Claire Moore (Queensland, Australian Labor Party) Share this | Hansard source

We have heard and we will continue to hear just how complex the National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2007 is. I am not going to take time up in the chamber today working through the various technical aspects of this bill. We have had that and we will continue to have that, and Senator McLucas has passed on a few of the issues that are important for us to consider. But I felt I needed to put some statement on record today as a member of the Senate Standing Committee on Community Affairs, which considered this bill.

I know that Senator McLucas mentioned our concerns about the focus and the process of our legislative committee, but I think it is essential to put on record the fear and anger that I have as a member at the lost opportunity that has been inflicted on the Senate and the wider community to effectively consider the impact of the PBS changes that are before us today. I do not pretend that there will be a large number of individual citizens in our community who will want to know every detail of the changes that are proposed in this legislation, but there are some who will. Even with the outrageous time frame that the government imposed on this committee, we were able to receive nine full submissions, and a number of other organisations and individuals made phone inquiries and raised concerns.

What was clear and what continues to be clear to all of us is that the Australian medical industry, the Australian pharmaceutical industry and many individual Australians have a great deal of regard for our PBS system. We have heard before here and we have seen in the literature and in the academic institution research that there is wide respect for the PBS. There is almost an individual relationship between people in our community and this system. It has been respected, it has grown with people over the last 40 years and there is a sense of ownership around the way it operates. People understand that there is a system provided by their government which gives them support to obtain safe, effective and cost-effective medicines in this country. So, when it is proposed that complex changes be introduced to this legislation, people demand to be advised about what is happening; they need to know what the impact on their own processes and on their safety is going to be.

When we had the American free trade agreement discussions, I think two years ago now, there was a huge component of public interest, media interest and also industry interest about whether that free trade agreement would have an impact on the PBS system. You would remember that there was extensive discussion in this place that varied between fear about what may happen and a commitment to ensure that the core values of the PBS would be retained by all governments into the future. That was a promise that was made. Now, as always, as legislation is introduced down the track, people need to know what is going on, and they are asking the questions.

We know that there is an ongoing process—no legislation remains untouched—and, particularly with the PBS, ongoing attempts need to be made to ensure that cost effectiveness is not only maintained but also backed up by an absolute security in the safety of all pharmacy products that are put before the Australian public. We have had that. There has been a sense of security in the process. All discussions around the, I think, almost iconic institution of the PBS must be based on safety being the No. 1 consideration, and after that comes the cost effectiveness of the process. Of course, we know that every system must be economically viable, and the cost effectiveness of the PBS to the government must be maintained. There is a shared commitment to that. Everyone understands that we must have the best possible way of ensuring that best prices are maintained so that effective innovation in the industry can continue. When people start talking about the figures involved in the cost of drug innovation and exploration, I get completely overwhelmed, because it does cost a lot of money for organisations to scientifically research and develop effective medications. We need to understand that, and we do. There is no question about the need to have the best spend for the Australian taxpayers’ dollar around ensuring that the PBS system is strengthened and maintained.

Underlying that, there must be a sense that the consumer is going to receive the best possible product. That is not just with the ongoing debate around this legislation, with the difference between drugs that have patents on them and the time when they come off patent, and we have that wide, burgeoning industry of generic medicines. A lot of the debate around these particular changes before us today is about the process of maintaining that, so that we are able to ensure that drugs are assessed adequately and that, when there are options, people are made aware of those options and the costs are maintained so that we are able to keep a solid base cost and people can receive good medication without either themselves or the government overpaying for it.

The various technical aspects of the different formularies and what drugs are going to go into them will be spelt out in detail in the legislation. What detail is not in the legislation is going to be placed in regulations that will evolve as the process continues. I want to say yet again, as I do consistently, that, when we have complex legislation before us which indicates that a lot of the detail is going to be in regulations and we have not got the regulations, I always have trouble. I cannot guarantee that I would understand all the regulations, but I am sure I would be able to get effective advice so that at least I would be able to see how the whole package operates. Very rarely can one stream in health legislation work by itself. We have the core legislation and then the regulation that works with it that allows the flexibility for things to be amended more quickly.

People in the industry do understand this legislation. They do study it, as we have found out through our committee process and through the range of visits that we have all had from people representing different areas of the industry. They do read and understand every element of the debate and they have quite specific questions, which they raised with us in the committee process. I return to my overwhelming concern of losing the valuable opportunity, through examining this bill in the committee process, to assuage some of the fears, to address some of the concerns and, most importantly, to keep the open discussion going. On a number of issues that came up in the committee process, we heard quite determined evidence by people who felt that things could be done better, who felt that there were threats to the PBS; there were specific allegations that things were put in the wrong area under the PBS. That came out in the committee process and the detail is available, for those who wish to read it, in Hansard and in our committee report.

When we were able to receive professional information from the department, when they came as witnesses to the committee, we were able to directly clear up a number of the issues. This is the value of the committee process: getting people together, making sure—through evidence, through submissions and through responses—that we are able to work effectively, through the Senate, to ensure that issues are clarified. It does not guarantee agreement, and we will probably see that when we go through the amendment process today. But nonetheless, we are able to work effectively towards coming to some understandings that make the legislation better. And we saw that even in the one-day process that we had on this bill. A number of the concerns that were raised about how people thought this legislation would work were cleared up simply by having that before us and being able to work through it. This is why I am disappointed. If we had had more time to get more discussion going, we may then have been able to have a stronger basis on which to move forward in this area. It is disappointing that, even at this stage of the process, we are still arguing about the lack of effective communication and consultation.

Now we know that the government, through the departmental processes, have regular meetings with the key stakeholders and certainly with the Pharmacy Guild. It was in evidence that there has been ongoing discussion with the Pharmacy Guild and their members about their role in this process, and we know there is a specialist agreement with the Pharmacy Guild and the government. That is strong and that should be maintained. We also had the same discussion with Medicine Australia and also with consumers in different times at different places. But there must be an opportunity for all of the stakeholders to get together at different times, to be able to at least hear—sometimes hear again, because there are certain people who do not move forward with their arguments, but nonetheless to get on the table again—what the key issues are.

Certainly a couple of the amendments that we have wanted to discuss with the government have been looking at that. We have been looking at clear definitions in the process. We have also been looking at a kind of monitoring process that would re-establish the role of the consumer, because, as I have said, from my point of view the role of the consumer must be absolutely valued in anything to do with our health system and in particular with the PBS. We had evidence from health consumers during the committee hearings that they were keen to continue in this way, in particular to see exactly what the impact of changes would be on the cost to people across Australia of their medicines. We have seen over the last decade an enormous rise in the co-contributions, and that has gone through this place in terms of exactly how the PBS operates for people who are going to purchase drugs at their pharmacies. The co-contributions have risen dramatically over last few years, but generally when people have understood how the process works they have understood the cost of the development of medication and they have had the security that the drugs they are going to be receiving on the Australian market are absolutely safe, that they are the best in the world that can be available.

They also understand that there is a genuine commitment from the government to minimise the cost and also to ensure access to generic brands. This is an industry that has risen in our country, as it has across the world. Generic products give people a choice at every level about the purchase of the medication that they going to receive. This is something that we on this side of the chamber celebrate with the government—that is, the decision to have the education campaign about the best use of generic products. There was some discussion at the committee about the best way of doing the program, and of course that is something that will evolve as it develops. But it seems to me one of the absolutely critical elements of how this legislation is going to work is the community understanding of exactly how the process operates, their understanding about the safety elements of using generic products, their understanding of their rights as consumers to work with their doctors so that they have some ownership over the types of medications they are purchasing and to be able to question that. It is part of the ongoing education process, which we have talked about many times, that an individual takes ownership of their own health, and the individual ownership of their health extends to the PBS process because this is an area where, once again, the person who is having treatment should have the knowledge about the treatment they are receiving and be able to engage effectively with the health providers who prescribe the medication as well as those who give it out at the pharmacy. That is something that we do celebrate, and it is an ongoing aspect of the legislation.

We are disappointed that there has not been more open dialogue about the process. We hope that, once again, that is a message we can take into the future. We are supporting the recommendation about the combination drugs because that came out clearly in the evidence, both in the written submissions, particularly from Medicine Australia, and in the evidence given before us at the committee. This is an aspect that can be looked at, and we are looking forward to the government’s response on that.

We acknowledge, as part of the government and also as health consumers, that the PBS is something that should be valued in our community. It is at many levels. We do expect that there is an increased understanding in the community about the way it works, and that came out consistently. Over the last 15 years there has been a growth in understanding of the way it operates and more questions are being asked by consumers about their rights in the system about not only the co-payment but also their right to question the way it works and to question what processes are put before them.

I would like to thank the organisations who gave their time and who responded so quickly to our committee requests. They came up with extremely detailed submissions. I would like to thank the department in particular and the officers of the department who gave their time to brief the committee. We could have done with a lot more, and we will continue to ask for this support, because, as we know, the PBS changes will continue. This is not a finite process; it will continue. I particularly note the speed with which they came back to the committee with responses to question that were raised. I also want to take this opportunity to thank the secretariat for helping us put together this report so quickly. We had the committee hearing and very detailed questions and comments came out and then we were reporting back to this place on Monday. If you do the maths, you can understand how speedily people had to get their heads across the process and get responses back. We are supporting the legislation, as Senator McLucas has said. There is a shared commitment to ensuring that the PBS is maintained and valued in this community. We do expect that there will be close monitoring of the impact on all stakeholders in this process and we do expect that, as changes continue to happen in this legislation, there will be a definite attempt to engage all of us so that we can work together to make this the best possible system we can have.