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

by leave—I present a supplementary explanatory memorandum and move government amendments (1) to (9):

(1)    Schedule 1, item 2, page 3 (lines 16 to 18), omit subparagraph (a)(iii) of the definition of consultant physician, substitute:

                 (iii)    if that specialty is also prescribed by the regulations for the purpose of paragraph (a) of the definition of specialistthe regulations provide that the medical practitioner is a consultant physician, rather than a specialist, in relation to that specialty or is both a consultant physician and a specialist in relation to that specialty; or

(2)    Schedule 1, item 6, page 4 (lines 10 and 11), omit the item, substitute:

               6 Subsection 3(1) (definition of nursing care)

Omit “registered nurse”, substitute “nurse who is covered by paragraph (a) of the definition of nurse”.

(3)    Schedule 1, item 9, page 4 (lines 25 to 27), omit subparagraph (a)(iii) of the definition of specialist, substitute:

                 (iii)    if that specialty is also prescribed by the regulations for the purpose of paragraph (a) of the definition of consultant physicianthe regulations provide that the medical practitioner is a specialist, rather than a consultant physician, in relation to that specialty or is both a specialist and a consultant physician in relation to that specialty; or

(4)    Schedule 1, item 14, page 5 (lines 16 to 21), omit the item, substitute:

               14 Subsection 19C(2)

Repeal the subsection, substitute:

        (2)    In this section:

practitioner means:

             (a)    a medical practitioner; or

             (b)    a practitioner, within the meaning of section 124B, of any other kind who is registered under a law of a State or Territory as a practitioner of that kind; or

             (c)    a health professional of any other kind who is registered under a law of a State or Territory as a health professional of that kind.

practitioner’s registration means:

             (a)    if the practitioner is a medical practitioner—the practitioner’s registration under a law of a State or Territory as a medical practitioner; or

             (b)    if the practitioner is covered by paragraph (b) or (c) of the definition of practitionerthe practitioner’s registration as mentioned in that paragraph.

Note:                The heading to section 19C is altered by omitting “medical”.

(5)    Schedule 1, item 15, page 5 (line 24), omit “medical”.

(6)    Schedule 1, item 16, page 6 (line 1), omit “medical”.

(7)    Schedule 1, item 17, page 6 (lines 5 to 10), omit the item, substitute:

               17 Before subsection 19CB(1)

Insert:

     (1A)    In this section:

practitioner has the same meaning as in section 19C.

practitioner’s registration has the same meaning as in section 19C.

Note:                The heading to section 19CB is altered by omitting “medical”.

               17A Subsection 19CB(1)

Omit “medical”.

(8)    Schedule 1, item 21, page 6 (lines 22 to 26), omit the item, substitute:

               21 Subsection 19CB(3)

Repeal the subsection, substitute:

        (3)    Unless sooner revoked, the direction has effect until the practitioner is authorised under the practitioner’s registration to render the professional service, or to render the professional service in the circumstances where the practitioner was not previously authorised to render it (as the case may be).

               21A Subsection 19CB(4)

Omit “medical” (wherever occurring).

(9)    Schedule 1, item 22, page 6 (line 27) to page 7 (line 4), omit the item, substitute:

               22 Subsection 19DA(1)

Repeal the subsection, substitute:

        (1)    In this section:

deregistered practitioner means a person:

             (a)    who was registered under a law of a State or Territory as a practitioner; but

             (b)    who is not currently registered under a law of a State or Territory as a practitioner.

practitioner has the same meaning as in section 19C.

As I mentioned previously, the government is moving amendments to the Health Practitioner Regulation (Consequential Amendments) Bill 2010 arising from submissions to the Senate inquiry on the bill. These amendments clarify the regulations relating to the recognition of a consultant physician or specialist for the purposes of Medicare and amend the definition of nursing care to clarify that nursing care may only be provided by or under the supervision of a registered nurse division I.

In recent years an increasing range of health professionals such as psychologists, speech pathologists and chiropractors have become able to provide Medicare eligible services. However, these health professionals are not currently subject to sections in the Health Insurance Act which prohibit the payment of Medicare benefits for a service provided by a health practitioner where the service is beyond the scope of the practitioner’s registration.

These amendments to the bill propose to extend the scope of the HIA to widen the scope of relevant sections in the HIA so that they apply to all health professionals registered under a state and territory law who render Medicare eligible services.

Again, I think that the shadow minister may have been otherwise engaged when I made these comments before. We do welcome the feedback that has been provided by the coalition. We have indicated our preparedness, as is seen in the amendments that are being distributed, to take on board their recommendations and we are very pleased that they have indicated that this bill will now be supported. It is indeed vital that this legislation is passed in time for the implementation of the scheme on 1 July 2010. We will all, on both sides of the House, be very proud when it is able to be introduced.

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

I thank the Minister for Health and Ageing for those comments. I do not intend to get into a tit-for-tat with the minister. The advice I received in relation to the report at 10.13 this morning is that, due to time constraints in the Senate yesterday, the report is now scheduled for tabling this afternoon. That is the advice from the Senate Community Affairs Committee and that is the advice I relied on in making my comments. Obviously there is some confusion somewhere, but that is the advice I received in writing. That is the advice we have most recently received.

The point that needs to be made on all of this is that this has been another bungled affair. When it comes to the health portfolio in the Rudd government, it is one bungle after the next. We have seen over the course of the last two years repeated mistakes made not just in this chamber but in the other chamber as well. That is why people now are starting to question whether this is a government that is sincere in all it proposes on health. We have seen promise after promise in a number of areas that this minister has responsibility for that have not been delivered on.

There is great angst within the medical community about aspects of accreditation and about great big new bureaucracies which are being created under this government not just in relation to this bill but in relation to the most recent proposals by the Prime Minister at the COAG meeting on health. These great big new bureaucracies are not going to create greater efficiencies, they are not going to create better patient outcomes and they are not going to create better professional standards if the profession is not brought along with the government’s reform. I think there is a level of angst amongst many of the professions at the moment that this government conducts these vendettas not because of a desire to seek better patient outcomes but because of these ideological positions adopted particularly by the minister.

There will be further amendments that will be required to this bill in due course because there are, in my view, unforeseen difficulties. I suspect that we will be made aware of them as they come to light, as will the government of course. I ask that the minister accept that that is the case. It is a significant reform. We do believe that national registration and a breaking down of those state barriers is important. We do not accept the original position of the government on accreditation, but I do accept that there has been some shift by the government on this. But again it was a ham-fisted approach from the start and it undermines the government’s credibility. I do not think the Australian public believe anymore that this government will deliver on the promises that it makes. There will be unintended consequences, perhaps through no fault of the government but perhaps because of its ham-fisted approach. Either way, let us accept that there will be amendments required. I believe the minister should give an undertaking to the House that she will deal with those in a timely manner and in a way whereby the professions can accept that there is some give from the government in relation to some of the difficulties that will arise.

That is the position of the opposition. We have been supporting the process as best we can, but there was considerable difficulty in what was first proposed by the government. This is not a perfect model that is being put forward and the amendments that will need to be made today and in due course, I hope, will address some of the ongoing concerns that the professions have to this approach. We support the amendments on that basis.

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

I would like to add a couple of comments following those questions that have been raised by the shadow minister. It is difficult on this occasion to continue to have patience with an opposition who refuse to acknowledge that in this instance all 10 professions covered by this legislation, all states and territories and the previous government that he was part of have signed onto this plan. If there were any complications, misjudgments or unintended consequences from the plan that the member opposite suggests that we put forward, I would remind him that it is his current leader who was the Minister for Health and Ageing at the time that the previous Prime Minister signed this agreement. It has only been our government that has been able to pursue it to implementation stage to iron out a vast range of complex issues.

The only part of the comments of the shadow minister that I agree with is that of course a new national registration and accreditation scheme over time will need to be able to change if problems arise. It is a complex system, and no-one is pretending that it is not, but I think it is more than audacious to come in here and deny the fact that we now have all 10 professions being covered by this calling for the registration and accreditation scheme to be introduced. We have all the states and territories on board. We are not required to pass the substantive legislation here. We are passing legislation which ensures that various financial benefits paid by the Commonwealth will be appropriately paid to people who are registered and accredited under this scheme.

It is simply wrong, quite wrong, to say that this will have no benefit for patients and no impact on improving standards. The very purpose of introducing a nationally consistent registration and accreditation scheme is to enable the easy mobility of our vitally important health workforce across the country, which of course has an immediate impact on patients, who need nurses, doctors and other health professionals to be able to move where there is need, where there are better employment opportunities or where their families might be and continue practising. Of course, it ties in very well with the national standards that will be established through the registration and accreditation scheme and expanded through the government’s National Health and Hospitals Network, where we are introducing national standards that apply clinically across the whole country.

I accept that the shadow minister would like to be sure that, if any future problems arise, they will be handled. Obviously, the government are always prepared to look at problems as they arise in the implementation of any scheme. It would be foolish not to. I do not think that requires an undertaking; I think that is common sense. I think the approach we have taken to date, including accepting the recommendations that came from the Senate committee report, is an important indication that we are prepared to do that. I hope that this legislation will now pass this House and be able to be dealt with expeditiously in the Senate.

Question agreed to.

Bill, as amended, agreed to.