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COMMUNITY AFFAIRS LEGISLATION COMMITTEE
HEALTH AD AGEING PORTFOLIO
Australian Institute of Health and Welfare
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COMMUNITY AFFAIRS LEGISLATION COMMITTEE
Department of Health and Ageing
Australian Institute of Health and Welfare
Senator CAROL BROWN
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COMMUNITY AFFAIRS LEGISLATION COMMITTEE
(Senate-Wednesday, 2 June 2010)
HEALTH AD AGEING PORTFOLIO
Australian Institute of Health and Welfare
Senator CAROL BROWN
National Blood Authority
Australian Organ and Tissue Donation and Transplant Authority
Senator CAROL BROWN
Aged Care and Standards and Accreditation Agency
General Practice Education and Training Ltd
Private Health Insurance Administration Council
Private Health Insurance Ombudsman
Pharmaceutical Benefits Division
- Australian Institute of Health and Welfare
- HEALTH AD AGEING PORTFOLIO
Content WindowCOMMUNITY AFFAIRS LEGISLATION COMMITTEE - 02/06/2010 - HEALTH AD AGEING PORTFOLIO - Australian Institute of Health and Welfare
CHAIR —I welcome officers from AIHW to the table. Dr Tallis, have you been with us before?
Dr Tallis —I have not. I have attended as an observer.
CHAIR —I did not think so. I believe Senator Boyce has a question, as does Senator Fierravanti-Wells.
Senator BOYCE —Thank you. Dr Tallis, Ms Lynelle Moon, as acting director of AIHW, yesterday launched the ‘go for red’ program. Why does the institute currently have an acting director?
Dr Tallis —Our substantive director, Dr Penny Allbon, is on leave at the moment. Ms Moon is, in fact, the acting head of our health group.
Senator BOYCE —You are Ms Allbon at the moment, are you?
Dr Tallis —I masquerade as her, yes, to the best of my ability.
Senator BOYCE —My initial questions are follow-up questions from last estimates in regard to the collection of data around alcohol and drug information in Queensland. Apparently someone had been appointed to do something about that. Can you update me on that situation please?
Dr Tallis —Yes, there is still work being done in Queensland in collaboration with us on looking at the data supply arrangements. That has not yet concluded, so we do not yet have Queensland in the mix for that reporting. We hope that that will be possible. There is a fair amount of technical work to be done on being able to bring this up from the alcohol and drug treatment services, but it will be a little while in the future.
Senator BOYCE —Fair amount of technical work? What does that mean?
Dr Tallis —This is the issue: are we able to obtain consistent data elements from the drug treatment services in Queensland such that when they are brought together with those from the other states we can do valid comparisons across the jurisdictions? That requires a good deal of data development. The alcohol and drug treatment services, where established, are jurisdictional ventures, and therefore they have their own service delivery models and what have you. It follows from that that they also have their own data content. Our process in all of what we call our national minimum data sets is that we enter into negotiations on an agreed set of data items that will be reported into the NMDS and that require two sorts of work. One is the work at the national level that establishes those common definitions, and the other is the work at the local level that allows the service delivery agencies to distil those items and roll them up in a consistent way, and that is going forward.
Senator BOYCE —Is the alcohol and other drugs area the only area where you do not have satisfactory data input from Queensland?
Dr Tallis —I believe that is the case. We have in the order of 22 or 25 NMDSs and, on my understanding, that is the only one in which Queensland does not report. I can validate that for you, if you like.
Senator BOYCE —The other question I had, and you will probably need to take this on notice, or you may be able to answer it, is: are you able to provide me with a list of states that do not contribute to other NMDSs?
Dr Tallis —Yes, we can certainly do that. It is a rather rare occurrence. Generally speaking, the hacking out of the NMDS specification is done through a careful process under the MINCOs, the committees that sit under that. It is usually the case that, once you have agreed on a specification, the states then verify that they are able to report against it. We can certainly provide that list. It is well known; in fact, it is visible in all our publications, and we will do that for you.
Senator BOYCE —The other question I have relates to how this will affect the health and hospital reforms package that the government is currently looking at. Is the institute involved in ensuring that, as the changes are put in place, the data is collected in such a way that it will be nationally comparative?
Dr Tallis —There are two aspects to that. There are some information requirements and agencies that are set up specifically under the reform package. Those arrangements are being negotiated among the governments and under the carriage of the department. Certainly, with any change in administrative or service delivery arrangements in health, we do, indeed, in cooperation with the jurisdictions, look at what that will imply for the data that can be coming out of the service delivery agencies in the NMDSs. That is absolutely right; we would be doing that work continuously through the reform package.
Senator BOYCE —Where is that work at, at the moment?
Dr Tallis —At the moment, the reform package has been announced in its broad, conceptual terms. We are certainly thinking inside the institute about the implications in principle of that, but it is really when the delivery models, financing arrangements and what have you are in place that we can then do an assessment, in a technical manner about what that implies for the ‘data supply chain’, as we call it. Most of that work is in our future.
Senator BOYCE —Would you think that that assessment will use the resources of the AIHW in a very large way or will it be a relatively small project for you?
Dr Tallis —It will be an important project for us. The actual call on resources will depend, I think, on the amount of change that happens back at the data supply origin. It is also fair to say that a good deal of the work is done by the institute in collaboration with the jurisdictions at these committees. All of us—all the eight states and territories, the Commonwealth, we and the Australian Bureau of Statistics—all contribute work to that. We have certainly planned for a good deal of thinking about the future data supply chain in our own work program. We have recognised that in the draft work program we are going to take to our board. Quantification, I cannot tell you. I am not trying to be vague, but we just do not know until we see what happens with the data origin.
Senator BOYCE —Do you have any extra resources required now to undertake that work?
Dr Tallis —For the exploratory work, we are able to travel with the resources we have available. If there were an implication of, say, a major new data collection that might come to us, or a major revamp of data items or lodging in our metadata repository, METeOR, then we would need to look at what resourcing would be required. We do not have an appropriation bid in for that at the moment, nor have we any particular funding stream under contract for that at the moment.
Senator BOYCE —Just briefly because I mentioned it, AIHW, yesterday, was involved in the launch of the Go Red for Women. I notice Ms Halton is a day behind here, wearing her red!
Ms Halton —I know. I am sorry!
Senator BOYCE —The campaign looks at women and heart disease. Could you just very briefly outline for us what the communication of those findings will be now?
Dr Tallis —Yes. As is typical of our reports, we issue, first of all, a range of media releases and briefing and what have you. That report, I should say, has generated a great deal of interest.
Senator BOYCE —As I think many of your surveys and reports do.
Dr Tallis —Yes, it is kind of you to say so. The follow-up procedure to the release of the report is that we then have a range of information packages that go into our other compendium publications, for example. Things are built into presentations. Our staff are very active in distilling from our publications and doing presentations at conferences and departmental fora and so on. That report, in particular—which is one of the prettiest, I think, that we have put out for a while—will appear in those guises as well. It was not available, I think, in time for incorporation in the next issue of Australia’s health, our flagship, which comes out in just a couple of weeks, but certainly future issues would incorporate the information out of that report.
Senator BOYCE —There is also an ongoing discussion around collection of health data for Indigenous Australians—
Dr Tallis —Indeed.
Senator BOYCE —based on the fact that we are focussing on closing the gap.
Dr Tallis —Yes.
Senator BOYCE —Could you tell me just a little about the institute’s work in trying to make sense of the data, so to speak?
Dr Tallis —Absolutely. It is a major focus for us. In fact, we have established a whole group, one of whose major responsibilities is looking after Indigenous health and welfare statistics and information. We have a number of efforts. We do mount particular data collections in this field. Our most important work is probably trying to ensure that Aboriginal and Torres Strait Islander people are identified appropriately in all of our data collections, so that we are able, for any health and welfare report, to do a slice, which identifies Indigenous people and compares them with non-Indigenous people and tracks the trends in Indigenous health services to Indigenous people. That is a major exercise because what it implies is trying to ensure that, at every point of health service deliver, in this instance there is standard way of ascertaining who is Aboriginal not Aboriginal is applied—that is a respectful way of asking people themselves to say how they go, according to the standard ABS question—and then seeing that that rolls up into all of the national reporting.
That has been a huge investment for us and for other agencies. We have issued, rather recently, guidelines on how that should be done, and we have an active campaign to ensure that that occurs throughout health service delivery, so that the statistics we have in the future are better than those we have at the moment. There has been, I think it is true to say, great progress in getting better and better Indigenous identification in data. We are able to do analyses and do reporting today that, even five or six years ago, we would simply have been silent on.
Senator BOYCE —Could you on notice, perhaps, just quantify some of those ‘progresses’, for want of a better word, that you have made? On notice, that would be good.
Dr Tallis —Yes; we would be very happy to. It probably will not be in the manner of quantification, because it is qualitative improvement, but we can certainly point you to both the activities we have in train and the improvements that we have been able to put into our main reports, as well as the Indigenous-specific reports.
Senator BOYCE —Thank you.
Senator FIERRAVANTI-WELLS —There has been constant commentary by the Prime Minister about this alleged decrease of $1 billion of public hospital spending under the coalition government. At the last estimates, I asked some specific questions in relation to funding. Thank you for your answers because your answers totally contradict the assertions that the Prime Minister has been making. For the record, can I ask you to confirm that Australian government funding of public health expenditure, in your answer to question 407, was $545 million in 2001 to 2005-06. I have got that from your answer. The most important figure that I would like you to reaffirm for the record is that funding of public hospitals in 1997-98 was $5.9 billion and in 2007-08 was $12 billion?
Dr Tallis —I do not have those figures in my head, but I would be very happy to go back to our table and confirm them.
Senator FIERRAVANTI-WELLS —You have produced this. I am asking you—
Dr Tallis —I do not have the document in front of me.
Senator FIERRAVANTI-WELLS —No. The reason I put these on the record is that the Prime Minister constantly goes on about public hospital funding decreasing by a billion dollars, but your figures contradict that assertion and show up the falsity of what the Prime Minister is actually saying. You do not have to comment, but I am making that comment.
CHAIR —Thank you. I take that as a statement. We are taking a break and we will come back with questions under outcome 13, Acute care.
Proceedings suspended from 11.00 am to 11.13 am
CHAIR —We will now resume with questions in outcome 13. My proposal is that we have 40 minutes under general questions on acute care, and then 20 minutes each under National Blood Authority and Australian Organ and Tissue Donation Transplantation Authority.
Senator FIERRAVANTI-WELLS —Just to be clear, Madam Chair, we will be dealing with all of outcome 13. Most of my questions in 13 are more about the hospital side of it.
Senator FIERRAVANTI-WELLS —Thank you. You are aware of some of the questions, Ms Halton. I think you mentioned earlier questions that I asked of finance. I asked some questions in relation to finance.
Ms Halton —In general, yes.
Senator FIERRAVANTI-WELLS —To sum it up, they said to me, ‘Well, look, we did costings based on assumptions and those are the assumptions that came from the Department of Health and Ageing.’ Let us look at some of these programs. The $1.6 billion that is set out there in the budget papers for the acute hospital beds, Finance said to me that they did costings for $800 million of that. Did Health and Ageing do the costings for the rest of it?
Ms Halton —The costings for that particular measure were actually costings agreed with the states. Finance had costed part of the initiative, and the part of the initiative that was announced prior to COAG, and, as you know, there was an additional element agreed at COAG. The overall position was agreed at COAG.
Senator FIERRAVANTI-WELLS —There was $800 million agreed to before COAG, which was presumably based on X number of beds. Of that, 1,316 beds that were in the budget papers, I assume—correct me if I am wrong—that $800 million of that was done in costings by finance presumably for a number of beds.
Ms Halton —Correct.
Senator FIERRAVANTI-WELLS —Can you tell me what the figure was?
Ms Halton —I will have to take it on notice, actually, I think, because you are going back now through several iterations. What I can tell you, though, and maybe this will help, when we had the conversation with our state colleagues at COAG—and you would probably understand that the use of sub-acute beds varies quite significantly from lower care cost beds in the community right through to very intensive rehabilitation kinds of beds. So the cost of a bed varies pretty substantially, depending on the nature of the bed. In the negotiations with the states in relation to the beds that were agreed, the 1,316 beds, the costings that were agreed in respect to those beds were in relation to a particular model which was negotiated and agreed with the states at COAG.
Senator FIERRAVANTI-WELLS —What were the assumptions that underlay the costing that, ultimately, Finance did for $800 million of a portion of that 1,316 sub-acute beds?
Ms Halton —I will take that on notice, because we will not have that with us.
Senator FIERRAVANTI-WELLS —All right. I assume that the assumptions that I have asked Finance to provide would be the same assumptions that you provided to Health and Ageing. If I ask you for assumptions, the two things should marry?
Ms Halton —I would hope so.
Senator FIERRAVANTI-WELLS —I would hope so, too, Ms Halton. Let’s say for assumption’s sake the figure that was in your costing was 650—half—does that mean that then the balance, the other 650 beds and the other $860 million was an assumption that was made, as you said, through the process, was that just then a replica of what finance had costed?
Ms Halton —No.
Senator FIERRAVANTI-WELLS —Okay. So somebody did maybe a back of the envelope type calculation, or would it have been a bit more technical than just simply doubling the figures?
Ms Halton —In terms of COAG?
Ms Halton —No. It was more technical than that because, as I have said to you, there is a variation across the nature of these beds, sub-acute beds. There was a process of looking to see what the nature of those cost variations were across the states, and it was on that basis that the agreement was struck, so, actually looking to see across all of the states for types of beds, what actual cost they were incurring.
Senator FIERRAVANTI-WELLS —Is the calculation that you would have looked at right across Australia, except WA, and then looked at—
Ms Halton —No, that is including WA.
Senator FIERRAVANTI-WELLS —Okay. So you looked at the marginal recurrent costs, and put a whole series of factors into a formula that then resulted in you being able to say that $1.6 billion over four years will deliver 1,316 subacute beds?
Ms Halton —A minimum of, yes.
Senator FIERRAVANTI-WELLS —And have you got a breakdown of where those 1,316 are? I have not seen, or perhaps I have not—
Ms Halton —We will have to take it on notice.
Senator FIERRAVANTI-WELLS —I could not find it anywhere—
Ms Halton —We will give it to you.
Senator FIERRAVANTI-WELLS —as to where they are.
Ms Halton —We have got it. We will give it to you on notice.
Senator FIERRAVANTI-WELLS —Sorry, Ms Huxtable. Did I miss it somewhere or—
Ms Huxtable —No.
Senator FIERRAVANTI-WELLS —It is not anywhere in the published material.
Ms Huxtable —I am saying that we can certainly provide the breakdown by state and territory.
Senator FIERRAVANTI-WELLS —Thank you. Obviously that has to take into account a mix of country and city beds, the different categories of subacute and those diverse parameters. All right. Could you provide to me the assumptions and also the breakdown of those 1,316. Again, with the emergency department beds, the 251.4, is that a similar process, Ms Halton?
Ms Huxtable —Yes.
Senator FIERRAVANTI-WELLS —Bearing in mind that, as I understand it, it is the one figure. It was not an addition, unless Finance did not mention that to me. It was not a two-part question.
Ms Huxtable —I think there are two types of issues here that we are talking about. One is the way in which the communique refers to the numbers of additional services that could be provided for the funding that is being provided. I might have missed the particular bit where you were talking about—
Senator FIERRAVANTI-WELLS —Sorry, I withdraw that question. You are correct.
Ms Huxtable —Yes. Can I just say, though, that the second thing that you are talking about in respect of subacute is actually the numbers that the states agree will be delivered as a part of a national partnership agreement, so they become tied to delivering this number of beds, and I think you made a comment about marginal. I know that we have been through this before in another place, but the 1,316 subacute care beds are fully funded by the Commonwealth over the forward estimates period. So it was very important, in discussions with states and territories, that we were all very clear that the moneys that were being made available were sufficient to fully fund the mix of subacute care services that would need to be delivered, as you say rightly, in various locations et cetera across that forward estimates period.
Senator FIERRAVANTI-WELLS —For the emergency departments and improving access to elective surgery, are there underlying assumptions as to targets and that sort of thing? Is that something built into the figure of $251 million, and the figures that are in boosting elective surgery capacity, and the $652 million over four years to reduce the waiting times? In effect, I mean the figures you see when you sort of run down the budget at a glance. Sorry, I have made it a little bit bigger, but it is a bit small, I have to say.
Ms Huxtable —I was going to say it is good; you can read it.
Ms Halton —Yes, we are back to that age reference.
Senator FIERRAVANTI-WELLS —Ms Halton, I think you might next year—
Ms Halton —I cannot read it either, if it makes you feel better.
Senator FIERRAVANTI-WELLS —So I assume that apart from the acute beds, there are certain assumptions built in in relation to these measures. Do those assumptions actually include numbers?
Ms Flanagan —I think that for elective surgery and emergency departments there are a number of funding streams. There is capital and facilitation funding, and also reward funding. It was a negotiated process, but we are going to hold the states to the arrangement. Just as Ms Huxtable has talked about the number of beds in subacute, there are targets that have been set for emergency departments around four hour access, and also for elective surgery, in that 95 per cent of people will receive their elective surgery within clinically recommended times. So the totality of the money flowing into the system for emergency departments and elective surgery is expected to reflect that—and we will hold the states to actually deliver on those targets.
Senator FIERRAVANTI-WELLS —We have a hearing coming up on this next week, so I will not delve into too much more, but suffice to say we will drill down into that. On page 357 of this document, it has got as part of the qualitative deliverables in health reform, elective surgery data reported. Ms Flanagan, that is the sort of stuff that you are talking about, in terms of—
Ms Huxtable —I think there are two elements to this, again. In the national partnership agreement which will oversight the elective surgery measure and the emergency department measure, there will be specific targets that form part of those national partnerships—for example, showing that states are making progress toward reaching that 95 per cent target in respect of elective surgery. This goes more to information that is made available in respect of elective surgery that is occurring within states and territories, so I think this is something that would be coincident with but side by side with national partnership agreements.
Senator FIERRAVANTI-WELLS —And also underneath that, there is the release of average cost of procedures in public and private hospital activity. Presumably you are already collecting that sort of data.
Ms Huxtable —That is right.
Senator FIERRAVANTI-WELLS —Is it envisaged that you are going to release that next year, and the data that you are now collecting is the data that underlies the assumptions that you used in the hospital reform?
Ms Flanagan —The data that we will need to collect around this is also critical for the new performance authority and the independent hospitals pricing authority to do its work. So, very clearly, we are asking the states to provide more data, and consistent data, so that that can actually be provided to those authorities as well.
Senator FIERRAVANTI-WELLS —I asked Finance questions about the independent pricing authority and the national funding authority. That is probably best dealt with when we cover those things next week, and it might be easier to drill down into a bit more detail in relation to that next week.
Ms Huxtable —Wherever you wish to ask questions.
Senator FIERRAVANTI-WELLS —I will do that next week, Ms Huxtable. I might just move, if I may, to the $29 million that is going to be used for the advertising campaign. I just saw the global figure, but can you break down the various elements of this campaign? In other words, how much is going to be spent on advertising by television, radio and newspapers?
Ms Huxtable —Ms Palmer can do that when she gets her folder out.
Ms Palmer —I can give you a breakdown for the activity on air.
Ms Palmer —We have $3.92 million for television advertisements, $1.09 million for radio advertisements, $0.98 million for newspaper placements, $1.17 million for internet advertising and internet search advertising. There is $0.28 million for non-English-speaking background/Aboriginal/Torres Strait Islander people advertising and print handicapped material, and there is $0.09 million for the cost of despatching the advertising to be placed. That comes to a total advertising or media placement for this financial year of $7.4 million.
Senator FIERRAVANTI-WELLS —Okay. So you have got $18.3 million to be spent 2010-11; and over the forward estimates, $1.1 million in 2011-12, obviously after the election campaign; for 2012-13, only $0.2 million, and then no spending on 2013-14. Given that some aspects of this go up to 2020, various aspects of this reform are spread over quite a number of years into the future, it is interesting that you are basically going to stop any advertising or any information distribution after 2012, notwithstanding that the operation of this plan will supposedly go into the future.
Ms Palmer —The aim of the campaign is to ensure that the Australian public are informed of the Australian government’s health reform plan and what it will mean for the health and hospital system and for Australians.
Ms Huxtable —Just to add to that, as you would be aware, there are various elements of the reforms which have already begun, and certainly are rolling out from 1 July 2010.
Senator FIERRAVANTI-WELLS —Sorry. You are reading from?
Ms Huxtable —If you look at page 124 of the red book, that has actually got the key delivery milestones that are set out in there. As you would be aware, the tobacco excise increase took effect from 30 April 2010, but there is also a variety of measures—some payments being made now, others occurring in the second half of this calendar year—and a range of things that are coming on line, obviously, over the coming years. Just to add to Ms Palmer’s response in respect of the purposes of the campaign, there is also a purpose to direct people to where they can find more information in respect of individual measures because, as you would be aware, this is a very complex reform landscape with a lot of individual measures, so it is important that people know where they can get more information. Certainly the feedback that we have been getting for some time—and it really mirrors some of the points that Senator Adams was making—is that people are very keen to know more and understand more about specific reforms and what it might mean for them. In that environment, it is important that there be that more detailed information, which is through the website.
Senator FIERRAVANTI-WELLS —Ms Huxtable, the inference—and correct me if I am wrong—it says 30 April tobacco excise increased: is that inferring that that is where the money is coming from for this?
Ms Huxtable —No. Are you on page 124?
Senator FIERRAVANTI-WELLS —I am.
Ms Huxtable —All this is a summary of what the key milestones are against all the various elements of the campaign. Clearly, the tobacco excise is part of the preventive health elements of the reform plan.
Senator FIERRAVANTI-WELLS —Okay. I shall keep that to the side. What other products are going to be produced under this allocation? Are we going to have more merchandise, or that sort of thing? Ms Halton is familiar with golf balls. Are we going to see little golf balls?
Ms Palmer —We are not planning any golf balls.
Senator FIERRAVANTI-WELLS —No golf balls?
Ms Palmer —No. We are planning a number of information products to assist consumers, but also help professionals and stakeholders. At the moment we are, for instance, working on, and have, fact sheets, brochures. We have our website which we will be continually updating and adding material to as a core information platform for the campaign. Obviously, with advertising, you cannot put a lot of very detailed information into a 30- or a 60-second television advertisement, as, of course, you would know. The website gives us a platform to put a lot more detail and to also put the source documents as well. A key component of the advertising is to enable people to really understand where they can go to get that extra level of information.
Senator FIERRAVANTI-WELLS —In terms of the TV ads, does this mean we are going to see Dr Rudd in the white coat and sitting on the edge of people’s beds? Is that the sort of stuff that we are going to be subjected to?
Ms Palmer —The TV ads need to comply with the government’s advertising guidelines.
Senator FIERRAVANTI-WELLS —Yes, Ms Palmer, we know all about that.
Ms Palmer —One of those guidelines is very clear about there being no party-political content.
Senator FIERRAVANTI-WELLS —We have heard that one before. I am asking you are we going to see Dr Rudd in the white coat like we normally see him?
Ms Palmer —No.
Senator FIERRAVANTI-WELLS —No posters, nothing like that?
Ms Palmer —No.
Senator FIERRAVANTI-WELLS —I am comforted that our television screens will not be inundated with Dr Rudd. What about the website? I assume there is a website.
Ms Palmer —Yes. It is the yourHealth website. We have continued that website through.
Senator FIERRAVANTI-WELLS —We have continued the yourHealth website. Okay. And how much is that costing?
Ms Palmer —In terms of the costing for the campaign? The website is updated by staff internally to the department. We have made a small allowance for website development and maintenance. This year, the allowance was $0.2 million, and for the 2010-11 year it is 0.6, and for the following two years after that it is also $0.6 million.
Senator FIERRAVANTI-WELLS —Over what period will this advertising campaign be spread?
Ms Palmer —We currently have, within our costings, advertising to occur in the 2009-10 and the 2010-11 years.
Senator FIERRAVANTI-WELLS —All right. Let me just say insofar as it started a few weeks ago, the ink was barely dry on the COAG agreement.
Ms Palmer —13 May is the date it started.
Senator FIERRAVANTI-WELLS —For those ads to have been ready by that date, when were they commissioned?
Ms Palmer —I can take you through the time line.
Senator FIERRAVANTI-WELLS —Yes, please.
Ms Palmer —We had authority to work on a campaign in mid-March. We had approval from the minister to develop a campaign on 19 March. Four creative agencies were invited to tender then and creative Q and A sessions were held with those agencies. We did this work in close consultation with the Department of Finance and Deregulation, who manage the guidelines, and they participated in this process. We engaged a research company to undertake concept testing and do benchmark research on 23 March this year. The creative tender closed, then we went to pitch concept testing. We ran 12 groups from 26 to 27 March. We also did some benchmark research on 26 to 30 March. The creative agency was appointed on 30 March as a result of the testing activity.
Senator FIERRAVANTI-WELLS —Who was that?
Ms Palmer —JWT is the agency that was appointed. We updated the minister on the progress of the campaign and we appeared before the independent campaign committee on 7 April. We had a second round of concept testing. We did eight groups at that point on 28 and 29 April. We updated the ICC on the progress on 21 April and 28 April. We did another round of testing on 5 May. The ICC considered the campaign and materials then. On the 6th and the 11th we received information from them regarding the compliance with the guidelines. On the 11th certification of the campaign was done on that day. The minister approved the launch of the campaign on 12 May. The campaign started appearing on the 13th.
Senator FIERRAVANTI-WELLS —That is right, well in advance of any agreement with the states. When did this whole concept—
Ms Huxtable —Sorry, Senator. COAG was on 19 and 20 April.
Senator FIERRAVANTI-WELLS —Yes, I appreciate that. I am going to ask Ms Palmer now—
Ms Huxtable —I will butt out.
Senator FIERRAVANTI-WELLS —I appreciate we are all a bit sensitive about advertising at the moment.
CHAIR —Senator, that is a comment. You can go ahead with your questions.
Senator FIERRAVANTI-WELLS —Can I take you back, Ms Palmer? Presumably the department started the process as far as this campaign is concerned, the advertising process?
Ms Palmer —We started the process when we had authority to do so.
Senator FIERRAVANTI-WELLS —And you told me that you had authority back in March.
Ms Palmer —Yes.
Senator FIERRAVANTI-WELLS —What work was done before March to gain that authority?
Ms Palmer —We started work on the campaign when we had authority to do so.
Senator FIERRAVANTI-WELLS —Right. There must have been some preparatory work. What was the date you gave me, mid-March?
Ms Palmer —Yes.
Senator FIERRAVANTI-WELLS —Who gave you that authority?
Ms Palmer —It was a government decision.
Senator FIERRAVANTI-WELLS —The minister communicated via a minute, or something like that? What was the form of that authority?
Ms Palmer —We acted with cabinet authority.
Senator FIERRAVANTI-WELLS —Okay. Ms Halton, what happened? The minister told you that you now had authority to engage in an advertising campaign?
Ms Halton —We had cabinet authority.
Senator FIERRAVANTI-WELLS —Okay. That starts in mid-March. So the campaign that is now being run is like this? This is the sort of stuff that is now being put in the papers. The authority to run this was given in mid-March?
Ms Palmer —The authority to develop a communication campaign.
Senator FIERRAVANTI-WELLS —The authority to develop the communication started in mid-March—and that is before COAG, before the budget, before any major decisions in relation to reform.
Ms Palmer —The campaign was about explaining the government’s health reform plan.
Senator FIERRAVANTI-WELLS —All you had, presumably, until March was this document here. Did you start with that?
Ms Huxtable —No, this document was released on 3 March, I believe.
Senator FIERRAVANTI-WELLS —Sorry. Okay. All you were doing was about to sell this?
Ms Palmer —Explaining the government’s health reform plan.
Senator FIERRAVANTI-WELLS —Okay. You were effectively allocated $29.5 million, or got authority, to sell this blue document?
Ms Palmer —To explain the health reform plan.
Senator FIERRAVANTI-WELLS —To explain what is in this blue document.
Ms Halton —Let us be clear. We had authority to commence the development of a campaign to explain health reform. Your point in relation to the release of that document is accurate, in terms of the timetable. The campaign itself was not finished and put into the public arena until after we had the COAG agreement.
Senator FIERRAVANTI-WELLS —My point to you is that you have obviously sought authority way in advance of what actually ultimately appears in the newspapers. Do you see my point?
Ms Halton —No, actually, I do not see your point.
CHAIR —You have a point of order, Senator Furner?
Senator FURNER —The senator has held up three pieces of material, two in booklets and one in a newspaper article. I imagine Hansard is having great difficulty in understanding what the reference is.
CHAIR —Thank you for your point of order.
Senator FIERRAVANTI-WELLS —Senator Furner, if you were listening before, we did hold it up. It was identified.
CHAIR —Excuse me, Senator. That was a point of order to the chair. We are trying to make this as smooth as we can. It was a point of order to the chair. In response to that, Hansard was aware of what was going on. Senator Fierravanti-Wells, the words will appear. The witnesses said that they did recognise the advertisements, so there was no need for tabling. Senator Fierravanti-Wells, you have about three more minutes before I give it to other questions in this section. Thank you for your point of order, Senator Furner.
Senator FIERRAVANTI-WELLS —In other words, we are out seeing advertisements like this, the process for which commenced way in anticipation of any health reform being agreed to with the states. It really would not have mattered what was agreed to at COAG because you had already started developing a campaign back in March-April.
Ms Halton —No, let us be very clear about this. The campaign, and the advertising, which involves the expenditure of significant amounts of money, was something that occurred once we had the COAG agreement, but—as Ms Palmer has taken you through line by line the processes that we have gone through to understand what people’s understanding about health is and about health reform, and the process of how you actually communicate that—this was not resolved until after COAG.
Senator FIERRAVANTI-WELLS —All right. My question is: what did you do before COAG and what did you do after COAG?
Ms Halton —I think Ms Palmer has already taken you through precisely that time line.
Senator FIERRAVANTI-WELLS —She has given me some sort of technical—I think it would be useful, Ms Palmer, if that was broken down to a more retail message, if I can put it that way. You mentioned ICC. If you could break that down, that would be very helpful. Obviously, there were initial preparations for the advertising campaigns. What was ordered or decided to be initiated before COAG and after COAG?
Ms Halton —Whilst you might be interested in a ‘retail story’ about this—
Senator FIERRAVANTI-WELLS —So will some of our listeners, Ms Halton—
Ms Halton —the bottom line is that this is a—
Senator FIERRAVANTI-WELLS —rather than bureaucratic mumbo-jumbo.
Ms Halton —It is not bureaucratic.
CHAIR —I am sorry. Can I just stop you for a moment?
Ms Halton —Thank you.
CHAIR —We cannot have two speakers talking over each other for Hansard. Senator, you had your question. Ms Halton is responding. This is the last question and we will have to go on to other questions. Ms Halton, you have a response for Senator Fierravanti-Wells?
Ms Halton —Thank you. What Ms Palmer has done is outline to you the process of development and testing of people’s understanding and how one best and most effectively communicates, getting a baseline in terms of people’s understanding, and then the development work that goes into any form of campaign, which ensures that the campaign achieves its objectives in relation to effective communication. I can tell you that what she has done is outline that in precisely the terms which are used right across the industry by people who understand how campaigns are developed. And then, ultimately inside government, it is decided that moneys will be spent. It is quite consistent with how this subject matter is treated right across government and has been forever, as long as I can remember.
Senator FIERRAVANTI-WELLS —All right. In that case, can you provide to me what was shown to the Independent Communications Committee on 7 April and what was shown to the communications committee on 21 April. What would have happened to this material had most states not signed up to the Rudd plan? Would it have just been dumped?
Ms Halton —There are two answers to that, the first of which is that I am not sure but I will find this out, as I have a suspicion that the information may be cabinet-in-confidence. If it is not, certainly it can be provided, but I do have to clarify that. Secondly, the latter question is a hypothetical and I therefore cannot answer it.
CHAIR —Thank you. Senator Brown and then Senator Siewert.
Senator CAROL BROWN —Just on that, was the process that you undertook for this campaign any different than previous campaigns that you have produced? Have you put some work in before you have—
Ms Halton —There are new guidelines, as you are probably well aware. Is it different to previously? Yes, it is, because of the change in the guidelines. In terms of the material elements of it, how we go about these things, no, it is no different.
Senator CAROL BROWN —So what has been told to us today is pretty much the same as what was normally done. Can you highlight the differences for me?
Ms Palmer —Yes. It is pretty much exactly the same process, in terms of pitching, getting agencies to provide creative, testing the creative to identify which creative is going to be most effective in achieving the communication objective, then refining that creative over multiple concept testings. For instance, with our sexual transmitted infections campaign, which was launched this year, we appeared before the previous committee, which was the interdepartmental communication committee, which included the review body, the ANAO. We appeared before them five times. By coincidence, we appeared before the new committee the same number of times on this campaign. We had to do more testing for the STIs, a much more difficult and subtle campaign, but we continue to refine communication materials in the same way as we have done and to engage with the independent review body throughout the process so that they are very familiar with it and can provide their feedback along the way.
Senator CAROL BROWN —So nothing unusual?
Ms Palmer —Nothing unusual at all.
Senator SIEWERT —I want to ask some questions around the new bodies that are being established. Should I ask that in terms of the independent pricing authority? In terms of the processes that will be undertaken, setting the efficient pricing, that will be established through that process. That is correct, isn’t it?
Ms Halton —Yes.
Senator SIEWERT —Is that going to be subject to review? If there is a disagreement over the price that has been set by the authority, what happens? I am predicting that there may be.
Ms Huxtable —I am just reminding myself. There is a section in the agreement that goes to the operation of the IPA, which has quite a lot of detail in it about the expectation of how the IPA will work. As usual, I cannot find exactly the bit that I want, but my recollection is that parties can make submissions to the IPA in respect of efficient price matters—so the states and the Commonwealth—but the IPA is the binding decision maker.
Senator SIEWERT —Sorry, I missed that.
Ms Halton —The independent pricing authority is independent, literally, and it has the capacity to determine what the price is. There is a provision in the agreement where it says, essentially, that the Commonwealth health minister and Treasurer have a reserve power in exceptional circumstances. I will just read you the part that comes from the agreement. It says: ‘The Commonwealth health minister and Treasurer should only exercise the reserve power when the Prime Minister and the first ministers of four states and territories, including at least three states, have agreed, prior to the exercise of their reserve power, to tabling any direction or decision in the Commonwealth parliament.’ The pricing authority is independent. It will be enshrined in legislation, so that will be available for scrutiny if that legislation passes, obviously. The notion of what any reserve power would be was explicitly agreed as part of COAG.
Senator SIEWERT —So that is a reserve. In terms of the internal process of the way the authority would run, is there a process whereby somebody can ask for a review prior to that, or is the only review process those reserve powers?
Ms Halton —There is nothing that I am conscious of in the agreement that goes to that issue. You probably fully understand that we are working through the precise detail of this with our state and territory colleagues at the moment, so I cannot answer that question in the negative or the affirmative at this point. And understanding, as you will, that the pricing authority will have a constant process of interaction with all of the parties engaged in this, not just states, territories and departments of state, but also hospitals and others.
Senator SIEWERT —I appreciate that, but you can also appreciate that, while it will be a process of consultation, that is different to a formal process whereby someone can trigger a review or ask for a review. If I understand correctly, what you are saying is that that has not been worked out yet. My question is: is that part of the discussions? Is what will be the review process for the authority outside of the reserve powers? I understand the issue around reserve powers, but that seems to me a pretty extreme use—
Ms Halton —Yes.
Senator SIEWERT —That would be an extreme process to use those powers, which you are not going to want to do if there is a state or even a local hospital network, for that matter, questioning or seeking a review. So is that process part of the discussions?
Ms Halton —It will need to be part of the discussions.
Senator SIEWERT —Thank you. The process around the issue of making binding determinations about cost shifting and border issues in health and hospital systems: what precisely does that mean, and does it involve penalties? Cross-border is not such an issue in Western Australia, I have got to admit, but the cost-shifting issues are. When it says ‘making binding agreements’ what does that mean and will there be penalties involved?
Ms Halton —Binding agreements usually involve, in this respect, money.
Senator SIEWERT —Yes, exactly.
Ms Huxtable —In the agreement itself, it refers to the binding determination powers of the IPA, but also says ‘with a view to resolving issues in a definitive, lasting and nationally consistent manner’. So I think that probably gives us some clue as to the sorts of determinations they may make. It also notes here, though, that mechanisms in respect of the binding nature of the determinations will need to be agreed by COAG in 2010-11. Again, that is one of the issues that, at the next layer of detail, will need to be worked through in terms of their operating guidance.
Senator SIEWERT —I have heard statements like ‘making final decisions’ et cetera before, but I have not seen that that has stopped cost shifting so far. What overall provision are you making to ensure that data collection is consistent across the states and the territories? The issue around data is relevant to this issue and it is relevant to the performance authority and, I would have thought, the Australian Commission on Safety and Quality in Health Care.
Ms Halton —Essentially, exactly as you say, what we have to do is ensure that data that is collected is collected on standard definitions and is consistent. In some areas that will be very easy to achieve and in other areas there will be quite a bit of development work that will be needed. If I give you, as an example, the safety and quality commission, there was a safety and quality commission meeting only held in the last week where, in fact, this issue was discussed and indeed the private sector were explicitly saying they want to be collecting and providing data on exactly the same basis as the public sector. So I think there is a great acknowledgement across all domains that what we now need to do is ensure that the way we collect data and are then able to analyse it is completely consistent. But there are a lot of legacy systems out there in terms of how data is currently managed, and in some cases that will take us a little while to sort out.
Senator SIEWERT —Okay. Is there one approach that has been taken for this whole process now, so that there are not individual negotiations going on over the data for each of the authorities, for example, and there is a consistent approach across all the states for all the data?
Ms Huxtable —For the data that is required to establish the national efficient price, there are clauses in the agreement about the need in the agreement that states will provide data according to the national classification systems. In respect of the performance authority I believe—and I could take it on notice and look for it—that there are similarly commitments made about the provision of data in a consistent way. There will be some core data that is common, but it will not necessarily be common across the two bodies when the pricing authority is very much focused on determining the national efficient price. The performance authority would be very much focused on what is actually happening within a local hospital network area in terms of the health outcomes in that area, so there will be different types of data. I am sure there will be a common set—and my colleagues who understand these matters more than me will be able to jump in, if you wish—but there will also be some more specific things that go into each of those governance bodies.
Senator SIEWERT —Thank you.
Ms Flanagan —Senator, I might just add that in the 2008 COAG agreement there was agreement to a work plan to come up with nationally consistent data definitions, certainly for hospital episodes of care, and also, I think, a performance framework that was also agreed at that time. One would imagine that those bodies of work that are currently underway would be handed over or form the basis of the work that the new authorities will undertake.
Senator SIEWERT —Thank you. What has been the progress made in those two areas?
Ms Flanagan —Mr Martin might be able to give some more detail.
Dr Martin —The progress is according to the plan that was published in the national partnership agreement, or what we sometimes refer to as the 2008 COAG ABF agreement. Progress is, I understand, proceeding according to plan, and the rollout of that planned nationally consistent data development has informed the timetabling of the movement through state-specific prices to efficient prices. So that nationally consistent data will form the base upon which efficient pricing is to be built when that comes.
Senator SIEWERT —Okay.
CHAIR —Senator, I am going to have to step in and move to the other agencies.
Senator SIEWERT —Okay. One more question on that. Can I just clarify: what you are saying is that you are on schedule for the time table that was set out in the partnership agreement?
Dr Martin —So I am informed, yes.
Senator SIEWERT —Okay. Thank you.
Ms Huxtable —Just before we finish, the reference on the performance authority is D6 in the agreement, which is on page 35.
Senator SIEWERT —Thank you.
CHAIR —We have now got 15 minutes each for the National Blood Authority and the Australian Organ and Tissue Donation and Transplantation Authority. Thank you, officers from acute care. Senator Carol Brown has questions for acute care which she will put on notice with a reference to Tasmania—I do apologise, Senator Brown—and there are questions on notice from Senator Adams from Western Australia.
[12 pm ]