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

Under standing order 74(5)(a), I seek an explanation from the Minister representing the Minister for Health, Senator Nash, as to why question Nos 2896, 2897, 2898 and 2899, which I placed on notice on 13 January, remain unanswered.

Fiona Nash (NSW, National Party, Minister for Rural Health) Share this | Link to this | Hansard source

I undertake to have a look at that and come back to the chamber.

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

Under standing order 74(5)(c), I move:

That the Senate take note of the minister's failure to provide the answer, or an explanation, to the Senate.

These questions are very important ones that I put on notice a couple of weeks after the Australian government responded to the Contributing Lives, Thriving Communities review of mental health programs and services. As senators will be aware, the Contributing Lives, Thriving Communities review was a comprehensive review of the mental health system, from the Commonwealth's point of view, right across the country, and their response. There were some major reforms to the way that they were going to provide funding for to deliver services from Commonwealth mental health programs.

Unfortunately, the response to the Mental Health Commission's review was very light on details and on an implementation framework. It did not provide me with the information I need to do my job as the shadow minister for mental health. It was certainly very general in its approach. I think it is only about 26 pages for a review that was more than 1,000 pages and had taken more than a year to complete. The government then took a year to respond to it, having managed to get the response out towards the end of the sitting calendar. The information in the response was really that, 'We will provide you with more information at a later date.' I had the opportunity at estimates to speak with the department and raise some of the questions, but because I had already put these questions on notice and sought this information, I said to the department that I would not necessarily pursue some of that information as I expected to be getting it within the 30-day time frame for answering questions. The time has now elapsed and we have been unable to get greater detail about how the mental health reforms are being rolled out, from the Commonwealth's point of view. To give you an example of that, in the government's response to the Contributing Lives, Thriving Communities review, which was released on 29 November, they said, 'We will be advising funded services in December about what arrangements there are for funding going forward.' A number of services got a letter on Christmas Eve, at about 3 o'clock in the afternoon, to say that they would have to apply for their funding in a funding round whose details would be announced in February. This was for funding that ends on 30 June.

So, where we are at the moment is that we have had a very substantial review completed and we have had the Australian government's—sort of—general response. We have services that do not have any funding certainty, where funding certainty runs out in the next four months. They have not been advised as to what those arrangements will be and what tender processes they will have to embark upon. Some services will be exempt from contestability. Other services have been told that their funding will be contestable. These are services that are providing support to some of the most vulnerable communities in Australia—people with a mental illness, people who depend on continuity of service delivery in order to live their lives as they need to. We have a situation where the services sector does not have any real idea of what is going to happen post 30 June. In our attempts to understand in greater detail exactly what the implementation framework will be, how the Commonwealth is going to be making these decisions, who is going to be involved in contestable tender arrangements and who will not, and how will headspace be handled, all of those questions remain very unclear, not just to me but also to the staff who work in those services and indeed to the people who use the services and their carers.

So, the questions I have asked are ones that you would believe would be fairly straightforward. On the day the minister announced the government's response, we had her saying that no-one would miss out on any care. This was her strategy. Yes, there would be changes—funding streams might be different and money might be devolved out to the PHNs—but no individual would miss out on a service. She went on to say that some people would be able to access individual packages, but, again, when you look at the details of the government's response there is no idea of where the funding would come from for those packages, how those packages would be determined, when they would commence, what the allocation will be over three years or what role the PHNs will have in that. The overall strategy also involves moving people into the stepped-care approach, meaning that they access the right care at the right level for the support they need. So there is a big push on.

On e-mental health or the digital gateway, again, there is no information on how that is to operate and how it will interact with e-mental health digital services that are currently provided. Also, there is no information on how the telephone hotlines would work. There is very little detail on how child mental health services will interact with, say, youth mental health. There is some new money for Aboriginal mental health—about $85 million—but it is not clear where that money is going and how it will be applied. There is a lot of concern from the Aboriginal controlled health organisations that they will have to negotiate any funding with the PHNs in that area. We know how contested that space is. For a long time we have had the Aboriginal-controlled health services establishing their service offerings in mental health, only now to be told they are going to have to go down the road and speak to the PHN about whether you will be eligible for the additional funding. In an area like suicide prevention, again we have 2,500 people a year in this country committing suicide. This is a massive area where reform is needed, and the Labor Party believes targets need to be set to see those numbers come down. Again, the detail in the government's response is very light on, talking about a new way of doing things, but, again, there is no indication on how that will occur.

The questions that I put on notice really went to fleshing out the detail, or the lack of detail, in the government's response. I think all those questions are reasonable and I cannot understand—we did give notice, as is convention, to Senator Nash's office about the outstanding questions—why this information is taking so long to get here. It is either that it is just tardy of the department or that some of these details are yet to be determined, which is even more concerning considering these reforms are due to roll out from 1 July. I have spoken to a number of services, and parts of my questions went to funding and funding certainty, about whether or not they have any certainty in their funding. This is not an insignificant area of primary health care delivery—it looks as though $300 million will be reallocated through the primary health networks starting presumably on 1 July—and there are services that have to advise staff about whether or not they will have a job on 1 July and what that job might be or whether they have to put in arrangements now and go and start negotiating with the PHNs. Again, the actual reform agenda is to give a lot of responsibilities to PHNs. I know that there is some concern about whether or not all of the PHNs will be in a position by 1 July to deal with these new responsibilities. The government's response talks about PHNs being required to complete regional mental health plans, comprehensive needs assessments, service mapping and gap identification, systems to share consumer history and information, the establishment of joint assessment processes and referral pathways, strategies to deal with rural and remote communities and regional specific early intervention strategies to support children. All of this is important work, absolutely, and in terms of having regional approaches to mental health service delivery that is something that the Labor Party supports—but, again, there is no detail on when these need to happen.

Some would argue that these should all be in place before the PHNs get the funding, which then determines the delivery of services, but in the interests of supporting a transition to a new way it could be accepted that these things would be done in conjunction with the first commissioning of services under the PHN model but, again, we do not know whether that will be the case. The role of consumers is very unclear. This is an area where, in my experience in health, consumers have played an essential role in the delivery of services, particularly when reforms are under way. The government's response talks about putting together a consumer participation framework, I think the language is, but it does not talk about when that will happen or how it will happen. There have been no discussions, as I understand it, with consumer organisations about how that work is to be progressed. It is not listed as a priority in the back of the document, which outlines a rough timetable of implementation, and these are all issues that need some more detail on them. That is why I put these questions on notice, so that I could get that information well ahead of these changes kicking in on 1 July. Consumers will want to be involved. One thing that I learnt in mental health in my time in the ACT was that you do not reform a system and then ask consumers how they feel about it, because more often than not their insight into the way they should be delivered should determine some of the decisions that government takes. Again, in this response the role of consumers is very unclear—as is the role of carers, for that matter, who also provide a lot of support.

One other area that I was trying to get further information on in these questions is the role of the NDIS and how the NDIS and the community mental health sector are going to interact with each other. We know that a relatively small proportion of people who live with severe and enduring mental illness will ultimately be accepted into the NDIS. Provision is being made for I think about 50,000 individuals but we know that then there are hundreds of thousands of people who have severe and enduring mental illness who will sit outside this. We also know that some of the programs that support them in the community are being rolled into the NDIS to fund services for the people who get accepted. That is great. For those people who get into the NDIS the service offering will be very positive for them and will support them well, but what does that mean for the people who do not get in who are currently using the programs, including all the carer support programs that are going in? Carers, as we know, do not get access to individual packages through the NDIS, so the programs that they currently use at the moment will not be available. These questions remain unanswered. They are all significant enough issues, during this massive time of reform, for this information to be well known to the government. It should have been well known prior to releasing the government's response.

This is not asking for the evaluation of how the reforms have gone or some assessment of the decision-making process. This would have been information that must have gone to government and cabinet as advice before decisions were taken on whether to support the government's response. I can understand, having been a minister myself, that there are delays for good reason with answering questions on notice, but there are also ways that that can be dealt with—for example, a simple explanation here that it required a lot of work in order to put answers together or that another priority had been identified. That is probably a harder one to argue, but there are ways and means that information could have been provided. Even if only half of them were answered and the others answered at a later date, I would have been more than happy and it would have been reasonable to accept that. But to not be able to give me some of the basic information that I believe must have made its way into a cabinet submission—if it did not then somebody is not doing their job—and have that information provided to me within the 30-day time frame, I think indicates that an explanation is probably unable to be given, which is why the minister was unable to provide that to the Senate today.

This is really important reform. To date, the opposition has offered support for the general direction of the government's reforms. We would like to see them work. We would like to see the PHNs successfully deliver targeted mental health programs to localised communities under local planning that had been developed and delivered by local services. I do not think there can be any criticism of the way that we have approached our response to the government's response, but I think that steps could have been taken to make sure that this information was provided. I would be very surprised if it was not contained in the department's estimates briefs, because that is what happens when you have questions on notice—you make sure that your officials are well briefed at the table in case those matters come up during estimates hearings.

At the estimates hearing I was more than reasonable with the department. The fact that they have not met the time frame and have let their minister down and forced another minister to stand up and say, 'Well, I'm sorry, I can't answer why those questions haven't been given,' is most regrettable, because this is a very important area. I know that there are a lot of people who work in the sector who are ringing my office to ask me whether I have heard things about if and when their funding might be coming up for tender. I think that is completely unacceptable. There are thousands of people that work in this sector, many of them lowly paid, often in casual arrangements with no job certainty in the future, and that is certainly being exacerbated by this reform agenda.

It is not just the staff. Let us spare a moment for the people who use the service—a very vulnerable group who rely on these services. If they asked today whether these services will be running on 1 July, I do not think anyone is in a position to be able to answer them. The sooner this information can be provided—not just to me, although I have a particular avenue through which I can pursue it, but more generally from the department out into the community—I think the better these reforms will go. At the moment the lack of information and some of the confusion about the way the reforms have been rolled out—or if they have been rolled or when they are being rolled out—will compound to make it a quite difficult reform agenda in the second half of this year.

I look forward to the minister representing the Minister for Health being able to come back to the Senate and explain. More than that, I look forward to the questions being answered and, in that spirit, continuing to work in the best interests of people with a mental health condition in this community to make sure that they get the services they need and that the workforce that supports them gets the support that they need to do the job that many of us would be unable to do if it was asked of us.

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

I join with Senator Gallagher and also with Senator McLucas in raising concerns about the detail of the answers that we need to have around the issue of the government response to Contributing Lives, Thriving Communities, long awaited review of mental health programs and services—

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

I am still waiting for answers from the Labor government.

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

Mr Deputy President, I am not concerned about what questions Senator Macdonald is concerned about. I would hope that Senator Macdonald would share our concerns about mental health in Australia, but maybe not. In terms of the focus, you would understand that there was a great deal of interest and expectation amongst the mental health community around the wide standing review of mental health programs and services. People were asked to contribute, and there was focus on exactly what was the best way forward for mental health in our country.

The people who work in the mental health services and also those who are consumers of those services are a particular group who have a great sense of ownership about their area and also a sense of expectation from governments over a period of time for delivery of effective service. With that sense of expectation has also come a long history over many years of frustration that their needs have not been effectively identified and there has not been a continuing response to ensure that mental health is placed clearly on the agenda. This is not something that has been a short-term process. For many years people within the mental health community have been worried about the fact that their issues may well not have had the urgency that they think they should have.

Given that background, when the review of services was announced, there was some hope that, with changing priorities and plans, this was a time when there would be a really strong focus and an investigation of what the effective services in mental health across Australia are and what contributes the most effective response to the range of issues around mental health. This is not a simple area, and Senator McLucas and I, through a number of Senate inquiries in the Community Affairs Committee, have had the great privilege of listening to people who have great expertise as well as personal experience about the issues a real mental health and the disadvantages that can be linked to that illness in our Australian community. The Senate community affairs committee had an extensive mental health inquiry, followed by specialised inquiries into Aboriginal and Torres Strait Islander mental health linked to the scourges of petrol sniffing and to disadvantage, and then—one of the most gut-wrenching inquiries; I am looking at Senator McLucas now—the one on suicide in Australia.

There were a range of programs introduced under the Labor government to respond to the issues that were raised in those inquiry reports. Throughout, we always said that there needed to be an effective link with the community—that this could not be a government process feeding down into the community; rather, it should be an engagement process which links to the consumers in particular. I have gone on the record a number of times here about the absolute necessity of having consumer engagement in a lot of social programs, but nowhere is consumer participation more important than in mental health.

A number of Senator Gallagher's questions asked where the linkages were going to be in the ongoing advisory process or engagement process—whatever the title of the month is—for consumers to participate in the process. That has caused great interest in the community. We often say in this place that we have received a number of calls from people or people have contacted us about certain issues, and I assure you, Mr Deputy President, there has been a very strong response from the community on the issue of consumer engagement in mental health. They want to know what is going to be in the consumer participation framework, something that was mentioned by the government—that one of the core aspects of the government's ongoing response was to reinstate, re-establish in some form, an active consumer engagement model. People have been waiting to hear how that is going to operate.

As Senator Gallagher said, in the relatively short government response that we have at this stage, there is absolutely no detail about how that will be put in place—no detail at all. That is frustrating and it is also worrying because, without the detail, there is a sense that it may not happen. There is a sense that appropriate resources will not be allocated, which Senator Gallagher's questions also went to. There is a feeling that it could be just empty rhetoric—and believe me, Mr Deputy President, people with mental illness in this nation have long had concerns about empty rhetoric in response to their issues—instead of some clear definition about how the consumer participation framework will be introduced, what consultation there will be, how people who will be part of the consultation will be identified, and what the process will be.

All of these things are not too difficult. We do have a history in this country of working with consumers. Clearly, we have organisations that have already been identified that have links with the mental health consumer network and also with the professional groups that provide services. Those organisations are in place. But we need the detail of how they will be engaged in the new process. In particular, on the question of consumer involvement into the future, there need to be detailed responses back from the government about what process they are going to fund and how they are going to ensure that the consultation will be real and not some kind of token exercise: 'We've had a couple of meetings and, therefore, there has been consultation.' That is not good enough. This group of people is well informed. They want to be involved, they do not want to be dismissed and they do not want to be shown a lack of respect by there being further delays about the detail on consultation. That causes great fear, I think. And it is particularly insulting to a group of people who are already vulnerable and who have had difficulties in the past, which are clearly documented, with a lack of effective consumer engagement. When you have already had that historically, to not have that acknowledged and to effectively be given a response at this stage actually causes fear and makes you wonder: has this detail in fact already been considered and has there been appropriate consideration and resourcing put into that area?

Another issue—and there are many questions, and Senator Gallagher has done a great job in putting these very direct questions on the record—is the fact that there is going to be significant change. We know that is going to happen, but the funding for organisations working in the field now is only until 30 June 2016. So many times in this place we talk about the way that programs are advertised, how tenders will occur—and we do not know whether there will be tenders because we have no detail about what process is going to be put in place. The only thing that the organisations who are currently working in the field of mental health response know is that they are only funded until 30 June this year. They know that there has been this detailed review of mental health services in Australia. In fact, I doubt there would be a single one of those service providers who did not actively engage in putting forward information to the review. They know that they have put forward their views about what was working, what was not working, and how they could best be part of a new approach to mental health in our nation, but they have heard nothing back. There is no detail that we are aware of that has been given back to them about how the transition will occur between what we are doing now and the 'brave new plan', which is due to commence on 1 July 2016.

Too often in this place we have to talk about the problems of not giving effective information to organisations, not giving organisations time to make plans and not working through a transition process with them. That leaves organisations with a sense of loss and also panic, as Senator Gallagher pointed out, who have staffing concerns and who are looking at their own processes but, most importantly, who are looking at the needs of the people that they work for—their clients, the people with whom they have built up personal relationships. Sometimes they are in regional areas and, as you know, Mr Deputy President, regional relationships are intensely important. What we have asked the government is: what are the processes going to be in the future for looking at how new tenders will be offered, how much funding will be allocated to establish different processes and what will be the transition arrangements?

These are very straightforward questions that are looking at areas particularly to do with the new Primary Health Networks, which are relatively new organisations that the government has put in place. I could speak for another long period about my concerns about the PHNs, their geographic coverage and what they are expected to do.

What we had, up until the change of government, was a structure that was based on the Medicare Local model, where exciting work had been done on mental health right across the country, particularly in my state, in regional and rural Australia. Medicare Locals had prioritised mental health in their program plans and had established networks and immediate responses which engaged people locally and looked seriously at the issues of mental health in the community. Those have all been closed. In some cases there have been ongoing discussions, but the role of the Medicare Locals has been completely dismissed.

Now that the new PHNs have been put in place, we have been advised that they will be concerned with the issue of mental health. There is no detail about how that is going to operate, there is no detail about how the funding will happen, and there is no detail about what services will be available to people who have already-identified mental health needs and where services need to be provided at local levels. None of that detail has been provided. All we know is that the PHNs will have a priority interest in mental health. That is not particularly comforting if you want to know where services are going to be provided in your area.

We have years of evidence about the need to have effective transition processes in place when you are looking at change and about the impact that change can have on individuals in terms of their own lives—all that is documented. We have had extensive Senate inquiries over the last two rounds of grant programming—both the DSS model and the Prime Minister and Cabinet model—for Aboriginal and Torres Strait Islander services. There were recommendations aplenty which talked about the need to have this detail, so that people are engaged in the process and know what is going on. There were inches of paper making these recommendations.

I remember very clearly—and I have told this story many times—going to an Aboriginal community in Western Australia, where one of the community leaders arrived with a wheelbarrow full of printed reports, put them down and said to those of us who were visiting, 'If you had done any of the work that you had promised you would do in response to the recommendations you made in these previous reports, we would not need to have the conversation we are now having.' I echo that community leader's views when we are talking about these questions on mental health in our community.

I know that the points have been well made, but it is so important that we get a response back from the government which gives body to the commitment that they have already made in response to issues that were raised in the review that they commissioned into mental health programs and services in our country. We need to have the detail because it has been so clear in the past that documents without detail not only are relatively useless in making a commitment to future action but are quite dangerous in setting up expectations about needs that will not be met. If a community knows what the plan is going to be and how the funding is going to be allocated in the areas of youth mental health, Aboriginal and Torres Strait Islander mental health and suicide prevention, they can at least work within that framework. But if it is just left in this nebulous mass—almost like that concept of 'trust us, we know better'—that will cause more damage to a group that has already identified that it has needs in this area.

Senator Gallagher mentioned a couple of questions that were put on notice about the NDIS. Consistently from the time the NDIS was in the planning stage, and also when we did the initial Senate inquiry into the development of the legislation on the NDIS in Australia, there was a very strong message from people in the mental health area who were concerned about how mental illness would be affected by the introduction of the NDIS. Senator Gallagher said that we are so grateful that there will be many people in Australia who will benefit from the NDIS. There has been great concern in the mental health community that perhaps the nature of mental illness could make it more difficult for individuals to be able to benefit from the NDIS program as it is being rolled out. This has been a major issue not only in the trial sites that are looking at people of all ages but also in the Tasmanian trial site that is looking at young people. The issue of how mental health, suicide and depression are going to be handled by the NDIS format is something that has been of genuine interest to people across the community.

There were quite clear questions about resources and funding allocated for people with complex care needs who are not accepted in the NDIS. We know—and it has been discussed many times here—that not every person with complex care needs will be eligible for full or even part packages under the NDIS. What we need to know is what wraparound services in the community will be available for those people who are not able to access NDIS. Those questions were very clear. None of the questions that Senator Gallagher put forward on 13 January should have come as a surprise to either the minister or her department. These are issues which are fundamental to any response to the review of mental health programs and services. They are the kinds of detailed questions that need to be answered so that people can do effective planning into the future. Just giving a response to a review does not end the need to continue communication.

We know that the response was a first-round response looking at general principles. The core issue now is how that general principle will be translated into action on the ground and how people will be affected by the change. Senator Gallagher had set out to find the detail that would respond to those questions. It is disappointing that we have not had any direct answers to those questions. It is also frustrating, because during the recent Senate estimates—which as, you know, Mr Deputy President, is the short estimates and so there is no time to follow up on these questions—we were not able to question the department closely about these matters. But we felt confident that, because Senator Gallagher had put these questions on notice, we would be able to get the answers. So we decided that we would not take the time in the limited space we have in the short estimates period in health to follow-up on these questions or to put on record how seriously we feel about the detail being critical to us having an effective response to mental health in our country. We did not do that because we felt that these detailed questions were being taken up in another way. We missed that opportunity at Senate estimates, although we can clearly put on notice to the minister that we take this issue very seriously.

Over one month has gone by without those detailed questions being answered. The implementation of the plan is 1 July, and we have a lot of worried people out in the community. This is not good enough. It is important to get a response, particularly as this Senate has consistently reinforced its concern and commitment to having effective mental health services in our community. This lack of detail shows neither that commitment nor that concern.

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

I also rise to express my disappointment and frustration—I think is the other word—at the fact that the questions that Senator Gallagher asked the Minister for Health in January this year are now overdue to be answered. There has been no reason given as to why there is this delay in responding to these questions. They have just said that there is a delay; they have not been answered. This is disappointing. These are reasonable and legitimate questions and they should be answered in the time frame—and they could be answered. If they cannot be answered then we have got a really big problem.

This minister and her predecessor have form when it comes to transparency and engagement and, in fact, even any notion of co-design when it comes to the mental health plan. Let's look back at what has happened over the last 2½ years. In the election of 2013, the then opposition, now government, gave a commitment in the mental health space that they would undertake a review. That is reasonable. I think it is a bit lazy, but it is reasonable that, given the reforms that had occurred under our government, an incoming government might want to have a look at the state of play. We accepted that the review would be undertaken, but right back then we started questioning the transparency of that review. At that time, I called on the government to publish the submissions—not the private submissions but the sector submissions—to this review. They did not. Some organisations published their own but there was no collected, comprehensive set of submissions to what should have been a big conversation about mental health in our country. The sector expected that, once the report was undertaken by the Mental Health Commission, it would be published. It was received on time on 1 December 2014 and, quite legitimately, the sector thought: 'Right. They've had nearly a full year to do this work. There would have been an iterative process between the commission and the department. We expect they will publish the report, and they will publish a government response in December 2014.' That did not happen.

So the next potential opportunity for the publishing of the report would have been in the lead-up to the budget of 2015. That is a normal government process. In the lead-up to a budget or even as part of a budget, the requesting document—in this case, the report of the Mental Health Commission and the response to that report—are published, along with the funding arrangements that sit around that. So we assumed that that would happen in the lead-up to the budget of 2015. As we know, that did not happen either. During the course of last year, on three separate occasions, I used the system of return to order in this Senate. All senators, bar the National and Liberal Party senators, supported my return to order that the government publish the report of the National Mental Health Commission. On three separate occasions the government did not follow the request to publish the documents of the Senate. The frustration must have been palpable.

We do not know who did it, but it ended up with the leaking of the report. Last year, the report was leaked to the ABC and the Crikey website. Last year, after that happened, I asked the Secretary of the Department of Health last year whether he was going to follow up on the leaking of that report. He said that he was not going to do that. I think he understood—I am presuming here, but I think he probably understood—that it was pretty embarrassing that it had gone on for so long. At least we had the report of the National Mental Health Commission in the public arena, but we still did not have any response from the government.

The next opportunity was National Mental Health Week, towards the end of last year. The sector was pretty sure that it would get a response from government to the comprehensive report that the commission had done. Again, they were let down. It was finally received on 29 November last year. The report I am holding up here is the document, Mr Deputy President. It is a very thin document. The report of the National Mental Health Commission is in volumes; there are thousands of pages. But the document that responds to that comprehensive report is scant.

You can have a number of types of government responses to reports. You can have quite slender documents like this, and that is not unusual. But behind a document like this has to be a lot of work, otherwise how would you be able to write the words in this document? That is why it is quite legitimate and reasonable for Senator Gallagher to ask the types of questions that she has been asking—because those are the questions that I would expect a minister to be asking in order to come up with the response that is covered in this report.

Quite substantial changes are being proposed in the government response, and they would have had to have had considerable work done to come to that view. We now know, though, that funding arrangements and service delivery contracts will expire at the end of June. We also know that good employment practice would require that, if changes to funding arrangements are going to occur, the government should give three months notice. We are about to get into March; these contracts are meant to start on 1 July. I suggest that we have a timing problem that has to be addressed and should be addressed. So I ask: is this government hiding the information that it should have, as I suggest has been happening over the last 12 months, or has the work not yet been done? If it is the latter, then I think there is real concern—frankly, either way there is real concern.

The mental health sector requires transparency. It requires an understanding and a sense of shared view about which way we are going forward, but I cannot see that over the last two and a half years since the change of government. As others speakers in this debate have spoken of, to get the trust that is so important in the delivery of mental health services, you need to have certainty, and people who are living with mental ill health need to have faith that the services are going to be there and that the type of service design will suit their needs as well as be able to respond to their changing needs. My observation is that mental health consumers do have increased levels of anxiety. They are concerned about service continuity. They are not being included at the levels that they should be expected to be, both as mental health consumers and as mental health carers, in the potential co-design of what are significant changes, which are proposed in this government response.

The government response talks about changing funding arrangements—that some services will be tendered out and some services will not be tendered out. Let us get some clarity on which is which and what people need to prepare to do. As Senator Moore indicated, there is a big change in the funding arrangements through the Primary Health Networks. These Primary Health Networks are quite new organisations. Some are having considerable difficulty in bedding down. There needs to be very strong management of the funding shift from the previous service array—which included in some respects the Medicare Locals but not all—to the pooled funding arrangements that are proposed through the Primary Health Networks. I put on record that there are some Primary Health Networks that are having a lot of difficulty trying to work out how they manage their services and the scope of services that they are going to have. We have heard of significant job losses as the transition from Medicare Local into the PHNs has occurred, and this is occurring around about now.

These questions that Senator Gallagher has asked are, as I have said, very legitimate. We want to know where the funding for the individual packages will come from. How does that interface with the rollout of the National Disability Insurance Scheme? We think, in principle, that the model of developing individual packages is a good and proper thing, but we need to know where that money is coming from. We want to know when the individual packages will commence and how many of them will be available in 2016 and the out years from there. Why do we ask that? Because consumers want to know the answer to that and the service sector wants to know the answer to that.

Senators will recall Mental Health Australia undertaking a survey of the service sector at the end of 2014. That survey showed there was considerable anxiety in the service sector back then. That is when, essentially, the funding was going to be rolled over. Now we are looking at considerable change. How many workers in the mental health sector are now thinking that they should be moving on? I hope that we can retain these passionate workers. They are people who have given hugely to serve the cohort of people who use their services. They are people with specific talents and skills that are not found easily in our community. Surely they deserve the respect of knowing what is going to happen come the end of June of this year.

The questions that Senator Gallagher asked also went to Aboriginal and Torres Strait Islander mental health and to suicide prevention more broadly. On the question of suicide, the government's response to the review states:

The Government will move to immediately implement a new national suicide prevention strategy with four critical components …

One of those components is:

…a systematic and planned regional approach to community based suicide prevention, which recognises the take-up of local evidence based strategies. This approach will be led by PHNs who will commission regionally appropriate activities, in partnership with LHNs and other local organisations …

The important words there are: 'The Government will move … immediately,' and 'systematic and planned regional approach'. If that is going to happen, why can't we have an answer to this question? If that is what the government has said they are going to do then why can't these questions that Senator Gallagher has asked be answered?

We are asking questions about what is going to happen about perinatal mental health. We know that this is a small but very identifiable group of people who do suffer from higher levels of mental health issues than the rest of the community. They are a group of people we can work quickly and easily with, if the funding is there. That is why we want to know what amount of funding is going to be allocated to perinatal mental health.

There is an important program operating in the country called the Mental Health Nurse Incentive Program—a very successful program. Evidence shows it has worked very well. But we want to know what changes are going to be made to the Mental Health Nurse Incentive Program. And, given the timing, the government should have the answer to that by now.

We want to know: aside from the $85 million in funding for Aboriginal and Torres Strait Islander mental health, will any extra funding be included as part of the implementation of the package, and how much and what will this funding be spent on? We want to know: is this $85 million new money or is it reallocated money, out of existing funding sources? That is an important piece of detail that not only is it reasonable for the Labor Party to understand but also, on behalf of the community more broadly, we need to know.

The final question that Senator Gallagher asked is on the interface between the National Disability Insurance Scheme and how the changed mental health funding arrangements will work. The National Disability Insurance Scheme will provide packages for a number of very severely ill people with persistent and chronic mental illness. We need to be able to work out the timing of those packages in line with the rollout of the National Disability Insurance Scheme and the rollout of this program. Surely the government is working across those two departments to ensure that this does happen in a timely way? We want to know, and it is reasonable for us to know, how those packages will roll out.

But, as Senator Moore quite rightly identified, we do have an issue with how we are going to provide services for people who are quite ill. They are people who are very ill, who do need ongoing packages of support. But they will not be eligible under the National Disability Insurance Scheme for a package of support under that definition of persistent and chronic mental illness. Those people are very concerned, and it is reasonable and legitimate for us to be asking questions like: 'What resources and funding have been allocated for the people with complex care needs who are not accepted into the National Disability Insurance Scheme?' If that work has not been done, we are in big trouble. If that work has been done and the question is not being answered, then this minister is being contemptuous, in my view, of questions that are asked in the Senate.

Here we are, 2½ years after this government was elected—2½ years in—and we still do not know where we are heading when it comes to mental health. It is my view that, with, firstly, the change of minister in the health portfolio, and, secondly, with not having a mental health minister in this government, we are in a situation where there is simply not the focus being placed by today's government on mental health in Australia.

Mental health is a growing concern in our community. We have not sorted out the way we need to provide mental health services in our country yet. But this delay, this lack of attention and this dismissive approach that this government has to people living with mental illness and the people who care for them is frustrating. It makes people very angry. And 'disappointment' is far too weak a word to describe the frustration and anger that people are experiencing.

I call on the minister to answer these legitimate and proper questions not only so that the parliament understands what is happening but also so that the people living with mental illness, their families and carers and the sector that serves them can get some proper answers to these questions.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

Mental health is an important area, and some of the issues that Senator McLucas has raised are things that I have been helping constituents with also, but I have not come into the chamber and made a political point about it in the hope that someone from the press gallery might be watching me. I have actually got onto the ministers and their officers and said: 'Look, these are problems. Can we do something about it?'

In a case that I am sure Senator McLucas knows about, because it is up in the area that she is supposed to be looking after, I have helped someone who was providing services in the mental health area with a contract termination and where it went from there. Just yesterday the friends of rural and regional health had a meeting here where the issue was raised of contracts for staff in rural and regional Australia terminating on 30 June, but them not knowing at this stage. As a result of that, immediately following the meeting, I took the people involved to one of the minister's advisers, who came around on the spur of the moment and spent some time with them. I could not stay, so I am not quite sure how it evolved. But I did get a message that the issue was being progressed and looked at. So you can do things without coming into the chamber and spending a lot of time hoping that you might get a bit of a news headline out of this sort of issue. That is an important issue, but Senator Nash and Ms Sussan Ley are two of the best health ministers that I have seen in my very long time in this parliament and they far outweigh and they far exceed the relevance, interest and action of the health ministers—I am not sure how many there were—under the Rudd-Gillard-Rudd governments.

The motion we are talking to is take note of the minister's answers on why a question asked 35 days ago has not been answered. Under the Rudd-Gillard-Rudd government it was over four years that I had asked questions of the Rudd-Gillard-Rudd government and they still were not answered. The Rudd-Gillard-Rudd government went out of power before my questions asked in the early days in 2008 were even answered by ministers in the Labor government. So spare me the hypocrisy about questions not being answered. The Labor Party made an absolute art form of never answering questions in spite of us raising it time and time again.

There is also something else that I will raise. These are important debates, but the Senate has a process and from 3 pm to 3.30 pm there is take note of answers and senators adjust their time accordingly. In the time that I have been waiting to speak on take note of answers I have been and chaired a meeting of the Senate Legal and Constitutional Affairs Committee. Senator Bilyk could not get there because she was waiting to speak here. Other colleagues have been to and from meetings. The minister was going to deliver perhaps the most important ministerial statement in years at 3.30 today, and we were all preparing ourselves for that and we all wanted to hear about that.

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

There is a point of order. Senator Macdonald, please resume your seat.

Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Link to this | Hansard source

I raise a point of order on relevance. For someone who comes in and lectures us about questioning the minister's lack of answers—

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

What is your point of order, Senator Polley?

Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Link to this | Hansard source

I am drawing back to the matter before the chair.

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

Your point of order is on relevance. There is no point of order. It is a debating point. Senator Macdonald has the call.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

I do not care. These are important debates, and it applies to Labor people. We did not have a quorum in the committee that I am supposed to be at because Labor members are not there and I am not there. All I am saying is: have these debates, but the Greens have started this. As I indicated the other day, every time the Greens start this process I am going to participate because it does not matter to me. I can put off my appointments. People are happy to wait to see me.

An opposition senator interjecting—

But someone has to somewhere along the line got to bring some discipline back. Senator McLucas spent 20 minutes and some of what she said was very important but she kept repeating herself. Whether this is a strategy of the Labor Party for some reason, which I am not aware of. I am not sure what the strategy would be. Senator McLucas kept repeating herself, repeating herself, repeating herself.

An opposition senator interjecting—

There was not anything new in the presentation.

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

Order, senators.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

It just leads me to think that for some reason Labor Party senators have absolutely nothing to do. Although I wish they would attend some committee meetings, many of which they set-up and then do not bother to attend. I say this the whole chamber—people organise their time from 3 pm to 3.30 pm to take note of answers, so you set these committee meetings up at 3.35 so that can happen. If this is going to become the norm from the Labor Party and the Greens, well just tell us so that we can make sure that these committee meetings are not set-up. We can tell the minister, with the most important ministerial statement in a long, long time, that we are all waiting for 3.30 and do not bother coming until six o'clock. Perhaps this is the strategy of the Labor Party. Here is a good news story on defence. The Labor Party are embarrassed because that is something they never did. They never had a defence white paper that was funded. They never had a white paper on defence that talked about any shipbuilding. Perhaps it is their strategy today to waste time so that this good news story of the minister's ministerial address does not get some airplay. I do not know what the strategy is, but it is a pretty poor one in any case.

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

There is a point of order. Please resume your seat, Senator Macdonald.

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

I rise on a point of order on relevance. It is my understanding that we were taking note on the lack of answer we have had from the minister about the mental health processes. I am not sure whether other people feel as though Senator Macdonald is being relevant to that particular issue or not. I do not believe so and I take a point of order.

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

It is a timely reminder of relevance, and I draw the senator's attention to the matter before the chair and that is that the motion moved by Senator Gallagher be agreed to.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

Thank you, Madam Acting Deputy President. The motion is that we take note of the answer of the minister. The contributions that I have heard have nothing to do with the fact that the minister has not answered a question. How long is it since the question was put on notice? Was it 33 days or something?

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

It was January.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

January, okay, less than two months. As I say, I waited four years from Labor ministers and I never even got an answer then. The government was defeated before we even got an answer. But anyhow, two months, 60 days, and I suspect it is not 60 days. The minister, as a recall her answer, said that she did not have the reasons. I think she is the representative minister in this area and she said she would find out and get back to the chamber. Since then we have had an hour and a half debate on the minister's answer. I can tell you I have sat here for some of it. As I said, I have been and chaired a committee and I have done a couple of things in the meantime. Most of what I have heard had nothing to do with the minister's response to why the question was not answered. If the Labor Party are going to do this then that is fair enough. I do not care; I really do not care. Important debates need to be set down. You have got opportunities to set down important debates, but please think of your colleagues. Do not think of me; I would not expect you to. But think of some of your own colleagues.

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

Senator Macdonald, I would just remind you to make your remarks to the chair.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

I just urge Labor Party senators to think of their own colleagues and colleagues across the chamber who organise their times and their meetings with a purpose. This sort of new arrangement is, as I say, something the Greens have started on. If there is a Labor Party and Greens combined strategy following their six years in coalition government together, that is fine—but just let the rest of us know so that we can tell the minister who is busy and tell senators who are doing serious committee work when they should have their meetings. That is all I am saying.

I will conclude now after nine minutes and not the 20 minutes that Labor senators used to filibuster, repeating endlessly things they have said twice or thrice before. It was pure filibustering and not a contribution to the debate in the chamber. I want to conclude in record-quick time in this debate by saying that, while I cannot speak for them, I know that Minister Nash and Minister Ley are two of the most assiduous ministers in the government. They will be doing everything possible to deal with questions placed on notice or taken here at the earliest possible time. They both deserve a lot of credit and a lot of praise. I will certainly give that to them because they are two of the best ministers in the health area that I have seen in my long time in this parliament.

Question agreed to.

Bill Heffernan (NSW, Liberal Party) Share this | Link to this | Hansard source

I seek leave to table a document.

Leave granted.