Nick Xenophon (SA, Independent) Share this | Hansard source

It is only Monday night but it feels like Wednesday or Thursday night in this place! I have serious reservations about the Australian National Preventive Health Agency (Abolition) Bill 2014 . I understand the government's intention and its concerns about the duplication of roles, red tape and waste. Just parenthetically can I say that the government seems to have this key goal of reducing red tape but, as it was pointed out to me tonight, part IV of our competition act consists of 74 pages—20,000 words—and in the United States it is less than one page and has the same effect and in Europe it is a solid page. So, if the government were serious about red tape, it could start with competition law, which is not so much a lawyer's picnic as a lawyer's smorgasbord. The government needs to be a little bit consistent when it talks about red tape and avoiding duplication, cost to businesses and cost to the community.

There is no denying that the government has a mandate from the electorate to return the budget to surplus, but that mandate is subject to promises made to the electorate, including 'no cuts to the ABC'. We need to be wary of false economies. The measures we are talking about—not just in terms of this bill but as part of the budget more broadly—do not come from areas where you can cut the bottom line without feeling the impact down the track. It is a bit like building a house. If you want to cut costs, you can but you can do it in different ways: you can choose to have a small building maybe with some cheaper fittings—things that still function perfectly well but perhaps are not as nice as you would like—and instead spend what money you have on making sure the structure itself is solid and built to last or you can choose to build a huge house but skimp on building products, pour a cheap foundation and hire dodgy tradespeople. In the end, either way you will still have a house. One of them might not have all the bells and whistles you want, but the structure will be there and it can be improved in the future. The other one probably will not be there at all. You might have saved money at the outset but I can guarantee you will be up for a far bigger bill in the very near future. This government has clearly taken the second option when it comes to this bill, because I believe this agency has an important role to undertake. If the agency is imperfect, if it is not fulfilling what the government considers to be the entirety of its functions, then I think that can be dealt with. That can be improved.

I think the government has taken an option that is not good for the health of Australians. Like that house, it will not be long before the whole thing falls down around our ears. Abolishing the Australian National Preventive Health Agency is only one part of the picture but it is an important one. The difficulty with preventive health, however, is that it is hard to quantify because it relies on long-term savings that occur when things do not happen rather than expenditure when they do. In their submission to the inquiry on these bills, the Public Health Association of Australia and the Australian Health Promotion Association estimated that every dollar invested in health prevention saves $5 in health expenditure. They write:

… in relation to alcohol, the reduction of alcohol supply to minors, advertising restrictions and behaviour change targeting binge drinking can prevent 14000 unnecessary hospitalizations for alcohol misuse annually. Obesity costs Australia 120 billion dollars annually, yet people who live in a walkable neighbourhood are on average 3kg lighter than those who cannot walk to school, work or around their community and every time someone rides to work — the economy benefits by more than $14.

So the Public Health Association of Australia and the Australian Health Promotion Association are concerned that the abolition of the Australian National Preventive Health Agency will reduce the already low spending on preventive health in Australia. They state the abolition:

… is a unilateral action by a single government to do away with an agreement reached between governments. It is one of a series of moves that undermine the actions that have been taken to promote preventive health in Australia. The abolition of the National Partnership Agreement on Preventive Health removed $367million over four years from public health. This is at a time when the Australian Institute of Health and Welfare estimates Australian spending on prevention to be less than 2% of overall health expenditure.

These concerns were echoed by other submitters to the inquiry. As others have pointed out, there is a strange sort of circular logic at play, where the government is abolishing this agency but setting up a fund apparently to support health research in the very areas in which the Australian National Preventive Health Agency is already acting. The future fund is an excellent idea in and of itself, but not if it is to be financed by $7 GP co-payment and savings from other existing measures—sorry, that is the medical research fund not the Future Fund; I am still in awe of Peter Costello's appearance before Senate estimates in relation to the Future Fund a few days ago. The medical research fund is a good idea, but financing it by a flawed mechanism is, I think, something that needs to be resisted. It is also a bit pointless to abolish the very agency that would be best placed to advise and support the fund in determining the best avenues for research. Writing in the Financial Review, Stephen Leeder calls this situation 'truly weird'. He goes on to say:

There is no policy that has guided the proposed cuts to federal contribution to health and education. There is no policy that led to the abolition of the ANPHA.

The proposed abolition—

These actions are not policy-based, at least not on policy as enacted in a democracy. They are ideological ideas. They depend not on discussion but on imposition. The Australian constituency is denied access to the reasoning, if there is any, behind the actions, whether they are on-water or off-policy.

So far, preventive health measures in Australia have focused on reducing smoking rates, reducing alcohol abuse and reducing obesity. But preventive health and its close cousin early intervention have far wider implications. For example, early intervention programs have been shown to have a huge impact on children on the autism spectrum. A well-funded program that uses evidence-based techniques can make all the difference to a child's life and their future, and the earlier children have access to this the better the outcomes.

Last Friday, I was in Huntfield Heights in the southern suburbs of Adelaide where I was part of the opening of the AEIOU centre in South Australia, a provider of early intervention for children with autism. AEIOU was founded by Dr James Morton, a highly regarded oncologist in Queensland. One of his children has autism. He set up the AEIOU centres—there are 10 in Queensland. They have done a magnificent job of early intervention, which makes a very big difference in the outcomes for these children. To give you an example of what early intervention and that preventive approach can do: if a child goes to an AEIOU centre on the full program, the chance of that child ending up in a mainstream school is 75 per cent compared to 20 per cent for those who do not. That is a staggering statistic and that is why it is so important that it is well funded. Unfortunately it is not, through an anomaly in the NDIS, which itself is a very worthy idea. That is another example of early intervention. In a sense, it is the cousin of preventive health.

Equally, early intervention is vital for mental health conditions. If people can access the care, support and treatment they need at an early stage, there is less chance of their condition becoming critical. This is not just good for savings in the hospital system but good for the individuals themselves. It makes a world of difference to someone's self-worth if they can continue to be part of society while receiving support and treatment.

In relation to mental health, there is a link between substance abuse and mental health. I am horrified by the number of people who have severe mental health problems as a result of addiction to ice. There is a link between cannabis and, in some cases, some pyschoses or schizophrenia. There is a link between so-called recreational drugs such as ecstasy and long-term mental health problems and depressive conditions, for instance.

These are issues that this agency can and should have a powerful role in driving good outcomes in respect of preventive health. If we go further, research into gambling patterns and the behaviour of addicts has shown us that there are simple ways to adjust poker machines and therefore reduce their addictiveness. It has also shown us that certain socioeconomic groups may be more susceptible to addiction and so treatment services should be concentrated in those areas. Of course, that particular example is an illustration of how preventive health measures can be twisted—poker machine operators use that same information to target vulnerable people.

I also want to emphasise the point that the government has already essentially abolished the agency and that the passage of the bill is really a formality. I believe this can be seen as showing a disdain and a contempt for the process of the Senate, and is an attempt to present a fait accompli so that the vote on this bill becomes almost redundant. Preventive health and early intervention provide better outcomes, particularly over the long term, in every facet of health care. Abolishing this agency goes    against everything we should be working towards.

If the government is looking for savings in the health system, it should talk to people—reasonable people such as Dr Rodney Pearce, former state president of the AMA in South Australia and a co-chair of a national network of GPs representing several thousand GPs. He makes the point that if you have a collaborative approach with the medical profession, with GPs who are the front-line of our health system, you can actually drive enormous savings. When Michael Wooldridge was Minister for Health in the Howard government, he drove some very significant changes that boosted immunisation rates. I think it cost in the order of $30 million or $40 million back then. But that program delivered hundreds of millions of dollars if not billions of dollars of benefits in terms of fewer kids ending up at doctor's waiting rooms and fewer kids ending up in hospital with medical conditions that were avoided by immunisation. That is the sort of thing that we should be looking at. If only the government could collaboratively with GPs then I think we could drive some very significant savings in the health system and the Australian Preventive Health Agency could play a key role in that in bridging that link between government policy and GPs driving very good and solid health outcomes.

Preventive health and early intervention provide better outcomes, particularly over the longer term, in every facet of health care. Abolishing this agency goes against everything we should be working towards. In relation to false economies, it is interesting to look at the comments of Professor John Dwyer, who wrote in The Australian on 16 May this year just after budget. The article was headed 'Harsh cuts won't help our health' and he made the point:

Expenditure on hospitals dwarfs Medicare expenditure ($140 bn v $19 bn), yet all the levers to reduce this (and solve our health expenditure problems) lie within the way we should use Medicare dollars to reduce hospital admissions. Herein lies the nub of the problems: we should actually be spending much more on primary care to reduce expenditure on hospital care—

And I dare say the corollary of that is that spending more money or maintaining a strong preventive health focus actually goes hand in hand with the sorts of measures that Professor Dwyer is talking about.

I do not think anyone denies that there are hard decisions to be made about Australia's economic future but short-term financial gain should not come at the expense of long-term socioeconomic pain. I have said it before and I will say it again: it is far better to have a strong fence at the top of a cliff than the world's best ambulance at the base of it. Equally, it is far better in my view to have an independent agency addressing these issues rather than the department. That is not being critical of the department. I just think the nature of the beast is different. A strong, independent agency in relation to preventive health is essential. We need to remove any potential bias, and the continuation of this agency is the best way to deal with that.

This bill is bad for Australians and bad for our economy, particularly in the long run. Abolishing the Australian National Preventive Health Agency is a false economy of the worst kind. It has the capacity to cause real, long-term damage. This is not the way to deal with the problems the government is trying to solve. I will not be supporting this bill, and I call on the government to reverse its decision, re-establish the agency as an independent expert body and put it to work in a way that means we can drive savings in our health system without compromising health outcomes. We can actually get better health outcomes if we have a greater focus on preventative health. It is a good investment, as previous speakers—including you in your speech on the second reading, Madam Acting Deputy President O'Neill—have indicated. Otherwise we will wake up one morning to discover that our house, built on shaky foundations with cut-price materials, simply will not stand up any longer.