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

The National Health Reform Amendment (National Health Per­formance Authority) Bill 2011 proposes to establish another new authority, the National Health Performance Authority. It introduces amendments to the National Health and Hospitals Network Bill 2010, only passed in the other place on 21 March. The Health and Hospitals Network Bill establishes the Aust­ralian Commission on Safety and Quality in Health Care as an independent statutory authority. If enacted, this bill will amend the National Health and Hospitals Network Bill 2010 by changing its title to the National Health Reform Act 2011.

Despite all this bureaucracy, we have still further legislation to come, which will establish a third statutory authority, the Inde­pendent Hospital Pricing Authority, which is currently the subject of a Senate inquiry. This legislation is part of the so-called health reform process so loudly touted by former Prime Minister Rudd and health minister Roxon on their magical mystery tour of hospitals, complete with blue scrubs. From memory, it went for months and months and months, but it fell in a heap when the current Prime Minister knifed the former Prime Minister, so that the health reforms so sol­emnly promised by Mr Rudd and then Ms Gillard ended up as a new accounting system announced on 2 August. Four years after it was promised, the 'health reform' was a deal that was more about money than about better health outcomes for patients. The chairman of the Australian Health Care Reform Alliance, Professor John Dwyer, summed it up to the ABC as 'a reform package in a financing/accounting sense rather than a system sense'.

The Prime Minister capitulated and gave the states billions of dollars so she could appear to be achieving something. In her year of decision and delivery, we have a health deal that will deliver something—maybe—in 2014 at the very earliest. This is what we have seen this year, her so-called year of decision and delivery: guarantees on elective surgery waiting times and emergen­cy department treating times have become targets; promised private hospital treatment has disappeared; penalties for poor perform­ance have been dropped; rewards have become up-front payments; and states have become the gatekeepers for the much hyped National Health Performance Authority.

Mr Rudd claimed in 2008 that an increase in funding in health could support an additional 3,750 beds in 2009-10. This number was to grow to 7,800 by 2012. The reality is far, far different. The State of our public hospitals report in 2010 reported an increase of only 11 measly beds across Australia. Mr Rudd and Ms Roxon promised that there would be no further bureaucracy in the health sector, but this bill introduces a new bureaucracy, the first of two new authorities with their attendant boards, secretariats and associated staff.

When the initial bill was introduced last year, the coalition called for the government to provide all provisions to establish all these bodies at the one time so that we could see the full intent of the government and the interaction between these bodies. But, as is usual for the health minister, we have a piecemeal approach of bill after bill and amendment after amendment, with all the attendant risks of poor outcomes as this minister tries to get it right.

It is worth recounting the history relating to this bill, this authority it creates and the warnings and concerns that have been loudly sounded. It is yet another outstanding exam­ple of the ineptitude of this government. When the health minister introduced the initial bill in September last year, as is the case with virtually anything this government attempts to do in health, it was described as historic and delivering on the government's health reform agenda. Of course, the so-called reform agenda was somewhat differ­ent back then. These were the Rudd-Roxon reforms for a hospital network that would be funded nationally and run locally. At that time, the now Prime Minister, Julia Gillard, was still on board with Kevin Rudd's reforms, telling the Committee for Economic Development of Australia in November last year that:

From July 1, the Commonwealth's share of hospital funding will increase to sixty per cent. … GST retention and dedication to health care will commence.

But, like so many of this government's promises, that of course did not come to pass. Earlier this year Julia Gillard uncerem­oniously dumped the Rudd clawback of GST, and the commitment to be the major funder of public hospitals has now become only a commitment to provide around 40 per cent of public hospital funding.

Yet in last year's election campaign the Prime Minister also stated:

I regard health care as one of the greatest responsibilities of any government. … If my government is returned to office on August 21, I will pursue our national reforms until the job is done.

We all know that standing by commitments and promises to the Australian people is not a high priority for this Prime Minister or her government. Of course, the same Prime Minister who spoke the famous words 'There will be no carbon tax under a government I lead' yesterday introduced 18 carbon tax bills that will add cost burdens to generations of Australians. Reform, in the form of this bill, follows the classic Labor path whereby 'reform' means creating another bureaucracy on top of the layers upon layers of bureau­cracy.

The National Health Performance Authority is to be charged with monitoring and reporting on the performance of Local Hospital Networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services—an incredibly wide-ranging brief. Unfortunately, the bill provides absolutely no performance indicators that the proposed authority would monitor and report upon. The government controlled House of Repre­sentatives Standing Committee on Health and Ageing held an inquiry into this bill. There was one extremely brief public hearing for the Department of Health and Ageing to answer seemingly one question. A report from the committee was tabled with just one recommendation, that being for the House to pass the bill with a minor amend­ment requiring an annual report to parlia­ment. Given that submissions to the inquiry outlined serious reservations regarding this legislation, coalition members presented a dissenting report stating that it would be unwise for the House to pass the legislation until stakeholder concerns were addressed. The dissenting report noted that there are far too many unanswered questions about the National Health Performance Authority and that the house should not debate the bill until the government clarifies matters. It also noted that a number of stakeholders who wanted to contribute to the inquiry were unable to due to the haste with which the inquiry was conducted.

So it is worthwhile looking in some detail at what some of the stakeholders said about this legislation. The Australian Medical Association, for one, has called for the legi­slation to be deferred, wanting an assessment of the impact of the legislation and detail of what data must be provided to the authority by health provider organisations. The exp­lanatory memorandum to this legislation states that its measures will have no regula­tory impact on business or on individuals. The AMA bluntly responded:

We do not believe this is a true statement.

The AMA is concerned that smaller private hospitals and medical practices will not be able to cope with some as yet undefined data collection. The AMA wants the data that is to be provided to the new authority to be included in a disallowable instrument and to be made publicly available prior to the passage of this bill through parliament. It expresses concerns that the legislation does not provide any information on the interaction between this proposed authority and the Australian Commission on Safety and Quality in Health Care, established in the prior legislation, or the proposed Inde­pendent Hospital Pricing Authority. This stakeholder wants consultation about what the authority will do. It wants open and transparent processes. It wants accountability to parliament.

The Consumers Health Forum of Austra­lia is another stakeholder wanting more information on the areas of performance to be assessed by this proposed authority. Its submission states:

… we consider that it is appropriate, and indeed necessary, for the legislation to outline at least a minimum scope for the areas of performance to be assessed by the Performance Authority.

Among other numerous concerns, at another point it says:

CHF would like to see more detail about the functions of the Performance Authority …

Consumers Health Forum also wants greater safeguards for patients in relation to inform­ation the authority may gather and release. Clarity, transparency and scrutiny are aspects that recur through stakeholder submissions.

The Australian Private Hospitals Association has concerns that this new authority will simply add 'yet another layer of compliance burden for both the public and private hospi­tal sectors'. Its submission to the inquiry stated that any national data collection must replace the current system of multiple reports to multiple government agencies which it says place 'a significant regulatory compli­ance burden' on private hospitals. The associ­ation argues for real reform, but it too wants scrutiny of the data that hospitals may have to provide to this proposed authority. It also says that when that data set is decided upon it should be presented to parliament as a regulation so that, as their submission says, 'it may be properly and publicly considered'.

The bill was also the subject of a Senate committee inquiry. The submissions to the Senate inquiry raised even greater concerns about this bill. The Royal Australian College of General Practitioners warns that the provisions of this bill hold long-term threats to 'harm the current high standard of medical services, and consequently health services, delivered to the community'. Catholic Health Australia held similar worries. In its submission to the Senate it stated:

The legislation as currently drafted is very broad—indeed vague—on the scope, range and detail of data that will be required to be submitted.

It wanted to see details set out in regulations as this would enable parliament to exercise oversight. It said such detail was needed to avoid 'unintended consequences' and that the authority should 'not result in health services unduly focusing on particular performance indicators to the detriment of their overall performance.'

Apart from those overriding issues, stakeholders found myriad problems with this bill. The College of General Practition­ers was concerned about virtually every aspect of the proposed performance authori­ty, from its composition to its functions and powers, its independence and its relationship to the other authorities this government has and is proposing to establish. A body with such wide-ranging reach over every aspect of health care, the college submitted, should draw on expertise from all sectors, yet the only specification for the make-up of the authority in this legislation is that one of its members must have experience in rural health. The college pointed out that it was unclear whether general practice will be monitored by the authority, and clarity is needed on the issue. It fears that if general practice is to be monitored then onerous data collection and reporting requirements could be imposed on already overworked and overstretched general practitioners and subtract from their capacity to deliver services to communities. Finally it noted that there is a 'significant overlap between the roles and functions of this authority and the Australian Commission on Safety and Quality in Health Care'.

Catholic Health Australia echoed many of those points, also calling for 'clarity' on the role of the authority noting that the Austra­lian Commission on Safety and Quality in Health Care, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics already collect data on hospitals and health services. CHA also wanted the legislation drafted in such a way that the governance arrangements of the authority would reflect the make-up of Aus­tralia's health system and therefore would have members with knowledge of public and private hospitals, primary health care and private or non-government healthcare provision.

The Australian Institute for Primary Care and Ageing also raised significant issues with the 'functional overlap' between this authority and the already operating Austral­ian Commission on Safety and Quality in Health Care, overlap that would 'place a substantial administrative burden on indi­vidual health services'. Its criticisms noted that there was 'no objective for the perform­ance authority itself and the bill provides only a list of its functions'. In response to the minister's past rhetoric about the importance of this new bureaucracy, the institute stated:

… it is difficult to see how the Bill will create the 'backbone of a modern, integrated, high-performing health system' when the Bill itself does not appear to be integrated.

A submission from the Council for Proce­dural Specialists queried the very need for the authority proposed by this bill. It said it could find 'no justification or compelling case as to why it needed.' It submitted that Australia already has an independent major national agency to provide reliable, regular and relevant information and statistics on Australia's health and welfare—that is, the Australian Institute of Health and Welfare. It said it had 'concerns about the agenda, nature and ultimate purpose of this new agency' and said 'the establishment of a new authority may have a wider purpose than that which is currently being outlined.' So we have these recurrent themes throughout many of the submissions to both the House and the Senate committees—namely that there is a lack of clarity about this legislation and the authority it will establish, vagueness about what it will do, a lack of goals and object­ives, concern about duplication with other new agencies this government is establishing and with existing agencies, worries about the administrative burden being placed on health service providers and concern about the composition of the authority board.

In assessing stakeholder commentary on Labor's so-called health 'reform', researchers in the Parliamentary Library found that many of the concerns raised by stakeholders were pertinent. In fact, the Bills Digest to this legislation raises more questions than it answers. Let me just take some of the issues raised in the Digest. It points out:

It is unlikely that the Authority, as a single entity, will be able to achieve these objectives ...

This Bill does not provide any details on how the three national governance agencies will work together to deliver improvements in the Australian health system ...

It is not yet clear how the ‘upstream’ National Health Performance Authority proposed in this Bill will connect with ‘downstream’ factors, namely health care providers ...

This Bill ... does not give the Authority any enforcement powers; it cannot compel state and territory governments, private and non-government organisations to provide performance data, and it cannot compel individual providers to make changes that will lead to better performance ...

It is unclear how many primary health care providers will be monitored directly by the ... Authority ...

The frequency of reporting by the National Performance Authority is not specified in the legislation ... the ... Authority is reliant on the goodwill of ... organisations to provide information ...

Currently, the proposed legislation is silent on the arrangements for private hospitals ...

... the lack of any specific provision regarding private hospitals in the ... Bill ... highlights the jurisdictional limits of the Commonwealth.

In its conclusion, the Digest makes some further interesting points, again echoing the concerns of stakeholders, that this 'legislation does not appear to reflect the initial remit of the authority except in very broad terms'; that 'there is a lack of clarity about the role and function of the authority' and that what the minister outlined as that role in her second reading speech 'differs to what has been previously outlined by the government.' The Digest concludes:

This lack of detail combined with the lack of power attributed to the Authority raises questions about the extent to which the Authority can achieve its objectives as set out in the Bill ... or as articulated by Government.

In other words, this was a totally flawed piece of legislation which should not be before this parliament and the amount of amendments presented today clearly high­lights that fact. The Australian Healthcare and Hospitals Association publicly expressed concern about the lack of consultation by the federal government with stakeholders in March. In its submission to the Senate inquiry, it stated:

It is clear that the legislation fails to recognise the formal role of state and territory governments as majority funders and system managers of public health services including overall responsibility (statutory and political) for the performance of LHNs—

local hospital networks—

public hospitals and state and territory primary health care services.

The West Australian Premier, Colin Barnett, made exactly that point in a submission to the Senate inquiry by stating:

I believe the Commonwealth has gone beyond what is contemplated as the role and function. of the National Health Performance Authority in the Heads of Agreement I signed at the COAG meeting on 13 February 2011.

The Premier points out that the authority is being established on the basis of a joint agreement at COAG, yet the provisions of the bill would allow the Commonwealth minister, without consultation with the states, to extend the functions of the authority. That, the Premier said, was unacceptable to Western Australia. The Victorian minister apparently expressed similar concerns in a letter to Minister Roxon.

The government is establishing a new bureaucracy so that the demands on health services, hospitals and other providers to provide this data will be immense. The coalition will be moving an amendment. We believe that the burden is unchecked and we will be moving an amendment which will at least allow an independent assessment of the size of the task and of how much extra red tape will be created in the first 12 months. In my concluding remarks, I say that this is so typical of everything that has happened in health and in so-called health 'reform' by first Mr Rudd and now Ms Gillard in relation to this whole sad and sorry saga that has been health reform in this country. In the end it is very, very clear that, despite the promise that there would not be additional bureaucracy, all this is doing is creating more and more layers of bureaucracy, with more bureaucrats in Canberra, and not providing beds. This has become a debacle.

Debate adjourned.