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

The bill before us today, the National Health and Hospitals Network Bill 2010, establishes the Australian Commission on Safety and Quality in Health Care as an independent statutory body and provides for the establishment of the National Performance Authority and Independent Hospital Pricing Authority under the proposed National Health and Hospitals Network reforms.

The commission was established under the previous coalition government by Australian health ministers on 1 January 2006. It evolved out of what was known as the Australian Council for Safety and Quality in Health Care, which had itself been established in January 2000. It has developed an important role in the Australian health system to, firstly, lead and coordinate improvements in safety and quality in health care by identifying issues and policy directions and recommending priorities for action. It disseminates knowledge and advocates for safety and quality. It reports publicly on the state of safety and quality, including performance against national standards. It recommends national datasets for safety and quality, working within multilateral government arrangements for data development, standards, collection and reporting. It provides strategic advice to health ministers on best practice thinking to drive quality improvement, including implementation strategies. And, finally, it recommends nationally agreed standards for safety and quality improvement.

There have been advances made in areas such as clinical handover and infection control as a result of the work of the commission. The commission is currently resourced through the Department of Health and Ageing by means of a cooperative agreement and funding from state and territory governments. The coalition does support an ongoing role for the commission within existing resources, but we hold serious concerns about this government’s capacity to efficiently and effectively implement its supposed health reform agenda.

There are reports in some jurisdictions that there have been signatories to the agreement who are now reconsidering their positions and have raised concerns about a number of aspects of this government’s proposed reforms. It was reported in the Age on 11 August this year that leaked emails show ‘a long list of concerns raised by executives from Victoria’s health department during a meeting with Commonwealth representatives last month’. The leaked emails, between Commonwealth and Victorian officials, reportedly went on to claim that it was extremely difficult to examine aspects of the reform package because it was ‘hard to tell what the Commonwealth was trying to do’. Some of the additional concerns specifically include how the new funding arrangements would work, Victoria not being included in discussions about the draft boundaries for Medicare Locals, how specialist hospitals would fit with local hospital networks and whether Medicare Locals would be private companies or statutory bodies.

The agreement establishing the National Health and Hospitals Network was motivated by urgent political need, rather than as genuine and considered policy response. This was evident very early with the scrapping of the National Funding Authority just after it had been announced. The authority was central to the National Health and Hospitals Network Agreement as ‘a joint payment authority which makes it absolutely transparent that the money actually goes through to the service providers’. That was the then Prime Minister, Kevin Rudd, on Sky News on 21 April 2010. To quote Kevin Rudd again:

What we’ve agreed to with the states and territories is not a state delivery agency; what we’ve agreed to is a joint state-Commonwealth statutory body which becomes the payment authority. There’ll be full transparency, therefore, about how the money is being delivered to each of the local hospital networks.

That was again on 21 April.

The minister’s response to the scrapping of the funding authority showed that the reforms were being driven as a political strategy out of the then Prime Minister’s office, particularly as he became more desperate day by day to cling on to power, and it was certainly not based in a sound health policy perspective:

I’m afraid you’d have to put the question to PM&C about why they decided to release it at a particular time last night, that’s not something that was in our remit.

That was not from a junior minister; that was actually from the Minister for Health and Ageing, Nicola Roxon, at a press conference on 17 June 2010. It demonstrated the dysfunction within the government of the day. It demonstrated that decisions were being made purely based on political outcome, not on good policy outcome. That was the approach of the then Prime Minister, Kevin Rudd. It is why the Labor Party got rid of the Prime Minister and it is why the health minister was completely excluded from deliberations which ultimately resulted in a compromise proposal, not one worthy of the much-needed health reform in this country.

In responding to questions as to why the funding authority had been so essential only weeks earlier, the minister stated:

… it’s not appropriate for us to establish an authority where there is not a need to do so.

Unfortunately, bureaucracy was not one of this government’s reforms. The bodies to be established include the Independent Hospital Pricing Authority, at a cost of $91.8 million; the National Performance Authority, at a cost of just under $110 million; Medicare Locals, at $416.8 million; National Funding Authority, cost unspecified and, of course, since scrapped; the state based funding authorities, cost unspecified; and local hospital networks, cost unspecified.

The scrapping of the National Funding Authority and Victoria’s leaked concerns about Medicare Locals and other elements of the proposed network show that there is a lack of coordination and huge scope for waste and mismanagement in the government’s approach to these reforms. The claims of the Commonwealth being the so-called dominant funder, as mentioned in the minister’s second reading speech, were never credible. John Brumby said at the time:

I object strenuously to the fact that these funds are being taken from our state and from other states and then being recycled back as “New Commonwealth money”. What our analysis shows absolutely conclusively is that there is no new money in this for Victoria.

That was on 8 April on the 7.30 Report. Rather than 30 per cent of GST being quarantined by the Commonwealth, as was first proposed, the budget estimates show that for some jurisdictions in 2011-12 it will be up to 49 per cent. We already know that taxpayers in states such as Western Australia receive far less back from GST than they pay. According to the COAG agreement, the amount of states’ GST dedicated to funding the federal government’s supposed 60 per cent hospital costs will not be fixed until 2014-15. It remains to be seen how many jurisdictions will remain a party to the agreement at that time.

I also take the opportunity to address the comments in the minister’s second reading speech regarding after hours care. Under the government’s health reform proposals, GP surgeries will lose $58 million in practice incentive payments for after hours patient care. The President of the Royal Australian College of General Practitioners, Dr Chris Mitchell, was reported on 15 July 2010 as saying that removal of the incentive payment of up to $6,000 a year per doctor will have ‘enormous implications for the role of the GP’ and ‘has the potential to have an impact on the viability of general practice to deliver the services outside normal opening hours’. In fact, Dr Mitchell went further and said the removal would:

… jeopardise the fragile availability of after-hours services in some areas, and potentially increase the burden on ambulance call-outs and emergency department presentations.

What becomes very clear about this government’s so-called plan is that it has adopted the same failed approach as the state and territory Labor governments—that is, to increase bureaucracy at every turn, to drag money away from frontline services. It is not a formula that has worked at a state or territory level. In fact, it has compounded much of what we see that is wrong in the health system today and this government, for ideological purposes, has decided to go down the same failed path. These incentive payments are to be withdrawn from 1 July next year, with Medicare Locals not operational for another two years—that is, until July 2013. This supports the concerns raised by the Victorian government and is further evidence of the inability of this government to competently implement policy. It is a matter the minister is yet to resolve.

The Labor government’s National Health and Hospitals Network reforms purport to localise control of the health system. Unfortunately, the evidence suggests that these changes will result in centralisation and bureaucratisation. The partnership agreement states that local clinicians are not to directly participate in their local hospital network. Of course, lead clinician groups were proposed in response to criticism of the government on this issue, but it is still unclear what practical role they will have in decision making and resource allocation. The coalition believes it is important that local clinicians have an active role in the running of local hospitals. Doctors and nurses who know their hospitals are better placed to respond to on-the-ground needs than bureaucrats in a central office.

A single local hospital network for all of Tasmania has previously been proposed. Clearly, this could lead only to a greater centralisation of health and hospital services. If local clinicians are not to participate in the local hospital network in which they work, what happens if ultimately one network covers an entire state? Only the coalition’s proposal for community controlled hospital boards would provide for genuine local and clinical control and better management of our health and hospital systems. I note that the minister made mention of the government’s 1,300 promised beds in her second reading speech. I remind the minister that the coalition promised more than double that number—in fact, 2,800 beds—which is what is really needed to address access-block and reduce elective surgery waiting times. The government’s Medicare Locals are themselves anything but local. Once again, it has been suggested that only one is to cover all of Tasmania and only one is to cover all of the Northern Territory. General practice needs more flexibility, not more red tape. Again, it has been difficult for the minister to articulate in practical terms how Medicare Locals will interact or coordinate with local hospital networks.

The minister also made mention in her second reading speech of the role of GP superclinics. The coalition strongly supports general practice as the cornerstone of primary health care. The coalition’s plan to invest significantly in longer GP consultations, after hours care, practice nurse services, MRI referrals, infrastructure grants and rural bonded scholarships would greatly enhance access to GP services and build on existing infrastructure. The coalition shares the concerns of many health and medical professionals about Labor’s policies that undermine the doctor-patient relationship and the viability of existing family GP services. In addition to the changes to after hours care proposed under these reforms, the bungled implementation of the GP superclinics program represents another policy delivery failure of the Labor government. In particular, with only four of the original 36 fully operational after the Labor Party’s entire first term of government, it underscores the ineffectiveness of this Prime Minister.

Many patients, doctors and other health professionals are concerned that the viability of existing family GP practices will be jeopardised by Labor’s poor implementation of this program. There is evidence that an unfair regulatory environment has been created for existing family GPs. GP superclinics not in districts of workforce shortage have been able to employ overseas trained doctors when established practices in the same area are not permitted to do so. The withdrawal of services by established family GPs will be detrimental to patients who have grown to trust and rely on the dedicated services of their family GP over many years. The minister must guarantee that no existing general practice services will be reduced or closed as a result of the government’s GP superclinics program which she referred to as part of her comments on this bill.

I was sorry, I must say, to hear the minister only make a passing comment on mental health care as part of her contribution. Access to specialised mental health services is vital in alleviating pressure on health and hospital services, especially in regional and rural areas, and it is an enormous failure of this government to exclude it as part of its proposed health reforms. The coalition has provided a comprehensive $1.5 billion plan to greatly improve access to services through 800 additional mental health beds, 60 new Headspace sites and 20 early psychosis prevention and intervention centres. If this minister were serious about genuine reform of the health system, she would listen to the support amongst health experts, within this parliament and in the wider community for this policy and act to implement it.

The bill before us does state that the act will be amended to include provisions to establish the Independent Hospital Pricing Authority and the National Performance Authority. Whilst the coalition supports the work that has been done and can continue to be done by the Commission on Safety and Quality in Health Care, we hold serious concerns about this government’s ability to establish new, stand-alone bureaucracies that have a tendency for blow-outs. That ability should be questioned because this is a government that has at every opportunity increased numbers within the bureaucracy, and this is no exception. As I said before, people need to cast their minds back to when this particular policy was formulated. It was formulated by a Prime Minister who at the time knew that the public tide was turning against him, who knew that his own colleagues were not supporting him. Over the course of the weekend I read Barrie Cassidy’s book, and it just underscored the dysfunction that took place in the government at the time. The public should never forget that this policy was formulated by a desperate Prime Minister at a time when he was trying to detract attention away from the debates about insulation and about the school halls rip-offs. This was not a policy which was developed to try and fix the problems that exist in health care today. This was not a sincere government in its approach to policy at that time.

The scrapping of the National Funding Authority did ring alarm bells about a general lack of coordination and forethought in the establishment of new bureaucracies. It is unclear how the function of the commission will coordinate or interact with the functions of the Independent Hospital Pricing Authority or the National Performance Authority. The government should have introduced provisions for all the proposed bureaucracies together. It remains unclear why the minister has delayed legislation for the National Performance Authority and Independent Hospital Pricing Authority.

I would like to draw the House’s attention to the comments of the former Minister for Finance and Deregulation, Lindsay Tanner, from his speech to the Australian Institute of Company Directors’ Public Sector Governance Conference on 14 October last year. He said:

The indiscriminate creation of new bodies, or the failure to adapt old bodies as their circumstances change, increases the risk of having inappropriate governance structures.

This in turn jeopardises policy outcomes and poses financial risks to the taxpayer.

He went on to say:

Incorporating a new function within a department is almost always the preferred option because of the difficulties a small body faces in meeting its own needs.

The coalition supports the role of the commission but, consistent with Mr Tanner’s views, believes that this can be achieved within the resources of the department. The coalition calls on the government to provide all provisions to establish all bodies intended under this bill.

This is a government that has turned a $20 billion surplus into a $41 billion deficit and is paying around $4.2 billion in interest on net debt this year alone. The coalition maintains scarce resources should be focused on front-line clinical care and will not support the creation of new bureaucracies without a strong and reasoned justification. At the very least, the minister should allow the parliament to scrutinise the complementary functions of the proposed bureaucracies together. Accordingly, I move the following amendment:

That all the words after “That” be omitted with a view to substituting the following words:“the House declines to give the bill a second reading until the following provisions are presented to the House for its consideration:

(1)

provisions establishing the Independent Hospital Pricing Authority, including its full functions and responsibilities; and

(2)

provisions establishing the National Performance Authority, including its full functions and responsibilities”.

This is a government that needs to be held to account. It has—and not just in this program but in a number of others—created additional bureaucracies by at the same time distracting and taking away valuable and scarce resources to front-line services. The government should be called for this stunt. This was set up as a political distraction and it really lets down the doctors, nurses and patients right across the country, all of those people working in health care who were desperate for the reform that they thought Kevin Rudd had promised in the 2007 election when he said that he would fix public hospitals. But this is a government that has failed and this is why the coalition takes a principled stance in relation to this matter. We will not tolerate Labor’s additional bureaucracies. Billions of dollars have been wasted at a state level and that same formula is now being applied at a federal level. We want to provide support to doctors and nurses at the front line. The coalition stands for a more practical, purposeful outcome, and we will continue to fight until we achieve such an outcome.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Bob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

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

I rise to support the bill in its original form and to oppose the amendment. It is the height of hypocrisy for those opposite to come to this place to talk about health care and say that they are taking a principled position when we saw over 12 years a decline in relation to the contributions that the then federal government made in relation to our health and hospitals system around Australia. It is the height of hypocrisy to stand and lecture us in relation to taking a principled position when they did everything in their power to try and kill off Medicare. This National Health and Hospitals Network Bill 2010 is an important and historic bill and represents a step forward in providing better health and better hospitals for all Australians. It establishes the Australian Commission on Safety and Quality in Health Care, thus delivering one of the major components of the government’s health reform agenda.

Through the government’s health reforms Australia is in the process of experiencing the most significant changes to our health and hospitals system since the introduction of Medicare. The only thing that stands in the way is those opposite. We are creating a National Health and Hospitals Network that is funded nationally and run locally. On the Central Coast of New South Wales they have already started to put in place a number of the reforms that are needed. In only the past few weeks the New South Wales government announced that one of the new local hospital networks will be that of the Central Coast. This will be a truly locally run network—in effect, a local area health service—which up until now has been part of a much larger area health service based in northern Sydney. My constituents have told me consistently that they want a local health network and not one that is part of Sydney or the Hunter. I have made very strong representations on this and I am very glad to see that it is now planned that we will have our own local hospital network. It is great news that the Central Coast will again have its own area health service as it did in the past. I am happy to say that the New South Wales government has listened to the wishes of those in our region and to the representations that I have made.

The reasons for the change were quite simple. Having an area health service attached to Sydney was not practical or effective for Central Coast people. Over the next year there will be a transition from the existing northern Sydney-Central Coast area health service to the new local hospital network based in and run entirely from the local region but maintaining key links and networks with other health services in the state. The new local hospital network will include clinicians, healthcare management experts and community representatives. Our own local hospital network will mean better services for Central Coast residents and will also allow Central Coast health professionals, including doctors, nurses and other health professionals, to have a greater say in how local health services are delivered in our community. The federal government will have a major investment in the new local hospital network, and I personally have a major interest in ensuring that the new arrangements work well for Central Coast residents.

We continue to witness ongoing challenges of supply and demand in our public health and hospitals system, with Wyong Hospital being the fourth busiest emergency department in the state and Gosford Hospital being the fifth busiest. I will do my utmost to see that with the support of this government we rise to meet these challenges. One of the key issues is ensuring our hospital emergency departments are able to see patients effectively and efficiently. Part of the streamlining of emergency departments involves having enough GPs in the community so Central Coast people can see a doctor when they need to and are not forced to go to the hospital emergency department instead. The GP superclinic at Warnervale will help alleviate area doctor shortages, as will the new GP superclinic closer to Gosford—for which a location has not yet been decided.

We have heard many and varied comments and analyses about the government’s GP superclinics, but I would like to say that the GP superclinic model in my electorate is shaping up to be a great example for other areas across the country. The government’s investment in the Warnervale GP superclinic is quite humble compared to the money put in by the operators, who will be putting in $16.5 million worth of state-of-the-art medical services for the fast-growing suburbs around Warnervale. The federal government is putting in only $2.5 million to ensure that that investment is made. More than 100 health professionals will be employed there across a broad range of medical services. The new clinic already has strong ties to the University of Newcastle and will provide a vital training ground for young professionals. The operators of the Warnervale superclinic already have vast experience from running a major medical centre in Toukley and are planning yet another multifaceted medical establishment as part of the overall redevelopment plan for the Mariners Football Club at Tuggerah in my electorate—a proposal that this government promised a further $10 million to in the last election. As part of the government’s health reforms, that is the sort of positive result that we have already started to see on the Central Coast.

Let us go over exactly what this bill will achieve. The government is implementing major reforms to the funding and governance of the Australian healthcare system, which will place it on sustainable foundations for the future. Under the National Health and Hospitals Network, which was agreed by COAG on 20 April 2010, with the exception of Western Australia, the Commonwealth will become the major funder of Australian public hospital services. These major reforms build on the strengths of the current system and will ensure that these remain sustainable into the future.

The new governance arrangements will consist of establishing three agencies: the Independent Hospital Pricing Authority, the National Performance Authority and the Australian Commission on Safety and Quality in Health Care. Arrangements for the IHPA and NPA are being finalised. It is intended that this bill will be amended to include provisions to establish the Independent Hospital Pricing Authority and the National Performance Authority. It is imperative that there be a strong focus on improving the safety and quality of health care that is delivered throughout Australia. To ensure that this is achieved, this bill will establish the Australian Commission on Safety and Quality in Health Care as a permanent, independent body under the Commonwealth Authorities and Companies Act 1997. This will ensure the independence of the commission, which is important to ensure its standing as an authoritative source of knowledge on healthcare safety and quality matters. The commission will continue in its important role in helping to reduce harm caused by preventable errors, which will continue to have a positive impact on community trust.

An important part of the commission’s expanded role will be to set new national clinical standards and strengthen clinical governance to lead the drive towards continuous improvement in quality and to safeguard high standards of care. The commission’s expanded remit also extends to ensuring the appropriateness of care in all healthcare settings, including primary care and mental health. Accreditation of health service providers is currently undertaken by a multiplicity of accreditation bodies and some high-risk services are not yet subject to accreditation, leading to a nationally inconsistent assessment of safety and quality standards. The commission will therefore continue its work in developing a national accreditation system and will develop a national model accreditation scheme. The development of national clinical standards, guidelines and indicators, together with its work on a national accreditation model, will support the take-up of the commission’s work.

The states and territories have been consulted on the bill and are generally supportive. The government is implementing major reforms to the funding and governance of our health system to place it on sustainable long-term foundations. We are changing the way that health services are delivered through better access to services designed around patients’ needs and a greater focus on preventive health and the provision of care outside of hospitals. We are also investing in our health system and our health workforce to deliver better care and better access to services for patients, now and into the future. The bill I am speaking on today is a key component of this overall health reform agenda, some of the key areas of which are the capacity of our health system, better connecting care, access to services, preventive health, sustainability and quality.

To ease the pressures on our health system, we need to increase its capacity and the services available. This means more doctors, more nurses and more beds. The Gillard Labor government is investing $1.2 billion as part of the National Health and Hospitals Network in doctors, nurses and allied health professionals. This will deliver 5,500 new or training GPs and 680 medical specialists over the coming decade. It will improve support for more than 4,600 full-time equivalent nurses working in general practice and help train and retain our valuable aged-care nurses. And we will support 800 allied health professionals working and training in rural areas over the next four years. We will also invest more than $1.6 billion for more than 1,300 new subacute beds, to reduce bottlenecks and capacity constraints in our system. These beds will be delivered in areas like rehabilitation, palliative care and, importantly, mental health services, so that people can get the right care for their needs.

As part of the National Health and Hospitals Network, the government will ensure that services are better connected and coordinated, reducing fragmentation and the blame game. Local hospital networks will be established, like the one on the Central Coast. They will be more responsive to local communities, and new funding arrangements, such as the introduction of activity based funding, will provide strong incentives for better performance and reduced waste.

The Commonwealth will also take funding responsibility for 100 per cent of primary care, ending duplication and divided responsibilities. The government will establish Medicare Locals, which will work with local GPs, allied health and community health providers to drive local integration and coordination of services and improve access to care. And, to bring the health system properly into the 21st century, the government will invest $466 million to establish personally controlled electronic health records, reducing mistakes and duplication and ensuring that, with patients’ consent, doctors have the information they need, when they need it.

The National Health and Hospitals Network will also deliver better, more timely access to health services in local communities across Australia. The government will establish a national after-hours GP and primary care service. This will enable anybody calling their GP out of hours to be referred to a nurse or a GP on the phone, and if necessary be referred to a local after-hours GP service, coordinated by their Medicare local. The government will also invest $355 million in more GP superclinics and expanded GP clinics in about 450 locations across Australia. These will bring together in a single location services such as GPs, allied health professionals and practice nurses so that patients can more easily get the full range of care they need. The National Health and Hospitals Network will also provide strong guarantees and targets to improve access to public hospital services—reversing the neglect from the Howard government ripping $1 billion from hospitals.

The Gillard government will invest $750 million so that emergency department patients will have a guarantee that they will be treated, admitted or referred within four hours, where clinically appropriate. An investment of $800 million for elective surgery will help back a target that 95 per cent of elective surgeries be delivered within the clinically recommended time, and a guarantee that patients facing excessive waits should have their elective surgery fast-tracked.

Keeping people well and out of hospital is a critical component of the Gillard Labor government’s health reform agenda: while we are improving our hospitals, we also need to reduce pressure on them and keep people out of hospital in the first place. To achieve this, the government will take world-leading action to combat tobacco, which contributes to the death of over 15,000 Australians a year. The government will introduce plain packaging for all tobacco products—a world first—in addition to raising tobacco excise, which is expected to result in 87,000 fewer smokers. The government will also invest $449 million to improve care for people with diabetes, which is fast on the way to becoming one of the major burdens of diseases in this country.

To ensure our health system is to be sustainable into the future, the Commonwealth will take, for the first time, funding responsibility for all GP and primary care services and all aged-care services. The Commonwealth will also become the dominant funder of Australia’s public hospitals, paying for 60 per cent of hospital activity and capital, as well as 60 per cent of training and research costs in public hospitals. These changes will mean that one government will have dominant funding responsibility for all parts of the health system, ending the blame game and the perverse incentives for buck passing and cost shifting.

The government has already begun delivering on its reform agenda in six key areas: our hospital projects, including expanding hospital capacity as part of the National Health and Hospitals Network, and landmark Health and Hospitals Fund projects and regional cancer centres; investing in our workforce, with new GP training places online from next year along with nursing and allied health scholarships and locum places; primary care infrastructure, through more GP superclinics announced recently, and funding rounds to upgrade general practices currently underway; e-health and telehealth, with Medicare rebates for telehealth from mid-2011 and electronic health records from July 2012; system reform, with local hospital networks and our first Medicare Locals being established from the middle of next year; and prevention, with investments being rolled out from mid next year for children and workplaces to prevent disease.

If we are to have a truly National Health and Hospitals Network spanning Australia, it is essential to have strong safety and quality standards so that all Australians can be confident that they will receive consistently high-quality care, wherever they live. This bill provides for framework legislation to establish the Australian Commission on Safety and Quality in Health Care. It is imperative that the government’s health reforms ensure that the Australian public receives safe, high-quality health care. The Australian Commission on Safety and Quality in Health Care will be established as a permanent body with an expanded remit to drive safe, high-quality care and ensure the appropriateness of services delivered in particular healthcare settings, including primary care and mental health.

This is an important piece of legislation and is part of an important reform process that this government is committed to. This bill should be passed without amendment. I commend the bill to the House.

Bob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | Link to this | Hansard source

Tonight I rise to address the National Health and Hospitals Network Bill 2010. I oppose this legislation because it directly affects federal funding going into the expansion of bureaucracy rather than into front-line services. My constituents demand that increased health dollars are focused on health outcomes, not building bureaucracies. When former Prime Minister Kevin Rudd was elected in 2007, it was on the back of promises to make our health system better. He promised ‘to take the pressure off emergency departments, free up hospital beds and reduce waiting lists’. He said, ‘I will work cooperatively to get our hospitals fixed, but in the end the buck will stop with me.’ The buck did not stop with Kevin Rudd. Instead, the buck was channelled into a massive national media campaign to promote Labor’s health plan.

As Kirsty Needham reported for the Fairfax media on 24 October this year:

The federal government’s health reforms, negotiated with the states, were the subject of a $9.3 million advertising spend over six weeks. This compares to $9 million spent by the Health Department over eight months on advertising relating to the H1N1, or swine flu, vaccine.

While Mr Rudd is no longer leader, Prime Minister Gillard has continued his grand promises. Sadly, these promises have not translated into health reform in my electorate of Paterson, where my office regularly receives calls from patients who have experienced unsatisfactory treatment. My constituents are still having trouble getting in to see a doctor, still having trouble accessing after hours care, still waiting months to see a specialist and still experiencing the never-ending and increasing waiting lists to get into hospital for surgery.

Political grandstanding means absolutely nothing to someone who is forced to spend the night in pain until the local health service opens at 9 am. It means nothing to someone who has to wait two months to have a tumour removed, or to a family who has to worry about a day off work and fuel costs because their specialist’s office is hours away. Introducing legislation into this House which broadens the health bureaucracy, rather than funding front line services, is an insult to my constituents. Increasing the bureaucracy will not ensure that my constituents get the service they require and deserve. That can be achieved only through consultation with local people, including professionals, who live in the area and work on the relevant issues each and every day.

Changes to the health and hospital system in Australia should be based on outcomes in the community, not on building bureaucracies. It was the Gillard Labor government’s focus on broad promises, rather than locally based outcomes, that led it to announce $7 million for a GP superclinic in my electorate of Paterson at Raymond Terrace. Many hours of discussion with patients and health providers, including Hunter Rural Division of General Practice and GP Access, which represents urban practitioners, has informed me that this funding could have been better spent to meet more outcomes in the community. I have therefore spoken and written to the Minister for Health and Ageing, Nicola Roxon, to implore her to adopt an alternative proposal. That proposal is backed by general practitioners and allied health providers who work in my community.

Our proposal is that the $7 million be divided so it can be invested in not one project but across three. Firstly, the $2.5 million should be spent on the already approved Health One clinic in Raymond Terrace. The New South Wales government first started planning this project in 2005 and the Hunter New England Area Health Service has now purchased a block of land at the old swimming pool site in Raymond Terrace. Capital works documentation has been sent to the New South Wales Department of Health and preliminary concept plans have been drawn up. Meanwhile, a development application has also been prepared for lodging with Port Stephens Council in preparation of starting construction in 2011. Everything going to plan, this facility will open its doors by mid-2012, offering general practitioner services as well as hosting community health, allied health, visiting specialists and other ambulatory care providers. Importantly, this proposal has the support of all the medical professionals in my electorate and in that region.

Spending $7 million on one clinic just down the road from where the state government is already planning to build its own clinic is nothing but a waste and duplication. The Health One clinic will be operating long before a superclinic could be operating. Further, $7 million is an extraordinary sum of money considering the fact that the GP superclinic that has already been built and is operational at Nelson Bay cost just $2.5 million. This $7 million in expenditure proposal has occurred only because the Gillard Labor government failed to talk to the right people, local people, about the health needs in the Paterson electorate. There were no meetings, no consultations, GP Access representing urban practitioners was not consulted, Hunter Rural Division of General Practice was not consulted—and they represent the rural practitioners in my area—and yet $7 million was apportioned for the GP superclinic.

Smart spending would see $2.5 million spent on the Health One clinic. That would leave $4.5 million for other worthy projects. There is no doubt that this represents value for money for the taxpayer, which is always important. It is a government’s duty to invest taxpayers’ funds wisely. It is also a government’s duty to represent those it serves, and what my constituents need is better health services in the Medowie-Tilligerry-Salt Ash area, as well as an increased GP presence in the Dungog-Clarence Town area. Recently, Clarence Town lost its last GP service because its only doctor retired. Local community groups have been crying out for a replacement service not only since losing their GP but also for the months prior. Despite this forewarning, the Gillard Labor government did nothing to assist. In fact, it refused a funding application from Dr Drew in Dungog, who was trying to expand his practice to accommodate the needs of people in Clarence Town.

I have met personally with members of the Dungog and Clarence Town Country Women’s Association and the Clarence Town Lions Club, who are working to find a way forward. Like Dungog-Clarence Town, the community around the Medowie-Tilligerry-Salt Ash region also needs increased health services. Demand is only increasing owing to the substantial residential growth in the suburbs, which includes RAAF personnel currently serving at RAAF Base Williamtown. Prior to the 2007 election, local RAAF personnel were promised a defence family healthcare clinic by Labor. However, despite winning government, that clinic was never delivered. In fact, it was one of the first promises broken by this Labor government. Thus, families who moved into the area have already missed out under the Labor government and now face increased pressure in not being able to see a GP. Many are now forced to travel outside the electorate into Newcastle in order to access the services that they need.

Therefore I would call on the Gillard Labor government to spend the $4½ million in savings on new health infrastructure for the areas that I have just mentioned. The projects could be put out to tender in order to get the best value for money and the best value for the community. Commonsense investments such as these are important for regional communities like the Paterson electorate, where there is fast residential growth and a rapidly ageing population. We must begin to prepare for our new residents now so that future communities do not suffer a lack of services.

The National Health and Hospitals Network Bill 2010 is designed to expand the Australian Commission on Safety and Quality of Health Care, which was set up by the coalition. The role of that commission is to be expanded to include ‘setting national clinical standards and strengthened clinical governance’. As part of this agenda, the Gillard Labor government has also flagged its intention to establish an independent hospital pricing authority and a national performance authority. It is therefore concerning that neither of those authorities has been detailed in this bill, and should legislation outlining them be presented to the House I would consider the issue.

The cost of expanding the commission, including the establishment of those authorities, was included in this year’s budget at a price of $236.5 million. It is the coalition’s view that this funding should instead be directed towards frontline services, including a major boost to mental health facilities. The funding could also cover the cost of the local health infrastructure needed across the country. In my electorate of Paterson, there is a need for a chemotherapy unit in Forster-Tuncurry. I have met with the management of Forster Private Hospital, which would be pleased to operate the unit for both public and private patients alike. Currently, chemotherapy patients have to travel to Taree, Port Macquarie, Newcastle or Sydney for treatment. This is an unnecessary stress, for both patients and their families, which could be avoided with a relatively small funding investment. A whole unit including computer systems, refrigeration, intravenous pumps and armchairs could be established for just over $30,000.

Similarly, the Cape Hawke Community Hospital and Health Association, which leases Forster Private Hospital, is in need of a hydrotherapy pool to service the community. A budget for this project has already been completed and the pool could be built for $750,000. This infrastructure would support a variety of patients with a variety of health needs. Hydrotherapy pools can be used to assist elderly patients with movement, for rehabilitation and pain relief and for treating illnesses such as rheumatic diseases, just to name a few. Unfortunately, the Gillard Labor government rejected funding for this worthwhile project under the latest round of the National Rural and Remote Health Infrastructure Program, despite a detailed submission prepared by the association. That is why I made it one of my priorities prior to the August election, when I committed the necessary funding under a coalition government. Parties aside, I now call on the government to meet this promise and, at the same time, meet the real need in the Paterson electorate.

I would like to finish by reminding this House that without our health we can do very little else. That is why real outcomes and improvements must be the priority for new legislation. When I am out and about speaking to my constituents, from Raymond Terrace in the south to Forster in the north, I am always told about the need for a hospital, more beds, another GP, specialist services, longer health operating hours—and the list goes on and on, such is the need. Never do people implore me for another level of bureaucracy. That is why I cannot support this, without being absolutely certain that it will lead to the increased frontline services that I have just mentioned. I am not convinced that the current bill satisfies the needs of my constituents.

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

In speaking to this legislation, the National Health and Hospitals Network Bill 2010, I note it is always very pleasing to follow the member for Paterson considering he comes from an area that is close to my electorate. I find it quite interesting that he has raised the issue of health services that are needed in his electorate given that he was a member of the Howard government from 2001 to 2007 and that during that time he was not able to have any of these projects brought to fruition. I might also add that he needs to acknowledge here in this place that it was the Howard government that put a cap on the number of GP places, which led to the chronic shortage of GPs and other health professionals that I know he and his people experience in his electorate and I and my people experience in the Shortland electorate. So I do welcome the additional training places that the Gillard government has brought on line. As I am sure the member for Paterson knows and appreciates, the Gillard government is investing $1.2 billion in doctors, nurses and allied health people as part of the National Health and Hospitals Network. It is for training an additional 5,500 new GPs and an additional 680 medical specialists over the coming decade, improving support for 4,600 full-time-equivalent nurses working in general practice, training aged-care nurses—which is vitally important for both the Paterson electorate and the Shortland electorate because they have very elderly populations—and providing $1.6 billion for more subacute beds.

Health is one of the most important issues confronting Australians, and it is about the ability to access health care when they need it and the ability to have services on the ground. During the Howard years I was involved with the health and ageing committee in an inquiry into cost shifting and coming out of that inquiry we prepared The blame game: report on the inquiry into health funding with its recommendations. The blame game report has been used as one of the starting points to develop the National Health and Hospitals Network. From there the current Minister for Health and Ageing has put in place a number of structures that have led to recommendations as to the legislation that has been presented here in parliament and the legislation that will be presented later this week.

What makes me just a little angry is that, for all the years that the Howard government was in power, the previous speaker, the member for Paterson was not raising issues but was lauding the health policies of that government—a government that ripped $1 billion out of our hospitals. Then he came in here this evening and went through his wish list, and even condemned the Gillard government for spending money in his electorate.

Health is important, getting it right is important and everybody working together is important. The legislation we have before us today is part of the framework of the Gillard government’s efforts to fix the mess created by the previous government—a government that did not even respond to the blame game report of the health and ageing committee. That report was noted for its groundbreaking recommendations and for the fact that it recognised all the key factors that were creating problems within our health system.

The bill before us today provides framework legislation to establish the Australian Commission on Safety and Quality in Health Care. It will be an independent body and will later be amended to include provisions to establish an independent hospital pricing authority and a national performance authority. The Commonwealth will provide $35.2 million over four years to jointly fund, with the states and territories, the continuation and the expansion of the commission to support improvements in safety and quality in health care.

The Gillard government is about safety and quality in health care. I previously stood in this parliament and spoke against coalition government legislation that downgraded the Commonwealth’s commitment to providing health services. Now I stand here tonight as a member of a Labor government that is committed to reforming our health system. The Gillard government will be introducing landmark legislation this week to secure better hospital services across Australia through fundamental reforms to the health system.

I implore members on the other side of this House to support that legislation. It is vital legislation that will deliver health care to their constituents. It is legislation that will put in place a funding model that will stop the blame game that was identified in the blame game report. The Commonwealth will be taking the majority funding responsibility for public hospitals and full responsibility for primary care, thus ending the blame game. There will be no more blaming the states or the states blaming the Commonwealth. It is a mature approach to health care. It is an approach which recognises that health care is about delivering health services to Australians rather than trying to abrogate the responsibility of governments by blaming the states or the Commonwealth. This is a Commonwealth which is taking responsibility. The change in funding arrangements will provide a foundation for major reform of the health and hospital system.

Madam Deputy Speaker Bird, I know you recognise how the Australian health system has suffered for such a long period of time from inadequate funding arrangements and from unclear accountability. That has gone on for far, far too long and the blame game report of 2006 recognised that. Unfortunately the then government did not even respond to that report which was delivered to it.

The new hospital arrangements will ensure for the first time that the federal government properly funds public hospitals in Australia, and that has been a very big issue over a long period of time. Those arrangements will reverse what happened under the previous government when the Commonwealth financed a declining share of hospital funding. In actual fact the previous health minister, the now Leader of the Opposition, ripped $1 billion out of the Australian hospitals.

The new arrangements will ensure for the first time that the Commonwealth will fund hospitals for each service rather than provide funding through block grants. This will increase accountability and will allow the Commonwealth, as the dominant funding provider, to introduce new national standards for public hospital services ensuring that all patients receive timely and quality services. It will also drive improvements in primary care and prevention.

The legislation will fund: 60 per cent of the efficient price of every public hospital service provided to public patients, which will lead to an improvement in health services; recurrent expenditure on research and training functions undertaken in public hospitals; 60 per cent of capital expenditure; and 100 per cent of GP and primary care services. This is a big change and is a real change in the way our hospital system works.

But the changes do not end there. I have already detailed the increase in the funding that has been committed to by the Gillard government. I have already spoken about the landmark reforms that the Gillard government has embraced. The Howard government ignored the need for these changes and actually cut training numbers and funding to hospitals. The establishment of the local hospital network particularly benefits the Central Coast part of the Shortland electorate. Previously the Central Coast was lumped in with northern Sydney; now they will have their own network. The Hunter New England hospital network will be very similar to the network that exists now. It has been shown to be a very strong integrated network, unlike what was happening on the Central Coast. Medicare Locals will be established to work with local GPs, allied health workers and community health to drive local integration.

What this will do is bring health into the 21st century. It will establish electronic health records, which I see as being vital, particularly to those people living in rural and remote areas of Australia. It will establish a national after-hours GP and primary care service. Whilst the member for Paterson may not embrace the GP superclinics in his electorate—

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

None of us do!

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

I know members throughout Australia have embraced GP superclinics. The member for Bowman says that he does not support GP superclinics. I will put that on the record because I know that members on this side of the parliament are getting very positive feedback from the constituents in their electorates about the benefits of GP superclinics.

Seven hundred and fifty million dollars will be provided so that the service that patients get when they go to emergency departments will be provided within four hours. I should note here that $280,000 has been provided to boost health services at Belmont Hospital. The residents in east Lake Macquarie will benefit from new medical equipment and improvements at the hospital following the historic health and hospital reforms, without which this would not have happened. The hospital will also undergo a $25,000 refurbishment which will improve the triage area, allowing staff an unobstructed view of the waiting area from the triage desk.

The Howard government did nothing to improve health services. It was a wrecker. It impacted on the services that people were able to obtain. It oversaw the development of a chronic doctor shortage and it lost track of the fact that governments are there to provide services to people, particularly in the area of health. Instead of providing services it took away those services.

I commend the bill to the House.

Debate adjourned.