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Monday, 25 October 2010
Page: 1365


Mr LAMING (7:49 PM) —No Australian is not immensely proud of our health system which has evolved over decades, one which leaves this country with the second longest quality adjusted life expectancy in the world. We are a nation that spends roughly an average proportion of GDP on health care amongst developed economies. We have a GP focused system which is almost unique in the world and we have a fascinating public-private blend that has seen both models thrive over the last two or three decades. We also have the pillar of a strong PBS. But all of this relies on safety and quality in health care, something that is utterly beyond question.

The history of the National Health and Hospitals Network Bill 2010 goes back to the year 2000, when the initial Commission on Safety and Quality in Health Care was established under the dutiful and careful chairmanship of Bruce Barraclough. Over the five or six years that followed—the initial five-year period was extended—this commission, from relatively humble funding means of around $50 million over five years, achieved enormous things in safety and quality in health care. Let me take this House back to the 1990s, when we faced an indemnity crisis that was almost unparalleled outside of the United States. At that time, the training of professionals like me was to never admit fault to a patient, to always keep exemplary notes and to accept that at some stage in your career, if not a multiple number of times, you would end up in front of a jury trying to defend your professional reputation in some of the most harrowing experiences a clinician can imagine.

That was changed, after a crisis that evolved throughout the nineties and up to 2001, under the care of Minister Patterson and then Minister Abbott. State tort law reform followed, and one of the great challenges that faced the Australian health system was resolved. At the same time there came a real focus on safety and quality. It was quite simple. We needed a commission with a relatively modest secretariat, which was effectively an ad hoc structure in parallel with the department of health and ageing at the time, and they had a broad and unspecified remit, under fairly modest financial arrangements, to work on safety and quality across the eight jurisdictions in the Australian health system.

The commission led and coordinated those challenges very impressively. They achieved significant gains in standardising the collection of data. We know that without the data we simply do not know what is happening and as a health system we do not know how to improve things. We cannot find the areas where there is a lack of services or areas in which things can be improved if we do not collect the data to establish that. One of the great benefits of having eight different jurisdictions offering health care is also something that is incredibly fraught—that is, the ability to compare and contrast between those services. Australia has an opportunity to have simultaneous health systems learning from each other, disseminating great practice. However, if, at the same time, we do not collate data in a consistent way, much of that can be undermined.

What happened between 2000 and 2006 was the establishment of recognised and agreed standards. Some of them did not require enormous amounts of funding. I would like to highlight the national framework for education in safety and quality. Health professionals of all sorts had never learnt about safety and quality in health care throughout their undergraduate degrees or even through their clinical training. Through the 1980s and 1990s most of it was intensively defensive. What we saw was an area developed by the commission that was picked up by all the states and territories and, ultimately, by the World Health Organisation and now it is used internationally. It has become an absolute world standard in safety and quality in health care.

Some of these things were hard to measure because the initial commission during those five years was not given a specific remit to implement. It was given, with its fairly modest funding arrangements at the time, only the opportunity to develop models which could be picked up by the states and territories. So it is with some regret that I recall that when the commission was eventually evaluated, one of the criticisms, quite disappointingly, was that it had failed to implement the very things that it was not initially established to do. But the one great thing that the Australian commission achieved is that it set up the platform that we are debating tonight, which is the need for an explicit authority to be built into the structures of Australia’s health system—Commonwealth and state. The authority is more narrowly focused on safety and quality. It has a board, a chair and a CEO structure, which is probably more appropriate. It also has governance and will not be utterly reliant on soft forms of funding or the will of the government of the day for its survival. That is all absolutely vital. The authority will be headed up by some very impressive clinicians. All of that is very promising—and no-one would begrudge the need for the highest levels of safety and quality monitoring in this country.

The problem that has been so well outlined by the member for Dickson is that this proposal comes in the absence, in almost a vacuum, of any sort of direct action on the provision of health services. It comes at a time when the entire debate around health and hospital reform is limited to a discussion about whether the federal government can deliver primary health care in isolation and whether moving the federal government’s contribution to health from 48-52 to 60-40 represents some form of a complete revolution in health care. If it is such a great idea, why not move to 100 per cent funding of the healthcare system? That has not occurred and there is a simple reason for that. Primary and acute health care are simply too hard for this government to reform. It was simply too hard to talk to administrations of a similar political ilk about the gaping chasm of health inefficiency, duplication, overlap and waste that currently exist between our two health systems. I have said before that Australia with the benefits in its health structure has one great challenge: a public system and a private system. With the latter, the faster you work the wealthier you get. With the public system, the faster you work the quicker you go broke. Those two are never going to work effectively until we have a system where there is clear delineation of which level of government does what, and that has not been picked up in these reforms.

Acute care continues to bleed with people stuck in casualty waiting to be seen, because there is no incentive to have patients seen quickly. This improves under some state administrations and then it leaches away under others. At the same time, people are waiting on public hospital operating lists with no real hope of ever getting their operation because there is a secret list above the operating list and urgent people get moved above less urgent patients. These waiting lists become exactly that—waiting for the operation that never comes.


Mr Lyons interjecting


Mr LAMING —I can bring out plenty of dental patients waiting for dental prostheses that will never come. There are people waiting for hip operations that will never come. The crude reality is that, if you look at some of these operations, they are being performed far more efficiently in the private sector. We can learn from the private health system by looking at how it operates, and there is no better example of that than in Queensland cancer service delivery. There will come a time when we face the fact that public hospitals cannot be expected to do everything and to do it well. There will be a time when private services will deliver it better. What we need is an unlocking of that potential within the health system, but at the moment that has not been achieved in these reforms.

The other focus of the government is the view that the move from 42-58 to 60-40 is some incredible change to service delivery. But I think the Australian people know very little is changing. They see that superclinics are being promised but not constructed and that when they are constructed they are placed right next to ailing public hospitals. They are not going into the areas of great patient need. Edifices are being built worth millions of dollars in places where they will be flat out staffing them or where they are right next to existing medical practices that will be destroyed by a revenue model that is fundamentally government funded. When you build a $3 million government funded facility, how can a private one just 500 yards down the road from it possibly compete?

I digress slightly to simply answer the great question, which is that, while we are waiting and Rome is burning for the tough health reforms that both sides admit have to occur, we have had the date for when the health system would be fixed—but that is now long past. We are waiting for action on waiting lists, including emergency waiting lists. We are waiting on the thousands of seniors in this country who are left in public hospital beds because they cannot find an aged care place. There has been nothing but promised inputs about transitional wards—but no action. It has been four years now and we have seen no change to most public hospitals in this country.


Mr Lyons interjecting


Mr LAMING —You need to visit a hospital, Sir, and see that 30 per cent of those medical wards are blocked by seniors who simply cannot find a bed in an aged-care facility. That situation is worse than it was five years ago. The bed block is worse because the funding for aged care beds is simply not being taken up. That is because the infrastructure payments are insufficient to build, fund and maintain these places for our seniors.

Without taking our eye off the ball, we know that safety and quality is probably the highest goal of a health system after access. Safety and quality is the true measure of whether we are committed to building a better health system, because it is one thing to be accessible and it is another thing to have well-trained clinicians working inside impressive buildings; but, ultimately, without safety and quality, we will have the situation where the wrong drips are put up, the wrong tablets are prescribed or, as many of us will remember in clinical situations, the patient walks in with a great big bag of glasses and says, ‘Doctor, none of these work.’ It is at that moment that you realise that thousands of dollars have been spent without a single improvement in the health of your patients. This legislation is a noble goal. There is no disputing that we need an authority. One was set up by a Howard government commission and it achieved great things but it is no substitute for having no action on the delivery of services for Australians around this nation.


The DEPUTY SPEAKER (Ms S Bird)—Order! The debate is interrupted in accordance with standing order 34. The member for Bowman will be given the opportunity to continue speaking if he so wishes when the debate is resumed.