Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Hansard source

The National Health and Hospitals Network Bill 2010 establishes the Australian Commission on Safety and Quality in Health Care as an independent statutory authority and provides for the establishment of the National Performance Authority and the Independent Hospital Pricing Authority under the proposed reforms. This matter went before a committee and was examined in detail. In the coalition minority report, we raised a series of questions about the need for yet another layer of centralised health bureaucracy in the form of the commission to be established by this bill. One of the biggest concerns about health changes mark I and now mark II is the extra bureaucracy which will be established. The commission already exists within the Department of Health and Ageing and is highly regarded within the healthcare standards sector. The establishment of a new, stand-alone commission will cost taxpayers millions of dollars and will supply many services already considered to meet international best practice. The setting of standards and accreditation is already being performed by an independent not-for-profit organisation, the Australian Council of Healthcare Standards. I refer the Senate to evidence given by an ACHS representative at the committee inquiry:

I also think it is a shame if the commission wastes too much of its time and effort on re-inventing the wheel.

Submitters were also concerned that there should be a measure of public consultation in regard to this provision before the bill became law. In this regard, Associate Professor Woodruff from the ACHS said:

I would just hate the wording of this bill to establish an authority that did not really have to engage people that have been working in this field with a good track record for decades.

Submitters also expressed concerns that the standards in mental health were not covered in the health reform process. Dr Darryl Watson, the Treasurer of the Royal Australian and New Zealand College of Psychiatrists, said the process:

... continues to neglect the needs of those with mental illness.

Dr Watson went on to say:

The college believes there is a need for specific focus on the special needs of the safety and quality issues in the mental health sector. Closer engagement between the commission and mental health consumers and carers would improve the influence of the commission on practice in this sector. The provision of this focus is not covered by this bill.

It is really unclear now where we are at in relation to what is in and what is out, what is part of mark I and what is part of mark II. At estimates I asked the department to provide a comparison between mark I and mark II health changes, so that we can at least try to see what has been dumped from the first agreement and what survives in the second agreement. The original proposals were for the establishment of two other bodies—the Hospital Pricing Authority and the National Performance Authority—which I understand will survive. Our concern and the concern of the coalition still stands—that is, the further bureaucracy will incur further significant cost.

At the committee hearing a number of the submitters said that it would be preferable to introduce the legislation in relation to this commission together with the Hospital Pricing Authority and the National Performance Authority as a package. Indeed, this was supported by the submission from the Consumers Health Forum of Australia. One of the most worrying aspects of this bill is the total lack of detail as to how the commission would go about its work. There is no detail as to how the new body would perform the most fundamental facets of its operations—that is, how they would measure performance and what powers they would exercise. However, it appears to us from this bill that compliance with the standards and guidelines developed by the commission will remain voluntary. If we are to aim for the highest standards of safety and quality in health care and if the commission is to drive this, some kind of incentive or sanction needs to be in place to encourage or enforce compliance. Otherwise, we run the risk of seeing a commission developing high-quality standards and guidelines which have no value because they are not adopted by our health services. In that instance, it becomes an expensive and irrelevant body.

In the absence of any clear delineation of the particulars of the enforcement methods and strategies to be employed by the proposed commission, submissions raised concerns about the lack of public debate on the commission’s proposed approach to enforcement, especially if financial penalties and/or incentives were used to effect compliance.

Debate interrupted.