House debates

Wednesday, 17 August 2011


National Health Reform Amendment (National Health Performance Authority) Bill 2011; Second Reading

Debate resumed on the motion:

That this bill be now read a second time.

to which the following amendment was moved:

That all words after "That" be omitted with a view to substituting the following words:

"the House decline 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.

10:02 am

Photo of Robert OakeshottRobert Oakeshott (Lyne, Independent) Share this | | Hansard source

I had only 30 seconds last night. I will continue on the substance of the National Health Reform Amendment (National Health Performance Authority) Bill 2011 and the range of amendments that are emerging not only from me but also from the coalition and the government, which has some substantial amendments. I am not opposed to establishing a national health performance authority as a concept. I think it is an important contribution to national health and hospital reform that this House and Australia have been chasing now for at the very least three years. To have in concept form a body to monitor the performance of all aspects of that health and hospital system is a sensible and much needed part of the oversight and scrutiny in regard to the health reform agenda on behalf of Australian taxpayers.

However, having said that, we are seeing before our eyes now some changes with regard to what was introduced in this parliament under the guise of the Health Performance Authority and now, with substantial government amendments, some substantial changes to the concept that was introduced, arguably even to the point where we could build a case that it is a separate bill altogether in structure. The amendments are so substantial in the way they change this from what started out as a national performance authority to what is now a gaggle of states authority. The command and control really is residing once again back in the hands of the states and territories. Back in 2008, when we started this journey, really largely the point of the exercise was to find a way for the Commonwealth to directly fund that resource and give the local health district networks or their equivalents around Australia much greater command, control and autonomy on the ground. That was the model when this bill was introduced in the House in the last session. The principle still stood and health and hospital reform generally was looking to still be on track.

I urge every member and anyone listening to this debate to focus not necessarily on the bill itself but on the 29 government amendments to their own legislation that they put before the House several months ago. The concern is in those amendments and how much has been given with regard to state clawback and the use of COAG as a Trojan Horse on behalf of the states once again wanting to get command and control of a system that they considered was under threat through what was, and hopefully still is, a very good and important reform for Australia in tidying up and essentially nationalising our health and hospital system in Australia.

In relation to the amendments before the House, the coalition's second reading amendment will be the first we will deal with. It states the coalition's desire for the House to decline to give the bill a second reading until:

(1)      provisions establishing the Independent Hospital Pricing Authority, including its functions and responsibilities, are presented to the House for its consideration …

I can understand the coalition's desire to want all of the health and hospital reform brought in globo and have us deal with it all at once. I hope that is the desire. From my reading of this, I think the link is tenuous at best to the Independent Hospital Pricing Authority. Health and hospital reform in some form is happening in a range of bills and my reading of this second reading amendment is that it is the continuation of the policy of wanting to be slow and difficult on all policy if not in control of the government benches. So I will not be supporting the second reading amendment from the coalition.

With regard to the in-detail stage, I will be putting forward an amendment concerning the reporting requirements of the health reform agenda and the National Health Performance Authority. This was put to the House committee that looked at this issue with regard to how the authority reports: does it report directly to the minister or should it also have some obligations to report to parliament? My perspective—and I am pleased that the House committee also supported these considerations—is that the authority should have responsibility to report as soon as practicable to the parliament so that reporting is not part of a game by the executive to release bad news the day before Christmas or to get up to any other tricks that everyone in this place knows can get played when governments are behaving badly. The authority should have some tight time frames for reporting and some clear and specific obligations for reporting to parliament and therefore to all of the 150 members and indirectly to 150 communities around Australia. I am hopeful of support for the amendment. I think that it is a small but important reflection on the role and status that parliament itself plays in the transparency process that delivers better policy outcomes for all of us.

There will also be a batch of 29 amendments that the government is introducing to their own legislation. It is here that I have most concern, and I will speak again in the in-detail stage. This is really where the dumbing down of this legislation is taking place, in my view. As I said at the start, whilst we are regarding these amendments as being an inch better than where we were before, we are still a mile short of where we could or should have been with health reform and the agenda that has been going on for the last three years. That is where the disappointment lies, in the lost opportunity of reform and allowing a performance authority, unfettered, with independence, to truly assess data from all states and territories of all hospitals regardless of who the direct authority is, so that we can get some direct benchmarking and some clear direction on who is or is not performing in health and hospital services today. In my view, the amendments that the government is introducing are tying the hands of the performance authority and really making it subservient to the states' authority.

That has been a big part of the problem to date that I thought the reform agenda was trying to resolve, and in the whole negotiation of trying to get all the states and territories on board there has actually been a compromise too far. I understand that negotiation and compromise have their place but I do not think that the balance has been struck. I think that compromise with the states has really given command and control back to the state and territory authorities to potentially continue to behave in an inefficient and less than value-for-money way than we desire.

I think I heard another speaker talk about the performance authority as a consequence being a 'toothless tiger'. I hope that is not the case and that is why I will continue to support the substance of the bill, because we have inched forward slightly. But I do think that it is a neutered tiger. I think that through this process it has lost a lot of its authority to truly assess the performance of health and hospital services across the board in Australia on behalf of Australian people with data that is given to the parliament and to the people without fear or favour, without any washing by any states or territories, without any tricks or political games with talk of various turnarounds of work schedules or how early the documents have to be given to state and territory health ministers so that they can get their guns loaded in response and without the use of COAG as the body to really hide a Trojan Horse for this re-emergence of state and territory command and control. I am very uncomfortable with those government amendments and will not be supporting those when it comes down to the in-detail stage.

I hope—and I flag and I warn—that this whole exercise is different from the recently signed health and hospital reform agreement documents and that this is not symptomatic of what is to come through legislation. I hope there is not going to be a range of legislation that sees the states claw back control three years after the beginning of a very good and very important reform agenda.

In 2008, in the previous parliament when the government was a majority government, I was still a very strong advocate for the importance of this reform. The then Prime Minister, Kevin Rudd, sat in the tea room of a local hospital, the Port Macquarie Base Hospital, and talked at length with the medical staff at the hospital and listened closely to discussion on the importance of the principles of the two Es—efficiency and equity. That is all I and communities such as mine have sought through this process, namely, efficiency being rewarded in the system and equity. Those services performing over and above should be rewarded. Currently in the funding models they are not, so that inefficiency, in many ways, gets rewarded. The resource distribution model controlled by the states does not deliver equity, particularly to rural and remote communities and to high-growth areas. Both are traditionally behind equity in the delivery of resources and funding.

The National Rural Health Alliance put a figure of $1 billion a year based on a failed model of the states resource distribution formulas not making it to where, on the state's own funding formulas, it should. It is a disgrace. It is one of the great failures of Australian public policy at the moment and it is the fundamental reason that reform is so important and that we need to be eyeballing the states rather than being subservient to them.

What I am seeing in these amendments that have come through whilst this bill is before the House is in my view too much compromise with those that are too much to blame for the problem—the very reason that we are reforming. So I would hope this is not the first of many. I hope this is a one-off where, for a whole range of reasons that I am probably not aware of, the states got a great big win through the range of amendments that have come in and Australian taxpayers as a consequence in my view got a great big loss.

I would hope that in upcoming legislation attached to the health and hospital reform agenda we do see the Commonwealth actually stepping up and sticking true to what the reform agenda was in 2008—that is, to start to have a Commonwealth funding authority working directly with local command and control. It is a sensible concept; let's deliver it.

10:16 am

Photo of Nicola RoxonNicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | | Hansard source

I would like to thank the very many members who have spoken on this bill from both sides of the House. It would be fair to say from listening to the contributions that people feel very strongly about making sure that our hospitals can deliver for local communities. The member for Lyne, the final speaker on the bill, is a very passionate advocate for making sure that his local community is well looked after. I can indicate to the member for Lyne that the government will be supporting his amendment when the opportunity comes for that. However, I do need to indicate to him and to the House that we fundamentally disagree with his assessment of what the amendments mean. I will be addressing that in more detail when I move those amendments.

Let me go to the summing-up and deal with those issues first and then for the convenience of the House I might mention that we intend to move the amendments together as a group. The National Health Reform Amendment (National Health Performance Authority) Bill 2011 establishes a key element of the Australian government's health reform agenda. (Quorum formed) I am sure that members are delighted to be here to know that the National Health Performance Authority will act as a watchdog over the performance of both public and private hospitals, local hospital networks and Medicare Locals. It will regularly report comparative information on the performance of these bodies and give the public information in respect of consistently poor performance. Performance monitoring will support the improvement in healthcare delivery, safety and quality by all of these services. Poor performance will be identified to allow for remediation and superior performance will be identified to allow for the dissemination of best practice approaches.

The establishment of the authority is a key part of the health reform agreement signed by all states and territories this month. We then introduced the legislation into this House in order to meet the time frames of the February COAG meeting but also were open to consider amendments which might be suggested from the states, the committee inquiry in this place or the Senate committee inquiry. State and territory health ministers agreed to the detail of the legislation and how it will interact with their health systems at a meeting of the Australian Health Ministers Advisory Council on 7 June. Amendments to reflect the detail of this agreement were distributed by the government in the last session of parliament.

Photo of Bruce ScottBruce Scott (Maranoa, National Party) Share this | | Hansard source

Would those members who are still standing out of their place and having little discussions either do that outside or resume their place in the chamber.

Photo of Nicola RoxonNicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | | Hansard source

I will be moving amendments in the committee stage of the bill. These also reflect amendments suggested by the Senate committee inquiry. The amendments will bring about a firm partnership between the Commonwealth and the states and territories in their endeavour to deliver better healthcare services to all Australians. The amendments to the bill will enshrine the independence of the authority giving it the ability to appoint its own chief executive officer as well as the power to remove that person in the case of poor performance or misconduct. Amendments will also foster greater cooperation with the states through consultation on the authority's strategic plan, consultation about reports of poor performance and the designation of local hospital networks. This shows that the government is committed to work with all jurisdictions on health reform and deliver an outcome that will put more information in the hands of Australian patients. I thank those members who have made constructive contributions to this debate. However, unfortunately, a number of members of the opposition have used their time to simply complain and criticise rather than to outline any plans they would use to deliver improvements to the health system. They have been consistently silent on their vision, except for a policy to wreak havoc on and cut health services.

It is a fact that this bill delivers on reforms that the Leader of the Opposition once talked about but never had the capacity to deliver. On 9 May 2008 he said the Howard government:

… would have empowered the public by requiring the states to publish detailed information about the specific performance of hospitals.

… … …

In return for continued funding increases, each state would have been required to provide detailed quarterly reports on the precise number and type of services delivered at each public hospital and to provide detailed quarterly reports on adverse events at each hospital.

So, while the opposition has an 'oppose everything' strategy, by not supporting this bill they will be opposing something that their leader himself once called for—although did not achieve in 11½ years.

We are now seeing the opposition, having no ideas of its own, continuing to play the easy game of trying to frustrate the government's significant reforms. This was highlighted earlier this year when the shadow minister took a similar approach in regard to the bill to establish the Australian Commission on Safety and Quality in Health Care, a body originally established, temporarily, by the Leader of the Opposition. Now we have had a bill before the House for some months, scrutinised and endorsed by committees in both the House and the Senate, and the best the opposition can come up with is saying that we should sit on it and not establish this important watchdog agency.

The shadow minister clearly knows that this agency is a key part of the health reform agenda and that this legislation has been endorsed by all the states and territories, including three Liberal states. He also clearly knows that this agency will have a watchdog role in scrutinising the performance of health services, whereas the Independent Hospital Pricing Authority will have a completely different role, an important technical and financial role, in determining the official price for hospital services. Rather than trying to wreck every bill, it might be worth the opposition's time to develop at least one health policy of its own.

Our government is determined to pursue the tough reforms, particularly when they involve more transparency for the Australian public. Standing on the shoulders of My School, My Hospitals and the work of the National Health Performance Authority, this agency will deliver for Australians unprecedented levels of nationally comparable information. It will also be a watchdog to detect poor performance in our public and private hospitals and primary care sector. I thank members for their contributions, my officials for their hard work and the states for their cooperation with these reforms. Question put:

That the amendment be agreed to.

The House divided. [10:30]

(The Speaker—Mr Harry Jenkins)

Question negatived.

Original question agreed to. Bill read a second time.