Alan Ferguson (SA, Deputy-President) Share this | Link to this | Hansard source

The President has received a letter from Senator Fifield proposing that a definite matter of public importance be submitted to the Senate for discussion, namely:

The collapse of the Government’s hospital reform process and failure to honour its commitments in health.

I call upon those senators who approve of the proposed discussion to rise in their places.

More than the number of senators required by the standing orders having risen in their places—

I understand that informal arrangements have been made to allocate specific times to each of the speakers in today’s debate. With the concurrence of the Senate, I shall ask the clerks to set the clock accordingly.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

It is not surprising that the so-called grand hospital plan that was touted by Labor is now coming to a sad and sorry end. In my contribution to today’s debate I want to go back and look at the history of this plan to see why it has got to where it is and to say to the Australian people that it is not surprising that it is finally falling apart simply because it was never a real plan. It was simply a smoke-and-mirrors exercise in true Labor tradition—all spin and no substance.

Let us go back to 2007 when New directions for Australian health: taking responsibility: Labor’s plan for ending the blame game on health and hospital care was released. In that policy document Kevin Rudd set out a strict deadline for achieving reform. It was repeated in the launch on 14 November: ‘I have a long-term plan to fix our nation’s hospitals. I will be responsible. The buck stops with me.’ One presupposed that the incoming Labor government actually had a plan. But when we traversed this issue in estimates on 10 February 2010 we actually got to the bottom of it. There was actually no plan. There was not even a back-of-the-envelope plan. There was no document that Labor brought when it came into government that outlined what its plan was.

Therefore they had to scramble. They had to find something. They had to do something on health because suddenly the gloss was starting to come off K. Rudd. That is when we suddenly saw the establishment of the National Health and Hospitals Reform Commission under the chairmanship of Dr Christine Bennett. This commission produced a number of reports including Beyond the blame game: accountability and performance benchmarks for the next Australian health care agreement. It produced A healthier future for all Australians: interim report. It traversed the countryside. It undertook consultation and finally produced this tome: A healthier future for all Australians: final report June 2009. It is a very comprehensive piece of work and you would think that then Prime Minister Rudd and Minister Roxon would have taken the 123 recommendations through the consultation process and at least responded to them. No, they had to then review the review. They had to consult about the consultations. They had to spend their time trekking around the countryside—surprise, surprise—to most of Australia’s marginal seat areas. Off went Kevin Rudd and Minister Roxon to trek around the countryside and have their picture taken in hospital garb. Mr Deputy President, I have this photograph that you corrected me on earlier, but I can tender it if you so wish.

Government Senators:

Government senators interjecting—

Alan Ferguson (SA, Deputy-President) Share this | Link to this | Hansard source

Order! Senator Fierravanti-Wells, the standing orders are quite clear about the displaying of photographs.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

If anybody is interested in looking at all of the photographs, they can go to the yourHealth website, because that is what all of this was about. We understand how the yourHealth website came into existence through a very amusing piece by Myles Peterson entitled, ‘Yes Minister meets Alice in Wonderland.’ It was a most amusing article which traversed how this website came into existence over a weekend. That website contained a whole lot of pictures of what Kevin Rudd and Nicola Roxon were doing around the countryside, but it also contained another piece of information—what they refer to as quick polls. This was their way of consulting with people. When you actually go and look at the website you see the government asserting that they have made major decisions based on consultations and these polls. When you have a poll of 62 people, I hardly think that forms a very valid basis for a consultation process. Not only did we pick this up at estimates last year, it is still sitting on the website, which tells you something about efficiency in the Department of Health and Aging. When you point something out to them, they still do not take it off the website.

After they had embarked on this consultation process with lots of photographs—every evening on our television screens there was another hospital and another photograph of Kevin Rudd and Nicola Roxon in the hospital attire and the little hats—

Alan Ferguson (SA, Deputy-President) Share this | Link to this | Hansard source

Order! Senator Fierravanti-Wells, you must refer to people by their proper titles.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

Prime Minister Rudd and Minister Roxon were in their attire posing for photographs next to hospital beds. Finally we got the blue book, which was released in March 2010. Before COAG we got the sales pitch, which was contained in the green book. The interesting thing about such books is the variation between the blue book, the green book and finally the red book, which was the document that was released at the time of COAG. Even before the ink was dry on the COAG agreement, this government had lined up its television advertising campaign. Nobody had seen the advertisements but this government had already lined up the $25 million it was going to spend trying to convince the Australian public of what it was trying to do. After that we got the National Health and Hospitals Network Agreement, which was much lauded and much trumpeted as a major reform. When you read the nitty-gritty of this agreement, you will see the absolute fabrication and lie that this government has perpetrated on the Australian public.

It talked about federal funding: the new era of federal funding. The ink was barely dry on this document when the national funding authority, which was much trumpeted as the vital mechanism for transparency that would make sure that the state governments used moneys that were directed for health for the appropriate purposes, was dumped unceremoniously. Most cynically it was dumped on the evening of the press gallery ball—slipped into an answer to a question on notice, through the Prime Minister’s department and the Prime Minister’s office. Minister Roxon was left standing there, not really knowing what was going on, telling journalists, ‘Oh, you had better ask the Prime Minister about that one.’ Here we had a major platform of this so-called reform being dumped unceremoniously—‘No, we don’t need pricing transparency anymore’—after they had spent months telling us how important this was.

The other misconception, the other lie that has been perpetrated, has been the falsehood about the networks being run locally. I have traversed this issue before. In this document it is very clear that the clinical expertise on these local hospital networks will not come from the local area; it will come from outside the local area. What is the point of having a local hospital network when the clinical expertise, those doctors who should know about that area, is not going to be appointed to those boards? This is all about maintaining the status quo, trying to portray some sort of national grand plan that is now well and truly falling apart. It faces sure extinction. The question I want answered is: what has been the cost to taxpayers of all the reviews, meetings and photo opportunities—all that stuff? What another instance of disgraceful Labor waste. The grand plan will be confined to terminal waste. It was never a legally binding agreement. It was more about giving us bureaucrats but no doctors and nurses.

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

This afternoon’s debate is about the health system, and I think it is really important that we have this debate. Senator Fierravanti-Wells, in her expressive speech, gave some chronology of what has been going on. There were some things—through you, Mr Deputy President—in Senator Fierravanti-Wells’s contribution with which I agreed. She had some documents that were produced by the government. I do believe they are accurate, because I have seen them before. I note that she talked about the National Health and Hospitals Reform Commission, which this government put into place, as it had promised during the election campaign, in the first few months of its term. The Rudd government put that into place as it had promised the community it would do. It acknowledged something that all of us had been hearing—that was another thing that I agreed with Senator Fierravanti-Wells about—as people had been talking about the health system, saying that there needed to be change. That is absolutely the rationale behind the process that the Rudd government and now the Gillard government have been putting into place, despite the extreme attempts by people from the other side of this chamber to put up every obstruction possible. From the very day that the Health and Hospitals Reform Commission was announced the opposition was saying that it should not happen, it would not work and that they would not be supporting it.

Every step along the way there have been arguments from the opposition. Certainly, there must be arguments about where we go for the best result for our health system, but every attempt to move forward in this area has been seen by the opposition as some kind of threat or reason to which they are philosophically opposed. That has come out through various debates in this place. As key aspects of the changes have come here for debate the opposition has consistently voted against them. In this debate about the whole area of health reform we know what the discussion is going to be before we stand up. Whatever the government says the opposition will disagree with; whatever we say will be passed away as some kind of symbol or as something that has no hope.

One of the things that seem to be most offensive to the opposition is the attempt that the government has made to work with and listen to the local community. We consistently hear raised the concern that the then Prime Minister and the minister for health, a person whose name and position seem to concern Senator Fierravanti-Wells greatly, actually visited hospitals across this country. They actually talked with people who worked in hospitals—with appropriate approvals—and spoke with people who were using the services of the hospitals. And sometimes they had their photos taken. That is the absolute joke. Under the circumstances I think it would have to be a first in Commonwealth government history: politicians were actually in the community, having told the community they would be there and what they were going to be doing when they visited, and then had their photographs taken, which later appeared on a website. I have not checked this afternoon how many hits there have been on that website, but I know a large number of them have been by members of the opposition, because they seem to keep a very close tally of how many photographs have been taken and where they were taken. They also seem to have a keen obsession with what the then Prime Minister and the minister for health were wearing on the day. I have to admit: that is something in which I cannot share because I do not know exactly what garb the people were wearing, but I do know that every time a visit was made to a hospital approval was sought beforehand. There are constant barbs about the fact that they were in medical gear, which would have been for the basic reason that that is what you should be wearing when you are in a specialised area.

Moving on from that, I need to respond, because so often in these discussions on this issue we get down to the process that was used by the government. Post the health and hospital reform commission hearings, people from the government have reinforced that by going out and listening to what people think. There are a number of forums across Australia, all I believe on the website. A number of methods are also used, one of which was the surveys. Once again, that was only one aspect of the strategy. In terms of where the government is going, from the start of this process a key element of the strategy for our health system was a cooperative arrangement through the pre-existing process that we have operated in this country for many years, the COAG system. This arrangement is between the state, territory and federal governments and is intended to develop a better response to issues in our health system. That was a key plank.

That is not an easy process. While I have never been there, I know that consistently there have been difficulties in the way that people have put claims forward and so on. There is a COAG meeting coming up next week. That could be the stimulus for this discussion in the chamber this afternoon. The COAG process is a tough process. What we need to have and what must occur is a form of national agreement. Towards the end of the last term of government an agreement was reached. There was a process of exchange between the GST and the funding of hospitals. That was but one element of the whole health reform process. That needs to continue to be discussed so that settlement can be reached. Every COAG meeting that I am aware of has had this as a key agenda item. That discussion, robust and difficult as it will be, will continue next week.

Over the last four years—since this Labor government has been in place—a number of things have been achieved. One of them that has had consistent opposition from those opposite is progress in electronic health. That was a key element of the health reform process identified in the health and hospitals reform review. It has been consistently discussed in this place. A number of Senate inquiries into it, some of which I have been involved in, have looked at the role that electronic changes will necessarily make to the future of our health system. There has been enormous progress in this area. This must continue. The first step has been made. A Senate committee examined this and it has gone through this chamber. That is one element that has been agreed to and which will be moved forward. But consistently there has been opposition from those opposite. They seem to take a philosophical approach rather than look at the issues that have come out in the range of consultations across the country.

One of the key aspects of the health changes has been a concentration on workforce issues. That has been going on in the short time that I have been here across a range of governments. We need to look at the way that the people who work in this system—those of all health professions—need to have a national registration process, a high skills level, consistent resources for training processes and a recommitment to the range of skills necessary to ensure that we have the best possible health system that we can get. These issues were again clearly raised through the health and hospitals reform process and also through local consultations. These were not people being talked at; rather, this was people who care about our health system sharing what they think should happen. That is the best possible way in which consultation can happen. The identification of workforce needs continues. The government has introduced a range of things over the last four years to directly address that. This includes scholarships, training and lifting the caps on GP numbers. That last thing was one of the things that we committed to in the first few days of our government, and that happened. What we are doing is working with the universities, colleges, professional groups and those entities being established to register workers in these areas to ensure that there is a cooperative arrangement across the states and territories.

The opposition make statements about how things have failed because the processes are moving slowly. There is no doubt that things are moving slowly, but changes in health systems do move slowly; they have done that consistently. I remind people on the other side of the chamber about the series of questions that we asked of then government ministers—in particular Minister Patterson—about what was occurring in the health system in those days. There were serious problems. We need to look at what is currently on the table and the structural changes that have been made and move forward. Perhaps we can all then have our photographs taken and put up somewhere for all of us to look at. (Time expired)

Russell Trood (Queensland, Liberal Party) Share this | Link to this | Hansard source

This government loves to talk about reform. There is nothing it likes to talk about more than health reform. At the 2007 election, it talked about health reform; during the Rudd years, it talked about health reform; at the 2010 poll, it talked about health reform. And now it is back on the agenda. But the reality is that this government’s record on all reform and in particular health reform is appalling. It has achieved so little that it is remarkable that it is even willing to contemplate further efforts. The problem for patients Australia-wide is very simple indeed and it became evident a very long while ago. As with almost everything else that this government does, it has not got the first idea about what it is doing. We have now reached a new depressing low in relation to reform and in particular health reform. The Prime Minister has signalled that she is on the verge of scrapping last year’s much-vaunted health reform agreement, one that drew in the states.

Bearing in mind that we are on the verge of ditching yet another so-called historic reform, it is useful to recall the government’s level of achievement in this area—the successes, if you like, that might be claimed in relation to change in the health area. There is probably not one of us here and perhaps more widely who do not recall Kevin Rudd’s 2007 superclinic promise. There were to be 31 monolithic health centres dotting the landscape from one end of the country to the other. These would offer bulk-billing, GP services, diagnostics, specialist suites and pharmacies. Everything would be together. All that one would have to do was make one stop and all one’s medical and pharmaceutical needs could be met at once.

What was the result of that promise? As at last year’s election, a total of three of these facilities were up and running—not even 10 per cent of the policy was achieved. Flushed with the success of not even achieving 10 per cent of the promise, the Prime Minister then announced that she was planning the construction of 450 new clinics. As I calculate it, the implementation of this program will take in the vicinity of 600 years. That might be slightly longer than most of us are going to be here to see the success and slightly longer than any other Australian might be around to see the success.

So having achieved that policy triumph and having made this announcement, where will we go from here? It is hardly surprising that there is another set of reform proposals. They are all in the marginal—not mainstream—areas of health. Having failed to succeed at that particular reform, the government moved on to not only superclinics but also a whole series of other very minor changes. They are all on the fringe of the real health reform that is needed in Australia. They are the pet projects of the social engineers within the Preventative Health Taskforce. They are everything but what we desperately need.

Back in 2008 Minister Roxon and her health department wasted an enormous amount of time, energy and resources by waging a war against sugary alcoholic beverages. It was quite clever politics because it served a particular constituency, but it failed to address the serious elements of health reform. The reform caravan moved on but it did not move onto mental health services, aged-care places, hospital waiting lists or the things that one would regard as the absolute core of genuine health reform; instead, it moved onto the debate over the cataract rebate. Here they sank to a new low by playing the politics of envy. It was an outrageous campaign that accused the specialists of being completely self-interested and that their opposition to the policy was essentially motivated by a desire to protect their income. All of this was for nothing more than 0.2 per cent of the health budget.

Alcopops, smoking taxes and cataract rebates are hardly the foundations of genuine and serious health reform, nor were the extravagant claims that the health system could be repaired in 18 months or so. There is no doubt that Australia’s health system is complex. There is no doubt that it tries to balance the interests of the public and private sectors. We have duplication and overlap between federal and state responsibilities. We have a $30 billion hospital system and a $20 billion Medicare service which often work at odds with each other rather than complementing each other. The result is a high degree of cost shifting on a grand scale between the two levels of government.

Mr Rudd proposed a solution to this problem. It was a very bad solution, in my view, because at the very centre of his proposal was what I would call a fiscal sleight of hand with the government proposing to fund a larger proportion of the hospital system expenses of the states by seeking to take 30 per cent of their GST revenues. I cannot believe that anybody in this country seriously believes that a better health system will be achieved by adding another layer of bureaucracy to that which already exists. But it made absolutely perfect sense to a Labor government to add another layer of bureaucracy because when one of these regional health arrangements inevitably collapses they can all blame each other and the Commonwealth can escape from under.

This was an ill-conceived scheme. It remains an ill-conceived scheme and we should perhaps be praising its decline. If the Prime Minister is going to ditch it, that is well and good. This was another case of reform that had run off the rails and it was another failure to make serious changes in an area where Australians expect change, need change and where a Labor government has failed to deliver.

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

This matter of public importance from the opposition is nothing more than an attempt to undermine the government’s health reform agenda. I am pleased I have the opportunity to set the record straight because all we have heard from the opposition today is political grandstanding and furphies of the highest order. Those opposite should be ashamed. It is time those opposite got onboard with the government to help deliver the better health services that the Australian people deserve. Instead, they seem far more content to play politics and to use the Senate as a vehicle to oppose and wreak havoc.

What do we hear from those opposite? Never an alternative plan or policy—those opposite are far more interested in wrecking and in being fiscally irresponsible. That is exactly what we saw this morning when they blew a $300-million hole in the budget. Those opposite can beat their chests all day long about being fiscally responsible, but what we got this morning from the opposition was fiscally irresponsible. It was all part of their campaign to derail and sabotage the budget. As Senator Wong said in question time, it was ‘political opportunism of the highest order.’ It is hardly the first time they have been caught out being fiscally irresponsible in this place; time and time again the opposition have behaved recklessly with the nation’s finances.

Those opposite have form in this area. In fact, it was only a few days ago when the opposition leader, Mr Abbott, and his shadow Treasurer, Mr Hockey, were announcing their alternative to the government’s vitally important flood levy that they were found to have once again made errors in their costings. Mr Abbott and Mr Hockey could not agree on the figures; they counted more savings than there actually were; they double counted. And I say they ‘again’ made errors in their costings because who could forget when Mr Hockey and Mr Robb, the shadow finance minister, made costing errors in the coalition’s election promises?

Today would not be the first time that those opposite have used this place to peddle the same old tired, point-scoring political lines. Those opposite clearly favour wrecking and opposing, trying to use this place as a wrecking ball, which brings us to today’s matter of public importance. Whilst those opposite can spread their furphies, the fact remains that since coming to office the Labor government have made significant investments in health and ageing. However, we are well aware that our hospitals are still suffering under the weight of a decade of neglect from those opposite and the Howard government. It was those opposite who, for 10 years, ignored Australia’s hospital system. They left the country’s health system in a shambles, through a tale of neglect, and removed $1 billion from the health system.

Who can forget that when the now opposition leader, Mr Tony Abbott, was health minister he capped GP training places at 600 a year. This resulted in a chronic shortage of GPs, meaning Australian families could not see a doctor when they needed to. So, after the health system was ignored for over 10 years, we are aware of the huge amount of hard work and improvements that need to be made. In my home state of Tasmania the Labor government’s investment in the public health system comes as a welcome relief, because during the Howard government’s last five years in office they underfunded Tasmania’s public health system by a staggering $70 million.

Whilst those opposite can cry crocodile tears all they like, since coming to office this government has set about investing heavily in our hospital system. We are also applying a renewed focus on preventative health measures through a historic $872 million investment, which could be placed in jeopardy because of the reckless actions of those opposite. The investment announced at the COAG meeting is the single biggest investment ever made by a Commonwealth government in preventative health measures.

However, we are well aware that our hospitals are still suffering under the weight of a decade of neglect from those opposite. After the previous government ignored the health system for 12 years, we are aware of the huge amount of hard work and improvement needed. As I have already stated, those opposite slashed $1 billion from public hospitals. They also caused a national shortage in the medical workforce by freezing medical student places through a cap on GP training places—which we have seen lead to a doctor shortage around the country. Those opposite also, as in so many areas during their reign, failed to plan for the future. They ignored the future challenges facing our health system such as an ageing population and the growing burden of chronic disease.

That is why since coming to office the Labor government has embarked on making significant investment in the health system. In fact, since coming to office in 2007 we have increased hospital funding by 50 per cent and invested in emergency department upgrades at 37 hospitals right around Australia. This is helping us deliver more timely services to people when they present at emergency departments. We have delivered 70,000 more elective surgery operations, 265,000 GP superclinic services and one million Teen Dental Plan services and we are training 1,000 more nurses a year. There are also 1,300 more subacute beds available because of the policies of the Labor government.

We have also made elective surgery improvements at over 125 hospitals and initiated 32 major Health and Hospitals Fund projects and 22 regional cancer centres. We are introducing the e-health records system, which will ensure that every Australian who wants an electronic health record will have one. This will be a valuable resource as it will allow doctors to look up a patient’s medical history so that they are able to provide the very best of care. We have also placed a renewed focus on primary care, by investing in 64 GP superclinics, GP practice upgrades and 4,600 practice nurses. I am pleased to report to the Senate that 28 of the original 36 superclinics are now completed, are operating interim services or are under construction. We have given nurses and midwives access to Medicare and the PBS. We have delivered the MyHospitals website.

These are indeed impressive measures, from a government totally committed to providing the very best health care for Australians. However, we will not rest on our laurels; we will not stop there. There is more work to be done. We are also making significant investment in the health workforce by delivering 1,000 extra nurses a year and over 6,000 more doctors over the next decade. In fact, after lifting the cap on Mr Abbott’s GP training quota we will have doubled the number of GPs entering training by 2014.

We recognise that to keep pace with Australia’s health requirements we need to continue to invest in our health workforce. That is why the government has set up Health Workforce Australia, or HWA. It will provide the government with advice on how to meet the future challenges of providing a health workforce that responds to the needs of the Australian community. HWA will develop policy and deliver programs across four main areas—workforce planning, policy and research; clinical education; innovation and reform of the health workforce; and the recruitment and retention of international health professionals.

We remain totally committed to investing in Australia’s health system, as the Minister for Health, the Hon. Nicola Roxon, outlined in her recent address to the Australian Health Care Reform Alliance Health Reform Summit:

Health reform has been a hallmark of this Government.

We have a strong and undeniable track record and remain committed to driving and delivering reform.

Our health system needs it; the future wellbeing of our country demands it.

On coming to office we also recognised that aged care was going to be a significant area of health concern in the future, so the Labor government is providing more funding for more services to more older Australians than ever before.

So, to recap, the records are clear and speak for themselves—there is a stark contrast between the records of the Labor government and the former Howard government. Our record speaks for itself—we have made record investments in Australia’s health care sector. We have invested significantly in extra hospital funding, we are delivering more doctors and more nurses, we have cut elective surgery waiting lists and we have placed a significant focus on preventative health.

On the other hand, we have the record of those opposite and Mr Abbott, which does not make good reading. Those opposite ripped $1 billion out of hospitals, capped GP training places and left a shortage of nurses. There was a workforce shortage across the country of 60 per cent. They adopted an ad hoc approach to our health needs. (Time expired)

Judith Troeth (Victoria, Liberal Party) Share this | Link to this | Hansard source

Two of the most important portfolios and departments in the federal government are education and health, and today we are looking at health. I feel sure that, as much as I respect Senator Brown, she could have reeled off another 10 minutes of statistics but the fact remains that none of this is being translated into better health care for the people who matter most, and they are patients who are in hospital beds and waiting in doctors’ surgeries. None of this is actually helping. The GP superclinics are going to absorb as many doctors from general practice—from family medical practices—as they are ever going to provide better systems for patients.

What has happened to mental health? We have seen little or nothing of that. In the words of the former Australian of the Year, Dr Patrick McGorry, the system itself is in a shambles. The shortage of nurses has nothing to do with government provision. The shortage of nurses is to do with the rapid ageing of the nursing workforce and the fact that state Labor governments will not provide sufficiently attractive working conditions to get other nurses into the system. And so it goes on. I am afraid that Senator Carol Brown’s statistics are no more than pie in the sky.

There are so many questions hanging over these health reforms that have now begun to collapse, and there are two that I would like to talk about today. It is true that there is disquiet about the financing changes, the centralised pricing and performance and the new geographical divisions called Medicare Locals. How many people know where these local divisions are going to be? Perhaps I could tell you that one proposal affecting my own state of Victoria is for a Medicare Local area to run from Deniliquin in New South Wales to the town of Seymour, which is one hour’s drive north of Melbourne. That is a huge area with differing human characteristics. Indeed, it puts one in mind of GroceryWatch, where the country was put into very large geographical areas and, again, all of western Victoria from Warrnambool to Mildura comprised one area where grocery prices would be advertised and compared. This is just nonsense. As I said, they are huge areas with vastly different characteristics, but it is typical of this government’s inability to recognise the needs of rural areas in particular.

Secondly, there is the lack of consultation that has taken place. While I admire Senator Moore and respect her views, her description of the then Prime Minister, Mr Rudd, and the Minister for Health and Ageing, Ms Roxon, moving from hospital to hospital at a light-like speed, and at the same time managing to fit in consultations with the hospital boards and local members, was absolute farce. I know, watching the newspapers earlier last year, on one day we would see Prime Minister Rudd and Minister Roxon in Brisbane and the next day they would be magically transported to Tasmania where, presumably, they were undertaking further consultations. Members of the government and members of the opposition know that this was as much about photo opportunities instead of real consultation with doctors and patients, who these schemes were going to affect the most. Indeed, a briefing note that was prepared last year for the New South Wales health minister, Mrs Carmel Tebbutt, quoted the federal government’s lack of consultation and pre-emptive announcements. Further than that, in later comments, the New South Wales government—again, presumably a friend of the government opposite—has quoted financial risks for states in the network agreement, risk management issues around the elective targets for surgery (and this has been quoted to me many times by Victorian doctors that these elective targets are just not possible; the AMA also had other thoughts about them), key governance issues, as well as funding and resource issues.

Where is the role for private hospitals in all of this? Surely they are able to help take some of the burden of increasing patient numbers away from government funded hospitals. Yet, apparently, they have no role in these health reforms. Not only that, both the Medicare Locals and the Local Hospital Networks, instead of the federal, state and local government funding that we have, place another sandwich layer of bureaucrats, so that we end up with five layers of bureaucracy rather than three in a health organisation that should be free-flowing and, as I said, able to service the needs of both doctors and patients—the two most important participants in this process.

These reforms in Victoria would have delivered approximately half of the number of urgent beds that are needed in Melbourne hospitals alone, let alone hospitals in the country. For instance, those people who think along Liberal lines do not want central funding such as this proposes. They want funding that is delivered locally so that it can affect people locally, so that you get the best outcome locally. That is the last thing that is going to happen with schemes like this. Indeed, the general indecision and lack of action along with the ridiculous theories that have been dreamed up have been summed up very well by Catholic Health Australia CEO, Mr Martin Laverty, who said that the uncertainty around these systems was causing system paralysis. There are very long lead times needed for health reforms and in the four years that this Labor government has had for significant health reform it has achieved virtually nothing except to further confuse the public, doctors and patients.

Louise Pratt (WA, Australian Labor Party) Share this | Link to this | Hansard source

It is an indictment of the former government that they never had any ambition for our health system. Indeed, this flippant motion demonstrates their flippant regard for our health system. Health reform has been an outstanding issue in this nation for years now, but we knew it was never going to be an easy task. There has been a lot of posturing in recent days. Certainly we have had a lot of it from Colin Barnett. But recent developments do not represent failure—far from it. We have made enormous progress already on the health reform front. Yes, we are at a critical, pointy part of the state-federal negotiations on these issues and certainly there will be more tough negotiations to come. But we must persevere. The health of the people in our nation depends on it—the health of Australians.

For too long now the health system in this country has simply not been serving the health needs of Australians. The Howard government put its head in the sand on this issue and shifted the blame to the states, but we are not making the same mistake. We know and you know that the states simply do not have the long-term revenue base to juggle the growing demands being placed on our health system. We are facing up to that issue by working with the states to find a way through it.

We know that this is a challenge and that it is one we must all face up to. Those on the other side of the chamber know it too. We must face it head-on if we want to be able to make available to Australians things like new medications as they become available; if we want Australians to have the advantage of new options for surgical procedures; if we want things like good quality, cost-effective primary health care; and, most importantly of all in my view, if we want a robust preventative health strategy to help Australians take control of their own health.

This government is delivering massive reform to the health system, something the Liberals never did when they were in government. We have been moving through the reform process and delivering outcomes for some time now and you can see that we have made considerable progress. We started this work back in 2008 and the work we have done is already bearing fruit. We have been rebuilding and reprioritising our health system. It is not a small task.

So how far have we come? How far have we come since Tony Abbott ripped a billion dollars out of hospitals, since Mr Abbott capped GP training places, since he left the nation with a shortage of 6,000 nurses and since he left the states holding up our overstretched hospitals—all while the term ‘primary care’ did not even seem to be in his vocabulary? What have we done since that time? For a start, we have increased hospital funding by a massive 50 per cent. We are investing in emergency department upgrades at 37 hospitals around this country and in elective surgery improvements at over 125. We are delivering on 32 major Health and Hospitals Fund projects and 22 regional cancer centres.

We have given nurses and midwives access to Medicare and the PBS. This was vitally important because they can now exercise the full range of their professional skills. That in turn frees up GPs and specialists to concentrate their energies and their special skills on the activities and procedures that only they can perform. This is a long overdue reform, one that will help contain costs and simultaneously ensure that more people can access quality care when and where they need it. This was a reform that the previous coalition government lacked the courage or the capacity to tackle.

We got rid of Mr Abbott’s limit on the training of new GPs and we are now undertaking proper national planning for our health workforce. We are training 1,000 more nurses a year to help address the desperate shortage of nurses that was Mr Abbott’s appalling legacy to the nation from his time as Minister for Health and Ageing. By 2014 we will have doubled the number of GPs entering training—in excess of 6,000 more doctors will be trained over the next decade. It is training that includes great innovations to support rural and remote practice. We are establishing the first national workforce planning body that this country has ever had—something our health workforce desperately needs. We need this body so that we can address the disastrous shortages of skilled medical personnel that confronted this country when we came to office. We simply will not let those shortages happen again.

We have delivered 70,000 more elective surgery operations and 265,000 GP superclinic services. There are now 28 superclinics open providing early services and there are others under construction. We have seen over one million dental check-ups provided to Australia’s teenagers and we all know that Medicare local planning is well underway. This will finally underpin proper attention to primary care in this nation. We are helping Australians get medical treatment when and where they need it with after-hours GP services, GP superclinics, upgrades for existing GP practices and telehealth services.

We know we need to keep people healthier and out of hospital by providing more care closer to home. It is only through such strategies that we can contain the ballooning costs that currently face our nation on the health front. These are costs that are driven up by our ageing population and the increasing burden of chronic disease. We know that many of these diseases are preventable, but we can only address them with a full and proper plan for our nation, one that those opposite should support.

We are acting. We are investing in prevention strategies—those strategies that give us the best chance of improving the health of ordinary Australians without imposing an enormous burden on taxpayers. We say unashamedly that preventative health strategies are the ideal health strategies—the better strategies for health for all Australians; the better strategies in the long term for the wallets and purses of Australian taxpayers.

But the opposition never think about the long term; they only ever think, as this discussion demonstrates, about short-term political gain. We have had to start a new national prevention agency in the face of short-sighted attempts by those opposite to stall this historic reform. It is reform that the opposition should have embraced. It is reform aimed at putting a fence at the top of the cliff so that we do not have to put an ambulance at the bottom. If ever there were an example of the opposition opposing things for the sake of it, opposing a national preventative health agency is it.

Despite the opposition’s reluctance to get onboard with a preventative health agenda, the government have persevered, and we are already making a real difference in this area. We have put nicotine replacement on the PBS and we have invested in new, hard-hitting TV ads to further bolster our prevention efforts. We are in fact implementing the world’s strongest anti-smoking campaign, including the world first of plain packaging. And we are tackling the hardest task of all: the task of hospital reform. Yes, hospitals need extra funding, but that extra funding must come with reform; otherwise it will not be spent effectively. For us, realising the future health of Australians is at stake is a reason to do what it takes to achieve real change.

Scott Ryan (Victoria, Liberal Party, Shadow Parliamentary Secretary for Small Business and Fair Competition) Share this | Link to this | Hansard source

It is a pleasure to join and conclude this discussion after what, I have to admit, I thought were not particularly passionate speeches from members of the government. I am not quite sure if they believed them themselves. After the weekend’s news that we could be seeing another backflip on another great moral challenge for our nation, which was the need for national health reform—‘the buck will stop with me; I’ll fix the problems or we’ll take it over’ (I must have missed that referendum)—what we have from the government is yet more contrived and confected talk of reform. I lost count of the number of times the word ‘reform’ was thrown around by those opposite. They are the little train that could—‘I think I can; I think I can’—as they bandy around the word ‘reform’ in place of actually doing anything.

Those opposite come from a party that simply has no credibility on health. They constantly talk down the Australian healthcare system. The system is not perfect, but every global survey says it is something we can be proud of, because while it is not perfect it is one of the best in the world. But, no, that does not suit those opposite, because you cannot run a scare campaign without beating up people’s fears. Just like in many other fields of policy, the Labor Party wants to justify a particular agenda, so all it does is stoke people’s fears. I remember—and I will talk more about this later—the fears it stoked when case-mix funding first came in.

This Prime Minister has no credibility on health. After all, we do not hear them talking about Medicare Gold too often. I suppose, compared to the deficit they are running now, those unfunded billions of dollars do not actually seem that much anymore. Medicare Gold, the great magic bullet to solve health care for senior Australians, disappeared, sank without trace to the bottom of the harbour, and the Prime Minister never talks about it. But it was Prime Minister Gillard, as shadow health minister, who came up with that abomination of a health policy.

What is this alleged reform we hear about? It is lots of picture opportunities. Nothing has changed at the front end except a few superclinics, chosen by politicians not by health experts, that have actually only taken doctors—often from the same community—into a government funded centre. They are not chosen on the basis of health need; they are chosen on the basis of political need.

We have these Orwellian-named ‘Medicare locals’, as if somehow drawing lines on the map and linking Deniliquin and Seymour, as Senator Troeth outlined earlier, is going to make a single bit of difference to a patient who needs health care and somehow employing more bureaucrats is going to make the system better. I expected nothing less from the former Prime Minister, who never saw a PowerPoint chart he did not like.

Most of all it starts with the conceit that they know best. It is not reform. They have tried to slash private health insurance on multiple occasions. They have tried to slash the rebates for cataract surgery. They have tried to destroy the primary care program that supports people who need dentistry when they have chronic disease, access to physios and even access to psychologists. That is what this government’s agenda is: they want to control how you spend your money; they want to control the health care you get. And God forbid if you invest in your own health care, because this government is going to punish you.

Senator Pratt talked about preventative health—if only! Preventative health to this government is nothing other than taxes and television ads—yet more television ads running on our screens, telling people what to eat; yet more taxes on products that they think people should not eat or drink—in order to plug the budget deficit they have driven. It is not real preventative health; TV ads and taxes are what drive it. At its core, this government wants to undermine choice. They want nothing more than a British style national health service in this country. It is their dream. They have never been able to do it and this is the way they are going about it.

We hear them talk about activity based funding. Well I am from Victoria and I remember the disgraceful and disgusting campaign run by the Labor Party against the Kennett government when that was introduced—and the late Minister for Health, Marie Tehan. The Labor Party vilified the people working on activity based funding and basically accused them of letting patients die. But the true scandal of our hospital system has not started in Canberra; it has started in the states with the decline in quality, with the capture by vested interests under state Labor governments, where people’s health has been put in danger, particularly in New South Wales and Queensland in recent years. The Labor Party does not have any credibility on this and no matter how often they use the word ‘reform’, the Australian people will not buy it.

Gavin Marshall (Victoria, Australian Labor Party) Share this | Link to this | Hansard source

Time for this discussion has now expired.