Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Hansard source

Whether they have gone up by 10 per cent, 20 per cent or five per cent, the fact is that there is now a safety net in place to deal with that—a safety net that this member opposite still cannot say what she will do with. If the member opposite were a serious contributor to the policy of the opposition, if she were a political performer even on a par with her two predecessors, this matter would have been dealt with. The fact that it has not been dealt with is a sign of just how little work this shadow minister has done.

Now we have the issue of workforce. I accept that for a long time the issue of workforce was not adequately, let alone comprehensively, dealt with. Between 1983 and 1996, when Australia’s population substantially increased and substantially aged, the number of doctors coming from Australia’s medical schools did not increase at all. There were 1,200 doctors coming from Australian medical schools every year in that whole period. There was no change throughout the period from 1983 to 1996. Since 2000, particularly since 2002, when we finally had comprehensive and thorough advice from the Australian Medical Workforce Advisory Committee that we did have across-the-board problems, this government has massively expanded the number of medical training places. In 2005 there were about 1,500 doctors graduating from Australian universities. By 2012 there will be about 3,000 doctors graduating from Australian universities, and there have been massive increases in the number of training places in all the other health professions. I do not say that the problem is solved. I do not say that these graduates will be riding to the rescue of our health services next year or even the year after that. But I do say that this is a serious government seriously tackling the problems of this country. For the shadow minister to blithely say that nothing has been done is just simply false.

Chronic disease is a very serious problem in an ageing population. I am interested to see the member for Pearce here. She is the co-chair of the parliamentary diabetes committee. It is great that her work and the work of her colleagues from both sides of the House on this committee has been seriously responded to by this government. As one illustration of what this government has been doing, let me refer the member for Gellibrand to the diabetes prevention program announced in the recent budget. This is certainly not the last word; nevertheless, it is evidence of this government’s seriousness in tackling the chronic disease problem. In the last financial year we had nearly 700,000 GP care plans put in place under Medicare; we had nearly 400,000 team care plans put in place under Medicare; and we had nearly one million allied health consultations funded under team care plans as part of our Medicare system. Since November of last year we have had almost 300,000 mental health care plans put in place under Medicare. Since November last year we have had more than 600,000 psychologist consultations happening under Medicare. These are serious services being delivered by high-quality health professionals under a serious policy put in place by a government that knows what it is doing, that does not rush in and think that complex problems can be solved by simplistic solutions but which uses the great Medicare system that we have got and the excellent health professionals that we have got to make a difference to the really serious problems that this country faces.

Let me turn to the issue of governance in our health system. We use the term ‘health system’ as a form of shorthand, but in fact we have tens of thousands of health institutions, some which operate in a more or less coordinated way with others. Essentially, we have some 50,000 doctors, some 200,000 nurses, 750 public hospitals, almost 300 private hospitals and 3,000 nursing homes, and they operate under quality arrangements, safety standards and professional standards. But to talk of ‘systems’ as if there were one person giving orders under which every last person and every last institution jumps to attention is wrong, and anyone who suggests that it should be something more like the UK National Health Service does not appreciate the strengths, as well as the complexities, of our health system.

In the end, the issue with public hospitals, for instance, is not who runs them; it is whether they are run well. The problem with public hospitals is not that they are currently run by state public servants as opposed to federal public servants. The problem is not that state public servants are useless and federal public servants are omniscient and omnicompetent. No, that is not the problem at all. The problem in our public hospitals is that there is too much bureaucracy, there are chains of command which are far too long, there is not enough local autonomy and there is not enough swift responsiveness to patients, to doctors, to nurses and to other healthcare providers.

The difference between this government and members opposite in relation to the Mersey hospital is that we know all of this. We know that public hospitals are complex and difficult institutions to run, and we think that if there is going to be a change it is better done incrementally. It is better done by proven example of good practice than by yet another sweeping reorganisation of the type that health systems have had time and time again, invariably to the dismay of the people working in the hospitals and often not to the benefit of the people that the hospital is supposed to be treating.

As I said, it is not the public servants that matter; it is the services that matter. I am confident that a Commonwealth funded, community controlled public hospital at the Mersey will in time deliver better services to the people of that region. I am also confident that over time this will be a beacon of better management that will inspire better practice in public hospitals all around Australia, whether they remain run by state governments or whether they might in some distant future be run by federal governments or at least be under federal government stewardship.

The immediate challenge for this government after the election will be to renegotiate the healthcare agreements. Again, I do not pretend that this is going to be an easy business, and I am certainly not going to give chapter and verse as to how that might go ahead. Let me say this: as far as this government is concerned, the next healthcare agreement will be about improving services to patients. It will not be about governance; it will be about services. I think that will be a huge advance, to the benefit of the people of Australia.

The challenge for members opposite is to say how the 27-page policy that they announced is actually going to play out for the people of Australia. Plan A is to have a commission. They do not know who will be part of it. They do not know what it will recommend. Plan B is to have more cooperative federalism. They think that might work out; they are not sure. Plan C, when that policy fails, as it inevitably will, is that they are going to take over the whole damn lot. They cannot tell us what the GST arrangements will be, they cannot tell us what the legal arrangements will be and they cannot tell us whether they will have a referendum or a plebiscite. What they cannot do is offer any reassurance at all to the people of Australia that they really know what they are doing. That is the problem. We have $52 billion worth of plan.

Let me say this in conclusion. When the people of Australia are asked who is responsible for problems in their health system, they say it is the state Labor governments, not the Howard government. (Time expired)

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