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

I am delighted to have the opportunity to speak on the second reading of the National Health Reform Amendment (National Health Performance Authority) Bill 2011, but not because I am delighted with the bill. This bill is not about reform, as the government would have us believe; it is about setting up yet another level of bureaucracy—a third level of bureaucracy, the National Health Performance Authority—to attempt to underpin the so-called reform that this government was so quickly going to put into place in December 2007. Have we seen anything yet? No. The government's explanatory memorandum tells us:

This Bill is intended to establish the National Health Performance Authority … envisaged by the National Health and Hospitals Network Agreement as settled by the Council of Australian Governments (COAG) meeting in April 2010 and reconfirmed in the Heads of Agreement—National Health Reform of 13 February 2011.

Even in that there lies the fact that the government could not get it right between 2007 and 2010. Yet again, having thought they had COAG on side and agreeing with them in April 2010 people, were still looking at issues on 13 February 2011.

Perhaps some of the most instructive things to look at in discussing this bill are the explanatory memoranda. All bills have at least one explanatory memorandum attached to them, but this bill comes with an explanatory memorandum, a supplementary explanatory memorandum, a revised explanatory memorandum and a fourth supplementary explanatory memorandum. When you look at some of the changes that the government has been forced to put in place by the states to get them to agree to this, you understand where all the argy-bargy and change has gone on.

The government's amendment will insert a 'legislative acknowledgement of the role of state and territory health ministers as health system managers of public hospitals and local hospital networks' and require the authority 'to have regard to that role when performing its functions'. That was not how it was planned by this government, was it? That was not how the government started out, but the states rolled them once again. The authority for running the hospitals is with the states. What was it that was going to happen when Mr Kevin Rudd was elected Prime Minister? Isn't that exactly the problem he claimed he was going to fix?

We have another amendment requiring the agreement of the Council of Australian Governments before additional functions can be conferred on the performance authority. So we are not going to let this performance authority do anything about the performance of hospitals without the governments that have performed so poorly over so many years having the say-so on how it happens.

One of the most controversial changes that have been forced on the government by the state health ministers is the modification of proposed section 62, requiring that the performance authority notify the relevant state or territory health minister when preparing a report showing poor performance by a local hospital network or public hospital—for the primary purpose, of course, of assisting the relevant state or territory health ministers to carry out their responsibilities as health system managers. This has absolutely nothing to do with giving the states the heads-up on poor performance or giving them the chance to work out how to spin their way out of the problems; it is all about health system management. Not only that, but the performance authority will be required to give a final draft report to the relevant state or territory health minister following notification of an assessment of possible poor performance within their jurisdiction and invite comments before finalising the report.

Now that they have all the whitewash sorted out, they can go ahead with putting in place this next level of bureaucracy, which will simply add cost without adding anything, it would appear, to the performance of the hospitals. That is the reason that the coalition has put forward an amendment saying that there must be an independent review of this authority, to be undertaken not later than 12 months after its commencement, and it must look at the operation and effectiveness of the performance authority. If it is simply going to produce information that health ministers can then rewrite on a whim, then what is the point of it? We also state that this review must include an opportunity for members of the public and healthcare professionals to make written submissions to the review. It must be completed within six months and its report must be tabled once the minister has received it. Unlike the potential reports that will go from the performance authority to the state ministers, this report cannot sit in a bottom drawer until the government works out how to spin its way out of it. As I said earlier, this bill is not about reform; it is about the semblance of reform, the semblance of doing something and the semblance of the federal government actually taking some control of the hospital system. But they have lost at every turn in actually getting control from the states on the subject of hospitals' performance. There are absolutely no performance indicators attached to this bill that the proposed authority would monitor and report on, and yet the government says the authority will be responsible for monitoring the performance of healthcare providers. I think we need to know what the performance indicators are before we can hope that they will be monitored.

The bill also says that the authority will be responsible for reporting against clinical safety and quality performance standards, despite the fact that we already have a commission which presumably is going to be set up by this government to do that—one of the triumvirate of authorities that will have authority over almost nothing except organising to tell COAG what COAG wants to hear in the end. They will be responsible for reporting on waiting times, adverse events, patient satisfaction and financial management in both public and private hospitals, but the legislation lacks any detail about these functions and how the proposed authorities and the stakeholders think they will happen. It is just another layer of red tape imposed on a hospital system that this government could not control the way they had hoped to.

How can this authority be a success when there are no performance indicators and when there is confusion over the range of health services it will monitor? It is not even clear what a local hospital network will look like. State health ministers, despite the wording of the bill, would appear to have the opportunity to decide what a local hospital network looks like on a whim—a wonderful way of fudging figures from year to year if you do not think you are going to like the outcome.

It is also unclear how the authority will obtain its data and whether it will simply be the information that the states want to feed in. I know in my own home state Queensland Health has been somewhat erratic and whimsical in the sorts of data it has chosen to provide. It is only in the last two years that it has managed to work out how to provide data on alcohol and other drugs related to hospital admissions and treatment. How does one go ahead with a preventative health strategy when one does not even have that data?

It is also very unclear how the authority would enforce requests for data. Again, the example I used before is a classic example of how the federal government and bodies such as the Bureau of Statistics and the Institute of Health and Welfare simply have to ask nicely and wait. If they do not get an answer from any particular jurisdiction, well, gee, they just do not get an answer from that jurisdiction! What is clear is that red tape and more red tape is a hallmark of this system, as are the inept attempts by this government to impose so-called reform onto our healthcare system. The legislation will add regulatory burden to hospitals already drowning in paperwork. I had a hospital administrator say to me the other day that they had been told by a bureaucrat, 'Oh, well, don't worry. Yes, you will have to do double reporting on it, but you could just report the same things to us that you are already reporting to others.' Wow, that sounds like reform to me!

There are already a number of local, state and national monitoring schemes that operate within the health area. At the local level, there are hospital boards and area and district health services with mechanisms for monitoring performance standards. Under a coalition government, of course, there would be far more devolution of authority to those local organisations that understand local needs. At the national level, there are also a number of performance-monitoring mechanisms. I hesitate to call it a performance-monitoring mechanism, although it is supposed to be, but the COAG Reform Council is responsible for reporting on the performance of the Commonwealth, state and territory governments in this space. The Institute of Health and Welfare collates and analyses huge amounts of data and has an amazing output of extraordinarily useful data. But, once again, it relies on the information provided by the jurisdictions, and at times that can be certainly less than optimal. The Australian Bureau of Statistics also collates and analyses health data and we have the government's brand new Australian Commission on Safety and Quality in Health Care who, amongst other things, report on the state of safety and quality in health care, including performance against national standards. We are two-thirds of the way through the great big new bureaucracy that will do nothing except reinforce the current structure within health.

There has been no attempt whatsoever by this government to replace the current system of multiple reporting requirements to multiple government agencies. Rather than replacing, the government is simply adding a whole multitude of new reporting agencies on top. This authority—the National Health Performance Authority—is just another impost on Australia's health system. Duplication of paperwork does not add to patient care. It does not add to quality health outcomes for patients. It detracts from it. I would not expect that a government that has given us so many other inept programs—Building the Education Revolution, the insulation issues and now the solar cell issues—would understand this, but just asking people to report does not help. In fact, we have examples from overseas and from some of the states that focusing only on meeting performance outcomes and cost-cutting targets, rather than on providing good quality care, can lead to patient deaths and to a lot of poor outcomes for many other patients.

I was bemused to see that the explanatory memorandum to this legislation says that its measures will have no regulatory impact on business or individuals. That statement would be laughable if the situation were not so serious, but it indicates that this government does not have a clue about the detrimental impact that its decisions have on the wellbeing of patients because it does not pay real attention to and does not consult properly with the actual users of our health system. But it is not only the increased regulatory burden that has everyone on edge. No-one, and I suspect this starts with the Minister for Health and Ageing, appears to be able to explain the relationship between the National Health Performance Authority, the Australian Commission on Safety and Quality in Health Care and the yet-to-be-legislated third arm of this wonderful brave new health world: the Independent Hospital Pricing Authority. No-one knows how the three of them are going to relate or work. This is something that is seen constantly by the Department of Health and Ageing, which of course is stuck with having to put the best face on the sort of information that government policy forces it into. No-one appears to be able to answer the question: how are they going to relate? Wait for the regulations, is the answer. If the regulations are anything like the legislation they will be a case of flying by the seat of our pants, waiting to see how loud the states scream about what we are doing and then just changing it all again to suit.

The data-sharing arrangements, responsibilities and functions of these three agencies remain a complete mystery, not just to the patients of hospitals and to other stakeholders but even to the people who are going to operate them. It is an exercise in seeing how it pans out when we start doing it in practice. That is a wonderful way to use taxpayer funds; I am sure that we will end up with another Labor government inspired mess that will take years to repair and, potentially, cost billions of dollars in lost savings to the health system along the way.

The National Health and Hospitals Reform Commission, in its final reportA healthier future for all Australians, does not even mention in its recommendations the creation of a performance authority. It says there should be a national performance reporting and accountability framework, but it does not say there should be an authority. So what have we got? We have got an authority that has no authority and no framework for imposing its authority. Where is this going to end except in a complete waste of funds? The government says that the authority will deliver further transparency on the performance of health and hospital services by developing and publishing hospital performance reports and healthy community reports. It says that these reports will help to identify high performing organisations and will shine a light on areas for further development and investment in the future. It is all very well at primary school to reward good behaviour and ignore bad behaviour; I do not think we can use the same standards for the multibillion dollar health and hospital system of Australia. Identifying high-performing organisations and shining lights on further development and investment in the future does not seem to me to be the way to improve performance and hospitals. In other words, by the government's own admission, the authority is a toothless tiger. It has been invested with no power, it is limited to the powers of the Commonwealth government in health care and it relies completely on the state and territory governments, private providers and NGOs to supply accurate performance data and accurate time data. So we are not quite sure what the government will do with that data except feed it back to the states so that they can whitewash it before it becomes public information—we will have nice little smiley faces, presumably, for the high performing hospitals and a little chat outside the classroom door for the others.

The net cost of the authority over four years is estimated to be $109.5 million. If you add this on to the other organisations that have been established—including the pricing authority, which, as far as I am aware, has not quite worked out how it is going to do anything just yet, despite the fact that the legislation is before the House of Representatives and on its way here—you will see that it is just a debacle. There is nothing that provides guidance on real governance, with real agencies undertaking real control, but the government continues to put further complexity put into our health system, with no provision for this to actually improve performance in the interim. Health reform by this government has been a complete and abysmal failure. It is time it said, 'Actually, virtually nothing has changed except that we have set up lots of bodies to give the appearance that reform is on its way.' It is not.

Ian Macdonald (Queensland, Liberal Party, Shadow Parliamentary Secretary for Northern and Remote Australia) Share this | Link to this | Hansard source

Senator Boyce made some very valuable points in her contribution to this debate on the National Health Reform Amendment (National Health Performance Authority) Bill, as did Senator Fierravanti-Wells earlier, on behalf of the coalition. I will just indicate my concern about the way that health is going. I am no great expert, I have to confess to the Senate, on health performance and health reform. I have, however, recently had a relative who has been hospitalised in both public and private hospitals. In visiting that relative, some things have become quite clear. One of those things, particularly in the public hospitals in Queensland, is that there is a clear indication of understaffing of people who are actually involved in the health care of patients. Every time I go to a hospital—fortunately, those visits are a couple of years apart—there seems to be more and more bureaucracy and fewer and fewer nurses and even doctors on the floor.

I am concerned, as the previous speaker mentioned, that this new authority seems to have no particular power. The nation would be better off if we put the $109.5 million that this authority is going to cost into better conditions or perhaps into additional numbers of people who are working on the floor and helping people with their health problems. As the previous speaker mentioned: what is this new authority going to do to improve performance? The best people to determine how to improve performance are those who are actually performing. My association with these people suggests that their concern about performance comes from the long hours they are expected to work. I am talking about hospitals in Queensland—some in major capital cities and some in small country towns.

Madam Acting Deputy President, can I use this debate to congratulate those who do provide that service in hospitals throughout Queensland and, I guess, throughout Australia, although I have no experience there. They do a fabulous job. It is just that they seem to be continually overworked. They are trying to look after too many patients, and at times patients are in the position where they feel they are not being well enough looked after. My experience, and again it is only anecdotal, is that all of those working in health care in the hospitals that I visited in Queensland are doing an absolutely fabulous job. They deserve every piece of congratulation and support we can give them. Setting up another $110 million authority of pen-pushers and bureaucrats makes me wonder how that is going to improve performance.

I understand that a lot of what this authority is going to do will depend on getting accurate performance data from NGOs, and I think the legislation actually says that. I wonder who these NGOs are. Could it be that the NGOs—non-government organisations—are associations like the Health Services Union? The Health Services Union would normally fit under the category of a non-government organisation, but we read in the paper, following the Craig Thomson affair, that it is really a dumping ground for Labor Party wannabes or would-bes. We learn that if you want to get a senior position in the Health Services Union you have to be a member of the Australian Labor Party. That union has been involved with the Australian Labor Party for quite some time, but we read in the papers that suddenly, and against the wishes of the general secretary, a meeting was held—quickly convened—which then disaffiliated the Health Services Union from the Australian Labor Party. I read in the paper that this is all about payback for Senator Feeney. I do not know whether this is true; I do not know enough about the Australian Labor Party's internal affairs. I do know that Senator Feeney was one of those who plotted against the former Prime Minister, Mr Rudd, and installed the current Prime Minister, Ms Gillard. Is this a payback for Senator Feeney from those who supported Mr Rudd? I do not know. I do not pretend to even remotely understand—or, I might say, care—about what happens in the Australian Labor Party, but I found Senator Feeney not a bad sort of fellow.

Mitch Fifield (Victoria, Liberal Party, Manager of Opposition Business in the Senate) Share this | Link to this | Hansard source

There's worse.

Ian Macdonald (Queensland, Liberal Party, Shadow Parliamentary Secretary for Northern and Remote Australia) Share this | Link to this | Hansard source

There is worse, as Senator Fifield says. I very rarely give praise to Labor Party politicians, but Senator Feeney seems to be doing a good job in the Defence area—in a part of the portfolio where I shadow him. He is diligent, he seems to be across that portfolio and he seems to do what is required of him in that. I would hate to lose him. It is reported that Senator Feeney wanted to leave the Senate to go to a lower house seat because his tenure in the Senate, on current voting indications, would be fairly limited. So he wanted to go to a safe seat in the lower house. But, with the Health Services Union, which apparently backs Senator Feeney, now no longer involved with the Australian Labor Party, Senator Feeney's chances of doing the numbers—or whatever it is you have got to do within the Labor Party to get pre-selection for a safe seat in the lower house—have dissipated and become rather untenable.

I raise this in the context of the debate on this bill. Is this performance data from non-government organisations? Is the Health Services Union a non-government organisation? If we were relying on data from the Health Services Union for the purposes of this bill, then it would seem we would be looking in vain, because I read in the papers—and I acknowledge that you cannot believe everything you read in the Age or the Sydney Morning Heraldthat it appears that the HSU is now notable for the amount of data that has gone missing. Nobody seems to be able to find internal data of the union's own affairs. Surely we are then not going to rely on this union, as a non-government organisation, to deliver some performance data which will allow this authority to conduct its activities. Perhaps we could find out in the committee stage of the bill whether the Health Services Union is a non-government organisation for the purposes of providing performance data. I mentioned these things in my speech on the second reading, so perhaps the relevant minister might be forewarned and be able to get some information.

Perhaps we could then ask which data that is reported from the HSU has gone missing. Is it data that might be useful for this authority, or is it just data about various memberships or is it data about what has happened to hundreds of thousands of dollars of members' money that appears to have gone missing? I appreciate that the missing data, the missing financial records, are, as I read, a matter of a police investigation in both Victoria and New South Wales at the present time. But it does raise the question of just what data has gone missing, how it has come to have gone missing, whether it is only, as the newspaper reports suggest, financial data of which a union official was using a credit card improperly, and what data there was that gave some detail of a printing contract that was entered into. Did that data indicate whether credit cards, to be paid for by the printing company, were issued to members of the HSU executive, who could then run up bills and not pay them back? I do not know what the answer to that is but perhaps it is something that could be inquired into in the committee stage. If we are relying on that non-government organisation to provide accurate performance data, then it would not seem to be a terribly satisfactory arrangement.

I am concerned that this authority is going to cost $109.5 million. If the government has that sort of money to splash around, I would much rather that they use it to help some of their low-paid workers in the health area. I am very conscious of course that the Health Services Union is a union which principally assists lower paid workers in the health area. If the union had not been spending so much time tracking down what happened to hundreds of thousands of unionists' membership dollars that went missing when Mr Thomson was in a position of authority, perhaps it would have been able to put a submission to the government saying, 'Is the $109.5 million for this performance authority a good expenditure of money or should we perhaps be using that $109.5 million to help with the wages of some of the lower paid workers?' I understand it is the lower paid workers that this union is supposed to be assisting.

These issues will continue to haunt this government. I can understand why a guy who was formerly the National President of the Australian Labor Party has arranged for the union to disaffiliate from the Australian Labor Party. I can understand that that is probably a fairly clever ploy to try to distance the Gillard government from whatever revelations will come out about the Health Services Union and the operations of that union by senior executive members who have very senior roles in the Australian Labor Party. I guess they think that disaffiliating the union from the Australian Labor Party will excuse the Australian Labor Party from whatever shenanigans might have been going on within the union.

When one sees this happening in the Health Services Union, one can only speculate how rife the use of union funds for personal benefit is right throughout the whole union movement. I would hope that some of my colleagues on the other side of the Senate who are former union members might use the opportunity at some stage in the debate to assure us that the type of activity that is being alleged in relation to ALP members who held high positions in the Health Services Union did not occur in their union—that they were never recipients or beneficiaries of shonky trading deals with printers or otherwise. One might hope that some of them would use the opportunity of debate in the Senate to criticise the Health Services Union and those who cannot seem to find out what happened to hundreds of thousands of dollars and to say: 'This never happened in our union. There was never a prospect where free lunches were given or free credit cards were handed out or wives' airline tickets were paid for or jobs were sought for members of the union who might want to get a benefit from someone from whom that job was being applied for.' They are the questions that spring to my mind when we hear that it is the NGOs who are going to use performance data for this particular performance authority.

I would be interested in who actually constitutes the performance authority. Have the personnel been announced? I am not sure, and I have not heard that they have been. I assume that, until this bill goes through, there will be no steps taken to determine the personnel for the National Health Performance Authority. One would hope that this is not going to be an authority comprising people from the HSU, for example, or people from other health unions. One would hope that, when the authority is set up, it will be set up by people with real skills and real understandings and who are independent and can make a real contribution towards improving our hospital systems.

I agree with previous speakers from the coalition side who have questioned the relevance of this authority, the rules relating to it, where they are going to get their performance data, what powers they have, and—I guess the bottom line—how is this new bureaucratic organisation going to actually improve the services and the provision of health care for the patients. After all, that is what is relevant to this parliament and should be the main issue of importance to the federal government—is what we are doing with this bill going to improve the particular on-the-floor health care of patients who rely on the health system? I hope those questions can be answered, perhaps in the Committee of the Whole, later on.

Don Farrell (SA, Australian Labor Party, Parliamentary Secretary for Sustainability and Urban Water) Share this | Link to this | Hansard source

The National Health Reform Amendment (National Health Performance Authority) Bill 2011 establishes a key element of the Australian government's health reform agenda—the National Health Performance Authority. The National Health Performance Authority will act as a watchdog over the performance of both public and private hospitals, local hospital networks and Medicare Locals. It will regularly report comparative information on the performance of these bodies and will give the public information in respect of consistently poor performance. Performance monitoring will support the improvement of healthcare delivery, safety and quality by all of these services. Poor performance will be identified to allow for remediation and superior performance will be identified to allow the dissemination of best practice approaches.

The establishment of the authority is a key part of the National Health Reform Agreement signed by all states and territories this month. It is a bill that has been endorsed by committee inquiries in both the House and the Senate. The government will be moving one small amendment during the committee stage, which will address issues to allow flexibility in the appointment of people with experience in the health field to the board. I understand that the opposition will be moving an amendment to introduce a review of the performance of the authority and, if passed, they will be supporting the passage of the legislation. On that basis the government is happy to also support the opposition's amendment.

I thank the Greens for their support of this legislation and for their commitment to transparency in our health system and the opposition for finally coming to the party to support these reforms. Unlike the opposition the government pursues the tough reforms particularly when they involve more transparency for the Australian public. Standing on the shoulders of MySchool, MyHospitals and our FOI reforms, this authority will deliver for Australians unprecedented levels of nationally comparable information. It will also be the watchdog to detect poor performance in our public and private hospitals and primary care sector. I thank the members for their contributions, the officials for their hard work and the states for their cooperation with these reforms.

Question agreed to.

Bill read a second time.