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Community Affairs Legislation Committee
HEALTH AND AGEING PORTFOLIO
Australian Commission on Safety and Quality in Health Care
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Community Affairs Legislation Committee
Fierravanti-Wells, Sen Concetta
Di Natale, Sen Richard
Furner, Sen Mark
Boyce, Sen Sue
McKenzie, Sen Bridget
Bushby, Sen David
Wright, Sen Penny
Siewert, Sen Rachel
Dr M Smith
McLucas, Sen Jan
Ms C Smith
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Community Affairs Legislation Committee
(Senate-Wednesday, 15 February 2012)
HEALTH AND AGEING PORTFOLIO
Department of Health and Ageing
Australian Commission on Safety and Quality in Health Care
Dr M Smith
Ms C Smith
Senator DI NATALE
Aged Care Standards and Accreditation Agency Ltd
National E-Health Transition Authority
Senator DI NATALE
Senator DI NATALE
National Health and Medical Research Council
Senator DI NATALE
Australian Institute of Health and Welfare
Australian National Preventive Health Agency
Senator DI NATALE
Australian Radiation Protection and Nuclear Safety Agency
Food Standards Australia New Zealand
Office of the Gene Technology Regulator
Therapeutic Goods Administration
Ms A Smith
Senator DI NATALE
- Department of Health and Ageing
- HEALTH AND AGEING PORTFOLIO
Content WindowCommunity Affairs Legislation Committee - 15/02/2012 - Estimates - HEALTH AND AGEING PORTFOLIO - Australian Commission on Safety and Quality in Health Care
Australian Commission on Safety and Quality in Health Care
CHAIR: We now move to the Australian Commission on Safety and Quality in Health Care.
Ms Halton : If I could apologise on behalf of the acting CEO—
Senator FIERRAVANTI-WELLS: It is Dr Smith?
Ms Halton : Yes.
Senator FIERRAVANTI-WELLS: Can you tell me what advice the commission has provided to Medicare Locals on safety and quality in primary care, when did this occur, what issues were covered, how does the information sharing occur, and what formal involvement will the commission have with Medicare Locals?
Dr M Smith : The Medicare Locals being formulated are still working their way through the specificities of their safety and quality approaches. The commission has adopted, over the last five years, a whole series of safety and quality programs, many of which are directly applicable into the primary-care arena. As the commission continues to do its work, it is specifically looking at its areas of medication safety, healthcare-acquired infection, clinical standards et cetera to make sure that they are directly applicable to care outside of hospital and the Medicare Locals, as they develop, are going to be a prime contract for us in making sure that we have an appropriate contact in the community-based healthcare professions.
Senator FIERRAVANTI-WELLS: Can you take on notice the more specifics of the particular components of that question that I asked?
Dr M Smith : Certainly, we would be happy to.
Senator FIERRAVANTI-WELLS: Can you tell me what advice the commission provided to the local hospital networks on safety and quality issues, how will the commission work with local hospital networks, and can you detail the data and information sharing processes with local hospital networks?
Dr M Smith : In the same way, I am happy to take that on notice and provide you with a detailed response.
Senator FIERRAVANTI-WELLS: Thank you. Has the commission provided any advice to the Independent Hospital Pricing Commission, can you detail the nature of that advice and when and how it occurred, and whether you have provided any input on hospital-acquired complications that may be excluded from funding under activity-based funding?
Dr M Smith : The commission is considering its response to the draft pricing framework. It is not yet complete but it will be done prior to the required date.
Senator FIERRAVANTI-WELLS: The National Health Performance Authority was to be up and running from 1 July 2011 but you are still in the pipeline. When are you going to be fully established and operational?
Dr Watson : I have been Acting Chief Executive of the National Health Performance Authority for two weeks. As you know, the act was passed in late 2011. We now have appointed board members, and the appointment of the chair and the deputy chair was made public mid-last year. The performance authority will hold its first meeting of the board members in March this year.
Senator FIERRAVANTI-WELLS: Could you take on notice staffing numbers and classifications for the authority? Given that the authority was to have produced reports on hospitals, local hospital networks and Medicare Locals from 1 July last year, according to portfolio budget statement at page 355, when do you expect to see your first reports?
Dr Watson : We are doing the work now in preparation for the first meeting of the members of the performance authority.
Senator FIERRAVANTI-WELLS: You said March?
Dr Watson : Late March.
Senator FIERRAVANTI-WELLS: In relation to all three aspects?
Dr Watson : Yes. One of the items in the agenda for the members is consideration of the topics and timing of report releases.
Senator FIERRAVANTI-WELLS: I have some questions on the national health funding pool.
Ms Halton : This is not a body or a person.
Senator FIERRAVANTI-WELLS: No, I am just asking.
Ms Halton : Mr Maskell-Knight can assist.
Senator FIERRAVANTI-WELLS: Can you tell me when this body is to be established, details, plans and progress?
Mr Maskell-Knight : There is not such a body as the national health funding pool, as the secretary just explained. There is an administrator of the national health funding pool and they are to be assisted by the national health funding body. The legislation to establish the position of administrator has to be passed by all states and territories and the Commonwealth. This lucky individual will have to wear nine different hats. Because legislation has to be passed by all jurisdictions, it has to be passed in the same format so discussions have been going on with great regularity for the last five or six months. We are hoping that legislation will be introduced this autumn into the Commonwealth parliament.
Senator FIERRAVANTI-WELLS: It certainly will not be operative by 1 July this year.
Mr Maskell-Knight : We have every intention that it will be; I see no reason why not. Having said that, of course I cannot speak for what the parliament might do, but I would have thought that if we introduce in autumn and pass in winter it should be up and running from 1 July.
Senator FIERRAVANTI-WELLS: This year?
Mr Maskell-Knight : Yes.
Senator FIERRAVANTI-WELLS: I have a question on the lead clinicians groups: what is the status of the lead clinicians groups? How many have been established and in what locations?
Ms Halton : The CMO can talk about the National Lead Clinicians Group.
Professor Baggoley : I can indeed. The National Lead Clinicians Group had its first meeting late last year, in early December as I recall it. It has its objectives of prioritising development of national clinical standards and guidelines, being a source of multidisciplinary and multisectoral clinical advice, being the focal point for engagement of senior clinicians, and providing an opportunity for clinicians and consumers to engage in discussion about health service delivery. It was a most successful first meeting. It was chaired by Dr Russell Stitz, an eminent surgeon from Queensland who previously has chaired the Committee of Presidents of Medical Colleges. There are 15 members, as well as a number of ex officio members. They include nine doctors, including a surgeon, a psychiatrist and four GPs, two from rural areas, as well as one academic. There is a palliative care specialist; an indigenous doctor; an obstetrician; a gynaecologist; a physician and a geriatrician. There is a dentist, two nurses—one with particular aged care expertise—a nurse practitioner from an emergency department, two allied health people, a physio, a pharmacist and a consumer. The next meeting is anticipated in early March, already focusing on clinical guidelines, particularly those that have been produced through the National Health and Medical Research Council. The National Lead Clinicians Group hit the ground running very hard and is continuing to fulfil its charter.
Senator FIERRAVANTI-WELLS: How many groups are going to be established and in what locations? Do we have an idea of that?
Ms Flanagan : I will ask Ms Anderson to perhaps give you the detail but we are currently negotiating with states and territories on local lead clinicians groups. They have been asked whether they want the local lead clinicians groups to be funded through states and territories or, in effect, set up around local hospital networks. Another model that is being contemplated at the moment is that Medicare Locals might also auspice a local lead clinicians group. We are currently negotiating that. Ms Anderson might have some more detail on where we are up to.
Ms Anderson : I understand it might be in the purple book. I think it indicated that we would be pursuing the establishment of the local lead clinicians groups this calendar year. We are, as Kerry said, working through the negotiations with each jurisdiction. There are different auspicing options. One of the rate determiners is the establishment of a new architecture. Local hospital networks are still coming into being in some jurisdictions. Medicare Locals similarly are in the process of being established. Until we have the two pillars, we cannot build the bridge.
Senator FIERRAVANTI-WELLS: Do we have a time line for fully rolling these out around the country?
Ms Anderson : We are confident that we will have the first allocation of funds to all local lead clinicians groups by the end of this financial year.
Senator FIERRAVANTI-WELLS: How far are you behind the original timelines?
Ms Anderson : We are on track.
Senator FIERRAVANTI-WELLS: I have some staffing matters which will probably need to be taken on notice, but we might just try. As an aggregate, what is the total value of staff salaries within the GP superclinics branch of the Department of Health and Ageing? Is that something I will have to ask in the GP superclinics area?
Ms Halton : You can ask it here because I will have to take it on notice.
Senator FIERRAVANTI-WELLS: How many staff does this relate to? What proportion of this is salaries to staff working in the GP superclinics program and what proportion is salaries to staff working on the primary care infrastructure grants program?
Ms Halton : I will take it on notice.
Senator FIERRAVANTI-WELLS: If other senators have some general questions I could come back for a couple more after that, if I may.
Senator DI NATALE: I have some questions on the number of FOI requests from the tobacco industry. Could you provide me with some information on that? I am interested particularly in whether the number of FOI requests has increased since the government's recent plain packaging legislation.
Ms Halton : We normally take this under outcome 1. I am just seeing whether the relevant people are here with information, and they are not yet.
Senator DI NATALE: No problem. I am happy to wait.
Senator FIERRAVANTI-WELLS: On that point, we can cover alcohol and those sorts of questions under the program.
CHAIR: We have often taken general FOI questions in this area. I am sorry to give you the—
Senator DI NATALE: That is all right.
CHAIR: Do you have any other general questions?
Senator DI NATALE: I am okay. Thank you.
CHAIR: Senator Furner.
Senator FURNER: Firstly, I ask some questions around basic general portfolio about the Health Reform Agreement. In particular, perhaps you could explain to the committee the transparency of the funding arrangements and how that will be improved as a result of the Health Reform Agreement reached by COAG.
Mr Maskell-Knight : The Commonwealth makes funding available in the form of block grants to states and territories, a top-up to that funding, and makes it available to public hospitals. It is reported in budget papers in various ways. It is very difficult—apart from in Victoria where hospitals are set up as separate entities with their own audited accounts—to work out what a particular public hospital spends. Under the National Health Reform Agreement Commonwealth funding is to be on the basis of activity as a general principle, block funding for some other hospitals. It is all to flow into state accounts within the national health funding pool. The states are to make their payments for activity based funding for hospitals into that same state account and then the administrator of the national health funding pool is to disperse that to local hospital networks. The administrator is also to report every month on how much money has gone where and on what the basis for that funding was.
Senator FURNER: You mentioned that it will be on activity by the states.
Mr Maskell-Knight : Activity based funding, yes.
Senator FURNER: That will be the transparency arrangements.
Mr Maskell-Knight : There will be transparency in that it will be clear what activity has been provided at a local hospital network and how much money has gone to them because of that. It will also be clear what other funding has been provided in the form of block grants to that local hospital network.
Senator FURNER: Could you also explain to the committee what the Commonwealth is investing through health reforms in the states and territories this financial year for subacute beds, emergency departments and elective surgery?
Ms Flanagan : I am hoping one of my staff will have the detail but, ranging across both health reform itself, under the recently signed agreement there will be a significant increase in base funding as well as—
Senator FURNER: Sorry, what was the increase?
Ms Flanagan : Ms Smith will have the detail. There are a number of components of funding that will be provided to the states and territories. There will be a significant increase in base funding. There will also be funding flowing through the national partnership on improving hospital services, which goes to your question around subacute money—money to improve elective surgery throughput and also funding to increase targets around emergency department throughput. Ms Smith can you give you the figures.
Ms Smith : Under the National Partnership Agreement on Improving Public Hospital Services, emergency department funding is $750 million over the life of the NPA, elective surgery funding is $800 million and subacute funding is $1.6 billion. There is also a flexible funding pool of $200 million which can be used for any of those streams—elective surgery, subacute—as determined by the state. They can apply it as they need to.
Senator FURNER: The $200 million is a top-up, then, of any of those streams.
Ms Smith : All the states have done different things. Some have put that funding into subacute, and some have shared it across elective surgery and emergency. They are able to use that flexibly.
Senator FURNER: How does that compare with previous financial years in terms of overall funding in those particular areas?
Ms Smith : Under the previous National Partnership Agreement on Hospital and Health Workforce Reform in 2008, $750 million was provided to emergency departments and $500 million was provided to subacute care. In addition, the elective surgery waiting list reduction plan in 2007 had $600 million available to all states and territories for elective surgery.
Senator FURNER: I do not have any further questions. Thank you.
Senator BOYCE: Ms Halton, I think you told us that you were expecting to have staff cuts of around 700 or so people to meet the efficiency dividend requirement.
Ms Halton : No, I think the last time we discussed numbers we were talking about a combination of the strategic review and efficiency dividend, and I think it was not quite that high.
Senator BOYCE: What I am seeking to ask is: could you update me on the anticipated impact of the efficiency dividend on DoHA?
Ms Halton : We are in the process of working through the numbers at the moment. As you would understand, there is a combination of factors here, both number of positions and the dollar value of those positions. What we are trying to do is finalise what the numbers actually are. We have not finalised the numbers yet.
Senator BOYCE: You have not finalised them, but you must have some sense of—
Ms Halton : We have some sense of the order of magnitude, yes.
Mr Stuart : In the PBS after the last budget we said that the strategic review and other measures would result in a reduction of about 420 staff from the core department over a two-year period. That was about a 10 per cent reduction. We now think we will be in the order of about a 13 per cent reduction in the core department over those two years.
Senator BOYCE: We were discussing before all the other bodies that hang off the department. What are you anticipating there?
Mr Stuart : The core department is about 4,000 staff.
Ms Halton : You might want to explain that to Mr Hockey, who seems to think I have 6,500 staff, which I do not.
Senator BOYCE: Would you like to have 6,500 staff?
Ms Halton : Of course, I would love to.
Senator BOYCE: We will see if we can arrange it.
Ms Halton : The colleagues behind would love to have 6,500 staff too. We can tell you what that number looks like but the final number—
Senator BOYCE: Yes, please.
Mr Stuart : The 13 per cent is somewhere in the order of 520 staff reduction over two years.
Senator BOYCE: Are you anticipating that 13 per cent would apply to the organisations that—I do not know your term for this—
Mr Stuart : The portfolio agencies; no.
Ms Halton : No, this is the department itself.
Senator BOYCE: Just the department.
Ms Halton : Yes.
Senator BOYCE: Are you anticipating that there will need to be efficiency dividends in agencies or are you expecting those to be managed by the agencies, as required?
Ms Halton : They will have to be managed by the agencies, although the measures that we are taking to drive efficiency—for example, back-office functions et cetera—we are working with all the agencies on how efficiencies can be delivered.
Senator BOYCE: Would you be able to provide perhaps a table on that, Mr Stuart, in terms of the numbers and what 13 per cent looks like?
Ms Halton : We will take it on notice.
Senator BOYCE: Thank you.
Senator FIERRAVANTI-WELLS: In relation to the issue of flexible funds, they were put out to open tender. I note from your application, and I am not sure where I actually found it, that applications needed to be received by 23 December. I did try and find the Health System Capacity Development Fund but was unable to do that. Leaving that aside, how many applications were received in relation to each of those funds? Is that something that is available?
Mr Stuart : Yes, I can tell you that. There were six funds advertised in November. The Aged Care Service Improvement and Healthy Ageing Grants Fund received 625 applications; the Substance Misuse Service Delivery Grants Fund received 224 applications; the Communicable Disease Prevention and Service Improvement Grants Fund received 72 applications; for the Health System Capacity Development Fund the department received 220 applications; for the Substance Misuse Prevention and Service Improvement Grants Fund, the department received 54 applications; and for the Chronic Disease Prevention and Service Improvement Fund the department received 370 applications.
Senator FIERRAVANTI-WELLS: Did the application make applicants aware that the final decision-maker was the minister? Did the application also explain that successful applications must agree to do media? Is that the situation?
Mr Stuart : The program guidelines made it clear—as program guidelines are intended to do; they are intended to point out all the conditions to the applicants so that they are very clear—the program decision-maker in the case of each of the funds is the minister. I am unaware of the answer to the other question; I think I would have to look at that more closely.
Senator FIERRAVANTI-WELLS: My understanding is that you did have that. I do not have a copy of it here at the moment but I would have thought that somebody must know the nature of the application. If that is the case, is that not a situation where under the previous system people had been assured, if I can put it that way, of funding, whereas now it is an open tender? Were potential applicants advised that there might potentially be hundreds of applicants? How were they informed in relation to that? Not being an applicant myself, I was not able to access that information.
Ms Halton : I am not quite sure as to the purpose of your question. For any process through which government advertises funding, anybody who applies, I think, anticipates that they will not be the only person who applies.
Senator FIERRAVANTI-WELLS: In relation to each of those, how many of those applicants were unsuccessful?
Ms Halton : There has been no decision taken yet.
Senator FIERRAVANTI-WELLS: When is that decision going to be made?
Mr Stuart : We anticipate, on current timetable, that that will be towards the end of March.
Senator FIERRAVANTI-WELLS: It is presumably in the process where it is either with the minister or shortly to go to the minister.
Mr Stuart : The department is still assessing applications.
Senator FIERRAVANTI-WELLS: It will go to not just the one minister, because, for example, applications for the ageing one would go to Minister Butler.
Ms Halton : Exactly.
Senator FIERRAVANTI-WELLS: I accept that. Is this not a matter of the minister picking winners? What criteria will he use in relation to making his final decision?
Mr Stuart : Each of the funds was very clear, in terms of the guidelines accompanying those funds, about the criteria that will be used to assess applications and also about the way that those would be assessed.
Senator FIERRAVANTI-WELLS: Can you explain the rationale for 'the successful applicant must agree to do media'?
Mr Stuart : I am sure that is not a direct quote from the guidelines.
Ms Halton : We will get the guidelines and perhaps we can come back to this.
Senator FIERRAVANTI-WELLS: If you get me the guidelines. The effect, as I understand, of that provision is that successful applicants agree to do media. What if successful applicants do not agree to do media? Is that going to discriminate against them? Did you have a case where people refused to do media?
Ms Halton : We are having a hypothetical conversation here. We want to get the guidelines to have a look at the exact words and then we are happy to have the conversation.
Senator FIERRAVANTI-WELLS: Presumably, by the time the answers to questions on notice are due, you will be able to give me the figure of those that are unsuccessful. Could you also tell me if there are applicants who refused to agree to do media, presumably media that is in favour of the government of the day.
Ms Halton : You are making a presumption. I want to see the words and then I am happy to have that conversation. Mr Stuart has indicated that they are due at the end of March but, the truth of the matter is, until ministers have decided and announced—we will give you on notice the answers to those questions when those decisions are made. Whether or not it is in that timetable or shortly thereafter, as soon as the minister has decided, of course we will be very happy to answer that question, but the hypothetical we will discuss when we actually have the words.
Senator FIERRAVANTI-WELLS: I might just leave it there and that means we have got five extra minutes.
CHAIR: Unbelievable. We have finished five minutes early in a segment, which I think is unprecedented in this committee. That completes questions for the opening area of general questions. We will go to morning tea and then we will come back at 10.25 with primary care.
Proceedings suspended from 10.09 am to 10.2 6 am
CHAIR: Good morning, Mr Janssen. I believe that Senator McKenzie has a couple of questions for you.
Senator McKENZIE: Just a couple of quick questions and then you can be on your way. They go to the incentives for GPET around getting GPs out into the regions. Could you expand on what they are.
Mr Janssen : Our contract with the Commonwealth has certain requirements as to distribution. A key requirement is that at least 50 per cent of all training activity takes place in what are called 'RA2 and beyond' localities. That is a classification system for localities essentially outside of the capital cities. In distributing training places we ensure that the distribution is such that it does result in quite an extensive amount of training taking place not only just outside the capital cities but right across to the most remote areas. We do this through our own agreements with training providers that are required under their contracts with us to meet certain distribution requirements. As a consequence, we have been able over the recent years, as the training program has grown, to grow the number of registrars training in more remote areas at a greater rate than even the regional areas closer into the cities. Providers themselves have incentive arrangements and support for accommodation and other arrangements for registrars, each determined on the basis of the particular regional characteristics and needs. It is essentially driven by a particular approach to distribution of the training places.
Senator McKENZIE: I have a follow-up on the methodology around what constitutes a region, because there seems to be no one whole-of-government perspective on what constitutes a region. For instance, is Geelong, with a population more than the whole state of Tasmania, considered a regional area under this scheme?
Mr Janssen : When I have used the term 'region' I have been reflecting the distribution or the pattern of regional training providers that we have contracted to GPET. There are 17 of those. Some are quite small. For example, the provider called Bogong is centred around Albury-Wodonga in the Alpine area and surrounds. Others are quite large—for example, WAGPET, a single provider for all of Western Australia, but within WAGPET they have eight or so regions or nodes for training activity which they would operate and registrars are allocated to. There are locally engaged medical educators and so on to support them. The 17 training providers themselves, or at least a number of them, have within their boundaries multiple regions and they organise themselves in such a way as to be able to service those.
Senator McKENZIE: Bogong region obviously includes Benambra, Omeo up on the top of the mountain and Albury-Wodonga regional city at the base. From what I can gather from what you were saying earlier, you have got a distribution mechanism within your allocation and then the regional training providers within that Bogong region have other incentives, so that all the training is not happening in Albury-Wodonga, it is getting out to those smaller hospitals.
Mr Janssen : That is right. Each year we consult with the providers as to the distribution. The way we fund providers also reflects the comparative cost of training, which may be greater in more remote areas, so, with the distribution of training extending to more remote areas, the funding that we provide to those particular training providers also increases.
Senator McKENZIE: Including travel costs et cetera?
Mr Janssen : We provide a global amount to each training provider through a funding methodology. At the regional level—at the provider level—they will allocate and make resource decisions around what they identify as the needs, in order to get an appropriate balance of incentives in place to get registrars to particular localities.
Senator McKENZIE: Can you provide on notice the amount of your funding contract? You mentioned earlier that you are contracted.
Mr Janssen : With the Commonwealth?
Senator McKENZIE: Yes.
Mr Janssen : Yes, I can get that figure.
Senator McKENZIE: Thank you.
CHAIR: Now we will move back to the outcomes. We will start with 5.1 Primary Care Education and Training.
Senator BOYCE: Where do GP superclinics come in?
CHAIR: We are all agreed GP superclinics are 5.2. On that basis, we will move to 5.2. There is a number of senators with questions in this area. Who wishes to start?
Senator McKENZIE: With regard to healthdirect Australia, for each month since July 2007, of all call episodes leading to a 'seek medical care within one to four hours' recommendation, what proportion of callers are confirmed to have obtained that care?
Ms Halton : Sorry?
Senator McKENZIE: With regard to healthdirect Australia.
Ms Halton : That is the call centre; it is not GP superclinics. That is why we are looking confused.
Senator McKENZIE: Sorry, yes, my fault. The end of my questions are to GP superclinics, which is where I left off my reading earlier. Sorry, my apologies. Does the Palmerston GP super clinic include a childcare centre?
Ms Taylor : We are aware that there is a childcare centre in that precinct. I am not totally sure whether it is open at this point.
Ms Halton : I have seen it but it is in the precinct.
Senator McKENZIE: How many children are in it? Indeterminate? That is fine.
Ms Halton : Sorry, Hansard, I don't know how you would report a waving hand!
Mr Butt : I have been to the precinct as well. It is part of a Northern Territory precinct which has a whole range of services. The child care is not part of the superclinic itself but it is in the whole collection of services provided there.
Senator McKENZIE: Was the childcare centre part of the original operational plan submitted to the department?
Ms Taylor : No, it was not part of the GP superclinic.
Senator McKENZIE: There is an article in the Northern Territory News—does the department have any comment to make about the article which I am now locating?
Ms Halton : Would you like to table it for us to have a look at?
Senator McKENZIE: Absolutely. We might go back to general questions.
Senator BOYCE: Is that childcare centre currently being used?
Ms Halton : We do not know. It is not part of the GP superclinic, so I cannot answer the question. We have all seen it. I cannot say that I saw children in it but that is all I can say; that is merely anecdotal.
Senator BOYCE: Let us work our way through the superclinic, shall we?: How many GPs have you got working at Springwood superclinic?
Ms Taylor : There are several GPs there who started on the clinic's commencement, and I understand they are looking to recruit over the next couple of weeks. I believe there are probably about two at the moment.
Senator BOYCE: Two full-time GPs?
Ms Taylor : I am not sure whether it is full time.
Senator BOYCE: Will you be able to check that for me?
Ms Taylor : We could.
Senator BOYCE: You have no idea what the capacity of those GPs is, how many patients they can see and so forth?
Ms Taylor : No, we do not track that sort of information.
Senator BOYCE: How do you know if they are operating properly?
Ms Taylor : There are no set numbers for the number of patients a GP will see a day.
Senator BOYCE: Are they not supposed to open for certain hours?
Ms Taylor : Yes, they are.
Senator BOYCE: If they have not got GPs there, they presumably cannot open.
Ms Taylor : There are always GPs there.
Senator BOYCE: Perhaps you could give me the full-time and part-time GPs that are there. You are confident that they are operating for at least normal business hours and that there is always a GP on the premises.
Mr Butt : That particular superclinic began operating on 30 January, it is a hub-and-spoke arrangement and it is building up at the moment in terms of patients, staff and so forth; so it is very early days for that one.
Senator BOYCE: Are there any specialist services being offered at Springwood at the moment?
Ms Taylor : The range of services that I understand are coming out of Springwood at the moment are practice nurses, allied health professionals, dieticians, diabetes educator, psychologist, chiropractor, physiotherapist, occupational therapist and an exercise physiologist. They anticipate to have shortly, if they are not already there, an ophthalmologist and a cardiologist. There is a kiosk for pharmacy dispensing. I believe that there pathology, sleep services and radiology will be in a facility across the road. A lot of those are sessional until the patient base builds. Clearly there is no point in having people sitting there full time—
Senator BOYCE: You can confirm that if I needed to see someone from those lists of specialists at Springwood superclinic there would be one there; that those services are being delivered as required?
Ms Taylor : We have been advised by the applicant, yes. As I said, that does not mean to say they will be in there on a daily basis but, as far as we are aware, those services are available at the clinic and will build, in time, as the patient base builds.
Senator BOYCE: How many GPs should be at Springwood GP superclinic?
Ms Taylor : We do not mandate the number of any particular staff at a clinic. That is entirely up to the operator of the clinic.
Senator BOYCE: I am told that the scoping for this said there would be 10 GPs operating out of Springwood.
Ms Taylor : That may well be true over time. I think they do have plans to increase over the first two to three years, but, again, it really is dependent on the patient base for the clinic. There is absolutely no point aspiring to have 10 GPs if you have only got enough patients for five.
Mr Booth : As Ms Taylor says, in terms of the GP superclinics, as they are established, they are established in a particular location and then they build up over time.
Senator BOYCE: That is a bit circular, is it not? If there aren't GPs there will not be patients, and it will go round and round.
Ms Taylor : It is very expensive to have GPs sitting in clinics without patients.
Senator BOYCE: I absolutely agree. In a letter to the committee on 9 January 2012—I am moving on to Redcliffe now—the secretary of the committee said that the GP superclinic funding agreement was based on an 'older template'. Can you explain what that means?
Ms Taylor : Over time, as the program has developed, we have improved the template. It was just a feature of when that actual clinic was signed up and the original template at that time was the one in use for Redcliffe.
Senator BOYCE: What are the differences between the old template and the new template, so to speak?
Ms Taylor : There is a number of things, mainly cosmetic, in terms of changing the ease of use of the template there are improvements around securities, reporting and milestone deliverables. In terms of the ease of working through the contract and finding out where all that information is there are slight changes to the frequency of things like bank account statements, reports on construction—a range of improvements of that nature.
Senator BOYCE: Why was that template not provided when you first set out the generic GP superclinic funding agreement?
Ms Taylor : As with most programs, we live and learn and we make improvements as we go along. The original template, I assure you, was developed by lawyers with specific construction experience and experience around the types of activities that we were looking to have funding recipients achieve.
Senator BOYCE: Can you, perhaps today, give us a copy of that older template? Is there a generic copy of the older template to be had?
Ms Taylor : I will have to look; possibly.
Senator BOYCE: It would be good if we could get that as quickly as possible. How many clinics signed up using the older template?
Ms Taylor : I could not tell you. As I said, it has been an iterative process, so there have probably been about three or four different templates over time.
Senator BOYCE: Could we then perhaps have a copy of each template, please, as soon as possible?
Ms Taylor : Yes.
Senator BOYCE: What has been the effect of having different templates for people seeking to start superclinics? How level is the playing field?
Ms Taylor : The playing field is level. There is nothing in there that requires them to do anything fundamentally different to what they did in the first place. As I said, it is just improvements around presentation and, essentially, reporting and those kinds of details. It is not additional things; it is just making clear what the arrangements are.
Senator BOYCE: Can you tell us what the status of the Redcliffe superclinic is?
Mr Booth : The Redcliffe superclinic is built, has been completed, and an external quantity surveyor has confirmed that it has been completed to the value that it should be done. The Redcliffe Hospital Foundation is looking for an operator for the clinic. As soon as that happens, fit-out will be done. We are anticipating that, as soon as that is done—
Senator BOYCE: One of the issues with the superclinic at Redcliffe was that Queensland Health would not give $5 million to the foundation to—
Mr Booth : No. The issue there, and Mr Butt may want to comment on this, was that because the clinic is built on Queensland Health land they needed to get the approval of the Queensland Minister of Health before they could apply for a loan.
Senator BOYCE: For them to borrow. I beg your pardon.
Mr Booth : They were not taking the loan from there; it was the approval process that was the issue there.
Mr Butt : For many months the indication and the written advice from Queensland Health was that they were recommending that a loan be approved and that they should talk to Treasury about getting a Treasury loan. Then, at the last minute, we were told—
Senator BOYCE: Where is that at now?
Mr Butt : What happened was that, as was announced late last year, we put in place arrangements to provide them with an additional $3.2 million to complete the building because they were unable to achieve the loan because the Queensland Health minister refused to give approval for it. As Mr Booth has said, that building is now complete and the organisation is looking for an operator to run the building.
Senator BOYCE: How long has it been complete and empty now?
Mr Butt : I think it was 31 January that the certificate of completion was signed off.
Senator BOYCE: Do you think it was completed on 30 January, Mr Butt, or do you think it had been completed for some time by then?
Ms Halton : It is not complete until there is a certificate.
Senator BOYCE: I beg your pardon. Yes, I realise that. I am just looking at the redaction in the agreement between the government and the foundation which was provided on notice following on from last estimates. I was a little surprised to find that—and I am having trouble finding it now—the date of the agreement, its commencement, had been redacted. Why is that? I am looking at page 64 of 78, sections 4 and 5 of schedule 1: the date that 'The organisation must commence the works on or before …' is blacked out and the date 'for practical completion for the works …', which is presumably when you got your completion certificate, is also blacked out. Why on earth are those dates commercial-in-confidence?
Senator McKENZIE: Privacy?
Senator BOYCE: Whose privacy, Senator McKenzie?
Mr Booth : When we go through the questions on notice we do try to give as many dates and as much of the information as we possibly can in terms of the information that we do provide.
Senator BOYCE: Why are the dates confidential?
Mr Booth : When we go through the questions on notice what we have to do, as you will be aware, is contact all external parties who are party to the agreement. We need to ask the external parties whether they agree to the information being released and put into the public arena. The majority of those private sector companies come back and say that they feel the information they provide is commercial-in-confidence and they would be concerned if that information were put into the public arena, because they believe that it would negatively impact on their business. In terms of doing this, we—
Senator BOYCE: Mr Booth, I am asking you to specifically explain to me why a date would negatively impact on someone's business, other than the Department of Health and Ageing's and the minister's alleged sticking to the timetable.
Mr Booth : The timetables are stuck to, but, as I say, we do two things: we look to the external people and we also take legal advice. Mr Reid may want to comment on the legal advice side.
Senator BOYCE: I do not want to spend too much time on this. I just find it completely bizarre that the dates, which mean that in fact this could be kept accountable, have been blacked out.
Mr Reid : The dates that things happen may be commercially confidential when you take into account that there is a certain amount of information publicly available about what is happening in the progress of the superclinic.
Senator BOYCE: That still sounds like 'covering the backside'-type confidentiality, but I will move on.
CHAIR: Senator Boyce, I will remind you that for the last period you have been cutting across the witnesses' answers, so I remind you—
Senator BOYCE: We have very limited time and listening to a long and involved—
CHAIR: That is okay. It still does not make any difference if you intrude on the answers.
Mr Butt : Could I add a bit on the comment about the accountability. We work on the GP superclinics program, as on all other programs, in the sense that we require the organisations that are funded to achieve milestones and deliverables. So we are very clear about accountability on that. Until we get that milestone and the deliverables and until that is signed off, they do not get any additional funding. That is very clear.
Senator BOYCE: The milestones and deliverables are way out from what was initially proposed by then Prime Minister Rudd and then Minister Roxon. I ask now about question E11-136 from the October estimates. We asked:
Has any GP Super Clinic applied for and been denied additional GP Super Clinic funding
We did not get an answer that told us whether any clinic had been denied funding. Could you answer that, please.
Mr Booth : As the answer indicated, from time to time funding recipients have raised the issue of additional funding. As a general rule, the department does not give details of organisations seeking funding from the Commonwealth. That is part of the business affairs, again, of the private company as to whether—
Senator BOYCE: I am not asking for details. I am asking for a yes or no: have any GP superclinics been denied additional funding.
Ms Halton : It depends on what you mean by 'denied additional funding'.
Senator BOYCE: They asked for additional funding and did not get it.
Ms Halton : As in capital funding?
Senator BOYCE: We asked about GP superclinic funding. I mean any sort of funding—any additional funding of any sort.
Ms Halton : I will have a look at this on notice. I will have another look at the answer to this question and talk to the officers about this. We cannot answer the question now.
Senator BOYCE: The answer to that question on notice was received on 24 January, which was two months after the deadline. It would be good if we can get the answer very promptly.
Ms Halton : I am conscious of the fact that there is a balance here between the specific question about individual bodies, and not being able to answer questions about that, and the generic question. I take your point about the generic question. I will have a look at it and we will see what we can tell you on notice.
Senator BOYCE: The next question, of course, would be to give as much information as you could about which clinics were denied additional funding.
Ms Halton : I understand your interest, but I will take it on notice. I want to have some further discussions about it.
CHAIR: You are finished, Senator Boyce?
Senator BOYCE: We are sharing; I think that is the answer here.
CHAIR: Senator McKenzie.
Senator McKENZIE: I hope you have the article from the Northern Territory News.
Ms Halton : Yes, I have it.
Senator McKENZIE: I just wanted the department's response to those issues but also to the AMA's concerns in the article about superclinics.
Ms Halton : One would make the observation this is the NT News; no more need be said, I suspect.
Senator McKENZIE: I am a Victorian; sorry.
Ms Halton : Reputation spreads across the country in this respect. What I can tell you in relation to the latter part of that commentary is that, in terms of the total timing, the program is on schedule. I just make that observation to you. On the question about precisely what basis those comments were made on, if they indeed were made, in terms of the second clinic in Darwin, the colleagues can talk to you about where that is up to.
Mr Booth : At the last estimates we talked briefly about Darwin. The issue with Darwin was that an ITA was put out but no responses were received to that ITA. There were no applications put in for that. What subsequently happened was that—
Senator McKENZIE: Do we know why? Do we have any on-the-ground knowledge as to why nobody was interested?
Mr Booth : In building the superclinic there?
Senator McKENZIE: Yes.
Mr Booth : There could be a variety of reasons in terms of—
Senator McKENZIE: Has the department done any work? That would be an important thing—an evaluation of a program to work out why people did not pick it up—wouldn't it?
Mr Booth : What has been going on is that we do know that with the Palmerston Super Clinic there were issues around location and where it could be, but things have moved on slightly in that the Northern Territory government were interested in looking at a superclinic. We understand that they are continuing to look at that. In terms of a couple of other issues that are actually in the article, it notes at the bottom that AMA president Steve Hambleton had asked the ANAO to do an audit. As I think we have previously indicated, the ANAO have said that they are going to audit the superclinic program and they are coming in this year.
Ms Halton : Let us be clear: the ANAO do not work at the behest of the president of the AMA.
Senator McKENZIE: I think we are all clear who the ANAO work at the behest of, and it is fantastic that they are going to do a review. Can I move on to Cobram up on the Murray, a region that is dear to my heart. On the Cobram GP Super Clinic, was the extension and refurbishment of the existing facility in the Cobram district health precinct already underway at the time the Commonwealth funding was announced?
Ms Taylor : The building itself was completed in January. It lacked the dental facilities. They were not able to be completed as part of that project. The superclinic funding enabled the fit-out—or an enhancement, refurbishment or however you would like to term it—and completion of that dental wing. Yes, the building had already been completed. There is no sense that we are trying to cover that up. It is that the refurbishment was required to make practical the use of that facility.
Senator McKENZIE: Was the extension and refurbishment of the existing facility in the Cobram district health precinct already underway at the time the funding agreement was signed?
Ms Taylor : As I said, the building had been completed in January. My understanding of the funding agreement being signed was—
Senator McKENZIE: Is that a blacked-out date?
Ms Taylor : No, we tell the world when our funding agreements are signed. Cobram was signed on 3 May.
Senator McKENZIE: The funding agreement was signed on 3 May?
Ms Taylor : That is right. The facility was finished in January; the funding agreement was signed in May.
Senator McKENZIE: I would like the department's perspective on whether the dental services would have been provided at Cobram whether or not the Commonwealth had provided the funding.
Ms Taylor : Our understanding is that there was an issue around the dental services in Cobram given that an existing practice there had closed down. They had not been able to attract any successors to that particular practice, so they were struggling to provide dental services to the town.
Senator McKENZIE: Is that because of a lack of facility or a lack of dentist?
Ms Taylor : I believe it was both. I believe it was ageing infrastructure that made it very difficult to attract new dentists to the town to work in the existing infrastructure. With the funding that we put into the medical and dental facility, that improved those facilities and enabled a number of new dental staff to be taken on, as well as enabling dental trainees and training to happen, which was not happening previously.
Senator McKENZIE: I am referring to question E11-380 from October about the Darwin GP superclinic, if we can turn to that one. It was not sufficiently answered in part (a). Can the department guarantee that the full $5 million promised for the residents of Darwin will still be spent on or has been reallocated on primary care infrastructure in Darwin? A simple yes or no would be fantastic.
Ms Halton : That is not a decision for the department. So no, we cannot give you a yes or no answer. There are a series of things that go to that question and ultimately this is not the department's decision.
Senator McKENZIE: What sorts of things go to that decision?
Ms Halton : A viable proposal and then a decision of government.
Senator McKENZIE: So the answer is no.
CHAIR: That is not the answer; the officer gave the answer.
Ms Halton : No, that is not the answer.
Ms Taylor : I believe there has been significant press from the Northern Territory health minister about discussions with the current health minister about progressing that proposal, so it is very much an issue that is alive.
Senator BUSHBY: Thank you to the department and parliamentary secretary for assisting us. On Sorell GP superclinic, I asked questions at the last estimates and I put one on notice. The answer to question E11-376 from October estimates indicates that the GP superclinic funding agreement with Sorell Integrated Health is being terminated 'at the agreement of both parties'. However, the media reported at the time that Edward Gauden, of Sorell Integrated Health, said:
We've definitely not withdrawn from the project. The Minister's release is absolutely wrong.
Can the department provide a comment on what seems to be a clear discrepancy between the two positions?
Ms Taylor : It was clear at the time in quotes in the media that what the minister had said was a direct quote from what the Sorell Integrated Health people had said, which was that they could not continue to develop the superclinic under the available funding. That was picked up in the media and interpreted as the Sorell Integrated Healthcare team having withdrawn, which clearly was not what was represented by the minister. We never attempted to suggest that they had withdrawn. We quoted exactly their comments to us after they had undertaken a range of activities to decide whether or not they could continue with that clinic. I think that is where the differentiation comes about.
Senator BUSHBY: The differentiation is the department determined the conditions on which Sorell Integrated Health wanted to proceed were not conditions on which it could proceed.
Ms Taylor : The Sorell Integrated Health proposal was costed at significantly more than the available money. It had been made clear for many months that that additional money they required was not available. They then told the department that, given the amount of money that was available, they could not proceed. We did not tell them anything. We just told them that this was the amount of money available and they chose not to go ahead with that amount of money.
Senator BUSHBY: Does the quote 'at the agreement of both parties' mean there was a mutual termination agreed to? It appears there were two different parties who had two different ideas as to whether the clinic was proceeding based on the differing conditions that surrounded it in terms of money and other things.
Ms Taylor : I believe it is an issue of semantics. Sorell Integrated Health are clear that they cannot go ahead given the current funding arrangements. They have made that choice not to go ahead. The department respects that view. There is no more money available and we are coming to terms around that termination. There is no sense that they are not a party to that termination.
Senator BUSHBY: In coming to terms about the termination, has a deed of mutual termination been signed or finalised?
Ms Taylor : It has not at this point. We have had legal advice very recently about a couple of the terms put to us by Sorell Integrated Health and we are working through that advice at the moment.
Senator BUSHBY: Do you anticipate having that finalised?
Ms Taylor : Very soon; absolutely.
Senator BUSHBY: In days, weeks, months?
Ms Taylor : I could not tell you exactly the time frame for that. We are working on it. We need some more details in line with the advice from the lawyers.
Senator BUSHBY: Do you anticipate that there will be any payment from the Commonwealth to Sorell Integrated Health for the termination of the agreement?
Ms Taylor : No.
Senator BUSHBY: Will there be any payment from Sorell Integrated Health to the Commonwealth for the termination of the agreement?
Ms Taylor : There is money to be returned to the Commonwealth, yes.
Senator BUSHBY: Is that a publically available figure?
Ms Taylor : No.
Ms Halton : We have to take that on notice.
Senator BUSHBY: The money that was made available for the Sorell GP Super Clinic—I know that there was an advertisement in the paper late last year, 10 December 2011, in which there was an invitation to apply for funding in three streams. What exactly does that mean?
Mr Booth : That is part of a program called the Primary Care Infrastructure Grants program and that is part of that; no?
Ms Taylor : It is slightly different. Just bear with me one moment so I can get you some more information. Those grants are based around—
Mr Booth : Based around that program.
Ms Taylor : That is right.
Mr Booth : There are three streams of grants that are appropriate there. The grants of between $150,000 and $500,000; stream B for grants of $500,000 to $1 million; and stream C for grants between $1 million and $2 million. The advertisement asked for applications within those three streams. The closing date for applications is 27 February.
Senator BUSHBY: When is the date for closure for those applications?
Mr Booth : 27 February.
Senator BUSHBY: We will probably ask more about that in June how that went there. I note that the funding amounts available according to that is $2 million. The original GP Super Clinic allocation was $2½ million. There is half a million dollars that has been expended in the development of the GP Super Clinic and failed. Is that correct?
Mr Booth : No, those are the streams in which different applications can come in, so people can apply within those streams. It would depend on the application as to which stream they went in.
Senator BUSHBY: According to the advertisement, it says funding up to a total of $2 million is available. The original allocation was $2½ million.
Ms Taylor : That is right. There was an amount of money spent on the Sorell Integrated Health Super Clinic.
Senator BUSHBY: Is it a breakdown of where that half a million dollars went to?
Ms Taylor : I believe we answered that at the previous estimates. The money was spent on—
Senator BUSHBY: Do you have final figures for where that half a million dollars went?
Ms Taylor : We have not had exact final figures, but I know it is around half a million dollars and I know it went on architectural fees, design fees.
Senator BUSHBY: If you can provide updated figures to what you provided at the last estimates in terms of how much for each of those areas, that would be appreciated.
Ms Taylor : I will take that on notice.
Senator BUSHBY: I will leave it there. That is fine.
CHAIR: More on GP Super Clinics. I know Senator Fierravanti-Wells had some more questions on Medicare Locals.
Senator FIERRAVANTI-WELLS: I have questions on Medicare Locals.
CHAIR: I want to conclude each item. I want to conclude GP Super Clinics before we move on to another item. I know we have healthdirect questions and we have Medicare local. I am calling now for GP Super Clinics.
Ms Halton : If we are done with GP Super Clinics, at that point I want to come back to something Senator Fierravanti-Wells asked which I need to deal with.
CHAIR: I will just check on super clinics before I—
Ms Halton : Yes, fine.
CHAIR: Senator Furner, then we will go back over here to super clinics.
Senator FURNER: Could you go through the list of communities that will benefit from the new GP Super Clinics program?
Mr Booth : We can give an update on the GP super clinics that are up and running and we can say where those GP super clinics are. Since we last updated the committee at the last estimates there have been an additional four GP super clinics that were constructed and are now providing services. That makes a total of 22 altogether. I will quickly run through the list. The GP super clinics that are currently up and running, the 22 operational ones: Ballan, Bendigo and Berwick in Victoria; Blue Mountains in New South Wales; Brisbane, the Annerley Hub, and Logan Hub and Bundaberg in Queensland; Burnie and Clarence in Tasmania; Cobram in Victoria; Devonport in Tasmania; Geelong in Victoria; Grafton in New South Wales; Ipswich in Queensland; Modbury, South Australia; Palmerston in the NT; Playford North, South Australia; Port Stephens, Queanbeyan, Riverina, Shellharbour and Southern Lake Macquarie in New South Wales; Strathpine in Queensland. Those are the 22 that are fully open and operational. We expect a number to come on stream in the short term as well. We can certainly provide the listing of the 22 that are available.
Senator FIERRAVANTI-WELLS: We have already that and the table that was provided on GP Super Clinics on the eve of estimates.
Mr Booth : The table was there, but I think the table was correct up to January and there has been an additional three that have come on stream since then. We will give you the table and then you can have the fully updated version about the 22 operational on that.
Senator FURNER: Out of that 22, just focusing on some if I describe as specialised areas or specialised services, would you be able to identify what those services might be that are being provided for these particular sites: Port Stephens, Queanbeyan, Riverina, Shellharbour, Southern Lake Macquarie—
CHAIR: Are you wanting an answer for each of those clinics separately? I am a bit worried about time.
Senator FURNER: In general, overall, because I understand there might be some unique services provided in these clinics as opposed to the other 22.
Ms Taylor : Certainly Port Stephens has a specific focus on its ageing population and they run a number of services there very specifically for that population. Which were the other sites?
Senator FURNER: Maybe some in Queensland—Brisbane Southside, Ipswich and Strathpine.
Ms Taylor : The Brisbane Southside and Ipswich clinics again have a variety of urgent care services so people can walk in off the streets if they cannot get appointments at their general GPs. I cannot remember which of the two it is, but I think it is the Brisbane Southside. Anyway, one of those two has services which are outpost services for street people, people without services of other GPs. They also have services for the disabled and a range of specific services that they are working with a number of the local community organisations providing particular services for homeless people and refugees as well.
Senator FURNER: Any Indigenous services, in particular?
Ms Taylor : I believe one of those. If you want me to have a look, I can, but I am just conscious of the time.
CHAIR: Considering the importance of the question, we will put it on notice.
Ms Taylor : Yes.
CHAIR: We have some more questions on GP Super Clinics, then we have three on healthdirect and then we have Medicare Locals. My understanding from the opposition is that is the rest of this area. I am just checking, Senator Di Natale, do you have any questions in primary health? Senators Furner or Brown on primary health? We will start with Senator McKenzie. You have a couple of GPs, then we will go to healthdirect.
Ms Halton : Can I just answer that question?
Ms Halton : Before the break Senator Fierravanti-Wells asked in relation to a suggestion that there was a requirement that people were 'required to do media' I think was the language used. We cannot find such a requirement, so could Senator Fierravanti-Wells help us with the reference. What I can tell you is that the guidelines that are established for the flexible funds are in accordance with Commonwealth grant guidelines and anyone who is successful will be listed on the web. Anything which is over $10,000 is listed on AusTender, as you know:
In the ITA the applicant agrees that
· a description of the project
· amount of funding and the name of the organisation
may be reported on the web in line with the Commonwealth Grant Guidelines used by the Commonwealth and media releases and other publications and/or used to compile a composite report. In the standard funding agreement the participant must acknowledge the financial and other support it has received from the Commonwealth (a) in all publication, promotional and advertising materials, public announcement and activities by it or in its behalf in relation to the project or any products, processes or inventions developed as a result of the project and in the standard agreement no right or obligation in this agreement is to be read or understood as limiting the participants' rights to enter into public debate or criticism of the Commonwealth, its agencies, officers, employees or agenda.
I think that is what that says. I cannot quite read the writing. As far as we can find the documents collectively and individually place no obligation on a grant recipient to 'do media'. As long as I have been working in grants administration, which I regret to say is rather a long time, we have had a requirement that people acknowledge Commonwealth funding and we also know that ministers of every persuasion have issued press releases in relation to successful grant recipients.
Senator FIERRAVANTI-WELLS: I will put further questions on notice in relation to that.
Ms Halton : If you can find something, because we cannot find it.
Senator BOYCE: The Emerald Super Clinic: have you got a date on when that was intended to be operational, please?
Ms Taylor : The arrangements for the Emerald GP Super Clinic were that we have recently completed an ITA process which was to be a direct funding arrangement with a local consortium. We are assessing that application at the moment, so there is no date associated with that.
Senator McKENZIE: I am conscious of time. I have got two, and I will put the rest on notice and we can move on. For each of the operational GP super clinics mentioned earlier, on a monthly basis since 1 February 2011, can you please provide the number of GP presentations and also the number of nursing allied health presentations?
Mr Booth : We do not provide information on an individual clinic basis because that is a matter for the individual clinic. We can provide general information for the whole program.
Senator McKENZIE: You have the data though.
Ms Taylor : We collect that data not a monthly basis, but I believe it is an eight-weekly basis.
Senator McKENZIE: If we have the data, I am presuming we could report it or give it out.
Ms Taylor : Yes, on a two-monthly basis.
Senator McKENZIE: Thank you, I will put that on notice. In response to earlier estimates question No. 385, the department was asked why the government decided not to collect data on the number of afterhours services being performed by GP superclinics when one of the functions of the GP superclinics program was to provide after-hours services. We understand that the department is not collecting this information, but the unanswered question remains: why is the data not being collected?
Ms Taylor : What the department is interested in is that they do in fact provide after-hours services.
Senator McKENZIE: Yes.
Ms Taylor : That is clear off their websites in terms of the extended hours of service.
Senator McKENZIE: Part of the evaluation of that service surely should be collecting data around the types and numbers of presentations after hours.
Ms Taylor : I understand there is an interest in that, but we do not do it.
Senator McKENZIE: I will put the rest on notice.
CHAIR: No further questions in-house on GP superclinics, so a number will be on notice. Thank you to the officers for super clinics; we move on to healthdirect. Senator McKenzie has some questions.
Mr Booth : The question was around healthdirect.
Senator McKENZIE: Yes, for each month.
Mr Booth : And numbers of—
Senator McKENZIE: The one-to-four-hour recommendation.
Ms Murphy : Can I give you a little bit of context about healthdirect?
Senator McKENZIE: Only in a very short amount of time because I am very conscious we have some other questions around Medicare Locals as well as healthdirect.
Ms Murphy : The question was about the data, was it not?
Senator McKENZIE: Yes. We want for each month since July 2007 all call episodes leading to a 'seek medical care within one to four hours' recommendation. What proportion of callers are confirmed to have obtained that care?
Ms Murphy : I cannot give you each month at the moment; I can give you the data for midnight on Sunday night. At midnight on Sunday night we had 60 per cent of the callers that came in—that was about 97,000 callers—referred to the GP because they were seeking a doctor immediately, they were assessed by the nurse that they needed to see a doctor immediately or they would need to see a doctor within four hours.
Senator McKENZIE: Sixty per cent of those callers at midnight on Sunday?
Ms Murphy : Yes, at midnight on Sunday. The total calls that came in midnight Sunday was—
Senator McKENZIE: Not all at midnight, up to midnight.
Ms Murphy : Up to midnight.
Senator McKENZIE: Very busy midnight hour. That is a lot of people on the phone.
Ms Murphy : Sorry, from 1 July to midnight Sunday we had 97,000 approximately calls.
Senator BOYCE: 1 July 20011 to—
Senator McKENZIE: Yes, Sunday night.
Mr Booth : 2011. This has gone from 1 July 2011.
CHAIR: I am totally confused.
Senator McKENZIE: No, I have it.
Mr Booth : The thing here is that the GP line was established from 1 July 2011.
Senator McKENZIE: Yes.
Mr Booth : This is when people phone up. Prior to then people would phone up and just talk to a nurse. As of 1 July 2011 people could phone up and then be referred on to a doctor.
Mr Booth : These figures, the almost 100,000, are from 1 July 2011 when that service started.
Senator McKENZIE: The 97,000 is the GP. Do we have some figures prior to that, when they are ringing up and talking to the nurse for a recommendation?
Ms Murphy : How many—
Senator McKENZIE: were 'seek medical care within one to four hours as a recommendation'?
Ms Murphy : Can I take that on notice? We do not have that detail today.
Senator McKENZIE: Absolutely. In urban regions where a medical deputising service is available what proportion of the calls in the 'seek medical care within one to four hours' were advised specifically of that service and provided with the contact details of that medical deputising service?
Ms Murphy : We do not have that exact detail. What happens is the nurse or the doctor gives the caller three options if those three options are available in the region. It could be there is a GP after-hours service open, here it is, here is the contact; there is the medical deputising service in the region, here is the contact; or none of those are available and there may be an emergency department available in your region. We do not specifically direct callers to one service in particular; we give callers some options in that area. If the only option is a Medical Deputising Service, that contact is given.
Senator McKENZIE: Once we have given the recommendation, how do we confirm that they have taken the advice?
Ms Murphy : That is compliance.
Senator McKENZIE: Yes.
Ms Murphy : The issue about compliance, either with the doctor on the telephone or the nurse on the telephone, is very similar to compliance with a face-to-face GP service. We are not recording compliance at the moment. The National Health Call Centre Network, who is the company that runs the healthdirect service, is doing a study of follow-up with callers and they are looking at the issues of compliance: What happens? Do callers take the advice? Do they turn up at the services that the nurse or the GP might call them to? That is going on at the moment; I do not have data on that around compliance.
Senator McKENZIE: That work is being done; when can we expect to have some information?
Ms Murphy : We will have it pretty soon, because we are interested in that data, to give that information to Medicare Locals who also have a role in the afterhours space. The importance of this service, it will identify where callers are not able to seek afterhours services and Medicare Locals' roles are to fill those gaps in after hours. We will have that soon, possibly by June this year.
Senator McKENZIE: It will be really important for the super clinics to be recording how many people present after hours.
Ms Murphy : Of course. What we are doing at the moment is working with the National Health Call Centre to provide that sort of data to Medicare Locals about where the calls are coming from within their region, the age, demography, all sorts of things around those callers. That data will be provided.
Senator McKENZIE: Finally on this topic, and then we will go to Medicare Locals, can the department confirm that any healthdirect Australia calls are referring any patients to the medical deputising services?
Ms Murphy : We have the medical deputising service linked and listed on the national directory that complements this service. I have spoken a number of times to the National Medical Deputising Association about the accuracy of that data and that that data is available. I can confirm that data is available to doctors and nurses to triage patients too.
CHAIR: Moving to Medicare Locals, Senator Fierravanti-Wells has the call.
Senator FIERRAVANTI-WELLS: How much funding is provided specifically for Medical Locals for each year over the forward estimates?
Ms Roe : There are two ways to answer that question; from 2012-13 approximately $171 million for core funding to fund the 62 regional Medicare Locals and also the new national body from 1 July.
Senator FIERRAVANTI-WELLS: That includes the 12.5 million for the national body?
Ms Roe : Yes.
Mr Butt : Includes 4 million for next year, so it is 12 million over three years.
Senator FIERRAVANTI-WELLS: The 171 million is over forward estimates for the four years?
Ms Roe : That is correct, for the basic core funding.
Ms Roe : Over and above that, one of the flexible funds is the Regionally Tailored Primary Health Care Initiative Through Medicare Locals Fund. The guidelines are being worked through on that and most of that will take effect from 1 July this year. That has recently been the subject of a discussion paper out in consulting with the stakeholders. The total of that is 1.4 billion over 2011-2012 through to 2014-2015. That includes that core funding but it also includes components like after hours, aged care access, rural primary health services. There are about eight different levels of program funding that have been collapsed into that flexible fund.
Senator FIERRAVANTI-WELLS: That is to be shared by 220 people, or whatever, who have that—
Ms Roe : No, it is predominantly to go to Medicare Locals.
Senator FIERRAVANTI-WELLS: How many are now established and operational?
Ms Roe : There were 19 established from 1 July last year, which is tranche 1, and a further 18 established from 1 January this year, tranche 2.
Senator FIERRAVANTI-WELLS: There has been criticism in the press and other places in relation to the inability to explain to the health sector the roles and activities. Can you explain, for example, that a tender that closes tomorrow calling for an organisation to develop accreditation standards and appropriate support and training materials for Medicare Local, there is a tender process which is due to close tomorrow. That tender asks for services and expertise to undertake a whole series of things to develop accreditation standards for Medicare Locals. You have already 19 up and running, you have 18 and you are still asking for tenders for accreditation standards. Isn't this policy on the run?
Ms Roe : No, definitely not. It has been a requirement—
Senator FIERRAVANTI-WELLS: What accreditation standards are they now operating under?
Ms Roe : If I can answer the question, senator. It has been a requirement for about the last four or five years for all divisions of general practice to be accredited; it is a requirement of their funding. If they lose that accreditation, they lose their eligibility for funding. It is a level of surety to the rest of the network and also to other funders about the quality of the services provided and that certain things around the business and the governance are in place.
Senator FIERRAVANTI-WELLS: These ones that have been operational for six months, they have been accredited and supported presumably under old rules that were under operation to the divisions; is that what you are saying?
Ms Roe : No. You have a copy of the funding agreement; there is a requirement once there is an accreditation framework in place that Medicare Locals have to be registered within three months.
Senator FIERRAVANTI-WELLS: I appreciate that. I am not asking for when you finally get your accreditation act together, I am asking what rules are they now operating under. I asked you if they were operating under the rules of the previous division. You have just said to me no they are not. You tell me accreditation might occur at some stage down the line, what are they actually operating under now?
Ms Roe : If the funding that they receive is through a Medicare Locals deed, there is no requirement at this point in time other than a commitment that they have to, once there is an accreditation framework up and available, and that will be available from January next year.
Senator FIERRAVANTI-WELLS: At the moment they are not accredited and they are operating presumably in some hiatus period with no obligations?
Ms Roe : I can assure you, there are some significant obligations; they just do not have an accreditation framework. Medicare Locals are quite different organisations to divisions and it is quite important to look at and consult with the networks—we have not been able to consult with a lot of networks, there is only 19 in place at the moment. If you start to look at where the Medicare Locals are, they are about putting the fundamentals into place, setting up new companies, setting up their community engagement strategies and all of those things.
Senator FIERRAVANTI-WELLS: Ms Roe, the sector and I are still no closer to knowing what they actually do, so we will not go there anymore. How have they been accredited and supported over the last six months, what training has there been, if this tender is still to not deliver its outcomes until the beginning of next year?
Ms Roe : Quite a few of the divisions of general practice are still being funded as we speak, so they are required to maintain their levels of accreditation. Secondly, there is funding provided through to Australian General Practice Network around managing transition from divisions through to Medicare Locals. A significant part of that is around capacity development and looking at the needs and what is supported around that. The third part of the accreditation side of things there is we are looking at what are the requirements around the core functions, and that will be essential for all. Another centres around those Medicare Locals that provide services, because not all of them are services. That is where we need to link in with the Australian Commission on Safety and Quality in Health Care and their primary health care standards.
Senator FIERRAVANTI-WELLS: I cannot understand, Ms Roe, why this work has been tendered out in the first place and why the department amongst its thousands of employees cannot provide this expertise. Why was it not done before the Medicare Locals were established? I would have thought the obvious thing to do is to get your house in order before you establish these things.
Ms Roe : I can understand where you are coming from.
Senator FIERRAVANTI-WELLS: It is the cart before the horse, is it not?
Ms Roe : I do not believe so.
Senator FIERRAVANTI-WELLS: It sounds like you have not got your act together.
Ms Roe : We had very little time in which to establish the first 19.
Senator FIERRAVANTI-WELLS: For goodness sake, it has been around for ages.
Ms Roe : If you also recall, within a small branch we have had to then bring forward COAG—
Senator FIERRAVANTI-WELLS: You do not have enough resources to do what you are supposed to be doing; is that what you are saying, Ms Roe?
Ms Roe : No, that is not what I am saying.
Ms Halton : No. The reality is, if you look at a whole series of professional programs, the accreditation arrangements require discussion with people in the sector, in an environment where they have a clear understanding of the program. That does take some time to work through with the sector. Professor Baggoley might have a comment about this as well. I do not think this is exceptional at all. In terms of the expertise that is required to develop accreditation arrangements, you do not keep that kind of expertise inside departments for use once every five years or 10 years. There are people who work more broadly in the sector who do have this expertise. It is exactly the same as what goes on with the medical profession, for example.
Prof. Baggoley : The accreditation process that was developed and is still being developed through the Australian Commission on Safety and Quality in Health Care, with which I had considerable experience and input, is something that has been developed over the last six years. It takes considerable time to understand the requirements to develop standards, to work on the approach to accreditation and inspections. This is not something that one normally finds within groups; the safety and quality commission has worked right across the country in that process.
Ms Halton : Exactly.
Senator FIERRAVANTI-WELLS: There is a contract currently for tender, 8 July 2011 to 30 June 2012, for a value of $140,000. The reason for this consultancy is for management advisory services to provide advice to support selection of Medicare Locals. What precise advice does the department need, after you have established 19, and there are 18 in process? Why are you going out to tender now to get advice to support the selection of Medicare Locals?
Ms Roe : I am sorry, can you repeat which—
Senator FIERRAVANTI-WELLS: There is a contract, CN425191, and the period of the contract is for 8 July 2011 to 30 June 2012; it is for $140,000, to provide advice to support selection of Medicare Locals. Can somebody explain to me when you have 19 established, 18 in the process, what sort of advice do you now need to help with the selection of Medicare Locals?
Ms Roe : I cannot comment on why the date was that. McGrathNicol was contracted to work with the invitation to apply process and provided expert financial advice to the assessment panels on the financial stability of the applicants, so it is completed.
Senator FIERRAVANTI-WELLS: You said McGrath; that is not on the contract notice view that I have which is dated 7 February. For some reason the name of the supplier has been omitted from the tender document; I was going to ask why did you omit it and if that is another error there. Perhaps you might like to correct the record there in relation to that. What advice does the department need now after you have established 19 and you have got 18 in the pipeline?
Ms Halton : That work is complete. The fact that there might be a more extended period listed there is immaterial; the work is complete. In concert with what we do in a number of other areas, including in aged care, we contract in expert financial advice in relation to balance sheet assessments with a number of organisations. That is not expertise which you routinely maintain inside a department; you have to bring in experts to do that work.
Senator FIERRAVANTI-WELLS: The contract was in relation to selection of Medicare Locals.
Ms Halton : Yes. You need to understand whether or not they are financially viable. What you are looking for is expert advice in relation to the financials.
Senator FIERRAVANTI-WELLS: Do I understand correctly? People are applying to become a Medicare Local network and so you are then contracting out the services for assessing whether they are financially viable. Is that the gist of what this concept was about?
Ms Halton : Exactly. We take advice from experts in relation to the balance sheets and the proposals in relation to the financing. This is not an exception; we do this on aged-care services all the time.
Senator FIERRAVANTI-WELLS: Notwithstanding that most of them are formerly divisions of general practice, you are now going through the process of some sort of checking—
Ms Halton : It is called due diligence.
Ms Roe : Quite a few of the applicants were consortia of not just divisions but other primary healthcare organisations.
Senator FIERRAVANTI-WELLS: What about in relation to the 19 that you have already established and the 18 that you are in the process of doing? You have established them, and you are now doing your financial viability then?
Ms Roe : No, this was part of the assessment process.
Ms Halton : No, this was done at the time.
Senator FIERRAVANTI-WELLS: All within that process.
Ms Roe : Yes, it has been completed.
Senator FIERRAVANTI-WELLS: Can you tell me then, in relation to each of those 19 and 18, when you signed off on their so-called viability pursuant to this contract?
CHAIR: On notice.
Ms Roe : On notice, yes.
Senator FIERRAVANTI-WELLS: There is another contract here to provide consultancy on Commonwealth management of the Medicare Local network for $214,000 or thereabouts to PricewaterhouseCoopers. What services and advice do you need from Pricewaterhouse to tell you how to manage the Medicare Local network?
Ms Halton : There are a number of things we are required to do as part of program implementation and some of these requirements are imposed by whole-of-government frameworks. This was one of those.
Senator FIERRAVANTI-WELLS: That does not tell me anything.
Ms Halton : I will come back to you on notice in relation to the details.
Senator FIERRAVANTI-WELLS: I am amazed that in your department you do not have expertise that tells you how you are going to manage these things.
Ms Halton : We were required to do this by external—
Senator FIERRAVANTI-WELLS: Can you give me precisely what it is that these contracts do; these contracts do not tell me.
Ms Halton : Happy to do that.
Senator FIERRAVANTI-WELLS: And tell me where the deficiency is in your department.
Ms Halton : Let us be clear. My department was required to undertake that consultancy by a decision of government; it was not within our capacity to make a decision one way or the other. In terms of the way this program was structured, we were required to do this. I am very happy to come back to you on notice about what the consultancy did and delivered. In terms of whether it has got anything to do with the expertise in my department, that is immaterial; it was a decision of government.
Senator FIERRAVANTI-WELLS: Tell me when that decision was made.
Ms Halton : Yes, I am very happy to.
Senator FIERRAVANTI-WELLS: The thing that worries me here is that we have a whole series of Medicare Locals that have been established around the countryside at the same time as we have tenders that are calling for how they are going to be established and managed. Can you explain this to me. Shouldn't these things have been thought of beforehand as part of this so-called grand hospital reforms and health reform plan? This looks like policy on the run.
Ms Halton : No, I do not accept that. We have more methodologies about implementation than I can poke a stick at.
Senator FIERRAVANTI-WELLS: You have more bureaucracy, Ms Halton.
Ms Halton : What we have been doing is pursuing in a very logical and methodical way an approach to program implementation. That does require sometimes for us to have external financial expertise. There are some requirements put on us by government; this particular one being a case in point. There was a decision of government that this would be done in this way, and we are implementing the program in an orderly fashion and on time.
Senator FIERRAVANTI-WELLS: I still recall the words of Mr Rudd at the beginning of all this that there would not be an increase in the bureaucracy, that it would not be expanded as a consequence of these reforms.
Ms Halton : Correct.
Senator FIERRAVANTI-WELLS: Aren't we seeing expansion of the bureaucracy through the back door here? You have all these consultancies out there, which are doing work, in my view, that ought to have been done properly in house. Is this not effectively an expansion of the bureaucracy?
Ms Halton : No.
Senator FIERRAVANTI-WELLS: In that case, could you provide to me the total external value of consultancies that have been contracted by Health to assist in any aspect of this health reform since 2007? I have picked out two today; there are many more consultancies, Ms Halton, that are all directly relevant to so-called health reform. When you add all those together and you see the large amount, it is bureaucracy in substitution. I will put my question on notice in more detail in relation to that because I know I do not have time at the moment.
Ms Halton : I think we—
Senator FIERRAVANTI-WELLS: Ms Halton, I have one more important question that I want to—
CHAIR: You cannot ask a question and make a statement without allowing—
Senator FIERRAVANTI-WELLS: I made a statement. I told Ms Halton that I would put my questions in relation to this on notice.
CHAIR: Yes, I do not need to be advised. I am pointing out that Ms Halton was making a response to your previous statement. Ms Halton.
Ms Halton : Yes, thank you. In terms of (1) the cost of implementing health reform, that is very transparent; and (2) the commitment on no increase in bureaucracy, Mr Stuart has already taken you through the departmental numbers, and indeed, Dr Sherbon when he was here took you through the fact that a number of the staff that he has acquired were a transfer from the department. In terms of size of bureaucracy, the numbers speak quite simply for themselves. In terms of technical work and expertise on implementation, we can all point to circumstances where with policy change we implement things. I can point to examples over many years as secretary in this portfolio where that was the case. It is certainly the case that, to implement programs properly, you do spend some money. That is not the same as the bureaucracy that runs things; we need to be extremely clear about that.
Senator FIERRAVANTI-WELLS: Thank you. Can you explain to me the funding formula used to determine the core funding to Medicare Locals based on the characteristics of each Medicare Local community?
Mr Booth : While Ms Roe is looking for the detail there, it is a formula that is based upon a number of different population characteristics. It takes into account issues such as age, socioeconomic status and Indigenous population. English as a second language is also one of the areas within there. It is a population based funding formula which comes from a number of areas.
Senator FIERRAVANTI-WELLS: It probably needs to be fleshed out a bit more; could you give me some details on notice?
Mr Booth : We could provide you further information, but that is essentially—
Senator FIERRAVANTI-WELLS: Previously in another inquiry there was some evidence given in relation to the Divisions of General Practice. If my memory serves me correctly, it had about 300 doctors that were not actually practising doctors but were part of the bureaucracy of the Divisions of General Practice. How many bureaucrats, if I can put it that way, is it envisaged that the Medicare Local network will have in its administration of the system?
Mr Butt : I do not know where the figure of 300 came from.
Senator FIERRAVANTI-WELLS: I have tried to fish it out.
Mr Butt : I have fairly good knowledge of the Divisions of General Practice and the number of bureaucracy.
Mr Butt : There are about three GPs across the whole network who are in CEO roles; otherwise, no, there were very few GPs who worked in the Divisions of General Practice. They were on boards but they were practising GPs. The vast bulk of staff who work in Divisions of General Practice are program delivery staff or practice support stuff, so they are delivering mental health programs. You find a lot of allied health nurses in there. You find them delivering programs in practice support, GP practices, cleaning data and so forth.
Senator FIERRAVANTI-WELLS: I will fish that out for you, Mr Butt. In relation to the budget and the funding that has been allocated to Medicare Locals, what percentage of that is a salary proportion?
Ms Halton : That may need to be taken on notice.
Senator FIERRAVANTI-WELLS: If you could take that on notice.
Ms Halton : We do not allocate it in that way.
Mr Butt : No. These are private organisations; they are private companies. We do not allocate it that way. How they structure themselves is really up to them.
Ms Halton : Yes.
Mr Butt : What we do is determine the functions that they need to perform.
Senator FIERRAVANTI-WELLS: You will give them an amount of money to run that Medicare.
Mr Butt : Based on a population based formula.
Ms Halton : That is right.
Senator FIERRAVANTI-WELLS: What about the accountability back?
Mr Butt : The accountability back is in terms of them performing against the contract that we have with them and also in relation to the schedules to those contracts, which are about the various programs that Ms Roe was pointing out they are funded to provide. They have to come back on deliverables, time frames and milestones. There is a strong accountability back.
Senator FIERRAVANTI-WELLS: There have been media reports about concerns where organisations, Medicare Locals, will be forced to pay more than $100,000 a year in fees to the department to access the data they need to carry out their role. Are you aware of those criticisms? Mr Booth, what is the veracity or otherwise of those assertions?
Mr Booth : The data was in relation to the health needs assessment exercises that Medicare Locals are required to carry out. The department has not made any specific requirements in terms of the data that they need to do that. The requirement we have is that they build on their existing data sources so there is no requirement for Medicare Locals to do that. As a department at the moment we are working through wider data requirements for further down the road, when more work is being done on health needs assessment and more detail is being done. We are looking at the data that is needed, but there is absolutely nothing in that claim.
CHAIR: I understand there are significant numbers of questions on notice for this area. Thank you to the officers.
CHAIR: We will now move into the private health area. Senator Boyce is going to open up this topic.
Senator BOYCE: I want to look at the proposed savings that the government is intending with its Fairer Private Health Insurance Incentives Bill 2011. Where will the proposed savings of more than $2 billion, I think it is, over the two years, go? Will they go to consolidated revenue or are they going somewhere else?
Ms Halton : That is a question for the finance portfolio not for us. As you would understand, the structure of the budget is a matter for Finance.
Senator BOYCE: They are not currently coming to Health, to your knowledge? Is that what you are saying?
Ms Halton : We publish a budget that has spending measures and savings measures in the context of the Commonwealth budget.
Senator BOYCE: Yes. You must be having discussions about the next budget and the savings that will be coming your way—or not?
Ms Halton : The process is in the early stages and I cannot make any comments about that.
Senator BOYCE: The reason for the question, Ms Halton, is that Ms Roxon said it would be used to fund e-health, new medicines, preventative medicines and hospital beds. The Treasurer in February last year said it could offset the cost of the pension increase. Ms Plibersek this year said it was a whole year's pay for 13,000 extra doctors or 26,500 extra nurses. We have also had an article from the current health minister saying it is money that could pay for new medicines and treatments.
Ms Halton : That is my point.
Senator BOYCE: You can understand that there is some concern. You currently have no knowledge of whether this money will come into the health department or not. Is that what you are saying?
Ms Halton : All of the people you have mentioned have been on the record about the sustainability of the budget and ensuring that the budget returns to surplus. All of the things you have mentioned are things which are funded from the budget, and therefore the budget being in surplus is something which assists in the funding of important initiatives.
Senator BOYCE: Yes.
Ms Halton : I cannot answer any more than that, other than to say that I think there is no inconsistency.
Senator BOYCE: I do not think you are going to get to fund all those initiatives, Ms Halton. Can you clarify for us, now that the start date is about four months away, the process for assessing an individual's entitlement to a rebate? Some of this has been talked about before, but that was in the context of the legislation potentially not being passed.
Ms Halton : Certainly.
Mr Bartlett : In terms of assessment it comes down to individual self-assessment, assisted by their insurer, to work out whether they fit into one of the tiers and what they therefore choose to do with their rebate.
Senator BOYCE: Will they have to tell their private health insurer about their income?
Mr Bartlett : If they wish to claim a lower rebate because they believe they will be caught up under the means testing arrangements, then they will have to nominate a band within which they fit. If they do not wish to do that, they can effectively get what rebate they are entitled to through the tax system at the end of the financial year.
Senator BOYCE: As a refund though at the end of the year.
Mr Bartlett : That is correct.
Senator BOYCE: How would you imagine that people who chose to tell their insurer would do so? Is there a process for that?
Mr Bartlett : There is regular annual consultation between insurers and policyholders about things like premium changes; presumably it could be done as part of that. We have had some very preliminary discussions with insurers over quite a long period of time about this legislation. Clearly, they are aware of the issues that are there in terms of implementation.
Senator BOYCE: So there are preliminary discussions, when it is going to be rubber to the road in four and a half months. You are not going to take any part whatsoever in what constitutes sufficient evidence for insurers? They are supposed to work all that out themselves?
Mr Bartlett : The issue for insurers and the issue for individuals is that the insurers will act on the information that they are provided by policyholders. If that information is incorrect, that will be dealt with through the tax system.
Senator BOYCE: Have you discussed with the insurers whether they are going to be contacting customers and asking them, 'Does your income range suit this or not?'
Mr Bartlett : We have had a number of discussions with insurers; the most recent was late last year. We will be having more, given the legislation is passed, about implementation measures, including the questions you are raising.
Senator BOYCE: You can confirm that the default position is: if they do not tell their insurer they will wait 12 months or whatever to get the reduction through their tax for a refund. Is that right?
Mr Bartlett : There are a few possible default positions. One is that they continue to get the 30 per cent rebate, their taxable income does not entitle them to the full rebate and they potentially have to deal with that situation when they put their tax return in at the end of the year. Another alternative is that they nominate a higher level than they expect their income to be and they are owed some money or they nominate that they do not want to get the rebate as part of the payment of their health insurance premium and instead they wait to claim whatever they are entitled to as part of their tax return.
Senator BOYCE: The changes are supposedly applying from 1 July. When would people be expected to tell their insurers about what their income for the 2012-2013 year was?
Mr Bartlett : There will be communication between insurers and policyholders about premium changes that will occur from 1 April. That is clearly an opportunity for insurers to be having discussions with people. At this stage the legislation is not passed. We have not had definitive discussions with insurers about how it will work.
Senator BOYCE: But you have planned with the insurers that they would start to inform their customers from 1 April, is that correct?
Mr Bartlett : We have not as yet discussed in detail a potential campaign that will occur involving insurers and the government. That campaign cannot be finalised until the legislation is passed.
Senator BOYCE: Where does the 1 April date come from then?
Mr Bartlett : The 1 April date is when the new premiums take effect each year, so there is communication that goes out from insurers to policyholders about those premium changes. It is one opportunity. It is not the only one.
Senator BOYCE: Are insurers supposed to pass on information to the ATO about income levels?
Mr Bartlett : They will not be passing on information about income levels. That will come from the individuals themselves. The insurers provide a statement which has to be put in with your tax about what has been paid; therefore, that allows assessment. The same thing happens now in terms of Medicare Levy surcharge eligibility or non-eligibility.
Senator BOYCE: For self-employed people, have they got any option except to wait until the end of the year and have to then try to claim a refund?
Mr Bartlett : They have the same options as anybody else. The question is that they make a decision as to what works best in their personal circumstances. If they are reasonably confident they can do it upfront. If they have concerns about the possibility of a liability at the end of the year, then they may choose to leave it to the end of the year.
Senator BOYCE: They need to predict their income. If the income changes during the year, what does the individual do?
Mr Bartlett : The individual, I would assume, can either choose to notify the insurer. They may ask to have their rebate payments lowered if they think that is going to be influenced, or they can wait and address it through the tax system at the end of the year.
Senator BOYCE: Are they required to notify their insurer or the ATO of a change of income within the given year and adjust the rebate level within that given year?
Mr Bartlett : There are no requirements, as I understand it. The requirement will be that when their tax is finalised the rebate paid will match their income.
Senator BOYCE: Can people elect to adjust their rebate level throughout the year to minimise a future tax liability?
Mr Bartlett : There is nothing, as I understand it, in the legislation to prevent that occurring.
Senator BOYCE: The 'as I understand it' is not a qualification?
Mr Bartlett : The qualification is that I have not read the legislation at the level of detail to be able to say that with great certainty. I will check that and confirm it, but my understanding is that there is no prohibition on ongoing change if that is what an individual wishes to do.
Senator BOYCE: Given that you are working on this in a very full-time way and people have four months to try to get their heads around the level of detail otherwise there is a financial—
Mr Bartlett : I will check that and give you a definite answer. There is an assumption made there that people will not want to spend all of their time reassessing their income against their potential rebate liability. It would seem to be a fairly involved way of trying to deal with this process. I will have to check that and come back and confirm that it is possible. I would think it is highly improbable that people will choose to do that.
Senator BOYCE: Is there any limit on the number of times that a person could notify a change of income in a given year?
Mr Bartlett : I am sorry?
Senator BOYCE: You could notify a change of income, if you chose, once a month?
Mr Bartlett : I have just had it confirmed that there are no limitations placed by the legislation on how often you can notify people about your changes. I would question whether both you and your insurer would particularly want to have a daily discussion about where you think your income is going to end at the end of this year.
Senator BOYCE: Given that people will be confused, given that there is potential for a tax liability at the end of the year, I would think people would want a lot of information to be sure about what was happening. If someone inadvertently underestimates their income will there be any concessions for repayment through their notice of assessment?
Mr Bartlett : That is a matter for the tax office.
Senator BOYCE: Have you discussed these matters with the tax office?
Mr Bartlett : No.
Senator BOYCE: There has been no discussion?
Mr Bartlett : There is legislation in place that talks about the income tax requirements.
Senator BOYCE: Yes.
Mr Bartlett : Discussions about what decisions they will make about people who make mistakes with their tax or things like that, however you define it, are a matter for them; they are not something we would normally discuss as part of developing legislation of this sort.
Senator BOYCE: No. One would imagine that there is the potential for some large tax implications in this measure. You presumably would not also know how long people would have to repay a debt in this area if they had one.
Ms Halton : No. As Mr Bartlett has indicated, those are questions that we have to direct you to the ATO for.
Senator BOYCE: Will there be additional compliance requirements for insurers as a result of these measures?
Mr Bartlett : I am not sure what you mean by compliance requirements.
Senator BOYCE: In terms of their needing to collect this information, deal with this information, hold this information securely et cetera.
Mr Bartlett : They will have to hold information that tells the tax office and the person what private health insurance they have had and what rebate they have received. The tax office and the individual will then be in a position to work through whether or not that rebate is appropriate for their level of income. I cannot see that there is a particularly onerous level of compliance to insurers in this. It will add some extra bands of potential rebate to what they are doing, it will tier the rebate, but in and of itself it does not seem to me to be a particularly onerous compliance requirement.
Senator BOYCE: When you talk about extra bands of compliance, presumably there will need to be some systems adjustments done. Have you discussed that with the industry?
Mr Bartlett : During the preliminary discussions that have been held over a number of years with the insurers these sort of issues have been discussed. When the changes came in that allowed a higher rebate for older people; the insurers were able to implement those changes very quickly.
Senator BOYCE: That was not quite of the complexity of this, is it?
Mr Bartlett : It is identical.
Ms Halton : Yes; I do not agree with that statement. That is not right.
Senator BOYCE: The compliance of insurers is not part of the scope of what the department of health is looking at in terms of this work; is that right?
Mr Bartlett : The department of health will be working with insurers to ensure that this legislation is implemented as effectively as possible with the minimum negative impact on policyholders that can be managed.
Senator BOYCE: You have mentioned a number of times, Mr Bartlett, that there have been preliminary discussions with insurers. Will there be follow-up discussions or more determined discussions at any stage?
Mr Bartlett : Yes, there will.
Senator BOYCE: When will they be?
Mr Bartlett : We will organise something shortly. Our last discussion was late last year. At that stage it was agreed there would be a follow-up discussion early this year; we will schedule it very soon.
Senator BOYCE: How would you characterise that? Not preliminary, I presume? What term would you use for the next lot of discussions?
Mr Bartlett : It will depend where the legislation is up to. If the legislation is passed then it is—
Senator BOYCE: If the legislation has, God help us, been passed, what sort of discussions will they be?
Mr Bartlett : Discussions about the implementation.
Ms Halton : We are in discussions with the private health insurance industry all the time. I have had a number of conversations with CEOs and I am not detecting in any of those discussions any high level of anxiety about implementation of this measure from any of those people. Whilst we may organise a specific discussion, I can promise you that there are multiple opportunities for interaction with the industry from the department.
Senator BOYCE: The government has amended their own legislation so that it will start on 1 July, because it could not start in January. There was a proposed $11½ million public awareness campaign; is that figure still accurate?
Mr Bartlett : The details of the campaign and its funding have not been finalised and will not be and cannot be finalised until the legislation is passed.
Senator BOYCE: You do not know if you have still $11½ million for it?
Mr Bartlett : At this stage the final amount for the campaign has not been finalised.
Senator BOYCE: When would you expect that to be finalised?
Mr Bartlett : Fairly promptly after the legislation has passed.
Senator BOYCE: Have you spent any money on public awareness campaigns to date around this issue, Mr Bartlett?
Mr Bartlett : Not to my knowledge.
Senator BOYCE: Presuming that we are starting on 1 July, when would you commence a public awareness campaign: one month out, two months out?
Mr Bartlett : That is going to depend very much on when the legislation is passed.
Senator BOYCE: You have not got much time to get a public awareness campaign up and happening that is going to be effective by 1 July, though, have you?
Ms Halton : We are in the hypothetical; the short answer to the question is: when the legislation passes then the timetable will be determined.
Senator BOYCE: Yes. I do not think we are in the hypotheticals in terms of how long it takes to get a public awareness campaign going, but never mind.
Ms Halton : No.
Senator BOYCE: Has there been any work done to date on the public awareness campaign?
Mr Bartlett : There has been some work done within the department to scope out possible campaign approaches; there has been no specific work done on a campaign.
Senator BOYCE: What do you mean by 'scope out campaign approaches'? I do not understand that.
Mr Bartlett : If we are looking to inform people about the changes that are occurring, what are the possible options open to achieve this and what is the option most likely to achieve the best result.
Senator BOYCE: What is the budget we have for it?
CHAIR: I want to break in to say Senator Di Natale has some questions.
Senator BOYCE: This is my last question. Can you provide us any further information: when will we know what is in the public awareness campaign? Please do not tell me: 'When the legislation is passed.'
Mr Bartlett : Sorry; I cannot give you another answer.
Senator BOYCE: Thank you.
CHAIR: I have to advise the PHIAC officers that there are no questions for them. If you have been waiting there patiently, I apologise to the PHIAC officers. Senator Di Natale.
Senator DI NATALE: I have some questions about the proposed means-testing of the rebate and the Medicare levy surcharge and the modelling that has been done about that. You have information about the modelling; is that correct?
Mr Bartlett : I have some information about the modelling.
Senator DI NATALE: That was Treasury modelling?
Mr Bartlett : It is based on Treasury's model, we use Treasury's model to model the effects of not increasing the Medicare levy surcharge.
Senator DI NATALE: Can you describe the assumptions that underpin that model very briefly?
Mr Bartlett : I will let my colleague do that.
Senator DI NATALE: Then I am going to ask about some of the numbers as well. Would you have the numbers at your fingertips, perhaps, beforehand? What are the projections in terms of the impact of the proposed changes in terms of changes in coverage?
Mr Bartlett : In terms of not increasing the surcharge?
Senator DI NATALE: Yes.
Mr Bartlett : The estimate is that around 100,000 extra people will drop out of private health insurance over and above the 27,000 that are—
Senator DI NATALE: That is over and above the 27,000—that was the first question—as a result of increasing the rebate?
Mr Bartlett : Increasing the rebate, yes.
Senator DI NATALE: That 100,000 does not include the existing Medicare levy surcharge; it is over and above the people who were—
Mr Bartlett : I will have to check the exact number. From my memory it is about 193,000 people, in the last period for which we have accurate data, pay the Medicare levy surcharge.
Senator DI NATALE: We are expecting that of that group an extra 100,000 will—
Mr Bartlett : They will be supplemented by an extra 100,000 people.
Senator DI NATALE: I have some questions about the modelling and how that was done. Have you got access to that yet?
Ms Halton : We probably have not had this conversation with you in the past, but, while the officers are looking, you would appreciate that there are a number of things in respect of modelling which we do not discuss because they go to matters which are commercially sensitive and/or budget matters, which we cannot discuss. We can talk in generality.
Mr Bartlett : We have a paper that has been provided to this committee before that sets out the basis on which the modelling was done; it sets out the assumptions. We are happy to provide that to you on notice. I apologise that we cannot get it to you now.
Senator DI NATALE: Thank you.
CHAIR: Any further questions?
CHAIR: Any further questions for the issue around private health? Senator Furner.
Senator FURNER: Consistent with the questions previously asked by Senator Di Natale on the modelling, what sort of percentage will maintain—if that is able to be provided in respect of the modelling on participation in private health insurance?
Mr Bartlett : Under the current bill as put forward, the assumption is that 99.7 per cent of people will retain their private health insurance.
Senator FURNER: What does that do to the bottom line? What sorts of savings are we looking at overall as a result of these changes?
Mr Bartlett : $2.4 billion over three years.
Senator FURNER: Any further projections beyond that?
Mr Bartlett : No.
Senator BOYCE: Do you have an alternative to modelling?
Senator FURNER: I think I have got the call.
CHAIR: We do have the ability for people to jump across and have follow-up questions.
Senator FURNER: What is the current private health insurance participation rate?
Mr Bartlett : I am looking, because PHIAC has just released the figures to the end of December. That was released at noon today.
Ms Halton : It was released at noon today?
CHAIR: Very lucky that they are now public.
Mr Bartlett : I checked.
CHAIR: If we finished at 12, we would not have been able to get that.
Ms Halton : We have delivered a scoop to Senate estimates, I can tell you that!
Mr Bartlett : As at the end of December, 45.7 per cent of the population had hospital treatment cover, 53 per cent of the population had general treatment cover and 53.1 per cent of the population had private health insurance cover of some sort.
Senator FURNER: I have been on this committee now four years and we have been discussing this for that length of time. What have been the trends over not necessarily the last four years but certainly some indicative trends in respect of recent years on private health insurance?
Mr Bartlett : The trend is one of a steady increase in the numbers of people with private health insurance. Quarter on quarter there was a 50,584 increase in the number of people with hospital insurance. Year on year there was a 286,158-person increase.
Senator FURNER: Thank you.
CHAIR: Any further questions? We have a couple of minutes if you have questions, or else we can end. Thank you very much to the officers from private health.
Proceedings suspended from 12 : 13 to 13 : 13
CHAIR: We will reconvene. We are starting outcome 11: mental health. Senator Wright and Senator Fierravanti-Wells both have questions.
Senator WRIGHT: Thank you for your attendance today. Good afternoon. First of all I would like to ask you some questions about the Ten Year Roadmap for National Mental Health Reform. What consultation was conducted as part of the lead-up and process in drafting the Ten Year Road Map for National Mental Health Reform?
Ms Campion : A range of consultation has occurred on the roadmap, including a workshop convened by the Mental Health Council of Australia in September last year, where there were around 60 attendees, including the minister. Two rounds of targeted consultation with experts were undertaken by the department. The minister has also undertaken a range of stakeholder consultations. States and territories have, in addition, undertaken their consultations. In the middle of January this year we released an online survey inviting comment and feedback on the draft road map, as well as submissions.
Senator WRIGHT: Thank you. When did the two rounds of targeted consultations with the experts occur?
Mr Singh : They occurred in the second half of last year. I do not have the exact dates but I am happy to get those for you, if you wish.
Senator WRIGHT: Thank you; I would appreciate that. Were they two occasions? When you say 'rounds', what do you mean by that?
Mr Singh : There were two occasions with the same individuals.
Senator WRIGHT: Did they meet together? Was it like a roundtable—something to that effect?
Mr Singh : We provided them with the current draft and we invited their feedback. On both occasions we also facilitated a discussion by teleconference.
Senator WRIGHT: They were shown a draft of the roadmap at the time for those two targeted consultations?
Mr Singh : That is correct.
Senator WRIGHT: You said you also had some consultation with stakeholders. Could you tell me what that involved?
Mr Singh : The drafting process of the roadmap has been informed by the consultations that Minister Butler undertook with mental health consumers in late 2010.
Senator WRIGHT: How did that pan out?
Mr Singh : There were 14 face-to-face forums and an electronic opportunity which focused on consultation with young people.
Senator WRIGHT: Would you take on notice details of what those forums were and who attended them?
Mr Singh : Certainly.
Senator FIERRAVANTI-WELLS: Could you add to that who issued the invitations and how many forums were held, if I could combine that?
Senator WRIGHT: That sort of detail would be useful. I am talking about the consultation process up to the release of the draft roadmap at this stage. Over what period would you say that consultation occurred?
Mr Singh : The initial consultations helped set the directions for mental health reform, and those are the 14 sessions that I alluded to. They started in December 2010. The drafting process formally commenced in about May 2011. Since that time we have been undergoing the other processes that we mentioned—the two rounds of targeted consultations, state and territory consultations, and now the public consultation, as well as the workshop.
Senator WRIGHT: Thank you. The questions I have already put on notice will give me an answer to my question: what organisations and individuals were consulted before releasing the draft Ten Year Roadmap? That is essentially what I have asked. How many submissions to the online surveys were received in response to the draft Ten Year Roadmap before the submission period closed on 1 February?
Ms Campion : We received over 1,600 responses to the survey and over 100 formal submissions.
Senator WRIGHT: Thank you. How does the government intend to respond to this consultation process now?
Mr Singh : We are working through those submissions and the comments. Obviously, we have collected a substantial amount of feedback and we will be working through that with the states and territories to inform the finalisation of the document.
Senator WRIGHT: What is the time line for the response?
Mr Singh : We really could not say at the moment. We need to work through those comments and decide what sorts of changes need to be made.
Senator WRIGHT: No possibility of giving me an idea of a year or six months?
Ms Campion : It will be later this year, but we do not have a specific time frame.
Senator WRIGHT: Later this year is as specific as you can be at this stage?
Ms Campion : Yes.
Ms Halton : As soon as we can, I think, is the short answer.
Senator WRIGHT: Thank you—when it is totally open-ended, I have no idea. Has the new National Mental Health Commission been involved in drafting the Ten Year Roadmap up to now and, if not, will it be involved in the finalisation of the Ten Year Roadmap?
Mr Singh : They have been consulted in the drafting and it would certainly be our intention to involve them from here.
Senator WRIGHT: How would you envisage that occurring?
Mr Singh : Once again, we would provide them with a draft. At the most recent meeting of the Senior Officials Mental Health Working Group, members discussed having a roundtable with the commission to help inform wide community scrutiny of the document.
Senator WRIGHT: Thank you. My last question on the roadmap is: will the new National Mental Health Commission oversee, monitor and evaluate the implementation of the Ten Year Roadmap?
Mr Singh : The government has said that the commission will have a role in evaluating and monitoring the roadmap. I think that the exact nature of that work has not yet been decided.
Senator WRIGHT: Thank you. I now have some questions regarding Better Access. As of January 2013 the number of treatment sessions available will be reduced from 16 to 10. In light of these projected changes to the Better Access program, what programs are currently being progressed to fill the likely need for services that will be caused by the changes that will come into effect on 1 January 2013?
Ms Campion : Some of the programs that will meet the needs of those patients include the Partners in Recovery measure, which was announced in the budget package, the expansion of the Support for Day to Day Living in the Community program, an existing program which received additional funding at budget, and the Early Psychosis Prevention and Intervention Centre program.
Ms Nicholls : Also the government is expanding the Personal Helpers and Mentors program, which is administered by FaHCSIA and provides support to people with severe mental illness.
Senator WRIGHT: What about the ATAPS program? You have not mentioned that one.
Ms Nicholls : Funding for the ATAPS program is being more than doubled; additional funding of $205.9 million over five years is being provided. ATAPS does not specifically target people with more severe and persistent mental illness. ATAPS essentially has a similar client focus and target as the Better Access program, which is not to say that some people with severe and persistent mental illness, whose care needs can be met by short-term focus psychological strategies, cannot access ATAPS.
Senator WRIGHT: So if I understand what you are saying correctly, you would envisage that some of the people who will be affected by the changes to the Better Access program that will take effect in January of next year will be able to access assistance under ATAPS.
Ms Nicholls : I would probably restate that by saying that both Better Access and ATAPS have the same client group. A decision about whether a client should be referred to Better Access or to ATAPS would need to take into account what the needs of the client were. ATAPS has been specifically designed and developed to complement Better Access and to deliver psychological services and other allied therapy services to people who would not otherwise be able to access them under Better Access. It particularly targets the hard-to-reach groups like rural and remote people, people in low socioeconomic positions, and Aboriginal and Torres Strait Islanders. There has been a significant expansion in support for child mental health services as well. The decision is in relation to that. Both Better Access and ATAPS will be able to provide some support to some people with severe mental illness, but not for people with persistent severe mental illness and people who need more than the number of services that Better Access or ATAPS can provide.
Senator WRIGHT: What is the current level of funding allocated to the Better Access program for the 2012 calendar year?
Ms Nicholls : Better Access does not specifically have an allocation. It is a demand-driven program. It does not have a fixed appropriation in that sense.
Senator WRIGHT: Has a budget amount been projected?
Ms Nicholls : I may need to take that on notice. I do not think I have any modelling with me. I can tell you what we have spent in previous years.
Senator WRIGHT: Perhaps you could tell me what you spent last year if that is available. Then you can take the question on notice.
Ms Nicholls : The last financial year?
Senator WRIGHT: The last calendar year—is that accessible for you or is it in terms of financial years?
Ms Nicholls : I have it in terms of financial years.
Senator WRIGHT: Perhaps you could give me that, and then look at the projections for this calendar year, because the cuts are going to take effect as of 1 January next year.
Ms Nicholls : The expenditure for last financial year was $605.1 million. I would need to take on notice what the projections into the future would be.
Senator WRIGHT: For the calendar year?
Ms Nicholls : For the calendar year.
Senator WRIGHT: Would it also be possible to give that so there is a comparison of calendar years for the last calendar year?
Ms Nicholls : Yes.
Senator WRIGHT: I am interested in knowing the level of funding allocated to the other mental health programs that are being progressed for the 2012 calendar year—for instance, the programs you mentioned, Partners in Recovery, PHaMs, Day to Day Living and EPPIC.
Ms Campion : We can provide with you those figures, but they are in financial year terms. If you would like them in calendar year terms we would need to take that on notice.
Senator WRIGHT: Do you have the financial years available now? Then I will ask for this calendar year on notice.
Ms Nicholls : For Partners in Recovery, it is $549.8 million over five years. That funding progressively ramps up over the years, so there is only a small amount of establishment money in this financial year. In 2012-13 it is $78.7 million; in 2013-14, it is $113 million; in 2014-15 it is $162 million; and in 2015-16 it is $195.5 million.
Senator WRIGHT: Thank you. So that is the Partners in Recovery.
Ms Nicholls : Yes.
Senator WRIGHT: For Day to Day Living?
Ms Nicholls : For Day to Day Living in the last financial year, 2010-11, it is $9.9 million. For 2011-12 it is $12.1 million; for 2012-13 it is $14.1 million; for 2013-14 it is $14.3 million; for 2014-15 it is $14.8 million; and for 2015-16 it is $14.9 million.
Senator WRIGHT: Thank you.
Ms Nicholls : But there was a significant increase in funding. It represents a nearly 30 per cent increase in funding from 2010-11.
Senator WRIGHT: So for 2010-11, for the sake of completeness—
Ms Nicholls : It was $9.9 million.
Senator WRIGHT: That is Day to Day Living. What about PHaMs?
Ms Campion : Senator, that is—
Senator WRIGHT: You are not able to give that? I was not sure; I was trying my luck there. For EPPIC?
Ms Campion : There are two lots of funding for EPPIC. There was an existing appropriation from an earlier budget measure and then it was expanded in the recent budget package. I could give you the combined figures, if you would like. The allocation for this financial year in total is $9.24 million. In 2012-13 it is $29.4 million; in 2013-14 it is $51.3 million; in 2014-15 it is $70.8 million; and in 2015-16 it is $80.8 million.
Senator WRIGHT: Thank you. Has an evaluation been conducted of mental health reforms and program funding to identify service gaps or shortfalls in service delivery?
Mr Singh : An evaluation of precisely the nature you describe has not been undertaken. The budget package was informed by consultations broadly with the sector in trying to identify the types of gaps that existed, as well as being informed by a policy process that was undertaken across the Commonwealth with a very similar aim.
Senator WRIGHT: Is any such evaluation proposed in future? The reason that I am asking is that there is a concern that there are gaps in needs and services.
Mr Singh : That is one of the reasons that the National Mental Health Commission has been established. Its remit certainly involves reporting to government on gaps in the mental health system and in services for people with mental illness.
Senator WRIGHT: Can you tell me what types of mental illness, if any, have been identified for targeted service delivery and, if so, how were they identified?
Mr Singh : In essence, the budget package responded to our identification of people with particular needs, particularly those who have severe illness, severe persistent mental illness, including those with complex care needs. There was substantial investment in the budget through the Partners in Recovery Initiative and through the expansion of the Day to Day Living Program and the expanding of PHaMs, as well as a recognition of those people who have high-prevalence mental illness but whose symptoms are not as severe or as persistent and who therefore can benefit, for example, from expansion in the ATAPS program.
At the same time there was reflection that we need to do more to actually prevent mental illness and to intervene early. That particularly is applicable to young people, since the majority of people with mental illness develop symptoms at an early age. Again that was the focus of measures such as the additional EPPICs and the expansion to headspace.
Senator WRIGHT: In terms of the answer to that question, I was interested in whether there has been an identification of types of particular conditions or illnesses and how they can be targeted, as opposed to the need requirements, the care requirements. Coming back to my question: in terms of specific mental illnesses, shall we say, perhaps psychotic illnesses generally or even getting down to things like schizophrenia, schizoaffective disorder, bipolar disorder, personality disorders or depression et cetera, has there been an identification of meeting the needs of specific types of conditions or illnesses in that way?
Mr Singh : Given that the budget package was very much aimed at a system-wide response, I think in general we did not target individual clinical diagnoses. But it is generally true that some diagnoses tend to correspond with more severe mental illness such as psychosis and schizophrenia, for example, and depression and anxiety tend to be in the less severe end of the spectrum. But it is absolutely true that major depression and anxiety are also a very debilitating and severe mental illness. So those individuals would be able to benefit from the initial investments of budget.
Ms Huxtable : If I could add to that: when we were doing a lot of the policy development work there were probably two things to note. One is the importance of a life-span approach, starting from early childhood. You would be aware that in the package there are some early childhood measures. Mr Singh has already mentioned the importance of addressing the markers for future issues early in life, including for adolescence, and clearly the early psychosis and headspace measures are focused on providing mental health services to that group.
The second thing is this: recognising that, even though people may have what are called high-prevalence disorders and less severe ones, I think the very clear feedback we got from the sector was that people will move in and out of severity. There will be times in the course of their illness where they have very acute needs, regardless of whether they have a depressive illness or a psychotic episode. Really we were focusing on putting in place the system characteristics to enable responses regardless of the cause of that condition so that people would not be excluded from service because they were diagnosed with a particular condition, but rather the service would be able to meet their needs, which would vary in terms of level of acuity, effectively.
Senator WRIGHT: That makes sense to me. The reason I am asking is that we also know that there are some organisations devoted particularly to a particular condition or illness that receive funding. I am interested in what the thinking is or what the policy is behind deciding how those funds are allocated, because that is not just looking at particular services but at particular conditions.
Ms Huxtable : In the case of the mental health reform package, probably the only example of that that I can think of is the early psychosis intervention. That was very much based on the evidence that intervening early in that process can be effective in the longer term. That particularly focused on young people. We certainly had evidence—I do not have it in my head anymore—at the time we were doing the early development work that the markers of mental illness are being seen in adolescents definitely. If you can actually put in place a coordinated service—and with the EPPIC services you are looking at a service that is beyond a health service that also links into education and employment services and provides a service for the whole family—that can be effective in enabling them to manage their illness and recover. Clearly there will be evaluations that will be part of the EPPIC model. I do not think there is any other example of that within this particular package. That is not to say that there is not funding provided to organisations outside of that package.
Senator WRIGHT: That is my point really. I am not just focusing on the reform package; I am actually focusing on what has occurred historically and what the ongoing situation is in terms of decisions about funding particular organisations in relation to particular conditions, as opposed to services that meet perhaps a more generic need. That is what I am interested in.
Ms Halton : If I can make an observation here about the broader health-funding sector, if I can mix my descriptions of it: if you look at the history of how we have funded a number of areas—take dementia, or I could note several other areas—
Senator WRIGHT: Sorry, could you speak up a bit?
Ms Halton : You could take dementia as an example where we have both funded the specific organisation and funded the system more broadly. As Ms Huxtable says, what we really tried to do here—and I would draw a very clear parallel with what we are doing in relation to Indigenous health—is work on a philosophy that says that if you can make a material difference to the longer term outcome, particularly for younger people, you are going to have a potentially whole-of-life consequence, which is by definition a good thing. In this particular case, that is expressed in the kind of service type that Ms Huxtable has been outlining to you, but at the same time strengthening the whole system, because essentially you have people on a life course with a clinical history with a set of social circumstances—we could go on—and so you need to basically tackle both areas.
You can see this philosophy in a number of things we are doing in relation to health outcomes, investing both in the current but also in some prevention, we hope. Those are important philosophies. That does not mean that over a period, in common with the other parts of the health system, we will not necessarily target at a particular time schizophrenia or target at a particular time people with a personality disorder, whatever it might be. The thing that we really try to do here—acknowledging, of course, that the history and the challenge with mental health services and policy are to create a more integrated framework—now is create that framework and create that service delivery system. It is not easy.
Senator WRIGHT: No, it certainly is not easy. We would probably all agree with that. That segues into my next question quite well. We know that some groups are at high risk of experiencing mental illness. For example, some of the groups that I am aware of are people in immigration detention, Indigenous Australians or Aboriginal Australians, people living in regional, rural and remote areas and members of the lesbian, gay, bisexual, transgender and intersex community. I am interested in whether or not the department are targeting any high-risk groups in your service delivery strategy. If so, what groups would they be, and what are the programs or services in terms of actually identifying particularly high-risk groups and working out what can be done for them?
Ms Halton : The officers can talk about a number of examples. I would make an observation to you that, for example, in the approach we have to Aboriginal and Torres Strait Islander peoples, there is a long history of having identified particular risks and the need to respond specifically. If I can give you as an example the Bringing them home work and particularly the need to focus on emotional, social wellbeing for Aboriginal and Torres Strait Islander people, as well as doing very specific work on suicide, what you will see in a number of our programs—the team can talk to you about the mental health program writ large—is a number of these very specific challenges and problems being tackled, sometimes in the context of a particular program.
Ms Campion : To give you an overview of some of the initiatives that are being implemented at the moment, Ms Nicholls mentioned that the ATAPS program, with the additional funding in the budget, was provided to specifically target hard-to-reach groups or groups that are not necessarily best served through Better Access. They are Indigenous Australians, children and their families, and other hard-to-reach groups. That includes some rural and remote areas.
Also, through the Taking Action to Tackle Suicide package, we have provided some funding. I think around $30 million over five years has been set aside to focus on particular community based approaches, targeting particular groups. The initial funding that we have provided there is $1.1 million to the Lesbian, Gay, Bisexual, Transgender and Intersex Alliance to undertake a project there that Mr Mackay can explain to you, and $6 million of that package has also been set aside for Indigenous-specific suicide prevention activities. Those are some examples. I might hand over to Ms Nicholls and Mr Mackay to add to that.
Ms Nicholls : The one that I would add is in relation to the Program of Assistance for Survivors of Torture and Trauma. The name pretty well tells you what the program is about. We provide funding to some very specific services who have specific expertise in this area. There is a network of eight not-for-profit specialist torture and trauma rehabilitation agencies. They provide a range of supports to people who have experienced torture and trauma before coming to Australia.
Senator WRIGHT: On that: are they people who are not in immigration detention but they are in the Australian community?
Ms Nicholls : They are in the community; that is right.
Senator WRIGHT: Do you have any oversight at all or any input into mental health programs for people who are actually in immigration detention and whose claims for asylum are still being processed?
Ms Nicholls : The Department of Immigration and Citizenship has responsibility for that. We liaise with them in relation to the various programs but they have primary—
Ms Halton : They do not have primary carriage; they have carriage.
Ms Nicholls : Sorry.
Senator SIEWERT: I would like to ask abouta specific issue to do with intellectual disability and mental illness. You will be aware that the National Intellectual Disability Council has raised concerns around funding and specific services for those people with intellectual disability and mental illness. I am wondering: have you had a chance to specifically address those issues? When we are talking about targeting specific funds, their argument is that within the mental health program there need to be some specific programs targeting those with an intellectual disability.
Ms Campion : I have just been handed an answer to a question that we took on notice in the May hearings. I have to apologise. I have been in the position for a couple of weeks. I am still learning everything that we do. The answer to the question says that we actually do not fund any specific disability and mental illness services but that we work with the sector to improve the knowledge and skill space of the workforce to meet the needs of the client group.
Senator SIEWERT: My response to that is: have you reconsidered that approach? Given that there has been specific cause for some specific funding, what have you done in response to those specific asks? You would be aware that during the Senate inquiry the need for some subprograms within the funding programs was raised very strongly. My question is: has there been any reconsideration and have you engaged with the council?
Ms Halton : They certainly have not approached me. We have had a number of dialogues with people representing people with disability, a number in relation particularly to access to primary care, for example, in the health context. I have to say that I am not aware of that. I am happy to have a look at it.
Senator SIEWERT: For a start, I will forward you the submission and I will let the council know that there has been some specific call. It is obviously not in the road map.
Ms Halton : No. As I said, we are in the process of going through all the submissions. We have just discussed the 1,600th. There is a long way to go to make sure that all of those issues are tied off. But I am very happy to have a look at that submission.
Senator SIEWERT: Thank you.
Senator WRIGHT: I will identify one group that I did mention that I have not had an answer on and that I am interested in, in particular. Is there any particular service or targeting of people in regional, rural and remote areas, as opposed to the general idea of ATAPS being more able to access people there?
Ms Halton : The short answer is yes.
Senator WRIGHT: And what would that be?
Ms Huxtable : One of the important programs in that regard is the work that is happening around e-mental health. There is funding made available in the mental health reform package to do a number of things in the e-mental health space, including establishing a virtual clinic, but also better pathways for people to access services and information online. The evidence certainly is that that e-mental health can be very effective in supporting people with certain conditions. I am sure the officers can add more but that is one that I would certainly point to. The other is to talk about headspace and the work that has occurred with headspace to expand its reach into rural and regional areas for young people.
Senator WRIGHT: I am aware of headspace and e-mental health. Are there any other ones?
Ms Nicholls : The other one I would mention is the ATAPS program and of course the Mental Health Services in Rural and Remote Areas Program, which is specifically targeting rural and remote areas. It is funding for mental health professionals in communities that would otherwise have little or no access to MBS. Thirty organisations are funded and they are delivering 39 projects in more than 200 locations in all states and territories other than the ACT. In 2010-11, over 17,000 clients accessed services through that program. There is $32 million provided over 2011-12 and 2012-13.
Senator WRIGHT: Could I ask you to take on notice—I will not hold you up now—to identify those 30 organisations and what they do.
Ms Nicholls : Yes.
Senator WRIGHT: The other area of high risk is prisoners. Is there any targeted service at all for people in prisons?
Ms Campion : I suspect that would be an issue for the state services.
Ms Halton : Health services that are delivered to prisoners are a matter for states and territories. They actually run explicit, separate prisoner health services.
Senator WRIGHT: Thank you. I thought that might be the answer. I wanted to clarify that. I am nearly there. I think I have had my share of questions. If I have some more, I can put them on notice. Thank you very much.
Senator FIERRAVANTI-WELLS: I would like to start, if I may, with an article in the Australian dated 31 January 2012. I am happy to hand up the copy, which makes reference to an article written by Sebastian Rosenberg, John Mendoza and Lesley Russell. Are you aware of that article?
Ms Campion : Yes, we are.
Senator FIERRAVANTI-WELLS: Are you aware of that?
Mr Singh : Yes, we are aware of the article.
Senator FIERRAVANTI-WELLS: That article makes a number of comments and, more so, it is an article, as I have said, which has been co-authored by Sebastian Rosenberg, John Mendoza and Lesley Russell. For the record, Professor John Mendoza was the former, handpicked, inaugural chair of the government's National Advisory Council on Mental Health when it was established in 2008, until he resigned in June 2010. As he went out the door he made some very scathing comments. Ms Lesley Russell I understand is a former adviser to Ms Gillard when she was shadow health minister, and I understand her soon-to-be husband was working for the Prime Minister to help her deal with business. It is a very credible piece and I would like to take you through it and ask you to comment about it. The three experts say that mental health's share of the overall health budget is shrinking instead of rising. Do you have any comment in relation to that, Mr Singh?
Mr Singh : We would disagree with that assertion. While I am not sure that I have the most recent figures, certainly last year Professor Mendoza made a similar assertion. I am just trying to find the figure. The point we would like to make, though, is that increases in mental health expenditure are actually growing as fast or faster than the overall health budget. We would be very surprised if the percentage of expenditure—
Ms Halton : Therefore was lower.
Mr Singh : That is right.
Senator FIERRAVANTI-WELLS: You might like to provide me with the figures that disprove the assertion that has been made there. Also, the experts say that there is a lack of centralised definitions. I might come to one of those. In the article there was no agreement on what constitutes a subacute mental care bed. We went through this with Ms Flanagan about what a 'bed' actually is. Do we know what a subacute mental care bed is?
Mr Singh : I am afraid that question is best addressed to Ms Flanagan, given—
Ms Huxtable : I believe the AIHW have definitions of those matters. If the AIHW are appearing, perhaps they could respond to that.
Senator FIERRAVANTI-WELLS: In other words, in the Mental Health Section, you are not following at all the mental health component of the promise for the 1,365 beds, which I understand does contain a component for mental health beds? You are not following that at all?
Ms Huxtable : No, that is not what I said.
Senator FIERRAVANTI-WELLS: Perhaps if you are following it—
Ms Huxtable : I can assure you that we are well aware of the beds that are provided.
Senator FIERRAVANTI-WELLS: What is your understanding then about what progress has been made in relation to those mental health beds as part of that 'reform'?
Mr Singh : If I might clarify, there is a substantial amount of information that we collect from the states and territories in relation to numbers of beds and other services that they provide. These figures are reported in things like the Report on government servicesand the National mental health report. I would be very surprised if as part of that there is no definition of subacute service. However, what I was trying to say, in relation to that particular national partnership, is that I am afraid I do not have the most current figures.
Ms Halton : More importantly than that, we need to be clear about this. The commitment given through that agreement with the states and territories was to an aggregate number of beds. The comment that was made at the time, and I remember it very clearly, was that some of these beds could and no doubt would be used for mental health purposes. The point has already been made about the growth in expenditure and therefore it is a proportion of expenditure. It was never the case that it would be a nominated specific number of beds. So to suggest that we should be tracking individual beds—that is not the basis on which that agreement was reached.
Senator FIERRAVANTI-WELLS: In other words, you are not aware of how many? Even without tracking, are you aware that some of those beds have been allocated to mental health?
Ms Halton : As I said, we are looking at the whole system.
Senator FIERRAVANTI-WELLS: Perhaps, without wasting time now, I will ask Ms Flanagan, who is probably listening and who no doubt is going to give evidence at some stage, if she could take on notice and provide further information in relation to whether that indication—I will not call it 'commitment'—about possible mental health beds has in any way progressed.
One of the other criticisms that have been levelled goes to the lack of consistency in how these funds are used. The article makes reference to the fact that there is no clear reason why nearly a quarter of the money dedicated by Western Australia to promotion, prevention and early intervention was allocated under COAG, whereas in Queensland almost nothing was spent on the same activity. Is that criticism warranted? What about the consistency in relation to that spend?
Ms Halton : I think we need to make a point here. When agreements were struck with the states and territories, there was a very clear understanding amongst the parties to those agreements that each state and territory was in a different starting position. You highlighted Western Australia. It is fair to say that Western Australia has invested a huge amount of energy and time in thinking about implementing and very genuinely attempting to engage with both patients' families and service providers.
Senator FIERRAVANTI-WELLS: I am not criticising the spend. Please do not think I am. My point is the issue of consistency.
Ms Halton : My point is that if everyone in this list had spent the same amount on each thing you would have perpetuated the existing irregularity. I do not mean that to be a negative. Perhaps I should just say there are different patterns across the states. You have made the point here about subacute. What we are actually trying to do is move the system into a more modern approach to the delivery of care and service. That requires, in some states, different actions than in other states. So the fact that there are different levels of expenditure here I do not actually regard as remarkable. We might have a view—in fact we would have a view—that over time we would expect that, as people fill gaps and move their system forward, we might see more consistency. Actually, from a starting point, that is not remarkable.
Senator FIERRAVANTI-WELLS: We were talking earlier about activity based funding. In relation to consideration about the effect of activity based funding and the work that has been done there, what will be the flow-on in relation to mental health beds? It is a broad question but you understand what I mean.
Ms Halton : I absolutely understand what you mean. Again, the advantage of activity based funding is that it does throw an absolutely stark spotlight on different activities and the costs that they attract. For example, if you go to this article, there is a reality, there is a point in here, which is absolutely well made, that you do not want somebody who is not in an acute phase of illness occupying an acute bed. That is a perfectly fair point. I agree entirely. It is also the case that some people will need subacute or step-down care and other people actually may be able to have whatever assistance they need by way of treatment or reintegration into the community, whatever it might be, in a community based setting. What you actually want over time is to ensure that the investment—this is the whole point of activity based funding and transparency and efficiency—the funding, is used in the most effective and efficient way. If you take as a starting principle that, if you treat somebody in the most effective way and in the most sensible environment, in time their return to work, social activity and family is as quick as it can be and as effective as it can be. By definition, that means the system is not only providing better quality of care but is actually more efficient.
Senator FIERRAVANTI-WELLS: Just moving through the article, there are a couple of other parts that I would like to come to. One is about the national action plans. I think two estimates ago I asked about progress on the national action plans. The second report, which dealt with 2007-08, had been released, as the article said, in September 2009. We still have not had any more national action plans released since then?
Mr Singh : That is correct. The third progress report is going through the COAG endorsement process, and I believe there is only one jurisdiction left, which we expect will provide their endorsement very shortly. Then that should be made publicly available. The fourth progress report is working through the approvals process. Firstly it gets approved by health ministers and then—
Senator FIERRAVANTI-WELLS: Let us just hope that at the next estimates I will have it. That is three estimates ago I think I asked.
Ms Halton : It is the joy of Commonwealth-state relations.
Senator FIERRAVANTI-WELLS: There is another comment that they make in relation to their criticisms about largely untested semi or non-professional coordination of services. They make the comment that there is as yet no data to assess how this new funding is progressing. I think they are referring to PHaMs and flexible packages of care. They make the comment that with this new spending a significant public investment as such deserves scrutiny. What is your response in relation to that criticism?
Ms Halton : If it is PHaMs, it is not something for me to comment on because it is FaHCSIA.
Senator FIERRAVANTI-WELLS: Then flexible packages of care?
Ms Halton : The truth of the matter is, Senator, let us not make a comment in relation to this particular statement because we cannot be clear what it is about. What I can tell you, and you would know this no doubt from your experience with aged care, is that we know that providing flexible packages of care for individuals with the right and assessed needs is often more than instrumental in both maintaining function and in keeping people out of institutional arrangements.
Senator FIERRAVANTI-WELLS: I think the criticism that has been levelled is about the scrutiny in relation to this. I appreciate that PHaMs is within FaHCSIA, but the point that I think the authors are making is about the scrutiny and the process of scrutiny of the effectiveness of these programs, and particularly about whether they are reaching the intended client base. That is what they are saying. That is the question that I was asking.
Ms Halton : Yes. The article explicitly refers to personal helpers and mentors. On flexible packages, this is very new. It does build on the over 20 years worth of evidence we have in a couple of other sectors—aged care and disability care being two examples. The thing I can assure you of, Senator, is that not only do we fully expect you to scrutinise this, but be assured that our colleagues in the department of finance will scrutinise it too. There is no suggestion that this will not be well examined, both in terms of targeting and in terms of effectiveness.
Senator FIERRAVANTI-WELLS: Can I move to another article which appeared yesterday in the Australian entitled 'Mental Health Policy 'Aimless' by Adam Creswell. Mr Singh, are you aware of it? I have a copy of it here.
Mr Singh : We are aware of it.
Senator FIERRAVANTI-WELLS: As I mentioned about Professor Mendoza, he makes a number of comments. Can you explain to me why the consultation process was done over the Christmas period and there were only two weeks to comment? As Professor Mendoza highlights in the comments that he made, the main avenue for making the comments was through a web-based interface that really just provided a range of suggested responses, with limited ability to include commentary as free text.
Ms Halton : To start with, Senator, that is not true.
Senator FIERRAVANTI-WELLS: I did try and access the online survey but unfortunately it came off the system as soon as the consultation period ended, despite my efforts to verify that.
Ms Halton : There are two things I want to say about this. Firstly, there have been a number of opportunities. In fact Senator Wright was taken through some of those opportunities. We will provide those details on notice and you will get them too. There is no doubt that, notwithstanding the time of year, 1,600 submissions suggests to us that a significant number of people have taken the time to provide comment. There cannot be any suggestion, I believe, that this process has not been available and accessible to people who want to comment.
Secondly, it is just not true that there was not an opportunity for people to provide free text comments. In fact the team have the pleasurable task of actually reading, digesting and analysing every single one of them. That will be done. I am actually chairing that working group across the states and territories in relation to this particular plan and it has been discussed amongst the state and territory colleagues that every single one of those comments is going to be analysed. Everyone agrees that that is important. My view is that whilst one individual is potentially being quoted as describing the policy in this way, all the evidence would actually suggest the contrary.
Senator FIERRAVANTI-WELLS: Obviously the article refers to this petition that Professor Mendoza is gathering and the article refers to his target of 500 signatures. It will be interesting to see the signatories to that. In effect, he is really being very critical that it does not define the problems, the goals and the priorities. It does not set out the targets and the measures. The article quotes Alan Rosen: 'How can you put out a road map if you do not have a destination?' This road map is really vague. It sets out a whole lot of intentions but there is actually nothing concrete as to when, where and how this is all going to come about.
Ms Halton : As Minister Butler has said on many occasions, the whole point about having a longer term road map is to give people confidence and an assurance that the focus on mental health is not a one-budget exercise. This is a long-term reform agenda. This is hard; we all know it is hard. I take the point, and in fact we welcome that people who are passionate about this are contributing to the debate. That is absolutely as it should be.
I would make the point that, as has been quoted here—but I have no other evidence that this is accurate—if the target of 500 signatures is accurate, we can contrast that with the 1,600 submissions provided on the website. My colleagues can take you through the balance of view about large parts of the draft for consultation, which, can we remind everybody, were actually very positive.
Senator FIERRAVANTI-WELLS: I too, Ms Halton, have been the recipient of comments in relation to the road map. I can assure you that the comments that have come to me have certainly not been very supportive. In fact they have been very critical.
Ms Halton : Senator, let us be clear. Who is going to approach you? People who are not happy. My point to you is that it is completely understandable.
Senator FIERRAVANTI-WELLS: Some people do approach me, Ms Halton, that are happy.
Ms Halton : I am pleased to hear it.
Senator FIERRAVANTI-WELLS: Unless you are reading my emails, you should withdraw that comment.
Ms Halton : Senator, we would all acknowledge that most of the people who correspond are not terribly happy.
Senator FIERRAVANTI-WELLS: Is this something that I do not know? Was outgoing Minister Roxon reading my emails? That is what I would like to know.
Ms Huxtable : It is the nature of democracy.
Senator FIERRAVANTI-WELLS: It is the nature of the democracy, is it? So it is not just Rupert Murdoch's organisation that is reading emails; it is the incoming Attorney-General. Well, I will remember that one!
Ms Halton : We should be a little careful here, Senator. We might give away our deepest secrets. Why don't we ask the team just to give you a reflection of the kinds of feedback we have had from the 1,600? Not everyone is going to be happy with all elements of this. This is the challenge with something where it is such a diverse sector; we all understand that.
Senator FIERRAVANTI-WELLS: I am happy to take some examples of those on notice. I am conscious of the time. Mr Singh, could you give me some of those on notice or just give me copies of them. I am happy to take them. I am conscious of the time, Senator Moore. This will have to require the cooperation of the states; that is the case?
Ms Huxtable : We have been working very closely with the states on the road map.
Senator FIERRAVANTI-WELLS: What is the position with Western Australia? Are they objecting to it or have they signed on?
Ms Halton : No. In fact, the WA premier's department is my deputy chair in this process.
Senator FIERRAVANTI-WELLS: So all the states have signed up or are in the process of doing so?
Ms Halton : Every state and every territory is an active participant in this process.
Ms Huxtable : In fact, jurisdictions themselves have been doing consultations in addition to the national consultations on the road map.
Senator FIERRAVANTI-WELLS: I have received some correspondence in relation to the fifth edition of the psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. I have experience in a previous life with DSM-IV. There is obviously some—
Ms Halton : Professionally, Senator?
Senator FIERRAVANTI-WELLS: Professionally, of course.
Ms Halton : I just thought you might want to qualify that.
Senator FIERRAVANTI-WELLS: Yes. With the new versions, as a government, will you have any input or will any of the committees that the government has have any involvement in relation to input into that?
Ms Halton : It is a clinical matter, Senator. At this point, I will look at the professor. This is a record because he has been required to make an observation in the first session, the before-lunch session and now the immediate after-lunch session.
Senator FIERRAVANTI-WELLS: Professor, there was an article on 4 December last year entitled 'Disorders Diagnosed to Suit Any Condition'. I am not sure if you have seen a copy of that.
Prof. Baggoley : No, Senator.
Ms Halton : While you are passing that over, I do want to give you this information before you see it in questions on notice. On the survey participants' responses, and on the numbers that I do have, which I would like to give you, 73 per cent of respondents strongly agree or agree with the vision, 83 per cent strongly agree or agree with the principles, 78 per cent support the identified key directions and more than 87 per cent support the identified actions. I actually think it is remarkable in a sector which has multiples of views on a document which is really hard to draft that we are actually getting that kind of result.
Senator FIERRAVANTI-WELLS: Ms Halton, it is a document which is basically full of statements that most people would agree with. There is nothing concrete there. This is really the criticism by Professor Mendoza, and I am sure others—certainly others have made it to me as well. It has just been encapsulated in the article that Professor Mendoza has commented on. There is just a whole series of very general statements. There is nothing concrete there. For example, let me ask you a very concrete question. One of the key directions, No. 2, is about early detection and intervention. There is nothing there about what we are doing with EPPICs. You are supposed to have dialogue with the states at the moment in relation to the EPPICs that are going to be brought online as part of your budget announcements. There is nothing in there. That is just one example. That is the sort of stuff that supposedly I would have thought was concrete action towards a certain objective, but that sort of stuff is just not in there.
Ms Halton : There are two things I would like to say about that, the first of which is that the whole point about having agreed reference points in the strategy, the whole road map, is so that all parts of—if I use the service delivery system that probably does not quite express it correctly, but I will use it just for the moment—the service delivery system understand that these are the key and crucial things that should be informing the way they deliver and develop.
The reason this is important is that we are not just talking about EPPICs and health services, because it is a given for them, and we are already working on that. But it is important that the clinical community understand this is really important. It is important that the police force, that people who run jails—all parts of housing service providers, all parts of the service delivery system—understand what is crucial in building a more integrated mental health service delivery system and, indeed, a culture and climate in this country that makes it easier for people to participate in this society.
Senator FIERRAVANTI-WELLS: I know that, Ms Halton. That is all very well. But where is the concrete action that is going to be necessary to achieve those key directions or whatever it is? This is what Dr Rosen is saying. It is all very well to have a road map but what is actually going to achieve those outcomes? That is really what this road map is lacking. There is nothing concrete in it. You make these general statements about what you want to achieve but there is nothing there to actually show how you are going to get there. That is my point. Are we going to see something of that nature? Are we actually going to see in the final road map something that has actually got a bit of substance to it that actually gives us the nuts and bolts of how we are going to achieve those objectives?
Ms Halton : Go back to the conversation we had before about the difference in levels of spending on different particular areas on a state by state basis. The whole point about this is that everyone is starting from a different position. The whole point about this is that, as the developments occur over time on a state-by-state basis, individual states will have different things that they will do in order to get to the longer term outcome. The whole point about this, and in fact the minister has been very clear, is that it will not have a fixed point in time set of actions in it because actually that will date it. It is meant to be a living document. People are meant to be assessed on an ongoing basis in relation to progress and that means that people will, on probably a relatively regular basis, have to think about delivery consistent with being on the road map, not at a particular fixed point in time.
Senator FIERRAVANTI-WELLS: Can you then tell me what status the national action plans will have? Will they sit alongside this road map? It seems to me to be a sort of version of the national action plans mark 2. What is the status? Are these things going to sit together?
Mr Singh : The road map is not intended to replace the fourth national mental health plan but it sits above it. The fourth plan is very much consistent with this approach. This document is really intended to be a strategic guide for governments in terms of framing future investments, whereas the fourth plan is a more specific, shorter term document aimed at particular outcomes in mental health.
Senator FIERRAVANTI-WELLS: That does not really tell me much. I am conscious of the time, Senator Moore. I will put the rest of my questions on notice.
CHAIR: On all areas of mental health?
Senator FIERRAVANTI-WELLS: On mental health.
CHAIR: Does anybody else have mental health questions? Senator Boyce, do you have some questions?
Senator BOYCE: I do. All I have to do is find them.
Ms Halton : Dr Sherbon was asked for the Independent Hospital Pricing Authority numbers to be tabled, and I now have copies of those which I am happy to table.
CHAIR: Thank you.
Prof. Baggoley : If I can respond to the question on the fifth edition of the Diagnostic and Statistical Manual ofMental Disorders, or DSM-V, I note that it is to be published in May 2013 and it will include a number of updates and revisions which are yet to be finalised, based on further consultation. The article to which I have been referred, headed 'Disorders Diagnosed to Suit Any Condition', refers to some public comment that had been made within Australia. It may or may not surprise folk to know that the psychiatrists do not necessarily agree on the matter that is raised.
Senator FIERRAVANTI-WELLS: Why would you say that, Professor Baggoley?
Prof. Baggoley : It staggers me, Senator.
Senator FIERRAVANTI-WELLS: They are at war with each other.
Prof. Baggoley : That there is some disagreement is not a surprise. You should note it is produced by the American Psychiatric Association, and that started in 1952. As Ian Hickie has pointed out nicely, the concerns over the manual are more relevant to the United States, where patients rely on medical diagnosis to qualify for insurance to access health care. Another point made is that diagnosis and treatment are a matter for clinicians based on individual patient needs, certainly not based on conditions written in a book that is more for coding purposes. I think its direct relevance to practical clinical care for patients could be questioned. There is a long way to go and there is a chance for some of these disputes to be settled before early next year.
CHAIR: Thank you. Senator Boyce, have you found those questions?
Senator BOYCE: I have not actually found my questions but I shall go ahead and ask them anyway. Clearly, once I have had a chance to check them, I may have some to put on notice. Ms Halton, it relates to Minister Butler's visit to Mount Isa last year following the suicide cluster in Mount Isa. Could you update us on what has happened with that program since?
Mr Mackay : Subsequent to the community forums on 6 October and a second forum on 7 December, a number of actions have been taken. A cross-agency suicide prevention coordination group has been established between both the Commonwealth and the Queensland governments to work on a local action plan. We have contracted an organisation called United Synergies, which is the lead agency for the StandBy bereavement suicide service. They delivered what is called a critical response service over eight weeks between 14 November and 31 January. That is more than eight weeks of elapsed time but there was a break in the project delivery over the Christmas period. So they were on the ground and operating for eight weeks.
Senator BOYCE: Are they a locally based organisation?
Mr Mackay : They are. That service was based in Mount Isa, working very much with the local community over that eight-week period. We understand, through the StandBy national coordinator, that the Mount Isa community has indicated at the conclusion of that service that they do not want to proceed with further work with StandBy at this point. We are in the process of assessing the final report out of the StandBy project and in consultation with both Queensland Health and the local service providers in the area.
Senator BOYCE: Will that report be made public and when?
Mr Mackay : We are still working through the report at the moment with the partners that we worked with. I would expect we would finalise our assessment of it shortly.
Senator BOYCE: Why have the local community decided they do not want to proceed? What were the reasons they gave?
CHAIR: I think that would be something for the report rather than an answer at the Senate estimates.
Mr Mackay : That is right.
Senator BOYCE: You cannot give us any indication at this stage of preliminary results?
Mr Mackay : We would need to finish our assessment of the report to develop a full understanding of what was delivered, what work was done and what the outcomes have been.
Senator BOYCE: I was just struck, whilst you were talking, Mr Mackay, that you are from the early intervention and prevention branch and yet it was an organisation providing critical bereavement services that was needed because there had not been early intervention and prevention in Mount Isa. Why is this? It took 23 suicides before a cohesive coordinated program was even developed.
Ms Campion : The issue is that these sorts of programs are introduced when there is a demonstrated spike in suicides in the community. We obviously need information about what the pattern is and whether it is a spike.
Senator BOYCE: Was there a suicide prevention specialist working in Mount Isa prior to this spike?
Ms Campion : We would need to take that on notice, Senator.
Senator BOYCE: I think you will find that the answer is no.
Senator McLucas: We will take it on notice.
Ms Campion : The other important issue with these sorts of programs is that we actually need to work with the state government and the community to develop a program to identify what the needs are and work out a way of addressing them.
Senator BOYCE: What is the process by which you identify spikes? What is the process by which you know there is a spike?
Mr Mackay : Senator, you would appreciate that the final data on suicides is the result then of the legal and coronial process of determining the cause of death, and that can take some time. In some jurisdictions in particular, that can be a process of several years. In addition to the final data that we have through, for instance, the Bureau of Statistics causes of death, we rely very much on advice from service providers in communities, and from state and territory governments who deliver services in local areas as well, to provide, if you like, local intelligence on what may be happening in a particular region or a particular community.
Senator BOYCE: Is that systemised in any way, or is it just a matter of them sending you an email when they are worried?
Mr Mackay : Yes, I think it is fair to say it is not part of a data collection. It can take several forms.
Senator BOYCE: Would they email you, Mr Mackay?
Mr Mackay : They might. They also might speak with our state and territory offices.
Senator BOYCE: Could you have a look at what the communications around concerns around suicide rates in Mount Isa were, the dates of those communications, and provide that information on notice?
Ms Halton : To the extent that we can do that easily, Senator.
Senator BOYCE: I beg your pardon, Ms Halton?
Ms Halton : To the extent that we can do that easily, yes. But these communications may be informal. There may be telephone calls which there may not be notes of. To the extent that we can find something simply, yes, we will, but we cannot trawl through every email in the department.
Senator BOYCE: I appreciate that, Ms Halton, but it would seem to me that it would be rather difficult to identify spikes from phone calls where no notes were taken. I am looking for perhaps more formal material that would give us an indication of when the department was advised, by whom, if possible, and the extent of the information made available, as far as you are able to, Ms Halton.
Ms Halton : Fine.
Senator FIERRAVANTI-WELLS: Just on that point about suicides, I have had some correspondence that has come to me from South Australia, from Strathalbyn, where there have been some issues about male suicide. Mr Mackay, in your questions could you take that on notice as well—whether that is something that has come onto your radar.
Also, in answer to question E11-432 about multicultural mental health, I asked about a publication and the answer was that you were liaising with New South Wales Health in relation to the release of the report and that you would expect to advise me in February 2012 whether this could be provided.
Ms Campion : We received our response from New South Wales Health yesterday. They have provided some information that we need to take a look at and consider in releasing the report.
Senator FIERRAVANTI-WELLS: Will you take that on notice? Even if it is a redacted version of it, I am happy with a redacted version.
Ms Campion : We expect that should be done within about a week.
Senator FIERRAVANTI-WELLS: I will put other questions on notice.
CHAIR: Thank you. That brings to an end questions on outcome 11. Thank you to the officers. Now we will move to outcome 4—aged care and population ageing. We will start with questions for the department, and questions under 4.1.
Senator SIEWERT: Can I start with some questions on ACFI. Am I correct in my understanding that you have done some evaluation of the costs associated with implementation of ACFI?
Ms C Smith : There has not been an evaluation per se, Senator. Obviously, with any special appropriation we monitor expenditure trends very carefully. We have determined that residential aged care expenditure growth is growing faster than anticipated and faster than historical trends. Obviously, with a new funding instrument you have to allow a period of time to elapse before you can fully assess trends, but that growth at higher than historical rates has become evident. There is an estimates variation that reflects that. We have established a process with the Ageing Consultative Committee and a subgroup of that committee which is looking at understanding the reasons driving that growth.
Senator SIEWERT: When I have heard talk of evaluation that is actually what they are referring to?
Ms C Smith : Yes.
Senator SIEWERT: I want to come back to that process, but, first off, can I go to the estimates variation. What is the degree of the actual variation for this particular issue?
Ms C Smith : It is $444 million in 2011-12. That equates to $1.9 billion over the four years.
Senator SIEWERT: Thank you for that. In terms of the process that you are going into now to look at the reasons for that, have you done any preliminary—I will ask about the time line for that in a second—work to look at some of the key reasons for that increase with the new tool?
Ms C Smith : As you would appreciate with the large amount of data that we are working through, it reflects changes in the level of frailty reported by providers as part of their claims under the aged-care funding instrument. Our preliminary findings suggest that there is not consistent growth across all the questions. There is higher growth within activities of daily living and complex health care, which is driving the majority of the growth.
Senator SIEWERT: I am sorry, I was taking a note of what you said previously and I did not process what you said properly. There is inconsistency—
Ms C Smith : No. There is not consistent growth. There are three domains within the aged-care funding instrument. There are activities of daily living and that gets into issues around assistance with toileting, bathing—those sorts of things. There is also complex health care, and then there is a behavioural domain. There is a higher level of growth within activities of daily living and complex health care which seems to be driving the majority of the growth. We are still working through in some detail, question by question, the very large amount of data as to what is responsible for that higher-than-expected growth.
Senator SIEWERT: Have you broken that down into regions? For example, I will pick on WA because it is my home state. Is there consistency across the country or are there specific areas where you are getting a higher growth?
Mr Tracey-Patte : We are not aware of any variations in claiming patterns at a state level. We might see it at a much smaller regional level because these are provider claims, but there is no state based variation that we are aware of.
Senator SIEWERT: Is that because you have not looked for that or because you have looked for it and have not found it?
Mr Tracey-Patte : We certainly have not tried to identify it at that sort of level. The initial analysis we have does not show that there is any strong indication of differences at a state-by-state level. It is very much about the questions themselves within the tool rather than differences from state to state.
Senator SIEWERT: Thank you. In terms of the review process and the analysis that you are undertaking, what is your time line for that analysis?
Mr Tracey-Patte : Senator, we are working as quickly as we can to understand this. It is a very large estimates variation and we want to understand it as soon as we can. There is no end date on it as such. We are just working as quickly as we can.
CHAIR: Senator Fierravanti-Wells, do you have any questions around the instrument before we move on?
Senator FIERRAVANTI-WELLS: Yes, I do. I was just out of the room and I am not sure if Senator Siewert asked questions in relation to departmental advice that was distributed in November to ACSA and ACAA about the concerns at the level of growth of ACFI.
Senator SIEWERT: I have not asked that specific issue, but I have been asking about the growth in the estimate—
Senator FIERRAVANTI-WELLS: If you have answered Senator Siewert just tell me. I understand that in about November the department sent out some advice to this effect, Ms Smith?
Ms C Smith : We certainly have been having discussions with stakeholders about these issues. As I mentioned earlier, we are keen to work with the industry and other stakeholders to understand what is driving the growth in the subsidies. We have discussed this with a subset of the key stakeholder groups, including the industry associations.
Senator FIERRAVANTI-WELLS: I understand the advice is that expenditure on residential aged care is currently growing at a higher-than-expected rate and is placing significant pressure on the budget and may have implications for aged-care reform. The department is keen to seek industry involvement in developing workable solutions to address this issue. I have just taken this to be an extract from the advice that you have provided to ACSA and ACAA.
Ms C Smith : I cannot comment without seeing the bit of paper you have quoted from.
Senator FIERRAVANTI-WELLS: In that case perhaps you can verify these various assertions. It says here that the increased frailty reported within ACFI claims is significantly higher than anticipated, and the department advise that this suggests that the higher-than-expected rate of expenditure growth is being driven largely by provider-claiming behaviour rather than genuine changes in frailty. Is that the government's view?
Ms C Smith : The view of the department is what I have just said in answer to Senator Siewert's question, which is that the fact that it is growing faster than anticipated is a matter of public record, and we have put through the estimates variation to reflect that. What we are trying to do is understand the reasons for the growth. We do know that residents are entering aged care at higher frailty levels than was previously the case but, given the continuing higher growth than anticipated, we are going through a very thorough and comprehensive analysis of the data to determine what is going on. We are keen to work with industry and other stakeholders as part of that process.
Senator FIERRAVANTI-WELLS: The department has advised that, while it is more tightly targeting specific claiming patterns within its current ACFI validation program, validation processes alone cannot address the growth. If that statement is correct, how are you more tightly targeting specific claiming patterns?
Ms C Smith : We have an existing validation program for ACFI that has been undertaken for a number of years. I might ask my colleague Mr Scott to talk about that. Certainly, it has always been the department's position from resident classification, scale days and since that we need to have an active validation program.
Senator FIERRAVANTI-WELLS: No. My point is not about the existence of a validation. This states that you have advice. I am asking you whether you have advised ACSA and ACAA to this effect—that while it is more tightly targeting specific claiming patterns within its current ACFI validation program, validation processes alone cannot address the growth. My question to you is: are you more tightly targeting specific claiming patterns?
Mr Scott : The ACFI validation program, as you are aware, has been in operation for about three years now. We have in recent months been refining the risk model that we use to target visits. You would be aware that we aim to have around 20,000 validations in any financial year. The risk model has been refined and we have been open with industry about the way we approach our risk modelling. We are putting greater emphasis on risk factors, such as major change appraisals, and significant increases in claims in a short time frame. There is a greater emphasis being given to some of the risk factors as we roll out the validation program.
Senator FIERRAVANTI-WELLS: I understand that you were preparing some more detailed analysis which you propose to share and discuss with the Ageing Consultative Committee which was scheduled to meet on 2 December. Did it meet and was that discussed?
Ms C Smith : We discussed these issues with the Ageing Consultative Committee at the December meeting. We have also established a subgroup of that committee which is working with us on understanding the issues and what is driving the growth. That is a very collaborative process that we have been going through. I think that group has met twice.
Senator FIERRAVANTI-WELLS: You have done that analysis. Obviously that is not available?
Ms C Smith : It is work in progress.
Senator FIERRAVANTI-WELLS: Do you intend to release it at some stage?
Ms C Smith : We will certainly be pulling that together and providing advice to government. Any release would be a matter for government in due course.
Senator FIERRAVANTI-WELLS: I understand that the objective of the subgroup is to develop workable solutions, and will have material effect on growth, or presumably will have the effect of at least halting some of that growth in 2012-13. What is your intended outcome—to reduce the growth in this area? What is your objective here? How much money, basically, are you looking to save?
Ms C Smith : Our first objective is to ensure that we understand the reasons for the growth and what is driving that growth, and to ensure that funding matches care needs.
Senator FIERRAVANTI-WELLS: What are your workable solutions? Have you got some at this stage?
Ms C Smith : I am not in any position to comment on that. At the moment we are still going through the process, in consultation with stakeholders, of understanding what is driving the growth.
Senator FIERRAVANTI-WELLS: Are you intending to look to savings in this area?
Ms Halton : We do not have a target, if that is the question.
Senator FIERRAVANTI-WELLS: Okay. That was my question.
Senator SIEWERT: Can I just follow up on a couple of question there. I am sorry if I missed this if you asked it, Senator Fierravanti-Wells, but when did you first realise that there was a big blowout in the ACFI costs?
Ms C Smith : I would not categorise it as a blowout.
Senator SIEWERT: It says a $1.9 billion extra ask.
Ms C Smith : It is a special appropriation, and it is quite normal with special appropriations for funding to fluctuate.
Ms Halton : Senator, there is probably a little historical context that we can go to here. We have introduced a number of new funding instruments over a number of years. I have certainly done one in my time when I was occupying Ms Smith's job. What we know is that when you introduce a new funding instrument, for the first few years you will get growth, more than probably historical trend, because people are adjusting to the new instrument and there probably are some additional care needs that are being acknowledged, which, of course, is the whole purpose.
What we expect, though, over a period is that that growth will moderate. So in terms of the point at which people started to focus on where the growth was, we had an expectation that there would be growth above what was historical trend for the first couple of years. But after that continued beyond what would have been our historical expectation about it, people said, 'We need to have a closer look at this.' That is exactly what we have been doing, in consultation with industry.
Senator SIEWERT: Over four years $1.9 billion is a lot of money in anyone's language. So whether you call it a blowout or not—we can play semantics all day—it is a significant increase. I am not having a go, because that is what is happening, but my question is: when did you first identify the need for a change?
Ms C Smith : There was the ongoing monitoring that we were doing, as you would be doing with any new funding instrument. We also did a review of the aged-care funding instrument, which I am just trying to recall—
Senator SIEWERT: The timing?
Ms C Smith : It was built in. It was always seen that you needed to have a review point after the instrument had been in place for a certain length of time to ensure that it was operating as intended.
Ms Halton : It was basically before we actually changed the estimates, Senator. As we have indicated, we had an expectation about where growth would be for the first two years. When we got to the end of that period and that growth had not started to trend back to where historically we expected it to be, that was the point at which—and ultimately that was reflected in the forward estimates.
Senator SIEWERT: Estimates variation has been made.
Ms C Smith : Yes.
Senator SIEWERT: I have either misunderstood your answer or I have not got it. You did the review how long ago?
Ms Huxtable : Senator, the review was in May of last—
Senator SIEWERT: I am sorry, I am having trouble hearing.
Ms Huxtable : There was a report in May 2011 in respect of the ACFI. What that review found was that basic subsidies had increased in real terms. While it did not make specific recommendations around the implementation of the ACFI, it did recommend that there would be careful monitoring of expenditure trends. Basically, that is what occurred in the course of the calendar year. I do not think we can say that one day we were not aware and the next day we were aware. It was more of a gradual awareness.
Ms Halton : The second half of last year would be the best way to answer that.
Ms Huxtable : As the secretary pointed out, the move to a trend was not occurring and that is the point at which we made the estimates variation.
Senator SIEWERT: Towards the end of last year, in other words?
Ms Huxtable : Yes, the second half of last year. MYEFO actually reflected those numbers. Certainly, people were coming to discuss a niggling concern probably about the middle of last year. Then, of course, you have to do the numbers and have a really good close look at it: is it artefact; is it real? Then there was a process of actually trying to quantify and think about what the issues might be.
Senator SIEWERT: Thank you. Is there any issue there related to the increase in the extra care that is needed to address dementia, given the increased incidence of dementia? Have you looked at the issues around complex health needs and daily living with the increasing numbers of people with dementia accessing aged care?
Mr Tracey-Patte : We look at all of the domains of care when we are doing our initial analysis, and certainly the number of people with dementia within residential aged care has been a factor of that analysis and our thinking. The growth in the ACFI expenditure has predominantly come out of the activities of daily living and the complex healthcare domains rather than the behaviour supplement domain.
Senator SIEWERT: I understood that. I can understand these issues around behavioural needs. But you do not think there are also additional requirements for people with dementia—daily living requirements and complex healthcare needs?
Mr Tracey-Patte : The tool has been designed to pick up the care needs of frail older people, including those who have dementia or cognitive skill deficits or other conditions. The tool itself, by design, contemplates those things. It is not necessarily a specific—
Senator SIEWERT: Thank you. I am done with ACFI.
Senator FIERRAVANTI-WELLS: I want to talk generally about the government's response to the Productivity Commission. Senator McLucas, during the 2010 election the Prime Minister stated that, if re-elected, further aged-care reform would be a second-term priority. On that same day Minister Roxon said we would quickly respond to the commission's recommendations. It has now been six months. When are we going to get a response, and has at least some work been undertaken in the department towards a government response?
Senator McLucas: As I am sure you know, Senator, Mr Butler has been running what he is describing as a conversation around some of the really significant recommendations that the Productivity Commission are making about the funding and operation of aged care in this country. I have been fortunate enough to attend one of those. I will put it on the record that he is consistently ensuring that he goes to regional areas so that those slightly different points of view are captured.
I am sure the officers will have a better view on the actual time line, but that process is occurring, or it may have been completed, I am not sure. Can I say that the people who have attended those conversations have found them extremely beneficial. As you would have read in the Productivity Commission report, they are talking about significant change, and you do not undertake that sort of change lightly. It was important that a second consultative process occurred.
Senator FIERRAVANTI-WELLS: Can I ask the department: what is the number of inquiries, formal inquiries and reviews, to which the department has provided submissions relevant to ageing and aged care since 2007?
Ms C Smith : I would not be able to answer that.
Ms Halton : We need to be clear about the scope of that question, Senator, because clearly we will have to take it on notice.
Senator FIERRAVANTI-WELLS: I would say there have been about 20.
Ms Halton : On aged care?
Senator FIERRAVANTI-WELLS: Ageing and aged care related matters?
Ms Halton : Let us put ageing to one side because there is a broader economic and social context to ageing. We are not responsible for all of those, because they go to pensions and everything else.
Senator FIERRAVANTI-WELLS: Ms Halton, all I asked you was this: how many inquiries, reviews, has DHA, the department, provided submissions to? I am not asking you what number you have conducted. I am just asking about the submissions—the number of inquiries to which you have made submissions?
Ms Halton : Are you including Senate committee inquiries, Senator?
Ms Huxtable : We will have to take it on notice.
Senator FIERRAVANTI-WELLS: I am happy for you to take it on notice.
Ms Huxtable : There are many inquiries that the Senate or the House of Reps initiates where Ms Smith's division would be providing input, because clearly the needs of older Australians are very much associated with health needs. So the remit would be very broad in that regard.
Senator FIERRAVANTI-WELLS: I appreciate that, Ms Huxtable.
Ms Huxtable : We are doing one on cybersafety at the minute—or cybercrime or something like that. It is a House of Reps one, I think.
Senator FIERRAVANTI-WELLS: It has now been 18 months since the Productivity Commission undertook its work, or commenced its work.
Ms Huxtable : No, I think the report was released in August 2011.
Senator FIERRAVANTI-WELLS: I appreciate the report was released in August. My question was: it is 18 months since the government sent aged-care issues to the Productivity Commission for inquiry. The sector has been waiting. I just wondered if there was any end in sight for the sector in terms of when a response is likely to be forthcoming.
Ms Halton : You have already quoted comments from the Prime Minister and, I think, Minister Roxon in terms of this being a priority. Certainly, as Senator McLucas has indicated, Minister Butler has been very publicly gathering views in order to formulate the government response. That process has just been completed.
Senator FIERRAVANTI-WELLS: I will come to those conversations next. You provided some answers to questions from Senator Furner, E11-149 and E11-148. In relation to E11-148, could you tell me who issued the invitations to these conversations?
Mr Tracey-Patte : The invitations were issued by COTA or the other affiliated organisations that were organising the individual events.
Senator FIERRAVANTI-WELLS: Can you tell me who chose the locations?
Ms C Smith : There was a process of scoping. The minister's office obviously had a role in that. COTA had a role in that. It was appropriate, once the broad geographic locality had been identified, to find a venue that was suitable for the number of people we were looking for and that had access appropriate for the target audience. It was one where we worked across the department, the minister's office, COTA and any other organisation involved in organising it to determine the appropriate venue.
Senator FIERRAVANTI-WELLS: The fact that these conversations were held mostly in ALP seats—I think there were two that were held in non-ALP seats and in the independent seats of Mr Katter, Mr Wilkie and I think Mr Oakeshott—obviously had nothing to do with it. Was that a criterion, Ms Smith?
Ms C Smith : It certainly was not a criterion from the department's perspective.
Senator FIERRAVANTI-WELLS: Perhaps you might explain to me why, for example, the conversation that was held in Wollongong, which is where my electorate office is, was run through the office of Mr Jones and you had to subscribe through his office to go and attend the conversation?
Ms C Smith : I am not aware of that.
Senator FIERRAVANTI-WELLS: The concern that I have is that the way it seems to have been staged is that these are conversations. It is all very well to converse with Australians so long as they are in Australian Labor Party seats—and then it would appear that you need to go through the local member to attend the conversation, Ms Smith. That is what concerns me.
Senator McLucas: Can I ask which town in Mr Katter's electorate was one of the towns?
Senator FIERRAVANTI-WELLS: I think it is Mackay.
Senator McLucas: No, that is Mr Christensen's seat, the seat of Dawson, held by the National Party.
Senator FIERRAVANTI-WELLS: Well then, that is three out of a total of—
Senator McLucas: How many more errors are there in your assessment of this list?
Senator FIERRAVANTI-WELLS: I think you get the gist of the question, Senator McLucas.
Senator McLucas: That is my question: how many more errors are there in this list? I am in Queensland.
Senator FIERRAVANTI-WELLS: There were three in Liberal seats and the rest were ALP or Independent. My question is: do you propose to have more conversations? Will some other Liberal seats be included or considered as part of that?
Ms Halton : It is a matter for the minister. The consultation process is a matter, as we have already indicated, of the minister listening to people around the countryside, and that is a matter for the minister.
Senator FIERRAVANTI-WELLS: I appreciate that, Ms Halton, but I asked what the criteria were and Ms Smith gave me very general criteria. I asked whether the seat or the nature of the seat was one of them and she said, 'No.' I am now asking: are there other areas where the minister proposes to have conversations?
Ms C Smith : I am not aware that the minister intends to have more conversations. I think 31 events have been held so far and over 4,000 people have participated. In terms of the invitation process, I think you would be aware that we engaged Council on the Ageing to assist with this process. They distributed invitations to their very extensive network. We also passed invitations on to all the other senior groups in the area—National Seniors, Legacy and other veterans groups. They went out to a wide range of community groups in the relevant area. Networks then passed them on so we could get as wide a coverage as possible. That was done in all locations.
Senator FIERRAVANTI-WELLS: I know that in answer to a question you gave to one of the other senators general issues were raised concerning some divergence, perhaps, in regional areas. Will there be a more formal document provided in relation to the upshot of these conversations?
Ms Halton : Not that we understand at the moment, Senator.
Senator FIERRAVANTI-WELLS: This has purely been driven out of the minister's office? Can you just confirm that for me, Ms Smith? Are these conversations purely driven out of the minister's office?
Ms C Smith : The minister obviously has a key role in determining how he will conduct consultation on this, and the department is providing support.
Senator FIERRAVANTI-WELLS: Can I just ask you in another way: what role has the department had in relation to these conversations—what role, if any?
Ms C Smith : We have had a role in logistics and organisational arrangements.
Senator FIERRAVANTI-WELLS: Such as? Such as paying for the venue?
Ms C Smith : Booking venues and providing staff to support the event, both from central office and from state and territory offices. We have also enlisted the support of consumer based organisations to assist us in that.
Senator FIERRAVANTI-WELLS: Why was COTA chosen as the organisation to be, effectively, the front?
Ms C Smith : COTA was judged to be appropriate because of its key role within the aged-care sector on consumer issues. I think you would be aware that it is one of the consumer sponsors of the National Aged Care Alliance. The other group that we have been working very closely with is Alzheimer's Australia. They have been facilitating a parallel process of discussion with their consumer base. The minister has also attended some of those events, but not all.
Senator FIERRAVANTI-WELLS: I do not have any more questions on conversations.
CHAIR: Senator Furner, do you have some questions on the issue of consultation?
Senator FURNER: Yes, along the same lines as Senator Fierravanti-Wells. I wanted to seek some clarity. I think Senator Fierravanti-Wells was referring to Liberal seats and to the seat of Dawson. Was that the question?
Senator FIERRAVANTI-WELLS: We have clarified that.
Senator FURNER: I am seeking clarity on that. I understand—
Senator FIERRAVANTI-WELLS: It was in Mackay, actually.
Senator FURNER: Mackay is in the seat of Dawson, which is held by the Nationals, not the Liberals.
Senator FIERRAVANTI-WELLS: That is what Senator McLucas said.
Senator FURNER: It is not a case of conversations held with regard to Liberal-held seats, it is also in National seats as well that there have been conversations.
Senator McLucas: That is correct. I know Queensland fairly well. I know which seats most of the towns are in, but I cannot say the same for New South Wales. I really just want to say that the minister has tried very hard to ensure that regional Australians have had an opportunity to have a say. If you look at some of those locations, they are not the ones that always get included in the consultation process. I think he has really put in a significant effort to make sure that regional variances have been captured. As a person who comes from a regional area, I pay tribute to him for that. He took the time to get on a Dash 8 to go that extra length to get to Mackay, after going to Gladstone and Rockhampton, then coming with me to open a facility in Bowen and then almost missing his plane back to Brisbane. He did not get home that night. That takes effort, and I commend him for it.
CHAIR: Any further questions or comments about the process of aged-care consultations? No? We are moving on to another topic. Senator Fierravanti-Wells.
Senator FIERRAVANTI-WELLS: I would like to ask some questions in relation to HACC and the takeover. How is that going, if you could give me something as to progress, in relation to WA and Victoria?
Senator SIEWERT: Are we dealing with that here? I assumed we were dealing with that tomorrow?
Senator FIERRAVANTI-WELLS: Tomorrow, in FaHCSIA?
Senator SIEWERT: HACC is in Health.
Ms Halton : HACC is definitely us.
CHAIR: We know because Ms Smith has a special folder. Senator Fierravanti-Wells, if you want to start, and other senators may jump in behind you.
Senator FIERRAVANTI-WELLS: In the process of the takeover, could you tell me where we are at with that, most particularly with WA and Victoria?
Ms C Smith : I might start with Victoria and WA. Basically that is part of the National Health Reform Agreement. There was agreement with Victoria and WA that current arrangements would continue. So Victoria and WA are on a business-as-usual arrangement. In terms of the transition with the other six participating states and territories, the transition process is going extremely well. We are working very intensively with state governments and with service providers.
In terms of the transition process, there are three distinct phases that we are going through. There are letters of introduction—which are basically 'Hello, we are from the Commonwealth'—to the service providers; letters of intent, where we actually indicate for that particular organisation what type and quantum of funding they can expect to receive from the Commonwealth; and then we will move through to a letter of offer, where they actually get offered the formal funding agreement. Letters of introduction have been sent to all service providers in the six participating states.
We have also conducted industry briefings in all jurisdictions except South Australia. In South Australia, though, the industry briefing process is going to be incorporated into a process of discussions held with service providers. In New South Wales, Queensland and Tasmania we have actually moved on to the letter of intent process. During the month of February we will be sending those letters of intent to service providers in the remaining three jurisdictions.
It is a very complex transition, with lots of moving parts, but at this point we feel pretty confident that we are on track.
Senator FIERRAVANTI-WELLS: Ms Smith, just drilling down, will part of this transition process allow some way that you will be able to look at perhaps practices, standards and those sorts of things in terms of what the Commonwealth is now going to be asking for of providers? For example, let us take an organisation, say, the Tweed Shire Council, which is a provider of certain services under the previous arrangements. If they are going to be a provider under new arrangements with the Commonwealth, are you going to go through some sort of process where you satisfy yourselves that organisations such as the Tweed Shire Council are complying with the requisite standards that the Commonwealth will require? Do you see what I am getting at?
Ms C Smith : I do.
Senator FIERRAVANTI-WELLS: It is almost like a stocktake of who was in HACC before at the state level. You are now moving to the federal level. Are you going to put in place some sort of quality assurance or are you assured that these organisations that may have done this for some time under state auspices are now doing a good job or a job to the Commonwealth's satisfaction?
Ms C Smith : We have a couple of different processes. We have community care common standards. Since March 2011, there has actually been a process where the Commonwealth and all states and territories have agreed that both Commonwealth package care providers and HACC aged-care providers actually deliver services against a common set of standards. That has been something that has been in place for nearly 12 months. Obviously that process will continue even once the program is split on an age basis.
There is also the process of the funding agreement that we will enter into with each service provider. We have been going through a really detailed process, both with state and territory governments and with service providers, of identifying the range of services that that service provider is currently contracted to provide. Some organisations are 100 per cent aged clients, some are 100 per cent disability clients. Most of them, though, are providing a mix of services to both age groups. There has been a line-by-line process whereby we have gone through and identified what they are required to produce for which client group. That will be reflected in the new funding agreement that they have with the Commonwealth. We will be contracting with organisations for the services provided for clients older than 65.
Senator FIERRAVANTI-WELLS: As part of that process, you might get some organisations that might, if I can put it this way, fall off the perch in terms of what they were previously doing and—how do I put this?—that may have delivered services in the past but may no longer meet the criteria to deliver services in the future.
Ms C Smith : We will be transferring—
Senator FIERRAVANTI-WELLS: It might be a rationalisation process.
Ms Halton : No.
Ms C Smith : We will be transferring to a Commonwealth contract all organisations who are currently funded to deliver services for older clients. We have also given an undertaking as part of the transition process that there will be no substantial change to service delivery before 2015.
What we will be seeking to undertake over the next couple of years, though, is to look at the variety of organisations that we fund so that we understand in a more direct way than we have in the past exactly what services are provided
Senator FIERRAVANTI-WELLS: If they are not coming up to scratch, is it the intention that you will look—
Ms C Smith : The Commonwealth will always have a normal approach of managing a contract diligently.
Ms Halton : That is a different issue. You describe it as a dropping off the perch. I describe it more as balancing on the scales. We will basically put organisations that are disability organisations for younger people on one side of the scales, because that is the jurisdiction of the states and territories. But for any organisation who touches or services older people, we will have then, within that group on that side of the scales, an approach which is about quality.
Senator FIERRAVANTI-WELLS: That is my question. That is really what it is going to. I want to know that there is a process in place that is going to pick up organisations that are no longer up to scratch because there may have been some problems with them and they may not have been picked up through the state systems.
Ms Halton : But what I do not want is for there to be a message out to the sector that on day one there is going to be a razor put through the list—
Senator FIERRAVANTI-WELLS: Sure. I understand that.
Ms Halton : above the line and below the line. This is about transition.
Senator SIEWERT: Can I follow up specifically on what is happening in WA and Victoria through that process? You were talking about the common set of agreements, the common set of criteria, and direct contracts with the providers. That is obviously not happening in WA and Victoria. So that money goes—
Ms C Smith : In Victoria and WA the money will continue to go to the state government, and the state government will continue to contract service providers, as they have for the last 26 years.
Senator SIEWERT: Will the state then be using the same criteria to do that as we have just been discussing?
Ms C Smith : The community care common standard is an agreement that the Commonwealth reached with state and territory governments nearly 12 months ago. So, yes, those standards apply in Victoria and WA now.
Senator SIEWERT: Whether it is the Commonwealth or the state?
Ms C Smith : And they will continue to in the future. In terms of the exact contracting arrangements, it is apparent now that each state and territory has a slightly different contract with HACC service providers. What we have tried to do is look at what everyone does and come up with a fair and reasonable document in the middle. The contracting arrangements that Victoria and WA have had in place they will continue to have in place with their service providers.
Senator SIEWERT: Which may be slightly different to the standard one you are using now for your direct contracting with providers?
Ms C Smith : It may be. There are very comparable core elements in a funding agreement that government agencies have with non-government service providers. There might be variations around the edges but HACC service providers are accountable now under the terms of their funding agreements and they will continue to be accountable.
Senator SIEWERT: One of the many issues that have been raised with me in Western Australia is the differences between some of the assessment processes. From what I understand, there could be times when clients are having to undergo several layers of assessment. The example I have been given is Western Australia. Have you had any discussions with the states about assessment processes?
Ms C Smith : Assessment is actually a very live focus of discussion. WA has a government that have actually invested quite a lot in a new assessment framework. They have trialled a new approach in metropolitan Perth, I believe, where clients accessing HACC services go through a central assessment process and then, once their needs have been identified, all that is then referred to a service provider. That is actually quite a significant step forward on someone actually approaching a Meals on Wheels provider directly because their neighbour down the street gets Meals on Wheels. Going through a centralised and expert assessment process means that you can have a look at the needs of the whole person. It might be that they do not need Meals on Wheels or that they actually have a need far greater than that.
Ms Halton : Take particularly, for example, someone who perhaps, without wishing to sound overly gendered when I say this, is an elderly man who has not been in the habit of cooking for himself. Then the answer may not be just to provide the delivered meal; it might actually be to provide some assistance in acquiring those skills.
Ms C Smith : Some of what they are doing is actually looking at short-term intervention. You might put Meals on Wheels in for an elderly gentleman, as the secretary describes, for 12 weeks. You then send him off on a learn-to-cook class, and in fact he becomes capable of becoming independent.
Senator FIERRAVANTI-WELLS: It would not be top drawer.
Ms C Smith : Not top drawer, but we will not go there.
Ms Halton : My trouble is that I have various elderly gentlemen in mind when I am saying this, but anyway!
Ms C Smith : It has been a period of change for the sector in WA, as it is when you trial any new way of doing things. There is an evaluation process, I believe, going on at the moment, and it is being done in collaboration with the sector, to learn what has worked well in this new approach, what needs to be fine-tuned. I believe they then are going to be trying to roll it out into regional parts of WA.
Senator SIEWERT: That may help solve some of the issues. I think there are some issues between the central assessment and the regional process. That may in fact address some of the problems that I am hearing about. Thank you.
Ms Halton : I have to say that I think I had my first discussion about the need to rationalise assessment in community care in 1984.
CHAIR: Any other questions about that project, HACC? We are getting close to time.
Senator FIERRAVANTI-WELLS: I just have a couple of questions to the agency.
CHAIR: That means we have finished with aged care and the main part of the department and we are now moving to the agency. Thank you very much to the officers. We will now move to the Aged Care Standards and Accreditation Agency.