John Murphy (Reid, Australian Labor Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for North Sydney has moved as an amendment that all words after ‘That’ be omitted with a view to substituting other words. The question now is that the words proposed to be omitted stand part of the question.

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

I rise to support the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010, which implements the federal government’s financial relations aspect of the National Health and Hospitals Network Agreement, as agreed to by the Council of Australian Governments, other than Western Australia, on 10 April 2010—a day I well remember, as I welcomed the outcome of that COAG meeting because it delivers great benefits to the Australian people. At the same time I felt very sorry for the people of Western Australia, who stand to miss out on the benefits that will be coming to Australians throughout the rest of the country.

Under this legislation the Commonwealth is retaining and dedicating a portion of the GST to fund health and hospitals and is establishing a National Health and Hospitals Network Fund. It introduces a new process, which the minister must complete before seeking to reduce specific purpose payments for health care, including to Western Australia. The Commonwealth commits to providing no less than $15.6 billion in additional top-up funding over the period 2014-15 to 2019-20. The bill provides flexibility in the provision of this amount of money.

Reform of the health system became apparent to all members of this House not in the last parliament but in the parliament before that when the then Minister for Health and Ageing, the current Leader of the Opposition, referred terms of reference to the House of Representatives Standing Committee on Health and Ageing to conduct an inquiry into health funding. He referred this matter to the committee because he was concerned that the health system was not operating effectively, that it could be more efficient. He recognised the need for change given that Australia had to have a health system that would be appropriate for the 21st century and beyond. The health and ageing committee brought down a wonderful report called The blame game – report on the inquiry into health funding.

The first recommendation of that report was that the Australian government, in conjunction with the states and territories, develop and adopt a national health agenda. It goes on to say that it should look at the roles and responsibilities of the different levels of government and at long-term sustainability of the health system, that it should support the best and most appropriate clinical care and that it should support affordable access to best practice, that it should look at structural reforms and inefficiencies, that it should give greater articulation to standards of service, that it should be responsive to the needs of the community and that it should redress inequities. That is just the first recommendation.

This report was tabled in the House in November 2006. By the time of the election, when the parliament rose in 2007, the then government had not responded. The then health minister had not shared with the parliament what his thoughts were on the report that he asked the member for Fairfax, the chair of the committee, to conduct. It was a very long, involved inquiry. If I might say so, the report was very detailed; it looked at all aspects of the health system. It identified that the current funding arrangements were not working. At the time that the terms of reference were given to the health and ageing committee, the then minister for health, the Leader of the Opposition, was keen to say that the states were shifting to the Commonwealth. The committee found that there was cost shifting both ways—the states to the Commonwealth and the Commonwealth to the states. In the long run it was the consumers, the Australian people, that were missing out. The report identified that very, very clearly. It also identified very, very clearly that there were issues of workforce shortage that needed to be addressed, and I am really sad to report to the House today that the then minister for health, the Leader of the Opposition, did nothing.

But I must say the Rudd government and the Gillard government have embraced the need for health reform. That health reform recognises the fine work done by the then health and ageing committee and recognises the changes that need to be made to ensure that all Australians can have quality health care and access to health services going into the 21st century and beyond.

The aspect of the National Health and Hospitals Network that we are looking at is how the GST is going to be used to fund health services and put money into public hospitals going forward into the 21st century. Seven separate health systems will be replaced by a single national hospitals network, remembering that one state is not part of this reform. It combines all public hospitals and all GP and related services. The Commonwealth is picking up 60 per cent of the funding of public hospitals. When the Leader of the Opposition was health minister he ripped a billion dollars out of our public hospital system. The Gillard government is agreeing to undertake 60 per cent of the funding for public hospitals—something that can only benefit all Australians.

This has needed to happen for a very long time, as was identified in the report The blame game – report on the inquiry into health funding. Health reform should have been undertaken many years before now. It really disappoints me, to say the least, that the opposition is continuing to be obstructionist in its response to the health and hospital reforms. It is refusing to support the legislation that we have before us today, legislation that addresses the issue of cost-shifting—which the then health minister was interested in at that time—and is putting in place a system that will benefit all Australians, with the Commonwealth taking full responsibility for all primary care and taking on the responsibility of 60 per cent funding for public hospitals.

It is setting up local hospital networks. In the area that I represent, there will be two local hospital networks. There is the Hunter New England local hospital network, which remains the same as it is at the moment, but it also sets up a Central Coast local hospital network. That is something that the people on the Central Coast have been calling for for a very long time. They wanted to have their own hospital network. They wanted to have a Central Coast focus on the delivery of health services. These reforms deliver that to the people of the Central Coast, and the feedback that I have had from my constituents is very, very positive.

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

You’re listening to the wrong people!

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

The member for Bowman says I am listening to the wrong people. The people I listen to are the constituents in Shortland electorate, the people who have been unable for a very long time to access the health services they want to access, the people who have been unable to visit their local GPs because of the shortage of GPs in the area. And that is a shortage that developed because of the action of the Howard government when they capped the number of training places for GPs, when they reduced the number of doctors that were being trained and when they constantly ignored the pleas of people like me in this parliament who were saying, ‘It’s not good enough that 8,000 constituents whom I represent in this House do not have one doctor.’ Time and time again I raised the issue of the doctor shortage within my electorate, and time and time again it was ignored. It was not one health minister who ignored it but three coalition health ministers who ignored it.

But the Rudd and Gillard governments have recognised the fact that all Australians, not only those living in inner Brisbane, inner Adelaide, inner Sydney or inner Melbourne, deserve to have quality health services. Those were not the only ones who deserved to go and see a doctor; it was all Australians. The reforms that have taken place under the Rudd and Gillard governments have meant that there has been a $64 billion agreement for health and hospital funds and $600 million for an elective surgery waiting list reduction plan. This has already kicked in in my electorate, with Belmont Hospital being earmarked to benefit from that and Belmont Hospital also receiving money for an upgrade of their accident and emergency department so that they can meet the guidelines that have been put in place. That is something that the previous government, the Howard government, chose to ignore. There has been an $872 million investment in preventative health. If you invest in preventative health, you are addressing the issues of health before people develop chronic disease, something that the previous coalition government chose to ignore. There has been investment in the rural and remote workforce as well as investment in the workforce in areas like the area I represent. With more doctors being trained, more nurses being trained and more allied health professionals being trained it really is a win for the Australian people.

We do have an ageing population. Shortland electorate has one of the oldest populations in the country. I stand in this place to argue for equity for the people of Shortland electorate. I have done that over a very long time. The people of Shortland electorate deserve to have quality health and hospital services. The legislation we have before us today and the reform of healthcare funding arrangements are required to deliver this to the people of Shortland and the people of Australia. This will put in place a framework that will ensure that health is adequately funded. That can only be done by putting in place the framework we have before us today to put legs on the National Health and Hospitals Network. This is vitally important legislation, and it will allow the Commonwealth to retain the proportion of GST to bring to fruition the 60 per cent commitment that has been made to the states. (Time expired)

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

The problem is that we all think we have got time, as Jack Kornfield said, but in health care, that is not the case. We have been waiting too long for solutions to the flawed and vexed challenges in the Australian health system. We know well that there are schisms running between federal and state provision, between private and public, and between after hours and working-hours care. The Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010 takes us no closer to solutions to those challenges. I guess that today is an appeal to the government on behalf of Australians in every corner of this country who ask: ‘What is actually happening?’ and ‘What is changing?’ It possibly reflects an overwhelming and pervading fixation by those opposite on the shell-and-pea game of fiddling with financial systems but not on actually getting down to working out what is going to deliver a better health system.

It seems good to have a national framework and it seems great to have local networks and an omniscient Commonwealth government that is able to make decisions from Canberra about the provision of community and public health in every corner of this great land. In reality we know that the tension that has existed for 100 years between the federalism of devolving responsibilities down to local communities and the other argument that we centralise to try and make sure that those decisions are as perfect as possible, has never really got us any closer to improving our health system. What has changed are revolutionary ideas about how we engage with community health from a hospital. We need to step away from the notion that people inside a hospital are so fixated on acute care that they cannot think about community care—this notion that because you work in a hospital you do not understand what it is like outside the hospital. We need to understand that our clinical staff and our researchers are the people who think about community, public and preventive health every moment of their waking lives and we need to involve them in that process. When this Labor government had a moment to think about how it would fix the challenge of the health system and had the audacity to set a date, I think everyone was struck by the possibility that they could actually get somewhere. In fact, we have seen that nothing happened by that date. We now have a new Prime Minister who is rolling out the same old bureaucratic changes that are almost a reflection of their own impotence that they cannot get down and sort out public and community health.

It is one thing to believe that if we take money from one pot, put it into a bigger pot and reassign it to where it was in the first place, things somehow will be better. I do not mean to demean or diminish the very hard work that has been done in drafting these changes, but I beg of every person listening to this debate to ask yourself, ‘How will public health provision in your community be different? How will it be improved?’ Here we are, in 2010, waving goodbye to another year of a Labor administration, but this side of the chamber has to ask the very important question, ‘What has changed?’ You cannot keep putting off what should have been done the day before yesterday until the day after tomorrow, because ultimately the things that were easy become hard, and the things that are hard become impossible. We need to join together as a nation and say that taking over 100 per cent of community funding and assigning it to the Commonwealth sounds seductive. But in reality this is a job that is done by communities; a job that is tailored to Indigenous communities, mining communities and rural communities. The case that has to be made by those opposite is that Canberra can do that; that case has not yet been made. They have not yet made the case that the states are failing in their role for any other reason than vertical fiscal inequity—they are not adequately funded to do the job. Sure, we all collect the GST and then it is reassigned after it has run through a Commonwealth Grants Commission process, but there are no longer adequate partnerships between Commonwealth and state, and these national partnership arrangements that are a billion dollars here and there simply have not done the job.

Before government members get too excited about the increased amounts in health care, let us add them all up. In 2009-10 that amount was $12.074 billion and next year it will rise to $14.74 billion. Unadjusted, that is an increase of just under 20 per cent. That is what used to happen under the old hospital arrangements, the old four-year funding agreements, where there were unadjusted increases of between 17 and 26 per cent. I commend the government for increasing health funding but that is what every government has always done, all of the time. Some governments will increase it more in some years than in others, but it is no more legitimate to say that we ripped funding out of the health system than it is to say that the Labor government rips funding out of the school halls program because it spent it all last year and not this year. It is silly economics. There are times when more money goes into health and other times when less goes in. Obviously, the previous coalition government had to pay off a massive Labor debt so we focused on doing that for very good reasons. When it comes to funding hospitals both sides of this chamber can lay claim to good and bad, but while this government is in power we need to ask, ‘What has it done this year and what did it do last year?’

The great frustration to many is that we keep having these administrative bills brought before the House. We dream that by setting up an independent funding authority, then a performance authority, then a Health and Hospitals Fund and then local networks, in some cases things will somehow be better. That case has not been made by the government. I know that they are seduced by the notion of large nationwide corporate structures that are controlled out of Canberra. But let us be honest: we have had a situation where we ran down the power of school principals and of hospital superintendents and it was centralised to either district offices or state governments. We have a system where we have slowly eked out of state bureaucracies the power to deliver services and centralised it here in Canberra. Then we have had the power of Canberra bureaucracies stripped away from them and centralised in ministers’ offices and finally we have had Labor ministers who complained they could not get in through the Prime Minister’s door—because all decision making resides there. Eventually it becomes intellectual constipation, waiting for an omnipotent prime minister to make decisions like some sort of communist decree that comes out of China or Soviet Russia.

We need to trust local clinicians. All we asked of the government was that we involve ordinary everyday folk in hospital boards, particularly in New South Wales and Queensland. We know that these hospitals and their decision making have basically drawn away like an outgoing tide from the local population. People turn up but cannot get into emergency and they wait on waiting lists that never materialise into an operation. They just want to know why. They know a lot of money is spent on health, but they do not understand how. I am not going to stand here and say that we need to slash the health bureaucracy. I am not going to say that we have frontline staff who are not performing clinical services and who therefore need to be done away with. No, that is overly simplistic. What we need to know is that leading figures in each community can be part of a hospital board.

Of course we need to resolve the issue of whether these hospital boards actually run the hospitals or simply monitor them. The role of a hospital board fundamentally is to be a conduit for passing information between a hospital, which makes the decisions, and the community, which is affected by them; and that is utterly legitimate. The criticism from Queensland Labor was that we have the butcher, baker and candlestick maker on the hospital board and they cannot possibly run a hospital. But they are ordinary, everyday people who have a grasp of what it takes to serve and what it takes to deliver health care. We need to incorporate these skills of people who are not necessarily health professionals into how health decisions are made. That was the simple request from this side of the chamber.

How the Labor government responded was fascinating. They simply said, ‘We will allow local decisions to be made as well.’ But the decisions will be made by $570 million of extra bureaucracy in a fourth layer of government that controls the health system. So we have the curious situation where the Commonwealth is involved in immunisation services, the state governments are involved in delivering immunisation services, local jurisdictions and city councils deliver immunisation, and now, thanks to Mr Rudd and Ms Gillard, a fourth level of administration will be running our hospital system. Worst of all it is a fourth level we cannot vote out, a fourth level that has no accountability to ordinary Australians, a fourth level that we have to blame in this post-Rudd environment where everyone is responsible for everything and the last thing we need is a situation where we do not know who is not performing.

The great attraction of clearing up this complex miasma of health decision making in Australia is to determine who delivers services most effectively and let them get on with competing to be a provider. But we remain, after all of these reforms, with a health system that has this curious bipartite purchaser arrangement and a single public provider that does not work with the private system. We still have a public system where the faster they work, the quicker they go broke and a private system where the faster they work, the richer they get. That challenge has to be resolved, but it is a nexus that we have not even begun to scratch the surface of.

The solutions are right in front of us but the government is not looking. You only need to see the complex cancer services or the eye operations that are being delivered through private providers, through streamlined systems, at a fraction of the price and with 100 per cent outcomes. I ask the other side of the chamber: why don’t we learn how those cancer services are delivered?

Let me throw a complex notion over to that side of the House; which is, that potentially the private system may do parts of our health work better than a public system will ever do. Let us also face the fact that some public services may well remain more efficient and more effective than private services ever can be. Why don’t we engage in a partnership to work out how those things are best done? Why don’t public hospitals accept that there are some things they simply cannot do as well as private hospitals? Why don’t we reach out across the fiscal divide and involve private services as a competing entity in provision? It is a simple challenge. Let us face it, they are the reasons people in my community of Redlands cannot get to see a doctor, wait for hours in casualty, sit on waiting lists for operations that will never happen and of course end up in medical wards taking up valuable acute bed space.

I put a simple challenge to the government: what are they doing for aged care provision, for the wages of our aged-care nurses and for the infrastructure costs of building aged-care facilities? There has been almost no movement on that in four years. An integral part of a functioning health system is to return people who are discharged to the community. I set the challenge to the government: what is happening with transitional care? What is happening to engage the private sector? What is happening to connect hospitals with community health care? It is one thing to say the federal government should be running community and public health, but where does that leave the states? Completely unengaged in the process. The last thing you want is for the jurisdiction paying 40 per cent of the hospital bills to have no interest in community health.

It would have been much simpler to have a dollar-for-dollar national partnership arrangement on this question and keep all eight jurisdictions in the room on community health. But, no, this government has lost seven of them and will go it alone in providing community health. The greatest mistake of the legislation we debate today is that seven jurisdictions walk away from community, preventative and public health and are no longer engaged. That is a great loss.

We all know the current funding arrangements and how we use partnership payments and health care special payments to fund the health system, which is primarily the responsibility of the states in the public area but the states are not adequately funded to do it. A courageous government would have stepped in and fixed that problem. They would have looked at that vertical fiscal inequity and said that a component of taxation should automatically be given to state governments. I challenge the other side of the chamber again to tell me why, if you are operating in a state government, you are simply incapable of providing these health services.

All of our states are big enough, smart enough, hairy enough and ugly enough to run community health and hospitals. You do not leave this chamber to join a state legislature and suddenly have no compassion or care or ability to run a health system. The states are just like us—they can do it if you give them the means. But they do not have the means because they do not have the funding. The healthcare costs index—which is a product of a technology index, a population’s hospital utilisation factor and health inflation—is going up by 10 per cent per year and the GST takings of six per cent cannot keep up. Why don’t we just fix that by covering the four per cent out of federal revenue? It would be far simpler.

To the other side of the chamber I say this: it is seductive and attractive to build massive, nationwide networks of bureaucrats, but in the end the question you have not answered is, ‘Why can’t it be done locally, reporting to a national partnership with priorities?’ Those priorities are clear. How we can fix it is clear. We need an auditor-general in health that actually examines the role and performance of health providers, and it should not have state government membership. Whoever is providing the health should not also be writing the monitoring and evaluation plans and then filtering the reports. We need to have a system where we engage the private sector. We need to remove the massive fiscal schisms that run through the health system. But that was all too hard. So today instead we debate a pea and shell game of moving money from one jurisdiction to another and then handing it right back and calling it a breakthrough in health. (Time expired)

Peter Slipper (Fisher, Liberal Party) Share this | Link to this | Hansard source

Before calling the honourable member for Dobell, I would commend to the member for Bowman the provisions of standing order 64.

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

I rise to support the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. I had the pleasure of sitting through the contribution by the member for Bowman. Obviously the 13th year of government for the coalition would have been a big one. The member for Bowman was very able to identify a range of problems in the health system—some of which, I totally agree, are challenges and problems we need to address—but he failed to recognise that, for the 12 years the coalition were in government, their record on health was atrocious. It is all very well to say that this is the plan and this is what we should do, but the actions of the coalition during their 12 years in government were simply to let the problems—many of which were identified by the member for Bowman—continue, to become worse. Only this government has taken this issue seriously and decided that proper, substantive and major health reform is something we need to effect in this country. Quite simply, we cannot let the health system carry on the way it did when the member for Bowman’s party was in government. We cannot continue with that pattern of reducing the contributions to health funding relative to GDP that happened under the former government. We need to make long-lasting and substantial reforms to the health system and this bill is part of that.

The member for Bowman had the hide to talk about wages for aged care workers. Look at the record of the previous government in relation to aged care and aged care workers. It was the previous government which uncovered the dedicated funding that went to wages for aged care workers. They changed the way it happens so that there was not this dedicated stream to make sure that aged care workers were paid properly and were able to move ahead. Instead, we saw in the aged care sector in particular that wages were stagnating. There is little wonder we have problems today in relation to attraction, retention and ensuring there are enough skills in the aged care sector. Again, it falls to this government to fix that up. More generally in relation to wages in the work force we had Work Choices and the difficulties that individual contracts put on people working in sensitive and vulnerable areas—in the health industry, in aged care, in the community sector. It is staggering for the member for Bowman to come into this chamber today and say that this is a problem which needs to be addressed. When the coalition were in government, they directly contributed to that particular problem and made sure that that was an issue not just in the health and aged care area but more generally right across the Australian work force.

Once again, when it comes to real reforms in the economy or in health, in education or in any area of administration, we find a stark contrast. Those on the other side are happy to do nothing, to let things ride along to the detriment of the Australian community. On this side of the chamber, we are not happy to do that. We are about making sure that, where we can fix things up, where we can make reforms, we get in and do it. There is no more important area of reform than the health industry. This bill is a major step but it is not a step taken in isolation. There are a series of health reforms which have gone through this parliament already and will be rolled out over the next few years. One of the major reforms in hospital and health funding is the introduction of the local hospital networks. No area in Australia has welcomed this government initiative more than the Central Coast of New South Wales.

The Central Coast of New South Wales had an area health service which took in northern Sydney as well as the Central Coast. For years, I have been campaigning to make sure that the Central Coast has its own area health service, its own local network, so that issues about funding and resources in health care for the betterment of the people on the Central Coast can be looked after and administered by the people of the Central Coast. It is little wonder that the reform put in place by this government has been so universally supported. Even the Liberal Party have been supportive of it. Chris Hartcher, the member for Terrigal and a well-known state Liberal MP, has welcomed with open arms the announcement of the local health reform network and the regional focus that is going to happen on the Central Coast. Mr Hartcher has said it should have happened some time ago. The reason it did not happen is that we were not in government some time ago. Those opposite were in government and we know that those opposite have no interest whatsoever in making sure that there are proper reforms to our health system. Instead, they are about leaving the health system alone because they have a very different attitude to health. They believe those who can afford to can take out health insurance and those who cannot afford it can be looked after by a second tier of health care.

On this side of the House, we have always been about making sure that we have a fair and equitable health system which all Australians can access. Today we are talking about a broad sweep of reforms which are going to change absolutely the way health care is delivered in this country.

Debate interrupted.