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

Diagnostic imaging is a wonderful technology that medicine has these days and it is certainly expanding in all sorts of directions, making it much easier to diagnose problems with patients. Of course, as all things in the health system seem to do, the cost expands commensurate with the expansion of the technology.

There is a term, ‘positron emission tomography’, and there are perhaps only two people in this parliament tonight who know what that actually is—with apologies to the parliamentary secretary; perhaps there may be three. Of course, this is the technology for PET/CT scanners. It is just wonderful technology used by the medical profession to look at potential cancers in the body. Its main attribute is that it is so sensitive that with one scan it can pick up information that other technologies might take several scans to do. It helps patients because a diagnosis can be made much more quickly—and if you are a potential cancer patient, you need to know what is happening as quickly as possible.

There are not many of these machines around Australia. In the great state of Queensland, the sunshine state, there is no PET scanner north of Brisbane. Australia’s largest tropical city, the capital of Northern Australia, Townsville, has no PET scanner. Patients who are serviced by the Townsville Hospital and by the Mater Private Hospital have to fly to Brisbane if PET scanning is ordered by their doctor. Currently there are 500 patients a year going through the trauma of having to fly to Brisbane to have a PET scan—and it is increasing. The carers will often fly with the patients or they may have to be put up in Brisbane, and the cost just grows. I looked at this problem and said, ‘What can we do?’ That is why I am particularly pleased to be supporting this bill, the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009, tonight.

I spoke to an imaging provider, who happens to be accredited, and that provider is keen to establish a PET scanner. They already have on their staff a doctor trained in nuclear medicine, so it was a no-brainer to see what we could do. I spoke to Queensland X-Ray and they agreed that they would fund half the capital cost of a PET scanner in North Queensland. It meant a great deal to the Commonwealth of Australia because it was a firm offer to have a publicly funded, bulk-billed PET scanner in North Queensland with $2 million put towards the cost of that machine.

In September we got a letter back from the Minister for Health and Ageing and, unfortunately, while she understood the need for North Queensland, she said that the government had announced $560 million in funding to build a network of up to 10 best practice regional cancer centres associated with accommodation centres. That is us in Townsville, but the problem is that it has to go through a tender process, which takes forever. The problem is that we do not have a resolution of that yet and it is now February. It seems to go on and on. Sometimes I have a bit of suspicion that bureaucrats delay these things to save money. Well, hello; there are patients out there—there are people in need. We cannot have the whole of Northern Australia without one of these wonderful machines. In the Townsville Bulletin in September, the editor was straightforward about it. He wrote:

Put bluntly, North Queenslanders are dying because we don’t have this piece of sophisticated medical equipment. Once again, geography is discriminating against the people of the North.

That is not fair. We are not second-class citizens in the north of Australia. We contribute so much to GDP with what we have in the north, and it is unfair that our communities do not have the same facilities as communities further south have. I sometimes wonder whether the line that was drawn in World War II called the Brisbane Line actually still exists, with the discrimination we see.

The PET scanner is a nuclear medicine facility that can determine the presence, progress and severity of cancers, neurological conditions and cardiovascular disease. PET images reveal the chemistry of organs and other tissue, such as tumours. There is certainly growing evidence of the usefulness and cost-effectiveness of PET scans for the treatment of cancer sufferers.

When the health minister responded to my letter she indicated a number of conditions to establishing a PET scanner in North Queensland. She said the views of the Queensland government would need to be established in order for funding to be considered. That is code for: the Townsville Hospital and their staff would have to be prepared to use a PET scanner in a private consultancy. I am very happy to say that the management of the Townsville Hospital are entirely, 100 per cent, supportive of this project. Their doctors and other staff know the benefit of securing a PET scanner in North Queensland and they are not going to have a turf war, as so often happens between public and private hospitals. They are pleased just to get a PET scanner. If it is not in their hospital they do not care; they are worried about the patients. What a wonderful approach. I thank the good people at the Townsville Hospital for adopting a common-sense view. Of course, Queensland X-Ray will take the public patients and do what a public hospital would do for them, so there is no disadvantage at all in having a PET scanner located in a private consultant’s rooms.

There has to be, according to the health minister, access to a secured and reliable source of radiopharmaceuticals. That is already the case. In Northern Australia we have those radiopharmaceuticals available. A further condition was the facility’s ability to meet the requirements outlined in the current PET determination 2008, and it does already. The facility would only be eligible for general PET items on the Medicare Benefits Schedule, and the consultant agrees with that as well. That really clears the way, and we have written back to the health minister guaranteeing that that is the situation. As we go from problem to problem in the Townsville Hospital—longer waiting lists, workforce issues, no beds—this is one bright star where we can provide a service if only the health minister will turn on the green light. I appeal to the health minister to think of us in Northern Australia and provide this much-needed machine.

On a related issue—and you, Mr Deputy Speaker Washer, will understand this better than most—specialists who consult in the private system and the public system continually say to me, ‘We’re twice as efficient in the private system,’ meaning that if there is a procedure happening you can do two in the private system in the same time as you can do one in the public system. And, by the way, I think the staff are happier in the private system as well. Why is that so? These kinds of workforce issues have to be looked at. You have to ask why in the private system there are three people in an operating theatre and in the public system there are 14. Why would that be? It is extraordinarily inefficient.

If a patient in the private system comes into the operating theatre and one piece of paperwork is not quite right—there might be something not filled in, a number missing or something—everybody in the operating theatre in the private system gets it fixed there and then. They jump on the telephone from the theatre, get the information that is needed, fill in the form and away they go. But what happens in the public system? If something, even the smallest detail, is missing, the staff down tools and send the patient back to the ward, and the operation gets cancelled and then rescheduled.

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

Mr Craig Thomson interjecting

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

It does, Member for Dobell. I have a litany of evidence which indicates that it happens in Queensland. Perhaps it does not happen in New South Wales.

David Bradbury (Lindsay, Australian Labor Party) Share this | Link to this | Hansard source

Put the evidence on the table.

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

Ring up any specialist in Townsville who consults and operates in the public and private system. They will tell you the same thing.

David Bradbury (Lindsay, Australian Labor Party) Share this | Link to this | Hansard source

No, no—specifics.

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

I will get you a statutory declaration. It is easy.

David Bradbury (Lindsay, Australian Labor Party) Share this | Link to this | Hansard source

Just give us the details.

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

I am not here to mislead the parliament. This is what the specialists tell me. They say, ‘Why can’t we do in the public system what happens in the private system? It would be so much more efficient.’ If you could do that in the public system, you would drop the waiting lists because you would be doing double the number of procedures. Why would you oppose that? Surely that is okay?

David Bradbury (Lindsay, Australian Labor Party) Share this | Link to this | Hansard source

So it is pretty easy? Is that why you did it?

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

It is pretty easy for you to stand up for your union mates—that is the problem. The unionisation of the public hospital system is half the problem. Earlier, I carefully said, ‘workforce issues’, but, if you like, I will spell it out plainly: unionisation in the hospital system is causing extended waiting lists, and the staff hate it. The staff want to look after the patients. You know as well as I do that the first responsibility of medical staff is to the patient. They are such caring people, but they are held back by all these rules. You go in the operating theatre, where there are 14 people, and somebody says, ‘Oh, I better do this job—I will tidy this up,’ and another person rushes over and says, ‘Don’t you do that; that is my job.’ That is no way to run an operating theatre. It is just wrong.

I have used this contribution to appeal to the government. Let us not get off the subject, which we all just did, but let us understand what this appeal is about. Minister Roxon, we need a PET scanner in North Queensland. We need it sooner rather than later and we need it to be part of the very important medical diagnostic imaging that is now available in this country.

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

Well, what a contribution that was! It highlights the absolute hypocrisy that we constantly get from the other side in the health debate. First of all, we get eight or nine minutes of a contribution complaining about the fact that they do not have a PET scanner in Townsville. They were in government for 12 years and what did they do about it? They did absolutely nothing. This is so typical of the opposition. They might promise something, but they will not deliver a cent for health. In fact, it is quite the opposite—what they do in health is rip money out of the system.

You are absolutely right to be scuttling out of here with your tail between your legs, Member for Herbert, given that abysmal contribution you just made on health. Not only did you not deliver at all for the Townsville electorate in 12 years—and Labor is going to deliver—but you complain about a tendering process. I forgot, of course: we are talking about the opposition that love the Regional Partnerships program and rorts. They do not like tender processes. They do not like an objective way of choosing the best project—a project which is going to be delivered in a proper manner so taxpayers’ money is spent correctly and which is going to benefit the most people. No, we have opposition MPs who are actually going to go out and choose. They do not like this tender process because there is ‘too much paper work’, we hear—too much paper work in doing these things the right way.

David Bradbury (Lindsay, Australian Labor Party) Share this | Link to this | Hansard source

‘Too many rules’.

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

‘Too many rules’—yes, that was the phrase. The member for Herbert then went on to talk about public hospitals, saying, ‘There are too many rules in public hospitals’—gosh, when there are problems in an operating theatre, suddenly there are all these rules that mean things cannot get done. The public hospital system is the backbone of the health system in this country. Having represented health workers in both the public and the private health sectors—and my union’s membership was equally divided between the two—I can say that health workers, whether they work in a public hospital, a private hospital, a private clinic or a public clinic, are committed to the work that they do and try to deliver the best outcomes they can for patients. For putting a general slur on the workforce in public hospitals, the member for Herbert should hang his head in shame. For too long we have had people like the member for Herbert out there badmouthing people who are working hard to deliver great health outcomes, without a lot of resources, to people in our public and private hospital systems. To go on some philosophical crusade about unions in the health sector is simply ignoring the facts.

The public health sector deals with the majority of cases. It deals with the most serious issues that come into our health system and also deals with the most complicated issues. This is often why there are different costs. Private hospitals tend to deal with operations of a simpler nature, which, because of that, can be done with fewer complications and often at a cheaper rate, whereas the public hospitals have always dealt with the most difficult issues and have always dealt with the more complicated issues. They do so on the basis of trying to provide the best level of health care that they can for the Australian public.

Other than the member for Herbert—and I think that any other speakers from the other side should immediately disassociate themselves from his diatribe—I would hope that everyone in this place recognises the great work which our public hospitals do and which those people who work in the public hospital system do. It was typical to hear him moaning about the fact that there is a lack of services in the electorate that he represents—after having been in government for 12 years and done nothing about it. Now, when this government is actually out there doing things, including dealing with the specific issue that he was on about, his complaint is that there is a tender process with too many rules. That was a contribution on health which should go down in the annals of this place as one of the poorest ever.

I rise in support of the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009. This bill amends the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007, which I will refer to as the DIA Act, to provide transitional arrangements for new entrants in the broadened scope of the diagnostic imaging accreditation scheme. The legislative framework for the diagnostic imaging accreditation scheme is being implemented in two stages. Stage 1 of the scheme commenced on 1 July 2008 and covered only radiology services. Stage 2 of the scheme will commence on 1 July 2010 and will cover all diagnostic imaging services—both radiology and non-radiology services—listed in the Health Insurance (Diagnostic Imaging Service Table) Regulations 2009.

This means that from 1 July 2010, for the purposes of Medicare, all diagnostic imaging services and the diagnostic imaging services table would need to be carried out at an accredited practice, or deemed accredited practice, to be eligible for Medicare benefits. This bill will amend the DIA Act to provide transitional arrangements that will allow practices providing non-radiology services and practices combining non-radiology and radiology services not accredited under the scheme in operation before 1 July 2010 to register for, and enter into, stage 2 of the scheme. From 1 April 2010, for unaccredited practices which provide non-radiology services, the transitional arrangements proposed in this bill will provide a registration period which would operate for around three months from 1 April 2010 to 30 June 2010 and which would give deemed accreditation to practices for 12 months, and an application process which would allow a deemed accreditation practice to submit documentary evidence for 12 months from 1 July 2010 to 1 July 2011.The arrangements will also provide for an accreditation decision to be made by an approved accrediter. Presumably, these rules and regulations are things that would cause the member for Herbert some difficulty.

The stage 1 scheme was introduced on 1 July 2008 to ensure Medicare funding was directed to radiology services that are safe, effective and responsive to the needs of healthcare consumers. The stage 1 scheme only applied to sites rendering radiology services. These sites accounted for around 84 per cent of the total number of diagnostic imaging services performed annually under Medicare. Non-radiology services, such as cardiac ultrasound and cardiac angiography, obstetric and gynaecological ultrasounds and nuclear medicine imaging services, account for around 16 per cent of diagnostic services performed annually under Medicare. These were not included in the stage 1 scheme. This was because prior to 1 July 2008 non-radiology services were managed by three separate memorandums of understanding which—unlike the radiology agreement that did not mandate the introduction of an accreditation scheme—links to the payment of Medicare benefits by 1 July 2008. Each of these memorandums expires on 30 June 2008. Consequential amendments will be made to the Health Insurance Regulations 1975 which currently exclude non-radiology services from the scheme.

The Rudd government is committed to making our health system better for all Australians. That includes the infrastructure, the training of doctors and other health professionals and Medicare, just to name a few aspects. This government is committed to improving the public health system. Let us start with hospitals, which are the most visible face of the health system. It is not a secret that many of our public hospitals are under severe pressure as our population ages and the burden of chronic disease takes hold. Having said that, if I were to get sick, Australia would be the country that I would want to get sick in because, despite the problems and the areas that we need to improve and despite there being a large amount of work to be done, Australia has a world-class and a first-class health system. That is something we should acknowledge right from the start whenever we enter into this health debate.

In my area, the Wyong Hospital is the fifth busiest emergency department in the state of New South Wales. As we are coming into autumn, it is going to become even busier. The Rudd government is strengthening our health system after years of neglect and buck passing by the former Howard government. The government is investing $64 billion in the hospital and health system across the country over the next five years. That is a 50 per cent increase on the previous agreement which the coalition entered into. We are investing $600 million in our elective surgery program. Stage 1 committed to a target of 25,000 extra elective surgeries in 2008 and delivered more than 41,000 procedures. Under stage 2, more than 150 hospitals across Australia will receive funding. We have invested $750 million in taking pressure off emergency departments and more than 30 hospitals will benefit directly. We are also now undertaking historic investment in nation-building health infrastructure. We are investing $3.2 billion in 36 major projects across our hospitals and medical research institutes, including $1.2 billion in world-class cancer centres. The government has provided $275 million to construct 34 GP superclinics across the country.

In my electorate of Dobell on the New South Wales Central Coast, one of these GP superclinics is being established. It has already been well received and although it is only on a temporary site for the moment, it has over 1,700 patients on its books and sees close to 1,200 patients a month. This is only while it is in its present temporary capacity. The operators of the GP superclinic have well-advanced plans. In fact, the site has been finalised and the operators have exchanged contracts for the land on which the new and permanent GP superclinic will be built. It will be built in Hamlyn Terrace, just near the new town centre of Warnervale.

In relation to that investment, the way in which this government has invested in GP superclinics has been to involve the private sector. We saw a great partnership here with this GP superclinic in my electorate; the federal government spent $2½ million on the GP superclinic and that encouraged the successful tenderer to spend $16 million. So in my electorate we are getting a GP superclinic which is going to employee 104 staff, is going to cost $18.5 million and which has only cost the taxpayer $2½ million. That is a great scheme. Furthermore, it has encouraged the provider so much and they are so committed to this model of the GP superclinic that they have provided a further $14 million to build a similar project at Tuggerah in my electorate. So, for the Commonwealth’s $2½ million investment on the Central Coast, we are getting $30 million being spent by the private sector on the GP superclinic.

This government is also providing $500 million for subacute care to help older people leave hospital and free up beds. As for the workforce, the government will invest $1.1 billion in training more doctors, nurses and other health professionals. This is the single biggest investment in the health workforce ever made by an Australian government. It will see 812 additional ongoing GP places from 2011 onwards—a 35 per cent increase on the cap of 600 places which has been imposed since 2004 by the opposition. So this government is making sure more GPs are trained and out there so that they can help deliver the vital primary care that is needed in our towns, cities and right around the country, whereas the previous government put a cap on them.

We are increasing by 50 per cent the spend in terms of the agreement between the states and the Commonwealth on public hospital funding. Those opposite, when they were in government and when the current Leader of the Opposition was the health minister, ripped a billion dollars out of health. The difference between the two in health is stark. If we go back to the contribution of the member for Herbert, we can see why there is such a different approach in terms of this particular debate.

This government will deliver $134.4 million for better targeting existing incentives and providing additional non-financial support to rural doctors. The reform introduces these incentives on the principle that ‘the more remote you go, the greater the reward’. Under the initiative 2,400 more doctors and 500 communities around Australia will become newly eligible for rural incentive payments.

Recognising that prevention is better than cure, the government will invest a record $872 million, the single largest investment ever in preventative health, to help keep people fit, healthy and out of hospitals. We are providing child health checks for four-year-olds to promote early detection of chronic disease risk factors. There will be $12.8 million to fund 190 schools around the country to construct either a kitchen or a garden under the Stephanie Alexander Kitchen Garden Program.

Dental care is an issue that is very close to my heart. In my previous job before I was elected I spent a lot of time campaigning to make sure that Australians got proper dental care. Our commitment as a government is a total of $650 million for two dental programs. The teen dental program commenced last year and provides a $150 annual payment to eligible families. To the end of December, 258,203 teenagers had received a dental check-up under the program, with 7,598 dentists—that is, 70 per cent of all dentists—providing services.

Unfortunately, due to the coalition standing in our way in the Senate, the Commonwealth dental program, which would provide up to one million consultations, has not been able to commence. We are putting money into dental programs. The first thing that the other side did when they came to government was cut the Commonwealth Dental Scheme, and what they are doing now is frustrating this government’s attempts to make sure that dental care is provided in a better manner to those in our community who cannot afford dental care. So, again, we have a stark contrast between those on this side of the House and those on the other side of the House.

In aged care, we are committed to providing $44 billion over the next four years to aged and community care. No government has invested more. This has already seen a record amount of aged and community care places allocated. We are rolling out an additional 2,000 transitional beds: a $293.2 million program to reduce the pressure on hospitals. Construction work is underway due to the government’s $300 million zero real interest loan program to create more than 1,300 new beds. We are providing $192 million in a year for the National Respite for Carers Program, which funds a national network of more than 600 community based respite services. Since being elected we have improved and strengthened quality measures by increasing announced and unannounced visits to homes by 3,000 a year and by investing more than $127 million in the aged care workforce.

For the future, the government has also embarked upon a path to build the health and hospital system that Australia needs for the 21st century. The government has committed to an overhaul of the health system to ensure that it can cope with future challenges, including an ageing population and rising health costs. Unlike those opposite—including the current opposition leader—who neglected health during their 12-year term in government, this government is about taking real steps to make sure that our health system is the best we can possibly have.

My electorate of Dobell on the lovely New South Wales Central Coast is a good example of the demands on our health system. Not only do we have a fast-growing population of young families who have moved to the area to seek new opportunities including a great lifestyle, but we have many senior citizens in the area, and the ageing demographic is increasing quite quickly. I mentioned young families. Many of these people are having children for the first, second or third times. Of course, they need their health services to be of the best standard possible. When mothers are expecting children, they deserve to have safe, effective and responsive services when it comes to diagnostic imaging.

This bill will provide transitional arrangements to enable approximately 1,400 unaccredited practices around Australia that are currently providing non-radiology services—and these make up around 16 per cent of the total diagnostic imaging services under Medicare—to register for ‘deemed accreditation’ and transition incrementally into the stage 2 scheme by 1 July 2010. Accreditation is a way of ensuring that patients receive a quality diagnostic imaging service irrespective of who provides the service or where the service is provided. There is no doubt that accreditation is important when it comes to diagnostic imaging.

This legislation is important in terms of making sure we have proper accreditation. It is part of the Rudd government’s agenda to make sure that in Australia we take concrete steps, as we have done in the last two years, to ensure that we have the best health system that we possibly can. We are coming from some way behind because from those on the opposite side we had 12 years of neglect. We had billions of dollars ripped out of the system. There was neglect in dental care and there were caps on GP places. These are all issues that we have addressed squarely and fairly, straight off. We have record investments in hospital infrastructure. This particular bill is part of that broader picture of the Rudd government addressing the health needs of this nation, and I commend it to the House.

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009, which aims to broaden the accreditation scheme for diagnostic imaging to cover all diagnostic imaging services. This legislation will amend previous health insurance amendment acts to establish the Diagnostic Imaging Accreditation Scheme, which requires radiology services to seek accreditation. This bill, when passed, will require practices providing non-radiology services or a combination of radiology and non-radiology services, which are not currently covered by the scheme, to obtain accreditation and will provide the relevant enabling transitional arrangements.

Whilst the coalition do not oppose this legislation, we do seek assurance that an evaluation will be carried out to ensure the scheme is working reasonably without an onerous cost burden being passed on to consumers. Given the importance and cost of health services, particularly in regional areas such as my electorate of Forrest—which, as you would know, Mr Deputy Speaker Schultz, is one of the three fastest growing regions in Australia and has a significant amount of seniors—this evaluation and review process is extremely important. I call on the government to commit to an evaluation process and timetable.

This legislation has been and continues to be a work in progress. Historically, management of diagnostic imaging services was undertaken by the Department of Health and Ageing cooperatively with the diagnostic imaging sector. This management was carried out through a number of agreements known as ‘quality and outlays memoranda of understanding’. In 2007 the coalition introduced legislation to initiate an accreditation scheme for radiology, which accounts for 80 per cent of diagnostic services covered by Medicare. That accreditation scheme began on 1 July 2008, at the time when the MOUs expired. The legislation established an accreditation framework for most diagnostic imaging premises and the basis for mobile imaging equipment to make sure that organisations met defined quality and safety standards in the delivery of their services.

The Diagnostic Imaging Accreditation Scheme is being implemented in two stages. Stage 1 establishes the framework and operational arrangements for the scheme and is due to expire on 30 June 2010, when stage 2 is due to commence. The transitional accreditation process proposed by this bill is broadly similar to that introduced under stage 1 of the scheme in that it involves two main steps. The proposed transitional arrangements would apply to providers of non-radiology diagnostic imaging services in the following ways. First, they establish a three-month registration period from 1 April 2010, during which time a practice can lodge a notice with an approved accreditor for a premises to be registered for ‘deemed accreditation’. Second, deemed accreditation would cease on 1 July 2011. A practice with deemed accreditation will have 12 months to achieve accreditation either by demonstrating compliance with three entry-level standards or the full suite of 15 standards or by obtaining accreditation under the Medical Imaging Accreditation Program. Under this legislation, a practice that fails to obtain accreditation by 1 July 2011 will no longer be eligible to render Medicare rebatable diagnostic imaging services.

As we are aware, ‘diagnostic imaging’ refers to a broad range of technologies that allow medical professionals to diagnose a wide range of medical conditions—a very important process. Through consultation with stakeholders, some concerns were raised about the suitability of a single accreditation model across a diverse range of medical practices, and also about the potential for duplication, costs and administrative burdens. However, I note that stakeholders—and that includes the Australian Medical Association, the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association—in general have not voiced any major concerns with this legislation and accept the scheme. Some have even stated that its extension was an ‘expected development’ and part of a ‘many staged process’, in their words.

The costs of participating in the scheme and becoming accredited will be met by the practices that provide non-radiology services under Medicare. The explanatory memorandum for this bill contains information regarding some of the costs that practices will incur by participating in the scheme, as derived from the business cost calculator. The calculator estimates the likely administrative cost to practices in lodging the registration forms. These are expected to vary depending on the type of labour resources used by the practice to lodge the registration form. Practices using administrative staff to lodge the forms would face the lowest cost burden, of approximately $47, whereas those using technical staff would face a cost of around $84. Practices using a diagnostic imaging specialist to submit the form would face the highest cost, estimated at around $600. It should be noted that the cost of any lodgement fees levied by accreditors is not included in the cost calculator estimates.

One of my constituents currently works for an independent diagnostic imaging network that provides general radiography, computed tomography, ultrasound, MRI and nuclear medicine services—a practice that employs nearly 100 full-time equivalent workers throughout a network of clinical bases in regional and remote Western Australia. We asked this particular constituent about this legislation and this is what he had to say:

Although this legislation will increase the cost for practices to achieve the required standard, I believe all Australian radiology practices should already be operating at this level.

Patients should be able to walk into a practice and be confident that it uses high quality imaging equipment, adequate sterilisation process and a comprehensive method of reporting.

That is a view I imagine is shared by the many patients who undergo diagnostic imaging, whether it be an X-ray, CT scan, MRI or ultrasound to name just a few procedures. There is a continuing need for innovative health care providers who are focused on delivering services to patients irrespective of their location, something that in Western Australia is particularly important, given the size of the state, providing not only innovative health care services but also services that provide exceptional care, communication and support. Referring doctors also need to have absolute confidence in the services provided by such diagnostic providers.

In conclusion, the coalition does not oppose this legislation, which has been labelled as an ‘expected’ development. However, we certainly seek assurances that an evaluation will be carried out to ensure the scheme is working reasonably without an additional onerous cost burden being passed on to consumers.

Kirsten Livermore (Capricornia, Australian Labor Party) Share this | Link to this | Hansard source

The Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009 amends the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act of 2007. It is being introduced to provide transitional arrangements to allow practices providing non-radiology services—for example, ultrasound and a combination of non-radiology and radiology services not accredited under the Diagnostic Imaging Accreditation Scheme—to register for deemed accreditation in the three months prior to commencement of the stage 2 scheme which will start on 1 July 2010.

Stage 1 of the Diagnostic Imaging Accreditation Scheme commenced on 1 July 2008. This scheme meant that all existing diagnostic imaging practitioners offering services covered by the Radiology Memorandum of Understanding were required by the Department of Health and Ageing to register for deemed accreditation. Stage 1 of this scheme covered only radiology services. Just over 2,700 sites are participating in the stage 1 scheme. The department is monitoring the implementation of stage 1 which has been well received within the sector. Stage 1 of the scheme did not, however, include non-radiology services such as cardiac ultrasound, angiography, obstetric and gynaecological ultrasound or nuclear medicine imaging services. These account for 16 per cent of the total number of Medicare funded diagnostic imaging services performed annually.

This bill will allow a transitional arrangement for the roughly 1,400 currently unaccredited practices that are providing non-radiology services to register for accreditation and transition incrementally into the stage 2 scheme by 1 July 2010. That is the commencement date of stage 2. It is planned that all diagnostic imaging services—radiology and non-radiology—listed in the diagnostic imaging services table of the Medicare Benefits Schedule will need to be provided at a site accredited under the stage 2 scheme. Practices who have been accredited for radiology services under the stage 1 scheme will not be required to register as they will be automatically accredited until 30 June 2012.

In the lead-up to the introduction of this legislation in March last year, the department consulted with professional organisations representing the providers of non-radiology services. They were consulted about the proposals to broaden the scheme and to provide transitional arrangements. The proposal was supported by these organisations. As we have heard from other speakers, the government has introduced a system of accreditation for providers of diagnostic imaging services because it is a way of ensuring that patients receive a quality service irrespective of who provides the service or where it is provided. This gives assurance to patients and ensures value for money for the government. Gaining accreditation will guarantee that all patients will receive quality service across the board, regardless of who is providing the service or where it happens to be provided.

This is very important to me and to the people of Capricornia, my electorate. It means that Central Queenslanders will be receiving the same level of treatment as someone in Melbourne or other major capital cities. The gap between health services in Central Queensland and those in the capital cities has been made a bit smaller thanks to the Rudd Labor government. It is an ongoing battle for regional and rural members of parliament to get the medical services and medical staff we would like to have in our electorates. That was particularly the case in my electorate when our needs were ignored by the previous Liberal-National government.

Nowhere was this more evident than in the struggle to obtain a Medicare licence for a full-time MRI machine located in Rockhampton. Why is an MRI machine so important and why did we battle so long to get one? Magnetic resonance imaging uses magnetic fields to generate images to help diagnose illnesses. An MRI scanner produces an extraordinarily stable and powerful static magnetic field that combines with radiofrequency pulses and rapidly changing smaller magnetic fields to manipulate the hydrogen molecules in our bodies to generate images. It is especially effective, I am told, on soft tissue. For example, the MRI machine is useful for attaining good images of spinal, brain and abdominal lesions. As such, it is an important tool for identifying and monitoring conditions such as stroke and cancers.

This government recognises that patients and communities throughout Australia need to have access to convenient and affordable MRI services. Labor recognised the need for such valuable diagnostic equipment in Rockhampton many years ago. I am pleased to say that in February 2008 this government announced that a fixed licence for a diagnostic imaging machine—an MRI—was granted for the Rockhampton Hospital. It was a welcome announcement which honoured our election promise to the people of Central Queensland. In fact, one of the most important commitments that we made in Capricornia at the 2007 election was to grant a full-time licence for an MRI machine at the Rockhampton Base Hospital. Following the federal Labor government’s commitment, a $70 million-plus investment was made by the Queensland state government, which included a building to house the MRI machine. The MRI machine is now being operated by Queensland Health on the basis that the licence from the Commonwealth government allows the cost of the service to be billed back to Medicare.

I am very happy to say that the MRI machine has now been operating in Rockhampton for five months. It has been up and running at the Rockhampton hospital since September 2009. The official opening of the first public MRI machine in Rockhampton took place on 12 September 2009 by the Queensland Deputy Premier and Minister for Health, Mr Paul Lucas. I am told that clinicians have found the MRI to provide excellent quality images which assist in the diagnosis and treatment planning of neurological and orthopaedic conditions.

The $6½ million three-tesla MRI scanner, which is one of the best in the country, will deliver an expanded service to people living in Central Queensland, doing up to 20 scans a day. It is predicted to scan between 3,000 and 4,000 patients per year. All patients receiving Medicare eligible scans are being bulk billed. This is great news for the people of Central Queensland. The MRI machine has already provided over 800 scans to Central Queenslanders and the hospital has successfully recruited two permanent MRI operators and one medical imaging nurse. As I said, the permanent licence for the MRI machine is something that we have fought long and hard for in Rockhampton at both the state and Commonwealth levels. We were ignored by the previous government, but it is fantastic that the MRI machine and the funding the Commonwealth government is attaching to it through the Medicare licence is now a reality.

Health is a very important policy area in which people are looking to the Rudd government to address some of the critical deficiencies of the previous Howard government. The history of this matter is a very good example of the failures of the previous government. It was in the lead-up to the 2004 election that Labor promised that if we were successful in winning government we would grant a licence for a full-time MRI machine at the Rockhampton hospital. Of course, we were not successful in that election, so instead the Howard government granted that full-time licence to a private sector operator. I remember at the time that I was asked by the applicant for that service to provide a letter of support. I did provide one because following the 2004 election the Howard government made it very clear that that was the only game in town. But there were problems with the level of service provided by that private MRI machine. The private sector operator put the MRI machine into a mobile unit that spent its time between Rockhampton, Gladstone and Bundaberg. In effect, Rockhampton, the major health hub in Central Queensland, only had access to an MRI machine on a part-time basis, which was completely unacceptable to me and my constituents.

It was a very anxious time for many of my constituents. Quite frequently I was told stories by local people of their wait for the MRI machine to come back into Rockhampton. They had been diagnosed with something or were concerned about a particular health condition and their doctor was anxious for them to get an MRI scan to make an accurate diagnosis but they were literally waiting for weeks for the MRI machine in the mobile truck to come back up the coast of Queensland to allow that to take place in Rockhampton. Throughout the time I was calling for a permanent MRI machine to be licensed and located in the Rockhampton Base Hospital, the Queensland government, particularly the state health minister at that time, Stephen Robertson, was also very vocal in saying that this was a priority as far as the Queensland health department was concerned. But we were ignored throughout by the then health minister at the Commonwealth level, who is of course now the Leader of the Opposition, Tony Abbott.

As I have said, this was something that Labor were determined to address for many years and when we got the opportunity as a result of coming into government in 2007 we took immediate steps to make sure that Rockhampton would get a licence for a permanent MRI machine. There is no doubt that this new MRI machine will save lives. It proves that this Labor government takes the health needs of people in rural and regional Australia seriously.

I also wanted to touch on some positive developments that are happening at the local university on campuses in Rockhampton, Mackay, Bundaberg, Emerald and Gladstone. The Central Queensland University has a new vice-chancellor in Professor Scott Bowman. He is absolutely determined to expand the range of courses that are offered at the university. He has a particular interest due to his own background as, I believe, a radiographer—I hope I have that right—and an academic in that particular field of medical imaging. He is very keen to provide courses at the Central Queensland University that will give graduates careers in medical imaging and as medical technicians. He is going to be very important in supporting the expansion of services not only at the Rockhampton Base Hospital but also throughout Central Queensland.

There is a very strong partnership developing between our health providers in Central Queensland and the Central Queensland University, who are working very hard to try to bring in allied health and medical imaging and medical technology courses. The university has well and truly put its money where its mouth is. It has appointed a deputy vice-chancellor for development, Professor Mark Burton, who is coming to us from Charles Sturt University where he had a great deal of success in establishing a similar direction for that university. I look forward to working with both the vice-chancellor and the deputy vice-chancellor of Central Queensland University as they take the university in this new direction that will provide a much more stable enrolment base for the university but also make sure that we have a highly qualified workforce that is home grown and able to fill positions in Central Queensland.

Coming back to the bill, I welcome the changes that the bill represents. They guarantee equality across Australia in providing these important diagnostic imaging services and patients will be comfortable to know that there is a standard of care that is being assessed, accredited and delivered. Stage 2 of the scheme will guarantee that diagnostic imaging services supported by Medicare are provided by organisations that are able to meet these transparent and specific standards. It ensures that the $2.2 billion of taxpayers’ money that funds these services is being used effectively. The government can be assured that these services are being provided by organisations that meet this stringent set of standards. The scheme has been well supported by all those in the industry, who know that this is an important way of ensuring quality of services and good value for money. I commend the bill to the House.

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

This Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009 is important legislation, notwithstanding its minor nature, in as much as it extends the accreditation processes associated more particularly with non-radiology services such as cardiac ultrasound and angiography, obstetric and gynaecological ultrasound, or nuclear medicine imaging services. Of course, when one is dealing with public health and people’s welfare, having these very expensive pieces of equipment operated by properly accredited operators must make a lot of sense, and the opposition welcomes this initiative to extend from scheme 1, which was introduced in 2008, when the accreditation arrangements only covered practices providing radiology services. We are now expanding the accreditation regime. It is not to be implemented until 1 July but there is to be a deeming provision, which is also a very sensible approach to taking up early opportunities for the operators to get accredited.

It is, nevertheless, an opportunity also in discussing this matter to look at many other issues relating to health services. I noted that the member for Dobell, who spoke earlier in this debate, was running the line that during the years of the Howard government nothing was done. I mean, it has got so repetitive it is an outrage. The Minister for Health and Ageing should go back to her office and have a look at herself on television and listen to herself as she carps away day after day after day attacking the opposition for its past faults when of course whatever they might be—and I reject that there were faults—they knew about those when they made their promises at election time. In fact, in government and as a leader of the opposition the Prime Minister made all sorts of promises about how he was going to fix the health system.

I found it quite interesting that the member for Dobell mentioned the $1 billion that was apparently removed, pulled back, from the hospital system. He never mentioned the GST and the massive revenues that that has delivered to the state governments. He never mentioned the fact that the Labor Party opposed it bitterly and, might I add, in a political sense. I hear them from time to time saying, ‘You only say these things to play politics.’ Play politics! The GST, or VAT as it is known in many parts of the world, is a universally proven means of raising consumer taxes that removes a lot of the silly things relevant to sales tax and other methods of consumer taxation. They came in here day after day with kids’ clothing and cream cakes and vegetables attacking the GST. Politically, that was successful. The Howard government lost something like 18 seats in the subsequent election. Remember that they went to the Australian people and said if you re-elect us we will bring in a GST. And we told them in detail what it would apply to, what the charge was going to be, 10 per cent, and so on.

The other thing that was said at the time was that whatever amount of money was to be raised through this taxation would be given to state governments—lock, stock and barrel. The Commonwealth takes all the odium, the Liberal Party lost a lot of seats and gave all the money to state governments. Why did we do that? To quote Prime Minister Howard at the time, it was so that the states had a growth tax, which it certainly demonstrated that it is, and it was to allow them to get on with their principal responsibilities of health, education, and law and order. But that is never counted. It is never counted in education and it is never counted in health. It has a growth characteristic, it is not specific, and unfortunately it was given to state governments without any instruction how to spend it. The then opposition made another big issue about the blame game: don’t blame the states; it is all our fault—the Australian government’s. One of the promises made by the then Leader of the Opposition was, ‘If I can’t get the states to fix it, I will take it all over myself.’ That would be an interesting issue of the economy because, as I said, the GST was provided, with great political pain, to the states primarily to assist them in running their hospitals.

I do not know how this agreement will come out if there is to be additional funding coming from the Commonwealth. But, again, what happens: do they get some of the GST back? The GST was supposed to also cancel out some rather nasty and unproductive state taxes. The states just did not do that; they just took the money. And now they are arguing amongst themselves as to who gets too much and who does not get enough.

The reality is that that money has never been counted in. There was that disgusting ad by the teachers union, with the Comcar driving past the little public school kids, suggesting that the Prime Minister was there. Taking into account the specific grants that relate to private sector education and government schools, no account whatsoever is made of the contribution of the Australian taxpayer, the consumer, through the GST, which does not go to private schools but goes in spades to public schools. Anybody who wants to check the record historically and over time will find that the Australian taxpayer, through the services of this House, pays about 50 per cent of the revenues of every state government in Australia—maybe 48, maybe 51.

So how can it be that the Australian government under John Howard paid less than half the costs of the states in running their hospitals? How can it be otherwise? Yet we get this chatter every day from a minister who cannot point to one improvement in the delivery of health services, who tips buckets all over us in her nasty, catty way. As I said, she should go and listen to a recording of herself in this place. The fact of life is that she cannot point to one improvement. She can point to all the money they have spent. The Prime Minister gets on it. I refer to it as a process of measuring excellence by expenditure.

The member for Dobell, as he ran out all the issues, said, ‘We have done great wonders with superclinics.’ I think he said he has got one in his electorate—in temporary premises. After two years I think there are only two functioning superclinics in Australia. But there is all this money ready and waiting to be consumed for that process. We have invested in this, we have invested in that, we have invested in something else: where are the results? Where are the shorter waiting lists? They are longer. Where is the total removal of instances of elderly persons and others who have fallen over and broken their leg being put on a trolley in the corridor for a lengthy period without assistance? Surely the promise should have been: ‘I will stop that.’ It is about time this government learned that you do not fix health by chucking money at it.

The member for Dobell had his list of criticisms and another myth—that the Howard government discontinued the Commonwealth Dental Scheme. The Keating government’s Commonwealth Dental Scheme went for four years and it was Paul Keating who said publicly: ‘John Howard is mad to give the states untrammelled access to the GST. He will get no value for the Australian taxpayer by so doing.’ He brought in a cash payment to the states to get rid of the waiting lists for public dental services. What happened? Did the states go and hire $200 million worth of dentists or dental nurses? No, they did not. In fact, I think if anyone checks the record they will find that they hired hardly any more. So where could the additional services be? The money disappeared straight down the hole. Of course at the end of it the Howard government could see that the waiting lists were just as long and nothing had been achieved, so we stopped it. And we agonised over it in our party rooms, as you, Mr Deputy Speaker Schultz, would know. Elderly people with severe dental problems were unable to get into the state services funded significantly by the Commonwealth—50 per cent—in the normal course of events.

We said, ‘It’s no good going back.’ We checked the numbers. There were not enough dentists flowing out of the universities who wanted to work for state governments. So if you just gave them the money, the service was not going to improve. So what did we do? Isn’t it interesting. We are virtually, through accreditation, improving the opportunity for people to gain services from the various imaging technologies through Medicare. The Howard government said, ‘We will create a Medicare number for dental services.’ It was not universal but it was done in a way so that people with very serious problems could go to their GP, get a referral and go and spend $4,000 with any dentist—the ones that were in practice, the best—which those people deserved as much as anybody else.

What was the response of this government when they came into office? They came in here with a piece of legislation to take us back to the bad old ways, and they are still whinging about the fact that all of the opposition parties in the Senate opposed that shift—the Greens, the Independent members and the coalition. Why? Because they all knew that that other proposal would not work. But, of course, it would have saved them money. These are the people who said, ‘We will spend as much as is necessary to give people the health services they need.’ The solution is good and it was the proper solution. But it did not stop the member for Dobell carrying on about it as some criminal act against elderly people needing dental services. They are getting them—not for the odd filling—and they were not getting any of them under the old system. So why did that have to change? It is a good policy.

Then we had the promise of all promises. We said, ‘You can’t trust Labor with health.’ Under Blewett they got to the precipice of destroying the private health system and that was their policy. And it was the Howard government which could see this system crashing down—and I want to come back to a special example in that regard—and we started subsidising persons, typically at 30 per cent, who chose to take on private health insurance, other than for some people over age 70 and 75. That means the person involved pays two-thirds of their costs of health services. That is a bad idea, despite the fact that they might be wealthier, on high incomes. And, when you take the rebate away, they will keep paying. I gave an example in an earlier speech today. A former Prime Minister of Australia, Paul Keating, boasted that he never had private health insurance. Why would he bother? Because, when his wife got sick, surprise, surprise, she ended up in a private room in an ACT hospital with surgeon of choice. I gave an example of a speech I heard from a leading administrator of health services in New Zealand, who said, ‘Waiting lists are part of the process of managing the budget of a public hospital.’ He then went on to complain about the administration of waiting lists and how they could be rorted and how, because of the good nature of a member of parliament, they could get people jacked up the list. It should not happen, not if it is true—and of course there is an example of that currently floating around.

The facts of life are that private health contributors pay two-thirds of their health costs. But, again, when we were told that there was a probability that the administration of public hospitals would be taken over by the Commonwealth I had to have a bit of a giggle because, as shadow minister for veterans’ affairs, I watched the Keating government dispose of the Veterans’ Affairs repat hospitals. They gave them away to the states, and two states—Western Australia and Queensland—said, ‘Thanks, but no thanks.’ The Ramsay Health Care group stepped into the breach, and I had representations from RSL members in WA, saying, ‘Wilson, how are we going to manage with nasty private enterprise?’ Three weeks later they said, ‘Wilson, don’t say a word; this is the greatest thing for us since sliced bread.’ Ramsay had reopened the hospital kitchens. The generous Australian government gave the veterans frozen TV dinners. The waiting list for a veteran to have elective surgery at the Hollywood repat hospital in Perth was 10 months. How did Ramsay Health Care fix that? They opened up their operating theatres on a Saturday. They got rid of the hospitals.

The Australian government saved $1 billion by giving away those hospitals. That was how much extra it cost the Commonwealth to run six hospitals. They were run thereafter, but the Commonwealth still paid for them. But they paid a fee for service, as do private health contributors. Take it from me: the bigger the subsidies we pay for people to go into private health the less money it will cost the Australian taxpayer and of course the service will be better. There is a fundamental in public hospital funding—it is called the block budget. The hospital is given a budget and that makes a patient a liability. You cannot have too many of them! They cost you money; they erode your budget. And you wonder why there are waiting lists. You wonder why people cannot get the orthopaedic items they want for hip joint replacements and all those sorts of things. That is the issue. The system is wrong, and I get angry about this. I watch people throwing money at a system that will never work in the shape it is currently in. Yet I watch people with a culture, with a philosophy that, if it is not run by the government, it is no good, thereby undermining a system that brought private health membership up to almost 50 per cent when it was just about to fall over and that gave people the right to pay two-thirds of the cost and to access medical services when they needed them. That is why, if there is any move by the Rudd government to make deals with the states, the ongoing system will not work.

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

It is with great pleasure that I follow that rather interesting contribution of the member for O’Connor that was all over the place. It was very difficult to understand what he was saying and where he was going because they were rambling words of a man that were said in order to insult the Minister for Health and Ageing. When a person’s contribution to a debate is based on pure denigration I do not think they have much to contribute to the debate or that they really understand the issue.

The Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009 amends the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 to provide transitional arrangements to allow practices providing non-radiological services—that is, services such as ultrasounds—and a combination of non-radiological and radiological services not accredited under the Diagnostic Imaging Accreditation Scheme to register for deemed accreditation in the three months prior to the commencement of the stage 2 scheme, which will commence on 1 July 2010.

Transitional arrangements for deemed accreditation will be required to be registered through them from 1 January 2010. Therefore, this legislation is time sensitive. This is because this would ensure that Medicare eligibility continues from 1 July 2010, when for the purpose of Medicare all diagnostic-imaging services listed in the diagnostic-imaging service table of the Medical Benefits Schedule would need to be rendered at a site accredited under the scheme.

This is important legislation. This is stage 2 of the legislation. Stage 1 of the legislation passed through this parliament in May 2007. At that time I spoke in support of the legislation, but I was a little critical of the way the minister went through the stages of preparation and of the reliability of costing. It was a bit all over the place. There was no attention to detail. We all know that with the then Minister for Health and Ageing, who is now the Leader of the Opposition, you have to look very carefully at anything he does, because quite often you will find out that what he says and what he does are very different things. We stood in this parliament on many occasions when he gave rock-solid, ironclad, rolled gold guarantees that he would not downgrade our health services in this country, yet he ripped $1 billion out of our hospitals. In addition to that, the first act of the Howard government—and one that the now opposition leader continues to support from when he was the health minister—was to close down the Commonwealth dental scheme. I will talk a little bit more about that as I continue with my contribution to this debate.

This is, I think, good legislation. There has been good consultation with people within the community, and due process has been observed. Currently there are 1,400 practices providing non-radiological services, and they will enter into stage 2 of the scheme, as opposed to ones at stage 1, which dealt with those practices and services of a radiological nature. This is really important because it will have a particular impact in rural and regional areas. So it is important that this stage 2, which will be positive for those areas, is passed through the House in the time that it needs to be passed through the House.

I thought that this might be a good time to pick up on some of those arguments put forward by the member for O’Connor, who, I might add, did not ever refer to the legislation. But I was quite happy to listen to what he had to say. I now feel that my contribution to the debate will pick up on some of the issues that he spent a lot of time on. He talked about dental. I must say that the Howard government’s record in relation to dental care and dental health was very poor. There was the introduction of enhanced dental care, which allowed for people with chronic health needs or illnesses to access dental care—this is a very small percentage of people—whilst thousands of people languished on waiting lists. The opposition have continued to frustrate reform of the dental system since they have been in opposition. The government committed a total of $650 million for two dental programs. The teen dental health program commenced last year, and it provides $150 million annually to eligible families. The other program that we put to the parliament is the Commonwealth Dental Health Program. Unfortunately, due to the actions of the opposition in the Senate, that has not come into effect. Instead we have the enhanced dental health program, which pays up to $4,100 over a two-year period to people with chronic illnesses. That leads to a situation where a large section of the community on low and middle incomes that would be able to access the Commonwealth health dental scheme that the government has put to the parliament are missing out, whilst a small number of people with chronic illnesses are able to access dental care.

Even worse than that, a number of people have been deemed to have chronic health problems because their doctors and dentists know that they need this vital dental health program. So you have a system being exploited simply because there is not a suitable, proper system in place for all Australians to utilise. I do not know how the member for O’Connor can stand up in this place and say that the Howard government’s record on dental health is something to be proud of. I am ashamed to think that he would speak in this parliament and condemn thousands and thousands of Australians to suffering because he will not support the Commonwealth Dental Health Program that the Rudd government took to the last election, which was supported by the Australian people and which the opposition is frustrating in the Senate.

I thought it would also be interesting to touch on the workforce issue. In the last parliament, the then health minister, who just happens to be the Leader of the Opposition now, gave terms of reference to the Standing Committee on Health and Ageing to do an inquiry into health funding and cost shifting within the health system. His underlying assumption was that he was going to prove that there was cost shifting by the states to the Commonwealth. The report showed that there was cost shifting in a number of different areas within the health system. There were a number of recommendations that were made in this report. The report was tabled in the parliament in November 2006 and I know you will be shocked to learn, Mr Deputy Speaker, that when we went to the election in November 2007 the government still had not responded to the blame game report. I see this blame game report as a blueprint and as a really good starting place to look at the health system and to work through some of the problems in the health system.

One of the issues identified as being a problem was the issue of workforce shortage. Under the control and leadership of the then health minister and now Leader of the Opposition there was allowed to develop a chronic workforce shortage in Australia—doctors, nurses and all allied health professionals. He ignored this chronic shortage and did nothing about it. Since the Rudd government was elected a very tangible policy has been implemented and action has been taken. I will say for the member for O’Connor’s benefit that there has been a 40 per cent increase in the number of doctors being trained. It takes a while for that to flow through, but eventually it will.

The Shortland electorate, the electorate I represent in this parliament, has the 11th oldest population of any electorate in Australia. As such, there are fairly high health needs in that electorate. Overall, it has the 18th highest number of people receiving an income below $650 a week. This shows an older population with a very small disposable income. During the time that the Leader of the Opposition was minister for health there was a drastic decline in bulk billing. That has improved enormously since the Rudd government has been in power. There was an increase in out-of-pocket expenses under the reign of the then health minister, now the Leader of the Opposition. Doctors were closing their books and it was a very sad story. Still there is a shortage of doctors in Shortland electorate and throughout Australia, so this will take time. That 40 per cent increase in the number of doctors training will eventually filter through the system, but until that happens we are going to be confronted with this shortage of doctors and the impact that it has on the health service within Australia.

I thought I would mention some of the achievements of the Rudd government just for the benefit of the member for O’Connor, who virtually challenged me to do so when he stood in this House and made his contribution to this debate. The prime aim of the Rudd government in the area of health is to strengthen it after years of neglect and buck passing by the former government. I think this blame game report and the reason it was commissioned—to prove that the problems in health were all caused by the states—are a really good example of buck passing and a government failing to take responsibility for what is its responsibility. Then, when they got the report, they did not respond to it. That is the first point I would like to make.

The Rudd government has invested $64 million in hospitals and the health system across the country since being elected—a 50 per cent increase on the previous government. We have invested $600 million on our elective surgery program, with stage 1 committed to a target of 25,000 extra elective surgeries. That was achieved in 2008 and delivered more than 41,000 procedures. In stage 2, more than 150 hospitals across Australia will receive funding. The hospitals in my own area have benefited from this extra funding.

We have invested $750 million to take the pressure off emergency departments in more than 30 hospitals, and a number of other hospitals have benefited. My daughter-in-law works in an accident and emergency department, and I know just how busy that accident and emergency department is. I also know how valuable extra money is in those accident and emergency departments. When I visit my local hospital, I can see how we have moved to a situation where we value the work that is done in hospitals. I value the work that is done in hospitals, both public and private. I believe that private hospitals make a valuable contribution to our health system and I am very lucky to have an excellent private hospital within the Shortland electorate—the Lake Macquarie Private Hospital. It has particular expertise in the area of cardiology, and it will be one of the hospitals that will need to register under stage 2 of this program.

Private health insurance is an issue that is brought up all the time by members on the other side of this House. I support private health insurance. I have already talked about the income level of people living in the Shortland electorate. The majority of people there will not be impacted on in any way by the changes that we are proposing to private health insurance in this parliament. I do not see why a pensioner living down the road from me should have to subsidise my private health insurance—I think it is indecent. I urge the opposition to get behind the legislation we have in the Senate, pass it and ensure that the pensioners in the Shortland electorate and in the states and territories no longer subsidise their private health insurance. We support private health insurance. We support private hospitals; we support public hospitals. We believe that to have a strong health system you need a mix. That does not mean that governments should pay a subsidy to high-income earners to help them pay their health insurance.

The Rudd government have made some enormous investments in infrastructure within the health system. The member for Dobell mentioned the superclinics and I know that the superclinic in his electorate will also service people in the southern part of the Shortland electorate and I really welcome that. As I mentioned, we have made some big inroads into addressing the issue of doctor shortage and also one of the initiatives that I find particularly exciting is the move towards a greater use of nurse practitioners. Once again, that is a piece of legislation that is languishing in the Senate.

When the opposition in this parliament talk about opposition, they mean opposing everything that comes before them. They have no thought of the impact this opposition will have on everyday people. The opposition have a policy of just saying no. They have refused to pass landmark legislation giving more support and recognition to midwives and nurse practitioners. They have refused to make private health insurance fairer. They have refused to allow more dental health services to be delivered to hundreds and thousands of needy Australians. Their stance on the preventative health agency leaves them open for condemnation. Last year they opposed and delayed a number of government reforms. They are an opposition that opposes everything, has no ideas and has an appalling record in the area of health, one that has delivered a lot of suffering to a number of Australian people. I commend the legislation to the House. (Time expired)

Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

Before I speak on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009 I would like to draw attention to the member for Shortland’s seeming preoccupation with the member for O’Connor. I just hope that it is purely platonic. While she is dwelling on the voting record of this side of the House, I would draw her attention back to the time she spent on this side of the House and her party’s continued opposition to every economic reform that was brought in by the previous government.

I rise to speak tonight on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009. Let me say it is generally a good piece of legislation. The original accreditation scheme was implemented under the previous government. We could argue about the way that this new accreditation program is being rolled out but, by and large, it is right that people should know when they go to a medical-imaging establishment that they are going to get a quality service. It is my understanding that in South Australia we have one major medical-imaging company that has already met the accreditation standards and I look forward to the rest doing the same.

My major issue with this bill is the sad story of unfulfilled commitment to my electorate which I have brought to the House before. It concerns a commitment from the government to establish a medical resonance imaging service at Port Augusta to service not just Port Augusta, which has a population of 14,000 people, but also Whyalla, which has 22,000 people; Port Pirie, 15,000; Port Lincoln, 14,000; the greater Eyre Peninsula, around 13,000; Roxby Downs, 5,000; and the Mid North, with probably another 8,000—in total more than 90,000 people. This machine, along with another 12, was committed by the Howard government in the second half of 2007. About an hour ago in this place I heard the member for Capricornia waxing lyrical about the government’s commitment to the MRI machine in the Rockhampton Hospital. Well she might, but it is a shame that the government have not shown the same commitment to the medical resonance imaging machine that they had promised to the people of Grey.

The tenders for the installation and operation of this service were due in by mid-November 2007. In February 2008 the Minister for Health and Ageing, Ms Roxon, as the representative of the new government, informed us of the new government’s commitment to delivering the service and I applauded that decision. She reaffirmed that commitment in May 2008 when announcing an extension to the tender process. I understand there were three tenders. The tenderers initially expected the announcement of the awarding of the contract within six months, but they have suffered no fewer than three extensions, eventually being informed in September 2009, almost two years after the tender was lodged, that the government had decided none of the tenders were suitable and was cancelling the project.

At no stage had the tenderers been asked for additional information, to make any alterations or had it adequately explained to them why they had been rejected. In fact, one tenderer who has confided in me said that during a debriefing after the rejection he was told his submission ticked all the boxes. He was told it was an excellent submission. These tenderers have had their lives on hold for almost two years, and they are financially committed to property so they can deliver what they promised they would deliver, only to be informed at the end of the process that the government was not interested in meeting this commitment that was made repeatedly from early 2008. The tenderers were required to meet a number of prerequisites including public access, professional standards, business plans, staff training programs et cetera.

Since the election I have inquired of the minister on a number of occasions when we could expect this service to commence and was continually referred to the minister’s January 2008 statement affirming her commitment. So it was that following the news of the cancellation in September last year I contacted the minister’s office and sought a meeting as a matter of urgency. At the meeting I explained that I believed her department had made an error of judgment. She committed to review the process and I committed to work with the minister. On 22 December, after the country’s media had gone to sleep for Christmas, I received information from the minister’s office reaffirming her decision to slash the project.

By this time I had been privy to one of the tender documents. Whilst the tender document requested start-up finance, it clearly stated that if it were not forthcoming then the proponents were prepared to meet the whole cost. This is where it gets mysterious: what is the cost to the taxpayer if the proponents are prepared to put all the money upfront? Where is the risk to the taxpayer? All they were asking for was the operating licence and the Medicare fee for service of payments, the same as every other MRI in Australia. The financial risk was all the proponents. If their business were to fail, what would the taxpayer have lost? Nothing. The taxpayer would not have funded the machine or the premises. Surely this is just a bureaucratic stuff-up. You just cannot believe that a department would give this kind of recommendation when they had been offered this kind of deal. I am very pleased to note that the Minister for Health and Ageing is in the House as I am speaking.

I wrote twice more to her asking her to take a personal interest in this issue. Her last reply is interesting. It alleged no tender had reached the four measured criteria. Those criteria were (a) a proposed pricing structure/patient charging policy, (b) hours of operation, emergency services and after-hours availability, (c) patient accessibility and (d) an ability to demonstrate an ongoing business plan. I have seen the tender and, in my opinion, it addresses all of those criteria. It is an excellent tender, as the tenderer was informed by the debriefing people from the department. However, the minister claimed that no tender reached a satisfactory level. The letter I received from the minister said:

You suggest in your letter of 8 January 2010, that if it is the case that all of the people in Port Augusta—

and I must make the point that we are not only talking about the people of Port Augusta but talking about most of the population of Grey—

who currently require MRI services are travelling to Adelaide for those services, the location of the MRI unit in Port Augusta would have no impact on the Government’s health budget.

That is what I said and it was quoted back to me. The letter went on to say:

However, previous experience clearly demonstrates that the provision of Medicare eligibility to an additional MRI unit results in additional Medicare rebateable MRI scans being provided, thus resulting in additional costs to the Government’s health budget. Therefore, the provision of Medicare eligibility to an MRI unit is not cost neutral.

So it comes back to money. The government’s commitment that they would spend whatever was needed to give the Australian public the health services they deserve comes back to money. And it would seem that the service we deserve in the country is less than that received in the city. This is preposterous. It makes second-class citizens of the country. Everything can be equal as long as it does not cost money. The nub of the problem seems to be about money and not the cost of delivery, but it costs more to get the same level of service in the country. That is not because the service costs more but because we are going to start receiving the same level of services that those in the city receive. The letter went on to say:

It was never the Government’s intention that supplementary funding over and above the necessary extra Medicare funding would be required to support the MRI business.

This was exactly what the tender I have seen offered. It said that if no extra funding were forthcoming they would meet the full costs of the installation of the MRI at their expense. It is a sorry tale of promises abandoned to go with all the other commitments that this government seems to be running away from by the day. I have suspicions that there are other complications. The South Australian Department of Health—SA Health—and Country Health SA have an interest in this. The state minister says he supports the MRI machine being positioned in Port Augusta. He has been visited by the mayors of Whyalla, Port Augusta and Port Pirie to support this proposition, but I am not so sure. This may be what the South Australian Minister for Health, John Hill, said, but I am not so sure it is fact. The Port Augusta hospital currently has no medical imaging contract. The contract expired last year and a call for a tender was unsuccessful. This could be just a coincidence or can we perhaps assume that there is a little more to this, that SA Health are recommending against the MRI in Port Augusta because they want to see more funds come back into their system? I am not convinced that SA Health are not trying to alter the deal to suit themselves. The minister went on to say in the letter:

I am considering other options which might be available to the Government and am consulting with relevant agencies. One possible alternative would be to redirect some of the Medicare funding planned for an MRI unit in Port Augusta to other worthwhile health projects in Port Augusta. Some possible projects, identified with the assistance of the South Australian Department of Health and Country Health SA, would involve the expansion of the day surgery waiting and outpatient consulting areas within the theatre and consulting suite at the Port Augusta Hospital, and the replacement of theatre equipment.

Apart from missing the point that this MRI machine is not about Port Augusta and the 14,000 people who live there but about the 90,000 people it would service, who benefits from this redirection of funds? The South Australian health department.

It is very interesting that this arises in the middle of the South Australian election campaign, and I might bring to this House the state of the seat of Stuart. Stuart has been held by the retiring member, Graham Gunn, who is retiring after almost 40 years, since its inception—in the last few elections, by a knife point. So we have two new candidates running for the major parties in the seat of Stuart: our candidate, Dan van Holst Pellekaan—a very fine man who is committed to this MRI machine in Port Augusta—and the Labor Party candidate.

What chance is it that in fact the funds that were to be directed to the MRI machine in Port Augusta will come out in a grand announcement in the next five weeks and support the local Labor candidate as we lead forward into the election? The fact is that the Port Augusta Hospital has no medical-imaging contract and I suspect the South Australian health minister has passed judgment that this machine should not be located there because he would like to see those resources put into the South Australian hospital system. It is about the federal government bailing out state government mismanagement.

I ask the minister to take the opportunity to come clean here. The state Liberal Party leader, Isobel Redmond, recently committed $2½ million to the establishment of this MRI unit in Port Augusta. This would cover all the set-up costs. All we need then are the Medicare operating fees. So will the health minister stand by her 2008 commitment and supply the operating licence? There is no risk. The funding will be met by other parties. The only difference is that the people of the region will start to receive the same level of service that those who live in the city receive.

In short, to come back to this bill, I will not be opposing the bill but I would dearly like to see the minister deliver on her commitments to my electorate so we too can enjoy the benefits of an accredited magnetic resonance imaging service within the electorate, thus avoiding the thousands of kilometres of travel to access this service in the city, and can address the admitted shortfall of service to my constituents.

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

Order! The question is that this bill be now read a second time. I think the member for Chifley was seeking the call.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

It’s not like the whip to seek the call when he’s not on the list.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I call the member for Chifley since the minister has given way to the member for Chifley.

Roger Price (Chifley, Australian Labor Party) Share this | Link to this | Hansard source

I appreciate the courtesy, Mr Deputy Speaker. I did not want to take up too much time of the House. I certainly support the legislation that the government is bringing forward, the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009. I was very interested in the comments about an MRI machine, because in Blacktown, with a population of about 300,000 people, Blacktown Hospital was provided with an MRI machine in the last few years.

I am very impressed with the department at Blacktown. Blacktown Hospital is twinned with Mount Druitt. Radiological and non-radiological services are offered at both campuses. The MRI, I am happy to report, is operating at capacity. We have now started using it on a Saturday. More particularly, we provide a same-day service, so it treats not only those patients who may be in hospital but also patients who are referred to the hospital for an MRI. Of course you would know, Mr Deputy Speaker, that MRIs are a much less invasive form than the traditional X-ray machines and CT machines.

I make no secret of the fact that it would be really good, given that machine now is reaching capacity, if we had an MRI machine at Mount Druitt. What would happen there is that the state government would provide the capital for the purchase of the machine. The federal government provides the licence and, of course, with usage it gets repaid.

Why am I anxious to have it at Mount Druitt? Well, there has been a significant change at Mount Druitt Hospital. It is to become an elective surgery specialist centre of excellence. At the moment we have 1.5 operating theatres—I believe it is only one actually operating—and we have four theatres, one of which was being used as a storeroom. But that has all changed. There is going to be an endoscopy unit provided for Mount Druitt Hospital and, as I say, we certainly hope that non-complicated elective surgery which otherwise would have been performed at Nepean Hospital, Westmead Hospital or other public hospitals will be able to be performed at Mount Druitt.

Judging from the briefing I received, it will be a challenge, I guess, trying to attract some of the doctors to Mount Druitt to do the operations, but they will be able to have guaranteed slots. I think one of the most disappointing aspects of elective surgery is when you are all prepped up ready to go into an operating theatre and you are told, ‘No, sorry; we can’t do it today because there’s an emergency being done ahead of you.’ One of the advantages of having a centre of excellence for elective surgery is that doctors who do their elective surgery there will have guaranteed slots, so patients who front up on Monday, Tuesday or whatever day wanting to have an operation will indeed have an operation.

I know the minister has been very generous in listening to my pleas for an MRI. She explains that she has a whole country to consider when it comes to MRIs. But I think, to be frank, this radical change for the New South Wales health system—going to elective surgery centres of excellence, as we are doing in Mount Druitt—would be immeasurably boosted by the provision of an MRI at Mount Druitt. We do more MRIs at Blacktown Hospital than are done at Nepean or even at Westmead. It is more fully utilised. We will get value for money. The other thing I should say is that it is a very modest fee that the hospital charges to referred patients. From memory, it is in the order of just over $200 for an MRI. But if you go to a private provider you can pay anything upwards of $1,000. So it would be really good for patients if we had it there; certainly the one at Blacktown is really good for patients.

Health is going to be an issue, and I want to finish on this point. I find it very difficult for the opposition to be believed in health when they ripped a billion dollars out of the health system. I know what a catastrophic impact that had just in Western Sydney, and you can replicate that in south-western Sydney as well. Not only did they rip a billion dollars out of the public hospital system but also they froze doctors’ places and they did not provide enough training places for nurses. I put on the public record my deep appreciation of the efforts of the Minister for Health and Ageing. I think she is doing an excellent job; she has inherited a mess and is working her way through it. I think the people of Australia can have confidence in Nicola Roxon as the minister for health, but they can have no confidence in the Leader of the Opposition, because in four years he took the billion dollars out of the public health system, he froze the doctors’ places and he did not provide enough nurses.

Much has been said about hospital boards. I was a foundation deputy chair of Mount Druitt Hospital and am very proud of that association. I used to be driven mad trying to work out budgets. I think back on what happened at Hawkesbury Hospital, which also had a board: they used to routinely blow their budget and always got supplementation to make it up. But there have been really significant and important changes that have occurred between Blacktown and Mount Druitt Hospital that I think a board might not have been able to achieve—for example, Mount Druitt Hospital has the palliative care unit shared between the two hospitals. It has the paediatric ward, which Blacktown does not have. It has rehabilitation that Blacktown does not have. Of course Blacktown has some things that Mount Druitt does not have, but the provision of these services and making them specialties of the hospital has in the long run, I think, continued the hospital and ensured its future.

Frankly, if I look back and think about how we were just a board, I see that it would have been so easy to close Mount Druitt Hospital, because it sits between Nepean Hospital, Blacktown and then Westmead. Whilst I enjoyed my time as a deputy chairman of a hospital, boards do not make up for a lack of money and they do not necessarily contribute to or have the ability to manage the huge changes and costs occurring in the health system. I think people ought to put their faith in the work of the minister for health and, of course, the Prime Minister and our commitments in this area. I commend the bill.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

in reply—I thank all of the members who have spoken and contributed on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009, particularly the last two speakers. I will address briefly the comments that have been made. I know that the member for Chifley has been a very staunch advocate of an MRI licence being provided at Mount Druitt Hospital. He never fails to take the opportunity to raise it with me—and, as a good member committed to his local area, it is his job to do that. I think he and the hospital at Mount Druitt are building a very significant case for why the changed structure that is being introduced in the region would mean that an MRI could be well utilised. But he also rightly points out what I have said to him and many other members: there is not a national process for the automatic allocation of MRI licences based on population or an automatic process where, if a machine is purchased, it will be recognised in a particular way. There is a fair amount of fairly ugly political history from the previous government, which is the reason that there is not a system in place, but obviously we are keen to make sure that we look at needs very carefully. If there are changing structures or demands, we are always interested in seeing if there is a way that we can assist members on both sides of the House.

That is why I am particularly interested, before I give a short summing up speech on this bill, in addressing the issues that have been raised by the member for Grey, who is indeed also a very difficult situation, as we believe we are as well in these circumstances, where a commitment was made to deliver an MRI licence. A tender process was undertaken. That tender process did not present an application that met all of the requirements. I listened very carefully to the member’s presentation because I know that he is genuinely committed to trying to make sure better services can be provided in Port Augusta. Unlike the situation that you are in when you run a tender process as a minister, we are not the assessors of the applications. There is an arm’s-length process. It is undertaken very carefully and there are very strict regulations for how it is done. Of course it is proper that I would act on the advice, and I am concerned—and we have had a number of discussions and correspondences, some of which were read into the House—that that leaves both the local member and the community frustrated that an opportunity may have been missed.

From our early contacts, I asked my department to go back and reassess the process. They have still advised me that none of the applications meet the requirements, and the most recent letter I wrote to the member was to say that we acknowledge that, if an appropriate tender had been available, it would have had a cost impact. That is fine. That is something we were committed to doing. Given that there has not been, did the member want to be involved in identifying other health projects of an equivalent value that can be of benefit to Port Augusta? It is absolutely a matter for the member for Grey whether he wants to be engaged in that process or not.

I do take exception to the allegation that this is somehow being used politically. I do not think it is the behaviour of a government or a minister that is behaving politically to write to a member of the opposition and say, ‘We are interested in your views on whether money can be spent locally on health for the benefit of your community.’ I can assure the member for Grey that, despite his queries and worries that something nefarious is occurring with the South Australian government, the South Australian government do not participate in the tender process, they are not part of the tender panel and they have no capacity or ability to interfere in that process. But in the situation we are now in—where we have money that we were prepared to spend in Port Augusta on an MRI machine and no successful tenderer to be able to pay that to—we are wanting to engage with the local member and the state health services to gather information for any existing projects.

I can also assure the member that he is not the only member who has been in this position. In fact, a very similar situation occurred in the seat of Braddon. A commitment had been made for an MRI service to be provided in Burnie, and a similar negotiation process—when there were no successful tenderers—was gone through with the member for Braddon. Discussions were had with the local health community as well as with the Tasmanian government about whether there were any options for providing additional health services. That was also not an easy thing for the community, but I think we ended up with quite a good resolution.

Of course, if the member for Grey tells me that he does not want this money to be invested in health services in his area, he is more than welcome to stand up and say that. In the absence of him telling me that, I look forward to a reply to the letter, which was quoted extensively, for any ideas or views that he has. It is tempting as a minister, when you hear these very heartfelt pleas, to again ask my department to go back and see if there is anything in the tender process that should be revisited, but I am very wary of doing that, having already been down that path once and assured again that there is no appropriate tender application that could be awarded.

I look forward to having future discussions. I can assure the member for Grey that there is nothing mysterious or political going on. We have been open with him and quite encouraging of him to be involved in this process, and I hope he will take that opportunity. It is a very legitimate consideration for Australians, no matter where they live, to want to be able to access decent health services—and MRI processes are becoming much more common. We are interested in doing all we can to make sure that, where there is a viable option, we would help establish these services. So I am sure there are going to be many other discussions, and I hope that we can continue to work with the member for Grey to find a resolution for Port Augusta and the surrounds. This bill does not actually deal directly with those issues raised by local members, but it is a good opportunity to put those issues on the record. A number of other members took the opportunity to raise similar issues in their local areas and of course the government takes note of those issues.

On behalf of the government, I would like to acknowledge the opposition’s support for the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009. It amends the accreditation act of 2007 to broaden the scope of the Diagnostic Imaging Accreditation Scheme. The bill establishes transitional arrangements for existing diagnostic practices providing non-radiology services or a combination of non-radiology and radiology services not accredited under the scheme to enter stage 2 of the scheme from 1 July 2010. These arrangements will enable non-radiology practices to transit into stage 2 of the scheme, with minimal disruption to the business of providing Medicare eligible diagnostic imaging services to patients. Through the implementation of the stage 2 scheme, the government and community can be assured that the 19.5 million or so diagnostic imaging services that are supported by Medicare annually are being provided by organisations that are able to meet specified standards and that taxpayer funded investment in those services totalling over $2.2 billion per year is being used effectively.

The government acknowledges that the success of the stage 2 scheme is dependent on the support of stakeholders. I would like to assure members, particularly those who raised this issue in the House, that the stage 2 scheme model has been developed and informed by an evaluation of the stage 1 scheme undertaken in 2009. The results of this evaluation will be released publicly soon. It is the government’s intention to ensure that the stage 2 scheme remains practical and affordable, by continuing to monitor and evaluate the scheme and, in the future, by conducting a review of the scheme. I am happy to confirm for the member for Boothby that the findings from that review will be made publicly available.

On behalf of the government, I restate our appreciation for the collaboration of all the affected medical groups that have enabled the government to reach agreement on the proposal to provide transitional arrangements and to enable the structure of the accreditation regime to cover all diagnostic imaging services. I commend the bill to the House.

Question agreed to.

Bill read second time.

Message from the Governor-General recommending appropriation announced.