Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I rise today to speak on the Human Services (Enhanced Service Delivery) Bill 2007, which will establish the government’s Department of Human Services access card. Labor supports the use of smartcard technology to improve service delivery and reduce fraud, but there are huge holes in this legislation. It certainly does not establish a framework for operation and administration that is even close to watertight. The member for Sydney has already moved a second reading amendment outlining many of Labor’s concerns, and I support the comments that she has made with respect to this bill.

This bill omits crucial aspects of the card’s operation, such as the appeal and review process and information protection features. I particularly want to talk about those in relation to health matters. Sadly, this bill has also missed the opportunity to make sure that this powerful technology is a viable vehicle for e-health programs. Worryingly, it seems that the government cannot even get its story straight on exactly what it wants this card to do. The current Minister for Human Services has portrayed the card as a time saver and a fraud stopper. The former minister portrayed it as an administrative revolution, with all sorts of bells and whistles. Yet the Minister for Families, Community Services and Indigenous Affairs, who introduced the bill in this place, told us it was solely a mechanism for streamlined service delivery.

It seems that the ministers are at cross-purposes on the uses of the card. Some want it to be all things to all people and others want to assure us that it will have few functions outside accessing government services. What is clear, however, is that this legislation does not pave the way for improvements to current e-health. This is disappointing because this technology could herald positive developments in e-health, but this does not seem likely to happen because of the government’s incompetent handling of this issue. For example, despite the fact that previous e-health trials, like the Tasmanian Medicare smartcard, are being wound up with the introduction of this card, we have been told by the member for Longman that this card would ‘not be an electronic health record’. There is potential—and I emphasise ‘potential’—for health information to be stored on the card, on the public section if you as an individual so choose, but this bill has shirked any responsibility to ensure that the information on the public section of the chip will be protected.

The government-commissioned KPMG report suggests that the card would be a single point of access for personal and emergency contact details and personal health information voluntarily supplied and managed by the cardholder. Aside from the privacy concerns which I shall raise shortly, the provision of medical information by non-medical professionals could lead to incorrect treatment if this information is used in an emergency. As it stands in the proposed legislation, you may, if you wish, put your penicillin allergy, your blood type or the name of your next of kin on the public section of the card in case of emergency. That sounds harmless enough, but this information would be readily available and accessible to anyone with a card reader. While this of course sounds okay and sensible in an emergency, what about when you lodge your application for family tax benefit? Do we really want all Centrelink staff to be able to access this health information—or a real estate agent or the bank?

We need to look at a more secure way to maintain emergency medical information. The access card in general raises serious privacy issues. In its latest discussion paper on voluntary medical and emergency information, the government’s own Access Card Consumer and Privacy Taskforce has looked into the privacy concerns around medical information on the card. The task force’s discussion paper recommended that the customer controlled area of the access card should contain a two-tiered system of emergency and health information in which the first tier should only list data which is absolutely necessary for emergency health treatment. According to the task force, the second tier would contain other medical and health data which should be PIN protected. It is unfortunate that no such considerations have been flagged in this legislation and no regulation of the public section of the card has been set out.

In commenting on the exposure draft, the Australian General Practice Network stated that the government needed to be more forthcoming in relation to the public section of the card. The report sets out a number of other considerations on the voluntary storage of health information, and I look forward to the task force findings, although I do hope that the recommendations are enshrined in the legislation and not developed simply as voluntary protocol. Last year, the former Minister for Human Services even floated the idea that stakeholders like the AMA may want to set up their own uses for the card. But surely you cannot introduce a card that will be held by almost every Australian and then open up the uses to a range of private stakeholders and provide no regulation.

Bear in mind, as I have already indicated, that Labor are not opposed to the use of technology in the health system. In fact, we clearly understand that e-health does have the potential to bring about a range of improvements in the delivery of health services in Australia. For example, if it is done right, e-health can make accessing health services more convenient and efficient for patients and streamline and improve care by removing duplication and reducing the risks of conflicting treatment or overprescribing. This was succinctly put by Dr Mukesh Haikerwal, the President of the AMA—that is, e-health is about giving health professionals access to:

... the right information [for] the right patient at the right time in the right place in order to deliver the best quality health care.

It does not seem, however, that this card is going to do any of that.

While there are clearly enormous benefits to e-health, there remains some work to be done in ensuring public confidence in any system that is developed. By floating thought-bubbles about private stakeholders using the access card to develop e-health records, the government does nothing to secure public confidence in the system. By skiving off and dodging the hard decisions, not only has the government missed an opportunity to move forward on e-health; it has potentially developed a less secure system that will undermine public confidence in years to come. If the government sees potential to use this smartcard technology for e-health, we need to be assured that the health and medical information will remain secure. It is vital that people have the utmost confidence in the security and privacy of their medical records. That is just one of the privacy implications of the card but obviously one which, as the shadow minister for health, I have a particular concern with. There are a range of other privacy matters, and I urge the government to accept Labor’s amendments to address these problems. I will not deal with them further in my speech, as many other speakers have already done so.

I do, however, have a particular interest in another range of provisions that deal with the eligibility for the access card which will have significant ramifications for young people. Under the current procedures, people aged 16 and over are eligible to obtain their own Medicare card. This legislation will now restrict eligibility for the card to those over 18. People under 18 who wish to have their own card must request a determination from the secretary of the department to be exempted from this provision. This administrative hurdle has the potential to deter young people from accessing healthcare services and to financially disadvantage them if they do access those services without a card. It is also enormously impractical for a number of young people who, for a range of reasons, live independently. It certainly goes against the government’s clearly stated aim of merely using this legislation to streamline access to services rather than changing access to them.

This would be a serious departure from current practice in the provision of Medicare services, with no explanation from the government as to why this departure is necessary. It could, of course, be us revisiting another version of the Minister for Health and Ageing’s controversial plan of several years ago to raise the age at which parents can access their children’s medical records. The plan, at the time, was shouted down by members of the government’s own backbench and by the AMA, just as this provision should be now. The AMA strenuously opposes this provision and states that it has a significant adverse impact on the rights of young persons to privacy and to make decisions about their health and life—decisions that they are legally and ethically entitled to make—with dignity and free of interference.

It seems that this provision of the bill has been included without considering the ramifications of withdrawing services to these independent young people, and I hope that the government considers amending this provision. I think we can all agree that there should be no impediment to a young person seeking the medical treatment that they need. I have been informed that negotiations are continuing with the government about this issue and that some assurances have been given that a range of guidelines will be introduced which may ensure that the existing rules will continue to apply—but not within the legislation. I call on the government to continue those negotiations in good faith. If this introduction of an access card is actually meant to be about the technology and not about changing entitlements, it should not be used as a backdoor way to change other entitlements which we might have a more forthright debate about in this place.

So I hope that the good work that is being done across the chamber to try to get issues like this one fixed will mean that we will not have to have a debate on this particular issue, because the government will stick to its original stated aim of using this to be about accessing services, not changing people’s entitlements to do so. It is surprising, though, that in this bill—where there are so many blank spaces and where there are so many unknowns about what will be done—there are also provisions that seem very ill considered. For instance, it seems nonsensical to start registration for the card before the government has finalised the document verification service and the scheme that will go with it. Without a verification system, this fraud-busting revolution, as it is described by the government, will be based upon documents that are readily falsified, such as birth and marriage certificates. Labor has put forward sensible amendments in relation to this service and it would be careless of the government to overlook them.

Equally troubling—and of particular interest for my electorate and, I know, for my colleagues here at the bench—is the uncertainty around what documents will be required for registration and whether overseas birth and marriage certificates will be accepted in obtaining an access card. While I understand the difficulty in verifying these documents, we do have to accept that we live in a nation of migrants. Over a third of the population in my electorate were born overseas, and any number of them, of course, married overseas. What provision will there be to enable us to establish the identities of these people in order for them to have the card? Surely they are entitled to enjoy the right to universal health care and to access government services as they do now. But no thought has been given to how they will be able to produce documents for registration that are acceptable under this scheme.

There remain several further questions about the access card: the use of the public section, the documents required to obtain it, the age requirements, the treatment of dependants, document verification and privacy. While I understand that a number of these issues—and others have been raised—may be addressed in future legislation, it is not good enough to run government on a promise. This is a major change. The government has taken a long time to work through it. It is not adequate to say: ‘Just trust us on this. Let’s just do this part and then we’ll fix the rest in the future.’ You cannot and should not rush such an important piece of legislation and say that you will leave the tricky bits until later on. Surely Australians deserve better than this half-baked legislation that creates more questions than it answers.

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