Katy Gallagher (ACT, Australian Labor Party) Share this | Hansard source

I welcome the opportunity to speak on this important legislation, the Medical Research Future Fund Bill 2015 and related bill. I would like to start by making some comments on this government's attitude to science since coming to power. I have listened to others who have participated in this debate and one could take from the comments from government members that this government is the biggest supporter of science and evidence based research informing policy decisions that the country has ever seen. But, if you go back and look at what has happened in terms of attacks on science, attacks on scientists and cuts to science and research across Australia since 2013, the record tells a much different story.

Certainly some very well documented analysis has been done around this. In my home town of Canberra we have seen the attacks that have been waged against CSIRO, with the loss of 600 jobs and over $111 million cut out of their budget. We have seen $75 million cut from the Australian Research Council. The CRCs have taken enormous cuts. The Institute of Marine Science has taken a cut. The Defence Science and Technology Organisation took a $120 million cut, the Australian Nuclear Science and Technology Organisation took a cut of over $27 million, and Geoscience Australia took a cut of $36 million. Of course, that is in addition to some of the attacks that we have seen on the university sector from this government. So, whilst we certainly welcome the government's attention to providing a revenue stream for medical research, we need to see that in the context of the government's broader attitude to science, the role of scientists and how evidence based science is then translated into public policy decisions.

Having been a health minister for some eight years, I understand very much the important role that research takes in informing the health services that are delivered across our community. I recall very starkly a piece of research that was done into radiation therapy for people having treatment for breast cancer and how research actually informed and underpinned a change to the way radiation therapy was provided to those breast cancer patients. It changed the type of treatment they had and the duration of that treatment. That not only provided a better experience for the women undergoing that treatment but also cleared the waiting list for radiotherapy breast cancer patients in a very short time. That was because the radiotherapy was truncated to a much shorter, targeted program. So it had benefits not only for the patients but also for the efficiency of the health system. That is just one example. I am sure all of us in here could talk at length about all the other research that has gone into the contemporary delivery of health services.

The CSIRO, in their submission on this bill, said that Australia’s health and medical system is a major part of the economy. Expenditure on health in Australia was estimated to be $130.3 billion in 2010, dramatically up from $77.5 billion in 2000. This expenditure trajectory has continued to grow between five and eight per cent per year in the last couple of years. This is due partly to an aging population but is also due to the increasing burden of chronic disease that has been experienced across Australia. The CSIRO went on to say:

Australia’s health system must become more efficient to provide the health services that Australians expect and more innovative in using new technologies to improve health outcomes and dealing with emerging health issues and trends.

I think all of us standing here in support of this bill today would accept that analysis.

As previous Labor members have said, the Labor Party will support the establishment of this fund and the improvements that will be made through Labor's amendments. It is very important that we embed research as a part of the health system and not have it seen as a sweetener to some of the other cuts. Looking at the origin of this fund, it came as the centrepiece, essentially, of a savage budget that sought to make a whole range of cuts to families across Australia not only through the social welfare system but also through the health system. It was this budget where the Medical Research Future Fund emerged. That was, of course, the first budget that looked at a GP co-payment Mark I, and we have seen various versions of it over the past 18 months but now it is in place with the indexation freeze on Medicare rebates. So, yes, research needs to be part of any modern, efficient and innovative health system, but it cannot be used to play off one side against another—which was the role of this initiative when it emerged.

There is no doubt that we need to be investing in research. But can we invest in research whilst we are cutting hospital funding, dental funding, preventative health programs, the flexible fund, e-health—which will actually help to deliver an efficient and innovative health system—and the health workforce? There have been those attacks on primary care that have been underway over the past 18 months. You can feed your research arm as much as you like, but it will not help if you do not have a system that is actually able to deliver health services to the community.

In some of the submissions and comments on the bill, other stakeholders have identified the importance of having a consistent and stable funding source going into medical research. The submission from the Association of Australian Medical Research Institutes talks of needing this fund but ensuring that it is not hijacked by anybody—government or future governments—to pork-barrel nor hijacked by special interest groups or state governments wanting to backfill clinical care. These are all important points that need to be acknowledged. I think that has flowed through the inquiry, which has looked at the need for very strong governance arrangements to be in place and independence from the arms of executive government. This is certainly a position that the AMA endorses. Others have also cited concerns that the medical research community is already organising how it will get money from this fund. With the amount of money involved and the ability for the private sector, the community sector and other health providers to be interested, there is absolutely no doubt in my mind that this fund and calls on it will be heavily oversubscribed. Again, this points to the reason to have really strong governance in place and a very strong, independent process that is tried and tested and will withstand some of the pressures that will come from this amount of money being available for research.

The process for allocating grants under the proposal, as outlined, although I acknowledge that there have been some amendments made in the House, is a broad process in terms of the definitions, but there is also the concern I raised as to how decisions around the grants process are taken and managed. There is without doubt, and others have spoken of it, a legitimate role here for the NHMRC, which is a tried and tested model. Since its establishment in 1926, it has had a pre-eminent reputation as to how it manages and allocates the existing funds. It is hard to understand why it could not be used in a more permanent way.

Having the chair of the NHMRC sit on an advisory council probably acts as a way to say, 'You have addressed that concern,' but anyone with an understanding of strong governance processes and how the NHMRC works would see it for what it was: a tokenistic acknowledgement of the chair and the chair's role rather than having it come under the formal structures of the NHMRC.

There is no doubt it is business that the NHMRC understands: it focuses on current and future public health issues. It already has relationships well established across Australia for delivering health grants. When you look back at the mid-year economic update, or it might have been the budget, a whole range of committees and structures were abolished. In fact, it was part of a key agenda from the finance minister to cut red tape, abolish all these bodies, streamline processes and make making doing business easier. The government uses that argument and, at the same time, for this important body that is to be established, it would goes around the body that has the skills and expertise to actually administer this fund, albeit under a different way with the special purpose fund, and looks to establish another group which has an advisory role to the minister, but the minister, ultimately, takes the decisions. Then it goes to a cabinet process where, no doubt, it could be fiddled with again and perhaps put a whole lot of focus on wind farms, for example. The health impact of wind farms probably needs at least another 15 studies done into it, for argument's sake. So it could be said by government that this is the avenue that this money could go to instead of focusing on what it needs to be doing: allowing those with the expertise and skill in the area to go through their established grants allocation process, which is peer reviewed and the best model to deliver the research that aligns with Australia's current and future health needs.

I might leave my comments there. I look forward to listening to the debate and, hopefully, to seeing the Labor amendments supported, which will strengthen the governance and independence of this fund and make sure that it can be used for what it needs to be used for. The government needs to apply focus rather than a scattergun approach to research. Use the NHMRC—it is there. At the same time we must also continue to argue for the effective and full funding of the health system. There is absolutely no point in having a well-resourced research sector if you are savaging the delivery arm of the health system at the same time and making sure that it is not in a position to deal with the continually growing need for health care. That need is not just in hospitals. It is right through—in community health, primary care, palliative care and outpatient services—and the demand is growing every year. Technology is supporting that growth, but we have to make sure that we are not savaging one part of the system to sweeten up the other.