Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I speak in support of the National Health Reform Amendment (National Health Performance Authority) Bill 2011. The Minister for Health and Ageing in her speech of 3 March this year said a couple of words which I think are worth repeating because they sum up the challenges that we are facing in this country. She said:

In many ways we are lucky that Australia has one of the most impressive public health systems in the world—our doctors and nurses are world class, our public system provides free hospital care for all and it delivers outcomes such as low infant mortality and long life expectancy.

But we’re faced with a health system that is fragmented, costly, underresourced, unsustainable, overly focused on acute care and with constant pressure to deliver for more patients with more complex needs.

In those few words I think that the minister summed up the challenges that we face in delivering good health services in what she later in her speech called 'the equality of provision' of services across the country.

This particular piece of legislation is important. It establishes the National Health Performance Authority, and it has been a mystery to me why the coalition has constantly campaigned against this particular measure. They have come up with every kind of excuse possible and criticised the proposal. We have had ridiculous comments from those opposite on this topic on many occasions. But this particular authority is part of a COAG process. It is there to monitor and report on the performance of the local health and hospital networks, the public and private hospitals, the Medicare Locals which we have established and other healthcare service holders as well.

So, it is a critical operation and a critical authority in terms of the overall power of the health service to make sure that in the regional and rural areas, as well as in the urban areas of this country, we get equality of provision of health service. We challenge those challenges which the minister talked about in her second reading speech on 3 March this year.

Additionally, the bill provides for the authority; it talks about the membership, the committees, the staffing, the planning and reporting obligations of the authority and disclosure of information by the commission and also by the performance authority.

The functions of the authority can be found in the legislation. The main function, of course, is to monitor and report on the performance of the health and hospital networks and the other organisations and services that I outlined. The Commonwealth will be responsible for appointing the chairperson, and the deputy chair will be appointed in agreement with the states and territories. As I said, it is part of the COAG process.

In my area we have seen some significant changes with regard to health and hospital services, and with the Medicare Locals we have seen some significant changes as well. Indeed, I had the opportunity to speak to the district manager in relation to these changes and to talk about this bill. So it is germane for me to talk about it here today.

I spoke with Pam Lane, who is the District Chief Executive Officer for the West Moreton Health Service District, about these types of reforms and the bill that is here before the House. We have had some changes in our area, and we have seen the Darling Downs Health Service District split from the West Moreton Health Service District. In my area this means that the West Moreton district will include Boonah, Esk, Gatton, Ipswich, Laidley and The Park—the Centre for Mental Health Treatment, Research and Education—as well. Pam looks forward to the challenges there, and I have spoken with doctors and allied health professionals about the health and hospital networks. The authority will oversee all of those.

As well, there are some changes with regard to the Medicare Locals. Fortunately, we have been part of the first 19 that have been appointed throughout the country and ours will be known as the West Moreton-Oxley Medicare Local. It functions from Oxley Creek in south-west Brisbane across to Ipswich, up the Brisbane Valley into the old Boonah shire, taking in Kalbar and Boonah, and out towards Toowoomba through the Lockyer Valley. It hubs around Ipswich, and I look forward to working with Vicki Poxon CEO, with doctors and with a number of allied health professionals in the area. I have already had a number of meetings with the Medicare Local in Brisbane and also in Ipswich to see how they are going to progress this issue.

There are a number of challenges in the provision of health services, and I think that the authority which we are talking about here today with this legislation will have the overarching opportunity to make sure those health and hospital networks and the Medicare Locals carry on and perform as we have entrusted them to do. I know that in the Brisbane Valley in my area there is a need for more primary health care services. I know the Lockyer Valley and the Brisbane Valley are growing quite rapidly, and Ipswich as well, so those regional and rural areas are in dire need of more allied health professionals as well as doctor's surgeries and the kind of equality of health service provision that is necessary. This legislation is really important and that is why I have never been able to quite understand why the coalition have been opposed to this. They have come up with arguments that this is some great overarching bureaucracy, but we think it is important. I cannot understand why members opposite who represent rural and regional seats, like me, have opposed this. I think this is an opportunity for health and hospital networks and Medicare Locals to make sure that the provision of health services in those areas is being carried out effectively and equally. I think that the coalition are really missing an opportunity here, as they have on many occasions. We know they have missed many opportunities. We know the opposition oppose this particular network, the authority and Medicare Locals. We know they oppose, for example, the GP superclinics, which this authority will oversee. The Ipswich GP Super Clinic in my electorate was so helpful to the evacuation centres at the Ipswich Showgrounds and Riverview. Without the GP superclinic, which the coalition propose to close down and not support, the people of Ipswich would have suffered from a lack of health provision.

The coalition can say we are not spending the money wisely and well, but this is a particularly important thing for my electorate. The policy to cut the GP superclinics, to rip out a billion dollars, as the coalition did when the Leader of the Opposition was Minister for Health and Ageing, is the sort of stuff we can expect from those opposite when they have to find $70 billion. We know that the authority that is the subject of this legislation will have an important supervisory and monitoring role in relation to e-health, which those opposite oppose, and the after hours GP online service, which the coalition proposes to get rid of. Those opposite oppose GP superclinics, e-health and the after hours GP hotline, so I really wonder how those opposite from regional and rural seats have the temerity to come in here and talk about health services.

This legislation is important because the performance authority is a key element of our health and hospital agenda. We are negotiating this with the states and territories, Labor and Liberal governments alike. As I said, it will monitor and report on all those organisations—public and private hospitals, Medicare Locals and other healthcare service providers. We have reached an agreement with the states. This authority is part of that agreement, and I suggest to those opposite they should talk with Ted Baillieu, Colin Barnett and Barry O'Farrell because they are in on this. They are supporting what we are doing in health reform. It does not matter which government is in power, they have signed up and supported it. We came to a historic agreement on 13 February this year when one or more of those state governments was held by the Liberal Party. We showed our commitment to the healthcare needs of all Australians and we have worked to get a better deal for patients across the country.

The agreement we came to, what we have carried out and what the Prime Minister has recently announced gives $19.8 billion in extra funding for public hospitals. It will be monitored by the authority that is the subject of this bill. There will be more beds, more local control, more transparency and more accountability. We have made a commitment to pay 50 per cent of the growth in hospital costs. We are going to do that in two stages, from 45 per cent eventually to 50 per cent. This is particularly important for regional and rural areas. I know from discussions such as those I had with Pam Lane how important the extra funding for subacute care is.

I know that we are putting about $8 million into the Ipswich General Hospital redevelopment. It is part of a commitment of over $120 million by the Bligh Labor government in Queensland. According to Pam Lane, that will be good for the Ipswich area up until about 2018 when I look forward to further discussions about the future of Ipswich General Hospital and whether it eventually gets relocated to the showgrounds. This is a question for the state government. We have put money into reducing elective surgery lists in Ipswich as well as emergency care departments. I have welcomed the Minister for Health and Ageing when she has come to Ipswich and looked at what we have done. We have made a major commitment to health in my seat as a result of these health reforms.

The tragedy of all of this is that we had virtually a decade of invisibility when it came to health and hospital funding in my area. I talk to the local doctors and nurses. It is not surprising that people in regional and rural areas are up in arms about the lack of doctors. When Michael Wooldridge was the health minister they took pride in the fact that they were capping GP training places. We will have trained 6,000 more doctors by 2020, including doubling the number of GP training places to about 1,200 a year by 2014. Those opposite pose, parade and posture about standing up for regional and rural areas. In regional and rural areas, increasing the number of doctors trained is so important because many of them end up going to those regional and rural areas and country towns—like Lowood, Kilcoy and Fernvale in my electorate. This is crucial because they are crying out for more doctors in regional and rural areas. That is why I mentioned the equality of health service provision, which is so important. People in the Brisbane Valley and the rural parts of Ipswich know how important it is.

They also know how important elective surgery is. They also know how important it is to have an authority which monitors it, to see how it goes. We have put in more than 70,000 elective surgery procedures which have been delivered in the last two years. We know that the coalition had in excess of 88,000 people on waiting lists in the last year of their tenure of the Treasury bench. We have backed up our commitment with money and we intend to do so again. We have doubled funding for health. We think our proposal with respect to the authority is important because we want to make sure there is proper funding for public hospitals. We want to reduce the waste. We know that the bureaucracy needs to be attended to. We need shorter waiting times, and that is why it is important that we have a target of 90 per cent of patients in emergency departments being treated within four hours. We think it is important that we provide more than 1,300 additional subacute beds. In a recent meeting with Pam Lane, she made the point that she appreciates our additional commitment to subacute beds. We think this is important.

We think these reforms are extremely necessary in all of these areas. We are committed to doing better. We think we can make a system that is more sustainable, transparent, efficient and well resourced. We are putting real money on the table. I am interested in what those opposite want to say about this, because they will cut GP superclinics, e-health and the GP after-hours care. We know that they kept people on waiting lists. We know they ripped $1 billion out of the health system when the Leader of the Opposition was the health minister. We know they have no significant commitment to rural cancer infrastructure despite the rural patients having up to three times the waiting times of people who live in the city. We know that. That is why we put in the 22 regional cancer centres that we are undertaking.

I am very interested in what they have to say, and I look forward to the member for Dickson being on their razor gang, trying to come up with savings for the $70 billion black hole they have. I look forward to what they have to say on this stuff, because they will criticise us but we will see whether they will put any real money on the table. They oppose the architecture that we have with this legislation. We know they have opposed the infusion of money into the system. We will see what they have to say. They say they are listening. We know there is a lot of vacuous white noise from those opposite with respect to health and hospital reform. They have not really listened to healthcare professionals. They do not really focus on local care. They do not focus on localism. We have massively increased the pool of funding and we have instigated some unprecedented transparency in this regard. The opposition has simply been an opposition for opposition's sake.

This legislation is a better deal for the country. It is a better deal for my community. I support the legislation.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. I take up the point of the member for Blair on regional and rural areas and training doctors. As a matter of fact, it was the Howard government that instituted and incorporated the James Cook University School of Medicine and Dentistry, the James Cook University school of allied health and the James Cook University School of Veterinary and Biomedical Sciences. All those things came through under the Howard government. I welcome those things. They were our commitment to the regions.

I also welcome the noise they make on all sorts of issues when it comes to health. The GP superclinics, I think, are a wonderful thing. In 2007, we were promised 16. Townsville was promised one; you can see it diagonally across the intersection from where my office is. It is still vacant. We were promised another one in the 2010 election. That has been walked away from. There is a building being gutted somewhere in Townsville that someone knows something about, but as yet the delivery system would see them deliver the last of the 52 GP superclinics, at their current rate of installation, in approximately 2197—which would be magnificent reform for this government!

I would also like to mention the Australian Institute of Tropical Medicine. We saw you walk away and not commit to that institute's installation at James Cook University. You would rather see the study of tropical medicine go to somewhere in Sydney or Melbourne. You do not worry about the first Australians. You do not worry about the Torres Strait. You do not worry about the cases of Japanese encephalitis and drug-resistant tuberculosis currently in the Thursday Island hospital. The member for Blair has now walked away.

This bill seeks to establish the National Health Performance Authority. This is the second step in the government's plan, and it changes a few names and places. It will also amend a few words and a few acts. That is about all this bill will actually do. These all relate to the National Health Performance Authority. This body is there to report on the performance of the local hospital networks in public and private hospitals, primary healthcare organisations and other bodies. These bodies look after the running of senior management at each of these workplaces. These senior managers look after the middle managers in the health facilities. These middle managers look after the supervisors who look after the individuals or small teams of people who will provide feedback on how this process is going.

What about the healthcare providers? They are the people who are actually out there looking after the patients and their health needs. But that is not a core responsibility of this department. No, for such a vital cog in this machine—for this new level of bureaucracy—what performance indicators would you think were in place? What key performance indicators should be there? What measures are in place to ensure that this $109 million is spent wisely? That would be none. It is $109 million, and there are no KPIs to ensure that they are not wasting money. This is $109 million that could go towards front-line services and actually provide something tangible for the tax dollars we are collecting. What we need is an agency which will ensure they are keeping the back office spend as low as possible and support the front office.

I have a friend who works on the front line in health at a major hospital. She spends on entire day per week on the computer with no patient contact. This is to allow her to complete all the forms required so that the back office can ensure that she is using the time wisely and not killing any patients. She has put a tag on those electronic files which will tell her when they are being accessed by others. This is so she knows that what she has done is being read. To date, not one of her files has been accessed by management for review in over 18 months. Extrapolate that across the front line of health and then stand there and tell me that what we need is another level of reporting. Better still, tell the doctors, nurses and healthcare professionals actually doing the work that they need another level of red tape in their lives. This, I am afraid, is typical of this government: grow the public service at the expense of delivering actual service.

Measures like these lead me to ask whether the minister or anyone in her department has actually spoken to a healthcare worker—someone on the front line. Have they explained to them why this new level of officialdom is needed. If so, what was the response from the nurse who has just finished a double shift? What was the response from the hospital orderly who, in Queensland, still cannot get his pay right? Have they explained to hospital health workers how this new level of red tape will help them achieve more on the floor?

This new authority does not even have the authority to obtain anything more than the states and private providers want to give them. So, for $109 million, what we have is an organisation which will be able to state categorically that the report from Queensland Health that is in front of them is in fact the report from Queensland Health. This government will be pretty happy with that. For one thing, it actually does something. That is better than most of the regulations they have imposed on Australia. This government will no doubt be hailing this as a new level of efficiency not seen since they won the 2007 election—and on that we will agree. This waffling and deflating government, this incompetent minister and department, have never seen a raft of regulations or a ball of red tape they did not like.

I know that there have been representations from various bodies, such as the Australian Private Hospitals Association, Catholic Health Australia, the AMA, the Consumer Health Forum and the Australian Council on Healthcare Standards, among others. But each organisation has stated that, while supporting the establishment of this body, there should be some consultation before the regulation and that it should have KPIs to ensure that it is working and we can all see that it is working. They warn that care must be taken; otherwise, waste will be the order of the day. Gee, where else have we heard that? In everything. All of these things have been said. What will this government hear? They only hear what they want to hear. This government do not actually listen. They stand there and put up their hands and say, 'I've made up my mind; don't confuse me with the facts.' All of this from a government which promised one new regulation in, one old one out, when they came to power in 2007. They are currently sitting at 220 new regulations in for every one out. Like so much of what this government have done it is prefixed with, 'Anything is good enough.'

If they had wanted to show some initiative, they could have got behind the coalition's PET scanner proposal for Townsville. The PET scanner is a major diagnostic tool. There is no need for it to be housed inside a hospital. We had two plans for a PET scanner. One was recently proposed by then Prime Minister Kevin Rudd and it was to be installed at Townsville General Hospital some time towards the end of 2014. We now have a plan where the Townsville hospital will have it put in some time before the end of 2012. We took to the election last year a plan for Queensland X-Ray, in a private-public partnership, to install a scanner off-site from the Townsville General Hospital. The cost for the government's plan, for the machine only and for the floor space, is $9 million. The cost to the taxpayer of the Queensland X-Ray one would have been $2.5 million. Even the Queensland Health people will tell you that they will be capable of doing three scans per day at the Townsville General Hospital. At Queensland X-Ray they can do between 15 and 17 if necessary. No-one would have to fly to Brisbane whilst they are having radiation, whilst they are having chemo, to have another PET scan, because they could have it done in Townsville. It could have been up and running in January this year.

Queensland X-Ray, to their credit, have gone ahead and done it anyway. They have put it in without a cent from the government, and this government are still vacillating. They still will not recognise that they have ever even seen a proposal for a PET scanner for Townsville. What we need to do now is make sure that they have Medicare accreditation so they can bulk bill all from North Queensland.

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

Will they bulk bill?

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

I thank you for what? You have done nothing. You have done nothing but stand in front of us. You have a health minister who has refused to even accept that there is a proposal on the floor. This government could have had a PET scanner up and running in January this year. You say, 'Is that a thank you?' What about the people who have had to fly from Townsville, from North Queensland, to Brisbane to get their PET scans done? You should hang your head in shame. You were in the hospital game. You know what sick people are like. That you can sit there and be flippant about that sort of thing just beggars belief.

Craig Emerson (Rankin, Australian Labor Party, Minister for Trade) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on a point of order. I think a little bit of civility and adherence to the standing orders would be warranted—that is, that he should not be addressing members across the chamber with the term 'you'.

Teresa Gambaro (Brisbane, Liberal Party, Shadow Parliamentary Secretary for Citizenship and Settlement) Share this | Link to this | Hansard source

Mr Deputy Speaker, on the point of order: it is a two-way street. The member opposite could stop interjecting as well.

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

I thank the member for Brisbane and the Minister for Trade for their advice. I remind the member for Herbert that he should not respond to interjections from across the chamber. That equally applies to members on the other side of the House. I also remind the member for Herbert that he should refer his comments through the chair and not to members as 'you', which is a reflection on the chair and, in this case, the speaker.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

Thank you, Mr Deputy Speaker. I will behave myself from now on.

Fortunately for the people of Townsville, Queensland X-Ray chose to go it alone, announcing last week that they would deliver Townsville its only PET scanner, without help from this government and long before this government were prepared to do anything. It is a sad day when the government cannot be trusted to provide vital, lifesaving medical equipment and that private enterprise is forced to pick up the slack alone and carry the bill. If this government could not see the economic sense in Queensland X-Ray's proposal then no wonder they think that $109 million is good value for a new level of bureaucracy, which has no power to require any more information from the bodies it is supposed to be watching than the information they are willing to supply. It beggars belief. On behalf of all the taxpayers in Australia, I urge the minister to consult, listen and act on the advice of people actually doing something in this industry. Do not just sit there and take up space.

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

I rise in the House today to add my comments on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. This piece of legislation is very important. As the minister said in the second reading speech on this bill, it will form the backbone of a modern, integrated, high-performing health system. It is as a result of the government's historic agreement with all states and territories to undertake fundamental reform of our health and hospital systems. The Gillard Labor government is committed to improving Australia's healthcare system so that all Australians can access high-quality services that meet their needs and the needs of their family. This legislation will create a National Health Performance Authority, a new watchdog for Australia's health system. It will tie in with our Medicare Locals and local health networks to ensure we deliver positive outcomes for Australians. The Commonwealth government is building on the national health reforms through changes to primary health care which will see key improvements, with a particular focus on specific needs of local communities. The performance authority will work to open up the performance of the health and hospital system to new levels of national transparency and accountability. It will allow for the identification of high-performing parts of the health system so those successes can be transferred to other areas. It will identify areas of the health system that require improvement so that action can be taken, and improve the health choices of Australians making key decisions about their own healthcare needs.

The reform of Australia's health system is one of the most important public policy challenges of this generation. It is much needed. In many ways Australia has one of the most impressive public health systems in the world. Our doctors and nurses are world class. Our public system provides accessible hospital care for all and it delivers outcomes such as low infant mortality and long life expectancy. Australia's life expectancy increased substantially over the last 20 years. It is now one of the highest in the world behind Japan and Switzerland, with 84 years for females and 79 for males. However, from working in hospitals for many years in Tasmania, including the Beaconsfield District Hospital and the Launceston General Hospital, I understand the issues that are facing our health system. We are faced with a health system that is costly, under-resourced and under pressure to deliver for patients with complex needs. We have an ageing population and also an increasing burden of chronic illness and obesity, as well as skills shortages.

The Labor government has delivered on our election commitment to end the blame game and end the cost shifting and blame shifting that have plagued our health system for decades. The Gillard Labor government inherited a health system in crisis from the Liberal-National coalition. The current opposition leader has a lot to answer for when it comes to this very important area. In 2003 the current Leader of the Opposition cut $108 million from public hospitals. In 2004 the member for Warringah cut $172 million from health and then in 2005 he cut $264 million—and it does not stop there. In 2006 he cut a further $372 million, and more again in 2007, his final year as Minister for Health and Ageing. That is more than $1 billion cut from hospitals by the Liberals in just five years. Despite the huge shortage of GPs in Australia, as health minister in the Howard government the current Leader of the Opposition capped federal funding of GP training places and left the nation short of 6,000 nurses. No wonder they are now on the other side of this chamber!

We cannot trust the Liberals on health. In 2006 the current opposition leader, the member for Warringah, indicated that he wanted to manage health by queues—and I quote from the Australian Financial Review of 1 June 2006:

Cost and queues is what ensures that services aren't overused … So [hospital] waiting lists and gap payments are a necessary part of the system …

The Leader of the Opposition has admitted that, if he becomes Prime Minister, he will make further cuts to health, carbon pricing, education, the environment, business, consultation, infrastructure, broadband and other services. This shows a lack of vision and is not in the best interests of this country. But it does show that the opposition are consistent. That is what we have come to expect from those opposite.

We, the Gillard Labor government, have a solid plan to fix the health system in Australia. We are implementing the biggest health reforms since Medicare—which I think has been the best thing for health in my lifetime—to ensure our hospitals are properly funded and to improve our local GP services and make them accessible to all Australians. The Australian health system has evolved and expanded greatly since the nation was formed at Federation in 1901, as the needs and expectations of the Australian people have changed. Despite the extent of this evolution in health service provision and medical knowledge and technology, there have been only a few occasions on which major changes have been made to the whole system. The Whitlam Labor government Medibank system was the major change in my lifetime. A key component of our health reforms is ensuring that communities have the health and aged care services that they need through more locally responsive planning and management. I should say that I worked in the courts when Medicare came in, and two-thirds of all our summonses were medically related. We had hospitals suing patients who were half dead and were never going to come out of hospital. It was a terrible system, and the Whitlam Labor government brought in Medibank, which was the saviour of our systems at that time.

The government's national health reform will deliver new services designed specifically to meet the real needs of communities through a model that enables a strong engagement with local health services and local communities. In regional Australia this will be achieved by Medicare Locals and local hospital networks. They will be made up of local community members and will work for their communities locally. Health, like most things, is best managed at the lowest possible level, where people have full information.

The National Health Performance Authority is an important part of our plan to improve health services in Australia. The National Health Performance Authority will exist to improve quality, increase transparency and drive value for money in the health system. This is badly needed. It will drive transparency in the health system by improving Australians' access to vital health information. Australians will have more access to information on their local hospitals, health services, primary health care and community health services. It will be a model that will benefit all Australians. This will be a powerful independent watchdog body that, by using the power of accurate information, will push our hospitals to deliver better services and push our primary healthcare sector to develop and improve.

In reaching agreement with the Australian states and territories on 13 February 2011, the Australian Labor government showed its commitment to meet the healthcare needs of Australians and to work with the states and territories to deliver a better deal for patients. The agreement includes $19.8 billion in extra funding for public hospitals that will deliver more beds, more local control and more transparency. It also means less bureaucracy and less waste. These national health reform measures are critical for creating a health system that delivers the services Australians deserve and expect. The Gillard Labor government is improving quality, safety, performance and accountability in our health system.

The Australian Labor government has a vision for social inclusion to ensure every Australian has the opportunity and support they need to fully participate in the nation's economic and community life. Ill health and disability can reduce a person's capacity to work and participate in education or social activities through both physical and mental health conditions as well as time spent receiving health care or caring for others, and all of these can exacerbate the financial strain of households.

Every family in Australia depends on our health system. That is why we must get it right for the future. Everyone, no matter where they live, deserves access to first-class health care. That is why we have ended the blame game through a national agreement to boost hospital funding, increase local control and expand primary and aged-care services Australia-wide. It means more money, more beds and less waste in public hospitals. Hospitals become more accountable and doctors and the community get more say. Plus there is extra support for GPs and aged-care providers.

Labor is the only party that cares about public hospitals and better health care. We are fixing a decade of waste and neglect left to us by the Liberal Party and we are delivering the hospitals and community care that Australians deserve. Patients are already seeing the results of the Gillard Labor government's investments in health with extra beds being delivered, an after-hours GP helpline established and new doctor training places beginning this year.

I look forward to locally responsive health services through the establishment of Local Hospital Networks and public hospitals using activity based funding, which will fund hospitals for the service they provide—not a bucket, which has been the tradition. This will drive efficiency, reduce waste and deliver greater transparency.

This bill is an important part of our healthcare agenda. I am proud to be part of a government that is addressing the problems in our health sector and preparing Australia for the future. This is a vital piece of legislation and I urge those on the opposite benches to join with us and all the state and territory leaders that support our Australian health reform.

Teresa Gambaro (Brisbane, Liberal Party, Shadow Parliamentary Secretary for Citizenship and Settlement) Share this | Link to this | Hansard source

I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. It establishes a new statutory authority, the National Health Performance Authority, and is designed to monitor and report on the performance of hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services.

On the surface, this seems to be another Labor attempt at creating much more big bureaucracy and even more big government, and it is very typical that Labor's version of health reform is more bureaucracy. It is about a bigger waste of money by duplicating more government departments that overlap already with existing agencies and it does not provide for what is needed at the grassroots level. It does not provide for more doctors. It does not provide for more nurses. All it does is create more boards, more secretariats and more and more bureaucracy.

A wide range of stakeholders have expressed extreme concern. There is a list of stakeholders who have expressed concern, but I will just deal with a couple of them today. The AMA has called for a deferral. The RACGP has concerns. A number of bodies have expressed concerns, particularly on what the performance indicators are going to be. How will the authorities monitor and report on those performance indicators?

The bill has very scant detail on how all of this is going to work in a real setting. It has very scant detail on how the three national government agencies—the Australian Commission on Safety and Quality in Health Care, the National Health Performance Authority, the Hospital Pricing Authority—will be able to work together to deliver improvements in the Australian healthcare system. The bill does not give the NHPA enforcement powers. It will be unable to compel any state or territory government to act to provide performance data. What is the point of that? Additionally, it cannot compel individual providers to make changes that will result in much better performance.

There is a whole level of confusion out there in the healthcare sector. I regularly meet with doctors and other health professionals who do not understand what these new Medicare Locals are going to do. No details are being provided. What will they do? What will be the interaction between stakeholders and the community? There is a whole level of confusion, and what this bill does is bring in another layer of confusion and another layer of bureaucracy.

The AMA has very grave concerns about the bill. The AMA has concerns about what data will have to be collected and how it will have to be supplied. We on this side are all concerned that this legislation does not provide for appropriate interaction between the authority and the Australian Commission on Safety and Quality in Health Care, the commission or the proposed independent Hospital Pricing Authority. There will be important synergies between these organisations that should be reflected in this legislation. For example, it is reasonable to expect that performance indicators formulated by the authority will be contingent upon the indicators relating to healthcare safety and quality matters that the commission formulates. The functions of the authority include the monitoring and the preparing of reports on matters relating to the performance of private hospitals and other bodies or organisations that provide healthcare services. The explanatory memorandum states that these measures will have no regulatory impact on individuals and businesses. Who believes that? We do not believe that that is a true statement of what is going to happen out there. The collection and the provision of data to the authority by very small hospitals, of which I have many in my electorate of Brisbane, and organisations that provide healthcare services, such as medical practices, will potentially have a significant impact on them, especially if it requires the development of new systems. And there will have to be new systems implemented to gather all of this data. As if private medical practices do not have enough bureaucracy already; they will be required to collect and report the data. The full regulatory cost impacts for these entities should be properly assessed. We have to be certain that the activity of the data collection and the reporting by the healthcare providers is not onerous and does not detract resources away from the primary health care that they provide day in, day out to thousands of my constituents in the electorate of Brisbane.

It may also be appropriate for the government to provide financial assistance to these entities for the additional cost of collecting and reporting against these performance indicators, because there will be a whole new level of procedures and bureaucracies that will have to be put in place in these medical practices and small private hospitals. Further, there is no certainty yet on the type of information to be collected. The legislation makes no provision for the type and the scope of the data to be collected—a very important aspect, seeing that information is the key of this particular bill. What cost is going to be involved in collecting the additional information that private practitioners and hospitals have to collect? As I mentioned, smaller private hospitals and medical practices will struggle to collect and provide data as opposed to getting on with their core business, which is primary health care.

Managers of local hospital networks or hospitals must be provided reports indicating 'poor performance', but there is no indication of what constitutes 'poor performance' and what devices will be used to compel these organisations to provide data or to take those very steps to correct this poor performance. The coalition oppose the establishment of this new bureaucracy and we stated that in the 2010 election. We propose to redirect the $109 million in the case of the NHPA to frontline services to make sure there is real action on hospitals, real action on funding nursing and a real plan for better mental health policies. These were well received by the people of Brisbane when we released these policies in the lead-up to the election. The people of Brisbane need more health services. What they do not need is more bureaucracy. They need more doctors, more nurses and more health professionals, not more agencies that collect data at the expense of very good primary health care.

The lack of clarity in the role that the authority has and the extensions of the levels of non-core improvements make it very difficult to see what is good about this bill. There are a number of local, state and national performance monitoring schemes already operating in the sector. Are you going to bring in another layer of bureaucracy? I have spoken to nurses. I have nurses in my family who spend their day, day in, day out, filling out paperwork and they feel severely impeded in their ability to care for their patients. Nurses are telling me the same thing. What they want is more resources. They want more staff to provide better care. They do not need to have good clinical staff taken away from the bedside, which is what we all expect, to undertake yet more onerous data collection.

Another cause of concern is the ineptitude that we already see in our state from the Bligh government running the health system in Queensland. The Bligh government will close down the Royal Children's Hospital and there has been absolutely no consultation. Again, they are taking away key, important services for one of the fastest growing areas—the inner city of Brisbane and the inner north. There are still ongoing battles that constituents come to me with day in, day out, including the nurses' payroll issues, which still have not been solved. Still many of my constituents come to talk to me and ask for my assistance in just getting some simple payroll issues rectified. And here we have more bureaucracy coming into health when in Queensland we cannot even get our payroll issues right. So imagine what putting another layer of bureaucracy is going to do to an already dysfunctional health system in Queensland. Elective surgery waiting lists continue to grow in my state and continue to grow in the electorate of Brisbane. To add further red tape to the system would only result in further problems in Queensland. This bill has many, many flaws. The government really needs to go back to the drawing board on this one.

Rob Mitchell (McEwen, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the government's National Health Reform Amendment (National Health Performance Authority) Bill 2011. One of the Gillard government's top priorities is health. We continue to invest in and fund healthcare services so Australians have the best health care no matter where they choose to live. As members of this place are aware, McEwen is a very diverse electorate, and I am fortunate enough to represent rural areas, farmlands, new growth suburbs, small towns and highly populated suburbs. McEwen is an example of how, no matter where you choose to live, the Gillard Labor government is investing in healthcare services for all. When you travel across my electorate you see the ongoing investments in health care and health services by this Labor government. Unlike the Liberal Party, we do not discriminate by postcode; we believe that all Australians have a right to affordable and accessible health care.

I am delighted to speak on this bill, which will go to strengthen and build on this government investment in health. The passage of this bill will establish a national performance authority under the Financial Management and Accountability Act 1997. The performance authority will be a statutory body which will come under the National Health and Hospitals Network agreement. The performance authority's function will be to monitor and report on the performance of local hospital networks, public and private hospitals, Medicare Locals and other healthcare service providers. The authority will deliver clear and transparent performance reporting against a new performance and accountability framework to provide Australians, for the first time, with information about the performance of their health and hospital services in a way that is both nationally consistent and relevant. Not only is the authority a key to the government's health reform agenda but it will ensure the production of clear and transparent reporting of every local hospital network and the hospitals within it through routine and regular hospital performance reports. This builds on our establishment of the MyHospitals website, which compares the performance of emergency departments and elective surgery in public hospitals around Australia for the first time. The Gillard government is investing $16.4 billion in the health system and imposing tough national standards to make sure that money goes where it should and in turn delivers the funding that our hospitals need.

The new health reform deal, which the performance authority will go towards strengthening, will deliver a better deal—a long-term solution and a deal that will last, not just a short-term fix—for Australian patients. The Gillard government is continuing to invest in our health services to ensure that all families, no matter where they choose to live, are able to access the services they require.

Recently I was pleased to announce as part of our 2011-12 federal budget that Kilmore and District Hospital will receive $10 million. Never before has the hospital received money of that magnitude from the federal government, but our government is committed to making sure that all people get access to good quality healthcare services. This funding will go to the redevelopment of the theatre suite and the day procedures and recovery unit; the expansion and enhancement of the acute inpatient facility to provide expanded acute care services and increase the number of acute care beds from 30 to 60; and the construction of a new outpatient facility to deliver comprehensive, integrated primary health care. This is fantastic news for my community.

The Baillieu Liberal government made an election commitment to also provide $2 million to Kilmore hospital. But, unfortunately, in the state budget this commitment was not funded. It was not delivered on either, despite the state government saying that in their first budget they would deliver on all election commitments—except, apparently, for their commitments on health. I will continue to put pressure on the Baillieu government to ensure that they keep their promise to the people of McEwen.

In this government's responsible budget, which will get us back in the black by 2012-13, we have seen a great investment in health. This is particularly the case in my community, and for that I would like to thank the Prime Minister, the Treasurer, the Minister for Health and Ageing and everyone that has been involved in understanding the importance of health care and its funding in my community. Locally, this builds on the government's $3.5 million commitment to building GP super clinics in Wallan and a GP super clinic in South Morang.

Those opposite opposed these measures, but who is surprised by that? The Leader of the Opposition ripped more than $1 billion out of hospitals in just five years. In 2003, he cut $108 million. In 2004, he cut $172 million. In 2005, he cut $264 million. In 2006, he cut a further $372 million. In 2007, his final year as health minister, he cut more. In 2007, the Leader of the Opposition was more focused on his own re-election than on getting health policy right. In July 2007, he would not start negotiations on the coming Australian healthcare agreements because he prioritised his own re-election over the health of Australians. On Lateline on 24 July 2007, the now Leader of the Opposition said, 'The important task at the present time is to get re-elected and that is where my energies are focused.'

Things have not changed; he is still the same. Without any real plans of his own, the Leader of the Opposition continues to oppose everything in the hope that one day he will become Prime Minister. He says he has a plan to get us back into surplus, but he will not say how he will do it. In fact, this week we learned that there is a $70 billion black hole in his costings, which would be a further burden for this nation to bear. He has nothing to say, but he likes telling people anyway. On all the big calls, such as the historic health reform deal that he opposed, the Leader of the Opposition gets it wrong. When it comes to mental health, the government is delivering a $2.2 billion comprehensive package focusing on early intervention and coordinated care—the largest ever package in mental health. The Liberal party would fund mental health by cutting essential services such as GP super clinics, e-health and the after-hours GP hotline.

Federal Labor has increased hospital funding by 50 percent. There are 1,300 new sub-acute beds and support for 2,500 new aged-care beds. On the other hand, when the Liberal Party were in office, they ripped $1 billion—which is equivalent to 1,025 beds—out of hospitals. The Gillard government is training 6,000 new doctors by 2020. This includes a doubling of the number of GP training places to 1,200 a year by 2014. But the Liberal Party wanted to put a cap on GP training places, and, at the end of the Howard government's 12 years of nothing, six in 10 Australians lived in an area with doctor shortages. That is an absolute disgrace. Under this government, more than 70,000 surgery procedures have been delivered in the last two years, slashing hospital waiting lists. Under the previous Liberal government, there were 88,630 Australians who had to wait longer than clinically recommended for elective surgery. Federal Labor is delivering 22 regional cancer centres and 44 McGrath Foundation specialist breast cancer nurses.

Compare that to what happened when the previous Liberal government were in power. There was no significant investment in rural cancer infrastructure, despite rural patients being up to three times more likely to die than their city counterparts within five years of their diagnosis. I think it is important that we look at the history—if you want to look where they are going, just look at where they have come from. Those opposite talk about the great old days of the Howard government, but it was not great if you needed health care; in fact, it was absolutely appalling. It appears that in Victoria the apple does not fall far from the tree and that they will continue down that path.

Australia's healthcare system is one of the best-performing systems in the world, and we are very fortunate to have well-trained doctors, nurses and medical staff. Patients are already seeing results from the Gillard government's investment in health. Extra beds have been delivered and new doctor training places are opening up this year. From 1 July, patients will begin to see the training of the 6,000 further doctors, the delivery of 1,300 more sub-acute beds and strict deadlines for emergency departments and elective surgery waiting times. Patients will get more information, and there will be tough national standards such as a four-hour emergency waiting time. However, we believe that we must continue to support and invest in our healthcare system to make sure that it remains the best in the world. We need to reform the system in order to meet the demands of an ageing population and increasing rates of chronic disease and to take advantage of improvements in medical and other technologies. The National Health Reform Amendment (National Health Performance Authority) Bill will go to strengthening the National Health and Hospitals Network agreement and building on this government's health reform agenda. There are endless reasons as to why we must improve our healthcare system, and this bill is one of the many measures we are taking to ensure patients get the best care when they need it.

This week we find the opening of the Northern Hospital, the one that the former Kennett government were threatening not to fund. I am sure, Deputy Speaker Vamvakinou, you would know the PANCH hospital well—a 500-bed hospital closed by a Liberal government. Then they opened the new one, the Northern Hospital, and they brought out 180 beds and said, 'Wow! Look at us. We have just opened an extra 180 beds in the northern suburbs.' I am sure even if they counted their numbers they would figure out that is still a shortfall. It is a shortfall that we have to continue to keep working on and delivering on.

Unfortunately, again, a Liberal government are now refusing to upgrade the emergency ward in the Northern Hospital to upgrade the training places and facilities. It is an area that has thousands upon thousands of more people moving into it and they want to cut back on hospital health care and services for the people of the northern suburbs of Melbourne. It is an absolute shame, but what it shows is the consistency of Liberal governments in cutting health care. They do not care about it. They are not interested in it—they never have been. The leopards over on that side will never change their spots.

I am very proud to support this government's National Health Reform Amendment (National Health Performance Authority) Bill because it continues to deliver on this government's commitment to bring better health care to people, no matter where they live.

Dan Tehan (Wannon, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. I would love to be standing here tonight saying that what we have is real reform for the Australian health system but, sadly, we do not. I have some personal experience with this because my mother, the late Marie Tehan, introduced serious health reform in the state of Victoria between 1992 and 1996. That period was incredibly challenging for the then government because the Cain-Kirner government had left the state of Victoria with a $33 billion debt. The interest on that debt was equal to that of delivering a large state government department. So when the Kennett government came in they were faced with getting the budget back in order—sadly, an all too familiar story—but also with really having to drive reform through.

My mother, the late Marie Tehan, had four principles by which she went about achieving reform in the state of Victoria. She wanted to put people first rather than institutions or systems. She wanted to ensure a fair distribution of limited resources to obtain value for taxpayers' funds and to provide a better health status and outcome for all Victorians. There were two major ways that she set about doing this. The first was to introduce casemix funding, which has been rolled out not only by other states in the Commonwealth but also overseas. Also, she introduced health networks. The bottom line was that an extra 30,000 patients were treated by Victorian acute hospitals in the first 12 months. On the category 1 waiting list that is for people who are waiting for heart surgery and life-saving surgery, 30,000 more patients were treated. That is what real reform is about.

After Neil Blewett stated in this parliament that those reforms were 'the most imaginative set of reforms to deal with the hospital system in this country in the last half a dozen years', an Age editorial in February 1994, with the headline 'Healthy praise', said:

Dr Neal Blewett, the former federal Labor health minister who retired on Thursday, used his retirement speech in the House of Representatives to praise the Victorian government’s health changes and to congratulate its health minister, Mrs Tehan, for introducing casemix funding in public hospitals.

The editorial went on to say:

In calling her changes ‘the most imaginative set of reforms to deal with the hospital system in this country in the last half a dozen years’, Dr Blewett not only speaks the truth, but gives a generous and genuine endorsement his former colleagues could do well to acknowledge.

I think that is true. It is sad that what we have before us here has not taken up the gauntlet and put real reform at the heart of our national health system.

Sadly, instead, what we are seeing once again is the creation of another great big bureaucracy. This is not putting the resources where they need to go. The resources need to go where there will deliver outcomes for patients, not where they will deliver outcomes for bureaucrats. These reforms, sadly, are not going to do this. I do not know why we need to always head down this path where we seem to think that having more people in charge overseeing the system will lead to better results. What we need to see is more doctors, more nurses and greater throughput of patients through our hospitals. What we need to see is better results from that throughput, better management and better health outcomes. This is what should be at the heart of this reform process, but it is not.

Some might see this as just partisan statements on behalf of our side, the coalition, but it is not. When you look at what some serious medical groups have said on this issue you will see that it highlights that we are not alone in saying that these reforms really lack the necessity of delivering a better health system in this country. The AMA, for instance, have called for the legislation to be deferred. They want an assessment of the impact of the legislation. They want to know the detail of what data will have to be collected and supplied. They dispute the government claims that the NPA will not have a regulatory impact on businesses or individuals and they fear that smaller private hospitals and medical practices will not be able to cope with as yet undefined data collection. They want open and transparent processes and accountability to parliament. These are serious issues, yet this government is not taking them into consideration.

The Consumer Health Forum says that there is a need for the legislation to outline at least a minimum scope for areas of performance to be assessed. It wants more details on the functions of the NPA and greater safeguards for patients. These comments and criticisms come from major stakeholders and should be taken seriously by the government.

The Australian Private Hospitals Association fears yet another layer of compliance burden, requiring multiple reports to multiple government agencies. Surely a simple reporting system would be at the heart of reform rather than another process leading to multiple reporting requirements. The Australian Private Hospitals Association wants parliamentary scrutiny of the data hospitals will be required to provide.

The Royal Australian College of General Practitioners warn that the provisions of this bill 'hold long-term threats to harm the current high standard of medical services, and consequently health services, delivered to the community'—very worrying—and that these provisions could drive health management to be focused on performance and cost cutting more than patient care. They had concerns about virtually every aspect of the bill. They warned of significant overlap between this new bureaucracy and the existing Australian Commission on Safety and Quality in Health Care. So, not only are we getting extra bureaucracy, we are once again getting extra regulation. Real reform would cut the number of bureaucrats needed to administer the system. Real reform would cut the regulatory burden on our hospitals, both public and private. We do not see that with this bill.

The Australian Institute for Primary Care and Ageing warned about functional overlap between the two bodies. The Council of Procedural Specialists could see 'no justification or compelling case' as to why the NPA was needed. There is still a lot more explaining for the government to do on this bill. The Australian Institute of Health and Welfare, an independent body, already collects reliable, regular and relevant information and statistics on hospitals and health care. We are still waiting to see some key definitions in the regulations on this bill, including how outcomes are going to be measured, probably the most difficult aspect of introducing any reform in the health system.

This is another area where the federal government, the Gillard government, seems to have a tin ear. The Gillard government has ignored the outcomes of COAG and produced a bill that has ridden roughshod over the states and territories. The minister has completely failed to recognise that the states and territories actually own and manage public hospitals. Why not introduce a system where you pick the best reforms that have occurred in each state and then encourage the other states to implement those? If they have been shown to deliver results in one state, surely other states would take them up and implement them. Wouldn't that be better than this system of producing a large bureaucracy in Canberra and telling the rest of the country how it should be done? Fortunately, in the recent negotiations the states have reasserted their dominant role in running public hospitals and local hospital networks. But we have to ensure now that the funding does not place a large burden on these state run hospitals and make sure that they can access the money to deliver the health outcomes that we so desperately need in this country.

There is no doubt that real reform is still needed in our national health system, but once again we have to be very careful about how we go about achieving it. We have to ensure that in the ultimate outcome patients and taxpayers are the winners. As I highlighted earlier, we are dealing with limited resources. We cannot continue to raise our debt ceiling on and on and upwards and upwards. We have reached $110 billion in the space of a bit over three years. If we continue to raise that debt ceiling then the limited resources that we can put to our health networks will diminish, not increase. That is an important thing that we must realise.

We also have to ensure that we put people first. I have been a bureaucrat, and I have a lot of respect for the people who work hard in our Public Service. But we have to understand that the role of the bureaucracy is not to grow; the role of the bureaucracy is to deliver results on the ground. Sadly, it would seem that what we are seeing once again is growth here in Canberra rather than funding to the local hospital networks and to driving the reform process through the hospital networks to deliver for patients.

I wish I was here saying that Dr Neal Blewett's advice to his Labor colleagues had been taken on board, that they had looked at what real reform had occurred already in our existing state networks and that they had used that as the basis to drive real reform nationally. Sadly, that has not been the case. I think once again we are going to see a continuation of the blame game, which we were promised was going to end under this Gillard government and, before it, the Rudd government. Hopefully, this is not another broken promise, but we do seem to be heading down that path where the blame game has not ended but will become a reality once again.

I wish that I could stand up here today and say that this has been a bill which will drive another major reform through our health networks. Sadly, I do not think that is the case, and we are going to have to wait for the coalition government to get in and then drive real reform into our national health system. This will not end the blame game. It will lead, sadly, to waiting lists growing rather than receding, and that will then lead to a lot of blame being apportioned from the Commonwealth towards the states, with the states being left with no alternative but to look at the federal government and say, 'It is your reforms which have led to this.'

I hope dearly that this is not the case for patients right across Australia, but given the way this government has rolled out and implemented its policies in the last four years one has to be very sceptical about how the government goes about implementing anything. Sadly, I think these health reforms are going to be like everything else that this government has touched and not end in a good result. (Time expired)

Deborah O'Neill (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the National Health Reform Amendment (National Health Performance Authority) Bill 2011. This bill is another fundamental step in Labor's reforms to the manner in which health services are provided throughout the Commonwealth. I have to take umbrage at the honourable member of Wannon who was just speaking about the rollout of amazing resources across this country under Labor leadership over the last four years. Since I was last in this place I opened $23 million worth of fantastic new facilities under the Building the Education Revolution program in my seat, and the way that has transformed learning and hope in learning communities on the Central Coast is absolutely phenomenal. The recognition in our community of that capacity to lead, to innovate and to invest in things that matter to Australians is absolutely palpable.

But health is an issue, and we as a government understand that and we will get on with delivering what it is that Australia needs—and it certainly needs what this bill is referring to. This bill is another fundamental step that represents the reforms that the Labor Party is committed to delivering throughout our Commonwealth. It is a victory of cooperation between the Commonwealth and the states and it indicates a commitment to effecting real and needed reform for our health system.

I speak to this bill this evening because the provision of health services on the Central Coast has long been a burning issue for my constituents. Throughout my time as the member for Robertson I aim to work with local agencies to improve the manner in which health services are provided on the Central Coast. This was overwhelmingly the most common issue that constituents raised with me during last year's election campaign. I believe that the provision of a GP superclinic on the Central Coast will do much to help alleviate the unmet demand for health services and integrated health care that wraps around the patient, rather than giving the patients the run-around.

The provision of a GP superclinic in my electorate was an issue on which I campaigned strongly and I am very much looking forward to its delivery. The project is on target, with negotiations with the preferred tenderer now completed, and Reliance GP Super Clinic Pty Ltd has been appointed as the service provider of the GP superclinic. This in itself is an important step in providing people of the Central Coast with greater access to medical care. Reliance will be establishing a new GP superclinic and building on that record of working with local hospitals, local GPs and community organisations. It is also planning to develop an outreach clinic on the Bouddi Peninsula, which currently has no medical services at all, subject to the availability of commercially available zone land. This southern Central Coast GP superclinic intends to provide integrated, multidisciplinary, team based, patient centred health care under one roof and it will certainly take pressure off other GP services around the area. It indicates at my local level the incredible investment that the Gillard government is making in GP superclinics across the country—$528 million committed to build 64 GP superclinics. We obviously have a great commitment to improving the health outcomes and health experiences of those Australians out there who rely on their government to take seriously the need for reform and rebuilding as their needs change.

Despite this great GP superclinic in my electorate, I want to speak on this bill because, in addition to that, there are quite a number of other health services that can certainly be further improved. We need to continue the complete and systematic reorganisation of our health services and set out transparently how they are being supplied throughout the Commonwealth. I believe that this legislation, the National Health Reform Amendment (National Health Performance Authority) Bill 2011, once enacted, will achieve these goals.

The primary reason the Central Coast as a region has had difficulty in meeting demand for health services is that there has been a distinct lack of decision-making power at the local level. This has also been a facilitator for a lack of transparency over the practical challenge of public funding, and it has often been a problem where money has been caught between federal and state governments. This is not the fault of those who work in healthcare management on the Central Coast—in fact, members of the electorate are always telling me how amazing their experiences have been in terms of the care that they receive—but the problems that exist have not been assisted by the fact that the Central Coast did not have its own local healthcare authority. In fact, we were attached to northern Sydney, which has a completely different demographic and a completely different geographical structure to us. I certainly believe that the establishment of the local hospital networks will improve the provision of health care on the Central Coast and in other regions where, similarly, the wrap-around will fit the community, instead of somebody's idea of a community watched from afar. I am also supported in this belief by having met many medical professionals and healthcare workers with whom I have discussed these matters. The reason I believe it will work is that local hospital networks will certainly have a far greater understanding of the healthcare needs of their particular local area—and, in my case, the needs of the people on the Central Coast. Furthermore, because the local hospital networks represent management at a local level, they will be under more direct accountability than any alternative involving a more centralised governance model. This will increase response capacity and it will also increase transparency and accountability to the local community who require the services.

An example of why the Central Coast, including my electorate of Robertson, needs its own local authority is the demographic characteristics of the region. Recently the Australian Bureau of Statistics declared the Central Coast a category 4 region for the collection of data, which is just below the state level, and, for the first time, when the census came through just a week or so ago, they gathered data about the Central Coast as a region. We know, based on the best available evidence at this point in time, that we have a very high proportion of constituents who are of retirement age. At the last census, the percentage of people at or above retirement was almost 19 per cent of our population, compared with a national average of about 13 per cent.

As a result, the Central Coast will be affected more severely by what some people might call the 'pension bomb'—in other words, the process by which the baby boomer generation will transition into retirement. In fact, there is a really important point that needs to be made about the 100 years of excellent health policy and education that has actually led to the arrival of two generations of aged citizens living at the same time. Having worked hard, many of them have decided to come and settle on the beautiful Central Coast and enjoy their retirement years surrounded by our beautiful beaches, bushland and waterways. It is a tribute to the work of those who helped to set up the care and public education to achieve that outcome.

It means, though, that we need to find ways to rise to the challenge that is present in different ways in different communities. The health care of ageing Australians is a challenge that exemplifies exactly why the way we organise the provision of health care needs to be reformed and to be locally responsive. Different local areas can have vastly different healthcare needs, and centralised management will often not address this.

I commend the government and the health minister in their efforts to reform the manner in which health care is funded. As has been explained many times in this place, the Commonwealth will provide half of the funding for meeting the growth in hospital costs. As has been set out in the Intergenerational report and elsewhere, the issues associated with the ageing population are the primary reason that hospital and healthcare costs have continued to grow.

I speak on this bill because I agree that accountability is fundamental in ensuring that the increased demand for health services is properly met through the Commonwealth—and I am most concerned about that in my electorate of Robertson. This bill, through the establishment of the National Health Performance Authority, the NHPA, provides for exactly this kind of accountability. Whilst I understand concerns raised in this debate that the NHPA is possibly an establishment of another layer of bureaucracy, we do need to understand that there has never been a system of ongoing and comprehensive review of how health services are provided. Audit, we understand, is essential for accountability, and the results are essential to drive review and enable ongoing improvement in any institution. The NHPA will provide that. I believe such a system will have immense benefits for how health services are critiqued, funded and developed on the Central Coast.

I also support this bill because it enables the government to be proactive when managing demand for health services. This is provided for under the legislation through the ability of the authority to produce hospital performance reports and health community reports. As a member of parliament, it will be immensely useful to have access to this type of reporting, which will provide comprehensive analysis of the healthcare needs of my electorate. The reporting will enable the government and the proposed local hospital networks to be much more proactive in dealing with issues related to provision of healthcare services. And that can only be a good thing.

The establishment of the Health Performance Authority will enable comprehensive transparency with regard to the operation of both local hospital networks and Medicare Locals. This reporting will enable Australians to have access to comprehensive information as to how both local hospital networks and Medicare Locals are allocating resources. Furthermore, the Health Performance Authority will provide Australians with information as to whether their money is being effectively and efficiently spent by the local hospital networks and Medical Locals. This transparency and accountability will help ensure the continued improvement of health services through the Commonwealth.

This new, groundbreaking legislation up for debate today really concerns the critical issues of transparency and accountability, and it will provide real and practical benefits to the local constituents in my area and right across the country. It does this in addition to devolving the management of hospitals and health services to the local community.

Whilst I speak of the benefits that this legislation will have in my electorate, I emphasise the fact that it will identify those areas right across the country where greater health funding is needed. It is right that Australians should have a fair share and a fair response to improve the outcomes for all of us, not just some of us. Furthermore, the information that the public will have regarding the healthcare system will be clear and objective. It will not be subject to political opinion and bias, and Australians will have an alternative to the information supplied by the media regarding their healthcare system. For a democracy, access to that information unmediated is a very powerful thing. I speak on this bill because I believe that it is a right for Australians to have access to information regarding the state of their healthcare system.

It is time that in the national interest those opposite support this bill and therefore support reform in our healthcare system. It is time that the national interest is thoroughly considered by all those here in the parliament. This legislation breaks new ground in providing Australians with transparency and accountability with regard to how our money is spent on health. The process by which this reform was negotiated with the states was long and difficult, as any negotiation is. But this government and our health minister have never lacked courage and continued to negotiate very constructively with the states with regard to the provision of health services. Despite the pessimism and carping negativity of those opposite and a few setbacks along the way, the government and COAG have pushed through and succeeded in providing real and practical hospital and healthcare reform in the interests of the nation.

Since being elected as the member for Robertson it has always seemed to me that those opposite cannot bear such good news. Any setback, any difficult negotiation and any compromise is heralded by those opposite as evidence of the impending collapse of the country—on a daily basis, no less. But such alarmist nonsense reveals that they have neither the nerve nor the drive nor the endeavour for reform. That is why critical reforms such as this bill have been left to the Labor Party. The Labor Party is the party that values hope for our future, the party that has the courage and the conviction to work through the challenges and arrive at the delivery of good news and practical action for the nation. And I do rather believe that the proposals contained in this bill before parliament are very good news—good news for the state of our national healthcare system, good news for our hospitals and for Medicare, good news for the people of the Central Coast and good news for the Commonwealth of Australia. I look forward to this significant improvement in how our healthcare services are provided and I commend the bill to the House.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

In joining the debate on the bill for the Health Performance Authority I certainly want to retain the very optimistic view that we have in Australia of a top-three-performing health system. It performs as such for very good reason: we have great people. Never let us forget that health systems perform because of the people in them, not the systems around them. It is important to get both right, but the absolutely necessary and sufficient element in that is the people. The great concern, then, is the zest and the zeal that was very much expounded by the previous speaker. This Labor zeal to reform is a privilege that is earned, not an automatic right of government. This government needs to remember that every one of its revolutions, as each revolution arrives, it is less funded than the previous one. So as these progressively less well funded revolutions occur, that zeal to reform and tip upside down and change and poke, with the desperate hope that it will be better, reminds me of that famous quote: I came, I saw, I was a little confused, I revolutionised—and not very much changed.

The great concern of people on the ground is that bureaucracy, certainly in health, has become this thousand-layer cake upon which ANHPA is effectively the icing—yet another layer in an attempt to keep measuring and monitoring health providers. I think everyone in this chamber would agree that we are trying to do exactly the opposite in health: we are trying to free up and deliberate the great ideas on the ground without compromising, obviously, the very important fiscal requirements of running a health system and containing the cost curve that every Western economy is battling with. We do not have that focus in this legislation. When we look for performance, let us read the detail and see if the word 'performance' is even defined. It is not. In this legislation is poor performance even defined? It is not. So the very notion of a health performance authority or agency is based on this hope, as you are running around with that hammer, that just to build one more bureaucracy could make the difference that the health system is yearning for. That hope is probably utterly futile because what we have are highly performing, competitive states operating in a very tight economic circumstances, and we know that in many cases with public services in states around this country the faster they work the quicker they go broke. Nothing will change with this legislation.

We have tonight in the great city of Gladstone, Queensland, a top-10 city in my state, no surgical coverage for 60,000 people. If there is an incident or a disaster on the Bruce Highway or if there is some need for urgent surgery, Queensland Health will instruct emergency officials in the hospital there to stabilise the patient and then throw them in an ambulance to Rockhampton. There is nothing in this legislation that changes that. Without appearing carping or negative, the great fear I have is that when Australians look at the health system they wonder: can I access a GP for my child when they need one? Can I go to hospital and hope to be seen in a reasonable time in an emergency? Can I get that operation without being continually shuffled from a waiting list to a waiting list to a waiting list? And I suspect if you are a senior you worry about bed block and the ability to be able to shift from being an inpatient to return to your aged-care facility and know that there are provisions available for that.

Those are the four prisms through which we need to examine any reform, because that is what Australians demand of us as law makers. They are not interested that we have been able to convene an authority and who the person is who will lead it or what the reporting arrangements are. They do not know that the AIHW collects data, that the Safety and Quality Council on Health Care collects data, that the COAG Reform Council is collecting data and that the ABS is doing the Australian Health Survey. And now what do we have for you, courtesy of the Labor Party? We have got ANHPA to collect more data. That is right. Do any of these bodies collect data together? Do any of these agencies say, 'I'm sorry, that was incomplete?' Do any of these agencies actually look at each other's data, pull it together and make sure it is reporting off the same platform? Of course not. We have just added in another data collector.

Do not look at me, please, as the guy who does not love health data, but it is not the sufficient element to get a functional health system. We are all collecting the data. The problem is it is not being processed; it is not being collected on a level platform; it is not being compared equally between jurisdictions. Will ANHPA do that? Alas, no. That is not their brief. Their brief can be most closely compared to the CGRIS, the coordinator-general that FaHCSIA have created in their own office to oversee Indigenous services in remote areas. This individual, who works extraordinarily hard visiting communities and writing large reports about how the data is incomplete and how things should be happening but they are not, is utterly powerless. The CGRIS is funded to write these reports upon which nothing is done. This individual could not even employ his own staff. He is meant to be independent of government and writing independent advice, but FaHCSIA employed all his staff. So the same problem that we see in FaHCSIA, the inability to report independently, will simply exist in Health, where there are effectively data collection agencies and rewards for doing the right thing in hospitals. But what will happen when we take money away from hospitals not doing things so well? The patients suffer. I come back to this element of performance. How do you screw down efficiency in a hospital without affecting quality? How do you make a doctor work faster without him jettisoning teaching? There is nothing contained in this legislation to ensure that occurs. When we employ public doctors in public hospitals, some of them are slower because they teach. How is this going to be measured under some of these reporting arrangements?

I go no further than outpatients where this weekend just gone Queensland Health dictated to the second largest hospital in the state that only two outpatient visits will be allowed before that patient has to be returned to their GP for another piece of paper, another referral. Then they can go back and see another two outpatient specialists before they are returned again to their local doctor—hitting up Medicare and sitting in the queue, which is the social cost of travelling to a GP. That is not integrated care. That is a direct result of the federal goal to set benchmarks around how often patients can be seen in outpatients, to encourage throughput in outpatients and, obviously, to create room—which we support—for new outpatients.

Queensland Health responded as any provider would: it capped the visits to outpatients. So a 50-year-old woman diagnosed with diabetes, late stage, low levels of literacy who has been brought into the hospital and referred to that particular hospital can see the diabetic doctor and can be referred across to the dietician. But, after that, down come the shutters. She must go straight down to her GP, wait in the waiting room and get another referral before she can come back and see the podiatrist or the cardiologist, let alone go back to the diabetic doctor again to report on what has happened. This is how we know that providers will respond in an exquisitely rationed environment where you do not have the incentives running the right way.

This legislation will not free up the consultants and the staff to do innovative and imaginative things because those immediately above them in the bureaucracy will be so panicked about having to report data that they will not allow the freedom. We do not reward clinicians for great innovation. There is nothing in this legislation that will allow that to happen.

I speak on behalf of patients who are looking for an interstate operation. Mr Deputy Speaker, from a smaller state like Tasmania, you will know that not every one of our eight jurisdictions, while they do an extraordinary job, can do every operation. We are a health system one-twentieth the size of the United States. Australia's health system, a great health system as it is, cannot expect to provide in every one of our eight jurisdictions every operation known to the health system. At some point there has to be consolidation, not just for breakthrough operations but for operations that are not done as frequently anymore like clipping a large aneurysm in the brain. Most of them are done with an internal platinum coil, but some of them are still so large that we have to do open brain surgery. There are so few of them done that in many jurisdictions there is barely one a year. Do we have to keep funding a doctor and keep that doctor trained to do one operation or is it more sensible to send that person across to a larger state? What happens? Up come the walls of bureaucracy. Does anything in this bill fix the problem for the lady with vascular disease of the brain who needs an operation on the Circle of Willis and waits weeks and weeks while hospital systems shuffle responsibility between each other and the respective states refuse to free up operating time? This is not addressed at all by a performance agency as described in this legislation at all. It will remain.

I want to tempt, for the optimism of the other side, an almost euphoric optimism that by creating this new body all things can be fixed in the health system. It is actually much harder than that. The right to reform a health system is a privilege that is earned. It is not an automatic shift to a new revolution because we need another press release. I said about our previous Prime Minister that he would revolutionise everything else and I said, 'I promise you he has not fixed the health system, but this ex-prime minister has one more revolution up his sleeve and that is the revolution of the health system,' and sure enough it came along and it came along just a couple of weeks after the opposition leader announced, so insightfully, hospital boards for the struggling health systems of New South Wales and Queensland. What were they? They were effectively administrative and reporting boards to oversee the work of bureaucrats in each one of our hospitals. They provided information to the public and they also took information directly to bureaucrats and obtained answers. Whether you like the idea of hospital boards or not, it was only weeks later that we were sold by this administration the notion of equally local boards that happened to cover regions as large as nine major hospitals.

To hear the previous speaker saying that decisions sometimes are better made locally is one of the great understatements from this current government, because there is nothing local about the Medicare Locals. The word 'Medicare' is only in there at the insistence of the staffers of the previous Prime Minister. So we are left with this curious term Medicare Locals that actually is an amalgamation of a number of divisions.

The previous speaker really loves local health decision making. What was wrong with basing it on divisions? What was wrong with working with our existing structures? They were completely adequate for that role. Instead, we are left with Medicare Locals that—wait for it—do not conform to local hospital boundaries. Here are our hospital boundaries and the Medicare Locals run across like this so patients are in one hospital boundary and a different Medicare Local. It should have been quite easy to fix. And would it not have been that hard also to align those boundaries with ambulance boundaries so that the ambulance takes you to the hospital where you live and where they work? It was not hard to do that either.

It was not hard to align some of those boundaries with local boundaries of interest like local government areas, because they run the emergency responses in most states I have been to. But what happens is they do not do it very often, they often do not have the capacity and then they find themselves with a conflict of interest because the large hospital is located in a different local government area to those where the people are affected. The Queensland floods were such a great example. Toowoomba was mostly focused on Toowoomba needs. All the other local government jurisdictions had neither the capacity to respond to the floods nor the ambulance services to go out and reach the Australians that needed them most. Another simple solution has been completely passed up.

I have spoken about the surgeons. I have spoken about the patients that rely on services. I have talked about how outpatients effectively will not change and how, if it does, we could compromise teaching. I have talked about waiting for a waiting list by being on a waiting list for the waiting list and by being constantly passed over. The only way off a state government waiting list in many cases, regrettably, is to get sicker until you need it urgently, give up waiting and take out private health cover or, for many tragically, to pass away. That is not the health system that we signed up for. We as a nation signed up for a responsive system that rewarded innovation. It is easy to say but will not be fixed with this notion of a performance authority.

The one glimmer of optimism—and I have been asked for optimism from the other side so I will give it to them—is that there are great people on the ground who will decipher the health minister's press release. It is one page. They try to work out what she is going on about and what this means for their job? The one thing about reform is that, when you threaten everyone with their jobs in reform, the first thing they focus on is keeping their job, and most of the health professionals right now are seriously wondering, 'Where will my program be when Medicare Locals evolves?'

What is the relationship with state community health, when in many major cases and jurisdictions they have refused to merge until 2015 or later? When people are frightened like that you do not get the innovation you need. You get perverse reactions and people often operating to work out a way to save their jobs. We do not have any undertaking yet on whether there will be a state based role for divisions and it seems almost inconceivable that this large number of Medicare Locals can operate completely independently and find the capacity they need to do training and operate as political bodies as well as funding bodies and then also to be reporting directly to Canberra. To do so without some form of state collaboration means that Medicare Locals cannot talk to state governments. That has been wiped out.

There are a number of concerns I have about this legislation that have not been addressed. Australians will look back on us and judge us harshly. They will look at the health system five years from now and they will judge the administration today for the decision they made. I remind them, without giving gratuitous advice, that they will look at waiting lists. They will look at the availability of a hospital doctor. They will not appreciate seeing public hospitals secretly bulking-billing patients, undercutting GPs, suspending continuity of care and, most importantly, undermining deputised medical services, the very after-hours care that ensures that people who get sick at night have their medical records transferred back to GPs. That is all wiped out as well. This is a government that does not understand after-hours care or how to deliver it. And it can all be solved with a hotline. They will learn that it is not that simple. Health care is extraordinarily complex. You tamper with it with great care and caution and you make sure that you have the best minds on your side when you do it.

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

It is no surprise that I follow a member of the opposition who, once again, has made his contribution to this debate by attacking the legislation and opposing it. He talks about how a patient asks how they will access a GP when they need it. He made a commitment to rationalise health services and he talks about Medicare Locals, and when he does that it shows that he has very little understanding of what a Medicare Local is and very little understanding about how it will operate. He also has no historic knowledge of what has brought us to the point we are at today.

The first step that brought us to where we are today came about in November 2006—or before that, when the Health and Ageing Committee tabled a report, the Blame game.The inquiry took place over the period from when the Howard government was elected in 2004 and it was conducted because the now Leader of the Opposition, the then health minister, thought that our health system needed reform.

The first recommendation of the Blame game was that the Australian state and territory governments develop and adopt a national health agenda—exactly what both the Rudd and Gillard governments have done. The national health agenda was to identify policies and funding principles to initiate and rationalise the roles and responsibility of government including their funding responsibilities. They were to improve long-term sustainability of the whole of the health system, support the best and most appropriate clinical care, support affordable access to best practice, rectify the structural and locative inefficiencies in the whole health system, give a clear articulation of the standard of service that the community could expect, redress inequities in the service quality and access, and provide a reporting framework on the performance of health services, providers and government. That is recommendation 1. The National Health Reform Amendment (National Health Performance Authority) Bill 2011 we have before us today does exactly what the last dot point says. It provides a reporting framework on the performance of health service providers and government.

I will just take us back to that Howard government of 2004 when the Leader of the Opposition believed that we should have health reform. He could see that there were inequities within the health system. He saw that the blame game existed where state and federal governments tended to shift the blame if something went wrong instead of taking responsibility. The whole package looks to deal with that, and this particular piece of legislation looks at the reporting framework.

I will also add for the benefit of the House, that this piece of legislation was referred to the Committee on Health and Ageing. We conducted a hearing into the legislation and we supported the legislation. We supported the establishment of a national health performance audit authority and we could see that this was about: making sure that we had national transparency and accountability; the identification of high-performing parts of the health system; the identification of those parts of the health system that needed to undergo some improvement; and improving the health choices of Australians in making decisions about their own healthcare needs. When this particular piece of legislation was referred to the committee—and it is part of the whole tranche of legislation that is being considered in relation to health reform—we decided that the legislation was good legislation. But we also recommended an improvement in the legislation, that an additional requirement be incorporated into clause 60(1)(b) of the bill to require that an annual report on the performance of local hospital networks, public hospitals, private hospitals, primary healthcare organisations and other organisations that provide healthcare services be compiled by the performance authority and presented to the Minister for Health and Ageing for presentation to the parliament. That was included in the recommendations of the committee. That was the only change that was made. That was made to improve the transparency and accountability and to bring together this health reform agenda.

The member for Bowman was not at all supportive of Medicare Locals in the region I come from, which is the Hunter and the Central Coast. The Hunter has its Medicare local appointed. It is GP access. The Hunter Division of GPs, who have extensive knowledge of the needs of the area, have been involved in providing after-hours service for a very long period of time and truly understand the needs of that area. The Medicare local has not been appointed yet on the Central Coast. It is important to note that, prior to the Medicare Local areas being identified, the Central Coast was part of northern Sydney. The North Shore of Sydney and the Central Coast were lumped together. You cannot tell me or any member of parliament from the Central Coast that those areas have the same needs. They are very diverse areas. The people who live in those areas know that what they need is different to what the people living on the North Shore of Sydney need. They know they do not have the same access to services as the people living on the North Shore of Sydney. This legislation delivers local solutions to local areas. This legislation looks at the transparency and the accountability that is expected from the government.

I cannot talk on this legislation without congratulating the Prime Minister on the agreement that was reached on 8 October. The Gillard government has delivered national health reform with an agreement now in place between every state in this country—something that was never achieved by the now opposition when the Leader of the Opposition was the Minister for Health and Ageing. Rather than division we have a positive outcome. We have something to move forward on. People are working together. We have reforms in place that guarantee more money, more beds, less wait and less waste. They also deliver better GP, primary and aged-care services—something that the previous Howard government could not do. Most importantly, it will end the blame game and the cost-shifting that marked the Howard government years. Why do I say that is the most important thing? Because that blame game and cost-shifting saw thousands of Australians go without their health needs being met. This is about delivering to Australians who had been marginalised by the Howard government during its time in power.

The reforms will, as I have already mentioned, deliver more money. There will be an extra $19.8 billion for public hospitals, covering 2.9 million more emergency cases. My daughter-in-law works as an accident and emergency nurse. I know how busy she gets. I know the constraints that are put upon them. This extra money will mean they will be able to deliver services to those patients who visit the accident and emergency department. It will cut the time that they have to wait in accident and emergency. The staff working in accident and emergency will have the support to do the things that they know need to be done. There will be two million more in-patient services, like major surgery, and 19 million more outpatient services, like minor operations and physiotherapy. People have had to wait not for weeks or even months sometimes but years to obtain those services in the public system.

As I have said, this is about delivering services to Australians in their community when they need it, in a timely fashion. It will mean more doctors. There will be 5,500 more GPs and 680 specialists trained—something the previous government failed to do. Instead of addressing the chronic shortage of doctors, specialists, allied health service providers and nurses, they exacerbated the shortages. There will be more local decisions. That is the Medicare Locals. The decisions will be made by the clinicians, the hospital staff and the community who know the needs of the community they live in.

These reforms also deliver less waste. Hospitals will be funded for what they actually deliver. There will be shorter waiting times in emergency departments and for elective surgery. Instead of people going on a waiting list and having to wait years—and I mean 'years'—to have surgery, it will happen a lot quicker. The reforms will also deliver better GP, primary and aged care. There will be more after-hours services, new GP training places, new GP superclinics and direct Commonwealth responsibility in most states for basic community care for the over-65s.

I want to commend one program that saw four GP practices within the Shortland electorate receive money. Under the health infrastructure program Jewells Medical Centre received $500,000. The facilities they are building there are fantastic. Not only will they be able to have more doctors working out of there, provide training for doctors and work very closely with Valley to Coast but they will also have room there for allied health professionals, like dieticians and psychologists. Even occupational therapists will be able to come in and work out those rooms providing, once again, local services to local communities where there is a need identified. The Labor Party is the only party that really cares about hospitals and ensuring that people can get services when they need them. We care about making sure that services are not determined on your ability to pay or where you live but on your needs. We are about fixing the blame game—something that the previous government did not do—and we are delivering the hospitals and community care to Australians when they need it.

As I mentioned earlier this particular piece of legislation was looked at in great detail by the Standing Committee on Health and Ageing. The bill stipulates that the performance authority also has the role of formulating performance indicators, collecting, analysing and interpreting performance information, and promoting, supporting, encouraging, conducting and evaluating research. This is vital information. We can have all the extra services, we can have Medicare Locals operating and we can stop the blame game, but if we do not have in place the proper accountability, the proper reporting requirements, then we cannot guarantee that our health system will operate as effectively and efficiently as it should. This is good legislation. It is about the Gillard government stopping the blame game and delivering health services to all Australians.

Andrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | Link to this | Hansard source

It must be hard being a Labor government member and talking about the government's health plans, because you really have to keep up. Every year the government has a new health plan. I think we are onto the Rudd-Gillard government's health policy mark 4 or 5. Before Kevin Rudd was elected Prime Minister he was going to fix the public hospitals by mid-2009 and he was going to step in and take them over if the states did not come up to the plate. Last year, while Kevin Rudd was still Prime Minister, he described his reforms as the most historic changes since Medicare. Those reforms did not proceed. Only just last month Prime Minister Gillard described these reforms as the most fundamental changes since Medicare.

It is really hard to have anything complimentary to say about this government's approach to health because after almost four years in government they have no runs on the board. There are no improvements to the health system or to health services that they can point to. Their legacy will be statutory authorities and more bureaucracy but no improvements in health services.

The National Health Reform Amendment (National Health Performance Authority) Bill 2011 is yet another example. It is another bill which proposes to establish another statutory authority. It does it by amending the National Health and Hospitals Network Act 2010, legislation only passed by the House at the end of March. This bill, amongst other things, aims to create the National Health Performance Authority. We already know that there will be future amendments to establish the independent hospital pricing authority. The current bill is the second step in the government's plan to reform the healthcare system. It changes the title of the act to the National Health Reform Act 2011 to reflect the changes made to the government's historic health reforms under the new Prime Minister Gillard.

I move to the functions of the authority itself. The purpose of the National Health Performance Authority will be to monitor and report on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services. There is a lack of clarity about the role and function of the authority. It has an extremely wide-ranging purpose statement. This is the problem across everything that the government has done on health.

When the previous Labor government introduced Medicare, that had a clarity of purpose. When the previous Howard government introduced the private health insurance rebate, that had a clarity of purpose which everyone understood. It was simple. No-one can follow the twists and turns, backflips and changes that have occurred in health under this government. On the specific performance authority the Bills Digest compiled by the Parliamentary Library states:

This lack of detail combined with the lack of power attributed to the Authority raises questions about the extent to which the Authority can achieve its objectives as set out in the Bill … or as articulated by Government.

This legislation raises more questions than it answers. There are absolutely no details about the performance indicators that the authority will monitor. We have a government authority that does not know what it is meant to be reporting on. They are meant to decide that themselves.

If the government were serious about this authority, the legislation would outline a minimum scope for the areas of performance to be assessed by them. It is also unclear how many primary healthcare providers will be monitored directly by the NHPA or what the scope of the monitoring will be. It is unclear whether general practice will be monitored. This is an area where clarity is needed, and has been requested by the Royal Australian College of General Practitioners.

We do not know how often the NHPA is going to report, how detailed those reports are going to be, or what they are going to contain. But, worst of all, it seems the authority will be limp when it comes to the power to compel organisations to provide information to the authority. The authority will be relying on the goodwill of healthcare organisations to provide the data they need. Indeed, the Bills Digest again states that the legislation:

… does not give the Authority any enforcement powers; it cannot compel state and territory governments, private and non-government organisations to provide performance data and it cannot compel individual providers to make changes that will lead to better performance.

On the reform agenda more broadly we in the opposition have repeatedly called for the government to provide all the provisions to establish their full reform agenda to this parliament at the one time. They should provide the legislative provisions to establish all their new government bodies at one time so that this House and those affected by the changes—the stakeholders and the community at large—can see just how all these bodies are going to interact before these measures are considered by the parliament. Instead, we have been drip-fed bill after bill and amendment after amendment and have been forced to put their health reform agenda together like a puzzle, working out where each piece is meant to fit.

These constant changes and amendments are just another example that the health minister is struggling to get this right. This is further demonstrated by the fact that the minister ignored the outcomes of COAG and produced a bill that walked all over the states and territories anyway. The content of their bill was contrary to, and overrode, the outcomes of the heads of agreement signed at the COAG meeting in February 2011. The states and territories actually own and manage the public hospital system. The states and territories are responsible for the planning of their state-wide health services, and the minister needs to remember that. This is compounded by the fact that the authority will have no power to compel the state and territories or their hospitals to provide information. The minister is now having to make substantial amendments to correct this attempt to walk over the states. The states won the battle and the minister has had to retreat. What we see today in the news is more back-downs and more retreating from their 'historic' health reforms—and I do not think this will be the last word on that.

There have been so many backflips by this government. The capitation payment for diabetes for general practice was not well thought through and was opposed by every health group, and the government backflipped on that. The lack of after-hours cover between the wind-down of the divisions of general practice and the tier 1, 2 and 3 payments for after-hours care and the establishment of Medicare Local were, again, not well thought through and the government had to back down on them. The social work and OT access to Medicare for people with mental health issues were, again, not well thought through and the government had to back down on them.

Every time an announcement in health is made, it is 'historic' and is 'delivering on the government's health reform agenda', but I fear that, like every other historic announcement, this will be a case of over-promising and under-delivering. As I speak to GPs, specialists, allied health providers and people who work both in primary care and in the hospital system, no-one believes that this government has a capacity to improve the running of health services. No-one believes that adding extra layers of bureaucracy and having more managers and more bureaucrats will improve health for patients or improve their journeys through the health system. The government have a long list of health announcements where they have over-promised and under-delivered. They promised 64 GP superclinics; there are currently 13 operational. This is a $650.4 million program. They announced Medicare Local, a $416 million program, which is already off to a false start with the revelation that, despite opening on 1 July, the organisations will take up to 12 months to become operational.

But the worst part of this reform is that this is just another great, big, new bureaucracy. At the time the original historic announcement was made—Kevin Rudd's announcement that this was the most significant change in health since Medicare—then Prime Minister Rudd and health minister Roxon promised that their reforms to the healthcare system would not lead to further bureaucracy. I can safely stand here today and tell the parliament that they have failed in this promise. The National Health Performance Authority is another layer of compliance and another reporting burden for healthcare organisations. The creation of this new authority to report on the performance of healthcare organisations will mean extra time that these healthcare organisations will have to spend filling out paperwork, writing extra reports and sending through data when they should be in the consulting rooms treating patients.

The government have been very successful at creating reports, reviews and working groups and adding layer upon layer of bureaucracy to everything they touch. The Department of Health and Ageing is no different. We see lots of new acronyms coming out of the department of health, each adding its own layer of paperwork. We have the introduction of the NHPA, the LHNs and the MLs, while being very vague about what they are meant to do. Even these organisations that have been established already do not know what they are meant to do. We have the National Health Performance Authority looking at and reporting on the success of Medicare Locals and we have the Medicare Locals looking at and reporting on the success of primary health care including the GP superclinics. Around and around we go and, where the paperwork stops, nobody knows. This is just another layer in the thousand-layer cake of the measuring and monitoring of our health providers. The only thing that we know for sure—the only thing we are absolutely guaranteed of—is that there will be more red tape, more paperwork and more wasted time under the proposal currently before the House. What we need is less talk, fewer discussion papers and reviews, less paperwork, less bureaucracy and more doctors, more nurses and more allied health practitioners on the front line, delivering those services that our communities really need.

There is a wide belief that the provisions of this bill will severely risk the current high standard of medical services delivered throughout the community. There have been calls from the peak medical body, the Australian Medical Association, for the legislation to be deferred. There were many common themes throughout the submissions to the House and Senate committees around a lack of clarity about the legislation and the authority, ambiguity over what the authority will actually do, a lack of goals and objectives for the authority, duplication of work with pre-existing agencies and, most importantly, concern from stakeholders over the extra administrative burden that this agency will create. In its current form, this bill should not be before this House. That is clearly highlighted by the number of amendments that the government have had to move to fix their own legislation. The opposition will be moving for the deferral of this legislation until such time as the government have presented all legislation which deals with so-called health reform.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I rise in support of the National Health Reform Amendment (National Health Performance Authority) Bill 2011. I do so because we know that this bill is about the availability of information to the public, and we know that the availability of information is paramount. I think that within a democratic society the provision of information and the availability of information is absolutely critical. I am sure that most of us in this House would recognise this as an obvious fact.

The bill before us today contributes to the information that will be made publicly available to the Australian public on matters concerning our health system and our hospitals. Specifically, this bill will create a performance authority which will be charged with monitoring and reporting on the performance of our local hospital networks, public and private hospitals, Medicare Locals and other healthcare service providers that service the people of Australia.

While informed public knowledge is important within a democracy, information is also rather important when we evaluate things. It is really important to the evaluation of services that are provided and, of course, the funding that goes into those services. And so for the very first time in our nation's history we will have a health system that is expected to meet new national standards of service provision. It will be expected to meet new targets in fields of practice such as elective surgery and emergency department waiting and turnaround times.

This is a great thing; this is something that this Labor government is delivering to the Australian public. It is delivering something to the Australian public that has always been far too hot a political potato for governments to deliver in the past. Setting benchmarks and publicly exposing where the health system is can only be a good thing. Looking and analysing whether we are meeting the standards and whether we are having successes or failures in meeting those benchmarks is very important.

As I said, this is a very open and transparent way of measuring our health system, our successes and performance. It is an extremely important and open process, which will benefit all involved. I, for one, am proud of this government's work; especially what this government is doing in this exact area. It is being more transparent and more open for all to see.

I am coming at this new emerging reality from the perspective of the people who rely on these health services: the people around Australia. In decades past we used to hear of elderly residents who were waiting for years and years, perhaps for a hip replacement; hobbling around home, minimising their trips to the shops whence groceries could not be carried away without great pain. People had to live with their pain for far too long. In a First World country such as Australia, with a first-rate health system like ours, this really stood out as a failure by all governments in the past to invest in people's good health, mobility and independence. By monitoring the system and knowing our performance rates we can see where relevant needs are.

We have probably all experienced the frustration of having to wait eight hours in an emergency department to see a doctor, especially for something that is not particularly critical. How many days of people's lives have been wasted waiting around emergency departments? How many labour hours are lost due to the emergency departments not being capable of seeing and treating people in a timely manner?

This government is setting service delivery targets that we can already see in hospital statistics through the MyHospitals website, which started in December last year. For example, the MyHospitals website gives information on the number of days people have had to wait for a given procedure or other service at any given hospital and the national average for that particular procedure. It gives those waiting times for the previous two financial years, so you can go back two financial years and see what the waiting times were in particular hospitals for particular procedures.

For example, in Adelaide's western suburbs we have the Queen Elizabeth Hospital. When you log onto the MyHospitals website you can easily find the table which shows the Queen Elizabeth Hospital waiting time for a full knee replacement for the last two years. In 2009 the Queen Elizabeth Hospital replaced knees after patients waited for 91 days as compared to a national average wait of 147 days. In 2009-10 QEH patients had to wait 140 days as compared to 180 days on average around Australia.

What is wrong with members of the public being able to access that information, and being able to see exactly how long they will have to wait for a particular procedure? Those figures I just gave you compare with the Royal Adelaide Hospital, where for the same service one would have to have waited 211 days and 191 days respectively. It is all very interesting and is of particular interest, as I said, to anyone contemplating full knee replacement surgery. The purpose of all this data accumulation, management and communication is, of course, to drive improvements in service delivery. This is part of the overall reform of our health and hospital system that this government has courageously undertaken, driving improved services that will be more cost effective and sustainable in the future.

The House of Representatives Standing Committee on Health and Ageing, which I have the honour of chairing, met to discuss this bill, and I tabled the committee's report during the last few weeks of the last parliamentary session. The committee recommended that the House of Representatives pass the National Health Reform Amendment (National Health Performance Authority) Bill 2011 with a further amendment which I believe will be moved later on in this House, that the performance authority presents a compilation of its performance monitoring activities to the parliament annually in addition to its publication on the authority's website. These are very, very important initiatives by the government. Under this policy the performance authority will work to open up the performance of the health and hospital system to new levels of national transparency and accountability. It will allow for the identification of high-performing parts of the health system so those successes can be transferred to other areas. It will identify areas of the health system that require improvement so that action can be taken and it will improve the healthcare choices of Australians making key decisions about their own healthcare needs—all good things.

Opening up the performance can only be good. Allowing the identification of high-performing parts of the health system so you can mirror them in other areas can only be a good thing. Identifying areas of the health system that require improvement so we can improve things is also a good thing.

This is a very, very good bill that should be supported by all—unfortunately I see that it will not be. It will better meet the health requirements of Australians in the future. This is one of the first steps in the government's major national health reform, which is critical to delivering to Australians a health system that will deliver the services that they deserve.

Ken Wyatt (Hasluck, Liberal Party) Share this | Link to this | Hansard source

I rise to speak against the National Health Reform Amendment (National Health Performance Authority) Bill 2011. I do so on the basis that I am part of the Standing Committee on Health and Ageing, which looked at this. After reflecting on the legislation, revisiting the Council of Australian Governments website and casting my mind back to three significant bodies that exist at the national level and that work in concert with state and territory jurisdictions, I came to the view that we are duplicating an area which, if it were tweaked within the three bodies that currently exist, would be a much more effective use of taxpayers' money.

The proposed bill will amend the National Health and Hospitals Network Act, which established the Australian Commission on Safety and Quality in Health Care as an independent statutory committee. I listened to the member for Hindmarsh's comments, which in a number of areas were important. But I think there are elements within the health arena that we have to seriously consider when we establish bodies to take on the national role of collecting data, reporting and monitoring. We have to consider how that information is used. Often the complexity of health is not considered in its fullest context because each state and territory implements its services differently. Their priorities are based on state and territory needs. The other element that we can never capture in data is the human element, which is absolutely critical in the role of the health workforce in improving health outcomes.

This bill will establish the authority which will monitor and report on the performance of the local hospital networks, which are still evolving; public and private hospitals; primary healthcare organisations and other bodies that provide healthcare services. What I found fascinating is that when you go to the COAG website you find a list of those agreements that have been developed under the Council of Australian Governments with the involvement of health ministers from each of jurisdictions. We have the National Health Reform Agreement, the National Partnership Agreement on Improving Public Hospital Services, the expert panel report, the National Healthcare Agreement, the Intergovernmental Agreement on Federal Financial Relations and a brief summary of the Commonwealth investments in public hospitals.

If you look at these NPAs, or national partnership agreements, you will see the structure of them. They talk about the focus of the work and the outcomes to be achieved. They also identify the reporting elements within each of the agreements. Within states and territories—through the COAG process and the reform under the Rudd government, and through the Australian Health Ministers Conference and the Australian Health Ministers Advisory Council made up of the directors-general—there is broad agreement on what the measures should be. There was rigorous debate through the Australian Health Ministers Advisory Council on the types of data that needed to be collected and how it was to be used, and what reforms would take place and how the data would underpin that. But the emphasis was on the states and territories. When you read through these—and I invite any member who has spoken today not to restrict themselves to the proposed bill alone—you can look at those other elements that have been negotiated over a period of time in reaching directional-setting objectives for the reform of the healthcare system and the delivery of services, policies and programs.

Another point I want to make is that the data that is collected is produced in reports. There are something like 28 reports from a number of minimal data collections. These data collections are reports that are released biannually or within an arranged time period when they are investigated, the data is collected and a report is done. I know for Aboriginal health a jurisdiction can pay additional money to the relevant agency—I will come that agency shortly—to get a particular state slant on the data. So they can receive a WA-emphasised report, or a report based on that jurisdiction.

I find it fascinating that we have so many datasets, collections and reports and yet we are not using those. In a sense, they have a historical basis. Why do we need to establish another authority to collect data when that authority does not tell me what is going to do with it? We talk about reform, but when I consider the burden of collecting data I realise that you are taking people away from frontline services. You are taking them away from delivery of health care that is needed at the various levels within each of the state and territory jurisdictions, including the primary healthcare providers. It is a cumbersome process. If we want a healthcare system that works, do not tie people in frontline services to collecting data that feeds a beast that has been established in Canberra. To me this is a centrist approach and what we will see again is a grab for the control of the health agenda. To me the Australian parliament sits at the heart of Australian federalism. The Australian parliament continuously positions itself as a dominant player in the national political deliberations but does not have exclusive responsibility. We have state and territory governments who are the front-end providers. Professor Brian Galligan, in a paper from the Politics and Public Administration Group on 26 June 2011, titled Parliament's development of federalism, states:

The National Government was given defined powers—either exclusive or concurrent—whereas the States retained the residual. Where there is overlap, Commonwealth laws prevail to the extent of any inconsistency.

It is my view that this bill will provide the Commonwealth with authority over the state and territory governments and this will be extended by practice through the implementation of public sector erosion of the responsibility of the states and territories. When you work in that sector you protect the area in which you work. If you have a leadership role then you certainly identify those very key things that you want to achieve within this framework. To me it is control by stealth.

By adopting a written constitution we confined notions of parliamentary sovereignty by the terms of the Constitution itself. Support for a federal rather than a unitary constitution was unanimous amongst the delegates in the 1891, 1897 and 1898 conventions because the states wanted to protect their responsibility for the provision of front-line services. Health is a key area where states and territories consistently deliver at the local level. Those programs and services are often shaped by the recipients. Certainly we use data about elective surgery waiting lists and about time spent in emergency departments but we also have to consider the drain and the pressure on health-care systems. Both parliament and federalism are core features of the Australian Constitution which created an indissoluble federal commonwealth based on the consent of the people of the Australian colonies.

The bill will change the title of the act to be the National Health Reform Act 2011. It amends the current act to distinguish between the two new authorities and introduces provisions relating to secrecy and disclosure of information. Why would you want secrecy if we are being transparent? Why wouldn't we want to make sure that everybody had the information that is being collected so it is relevant and seen by all?

These authorities came from the first set of commitments made under the Rudd health reforms and outcomes of the COAG meeting that was held in April 2010. I spoke against the original bill and questioned the need to establish three new authorities given the existence of the Department of Health and Ageing, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. I turn to these bodies. In the Australian Bureau of Statistics Act 1975 it states:

ABS is one of many providers of statistics (albeit the largest) that are used to inform research, discussion and decision making within governments and the community. The organisations and arrangements, formal and informal, which together provide such statistics, form Australia’s national statistical system.

Section 6(1) of the act outlines the function of the ABS, and I want to cite two of these:

(a) to constitute the central statistical authority for the Australian Government and, by arrangements with the Governments of the States, provide statistical services for those Governments;

(b) to collect, compile, analyse and disseminate statistics and related information;

Why wouldn't you use the ABS and extend its role and function without having to create another layer of bureaucracy?

Secondly, the Australian Institute of Health and Welfare informs community discussion and decision-making through national leadership and collaboration in developing and providing health and welfare statistics and information. The Australian government, through AIHW, collects health and welfare statistics related to the information they seek and then develops specialised statistics standards and classifications relevant to health, health services and welfare services in conjunction with the ABS. The AIHW is prescribed as a Commonwealth authority under the Commonwealth Authorities and Companies Act 1997, and it has a leading role in supplying national data for reporting on a range of performance indicators and output measures for the national agreements adopted by the Council of Australian Governments. The institute develops, collects, analyses and reports high-quality national health information, and I have been a user of those reports. The information contained in those reports is very informative and publicly available and it helps with some of the planning directions that need to be set. AIHW works with the Australian government, state and territory governments and other stakeholders to ensure that high-quality and consistent data and information are available to underpin the COAG reform agenda and the health reform agenda.

Finally, we have the Department of Health and Ageing, which has a broad functional role but is still one of the key Commonwealth bodies. So we have three significant bodies and if I were in the position of determining whether we needed another one, I would determine that we did not. I would argue that we should use those bodies effectively, sending the money and funding to front-line health services that are badly needed in rural and regional Australia, and then through the hospital networks. It is a pity that we become consumed with the establishment of additional bodies that collect and report data, and certainly the Senate inquiry had its own findings with respect to the legislation.

Western Australia, in correspondence signed off by the Premier of Western Australia, made the following point:

Firstly, in relation to the scope and functions of the NHPA, the Bill as currently drafted allows for the possibility that the real work of the NHPA could be broadened in scope beyond that contemplated by the HoA.

In other words, there is a capacity to extend its role and function. There is not a requirement, as the WA letter goes on to say, to go back and deal with those issues. In a major rebuff, the health ministers in a communique stated:

Health Ministers agreed that States and Territories are the system managers and as such the performance managers of public hospitals in Australia. The Performance Authority will report on the performance of hospitals and health networks, and these reports will be provided to State and Territory Health Ministers, as the system managers, prior to public release;

Then they go on and talk about the watering down of powers, the role of the NHPA, empowering state ministers and requiring the Commonwealth minister to seek state ministerial and, in some instances, COAG approval for the role of the authority. This is not a bill that I would support. I would certainly support its referral to a Senate committee to have a look at the issues within the bill, to identify and look at how the roles and functions of those three existing Commonwealth authorities operate and provide that service now, and also to look at the cost-effectiveness of the use of taxpayers' money, which could be better directed to frontline services that would see the reduction of elective surgery lists, see better health care being delivered at the point of need and the underpinning and support of the local Medicare networks that will come into place.

I believe that we do need real action and real reform, but there is also a reality in this day and age that we do not have an endless bucket from which we can pull all of the initiatives that are being announced and all of the bodies that are being established under various pieces of legislation. I ask the government to be much more considered in the establishment of this authority, be more frugal in expenditure and utilise the resources that are currently in place that have served health systems at the state and territory level and at the Commonwealth level. There are also the COAG processes that complement the work that they do.

Amanda Rishworth (Kingston, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the National Health Reform Amendment (National Health Performance Authority) Bill 2011. This government has consistently demonstrated a real commitment to improving and transforming Australia's healthcare system. Those on this side of the House believe that everyone, no matter where they live, deserves access to a first-class healthcare system close to home. That is why we have now ended the blame game through a national agreement—and I must commend the Prime Minister on this national agreement—to boost hospital funding, increase local control and expand primary and aged care services Australia wide. The National Health Reform will mean more money, more beds, less waste and less waiting in public hospitals.

This Labor government's record in health reform and funding highlights our commitment to improving the healthcare system for all Australians, and it is a record that I am very proud to support. Since entering office, this government has made a number of considerable improvements to the healthcare system, including new elective surgery equipment for over 125 hospitals, the delivery of over 70,000 more elective surgery operations, upgrades to more than 37 emergency departments and an increase in the number of nurse places in universities by over 1,000 each year. In addition, I was very pleased this year to see in the budget $2.2 billion over five years for mental health services. This includes a $269.3 million boost for community mental health services. This represents the largest Commonwealth commitment to mental health in Australia's history, and I commend the government on its continued support for these much needed services in communities right around Australia, including my electorate of Kingston. I know that in my electorate the residents have certainly welcomed the government's considerable investment in mental health services.

I was very pleased, earlier this year, that the government announced a further $1,296,000 to be allocated to the Mental Illness Fellowship of South Australia to continue their work in providing the personal helpers and mentors program. I have visited and seen firsthand how this program really affects the lives of many who rely on it. It is an example of people with lived experience of mental illness actually working with those who are suffering to link them into services and to help them through perhaps an acute episode of mental illness. I think it is a wonderful program and I would like to take this opportunity to congratulate all of those involved in it. All of the workers do a great job. The funding extension that I have just mentioned will allow this wonderful service to continue, providing people within our community whose lives are severely affected by mental illness with some assistance and help.

In my electorate there has been another government announcement that shows its commitment to mental health. The commitment is that the youth-specific mental health service Headspace is going to be established at Noarlunga in Southern Adelaide. We know that two-thirds of all people with mental ill health experience their first symptoms before the age of 21, so it is critical that we do have these youth-specific facilities and services available. This service will provide local young people with not only mental health services but also appropriate physical health care and other help when it comes to drugs and alcohol, so it is a collaboration of a service that I think will make a real difference to people in the area. I look forward to working with the Southern Division of General Practice, who have been named as the lead organisation to establish the Noarlunga Headspace.

Those a just a few examples from my local area of how the government is making real improvements to mental health in my community. They are also examples of things that are happening all around Australia. In addition, of course, we have had significant investment in the local area through the building of the GP Plus Super Clinic at Noarlunga and the investment at Flinders Medical Centre, in both the elective surgery and accident and emergency areas. I must also mention the Primary Care Infrastructure Grants. These have been important grants that have helped doctors' surgeries in my local area to expand their services, provide practise nurse services and provide allied health services. So, a whole range of different services are now available in the local area.

This government has been committed to putting services on the ground, and I would dispute with the previous speaker that authorities like this do not help deliver these important services on the ground. We are fortunate to have a world-class public health system. This is a system that provides all Australians with access to public hospital care where they can receive treatment from world-class doctors and nurses. However, we are still faced with a health system that is highly fragmented, under-resourced, unsustainable and suffering under the pressures to provide for patients with increasingly complex needs. While this government has consistently committed crucial investment towards reshaping our healthcare system, fundamental reform is required to ensure that it remains on a sustainable path. This fundamental reform is what underpins the bill before the House today. This bill seeks to provide safer and higher quality services and to ensure the effective reporting and monitoring of health service providers.

The bill before the House today introduces a new watchdog for Australia's healthcare system—namely, the National Health Performance Authority. The main function of the National Health Performance Authority will be to monitor and publish reports on the performance of local, public and private hospitals as well as primary healthcare organisations. The hospital performance reports and healthy community reports will be made publicly available through the internet and will allow Australians to determine where they can receive the best treatment. I think this is a critically important part which illustrates that this government is committed to transparency. The information that will be provided will not just be used by government departments; it will be available. In South Australia I must commend the Minister for Health, the Hon. John Hill, who has already taken great strides in ensuring that now there is a lot of information made available not just for the department but for the public. The authority will open up the performance of the health and hospital system to new levels of national transparency and accountability. It will also identify areas of the healthcare system that require improvement. Overall the National Health Performance Authority will improve quality and drive value for money in the healthcare system. This will be important, as we want to move towards a more sustainable system.

The bill before the House is taking decisive action to deliver a better deal for patients and a better deal for communities. This is part of this government's commitment to national healthcare reform. As we have heard recently, we have developed a National Health Reform Agreement, which has now been signed off by the states and the Commonwealth. It will see the Commonwealth injecting an extra $19.8 billion into our public hospitals to 2019-20. I believe it needs to be noted that this is a stark contrast to the previous Commonwealth government, led by Prime Minister Howard, which spent a lot of its time working out ways to dud the states instead of paying its fair share to the public health system. So I am very pleased that we are looking at long-term sustainability, where the Commonwealth will step up and transparently ensure that we contribute to making this system sustainable into the future.

A new national funding pool will also be created, meaning all hospitals will be paid in the same way to ensure transparency in the way hospitals are funded. Increased transparency will improve public services and empower the public to make health decisions based on a wide range of relevant information. Advice from the National Health and Hospitals Reform Commission stated that performance reporting is the most effective way to promote continuous improvement and improve consumer literacy on the health system. The establishment of the National Health Performance Authority by this bill will further drive the system of performance reporting that Australia's healthcare system requires. Furthermore, its independence will provide Australians with nationally comparable information. It will allow Australians to better gauge how their health services are performing in relation to other areas of Australia. This principle will significantly drive improvements in patient care and therefore enhance Australia's health system. Finally the National Health Performance Authority will build on the government's MyHospitals website, established last year, which allows Australians to compare the emergency department and elective surgery performance of public hospitals around Australia.

Guiding and securing Australia's health system into the future is one of the most important challenges facing the current generation. This government recognises that Australia must strive to ensure that we have a healthcare system that is providing all Australians with access to quality care. It also recognises that Australia's population is rapidly ageing and that our health system must be significantly improved to meet the challenges that lie ahead.

It is no wonder that the opposition leader is opposing these reforms, given his track record as Minister for Health and Ageing in the previous government. Between 2003 and 2006 the current opposition leader, then Minister for Health and Ageing, cut funding for public hospitals by over $1 billion. The opposition leader clearly does not understand the importance that Australian families place on getting access to health care when they need it. He is clearly out of touch with the needs of Australians.

While the opposition leader continues to do what he does best and say no, this government is committed to improving health services for all Australians through a transparent health system that is appropriately funded nationally and run locally. The bill before the House represents groundbreaking reforms that will positively transform Australia's healthcare system into one which is modern, integrated and high performing and which represents and supports Australians now and into the future. I would like to take this opportunity to congratulate the Minister for Health and Ageing on the introduction of this significant legislation, and I commend the bill to the House.

Luke Simpkins (Cowan, Liberal Party) Share this | Link to this | Hansard source

As always, I welcome the opportunity to speak on the bills that come before the House and that I have a special interest in. It is always good to follow the member for Kingston, and it is funny how it has worked out on so many occasions in recent times—although I would say that obviously we see things in a completely different light.

When you go to front doors around this country and have the opportunity to speak to people and you ask them what issues are of concern to them, it is normal that the default issues, if they can think of nothing else—if they can think of nothing that affects their street or that is really burning them—are always health and education. So the feeling of Australians all the way around this country is that everyone is interested in better health—and obviously education, but on this occasion I speak of health. It is one of those default issues that we will often see and often hear about, and therefore it remains forever in the minds of Australians. It is also the case that everybody in this country—and in this parliament—wants better health. There is no doubt about that. As I also say in schools within the electorate of Cowan, both sides of this parliament believe in making this country the best it can be but the way to get there is where the difference is. The way we make this country as good as it can be and the way we make the health system in this country as good as it can be are the differences between the two sides. This is certainly the case tonight and in the debate on this bill.

When you look at what the government proposes—and I will go into some more detail on these things a little bit later—there have been plenty of grand statements and the usual thrown-in lines of 'decisive', 'historic' and maybe even 'groundbreaking'. In the end there is no doubt that there have been big promises. Unfortunately, in the case of this government, as is also the case with the big bureaucracies, there are calls for revolution and historic agreements, but at the heart of it you will always find a big bureaucracy that just appears. As always, that is the illusion of progress on the government side.

I begin my contribution tonight by congratulating Colin Barnett, the Premier of Western Australia. It was he who led the way for the states standing strong against the federal government and getting the government to back down so comprehensively on these so-called hospital reforms. As usual, what was on offer represented a further degradation of the relationship between the government and the powerhouse of this nation—I am of course referring to my home state of Western Australia. It represented a further loss of federal support to Western Australia and a further drift of a fair go from the west to the east, and therefore in our opposition to the federal government's plans we assisted in providing the opportunity for Colin Barnett to extract a better deal for our state. We should feel vindicated on the value of holding such a deal up to the light of scrutiny in this place.

The federal government originally said that it would take back a third of the GST. It was going to rewrite the intent of the GST—that growth funding for the states—and take that money back for the Commonwealth. Yet what we have seen is the big back down in a complete reversal of that 30 per cent GST clawback, which is to be replaced instead by an additional $1.6 billion for Western Australia over six years. This is another back down and further evidence of the inability of this Gillard-Brown government to match what it announces with what outcome eventually results. There have been plenty of such failures, but in order to remain relevant to this bill tonight I will have to go there on other occasions. I will not reiterate the failings of this government beyond the policy areas that we are discussing tonight and as relate to this legislation.

I would, however, like to set the scene before moving on. When I speak in my electorate I remind people that the job of government is to establish the basis on which people can succeed. It is not the role of government, at least under the coalition's political philosophy, to be at the centre of national life. Rather, we should see individuals, families and small businesses as the centre of our national success, supported with the tools to enable that success. Government should be in support, rather than telling individuals in a proscriptive manner how they should do everything in their lives. The first resort of this Gillard government is more regulation and, as we see time after time, more and more taxes. Less regulation is required, not more. Greater freedom for innovative Australian businesses and individuals is required, not the stifling nature of an increasing regulatory burden and additional bureaucracies, although more Public Service positions in Canberra are no doubt welcomed by the members for Canberra and Fraser, particularly as the cost is borne by the rest of the country.

When I speak of additional bureaucracies it brings us to the bill that we are debating today, the National Health Reform Amendment (National Health Performance Authority) Bill 2011. This bill has the central intent of establishing the National Health Performance Authority and it will also see the establishment of the Independent Hospital Pricing Authority. The task of the National Health Performance Authority is stated to be the monitoring and reporting on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services. Reflecting more locally on this, I wonder whether the authority will be able at some point to report on the Wanneroo superclinic—or perhaps they would do so if they could find it. I note, as we approach the fourth anniversary of the announcement of the Wanneroo superclinic, that it still does not exist and many are wondering how many more anniversaries will pass before a patient is actually seen at this illusory superclinic.

Should the Wanneroo superclinic ever open, it should meet the expectations of the people in my electorate. By that I mean it must be in the suburb of Wanneroo, it must be in addition to existing clinics, it must have a significant increase in the number of general practitioners available to be seen and it must comprise allied health services that are not just moved from elsewhere in Wanneroo to this other location but provided in addition to those allied health services already in existence within the Wanneroo area. What I have described are the expectations of the people of Cowan and particularly the people of Wanneroo. Those are the expectations that were built up in the lead-up to the 2007 election by the then opposition and now government. I support the delivery of exactly those additional health services as I have described on behalf of the Wanneroo community. I also reject any attempt to rebadge existing services and their representation as new services, because that would be nothing but spin. If this bill is successful, perhaps the National Health Performance Authority will be able to support the spin or, if they are truly independent, they will tell it like it is. We will see how this bill proceeds and then how the authority proceeds in the future. Of course, a lot has changed since the time when the so-called health reform plan was conceived. What we have seen is that the plan has been greatly modified, and not only along the lines of the backflip that saw a better deal extracted for Western Australia. Having been beaten up by Colin Barnett, leading to that backflip, the plan had other changes made to it as well. We can look at those changes to see how that original plan has been changed dramatically. Firstly, under this bill the substantial involvement and power of the federal health minister over the authority has been wound back. The submissions to the Senate inquiry noted how the original plan neglected the role of the states as managers, owners and operators of the state hospitals and other health service deliveries. The latest Australian Health Ministers Conference resulted in an agreement limiting the actions of the federal minister without state agreement and empowering the role of states in dealing with matters associated with the National Health Performance Authority, whilst recognising in this legislation the states' roles and authority over local health networks as well as public hospitals and providing for greater involvement and oversight from the Council of Australian Governments.

Specifically, the amended bill that we have here will see the acknowledgement of the role of state and territory health ministers as health system managers in relation to local hospital networks and public hospitals and that, in relation to local health networks or public hospitals, the federal parliament intends that the National Health Performance Authority should have regard to the role of state and territory ministers for health. In fact, the amendments that this bill brings forward will establish the National Health Performance Authority with regard to and involvement of the states but with less involvement by the federal minister. The reality is that the states, led by Western Australia, have forced the government to back down repeatedly on health matters.

Let me now be very clear about this bill. The coalition opposes the establishment of these sorts of new bureaucracies, and that will always be the case. Like so many other stakeholders who gave evidence before the Senate committee, we believe it is the right thing for this bill to be deferred until more information and the regulations are available, so that all the matters concerned with the authority can be properly assessed. As in our direct action plan on health at the last election, we oppose new bureaucracies. We instead believe that the funding for the new bureaucracies should be directed to actual frontline services, as outlined in our Real Action on Hospitals and Nursing policy and our Real Action Plan for Better Mental Health policy.

This country does not need an increase in bureaucracy, a complicated funding structure and no guarantee that funding will flow to frontline services. Rather, a health policy in Australia should be the 'beds and boards' policy of the coalition: direct action that will make a real difference by directly tying increased funding to the delivery of increased services—in effect, the productivity that this country so much needs in so many ways but that unfortunately has been missing in recent times. The government wants more bureaucracy, while we as a coalition government would reduce centralised bureaucracies and allow hospitals to better respond to the needs of patients and healthcare workers. As we know, the differences between the Labor Party and the coalition do not end there. We at least appreciate that our plan, Real Action on Hospitals and Nursing, must take pressure off the public system, and part of that involves work to ensure private health insurance premiums remain affordable. That is one of the tenets that we stand by, that we must retain full private health insurance rebates for all Australians.

The reality is that our health system is fundamentally a good one. Of course, it can always be better. When you visit most of the rest of the world you can see that our system really does stack up very well compared to others. But that should never remove the requirement for us to look for ways to improve our system. The reality is that we are better than most competing nations of our standard and those in the region. But our assessment should be based on our own criticism of ourselves, not on looking at other systems as being more favourable than ours. It is certainly the case that we need to improve, and we should always be looking at the fundamental responsibility of the parliament as a way to improve our health system.

When you look at what this bill puts before us, there is a shortage of information. There is a need for more to come out about this and for the regulations to be looked at. The stakeholders agree with this. So the right thing for the government to do is to take this bill off the program until all that information is available.

Andrew Leigh (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

On 2 August I was pleased to visit the Canberra Hospital in the company of the Prime Minister, the Minister for Health and Ageing, the member for Canberra, and Katy Gallagher, the Chief Minister of the ACT. We were generously shown around the Canberra Hospital by our ACT Health hosts, Lee Martin, Rosemary Kennedy, Kate Jackson and Sarah Majeed. It was a real eye-opening visit to see hospital reform in action; to see what is already occurring in Australia's hospitals as a result of having a federal government that is committed to improving health. Our party met with 16-year-old Jake Floro and his mother Kerrie-Anne Floro. Jake had a hip operation on 15 April and he is recovering really well.

This visit through the Canberra Hospital, one of the great hospitals in Australia, reinforced the positive experiences that I and my family have had at both the Calvary Hospital and the Canberra Hospital over recent years. I learned a lot from those personal experiences. As the dad of a couple of young boys who seem to always be falling off things, I have spent my fair share of time in emergency wards. But I have also learnt a lot about the ACT hospital system through speaking with my friends, Caroline Fahey, Mary-Ann Kulh and Mike Hall. At the outset I will speak generally about the bill, but I want to return to some ACT specifics of this bill at the end of my speech. The National Health Reform Amendment (National Health Performance Authority) Bill 2011 will deliver another $20 million in extra funding for public hospitals. In practical terms, that means more beds, more local control, more transparency; it means less bureaucracy, less waste and less waiting. Under the new health agreement that was struck with all the Australian states and territories on 13 February this year, the Commonwealth will permanently pay for 50 per cent of the growth in hospital costs. Initially, from 2014-15, the Commonwealth will pay 45 per cent and then from 2017-18 it will be 50 per cent. There will be a national funding pool, so hospitals will all be paid the same way regardless of whether they are in Bourke or Ballarat. That will deliver unprecedented transparency in hospital funding arrangements.

Across a whole range of public sector management issues, transparency drives reform. We see this in early childhood, in schools, in universities and in hospitals. The states and territories, under this historic agreement, have agreed to deliver substantial reforms. They will provide greater local control of hospitals. There will be a national price for activity based funding. As a former economics professor, and I would like to think a current economist, I regard this as a great way of driving efficiency and reducing waste. We will have new national standards and new targets to cut those waiting times in emergency departments and in elective surgery waiting lists. As someone who has spent a fair number of hours sitting in emergency departments, I know the stress that can build up while waiting for service. It is really important we do what we can to cut those emergency waiting times to make sure that those families that do not need to be in emergency rooms are not there and those who need to be in emergency rooms are seen quickly.

As a result of this legislation, there will be a new National Health Performance Authority. It is a key element of the government's health reform agenda and the COAG agreements. Its role will be to monitor and report on local hospital networks, public and private hospitals, Medicare Locals and other healthcare service providers. It will deliver clear, transparent performance reporting. There will be a new framework that will provide Australians with information about the performance of their health and hospital service in a relevant way and which is nationally consistent. As with the MySchool website, where parents can now compare schools right across the country, patients will have more information on their local healthcare services and those patients will spur reform. The authority will produce clear reporting. It will produce Healthy Communities reports for every Medicare Locals geographic area. You will be able to see, for example, how your local healthcare services are performing, preventive risk factors and access to GP services.

I moved a private member's motion earlier this year about the importance of transparency across the board and about the reforms that are driven by having a MyChild website, a My School website and a MyHospitals website. The MyHospitals website, which went live in December last year, compares the emergency department and elective surgery performance of public hospitals around Australia for the first time. The MyHospitals website is a critical element in ensuring that Australian health services are as good as they can be.

I move on to speaking from an ACT perspective about what this means. The ACT government—as a strong reforming Labor government—has already taken action to make sure the ACT health system can respond to growing health service demand. For the ACT, one of the big challenges is that many of the patients who are served in Canberra's hospitals come in from New South Wales. That is particularly true in the ski season when many people who find themselves injured on the slopes will eventually end up in a Canberra hospital. There is a lot of pressure placed on Canberra's hospitals, which they respond to well.

A part of the reforms the ACT government has put in place is a program called Your Health-Our Priority. It is a major infrastructure program which is facilitating investments such as a new cancer centre at the Canberra Hospital. There are also important investments that the ACT government is making in e-health. I note that this is an area of major difference between the two parties in this place. Those opposite would be quite happy to do away with e-health. They would be quite happy to stick with the old paper records, the errors and the inefficiencies that are inherent in using a paper based system. But the ACT government, as with the Gillard government, is committed to moving towards e-health and recognises that faster broadband will offer new opportunities in the future. And right now we can start getting those e-health records to ensure that, if you turn up to a different GP from the one you usually see, your new GP will be able to see your entire health record. That new investment is going to be absolutely critical to reducing error rates and ensuring patients do not have to repeat their health history every time they go to see a new doctor. These big investments will ensure the ACT health system is greatly improved. The Independent Hospital Pricing Authority will be a key part of this.

The ACT Legislative Assembly has established an ACT Local Hospital Network as part of this new reform. That will be a network system that holds service contracts with ACT Health. It will comprise the Canberra Hospital, Calvary Public Hospital, Clare Holland House and the Queen Elizabeth II Family Centre. The ACT government will continue to manage the system-wide public hospital service planning and performance, including the purchasing of public hospital services, and it will be responsible for the management of the performance of the ACT Local Hospital Network.

That Local Hospital Network, as I mentioned, will be overseen by a high-powered board. That board includes Michael Peedom, who is the Director of Legal Services of the ACT Regional Office of the Australian Government Solicitor's Office; Professor Nicholas Glasgow, the Dean of the ANU Medical School; Lynette Brown, a member of the ACT Health Council; Mary Montgomery, a member of the Calvary Health Care ACT Community Advisory Board; Colleen Duff, the Secretary of the ACT Branch of the Australian Nursing Federation; Dr Rashmi Sharma, a director of the ACT Division Of General Practice; Michael Moore, a former ACT health minister and a long-time campaigner for better health services in Canberra; John Runko, CEO of the property industry; Darlene Cox, a member of the Health Care Consumers Association; and Megan Cahill, and Associate Director in the Health and Human Services Practice of KPMG. These dedicated Canberrans will be an important part of ensuring that the Local Hospital Network serves all Canberrans.

Another exciting health reform for Canberra, which I know many of my constituents are looking forward to, is the establishment of a GP superclinic in the ACT, a GP superclinic that will ensure that we bring together many of the skills we have here in Canberra, joining together strong medical research teams, medical training teams and their expertise in delivering primary health care.

I want to use this opportunity too to pay tribute to the West Belconnen Health Co-op. My friend Michael Pilbrow has been heavily involved in this. The West Belconnen Health Co-op has done a great deal to boost bulk-billing rates in the ACT and to bring new doctors into Canberra. They are servicing one of the more disadvantaged parts of the ACT and they have expanded from their Charnwood site to open a new site in Belconnen. As part of that, they are really serving a great mission of community medicine, ensuring that doctors are there for those who need them and bringing specialists in to the West Belconnen Health Co-op so that patients do not have to travel all around Canberra to see an expert. Once a month, say, a specialist will come in and see people with particular issues.

Winnunga Nimityjah is another health centre in the ACT, an Aboriginal health service operating out of Narrabundah but servicing many people on the north side of Canberra. Winnunga Nimityjah often drives its clients down to the health service. They go above and beyond to provide a level of health care to Indigenous Canberrans. And of course, if we are to close the gap, it will be through initiatives such as Winnunga Nimityjah. I would like to use this opportunity to pay tribute to those workers there.

All of these are mainstream reforms. You would expect them to be supported by both sides of parliament. But what we have seen is the coalition opposing efficient pricing and opposing transparency. It is of a piece with much of what we have seen from the current Leader of the Opposition. The current Leader of the Opposition only has one word in his vocabulary and that word only has two letters. The Liberal Party has become the party of 'no': the party of opposition to everything. In the case of private health insurance, the current Liberal Party says that Australians without private health insurance who earn the minimum wage should be subsidising the private health insurance of millionaires. They are unwilling to means-test the private healthcare rebate for millionaires. This is what we might expect given that the Leader of the Opposition is the man who ripped a billion dollars out of our healthcare system. It is a sad thing to see that those opposite are so committed to an ideological oppositionist agenda. The reforms that we are putting forward are sensible reforms, reforms that will deliver more beds, more transparency, more efficiency to our healthcare system. But those opposite seem only able to learn from the scare campaigns of the US Republicans and their Tea Party friends. They seem to have decided that whatever issue comes up, they have to oppose it. Maybe the next time we start talking about efficiency here, we are going to hear those opposite start to raise spectres of death panels, as the US Republicans have done.

It is sad that the modern conservative parties have now become fringe oppositionist parties. It is very different from the mainstream parties of small 'l' liberalism that the Liberal and National parties once were. They have now become the party of 'no', the party of rallies, the party of radicalism. The modern Liberal and National parties have lost touch with what ordinary Australians want. When I hold my community forums and mobile offices, Canberrans tell me that what they want is quicker access to doctors. They want access to GPs and they want to make sure that when they go to hospitals they get seen as quickly as possible. They want to know about the performance of their local hospitals and they want to be able compare those local hospitals. They want to be sure that at all times their healthcare system is operating as efficiently as possible.

My constituents know, as, sadly, those opposite appear not to know, that a more efficient system means that we can spend more dollars on high-priority areas. We can invest in cutting waiting times, we can invest in closing the gaps and we can invest in e-health, ensuring that the technology of the future is available in Australian hospitals today. I commend the bill to the House.

Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. Just before I begin, I am just drawn to comment on the remarks by the member for Fraser, who suggested that the opposition had become a fringe opposition. I suggest he might prevail upon his Prime Minister to call an early election and we might test that opinion in the public arena and see whether in fact the majority of Australians agree with his assessment.

This bill is a demonstration that rhetoric is cheap; action is difficult. Once again we are witnessing the results of 'thought bubble' government. This government has continued to over-promise and under-deliver and this latest agreement on national hospitals is so far away from Kevin Rudd's original plans that it is barely recognisable. We on this side of the House go on almost ad nauseam on the government's failures, but it pays to reiterate them. I am sorry, but you are going to have to wear it again. Policy areas where we have seen backflips and changes of direction include Fuelwatch, GroceryWatch, pink batts, green loans, the NBN, the mining tax, asylum seeker policy—what a debacle that is—the Murray-Darling Basin reform, the live cattle disaster, the ETS and of course now the carbon tax. Paradoxically, the government is failing to deliver on the thought bubble of no carbon tax and they are actually delivering something which they said we would never have. Mr Deputy Speaker, I said this would make you a bit nauseous, a bit sick. It makes me a bit sick and that is without even mentioning the subjects of debt and surplus.

Government members have been on the doors of this place in the last few days telling us that this year, 2011, is the year of delivery for the Gillard government. They are claiming this bill, which is really a humiliating capitulation on health reform, as one of the delivered goods. They are also claiming the national disability insurance scheme as a delivered good. It is a good idea, but it is a long way from being delivered. They say the forestry agreement is a delivered good, when in fact it is wallowing in the Tasmanian parliament again. They say the Malaysian people deal is a delivered good. They say Manus Island is a delivered good. It is far from delivered. In fact, I have even heard the fast train said as being almost a delivered good, and that probably has a 20- to 30-year time frame.

Mike Kelly (Eden-Monaro, Australian Labor Party, Parliamentary Secretary for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on a point of order. I believe we are discussing the National Health Performance Authority. I have not heard a word about this bill so far. I ask the member to be relevant to the discussion.

Mrs Bronwyn Bishop (Mackellar, Liberal Party, Shadow Minister for Seniors) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on the point of order. I thought I had been exceedingly generous previously. If the minister across the chamber wishes to take this point, I will enforce it very stringently on theirs.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

I note the point of order. I invite the member for Grey to debate the bill and to relate his remarks to the bill before the House.

Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

I am very pleased to do so because this bill is just latest in a raft of policies that are watered-down goods. This is a bill to establish yet another layer of bureaucracy, another statutory body, and it is another attempt to improve inadequate legislation. Why is this a watered-down bill? How did we get to this point? We have to consider the record. The previous Prime Minister, Kevin Rudd, gave the states 12 months to rebuild the health system or he would enforce a full takeover. He promised to end the blame game. The outcome of that commitment from Kevin Rudd was the 60 per cent funding formula, which was to take 30 per cent of the states' GST. Sixty per cent of funding was to come from the Commonwealth, and 40 per cent from the states and the Commonwealth was to meet the majority of all new costs. It was to implement activity based funding. The federal government was to take responsibility for standards and throughput. With that federal funding came the commitment—and this is very important—of local management. We were offered federal funding and local management.

When the deal fell through, when that thought bubble went away, there was the 50-50 deal, which finally came out as the meek and mild 45 per cent of increased costs from 2014-15. Interestingly enough there is to be nothing until after the next election. This funding commitment is to rise to 50 per cent in 2017-18—50 per cent of increased spending, not overall spending, and that will be after yet another election, two elections away. This is the year of delivery, and we are talking about 2018!

The government has indicated an extra $175 billion over 20 years. Twenty years is a long time for people to be able to foresee the future. It is 16 years outside the forward estimates. Chernobyl was 20 years ago. I am informed the internet was born 20 years ago today. Who 20 years ago would have predicted what influence the internet has on our lives today? To predict that there will be an extra $175 million over the next 20 years is very brave indeed. Perhaps we will put it in a time capsule. Significantly, this deal has given up the promise of Commonwealth control. The Commonwealth are instead to become a monitoring agency. The government has rolled over to the states on just about every issue. We were promised federal funding and local control, and we have to ask: what has happened?

The federal government has totally capitulated to the South Australian government because in fact there is to be no change to the current modus operandi. The state is to keep managing public hospitals and the local management is to be achieved through one body. There is one body for the whole of South Australia, and that body is to be Country Health SA. The regions of South Australia cover around one million square kilometres and we are to have one body, which answers to itself and ultimately to the government, to run the whole hospital health system. The government has implemented hospital and community committees, which have no power. They are muzzled. They are unincorporated advisory committees. That is the South Australian government tipping its hat to local control. My electorate alone has more than 30 hospitals, including two community hospitals. I will say a little more about them later.

It gets worse because we are dealing with the whole of South Australia, not just my electorate. There will be one local board to cover all the hospitals. From Mt Gambier to Ceduna is over 1,000 kilometres by road. From Yorketown to Coober Pedy is 900 kilometres by road and to the Marla clinic—if Country Health takes responsibility for the Marla clinic, as it should do—it is 1,300 kilometres. People who are required to have knowledge about Mt Gambier also need to have a working knowledge about Marla or Coober Pedy. Where will this powerful body reside? Adelaide. This new agreement just does not stack up as local control. The news from SA Health is that they do not expect to make any changes. In their opinion the current management models meet the criteria. For the record this means: no local boards, regional bureaucrats, HACC committees with no teeth and effective control in Adelaide. So this country health board, the author of the now disgraced and discredited country health plan in South Australia, which was a plan to shut down and downgrade country hospitals, is to be given full control by the Commonwealth government of hospitals in South Australia, just as they have done in the past.

I thought back on where we had been in this debate when I was planning what I would say in the House tonight on this bill. I looked at a newsletter I published in May last year for interest. It said:

There is no detail on the commitment to local control, but it won't mean local boards. There are vague references to Local Hospital Networks established by appointment. The news from Health SA is they don't expect to make any changes, in their opinion the current model meets the criteria! For the record this means, no local boards, regional bureaucrats, HACC committees with no teeth and effective control in Adelaide. No change!

The government has promulgated a view that state governments are broke and the Federal Government has a bottomless bucket of money. The fact is, while both have the ability to raise taxes to pay for services, whichever level of government raises the tax, it is the same Australians who will pay the bill.

That is what I said in May last year, I think with a better degree of a view of the future than perhaps the prediction of what we will see with the next 20 years of hospital funding. So there is no change—no change in the line of responsibility, no change to local management. Watered down is hardly the word for this health agreement the government lists as one of its delivered objectives.

I spent 10 years on local hospital boards servicing country South Australia. I can only speak for South Australia, but I have been appalled by the decline in local services, particularly over the last 10 years as the city-centric government in South Australia, the Rann state Labor government, has grasped control of hospital management. There are communities where surgery and birthing services have been withdrawn, requiring people to travel hundreds of kilometres for services their parents took for granted. This withdrawal of services leads to deskilling of local staff, dismantling and removing equipment, general rundown of hospital facilities and deferred maintenance until eventually this remote body, Country Health SA, declares the hospital is only fit as a first aid post and the locals will be better off without the service.

It is worth pointing out that the current South Australian state Labor government with the latest agreement has been endorsed as the operator of hospitals in South Australia. It is a great sadness that this government, which promised local control, has allowed that opportunity to slip. It has said: just keep doing what you are doing. I said I would mention the community hospitals affected in South Australia by the state government withdrawing funds. In fact we have passed motions in this House and in the Senate, both condemning the South Australian government and asking them to restore the funding to these three hospitals. These three hospitals are community hospitals and are serving the need just as public hospitals do in the system, but there has been no motion from the South Australian government to fix the problem and, I regret to say, it seems there has been little activity from the federal minister to actually carry out the wishes of this House and the Senate to get on the phone to John Hill and say, 'Put the money back.' In fact, the federal government, as you well know, Mr Deputy Speaker Thomson, has immense power over state governments because they provide the bulk of their funding.

Country people cannot understand how they continually pay more and more for health services but are losing their basic services. Why do they no longer have birthing services? Why can't they have elective surgery in their community? Why can't they in some cases get a broken arm set locally and instead have to drag children hundreds of kilometres? I am well aware of cases in this area enduring long hours of pain and delay waiting for something to be done that used to be delivered in their local hospital.

Remember when the midwives came to Canberra last year? They were campaigning for insurance and the right for people to have their babies in the home. That is well and good and I support them. But let me say, and I said it at the time, that women in my electorate were not coming to me and saying, 'Please, can I have a baby at home?' They were coming to me and saying, 'Please, can I have a baby in the hospital?' They were allowed to have a baby at home with a midwife but they were not allowed to have the baby in a hospital with a doctor. Instead, they have to travel. If you live in Roxby Downs, you have to travel 600 kilometres to Adelaide or 200 kilometres down the road to Port Augusta. If you live out where I do in Kimba, you are expected to go 160 kilometres to Whyalla to have a baby. I was born in the Kimba hospital and so was my—

Ross Vasta (Bonner, Liberal Party) Share this | Link to this | Hansard source

Not that long ago.

Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

Not very long ago, I must say. To think that we are actually going backwards in provision of services is of great concern to communities. To think that we are re-empowering the state government and Country Health SA to keep riding roughshod over these communities is a great loss of opportunity and an undelivered promise from this government. (Time expired)

Mike Kelly (Eden-Monaro, Australian Labor Party, Parliamentary Secretary for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

What an exciting time it is to be a member representing a rural and regional seat in this parliament and as part of this government. What a pleasure it is to be standing alongside the Minister for Regional Australia, Regional Development and Local Government, who is doing such a magnificent job in carrying forward regional and rural development. The most exciting part of that agenda is our health reform agenda. There is absolutely no question that for people in rural and regional areas the No.1 issue was the neglect of their health services through those many Rip Van Winkle years of the Howard government, particularly the damage done by the Leader of the Opposition in allowing the Commonwealth's contribution to health services to drop to 40 per cent, effectively ripping a billion dollars out of the system.

This was setting state budgets in health on an unsustainable path. There was no question about it. We knew in New South Wales, for example, that by around 2045 the health budget would consume the entire New South Wales state budget. That was simply unsustainable. In addition to that we have to find more efficiencies and more savings in the system to also meet the future budgetary demands of the changing demographics and other issues that we face in this community. Also very encouraging from my point of view is the emphasis that the government is placing on preventative health to help ease the burden—an area totally neglected by the previous government. In my own region this is a critical issue. Last year I conducted a survey of the electorate and I had over 7,000 responses. It was a magnificent response from the community, engaging with me genuinely in a conversation about the needs of the community. The No. 1 issue among those 7,000 responses to that survey was health—no question about it.

The previous speaker talked about delivery, and delivery has certainly been happening apace in health in my region. This reform, the National Health Performance Authority, is part of that magnificent package that now forms the National Health Reform Agreement. It is part of those oversight and efficiency mechanisms—the three columns, as we might refer to them—which also include the clinical standards monitoring authority. Certainly we have had some issues in our region in relation to clinical standards, including the famous, or infamous, Dr Reeves incident, and we certainly know how important it is to monitor those clinical standards. We in rural and regional areas just are not prepared to put up with second best, as we are not prepared to put up with second best in relation to the National Broadband Network, which will also underpin the efficient delivery of health services in our regions. Another column is the pricing authority, which will establish the efficient cost of the delivery of these activities in our health performance agreements, our health performance monitoring authority and the performance that is delivered in the various levels of health services in the region.

The National Health Performance Authority mechanism will include functions of monitoring and reporting on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare service, and it will publish reports. It will also perform the functions of formulating performance indicators, collecting, analysing and interpreting performance information, and promoting, supporting, encouraging, conducting and evaluating research. You cannot run a system without information. We must be constantly keeping on top of what is a changing dynamic in the health area, with the improvements in technology, issues with costs as they evolve and also the demographics in particular communities.

That is important for a region like mine, where there were certainly great concerns about the Greater Southern Area Health Service. There were many decent and hardworking men and women who served faithfully in the Greater Southern Area Health Service, but I think it is fair to say that there was a great deal of dissatisfaction with the way that that service worked. Mainly those people were victims of the structure of that organisation. Now we have stepped forward to cure that with the establishment of local hospital networks. These networks do give the community a voice in their system to bring it back to a more local scale that will enable it to meet, reflect and respond to the regional needs, interests and issues that the community raises. Within those local hospital networks, you will have clinical representation and you will have consumer and community representation. That is already up and running and operating successfully in Eden-Monaro. This performance authority will be able to monitor the performance of the governing councils of those local hospital networks and to ensure that they are performing to the standard necessary. There will be transparency associated with this. The minister will have the ability to publish reports as they see fit, while of course ensuring confidential material is not revealed, and certainly there are privacy protections in this legislation.

Also we have preserved the relationship with the states through this system. The state and territory health ministers will be sent copies of any reports where there is an indication of poor performance of a local hospital network or public hospital and then they will have 30 days to provide comments on the report. Once the consultation period has expired, the ministers will be provided with a copy of the final draft report and be invited to provide any further comments within 15 days of receiving that report. So the engagement with the state authorities will be effectively enshrined in here. It is important to emphasise that the difference with the previous proposal is that the states have insisted on retaining responsibility for their local hospital systems. It will now be important for the state government in New South Wales to deliver on promises made in my own region in that respect. They have asked to retain that authority; therefore they have no-one but themselves to answer to in relation to the delivery of outcomes in my region, including the undertakings that have been made to the Pambula hospital, for example.

There are many other aspects to this health reform that make up this matrix. An exciting announcement was made today by the health minister, who I believe will go down in the history of this country as the most successful health minister we have ever seen, delivering groundbreaking reform for this nation to set us on the path for a decent health service. I congratulate her on her work and the work of the government in general in delivering this package. The announcement made today—around the IT infrastructure for electronic health delivery for the personally controlled electronic health records system—is a great milestone and step forward in delivering our e-health. This e-health objective is critical because we know that up to 80 per cent of the mistakes that are made in treating patients are made through faulty record management or difficulties with record management. We also know that a lot of costs in the system arise from double servicing or over-servicing of patients. Certainly an effective and efficient e-health system will help reduce or eliminate those inefficiencies and save money in the system in that respect as well. This is another great step forward for the system and I congratulate the minister on that announcement.

When we see the National Broadband Network rollout, we will see huge advances for regional health in terms of the delivery of telemedicine opportunities. We have already seen the Medicare schedule adjustment so that there can be combined consultations with specialists. Patients in rural and regional areas will be able to sit with their GP and consult with specialists who may be halfway around the world if necessary, without even leaving their local town. We have also seen the delivery of home based services through telemedicine for patients who may not even need to leave their home in certain circumstances. This will be a tremendous outcome for rural and regional areas: the National Broadband Network underpinning the delivery of this health system.

Certainly, we also know that there is a lot to catch up on in relation to our rural hospitals. We intend to maintain the block funding arrangements for those small rural and regional hospitals. It is very important that we do so; there is a lot to catch up on there. I know that the minister visited the Bega hospital with me and understood clearly what the situation was there, and understands the situation generally around the country.

The previous speaker talked about delivery. I am intensely proud of what we had already delivered even before the agreement was secured in my own region. As I indicated, we had urgent problems in relation to a deficiency of doctors and facilities. You will not attract decent health workforce personnel to poor facilities in isolated areas. You need to provide the support mechanisms, the incentives and the facilities. I am pleased to say that we are doing that. We have seen already the GP superclinic open and operational in Queanbeyan, doing that wonderful job of meshing our allied health services with our GP services and providing after-hours services which are so necessary.

We have seen the advancement of the GP superclinic for Jindabyne. That will be open by 2013. The process is in progress there, with consultations with council and the Southern General Practice Network. We have seen very crucial and timely investments in places like Bombala, with $260,000 to assist with a doctor's house and surgery facilities to enable us to attract a new doctor. The local doctor in Bombala, Dr Colin Pate, was just about ready to fall over with the workload that he had. He was close to packing up because he could just could not cope. That timely investment of money enabled us to attract the doctor. It is true that that doctor has now decided to move on, but because we have made that investment we will be able to attract a replacement for her.

We have also seen, of course, many investments in GP clinics all around the region to add medical training facilities for students, and this is attracting students into our region. They see the benefits and the beauty of the lifestyle in our wonderful region. We are, in fact, one of the happiest regions in the country. If you look at the wellbeing index you will see that it rates just about at the top of happy areas in this country. So once you demonstrate the lifestyle to medical students you have a better chance of hanging on to them. The facilities are there to provide good training and to give them the range of experience that you get in rural practices, which is helping to keep those personnel in our region.

There was $500,000 for the Bombala Street medical practice in Cooma. We have seen $500,000 going into the Queen Street practice in Moruya and we established a new practice in Tuross Heads for $212,000, new dental facilities in Dalmeny for $200,000, and a mobile dental service to help with our Indigenous community for $380,000. We have paid $100,000 to a number of clinics to establish after-hours services, such as at the Brindabella practice in Queanbeyan, at the Blue House Surgery in Narooma, and also in Bungendore. There have also been investments in Braidwood to establish dental services there.

I am of course really proud to say that, most importantly of all, there is the new regional hospital—the only C1 hospital in our region—at Bega, where funding of $160 million of federal money has been committed for a brand new hospital, adding to that $10 million of state money which will bring home the final piece of the puzzle for us. This will be a magnificent, state-of-the-art facility which will take advantage of all that new technology and will add magnificently to the capacity of health service delivery in our region. On its own and in its own location it will be able to do pharmacy, pathology and imaging services. There will be 136 beds in this facility, including for the first time an expanded possibility for mental health beds. It will have an expanded emergency department and will be able to take advantage of the available technology in telemedicine and the latest developments there.

This is a facility that has been welcomed with open arms within my community. They have been absolutely delighted by this investment. But I have to say that we know that it is all under threat. All of these things—all of this health reform—is under threat. There is the $70 billion hole that we know is coming our way if the coalition were to succeed at the next election. This threatens all of this—all of it would go, including the NBN that would underpin these health services for these rural and regional areas. You would need fibre cable to deliver it: it would go. The regional hospital in Bega would go. You would not be able to fund that hospital by taking $70 billion out of the budget, and we already know that the coalition says they would pull the pin on this health reform. It would all go; it would not be there. The funding would not be there.

My community knows that; they know what they voted for at the last election and they are seeing the delivery of it. That was the choice at the last election: there was no commitment to a regional hospital by my opponent at the 2010 election. All he offered was a paltry amount of about $1 million for the Bega hospital, which was even under costed for what he was promising.

This is the big risk: $70 billion will rip the guts out of our health system, will once again betray rural and regional Australia. It will take away all these reforms and deliveries that will finally see the sorts of services that the previous coalition government ripped off rural and regional areas or neglected to deliver to them. Now that people are seeing it they will not let it go. They have their hands on the prize, they understand what is at stake and they will not be treated as second-class citizens with the city getting the Bentley in the NBN and the country getting the Commodore. They are not going to put up with that either. The choice is very simple, and my community is ready to make that choice.

Jane Prentice (Ryan, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. It proposes yet another statutory authority, to be named the National Health Performance Authority.

We are here tonight speaking, yet again, on an amendment. But this time the legislation being amended was not introduced when Labor first came to government in 2007, four years ago, giving us time to see what changes needed to be made. It did not even come in two years ago, or even 12 months ago. We are debating amendments to legislation passed by the House as recently as 21 March this year, less than six months ago. This seems incompetent even for this government. Then again, the legislation we are debating for amendment tonight, the National Health and Hospitals Network Bill 2010 was part of the reform put forward by former Prime Minister Kevin Rudd. With that in mind current Prime Minister Julia Gillard's attitude towards the legislation is perhaps less surprising.

The former Prime Minister and the then Minister for Health and Ageing promised that reform of the health system would not create further bureaucracy, yet here we are again debating substantive change that creates yet another layer of bureaucracy. I understand that tonight's debate is regarding just the first of two proposed authorities, two more bodies that will generate boards, administration offices and staff, growing the bureaucracy instead of providing more hospital beds and hands-on carers. Given that two bodies are being proposed under changes to the health system, I wonder why we are debating their establishment separately. Why not put both bodies forward at the same time, as the coalition called for last year? Could it be that the government is concerned that the costs involved in establishing two new bureaucracies could be better spent?

We see horror stories, absolutely terrible stories, every day in our papers about how the health system is failing Australians, how patients cannot get surgery, how patients need to be rushed to larger hospitals sometimes hours away to be treated and how patients are dying unnecessarily. This week alone I read news articles about a young boy in Sydney who unnecessarily lost his life after suffering through 12 hours of a burst appendix, a diagnosis correctly made by the first doctor he saw. I read another story about a 13-year-old girl who gave birth on a runway in transit to a larger hospital as the local facility did not have the capacity to help her. We all know these stories—we have heard them in this chamber tonight—from the terrible conditions in Townsville to Gladstone patients being stabilised before being rushed to Rockhampton, two examples from members in my home state of Queensland alone.

Hopefully based on this, the government have identified that Australia needs major reform of the health system. They are right—something historic needs to be done to improve our health system. But their solution is more bureaucracy, a bureaucracy that will be charged with monitoring and reporting on the performance of local hospitals, primary healthcare organisations and other bodies that provide healthcare services. That is a very broad role for the National Health Performance Authority. It is an especially broad task when you read through the legislation and discover that nowhere is there a definition of 'performance'. This is a body set up to monitor performance without clarity on what a well or performing health service actually is.

This is obviously cause for reservations. There are no key performance indicators, KPIs. How then will this statutory body assess performance? That is a big question which has been left unanswered. It is a question that could have been resolved through a proper inquiry. The government did conduct an inquiry. However, true to form, it was brief, it was conducted in haste and it did not address many major questions and concerns that continue to hang over this debate, questions that none of the members opposite has been able to answer. The haste with which this inquiry was conducted is made clear in a statement made in the dissenting report:

… that a number of stakeholders that wanted to contribute to the Inquiry were unable to due to the haste with which the Inquiry was conducted.

It seems to me that the Gillard government may be trying to rush this amendment through for political reasons, rather than as true reform which will actually address health problems and provide real outcomes for Australians. Major stakeholders have concerns, including the Australian Medical Association which is calling for the legislation to be deferred as it would like to see an assessment of the impact of the legislation and details of what data must be provided to the authority by health provider organisations. That is right: as well as having no performance indicators, it is unclear what data health services have to provide.

Those opposite have spoken tonight about accountability, fixing hospitals and historic reform, but how will health providers be accountable to this body? It has no disciplinary powers. There is no way this body will be able to compel the states to improve services. Is it simply going to be a toothless tiger? Simply establishing an authority, a body of bureaucrats with the word 'performance' in its name, does not improve services. It does not make anyone accountable or improve performance in any way. Without any definitions, without indicators or benchmarks, how will this body work? That is the question stakeholders want answered, that is the question the coalition wants answered and that is the question Australians deserve to have answered.

Furthermore, as stated by the Australian Healthcare and Hospitals Association, the legislation:

… fails to recognise the formal role of state/territory governments as majority funders and system managers of public health services including overall responsibility … for the performance …

It is not real reform. It is, in fact, a backward step from what the current Prime Minister's predecessor announced. Then Prime Minister Rudd promised historic reform, yet when that agreement simply could not be reached, perhaps for reasons mentioned previously, Prime Minister Gillard still heralded her 'historic reform'. However, it seems that, while the current Prime Minister was busy announcing historic reform, her Minister for Health and Ageing was quickly realising that without some serious consultation with the states and subsequent amendments this legislation would be unacceptable since so many changes had been made without the states' agreement. An emergency meeting was called and the resulting communique from that meeting stated that ministers from the states and territories insisted that they are the performance managers of public hospitals in Australia. So what is the new body now going to do?

On top of this, we have heard tonight from the member for Hasluck that there are already many organisations that collect data about the performance of health providers—yet another example of duplication which again raises the question of why this body is needed. Why funnel more taxpayers' money to bureaucracy for information that is already being collected? Every dollar that goes into funding data collection for a statutory body is yet another dollar removed from frontline care, from saving the lives of those such as the young boy who died from a burst appendix.

Members opposite have attacked the Leader of the Opposition tonight, accusing him of standing in the way of Australians accessing health care. A statistic is not health care. A patient who is suffering in a waiting room for hours is not comforted by the knowledge that someone somewhere is recording how long they are waiting. They are confused and angry because that data collection just soaked up funding that might have meant they would see a doctor sooner.

A local surgeon in my electorate, Dr Christian Rowan, came to see me the other day. We were discussing the health system in Queensland, and he reminisced to me about completing his residency in Brisbane during the 1990s, recalling that an entire wing of his former hospital that was once full of beds is now full of bureaucrats. Queensland Health proudly announces on their website that they are the third-largest employer in Australia; however, a report put forward by the Australian Medical Association's Queensland branch shows that in 2008-2009 they employed 13,645 managerial and clerical staff—an increase from just 5,060 in 1995—compared to just 6,715 doctors. Additionally, these 6,715 doctors spend approximately 20 per cent of their time filling out paperwork, caught up in red tape. That is 20 per cent of their time not spent with patients, not addressing the 180,000-plus patients on the elective surgery list—20 per cent of time spent on bureaucracy on top of the paperwork already being administered by a bureaucracy twice the size of the doctors workforce.

This report was compiled back in the first round of 'historic reform' under former Prime Minister Kevin Rudd and was put together to ensure such reform would be right for Queensland. I cannot imagine the disappointment that organisation would feel knowing that we are currently debating reform that is proposing to establish a bureaucratic body to somehow measure the performance of the health system that already suffers a problem with bureaucracy. When the legislation has no clarity, how will providers know how they will be affected? How will they know how their patients will be affected? Do the bureaucrats who will comprise these bodies know? Simply announcing 'historic reforms' does not cut it.

We need less talk, we need fewer bureaucrats and we need fewer amendments. We need more action; indeed, we need more outcomes. What we really need are more patients receiving better treatment, resulting in more healthy Australians. This bill simply does not give me any confidence that this will happen. It is unclear, it overlaps and it creates a growing administrative burden. It is flawed legislation, and I have grave doubts that it will provide any real outcomes for Australians.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the National Health Reform Amendment (National Health Performance Authority) Bill 2011 and in support of what this bill will do. The bill has two clear purposes. One is to insert a new chapter into the act. That will contain the provisions that will establish the performance authority. It will also amend the act to differentiate the commission from the performance authority. It will insert provisions to do with secrecy and information disclosure as well. The reason I speak in support of the bill is that, contrary to what I just heard from the opposition, it will do the things that it is designed to do. It will ultimately be about patient care and patient outcomes. That is what health is about. Why would you amend an act and set up an authority if that is not what the goal is? That is what it is all about. We talk about historic health reforms—and they are historic—but it is action, not just talk. I heard plenty of talk on the other side but there was little action over the last few years and over the 12 years they had in which to do it. They did not do it; they did not tackle the hard things in health reform.

I also speak with a little bit of experience, having served on health boards, set up health services and been a health advocate in my area. I have had some experience and involvement in some reforms that have had to happen at the local level. One of the things in health that can be difficult is measuring performance, because we measure performance in objective ways. I can understand that some of the medical and health personnel can feel a bit apprehensive about that: 'Is it measurement of me?' A lot of people can feel like that in any workplace. Originally, it was quality assurance. When that was introduced to a hospital where I was on the board there was some nervousness about it. It was being done at a local level but also at a state level when we rolled it out, and there was a whole discussion that went on around that.

I see that the National Health Performance Authority will be a good thing in terms of patients and patient care. There is widespread support for this bill. This bill does five key things at the operative level. It changes the title. That might not seem a dramatic thing, but it is really important because it brings together a number of operations. This bill changes the objects to include the performance authority and adds some corresponding definitions. It inserts distinguishing provisions regarding the members and CEO of the commission and the Australian Commission on Safety and Quality in Health, and introduces provisions relating to the secrecy and disclosure of information to the commission, which I will mention a bit more about later in my contribution. The bill does add that new chapter, which is a seminal chapter, to establish the performance authority. Then there are also some miscellaneous provisions. Firstly, I will deal with the secrecy and disclosure, then turn to the performance authority and its roles and functions and locate it within the policy framework of the federal Labor government since we were elected in 2007 together with the historic health reforms the health minister so rightly referred to, which were negotiated recently with Prime Minister Gillard. An offence provision is to be inserted so that anyone who is or has been an officer of the commission and has obtained information in that capacity is not able to use or disclose that information. To do so can incur a penalty by way of sentence. The sentence is substantial; it is two years imprisonment or 120 penalty units or both.

This bill also causes the insertion of parallel provisions relating to the commission, and there are, of course, permissive as well as prohibitive provisions, as the information I am talking about in this context is to be used for lawful purposes. The way I have read that is that the legislation gives it a coverall with some overriding application pertaining to patient protection, because that it is what this is about. It is about patients, so anything that is in the act that pertains to the patient is about patient protection. The policy that gives rise to this comes from the health reform that I talked about that was embarked upon in 2007 and has continued since then.

In looking at the benefits of the health reforms for patients, I understand that within the broad health reforms there are a couple of key things. First of all, there is more money. I am going on memory here, but I think there is $19.8 billion more going into the health system and going into patient care. More money does not resolve everything, but more money certainly helps. We know of the escalating costs in health and we know that they have been rising faster than state governments have been providing for in patient care. It is important to have that injection of funds. There has already been an injection of funds, and there are more funds that will be injected into the system over a period of years.

I know in my seat of Page that people who are patients—I know some people call them consumers or clients; I say 'patients' as I know when I use health services I still like to be called a 'patient', so I will stick with that word—have benefited in a number of ways. Firstly, there has been extra capital available, and in my area you only have to look at the integrated cancer care centre at Lismore Base Hospital to see the benefits there. There was additional money that came through from the federal government to allow it to come online one year sooner than it would have, so extra money was committed to capital costs to make sure that the centre was open a year ahead of time. That meant that people did not have to travel to get radiotherapy; they could have it in their area.

Also, across the road from Lismore Base Hospital, where the regional integrated cancer care centre is, we in the community are refurbishing and remodelling a 20-room accommodation building. We have put about $2.6 million into that and another $900,000 has gone in to make sure that patients and their families are able to stay close by when they are having treatment there. Money has also gone into Grafton Base Hospital. These are things that had not been provided and that communities were crying out for. When people in the opposition talk about no benefit to patients, it is absolute nonsense. You only have to look around Australia. It is not just in my electorate or just in Labor electorates; it is in electorates across Australia that these health reforms are starting to kick in.

This is a continuation of that package. So, even though I am straying a little bit off the bill before us, I am talking about the framework that this bill is located in. So, Mr Deputy Speaker, I am being indulged a bit but not too much as it is still within that framework. The performance authority is not merely a part of the health reform; it is a key element. It is part of COAG agreements and the National Health and Hospitals Network agreement. The heads of agreement was signed by all states and territories earlier this year, I think in February. That required that the performance authority would be established this year. The main purpose of the performance authority is to monitor and report on local hospital networks. It will cover Medicare locals as well, as they are being rolled out—another great initiative under the health reforms—and other healthcare service providers and, of course, the hospitals.

The authority will also deliver clear and transparent performance reporting, and it will be set against a new performance and accountability framework. For the first time, that will provide Australian patients and other people with information about the performance of their health and hospital services, and it will do that in a way that has consistency. It will be consistent at a national level and it will also be of relevance at a local level, because everything is local. We have to do things that sit and are situated within a national framework and we have to have a rational approach—we have to make sure it is set up like that—but it has to speak at a local level, and this clearly will do that. It will allow patients to have more information if they want it—and a lot do—on their local health services. Ultimately, if you have more information and people can access that, that leads to improvements in patient care, because that is what the system is set up to do.

The authority will also be able to report on the performance of our local hospital networks and the hospitals within them. I understand there will be regular performance reports on hospitals, and there will be reports within our Medicare Local geographic areas as well. That will be very useful for primary care in particular. These reports will include information about how well local health services are performing. They will also look not only at direct patient care but also at patient care that is preventative and at access to GP services.

We have all seen the government's establishment of the MyHospitals website, www.myhospitals.gov.au. I know that a lot of people have been looking at that, and it shows some of the emergency department and elective surgery performance; it is about looking at elective surgery performance. That is really important, again, for people to know. Local people know their local hospitals. We now have the local hospital networks in place. We have the governing councils—locally we still call them the committees—and they are in place. People who know them know well how their local hospitals are working, but this gives us another measure. It is about a system that is nationally consistent and locally relevant, and it is about having a system that is our system and is not alien to us. Sometimes the health system—how it works and how it operates—can be a bit of a mystery to people, and we live in a day and age when that is just not acceptable. Things like that have to change, and this amendment—this bill—is part of that whole national health reform package. In closing, I want to say that I commend the minister for the really good work—rather exacting work—that she has been able to do in this difficult area.

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

This bill, the National Health Reform Amendment (National Health Performance Authority) Bill 2011, proposes to establish a statutory authority known as the National Health Performance Authority. It introduces amendments to the National Health and Hospitals Network Act 2011, which was only passed by the House on 21 March this year. The National Health and Hospitals Network Act establishes the Australian Commission on Safety and Quality in Health Care as an independent statutory authority. If enacted, this bill will amend the National Health and Hospitals Network Act 2011 by changing its title to the National Health Reform Act 2011. Still to come is further legislation which will establish a third statutory authority, the Independent Hospital Pricing Authority. When the initial bill was introduced last year, the coalition called for the government to make all provisions to establish all of these bodies at the one time. But, as usual with the government, what we have is a piecemeal approach of bill after bill and amendment after amendment.

It is worth recounting the history relating to this bill, the authority that it creates and the warnings and concerns that have been sounded loudly. It is an outstanding example of the ineptitude of this government. When the minister introduced the initial bill, the National Health and Hospitals Bill, in September last year, as with virtually anything this government attempts to do with health, it was described as 'historic' and as delivering on the government's health reform agenda. Of course, the so-called reform agenda was somewhat different back then. These were the Rudd-Roxon reforms and, as the minister told the House, they were all about the hospital networks that would be funded nationally and then run locally. At that time the current Prime Minister, Julia Gillard, was still on board with Kevin Rudd's reforms, telling the Committee for Economic Development of Australia in November last year:

From July 1, the Commonwealth's share of hospital funding will increase to sixty per cent … GST retention and dedication to health care will commence.

As with so many of this government's promises, that just did not happen. Julia Gillard earlier this year unceremoniously dumped the Rudd clawback of the GST and the commitment to the major funding of the public hospitals and is now going to provide only around 40 per cent of the public hospital funding. Yet in last year's election campaign the Prime Minister also stated:

… I regard health care as one of the greatest responsibilities of any government.

…   …   …

If my government is returned to office on August 21, I will pursue our national reforms until the job is done.

We all know that standing by commitments and promises to the Australian people is not high on this Prime Minister's list of achievements for her government. Her action in health is every bit as vigorous as the reversal of her promise that no government she led would introduce a carbon tax, a tax that Australian people do not want yet one that she steadfastly insists on inflicting on them by the middle of next year.

The National Health Performance Authority is to be charged with monitoring and reporting on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and the bodies that provide health care services. It was to be an incredibly wide-ranging brief. Unfortunately, the bill provides absolutely no performance indicators that the proposed authority would monitor and report upon. It just sounds hard to fathom that a bill with such intense overtures has no performance indicators. The government controlled House of Representatives Standing Committee on Health and Ageing held an inquiry into this bill. There was one extremely brief public hearing for the Department of Health and Ageing to answer seemingly one question and a report from the committee was then tabled with one recommendation, that being for the House to pass the bill with a minor amendment requiring an annual report to the parliament.

Given that submissions to the inquiry outlined serious reservations regarding this legislation, coalition members presented a dissenting report that it would be unwise for the House to pass the legislation until stakeholder concerns were addressed. The dissenting report noted:

… there are far too many unanswered questions about the National Health Performance Authority … The House should not debate this bill until the Government clarifies …

matters. It also noted:

… a number of stakeholders that wanted to contribute to the Inquiry were unable to due to the haste with which the Inquiry was conducted.

This debate has been on the agenda for many months and to think that the process would have been rushed through is unthinkable, so it is worth looking at some of the detail of what the stakeholders said about this legislation. The explanatory memorandum to this legislation states that its measures will have no regulatory impact on business or individuals. However, the AMA bluntly responded, 'We do not believe that this is a true statement.'

The Australian Private Hospitals Association has concerns that this new authority will simply add 'yet another layer of compliance burden for both the public and private hospital sectors'. Its submission to the House committee inquiry stated that the national data collection must replace the current system of multiple reports to multiple government agencies which it says place 'a significant regulatory compliance burden' on private hospitals.

The bill was also the subject of a Senate committee inquiry. The Royal Australian College of General Practitioners warns that the provisions of this bill hold long-term threats. They will:

… harm the current high standard of medical services, and consequently health services, delivered to the community.

Catholic Health Australia held similar concerns in its submission to the Senate and stated:

The legislation as currently drafted is very broad – indeed vague – on the scope, range and detail of data that will be required to be submitted.

It wanted to see detail set out in the regulations that would enable the parliament to exercise oversight. It said such detail was needed to avoid unintended consequences. Looking at a particular incident in the UK, it said:

We need, for example, to learn from the recent experience of the Mid-Staffordshire NHS Trust in United Kingdom, where it has been reported that between 400 and 1200 excess deaths together with appalling lapses of patient care and hygiene occurred between 2005 and 2009 as a result of the local board and hospital management focusing more on meeting performance and cost cutting targets than on actual patient care.

The College of General Practitioners pointed out that it was unclear whether general practice will be monitored by the authority and clarity is needed on this issue.

Catholic Health Australia echoed many of those points and also called for clarity on the role of the authority, noting that the Australian Commission for Safety and Quality in Health Care, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics already collect data on hospitals and health services. CHA also wanted the legislation drafted in such a way that the governance arrangements of the authority would reflect the makeup of the Australian health system and therefore would have members with knowledge of public and private hospitals, primary health care and private or non-government healthcare provisions. A submission to the Senate inquiry from the Council for Procedural Specialists queried the very need for the authority and said it could find 'no justification or compelling case as to why it is needed'.

There were recurring themes throughout many of the submissions to the House and Senate committees, namely, that there is a lack of clarity about this legislation and the authority it will establish, vagueness about what it will do, a lack of goals and objectives, concern about duplication with other new agencies this government is establishing and with existing agencies, worries about the administrative burden being placed on health service providers and concern about the composition of the authority board.

Predominantly, this bill tries to speak to the intent of giving power to the regions by having their own boards. However, the confronting reality is that the boards will neither have the power to make local decisions nor employ staff on a needs basis. This is just another expansion of Labor's overarching centralised policies which continually haunt the political landscape. This bill does not speak to decisive action on waiting rooms, yet it speaks to predetermined goals of 90 per cent of patients being treated within four hours. When I speak with my local practitioners, who are already under duress, some suggest these goals are laughable.

This bill gives no guarantees to people on waiting lists—at either my Beaudesert Hospital or the Gatton Hospital—that they are going to be treated any quicker. Introducing another layer of bureaucracy does not assist the frontline staff in meeting their day-to-day demands. These reforms are not patient focused and it would appear that the only focus of this government is to create a record number of bureaucrats in an already bloated public sector.

What we are looking for is flexibility for the people on the ground to be able to make decisions that impact on their workplace on a daily basis without having to deal with another layer of bureaucracy, without having to deal with a regional body that could be based hundreds of kilometres away and without having to play second fiddle to larger hospitals that will have their own priority lists. Once more, regional Australia will be left out in the cold.

As I have alluded to in my speech, too many of the peak body groups are starting to lose confidence in this system. More changes at the top, increased bureaucracy and unanswered questions ultimately end up producing fewer results on the ground.

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

In the very short time that I have to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011 tonight, I will refer to some administrative matters. One is that I understand there is a second reading amendment before the House from the coalition which states:

... the House declines to give the bill a second reading until provisions establishing the Independent Hospital Pricing Authority, including its functions and responsibilities, are presented to the House for its consideration.

Likewise, I will be presenting in detail an amendment as recommended via the House committee that worked on some aspects of this bill. That will be in the consideration in detail stage and I understand there are substantial government amendments to be presented at that stage. I encourage all members to have a look at those amendments because in many ways what we started with when it was first introduced in this parliament—

Debate interrupted.