Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

On behalf of Senator O'Neill, the Chair of the Select Committee on Health, I present the interim report of the Senate Select Committee on Health.

Ordered that the report be printed.

I move:

That the Senate take note of the report.

This is the second interim report of the Senate Select Committee On Health. It covers the activities of the committee in the first half of 2015. I present this report on behalf of our chair, Senator O'Neill, who had been attending a funeral. I am so pleased that you are back, Senator O'Neill, and you may wish to speak as well.

I want to give the Senate a flavour of the work that this committee has been doing. This second report outlines the evidence received to date regarding the government's primary health care and general practice policies, and, in particular, the report will be a record of the government's frequent changes of policy since the 2014 budget.

The report goes into some detail, explaining what I call the chronology of chaos when it comes to what has been happening in the health portfolio of this government. Let us go through it. In May 2014, the budget introduced the $7 co-payment on GP visits, diagnostic imaging and pathology as well as a pause on indexation of some MBS fees. In December 2014, the then health minister, the honourable Peter Dutton, announced that the $7 dollar co-payment have been dropped. In its place the government introduced a package of reforms, including: a reduction of the MBS rebate for short consultation times; a $5 co-payment with certain carve outs; and a four-year extension of the previously announced indexation freeze across all specialist and GP services under the MBS. We all remember what happened then. There was another outcry—a similar outcry to the one that followed the $7 co-payment that was announced in the 2014 budget. The government then, at the end of December, changed ministers. Changing their minister was the answer to the $5 co-payment.

In January 2015, after a concerted campaign from GPs and health consumers, the newly appointed health minister dropped the short consultation policy and the $5 co-payment policy. However, the indexation freeze remained and the minister announced her intention to consult with GPs and other stakeholders in order, she said, 'to come up with sensible options to deliver appropriate Medicare reforms.' The minister also said at the time—and this is of concern to Senator's who sit on this side of the chamber—that consultations will include the need to:

… insert a price signal of a modest co-payment into the health system for those who have the capacity to pay

In other words, this is still the end of Medicare. Let me tell you what Dr Kamerman had to say about what that would mean. Dr Kamerman is a well-regarded doctor from the Tamworth region, from recollection. He told us that because of these changes—the $5 co-payment—he would either have to remove staff from his practice or increase his fees. He said that currently the payment to go to the doctor for a regular consultation was $35 for someone who was not concessional, and he would have to put that up to between $60 and $65.

So again, we have the minister having to respond to outcry in the community. And then in March, while the health minister's consultations continued—with little clarity about what they were actually doing—there were still concerns being expressed about the lack of detail in the government policy direction leading into the 2015 budget. The health minister then announced that the $5 co-payment 'has been taken off the table as it lacks broad support.' I could have told you that myself.

The minister continues to argue that expenditure on Medicare is unsustainable, against all advice from our committee and from what I am sure she hears across her consultation tables. She still insists that Medicare is unsustainable. That goes against all the evidence that we have received as part of that committee.

Minister Ley still insists that we need to put a price on going to the doctor. She said:

It's definitely good policy to put the right price and values signals in health to make sure number one people that people value the service that they get from doctors …

I can tell you now that people do value the service they get from their doctors and they do not need to be told that they have to pay extra for that. And then the budget we have just had in May introduced a broad-ranging review of the MBS items, and that is not a bad thing to do. But there have been some conditions that many, including the AMA, have commented on—'let's review the MBS items, but not as a cost-cutting exercise; let's make sure we make good decisions about which items should be there and what they should be paid for, so that we end up with a quality health system—an even better health system than we have now—but let's not do it just as a cost-cutting exercise'. But again, the four-year indexation freeze remains, and $57 billion is confirmed as being cut from public hospitals. Let us go to the evidence that we have received about the impact of a freeze of four years—and in some cases five years—on MBS items. The research, undertaken by the University of Sydney, indicates that the indexation freeze will cost GPs $384.32 in 2017-18 per 100 consultations, requiring an $8.43 co-payment per non-concessional-patient consultation. The research also shows that the total estimated loss in rebate income to GPs would be $603.85 in 2017-18 per 100 consultations, which equates to a reduction of 11.2 per cent. So we have the situation where either GPs just take a pay cut of 11 per cent—I do not think that is on the cards—or we will see an increase in co-payments—and, frankly, a decrease in bulk billing rates.

The final issue I want to go to in the time available is the broader question about where we are heading with health policy in this country. Where are we heading? It is a confused mess. It is chaotic. It is dysfunctional. And there is real uncertainty in the community and in the health sector about where we are going. Many of the witnesses who appeared before the committee brought this fundamental question to the table. In fact, Alison Verhoeven, CEO of the Australian Healthcare and Hospitals Association, said:

Overall, it is the AHHA's view that the health portfolio continues to have a burning need for strategic vision, for genuine consultation with all stakeholders, and not just a chosen few, and a true partnership with the states and territories and regional health bodes, rather than a penalising approach, in order to deliver what we all want: a healthy productive Australia with healthy contributing citizens.

We want to know where the government is heading. There is no understanding, there is no voicing of the policy and plan for health in this country. We are just lurching from cuts to cuts to unclear advice to the community as to where we are going. That is so evident in what we have seen with the cuts to the flexible funds.

Today, I asked the minister about the cuts to the flexible funds and I used a figure of $800 million. The minister has refuted that. I point the minister to page 16 of our report, where we quote Ms Melanie Walker, the Acting CEO of the Public Health Association of Australia. She explains what happened in the budget lock-up, where the secretary of the department told those who were in attendance—well, he did not give them a figure about how much the cuts to the flexible funds would be. 'We subsequently found out', she said, 'that another $500 million or so' was going to be cut—that is on top of the $197.1 million due to non-indexation. In Ms Walker's view, that is about $800 million. And I concur with her.

I thank the committee secretariat for everything they have done to support the committee, and I commend the committee's Second interim report to the Senate.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to address the Second interim report of the Senate Select Committee on Health. I thank Senator McLucas very much, not only for her wisdom and experience as a member of the committee—particularly with that powerful interest that she has in mental health—but also I thank her for being ready to step in for me here in the Senate today, as I have been attending the funeral of a fine Irish Australian, Bernie Lowe, which was held on the Central Coast at The Entrance today at 11 am. I am very pleased to be able to return and speak to matters that I know would have inspired him to act for his local community. I want to convey my condolences formally on the record to his wife, Isobel Lowe.

Health is such a critical part of the way people interact with their governments. Sadly, we have been recording, over the course of the last six months, the fallout of the government's policymaking on the run. I want to put on the record the words of the President of the Royal Australian College of General Practitioners, Dr Jones, who gave this very salutary warning to the government:

Australian general practice patient services have been unfairly targeted by the government to find savings within the health budget. GPs and practices are now faced with an ethical dilemma of providing ongoing quality care balanced against practice business imperatives. Please remember—

'please remember', he says, pleading with the government—

that most general practices in Australia operate as small businesses.

But the attack that we have seen on the businesses which are our general practices across this country has been absolutely unprecedented. Far from the drama that those opposite attempted to create when they were claiming that Australia's Medicare system was in crisis and threatened to become unsustainable, the Bettering the Evaluation and Care of Health in Australia (BEACH) program report from 2013-14, entitled General practice activity in Australia 2013-14, states:

Australian general practice can reasonably claim to represent world best practice in terms of both cost and patient outcomes. There is ample evidence that preventive and primary care services that are patient-focussed rather than disease-focussed provide the most cost effective health outcomes for those individuals and communities.

That is the evidence base—GPs telling the government that the government are making decisions on the run that are causing chaos and threatening the provision of primary health care across the nation, and the BEACH report, an independent study, saying that Australians get good value per dollar.

But this government cannot help themselves—they opposed Medicare at every turn, and here we are, in 2015, with their best efforts to destroy that very effective system of health access. They have had a few goes as it. And I absolutely concur with the comments of my colleague Senator McLucas who went through the litany of disastrous policy-making on the run that has characterised the health ministers of this government so far.

Can I say: it is a very different approach from the approach that Labor would take. But I do want to go, in particular, to the impact of the decision making of this government to continue a freeze on indexation. The $7 co-payment was so badly received, by a sector that was completely ignored at any point of consultation, that it was overturned by political will, frankly. The second phase of the $5 GP co-payment and the level A and B fiasco were similarly overturned by political will because of the terrible damage that they would do to the system and to those businesses run by our GPs across this country and, through that, to the access of Australian people.

But this government continues to say—and that is why this report is so important—that they want to put a price signal, a gap, between people seeking health and the person who can provide it for them. They want to put a gap between sick and vulnerable people—elderly people, the chronically ill, ordinary Aussies walking around healthy today but sick tomorrow, and children—and the health care they need. They want to send a price signal. It was bad when they wanted to do it themselves up-front, but the way they want to do it now is even sneakier. They want to do it by indexation.

So what does it mean, this indexation? I will use the words of Stephen Parnis, the vice president of the AMA, who indicated that the indexation freeze proposed by this government was a 'co-payment by stealth'. He said:

… irrespective of the model of business that you adopt, when the government component of contribution is fixed at zero per cent while all of the other overheads continue to rise, that means the margin there will diminish. If one is a practice that exclusively bulk bills, it will not take long before that impacts. Inevitably doctors will have to make decisions to change the way in which they bill—effectively, asking patients to make a contribution where the government is not. We believe that bulk billing rates will diminish.

That is what the government's policy is set to achieve—to place that price gap between ordinary Australians and the health care that they need. A freeze on indexation means that those who are providing the service will not have any increase in the provision of that service into the foreseeable future over the forward estimates. And of course as businesses—and, as I said at the very beginning, these GPs are businesses—they will not be able to continue to deliver that service. We have seen and recorded the struggle that GPs are already talking about. How do they discern who can pay and who cannot? How do GPs in poor communities discern who is the rich one that they are going to overcharge so that they can afford to give a basic service to somebody who has no capacity to pay?

We are not just talking about people here who might be on a concession card with carve-outs—because this is the other myth that we have been able to explore in the course of our inquiry. The reality is that there are many chronically ill people who manage their health very well, by attending their GP on a frequent basis and getting the good preventive care that they need, and who are working and paying taxes. There is no proposal from this government to look after the chronically ill—none whatsoever. They are so determined to push ahead with this disastrous proposal.

I want to speak, briefly, in the time that remains, of the threat that this is, and not just to people in the city; I want to record the concerns that were raised with us in the regions. Regions are particularly vulnerable because we know that, in many cases, there might be only one place in which that service is provided. The concerns that are being raised with us are being raised in the states of Queensland, New South Wales and Victoria. They were raised most recently when we were in Broken Hill, in the health minister's own seat of Farrer. And the shameful thing that went on there—and, again, it reveals why this report is so important—is that the CEO of the local health district, albeit a state government employee, sent out an email, which we have recorded, telling his chief executives that, if they were contacted by the Senate Select Committee on Health, they were not to cooperate; they were not to respond. That is trying to hide what is going on—trying to hide every day the shameless attack that this government has been perpetrating, from the day that they came in, against health workers, health providers and health seekers across this nation.

Barry O'Sullivan (Queensland, National Party) Share this | Link to this | Hansard source

Mr Acting Deputy President, I rise on a point of order. The imputation in that delivery by the senator is a very, very serious one. It is suggesting that, somehow, the federal Minister for Health—

Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

What's the standing order?

Barry O'Sullivan (Queensland, National Party) Share this | Link to this | Hansard source

Well, the standing order is—and you can go to Odgers, too; I can give you the lot today, because I have done the research. But Odgers itself talks about improper motives or personal reflections, and this has been attributed, as an improper motive, to the Minister for Health—that somehow she has got some local official engaged to do the bidding of the government, to prevent them from cooperating with a committee of this place! I do not think you could make a more serious imputation on someone's character or personality, and I think you should ask the senator to withdraw it.

Alex Gallacher (SA, Australian Labor Party) Share this | Link to this | Hansard source

Thank you, Senator O'Sullivan. Senator O'Neill, I would just draw your attention to the meaning of the temporary chairs and the President that we are to lift the standard, so to speak, of debate in the chamber, and, if you have made an imputation which you may wish to reconsider, feel free to do so.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Thank you very much, Mr Acting Deputy President, and I did make an effort to indicate that it was a state matter before I made the commentary. But it is, nonetheless, in the federal Minister for Health's seat that we were given a clear understanding of the impact of the decision making and the chaotic announcements of this government on a local GP in her own town of Broken Hill. There has been a 20 per cent reduction in people seeking help from their local GP because they are so fearful of the price signal that this government has created, even as it has had to pull it back because of political pressure. The problem is that people have not been able to go ahead and seek health care when they need it.

Ms Jenny Johnson, the CEO of the Rural Doctors Association of Australia, indicates in our report—and we have quoted this in our executive summary—the complexity of the rural doctor's role:

… a rural doctor who is working in his or her general practice will also most likely be providing visiting medical officer services to the local hospital.

Her comments are very much worth having a look at, as are those of the Australian Healthcare and Hospitals Association, the head of the AMA and the Royal Australian College of General Practitioners. There is one voice decrying this government's policy making in health, and this report gives voice to those critics right across the nation.

Katy Gallagher (ACT, Australian Labor Party) Share this | Link to this | Hansard source

Order! Senator O'Neill, your time has expired.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to continue my remarks later.

Leave granted. Debate adjourned.