Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

Mr Deputy Speaker Thomson, may I take the opportunity to wish you a very merry Christmas and a happy new year. There is goodwill all round here, except for this Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. This bill enables the Commonwealth government to retain part of the GST for dedication to the National Health and Hospitals Network fund and about $50 billion in GST revenue over the current forward estimates will be rebranded as increased federal government spending on health. This bill does not provide the details of the new health arrangements. It simply delineates the financial aspects of the government’s new health policy.

Under the agreement, the Commonwealth will cover 60 per cent of the costs of the public hospitals and 100 per cent of a range of other healthcare services in return for the states handing over about one-third of their GST, although the exact proportion differs between states. So this is simply about shifting money from the states to the Commonwealth. Ironically, it comes from the Commonwealth, it goes to the states and now it is going back to the Commonwealth, and this is dedicated reform, according to the Labor Party in government. States will also be eligible for additional money called top-up payments.

There is no detail about the criteria under which these new payments will be provided. These will be at least $15.6 billion, although the minister can specify a lower amount. The payments will not commence until 2014-15. How convenient that might be. It just happens to fall outside of the existing four-year budget. It is amazing how these additional payments just pop up at a date well after the next budget forward estimates.

The motivations to fix the hospital system are noble—we all want to have a better hospital system—but the policy prescription is inadequate. The hospital system needs good public policy, but a simple cash grab by the Commonwealth is not the answer. The government’s new health policy aims to achieve accountability by better delineation of health responsibilities. However, the new model adds an extra layer to the administration of the health system and will not end the blame game that is the nature of health care in Australia.

Measures such as the local hospital networks sound good in practice but will do nothing to alleviate incompetent management in some hospitals. The litmus test for these health reforms will be better and more accountable service under this new system. The government has failed miserably to prosecute this case. We all know that the Labor Party just cannot manage money. The Minister for Resources and Energy knows that, and so do the Australian people. This bill drives a massive increase in revenue for a Commonwealth government that has proven itself incompetent and wasteful in the delivery of services. The total revenue redistribution that is shuffling money here and shuffling money there of $50 billion over the forward estimates involves a substantial amount of effort and it will lead to a significant increase with little planning as to how it is spent.

We are concerned about the lack of detail in this bill. Nowhere in the bill or in the explanatory memorandum is there mention of the precise amount of the GST to be taken from the states. If it was about a third, as indicated by the Treasurer in his second reading speech, it would be about $56 billion in additional federal revenue over the three years of the forward estimates—just a lazy $56 billion lying around which the federal government is just plucking out of the states. In the Mid-Year Economic and Fiscal Outlook, released a week after the Treasurer presented his second reading speech on this bill, it was said to be $44.6 billion over three years of the current forward estimates, excluding Western Australia. At this stage the amount involved looks to be around $50 billion. Under the proposed section 6A, the minister determines the amount of GST revenue to be paid by legislative instrument. This decision of the minister cannot be disallowed by parliament. This is an incredibly dangerous precedent for the federal government, which has shown time and time again that it will use any means necessary to pay for its reckless spending. I nearly choked on my oxygen yesterday—

Bruce Billson (Dunkley, Liberal Party, Shadow Minister for Small Business, Competition Policy and Consumer Affairs) Share this | Link to this | Hansard source

Your weeties.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

It was well past weeties time. I choked on my oxygen in question time yesterday when the Prime Minister said somehow the Liberal Party is the party of higher taxes. The Prime Minister so conveniently forgets that she was a member of a cabinet that dared not speak its name under the previous Prime Minister, Kevin Rudd, that introduced a new tax on alcohol, a new and higher tax on motor vehicles and higher taxes on cigarettes and made significant changes to taxation arrangements for a whole lot of different areas that were enjoying certain concessions. Of course, the Prime Minister forgot that yesterday, and the Prime Minister forgot that she is now contemplating a carbon tax and that she was advocating an emissions trading scheme and a mining new cost. Of course, the Prime Minister forgot old Marn’s mining tax, but there have been so many versions of it that it is hard to keep up. It is just a lazy $10 billion, isn’t it, Marn? What are you going to do with the royalties there, son?

Martin Ferguson (Batman, Australian Labor Party, Minister for Resources and Energy) Share this | Link to this | Hansard source

Industry has signed up to it.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

And industry has signed up to it. Is that right? Twiggy Forrest, Gina Rinehart and a whole lot of other people who would consider themselves from time to time part of the mining industry would say that industry has not signed up. We really look forward to seeing that bill in this place. I know there is a history in the Labor Party of giving ministers hospital passes. Look at poor old Peter Garrett on the receiving end of pink batts and green loans. What about the former Minister of Education, Julia Gillard, who was on the receiving end of the BER program that she thought was a great idea—such a great idea that she had to commission an independent inquiry into it? But there is more to come out of that today, I suspect. Now we have a Minister for Resources and Energy who thinks that it is a great idea to tax the resources industry. Mr Deputy Speaker, I know I am indulging here a little—

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

You are right about that.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

But I do want to give a little bit of career advice to the Minister for Resources and Energy: take up that ambassadorial appointment before the end of this term, old buddy. You do not want to be the one in this place to miss out on the opportunity to get your mining tax through. You will be blamed. So while you have some leverage on the Prime Minister, take that ambassadorial appointment.

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

The member for North Sydney will return to the bill.

Bruce Billson (Dunkley, Liberal Party, Shadow Minister for Small Business, Competition Policy and Consumer Affairs) Share this | Link to this | Hansard source

Martin the Mountie could go to Canada and follow up his love for mining.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

That is right. Canada is nice. Martin always gets his mounties, does he?

Bruce Billson (Dunkley, Liberal Party, Shadow Minister for Small Business, Competition Policy and Consumer Affairs) Share this | Link to this | Hansard source

He has done more for mining in Canada than in Australia.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

Anyway, some states will have to sacrifice up to 50 per cent of their GST revenue. I do not think they are very happy about that. Quite frankly, Western Australia is so unhappy about it that it has not agreed. So this is only partially a bill for part of Australia because that great chunk of Australia on the other side of the black stump is not prepared to give up its GST. In the case of the ACT, Treasurer Katy Gallagher’s office confirmed that the territory would be handing back between 48 and 50 per cent of its GST to Parliament House.

Bruce Billson (Dunkley, Liberal Party, Shadow Minister for Small Business, Competition Policy and Consumer Affairs) Share this | Link to this | Hansard source

It will not have to travel very far.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

No, it will not. Queensland health minister Paul Lucas’s office said ‘the state would be handing back 39.3 per cent of its GST’. And the Queensland shadow health minister claims that Queensland will be forced to hand over 42 per cent of its GST in 2012-13.

What happened was that the Labor Party started running out of money. They not only spent all of the surplus but also raided the net assets of the Commonwealth. They started borrowing money because they ran out of money to pay for pink batts and school halls. They imposed their alcopops tax and their tax of motor vehicles at exactly the wrong time. Of course, that did not work because they started to run out of money again. They then introduced the mining tax into the public debate. When they ran out of all of that money and started borrowing $100 million a day they raided the GST cookie jar, which is the money that goes to the states.

This mob has spent everything that moves and you have to ask yourself, ‘Where does it go?’ It goes to the states. As Margaret Thatcher said, the problem with socialism is that sooner or later you run out of other people’s money. That is exactly what this mob are doing—they are running out of taxpayers’ money. Despite handing over significant sums of money, there is no guarantee that the states are going to end up with improved health care.

The bill is premature in discussing final arrangements because they are not finalised. The explanatory memorandum to the bill notes:

The extent of expenditure covered under the Commonwealth’s new funding commitments will be finalised with participating States as part of the implementation of the NHHN reforms. This is not covered in the amendments to the FFR Act.

So this worsens the blame game in health funding that the agreement was meant to stop. This suggests that in late 2010 the government has not finalised the figures for how much money will be provided to hospitals and health care facilities. This is quite a dangerous precedent for our parliament, especially with the upcoming election in New South Wales and the Victorian election this Saturday, where the state oppositions have expressed strong concerns over the new health arrangements. I quote the shadow Treasurer in New South Wales, Mike Baird—a very good man—who said this:

The GST is efficient and stable and grows with the economy. Do the Premier and the Treasurer of this State think this State is no longer going to grow, so they are happy to give away the GST? That could be their argument. Why did John Brumby and Colin Barnett argue so strongly? Colin Barnett continues to argue strongly that he does not want to give up the GST but is happy to contribute to the new program. We understand that health costs are rising at a rate that is unsustainable for the States to manage them, and the States want the Federal Government to contribute. We are happy to make a contribution but not from our growth tax. Why should we give away our growth tax, which is the only tax that grows with the economy? The National Health and Hospitals Network agreement contains some good points. What is the State’s GST contribution that this Labor Government has signed up to? There is nothing mentioned in that agreement, no percentage amount. That means that the amount we are going to give in GST is a blank cheque.

It is a blank cheque. I was in this place sitting in the position where old Martin is now—

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

The member for North Sydney will refer to members by their titles.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

Sorry, the Minister for Resources and Energy. As Minister for Financial Services and Regulation, I sat in that chair for three days—I think that is why it has a little sag in it—as we passed through all of that GST legislation which the Labor Party opposed root and branch. In fact, the former Prime Minister, the member for Griffith, described the day the GST came in as ‘fundamental injustice day’. He so hated the GST that he wanted to collect it himself. That is why he negotiated this health agreement.

I say to the Minister for Resources and Energy that eventually your history catches up with you. On this occasion there must be just a tinge of embarrassment at the hypocrisy of the Labor Party once so desperately opposing the GST but now wanting to take it themselves. That is how opposed the Labor Party were to the GST. They thought it was a very bad tax.

You may remember that Kim Beazley, the former member for Brand and Leader of the Opposition, said something to this effect to his caucus: ‘We are going to surf the wave of GST all the way into government.’ The members for Dunkley and Bonner remember that. If I was the Minister for Resources and Energy or the Treasurer, I would pick up the phone to the now ambassador in Washington and say, ‘Hey old mate, are you going to be embarrassed if we now try to claim the GST for ourselves given that we were so opposed it?’ In fact, the Minister for Resources and Energy here at the table voted against it. Do you remember that vote?

Martin Ferguson (Batman, Australian Labor Party, Minister for Resources and Energy) Share this | Link to this | Hansard source

I remember you and Work Choices.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

He does remember that vote. I am so pleased he recalls that vote. I know there is some fading memory there. Of course, former ACTU presidents have selective memories, especially in this place. I would say, though, that he is not a bad guy, the old minister for resources, the old charmer. In the deep, dark recesses of his memory, he will recall that he voted against the GST. But, I would say this to him: give that part of your brain a little bit of oxygen, give it the opportunity to rebirth and remind yourself of the fact that you voted against the GST, and now you are voting for legislation that wants to claim it back.

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

Order! The member for North Sydney will address his remarks through the chair.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

You are the same, Deputy Speaker. I remember those battles well.

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

The member for North Sydney will not engage the chair in debate.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

I remember the battles with the member for Wills. The member for Wills was one of the strongest advocates for the Labor Party’s position and he was formidable in the debate.

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

The member for North Sydney will return to the bill.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

I was on the receiving end of all of that at question time. The Labor Party would come into the House with packets of salad and Hockey Bear pyjamas. Remember the Hockey Bear pyjamas?

Martin Ferguson (Batman, Australian Labor Party, Minister for Resources and Energy) Share this | Link to this | Hansard source

Yes.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

That’s right. And they brought in bottles of Coca-Cola. They would say: ‘Look at the price. Look at these Hockey Bear pyjamas, they are going to go up 10 per cent. How much is a packet of salad going to cost after the introduction of the GST?’

Martin Ferguson (Batman, Australian Labor Party, Minister for Resources and Energy) Share this | Link to this | Hansard source

With mayo and without mayo.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

Yes, with mayo, without mayo, with salad dressing and so on. I do recall those moments. These dispatch boxes still exist but, sadly, the minister for resources—who obviously drifts in and out of the political Alzheimer’s club—fails to recall the strength of the advocacy of the Labor Party against the GST at that time. Now they are taking the GST off the states.

The reason we gave the GST to the states was that the states had growth areas of expenditure—granted, it is the case that health is an area of growth. Having worked in state government, one of the challenges for the states is that their revenue does not grow at the same speed as their necessary expenditure on health, education and so on. But, this is the point that Colin Barnett is making: if the federal government is going to provide assistance to the states in this area of significant growth—health expenditure—then the federal government should do it out of its own sources of revenue and not out of the revenue that is allocated to the states. I fully accept the concern of Western Australia in that regard, particularly given—whether it right or wrong—that Western Australia has a current concern about the Grants Commission formula.

Deputy Speaker, as someone who is familiar with this, you will appreciate that I have to move the following second reading 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:

             (a)    there has been laid on the table of the House a copy of an agreement reached between the Commonwealth and each of the states and territories about GST handback in relation to the measures in this bill;

             (b)    each of the states and territories has signed that agreement; and

             (c)    given that the state opposition parties in New South Wales and Victoria have signalled that they do not support the current agreement, the people of those states have voted in their upcoming state elections”.

This is a very important point. The government are asking us to vote on a bill that will be immediately undermined should there be a change of government in Victoria on Saturday or in New South Wales in late March next year. Therefore, now is the time to put in place a framework that ensures that not only does the government deliver on all the preconditions for this bill upfront but also the government does not go down the path of trying to legislate for something that will not be able to be delivered.

I make another key point. The GST was introduced to try and reduce the serious vertical fiscal imbalance in Australia by providing a large and growing revenue stream to the states. This is a very important point: the coalition are firmly of the view that governments should be responsible for raising the revenue that they choose to spend—this is a key principle. It is easy to spend other people’s money. It is hard to spend the money that requires political pain to raise it. That is why exacerbating vertical fiscal imbalance in Australia with this bill is a bad decision.

Even though the Commonwealth government collects the GST on behalf of the states, all the revenue goes to the states. Therefore, the states should be in the business of determining exactly where that money goes rather than having a fixed formula where only a part of the GST goes to the states. Most significantly, the states were the ones at the end of day that supported the GST through the Senate. I remember the impact on negotiations with the Democrats to get the GST through the Senate—as my colleague the member for Casey, who at that time was working for the Treasurer, will recall. It was significant for the Democrats to get their support that the revenue was going to the states.

Not all the states abolished all the taxes that were part of the GST deal. What a surprise that the New South Wales Labor government did not keep a deal! The only deals they keep are in relation to jobs for their own people, but they do not keep a deal between states. To be fair to old shoebox over the table, the minister for resources, he knows as I know that Kristina Keneally rejected the national approach to occupational health and safety and so there is a broken deal there. I think the minister for resources would be very keen for New South Wales to keep its commitments.

Martin Ferguson (Batman, Australian Labor Party, Minister for Resources and Energy) Share this | Link to this | Hansard source

Have you run out of steam? You have morning tea on your mind.

Joe Hockey (North Sydney, Liberal Party, Shadow Treasurer) Share this | Link to this | Hansard source

No, I am just wondering. I am curious. I would say to the minister for resources: if you want to keep your deals then the key aspect of that for this bill is that the states continue to receive the revenue out of the GST rather than having it shanghaied by the federal government.

In conclusion, the opposition in both Victoria and New South Wales have expressed serious concerns about this agreement and there are still enormous uncertainties about the terms of this agreement. As well, this is a government that is more and more addicted to spending and looks all the time for new revenue-raising sources. Look no further than today. Yesterday the Assistant Treasurer said that he was going to investigate applying the GST to online purchases and then he scurried out onto ABC TV today and desperately tried to recover the situation by saying, ‘We’re not going to place a tax on online purchases.’ That is the way the government’s tax policy is framed. It cannot hold a policy on tax from midnight to dawn, let alone hold a policy on tax from budget time to election time, like the mining tax, or hold a policy on tax for six months in relation to carbon emissions.

This is a confused government. It does not know what it stands for and therefore is incapable of delivering policy that people believe in. So when it comes to this initiative on health, with a lack of detail in the bill and a lack of certainty in relation to tens of billions of dollars, the coalition will oppose this bill because it is bad policy and we would ask the parliament to support our second reading amendment, which defers any further consideration of the bill until such time as additional information is provided by the government.

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

Is the amendment seconded?

Tony Smith (Casey, Liberal Party, Deputy Chairman , Coalition Policy Development Committee) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Sid Sidebottom (Braddon, Australian Labor Party) Share this | Link to this | Hansard source

If you listened to the previous speaker, the member for North Sydney, you would not know what this debate was about but you would know what the opposition are about because, apart from the blowhard performance, which he traditionally puts on and has replicated before this, he talked obstruction, deferral and delay over and over again. Every comment made about legislation in this place by those opposite is for obstruction, deferral and delay. They are Her Majesty’s opposition and it is their role to avail themselves of and critically appraise legislation, but that is not what I heard from the shadow Treasurer in dealing with this financial bill. All I heard was waffle, waffle, waffle and no detailed discussion of the bill.

Australia’s health system has suffered from inadequate funding arrangements and unclear accountability for too long. Everybody in Australia knows this. We have many good things in our health system and we have terrific health providers, but funding has been inadequate and/or inefficiently accounted for and used. The Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010 is about trying to fix this. The new funding arrangements for Australia’s health and hospitals system—for the record, because you did not hear it from the opposition Treasury spokesperson—will ensure for the first time that federal governments properly fund Australia’s public hospitals, reversing the Commonwealth’s declining share of hospital funding, which occurred in particular under the regime of John Howard and now opposition leader Tony Abbott’s time as health minister. Indeed, the decline has gone from a 45 per cent federal government contribution to 38 per cent. This legislation is intended to fix that.

Secondly, the bill will ensure that for the first time the Commonwealth will fund hospitals for each service they provide rather than through block grants—that is, meeting increases in demand and helping to take pressure of hospital waiting lists. The third intention of the bill is to allow the Commonwealth, as the dominant funder, to introduce new national standards for public hospital services, ensuring all patients receive timely and high-quality services. Fourthly, it will drive improvements in primary care and prevention, because the Commonwealth, as the dominant funder of the hospital system, will have an incentive to provide better primary care and prevention services to take pressure off our hospital system.

As I mentioned earlier, the Commonwealth’s share of funding for hospital services has dropped from 45 per cent to 38 per cent, so the legislation represents the first time that we will be guaranteeing a fixed share of hospital funding into the future. That is the historic element of this legislation not discussed by those opposite, merely obstructed.

It is also important to note that this legislation builds upon significant investments in the health system initiated by this government. For instance there was a 50 per cent increase in hospital funding negotiated at the end of 2008, when we came into government, and there is the $7.4 billion health reform package which sits on top of that record investment in hospital services. This includes the delivery of 1,300 more hospital beds; training for more than 5,500 GPs over the next decade; more nurses, more practice nurses and hundreds of extra specialists going to rural and regional areas; expanding primary care facilities with small infrastructure grants for more than 400 GP clinics and an additional 28 new GP clinics across the country; and our world-leading preventative health measures such as the introduction of plain packaging for tobacco, which is aimed at reducing smoking levels, to take pressure off our hospitals over the longer term. That is at the essence of this legislation.

Under the agreement proposed by this legislation 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. That is at the core of this financial arrangement. In turn, the efficient pricing arrangements will mean that Australia will get value for money from our health dollars to deliver services as effectively and efficiently as possible. We are asking those opposite to support this historic legislation.

The member for North Sydney has already indicated a number of amendments to this legislation, merely delaying this legislation into the future. If they have any concern for health in this country and understand the economics and the projected growth of health services, they will know that what we are proposing is the most sensible, efficient, effective and transparent method to deal with increasing costs—that is, for the Commonwealth to take on that responsibility. Taking on that responsibility would give us the ability, through our funding arrangements, to leverage better standards of services provided by state and private practitioners. That is at the heart of this legislation.

There are many other aspects of health reform which will be affected by this legislation. When I look at our record of only three years on health, I think it is remarkable. There is a lot more to do and that is why this legislation is coming in as part of a tranche of health reforms. We have increased the capacity of our health system to deal with the needs and demands placed on it, particularly with training more doctors and nurses and providing more beds. The government is investing $1.2 billion as part of our National Health and Hospitals Network—in doctors, nurses and allied health professionals. We will also be investing more than $1.6 billion for more than 1,300 new subacute beds, to reduce bottlenecks and capacity constraints in our systems. These beds will be delivered in areas like rehabilitation, palliative care and, importantly, mental health services so that people can get the care they need.

We are also investing heavily in connecting care services. I look forward to a local hospital network system developing in my state where I see essentially the need for three hospital networks reflecting the three subregional parts of my state—the north, north-west and the south. I look forward to working with the Minister for Health and Ageing and with my federal and state colleagues to bring about an efficient, effective local hospital network system in Tasmania based on the three regions. The soon to be established Medicare Locals program, which will work with local GPs and allied health and community health providers, will drive local integration and coordination of primary health services and improved access to care. On top of this, we are investing $466 million to establish a commonsense, integrated health record system by establishing personally controlled electronic health records, hopefully not only making it more efficient and effective but also reducing mistakes and duplication, ensuring that, with patients’ consent, doctors have information when they need it—a very important reform.

We also want to make it easier for people to have better access to services. That is why we are establishing a national after-hours GP and primary care service. Anybody calling their GP out of hours will be referred to a nurse or a GP on the phone and, if necessary, will then referred to local after-hours GP services coordinated by the Medical Locals program—that is, the Medicare area networks set up to assist people to integrate GP, primary and preventative services in our regions.

The government will also invest $355 million in more GP superclinics and expanded GP clinics in about 450 locations across Australia. I have two GP superclinics in my region of Braddon in North-West Tasmania, one of which is completed and the other is well on the way to completion. This has added greater capacity in my region for people to access integrated healthcare services. I cannot think of any more commonsense approach than to connect the health providers that provide health services in my region to each other. It will lead to better health care and better management of health services for individuals. That is part and parcel of our policy. That has been opposed by those opposite but I should not be surprised, because they have opposed everything of note that we have put up for health services and communications for this country.

Our government will invest $750 million so that emergency department patients will have, hopefully, the guarantee that they will be treated, admitted or referred within four hours where clinically appropriate. That is a very tall order and to get that consistently across the nation will be difficult, but we are investing in that and we are seeking to make that happen. The government will also invest an additional $800 million for elective surgery to help back a target of 95 per cent of elective surgeries being delivered within the clinically recommended time, with a guarantee that patients facing excessive waits should have their elective surgery fast-tracked. Again, this is a difficult target and one which we must strive to achieve.

This government is determined to tackle preventative health. We have tried to do this by taking world-leading action to combat tobacco, which contributes to the death of 15,000 Australians a year. The government will introduce plain packaging for all tobacco products—a world first, again—in addition to raising tobacco excise, which we hope will 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 our major disease burdens.

On sustainability, this government is seeking through this legislation to be the dominant funder of Australia’s public hospitals, funding 60 per cent of hospital activity and capital, plus 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 buckpassing and cost shifting. This legislation will play a historic part in achieving these aims.

Don Randall (Canning, Liberal Party, Shadow Parliamentary Secretary for Local Government) Share this | Link to this | Hansard source

I am pleased to speak today on the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. Let us understand why we are here today. We are here because before the 2007 election the former Prime Minister Kevin Rudd made a threat that if the hospitals and health networks of the states did not get their act together he was going to take them over, 100 per cent. In fact the threat was made a number of times. He threatened that the Commonwealth would use its powers to take over state health jurisdictions. What we have here today is a watered-down version of that. We have a watered-down version because of the fact that the former Prime Minister no longer holds the same position and his deputy then, who I suspect supported everything he said, has now come to the conclusion that this is the fall-back position.

Today, on what I understand is the third anniversary of the election of the Rudd government, we are no better off. If the Australian people were to ask themselves whether they were better off or worse off after three years of Labor, they would have to say they were worse off—substantially worse off.

Sid Sidebottom (Braddon, Australian Labor Party) Share this | Link to this | Hansard source

Go to Greece, Portugal, Ireland, Spain.

Don Randall (Canning, Liberal Party, Shadow Parliamentary Secretary for Local Government) Share this | Link to this | Hansard source

I hear the interjection from the member for Braddon, and he would say these sorts of things because Tasmania is the biggest beneficiary of this proposal. Of course, Tasmania needs to be because it is a leech on the teat of the Australian economy, supported by states like Western Australia. We are sick and tired of propping up mendicant states like Tasmania and the largesse that goes to people like the member for Braddon who has just bragged about having two superclinics in his electorate when other electorates around Australia are in need of all the support they can get. My electorate, for example, does not have a GP superclinic and there is not one earmarked. And we do not want one. I have had the doctors in my area come to me and say, ‘Please don’t allow the Commonwealth to waste money by putting a GP superclinic in our area.’ We have got a very good set of hospital services and GP clinics funded by GPs themselves, and they do not want to be imposed on or competed against by a taxpayer-funded GP superclinic in the electorate of Canning, thank you very much.

We oppose this bill—we have to oppose the bill—because as it is an unfair bill. For years Labor opposed the GST. They went to three elections, starting from Paul Keating, opposing the GST. They did not want a GST. You will remember Kim Beazley, a former Western Australian colleague now enjoying his sinecure in the United States, going on about roll-back. If they got in they were going to roll the GST back. They thought it was terrible. The Rudd-Gillard governments have since been elected twice. I use the term ‘elected’, but we actually have more seats on this side. I remind the House on the third anniversary of the Labor government that it was ‘selected’ by the Independents after the last election because it failed to get enough seats. After three years the government has had an opportunity to roll back the GST and it has not.

In this bill the government is now saying, ‘The states have got the GST’—because we know that every cent raised by the GST goes back to the states as a growth tax—‘and we want to help ourselves to some of that.’ I say to the states: beware. Beware of the Commonwealth dipping its hand in your little back pocket and taking your money away from you because they will continue to erode that growth tax that was given to you as a reform of Commonwealth-state financial relationships. Remember the great Paul Keating saying:

Never get between a Premier and a bucket of money.

That is why we had to have a sustainable way of financing the states. Under the GST arrangements, every cent collected by the GST goes back to the states. This bill is opposed by many people. John Brumby put up a false front for a while, trying to ratchet up a better deal before he agreed to it. Mind you, no-one has signed any agreement yet. That was confirmed by the Prime Minister as reported in an article in, dare I say, the Australian on 19 November. The article by Sue Dunlevy and Matthew Franklin, referring to the government, says:

… it confirmed yesterday it had not secured a single signature agreeing to change the state, territory and federal tax arrangements.

Not one signature. The article goes on to say:

Six of the eight state and territory governments have “agreed in principle” to the reforms but Western Australia and Tasmania are holding out.

I say to you that Western Australia will not agree to sign on, not at all. Being a Western Australian member, I have been present on many occasions when Colin Barnett has confirmed and reconfirmed this. We will not sign on to this and the WA Minister for Health, Kim Hames—he is the member for Dawesville, which is in my electorate, and he is somebody I have a lot to do with—continues to reiterate that we will not sign on. Yes, we will voluntarily hand over 30 per cent of our GST, but we are not going to formally give away the opportunity for growth in this tax revenue, because, as I will point out shortly, we are essentially being dudded under the GST arrangements in any case. This bill is an attempt by the Commonwealth to claw back some revenue from the states and it plans to do that progressively over the years.

The tables in the Mid-Year Economic and Fiscal Outlook, MYEFO, are quite interesting. When we were first told about this, the contribution from the states was going to be 30 per cent. Now we find out that there is going to be quite a bit of variation between states. New South Wales is pretty much on track for 30 per cent. Their total GST revenue in 2010-11 is going to be about $14½ billion. In 2011-12, it will be $15.8 billion. Out of that, they will pay $4,774 million. The MYEFO table goes through each state. Victoria, for example, would be $2.8 billion in 2011-12, which is 25 per cent of its GST; Queensland is $3.54 billion, which is 40 per cent; South Australia is $1.229 billion, or 26 per cent; Tasmania, 20 per cent—the member for Braddon should hang his head in shame; they are barely contributing—the ACT, 50 per cent; and the Northern Territory, only 14 per cent due to its status as a territory et cetera.

But all of those figures grow over time. By the time you get to 2013-14, it goes up to 31 per cent for New South Wales; Victoria stays the same; Queensland goes from 40 to 44 per cent; South Australia goes from 26 to 27; Tasmania from 20 to 21—barely a contribution, as I said—and the contribution from the territories also grows, as I indicated. Interestingly, under Western Australia the figure is zero, because we are not contributing—we are not going to sign on. We are happy, as I said, to rebate the GST, but we are not going to get caught up in this growth grab from Canberra, this attempt by them to continue to dip their hands in our pockets. The Premier made his position very clear, as reported in an article by Paul Kelly in the Australian on 30 October. In that article, Colin Barnett is reported as saying:

… that he would never surrender a third of Western Australia’s entitled GST revenue to the commonwealth, under the terms of the federal government’s national health agreement.

Is it any wonder? Western Australia has a very bad hand dealt to it by the Commonwealth Grants Commission through the GST arrangements. We get 68c in every GST dollar returned to us—only 68c. Victoria, I understand, gets back roughly 89c in the dollar, Queensland 91c and New South Wales 93c. It is unfair and we are continually being ratcheted back. The article goes on to report Colin Barnett saying:

This situation has become simply unacceptable to me … It is unacceptable to all Western Australians. And the public understands this. Yet projections over the next three years are that this return will fall to 54c and keep heading south.

So why would we sign on to something as ridiculous as this when, as he said, the Minister for Health and Ageing, Ms Roxon, has been threatening him about not handing over other money? She told the Premier that he would pay the price, but he told her that he was unwilling to pay the price because the amount he was forfeiting—$356 million over four years, or $90 million a year—was, he said, only ‘enough to run our health system for five days’. So of course we do not mind going it alone, because we are not going to be led by the nose.

The most disappointing thing about all of this is that, as I said earlier, this legislation is in this House before everyone has signed on. Worse than that is that there is an election in Victoria this weekend and the opposition have said that, if elected to government, they will not sign onto this. In New South Wales, similarly, the opposition have said that they want to have a further look at it. So we are now getting ahead of the game, imposing the will of the Commonwealth on people in states where there is a huge chance—certainly in New South Wales—that the state government may change.

When I was doorknocking during the election campaign, one of the main things, apart from the issue of the further attack on Western Australian through the mining tax, people were saying to me was: ‘Whatever you are doing, make sure Colin Barnett holds his ground on this GST. We do not want WA people handing over this money to the Commonwealth.’ How can a bureaucracy from this far away, over 3½ thousand kilometres, administer, or even attempt to administer, health arrangements in Western Australia? We are out of sight, out of mind. Somebody, in fact, today referred to Western Australia as the other side of the black stump. You might say that, but do not forget the fact that we contribute a massive and disproportionate amount to Commonwealth revenues. We might be out of sight and out of mind, but you certainly want us to continue doing what we are doing.

In the last few moments, I just want to mention the fact that, as the member for North Sydney said, this is essentially saying to the Commonwealth government, Prime Minister Gillard and Minister Roxon: ‘Here’s a blank cheque from the states. We’ll sign on and you can grow the amount that you take away from us.’ We are not going to be doing that sort of thing. The member for Denison went on about GP superclinics, and I have addressed the fact that we do not want one in Canning because our doctors are running their GP services very well. He talked about after-hours GP services. We have had after-hours GP services operating out of the Armadale hospital for years, funded to some degree by the Commonwealth. So this is nothing new. We are doing very well, if you don’t mind, so we certainly do not want the Commonwealth imposing themselves on us.

We are actually quite leading-edge in the way that we run our health system in Western Australia. We were the first state to introduce the four-hour waiting program in emergency departments, based on the British model. If you are in an emergency department of a hospital, rather than being parked on an emergency bed somewhere in the corridor, you have to be admitted to a bed. All the ramping that goes on regularly in hospitals is another issue that has to be addressed. So the four-hour waiting rule has been introduced in Western Australia and—surprise, surprise—I see the Commonwealth and other states starting to say, ‘It wouldn’t be a bad idea if we could do this throughout the rest of Australia because it sounds as if it’s the right thing to do.’ We did not need to pinch anyone’s GST to do that in Western Australia; we are quite happy to fund it ourselves, if you don’t mind.

But what we do object to in this bill, which is just another attack on Western Australia, is the money it wants to leach off us again. As I said, thank goodness for the geniuses who thought up the mining tax before the last election. That is why you only have three seats out of 15 in Western Australia, so keep it coming. I will be happy to make sure you have that policy leading up to any future election, whether it is in three years or before that, because Australians have a deep affection for the mining industry in this country. It is a bit like the deep affection we had many years ago for riding on the sheep’s back. Now we are riding on the mining industry, and any tax or any attempt to slaughter it for short-term gain is not held well by Australian people. They want it to continue to grow and make us prosperous, because the prosperity of this country comes from our resources, and this is a time when the rest of the world wants to soak up many of our resources. So we oppose this bill because it is an opportunity for a government that cannot stop its reckless spending and we will not sign on to it.

Chris Hayes (Fowler, Australian Labor Party) Share this | Link to this | Hansard source

There is one thing that can be said about the electorate’s attitude to health and hospitals, and that is that it does need to be improved. Regardless of the position of the member for Canning, whom I have a lot of respect for in this House, I have to say he gilded the lily when he tried to advance the argument that everything is well in health and hospitals in his own state. Perhaps he should start looking at the statistics.

Since the Labor government announced its plans for a health and hospital network, I have had the opportunity to be out there campaigning, doing what most local members do, such as holding street meetings. One of the hottest topics at street meetings, when people come up to mobile offices, is health and hospitals. It is not surprising. I live in an area with plenty of families. If you ask any parent what is important to them, it is the health system. My constituents want me to know that they are not content with the current arrangements. Going to emergency services in the local hospital at either Liverpool or Fairfield to find you are waiting for hours, not having after-hours healthcare facilities when they need it—these are the things that mums and dads talk about. And it is not just me. Let’s face it: everyone who goes out and consults with their constituents knows that that is the truth.

The fact is that people are generally happy that, for the first time, a government has come out and said: ‘We are going to make a major investment in the health and hospital system. We are going to invest in training more doctors.’ You know what the record of those opposite was when it came to doctor training. They actually slashed it in half when they had a chance to do something about it. We are doing something about disproportionately advancing the number of trained nurses in this country and ensuring that our local experts have a greater say in the way hospitals are run. This is not about setting up some situation of quasi-local boards and all the rest of it; this is about making sure that our medical professionals and practitioners in the field have a say in the way medical resources are distributed within their sphere of influence.

I would have thought that was something the other side would want to take some pride in as well. Do not forget that it was not all that long ago that the current Leader of the Opposition was the health minister. He actually championed this position in this place. He went out on a limb to say that the federal government should take over hospital funding. They wanted greater control of that. It is a pity he could not control that in his party room, but that is not surprising, I suppose. The thing is that this was an initiative that Tony Abbott at one stage wanted to take credit for within his own party. I have to say, they have done many spellbinding backflips over on that side of the House, but this is really one that must be looked at in the cold light of day. People just cannot come into this place, have a position and then completely turn 180 degrees from it—unless you want to believe that we are all a bunch of politicians and it is all about garnering a vote. I would not want to say that that is the spirit of everyone in this place. I know winning elections is important, but maybe following your beliefs should trump that notion.

The Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010 implements the financial details needed to ensure that the government can get on with the necessary business of improving health and delivering the government’s health reform program. I will go into some detail about that, but firstly I would like to take a little bit of time to talk about something that is pretty special in my electorate at the moment because the government has just called for tenders for the new $15 million GP superclinic at Liverpool. Liverpool Hospital is certainly a fantastic resource that we have. It is currently being expanded at a rate of knots. I have one of my sons working on that, so I get to see a fair bit and hear about the construction on that site. When completed it will be the biggest hospital in the Southern Hemisphere. But—and wouldn’t you know it?—one of the bottlenecks at that hospital is the issue of access to its emergency clinics. One of the reasons why I personally lobbied for a GP superclinic in this area, notwithstanding the fact that we have this huge hospital being extended, is to do with the fact that in the south-west of Sydney we need to take the pressure off hospitals, such as Liverpool and Fairfield, and this is one way of doing it.

According to the latest statistics from the Primary Health Care Research and Information Service, the Liverpool and Fairfield area has 198 GP practices. It is estimated there are about 400 doctors serving a population of 397,000 people, so that is about one doctor for 980 people. Those surgeries do not operate all hours and, as a consequence, when kids are ill their mums and dads front up with them at either of the two hospitals, Liverpool and Fairfield. With the population of south-west Sydney due to grow by 100 per cent over the next 30 years, it is absolutely time that we made a significant investment in health care, just as we need to do more about training and maintaining doctors in the area. But we must provide services and one of those which I think will be greatly valued in my area is the establishment of the GP superclinic. Without the government’s commitment to it—and it is a pretty ambitious project and is certainly a very well needed piece of infrastructure—we would not be able to have more flexible and deliverable health services for the people of Fowler.

A colleague out there is Dr Andrew McDonald, the state member for Macquarie Fields and the Parliamentary Secretary Assisting the Minister for Health. He has rightly flagged the potential of this superclinic to be used for the training of medical students, particularly those from the University of Western Sydney. Andrew should know about that as, apart from being a state member of parliament, he is a paediatrician. This bloke goes out and works pro bono one day a week, in many of the housing commission suburbs of his electorate, as a doctor. So I actually rate highly what he does and, apart from that, he is also an associate professor of medicine at the medical school of the UWS. I take note when a person like that comes out and speaks. He is not just another politician; he is a person who genuinely cares for his community, and you see that in the way he handles not only his portfolio but his role as a doctor, being someone who cares about the community generally. So that is his view of what the superclinic is capable of delivering in the south-west of Sydney. The superclinic will substantially relieve the patient load in one of our state’s biggest emergency departments, that of Liverpool Hospital. I am happy to report that as the tenders have been called a number of local doctors have been looking at arrangements and consortiums and at how they are going to tender, so we are looking now at advancing that position in the short term.

Another commitment that we have made is to invest more than $51 million to improve health services in my electorate, including $46.9 million to build the Ingham Health Research Institute at Liverpool. Attached to the Liverpool Hospital, this major research centre is called after the Ingham family, our local poultry group and probably the owner of many racehorses. This group was behind the foundation of this research institute—one of the primary research institutes for cancer therapies in the country. I am happy that is being developed to operate in conjunction with Liverpool Hospital. In addition to those investments, we have also committed money to ensure that elective surgery waiting lists can be shortened and to improve after-hours GP services. It is not simply about the GP superclinic; it is also about being able to have doctors look at extending their hours and also putting on casual doctor services to ensure that the needs of my area are being adequately taken care of in that respect. This is all a substantial investment in local health care and it sends a very strong message that this government is not prepared to leave the health system in a business-as-usual situation.

As a parent, I hope that my kids and, happily, their children will have access to world-class healthcare services not on the books but when they need it. That is what we are striving to deliver. I am sure the vast majority of parents would also have the same view. I strongly urge members on the other side of the House to put politics aside and support this bill today. So far I have heard members opposite wanting to criticise the Gillard government’s national health and hospitals plan, and I wonder what fuels that criticism. I mentioned a little earlier the Leader of the Opposition’s foray into this area, particularly when he was the health minister, so those opposite do have form in looking positively at things like this to deliver services to a community. So I am urging them not to turn their back on that. If it was good enough for the Leader of the Opposition, when he was the health minister, to try to champion an argument within his own party room that this was an area in which the federal government should become inextricably involved, then you would have to ask what, other than party politics, is fuelling this criticism that they have? I think that is what it really boils down to. This is rank opportunism and politics.

We are here for one reason, regardless of which side of the House we get to sit. We are here to serve the community. We are here to actually look at what is good for communities here and now or, perhaps, for the next election and we are here to give long-term legacy to communities that we have the honour to represent. I would ask members opposite to start thinking about that as opposed to looking at cheap and rank political positioning when it comes to something as significant as this bill.

In a recent survey that was conducted by New South Wales Health in Liverpool, Liverpool Hospital had one of the lowest patient ratings in respect of people who attended emergency service departments. Regrettably the figures showed that eight per cent of patients rated their experiences as poor and 18 per cent rated them as fair. At Fairfield Hospital, which is another service in my electorate, five per cent of patients rated their experiences at emergency service departments as poor, with 12 per cent rating them as fair.

I do not mention these figures to embarrass or offend the hardworking staff at either of these hospitals. The staff do a fantastic job with the resources they have and with the constraints they work under. However, I do raise them as further proof that the National Health and Hospitals Network is needed. This is not to point the finger at the New South Wales government-run system, as any other government would probably do the same. I want to make the point and keep reiterating it that, when it comes to a matter as important as health and hospitals, we cannot be content with the business-as-usual approach.

This country’s health system is struggling to keep up with an ever-increasing growth in demand, which is fuelled by a growing and ageing population. We all know that. That is why we need to reform our funding arrangements for health care in this country. That is what this bill entails. This bill will reduce pressure on increasing healthcare costs and will help the budgets of our states and territories into the future. Through this bill the government will become the major funder of health and hospital systems in Australia. It will take full funding and policy responsibility for primary health and aged care. It will be responsible for taking health and hospitals into the 21st century.

We are in a situation where we are seeing an extraordinary number of people with disturbing health problems. In my electorate 22,000 people over the age of 15 have been diagnosed with obesity, 11,000 people have type 2 diabetes, 26,000 people suffer from high cholesterol, and 30,000 people suffer from asthma. It is absolutely overwhelming and we must take steps now to relieve that pressure on our health and hospital system. I commend the bill to the House. (Time expired)

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

I rise to support the shadow Treasurer’s amendments. As we know the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010 strips unspecified amounts of GST funding from the states to be retained by the Commonwealth simply so that the Labor government can make the false claim that it will be the dominant funder of health spending. And I suspect that the other reason is to make a grab for future state wealth through their individual increased GST revenues—their growth source.

This measure simply re-badges $56.1 billion of GST revenue—perhaps, because there are several different figures out about that now—over the current forward estimates, although this figure, as I said, may not necessarily be accurate at all. In the MYEFO released a week after the Treasurer’s second reading speech on this bill, it was said to be $44.5 billion. And recently we have heard sums of perhaps $50 billion. This demonstrates the problems with this particular bill as there are no definites.

Perhaps the Treasurer of Australia could clarify this for the parliament. We should actually not be voting on legislation that does not specify the exact amount of GST that the Labor government will retain by this measure nor should we vote on legislation which is in breach of the GST agreement between the states and territories. It is an abuse of parliamentary process that we in this House are expected to vote on this before all state and territory governments have signed agreements with the Commonwealth about what amount to hand over. This is an agreement to hand over a significant but, as yet, unknown share of their GST to the Labor government.

It is an attack on our Federation and an undermining of the financial independence of the states. It is an embarrassment to the parliament that passes it and an abrogation of duty by state governments that have agreed to it. I only hope that people in these states hold their individual governments to account for their decision to sign the health agreement. This is not a bill about health reform. It is, as I said, all about federal-state financial relations and federal financial control.

Being a proud Western Australian, I acknowledge the strength and foresight of Premier Colin Barnett in not agreeing to this latest Labor mess. He is the only state Premier in Australia not to abrogate the rights of his state or, indeed, his people. Colin Barnett and our health minister Kim Haines both know that, if this was genuine health reform, the Prime Minister and Treasurer would have agreed to WA’s offer to commit an equivalent amount of WA revenue into health reform. The Western Australian state government funds over 60 per cent of the operating costs of our public hospital system right now. It is the dominant funding source.

The Labor government’s proposal to become the major funder by simply increasing the Commonwealth funding from 35 to 60 per cent is, by sleight of hand, using the state’s own GST revenue to do so. They are taking at least one-third—at least, we do not know yet—of these funds, re-badging it as federal funding and then making the claim that the 60 per cent is all Commonwealth funding. Clearly the Labor government is proposing that any additional funding needed for the health system will come directly from the states through those increased GST revenues. And once again WA, if it agreed, would be the loser and would continue to prop up other states. Our GST share is already down to 68c while New South Wales is receiving 95c under the Grants Commission formula.

So how would Western Australia keep funding our remaining 40 per cent share of public hospital costs when the growing source and base revenue, at least 30 per cent of the GST, would be in the control of the federal government? We would still have to fund our other 40 per cent share. This bill provides no clarity or certainty on exactly how much GST revenue the states will actually have stripped away by the Commonwealth. This is an open-ended deal in which the Treasurer has loosely said that the states and territories will dedicate around one-third of GST revenue. ‘Around one-third of GST’—that is bound to give the states a great sense of confidence, as it obviously did for Colin Barnett. After all, to a federal Labor government addicted to spending, what is a few billion dollars here or there, as we have seen? Let’s face it, of all the billions of dollars splashed around, wasted or rorted in stimulus packages, not one cent went to health.

I cannot believe that any state premier or government would have signed even an in-principle agreement without knowing exactly what amount of GST is to be taken from their state. A government that has been unable to give away free pink batts and unable to run a green loans scheme, Fuelwatch, GroceryWatch or the BER program is saying: ‘Trust us. Sign up now and we’ll let you know later what it is going to cost you.’ Added to the open-ended nature of this is the fact that, under proposed section 6A, the minister will determine the amount of GST revenue to be paid, and here lies the danger and the very real problem for the states and territories. That is why they should not sign even an in-principle agreement. This decision of the minister cannot be disallowed by the parliament. Simply put: this will be the only opportunity for the parliament to pass judgment on these arrangements. As with the Home Insulation Program and the NBN, there will be no scrutiny—just trust Labor to get it right. I will say again for the states and territories that have already signed the in-principle agreements: the decision of the minister cannot be disallowed by the parliament. I just wonder whether those premiers are actually aware of that. Are the people in the states aware of it? I ask: have you discharged your responsibility to your states by signing an open-ended agreement? The federal minister will determine the amount of GST revenue that your states are going to lose. It is an open-ended deal.

Given the constant repeated waste and mismanagement of taxpayers’ funds and the government’s addiction to spending, having an open-ended deal is like a red flag to a bull to a debt and deficit government, particularly one that proposed to fix hospitals by 2009. Figures taken from MYEFO show percentages from 14 to 50 per cent—and perhaps 60 per cent, we have heard—of GST revenues. That is what will be removed by the Commonwealth. The states that have signed have clearly signed up blindly or were oblivious, or perhaps not caring, of the amount of GST that will be stripped from their revenue streams and future growth or, worse, unwilling to stand up for their state’s rights. I wonder how the signatory states are feeling right now when they look at this bill and I wonder whether they are having second thoughts. We know that ACT Treasurer Katy Gallagher’s office has confirmed that the territory would have to hand back 48 to 50 per cent of GST, and Queensland’s Minister for Health and the shadow health minister believe that their hand-back will be between 39 and 42 per cent of GST in 2012-13.

It is absolutely extraordinary and sets a dangerous precedent that states would sign up to this when the explanatory memorandum states that the funding commitments are yet to be finalised. No wonder Colin Barnett said no. This is an open-ended deal and Premier Barnett, in strongly representing Western Australia’s interests, has said that he believes that the handover of any part of the GST will eventually lead to the Commonwealth having 100 per cent control of the growth revenue stream of the GST, which affects the ongoing sustainability of states. Given the growth and development in Western Australia, this would be literally like letting the fox in with the chickens. I can imagine Treasurer Wayne Swan in charge of Western Australia’s revenue. It does not bear thinking about. We only have to look at the Labor government’s proposed mining tax, which is basically a tax on Western Australia, and the carbon tax on top. Add the GST grab and Western Australia will simply be a mendicant state, begging at federal Labor’s feet—something I know this government would very much like to achieve and is, by way of this agreement, trying to achieve.

I will be very interested to see how the government progresses with this health bill, given those changes to GST arrangements require unanimous agreement by the Commonwealth and every state and territory noted in the Treasury incoming government brief. This is the same advice that told the Treasurer to resolve this issue before the reintroduction of this legislation, but the Treasurer clearly has not listened. He has not resolved this issue and has not achieved unanimous agreement, but he has reintroduced the legislation. I also understand that not one single state or territory has actually signed over its share of GST revenue to the Commonwealth. Again it is clear that the Treasurer should not have progressed with this legislation until he had unanimous, signed agreements from all states and territories. As well as the people of New South Wales and Victoria having had an opportunity to pass judgement through their elections on Labor state governments who have agreed in-principle to abrogate their state rights with this deal, we have moved a second reading amendment to this effect.

In Western Australia we owe much to our historic strong leaders. In 1897, over 107 years ago, WA Premier Sir John Forrest, after whom my seat is named, was one of the greatest leaders of our state. He was a driving force in amending the legislation that eventually became the Australian Constitution. He did so to protect our state’s rights. He was concerned that the state of Western Australia would effectively become mendicant to the Commonwealth of Australia. He would have been equally as concerned today with this bill. The problem then was the same as this: one of finance. There is no doubt that whoever holds the purse strings dictates what can or will be done. John Forrest fought hard to negotiate fair funding arrangements for his state and I will continue to do so, as will members on this side of the House.

The Labor Party has clearly agreed to strip GST revenue from the states and territories. On 31 October 2010, the Western Australian Labor leader Eric Ripper—not everybody agrees with this—was reported as calling on the federal government to urgently address the state’s share of the GST and rejected the Gillard grab for our state’s GST. Mr Ripper said:

There’s an issue here that needs to be fixed and the Gillard government has got to look at addressing this GST share issue for WA.

The report stated:

WA’s share of the GST is one of the reasons Mr Ripper is opposed to the state signing up to a national health reform agreement, which would see it hand over 30 per cent of its remaining GST revenue.

Mr Ripper further said:

We can’t accept the GST claw back, which in WA could even be as much as 60 per cent of our remaining GST which is already far too small and unfair.

So in Western Australia even the local Labor Party opposes this deal. I hope the remaining Labor members in this chamber from WA take note of this and support their state leader by joining with us in our move. In the state of Western Australia, the people and our political parties demand it. But in spite of the Labor government taking over the states’ GST to fund health and hospitals, they claim to be the majority funder by only using the states’ own GST for the purpose.

Even though this bill does not provide details of the new health arrangements, we do know that it will be a massive new, expensive, ever expanding, gross and likely incompetent bureaucratic beast under this Labor government and there has been a failure to deal with practical issues. We are yet to see the details and this bill fails to provide any of the details. What we do know, however, is that the government is committed to centralising planning and control, and that is a concern. There are very many valid reasons against it. In March the health minister admitted that this health plan may end up increasing taxes and costing jobs in the health sector. We do know that there will be four new health bureaucracies created at a federal level and one in every state on top of an undecided number of local hospital networks and primary healthcare organisations. So, unfortunately, I can see where the states’ GST will be going. As I said, there are many valid reasons not to support the legislation in this form. If this is put to a vote now, this is of real concern. I support the amendments put by the shadow Treasurer.

Michelle Rowland (Greenway, Australian Labor Party) Share this | Link to this | Hansard source

I am very pleased to rise and speak in support of the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. It is a subject very close to my heart. My interest in public health is a long one. Ten years ago I put my hand up to be a community representative on the then Western Sydney area health service and I learned a lot about the fundamentals of health economics. I learned about emergency department access blocks, I learned about triage and I learned about bed funding. I learned about preventive health and that sometimes the most effective spending is the spending that keeps people out of hospital, preventing them from having to actually need treatment in the first place.

The Labor Party has always been the party of health reform. We have also promoted the importance of a universal and quality healthcare system. The Curtin Labor government began funding public hospitals for the first time and it was the Chifley Labor government that introduced legislation to create a public health system, paving the way for the creation of Medibank and subsequently Medicare. The Whitlam Labor government legislated for the introduction of Medibank, a precursor to a universal public health system. And the Hawke and Keating Labor governments enshrined universality into the heart of our healthcare system by introducing Medicare. I am proud to be a member of a government that is continuing Labor’s strong tradition of health reform.

In contrast, the Liberal Party make it quite clear that they do not share this belief in the importance of universal health care, and it is evidenced by their negativity in this debate today. They have a history of repeatedly scrapping vital health programs and cutting funding for health services—a shameful tradition that would have continued if they had won the last election. The health policies of Robert Menzies simply led to uncapped fee-for-service medicine and inadequate rural medical services. The coalition constantly opposed the Whitlam government’s legislation to introduce Medibank and when they were in government from 1975 to 1983, they undermined the scheme, removing any semblance of universality.

When in government the then opposition displayed absolute contempt for our health system. Bulk-billing rates plummeted and $1 billion was cut from our public hospitals. The blame game not only continued, it became worse, to the detriment of constituents. And Australia was left with a shortage of 6,000 nurses and a queue of 650,000 people on public dental waiting lists, with 2,300 older Australians being left in hospital beds every night because of the shortage of aged care beds. Had they won the last election, they would have cut GP superclinics, which are designed to take pressure off hospital emergency departments and provide quality health care when it is needed. This would have hurt residents in my electorate of Greenway, where a $15 million GP superclinic is being built in Blacktown. I am very pleased that the tender process for this very important project has in fact commenced, and it is being widely welcomed by the people of Greenway. Indeed, the Liberal Party showed a complete and utter disregard for the healthcare needs of residents in Western Sydney. We are always the afterthought in their eyes. The local Liberal Party candidate, for example, claimed that an Abbott government would not cut the proposed Blacktown GP superclinic, completely contradicting his own party’s policy. He refused to participate in a community health forum organised by nurses at Blacktown Hospital, which I was very happy to participate in. The contrast between the Labor and conservative parties on the issue of health care could not be clearer and it is on display in this debate.

This debate also gives me the opportunity to again discuss something very close to my heart—the issue of Blacktown Hospital. For the benefit of those here, it is very useful to take into account the enormous scale of Blacktown Hospital, serving residents in Blacktown, which is the largest local government area in New South Wales and I think now the third-largest in Australia. Each year Blacktown Hospital treats more than 35,000 people in its emergency department. It has approximately 24,500 patients staying at least one night in hospital. It performs 8,000 surgical procedures, provides 214,000 outpatient services and assists with the birth of more than 3,300 babies—a rate that continues to increase as Greenway continues to be Australia’s nursery. The catchment area is absolutely enormous and, taking all that into account, it is therefore with responsiveness to the people whom I represent in this place that I am very pleased that we are having a $15 million GP superclinic built. We have the $17.6 million construction of the University of Western Sydney’s clinical school and research and education centre at Blacktown Hospital, which will train more doctors and nurses and health professionals in Western Sydney and, importantly, will train local students. Local students being trained locally means that they are more likely to stay and serve the people with whom they live. There is $4.2 million for 18 additional beds at Blacktown Hospital, which includes six new acute beds, and $854,000 for new equipment at Blacktown Hospital, including a new defibrillator, heart monitoring and breathing machines and urological equipment. Given all these things, I am very pleased that I am able to look my constituents in the eye and say that I am doing my bit to deliver for them the health services they need.

I am very pleased to support the bill before the House because I know that it will continue Labor’s proud tradition of health reform. This bill represents transformational reform, and nothing represents transformational reform more than the benefits of the National Broadband Network. I draw the attention of the House to a public document, a report commissioned by the Department of Broadband, Communications and the Digital Economy on the impact of high-speed broadband for e-health. Some very interesting and instructive items come out of this report.

The department requested this report on the financial and externality impacts of ubiquitous high-speed broadband—in other words, what the NBN precisely is—and, in particular, the impacts that would result from the increased use of things such as telemedicine for remote consultations, remote home based monitoring of chronic disease patients and the aged, and remote training of health professionals. The conclusion that this study came to was that the estimated steady-state benefits to Australia from wide-scale implementation of tele-health using ubiquitous high-speed broadband may be in the vicinity of $2 billion to $4 billion per annum. Every year those benefits will accrue to the Australian public. When you multiply that and think about how that money could be invested in hospitals, you can see that this one aspect of the NBN has benefits that clearly mean that the quality of people’s lives is going to be very directly impacted in a positive way.

I draw the attention of the House to a couple of items raised in the report. I did mention chronic disease. Over two-thirds of health expenditure in Australia is consumed by chronic disease. The report very interestingly points out that chronic conditions are ideally suited to remote monitoring. Conditions commonly covered by remote monitoring include cardiovascular disease—the Blacktown local government area has one of the highest rates of cardiovascular disease in New South Wales—diabetes, cancer, infections, skin injuries, and the list goes on.

These are benefits in terms of not only chronic disease but also, in a very real sense, social inclusion. The Australian e-Health Research Centre has pointed out that using tele-ophthalmology for diabetes prevention in remote settings is particularly well suited to delivery over high-speed broadband networks. This is significant given Australia’s Indigenous population has one of the highest rates of diabetes in the world. So when we talk about social inclusion, when we talk about bridging the gap, we can see how high-speed broadband for tele-health can directly benefit those in our society who are the most vulnerable and continue to be the most vulnerable.

This bill implements significant changes to federal financial arrangements in order to implement key aspects of the National Health and Hospitals Network agreement that was endorsed on 20 April 2010. As we have heard, the Commonwealth will take responsibility for funding the majority of Australia’s health and hospital systems. This is vital in order to stop the blame game. As I go around my constituency on a daily basis I am continually told that the blame game must stop. The blame game between the state and federal governments needs to end in order for constituents to have the highest quality health care system.

Unless we address these health funding arrangements, our health and hospital system will simply struggle to keep pace with our growing and ageing population. The Intergenerational Report released in January of this year shows that the proportion of our population aged over 65 is forecast to increase from 14 per cent this year to 23 per cent by 2050, and 5.1 per cent of the population is projected to be over the age of 85 by 2050. This will lead to an increased number of people requiring services and treatment to help with dementia, mobility, hearing, eyesight and general frailty. Meeting these needs will require not only additional services but also more expenditure in the area of health. The report also highlights that the ageing population and population growth itself will account for approximately 40 per cent of the expected increase.

State and territory governments cannot deny reality. Their revenue levels do not grow as fast as hospital costs. State government budgets will simply be crippled by the weight of rising health care costs and the quality of our system will suffer as a result. Indeed, some commentators have warned that entire state budgets risk being consumed by health and hospital costs unless reform is undertaken. That is why this government is taking action to reform our health system.

The Commonwealth will dedicate one-third of total GST allocations to health and hospital spending and will fund 60 per cent of the efficient price for all public hospital services and 60 per cent of capital, research and training in our public hospitals. The Commonwealth will also assume full funding and policy responsibility for GP and primary healthcare services and for aged care services.

I am very pleased to speak in support of this bill because I know that residents in my electorate of Greenway will directly benefit from these significant reforms. As I have said, unless the reforms occur we will not have a health system that will be able to cope into the future. In fact, one week after the COAG agreement was reached the Commonwealth and New South Wales governments announced the additional 18 new beds that I mentioned, totalling $4.2 million, for Blacktown. I was present when that was signed, in the old building of Blacktown Hospital where I was born so it was certainly a very significant day for me and here we are at a very significant point in reforming Australia’s public hospital systems.

It is crucial that the National Health and Hospitals Network bill is passed by the parliament to ensure that west and north-west Sydney continue to benefit from the additional resources that will flow. I am extremely concerned that failure to pass this bill will have hugely significant negative implications for Australia’s health and hospital system. The opposition’s refusal to support this legislation will directly hurt my local community.

Let us be clear: a vote against this legislation is a vote against more funding to provide more hospital beds, more doctors and more nurses for communities across Australia; a vote against this legislation is a vote against addressing the significant challenges posed by the ageing population; a vote against this legislation will simply place short-term political opportunism ahead of the national interest. As I said at the outset of my contribution, there is a fundamental difference between Labor and Liberal governments when it comes to health care and certainly it is on display today. We on this side of the House believe in and value the importance of a quality healthcare system. Those opposite do not. This legislation ensures our proud legacy of health reform continues.

I will go into the break being able to look my constituents in the eye and say that I have put up my hand to ensure that we end the blame game when it comes to hospital funding, that I did my bit to ensure that they received the highest quality health care. I urge those opposite to do the same today so that they can go back in the break and do the same in their own electorates.

Sharman Stone (Murray, Liberal Party) Share this | Link to this | Hansard source

Unfortunately, the member for Greenway is misguided in her hopes for the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. She is quite wrong in proposing that this bill would lead to major changes in health service provisions in her electorate or anywhere else in Australia. This bill is not about any proposed health reforms. The bill is simply about federal-state financial relations. It is specifically about the federal-state Labor deal to take $50 billion of GST revenue away from the states and territories and hand it to the Gillard government from 1 July 2011.

If this was a great government that had a track record of spending dollars very efficiently and producing great value for money we would feel less alarmed, but we all know what this government does with funds. We have the BER as an example of getting extraordinarily poor value for money. We have the pink batts debacle where not only dollars were wasted but also lives were lost. In my electorate and right across Australia there are still thousands of householders who live in fear and dread of what dangers lurk in their ceilings as a result of such a badly mismanaged government policy. In fact, I defy anyone to find anything more badly mismanaged in our history since Federation.

The problem is that after more than $40 billion in new or increased taxes in the past three budgets and $94 billion in new net debt, the Gillard government now wants to get another $50 billion of GST revenue at the expense of states and territories. Not unsurprisingly, some states, particularly New South Wales, Victoria and Western Australia, are saying that they are not going to support health reform.

This bill does very little for the problems which face rural and regional populations in particular. Let me quote a few statistics. According to the Australian Institute of Health and Welfare, people in rural and remote communities experience poorer health, have higher rates of most chronic diseases and have higher mortality rates than those who reside in metropolitan areas. People in rural and remote communities experience higher death rates than their counterparts in metropolitan areas, with death rates increasing for more remote communities. Compared with major cities, the life expectancy in regional areas is one to two years lower and in remote areas it is up to seven years lower, reflecting a higher proportion of Indigenous population in those remote areas. Death rates in inner and outer regional areas are about 10 per cent higher than in major cities, and the death rates in remote and very remote areas are 20 to 70 times higher than in major cities.

This bill does nothing to address the fact that if you are born in the bush and you live in rural and regional areas your health is on average substantially poorer than if you live in a metropolitan area, and the allied health and other key health services that are provided to you—such as oncology and so on—are substantially poorer, even though the Medicare take for tax purposes is the same whether you live in Burke, Echuca or Burwood. That is not fair in a country that claims to do a fair deal for all Australians.

The AIHW reported that people living in regional and remote areas were more likely to report chronic diseases such as asthma, arthritis and bronchitis, but less likely to report osteoporosis, than those living in major cities; however, rates of diabetes, cerebrovascular disease and coronary heart disease were generally similar across all areas. So there is good news and bad news there, but, unfortunately, in 2001-03 the incidence of cancer for people in regional areas was about four per cent higher than in major cities—particularly for preventable cancers, such as those associated with sun exposure. The statistics go on and they are not a happy read, let me assure you.

So what has this government done about all this, other than state that it is going to try to get more GST funding out of the states? The federal government will try but we know it is going to have a real battle there. Why is the government not focusing on real issues such as access to health services? For example, a Senate report found that the provision of hospitals and hospital beds is concentrated in major cities. Some 22 per cent of public hospitals but only 4.8 per cent of available beds are located in rural and very remote areas that comprise about six per cent of the population.

Most small rural hospitals are not equipped to provide the full range of specialised services, and people must be transferred to larger regional or metropolitan centres. The report found that the supply of health workers declines with remoteness. The number of medical practitioners per 100,000 people was 326 in major cities compared to only 179 in inner regional areas, 155 in outer regional areas, 154 in remote areas and just 130 in very remote areas. So there is an enormous difference in access to health services, including dental services.

What has this government done? It has just very recently decided to change the classification system for how it offers incentives to get medical doctors to live and work beyond metropolitan Melbourne, Adelaide, Sydney and the other major cities of Australia. The Department of Health and Ageing has recently completed an internal review of its funding models for medical services. As part of this process, DoHA has decided to replace its current measure of geographic dispersion, the Rural, Remote and Metropolitan Areas—or RRMA—Classification, with the Australian Standard Geographical Classification—Remoteness Areas system. This is the ASGC-RA system. This change was due to be implemented on July 2010. The coalition was very concerned about this when we were in government, but the idea is to make sure there is a whole range of incentives put into various parts of Australia that reflect the need to attract and retain medical practitioners in those areas.

But what have we got with this new system that has been introduced by this government? We have a system which has places like Deniliquin competing with outer suburban areas like Sunshine because they will be offering the same incentives to attract and retain medical practitioners. That is an absurdity. Of course a very different range of incentives is required to work in outer suburban Melbourne compared to relocating your family to Deniliquin or Echuca. Subsequently, small and relatively isolated inland towns will be left to compete with much larger outer metropolitan and regional centres for GP recruits. These are the places that are now to be zoned inner regional RA2. With the significant differences and relocation and retention incentives proposed between these different levels, it is going to make it almost impossible to recruit general practitioners to small rural towns that do not have a more remote classification—in other words, outer regional RA3+.

Given the shift to the ASGC-RA system is intended ultimately as a whole-of-government initiative—and we know it has already been used in the criteria for access to youth allowance—there will also be implications for the rurality loadings in practice and service incentive payments as well as the bulk-billing incentives. This is a very serious problem. With capitation and pay for performance likely to become a far more significant component of practice income, pending the National Health and Hospitals Reform Commission recommendations on blended payments, the viability of practices in these towns must now be seriously questioned.

This new system of reclassification has seriously compromised the capacity of those, for example, in the new so-called inner region to survive with medical health services. I am referring to a report prepared by the Murrumbidgee General Practice Network, the Murray-Plains Division of General Practice and the Albury-Wodonga Division of General Practice. They have done an enormous amount of work in this area. They are very concerned and I join with them in their concern. We have to change the system. It is nonsense putting Sunbury and Sunshine in the same category as Echuca and Deniliquin. The rural health recruitment and retention incentives include the general practice component, the Rural Relocation Incentive Grant, overseas trained doctors and foreign graduates of an accredited medical school program, the bonded medical places and the Medical Rural Bonded Scholarship Scheme, and of course the HECS reimbursement scheme. All of those different incentives hang off this new system of classification which has outer suburbia competing with the same level of incentives as places like Echuca, Kyabram, Deniliquin, Moama, Nathalia, Numurkah and the list goes on. All of those places struggle to have doctor replacements, but they are not going to be able to offer any better incentives than places that are on a tram track or a short suburban train ride from downtown CBD Melbourne. That is a nonsense.

This bill before the House is only about state-federal relationships; it is about stripping away more funds from the states and putting them in the pocket of the federal government—a federal government that has a horrendous track record of poor value for money and very serious misadventure when it comes to spending taxpayers’ dollars on essential services. I commend the amendment moved by the shadow Treasurer, Mr Hockey, the member for North Sydney, which states:

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:

             (a)    there has been laid on the table of the House a copy of an agreement reached between the Commonwealth and each of the states and territories about GST handback in relation to the measures in this bill;

             (b)    each of the states and territories has signed that agreement; and

             (c)    given that the state opposition parties in New South Wales and Victoria have signalled that they do not support the current agreement, the people of those states have voted in their upcoming state elections”.

The bill’s premise is basically hypothetical. We are not talking about a bill which is going to advance the cause of delivering better health services and more health service professionals to rural and regional Australia. I find that extraordinarily disappointing in a government that claims to know about social inclusion and giving everybody a fair go.

The best thing that ever happened in my part of the world was the coalition’s introduction of departments of rural health and clinical schools and the funding provided to universities so that students in their final years of medical training could live and work in rural communities, and experience the life and the culture with the hopeful view that they might fall in love with life beyond the cities and stay there. The department of rural health and clinical school in Shepparton together with the University of Melbourne has been extraordinarily successful. Medical students at the Shepparton campus who are about to graduate experience higher outcomes in their academic results than those who remain in Parkville, and the students who go to the Wangaratta, Ballarat and Bendigo campuses are not far behind them. Therefore, we hope this government will look at those sorts of initiatives rather than the nonsense of simply playing games with the states over their GST funding. The issues are too important. I have already provided the data to the chamber about the differences in the mortality and morbidity rates between metropolitan and rural Australia. Those are real statistics. If you are born beyond the tram tracks and beyond where the government focuses its attention, it is not fair to expect a shorter life and a life with higher rates of chronic disease and disability.

My electorate has two large hospitals—Echuca and Shepparton. The one in Shepparton is called Goulburn Valley Health and Echuca is called Echuca Regional Health. Both of those hospitals urgently need an injection of capital. We have had no commitment from the Brumby government to put any additional funding into either of those hospitals. However, we have had a commitment from the state coalition in regard to the Echuca hospital. This government should be looking into issues like that. The Echuca hospital, for example, has not had any major upgrades since 1962. People going into the wards at that hospital in winter have to take their own heaters. It is an absurd almost Third World situation to ask patients to take heaters to hospital so they can be warm in their ward. Women in labour have to compete for bathrooms with those attending the accident and emergency department. Goulburn Valley Health’s accident and emergency department has the second longest waiting period in Victoria. It has the highest number of people who turn away in despair because they cannot get access to a doctor when they have presented with an emergency. This bill is not a bill which any government should be proud of and the coalition will certainly attempt to amend it.

Debate (on motion by Dr Mike Kelly) adjourned.