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Community Affairs Legislation Committee
HEALTH AND AGEING PORTFOLIO
Department of Health and Ageing
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Community Affairs Legislation Committee
CHAIR (Senator Moore)
Fierravanti-Wells, Sen Concetta
Furner, Sen Mark
Di Natale, Sen Richard
McKenzie, Sen Bridget
Brown, Sen Carol
McLucas, Sen Jan
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Community Affairs Legislation Committee
(Senate-Thursday, 31 May 2012)
HEALTH AND AGEING PORTFOLIO
Department of Health and Ageing
CHAIR (Senator Moore)
Senator DI NATALE
Senator CAROL BROWN
General Practice Education and Training Ltd
Senator DI NATALE
Australian Commission on Safety and Quality in Health Care
Senator DI NATALE
Therapeutic Goods Administration
Senator DI NATALE
Food Standards Australia New Zealand
Office of the Gene Technology Regulator
Senator DI NATALE
Australian Radiation Protection and Nuclear Safety Agency
Senator DI NATALE
National Health and Medical Research Council
Senator CAROL BROWN
Australian National Preventive Health Agency
National Industrial Chemicals Notification and Assessment Scheme
Private Health Insurance Ombudsman
- Department of Health and Ageing
- HEALTH AND AGEING PORTFOLIO
Content WindowCommunity Affairs Legislation Committee - 31/05/2012 - Estimates - HEALTH AND AGEING PORTFOLIO - Department of Health and Ageing
Department of Health and Ageing
Committee met at 09:03
CHAIR ( Senator Moore ): We will open this hearing of the Senate Community Affairs Legislation Committee, continuing the budget estimates for the Health and Ageing portfolio. We welcome back Senator McLucas, officers from the Department of Health and Ageing, and Mr David Butt, the deputy secretary. The committee will now continue with the program as circulated, commencing with outcome 5.
Senator FIERRAVANTI-WELLS: I would like to start with the Sunshine Coast GP Super Clinic. Can you confirm that the Commonwealth-led invitation to apply for the Sunshine Coast GP Super Clinic in fact closed on 23 May?
Mr Butt : Before Mr Booth answers that I would like to table something.
Senator FIERRAVANTI-WELLS: Yes, absolutely.
Mr Butt : This is your favourite table about GP superclinics, which was provided two days ago. As you are aware, we leave it very late in the piece because we want to give you the most up-to-date information.
Senator FIERRAVANTI-WELLS: I appreciate that.
Mr Booth : Could you repeat the question.
Senator FIERRAVANTI-WELLS: I have a series of questions on the Sunshine Coast and ACT GP superclinics, so we will concentrate on those for the moment. I am starting with the Commonwealth-led invitation to apply. Did that, in fact, close on 23 May for the Sunshine Coast?
Mr Booth : Yes. The ITA closed on 23 May.
Senator FIERRAVANTI-WELLS: How many applications were received?
Mr Booth : We had nine applicants for that.
Senator FIERRAVANTI-WELLS: On what dates did the departmental application assessment panel commence and conclude?
Mr Booth : We would need to get the exact date on notice, but normally the panel meets within two to three weeks of applications coming in. We can get the exact dates for you.
Senator FIERRAVANTI-WELLS: Do you have the documentation in relation to the Sunshine Coast GP Super Clinic?
Mr Booth : Apologies. We just found out yesterday that the department assessment panel was convened to consider the nine applications and sat through July and August 2011.
Senator FIERRAVANTI-WELLS: All up, did it take a couple of months?
Mr Booth : To go through the assessment process?
Mr Booth : It would have been around about that time, yes.
Senator FIERRAVANTI-WELLS: Was the application assessment panel for this GP superclinic supported by a probity adviser?
Mr Booth : Yes, as with all GP assessment panels.
Senator FIERRAVANTI-WELLS: The probity adviser gave sign-off to the assessment process?
Mr Booth : Yes.
Senator FIERRAVANTI-WELLS: Can you give me a copy of the report by the probity adviser?
Mr Booth : We do not do a separate formal report. The assessment panel will sit and, as you are aware, it will consist of officers from the department together with specific medical advice, an independent medical adviser. They will produce their report for the delegate.
Senator FIERRAVANTI-WELLS: So it is a tick-off rather than a formal report?
Mr Booth : It will be part of the report.
Senator FIERRAVANTI-WELLS: It is a section of it, so it is not separate. On what date did the panel provide a relative merit list from the applications?
Mr Booth : It would have been around about November 2011.
Senator FIERRAVANTI-WELLS: When did the recommendation go to the first assistant secretary of Primary and Ambulatory Care?
Mr Booth : In that same time frame.
Senator FIERRAVANTI-WELLS: Did the process identify a preferred applicant?
Mr Booth : It did, yes.
Senator FIERRAVANTI-WELLS: On what date did the assessment process conclude and the department notify applicants whether they were the preferred applicant or not?
Mr Booth : I will pass over to Ms Thorpe.
Ms Thorpe : The process here is that negotiations commenced with the preferred applicants. There is no notice to other applicants until the funding agreement is signed, on the basis that one can never be certain that the negotiations will reach a successful conclusion.
Senator FIERRAVANTI-WELLS: When did you open negotiations with the preferred applicant?
Ms Thorpe : Mid-December 2011.
Senator FIERRAVANTI-WELLS: I notice that in the Sunshine Coast Daily of 13 March 2012—and I am happy to give you a copy—there is a quote from a spokesman for the federal health minister that said, 'Negotiations are well advanced between the Department of Health and Ageing and a preferred applicant for the Sunshine Coast.' That is 13 March. Can you tell me if the preferred applicant that you are talking about there is the same preferred applicant that you opened negotiations with back in mid-December?
Ms Thorpe : Yes, that is correct.
Senator FIERRAVANTI-WELLS: That was the preferred applicant that was identified by the assessment process?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Has the funding agreement now been signed for the Sunshine Coast GP Super Clinic?
Ms Thorpe : Yes, it has. It was signed last Friday.
Senator FIERRAVANTI-WELLS: On what date was the Sunshine Coast GP Super Clinic funding agreement—sorry, it was the same date. What date was it signed with Ochre Health? Was it the same day?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Can you explain that to me?
Ms Thorpe : Just to be clear, the date of the funding agreement is the date that the Commonwealth executes it, so, although a letter of offer is made to Ochre, it is not until that is returned and then signed by the Commonwealth delegate—
Senator FIERRAVANTI-WELLS: You have Friday, 25 May as the date the Commonwealth signed it.
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Has Ochre Health signed the funding agreement?
Ms Thorpe : Yes. They must sign it before it comes to the Commonwealth and it is on execution by the Commonwealth that the agreement is formed.
Senator FIERRAVANTI-WELLS: When did they sign it?
Ms Thorpe : They signed it earlier that week.
Senator FIERRAVANTI-WELLS: Before 25 May?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: In just looking at that timetable, can you tell me why it took 12 months from the closure of the application date to conclude the funding agreement?
Ms Thorpe : The assessment process is a rigorous one, as has been made clear. The applications we receive are substantial and contain a great deal of detailed clinical service information, or proposed medical services information, and financial information. We receive a comprehensive report from an independent financial adviser. The panel members obviously take time to read all of those applications. As you are aware, and as the minister announced, there were nine applications in this process. That takes some considerable time. It is not uncommon for the panel to take up to a whole day to assess each application. It must then review all of those and review the outcome and the reports. It must ensure that each member is satisfied with the write-up of those reports and then, having come to the delegate, as we indicated, in the latter part of 2011, in early December, you then commence a process of negotiations.
The negotiation process has taken several months because of the identification of a suitable site for one of the hubs. The main site of the superclinic was altered during the negotiation process and the department then has a process for establishing that that site will achieve a comparable outcome to the site that was assessed in the application when it was originally received. There are negotiations backwards and forwards. There is detailed information about the nature of the site, its location and how it will service the arrangements. That takes time. There is often involvement of other specialist people, such as lawyers, advising both parties and ultimately you reach an outcome, but it has to be an outcome that the department is satisfied will achieve the GP superclinic program objectives to the standard that the panel envisaged it would when it made that nomination of a preferred applicant.
Senator FIERRAVANTI-WELLS: Can I take you to page 25 of the program guide.
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: It states:
… where the assessment process does not identify a preferred applicant, the Department reserves the right to broker an arrangement …
Was the Sunshine Coast GP Super Clinic one of those occasions where the assessment process identified—in other words, was Ochre the original applicant that was preferred?
Ms Thorpe : Yes, it was. The brokered local solution is a process that refers to a situation where the ITA fails for some reason.
Senator FIERRAVANTI-WELLS: I wanted to go around and ask the direct question, so I am fine with that. Did the Ochre Health application meet all the mandatory requirements of the invitation to apply process?
Ms Thorpe : Yes, it did.
Senator FIERRAVANTI-WELLS: Did Ochre Health provide an address for their proposed GP superclinic in their application?
Ms Thorpe : The idea of an address for a superclinic is not something we always typically receive. As you can imagine, many superclinic sites are in areas that may require subdivision—greenfield sites. So, in particular, the specification of an address is not always that common, but we will get the name of a road, a Google map marking out where it is going to be or photographs of the site. Sometimes a specific postal address is simply not available. In this case the Ochre model is a hub-and-spoke proposal, so there are parts of that proposal where there are sites in the hinterland for which there is literally an address, but the main site does not currently have an address because the site would have to be determined. It is part of the campus of the University of the Sunshine Coast.
Senator FIERRAVANTI-WELLS: Do I understand from that that there was no address given in the application form?
Ms Thorpe : I have explained that the situation was that—
Senator FIERRAVANTI-WELLS: There must be a box that says ‘address’ and you put the address.
Ms Thorpe : Sorry, of course there is an address for the applicant, but that is not the same as the address where the clinic might go.
Senator FIERRAVANTI-WELLS: My question was a pretty simple one: was an address given for this site? It is either, 'Yes, there was, and it is this place,' or, 'No, there was not, for whatever reason.'
Ms Thorpe : It is a proposed site.
Senator FIERRAVANTI-WELLS: Yes, a proposed site.
Ms Thorpe : The proposed site offered was the university campus, subject to negotiation with the university.
Senator FIERRAVANTI-WELLS: On what date did the government agree to the superclinic being established at the Sippy Downs location?
Ms Thorpe : In fact, the Commonwealth’s actual agreement to a particular site will not occur until under the funding agreement it receives a land acquisition report that it deems indicates that the site is satisfactory. As you can imagine, soil contamination, council approval arrangements and things like that might change, so, although there is a proposed site, the Commonwealth’s formal approval of that will not occur until the arrangements are received as a deliverable.
Senator FIERRAVANTI-WELLS: In that way you cannot assist me with when you have agreed to it being established at this Sippy Downs location?
Ms Thorpe : I think you could propose that the execution of the funding agreement nominating a site in the university campus or opposite the university campus indicates that the Commonwealth has approved that as being the site of the superclinic. However, the formal approval is not made until a land acquisition report is received.
Senator FIERRAVANTI-WELLS: The application form, as I understand it, says that the application panel will have regard to criterion 3, which is the geographic location of the proposed superclinic, and that applications need to, at a minimum, include the address or addresses of the site or sites at which the GP superclinic will be built, refurbished and/or extended. That is at page 7. I would have thought that you would have had to have included not just the address, but also the addresses of the other sites as well.
Ms Thorpe : That is the case.
Senator FIERRAVANTI-WELLS: Was that done?
Ms Thorpe : Yes, it was.
Senator FIERRAVANTI-WELLS: So in that original application you had all the necessary addresses that you needed?
Ms Thorpe : For the proposal, yes, but, as I indicated, during the negotiation process there was a change of site for the main hub of this hub-and-spoke superclinic.
Senator FIERRAVANTI-WELLS: Tell me a little bit about the process. It was at the university. Tell me a little bit about the changes that led to another site.
Ms Thorpe : In fact, the other site that is nominated is the one at Sippy Downs on the university campus. I think they proposed a two-hub proposal initially and there were some changes due to negotiations they had with sites that were in the hinterland and the main site. That is a natural part of the negotiation process. It is a lengthy process, as you have pointed out, and sometimes there are some changes in the site that is chosen. The important point is that in the negotiation process we take steps to ensure where it goes lines up with the same elements that you have referred to under criterion three.
Senator FIERRAVANTI-WELLS: When did the change occur? At what point of the negotiations was the Sippy Downs decision on the location made?
Ms Thorpe : March this year.
Senator FIERRAVANTI-WELLS: At any time were you aware that Ochre Health donated $15,000 to the national ALP and $4,400 to the Queensland ALP prior to the 2010 election?
Mr Booth : No.
Senator FIERRAVANTI-WELLS: You do not know. Are you aware of that now?
Mr Booth : I think that has been read in the media.
Ms Thorpe : We were aware, because Ochre Health has established the Grafton GP Super Clinic and the senators asked questions subsequent to that about a donation of $4,400 to the Labor Party. We became aware of that at that time.
Senator FIERRAVANTI-WELLS: At the time when the assessment panel was making its deliberations, was the department aware of those donations? I am just going back over my notes. We are talking about July-August 2011.
Ms Thorpe : I am unable to say whether the individual panel members on the assessment panel were necessarily aware of the donation.
Senator FIERRAVANTI-WELLS: Do you know if the minister was aware at this time?
Mr Booth : No, we would not know that.
Senator McLucas: I can assist you. I am advised that the minister did not have any role in determining the outcome of this competitive process. The department advised the minister’s office of progress in concluding the assessment process. In the case of Ochre, the minister’s office was advised that negotiations had commenced with a preferred applicant in December 2011.
Senator FIERRAVANTI-WELLS: So the minister first became aware in December 2011?
Senator McLucas: Yes. I think it is very clear that the minister had no role at all in the selection of this particular applicant, and in fact it is important to note that this application scored better than other applications for a number of reasons, including the hub-and-spoke model providing services to the hinterland. Senator Moore knows this country better than anybody. That hinterland area is underserviced. The lack of services in the hinterland was raised in the local public consultations as an issue for the local area. Local consultation identified the lack of chronic disease services in the area, which the GP superclinic will help address, and planned extended opening hours to 8 pm six days a week for the first 12 months were also identified. There is a whole range of other reasons why this particular applicant scored so well, but to imply that there was any knowledge of or interference in the process by the minister is absolutely incorrect.
Senator FIERRAVANTI-WELLS: I would like to take you back, Mr Booth. As I understand from the documentation and the program guide, basically the applications need to describe the proposed property arrangements for sites at which the GP superclinic will be constructed or substantially extended, including the address and any title details. I note that the mandatory requirements are specified at page 24. I note that any application that does not comply with any or all of the mandatory requirements will not be further assessed for funding. If I understand correctly, there were some mandatory requirements which do not appear to have been met in relation to this application.
Ms Thorpe : That is not the case. This application did meet all the mandatory requirements. Those mandatory requirements include that it is signed, that it is not a generic proposal that is lodged in more than one location and that it addresses the requirements of the ITA. This application did address the requirements of the ITA, and one of the things that happens when every application is received is that there is a compliance check done against each application to ensure that it does meet the mandatory requirements. If there is a suggestion that it may not, we consult with the department’s probity adviser to obtain additional advice about whether there is any uncertainty about whether the mandatory requirements are met. This application by Ochre Health certainly did meet all the mandatory requirements.
Senator FIERRAVANTI-WELLS: Perhaps under the circumstances it would be appropriate if you could table a copy of that application and take out any sort of personal—
Ms Halton : We are not permitted to do that. I think this has been discussed in this committee on multiple occasions. Obviously private information that is provided to the department is provided on that basis. The officers have given you a very clear assurance that the application, as signed off by the probity adviser, met all of those requirements.
Senator FIERRAVANTI-WELLS: So, notwithstanding the fact that the original address on the application now differs from where it actually was, other than discussions between the department and Ochre, were there any other parties that were involved in any other discussions or negotiations?
Ms Thorpe : No, not for this process. We negotiate continuously with the preferred applicant until it is determined that there is agreement and the department is satisfied that any matters identified as needing to be addressed during negotiations have been resolved either successfully or otherwise. It is only if those negotiations failed that we would then move on to consult with another party.
Senator FIERRAVANTI-WELLS: Senator McLucas, I assume you had information there from the minister’s office. Can you tell me whether Mr Slipper had any involvement at all in any matter pertaining to this GP superclinic decision? Were there any discussions at all between the minister post-December—I think you said earlier that it was December 2011.
Ms Halton : I apologise for interrupting, but we need to be very clear that this is not a decision of the minister’s. This is a decision of the delegate. The delegate is a departmental officer and, as the officers have indicated very clearly, there is an internal process. The process, granted, can be protracted. This is a very thorough administrative process, signed off by our probity advisor. This is not a matter for the minister.
Senator FIERRAVANTI-WELLS: I am not saying that the minister has made the decision. I understand that, Ms Halton. I am just asking, between the period of December 2011 and May 2012, what involvement, if any, the minister had in relation to this project. The answer may well be no.
Senator McLucas: I am advised that there were no discussions whatsoever with Mr Slipper on the decision to award the tender to Ochre.
Senator FIERRAVANTI-WELLS: So, that is no discussion between the minister and the minister’s office?
Senator McLucas: Yes.
Senator FIERRAVANTI-WELLS: Is that the case?
Senator McLucas: Yes.
Senator FIERRAVANTI-WELLS: Can I now turn to the ACT GP Superclinic—
Senator FURNER: Could I just ask, sorry—
Senator FIERRAVANTI-WELLS: Yes, did you want to go on the Sunshine Coast?
Senator FURNER: Yes.
Senator FIERRAVANTI-WELLS: Yes, sure.
Senator FURNER: Just following up on some of the responses that you provided to the senator, you mentioned the site is relevant to a satisfactory assessment. I think you expressed some criteria around what is satisfactory. Is there any consideration given for transportation for potential patients to the clinic? Is that part of the assessment?
Ms Thorpe : Yes, there is. In this instance, the fact that it is on the motorway and it is close to another significant road that the university plans to expand into a new entrance, with a bus stop installed onto the corner, was a factor in ensuring that people would have ready access. We should note that this is in a population growth corridor where population growth is estimated at the moment by the Queensland government at 14.1 per cent. The business of actually providing reasonable access for people by both public and private transport is an important one.
Senator FURNER: What sort of public transport is available in your assessment of the site being satisfactory?
Ms Thorpe : Ochre Health have indicated to us that the university, in its development of a new entry to the university campus there, will be obviously working with the public transport providers, but they have plans for the installation of a new bus stop at the corner where the superclinic will be located.
Senator FURNER: So, Ochre provides you that information? It is not a case of the department seeking that information in doing an assessment on appropriate transportation?
Ms Thorpe : Well, ultimately, when the land acquisition report comes in to us it should include a range of information that Ochre have obtained. What happens in many circumstances is they have the support of a traffic management consultant, they might have access to or evidence of other discussions and we look at a wide range of that but, yes, it is provided ultimately by Ochre, generally with the support of a range of professionals that we then have regard to. If we have got any concerns about how resolved the arrangements are, we can always go back to them and ask for them to obtain additional professional support in order for us to be certain that the arrangements are actually going to work.
Senator FURNER: Was the initial consideration for the site somewhere around Caloundra?
Ms Thorpe : No, it was not.
Senator FURNER: Where was it?
Ms Thorpe : Sippy Downs, still.
Senator FURNER: So, it has always been Sippy Downs?
Ms Thorpe : Yes, under a hub-and-spoke model. I need to point out that there are three other areas also being serviced by this clinic, in Eumundi, Maleny and Montville, but the hub was always to be in the Sippy Downs area.
Senator FURNER: Lastly, what feedback do you provide to unsuccessful applicants?
Ms Thorpe : As thorough as we can; it is reasonably extensive. We can go through areas around which their application would have been strengthened if they had provided as to them. We aim to make it constructive and thorough and provided by a member of the assessment panel.
Senator FURNER: Out of the applicants, how many of them would have been existing GP superclinic business holders?
Ms Thorpe : I am uncertain. We do not typically talk about the breakdown between existing and otherwise. Obviously in this case an Ochre entity was already the funding recipient for the Grafton GP Super Clinic.
Senator FURNER: Thank you.
Senator FIERRAVANTI-WELLS: Ms Thorpe, were the addresses of the hub and spoke also on the original application?
Ms Thorpe : I think the street addresses for a couple of them were. There were further negotiations to be made in one of the communities, which has all been resolved and finalised, but I think they indicated for Eumundi and Maleny that because—as the parliamentary secretary mentioned, and I did conduct this public consultation—there was strong feedback of a need for chronic disease management services in the hinterland. I certainly recall discussing that that could be delivered as an outreach arrangement. That is what is going to be proposed. Nurses and allied health professionals will go to existing clinics and expanded community services to increase access to areas where there is significant socioeconomic disadvantage.
Senator FIERRAVANTI-WELLS: The point that I am making is that your rules have certain mandatory requirements. It seems to be a little bit somewhat loose when you put such strong mandatory requirements in your program guides, yet it seems to be very fluid from what you have said about this application in relation to addresses, and particularly since addresses and geographic location are key criteria in relation to selection. I am just trying to reconcile what appears to be a rather flexible arrangement with what you have as mandatory requirements. It says in your rules that if the mandatory requirements are not met then there will not be further assessment for funding.
Ms Halton : That is not a fair representation of the mandatory requirements. The officers can go through that with you in detail.
Senator FIERRAVANTI-WELLS: That is what it says.
Ms Halton : No, I do not believe that to be correct.
Senator FIERRAVANTI-WELLS: Perhaps you might like to tell me. It says here, ‘All applications will be checked for compliance with the mandatory requirements,' and talks about any application that does not meet mandatory requirements and then it talks, at various parts of the application form, about what must be provided.
Mr Booth : If I can be of assistance to you here, on page 29 of the 2010 edition of the National Program Guide you will find that at the top of that page the mandatory requirements are set out. It says that the application must be signed on the verification page, be lodged in the tender box by hand, provide details and responses at all required points in the application form, include attachments as specified in the application form, include letters of support where appropriate, and make reference to the specifications in the invitation to apply statement of requirements. The compliance check is that those elements are there. That is not that each of the elements of the application form, as they are suggested that people may provide, are present. This is why it says 'the application must’; that is at the point at which the mandatory requirements are set out.
Senator FIERRAVANTI-WELLS: What about the summary of application at page 7 where it says, ‘The application provides … including as a minimum the address of the sites at which the GP superclinic will be built, refurbished and/or extended’?
Ms Thorpe : That is not actually a mandatory requirement. It is an invitation to people saying, ‘At the very least, tell us about these things.’ That is unlike the conditions that are set out on page 29 of the guide where we are clearly saying that if you do not get those things done your application will not proceed to assessment.
Senator FIERRAVANTI-WELLS: So, in summary, can I take it then that you do not need—on an application form for a GP superclinic whether it be for a single site or for a hub-and-spoke arrangement—to actually put down the addresses of where it is going to be built, even though you have to have regard for the geographical location of a GP superclinic? It seems a bit strange to me.
Ms Halton : On the contrary, it is not strange. As the officers have already indicated, and this is exactly the same in the residential care area, the truth of the matter is very often you do not move to finally secure a site until such time as you actually have an approval. It is a question here of cart and horse; the horse needs to be in front of the cart. Sometimes it is the case that people have sites, but very often not. Indeed, as has already been indicated by the officers, I think all of us can recall in the nursing home context sites which have had chemical and other contamination. Some of them can go on for years—Senator McLucas is looking at me and I know that is what she is thinking about when she looks at me in that way and has that tone of voice—but the truth of the matter is that specific sites may or may not proceed, depending on a whole series of assessments. It is not the case that you would always expect the precise address.
Senator FIERRAVANTI-WELLS: Perhaps you might then tell me what the minimum means? Why put that in there if you do not actually have to provide an address?
Mr Butt : I think we have already made it clear that locations were provided in the application.
Senator FIERRAVANTI-WELLS: Yes, but it says 'address'.
Mr Butt : So, we have said that many times. As the secretary has said, these things change. You are not expecting organisations to start going through the process of spending quite considerable sums in securing a site if they are not awarded the contract in the first place.
Senator FIERRAVANTI-WELLS: I think I will leave it there. It just seems very strange to me that you have a whole range of criteria which clearly do not appear to have been met here. Nevertheless, we will move on. Can you confirm the date that the Commonwealth-led invitation to apply for the ACT GP Super Clinic closed?
Ms Thorpe : It was on 15 March 2011.
Senator FIERRAVANTI-WELLS: How many applications were received for the ACT GP Super Clinic?
Ms Thorpe : We do not normally indicate how many applications are received in case it compromises the process. In the instance of the Sunshine Coast, the minister herself announced the number of applications a couple of days ago. Normally, we do not indicate how many applications are received. We have not in the past.
CHAIR: Is that operating after the decision has been made?
Ms Thorpe : Yes. It just has not been our practice on the basis that if there are only a couple of applications and we still have to provide feedback we do not indicate the number. In this instance, there were four applicants.
Senator FIERRAVANTI-WELLS: Just following on from the previous question, can you tell me the dates that the Departmental Application Assessment Panel commenced and concluded for the ACT GP Super Clinic?
Ms Thorpe : We will have to take that on notice, but we think it was in September 2011.
Senator FIERRAVANTI-WELLS: How long did the panel take to do its work?
Ms Thorpe : Again, we would have to take it on notice, but over several days.
Senator FIERRAVANTI-WELLS: Several days?
Ms Thorpe : Yes, as I explained earlier, generally a panel takes about a day to assess each one and then it is a question of availability; in particular, because there is a medical practitioner on the panel, we often have to arrange the panel sitting dates around the availability of that medical practitioner.
Senator FIERRAVANTI-WELLS: Mr Booth, to clarify an answer that you gave me earlier, when you said that the panel did its work over July and August, you did not mean that it took them two months to do the work?
Mr Booth : They were not working on it for the entire time. As indicated before, there was a significant number of applications for that particular superclinic. As Ms Halton said, they are complex applications to go through and it takes time to go through them properly.
Senator FIERRAVANTI-WELLS: In relation to both the assessment panels for Sunshine Coast and ACT, can you give me a list of the people who sat on the panel, or can you direct me as to where I could get a list of those people who were on the application assessment panel?
Ms Halton : No, we do not release the name of officers.
Senator FIERRAVANTI-WELLS: So, it is officers within the department only?
Ms Thorpe : We have previously advised that it is chaired by an officer of the department and there is generally one other senior officer from the department and there is a medical adviser.
Senator FIERRAVANTI-WELLS: Does the probity officer come from within?
Ms Thorpe : The probity officer comes from the department’s probity advice unit and attends and briefs the panel at the commencement of its considerations and is brought in from time to time should other issues arise.
Senator FIERRAVANTI-WELLS: Would there be common members on the assessment panel that considered the Sunshine Coast and the ACT? Are there no common members?
Ms Thorpe : No.
Mr Booth : Not necessarily, no.
Senator FIERRAVANTI-WELLS: Not necessarily or, no, there were not in this instance?
Mr Booth : No, there were not.
Senator FIERRAVANTI-WELLS: Are you sure about that?
Mr Booth : Yes.
Senator FIERRAVANTI-WELLS: So, they had a completely different panel that looked at Sunshine Coast and ACT?
Ms Thorpe : They may have the same medical adviser, who is not an officer of the department, but the officers of the department would be different.
Senator FIERRAVANTI-WELLS: Ms Thorpe, could you just check that and make sure of that, in case you want to clarify anything you gave me?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: I take it from your answer that there was a probity officer for the ACT panel as well?
Ms Thorpe : Yes.
CHAIR: Ms Thorpe, is that standard practice?
Ms Thorpe : Actually it is. In the department it seems to be the rule.
CHAIR: That is what I thought, yes.
Senator FIERRAVANTI-WELLS: So, there is nothing unusual? It seems to be as to the rule.
Ms Thorpe : Part of the funding process is that we have a probity plan.
CHAIR: That is the thing, the probity process is standard.
Ms Halton : In our department.
Senator FIERRAVANTI-WELLS: Yes, even though it says the panels may be supported by—
Ms Halton : In practice they are.
Senator FIERRAVANTI-WELLS: On what date did the panel provide a relative merit list from the applications?
Mr Booth : Approximately September.
Senator FIERRAVANTI-WELLS: When did the recommendation go to the first assistant secretary?
Ms Thorpe : That is the same thing.
Senator FIERRAVANTI-WELLS: About the same time?
Mr Booth : Yes.
Senator FIERRAVANTI-WELLS: Did the assessment process identify a preferred applicant?
Ms Thorpe : Yes, it did.
Senator FIERRAVANTI-WELLS: Was Ochre Health the preferred applicant?
Ms Thorpe : Yes, it was.
Senator FIERRAVANTI-WELLS: This is the same question as before about the other applicants, so I will take your answer to be similar, that you leave it open and you do not notify other applicants.
Ms Thorpe : Until after the funding agreement is executed.
Senator FIERRAVANTI-WELLS: I might move now to the Grafton Super Clinic, if I may. Can you confirm—
CHAIR: Can I just check how many superclinics? I am concerned about time.
Senator FIERRAVANTI-WELLS: In this bracket I would like to cover Grafton. I have some questions about Grafton.
Senator FIERRAVANTI-WELLS: When are we due to complete this section?
CHAIR: At 10.30 and then we come back with other parts of the—
Senator FIERRAVANTI-WELLS: Just to give me an idea in terms of timing; what time do you propose to cut me off?
CHAIR: I am just looking at where we want to go because Senator Di Natale has some questions around Medicare locals. I would imagine you do as well. Then we go back to primary care and primary care financing.
Senator FIERRAVANTI-WELLS: I am happy to use my time continuing on GP superclinics. If I do not get to Medicare locals, I will put that on notice.
CHAIR: I am making it so that we work out this time as fairly as we can. You have got GP superclinics and Senator Furner has a couple. We will go until about five past 10 on GP superclinics and then see how we go. That gives everybody an idea of our timing.
Senator FIERRAVANTI-WELLS: Yes. Chair, I just wanted to let you know that in relation to the next section—
CHAIR: Section 5.3?
Senator FIERRAVANTI-WELLS: Yes. On section 5.3 I only have a short batch of questions as to General Practice Education and Training Ltd.
CHAIR: You will not have 45 minutes there. We will have 20 minutes after the break in that area, so we can go over that. In that case, in terms of GP superclinics, we will go through to quarter past. My understanding is that you and Senator Furner have questions on superclinics and I have got a note to say that Senator Bushby may be coming up on superclinics as well.
Senator FIERRAVANTI-WELLS: Obviously I have got those questions in here.
CHAIR: We will go to quarter past 10 on superclinics; then we will go to Medicare locals. ‘
Senator FIERRAVANTI-WELLS: Can you confirm that the Grafton GP Super Clinic bulk-billing rate is 69.7 per cent of its patients since it opened? There is an article that I have got a copy of.
Ms Thorpe : I am familiar with the article to which you are referring.
Senator FIERRAVANTI-WELLS: I do have a copy here for you.
Ms Thorpe : I am familiar with it. What I wanted to let you know, as you may have been aware, is that the CEO of Ochre Health held some media interviews in the past few days in which the bulk-billing rate at the Grafton GP Super Clinic was discussed. He indicated that the bulk-billing rate there is, in fact, up around 81 per cent and that there was a journalistic error associated with interpreting exactly how bulk-billing rates are calculated. Indeed, I think he pointed out that at that time—I do not know if it came through in the article—bulk-billing rates nationally in large rural areas were at about 76.7 per cent, so Grafton was sitting comfortably above that.
Senator FIERRAVANTI-WELLS: So, what is the real figure according to the stats?
Ms Thorpe : I think the real figure is just over 81 per cent at the moment.
Senator FIERRAVANTI-WELLS: For Grafton?
Ms Thorpe : Yes, for Grafton.
Senator FIERRAVANTI-WELLS: About 80 per cent?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: What is the national average?
Ms Thorpe : It is 76.7 per cent in large rural centres.
Mr Butt : It is about 80 per cent nationally, but you tend to have higher bulk-billing rates in capital cities.
Ms Halton : Except for Canberra, of course.
Mr Butt : Except for Canberra, yes.
Senator FIERRAVANTI-WELLS: Just looking at—
Ms Halton : I just have to say that my colleague here says that Canberra is not a real capital city. The denizens of this town may object to that.
Senator FIERRAVANTI-WELLS: Ms Halton, I went to ANU. Unlike some of my colleagues, I think that Canberra is a very nice place.
Ms Halton : That is not what is in dispute here.
Senator FIERRAVANTI-WELLS: To your knowledge, does the clinic bulk-bill for concession card holders and children under 16?
Ms Thorpe : The situation at Grafton is as with many clinics. As you would be aware, the actual decision to bulk-bill is made by each GP; however, what is very common at Grafton is that patients who are under 18 years of age, Aboriginal and Torres Strait Islanders, pensioners and health care concession card holders are bulk-billed. Importantly, all chronic disease management MBS items and chronic disease clinics are bulk-billed, regardless of the person’s existing entitlements.
Senator FIERRAVANTI-WELLS: Sorry, go again, Ms Thorpe.
Ms Thorpe : Anybody, regardless of whether they are a pensioner, their age or whatever, who receives services under chronic disease management items of the Medicare schedule or attends chronic disease clinics is bulk-billed at the Grafton GP Super Clinic.
Senator FIERRAVANTI-WELLS: I do not know if you have seen their website. It says, ‘We will bulk-bill where possible.’ Have you seen that?
Ms Thorpe : Yes, that is fine. We have checked every website.
Senator FIERRAVANTI-WELLS: Yet we have the minister—and Ms Saffin—on 14 July saying that they would offer bulk-billing services for concession card holders, children under 16 and patients with chronic conditions and complex care needs et cetera. There seems to be a bit of a discrepancy. On their website they are saying that they will bulk-bill where possible, but the minister is actually indicating, as part of her announcement, that Ochre Health would run the $5 million GP superclinic and that they would bulk-bill for that category of people.
Ms Thorpe : I think the point that you have made is that they would offer bulk-billing and they do. The GP superclinics program, as I know you are aware, is targeted at people with or at risk of chronic disease. All chronic disease and Medicare items and chronic disease clinics are bulk-billed at the GP superclinic at Grafton.
Senator FIERRAVANTI-WELLS: Yes, but what about the concession card holders and the children under 16?
Ms Thorpe : The point here is that nobody can compel a GP to bulk-bill; however the bulk-billing rates at this clinic are above the regional average.
Senator FIERRAVANTI-WELLS: So, you are saying that the inference is that they are doing their bulk-billing for everyone that they should?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Was a part of Ochre Health’s original application for Grafton that concession card holders and children under 16 would be bulk-billed?
Ms Thorpe : We would have to take that on notice, but we do not normally discuss the content of what is in the original proposals. Importantly, what we do look at is whether they are going to make sure that people who need access to services are able to receive those services in a way that is affordable. So, yes, we would have had consideration of that at the time. I would point out that the part of Ochre Health Group that operates the GP superclinic at Grafton is Ochre Health Foundation Ltd, a not-for-profit entity.
Senator FIERRAVANTI-WELLS: Rather than Ochre Health?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Is it still a subsidiary of Ochre Health? Is it a corporate arrangement?
Ms Thorpe : It is a charitable foundation, so it is connected to the Ochre Health Group.
Senator FIERRAVANTI-WELLS: Does it have the same directors?
Ms Thorpe : I am unaware of that. We would have to take that on notice.
Senator FIERRAVANTI-WELLS: It is just the inference. It may well have commonality.
Mr Butt : My understanding is that the foundation has a separate board.
Senator FIERRAVANTI-WELLS: A separate board?
Mr Butt : Yes, but I will check that.
Senator FIERRAVANTI-WELLS: The same address? Same registered business location?
Ms Thorpe : We will take that on notice and let you know.
Senator FIERRAVANTI-WELLS: I find it interesting that in their press release the minister and Ms Saffin went out and made that statement specifically. I am just wondering if they have done it because there happens to be some other indication elsewhere that there was not bulk-billing. That was the point that I was trying to make, but I think we have covered it. Has the previous minister, Minister Roxon, or Minister Plibersek ever met with any representatives of Ochre Health?
Mr Booth : We would not know that.
Senator FIERRAVANTI-WELLS: You do not know that?
Ms Halton : No. We are not responsible for the diary.
Senator FIERRAVANTI-WELLS: Could you please take that on notice, Senator McLucas?
Senator McLucas: I will see what I can find out for you.
Senator FIERRAVANTI-WELLS: Just in light of what was referred to by Ms Thorpe regarding two current media articles from the Sunshine Coast Daily where it refers to ‘Ochre chief defends superclinic contract’, were there any meetings and, if so, can you give me the dates of those meetings? I might move on, if I could, to the Redcliffe GP Super Clinic. If I can double-check, the application note in relation to Sunshine Coast and ACT was made by the corporate entity, not by the not-for-profit?
Ms Thorpe : We would have to check that.
Senator FIERRAVANTI-WELLS: Could you check that, please, if you do not mind?
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Could you also check whether the foundation had any role in any other entity? Can you take on notice to check the involvement of both the corporate entity and the foundation in any GP superclinic?
Ms Thorpe : What I can tell you is that the funding agreements are in fact with different entities. They are part of the Ochre Group, but the funding agreement for the ACT GP superclinic is with an entity called Ochre ACTSC Proprietary Limited. It is a subsidiary. It is an entity.
Senator FIERRAVANTI-WELLS: You could take that on notice. I think you understand the gist of that question.
Ms Thorpe : Yes.
Senator FIERRAVANTI-WELLS: Can you give us an update on the Redcliffe GP Super Clinic? After all of that, I should have checked.
Mr Booth : Yes.
Ms Thorpe : I can give you the update. We are very close to receiving documents from the foundation which suggest that its negotiations with a preferred third party operator have reached a satisfactory conclusion, noting that that would then be subject to approvals of both ourselves under our funding agreement and the Queensland government as both the caveator over the land and in its regulatory oversight role under the Statutory Bodies Financial Arrangements Act. There are three levels of approval to go through, but we are close to a satisfactory outcome on negotiations with a third party operator.
Senator FIERRAVANTI-WELLS: Has the operator been found?
Ms Thorpe : As I said, we understand—
Senator FIERRAVANTI-WELLS: I was just double checking.
Ms Thorpe : The Redcliffe Hospital Foundation is negotiating with a preferred applicant following the tender process, and we understand that it is very close to a successful outcome.
Senator FIERRAVANTI-WELLS: But we do not have a name yet?
Ms Thorpe : No.
Senator FIERRAVANTI-WELLS: Is the building complete?
Ms Thorpe : The base building is complete. The fit-out will be carried out by the third party operator.
Senator FIERRAVANTI-WELLS: So the DA has been approved. Do we know how long the internal fit-out is likely to take?
Ms Thorpe : We imagine it will take some months. It will potentially be done in stages. We imagine that the ground floor will be completed first, that there will be retail tenancies such as radiology, pharmacy and things like that and some clinical services moving in at that level with the IT set-up. There will then be level 1 and so on through the building. Simultaneously, we understand that the fit-out of the floor space for the University of Queensland and so on will be carried out at the same time.
Senator FIERRAVANTI-WELLS: I do not have it in front of me, but I understand that the table that was provided on 7 May looks at the opening being mid-2012, however I noticed that the proposed opening date on this table of 24 May is now late-2012.
Ms Thorpe : That is correct.
Senator FIERRAVANTI-WELLS: You have obviously revised that up in the last couple of weeks.
Ms Thorpe : Yes, in response to our understanding of the time which the negotiations will take to conclude, the period of time we anticipate the Queensland government may take to complete its approvals and then the need for a tender for the fit-out.
Senator FIERRAVANTI-WELLS: Does that mean that, given the problems that happened last time, it now has to go through another process with the incoming government?
Ms Thorpe : No, it has always had to. Those approvals have always been required.
Senator FIERRAVANTI-WELLS: I might move to some general questions about the GP superclinic budget cuts. I refer to Budget Paper No. 2 page 177, GP Superclinics Program Streamlining—can you explain the $44 million? It states:
The government will remove uncommitted funding for the provisions of development networking and other operational activities.
Can you explain that?
Mr Booth : At the beginning of the GP superclinic program some recurrent funding was put aside, as has been said, for some developmental and reporting activities that were planned to be undertaken once the majority of GP superclinics were up and running. That funding has not been used and, as a media release accompanying that indicated, the new Medicare locals will be taking over part of that role as well, which was around service planning in a particular area. That money that was put aside was not used so the key thing here is that none of the funding for the actual building of the GP superclinic program has been affected at all.
Senator FIERRAVANTI-WELLS: So will that funding still be for provision of networking and other operational activities? Are the funds that are going to Medicare local specifically for networking and other operational activities?
Mr Booth : Medicare locals already have networking activities within their core function.
Senator FIERRAVANTI-WELLS: So this is extra money that is going to go to them.
Mr Butt : Yes. As time has moved on and the role of Medicare locals has evolved, we have identified that these funds were not necessary and that it is not a matter for individual GP superclinics to do it; rather, it is the Medicare local looking at integration more broadly.
Senator FIERRAVANTI-WELLS: Where did this uncommitted funding come from?
Ms Halton : It was an allocation that was made. When the program was originally set up and we budgeted for a series of activities in this program it was estimated that we would need funding for this kind of activity and, to be fair, in the first instance we used some of it for that purpose, but as time has gone on and the administration of the program has become more streamlined—and this is back to the conversation we had several times yesterday about constrained circumstances and what we could effectively, if we tightened our belt, live without—this was high up the list.
Senator FIERRAVANTI-WELLS: It is nothing to do with relocation incentives that were intended?
Ms Halton : No.
Senator FIERRAVANTI-WELLS: Nothing to do with Sorell or any other problem?
Ms Halton : No.
Mr Butt : It was not capital funding.
Ms Halton : You could describe it as program support costs. That is probably the best way to describe it.
Senator FIERRAVANTI-WELLS: Nothing to do with Redcliffe?
Ms Thorpe : Not at all.
Senator FIERRAVANTI-WELLS: Portfolio budget statement 5.2, 'key performance indicators', lists the number of GP superclinics that commenced delivery of services, including early services, for the full year. What is the number of GP superclinics that the department expects to officially open?
Mr Butt : By when?
Senator FIERRAVANTI-WELLS: It says 2012-13. It says 12, nine, six, eight and nine.
Ms Thorpe : There was a corrigendum issued to that to bring the final 2015-16 year down to six.
Senator FIERRAVANTI-WELLS: I missed that one. That must explain why I asked the question.
Mr Booth : That is why the numbers—
Ms Thorpe : It did not add up.
Senator FIERRAVANTI-WELLS: There is only one of me and there are lots of you. Just going back to the Sunshine Coast, can you tell me whether Ochre had a conditional contract on premises in Kawana which were a former call centre that was not suitable, given that one of the Sunshine Coast’s largest GP practices was residing next door? Are you aware of that.
Ms Thorpe : They looked at that site. That was one that they evaluated during the negotiation process. Certainly there would never be an intention to set up a superclinic; it just would not make sense to set up a superclinic right next door to a significant general practice.
Senator FIERRAVANTI-WELLS: Having said that, was there another one? Was it Strathpine? Was it that one that ended up setting up just across the road or around the corner from an existing GP practice?
Senator FURNER: Not at all.
Senator FIERRAVANTI-WELLS: There was one. My memory is being tested now. I thought we had canvassed where there was an instance where that had happened. They all merge into one now. I might move on to Northam. Let me have a quick look.
CHAIR: We could go to Senator Furner.
Senator FURNER: I will start with Gladstone, one of the resource boom areas of my state. How is the existing GP superclinic going up there?
Ms Thorpe : It is not an existing GP superclinic. The situation is that there are early services being provided by the Windmill practice locally while the superclinic is in development. Unfortunately for the funding recipients, there have been some delays in progressing this development because there were two appeals against the council’s development approval for the site, so council approved the proposed superclinic on the site where it was to be, but two local organisations lodged appeals in the Land and Environment Court. That has taken an extensive period of time to resolve, with negotiation basically through an arbitrated process. One of the appeals has been satisfactorily dealt with, but the other one is very close to finalisation, at which stage the construction of the clinic will then be able to proceed.
Senator FURNER: My understanding is those appeals were based on some traffic flow arrangements for getting in and out of the site.
Ms Thorpe : Yes. Stocklands owns a large commercial development nearby and was concerned to make sure that traffic flow in and out of its facility was not impeded. The grounds for the other application were not quite so clear and might potentially be seen as vexatious, but that has been resolved.
Senator FURNER: What are the early services in terms of opening hours? What are they offering clientele?
Ms Thorpe : The early services which have been offered there since December 2010 include GP consultations, dietetics, psychology, pathology collection, immunisation clinics, bulk billed blood collection and a skin cancer clinic. In February this year, some chronic disease management services commenced and it is anticipated that will expand over time as it transitions over into the superclinic.
Senator FURNER: Any Indigenous health arrangements?
Ms Thorpe : I am not aware from the information I have here about Indigenous health arrangements. I know that the Nhulundu Wooribah Indigenous Health Organisation is a key stakeholder and the practice has a strong relationship with that organisation, but at the moment I am not certain if, in the early services, there are specific services made available.
Senator FURNER: What are the early services hours of operation?
Ms Thorpe : At the moment Monday, 7 am to 7 pm; Tuesday, 7 am to 5 pm; Wednesday, 7 am to 6 pm; Thursday, 7 am to 5 pm; Friday, 7.30 am to 5 pm; and Saturday, 9 am to 5 pm. There is also a 24-hour on-call service available and the clinic visits provides palliative care and home visits as well to residential aged-care facilities. It shares an obstetric call roster to cover the two local hospitals.
Senator FURNER: Given the area is a large resources sector and there are a lot of shift workers, is the intention to move to expanded hours of operation for the full services?
Ms Thorpe : Yes, certainly. The intention is that they will actually move to 7 am to 7 pm weekdays and 9 am to 5 pm both days of the weekend.
Senator FURNER: I might go down to Strathpine, my backyard. How is that going?
Ms Thorpe : Would you like to know the services currently available at Strathpine?
Senator FURNER: Yes.
Ms Thorpe : The multidisciplinary care services at Strathpine incorporate GP consultations. They have Indigenous health nursing, as I am sure you are aware, chronic disease management and mental health services. They have a variety of allied health practitioners there for diabetes education, mental health and psychological services, audiology, physiotherapy, podiatry, dietetics, exercise physiology, pathology, chiropractic care and occupational health services. They deliver Indigenous health services at this clinic. Importantly, and something that clinics won a couple of awards for, is the integration of social work trainee positions which actually move across the clinic and bring a social work element and understanding to these wide range of allied health professional services.
Senator FURNER: What are their hours of operation?
Ms Thorpe : Their hours of operation are 8 am to 7 pm weekdays, 8 am to 6 pm on a Saturday and 9 am to 5 pm on a Sunday. They use a deputising service, the Family Care medical services, so that patients have access to 24 hours of care.
Senator FURNER: I move now to Shellharbour GP Super Clinic. What are the hours of operation down there?
Ms Thorpe : At Shellharbour?
Senator FURNER: Yes.
Ms Thorpe : Shellharbour is 8 am to 6 pm Monday to Friday and Saturday is 8.30 am to noon on a fortnightly basis. They have after-hours coverage provided by the Wollongong Radio Doctor Service.
Senator FURNER: What sort of services are they offering?
Ms Thorpe : As you would be aware, it trades as Shell Cove. Family Health and it began with a strong focus on mental health services with the headspace program at its heart. The current team includes GP consultations, nursing and allied health professional services such as exercise physiology, clinical psychology, dietetics and speech therapy. They have students in here as well and they really strive very hard on their team based approach. They offer specific clinics for patients who have risk factors with respiratory disease and diabetes. X-ray and pharmacy are located not far away and a pathology collection service is available.
Senator FURNER: Thank you.
Senator FIERRAVANTI-WELLS: Just on that and in the light of the questions that I previously asked Ms Thorpe about the entity, we have the fund recipient but I just noticed that you mentioned ‘trading as’. It has here the funding recipient for Shellharbour in the latest table as the Illawarra Division of GP, but it is ‘trading as’.
Ms Thorpe : It is, yes.
Senator FIERRAVANTI-WELLS: I wonder whether it would be appropriate in the next iteration if you would kindly put the trading name?
Ms Thorpe : Certainly.
Senator FIERRAVANTI-WELLS: That would have probably avoided the sorts of questions that I was asking in relation to foundations and so on. So could you put ‘trading as’?
Ms Thorpe : We make that information available in the implementation progress sheets that we publish on the website, so it has the name of the location and superclinic and then the trading name.
Senator FIERRAVANTI-WELLS: This table has become a bit parochial. Thank you.
CHAIR: That is the end of GP superclinics. I expect there will be some questions on notice. We will take the break now and then come back to Medicare locals.
Proceedings suspended from 10:18 to 10:38
CHAIR: We will reconvene. We will go back to questioning in Outcome 5, Medicare Locals.
Senator DI NATALE: I have a few general questions to get a bit of an update. Firstly, can you outline the funds in the forward estimates that have been allocated specifically to Medicare Locals?
Mr Booth : The budget for Medicare locals is a total of $493 million over four years. In 2010-11 we had $8.9 million. This, of course, reflects the fact that they are in three tranches and moving forward over time. In 2011-12 the budget is $93.8 million, in 2012-13 it is $216.8 million and in 2013-14 it is $173.8 million.
Senator DI NATALE: What is the reason for the peak and then the decrease in funding? What is underpinning that?
Ms Roe : There was some additional funding over two years for practice facilitation. That is one of the things that is supporting Medicare Locals in their early development, and that is why it is only over the first two years and it peaks next year.
Mr Butt : The actual core funding for Medicare Locals is just over $170 million.
Senator DI NATALE: That was going to be my next question. You think it would be baseline at about $171 million as core funding?
Mr Butt : Yes.
Senator DI NATALE: Obviously there is a huge variation in terms of the geography with some of these Medicare Locals. Does the funding for each of those reflect the differences in geography?
Mr Booth : That is correct. The core funding for Medicare Locals reflects a population-base funding formula, and that formula takes into account issues such as the population makeup. It also has a measure in there for rurality and for people with English as a non-first language. There is a variety of different factors to try to reflect the local makeup of the population.
Senator DI NATALE: On notice, can you give me a breakdown of the funding formula? If you have those available for me that would be great.
Ms Roe : As a general rule we do not provide the actual specifics of the weightings, but it is rurality, socioeconomic status—that is, SEIFA index—Aboriginal and Torres Strait Islander populations, level of English speaking proficiency and aged related profiles.
Senator DI NATALE: So you do not have a formula?
Ms Roe : We do, but it is not generally made available for a lot of programs.
Senator DI NATALE: One of the issues that has come up fairly consistently is the question of the relationship between Medicare Locals and local hospital networks. Obviously one of the huge challenges is trying to ensure that both systems are integrated and trying to get primary care much more integrated into the acute care sector. What sorts of resources are being dedicated to that specific problem?
Mr Butt : To start with, in forming the Medicare Local network the aim was to try to get as much alignment of boundaries with local hospital networks as possible, and there was a reasonable success rate in that. It is not entirely contiguous. We have 62 Medicare Locals and 137 local hospital networks, but then 86 of those are in Victoria. We had particular issues of alignment in some places. When you look at the roles and responsibilities of Medicare Locals they are about doing population health planning, engaging with providers, the community and with non-government organisations more broadly. The additional funding picks up things like taking on a new responsibility, such as population health planning needs assessment. The first two tranches of Medicare Locals have just been providing their first needs assessments of their local communities, and they have done that in partnership with other providers, including local hospital networks. We are not expecting Medicare Locals to do this in isolation; indeed a lot of population health planning competence lies within local hospital networks in the state systems, so they are working together on those.
We have particular models. I can use Metro North Brisbane Medicare Local and Metro North Local Health and Hospital Network—I think the name in the Queensland local health and hospital networks changed again two weeks ago. They have aligned boundaries. They have formal mechanisms in place where they are planning together. The local health and hospital network funds the Metro North Brisbane Medicare Local for its team care coordination programs: to keep people out of hospital or for avoidable hospital admissions. They have hospital collaborative meetings and there are MOUs between the Medicare Local and all of the hospitals, including the private hospitals. The Medicare Locals pay for GP liaison officers in all hospitals. They also have a planning partnership which is part of their formal governance arrangements. They have formalised the way they will meet and work together as the two key pillars of the health system in that area.
There are other models developing all around Australia. As you said, there is great diversity and they do it in different ways. Some of it is at a governance level, some in terms of formal planning committees and some of it is terms of clinical engagement and shared clinical governance arrangements.
Senator DI NATALE: Does local government have a role to play, given that they have significant resources dedicated, in some cases, to population health planning?
Mr Butt : They are certainly an important stakeholder and that has been identified in terms of who they should be working with. In some areas they are formal partners—particularly, for example, if you look at Victoria, where local government has quite an extensive role in terms of primary health care. You have things like the Barwon Medicare Local, which has what is called the G21—the Geelong 21—and which includes all the local government primary care partnerships, community health centres, hospitals and the business centre more broadly.
Senator DI NATALE: I suppose Victoria is a good example. I think some of the concerns coming out of Victoria are that there is a unique community health model and whether Medicare Locals might enhance or undermine the existing model that exists around community health care.
Mr Butt : There has been some uncertainty from PCPs in Victoria and some of the community health sector, but the reality is—and these are new organisations—that in most places they are working together, forming partnerships and seeing the synergy there. I was meeting with a lot of the community health sector in Victoria last week at the Victorian Health Care and Hospitals Association meeting, and there are some very good models. For example, at Loddon Mallee Murray the partnership involves 15 organisations. It evolved from the division of general practice, but it includes the PCPs, community health and local hospital networks as members of that organisation. They have very good examples of how they are working together—community health GPs, the business sector is involved and so on. There are some really good models developing in Victoria.
These are new organisations, so there are issues about building up trust and credibility across the two sectors as we try to bring them together, because you have obviously got on community health a strong public sector background, whereas divisions of general practice who are evolving into Medicare Locals and taking on these broader responsibilities have a strong connection with the private sector.
The whole point of the Medicare locals network was to come up with a way of integrating the primary health care sector, which quite frankly has not operated as a sector in the past. They have operated as separate components and do not always work well together. The model is about bringing public and private together to get the best synergies for both.
Senator DI NATALE: I agree it has huge potential. What resources have been directed towards the medical profession? The medical profession, particularly general practice, is often regarded as the gatekeeper of the primary care system. There is obviously some concern around what the implications are for general practice—the change away from divisions of general practice and so on. Has there been direct engagement with general practice to try to bring the profession along?
Mr Butt : Very much so. That has been a large part of the agenda over the past few years, certainly in the design of the Medicare Locals and the fact that the National Health and Hospitals Reform Commission and the National Primary Health Care Strategy recommended that primary healthcare organisations evolve from or replace divisions of general practice, recognising the central role of general practice in that. One of the first things that is important to emphasise is that you have 20 years of history of the divisions of general practice working with GPs and doing practice support, practice liaison, a whole range of program support arrangements, chronic disease management, immunisation, e-health, et cetera, and all of those functions and funding for those functions is now transitioning across to the Medicare Locals. Principle No. 1 in the establishment of the Medicare Locals is that they needed to maintain the existing services of the divisions and that they needed to ensure that this included strong general practice support. That has been a fundamental part of what they need to do.
Ms Halton : Let us be clear. As we have said over and over again, Medicare Locals are not divisions with a changed badge. I do not want the message to be ambiguous about this. It is the next phase of the development of integrated primary care.
Senator DI NATALE: Which is something we all want to see. What I am really getting at is: what about communication at the individual provider level as opposed to working through divisions? What sort of dialogue is there with individual practitioners?
Mr Butt : The Medicare Local has taken on that responsibility for practice support. They have picked up the ongoing practice liaison role that was done previously by divisions, but they have had to expand that—as the secretary was saying and as I think you are saying—to now engage with the broader primary health care sector and also with the interface with the acute sector. Those services are continuing. In a lot of places the feedback that we are getting is that they have been strengthened, because of course we have gone to a broader system where in some areas you would find that the fee support was previously fairly patchy. We have gone to 62 more robust Medicare Locals that are now able to do that more effectively.
Senator DI NATALE: I will just finish off by commenting that there was some discussion recently about the potential for funding not to continue. How would this work if there was a change? How would this work proceed if that budget of $173 million was substantially reduced? Would it be possible to do that population planning and to integrate primary care in some other way?
Senator McLucas: That is a very good question. In terms of the future of Medicare Locals, I think over time we have grown the collaboration and the collaborative approach in regions around primary healthcare to a point now that I think is quite exciting, particularly in terms of preventative health. If we were to lose the structure that we have through Medicare Locals I think all of that good work and effort that has been done for many years by general practitioners originally and allied health people more recently—and, as I can also say as a former member of the Cairns Division of General Practice representing the community, by the community more broadly—and that infrastructure and architecture, as has been mooted by the opposition, we would run the risk of all of that effort falling away and starting from scratch in terms of designing the architecture that would deliver quality preventative health and quality primary health services in our country.
Ms Halton : The other thing to remind you of is that basically there are a number of programs that run off this platform, including things like ATAPS.
Senator DI NATALE: So what would happen?
Ms Halton : That is unclear to me.
Senator McLucas: It is very concerning. As a general practitioner yourself, you know what has happened in the last 20 years from the instigation of divisions of general practice in the early nineties. In terms of the effort that has been put in to encouraging our primary health care services to be able to work collaboratively it is not a natural fit, but we have done it. I think that to pull away the structure that we now call Medicare Locals would just completely collapse all of that effort. Who would know what would replace a structure in that form to do the work that is currently being done?
Ms Roe : I have been around the Divisions of General Practice program an awful long time. But just in the last 12 months in terms of the tranche 1 Medicare Locals, there are three things that I am starting to see now that the rubber is hitting the road.
Ms Halton : I think the question has been answered.
Senator FIERRAVANTI-WELLS: Mr Roe, in the budget estimates in February you told me, in answer to some questions at page 46 in relation to Medicare locals: ‘We had very little time in which to establish the first 19.’ Do you think that with hindsight it was all a bit rushed with timeframes and implementations?
Mr Booth : No, I think the implementation has gone very well. We will hit our targets, and all Medicare Locals will be up and running by 1 July of this year. We have brought the implementation forward and it has gone well.
Mr Butt : The announced initiative was that there would be 15 on 1 July last year and we have 19. There was a bringing forward of 15 to 1 January this year, and we actually established 18. We are ahead of schedule.
Senator McLucas: I would like to put on the record that I think you have done extremely well, given the work that I have done with my various Medicare Locals in my community.
Senator FIERRAVANTI-WELLS: Who decided on the rollout schedule for the Medicare Locals? Is that ultimately a decision of government?
Mr Booth : The rollout schedule in terms of which Medicare Locals in tranches 1, 2 and 3?
Mr Booth : That was part of the application process that individual Medicare Locals went through. As you would be aware, there was an invitation to apply for the Medicare Locals that was put out in February last year.
Senator FIERRAVANTI-WELLS: I meant in relation to the 19.
Mr Booth : The first 19 with the highest scoring?
Ms Halton : That was about the preparedness.
Senator FIERRAVANTI-WELLS: You say that was automatic?
Ms Halton : Yes, based on the assessment of the content of the material provided by the applicants.
Senator FIERRAVANTI-WELLS: Can you explain in more detail the funding formula used for the core funding of Medicare Locals in response my question E12-255? If I understood correctly, in response to an answer that you gave Senator Di Natale, that is worth $171 million.
Mr Butt : That is right.
Senator FIERRAVANTI-WELLS: Did I hear correctly?
Mr Butt : Of that order; I think that is right.
Senator FIERRAVANTI-WELLS: Which of the five listed considerations are weighted higher than any other?
Mr Butt : As was stated before, we do not tend to release the formula on these things.
Senator FIERRAVANTI-WELLS: Like we did not get the criteria for the establishment of Medicare Locals until well into the program—is that what you are saying to me?
Mr Butt : No. The criteria for the establishment of Medicare Locals was released in the invitation to apply on 22 February last year.
Senator FIERRAVANTI-WELLS: Well after the decision was made; but we will not go there. We have traversed that.
Mr Butt : The decisions were made after the applications came in.
Senator FIERRAVANTI-WELLS: These five considerations are not weighted in any way?
Mr Butt : There are weightings on a formula, yes.
Senator FIERRAVANTI-WELLS: Does each of them have a value?
Mr Booth : In terms of the weighting?
Mr Booth : There is a different weighting to each of them.
Mr Butt : If you took a value of one and then weighted it with the various factors such as Aboriginality, rurality and so on, you would come out with a percentage of one plus or one minus and you would then apply that to your formula.
Senator FIERRAVANTI-WELLS: So you cannot give me the exact formula?
Mr Butt : As advised, my understanding is that—
Mr Booth : We do not normally give out the individual weightings.
Senator FIERRAVANTI-WELLS: So there is a formula, but you cannot tell me what it is?
Mr Booth : We can tell you the components of the formula and what goes into that.
Senator FIERRAVANTI-WELLS: Which is in the answer at 12—255?
Mr Booth : Yes.
Senator FIERRAVANTI-WELLS: So $171 million is going to be distributed to Medicare Locals, taking into account these five elements. Is that right?
Mr Booth : That is right.
Senator FIERRAVANTI-WELLS: That is it in a nutshell.
Ms Halton : It is a weighted population base. It is by population and then controlled for these areas. We will take on notice whether we can give you a little more information on this.
Senator FIERRAVANTI-WELLS: So the $50 million to the Medicare Locals for the rollout of the e-health system is going to be distributed and split up. The minister’s release of 18 May talks about the $50 million. How is that going to be split up?
Mr Butt : The intent with that is to build on those Medicare Locals that are the leading adopters of e-health across the Australian health system. There was discussion yesterday, for example, about the way one site has involved three Medicare Locals.
Ms Halton : This is really something that should be discussed under e-health. The officers can give you broader answers, but they certainly cannot talk to you about the details of the rollout of the PCEHR.
Senator FIERRAVANTI-WELLS: So anything pertinent to that $50 million needs to be in e-health?
Ms Halton : No.
Mr Butt : I can provide more information on it, but obviously e-health is not in my area and we have dealt with that area already. The intent would be to develop clusters of Medicare Locals and base it on the lead wave sites and others that are exemplars in providing e-health so that we use the expertise that has been built up across Medicare Locals through, as I said, the wave 1 and wave 2 sites, and also a long experience in e-health across the network more broadly. They will then work on issues such as education, readiness of practices and connecting practices to other services, such as local hospital networks. They will also be linking into allied health within the community and with NGOs or, for example, community based specialists who are often—
Ms Halton : You might recall yesterday that there was a conversation about change and adoption. We talked about the fact that we have a significant investment in change and adoption, and the change and adoption partner that we are working with. Clearly, what you need is—
Senator FIERRAVANTI-WELLS: This is in answer to questions from Senator Sinodinos?
Ms Halton : Yes. Maybe you were not in the room.
Senator FIERRAVANTI-WELLS: I may not have been.
Ms Halton : You may not have been, if I think about it. There was quite a bit of discussion about change and adoption. We have a tender we have let as part of change and adoption in terms of what the rollout process is, how you support general practice in this particular instance in terms of the rollout, and obviously with the Medicare Locals you need to have on-the-ground infrastructure to help you do that. This particular arrangement facilitates that. We did talk about that a fair amount yesterday.
Senator FIERRAVANTI-WELLS: As I understand it, you have doctors over here. I have not drilled down into the detail of the e-health part. I have left that to Senator Boyce, who seems to have a fascination for it. With this $50 million, as I understand it, we are going to help Medicare Locals to help the doctors. I am trying to simplify it, Mr Butt.
Mr Butt : As the secretary is saying, it is part of the overall change and adoption scheme. There needs to be a workforce on the ground that can go into practices.
Ms Halton : To help people.
Mr Butt : Yes.
Senator FIERRAVANTI-WELLS: So change and adoption means helping people?
Ms Halton : Yes, that is right. It is fancy consulting speech for helping people.
Senator FIERRAVANTI-WELLS: That is what it is. Is it foreshadowed that therefore there will be a linkage between the Medicare Locals and practitioners in relation to health records for where those Medicare Locals might be involved in, say, programs that might require access? Is it eventually leading that way?
Ms Halton : No.
Senator FIERRAVANTI-WELLS: It is simply helping the industry?
Ms Halton : Yes. You know that over the years we have done a number of things to move the whole industry out of the cards-in-shoeboxes or paper files.
Senator FIERRAVANTI-WELLS: Some have been a bit more resistant than others? I am being facetious.
Ms Halton : That might be true. This has been a practice we have had over a series of governments, as you know, moving people away from the paper file behind the receptionist into the e-enabled world. The first thing was PCs in offices and then we got into high-speed connectivity to the internet. There is a series of things we have done to try to move the whole health sector into this more e-enabled world. We are now moving to connectivity, as you know, and the PCEHR. It is the next phase of modernisation.
Senator FIERRAVANTI-WELLS: I am interested that this announcement was made after the budget and was not included in the budget as such. Is there any reason for that or you just did not quite get around to it?
Mr Butt : It was a decision of the minister about when to announce it.
Ms Halton : It was in the budget. The money is appropriated in the budget.
Senator FIERRAVANTI-WELLS: Where was it in the budget?
Mr Butt : It is not separately identified, but when we were talking earlier about the Medicare Local fund, for example, where we talked about core funding plus additional funding, some of it is in there.
Ms Halton : Yes.
Senator FIERRAVANTI-WELLS: Is it in the $233.7 million?
Mr Butt : Yes. Ms Roe mentioned practice facilitation funds, and that is largely where it comes from.
Senator FIERRAVANTI-WELLS: The minister in her announcement talks about the practical training and how to get the practice ready for the e-health record. I am surprised that you are doing this in the next two years; arguably, wouldn't it have been more sensible to do it before 1 July when people are able to register for PCEHR?
Mr Butt : This is not the only thing that is happening with Medicare Locals and practices. Again, the wave 1 sites have been preparing for some time. In the wave 2 sites, there are a lot of Medicare Locals involved as well in those broader models. There has been a building of expertise by their involvement in these things. As I said, the model we are looking at, in terms of change and adoption, is to base the work of the broader Medicare Locals network on the expertise gained by those wave 1 and wave 2 sites.
Senator FIERRAVANTI-WELLS: I am struggling with the fact that you are educating GPs on a registration process after the registration process has already begun.
Mr Butt : Again, there is a level of expertise that has been built up over time which will now be spread more broadly. We are getting into e-health again.
Ms Halton : Yes, we are.
Mr Butt : As was explained, it is not as if everyone, from day one, is going to be getting enrolled with every practice. There will be those who will be early adopters and those who will come later. It is actually about building the momentum throughout the network of general practices over time.
Senator FIERRAVANTI-WELLS: It seems to me that there was this sort of arbitrary deadline imposed by the previous minister and I think that there is a bit of catch-up in the department to meet that arbitrary deadline.
Mr Butt : We are getting into the operational phase. This is, indeed, the appropriate time for them to be spreading more broadly.
Senator FIERRAVANTI-WELLS: I am conscious of time. Will there be key performance indicators for this $50 million and will they be published publicly?
Mr Booth : Yes, there will be indicators.
Senator FIERRAVANTI-WELLS: How many staff from the department are involved in the management of the Medicare Locals and divisions of general practice and the total staffing costs? If you could take that on notice.
Mr Booth : We would need to take that on notice in terms of the costs.
Senator FIERRAVANTI-WELLS: What about the guidelines for the Medicare Locals flexible funding pool? Has that been finalised?
Ms Roe : Yes. It was approved several weeks ago and it is on the website. It has been issued to all Medicare Locals.
Senator FIERRAVANTI-WELLS: Has it? I tried to look for it. Perhaps I was not looking in the right place.
Ms Halton : We will get you the reference and give it to you at some point.
Senator FIERRAVANTI-WELLS: We should be able to find that on the website. Chair, in terms of timing, we have to finish—
CHAIR: At 11.45.
Senator FIERRAVANTI-WELLS: We have to finish the health section by 11.45?
CHAIR: That is right.
Senator FIERRAVANTI-WELLS: Can I get an indication of questions from other senators? Senator Di Natale has asked his questions on Medicare Locals.
CHAIR: There are no more in outcome 5.
Senator DI NATALE: I have a question around the practice incentives.
Senator FIERRAVANTI-WELLS: There is the general practice education.
CHAIR: Yes, that I have been given from Senator McKenzie and I also have something from Senator Fawcett. Is that right?
Senator McKENZIE: Yes.
CHAIR: Is he coming up or are you doing the questions?
Senator McKENZIE: He is supposed to be coming up.
CHAIR: We have a question from Senator Di Natale and then the rest are yours.
Senator FIERRAVANTI-WELLS: In relation to the practice incentive payments—and this may traverse things that Senator Di Natale mentioned—can you tell me what industry consultation has been done regarding the e-health PIP payments before the budget was released?
Mr Booth : The e-health changes for the PIP incentive were discussed with NEHTA, and were also discussed with the PIP Advisory Group—the PIP AG.
CHAIR: Should those questions be in other outcomes?
Mr Booth : The e-PIP sits within the overall funding of the PIP allocation. The details around the requirements for the e-PIP probably sit within the e-health area, but we look after the entire PIP appropriation, if that makes sense.
Senator FIERRAVANTI-WELLS: I will ask some questions and, if they are appropriately dealt with by the e-health people, others can go on notice.
CHAIR: They can go on notice. Just let us know question by question whether it is your area or whether it is on notice.
Mr Booth : Yes.
Senator FIERRAVANTI-WELLS: What are the detailed criteria for a general practice to be eligible for the e-health PIP payment after 1 July?
Mr Booth : There are five criteria and I will ask my colleague, Ms Kneipp, to read through them.
Ms Kneipp : The e-PIP incentive is basically focused on building capacity in practices and there are five requirements that enable that capability to be developed. The first one is secure messaging. The second one is integrating healthcare identifiers into electronic practice records. The third one is using data records and clinical coding of diagnoses. The fourth one is creating and uploading shared health summaries and event summaries using compliant e-health record software. The final one is sending prescriptions electronically to a prescription exchange service. As Mr Booth mentioned, these five elements were discussed with the PIP Advisory Group and also with NEHTA.
Senator FIERRAVANTI-WELLS: In the budget paper at page 201 it refers to ‘participate in the PCEHR system’. What does that mean a practice has to do?
Mr Booth : A practice would need to demonstrate the capability and reach those five areas before they receive the PIP payment.
Mr Butt : It is about demonstrating capability. It is not a target number or anything like that.
Senator FIERRAVANTI-WELLS: How can a general practice be expected to input data into PCEHR when practice management software will not be updated to link to the PCEHR until at least September, which is three months after the changes to the PIP payment are introduced? How are you aligning those two things?
Mr Butt : Again, it is about demonstrating a capability. The e-PIP does not come into place until 1 February 2013.
Senator FIERRAVANTI-WELLS: So you think that is sufficient time?
Mr Butt : Yes.
Senator FIERRAVANTI-WELLS: In relation to the industry consultation, I think Mr Booth said that was part of the e-health group.
Mr Booth : Yes.
Senator FIERRAVANTI-WELLS: We will talk about that.
Mr Butt : Ms Kneipp might want to mention the membership of the PIP Advisory Committee.
Ms Kneipp : The PIP Advisory Group has four permanent members. It is chaired by me, and there are GP representatives and one senior organisational representative from the AMA, the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, the Rural Doctors Association of Australia and the Australian General Practice Network, now the Medicare Local Alliance; one senior representative from the Australian Association of Practice Managers; and two senior representatives from NACCHO, the National Aboriginal Community Controlled Health Organisation. The next meeting is in July.
Senator FIERRAVANTI-WELLS: Thank you. I have some brief questions in relation to a number of PI payments. Immunisation PIP was discontinued due to the requirement to have a child immunised to receive family tax benefit a payment. Was it the department’s recommendation or advice that the immunisation PIP be discontinued; or, if it was not the department, whose decision was it?
Mr Butt : Again, reflecting on the budgetary situation, we were obviously looking at areas where we could actually find efficiencies, and this is one where we identified that there were a range of other support measures in place in relation to immunisation, such as the family tax benefit or family assistance payments generally. There is still a payment in place for registration on the ACIR, Australian Childhood Immunisation Register, and there are also, of course, MBS payments still available for GPs and practice nurses who do a lot of the immunisations. There is now a new arrangement in place for practice nurses. There are a range of incentives available in relation to immunisation, so this was an area that we identified.
Senator FIERRAVANTI-WELLS: So it was the department’s recommendation following directives or otherwise to look for savings?
Mr Butt : Again, as I said, we were recognising the economic circumstances and all departments being asked to identify priorities.
Senator FIERRAVANTI-WELLS: As part of that work, were you aware of the number of families that are not eligible to receive tax benefit A and, therefore, not covered by the new immunisation changes, that will now fall through the cracks?
Mr Butt : I am not aware of the exact number, but we are aware that obviously not everyone is eligible for that. That is only one of a range of alternatives available in terms of GPs. In terms of good practice, they will follow up on immunisations. They get an MBS payment and they do have practice nurses.
Senator FIERRAVANTI-WELLS: Suffice to say you felt that there were sufficient other alternatives available to cover those families who do not receive tax benefit A, in summary?
Mr Butt : Yes. In summary, there are other incentives in place.
Senator FIERRAVANTI-WELLS: Thank you. What industry consultation had been done by the department regarding the changes to the diabetes PIP before the budget was released?
Mr Butt : It is probably important to say that in relation to PIP payments the health system does not stand still, whether we are talking about diabetes or cervical cancer screening. The diabetes target has been in place since 2001 and it was actually a fairly low target. A lot of practices, in fact, already exceed the target of 20 per cent of practices having a diabetes cycle of care. Setting a higher target reflects the fact that the health system is changing and it is good practice to have diabetes cycles of care in place when you have diabetes patients. It is about continuously improving and not always having the same targets.
Senator FIERRAVANTI-WELLS: Do I infer from your answer that there has been ongoing consultation with the industry and that the evidence was readily available or evident?
Mr Butt : This was a budget process, and obviously there is confidentiality in that. I am not saying that we had consultations with the industry about the changes to it. What I am saying is that we were looking at how we continuously improve.
Senator FIERRAVANTI-WELLS: What evidence was there to support the decision that the target needed to be increased?
Ms Kneipp : Perhaps I can provide some of that evidence. The fact is that the target for diabetes has been at 20 per cent for some time, and currently 35 per cent of practices are already reaching the 50 per cent target. So that alone demonstrates to us there is capacity in the system to achieve a better outcome through this PI payment.
Senator FIERRAVANTI-WELLS: What is the current pre-July 2012 PIP diabetes incentive target for general practitioners?
Ms Kneipp : Could you repeat your question?
Senator FIERRAVANTI-WELLS: What is the current pre-July 2012 PIP diabetes incentive target for general practitioners?
Mr Butt : Initially, you need two per cent of your patient population to have diabetes and then you have a target of 20 per cent with the diabetes cycle of care. As I said, that has been in place for over 10 years and, as Ms Kneipp pointed out, many practices are exceeding that.
Senator FIERRAVANTI-WELLS: Can you explain why, in the budget paper on page 201, it lists the changes to the incentive as shifting from 40 to 50 per cent and not from 20 to 50 per cent?
Mr Butt : The current target is actually 20 per cent.
Senator FIERRAVANTI-WELLS: It has 40 there. I am just wondering whether that is a typo.
Mr Booth : We will take a look at that, because the current target is 20.
Ms Kneipp : We will follow up on that.
Senator FIERRAVANTI-WELLS: In relation to the cervical cancer screening PIP, was there any industry consultation before the budget was released?
Mr Butt : Again, this was a budget initiative to continuously improve and have targets, moving the target from 65 per cent to 70 per cent.
Senator FIERRAVANTI-WELLS: What evidence was there to support the decision to increase the target and was it a decision by the department?
Mr Booth : Again, we know that a significant number of practices already achieve some of the higher levels.
Ms Kneipp : This was a decision of government to lift the target, and there was limited consultation.
Senator FIERRAVANTI-WELLS: I have another question in 5.2 on the National Health Call Centre Network, with the funding cut from Queensland and Victoria. It is in Budget Paper No. 2, on page 195. Can you elaborate on the funding cuts to Queensland and Victoria?
Mr Butt : It is actually not a funding cut to Queensland and Victoria. It is a cut to the program because Queensland and Victoria are not participating in the healthdirect component of the National Call Centre Network. We have had funding set aside for some considerable time in the event that they joined the National Health Call Centre Network. They have not done so, but they have come on board in relation to the after-hours GP component of it. We now have a national system in relation to the GP after hours. Queensland is still using a nurse-on-call system. Victoria also has Nurse on Call. Queensland is still using its system, but that then plugs into our after-hours GP.
Senator FIERRAVANTI-WELLS: So that was the basis on which Queensland and Victoria did not commit?
Mr Butt : Yes.
Senator FIERRAVANTI-WELLS: Is it still open for them to opt in and access those funds in the future?
Mr Butt : It would be open to them to decide to opt in, in which case it would be a decision for government about whether funding would be provided for that.
Senator FIERRAVANTI-WELLS: I will go back to Medicare Locals, as the officers are still at the table. I have two short questions. How much, just in broad terms, is the Medicare Local budget for salaries? Do we have some figures in relation to Medicare Locals and their operating costs and how much of the government funding is actually going into salaries?
Mr Butt : We do not and we would not be seeking that information. These are private sector organisations. They are companies limited by guarantee. We fund them for the achievement of outcomes. As was pointed out earlier, these organisations vary significantly because some of them are very large service providers. We certainly do not look for input information in relation to staffing.
Senator FIERRAVANTI-WELLS: But you have determined their funding window up to 30 June 2013? Have you, in some cases, delineated when their funding ends or outlined to them when their funding ends?
Mr Butt : For the Medicare Locals it is ongoing program.
Mr Booth : It is an ongoing program for Medicare Locals.
Senator FIERRAVANTI-WELLS: I noticed in the Weekend Australian of 19-20 May this year that there was an advertisement for a Medicare Local project manager. I am sorry, I only have one copy, but I can provide it if you want to give it further consideration. It says in this advertisement, ‘Positions offered on a contract basis until 30 June 2013. Attractive remuneration with access to salary packaging.’ It says, ‘Extension beyond that time is subject to continued funding.’ It is for the Tasmanian Medicare Local office, which has offices in Hobart, Launceston and Ulverstone.
Mr Butt : I would need to have a look at the ad. If it is a project officer position, it depends what sort of project you are talking about.
Senator FIERRAVANTI-WELLS: PCEHR deployment and adoption. Would that account for the 30 June 2013 time line?
Mr Butt : I would have to ask the Medicare Local about that.
Senator FIERRAVANTI-WELLS: I will give you a copy and perhaps you might like to take that on notice. Just by way of some statistics—did I understand correctly from your answer earlier that they are private companies and, therefore, you do not have data in relation to salary or any of their own costs?
Mr Butt : We do not seek that data.
Senator FIERRAVANTI-WELLS: I will get you a copy of that document when I give my questions on notice. In that same vein, if a Medicare Local decides to go out and hire a lobbying firm to do its work, to engage in government relations or to lobby the federal government, then that is a matter for them—is that the case?
Mr Booth : As we said before, they are private companies but they have to operate according to the guidelines that were laid out quite clearly in terms of the strategic objectives of the Medicare Locals. We very carefully look at the activities of Medicare Locals to ensure that they are in line with the strategic objectives that they have signed up to.
Senator FIERRAVANTI-WELLS: So, if you have, for example—going back to my previous question—Medicare Locals undertaking activities such as lobbying federal, state or local government and using their funds to do that, that would not be appropriate?
Mr Butt : It is a little hard to understand your question without being a bit more specific about it. One of the roles of Medicare Locals is to inform and educate people about what Medicare Locals do. I would not call that lobbying, so I am not actually sure of the specifics that you are asking.
Senator FIERRAVANTI-WELLS: I do not want to publicly provide details, but let me just say that in a circumstance where you had a Medicare Local that was listed as a client on a lobbyist list—and these lobbyist lists are freely available on registers both at state and federal levels—would that be appropriate? That would infer that they are using their funds, presumably, to engage the services of a lobbying firm.
Ms Halton : We would look at the specifics of that. That is the short answer. You cannot provide a blanket answer. We all know individuals who may be on the lobbyist register but who actually undertake a variety of activities that would be consistent with the guidelines. It would depend on the activity.
Senator FIERRAVANTI-WELLS: Can you take that on notice.
Ms Halton : If you could give us the specifics then I would be very happy to look at it.
Senator FIERRAVANTI-WELLS: Mr Booth, you mentioned it was in the guidelines. Where is that reference?
Mr Booth : The initial guidelines, which outline the strategic objectives for the Medicare Locals?
Senator FIERRAVANTI-WELLS: Yes. What is the page number?
Mr Booth : The key objectives of the Medicare Locals are contained within—
Senator FIERRAVANTI-WELLS: But it does not make any reference to political or lobbying activities?
Mr Butt : No.
Senator FIERRAVANTI-WELLS: That is what I am getting at.
Mr Butt : It is very hard to be any more definitive unless we get some definitive advice on the activities.
Senator FIERRAVANTI-WELLS: Thank you. I do not have any more questions.
CHAIR: Senator McKenzie.
Senator McKENZIE: My question is on a similar issue but goes to one of the Medicare Locals that you cited as a good local model, which is from Victoria, being the Loddon Mallee Murray Medical Local. In terms of the board governing that particular Medicare Local, are we able to get the number—not the names—of applicants who applied?
Mr Butt : There was a seven-member board appointed on a skills matrix through an independent process involving 121 applications.
Senator McKENZIE: So 121 applicants?
Mr Butt : It is pretty popular.
Senator McKENZIE: The community spirit is alive and well in the Loddon Mallee Murray area.
Senator CAROL BROWN: That has to be abolished!
Senator McKENZIE: That was a good warning earlier, Senator Fierravanti-Wells. So, 120 applicants for a seven-member board. When you say the skills matrix, is that a publicly available criteria?
Mr Butt : I would expect it would be. One of the things that we did say—and we gave some guidance on this in relation to the type of skills you would use in governance of a Medicare Local. My understanding is that the Loddon Mallee Murray board includes GPs, lawyers, business, health service executives, ambulance, community. That sounds like more than seven to me, though.
Senator McKENZIE: They might do more than one thing in your local community.
Mr Butt : They might do more than one thing. This is true.
Senator McKENZIE: That is often the case.
Mr Butt : It is Loddon Mallee, after all.
Senator McKENZIE: That is excellent. If there is a document outlining the criteria used for that particular board or one that you use generally, can we get a copy of that, please? The deputy chair of the board is actually a staff member of the local ALP member for Bendigo, Mr Steve Gibbons. How does that occur? Is that typical? Is there a perceived conflict of interest there?
Mr Butt : Once again, their company is limited by guarantee. There was an independent window, there was an independent process in that one that is a partnership that does involve 15 public sector and private sector organisations. They have obviously made their decision on that, and all I can assume is that the decision was made on the basis of the skills that that particular individual brings to the board.
Senator McKENZIE: Okay.
Mr Butt : But we do not get involved in that.
Senator McKENZIE: We had 120 applicants. Somebody was appointed that could be perceived from the outside, from the community, to have a conflict of interest in decisions around the Medicare Local; how could they be appointed over equally experienced in industry or community from that pool of applicants?
Mr Butt : I really could not answer that. As I say, it was an independent process and we were not involved in it.
Senator McKENZIE: Do you know who ran that independent process? Could you take that on notice?
Mr Butt : Yes. I would suggest that the CEO would probably know. We can give you details of the CEO’s contact information if that would help.
Senator McKENZIE: Okay, but you do not know?
Mr Butt : No.
Senator McKENZIE: You would not be able to find out who? Could you take it on notice?
Mr Butt : We will take it on notice.
Senator McKENZIE: Thank you. I would appreciate that. I am just wanting to know how much funding Loddon Mallee Murray Medicare Local will receive.
Mr Booth : We generally do not make available the individual funding amounts for individual Medicare Locals.
Senator McKENZIE: Generally do not make available or you do not make available?
Mr Booth : We do not make available.
Senator McKENZIE: Okay. Would you be able to tell me how much of that funding was spent on actual service delivery?
Mr Butt : What we have got is core funding and then a whole range of program funding. The core funding, when you talk about service delivery does include service delivery in the sense of—
Senator McKENZIE: Coming from another bucket?
Mr Butt : No, the core funding does actually include service delivery when you think about what they are doing in terms of engagement with community and with other health services, et cetera. The core funding does include the population health planning and the engagement processes and the support processes for primary health care general practice. On top of that, there are a whole range of schedules that are then attached to their contract which cover things like mental health services. So, for example, ATAPS, as was used earlier. Particularly in that area you would have rural programs attached to it. Ms Roe, did you want to add anything?
Ms Roe : After hours.
Mr Butt : After hours, immunisation funds, ehealth funds—there are a whole range of different things.