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

I rise to speak on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. The coalition will not be opposing either of the bills or the amendments to the bills being introduced.

Can I, at the outset, say that the coalition has a strong record on investing and delivering in e-health. For example, it was under a coalition government that the computerisation of general practice increased from 17 per cent in 1997 to 94 per cent in 2007. This was achieved through a $740 million investment over those years. The coalition has always supported the concept of shared electronic health records. Indeed, it was the coalition that originally started the focus on a shared electronic health record. At this point, I pay tribute to the work of past health ministers Michael Wooldridge, Kay Patterson and Tony Abbott, who did a lot of work in this area.

Unfortunately, despite the focus and direction that was established under the Howard government towards e-health, Minister Roxon and the Labor Party's implementation of the system since taking government in 2007 has received severe criticism from industry for its poor management of the programs being developed. One only has to look at the press in recent days to see that this rollout still has major problems—not that that is surprising given the record of both the Rudd and the Gillard Labor governments in quite a number of areas of health.

It is the government's fault that we are now at this point where we will not be ready to go on 1 July. I draw an analogy with the GST. When it was introduced, the legislation had been in place for 12 months before the start date; whereas it is very, very clear that we have so little to show at this point because of the government's poor track record here. Basically, this government has been gradually winding back expectations of what will be available on 1 July. In fact, there will not be much at all. It was so typical of Kevin Rudd to go for the big bang approach. Yesterday we were talking about his so-called health reform as the incoming Prime Minister. He had the grand plan, but we realise that there was not even anything about it written on the back of an envelope. It is the same thing with e-health. He wanted to go for the big bang approach, but as we approach 1 July there will not be much to show for it.

One only needs to look at an article in today's Australian entitled 'E-health record service delayed by incomplete infrastructure'. Here we have an article in the Australian today telling us that the plans that Minister Plibersek had to mark the start of the $1.1 billion e-health records service are on hold as key parts of the system are not ready for the much feted 1 July launch. I quote:

Sources who declined to be named—

I am not surprised—

say a ceremony planned at St Vincent's Hospital in Sydney on Monday, July 2—the first working day of the new system—has been cancelled.

The minister's office was tight-lipped when The Australian asked whether the event had been postponed to a later date.

This, of course, is not surprising. The spokesman for the minister tells us, 'We look forward to the launch of e-health', but we do not know when that launch is going to be. The pilot sites of e-health that were reported last month—and one of the most successful had apparently been at St Vincent's and Mater Health in Sydney, which lends credence to the launch being there—had recruited only 4,446 consumers to its East Sydney Connect shared e-record out of the hoped for 46,800 participants.

There was no comment at all from the minister or her spokesperson in relation to the recent visit by Mr Peter Fleming, the Chief Executive of the National E-health Transition Authority, to deliver the bad news. This, understandably, includes the lack of readiness of the national IT infrastructure that is being built by NEHTA according to specifications, at a cost of $91 million, and that is yet to go live. Here we are, a couple of weeks before 1 July and, no, we are not going live on e-health—which I thought would have been obvious. We know that there are still some critical user verification, authentication, issues. We are going to an interim system, which is going to be provided by Medicare. You cannot go online to register. You can do it by phone or in person at the Medicare office, but you cannot do it online. Also the records system is unlikely to be operational any time soon. So there was a great e-health launch with a great big bang, but we are not seeing very much for our money.

Meanwhile, the costs to take e-health to this point have been topped up to $1.1 billion. The recent budget allocation was of another $224 million and another $50 million for adoption by Medicare Locals. We do not know what Medicare Locals are going to do, let alone what they are going to do in the e-health space. And of course it is more than doubling previous commitments.

Since 2007 there have been problems upon problems in relation to how this government has rolled out e-health. Just to name a few of those problems, the government has repeatedly stated that it would be able to take the user registrations from 1 July this year. Of course, we know that that is not going to happen. One industry expert has been quoted as stating that it will be many years before the system is ubiquitous. Like with so many other announcements by this government, they announced a major project and now they are scrambling to meet their own deadlines.

Legislation was brought on for debate in the House of Representatives long before the Senate inquiry into these bills had concluded. The Senate inquiry in its public hearing on 6 February heard testimony highlighting quite a number of stakeholder concerns with these bills and yet the government pressed on debating them in the House.

Let us just go to some of those concerns. These concerns were outlined by, in particular, the dissenting report by the coalition senators. It indicates that:

There is currently a concerning dissonance between the assurances of the Government and the very real concerns raised by practitioners and experts in the e-health industry.

Naturally the coalition has been concerned that the government's political need for the big bang approach to introducing e-health on a given date is being given primacy over common sense and a proper rollout of the system. The majority of the witnesses that appeared before the Senate inquiry expressed serious concerns with the process so far and the consequences of the legislation if it were to proceed in its present form.

Those concerns broadly covered four major issues: functionality and interoperability of the system; confidence of consumers and clinicians in the proposed e-health system; governance and conflicts-of-interest problems in the system designed to hold the health records of every Australian; and risk and patient safety. These four major concerns are the very spine of a high-quality and safe system and yet in the Senate inquiry a very short period of time ago many witnesses questioned aspects of the potential for successful adoption, functionality and operability of the system within the legislated system, particularly within the time frame. Certainly the major concerns were about adoption, functionality and interoperability.

Issues were raised in the Senate inquiry about the absence of no-access controls, which go to the very heart of the system and further undercut the claims that have been made by the Department of Health and Ageing and NEHTA that the key design features of the system are present. Some have not been. Consumer concerns were raised, and they were also reported. There was much criticism of the consumer complaints provision of the proposed legislation. As I said, issues were raised pertaining to structure and transparency.

A point that was highlighted by coalition senators and raised in evidence as well was that:

… NeHTA is not subject to the standard Government accountability processes, including FOI, this has led to perceived culture of secrecy and a lack of responsiveness to key stakeholders around strategic issues.

Privacy has been a major issue. The Information Commissioner also raised concerns about the adequacy of the proposed legislation in dealing with data breaches. None of these were adequately dealt with in the legislation.

Also there are unanswered questions about medical indemnity and legal liability and the concern that the government has not developed satisfactory processes. There are clearly doubts about the liability in the event of medical misadventure predicated on information contained in the system. All of this casts doubt on the integrity and viability of the proposed legislation.

There is a concern about risks to patient safety. Patient safety is the bedrock of any health system. Those concerns were also highlighted in evidence to the inquiry. They came from industry experts, clinicians, consumers and privacy advocates. Many stakeholders basically said that they had lost confidence in those who were developing the e-health system.

At that stage, when the report was finalised by the Senate, we were barely four months away. We are now two weeks away and we are still debating this issue and concerns are being raised about the system. As I said, with all these concerns, it would have been prudent for the Minister for Health and the government to defer debate on these bills until the Senate inquiry had publicly reported on its findings. Instead, the legislation was rushed through and now we have amendments to the legislation which have to pick up problems. Some of those problems are yet to be resolved and I would like to highlight a number of them that are still of concern. There are concerns about the costs so far and the ongoing funding for NEHTA. I think it is very important in the current economic climate for the government to come clean on the future long-term costs of managing and operating the system. We know that NEHTA's funding agreement expires on 30 June, the day before the system is supposed to go live on 1 July. The Standing Council on Health, as part of the COAG process, has agreed to fund NEHTA after 30 June, but no details have been released as to the level of funding agreed to. Until the budget was released, this uncertainty prevailed.

I have referred to other measures that have been announced. For example, there has been no comment or discussion on the long-term costs relating to the ongoing maintenance of the system, upgrades to the system or the provision of help desk or support staff for the system. One only needs to look at the situation in the United Kingdom, where they spent £12 billion on the e-health record equivalent, which was scrapped in late 2011. This is not a scenario that we can afford to impose on Australia's taxpayers.

When you look at the evidence that was given to the Senate committee and the concerns that were raised by software vendors, they were almost unanimous in their concerns about NEHTA's and their own legal liabilities under the proposed legislation. So I think this is of great concern.

Another concern that has been regularly raised is the lack of encouragement or incentives for general practitioners to create the shared health summaries which are proposed to be part of the system. The health summary is a collection of a patient's medical history and will make up one important part of the system. There have been concerns in relation to confusion from general practitioners over whether they will be able to claim the higher Medicare rebate that would normally apply if setting up an e-health record pushes the consultation into a higher band. There are a number of stakeholders who claim that there was a significant lack of proper and thorough consultation with them. So the list of concerns goes on.

In the remaining time I want to focus on the amendments. As I indicated, the coalition will support the amendments. Whilst these amendments go towards addressing some of the recommendations of the Senate inquiry, there are still some major issues to be looked at, certainly given the media reports that are out there today, to ensure that this system is effectively rolled out.

I would like to underline for the record that it was the coalition that originally referred these bills for inquiry. As I said, the bills were forced through the House of Representatives before the Senate inquiry's report had been handed down. At the time, the coalition called for the deferral of the debate in the House of Reps until the Senate inquiry had been completed, and perhaps we would have saved ourselves a lot of time and angst. But of course the government refused this call and forced the debate regardless. It would have been easier to correct the legislation rather than having to do a patch-up job, and it is very clear now that the bills do not actually achieve all that needs to be done. This is just another example of the incompetence of this government. As we saw today, this is a government that cannot manage its own legislative agenda. How can we expect it to manage something as important as this, manage the budget or indeed manage our country? But we will not go there at this point.

These amendments were introduced following the committee's inquiry. The amendments seek to broaden the scope of the future review of the legislation in two years time, which will include reviewing the identity of the system operator, alternative governance structures for the system and the opt-in nature of the system. I know, having participated in a number of inquiries, these issues were raised directly as a result of various community affairs committee inquiries. Hopefully the amendments will also strengthen the consultation that will be required before PCEHR rules are made and adopted.

One of the major concerns of the Senate inquiry surrounded privacy. Whilst these amendments go some way to resolving particular issues which were raised in the inquiry by clarifying and strengthening the Australian Information Commissioner's functions and powers with respect to investigating breaches, it will be interesting and important to see how these privacy concerns roll out. Under the amendments, the role of the system operator in providing de-identified data for research and public health purposes will be clarified. Provisions contained within the amendments will also strengthen consent arrangements in a number of circumstances. There are also a number of other minor technical amendments. As I said, the coalition will not be opposing these bills.