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

As I was saying previously in relation to Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010, the contrast between those on this side of the House and those on the other side could not be more stark in their approach to the health industry. We are about making sure we can put in place real reforms to the health system—reforms which will matter to people, ensuring health is delivered in a better, more localised way, so that people can access public hospitals and there is a proper flow of funds.

What has been on offer from the other side in relation to health is staggering. The coalition had 12 years in government when they did nothing. All they did was to decrease the proportion of Commonwealth funds to the health system. Meanwhile, our hospitals were struggling with increased workloads. What did that government then do? Absolutely nothing. In fact, the Minister for Health and Ageing at the time, who is now the Leader of the Opposition, ripped $1 billion out of the health system. That was the solution. When they first came into government they canned the Commonwealth Dental Scheme. The coalition have never been the friends of people who need health care in this country. When real reform is needed, it is only this side of the House that can implement real reform. That is what this bill is about. We are putting forward changes through a series of reforms to the health industry.

It is not just the sorry past record in health that the coalition stands condemned for. We could be generous and say that maybe they learnt that in 12 years of government they cannot sit around and do nothing. But they have not learnt. It just gets worse. What we saw in the last election was that the highly successful GP superclinics are going to spread even further around this country, changing the way in which primary health care is delivered in many communities. What was the opposition’s solution to this? Did they get on board and say that this was a good idea? Did they come up with a new promise saying, ‘We are going to do more of this’? No. Their solution, as is typical of their history in relation to health, was to cut the program. If they were elected they were going to cut GP superclinics.

I was fortunate enough that in the 2007 election a GP superclinic was promised for Dobell. We have had a temporary GP superclinic up and running for about 18 months. It is overwhelmed by the support it has from the local community. In doorknocking and going around my electorate for the 2010 election the very idea that these sorts of facilities might be cut or not proceeded with horrified the good people of the Central Coast. Luckily, we prevailed in this election and I can report that the Central Coast is getting a second GP superclinic and that is only going to add to the level of care that is delivered on the Central Coast. The Central Coast has both the fourth and fifth busiest emergency departments in New South Wales so these types of solutions are absolutely vital to make sure that we take the load off these very busy emergency departments. We will make sure that there is proper access to doctors and other health professionals so that people do not have to wait for weeks to see a doctor.

On the Central Coast many of the existing GP clinics—not the superclinics—are full. They are not taking any more patients and you cannot get in to see a doctor. I had someone come to my electoral office the other day while on holidays on the Central Coast—a good choice of holiday; one I would recommend to anyone—and they were quite ill. They had been told they could not get in to see a GP and they ended up in the Wyong Hospital emergency department because that was the only option available. We have said we know there is a problem here. We are not going to sit on our hands for 12 years and do nothing. We are going to address these problems. We are about fundamental health reform to make sure that the citizens, not just of the Central Coast but right around Australia, get a much fairer deal in health care. It is not surprising that when asked whether people supported Labor’s reforms of the health system we find that 76 per cent of Australians are right behind the sorts of health reforms that we are doing. That should not come as a surprise to anyone.

When you look at the six major areas that we are reforming in health you can see the breadth and the depth of the changes we need to look at. The six areas are: hospital projects, which is about expanding hospital capacity; investing in our workforce—training more GPs, making more nurses and allied health scholarships available so that we do not have the sort of workforce shortages that I was talking about regarding GPs but also other allied health professionals; making sure that there is primary care infrastructure, as I mentioned through GP superclinics; and e-health—another area that the policies of the opposition were to cut. They do not get this area at all. They do not get that these are the sorts of investments that are needed to save lives and improve the care that is needed for citizens around this country. Another area that we are reforming is prevention, which is in record numbers.

Those are five of the areas, and then there is the area that this bill is concerned with—the establishment of local hospital boards. There is no area that is happier with the proposed local hospital network than the Central Coast. We have been locked in to the Northern Sydney Area Health Service for the last number of years and everyone on the Central Coast has applauded this decision, even the Liberal Party. The state member for Terrigal, Mr Chris Hartcher, welcomed the decision to set up the local hospital network on the boundaries that we have been campaigning for. Even he has seen some good sense in it. The only ones who cannot see any good sense in it are those who are opposite, and they stand condemned for their opposition, for their getting in the way, for their carping about the essential reforms that are needed for the health system. We on this side of the House, on the other hand, are getting on with the job, making sure that we are putting the interests of Australians and their health care first. We are not carping, we are not blocking, we are not trying to wreck. We are getting on and reforming this health system.

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

I rise to address the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. We are asked to believe that this bill will fix all the problems in our hospital systems. It does not matter how I line it up, I am afraid I just see it as a pea and thimble trick. What are we doing? We are shifting a funding split basically from 40-60 to 60-40 and taking the money from the states to fund it. That means the federal government will take roughly one-third—and I say ‘roughly’ one-third because now we find the states do not know what part of their GST receipts they will be giving up. I must say it is quite curious to me that the Labor-controlled state governments have been in such a rush to sign on to something they cannot possibly fully understand at this stage. It does in fact have a parallel with what the parliament is being asked to do with the NBN at the moment, which is to sign a blank bill. We have heard of blank cheques but this is in fact a blank bill. The states are unsure what they will be paying for the privilege of having 20 per cent of their hospital funding obligations taken off them.

When the then Prime Minister Kevin Rudd proclaimed this new deal it was about the federal government taking over the whole system and, as the major funder, the Commonwealth would of course assume responsibility. But, no, that is not exactly what has been negotiated. The states are to be left in charge but answering to a new bureaucracy, the Australian Commission on Safety and Quality in Health Care—and we have debated the formation of that body in this place before.

In my state of South Australia, not only is the state bureaucracy to be left in charge; the government has also managed to convince their federal counterparts the management systems we are using at the moment are just fine, thank you very much. Very little is likely to change. As far as the administration of hospitals in South Australia is concerned, we are being told that we are to have very little change, yet this is to fix a health system that is in need of major reform. I really do not see what is going to happen here that is very different from what is happening at the moment. It concerns me because the track record of the Labor regime in South Australia towards regional health services is deplorable.

In 2008, the Rann government launched an attack on regional hospitals with its ill-conceived country health plan. The intent was to reduce services in country areas. It elicited outrage from not only the affected communities but from right through the South Australian public, and the government was forced into retreat. In a similar time frame, the government sacked our local hospital boards, which had largely established these services and which were the community advocates for our hospitals, our health services and, in many of the smaller towns I represent, our aged-care services. To me, this was the really big change because, after it, local communities had no say in the operation of their local hospitals. That is why I was pleased that, last election, the coalition committed to reinstating the boards. The state Liberal team still has that intention if it is elected to government, which will hopefully occur sooner rather than later.

We well remember the great debates that came with the introduction of the GST, which the Labor Party implacably opposed. Government members should remember what their voting record on economic reform was when they were in opposition, because we are hearing much nowadays about the way oppositions should behave. It was a very important reform for the nation and particularly for the states, because they had a totally new growth tax. I am just amazed that the Labor state governments are prepared to give up access to this tax and take on what is basically, as I said, a blank bill.

I want to keep this relatively short today, but I do want to focus on something that has been happening very recently in South Australia as a result of the state budget, which was delayed and delivered in September. It is an example of what can happen with country health systems if you have hostile and uncaring governments. There are 32 state government hospitals in my electorate and there are two not-for-profit community hospitals. These not-for-profit community hospitals, Moonta and Ardrossan, have been receiving a small part of state funds to supplement their income. In total, the Ardrossan Community Hospital has been receiving $140,000 a year, which covers about 50 per cent of the cost of their accident and emergency. Moonta Hospital has been receiving $288,000 a year, which pays for up to eight public beds, should they be occupied, at about $110 a day—a pretty good deal for the Commonwealth, I might point out.

The state government has decided to pull that money out of those hospitals. In the case of Ardrossan, which is a 22-bed hospital, 50 per cent of their admissions come through their A&E department. It is highly likely that their admissions will take a big dive. These are private, paying patients and, without them, the hospital would be likely to close. The extra ‘hang on’ in this case is the 25-bed aged-care facility attached. If there is no hospital, there will be no aged-care facility. So it is a tragedy for the community and we will keep working to try to put pressure on the state government to reverse the decision. Up the road at Moonta, if the $288,000 is taken out of the budget it is highly likely that the acute services there will cease and the hospital will have to be turned into an aged-care facility.

I would like to speak much more about both of those issues and about the GST changes that are proposed with this bill, but I will keep it short and just reiterate my opening comments. I believe this is a pea and thimble trick and that very little will change on the ground. We are being sold a pup.

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

I rise to speak in support of the Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010. Listening to the member for Grey, I thought he put up some very good reasons why he might have supported this bill, but it is obviously his prerogative to take positions as he sees fit. When the Labor government came to office in 2007, the health system across Australia was in a mess. In fact, it is my view that it was one of the key reasons the Howard government lost office.

We know that there was a shortage of doctors in our hospitals and in general practice, there was a shortage of nurses and a shortage of hospital beds, there were lengthy waiting times in hospital emergency departments, there were a whole range of different medical demands not being funded and elective surgery waiting lists were way too long. The system was in so much of a crisis that former Prime Minister Howard, in the late stages of the 2007 election, made a rush to Tasmania to try and save the Mersey Community Hospital. This was, I guess, an attempt to show some leadership by trying to restore the health system of this nation. It did not work because, quite rightly, the electorate knew that he had had 12 years to show that leadership and that he had not done so. More importantly, it did not work because the electorate also understood very well that the reason the health system was in such a crisis was a lack of funding from the federal government over those 12 years. We certainly know the record of the Leader of the Opposition, then Minister for Health and Ageing, in cutting a billion dollars out of health funding across this country.

In addition to that, we saw that there was not only insufficient funding but poor planning of medical services across this country and, in particular, poor coordination of services between the state and federal governments. That overlap of responsibility between the state and federal governments often led to a whole range of inefficiencies and even wastage. The national health system is of priority to families across Australia and it should be to the national government. It is certainly of priority to this government. Since we came to government in 2007, not only have we taken our responsibilities in respect of providing a good health service across this country seriously but the government has made significant investments across a range of measures relating to the provision of health services throughout Australia. We have invested more in training doctors. We have invested more in recruiting nurses. We have invested money in the establishment of GP superclinics and medical research. We have also put substantial amounts of money into reducing elective surgery waiting times and waiting times at emergency departments of hospitals.

But we know that health costs in this nation will continue to rise. Based on the best predictions, in around 30 years time, if we continue with the current system that we have, many of the state governments will have almost their entire state budgets consumed by their health costs alone. That is one of the critical concerns that we need to address today. It is no good waiting for 20 or 30 years and then having someone quite rightly stand up and say: ‘You knew this was going to happen. Why didn’t you reform the system earlier on?’ So the duplication and inefficiency of the health system that has been created over the last 100 years—it evolved from the different practices of all the different states—has to change. It has to change if we are going to ensure that it is financially sustainable and if we are going to be able to continue to provide the health services that the community of Australia is entitled to and quite rightly expects. The reforms that are being proposed as part of this measure will ensure that we have a much more efficient health system and a more sustainable health system.

The member for Grey also alluded to the GST payments. There is no question that, if we are going to reform the system, we will have to reform the funding arrangements between the Commonwealth and the states, and that is exactly what this bill seeks to do. GST payments will be withheld from those states that have agreed with the Commonwealth that we need to change the system, and those payments will go directly into the provision of health services around the country, in addition to new money that the federal government will make available in the years ahead. The implementation of a national health system will also ensure that we have better services, because there will be less wastage. If you do not have the duplication and overlap of services that we are currently seeing, there is no question in my mind that we will have the ability to save money along the way which can in turn be put into the provision of services. Additionally, we will ensure that all Australians have consistency and uniformity in the services that they get, wherever they live in Australia.

I said a moment ago that this system has evolved over the last 100 years or so, and so we all expect that change will not be easy and there will be criticism along the way. There will be arrangements that are currently in place in local communities and there will be local practitioners who oppose any change that we propose. But the reality is that we cannot continue to operate the national health system under the current arrangements. It is disappointing to see that every time there is a bill in this place that endeavours to reform the health system the opposition opposes it. We saw the criticism of the government’s GP superclinics proposal, and yet we see opposition members who would dearly love to have a GP superclinic in their own electorate if they could. We know that it was in fact the opposition who first mooted the idea of an e-health proposal, and yet when we include it in our budget and in our proposals the opposition opposes it. What is even more disappointing is that many of these initiatives did not come just from the government. They were in fact initiatives that came through discussions with the health sector generally and have been supported by the medical sector across Australia. I have to say I am absolutely bewildered as to why the opposition would think that they know better than the medical sector generally.

Under this bill, the Commonwealth government and the seven states and territories have agreed to a fundamental shift in the delivery of vital services for our country. The establishment of the National Health and Hospitals Network will in fact be the most significant reform to our health system since the introduction of Medicare. Under the proposals, our hospital system will be funded nationally and run locally. Yes, the Commonwealth will take on 60 per cent of the efficient cost, with hospitals being managed by local hospital networks. That in itself is an important shift, because it means that the local hospital network is in a good position to determine the priorities and needs of the network which they oversee. The Commonwealth will take 100 per cent of the funding and policy responsibility for GPs, primary care and aged-care services. Medicare locals will be established to coordinate services in local areas.

Under the National Health and Hospitals Network, the Commonwealth will become the major funder of the Australian public hospital system. The Commonwealth will fund 60 per cent of the national efficient price of every public hospital service provided to public patients; 60 per cent of recurrent expenditure on research and training functions undertaken in public hospitals, which are currently funded by states and territories; 60 per cent of block funding paid against COAG agreed funding models, including for agreed functions and services and community service obligations required to support small regional and rural public hospitals; 60 per cent of capital expenditure on a user cost of capital basis where possible; and, over time, up to 100 per cent of the national efficient price of primary healthcare equivalent outpatient services provided to public patients. The Commonwealth will also take on full policy and funding responsibility of primary health care and aged care, including the Home and Community Care Program.

Since the agreement was mooted in April 2010, the implementation timetable has already begun with a number of key activities having commenced in 2009-10. New funding to states and territories to improve emergency department waiting times and increase the numbers of elective surgery procedures began to flow in June 2010. Legislation to establish the Australian Commission on Safety and Quality in Health Care as a permanent body responsible for new national clinical standards and strengthened clinical governance was introduced in parliament on 23 June 2010. Legislation to implement changes to federal financial arrangements to give effect to reforms to the financing of health and hospital services, including the dedication of a portion of goods and services tax, or GST, revenue to health care, was also introduced in parliament on 23 June 2010. In e-health, the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010 were passed on 24 June 2010 to establish the Healthcare Identifiers Service. The service will assign unique identifiers to individuals, healthcare providers and healthcare organisations to improve safety and quality of patient care. On 25 June 2010, applications opened for Primary Care Infrastructure Grants of up to $500,000 each to upgrade facilities in general practices, primary care and community health services, and Aboriginal Medical Services. In respect of the Primary Care Infrastructure Grants, I am pleased to say that a number of GP clinics in my electorate have put in applications to access funds under that program.

I am particularly interested in how these reforms will affect South Australia. It is my view that the South Australian health system will directly benefit as $20.2 million has been allocated to expand the capacity of public hospital emergency departments by undertaking infrastructure projects which will enable faster treatment; $36 3 million in facilitation and reward funding has been allocated to meet four-hour national access targets for emergency departments; $13 million has been allocated to boost elective surgery capacity in public hospitals; $47.3 million has been allocated to facilitate and reward the staged achievement of national access guarantees and national access targets for public elective surgery patients; $119.8 million in capital and recurrent funding has been committed to deliver 97 subacute beds; and $16.6 million has also been allocated in flexible capital funding for emergency departments, elective surgery and subacute areas, so there will be the flexibility to direct that to the highest priority needs within a particular jurisdiction. Additionally, about $266 million is being invested in health workforce measures to support doctors, nurses and allied health professionals and in aged care to provide better, more appropriate care for older Australians and reduce the pressure on hospitals. This funding will also be invested in the provision of better coordinated and integrated care for people with diabetes, which will provide better care in the community and reduce avoidable hospitalisations. Overall this means that South Australia will receive from the Commonwealth both direct and general benefits totalling about $519 million as a result of these reforms.

In closing, I will comment briefly on the amendment moved by the opposition. Essentially, they are seeking to defer any decision on this matter until after the elections in Victoria and New South Wales, using the argument that the opposition parties in both those states oppose the reforms that are contained in this bill. Firstly, both governments of New South Wales and Victoria signed this agreement when they were not in caretaker mode; they were the legitimate governments of those states, and the New South Wales government is still. Secondly and more importantly, it seems to me that this is simply another delaying tactic as is the case by those opposite with every bill that is brought into this place by this government. Every time we seek to reform any area of government and we bring a bill into this place, the opposition opposes it by, in most cases, introducing and implementing delaying tactics. That is all that this amendment seeks to do: delay the decision making even further. It is my view that these reforms are well and truly overdue and that this bill should be supported. I commend the bill to the House.

Debate (on motion by Mr Albanese) adjourned.