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COMMUNITY AFFAIRS LEGISLATION COMMITTEE
(Senate-Thursday, 24 February 2011)
FAMILIES, HOUSING, COMMUNITY SERVICES AND INDIGENOUS AFFAIRS PORTFOLIO
Department of Families, Housing, Community Services and Indigenous Affairs
Ms S Wilson
Equal Opportunity for Women in the Workplace Agency
Senator CAROL BROWN
Department of Families, Housing, Community Services and Indigenous Affairs
Ms S Wilson
- Department of Families, Housing, Community Services and Indigenous Affairs
HUMAN SERVICES PORTFOLIO
Child Support Agency
Senator CAROL BROWN
- Child Support Agency
- FAMILIES, HOUSING, COMMUNITY SERVICES AND INDIGENOUS AFFAIRS PORTFOLIO
Content WindowCOMMUNITY AFFAIRS LEGISLATION COMMITTEE - 24/02/2011 - HUMAN SERVICES PORTFOLIO - Medicare Australia
CHAIR —We will now move to questions for Medicare. I believe Senator Fierravanti-Wells has questions in this area.
Senator FIERRAVANTI-WELLS —I wanted to start with some questions in relation to the problems with AHPRA and the registration issue. I am not sure if any of the officers were watching the estimates with Health and Ageing when we discussed this issue. At those estimates I was referred to Medicare for statistics, so I will ask you a series of questions, most of which you will probably take on notice. How many patients across Australia were denied Medicare rebates as a consequence of the problems that AHPRA had with registration?
Ms Kruse —We do not have the figures regarding medical rebates where they have been denied. They are very difficult to find. It is hard to know that they were denied because of that particular issue.
Senator FIERRAVANTI-WELLS —Let me take the issue from another angle. Deregistered doctors cannot treat patients. From our perspective, we have been advised that Medicare had been contacting doctors to tell them that they were deregistered and should not be treating patients. Can you tell me about that aspect of it?
Ms Kruse —Certainly. We receive information from AHPRA. That information comes in twice a week on a Tuesday and a Thursday. If there are any doctors that have not registered and we have been notified by AHPRA that we need to deregister them, we send a letter to them to inform them of the case. We make two phone calls to alert them to that. We do not necessarily always get on to them both of those times, but we certainly endeavour to do so. That is to alert them that they will be deregistered and it is also to inform them that they cannot claim medical rebates while they are deregistered.
Senator FIERRAVANTI-WELLS —When did you start doing this? This has been a problem, basically, since the new national scheme started in July.
Ms Golightly —This is a normal process that happens all the time. Previously it would have been the state registration boards that would have been notifying us. This is a normal thing.
Senator FIERRAVANTI-WELLS —The other evening we talked about figures of five to 10 per cent in terms of a normal figure, if I can put it that way. Ms Kruse, is that an accurate assessment?
Ms Kruse —I would not like to say. All I can say is that, at this stage, we could get the figures for you.
Senator FIERRAVANTI-WELLS —Please take them on notice. In that case, can you give me some statistics in relation to the normal processes of deregistration that happen in the normal course of events, and the figures that have occurred since July so that we can make a comparison?
Ms Golightly —Yes. We can take it on notice, but my information is that we have not experienced any increase.
Senator FIERRAVANTI-WELLS —I am concerned about those practitioners, and I am talking practitioners across all streams. W are not just talking about doctors, we are also talking about other medical professionals whose services attract Medicare. I am concerned about their registration having been interrupted. What happens to that person? Their registration has been interrupted as a consequence of this problem. What goes on their deregistration documents? Do you understand the concerns that we were trying to raise the other evening?
Ms Golightly —Perhaps I can give a bit of general information and Ms Kruse can follow up. The reason Medicare Australia is involved is their registration is needed in order for them to be able to claim Medicare benefits. AHPRA, and others, deal with their registration for other reasons. That is the reason we are involved. In us deregistering it is about whether they can access Medicare benefits. We do not necessarily deal with all of the professions that you just mentioned, but we deal with a lot of them. That gives some general background just to clarify the context of our work. Ms Kruse can add to that.
Ms Kruse —When a health professional is deregistered, if we produce numbers, the numbers may not necessarily reflect the real number. There may not be as many deregistered as the number says. I might get a feed of information in today that might say the number of doctors or health professionals that need to be deregistered, but some time through that passing it could be that that health professional has reregistered. Whilst it might show up today, in two days time when we get the next feed through it might say that this health professional has been reregistered. If we just counted the numbers we may not get a true reflection because that actual person may have been reregistered.
Senator FIERRAVANTI-WELLS —Let us take it from the other angle. Can you give me information in relation to patients who have had their Medicare rebates refused?
Ms Golightly —No, because they can be refused for any sort of reason, just as medical professionals can be deregistered for any sort of reason.
Senator FIERRAVANTI-WELLS —So you have had this problem with the registration, but you cannot distinguish rebates that have been refused?
Ms Golightly —What we are saying is that we have deregistrations as a normal part of our business and we can give you figures on how that is going, as you requested, over a period of time, but to then go to that next level, which I think you are asking for, is the bit that we will not be able to do.
Senator BOYCE —Are you able to break them up by where rebates are refused? Do you categorise those at all?
Ms Kruse —No. We do not say it was because the doctor was deregistered or whatever the reason was.
Senator FIERRAVANTI-WELLS —Say you have a patient who has gone along and then his or her rebate has been refused and the registration of that doctor subsequently is rectified, what happens to that patient? What can that patient do?
Ms Kruse —If the health professional was deregistered and there was a time lag due to being in the mail or whatever, then when AHPRA receives that registration they inform us of what date to reregister them at. If the patient has tried to receive medical benefits during that period that the doctor has been registered back in there, they can then resubmit their claim and it will be paid.
Senator FIERRAVANTI-WELLS —As a result of the chaos that has ensued as a consequence of this registration problem that AHPRA has had, have you taken any steps to inform members of the public that may have been affected? Have you taken any action to inform prospective people at Medicare?
Ms Golightly —The issue here is that if the—
Senator FIERRAVANTI-WELLS —For example, what will happen when somebody who has their rebate refused is at the counter? Do you say to them, ‘Your doctor has been deregistered. Come back if they become reregistered.’ How will that person know if they can come back?
Ms Kruse —I have to say that we are not getting these series of phone calls or complaints any more than we would normally get for the registration process. We are not going to an unusual area.
Senator FIERRAVANTI-WELLS —You cannot tell how much of what is happening at the moment. You said to me before that you cannot say that it is one way or the other. My point is that obviously patients and persons who are entitled to a Medicare rebate for a particular service are inconvenienced as a consequence of a registration issue. How do you, in the normal course of events, deal with that person?
Ms Golightly —As it is a normal course of events, I will take on notice what our normal script is. The medical professional could have been deregistered for any reason, including choosing, themselves, not to register. I will take on notice what our normal script and advice is that we give over the counter.
Senator FIERRAVANTI-WELLS —Have you contacted some practitioners or medical professionals as a consequence of the problems with AHPRA?
Ms Golightly —What we mentioned before is that as AHPRA lets us know, we let the medical professionals know. I am also aware that AHPRA has been contacting medical professionals as well.
Senator FIERRAVANTI-WELLS —So it is only after AHPRA has contacted them as well?
Ms Kruse —No. AHPRA send the information to us. As soon as we receive that information we send a letter immediately and we call them twice.
Senator FIERRAVANTI-WELLS —Did you not just say that in this instance AHPRA has also been doing it?
Ms Golightly —I can check, but that is what we do.
Senator FIERRAVANTI-WELLS —As a consequence of this?
Ms Golightly —No. I think it is the normal part of its business of letting people know how to register.
Senator FIERRAVANTI-WELLS —Have you had some contact with practitioners in relation to concerns around the registration? Can you put a figure on that, or is it anecdotal?
Ms Golightly —We can check, but I am not aware that any have contacted us with concerns.
Senator FIERRAVANTI-WELLS —Senator Boyce asked in relation to the streams. Do you have deregistration statistics in terms of a breakdown of professionals, in the categories of profession?
Ms Kruse —We could, but, as I said, the deregistration statistics may not really reflect the true number because they could be reregistered at another time.
Senator BOYCE —What is the general level of refusals of rebates?
Ms Golightly —I do not have that here. I took that question on notice.
Senator FIERRAVANTI-WELLS —That finished my questions on registration. Can I keep going?
Senator FIERRAVANTI-WELLS —I would like some information on Medicare utilisation figures.
Ms Kruse —That is not me.
Senator FIERRAVANTI-WELLS —I might say the areas where I have questions. I have questions regarding Medicare provider numbers and a question on the Medicare provider number legislation, some general billing questions and then the dental program. Ms McNally, you have details in relation to the location of the 64 GP superclinics that the government has announced at various stages in recent years?
Ms McNally —No. I do not have that information with me. I could take that on notice.
Senator FIERRAVANTI-WELLS —Yes. Do I have to give you a list of the 64 or can you procure that?
Ms McNally —I can procure that.
Senator FIERRAVANTI-WELLS —For each of the locations where these GP superclinics are—and there are only eight that are operational—can you tell me what the Medicare utilisation level is for each of those locations?
Ms McNally —We would not have that information readily available. We would have to run a query to provide that level of information.
Senator FIERRAVANTI-WELLS —I will ask the questions and then I will let you deal with them appropriately on notice. Can you give me the average Medicare utilisation level? Do you have that statistic?
Ms McNally —We can take that on notice.
Senator FIERRAVANTI-WELLS —I can then ascertain whether the utilisation level for each of those is above or below the national average. In relation to each of those 64 GP superclinic locations, can you tell me what the level of safety net benefits is as well and what the national average of safety net benefits is for each of those? Can you take that on notice?
Ms McNally —Yes. One of the issues around providing that kind of data is that we have to run it on a postcode basis, so, in terms of where the services are delivered, people may come from other areas outside the actual postcode.
Senator FIERRAVANTI-WELLS —I appreciate that it will come to me with that qualifier and you will state that it is put on that basis. Those are my questions in relation to Medicare utilisation. In relation to Medicare provider numbers, obviously without identifying any individual medical practices or any individual medical practitioner, how many Medicare provider numbers have been issued in total to the nine GP superclinics that are operational? Do you have that?
Ms McNally —No.
Senator FIERRAVANTI-WELLS —Will you take that on notice?
Ms McNally —Yes.
Senator FIERRAVANTI-WELLS —And also could you provide the remaining 27 GP superclinics from the 2007-08 election commitment, which are still not operational, and the 28 GP superclinics which are the 2010-11 commitments? Could you also take on notice how many of the provider numbers that I have referred to have been issued to medical practitioners who are recognised as general practitioners by Medicare Australia? How many services have been billed to Medicare against the provider numbers and how many services have been billed to Medicare against the provider numbers issued to medical practitioners who are recognised as general practitioners by Medicare Australia? Do you understand that?
Ms McNally —Yes. We will take those on notice. Again, we will have to add some qualifiers if that happens to identify individuals.
Senator FIERRAVANTI-WELLS —By all means. I did make that qualifier: without identifying any individual or any individual medical practitioner. Are you aware of the report 2010 Review of Medicare provider number legislation of December 2010?
Ms McNally —Yes. That is Health and Ageing.
Senator FIERRAVANTI-WELLS —So any questions in relation to this I need to direct there?
Ms McNally —To Health and Ageing.
Senator FIERRAVANTI-WELLS —In relation to the recommendations and whether they have been fully implemented?
Ms McNally —That is correct.
Senator FIERRAVANTI-WELLS —We will detail those through Health and Ageing. I have a few final questions. What areas of Medicare billing are expanding most rapidly? Can you give me the number of billings and dollar value? Is that something—
Ms McNally —I will take that on notice.
Ms Golightly —Do you mean the type of service?
Senator FIERRAVANTI-WELLS —Yes. What is on the rise and what is on the decline.
Ms Golightly —Certainly.
Senator FIERRAVANTI-WELLS —Could you tell me about how the uptake of the government’s Teen Dental Program is going nationwide?
Ms McNally —In our annual report on page 29 we reported that in 2009-10 Medicare Australia processed approximately 423,000 services and paid more than $63 million in benefits.
Senator FIERRAVANTI-WELLS —Do you have a breakdown across different jurisdictions across states?
Ms McNally —I would have to take that on notice.
Senator FIERRAVANTI-WELLS —Would you take that on notice. Also in relation to the Senior Dental Program, could you give me some information in relation to the levels of uptake? Please take that on notice, if you could, and if you could also indicate to me whether you are aware of any inappropriate access to both these items? Finally, could you provide me with a list of Medicare items that have been removed or cancelled in the last financial year?
Senator BOYCE —I may not be asking this in the right place, but could we put it on notice? What is the number of individual health identifiers issues in the three categories by Medicare?
Ms Golightly —The three categories being individual, organisation and professional?
Senator BOYCE —Yes.
Ms Golightly —We might have that information here.
Ms Briggs —Identifiers have been assigned to 23.5 million individuals. On top of that—
Senator BOYCE —Does ‘assigned’ mean they actually have them and know they have them?
Ms Briggs —‘Assigned’ generally means behind the scenes health—
Senator BOYCE —Discreet?
Ms Briggs —That is exactly right. Approximately—
Senator BOYCE —Sorry, could you give me that figure again?
Ms Briggs —It was 23.5 million people.
Senator BOYCE —That is how many there will be, though, rather than how many there are. I know you are using the word ‘assigned’ but—
Ms Briggs —Very carefully, yes.
Senator BOYCE —how many people have actually gone on the website and done something about this?
Ms Briggs —I do not know that figure.
Ms Golightly —We can get you a figure there, but the reason they would go on the website is basically to look up their number. There is nothing to do with it, if you know what I mean.
Senator BOYCE —I am also wanting to know not only the fact that everybody has one but also what level of interest there has been in that piece of information to date, so to speak.
Ms Golightly —I do not actually have that particular figure here, but we would be able to get—or we will try to—the number of people who have looked on the website.
Senator BOYCE —The number who have looked up their healthcare number.
Ms Golightly —People can also ring up and come into a Medicare office and ask, so we will see what sort of statistics we can get.
Senator BOYCE —How would a person know that their IHI was activated, so to speak?
Ms Golightly —Everybody’s IHI is there to be used. The issue, as you know, will be what they can be used for as various things are rolled out. The IHI is live and it is there ready to be used.
Senator BOYCE —How would I know, for instance, if someone had looked at my IHI without my knowing?
Ms Golightly —Yes. Part of our responsibility is that we keep a log of who has looked at what, and anybody can ring us at any time or come in and request details of who has looked at their IHI.
Ms Kruse —If you have a Medicare online account you can log on to your Medicare online account. You can see your IHI number and you can also see who has accessed it. If you see on there that a doctor or somebody has had access to your IHI you can ring up and let us know if you do not feel that those people should have had access to it.
Senator BOYCE —Has that occurred?
Ms Kruse —Not to my knowledge.
Senator BOYCE —Again, could you take that on notice, please. This is very early days and not many people have a reason to do anything about their IHI right now.
Ms Golightly —We can certainly take it on notice. I know that a number of people have rung up and/or looked at what their IHI is. I do not know how many have asked for the log, but we can take that on notice and check.
Senator BOYCE —It does not sound like a terribly secure or instant system of knowing—
Ms Golightly —I disagree. As Ms Kruse just mentioned, people can log on to their online account at any time and see the log instantly. It would be pretty much the same if they rang us up, for example.
Senator BOYCE —But in the end we could potentially have 23 million people logging on to check who has logged on every day?
Ms Golightly —Yes, and we have that already because people who have an online account, for example, can now log on every day if they like to look at their other Medicare business.
Senator BOYCE —But they are only transactions they are doing with Medicare really, are they not? They do not involve any external information, if you are following my point? No?
Ms Golightly —I am not sure. But if you are worried about whether the system has capacity, that is not an issue at the moment, if that is your point?
Senator BOYCE —I know the capacity is not yet an issue, but if the only way I can check to see if there has been any unauthorised use of my IHI is to log on—
Ms Golightly —No, that is not what we said. We said that was one way. I also mentioned that you could ring up and I also mentioned that you could come into one of our offices.
Senator BOYCE —But it requires that the individual does the surveillance and that the individual initiates any complaint or inquiry?
Ms Briggs —If I may supplement Ms Golightly’s answer: the IHI system has a full audit log associated with it that Medicare Australia is responsible for and that operates in the same way as our existing systems do. Anything peculiar in the operation of access to IHIs would be floated up through that system.
Senator BOYCE —Is that audit system functioning now in terms of IHIs?
Ms Briggs —Yes, it is.
Senator BOYCE —On notice, would you be able to give any sort of activity report around what, if anything, has come up in that area, please?
Ms Briggs —Yes.
Senator FIERRAVANTI-WELLS —During the inquiry we had into the identifier legislation we did raise issues about inappropriate access and, in terms of privacy, it really was a concern to both Senator Boyce and me, as well as to other senators. Listening to your answer, that somebody can just ring up and check details, I would assume there is some sort of—
Ms Kruse —No, not anybody can ring up. I could not ring up and try to get your number. I would have to identify who I was—
Senator FIERRAVANTI-WELLS —But we were given all these assurances at the time of the hearing, and that there was proof. At the time we did raise questions in relation to previous incidences that had occurred with Medicare and sought assurances that those problems of inappropriate access have been rectified and that the identifier framework would not be subject to and could not be subject to the same sort of inappropriate access. Assurances were given to the Senate—
Ms Briggs —Quite rightly so. We do not want anything that we have said to be misinterpreted. We have taken these privacy matters very seriously. We have worked with the National eHealth Transition Authority and the Department of Health to always act in the best interests of Australians and protect the privacy of their health information and data, which is very precious to us. Where the confusion here might have arisen here was the officials at the table were trying to explain to you that, if you wanted to see personally who had access to information that we hold through the identifier service, you could do so. Part of this approach is very much focused around the individual controlling their health record. We are trying to facilitate that kind of individual control.
Senator BOYCE —This is the EHR?
Ms Briggs —Yes.
Senator BOYCE —Could you give me the other IHI figures as well?
Ms Briggs —Of the order of 400,000 healthcare provider identifiers are registered in the health identifier service.
Senator BOYCE —Again these are there but not—
Ms Briggs —Not all used.
Senator BOYCE —Again, is there a way of telling us how many, if any, are active as yet?
Ms Briggs —I am sure we could do that, yes.
Senator FIERRAVANTI-WELLS —One of the issues that was raised at the inquiry, you would remember, was that because there was a compulsory issuing of numbers to everybody, and you have assigned 23 million, people had objections to having a number assigned to them. I do not want to traverse through all of that. Have there been instances of people who have objected to the fact that they have had this number issued to them? We did canvass that. Maybe it is just early days yet.
Ms Golightly —I am not aware of any, but we can check that for you.
Senator FIERRAVANTI-WELLS —I would not envisage that there would be many. As more and more people—
Senator BOYCE —The vast majority of people do not realise they have one.
Ms Briggs —We have it, but we do not think about ours either.
Senator BOYCE —I have not much reason to have done anything about it just yet, as an individual.
Senator BOYCE —The other figure, Ms Briggs?
Ms Briggs —At this stage only 10 healthcare organisations have been issued with the organisation numbers.
Senator BOYCE —Why is that?
Ms Briggs —There is a reason for that. I just cannot remember it.
Ms Kruse —As the electronic health record work starts ramping up, that is when healthcare organisations will require it. We are working with a number of organisations to work through getting their organisation number, providing all of the identify information—
Senator BOYCE —This is if they have not done the preparatory accreditation or quality control work that is needed?
Ms Kruse —They have certain requirements under the legislation and they have to prove that they are a legal entity and provide that information to us. They have to prove that the person that is going to be managing their organisation is the person they are, and they have an association with that legal entity. We need to make sure all of those documentations are correct.
Senator BOYCE —This is because they have not yet reached the stage of offering that information to you or when they do it is not adequate for your use? I am trying to understand if you have thousands of them who have not done it properly or hardly anyone has done it?
Ms Kruse —No, they are only just starting to go through that process now. There are not thousands of them out there, and there are not lots of people who have given them to us and it has not been correct. It is actually the operation of giving the organisation numbers. Admittedly it is only 10; it is running quite smoothly at the moment. The organisations, like hospitals, are only just starting to get to the thought of actually having to go and apply for one.
Senator BOYCE —How many IHIs in the organisational category are you expecting?
Ms Kruse —The IHIs are for the individual.
Senator BOYCE —Sorry, health identifier numbers for the organisations?
Ms Kruse —How many numbers can we issue for organisations?
Senator BOYCE —How many do you expect would need to be issued?
Ms Kruse —I think they are talking something around 800. I would have to take that on notice. I am not sure.
Ms Golightly —In relation to the privacy concerns, the Office of Information Commissioner has agreed to all of the controls that we put in place, both through input we have had from various people, including the inquiry.
Senator BOYCE —I asked the Office of Information Commissioner about NETA earlier this week.
CHAIR —I now ask witnesses from Australian Hearing to come forward.
Senator SIEWERT —I have had reported to me that some of the very early Cochlear implants are no longer available. So, when the old ones run out, there will no longer be processes to fit that, yet I can clearly remember when we went to visit, as part of our hearing inquiry, that it is technology for life, and these can be retrofitted.
Ms Clapin —The main implants fitted in Australia are made by Cochlear Limited, and they can be retrofitted. The oldest ones of the implanted part of the implant are now over 20 years old and still working. As they introduce new speech processes we upgrade them. I do not think there are any issues that I am aware of.
Senator SIEWERT —I am not mistaken in what was communicated to me, but perhaps there might be some misunderstanding on the part of the people who were talking to me about it. They were concerned that there is a group of people who will no longer be able to use these. There is an issue of cost, and I will refer to that shortly. They were saying that they no longer will be available and be able to fit to the old technology.
Ms Mavrias —It may have related to the actual external part, the speech processor. Some of those have been made obsolete in terms of technology, but Cochlear is still able to maintain the implanted part.
Senator SIEWERT —My understanding was that the implant itself will always be able to be linked to some form of speech processor.
Ms Clapin —Possibly what could have happened is that for some people who had an older speech processor perhaps it could no longer be repaired, and it was their concern that they could not get that model or the parts for that.
Senator SIEWERT —I do not mean to harp on this but, no, that is not what they meant. They meant it was no longer compatible with their implant. I think it is very well known that your speech processors only last for a specific period. In fact, that is one of the issues that came up at the inquiry. The cost of replacing those can be prohibitive for some people. But that is a separate issue to whether the technology is actually compatible fully with the implant.
Ms Clapin —As far as I know it is, and we will take that on notice and confirm that for you.
Senator SIEWERT —If you could, that would be appreciated, because I must admit I was quite surprised. The way it was explained to us, it looked like a really good system in terms of the implant always being compatible with the processor. I do understand the point about processors. In fact, that is the point about this technology; it is getting better and better all the time. If you could take that on notice, that would be great. I want to go to another issue that exercised us quite a bit during the inquiry and continues to be raised with me, and I refer to the issue of hearing devices that do not suit the needs of many people. Therefore, they do not get used and people think that their hearing aids do not work. Various suggestions have been put forward about how to improve that. Have you been asked to provide any advice to the department or to government about a quality improvement process in terms of not the aids themselves but fitting aids that meet peoples’ needs? I must admit I have now had a number of people say to me that they have been fitted by your people but with aids that do not meet their needs, for various reasons. You will know all of those.
Ms Clapin —Yes. Over the years the Office of Hearing Services, which administers the program, has worked to improve the qualifications and standards of the practitioners in the industry, which has assisted in improving all the fitting skills and making sure that the hearing aids are most appropriate for the clients’ needs. We have not been provided with any more recent advice as to specific qualitative improvements that they could make to the program.
Senator SIEWERT —You say ‘not recent’? How long ago in terms of years?
Ms Mavrias —Certainly in the last 18 months we have been in discussions with the Office of Hearing Services. They made a change this year, on 1 July, to introduce a minimal threshold with regards to fitting, and that was an attempt to ensure that hearing aids were being fitted to the clients who will use them and who need a hearing aid. There was industry consultation on that initiative.
Senator SIEWERT —We did have quite a bit of discussion about that initiative. I understand the rationale behind that. It has not solved the fact that people are still talking to me about the fact that there are still issues with regard to service and appropriateness of the devices, whether they are meeting their needs, et cetera. The point that has been put to me—and this came up very significantly during the inquiry—is that this is a significant barrier to people actually using their aids. I will not go through again the details of people putting them in their drawers. You have not been engaged with government since the issues around the minimum threshold were raised in how you can further improve service?
Ms Mavrias —In terms of enhancements, we are certainly open to having those discussions. Australian Hearing takes the approach of looking at outcomes, and that is after our focus around rehabilitation techniques. It is very much focused on looking at the clients’ needs and ensuring that whatever rehabilitation we provide we look at the outcomes and positive things. In terms of the program, we encourage a more outcomes based focus.
Senator SIEWERT —Thank you. I know that I need to pursue that with the department as well, and unfortunately we ran out of time yesterday so I will put some questions on notice for the department. I would like to move on to Aboriginal and Torres Strait Islander hearing and issues around sound fields. A point has been made that you can provide support to Aboriginal clients for hearing aids but still not sound fields. Have you since spoken to government about progress in that particular area?
Ms Clapin —As you know, the recommendations have not been tabled by the Department of Health and Ageing, and we are waiting for those to come out before we can finally plan to progress any of those implementations.
Senator SIEWERT —I will wait for the government’s response to our committee report. Minister, do you know how far away that is?
Senator Arbib —Sorry, I do not have any information about that. I can seek it for you.
Senator SIEWERT —If you could, that would be very much appreciated. How are you going with your funding? Does it meet all of your research needs?
Ms Clapin —Yes. At the moment we are on track with our funding. We are not overspent, and it is meeting our needs.
Senator SIEWERT —When we went out to visit the lab, we saw some very innovative projects. Are you still able to maintain that level of activity? From my limited exposure and knowledge, it is leading edge research?
Ms Clapin —Yes, and they are still maintaining those activities and have some very interesting projects going at the moment.
Senator SIEWERT —When you develop up this technology, can you market that technology?
Mr Grundy —National Acoustics Laboratories, NAL, receives funding to undertake that research. In relation to that research, it is either going into the program or in some cases they are engaged by the CRC trying to take research into the market.
Senator SIEWERT —Can you then invest that back into further research?
Mr Grundy —The funding that they receive from the commercial area is in the form of a grant that covers the cost of developing that research. The majority of funding which covers the cost of NAL is via their grant allocation.
Senator SIEWERT —If you can commercially develop the technology, you can then use that to reinvest in better outcomes—to just the lab?
Mr Grundy —That is correct, yes.
Senator SIEWERT —It goes back into the lab?
Mr Grundy —Yes.
Senator SIEWERT —In terms of engagement with Indigenous hearing and the uptake of devices—I understand that that has been a significant issue. One of the reasons why sound fields would work well is it gets over part of that issue, and I understand the other reasons. Since you cannot do sound fields at the moment, are you able to work with communities in terms of ensuring that devices are used and working with schools, for example, to maximise their use?
Ms Clapin —Yes. When we undertake our outreach programs we work with the whole community. That involves working with the clinic as well as the schools. Generally we have a service level agreement with the community that outlines the aims of our program. We have been successful in increasing the number of Aboriginal children across the country who are wearing hearing aids.
Senator SIEWERT —Do you have that in a quantitative form?
Ms Clapin —In terms of numbers, we have gone from 686 aided Indigenous children up to 905 in the June 2010 year.
Senator SIEWERT —That is the number of children who have received aids?
Ms Clapin —Yes.
Senator SIEWERT —Do you follow up in terms of the use?
Ms Clapin —Yes. With our programs we do not go just once to a community; we have a regular program of visits. Some places we go to once a month; sometimes we go three or four times a year. We will have liaisons and phone calls as well in between those visits so that we can track what is happening.
Senator SIEWERT —Have you done any work with respect to how that is assisting with overcoming some educational barriers in schools? We took a lot of evidence—and I know that you know it—in terms of Aboriginal children’s hearing and that being a barrier when they start school and the negative educational outcomes. Have you been doing any work in looking at that link?
Ms Clapin —We do not have any actual data that will show that by fitting a hearing aid the children have improved in their schooling better than other children or anything like that. We have done a lot of work on the form of the hearing aids so that they are much more acceptable and that the children are happy to wear them and go to school with them.
Senator SIEWERT —Do you think that is one of the reasons you are getting that increase in the number of children wearing their aids and continuing to wear them?
Ms Clapin —I think that is why. We also have had an increase in the number of Indigenous adults whom we have fitted and we think that is also helping. As the children see the adults wearing hearing aids, it is more acceptable.
Senator SIEWERT —When you say you have had the increase, how many adults does that involve?
Ms Clapin —It appears we have gone from 1,601 to 2,544.
Senator SIEWERT —That is good—double. Have you been assisting the government to talk to anyone about looking at how to address the overall issue of improvement in hearing in Aboriginal communities?
Ms Clapin —We have been working with OATSIH and the community controlled Aboriginal health organisations. They have been revamping all of the Aboriginal ear health workers training, and we have been involved in that. We have also worked with the state programs in developing new primary healthcare measures that then help to limit the ear disease burden.
Senator SIEWERT —Just recently in Western Australia—I think it was in December—the Telethon Speech and Hearing Centre did an assessment of the hearing of women in Bandyup Women’s Prison. They found 44 per cent of the Aboriginal women in prison had a hearing impairment compared with 10 per cent of the non-Aboriginal women. Have you been involved in any discussions anywhere in Australia about addressing hearing impairment for prisoners?
Ms Clapin —We are aware that there would be a much higher incidence of hearing loss amongst the Indigenous prisoners. Last year it was clarified that, if Indigenous persons were in prison and were under 21, they remained eligible for our services. So we have been able to provide some services.
Senator SIEWERT —How many services have you been able to provide? I am looking at need versus what needs have been met?
Ms Clapin —The numbers have been small. I do not have the actual number here. We have not actively developed any programs with any of the authorities to seek out those people and actively go out to prisons or anything like that.
Senator SIEWERT —I have a couple of questions around that issue. Could you take on notice how many and in which state? Further, could you be proactive in talking to state authorities around addressing hearing impairments in prisons? Finally, if you could, do you have the funding or do you need the funding?
Ms Clapin —Our role is more of a tertiary-level role. We do not generally take on the role of the screening of people. We provide the hearing aids. It would really be more appropriate for the state authorities to do that screening, and then if the people were eligible, to refer them to us and we could provide the hearing aids. We would be able to accommodate that within our funding, if they are eligible.
Senator SIEWERT —I understand the issue around the screening. That is an issue that I will keep pursuing, because I think the issue in Bandyup highlights the scale of the problem that people have long suspected. Whose job is it then to work with the state to ensure the screening happens? I take your point, and if you are not doing it, who is doing it?
Ms Clapin —We do undertake some educational type activities like that to raise awareness. Yes, it would be within our remit to meet with the relevant state authorities so that they became aware of the problem and could start some screening programs.
Senator SIEWERT —Thank you. That is all of my questions. I will take some of the other questions to the department.
CHAIR —As there are no other questions for Hearing Services, we will end today’s hearing. I thank the officers from Human Services and those who are still here from Hearing Services. We appreciate your patience and your professionalism. Thank you, Minister, and thank you, Hansard and Broadcasting. We now end today’s hearing.
Committee adjourned at 10.38 pm