Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

It gives me pleasure to speak on the National Health and Hospitals Network Bill 2010 because it gives me an opportunity to talk about some things happening in my electorate. I was a local hospital chairman for seven years of my life before I entered this place. I must say that, when I look back on that time in local hospital management, the frustration of seeing more and more of the health budget soaked up in administration rather than actually being spent at the coalface of health delivery as it were has been of great concern to me. We extended office space and we created more work stations but we did not build any extra beds. In effect we had more admin and fewer health workers.

This bill unfortunately is more of the same. It is another layer of bureaucracy. It is yet another body devising hoops for the work-stressed health professionals to jump through. Usually these types of bodies are more interested in making themselves an indispensable part of the system, which is protecting their jobs

This bill talks about setting national standards. Unfortunately, what we deal with in my electorate are the loss of standards and the loss of service as a result of the recent state budget. In South Australia we have had eight years of the Rann-Foley government and in that time we have seen an explosion in public service jobs—almost 18,000 in total. The state Treasurer, Kevin Foley, has been telling us for eight years that he is the greatest treasurer in Australia. He has built this reputation upon a AAA credit rating, which has actually been built on the billions of dollars of unbudgeted revenue that have flowed into the state from the GST rivers of gold and the explosion in land tax receipts.

Unfortunately, like their federal counterparts, they have spent it all and then some. In fact, the state is now $7 billion in debt, and it is worth casting our mind back to the State Bank disaster in South Australia, which left the state $11 billion in total debt. We are fast approaching that horrific level of debt, which hung like an albatross around the neck of the state for years to follow.

In eight out of the eight budgets Mr Foley has delivered actual outlays have exceeded budgeted outlays. Now he says we are in deep trouble and we need to make drastic cuts. I could give you the whole list, Mr Deputy Speaker Scott, but essentially: 3,750 public servants are going to be retired and one would have to ask why on earth they were put on in the first place if we do not need them now; there is a reduction in long service entitlements and a move to abolish leave loadings for public servants; removal of a 3.3c subsidy for country petrol; mining royalties are up; cuts to small school supports; and taxes are to increase over the forward estimates by $1 billion, meaning a 76 per cent increase since the Rann government came to office.

This is where the issue comes back to this bill. Importantly, in health there is a grand saving of $1.2 million in support of four community owned not-for-profit private hospitals. There are two in my electorate and they all are in state Liberal-held seats. The two hospitals in question in my electorate are Moonta and Ardrossan and they are both community not-for-profit hospitals. Last Friday, I attended a large angry meeting in the township of Ardrossan and today, as we speak, there is a protest crowd gathering in Adelaide at the Adelaide Oval, and they will be marching upon Parliament House.

Ardrossan is the biggest town in the Yorke Peninsula council area. It has a population of around 1,200 but it services a total population of about 3,000. The hospital was established in 1914 and offers an accident and emergency section, 22 acute-care beds and an attached 25-bed aged-care facility. Mr Foley’s budget cut, in which he plans to save this $1.2 million in support of four hospitals, amounts to $140,000 at Ardrossan Hospital. It is a piddling amount but that $140,000 pays about 50 per cent of the costs of the accident and emergency section. But, for a community that is already raising a significant amount of funds in support of its hospital and has a high rate of private health insurance in support of a private hospital, it is a real obstacle. Fifty per cent of the admissions to the acute-care section of the hospital come through accident and emergency. So you can see that the loss of accident and emergency care at Ardrossan Hospital would lead to a dramatic drop in the admission rates to the acute-care section of the hospital. In effect, if we lose A and E, we are likely to lose the acute-care facility at the hospital as well.

One must then ask what will happen to the 25-bed aged-care facility. A 25-bed aged-care facility, as we know, is well below the optimum size to operate for profit or even to break even. So, if they lose that link with the hospital, their dependency on the hospital for laundry, cleaning and kitchen services will in effect threaten the viability of the aged-care services as well. What will happen then? There is a staff of about 50 involved in the whole operation. I must say that it is not so far in terms of distance to the next public hospital. It is 20 minutes up the road to Maitland, but there is another 20 to 30 minutes on top of that for the catchment area for the Ardrossan Hospital so some people would be looking at periods of 50 minutes to an hour to access accident and emergency services at the hospital.

Additionally, Ardrossan is in fact a fast-growing area, like much of the very beautiful Yorke Peninsula. It is only about 1½ hours from Adelaide and people are looking at this beautiful coastal region of South Australia as a retirement option. There is also a very high probability of mining very close to the town. Rex Minerals’ Hillside project is shaping up to be a world-class copper prospect. It is likely that we will see some hundreds of mining jobs come on stream there in the next few years, so there is likely to be a growing demand in this area. The extra demand caused by the closure of the Ardrossan Hospital and the anticipated expansion in the workforce and in the population will almost undoubtedly lead to the overload of the Maitland facilities, and we have to ask: what then? Are we looking at a substantial rebuild of the Maitland Hospital?

I will turn now to the Moonta community hospital, which is also affected by these budget cuts. Once again we have an acute-care facility, accident and emergency and an aged-care facility. There are 14 acute-care beds and a 64-bed aged-care facility. The state has been providing up to $280,000 to pay for the provision of eight public bed spaces at the princely rate of $120 a day. That is a pretty good deal for the taxpayer, I would have to say—$120 a day for a bed in hospital. That allows the public access. It is a very low fee, there are no capital outlays for the government and they do not pay for unused capacity. If there is no-one in those beds they do not pay the $120 a day, so it is a pretty good deal for the taxpayer generally. If the Moonta acute care crashes, obviously the accident and emergency would go because there is not much point in having an accident and emergency section at a hospital if you are not going to actually have a hospital, so that would be the end of that service.

Because Moonta has the 64-bed facility we could argue that it would be more than likely to be converted to a full aged-care facility, which actually gives a future for the workforce and facilities. But the patient load would be transferred to the Wallaroo public hospital. It amounts to around 1,400 private bed days a year and 1,800 public bed days. Wallaroo has 21 public beds and six private beds, and I can tell you that it is already under pressure. It is operating at capacity. In fact, the overload from the Wallaroo Hospital gets sent to the aforementioned Maitland, which is about an hour down the road. So you can see that this is all coming together and we are going to see a great loss of access to acute-care beds in hospitals in this region of the state. The Wallaroo Hospital is not that old but there are already plans for a major rebuild to expand its facilities to 50 public beds.

This is where it links back to talking about the Commonwealth’s involvement in this. We have just had a bill tabled by the minister, addressing the new funding arrangements. If the Commonwealth is going to pick up 60 per cent of the responsibility for healthcare funding in the hospital system, then, if we have to spend, say, another $10 million at Wallaroo and another $5 million at Maitland to meet this extra demand on the hospitals just because the state government has withdrawn this small amount of money which allows these private hospitals to exist, in the end it comes back to the feet of the federal taxpayer and the federal government. The government has been talking about this new relationship with the states in which no blame will pass between them, but here, with an underhand movement, we are seeing the pushing back of funding of hospitals to the federal government. It is madness, in my opinion, to be forcing the closure of these two hospitals only for the government to try to save $420,000 a year between them, when they will be spending millions to meet that increased demand on the public hospitals that are the next in line. Really, it is a measure to fix today’s budget problems in the state with very little regard to the future.

The other two of the four hospitals affected are Keith and District Hospital and Glenelg Community Hospital. Keith hospital is in the south-east, in the federal electorate of Barker—I know that my good friend the member for Barker has had a fair bit to say about this issue as well. Over 1,000 people turned up at a public meeting about this issue in Keith. Glenelg Community Hospital is in the city of Adelaide. I do not profess to fully understand the workings of the Glenelg hospital, other than to say that it was established by an organisation of which I am a life member, and that is the Glenelg Apex Club. I am a member of Apex. These are four private hospitals but none of them are for profit. None of them are about making money. I feel that the state government has quite possibly got this thing about private hospitals not being a concern of the government. These are community hospitals. When the state government was taking over many community hospitals in the state, these hospitals stood their ground and said, ‘No, we would prefer to operate under our existing entity.’ Here we are, some years down the track, and they are being deserted by the very small amount of public support that they were receiving.

This bill is about national standards, and it incorporates the building of a new bureaucracy. As I said, part of the new deal is that we are not supposed to blame the states, but we are faced with a practice where very little has changed. I think the intent of this bill will change things very little, except to put in a new raft of bureaucratic changes.

There is a rally in Adelaide today, as I said. They are probably marching as I speak. I wish them well, and I wish I could be with them. I believe that the chairman has a meeting with the state minister, John Hill. I also wish them well. While this is not a direct federal responsibility, I have drawn attention to the fact that it has federal implications, and I ask Minister Roxon to take an interest in these issues and to turn her mind to the practical things that will deliver a standard of medical care for regional and metropolitan areas across Australia.

Sharon Bird (Cunningham, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to support the National Health and Hospitals Network Bill 2010 as presented to the parliament by the Minister for Health and Ageing. I want to do three things in the time that I have available to me today: firstly, to talk about the content of the bill as it stands before the House; secondly, to put the bill within the context of the national health and hospital reform agenda of this government; and, finally, to talk about the implications of that for my own electorate.

The National Health and Hospitals Network Bill 2010 is part of a suite of bills that are aimed at implementing major reforms to the funding and governance of the Australian healthcare system. The intention of the reforms is to place the healthcare system on a sustainable foundation for the future. The new governance arrangements will involve the establishment of three agencies. The first agency is the Independent Hospital Pricing Authority; the second is the National Performance Authority; and the third is the Australian Commission on Safety and Quality in Health Care, which is the one referred to in the legislation before us today. It is intended that this bill will be amended to include provisions to establish the Independent Hospital Pricing Authority and the National Performance Authority—the other two agencies I mentioned.

It is imperative that there is a strong focus on improving the safety and quality of health care as it is delivered throughout Australia. Part of the national COAG agreement was around issues of not only funding but also quality assurance and transparency. To ensure that this is achieved, the bill will establish the Australian Commission on Safety and Quality in Health Care. It will be a permanent independent body under the Commonwealth Authorities and Companies Act 1997. The intention of placing it in this way is to ensure the independence of the commission. It is important to ensure its standing as an authoritative source of knowledge on healthcare safety and quality matters. I think that is achieved by the construction of the commission and where it is placed. It will continue its important role in helping to reduce harm caused by preventable errors. Some of the contributions to this debate from both sides of the House have acknowledged the important culture change that has occurred over recent decades from a less closed, defensive view by medical practitioners to a more collaborative and review type of culture. Certainly the commission will continue its role of looking at areas in which preventable errors occur. I think that is important because it is part of building community trust and confidence in not only the system but also its processes.

An important part of the commission’s expanded role will be to set new national clinical standards and also to strengthen clinical governance. This is an extension of some of that earlier work and it is to lead the drive towards continuous improvement in quality and to safeguard high standards of care. It is an important component of the ongoing commitment of the whole health services sector in looking for ways to be constantly improving clinical standards and increasing community confidence in them. The commission’s expanded remit also extends to ensuring the appropriateness of care in all health settings and, importantly, including both primary care and mental health—two areas which we have given particular focus to since coming to government.

The 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, which leads to a nationally inconsistent assessment of safety and quality standards. Part of the commission’s role will be to continue its work in developing a national accreditation system, and it will develop a national model accreditation scheme. The development of national clinical standards, guidelines and indicators, as outlined in my previous comments, together with its work on a national accreditation model, will support the take-up of the commission’s work by health authorities.

The state and territory authorities have been consulted on this bill and are generally supportive of it. This bill, as I indicated, sits within the reform agenda of this government to address the problems within the health and hospital system on coming into government. I listened to the contribution of the member for Grey. I acknowledge that he was talking about some of the capacity constraints and issues that exist in his electorate. I am sure that we could all talk about constraints like that across all of our electorates. It is exactly why this government has undertaken health and hospital reform. I think you should be a bit fairer to some of the state governments, in that the increasing pressure they have been under to fund hospitals over a period where there was a growth in demand and expectation of our hospital system occurred when the Howard government was failing to expand its commitment to the public hospital system. The end result was, in effect, a billion dollars withdrawn from the public hospital system.

Hospital authorities, particularly those of state and territory governments, were struggling to meet a growing demand with a decreasing responsibility by the federal government in putting its shoulder to the wheel in that task. That is part of what was addressed in the House of Representatives Standing Committee on Health and Ageing report The blame game. It certainly contributed towards the development of our policy that we took to both the 2007 and 2010 elections and that I believe is well supported in the community.

We are attempting to address two areas through this reform. One is to address the physical challenges and capacity constraints in our health system of capital and hospitals—money for equipment and so forth—and the other is to address the chronic shortages that had developed in the provision of hospital staff—doctors, nurses, allied health professionals and so forth as a result of the caps and constraints on the training places in place for so long under the Howard government. It is a big task and we understand that.

This bill sits within that reform process, particularly as it was developed through the COAG process. Part of that reform is investing $1.2 billion in doctors, nurses and allied health professionals. Communities constantly say they are concerned—even when you get new capital for the hospital or a new GP superclinic or where many GP services, as in my area, have applied for the upgrade program available under the superclinic program—about shortages of medical staff and ask whether their new facility will be able to be serviced. It is important that, in parallel with those commitments, we are developing and giving commitment to the training of new doctors, nurses and allied health professionals. That is something that suffered significantly under the Howard government and was creating real challenges for health services. In my own area, the University of Wollongong’s medical school has a unique and very well developed program to bring in doctors from regional areas to train at the university and keep them connected to their regional areas by doing practice placements in GP clinics in regional parts of the nation. Therefore, hopefully, having retained their connections to the communities, they will go back and service those communities.

We have also invested in beds and facilities in hospitals as well as undertaken to provide 60 per cent of the capital requirement for new facilities at hospitals. That is only one part of the health and hospital reform. I am particularly pleased that we are also taking over 100 per cent of primary care. An ounce of prevention is worth a pound of cure, as the old saying goes. It does not take very long when you talk to health professionals to get a very clear picture that, if we do the primary care at the end of the spectrum better, that is one of the most significant things that we can do to ease the pressure on our hospital system. This bill sits within a comprehensive take on reforming the health system and making it function more effectively, recognising that it is increasingly important, as it is an increasing share of state budgets, that the federal government continue to sustain its commitment to health and hospitals.

In the few minutes I have left I want to talk about what has actually happened in my electorate under this government’s reform process. In September 2009, the Minister for Ageing came to our area as part of the reforms that occurred all around the country under the health and hospital reform agenda and we had a consultation session with many health service providers in the region. Certainly there was a great deal of advocacy for better hospital support in our region, but also raised at that forum were preventative health, primary healthcare and mental health issues. At that time, in September 2009, we were part of the rollout of elective surgery money which was an attempt to reduce waiting lists. There was over $400,000 injected into the Wollongong Hospital to help with that waiting list reduction plan. That obviously was very, very welcome at the time and, in particular, for the Wollongong Hospital, which is the major referral hospital for the region.

This was followed in April 2010 by a visit from the Prime Minister, who announced that we would be putting $12.1 million towards the Illawarra Cancer Care Centre at Wollongong Hospital. That component of Illawarra cancer care is the major referral for cancer support services in the rest of the region. As part of that package, Nowra also got a component of funding to make that cancer care centre operate more effectively as a regional hub service. That money was matched with $2 million from the state government. It was to provide radiotherapy services at the Illawarra Cancer Care Centre. It included additional infrastructure for outpatient clinics and day oncology. It included enhanced facilities for haematology and therapies. It included one additional linear accelerator and one additional radiotherapy bunker, six additional chemotherapy chair beds and medical diagnostic equipment. It was extremely welcomed not only by the health professionals and the patients who were there but also by the community more broadly, as it was something for which we had been lobbying for quite a long time.

In June 2010 the health minister visited the area to announce an additional 21 new beds—19 emergency department and two high-dependency beds—for the Wollongong Hospital, which were part of the COAG agreement. At the same time we met with some young doctors in training as the health minister announced an additional $5 million for new training facilities at the Wollongong Hospital. That was important. There were about half-a-dozen students in training that we met at that time, all of whom were young people from regional and rural New South Wales. They were doing their training at the University of Wollongong and their hospital placements at Wollongong Hospital and they certainly welcomed the commitment under the clinical teaching and training grants that the minister announced on the day.

For me and my constituency the reality is that over the past two years we have seen important commitments made by this government to the health and hospitals in the area, not only for physical buildings but for equipment and staffing—all the components that add up to making it work. Out of fairness to the former government I thought I would check what money they had injected into the hospitals in my region over the nearly 12 years they were in power. Sadly, I could not find anything. I leave it up to them to correct the record, but I did go to Senator Connie Fierravanti-Wells’ website, where she had outlined all the money that had been given to the region—very handy; thank you very much, Senator. Under health and ageing funding I can find the ongoing recurrent money that federal governments commit for general practice, hearing services, aged care and so forth, but no actual hospital money and certainly no new injections. So I commend what this government has done not only with its commitment to reform of the system and to reform of training and development opportunities for health professionals, but also specifically with its commitment to upgrade the services and facilities in regions like mine.

Daryl Melham (Banks, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the National Health and Hospitals Network Bill 2010. The explanatory memorandum sets out the following on page 3:

The Bill provides for the establishment of the Australian Commission for Safety and Quality in Health Care (the Commission) as a permanent, independent statutory authority under the Commonwealth Authorities and Companies Act 1997.

The legislation provides a framework for the establishment of the Commission, including the expanded role for the Commission of setting national clinical standards and strengthened clinical governance.  It is intended that these arrangements under this expanded role will be further developed in consultation with the states and territories and subject to finalising financial commitments.

The establishment of this body forms part of the National Health and Hospitals Network Agreement between the Commonwealth and the States (with the exception of Western Australia) and Territories endorsed on 20 April 2010.

In the bill itself, the functions of the commission are outlined in section 9. I do not propose to read those, but they are expansive, as they should be. I do, however, want to quote from a press release dated 25 October 2010 from the Prime Minister, the Treasurer and Deputy Prime Minister, and the minister for health, which basically outlines the purpose of what we are talking about today. I quote:

The new funding arrangements for Australia’s health and hospital system will:

• ensure, for the first time, that Federal Governments properly fund Australia’s public hospitals—reversing the Commonwealth’s declining share of hospital funding;
• ensure that for the first time, the Commonwealth will fund hospitals for each service they provide, rather than through block grants—meeting increases in demand and helping take pressure off hospital waiting lists;
• allow the Commonwealth, as dominant funder, to introduce new national standards for public hospital services, ensuring all patients receive timely and high quality services; and
• drive improvements in primary care and prevention, because as the dominant funder of the hospital system, the Commonwealth will have an incentive to provide better primary care and prevention services to take the pressure off our hospital system. 

Specifically the legislation will ensure the Commonwealth will fund:

• 60 per cent of the efficient price of every public hospital service provided to public patients;
• 60 per cent of 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 health care services.

               …            …            …

The legislation reflects the historic agreement to reform Australia’s health and hospital system signed by the Commonwealth and seven States and Territories.

Under this agreement, the Commonwealth Government will relieve the States and Territories of $15.6 billion in growth of health costs from 2014-15 to 2019-20 - allowing them to invest in other essential services.

It is really a massive investment in our health and hospital networks, as it should be, because they were in need of that massive injection of funds. Over the 11½ years of the former government, public hospitals were dying a death of a thousand cuts. There was an ideological spend by the former government that was more interested in other aspects of the health system than public hospitals and the general welfare of the community. It was ideologically driven and we are still getting that in the current opposition. That is no way to provide services.

I also want to point out a couple of things that have happened over the last couple of years in my area and adjoining my area in terms of the hospitals under the Labor government. In January 2009 it was announced that there would be a Medicare-eligible magnetic resonance imaging service at Bankstown hospital. The member for Blaxland, Jason Clare, and I visited the hospital and that service is now up and running. We have also had a fresh visit to the hospital. It is something I welcomed at the time and it is certainly an area of need. Bankstown hospital is a terrific hospital and it will provide a wonderful service through the MRI. Too often we used to miss out under the former government.

In March 2009, the then Minister for Ageing, Justine Elliot, announced one-off funding grants worth almost $18,000 to Sydney South West Area Health Service, including Bankstown Ethnic Day Care, the Community Independent Support Service and the Bankstown Dementia Respite project. These one-off grants would improve and support respite services for carers in Bankstown to cover costs such as minor building modifications or to purchase or replace equipment and furniture. These sorts of grants go a long way, because we have an ageing population. There is a need for assistance for the services that are provided. We cannot continue to rely on the goodwill of people in the local community and on Squibb making a contribution.

In July 2010 the Attorney-General, the federal member for Barton, and the state member for Oatley, Kevin Greene, as a result of the COAG agreement, saw $790,000 for new surgical and emergency equipment and minor capital works at St George Hospital, which is at the other end of my electorate. It is not actually in my electorate, but it does service my electorate. That was about enhancing patient care. Robert McClelland, Kevin Greene and I visited the hospital. We sat down with the nurses and the doctors, and they were over the moon about what that extra funding would do. Patients at St George Hospital were set to benefit from more than $5.4 million in additional funding for the South Eastern Sydney and Illawarra Area Health Service under those reform agreements. That reform agreement was actually about more money, which is very much needed.

The package of new medical technology for the hospital included an anaesthetic-monitoring system for $450,000, a cryosurgery machine for $200,000, two ECG machines for $24,000, a compact ultrasound machine for $40,000, a ventilator for $20,000 and a bariatric trauma bed for $15,000. Also included in emergency department funding was $25,000 for minor capital works to facilitate early assessment for patients needing emergency care.

A lot of support is given by the local community in the St George area and the Bankstown area to their local hospitals through the club movement, of which I am a proud member. I am currently the elected President of the Revesby Workers Club. Sporting clubs such as the Bankstown Sports Club kick in to Bankstown Hospital for particular projects. Our charity last year gave $45,000 to Bankstown Hospital. We will give more money to them for particular projects this year. St George Hospital has a wonderful support structure, not just from the clubs but also from local residents—people who have been the beneficiaries of operations at the hospital. That all supplements what the Commonwealth and the state government do, and it should not be underestimated. The local community has raised millions of dollars for St George Hospital over time, and they are to be commended for it.

On 7 October Carmel Tebbutt, the state Minister for Health, visited Bankstown Hospital, together with the state member for East Hills, Alan Ashton, and the state member for Bankstown, Tony Stewart. There was $1.2 million in funding for new medical equipment, all arising out of the health and hospital reform agreement signed by the NSW government and the Commonwealth government. As a result of the funding boost, Bankstown Hospital’s emergency department would receive more than $350,000 in essential equipment, including heart-monitoring equipment, a defibrillator and an ECG machine to record patients’ heart activity. The hospital’s operating theatres would also benefit from more than $920,000 in funding for internal camera equipment for endoscopy procedures and for an extra recovery bed. That is all very much needed.

On 14 October the member for Barton and I announced funding of $2.9 million for a training facility for Wesley Hospital at Kogarah, which is in the member’s electorate. This $2.9 million is to build a new clinical training facility at Wesley Hospital. The project will create space for clinical training facilities where students will gain practical experience in psychology in a private psychiatric hospital, expand training positions within the Sydney metropolitan area, provide students with exposure to patients in an acute psychiatric context and meet training concerns in areas of professional workforce shortage.

That is the sort of money we should not apologise for. That is where our taxes go, and we should explain that to our communities. It is essential that governments look, over time, at increasing this sort of funding to these hospitals, because they do good work. I commend the bill before the House. I think it is on the right track and that the government is trying to do the right thing.

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

There is a reform debate on right now, and it is an important debate on a range of topics—none more important at this moment than health reform in this country. It is my understanding that over the past few years it has been largely a bipartisan exercise—or a multipartisan exercise—and I would hope that with this first reform bill—the National Health and Hospitals Network Bill 2010that multipartisan reform agenda can continue.

For a region such as mine—a growth region that has for too long suffered from inequity of funding and inequity of health service delivery, and therefore the secondary consequences of less productivity, less participation in the economy and the greater impacts on an ageing community—this is critical to the reform agenda. It is critical for a growing region like the mid-North Coast of New South Wales, and, I would have thought, more generally for the productivity and participation interests of the reform agenda of Australia.

I have previously described the concepts and the theory around health and hospital reform as a slam dunk for the growth regions of Australia. While there have been some incursions by the states into this reform agenda through various COAG meetings, I still fundamentally believe that this reform is important and must happen quickly. We pitched to the previous Prime Minister the importance of two reform agendas in this broad concept of more Commonwealth funding and more local command and control in clinical services. There must be two Es included in this process that will either make or break the successful reform of health services. The first E is equity of funding. For too long, growth regions in this country have been funded for health services in an inequitable way. I think that can also be said for regional Australia generally.

At a recent meeting, the National Rural Health Alliance said they are underfunded under the various state government funding formulas by up to $1 billion per annum. That is an outrageous reflection of how the resource distribution formulas used by the states do not deliver in the interests of all Australians. Over time there seems to have been an acceptance of inefficient overfunding in metropolitan locations at the direct expense of underfunded and efficient regional and rural services. This has led to chronic workforce shortages in rural and regional Australia and to health indicators that clearly demonstrate that sometimes it is a health risk to live in regional and rural areas. The obvious example comes from figures relating to cancer and cancer services, where there are higher death rates in rural and regional areas than in metro areas. So, reform matters and equity of funding matters.

In New South Wales, the Garling report was done in 2007. Specifically for the North Coast, it identified the growing region missing out on up to $70 million per annum based on the state’s own resource distribution formula. For some reason governments have been unwilling to treat the issue of equity as an important part of their brief and they have chosen what I consider to be the lazy option of continuing to overfund some areas and underfund others, and not make the difficult political decisions that would match people movement in this country.

This legislation will hopefully help on the equity front, but it is an ongoing discussion and I will raise it when every single relevant bill about health and hospital reform comes through. The Commonwealth must tie the principle of equity to the flow of Commonwealth dollars to drive this reform process. If that equity principle is not tied to the Commonwealth dollar, we are potentially just going to spin the wheels and fall into the trap of a government once again not making hard decisions when cutting deals on service agreements with all these new local health networks. We will just have a different version of what we had before. I continue to advocate for that equity principle to be included. I know the previous Prime Minister, the now Minister for Foreign Affairs, got it in regards to equity and I hope the current Prime Minister and executive also get it, because that is the key driver of broad reform and it will make these changes to the way health is delivered in this country more significant.

The other E that those of us from growth regions continue to lobby and advocate for is efficiency. One of the original concepts behind the reform agenda was that if a local health and hospital network comes in under benchmark then that money should be returned to that local health network as a way of encouraging efficiency within the system. A criticism up to now is that those that are efficient are not rewarded and therefore there is no incentive to be efficient in the system. This is why comparisons of the costs per bed between private and public hospitals quite often raise alarm bells about why the costs at certain hospitals are so much higher than in other similar hospitals.

Again, I will continue to advocate and lobby for efficiency to be a critical part of this health reform agenda. It will drive efficiency not only on the ground but also within local health and hospital networks. Along with the principle of equity, it will make this reform agenda matter. I would hope those two Es—the principles of equity and efficiency—are front and centre in all thinking as we see these bills come through. I do not see it in writing. I certainly hear plenty of words about it and I continue to seek feedback from the minister and the government about the details of how we are going to see those two Es survive this process and make it valuable.

I think there are quite genuine concerns within the community and health sectors about the final COAG meeting that sealed the deal on this health reform agenda and saw Western Australia fall out and various state agencies somehow slot back into the organisational structure. There are quite genuine concerns about what happened in that last COAG meeting and the implications of that for the reform agenda. I am told, and I hope it is true, that slotting the states back into the organisational chart is nothing more than a mailbox for the flow of money to the ground. But I am certainly watching it closely, and I would hope everyone watches it closely. As soon as a state has the discretion to start making decisions again that are akin to choices about resource distribution, growth regions like the North Coast will again bear the brunt of those decisions. Rather than making the hard decision to take something away from one area, it is easier in politics and policymaking to deny a growing area much-needed capital and recurrent funding. In raw politics that is the way decisions can be made.

I flag as an important issue that that element of human discretion at a state level must not be there. If it is, I will fight it. I will also continue to seek those two key principles—equity and efficiency—as the drivers within important reform. If we can achieve that, I will continue to think this reform process is a slam dunk for growth regions, a slam dunk for this nation on reform and a bit of an answer to today’s media that are asking what the government’s reform agenda is. As everyone is pointing the finger at each other on reform in the last 24 hours, I would hope that this is one of those reform agendas where there is bipartisan and multipartisan support and that through this process that continues over the next critical six to nine months.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the National Health and Hospitals Network Bill 2010a historic bill. The health reforms that are reflected in this bill are the largest reforms since the advent of Medicare. I want to talk about some of the local issues in the health service that covers my area of Page—and also covers the areas of Richmond, Cowper and Lyne. The previous speaker, the member for Lyne, spoke about issues I am quite familiar with because we share the North Coast Area Health Service.

This bill gives the legislative framework to enable the government to shepherd in the health reform agenda, a key part of the government’s program, and the establishment of the permanent body, the Australian Commission on Safety and Quality in Health Care, which will become an independent statutory authority under the Commonwealth Authorities and Companies Act 1997. That is a good thing because for the health reforms to kick in we need to have this as a standing body and a statutory authority. The agreements in the health reform agenda entered into with the states, with the exception of Western Australia, were endorsed on 20 April this year. The new National Health and Hospitals Network will have a performance and accountability framework. That is important because the framework will include national standards and the commission will be able to work on developing those.

The member for Lyne spoke about equity and efficiency, issues I also give some attention to. Under the new health reforms we are going to have case-mix funding, which does operate already in other jurisdictions. Case-mix funding is not new but what is new is that it will be part of the health reform agenda. In New South Wales we have the resource distribution formula, the RDF. In the area that I live in, even though the RDF has been improving over the years the North Coast Area Health Service has been underfunded, according to the RDF. I have said that the case-mix funding will correct that and some of the local doctors have also said that and have welcomed it. That is one of the issues that I am quite pleased about and that we will not have to continue to grapple with it. The other issue is that the small hospitals will be given block grants, and other measures will be looked at to ensure they are able to operate really well.

This bill will involve establishing the Independent Hospital Pricing Authority—that is the agreement that this bill is premised on. It will establish the National Performance Authority and it will amend the Federal Financial Relations Act. The permanent commission will formulate and monitor quality and safety standards. The explanatory memorandum sets this all out quite well.

The commission will also provide advice to the Commonwealth, state and territory health ministers about which standards are suitable for implementation as national clinical standards, and I know that there will be clinical input into that as well through the local hospital networks. In my area the ads recently appeared in the paper, inviting people with particular interests and skills to nominate for the local hospital network governing council. They will be responsible for implementing the national clinical standards once they are agreed to. This is a good thing. I know that, in practice, it will take some working out, some negotiation and lots of goodwill, but it is important that we have it in place.

The bill also talks about consultation, which is particularly important in the area of health. One key area of consultation will be the expanded role of the permanent commission. It will complement the activities that were undertaken by the temporary commission and will come up with guidelines and indicators as well.

I want to talk about another part of the national health reforms, which is the lead clinicians groups. These will be set up and funded by the federal government to deliver a greater say for local health professionals. These will certainly be helpful to the local health and hospital networks in implementing the clinical standards that come from the permanent commission. I will just say a little bit about lead clinicians groups. Fifty-eight million dollars was made available to establish these groups in local hospital networks and at a national level. They will provide local health professionals, as you would expect—doctors, nurses and allied health professionals—with a permanent and influential voice in the National Health and Hospitals Network. A key finding from the government’s health reform consultation process was that clinicians felt locked out and disengaged from the operation of public hospitals. Even though they are a key feature of public hospitals and operate in them all the time, they wanted more say, particularly in clinical and medical pathways. Within the public system there are lots of existing administrative pathways but they particularly wanted more say in the clinical and medical areas.

Lead clinicians groups in local hospital networks will ensure that local health professionals have a say in improving quality and safety in hospitals. That is always a work in progress, but under the new system, particularly with the commission, it will be foremost in our minds. They will plan the most efficient allocation of services within a local hospital network, which is also important. At a local level we often want everything to happen at our local hospital. That is normal; that is what communities ask for. But sometimes it is not possible, and not in our best medical interests, to have things happen at certain hospitals. Within a local hospital and health network we can work out where those services can be delivered with the best trained and most appropriate medical personnel.

It will also be about developing different solutions that best address the needs of local communities. As a bit of a snapshot, in my area, particularly across one valley, we have a very high incidence of diabetes. It is for a whole range of reasons. It is to do with our ageing population; it is to do with our Indigenous population. If you look at the North Coast area, which is covered by the North Coast Area Health Service, you see that nearly 11 per cent of the population are Indigenous, which is quite a significant number of people.

With regard to the health reforms in general, for the first time we will have health that is funded nationally, with the Australian government taking on the dominant funding responsibility for the health system to end the blame game. There was a report called The blame game: report on the inquiry into health funding produced by the Standing Committee on Health and Ageing, and it is a matter that has been debated in the parliament. The reforms will eliminate waste and meet rapidly rising health costs. The networks will be run locally, which is really important to locals. They want their hospitals run in the best possible way with the best medical service available but they also want to have input. They did feel shut out, which is one thing that the federal government kept in mind in planning its reforms.

I want to thank Minister Roxon for the wonderful work she has done in this area. I also thank the former Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery, who visited my electorate at different times, along with Minister Roxon. Minister Snowdon visited every hospital in my seat. It was quite a busy two days.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

He’s a legend.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

He is a legend, as Minister Roxon says.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Ms Roxon interjecting

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

Yes, Minister Roxon has been to Lismore and Grafton. What we did—and it was really important—was consult. We went to every hospital. I know reforms are not just about hospitals, even though we focus on hospitals; they are about providing better care in the community and a whole range of primary health care. But we used the hospitals as our focal point, invited people in from the community and talked about what these health reforms mean. It was a really wonderful exercise.

We were able to do that as well in my area when we established the GP superclinic. I did a year-long consultation myself to make sure everybody was on board with it before the formal consultation happened through the Department of Health and Ageing. We were able to bed down what was happening and everybody was comfortable with it. Everybody wants reform but the question is: how do you implement it? It is in the implementation that we have to do the groundwork.

Also the national network will bring together eight state-run systems with one set of tough national standards to deliver better hospital services. This commission is the subject of the bill and one of the key things it will be able to implement. The Australian government will be taking over full responsibility for the GP and primary healthcare services. In my area we are quite ready for this with the local GP networks getting ready to turn into primary health care organisations or Medicare Locals, as they are called. They will cover the whole North Coast Area Health Service, where a decision has been made that there will be two local hospital and health networks. The North Coast Area Health Service is a big area which will be divided in two. A lot of work has been done on the ground so that we are very comfortable with that model. We are looking forward to operating with those two networks and we are looking forward to working within the new framework, particularly in mental health. We are lucky in our area—we have some wonderful, expert people working in mental health.

It gives me great pleasure to speak on this bill, which is one part of the national health reform agenda. Health reform is not easy. Sometimes it would be easier to shy away and not tackle reform because a lot of health reform that has happened throughout our history has been bits added on here and bits added on there. You can end up with quite a disjointed health system. These health reforms go a really long way to being real reforms where we are trying to recalibrate how we deliver services in communities, with equity and efficiency. I commend the bill to the House.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

I would like to thank the member for Page and the very many members who have contributed to this debate. The National Health and Hospitals Network Bill 2010 is an important piece of legislation. It is an important part of our national health reforms and members’ contributions highlight how much these reforms mean to local communities. They also highlight how it is vitally important for us to make sure that we put quality and safety at the top of the agenda when we talk about delivering health services to our local communities. I note the opposition has moved a second reading amendment which tries to delay the passage of this legislation. We will not support this second reading amendment. We are not prepared to delay this important legislation further. The proposal from the opposition is that this legislation should not be considered until the Independent Hospital Pricing Authority and the National Performance Authority are debated by this House.

The opposition has already indicated that it opposes these bodies. This is despite the fact that Mr Abbott, the current Leader of the Opposition and a former Minister for Health and Ageing, has said that these very reforms are the types of things that would improve our health system across the country. It seems the opposition is once again playing its usual game of trying to hold the public to ransom by failing to deliver important health legislation. It is the same approach that the member for Dickson is taking with relation to be Australian National Preventive Health Agency Bill 2010to be debated later in this House. It seems the member for Dickson is determined to block every reasonable and sensible proposal for something the community and health experts across the country would regard as noncontroversial.

We really have to ask: how could the opposition regard this bill is controversial? This is a bill to make permanent the temporary Quality and Safety Commission, the very temporary commission which was set up with the support of all states and territories and the Commonwealth at a time when the Leader of the Opposition was the Minister for Health and Ageing. The logic and importance of having quality dealt with in our hospitals is not lost on the opposition. Nevertheless they want to play politics because they have no plans of their own, no plans for delivering better safety and better quality health care. It seems they have no plans for anything in health other than to block every piece of reform legislation the government puts before it.

I ask the community to consider this. One in 30 adults contracts an infection while in hospital, 12,000 of these are severe hospital acquired bloodstream infections and up to a quarter of these patients will die. That is, approximately double the number of patients die from hospital acquired infections as they do from deaths on our roads. We can do something about this worrying statistic. A national body dedicated to monitoring and improving safety and quality in health care can address this problem and can promote better health outcomes from our hospitals.

The Australian and Commission on Safety and to Quality in Health Care is not simply another layer of bureaucracy which wastes public resources, as the opposition would have us believe. For example, its recent release of the national hand hygiene guide and the Australian infection control guidelines will be pivotal in our fight against major health issues such as the hospital acquired infections I have just mentioned. Leaving the commission as a temporary advisory body hampers its ability to give independent and informed advice to all health care providers and thus drive continual quality health improvements for all Australians. Only its establishment as an independent and permanent body can best realise its full potential for ensuring patients safety.

I ask the opposition how they intend to explain to the public why such issues cannot be addressed in this rigorous and sustainable way. I cannot imagine that this is their new contract with Australia where they are going to work tirelessly to defeat every sensible proposal that comes before the parliament. They are determined to make this parliament not work. On the other hand, the government are determined to ensure that members have the opportunity to debate and vote on important measures such as this one. The government will bring legislation to establish the Independent Hospital Pricing Authority and the National Performance Authority before this House. However, we have made a commitment that we will continue to consult with states and territories on the terms of reference for these bodies and other technical matters, which is what we are doing. These bills will be brought before the parliament early next year.

11:14:51

There is no reason, however, why the parliament should not consider this legislation for this Safety and Quality Commission in the meantime—a body which is currently in operation as a temporary body and providing an excellent service for the Australian health system. As I mentioned before, it is a body that was in fact established in 2006 in its temporary way under the coalition government and the then Minister for Health, Mr Abbott.

The National Health and Hospitals Network Bill 2010 marks an important development in reforming Australia’s health system. By establishing a permanent independent safety and quality body, it formalises the government’s commitment to drive continuous improvements in quality and safeguard high standards of care for all Australians. We urge the parliament to support this legislation.

Question put:

That the words proposed to be omitted (Mr Dutton’s amendment) stand part of the question.