Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health and Medicare) Share this | Link to this | Hansard source

The Australian Institute of Health and Welfare is an invaluable resource for health policy-making in this country. For the last 30 years it has been Australia's principal source of health and welfare data. So important is it there was a very strong move when the government attempted to amalgamate the AIHW into the ABS. The entire health and welfare sector mobilised very strongly to make sure that the government did not do that, so valued is the AIHW amongst the health and welfare sectors and academics across the country. It produces accurate and trustworthy statistical information and reports that contribute a great deal to our understanding of our collective wellbeing. It is well-respected across the health sector for its independence, its professionalism and its ethical integrity. It has a broad remit. In the past month alone it has produced reports on everything from eye injuries to palliative care services, smoking rates to disability support and, of course, Australia's health 2018, a very important publication that gives us a broad insight into what is happening across the health of the nation—into funding and into health status—as well as providing guidance for future policy makers. In a sense, the AIHW in itself is a diagnostic tool. It tells us precisely what's wrong with the nation's health so that we in this place can come up with policy prescriptions. Critically, it also tells us what we're doing right so that we know where to double-down. I think the AIHW and its staff do a fantastic job.

As the shadow health minister I don't have unfettered access to the vast resource that is the Department of Health so I have to look elsewhere for reliable data to shape opposition policy. The AIHW is an absolute treasure trove of this information. Without the institute we'd often be flying blind, and evidence based policy-making in this country would be all the poorer for it. So, Labor values the AIHW and wants to see it thrive. We want to see it continue to be as important and relevant 30 years from now as it has been for the last 30.

Having said all of that, the AIHW exists in a radically different environment today than it did when it was established in 1987. It no longer enjoys a monopoly in the analysis of administrative health data. The Australian Bureau of Statistics has moved into this space as it has outgrown its traditionally narrow census and survey role, and policy agencies like the Department of Health are doing an unprecedented amount of their own in-house analysis. We hope they are able to do more.

This all raises some pretty fundamental questions about the institute's role into the future, which is why the department commissioned a review of the institute in 2015. The Nous Group review considered the institute's role and purpose; its business model, product range and funding model; and its internal governance and organisation. The review made some 35 recommendations, most of which do not require legislation. It recommended a change to the institute's funding structure, better coordination between funding departments and better coordination with other information bodies, but its central finding was that the institute needs to undertake a major reorganisation and transformation to secure its future as a leading information agency. That is primarily what this government bill, the Australian Institute of Health and Welfare Amendment Bill 2018, aims to do, and Labor is happy to support those changes.

The bill amends the Australian Institute of Health and Welfare Act 1987 to make changes to the governance and administration of the institute. The bill's major provision is to establish a skills based board replacing the current board structure, in which members are selected based on the groups that they represent. Currently, the board includes representatives from Commonwealth departments, COAG committees and stakeholder groups, a structure that the review concluded had encouraged a focus on operational rather than strategic issues. That being said, I do want to recognise and commend the boards across all of those 30 years for the work that they have done in ensuring that the institute continues to deliver good health and welfare data for the nation.

Under this bill, the new board will have up to 12 members, including a chair, a deputy chair, a CEO—renamed from 'director'—up to three members nominated by the states and six others. Each of these members will be required to have skills or experience in public administration, education, Indigenous health and welfare, data, statistics, performance reporting, financial and corporate management, consumers' interests and/or law. Board members will be appointed for up to five years.

The bill also reassigns responsibility for appointing board members from the Governor-General to the Minister for Health. The change is intended to streamline appointments and to bring the institute into line with other Health portfolio agencies. Whilst I acknowledge the moving from the Governor-General to the Minister for Health, I also strongly encourage the Minister for Health to consult with the opposition on the appointment of the chair, certainly, given the fundamentally bipartisan and independent role that the AIHW plays.

The bill also removes the requirement for the AIHW to seek agreement from the Australian Bureau of Statistics to collect health- and welfare-related data, instead requiring it only to consult with the ABS as necessary. The bill also includes a number of minor provisions—for example, setting out probity requirements for board members and procedures for board meetings. I think these are not radical changes by any means, but Labor certainly supports any measures that will help the institute reposition itself so that it remains relevant and even indispensable for decades to come.

Tony Zappia (Makin, Australian Labor Party, Shadow Assistant Minister for Medicare) Share this | Link to this | Hansard source

I begin by commending the comments of the member for Ballarat and concurring with those comments. As the member for Ballarat quite rightly pointed out, the role of the Australian Institute of Health and Welfare is invaluable in assisting governments and oppositions in preparing their policies and frameworks for health budgets in this country. Indeed, the data is important in that it not only determines progress that is being made with respect to policies that are currently in place but also assists governments and oppositions in assessing expenditure efficiencies and enables governments and opposition to set priorities, to identify emerging issues and to identify social inequalities between communities when it comes to the Health portfolio. And I'm sure that there would be many other matters that would arise from the work of the institute.

Health expenditure in this country for 2015-16, which is the last year for which I've got the breakdown of data, was $170 billion. Of that, $70 billion came from the federal government, $44 billion from the states and territories and some $56 billion from private health insurance and patients. All would agree $170 billion of expenditure is a large chunk of money that the Australian economy pays each year for a particular service or a particular sector. It's important to ensure that that $170 billion is well spent and that we're getting the best value for the dollars that are being put into the health system, and whether we're doing that well enough at the moment is indeed a vexed question.

Could we do better? I suspect in some areas we could. That was a question that the Productivity Commission looked at in a research paper in April 2015, which it published under the title Efficiency in health. I will quote just one part of the commission's paper, because it goes to the heart of the importance of the work being done by the institute. I quote directly from page 73 of the report of the Productivity Commission:

Information is central to an efficient and effective health system. It shines a light on good and bad performance, helps the community and governments to hold health care providers to account, facilitates good patient care, and forms part of the evidence base on health interventions. But transparency has fallen short of its potential in health, either because data do not exist or, more importantly, data are not made available. The United Kingdom, United States and Canada outperform Australia in collecting and releasing data on particular aspects of health service delivery, such as performance data on individual hospitals and administrative data on the use of health services. Better progress in these areas would benefit clinicians, hospital managers, researchers, policy makers and, ultimately, patients and taxpayers.

That quote highlights not only the importance of the work that is being done by the Australian Institute of Health and Welfare but, equally, the shortfalls that we currently have. There is a lot of data within our health system that is either not being collected or not being shared. By it not being shared in particular—I know that some of the data which I refer to is collected—it makes it much more difficult for governments to implement efficient health systems and it makes it much more difficult for us as a nation to try and provide the best health care possible across the country.

Indeed, only last week at a presentation in this parliament with respect to the future value of e-health in this country, the point was very strongly made that the e-health system will enable much more coordination of health services across the country, which, in turn, will lead to efficiencies simply because there is very likely going to be much less duplication of medical services than is currently taking place. Currently, because quite often a doctor or a hospital is not aware of the particular conditions of a patient, they duplicate tests and spend time in providing other health support that perhaps others have already provided. Had the information been available to them through, say, the e-health record system, it would have saved that unnecessary expense. We can and should do better. Again, it's the collection of data that will make that possible.

The question with respect to the Australian Institute of Health and Welfare also raises the question of who is collecting data. Again, the member for Ballarat talked in particular about the Australian Bureau of Statistics and the overlap that now seems to have arisen between the work of the ABS and the Australian Institute of Health and Welfare. Perhaps there is an overlap, but I have no doubt that when an organisation has existed for some 30 years it has some history that goes to not only its credibility but also its development of the most efficient and expert ways of collecting that material. In fact, it would be an absolute shame to see the organisation in any way diminished either by funding cuts or by taking away some of the work that it has been doing over those 30 years. Surely the expertise that has been built up over those years in the department should not be lost, and I would hope it's not. Of course, that's not to say that the institute couldn't be improved. I see this legislation as perhaps a way of improving its work. Again, as the member for Ballarat quite rightly pointed out, the Nous Group conducted a review of the department and, in turn, came back with some 35 recommendations, and this was one of the key ones.

I want to talk for a few moments about the work of the institute and provide some examples of the important work it does. In its latest report to do with the state of health in Australia in 2018, I'll talk about three different areas. The first is the health status of Indigenous people in this country. We know that there are about 787,000 people of Indigenous identity. Two-thirds of them live in regional, rural or remote Australia. whilst I accept that in recent years there have been some improvements with respect to their health status, in particular relating to child mortality, a reduction in smoking rates and an increase in life expectancy, the reality is that there are still many gaps. I will read out some of the gaps that the institute points to in their latest report.

Compared with non Indigenous Australians, Indigenous Australians are 2.9 times as likely to have a long-term ear or hearing problem amongst children, 2.7 times as likely to smoke, 2.7 times as likely to experience high or very high levels of psychological distress, 2.1 times as likely to die before their fifth birthday, 1.9 times as likely to be born with low birth weight, and 1.7 times as likely to have a disability or restrictive long-term health condition. A lot of that is attributed to things like lower education levels, poorer housing quality, unemployment lower income, higher smoking rates and alcohol consumption and poorer access to health services. They all contribute to those statistics. Nevertheless they are statistics that paint a very clear divide between city Australians and country Australians and, in particular, the Indigenous Australians that live out in the country.

The other example I use from the report is in respect of the poorer health outcomes experienced outside of major cities—again, where nearly a third of the population lives; three out of 10 Australians live outside of the major cities. I go to the question of smoking rates. In the major cities, it's 13 per cent; in inner regional areas, it's 18 per cent; and in outer regional and remote areas, it's 22 per cent. In terms of obesity, another issue that is frequently talked about as a measure of our health in this country, in the major cities, 61 per cent of people are either overweight or obese; in inner regional areas, it's 67 per cent; and in remote areas, it's 68 per cent. The last of the statistics I will use is the lifetime risky drinking habits. In the major cities, it's 15 per cent of the population; in inner regional areas, it's 18 per cent; and in outer regional and remote areas, it's up to 24 per cent. Those statistics paint their own picture and tell their own story. As I said, when we talk about people living in outer regional, remote and even inner regional areas, that's also where a lot of our Indigenous people live and in particular where a lot of the people that will be classified as people in the lowest socioeconomic status live. That's the last category I want to turn to with respect to some of the statistics.

Compared with people in the highest socioeconomic group, people in the lowest group are 2.7 times as likely to smoke, 2.6 times as likely to have diabetes, 2.4 times as likely to state cost as a barrier to seeing a dental professional, 2.3 times as likely to state cost as a barrier to filling a prescription and 2.1 times as likely to die of potential avoidable causes. A higher ratio of people living in rural regional and remote Australia fall into the low socioeconomic status. Go away from the big cities and not only are people experiencing worse health effects; they are also in a higher level in the lower income group and the lower socioeconomic group.

It's a major problem. That is the point I'm trying to make very clear with respect to the report and why I alluded to those three passages. The message is absolutely clear: Australians in regional rural and remote parts of the country have much poorer health outcomes than those in the city areas. The latest Australian Institute of Health and Welfare report confirms that. The question is: what are we as a society doing about that, and what is the Turnbull government doing about that? I know that there have been some programs put in place. I accept that and we support most of them. Indeed, we supported in particular the appointment of the Rural Health Commissioner, and I note that his annual report has just been released. But the truth is the government's now been in office for five years, and many of the programs that the government has committed to will not see results for many more years to come as well. So it's a long time waiting for people in country Australia to see a real shift and a real improvement in their health outcomes.

It is that point that I wish to stress to the minister—and I see that the minister is here at the table. We as a parliament, on both sides of parliament, need to do a lot more because, quite frankly, we shouldn't have two classes of Australians when it comes to health outcomes in this country. It has been the case for too long. We know it's been the case for the Indigenous people. Whilst we have a Close the Gap strategy in place and, as I said earlier, we are making some progress, the progress is simply not enough, and it will not be enough until we make greater commitments to funding of the services that those people need.

I get back to the core of this debate, and that is about the Australian Institute of Health and Welfare. The importance of that institute is that it provides us with the statistics that we need in order to make sensible and effective decisions when it comes to health expenditure in this country. With those remarks, I move:

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

"whilst not declining to give the bill a second reading, and while acknowledging the valuable work of the Australian Institute of Health and Welfare, the House condemns the Government for its relentless cuts to Medicare and the impact on the health and welfare of all Australians".

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Ed Husic (Chifley, Australian Labor Party, Shadow Minister for the Digital Economy) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Makin has moved as an amendment that all words after 'that' be omitted with a view to substituting other words. If I suits the House, I will state the question in the form 'that the amendment be agreed to'. The question now is that the amendment be agreed to.

Greg Hunt (Flinders, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

Mr Deputy Speaker Irons, let me begin by thanking you for your passionate advocacy for the Curtin Medical School in Western Australia. Without you and others, this would not have happened, so you've played a very important part in ensuring additional resources for additional doctors and additional nurses in rural and regional Western Australia, and hopefully they will also practise elsewhere in Australia.

This bill amends the Australian Institute of Health and Welfare Act 1987. The bill will modernise governance arrangements at the Australian Institute of Health and Welfare, the institute, by implementing a board which collectively possesses skills or experience or significant standing in a range of different fields. Prescriptive eligibility requirements will be removed, as will ex officio positions and other representative positions. The changes will ensure that the board has the necessary expertise to focus on the key strategic issues and challenges faced by the institute in an increasingly contestable market for its services. The bill will recognise jurisdictional interests, with up to three members of the board to be nominated by state health ministers. This is critical to ensure the ongoing production of high-quality and relevant data and statistics. The bill will ensure that vacancies are filled in a timely manner, with the Minister for Health rather than the Governor-General being responsible for appointments to the board. Furthermore, the measures will bring greater stability to the board through membership terms of up to five years.

The bill also makes other amendments designed to improve the operations of the institute, including changing the title of the director to 'chief executive officer'; assigning the board responsibility for appointing the chief executive officer; and removing the need for ministerial approval of contract limits. The bill modifies the institute's functions in relation to data collection activities, with the institute to consult with rather than seek agreement from the Australian Bureau of Statistics on the collection of health and welfare related information and statistics. The bill also includes transitional arrangements to ensure that the chair and the CEO can continue in their positions for the balance of their current terms, along with clarification on delegation of powers. I particularly want to congratulate both the current director, Barry Sandison, and the current chair, Louise Markus, for the AIHW's Australia's health 2018, a comprehensive review that was released last week. It highlighted many of the strengths and many of the challenges in Australia.

I note the member for Makin's comments about the need for stronger support for rural and regional Australia, which underpinned perhaps one of the most significant budget measures—the $550 million stronger regional outcomes package, which will deliver 3,000 new nurses and 3,000 new doctors to rural and regional Australia. But I do agree that the results in Indigenous Australia are simply not acceptable. Neither side in this place will rest, or even consider resting, until we achieve parity between Indigenous and non-Indigenous Australia.

In that context, I particularly want to thank the opposition for the bipartisan way in which they have approached this bill. Ultimately, through this bill the board will be better equipped to focus on the strategic issues and challenges faced by the institute. The bill will also reduce the administrative burden associated with the appointment of new members to the board, resulting in greater stability and the timely filling of vacancies.

The Australian Institute of Health and Welfare is a national resource. It is staffed by the most extraordinary group of men and women, who give frank and fearless advice. They provide data that helps us to understand and to improve our health system. I thank them and congratulate them. I thank all of the members in this House for their contributions to debate on this bill.

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

The question is that the amendment moved by the member for Makin be agreed to.

Question negatived.

Original question agreed to.

Bill read a second time.