Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

This is an opportunity to talk about Australia's world-class health system, which, like all health systems, is facing a significant struggle. It's the product, obviously, of a Commonwealth-state arrangement, with Commonwealth-state health-financing agreements. In our good state of Queensland, 39 public hospitals are now funded under activity based funding on a national efficient price and another 83 public hospitals on a national efficient cost, where those smaller services and smaller public hospitals still get block funding. The movement to activity based funding is absolutely critical, and the Commonwealth, at arm's length from the operation of hospitals, is reliant on activity based funding to put a value on everything that happens inside the walls of a hospital.

Of course, there's been additional finesse and detail added to how we calculate this. There was a degree of back-casting going on, which meant that, as soon as we gave additional criteria whereby we would fund certain patients with more money, in many cases states were simply signing every patient up to every category to maximise the amount of activity based funding they got. What that led to was a need for the Commonwealth to back-cast and identify whether we should have absolutely every patient in the system suffering every single symptom in order to get more money. Clearly that was preposterous and had to stop, and that's one of the reasons why there was some disagreement between states and the Commonwealth on funding in 2018. That was the essence of that issue.

Apart from that, these very laborious Commonwealth-state health state agreements are interesting beasts, because they have allowed certain states to try different models. I well remember that from 2007 to 2010, under the Rudd administration, for the first time we allowed public hospital patients to access Medicare inside public hospitals, which up until then we had thought was anathema but which is now commonplace. This interface between what Medicare funds and what is a public hospital responsibility continues to shift, and I'm putting down here today that ultimately a patient who spends the night in a facility remains the responsibility of the state, while a patient who doesn't spend the night in a facility will one day become fundamentally part of the public health responsibility of the Commonwealth. That's where I think things will go over the next decade.

Because my time is limited now—but I'm going to continue later—I want to make some very brief observations about the challenges of using an ABF system in financing hospitals and how difficult it is to get clear information from states about how they spend the money. The Commonwealth is continuing to increase its contributions, but let's be honest: it's still a minor funder of the system. But it's moving up, and it's important that states don't fiddle with the data to unfairly obtain more ABF than they're entitled to. It's the job of large numbers of Canberra public servants to monitor that, but it's also for the community to be completely frank about whether state governments are being honest.

I want to note what the member for Capalaba, in my area, said on behalf of the state Labor government, in relation to the problems at the hospital in my area, where you are more likely than not to be ambulance ramped. Fifty-one per cent of people arriving at Redland Hospital are likely to be ambulance ramped, and the excuse given is that that is predominantly because of long-term dementia patients being unable to return to an aged-care facility—which, yes, is the responsibility of the Commonwealth. So let's be clear here: we’re all on the sticky paper together. But we do need solutions, and we need to make sure we're not simply blaming dementia patients for the ills of the hospital. We can't use dementia patients as an excuse for why, because the ambulances are all stacked up outside the hospital, there can't be an ambulance on the sideline of a football field where kids are getting broken jaws and broken legs. This is the point I'm making. We're building a multistorey car park at Redland Hospital, but what's the point if it's filled with ambulances with patients sitting in them and high-quality ambulance staff sitting there looking at patients for up to 12 hours because there's nowhere to put them in the hospital?

This is not about bigger A&E centres. This is not about more passionate staff. This is not about having more ambulance workers, because fundamentally, no matter how good they are, there's nowhere to put those patients. There is no bed available. We have to find a way to provide an incentive for states to operate efficiently and to return dementia patients when they can. That is an important contribution that I will detail in subsequent debate.

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