I rise to speak on the Private Health Insurance (National Joint Replacement Registrar Levy) Amendment Bill 2026. Before I was a lawyer, long before I was a member in this place, I worked in anatomy. I spent many days and years in a lab at the University of Sydney preparing human specimens for teaching. My work was not only teaching anatomy but also embalming people who donated their whole body to science through the University of Sydney's program. It's not the most common opening line you'd have at a dinner party, for sure! It might clear a room, but it also might strike up a really good conversation with someone who might be curious about the work that I was doing. But I want to say something sincere about this work because it shaped how I see this bill. Every specimen I prepared had once been a person, someone who was a family member, who had a favourite chair or music and who chose to give their body to science for strangers to learn from. I never stopped being grateful to the many people who donate their bodies to science, and I never will.

Some of my favourite work was particularly working with trainee surgeons. Through the courses run by the Royal Australasian College of Surgeons, I helped prepare human specimens for doctors specialising in orthopaedics. Let me tell you, trainee orthopaedic surgeons are a particular breed. They're wonderfully skilled and focused, with an enthusiasm for power tools that would probably put most weekend renovators to shame. I used to watch them work out the angle of a cut, the feel of the bone under their hands and how a joint is actually meant to sit and move in the human body. I thought: 'Somewhere out there is a stranger who doesn't know yet that they'll need a new joint. One day they'll be lying on a table trusting that the person holding that scalpel knows exactly what they're doing and that the device is going to work well and also be safe.'

Let me tell you what the National Joint Replacement Registry is, because it is vital. The Australian Orthopaedic Association runs it. It collects information from hospitals across the country to really improve the quality of care for people having joint replacements. Think of it as the most patient record keeper in the world. It follows these devices for years, for decades. If one starts performing worse than it should, the registry is how we find out.

But even the most dedicated registry has to pay its bills. The cost of running it is funded under a Commonwealth grant agreement, and that cost is recovered through a levy on the medical device companies that supply the devices used in joint replacement surgery, which makes sense. If you profit from supplying those devices, you chip in to keep that system honest. That is fair to say.

Here's where we hit a bit of an issue. Under the Private Health Insurance (National Joint Replacement Register Levy) Act 2009, the levy is capped at $5,000 per device per financial year. Our cap sounds perfectly reasonable—it's got that tidy vibe to it—but, in practice, it has produced a result that is not balanced. Picture two companies. One is a big supplier shifting enormous volumes of devices. The other is a smaller medium-sized business supplying much fewer. Under the cap, the big supplier hits that ceiling pretty quickly. From then on, every additional device is effectively free of levy. Meanwhile, the smaller company is paying close to the full amount on each device it sells. So the company moving the most product pays the least in proportion, and the smaller players carry more than their fair share. If you were designing a system from scratch, I don't think anyone would sketch it that particular way.

I spent about a decade, after working at Sydney uni, as an employment industrial relations lawyer, representing workers as well as employers and big and small businesses. One thing I learnt in that time is that a cost feels very different depending on where you're standing—so for a large company an unfair levy is a line in some sort of spreadsheet, but for a small or medium-sized business it can be the difference between hiring additional staff, backing the next innovation and staying in the market or not. Fairness in how a cost is shared isn't some abstract principle or thought; it is a practical one.

Here's the fix, and it's quite simple. This bill amends the 2009 act to remove the cap of $5,000 per device per financial year. Once it's gone, the levy will be allocated in proportion to the actual volume of devices each company supplies. Supply more, contribute more; supply less, contribute less—fairer, simpler and exactly what we promised in the 2025-26 budget. I want to be clear about what this is not: it's not a new tax. It doesn't change what the registry does or how it does it. It simply changes how a cost that already exists is shared out, so the load sits where it should.

Let me bring this in a more practical way to my electorate of Barton, because this is where it gets real—especially for me; I played too much tennis as a kid, and trying to play squash these days in the courts downstairs and also doorknocking in my community takes a toll on my knees. But when you walk through my electorate, in Hurstville, Rockdale, Kingsgrove, Bexley and Carlton, you'll meet people whose lives have been changed by a joint replacement. A grandfather in Hurstville who spent 40 years on his feet in the kitchen can finally go to the park with his grandkids. A nonna in Earlwood who swore she'd never see the garden in spring is now bossing around tomatoes and probably scaling those prickly pear bushes as well—and that's a reflection of my childhood, growing up with the Italian family that raised me. There is the bricklayer in Kingsgrove whose knees clocked out long ago. And it's not only our older residents; it's also sporting people. It's the netballer on the courts of West Botany Street who has done her knee for the second time and is already asking whether she can get back out there. It's the weekend footballer who has been playing since he was six and whose body is now sending him a very detailed invoice on the system. These are people who fill our clubs, our halls and our sidelines. They are the heartbeat of the electorate of Barton, and when their joints let them down they deserve a health system that gets them moving again.

Here's the thing, though: nobody is thinking about a registrar or a levy when they're on the operating table. Why would they? They're thinking about whether it will hurt, how long the recovery is going to take and whether they'll be dancing with their daughter at her wedding next year. But they are relying on this system all the same. They're relying on the fact that somebody is going to be keeping track. A database somewhere is watching how these devices perform over 10, 15 or 20 years. If something goes wrong, someone will notice and the surgeons will know. That's the quiet assurance of the registry. A registry only keeps its assurance if it's properly and sustainably funded by a system that the industry itself can see is fair. A levy that squeezes little guys while the big ones coast doesn't build confidence. It really is a levy that treats everyone proportionately.

Let's not forget about the businesses themselves, because Australia has small- and medium-sized medical device companies doing really clever, innovative work—some right in my electorate of Barton; we have a large health precinct in the St George area—and we want them here. We want them competing, inventing and giving Australian surgeons and patients more choice. An unfair cost structure is a very much a quiet barrier to all of that, so fixing it is good for business, but it's even better for patients.

I appreciate that there has been an amendment moved by the coalition for this particular bill, and that is entirely appropriate. The situation with the Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2026 is that, sadly, there is an inequity. I listened to the member for Barton talk about fairness and proportionality, but, sadly, there is a huge gulf at the moment between country and city medical provisions. I note that, earlier this year, in March in fact, Professor Kerin Fielding came to parliament. She is the president of the Council of Presidents of Medical Colleges. She's also a Wagga Wagga orthopaedic surgeon. She, very much, told us how it is in regional centres. She spoke of the difficulties with regional health as opposed to metropolitan services, and she would know.

As I say, she is a fine orthopaedic surgeon. She's also, in fact, the wife of the independent state member for Wagga Wagga, Dr Joe McGirr, who is himself, obviously, a medical professional. She had this to say in relation to older Australians. She was talking about the cost, whether, in fact, older Australians could still afford health care, how long an older Australian would have to wait and how far they would have to travel. She referenced her 90-year-old mother, and she said:

They're getting bills they didn't expect, or they're avoiding a referral altogether because they don't know what it will cost.

The Minister recently told Parliament that over 800,000 Australians delayed specialist care last year because of affordability. That is a serious problem. Australia has one of the best health systems in the world and every Australian should be able to access affordable, high-quality specialist care without risking financial hardship.

I don't think there would be too many people who would disagree with Associate Professor Fielding's remarks in that regard. I have referenced this in the parliament before, in relation to the statistics that she used—and there were Labor members and ministers at this particular speech that she gave in this place. She referenced that rural Australia has 2.7 doctors per 1,000 people compared to metropolitan Australia, which has 4.3. She said:

Potentially preventable hospitalisations are 30 per cent higher in outer regional areas and 70 per cent higher in remote communities.

Thirty per cent of the country's population, are too often overlooked, and for too long, our health system has been built around metropolitan centres. The consequences of that are felt every day in regional communities. The communities that grow and provide our food and much more!

I reference that in relation to this bill because I think, when we talk about health, we do need to talk about and, moreover, act upon the inequities of our system. Associate Professor Fielding is absolutely 100 per cent correct. I think the member for Barton would agree, too, that we do have a very, very good health system, and we're very lucky.

It doesn't matter which side of politics is in government—well, it does. I'd sooner be in government than be in opposition, trust me. But, as far as our health system is concerned, I know there's often at election time these fibs told about the fact that the coalition is selling off Medicare and all these other things to try to get a vote, which is, of course, not true. It worries me that the Prime Minister pulls out his green and gold Medicare card and says, 'This is all you will need.' It worries me that the urgent care clinics are not distributed fairly—and they are not—across Australia. It worries me that there is an inequity in health between country and city. We don't need that sort of divide.

This bill will remove the cap of $5,000. It always worries me when we start talking about caps of $5,000, having had that allied health experience with the $5,000 cap with veterans, but, thankfully, the government has finally come to its senses and said that it will change that. I just wait to see the devil in the detail with that. Removing this cap from the national joint replacement registry levy act that can be imposed per medical device listed on the prescribed list of medical devices and human tissue products for a financial year—so it goes, with this change, the levy will be allocated in proportion. I heard the member for Barton speak to that. The levy will be allocated in proportion to the actual volume of devices supplied by medical device companies, creating a fairer and more equitable distribution of the levy. Hopefully, that stacks up and certainly is as it is intended to be. The Australian Orthopaedic Association collects information from all relevant hospitals in Australia to define, improve and maintain the quality of care of individuals receiving joint replacement surgery.

I do worry as well, though, when we talk about relevant hospitals. Again, when we look at the health legislation and health policy before us at the moment, we have the situation where the private health insurance rebate that over 65 have relied upon is being taken away, and that is bad in itself, let alone the fact that hospitals are very worried that this will push their patients onto the public state hospital system. Our state public hospitals already have long, long queues for certainly such things as hip replacements, knee replacements and joint replacements, per se. There is going to be a huge dilemma that that insurance rebate situation for over 60 fives—it's a cliff, and we're about to go over it. The worry is that we will lose some private hospitals. We will actually have hospitals close. These are not my words. That is already the fear being expressed by many in the health sector. Just as bad as that—and we don't want to see any hospitals close—is the fact that it is already difficult enough for our state public hospital system to cope with the number of patients they have now.

I am very, very lucky in Wagga Wagga. I have the Wagga Wagga Base Hospital, which is relatively new in the scheme of things, and we've also got the Calvary Riverina Hospital, which has been operating for many, many decades, and both do a fine job. They're all in the one Docker Street medical precinct, and long may they not only service the entire Murrumbidgee Valley, which encompasses, quite frankly, probably around a quarter of a million people, if you add up all the people who go to that hospital from not just Wagga Wagga, a population of 73,000 or so, but also the Murrumbidgee irrigation area centred on Griffith, a population of 32,000 or so, and everywhere in between but service elsewhere as well throughout the Riverina and south-west and southern New South Wales. Fortunately, there is a good relationship between the public hospital, Wagga Wagga Base Hospital, and the private hospital, Calvary hospital, and we have other day surgeries as well. They all perform hip replacements, knee replacements and joint replacements, and that is good.

The Australian Orthopaedic Association is provided funding for components of the registry's administration through a Commonwealth grants agreement which is efficiently cost recovered through the imposition of a levy under the Private Health Insurance (National Joint Replacement Register Levy) Act of 2009. The levy is paid by the medical device industry. This is the situation with the particular bill before us. I appreciate that it has the support of Private Healthcare Australia, the Australian Orthopaedic Association and the Medical Technology Association of Australia, as you would expect it would. I would like to think that something as important as this which will have some profound impacts upon the health sector would have received the stakeholder engagement and the stakeholder support that in fact it needs. The Commonwealth grants agreements are something that the health minister controls and runs. It is an important process not just with the public system but with the states as well.

This is important as we get older. I heard the member for the member for Barton talking about the strain on her knees while she doorknocks. My goodness, she's still in her 30s—a long way—

Thirty-nine.

Oh, 39? Okay, well, you've given your age away. I would never suggest to give a woman's age away! But, anyway, I'll just take that interjection. She's a long way from getting knee and hip replacements, I hope. It's her reference, not mine. Please don't think I'm doing anything wrong here. But, rest assured, there are older Australians who thankfully do have—

A division having been called in the House of Representatives—

Sitting suspended from 17:27 to 17:36

As I was saying before the division, when the member for Barton is doorknocking around Kogarah, Banksia and Bexley North, I do hope that her knees hold up; I certainly do. That's genuine. Older members of her community who need health care fortunately will have it in spades. But it's not that easy—the further you go from the bright city lights, the harder it gets. I appreciate that the assistant minister for health, who sits opposite, understands that too. She in fact was at Associate Professor Fielding's address in March this year and heard the good orthopaedic surgeon from Wagga Wagga detail just how difficult it was for country people, particularly older regional people, to access those health services.

It wasn't that long ago that the NSW Council of Social Services put out a report. They commissioned it. It was conducted by the University of Canberra. It was entitled Access denied: Australians locked out of quality healthcare, and it revealed an alarming situation in primary health in my home state. Since the last NCOSS report in 2020, the Riverina has had a more than 330 per cent increase in people who can't afford to visit a GP, let alone a specialist, let alone a specialist who may well have to replace a hip or a knee or another joint. More than one in three people, 37 per cent in fact, delay or avoid seeing a specialist due to cost, an increase of over 180 per cent since the previous report in 2020—admittedly, this was a 2024 report, but the situation hasn't improved—whilst almost a third of people, 32 per cent, visited the emergency department in the Riverina because their GP wasn't available. This is higher than the New South Wales state average of 23 per cent.

NCOSS chief executive Cara Varian said the report found that patient experiences with vital health services, including general practitioners, specialists and dentists in New South Wales, had gone backwards since its 2020 report, and regional areas were more heavily impacted than metropolitan areas. This quote really, sadly, sums it up:

This report illustrates that the health system is broken.

I refer to what I said earlier. Our health system is very good, but we can do a whole lot better. We can do a whole lot better for the sake of country people, who, as the associate professor said, provide the food and the fibre and the mining and the resources, and help our balance of payments. The obligation and the commitment and the duty of care is on governments at all levels to make sure that they do better, certainly for regional Australians.

I understand the member for Pearce would like to present a copy of her speech for incorporation into Hansard, in accordance with the resolution agreed to on 6 November 2025.

The incorporated speech read as follows—

The National Joint Replacement Registry is one of Australia's quiet success stories in health care. Administered by the Australian Orthopaedic Association, it collects information from virtually all relevant hospitals across the country to define, improve and maintain the quality of care for people receiving joint replacement surgery. Its value is not abstract. The registry improves clinical effectiveness by tracking long-term outcomes, identifying which prostheses and surgical approaches perform best and giving clinicians the evidence they need to make better choices for patients. It has collected data on more than two million procedures since 1999, with coverage exceeding 99 per cent of 'primary' and 'revision' joint replacements in Australia. That depth and continuity of data allows us to see, over years and decades, which implants last, which fail, and why.

This is real-world evidence that saves patients from unnecessary pain, additional surgery and lost time with family and at work. It also saves the health system money. Independent analysis finds the registry delivers around $10 in benefits for every dollar spent, with net benefits of roughly $390 million to 2022.

The Australian Orthopaedic Association is provided funding to operate the registry through a Commonwealth grant agreement which is efficiently cost recovered through the imposition of a levy authorised by the Private Health Insurance (National Joint Replacement Register Levy) Act 2009. That levy falls on sponsors of joint replacement devices listed on the Prescribed List of Medical Devices and Human Tissue Products—in other words, the companies that supply these devices into the Australian market. This design is intentional.

Those who benefit from the registry's work, including manufacturers whose products are monitored and compared, contribute to its ongoing operation. At the same time, the cost recovery model ensures that the registry remains independent, clinically led and focused on patient outcomes, rather than commercial interests.

The purpose of the Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2026 is straightforward: to remove the $5,000 levy cap per device per financial year. Under the current law, no matter how many units of a particular device a company supplies in a year, the levy payable for that device type is capped at $5,000. That cap was designed with good intentions—to avoid excessive burdens on industry—but, in practice, it has produced an inequitable outcome.

The existing levy cap has resulted in smaller and medium sized medical device companies bearing a disproportionate share of the financial burden, while companies that supply large volumes of devices pay comparatively less per unit. A company that supplies a modest number of implants can quickly hit the cap and then pay no further levy on additional units, whereas a very high-volume supplier effectively pays a much lower levy per device once the cap is reached. This distorts the market. It means the levy is not allocated in proportion to the actual volume of devices supplied. It also means that the companies doing the most business in joint replacement devices are not contributing proportionately to the system that monitors the safety and performance of those same devices.

By eliminating the cap, the amendment ensures the levy is allocated in proportion to the actual volume of devices supplied by the medical device companies. Removing the cap will create a fairer and more equitable distribution of the levy across the industry. This is important because, as demand for joint replacement grows with an ageing population and increasing rates of chronic disease and obesity, the registry will become even more important to maintaining safe, effective and high-quality orthopaedic care.

Australia already sees tens of thousands of hip and knee replacements each year, and those numbers are rising. Every additional procedure adds to the data that keeps the registry robust, but it also increases the stakes. We must be confident that the implants being used are the best available and that emerging problems are identified early. A well-funded, independent registry is central to that confidence. It allows the Therapeutic Goods Administration, clinicians, hospitals and patients to see which implant combinations have higher-than-expected revision rates and to act on that information. It supports continuous quality improvement, not just at the level of individual surgeons and hospitals but across the entire national system.

The government's continued support for the registry reflects its commitment to evidence based health care, patient safety, clinical quality and the responsible use of private health insurance contributions. Australians who hold private hospital insurance expect their premiums to be used wisely. They expect that the devices implanted in their bodies are monitored, that poor performers are identified quickly and that clinicians have access to the best possible information when making decisions.

The National Joint Replacement Registry delivers exactly that. It turns routine clinical data into actionable intelligence. It has already influenced practice—for example, by highlighting higher revision rates for certain implant designs and bearing surfaces and by showing where particular patient groups face greater risks. It has supported the expansion of data collection beyond hips and knees to shoulders, elbows, wrists, ankles and spinal disc replacements, reflecting the evolving needs of patients and clinicians.

Ensuring the levy is fairly distributed strengthens the financial base for this work. It means the registry can continue to invest in data quality, timely reporting and the integration of new measures such as patient reported outcomes, which are increasingly important in understanding how people actually feel and function after surgery.

This bill is targeted and proportionate. It does not create a new tax. It does not expand the scope of the levy. It simply removes an arbitrary cap that has produced unintended and inequitable results. Medical device companies will continue to pay the levy only on devices that fall within the prescribed list. The rate structure remains unchanged.

What changes is the total levy payable, which will now reflect the true volume of devices supplied so that larger suppliers contribute in line with their market presence. For smaller and medium sized companies, this reform levels the playing field. For larger companies, it ensures their contribution matches the scale of their activity in the Australian market. And, for patients, it reinforces the principle that the system that watches over implant safety is funded fairly by those who participate in that market.

In the electorate of Pearce, we see the importance of this work every day. Our community includes many older Australians who have benefited from hip and knee replacements to regain mobility and independence as well as younger patients seeking to return to work and active lives after injury or arthritis. Families in Pearce rely on our public and private hospitals to deliver safe, high-quality orthopaedic care, and they trust that the implants used in those hospitals are monitored rigorously for safety and performance. Strengthening the funding model for the National Joint Replacement Registry is, in practical terms, a way of standing with those patients and their surgeons and ensuring that the data that protects them remains robust, independent and sustainable.

Joint replacement surgery transforms lives. It restores mobility, reduces pain and allows people to return to work, sport and family life. But, like any surgical intervention, it carries risks, and the quality of implants and techniques matters enormously to long-term outcomes. The National Joint Replacement Registry is a cornerstone of Australia's approach to managing those risks. It is clinically led, nationally comprehensive and internationally respected. Ensuring its funding model is fair and sustainable is a basic responsibility of this parliament.

The Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2026 does exactly that. It removes the $5,000 cap so that the levy is allocated in proportion to the actual volume of devices supplied, creating a fairer and more equitable distribution of the levy across the industry. In doing so, it strengthens the foundation for a registry that will be even more critical as our population ages and demand for joint replacement continues to grow. I commend the bill to the House.

The Private Health Insurance (National Joint Replacement Register Levy) Amendment Bill 2026 removes the $5,000 cap on the levy payable per device per financial year by sponsors of joint replacement prostheses. The levy funds the Australian Orthopaedic Association National Joint Replacement Registry. To date, the cap has meant that small and medium sized device companies have been forced to carry a disproportionate share of the registry's costs. Removal of the cap will ensure that the levy paid is proportional to the number of devices sold by each company.

The National Joint Replacement Registry is an excellent demonstration of what can be achieved with good clinical data, but its success reflects how Australia is failing in other ways with our health data. In 2002, Australian surgeons performed more than 50,000 hip and knee replacements. At that time, we had no good data on the long-term effect of those devices. The best estimate was that one in five hip replacements would eventually need revision. Australian orthopaedic surgeons decided that that wasn't good enough. They built a registry which now collects data from every relevant hospital in Australia, public and private, on every joint replacement performed. That registry has saved Australians from real harm. In 2007, the registry identified the ASR metal-on-metal hip resurfacing device as an outlier, with a revision rate more than double that of comparable prostheses. By the end of 2009, the manufacturer had withdrawn both ASR devices from the Australian market.

Australia now has more than 140 clinical registries operating nationally and across jurisdictions. They inform best-practice care, quality improvements, health policy and resource planning. Some of them are world leading. But they're a patchwork, established at different times for different reasons and funded in different ways. The Joint Replacement Registry is funded by an industry levy collected under its own legislation. Other registries are funded through time limited Commonwealth grants. The National Clinical Quality Registry Program provides $40 million over four years to support 10 existing national registries. Other registries rely on the Medical Research Future Fund or on time limited NHMRC grants. Some are funded by state governments. Some are funded by specialist colleges or universities, charities or patient groups. Others are funded by pharmaceutical companies with a commercial interest in their outcomes. Many, if not most, survive on the goodwill of clinicians who enter data into those registries in their own time, and I know this from personal experience.

I founded the Australian Neuromuscular Disease Registry in 2020. It's housed at the Murdoch Children's Research Institute. It's one of 70 registries in the TREAT-NMD global network, which harmonises datasets so researchers across the world can pull data across borders, which was essential when every one of the conditions that we were studying was rare. The registry is funded by patient groups like Muscular Dystrophy Australia and Save Our Sons, with some support from pharma. It largely depends on the dedication of clinicians like my former colleagues Dr Eppie Yiu and Mrs Robin Forbes.

The reality is that long-term data has never mattered more. If we look at the gene therapies and genetic therapies now being given to Australian children with neuromuscular disease, which are given once and meant to last a lifetime, approvals are largely based on short-term data from small clinical trials. The TGA has adopted the European guideline on the quality and clinical aspects of gene therapy medicines—

A division having been called in the House of Representatives—

Sitting suspended from 17:44 to 17:57

The TGA has adopted the European guidelines on the quality and clinical aspects of gene therapy medicines but has not adopted the companion European guidelines on long-term safety and efficacy follow-up, which recommend that patients receiving gene therapies be followed for up to 15 years. The long-term follow-up that those patients need falls back on registries like ours, registries run on goodwill and short-term grants. When the Commonwealth consulted on a national clinical-quality registry strategy, stakeholders were unified in saying that our approach to registries is ad hoc and fragmented and that the sector needs sustainable national funding.

But funding was absent when the national Clinical Quality Registry Strategy was finally released in 2021 and is still absent five years later, so whether a condition, a device or a procedure is properly monitored in Australia depends less on its importance to public health than on whether a group of committed clinicians start a registry of their own. Australian women harmed by transvaginal mesh implants know what that costs. So do those who received defective breast implants produced by Dow Corning and those placed at risk by the now recalled Philips sleep apnoea devices.

Last week in Kooyong I met with Catherine Shang, the CEO of the Australian Cardiovascular Alliance. Heart disease and stroke account for one in four deaths in Australia, but we have no national profile of them. Cardiovascular data is held in hospital records and standalone registries in different formats in different jurisdictions. Compare that with cancer, where mandatory reporting of every diagnosis has supported a national database since 1982. The gap is most stark in sudden cardiac death. Sudden cardiac arrest affects over 25,000 Australians every year. On average, one Australian under 35 suffers a sudden cardiac arrest every day. Those statistics are derived from a Victorian registry that was enabled through a philanthropic donation but has now stalled.

Kooyong constituents Gordon and Bronwyn Thoms know the cost of that. In 2023, their daughter, Alexandra, died from sudden cardiac arrest at just 23 years of age. Alexandra was a happy 23-year-old who had recently completed her double degree. She died in her sleep without warning. Before losing Alexandra, the Thoms family had no concept that a seemingly healthy young person could die suddenly from an undiagnosed cardiac condition. That lack of awareness is itself part of the challenge that we face. Tragically, it took Alexandra's death to find the underlying genetic cause that then enabled preventive monitoring and potentially life-saving intervention for other family members. Alexandra's brother, Charlie, was diagnosed with the same cardiomyopathy and subsequently received an implanted defibrillator.

The Australian Sudden Cardiac Arrest Alliance has brought the sudden cardiac arrest community together to identify what we need to do. Working with clinicians, researchers, survivors and bereaved families, they have developed evidence based recommendations for a coordinated national sudden cardiac arrest plan. One of AuSCAA's central recommendations is a near-real-time registry of cardiac arrest cases able to identify risks, measure outcomes and drive continuous improvement. Victorian researchers were tracking every arrest in people aged one to 50, determining the cause and circumstances of each to target prevention. A similar registry being established in New South Wales now is struggling to connect emergency services with forensic information, and its ongoing funding is uncertainty. Organisations like AuSCAA shouldn't have to fight for data infrastructure and coordinated action. The Commonwealth should be providing that. It now needs to meet with AuSCAA. It needs to act urgently to fund and implement a national sudden cardiac arrest plan.

Another problem is the fact that our registries and the larger government data collection don't speak to each other. The Australian Institute of Health and Welfare holds national hospital mortality and cancer data. Communicable diseases are reported through the National Notifiable Diseases Surveillance System. Occupational lung diseases, like silicosis, are captured in the National Occupational Respiratory Disease Registry. Each of these have their own legal basis, governance, data standards and custodians. But, when registries want to link data with hospital records or death records, they're often forced to do that as a one-off project. They have to seek approvals in each jurisdiction, negotiate with multiple data custodians and satisfy multiple ethics committees. One-off linkages are labour intensive, slow and expensive.

This country collects enormous amounts of healthcare data but then walls it up in separate silos. Look at Medicare. Every time an Australian sees a GP or a specialist, undergoes a procedure, has a pathology test or an imaging study or fills a PBS script, the Commonwealth has a record of that. Medicare and the PBS constitute one of the biggest and most complete longitudinal, population-wide health datasets in the world. But our clinical registries struggle to access that data. Think about what routine access to that data could do. A registry tracking a new hip or knee device could see, without asking a single extra question of the surgeon or the patient, whether recipients go on to need more physiotherapy, less pain medication, more imaging or more specialist reviews than recipients of other devices. A registry for a chronic condition could measure in real time whether the care that Australians receive matches the guidelines that we spent so much time and money writing. The Commonwealth is already paying for this data. It has the legal authority to share it safely and under strict privacy considerations, but it's lacked the infrastructure, the will and the single focus for it until now.

This year, after nearly four decades of advocacy from public health experts, Australia has finally established the Australian Centre for Disease Control. The CDC was created to be a data-driven organisation, one able to modernise our surveillance systems and enable data sharing and linkage across the Commonwealth, the states and the territories. It already houses the National Notifiable Diseases Surveillance System and the National Occupational Respiratory Disease Registry. The COVID-19 response inquiry recommended that the CDC be expanded to include non-communicable diseases, building on that data infrastructure and that linkage capacity.

I believe that clinical and disease registries should be part of that expansion. Imagine if, instead of 140 separate registries, each with its own funding fights, IT systems, data standards and linkage negotiations, we had a national registry platform hosted by the CDC, working closely with the AIHW and the safety and quality commission. Registries could keep their own clinical leadership. They should, but the infrastructure, the secure data environment, the common standards and the enduring links to Medicare and the PBS, to hospital records, to other registries and to the National Death Index could be built once and shared by all. That would mean routine rather than one-off data linkage and a sustainable, transparent funding model which doesn't depend on which registries happen to have their own act of parliament. Australians are rightly cautious about how their health information is used. A national platform would need strong legislative safeguards, independent oversight and genuine transparency about who accesses what data and why, but I think it's fair to say, given my experience of the milieu, that a single well-governed, well-secured national system could well be safer than dozens of underresourced ones, each managing sensitive data on its own.

As it stands, progress in the health portfolio is slow. I would argue too slow. The government's health technology assessment review made 50 recommendations more than two years ago, and its implementation advisory groups roadmap has been in limbo since the end of last year. The strategic examination of research and development handed the Albanese government 20 recommendations last December. We're still waiting for a government response to those. There are more reasons for urgency. The government is now working through how artificial intelligence should and could be adopted and used in our healthcare system. AI is only ever as good as the data that it learns from. Coordinated, high-quality national health data should be the foundation of the government's AI agenda in health, not an afterthought.

The national joint replacement registry has shown us what Australian doctors are capable of. This bill helps to make that registry sustainable. I support it, and I thank the government for introducing it, but I'd urge the minister to see this bill as a start of the conversation. Every Australian who has a hip replacement deserves to know that someone is watching to see how well it works—that's happening—but so does every Australian who receives a heart valve, a breast implant, a new cancer treatment or the diagnosis of a rare disease. We have that data. We have that expertise, and we now have a national centre for disease control. What we need is the ambition to bring them together in the interests of data interoperability to further advance our healthcare system. With that in mind, I move the amendment as circulated in my name:

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

"the House:

(1) notes that:

(a) for more than two decades, the National Joint Replacement Registry has demonstrated the value of high-quality clinical registry data to patient safety;

(b) Australia's more than 140 clinical registries are fragmented and poorly integrated, and rely on inconsistent and often insecure funding; and

(c) Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data remain largely unused by clinical registries despite their unique value as population-wide, longitudinal health records; and

(2) calls on the Government to urgently:

(a) develop a coordinated national approach to health data collection, including for clinical quality registries;

(b) establish common data standards and enduring, privacy-protected linkage between clinical registries, MBS and PBS data, hospital, cancer and death records, and national genomic data resources;

(c) house a national clinical registry in the Australian Centre for Disease Control;

(d) prioritise the development of coordinated, high-quality national health data so that the research potential of artificial intelligence in health can be fully realised; and

(e) release and respond to the Health Technology Assessment Review Implementation Advisory Group's final report and respond to the Strategic Examination of Research and Development report".

Is the amendment seconded?

I second the member for Kooyong's amendment, and I'd like to make a few brief remarks. We are so lucky to have someone of the calibre of the member for Kooyong in our House to make an amendment such as this with the expertise that she brings to this subject matter. Her career as a medical researcher, as a paediatric neurologist and, indeed, as someone, as she's told us, who established her own register is incredibly important, and it's really pleasing to see the minister in the House listening intently to what she had to say, because she brings such expertise to this subject area.

As the member for Kooyong points out, Australian healthcare data is currently fragmented over more than 140 separate clinical registries. MBS and PBS data is a largely untapped goldmine of longitudinal population-wide health records, and I'm acutely aware of the power of data. It's what transforms our individual experiences into a workable evidence base to support better treatments, safer clinical decisions and more effective policy-making. In my early years as a researcher, I spent a lot of time in Sweden, and Sweden, of course, is part of the broader Nordic goldmine, indeed a treasure chest, of linked clinical data. Together, they form a cluster of registry based medical research based on population ID. The amount of epidemiological information that I was able to tap into as a researcher in Sweden was incredible, and it's something that I simply couldn't do as a researcher in Australia.

There is so much to learn from bringing together our medical evidence so that we can collectively have the power to produce results that can truly change people's lives, and the member for Kooyong has outlined that in such a powerful way. At a time when the economy is crying out for productivity gains, I say this: here is such a brilliant productivity gain. I urge the government to unlock the potential of our clinical data. I commend the member for Kooyong's amendment to the House.

I thank honourable members for their contribution, especially the member for Indi and the member for Kooyong—may you long be the member for Kooyong! The contributions you each made were very thoughtful. Thank you very much for sharing your insights. It's very interesting work, and I'm interested to understand how we might do better when it comes to the interoperability of information across the broader health system and making sure we ultimately deliver better health outcomes through the use of that information.

Having said that, whilst I recognise the value in the member for Kooyong's contribution, we won't be supporting her amendment or the member for Lindsay's amendment. This particular bill does a specific job, which is to make sure that the joint registry can be appropriately funded in a way that recognises the contributions that small and large companies are making, and, by removing that cap, ensuring the levy is allocated proportionate to the value of the volume of devices supplied by medical device companies, which makes it fairer, which supports the sustainability of this particular registry.

I've got a copy of the amendment moved by the member for Kooyong; I'm happy to raise that with the minister and continue discussions. I thank all members for their contributions on this bill.

The original question was that this bill be now read a second time. To this, the honourable member for Lindsay has moved as an amendment that all words after 'That' be omitted, with a view to substituting other words. The honourable member for Kooyong has moved, as an amendment to that amendment, that all words after 'reading' be omitted, with a view to substituting other words. The immediate question is that the amendment moved by the honourable member for Kooyong be agreed to.

Question unresolved.

As it is necessary to resolve this question to enable further questions to be considered in relation to this bill, in accordance with standing order 195 the bill will be returned to the House for further consideration.