parkinson’s disease and Alzheimer’s disease. You do not need to be a doctor—and I am most certainly not—to realise when you go through that list that we are talking about chronic conditions for which people take their medicines for a lifetime. They are not the sorts of conditions where you have an episodic illness, you go and get a course of antibiotics or whatever, you finish the course and that is the end of your need for prescription medicine. They are chronic conditions which people manage over a lifetime with the assistance of prescription medicine. If we know that fewer prescriptions are being filled in these crucial categories, that does not mean that those people have got better; that means that those people are going without their medication. Just to make sure that people understand: that means people with chronic ailments like cardiovascular conditions; anaemia and blood clotting problems; hormone replacement therapy needed because of thyroid, pituitary or pancreatic problems; and mental illness, epilepsy, Parkinson’s disease and Alzheimer’s disease are taking less medicine not because they do not need it but because they cannot afford it.

If you were confining your world view only to the columns of the federal budget you might say, ‘That’s okay; I’ve saved some money in columns in my federal budget, which makes the budget papers look nicer.’ As I have said before, sustainability in the PBS is a real issue, but you do not fix sustainability in the PBS by ending up with a situation where people with chronic and complex conditions go off their medication—because their health problems have not gone away. What will happen is that their health problems will turn up in some other part of the health system. Those people were taking their prescription medications for a reason. If they do not take them, their conditions will become more acute and they are very likely to end up in our hospital system or having some other sort of acute health episode.

If you were really looking at this as a sensible economist—not the Treasurer, but a sensible economist—taking a view across our health system about what is good for costs and what is bad for costs, you would see that it is crazy to deny people access to medication only to have them end up paying for much more expensive acute hospital care somewhere down the track. To take a simple example, it is much better for all of us if someone continues to take their cardiovascular medication rather than have a heart attack. It is much better for the person involved—there is no doubt about that—but also much better for the health system, because acute coronary care is expensive, and we do not want people in acute care hospitals if they do not need to be there.

The officers of the Minister for Health and Ageing have tried to say that the fall in prescriptions is not serious because it does not include drugs dispensed through the highly specialised and high-cost schemes. But an analysis of the data shows that this explanation is wrong. That is, there were some special factors coming out of the highly specialised and high-cost schemes which would explain this result. Then the Department of Health and Ageing, knowing that its first explanation was a stupid one, tried to come up with a second explanation and said that it was something to do with Vioxx being taken off the PBS. But this is again wrong. There is a clear and unambiguous decline in PBS growth rates regardless of the Vioxx effect.

Furthermore, what Health has tried to say—which is that it is all okay: ‘Don’t worry about it; it doesn’t matter’—is directly contradicted by the Treasury papers, particularly the Mid-Year Economic and Fiscal Outlook, MYEFO. That paper now states that the growth rate in PBS expenditure in 2005-06 will be 2.2 per cent less than the budget projection of 7.4 per cent. MYEFO states that that will see a windfall for the government of $283 million. That is money that would have been spent on the PBS that is no longer going to be spent on the PBS.

There is a big issue here about affordability. It is an issue that has occurred whilst the government has made it harder to reach the PBS safety net, and it is an issue that is going to be made worse with the new 20-day rule, which is yet to kick in. With the new 20-day rule, it is much more difficult for people to get the cost of their prescription medicine counted towards the safety net. So we have got a pincer movement here: costs are going up, the PBS safety net is not as good as it used to be, and the 20-day rule is going to make that even more the case. There will be artificial counting of which of your medications ought to be counted for your safety net costs. That means that there will be people who should be taking their medications who are not taking them.

This is a serious issue. It is an issue that the government cannot even be bothered analysing, let alone addressing. We have suggested to the minister for health that he actually take a look at this, that he have some sort of study, some sort of investigation, to ascertain whether or not there is an issue with affordability that is preventing people from taking their medications. He has just brushed these concerns aside. They are too serious to be brushed aside. Again today I call on the minister for health and the Treasurer to look at the full impact of their short-sighted and short-term policies to cut the PBS.

With that, may I conclude by moving the second reading amendment standing in my name:

That all words after “That” be omitted with a view to substituting the following words: “whilst not declining to give the bill a second reading, the House condemns the Government for:

(1)

failure to investigate the impact of PBS co-payment increases on patients’ access to needed medicines;

(2)

recent changes to the PBS safety net which mean patients must pay more out-of-pocket; and  

(3)

the confusion and difficulties presented to patients, doctors and pharmacists by the new 20-day rule on repeat prescriptions”.

Phillip Barresi (Deakin, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Simon Crean (Hotham, Australian Labor Party, Shadow Minister for Regional Development) Share this | Link to this | Hansard source

I second the amendment.

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

I rise today to speak in support of the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006. This bill proposes the amendments made as a result of the fourth community pharmacy agreement negotiated between the government and the Pharmacy Guild of Australia, aimed at ensuring Australians, particularly in rural and remote areas, have access to the supply of pharmaceutical benefits. The bill will include more flexible location rules, which will preserve the traditional community pharmacy and enable pharmacists to move to areas of high unmet demand for PBS drugs.

In the Riverina I have found community pharmacies are vital in providing a service to residents and that customers value the commitment and dedication of the pharmacists. As I have said in this House many times in this same debate, in many areas the pharmacist is the only real medical attention that members of my communities have. They may go to a doctor in another town, but they come back to fill their prescriptions, and they rely on their pharmacist for a host of advice in the way in which they use the drugs available on the market. So it is really most important that pharmacists are valued, particularly in those smaller community areas.

This pharmacy location rule has had some unintended consequences, though, in the application of the current location rules. One such unintended consequence has been that an area not in my electorate but just outside of it has seen a particular pharmacist purchase both pharmacies in that community. Then of course the community members were not given a choice and there was concern that there were many overpriced goods. However, the pharmacy location rule prevented any other pharmacist from moving into that area to dispense.

Whilst I support the location rule, it does have some unintended consequences. It makes sense for a discretionary power to be made available to address on an individual basis any area where there is an unintended consequence of the location rule. One such situation occurred within my electorate. Recently in Wagga Wagga there was an issue with a new suburban shopping centre, because the pharmacy location laws created some confusion about the dispensation of medicines. The existing legislation and location rules came into play because a pharmacy was located too close to the new location. Because of the location rule, there was an issue about where the dispensary was going to be located within the shopping centre.

The angst came about in August last year with the inception of a mobile dispensary in a portable building in the middle of a paddock just 100 metres away from the shopping centre—a portable building was sitting there in the middle of a paddock because there was another suburb just 100 metres outside of the distance factor of a pharmacy location rule. People were having to drive away from this new shopping centre location in order to access their pharmacy requirements in another pharmacy. It was quite ridiculous.

It was reported in the Daily Advertiser that customers found out about the legislation when a sign was put at the front of the temporary location. It read:

Under the current New South Wales laws, a chemist cannot open within two kilometres of an existing chemist. The shop inside the mall is too close to an existing chemist at Ashmont, so we had to position it 100 metres away.

So a pharmacy, a mobile dispensary, was set up in a padock. This situation shows the need for some sort of discretion to intervene when there is a brand-new shopping centre to service an entire suburb—the entire suburb was going to do their shopping there—but, because of the location rule, the customers would have to travel to a pharmacy elsewhere for their very essential pharmaceuticals.

The minister has indeed acted on some of those anomalies and given himself some room to move. Basically people were travelling two kilometres to another pharmacist when there was one available to them. As I said, somebody set up a mobile dispensary in the middle of a paddock. The management of South City at Glenfield said that the portable dispensary was closer for customers. They would have had to drive two kilometres to the nearest alternative, which for customers and staff was completely inappropriate.

The fourth pharmacy agreement was introduced in November last year and has meant some changes to location rules. New provisions allow pharmacies to relocate to large medical centres with eight or more doctors that operate extended hours, which is a fantastic move; to small shopping centres such as the one that I have just spoken about, with 15 shops and a large supermarket; and to large, single-pharmacy rural towns. The provision of a pharmacist at a shopping centre with 15 shops and a large supermarket will see the resolution of the problem at the Glenfield shopping centre, South City Shopping Centre. It will also enable pharmacists to move to a large, single-pharmacy rural town with 8,000 or more people and to urban areas with high population growth.

The agreement also ensures that pharmacies are prevented from opening in, or having public access to, supermarkets. I absolutely welcome this. I welcome the minister’s advice that this agreement will continue the prohibition on pharmacies within supermarkets. It is no secret that I sincerely oppose the attempts by Woolworths, Coles and other large multinationals to take pharmacies into their operations. I again reaffirm my opposition and thank the minister, in his wise judgment, for precluding pharmacists from being able to set up in supermarkets. I am deeply opposed to the idea of companies like Woolworths, Coles and others being given an opportunity to set up concise and limited pharmacy applications within their supermarkets. It is something that I will always be deeply opposed to, moreover because I rely particularly on community pharmacists providing valuable medical advice, support and contact to the people I represent in towns throughout the Riverina.

Our pharmacists work extremely long hours in rural and regional areas and they are perhaps not recognised for the amount of work that they do. Many of them work to cover the shortfall in the numbers of general practitioners in many of my rural areas. Pharmacists ease the burden of many people. Residents can have access to educated, reliable advice and assistance to help them through troubling times, particularly if they have to go off to another town to attend a GP or a specialist and they come back with a prescription to be filled.

Often in rural areas the pharmacist knows the customer, who is his client, and he certainly knows their problems. Community pharmacies have an amazing commitment. It is not just an employment option but a choice of lifestyle in regional areas where they can serve the community with the best advice and assistance. I know that this type of care would not be made available to customers if profit for shareholders was first and foremost.

Pharmacies provide many services free of charge. Pharmacists are generally always available. They generally provide home deliveries for the elderly. Many provide a subsidised Webster packing service, which is a major issue. Once you put in a packing service for a Webster pack, you might provide a treatment for a few months. If the doctor changes that treatment then the pharmacist gets all the packs back. They have to take them apart and repack them. It is a very time-consuming option, but pharmacists still provide that service. Would we see that happening in supermarkets? I think not. The majority would just be dispensing a schedule of drugs with the least time possible put into serving the clients’ needs.

Pharmacists can also be subagents for Diabetes Australia. We all know about the major problem we are experiencing worldwide through the onset of diabetes type 2 and juvenile diabetes. We have a management program which is assisting us in being able to manage our diabetes across the board in rural areas. Community pharmacies should not be diminished by letting multinational supermarkets just cherry-pick a small number of items and completely knock out the system that is operating in rural and regional areas—and, more particularly, one that I am very proud of that operates in the Riverina. This is the greatest threat to my communities from a health perspective. Pharmacists offer programs for asthma management and certainly diabetes assistance—an enormous amount of advice on a host of illnesses that are treated by GPs. As I said, they really are in many cases the lifeline link for many communities that do not have a GP.

The government has been committed to ensuring that people living in rural and regional Australia have access to pharmacy services. It has increased its funding support for rural pharmacy programs by $40 million to $111 million with the new agreement. This amendment bill is another step forward in reducing the location issues of pharmacies and allowing the inception of a chemist, including dispensary, in shopping centres with 15 shops and a large supermarket, which has been and is currently an issue within the Riverina.

I support this amendment bill. I congratulate the Minister for Health and Ageing on his work towards making sure that community pharmacists can continue to serve their communities in the most effective manner. I applaud the minister for recognising the concerns that have been presented to him time and time again on this fourth pharmacy agreement, particularly with the issue of looking at changing the location rules so that pharmacies can operate in supermarkets. I applaud the minister for the sensible decisions he has made in this Health Legislation Amendment (Pharmacy Location Arrangements) Bill, which does give some ability to address unintended consequences of the application of the location rule. I commend the bill to the House.

Chris Hayes (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

It is about time that this legislation appeared in this place. I welcome the provisions of the amendments that appear in the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006. I think it is a win for consumers, not only those in rural and remote areas of Australia but also those in the fast-growing outer metropolitan areas and suburbs, including those in my own electorate of Werriwa. I have no doubt that the prospect of more pharmacists, with increases in competition as such pharmacists seek to differentiate themselves from one another on the basis of service, will be a good thing for consumers.

The fourth community pharmacy agreement will allow the relaxation of the location rules—the subject of this bill—and allow pharmacists to set up in large medical centres and indeed in some shopping centres. But the relaxation of the rules will not go to allowing pharmacies to be set up in supermarkets, which is a concept that I personally remain opposed to. I think relaxation in that respect would simply allow supermarkets to cherry-pick locations with a view to maximising services within a particular supermarket chain, which would very clearly be at the expense of regional and some outer metropolitan areas.

Getting back to the matter at hand: the National President of the Pharmacy Guild, John Bronger, said on 8 November last year:

Neither side has got everything it wanted, but at the same time I believe on the whole this Agreement will underpin access and equity of the PBS and pharmacy care to all Australians ...

He went on to say:

Pharmacists serve the community in many ways with passion and commitment.

This is an important point. As you know, I represent the electorate of Werriwa, which embraces areas of Liverpool and Campbelltown. In that area we have about 50 pharmacists. These pharmacists play an important role in communities like mine. This statement made by Mr Bronger reminds me of the work of pharmacists like Paul Sinclair in Ingleburn, who is very active in his local community.

Paul Sinclair owns the local pharmacy, but he also has a healthy interest in the improvement of our local community. He is an executive member of the Pharmacy Guild. Paul also has the time to be heavily involved in the work of Kids of Macarthur. He is actually chair of Kids of Macarthur, which is a group made up of locals who wish to make a real difference in children’s health services. Indeed, Paul is also the chair of Myrtle Cottage, which provides services for the frail, the disabled and those needing respite. Without labouring this issue, Kids for Macarthur does a fantastic job in my area. It purchases equipment for the paediatrics department in our local hospital.

My family was a direct beneficiary of the work of Kids of Macarthur when my recently born grandson, Noah, developed sleep apnoea. As a local resident, I have to say that, when a child turns blue around the mouth and suffers the effects of not breathing, to know that you have specialists like Dr Freelander and the staff of Campbelltown’s paediatric department on hand is, quite frankly, very much something to be proud of. Their degree of commitment will remain with me, and I praise the work of the people of the Campbelltown Hospital. It is a hospital that has been much maligned in the press. Quite frankly, it is a hospital that has a lot of dedicated people. On behalf of my grandson, Bernadette and I and my family are very indebted to the professionalism shown by the people of that hospital.

I welcome the contribution of many pharmacists to the community that I live in and recognition of the ongoing benefits that pharmacists like Paul Sinclair play in their community. It is not the focus of this bill, but it should at least be acknowledged.

An improvement to the access to pharmacies is only one part of the fourth community pharmacy agreement. The other issues that are dealt with in these changes are the way that the Secretary of the Department of Health and Ageing is able to approve more than one pharmacist to supply pharmaceutical benefits. There is no doubt about the importance of pharmaceutical services to Australians, and there is no doubt about the importance of the PBS to people. It is virtually impossible to consider changes to the operations of more than 5,000 pharmacies throughout Australia without taking some time to reflect on the operations of the PBS.

There is absolutely no doubt that the PBS must be kept sustainable. Australians have come to expect, and rightly so, that they will be able to have affordable access to the medicines they need. With some having just celebrated a decade of the Howard government, it is timely to reflect on the impact that this government has had on affordable access to medicines and on the PBS. To put it simply, this government has not been the best friend that Medicare has ever had. For 10 long years it has consistently acted to undermine our system of universal health care. It has attacked Medicare, underfunded hospitals, systematically dismantled the PBS, ignored mental health and abandoned all commitment to public dental health. It has also cut training places for GPs, which has resulted in patient to GP ratios of more than 1,700 to one in my electorate. I bring to your attention, Mr Deputy Speaker Wilkie, that one GP to 1,000 is the preferred level of the federal Department of Health and Ageing. Even this government considers that anything above one GP to 1,400 is an area of serious need and yet my area of Werriwa has one general practitioner to 1,700 within our electorate. That is the record of this government when it comes to health care. Despite promises made in the heat of the last election campaign—and I think the words ‘ironclad guarantees’ were used, if I remember correctly—this government continues to chop and change the rules when it comes to our medical system. This government keeps changing the rules, and sick Australians, the people who rely on the great system we once had, are paying the price for these changes.

The changes to the PBS introduced last year have meant a diminution in access to affordable medicines. The government has justified this on the basis of cost and long-term sustainability of the system. This government’s concern with cost cutting has overridden any concern that it may have once had for health outcomes. The medical implications of continued cuts to the PBS have taken a back seat to budgetary implications under this government. The facts speak for themselves. Last year the government introduced changes that, simply put, reduced access to the PBS. Since the 21 per cent increase in the PBS copayments and the 12.5 per cent cut in the generics, PBS growth has fallen by 2.5 per cent and is expected to fall further. As I understand it, based on the most recently available Medicare Australia data, savings to the PBS for the next financial year could amount to $1.38 billion, with 11.4 million fewer prescriptions. This is nothing more than cost cutting.

The government figures also indicate that people’s health is being put at risk. Fewer prescriptions are being filled in categories such as cardiovascular conditions, hormone replacement therapy, mental health, epilepsy, Parkinson’s disease and Alzheimer’s disease. These reductions point only to one thing—and that is not a decline in the incidence of those conditions. What they indicate is that people are making a choice between putting food on the table and filling their prescriptions. It is a sad day for all of us when people are making purely financial decisions about their health.

These results are prior to the impact of the PBS safety net and the introduction of the 20-year rule. There is considerable anger in the community about these most recent changes to the PBS. People are confused by the operations of the new 20-day rule. More and more people will be forced to make health decisions from a financial perspective rather than from a health and safety perspective, yet the relentless march to the Americanisation of our health care system continues under this government.

This march has manifested itself not only in the ongoing and almost habitual cuts to the PBS but also in increases in private health insurance premiums. Recently Australian families copped it again when the Minister for Health and Ageing could not help but approve yet another increase to private health insurance premiums. This time it was 5.7 per cent, and the minister was pleased because this was the lowest increase since 2001. It was only 5.7 per cent this time, but there has been an overall increase of 39 per cent since 2001. For an average working Australian, that is a shameful figure. In the simplest terms, this 5.7 per cent increase in private health insurance premiums means that families in south-west Sydney—in fact, families across Australia—will now be expected to pay up to $150 more for their private health insurance. Of course, every single taxpayer gets to share in this joy through the $3 billion a year subsidy that goes to the private health insurance industry!

The government needs to shift its focus from cutting costs in one area of health care in order to prop up another area within the health care budget. When it comes to the health care system, this government needs to shift its focus from the health budget to health services. Australians should not be forced to choose between putting food on the table and filling their prescriptions. The gradual erosion of things in the Australian system that people hold dear has to stop—and, for the welfare of the vast majority of Australian families, I believe it has to stop sooner rather than later.

I welcome the changes to the location rules that take into account the need for people to have good access to their pharmacist. I support this bill and I support the work of the great many pharmacists in this country in what they do for our community. Consumers will benefit from the changes contained in this bill but, at the same time, this legislation will allow pharmacists and pharmacies to continue to play an important role in their local communities.

However, while I support the changes contained in this bill, I believe that this government needs to take a serious look at its management of the health care system and reconsider its priorities in that regard. Health care is about care for the sick—it is not about care for the bottom line of the budget.

Michael Johnson (Ryan, Liberal Party) Share this | Link to this | Hansard source

I am pleased to speak in the parliament today in support of the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006. As the federal member for Ryan I want to say at the outset that I very strongly support all the pharmacies and pharmacy owners in my Ryan electorate. They do a wonderful job in providing a community service as well as in providing a service in the nature of their small businesses. That is one of the key things I want to get across in this debate on this important piece of legislation—that pharmacists across the country are small businesses also and they deserve the full support of the Australian government.

I am a strong supporter of small business in the Ryan electorate and, as someone who has a great degree of admiration for the health minister, I would compliment him at the outset for his negotiation of the community pharmacy agreement. It was no doubt a difficult and challenging set of negotiations, but I think this legislation strikes the right balance between the government’s overall responsibilities, its national interest responsibilities and, of course, the protection of pharmacists in the country, who provide a very special and unique service in the overall architecture of a health service to the people of this country.

There are some 5,000 pharmacy owners across Australia—in my electorate of Ryan there are almost 1,000 pharmacists—who provide a very important service. In the 2005 Morgan gallop poll, pharmacists came second on the list of those regarded by the Australian community as the most ethical and as being in the most honest profession. I am sure that is a position that they guard very jealously. It is a position which they rightly deserve and one which many others can aspire to.

As I said, I want to commend this bill very strongly. It amends the National Health Act 1953 to implement aspects of the fourth community pharmacy agreement. As part of the agreement, the bill sets out changes to the pharmacy location rules and the Australian Community Pharmacy Authority. Since 1990, the Commonwealth of Australia, through the government of the day and the Pharmacy Guild of Australia, has entered into five-year agreements known as community pharmacy agreements. Primarily, the agreements set out the remuneration that pharmacists will receive for dispensing Pharmaceutical Benefit Scheme medicines—PBS medicines. Over time, these agreements have increased in scope to include other relevant provisions, such as location arrangements and professional pharmacy programs and services.

This is the first opportunity, since negotiations were completed in November last year, that members have had to speak in the House about these agreements. As I alluded to earlier, I recognise that these were very challenging negotiations because of the nature of the sector that all stakeholders were dealing in. I have already congratulated the health minister, but I also want to pay tribute to the Pharmacy Guild for its commitment to come to an outcome that is in the interests of the government, the guild’s stakeholders and, more importantly, the Australian people.

The fourth community pharmacy agreement will provide in excess of $11 billion in payments for the dispensing and supply of PBS medicines. This represents a substantial increase to the $7.9 billion paid under the third agreement. It equates to an average payment of some $11.38 per prescription dispensed. This represents a normal increase of 14.5 per cent on the average payment under the third agreement, which was $9.93. Most importantly, the agreement will achieve $306.8 million in savings over the life of the agreement primarily through a reduction in the wholesale mark-up. This will improve the sustainability of the PBS and help to ensure that new medicines can continue to be listed in the future.

I think it is important for members of parliament to frequently emphasise the importance of policy and initiatives that will address or redress the increasing call upon the PBS budget. We are an ageing population; it is important also to stress that. It is important therefore that government policies take into account our ageing population and the increasing stress being placed on the health budget and specifically on the PBS budget. This is an important aspect of the Australian health policy under the Howard government and it is important that it be maintained, preserved and sustained because it provides a very important benefit to the Australian public.

The new agreement that I am referring to retains the current pharmacists payment structure with payments covering the cost of the medicine, the cost to have the medicine delivered to the pharmacy by a wholesaler, a retail mark-up, a fee to cover the pharmacist’s costs for the handling and storage of medicines and a fee for the pharmacist’s professional advice and service in dispensing the medicine to the patient. One of the important aims that the government wants to achieve through the community pharmacy agreement is, as I have touched on, to ensure the sustainability of the Pharmaceutical Benefits System. This is an important system and it is therefore important that government policies take into account as much as possible the PBS structure. To this end the fourth community pharmacy agreement will establish the community service obligation pool. This funding pool will be used to make direct payments to pharmaceutical wholesalers, to make sure that they deliver the full range of PBS medicines to all pharmacies, irrespective of location, usually within 24 hours. The fourth community pharmacy agreement will also deliver increased funding for rural pharmacy programs and programs which support and improve access to pharmacy services by Aboriginal and Torres Strait Islander Australians. This is a further reflection of the government’s commitment to our Indigenous Australian and also our rural and regional Australians. In total, the fourth community pharmacy agreement will provide some $500 million in funding for professional pharmacy programs and services. This reflects an increase of some $100 million on the allocation under the third community pharmacy agreement.

Changes to the pharmacy location arrangements will aim to deliver pharmacy services to where there is most community need and to provide as well an increased level of competition between pharmacies. It is widely known that the pharmacy location rules state that any pharmacist who wishes to relocate their pharmacy or any pharmacist who wishes to establish a new pharmacy must apply to the Australian Community Pharmacy Authority. The ACPA considers all applications according to location based criteria before approval is given to dispense medications under the PBS program. This can be granted by the Secretary of the Department of Health and Ageing. During the negotiations on the fourth community pharmacy agreement, certain groups—most notably our large, well-known retailer, Woolworths, through its CEO, Mr Roger Corbett, and the Australian Medical Association, through its then president, Dr Bill Glasson of Queensland—were of the opinion that the current pharmacy location arrangements were too protective of the pharmacy industry and that this was competition policy in reverse. Both called for reform which would allow Woolworths to operate in-store pharmacies. Mr Corbett commented on the ABC’s 7.30 Report in April 2004:

For this Government, which is a free enterprise Government, to be taking such action is quite extraordinary.

Other commentators have been less diplomatic, saying that the government has effectively been impotent for not deregulating the pharmacy market. I have given speeches in the parliament previously expressing my strong disagreement with Mr Corbett. With all due regard to his undoubted talents as a very senior and highly respected CEO in this country and to his very successful stewardship of Woolworths, in the parliament today I again put on record my strong disagreement with his views. This government has been very amenable in its policies in allowing greater competition and fostering greater deregulation across the Australian economy. As I have said, I have commented in this House previously on my position. Mr Corbett’s views that the government’s policy on pharmacies is quite extraordinary are quite unwarranted. This government can stand very proud of its record of opening up the economy in its 10 years in office. No doubt it will continue to do so, and I would encourage it to continue to do so.

I know that Ms Janet Albrechtsen, writing in an Australian article on 22 June 2005, also called for the government to act expeditiously to redress this alleged wrong. I offer all due respect to Ms Albrechtsen, who I know has very high respect for Australian government policies. I salute the work that she does as a member of the ABC board. She is doing a fine job in that capacity, and I know that all members of this parliament will acknowledge her contribution to the national political debate through in her articles in the Australian. But on this particular issue I have no hesitation in saying that Ms Albrechtsen is entirely wrong. She is paddling a canoe up the river the wrong way and her paddles are not functioning effectively.

One of the reasons why I very strongly support local pharmacies, not only in my electorate of Ryan but throughout the country, having some degree of support through these community pharmacy agreements is this: not only are they, given the nature of their work, a small business but also they provide a unique service. They provide a very specialised service as part of the allied health group. They are a part of the architecture of the health structure of this country. They are not just another corner shop. They are not just another Boost Juice franchise. They are not just a shop on a shopping strip. You can have a handful of them on the same shopping strip and they can compete. This is not a situation whereby we want pharmacies littered throughout the shopping malls of Australia. They are small businesses first and foremost that provide service of a very professional nature in the health architecture. I reject entirely the comments of commentators who say that the government’s position of standing side-by-side with the pharmacy community in Australia is incorrect. I have strongly supported the Minister for Health and Ageing in his negotiations and I commend him for taking the stand that he has.

The pharmaceutical market in this country is some $9 billion a year. It is little wonder, therefore, that the likes of Woolworths want a piece of that pie. I do not think that anyone would resent Mr Corbett or senior executives of Woolworths for making the representations they are making to have a slice of that $9 billion pie. No doubt if I were a CEO of Woolworths or Coles I would want to have a pharmacy located in my stores. But the responsibility of this government is to protect the overall Australian community and the national interest; it is not to ensure that Woolworths’s share price goes up because all of a sudden it has a big chunk of that $9 billion a year industry.

I know that many of my fellow Australians are shareholders in Woolworths. As an aside, members of the parliament who are shareholders of Woolworths will have that declared on their register of pecuniary interests, and it will be interesting to see who they are. More importantly, this government’s responsibility is to govern in the national interest. Governing in the national interest ensures that the likes of Woolworths are not able to expand their empires without having to take into account the pharmacies in their midst. I want to put on the record very strongly my support of the almost 1,000 pharmacists in the Ryan electorate. I visit their stores frequently and I have a very high regard for their professional expertise. Again, I strongly repudiate calls by any sector of the Australian business community to erode the pharmacy agreements and to entertain the notion that big retail chains include pharmacy stores.

In 2003 an independent study by Curtin University estimated that, if you take into account the value-added service that pharmacies provide to customers when they come into their stores to buy prescription drugs, pharmacists provide over 78 million free consultations annually. When I go to my local pharmacist as a consumer to purchase an item, I invariably end up speaking to him for some five, six or seven minutes. If that were multiplied by the many people who go into his store, and if a price were to be put on it, a very valuable service is being provided.

Studies commissioned by the Pharmacy Guild also show that pharmacies are more than just drug-dispensing counters. Not only do they provide these free consultations but they also provide a degree of care and compassion to their customers that, I would be so bold as to say, someone in a Woolworths pharmacy would not provide. Supervised administration of individual doses occurs in community pharmacies for many thousands of Australians and for patients of doctors who go to their pharmacy and collect their prescribed drugs after a consultation. This is important to note. Counselling occurs in these private locations in the pharmacy on many occasions. It has been estimated that counselling occurs in pharmacies across the country on almost 14½ million occasions annually.

It has been calculated that 385,000-plus screening tests for undiagnosed chronic conditions and 25,000 pregnancy tests were conducted annually in pharmacies. More than 40 per cent of pharmacies are very active in methadone or buprenorphine dosing and needle exchange. While it is true that Woolworths, were it to be granted access to pharmacies, intends to staff its in-store pharmacies with registered pharmacists, I still subscribe to the view that, under the cost-cutting and profit driven environment of these major retail chains, invariably there would come a point where the community would suffer and these valuable services provided by pharmacies would cease. Not only do community pharmacies provide these services but they act as an important check for doctors. It is important to acknowledge that they provide an important complementary service to doctors.

Pharmacy location rules are important not just because they prevent operators like Woolworths from owning pharmacies or because they prevent pharmacies from being located within, adjacent to or connected to a supermarket; they also help to ensure widespread community access to pharmaceutical services and the continued viability of existing pharmacies. This gives much needed security to pharmacists, to consumers and, of course, to the PBS—a structure which this government is striving very hard to keep in check. This bill will extend the operation of the pharmacy location rules to the conclusion of the fourth community pharmacy agreement in June 2010 and also make some other minor changes agreed to under that agreement.

As the federal member for Ryan, which I have had the great honour of representing since 2001 in this parliament, I am a very strong supporter of the some 1.2 million small businesses in Australia. Pharmacies are also small businesses. They are dotted throughout the Ryan electorate and form the small business architecture of this country. It is incumbent upon all of us in this parliament on both sides to strongly support small businesses. I note that the Leader of the Opposition has previously said—he is famous for this remark—that Labor is not part of small business—(Time expired)

Martin Ferguson (Batman, Australian Labor Party, Shadow Minister for Primary Industries, Resources, Forestry and Tourism) Share this | Link to this | Hansard source

I rise to address changes to the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006. At the outset I express to the House that the introduction of greater flexibility in the location of pharmacies under this bill is a welcome move. Hopefully this flexibility should act to increase the accessibility of drugs to those in need, particularly in rural areas. In that context, I note with dismay the fact that the members for Hinkler and Maranoa have withdrawn from the speakers’ list this evening because I think the amendments in this bill are exceptionally important to rural and remote Australians. That does not augur well for the National Party’s commitment to representing those areas.

Australians deserve far better than the protracted and heated negotiations that have prefaced this final outcome. The amendments are the result of the fourth pharmacy agreement between the Commonwealth and the Pharmacy Guild of Australia which commenced on 1 December 2005 and will terminate on 30 June 2010. The agreement appropriately provides for new pharmacy location arrangements to commence on 1 July 2006, and this bill appropriately gives effect to some of the issues around those arrangements. The opposition welcomes the changes including the co-location of pharmacies with large medical centres that operate extended hours, the location of pharmacies in small shopping centres and in particular the relocation of an additional pharmacy to one-pharmacy rural towns and high growth areas. It is essentially about trying to make sure that the services are available where they are needed.

On the issue of location I am pleased to remind members of the House of the importance of the fact that supermarkets have been knocked back in their attempts to have in-house pharmacies. I also remind the House of the motion that I moved in the House on 5 September 2005 concerning this issue, which clearly expressed the opposition’s opposition to the major retail chains such as Woolworths and Coles being able to open pharmacies in supermarkets. I am pleased to say that the campaign by the Pharmacy Guild of Australia, with the support of the opposition as expressed by that motion which was debated in the House of Representatives on 5 September 2005, has actually won the ear of government.

Whilst the opposition welcomes the changes under this bill, the final pharmacy agreement is hardly something about which the Howard government and the Minister for Health and Ageing, Mr Abbott, can be proud.

Michael Johnson (Ryan, Liberal Party) Share this | Link to this | Hansard source

Rubbish!

Martin Ferguson (Batman, Australian Labor Party, Shadow Minister for Primary Industries, Resources, Forestry and Tourism) Share this | Link to this | Hansard source

Perhaps the member for Ryan should listen to this: it is the result of secret and difficult negotiations that reflect poorly on how this government does business and how it regards pharmacy services to Australians. The incompetence of the health minister throughout these negotiations can be illustrated by the fact that this is the third time in less than 12 months that the parliament has been required to act on these rules. It is important for the House to acknowledge and welcome the changes but it is also important that we highlight and hold the government accountable for the drawn-out tortuous process that created uncertainty in the pharmacy industry and uncertainty in the minds of many Australian consumers.

Those negotiations did not do justice, in terms of the performance of the minister for health, to the needs of the frail and elderly who do not have ready access to pharmacies. It also created uncertainties in their minds about whether or not supermarkets such as Coles and Woollies would be able to win the ear of government and take away from their local community shopping strips the pharmacist that they so much depend on, because those pharmacists—unlike the major retail chains such as Coles and Woollies—are part of the local community. All too often these people cannot afford to go to doctors because of the decline in bulk-billing, so they go down to the local pharmacy. They have often known the pharmacist for many years. The pharmacist has known the family and has been able to give medical assistance over and above filling prescriptions. The handling of this bill by the Howard government was an utter disgrace, because it created uncertainty and insecurity in the minds of many frail and elderly people who rely on their local pharmacists on a regular basis.

Moreover, the legislation neglects the fact that the agreement covers some 22 per cent of PBS spending. The real concern is that these beneficial changes are being seriously undermined by the Howard government’s attack on the Pharmaceutical Benefits Scheme. Next to Medicare, the PBS is a vital part of our health care system. We should not forget that it has now been in operation for 50 years. The scheme means that potentially life-saving drugs are accessible to all through a critical government subsidy system which has been among the best in the world—something we as a nation have always prided ourselves on and something that other nations such as the United States of America are envious of.

In the early days of the PBS, this meant that parliament legislated to supply free medicines to immunise against diphtheria and whooping cough. In the 1970s, the emergency supply of medicines after the devastation of Cyclone Tracey in Darwin was critical to minimising the risk of a public health disaster through immunisation against cholera, typhoid and tetanus. These are some examples of the success of this scheme and its great benefit to Australia. These examples further illustrate the crucial role that a government plays through publicly supported access to vital medicines through a scheme known as the Pharmaceutical Benefits Scheme and its importance to public health. Since those days it has broadened to include access to more than 590 generic drugs.

Around 80 per cent of medicines are funded under the PBS, and around 170 million prescriptions were covered by the scheme in the year to June 2005. These are important medicines that we all depend on and that help us all to lead healthier lives. This effectively means that the PBS is a great investment in terms of taxpayers’ scarce dollars. I therefore argue that, given the value of this program and its history, it is disturbing to witness the way in which the government is undermining the PBS.

Yes, providing subsidised medicines is not a cheap exercise for governments but the reality is that prescriptions are falling. Moreover, the data generally indicates that the proportion of funding Australia devotes to pharmaceutical subsidies is lower than that of other OECD countries. Despite this, there has been a 21 per cent increase on PBS copayments—that is, the amount that patients have to pay for accessing medicines. Since the increase was introduced last January, the PBS growth rate has now fallen to 2.5 per cent and is expected, unfortunately, to drop even lower. According to recent Medicare Australia data, the potential savings to the PBS could amount to $1.38 billion for the next financial year, with 11.4 million fewer prescriptions. I wonder whether that is a good investment in the overall wellbeing and health of the Australian community.

The reduction in prescriptions follows the increase faced by patients and reflects the government’s willingness to cut costs at any expense, including the health of Australians. Like other areas of policy, this government is content to allow the Americanisation of health care and medicines. We all know what that means—a sick and desperate underclass, penalised simply for the fact that medicines are extraordinarily expensive.

The PBS, I contend, goes to the heart of the difference between the opposition, represented by the Labor Party, and the coalition government. Increased PBS copayments are increasingly raising out-of-pocket health care costs and hitting the sickest and neediest Australians. Some 80 per cent of PBS beneficiaries are patients already receiving concessions. They depend on the system. Moreover—and we should never forget this—Indigenous Australians get dramatically less access to the PBS than any other Australians—and just look at the problems of health care confronting the Indigenous community.

The government has also deliberately undermined the PBS safety net through the introduction of the 20-day rule. Under this rule, a repeat supply of the same medicine within 20 days on certain medicines will not be covered by the safety net. So, under this government, access to the PBS is being restricted, drugs are being delisted and copayments are rising—facts which are pushing Australians to make critical decisions about how they spend their money.

How can we as a nation, in the 21st century, force Australians to choose between buying their medicines or the other necessities of life? Yet the figures clearly show beyond any doubt that fewer prescriptions are being filled for serious health conditions such as cardiovascular conditions, anaemia, blood clotting problems and mental illness—all fundamental, critical health care issues that need government assistance and leadership.

Let us take the issue of mental illness, a major and growing problem in Australia. It is hard to believe that drugs for this major health problem are being restricted when, only recently, mental health was right at the centre of the COAG announcements. The government simply cannot have its cake and eat it too. It is either committed to doing something about mental health, including assistance through the PBS system, or it is not making that fundamental commitment. It is a problem that we, as a community, have correctly realised that we have to front up to. We have to invest in trying to assist these people—often very desperate families trying to manage the problems of mental health.

This contradiction, I believe, reflects the difference between government rhetoric and policy. The bottom line, especially when it is in the black, should not be pursued as an end in itself and certainly not at the expense of the health of Australians in need of medicines. This is a fundamental right of all Australians and something that we expect in any decent society, especially in a nation such as Australia which prides itself on its capacity to play above its weight, not only in assisting people at home but also in appropriate overseas aid for more needy nations beyond Australia’s shores.

To top it off, the health minister, Mr Abbott, takes it upon himself to remove, for example, calcium tablets, without any expert advice. He saved $9 million. But will this result in the deterioration of health outcomes as a result of that short-sighted decision? I would also point out to the House that people left without access to PBS calcium tablets are people with osteoporosis—a disease that costs Australia $1.9 billion per annum in health care costs. One can only say that that decision by the minister for health was not a good investment because enabling people to try and care for themselves, if properly done, represents a long-term saving to the Australian taxpayer by avoiding far more difficult personal health challenges. The minister for health therefore simply would not know, I suggest to the House, because he did not bother to get that advice. He, as always, took it upon himself, without proper advice, to basically impose his opinion on the Australian community. In essence, it was about simply cutting costs today at the expense of better health tomorrow, in complete disregard for expert opinion and good policy. Yet, as a minister, he is expected to be committed to proper public policy rather than short-term savings decisions which, in the long term, are to the detriment of a lot of individuals’ health, their families, their communities and the nation at large.

This means that the cost, for example, to concession card holders who are accessing calcium from the PBS has gone from $4.60 to around $13 a bottle. For those people that is a big personal hit. They live from week to week. They are finding it very difficult to make ends meet at the moment. To go from $4.60 to around $13 a bottle might not appear much to a minister on an especially generous salary, if he or she had the same problem, but for the ordinary pensioner that is a huge slug which many of them just cannot meet financially. But I am pleased to say that, after this knee-jerk cost cutting by the minister for health, he had to back off and to back-flip. That effectively meant that calcium was put back on the PBS for people with kidney conditions—the result of failing to seek sound advice before making a hasty decision.

The question must therefore be asked: just how is the government’s PBS policy reducing access to much needed medicines? How, in turn, is this policy acting to increase costs in other areas of health care? The reality is that this policy neglects the importance of the role of medicines in preventative health care. Yet that has got to be the No. 1 objective of government policy: how do we lift our game in terms of preventative health care?

Ultimately, the issue is not simply about capping costs; it is about ensuring that money is well spent towards producing good health outcomes and good public policy. If the health minister spent more time understanding the long-term preventative benefits of the PBS rather than slashing costs—if he took better advice—Australian health would be better now and for future generations.

As I said at the outset, the opposition supports the bill before the House. The bill is, appropriately, about the introduction of greater flexibility in the location of pharmacies, which is especially important for regional Australia and growing suburbs.

I stress once again that the decision by the Howard government to back away from its intention to extend pharmacies to major retail chains such as Woolies and Coles is the right decision. I am pleased that the Prime Minister was forced to acknowledge the commitment given to the Pharmacy Guild during the last election in the form of an exchange of letters which committed to that policy position but which the minister for health and others on the other side of the House sought to undermine.

We should never forget that these community pharmacies are part of the fabric of the community. Out in the suburbs and in rural, remote and regional Australia, pharmacies are part of the leadership of our local community. We all depend on the community pharmacist. We should never forget that they are essential in our local metropolitan and regional communities. They give crucial advice. They often make sure that people properly attend to safe medical and medicinal practice. This is about the better health of all Australians. As far as I am concerned, the professional services provided by pharmacists are vital to a decent Australia in the 21st century.

In conclusion, I make one point. We have major skilling problems in every other sphere of Australian life at the moment. The Australian government also has to do more with the Pharmacy Guild and associated entities to train more pharmacists. Our neglect of training for Australians, be they in traditional trades or the professions, effectively means that we are in serious trouble as a nation. I know that from my own responsibilities as shadow minister for resources, energy, forestry and tourism.

We are now losing investment because we do not have the skills base to enable capital decisions to be delivered on time and on budget in Australia. When you ask the major resource companies and hospitality providers to identify the key issue or challenge that they confront at the moment, they speak of a shortage of trained Australians to actually do the work. Skilled migration might be of assistance in the short term, but it is not the long-term solution. In the same way as we have had to rely on overseas doctors, we are now relying on overseas pharmacists.

I simply make a plea to the government. Having got in place a new pharmacy location arrangements bill that has the support of both sides of the House, please start paying more attention to the issue of how we train Australians to succeed the current generation of pharmacists that we depend on as a community. If you do not, we will not only see pharmacy shops close in the local community shopping strips in the suburbs and in rural, remote and regional Australia, but also see associated neglect and a decline in the health of the Australian community.

I commend the bill to the House but also say to the government: please start getting your head around what is probably the biggest priority in Australia at the moment—how we invest in the skilling of Australians, be it in a trade or a profession. If we do not do that, we are going to effectively reduce the size of Australia’s economic cake for future generations.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 and put on the record the views and interests of the people of Hindmarsh. The bill is just one aspect, but a very important one, of the greater fourth community pharmacy agreement, originally due for implementation in July last year. The five-year community pharmacy agreements were created by the federal Labor government in 1991 as a result of dissatisfaction with remuneration arrangements and decisions of the Pharmaceutical Benefits Remuneration Tribunal. The Labor government’s second community pharmacy agreement of 1995 continued to set out remuneration arrangements for pharmacies, but also began to establish mechanisms for recognising and compensating pharmacists for their expanding health care role, and worked toward a broader distribution of pharmacies throughout the community. The third agreement saw this focus on the distribution of pharmacies codified in the establishment of ‘pharmacy location rules’. This focus was intensified in 2004 with the supplementary rule that pharmaceuticals could not be dispensed from supermarkets.

The purpose of the location rules is twofold: first, to provide widespread community access to pharmaceutical services, and second to ensure the continued viability of existing pharmacies. In this fourth agreement, additional flexibility was given to the rules so as to allow for the possibility of pharmacies co-locating with after-hours medical centres or relocating into certain types of shopping centres, single-pharmacy towns and urban areas with high population growth. There is also a reduction in the minimum distance between pharmacies supplying pharmaceuticals under the PBS—from 1,500 metres to 500 metres by straight line measurement.

As with most things, perceptions of the appropriateness of the rules are varied. A few people have said that to interfere with market forces can only lead to abuse, with some people making more money than they should and with customers being ripped off, being unserviced and the like. I think everyone else in the country, including this government, the Pharmacy Guild and the Australian Labor Party, which started this process, recognises that, without interfering in the distribution of medicines covered by the Pharmaceutical Benefits Scheme, at least one of these negative outcomes is much more likely to become a certainty in areas across metropolitan and regional Australia. I am speaking of the geographic availability of medicines and the service Australians receive under the PBS.

The Australian population is ageing substantially. The electorate of Hindmarsh, which I represent, has 25 per cent of electors aged 65 or over. And people are living longer in the community. That is a good thing. By community, I mean a long-term or family home or, if not that, a newer and more manageable home unit or apartment. This means that people are continuing to be—perhaps increasingly being—out in the middle of a suburb somewhere, without nursing or caring staff to look after things for them.

Many pensioners without savings cannot afford private transport. They are too frail to use the public transport system, which would probably require quite a hike, and the prospect of PBS medicines being dispensed in blocks of chemists within regional supermarket and shopping centre complexes about five to 10 kilometres away would make life that much tougher.

The introduction of the rule banning supermarkets from dispensing pharmaceuticals deserves special attention. A concern I have with supermarkets is their capacity for unequal competition with small, often family run businesses, including community chemists. By virtue of their enormous multi- and single-store capacity, they have the substantial ability to cross-subsidise many more products than a local pharmacy. How would pharmacies be able to continue to remain viable in a deregulated environment? In the case of the local deli or butcher, many people honestly do not care, but the availability of medicines to maintain life, either in essence or at some reasonable level of quality, is a very different matter.

I have been told of the 80-20 rule which generally applies to pharmaceuticals. A pharmacist will get approximately 80 per cent of the turnover from 20 per cent of the lines. It is the remaining lines—over three-quarters—which account for only 20 per cent of the turnover that are problematic. Pharmacists keep an extensive range of drugs in stock and nothing is cheap, and these slow sellers—the over three-quarters of stock that is not in high demand—still need to be kept and replenished in a timely manner in case of demand. Pharmacists work outside the normal supply and demand market dynamic. They need to, and all governments need them to, for the good of the public’s health. Supermarkets, I believe, will lead to the withering of local access to PBS products.

A representative of the Australian Consumers Association argued on Adelaide radio station 5AA last October against community pharmacists and in support of supermarket dispensaries, with the assertion that pharmacists place a 70 per cent automatic mark-up above the government approved price for pharmaceuticals. They actually complained to the ACCC, a complaint that was, I am told, dismissed as nonsense. It appears that many consumers agree with this dismissal and do not believe their hip pockets are being sacrificed in order to financially prop up the local pharmacist’s business.

Last year I circulated a petition within the electorate of Hindmarsh calling on the federal government to negotiate an agreement which recognises the real value of community pharmacies. This sparked some correspondence from within the industry, which one would expect. I will read some of the comments I received. The Pharmacy Guild of Australia’s executive director gave his acknowledgment of the fourth agreement, stating:

We agree with your view that these measures, and more broadly the Fourth Agreement, are very much in the public interest.

Another letter said:

I am aware of your stance and have been particularly impressed with your understanding of the issues ... thank you again for your interest ... on behalf of our customers.

Another letter spoke of the fourth agreement’s community service obligation. Symbion Pharmacy, well outside of my electorate, wrote:

Reaching an agreement on the community service obligation ... will ensure community pharmacies, particularly those in rural and regional Australia, will continue to receive the full range of PBS medicines in a timely manner. We believe this is the most fiscally and socially responsible outcome that could have been negotiated. Symbion Pharmacy (formerly Mayne Pharmacy) can continue with more certainty to deliver the full range of PBS medicines across Australia.

As for the customers, it was not long before the completed petitions began flooding in. It has been the second largest response to a petition or survey that I have run since becoming the member for Hindmarsh. I have received approximately 4,000 signatures from members of the community who want the level of service they get through their community pharmacist continued and not compromised.

The level of service they want continued includes the professional advice they receive from the pharmacist, including through home medicine reviews—of which I spoke in this place last year—whereby, if a GP suspects that a patient might be finding it difficult to correctly use all of their medications, a pharmacist can go to that patient’s home and check that everything is working as it should. It may be that there are too many medications to keep up with or that prescription medicines are interacting with over-the-counter medicines that the GP was not told the patient was taking. It could be that the equipment used to administer medicines, such as a nebuliser, is old or broken. These consultations can take quite some time, but the results for the patient are excellent and often lead to the prescribed medications being more effective.

What have other people in this place said about PBS medications being dispensed from supermarkets? The member for Hinkler spoke in this place in May 2004 of the special needs of customers that would not be met within a supermarket. He said:

... pharmacies are a place where the frail, aged and chronically ill can find a little peace while trying to get clear advice on their medications.

…            …            …

That advice should not be compromised by the vagaries of the retail market or by a supermarket group’s buying arrangement with an individual supplier, or, dare I say, an individual drug manufacturer.

The member for Franklin stated:

If Coles and Woolworths were allowed to place a pharmacy within their supermarkets, there would be pressure on what products were stocked, how restricted stock could be marketed and what services could be provided. It is a clear warning to each and every one of us in this House, and through us to our communities, that the service and standards the community enjoys with its community pharmacists would change dramatically under the Coles and Woolworths corporate pharmacist regime.

And I respect the clarity of the member for Herbert’s statement when he simply stated:

... supermarkets and health do not mix. It is as simple as that.

I am relieved, as I am sure members of the community will be, to know that community pharmacies will not be driven out by supermarkets at this time. Thousands of jobs, hundreds of local pharmacies and millions of free consultations provided by pharmacists will be under threat if any new agreement fails to recognise the importance and the valuable role of community pharmacies.

What sets community pharmacies apart is that they provide careful advice to their customers on the side effects of prescribed medicines and on combinations of medicines. Community pharmacists take the time that is needed to care for their customers. As a result, Australia has half the rate of hospital admissions from medicine misuse when compared to the United States. I am glad that the federal government appears to have listened to the community’s wishes on this occasion and recognised the fundamental role that community pharmacists play in maintaining the day-to-day health of so many Australians. I commend the bill to the House.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Community pharmacies play a vital role within our community. I find it very disturbing that it has taken this government so long to reach that conclusion. It has taken this government up until now to acknowledge the fine role that our community pharmacies play within our communities throughout Australia. Whilst I will support the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006, I do think it very important that I place on the record that I support the second reading amendment that the shadow minister for health has presented to the House tonight. That amendment condemns the government for its failure to investigate the impact of the PBS copayment increase on patients’ access to needed medicines; for the recent changes to the PBS safety net; and for the confusion and difficulties caused by the new 20-day rule. These are all issues that constituents within my electorate have raised with me and all issues that I think go to the safety of the way medications are used and supplied throughout Australia.

The changes to the pharmacy location rules introduced by this legislation have the potential to improve access to pharmacies and pharmaceutical services through the PBS for people who live in rural and remote areas and in developing suburbs. I feel that that is a very good thing. It is important that people can get the advice that they need from their local pharmacies when they are sick and when there is no doctor available. People also need to know that the advice they get is accurate. If there is no pharmacy within the area that a person lives in, they are severely disadvantaged.

I was speaking to an elderly resident recently who lives in the Shortland electorate. She has been housebound. The only way that she was able to get her medication was by her local community pharmacy delivering that medicine to her home. That is so important for her wellbeing, for her recovery. It shows the types of services that our community pharmacies provide. If there were no community pharmacy within that area then this elderly woman would have to go without the medication that she so vitally needs.

I think it is fairly important that I go through what the actual changes to the pharmacy location rules will mean. They will permit the co-location of pharmacies with large medical centres that operate extended hours. Obviously, that is of vital importance because, if you can see a doctor after hours, you need to be able to have the prescription that that doctor provides you with made up. Quite frequently, at the moment those pharmacies are not located anywhere near the medical centres and the person may have to wait until the next day to be able to have that prescription filled. If they can co-locate on the premises, that will obviously advantage those people who see their doctor.

The changes will allow for the location of pharmacies in small shopping centres, which I think speaks for itself. They will also allow for the relocation of an additional pharmacy to one-pharmacy rural towns and one-pharmacy high-growth areas without regard to the usual distance criteria. This has been a bone of contention for many years and I think this is a sensible change.

The changes to the pharmacy location rules will also remove the requirement that a specified number of commercial establishments are open and trading before an approved pharmacy can relocate to a shopping centre. For developing areas, that is obviously an important change. It is also an important change for very small communities. The changes also provide greater flexibility for pharmacies located in private hospitals by allowing the establishment of satellite dispensaries for hospital in-patients.

I thoroughly concur with those changes. Unfortunately, I think that this government has failed the pharmacy operators, pharmacists and the Australian people with the long, drawn-out process that was undertaken in signing the latest agreement. I was approached by pharmacists because they were really concerned about the government’s failure to say once and for all that they would not support the location of pharmacies in Woolworths and Coles. They were most concerned that this would erode the quality information that the Australian people were used to receiving from their pharmacists.

I was speaking to one pharmacist within the Shortland electorate last year. He had worked in Scotland. He had been a pharmacist in various places in the UK. He had worked under a system where pharmacies were allowed to operate within supermarkets. He told me that the government was deluding itself if it thought that it would maintain the same quality of service that is provided to people at the moment by their local community pharmacy.

I think the fact that the CEO of Woolworths, Roger Corbett, had the ear of the minister for health played a very large part in the delays in reaching that agreement. We all know in this parliament that the government is a slave to big business. If big business wants a change then the government will jump. The government was prepared to accept the argument that the changes were about flexibility, making it easier for people to obtain their medication and making the medication cheaper. But overseas experience has shown that exactly the opposite result is achieved. So I think that the government stands condemned for its inaction in reaching that agreement. It is very important that that is placed on the record and that the people of Australia are aware of how this government allowed this to drag on and on. We came back into this parliament, I think on two occasions, extending the time of the last agreement.

If the government had really been acting in the interests of the Australian people, they would have recognised, as I said earlier, the valuable role of community pharmacies. They would be very aware that it is our pharmacists who provide people with the advice they need when they are taking medication. Pharmacists, when they fill a prescription, give advice on how to use the medication. On one occasion I was taking medication and my doctor had not told me that I should not eat a particular product and that eating that product had the potential to make me very ill. It was the pharmacist who said, ‘When you take this medication you should not eat that particular food.’ That is the kind of advice that pharmacists are giving people each and every day—and that is prescription medication.

When my children were young I visited the pharmacist when they had a cold, an earache or some minor complaint. Before going to the doctor I would seek the advice of the pharmacist. You could rely on that advice. If the pharmacist thought you should take your child to the doctor, they would give you that advice. That is why pharmacies play such a valuable role in our community. It is not the Australian way to place pharmacies in supermarkets and have the level of advice and service that would be provided there. It is not the kind of service that Australian families and Australian people deserve.

In reaching this fourth pharmacy agreement and the new pharmacy location rule, the Howard government have tried to paint a very pretty picture, stating that they have achieved a very positive outcome for the Australian people. This is despite the fact that they took so long to negotiate this agreement. It is also important to put on the record that the government have really undermined our PBS. These protracted negotiations have gone along with this general undermining of pharmacies and the PBS. Since the introduction of the 21 per cent increase on PBS copayments last January and the 12.5 per cent cut in generic medicines in the middle of the year, there has been a massive decline in the number of prescriptions being filled. I say ‘massive’, but it is when you consider it in the context of the provision of prescriptions that maintain the health of the Australian people. There has been a 2.5 per cent decline in the growth rate of the PBS, and that is expected to drop even lower. Based on the most recent Medicare Australia data, savings to the PBS for the next financial year could amount to $1.38 billion, with 11.4 million fewer prescriptions being filled.

What that means is that Australians are no longer taking vital medications that they need to maintain their health. It is argued very strongly by this government that the increase in the use of the PBS is a financial burden to Australia, that there should be fewer prescriptions filled and that Australian people should pay more for those prescriptions. But I would say to the government: there is a cost associated with that also. Those prescriptions prevent people from getting ill and prevent increased health costs in other areas. The government should think very seriously about that. Not only does it lead to a greater severity in illness and increased hospitalisation; it also leads to an increase in unemployment and more people needing to receive income support. The areas that it pervades are enormous.

As I mentioned, the only good news in the decrease in the use of medication is in the budget bottom line. It does not do anything for health outcomes. The government constantly confuses PBS sustainability with cost cutting, and it never looks at the impact on the overall health system and the abilities of patients to afford their medications. I have had constituents come into my office and tell me that they cannot afford to purchase their medication. I have had other constituents come in and tell me that they share their medications because of the increase in costs. That is not good enough. These are patients that suffer from quite critical conditions that really need medications, such as cardiovascular conditions, blood conditions, mental illness and epilepsy, just to name a few.

It is obvious that the rising out-of-pocket costs due to increased co-payments, special patient co-payments and therapeutic and brand premiums are hitting the sickest and the neediest Australians, which means that too often they must choose between buying their medication and putting food on the table, buying their medication and putting petrol in their car or buying their medication and giving their children books for school. I do not think that is the Australian way, and I do not think that is the kind of society that we want.

The impact of the change to the PBS safety net and the new 20-day rule is yet to kick in. Many people do not understand the implication of the 20-day rule. Many people will find that, because of the 20-day rule, the safety net will not kick in when they expect it to. The thing that makes me really sad as I stand in this House tonight and talk about these changes is that on one hand we have changes that will improve access to community pharmacies but on the other hand the government is increasing the costs of health in every way. Pharmaceutical benefits are no exception to that rule.

This government has a philosophy that the user should pay—and pay through the nose—for all the services that they receive. I have a different philosophy. My philosophy is that if you are sick you should be able to get the medication that you need. My philosophy is that if you do not have a lot of money—because you are not as well off as members on the other side of this House—you should be entitled to the medication and the medical treatment that you need. Your needs are as great as those on the other side of this House and their friends. Although I will support this bill, I reiterate that the government stands condemned for its failure to investigate the impact of the PBS copayment increases on patients’ access to medication and the recent changes to the pharmaceutical benefits safety net and for creating the confusions and the difficulties associated with the 20-day rule.

Duncan Kerr (Denison, Australian Labor Party) Share this | Link to this | Hansard source

The shadow minister has moved amendments in this House to the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 and drawn attention to the government’s failure to investigate the impact of the PBS copayment increases on patients’ access to needed medicines; the recent changes to the PBS safety net, which mean that patients must pay more out of pocket; and the confusion and difficulties presented to patients, doctors and pharmacists by the new 20-day rule on repeat prescriptions.

Certainly I would join with the shadow minister in emphasising that the neediest and sickest of Australians will now be forced to choose between buying their medicines and other necessities of life, and there is no doubt that the 20-day rule will make it increasingly difficult for some patients to get their PBS costs to count towards the safety net. The shadow minister drew attention to the fact that this is not just confusing and troublesome for patients; it is making life difficult for busy doctors and pharmacists. There are many legitimate reasons why patients will require access to their medications within 20 days of the dispensing of their previous script.

Whilst all those general points are extraordinarily important in this debate, tonight I want to highlight a particular circumstance that has come to me through one of my constituents, Mr Jack Clear, because it draws a particular issue to the fore. I put it before the House that this is an issue that fully justifies the shadow minister’s concerns about the 20-day rule but I also propose it to the government by way of some requirement for it to take attention of the way in which this policy is being implemented.

Mr Jack Clear is a man who requires a number of medications and is of course deeply troubled by the increased costs that the changes to the PBS will impose upon him. But, more particularly, he is a person who from time to time seeks repeats of prescriptions that have been issued. Some little while ago he came to me—and I was certainly not mindful of this debate; this is a matter which arose quite independently of it—because he had tried to have a script dispensed 21 days after the last dispensing. He was told by the pharmacist that this fell within the 20-day rule, so he could not count the cost of the script towards the PBS safety net. It would appear that, whilst it was the intention of the legislation to ensure that the 20-day rule permits a script to be dispensed after that period expires, on the 21st day, a number of pharmacies are using a dispensing program called ‘Winifred’, which interprets the 20-day rule as meaning that there must be 20 days in between each dispensing date—that is, it starts counting the days on the day after the script is dispensed. So, in effect, it is adding an extra day to what I believe was the intention of the parliament. In that instance, Mr Clear was presented with a quite expensive account for the drugs which were dispensed, which cannot count towards the safety net.

I do not doubt that, given that this is a computerised system that is operating across a number of pharmacies, similar circumstances will apply to a number of people. Those people, properly being aware of the nature of the rule, will present themselves to their pharmacy in order to get a particular drug dispensed, believing that they will be automatically entitled to the benefit of the safety net. They will discover that in fact the set-up that the pharmacy operates to implement the government’s decision precludes them from being able to access the safety net payment. That of course will mean that those persons cannot make the scripts that they have had dispensed count towards the safety net.

The pharmacist that my office spoke to said that the government’s intention was not unambiguous, that the meaning of the legislation was unclear. Plainly, the pharmacist and those who are part of the network of pharmacies that are using the prescription system that operates in this instance understood the government’s legislation in the manner which caught Mr Clear unawares, to his great cost.

I would like it made plain by the government that the intention is such that, if a person applies on the 21st day after the dispensing of a drug, they are not excluded by the operation of the rule. That would seem to be a commonsense understanding of the intention of the parliament—although, in defence of the pharmacists who are themselves, I am certain, trying to make the best of a complex and highly unsatisfactory legislative rule, section 84AAA is, on its face, not so simple in its interpretation as to preclude the interpretation that the pharmacists have put into operation through their computerised system, to the detriment of those who come forward on the 21st day to seek the dispensing of drugs and coverage under the PBS. I believe the government should act immediately to clarify this section of the legislation and to ensure that dispensing programs that are being operated across Australia by pharmacies are made consistent with the understanding that I would hope this parliament has embraced in this legislation.

It is one thing to note that the 20-day rule itself is capable of causing considerable difficulty. It does not recognise that there will be perfectly legitimate reasons why some patients wish to acquire their medications in a shorter period after the dispensing of a previous prescription. For example, they may be travelling interstate or they may have particular requirements that limit their capacity to travel. Some are handicapped. Some are not as mobile as others. They may rely on friends to make occasional visits. In particular, those living in rural and regional areas do find it difficult to make arrangements to travel to pharmacies as easily as those living in metropolitan Sydney, Melbourne or even Hobart. It is one thing to acknowledge that. It is another to then have this catch-22 situation apply that, where somebody acknowledges and acts in good faith on the expectation, having allowed 20 days to expire since the dispensing of their script, they will still fall foul of these new rules. The government should make it plain that those who have been caught by this problem are sought out, reimbursed and reincluded in the safety net, because I imagine that the circumstance of my constituent Jack Clear would not be unique.

Those are the specific points that I wish to add to this debate, and I commend them to the minister at the table to convey to the Minister for Health and Ageing. They are specific concerns that emerge irrespective of the passage of this legislation, but they only go to emphasise the cavalier way in which this government is treating those sick and neediest Australians who are dependent on the PBS safety net to enable them to have their medicines at a reasonable price.

I am certain that the difficulties I refer to are not ones of malice. The rules that have been brought in are confusing and troublesome, not only for patients. They will be making life difficult for busy doctors and pharmacists. They confront doctors and pharmacists with considerable difficulty in providing the services that they would wish to their patients in the manner which they believe is in the best interests of patients. It is certainly not my intention to engage in any pharmacy-bashing speech but rather to say that this is an issue that requires resolution. It requires goodwill on behalf of the government. Irrespective of the overall intention of the legislation, it needs to be clarified to ensure that dispensing programs that are utilised by pharmacies across Australia to give effect to the government’s intention are uniform, correct and do not result in persons who would be properly and lawfully entitled to receive benefits under the PBS safety net being excluded from them.

Given the time—I think there is only a minute to go—I will conclude my remarks at that point. The Labor opposition hopes that the concerns it has expressed by way of the proposed amendment moved by the shadow minister do have some reflection in the actions of government and are not simply ignored, because these issues are important. They impact directly on those who are needy and sick in our community.

Debate interrupted.