Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

I rise to speak on the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010. After all the ups and downs, it is interesting to see this bill finally come up. I want to place on the record that Minister Roxon has made comments in the other place criticising the coalition for supposedly blocking this. Here we are, almost at the death knell, and because they could not get their act together and get their programming right we are now dealing with this in a hurried manner. It has been shuffled down the list repeatedly.

Indeed, that is also the case with the National Preventive Health Agency and the legislation dealing with that. I raise this because we have to put up with the comments from Minister Roxon. She cannot get her facts right and so she puts out these silly press releases that tell us that it is being blocked by the opposition. The preventive health agency bill is one that I inherited when I became shadow minister for ageing, looking after health and ageing in this place. It has been sitting on my shelf for the last six or seven months. Why? Because this government has not been able to get its act together. It was with Senator Cormann when he was looking after health in this place, so can I just tell the minister to either get a copy of the Senate procedures and understand them or go back to the people that put order and procedure into the Senate and complain to them. Do not come out and complain to the opposition if you are having a hissy fit because your bills are not getting through the Senate.

Having said that, I now turn to the healthcare identifiers legislation. This bill is another example of this, and because of the time constraints I will not go through the various things this bill actually does. I do want to say that it is very important. This is a bill that goes to e-health. We support e-healt; indeed, it was an initiative started by the coalition. But it was very important that this bill be correct to ensure that the improvements in patient safety, medical care, privacy and coordination have a critical and solid foundation in relation to its future. It is important that we get this right.

In the lead-up to the last federal election we heard many promises from the former Prime Minister on health. For example, ‘We are going to plan to fix the hospitals.’ Indeed, one of the points we keep hearing about healthcare identifiers and e-health—and we heard it again last week in relation to the COAG inquiry—is that they are important. Yes, it is, but it is important that we do get it right. It is also interesting to see that there was a whole range of promises in relation to a whole lot of things on the grand hospital plan. Might I say that this was a plan approved by the gang of four, so again it was one of those rushed jobs where the formalities did not actually start until three weeks before COAG. Of course, the Prime Minister—the former Deputy Prime Minister—was right in there making those decisions.

I will not trawl through the various problems in relation to health, but I will say that in relation to e-health there were concerns about the original legislation. When we examine the history of this legislation we see a repeat of common features of the Rudd record on health: planning, rushed legislation and a lack of appropriate consultation with stakeholders. The lack of consultation, and putting out draft legislation where so much of the legislation was actually in regulations that were not put out, really caused a lot of angst for stakeholders. It was because of this angst that the coalition pushed for a Community Affairs inquiry. Regrettably, at the time of the hearing we still did not have the regulations. And as so much of the parameters of this was going to be in the regulations it was really unfortunate that they were not out in the public arena. Now, here we are, and it is, as I said, the death knell.

Another concern that was raised following the lack of consultation time available to stakeholders was the fact that this system was due to commence on 1 July this year. It defies belief that the government has delayed—and this comment needs to be made—providing software manufacturers and developers with the specifications to enable them to design the appropriate IT framework or to integrate healthcare identifiers into existing packages.

Concerns were also raised about the breadth of this legislation. In particular, there was potential for privacy laws to be overridden if the action was in relation to disclosure under any other law. Given the reports in the press, particularly in the Australian on 2 March this year—and we trawled through this at the committee hearing—about concerns and allegations raised against Medicare Australia staff in relation to inappropriate viewing of confidential patient records without authority in the past financial year, it was really important that the parameters in relation to access to healthcare identifying information work were properly delineated.

There were additional concerns in the minority report and I contributed to that minority report. It must be stressed that, whilst we do not oppose this legislation, we thought it was important that stakeholders be given that further opportunity for consultation through the committee process. One of the concerns was this potential function creep and the use of healthcare identifiers being extended to other purposes. The final concern was the possibility that the scheme would not be ready for implementation on 1 July.

The coalition presented eight amendments to the government and in a press release on 21 June the responsible shadow minister, Dr Southcott, stated that there were discussions in relation to amendments put to the government. They covered four basic areas: to prescribe the requirements for assigning a healthcare identifier to a healthcare provider or recipient as a schedule in the bill; to confirm that the operator of the health identifying service can only be changed by legislation; to provide a guarantee of a right of appeal or review under section 9 of the proposed legislation; and to delete the provisions which allow the healthcare identifier to be released if permitted under another law. We believed that these amendments would significantly improve the legislation and urged the government to support them.

We are very pleased that Minister Roxon has significantly backed down from the original legislation. We believed that the Labor government needed to go much further to ensure important privacy protections and prevent function creep. Therefore, we are pleased that Minister Roxon has heeded our concerns and accepted six of our amendments—namely, those going to requiring legislation to change the service operator from Medicare, those requiring legislation to proscribe the data source, definitions for healthcare providers to be done by way of legislation and not regulation which is very important, and requirements for assigning identifiers to be done by legislation and again not by regulation.

Our two remaining amendments were in relation to limiting the disclosure of information and removing a person’s ability to disclose information under another law, a concern raised at the inquiry. Following discussions with stakeholders such as NETA and after exploring the issue with the government, there are legitimate concerns with the operation of the outstanding two amendments about the potential to overly restrict the use of health identifiers and potentially expose clinicians to offences for aspects of routine health care. As I said, very little time was afforded to stakeholders to submit their views on the draft legislation and not all these concerns were addressed. For legislation such as this, which is very important and deals with highly confidential healthcare information, it is vital that it is right.

I conclude by saying that the coalition will not oppose the legislation and we will not oppose the government’s amendments. We will also not be moving our amendments, given most of our concerns have been taken up by government amendments. I am not sure what the position is in relation to the Green amendments and Senator Siewert may clarify that. We saw some Greens amendments which allow individuals to opt out of the identifier scheme. The coalition will not support the Greens amendments which we believe are unnecessary at this stage. Critically, this will be dealt with in the next step which is the electronic health record. This will be an opt-in system in that you will have to provide explicit consent to have a personally controlled electronic health record.

Anne McEwen (SA, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to have Senator Xenophon’s speech incorporated in Hansard.

Leave granted.

The speech read as follows—

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

The incorporated speech read as follows—

The Healthcare Identifiers Bill 2010 is the first Bill that will introduce an e-health system to Australia.

e-Health is, to use a cliché, the way of the future.

Similar systems are in place or being developed in Europe, Canada and the USA and I’ve been advised that the technology currently being used has been not only highly secure but incredibly useful and beneficial.

e-Health offers doctors and patients access to accurate, up-to-date medical records and health information.

It will make changing doctors or being referred to specialists easier, especially for patients with complex medical conditions.

And having been in that boat myself, I can see how it will be helpful.

The transfer of records, x-rays, test results ... all the information we as patients forget or remember incorrectly, will be available to any doctor we see, anywhere in Australia, with the appropriate permissions, which can only benefit treatment of patients.

Such a system will also help to monitor ‘doctor shoppers’; patients who move from one doctor to another in order to collect multiple prescriptions, often in order to feed prescription drug habits.

However, while I do support the introduction of e-health, even at this very initial stage, I do have concerns regarding privacy.

I note that the Government has acknowledged these stakeholder concerns also, and I appreciate that.

It is vital that such a system does not compromise an individual’s privacy with regards not only to their health history but also any identifying information.

And as this scheme develops, I indicate now that I will be monitoring subsequent legislation very closely to ensure that the privacy of Australians remains in tact.

I understand that there have also been concerns expressed around ‘function creep’; that the Unique Healthcare Identifier number may gradually be expanded to include purposes and functions it was not originally intended to be used for.

The legislation as it currently stands only allocates the use of the Unique Healthcare Identifier to health, and it must stay this way.

I think it’s important at this stage that we recognise that this particular Bill does not establish the actual working system of electronic health records; it simply puts the framework for such a system to be established in place.

Therefore, there will be further stages where thorough review will be conducted and I look forward to debating the subsequent legislation concerning the implementation of this scheme, and the associated issues that will be raised with it.

I support this Bill, and I support the establishment of e-Health in Australia.

I believe that, with the appropriate scrutiny and safeguards, that such a system will be a good thing for Australians, and a positive step in improving our healthcare system.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

This is just another example of the farce in this chamber this afternoon. We got a phone call asking if we would consider bringing the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010 on and, in trying to be facilitate the debate, I said: ‘Yes, I have amendments. I can happy to decide them on the voices and I won’t call a division. We will try and facilitate this getting through the chamber.’ About five minutes later we got another phone call saying, ‘No, it’s not coming on.’ I sent my staff home. Nobody had the courtesy to phone my office to tell me this bill was coming back on. In fact, I would not have known if I had not been in the chamber for the previous bill. Since when is that good government process? I could call a division right now on my amendment and you would not be able to finish this. It is only my good grace that prevents me from doing that.

Now I have that off my chest, I will address the bill. This is an important piece of legislation and it deserves to be treated better than this. This is setting up a system that is very important for the future of the health system in our country. It is quite controversial. This is the first bit of that legislation and e-health is very controversial. I realise that this is only an initial phase, but a lot of people see this as the thin end of the wedge, which is why we have been paying such close attention to this legislation. This bill sets up a national system for identifying healthcare consumers and sets out the purposes for which healthcare identifiers can be used. It establishes a national healthcare identifiers service to allow electronic communication between healthcare providers.

I know there remains a great deal of confusion as to whether this legislation is about electronic health records or creating the building blocks for the e-health system which is why people are anxious. This is why it is important for us to have a proper debate so that people actually understand the sequence, what the identifiers mean and what the electronic records mean. This deals with establishing the foundation of a future electronic health record. The Greens believe that universal data will contribute to reducing the incidence of misadventure, save costs and inform performance across our health system. In order to get to that point, we have to start somewhere. As such and with a number of caveats for the future development of electronic health records, the Greens will support this legislation.

However, it seems disingenuous to discuss the issue of healthcare identifiers without consideration of the wider issues of electronic health records, because this is the initial building block. The minister commented in her second reading speech:

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.

              …              …              …

The implementation of a healthcare identifiers system for patients and healthcare providers is an important step towards building an effective national e-health system.

The first time many Australians will be aware that they have been assigned the identification number is when they visit a doctor’s office or a Medicare office and a staff member asks them for their identifying information.

In the UK, University College London has just released a report that evaluates the early stages in the development and implementation of electronic health records in the UK national health system. The report, titled The devil’s in the detail, highlights the differences between both sides in this debate. On the one hand, there is the view that centrally stored electronic summaries, accessible by patients and authorised staff, are a part of a broader common good. Advocates speak of choice, empowerment, quality, safety, efficiency and personalised care. The opposite view portrays policymakers as being seduced by a vision of technological utopia, professional leaders as being obsessed with standardisation, the public as being largely disengaged and the government as extending electronic surveillance into intimate parts of citizens’ lives. The problem is that both versions can, unfortunately, be backed up by evidence to some extent.

A unique electronic patient identifier, in conjunction with an electronic health card, was first advocated by the House of Representatives Standing Committee on Family and Community Affairs in 1997. The National Electronic Health Records Taskforce recommended in its report in 2000 that a national health information network be developed. The report cited the benefits of national health identifiers and talked about increased community safety, informed consumers being able to make better choices, better healthcare providers providing better health care, provider access to healthcare information, fewer diagnostic tests, improved warning systems, better planning and coordinated healthcare provision.

The National E-Health Transition Authority was endorsed by health ministers and set to work on e-health priorities. One of these priorities was the development of the patient identifier system, which, when combined with a product and medical database and national healthcare provider index, was to form part of the shared e-health record. In June 2009 the government’s National Health and Hospitals Reform Commission endorsed the directions proposed in the e-health strategy on the understanding that personalised health records remain at all times owned and controlled by individuals, who must approve access to these records.

The Senate committee inquiry into healthcare identifiers found that, while most who submitted evidence were supportive of identifiers, concerns were expressed around three themes: protecting the privacy of healthcare consumers from unauthorised access to their medical records; function creep, whereby healthcare identifiers start to be used for purposes other than that for which they were originally intended; and the implementation of the legislation by 1 July this year. It was widely acknowledged by witnesses and submissions to the inquiry that there was a need for a single healthcare identifier as proposed in the bills. In the words of one witness:

This is a fundamental building block that we know has direct payback, immediate payback, in terms of patient safety and cost reduction.

The Consumers Health Forum provided in their testimony a sense of the efficiency gains that a single healthcare identifier can bring for health consumers. The Nursing Federation also expressed support for healthcare identifiers.

Few witnesses or submissions disputed the concepts of healthcare identifiers and e-health. They did not dispute that they were likely to improve delivery and administration of health care in Australia. So it is not that people do not support identifiers; what they have concerns about are privacy and other concerns that I have listed. However, there remains confusion about what this initial piece of legislation does. The issue was identified by the Consumers Health Forum, which noted:

Many privacy concerns that were raised with us are valid … but they relate mostly to e-health records as opposed to individual health identifiers …

This debate is important so that people understand that we are just talking about the identifiers at the moment. This legislation does not allow access to patients’ records. All that further information comes through the e-health process. These bills cover only the creation of a national system to accurately identify healthcare consumers and healthcare providers. They do not allow medical and clinical information to be attached to an individual healthcare identifier—although it is not correct to say that these are unrelated concepts; of course they are.

The Privacy Commissioner emphasised:

Different privacy issues will arise if healthcare identifiers are to be used for expanded purposes within the national health system and if clinical information is to be associated, or held, with a healthcare identifier. In particular we would be concerned if healthcare identifiers could be used for expanded purposes without further consultation and Parliamentary scrutiny being required.

The Privacy Foundation was strongly opposed to the bills and claimed that the benefits to patients that were likely to come from the introduction of healthcare identifiers were outweighed by risks to individual privacy. The foundation asserted that the security of electronic information is difficult to guarantee and suggested that clinical staff may share secure information. These issues are all really felt by people and need to be addressed. If you talk to doctors, nurses and allied health workers, they are quite frank about the fact that they share logon details, passwords and patient records. I am not convinced that electronic health records are somehow less safe than what already exists. As was also pointed out during the Senate inquiry, there are currently privacy breaches in the clinical environment.

Some have argued that the risk to the privacy and security of information lies in the fact that health identifiers are being considered in isolation from future legislation. However, I am not convinced by that argument, which is why we are supporting the bills. We understand very clearly that separate legislation will be needed for e-health records. That is why, as I said, we are keen to make sure that we articulate that we have some concerns about e-health. I am not saying we oppose it; I am saying that there are issues that need to be fixed. We have spoken with the government about our concerns about privacy, which is one of the reasons I am putting up an amendment about opting out. This came up at the Senate inquiry, and the government said that it had looked into it and that it is too hard to opt out. However, they do it in the UK, which is why I will move an amendment. We understand that people do not have to use their identifier number, but people are concerned that there is a number against their name on the record. That still remains a concern for us—it is not the same as opting out—and that is why I will move the amendment. As people will be aware, I also have a second reading amendment, and if people read it they will see exactly the recommendations of the Senate committee report around the involvement of stakeholder groups as the system develops and as the implementation plan develops. It talks about publication of this plan before it is finalised and the development of a targeted education communication strategy.

We think this provides good safeguards around the identifier process and recommend it to the House. We will be watching the development of both this and the e-health process very carefully. We believe there are very strong reasons why we want to go to an e-health process, but there are concerns that need to be addressed. In supporting this we are saying that, yes, we support this first step but we have some concerns. We want to work through the e-health process very carefully and understand people’s particular concerns about privacy. If people are concerned about the privacy of their electronic records, they may actually be deterred—for specific illnesses—from seeking health care, and that is a very strong concern for us. We need to make sure those provisos are there. I move:

At the end of the motion, add:

                 but the Senate calls on the Government to ensure:

             (a)    the involvement of key healthcare stakeholder groups, including state and territory governments, private and community health providers, and healthcare consumer groups, in the development of a Healthcare Identifiers Service implementation plan which covers the period from now to 30 June 2012;

             (b)    the publication of this plan for public comment prior to its finalisation; and

             (c)    the development and implementation of a targeted education and communication strategy which targets both healthcare providers and healthcare consumers, and which clearly lays out the facts behind healthcare identifiers and provides contacts for people to access further detailed information. This strategy should be implemented prior to the Healthcare Identifiers Service coming into effect and no later than 30 June 2012.

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I can do nothing but reiterate the comments of Senator Fierravanti-Wells and Senator Siewert about the bizarre and quixotic way the government has gone about attempting to bring this legislation in. After lunch today, this legislation was not on the list, yet Minister Roxon has been lecturing the coalition for months now about how we needed to get our act together to get this legislation through. In terms of getting one’s act together, I do not think I have seen any thing more bizarre than today’s activities. The government did not have this on the list; now the government has it on the list. As I understand it, the identifier system that this legislation will support is supposed to start operating on 1 July. It cannot do that without this legislation. We are now informed that the House of Representatives, where the government has the majority, is about to stop sitting, or has stopped sitting, and therefore this legislation cannot go back to them to be passed in time for it to start on 1 July. I have subsequently been told by Senator Siewert that this legislation is now not supposed to start until 1 October. Can we get this right? I continue to be bemused by Minister Roxon’s pathetic efforts to get legislation through and her attempts to blame us for it. I would like to read to the Senate a line from an article by Karen Dearne in the Australian on 1 June. She said:

One month out from the start of the Rudd government’s mandatory Healthcare Identifiers regime, Medicare is yet to sign a contract for service delivery.

They had not signed up the service deliverer a month out from when they said the only thing stopping this from happening was the opposition’s opposition. What complete and utter garbage! In any other organisation the current health minister would be out of a job in 10 seconds. She is the implementer from hell. Given the record of this government, she will probably get a promotion. Implementation is certainly not high on their agenda, and the way that they have gone about this is even more hopeless.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

Nurse Roxon might become Dr Roxon!

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

That is true. I certainly think that this effort will probably earn Minister Roxon a very, very big promotion, given that implementing successfully is a black mark against you in this government.

The coalition has long had a supportive attitude to e-health. Ten years ago we began the process of getting Australia an e-health program. The groups that will particularly benefit from this are people with chronic illness who need frequently to go to doctors and specialist for tests and who need frequently to tell their health professionals what has been done. In the end, this program is the first step towards a system which can be automatically brought up on their computer. We are currently in a situation where this cannot now proceed from 1 July. This is entirely in the hands of the government and Minister Roxon. Even if it were to proceed, there is absolutely no confidence anywhere that it is going to work. As I said, a month out, Medicare had not been signed up as the contract service provider.

During estimates, I asked questions on this area. In early June NEHTA, the National E-health Transition Authority, had finally managed to get itself sufficiently sorted out to invite medical software companies to tender and to get involved in the process of providing the software. On 6 June they had signed up three companies out of a potential 200. Had the trials happened? No. We kept being told that NEHTA had trialled the identifier systems with Medicare in a practice environment but there had been no real testing. Yet every medical software developer in the country has said, ‘You’ll need at least six months of live testing to have any confidence that what you are going to do will work.’

In the middle of this we already have concerns about Medicare wrongly sending out information, wrongly advising GPs of tests and getting the current Medicare numbers confused, let alone using a system that is meant to be more sophisticated than they currently have. I want to give you a sense of the size of this. I asked for an idea of what was going to be involved. The list goes like this: 100 million GP consultations, 100 million GP prescriptions, 200 million medications dispensed, 40 million GP pathology requests, 60 million pathology reports to GPs, 10 million GP imaging requests, 10 million imaging reports to GPs, eight million GP specialist referrals, and eight million specialist reports to GPs. That just begins to give you the scope of what this system is designed to deal with.

They cannot get themselves to stay long enough to get their own legislation through. They cannot get their medical software industry consulted in a timely fashion. Why would we believe that they could ever implement this system correctly? We agree with the Pharmacy Guild and the AMA that we should just get on with this. If there are problems with it, let’s fix them and just get on with passing this legislation and getting the system going. But how can we?

Brett Mason (Queensland, Liberal Party, Shadow Parliamentary Secretary for Education and School Curriculum Standards) Share this | Link to this | Hansard source

This debate is perhaps more important than many honourable senators appreciate. It has long-term implications for our community. Senators more eloquent than I have pointed out the importance of e-health. It will assist in the diagnosis and treatment of illness and it will help patients in rural areas particularly, and it is true that services will be cheaper and, perhaps, more efficient. But there are implications for privacy, and they are fundamental concerns in any liberal democracy. The balance to be struck between the efficient delivery of government services and medical services on the one hand and the right of individuals to keep intimate information private on the other is a difficult one. One of the best examples of this the most intimate of all information: the health record. For example, we have a public figure, a politician, who suffers from depression. We now know that there will be hundreds of thousands of people who will potentially have access to those records. If those records are not absolutely confidential it could, for example, not only destroy the parliamentarian’s career but also potentially influence national security.

These are weighty, difficult and important issues. Whenever a state or government seeks to number its citizens, it bears the heavy onus of showing why that is necessary. As Senator Siewert mentioned, the fear amongst some members of the community is that this bill could provide the architecture for a national surveillance system. All of us would agree that we should never meet the needs of government and administrative convenience and meekly surrender to perpetual surveillance. No government efficiency is ever worth some sort of Orwellian dystopia. Mr Rudd was never quite Big Brother and I am sure the new Prime Minister, Ms Gillard, is no big sister, but all democrats should share a scepticism of enhancing the capacity of the state to monitor and survey its citizens. All of us should share that scepticism, and government bears the heavy onus of showing why it is absolutely necessary.

The purpose of these bills is to establish an individual health identification number for every Australian. Whilst the coalition supports the uptake of important advances in the delivery of contemporary medicine such as e-health, the fundamental problem with these bills is that it is so hard to determine where we are going to go from here. The bills are essentially incomplete. They cover only a small but essential element of a much broader health identification and surveillance system, including future personal e-health records. They leave so much detail to be worked out later on by parliament and administratively, and that is the difficulty. It is very hard to know where the government will go next.

Any data-matching scheme, and these bills contemplate a data-matching scheme, must look at two essential elements. First, who has control over the access to the data, the information or the unique number? Second, what data is linked to that unique number, to that individual health identifier? Both those aspects must be controlled and very closely monitored by the Commonwealth parliament. We must never abdicate our responsibility to another parliament, to a minister or to administrators. That is why I strongly argue that any extension of the use of information or a unique number should be explicitly authorised by the Commonwealth parliament.

Function creep, as Senator Siewert mentioned, is the most significant issue not addressed by government and not sufficiently appreciated in this debate. Under these bills, health information may be disclosed for other purposes not detailed in the bill where that disclosure is authorised under another law. This means that it might be authorised by other Commonwealth, state or territory legislation or regulation. I believe that, where other agencies seek access to a unique identifying number or any information attached to it, access to such information should not be granted automatically by virtue of other Commonwealth legislation or, more importantly, by regulations or legislation passed by a territory or state parliament. This will ensure that the Commonwealth parliament retains direct oversight and responsibility for any extension of the entitlement to access information by government agencies.

The individual health identifier, that number, is a creature of the Commonwealth parliament. No other parliament should be entitled to legislate access for their own instrumentalities. For example, why should the Queensland parliament, the parliament of my home state, be able to legislate access for the Queensland Police Service? Why should they be able to do that? In my view they should not. No-one should be able to legislate for access to this unique identifying number except the Commonwealth parliament. So should access to this unique number be at the mercy of state parliaments or even regulations made by state parliaments? No, it should not. I accept that this number might facilitate administration but this parliament and this parliament alone should decide who has access to this information—not a state and not a territory and not their parliaments. It is as simple as that.

The second issue, and there is progress on this, in any data-matching scheme is that the Commonwealth parliament should explicitly authorise what information or what data is linked to the individual’s unique number. The parliament should explicitly authorise the data that is linked to this number. It has critical implications for privacy. The responsibility for that can never go anywhere other than to the Commonwealth parliament—not to a minister by regulation and not to other parliaments. We have had progress on this issue and I hope that the government will move an amendment to address this issue. I understand they will and I look forward to it.

My friend Senator Fierravanti-Wells has spoken about the appointment of a service operator. To save time I will not go into that. I understand that is being addressed. Guaranteeing the right of appeal I understand is also being addressed and I will not address that either. I understand those issues have been catered for by the government.

The compulsory nature of the scheme means it is compulsory to have a number. Every Australian will have to have a number. I am not happy about that. Ideally, citizens should be able to opt out if they do not want it. But I understand that you will not need to provide a number to supply or to obtain medical services, so this is something that is at least better than it was. I thank the government at least for that.

I conclude with a few remarks which I make somewhat pointedly. With the passage of this bill we have the first essential element of a national identification scheme. For the first time since World War II we will have a unique identification number for every Australian, and we have never had that before. Neither the Medicare number nor the tax file number is universal and none of them is compulsory. My point is that this is a unique identifying number for every Australian. If it is the intention of the government to use these bills and this number as a legislative subterfuge for the introduction of a national ID card, they have got it wrong. I raise it for this reason. The previous government tried to use the argument that to facilitate the access to welfare with a smart card was a good idea.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

We cancelled that.

Brett Mason (Queensland, Liberal Party, Shadow Parliamentary Secretary for Education and School Curriculum Standards) Share this | Link to this | Hansard source

Yes. In fact, I chaired the committee that, without dissent, recommended against the adoption of that scheme. You may remember that, Acting Deputy President Trood. Why? Because that would have led to a de facto national identification scheme and an ID card.

The critical issue for this parliament over the next few months when this debate is fully ventilated will be this: what form will the use of this number take? Will it be a number on a card with a photo? If it is, let me put this on the record. It will become a de facto national identification number. The critical part of this debate that has not been caught today is how the government is going to use this number and how individual Australians will carry it. This is a critical issue for the citizens of this country. If the government is trying to use this to camouflage a broader intention to bring in an ID card or some such thing, they should think again. If there is an attempt by any government to extend access to this unique number beyond health professionals, or to expand the data to be collected beyond patient records and health matters, or to use the unique number as part of a de facto ID card, this debate will erupt. It will not be like a nice calm debate on the last Thursday before eight weeks without sittings; this debate will erupt. To any public servant, any doctor, any lobbyist or any politician who thinks that these bills are the first step towards greater surveillance of our citizens, I say they should think again. Like Big Brother, all of us will be watching.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I thank senators for their contributions to the second reading debate on this the Healthcare Identifiers Bill 2010. I also categorically rule out the bill being used as a national ID card—

Brett Mason (Queensland, Liberal Party, Shadow Parliamentary Secretary for Education and School Curriculum Standards) Share this | Link to this | Hansard source

It is de facto.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I am happy to add ‘or a de facto national ID card’. I am advised that it is even specific within the legislation itself.

Brett Mason (Queensland, Liberal Party, Shadow Parliamentary Secretary for Education and School Curriculum Standards) Share this | Link to this | Hansard source

But that does not stop it from being used de facto.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I have categorically ruled it out, as I am advised. I also table a replacement explanatory memorandum relating to these bills.

Question negatived.

Original question agreed to.

Bills read a second time.