Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services, Health and Wellbeing) Share this | Link to this | Hansard source

The Health Insurance Amendment (Pathology Requests) Bill 2010 is a very straightforward bill. It provides for greater patient choice of pathology services. An individual’s choice of pathology practitioner is currently restricted by the Health Insurance Act 1973. This act requires that in order for a Medicare benefit to be paid for the pathology services rendered, a referral to a named provider is required. This means that a patient must take the request for service to the pathology provider specified by their doctor. This amendment enables a general referral to a pathology provider to be made, allowing patients to have a choice as to who they see. Whilst under the legislation a patient will still be required to have a referral for pathology services, this will be a generic referral and will not restrict the service provider they can visit, as is currently the case. This legislation should foster a system where there is some competition and also, most importantly, choice for patients. It gives patients choice regarding price, location and reputation of the provider.

This amendment brings the treatment for pathology services into line with those for other diagnostic services, where there is no requirement to name a provider in order to receive diagnostic imaging services. Specifically, these amendments ensure that, providing a patient has a current referral to a pathology service or pathologist, they would be entitled to take that referral to the provider of their choice for their service. There is a provision for pathology providers to provide branded request forms, as is currently the case. There is a requirement in this legislation that the patients be aware that they can take the referral to any pathology provider of their choice. There is no prohibition on the referring doctor suggesting a pathologist to their patient. This legislation anticipates that that discussion should occur between patients and their doctors. However, the patient does have a choice as to whether they accept the recommendation of their doctor or whether, for their own reasons, they choose to use the services of another pathology provider.

These proposed amendments have the effect of removing the existing requirement that a pathology request be made to a particular approved pathology practitioner or authority whilst retaining the requirement that a written request for pathology services be made by the treating practitioner. It should allow for more choice than is presently the case, and it should allow for patients to determine to take their business to the pathology provider of their choice, which they might use on the basis of service, on the basis of price or on the basis of locations. The opposition will not be opposing this legislation; it seems a sensible step in providing for more patient choice.

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

At the risk of quoting someone who is not often quoted on this side of the House, I note patients should have freedom to choose, as Milton Friedman said. The truth is patients should be able to choose their GP and they should be able to choose their pathology provider without any cosy arrangements. There was some comment made in relation to the Health Insurance Amendment (Pathology Requests) Bill 2010 by the Royal College of Pathologists of Australasia claiming that it is a professional right of doctors to determine to whom they refer their patients and that that would affect the quality of care. I think that is simply nonsense.

What we are doing here is ensuring better competition and improving the quality of service. It gives patients the opportunity to choose. Doctors will still be able to discuss this issue, as I am sure they do with patients concerning their care. It brings it all into line with other diagnostic imaging requests. It is simply quite amazing that these sorts of cosy arrangements have continued for a long time. Patients will inevitably, on the basis of geographic convenience, price and any number of other reasons, choose the pathologist of their choice. It does not stop doctors discussing this issue with their patients. I am sure that they can do it. Pathology providers will continue to be able to produce branded request forms that include the company logo and address. It simply means that patients have the opportunity as consumers to work out which provider of pathology services they want. In order to do this we have to amend the Health Insurance Act.

This 1973 act, so it goes back a long way, says that there needs to be a particular pathology provider if there is a request in relation to a Medicare-eligible pathology service. This legislation before the House removes that restriction. It means that the doctor will give the patient the opportunity to choose the pathology provider which they want. These legislative amendments take place from the middle of this year. They are well-crafted and necessary amendments, improving the quality of health care. They will improve information. It will mean that doctors will have to discuss this issue with their patients and that there will be competition on price accordingly. There will be a greater opportunity for patients to choose. I think, as many on both sides of this House think, that it is the right of Australians to choose the doctor that they want and that we will see an improvement in pathology services. I have seen correspondence in relation to this from pathologists and from the association which governs them. The correspondence they have undertaken in relation to this matter is quite hysterical. For the life of me I cannot understand why they are not in favour of increased competition and improved patient choice. The legislation that we have provided will make it fairer for patients.

The peak representative bodies have, as I have said, expressed concerns. I think that is rubbish. Doctors are still able to discuss the issue with their patients. Medicare benefits will be payable for pathology services. It will allow the patient to take a pathology request to an approved pathology practitioner of their choice. There will be a transition period of 12 months in respect of the changes to the regulations to minimise any difficulties in terms of the regulatory impact on practices. It will make a difference by having the Department of Health and Ageing undertake a communication strategy to inform the public, as well as doctors and pathologists, about this change. We allocated about $140,000 in the previous budget to undertake this. That includes the funding for the communication strategy. This will benefit patient choice in the community. I think it will improve pathology services and improve the health system. In all the circumstances I commend this legislation to the House.

Peter Slipper (Fisher, Liberal Party) Share this | Link to this | Hansard source

The question is that this bill be now read a second time. In the absence of the honourable member for Bowman, who is due to speak next, I am wondering whether the honourable member for Indi might like to make a short contribution while arrangements are made to have the next scheduled speaker arrive.

Sophie Mirabella (Indi, Liberal Party, Shadow Minister for Innovation, Industry, Science and Research) Share this | Link to this | Hansard source

I am happy to assist the House by rising to speak on the Health Insurance Amendment (Pathology Requests) Bill 2010. This bill is about choice. It is about giving patients choice and we on this side of the House have extended that principle of patient freedom and patient choice. We have been consistent. We have spread that to choice for private health insurance, for example. My electorate is a rural electorate. It is not an electorate with a particularly high income. In it we have over 40 per cent of people covered by private health insurance, because they choose to have it, and in the area of health, where if you do not have technical knowledge you rely on the experts, it is even more important to give patients peace of mind that the choices they make are the best possible choices in terms of selecting those who can look after them, those who can conduct certain tests and those who can guide them through some medical issue or problem.

This particular bill amends the Health Insurance Act. It removes the need for a Medicare-eligible pathology service to be made by a specific pathology provider, thereby allowing a patient to exercise their choice to take their request to a pathology provider of their own choosing. So that does add some additional choice. For once it is good to see the Labor Party in this way, perhaps a small way compared to what they are trying to do to private health insurance, supporting patient choice. I thank the House for the opportunity to be able to contribute to this very important debate.

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

I thank the honourable member for Indi.

Mike Symon (Deakin, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Insurance Amendment (Pathology Requests) Bill 2010. It will provide a choice for Australians who have been referred for a pathology service by their medical practitioner and thus encourage greater competition in the industry.

Pathology testing services are crucial to the ongoing health and wellbeing of all Australians. Pathology tests screen for numerous disorders such as infections, diseases and cancers. They also test body functions. Pathology tests include bowel cancer screening programs, pre-diabetes and cholesterol tests, women’s health programs such as breast screening, biopsies and pap smears, and also men’s health programs. They cover just about every area you can think of.

The contribution of this industry to the nation’s health cannot be overstated. In 2009 the industry delivered $2.1 billion in pathology services for Australians. Over 80 per cent of these services were bulk-billed through Medicare at a cost of $1.8 billion. At 80 per cent of all services provided, this is the highest bulk-billing rate for any medical procedure. Bulk-billing of pathology services is important to ensure that Australians who have been prescribed pathology tests by their medical practitioner go ahead and have their tests taken. Any reduction in the bulk-billing rate of pathology may lead to the situation where patients miss out on important diagnoses due to their wanting to avoid out-of-pocket expenses.

The effect of reducing bulk-billing on the community may be profound if patients choose to forgo tests in the area of pathology. As an example of the importance of pathology services, currently over six per cent of pathology tests are for the presence of type 2 diabetes. Many people who undertake these tests might have spent years not knowing that they were in that situation. So it is vital that they go to a pathology provider as soon as they have been told to do so by their medical practitioner. To reduce the damage of type 2 diabetes to our population, more Australians who are at risk need to take the test in order to find out whether or not they have it. As I said, if there is any impediment to a person undertaking a test once they have been prescribed a check-up, the damage from that delay is long term. Obviously, it accumulates.

Last year, a number of pathology providers wrote to local doctors asking them to identify healthcare cardholders so that they could charge all other patients for services that were currently being bulk-billed. This is a concerning development as it is the belief of the government that pathology services are profitable and that the current practice of bulk-billing should continue, with 80 per cent of pathology services being bulk-billed to Medicare. This bill will give patients the power to choose another pathology service if the recommended service does not bulk-bill, if the service is too far away or if they prefer to attend another practice. This amendment will put pressure on service providers to continue the practice of bulk-billing pathology tests.

The primary effect of this bill is to amend the Health Insurance Act 1973 to remove the current restriction on Medicare funding for pathology tests. Under the Heath Insurance Act 1973 a patient must attend the pathology service specified on the referral from the medical practitioner. The bill will enable patients to have the option of using a pathology service other than that recommended by their medical practitioner. The bill will remove the anomaly that exists between pathology and diagnostic imaging services whereby, under the current act, patients are able to use a diagnostic imaging provider of their choice whilst being given no choice of a pathology service provider. Patient choice is a key element of quality health care, and this bill will open up choice to patients in the area of pathology.

For organisations providing pathology services, this bill will provide them with an opportunity to attract more patients to use their services. The pathology industry estimates that there are 36,000 people directly employed in providing pathology services within Australia. As I mentioned previously, the industry has a national turnover of $2.1 billion. Pathology services generally involve local clinics in the suburbs and towns of Australia, including a number in the electorate of Deakin, as well as transportation and the major laboratories which conduct the tests. The industry covers a very wide-ranging workforce. An example of a pathology lab is Pathlab, which sits just outside the electorate of Deakin, in the suburb of Burwood. Pathlab is an independent lab that was established in 1994. It employs pathologists, graduate scientists, technicians, trained pathology collectors, couriers, clerks and ancillary personnel. In total, over 80 people are employed at Pathlab. For those working in the industry, it is a highly skilled and specialised industry that provides many opportunities. The industry also has many close links with higher education institutions.

The government supports this industry, and I believe that this reform will provide an opportunity for providers of pathology services to differentiate themselves and grow their business. Under this reform, pathology providers will be able to continue producing ‘branded’ request forms and providing them to medical practitioners. The forms may include a list of the locations of that provider’s collection centres and their logos. However, from 1 July 2011 there will be a requirement that the request forms have a clear and understandable and obviously positioned statement, making patients aware that these forms can be taken to any approved pathology practitioner or approved pathology authority. Patients will then be able to make their own choice as to which provider offers them the best service at the best location. Also, for most patients, a key determinant will be whether or not the service provider bulk-bills. Pathology providers can continue their relationships with medical practitioners and, at the same time, build their reputation in the community to grow their business.

This bill will ensure that patients have a right to choose their pathology provider and that they are made aware of that fact. I am sure it will lead to increased competition and better service among providers. This bill will remove anomalies whereby patients can chose providers of medical services other than those offering pathology services. Pathology services make up a substantial part of our health system. Approximately 34 per cent of Medicare activity relates to pathology. In 2007-08 there were 29 million pathology services claimed under Medicare. This bill will provide an opportunity for the industry to compete for patients who have been referred for pathology testing, and it will give patients the power to choose.

The Health Insurance Amendment (Pathology Requests) Bill 2010 is just one part of the Rudd government’s decisive action in delivering a better health system for all Australians. Providing choice of pathology service will give patients the freedom to decide which service they use, and it will give those in the industry an opportunity to differentiate their services from that of others. I commend the bill to the House.

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

This debate would be incomplete were we not to talk about the other part of the Rudd government’s record in pathology services. No-one in this country—no pensioner, no child and no patient sitting in any GP practice—will forget the Rudd government’s decision to slice, to excise and to remove the ability of a pathologist to charge for more than five services in a single request. This has had enormous financial implications for pathologists and it has had enormous implications for seniors who in particular face multiple testing through pathology. This relatively minor bill, the Health Insurance Amendment (Pathology Requests) Bill 2010,is merely an opportunity to remember the three years of this government’s destructive interference in pathology.

No-one could disagree with the idea that a patient should be able to see any pathologist that they wish, but let’s have a small dose of GP-centered reality, which is that most GPs sit there with a bundle of referral pads from which patients can choose for themselves which provider they wish to attend. Let’s be completely honest that the overwhelming majority of patients walk straight outside the GPs surgery and around the corner into a pathology laboratory and have the tests done. And let’s make one other obvious economic observation, and that is that pathology services are pretty interchangeable. They all have sharp needles, haven’t they? They all sting when they go in. It is not as though you are trying to buy a car or a house. This is so often about a blood test or other kind of test, and when it comes to getting that test the services are often completely indistinguishable to patients that attend them. The services are almost identical except for how comfy the chair is that you sit in when you have the test done. So let’s remember the size and scope of this very unambitious and underwhelming bill that is dressed up in the guise of increasing competition.

The previous speaker, the member for Deakin, talked about $2 billion that is spent every year processing 30 million tests. That is a mind-boggling figure in the Australian health system. It represents 34 to 35 per cent of all MBS spending. But do not forget that in pathologists we are dealing with the foot soldiers of the health system, who are often unrecognised and go to extraordinary lengths to deliver services in every corner of this country. If you were to ask me what aspect of pathology services for this country is in most urgent need of reform, I do not think I would be wasting legislative time on only one minor reform enabling a patient to go to any provider they wished. I will give you one priority that is far, far bigger than that: a concessional patient who needs five, six, seven or 10 pathology tests and has a federal government which refuses to rebate the cost of those tests to the pathologist and instead puts the pathologist in the abhorrent position of having to decide whether or not to bulk-bill for the increasing number of tests and increasing expenditure needed to give the care to the patient that Australians expect. That is what the Rudd government did surreptitiously. It introduced an untrustworthy process that did not hide or obfuscate but took away the ability of a patient to be a bulk-billed for a test. In doing that, you simply disadvantage the patients who need more tests done.

I recognise in this chamber the private pathologists, because they stood up to the Rudd government. In the last three years, they started one of the most compelling postcard campaigns that we have seen, saying to this Rudd government, ‘What is the difference between the first and the fifth and the sixth and the seventh pathology test?’ There is no difference. They are ordered by a doctor for good reason. Our Prime Minister decided, ‘No, some tests are more equal than others’, but if you remove the ability to bulk-bill those and even remove the capacity of our health system to fund those tests you leave the patient and the pathologist in that awkward position. In the discussion between a doctor and a patient in every corner of this country, the patient would not say, ‘I want to go to a different pathologist’ but, ‘Why can’t I have those tests bulk-billed? Why must I pay an out-of-pocket cost?’ These changes were implemented by the Rudd government in the hegemony they enjoyed when Mr Rudd had a 70 per cent approval rating. This government thought they could get away with it, but is not forgotten today and it is not forgotten in this legislative debate.

Who are we talking about here? We are talking about nursing-home patients, children who might be 13 or 14 and do not qualify as children under the bulk-billing rules for a pathology practice, and patients who have a pension card or a seniors card and who are worried about no longer being eligible for bulk-billing. What is set up is that invidious situation where patients start choosing for themselves not to have a pathology test because of the cost. They make their own decisions not to get the care they need, because they simply cannot afford it. There is a simple principle at play here, and that is that it is obviously the GPs decision how they charge. Some bulk-bill, some do not and some have mixed practices. But in talking about pathologists, I cannot see the justification for Mr Rudd saying, ‘We will not provide an option for those services to be refunded,’ and that is what this government did.

I spoke earlier of pathologists being the foot soldiers of our health system. They are rarely recognised and rarely congratulated, but they often work in large practices to bring costs down and operate efficient services in pathology. So I think it is really important for us to have a look at pathology’s dedication to bulk-billing. Back in 1996, bulk-billing was used for 80 per cent of all services, and in 2010 it still sits at around 80 per cent. That is in stark contrast to other diagnostic imaging, where bulk-billing is at just over 60 per cent; to Medicare, where it sits at around 75 per cent; to general practice at just under 80 per cent; to specialists at 30 per cent; to obstetrics, where it has climbed from 20 to 39 per cent; and to anaesthetics, at around 10 per cent. Pathologists have stuck by Medicare more than any government ever has. They were loyal and they were absolutely determined to make pathology as cost-free as possible to patients, and this is how they were thanked on the other side of the chamber. It was a disgraceful decision at a time when this Prime Minster cared little for the views of people who attended pathologists for their essential care.

I also want to read in exactly what has happened to pathologists while many other benefits have flowed to other parts of the health profession. It is only right to know the context when we consider how they have been treated by the Rudd government. In Medicare payments, we have seen significant growth to the point where, since 2000, we have seen a 77 per cent expansion in payments made to GPs compared to an increase in average weekly earnings of 56 per cent and a CPI increase of 34 per cent. But pathology, with that $1.8 billion that is spent every year, has seen a growth of just seven per cent since 2000.

I will drill back a little further. Since 1996, we have seen an increase in the CPI of 149 per cent and an increase in average weekly earnings of over 200 per cent while pathology rebates have gone down by 4.9 per cent. You can only use improving technology as an excuse for that up to a point. There are bands within which pathology loyally stays to make sure that prices are as low as possible and then, overlaid upon that, there is a Rudd government that rips the carpet out from under pathologists and simply says to Australia, ‘If you have a few tests we will bulk-bill you, but if you have a few too many it doesn’t matter if you are a retiree, a child or on a concession card, we will not allow those services to be billed through Medicare.’

It was short-sighted. It was foolish. It was penny-pinching, nickel and diming, from the Rudd government. That is what we saw in so many cases until they hit the screen and there was a need for a political pre-election escape. Then the money flowed, and we are now learning just how much of that will be spent on wasteful regional bureaucracies. There is no health revolution in this country; there is merely a revolution in the government of health care.

What they have done with pathology is one of the darkest moments in Rudd’s so-called health reforms. We have seen over the last 2½ years very little that pathology can be thankful for. This government in this term had a chance to fix that, to amend it, and make good with pathology, but instead it came up with this piece of minor, flimflam, insignificant legislation about increasing choice for pathology services. It is a great smokescreen. It is a complete tragedy for the thousands of people employed in pathology around this country who devote their lives to serve the people who under the Rudd government are now least able to afford it.

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

I rise to support the Health Insurance Amendment (Pathology Requests) Bill 2010. This bill amends the Health Insurance Act 1973 to improve patient choice with respect to pathology services. Currently the act requires that, in most cases, in order for a Medicare benefit to be payable for a pathology service rendered by or on behalf of an approved pathology practitioner, a request for the service must be made to that particular pathology practitioner or the approved pathology authority, who is the proprietor of the laboratory at which the service is rendered. This means that a patient is effectively required to attend the approved pathology practitioner or authority named on the request form. This restriction does not apply to other diagnostic services that attract Medicare benefits.

This bill removes this restriction so that, while there will still be a legislative requirement for a request for a pathology service to be made, there will no longer be a requirement that the request be made to a particular approved pathology practitioner or approved pathology authority. This legislative change will allow patients to take a pathology request to a pathology provider of their choice and will encourage providers to compete on price and convenience for patients.

This measure was announced in the 2009-10 budget with an effective date of 1 July 2010. There was $140,000 allocated for this measure in the 2009-10 budget. This included funding for a communications strategy. The Rudd government has made a major commitment to health reform for all Australians. Part of that reform is to increase competition and patient choice, and that is what this bill does.

As further evidenced in the budget delivered by the Treasurer last night, this government is taking action on its major commitment to health reform. In the budget the government is acting to ensure more Australians can more easily access appropriate health care by making a strategic investment to support and recognise the work of nurse practitioners. As part of the government’s nursing package, $390.3 million will be provided to better support practice nurses and for the first time provide funding for GPs in urban areas to help employ practice nurses. Annual incentive payments of $25,000 per full-time GP for a registered nurse and $12,500 per full-time GP for an enrolled nurse will be made available to eligible accredited general practices.

The government will transform the way Australians with long-term illnesses are treated, starting with improving health outcomes for the nearly one million Australians living with diabetes, too many of whom end up being treated in hospitals unnecessarily. The government is committing $449.2 million to improve care for people with diabetes. For the first time Australians with diabetes will have the option of signing up with a GP practice. The practice will be responsible for managing all aspects of their care and be paid in part for keeping patients healthy and out of hospital.

Through these key reforms this government is committed to delivering better health outcomes for all Australians. The 2010-11 budget will deliver a massive $1.2 billion boost to GP and primary health care, including $355.2 million to building and upgrading GP superclinics. This will honour the Rudd government’s commitment to deliver real improvements in front-line health services for patients across Australia. The Rudd government will upgrade around 425 primary healthcare facilities into GP superclinics and construct around 23 new dedicated GP superclinics. This strengthens the Rudd government’s $275.2 million GP Super Clinics Program, which is delivering 36 GP superclinics across the country.

GP superclinics take pressure off public hospitals, provide better integrated and more accessible care, help attract health professionals to areas of need and give health professionals of the future more training options. The government is delivering a GP superclinic in the northern area of my electorate, which has the full support of not only the local community but the division of general practice, doctors in general, the University of Newcastle and the area health service.

Once this new GP superclinic is fully operational in the Warnervale area it will employ more than 100 health professionals. It will take demand off the emergency department of Wyong Hospital, which is now one of the busiest in the state—in fact, the fourth busiest in New South Wales. Already, even though it is only a temporary GP superclinic, there are 2,000 patients on its books, which reflects the need for additional doctors and health professionals in the growing suburbs on the Central Coast. To further alleviate the pressure on emergency departments, including the one at Wyong, the budget outlined by the Treasurer last night allocates new money towards limiting to four hours the time in which patients will be seen to in emergency departments. This will be done by increasing the capacity of the emergency departments.

Of the new GP superclinics, about nine large clinics will be built where doctors, nurses and health professionals will be supplemented by more specialised services such as renal dialysis, minor surgical procedures, rehabilitation services and radiology. The remaining new GP superclinics will be built along the lines of the 36 clinics already under construction. By providing patients with more convenient one-stop shops the government will help and encourage patients to get the primary care they need to stay fit and well, particularly if they suffer from chronic illnesses.

Three types of funding will be available to help existing general practices expand their facilities, with grants of up to $500,000. These larger grants will be available to those practices that also establish teaching facilities. Additional services will be made available as a result of the infrastructure investment, with space made available in GP clinics for allied health services; group education, such as diabetes management; counselling; and community health promotion.

The injection in super GP clinics builds on the additional primary care being committed to by the Rudd government, including funding for a record number of GPs, more support and training for around 4,600 full-time equivalent practice nurses and a new innovative approach to improve the treatment of diabetes in GP practices. These infrastructure investments are part of the government’s move to take over full funding and policy responsibility for primary care.

We are also improving Medicare and making Medicare more accessible to Australians. The figures show that Medicare is working. In the December quarter 2009 a total of $3.9 billion was paid in Medicare benefits for 77.1 million services. This represented 3.5 services and about $179 in benefits for every Australian. In that quarter 73.9 per cent of all services were bulk-billed, up 0.2 per cent on the September quarter 2009 and up 0.1 per cent on the December quarter 2008. A total of 79.6 per cent of non-referred GP attendances were bulk-billed, up 0.8 per cent on the September quarter 2009 and up 0.6 per cent on the December quarter 2008. Medicare is working, and so is private health insurance. Yet amazingly, no matter how much evidence there is about the continuing improvements to both of these health insurance systems, those on the other side cannot accept the truth—they simply ignore the facts and figures.

Even more evidence was released recently that proved the opposition got it wrong when they predicted a huge drop in private health insurance membership. Private health insurance membership figures released in February revealed that the number of Australians taking out cover continues to grow. More than 45,000 extra people are now covered by private hospital insurance and more than 55,000 extra people have general treatment or ancillary cover. A total of 44.7 per cent of all Australians were covered by private hospital insurance in the December 2009 quarter, continuing to be the highest proportion of people with hospital insurance since December 2001. The opposition said that up to a million people would drop their private health insurance because of the Rudd government. Instead, the people have emphatically proved their claim wrong with 474,000 more taking out hospital cover under the Rudd government. Yet the opposition do not accept that they are wrong—they never do. It is time that the opposition came clean and admitted they got it wrong on private health insurance.

The government is making the private health insurance system fairer and more sustainable. Under changes proposed by the government the private insurance of singles on incomes of over $120,000 or couples earning more than $240,000 will no longer be subsidised by the taxpayers. That is fair, Madam Deputy Speaker Saffin. Treasury modelling estimates that after these reforms 99.7 per cent of people will remain in private health insurance. This measure is part of the government’s reform of the health system. It will save $1.9 billion over the next four years and allow the government to invest more in better services, new medicines and improved technology.

We are embarking on the largest reform of our health and hospital system since the introduction of Medicare. We are intent on delivering better health services and better hospitals by establishing a National Health and Hospitals Network. Under this plan there will be a national network to bring together eight state-run systems with one set of tough national standards to deliver better hospital services. The network will be funded nationally, with the Australian government taking on the dominant funding responsibility for the hospital system. The government will end the blame game, eliminate waste, and shoulder the burden of funding to meet rapidly rising health costs.

And while it will be funded nationally, the network will be run locally through local hospital networks. These networks will bring together small groups of hospitals where local professionals with local knowledge are given the necessary powers to deliver hospital services to our communities. These changes will be achieved by the Commonwealth taking the following actions: we will take 60 per cent of funding responsibility for public hospitals; we will take over full responsibility for GP and primary healthcare services; under our plan the local hospital networks will be run by health and financial professionals who will be responsible for running their local hospitals, rather than central bureaucracies; local hospital networks will be paid directly for each hospital service they deliver, rather than block funding grants being handed over to the states; and we will bring fragmented health and hospital services together under a single National Health and Hospitals Network through strong transparent national reporting. These reforms have been put to the states and territories and have been agreed to at the COAG meeting on 11 April.

The people of the New South Wales Central Coast, where my electorate is, would welcome a stand-alone health system and a local hospitals network that is truly local, unlike the present structure in which our health system is just part of northern Sydney’s health system. We are fighting hard on the Central Coast to gain a true regional identity, one that sees all the major institutions including health and education become their own local organisations and not just systems that are part of either Sydney or the Hunter.

After nearly 12 years of neglect of Australia’s health system by the coalition, this government is getting on with what Australians have been crying out for for a long time: to fix our health and hospital system. Over the coming months the Rudd government will make further announcements about important investments in more doctors and nurses, increasing the availability of hospital beds, improving GP services, and introducing personally controlled electronic health records, which was announced last night in the budget.

My constituents of Dobell on the lovely Central Coast have consistently told me how important it is for the blame game to be over and for us to get on with the job of improving the health system. Those on the other side must let us get on with this task and not block it like they have done so many other times. The establishment of the National Health and Hospitals Network will build on the record investments in health and hospitals made by the Rudd government over the past two years, including a 50 per cent increase in hospital funding, increasing GP training places by 35 per cent and training more nurses.

The government’s actions are in stark contrast to those of the Liberals, who ripped $1 billion from our hospital system when they were in government, capped GP training places and ignored the shortage of nurses in our community. And now the opposition is standing in the way of further reforms that would make the private health rebate system fairer for families. To private health insurance there would be a sensible moderate change that asks high-income earners to contribute more for their insurance so that it is sustainable for us to provide generous support to lower and middle-income earners. On Tuesday, 9 March this year the private health insurance rebate, the last piece of three pieces of legislation, was rejected by the Senate. This decision blows a $2 billion hole in the budget and by the middle of this century that will be $100 billion. This is money that needs to be better spent within the health system, providing for the growing health needs of the community.

But 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 Liberals are blocking other changes in the Senate. They 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. This is an opposition which is determined to say no. It is an opposition that is taking a reckless approach to the Senate, and it is about time that the public understood the lengths that the opposition leader will go simply to oppose for opposition’s sake.

We have a major task ahead under these reforms, and the bill I am speaking in support of today is but one part of that reform. Let me go back to some of the details of what the Health Insurance Amendment (Pathology Requests) Bill 2010 will achieve. The bill will amend the current legislative requirements concerning when Medicare benefits are payable for pathology services to allow patients to take a pathology request to an approved pathology practitioner or approved pathology authority of their choice. Doctors will still be able and encouraged to advise patients on their choice of pathology provider. It is anticipated that in most cases patients will attend the approved pathology practitioner or approved pathology authority recommended by their doctor.

Peak representative bodies for the pathology industry have expressed concerns over how this initiative will affect continuity of care for patients. Doctors are free to inform patients that taking the request form to the doctor’s preferred pathology provider may allow better tracking of their results. Pathology providers will still be allowed to produce branded request forms—that includes a provider’s company logo and address—and provide these to requesting practitioners. Changes to relevant regulations are planned to mandate that requests for pathology services include a clear and understandable statement, which is obviously positioned, making patients aware that requests can be taken to any approved pathology practitioner or approved pathology authority.

This proposal will be implemented from 1 July 2010 with a transition period of 12 months in respect of the changes to the regulations to minimise any regulatory impact on practices. The Department of Health and Ageing will undertake a communication campaign before the changes are implemented to ensure that the changes are well understood by practitioners.

The Liberal Party, the opposition, have stood in the way of almost all the reforms that this government has put up in terms of health. People in my electorate simply want them to get out of the way and let this government get on with providing better health care for the people of the Central Coast. Not only have they been blocking it; they are also now telling untruths. It is unfortunate that I have to report that the Liberal Party candidate for the seat of Robertson has today misled the local community in relation to an announcement made by the Prime Minister two weeks ago for a cancer unit on the Central Coast for which the federal government is providing $28.6 million. This cancer centre is one that for which we have signed a contract with the state government and is to be up and running in 2013. The member for Dickson—

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

2013?

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

Yes, in three years time; in 2013. The member for Dickson will understand that there is a need to be factually correct in his former job, and it is of some disappointment that the Liberal candidate, currently a policeman on the Central Coast, has been saying that this cancer institute being set up on the Central Coast that we have all campaigned so hard for will not be up and running for 10 years.

If this is evidence of the bona fides of this candidate, if he is prepared to lie outright in terms of what is actually happening, then it is a very sad reflection both on him personally and on the Liberal Party in relation to what lengths they will go to. We know that the Liberal Party and the truth are not comfortable bedfellows, but I think it is atrocious that we have a candidate in the field lying outright about a particular issue and saying that this cancer institute will not be up and running for 10 years when it was clearly announced by the Rudd government, by the Prime Minister himself, that it will be up and running in 2013.

It is a very sorry state when you have a candidate who pays no regard to the facts, no regard to the truth. This is a candidate that I expected more of. Both he and I are members of the Terrigal Surf Lifesaving Club, and we know each other well. It is very disappointing, and I can hopefully put it down to inexperience. It is very disappointing that he is making public comments without checking his facts and totally trying to mislead the local community in relation to this matter.

It is an example—unfortunately, a local example—of the type of approach we get from those opposite in relation to health. They will say anything. They will do anything to try and mislead, to put an oppositional position, in relation to what are great reforms, great advances, that this government is doing in taking on and trying to improve Australia’s health system. This bill is a small part of those reforms and one that I commend to the House.

Peter Slipper (Fisher, Liberal Party) Share this | Link to this | Hansard source

While I am not aware of what the Liberal candidate for Robertson has said in relation to the matter of this cancer centre on the Central Coast of New South Wales, even if the Rudd government has promised that this particular centre will be established by 2013, given the serial policy of breaking of promises we have seen from the Rudd Labor government in recent times, one could not be confident that the cancer centre would in fact be constructed by 2013; in fact, one could not be surprised if it was not built until 10 years time.

Having said that, I want to stress strongly that the provision of health services remains an issue of concern for the people I represent in the electorate of Fisher on the Sunshine Coast. We desperately need the Sunshine Coast University Hospital that was promised before the last state election by the Bligh Labor government. No sooner had they crawled back into office when they postponed the construction date for the Sunshine Coast University Hospital by a couple of years. This is at a time when the state government is seeking to massively increase the population of the Sunshine Coast through development without making sure that we have in place the infrastructure needed to meet the needs of such a dramatically growing population.

I have written to the Prime Minister and have not received a reply, and I have also written to the Minister for Health and Ageing. She has replied via her parliamentary secretary seeking that the federal government should step in and fund the Sunshine Coast University Hospital, given the fact that the Bligh Labor government has broken its promise to build the hospital by a certain date.

I am very disappointed that in the budget we saw last night there was no mention that the Sunshine Coast University Hospital would be funded. I suppose it is no surprise because, after all, the way this government has spent this country into deficit, it is simply broke. Not only do we have a situation where the future of today’s Australians is mortgaged; the future of Australians not yet born will be mortgaged for many years into the future.

Sunshine Coast residents will, however, welcome the provisions of the Health Insurance Amendment (Pathology Requests) Bill 2010. I support this bill in the context of complaints I have had from local constituents about the varying charging policies of pathology providers on the Sunshine Coast. There was a situation where a certain pathology provider had been bulk-billing services provided to patients but had then unilaterally decided to stop bulk-billing those services. Some constituents were left out of pocket as a result of that pathology provider’s change of policy. When people contacted me, I pointed out that it is not possible to determine from a government level whether individual pathology services choose to bulk-bill or not, but that clients of pathology services—constituents of members of parliament—are entitled to vote with their feet. I have advised constituents that they ought to shop around to ascertain which pathology services are bulk-billing and which are not. I am very pleased to report that, when people moved in the other direction, the pathology service which had stopped bulk-billing started bulk-billing again. I suppose that showed the strength of the market.

We on the Sunshine Coast are very fortunate to have a large number of pathology providers and a large number of centres where people are able to pass on specimens requiring analysis by pathology providers. This bill, the Health Insurance Amendment (Pathology Requests) Bill 2010, will mean that patients will be able to go to a pathology provider of their choice. I think this will make it easier for constituents to shop around in the event that some pathology providers choose to charge a very large gap fee for people needing their services.

The opposition is not opposing this bill and I think that is very much the appropriate way to go, but I just want to stress that we on the Sunshine Coast are very disappointed with the policies of the Bligh Labor government and the Rudd Labor government with respect to the healthcare needs of Sunshine Coast residents. We are a very important area. Our population will double over the next 10 to 15 years. Unfortunately governments are failing us in so many ways with respect to the provision of very necessary infrastructure. I noticed that last night’s budget made no mention of upgrading the Bruce Highway to six lanes all the way from Caboolture to the Sunshine Coast. There was no indication that we were going to receive the government assistance that we so desperately need in so many areas. It is as though we are a support-free zone as far as the Labor government is concerned.

When one looks at the budget, it is clear the whole thing was predicated on a great big new tax, the mining tax, which is by no means certain to pass through the parliament. It is by no means certain that the mining companies will stay in Australia. The Canadian government has even made overtures to these mining companies, inviting them to go to Canada. Mining companies can vote with their feet and they can move abroad and it could well be that this great big new tax is not passed into law. It could well be that, even if it were passed into law, the mining companies might not be prepared to continue to provide employment here. They might not be prepared to continue to have the level of involvement in Australia that they currently do. If you take away the rug—that is, the great big new tax of the Labor government—then the budget is entirely unfunded. It is another typical Labor budget which is simply a spend budget, another budget making the future of Australians even grimmer. It is important to remember that, when this government was elected to office in 2007, it inherited a budget surplus. Now we are almost the only Third World country where you can drink the water.

This bill of itself contains very positive measures. I support it strongly, but I just wanted to highlight the serial failure of the state and federal Labor governments to attend to the healthcare needs of residents of the electorate of Fisher on the Sunshine Coast. I commend this bill to the House.

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

I, too, add my support to the Health Insurance Amendment (Pathology Requests) Bill 2010. This bill removes the requirement that a request for a Medicare-eligible pathology service be made to a particular pathology provider. Currently, when a doctor sends a patient off for a diagnostic test, the patient will be handed a request form including the name of a particular pathology provider. This has been a feature of the existing Medicare arrangements, according to which a Medicare benefit is only payable if a designated pathology provider is named in the referral request. The patient is therefore required to go to the pathology provider specified by his or her doctor. This means that the choice of pathology provider is one for the doctor to make. Usually the doctor hands the patient a form produced by a pathology provider headed up with that provider’s brand and logo and that is the provider the patient goes to. The referral request, as I said, must nominate a specific pathology provider for the service to then be eligible for a Medicare rebate.

The bill before the House seeks to amend the Health Insurance Act to remove that requirement. Our proposal is for patients to be free to take the pathology request to any approved and accredited pathology provider. As previous speakers have highlighted, we anticipate that this will lead to increased competition between pathology providers and hopefully keep costs down for both patients and the health system. The act will still require a pathology provider to be in receipt of a referral from a medical practitioner. There will, however, no longer be a requirement for that referral request to specify a particular pathology provider in order for the service to be rebatable through Medicare. Under this new system, the patient will be free to go to any accredited pathology provider and a rebate will be payable for that service.

Importantly, there is nothing in the bill to stop doctors from advising their patients on their choice of pathology providers and providers are still allowed to produce branded request forms and to provide these to medical practitioners to hand out to their patients. Changes to current regulations will, however, mean that those forms will now also include an obvious statement to make patients aware that requests can be taken to any approved pathology provider of their choice. This is a change, but it is important to note that the proposal in this bill is similar to the system that has operated in the diagnostic imaging sector for some time.

In contrast to the pathology sector, right now when a patient is referred to a diagnostic imaging provider there is no corresponding requirement for a particular provider to be specified in the request. Patients with a referral to a diagnostic imaging service can therefore take their request for service to any provider. This change brings the pathology sector into line with the existing practice in the diagnostic imaging sector.

On the face of it, this measure is a simple one. It is, however, part of the government’s broader response to the challenge of preparing our health system for the future. We know that we face rising health costs due to our growing population, the ageing of the population and the increase in chronic disease. These are all big challenges that will put huge demands on our health system. We came to government knowing that we had to undertake reform of our health system to make sure it was ready to meet those demands. To do that, we have to remove the duplication and inefficiencies from the current system. We have to make sure that our health-spending dollar is spent as efficiently and effectively as possible. This measure to increase patient choice and encourage competition in the pathology sector is consistent with those goals.

I want to also use my contribution tonight to record my support for the government’s proposals to improve Australia’s health system, and that list is growing longer by the day. There is already a very long list of reforms, more in the budget last night, and important investments in the health system that this Labor government is delivering on in stark contrast to the record of inaction and neglect of the previous government. We are dealing with the legacy of the previous Minister for Health and Ageing, now the Leader of the Opposition, who did nothing to improve the health system and its capacity to meet the needs of the Australian community. On the contrary, the opposition leader took money out of our public hospitals, capped the number of doctors being trained and did nothing to rein in rising costs and inefficiencies that threaten the viability of the entire system.

We want the health system to work better. The Australian people are looking to us to restore faith in the health system and to make sure it is prepared for the future. We have spent our term in government working on the longer term question of how best to structure and fund our health system, but in the meantime we certainly have not ignored the immediate challenges and problems we inherited from the previous health minister. That is why very early in our term we negotiated the current Australian Health Care Agreement with the states, which includes a 50 per cent increase in hospital funding in the life of the five-year agreement. That amounts to a $64 billion investment in health care.

Already we have committed an unprecedented $1.1 billion towards training more doctors, nurses and health professionals. Under this plan we were already on target to increase GP training places by 35 per cent over the numbers that the opposition leader left us when he was the health minister. Earlier this year, we announced that we would build on that existing commitment to training with an additional $632 million. This will make it possible to train a record number of doctors. We will finally be able to turn the tide on the shortage of doctors that has been at the heart of so many of the problems with our health system for years now, a problem that was completely ignored by the previous government.

We are talking about doubling the number of places available for medical graduates to train to become GPs from 600 when this government took office to 1,200 a year by 2014. It more than doubles the current number of places available for medical graduates to undertake training to become specialist doctors from 360 to 900 by 2014. In even better news for electorates like mine, priority will be given to providing training places in rural and regional areas where access to specialists has been particularly difficult for many years.

There will also be more opportunities for junior doctors to experience a career in general practice before they become fully fledged doctors. The current Prevocational General Practice Placements Program gives junior doctors the opportunity to undertake a 10- to 12-week placement with an experienced general practitioner after they graduate from medical school. This program will be expanded from 400 places to 975 places by 2013-14.

The previous government ignored all the warnings about doctor shortages and even took decisions that made matters worse. Our government is serious about health reform and a big part of making the health system work for all Australians is making sure that there are enough doctors and that there are doctors located right across the country in towns and cities, big and small.

The new funding announced in March shows that we have listened and understood the warnings and that we are determined to build a health system that will be strong enough and flexible enough to meet the growing demands for health care. This latest package of measures will deliver an additional 5,500 new or training GPs, 680 medical specialists and 5,400 prevocational training places over the next 10 years. Finally, we are turning the tide on doctor shortages. That is great news for all Australians and particularly for the people in my electorate who have first-hand experience of what the doctor shortage means for those living outside the capital cities.

I am pleased to say that our commitment to better health care goes even further than that. There has been unprecedented direct investment by the federal government in the capital needs of local hospitals. There was $76 million in the 2009 budget for the Rockhampton Base Hospital alone. That is happening right around the country and shows that this Labor government wants to work with local hospitals and health services to understand the present and future needs of their communities and to make the necessary investments in the infrastructure to meet those needs. Another local example from my electorate is the full-time MRI licence the Rockhampton Base Hospital was promised in the 2007 election and granted in 2008. Thanks to the Labor government, we now have a full-time MRI machine operating in Rockhampton and the Commonwealth government is providing Medicare rebates for those services. Other reforms include our investment in preventative health. This is something that everyone agrees is necessary if people are to live healthy and productive lives and something that needs to be a central part of our health system if we are to manage increasing rates of disease and the escalating costs associated with that.

All of these are important reforms, and there are so many more that I could mention. These reforms all now fit within the broader structural reform the Prime Minister and the premiers signed up to last month—that is, the pledge by the government that the Commonwealth will assume the majority funding responsibility for public hospitals through a National Health and Hospitals Network that will be funded nationally and run locally.

I have outlined what is just a part of the government’s plans for major health reform in this country—health reform that is all about delivering better services to the people—to demonstrate our determination to do what needs to be done. The opposition leader had his chance when he was health minister to show that he cared about the health care that people received in communities around Australia, but he failed that test. He walked away from that responsibility time and again. However, not content with his failure to deliver as health minister, he now wants to get in the way of the government’s plans to fix the mess he and the previous government left us with.

One of the goals of health and hospital reform is, obviously, to deliver better care, but that is not possible unless you put the health system on a strong and sustainable financial footing. We cannot go on ignoring the warnings, like the Intergenerational report, the way the previous government did. We would end up with the health system buckling under its own weight and being completely unaffordable. That is why all of our reforms are very focused on spending money where it needs to be spent so that spending is as efficient and effective as it can be in delivering health outcomes.

In contrast, the opposition are intent on blocking every savings measure we put forward—sensible, responsible savings measures that help underpin the reform that is needed to the health system. They opposed the means-testing of the private health insurance rebate, at a cost to the budget of $2 billion. They backed the ophthalmologists when the government tried to adjust rebates for simple procedures. They blocked the government’s efforts to close down the flawed chronic disease dental scheme, a program that was supposed to cost $377 million over four years but which has cost $800 million in the last two years alone. The list goes on. Altogether, the opposition are blowing an $11 billion hole in the health budget over the forward estimates. The opposition’s failure to implement changes like these is financially irresponsible and puts our health system at great risk of not being able to cope with the rising demand from our growing and ageing population. We know we need that money to be put to work in a better health system.

The people of Central Queensland have been telling me for years about their priority when it comes to health services: there is a great need for an improvement in cancer services in Central Queensland to stop the heartbreaking reality of so many people having to travel to Brisbane and be separated from their family to receive the treatment that they need once they have been diagnosed with cancer. That is why I welcomed the call in November last year for applications to the government’s regional cancer centre program and I strongly supported the application which went forward to that program from the Rockhampton Base Hospital. I was delighted when the Prime Minister came to Rockhampton just a few weeks ago to announce that, indeed, the Rockhampton Base Hospital would be the site for one of those regional cancer centres. We will be putting $67 million towards the upgrade to cancer services in Rockhampton which will serve the whole Central Queensland community—people in places like Emerald and Gladstone as well as in the rural towns around Rockhampton. Among other things, the funding will provide for additional chemotherapy chairs, taking the number of chairs from five, I think, to 16, and also for moving towards being able to provide radiation therapy in Rockhampton.

I raised the issues of the MRI and the cancer centre just to illustrate once more why the government are so focused on finding efficiencies and savings within the health budget. We need to get the most out of every health dollar to ensure Australians can get the care that they need now and into the future. The change contained in the bill before the House right now is a fair and common-sense proposal and it is consistent with this goal. It increases choice for patients, and we also hope it will increase competition in the pathology sector. It is a very sensible reform and one that I am happy to support.

Sharon Grierson (Newcastle, Australian Labor Party) Share this | Link to this | Hansard source

I rise to give support today to this amendment to the Health Insurance Act 1973, the Health Insurance Amendment (Pathology Requests) Bill 2010. This important amendment aims to improve patient choice in respect of pathology services. The act in its current form requires that, in order for a Medicare benefit to be payable for a pathology service rendered by or on behalf of an approved pathology practitioner, a request for the service must be made to that particular pathology practitioner or to the approved pathology authority, who is the proprietor of the laboratory through which the service is rendered. The Health Insurance Amendment (Pathology Requests) Bill amends the Health Insurance Act by removing this restriction.

To explain it more simply, under the current act a patient is effectively required to attend the approved pathology practitioner or authority named on the request form by a GP or specialist. This legislative change will allow patients to take a pathology request to a pathology provider of their choice and will encourage providers to compete on price and convenience for patients. It improves choice and increases convenience for patients, and that is something the Rudd government are committed to providing in the healthcare sector. Doctors will still be able and encouraged to advise patients on their choice of pathology provider. It is anticipated that in most cases patients will attend the approved pathology practitioner or approved pathology authority recommended by their doctor. It must also be mentioned that pathology providers will still be allowed to produce branded request forms that include a provider’s company logo and address and provide these to requesting practitioners.

This proposal will be implemented from 1 July 2010, with a transition period of 12 months in respect of the changes to the regulations, to minimise any regulatory impact on practices. This amendment will ensure that patients have real choice in pathology services. Most importantly, it will make access to pathology services easier for patients. I must stress that, in my own electorate, having choice in terms of access to medical services and having convenience in accessing those services is an issue that is front and centre.

Recently we saw the closure of the Lambton Family Medical Centre. When we do not see a patient centred approach to the provision of medical services, as elected representatives we certainly learn all about it. The medical centre that I am referring to was owned by Primary Health Care and was closed by Primary Health Care with no notice to staff or patients. In fact, it closed on a Friday. Anyone who turned up at the door of that surgery or who rang trying to arrange future appointments or get access to other information or services on Friday, 19 March was told of that closure. Staff and doctors themselves were informed on that very day. A sign was placed in the window of the Lambton Family Medical Centre informing anyone walking past that the practice was closed, that the transfer of the practice would happen over the weekend and that Primary Health Care would take the Lambton Family Medical Centre to its other Newcastle based medical centre, at Charlestown.

I must stress that the Lambton Family Medical Centre premises have been used as a general practice surgery for 108 years. Lambton is a suburb with many long-term residents and so you can imagine that there is an amazing attachment to that centre by those much older patients. The premises were leased to Primary Health Care by one of the doctors working with that practice.

When the distress of patients became obvious, naturally I wrote to Primary Health Care for some explanation as to why they would close that practice so abruptly without regard to patient need, as was being brought to my attention. I received a response from Mr Henry Bateman himself, the CEO of Primary Health Care, and I spoke to him personally on the phone. He said to me that it was no longer a viable practice and he could not be assured that the lease would be renewed or of the continuity of availability of the two full-time GPs and five part-time GPs operating from that centre. He also said that it was tough managing medical practices, that the rebate was not sufficient to make them viable and that he actually used his own pathology services to cross-subsidise the practice. I can say to you that the patients were not particularly interested in that. They were very concerned, particularly when on the following day, Saturday, a company called Sidameneo, acting on behalf of Primary Health Care, came in to vacate those promises and make them good. I have seen photos of and I have looked through the window at the damage done to that surgery. It is extensive, it is extreme and certainly there would be concerns that there was some intent to do as much damage as possible. I looked up that company, Sidameneo, in the Australian Securities and Investments Commission records, which showed that this company is a one-share, one-dollar company and it has four directors: Mr Henry Bateman, Mr Gregory Bateman, Mr James Bateman and Mr Andrew Duff.

Obviously the patients were witness to the fate of that practice—it is in their local shopping centre—and they were distressed by it and concerned that a practice that they had frequented and felt some sense of loyalty towards was being treated in such a way. I am told that there were 11,900 people registered with the Lambton practice who were active patients in the last two years. They started to contact me, concerned for their patient records, for the continuity of care and about the transfer of the practice and their records to Primary Health Care’s Charlestown centre.

I visited the site of the former Lambton Family Medical Centre. I had advertised my planned attendance at the centre only that morning on local radio and, when I arrived, there were already 70 people waiting to see me. Over 100 people came during the day and a half to talk about their feelings. They expressed to me their anger towards Primary Health Care for the way the practice had been closed and for how they had not been informed. They expressed that there was now some great distrust towards Primary Health Care. Many patients told me of the disruption to their care. One IVF patient needed constant monitoring by her doctor. Another patient was booked in for heart surgery, but, because specialist results were no longer available and no-one could track those down in time, his heart surgery had to be deferred.

When told about the transfer of records to the Charlestown centre, patients were particularly telling me that it was inconvenient. It is not a great distance from Lambton, but it is across a major highway and very inconvenient for older patients to attend. Some alleged they had attended that centre to ask for their records or to ask what was happening, and there were long queues of people outside the surgery trying to find out about their records. They also had no medical tests; they were awaiting medical tests. Many of the older people are on a special anticoagulant drug that needs constant monitoring. They wanted someone to tell them that their records or their test results were there so that they could find other GPs.

At that stage I had 200 patients request that their records not be left with Primary Health Care and that GP Access, our local division of general practice, manage the distribution of their records. I wrote to Primary Health Care suggesting that they could perhaps consider entering into an agreement with GP Access to manage the transfer of the 11,900 patients. GP Access, of course, is the nation’s leader in after-hours care and has a call centre available all day. It offered to do that at no cost to Primary Health Care and no cost to patients. The patients who were arriving at Charlestown were told that, if they did not find a GP to help them access those records within a month, they would be charged up to $100 for their records. They had great difficulty, given the shortage of GPs, getting an appointment with another GP.

Fortunately GP Access provided some special after-hours clinics at the local centres that they operate to fix up prescriptions and attend to any urgent matters of those patients. Some local GPs whose books were closed offered one consultation for the patients of Lambton Family Medical Centre just to help them out—and remember this was two weeks before the Easter period, so it was a very hard time for those patients. That was refused by Primary Health Care, as was their right. They said to me: ‘We are competitors. GP Access and Primary Health Care are commercial competitors in the medical services field.’ They said they would not be entering into any agreement. That was disappointing because it would have brought some credit to Primary Health Care and would have shown some concern for their patients.

The difficulty was that only one doctor transferred to the new Primary Health Care centre. Of course he was able to make appointments for any Lambton Family Medical Centre patients, but patients then told me of the difficulty of getting an appointment and the queues that they had to endure to access any doctor at the new centre. Unfortunately, things did not end there. It seems that Primary Health Care had entered into a contract with the previous doctors who worked with them, and then they proceeded to exercise restraint of trade clauses. This is in a regional city that already has shortages of medical general practitioners. It is a difficult situation where five doctors are taken out of circulation and Primary Health Care can only offer access to one, and then we have them exercise a restraint of trade clause through litigation.

There was also litigation from the landlord, a doctor who owned the premises, for the damage to property. It is a fairly nasty situation, and for me, as the member for Newcastle, my concern is patient care. I would like to share with you some of the stories of patients at that practice. For example, one of my constituents says she had been a patient at that centre for more than 36 years. She had two pulmonary embolisms nine years ago and has weekly blood testings. She is known for her prescription for warfarin. Usually she could ring the family medical centre and get the results over the phone without having to speak to her doctor. When she rang the new Primary Health Centre at Charlestown for results after her records were transferred, she was put on hold for 30 minutes before being told those results were not available. She called four times the next day for those results but still was not given an answer. She had her number taken each time and was told she would be called back, but she was not called back. During the last call she was told her new doctor would have to call back to get her results. She was not called back until 7.30 pm the following evening, two days after her initial inquiry.

Another constituent of mine from North Lambton is a 33-year-old mother of two. Her husband passed away on Good Friday of a terminal illness. As a former patient of one of the doctors who had practised at Lambton Family Medical Centre, she was required to contact her doctor to have the death certificate of her husband signed. She went to the Charlestown Centre on Saturday, the day after her husband died, to ask if the previous doctor was available to sign the certificate. But she was told that they were unable to contact that doctor and that no other doctor was available to sign the death certificate. Fortunately GP Access did assist her to find that doctor and have the death certificate signed. Primary Health Care must have realised that their actions were an extremely rude and inconsiderate thing to do to a patient, and they asked her to come and speak to them about that. They spent a few minutes apologising and then they spent the rest of the time justifying their actions, seeking sympathy for what they had done. Her words to me were, ‘I don’t like to be rude, but, after 10 minutes of hearing them justify their position, I left.’ That is just unacceptable.

Another constituent told me that he had a serious diabetes condition and for over 20 years had been with one of the former doctors. He was unable to access the new surgery and when he did he faced long waits to see his doctor. Because he had built up trust with that doctor, he did not want to see other doctors. He did manage to find another GP in a nearby suburb, but his health deteriorated rapidly and he was faced with a wait of up to a week to access another GP. Unfortunately that patient passed away shortly after. I do not draw any connection to that, but what I have to say is this was distressing for very many aged patients. There were no measures put in place by Primary Health Care to monitor high-needs patients and respond to their needs. Other patients complained of the lack of independence. One of my constituents, who is blind and has a guide dog, could walk to the surgery and now feels that his whole independence has been taken away from him.

I know that each patient has an individual situation, but these were just a few of the hundreds of patients who shared their stories with me. It is not good enough for Primary Health Care to adopt a corporate approach to the delivery of medical services. Under duty of care, under negligence laws, it must be a case of them having to do a little bit more than they did in the case of the Lambton Family Medical Centre. I am distressed for my constituents that Primary Health Care conducted themselves so badly. I do not feel there was a need for that. I do feel there was an opportunity for decent collaboration that would have assisted continuity of care and certainly Primary Health Care could do everything it wanted after that, after it fulfilled that responsibility, to compete hard for the patients.

I would have thought that the bottom line of any business would always improve when customer service was at least part of the plan. When I look at the media records around Primary Health Care—their closure of the Lambton Family Medical Centre, their closure of two practices here in Canberra in a similar way and the speed at which Dr Bateman and Primary Health Care enter into litigation, a very good way of stopping any opposition—I have to say to Dr Bateman: that is not acceptable practice.

I was so concerned about that sort of action that I wrote to all the peak bodies in Australia asking them how they enforce or encourage best practice and ethical standards in such an important area, patient care. I asked them:

• Does your professional code of conduct encompass ethical behaviour regarding notification to patients and staff of the closure of medical practices?
• What principles do you think should apply to the notification and management of closures?
• As each state and territory has different laws governing patient records, what general principles and protocols around the management of patient records do you include or do you think should be included in your professional code of conduct?
• Given the GP shortage, particularly in regional areas, how does your organisation view the current mismatch between the professional duty of care to patients and the application of commercial provisions such as restraint of business clauses that restrict access and competition?

I have received one response in that short period of time, from the Australian Medical Council. They have been instrumental in drawing up a national code of professional conduct for medical practitioners. That new code, Good medical practice, is very much needed because we are looking at requiring national registration of medical practitioners from the middle of this year. (Extension of time granted) I thank my parliamentary colleagues for their support in allowing me to extend my time to address these issues.

I am pleased that there is going to be a national code of conduct, but how is it going to be enforced? If it is going to be enforced through litigation, how are people going to withstand that? We know that Primary Health Care are even taking litigation around the use of the term ‘primary health care’—a phrase that preceded their existence. They are claiming all commercial rights to that phrase. I understand the issues of commercialisation and profit and return, but I do not think they fit well with a patient centred approach to medical care. I say to Primary Health Care: you would do well to try to marry your commercial needs with the needs of patients in a more humane and ethical way.

As you can imagine, Madam Deputy Speaker, I became very involved with the minister, Nicola Roxon, and her office and with the Prime Minister on these issues. I am delighted to see in the budget that, just as in the legislation we are discussing, we have put patient care at the centre of the relationship between doctors and pathology services and patients.

The situation with the Lambton Family Medical Centre in my electorate is unresolved. GP Access have done everything they can to help the patients to find new doctors and to assist the doctors who have been misplaced, but litigation continues. The litigation is now even extending to other places that host doctors from the centre that have not been satisfied to stay under the umbrella of Primary Health Care. I note from recent press articles that Primary Health Care adopted a practice at some of their centres of charging a co-payment. When a patient walked into one of these centres and said, ‘I want to see a GP,’ they would pay a co-payment. They might be told, ‘It’ll be 30 minutes.’ If they had to leave before seeing a doctor, to pick up their child from child care or whatever, even if they had sat there waiting for two or three hours, they would have to forfeit the co-payment. I find it extraordinary and unbelieve that that would be acceptable to any firm in general practice. I say to Primary Health Care: please reconsider taking legal action in the case of doctors involved at the Lambton Family Medical Centre, please reconsider your conduct for the sake of your reputation, and please follow the codes of conduct that are being developed.

Patients in Newcastle will be very pleased that we are addressing some of these problems. E-health records will be such a benefit. Patients having control of their records will be exemplary in the area of patient centred care. At this stage in Newcastle people are getting half a page to represent 20 years of interaction with their doctors. That is not a patient record. I do not know why patients are not being given their full records, but I do not think it is acceptable. E-heath records will be an improvement, as will be the ability for doctors to apply for infrastructure grants. Looking at the destruction of the Lambton Family Medical Centre, I know it is going to take a grant to restore it to a surgery. I am told by the landlord that the improvements are his improvements; they do not belong to Primary Health Care. That is, of course, a matter of legal dispute. Grants for infrastructure will be a great thing, as will a Medicare local, using local networks of GPs, who can cooperate around these issues. Those are very welcome developments.

I thank Minister Roxon. I thank the Prime Minister for his interest in this matter. I particularly thank GP Access, who did everything they could to assist the patients in this regard.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

The Health Insurance Amendment (Pathology Requests) Bill 2010 removes the legislative requirement for requests to be made to a particular approved pathology provider for Medicare benefits to be payable. The change will allow patients to access pathology services at any approved pathology provider. It is claimed that this measure will give patients additional choice and encourage price competition within the sector. On the face of it, the intent of this bill seems worthy. The coalition supports patient choice in accessing health care but we note concerns regarding the implementation of this change to pathology referrals. This is a significant change, and proper consideration needs to be given to patient safety and quality of care.

The 2009 budget measure was not subject to consultation. Submissions to the Department of Health and Ageing on implementation of this measure only closed on 22 February, some 12 days after the Minister for Health and Ageing introduced this bill into the parliament. As such, compelling concerns raised by stakeholders were not considered by the government prior to proceeding with this bill. There is variation in the range of services offered by pathology practices, the methods and equipment used and methods of communication between pathology practices and referring doctors. Cost is a very important consideration for patients, but it may not always be the most appropriate basis for deciding on a service provider.

In the minister’s second reading speech she admitted that ‘there are often valid clinical reasons for recommending a particular pathology provider over another’. The minister’s only comment on this issue was to say that the government will continue to encourage medical practitioners to discuss options with patients. That is an entirely insufficient response to a fundamental issue in this legislation. Clinical issues are not the only concern, though. Presently there are clear lines of communication between referring doctors and pathology practices. Pathology practices ensure that results are provided to GPs and other medical practitioners in a timely manner by means of established delivery systems and compatible IT systems. Pathology practices also often have established means of contacting referring doctors after hours and in cases of emergency.

The government has failed to explain how new referral pathways will operate in cases where the pathology practice is unknown to the referring doctor. A lost or delayed result may have very serious consequences for patients and medico-legal implications for the referring doctor. There are over 2,100 collection centres and almost 400 pathology laboratories in Australia. On the available information, there will be no way for referring doctors to trace results if a report goes missing or if the result is delayed. These are issues that the government should have considered and resolved prior to proceeding with this legislation.

It has been noted that similar arrangements already exist for diagnostic imaging. There are differences between pathology and diagnostic imaging procedures, and the number of tests per patient is generally lower for diagnostic imaging. Imaging tests are usually undertaken with the patient present, and the patient is provided with the results. It is also argued that imaging methodology is standard across all providers and, unlike pathology, diagnostic imaging is not as frequently used to monitor chronic conditions or medication treatment. It is incorrect to claim that the process that works for diagnostic imaging will work for pathology services.

The government’s record in health has done nothing to improve the situation for patients. There is growing concern in the community about decreasing levels of bulk billing for pathology. This largely affects older Australians—self-funded retirees and pensioners with fixed incomes. Now faced with a situation of increased patient out-of-pocket expenses, the minister is responding by rushing through another measure. Once again, she has not thought through the detail, and bungling of this measure will affect patient health outcomes. It is irresponsible for a minister of the Crown to announce a policy without having any plan for its implementation. Unfortunately, we have seen the disastrous consequences of such recklessness with the Rudd government’s Home-Insulation Program.

This minister has a long list of bungles of her own. This House, and most Australians, are all too familiar with her bungled handling of health policy, including her baseless cuts to the cataract surgery rebate, the attempted capping of Medicare benefits for macular degeneration treatment, the bungled capping and backflip on Medicare IVF assistance, the cutting of funding for chemotherapy treatment, the complete farce of amending the government’s own midwife and nurse practitioner bill and then withdrawing the amendment and her blatant broken promises on private health insurance. Whilst there might be support for the intent of the bill before us, its implementation looks set to again be a bungled episode by a minister who has not worked through the detail. The minister has introduced a simple bill on pathology referrals without any idea of how it will operate in practice. If this minister cannot get the so called small ticket items right; how on earth can Australians trust this minister—or indeed this Prime Minister—to deliver major reform for our public hospitals?

The Rudd government could not manage a program putting insulation into ceilings. It is no wonder that there is so much concern about their ability to manage the health and hospital system. This will only get worse with the economically reckless Rudd government. The Rudd government cannot be trusted to run a $100 billion health system, and the minister’s inability to be across the detail is on display with this bill today. There are significant unresolved issues regarding the implementation of this measure which the government should have addressed prior to its introduction. The coalition does support measures which improve patient choice, but the government must demonstrate that a different pathology referral process can work and that patient health outcomes will not be adversely affected. A Senate committee inquiry into this bill is in its final stages and will hopefully provide some of the answers and do the work that the minister should have done.

Before I close, I want to address some of the false allegations that were made in an earlier contribution by the member for Dobell in relation to the candidate for Robertson, Darren Jameson. This was a grubby attack by the member for Dobell on the Liberal candidate for Robertson. It was a grubby, baseless attack, and it needs to be addressed. What I can say about Darren Jameson—

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

The member for Dickson is straying. I did not hear the comments from the member for Dobell, but this is not—

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

They were at length.

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

The member for Dickson will hear me out. This is not relevant to the bill. There are other forms in the House in which this matter can be taken up.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

On the point of order, if I might just point out to the House and for your consideration that this is in fact relating to this bill, not just because there was a contribution made in the member’s speech but also because the health insurance amendment bill 2010 directly relates to the issue which is in dispute. The comments that were made by the member for Dobell relate to—

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

If you can link them to the bill then I can see it, but I cannot at the moment. If you can relate it for me then please do.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

They relate to a service in relation to cancer and oncology services in this electorate, and that is how it relates to the health insurance amendment bill 2010. Some of the funding in this bill, as I understand it, is provided for these services, including those to which the member for Dobell referred earlier. So it is entirely appropriate that this be addressed because the Liberal candidate for Robertson, Darren Jameson, in a press release said that he was disappointed to learn that the new cancer clinic at Gosford Hospital announced by the Prime Minister was not a priority, is at the bottom of the list and could be some years away from becoming a reality. To quote:

Like all residents on the Central Coast I—

Darren Jameson—

welcome any funding that is directed into health services in that local area and as such I fully support the announcement made by the Prime Minster in Gosford.

However, it’s unforgivable to give false hope to cancer suffers and the impression that this facility was about to be delivered, when in reality the announcement was yet just another photo opportunity for the Prime Minister and the Premier.

Mr Jameson goes on:

I now urgently call on the government for some direct action, to commence discussions with the Central Coast Radiotherapy Oncology Centre …

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

I think the member for Dickson has made his point and is straying from the bill again.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

Madam Deputy Speaker, I of course take your counsel. But, for your consideration, this is directly related to the health insurance amendment bill and to that head act. I do think it is relevant to address it not only because of that but also because it was brought up and addressed at some length in a previous contribution, and apparently that was within the standing orders.

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

The member for Dickson, as I said, I did not see it. If the speaker did not take it up with the member for Dobell, I will actually go and view that. The difficulty I have is that if everybody bends the rules then I am left with no rules. Then I am—and every occupier of the chair is—put into an insidious position. But as the first Deputy Speaker—you have copped me, I am sorry—I actually have to set the benchmark a bit higher than the rest. I appreciate what you say. Latitude can happen in debate, but I think we are straying now and I would ask you to wind up if you are getting to that point.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

I of course would not seek to cause you any distress. In conclusion, the coalition does support this bill. We do not support grubby attacks like that from the member for Dobell. We have highlighted the concerns in relation to this bill. We hope that the minister heeds the concerns of the industry and of patients. The coalition is about choice. We are about providing better patient outcomes. We are concerned that this is going to be yet another botched attempt by the Rudd government in relation to health. The Rudd government promises so much in relation to health, not just this bill but other measures, and, regrettably, on many occasions, just gets it wrong or simply cannot deliver. They are our reservations and we highlight them again. We support the thrust of the bill but we are concerned about yet another bungle by this minister.

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

I thank the member for Dickson for his assistance.

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

I thank all the members who have made valuable contributions in relation to this debate. Of course the Health Insurance Amendment (Pathology Requests) Bill 2010 removes the legislative restriction that effectively requires a patient to take a request for a pathology service to the approved pathology practitioner or approved pathology authority named on the request in order for a Medicare benefit to be payable for the pathology service provided. This legislative change will allow patients to take a pathology request to an approved pathology practitioner or approved pathology authority of their choice and will encourage pathology providers to compete on price and convenience for patients. These amendments will take effect from July 2010. Of course doctors will be encouraged to continue to advise their patients on the best choice of pathology provider for their needs. I commend the bill.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.