Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

I am delighted today to rise to speak about the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006. I want to first point out that it is through this coalition government that living in rural and remote parts of Australia has vastly improved since this government was elected a little over 10 years ago. Communications, infrastructure and technology have been enhanced, education and health facilities are more accessible and road, rail and air links have been improved. This bill is just another way the Australian government is assisting people who live in rural and remote communities and recognising the unique environment in which they live.

Pharmacies deliver one of the essential services in rural communities, as they are not just dispensaries. They offer communities the opportunity for first-aid items. Pharmacies sell cosmetics and gifts, and some have photographic services. But, more and more, pharmacies are involved in a variety of other health care services such as testing and screening, medication reviews, post-hospital care, wound management and public health programs such as quitting smoking. Clearly, pharmacies located in rural areas provide a unique point of difference to pharmacies in urban areas, and the importance of such businesses in rural communities is extremely high. Further, pharmacists themselves get personal satisfaction from providing a valuable service to the communities and assisting customers with their health needs.

However, many people living in rural and remote communities have limited access to pharmacies because of the tyranny of distance and the frequent unpredictability and nature of our weather. The introduction of this bill will mean people living in regional and rural areas will have greater access to pharmacies. While this bill seeks to make some headway in improving access to pharmacies, it makes the assumption that pharmacies will relocate to rural and remote areas of need. In practice, this may not happen quickly, or at all, and people will still find it difficult to easily gain access to pharmacies because of the size of some of the towns.

For the benefit of the House, I would like to outline the unique situation that people in many parts of my electorate are in when accessing pharmacies. For instance, the little town of Thargomindah, which is located some 200 kilometres west of Cunnamulla and more than 1,000 kilometres west of Brisbane, has a population of 250 people. It is the largest town in the Bulloo shire; it is the main town in the Bulloo shire—a town of 250 people. That shire and that town do not have a pharmacy. Thargomindah does have an outpatient centre and the Royal Flying Doctor Service visits once a week. Obviously, it is not financially viable for a pharmacist to open a pharmacy in a small western Queensland community like Thargomindah.

This scenario is not uncommon. Many communities across my electorate of Maranoa would be in a similar position to the one I have just described at Thargomindah in the Bulloo shire. People living on remote properties and in small towns where there is no pharmacy have to plan trips to their closest major town, often taking time off work. These trips are often infrequent and, as such, people plan their trip and have several jobs to take care of when they visit their nearest major town. For instance, they might visit their doctor, go to the local library, pay their bills and do their banking. Of course, having visited their doctor they may need to get a prescription filled, necessitating a visit to their local pharmacy.

I mentioned earlier that it is not uncommon for people in my electorate to have to drive two hours or more in some cases just to physically access a pharmacy. This can mean a trip of 200 or 300 kilometres just one way so they are able to get prescriptions filled and receive the medication prescribed to them. This is a great commitment for these people in terms of time and costs. Obviously there are car costs, such as fuel and maintenance. In addition, when people do go to town they may find that the roads are closed because of rain—we hope this will happen more often in some parts of my electorate. They can be closed for several weeks at a time. Currently most of my electorate is in the grip of the worst drought that I have known and the record is extended every day that the drought does not break in western Queensland. In contrast to that, when we do get rain we get flooding rains that often mean the roads are cut for weeks on end. Of course, these rains come without any great warning to the community, as we saw with the cyclone in North Queensland recently.

Mr Deputy Speaker Hatton, I am sure you would agree that such a situation would be foreign to many people living in our large regional centres or, in fact, our capital cities, like the one that you live in. We acknowledge that the people who live in these rural communities live there by choice and they understand the circumstances which they confront. It is not a complaint; it is just confronting the reality of where they live. That is why the federal government will be assisting people who live in rural and remote parts of Australia to have access to medication.

In the past few months I have received several concerns from not only pharmacists who service these regional towns and smaller communities but also consumers who have to access medication on a regular basis. These concerns have come from various parts of my electorate, including my home town of Roma; Barcaldine, where I will be next Thursday; Blackall, south of Barcaldine; Charleville; and Dalby. Constituents and pharmacists have been getting in touch with my office.

The main issue for people is not being able to have repeat prescriptions filled inside the 20-day rule and have the cost count towards the PBS safety net, even though they have made a special trip into town to have them filled. If the trip is made inside the 20 days and the person knows they will run out of medication before their next trip into town, they must purchase the medication, but they are disadvantaged by the cost not contributing to the safety net. Many people in my electorate have been caught trying to fill a repeat inside the 20-day rule.

I understand the fourth community pharmacy agreement makes allowance for people living in rural and remote parts of Australia to gain medicine in a timely manner under the 20-day rule and under regulation 24. However, there are some fundamental problems even with this regulation. Firstly, without the use of this regulation consumers have to pay the full price for the medication and, as I said earlier, it will not count towards the safety net. A further element is that doctors will need to insert ‘regulation 24’ on the initial script and all repeats have to be filled at the same time. In that case each lot of medication case counts towards the safety net. Perhaps it is through a lack of understanding, awareness or eduction that regulation 24 is not widely used. I am not casting aspersions on doctors or pharmacists. It is something that we need to do more about. We need to advise doctors, particularly those in rural and remote communities, that regulation 24 is a way around the 20-day rule in certain circumstances for people needing access to these medicines.

I understand the need for the 20-day rule in an attempt to reduce medicine stockpiling. I think we all on both sides of the House agree with that. This is good public policy, particularly when, for example, older people may accidentally take medication that is past its expiry date. When people have timely and affordable access, pharmacists can monitor the medication they are taking. Pharmacists are part of the triangle of health care in all of our communities, so we need pharmacists to be part of medication management. In many ways, the pharmacist is like the eyes and ears of the doctor after the doctor has prescribed the medication, because patients see their pharmacist more often than they see their doctor unless there is a need for a return visit to the doctor.

This bill is the start of making access to pharmacies easier, but it will not end there. Regulation 24 will assist people living in rural and remote parts of Australia to access pharmacies, but we need to do more on education so that people are aware of this regulation and understand how it works. I know this because I have had personal representations from people in my community who have been caught out unknowingly. There is another way around this. As members of parliament, we hear from our constituency about problems when they arise. This bill will certainly make some of the changes needed, but we need education and awareness. We need to advise our constituency through newsletters and in whatever ways we can that regulation will change things and make it easier for people living in rural and remote parts of Australia. I commend this bill to the House and look forward to working with the minister to develop more ways of providing reasonable pharmacy access to people living in rural and remote communities.

I have mentioned Thargomindah, in the Bulloo shire, which does not have a pharmacy, and I am sure that many other electorates across rural and remote Australia are in a similar situation. But they do have visits from the Royal Flying Doctor Service, which is an icon of the mantle of safety for all Australians. I would like to take the opportunity to again place on the record my appreciation for the work of the Royal Flying Doctor Service and the doctors, pilots and nurses who deliver this service in so many rural and remote parts of Australia. They are a great, dedicated team. I commend them and thank them for the work they do.

Annette Ellis (Canberra, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006. The purpose of this bill is to amend the National Health Act 1953 to make several changes to arrangements for approving pharmacists to provide medicines under the Pharmaceutical Benefits Scheme. These amendments are the result of the fourth pharmacy agreement between the Commonwealth and the Pharmacy Guild of Australia, which commenced on 1 December 2005. The agreement provides for new pharmacy location arrangements to commence on 1 July 2006, and this bill gives effect to some of the issues around those arrangements.

Changes in the pharmacy location rules will allow co-location of pharmacies with large medical centres that operate extended hours, allow the location of pharmacies in small shopping centres, 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, remove the requirement that a specified number of commercial establishments must be open and trading before an approved pharmacy can relocate to a shopping centre and provide greater flexibility for pharmacies located in private hospitals by allowing the establishment of satellite dispensaries for hospital in-patients.

Labor will support this bill because the changes will have several benefits, especially for people living in rural and remote areas and growing suburban areas. We have some concerns—a second-reading amendment has been moved—and I will address some of the concerns that I personally have. However, the co-location of pharmacies and medical centres will help people to access pharmacy services for acute medication needs at the time of their medical consultation. The location of pharmacies within small shopping centres recognises the trend in retailing towards smaller centres with larger supermarkets. The existing requirement—large shopping centres with at least 30 commercial establishments—limits access to pharmacy services in many retail developments.

The fact that not all of the required commercial establishments in a shopping centre need to be open and trading at the time of the application approval will also increase access to pharmacy services. In some cases, this requirement has delayed access to pharmacy services in new shopping centres. Rules for relocation of an additional pharmacy to single-pharmacy rural towns and high-growth urban areas will mean a second pharmacy can be approved in these communities. This will assist all those members of our community who need to access pharmacies at all sorts of hours, which should be as convenient as possible for them. For all of these reasons, Labor will support this bill.

However, as I have said, there are some concerns, and an amendment has been moved by the member for Lalor. This legislation raises several issues of concern in relation to the provision of pharmaceutical services in Australia. While I support the location of pharmacies in medical centres, I am concerned that there may be a growing trend towards the corporatisation of pharmacies and what this will mean. The government and the pharmaceutical industry must monitor the impact this legislation will have on the role of local pharmacies, and I use the word ‘local’ advisedly. I am aware that there is concern within both the industry and the community that the role of local pharmacies could be devalued if the sector becomes overcorporatised. I believe it is important that the people in my electorate of Canberra continue to be able to access the expertise and individualised service provided by their local pharmacist.

Another major issue of concern to me is the impact the Howard government policies have had on the PBS and the affordability of essential medicines. Since the introduction of the 21 per cent increase on PBS copayments in January 2005 and the 12.5 per cent cuts in generic medicines in the middle of 2005, the PBS growth rate has now fallen to 2.5 per cent and 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. These are very big figures. This is good news only if you put budget savings ahead of health outcomes. The Minister for Health and Ageing and the Treasurer consistently confuse PBS sustainability with cost cutting and never look at the impact on the overall health system and the ability of patients to afford their needed medicines.

The government’s own figures show clearly that fewer prescriptions are being filled in some crucial categories, such as for 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. It is obvious that rising out-of-pocket costs due to increased copayments, special patient copayments and therapeutic and brand premiums are hitting the sickest and neediest Australians, meaning that too often they must choose between buying their medicines and the other necessities of life.

And the impact of changes to the PBS safety net and of the new 20-day rule, which the previous member referred to, is yet to kick in. In the meantime, the Treasurer, the Minister for Finance and Administration and the Minister for Industry, Tourism and Resources push on with their plans for more PBS budget savings. They either are oblivious to the consequences or do not particularly care. It seems that these decisions are being made with little, or without any, reference to the minister for health. This is a serious concern, one that we consider seriously on this side of the House. It brings into question the important balance that must be struck between financial responsibility and the health outcomes and considerations that we would all expect in our communities.

I conclude by reiterating my concern in relation to the corporatisation of medicines generally and pharmacies particularly. I would dare to say that many members in this House have already seen that beginning to happen. We are seeing small medical surgeries close down as they are corporatised into larger centres throughout our urban areas, let alone our rural centres, and we then see the corporatisation of pharmacies attached to them in a physical sense. That means we are running the risk of the removal of the small corner pharmacy, which provides an invaluable service to most members of our community.

Over the years that I have been fortunate to serve in this place, I have had many a discussion with pharmacists and pharmacy organisations within my community. I understand what they are attempting to do and they understand our concerns. At the end of the day, it is fair to say that the good pharmacist sitting down at the shopping centre, available for discussions with our community as they get their medicines and prescriptions, is a very valuable community service that we must ensure stays as viable as possible into the future.

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

The Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 puts into legislation the provisions of the fourth pharmacy agreement, reached late last year, between the government and the Pharmacy Guild. The provisions themselves are non-controversial, and Labor supports them. As shadow minister for regional development I particularly support the new arrangements that will improve access to pharmacies and to pharmaceutical services for people in rural and regional areas and in the developing suburban areas.

In this and in so many other areas of service delivery in our regions we do need innovative solutions. This bill presents a small but nevertheless important demonstration of that innovation. The truth is that one size does not fit all as far as service delivery is concerned in the regions. My experience as minister has been that regions left to apply flexibility to available resource allocations do innovate in creative ways, and government needs to find more creative and innovative solutions and it needs to encourage them. It needs to reward those regions that come up with those solutions and it needs to present something of a best-practice list for others to adopt. I am going to ensure that this approach of encouraging and rewarding creative and innovative solutions to service delivery generally in our regions forms an integral part of Labor’s regional policy in the development of sustainable economic, social and environmental growth in our regions.

The bill also raises aspects of the government’s health policies with which the opposition strongly disagrees and which have disadvantaged many Australians. It is on that basis that we have moved a second reading amendment which identifies a number of the government’s failings. It identifies the failure to investigate the impact of the government’s copayment increase and its implication for people’s access to medicines, particularly for pensioners. This copayment would have been unnecessary if the government had been prepared in the last term to work with Labor on identifying a list of savings measures to the PBS.

We know we have to find savings to make this scheme viable, but it is far better for the government, especially if it has got the cooperation of the opposition—and we were offering it—to find those savings through government activity rather than having to slug people for their medicines. We invited the government to work with us in a bipartisan way to obviate these increases. It refused. Pensioners are now paying the price. Our amendment also condemns the recent changes to the Pharmaceutical Benefits Scheme safety net which have also burdened Australians who need medication by increasing their out-of-pocket costs. Our amendment also condemns the confusion that the government has created for patients, doctors and pharmacists—it is a rare trifecta to have all of them complaining—by the new 20-day rule on repeat prescriptions. In the broader field, not specifically in the narrowness of this bill, this is another example of and another reflection on a government that just does not get it right. It ignores cost savings which are in its purview and control and which we would assist it with, it slugs patients more for their medicines, it mangles new procedures and it delays dealing with issues and changes to further improve affordable access in regional areas.

The bill extends the operation of pharmacy location rules and their administration by the Australian Community Pharmacy Authority until 30 June 2010. The bill gives the minister discretion to approve a pharmacy not otherwise approved. The bill simplifies the process for approving changes to pharmacies that are already approved and makes some other minor technical amendments. As I said at the outset, these are not controversial in themselves, but the measures in the bill should actually go further in the way that I have already identified.

There is another aspect of the pharmacy agreement, one that is outside the scope of this bill but which the government has to act on quickly. It is the community service obligation on pharmaceutical wholesalers to make medicines available promptly and affordably all over Australia, with availability at affordable prices in the regions as in the cities. I am particularly aware of this issue not only because of my responsibility for regional development and affordable access to medicines in the regions but also because one of the major medicine wholesalers, Sigma Pharmaceuticals, has its distribution and dispatch centre in my electorate. It is also a major employer in my electorate. It is a significant participant in the growing biotechnology industry sector based around Monash University in the south-east corridor of Melbourne.

Anyone who visits Sigma’s distribution centre in Clayton would be impressed by this highly efficient operation. The business model is working. What is failing is the government, in identifying and agreeing on its contribution to the community service obligation. In discussions with Sigma the matter of remuneration of wholesalers for meeting that obligation to the community, particularly in high-cost rural and remote areas, still has to be determined. This was an agreement that was reached at the end of last year. But here we are at the end of March with the government saying it is concerned about affordable access in the regions yet it still has not kept its side of the bargain for a major distributor of pharmaceuticals. This applies not just to Sigma but to every other distributor of pharmaceuticals.

This is another example of the government’s failure to follow through. It talks the talk but does not undertake the actions. So I call on the government to bring this to a conclusion, to determine with industry the level of remuneration on a fair and equitable basis. This is not a question about business getting its act right. It is not a question about business efficiency. It is another example of where markets fail, given the distance and the costs associated with getting products out there. Governments have a role to play if they are committed to affordable access in the regions. That is what is called a community service obligation. It requires a contribution by government. They are the basics, but the government has not secured and finalised the detail. I urge it to do so, and I will keep on its hammer, on behalf of constituents of mine and the people that work for them, to ensure that it does.

This bill basically continues current arrangements relating to pharmacy locations. These arrangements have in themselves been the subject of some discussion and controversy. They seek to balance what can be in some cases conflicting goals: on the one hand community access to pharmacy services; on the other hand ensuring the continued viability of existing pharmacies—and we all know of the debate about the big supermarkets wanting to get into this area of activity. In a sense, they are two sides of the same coin: access to pharmacy services for communities. The arrangements have been criticised on the grounds that they are anti-competitive and protect a monopoly service. This was the argument for the inclusion of pharmacies in those supermarkets that I have just alluded to. It is not a problem in many areas. Indeed, I note with interest, again drawing on the circumstances of my constituency, that a new pharmacy is about to open next door to my electorate office in Clayton when there are already four other pharmacies within 200 metres of it. I understand that the new entrant’s pharmacy approval has been moved in effect from a smaller shopping centre—one at Westall, which is also in my electorate—two kilometres away. It means that people in Westall will be disadvantaged by having to travel further for their pharmacy needs. I am not certain what a fifth pharmacy in Clayton is going to add to the availability of services in that shopping strip.

However, access to a pharmacy and to PBS medicines is a real issue for many Australians living in rural and regional Australia. The local pharmacy is a critical part of a town’s health and social infrastructure. For many people, particularly older people or those without cars, it is very difficult to travel to get access to prescription medicines, and then there are issues of privacy if someone else does the errand for them. So better and affordable access to health services and to the advice and assistance of a pharmacist are significant issues for people living in rural areas.

Regional development is a key Labor priority. Regional development is good for our regions and it is good for the nation. Australian regions are the powerhouse of this economy. Most of our GDP is created in the regions—in mining, agriculture and industry. A federal Labor government will harness the potential of the regions; it will reduce disparity between regions for economic, social and environmental sustainability. Federal Labor is committed to regional development, and it has three main priorities to deliver successful regional policy.

Firstly, Labor will develop location based responses to regional challenges. We cannot continue to ask regions to just respond to programs. A one-size-fits-all approach will not work. I have mentioned this in the context of the flexibility that this bill demonstrates in relation to pharmacy locations. So, if the one-size-fits-all approach does not work, we have to make the programs more flexible to what does work—that is, the innovative solution that the regions themselves come up with. Labor will encourage locally-driven approaches to respond to the challenges which vary from region to region.

Secondly, federal Labor will revitalise current regional structures to empower local communities—creative and innovative solutions are best developed by working with local communities, not imposing solutions from the top down—and to take up the examples of best practice, including capitalising on regional specific resources, their know-how and developing location based strategies to encourage local investment.

In tandem with working with local communities, Labor will revitalise regional Australia’s structures to deliver those local solutions. Area Consultative Committees, which were established under the Labor government—in fact, by me when I was the Minister for Employment, Education and Training—should be given the capacity to develop strategic economic plans and good outcomes, innovative outcomes, that suit the region’s needs for that particular area.

I and many colleagues in the Labor Party have been consulting with these Area Consultative Committees across Australia over past months. They are saying to us that they want to be able to develop the strategic plans. They then want to be able to deliver long-term economic and social development in a sustainable way. I think that we have to tap into the leadership that these Area Consultative Committees provide. I know they work, because when I was employment minister and gave them the task of helping us put the long-term unemployed back into work they responded magnificently—300,000 jobs were created by the Area Consultative Committees in the last six months of Labor’s term. That is really saying to the regions: ‘We will make the resources work responsively to your needs. We want you to give the leadership. You know best what suits your region, the skill needs of your region, and what you need to get local industries going. What we want to do is to give you the capacity to develop responses that meet those needs.’ It has been demonstrated that, if you empower regions, ask them for leadership and resource them, you will get the results. That will be a vital plank in Labor’s approach to regional development as well.

Thirdly, a federal Labor government will restore Commonwealth leadership in regional development. A location based response must be supported by strong Commonwealth leadership. I am reminded that, when this government first came to power in 1996, the first statement it made in relation to regional development was: ‘There was no constitutional role for the Commonwealth in regional development.’ It gave up. It buck-passed. It said that it was the responsibility of the states and the responsibility of local government. Of course it is, but it is also the responsibility of this government. If you simply get to this exercise of saying that it is someone else’s jurisdiction rather than fixing the problem, it is no wonder that voters turn off you. Labor are saying, ‘We have to provide the leadership in a way that facilitates all levels of government in responding to those location developed agendas that stack up.’

There is an area of health policy of particular concern for people living in regional areas, and that is mental health. It is another area where I believe the government has failed the regions. People are suffering in isolation and loneliness, far from appropriate diagnosis and treatment. Recently, we have seen the grand announcement by the Minister for Health and Ageing of $1½ billion for mental health but no details of how it is going to be spent. Certainly no strategy is being developed for rural and regional areas, and this at a time when the Better Outcomes for Mental Health program funding has been reduced by the government and the number of prescriptions being filled for medicines to treat mental illness is declining.

The funds in regional programs could also be better spent on addressing issues in regional areas. I was interested to learn yesterday, in a very informative meeting I had with Mission Australia, that they have been funded by the Macquarie Bank to undertake a significant study of social research into the needs of the regions. I see the Parliamentary Secretary to the Minister for Education, Science and Training at the table nodding with interest. I urge him to read this report because it is very revealing.

It is probably not understood that 36 per cent of people, more than one-third of our population, live outside the capital cities. That is a huge population base. They suffer the same problems as people living in the cities but they experience them in circumstances of greater isolation and with less access to the range of available, affordable services. The report is entitled Rural and regional Australia: change, challenge and capacity. It sets out clearly the challenges that confront regional Australia in a rapidly changing social and economic environment. It identified that, while some regions are prospering, a number are struggling. For example, 72 per cent of students in metropolitan areas complete year 12 but only 62 per cent in the regions. Sixteen per cent of regional and rural households earn only $300 a week compared with less than 13 per cent of metropolitan households, so their income base is much lower. Also, people from rural and regional areas suffer higher incidences of injury, mortality, homicide, diabetes and coronary heart disease.

The report calls for more resources and services to prevent regional Australia’s vibrant population from ebbing away. I was interested and I asked them about the ways in which they were addressing the issue and they are coming up with some innovative approaches. I am keen to continue to work with them, visit them and see some of these innovative solutions because, when you think of it, it fits neatly with the sort of policy prescription that I was outlining before. If we can free up the resources, for example, and have flexibility as part of the health budget to respond to innovative solutions, creative solutions, best practice solutions and solutions that are efficient and stack up, why shouldn’t we be funding those? Why shouldn’t we be responding to the solutions that regions come up with? At the moment, we cannot because of the rigidity within the programs imposed by a program driven approach. We have to get to a location specific approach and that is what we will be arguing.

Brendan O'Connor (Gorton, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 and also to support the second reading amendment moved by the shadow minister for health. This bill is a result of negotiations that have taken place with a number of parties. In May 2005, parliament voted, with our support, to extend the current provisions with respect to the pharmacy location rules to 31 December last year through a provision in the Health Legislation Amendment Bill 2005. Then, in October last year, these provisions were further extended until 30 June this year through passage of the Health Legislation Amendment Bill 2005. On both occasions the government stated the reason for the extension was to allow time for the government to consider the findings and recommendations of the joint review of pharmacy location rules received in June last year. However, at the same time, protracted negotiations were under way with the Pharmacy Guild of Australia over the fourth pharmacy agreement. It was clear, certainly to us, that the pharmacy location issues, linked to the ability of pharmacies in supermarkets to dispense PBS medicines, were being used by the government as a heavy handed negotiating tool.

Labor has always opposed the location of pharmacies within supermarkets. People and the pharmacies themselves are concerned about the threat to pharmacies and to the quality of drug dispensation if laws are enacted to enable supermarkets to effectively take over the core business of pharmacies. For that reason, we do support the bill. I am mindful of the fact that the second reading amendment goes to Labor’s grave concern about the way in which the PBS has been handled by this government. The member for Hotham has already articulated most of those concerns that we have expressed ever since the government hacked at the PBS.

In my own electorate, many people who are in need of prescription drugs felt the effects of the increases to the Pharmaceutical Benefits Scheme, increases which of course have added a particular burden to the household budget. The increases were quite significant and, for those people reliant upon drugs registered under the PBS, there is no doubt that there has been a considerable strain not only on their budget but on choices that they may have to make as to whether they can continue using such medication. I am not sure whether the government realises how difficult it is for people in households with low incomes seeking to look after their health under a system which is becoming increasingly more expensive for them, but I can assure the government that people are aware and sensitive to the impost placed upon them by decisions made to hike the prices up on the PBS copayments.

Since the introduction of the 21 per cent increase in PBS copayments last January and the 12.5 per cent cuts in generics in the middle of the year, the PBS growth rate has now fallen to 2.5 per cent and is expected to drop even further. 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. That is only good news if you put budget savings ahead of health outcomes. The Minister for Health and Ageing and the Treasurer consistently confuse PBS sustainability with cost cutting and never look at the impact on the overall health system and the ability of patients to afford their needed medicines.

The government’s own figures show clearly that fewer prescriptions are being filled in some crucial categories: anaemia and blood-clotting problems, hormone replacement therapy needed because of thyroid or pancreatic problems, mental illness, epilepsy, Parkinson’s disease and Alzheimer’s disease. It is obvious to at least those of us on this side that the rising out-of-pocket expenses caused by the hike in the copayments, special payment copayments and therapeutic and brand premiums are hitting the sickest and neediest Australians, meaning that too often they must choose between buying their medicines or other necessities of life. The impact of changes to the PBS safety net and the new 20-day rule is yet to start.

There are more problems ahead for people who are already doing it tough in providing the health benefits they need. A consistent approach by the government is its attempts to save money by attacking the most vulnerable. We see it in its so-called Welfare to Work legislation, where it is attacking people with disabilities—the most vulnerable in our community. We see it in the Work Choices act where it is looking to expose ordinary Australian working families to very uneven, unfair, extreme and pernicious laws that will allow an employer to dismiss at will any employee in this land if they are in a company of fewer than 100 employees. We see that approach in each and every significant piece of legislation introduced in this House by this out-of-touch and arrogant government. We also see it in its decision to increase the PBS copayment and other provisions which have certainly caused people in the electorate of Gorton much pain—as, indeed, I am sure it has caused people pain in all electorates of this country.

We are happy to see this bill go through. I think the government should take heed of the amendment moved by the shadow minister for health. She has quite rightly raised concerns that the opposition have in the area of health—the assault upon ordinary working families and upon people in need of particular health benefits, indeed prescriptive drugs, such that they are now choosing on occasion not to use the drugs at all. When you define a wealthy and healthy country, you certainly would not define it as one that would have its citizens choose between whether to use drugs that will save or extend their lives or whether to eat and pay the rent. I am very proud to be a member in this place representing so many Australian citizens—people who, I would think, see themselves as being in relative wellbeing—but when you see legislation that attacks people’s household budgets by raising the PBS you wonder sometimes what the government is thinking and whether it is sensitive to the needs of ordinary Australians. I am not sure that it is. The opposition supports this bill, but we ask the government to take seriously the comments made in the second reading amendment and to attend to those concerns as soon as possible.

Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for Northern Australia and Indigenous Affairs) Share this | Link to this | Hansard source

As you have heard, Mr Deputy Speaker, the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006 aims to increase the number of pharmacies in regional centres in outlying suburbs of Australian cities where there might otherwise be a shortage by relaxing the rules about where pharmacies can be located. The bill does this by permitting co-location of pharmacies with large medical centres that operate extended hours, allowing the location of pharmacies in small shopping centres, allowing the relocation of an additional pharmacy to one-pharmacy rural towns and one-pharmacy high-growth areas without regard to the usual distance criteria, removing the requirement that a specified number of commercial establishments are open and trading before an approved pharmacy can relocate to a shopping centre and provide greater flexibility for pharmacies located in private hospitals by allowing the establishment of satellite dispensaries for hospital in-patients.

I note that the shadow minister for health in her speech in the second reading debate indicated that Labor is prepared to support this piece of legislation, but she also moved an amendment that 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”.

For those people who might be listening, the electorate of Lingiari is one where 40 per cent or thereabouts of the population—my constituents—are Indigenous Australians. It comprises all of the Northern Territory except Darwin and Palmerston and also the Indian Ocean territories of Christmas Island and the Cocos (Keeling) Islands. For my part, and for my electorate, the real failing of this piece of legislation is that it does nothing to improve the access of Indigenous Australians to the Pharmaceutical Benefits Scheme. I also note that the shadow minister for health only briefly raised this in her contribution. I intend to spend a little more time considering this point. Nothing in this bill as it stands will address the shameful disparity between the access that non-Indigenous Australians have to the Pharmaceutical Benefits Scheme compared with Indigenous Australians. There was a report in the Age of Thursday, 6 October 2005 headed ‘More funds needed to lift health status’. It was an article about Indigenous health, reporting on comments from the Australian Medical Association, which makes a very pertinent and shameful point:

For every dollar spent on non-indigenous PBS, only 38 cents is spent on indigenous PBS.

So in the the Pharmaceutical Benefits Scheme, for every dollar spent on non-Indigenous Australians, only 38c are spent on Indigenous Australians. I will come in a moment to why that is so shocking, given the appalling health status suffered by Indigenous Australians. This legislation presents yet another lost opportunity for the government to act to make available to Indigenous people the same health services that are available to non-Indigenous Australians.

The Australian Medical Association wrote about the parlous state of Indigenous health in its Position statement on Aboriginal and Torres Strait Islander health, published in 2005, a copy of which I have before me. It noted that in 1999-2000 the life expectancy of Indigenous men was 56.3 years, as opposed to 77 years for non-Indigenous men. For women, the difference was 62.8 years, as opposed to 82.4 years. You do not have to be Einstein or a mathematician to know—in fact, a very low level of primary school maths would help you work out very quickly—that non-Indigenous Australian men have a life expectancy of between 45 and 50 per cent greater than Indigenous Australian men. That is shocking, and we are now of course in the year 2006, not 1900.

We also know that the instances of chronic disease are too high among Indigenous Australians. I will give you an example from my electorate in a recent report produced by the Centre for Remote Health—a joint venture between Flinders University and Charles Darwin University—entitled Indigenous populations and resource flows in Central Australia: A social and economic baseline profile. This report shows that between 1979 and 1995 one-fifth of all deaths among Indigenous people were related to five chronic diseases. They are kidney and renal disease; diabetes; high blood pressure and hypertension; heart attack and related heart diseases; and chronic obstructive airways diseases such as emphysema and chronic bronchitis. We know that Indigenous people are suffering these chronic diseases in far greater numbers than non-Indigenous people.

In 2001, Indigenous people living in remote areas were twice as likely as non-Indigenous people to have diabetes. There is an even greater gap in renal disease. Based on data for 2001, new incidences of renal disease were mostly reported among Indigenous people—80 per cent in males and 86 per cent in females. This is despite the fact that in the remote Australian communities that were studied they comprise only 30 and 27 per cent of the population respectively. That paints an alarming picture.

We also know that these chronic diseases are attacking Indigenous people at a younger age than non-Indigenous people. Between 1991 and 1995, Indigenous males in the Northern Territory faced death rates from chronic diseases that were the equal of non-Indigenous males 10 to 20 years older than them. That is just shocking. The obvious question is: why is the health system not better able to treat these chronic diseases? If we look at the access Indigenous Australians have to medicine, we begin to see why. In accessing medicines available under the PBS, we see the same extraordinary gap between Indigenous and non-Indigenous people as we see in the other health indicators such as life expectancy.

I have already made the point about the figures produced by the AMA and reported in the Agethat is, 38c is spent on Indigenous Australians for every $1 spent on non-Indigenous Australians. Clearly one of the major problems is that many Indigenous people are prevented from accessing the medicines available under the PBS. They are prevented for a range of reasons.

The 1997 Keys Young Report into Aboriginal and Torres Strait Islander access to Medicare and the PBS across Australia identified a number of obstacles to Indigenous people accessing the PBS. They include problems with awareness about entitlements under the PBS, and a person’s ability to establish their PBS entitlement—for example, lost cards and entitlement numbers. It is very hard to get people who do not have any experience of remote communities to understand how this could be so.

Most of us live in a sophisticated urban environment. We probably carry a wallet; we probably have a few sets of clothes; more than likely we live in a house with a few drawers and we can store our belongings safely. But many Indigenous people live in the bush in very rough conditions. If they are lucky, they may have a couple of sets of clothes. Most probably they do not have a wallet, and keeping and maintaining personal records such as cards is certainly a difficult problem.

The copayment requirements for accessing PBS medicines are very difficult for people on low incomes to meet. You do not have to be Einstein to work that out. Some medications felt to be critical in treating health problems common amongst Indigenous people are not listed on the PBS. The inadequate supply of medicines due to isolation is also a significant problem. Most of the circumstances the report highlighted remain relevant today, nearly 10 years on. Nothing has changed substantially which would alter the assessments made in 1997 by the Keys Young report in relation to the access to medicines by Indigenous people.

Let me compare two practical examples of access to pharmaceuticals in Indigenous communities. Many of us, when we visit a GP, are given a script for medication. I live in Alice Springs. There are a number of general practitioners within the town. I can visit my GP, get a script, rock down to the pharmacy, of which there are a number in the town, and have it filled almost immediately. On most occasions it is possible to roll the visits to the GP and the pharmacy into the one activity. I know this from my own experience and regard myself—as, I am sure, do the people of Alice Springs—as very lucky. The same situation is true for most non-Indigenous Australians living in urban areas. They have access to medical practitioners and pharmacies which, more often than not, are conveniently located.

However, consider if you live in a remote Indigenous community. Let us understand what we mean here by ‘remote’. You could be 400, 500 or 600 kilometres away from the nearest pharmacy. More often than not you will not have a regular GP service, and you certainly will not have a local pharmacy. You need to get access to these medicines, but if you had to travel to the pharmacy you would be required to spend a long time travelling over rough conditions at a very high cost. Assuming you can get a GP to write you a script if you live in one of these very remote communities, how do you go about getting it filled? In many cases, you will have to rely on what is known as section 100 funding under the PBS.

Section 100 funding, provided under the National Health Act, is where the Northern Territory Department of Health and Community Services or Aboriginal health clinics have an arrangement with pharmacists in Darwin, Alice Springs or another regional centre to fill script orders and mail or freight them to the health clinic for distribution to those who require the script. The funding is to cover the cost of transport, security and administration of the service. If the process is working well, scripts can be processed and delivered in a day or two, if you lucky. But that is a big ‘if’ because often it takes a lot longer. The reality is that there is always some contingency that will interrupt the smooth running of the process. It could be heavy rainfall and closed roads and airstrips. The climatic conditions vary. We have seen the very sad situation that occurred in Queensland with Cyclone Larry. That situation—not the devastation but the impact of cyclones—is relatively common across the Top End of Australia. It could be that flights are diverted because of some other emergency, which is always a possibility, especially during the wet season.

Any manner of things could cause a delay. For instance, on Christmas Island a flat tyre on a aircraft can mean a minimum 24-hour delay for documents and medicines to get between islands 900 kilometres apart, as replacement aircraft or parts have to come from Perth 3½ thousand kilometres away. The bottom line is that people waiting for a script cannot drop into the local pharmacy at lunchtime or on the way home from work to get it filled. People in remote communities sometimes have to wait days. Not only is this inconvenient but it has medical implications, as recovery can be delayed, a condition might get worse or other medical conditions may result. The section 100 service, although secure, lacks those incidental in-built checks and balances that a pharmacy in close proximity to the surgery provides in a well-serviced community. Section 100 funding also provides for the pharmacist to visit the communities. However, given the shortage of pharmacists in remote areas it is often not possible for pharmacists in regional centres to find the time to visit the more remote communities. If they get the chance to visit once or twice a year, they are doing extremely well.

The AMA’s position paper calls on the government to implement the joint proposal to increase Indigenous access to the PBS put to it by the Pharmacy Guild, the National Aboriginal Community Controlled Health Organisation—NACCHO—and the AMA in May 2004. Equitable access to the PBS is vital for improving health among Aboriginal and Torres Strait Islander peoples, wherever they live. The joint proposal explains:

Access to medicines is always a major plank of provision of effective primary health care and therefore must be guaranteed for this particularly disadvantaged population.

While the proposal reports some success in improving PBS access through a provision of section 100 of the National Health Act, that improvement has only represented a 29 per cent increase in Indigenous access to the PBS. Clearly, that number needs to be higher. The joint proposal calls on the government to broaden the section 100 provision for improving PBS access by accommodating greater flexibility given the diverse needs and capacities of remote Indigenous health services, and providing greater funding and support for the health services that are working to improve access to PBS medicines. This bill should have been an opportunity to undertake the changes that are necessary to improve access to the PBS for Indigenous people.

Let me just reiterate how important access to medicines is. The joint NACCHO, Pharmacy Guild and AMA report talks about access to medicines on page 5 and makes this observation:

A study conducted in the Northern Territory showed that in those with hypertension or diabetes, rates of natural deaths were reduced by an estimated 50% and renal deaths reduced by 57% after a mean follow-up of 3 years of ACE Inhibitor drug treatment.

That is how important drugs are in treating many of the chronic diseases which I outlined earlier in my contribution. We need to do a great deal more to ensure that the PBS is accessible to all Australians, regardless of who they are and regardless of where they live. We particularly need to do a great deal more to address the primary health care needs of Indigenous Australians—the poorest in this nation and those who are most disadvantaged and most in need—through changes which should be brought about to the PBS.

Peter Andren (Calare, Independent) Share this | Link to this | Hansard source

In rising to support the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006, I want to make a few brief comments about why this legislation is so vital for small towns in the Calare electorate. The bill proposes a number of amendments to the National Health Act relating to the provision of community based pharmacy. The amendments are a result of the fourth community pharmacy agreement between the Commonwealth and the Pharmacy Guild of Australia, an agreement that is due to run until 30 June 2010. This legislation also provides the minister with discretionary power to approve a pharmacist not approved by the Secretary of the Department of Health and Ageing to supply PBS medicines. As the explanatory memorandum says, this power is to enable the minister to address unintended or unforeseen consequences of the application of the pharmacy location rules which, for example, may result in a community being left without reasonable access to the supply of pharmaceutical benefits. Importantly, this ministerial power can be reviewed through application under the Administrative Decisions (Judicial Review) Act.

The matter of pharmacy location has been the subject of widespread debate over many years, with the major supermarket chains applying increasing and constant pressure for relaxation of the pharmacy location rules. No-one living in rural and regional areas will doubt the importance of the pharmacy to the welfare of the community. Let me use as an example the town of Molong in my own electorate. Last weekend one of two local supermarkets devastated by flooding last November reopened. The second supermarket in Molong was so badly damaged and its repair bill so great that it will remain closed. I joined the state minister, Tony Kelly, and about 300 locals for what was a pretty emotional event. Despair, loss, grief and now overwhelming joy to see these businesses being restored came together in one of the most emotional moments that I have experienced in a small community in many a day.

The town’s pharmacy was also severely damaged, as were half the businesses in the main street, Bank Street. Due to the determination of the community and their loyalty to local businesses, the supermarket has reopened bigger and better than ever. The pharmacy is back providing a vital service to back up both local doctors. The newsagency was demolished and is also being rebuilt. Interestingly, as we talk about the need for competition, I would suggest that the fact of the second supermarket not reopening has enabled the existing supermarket to stick its neck out a bit more in the provision of services. It can provide a far greater range of products. It has a marvellous fruit section and a delicatessen—something that had not been seen in Molong for many a year. By dint of the fact, yes, it is probably a monopoly situation now enjoyed by one provider, but because of the critical mass available to shop in the town I would argue that the town will support this supermarket very strongly. A couple of supermarkets always made the situation fairly marginal.

Due to determination, these businesses are back on track. If any of those businesses had permanently hit the wall, the economic fabric of the town would have begun to unravel. By allowing supermarkets in nearby Orange or any other major regional centre to provide pharmacy services—and the newsagencies they would also want to run—the death warrants of towns like Molong would inevitably be sealed.

The purpose of the location rules retained in this legislation is clear. They provide widespread community access to pharmaceutical services and continue the financial viability of existing pharmacies. I would add another far more important reason: the location rules ensure the community fabric of towns like Molong, Canowindra, Blayney and other small towns through the electorate of Calare and right throughout rural Australia remains intact. With community, the financial viability follows. Those who would argue against the location rules are arguing purely on textbook economic grounds that there is insufficient competition in the sector or something along those lines. How would the inevitable concentration of pharmacy services in supermarkets and major shopping centres really help competition? Sure, it might lower prices—although we have seen, with the provision of petrol in supermarkets, most often the price of fuel settles in a cent or two below the community service stations in places like Blayney that absolutely struggle to compete.

Where are the words ‘service’ and ‘community’ in this whole argument? It reminds me of a call I received from a constituent that she wanted to be part of a society first and an economy second. Woolworths and Coles and the major political parties, including The Nationals, who I know can no longer be called major, would do well to hear that call.

The government has extracted a price for continuing the local pharmacies or location provisions. We do not know the exact figure, but the location rules were used as a bargaining chip to wind back the rate of payments to the pharmacy sector. That is probably not unjustified, but the provision of services by community pharmacies are very important, particularly in providing for the needs of their aged customers which, one would argue, a supermarket pharmacy would not have the inclination or the time to provide, whatever it might say prior to gaining the supermarket pharmacy.

The government’s fact sheet shows it has managed to negotiate a saving of $350 million over the life of this agreement, including a reduction in allowable mark-ups on wholesaler costs. However, there has been an increase in pharmacists’ dispensing fees. The bill gives effect to the targeted easing of existing rules—one of the government’s trade-offs in negotiating this agreement. Pharmacies will be allowed to co-locate with after-hours medical centres, relocate into certain types of shopping centres, single pharmacy towns and urban areas with high population growth. According to the explanatory memorandum, this will improve flexibility and increase competition.

However, as communities like Molong will tell governments—if they listen—with most services in rural areas outside the largest centres, there is no truly competitive model. Usually, a town with one or two doctors, one pharmacy, one butcher, one newsagent and two service stations cannot, as I said, sustain significantly greater competition. There is simply not enough critical mass of demand. That is where the competition mantra goes sadly astray at times, whether it applies to delivery of pharmacy or telecommunications services. There is a very thin line between flexibility and viability in country towns, and it takes but one flood down Molong Creek to show just how tenuous that viability is.

I hope this and any future government do not become complete captives to the competition argument in all cases, for that would spell the end of key community businesses, the gradual withering of many towns and an increase in the phenomenon of larger centres like Dubbo and Orange becoming sponges, soaking up the business of smaller surrounding villages and towns. That said, I commend the legislation, with those reservations, to the House.

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

In rising to sum up this debate on the Health Legislation Amendment (Pharmacy Location Arrangements) Bill 2006, I would like to thank all the various members who have taken part. I am sorry that I have not been able to listen in the chamber to all of the speeches, but I was certainly pleased to hear the constructive contribution from the member for Calare, as I was earlier pleased to hear from the member for Lingiari about some of the practical difficulties that his constituents face in accessing pharmaceuticals.

There is no perfect system, but I think as a result of this legislation the system will be better than before. The bill seeks to implement the various provisions of the fourth agreement between the Pharmacy Guild of Australia and the Commonwealth government that was finalised late last year. There are probably two very significant aspects to this legislation that I should again highlight to the House. The first is the provision that the 1.5 kilometre rule—that is to say, the 1.5 kilometre exclusion zone, if you like—for new pharmacy licences can be moderated in the case of large medical centres and small supermarkets. This is a significant change, although it is in keeping with what I take to have been the enduring spirit of these agreements and rules. The other significant change is the provision in the legislation of a discretion to be exercised by the minister after the ordinary procedures have been concluded if, in the judgment of the minister, the operation of the rules is resulting in a substantial denial of access to a significant potential demand.

Another key feature of the agreement is the continued exclusion of supermarkets from retailing pharmaceutical products. I have a great deal of admiration for Australia’s major supermarket chains. Roger Corbett, the head of Woolworths, is a constituent of mine and an extremely distinguished one. Having said that, I am not sure that the culture of general retailing is necessarily appropriate for the culture of the marketing of potentially dangerous drugs. Within reason, we wish to maximise ordinary sales but, generally speaking, we want to minimise the sales of pharmaceuticals to those which are absolutely necessary for the good health of patients.

In addition—and I say this particularly conscious of the presence in the chamber of the member for Calare—the fourth pharmacy agreement provides for a $150 million community service obligation fund. This should ensure that we continue to have timely delivery of low-volume drugs everywhere and of drugs to non-metropolitan pharmacies.

This is a piece of legislation which further develops our excellent Pharmaceutical Benefits Scheme. We have a good system for the sale and distribution of pharmaceutical drugs in this country. But it can always be finetuned, it can always be finessed and I think that is precisely what this legislation does. I commend it to the House.

Peter Lindsay (Herbert, Liberal Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Lalor has moved as an amendment that all words after ‘That’ be omitted with a view to substituting other words. The question now is that the words proposed to be omitted stand part of the question.

Question agreed to.

Original question agree to.

Bill read a second time.