Gary Humphries (ACT, Liberal Party) Share this | Link to this | Hansard source

I present the report of the Community Affairs Committee, Highway to health: better access for rural, regional and remote patients, together with the Hansard record of proceedings and documents presented to the committee.

Ordered that the report be printed.

I seek leave to move a motion in relation to the report.

Leave granted.

I move:

That the Senate take note of the report.

This report is reporting on the various patient assisted travel schemes which operate around Australia. In 1978, the federal Patient Assisted Travel Scheme was established and, at that point, it was operated by the Commonwealth government. In 1986, that scheme was devolved to the various states and territories of Australia, and this inquiry was intended to establish how well those schemes serve the needs of Australians living in rural and remote Australia.

The inquiry found that there were serious inadequacies in the various schemes: that the subsidy levels were unrealistically low in many cases, that the thresholds that people had to travel before they qualified for assistance were often too high, that the schemes themselves were complex and obscure, that access to them was difficult, and that there were marked inconsistencies between the way these schemes operated from one jurisdiction to another. And, when so many people were, in effect, crossing state boundaries, by virtue of these schemes, to access services, those inconsistencies became a matter of some vexation to the users of the schemes. What was also disturbing was that, in conjunction with those facts, there was clear evidence of poorer health outcomes for people living in rural and remote Australia—for example, more depression for people in remote Australia, higher rates of communicable disease, a greater incidence of very low birth-weight babies, and, generally, lower levels of life expectancy.

We might expect that there would be a certain degree of lower or worse health outcomes by virtue of people living a long way from health services, but the question is whether the various PAT schemes are able to mitigate the effect of that distance. Real questions remain as a result of this inquiry as to whether they effectively do that. PAT schemes certainly alleviate some of the financial burden associated with having to travel for medical assistance but only a relatively small proportion of that. Something like one-fifth to one-tenth of the costs usually entailed in travelling long distances for medical assistance is the level of reimbursement that people can expect. That leaves many Australians with significant financial hardship associated with medical illness. Most disturbingly, perhaps, is the fact that the cost of travel actually dissuades some people from seeking medical attention. It actually dampens demands for certain preventative services—for example, breast cancer screening—and it leads others to choose not to be treated or to be treated too late for intervention to be effective. That has led the committee to make a number of recommendations, key among which are: firstly, that there should be a building-in to the next Australian Health Care Agreement of attention to this issue so that it becomes one of the measures whereby Australia gauges the effectiveness of its health and hospital related services; and, secondly, that the Australian Health Ministers Advisory Council establish a task force to look at a range of issues affecting the operation of the PAT schemes, including obviating the differences between jurisdictions and establishing national standards to ensure that a certain amount of consistency can be achieved and the standards applicable in these schemes can be raised across the nation.

I do not propose to speak for any longer than that. I simply want to thank the committee secretariat for its very hard work in putting together this report. I thank the other members of the committee. I particularly thank the senator who was the driving force and inspiration for this inquiry, Senator Judith Adams. It is true that the committee began the task of this inquiry with a certain reluctance based on some view that this might not be an issue of great substance. I have to say that by the end of the inquiry we were convinced that this was an issue affecting very substantially all people who live in rural and remote areas of Australia and did need very serious public policy attention.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

Most of us on the committee actually always felt that this was an issue of great substance. The reason we felt that way is that for so many people who came to talk to the Senate Standing Committee on Community Affairs at previous committee hearings for inquiries on topics such as cancer—for the report The cancer journeygynaecological cancer services and even poverty several years ago brought up in evidence the issue of patient assisted travel. If you do a scroll through the website, you will find that so many people who live across our country acknowledge that the cost of travelling to access their right to effective health services was deterring them from making the decisions that could be best for their health and for the health of their families. I think the most confronting thing for all of us in this process was hearing the evidence from people across the country. This was not limited to one state; these issues were common across every state we visited. Those whom we could not visit wrote submissions. The inquiry was long awaited and I know that many people are waiting to see the recommendations and to see what difference we can make as a result of the evidence they gave to us. I particularly—and I think this is a common theme for our committee—want to thank the people from across the country who were prepared to be involved in the Senate process, who acknowledged that there were significant issues around the cost of travel and accommodation linked to health services and who were prepared to come and talk with us about those things. These inquiries would not operate if we were not getting submissions and evidence from people. Again, we were overwhelmed by how many people wished to talk with us.

The recommendations, as Senator Humphries pointed out, are focused on putting this issue higher on the priority list. We had evidence from many state governments. My own state government gave a detailed submission but did not feel they needed to come and give evidence at the inquiry. Nonetheless, they did provide a detailed submission to the inquiry process. The evidence that state governments were giving us had a common theme. They all acknowledged that there was a need for a patient assisted travel scheme, they all told us about internal reviews they had undertaken to look at the needs in their own areas and they all reinforced the fact that the patient assisted travel scheme—or whatever it was called in their local jurisdictions—was only ever meant to be a subsidy scheme. They said there was never any intent that it would cover a full reimbursement of costs. That was common. What was also common in the committee’s experience was the comment, ‘We acknowledge there should be a subsidy; we do not think the subsidy is enough.’ That reaction was shared by every state. I also want to give particular credit to Senator Adams, who took the committee with her on her quest to ensure that the issue of patient assisted travel is recognised and brought up to the authorities in each state government. There have been efforts to improve schemes; I think that was common and it should be acknowledged. The evidence we heard was not new to any state authority and there has been some movement forward, but it needs to be coordinated; it needs to be a COAG issue. We need to ensure that the amount of travel and accommodation subsidies are increased. People who are in crisis about their health do not need the extra pain and suffering of financial problems.

I also just briefly want to say that the most worrying aspect for me was the evidence that we received that people were making health decisions based on their economic situation. Although it came up in other places, too, I think that I will be particularly haunted by the evidence that we received in Alice Springs about women who were making decisions about breast screening and subsequent urgent breast cancer treatments based on access to services in their local areas, which were non-existent. As we speak today, there is no effective screening process in Central Australia for breast cancer. Among all the other issues that we are facing in these areas of health care, that one comes closest to my own experience and it is one that I was worried about. I could not help but contrast my own experience—the way that I was supported and taken very quickly through immediate treatment—with that which is available to women in that part of Australia. If we can do anything with this inquiry, bringing that issue and the Patient Assisted Travel Scheme to the awareness of the public will be a start. We can make a difference. There is goodwill. There has to be good action.

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

As a relatively new senator, this was the first inquiry that I have had the opportunity to participate in from beginning to end. I would like to thank the secretariat and the members of the committee, particularly Senator Judith Adams, for the very worthwhile experience that this inquiry produced. Probably the first thing to say about the PAT programs as they are used in each state is that they are very little programs trying to do a massive job. They are trying to provide equity of access to people from rural and remote areas with a very small subsidy. One of the things that particularly struck me with regard to the submissions that we received from the state governments was the very cautious nature of those submissions in terms of trying to control the money. We heard evidence that often towards the end of the budget year people would be refused subsidies when earlier in the year the very same set of circumstances would have resulted in a subsidy being received. There was not only a lack of consistency between states but a lack of consistency within states in terms of the subsidies given to people.

To me, the very real value of this inquiry was the fact that it put a human face on the decisions—for example, a mother not being given a subsidy to travel to donate an organ for her son’s welfare—a son in his thirties and with children and obviously someone who this community needs to be as healthy as he can be. One of the images that will haunt me, Senator Moore, was the image of a very sick Indigenous man from remote Australia arriving at Adelaide airport for treatment and not being met by anybody and not understanding how one might get from the airport to the hospital. Obviously, there is a lot of work to be done to improve this. I support the comments of my fellow senators and join them in recommending that COAG is the place to do the work that is needed to give real access to health facilities to remote and rural Australians.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to also speak on this report of the Senate Standing Committee on Community Affairs. I share the views of my fellow senators. I thank Judith Adams for her contribution. She ensured that we followed through with this inquiry. It would be fair to say that Senator Adams, coming from Western Australia, knew only too well the issues facing her fellow Western Australian citizens in trying to access adequate medical services. From living in Tasmania, I do, too. Although we are geographically not as large as Western Australia, the landscape of Tasmania makes it difficult to access services at times. Most states and territories were represented on this committee. This is a national issue. This is one of those issues that we cannot afford to play the blame game with. It is a responsibility of state governments and the federal government to address this.

There were many instances of very emotional evidence given about the hardships suffered in cases in which PATS did not allow family members to travel. People talked about going to cities which they did not know. There were many issues relating to the lack of financial assistance through this scheme. As Senator Moore said, it is there to subsidise people. We have to address the concerns that were raised in this inquiry in relation to the money that is afforded for accommodation. We have to look at other options for accommodating people when they have to travel either interstate or intrastate, as they do in our great country. The concerning issue that confronted me and, I am sure, my fellow colleagues was that families are now making decisions about their health based on financial circumstances. That is something that we all need to be reminded of.

We need to ensure that these 16 recommendations, which are very good recommendations, are followed up on. I feel very strongly that we have to follow up on this inquiry. Too many reports gather dust in this place. I for one would like to be able to participate in continuing to monitor this scheme. I want to place on record my thanks to the secretariat for their hard work. If I dare say it, without a doubt, the secretariat of the Senate Standing Committee on Community Affairs work harder than most other secretariats. I also want to particularly thank those people who came before us and gave evidence and thank people for all the written submissions that we received. I commend the report to the chamber.

Carol Brown (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I too would like to express my support for all the contributions that have been given here today on the Patient Assisted Travel Scheme inquiry. I will start by expressing my support for our leader in this inquiry. I apologise to the chair, Senator Humphries, and the deputy chair, Senator Moore, but it was quite clear that this inquiry was driven and led by Senator Adams.

What also became clear from these hearings is that there are some fundamental problems. One of those problems is the promotion of the scheme. In Tasmania, we heard two stories of where changes made to the Patient Assisted Travel Scheme were actually beneficial to the patients. One of those stories was to do with renal dialysis and the change to the strict 75-kilometre travel rule. There did not seem to be a view that, other than making the change, it should be promoted. The Tasmanian branch of Kidney Health Australia knew nothing about the change, and I understand most of the patients affected knew nothing about the change. It was left to the coordinators in Burnie.

In Tasmania we have a review committee—a standing committee, I believe—which encompasses the coordinators and other managers of the scheme, but it does not have a consumer advocate on it. It is clear that consumers are concerned that they are being left out; they believe they are not being listened to and they want their concerns addressed. This inquiry provided to many witnesses, particularly the users, the advocates and their carers, an invaluable opportunity—some for the very first time—to voice their concerns and put forward to a national audience their views on the benefits, shortcomings and fundamental importance of the Patient Assisted Travel Scheme.

The terms of reference with regard to the operation and effectiveness of the travel scheme allowed us to range over all aspects of the scheme, such as the need for greater national consistency and uniformity, the need for national minimum standards, the current level of utilisation of the scheme and, of course, the level of unmet need. The depth of interest in this inquiry is indicative of the depth of engagement on health issues in this country.

My home state of Tasmania has the most dispersed population of any state. The percentage of the population that is located outside the capital city is higher in Tasmania than in any other state. Given Tasmania’s low population relative to other states, a range of services are not available intrastate, which means assistance with travel is essential for many Tasmanians.

It became clear from the committee’s work that we need increased patient liaison and better communication to ensure continuity of care for patients. It also became clear that the demand for PATS would increase and other pressures would also impact on the demand for the scheme. We have heard that there is a great need, but there is also a massive job to be done. That is why I fully support the recommendations, particularly recommendation 2, which states:

That as a matter of urgency, the Australian Health Ministers’ Advisory Council establish a taskforce comprised of government, consumer and practitioner representatives to develop a set of national standards for patient assisted travel schemes that ensure equity of access to medical services for people living in rural, regional and remote Australia.

It needs to be a national approach. It was clear from all the submissions we received that that is what the patients need and want.

I would like to commend the secretariat for their work; as usual, they have done a very good job. I commend the report Highway to health: better access for rural, regional and remote patients to the Senate, and I hope that its very important recommendations will be taken up and acted upon.

Judith Adams (WA, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Senate Standing Committee on Community Affairs report Highway to health: better access for rural, regional and remote patients. I would like to sincerely thank my Senate colleagues for agreeing to the community affairs committee holding this inquiry. As the chair of the committee said at the start, certain members were a little dubious about whether this was a very important inquiry. But I think we have probably proven with this report that it was important. Those who read the report will certainly realise that there is a problem in rural and remote Australia. The committee members have certainly supported me very strongly, and I thank them for their remarks. I thank the committee secretariat, because it was no easy task. There were 196 public submissions and four confidential submissions. We held hearings in Canberra, Alice Springs, Melbourne, Perth, Launceston and Brisbane. That meant the secretariat had to leave their homes and travel and put in some rather horrific hours. When we went to Alice Springs we were able to look at the Aboriginal congress and also visit the hospital and speak to those people who are actively involved with policing the PATS. I think doing that gave everyone an idea of just how important the PATS is. I would like to quote from my first speech in this place on 11 August 2005. I said:

I firmly believe that the Patient Assistance Travel Schemes in each state need best-practice national guidelines to ensure rural patients have flexibility in accessing the best possible medical assistance. Since the Commonwealth handed the responsibility of the Patient Assistance Travel Scheme, PATS, over to the states in 1987, this issue has been reviewed many times. Recommendations from five recent parliamentary committee reports have highlighted the problems associated with these travel schemes. We have the evidence and data to tackle the problem, and I will be strongly recommending to the Senate Community Affairs References Committee—

as it was then called—

that the administration of PATS must be dealt with urgently. It is a complex issue, as it falls within the states’ jurisdiction, but something must be done.

So, after two years of really annoying my colleagues and pushing very hard, we have finally tabled our report—and that is no mean feat.

I thank the people who put forward submissions. We had support from many organisations. I was a member of the National Rural Health Alliance for six years, as a councillor representing the Australian Healthcare Association. That has 27 organisations, which include rural nurses, doctors, allied health groups, service providers such as the Royal Flying Doctor Service, consumer groups like CWA and academics. We had support from national bodies such as the AMA and the Australian General Practice Network, state governments, local governments, cancer groups, Aboriginal health organisations, teaching hospitals, consumers and health service boards. It goes to show that this really was a national inquiry. Everyone is concerned about it. As there are fewer and fewer of us living out in rural, regional and remote areas, I think we have done a service. We have the evidence now. It is there for someone at a higher plane to act on. There has to be coordination of all the states. At the moment we have—excuse the pun—a ‘dog’s breakfast’ as far as the different PATS areas go.

I was pleased to receive a flyer from the AMA called Bridging the gap, which we celebrated several days ago. The fifth item on their flyer is very good. It is about the Patient Assisted Travel Scheme. I think this is important, as it is coming from a body such as the AMA. It says:

The Australian healthcare system is based on the principle that all Australians are able to have access to the same level of health care regardless of where they live. Those who live in regional, rural and remote Australia should not be disadvantaged if they must travel to larger centres to access quality health care.

They go on to say, and this is one of our recommendations:

The AMA believes that the Commonwealth should work with the States and Territories to expand PATS to cover other treatments available under the Medical Benefits Schedule (MBS)—including access to allied health professionals where a doctor coordinates the patient’s overall care.

In this climate, PATS has become very much out of date since it was handed over to the states in 1987. We need to look at how we organise health. Primary health care is very important, but no longer is it just the bailiwick of the doctor, the GP or the specialist. It is the multidisciplinary team that sit behind them as their support. This might be with our remote area nurses. It is definitely with our allied health people.

I think it is important—and it is part of one of our recommendations—that the patient is not necessarily sent to the nearest specialist, who may not be the most appropriate specialist. If the patient has to go to someone that is not quite the person they should be seeing, they are probably going to create a much larger debt to the health system than they would have if they had been able to access the most appropriate specialist. So this has been one of my very strong pushes. That is contained in one of our recommendations.

I spoke in my first speech about the development of national standards. This is our recommendation:

Development of the national standards should include (but not be limited by) consideration of the following areas:

• patient escorts including approval for:
• psycho-social support;

At the moment it is only for medical support. Many people are sent to the city areas by themselves to undergo radiotherapy, chemotherapy and treatment for other symptoms. They are alone. This is completely unfair; it is cruel. It is not on at all. When we went to Alice Springs and spoke with our Indigenous people we heard some horrific stories. English is not the first language of a number of these patients. They are sent off to a city by themselves on an aircraft or in a bus, probably never having been in an aircraft before. Nobody meets them; nobody takes them anywhere. Where do they stay? What happens? There have been some dreadful instances. In the Northern Territory an elder, a very old gentleman, was dropped off at the airport very early in the morning and had nowhere to go. He was found deceased seven days later. These are the sorts of things that just cannot happen in this day and age. We have other instances, especially in my home state of Western Australia, where the bus will drop off a patient who is a mother with a baby at three in the morning, when she has another 400 kilometres to go and she is hoping someone will come and collect her. They do not come and collect her. These are the sorts of things that we just have to do something about. Patient escorts are very important.

The second problem is obstetric services in rural and regional areas being limited for safety’s sake to prevent litigation. You have to have an operating theatre and an anaesthetist standing by. I seek leave to continue my remarks at a later date.

Leave granted; debate adjourned.