Yvette D'Ath (Petrie, Australian Labor Party) Share this | Link to this | Hansard source

Last night prior to the adjournment, I was taking the House through all of the initiatives that the federal government has implemented in relation to health, from the initiation of the National Health and Hospitals Reform Commission inquiry back in February 2008 right through to the significant increase—up to 50 per cent—in health funding, the increase in training places and other initiatives.

In contrast, the Liberals in government, under the stewardship of the then health minister, now Leader of the Opposition, slashed $1 billion from public hospitals. They caused a national shortage in the medical workforce by freezing medical student places and capping GP training places, leading to a critical doctor shortage affecting 60 per cent of the population. They did nothing to plan for future challenges like the ageing population and the growing burden of chronic disease.

Last night in the debate on these bills, the member for Herbert referred to the problems associated with Townsville Hospital. I do have to ask: on how many occasions, when both the Leader of the Opposition and the member for Herbert were in government and the Leader of the Opposition was health minister, did the member for Herbert on behalf of his constituents actually raise concerns about Townsville Hospital and how the federal government should assist?

It is important also to look at the Liberal Party since coming into opposition in 2007. They opposed the alcopops legislation, which was an important measure to address binge drinking by young people; they opposed the Australian National Preventive Health Agency Bill, which sought to establish the first-ever national approach to preventive health through this national preventive health agency; they opposed means testing for private health insurance, which would ensure that the government provides rebates in a way that is fiscally responsible and direct taxpayer dollars into areas that are most in need, such as health reform.

Mr Tony Abbott is working hard to distinguish himself from the previous leaders of the opposition and the Rudd Labor government. This leader of the opposition is doing so by saying ‘no’ in the Senate on every policy that has been put forward in the area of health. Mr Abbott’s latest example of this is the rejection of the private health insurance rebate bill. This decision blows a $2 billion hole in the budget and, by the middle of this century, it will be a $100 billion hole. This is money that would be better spent within the health system. Unfortunately this is not the only piece of legislation that is being blocked in the Senate when it comes to health and important priorities for the community.

The landmark legislation that will give more support and recognition to midwives and nurse practitioners has been delayed month after month after month, and the Liberal Party have not yet agreed to support this important reform within the health system. The opposition have twice blocked changes that we took to the last election to make sure that we could provide more than a million extra dental services to the most needy in our community. Unfortunately, it is not only health reform that the opposition is blocking in the Senate. Even our young people wanting to study at university have been left in the lurch because of the opposition refusing to pass the income support for students bill. The protection of the environment into the future through the Carbon Pollution Reduction Scheme is also a target for the opposition. In fact, the opposition has blocked 41 bills in the past year, which is four times as many as any other opposition in the past 30 years.

I have to say that the LNP candidate for Petrie has recently come out saying that he supports local hospital boards. I hope that means he will now support local hospital networks. The other members from Queensland in this chamber may be very interested to know that he says he is going to advocate strongly for Logan Hospital to be the first off the mark. I am sure that Logan is a lovely hospital, but Logan has about four other federal electorates between Petrie and where it actually resides, and it is certainly nowhere near outer northern metropolitan Brisbane.

Steven Ciobo (Moncrieff, Liberal Party, Shadow Minister for Youth and Sport) Share this | Link to this | Hansard source

Mr Ciobo interjecting

Craig Emerson (Rankin, Australian Labor Party, Minister Assisting the Finance Minister on Deregulation) Share this | Link to this | Hansard source

Dr Emerson interjecting

Yvette D'Ath (Petrie, Australian Labor Party) Share this | Link to this | Hansard source

I would say good on the LNP candidate for Petrie promoting Logan as the first off the mark, but, as the member for Petrie, I will actually be advocating for Redcliffe Hospital and my local health professionals to support our area to be the first off the mark.

For the Rudd government the message is simple: we are serious about health reform; the opposition is serious about playing politics. This legislation before the House is part of the Rudd Labor government’s commitment to health reform and is another step forward to positive change. I commend the bills to the House.

Harry Jenkins (Speaker) Share this | Link to this | Hansard source

I thank the Queensland members present in the chamber for not showing their territorial biases too much.

Steven Ciobo (Moncrieff, Liberal Party, Shadow Minister for Youth and Sport) Share this | Link to this | Hansard source

I rise to speak on the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010, which are before the House this morning. There can be no doubt that for the Australian community health is one of the key national policy priorities for government. We have seen a shift in our aged population. In the early 1990s, around 12 per cent of the population were aged 65 and over. Based on demographics, we anticipate, with the affliction of time and the ageing of the population, that those Australians aged 65 and over will become roughly one in three—nearly 30 per cent of Australia’s population—in the next couple of decades. We have a landmark change happening across the Australian community in the number of older Australians.

The increasing number of older Australians, predominantly driven by the baby boomers, who were born after the Second World War, has meant a number of things. The first is that, where you have a large socialised health compact, as we have in Australia, there will be an increasing demand upon the services provided by the Commonwealth. Coupled with that is the fact that with the ageing of a large proportion of the population there will be fewer people actually contributing to Australia’s tax system. Indeed, with a large number we will be in the situation of having a net drawdown, so to speak, by taxpayers of consolidated revenue for services such as health.

It is crucially important that we continue to identify measures that can be taken to increase efficiency. We need to consistently utilise new technology to ensure that we develop maximum bang for our buck. That is crucial because, with a decline in the number of taxpayers paying tax and an increase in the number of taxpayers drawing on those services, we need to make our dollar stretch further. This is a problem that besets all governments. It is not something that is unique to the Labor Party and it is not something unique to the coalition; it is a common policy challenge, something that as a nation we must address.

The bill that is before the parliament today to some extent addresses this issue. It effectively provides a resource for government to ensure that we are able to gain greater efficiencies and improve productivity when it comes to the administration of the health system. The Healthcare Identifiers Bill will provide for a 16-digit identifier for every Australian and every healthcare provider. This will provide greater efficiencies when it comes to the administration of this scheme. If I look back over the past several years I am conscious of the fact that it was the previous coalition government that took perhaps some very bold steps—I would argue too bold—with respect to advocating for an access card. The access card, which some may consider a forerunner to or a super-duper version of a healthcare identifier card, on the plus side would have provided for greater efficiencies with respect to the administration not only of health but more broadly of the social welfare system in this country.

The concern that I had at the time, albeit it was a coalition initiative—and I certainly spoke quite strongly within my own party room about the access card—was that a situation might arise where, with the passage of time and function creep, the access card would have become a national identity card. For Liberals like me the notion that we would hand up to government the power to have something like a national identity card was one step too far. We saw around the world other governments moving down that pathway. Indeed, the United Kingdom has moved down that pathway, forcing all citizens and residents in the United Kingdom to have a national identity card.

The parallel between that and the bill today means that those of us who are concerned about the relationship between the individual and the state must remain vigilant about where exactly we go with this legislation. On the face of it, the bill that is before the House is not, I believe, of significant concern. It is about efficiencies. It is about ensuring that government can utilise technology that will enable it to stretch its health dollar further, that will enable it to ensure that the administrative arrangements that are in place are utilised most efficiently and productively so that all Australians benefit from a more efficient system. Let’s be frank: there are not too many Australians who would argue that when it comes to government administration we are among the most efficient in the world. That notwithstanding, we need to be conscious of unintended consequences and function creep. These remain for me very serious considerations which I believe all members of this parliament should be concerned with.

The introduction of a healthcare identifier, which provides a 16-digit number for every single Australian, means that there will be, for the first time, a great ability for governments to have, through the use of that single identifier, access to a raft of health information on every single Australian. As I said, on the face of it I am comfortable with that insofar as it provides greater opportunity for efficiency and, perhaps even more importantly, the opportunity to ensure that, when it comes to the administration of health and linking patient records with patients, there is less room for error. That has to be a positive.

I certainly do not believe this legislation is bad. I think it has taken a long time to come about. We have had a vacuum for a couple of years now while this government has been ambivalent about which way to move. Nonetheless, it is in broad terms a logical and solid step forward in the administration of Australia’s health system.

I want to state on the record that I will continue to watch closely the development of policy around this bill and associated bills that deal with the labelling of each individual Australian with a single number which provides government greater access to records all administered through one number. I believe that we will see with the passage of time increasing pressure to utilise this number as successive governments say: ‘Look, we are only seeking to add on this particular function. We are only seeking to ensure that when it comes to your unique health identifier number we are only adding on this one particular aspect.’ Who knows what that will be? Perhaps it will be combined with passports in the future. Perhaps it will be combined with drivers licences in the future. Perhaps it will be combined with tax records in the future. Perhaps it will be combined with welfare records or family tax benefits in the future. There is a whole raft of different things that successive governments could say, ‘This will stop duplication and mix-ups.’

Each argument individually will make sense. Each time a government stands up and says, ‘Look, when it comes to making government more efficient we believe this is a step in the right direction.’ I concede that I would agree with each one of those arguments if they were taken in isolation. But the problem we have as policymakers is that it is actually not that far of a journey between starting with a system like this and ending up with a situation that I foresee down the track: where each and every Australian has a 16-digit number identifier which links them back through all government records about them in all government agencies and departments. It would also seem logical to conclude that it would not be very long before criminal records, police investigations and all such matters are all linked as well to those unique 16-digit identifiers.

Some Australians, I concede, would have no problem with that. Some Australians would be very comfortable with government agencies being able to access all of those records at the push of one or several buttons. But we must remain vigilant about the abuse of power by governments. It is well and good for the population to say: ‘Well, we’ve got nothing to be concerned about. Governments have, over time in this country, proven that they don’t abuse powers.’ Other Australians would say there have been many examples of abuse of government power in the nation’s history. It all depends on your perspective. But I can say with authority that when you look around the globe you see many examples of governments misusing power as a direct result of the adoption of technology which enables all of that information to come to one particular person.

Over the past several weeks I was concerned when I saw numerous media reports talking in particular about the unauthorised access by bureaucrats of people’s private information in health records. When audited, there were thousands of examples of unauthorised personnel within Australian government agencies and departments that were accessing other people’s private information with no authority and—it would appear on the face of it—with no proper motive.

This has been a concern that the tax office has dealt with for some time. Occasionally we do see, unfortunately, from the tax office the personal tax records of high-profile individuals and celebrities being accessed without authorisation, and, on occasion, if memory serves me correctly, some of that information has spilled into the public arena. If I was one of those Australians, I would be saying, ‘Whose business is it that my private tax records should be out there in the public domain because a bureaucrat somewhere has taken it upon themselves to access my information and put it out there?’ That is just one single agency’s record. Can you imagine what the potential could be for the abuse of information if every single government record or piece of information about an individual was accessible from all departments through one unique identifier?

We might say, ‘Well, they’re celebrities and they can deal with it.’ The reality is, as recent media reports have demonstrated, there are many examples where people have misused and accessed information on other Australians. Perhaps it is a friend of the bureaucrat or someone who happens to be in the newspaper or the Woman’s Day that particular day, and their interest is piqued and they have a little squiz at what they have in their health or tax records. I would like to pretend that that is never going to happen but the truth is, as we have seen in recent weeks, it happens thousands and thousands of times every single year. It is for that reason that I think as Australians we need to remain vigilant about where these particular initiatives go—certainly I will as a policymaker.

But that is part of the broader fabric of the debate about when successive political parties take the reins of government and help to move Australia’s health system forward, and the administration of Australia’s health, welfare and other systems when governments seek greater efficiencies. I am not a troglodyte. It is not that I believe that all technology is bad, but we must recognise that with this new technology in particular there is a greater ability to misuse the information that is contained within the 16-digit identifier.

I will touch upon some other health related issues which are more pertinent and perhaps more germane to the aspects of this bill. I noted previously that the member for Petrie and others in this debate have railed against the coalition recently blocking the private health insurance legislation. The first point I would make is that the coalition is unable to block anything. We hear the Labor Party talking about how the coalition blocks this, that and the other, but it is simply untrue, because Labor members know that the coalition cannot block anything in the Senate. The coalition can be opposed to something but it requires other senators to support the coalition in order to block legislation.

It is simply convenient for the Labor Party to make out that their legislative agenda is frustrated, when in reality they have not been able to advocate a reason strongly enough for why other senators should support their legislation. We on this side of the House know bad legislation when we see it, and that is why we stand opposed to it. And do you know what? It seems that there are other non-major political party senators who also recognise bad legislation when they see it. I say good on them for standing up to this government and good on them for ensuring that this government does not have the freedom to reign all over the place when it comes to policy and when it comes to introducing policies that would be damaging to Australia’s national interest. If the Labor Party cannot come up with policies that garner enough support; so be it. It is the Labor Party’s problem to ensure that they get the support of crossbench senators to get their legislative agenda through.

In addition to that, you have really got to scratch your head when the Australian Labor Party stands up in this chamber and says, ‘How unfortunate and how dare the coalition block our attempts to make private health insurance less attractive to the Australian people.’ This is from the government whose Prime Minister, before the last election, hand on heart, said: ‘We will not touch private health insurance. Trust us. The Australian Labor Party has no ideological war with private health insurance. You can trust us. We won’t touch it; we won’t do anything to it.’ That is basically what the Prime Minister said. Lo and behold, less than two years later the original moves to gut private health insurance were made by the Labor Party. They have the audacity to come into this chamber and say, ‘How dare the coalition block it.’ I would say the Australian people recognise when a government is breaking a promise. How absolutely absurd for a member of the Australian Labor Party to come into the chamber and say, ‘How dare the coalition block our attempts to gut private health insurance.’ You know what? My response to the Australian Labor Party is: honour your election promises. How dare the Prime Minister walk into this House and seek to make a change to private health insurance after he promised that he would not.

Government Members:

Government members interjecting—

Steven Ciobo (Moncrieff, Liberal Party, Shadow Minister for Youth and Sport) Share this | Link to this | Hansard source

I see the sensitivity of Labor members now.

Craig Emerson (Rankin, Australian Labor Party, Minister Assisting the Finance Minister on Deregulation) Share this | Link to this | Hansard source

Mr Deputy Speaker, I draw your attention to the departure by the member for Moncrieff—

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

What is your point of order?

Craig Emerson (Rankin, Australian Labor Party, Minister Assisting the Finance Minister on Deregulation) Share this | Link to this | Hansard source

It is on relevance. He is being irrelevant, and we are seeking to honour election promises and they are being blocked.

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

The minister has no point of order. The member for Moncrieff will continue.

Steven Ciobo (Moncrieff, Liberal Party, Shadow Minister for Youth and Sport) Share this | Link to this | Hansard source

We see the sensitivity of Labor members in this chamber. I notice that the minister at the table, the honourable member for Rankin, did not jump up when the member for Petrie was talking about this exact same issue. I notice the Labor members were nowhere to be seen when it came to the member for Petrie talking about the injustices of the coalition trying to force the Labor Party to honour their election promises. But now, when the truth comes out, we see them springing up trying to take points of order.

Let us look at the health system in this country, because we all know that one of the other promises made by the Prime Minister was that the buck would stop with him when it came to Australia’s health system. Now, two years later, we have the absolute debacle of administration of health in this country as the Prime Minister desperately tries to get state governments to stitch together and sign up to his particular initiative, if you want to call it that, on health. We saw the Labor Premier In Victoria, John Brumby, absolutely tear apart this Prime Minister and this government’s latest proposal when it comes to health and ask how it is possible that the Labor Party, which signed up to the most recent GST arrangements, would now seek to rip those apart and leave state governments in a situation where they have far less money to run their own states and their own health systems and instead try to siphon off 30 per cent of that money to the federal government. Little wonder that Colin Barnett, John Brumby and, I predict, probably Kristina Keneally and others will rail against this government’s myopic approach to health administration in this country.

On a final point when it comes to health, I would like to touch upon Labor’s much vaunted proposal, which I believe should be much maligned, to deal with health through GP superclinics. In my own electorate of Moncrieff on the Gold Coast, the fastest growing region in this country, the coalition introduced a number of initiatives when we were in power to help provide Gold Coasters with greater access to health. One of those was funding for doctors to be able to treat patients after hours. The Labor Party said that that was not necessary because they would introduce a GP superclinic, which would facilitate access to doctors by the general public. In my seat they axed funding for after-hours medical treatment. What did they do? It would be logical to conclude they would have built a GP superclinic. But, no, here we are two years later, the sixth largest city in the country, and we have no GP superclinic. This is a government that ignores the sixth largest city in this country and expects to get the support of its citizens. They can forget about it, absolutely forget about it. I turn my back on their failed policies and I know my constituents will as well.

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

It is because I rise to very clearly support the legislation that we are currently debating—the Healthcare Identifiers Bill 2010 and cognate legislation—and also because I am afraid that my colleague the member for Rankin will take a point of order on relevance, that I would like to address my remarks to the legislation rather than counter the irrelevant diatribe that we just heard in the last half of the member for Moncrieff’s speech.

This is a significant piece of legislation and, yes, there are issues that must be dealt with when it comes to dealing with people’s health records, and I will come to some of those issues in a minute. Can I begin by saying that this legislation introduces a 16-digit number which could be the difference in saving someone’s life or indeed improving their quality of health care and therefore their wellbeing for the rest of their life. It is absolutely essential that, if we are going to provide better quality health care in this country—and we all acknowledge, across all levels of government and across the broader community, that there is a need to improve our health system—then we need to embrace the advantages of the digital age, the advantages of new technology, and look at ways in which we can use that technology to improve the healthcare system. This 16-digit number, the individual health indicator, that will be provided to every Australian will go a long way to improving the quality of health care. It is an important initiative. It is not a new one. It was agreed by COAG in 2006, which was prior to the election of the Rudd government, and indeed it was affirmed again by COAG in 2008. Clearly all of those in the government involved in the provision of healthcare services, whether at the state or Commonwealth level, acknowledge that this is a single, very significant reform that will improve health care for all Australians.

We acknowledge that the fundamental premise for anyone using the health system and being provided proper health care is the qualifications and skill of the medical practitioner they go to see. That is essential. But this particular reform means that we have acknowledged that sometimes even the most qualified, well-trained and clever medical practitioner can make a mistake or not provide the best health solution for that individual patient simply because they do not have all of the information or they do not have accurate information that will assist them in their diagnosis and their prescribed solution.

This is a very important reform because it adds to the very skilled work done by our medical professionals. It makes their job easier and it also makes their job better in terms of providing appropriate health care. The statistics show that. There have been studies done in hospitals that show somewhere between 17 and 19 per cent of tests are unnecessary duplicates simply because there is a lack of information about a patient’s medical history. More significantly, 18 per cent of those tests showed medical errors were attributed to a lack of information. So we are not just talking about duplication or unnecessary treatments for people who have a medical history. We are actually talking about the potential for a wrong diagnosis or a wrong treatment. Eighteen per cent of those tests showed medical errors attributed to a lack of information.

So doesn’t it make sense for us to introduce a single, simple process at a national level which provides accuracy and consistency of information that will give everyone accessing the health services greater confidence that their medical practitioner, the health professional they have gone to see, will be able to give them the best quality care because they have all the information they need at their fingertips? It makes perfect sense. It is something I applaud the Prime Minister and the Minister for Health and Ageing for introducing.

I think it is interesting that even amongst the broader medical community there is strong support for this initiative. In fact, during the consultations that occurred around the Health and Hospitals Reform Commission report, I invited a number of local health professionals within my electorate of Bonner to come and discuss with me the proposals that were put forward by the commission. We had a range of people there. We had nurses, doctors, allied health workers and people who worked in aged care in nursing homes—a broad range of people involved in the health sector. They were all very experienced and skilled people and obviously very committed because they took time out of their busy days to come and sit down and have a discussion about the ways that they believed the health system could be improved. They offered us a range of suggestions that I think were very interesting and very exciting. What stood out to me was that, to a person in that room, the single reform they all said could change the quality of health care in this country was moving towards e-health and having a consistent and accurate database of information that was easily accessible by health professionals and health providers across the nation so that, no matter where you were or who you were, your medical history would be available to anyone you went to see because you needed medical advice or medical assistance.

I am very pleased that, having consulted with my local community, obviously this initiative has been reflected across the broader community and has come out as part of a recommendation in the reform commission’s report and has been acknowledged by the minister to the extent that we now have this legislation before us. I think this is a very exciting initiative. I know amongst the broader medical community and across the general Australian community there will be an acknowledgement that this will significantly improve our health system.

Of course, we will have to be mindful that there are issues around introducing an identification number. We have to be mindful that people are quite rightly concerned about anything that they may see as intruding on their privacy, particularly with something as sensitive as their medical history and health information. It would not be acceptable to anybody in this parliament if legislation were introduced that did not reflect and honour the need to protect privacy wherever appropriate. That is why I am pleased that as a result of this bill the health minister has included a number of initiatives and a number of safeguards that go towards protecting privacy. Indeed, the bill was drafted after three privacy impact assessments had been done, and all of the issues and concerns raised as a result of those assessments have been included in this legislation. It is important to point out to those opposite and those in the broader community who will want to make a bigger issue about the privacy impact of this legislation than the significant and positive improvements that this reform will make that safeguards have been identified to ensure that minimal demographic information will be required to assign and obtain healthcare identifiers. The service itself will not be the retainer of all that medical information. There will be minimal information in order to simply provide the process needed for health providers accessing this.

No clinical information will be held by the service operator. Only authorised healthcare providers will be able to access the healthcare identifier service and obtain healthcare identifiers for their existing patients. The Medicare card and the Department of Veterans’ Affairs treatment card are to be used as tokens to obtain an individual’s healthcare identifier. So it is very clear that the minister has listened to any concerns about privacy and has included very important and appropriate initiatives within this bill to ensure that we allow this service to be introduced and we enable medical practitioners to access significant information to support them in their job of caring for and curing the Australian community, but not at the expense of the privacy of information.

I said it earlier, but, on that point, I do think that I need to address some of the doomsday pessimism coming from those opposite on this issue. We do live in a digital age. Almost every single thing we do these days depends on a computer or some form of new technology. Information these days is disseminated, accessed and spread by new technologies. People pay for all sorts of goods and services using their credit cards over the internet. We know that this is no longer a novelty. We know it is not some sort of new thing that we like the look of but should be a little bit scared about. This is actually the way that we conduct our day-to-day business, so I do not think we need to be too scared anymore of using the advantages that these new technologies provide to improve the services that we as a government are responsible for providing to the Australian community. We need to embrace technology and use it for better. There is no better example than this bill, which takes advantage of technology through the simplicity of a national database and a 16-digit number—that is all it needs to be—to make the difference between living a good and healthy life and finding suffering and pain as a result of a wrong diagnosis or a wrong treatment. I think the bill speaks for itself and I commend it to the parliament.

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

I rise to speak on the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010, which will see the introduction of a 16-digit identifier for every Australian and every healthcare provider. The introduction of these individual healthcare identifiers is a part of establishing a national e-health system for the future. Healthcare identifiers are just the first step in establishing this system to ensure a more cohesive, coordinated healthcare system for Australian patients.

The coalition is supportive of the concept of e-health. However, we, and I particularly, have very serious concerns and issues about the security of information under the system. An e-health system would provide an opportunity to improve health care in Australia. We have a healthcare system that we know is under pressure. For this reason, it is important to continue to improve health care in Australia across the board. As we know, Australia is behind countries such as Great Britain, Germany and Canada in the implementation of e-health measures. The systems introduced in these countries share diagnostic imagery between providers and e-prescription services and facilitate communication between providers, reducing the silo method of treating patients—important to each patient.

However, as I mentioned earlier, while I believe that a national system will provide for greater consistency of health care, I have a number of concerns surrounding the privacy and the security of patient information. In introducing the system, the government must categorically guarantee the security of patients’ information under this system. There are no ifs and buts—it must guarantee that. My questions arise because the government is yet to really outline the stringent regulatory framework to ensure absolute security of health information further into the future.

I note that, in an article in the Sydney Morning Herald, the National E-Health Transition Authority has admitted it is yet to decide how access control would work, yet we have the bill before the House today. To further compound the problem, the system is due to start on 1 July, yet the software makers have not yet been provided with the specifications to design an appropriate IT framework or to integrate healthcare identifiers into existing software packages. This alone should be of concern to everyone in this parliament. We have previously seen firsthand the problems of rushed and bungled legislation—the tragic Home Insulation Program, for example.

I have very genuine concerns about exactly how the government will guarantee the security of this patient information. That and the lack of thoroughness of this legislation have also been raised by doctors and others. An article in the Australian on 19 January stated that doctors and other experts have raised concerns about breaches of patient privacy and criticised the rushed and limited one-month consultation period for the new laws—conducted over a holiday period. The article quoted the Royal Australian College of GPs as stating that greater clarity was needed about who would have access to patient information and whether doctors needed their patient’s consent before using a healthcare identification number. Recently we have heard that Medicare has investigated over 1,000 employees for potential unauthorised access to client records in the past three years. If Medicare is going to be the handler of Australian patients’ personal information, then clearly we have very serious concerns about the security and integrity of these processes.

The National E-Health Transition Authority’s Dr Haikerwal also raised concerns over the Labor government’s proposed e-health legislation, but this time in regard to the costs of the system. In the Herald Sun, Dr Haikerwal said:

If you look at e-health systems around the world, the cost falls on to the shoulders of the healthcare providers; the benefits are reaped by the patients and Government.

The government released a discussion paper in June 2009 and drafted this legislation in December 2009. Fifty-five organisations and individuals made submissions on the draft legislation and while most were supportive of the legislation they raised a number of technical points, including the possibility that doctors may be in breach of legislation by disclosing healthcare recipients’ identifiers, the exclusion of private health funds from using the new healthcare identifiers and the compliance costs of an extra level of privacy legislation.

As I have stated previously, we continually see examples of the Labor government rushing health legislation without serious, detailed and inclusive consultative processes. We saw the government’s attempt to target thousands of Australians by proposing that the most vulnerable, those needing cataract surgery, would have to pay hundreds of dollars more for life-changing cataract surgery. As we know, the majority of those are seniors—the very people who can least afford to pay more. There was the IVF debacle where the minister was forced to backflip on the government’s proposed halving of the Medicare rebate for IVF treatment. The WA Liberal government has also expressed concerns about the rollout of GP superclinics in Western Australia, and we have also seen the Labor government continue its attack on those with private health insurance. Fortunately for those holders of private health cover in my electorate, the Senate voted against that legislation two days ago.

Australians deserve a national system that will provide for greater consistency of health care but, in such a system, they also must have absolute confidence in the government guaranteeing complete security of their private information. I am particularly interested in, but extremely concerned with, the processes that the government will use to provide this guarantee of privacy and the penalties for those who access, use, pass on or sell the information.

An article in the Medical Observer referring to Medicare staff who had accessed patients’ information illegally quotes a Medicare spokesperson as saying:

… there would be an audit log of all access to healthcare identifier systems, which would be used to identify potential inappropriate access.

Well, this is no deterrent at all. This is like shutting the gate after the horse has bolted. And I have no doubt that those seeking to access the information will still do so. The Medicare spokesperson went on to say that ‘customers would also be able to use the log to learn when their UHI record had been accessed’. Again, this is too late. Who has it? Where is it? What is being done with it? You might be able to identify that someone has accessed it, but they have already got it and it has gone. I do not know what sort of comfort that will be to people. If you can tell your UHI record has been accessed, it is already too late. Whoever wanted that information, such as someone with potential commercial gain, already has it. And, in a broader e-health sense, I would suggest that no Australian would want their personal medical information broadcast to the world or used for any purpose without their express permission. I can only imagine the concerns of someone who may be suffering from depression or any member who has any particular personal or private medical condition—and such conditions are often extremely sensitive—and the trauma for those same people if those details are publicised or used illegally.

The very same article in the Medical Observer quoted Dr David More, a health IT consultant, as saying:

If Medicare can not manage its own staff, and not have them snooping, then we have to wonder about trusting them with the UHI numbers, and eventually with e-health records …

I share Dr More’s concern and hope that he is one person whom the Senate inquiry takes evidence from. I want to see the security measures for the storage and transfer of e-health details and the regulatory framework in which e-health is set to operate.

As a member of the House of Representatives Standing Committee on Communications, which is currently investigating cybercrime, I make a very, very strong recommendation also that the Senate inquiry take evidence and information from those involved in investigating cybercrime, such as the Australian Federal Police, state based technology crime investigation units, security organisations and various cybercrime agencies. Given the evidence we have taken during the hearings into cybercrime, I think there is a serious issue in relation to the capacity of government to guarantee the security of patients’ information from both domestic and international hackers, from organised crime elements in time and from those who seek to profit from the information contained in patients’ records—and there will be many who have a very direct and significant commercial and vested interest in e-health records. There are also those, I would suggest, who would be prepared to pay, and pay well, for perhaps Medicare staff, or whoever has access to the healthcare identifier systems, to allow them to access information. We do not need another rushed program. The potential for misuse and harm is too great. The Senate inquiry must fully explore and expose any and all of the potential flaws in this proposal.

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

I am pleased to speak this morning in support of the Healthcare Identifiers Bill 2010 and its related bill. This bill is designed to establish a national Healthcare Identifiers Service. It also sets out arrangements for its operation and its functions, which will be to assign, issue and maintain healthcare identifiers for individuals, healthcare providers and organisations. This bill is one of many that we have had before the parliament through the term of this government that is about preparing our healthcare system for the future, making sure that the healthcare system that Australians rely on now will be there for them well into the future, delivering the care and the services they need.

When the Rudd Labor government took office in 2007 we knew that we had a lot of work ahead of us to undo the damage done to Australia’s health system by 11 years of the Howard government’s neglect and underfunding. Who can forget the legacy of the former Howard government’s health minister, now Leader of the Opposition, Tony Abbott, who presided over the ripping out of $1 billion from the public hospital system? Our constituents are still feeling the effects of his decision to cap GP training places each time they call their local doctor’s clinic to be told that there will be a week’s wait to see a doctor or, even worse, that the books at that particular clinic are closed to new patients.

We got to work on this huge task straightaway. Already in our two years of office the government has put significant new funding into health and put forward initiatives to solve some of the immediate problems we inherited from the previous coalition government. There has been a 50 per cent increase in hospital funding over the next five years in Australian healthcare agreements with the states and territories, and this represents a $64 billion investment. We have committed an unprecedented $1.1 billion investment towards training our doctors, nurses and health professionals, not the least of which is a 35 per cent increase in the number of GP training places. We are funding a rural doctors incentive scheme that now extends to 500 additional communities, and I am pleased to say that a number of those communities are in my electorate. As a result, there are incentives for 2,400 additional doctors to encourage them to stay in the bush.

There is now a greater emphasis on preventative measures, including an $872 million investment in programs to be rolled out in schools, workplaces and local communities to focus on reducing risk factors such as smoking and obesity and encourage people to increase their physical activity and eat healthily. For the first time, the Australian government is investing more than $1.8 billion directly into expanding emergency departments, post-acute care and elective surgery. Also for the first time, the Australian government is investing directly in the capital needs of local hospitals. Rockhampton Base Hospital, which is the largest hospital in Capricornia, received $76 million in last year’s budget for an expansion that will mean more operating facilities, more training facilities and a capacity for the hospital to deliver more cancer services in the future.

This funding, which is not insignificant, and these initiatives deal with some of the most pressing issues, such as waiting lists, infrastructure and workforce. But we know that we have a health system that is stretched to breaking point right now and is in no shape to cope with the demands of the future. That is why the government has also engaged in the extremely challenging work of looking at the structural reform required to meet those and other future demands. The report produced last year by the Health and Hospitals Reform Commission was very clear—our health system is not prepared for future challenges, for a number of reasons. Those challenges are well known to all of us. First of all, we know that we are facing an ageing population, and that means an increase in the healthcare needs of the overall community and an increase in the cost of meeting those needs. Our population overall will grow, calling for more health services infrastructure and a larger health workforce.

The rates of chronic disease are projected to grow. For example, type 2 diabetes is projected to increase by more than 520 per cent between 2002 and 2032. That is a staggering increase over a relatively short time. The workforce shortages that already impact on our health system will not go away. We need to be training more health professionals and doing more to make the most of the skills of the various parts of the health workforce. The recent Intergenerational report reinforced the need for change. That report included estimates that by halfway through the century health costs would consume the entire revenue raised by state governments. Furthermore, the ballooning of health costs presents risks to the entire Australian economy. In light of those warnings, the only answer is reform of the health system in a big way.

Again, the work of the Health and Hospitals Reform Commission highlighted the weaknesses in our present system that need to be addressed if our health system is to be strong and sustainable into the future, if it is going to be there for all Australians in the way we have rightly come to expect. The first of these weaknesses is that there is too much blame and fragmentation going on amongst governments. At the moment we have eight different health systems split between our states and territories, and we also have Commonwealth funding for various parts of the health system but this is not necessarily in any logical order. Responsibilities for health between the different levels of government are very unclear, resulting in duplication, cost shifting and blame shifting.

The classic example that always comes to my mind is a community in my electorate where there is a small rural hospital and right next to the hospital is a GP clinic. The same doctor services the public hospital and has the right of private practice. There is no problem with that, but you end up with patients being sent over to have a procedure done in his clinic, I do not believe for any clinical reason—it is the same doctor—but the cost then does not come out of the Queensland Health budget attached to the hospital; it is billed to the Commonwealth through Medicare. I do not think there is any healthcare impact of people having to walk from the hospital to the surgery, but it just highlights the unnecessary cost shifting and complication that is there, just in one small town in my electorate. If you can imagine that happening right across the health system, you can understand why that fragmentation and those incentives for cost shifting are such a problem.

There are also gaps and poor coordination in health services that people need. So, again, particularly elderly people or people with chronic illnesses will be accessing a suite of different services being provided by a whole range of health providers. Some of those are going to be Commonwealth funded and some will be state funded, and some will be half and half. When there are those gaps or this lack of coordination, you can just see that there is room for people to fall through the cracks and not have their health needs met, or certainly not have them met in an efficient or timely manner.

There is too much pressure on our public hospitals and health professionals. In Australia we have much higher rates of hospital admission than other comparable countries. Our public hospitals are just the default for anything that happens in our health system, and of course we know that that is not the most efficient or cost-effective way of dealing with many of the health problems that we have. Certainly as we look into the future, where chronic disease is going to take up much more of the health system’s time and resources, public hospitals will not necessarily be the answer to meeting those needs.

There is also too much waste and inefficiency. The Commonwealth government currently funds states with block grants for public hospital services. Even though we know that some states are delivering services more efficiently than others, it is still difficult to identify exactly where that is happening and to reward those who are meeting best practice. The government has seen the warnings in the Intergenerational report and from the Health and Hospitals Reform Commission and have also listened to the views and experiences of thousands of health professionals and advocates during more than 100 consultations in hospitals and communities around the country. We are convinced that now is the time to act if we are to build an efficient and reliable healthcare system, and that is what we are going to do.

A major part of the government’s reform plan for health was announced last week. For the first time the Commonwealth government will take on majority funding responsibility for public hospitals, along with full funding and policy responsibility for GP and primary health care. The government will use its position as the majority funder of health and hospital services to impose strong national standards for health care and build a nationally unified health system. That is the plan that will go for discussion to the COAG meeting with the premiers at the beginning of April. We hope that the premiers can come on board with that plan because the warning in the Intergenerational report was that state revenue bases are just not going to be able to handle the pressures coming down the line towards them—the demands from the healthcare system. They are not going to have the financial wherewithal to deal with those pressures and this is a way for the Commonwealth government to step up and take on that financial responsibility—but, through assuming that responsibility, we also want to be able to build a properly unified health system that overcomes some of those current weaknesses that were identified in the Health and Hospitals Reform Commission report.

As I said at the outset, this bill is part of the government’s looking to the future and looking to what we need to do to prepare a future health system that is strong, sustainable and on a financially secure footing. One of the areas that the Health and Hospitals Reform Commission spent some time on in their report was the whole question of e-health—electronic health. That is what this bill is taking steps towards. The Healthcare Identifiers Service will be asked to provide a national capability to accurately and uniquely identify individuals and healthcare providers to enable reliable healthcare related communication between individuals, providers and provider organisations. This is something that the previous government and COAG have been working towards for some time now. There is a general recognition that we have to do much more in the area of e-health if we are to capture the efficiencies, increase effectiveness and have better coordination within our healthcare system.

I was reading through the national e-health strategy, which was prepared for the government by Deloittes. They put the benefits of e-health as moving towards an individual electronic health record that each patient, each person, in Australia will have control of and that will seamlessly and efficiently transfer information about that individual patient to all the sections of the healthcare system that they interact with. The challenge that the national e-health strategy report puts out is:

The Australian health system is straining to deal with increasing cost and demand pressures and a shortage of skilled health workers. Given this reality, we need to move to a system where every interaction between consumers and care providers achieves maximum impact on health outcomes and where scarce financial and human resources are deployed as effectively as possible.

I believe an individual electronic health record does give consumers and individuals much more power and input into managing their health and their interaction with the health system. It also means that care providers and healthcare managers can reliably and securely access and share health information in real time across geographic and health sector boundaries.

When you look at what we are missing out on in this area under the present system, you see there are real costs. Most seriously and significantly, costs occur in the medical areas when there are bits of paper held all over the place—some in the public hospitals and some with your GP. Some of the figures show that up to 10 per cent of visits to GPs are of people seeing that GP for the first time. I am not sure whether that is the figure I read in preparation for today, but I wonder whether it might be even a higher figure than that. When you have people travelling around in an electorate like mine, where a lot of people are doing fly-in fly-out work in the mining industry, there is a lot of mobility between communities. Studies have found that up to 18 per cent of medical errors are due to the inadequate availability of patient information, because at the moment it is up to patients to be transferring all of that information and taking that information with them and making sure they are giving it to the right person at the right time. These adverse events coming out of that lack of coordination represent approximately $3 billion in avoidable annual expenditure, money that could be better spent absorbing additional health sector demands driven by an ageing and sicker population. The government is convinced that this is the right way to go, that we should be moving towards the development of electronic health records, but putting in place the Healthcare Identifiers Service is the first step. 

The previous speaker talked about the issues of privacy and the integrity and security of information contained in any electronic health system. That is a big part of what the Healthcare Identifiers Service will be doing. This legislation also makes minor amendments to the Privacy Act 1988 and the Health Insurance Act 1973 to support the robust privacy framework which has been developed for the Healthcare Identifiers Service. Privacy and security of that information is very important.

I notice, in reading the e-health strategy documents, that with an electronic health record the idea is for the consumer, the individual, to have control, to have access to that record. In some ways, that actually gives some more security and more peace of mind than might otherwise be the case. That kind of electronic sharing of data brings with it a trail or a record so that the individual consumer can keep track of who has accessed that information. I know that I have a health file at the Rockhampton Base Hospital, but how do I know where it is right now, who might be looking at it, who looked at it yesterday or what they did with it? The evidence there on electronic health records indicates that there is the capacity for those records to have an electronic trail that would allow consumers to give themselves peace of mind on who is accessing their information, when and why.

This legislation is very clear on the importance of that privacy. It explicitly limits the adoption, use and disclosure of healthcare identifiers to healthcare information management and communication purposes as part of delivering healthcare services or for other related purposes. There are also penalties for the misuse of healthcare identifiers by the Healthcare Identifiers Service operator or any other persons or organisations.

We are going to continue towards the development of this electronic health capacity, because we see that it is complementary to what we are trying to do in reducing the fragmentation and duplication that goes on in our current system. I support the legislation that is before the House.

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

Before I start my speech, I would like to commend the member for Capricornia for her models on the increasing incidence of chronic disease. I support her in a lot of what she said.

The Healthcare Identifiers Bill 2010 aims to implement a national system for consistent identification of customers and healthcare providers, and it sets out purposes for which healthcare identifiers can be used.

In July 2004, health ministers endorsed the formation of the jointly funded National E-Health Transition Authority. The authority was to be responsible for establishing a national health information management and information and communication technology entity. One of its fundamental objectives was the development of a patient identification system, which, together with a product and medicines database and national provider index, was to contribute to a national shared e-health record. COAG agreed to accelerate the development of a national electronic health records system in 2006 with funding of $130 million to June 2009.

In 2007 COAG agreed to a further $218 million over three years and signed the National Partnership Agreement on E-Health. This signed agreement outlines a framework for cooperative jurisdictional arrangements and responsibilities for e-health. It sets out the objectives and scope for the Healthcare Identifiers Service, as well as relevant governance, legislative, administrative and financial arrangements. Once enacted, this bill will operate in conjunction with this agreement to support the operation of the service.

Implementation of a national healthcare identifiers system will: support messaging from one healthcare provider to another by providing a consistent identifier that can be used in communication; facilitate electronic communications between providers by establishing a way for healthcare providers to look up the contact details of other healthcare providers; and support the implementation of a security and access framework to ensure the appropriate authorisation and authentication of healthcare providers who access national e-health infrastructure.

The communication of health information and accurate identification of individuals is a critical part of effective health care. It is estimated that 10 per cent of hospital admissions are due to adverse drug events and up to 18 per cent of medical errors are a result of inadequate access to patient information. The use of individual healthcare identifiers will assist healthcare providers to accurately match the correct records to their patients and improve the accuracy when communicating information to other healthcare providers.

Greater accuracy of information available is not only critical to effective health care for the individual but it also enables greater efficiency and productivity. Other countries which have implemented e-health systems have demonstrated significant improvements in productivity. It is thought that the implementation of e-prescriptions in Sweden, Boston and Denmark has reduced providers’ costs and time, resulting in an improvement of productivity of over 50 per cent. E-referrals in Denmark have reduced the average time spent on referrals by 97 per cent; and in America and France test ordering and results management systems have reduced time spent by physicians chasing up test results by over 70 per cent.

By outlining solutions for e-prescriptions, e-referrals and electronic test ordering, it is estimated that Australia’s e-health strategy will reduce by 10 per cent the time currently spent by care providers in discovering information. This conservative figure may not sound significant, but in net present value terms this is in the order of $2.8 billion over 10 years. Around 25 per cent of a clinician’s time is spent seeking information about a patient, and 35 per cent of referrals are inappropriate as a result of insufficient direct access to specialists and insufficient information being passed from primary care to specialist. I can vouch for that problem.

Another concerning issue within our healthcare system is unnecessary or duplicated treatments. It is thought that unnecessary duplicate testing in hospital environments occurs at a rate of around nine per cent to 17 per cent—and I would suggest that that is a pretty conservative estimate. It is estimated that the implementation of e-health will result in a 15 per cent reduction in unnecessary tests. Based upon an average cost of $36 per test this would result in benefits of around $800 million in net present value over a 10-year period.

Although those healthcare providers who elect to participate may incur some costs associated with complying with required regulations, the system will result in efficiencies in a number of areas. The use of identifier numbers is likely to result in improved business practices and more efficient communication with other providers. Costs that may be incurred would include the upgrading of IT systems to incorporate appropriate minimum standards and security features to access the Healthcare Identifiers Service. However, the service draws heavily on the same IT infrastructure as Medicare Online. So for those providers that already have this in place that will be of no concern. The other cost will be the time required to educate and train staff; however, reference materials will be available to minimise this time outlay. A public awareness program via a range of methods will provide consumers with information about the service and its benefits. Those healthcare provider organisations that elect to participate in the service will also be provided with materials and appropriate sources of information to provide to patients.

An individual healthcare identifier will not be required for claiming healthcare benefits. So, if the healthcare provider is unable to obtain a person’s identifier for whatever reason, the patient may still undergo treatment. The implementation of the system will not affect anonymous healthcare services that are currently provided. Where lawful and practical, individuals may still seek healthcare treatments and services on an anonymous basis.

As Medicare Australia will be the operator of the Healthcare Identifiers Service, the bill confers functions upon the CEO of Medicare Australia. These functions include: assigning, collecting and maintaining identifiers for individuals, individual healthcare providers and organisations by using information already held by Medicare Australia for its existing functions; collecting information from individuals and other data sources; developing and maintaining mechanisms for users to access their own records and to correct or update details; using and disclosing healthcare identifiers and associated personal information for the purposes of operating the service; and disclosing healthcare identifiers for other purposes set out in the bill.

The bill outlines what permitted purposes for identifiers may be disclosed and the offences and relevant penalties for misuse or breach of the legislation. This clear framework supports the proper use and disclosure of healthcare identifiers. The Federal Privacy Commissioner will provide independent regulation of how healthcare identifiers are handled and of the operation of the service and will handle any complaints that are made. Where states have existing privacy arrangements, including an appropriate regulator, that regulator will be responsible for handling complaints which are made against a public sector organisation in their jurisdiction. For those states and territories that do not have such arrangements, these will also be handled by the Federal Privacy Commissioner.

The bill also establishes a ministerial council, whose key functions include development and review of regulations to support the operation of the service and the issuing of policy directions to the service operator, Medicare.

The service will be funded until 30 June 2012 as part of the $218 million allocated by COAG to the National E-Health Transition Authority. Of the $218 million, $52.02 million has been allocated to the operation of the service by Medicare. Funding beyond this date will need to be determined between the states and territories and the Commonwealth. In addition to this funding, $0.5 million has been allocated by the Commonwealth for the Office of the Federal Privacy Commissioner for regulatory oversight and advice on the introduction of the identifiers.

In summary, a national e-health system will improve safety and quality of healthcare in this country. It will improve access for healthcare providers to reliable healthcare information when and where it is needed. It will enhance shared care of complex medical problems and chronic disease. I would emphasise that as a major failure of Medicare currently, which is dysfunctional in the management of chronic disease. A national e-health system will reduce the burden on the health sector through better health management; improve healthcare planning to ensure resources are directed to where they are needed most; and, most importantly, save lives through better decision support, increased access to information and reduction of adverse events.

Obviously, there must be appropriate security measures and standards imposed throughout the health sector to ensure that privacy and confidentially of information are maintained and that there is the capacity for effective handling of complaints and review of the service. I would suggest, just light heartedly, that it is better to be alive and well than to have a little confidentiality breached and be dead. A bill which aims to introduce such a national e-health system is to be commended.

Darren Cheeseman (Corangamite, Australian Labor Party) Share this | Link to this | Hansard source

I would like to recognise the contribution made by the member for Moore. He has had a long history in health care. As a doctor in this place, he has helped quite a number of members of parliament from time to time.

I take this opportunity to make my contribution in the debate on the Healthcare Identifiers Bill 2010 and cognate bill. This legislation is another example of why Australia’s healthcare system—and of course Labor’s Medicare system is at the heart of our country’s health system—is one of the best systems in the world. This legislation and Labor’s proposed healthcare reform program, as announced by the Prime Minister last week, show a pathway towards maintaining our mantle as having the best system in the world.

This legislation shows a core quality that is one of the primary reasons we have such a fantastic system that is the envy of the world. This quality is the quality of continual improvement. We know we have a fantastic system, but we do need to continue to work on it and refine it to ensure that it delivers for all Australians. We have to be vigilant and keep reviewing and improving our healthcare system. This legislation is about building the best healthcare system for the future—future-proofing our system.

The Healthcare Identifiers Bill will establish a national Healthcare Identifiers Service and sets out arrangements for its operation and its functions which will assign, issue and maintain healthcare identifiers for individuals, healthcare providers and organisations. This bill will provide a national capability to accurately and uniquely identify individuals and healthcare providers to enable reliable healthcare communication between individuals, providers and provider organisations. This approach to healthcare identifiers was agreed by COAG, the Council of Australian Governments, in February 2006 as part of accelerated work on electronic health records to improve patient safety and increase efficiency for healthcare providers.

We know this issue has some risks. The importance of confidentiality and security of information is paramount. So we know there is risk, but we also know that that risk can be managed. We also know we have to take this step for the sake of providing better healthcare services and for the efficiency that electronic health records provide. We also know from similar types of projects in other institutions in our society that we will be able to do it well.

I believe that this is a very big step in developing a future health system that is more efficient, more flexible, more reliable and safer for those involved. This legislation establishes the Healthcare Identifiers Service and allocates functions to Medicare Australia as the initial service operator. Medicare Australia’s existing information and service infrastructure is to be used to establish the individual and provider identifiers.

The key objective of the Healthcare Identifiers Service will be to provide a national capability to accurately and uniquely identify individuals and healthcare providers to enable reliable healthcare related communication between individuals, providers and provider organisations. The identifiers are a fundamental building block for the national e-health system.

E-health has the potential to improve patient safety and of course health outcomes for all of us. We should consider these facts as key drivers. It is estimated that between 30 and 50 per cent of patients with chronic diseases are hospitalised because of inadequate care management. Up to 18 per cent of medical errors are attributed to inadequate availability of patient information and between nine and 17 per cent of pathology and diagnostic tests are unnecessary duplicates. Think of the waste when these statistics are translated into dollars across the system. If we could just halve these error rates—and e-health records hold out real promise in this regard—we would save our country billions of dollars over the decades to come. This money of course could be reinvested into other new and emerging technologies. Think of the many ways this money could be spent to further improve the treatment that patients receive. E-health has the capability to radically improve the amount of waste and, therefore, make our fantastic health system even better at delivering for all of us.

In my electorate of Corangamite, I recently released a four-point plan to improve the health of the region. It is about creating better health solutions in my region. The last federal health minister in the Howard government, Mr Abbott, did tremendous damage by ripping more than a billion dollars out of our health system and capping the number of GP training places. This is having a real impact in regions like Corangamite where there are skill shortages today. The key parts of the plan that I announced strongly support the Rudd government’s health reforms, which will establish local hospital networks to be run by health and financial professionals—who will be responsible for running local hospitals rather than central bureaucracies.

We will work with local councils and sports clubs to apply for one of the Australian government’s Healthy Communities comprehensive five-year intervention trials, whereby sports clubs and officials will be funded to significantly raise the level of participation of young people in sport. This will particularly relate to the Colac Otway region. Sport is fundamental in securing better health outcomes in the long term.

We will work with Deakin University medical school to ensure that nursing training continues to be rolled out across the region as well as the training of new GPs who will be coming out of the Deakin University medical school over the next few years so that they can take up the opportunity to practise medicine in regional communities such as Corangamite.

Better e-health and better data are critical in making and developing the case in each of these areas. If we are able to integrate information and share that information where appropriate amongst healthcare providers and individuals, it will lead to much stronger outcomes for the patients.

The Colac Otway region, which is a very important part of my electorate, has high health needs in different areas and, due to the nature of the region, hospitals are not often that close. The federal government is attempting to undertake a massive shift in our health spending based on preventative health. I think that an e-health record is very important in terms of setting up strong, well thought through, individually tailored, preventative health strategies. Good e-health services are central to that policy shift, in my view.

One of the local proposals I have put forward in the area of preventative health in our region is to secure the opportunity of being part of the five-year preventative health trials, and having strong e-health records will assist with that. I want to see our local shire councils combine with our sports clubs and other health stakeholders to drive participation in sport, and an e-health platform is very much an enabler of that.

The most important organisations in our shire and our region, in terms of keeping young people active, are the sports clubs. Good e-health capabilities will, in my view, enable us to design systems to analyse the impacts that sporting activities might have over a significant period of time.

The federal government’s preventative health strategy has a vision for Australia to be the healthiest country by 2020. The strategy provides the road map for a series of strategic and practical actions to be implemented across all sectors between now and 2020. The preventative health strategy is being driven by projected future costs in our healthcare system, which are experiencing significant pressure particularly because of our ageing population. In light of this projection, in 2006 the Council of Australian Governments, COAG, established the Australian Better Health Initiative with the aim of refocusing the health system towards promoting good health and reducing the burden of chronic disease. Good e-health systems go hand in hand with these initiatives.

These bills are about taking a national approach to ensure that the frameworks and the key infrastructure components are coordinated and aligned across Australia. The Commonwealth portion of funding for the costs of operating the Healthcare Identifiers Service, which totals $52 million over the next couple of years, was agreed through the Strategic Priorities and Budget Committee on 26 November 2008 as part of the total amount of $218 million to provide this e-health framework. The Commmonwealth share will be $26.01 million, which is 50 per cent of those costs. I believe that spending this money is one of the best things we can do to invest in a modern healthcare system for the future.

I should also note that the identifiers will not hold any clinical information. They are not electronic health records but they are a key step in building the infrastructure for an electronic health record into the future. They are the building blocks for a thoroughly modern future health system. Individual health identifiers, IHIs, will be allocated to all individuals who receive health care in Australia, but consumers will not be refused health care if their identifier is not available for some reason. The IHI will be generated as a temporary number in situations where an individual cannot be identified at the point of care—such as in emergency situations such as traffic accidents—or where a person is not entitled to Medicare provisions, such as tourists who have come to Australia.

In conclusion, this legislation has very lengthy origins and was developed as part of a COAG process. I will not go through all of the steps, but, most recently, on 7 December 2009, COAG considered a report on the outcomes of the public consideration on healthcare identifiers and privacy and signed a national partnership agreement setting out cooperation between jurisdictions and arrangements for e-health, including the Healthcare Identifiers Service.

The government has committed to work and consult closely with government agencies, state and territory governments and clinical, community and consumer stakeholders in the rollout of the Health Identifiers Service. The Minister for Health and Ageing is required to have a report prepared on the operation of the IHI service and the legislation, which will be tabled in both houses of parliament. This legislation has all the checks and balances that ought to be required in legislation of this nature. It is legislation that is on the cutting edge of a modern healthcare system in Australia. It is legislation that will be good for Australia, will save billions of dollars into the future and will provide better health outcomes for all of us. I commend these bills to the House.

Tony Zappia (Makin, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010. Since coming to office in November 2007, the Rudd government has embarked on a major reform of the Australian health system, a reform needed in response to both the immediate health needs of today and the changing health needs and growing health costs of the future. Treasury estimates have concluded that by 2045 health spending will consume the entire budget of the state governments. That is something that we certainly need to be aware of and plan for accordingly.

Health needs have weighed down the health services in Australia for over a decade, and I have to say that in that respect the previous government largely ignored the reforms that were needed. We have a national health system that is financially inefficient and which does not deliver the best possible care to the Australian people. The Rudd government has made it a priority to address the inefficiencies in Australia’s health system and to ensure Australians have access to better health services. To date, the Rudd government has increased health and hospital funding by 50 per cent to $64 billion over the next five years. That funding includes: $1.1 billion to train more doctors, nurses and allied health workers, in the largest ever investment in the health workforce; $750 million to take pressure off emergency departments; upgrades of 37 hospitals around the country; $500 million for subacute facilities, including rehabilitation, palliative care, geriatric evaluation and psychogeriatric services; $600 million in an elective surgery waiting list reduction plan that has delivered more than 62,000 procedures, and new elective surgery equipment and operating theatres for 125 hospitals across the country; and $275 million for 36 GP superclinics around Australia. I am pleased to say that one of those GP superclinics is in the electorate of Makin, and if time permits I will talk a little bit more about that later on.

There has been an $872 million investment in preventive health programs to be rolled out in schools, workplaces and local communities with a high incidence of chronic disease; $1.6 billion allocated to close the life-expectancy gap between Indigenous and non-Indigenous Australians; $134 million invested in the rural and remote workforce; and $3.2 billion invested in health infrastructure projects, including $1.5 billion to upgrade 18 hospitals around the country, $1.3 billion over six years to modernise Australia’s cancer infrastructure, $430 million to upgrade 12 medical research and clinical training facilities and $293 million allocated for 2,000 transition care places.

Last week the Prime Minister announced the Rudd government’s national health reform proposal. It is a proposal that brings together the work of the Bennett health review and the subsequent widespread consultation by the government with health service providers and the community around the country as part of that review. Under the Rudd government’s national health reform proposal, the federal government will replace eight separate health systems with a single national health and hospitals network, combining all public hospitals and all GP services and related services; dedicate one-third of GST revenue directly to health and hospitals; and put local hospital networks in charge.

To deliver this system, the federal government will take 60 per cent of funding responsibility for public hospitals, take over full responsibility for GP and related services provided outside of hospitals and pay local hospital networks directly for each hospital service they deliver, rather than just handing over block funding grants to the states.

The measures in this bill are another important step in modernising Australia’s health system. It is a proposal that benefits the patient, the health professionals and the Australian taxpayers. As the Minister for Health and Ageing, Nicola Roxon, stated in her second reading speech:

This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

I note that this system is being implemented after agreement with all the Australian states and territories. In fact it was an agreement reached, if I recall correctly, in November 2008.

The existing system of medical data is outdated, inadequate and wasteful. As other members have pointed out, including the member for Corangamite, who has just spoken, it is estimated that between nine per cent and 17 per cent of medical tests are unnecessary duplicates, wasting both patient time and tens of millions of dollars. I agree with the member for Corangamite, who quite rightly asked the question: wouldn’t those tens of millions of dollars that are being wasted be better spent on services which the community is screaming out for but for which funds are not available? That is a stark example of how our health services across the country could be improved.

Looking at this from a patient’s perspective, we see that up to 18 per cent of medical errors are attributed to inadequate availability of patient information. One wonders about that figure not simply as a percentage but because of the emotional cost that patients incur as a result of medical errors, which in turn occur because the system could be working much better—and making it work much better is exactly what this proposal aims to do.

I am aware that there have been some concerns expressed about this proposal, particularly concerns relating to the privacy of medical information not being properly protected and that wrong medical diagnoses may form part of a patient’s record. I was pleased to hear the member for Moore make a contribution to this debate because as a practicing GP he knows only too well the system that GPs currently operate under. In response to both of those matters, though, it is my view that both of those concerns are valid under today’s management of the health system. The privacy of medical information and wrong medical diagnosis are already issues under the existing system. Whilst it might have been an issue that was raised as part of the response to this proposal, it is my view that it is no greater issue than exists under the current arrangements.

On the issues of privacy and wrong medical diagnosis, the minister has stated that no clinical information will be held by the service operator. Only authorised healthcare providers will be able to access the Healthcare Identifiers Service and obtain healthcare identifiers for their existing patients. The Medicare card and the Department of Veterans’ Affairs treatment card are used as a token to obtain an individual’s healthcare identifier. In fact, the legislation was considered by the Office of the Privacy Commissioner, the Attorney-General’s Department and the Solicitor-General, amongst others. I also note that the issues of privacy are specifically dealt with by the consequential amendments that are attached to this bill.

Australians want the government to deliver a better health system. This message could not have been made clearer than in that which we are seeing in the lead-up to the South Australian state election, where health has become a dominant election issue, as it was in the last state election in 2006 and in the 2007 federal election. There has been a range of commitments made in the lead-up to the state election in South Australia. I am pleased to see that the South Australian Rann government is committing to building a brand new Royal Adelaide Hospital if it is re-elected—a brand new hospital that would deliver after many years the kinds of services that are required by the people of Adelaide; a brand new Royal Adelaide Hospital that has the support of much of the medical community in South Australia. Again, that was made abundantly clear last week when a number of key senior medical people from South Australia openly stated that we needed a new hospital in South Australia. It is a huge investment but it is required to ensure that the health services in South Australia in the future will be able to provide the level of services that the people quite rightly expect.

I am also pleased to see that only yesterday the Premier of South Australia, Mike Rann, committed an additional $44 million to the upgrade of the Modbury Hospital in my electorate of Makin. This $44 million is in addition to a $25 million commitment to establish a GP superclinic almost adjacent to the hospital. It is a $25 million commitment made up of $12.5 million of federal government funds and $12.5 million of state government funds. It will be a service that will complement the services provided by the Modbury Hospital. I reiterate something I said in this House only a couple of weeks ago about the Modbury Hospital. The hospital services the north eastern parts of Adelaide and has done so since 1973, when it was established by the Dunstan Labor government of the time. In 1993 the Liberals came to office in South Australia and immediately privatised the Modbury Hospital. As a result of privatising the Modbury Hospital, the services from that hospital began to deteriorate—so much so that by the time the Labor government was re-elected in 2002 the local community was screaming out for the state government to take back control of the Modbury Hospital. At the expiration of the agreement with Healthscope, which was the private operator that had been managing the Modbury Hospital, in 2007 the state government did exactly that and took back ownership and control of the hospital in every sense of the word.

Since 2002 the Rann Labor government has committed $39 million in additional funding to begin to restore the services that the local community quite properly expect from that hospital. To see an additional commitment now of $44 million towards that hospital is something I certainly welcome. The $44 million includes the development of 25 purpose-built emergency cubicles and the redevelopment of levels 5 and 6 to provide 36 single rooms in those two levels. Those are two levels of the hospital that have been largely unused for several years now. The emergency services are the critical aspects of the hospital that the community wants to see upgraded. Again, as someone who represents the people out there and who has called for the upgrade of the emergency services department, it is something I certainly welcome.

I also welcome, and I have very much supported, the $25 million investment in the GP superclinic. One of the issues that was clearly raised with me when I visited the hospital in the lead-up to the 2007 election was that the hospital emergency department was dealing with an overwhelming number of people who were coming into the hospital but who could, and should, have otherwise gone to their local GP. But because they did not have access to their local GP for a range of services they were using the hospital, thereby draining not only the financial resources of the hospital but also the staff time needed to attend to them. The establishment of a $25 million GP superclinic in close proximity to the hospital will take that kind of pressure off the hospital and allow the hospital to get on with the services which hospitals are built for.

As part of health reform in this country, when the state Labor government came to office it embarked on a similar program to that which I am now seeing the Rudd Labor government do at a national level. I am pleased to see that the South Australian Minister for Health has come out in support of the Rudd government’s national health reform proposals. But the state Labor government at the time also embarked on a proposal of its own where it was going to reform the health system after a lengthy inquiry by Mr John Menadue, who is considered to be an authority on the provision of health services in this country.

Part of that reform meant that there was some restructuring of the Modbury Hospital. But I make it absolutely clear that the Modbury Hospital was built by a Labor government, it was privatised by a Liberal government—demonstrating their lack of interest in the services being provided by the hospital—and it took a state Labor government to bring it back into the public fold and make real commitments to ensuring that the hospital is able to deliver the services that are required. I also point out that, in the years that the hospital was privatised, over the last decade, hospital funding in this country was cut by over $1 billion by the current Leader of the Opposition. It is no wonder that hospitals around the country, including the Modbury Hospital, saw a deterioration in the services they provide. Again, it has taken the Rudd government to reinstate that funding—and in fact increase it by 50 per cent.

These bills, as I said earlier on, are part of a range of reform measures that are required to ensure that into the future we have a health system that people around the country will benefit from, a health system that will be efficient for the Australian people and efficient for Australian taxpayers in that it is not wasteful. It is one of a number of measures. I understand that this is the first step to establishing an e-health records system around the country—again, something that is absolutely necessary in today’s modern society. We have said on many occasions in this place, in respect of a whole range of matters, that we have moved on since Federation. People in this country move around, from one state to another, on a regular basis. Their employment takes them from one place to another. Whether they are on vacation or whether they are studying, Australians move frequently. If people move frequently the best care we can give them is to ensure that the doctors who are treating them at the time have the most up-to-date and accurate records in respect of the health of those people—and that is exactly what this proposal begins to do. I commend the bills to the House.

Mark Butler (Port Adelaide, Australian Labor Party, Parliamentary Secretary for Health) Share this | Link to this | Hansard source

I have some comments to make in relation to both bills. The Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010 seek to establish a single national healthcare identifier system for patients, healthcare providers and healthcare provider organisations. This system will not only facilitate more reliable healthcare related communications and the management of patient information but provide the core infrastructure to develop a national e-health records system.

I would like to thank the members for their contributions to the debate on these bills. E-health has a crucial role to play in ensuring the success of the healthcare reform agenda which the government is currently undertaking. The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.

Governments across the country have invested considerable amounts of time, money and energy in developing e-health initiatives, but until we have a national healthcare identifier system in place there will continue to be a barrier to developing a well connected, national healthcare system. The Healthcare Identifiers Service will establish the infrastructure necessary to support future e-health development by overcoming the fragmented approach that currently exists when it comes to identifying patients and healthcare providers. Combined with a national authentication system, and the appropriate regulatory support, healthcare identifiers will deliver the access and identity requirements critical to ensuring confidence in the way a patient’s health information is handled in an electronic environment.

The bills seek to limit the use of healthcare identifiers to activities regularly associated with the delivery of healthcare, including for communication and information management purposes and other specified purposes, and to establish privacy protections to support the appropriate handling of healthcare identifiers. The government is committed to working with a broad range of patients and healthcare providers to educate them about the healthcare identifiers and the benefits associated with them.

I am aware that there is considerable community and stakeholder interest in this legislation and in the government’s e-health agenda more broadly. That is why the government conducted two rounds of public consultation on the policy proposals and draft exposure legislation in 2009. To further allow as much consultation as possible on these bills the government has referred both bills to Senate Community Affairs Legislation Committee for consideration.

Healthcare identifiers are an essential building block to developing a national e-health system, which will over time improve the way in which healthcare is delivered in this country. This will help to ensure that as a nation we are in a position to continue delivering quality health care to all Australians. I commend the bills to the House.

Question agreed to.

Bill read a second time.