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

I speak in support of the National Health Amendment (Continence Aids Payment Scheme) Bill 2010. The member for Dickson was critical in his speech of the Rudd government’s initiatives in relation to health and aged care, but the problems he mentioned have not been the experience of the constituents in the electorate of Blair, which I have the honour to represent in this House. In our area there has been substantial investment in health and ageing—in the 2008-09 budget, the 2009-10 budget, and the 2010-11 budget, which we have recently passed.

Incontinence is a real problem for some of our senior citizens and many in aged-care facilities and, while the member for Dickson was critical of what we are doing in relation to so much of the legislative agenda of the Rudd government, if he were to come to the electorate of Blair he would see in Ipswich and the rural areas outside significant investment in health, particularly in hospitals, such as the Ipswich General Hospital, and in aged-care facilities. We have some fantastic aged-care facilities in the electorate of Blair, such as Cabanda Aged Care at Rosewood, a rural area outside Ipswich City. The Rudd government is supporting 500 jobs in a $1.5 million election commitment to that facility. Another wonderful facility is Elim Village, part of the Queensland Baptist Care facility. Recently I was there to salute their service. There was a flagpole and a memorial set up there. There are many other fine facilities. Colthup Home in Ipswich is another great facility run by Queensland Baptist Care.

Many of the residents in our aged-care facilities across Australia suffer from the terrible embarrassment and difficulties of permanent and severe incontinence. This is defined as a frequent and uncontrollable moderate to large loss of urine or faeces which impacts upon a person’s quality of life and is unlikely to improve with medical, surgical or clinical treatment regimes. The definition in the new scheme we are establishing is the same as in the old, but the legislation before the House is about improving open markets and flexibility and choice for those poor people who are suffering from this embarrassing problem.

All of us in this place have relatives, and all of us in this place have had senior relatives suffering from illness, disease and other ailments. My father, who died earlier this year, suffered this problem significantly in the latter part of his life. He suffered from prostate cancer for seven years before he died in January this year, and I know the embarrassment, the difficulties, the troubles and travails that he had in his personal life as he went through the last 18 months of being bedridden and having problems of incontinence. This is a problem which affects the families, relatives and friends of politicians and all other people in Australia. It is a serious problem for many people in this country. I am pleased that the coalition is supporting this initiative as it deserves bipartisan support.

We are introducing the Continence Aids Payment Scheme, which will replace the current Continence Aids Assistance scheme. The bill will allow the Minister for Ageing, the Hon. Justine Elliott, to formulate a Continence Aids Payment Scheme through a legislative instrument, as the member for Dickson said. It will allow the Commonwealth to make payments to eligible persons under that new scheme and will ensure an adequate process is put in place to facilitate the transfer of clients from one scheme to another and to provide information and news so that people understand what is happening. There will be a transition process. Power is conferred on the Secretary of the Department of Health and Ageing and the Medicare Australia CEO to request information in relation to the provision of payments under the scheme in order that there be an adequate and appropriate auditing of the scheme.

The bill delivers on the commitment we made in the 2009-10 budget. The cost of such a scheme, obviously, has to be demand driven. People do not choose to suffer from this problem, and it causes them significant embarrassment and difficulties in their personal lives. The payment is made through a special standing appropriation under the National Health Act 1953. The National Health Act provides the legislative framework for the provision of services to the Australian public, whether they are medical, dental, pharmaceutical or other types of services. We are seeing a legislative change which will enable a new scheme to be put in place. The funding will be made available through the special appropriation. The CAPS payments will be up to $489.95 for the 2010-11 financial year and will continue to be adjusted, obviously, with indexation.

We are providing greater flexibility and choice for recipients under this scheme. Currently, they are stuck with simply having to use one particular provider. This will provide more consumer choice. Consumers will be in a better position to control their destiny, and that is a good thing in the circumstances. The minister in her second reading speech made reference to the fact that promotion of consumer choice and control is consistent with the government’s Charter of Rights and Responsibilities for Community Care released in 2009. This is also a worthy aspect of the government’s legislative framework and agenda. There is a bit of mythology perpetuated by those opposite that Labor governments do not promote choice, do not promote competition and do not support open markets. I have never subscribed to that view. I think that is simply nonsense. Labor governments are every bit about improving the power of consumers and their ability to decide their destiny. Independence or autonomy is particularly important for individuals, no matter whether they are young or old, no matter whether they have sickness or injury and no matter whether they enjoy good health.

The Continence Aids Payments Scheme is not a reimbursement scheme. Clients of the scheme will not be required to produce receipts. Of course, the CAPS payment will not affect a person’s income. Income tax exemption has been approved for CAPS. The Department of Health and Ageing will write directly to all existing clients under the old scheme to ensure that they understand and have information about the transition. Professionals such as doctors and other allied health workers associated with those patients or clients will also be notified. Intouch Direct, which is the sole provider for continence services under the old scheme, will continue to offer their services and products but they will suffer and endure what most other companies and businesses have to go through—that is, they will be faced with competition. Of course, clients can choose to purchase products from Intouch, if they wish to.

The CAP Scheme is designed to help people with permanent and severe incontinence meet some of their costs. No government, coalition or Labor, has ever aimed to ensure that the full costs of a client of the scheme would be covered. The scheme provides assistance. It is a helping hand to those people who suffer from this problem. In the Department of Health and Ageing forward estimates on the financial impact of the changes to the scheme, the figures range from approximately $40 million to $46 million per annum over the next four years. I think that is a small price to pay to assist people who are suffering from this problem. This assistance will improve their life and lifestyle. It will allow them to enjoy recreational activities as well as other opportunities at home, outside the home and in the workplace.

To provide people with choice and assistance is, I think, a decent and humane thing to do. It is the Australian thing to do. I welcome the fact that the coalition supports this legislation. It will support the lives of thousands of Australians who are suffering from this problem, and it will make a big difference in helping to ensure that they live their lives to the full and that they enjoy an abundant and fruitful retirement and that the years left in their life’s journey are also abundant and fruitful.

Luke Hartsuyker (Cowper, National Party, Deputy Manager of Opposition Business in the House) Share this | Link to this | Hansard source

The Continence Aids Assistance Scheme has proven to be very important in providing the supplies needed to allow people affected by incontinence to live with dignity. Incontinence is a subject that is rarely discussed, despite it affecting a significant number of Australians. Incontinence affects up to four million Australians of varying ages and for a variety of reasons. According to the Continence Foundation of Australia, incontinence affects 20 per cent of Australian men and 37 per cent of Australian women. For many people, this condition is embarrassing and inconvenient. The Continence Aids Assistance Scheme helps to pay for the supplies needed to allow people to manage incontinence. Under the current scheme, eligible people with severe and permanent incontinence may receive up to $489.95 in incontinence products. The products are supplied by a sole provider on behalf of the Department of Health and Ageing.

The National Health Amendment (Continence Aids Payment Scheme) Bill 2010 , which is before the House today, will allow the Minister for Health and Ageing to formulate a scheme to provide direct payments to eligible persons as a contribution towards the cost of incontinence products. Medicare will administer the new scheme, which is to be called the Continence Aids Payments Scheme, or CAP Scheme. The CAP Scheme is intended to give recipients more flexibility and choice and to promote competition. The bill also provides for a transition period to allow people currently under the CAAS to move smoothly onto the CAP Scheme. Given the Rudd government’s track record in service delivery, I very much doubt that the transition will be as smooth as the minister would have us believe.

As a principle, the opposition supports measures that increase competition and that allow individuals to take greater control of their own lives. For many people, this change will be positive. However, I have recently been contacted by a group of local incontinence advisers and stomal therapy nurses who are concerned about the changes. The nurses are mainly concerned that the money provided under the CAP Scheme may not in some cases be spent on incontinence aids. The nurses are also concerned that the changes may lead to some people purchasing incorrect or inappropriate products for their individual circumstances, leading to an increased risk of falls or infections. The nurses also expressed concern about the increased stress and cost for carers who are responsible for managing a person’s access to incontinence products.

There are also questions about whether the new CAP Scheme will make it more difficult for people to access the New South Wales Program of Appliances for Disabled People. Under the current arrangements, people who are living in New South Wales can access help through the state system once they have exhausted their allowance from the Australian government. The new CAP Scheme will make it more difficult to determine when someone has used their entire entitlement from the Commonwealth and it has the potential to result in some people being denied access to the state system for a period once they have used up their allowance from the Commonwealth. My office has been in contact with the North Coast Area Health Service for advice about how the new CAP Scheme will interact with the New South Wales system. I have been told that the details are yet to be worked out.

With the scheme to come into operation shortly, we have a situation where the details are yet to be sorted out. I must say that this government has proven itself not to be good at paying attention to detail. In the overall scheme of the national health budget, this is a relatively minor program worth around $40 million each year, but lack of attention to the detail of this program is not isolated and is being repeated around my electorate. In the Cowper electorate, we have Coffs Harbour Health Campus and Kempsey District Hospital, plus hospitals at Maclean, Bellingen and Macksville and a multipurpose facility at Dorrigo. In the smaller hospitals, we have seen the North Coast Area Health Service continue to downgrade services and cut resources from smaller facilities. This has not only outraged residents from smaller communities but also placed extra pressure on the larger campuses, such as Coffs Harbour, as more patients are transferred there for treatment or care.

I take this opportunity to acknowledge the great work of local communities who support their hospitals in Bellingen, Maclean, Kempsey, Macksville, Coffs Harbour and Dorrigo. In Bellingen, the Bellingen Health Action Group is very active and very supportive of their local hospital. I recently organised a meeting between the shadow parliamentary secretary for rural health, Dr Andrew Southcott, and the Bellingen hospital support group. Attending the meeting were Barbara Moore, Fiona Crosskill and Solvieg Larsen from the action group, Dr Deidre Little from the medical staff council, Mayor Mark Troy and council general manager Mike Colreavy. I also joined the Bellingen community in a public rally about the hospital on 15 May.

The Bellingen group is genuinely concerned about the ongoing downgrade of services at its local hospital. In recent years we have seen maternity services withdrawn and the executive officer and director of nursing positions scrapped. There have also been ongoing concerns about plans to close the accident and emergency ward from 11 pm until 7 am. That is despite the fact that the emergency department in Bellingen handles around 30 emergencies each year involving triage 1 or triage 2 patients. Such cases require immediate treatment and therefore should not be delayed because the patient has to get to the Coffs Harbour Health Campus some 30 minutes away. As one of the hospital action group members said to me recently, these are lives that could have otherwise been lost.

In the past few weeks, the North Coast Area Health Service have pledged not to close the emergency department at night and have flagged that they will restore maternity services. However, whilst these words are welcome, the Bellingen community knows that the fight is not over. Too often in the past we have had plenty of promises but very little action. The removal of maternity services at the hospital has highlighted how the area health service can say one thing and do the complete opposite. At Bellingen we have seen out-of-hours and on-call X-ray services cancelled and the use of the operating theatre severely cut back. The cutbacks and downgrading of services has had a spiral effect on the training and skills base of the staff. In the end, staff may have had no choice but to resign or seek work elsewhere.

The treatment of the Bellingen community by the local area health service has been nothing short of deplorable. The bottom line with Bellingen hospital is that the Bellingen shire is flood prone. Last year was enormously challenging, with up to six floods in the Bellingen local government area. In many cases, Bellingen was cut off from Coffs Harbour. Having adequate health services at Bellingen hospital was therefore vital to treat those who needed medical assistance.

The Bellingen River District Hospital services the Bellingen Valley and Dorrigo communities. For more than 108 years, it has done so in an excellent manner, but despite the growing population services are being eroded. Given the changes to the health system which this government has announced, the very least it could do is to ensure that there are no further services cut or positions abolished. Only last week, there were media reports that a further 80 jobs were being cut across the North Coast Area Health Service. That is why there is real concern that the Rudd government has come up with a political fix rather than reforms that will genuinely improve health services on the North Coast.

Recently I called for an immediate cessation of ongoing costcutting in hospitals across the North Coast until the Rudd government explains how health services in the region will be managed in the future. It is clear that local communities are scared about what these changes mean for smaller hospitals. They are worried that the North Coast Area Health Service will continue to slash services and sack staff and that the proposed new hospital networks will only disadvantage smaller health facilities. If these proposed new networks are going to deliver better outcomes for regional communities, the slashing and burning must cease. That is why I join the Bellingen Hospital Action Group and remain vigilant to ensure vital services are restored and that there are no further downgrades, regardless of what the North Coast Area Health Service says.

I know the North Coast community is also concerned that the Prime Minister’s health package is going to do nothing more than add another layer of bureaucracy. The recent federal budget set aside an additional $500 million for bureaucrats, which means an expanded federal layer of administration. That is more expenditure on desks than on beds. Instead of investing in beds, the government is investing in desks. Regardless of what the Prime Minister says, we must remember that under his new health agreement state governments retain control of the health-funding pool. We all know that it is the poor management of public hospitals by the state government which is the real reason why health services in New South Wales have descended into such a parlous state. One must question whether this new agreement will actually deliver meaningful outcomes on the ground or whether we are going to see more waste and more mismanagement.

I previously touched on the downgrading of Bellingen hospital and its flow-on effect to the workload at Coffs Harbour Health Campus. Almost every day there is a shortage of beds at the Coffs Harbour Health Campus. One of the main reasons for this is that patients are not being treated at their local hospital but rather are being transferred to Coffs Harbour. As a result, the Coffs Harbour Health Campus is bursting at the seams and there is a lack of beds in the medical wards. This flows back into the emergency department where waiting times continue to blow out because the emergency department has nowhere to transfer treated patients. Doctors and nurses are being asked to do more with less and that places unsustainable pressure on our medical staff. In the end, patient care is suffering despite the best efforts of that very dedicated staff.

One of the problems with the health bureaucracy is that they are quick to reject statistics and figures which are presented to them by hospital medical professionals, but at the same time they will embrace their own data if it provides some justification for reducing investment in services. For some time now the nurses at Kempsey District Hospital have put forward a logical case, supported by strong statistical evidence, that their emergency department should have an additional registered nurse on each shift. In recent weeks the local area health service has at least acknowledged the problem, but I believe the House should be made aware of the long battle which these nurses have endured just to get to this point.

The Kempsey nurses have produced evidence which shows they are not receiving resources which reflect the number of presentations in the emergency department. I acknowledge the work of nurses such as Di Lohman, Jennifer Clarke, Jo Hensler and Linda Weir. I also acknowledge the tireless support of Mayor John Bowell, who has been an active supporter of the hospital for many years. Collectively, these people, along with many other colleagues, do a great job in representing the interests of health services in the Macleay Valley. The North Coast Area Health Service and the Minister for Health and Ageing have consistently ignored these people, despite the strong case that has been put. The area health service is guilty of treating Kempsey as a poor cousin of the Port Macquarie Base Hospital. In Kempsey, the nurses have comparisons of their hospital with similar hospitals where the difference in the number of presentations is 20 per cent yet the difference in the level of resourcing is 300 per cent.

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

Order! It being 2 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour and the member will have leave to continue speaking when the debate is resumed.