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

I welcome the opportunity to again speak on this important bill, the National Health Amendment (Continence Aids Payment Scheme) Bill 2010. I will add to my earlier remarks. I tendered that many of the presentations to Kempsey hospital were complex and involved mental health issues and violence. I know this is not unique in emergency department terms, but this puts extra pressure on the doctors and nurses in Kempsey. Kempsey hospital services a large area that stretches from Millbank in the upper Macleay across to South West Rocks and down to Crescent Head. It is a huge area, and it is important that the services are maintained and not eroded. I have supported public rallies which the Kempsey nurses have hosted and have shared the frustration and anger they feel towards the bureaucrats and ministers who continue to reject their case for more resources.

The recent acknowledgment by the North Coast Area Health Service that the nurses may have a case is welcome. A review—one of the endless reviews—is taking place and that is indeed long overdue. But there is no excuse for the way Kempsey nurses have been treated in this matter. I, like the Macleay community, will remain vigilant on this matter until Kempsey hospital secures the additional resources required for the emergency department.

There is not a hospital on the North Coast that has stronger community support than the Maclean District Hospital. Whether it be the hospital auxiliary or the local community, lower Clarence residents understand the importance of supporting their local hospital. But there is little doubt that the lower Clarence residents have, over time, been treated as second-class citizens by health bureaucrats. In 2007 the North Coast Area Health Service sold some land next to the Maclean hospital. Local residents thought the funds raised would be invested in upgrading infrastructure in Maclean—but, no, the North Coast Area Health Service decided instead to upgrade the emergency department in Grafton. In 2008 the NCAHS tried to sell more land adjacent to the Maclean hospital, but the community outcry eventually ensured there was little interest in the land and the area health service took it off the market. Slowly but surely the North Coast Area Health Service has been withdrawing resources from Maclean hospital. The hospital no longer has its own executive officer in charge, and a security guard’s position has been axed. Once again, the smaller hospitals are being screwed of every last dollar as services are centralised to larger regional hospitals.

Many of the concerns which I have detailed with regard to the above hospital also apply to Macksville Hospital. Macksville Hospital now has to share a director of nursing and an executive officer with Bellingen Hospital. Staff at Macksville Hospital do a great job in providing services to the Nambucca Shire but they have no choice now but to refer many cases to Coffs Harbour, which is 50 minutes drive away.

I would like to bring the parliament’s attention some comments that the federal member for Page has recently made. In the Northern Star newspaper the member for Page made the following comments in relation to provision of dental care:

These waiting lists grew to more than 600,000 after the Howard Government scrapped the Commonwealth dental scheme in 1992 … Rather than pass legislation to provide dental health care to those most in need the Opposition senators would rather keep a flawed Howard Government Scheme  where the poorest people get nothing.

These comments were made in a letter to the editor, so I do not think they were made in the heat of the moment but I do believe that she was not telling the gospel truth. Firstly, the Howard government did not scrap the dental health scheme in 1992—Paul Keating was our Prime Minister in 1992. But, more importantly, the Rudd government has been intent on scrapping the Howard government’s dental program. This scheme allowed people with chronic and complex health problems, where dental health was a contributing factor, to receive up to $4,250 over two years for dental therapies.

The federal Minister for Health and Ageing claimed in parliament that the program had only helped 15,000 people in four years. However, Ms Gay Santiago, acting assistant secretary of the primary care financing branch of the Department of Health and Ageing has told a Senate estimates hearing that the scheme provided 311,943 services between November 2007 and 30 April 2008. These services are vital for those who have the most genuine need for major dental work yet the Rudd government, including the federal member for Page, are willing to turn their backs on their people and it seems they are most willing to bend the truth when presenting their case.

Whether we speak about this legislation today or whether we debate the broader implications of the Rudd government’s approach to health, the real concern here is that the Prime Minister’s focus is not so much on people but on politics. This is why quite often the government falls short when we look at the detail. We should never forget that health is not about headlines, it is about human beings. Politicians like the Prime Minister who dress up new health agreements as a major reform but fail to provide meaningful detail are treating Australians with contempt. The details of health policy are the difference between health and illness, between help and despair, between dignity and embarrassment and, in extreme cases, between life and death. The opposition cautiously welcomes the government’s changes to the CAAS program but we will continue to scrutinise the government’s every move in the health portfolio. They have a track record of failure rather than success on everything they touch.

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

Before I get to the substance of my contribution to the debate on the National Health Amendment (Continence Aids Payment Scheme) Bill 2010 the member for Cowper may like to hear what I have to say about the enhanced Medicare scheme and how it relates to the provision of service for people with chronic and complex dental health problems. I will set the record straight. It was in 1997 that the Howard government ended the Commonwealth dental program that helped many thousands of Australians throughout the country.

In relation to the program the member for Cowper spoke about I would like to give a real live example from the Cowper electorate. My mother lived in the Cowper electorate and I told her about the program. She had very complex health needs—in fact, she died because of the health problems she had. I gave her a handout on the program, and she went to talk to her doctor about it. The doctor said: ‘You wouldn’t qualify for this and, besides, there is no dentist within the vicinity that actually will utilise this program.’ I sent her back again and said, ‘Go and see your doctor, go and talk to your doctor. You would definitely qualify for this program. Surely there must be one dentist in the area. Try Coffs Harbour.’ She lived at Nambucca Heads. Her doctor eventually gave her the referral. Then she had to find a dentist that would provide the service for her under the Howard government’s wonderful scheme. There was no-one in Nambucca Heads, there was no-one in Macksville, there was no-one any closer than Sawtell. She finally found a dentist that would provide the service for her, and she got the dental treatment that she needed. She had quite a significant dental problem. She managed to have it done before she died, but only just.

If that scheme is held up as one that benefits Australians, and if that is something that the member for Cowper is proud of, then he needs to look a little more carefully at the number of people who need dental health treatment and cannot afford it. The Labor Party’s program is about providing dental health care to all those people that need it. I am very familiar with the health services in the Cowper electorate. I would encourage the member for Cowper to be quite honest with this House in relation to the services that are available there and in particular to that dental care program that he spoke at great length about and which his constituents have been unable to utilise. Having had my say on that particular program, I would like to turn to the legislation that we have before us today, which the member for Cowper only briefly mentioned as he concluded his contributions to this debate. This legislation will allow for the introduction of the Continence Aids Payment Scheme. I will refer to it as the CAP Scheme as opposed to the continence aid assistance scheme, which I will refer to as CAAS in my contribution to this debate.

This amendment allows for an instrument for the minister to change the way continence aids are paid for. It allows for the Commonwealth to make payments to people who are eligible under the CAP Scheme and ensures that there is an adequate process in place to facilitate the transfer of clients under the CAA Scheme, which has basically been provided by one provider, to the CAP Scheme, where people who use the scheme can choose their own provider of the continence aid. Obviously, this service will be provided by Medicare, which is a change to the way the first scheme operates.

Mr Speaker, you would be aware, I am sure, that an enormous amount of information has gone out to clients of the CAP Scheme. There are about 75,000 clients throughout Australia who are aware that the CAP Scheme will come into place. This will allow them to access continence aids at a time and in a way which is much more convenient for them. The current scheme provides $470 per person per annum for continence aids, which is what it costs the government, and I think that is indexed and due to go up to $489.95.

I thought it would be worth while having a look at the need for continence aids. Quite a few Australians have incontinence problems. I am referring here to the Australian incontinence data analysis and development report of March 2006. So, yes, the information is a little dated, but, if you look at the population today and make a correlation between the figures I am about to give to the House, you will find that it is pretty accurate, with 2.8 per cent of the Australian adult population experiencing severe incontinence. For 128,000 people living in cared accommodation who also need assistance with bladder and bowel control, this is handled differently.

This scheme relates to people living within the community. To give you the combination of how the 545,000 is made up, 240,800 people living in households experience very severe urinary incontinence and 202,100 people living in households experience frequent or very frequent faecal incontinence. Those figures show that there is a significant need for this program in the community. It is also important to know that there are 723,100 Australians who experience moderate urinary incontinence and another 2,877,500 Australians who have slight urinary incontinence problems. This really brings home the fact that this scheme needs to be in place.

People need to link in easily to the CAP Scheme. It is a flexible scheme which people who need continence aids can access locally. I am sure I am not the only member in this House who has a constituent with this problem—in my case it was a parent with an intellectually handicapped daughter who needed continence aids. There were problems accessing the aids and a delay receiving them because they were not provided in the area in which she lived—even within the Hunter area—and those aids were available from different sources. I think this is such a positive move.

Talking about the prevalence, it is worth while looking at the age factors associated with incontinence. Of the 284,000 Australians who always or sometimes need assistance with bladder or bowel management, 79 per cent are over 50 and 65 per cent are over 70. I bring those figures to the House because it is important for us to note that in a situation where we have an ageing population this is obviously going to become more prevalent. Since the 2006 report, there would have been an increase in the number of people needing continence aids simply because in those four years our population has aged further. It is important to note that females represent two-thirds of the people who are likely to experience severe incontinence and 45 per cent of the people live in cared accommodation. That means that 55 per cent of the people live in the community and these are the people who will benefit enormously from the scheme we are discussing, which will be covered by the legislation. Females represent 55 per cent of people living in households who need assistance with bladder or bowel control and 73 per cent of people living in cared accommodation. It is also interesting to note that 89 per cent of people living in care who are 70 to 84 years of age need assistance. There is a correlation between those people living in the community and an increase in their need for continence aids. So, by looking at these figures and at the fact that we are an ageing population, it is indisputable that a program like this is needed and it is also indisputable that people needing continence aids should be able to receive them close to where they live.

Disorders such as arthritis and related conditions often accompany people that have severe incontinence. Dementia is the most common health problem in relation to people that need continence aids. Based on the demographics and on the condition of incontinence, there can be strong support for having a scheme in place that is flexible and meets the needs of people who require continence aids.

It is interesting to note that the definition of incontinence that accompanies the scheme says that a person must suffer from a moderate to severe level of incontinence. For males, one of the diseases that have in the past led to incontinence has been prostate cancer. I know there have been enormous developments in treatment in that area, and operations and treatments that are now conducted are no longer leading to the problems they did in the past. The CAP Scheme is designed to help people with permanent—and I think that is important—and severe incontinence to meet some of their costs. Under the current scheme the government contribution—as it has always been—does not cover all the costs. It is similar with the CAP Scheme.

Clients who are currently receiving assistance under the CAA Scheme will receive a letter from the department about the changes to the scheme. I know from talking to people in my electorate that a number of clients have already received that information, and I know that there has been correspondence sent out to a number of constituents in Shortland electorate giving them advice about the new scheme. Cash payments made to people that need the continence aids can be made on either a yearly or six-monthly basis. Throughout the transition period the current provider will be in touch with clients of the CAA Scheme to provide information about the new CAP Scheme, and those clients will continue to access their subsidy until 30 June 2010, which is right about now.

It is important that this legislation gets through the parliament before the parliament rises, because it is legislation that will advantage so many Australians who need the continence aids that will become available through the CAP Scheme. The flexible provisions of the scheme will be enormously useful and beneficial to each and every person who needs to utilise continence aids.

There is one important change that is worth mentioning. Currently CAAS clients may be required to complete a CAPS transfer form. The important difference is that Medicare Australia will be the body funding this scheme. Completion of the CAPS transfer form will allow the payment to be made to the nominated bank account of the client.

This is, as I said, a vitally important scheme because it creates flexibility and gives some control to older Australians. As I have mentioned, we have an ageing population, so we need to make things happen easily. We need to be mindful of the quality of life that people enjoy. Through this CAPS program, we will be delivering a service to older Australians that will be extremely beneficial to them. I commend the legislation to the House.

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

Order! Before I call the member for McPherson I indicate to members that the House has agreed that there should be no points of order during her contribution. The member for McPherson.

Honourable Members:

Hear, hear!

Margaret May (McPherson, Liberal Party) Share this | Link to this | Hansard source

Mr Speaker, on indulgence: since announcing my intention not to stand at the next federal election, I have spent some time reflecting on my years of service as the federal member for McPherson, on what this role has meant to me, on what the people of McPherson have meant to me and on the many people who have supported me and made my time in this place and in the electorate so memorable. They are memories that I will cherish for a lifetime. I have also spent time reflecting on this great country of ours and on what governments of both persuasions have done, and I hope will continue to do, for the people of this country in the name of democracy. It is the strength of our democracy that means so much to me personally.

As someone who lived under a military dictatorship for many years and witnessed poverty and deprivation of human liberties, I look at the history of this country and what we have achieved through the democratic processes that have evolved since Federation and I am proud of what our forefathers and indeed the modern leaders of our democracy have given us as citizens. However, the world is still facing challenges, with hunger, disease and suffering still at levels that are totally unacceptable in the modern world. With natural disasters and tragedies like floods and fires often imposing a heavy toll on communities and individuals, and with the world still on alert against terrorism which threatens our freedom, I once again say that this country has much to be proud of.

We often hear politicians talk about the honour and privilege of representing people in the federal parliament. It is both and I am no different from others who have gone before me in saying just that. It has been an honour and a privilege. More than that, it has been an unforgettable journey, a journey filled with wonderful people, extraordinary events and unbelievable experiences that will stay with me for a lifetime. But above all it has been the people—the people who have supported me through four elections; the people who did not support me but whom I nevertheless grew to respect for their different views; the people who challenged me with ideas and issues; the people who questioned the policy and policy directions of my government; the people who did not have a voice and looked to me as their voice; the talented young people in my schools and universities whose ideas often shocked me and certainly challenged me; the senior Australians who shared their wisdom, experiences and knowledge; and the new Australians on whom I bestowed Australian citizenship, with their wonderful stories of hope in a new land of opportunity. There have been so many people who have enriched my life and who make up the rich tapestry of people that is the federal seat of McPherson. To all those people: thank you. Thank you for the wonderful and rewarding position you entrusted me with for 12 years. You will not be forgotten.

To my party members, those people who share the same ideals and beliefs as me: thank you. Thank you for supporting our great party, the Liberal Party of Australia, and thank you for supporting me for the past 12 years. I have just one message to you all: stay involved and stay committed to our cause during this election year. Remember why you joined our great party and continue the fight and the dream for tomorrow’s children. We can win in 2010.

Opposition Members:

Hear! Hear!

Margaret May (McPherson, Liberal Party) Share this | Link to this | Hansard source

As individuals in this place, we are not able to carry the burden of office without the commitment, help and assistance of our staff. As a former staffer myself, I know just how much we rely on these very important people. They are often the first contact with constituents. They are our eyes and ears. They work long hours and often put the office before their own families. I have been extremely blessed over the years to have the most loyal staff, who have worked hard in the electorate office and here in Canberra. They have supported me above and beyond what I could ever have expected. We have faced many challenges together over the years. We have shared some wonderful highs and lows. We have laughed and even cried on occasions. We have celebrated birthdays and milestones, but above all we have respected each other and supported each other, particularly during the long periods away from home.

To my current staff, Karen Embrey, Krystyna Homik, Sandra Tomlinson and Amanda Belton, who are all in the gallery today, ‘thanks’ does not seem enough or indeed appropriate for the years of service, support and loyalty you have given me. You made the job so much easier and I hope our paths will cross as we embark on our different journeys in the future. To each of you, most sincerely and from the bottom of my heart: thank you. I would also like to mention a couple of other staff members who worked with me when I was shadow minister for ageing. To Amelia Walsh and Damian Marwood, who have now moved on to new lives—Amelia in Chicago and Damian in Sydney—thank you both for your individual contributions over a number of years. To Ann Phillips, our wonderful volunteer who comes in every week and has done so for many years: the girls and I will be forever grateful for your contribution to our office. Thank you. And to a number of my past employees, Carol Johnson, who is in the gallery today, Gwen Olsen, Johllene Elson, Sandra McCulloch and Annette Poppett: you all set the bar very high during your time with me and I thank each of you for your contribution to the office and your continuing friendship. There have been so many wonderful people and such a mixture of personalities and age, from baby boomers to gen Ys. I have learned so much from each of them.

During my time as the federal member, I believe my achievements were many and varied. There were some large projects that made front-page stories and there were some great outcomes for my communities, but just as rewarding was delivering, for constituents, outcomes that went under the radar but which made such an impact on individuals and their lives. As someone who believes very strongly in serving my community and that delivering on projects was my job, I am, however, going to put on the record today one of the great outcomes that came about in the electorate because of people power.

I was the voice in Canberra, but my voice was heard because of the voices of many—the people of Tugun. We needed a road—a bypass in fact—that would alleviate the noise, the long traffic delays, the pollution and the thundering of trucks day and night through the streets of Tugun. The fight for this bypass had gone on for many years. The project involved two local government authorities, two state governments and, of course, the federal government. The planning had to be designed around an international airport, people’s homes and the environment. We had a fight on our hands about the route. The Queensland state government wanted the eastern route, which was going to mean the resumption of people’s homes. It was a very sad day when this route was announced, but the people of Adina Avenue and Tugun were not going to have a bar of it. The fight was on, not just a fight for the funding to build the bypass but a fight to save people’s homes and move the route west of the airport.

We had rally after rally—good old-fashioned politicking—at the local community hall and out in the streets. We picketed the state government member’s office in Tweed, complete with megaphone. I think Larry Anthony and I were nearly hoarse, but I loved it. I got to know those people in Adina Avenue so well. They loved their homes. They loved living next to the airport. We could have made our own movie. The Castle had nothing on us. We had real people—people with hopes and dreams that were being dashed by a government and a government bureaucracy who thought they knew better. Well, they did not and the people won. The route was moved and the homes were saved. The Tugun bypass was built—a magnificent stretch of road just 7.5 kms long—and it has made such a difference to the local Tugun community. But I guess the moral of the story is that people can have a say and make a difference. As the local member, I became the people’s voice in Canberra. Even in the dark days when we did not think we would win the fight, no-one gave up. This shows, I believe, the power of people who are living in a democracy to turn the tide, to make the bureaucrats listen and to make governments listen to people’s needs.

As I said before, most of the work we do as members of parliament falls under the radar, but I think some of the most rewarding work we do is helping an individual or a group of people in our electorates to find a positive outcome to a difficult issue. Sometimes we are challenged as individuals to stand up and speak out on a principle or for a belief that is yet to be adopted by one’s party as policy. Unwittingly, I did just that on Friday, 16 May 2008 when I endeavoured to launch a petition in support of the age pensioners of Australia. It was the end of budget week. The pensioners did not get a pension rise. They were hurting. Rising living costs meant that older Australians were finding it difficult to make ends meet. I was angry—angry that we were turning our backs on the most vulnerable in our community. I did the worst radio interview of my political life and I had no shortage of shadow ministers and advisers who let me know just that, but the issue made news and it continued to make news. Our pensioners started to mobilise. They took their clothes off on a street in Melbourne—not a pretty sight, Mr Speaker, but a very powerful message. I collected thousands of signatures on a petition. Seniors groups around the country kept up the pressure. My own party introduced legislation in the Senate in September 2008 for an increase in the pension but the bill was defeated in the House of Representatives. However, the debate over a pension increase continued through to budget 2009 and the pensioners finally received their increase in the 2009 budget. I like to think that my press release, my terrible radio interview and my continued outspokenness made an impact and kept the issue alive for nearly 12 months. Life for me was not easy during this time, but I survived and my pensioners were the winners.

Some of the most valuable work we do in this House is through our committee system. In my view, it is often undervalued. It is not given the recognition it deserves but there would not be a person in this place who has not benefited from the committee system. During my time in this House, I have been a member of a number of committees, which has enabled me to make a difference through policy and, indeed, in the administration of the House. In my first term, I was appointed chairman of the Joint Standing Committee on Migration. During this period, I remember visiting the Kosovar people to whom we had given safe haven while civil war raged in their own country. That was a wonderful humanitarian program that we can be proud of.

At a later date, I was appointed chairman of the House of Representatives Standing Committee on Procedure—a challenging position but one that brought about some real changes to this place. We changed the sitting hours. I remember when I first came to this place that parliament sat till 11 pm and it often sat through the night—horrendous hours that made a huge impact on people’s lives and their health. The change of sitting hours was made without sacrificing any time for debate. The latest we finish now is 10 pm and we do not often sit through the night. What a relief that is to all of us.

We rewrote the standing orders—the rules that govern this place. It was a mammoth task. Our brief was to modernise and recategorise the standing orders to make them user-friendly. Each and every standing order was assessed, debated and, in many cases, rewritten. This job took the best part of 12 months but finally we finished the rewrite and our work was adopted by the 2004 parliament. Those standing orders are relevant today. The committee also recommended a petitions committee be introduced into this place to allow Australians a voice and a more accountable pathway to bring to the House’s attention the issues of the day through their local member. I am delighted that the current government adopted that recommendation after the last election and a good friend, the member for Fowler, is the first chairman of that committee. We had a recommendation adopted to protect members’ time for three-minute speeches in the Main Committee if a division were called. These are small changes but they have made an impact and improved the workings of this place.

My committee tabled 20 reports over the six years I was chairman, including a history of the committee to celebrate the committee’s 20th anniversary. The reports, recommendations and subsequent changes to the practices in this place would not have happened during my period as chairman without the support of my two deputies—the member for Chifley, Mr Roger Price, who I am delighted is in the House today and who is now Chief Government Whip; and the member for Banks, Mr Daryl Melham. who is also in this place. To you both I say thankyou for your support and friendship during my period as chairman. We can be proud of what we achieved on a bipartisan level through that committee for the benefit of all in this place. I would also like to say a special thankyou to Judy Middlebrook, Bernard Wright, David Elder, Robyn McClelland, Joanne Towner and Ian Harris for all their valuable advice to the committee. Without their knowledge and support, our work on the committee would not have progressed to where it is today. Of course, there is more to be done. My own disappointment is that we do not really debate in this House. We do have an intervention rule in the Main Committee but it is not used very often. The public see the very rowdy question time each day and more televised committee hearings but, sadly, I do not think we give the public the opportunity to see real debate. Maybe that will come at a later date.

Another committee that I really enjoyed was the House of Representatives Standing Committee on Health and Ageing, of which I was a member while I was shadow minister for ageing. One inquiry and subsequent report that made some very important recommendations was on obesity. We all know in this House how much obesity is impacting on our society. There is the desperate need for education and even the teaching of the basic life skill of cooking. As a devotee of MasterChef and someone who loves to cook, I am very supportive of the kitchen garden idea that Stephanie Alexander developed and implemented first in a Melbourne primary school—a school that we visited and where we shared a meal that was grown, cooked and served by the kids. It was a wonderful experience for the committee and a powerful initiative that I would personally like to see adopted right around the country. I believe practical ideas like this one will go a long way to ensuring a new generation of great cooks but also a new generation of Australians who will understand the benefits of eating properly. I think we in this House could also set a better example to all Australians about the benefits of a healthy lifestyle. Our former Prime Minister certainly had us all hooked on walking. But we do need to do more in this place, even down to the meals that are served, particularly at lunchtime. There is nothing wrong with a great sandwich or a salad instead of half a beast on a plate, swimming in sauce and nothing green in sight!

I joined the Liberal Party 20 years ago, a move I have never regretted as I strongly believe in the values and beliefs of the modern Liberal Party that Sir Robert Menzies formed in 1944. I have always believed very strongly in the individual. I have always believed in reward for effort. And I firmly believe that education and the pursuit of one’s goals and dreams will unlock a wonderful world of adventure, success and fulfilment.

However, there are those in the world who do not have access to education and who just struggle to survive—and without access to education they are trapped in a world of poverty. The key to unlocking that world of poverty is education. I would like to encourage all my colleagues on both sides of the House to support the Millennium Development Goals, to ensure that successive governments in this country continue to increase our foreign aid budget so that men, women and children across the globe have access to the basic necessities of life—food, shelter and clean water—and access to education.

In concluding my remarks today I want to express my love and thanks to the special people in my life, the people who have supported me with unconditional love during my years here in the parliament. To my sisters, Heather and Anne: you are simply the best. I couldn’t want two more wonderful people as sisters who have shared my life’s journey. Both are in the gallery today, along with my brother-in-law, John Stephens. To each of you: thank you for being there during the highs and lows, with wise words of advice to boost my confidence when I was facing challenges. I love you all so much.

To my children and their partners: my daughter Dimity and her husband, Raymond; my son, Dayne, and his wife, Nadine; and my youngest daughter, Kristin, who is also in the gallery today, and her partner, Pete. I love you all and am so proud of what each of you have achieved in your chosen careers, the wonderful individuals you have become and the joy and happiness you bring to my life. And, of course, the beautiful grandchildren you have given your father and me: Jaiden, Emily, Angus, Abby and Sam, and No. 6—another boy—due in August to Dimity and Raymond. These little people just light up my life.

To my mum, Rae Kerr. Mum was there for my first campaign and she has continued to support and encourage me during my parliamentary career. Her wisdom, her belief in me, her advice and her unconditional love certainly gave me the strength and confidence to follow my dream and sit in this place. Simply, Mum, I say thank you for being my mum.

And, lastly, to my husband, David—the person who has been at home with the welcome mat after long days on the road, weeks in Canberra and commitments in my electorate. David has never faltered in his support for me. He is my best friend and the love of my life. Thank you for just being there and keeping me sane, the family together and our marriage strong and happy with lots of love and laughter.

Mr Speaker, I do feel a tinge of sadness in leaving this place, leaving friends from both sides of the political divide. I have given the job 100 per cent. I leave with my integrity intact, my beliefs in the Liberal Party still strong, and I look forward to a new life with my family and long-suffering friends at home on the Gold Coast. Thank you.

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

Can I begin by acknowledging the valedictory speech we have just heard from the member for McPherson and paying my respects to her for her contribution to the workings of this parliament, for the work she has personally performed in the course of her membership of this place and also for her work in representing the people of her electorate and the people of Australia. I certainly concur with her remarks towards the end of her speech about the importance of education. I also wish her well in the years ahead.

I welcome the opportunity to speak on the National Health Amendment (Continence Aids Payment Scheme) Bill 2010, and I say that because this is a matter that I raised some time ago with the Minister for Health and Ageing on behalf of one of my constituents in the electorate of Makin. I am pleased to see that the minister has responded with this bill because what I raised with the minister is exactly what this bill now provides, and that is the opportunity for someone who is provided with financial assistance for purchasing continence aids products to do so at their choice with the supplier they wish to deal with.

The intent of this legislation is consistent with other health initiatives of the Rudd government which also provide financial support to enable people to manage their own health conditions. For example, for a child with autism, the government provides up to $12,000 for a child up to the age of seven years, with up to $6,000 of those funds accessible in any one financial year to assist with autism intervention and support. Similarly, payments of around $1,200 a year to cover the costs of day-to-day GP care and additional services are made available for people who suffer from diabetes. In fact, the Rudd government has committed $436 million to provide personalised care for diabetics, with payments of around $10,800 a year also being made available to GPs who become responsible for managing their care, including by developing a personalised care plan; by helping to organise access to the additional services they need, such as care from a dietitian or physiotherapist, as set out in their personal care plan; and by being paid in part on the basis of their performance in keeping their patients healthy and out of hospital. Again, the payment of continence aids funds directly to the patient is consistent with that theme.

In summary, this bill will allow for the introduction of the Continence Aids Payment Scheme and the replacement of the existing Continence Aids Assistance Scheme, which provides financial assistance with the cost of continence aids. This bill will allow a Continence Aids Payment Scheme—or CAPS as it is often referred to—to be formulated by the Minister for Health and Ageing through a legislative instrument. It will allow payments to be made directly to eligible persons under the CAPS, it will ensure an adequate process is in place for the transfer of clients from the Continence Aids Assistance Scheme to the new CAPS and it will confer power on the Secretary of the Department of Health and Ageing and on the CEO of Medicare Australia to request information in relation to the provision of payments under the scheme.

The existing scheme provides a subsidy for eligible recipients of up to $489.95 per year on continence products purchased through a sole provider. This sole provider is in turn paid directly by the Commonwealth. Expenses above $489.95 are then borne by the user. Under the new scheme, clients will now have a choice between receiving the full payments in July or, alternatively, receiving two payments of half the amount, one in July and the other in January each year. Medicare Australia will make the payments directly into the client’s bank account.

The CAPS is not a reimbursement scheme but a funding support scheme. It is intended that these new measures will come into effect from 1 July 2010. The payment will remain at $489.95 for the 2011-12 financial year and then it will be adjusted annually in accordance with CPI increases. The scheme currently assists more than 50,000 people. I am very much aware that, in addition to those 50,000 people, there are others in nursing homes or under other aged-care packages that will also access continence aids in this country.

The definition of what constitutes incontinence and how eligibility for the support package is determined will remain the same as that for the current scheme. The new scheme will mean suppliers will compete in an open and competitive market, and that will only be good for consumers because it will ensure that prices are competitive. I was approached by a constituent in my own electorate on this issue because the products were being made available by other suppliers in the broader community at a better price than they could be purchased under the previous arrangement and, therefore, consumers were not necessarily getting the best value for the amount of dollars allocated by the government to assist them with these products.

This week—that is, between 21 and 27 June—is World Continence Week, so it is timely that this bill is being discussed in this place today. Incontinence is a universal issue but not one that attracts much public attention and yet it affects so many families. Around four million Australians of all ages are affected by incontinence. They and their families are severely affected. I am sure that all of us in this place know of someone who is affected by incontinence and many of us may have family members whom we have to assist with this problem.

It is not a problem that is talked about widely throughout the community and yet it is a very real problem. In many cases, with the right treatment, the condition can be remedied. In other cases it simply cannot. For those who need the use of continence aids, those aids enable them to get on with their life and those aids certainly make life for their family members and carers much easier.

I also note that between 1 and 7 August this year will be national Continence Awareness Week in Australia. I hope that, as a result of the educational and promotional activities of that week, incontinence may become one of those topics that the community is better prepared to speak about, because it is only by the community at large talking about it more openly that we as a community can in turn respond with the best possible support available for both the people suffering from incontinence and their family members.

Many of the people who suffer from incontinence will clearly be entitled to financial assistance provided under this bill. The changes encompassed in this bill will be welcomed by all of those people eligible for financial assistance under this scheme because, as I said earlier, it will ensure more value, more choice and less expense if they were to normally exceed the $489.95 allowance. The fact that they have choice, I am sure, not only will mean that they will be able to shop around and get the best value for their dollars but also, as I also said earlier, will mean that, because there is a competitive market for the products, the price of the very products themselves can be expected to start to come down. People who need continence aids frequently have other medical conditions as well. If they are able to make any savings at all through the purchase of these aids, I am sure that those savings will be put to very good use to assist them with the purchase of other things in life that they will need as a result of the medical conditions that they inevitably suffer from in addition to incontinence.

This is a commonsense measure that has been implemented by the government. It is again consistent with the Rudd government’s message that health is of paramount importance. Health has become a priority for this government and, to date, the government has reflected that priority by the commitments that have already been made to the nation in health funding. I note that the government has already increased health funding by 50 per cent to $64 billion over the forthcoming agreement with the states. That is a 50 per cent increase to the health and hospital funding agreement with the states. In contrast to that, the previous government cut $1 billion from the agreement.

In addition to that increase, what this government has done is clearly identify where the priorities lie with respect to ensuring that the nation has a much improved health system and has, step-by-step, methodically worked through supporting all of those areas, beginning with committing additional funding to reduce elective surgy waiting lists around the country, providing additional funds for training of our nurses and doctors around the country, providing funding for GP superclinics around the country, providing funding to close the life expectancy gap for Indigenous people in Australia and providing funding to help with what we call low real interest rate loans for those people who are providing residential aged care. These are simply some of the steps that the government has already taken.

I note that in the last budget, announced only weeks ago, there was an additional $2.2 billion committed to providing health services for Australian people. I particularly note that, of that $2.2 billion, $355 million was provided for additional GP superclinics around the country, $417 million was provided to enhance after hours services for people in Australia, $523 million was provided to train our nurses and $467 million was provided for individual electronic health record systems to be established. I particularly note that $2.2 billion because the opposition leader has made it absolutely clear that, if they are elected, they will not proceed with the funding for the GP superclinics and not proceed with the funding for an electronic health record system for Australia, which I think is shameful because the electronic health system in particular is something that will enhance the ability of this country to provide better health services for people wherever they are. I am surprised that they would oppose electronic health funding because they suggested that it ought to be paid for by the federal government and implemented by the federal government when they were in government. I say to them: it is certainly something that surprises me. They should think again because, if they are serious about improving health services to the people of Australia, that is certainly one improvement that is not only long overdue but also needed if we are to provide good health services to people around Australia.

As I said in my opening comments about this bill, this is a matter I support. I have personally taken it up with the minister on a previous occasion and I commend the minister for looking at the issue and coming back with this legislation, which gives choice to the recipients of the funding. I believe, in providing that choice, it will be a very welcome measure. I commend the bill to the House.

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

If the intention of the National Health Amendment (Continence Aids Payment Scheme) Bill 2010 is achieved, it will be a further recognition of the great disadvantages faced by people who have lost certain personal bodily functions and who suffer incontinence. It is extremely expensive because they must equip themselves, at all times, with the appropriate aids. I have no evidence that there is any opposition to this scheme from within the ranks of the opposition. It is worth referring to the explanatory memorandum and making some comparison between the present and the future as proposed by this legislation, but without the detail of the assistance to be given.

This is what the explanatory memorandum tells us: under the CAA Scheme—in other words, the current scheme implemented by the Howard government—eligible people with severe and permanent incontinence are provided with up to $489.95 worth of products each year, indexed annually, to help manage continence. The CAA Scheme is managed by a sole provider on behalf of the Department of Health and Ageing. One can only assume the costs involved in that virtually $500 assistance package are being properly overseen by the health department to ensure that entitlement is stretched as far as possible. That is something that these unfortunate people know about and are receiving at present. So what happens next? Under the CAP Scheme, which is what the legislation is proposing, eligible people will instead receive a payment as a contribution towards the cost of the products. The new arrangement will provide greater choice to the consumer and promote competition and is expected to reduce the administrative costs associated with the continence aids program.

Why will it reduce administrative costs? A person presently has the entitlement to purchase directly from a provider, overseen by the health department. They are able to obtain that on the basis that they are eligible. The new process clearly involves all of the practices of Medicare—that is, each time you incur a cost, as you might in attending a non-bulk-billing doctor, you will have to apply for a refund. The minister, in addressing the House at the end of this debate, might tell me, ‘That is not so.’ Well the parliament does not know. All we are told further on in this explanatory memorandum is that Medicare Australia will deliver the program. The amount of the contribution payment will be specified in the legislative instrument—in other words, delegated legislation—and the parliament is passing this legislation with no knowledge how much that might be.

As is typical in so many matters proposed by the Rudd government, there is a lot of smoke and mirrors around. The people have a program. It is administratively simple. Whilst it could be argued that competitive forces might lower the price of continence aids, with other suppliers involved—presuming that there is competition in the tender to be the sole supplier—if the price is reduced through competition, is the refund going to be a percentage of that or a fixed amount? We do not know. When will these people, with their serious disability, be able to find out?

Clients of the CAA Scheme will be taken to participate in the CAP Scheme—well, that is pretty good—and will be eligible to participate in the CAP Scheme from 1 July, provided they give certain information to Medicare Australia’s CEO to facilitate contribution payments being made to their nominated bank account. In other words, they will pay full tote on purchase and then wait for a refund—back to the bad old days of bulk-billing or not bulk-billing. After 30 June 2011 they must meet the eligibility criteria specified in the scheme. We do not know exactly what they are.

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

Look it up.

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

How do we look it up? We have not got the delegated legislation. It raises a rather interesting point as far as I am concerned. Frequently this House transfers huge amounts of power to the Public Service in terms of delegated legislation—which I presume the member for Makin understands is tabled in these two houses; I wonder when he last looked at any of it—and it becomes law, with all the meanings of the law, notwithstanding that it can only be stopped by a disallowance motion in either this House or the Senate.

The financial impact statement is very brief. It says:

The Bill delivers on the 2009-10 Budget commitment to introduce the Continence Aids Payment Scheme.

Funds for the CAPS payments from 1 July 2010 are included in the Department’s Forward Estimates.

As I recollect, the purpose of bringing in a financial impact statement was to tell the House how much something is going to cost, not to send us off on some wild goose chase hunting through the budget for amounts of this denomination. I smell a trick. I will not be voting against the legislation; I just hope that this is not another Ruddism, where promises are invariably broken.

It is all in black and white there. I have only read from the description given to this legislation by the clerks, and I draw the House’s attention to the fact of its brevity. None of the details which people would like to know for overcoming the financial aspects of their difficulty in the future are provided to the House. That is all left for another day and, if history repeats itself, maybe never, because this legislation quite obviously overrides the present scheme. A lot of people took this government on trust three years ago. The evidence is arising that they are very disillusioned by the outcomes.

As this is a health measure, it allows me to address some other health matters, as the member for Makin did a moment ago when he started talking about superclinics. There are serious matters arising in my electorate of O’Connor and, I am sure, in many country regions throughout Australia relating to the availability of general practitioners. There are constant allegations as to who created the shortage and who reduced the number of undergraduate courses. There may be blame laid on both sides of the House, but I can assure the House that the first attempt followed the bulk-billing initiatives of the Hawke government.

Why was the number of undergraduates cut back by, as I recollect, about 4,000? We had the appearance of Dr Edelsten. Remember the bloke who bought the Sydney Swans because he was making so much money out of bulk-billing? There was panic within the Hawke government that all these graduates were coming out, going to highly populated parts of the major capital cities, hanging out their shingles and then freeloaders, if you like, or less needy people were turning up to get prescriptions, in some cases for a packet of aspirin. The money was flowing out of the federal coffers as a consequence. The response of the Hawke government was to cut back on the number of undergraduate places, for the purpose of reducing the number of people who could get on the bulk-billing bandwagon. As I warned the shadow minister for health in that period, when the government becomes the sole customer of the medical profession, the profession will eventually get squeezed, as of course materialised on a number of occasions. Many more doctors today are abandoning bulk-billing, more so in country areas, where it is virtually impossible to run a practice on the rebate.

Let me draw to the attention of the House the fact that last week local government representatives around Australia turned up here for their annual conference. Numerous members arrived from my electorate and each and every one of them had been contacting me regarding their problems in ensuring their community had an adequate GP service. They have been doing it in Western Australian rural areas for years, gradually consuming up to half their rate base on subsidising a GP to stay in their town—up to $500,000. That was even a shock to me, as someone who has been watching this process get worse and worse over the 30 years I have been representing O’Connor; getting worse, getting worse, getting worse. If I had been asked what the typical contribution was from a local authority, outside of the capital commitments they have made in housing, doctors’ surgeries and things of that nature, I would have thought something under $100,000. These are small communities desperate to get a doctor.

The response to that payment, we are told, is: ‘It’s a federal responsibility.’ We know it is a state responsibility and state governments around Australia are refusing to put salaried doctors into the hospitals that exist on the grounds that they are not allowed to claim Medicare rebates if they are a salaried doctor. Too bad for the community. That is the way they deal with it. I know of nothing in this new, you-beaut deal, which seems to be falling apart every day in recent times, that would compensate those councils for this cost, would guarantee that the states provide salaried medical practitioners under the state-Commonwealth agreements. I bet that was not discussed during all the bullying that went on to achieve the loss in every state bar Western Australia of their GST share, attributable, if you like, to health. That was to be brought back here to government, which, under Keating, sold the six repatriation hospitals at a saving to our revenue of $1 billion. Fortunately, in Western Australia, it was taken over by Ramsay Health Care, who, according to the RSL and others over there, has given them a vastly improved service.

But the reality is that, amongst others, a company called Meridian commenced assisting these local government authorities by arranging the importation of doctors and allocating them in various areas on a sort of package with an obligation to provide locum services and at least give these one item GPs the opportunity for leave and have some family time or whatever else. That in itself has become a problem. A retired GP living in the town of Albany was in my office last Friday explaining how, since he retired, he has never worked so hard in his life, trying to fill as many locum positions as he can when his preference would be to be holidaying in Europe or something like that—a responsible man who is seriously concerned about the circumstances that exist in the electorates and in particular the electorate of O’Connor.

Meridian was supplying a doctor in Southern Cross, a town in the district of about 1,500 people, and Lake Grace, I guess of similar size—not huge but it is a long way between stops—and of course others. They have just advised that they are discontinuing this service, not because they have not been remunerated, not because they think they might do something else but because they can no longer get accreditation for the doctors available to come from various parts of the world to service these particular communities. Why is that? Because over the life of the Rudd government there has been an ever-tightening of the accreditation requirements, so much so that this doctor, who continues to work in his retirement to aid the community, openly admitted that he could not pass these exams either. Examinations of that nature are for the young and they are necessary to prove they have learned their lessons. As time goes by, they accumulate huge amounts of experience but, as those of us who have been around a while know, answering the sorts of questions that arise in these accreditation examinations is very, very difficult. Others have said to me that doctors previously admitted and accepted as giving good and reliable service in many communities also could not have succeeded in passing this examination. But it goes one step further: if you are willing to give it a go, you cannot get a slot to undertake the examination. It is a bit like the old French non-tariff barriers: if you did not want a certain product to come into your country, you never put a ban on it; you had one officer throughout the nation sitting in some obscure locality to whom you must apply for an import licence. That is what has happened, and who has lost out? Rural areas.

The member for Makin says we are going to have these wonders called superclinics. The minister wrote to me and said I could have one in my electorate. I said, ‘Thanks, but no thanks.’ The last thing I want is some nationalised facility with extensive government funding that sucks the last of my individual GPs out of their towns for the easy life of having a nice regulated nine-to-five job or whatever—fixed hours and the weekends off or two days off during the week. I endorse entirely the opposition’s view that these are an unnecessary proposal when the real problem is the availability of doctors. Yes, you might be able to fill up the superclinics with doctors, whatever they will be paid, but somewhere else people will lose them.

It is another one of those promises to which I have just referred. There were 36 to be built in their first term of office, along with millions of computers for school kids, and now we have got ministers pointing fingers at us saying, ‘If you cut back on the funding, people will not get these things.’ They are supposed to be there—not three but 36. If we add another 28, goodness knows when they are going to turn up. But there are opportunities and it was suggested to me by this GP who visited that we should just bring these doctors in, particularly from the UK and other places, and have a mentor here to look after them. (Time expired)

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

I rise to speak on the National Health Amendment (Continence Aids Payment Scheme) Bill 2010, which will amend the National Health Act 1953. The amendments contained in this legislation will provide the minister with the legislative authority to formulate the Continence Aids Payment Scheme, providing for payments to eligible persons as a contribution towards the cost of purchasing products that help them manage incontinence. The CAPS will replace the Continence Aids Assistance Scheme, or CAAS.

To give some background, the National Continence Management Strategy was established in 1998 by the coalition government to provide funding to research and service development initiatives aimed at prevention and treatment of incontinence, which of course is a very serious issue. During 2007, the CAAS was expanded to reach further age groups and those with certain conditions. Through this legislation, CAPS will make direct cash payments to eligible people with permanent and severe incontinence to assist with the cost of their products. This differs from previous arrangements where there was a government agreement with a sole supplier—Intouch. It is envisaged that this change will give greater choice to consumers and facilitate the purchase of products that best suit their needs. The subsidy arrangement will remain in line with the CAAS and continue to be indexed annually.

Incontinence affects nearly four million Australians of all ages and for a broad variety of reasons. According to the Continence Foundation of Australia, 65 per cent of women and 30 per cent of men sitting in a GP clinic waiting room report some type of urinary incontinence. I note that the member for O’Connor referred to regional GPs. My area is one of those that suffers from a shortage of GPs. In fact, in my particular electorate the South West Medical Attraction Taskforce has been formed to try to address this issue. I note that one of their very important recommendations is that we encourage young people from the electorate into medicine in the hope that they will return to practice in the future. I also note that the definition of ‘inner regional’ in the youth allowance criteria is now inhibiting the opportunities and ambition of many young people in my electorate. I have a family where more than one sibling wants to study medicine, but because they will not be able to access independent youth allowance this opportunity is now compromised. The South West Medical Attraction Taskforce is going to continue its efforts to attract and retain general practitioners in regional areas in the south-west of Western Australia, something that will continue to be an issue because the population continues to grow. It is an ongoing issue for my electorate.

I am aware that the risk factors for urinary incontinence include pregnancy and pre- and post-natality. That is why so many women make sure they conduct their exercises while they are actually in hospital and when they get home. It is very important to be involved in those types of exercises, particularly post pregnancy. Younger women who have had children and some women who are overweight also have the same problem. Menopause can cause the same problem, as does obesity. Urinary tract infections are quite common, particularly in mature aged people, and are also a major cause of incontinence. Sometimes surgery can also increase the incidence of incontinence and also reduce mobility.

These issues are really important, particularly in the management of nursing homes and aged-care facilities. Approximately 77 per cent of nursing home residents in Australia are affected by incontinence, which is why these measures are so important. Forty to sixty per cent of people in nursing homes are seriously in need of this type of support. In my electorate of Forrest, there are currently around 19,000 people over the age of 65 and this figure will increase rapidly over the next decade. My electorate currently has 30 aged-care facilities and this number and capacity will need to increase as the demographic within the electorate also increases. Two of these aged-care facilities in my electorate raised concerns that high-care patients are excluded from this scheme, essentially leaving the aged-care facilities to meet the cost of those patients. I am equally concerned to ensure that people in such care receive frequent attention and the care they need for frequent changes in regard to this issue of incontinence. Limiting access of continence products to residents is a very serious concern. It poses a health risk for residents and raises quality-of-care issues. I urge the government to seriously consider the impact the high-care residents subsidy and its effect on aged-care facilities and their capacity to provide the appropriate level of care.

I know that the disability sector has expressed concern to Senator Fifield that the new scheme may incur delivery costs; however, it is hoped that increased competition will ensure free delivery will be offered as an incentive to purchasers. This is a view that has been reinforced by the Continence Foundation of Australia, but I am yet to be convinced that this will actually occur and we need to seriously monitor this during the rollout of the program and beyond to ensure that it is actually the result. In conclusion, I am supportive of a bill that will see payments go to eligible people living with the permanent and serious issue of incontinence.

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

in reply—I am very pleased today to have the opportunity to sum up debate on the National Health Amendment (Continence Aids Payment Scheme) Bill 2010. The debate highlighted the importance of achieving a balance between empowering consumers with flexibility and choice and providing appropriate support and educational safeguards. The bill delivers on the 2009-10 budget commitment to introduce the Continence Aids Payment Scheme. The Continence Aids Payment Scheme replaces the current Continence Aids Assistance Scheme, which provides continence products through a sole supplier. The bill will enable the formulation of a legislative scheme under which the Commonwealth will make direct cash payments as a contribution towards the cost of buying products that manage incontinence. Medicare Australia will transact the payments, with the Department of Health and Ageing to retain policy authority.

The bill also provides for transition arrangements for clients of the current Continence Aids Assistance Scheme to the Continence Aids Payment Scheme from 1 July 2010. Accountability and transparency of the new scheme are supported by the conferral of powers on the Secretary of the Department of Health and Ageing and the Medicare Australia CEO to request information about eligibility or payments. Prompt investigation into any claims of ineligibility or improper use of funds will be undertaken, and failure to comply with a request for information will be an offence under the National Health Act 1953. Participants in the scheme will also have recourse via the Administrative Appeals Tribunal. Consistent with the government’s 2009-10 budget announcements, the program will be funded by a special standing appropriation enabled under section 137(1) of the National Health Act 1953. This is particularly important in the context of an eligibility based, demand driven program.

Subject to the passage of the bill through parliament, the new scheme’s arrangements will take effect from 1 July 2010. The Continence Aids Payment Scheme promotes consumer choice, consistent with the government’s consumer rights and responsibilities charter for community care, released in 2009 and promoted in the Commonwealth aged care programs throughout the Aged Care Act. As a result of the successful passage of the bill, recipients under the scheme will have greater flexibility and choice in where they purchase their continence products. Product suppliers and service providers will have equitable access to the client base in an open and competitive market. Those who wish to continue to have their products provided by the current provider, Intouch, can continue to do so from 1 July. Consumer feedback supports the provision of a cash payment to allow increased flexibility and choice.

I am very pleased to deliver on an important budget measure that provides choice and flexibility to people with severe and permanent incontinence. I would like to thank the members of the House who have made contributions to this debate and those who were involved in developing the new payment scheme and this bill. I commend the bill to the House.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.