David Hawker (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Gellibrand proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The Government’s failure to tackle the challenges facing the Australian health system.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

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

It is good to be here to be debating the challenges that we face in the health system. It seems to me that, for the Minister for Health and Ageing, it is pretty difficult to tackle the nation’s health problems if you are too busy tackling your colleagues on your internal problems. The states, stakeholders and health professionals have been asking the health minister for months to deal with the issues, the crises, the major problems and long-term decisions that need to be made in our health system—they have been pleading with him to take some action. His answer to them has been: ‘I can’t do any of that now, because there is an election in the offing. I’m going to concentrate on the things that need to be done now.’ In fact he even publicly said, when the states asked if they could now recommence negotiations with him for the healthcare agreement: ‘No, I’m not going to do it now. It doesn’t have to be done now so I’m not going to do it now.’ He was as blatant as that.

Then I was surprised to read in the paper in the last couple of days that the very same minister has been giving all of his colleagues, who were obviously dealing with other internal matters, a lecture saying:

… as far as I am concerned we should be focused on being a good government now, and a better government in the future.

That was even after he has been spending months and months saying all he was going to do was clock off on some sort of extended smoko because an election was in the offing—he had no more duties as the health minister; he was not going to talk to the states; he was not going to try and solve any health problems; he was not going to deal with chronic disease; and he was not even able to make up his mind what his health policy was.

The most entertaining thing this week happened in question time today, when the minister was determined to try to make a mockery of our $2 billion health and hospital reform plan. He had the nerve to ask what the criteria would be for taking over a hospital. Maybe I could ask the minister what the criteria are for taking over the Mersey. I might suggest that the only criterion the minister is going to use is the electoral pendulum: ‘Where do you all come on the pendulum?’ Whether a hospital is going to be taken over by this minister depends on the government’s electoral prospects. Those are the full criteria that he uses. To stand up and say to us, when we have released a comprehensive plan with clear targets, benchmarks that are going to be signed off on and a whole range of opportunities—much more detail than your electoral pendulum—

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

Table it!

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

You have a copy of it, Minister. You have a copy of the benchmarks. You know what they are. Can you reduce readmissions? Is that a good idea? Is it a good idea to reduce readmissions to hospitals or not? As the health minister, you should know the answer to that.

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

Mr Deputy Speaker, I rise on a point of order. She is putting challenges to me. I’d like her to table the documents and, if she cannot table them, explain precisely what she is talking about.

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

Order! There is no point of order and the Leader of the House will refer to members by their titles.

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

It is interesting how touchy the minister is on this, isn’t it? And do you know why he is touchy? He actually would rather be on our side of the House when it comes to hospital policy. He is the one who wanted to take over hospitals—not that long ago, was it, Minister? And you are just embarrassed that we have had the guts to do it and you haven’t!

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

Mr Deputy Speaker, on a point of order: if I am not allowed to refer to her as ‘she’, she is not allowed to refer to me as ‘he’.

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

All honourable members will refer to other members by their titles and all remarks will be referred through the chair. Discussions across the table are not helpful at any time, especially now.

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

Mr Deputy Speaker, I will always refer to the health minister as the delicate petal that he clearly is. He is obviously unable to deal with an issue where we have been prepared to make a difficult decision. The Leader of the Opposition has stood up and said: ‘The buck will stop with me.’ We would like to make sure that we can improve our health and hospital system with the states. We want to do it in cooperation with them. We are going to negotiate with them on a range of measures that are going to take pressure off our emergency departments, deal with our elderly in a more appropriate way and make sure we reduce preventable hospitalisations. This is already five times more detail than the minister has released of his criteria for taking over the Mersey hospital.

The government only has one plan for one hospital in one electorate in one state. We have a $2 billion national plan for dealing with the long-term future of the health and hospital system. This is something that, frankly, the community expects the minister to be able to take some responsibility for. He is embarrassed because he has been caught out. He is on record as having said what he would like to do. He is on the record as having said that the system between the Commonwealth and the states is a ‘dog’s breakfast’. He is on the record as having said that the states should vacate the field and let the federal government run the health system altogether from start to finish.

What does he say when Labor comes up with a clear national proposal? ‘Oh, no, I’m older and wiser and have decided that that’s not such a good idea.’ In other words, ‘The Prime Minister said no and I didn’t have the guts to follow it through.’ That is what happened with this minister, and he now is embarrassed that he finds himself with his views on health policy more in line with ours but not able to pursue them.

I can tell you, Minister, that you have left everybody very confused about your view on hospitals. It seems to change every week: you want a federal takeover; you do not want a federal takeover. Then, of course, the Prime Minister launches a takeover of one hospital; you are not sure whether that is a test case and whether it is going to happen in other hospitals. You changed your mind five different times in one week, and then, when asked in an interview if this was an election stunt, you were unable four or five times to deny that that is all it was. People have been asking the minister for his criteria. As I say, I can table the minister’s criteria if that would be of assistance, because it seems to me it is the only way that, in this House, we will know whether hospitals are going to be given any attention by the Howard government or not. If you are not close on the pendulum to the electoral interests of the Howard government, you have no hope of anybody paying any attention to your healthcare needs in the community.

Ken Ticehurst (Dobell, Liberal Party) Share this | Link to this | Hansard source

What are you going to do with the Central Coast?

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

There are a lot of concerned people on this side of the House and a lot of other concerned people—the member for Dobell is one who is acutely aware of the needs of the health community in his electorate and would certainly be interested to know whether he is close enough to be within the minister’s range or not. I am not sure whether he will be or not.

Kim Wilkie (Swan, Australian Labor Party) Share this | Link to this | Hansard source

Mr Wilkie interjecting

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The honourable member for Swan is not helping.

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

We have arrived at a position where, when the minister goes on national television for an interview, even the interviewer, let alone the public, does not expect him to be asked a question about health. He does interview after interview; he talks about the leadership challenge; he talks about internal issues. He talks about anything other than health policy every time he does an interview. And do you know what? No-one is even surprised because, when he does talk about health in here, he never tells us anything about his policies. He probably spends a bit of time attacking us. He likes talking about Queensland politics. He tries doing everything he possibly can. He likes to belittle people—that is his main approach with me. But, Minister, the truth is that most people would like to know what you are offering them at this election. You have made a whole range of rock-solid guarantees in the past that have never been followed through.

I thought it was interesting: the minister made another rock-solid guarantee today—he said that there was ‘rock-solid support’ behind the Prime Minister and the Treasurer. I thought: ‘I’ve heard that somewhere before. What does his rock-solid guarantee actually mean?’ If I were the Prime Minister I would be worried that my most trusted lieutenant is making a rock-solid guarantee when the last one he made only lasted a number of days, or it might have been a month—certainly not very long and certainly it was not the highlight of the minister’s career. He has said as much himself. But that he actually used those words again—I wondered whether it meant that the leadership challenge was not really over.

The serious part of this whole debate is that Labor are in the business of laying out an alternative health and hospital plan for the future of the country. We have a $2 billion plan—new money on the table in addition to the money that is already there—that is going to kick-start a reform process. It is us as the Commonwealth putting our money where our mouth is and being prepared to actually take a step and say the Commonwealth needs to invest. We are going to push the states. We want them to pull up their socks in some areas too. If they do not want to play ball, then we will consider whether we take over financial control of hospitals. We have made that perfectly clear. There is nothing secret about that. Despite the minister’s posturing, we have made quite clear that our preference is to work with the states. We believe it will be the best outcome for the community if every Commonwealth health dollar and every state health dollar is used to maximum benefit in a cooperative way—get rid of duplication; get rid of all of the blame shifting and cost shifting.

We are going to this election with the clear message that, if that cannot be done, we will not let those negotiations and that inaction drag on forever. If the states will not play ball, we will go to the public and seek their approval to take over financial control of the hospitals. We will not just waltz into one hospital in one electorate in one state and say, ‘Have we got an offer for you!’ Ten weeks before an election we will not say, ‘Have we got an offer for you!’ when every other hospital and every other community in the country says: ‘What about us? What are you doing for us? What is the plan for us?’ The government has not done the work. Either the minister has not done the work or he is not prepared to argue to get it through his cabinet colleagues. Then he got caught—blindsided, I think—by the Prime Minister, who was prepared to do this in one seat and hope that it might have some electoral benefit but was not prepared to put it together as part of a comprehensive plan.

We are proud of the fact that we have a comprehensive plan which will be nationally consistent, because if it is not nationally consistent it is not going to be sustainable. That is the real risk for the community in northern Tasmania: is the government’s proposal going to be sustainable? It is fine to go in and offer it—and I am pleased that the minister was able to report today that the Tasmanian government and the Commonwealth government are having better negotiations on the outcome of this, because everyone needs that to be a successful proposal for that community—but the truth is that the work was not done first. The government just waltzed in and said they had an offer. There is absolutely no way they could make the same offer to every hospital around the country, even if there were the need, and we know that there are many people who will be left out by their proposal.

I am very concerned that the minister has just taken an extended smoko break. For someone who is so anti union I am surprised that he is prepared to make use of those sorts of award conditions, that he is prepared to just clock off when he has not got time to keep doing his work because he is more worried about saving the government’s skin. Here is Labor, delivering a plan and focusing on delivering better results for patients, when the Howard government is focusing on winning votes. We are interested in campaigning on health and providing better services to the community. We are interested in doing that in a long-term, sustainable way. We are interested in having a plan that is not just for 10 weeks, for this election period, but for the next 10 and 20 years. We are interested in really making sure that our health and hospital system is viable in future. If we do not retool and re-equip our health system for the future, we will not be able to cope with the challenges that we face.

Many members on this side of the House very much feel the ageing of the population. Many of us represent communities in which there are a large number of elderly people who need a different type of health care from what was needed when the number of elderly in the community was a much smaller proportion. We need to get it right. We need to have care that is not just hospital care but community care—appropriate care—and aged-care facilities. We need to deal with the growing burden of chronic disease. I went to a hospital in Bennelong the other day where 25 per cent of the patients were diabetic. They were not admitted particularly for diabetes related conditions—some of them were—but when the diabetes clinic that is linked to the hospital did a survey, 25 per cent were found to be diabetic. If we cannot ensure that we have systems in place where we can treat and prevent, where possible, diabetes or have better processes in our hospitals so that people with complex conditions and a range of comorbidities are able to be treated—

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

Tell us what they are.

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

The minister says, ‘Tell us what they are.’ Minister, you have been in government for 11 years and you have no idea what the solution is, have you? You have no idea whether or not you are prepared to provide more funding to that clinic. You have no idea whether or not you could fund—

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

Mr Abbott interjecting

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

Minister, it is quite staggering. How many years has he been health minister? Is it four years or three years?

Opposition Members:

Opposition members—Too many!

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

We know it is too many years. When we have an idea, rather than saying, ‘That’s a good idea; I should have thought of that,’ the minister says, ‘Tell us some more detail because I’m not sure what I’m going to do about it.’ That is his approach: no solutions, no options. It is the case with a whole range of things. If the minister is serious and interested in what he can do for diabetes, why does he not look at a couple of things that have been on the table for a long time? Why does he not look at the COAG plan that everybody else has been calling for the government to sign on to?

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

Mr Abbott interjecting

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

You have done about a quarter of it, Minister. You have not been doing all the hard stuff, all the expensive stuff.

Opposition Members:

Opposition members interjecting—

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

I think he has had his angry pills.

Opposition Members:

Opposition members interjecting—

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

I do not think the numbers were quite as clear as he was hoping for. Minister, this is a serious issue. We have a national coordinated plan for health and hospitals. We have a $2 billion plan and you are on extended smoko. (Time expired)

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

It is nice to be debating health. I am just sorry that we did not get anything remotely resembling a debate from the shadow minister for health. It is all very well to express an aspiration; it is all very well to come up with a wish list. Under a bit of pressure the shadow minister said today that she had a serious plan to take pressure off emergency departments, she had a serious plan for dealing with avoidable hospitalisations and she had a serious plan to deal with the growing burden of chronic disease. She does not have a plan to deal with any of these issues. All she has is the expression of the desire to deal with them.

I accept that this government is far from perfect and I accept that you have never uttered the last word in healthcare policy. I accept that healthcare policy is always a work in progress. But it is not enough to say, ‘These are the problems we need to have solved.’ To be taken seriously you must have some idea as to how they might be solved. Of actual ideas, as opposed to a mere wish list, this shadow minister and this opposition are absolutely, utterly and totally bereft. I regret to say that what we have had from the shadow minister today is another illustration of just how shrill and shallow she is. I am afraid any objective observer listening to her performance would say: ‘Cliche piled on platitude, piled on wish list; utterly devoid of any hard policies to deal with serious, practical problems.’

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

Give us the details!

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

We have shrieking from the member opposite: ‘Give us the details.’ I now propose to give her precisely that. What are the four big challenges facing the Australian health system—challenges that we did not have detailed from her? First of all, there is the challenge of affordability: how can we ensure that all Australians have affordable access to high-quality health care? Then there is the challenge of workforce: how do we make sure that we have the health professionals we need to deal with an ageing population? Then there is the issue of chronic disease: what are we going to do to try to ensure that these things are tackled sooner rather than later in an acute hospital setting? Finally, there is the issue of the governance of all of the various individuals and institutions in our healthcare system. Let me take them in turn.

Affordability is a serious issue. I am very proud of the fact that, since I have been the Minister for Health and Ageing, GP bulk-billing rates have gone up from 66 per cent to 78 per cent, and at over 73 per cent the bulk-billing rate in this country is at an all-time high. When I became the health minister, every other question time Labor asked questions about bulk-billing. I cannot remember when the last question on bulk-billing was asked. The bulk-billing issue has been addressed by this government. Overall bulk-billing rates are at an all-time high. Bulk-billing rates for children, for people over 65 and for people in country areas are all at an all-time high.

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

Those behind you don’t have great stats—Dobell and Macquarie.

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

She is just nattering away constantly, thinking that that kind of schoolyard banter is a substitute for serious policy work. If she is really concerned about affordability, what is her view on the Medicare safety net?

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

Mr Deputy Speaker, I rise on a point of order. I am responding to the invitation from the Minister for Health and Ageing. Since he has flagged affordability as the major issue of concern for the government—

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

Order! The honourable member knows there is no point of order, and no opportunity—

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

what are the out-of-pocket expenses for GPs? Have they doubled under your government?

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The member will resume her seat!

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to 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)

Duncan Kerr (Denison, Australian Labor Party) Share this | Link to this | Hansard source

The alpha and omega of health is birth and death, and the focus of this government is on death. ‘Howard will fight to the death’ say the headlines. He will fight to his death and that of all those that serve with him. The government are going to the next election chained to a political corpse. It is a plot worthy of Melville, and he knew a thing or two about the illusions that drive men and women to their doom against all sense. One of the things that is driving the government to their doom against all sense is their failure to recognise their own shortcomings and to appreciate the strengths of the arguments that are being advanced against them. They have become so inured to their self-rhetoric that they do not recognise that the community demands and expects more of them.

What we have got in this country now is an argument being advanced by the Minister for Health and Ageing not on health issues but on politics. He is a bit like the characters in the film Weekend at Bernie’s. There he is, dragging around a political corpse of the Prime Minister, saying that he is really alive. ‘You have got to believe it. You have got to have faith: the Prime Minister is really alive.’ That is the health policy: believe that something that is false is actually true; persuade yourself and perhaps you can fool the people. It is an extraordinary situation.

What is happening now really demands an author of the calibre of someone like Melville, with Moby Dick. We have a captain going down with his ship. Of course, in true heroic tradition, that usually happens after you have put off the paying passengers and your own shipmates—and then the captain goes down with the ship. But, no, in this instance, the passengers and crew are also to go down with the Prime Minister, with the would-be mutineers cowed to silence, the old captain, something like Captain Queeg, with the steel balls in his hand, cabin fever in his eyes, aglitter with hate for those who have told him it is time to go. That is notwithstanding that he actually asked the French-speaking first mate to inquire as to whether or not the crew were happy with his conduct. He had come back saying: ‘Not happy, Captain. Time for you to stand aside.’ But, of course, what he then does is keelhaul those who speak out, cow to silence those who stay aboard and threaten to scuttle the ship—threaten to open the seacocks if anyone speaks against him. And of course they are all cowed to silence.

What of the ship’s second-in-command? What we have is essentially a character that would better fit Flashman novels—all strut and no courage or loyalty to his own party: the Treasurer. That Flashman stands aside of his responsibilities, neither having the will to stand with the Prime Minister nor to strike him down. The Minister for Health and Ageing, who has been so beautifully characterised by the shadow minister as putting his whole focus on the political survival of this government, goes before the state ministers that he castigates about their failures in health policy and says, as to the Commonwealth health agreements with the states: ‘I will not discuss this further. I will not examine it. I am now focused entirely on politics.’ That is exactly what you can see: the ship’s doctor, the fanatical Dr Abbott, handing out rum and opium to keep alive the dull hopes and fantasies of the crew, who are still struggling with some hope to keep the rotting hulk of their government afloat for a few more weeks.

That is essentially where we are at. This is the ugly place the Howard government have got to: becalmed, going nowhere, political death stalking them by denying reality. How do they deny reality? They deny reality by trying to address with bandaids the problems that confront them. Instead of responding to the Tasmanian state government—which had put forward the bravest and most constructive plan ever for health reform in Tasmania to address a crisis of health policy in that state and to deal with parochialism and the misallocation of health resources over historical time—instead of saying, ‘We will assist you with funding if you fall short of the resources you require to make this work effectively,’ they step in and play up parochialism in a most destructive way. Of course, in the end, if you are offered something like $45 million or so to take a hospital off your hands, a state government is going to accept it. But this is the worst kind of long-term policy for Australian national health planning.

I was a member of the Royal Hobart Hospital board of management—a community run hospital in the old terms. Do you know why we stopped having community run hospitals in Tasmania? It is because each and every one of those boards ran their hospitals for their local, parochial interests. We drove the funding of those hospitals over budget each year, then put our hands out to the government and said, ‘You’ve got to fund us or we’ll close surgical units or the like.’ We had in our state a constant demand for hospitals but in places where demand was insufficient, so we would put hospitals in every small settlement. Some have been closed over time as a response to increasing demand elsewhere. To get rationality across the state, Lara Giddings put forward what was the bravest, strongest and most sensible plan ever for health allocation, to get away from that kind of parochialism. And do you know what the federal minister did? In he came and said: ‘Look, I’ll play to the lowest common denominator of partisan politics. I know this kind of parochialism works. It’s worked before. I’ll gee it up again,’ and off we go.

I know that this is the kind of outcome that, if applied consistently across Australia, would destroy our health system. It is not a solution. The federal opposition has come up with a $2 billion injection which will go across the health system to make certain that all hospitals operate effectively and provide services efficiently to those that they service. We expect the states to cooperate—this is not being done with an expectation that there will be failure. But we also have in reserve the capacity to step in ourselves if the will amongst the states fails, because we do know that this is hard politics. The easy thing to do is to just spray money around without regard to the long-term responsibilities of a national government—to keep funding the creaking door, the squeaking door, wherever it might be, and to ignore those long-term demands and drivers of the health system. What are they? The first is an ageing population. The second is the fact that the cost of the provision of health is increasing faster than the CPI. The third is the fact that the Commonwealth has reduced its commitment to hospital funding nationally so that, instead of providing 50 per cent of the balance of funding required to the states, it now, I think, provides in the order of 43 per cent. That is off the top of my head and I will be subject to correction, but I think it is 43 per cent. What that means is that there is a $70 million shortfall in my home state of Tasmania alone. That then creates further difficulties and issues that all state governments are having to confront.

What we need is a national government that responds efficiently and proactively to all these long-term demands. Instead, we have a health minister focused on the political corpse of the Prime Minister, with the stethoscope out, pretending there is a heartbeat. We have the remedies from other doctors. Dr Bolt and Dr Albrechtsen have indicated that the dead tissue has to be cut out. But, bizarrely, today, again in some kind of political knee-jerk reaction no doubt driven by the Prime Minister’s office, we have the headline: ‘Costello must go for sake of Liberals’. That is the strike back—the dead striking at the living. We have Dr Rolfe counselling that the Liberals should cut out the living tissue. Finally this morning we had Dr Hewson, the only real doctor in the business, saying: ‘Look, don’t you worry about that. Everything is going perfectly swimmingly.’ This is the denial of reality that the coalition is operating under. At the end of the day, how can they ask the people of Australia to trust them with their future when they are not going to be part of it? How can the Prime Minister ask the people of Australia to trust him with the future of health care in Australia when the Prime Minister himself is not going to be part of that future and his own colleagues have told him that they no longer want him?

Andrew Southcott (Boothby, Liberal Party) Share this | Link to this | Hansard source

In addressing the future of the health system it is important to first have a look at where we are now. When you look at any number of measures you will see that the population health of Australia is one of the best in the world. There are only a handful of countries with a greater life expectancy than Australia. Australia has always followed a third way between the fee-for-service model of the United States health system and the National Health Service of the United Kingdom. More importantly, on any number of objective measures, our population health is better than that of those two countries.

As the Minister for Health and Ageing said, the Commonwealth government spends $52 billion on health and aged care. It is a substantial amount of money from the Commonwealth budget and it is a substantial amount of money in a $1.1 trillion economy. We have Medicare, which was introduced by the Labor Party but which has been strengthened by the Liberal Party. Medicare includes things such as free access to public hospitals, bulk-billing and access to subsidised pharmaceuticals. During this government’s life, we have made a number of improvements to Medicare. Just recently, in July 2007, we established the National Health Call Centre Network. That provides nurse based telephone triage 24 hours a day. In the 2004 election, we promised to have 100 per cent Medicare, up from 85 per cent of the MBS items. That was delivered in 2005. Nationally, we have seen the number of bulk-billed services increase across the country. In part, that was due to the incentives that we provided for bulk-billing for children under 16 and concession cardholders. In my own electorate of Boothby, there are almost half a million visits to general practitioners that are bulk-billed. That is 72.7 per cent of all GP services which are bulk-billed. That is a significant increase on the last three years.

We have done a number of other things. Almost all general practices are now computerised. That was achieved through the Practice Incentives Program. Information management and information technology are now a standard part of most general practices in Australia. We provided incentives for GPs to offer after-hours care. We provided incentives to allow for the teaching of medical students. Over the last eight years, we have also had enhanced primary care items in Medicare. This was to help with the management of chronic conditions and patients who need complex care. We have listened to people and improved the dental items on the MBS as well. That was in the 2007 budget. Again, that was for people with chronic illnesses and with complex care needs.

We have introduced the extended Medicare safety net for out-of-pocket, out-of-hospital expenses for visiting GPs, specialists and diagnostic services. That has been a very important improvement for families, who occasionally were hit with substantial out-of-pocket, out-of-hospital expenses for visiting specialists, doctors and diagnostic services, such as radiological services and so on. We have also improved the access to after-hours GP services. Again, in my own electorate, which I am principally familiar with, we spent $100,000 to establish an after-hours GP service at the Blackwood community hospital.

Another side of the health system is the Pharmaceutical Benefits Scheme. We have seen a substantial increase in the amount spent on the PBS and we have introduced newer drugs for arthritis, Alzheimer’s, cardiovascular disease, cancer, psychiatric illnesses, diabetes and epilepsy. Over the five years of the current Australian health care agreements, we have increased the amount put in to public hospitals by $10 billion over the previous agreements. The next agreement, which will be a five-year agreement, will be negotiated at the end of the year.

Importantly, we introduced the private health insurance rebate in 1998. It has been very important as an incentive to keep people in private health insurance. It is 30 per cent for most people, 35 per cent for people over 65 and 40 per cent for people over 70. We have seen the number in private health insurance, which was only 33.6 per cent in June 1996, increase to 43.5 per cent in June this year. Having people in private health insurance plays a very important role in keeping pressure off the public hospital system. It has always been a very important part of the Australian health system and it is one that we are very strongly committed to.

We have had a number of other improvements, such as the Australian Organ Donor Register. Previously organ donation was done in a more haphazard way. It really depended on which state you were in. Some people would do it through their drivers licence. We have established the Australian Organ Donor Register and there are five million Australians on it. We have also improved the regulation of blood products, with the establishment of the National Blood Authority.

Indigenous Australia has been highlighted by the recent intervention in the Northern Territory. Over the last 15 years or so, we have seen a decrease in mortality from all causes in Indigenous communities and a decreased mortality from circulatory disease. So there are improvements being made, but the health of that group in Australian society is still much worse than that of the rest of the population. An important priority for any Australian government is to improve the health of our Indigenous Australians.

I want to look now at mental health services. When I was first elected I remember being part of a number of forums and seminars on youth suicide. I am pleased that the number of people who take their own life amongst younger Australians has fallen since 1997. I think that organisations like beyondblue have played a very important role in highlighting the issues of depressive illness and youth suicide.

More recently, in last year’s budget the Australian government put in $1.9 billion for national mental health reform. That included a number of things such as better access to psychiatrists, psychologists and GPs. We look at the area of public health as a very important area. A lot of our health system has been focused on intervention, but it is very important to arrest things if possible. So, for example, we can look at things like the early detection of cancer and combating alcohol and drug abuse. Over the last 11 years we have seen substantial declines in the smoking rates. We have one of the lowest rates of smoking in the developed world and one of the lowest rates, by definition, in the world. That has come about through very effective campaigns in the whole area of tobacco control. We have seen a decrease in deaths from cardiovascular disease, breast cancer and cervical cancer. We have put $1.4 billion into the Tough on Drugs strategy, including most recently $149.5 million extra for health and law enforcement especially with respect to ice.

There is still a lot more to do. It is of great concern that we see rising levels of obesity and decreased levels of physical activity. This is an important factor which predisposes people to a whole range of conditions, not least of which is diabetes. There are a number of things we have done to improve the health and activity of schoolchildren and to encourage better lifestyles in Australia. A number of other initiatives undertaken by the government include the establishment of Cancer Australia, the establishment of a national bowel cancer screening program and, since 1995-96, a fivefold increase in investment in health and medical research. These are just some of the things that the Howard government has done in the area of health. (Time expired)

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

It was interesting listening to the member for Boothby give a glossy version of the government’s health record. It was one with no substance and one which did not touch on the real issues that are affecting the real people I and members on this side of parliament represent—real people whom, I might add, government members represent but whose interests they do not always take into account. The Howard government has failed to deliver quality, affordable health care and health services to the Australian people. The Howard government’s performance in the area of health is abysmal. It stands condemned for failing to address the hard issues in health. This is a government big on rhetoric and small on action. In more recent times it has been totally obsessed with its internal machinations rather than delivering quality health services to the Australian people. It has taken its eye off the ball and focused totally on its own internal machinations.

In November 2006 the House of Representatives Standing Committee on Health and Ageing delivered a report called The blame game. It was an excellent report. It looked across the spectrum at health. It made a number of very sound recommendations, 29 in fact. Guess what? To date the government has not even bothered to respond to that report. I think this really shows just how serious this government is about health. There has been no action on these important issues and yet the blame game continues. The Prime Minister and his Minister for Health and Ageing refuse to take responsibility for anything, particularly problems in the health system. The favoured approach to solving problems in the health system is to blame the states. They are always looking for somebody else to blame when things are not going right. They accuse the states of cost shifting. But if they had a look at what is happening in the health system, they would see that many of the inefficiencies and much of the cost shifting happen at a federal level. They accuse the states of failing to treat patients in public hospitals whilst simultaneously reducing funds to the states. As previous speakers have highlighted, this government has actually cut funding to the states for hospitals, yet it asks them to do more and more. When they do not deliver, it blames the states. This government is very good at abrogating its responsibility and blaming others.

One of the first acts of the Howard government was to cut the Commonwealth dental health program. People are now languishing on lengthy waiting lists. In my electorate there are people who have waited up to six years to get the vital dental treatment they need. Under the Howard government, a chronic doctor shortage has developed. In the electorate of Shortland, all the doctors between Belmont and Swansea—which is quite a significant geographical area—have closed their books, simply because they do not have the capacity to see any more patients. You have elderly people languishing in their homes, unable to see a doctor, simply because the doctors do not have the capacity and cannot see them. The accident and emergency departments in the local hospitals at Belmont and right across the Hunter New England Area Health Service have burgeoned. People are waiting for longer periods of time. I have spoken to the executive of the area health service and they placed that directly at the feet of the Commonwealth government, because those people simply cannot get to see a doctor locally. There is no doctor to see in their community, so what do those people have to do? They have to front up at the accident and emergency department. The government has done nothing about that except blame the states.

The Howard government has seen a skyrocketing of out-of-pocket expenses, and acute beds in public hospitals are used for frail aged people who should have beds in aged-care facilities. Unlike the government, the ALP has a real plan, and the plan is not to blame other people; it is to spend $2 billion in addressing the crisis in the health system. It is a plan to stop the blame game; a plan to slash the dental health waiting list. The minister emphasised that the government has a plan. I would argue that the only plan that the government has is to win the election, and its aim is to win that election at all costs. It will do nothing whatsoever—(Time expired)

Paul Neville (Hinkler, National Party) Share this | Link to this | Hansard source

I could not see that plan. I tried very hard to see it. The shadow minister gave us a rendition of carping and sniping at the minister. That was followed by a theatrical performance by the member for Denison—a very good one, I might add. I have great respect for my colleague from the Hunter and I think that she is a quite genuine participant. But this is me. I come from Bundaberg. Ding, ding: does that ring a bell? Queensland Health; Dr Patel. Remember that? I have been through that for two years, and that was solely under the control of the ALP government of Queensland—every last bit of it.

The person who blew the whistle on Dr Patel was not someone in the government of Queensland; it was my National Party colleague Rob Messenger, the member for Burnett. He was vilified by the minister at the time, Minister Nuttall, and then, after about three days, when the sick and maimed patients came out of the woodwork, everyone was ducking for cover. Crossing the floor in a division in the house, Nuttall said to Messenger: ‘You’ve ruined the life of a brilliant surgeon.’ This is a health minister, for God’s sake. Then he came to Bundaberg, lined up the senior nurses and said: ‘You’re a mob of racists. You will not talk to Messenger or the Bundaberg News Mail’—our local paper—‘and there’ll be no inquiry.’ Famous last words!

It is interesting that the member for Gellibrand, who raised all these things today, came to Bundaberg a few weeks ago and insulted the people of Bundaberg by standing outside the Bundaberg Base Hospital—the site of Labor’s greatest betrayal of any community in Australia, to say nothing of the betrayal of the staff who lived under psychological and physical pressure the whole time. It was the subject of two royal commissions.

Let me look at the record of the Leader of the Opposition, when he was at Wayne Goss’s side in the Premier’s office. During that time, they sacked all the hospital boards and created huge bureaucracies in a structure that is in part to blame for the ‘Doctor Death’ fiasco. They closed 2,200 beds, sacked local ambulance boards, closed maternity services, allowed elective surgery waiting lists to blow out to extraordinary levels, abolished the role of the chief nursing officer—you must not have anyone sticking up for the nurses—closed three operating theatres at the Princess Alexandra Hospital and Royal Brisbane Hospital and had dental waiting lists blow out to four years—some record! And you seriously think that the people of Australia want that to happen under a federal Labor government? If that is the role of a state Labor government, what would you expect from a federal Labor government?

The Leader of the Opposition, in his manifesto, says that he will spend $2 billion on the hospitals and, after that, if they do not come up to scratch, he will take them over. But look at $2 billion spread over two years. Queensland’s share would be about $90 million a year. Mr Beattie promised $41 million to the Bundaberg hospital to get it back up to scratch again and that that would be delivered by early 2008. We are nearly at 2008 and he has spent $2½ million of $41 million. So, even if we went ahead with Labor’s plan of $2 billion, the Bundaberg Base Hospital alone would take half of one year’s allocation for Queensland—one hospital alone.

Tell me the logic of this: how is it that it is wrong for the coalition government to take over the Mersey hospital, but the Leader of the Opposition says, in unequivocal terms: ‘If I don’t get my way with the states and they don’t toe the line, I’ll take over all the hospitals.’ Pray tell: where is the difference? Look at the figures for bulk-billing, look at the figures for private health insurance, look at the figures that we have invested in health and you will find that there has been very little opposition criticism of that because it has been very good. We will continue to run health well in Australia, and we obviously do not need the sort of nonsense that we heard today in a theatrical performance and a carping whinge.

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

Order! The time for the discussion has concluded.