Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Link to this | Hansard source

I move:

That the Senate take note of the answer given by the Minister representing the Minister for Health and Ageing (Senator Ludwig) to a question without notice asked by Senator Cormann today, relating to chemotherapy drugs.

The Rudd government has been a complete failure in health. The Minister for Health and Ageing, Nicola Roxon, has been a complete failure in the health portfolio. In the lead-up to the last election, we were promised that by the middle of 2009 a Rudd Labor government would fix public hospitals. Labor supposedly had a plan. The buck would stop with the Prime Minister. He was going to work with the states. He had learnt from Labor’s mistakes of the past and was no longer going to go after people with private health insurance. But what have we had? What have we had? We have had a 20-month review on how to fix hospitals. We are now having a review into the review and we are going to have a bureaucratic process into the never-never trying to come up with a way forward in the health portfolio. The minister is completely out of her depth. She has not got a clue as to what she should do to improve our public hospitals in Australia. And we have a government that is spending billions and billions of dollars, that is borrowing money to give it away. But vulnerable cancer patients are being asked to pay the price of Labor’s reckless spending.

The budget measure that I asked Senator Ludwig about was first listed in the budget in May 2008—that is, 15 months ago. The government was going to save $140 million from ‘efficiency measures’, as it put it, in the management of benefit payments for chemotherapy drugs. We asked some very benign questions at the time in Senate estimates. We were trying to find out how it would work, how the government was going to achieve the savings, who would miss out and how it would work in practice. The answer I got about 12 months ago was: ‘It’s still a way off. We’re still working through the detail. We’re going to work with stakeholders. We’ll let you know when we get a bit closer to the time.’ Of course, as we got closer to the time—in the lead-up to 1 July—it was very clear that the government had not done its homework and did not know how achieve the savings without hurting cancer patients. It back-pedalled from that measure at 100 million miles an hour and delayed it to 1 September. Now 1 September is less than three weeks away. There is serious concern among cancer patient support groups and healthcare professionals as to what will happen on 1 September. The minister told us today that the government was going to delay the measure briefly yet again. What does ‘briefly’ mean? How long are you going to delay it for, Minister?

Let me just explain a few things, because the story changed every step of the way. When we first asked questions about it, we were told: ‘There is an unused proportion of a phial of very expensive chemotherapy drugs. If it is not used we don’t want to fund it.’ Community pharmacists are just discarding the unused portions of these very expensive chemotherapy drugs. The reality is this. We are talking about very dangerous drugs. We are talking about people who are in protective gear from head to toe when dealing with these drugs. They treat very carefully something that is no longer allowed to be used after the phial has been opened. We are talking about TGA requirements which say that, once a phial has been opened—even if there is an unused portion in the phial—you are not allowed to use it for any other patient. That unused portion of the phial has to be discarded. It has to be done away with. Then the government changed its story. It said, ‘There are pharmacists out there who are discarding whole unopened phials.’ What a joke. How many community pharmacists do that? What are your figures? What is your modelling? They were not able to answer those questions. No answers whatsoever were available.

The government have been ducking and weaving. They know they have made a mistake. They know they did not think things through. It is the way they usually do it in the health portfolio. They come out with these budget cuts, with Treasury driven initiatives, and the Minister for Health and Ageing goes out there like a propaganda minister, selling the Treasury line, and it is cancer patients across Australia who have to pay the price.

Here we have health department officials now sending out emails to stakeholders telling them, ‘We’re still not ready.’ I will just read this into the record, because it is a disgrace—stakeholders are now being made responsible for the government’s complete failure on this measure. This is what an official from the health department told healthcare professionals across Australia:

… without further cooperation from stakeholders, some of the proposed ways forward are not feasible.

Well, why didn’t you speak to stakeholders before you put this measure in the budget?

The Government is briefly delaying implementation of the measure beyond 1 September, and will provide a further update on its implementation plans in the near future.

We are less than three weeks away. Cancer patients across Australia deserve to know what the government’s intentions are, because we are talking about hundreds and hundreds of dollars for every single dose that people might have to pay out of their own pockets if the government goes ahead with this absolutely ill-considered plan.

Kate Lundy (ACT, Australian Labor Party) Share this | Link to this | Hansard source

I think in the first instance I need to respond to Senator Cormann’s offensive diatribe, aimed at the minister for health, in his opening remarks in taking note of answers today. It was completely unnecessary if he had valid points to make about the handling of this chemotherapy issue. Had he listened carefully to the minister he would have realised that most of the things that he complained about in his presentation to the Senate today were specifically addressed. I think we have all noted now that the measure, which was to commence on 1 July 2009, was delayed until 1 September, and you have now been advised, as have stakeholders, that there will be further information provided by the government. This is obviously information known to you, Senator Cormann, yet you insist on coming into the Senate and implying that nothing is being addressed, nothing is being done, when every effort appears to have been made to keep you in the loop.

Senator Cormann would probably also know, had he listened to the minister’s response, that the Rudd Labor government is committed to a sustainable and strong PBS, and this means we need to always try—as previous governments have tried, not without controversy—to manage the costs of the PBS as those costs rise and rise and rise. We remain absolutely committed to implementing our chemotherapy measure that reduces wastage of expensive chemotherapy medicines by funding the actual quantities of medicines that are delivered to cancer patients. By any test this is a reasonable approach and a responsible approach when expending taxpayers’ money.

There is no doubt that there are currently no incentives to promote efficient use of these very expensive medicines—and Senator Cormann himself went to some lengths to point out one of the reasons they are so expensive: they are very difficult medicines to manage. We believe that the only way we can improve the use of these medicines is to continue to ensure that they are both accessible and affordable for all Australians.

Now, we do need to be careful—and I have to make this point—that we distinguish between legitimate concerns that are being expressed about this issue and misinformation that is being provided, including in the chamber today by Senator Cormann from the opposition. Despite claims to the contrary, patient safety—and this is a good example—will not be adversely affected by this measure, as it does not promote any change from current pharmacy practices in relation to the multiple use of chemotherapy phials. As Senator Cormann also knows, the government is reviewing the measure to ensure that patient treatment is not compromised and that public and private oncology pharmacy services remain viable so that there will be no influx of patients from the private to the public sector.

Labor have also invested, as a result of our 2009-10 budget, some $600 million to ensure that Australians are able to receive much-needed medicines. As I said at the beginning of my comments, we have a commitment to making sure that the quality of service received by cancer sufferers in Australia’s health system improves.

I would like to remind colleagues in the Senate that the Rudd Labor government did release a substantive statement on future health reforms just recently. I cannot help but think that, in light of that and in the absence of any constructive contribution from the opposition in relation to much-needed and long-awaited major national health reforms, there is a bit of discomfort on the other side of the chamber about the poor performance of the former Howard government in the area of health. For years we watched from the opposition benches the mismanagement of the health portfolio. We watched the costs rise but saw no structural reform of or impact on the health system by the former Howard government. It was, as usual, left to federal Labor to step in with a visionary plan of substantive reform, and that has been placed on the agenda with the statement put forward by the Prime Minister just the other day.

So I think what we are seeing here is a very narrow question and a very narrow taking note of answers trying to attack an embedded budget measure to reduce waste, increase efficiency and therefore enhance the sustainability of our health system, rather than any issue of substance. (Time expired)

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

I am very close to this issue at the moment, as I myself am undergoing chemotherapy. During the months that I have been attending the clinic, I have been asked by a number of medical oncologists what is going on: ‘Why is this being delayed? Are they still going on with it?’ ‘Are our patients going to suffer?’ As far as community pharmacists in rural areas are concerned, this is not waste. But who is going to have to pay for the extra bit of the drug that cannot be used? As you heard Senator Cormann say, pharmacists are not supposed to use it. I asked the following question on notice of the department at budget estimates:

Is the department aware of the effect on pharmacists if the government pays for only the amount of chemotherapy used?  Eg, if only ¾ of a vial is used the pharmacists would be out of pocket for ¼ of a vial. Therefore a pharmacist could be out of pocket by up to $640 for a drug such as Herceptin?

The answer was:

This measure is designed to encourage the efficient use of chemotherapy medicines.

I take absolute umbrage at this, because I have watched these medicines being drawn up and the way they are prepared in the clinic that I attend, and these people are very, very careful; as far as efficiency goes, they do the best they possibly can. I think it is very poor of the government to criticise these health professionals who are doing their best for a number of very vulnerable people in the community.

The clinic I attend has 70 patients in the morning. Those people work very hard and make sure they do absolutely the right thing. Who is going to pay for the gap if the patient no longer needs to use a full phial because their weight has reduced, which often happens with cancer treatment? What if they now only need to use three-quarters of a phial? That is the problem. Is it going to be passed on to the patient or is it going to be the pharmacist who is going to have to pay for it, like I talked about in country areas?

I listened to the minister’s answers today. I was once again in the midwifery inquiry asking when this is going to happen. The responses I got were: ‘briefly’, ‘in the near future’ and ‘shortly’. We really do want to know. These regulations were going to start on 1 September, but we are still having ongoing consultation with stakeholders. Just how much consultation can one have? Looking back at my other questions on notice, I see, ‘The department has undertaken extensive stakeholder consultation.’ I am getting fed up with hearing day after day at every inquiry, ‘We’re doing extensive consultation.’ When you ask who the stakeholders are they cannot be named. They say, ‘We are reviewing the treatment and looking at patient safety.’ Surely you looked at patient safety at the start.

Somehow we have to get past this ‘briefly’ and ‘in the near future’ and having policy made on the run with nothing to back it up. This should be resolved. For goodness sake, I am sure that savings can be found somewhere else rather than hitting this very vulnerable area of the community.

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

This is a very emotional issue to take note of answers on. Senator Cormann made some comments that were quite disingenuous considering the former Howard Liberal government’s 12 long years of neglect of the health system in this country. Senator Adams, as we all know, does have a firsthand account of cancer, and I have a family member who now, unfortunately, will not survive with these cancer treatments.

We can all come into this chamber and play politics with people’s health, but I do not think that serves the community’s interests and I do not believe it serves the country. As I said in the last sitting when we had a debate on health, I would stake the Rudd Labor government’s health agenda against the 12 long years of neglect of the Howard government any day of the week. Bring it on, Senator Cormann! Give us 12 years in government and our record on health will diminish any limited capacity that your former government had in looking after the health and welfare of Australians.

I remind people that this week, hopefully, we will get to debate the alcopops tax. If you were really serious about health then you would support that legislation, Senator Cormann. You were one of the most vocal in opposing that legislation because your interest in health is one that only serves your own political agenda.

The Rudd Labor government, as all Australian governments do, has it foremost in its mind to always consider the taxpayer when expending any money. We are committed to ensure there is no wastage. If you listened to the contribution of Senator Cormann, you would have heard: ‘It’s okay to waste. It doesn’t matter if we waste. What difference does it really make? We should just make this available.’ We have a responsibility to govern for all Australians and to ensure that we get the best value for all taxpayer money that is expended.

As I said before, you can come here and play politics with people’s health, but that is not our agenda. We are about improving the health system. Ultimately, the taxpayers will benefit from reducing the wastage of expensive medication. There have been lots of injections to improve the Launceston General Hospital over the last 18 months because it is one of the many hospitals in rural and regional Australia that were neglected by the former Howard government. As a former member of that hospital board I know only too well the cost of medical equipment and medicine in providing the health system that we have in this country, which I consider to be the world’s best. In delivering those services we have a responsibility to the taxpayer. Unlike the previous government, we are accountable for every dollar this government expends, whether in health or in any other area.

In relation to access to chemotherapy and the measures that this government is undertaking that were announced in the budget, we are consulting, and I think that is a very good thing. The Australian people expect us to consult. We are not as arrogant and out of touch as those opposite were when they were in government. This is another prime example of where they do not want to consult and be accountable. We take our role in governing this country very seriously and we will continue to do so.

We need to be very careful to distinguish between legitimate concerns and misinformation. I think that has been borne out over recent weeks in terms of misinformation and emails—and we do not need to go there. We need to focus on the contribution Senator Cormann made to this debate. I acknowledge the contribution of Senator Adams and her concerns, as she too knows firsthand the issues that confront not only individuals but families who are experiencing cancer.

I reiterate that no patient’s treatment will be compromised by these measures. I think that at the end of the day that is the most important thing. It must be on the record that we will do nothing that will compromise a patient’s health and wellbeing.

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

I also seek to take note of Senator Ludwig’s answer. I would like to thank Senator Adams for her contribution to this discussion this afternoon, in contrast to the contributions we have seen from Senator Lundy and Senator Polley. Senator Lundy tells us that it is trivial to care about the effects of government policy on chemotherapy patients. Senator Polley wants us to worry about how accountable the current government is for its funding—it is apparently so much more accountable than the Howard government. Could I invite her to have a look at the relative surpluses and deficits of those two governments and to think about who was actually being accountable for funding spent instead of attempting to develop a sense of Ruddian omnipotence. There seems to be a view amongst the government that to criticise policy in any way is to play politics. Apparently, with their current omnipotence, this government is completely above politics. To suggest that a chemotherapy patient might have to pay more, that someone is going to have to pay for this mistake—one of the many mistakes made by the Minister for Health and Ageing—is apparently to play politics.

It is not about playing politics. It is about trying to get policy that has had plenty of time to be fixed, fixed properly. Why hasn’t that happened already? The fact is that this was a May 2008 budget measure—that is when it was first proposed. But then, oh goodness, we have the health minister, Nicola Roxon, coming out on 27 April to say they are going to ‘delay implementation of the chemotherapy budget measure from 1 July for two months till 1 September’ so that they can:

… work with key stakeholders on resolving outstanding issues and to negotiate with industry stakeholders on modified arrangements.

As Senator Cormann has very ably pointed out, they will not even manage to do this by 1 September, in three weeks time, which was their new deadline. How much ‘continuing to work with stakeholders and industry to make sure we get the details right’, as Minister Roxon said, can one person, one department or even one minister do? Then we have Senator Ludwig pointing out again today that this will now be delayed past 1 September to allow for ‘ongoing consultations with stakeholders’. Oh dear! This is from May 2008. You would have thought that before this went into the budget the first time they would have done their consultation with stakeholders.

This is going to have a disastrous effect on people undergoing chemotherapy treatment. We currently have a situation where we are being told by the government and the department that, if, for example, 10 phials of chemotherapy drugs are prescribed and only eight are used, the other two can be used later. But we are being told over and over by the industry and the stakeholders—who apparently have been being consulted for almost two years; if the government has listened once to its stakeholders it would have heard this—that this is dangerous and it will be unsuccessful. These are volatile and dangerous drugs. John Stubbs, from the Cancer Voices Australia organisation, says that in fact it will lead to an increase in bacterial and viral infections. He says it is a completely flawed notion to think that leftovers can be safely used.

Why can’t the minister finally do some real consulting and, if she wishes to have real efficiency, try to work out a method for reducing the size of the phials that are used? This must be perfectly achievable. But, of course, the government has said: ‘Oh, no, that would involve talking to pharmaceutical companies. This would involve international discussions. We couldn’t possibly do that.’ I figure that, in fact, they could not do it—it would be possible for a competent minister to do it, but it is probably well beyond the capacity of the current one. In the meantime, places like the Gympie Hospital will have to cease treating chemotherapy patients if this legislation proceeds.

Question agreed to.