Sue Boyce (Queensland, Liberal Party) Share this | Hansard source

I would like to support the comments of Senator Cormann. Any changes that could be made to develop the joint replacement register so that it becomes even more useful than it has been must certainly be applauded but, once again, the method and the process leave a lot of questions. Firstly, as a member of the Senate Community Affairs Legislation Committee which oversees the Department of Health and Ageing, I think we almost need a recording now that says the department did not consult. Every inquiry we have we hear about consultation which has not actually listened to the people consulted. Perhaps we need new definitions of what consultation is. Time and time again we are told that whilst the key stakeholders were told what the department thought the department would do, they were not asked for input. If they were asked for input, it was not accepted and the practicality of suggestions put was often completely ignored. We had evidence of this during the inquiry we held around this bill. Lifehealthcare Distribution noted:

Certainly this kind of proposal should follow appropriate consultation to achieve a result fairly across the spectrum of stakeholders, and there has been no consultation so far from the Department of Health and Ageing with the industry on this matter.

Further, the Medical Technology Association of Australia, which represents all the manufacturers and suppliers of prostheses, who are referred to as sponsors, commented:

… there has been no exchange of views on how best to implement this legislation through the rules. Although the Department intends that the levy on listings could be as low as zero, they conceded that they do not have accurate utilisation data on which they will presumably base exemptions. This is a process which should be understood as being practical and achievable before the legislation is passed.

So once again we have the situation of the cart being put before the horse. Let us hope that the system the government has developed is workable and that it does not lead to skewing within the market.

We were given evidence during our hearing that if there are costs involved, there is the possibility that prostheses manufacturers and suppliers might choose not to list products that they hold in reserve for replacements when they are needed and lesser used products. The UK system, which the Department of Health and Ageing tells us was closely examined before this system was put in place, in fact works on a utilisation basis, not on a levy on prostheses manufacturers and suppliers simply for holding prostheses. So we have that concern about this. I am also concerned that there has been little examination, it would appear, from the Department of Health and Ageing about the fact that the Australian Orthopaedic Association are the only group involved in running and having control over the register. I think it is quite excellent that this register has given us the chance already to examine faulty products and remove them from the market. It has brought about the need for a lot fewer replacements, and many fewer revisions of replacements need to be done. It is giving us a much, much better picture of the costs and benefits of good surgery and good products. But, as has been pointed out by the Medical Technology Association, it is not just faulty products that can lead to faulty operations and faulty performance of prostheses. It can also be that particular surgeons or particular ways of undertaking surgery, even particular postoperative procedures, can affect the way a replacement operation works and the level of success it has.

So these are also issues that need to be looked at. Medtronic Australasia, commented:

When any single group that is involved runs the entire process there is the potential for a conflict of interest. We do not suggest that the Orthopaedic Association has a particular conflict of interest. However, if data being collected that involves multiple stakeholders and only one stakeholder group owns the data and directs the design of the registry, there is always the potential for a conflict of interest.

So this is an area that I think needs to be watched closely. It is not just the prostheses themselves that can lead to failures in operations. There are many other reasons as to how this can occur. The register, used properly, will give us a wonderful opportunity to look at this but we need to be concerned that the governance of this register is undertaken in such a way that all aspects of legislation are looked at. I would certainly hope that there will be a review by government within 12 months to two years of the way the register is working with this levy.