House debates

Tuesday, 18 October 2016


Appropriation Bill (No. 1) 2016-2017; Consideration in Detail

12:31 pm

Photo of Sussan LeySussan Ley (Farrer, Liberal Party, Minister for Sport) Share this | | Hansard source

I am pleased to speak in support of the budget in general and on the health portfolio in particular today to emphasise our very real commitment to sustainable health spending that continues to increase, that continues to take the path of sensible measured reform. We are not standing still, we are not avoiding the tough decisions but, most importantly, we are doing two things: we are putting patients at the centre of health care and we are making sure that every single health dollar is as efficient as it possibly can be. If you look at the twin priorities of any federal health minister anywhere in the world, those two should be absolutely front and centre.

The reform that we commenced prior to the election, that were enhanced by genuine commitments during the election is continuing. It is continuing in two key areas. Firstly, the review of the Medicare benefits schedule is ongoing, done by clinicians with, again, the practice of medicine at the centre. The numbers of clinical committees and the work that is being led by Professor Bruce Robinson has not happened at any stage within the Australian health system. In fact it has been 30 years since the MBS was reviewed. If you talk to anyone who uses the MBS—doctors, general practitioners, specialists—they say they want it to reflect contemporary clinical practice. And sometimes the things that they do in their operating theatres or consulting rooms every day are not even in there and they have to manage workarounds instead. Or they see things in there that are quite laughably out of date. So this is important work, it is bipartisan work and it is necessary work.

Secondly, the other key plank of our reform is our Health Care Homes model, which is a new way of remunerating general practice if you look at it from the provider aspect. But importantly it is a new way of treating patients with chronic and complex conditions if you look at it from the patient's point of view. So if you are in the top 25 per cent of patients in Australia with chronic or complex conditions, we have for you a reform that enrols you into a health care home. The trials of Health Care Homes are starting now and the lead up to this work has been about 12 months because we wanted to get it right. As with our other reform measures, codesign is vital. Doctors, nurses, consumers and allied health professionals were part of the design of Health Care Homes. We are now in 10 primary health networks across Australia, rolling out the trials in 200 practices with about 65,000 patients.

The modern GP might be a younger person compared to the older style general practitioner who opens their doors at nine o'clock and closes their doors at five o'clock. I am constantly being approached by younger doctors who say, 'I would like to trial some innovative methods of practice. I would like to be in touch with some of my newly diagnosed patients at the end of the day. I would like to bring technology to bear in a much more exciting way to look after their needs. I would like to visit the aged-care home and spent half a day there doing some different things—for example, training the nurses. I'd like to have the pharmacist more involved in my general practice. Where I live is a low socioeconomic area; I would like to try having a pharmacist here every day, helping people manage their medicines.' All of these things are perfectly possible within the Health Care Homes model. But instead what we have now is a very regimented, transaction based Medicare system. At no stage are we judging the outcomes in the way that we should. The Health Care Homes model is going to do exactly that.

I have touched on two key reforms but, as I said, they were enhanced by genuine commitment in the budget—$20 million for a Zero Childhood Cancer initiative and $7 million for clinical trials. I have just come from a rare cancers event in Parliament House. It is very clear to me that access early on to medicines that would not normally be listed on the PBS is vital. Our commitment to medicines when compared with the opposition is incredibly different. We have listed three times as many medicines at $4.5 billion compared to Labor, who listed $1 billion worth of medicines and, at some points in their stewardship of the health portfolio, actually refused to list medicines at all because their budget could not pay for it.

12:36 pm

Photo of Julie CollinsJulie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | | Hansard source

Let's be frank about this: there are a lot of very bad measures in this appropriation bill when it comes to health, particularly extending the Medicare freeze for six years. That might just be the very worst in the whole appropriation bill. It is worth reflecting on the history of this freeze, though, because we hear from the other side a lot about the history of this freeze. Let's be truthful about it. The Abbott government tried and failed to impose the GP tax three times. When they failed, they introduced this freeze on the Medicare rebate—a co-payment or GP tax by stealth. The current Prime Minister sat in the Abbott ministry, as did the minister. So the GP tax or co-payment by stealth is as much the minister's and the Prime Minister's as it is the member for Warringah's.

I want to give credit where credit is due. GP rates were indexed in July 2014, as the last Labor government had budgeted for. When the current minister says that Labor initiated this freeze on the Medicare rebate, she is talking rubbish and she clearly knows it. She is not being truthful. Even though the member for Warringah and the member for Dickson indexed GP rates, it is something that this minister and the current Prime Minister may never do. In his very first budget the current Prime Minister not only kept the freeze on the Medicare rebate but extended it for six years. He did that in spite of the assurances the minister had given to doctors. We understand the minister went around and consulted with doctors and whispered to them or whatever, keeping them in the tent and telling them that this freeze would be lifted. So you can imagine the surprise of doctors when the freeze was actually extended. Instead of four years, which was bad enough, the freeze will now run for what the Rural Doctors Association are calling an ice age—a very long time, indeed.

Everybody in this place knows that that freeze will drive down bulk-billing and drive up out-of-pocket costs for patients. We know that GPs simply cannot afford to keep bulk-billing if Medicare does not keep pace with the rising costs. It is pretty much economics 101. If costs go up and you do not get more costs coming in, it works out like that. Now we have heard the current minister cherrypicking the statistics and arguing against this inevitability. She is trying to use different statistics and be a bit clever about it, but the minister should come clean with the Australian public and answer some basic questions about what percentage of patients, not services, are currently bulk-billed and what percentage of GP services for those patients—not all services but GP services—are currently bulk-billed. We know that this is changing, and that, as this freeze goes on longer, it will change more. We know that the minister is unlikely to answer those questions because she knows what the answers are going to be. But, try as she might, she cannot really hide the impact of that freeze from Australians, because of course, every time they go to a GP or they are referred to a specialist, the freeze will hit them where it hurts. Out-of-pocket costs are a really serious issue out there in the community.

Australians who are not bulk-billed already pay an average of $35 to see a GP. That is up 20 per cent in just three years under this government. Around Australia we are seeing practices abandoning bulk-billing. In my home town of Hobart, the Grosvenor and Collins Street General Practices have been forced to charge pensioners and Health Care Card holders for the first time. Their sign actually says it is due to the freeze on the rebate. This is at a time when we already know that one in 20 Australians does not see their GP because of the cost. So we already know that people are making a decision not to go to the GP because of the cost. The government knows the impact that this is going to have.

What has the minister said? Interestingly, during the campaign she did say something. She said:

I've said to doctors I want that freeze lifted as soon as possible but I appreciate that Treasury and Finance aren't allowing me to do it just yet.

Then of course she went into hiding because it was a bit of a gaffe. They did not say very much about GP tax—and she certainly did not come out and say very much at all—until just before the election day, when the Prime Minister went on Sunrise and guaranteed that no Australians would pay more to see a doctor as a result of this government's freeze. So the health minister must have known the Prime Minister was wrong when he made this undertaking.

12:41 pm

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

After five minutes of kabuki from the other side of this chamber about bulk-billing rates, we might inject some numbers so that we can have an informed discussion in this chamber. The pinnacle of bulk-billing under Labor was 79 per cent for all services. That is now up to 85 per cent. Looking specifically at GP services, over 75 per cent of services are now bulk-billed, something that the Labor Party could only ever dream of while they were in government. The reality is that, with supply and demand—with your University of Tasmania degree and your understanding of basic economics, yes, you are correct—it is the supply of doctors to bulk-bill as much as it is the supply and demand of patients. It is actually doctor provision and distribution around the country that is far more important in this debate.

But it is fascinating to see, Minister, that we have an opposition asking questions about recutting the data and counting it differently: 'We don't like the answer about services bulk-billed, so let's recut it.' Of course they are not going to recut backwards and look at how bad the data looks from when they were in government. They just do not like the results of bulk-billing figures going up under a coalition government. Let us just think of the numbers here too. If we are talking about 85 per cent of services being bulk-billed—and that is presumably roughly either side of 85 per cent of individuals being bulk-billed, although it will vary slightly—who are the Labor Party fighting for when they ask these questions of the minister? Is it the 15 per cent of Australians who are not being bulk-billed, who are predominantly in areas of regional Australia, where in fact we are getting more services out and being delivered? In the city areas, of course, bulk-billing rates in many electorates are far higher.

I think, just on the general pub test, most Australians would say that one in 10 of us can afford to pay to see a GP. One in 10 of us, at the highest income levels, can probably afford to—and do every day without blinking, because they know it is a very important quality signal they send to their GP about the services they are receiving. I am not talking about the bottom 10 per cent; I am talking about the wealthiest 10 per cent in society. You are trying to conflate this debate. You are concerned that only 85 per cent of services are bulk-billed. It is extraordinary that most of us in this building walk into a bulk-billing GP and do not pay for our services. We are incredibly lucky to be in a nation that achieves that, and we have had a Labor government that, yes, is fixated on nothing but how much 40 bucks is for someone who is on $250,000 a year, as you are on the opposition frontbench.

It really comes down to this. We have a Labor Party that, when in government, when we were asking questions of the minister, could only come up with a debate about how much money there is in the system and yet deliberately ran down the money in the system until the cupboard was bare and then deferred, indefinitely, the listing of essential medicines. How is that not emblematic of their economic management?

I would like you to remember, Minister, if you could, a couple of those examples of very important mental health drugs that were simply deferred indefinitely. How is it a deferral if you do not say how long it is going to be deferred for, Minister? That is actually a refusal of an approval. To call it a deferral was just to ameliorate the reality that this opposition when in government utterly ran out of money. That was the true situation.

Then they come in here and nickel and dime because there are 10 per cent or 15 per cent of Australians left who are not being bulk-billed. You have managed to argue over the minors here, desperately trying to find a general practice that says, 'We're going to have to start to charge.' Well, there are plenty of general practices opening that are fully bulk-billing. I would love to get to the bottom of those bulk-billing numbers as we go around the country. I see a member here who was quite happy to have a big billboard saying 'Save Medicare' with his scone on it. The minister might remember that the billboard got him elected but that bulk-billing was in fact beautiful in your part of the world.

Mr Dick interjecting

That is right, and I am one of those. So I know a bit more about it than just sitting in a waiting room of a general practice. As a doctor, I know a bit more about it than the visiting hours of the local hospital which you represent. I know when you walk in you have people in there who know way more than just indexation, and that is what I am going to turn my mind to here in the last few seconds.

This is about the quality of the service that Australia is promising. There is a focus on primary care, which never happened under the Labor Party. The notion of spending more cleverly never crossed the minds of those over there. So, Minister, I would love to know more about the work that is being done by Steve Hambleton and by Professor Robinson—genuinely picking apart these items and putting in the ones we need and replacing those that we do not—and look at primary health care and healthcare homes and, finally, the commissioning of our primary healthcare networks and, for the first time, having KPIs around stuff that is very important to Australians. Medicare locals just ambled along with no direction, and the change to PHNs, which are absolutely aligned with health and hospital regions at a state level, promises a new beginning. We would love to know more about that, Minister.

12:46 pm

Photo of Julie CollinsJulie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | | Hansard source

Perhaps when the minister has her turn she might repeat the guarantee of the Prime Minister—if they want to assert that the Prime Minister is right—when he said that out-of-pocket costs will not increase for GP visits. In the 100 days since the election, we have not had anyone from that side repeat that guarantee. We have asked the Prime Minister about it in the parliament, and he has not wanted to repeat it. So perhaps when the minister next gets to her feet and has her go she could actually guarantee that people's out-of-pocket costs to go and see a GP will not increase as a result of her indexation. That is what the Prime Minister guaranteed, and we have not heard anything from the government since.

In fact, we have not heard very much from the government since we heard the Prime Minister have his little dummy spit after the election. We all remember having to wait up really late to see what the Prime Minister might say. Then he settled down a little bit and four days later came out with this quote:

We have to do more to reaffirm the faith of the Australian people in our commitment to health and to Medicare.

But what have we seen in that 100 or so days since the last election? We have seen nothing—zero; not a single thing. Indeed, every single health cut that this government took to the election remains on the table—every single one. They are as committed as ever to gutting Medicare, and we have just heard them try to justify making Australians pay more. That is their GP tax by stealth, which we know will reduce bulk-billing and drive even more patients into the overcrowded emergency departments. We know that really nothing has changed.

We know that the policy around making people pay more for vital tests and scans, including pap smears, has not changed. Nothing has changed since the election when it comes to that either. We also know that hiking up the costs of prescriptions has not changed. We have not heard very much from the other side about the cost of medicines. They are talking about putting more medicines on the PBS. Of course, some great reforms that Labor put in place when we were in office have allowed them to do that. Then of course we get to abolishing the Child Dental Benefits Scheme, pushing those five million children onto long public dental waiting lists. Nothing has changed from the government. I am not sure whether the minister understands the Child Dental Benefits Scheme. In Tasmania, if you go on the public waiting list, you wait for three years—three years! Under the current scheme, people can spend up to $1,000 over that two-year period for children and they get in to see a dentist when they need to.

Then we get the changes to the Medicare safety net—the taking of money out of the Medicare safety net. Again, nothing here has changed, and it appears that the government really has not learnt its lesson at all. Clearly the government does not understand what it is doing to people who are unwell. Clearly it does not get that people who do not have the funds in their pocket at the time are not going to get the health support that they need. Indeed, just last week we had the minister come out and say that the current policy settings are correct and that it was the campaigning that was wrong. The government really believes that it only lost all of those seats at the election, that Medicare was only an issue at the election, because it got its campaigning wrong. Clearly it is not listening to the people.

At a town hall meeting just outside my electorate on Sunday, our leader, Bill Shorten, got a question from a women with chronic illness. She talked constantly about her out-of-pocket costs and about how she is in pain and cannot get the services that she needs because of the costs. It is really serious. The AMA has said that this government's policies mean that the poorest, the sickest and the most vulnerable will be the hardest hit, and the government do not seem to care. The Prime Minister showed a bit of contrition a couple of days after the election, but nothing changed. Now the minister has come out saying that the policy settings are correct. Clearly they do not understand.

Just two weeks ago we had the health minister come out and say, 'I'm not going to accept that bulk-billing rates are falling, because they are not.' She is clearly backing in the Prime Minister with his guarantee. When I conclude here, I hope that the minister gets up and repeats the Prime Minister's guarantee that people will not be paying more out-of-pocket costs to visit the GP because of their indexation freeze. It would actually be nice to have the minister show a bit of empathy and understanding when she talks to people out and about in the community as health minister. This is really a very serious issue here, and the government need to do much more about it. They need to actually get out and about and they need to answer the questions of real people.

12:52 pm

Photo of Chris CrewtherChris Crewther (Dunkley, Liberal Party) Share this | | Hansard source

I would firstly like to congratulate the Minister for Health and Aged Care for the tremendous job she is doing not only nationally but in the Dunkley electorate. The minister came down to Dunkley electorate twice during my recent campaign and announced several health initiatives for the local community. On home and community care, the minister announced increased funding for a number of local organisations who do wonderful work assisting with mental health issues, health issues, homelessness and other issues. For example, Mentis Assist is an organisation in my electorate, led by Dawn Fisher, the chair, and a wonderful team around her, and they received increased HACC funding, as did Andrew Kerr and the Village Baxter. I would like to congratulation the minister for that increased funding in my electorate, which will really make a difference to people's lives.

Locally in Dunkley as well, the minister for health came down and announced $6 million for MRI services at Frankston Hospital, which will mean a full MBS licence for MRI at the hospital. This will positively impact over 2,000 patients every year. I note that, under the watch of the former Labor government, this licence lapsed at the hospital, so it is a Liberal government offering those services to the local community. That will make an enormous difference to people and patients in my community. Instead of going outside the region or having to pay for access to MRI at the local private hospital, they can receive free MRI services.

In addition, in my electorate $536,000 was committed by the minister for health for Peninsula Home Hospice, which provides home based palliative care in the community. That not only impacts Mornington, where the Peninsula Home Hospice centre is based but it impacts right across the peninsula, the Frankston region and beyond. That is a tremendous announcement, and it is a community-led organisation who will greatly benefit.

The minister for health also increased Headspace funding for Frankston Headspace, through the local PHN. That will mean increased funding for specific and lead-site services to assist in mental health issues, particularly for young people in the community. We really need to assist young people in our community who have mental health issues. As the youngest MP in parliament myself, I am passionate about making a difference to young people in my community.

In addition, the minister for health also committed $5.6 million for ice and drug rehabilitation services in my community. Not only has she committed those several other things that I mentioned but also this will really help those who are dealing with ice and drug use issues locally. As we know, the Turnbull government has committed over $300 million to tackling ice across Australia. I know that not only Frankston is impacted by ice and drug use but communities across Australia are impacted. So I greatly thank the minister for that commitment.

I also note that as the minister has outlined previously the Labor Party is continuing to lie to the Australian public about Medicare. We saw it during my campaign in Dunkley, in particular, but also across Australia where lies and a scare campaign were being spread about Medicare. In fact, Medicare funding is increasing each and every year. Under the Turnbull government, we have made it quite clear that Medicare will never be privatised, so it was quite disgraceful during the campaign to have text messages sent out to constituents that did not have any authorisation or indication to say that they did not come from Medicare. It was also quite disgraceful to see little Medicare cards being handed out and Medicare logos used on billboards and signage throughout my electorate.

The Prime Minister has committed to the fact that Medicare is a core government service that will never be sold. He committed to the fact that every element of Medicare currently delivered by government will continue to be delivered by this government and will increase year to year. We have a very strong record when it comes to Medicare funding and this year we are investing more than $22 billion to Medicare, over $1 billion more than last year. This will increase to nearly $26 billion by 2019-20. We are the party with an economic plan but we are also the party—thanks to the leadership of the minister for health—with a strong health plan.

12:57 pm

Photo of Tony ZappiaTony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | | Hansard source

Perhaps the minister would care to answer some questions, given that she has not answered my colleagues questions so far. I presume she assumes that by putting them all off that will limit her time to speak and therefore she will not have to get to them. I ask the minister about her attempts to outsource and privatise our health system, many of which are contained in these bills.

The minister sleeps at night by telling herself the election turned on a text message. She does not want to admit that Australians were scared by her cuts and scared by her attempts to flog off our universal public health insurance scheme. But Australians know the truth, and so do to the doctors and GPs I speak to. On 2 July they voted to save Medicare. Minister, isn't it the case that you tried to privatise the Medicare payments system?

Unlike some of the minister's other policies, the rural health commissioner comes to mind. This was no thought bubble. The government spent years and at least $5 million on its secret plan to give Medicare to a bank or another corporation. The minister and the Prime Minister claim that they have changed their minds. They can say the plan never went to cabinet, while making relevant documents cabinet-in-confidence, but Australians are not fooled. As Bob Hawke so rightly put it: 'Everybody knows you do not set up a Medicare privatisation task force unless you aim to privatise Medicare.'

I now turn to the National Cancer Screening Register. Minister, isn't it the case that you outsourced the National Cancer Screening Register to Telstra? The national register is a good idea and Labor supported the bills to establish it, but the register will hold Australians' most sensitive data—like results of cervical and bowel cancer screenings—so who did you pick to operate the register? Was it the human services department, which runs the National Bowel Cancer Screening Register? Was it the Victorian Cytology Service, which has been operating cervical screening registers for almost 30 years? No. The minister picked Telstra and signed a $220 million contract, on the eve of the election, before parliament even saw the necessary legislation.

This is a telecommunications corporation with no experience in handling sensitive health data on this scale. As the Senate inquiry heard, this is the first time that a for-profit corporation will operate a cancer screening register anywhere in the world. The minister knows her contract stinks, because she cannot bring herself to mention the word Telstra in parliament. Today could be the first time, Minister.

I wish it ended there, Australians wished it ended there, but, Minister, isn't it the case that you put profits before patients time and time again? Today there are new reports that the minister has backed away from the reforming the prosthesis list. Just last month the minister said she would reform the list to:

… make private health insurance more affordable.

But the corporate giants who dominate the sector came knocking in the middle of the election campaign, and now we learn that cabinet has decided against reform this year. Imagine my surprise.

It is the same story as the minister's deal with Sonic, the multinational corporation that dominates pathology services. When the minister cut Medicare bulk-billing incentives for vital tests, patients reacted furiously: 600,000 Australians signed a petition against the cuts. So this minister did a desperate pre-election deal: Sonic accepted the abolition of its patients' bulk-billing payments in exchange for reregulation of pathology rents. We have not seen the draft regulations yet, but there is a very real chance they will hurt patients and GPs. Sonic profits again before pathology patients.

I could go on, because this is the minister who is watching on as her mates in New South Wales privatise public hospitals. This is the minister who still wants to privatise Australian Hearing—and we have not heard too much about that either. I am aware that there were discussions before the election about doing just that, but they seemed to go quiet in the lead-up to the election because clearly the minister knew that any thought of privatising Australian Hearing would not have gone down well before the election. And this is the minister who, with her mate Alan Tudge, is now running Medicare into the ground to justify another attempt at privatisation. But time is short, so I ask the minister: is there any part of our health system you will not outsource or privatise? Will there be a time when you put patients before profits?

1:01 pm

Photo of Sussan LeySussan Ley (Farrer, Liberal Party, Minister for Sport) Share this | | Hansard source

I just want to offer some gratuitous advice to the member for Franklin and the member for Makin. Member for Franklin, niggling interruptions are never a substitute for the power of good argument. And Member for Makin, from the screed that you read out, try next time to have a small component of fact in there which would actually give me an opportunity to respond.

But you did actually raise something that made me think. You said that I sleep at night because of certain things. But I will tell you what does keep me awake at night—and this is a completely bipartisan comment; it would be the case with every health minister—when you know that someone has a rare cancer and they do not have access to a life-saving drug, when you know that someone cannot get the treatment they need because the Australian health system cannot afford it, when you know that your medicines policy is not meeting everyone's needs everywhere. I am happy to say that ours is striving to meet that need, but there will always be more to go. These are the things that all health ministers worry about. We worry about the patients at the centre of our health system. The member for Oxley started talking about doctors campaigning. Hey, I love the doctors; we get on very well. I do not build the health system for the doctors; I build the health system for the patients. And if you put the patients at the centre of everything you do, you cannot get it wrong.

The member for Dunkley talked about some of the achievements in his electorate, and I just want to make the point that only a health system that is well managed, that is using every dollar as efficiently as possible, that is driving always harder every day to do the most they can with those dollars. What the Labor Party does not understand is there is a finite number of those dollars. With our gross debt approaching $450 billion, with our interest payments where they are thanks to the mess that was left to us by Labor—we will not go there because people do not necessarily want to hear about that today—there is only a finite amount of dollars. It is not like the years when I first came into parliament, Madam Chair Vamvakinou, as you did too, where we could add dollars from outside the health system for patient care. We cannot do that, so we have to make every dollar count. The investments that the member for Dunkley talked about in palliative care, in mental health, in MRI for his communities can be paid for because this government recognises that you sometimes have to make the tough decisions and everybody does not always get everything they want.

The member for Franklin comes from Tasmania—she is lucky; it is a lovely state—and she talked about dental care. The dental policy that I proposed was warmly welcomed by the health minister in Tasmania for precisely the reason the member for Franklin mentioned, which was that access to public dental health was taking too long. What we intended doing—and hopefully can still do, because Labor hasn't accepted the dental reforms that we have proposed—was to introduce a truly public dental health benefit for truly public patients.

What Labor introduced was something called the child dental benefits scheme. Only a third of those who were eligible accessed the scheme, and the scheme could be accessed by those who were at the top level of family tax benefit part A, which can be paid at a very generous level of income. Quite a few people who accessed the CDBS had private health insurance. Quite a few people were quite happy to access it—of course they were, because effectively it was subsidising the dental treatment, but it was treatment they would have got anywhere. I have been in schools across this wonderful country and I have seen children who have never seen a toothbrush, let alone a dentist, children whose parents would never take them to a dentist because those parents themselves—perhaps they have dysfunctional and chaotic lives through no fault of their own—are not going to make an appointment with a private dentist. They are the public dental patients.

In constructing the national partnership that I wanted to construct with the states, and I still hope to do, my intention with every state government was to say, 'You build your public dental infrastructure for the long term so that you can have somewhere to treat your truly public patients, not just children but adults as well.' Unfortunately, Labor did not see the wisdom of this and is persisting in hanging on to a scheme that, let us face it, is poorly targeted and underutilised, but most importantly does not treat the people who need it the most, the people who, as I said, we should be building the health system for. When I listen to members of the Labor Party I hear a couple of refrains. It is all about a Medicare lie—which is pretty much accepted as a Medicare lie—and it is all about a pause on GP payments, but it is never about Labor's plan for the health system. Not one shred of what is ever presented to me it describes Labor's plan for the health system. Labor hasn't a single policy. I know those opposite will say they have, but if you cannot pay for it you cannot deliver.

1:06 pm

Photo of Julie CollinsJulie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | | Hansard source

Given that the minister does not want to talk about the Medicare freeze very much at all and she does not want to re-give the Prime Minister's guarantee—clearly she does not want to talk about the Medicare freeze in broad terms and give us some proper data on it—I might move on and ask the minister some questions on aged care. As the minister would know, Australia's baby boomers are moving or are about to move into retirement. Over the coming decades, the need for affordable and sustainable aged-care services is going to increase dramatically. We are all aware that that is coming. That is why we had Labor's reforms—the living longer, living better aged-care package, $3.7 billion over 10 years—that were bipartisan and followed a Productivity Commission report Caring for older Australians. We did a lot of work.

What we are really concerned about now is some of the implementation around the living longer, living better reforms. We are concerned that it will put at risk some older vulnerable Australians. We are particularly concerned about the way the government has implemented some of the recent cuts to the aged-care sector. In December 2015 the minister announced of $472 million for residential aged care. Six months later in the budget there was $1.2 billion worth of cuts to aged care. So I am curious about the modelling and the predictability. Obviously it is demand driven with the ACFI funding model—I get that—but surely we have better modelling from the government and the department about what the projection is going to be so that we know into the future what this is going to look like. If we don't, we certainly to do a lot more work around that. Indeed, I moved a private member's bill on it.

It would be interesting to know whether the minister supports the inclusion in the living longer living better review of a review of ACFI, the aged-care funding instrument, because it is a very complex, demand driven instrument. The Federal Court and others have said it is very complex. The minister knows the sector is saying it is very, very complex and needs some sort of reform so that we can get some predictability and sustainability into the system both for the providers but importantly also for older Australians who are going to be moving into the aged-care system. We need to make sure that as we go forward we have predictability and sustainability in the system. We have had bipartisan support, as I said, on living longer living better. It would be good to know whether the government is going to include a review of ACFI as part of the legislative reform that she has appointed David Tune to do, because we would really want to have ACFI looked at because is going to be critical going forward.

We have also got coming up in February the changes to in-home care. I have been briefed by the department, for which I thank the minister, but I still remain concerned. I just want to make sure that consumers and the public are prepared for the changes. Importantly, the government's My Aged Care website has had some really serious issues. It has been clunky and I have had a lot of feedback that it is still very difficult to use for people who want to access the aged-care system. I want some reassurances from the minister that we are ready for the reforms that are coming in February, understanding that the government are going to write out to a whole heap of people who have been assessed through the ACAT process as being eligible for a package and the government are going to do a whole heap of work around trying to predict what the unmet need is. I have asked some questions of the minister's department around that.

We really need to make sure that the system is ready and also that the public understands the changes that are coming and are able to use the tools that the government are providing to them to access what should be a fair and reasonable aged-care system to make sure people get the support they need and deserve. If we are serious about keeping people in their homes longer so that we do not have such a reliance on residential aged care going into the future, it is really critical that we get this in-home care right. It is really critical that we make sure that vulnerable older Australians and their families and carers know how to use this system and that it is not going to let them down. So I would appreciate the minister answering those questions.

1:11 pm

Photo of Sussan LeySussan Ley (Farrer, Liberal Party, Minister for Sport) Share this | | Hansard source

I will answer just briefly because the member for Franklin has indicated that she has had a briefing from my department and it has explained how we will transition a sector that is providing aged-care packages in a somewhat limited way now to a sector where the consumer has more choice over the providers of those packages in, as she said, February 2017. She correctly identified that this is an important area to get right.

The member for Franklin also mentioned a saving that both her party and our party have agreed was necessary in the aged-care funding instrument of $1.2 billion, given that the budget for that funding instrument had blown out by $3.8 billion over the forward estimates. It happened once before under Labor and they took the same corrective action that we are now. We have agreed that that corrective action needs to be taken, and I am consulting with the sector about what we will do to make sure it does not happen for a third time. We also need to recognise that the certainty that is needed when you are a provider of aged care is very important.

It is not a cut. It is not going to be described by me as a cut because it is actually a growth that is continuing at about 5.1 per cent. So our spend in aged care is budgeted to continue at 5.1 per cent, and it will. But if that expected growth blows out, as it did with this aged-care funding instrument, we will bring it back to trend. We will have no choice, to come back to my point about the scarce health dollars. By the way, even if they were not scarce, it would still be the right thing to do to properly manage the system. You just cannot let expenditure in one area run away.

We are very excited about the reforms in aged care. They are going to make a difference to every single older Australian. They are going to bring the consumer to the centre of their care. I am looking forward to older Australians becoming empowered and able to make their own choices and not to feel like they are passive recipients of packages and that they have to do certain things because that is what the package does. They will have choice and control. They can say, 'I don't want my house cleaned this week; I want to go down to the club and have a few drinks with my mates. I don't care about the dishes in the sink today.' Just to have that flexibility and choice is absolutely vital. Why should we ever expect that older Australians somehow have to have this one-size-fits-all approach when it comes to policy and funding support from Canberra? This is, indeed, a transformation in aged care and one that I very much hope the Labor Party will join us in supporting.

1:14 pm

Photo of Julie CollinsJulie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | | Hansard source

I appreciate that the minister did make some attempt to answer those questions. I am still curious as to whether she is going to consider a review of the ACFI as part of the Living Longer, Living Better legislative review that Mr David Tune is doing. Hopefully she will be able to answer that.

I also have some questions I want to ask about some statements around mental health. We have had bipartisanship on mental health in the past and the minister made some comments earlier, as did the member for Dunkley, that I certainly agree with about making sure that people who need to access mental health services have an opportunity to do so.

Obviously the minister is very busy with a very broad portfolio. One of the issues she talked about, as did member for Dunkley, was reforming through the PHNs. I am really keen to hear from the minister about how the rollout of reforms is going, particularly around the PHNs and around mental health commissioning. I am concerned that some of the PHNs might not have the expertise or experience in mental health to be able to commission those. I am also concerned of course that there is no gap in existing services to the PHNs commissioning those services. These are vulnerable people with mental health issues out and about in the community, and we want to make sure that that they can access the services that they need at the time that that they need them.

Continuing on with the reforms that are happening, we have the fifth national mental health plan. We know that it is in draft and that it is going out to consultation but the fifth mental health plan, I understand, from COAG will not be signed off on until April 2017 and the last one expired in 2014. So I am a bit curious as to why we have had three years with no agreed national mental health plan. I am also really concerned that after four national mental health plans, we do not know if they actually worked because we did not have any measured outcomes in those first four mental health plans. So I am curious as to whether the draft fifth plan actually will have some measurable outcomes in it rather than just measure activity to see if the reforms that are so critical are making a difference. I think we really need to make sure that whatever we are doing when it comes to mental health—and we are investing, as the minister likes to use the term, 'scarce health dollars'—that we are actually getting results and making a difference to the mental health of the community, so that is really critical.

The National Mental Health Commission talked about a suicide prevention target, which I want to ask the minister about. Labor did say that we would agree to this in the lead-up to the election. The commission recommended a 50 per cent reduction over 10 years. We have not heard from the government about whether or not they support that target or whether the fifth national health has a target for suicide reduction in it. I think we would all agree that one death is too many and we all need to do everything we can given the latest ABS statistics in this area, which are really quite heartbreaking.

There is so much more that needs to occur. I appreciate that mental health is in reform at the moment. There is a lot of reform going on and I ask the minister these questions genuinely. I am genuinely concerned that with some of the programs that exist at the moment and with some of the things that we are doing at the moment, we do not know whether they are working. With the programs at the moment, we need to make sure that the PHNs do have the expertise around mental health, make sure that there is continuity of service as this commissioning occurs, and make sure that existing programs and the people accessing them are not going to be at any risk. I am sure there are transition plans, so I would be really keen to hear what they are.

The one thing that we do argue about with mental health is the dollars. I have also got a question for the minister about the dollars. In the last MYEFO, the government did cut or make savings of $141 million from mental health programs. Then of course there was an election commitment of $192 million over the forwards. I am just wondering whether that $192 million is on top of the health funding before the cut of $141 million or whether it is minus $141 million plus $192 million so therefore an increase overall of $50 million. I am curious as to when the minister says 'effectively new mental health money' whether she means it actually is $192 million on top of where it should have been or whether it is just the $50 million.

I ask the minister these questions around mental health genuinely because it is a bipartisan area and we have been trying to work with the government in this area in the past. I am concerned about vulnerable Australians in this area.

1:19 pm

Photo of Tony ZappiaTony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | | Hansard source

I will keep my questions brief given that we are almost running out of time. Earlier on, when the minister was talking about the Child Dental Benefits Schedule, she talked about a third of the people accessing it. In my state of South Australia, my understanding is that nearly 40 per cent of the eligible families accessed that scheme. But more particularly, I ask the minister: how will families in remote Australia get to a public dental service if they live hours away from it? And how will families get to a public dental service if the services are not expanded out into rural and remote regions?

How will they get to them if they need to see a dentist urgently when in some states there are waiting lists of several years? What does the minister intend to do to improve accessibility to those public dental services and reduce the waiting list? I hope the minister does not simply say that is a problem for the states.

Secondly, in her responses earlier on the minister failed to mention the matter of prostheses. Again I ask the minister: what does the minister intend to do to bring down the cost of prostheses? Nor did the minister mention the regulation of pathology rents. Again, how does the minister intend to do that, when does she intend to do that and what mechanism does she intend to use to bring down the pathology rents in the doctors' surgeries?

Photo of Sussan LeySussan Ley (Farrer, Liberal Party, Minister for Sport) Share this | | Hansard source

As the member for Makin said, we are running out of time, so I will try to address as many points that have been raised as I can. On the public dental benefits services in South Australia: it is the role of the state government, not the Commonwealth government, to establish public dental infrastructure. South Australia is actually quite good at using the private dental service to do what the public dental service should have, and quite a few of your dentists have made me aware of that. In terms of building infrastructure, some states have done it well—Queensland, for example. Some states have in fact relied on dollars in what is I think an easy way of channelling them into private dentists to do what really should be public dental work. No-one argues that public dental services are the preserve of state governments. So there might be some questions for your South Australian colleagues there.

Around pathology the misunderstandings continue to abound. I wanted to say that the agreements that were made between the government and Pathology Australia, representing the pathology sector, have indicated that bulk-billing will continue. We are having ongoing discussions about addressing the circumstances of pathology rents, and there is genuine agreement around the table. Much of that is on the public record.

On mental health: I know that, if he had time, the member for Dunkley would have talked further about the valuable work that his headspace does and the young people that it helps. I am glad the member for Franklin understands the allocation of scarce dollars in mental health even though she does not seem to appreciate the allocation of scarce dollars across the health portfolio generally or she would not continue to make the repetitive comments she does about Medicare. But I assure her that the purpose of Primary Health Networks is to commission the dollars to the services that provide the front-line support and to get those services where they are needed in the best possible way.

The people in the Primary Health Network do not provide services. They should not be service providers. But they are people who are very good at getting the best value out of the health dollar. Importantly, their decisions are informed by clinical committees and consumer committees, so every Primary Health Network has those networks that inform it where the dollars should go to meet the need. For example, severe youth mental health, anxiety and depression the organisations that do the best on the ground are the ones that will get the dollars, and you as consumers can be satisfied that we are getting the best possible spend. If you have one size fits all from Canberra, you have what sometimes almost seems a historical accident that certain organisations get funded and certain organisations do not. Some will say, 'Here's an organisation that is doing really good work.' It may be doing really good work and it may continue to get funded, but our job is to have the very best front-line services, particularly for young people with mental health.

The shadow minister speaks about the Fifth National Mental Health Plan and, if she looks at the history, she will see what the first four plans achieved. She will also note that a previous Labor Prime Minister said that they would make mental health a second-term priority. It is not something I say very often, Member for Franklin, because I want to be bipartisan about mental health, but I think you can be really reassured that we are not holding back when it comes to reforms in mental health. There is the $192 million that the Prime Minister allocated during the campaign because of his personal passion for suicide prevention. We are starting to work out how we can absolutely provide that to the organisations that can do the very best work in suicide prevention, in research—because we really do not know what works and what does not work—in severe psychosis and in our commitment to 10 more headspaces, all of which is being funded.

I end where I always begin with health: if you cannot fund it, you cannot deliver it.

1:24 pm

Photo of Rebekha SharkieRebekha Sharkie (Mayo, Nick Xenophon Team) Share this | | Hansard source

Minister, I would like to ask you some questions in relation to aged care and mental health for young people in my electorate of Mayo. In relation to aged care services, I would like to ask some questions in relation to the Commonwealth Home Support Program. My understanding is that the first step to access this program is through the My Aged Care website and a call centre that acts as a screening gateway.

Are the call centre operators required to have qualifications and experience in aged care and, if not, how are they suitably qualified to assess eligibility? Previously, as you are aware, eligibility for this program was determined by the local level, with a site visit from a local provider. Now an applicant must go through a screening gateway and is deemed eligible or not through an arms-length process. For many older people it is quite hard to articulate their needs over the phone.

If this process assesses them to be eligible, my understanding is that a site visit is conducted by a regional assessment service; however, they also have a large geographic area to cover, particularly in my electorate. Then the client is referred to their local service provider, who must also conduct a site visit before a service can be put in place. So one site visit holistic assessment has now been replaced by a gateway assessment, via telephone, with two site visits carried out by two different organisations, sometimes for a service as simple as a once-off gutter clean.

Can the minister explain why this level of complexity has been introduced, how many people in total have applied for this service since the introduction of the online gateway and how many have been deemed eligible or not eligible? Would the minister also please advise, through her department, whether they are considering alternatives to the screening gateway, because the online gateway and call centre frequently acts as a barrier for older people who should be eligible for these low level support services? It is a barrier for them to stay safely living in their community. I would also like to ask the minister what sort of wait times elderly people are experiencing between their first call and receiving a service and whether those wait times have increased since the introduction of this service.

In relation to mental health, I have been advocating very strongly for a headspace in my electorate of Mayo. My understanding is that there will be some sort of outreach service delivered shortly in Mayo. Would the minister please advise me what that looks like, how many young people it is expected to support and whether it will allow a proper outreach that will go down the peninsula, considering I have 9,300 square kilometres with no youth mental health specialists, such as headspace?

1:27 pm

Photo of Sussan LeySussan Ley (Farrer, Liberal Party, Minister for Sport) Share this | | Hansard source

As time is reasonably short I might try to answer the member for Mayo's questions quickly. The detailed questions she has asked about, regarding My Aged Care and the Commonwealth Home Support Program, we can take on notice and provide her with the statistics she has asked for.

It is, indeed, the case that when you call My Aged Care you are referred to a regional assessment service, and that service makes a follow-up call or visit, depending on your circumstances, to assess you for the need. When My Aged Care began there were issues—and I am certainly not going to walk away from that—but now, I understand, the wait times are shorter, the referral pathways are quicker and so on. In fact, we added about $102 million in the budget in order to improve My Aged Care. So I am very happy to give the member for Mayo a briefing, particularly to pick up the detailed questions that she has asked.

In terms of headspace, as I noted in my previous answer, we have undertaken to provide 10 more headspace centres as part of our election commitments and my intention is that they go in the areas that need them. Meanwhile—and until such an application might be made, and I cannot forecast whether it will be successful—it is important that your existing service be able to provide the outreach that it seems to be able to do. So I am very happy to have a further conversation with you about how we can support the access for your young people.

1:29 pm

Photo of Julie CollinsJulie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | | Hansard source

Given the short time available, I just want to correct the minister on a few things. When I said 'scarce health dollars' I was quoting the minister. We really need to get away, Minister, from this fact that health is a zero-sum situation. The government is still committed to $50 billion in tax cuts, of course, of which $7 billion is going to the big banks—and we know how much they like to protect the big banks. So this assumption that somehow there is no more money at all in the whole of government—ever—for health from hereon in is a wrong position for the minister to take.

The minister unwittingly referred to a comment where she said the PM allocated $192 million to mental health. That shows the minister does not have a lot of credibility around the cabinet table. She has clearly indicated that she has struggled to get Treasury and Finance and the rest of the cabinet to agree to put more money into the health portfolio more broadly. She has not given a guarantee about the GP rebate and the no-increased costs.

We have not had very many answers from her on some of the serious issues that are affecting consumers and patients out there—with the freeze, the pathology cuts, the diagnostic cuts, the imaging cuts, the child dental scheme, the PBS co-payments, the increased costs of medicine and the Medicare safety net. The list goes on about the number of things that the minister has not answered as she has been here today and has been required to do.

The public remain bitterly disappointed in the minister. She has made it abundantly clear that she does not have the authority she needs around the cabinet table to get the money. The health-scarce dollars that she refers to are only scarce because she does not have the ability to get any more money into the health portfolio. When you are talking mental health you are talking ageing, and you are talking health care for vulnerable Australians who are sick, unwell, old or have mental ill-health. Clearly, more money is needed and, clearly, this minister does not have the ability to get it out of the government.

Photo of Maria VamvakinouMaria Vamvakinou (Calwell, Australian Labor Party) Share this | | Hansard source

The question is that the proposed expenditure for the health portfolio be agreed to.

Proposed expenditure agreed to.

Sitting suspended from 13:31 to 16:01