Ricky Muir (Victoria, Australian Motoring Enthusiast Party) Share this | Link to this | Hansard source

Due to the confusion in the Senate in the lead-up to this sitting period there was uncertainty as to whether the Social Security Amendment (Diabetes Support) Bill 2016 was going to have an opportunity to be debated, so I would like to thank the chamber, and of course my parliamentary colleagues, for the opportunity to present my second reading speech today. Some would ask, why would the representative of the Australian Motoring Enthusiast Party be debating a bill in relation to type 1 diabetes? Well, the party may have a single-issue name, but we are all too aware that this position—my role—comes with a responsibility to all Australians. This is an important issue, and I am proud to be the one to bring it front and centre in parliament and for it to be debated, hopefully quite thoroughly.

Type 1 diabetes directly affects over 120,000 people in Australia alone, some of whom work right here in Parliament House. Type 1 diabetes, an autoimmune condition, is a non-choice disease that lasts for life. The Social Security Amendment (Diabetes Support) Bill 2016 will ease the impact of diabetes on individuals who are affected by the disease. The purpose of the bill is to amend the Social Security Act 1991 to give individuals with a diagnosis of type 1 diabetes access to the required medication and peripheral devices that the disease imposes upon them, regardless of their geographic location or social status.

Type 1 diabetes is a form of diabetes marked by a complete lack of insulin. Therefore, insulin replacement is required for survival. Type 1 diabetes can create a significant financial and emotional burden for patients, their family and the community. Differing social statuses can result in an unintended disregard for an individual's care plan, leading to a higher risk of complications that require hospital admissions. As a result, it can impose a significant burden on the taxpayer.

The more time people with type 1 diabetes spend outside the normal range of blood glucose levels, the greater their risk of serious health complications. Currently the cost of hospital admitted patient services as a result of diabetes-diagnosis admittance is equal to expenditure on blood-glucose-lowering medications. This level of hospital admittance is a completely unnecessary burden on the taxpayer which could potentially be reduced should this bill be supported. This bill ensures that access to medication and peripheral devices that are required by individuals with a diagnosis of type 1 diabetes are accessible regardless of socioeconomic status.

I was approached by Dr Peter Goss of the Gippsland Paediatrics diabetes unit in Sale, in my electorate of Victoria, in October 2014. Dr Goss requested that I advocate for the age group of 18- to 25-year-olds with type 1 diabetes. At the time, he cited that this group has the highest rate of death from diabetes. With such a substantial number of Australians being directly and indirectly affected by type 1 diabetes, this was something I was more than happy to discuss further and support unconditionally.

Type 1 diabetes is an unwelcome and unwanted intruder into the life of an individual and their family. It is an autoimmune disease that cannot be prevented or cured. Before the discovery of insulin in the 1920s, type 1 diabetes was a fatal condition. Although type 1 diabetes is now manageable, it places an enormous burden on families by requiring them to enter a daily and relentless grind of blood testing and insulin injections. There is solid evidence that the peak risk of poor control of type 1 diabetes and death is between ages 16 and 25 years. Currently a child with type 1 diabetes often loses their Health Care Card at 16 years, which imposes a significant financial burden on the person with type 1 diabetes as they enter their most vulnerable period of life. There is also anecdotal evidence that young people are more likely to skimp on the essentials of diabetes care, such as insulin scripts, glucagon scripts, blood glucose and blood ketone test strips, insulin pump consumables and even quality food because of the cost.

This lack of attention to scripts, doctors visits, diabetes education visits and devices due to lack of financial assistance can create long-term complications and possible hospital admissions, which imposes significant health and financial burdens on not only the individual but also the community. Given that type I diabetes is a lifelong autoimmune disease, it is not unreasonable to not only try to ease the pressure on such a high-risk demographic but to make available to all those at risk a healthcare card to assist sufferers of type 1 diabetes in accessing the medical and peripheral devices required.

On 20 August 2015, I moved a motion in the Senate in relation to type 1 diabetes. The text was:

That the Senate—

(a) notes that:

(i) Type 1 Diabetes Mellitus is an autoimmune (not lifestyle) condition which affects over 120 000 Australians,

(ii) people diagnosed with Type 1 Diabetes require insulin to manage their diabetes for life,

(iii) Type 1 Diabetes is one of the most common chronic diseases affecting children in Australia, and

(iv) Type 1 Diabetes creates a significant financial and emotional burden for its patients, families and the community; and

(b) acknowledges the importance of access to optical medical management for people with Type 1 Diabetes regardless of geographic location or social status.

This motion was passed in the Senate unopposed. In addition to this, I note that the Australian National Diabetes Strategy 2016-2020, which was released to supersede the National Diabetes Strategy 2000-2004, was endorsed by the Australian Health Ministers' Advisory Council on 2 October 2015, noted by the COAG Health Council on 6 November 2015 and publicly released on 13 November 2015.

Since I moved my motion, I am pleased to note that the Australian government has developed a new national diabetes strategy to update and prioritise the national response to diabetes across all levels of government. I appreciate that there are current government initiatives in place in addition to the recently developed Australian National Diabetes Strategy 2016-2020, such as the National Diabetes Services Scheme and chronic disease management assistance to assist individuals. I strongly believe that the Social Security Amendment (Diabetes Support) Bill 2016 can work in collaboration with the key government initiatives which are essential for individuals diagnosed with Type 1 Diabetes. I also believe that the Social Security Amendment (Diabetes Support) Bill 2016 can support some of the key purposes outlined in the Australian National Diabetes Strategy.

The purpose of the Australian National Diabetes Strategy 2016-2020 is:

… to prioritise Australia’s response to diabetes and identify approaches to reducing the impact of diabetes in the community. It recognises the social and economic burden of the disease and provides action areas that:

More specifically, goal 3 of the Australian National Diabetes Strategy 2016-2020 aims to:

… reduce the occurrence of diabetes-related complications and improve quality of life among people with diabetes.

The potential areas for action addressed with this goal are:

Develop nationally agreed clinical guidelines, local care pathways and complications prevention programmes …

Expand consumer engagement and self-management …

Develop and implement quality improvement processes …

Use information and communication technology …

Improve affordable access to medicines and devices …

Improve workforce capacity …

Improve funding mechanisms …

Provide mental health care for people with diabetes …

Strengthen and expand transition from child to adult services …

Make preschool, school and child care diabetes safe environments …

Provide high-quality hospital care.

Many of these potential areas for action can be addressed directly and indirectly through support for this bill. More specifically, optimal diabetes care for children or adolescents in school is crucial to achieve the best possible diabetes control and to prevent any present or future risk of harm to their health and wellbeing. This will give affected children and adolescents the best opportunity to concentrate, participate and learn whilst at school.

Children with type 1 diabetes should have the same educational and social opportunities as children without diabetes. Every child has the right to participate equally in school activities, including outdoor activities and sponsored events away from school, and to receive support for diabetes care. Ensuring the implementation of accessibility to diabetes care from a younger age will carry over into better diabetes care practices into adolescence and adulthood.

In closing I would like to readdress the importance of awareness surrounding type 1 diabetes. Not one person who has type 1 diabetes had a choice in their diagnosis. It cannot be prevented or cured. Type 1 diabetes creates a significant financial and emotional burden for patients, families and the community. This bill will ensure medication and peripheral devices that are required by individuals diagnosed with type 1 diabetes can be accessed regardless of one's socioeconomic status. If we are in any way serious about improving the quality of life of people with type 1 diabetes, I suggest all senators support this bill.

I would also like to take this opportunity to inform the Senate that, since I introduced the Social Security Amendment (Diabetes Support) Bill 2016, I have received copious amounts of correspondence and support. It is moving that so many people have taken this opportunity to reach out to me, sharing their personal accounts of the highs and lows associated with the burden that comes with being diagnosed with type 1 diabetes. These often saddening accounts have come not only from individuals who have been diagnosed but also from their loved ones: the parents who have to care for their child knowing that every decision they make will affect the future health of the life they created; the brothers and sisters who have to accept a feeling of helplessness when their sibling may not have the same support and health care as themselves for a disease which is not their fault; the extended family members and friends who can do nothing but sit back and watch loved ones doing all they can in an often disheartening battle.

I would like to share a couple of these messages from individuals who have made contact with me. Kyla sent to me on Tuesday, 8 March:

Dear Mr Muir

Thank you so much for addressing this vitally important issue.

My son was diagnosed with this horrific chronic disease a week after his second birthday. It has changed our life in every conceivable way.

There are of course the numerous finger pricks, insulin injections, set changes; the weighing and calculating of every gram of carbohydrate, fat and protein of every mouthful of food that passes his lips; the never ending night checks and constant zombie state of sustained sleep deprivation; and the unending worrying about how every bit of exercise or play or even a common cold will effect his blood sugars. There's the largely unspoken detrimental effects on partnerships and family relationships, the constant stress and fear of your child not waking up alive and the fear of every day childhood occasions like birthdays, sleepovers, and even just being away from you at school.

There is also a huge financial burden - even with a health care card.

… and all of this is just from a parents point of view.

My little boy will have to deal with this for the rest of his life. There is no way that this disease was his fault. As you know Type 1 Diabetes is not caused by eating too much sugar or not exercising enough. This is a life threatening autoimmune disease. He will have so much to deal with every hour of every day forever, and that's not counting any of the other everyday stuff.

Please, please, at least continue to allow him, and every other person with Type 1 Diabetes, fight this ongoing battle with the subsidised medical necessities they need throughout their lives.

Yours in hope

Kyla

Juanita sent to me on Wednesday, 9 March:

I'd like to see ALL Type 1 Diabetics be included in this Bill. As a Type 1 Diabetic, the costs associated with this disease are high. It becomes a financial juggling act with the questions 'do I buy diabetes medication and peripherals or do I buy food' this week? The costs associated with Type 1 Diabetes are often subsidised, however, even with these subsides it is expensive and often we have to 'go without' necessary medications/insulin, test strips and other peripherals, simply because we cannot afford them. My council, has taken away all public sharps containers, it now costs $22 for every 2.5kg container $7.50 per container as well, so, that's around $30 per disposal. Add to that the cost of test strips, machines, insulins etc each week and that's before you even think about buying 'healthy' foods, such as fresh produce. We, as Type 1 Diabetics, get 5 free visits per year from the government, however, with Diabetes Educator, Dietitian, Exercise Physiologist, Podiatrist and Optometrists visits, that's just one visit each per year and I've have several visits alone, just with the Diabetes Educator in these last few months. That means no Dietitian, Podiatrist, Optometrist or Exercise Physiologists for me for another year and if I need to see my Diabetes Educator again, it will cost me around $70 per visit. I can't afford that. Type 1 Diabetes, is not a lifestyle disease, it's not something I brought on myself and it's hard enough to live with, without the costs associated with trying to maintain it to it's optimum level. It ends up being a choice between 'do I want to keep my blood sugars under control? Or do I want to eat this week?' Each week, I have to decide which Diabetes product I need the most, test strips? Or Insulin? Glycogen? Glucose? Hypo snacks? If I had a Health Care Card, I could afford to do what I'm supposed to do, with medications, etc and thereby, easing the burden on the health care system in the future. Unless there are changes to all health care cards, I'm a statistic waiting to happen, will it be Kidney failure and Dialysis? Or perhaps, Heart disease? Amputation of limbs? The list goes on. Give ALL TYPE 1 DIABETICS a permanent health care card. It will be cheaper in the long term!

Juanita

This is just the tip of the iceberg. Not one individual's situation is the same as another's. A doctor cannot simply look at an individual diagnosed with type 1 diabetes and say, 'Okay, you have diabetes; take this medication.' The healthcare plan required by each and every person diagnosed with type 1 diabetes is individually tailored to them by a team of healthcare professionals, including but not limited to endocrinologists, diabetes educators and dieticians.

I would also like to address some questions I have received from individuals in relation to my introduction of this bill. As mentioned earlier in my second reading speech, this healthcare card would only be applicable to individuals who are diagnosed with type 1 diabetes. This is due to the fact that type 1 diabetes is a non-lifestyle disease. There is no prevention for type 1 diabetes. There is no cure for type 1 diabetes. Unlike other forms of diabetes, there is no alternative to insulin injections for life for the individuals who fall into this category. As a nation we need to be looking at preventative health. Assisting individuals diagnosed with type 1 diabetes to maintain optimal health could significantly reduce future health costs associated with disabilities derived from diabetes related complications.

If there is the opportunity to ease the emotional and financial burden on individuals and families affected by type 1 diabetes, why would it not be considered? If there is the opportunity to make diabetes control more accessible to people diagnosed with type 1 diabetes, preventing permanent damage, why would it not be considered? This is the first step in a preventative health approach, setting a positive precedent for the future of Australian health.

David Fawcett (SA, Liberal Party) Share this | Link to this | Hansard source

I rise to make a contribution on Senator Muir's bill on diabetes—the Social Security Amendment (Diabetes Support) Bill 2016—and the topic of concession cards. I would like to talk a little bit about diabetes up-front—particularly for South Australia because it is a significant burden for individuals there. We actually have the highest rate of diabetes in Australia. I would also like to talk a little bit about the current process of how the government provides support to people who are suffering with diabetes. Lastly, I will talk a little about concession cards.

The framework of my points on this is that concession cards are something that the government targets to people on the basis of means and not on the basis of a condition. We have traditionally provided support for people with a medical condition to make those treatments affordable and sustainable. There are areas in that where I concur with Senator Muir that there are perhaps improvements to be made, but I would argue that it is within the established system that we need to extend those improvements, rather than crossing purposes, if you like, with a system that is designed to support people on the basis of income as opposed to their condition.

As I said, South Australia has the highest prevalence of diabetes of all Australian states and territories. The last quantitative report, of 30 June 2015, showed that 1.17 million Australians, some 4.9 per cent of the population, suffer with diabetes. In South Australia that rate is at 5.8 per cent, which means that over 98,000 people in South Australia are suffering with diabetes. The rate of diagnosis is estimated to be around 600 people every month in South Australia. That is approximately 20 people every day in South Australia who are diagnosed with diabetes.

It is Australia's fastest-growing chronic condition and it leads to quite serious complications, the consequences of which can include heart attacks, stroke, blindness, kidney damage and foot ulcers that in far too many cases lead to amputation. So it is a serious issue that we need to understand and manage and then, where we cannot manage pre-emptively and help people to avoid it—as Senator Muir has pointed out, type 1 is not necessarily something that you can avoid—then we need to make sure that people can adequately obtain the services, medications and items they need to live with the condition.

Part of managing and understanding is actually monitoring and looking at trends. According to the Australian Institute of Health and Welfare there is actually no measurement data for monitoring trends in diabetes prevalence at the moment. There is a great deal based on self report, but even the self-reporting has doubled from around 1½ per cent in the early 1990s to around 4.2 per cent in 2011-12. As I said, now the national rate is some 4.9 per cent.

There are a few reasons for that. One is that with an increased awareness of diabetes, people are seeking diagnosis and then reporting for that. Also, with increased and improved management people are living longer and therefore there is a greater period where people who have diabetes are part of the population. But that does not mask the fact that this is, across both type 1 and type 2 diabetes, a growing problem in Australia that we do need to manage.

We need to manage it from two perspectives. Clearly, one is the impact on the individual and their family. As Senator Muir has pointed out—particularly from the letters from constituents that he has received—it does have a significant impact on the individual's lifestyle and on their family or carers. This is particularly where we see the incidence of things like overnight monitoring. We have had a young lady, tragically, pass away in Australia just recently because of the fact that her blood sugars dropped dramatically overnight and that was not picked up. So it does have a significant impact on people's lifestyles.

The other aspect that we need to address, though, is that the consequential costs to Australian society and to our economy are large in terms of the treatment that is required. In some cases—for example, post-amputation, if people lose a foot or more due to diabetes—the ongoing rehabilitation and care, prostheses and other services for those people are dramatic costs that our country can ill afford. So there are a couple of significant reasons why we should seek to manage and provide support for diabetes in the best possible way.

The other point I just want to raise on this is that if we look at diabetes as a whole, our Indigenous population actually has a substantially higher rate of diabetes than other Australians. If you look at the hospitalisation rates for both diabetes and renal diseases, it is some eight times higher for Indigenous people than for other Australians. And so this is something that we need to be very proactive about in our preventative and management work for people in those communities.

In South Australia, for example, one of the measures that the South Australian health department reports is that over a five-year period there were some 63,300 hospitalisations as a result of diabetes. Type 2 was the principal secondary diagnosis in many, but there were also 12,671 hospitalisations with type 1 diabetes being listed as the principal secondary diagnosis. Mortality attributed to diabetes has not changed significantly but it is a significant number, with an average of 280 deaths reported—106 of these over a five-year period attributed directly to type 2 diabetes and another 31 attributed to type 1 diabetes. A further 144 deaths were attributed to diabetes, but the records did not show whether it was for type 1 or type 2. Clearly, there is a significant impact on people and their families through this disease.

So what does the government do at the moment? I come here specifically to type 1 diabetes. Under the Pharmaceutical Benefits Scheme we supply and support subsidised medicines. We also supply diabetes products through the National Diabetes Services Scheme, or the NDSS. Over the past five years there has been $1 billion supplied by the government into the NDSS to meet these support needs.

In 2014-15, expenditure on medicines for diabetes through the PBS was $526 million. That was for things such as insulin. Expenditure on products supplied through the NDSS was $185 million. That is on top of the $35 million that was provided to the Juvenile Diabetes Research Foundation—the Australian Type 1 Diabetes Clinical Research Network—to help find a cure and to provide support and education for people suffering from this.

So the current agreement for the National Diabetes Services Scheme has been running since 1987. As I said, over the last five years that has had approximately $1 billion. That agreement is coming to an end during this year. That does not mean the funding is coming to an end; it means the agreement for the current service provision is. One of the changes that we are looking at there, which I think needs to be accelerated, is just like under the PBS, where providers can come to the government and say, 'We have a product that we wish to see listed,' and there is an independent body which assesses the efficacy of that product and the difference it will make in people's lives. I think we need the same kind of system in the diabetes space so that where we see, particularly, young people who have that very intensive daily routine, and there are certain technologies that can help them to manage that more proactively, that people could put forward their case to an independent body and say, 'This is why an investment in this technology, subsidised and provided to sufferers of type 1 diabetes, will be a saving to the government in the long run'. We could see that kind of support provided.

I come back again, Senator Muir, to the point that the way our system works is that we provide support through these kinds of schemes to people with a condition, as opposed to giving them a card for the condition. As we look at renewing the agreement the funding will continue; it is an uncapped scheme. I think it is important to note that it is uncapped funding for the NDSS. But as we change the agreement we need to look at that opportunity and ask, 'What are the other measures, technologies, services or support that would deliver long-term savings that we can bring into this scheme?'

The scheme is available to anyone who is a resident of Australia and has been diagnosed with diabetes. It is free and the products that are subsidised currently includes syringes and needles, blood glucose test strips, urine ketone test strips, insulin pump consumables et cetera. All of these are designed to help people to self-manage their condition in an affordable manner. There are also new services being developed through the National Development Programs which are targeted priority areas such as Indigenous health. I would like to see that independent body associated with the NDSS so that we can see the specific programs and products provided to people who need them.

The other program that is funded by the federal government is the Insulin Pump Program. That provides a means tested subsidy for insulin pumps and associated consumables for people under the age of 18 with type 1 diabetes. Again, the means testing in these programs is a way to address the concerns raised by Senator Muir, where those who can afford to pay for the service with some subsidy do so, but for those who do not have the means, the means testing is there so that this enhanced subsidy is available for them. The program is designed to increase the affordability of the insulin pumps for families, who do not have access to other means for reimbursement such as private health insurance. Subsidies are available for families with an annual income of up to $101,000 and that is indexed each year. There is an attempt there to address the point Senator Muir was talking about in terms of making sure those on a lower incomes do have access to subsidised services.

It is an area where, again, if you look at the cost of not managing diabetes, perhaps that program and those subsidies should be enhanced and I would certainly support consideration of that. But I think that is the mechanism to do it rather than a concession card, which is not something we do in our current system. Concession cards are provided to people on the basis of their income not on the basis of a condition.

The framework within which we can take some of these conversations forward is the Australian National Diabetes Strategy, which is over the period of 2016 to 2020. That was launched in November last year. It is a strategy that aims to have goals and areas for actions that cross different levels of government. It is important to realise that this does cross levels of government. It also includes private practice, it includes research and it includes not-for-profit groups who provide training and support for people with diabetes. All of those efforts need to be keyed up for this to work well.

The Australian Health Ministers' Advisory Council has undertaken to develop an implementation plan for the strategy and, as always, strategies are not worth the paper they are written on if they just sit on a shelf. There needs to be an effective implementation plan that crosses all of those areas.

The Department of Health is also looking beyond diabetes to develop a National Strategic Framework for Chronic Conditions to update how we approach support for people suffering from chronic conditions in Australia. That was to provide an overarching policy framework for national and state based strategies. That will include disease specific strategies such as the Australian National Diabetes Strategy.

It is important that we do get alignment in terms of our approach to all chronic diseases because as bad as diabetes is it is only one of a number of diseases that are chronic and affect people long-term. We owe it to the people of Australia to provide the level of good governance that can see us working collaboratively not only on a bipartisan basis here but also across state and federal boundaries to make sure we have a coherent approach to providing affordable and effective care to people. To do that the cross-jurisdictional working group has been established, and that is officials from each state and territory and federal department. The key deliverable they have set for this year is the final implementation plan, which will identify short, medium and long-term goals.

Prevention is also important. Again, for type I diabetes specifically this is perhaps not as applicable, but the prevention and management of chronic conditions is important. The Primary Health Care Advisory Group is looking at ways to get better prevention and connection between primary health care and hospital care. The Medicare Schedule Benefits Review Taskforce is looking to consider how services can be aligned with contemporary clinical practice to improve health outcomes for patients. The National Strategic Framework For Chronic Conditions is being developed to give an overarching framework.

The kinds of areas where these reviews could be of benefit are, for example, the Podiatry Association have come to me in the past seeking support for some of the work that they are doing where they have looked at the fact that there are some 10,000 hospital admissions nationally due to diabetes related foot ulcerations and in excess of 4,300 amputations every year due to diabetes. Each of the amputations alone costs the Australian healthcare system some $26,700, not to mention the after-care costs in terms of rehabilitation, prostheses and support for the person who has lost one or more feet.

Best practice research by the podiatrists indicates that improving access to podiatry services for patients with foot complications from diabetes can prevent future hospitalisations and amputations, which would well and truly recoup the cost of the services of the diabetes compared to the costs of the amputation and the follow-up support. Cost savings in the implementation of best practice research were estimated in 2012 of being in the order of $397 million annually. Whilst the Medicare Benefits Schedule Review sounds like something that is just another process, one of the letters that Senator Muir referred to referred to a lady who said there are only five services available—one visit to the podiatrist a year. However, it is this kind of review that has the potential to look at the cost burden of not providing these services and to put in place affordable access for people for those allied health services they need to better manage their health condition so that not only does the individual stay healthier but the economy overall has a better outcome in terms of a lower cost of providing the preventive care.

Even with type 1 diabetes, there are consequential effects so that, if we are more proactive and effective in our preventative measures—whilst we cannot change the fact that people have type 1 diabetes—we can pre-emptively put in place measures that will improve the quality of life for the individual, improve the quality of life for those who are caring for them as well has having long-term positive outcomes for our economy.

The contribution I have made to this bill, Senator Muir, through you, Mr Acting Deputy President Williams, recognises the significant burden, as I say, in South Australia, where we are particularly affected in terms of not only our total population but also our Indigenous population. I support your call for affordable services for people to make sure they get the care that the need.

My contention is that the concession cards that the Commonwealth government gives out—such as the pensioner concession card, the health care concession card and the Commonwealth seniors health card—are more around people's financial positions as opposed to a specific condition. We already have schemes in place—whether it is the Medicare scheme and specific strategies such as the NDSS—to provide support to people with particular conditions. My advocacy has been in the past and continues to be that it is through those schemes and processes such as the Medicare Benefits Schedule Review that we need to be pushing for enhancements to see sufficient access to the right services that will make a difference to people—whether they are affected type 1, type 2 diabetes or other chronic conditions—that will not only improve their quality of life but from the taxpayers' and community's perspective deliver longer-term savings to the government.

Katy Gallagher (ACT, Australian Labor Party) Share this | Link to this | Hansard source

I welcome the opportunity to speak to the Social Security Amendment (Diabetes Support) Bill 2016 this morning. This bill will amend the Social Security Act 1991 to automatically issue a healthcare card to all Australians with type 1 diabetes and people with dependent children who have type 1 diabetes.

It would entitle those cardholders to diabetes services, including medical and allied health consultations and goods—for example, to administer insulin—regardless of their income. It would entitle those cardholders to other healthcare card benefits below certain income thresholds—$88,000 for singles and $176,000 for couples—and make other technical changes related to residency compliance penalties and indexation. This bill itself does not provide the funding for the increased expenditure associated with these additional benefits.

The issue in this bill raised by Senator Muir is a valid one. There is no doubt that people with ongoing health conditions have additional cost burdens placed on them to manage those chronic and ongoing health conditions. When we look at the statistics across the country, more broadly, around chronic disease, of which diabetes is one, the Australian Institute of Health and Welfare estimates that one in five Australians is affected by multiple chronic diseases. The leading one of course is cardiovascular disease: one in five. In cancer, it is one in two men over 85 or one in three women over 85. One in 10 Australians have chronic kidney disease. One in 19 Australians have diabetes. One in five are affected by mental health. One in four Australians have musculoskeletal conditions. In oral health, for example—something that not many people focus on in the area of chronic disease but it is a very important one—three in 10 adults suffer from teeth decay. Then there are the very large numbers of people who have asthma—one in 10—or other respiratory contributions, for example, COPD: one in 42 Australians.

There is no doubt for anyone who is interested in health care or understands the healthcare system that managing the ongoing human and economic costs of those chronic diseases is one of, if not, the biggest challenges facing the health system in the future. It is right up there.

The cost to the community is not only large in terms of expenditure from budgets and revenue raised through tax; it is also the economic cost of people not being able to work or having long periods of time where the management of their health condition is unstable. If you approach this bill from that point of view, the arguments that Senator Muir put forward are well understood and have merit.

I also think in relation to type 1 diabetes, particularly, its onset is often between the ages of 10 and 14. The human cost of managing a child who suddenly has a lifelong condition and the additional expenditure that comes with it are very difficult things for families to manage.

The information that the ABS and the AIHW collects shows us that the rate of type 1 diabetes in Australia is remaining stable but it is still not an insignificant number of people: in 2013, there were 2,300 with 23 new cases of type 1 diabetes in Australia, which equals 11 cases per 100,000 population. The incidence rate for type 1 diabetes is higher in males than females. It peaked at age 10 to 14, where 33 per 100,000 population were diagnosed with type 1 diabetes. More than half of all new cases of type 1 diabetes were in young people under the age of 18.

When you look over the long term, from 2000 to 2013 there were 31,895 cases of type 1 diabetes diagnosed. This was around 2,300 new cases of type 1 diabetes each year, or six new cases a day. That incidence rate has remained stable over the last 13 years. That puts us in contrast with other countries that are seeing increases in the incident rate of type 1 diabetes. That is not being seen in Australia. One other interesting issue is the low rate of type 1 diabetes in Aboriginal and Torres Strait Islander people, which is in stark contrast obviously to the rate of type 2 diabetes for those population groups.

There is no doubt that type 1 diabetes is an enormous burden on both individuals and the community. Those who have the condition require lifelong health management. It has associated health problems—in some cases disability and in other cases it certainly affects quality of life and can lead to premature death, particularly if it is not managed well in the primary healthcare system. The Incidence of type 1 diabetes in Australia says that the financial burden of type 1 diabetes is estimated to be $517 million annually. The incidence rate of type 1 diabetes amongst children and young people in Australia is relatively high when compared to other countries. Australia is in the top 10 countries in the world even though, as I have previously commented, this rate has remained stable over the last 10 to 15 years.

More broadly—and again the health economists can easily pull numbers together on what the direct and indirect health costs are—back in 2008-09 direct health costs to manage chronic disease in Australia were estimated to be about 36 per cent of all health expenditure. I would expect that, as that data is quite old, that percentage rate would have increased slightly with the huge growth we are seeing in the number of Australians experiencing and living with chronic disease. Of course, then there are the indirect costs associated with those conditions.

There is no doubt that the health costs associated with chronic disease management more broadly in Australia are a massive challenge for governments and parliaments when considering legislation that seeks to extend or increase the amount of support that is provided. Certainly in the states and territories the expenditure on health, mainly through the hospital system, is eating up increasingly large areas of their revenue base. Anywhere from 30 to 35 per cent—heading to 40 per cent pretty quickly—is being spent on health care. Whilst we have seen some reductions in the growth rate that the Commonwealth is prepared to fund, there is still a large amount of expenditure going into health from the Commonwealth as well. We would argue that the decisions around cutting back on the growth rate to hospitals in particular, the cuts that have been made, are making it increasingly difficult for people with chronic illness to manage their condition, as are the cuts that have been flagged and imposed in the primary healthcare system.

From a health point of view one of the great things about Australia is Medicare. Labor designed the Medicare system, and we will protect it as a priority. Medicare makes sure that health services are available to all people. Wherever you are in Australia you are able to access top-quality health care if you need to. That is a fundamental principle that underpins Medicare and it is why Labor will fight so hard to ensure that Medicare is protected. The minute you start tinkering with that we start walking away from that principle.

We also believe that people, particularly those on low incomes, must be able to afford the costs associated with accessing health care. That goes to some of the entitlements that are received through access to a healthcare card. That is targeted to income and access to that healthcare card does not specifically give additional entitlements for particular health conditions. The main focus must be that any decision government makes to provide financial support for people with ongoing health conditions must be targeted to those who need it and to all who need it. That is why the cuts to bulk-billing, the freezing of the indexation rates for GPs, the pathology changes and the pathology cuts are so critical in this space. They will mean that people, particularly those with chronic health conditions like diabetes, will end up having to pay a lot more money.

It is not just about meeting the costs or improving on the costs that they are currently experiencing; it is the fact that some of the changes being proposed, whether it be through the MYEFO or for decisions already taken, will mean that people with diabetes, for example, could be hundreds of dollars every year out of pocket for the cost of actually staying well—that is, going in for monitoring, for blood tests, for urine tests or for checking on the function of their kidneys. All of those tests that people who have diabetes must have to manage and keep their diabetes stable will potentially now cost a lot more money. Labor has been resisting and arguing against precisely that because: first, it will mean people who have already got additional health costs will have to pay more; and, second, it will potentially reduce the availability of those services to people who need it. There are enough service providers in the pathology industry saying that that will be the result.

Also, if those tests are not done and if people do not keep on top of the management of their diabetes in the community then they will end up in hospital. When they end up in hospital, the costs associated with that care are much greater. We would argue that this is a very short sighted save the government is proposing because it will provide a disincentive for people to actually proactively manage their disease well so that they do not end up in hospital. Once they enter hospital, there is a whole range of human costs and financial costs associated with that.

Listening to the debate this morning, the other issue that comes up from time to time is whether some particular diseases and illnesses should be treated preferentially to others—it is not an easy discussion—because some diseases and illnesses are the result of lifestyle factors and others cannot be helped at all; therefore because an individual did not, in a sense, bring it upon themselves, the entitlement to access financial supports may be greater. I think that is a very difficult argument to resolve because when you look at the expenditure in health care, an amount of it no doubt is expended because of choices individuals make about their lifestyles. There is obviously a whole range where that is not relevant but I think one of the fundamental strengths of a universal healthcare system is that there is not judgement attached to the particular illness that may require you to access health services. It is a pretty slippery slope that will act as a disincentive for people to seek treatment, to seek support. For the greater good of the community, we need to have those options available to people.

Whilst I completely understand and sympathise with families who are having to manage some of these costs, I think it is worthy of review. It is worthy of further examination across the board as to whether the current arrangements are adequate. Some would argue that the MBS review will allow that broader examination. I know that there are various health groups that have provided input into the adequacy of the current arrangements but I think that is probably a broader debate than we can pursue in relation to this bill.

I think the main focus for us as politicians who are interested in the future of the Australian healthcare system should be to ensure that we protect the fundamental principles of the healthcare system, which is Medicare for a start. It is appropriate to fund the primary healthcare system, the hospital system, the exit points from the healthcare system and to make sure that those who are unable to afford care still have access to top-rate, first-class, international quality health care. If you accept that those are the criteria for which you plan and fund your healthcare system then the flow down from that will benefit people who have ongoing chronic and lasting health conditions. There is no doubt if we can better manage people in the primary care system, if we are able to put the focus on preventative health care—and that will not affect people with type I diabetes; I accept that—and if we can lessen the burden of disease in other lifelong and chronic health conditions then resources will be freed up to plug into other areas of demand within the healthcare system.

The healthcare system is going under such huge transformative change at the moment that the opportunities to reallocate should be real. The government has not helped here with the cuts to the Preventative Health Agency or with the cuts to the National Partnership on Preventative Health, which go precisely to that point. Early investment in this area will actually deliver long-term benefits if we are able to stop the amount of escalating cardiovascular disease, respiratory illnesses and mental health conditions. If the investment goes in early, the benefits are there for all of the community including for those who have ongoing health conditions that cannot be addressed by a change of lifestyle.

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

It is with pleasure that I rise to contribute to the debate on the Social Security Amendment (Diabetes Support) Bill 2016. Issues around diabetes are very dear to my heart. It is an issue that I have worked on extensively in this chamber, particularly as diabetes relates to Aboriginal and Torres Strait Islander peoples, because we know that they are disproportionately affected by some of the end-stage kidney diseases that are related to diabetes. I am also very passionate about issues for young people with juvenile diabetes. It is an issue that we all need to be paying attention to. The fact that this bill is being debated will highlight the issue extensively and I do congratulate Senator Muir taking up this issue. This debate helps to bring this very important issue to national attention and to the attention of the government so that they know there is a lot of public pressure and commitment from many of us in this chamber to addressing this issue. We know diabetes is recognised as a national health priority due to its significant contribution to the burden of chronic illness in this country. It is a very significant chronic illness and it is a significant contributor.

Australia has, unfortunately, one of the highest rates in the world of type 1 diabetes, with over 130,000 Australians living with its effects. It is the fastest growing chronic disease in Australian children. There is much that can be done in the management of type 1 diabetes that would prevent serious consequences from progression of the illness and there are new techniques that can help to avoid hospitalisation and debilitating or even life-threatening events. Those developments are there in part because of the ongoing advocacy on this issue. Many of these management approaches and technologies would relieve the considerable stress on people with diabetes and their families and save money in the acute aspects of the budget. As with most things in health, prevention, early intervention and good management is better all round for patients, for their families and for the health system.

Senator Muir's bill would provide an automatically issued health care card to those who suffer from diabetes mellitus—I usually just refer to it as diabetes type 1, its common name—who meet a means test of up to $176,000 for a member of a couple or $88,000 from an individual. This bill cannot appropriate funds, as we know the issues around that in the Senate—to actually make a payment an appropriation is needed. The bill would introduce an anomaly into concession card arrangements providing concessions for those with a specific health condition. While we congratulate Senator Muir for picking up this issue, we think there are some issues around this particular mechanism. I know that we do need a mechanism, but it is a different approach to the way that we make arrangements for concession card arrangements. The card would also be anomalous, in that it would entitle holders only to concessions relating to diabetes treatment, management and for those who only qualify through HHS under the proposed conditions. It is unclear how this would apply in the case of the Medicare safety net concession thresholds—for example: would the concession thresholds apply only to diabetes related services? I understand very clearly—and I am sure many of us do—the predicament of advocates for people with type 1 diabetes, who are keen to see more support from government, and we share that very strongly. They, obviously, would see the bill as a way of doing this. I know of the work of the Danii Foundation, which was set-up in the name of Danii Meads Barlow, who tragically lost her life to type 1 diabetes at the very young age of 17. Having done a lot of work in this area, I also know of other young people who have lost their lives at a very early age to type I diabetes. I am aware of the Danii Foundation's submission seeking a program to subsidise 4,000 continuous glucose monitor sensors for high-risk children and adolescents with type 1 diabetes who have impaired awareness of the warning symptoms of severe hypoglycaemia, yet can be protected from seizure, coma and potential death through these CGM sensors—hence their importance.

I also believe they would be happy with other strategies such as funding through the National Diabetes Services Scheme—known as the NDSS. I understand that Minister Ley's office is looking at whether they can add new devices to the NDSS, but, as usual, they are under financial pressure. Of course, we believe that we need to be putting more effort into making sure that people have access to this vital equipment.

Much like the rest of the world, Australia's health system is facing rising costs and uneven quality. The system is also facing rising public expectations for new treatments and technologies to be made available as they come to our attention. The health system adopts these technologies, but the bureaucracy of the health system has been slow to figure out ways in which they can respond to these new technologies and to funding for these new technologies advancements. There is a relentless public debate about the state of the government's finances. The debate shifts from fiscal crisis to a crisis in growth or productivity at the government's political convenience. So we have this conundrum of rising health costs, a pipeline of innovation, rising expectations, growing inequality and a paralysis on revenue generation. The Greens believe that health spending is a reflection of our values. It is a choice. It should not be seen as a drag on our economy. Better health outcomes are good for labour force participation, for productivity, for families and, of course, for our wellbeing. We know from the now extensive literature on the social determinants of health that poor health outcomes do have a significant impact and we know that inequality has an impact on our health.

The Greens have the courage and the vision to see that we need to spend more on our health rather than spending less. We have a suite of tax reform measures that will generate additional revenue, that do this in a fair way and that direct investment towards more productive areas of the economy and, in doing so, enable us to make better choices about how to use our collective wealth. Just this morning we released costings from the Parliamentary Budget Office that show we can raise an additional $4.1 billion over the forward estimates from making the deficit levy permanent and introducing a new marginal tax rate for the people who earn over a million dollars a year. That kind of money can help to pay for vital health care, education and infrastructure. These are choices that the government could be making.

I am not saying that there is no need for improvements in our health funding. We can always be more efficient, and we should target our spending better. We are a wealthy country and we can afford to deliver better quality health care for all. But we are concerned that this bill, which would amend the Social Security Act, is rather clunky. It creates a precedent for a single health issue but does not actually appropriate funds to cover costs, and for this reason we have some serious concerns about the bill. I also work in a number of other areas that address issues round health. This bill deals with a single health issue. Do we start addressing this issue by making the same sort of concession for each particular health issue and chronic condition? I have just articulated some other ways that we could be addressing this issue, because we are very committed to making sure that we are helping those with type 1 diabetes. There is some concern about this amendment to the Social Security Act. Being the spokesperson on social services for the Greens, I am very aware of the overall clunkiness of this legislation and the extreme complexity of the act.

People have raised with me their concerns about the cuts to health which will result in people having to pay for certain pathology tests and other procedures. I have, quite frankly, lost count of the number of emails that I received. They number into the thousands, and I am sure all my colleagues are getting the same sorts of emails. People are deeply concerned. In fact, when I was out in the community during the weekend, the one issue that people raised with me on an ongoing basis was the additional cost for pathology that people will have to pay and the fact that, because of this additional cost, people with chronic conditions who require access to things like pathology tests on a very regular basis will delay some of their test requirements, endangering their health even further. On that, I share the concerns expressed by Senator Gallagher and others in this place who are concerned about those particular proposals by the government.

We add the voice of the Australian Greens to call on the government for action to ensure vital healthcare and health technologies with proven benefits and safety make it to Australians in a timely and affordable manner. This bill has enabled us to have this debate and, hopefully, to provoke the government into taking this issue seriously. I seek leave to continue my remarks.

Leave granted; debate adjourned.