Mr JENKINS(7.35 p.m.) —One of the greatest achievements of the Whitlam Labor government was the establishment of community health centres. In announcing the creation of community health centres in the budget in 1973, the then Treasurer, Frank Crean, stated that they would be `regionally organised, community based health services, with their emphasis on rehabilitation and preventative rather than curative health measures'. This program was a new approach to health care in Australia which examined for the first time the impact that environmental and social factors have on a person's health.

Community health centres were the Whitlam government's response to the 1972 May report of the Interim Committee on Hospitals and Health Services entitled A community health program for Australia. The then Minister for Health, Dr Everingham, stated:

The program should provide the required impetus for the establishment of much needed, but often overlooked, community based health services and should encourage communities and regions to examine their own needs and priorities and to express them to the relevant health authorities.

Community health centres have traditionally taken a holistic approach to medicine with direct service provision and the wider issues of community development, education, preventive health care and self-help. Because they were administered by and accountable to the community, the centres aimed to empower local communities and individuals and offered them the opportunity to determine their own needs.

The Whitlam government recognised that there needed to be a federal approach on the issue of community based medicine. This was in part due to the Labor Party's strong belief in the role that the Commonwealth has to play in these matters. However, it was to a large extent a matter of necessity, given the parlous state of health services in the states after long periods of conservative government in most of them.

Regrettably, the Fraser government attempted to sabotage the scheme by handing over community health centres to the states, failing to appreciate why the Commonwealth had taken action in the first place. This has meant that over the years community health centres have fallen victim to the economic rationalist ideologies that have gripped the nation. An emphasis on preventive medicine and community development to help avoid illness is a concept that an economic rationalist has great difficulty comprehending. The idea that money can be spent now to prevent far greater expenditures and social problems in the future just does not fit into the economic rationalist paradigm. Seeing the world as a series of budget bottom lines fails to appreciate the role of community health.

There have been, and continue to be, attempts by various state governments to take the community out of community health. In Victoria this June, the Kennett government replaced the elected committees of community health centres with government appointed bodies. In addition, the state government has created a number of regional health networks consisting of the hospitals and other health service providers in a particular region. These networks tender to the government to provide health services. The concepts of competitive tendering and block funding have taken their toll on community health centres. Local community health centres in the area I represent understand that they must cooperate with these networks in the delivery of health services. They are willing to examine the ways to achieve this required cooperation; however, some of the models under consideration threaten the very existence of community health itself.

Currently, the five community health centres in the north-eastern region of Melbourne—Eltham, Plenty Valley, Banyule, East Preston and Northcote—have formed an alliance and are considering proposals for their future. One of the proposals, and the preferred option, is for the retention of individual services with the creation of a coordinating body to look at planning issues and service provision issues. Another option is for the complete amalgamation of all five into one—either as part of the local regional health network or with an administrative body of its own.

However, such regionalisation of community health would mean that they have a different regional focus and would not have the ability to take into account specific local community needs and interests. This would mean that, if it was under the regional network, the regional network board would run the community health centres with only local advisory committees. However, advisory committees are exactly that—advisory. They have no real power. This model has already been accepted in one network in Victoria. By becoming just another part of the regional network, the community health centres lose an integral part of the reason for their success—the community involvement.

I am concerned that the network or the amalgamation models could be adopted by the alliance of the five north-eastern community health centres. This would be a disaster for the people of the north-eastern region of Melbourne, and the amalgamation/network option should be unconditionally scrapped.