Geoff Lyons (Bass, Australian Labor Party) Share this | Hansard source

The National Health and Hospitals Network Bill 2010 is a historic bill providing an opportunity for the removal of cost shifting and the blame game, with the focus to be clearly aimed at service delivery. I would like to have it placed on the public record that I am a strong supporter of the Gillard Labor government’s health reforms; that is, the implementation of local health and hospital networks—the most significant reforms to Australia’s health and hospital system since the introduction of Medicare. For the first time in our nation’s history, our hospitals will be funded nationally and run locally, with decision making at the local level.

Local health and hospital networks are a perfect model for Tasmania’s three regions, with one network in each of those three regions. Some of you may not be aware of or familiar with the idea that, although Tasmania is relatively small in size geographically, there are three distinct regions—the South, the North and the North-West, including the West Coast—all three regions having different needs and requirements for health services and delivery.

There has been much discussion in Tasmania, including my electorate of Bass, about the best model for health reform and service delivery in the state. It is vital that Tasmania has three local health and hospital networks that are run at the local level. I cannot emphasise enough how important it is for hospitals and health to be run at the local level. I worked at the Launceston General Hospital for 17 years and can see how far reaching the benefits this model of management will be for the delivery of health services in Bass. I worked as a manager of a small country hospital until the Tasmanian Liberals sacked the boards. I then worked under a regional structure until, again, the Liberals sacked the regional boards. I then worked under a state model which disempowered the local providers, divided service delivery and created silos of power, which increased costs and created greater queues. At that time the Liberals subscribed to the theory ‘if you cannot manage restructure and some people will think you are doing something’. The statewide plan isolated services and governments, in their ignorance, even split services to different ministers. It is possible for some primary or community services to close their books as they run out of budget. It is impossible for emergency departments to close their doors.

In Northern Tasmania services are gradually moving back to a regional model. In my opinion, all services should be in the one funding model, a single funder, so that the best care is the overriding aim. The only way to save money in health and community services is to do it right and to do it early. The regional model is the best fit for Tasmania. It is the model that works. It is the model that the community wants and it is the model that best suits Tasmania’s population and culture. The management structure for the health and hospital networks needs to be flat, with medicolegal, accounting and management expertise mostly available from within the system at present.

The reporting system needs to be one which provides the same information to the federal government as to the state government so that duplication and reporting is not the focus of activity but is merely a method of reporting outcomes. The state governments and the Australian government must agree on activity and contract the local network to complete that activity. That way the focus will be on activity with smart reporting not lengthy reporting.

In the past a funding model I call bucket funding has prevailed. This is where a bucket of funding is provided to the health and hospital providers, and then they are required to meet the activity demand from that bucket. The new hospital and health funding will link activity to the true cost and focus on services not on who will pay. The cost-shifting will be at an end as a result of these changes. Politicians have not been good at saying that a condition which will not get worse in four years will never be undertaken in our public hospital system. We should be honest. Some people with those conditions have waited in the false hope of a procedure when it is known that more urgent procedures will bump the less urgent. The funding through the National Health and Hospitals Network should eliminate cost-shifting with the budget activities agreed by the Australian government and the states. The funding should then follow that activity.

After a visit to Victoria in the early nineties I learned that Victorian hospitals were creating private clinics so they could bulk-bill the Commonwealth for services formerly provided by the states. Tasmania, soon after my return, commenced private clinics in our public hospitals so that patients could be bulk-billed, which was a cost-shift to the Commonwealth. I have been around long enough to remember that Professor Rob Fassett was told by the then head of the state health department that no renal dialysis would be done outside of Hobart. Professor Bernie Einoder AM, who is to be congratulated for his recent elevation to life membership of the Australian Orthopaedic Association, after completing the first arthroscopic procedure in a public hospital in Australia was told by the Hobart bureaucracy that arthroscopic procedures would never catch on. These are just some blatant examples of where local input is vital to the delivery of health services.

The local health and hospital networks will receive funds and will be responsible for making decisions on the day-to-day management of hospitals and health within their networks. That means local services will be more responsive to local needs and that local health and hospital networks will be directly accountable for their own performance. The health and hospital reforms will mean that doctors and nurses who work locally will have a greater say in how the local health and hospital systems are run, which is vital input to the delivery of effective health services. Governance and management of local health and hospital services will be run at the local level, increasing local autonomy and flexibility, which will mean that services will be more responsive to local needs.

The Labor government is committed to ending the blame game and to ending the cost-shifting that has plagued our health system for decades. Under this bill better access to services through GP superclinics, expanded GP services including after-hours service and assistance with infrastructure, which will develop training positions for the full range of primary care, will all be integrated into the local area networks. The government will also establish personally controlled electronic health records. This will mean that patients will have their full and accurate medical history, thus making it easier for patients travelling interstate. This will also reduce mistakes and ensure that doctors have all the information they need and with the patient’s consent. The system will also be more transparent, and it will mean that strong performance can be identified and replicated in other areas.

The Gillard Labor government is committed to health reform and to the development of a nationally consistent approach for the delivery of healthcare services in Australia. The National Health and Hospitals Network is the model that best suits the community and its needs. Better health and hospitals means better health for all Australians. I commend the bill to the House.

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