Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

The Health Care (Appropriation) Amendment Bill 2008 will increase the appropriations of the state and territory governments under the Australian healthcare agreements by $10.25 billion. Of the $10.25 billion appropriated by the bill, $9.7 billion is to be spent under the Australian healthcare agreements and half a billion dollars is to be spent directly on public hospitals. Health inflation is roughly accepted to run at approximately 4.1 per cent per annum. Hospital inflation runs at approximately 4.8 per cent per annum. Therefore, this increase is, at best, keeping pace with inflation. It is certainly no windfall gain for the public hospital system. The states and territories will have their work cut out for them. The state run public hospital system is in a state of chaos, and in some places it is getting worse by the day. Labor state governments make a profession of fudging hospital related statistics.

Even the official statistics are sobering reading, if you can find them. According to the State of our public hospitals report from June 2007, the average waiting time for all procedures was up to 61 days here in the Australian Capital Territory. Just over half the people in emergency departments are seen within the recom-mended waiting times in most states. In Tasmania, nine per cent of people have waited over a year for their surgery.

The true story is probably far worse. You cannot open a newspaper today without reading about a patient who has been waiting for over a year for elective surgery. In every state we hear about patients waiting for months and, when they turn up to have their long-awaited operation, it is cancelled at the last minute due to bed closures, theatre closures or a general shortage of hospital beds. Take, for example, those sitting around on the interminable waiting list for a total hip replacement. Arthritis of the hip to the point of requiring a total hip replacement is an agonising condition. I know a number of people who have gone through it. Patients depend on serious and sedating painkillers. They are obviously curtailed in their daily activities. Having a shower, doing the shopping or caring for grandchildren become incredibly painful endeavours.

The so-called access block, which is a lack of hospital beds, is the biggest threat to patient safety in the hospital system. When hospitals reach their critical mass of 85 per cent occupancy, things have a propensity to go pear shaped, and yet for too many Australian hospitals over 85 per cent capacity is the norm. Hospital managers are under pressure to reduce bed numbers but increase occupancy rates to improve operational efficiency. This just flies in the face of good research which has shown that overcrowding in the hospital system causes the average hospital stay to lengthen. This is bad for patients and a double-whammy for the budget. Of course, the Prime Minister said he will fix all this because the buck stops with him. The fact is that an overcrowded hospital is an unsafe hospital. Overcrowding will inevitably lead to unnecessary patient deaths and poorer patient outcomes. In fact, some studies have shown 43 per cent higher death rates for patients in overcrowded hospitals, but the Prime Minister said that he will fix all that because the buck stops with him.

Waiting lists for public hospitals are unlikely to get any shorter in the near future. In fact, quite the opposite is true. With the Prime Minister’s direct attack on private health insurance, more and more Australians will rely on state run hospitals to have their healthcare needs met. So, far from the buck stopping with the Prime Minister in relation to hospitals, he is worsening the situation by taking a baseball bat to private health insurance. This is all despite promises by the Prime Minister that he supports private health insurance generally. His true agenda is now revealed.

In introducing the new higher Medicare levy surcharge thresholds in the 13 May budget, the Prime Minister did indeed take a baseball bat to private health insurance. The Medicare levy surcharge formed part of the coalition’s three key policy pillars to support private health insurance. Those are: the very successful private health insurance rebate, the Medicare levy surcharge and Lifetime Health Cover. When we came to office in 1996, health fund membership was taken up by 35 per cent of the population. Public hospitals were struggling under the burden of patient numbers and insufficient funding. In 1997 the then coalition government introduced the Medicare levy surcharge. The MLS is an additional one per cent surcharge on taxable income. It is imposed on those earning above a certain threshold income who are eligible for Medicare but do not have hospital insurance with a registered health insurer. The MLS is in addition to the normal 1½ per cent Medicare levy.

The income thresholds above which the MLS kicks in are currently set at $50,000 for singles and $100,000 for families. It is an incentive for those who can afford to contribute to their own health care to take out private health insurance and alleviate some of the pressure on the public hospital system. This measure initiated a pattern of increases in private health insurance memberships that has continued to this day. In January 1999 the government introduced the 30 per cent private health insurance rebate. Australians who agreed to make a contribution to the costs of their own health care were subsidised by the coalition government to the tune of almost one-third of their total private insurance premiums.

In 2004 we introduced loadings on the rebate for older Australians. This amendment saw the rebate increase from 30 to 35 per cent for persons aged 65 to 69, and 40 per cent for persons aged 70 and over. This measure again saw a further increase in the uptake of private health insurance, but the coalition in government recognised that more needed to be done. Therefore the third pillar, Lifetime Health Cover, was introduced in July 2000. This measure made it worth people’s while to join health funds earlier and to stay members. Under Lifetime Health Cover, Australians aged over 30 who remained uninsured after July 2000 had their future insurance premiums subject to a two per cent surcharge for each year of age that they remained uncovered. So, for example, a person aged 40 who purchased health insurance for the first time in 2004 became subject to a 20 per cent surcharge on their current and future premiums. That is the difference from the age of 30, which the Lifetime Health Cover measure sets as the base, and the actual age of assumption of cover. If the same person delayed purchasing health insurance for a further 10 years, the surcharge would go to 40 per cent. The Lifetime Health Cover surcharge is capped at a maximum loading of 70 per cent. Australians born prior to 1934 are exempt. In addition, people in Lifetime Health Cover can take a two-year period of absence without incurring a higher premium.

Together, these policy pillars led to the highest number of Australians in private health insurance in the history of the country. In fact, the latest figures from the Private Health Insurance Administration Council show that 9.477 million Australians, or 44.6 per cent of the population, now have private health insurance. Of course, that was before the Rudd government took a baseball bat to private health insurance by changing the Medicare levy thresholds. Because of the raising of those thresholds, up to a million people will drop out of private health cover, according to an Access Economics report commissioned by the Australian Medical Association.

It stands to reason that those who will be the first to step out of private health cover will be those who can afford it least and are benefiting least from the cover. They are the young and the fit, struggling with high interest rates, high fuel costs and high grocery prices. As these people leave the private healthcare system, premiums will increase. This will see a further exit from the private health insurance system. We will see the cost of insurance spiralling and ultimately this will have to be borne by policyholders. Let it be stated clearly: premium increases from next year will be the Rudd premium increases in private health insurance. They will be the direct result of this government’s changes to the Medicare levy surcharge. I can guarantee you, Mr Deputy Speaker Andrews, that we will do everything we can to point out to the 9.4 million Australians with private health insurance that their premium increases are a direct result of the policy initiatives of the Rudd government in their first budget.

As these people leave the private health care system and premiums increase, there will be people who will be left behind. Firstly, it comes down to a very difficult time for health insurers generally. Roughly half of the income of insurance firms comes from investments in various markets, such as the stock market, the property market and a range of other financial instruments. The stock market and property market corrections have seen these investments lose value, and that of course will have an impact on the investment income for a lot of these funds.

Currently the health funds industry’s net margin is 5.6 per cent. Raising the Medicare levy surcharge will put a lot of pressure on funds’ reserves and hence their investment portfolios to cover the gaps left by departing members. So they have all the whammies coming together: the whammy of decreasing membership, the whammy of poor investment returns and the third whammy—the fact that their customers are under increasing financial pressure with rising grocery prices, rising housing prices, rising interest rates and rising fuel costs. So not only are the health funds under pressure but their members are under pressure. You have to ask yourself: ‘What is the impact, for example, on a pensioner earning $273 a week who is desperate to keep his or her private health insurance? What is the impact on that person of a premium increase of 10, 12 or 14 per cent directly a result of the Rudd government policy initiatives?’

Until now the government that promised so much in accountability and transparency has refused to table Treasury modelling which would throw light on how these changes will impact on our health system. Whether, as the Treasurer told the National Press Club, it is 485,000 Australians who will quit private health insurance, or, as Access Economics asserts, the number is closer to one million, the impact is similar. The public hospital system will be flooded with new customers. If these people are not taking responsibility for their own health care, they are going to go to the universal coverage provided by the public hospital system. And if the public hospitals are under pressure now, then how about another half a million to one million Australians queuing up at the door over a period of time because they would have previously gone to a private hospital but now they are going to the public hospital?

You can actually understand in pretty simple language what the impact will be on the public hospitals of the Rudd government initiatives on private health insurance. Given that is the case, this is an almighty cost-shift. Let us just go back to when the private health insurance initiative was announced by the Treasurer. The government is very big on spin over substance. They are very big on trying to con the Australian people. I know ‘con’ is a serious word, but it is a confidence trick. For example, they pretended that the alcopops tax was a health measure. In the budget papers all was revealed—that they were going to raise $3.1 billion from their so-called health measure. In fact, all of the evidence coming out now is that young people are turning to alternatives. Even a report released yesterday came out with further evidence that young people are turning to bottled spirits and wine based equivalents of alcopops. If you ask any liquor shop owner or publican they will tell you that they are seeing an increase in sales of alternatives to alcopops, yet the government claimed that this was about health—about binge drinking. If you look at the national alcohol and drug surveys, alcohol consumption by young girls has actually stabilised or decreased over the last eight years. But the government failed to mention that. The government failed to mention that this was not a health measure but that in fact it was a revenue-raising measure which they were parading as a savings measure.

I digress a little bit, but I always thought a savings measure was when you saved money by not spending money. But, instead, this government is dressing mutton up as lamb and pretending that the savings measures in the last budget are all savings, reducing expenditure, when in fact they increased expenditure in the last budget. They did not grow it as fast as previous budgets may have done, but they did increase expenditure with the net result that they needed to have so-called savings and the savings measures turned out to be tax increases—which, ironically, they did not tell the Australian people about.

So, coming to the great example of the government’s own program with the Medicare levy, they tried to paint it as a tax cut for battling families. That is what they paraded it as on a Saturday morning, with strategic leaks to the media: ‘We’re giving tax cuts by increasing the Medicare levy surcharge thresholds. We’re giving these great tax cuts to the punters. Gee, we’re generous.’ I though to myself, ‘Why would you announce that only a few months after you had promised $35 billion of tax cuts?’ Why would you announce a further tax cut given that there is an argument that tax cuts are stimulatory? I thought to myself, ‘Maybe they’re saving some money.’ And lo and behold, when the budget papers came out we could understand that they were projecting a massive saving to the budget of in excess of $950 million, because they will be paying out the 30 per cent private health insurance rebate to fewer people. So in this situation they are trying to make it a savings measure—and they did—by not paying the 30 per cent private health insurance rebate to as many people. So it is all smoke and mirrors. That is why I say that you have to look carefully at what the government does, not what it says.

I want to give another example of a key area where the government’s policy initiative will actually put more pressure on the public hospital system, not less. That is in relation to dental care and the government’s proposal to dismantle Medicare dental. Now, let us be very clear: Medicare dental saw 172,000 services delivered over its five-month life. They were not consultations or examinations. They were services—real dental work—and they were delivered to Australians with complex healthcare needs. These were the most disadvantaged Australians with the least ability to pay for dental care. With less than 10 per cent of the dental workforce employed in public clinics it will take a hell of a lot more than a fistful of dollars to get good dental care to these people and to meet demand.

One of the reasons we put dental services into Medicare was that Medicare, as an uncapped scheme, provides the sort of service that these people are after. As the last government, we had the capacity to do it and we did it. One of the first acts of this new government—and we will come to this in the debate on another bill—was to abolish the dental program in Medicare and to hand out vouchers to the parents of children under the age of 12 and say, ‘Okay, you can get a free examination but not one treatment.’ The first factor in relation to this is that the parents can find out that a child’s teeth are poor or that a child needs urgent dental work but there is no government funding to support that dental work. So if you are a parent and you get this voucher and you get the child’s teeth checked and they say, ‘Well, it’s going to cost $300 or $400 to get something fixed,’ what do you say if you have not got the money? Would you use that voucher?

The second factor is that a $150 voucher, which the government has laid down as part of the replacement for Medicare dental, may well not cover the costs associated with that initial examination. So 90 per cent of dentists operate in the private system and yet the government has taken away Medicare dental, which will help the patients who need it most. When they have huge queues in the public dental system obviously the only way to address it is to get more people going to the private system with government support, and this government has abolished that.

The government, overall, needs to do more to promote the health of Australians. Dismantling Medicare dental means only that more people will go to public hospitals. Dismantling—or, I should say, taking a baseball bat to—private health insurance means that more people will go to public hospitals. The Prime Minister said to Australians that the buck stops with him with public hospitals. He said: ‘Let’s end the blame game. The buck stops with me when it comes to public hospitals.’ We are going to keep the Prime Minister to that. We are giving him a lot of rope. We are allowing the Prime Minister to run this charade that he is fixing the public hospital system. We are not opposing this bill. We will be moving an amendment but we are not opposing this bill, because we want the money to go to the public hospitals. Let me point out that neither this bill nor anything else I have seen from the government is addressing the existing chronic shortage of funding in state hospitals but, significantly, it is putting additional loads onto state public hospitals.

I will make this final point. Prior to the last election, health minister Tony Abbott, the member for Warringah, announced an extra $18 billion that would be available in the new healthcare agreement from the government. That is a significant increase in funding. Firstly, that additional $18 billion would have been available to help the states address some of the challenges they have in terms of funding the state hospitals, but significantly it was going to be tied to better reporting by the hospitals, particularly in relation to data and performance of the hospitals across the states and territories. Secondly, the funding was going to be linked to some long-term goals associated with outcomes that the Australian people—patients, in particular—demanded of hospitals in a whole range of areas. That extra $18 billion which was available before the election has not even been referred to by the new health minister nor the Prime Minister. But the point I make is that there is a high bar that has been set for the Prime Minister and the health minister in relation to public hospital funding.

The second factor—and this is a very important factor—is that the Prime Minister said that, if he has not fixed the hospitals by 2009, there will be a referendum for the Commonwealth to take over the hospitals from the states. I want to say here in this chamber that we will keep the Prime Minister to that. We are not going to let the Prime Minister scurry behind the Health and Hospitals Reform Commission’s report, with its various interim reports over the next 12 to 18 months. We are not going to let him hide behind that as an excuse to say that he has done something for the hospital system, because he said not only that he would fix it but also, significantly, that if it is not fixed—if the outcome has not happened—by 2009 then he will have a referendum. We will give him the whole of 2009. He said that if he has not got an outcome on hospitals—if he has not fixed the hospitals by 2009—he will have a referendum to take them over. It is not good enough to say in 2009 that he has a plan to fix them. I can see this being set up by the Prime Minister already—that he has a plan to fix them, that he has had a report from a committee that was set up and has consulted widely and that it has got these great benchmarks. That is all pollywaffle. The Prime Minister said that the buck stops with him and that he will fix the hospital system by 2009; otherwise the Commonwealth will take over the hospitals. It was a dramatic statement at the time when he made it, and we are going to keep him to it.

There has not been a series of questions in the chamber from me to the Prime Minister about the buck stopping with him, because I think the Prime Minister and the government deserve the opportunity to try and fix the hospital system. There is not going to be unnecessary carping from me on the sidelines if, in fact, they really want to do that. But I do say that it is not good enough to make promises and not deliver. This bill does not deliver, and therefore I move the amendment circulated 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:

(1)

notes that the funding provided is a short-term solution to a growing crisis in our public hospitals;

(2)

notes that the Government through its changes to the Medicare levy surcharge is placing a massive additional burden on public hospitals which has not been taken into account in current funding allocations;

(3)

notes that the Prime Minister pledged ‘the buck’ would stop with him in relation to public hospitals and this bill does nothing to address that;

(4)

notes that there is no long-term solution in this bill for public hospital funding to meet inflation; and

(5)

notes further that there is still no consistent and reliable reporting mechanism provided by the States and Territories that allows comparisons to be made between hospitals across Australia.”

Kevin Andrews (Menzies, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Greg Hunt (Flinders, Liberal Party, Shadow Minister for Climate Change, Environment and Urban Water) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Damian Hale (Solomon, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to make my contribution to the debate on the Health Care (Appropriation) Amendment Bill 2008. This vitally important bill proposes to amend the Health Care (Appropriation) Act 1998. It is a vital bill because, among other things, it provides the legislative basis for the Commonwealth to pay financial assistance, under the Australian healthcare agreements, to the states and territories. At the COAG meeting in March this year the Prime Minister, along with all state and territory leaders, announced that the Rudd Labor government would relieve pressure on our public hospitals by committing $1 billion in additional funding. The passing of this bill is an essential part of implementing our commitment to allocate $1 billion for 2008-09 and to pay $500 million of that money to the states and territories before the end of the financial year.

The current Australian healthcare agreement expires on 30 June this year. To ensure that there is no break in the continuation of hospital payments to the states and territories, we must pass the amendments to this act during the winter sittings. Importantly, it should be noted that these amendments will ensure the continuation of public hospital and related funding for the next financial year. During this time, new agreements will be developed and put in place because, by rolling over these terms and conditions for another year, the Commonwealth can start delivering on our commitment to improve health care for all Australians. Our government is absolutely committed to delivering on election promises. Our budget initiatives demonstrate this, and this bill definitely demonstrates this. It is about delivering healthcare improvements for the people of Australia. After a decade of funding cuts and neglect, we are committed to working with states and territories to fix our hospitals and deliver health care to working families.

This is an important issue because, for the first time in 11 years, we have an opportunity to end the blame game when it comes to public health. As I said earlier this week, all the regions of the Northern Territory have suffered due to the blame game continually being played, and what this has caused is confusion, resentment and a lack of progress on many key issues that are affecting the lives of the good people of the Top End. Never has it been more evident than in health care.

The people of Australia, particularly the people in Solomon, suffer as a result of the previous government’s neglect and underfunding of the Australian healthcare system. That is why this piece of legislation is not only good for Australians but absolutely essential. I have been speaking with the Northern Territory government about this bill, because that is what the government wants to do—we want to talk to our colleagues in the states and territories, unlike those opposite, who for 11 years were in a perfect position to work with states and territories to improve the lives of Australians, and yet the best game plan they could come up with was to perfect the blame game.

As I have said, I have had discussions with the Northern Territory Minister for Health, and he has informed me that this additional funding from the Rudd government will go towards things like further funding for respiratory services. Currently there are limited respiratory services provided across the Northern Territory acute care network, despite respiratory and obstructive-airway disorders representing four of the 25 highest volume conditions requiring hospitalisation in the Territory. To enhance respiratory services, $400,000 will be allocated to improve specialist services in this crucial area.

Further to this we are committed to special needs dentistry. Across the network there are approximately 860 patients per year that require access to special needs dentistry, particularly patients who have other complicating factors such as renal and cardiac conditions and physical and mental disability. A small special needs dentistry suite will be established at the Royal Darwin Hospital. This will include the installation of a special dental chair and equipment, and funding to have a special needs dentist undertake the work.

Since 2001, 70 new beds have opened at Royal Darwin Hospital. Along with these beds there have been other new services introduced to address the demands of the emergency department. These increases in patient capacity have resulted in a greater throughput of patients and an increased demand on radiology services. An additional $1.7 million will be allocated to fund additional radiology services at Royal Darwin and Alice Springs hospitals. This is a critical service that needs these additional resources, because timely radiology services assists with the provision of high-quality patient care for treatment and discharge.

These improved services are a start to meeting the current demands and to implementing expanded or new core hospital services across the Northern Territory. In addition we have committed $10 million to establish a 24-hour GP superclinic in Palmerston. There is much work to be done in health. We have a health system that has been neglected for 11 years. But the Rudd Labor government have made a very strong start, and we intend to continue for the long haul. All Australians, and especially the good people of my electorate of Solomon, want and expect an end to the 11-year legacy of neglect from the previous government. This bill and the funding attached to it are a very important part of a long journey to ensure a better health system for all Australians, and we as a government are absolutely committed to delivering it. I commend this bill to the House.

Wilson Tuckey (O'Connor, Liberal Party) Share this | Link to this | Hansard source

Thank you for your consideration, Mr Deputy Speaker Adams, in the matter of my late arrival. I did anticipate that the previous speaker would speak a little longer considering how proud the Labor Party is of this particular initiative. I have come really to talk about why a bill relating to money is not the solution in itself as to how to better administer health for the Australian people. Politicians, per se, have a habit of measuring excellence by expenditure. It does not work, and it works least in the delivery of public health services. The member for North Sydney has already quoted some of the amounts that are being made available under these appropriation bills and they are testament to the belief—and I think the general public has the same belief and I am not suggesting that the coalition has any plans to significantly change it—that government is best able to guarantee services to people. In other words, to give the service that people desire and to which they are entitled we believe that we have to own the shop.

What do we do next? We stand up in here and introduce an appropriation bill, and we talk billions of dollars for this and hundreds of millions of dollars for that. But, because of the nature of our federation and because of the attitude, I might add, here in Canberra where people are more anxious to send the money than ask what has happened to it, we shunt this money off to the constitutional managers of health—the providers of health services at the public level—and we think we have done the job. And what is the outcome of that? In the first instance, you have a circumstance where that money is divvied up by means of some formula and a major hospital—what was once known as a teaching hospital—gets a budget. Now, the first outcome of a budgeted hospital management is that patients are a liability. You have to be very careful that you do not have too many of them, if you are the finance controller. And, of course, you have to be terribly careful that they do not all want a hip joint replacement, because those are things that you have to buy and you have a limited number of them under budgetary management. So when you run out, that is just too bad. Then, of course, you have all the other matters that arise in the management of that sort of hospital.

I thank the two members opposite for listening to my speech. Maybe they will take some of these thoughts back to caucus. They would not have known Con Sciacca, who was a minister in the previous Keating government. I admired and was friendly with Con. He was the minister who, by his own initiative, instituted ‘Australia Remembers’. I happened to be the shadow minister in some respects copying him. I went around Australia congratulating him on that initiative because I thought the veterans deserved it.

But Con sold the repatriation hospitals, which were the property of the Commonwealth and managed by the Commonwealth. When we get onto privatisation, from time to time, if you like, you have got form. I endorsed that decision. But, having done so, the Labor New South Wales government and the Victorian Liberal government said, ‘We want them.’ So they took them over. You can check the history in Victoria; it became quite a mess. I think they sort of revolted. But in Western Australia and Queensland the state governments—again, I think, Liberal and Labor—said, ‘No, we don’t want them; sell them to the private sector.’

The Hollywood hospital in Western Australia, as it was known—the Hollywood Repatriation Hospital—was taken over by the Ramsay Health Care group. I can tell you the RSL were terribly concerned about this. They lived in this culture of ‘government needs to own the shop to guarantee us the service’, notwithstanding that at that stage there was a 10-month waiting list at the repat hospital for elective surgery for veterans. Anyway, I called in about three months later to see how things were going and they said: ‘Oh, it’s magnificent. We’ve gone from TV dinners to the reinstatement of the hospital kitchen, and the waiting lists are nearly all gone.’ And how was that achieved? They opened up the operating theatres on Saturday. How could Ramsay do this but a government funded instrumentality could not? In the process of the sale, they got an agreement that this parliament would pay them for services rendered. So, all of a sudden, a patient was not a liability; they were an asset. They took steps such as opening their operating theatres an extra day a week to in fact earn revenue by the process of looking after them—which, I would think, is the purpose of us allocating these huge amounts of money by way of appropriation: to give people service.

So what has happened? The only way that the general citizenry can benefit from that sort of incentive based process is to be in the private health insurance system. That is the only way. This is not policy either. In 1998 I happened to have the opportunity to write a policy about health and I did it on the basis that every Australian should be in the private health system and should be subsidised, according to their needs, for up to 100 per cent of the premium cost. That meant that, from there on in, everybody was in a system where they were welcome at a hospital. When I went around my own electorate—and I want to talk a little bit more about that in a moment—to the hospitals, which were run by hospital boards as government entities, and I explained to them how this would work, because a government hospital would still remain a government hospital but it would send the bill to MBF, Medibank Private, HCF, you name it, they all worked out that they would be better off financially just on the number of patients they handled at the time. But there was also an incentive to go back to introducing gynaecological services and so on, to encourage women to stay in that country town and have their babies. Some in the perimeter around Perth said, ‘When someone has an operation in one of the major city hospitals, where it is appropriate, after a couple of days they could send them out to us and we will go through their period of care.’ Now, all of that happened. As I go around my electorate now, most of those hospitals are closed.

During the time that was my area of responsibility, I went to a big conference where the keynote speaker was a ‘Lady’, an aristocrat—dame whatever—who had got that order for her services to the public health system. During her presentation, she said: ‘Waiting lists are a formal component of delivering public health services. We have to have them to manage our budget.’ She then went on to complain about the administration of waiting lists and how—and we may all be guilty of this—if you have got the right sort of member of parliament and they kick up enough fuss, you get pushed up the waiting list. I will not name names, but the wife of a very, very important member of the Labor Party, at the time resident in this town in a salubrious dwelling provided by the taxpayer, got gallstones. He was not, philosophically, privately insured. But where did his wife go? She went to Calvary Hospital, to a private room. The surgeon who operated on her was—surprise, surprise—a private surgeon, but she was told what day of the week he would be operating. Now, that is okay; that is the system. But that was this lady’s complaint. It was pretty interesting, because she was right: if you are going to have a public health system and you are going to have waiting lists, nobody should be able to get kicked up the list other than because of an emergency.

So it is not a very nice system. Of course, if you are privately insured, your doctor, having decided you need some form of elective surgery, picks up the phone and says, ‘Hang on a minute; I’ll get you booked in for next Wednesday.’ And it happens.

Not everybody can afford private health insurance and, to assist people in the community who had that desire, our government eventually picked up part of my proposal. I feel they picked up quite a few aspects of it over time in an ad hoc way, which I was not that pleased about because I thought the package was better. We decided that, where people were prepared to invest a significant amount of their own money in a private health insurance policy, we would subsidise their premiums to 30 per cent—that was for all comers—and then to 35 per cent for those over 65, I think the figure goes, and to 40 per cent for those over 70.

One of the things I also found in putting together my proposal was the actuarial advice as to where the demand for health services is most obvious. I do not have to tell anyone that. We proposed a three-tier premium system. Of course, people under 18 or 19 cost the system less than any other group, people in the middle cost more, and those people over 65 cost three times as much as others. That is another problem. When you have competing systems—that is, Medicare and private health—and the fact that ill heath or the need for medical services and hospital services increases with age, people will always have the habit of saying: ‘Medicare will do. If I get hit by a bus or have a premature heart attack, Medicare will look after me in a reasonable way.’

I still limp because I forgot to tell anyone after I had a very serious car accident that I was privately insured. I found I was being practised on by interns, registrars and others and I ended up coming out of hospital with a leg that was very bent. Then I remembered I had private insurance—I was not too coherent at the beginning of all of that—and I arranged for private health insurance to straighten my leg out. That is okay, but the fact of life is that when you are privately insured, you get a service of the level you desire. But we also provided subsidies.

What I am coming to is that, in legislation forthcoming but consistent with the funding package, we are seeing a relaxation of the pressure to join private health which is put on people through the tax system. That is an open invitation to many of them to walk away from the private health system. I was here during the Hawke-Keating government and I watched that happening. I believe there was a simple conspiracy to make sure that the private health system was put out of business. Please remember—for those who bother to read our Constitution—that the civil conscription of doctors, dentists and such people is forbidden under our Constitution. As a government, you cannot implement British national health because you cannot conscript the people you need to run the shop. But, of course, if you send the private health system broke, there is no choice and, if you have a penchant for a British national health system, you achieve it by default.

What I saw, particularly in the Keating years—and not particularly because of him; the matter was just getting into a massive situation—was that the membership of private health was collapsing exponentially. Every time another group of limited claimers or nonclaimers left, the premiums went up substantially and as a result of that another group of the less demanding left—the ones who balance the book, if you like, in the bookmaking of insurance, and that is all it is—and then the premiums escalated even further. Of course when the Howard government came to office, private health insurance was about to fall over. I have said, had Keating won one more election, that would have been the end of the private health system because there just would not have been enough people left. You would have to be super rich to have stayed in and paid the full premium cost.

Now there is another aspect of insuring people for health, and that is the increase in the state of technology. The solution once for bad knees, bad hips and other such complaints was to buy a wheelchair. The technology was not there to repair your hip and your knees as it is today. That is occurring across the board and, as a result of that, the cost of delivering health services will always rise much more rapidly than inflation or whatever else you want to talk about. As a member of this parliament, I am willing to endorse taxes necessary to see people have that service.

What I hate is to see speeches like this one which says we will achieve excellence by expenditure. State governments, no matter what political persuasion, will never have enough money to do the job. In Western Australia we have been promised a new hospital—the Fiona Stanley Hospital. If I were that lady of great importance, an Australian of the Year, I would say, ‘For God’s sake, take my name off it; I’m getting embarrassed.’ It is still not operational. Furthermore, the other day the government did not even put up reasonable financial support for the Royal Flying Doctor Service. They still think it is a charity when, every time they close a hospital in some country area, they call on the RFDS to be the taxi service to bring those people from much depleted facilities into a major hospital, typically in the metropolitan area or maybe in a large regional area. For shorter distances you have volunteers, connected to the St John’s Ambulance charity in my state, having to do the same thing. People who are only reasonably ill have to be driven to the metropolitan area because there are no amenities left in the country and that has happened in the last 10 or 15 years. So what has happened to the money that has been sent there? Does the system deserve the support that we impose on the taxpayer, or should we be looking to a payment for service system, whether it is applicable to a public hospital or a private hospital? Should we be genuinely trying to get rid of waiting lists, which every senior hospital administrator will tell you are a part of their budget control system?

I refer you to that lady from New Zealand who got it right. She was happy to have waiting lists but she was very cranky about those who could step up the list, including a very important person who sat in this parliament for a long time. It should not work that way, but that is what communism was all about. I remember talking to a communist MP who said: ‘I knew as a young man how to get ahead in Russia. I had to join the Communist Party, because then I got privilege.’ We should not have that in Australia. As I say, this is a genuine attempt to make some of the newer members who attend caucus ask, ‘Is there a better way?’ It is not that we should not allocate the money, but we should do it better.

Craig Thomson (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

I hesitate to comment on the member for O’Connor’s contribution, but I think a couple of points need to be made and put in the Hansard. The work that doctors, nurses and other health professionals in public hospitals do is first class. It is world class and it should not be denigrated in this particular place. Having represented health workers—doctors, nurses, ambulance officers and health workers of all sorts—for over 19 years, I found some of the member for O’Connor’s remarks offensive. There are people who are saving lives and doing a fantastic job in our public hospital system in every state around this country.

Wilson Tuckey (O'Connor, Liberal Party) Share this | Link to this | Hansard source

Mr Deputy Speaker Adams, I rise on a point of order. There is no need to take a sleazy approach to a genuine effort to draw your attention to this. That is not what I said.

Dick Adams (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

Order! There is no point of order.

Craig Thomson (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

The issue that the member for O’Connor raised that was in fact correct was that, by itself, putting money into public hospitals to reduce waiting lists is not the full answer. That is why the Rudd government has a comprehensive plan in relation to health and is not relying just on the Health Care (Appropriation) Amendment Bill 2008 alone.

I also need to make some comments about the proposed amendment from the member for North Sydney. The blinding hypocrisy that the member for North Sydney has shown in lodging this particular amendment almost bowls you over. If we look at what the amendment says, we will see that it first of all notes that the funding is provided as a short-term solution to the crisis in our public hospitals. The question has to be asked: why are our public hospitals having this particular crisis? The answer to that is blindingly obvious. We used to have a situation where the contributions from the state and federal governments were approximately 50 per cent each. But in the last 11½ years of the Howard government we saw the federal contribution decline. We in fact saw it decline to such an extent that the federal government contribution was just a little over 40 per cent and the states’ contribution had to increase to fill the gap. No wonder the public hospital system and the states have been crying out for more money to make sure that they can do what they are charged to do. It is because the former government was starving them of funds. One of the main purposes of this bill is to provide over $1 billion worth of funding to the states to go some way towards rectifying the neglect that the previous government inflicted on our public hospital system over 11½ years.

The second part of the amendment that the member for North Sydney put up was in relation to the Medicare levy. Quite frankly, this is a cheap political stunt. Legislation on the Medicare levy surcharge has been argued and debated in this House, and to put up an amendment that seeks to make a political statement on a bill that has nothing to do with the surcharge is nothing more than cheap politics and should be seen as such.

The other point that needs to be looked at in relation to the former government’s record on health is exactly what they were promising at the last election compared to what we the Rudd government are delivering in the budget and in where we are going with public health. Leading into the election, the former government’s health policy had two points. One was to create local hospital boards and a new level of administration at every hospital. By the time the election campaign was over, they were not particularly sure whether that was still their policy, because it was going to be a nightmare to administer. The second policy they had for health was the cheap political stunt of looking at buying out a hospital in Tasmania. One hospital was their answer. Their entire health policy was to create another level of bureaucracy in the form of local hospital boards and to buy out a single hospital in Tasmania in a marginal seat that they thought they would be able to win if they made that promise.

Members of the opposition are in opposition because the voters saw through those tactics. They saw that they were inadequate to address the health needs of this country. The former government were not even able to win the seat in which they tried to bribe the electorate, because the voters saw through the lack of forward planning and the lack of a proper plan for health care.

Australia’s systems of government are creaking with age. This is evident in many vital areas of people’s lives, including in water, environmental laws, infra-structure and education. The age of our federalism, to me, is most evident in our health systems. We face many challenges in modernising federalism. It is going to be tough. Tough decisions will have to be made. Entrenched power and familiar yet inefficient processes will need to be challenged.

As I said, from my experience of representing health workers for close to 20 years, and being the elected member for Dobell, it is very clear to me that the Australian people want to end the blame game that has so defined governance for decades. I know that the tit for tat of the federal government bashing the state government and vice versa has been the staple diet for many of our local newspapers. It is the cheap and easy way for lazy politicians to get the hard work done. The former government turned it into an art form. We all saw that in the Crosby Textor leaks last year that said attacking the states was a winning political formula. The Rudd government takes a different approach on these issues. The Rudd government says that we need to lay out a proper plan for Australia’s health future and we need to be putting our health dollar where it is most needed. We also need to be doing more than criticising other levels of government.

That, principally, is what the Health Care (Appropriation) Amendment Bill is about. It is about providing a billion dollars to the states, to the public health system—a billion dollars which the previous government had ripped out, a billion dollars which is needed to make sure that we have an efficient health system that can operate and provide the outcomes that patients want. In health, we saw that the previous government cherry-picked only one of the 700 public hospitals to try and demonstrate symbolically that they were interested in public health. But the electorate knew that it was only symbolic. The electorate knew that the previous government had no interest in public health—and the contribution from the member for O’Connor today only confirmed that further.

The purpose of the bill before the House today is to increase the appropriation to state and territory governments under the Australian healthcare agreements by $10.25 billion dollars. This will ensure continued funding for state and territory healthcare systems during the Australian healthcare agreements negotiations, scheduled for the latter half of 2008.

The Australian healthcare agreements are five-year bilateral funding agreements between the Commonwealth and the states and territories to provide public hospital services. Under the Australian healthcare agreements, the Commonwealth and the states and territories share funding, but management of the services is delivered by the states and territories. The Australian healthcare agreements are the key funding mechanism for state and territory healthcare systems—namely, public hospitals. There is a provision in the Health Care (Appropriation) Act 1998 for other healthcare programs to be funded provided they improve service delivery or patient outcomes.

Historically, negotiations have been protracted and, at times, the states and the Commonwealth have been at loggerheads over the proposed contributions, with the states and territories claiming during the last negotiations that the Commonwealth share of funding had declined—which clearly it had. The current Australian healthcare agreement is due to expire on 30 June 2008. This appropriation reflects the commitment made at the Council of Australian Governments meeting on 26 March 2008, where the Commonwealth government undertook to provide an immediate allocation of $1 billion to the public health system, with $500 million to be provided before 30 June 2008. It is intended that this money would be used by the states and territories to relieve pressure on public hospitals.

This bill is about providing some funding to the states and territories for their public hospital systems while these agreements are negotiated. The Rudd government is concerned about making sure that we come to the table with the states and territories, in good faith, that we put our money where our mouth is and that we sit down in good faith to negotiate five-year agreements. But, to do this with any sort of decency and to try to make sure that the public hospital systems are able to operate as they should, this bill needs to be passed so that the billion dollars in funding can be provided and so that those negotiations can continue.

This bill, in providing funding to the public hospital systems, complements other legislation and other initiatives that were announced in the budget by the Rudd government—in particular, the $3.2 billion National Health and Hospital Reform Plan. As part of that, there was the GP Super Clinics initiative that was announced at the last election and funded in this budget. It goes to perhaps the only point that the member for O’Connor made that is worth remembering, and that is that our health system is not just about public hospitals; it is also about providing primary care and making sure that preventative health care is taken. In my electorate, we have a promise which was in the budget of a GP superclinic for $2½ million, and that is absolutely vital to the health of our public hospital system, because we have a chronic shortage of GPs in our area—a chronic shortage of GPs that happened on the watch of the previous government.

I believe it is vital that this bill is passed. It provides much-needed money for the states and territories to run their public hospital systems. It is one that should be supported unamended. I commend the bill to the House.

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

Over the years, I have risen in this House on numerous occasions on the issue of health across rural and regional Australia, and tonight is no exception. I rise to speak on the Health Care (Appropriation) Amendment Bill 2008. I have raised many of the issues and concerns of rural and regional Australia for a long time in my role as part of the government over the last three terms. It has taken an enormous amount of effort. Sometimes there is success; sometimes there is no success.

I look at the appropriation bills and I read through the health areas with great interest because of course I am always looking for the rural perspective on health. I am pleased to see that there is certainly some rural perspective. Some would criticise and say, ‘Not enough’—I am probably one of those people. But, hope-fully, over the three years, more resources will be made available as they are required. I have always said the test of a government is how they respond to issues when required—such as when we were determined to build a Riverina Cancer Care Centre and there was no funding made available for that. The community raised $3 million in a very, very short period of time to build the centre.

Eventually, the minister funded the linear accelerator in the Riverina Cancer Care Centre. When it was realised that we were a sustainable unit, the last government, of which I was a part, went on to fund the second linear accelerator, which has seen an exceptional workload coming to the Riverina Cancer Care Centre, to deal with many Canberra people and people from many other areas who come to the community funded Lilier Lodge accommodation centre and also avail themselves of the fabulous services of the Riverina Cancer Care Centre. There is another community fundraising operation taking police now to extend the Riverina Cancer Care Centre. I went to a cocktail party last Friday evening. Again the community are being asked to dig deep into their pockets to expand the centre. I am sure there will be times in the future when we will require government help to match community cooperation and funding attempts being put into delivering cancer care services to rural and regional areas, particularly in my area of the Riverina and beyond.

I lobbied the last government. That government came to an end far too quickly for me to be successful in getting a PET scan in Wagga Wagga in order to give a comprehensive cancer care service to the people in my electorate who are dealing with cancer and certainly to make life a little easier so that they are not forced into city areas for diagnosis and then back for some of their treatment. They can get the majority of their diagnosis on the ground and can then undertake treatment. The Riverina Cancer Care Centre is a wonderful place and I am sure the minister will consider modelling other options for rural and regional Australia on this community-government-public sector model which has seen the delivery of excellent services to rural and regional people, giving them equity when confronting cancer.

Also, I fought long and hard to have mental health addressed. I have long been an advocate in this House for mental health services. We established Sunflower House in Wagga Wagga but it could not get the funding required from the New South Wales state government over long periods of time. Eventually last July, under the Howard-Vaile government, we were able to provide more than $1.3 million for Sunflower House to open its doors and to provide critical mental health services in and around the Wagga Wagga district. It was a sensational outcome. Mental health sufferers now have access to services and assistance in the mental health issues that confront not just our region but certainly regions right across Australia. Many of these people have been associated with previous drug use. That could be previous marijuana use, which has led to an enormous rise in schizophrenia and a whole host of mental health problems due to the THC content in cannabis, which is obviously rising with an enormous amount of hydroponically grown cannabis now. We were able to establish in the Riverina for the first time a rehabilitation service for those recovering from illicit drug use.

When I was the chairperson of the Standing Committee on Family and Human Services, in the report of the substance abuse inquiry entitled The winnable war on drugs we sought more money on the ground for services, particularly detox. Detox is sincerely required before rehabilitation can proceed. People who do not have adequate detoxification from illicit drugs, alcohol or pharmaceutical or prescribed drugs really cannot access a rehabilitation centre. The requirement for detox is significant. While I was able to achieve a lot from the past government and delivered a lot to my region, including funding for the Peppers rehabilitation program back in April 2000, which was re-funded in 2003 and again in 2007, I would sincerely ask the ministry to consider looking at the availability of detoxification in order to access rehabilitation centres. That is a way in which money can be put to very good use, not just in city areas where the service is still quite scarce, but it is almost impossible to find detox if you live in a rural and regional area. I encourage the minister to look at these detox issues.

In addition, the divisions of general practice delivered extraordinary services in the 10 years of the last government. I would hope they will continue to deliver fantastic services. They have rolled out rural palliative care services in my Murrumbidgee Division of General Practice. We funded them to roll out rural palliative care, to get GPs involved in the delivery of palliative care, ensuring that people who had terminal illnesses were able to stay in their home longer as a result of GPs entering a palliative care program which enabled them to look after sufferers at home longer than they would normally, having quality of life at home before being moved to a hospital. When I looked at the budget lines, I was quite happy to see international medical graduates proposed in the budget, but when I was looking through the appropriations I could not see any money allocated to the training and encouraging of the 5,000 international medical graduates into general practice, which we are in desperate need of doing.

Many of the speakers here today have talked about the decline in the availability of GPs and doctors in general across Australia. If we want to enhance our workforce with these 5,000 IMGs, we need to acknowledge that they require an enormous amount of assistance to traffic them into options for rural GP service. We have many training providers right across the nation. I know I have a very effective training provider in Wagga Wagga—CityCoastCountry Training—that assists internationally trained graduates into service that can provide great benefits to rural and regional communities. I applaud the 5,000 international medical graduates initiative, but I also ask that the minister look into the provision of funding to encourage, train and support these graduates through the process and into general practice. That is certainly a costly experience and one that requires some financial resources.

I move on to an issue that I have been most passionate about since entering parliament. I speak in particular of HIV-AIDS and hepatitis C. When I came into parliament, I chose to go on the HIV-AIDS committee, which was under the then Minister for Health and Aged Care, Michael Wooldridge. Each time we have had that committee re-formed I have volunteered for it. It has been a difficult task over the years to get that committee re-formed. It is essential that there be another parliamentary committee on HIV. We really need to understand that HIV-AIDS management has fallen off the radar. Over the past years, we have seen HIV-AIDS start to decrease in its importance or recognition or action. I stand here this evening speaking on this health appropriation bill not to criticise the previous government or the current government but to put forward the need to recognise that we have over 1,000 new infections taking place in Australia per year. There are more people living with and responding to HIV-AIDS than we have ever experienced before in Australia. We require a new way of thinking about HIV-AIDS. We should be motivated and innovative in ensuring that we in Australia are keeping up with world’s best practice. In the past, we have always been recognised as absolute leaders in this field, and I have always been very, very proud of that. Compared to sub-Saharan Africa and many of our island nations, including PNG, we have a very small incidence of HIV. Nonetheless, it requires a very significant strategy so that we do not have larger numbers to deal with and so that we manage lifelong health problems for HIV sufferers, because they in turn are entitled to have equity of services available to them.

It is very, very difficult to get access to services if you are an HIV sufferer in rural and regional Australia. It is almost impossible. We have moved a long way in antidiscrimination, we have more understanding and we are a more educated population now than we were back in the Eve van Grafhorst days. Many of the young parliamentarians may not remember the case of Eve van Grafhorst—a premature baby who acquired HIV-AIDS from a blood transfusion. The discrimination that she and her mother were subject to was extreme. We have moved a long way in those areas, but we have not kept pace with what is required in order to lead the world in HIV management—to lead the world with programs that will provide long-term treatment for those suffering from HIV as well as prevention of and reduction in HIV. We tend to want to put it to the side and deal with it in a less public way, but I believe that that can no longer happen. I am very conscious of the fact that we need a new international strategy. We need to be involved with the management, prevention, reduction, treatment and recognition of the new and emerging issues that are facing our communities as a result of HIV. We tend to want to isolate HIV. We are particularly lucky in Australia where we are in a controlled environment. We seemingly have controlled outbreaks whereas in the international environment epidemics are generalised. They are not the contained epidemics that we have in Australia.

So it is very important that attention is paid to this critical area of health funding, because it is not something that people stand up and champion all of the time. If you suffer from cancer, or from any number of different illnesses, you can garner an enormous amount of support around you for lifelong treatment and a quality of life experience through the health budget. But it is much more difficult when you are a sufferer of HIV or are working in agencies associated with assisting HIV sufferers, their families and the community. It is a very difficult place to be; it is not a sexy place that immediately grabs everyone’s attention and they want to run to fix the problem, as happens in many other areas.

The more people in this House who are involved with ensuring equity of access for all Australians to health services, quality of life and lifelong treatment services the better. Once HIV-AIDS was a death sentence—nothing was surer; you could bet on it. But now things are different. I supported a hospice in Kenya, called Nyumbani, which cared for children who had lost their parents to AIDS and were HIV-AIDS affected themselves. At one stage they went to Nyumbani to enjoy some quality of life and die peacefully. Now, through the introduction of antiretroviral treatments, Nyumbani has become an orphanage and the children are now being adopted by many countries, including Ireland and Scotland.

So we have to deal with HIV in a totally different way internationally, but it starts by us being very aware of the needs within Australia. The mental health aspect of HIV is also important. Once you are a sufferer of HIV, access to mental health services is key to your survival and your success, because stress can be a dangerous factor in reducing your immune system and driving your CD4 counts down, putting you at risk of toppling over into full-blown AIDS, which requires far greater treatment.

This evening I have covered quite a few areas of health that I believe need constant attention. Each area is very important, and some are not as highly favoured in the health budget.

Kerry Rea (Bonner, Australian Labor Party) Share this | Link to this | Hansard source

I am very proud to rise this evening to talk about the Health Care (Appropriation) Amendment Bill 2008. I want to talk about the substantive content of the bill, which concerns our public hospital system. In particular, I am very proud to be part of a Commonwealth government which is finally putting its money where its mouth is and dealing with the very real problems that exist in our public health system at the moment, in particular our hospitals.

I represent the electorate of Bonner, which is in the state of Queensland. It is part of Brisbane and the south-east corner, one of the fastest-growing areas of population not just in Queensland but, indeed, in this country. Many residents in my electorate are well aware of the pressure our public hospitals are currently under and are looking to any level of government, in particular the federal government, to put more emphasis on this issue. That is why this appropriation bill is so important.

The significance of injecting this $1 billion into the public health system to help state governments deal with the public hospital system is great, for two reasons. Not only is the Rudd Labor government once again demonstrating its commitment to implement election promises by providing this money—and providing it early—to state governments; it is also delivering on its very key election commitment to end the blame game. It is about working in partnership with state governments for ordinary working Australians out there who deserve a high-quality healthcare system. They have a right to a free public hospital system that will meet the needs of them and their families. This is the election commitment that is delivering to them.

For too long we had a federal government that simply sat on its hands. The only exception to that was when it pointed the finger of blame at the states for the public hospital system, meanwhile reneging on $1 billion of funding, which has contributed significantly to the pressure currently on our public hospital system. Of course, that is the easy way out. It is very easy to blame state governments, particularly if they are not of the same political persuasion as you, instead of actually rolling up your sleeves and dealing with the issue.

It is a bit rich, though, for the previous federal government to blame the states when in fact their lack of desire, courage and action contributed significantly to many of the issues that are putting our public hospitals under pressure, particularly in the area of skills. We are dealing with a lack of trained nurses—in fact, we have a nationwide shortage of almost 6,000 nurses and funding was not provided by the previous government to support training of those health professionals. Also, when you consider that across Australia we are now faced with a shortage of doctors, which affects 60 per cent of the population, it is clear that the Commonwealth has not been pulling its weight in this area. Indeed, it has been almost negligent in its lack of support for state governments and the public hospital system.

So, as I said, the bill delivers two election commitments: $1 billion to work in partnership with the state governments to deal with the pressure on public hospitals and, in that line, to end the blame game and start building partnerships with state governments to make sure that it is the community that benefits. What is significant about this appropriation bill is that it will begin with the bringing forward of $500 million to be allocated this financial year to the support of public hospitals. We have heard much about the fact that this is a problem for state governments and that the Commonwealth should not be bailing them out. But I would like to remind members in the House of the Medicare principles that this Commonwealth government developed and endorses: to ensure free treatment in hospital for eligible persons and to ensure access to services based on clinical need within a clinically appropriate period, one of the most significant being equity of access regardless of geographic location. I would include in ‘geographic location’ living in a Labor electorate or indeed a Labor state, where you should also have equity of access. This does not seem to have occurred over the last 11½ years. This bill sees a funding increase of 10.2 per cent over the next 12 months.

What I am also pleased about is that the bringing forward of these funds is part of, and works in conjunction with, the discussions of COAG in March this year, when the state, territory and Commonwealth governments sat down together and agreed to do a range of things. They agreed that they would work in partnership. The Commonwealth put significant extra funds on the table. They also agreed that they would roll over the terms and conditions of the current healthcare agreement so that we could spend a significant amount of time—in fact, the next 12 months—talking about and negotiating an agreement that would see real, long-term strategic benefits for health care, in particular for the public hospital system in this country. At discussions in March between the key stakeholders—the states, the territories and the Commonwealth—it was agreed that a new healthcare agreement would clarify the roles and responsibilities of governments. It is a significant step towards a national registration and accreditation scheme for health professions to be implemented by 1 July 2010. Initially this scheme will cover nine health professions: medical practitioners, nurses and midwives, pharmacists, physiotherapists, psychologists, osteopaths, chiropractors, optometrists and dentists, including dental hygienists, dental prosthetists and dental therapists. So we are seeing real, long-term strategic negotiations that will deal with our public hospital system.

It is interesting when you consider the amendment that was put forward by the member for North Sydney and his criticism that this bill does nothing about long-term health care. I am particularly pleased that COAG has asked Skills Australia to give it by July this year advice on the possibility of allocating up to 50,000 additional vocational education and training places to the health workforce over the next three years. If that is not a commitment to dealing with the long-term issues that are putting pressure on our public hospital system, I do not know what is. I would particularly like to focus on the additional $100 million to support the Queensland health system in this bill. We know that public hospitals in Queensland are under pressure and that the state government is looking at every avenue it can to relieve the pressure for both patients and health workers.

This $100 million will go to helping to train more doctors. If you ask anyone who is either a patient of the health system in Queensland or a worker in the public hospital system in Queensland, they will tell you that one significant issue they face is simply and purely a lack of doctors. That goes to the extent that the Queensland state government has put its money into extra medical training places. It is the first time a state government in this country has had to put money into funding doctors because of the lack of—and, in fact, the decrease of—funding by a federal government. So, once again, there is $100 million for Queenslanders to see an extra 235 medical student places at Griffith University on the Gold Coast. This will be a major benefit to our public hospital system, a major benefit to the health workers of Queensland and a major benefit to the residents of Bonner and all those other electorates. They will want to make sure that the public system is accessible for them to get the treatment they need when they need it. Thank goodness we have a Commonwealth government that wants to work in partnership with the states and that puts its money where its mouth is to deal with health issues in our public hospital system, not simply point the finger.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I want to comment on the terrific contribution made by the member for Bonner, whose electorate is about three away from mine in south-east Queensland. I rise to speak in support of the Health Care (Appropriation) Amendment Bill 2008. This bill seeks to amend the Health Care (Appropriation) Act 1998, which provides the legislative basis and the standing appropriation for financial assistance under the Australian healthcare agreements and permits the Minister for Health and Ageing to determine grants of financial assistance to the state and territory governments. The proposed amendment will bring into effect the Commonwealth’s COAG commitment made on 26 March 2008 to give $1 billion to the state governments to relieve pressure on public hospitals for 2008-09. This bill’s passage will ensure that $500 million of the $1 billion will be received by the states and territories before the end of this financial year. Further, the terms and conditions of the current healthcare agreements will be extended for one year to allow for new agreements to be negotiated with the states.

Since the election of the Rudd Labor government we have been working hard to relieve the pressure on our nation’s public hospitals and pursue our long-term plans for healthcare reform. Our hospital system reform is underway. Those on the opposite side of the chamber leave us with a legacy of 11 years of neglect in the area of health funding. Instead of investing in health care and improving our hospital system, they pursued a policy of blame-shifting and politicking. The Rudd government is resolved to end this approach and instead work to improve our national health system and take a national approach. We understand there are many challenges when it comes to long-term planning for our health system, including the duplication of services, overlap and blame-shifting, an ageing population and long-term workforce planning. Only the Rudd Labor government understands that our national health and hospital system is in need of radical surgery. The challenge to improve our national health system is not just an issue for next week, next month or even this year; it is a challenge for the decade ahead. It is a challenge the Rudd Labor government will take up for the good of the nation, because only the Rudd Labor government is committed to doing the task.

The $1 billion injection comprises the $500 million additional new funding plus indexation of the previous Commonwealth allocation for 2007-08. The amendment in this legislation will appropriate funds to continue the payment of healthcare grants to the states in 2008-09 while the new national healthcare agreements are negotiated. COAG agreed that the new agreements would be signed in December 2008 and commence on 1 July 2009. This $1 billion injection into our public health system is a significant investment. It is the first step on the long road to rebuilding our health system after 11 years of neglect and funding cuts, and it reverses the trend of decline under the previous coalition government.

We have seen enormous investment by this Rudd Labor government in a whole range of areas, including the funds we have allocated nationally for depression. It is an issue which has affected a lot of people in my constituency, and they have raised this issue with me. They have commended the government for the plan that we have, with $55 million allocated. Also we have allocated $249 million over five years to the National Cancer Plan to improve diagnosis and treatment, including new cancer centres to service city, regional and rural patients. This is particularly important to me because currently my father is in hospital with not just primary cancer but also secondary cancer. My family in particular has been the beneficiary of tremendous professionalism by those dedicated doctors and nurses in my area who have cared for my father in this time of great family need. I want to commend them in parliament today for the love and affection they have shown my father particularly and note that this government is committed to helping them to help others.

I commend the government for the $10 billion Health and Hospitals Fund to support strategic investments in health and the $600 million we have allocated to cutting elective surgery waiting lists. I also want to thank the Prime Minister and the Minister for Health and Ageing for the $275 million allocated over five years to deliver 31 GP superclinics across the country. This is very important in my area, where there is only one doctor for every 1,609 people living in the region of Ipswich and West Moreton. And you can wait up to two years to get the public health system to see your teeth. There is $780 million over five years to slash public dental waiting lists, which is a welcome relief for the people of Blair.

I list these health commitments because they are substantial and significant. They demonstrate the government’s commitment to health. They demonstrate that the government, only six months in office, is focused on improving the health system, particularly in my area. I want to thank the Prime Minister and the Minister for Health and Ageing for the commitments they have made locally for a GP superclinic in Ipswich and for the $300,000 in funding—at $100,000 per annum—for the after-hours clinic at Ipswich General Hospital. I am pleased to have secured that money during the election campaign. That will go a long way, and I commend the work of the dedicated staff at that clinic. It is tremendous because, as we all know, children and other people do not get sick just between 9 am and 5 pm; it happens at all times of the day and night. As a parent of two daughters, I know that I have had the experience on many occasions of children being sick after hours.

Australians were also sick and tired of the blame game by the former coalition bickering with the states to smokescreen their neglect of the health system. This legislation marks the end of that. Instead of engaging in political games, this government is committed to delivering better health services across the country. Only this government understands the need for serious negotiations with the states about how to reform the health system. Issues like preventable hospital admissions, pressure on our emergency departments and how we treat our older and ageing Australians are future challenges the health system will face, and how we will deal with those issues will say  much about our attitude of compassion, caring and commitment to those less fortunate than ourselves. The former coalition government lost interest in pursuing these big issues at a time when they really needed to be investing in and re-equipping our health system for the challenges of the future. The Rudd Labor government is aware that the Australian public is heartily sick and tired of buck passing. They are sick and tired of politicians using the health system as a method by which they can blame one another. It is not a constructive way to mend the health system. Blame shifting does not help someone who is sick, it does not help someone find a doctor, it does not help someone find an aged-care bed or a specialist and it does not reduce the health waiting lists.

I strongly support this bill, which I think will do a lot to help our people locally in Blair. I had the privilege of serving on the Ipswich and West Moreton Health Community Council for many years and saw the activity statements and the waiting list issues. Every month I would go to those meetings and I would see the challenges, and I raised issues on many occasions with the district manager. On each and every occasion it was, ‘We need more funding, we need more funding.’ I chaired health reference committees in the rural areas of my electorate. I visited hospitals like the Boonah Hospital and the Laidley Hospital, not just the Ipswich General Hospital—which is a fantastic hospital also. And people cried out at those health reference committees for further government funding. The Rudd government’s increased expenditure on health demonstrates its commitment to those hospitals in my electorate.

Since 2000 the coalition government removed $1 billion from Commonwealth-state funding to our hospitals, but those opposite seem to be suffering from a certain political amnesia. I listened to the contributions made by the member for O’Connor and the member for North Sydney: it is almost like they have forgotten about their failings in funding for public hospitals. In fact, during the 2007 election campaign an admission was made on 5 October by the then federal minister for health, the member for Warringah. He fessed up about the former coalition government’s underfunding of health. He admitted in an interview that the share of federal government funding had gone down from 45 per cent to 41 per cent. It was like pulling teeth to get that admission, but the interviewer conducted a bit of oral surgery on that particular occasion and the member confessed that the then federal government had failed in its funding. In defence of the state Labor governments, that admission exposed the erroneous criticism that had been foisted upon them. There is no doubt that the state governments increased their spending on hospitals—and public hospitals at that—at a much faster rate than that of the Commonwealth government under the previous Howard administration.

The former minister for health was forced to make this frank admission following the release of a report prepared by the Australian Institute of Health and Welfare in Canberra. What that report revealed was stark. It said this: the previous coalition government’s public hospital funding had significantly declined proportionately over the life of the coalition government, and it was the state Labor governments that were in fact increasingly carrying the burden when it came to funding. That report was released on 5 October 2007 and it exposed that from 1995-96 to 2005-06 the former coalition government’s share of public hospital funding decreased from 45.2 per cent to 41.4 per cent. While the former coalition government criticised the states and shifted the blame, the truth was that the states were carrying the slack; they were taking responsibility. The report found that the state and territory government funding during that same period increased from 45.8 per cent to 50.6 per cent. It exposed the fallacious arguments made by the former coalition government that the states were not investing in health. The truth of the matter was that the former coalition government had acted in bad faith. The former coalition government had failed to make the critical investments necessary for the public health system in this country and to prepare for future growth.

The Australian public understood this on 24 November last year, and that is why they elected the Rudd Labor government. The difference between the Labor Party and the coalition at the last election in relation to health was simply this: Labor was prepared to take responsibility to fix the system; the coalition was not and had not in 11½ years. All it could offer was an admission of failure. I want to close by saying this: I commend this bill to the House because it is just the start. It is the start of a plan to reverse the damage to the health of the health system perpetrated and perpetuated by the previous coalition government over 11½ long years. The people of my electorate felt it, lived it and understood it, and that is why they voted in the Rudd Labor government and me particularly to carry that fight on their behalf.

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

I rise to speak today on the Health Care (Appropriation) Amendment Bill 2008. This bill will honour the government’s commitment to provide $1 billion to the states to relieve pressure on our public hospitals. This Labor government is committed to turning around the many years of neglect by the former Howard government. That is why we are making a considerable contribution to our state and territory public hospitals. These funds include $500 million to be paid before the end of the financial year. This is a new payment and is intended to assist our nation’s public hospitals. The $500 million is in addition to the increase of $1 billion due to the indexation on the previous Commonwealth allocation for 2007-08. These funds will provide services to thousands, if not millions, of Australians who rely on our nation’s public health system.

Every Australian is entitled to use a public hospital free of charge if they choose. That is an integral part of a universal health system and something that we on this side of the House are very proud of. As a government, we have recognised the need for preventative health measures in addition to the need for funds to reach our hospitals. This government recognises the urgent need to invest in primary and preventative care in order to keep people well and out of hospital. The GP superclinics, costing $275.2 million, will bring health professionals together in one place, providing a one-stop shop for many health services and much greater convenience for patients, particularly those with complex and chronic diseases.

This bill will ensure that the states and territories continue to receive funding while the Australian healthcare agreements are being negotiated. Funds to the states will assist in providing services to tackle some of the greatest health challenges of our time, including obesity. Obesity affects thousands of Australians and its incidence is on the increase. I know that we saw some reports this week where particular sections of the community were dissected, but all the figures show that it is an upward trend. It is essential that we make obesity a national health priority area to help drive collaborative efforts aimed at tackling obesity at national, local, state and territory levels and to ensure that obesity receives the attention it deserves as a matter of urgency.

This government is dedicated to establishing measures for the long-term health of Australians. This bill will feed more money into the health system, which will aid in our preventative health strategies. The Australian government in April announced the establishment of the Preventative Health Taskforce. This task force, made up of health experts from around Australia, will develop strategies to tackle the health challenges caused by tobacco, alcohol and obesity and develop the National Preventative Health Strategy by June 2009. The government also announced that it will take immediate action to ensure preventative health measures become a key part of health funding agreements between the Commonwealth and state and territory governments.

New funding takes up the fight against alcohol abuse, with the government committing $53.6 million to tackle binge drinking. Another $15 million is committed to help reduce smoking. There have been reports showing the annual social costs of tobacco, alcohol and illicit drugs have grown to $56.1 billion. I am quite proud to say that this June will mark four years that I have been tobacco free. I would urge all other members of this House—the ones that do participate in the intake of nicotine—to think seriously about giving up tobacco. I am sure, Mr Deputy Speaker Washer, you agree with me on that and I am sure most people in this House would agree. The figures on smoking are alarming, with 5.4 million people dying a year due to related illnesses such as lung cancer and heart disease. This figure is set to rise as the number of smokers, especially in developing countries, increases. According to the World Health Organisation:

Tobacco kills up to half of those who use it. Yet tobacco use is common throughout the world due to low prices, aggressive and widespread marketing, lack of awareness  about its dangers, and inconsistent public policies against its use.

The 2008-09 budget delivers on the government’s election commitments to reform the nation’s health and hospital system on behalf of all Australians, providing better health care for all Australians. Health reform is both a vital social priority and an urgent economic priority. Keeping people healthy makes sound economic sense: healthy, active people participate in the workforce, engage in the community, contribute to the national economy and ease the burden on the system. That is why there have been measurers already put in place to begin to look at preventative measures to keep people healthier longer.

First and foremost, measures in this budget underscore the government’s commitment to ending the blame game between the Commonwealth and the states and territories. This is central to our reforms. No more buck passing; no more cost shifting. The government will provide greater and more affordable access to dental health for working families, teenagers, older Australians and people most in need. This government will invest a total of $780.7 million over five years, helping to slash the public dental waiting lists and provide preventative dental check-ups for teenagers. The budget contains funding for the government’s National Health and Hospitals Reform Commission, which began its work early in February. The commission will develop a long-term plan for tackling current and future challenges in the health system. We will build a health workforce for the future by encouraging up to 8,750 qualified nurses to return to the workforce and creating new Commonwealth supported places in nursing in the second semester of 2008, with a further 1,170 places in 2009. In undertaking a long-overdue reform of the health and hospital system, the government has embarked on an important journey with the aim of delivering the modern health system that Australia deserves. I commend this bill to the House.

Justine Elliot (Richmond, Australian Labor Party, Minister for Ageing) Share this | Link to this | Hansard source

The Health Care (Appropriation) Act 1998 provides the legislative basis for the Commonwealth to pay healthcare grants to the states and territories and Commonwealth own-purpose outlays for mental health, palliative care and the Hospital Information and Performance Information program. The Health Care (Appropriation) Amendment Bill 2008 makes amendments to that act. The 2003-08 Australian healthcare agreements expire on 30 June 2008. At the Council of Australian Governments meeting of 26 March 2008 it was agreed that new healthcare agreements would be signed in December 2008 and commence on 1 July 2009. This means, in effect, that 2008-09 will be a transitional year in which the new agreements will be developed and implemented. At the COAG meeting the Commonwealth agreed to commit an immediate allocation of $1 billion to relieve pressure on public hospitals. This $1 billion is made up of the indexation of the previous Commonwealth allocation for 2007-08 plus a further $500 million of new money. The proposed amendments are a key step in enabling the Commonwealth to meet these commitments.

The act currently provides that total grants of financial assistance must not exceed $42.01 billion over the five-year life of the 2003-08 Australian healthcare agreements. The bill proposes amendments that will increase the appropriation amounts stated in the act by $10.25 billion to $52.26 billion and change the appropriation periods stated in the act from five years to six years. These amendments will ensure continuity of public hospital and related funding for the 2008-09 financial year, during which the new agreements will be developed and put in place. The terms and conditions of the current Australian healthcare agreements will be rolled over for that year to provide a framework for the administration of the payments. The $1 billion to be provided as a result of this bill is significant for a variety of reasons. First, it enables us to take the first steps on the long road towards rebuilding our health system after nearly 12 years of neglect and underfunding by the coalition government. I was surprised when the member for North Sydney stated earlier that the bar had been set very high by the previous government in relation to public hospital funding. I find that quite remarkable.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

By the Prime Minister!

Justine Elliot (Richmond, Australian Labor Party, Minister for Ageing) Share this | Link to this | Hansard source

It is very curious indeed that the coalition government ripped $1 billion in funding from public hospitals—that was over the course of the previous healthcare agreements—and he can then come here—

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Mr Deputy Speaker, on a point of order: if the minister is going to quote me then she should do so accurately. It was the Prime Minister. He said the bar had been set very high by the previous government.

Mal Washer (Moore, Liberal Party) Share this | Link to this | Hansard source

The member will resume his seat.

Justine Elliot (Richmond, Australian Labor Party, Minister for Ageing) Share this | Link to this | Hansard source

The member for North Sydney said that the previous government set the bar quite high in what they had done. But put that aside for one minute. Let us have a look at what they actually did: they ripped $1 billion in funding from our public hospitals. That is why we have this bill today. They did that over the course of the previous healthcare agreement. They abandoned the people of Australia when it came to hospital funding, so it is great to see this bill going ahead.

This bill is also significant because it is a major part of this year’s Health and Ageing budget, which for the first time will be above $50 billion. Finally, it is significant because it signals the end of the blame game and the beginning of a new era of cooperation, allowing us to deliver better health services across Australia together with the states and territories. That is what we are committed to doing. We are committed to rebuilding the Australian health system after nearly 12 years of coalition neglect. Of course, it will take a little while to do that, but we are committed to achieving that. We are really proud of the very strong start we have made in health, and we are determined to continue as we have begun.

Ms Anna Burke (Chisholm, Deputy-Speaker) 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 North Sydney has moved as an amendment that all words after ‘That’ be omitted with a view to substituting other words. The immediate question is that the words proposed to be omitted stand part of the question. There being more than one voice calling for a division, in accordance with standing order 133 the division is deferred until after 8 pm.

Debate adjourned.