Nickolas Varvaris (Barton, Liberal Party) Share this | Link to this | Hansard source

I am very proud to speak today on this bill. I am also very proud that all Australians have access to a world-class health system, with access to top-quality medical services and excellent health-promotion and preventative programs.

Australia has an ageing population; people today have longer life spans than their predecessors. We are simultaneously faced with chronic illnesses, diseases and lifestyle choices that produce adverse health effects in the long term. There is an increased need for government to implement proactive health policies, and effective programs with sustained funding. Individuals are now expected to live longer with better access to health care than ever before.

The coalition believes in supporting individuals to embrace healthy and beneficial lifestyle choices and enabling them to take control of their lives with enhanced awareness. The government is committed to supporting, building and enhancing our health system and its allied professionals in developing sustainable innovations, incentives and networks to help all Australians make informed lifestyle choices.

In order to achieve these objectives, relevant information must be readily available to the targeted audience to influence desired health behaviours. The government's role is to ensure that the relevant department can disseminate such information so people are engaged to take control of their own behaviour and make their own decisions. Over the last few years, the three major health concerns facing Australians are tobacco, harmful use of alcohol, and obesity; and lifestyle choices have significant influences on all of these.

In light of this, the former Labor government in 2010 established the Australian National Preventative Health Agency, known as ANPHA, through the Australian National Preventative Health Agency Act 2010, as an outcome of Council of Australian Governments meetings. The focus of ANPHA was to establish and deliver preventative health programs and initiatives. This did not exclude the Commonwealth Department of Health from continuing its preventative health programs—which it had been doing for some time, with constant funding for these activities. In fact, the vision statement of the Department of Health is 'Better health and wellbeing for all Australians', with 'primary health care and preventative health' listed as some key areas of focus.

The Australian National Preventative Health Agency was founded on the basis that it would allow for states and territories to direct funding in return for specific preventative health advice. It would be a Commonwealth backed operation to deliver specific services to the states and territories at their request. However, it has been noted that funding simply based on projects delivered to states and territories will not be enough to sustain the agency.

Since its inception, ANPHA has been solely funded by the Commonwealth, and, to date, no work has been provided to states or territory bodies. Further, its listed programs and initiatives have been jointly conceived or delivered alongside the Commonwealth Department of Health. No doubt it can be confusing navigating the distinct differences between the two agency functions for stakeholders. In addition, the Commonwealth Department of Health still provides programs, policies and advice on preventative health programs, in alignment with stakeholder concern for states and territories, which begs the question: why is ANPHA needed?

Although the previous Labor Minister for Health, the Hon. Nicola Roxon had noted that Australia's preventative health efforts were 'fragmented and lacked cohesion and focus', the performance of ANPHA to date has not been an enhancement to the important work the Department of Health was already doing.

Two separate government agencies with similar key objectives, with similar outputs, but requiring two lots of funding seem to make at least one of them redundant. The Commonwealth Department of Health has played a role in preventative health initiatives and programs through its continued policy work for a long time as part of advisory roles in addressing chronic illnesses and other major health reforms.

Departments performing similar if not sometimes identical roles in preventative health is arguably not an efficient or effective use of taxpayer funds. There is no clear demarcation of roles and responsibilities between Australian National Preventative Health Agency and the Commonwealth Department of Health; hence the inevitable duplication of responsibilities and overlapping of preventative health functions. This bill would repeal the ANPHA Act and, in turn, abolish the agency to create better demarcation and division of roles. It would streamline administrative, policy and program functions and enable efficient use of Commonwealth—that is, taxpayer—funds.

The coalition is acutely aware of specific health problems facing the Australian population and we absolutely endorse relevant preventative health initiatives to empower behaviour changes that would ultimately reduce the abuse of alcohol, lower tobacco use and decrease rates of obesity. Having duplicate functions and departmental staff is not the key to prevention itself.

I note that the list of initiatives and preventative health programs already performed by the Department of Health as outlined on their website are also the intentions of the Australian National Preventative Health Agency. There is nothing that ANPHA has done that suggests it is uniquely different and independent to the Department of Health; hence, additional staffing, administrative arrangements and a special advisory committee at ANPHA are costly without the necessary quantitative benefits.

By keeping the Australian National Preventative Health Agency, taxpayer funds contribute to a bigger bureaucracy without addressing the real needs of medical health prevention. In my electorate of Barton, the St George and Sutherland Medical Research Foundation is an example of a program that is at the medical forefront, using science to provide key breakthroughs for better health outcomes.

The coalition is committed to proactively addressing increasing rates of health complications arising from lifestyle choices but believes in better ways of managing this. Repealing the Australian National Preventative Health Act will abolish the agency and streamline key functions and merge key roles with the Commonwealth Department of Health and save wasted Commonwealth funding on the fragmented, disjointed and overlapping of functions by the two departments.

Empowering individuals through personal health responsibilities is pivotal. Many of the social determinants of health are beyond the healthcare system itself—at times, affected by socio-economic status. It is not apparent exactly how ANPHA will address this through its framework. I stress the importance and merit of taking ownership of health problems. Facilitating better use of taxpayer funds through effective preventative health programs, not duplication of processes and channels, will enable sustainable and better outcomes for all. Again, this is something the Commonwealth Department of Health has accomplished already.

Budget papers and forward estimates indicate that abolishing ANPHA with this bill will save $6.4 million over five years, which is important Commonwealth funding; money derived from our taxpayers that can be and should be used towards programs at the forefront of preventative health research, such as the one in my electorate and, recently, a national medical research fund. The medical research fund is an excellent initiative devised by this government that will complement the work of establishments such as the St George and Sutherland Medical Research Foundation to implement outstanding medical research that can prevent and cure existing ailments and chronic diseases. This is a first in Australia and will save Australian lives at a time when individuals are living for longer but not always better due to crippling diseases.

Unfortunately, ANPHA is not doing the above or anything else the Department of Health has not already committed to or acted upon. When we have the debt and deficit left by Labor, it means a responsible government has to get the best value for taxpayers' money that will generate forward savings, produce real outcomes and assist our future generations. But, regardless, of deficit or surplus, it is what any responsible government should do. We are, however, in a more precarious position to make these decisions because our health system is already unsustainable in the long term based on current needs and further exacerbated by Labor's economic mismanagement. The path to surplus is not possible without identifying, assessing and streamlining duplication in our Commonwealth portfolios, and eliminating functions that simply are not value for money on the public purse.

The repeal bill will allow transitional arrangements for a smooth handover of existing projects for a wind down of ANPHA to reintegrate with the Department of Health. Since existing work on addressing tobacco, alcohol and obesity reforms have been underway for some time this will be a natural progression. The coalition is focused on existing commitments on grants, social marketing, analysis and expert advice on key health issues—all of which have been performed by the Commonwealth Department of Health. I must reiterate that, whilst transitional arrangements are in place, this government will continue to support Australia's world-class health programs and preventative health measures.

There is no denying that tobacco smoking is one of the largest causes of preventable deaths and diseases in our country, and decreasing the rate of smoking is a must, immediately and into the future. There is no denying that obesity has a multitude of ongoing public health concerns and consequences for generations of Australians if nothing is done and that measures must be in place and appropriate programs implemented so that Australians are empowered to make lifestyle choices that can prevent the chances of increasing obesity and intergenerational health problems. Finally, whilst it is a steadfast Australian pastime to have a drink, abuse and misuse of alcohol have long been documented to have adverse effects on the individual, with other social economic effects. Again, targeted programs can alleviate these issues and allow individuals to make informed choices that benefit their health in the long term.

Addressing these key concerns is of national interest and one the coalition is devoted to. Simultaneously, it is also about responsible public spending and ensuring that previous funding is not wasted on maintaining a separate agency that performs the same functions. Allow me to assure the opposition that the new streamlined strategy does not devalue preventative health nor diminish the role preventative health management has on the Australian public. The coalition does not assume—nor should anyone on the other side of the chamber—that preventative health measures are only derived through the agency. The key functions of the Department of Health will allow states and territories to facilitate measures by methods that are suitable for them to support its stakeholders in living better, sustainable lives.

The coalition has a strong track record in delivering effective preventative health strategies, and abolishing the Australian National Preventative Health Agency has nothing to do with cost cutting on preventative health programs. For example, it was the coalition who implemented the highly successful National Bowel Cancer Screening Program in 2006, which has saved lives and we will continue to fund this important program for biannual screenings of all Australians between the ages of 50 and 74.

Preventative health care is a key concern that should be shared by all. At the same time, government agencies established with the intention to prevent national health issues need to be scrutinised to ensure funding is producing the intended results. It is the coalition's responsibility—one which we are happy to actively work towards—to ensure that we have preventative health programs and initiatives that work in the best interest of all Australians and utilise the best value for taxpayers.

Having two separate agencies that produce almost identical functions and programs with the same key objectives is not sustainable, particularly when there is a lack of clear demarcation of roles and responsibilities, a lack of cohesion in a national framework and how obligations between states, territories and other agencies are achieved. We owe it the taxpayers of Australia to ensure their money is invested without folly. Abolishing the Australian National Preventative Health Agency Act is the first step in addressing this.

Joanne Ryan (Lalor, Australian Labor Party) Share this | Link to this | Hansard source

I rise like many of my colleagues to oppose the Australian National Preventive Health Agency (Abolition) Bill 201. Abolishing the Australian National Preventive Health Agency is a retrograde step but, sadly, is typical of this government's actions when it comes to health. It makes a huge case about the long-term costs of health for our ageing population—to justify cuts to spending—but fails to understand the old adage 'a stitch in time saves nine'.

Minister Dutton, the member for Dickson, has regaled us almost daily about a lack of frontline services in health spending like a tone deaf harpsichord player—discordant, aggressive and meaningless—and not just tone deaf but deaf to any voice but his own. Most alarmingly, the minister seems to be deaf to experts.

When Labor introduced the Australian National Preventive Health Agency, it did so with advice from the National Heart Foundation, the Public Health Association and the Royal Australasian College of Physicians. Labor established the Australian National Preventive Health Agency with an eye on health outcomes and an eye on the rising costs of health care in this country. It did so because preventative health care is a sensible way to keep our community healthy and to reduce costly hospital and specialist treatments. In stark contrast, the 'minister for a less-healthy Australia', introduces this legislation and shows a decided lack of understanding and vision for a healthy Australia.

The National Preventive Health Agency was established to take a national leadership role in preventative health, to coordinate, analyse and advise on key statistics and data in relation to chronic disease and prevention, to deliver and administer a preventative health research fund and to look closely at data to inform health strategies that will (a) improve health and (b) reduce the costs of health care into the future.

Data provided by the Australian Institute of Health and Welfare tells us that the 672,000 hospital admissions in 2011-12 could have been avoided if we invested in primary care. This number includes selected chronic conditions: 38,500 with asthma, 51,000 with congestive heart failure, 68,000 with chronic obstructive pulmonary disease and 87,000 with diabetes.

Data like that from the OECD in 2009 tells us that our hospitalisation rates are among the world's highest. They are higher than the OECD average, higher than those in the US and the UK and double the rate in Canada. Data provided by the Royal Australian College of General Practitioners in 2014 tells us that GPs provide comparatively cheap primary care: antenatal care with a GP costs $47 and at a hospital $223; a sexual health visit at a GP could cost $70 and at a hospital $253; vivisection for a GP costs $73 and at a hospital $438; a skin biopsy at the GP would cost $63 and at a hospital $289; and, wound management at a GP would cost $36 and at a hospital $162.

To date, this task has been undertaken with great professionalism and the links developed to health services across Australia have been invaluable. I know in my electorate, where diabetes, obesity, kidney, dental and eye health problems are prevalent, the relationships established through the Medicare Local, the GP superclinic, the headspace centre, ISIS Primary Care, private GP's and the Mercy Hospital have been terrific—all critically working together to improve health outcomes and the impact was flowing through. All this hard work could now be lost.

The Labor government knew the value of preventative health and supported the health system with services like those I just mentioned. We built GP superclinics, we established Medicare Locals, we funded headspace centres and, through national health agreements, we provided much-needed funds to hospitals for infrastructure.

In contrast, this government has no positive future plans for health services and this repeal bill is one small demonstration of that fact. In fact, I am having trouble working out what it is that the Abbott government ministers will being doing with their time, given the number of programs they have cut and the agencies they plan to abolish or amalgamate. Why would a government have such a short-sighted approach? A quick fix on the bottom line for the next year will result in an extra burden being placed on the health system in the future. It just makes no sense.

Why would a government and a health minister attack important efforts in preventive health? We see it again today in an article in TheDaily Telegraph trivialising the work in the preventative health sphere. We have heard members opposite speak of this today. The ANPHA funded the promotion of the My Quit Buddy app at Summernats, an event that attracts over 100,000 men who are principally 25 to 40 years old—a target group which is difficult to get to take health seriously and a core target audience for the National Tobacco Campaign. The campaign clearly had an effect with 55,000 downloads of the app at Summernats in January, compared with 19,000 in the month prior—a threefold increase in one month.

One of the most fundamental mistakes of policymakers is to try and make change from the top without bringing the sector with you and to make change without the active engagement of third parties. I have seen this in education and it is logically the case for health policy. The way this government has approached health initiatives in this budget is to focus more on running it as a business, rather than looking at how you achieve reform to the health system and how efficiencies translate into better care and improved health outcomes.

I heard of a case recently in my electorate where a local hospital emergency ward doctor spent six hours on the phone trying to secure a patient transfer, six hours he could have spent treating other patients. There must be a way to ensure efficiencies. I do not know the details of this patient's health issue but perhaps a well-resourced preventative health service may have avoided his emergency room visit in the first place.

The only thing this government appears to have tried to achieve in this budget is savings and the government appears to want to achieve those savings with little care or consideration for what the effect will be. The savings the government appears determined to achieve will hit at every level of the system: with this bill and the resulting cuts to preventive health programs, by imposing barriers to accessing primary care through additional out-of-pocket costs, by increasing the cost of medicines, by freezing rebates for specialist services and, of course, by cutting billions of dollars from the hospital system and public dental services.

These are not sensible savings; they are not savings that are reinvested back into strengthening Medicare or providing better access to services.

The intention to charge for GP visits, including for those that have to this point been bulk billed, is such an inequitable measure, as it actually provides a disincentive for GPs to bulk bill. And of course it is a solution based on a problem that does not exist. Australia does not have a higher level of GP consultations than the OECD average. With our ageing population and increasing rates of obesity, diabetes and heart disease, the Preventive Health Agency was rightly focused on measures that keep the population healthy and out of hospital. This is not what the changes proposed by this government will do. They will damage the system and not only stall the advances we have made but take health outcomes back decades.

In my electorate of Lalor we are well served by Mercy Health. However, this service was designed for an estimated population of 90,000. We will hit 200,000 people next month, and this government has no plans for the growth of that service—no plans to extend services in this high-growth area and only punitive measures taking away existing services. I will not and cannot support the erosion of Medicare, in any of the forms the government is trying, whether it be the GP tax, increasing the cost of medicines or cutting funding to public hospitals. I am and remain very concerned about the government intentions in relation to private health insurance and primary care. I want to support more funding for medical research, but not off the back of taxing people when they are sick.

I watched with interest as Labor introduced many health reforms in the previous two parliaments. Labor in government embarked on a substantial period of health reform through the health and hospitals reform process. I saw the hard work, firstly of Nicola Roxon and then of Tanya Plibersek, to secure these agreements with the states. These were great achievements, and there were other milestones. We achieved things like the highest rate of bulk billing in Medicare's history; more in public hospitals, with the establishment of new efficient mechanisms to start to fund them into the future; heavy investment in new medical research facilities; new cancer centres in our regions; the establishment of e-health systems; upgrades and new integrated GP clinics; primary and community health centres; and Aboriginal medical services, to name a few.

Labor established Medicare Locals to provide a mechanism to directly support the integration between primary care and hospitals, to close gaps in service delivery and to address population health issues at the local level. I meet regularly with the team from the South Western Melbourne Medicare Local and am always impressed with the hard work and dedication of the team. And when I meet with other local health service providers, even those who were sceptical at first, they now sing the praises of this Labor initiative.

It is worth noting again that the cuts to health by this government are ill advised and will hurt the Australian population in the short and long term—and it is not just Labor saying this. This month's editorial in the Medical Journal of Australia also says so and makes some very salient points. I quote:

The direct effects of the proposed federal Budget on prevention include cuts to funding for the National Partnership Agreement on Preventive Health, loss of much of the money previously administered through the now defunct—

soon to be defunct—

Australian National Preventive Health Agency, and reductions in social media campaigns, for example, on smoking cessation.

The editorial also made the point that the $7 GP tax will more likely be a $14 co-payment for those with chronic illness, because they generally include a test. It says clearly:

The effects of these copayments on preventive behaviour are greatest among those who can least afford the additional costs

It goes on:

The potential for prevention is greatest among poorer patients, who are often at a health disadvantage.

The journal made this salient point about preventative health and cuts to hospital services:

The greatest pity of all is that the proposed cuts to funding for health come at the time when the first evidence is at hand of potential benefits of the large-scale preventive programs implemented under the national partnership agreements. A slowing in the rate of increase in childhood obesity and reductions in smoking rates among Indigenous populations have been hard-won achievements.

Hard won achievements but not worth pursuing, according to this government.

I believe preventative health measures should not be a pawn in a budget game. They should be embedded in health policy and funded appropriately. A government serious about people being fit for work until they are 70 should be seriously investing more in preventing chronic disease, not less. Labor opposes this bill for the short-sightedness that it demonstrates in relation to the key priorities facing Australian's health today and for the lack of vision the government has in relation to understanding the challenges facing the health system into the future. Labor is also opposed to the government's callous decision to cut preventative health funding to the states and territories for work in increasing physical activity and improving nutrition and healthy eating and for support smoking cessation and reduction of harmful alcohol consumption in communities around Australia.

We often hear those opposite complaining that we on this side are whingeing. We heard it again today. We are not whingeing, and neither are the people who will be hurt by this bill—now and into the future. We are rightly pointing out the disastrous impacts the government changes will have on this country. We are responding to real people's concerns and the concerns of the health experts in this country. We are responding to real people's requests that we oppose the government changes that will negatively impact on health outcomes and the long-term cost of health care in this country.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I rise to speak about the Australian National Preventive Health Agency (Abolition) Bill 2014. This will repeal the 2010 bill that created the agency. As a result of this bill, the Australian National Preventive Health Agency will be abolished. I wish to explain why. Essentially, we had a massive duplication of roles and responsibilities, a duplication of the bureaucracy, with the creation of ANPHA.

You must remember: we do have a Department of Health with its own section dealing with public health issues. We also have six state governments with their departments of health and, similarly, their sections for public health. We all know that prevention is better than cure. We all know and appreciate that fact, but we also know that duplicating bureaucracies just increases costs, confusion and duplication and produces less outcome. It will not—I beg to differ—increase health outcomes. I think it will inadvertently just lead to a waste of a lot of money.

I see this recurring pattern of behaviour with the previous Labor government. They identified an issue that was live in the community and they thought the answer was to create another bureaucracy. It was quite a regular phenomenon. Increasing bureaucratic activity does not necessarily lead to the outcome that will fix any problem.

The focus of the Department of Health on alcohol abuse, obesity and smoking will remain, but we will not have the duplication of office leases, an increased number of staff, increases in committees and the duplication of secretariats. ANPHA's existing commitments and the essential ongoing functions will be resumed by the existing Department of Health. This is not going to affect the state departments of health, because it is 100 per cent federally funded. It was created to help the departments of health in the states, but, as of the announcement of this bill, there have been no approaches whatsoever by the state departments of health. Not one thing had ever been referred to them.

We all know that too many Australians consume too much food, too many calories, and they do not get enough exercise. We know that too many of us consume too much alcohol and that we binge too often rather than drinking in moderation. Everyone in Australia, I am sure, knows that smoking is bad for your health. Unless you have been on a desert island for the last 40 or 50 years, everyone knows that smoking is bad for your health. So, without issuing motherhood statements—

Alan Tudge (Aston, Liberal Party, Parliamentary Secretary to the Prime Minister) Share this | Link to this | Hansard source

It might need a website!

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

We might need a website! That is the answer! If you have a problem, let's create a website, after we have created a department and we have created a lot of subcommittees! How often have we seen this phenomenon? Not only do we have the magic pudding school of economics that the opposition go through before they get into parliament; we have the 'let's create a committee' school of thought.

I am quite sure that the state departments of health can get the message out. Not only do we have the six departments of health and the federal Department of Health; we have an army of general practitioners, specialists and dietitians. We have TV shows occupying the 'fat space' and trying to get people to lose weight and do more exercise. We have an explosion of cooking shows, even some with children in them learning how to use unprocessed food in a good fashion rather than highly processed, highly calorie-dense foods. So we have an explosion of information. Even the Sunday papers now have a lifestyle section with lots of healthy recipes and examples of what to do and what is bad.

We just need to stop and think. Do we relieve that inner bureaucratic urging that some governments have, or do we just stop the bus, get off and see where we can use our health dollar better? There are 23 outside agencies doing the functions that the Department of Health is charged with doing, and ANPHA are just one of the most recent. I know there are a lot of august experts who have been assembled by ANPHA, but I just went to their website, and there are not one, not two, not three, not four but five expert advisory committees to the agency. One is on research, one on alcohol, one on obesity and one on tobacco, and then we have the National Evaluation Advisory Committee, which has an unlisted number of members. On research, we have nine; on alcohol, we have seven; on obesity, we have eight; and on tobacco we have nine. All these committees report to the CEO, who then advises an advisory council. This is a merry-go-round of meetings and committees and advisory bodies. As I said, I have looked at the people on them. They are all experts in their fields, but, really, is this going to achieve what we want?

What we want is behaviour change, and that is so hard to achieve. You can have brochures. You can have TV programs. You can have TV advertising programs. But eventually it comes down to the individual to make wise choices and apply discipline. We can collect all the data that we want. We know an awful lot about the nutritional state of the country and that it has deteriorated despite a profusion, a wealth, of food being available, which was not so easily available to previous generations. But I think that everyone has got that take-home message, and it is up to individuals.

I looked at the achievements of ANPHA so far, and they are not that impressive when you compare them to the achievements of the coalition in its previous government. Between 1995 and 2007, the immunisation rate amongst children went from 52 per cent to 90 per cent. In smoking advertising, the graphic health warnings were introduced by our current Prime Minister when he was the Minister for Health and Ageing—30 per cent graphic health warnings on the front of a pack, and 90 per cent of the pack was covered as well. Smoking rates from 1998 to 2007 had the biggest drop on record, from almost 22 per cent to 16½ per cent. Six million doses of Gardasil, the human papillomavirus vaccine, were administered between 2006 and 2010. During the coalition's last term of government, eight new medical schools were introduced.

As opposed to this, the more notorious achievements of ANPHA included a 'fat tax' study that resulted in no change whatsoever—but they managed to spend $463,000 studying it. They created a virtual, or fake, Smokescreen Music Festival that annoyed most people that went to the website—and there were very few that did. The cost of that was $236,000. And we have had previous speakers mention the Summernats program to sponsor burnouts—$129,000.

The take-home message is that this is reducing red tape. There will be savings that can go into the increased spending we are putting into the state health budget—nine per cent every year for the next three years and then six per cent in the last of the four years. It will mean that there is efficient use of the taxpayers' dollars. All the functions that ANPHA was tasked with doing were duplications. There was confusion about responsibility and, as far as I can see, no net improvement, although there was a lot of bureaucratic activity. Individuals change their lifestyles; committees do not. We can have as many brochures as we like, but it is up to individual responsibility and individual choices to get healthy. I commend the action that this bill will lead to—using our health dollars more wisely.

Debate interrupted.