Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I was talking about the Greens’ position on the Australian National Preventive Health Agency Bill 2009 and the establishment of this agency. At the time, I think, I was outlining the Greens’ concerns about the bill and why we thought it was important that amendments were made. As I was articulating yesterday, we believe this is a significant step forward. However, I must admit that I am doubtful as to the government’s commitment to this agency, as to whether they actually want it to succeed and whether they actually want to get it through this chamber.

To date we have had what I would say are fairly lukewarm discussions with the government about this bill. We have not, we think, made excessive claims or requests; we have genuinely been negotiating for a successful outcome, and I am exceedingly disappointed that the government have not, I think, participated in those discussions in a meaningful way. I am exceedingly disappointed with some of the feedback that the Greens have been getting, and I think the government think that we will vote for this bill regardless of how they negotiate with other parties. I tell the government that they are wrong and that we will not be supporting this if they do not negotiate with us in good faith. They cannot assume that they can do what they like to the Greens and that we will support this bill.

We are very genuine in our attempts to pursue good health outcomes for this country, but we will not be treated in the way that this government thinks it is acceptable to treat the Greens. The message to the government is that we will not be voting for this bill unless the government negotiates with us in a meaningful manner on the outcomes that we think are appropriate and the amendments that we have put up in good faith. When we negotiate with the government, we expect it to stick to the promises that it has made and not go back on them. As I said, the message is: do not expect that we will be voting for this bill if the government does not engage with us in a meaningful way. The government needs the Greens, Senator Xenophon and Senator Fielding to get this bill through if it does not have the coalition. I ask the government to bear that in mind. We have put up amendments in very good faith. We have put up amendments to include alcohol in the range of issues that the agency deals with to amend objectives and to put some more independence in the authority. (Time expired)

Simon Birmingham (SA, Liberal Party) Share this | Link to this | Hansard source

It is a pleasure to rise to speak on the Australian National Preventive Health Agency Bill 2009 and to outline some of the concerns that I have both with the nature of this bill and, indeed, with some of the broader subject matter and policies that it encompasses. I say at the outset that, as my colleague Senator Cormann has argued so strongly, this bill is very much a case of the government seeking to put the cart before the horse. This is a case of the government deciding that it is about serving the Public Service and creating a bigger bureaucracy before it actually gets on with talking about policy decisions and policy actions. These are the great disappointments that lie in its decision to introduce this bill in response to an inquiry and a report. That is the only significant response the government has made, and the response is simply to set up an agency—not to consider any of the other substantive recommendations of the report but to swell the ranks of Canberra’s Public Service a little bit more by setting up an agency.

This is one of the many, many reports that this government has commissioned in its two years in office. Report after report has piled up through this time, including in the health portfolio. There are so many reports and reviews and yet there has been so little substantive policy action on the recommendations or findings of the reviews. We see in the health area the classic example. The government promised big before the last election. On public hospitals it promised that it would take over management by July this year—the July that has already passed—if the states had not got their acts together. Of course, that promise has been thrown out the window.

We have seen a review come back to the government on the public hospital system and the health system. They have had their review and it has reported. What have they done in response to that report on the public health system and the many, many recommendations contained within it? They have gone to consultation. We had a review into the public health system and our hospitals, and they have now gone to consultation.

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

And reviews into the review.

Simon Birmingham (SA, Liberal Party) Share this | Link to this | Hansard source

As Senator Cormann says, it is a review into the review. They have gone to consultation. Little wonder that yesterday in question time government senators appeared to look so dispirited, worn and tired, because I understand that the consultation strategy proceeded yesterday with the Prime Minister in the Labor Party caucus giving a PowerPoint presentation on the consultation strategy. People like to talk of death by PowerPoint. I can only imagine what a PowerPoint presentation by the Prime Minister would be like. I understand he inflicts these presentations on the Labor Party caucus on quite a regular basis, which must be a most painful activity for all and sundry who have to go through it. I can only imagine that in this instance the Prime Minister would have stood there and there would have been a picture of the Prime Minister and Minister Roxon with some nurses and then another picture of the Prime Minister and Minister Roxon, perhaps in surgical gowns—some nice photos that could, perhaps, go in their electorate publications as long as the Department of Finance and Deregulation approved the content as not being electioneering. I can see slide after slide of the Prime Minister’s holiday tour around the nation’s hospitals as part of his review into the review and his consultation strategy.

It is a strategy that is so light on action and detail. All he is doing is talking and running around the country. What he is not doing is fixing the hospitals, hospitals that state Labor administrations have neglected and worn down for so many, many years. He is now failing to show the courage to stand up to those state Labor administrations and actually ensure there is some action in this area rather than an awful lot of photo opportunities.

In my home state of South Australia recently one of these consultations took place. The Prime Minister went to Murray Bridge. He wanted to talk about regional health, apparently, and visit a regional hospital so he very carefully chose Murray Bridge. The Prime Minister and the Minister for Health and Ageing know all too well that just there in Adelaide’s north lies the Gawler hospital. Hidden away in the budget details this year was a rezoning, a reclassification, of the Gawler hospital away from being treated as a regional hospital to being treated as a metropolitan hospital. The Prime Minister could have chosen to go to that semiregional, outer metropolitan area and talk to people there, but of course, no, he would not go there. He has not gone anywhere near the Gawler hospital in these consultations, because he knows the community there are very angry that the sneaky budget decision of this government last year is going to cost that community their health services and make it a whole lot harder to attract doctors to that area of Adelaide’s north.

This is the type of decision that the government are making. We have seen it on cataracts, as we have discussed at length today. There are sneaky decisions in the health budget that take away services and benefits from communities, whilst the government conduct roadshows and PowerPoint presentations talking about what they might be able to do and trying to once again convince the Australian people, as they did before the last election, that they stand for something, even though there is no action behind all of those words.

That was the review into the public health system, which has gone off to its consultations and review. Then we had the Preventative Health Taskforce review. I think 134-plus recommendations came from the Preventative Health Taskforce review. There were a stream of recommendations there, and what has the government decided to do? What is its action out of this? Its action is contained in this legislation. That action is the Australian National Preventive Health Agency. I am sure we all look forward to having yet another agency in Canberra, yet another bureaucracy established, yet more public servants being paid.

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

They grow like rabbits!

Simon Birmingham (SA, Liberal Party) Share this | Link to this | Hansard source

Indeed. There is no shortage of public servants. What we have seen in state Labor government after state Labor government around the country is a ballooning of public service numbers. They do not even know, half the time, how many extra they are getting. In South Australia they have thousands more public servants than even the Labor government ever budgeted for. They just woke up one day and had all these extra public servants. Quite clearly, this federal Labor government is going to go down the same path. Numbers will slowly creep up in all of the existing agencies and, on quite a regular basis, we will have new agencies coming into power. The Australian National Preventive Health Agency will of course be one of them.

What we need is health outcomes, not health bureaucrats. What we need are actions, funds and policies on the ground and in communities around Australia that provide real, tangible health benefits, not more health bureaucrats sitting in Canberra trying to tell people how to live their lives. This agency is going to have a $133 million budget. It will spend $2 million this year on marketing campaigns—and I will come in a moment to some of those ideas of marketing campaigns and agencies telling us how to live our lives. That figure will balloon out to $33.8 million in 2010-11. So there will be nearly $34 million that year in marketing campaigns by this new government agency, with all of its bloated bureaucrats and so on adding to the great Canberra bureaucracy.

Thirteen million dollars over four years will go into what is euphemistically described as ‘translating research into practice’. It would be interesting to see just what that actually meant. It may well mean yet more research, or it may mean—and this is the great fear out of this—that the government will hand over policy powers, some level of arbitrary decision making, to an unelected body. We believe that the government should respond to the Preventative Health Taskforce report in its entirety. That is what the second reading amendment to this bill, sensibly moved by Senator Cormann, calls for, and I hope that this chamber will support it. The second reading amendment would ensure that the government actually gave a response to all of the recommendations in the Preventative Health Taskforce report and that the government set the policy and did not handball the policy decision making off to unelected health bureaucrats. That is the risk in establishing these types of new agencies—that is, that the government takes decision making out of the hands of this parliament, out of its own hands, and gives it away because it finds it easier to let other people make decisions and finds it easier then not to have to front up for the blame for the types of actions and decisions that these agencies might follow through with.

This whole agenda around preventative health is an interesting one, because it is an area where, with too many powers, agencies such as this one could have very profound impacts on the way people choose—quite knowingly—to live their lives. It is not a news flash, it is not some earth-shattering, groundbreaking news, to tell Australians that smoking is bad for them. It is not earth-shattering news to tell Australians that drinking to excess is bad for them. Equally, it is not earth-shattering news to tell Australians that gorging themselves on fatty foods is no good for their ongoing health. These are not groundbreaking bits of news—far from it. These are facts that the overwhelming majority of Australians already understand.

I would hazard a guess that, if you asked that question—whether smoking was good or bad for them, drinking to excess was good or bad for them or eating an unhealthy diet was good or bad for them—of 99 per cent of Australians, they would all know that each of those things was bad for them. Yet they continue in some instances to do it. That is not to say that it is good that they do it but it is to say that no number of marketing campaigns, no number of budgets in these areas will enable you to convince or stop people from making what in the end to some extent are free choices to be able to actually decide how they lead their lives. Unhealthy lives we would all like to discourage, but there are limits to how much government should interfere in people’s lives to discourage them from leading unhealthy lives. Government is not some nanny state that is there to hold the hand of everybody each time they go to the supermarket, to tell you, ‘No, you should not put that in your shopping trolley.’ That is not the role of government and that is not what we should be seeing out of these types of preventive health agendas.

Preventive health is far wider an issue than the government has chosen to pursue in this particular taskforce report and indeed the working of this agency. Preventive health relates to the overall avoidance of disease development, supporting early diagnosis and reducing negative impacts or complications of established diseases—all very worthy aims. Using condoms, washing hands, cleaning areas of food preparation and providing immunisations are all quite worthy aspects of preventive health. These are things that seem to be overlooked in the remit for this agency and seem to be overlooked in the approach of the task force. Yet early screening, testing for a range of diseases and more work on family history are all important things that the government should be putting high on the priority list. But no, it chooses to go for the sensationalist aspects that get good, cheap headlines: those things to do with smoking, drinking and fatty foods. The media lap up the stories on clamping down on these things. They love to hear the stories of inflated estimates of just how much these types of activities might actually cost.

Let us look at how much some of these things cost, not in terms of overall economic loss that takes in a whole range of extraneous factors that those who like to sensationalise put together but let us actually look at cost to hospitals. We will pick on smoking because everybody else picks on smoking. I do not see why I should not as well. A federal government report in 2005 found that the cost of smoking to the hospital system was some $670 million. That is a significant cost of smoking to the hospital system, and I acknowledge there would be other direct costs to the health system from smoking that would add to that very significant price tag. But what do we collect in tobacco excise? It is $5.5 billion, with GST on top of that. There is $5.5 billion in tobacco excise collected every year. We are already taxing smokers and drinkers quite significantly to pay for their sins of smoking or drinking to excess, to make sure that they pay for the additional cost that they put on the health system and our health services, to make sure that there is a financial disincentive as well. A financial disincentive is welcome and is an important part of the types of measures the government has pursued over the years. These are reasonable measures that have been built up over a long period of time.

Taxes on tobacco and alcohol have their place. They have been growing over many years to the level we have today and they act as a deterrent. There comes a point where you push beyond that deterrence level and you start to encourage, in the case of tobacco, the use of chop chop, illegal activities, activities by bikie gangs or others. You end up with government policies that encourage the types of underground businesses that prohibition for time immemorial has been seen to foster that society should not encourage. That is why getting the right balance in these policies is so important.

It seems that very little of this debate has actually focused on when we cross the line of unnecessarily telling people how they should live their lives or unnecessarily instructing businesses on how they should run their businesses. There is no way that in those types of interference we should be handing power over to an unelected body like the Australian National Preventive Health Agency. We should be ensuring as a parliament that we set the policies in these areas; that we make sure that the tax rate applied to these areas is correct, not too much, not too little; that we make sure that the public education campaigns applied to not smoking, not drinking to excess and having a healthy diet are not too much, not too little; that we make sure that the parliament and the government and the elected officials are actually the ones who have the total control over these very important policy areas that impact directly on how people choose to live their lives. It is not up to unelected bureaucrats, and indeed we as elected officials should be very mindful that we do not cross that line of unnecessarily impinging on people’s freedom of choice to be able to live their lives as they reasonably see fit so long as they do not cause harm to others. That needs to be the prerequisite. We of course need to pursue the types of policies that have been pursued over the years in relation to smoking and in relation to drinking that minimise the harm caused to others, that seek to eliminate the harm caused to others. But in the end people’s choice to do these things for their own selves, in their own body, needs to remain their own choice.

There are some reasonable ideas contained in the Preventative Health Taskforce report. Increasing the provision of fresh food to remote Indigenous communities is something government should be actively addressing. Working to reduce tobacco and alcohol abuse, particularly in those communities, is something government should be addressing. Tackling obesity and diabetes and providing for better sports and encouraging active, healthy lifestyles in schools is something government should be addressing. But government should be addressing those things before they ask us to vote on this bill. We should be expecting that this government and this Senate defer consideration of this bill rather than handballing another report off to another agency that will probably undertake another review. Let us hear your comprehensive responses to the Preventative Health Taskforce. When we hear your comprehensive responses, we will happily debate this bill. When we know what the agency may or may not be undertaking on a policy basis, we can make a considered decision. Until then, this bill should lie on the table or be defeated.

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

I support the second reading of the Australian National Preventive Health Agency Bill 2009. I understand the coalition’s criticisms of this bill, but I believe that it is an important way forward. It is important because having a preventive approach to sickness is pretty fundamental to any good health system, and I commend the Minister for Health and Ageing for going down this path. The fact that this will be a statutory body is welcome as well, but I think that it also needs to be independent and to give advice that it is clear, unbiased and free of any government interference. That is why I believe that the amendments to be moved by the Australian Greens have a lot of merit when it comes to the independence of this body.

Australia does not need a bigger health bureaucracy without more information and better advocacy. That is why it is important that the focus of this agency be on making robust recommendations on bettering the health of Australians in order to prevent illness and disease. It is important that the agency provide leadership on preventive health surveillance and data and to promote standards of preventive health. This body has an enormous opportunity to do a lot of good in the community when it comes to health, and I commend the health minister for introducing it, but I believe that it could be more independently structured. I note that the Australian Greens have proposed amendments to the bill that relate to the agency’s scope for looking at alcohol and tobacco. I also note Senator Fielding’s very genuine concerns about alcohol abuse in the community. It is important that this body look at preventive strategies in that area. Other substance abuse also needs to be covered. We cannot underestimate the devastation that substance abuse such as crystal meth and heroin abuse causes to individuals, families and communities. That is why this bill must have a clear focus on dealing with other substance abuse.

I have a concern about the independence of the body, which should be embedded structurally. I also have concerns about the recommendations that this body makes, which should be as transparent as possible. After all, if we are dealing with an issue of public health, those recommendations ought to be transparent and subject to public scrutiny. That is why I will be moving an amendment that will ensure that recommendations made go on the web. That does not require the government to actually implement those recommendations, but it does require a degree of transparency and robustness in the debate on this.

I expect that I will have much more to say about this in the committee stage. I support the second reading of this bill. It is important that we get it right. It is also important that the government be transparent in any negotiations that it has undertaken with all parties on this bill and that we do not lose this opportunity to make some significant advances in preventive health in this country. I commend the minister’s focus on that. I also commend Senator Cormann for his forensic and robust advocacy of his concerns—

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

Senator Cormann interjecting—

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

I think that Senator Cormann is doing what a shadow spokesman should be doing: keeping the government to account. The government’s failure to provide details of recommendations should be condemned, and I supported the opposition on that. I agreed that those details should be provided, but I do not agree with the opposition’s belief that the government’s conduct on the recommendations is a reason to stop this body being set up. That is my fundamental difference with the opposition. I look forward to a robust committee stage and hope that the government acknowledges the merit of a number of amendments that are being moved, so enabling this bill to be passed.

(Quorum formed)

Ursula Stephens (NSW, Australian Labor Party, Parliamentary Secretary for Social Inclusion and the Voluntary Sector) Share this | Link to this | Hansard source

I thank the senators who have contributed to the debate on the Australian National Preventive Health Agency Bill 2009 and confirm for those who may be listening to this debate that the government absolutely acknowledges that our health system is in desperate need of reform and that we need to deal with the health issues of the 21st century. I am not going to dignify Senator Birmingham’s contribution—some of the nonsense that he put forward was quite ridiculous. We could only begin to wonder how the coalition’s consultation process would have played out given the intensity of the issues and the concerns that Australian people have about our reform agenda and the situation with respect to health in Australia at the moment.

It is very clear that the Australian people understand that the Rudd government has a very ambitious three-pronged health reform agenda. It is a complex issue, one that the previous government shirked and short-changed for over a decade and one that our government has said it is determined to tackle. In opposing the passage of this bill today, those opposite have disgraced themselves on the issue of health. The government has undertaken three interlocking and complementary reviews via the National Health and Hospitals Reform Commission and the national Preventative Health Taskforce.

A key part of their recommendation is the establishment of some infrastructure to guide, oversee and build the evidence base for more effective preventative health measures. The agency was scheduled to start work on 1 January next year, with $133 million allocated for its immediate work to fund research, to conduct public health campaigns and to develop contemporary national guidelines, standards, codes and other activities. One of the first tasks earmarked for the agency was to run a new, focused antismoking campaign and to conduct some translational research to reduce obesity—the scourge of the 21st century around the modern world. Just five days ago, we had Liberal Party support in the other place for this agency. The member for Dickson said:

The objective of preventative health measures to alleviate pressure on the public hospital system is rightly supported by both sides of politics.

But today what have we seen? We have seen Senator Cormann come in here and undermine his health spokesperson and move an amendment that is effectively about blocking the establishment of this agency.

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

Mr President, I raise a point of order. The speaker for the government is misleading the Senate. Obviously she has her talking points from the Minister for Health and Ageing, who is getting so desperate given that she is not making any inroads in her health portfolio that she now has to perpetuate these sorts of lies.

Mark Bishop (WA, Australian Labor Party) Share this | Link to this | Hansard source

There is no point of order.

Ursula Stephens (NSW, Australian Labor Party, Parliamentary Secretary for Social Inclusion and the Voluntary Sector) Share this | Link to this | Hansard source

Senator Cormann’s amendment moved today to delay and effectively block the establishment of the agency has a purpose. It defies logic that, 12 months after this was announced, months after it has been publicly debated and only days after it was supported as noncontentious by the Liberals in the Main Committee, they are now against it. It makes no sense.

Debate interrupted.