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

I present a supplementary explanatory memorandum to the bill, and I ask leave of the House to move government amendments (1) to (29) together.

Leave granted.

I move:

(1) Schedule 1, item 15, page 5 (line 25), omit "For the purposes of paragraph (b), body includes a part of a body.", substitute "If a body is established by or under a law of a State, the Australian Capital Territory or the Northern Territory, the Minister must not specify the body in an instrument under paragraph (b) without the written agreement of the State/Territory Health Minister of the State or Territory, as the case may be. For the purposes of this definition (other than paragraph (a)), body includes a part of a body.".

(2) Schedule 1, item 29, page 8 (line 17), at the end of the definition of public hospital, add "If a facility is situated in a State, the Australian Capital Territory or the Northern Territory, the Minister must not specify the facility in such an instrument without the written agreement of the State/Territory Health Minister of the State or Territory, as the case may be.".

(3) Schedule 1, item 130, page 24 (after line 25), at the end of Part 3.1, add:

58A Role of State/Territory Health Ministers as health system managers

(1) The Parliament acknowledges the role of State/Territory Health Ministers as health system managers in relation to local hospital networks and public hospitals.

(2) The Parliament intends that the Performance Authority should, in performing a function that is relevant to:

  (a)   a local hospital network in a State, the Australian Capital Territory or the Northern Territory; or

  (b)   a public hospital in a State, the Australian Capital Territory or the Northern Territory;

have regard to the role of the State/Territory Health Minister of the State or Territory, as the case may be, as the health system manager in relation to local hospital networks and public hospitals.

(4) Schedule 1, item 130, page 25 (line 33), at the end of paragraph 60(1)(f), add "with the agreement of COAG".

(5) Schedule 1, item 130, page 26 (after line 7), after subsection 60(2), insert:

(2A)   Subparagraph (1)(a)(v) does not apply to a particular body or organisation unless:

  (a)   COAG has agreed that that subparagraph should apply to the body or organisation; or

  (b)   both:

     (i)   COAG has agreed that that subparagraph should apply to a class of bodies or organisations; and

     (ii)   the body or organisation is included in that class.

(2B)   COAG is to give its agreement for the purposes of paragraph (2A)(a) or subparagraph (2A)(b)(i) by a written resolution of COAG passed in accordance with the procedures determined by COAG.

(6) Schedule 1, item 130, page 26 (after line 15), after subsection 60(3), insert:

(3A)   COAG is to give its agreement for the purposes of paragraph (1)(f) by a written resolution of COAG passed in accordance with the procedures determined by COAG.

(7) Schedule 1, item 130, page 27 (lines 5 to 23), omit section 62, substitute:

62 Additional provisions about reports

Scope

(1) This section applies to a report prepared by the Performance Authority under paragraph 60(1)(a) if the report indicates poor performance by any of the following entities or facilities:

  (a)   a local hospital network;

  (b)   a public hospital;

  (c)   a private hospital;

  (d)   a primary health care organisation;

  (e)   any other body or organisation that provides health care services.

Objects

(2) The primary object of this section is to assist State/Territory Health Ministers in carrying out their role as health system managers in relation to local hospital networks and public hospitals.

(3) The secondary object of this section is to authorise appropriate consultation in relation to the preparation of the report.

Local hospital networks and public hospitals—consultation with State/Territory Health Ministers

(4) If the report indicates poor performance by:

  (a)   a local hospital network in a State, the Australian Capital Territory or the Northern Territory; or

  (b)   a public hospital in a State, the Australian Capital Territory or the Northern Territory;

then, before completing the preparation of the report, the Performance Authority must:

  (c)   give a copy of a draft of the report to the State/Territory Health Minister of the State or Territory, as the case may be; and

  (d)   invite the State/Territory Health Minister to give the Performance Authority written comments about the draft report within 30 days after receiving the draft report; and

  (e)   have regard to any comments given by the State/Territory Health Minister within the 30-day period mentioned in paragraph (d).

(5) If the Performance Authority gives a copy of a draft of the report to a State/Territory Health Minister under subsection (4), then, before completing the preparation of the report, the Performance Authority must:

  (a)   give a copy of the final draft of the report to the State/Territory Health Minister (even if the final draft is the same as the draft given under subsection (4)); and

  (b)   invite the State/Territory Health Minister to give the Performance Authority written comments about the final draft within 15 days after receiving the final draft; and

  (c)   have regard to any comments given by the State/Territory Health Minister within the 15-day period mentioned in paragraph (b).

Local hospital networks and public hospitals—final draft to be given to manager of entity or facility on an "information-only" basis

(6) If the report indicates poor performance by:

  (a)   a local hospital network in a State, the Australian Capital Territory or the Northern Territory; or

  (b)   a public hospital in a State, the Australian Capital Territory or the Northern Territory;

then, at least 15 days before completing the preparation of the report, the Performance Authority must give a copy of the final draft of the report to the manager of the network or hospital. The manager of the network or hospital is not entitled to give the Performance Authority any comments about the final draft.

Consultation—general

(7) Before completing the preparation of the report, the Performance Authority may consult such persons and bodies as it considers appropriate.

(8) However, if the report indicates poor performance by:

  (a)   a local hospital network in a State, the Australian Capital Territory or the Northern Territory; or

  (b)   a public hospital in a State, the Australian Capital Territory or the Northern Territory;

the Performance Authority must not consult, and is not otherwise obliged to observe any requirements of procedural fairness in relation to:

  (c)   in the case of a local hospital network:

     (i)   the manager of the network; or

     (ii)   an employee of the network; or

     (iii)   the manager of a facility that belongs to the network; or

     (iv)   an employee of a facility that belongs to the network; or

     (v)   any other person who provides services in a facility that belongs to the network; or

  (d)   in the case of a public hospital:

     (i)   the manager of the hospital; or

     (ii)   an employee of the hospital; or

     (iii)   any other person who provides services in the hospital.

(8)   Schedule 1, item 130, page 29 (after line 24), after section 66, insert:

66A Policy principles—COAG

(1) COAG may give written policy principles to the Performance Authority about the performance of the Performance Authority's functions.

Note:   For variation and revocation, see subsection 33(3) of the Acts Interpretation Act 1901.

(2) The policy principles are to be given in accordance with a written resolution of COAG passed in accordance with the procedures determined by COAG.

(3) The Performance Authority must publish a copy of the policy principles on its website.

(4) The Performance Authority must not perform its functions in a manner that is inconsistent with the policy principles (if any).

(5) The policy principles are not legislative instruments.

(9)   Schedule 1, item 130, page 38 (line 30), omit "Minister.", substitute "Minister; or".

(10)   Schedule 1, item 130, page 38 (after line 30), at the end of subsection 90(3), add:

  (c)   a function or power under Part 3.7.

(11)   Schedule 1, item 130, page 39 (line 21), omit "Minister", substitute "Performance Authority".

(12)   Schedule 1, item 130, page 39 (line 24), omit "Minister must consult the Performance Authority", substitute "Performance Authority must consult the Minister".

(13)   Schedule 1, item 130, page 40 (line 4), omit "Minister", substitute "Performance Authority".

(14)   Schedule 1, item 130, page 40 (line 28), omit "Minister", substitute "Performance Authority".

(15)   Schedule 1, item 130, page 41 (line 10), omit "Minister", substitute "Performance Authority".

(16)   Schedule 1, item 130, page 41 (line 12), omit "Minister determines", substitute "Performance Authority determines with the written agreement of the Minister".

(17)   Schedule 1, item 130, page 41 (line 21), omit "Minister", substitute "Performance Authority".

(18)   Schedule 1, item 130, page 41 (line 23), omit "Minister", substitute "Performance Authority".

(19)   Schedule 1, item 130, page 41 (lines 25 and 26), omit "Minister must notify the Performance Authority", substitute "Performance Authority must notify the Minister".

(20)   Schedule 1, item 130, page 41 (line 28), omit "Minister", substitute "Performance Authority".

(21)   Schedule 1, item 130, page 41 (after line 29), after subsection 100(1), insert:

(1A)   The Performance Authority may terminate the appointment of the Performance Authority CEO if the Performance Authority is satisfied that the Performance Authority CEO's performance has been unsatisfactory.

(22)   Schedule 1, item 130, page 42 (line 1), omit "Minister", substitute "Performance Authority".

(23)   Schedule 1, item 130, page 42 (line 16), omit "Minister", substitute "Performance Authority".

(24)   Schedule 1, item 130, page 42 (line 19), omit "Minister must consult the Performance Authority", substitute "Performance Authority must consult the Minister".

(25)   Schedule 1, item 130, page 42 (line 23), omit "determined by the Minister", substitute "determined by the Performance Authority with the written agreement of the Minister".

(26)   Schedule 1, item 130, page 47 (after line 11), after subsection 112(3), insert:

(3A)   Before completing the preparation of the plan, the Performance Authority must:

  (a)   give a copy of a draft of the plan to each State/Territory Health Minister; and

  (b)   invite the State/Territory Health Minister to give the Performance Authority written comments about the draft plan within 30 days after receiving the draft plan; and

  (c)   have regard to any comments given by the State/Territory Health Minister within the 30-day period mentioned in paragraph (b).

(27)   Schedule 1, item 130, page 49 (after line 24), after section 116, insert:

116A Disclosure to a State/Territory Health Minister

     An official of the Performance Authority may disclose protected Performance Authority information to a State/Territory Health Minister.

(28)   Schedule 1, item 130, page 49 (lines 25 to 27), omit section 117.

(29)   Schedule 1, item 132, page 55 (lines 15 to 28), omit the item, substitute:

132 Appointment of acting Performance Authority CEO

(1) The Minister may, before the end of the 6-month period beginning at the commencement of this item, appoint a person to act as the Performance Authority CEO during a vacancy in the office of the Performance Authority CEO, so long as no appointment has previously been made to the office.

(2) An appointment under subitem (1) is to be made by written instrument.

(3) Anything done by or in relation to a person purporting to act under an appointment under subitem (1) is not invalid merely because:

  (a)   the occasion for the appointment had not arisen; or

  (b)   there was a defect or irregularity in connection with the appointment; or

  (c)   the appointment had ceased to have effect; or

  (d)   the occasion to act had not arisen or had ceased.

Note:   For more about acting appointments, see sections 20 and 33A of the Acts Interpretation Act 1901.

(4) If a person is acting as the Performance Authority CEO in accordance with an appointment under subitem (1), the Performance Authority must not appoint anyone, under subsection 94(1) of the National Health Reform Act 2011, to act as the Performance Authority CEO.

(5) If, immediately before the end of the 6-month period beginning at the commencement of this item, a person is acting as the Performance Authority CEO in accordance with an appointment under subitem (1), the appointment is terminated at the end of that 6-month period.

(6) Subitem (5) does not prevent the person from being appointed by the Performance Authority, under subsection 94(1) of the National Health Reform Act 2011, to act as the Performance Authority CEO after the end of that 6-month period.

As mentioned in my summing-up speech, these amendments take into account the resolution of a meeting of health ministers that was held on 7 June which supported in principle this legislation with these amendments. It is very important to note that these amendments give the National Health Performance Authority the power to appoint and dismiss its own CEO; set mechanisms for notification of poor performance to states and territories, local hospital networks and hospitals; deal with the definition of public hospitals and local hospital networks; consult the states on the strategic plan; allow for disclosure of information to state ministers; and deal with the act's functions.

It is not right, as the member for Lyne and on occasions the opposition have put it, that these changes give the states power to do what they want in hospitals. Nothing could be further from the truth. This bill, with these amendments, will introduce the most rigorous performance measures that have ever existed in Australia's history for our hospital system. That is of course why the states fought hard to make sure that the detail was practical. As systems managers of our hospital system, they would be aware of and responsible for the fixing of problems within our hospital system—something I would think all members would be keen to support.

These amendments have, by the nature of the process for getting agreement through a COAG arrangement, been subject to extensive consultation with my state and territory colleagues. They also address issues that were raised through the Senate Community Affairs Legislation Committee hearing. These amendments will ensure that the act has the support and cooperation of state governments so that the authority can properly undertake its role as a watchdog of public hospital, local hospital network, private hospital and Medicare Locals performance.

By addressing these amendments we will achieve what has long been wished for in the Australian health system: independent, hospital-by-hospital reporting of performance. I cannot think of anything that is a better indicator of how we will improve performance year after year after year than making sure that we have an independent system which assesses the performance of each hospital and allows us to make sure that those that are underperforming improve and those that are doing well can be copied around the country. I am very proud of these amendments and the bill as a whole. I think it is a historic part of our agreement, and I think the view that the states and territories might occasionally like to have put in the media that they had a big win on this just is not supported by the evidence of what is in this bill and these amendments. I commend these amendments to the House.

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

Since I last contributed to this debate on the National Health Reform Amendment (National Health Performance Authority) Bill, significant developments have taken place. The most significant development is that the states have completely and utterly won out in this debate against the Commonwealth. I want the House to understand—and I am going to ask the Minister for Health and Ageing some questions in a moment but I think the Australian public has seen it for what it is— that what has taken place here is that the Prime Minister was desperate to claim to the public that she had had a win. This Prime Minister was desperate over the break to try and flick the switch away from the carbon tax and she was wanting to say to the Australian people that on health reform the Commonwealth was able to strike a deal.

Let us look at the circumstances under which the Commonwealth has been able to strike this deal, and some of it has been discussed in the contribution of the member for Lyne. Essentially, the government has agreed to continue business as usual in Australia's 750 public hospitals in return for the agreement of the states—in particular, the states that held out, namely, Western Australia and, to a lesser extent, Victoria. It has meant a huge bucket of money. The states have got a huge amount of money and there are 29 amendments to this legislation to try and accommodate the capitulation of the Commonwealth to the states. So the Commonwealth again has got itself into a financial bind where this incompetent federal government has said to the state premiers, 'To get a signature on the paper we will do whatever it takes.'

Could you imagine negotiating any sort of business contract in the real world on this basis? Go to BHP and say, 'We are desperate to do a deal with you and, whatever condition you put in the contract, know that we will sign it.' That is basically what has happened here. This government is desperate and on its knees, and it cannot manage money. In trying to give the public the perception that some sort of grand health deal has been done, the Commonwealth has sold out not only this government but also future governments. Future legislators in this place will be bound to this incompetent and lazy deal. It is not good for parliament, it is not good for the Australian people and, most importantly and it is not good for the doctors and nurses that work in public hospitals or, indeed, the patients who access the services. I think it is right that this minister is condemned yet again for the latest failing in the so-called health reform debate.

I might say as part of this contribution that I welcomed some of the words from the member for Lyne, who I think has a genuine interest in the area of health reform. The sincerity stops, I am afraid to say, where the member for Lyne—in spite of having made all of those statements before: that this is bad legislation; that basically the Rudd vision that he was tied up to, quite willingly, has now been abandoned; that the states have won out; and that we are going to have business as usual at a huge cost to the Australian taxpayer—is still going to support this legislation. I think it is disappointing because, as I said, I think he does have a genuine belief in wanting to reform our health system—as we all do.

But we are not going to get that if we end up with the government's own legislation being amended 29 times before the bill has even passed the parliament. Just to put that into context: this is a government that has had to amend its own bill in 29 different areas. Basically, it completely undermines the intent of the original bill. The intent of the original bill was to vest certain powers in the Commonwealth so that we could drive efficiency, productivity and changes in the hospitals, which are owned and managed by the state governments. The member for Lyne has said, 'I'm going to oppose these amendments because I think they weaken the original bill'. He is not going to oppose them, knowing that the other Independents will support his position so that ultimately the amendments would go down. The member for Lyne has decided ultimately to support the bill, which I think undermines credibility in this debate. I think that it has to be put on the record, because I suspect that the member for Lyne would not oppose these amendments if the member for Lyne knew that he could possibly defeat them.

In this debate people should really put their cards on the table, because this is bad legislation. The member for Lyne, who, as I said, does have a genuine interest in health reform, acknowledges that this is just the latest example of a failure to deliver on health reform in this country. I would like to ask the minister: can this minister point to anywhere in this legislation where the Commonwealth has the final say in relation to any aspect of the bill before the House?

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

I will talk specifically about the amendments, but I cannot let the somewhat obsessed commentary on my sincerity go without a response.

I am here participating in this debate with sincerity for the right outcomes, as I hope all members of this chamber are.

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

Well, vote against the bill!

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

If you listened closely to what I said: I said that with regard to the substance of the bill I think it is an inch further than where we were before, but it is a mile short of where we could be. In language that is as simple as I can possibly make it, it is a step forward but it is a lost opportunity for where we could be. If you think that fails a sincerity test then I think that is a disappointment that reflects poorly on you, sir, the member for Dickson, in your running commentary in a partisan way.

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

Why don't you hold out and get a better deal?

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

Order! The member for Dickson was heard in silence. He will extend the same courtesy.

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

And in response to the interjection as to why I am running a commentary on the member for Dickson, it is in response to his running commentary on me. I would not have commented otherwise.

With regard to the amendments before the House: I think they are a watering down of where we could be. In fact, I like the substance of the legislation and the bill that was originally put before the House. That is the bill I want to support, not reject, as the member for Dickson seems confused about. I want to support a National Health Performance Authority that is unfettered in its business in the way it works through the various hospital and health providers and reports accordingly for good or for bad.

I understand administrative principles of natural justice and procedural fairness, particularly in relation to individuals who work within the public sector—in fact, for all Australian citizens. I think that principle does not stand as much for state bodies that may feel aggrieved if there is a poor performance report around a particular hospital. These amendments seem all about what I consider to be the weak argument of procedural unfairness that has been run by the states in an effort to try to get some buy-in with regard to command and control back within the health and hospital reform agenda.

I will quote some examples. Amendment (4) to section 62:

(4) If the report indicates poor performance by:

  (a) a local hospital network in a State, the Australian Capital Territory or the Northern Territory; or

  (b) a public hospital in a State, the Australian Capital Territory or the Northern Territory;

Then there is this process where a copy of the draft of the report has to be given to the state or health minister; there has to be an invitation to the state and to the health minister to give the performance authority written comments about the draft report within 30 days; and there has to be regard to any of these comments.

If we are serious about an unfettered performance authority and genuine independence, and with reliable data—and I accept COAG reform, and McClintock and crew have been talking about poor data within many systems and the timeliness of that data—do not buy the argument that there is procedural unfairness, that the states seem to be treated unfairly if under the performance authority rules of engagement a particular hospital is found with poor performance. Based on the unfettered powers that they may have, I do not accept procedural unfairness to the state. Yes, I think we have to protect individuals—hospital managers and any of the health workforce—but as far as the states are concerned, I think they should cop it and they should do what they can to improve whatever the performance authority publicly releases either to the parliament or to any other body.

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

Well, move that amendment!

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

I am going against these amendments, member for Dickson. I cannot understand your confusion with regard to how explicit I have been. I support the original legislation before the parliament. I do not support these.

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

Move an amendment to strengthen it up!

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

I do not support these. I do not want to amend them; I do not support them. I do not understand your confusion or your interjections, sir. You will get the right to speak again, and hopefully you can explain yourself.

I also have a problem with the states having input into the work plan of the performance authority. This should be the equivalent of an integrity body that has its own work program, not one that has the states or the Commonwealth directly inputting into that work program.

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

I am happy to take all of the comments. This is consideration in detail. I am happy to take any objections, questions and queries that people have and deal with them all at once. I do not think that it will serve the House that well for us to prolong this if there are not new issues to discuss.

I think we need to bring some of the detailed information back to the focus of the House, and I can pick up the points that the member for Lyne is making and some that the shadow minister is making. I think people are confusing things and alleging things about the original bill that was put forward. At the time that it was put forward we clearly stated that there were still to be negotiations with the states and territories and that amendments would be moved; we said that on day one. We also acknowledged that there was a lot of interest and that there would be inquiries in both the House and the Senate, and we understood that that might lead to some changes. That is the sort of open policymaking that people ask for from governments. Yes, you could do it differently—you could have an exposure draft; you could do some negotiations first—but ultimately the parliament enables this process, and we have been pretty up-front about it. So I do not think there is anything peculiar in the way that the member for Dickson seems to be suggesting—that, because there are a lot of amendments, that is somehow a bad reflection on the process. I think it actually shows that the process, as we indicated from the beginning, has worked quite well.

But where the confusion seems to come in is that these amendments are being seen as a removal of Commonwealth power when actually what this legislation is establishing is an independent body. It is not a body that is going to be controlled by the Commonwealth. It is not a body where we are asking for final control. It is a body where we are saying that we should remove from the political agenda an assessment of performance hospital by hospital. A vast number of those 29 amendments make clear that it will be more independent from the Commonwealth than the original draft. It is not moving from the Commonwealth to the states but moving from the Commonwealth—for example, the minister having the ability to employ and dismiss the CEO—to giving the board the power to do that. I think that that actually increases the assertion that we have made from the beginning that this is an independent body. It makes it even clearer that we are serious about it being an independent role.

The example that the member for Lyne raised, which is a significant one, goes to some practical objections that the states and territories had about when they are the ones that are required to help improve a hospital facility if it is found to be lacking in performance, which is the very thing that the member raised at the end. What I want them to do if there is a performance problem is get on with fixing it. They asked that they have the opportunity, in a very short time, first to check that the data is correct—and unfortunately in health this has been a problem that has dogged the system, so I think it is not an unreasonable request from people who want to make sure data is correct—and second to be able to get on straightaway with fixing a problem while this process of reporting continues. From my perspective, for the patient that is a good thing. It means that the states are asking for that information to be given to them early so that they can respond and fix performance problems early and so that for patients we have things picked up more quickly.

I can understand that people might have some scepticism. There has been a fair bit of history in a lot of parts of the country where there is not always confidence that the states have done what they ought to in particular areas. What the Commonwealth is interested in doing with our reforms—and this legislation is a big part of it—is making much clearer the lines of responsibility of who does what, who fixes what, how we know when something needs to be fixed and how we make sure the performance is publicly available to people. And we will be. I know as the health minister that every member in this House, if their hospital is found not to be performing properly by this Health Performance Authority, will be in here asking me about what else can be done to fix it. That is how this sort of reporting drives improvements in the system.

So I do not accept the criticisms that are made. I do understand that a number of them are made totally in good faith, but this is a huge leap. It is not an inch further from where we were; it is a huge leap from where we were. I am sure that, over coming years and in the future, people will watch how the performance authority works and may well seek to improve it even further in the future.

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

I will be brief and will just clarify any perception of confusion. I accept the minister's argument that this is the movement from the Commonwealth to an independent authority and not necessarily an ongoing running battle between the Commonwealth and the states, but I would also put on the record, Minister, that I know independence and this is not independence. That is the concern specifically about the amendments. I refer you to the policy principles of COAG at proposed section 66A, where it is COAG itself that is giving written policy principles to the performance authority about the performance of the performance authority's functions. COAG, if I read it correctly, will be a gathering of health ministers, state and federal, and therefore it remains a part of the political process. Likewise, with the similar issues around amendment (26) in regard to who decides the work plan of the performance authority, it is by agreement, as I understand it and read it, between the state and federal health ministers. That is arguably much more a political decision than an independent one.

So I fully back the concept of an independent performance authority with unfettered powers alongside an audit office, an ombudsman and inspectors-general of defence or taxation. If we are serious about establishing an independent body, it needs to be unfettered and to be genuinely removed from the political process. These 29 amendments are the political process using its claws, and particularly the states, to work against what is a very good concept as part of the health reform agenda. So no confusion, just disappointment. Maybe it is a reality of negotiations in a federated system that once again the Commonwealth takes a bullet as a consequence of having to negotiate with states. But I, as the local member representing my people in the federal parliament, in what I consider the 'common wealth' parliament, should not accept this incursion from the states once again. In 2008, it was finding ways to get around state command and control which was one of the fundamental reasons we were doing what we were doing.

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

I welcome some of the comments in the Minister for Health and Ageing's previous contribution, but I think they go further to underscore the fact that this is a terrible deal for the Commonwealth. As we mentioned before, when Kevin Rudd won the 2007 election the promise was that hospitals would be federally funded but locally run. As a principle, that is admirable. As the member for Lyne has commented on a number of occasions, that would have been a better and more desirable outcome. But the more we look in detail at these amendments the more we see the way in which the Commonwealth has capitulated.

Far from being a federal takeover or a greater concentration of funding power to try to drive changes, this has been a takeover in reverse. The states have effectively usurped the Commonwealth's power in relation to this bill and, I suspect, many others that we will see before the parliament. I asked the minister a very specific question about in what area the Commonwealth might have a final say. The minister tried to fob that off by saying that this was an independent authority, but if you look at the government's original intent in relation to this authority certain appointments were made by the minister, by the Commonwealth, and certain obligations were imposed on the authority by the Commonwealth. The Commonwealth's intent was very clearly to try to drive this performance authority so that we could see better outcomes in our public hospitals.

It is abundantly clear—and it should be clear to all Australians—that this is yet another demonstration of a bad government in action. This is a government that has locked this nation's healthcare future in mediocrity. This is a situation that is of the Prime Minister's own making. In a way I feel for the current health minister because not only was she gazumped by Prime Minister Rudd but also she has been completely sidelined by this Prime Minister. It is humiliating for a minister, particularly for a cabinet minister, when that cabinet minister is put to the side because he or she has no capacity to deliver the outcome that the Prime Minister desires. I think that is part of what has happened here. The minister cannot come before this House with a serious and sincere look on her face and say that this is what she intended out of this process.

There is no final say for the Commonwealth, as there was in the original draft of the legislation, because the states have their fingerprints all over this bill. We can have a debate about federalism and the role of the states in the health system. That debate will no doubt take place in coming years, as it has in previous years. But people should be under no illusion that this does anything to end the blame game, to fix public hospitals, to improve standards. You only have to look at the detail. There is no financial penalty. I asked the minister what happens in a situation of proven incompetence or demonstrated poor clinical outcomes in a public hospital continuing under this process. What power does the Commonwealth have, without having to consult the states or territories, to deliver some sort of financial penalty on the states? What sorts of powers does that extend to?

I know that sometimes, particularly given 29 amendments have been moved, some of the detail gets brushed over. But there is a benefit in putting on the record what some of these amendments entail. I only have a short time, but I intend to detail a couple which serve to underscore our argument that this is a bad deal. Amendment (2) goes to amend section 5. It provides a definition of public hospitals, which is fine, and adds these words:

If a facility is situated in a State, the Australian Capital Territory or the Northern Territory—

it is hard to imagine where a facility could otherwise be situated; so a public hospital anywhere in the country—

the Minister must not specify the facility in such an instrument without the written agreement of the State/Territory Health Minister of the State or Territory, as the case may be.

Ask yourself why the Commonwealth did not see fit to put those words into the original legislation, but does now. As I said, it goes to this federal government having completely given up on any reform. They were desperate to do a deal that they have surrendered everything that was going to provide capacity to improve our public hospitals which is what the Australian public demand. I have some other amendments which I will go to shortly, but I ask the minister to address directly those issues so that I can have a response to that particular question. (Time expired)

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

This is not a Q and A session. This is a debate on the amendments. If the shadow minister wants to tell the House his other concerns, I am happy to listen to them and respond to them when he has done so.

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

The Minister for Health and Ageing is having difficulty. My question went in particular to what financial penalty the Commonwealth could impose without consultation with the states and territories if there has been proven clinical failure, demonstrated incompetence or a failure of management at a particular hospital. If we saw, for argument's sake, the premature birth of a baby in a public hospital toilet outside an emergency waiting room, what could the minister do under this legislation that she cannot do now? They are important questions and they go specifically to the amendments.

It is not for the minister to try to usurp the process of this parliament. The minister has to provide detailed responses. That is what the minister is obliged to do. Minister, what could you do if that happened in a public hospital today that you could not do under the previous arrangements without the aid of this legislation? I have further contributions to make.

Tanya Plibersek (Sydney, Australian Labor Party, Minister for Human Services) Share this | Link to this | Hansard source

Mr Deputy Speaker, I seek your advice on whether this is a Q and A session or Senate estimates, or whether we are now dealing with the amendments to the legislation.

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

My response is that the House is considering the bill in detail. Are there any further speakers on the question that the amendments be agreed to?

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

I am comfortable with providing comment on amendments if members want to raise questions on it. I am not going to allow this parliament to descend into a rambling Q and A from a shadow minister who has not asked me a question in question time for two years and is asking a question about something which is actually not the remit of this bill. He wants to know if there are financial penalties. This bill does not deal with financial arrangements between the states and territories.

This bill and the amendments deal with the reporting of poor performance. He might want to ask, if there is that poor performance, what other sorts of financial impacts are there? But he cannot turn this debate into a general Q and A session when he cannot get through his own tactics people a question in question time and has not bothered to ask me a question about health or health reform for two years in question time. He cannot now come in here and try to use this for a rambling discussion about a whole range of other things.

What we have before us is a detailed bill which is a fundamental change to the way that performance is going to be reported about our hospitals. It is going to provide much more information to the public and it is going to have a much more rigorous assessment process so that states and territories are not able to have poor data or, in an even worse scenario, have it somehow presented in a way which is fraudulent, as unfortunately we have seen with a couple of reported cases in various hospitals across the country. No state or territory wants that to happen either, so this is now a process, and, with the amendments, is an agreed procedure between the states and the territories.

I am very comfortable that it gives the new independent authority far-reaching power to do things that have never been done in our federation before. I accept that there are people in this House, and the member for Lyne is clearly one of them, who think that they are good steps but would like it to go even further. I accept that there are people who have that view, and I would imagine that there are people in that category who—once this bill is passed, if it is passed, and once the authority is set up—will be campaigners who will see what it delivers and will want to argue for further change into the future.

But that is different to coming in here, as the federal opposition is doing, and having a general spray about every issue that they are frustrated about not being able to raise elsewhere and expecting me to enter into a debate with them about it. There are other forums of this House. Bring on a matter of public importance. Do some work yourself and move an amendment, rather than interjecting that the member for Lyne should move one if he feels strongly about this. Where are yours on that, if you think this is such an important issue? Let us actually use the parliament for what is intended. We are clearly going to have to agree to disagree. We get an opportunity to vote on these amendments.

I understood, when I came into the House and asked the shadow minister if he was voting for these amendments, that he said yes. Now he has a whiff that the member for Lyne is not, so the opposition have changed their minds and now are not voting for the amendments. This is the sort of policymaking that the federal opposition are into. They are not actually reading the bill. They are not making a decision about whether this is good or bad policy. They are looking at the politics. They think that if they have got one Independent they will be able to knock off this bill and that might be an embarrassment to the government, so they will jump on it.

None of this is to do with any desire that the shadow minister has for hospitals to improve their services across the country. I am very confident that this bill, if enacted, will deliver fundamental change to the way we report hospital performance across the country. It is on that basis that I commend the bill to the House, and I think that if the shadow minister does not have anything to say that is relevant to this debate then we should put the question that these amendments be agreed to.

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

Just to clarify a couple of facts in this debate, I have been asking questions on health in this place. I have asked them of the Prime Minister over the course of the last two years because we cannot get a straight answer out of this health minister. We moved an amendment in relation to this bill only a few minutes ago. I am not sure if the minister recalls that debate and, in fact, that vote. If it rings a bell, Minister, we did move an amendment, which the government, of course, did not support.

I want the minister to provide in detail some response, as is required in this debate by any standard. The minister put before that essentially I wanted answers but then provided no answer. This is a performance authority, yes, but if there is not performance, what is the penalty? Is there a financial penalty that is imposed? Is money withheld? Can you demand from a state health minister particular outcomes at particular hospitals?

What happens, Minister, if we see a tragic situation occur in a public hospital in a month's time after this legislation receives royal assent? How does that differ from your response today? What is the purpose of this legislation if you cannot direct change in our public hospitals? What is the purpose, if you have surrendered every aspect of responsibility that the Commonwealth wanted from this piece of legislation and you have provided that to the state and territory ministers? What has all of this debate been about over the course of the last three or four years, where the Labor Party have said that they want to fix public hospitals? That is a promise that has long been abandoned.

Can the minister answer the question? If performance does not improve—in fact, if it deteriorates—in a public hospital somewhere in the country, what can she do as a result of this legislation? These are basic questions that the minister continues to refuse to answer. If people can look to this government and see any sincerity in what it is they are proposing by this legislation then I think the minister needs to get to her feet now and answer these reasonable questions so that we can at least have some faith that we are moving forwards and not backwards.

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

I think we are going to be in for a very long and unedifying toing and froing, because I am answering the shadow minister's question by explaining to him that this piece of legislation does not deal with financial penalties to the states. It did not when we introduced it into the House and it does not with the amendments that are moved today. This is a fundamental misunderstanding by the shadow minister of the purpose of performance reporting. The purpose of performance reporting is not solely to be able to deal with one isolated, tragic incident that might occur in a particular hospital. We all know that the reality of people being unwell and presenting at hospitals can have tragic consequences. This is about moving beyond one isolated, tragic circumstance and looking at how we actually lift the standard across the board, across hospital services and across each and every hospital in the country. This sets up a system that enables us to provide information that is collected at arm's length and rigorously checked and therefore can be held up to the states, as systems managers order the local hospital networks to say: 'This is your performance. Look how it compares to everybody else's. You need to lift your game, and we will give you resources to do this and we'll do a whole range of other things.'

The shadow minister for health cannot come in here and ignore every other part of the health reform bill and use this as an opportunity to have a general spray at the government. I know he does not agree with a whole range of things. Frankly, I am a little bit surprised to hear him say that he is now a big advocate of the reforms that were proposed by Prime Minister Rudd, because I seem to remember him and his leader in here ranting and raving, opposing them. Now that an agreement has been struck with every state and territory leader—which is different from but maintains the fundamentals that were put forward by Prime Minister Rudd—they are now actually advocates for that.

Those opposite have no idea what sort of health policy they would adopt if they were in government. They did not take any policy to the last election and they are not formulating any that they are making clear here. Whilst I am happy to answer genuine questions about matters that relate to this bill and the amendments, it is not an opportunity to raise each and every other issue. I cannot be clearer in answering the question: this bill and these amendments do not go to any financial arrangements between the states and the Commonwealth.

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

The question is that the amendments be agreed to. I hope the minister and the shadow minister have something new to contribute; that would be helpful.

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

If we could see something new in this debate that provided us with some promise, some hope—even a slight glimmer—we would be happy, let me tell you, Mr Deputy Speaker Thomson. I think what the Minister for Health and Ageing has just done is bell the cat on what a failure this bill is. If members of the Australian public read this bill, the National Health Reform Amendment (National Health Performance Authority) Bill 2011, they would look at the words 'National Health Performance Authority' and presumably, like me, think it was about the performance of our public hospitals and an authority that would improve that performance. But what the minister has basically just said is that what they are doing—again, in true Labor style—is creating yet another health bureaucracy. This was the great failing of the state Labor premiers: every time they received more money in Health, they did not put it into doctors, nurses or beds; they put it into new bureaucracies. The fact is that this is what is happening at a federal level.

This is a new bureaucracy, a toothless tiger. It is going to gather statistics and look at poor performance and, in the end, do nothing about it. That is, I think, the best way to sum up this government's approach not just to health but to the whole running of government. This government has lurched from one policy disaster to the next, and now that dangerous disease has infected the health portfolio. This is a government that promised to increase performance, but at every turn—and we see the evidence in black and white in these 29 amendments—we see that they are not going to do anything more than give additional and overriding powers to the state premiers.

I want to take the House to government amendment (7), which abolishes or strikes out the previous section, which had additional provisions about reports. Basically, there is a whole section that has been rewritten. Subsection (6) of the amendment reads:

If the report indicates poor performance by:

(a)   a local hospital network in a State, the Australian Capital Territory or the Northern Territory; or

(b)   a public hospital in a State, the Australian Capital Territory or the Northern Territory;

then, at least 15 days before completing the preparation of the report, the Performance Authority must give a copy of the final draft of the report to the manager of the network or hospital.

But listen to this:

The manager of the network or hospital is not entitled to give the Performance Authority any comments about the final draft.

The government have gone completely insane with their proposed 29 amendments. This amendment takes away any meaningful capacity, once they have identified a poor performance, to do anything about it. That is why even the No. 1 ticket holder for this government, our friend the member for Lyne, says that this is a watering-down, this is bad policy and these amendments make bad policy worse. I think this is an opportunity for the member for Lyne and others to vote against these bad amendments. We will be voting against this bill because we believe that these amendments make a bad bill worse.

Ms Roxon interjecting—

That is the problem that this minister has. She has absolutely no capacity to deliver what is said publicly. There are other amendments which are worthy of noting, but in many parts they basically go towards withdrawing the minister's own capacity. I take the House to amendment (11), which alters section 93 of the bill. Subsection (1) says:

The Performance Authority CEO is to be appointed by the Minister.

That is in the bill in its original form. In the amendment, 'minister' has been struck out, with the performance authority CEO now to be appointed by the performance authority. Subsection (3) says:

Before appointing a person as the Performance Authority CEO, the Minister must consult the Performance Authority.

The minister, who has carriage of policy in this area, under the original bill had the power to make the appointment and was required to consult the performance authority on that. Otherwise, the minister was not overwhelmed with considerations; she just had to consult them. But government amendment (12) strikes out the words 'the minister must consult the performance authority' and inserts in its place the words:

Performance Authority must consult the Minister.

The minister does not have final say. The minister can provide some sort of feedback or response, like she is some sort of subservient public servant providing advice to a minister. The relationship has been flipped and it completely undermines this process. (Time expired)

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

The question is that the amendments be agreed to. All those of that opinion say aye, to the contrary no. I think the ayes have it.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

Mr Deputy Speaker, I was on my feet.

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

No, you were not.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

I am on my feet.

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

Yes, but I have put the question. I think the ayes have it. Is a division required?

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

On a point of order, Mr Deputy Speaker: I will seek to dissent from your ruling. Clearly, the member was on his feet seeking the call.

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

The member was not on his feet seeking the call so I put the question.

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

Then I will seek to dissent from your ruling.

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

Mr Deputy Speaker, on indulgence, if it would help the course of the debate, I think in the circumstances it is reasonable to hear from the shadow parliamentary secretary for health in a succinct way and this is the process. That would preclude other courses.

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

I understand the spirit in which that is offered. The fact is that the member for Boothby was sitting down. I therefore called for the division. For a member to rise after a division having been called, they are not entitled to get the call and to speak.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

Mr Deputy Speaker, we have not gone into a division. We are in the consideration in detail stage. We are still discussing the bill and the minister had had no chance to respond to the issues raised by the shadow minister.

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

Mr Deputy Speaker, on the point of order, if I might contribute here, it would be a very unusual process and it is no doubt provoked by the toing and froing. I do not think it is in the House's interest for there to be a dissent from a Speaker's ruling. I am comfortable—

Mr Dutton interjecting—

If you would actually listen to what I am about to say, it might be helpful. For once, it will take two seconds for you to sit quietly while I say it was probably in the House's interest to be able to hear any other speakers, but I do think it is timely to bring this debate to a close. The shadow minister has spoken probably 10 times and not raised anything new. The member for Boothby has not spoken. It is an awkward position because the Deputy Speaker rightly put the question when no-one was on their feet. But I am certainly comfortable, if it assists the House and the chair, for members to be able to make contributions. We are not seeking to stop that but, ultimately, the contributions should be about this debate and then we should bring the debate to a conclusion and allow the vote to be taken.

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

If the member for Paterson wishes to withdraw his dissent, I will allow further discussion on the question that the amendments be agreed to.

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

I withdraw, given your statement, Mr Deputy Speaker.

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

I call the member for Boothby.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

In speaking to the government amendments, I am interested in amendment (7) and the scope of the report. Specifically, what this amendment talks about is the reports prepared by the National Health Performance Authority which will indicate poor performance by any of the following entities or facilities, and it goes on. Specifically under this section it talks about 'any other body or organisation that provides healthcare services'. My question to the minister is: does this encompass primary healthcare services which are delivered by the state governments? Does this cover the ambulance services which are covered by state and territory legislation? Does it cover, for example, the child and adolescent mental health services which are covered at the state level? Does it cover any other primary care services which have been areas of responsibility for states? Most importantly of all, does it cover general practice?

The RACGP have been particularly interested in this issue. I am seeking clarification on this because the clarification is not there in the bill. It says in this proposed amendment by the government, which is amendment (7), to clause 62(1)(e), 'any other body or organisation that provides health care services'. I am asking the minister: does it cover any of the organisations which I have mentioned? What is the scope of the reports prepared by the performance authority? Do they cover general practice? Do they cover those primary healthcare services which are currently delivered by state governments and which are enshrined in state and territory legislations?

My other question on this is: does the minister require the permission of the state or territory minister for health in those areas which are state primary healthcare services, state-run community healthcare services, state-run community mental health care services and state-run ambulance services and are they covered by the scope of these reports?

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

I am happy to answer a question on an issue for debate which is actually on the topic of this legislation and amendments. As is set out clearly in the detail of these amendments, the bodies that the Health Performance Authority will report on are public and private hospitals, local hospital networks and Medicare Locals. As the member for Boothby would know, Medicare Locals do have a remit which goes broadly across a particular community and will include the level of services, for example, provided by GPs in the community. It is not a reporting function about individual GPs, if that is the question that you are asking.

On the question of the scope to report on other state funded services, for example ambulance services that have never been included as part of the health system although they are obviously a vital part of how the health system works, they are not captured by this reporting. There is a provision, as the member for Lyne mentioned, that COAG can agree to extend the remit of the Health Performance Authority, so it might in its negotiations decide that X, Y and Z in the future should also be reported upon, and that would be something that the performance authority then would be able to do. It has been created by an agreement of COAG. This legislation gives force to that agreement struck by COAG. Its reach and remit does not extend beyond that agreement unless there is a future agreement that extends it.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

I am seeking further clarification on the same amendment—amendment (7). Proposed section 62(1) talks about the scope of the reports prepared by the performance authority and specifically about the entities or facilities which it can report on and it says in paragraph (e):

any other body or organisation that provides health care services.

As we stand here today with the current COAG agreements, are there any bodies or organisations that are covered by this paragraph? Is this just a catch-all paragraph that will allow any future decisions of COAG to include things? Does it include, for example, local government authorities that are offering immunisation services? Does it cover, for example, the Royal District Nursing Service? Does it cover things like home visits by nurses as well? I am seeking clarification from the minister as to the scope of proposed paragraph (e), which states:

any other body or organisation that provides health care services.

On reading it, it could be extremely broad. From what the minister has said, it is not envisaged that a number of the areas I have mentioned—such as the state primary healthcare services and general practice—are included by this paragraph. So what is included by this paragraph?

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

Again my question relates to the scope of amendment (7) and proposed section 62(1)(a) that covers the local hospital network. Mindful that data is already collected by the Commission on Safety and Quality in Health Care and by the COAG Reform Council around performance measures in hospitals—and obviously the AIHW performs an important role—I want to know what is in this legislation to avoid duplication of data collection, collecting data that has different baselines and benchmarks collected from different periods and collecting data that is unable to be compared accurately. What are the arrangements between the four bodies I mentioned to ensure that that reporting is harmonised so we can make sense of different reports, minimise the overlap and ensure there are not data omissions? Finally, which of these NHPA rated responsibilities for data collection could not have been done already by those existing three bodies?

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

I will deal with both of those contributions. I refer the member for Boothby to amendment (5), which requires COAG agreement to extend the scope. Amendment (7) deals with the way reporting works but not the scope of what else can be reported. I think that should satisfy his request for clarification.

The member for Bowman raised a very legitimate question about the range of data that is already collected and also concerns about timely data and comparable data. One of the big changes that have been agreed to by the states and territories as part of this negotiation and the introduction of the performance authority is the streamlining of reporting so it is more timely, comparable across jurisdictions and able to be provided hospital by hospital. The Health Performance Authority will work with those existing datasets and in some areas create new datasets to be able to do its job properly. So a range of things that were not available before will be available when the Health Performance Authority is able to do its work properly. We will have truly comparable and timely data about each hospital across jurisdictions.

Health ministers have already agreed to do some work on how we can streamline all of the different existing datasets. We do not have any interest in reporting for reporting sake. We want the reporting to be better in having more indicators and being more comparable across the country. Whilst everyone said we should look at what the Australian Institute of Health and Welfare collects and we should look at what is already provided for reporting in each of the states, we also are moving forward on agreed national reporting measures, for example, on infection rates. In October this year for the first time hospital-by-hospital infection rates will be published on the My Hospitals website. None of that could have happened if we did not have agreement on how we are going to progress with all of this performance reporting.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

My question relates to the My Hospitals website. The My Hospitals website has information about the sorts of patients that are seen in emergency departments, waiting times and waiting lists in various subspecialties within each hospital. In terms of the scope of the reports that are to be prepared by the performance authority, what consideration has been given to looking at things which relate to quality and safety in the local hospital networks, the public hospitals and the private hospitals? The minister mentioned in her previous answer looking at the infection rates for the first time. It sounds like a good idea to have an idea of the infection rates in an individual hospital. What measures are proposed by the performance authority to look at quality and safety: mortality rates within a certain period in a hospital, mortality rates after discharge, complication rates from surgery and any complications that occur during the admissions?

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

I do not have all of that detail here in front of me right now. There are a whole range of them and this is a very complex bill. I might remind the House that the shadow minister was briefed on these amendments and, as I say, less than an hour ago told us that he supported them. I am not questioning that other members have legitimate concerns. I am happy for them to be provided with a briefing. But the truth is that the opposition have indicated they oppose these amendments now, although an hour ago they did not. I do not think that it will serve this parliament much more to continue this ongoing Q&A about a whole range of different issues. I am happy to provide that information as the bill makes its way through the rest of the parliamentary process, but I think it is well and truly time for the amendments to be put.

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

I thank the minister for answering the first of my two questions. She emphasised that there is an effort through amendment (7) to harmonise the data collection and reporting. The second part of my question is: what parts of the work that has been assigned to the authority could not have been done by the existing structures already in place? I go back to the question: can she explicitly explain? This is the basis for the entire legislation and also of course it begs the question: if we need to set up a fifth authority to monitor the other four are we going to be back here again setting up a sixth one to monitor the previous five? What is it with the COAG Reform Council, the AIHW and the Council for Safety and Quality in Health Care that makes them unable to do the very things that have been described in this legislation that are being assigned to the authority? That comes under the scope of the work in amendment (7).

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

I think that comment just reveals that, for some reason unknown to us, there is a delaying tactic being undertaken by the Liberal Party. Every bit of the legislation, the second reading amendment, the summing-up speeches and the speaking on the amendments makes clear what new role the Health Performance Authority takes. I stand by all of those comments and I refer the shadow minister to those if he is genuinely interested in it. The government has no more comments to make on these amendments.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

This goes to amendment (7), which talks about the reports prepared by the performance authority, and specifically 'if the report indicates poor performance by any of the following entities or facilities'. While it might be very clear what would constitute poor performance for local hospital networks, public hospitals and private hospitals, I am seeking clarification from the minister as to what would constitute poor performance by a primary healthcare organisation which would be caught in the scope of amendment (7). It seems that while primary healthcare organisations—or, as they have been called, Medicare Locals—have some role in the area of service delivery, in that they are going to be taking responsibility for after-hours care, they will not principally be in the front line of service delivery. The department has assured us that the primary healthcare organisations will not be fund-holding organisations, as we see in similar organisations in the United Kingdom or in New Zealand.

So, given that the scope of the primary healthcare organisations is still a little ill-defined, I am seeking clarification as to what would constitute poor performance by a primary health organisation. Would it be that they are not offering enough continuous professional development? Would it be that they are not holding enough seminars? Would it be that they are not liaising well enough with allied health or practice nurses? I am just seeking clarification from the minister as to what would constitute poor performance by a primary healthcare organisation as is envisaged in amendment (7).

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

It is with a great deal of regret, I think, that the minister now refuses even to respond. This is a very important parliamentary process.

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

The member for Dickson, and everybody, should realise that consideration in detail is not question time.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

It is consideration in detail.

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

It is consideration in detail. There is actually no requirement under the standing orders for the minister to respond. The chair has given a great deal of latitude in this regard.

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

I do think that it is a very important parliamentary process to be able to consider in detail amendments moved by the government. These are important questions because they go to the very soul of how our health system will operate into the next generation. This is a government that proclaimed that they wanted to fix public hospitals. They have created all these new bureaucracies. They have now capitulated and weakened even the original process that they put forward. They now have 29 amendments on the books. Yet, remarkably, the government will not go to the detail of the amendments, either because they do not know the detail or because they are embarrassed by the detail.

To go to your point, Madam Deputy Speaker, nobody pretends that this is about question time; but what does consideration in detail mean if the coalition cannot ask questions about the detail of the amendments? These are not flippant, tidying-up, clerical error type amendments that you sometimes see in this place. These are substantive amendments, 29 in total, and they completely water down, completely dilute, the original intent of the legislation. In some places whole sections have been struck out and new words have been submitted, and it is quite appropriate for us to ask detailed questions about why that has taken place. But, as importantly, it is incumbent upon the minister to answer in detail those considerations. To sit there silently and not contribute to the debate I think is a poor reflection on the minister and also shows the minister's contempt for you, Madam Deputy Speaker, as the chair in this place, and for the parliamentary process. We have reasonable questions that we want to continue to ask. We are frustrated by the process—there is no question about that—because right from the start the questions that were put have not properly been answered. We asked the minister reasonable questions from the commencement of this consideration in detail. The minister has plucked out a couple of questions and answered those, but the detail has not been forthcoming from the government. As I say, people need to ask the question: why wouldn't reasonable questions be answered by this minister? If this minister had an involvement in the construct of these amendments, why wouldn't this minister be prepared to step up and defend the amendments? If the coalition has questions to ask about why significant changes have been made—necessarily it seems at the hands of the premiers in order to do a deal by a desperate Prime Minister—why wouldn't the health minister in accord with the standing procedures in this place answer those reasonable questions?

This is not a process where a minister can come in, with due respect to the minister, and somehow answer the questions that suit the minister's own knowledge but completely ignore those questions for which she has no substantive response. I think it is for the minister to answer the questions that have been put but not yet answered. It is incumbent upon the minister so that there is faith in this process for the doctors and nurses who are waiting to see whether or not this will substantially change their workplace and whether or not this is going to be the reform that people thought they voted for in 2007 and 2010. The minister's accountability is at question here. I think it is absolutely absurd if the minister continues to refuse to partake in this debate because we will continue to contribute and put questions until this minister answers the reasonable questions that have been put. If this process has to continue on until question time, it will.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

The more I read these amendments, the more questions they pose. In terms of amendment (7) I do have some questions about the reports which will be prepared by the performance authority. The amendments go into quite a lot of detail about what must be done if the report indicates poor performance, the consultation that must be done with the state and territory health ministers and that they must be given an opportunity to respond.

In reading the legislation and reading the amendments it is not clear what happens to the reports after they have been prepared. My question to the minister is: is there any requirement for these reports to be made public within a certain period of time? This is especially important in the area of quality and safety—there have been disasters in Australia, for example in the Bundaberg Hospital, and we do not want to see a repeat of what happened at Bundaberg Hospital. We need to know, if reports show poor performance in the local hospital network or in a public hospital, that these reports will ultimately be made public. Amendment (7) talks a lot about the consultation and the periods of consultation that are required but my question here is: what is the requirement on making these reports public? Is there a specific time line here? We would like to know when we will be able to see them and when these reports will be made public. I go back to my previous questions that still have not been answered on the area of primary healthcare organisations.

Mr Perrett interjecting—

They have not been answered, dopey.

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

The member will withdraw and the member will not interject. This is not helping the situation.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

I withdraw. I thank the minister for her answers to my earlier questions, but I still have an unanswered question about what constitutes poor performance by a primary healthcare organisation. Would this be in the area of the delivery of after-hours services? Would it be if they are not sufficiently making networks with allied health practitioners or practice nurses—what would really constitute that? I also am particularly interested in quality and safety. I would like to know what quality and safety information will be prepared and made available to the public in these reports that are being prepared by the performance authority.

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

I raise from a tactical point of view what is becoming increasingly clear to everyone in this chamber. I raise it in defence of parliamentary processes and I raise it as, most people would know, a strong advocate of MPs' rights—that is, that the arch enemy of parliamentary processes and an MP's rights is the filibuster. What we are increasingly seeing before us is a tactic to filibuster. I do not know why. That is up to the coalition to defend, but the indication from the member for Dickson that he wants to push this through to question time and the indication from the member for Boothby that he is only just reading these amendments clearly demonstrate that this is a tactic over and above a true and genuine parliamentary process of inquiry into amendments before the House.

I do not think I have ever supported the gag, I would have to go back and check my record, but I am not far away from actually moving it. I would hope that we have genuine questions being asked, we have genuine responses and we wrap up what has been at least a 50-minute conversation with very little contribution now to genuine consideration of these amendments.

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

I want to address briefly those remarks and again I am sure they are held sincerely. There is no filibustering going on. The fact is that we have asked questions, Member for Lyne, and we have not received adequate responses. The member for Lyne may well be satisfied with what the government has put up. He has expressed some concerns and he is going to take a certain course of action. I respect that. It is his right to do that as a member of this parliament. We have not sought to cut short his contribution, and nor would we.

But we have serious misgivings about this bill. Many of the reasons that you stated in your earlier contribution, Member for Lyne, cause us even more grief because we think that this government, by moving its 29 amendments, is without precedent in this public debate about health. They are substantive amendments, as I say—they are not 'tidy up' amendments—and they deserve an adequate and fulsome response from the minister. So, yes, we are frustrated, as I said before. There is no question about that.

The Bills Digest talks about these points. It says:

It is unlikely that the Authority, as a single entity, will be able to achieve these objectives …

Does that not cause the House concern? It goes on to say:

This Bill does not provide any details on how the three national governance agencies will work together to deliver improvements in the Australian health system.

That is exactly the point that we are trying to make. These are reasonable questions asked by the people from the library who prepare the Bills Digest. They are not members of the coalition, they are not Independents, they are not people who support or oppose the government—

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

They're truly independent.

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

These are truly independent people asking these questions. So why would it be unreasonable for us to ask these questions? More importantly, why would it be unreasonable for the minister to answer the questions? The Bills Digest goes on to say:

It is not yet clear how the ‘upstream’ National Health Performance Authority proposed in this Bill will connect with ‘downstream’ factors …

That goes directly to questions being asked by both of the shadow parliamentary secretaries for health on this issue, so those questions are completely reasonable. The Bills Digest goes on to say:

This Bill … does not give the Authority any enforcement powers …

That is exactly the point we were trying to make before. What penalties are in place? If the government, having collected all this data, having created this new bureaucracy, having spent all of this money, are not happy with the way in which the data is trending, what can they do? This is a basic question and it has been raised not just by us but by the Parliamentary Library, the member for Lyne and others. The Bills Digest goes on:

It is unclear how many primary health care providers will be monitored directly by the National Health Performance Authority.

That, again, goes to questions that were reasonably asked before. I do not think that a guillotining in this situation should even be canvassed, frankly, until these questions have been properly answered. For the minister to stay in her seat and refuse to contribute answers to reasonable questions is unacceptable.

In conclusion, the Digest makes a number of other points, and I think it goes to the concerns, as I have said before, of many stakeholders—not just those of the coalition and the member for Lyne. Those stakeholders have a real interest, as do many of us, in making sure that these reforms are tangible, are meaningful and achieve the aspirations that many of us in this place, including the member for Lyne, have spoken about both privately and publicly. That is why I think it is completely reasonable for us to put these questions and, most importantly, for the minister to respond. It is incumbent upon the minister to at least make some contribution to try and answer what are reasonable questions.

Warren Snowdon (Lingiari, Australian Labor Party, Minister for Defence Science and Personnel) Share this | Link to this | Hansard source

I want to make an observation. I have been in this parliament off and on for 24 years. I have seen different tactics used in this place to try and thwart debate. I have seen filibustering and attempts to change the dynamic. But it is a bit of an affront, given the history of this legislation and the detailed briefings the shadow minister has received around this legislation, to have him and his colleagues doing this. They are genuinely nice people by and large. We get on okay; we can all be mates. But I think it is worth while for them to ask themselves why they are doing this at this point. What is your attitude to the legislation—do you support the health reform process or not? If you do not, if you plan to vote against the legislation in any event, given that the amendments will have already been voted on, why are we participating in this farce? I think it raises serious questions about the judgments which are being made.

I have been in my office engaging in meetings since the last division and I have had on in the background the parliamentary debates. With great respect to the shadow minister, I have not seen the minister demure; I have seen her fully engaged in the discussion. She has chosen, rightfully, to hear you out and to provide the capacity in other places—because this will be dealt with in the Senate as well—to deal with this. If your concerns are genuine you could have raised them in direct dialogue, through the process of briefing. You have not done that, and today we see you, after this legislation has been in place for a number of months, reading from the Bills Digest. It makes one wonder what your game is. I say to the shadow minister—with great respect, Madam Deputy Speaker—that, if he is genuine about a discussion around these issues, this is not the tactic to adopt. We expect that, when these amendments are voted on, they will be opposed by the opposition. So what is this process all about? I suspect that the shadow minister, if he were in our shoes, would be asking the very same question. I say to the shadow minister—and I heard the member for Lyne, whose views I respect—that this is culminating in a filibuster. I say to the shadow minister that it is in our best interests that this debate be concluded. Vote against the amendments if that is your desire. They will be dealt with somewhere else and we will have a further discussion. This is not the end of the debate, as you know. If you were concerned about the content of the Bills Digest, why was it not raised previously? You have had plenty of opportunity to do so. I support the views being expressed by the member for Lyne. It is about time you took a mature approach to this discussion and conceded that we should finish this part of it and get on to the next stage.

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

Before I call the next speaker, I point out, as the member for Paterson has rightly done, that this is consideration in detail of the bill before us. I have allowed a latitude around what we are debating, but we will return to the bill before us. We will understand that consideration in detail is to consider the bill; it is not a question and answer session. The standing orders do not provide for anything otherwise. If you wish to establish a new procedure, you should take it to the Procedure Committee.

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

I, for one, am happy to be judged on the quality of the questions asked and by our scrutiny of the conduct of the minister, who is refusing to answer these questions. Already, one out of two questions has not been answered, so I focus again on amendment (7), which involves proposed subsections 62(5), (6), (7) and (8). My great concern with 62(5) is that, apart from the obligation upon the performance authority minister to give a copy, invite comments and have regard, after that this legislation and this particular amendment are silent on what occurs next.

In 62(6), I am concerned about the reference to the manager of the network, who, having received a report 15 days prior to its completion indicating that there is poor performance, is not entitled to give any comments on that final draft. I think it is a fair question and the public is entitled to expect an answer as to why it is in the public interest for that not to occur.

We would like a clear understanding of 62(7) and (8), given that over this four-year process these were only released weeks ago. Before completing a report, the performance authority is at liberty to consult with any persons or bodies it considers appropriate, yet, if that report does indicate poor performance, Minister, the performance authority must not consult and is not otherwise obliged to observe any requirements of procedural fairness.

Minister, my third question to you is this: regarding 62(7) and (8), why, in the preparation of a report, is it appropriate for the performance authority to consult with any person or body it wishes but if that report, particularly focused on a local hospital network or a territory hospital, indicates poor performance the performance authority must not consult, having, prior to that report being prepared, been at liberty to consult? I think it is a very important distinction that needs to be clarified in this consideration in detail stage.

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

The question is that government amendments (1) to (29) be agreed to. Question put.

The House divided. [12:07]

(The Speaker—Mr Harry Jenkins)

Question agreed to.

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

by leave—I move together amendments (1) to (3), as circulated in my name:

(1) Schedule 1, item 130, page 46 (line 23), omit "report", substitute "reports".

(2) Schedule 1, item 130, page 46 (line 24), before "The Performance Authority", insert "(1)".

(3) Schedule 1, item 130, page 46 (after line 29), at the end of section 111, add:

  (2) The Performance Authority must, as soon as practicable after 30 September next following the end of each financial year, prepare and give to the Minister, for presentation to the Parliament, a report consisting of a compilation of the reports prepared by the Performance Authority under paragraph 60(1)(a) during that year

  (3) The Minister must present the report described in subsection (2) to the Parliament as soon as is practicable.

Note:   See also section 34C of the Acts Interpretation Act 1901, which contains extra rules about annual reports.

Very briefly, as explained previously, this is about getting reporting requirements to the parliament as well as to the minister and to the various state ministers and to COAG so that there is some public accountability attached to the annual reports of the performance authority. I understand it has the support of both sides. I hope that remains the case, and that therefore everyone can get to lunch as quickly as possible.

Question agreed to.

Question put:

That the bill, as amended, be agreed to.

The House divided. [12:18]

(The Speaker—Mr Harry Jenkins)

Question agreed to.

Bill, as amended, agreed to.