Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

I move:

That the Senate take note of the answers given by the Assistant Minister for Health (Senator Nash) to questions without notice asked by Senators McLucas and McEwen today relating to health funding.

Today was an opportunity for Senator Nash, the Assistant Minister for Health, to clarify a statement that she made in question time yesterday when she said:

… there is a range of programs across portfolios for which we will be determining whether they are delivering appropriate and efficacious service.

To opposition senators that sounded like a program of review that was being undertaken in the Department of Health, a meticulous program of review. So it was reasonable then for us to ask how and by when these determinations will be made. Unfortunately, the answer is the National Commission of Audit, which is a very, very different answer to the answer we received yesterday.

Senator Nash said that there was a commission of audit and that we all knew about that. That is fine, but that does not fit with what happened to the Alcohol and Other Drugs Council. Given there is a commission of audit, why is it that the Alcohol and Other Drugs Council were unceremoniously defunded just the other day? There is no logic to that. On the question of how and by when these determinations will be made, frankly, there was no answer at all. I then asked the minister to give a categorical assurance to the Senate that the Pharmaceutical Benefits Scheme, the Medicare rebate and Medicare Locals would be quarantined from any cuts. We did not get any reference to the Pharmaceutical Benefits Scheme and the Medicare rebate, which will be very concerning to the community—two important elements of our health system that are very much cherished and are very important to the health of our nation.

But the minister did say that Medicare Locals would be under review and she did say that it was inappropriate to pre-empt the outcome of that review. That sends a strong message to those people who are working in Medicare Locals. That says something very clearly to the people who are delivering the front-line services in the Medicare Locals. That also fits with exactly what Minister Dutton said last weekend. On Sky, he was asked: 'Do you reaffirm Tony Abbott's commitment that no Medical Locals will close?' He did not. He was given an opportunity to say that they were not going to change any of the services in Medicare Locals and he said:

I think that that should be able to do its work, [and I'll] come back with recommendations, and we can make decisions about that which we accept, and that which we reject.

That is a clear message: there are going to be big changes in Medicare Locals. We know that this will happen. There was an absolute push-back from the then opposition when we introduced fantastically coordinated services in the community that are providing direct services, particularly in mental health, to people right across our country.

I then gave Senator Nash the opportunity to back her Prime Minister's statement on the ABC on 1 September that there would be no cuts to health. This was a gimme. This was an opportunity for the minister to say, 'Yes, I support my Prime Minister.' But she did not say that. She did not say that there will be no cuts to health. We asked a couple of times because there was a lot of avoidance in her answer, but she did not say there would be no cuts to health. There is a lot of nervousness in the health sector. There is a lot of nervousness in the Alcohol and Other Drugs Council—nervousness meaning they have gone into liquidation. There is a lot of nervousness in the Department of Health with the establishment of the business service centre, where people are being sent to work—some kind of gulag. People will potentially lose—

Senator Abetz interjecting—

Read the Senate estimates. Read what happened in Senate estimates and you will find out. There is a lot of nervousness in Health Workforce Australia and a lot of nervousness in Medicare Locals. Frankly, there is a lot of nervousness in the community. If we cannot get an unequivocal commitment from the Assistant Minister for Health that the Pharmaceutical Benefits Scheme and the Medicare rebate will be quarantined from any cuts by this government, people will be extremely concerned.

Concetta Fierravanti-Wells (NSW, Liberal Party, Parliamentary Secretary to the Minister for Social Services) Share this | Link to this | Hansard source

What hypocrisy from those opposite. It is hypocritical of Senator McLucas to dare to criticise the coalition after Labor's appalling record when in government. I would like to remind the Senate of Labor's record in government. Let us look at it: $1.6 billion ripped out of public hospitals, $4 billion ripped out of private health insurance, $1 billion ripped out of dental health through the closure of the Medicare Chronic Disease Dental Scheme.

There was the promise of 16 early psychosis prevention and intervention centres, the EPPICs, supposedly in partnership with the state governments. When the agreements were about to be signed with some of those states, Minister Butler suddenly changed his mind, ripped up the agreements and changed his tack on those centres. All we had was a one-page press release which told us absolutely nothing. Then there was, as Senator Abetz correctly said, the absolute debacle of the GP super clinics, which to this day remain one of the financial disasters amongst the many in the Health portfolio that those opposite oversaw.

Then there are Medicare Locals. Why is there a need for a review of Medicare Locals? From a coalition perspective, we support the role of coordination of primary health services. However, it was very clear to us that in the establishment of Medicare Locals there was a considerable lack of detail and conflicting information regarding the objectives of Medicare Locals. I too trawled through estimates and had to extricate—like hens' teeth—the objectives of Medicare Locals. In particular I noticed a lack of detail on allied health professionals, patients and how funding was being administered. A lot of money was channelled through Medicare Locals, but there were legitimate questions about how those moneys would be administered. In effect, was the Commonwealth getting value for money as far as Medicare Locals were concerned?

During the dying days of the Rudd-Gillard-Rudd governments there was legislation showing what those Medicare Locals were about. The government could not use the word 'Medicare', because it was not legal to do so. They had to retrospectively pass legislation to enable them to use the word 'Medicare'. Why did they use that word? Because they were trying to dupe the Australian public into thinking that Medicare Locals were providing services. When you go into a Medicare local—I invite those opposite to go into a Medicare local—can you get a Medicare rebate? Can you get your forms processed? No, you cannot. There were 3,000 new bureaucrats as part of the Medicare local network, and what precisely did we get? When I first heard the name 'Medicare Locals' I thought they were places to get a refund and a beer, quite frankly, but it is very clear that that is not exactly what they are.

What was the legacy of those opposite in relation to so-called health reform? Remember the photoshoots from Prime Minister Rudd and Minister Roxon travelling around the country. Often we did not know which hospital they were going to turn up at for the photo opportunity. Goodness knows, given what Minister Roxon told us about her poisonous relationship with Prime Minister Rudd, what they found to talk about on those many hospital visits, but all those visits were about was Dr Rudd and Nurse Roxon tracking around the countryside for photoshoots. That is their legacy in health reform.

Anne McEwen (SA, Australian Labor Party) Share this | Link to this | Hansard source

After question time today the people of Australia would have to be asking: did Prime Minister Tony Abbott deceive the Australian people before the federal election when he promised that there would be no cuts to health? Today in the chamber the Assistant Minister for Health, Senator Nash, refused to come in behind her Prime Minister and confirm that there would be no cuts to health. Despite repeated questions from the opposition, she refused to confirm that commitment given by the Prime Minister before the election. We can only assume that there has been another backflip on the part of the government in its commitment to the Australian people and that the Prime Minister has deceived the Australian people.

Today Senator Nash refused to rule out cuts to integral parts of Australia's health system. Anyone in Australia, particularly those in regional Australia, would be worried about the future of health services in the regions. The failure of the Assistant Minister for Health to guarantee things like Health Workforce Australia is particularly worrying. I asked the assistant minister many times to confirm that Health Workforce Australia would continue. This agency of government was set up after the Productivity Commission review with the specific purpose of making sure that health services would continue to be provided in Australia, including in rural and regional Australia, in the places where they are needed and that those services would be for all Australians. The Assistant Minister for Health was unable to confirm that Health Workforce Australia would continue and she would not guarantee the futures of employees of Health Workforce Australia in South Australia, in particular.

Hiding behind the usual conservative government strategy of having a commission of audit, the assistant minister was unable to guarantee the future of Health Workforce Australia or indeed of Medicare Locals or of other important health infrastructure. We know what commissions of audit are all about, don't we? We have seen them used by conservative governments repeatedly as cover for health cuts and for cuts to other important social services in Australia. We have had no reason to expect that this government will do anything other than use the commission of audit as a smokescreen for health cuts. In particular, this government will use the commission of audit to cut the independent advisory bodies like Health Workforce Australia because they do not want to receive independent advice about what is most important in the health sector, just as they have refused to rule out cuts to Medicare Locals.

We have listened to a tired tirade from Senator Fierravanti-Wells about Medicare Locals. I have actually been to Medicare Locals, as have most opposition senators. In particular, I spent some time at a country South Australian Medicare local in Murray Bridge in the electorate of Barker. I can tell you that organisation is doing a fantastic job of coordinating important health services to rural and regional South Australia, in particular in the Riverland and in the south-east. There was no dissent from the doctors, the nurses, the providers, the other health professionals, the families or the children of families I met on the occasion I was there. They clearly understood that Medicare Locals, like other health infrastructure, are integral and essential to the provision of health services in Australia.

It was very disturbing, and I am sure it is disturbing for all Australians today, to hear the Assistant Minister for Health fudging her answers on commitments that the Prime Minister made to Australians about the future of health funding in this country. I would ask the government to be upfront with the Australian people about what they actually have in store for Australia's health budget and for the provision of health services to Australians, because what we saw today was them running away, backtracking, backflipping and denying what the Prime Minister had promised to Australians. It is a worrying time for Australia when we do not have a commitment to the health budget. (Time expired)

Bridget McKenzie (Victoria, National Party) Share this | Link to this | Hansard source

Here we go again with Senator McLucas on the shadow front bench asking questions of Senator Nash about the government's perspective on rural health. Our government will be committed to a strong health workforce, particularly in regional Australia. What the opposition does not actually realise is the election has been held; the questions have been asked and they have been answered by the Australian people. They did not choose the response of those opposite to the issues and challenges that our nation faces over coming years.

The other trick we have to remember is the word 'review' does not equate to cuts. If we are going to govern for all and govern in a way that is appropriate, then we need to ensure that the taxpayers' dollar is spent in a strategic manner. We have also promised to review Medicare Locals, to reconstitute the Australian Building and Construction Commission, and to repeal the carbon tax and the minerals resource rent tax to deal with the escalating net debt position that would see us exceed $300 billion come December—from a position, I might say, of $50 billion in the bank when the opposition came to power only six short years ago.

Just because you do not like it does not mean you should not be supporting it. Those opposite are like teenagers who were throwing a party for a few mates and, thanks to Facebook, it got a little out of control and they ended up trashing the joint. The ALP stands up to face the Australian public day after day, not apologising that they got it wrong, not even saying to the Australian people that they recognise you wanted a different approach, that they did not mean it and that they did not mean for it to get so out of control. The ALP does not even offer to help clean it up. Those opposite need to accept the reality that the situation we are in needs to be rectified. It is not going to be easy. The people have voted and they want someone to clean up the mess.

Our commitment to a strong health workforce is actually going to be supported by a series of programs ensuring the recruitment of medical students from rural areas because research shows that if you are from a rural area then you are more likely to practise your particular specialisation in a rural area. Providing supporting scholarships will deal with the fact that those on the lowest median income do come from regional Australia and so do need additional financial assistance to move to where those medical schools are, mainly in capital cities. Delivering clinical training within rural clinical schools will ensure that all young medical professionals experience the great spectrum of medical training that is available by practising in the regions. You do not just have a narrow curriculum or a narrow section of patients. Being a rural GP or a rural specialist, you get to do everything in a day from setting a leg and prescribing painkillers to dealing with mental health issues, adolescent health issues and working with the aged. It is a quite diverse and exciting place in which to practise your medical specialties.

All governments, universities and hospitals contribute to the costs of supporting clinical training of health students. The Commonwealth provides funding for training through support of universities, public hospitals, the rural clinical schools and other workforce programs, so it is an absolute misrepresentation for Labor to stand there in opposition, not accepting the reality of the election, and claim that the government is not committed to ensuring a satisfactory workforce, particularly in regional areas, when it comes to rural health provision. We are actually interested in outcomes. If we can see an inefficient program, through a review, that is not delivering health outcomes on the ground in regional Australia, then would not the smart thing—the prudent thing, the right thing to do—be to say let us take that money and put it where it will make a difference to the health outcomes for regional Australians? That is what we are interested in: actual outcome.

The government is carefully considering proposals before committing additional funding in the interests of efficiency and effectiveness. This is especially important given that the former Labor government left behind a massive debt—the debt they do not want to talk about. We will continue to invest in a range of programs to meet the very real health service provision needs of regional Australia. If you do not want to help clean up the mess, that is fine—don’t. Just get out of the way so we can.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I too would like to take note of the disturbing bits of information that dribbled out of the Assistant Minister for Health's resistant response to questions today about cuts to health and threats to the health and wellbeing of the community, particularly in regions such as the one I live in.

The coalition has already outdone itself on broken promises in three weeks here in the parliament. It has broken its ironclad commitment to quarantine health care from cuts. It is broken. They have broken it already on a number of occasions. This is from a Prime Minister and a minister who told the Australian people that they were going to be a government of grownups. They are pretty stingy grownups, from what we have seen so far—and ones who do not care about the health outcomes of ordinary people in communities like the one that I come from, the Central Coast. This is from a Prime Minister who told the people of Australia that they would be a 'no surprises' government. It would have been better to say, 'We'll be a "no delivery" government.' Surprise, surprise. The Liberal Party have not kept their promise and I fear that things are going to get worse and worse.

Senator Nash revealed on Wednesday that the government has moved to cut $1.6 million in funding to an important healthcare advisory body—the Alcohol and Other Drugs Council. When I look around me I do not see fewer and more easily-resolved drug and alcohol issues. How can it be that this august body can be so summarily dismissed—after a promise that there would be no cuts under 'the government I lead'? The government broke this promise despite its reassurance to the department that their funding would be secure until July 2015. This government has turned its back on the real victims of drug abuse in this country, and that is every family, every worker, every person who loves and cares for somebody who finds themselves caught up in the issues and problems that drugs and alcohol can present.

When called to the benches of power, the coalition has shown nothing more than ignorance about health care, ignorance about the effects of drugs and alcohol in this country and ignorance and dismissal of its own election promises. Senator Nash has thrown out a valuable healthcare body, and this move effectively erases decades of corporate knowledge. Those are not my words but the words of the former Liberal MP, the board's former president, the very honourable Dr Mal Washer—a man universally respected across the aisles of this place and a man known as the 'doctor of the parliament'. He is a man who even helped me out on one occasion when the air conditioning got to be a bit too much for my very gentle eyes. A great man. This is the man the government refuses to receive health advice from. But this is not the end of the hypocrisy of those opposite. The government has indicated, and the senator has restated today, that there are a number of other programs it wishes to review. Indeed, she said today that they are assessing all of the government programs.

In making the case for cutting the Alcohol and Other Drugs Council the minister tried to distance herself by saying, 'This body was Labor waste.' If the minister had any appreciation of the facts about this body she would know that it has existed since the days of Prime Minister Menzies. Since 1966 the council has been advising successive governments on drugs and alcohol, and I do not see the problem going away. For the first time in nearly five decades, it will no longer be able to do its important job.

And there is more we should be concerned about. What other bodies does the senator have on the chopping block? She certainly did not want to say today. Everything we heard from Senator Nash confirms that the health community should be very worried. And when health professionals in my community tell me they are concerned about more cuts coming down the line, I have to be concerned for the people on the Central Coast and in the electorates that I represent in this place—and I am concerned. We had the confirmation—organisations under review. We have had the claims repeated today.

Medicare Locals could be under serious threat. Let us not forget that Minister Dutton made some comments that he was going to cut them. It is a fallback position to say 'we are going to review them.' On the Central Coast this wonderful agency is delivering absolutely vital primary healthcare services to people in ways that were never, ever offered before: a mobile X-ray machine that goes to people in aged-care facilities; diabetes care; children's care; food programs; Partners in Recovery, building connections around people suffering from mental illness; and so much more. All of that is to be cut by a government going back on its promises. (Time expired)

Question agreed to.