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

I move Greens amendment (1) on sheet 7014:

(1)    Clause 5, page 3 (after line 7), after the definition of Chair, insert:

clinician means an individual who provides diagnosis, or treatment, as a professional:

             (a)    medical practitioner; or

             (b)    nurse; or

             (c)    allied health practitioner; or

             (d)    health practitioner not covered by paragraph (a), (b) or (c).

I articulated the reason for this amendment in my speech on the second reading. That was so we are really clear that the definition of ‘clinician’ does not just relate to a GP, because that is what people generally think of as a clinician.

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

I just wanted to advise that the coalition will not be supporting the Greens amendment. Our position in relation to the National Health and Hospitals Network Bill 2010 is that the provisions establishing the other authorities should have been presented together. As Senator Farrell said, we did move a second reading amendment in the House calling on the government to do so. It should be noted, and I would like to reiterate this for the record, that we support the work of the commission within the department. Our view is that you do not have to create another layer of bureaucracy and a stand-alone bureaucracy to achieve the good work that the commission is doing and has been doing since its establishment in 2006, particularly in view of the evidence that was given at the Senate inquiry. The other reason why the coalition is concerned and has called for the consideration of these authorities together is that it is unclear how the function of this committee will coordinate or interact with the functions of the Independent Hospital Pricing Authority or the National Performance Authority. As I have said, the government should have introduced provisions for all the proposed bureaucracies together.

Senator Farrell comes in here and talks about delay. Delay by Minister Roxon has been a hallmark of her time here. She jumps up and down and complains that the Senate is not passing her legislation. Of course, what she does not say is that the delays are a consequence of her own measures and the programming of matters here in the Senate. This is not the first time that Minister Roxon and this government have been caught out by delays. Don’t come and talk about delays, Senator Farrell. You are responsible for programming in this Senate. The government is responsible for programming in the lower house. So as far as that is concerned you have the running of when these matters are listed and when they are considered.

As I said, you should have introduced provisions for all proposed bureaucracies together. It still remains unclear as to why the minister has delayed the legislation for the National Performance Authority and the Independent Hospital Pricing Authority. I hear from Senator Farrell that one is going to be introduced. It is the typical ramshackle drip-feeding fashion that this minister has adopted in this portfolio. We know the criticisms that were levelled at the way that the government handled this in the Senate inquiry. In fact, Senator Siewert herself made a reference to it and reiterated that. Therefore, on that basis, I am surprised that despite the criticism you have already received you still are not bringing these authorities in together so that we can see how they are all going to work and how they are going to interact. Maybe you are not doing so because you still have not worked out what they are going to do, because you still have not worked out what survives the health changes mark 1, what does not survive, what is in, what is out and what is being changed. It was very clear at estimates last week that you still have not worked out, despite all the work that has been done, what your Medicare Locals are going to do and what your local hospital networks are going to do. The whole thing is just one big question mark, particularly in terms of detail, because attention to detail certainly has been scarce.

Regarding the reason we have been concerned about this, I would like to draw your attention to certain comments that former Minister for Finance and Deregulation Lindsay Tanner made in a speech on 14 October 2009 to the Australian Institute of Company Directors at a public service governance conference:

The indiscriminate creation of new bodies, or the failure to adapt old bodies as their circumstances change, increases the risk of having inappropriate governance structures.

This in turn jeopardises policy outcomes and poses financial risks to the taxpayer.

               …            …            …

Incorporating a new function within a department is almost always the preferred option because of the difficulties a small body faces in meeting its own needs.

As I said, the coalition supports the role of the commission but, consistent with Mr Tanner’s views, believes that this could have been achieved within the resources of the department. It is very important that we have before us all the provisions to look at how these bodies are going to interact. Why are you going to go out and create new bodies if you already have a commission that is doing good work? Considering the evidence that was given to us in the committee inquiry, by all accounts it has been doing a very good job in accordance with international standards. This is particularly so at a time when you have turned a $20 billion surplus into a deficit of over $40 billion and every day you are borrowing $100 million. You keep talking about scarce resources. Quite frankly, scarce resources in this area should be focused on front-line clinical care rather than the creation of new bureaucracies without a strong and reasoned justification. But at the very least, having embarked on yet another layer of bureaucracy, I think the minister should have allowed the parliament the opportunity to scrutinise the complementary functions of the proposed bureaucracies together.

We really are talking about circumstances, just like with the health changes mark 1, where we are left with so many details to be worked out. As I said earlier, with the ink barely dry it began to fall apart with the dumping of one of its mainstays, the National Funding Authority. Notwithstanding the passage of time, we see that so much of the detail still remains unclear. You have been talking about these authorities, whether they be in an iteration of mark 1 or mark 2, for however long now and you still have not worked out what they are going to do. You still have not advised the parliament as to how they are going to interact. You still use these arguments that ‘We are going to achieve this, we are going to do this and we are going to do that.’ You have this big jigsaw puzzle and you have all these bits and pieces all over the place, but you still have not told the Australian public how this whole thing is going to work together, how increasing these bureaucracies is going to make a difference.

Labor state health ministers have complained about the way this whole thing has been handled. There have been comments in the media by the New South Wales Minister for Health, Carmel Tebbutt. Leaked emails which talked about the high-handedness with which the Commonwealth had embarked on these so-called reforms came out of Victoria before the change of government. Now concerns have been raised by the Victorian and other governments in relation to the detail. As I have said before, you only have an agreement to think about an agreement; you have not actually signed on the dotted line. This commission is only a part, but you are now talking about how fundamental it is. So was the National Funding Authority, but you did not think twice about dumping that. Now, for political expedience, or whatever reason—we are not quite sure—you have decided to reinstate the very thing that last year you advocated as a fundamental hallmark of transparency and accountability in the health changes mark 1. That got dumped. Now, suddenly, you have this funding pool, and we do not know what it is going to do. You are all over the shop. You really do not know what you are doing. Here we have another example of a piece of the puzzle of so-called health reform which has been around, but we still cannot be told how it will fit into the bigger picture.

It is all very well to have photos of back slapping and handshakes at COAG meetings—they may help give Prime Minister Gillard a temporary political reprieve. There is a hollowness about what has been ‘achieved’ compared to what was promised, and there is a complete lack of mechanics to deliver the nuts and bolts. What this is all about is still very unclear. Just ask patients who are waiting in hospitals from day to day, and who have been waiting since 2007, when then Prime Minister Rudd promised the grand hospital plan. It is worth while reminding the Senate that Mr Rudd, as Leader of the Opposition, made these grand promises on health. But when you actually came into government you did not have a plan, you did not have anything—you did not even have a back-of-an-envelope plan, and that has been very clear from what has come out at estimates.

You set up a commission which did a lot of work and produced a very good report, which of course was put aside. Then Prime Minister Rudd and Ms Roxon embarked on their grand hospital tours dressed in hospital attire so that it would look like they were really doing something on health. Those tours were really only photo-opportunities which found their way onto the MyHospitals website. They still have not been taken down.

From there you went onto the green book, the blue book and the red book. Every single step of the way you wasted more money, whether it was in advertising or in producing material which was changed every time to suit whatever political necessity you needed and whatever political spin your spin doctors were telling you would be necessary to give the appearance that you were doing what you said you would. We have not seen the necessary detail.

Now we are talking about 1 July. So many things need to be done by 1 July—so many things need to be ticked off by the states. I really do not see how that is going to happen. Senator Farrell spoke about the various authorities and the need to have state action in relation to some of the complementary state legislation and provisions that will be required to meet the financial obligations between the states and the Commonwealth. We still have not seen any of that. The coalition opposes this bill and, for the reasons that I set out, we will not be supporting the Greens amendment.

Progress reported.