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Thursday, 10 May 2007
Page: 57

Ms HALL (12:47 PM) —I will commence my contribution to this debate on the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007 by concentrating on a couple of the issues that have been raised by the previous speaker, the member for Moreton. He spoke at some length about dental services and the government delivering dental services to people in this budget. I will share with this House the issues around dental services that are very strong within my electorate.

Whilst the government may believe that it has delivered on dental services in this year’s budget, I was extremely disappointed with the announcement on dental services. This government has failed to recognise and meet its obligations to dental services. We have lengthy waiting lists for dental services within the public system. As a former state member, I can say that those waiting lists developed when this government, the Howard government, removed the Commonwealth dental health scheme. It was like turning off the light—one day people could go and get the treatment that they desperately needed and the next day they were denied that treatment. The initiative in the budget of course is welcome, but it is only an extension of a scheme that is not working at the moment. It is a scheme that requires a person to have a chronic condition before they can access dental health services under Medicare. I do not believe that is good enough. That will not help the people that I represent in this parliament.

Another issue that the previous speaker raised was the need for more radiologists. We definitely need more radiologists, but in the electorate of Shortland, which is the electorate I represent in this parliament, we need more doctors. In the suburbs of Belmont and Swansea all the doctors have closed their books and people cannot access a doctor when they need to. The government has failed the people that I represent in this parliament. I get letter after letter from ministers who respond by passing the buck, doing nothing, and failing to recognise the needs of people in the area that I represent.

That is another area that I was particularly disappointed about in the budget. Nothing that this government announced in the budget is going to help the people that I represent in the electorate of Shortland in this parliament to deal with the doctor shortage. The crisis in dental health and the crisis of the shortage of doctors was borne out in a survey that I have just conducted electorate-wide. Overwhelmingly, they were the two issues that were highlighted. The member for Moreton may have been extremely pleased with the government’s commitment in the area of dental services, but it did not work for the people of Shortland.

The member for Moreton varied quite substantially from the legislation before us, and I have taken the same liberty. Thank you for allowing me to do that, Mr Deputy Speaker. The bill proposes to amend the Health Insurance Act to establish an overarching framework for the operation of an accreditation scheme for diagnostic imaging services. Accreditation should happen—it is widely supported by us on this side of the House—but I am quite critical, as is the shadow minister, of the lack of thorough preparation of this scheme and of reliable costings in the legislation. It is quite worrying that there has not been a full investigation and a complete analysis done on this legislation, but we on this side of the House have come to expect that. I sometimes think the government is a little lazy in its approach. It is important that we are aware of these issues when we debate legislation and, unfortunately, an analysis was not included in this legislation.

The government and representatives from the diagnostic imaging sector have agreed to the introduction of an accreditation scheme. In 2003, there were negotiations for a radiology MOU. Accreditation schemes have proved to be a sound method of reviewing and improving systems of care throughout the health sector. Madam Deputy Speaker Bishop, when you were the minister for aged care you oversaw accreditation in the aged-care sector. It was a very good example of the accreditation process and has been of great benefit to the aged-care sector. Indeed, it has gone a long way to ensuring the quality of aged-care services within residential settings.

I hope this legislation will do the same thing for the diagnostic imaging sector. The legislation does not provide operational details—for example, the standards to be used, the names of approved accreditors, the accreditation process and the period of accreditation. Instead it allows the minister to establish the rules and operational details of the scheme through legislative instruments. That makes me a little nervous; I like to know the details of the process. The representatives of the diagnostic imaging sector have also raised some concerns. They would like to have a little more knowledge of the operational details of the scheme, and I understand that they are still considering this aspect of the legislation.

I would also be much happier if full costings had been included with this legislation. The accreditation will require enhancement of Medicare Australia’s processing systems. These costs are estimated at $1.2 million, based on previous similar announcements. The full costings will be announced in the subordinate legislation, which is yet to be developed, and the scheme is to commence in July 2008.

Diagnostic imaging plays a very important role in our health system. It includes a wide range of diagnostic medical services, including ultrasound, CT scans, nuclear medicine, radiography, X-rays, MRIs and PET scans. The previous speaker, the member for Moreton, spent some time talking about the expansion of MRIs within the Australian community. I am a little disappointed that the budget did not provide for a PET scanner at the Mater Hospital in Newcastle, but so be it—it is at the whim of the government but to the detriment of the people of the Hunter.

The government provides Medicare rebates for a number of diagnostic imaging services listed in the diagnostic imaging service table that is attached to the legislation. Diagnostic imaging services under Medicare are undertaken cooperatively between the government, through the Department of Health and Ageing, and sector representatives, through the college. The MOU is one of four collaborative agreements between the government and diagnostic imaging representative organisations. The MOU was part of the 2003-04 budget process for managing Medicare funded diagnostic imaging services. Additional MOUs for cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasounds are also in place. The radiology MOU accounts for about 80 per cent of all diagnostic imaging services. The explanatory memorandum, which I will refer to more in a moment, indicates that in 2005-06 approximately 12.6 million services were claimed and the government provided more than $1.3 billion in Medicare benefits for services covered by the MOU.

It is appropriate to visit the accreditation process and to consider what accreditation delivers to the healthcare industry, to government and to consumers as a whole. The memorandum of understanding attached to this legislation recognises that accreditation is a vital tool within the industry for reviewing and improving the system and ensuring that we have safe, high-quality health services. This is what accreditation provided to the aged-care industry. As set out in the memorandum of understanding, it is a means of ensuring minimum standards of practice in operations. It is a benchmark for maintaining competency and, over time, it provides feedback on the overall enhancement of quality in a professional discipline. This is extremely important to a person who is undertaking some sort of diagnostic imaging investigation. You need to be sure that the minimum standards are in place and that there is a competency benchmark. It is very important because if standards are not in place there can be enormous health implications for the person undergoing the investigation.

Whilst we can be fairly certain that appropriate practices are in place currently, we cannot be absolutely certain. What we need to do and what this legislation will do is ensure that all staff in radiology practices will be appropriately qualified. I am certain that any Australian who was about to have some sort of health service would like to know that that was the case. The legislation will also ensure the effective management of resources, that proper systems are in place, that there are multi-disciplinary teams and that the health outcomes are the right ones because there is quality of service. People will know that, in every practice providing diagnostic imaging services, each person working there will be qualified—they will have the expertise—and that the service is being delivered in a safe environment. It is an area in which technological advances are constantly being made, and we need to make sure that the industry keeps up with those advances.

There is currently—and I think this is an important point—no regulatory mechanism to ensure that all elements involved in the delivery of diagnostic imaging services work together. This is a problem for the people of Australia who are relying on those services. There is no guarantee for the patient that optimal radiology services are being provided. Accreditation provides assurance that the amount of money that the government invests—and it is a large amount of money—in the provision of diagnostic radiology is being well spent and that we are getting the appropriate outcomes.

It is also important to note the kinds of people who use diagnostic imaging. Radiology services are provided by a diverse range of provider groups. There are specialist radiologists, vascular surgeons, cardiologists, general practitioners, obstetricians, gynaecologists, sports physicians and dentists. Also, their services can be provided in a wide range of settings. They can be provided in a consulting room of a one-man practice, in a large practice where there is a level of expertise with practitioners specialising in diagnostic radiology, or in a hospital. We need to be sure that there is consistency across the services provided. Hopefully, this legislation will deliver that consistency. Currently there is a potential for inconsistency in the delivery of the service, and there is a variation in the qualifications and experiences of practitioners, the standards of supervisors, the equipment used, the practice protocols and the administrative procedures—and they can all lead to inconsistency. That is why accreditation is so good. It establishes common standards and benchmarks that everyone delivering those services must meet.

I see this legislation as vitally important. My concerns surrounding the legislation, as I said at the commencement of my contribution to the debate, go to its lack of detail. There should be a little more consultation. There is also the issue of transparency. One of the most important elements in any legislation is transparency, and along with transparency comes accountability. The inclusion of these elements in legislation will deliver the best form of accreditation that can be put in place.

I support the legislation. I have my concerns about transparency and the lack of detail on costing but, given the overall picture of the legislation, those concerns are secondary to the need for a system of accreditation that will ensure the integrity of diagnostic imaging.