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Wednesday, 25 March 1998
Page: 1570


Dr NELSON (4:57 PM) —This issue and the Health Legislation Amendment (Health Care Agreements) Bill 1998 really illustrate, if not emphasise, two things that are failing Australia: the first is state-Commonwealth relations—the solution, if it is ever found in health, will not be found until we have dealt with that, and taxation reform is a significant part of that—and the second is party politics and the failure of people in public life to be honest about both the nature of Australia's health problems and the solutions which are necessary for them. I would like to read a quote from the Australian Financial Review of 14 April 1992:

Federal Government officials indicated yesterday that the Commonwealth would reject all claims by the states today for an additional $1.1 billion in public hospital funding as part of the next five-year Medicare agreement.

. . . . . . . . .

In particular, the Commonwealth wants the States to introduce State-based hospital waiting lists and to introduce national protocols for hospital admissions and procedures.

This was at a time when the Keating Australian Labor Party government was governing federally and the health minister was Mr Brian Howe. On 10 April 1992, the Australian Financial Review went on to report:

Federal and State government health ministers are expected to open next week's negotiations on the new five-year Medicare agreement with a clash over hospital funding.

. . . . . . . . .

Sources said the Deputy Prime Minister and Health Minister, Mr Howe, will tell the States that they have the capacity to increase funding of their public hospitals.

He would be `surprised' if the States could not raise more funds for public hospitals.

. . . . . . . . .

A spokeswoman for the Victorian Health Minister, Ms Maureen Lyster, said Victoria would not consider the Federal Government's proposals to link funding to efficiency before gaining a commitment to increase federal funding.

She said Victoria was seeking $1,107 million annual increase from the Commonwealth to the States, including $300 million more for Victoria . . .

The reason why I have read those passages to the House is to put this whole debate into a proper context. It appears not to make a great deal of difference which party, politically, is governing either at a federal or a state level in terms of the core issues in relation to Medicare financing of public hospitals.

To further illustrate that point, let me say that occasionally the political process throws up some people who are honest and people who are of integrity—and they are on both sides of politics, but they are few in number. I would like to read you the speech that was delivered on 27 May 1992 to the Operation Hospital Survival rally that was organised by the Australian Hospitals Association and the Australian Private Hospitals Association on 27 May 1992. This speech was delivered by the then Minister for Health of Western Australia, Mr Keith Wilson, a member of the Carmen Lawrence cabinet at the time. He said:

I would like to thank the organisers of today's conference, the Australian Private Hospitals Association and the Australian Hospitals Association, for inviting me to give this address. I was happy to accept because I want to draw attention to the major issues which are of primary concern to me as Minister for Health in Western Australia—the provision of hospital services in that state. I have good reason to believe that these concerns are also high on the agenda of most, if not all, state ministers for health.

The pre-eminent issue, which I believe this conference must focus on, is that seriously sick Australians are daily unable to gain access to needed hospital treatment. The tragedy is that the people who are most affected are the aged and those on low incomes with chronic disease. What we are seeing is the growing failure of hospital Medicare to protect the most vulnerable members of the community; the exact opposite of the original objectives of Medicare. The increasing inability of hospital Medicare to fulfil its obligation to Medicare enrolees is unequivocally demonstrated by the growing numbers of people on public hospital waiting lists who are finding that they are no longer assured of timely access to a public hospital.

I remind the House that it was under both a federal Labor government and a state Labor government that this state Labor health minister was making these remarks.


Mr Melham —So what is your point, Brendan?


Dr NELSON —I now go on:

For a great many people it is now not unusual to wait six, 12 or more months for admission to hospital. Elderly sick patients are all too frequently finding their long awaited appointments for admission to a public hospital have been cancelled and re-scheduled at short notice, as the hospital has no available beds because of a sudden unexpected increase in emergency admissions. What has become increasingly evident is that hospital Medicare works well for people with urgent life threatening illness requiring immediate or emergency care, but not for those who are poor, have a chronic but not life threatening disease and require hospital treatment to eliminate or reduce severe disability or pain. It must be cold comfort for chronically ill people on low incomes waiting months for admission to a public hospital to hear repeated assertions that Australia has one of the best hospital systems in the world.

Mr Wilson went on further that day to say:

What is relevant is the trend in total Commonwealth general revenue grants to the states, including the public hospital funding grants over the period since the introduction of the Medicare system.

He said:

In the first full financial year of Medicare, 1984-85, the Commonwealth contributed nationally about 48 per cent of total public hospital costs, the states 40 per cent and private patient fees about 12 per cent. By 1989-90, the percentages had changed to the Commonwealth providing about 41 per cent, the states 50 per cent and private patient fees 9 per cent.

He went on to say:

There is a very important point to be made. It is quite outrageous of the Commonwealth to make a song and dance about hospital efficiency when it is perpetrating the most inefficient and ramshackle hospital funding system one could imagine.

Mr Wilson, during the text of this speech, further said:

Additional funds must be found for hospital services either from the public or private sectors. This may be an unfashionable statement in times of economic constraint. It is however my view an unavoidable requirement. There is a need for the Commonwealth to recognise private health insurance as a necessary complement to hospital Medicare.

He concluded that day—and I repeat that this was the Labor health minister in 1992, at the time when we had a federal Labor government and when, I understand, the finance minister at the time was the current Leader of the Opposition (Mr Beazley)—by saying:

I believe that it is essential that we continue to press the Commonwealth for urgent and sensible reform of hospital Medicare. Without such reform we will witness the progressive deterioration of Australia's public hospital system and increasing injustice to many seriously sick Australians throughout this country.


Mr Melham —You've had two years and you've done nothing; you're doing a Fraser.


Dr NELSON —He continued:

Finally, if sensible reform is not forthcoming from the Commonwealth, I would like to give you a foretaste of action which Western Australia will be forced to carry out in the relatively near future. I have brought along a copy of a sign which could shortly appear in Western Australia's public hospitals: `This hospital has been under-funded by the federal government since 1984'.

The point that I make in response to the interjections from the member for Banks (Mr Melham) is that the arguments that were put in 1992 are precisely the same arguments that are being put today, except there is not an argument being put that the Commonwealth is not doing anything at all to support private health insurance. In other words, you had a state Labor government that was criticising a federal Labor government in precisely the same terms that the states are now arguing with the Commonwealth over Medicare financing agreements.

Turning directly and specifically to the bill: what this government is doing is setting into legislation the hospital financing, philosophy and principles of Medicare, of universal access for all Australian residents to Australian public hospitals and that access being free of cost to sick Australians, irrespective of age, income or health status. The ignorance of the member for Dobell (Mr Lee) and his colleagues is such that they are opining that this is no longer called a Medicare agreement. That is because they are ignorant of the fact that what the bill is seeking to do, amongst other things, is broadband services that are being provided—health care services and services provided in the community—so that hospitals will be financed under these agreements to provide not just in-patient services but step-down care, hospital in the home, renal dialysis at home and a range of services that are not currently funded under Medicare.

What we are on about as a government finally is health, not just the financing of health. That is why the title of the bill has been changed. The financing proposal that has been put on the table by the Commonwealth is $30.17 billion over the next five years. That is $2.9 billion over and above forward estimates for the next five years and includes: $1½ billion in base funding for five years; $750 million for veterans, although of course veterans, quite rightly, have entitlements outside this agreement from which the states are financial beneficiaries; $500 million for improving efficiency in hospitals, especially in the area of information technology; and $120 million for waiting lists. The Commonwealth is making available $4 million a week to treat 1,300 people a week languishing on waiting lists, some of whom are at risk of serious ill-health and, without exaggerating, some of whom are at risk of dying as they wait on a waiting list. This represents a 6.9 per cent real increase in the first year of funding. That will move to a 15.4 per cent real increase in funding over the five years of the agreement.

The states, as they were in 1992, some of them Labor governments, are demanding an extra $5½ billion over the next five years which, when you consider what happened in 1993-94, keeping in mind that Brian Howe managed to get the states to sign up just before the 1993 federal election, the first year of operation of the current agreements is such that the previous Commonwealth government succumbed to the demands of people like Keith Wilson when he was the ALP health minister in Western Australia, and it increased funding in the first year of the agreements by 11.4 per cent. So what happened? The states cut funding by 11.7 per cent. What happened in one year was that the Commonwealth's share of public hospital financing increased from 45 to 55 per cent, and it has taken three years for it to recover.

Some of the most vocal criticism of the Commonwealth's current offer is coming from Victoria. In the first year of those Medicare agreements in Victoria, the amount of money that the state contributed dropped by $205 million compared to 1992-93. One year after that, it had dropped by $396 million compared to 1991-92. To be fair to the current Premier, Mr Kennett, that agenda was driven by Dr John Patterson, who was head of the department at the time, and supported by Mrs Marie Tehan, who was then the health minister.

In January 1995—I had moved to Sydney about a month earlier—I was listening to the radio one Saturday afternoon. I heard the Victorian Premier come on and say that there was not a problem in the public hospitals in Victoria. He had just done a tour. I thought, `What kind of nonsense is this?' I rang one of my colleagues who was president of the Victorian branch of the AMA and I said, `I would like you to arrange a tour of the hospitals for me.' I did a tour.

At St Vincent's Hospital I found two patients with brain tumours, both of whom had hemiplegia, which means that they could move neither their right arm nor their right leg, and were filled up with cortisone to reduce the pressure on their brain tumours. These two patients had waited three weeks for elective surgery. In an 18-bed neurosurgical ward, only one nurse was specialist trained in neurosurgery. I found a hand surgeon and his anaesthetist waiting in a theatre that had been empty for an hour and a half because there was not a clerk to admit and process the patient because of the cutbacks that the state government had undertaken at the time in funding the hospital.

I went into the emergency department at 10 o'clock on a Tuesday night. There were two empty beds in the entire hospital. The hospital was on bypass. The problem was that every other public hospital in Victoria that night was also on bypass, which means the ambulances are supposed to take the emergency cases somewhere else. The waiting room was full.

All five of the intensive beds in the emergency department were full. One of the five patients was being mechanically ventilated, which is something you should not do in an emergency department. There were five patients who had already been determined as being in need of admission despite the fact that there were only two empty beds in the hospital. The director of nursing said to me that night—I will never forget this—`A member of our staff goes home crying every night.' That was when we had a federal Labor government and of course by that stage we had a state Liberal government.

I went to the Alfred Hospital the following day. The emergency department was like something you would find in a war zone. Patients on elective surgery waiting lists were phoning every day and many were in tears when they were told for the second, third or fourth time that their surgery had to be cancelled. There was a lack of cardiac monitors in the hospital and some patients with cardiac arrhythmias were not being monitored in the outpatient department. A suicidal patient with a drug overdose had waited 24 hours to be seen by a psychiatric registrar.

I could speak all day about those kinds of experiences—real experiences affecting real people. The point that I want to make is that it is time that the bickering between Commonwealth and state governments in this country ended and both sides of politics supported a meaningful taxation reform agenda which is critical to reform of Commonwealth-state relations and, most importantly, that the party politics is got out of health.

The point I was trying to make at the start of my contribution was that in 1992-93 Brian Howe had exactly the same problems that the current Minister for Health and Family Services (Dr Wooldridge), the member for Chisholm, has in negotiating with the states. But what has happened here is that the Commonwealth has had the courage to put a meaningful offer on the table, which to all intents and purposes is generous, in the knowledge that two states—Victoria and New South Wales—hung out right up to election day, literally, in 1993 and then got more money. I think New South Wales got $78 million. They hung out, and the states are trying to do that again now. The people who are suffering in all of this are the people that Keith Wilson referred to in his July 1992 address—the most vulnerable people that it is intended the Medicare system support most.

Thank you for giving me the opportunity to make this contribution. There is great dishonesty in this debate. There is great anger in the community about it. I think that the state premiers, whatever their political persuasion, ought to do what the taxpayers and the hardworking men and women urge them to do and pay them to do—that is, come to Canberra and talk about a meaningful financing arrangement for public hospitals.