CHAIRMAN —I now welcome witnesses from the Department of Transport and Regional Services. Although the committee does not require witnesses to give evidence under oath, you should understand that these hearings are legal proceedings of parliament and warrant the same respect as proceedings of parliament itself. Giving false or misleading evidence is a serious matter and may be regarded as a contempt of parliament. Are there any corrections or amendments you would like to make to your submission?

Ms Ellis —No.

CHAIRMAN —The committee prefers that all evidence be taken in public, but if you wish to give confidential evidence to the committee you may request that the hearing be held in camera and the committee will consider your particular request. Ms Ellis, before we ask you some questions, do you wish to make an opening statement?

Ms Ellis —Ms Kava will make an opening statement.

Ms Kava —The Department of Transport and Regional Services, through its Territories and Regional Support Division, has carriage of the administration of Commonwealth responsibilities in relation to the self-governing territory of Norfolk Island. Under the Norfolk Island Act 1979, the Norfolk Island government has a range of powers and functions broadly comparable to the ACT and Northern Territory. They also have some powers that are exercised by the Commonwealth with regard to immigration, customs and quarantine. Health is a schedule 2 matter under this act, and by this I mean that schedule 2 matters are those over which the Norfolk Island government has sole responsibility. Commonwealth health legislation, including the Aged Care Act 1997 and the Health Insurance Act 1973, does not extend to Norfolk Island.

The department's interest in Norfolk Island health is twofold. Firstly, the department, under its regional services responsibilities, is of the view that people living in rural, regional and remote communities in Australia have a right of access to a level of services, including primary and secondary health care and health insurance, comparable with those of their fellow Australians. Secondly, where practical and appropriate, the department works with the office of the Norfolk Island Administrator and the Norfolk Island government to provide information and assistance and to facilitate liaison between Norfolk Island and relevant Commonwealth agencies that also have carriage for health responsibilities. As a self-governing territory, the Norfolk Island government is always at liberty to approach Commonwealth portfolio ministers and other state governments directly on matters of mutual concern.

Our submission was prepared in consultation with the administrator and the official secretary on Norfolk Island. It drew on a number of reports, complaints to the Minister for Regional Services, Territories and Local Government and other printed sources, and it was cleared with the Department of Defence, the Department of Health and Aged Care and the Department of Veterans' Affairs. The department made its submission to the committee on the basis of concerns held for some time in relation to access by residents and visitors to Norfolk Island to a comprehensive range of health services. Some of these concerns were highlighted in the Commonwealth Grants Commission report on Norfolk Island in 1997. It concluded that, in the area of health insurance and private health care, the standard of government services on Norfolk Island was below that provided on the mainland and that the below standard of service was of particular concern to the less well-off. It also stated that community health services provided on Norfolk Island were narrower than that available in small remote communities on the mainland.

The department's specific concerns against the committee's terms of reference included the lack of preventative health initiatives on the island that have implications for both residents and visitors, visitor ignorance of the health arrangements on Norfolk, the limitations of the Norfolk Island health care scheme, particularly in relation to low income earners, the standard of aged care facilities on Norfolk Island falling short of the standards required and provided on the mainland, access to and cost of health care on Norfolk Island in comparison to the mainland, lack of Norfolk Island residents' access to national health programs and the significant reliance of the Norfolk Island government on the RAAF for emergency medical evacuations, the lack of alternative health insurance coverage for emergency patient transport and the trauma to residents and visitors of the high cost, of the order of $23,000 or more, of evacuation at the time of the medical crisis.

Health is one of the issues discussed at the intergovernmental meetings held between the Commonwealth and Norfolk Island governments. The issue was discussed at some length at the last IGM, held on Norfolk Island in August 1999, in particular in relation to veterans' health, hospital and health insurance and medivacs. The Commonwealth, through the Department of Veterans' Affairs, has recently funded a consultancy assessing the aged care needs of veterans on Norfolk Island which resulted in the report on the visit to Norfolk Island by the New South Wales state Office of Veterans' Affairs, which was August 1998.

The main thrust of the recommendations of this report is to create a community oriented aged care services structure which explicitly attempts to provide all needed support to the aged to enable them to continue living in their own homes with dignity and independence for as long as possible. At the time of the IGM a further Department of Veterans' Affairs delegation visited the island to assess aged and community care needs, to initiate home front assessments and to establish a day care club on the island. The Minister for Regional Services, Territories and Local Government had also written to the Minister for Health and Aged Care in July 1999 seeking his support in exploring options for reviewing Norfolk's current hospital and health services, particularly in relation to health insurance and Medicare matters.

The department had had discussions at officer level with the Department of Health and Aged Care and was developing an options paper which would include data previously requested from the Norfolk Island government. I note that whilst a discussion paper was drafted the matter was put on hold pending this inquiry. The paper was used as the basis for our fairly lengthy submission. Following the intergovernmental meeting, the Commonwealth undertook to facilitate communications between the Norfolk Island government and the Minister for Health and Aged Care, the Hon. Dr Michael Wooldridge. A meeting was arranged between the Norfolk Island Minister for Health, Mr Geoff Gardner MLA, and Dr Wooldridge for late November 1999. This meeting occurred.

In relation to medivacs, the administrator's office had, prior to the intergovernmental meeting, taken action to resolve some confusion surrounding procedures by publishing them in the local newsletter, the Norfolk Islander. While the Department of Defence has advised they will continue to provide assistance to Norfolk Island in times of genuine need, they have stated that aeromedical evacuation support for Norfolk Island should be the exception rather than the rule.

Officials also undertook to help develop a more expeditious method of handling medivacs. A draft protocol was prepared by this department and forwarded to the CEO of the Norfolk Island administration for discussion. I believe Minister Gardner referred to this document in his submission to the JSC public hearing on Norfolk in November. However, we have received no formal response from them on that document. Subsequently, a copy of the Department of Defence protocols for medical evacuations has been made available by the department to the Norfolk Island government through the Office of the Administrator.

General information concerning the Royal Flying Doctor Service and telemedicine facilities has also been provided to the Norfolk Island government through this channel. The department recently arranged a meeting with the Aged and Community Care Division of the Department of Health and Aged Care to explore the potential for the provision of some programs to Norfolk Island. This meeting revealed that, as the Aged Care Act does not extend to Norfolk Island, none of the initiatives provided for mainland residents for residential or home care are available to the elderly on Norfolk Island.

The department believes the application of Medicare services to Norfolk Island is a matter between the Norfolk Island government and the Commonwealth Department of Health and Aged Care. The Department of Transport and Regional Services has not progressed discussions on this matter with the department of health since the initiation of this inquiry so as not to anticipate any outcomes of this inquiry. There are a number of options under which Medicare services could be extended to Norfolk Island. An amendment to the Commonwealth Health Insurance Act 1973 could also provide for continuity of health care cover for mainland residents when visiting Norfolk Island.

The department acknowledges the good work of health professionals on Norfolk Island and the recent high priority placed on health issues by the Minister for Health, Mr Geoff Gardner MLA. The recent election of a new Norfolk Island government and the early indication of a preference to work with the federal government on priority areas have created an ideal opportunity to progress some important issues on Norfolk Island, including health. The health review initiated by Mr Gardner and commenced in January this year, with the assistance of Griffith University, is developing a health profile for Norfolk Island that will go a long way towards identifying the type and level of services required on the island. We are advised the team are in the final stages of their data collection.

To capitalise on this good work, it is important that the Norfolk Island government develop a detailed strategic plan for the development and management of health care on Norfolk Island. Health care, including hospital, medical and community services, on Norfolk Island must be coordinated to ensure better health care for residents and for visitors. Perhaps the biggest challenge facing the new Norfolk Island government is addressing their limited administrative and financial capacity to make progress on priority issues like health. We understand the Norfolk Island government is currently reviewing health, immigration, land and their revenue raising capacity. This department is only too happy to assist where possible and practical. However, the burden for progress on the health issue rests with the Norfolk Island government as a self-governing territory and with the Norfolk Island administration.

It is important that the island's positive relationship with the Department of Veterans' Affairs continues. A strong relationship between the Norfolk Island government and the Department of Health and Aged Care would also be appropriate to assist the Norfolk Island government in providing their residents and visitors with an acceptable standard of health care. In our view, liaison with the Department of Health and Aged Care is essential for the future possible application of Medicare services in some form to visitors and/or residents, the potential for reciprocal arrangements for Medicare services similar to that with New Zealand and the provision of advice and potential assistance to Norfolk Island in relation to the expansion of primary health care on the island.

Health is an issue for which the Norfolk Island government is responsible. The department trusts its contribution to this inquiry has identified areas of concern and provided some constructive options for assisting the Norfolk Island government with its review of health services and the provision of future high level standards of health services to the residents of and visitors to Norfolk Island.

Senator WEST —Mr Chairman, after this department has appeared before us, we might want to consider bringing the representatives of department of health back to answer a few questions that have arisen from this submission and from some of the answers that have been given already, so I would flag that.

Mr NEVILLE —To which I add, Senator, `Hear! Hear!'

CHAIRMAN —I think that is an excellent suggestion. I am sure that the secretary will—

Senator WEST —I will flag that because you have talked in your submission about the need for close liaison, not just between you and Norfolk Island, but actually involving the other departments here on the mainland. I had thought that the aged care division was in the business of actually being a bit commercial and proactive in selling some of their resources and their knowledge on aged care; I wonder why they have not picked up Norfolk Island. Do you know why no full response has come back from the draft protocol for Medivacs that has gone to the CEO over there?

Ms Ellis —It may in fact have been overtaken by events in that the draft protocol was put together when there was a time of some confusion and some difficulties on the island. I think on the committee's visit to the island, it was raised that it can take up to nine hours for the plane. Since then there have been discussions between the Norfolk Island government and Department of Defence. The Department of Defence have provided a clear list of their protocols and I think in fact that it clarified whether or not ministerial approval was also required and cut out a role of at least one of the particular parties. To our knowledge there have not been the same problems since.

Senator WEST —Right. So those problems to some extent have been overcome?

Ms Ellis —We will have the opportunity to clarify that with representatives from the Norfolk Island government. They are coming out in two weeks. It is our intention to clarify that in fact that is now resolved and that we do not have to pursue the draft protocols that we did discuss.

Senator WEST —Who from the island was out this week?

CHAIRMAN —The new chief administrator, the Hon. Ronald Nobbs.

Senator WEST —What is the progress in the negotiation of discussions with the RFDS in terms of Medivac? Can you give us some indication there?

Ms Ellis —That is in fact a matter for the Norfolk Island government. Because they are a self-governing territory, our role, as Ms Kava alluded to, is to facilitate discussions where we can. It is a balancing act to ensure that we do not step in where we are either not invited or not wanted. What we have done is pursue some information in relation to the RFDS and made that available to the Norfolk Island government through our office of the administrator. Being aware that the Norfolk Island government's capacity is a little limited, we do what we can to pick up that sort of thing. But as far as progressing discussions, I could not comment.

Senator WEST —Okay, that is fine. In terms of health there, do you know if there are any health demographic statistics and disease incidence statistics available that we can look at to compare with mainland Australia to see if the life expectancy is anything like ours, if rates of dementia for elderly people are the same and how incidences of certain diseases, such as lung cancer, diabetes and those sorts of things compare?

Ms Ellis —I am not aware of any recent studies. We could check the files and see if we have any old studies. The actual health inquiry that has been initiated by the Norfolk Island government with the assistance of the Griffith University kicked off in January on the island. They are in fact developing a health profile on Norfolk Island through interviewing residents, taking blood tests, getting medical histories et cetera, so we will hopefully in the near future have some very up-to-date data on that sort of thing. But as far as I know, the team are still on the island. I think they are winding up their data collection this week and next.

Ms Kava —I should just point out that the Norfolk Island government will have that information. We will not necessarily—

Senator WEST —I guess that is the next question. Does anybody have it? It must make it a little bit difficult for you to be able to carry out some of your administrative and facilitating roles if you are not able to have those statistics and gauge their accuracy. You have to know how the statistics are collected if we are going to compare the incidence of, say, diabetes on Norfolk and in Australia. Unless you know that the statistics are being collected using the same methodology, they are not going to be of any use to anybody for comparative purposes, are they?

Ms Kava —Senator, we would have to go to the expert department in any case for that sort of information. We are not specifically skilled in the health area, as Maureen said previously. Because health is a schedule 2 matter it is the sole preserve of the Norfolk Island government. But they are at liberty to approach us or any other department for assistance and for information and we are certainly willing to assist them. I guess it is a matter of the Norfolk Island government wanting us to be involved and we cannot presume upon that relationship given the clear responsibility lines for health.

Senator WEST —If we are going to spend any money in Australia on health, giving it to the states under whatever agreements there are, we require those states to provide us with statistics and information. One of the problems that we have had in the past has been that with emerging programs and the information and statistics being collected, the methodology that is being used was not necessarily the same and you were measuring apples with oranges. I would be hesitant to say, `Yes, these schemes and initiatives are great ideas and we can give this amount of money,' if we are not measuring apples with apples. I think that somebody should look at ensuring that the methodology used on Norfolk Island is the same as that being used here—and maybe I should have asked the department of health about that and that is one we can look at for the future. Would you be conscious of the need to ensure that the methodologies are similar between Norfolk Island and the mainland so that we can actually get an accurate comparison of the statistics and the incidence and things like that?

Ms Kava —Given that the study is actually being done by an Australian university, and I am only assuming therefore that it would bear some relationship with national standards in that regard, I would have to agree with your point that health is really the appropriate department to ask in terms of the consistency of that data.

Senator WEST —There does not seem to be a great deal of consultation taking place between health and Norfolk Island—is that correct or not?

Ms Ellis —It would appear so. We did arrange a meeting with the health minister from Norfolk Island, Mr Gardner, with Dr Wooldridge in late November last year. We are not aware of the actual outcome of that meeting. The department has had quite a bit of liaison with the department of health but with regards to the direct link between Norfolk Island and the department of health I am not aware that there has been extensive dialogue there.

Senator WEST —As the department that would have the overarching control and the consultative, liaising and facilitating role for Norfolk Island, you are unable to tell us what the outcome has been of the consultations or discussions with Dr Wooldridge and Dr Gardner?

Ms Kava —I am not aware that we have been advised. Minister Gardner will be coming to the Australian mainland in a couple of weeks time so we are quite happy to follow that up. But, again, it is a matter of health being a schedule 2 matter about which we cannot appear too intrusive, but we can certainly follow up with the department of health. They have not, as far as I know, provided us with any information. We have no direct responsiblity—I am sorry to be repetitive on this point—for health matters, per se, because our minister has no responsibilities for health matters on Norfolk. Certainly we try to facilitate, in terms of talking to departments ourselves and arranging meetings, but we were not in attendance at that meeting. We are happy to pursue the issue both with Minister Gardner and the health department.

Senator WEST —I am just—I am not quite sure what the word is—

CHAIRMAN —Perplexed?

Senator WEST —That is probably a very good word—as to how you are able to operate, or what constraints that must place on you if a department within the Australian context does not get back to you and give you feedback on the results of some consultations that you actually initiated. Perhaps I need to think about that one some more.

Mr NEVILLE —May I first, Ms Kava, congratulate you and your colleagues on this submission. It is comprehensive and it is pertinent. Without exceeding the bounds of policy, you have made very clear-cut comments on equity and such matters. That gives the committee the ability to be able to proceed with some sense of confidence in what you have given us. I thank you very much for that.

I know it is very difficult—as you say, you are not in the delivery of health care—but I might start with the RFDS. As you say, we do not want to interfere in the prerogatives of the Norfolk Island government but, after all, it is an inquiry into the provision of health care services on Norfolk Island. The alternative to finding some mainland instrumentality to provide evacuations is the RAAF and other mainland based services. So I do not think we should be too precious in offering suggestions to the Norfolk Island government. My personal view, at least from the anecdotal evidence we have picked up now, is that there would be some merit in exploring the RFDS out of Sydney and/or Brisbane.

I was doing some rough calculations here earlier and it looks like the average trip of the RFDS in Australia is about 653 kilometres. The average cost is about $1,000. On this briefing note provided here by the secretariat, which I am sure they could make available to you from their last annual report, they had 22,000 evacuations across Australia for a total turnover of a bit over $20 million. So you can get a bit of a grip on what it is costing them per service. I know that is a fairly tenuous argument on its own; you would have to discount that for distance and other factors. But I think it gives us the flavour of what is possible compared with $131,000 suggested by the RAAF, even though they might be only charging the department—was it $25,000?

Ms Kava —It was $25,000.

Mr NEVILLE —It looks like they need about 25 trips a year of one sort or the other. I just wonder whether you would like to comment on the possibility of your department exploring that more fulsomely.

Ms Kava —I would just like to just clarify those numbers. As far as I am aware, the Department of Defence does not charge our department in any way for those trips. The cost is borne by the Department of Defence. I do not know whether that—

Mr NEVILLE —I thought you said there was a transfer of costs of $25,000.

Senator WEST —That was the DVA.

CHAIRMAN —There is no cost, Mr Neville, to Norfolk Island, but there is to the other territories.

Mr NEVILLE —Yes. There is a cost to the Commonwealth in one form or another. What is the best way to ameliorate those costs? Is it to leave it with commercial operators, with the RAAF or perhaps to explore the RFDS?

Ms Kava —It is certainly a difficult one. As has been mentioned, any evacuations from other territories are paid for directly. Indeed, in the Indian Ocean territories, for which we provide services, the arrangement is quite different because they are a non-self-governing territory. We actually fund those evacuations.

Mr NEVILLE —What are they costing you per trip?

Ms Kava —I would have to take that on notice, Mr Neville.

Ms Ellis —Having worked on the Cocos islands, I know a medical evacuation was $23,500 about three years ago. But the $25,000 mark is similar.

CHAIRMAN —Was that to Darwin?

Ms Ellis —No, to Perth.

Mr NEVILLE —Do you have any handle on what proportion of Cocos and Christmas residents are Medicare contributors?

Ms Ellis —No, we would not necessarily have that sort of data.

Mr NEVILLE —It is not your primary field of concern. Do you not have it from your experience as administrator either?

Ms Ellis —Obviously, all taxpayers are Medicare levy contributors. On Cocos you have the difficulty of a high proportion of unemployment and social service recipients.

Mr NEVILLE —It is the highest proportion in Australia, I understand.

Ms Ellis —Yes, it is, Mr Neville. Cocos would be quite different from Christmas Island whose population at the moment is running around 1,500. The unemployment statistics are much lower.

Mr NEVILLE —I will just interrupt my questioning. The chairman has to leave shortly and would like to ask some questions so I will wait for a while.

CHAIRMAN —I do appreciate my colleague deferring to me over my necessity to go back and see my family in Western Australia for at least a day before I come back here on Sunday. I am sure Senator West's heart is weeping for me. I thank you for your concern, Senator West.

I join my colleague, Mr Neville, in commending you for the high professional standard of your submission. It does make it much easier for us to see where you are coming from. If we can encourage you to keep up this high standard we are quite prepared to praise you and for you to read it in Hansard at some stage. It is an excellent report and I thank you again for it.

I want to ask you, Ms Ellis—I think you mentioned this—about the statement that you believe that health is really a problem to be solved between the Norfolk Island government and the Department of Health and Aged Care. Does that reflect roughly what you said or what was in your report?

Ms Kava —Yes, it does.

CHAIRMAN —Yes, thank you. We understood from the evidence we took this morning from the Department of Health and Aged Care here that they sort of washed their hands of responsibility for health care on Norfolk Island.

Mr NEVILLE —Who is responsible?

CHAIRMAN —There is some ambiguity there. Perhaps you could clear it up.

Ms Ellis —Basically, it is the Norfolk Island government. The Department of Health's legislation, which empowers them to do what they do on the mainland, does not extend to Norfolk Island; and neither does the Aged Care Act. The application of Commonwealth legislation in relation to the external territories automatically applies to the Indian Ocean territories unless expressed not to do so. In relation to Norfolk Island, it does not automatically extend; it has to be expressed to do so.

The Commonwealth health legislation did extend to Norfolk Island and was revoked in the late 1980s with the inception of the Medicare arrangements. Because of the fact that neither of those two acts extend, that department does not necessarily see a role. Our position that Medicare or health care cover is a matter between the Department of Health and the Norfolk Island government means that it is really the Norfolk Island government's responsibility if they see that Medicare in various options would be appropriate to extend to Norfolk Island.

CHAIRMAN —Pardon me interrupting you. You are saying that on the basis of a legal and constitutional responsibility that Norfolk Island has and not in any other respect. Is that correct?

Ms Ellis —Yes, that is what I am explaining.

CHAIRMAN —Please proceed.

Ms Ellis —If Norfolk Island wish to proceed with any options that relate to Medicare, the Norfolk Island government would appropriately liaise with the department of health in relation to the options available, whether that was possible, whether it would have implications for legislative amendments, et cetera cetera.

CHAIRMAN —It seems a little inequitable when we have, among other things, the Royal Flying Doctor Service. I spent most of my life in the bush and the outback, mostly in the outback, where you always had this feeling of security because you could get on the pedal set—although it was electrical by that time, but it was still called the pedal set—and you could call up the RFDS. They would be out to where we lived in an hour and a half in a Beechcraft Baron, they would pick you up, whether you had a broken leg or whatever, and take you back, so you did have some security. Norfolk Island people do not have that same security. Yet that RFDS service probably costs maybe $10 a year per capita in Australia to maintain. Do you think, in terms of equity—not in terms of the aggregate that they would collect from Norfolk Island—that if we extended the RFDS to Norfolk Island and they paid the same per capita amount that we pay in Australia—that is, $10 per annum, which nets $200 million—that would be a fair way? I think there is probably a constitutional argument that that could be one way of solving Medivac problems in Norfolk Island—that is, to have a permanent RFDS base there. What is your opinion about that?

Ms Kava —I do not know enough about the RFDS to comment in detail, but I would make the general comment that those living on Norfolk Island and visiting Norfolk Island do not have an equitable arrangement compared to other Australians and that we do need to find a solution. Whether or not per capita cost for those on Norfolk Island comparable with the mainland is the answer it certainly has some appeal in terms of equity. In relation to costs, given that it is a flight over water and that there are probably restrictions in terms of what types of planes can undertake that flight, the costs may be quite different. But I would agree that we need to come to some more permanent solution than exists currently, with people either being covered by their travel insurance and having to get some form of emergency flight, some small commercial flight, or relying on the RAAF being able to assist in time. That is clearly not a sustainable long-term solution.

CHAIRMAN —I think you are right. In terms of the economics of it, it is ludicrous that an aircraft that has a capacity to take 100 troops with their webbing equipment and their arms and to lift 50 or 60 tonnes of trucks or tanks at the same time should be sent for one medical evacuation. If it costs $130,000 per patient to get in the C130 Hercules, if you multiply that by six it is costing $700,000 or $800,000. It seems to me to be retrograde, in economic terms, not to consider having an RFDS base. It would certainly cost money, but it probably would not cost that amount of money.

Ms Kava —Could I add that it is very important that the Norfolk Island government, which is responsible for health, would need to be involved and contribute to any solution to do with Medivacs. It is very much of the view that it is their business and would want to be a main negotiator of any solution.

Mr NEVILLE —Could you arrange for the minister to meet with the committee when he is here next week?

Ms Kava —It is not next week, I think it is the week after. I could certainly take that on board.

CHAIRMAN —Yes, I appreciate your comments and I am glad that we have that on record now. I just used the RFDS because of my knowledge of it, and some in-depth knowledge of it as well, having used it on a couple of occasions. I have drawn the conclusion with respect to interdepartmental relations, where the health services cross over, that there is some recalcitrance between the departments to assist in preventing or minimising overlapping. The Department of Health and Aged Care might be one of those departments that is perhaps not as cooperative as it might be practical to be with, say, your Department of Transport and Regional Services. Is that a wrong perception?

Ms Kava —It would be true to say that relations between departments at different times—particularly for an area within our department that is looking at an issue like territories and contacting many different departments on many different issues—are helpful to a greater or lesser degree. I make no comment about Health and Aged Care. I am not as aware that we have had any particular difficulties there whatsoever, but obviously, at different times and on different issues, the ability to move quickly through issues varies.

CHAIRMAN —Does this committee need to facilitate better relations in terms of economics? I am not going to say that there is antipathy between government departments, but does this committee need to look at facilitating more cooperation to draw the best from the Department of Veterans' Affairs, your department, the Department of Transport and Regional Services, and, say, the Department of Health and Aged Care?

Ms Kava —I would emphasise that I see no antipathy between any of those departments.

CHAIRMAN —Yes, I tried to steer clear of that by saying it.

Ms Kava —Certainly, I think working constructively would be a very positive thing with the common aim in terms of improving the health status of Norfolk Island.

CHAIRMAN —Yes. On some of the evidence we have taken, it would appear, without analysing the minutiae of it, that there could be some benefit drawn from those particular three departments where there is overlapping health concerns, and particularly for Norfolk Island, if we were to try and draw the best out of the redoubtable contribution that each department could make.

On the issue of Norfolk Island being a self-governing territory, do you think that this committee could look at an education program where Norfolk Island was spelled out to the Australian public generally, and that would include government departments, that it is an integral part of Australia and not separate, that it is not independent. If it is not an integral part of Australia, then let it go, but if it is an integral part of Australia they deserve exactly the same sorts of health services that we have on mainland Australia, the same sorts of health services that they have with a multimillion dollar new hospital on Christmas Island, the same health services that we have in the mendicant territories, the ACT and the Northern Territory. Do you think the committee should do something about that?

Ms Kava —Any efforts that emphasise the fact that Norfolk Island is an integral part of Australia, which is something that is not as widely known as it should be by Australians, or even by parts of government departments, would be a very positive thing. Norfolk Island does have a slightly different status in terms of health. A matter that I understand was mentioned with the previous speakers was the fact that Norfolk Island residents do not pay tax. That makes it a little unusual and different in terms of getting that parity. But, certainly, any effort to clarify more generally—and it is an issue that we have looked at trying to address with government departments—would be extremely welcome.

CHAIRMAN —Thank you very much, and I apologise for having to leave.

Mr NEVILLE —I would just like to return to the cost matter. Ms Ellis, you might be able to tell us: do you know what the hospital cost is on the island territories?

Ms Ellis —No. I would happily take that on notice, but I do not know offhand, I am sorry.

Mr NEVILLE —Pursuing your option 2 as to what might happen, apparently there has been some modelling done, because the Department of Health and Aged Care says it will cost $2.2 million to bring Norfolk under the Medicare umbrella. That is my reading of your submission. I do not know what page it is on in yours, but in our papers it is on pages 35 and 36. I am sorry, that is the summary. You said there were three possible options for Medicare on Norfolk Island. Apparently there has been some modelling done. I imagine there would not be a lot of contributors, even on Norfolk, given the mean income on the island. If we assumed that it would cost $2.2 million to bring them under the Medicare umbrella, wouldn't it make more sense for the Commonwealth to top up their existing system than to just—I used the term in earlier evidence and got chastised by the chairman—Australianise the system, so to speak? If the island is already 80 per cent self-sufficient, do we do them a service by putting them under some regime that does not perhaps add a heck of a lot more to their quality of health care but bureaucratises a fairly simple system over there? Wouldn't it be better to have a top up? What is your view on that?

Ms Ellis —The difficulty with that, Mr Neville, may lie with the fact that the Commonwealth Grants Commission have identified that if the Norfolk Island government has the will to increase its revenue raising capacity, there is the scope there to raise it. So I suppose that is countering that argument with the justification of topping up.

Mr NEVILLE —But as the chairman said, all of us on the mainland, to some extent or the other, receive assistance from the Commonwealth well beyond our Medicare contribution. I think the witnesses from the health department said that the Medicare levy represented only about 20 per cent of the real cost of the Commonwealth contribution. I thought in the light of that, and in the light of the fact that they have been largely self-sufficient, it made better sense to build on what they have already got rather than to destroy that and have to pay the lot. That is my proposition.

Ms Ellis —Yes, given that the difference between the Medicare levy component and the rest is actually paid by the Australian taxpayer, that is a difficulty. Again, because Norfolk Island residents do not contribute in that tax sense, that is, if you like, the complicating factor in all of this: how to find a solution that is fair and equitable to those on Norfolk Island and those visiting it but that is not disadvantaging mainland residents that pay tax.

Mr NEVILLE —Another way of looking at it would be: is it possible to have a system of highly focused and targeted one-off grants, for example—you make comment on it—for what purport to be retirement units that are allowed to fall into disrepair? Even when we were over there, one or two were rented. I do not know what the reason for that is, but I think that is appalling in one respect. Perhaps that was the model that was given to them—just a row of units. When I go into modern aged care facilities today, that is not the way it is done; it is done in cluster developments, where people have their room and en-suite and have some common living area. That might have worked better because they are a very family based community. To put people into individual little boxes might have been why that failed rather than to have a more inclusive type of model. What would you think of a couple of specialised one-off grants to upgrade the hospital and then perhaps try a different model of nursing home?

Just before you answer that, in Australia we allow 100 beds per 1,000 population over 70 years. So if we take, for round figures, 3,000 people on Norfolk and we say 10 per cent of those are above 70 years of age, they would be entitled to about 30 beds. The Department of Health and Aged Care's modelling is: 40 per cent go to hostels, 50 per cent to nursing homes and 10 per cent to home care packages. I might have that 40 per cent and 50 per cent back to front. On the basis of what we enjoy on the mainland in aged care, and on the basis of the formula we apply on the mainland, we would be providing about 30-odd beds: perhaps about 12 of one, 15 of the other and a few aged care packages. On that basis, would a one-off grant that moved towards that type of model not be an experiment worth trying, without trying to dismantle the whole Norfolk Island health care system?

Ms Kava —It is very difficult to comment without any particular expertise in health.

ACTING CHAIR (Mr Neville) —I know I am generalising. But with all this there is no starting point, is there?

Senator WEST —All the Commonwealth is providing at present in aged care basically is the recurrent funding. Your proposal would not address the issue of the recurrent funding. Whilst we give recurrent funding, there is also a significant contribution made by the resident, and I do not see how they could do that as well. I hate to poke a hole in your idea, but it strikes me initially from a quick think through that there is where a problem would arise.

Ms Ellis —One of the difficulties Norfolk Island has in accessing mainland grant type initiatives is whether or not the legislation extends. That is the problem with aged care. The legislation does not extend so they do not have access to those initiatives. There are other Commonwealth initiatives where the Norfolk Island government have had access to grants. They recently got an environmental grant for waste disposal and they have also recently got some NTN funding. It just depends on the vehicle and whether or not they can have access.

Senator WEST —NTN?

Ms Ellis —Networking the Nation for communications.

ACTING CHAIR —The area where we would really fall down is with health and aged care. That is my personal observation. There are a few other things, but I defer to my colleague, Senator West.

Senator WEST —You might want to take this on notice for the other party or department on the aeromedicals and aircraft type that can operate on that distance over water. That might also have an impact on whether the RFDS ideas that some of my colleagues are coming up with are feasible. I am aware that transport in the aviation area does certainly have some criteria as to what aircraft size can be used. I know the RFDS in New South Wales are basically flying Super King Airs. I do not know that the Super King Air range would meet that criteria.

Ms Ellis —The fuel capacity range is one of the major criteria.

Senator WEST —I would be interested if the other side of your department can provide us with some guidelines about aircraft type and distances looking at those smaller sized aircraft rather than a C130 option.

Ms Kava —We would be happy to provide that.

Senator WEST —Thank you. Thank you for your attendance. There may be some matters that we may need additional information on in which case the secretary will write to you. I think you took some questions on notice.

Resolved (on motion by Senator West, seconded by Mr Neville):

That this committee authorises publication of the proof transcript of the evidence given before it at public hearing this day.