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Tuesday, 16 August 2011
Page: 8231


Mrs PRENTICE (Ryan) (20:51): I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. It proposes yet another statutory authority, to be named the National Health Performance Authority.

We are here tonight speaking, yet again, on an amendment. But this time the legislation being amended was not introduced when Labor first came to government in 2007, four years ago, giving us time to see what changes needed to be made. It did not even come in two years ago, or even 12 months ago. We are debating amendments to legislation passed by the House as recently as 21 March this year, less than six months ago. This seems incompetent even for this government. Then again, the legislation we are debating for amendment tonight, the National Health and Hospitals Network Bill 2010 was part of the reform put forward by former Prime Minister Kevin Rudd. With that in mind current Prime Minister Julia Gillard's attitude towards the legislation is perhaps less surprising.

The former Prime Minister and the then Minister for Health and Ageing promised that reform of the health system would not create further bureaucracy, yet here we are again debating substantive change that creates yet another layer of bureaucracy. I understand that tonight's debate is regarding just the first of two proposed authorities, two more bodies that will generate boards, administration offices and staff, growing the bureaucracy instead of providing more hospital beds and hands-on carers. Given that two bodies are being proposed under changes to the health system, I wonder why we are debating their establishment separately. Why not put both bodies forward at the same time, as the coalition called for last year? Could it be that the government is concerned that the costs involved in establishing two new bureaucracies could be better spent?

We see horror stories, absolutely terrible stories, every day in our papers about how the health system is failing Australians, how patients cannot get surgery, how patients need to be rushed to larger hospitals sometimes hours away to be treated and how patients are dying unnecessarily. This week alone I read news articles about a young boy in Sydney who unnecessarily lost his life after suffering through 12 hours of a burst appendix, a diagnosis correctly made by the first doctor he saw. I read another story about a 13-year-old girl who gave birth on a runway in transit to a larger hospital as the local facility did not have the capacity to help her. We all know these stories—we have heard them in this chamber tonight—from the terrible conditions in Townsville to Gladstone patients being stabilised before being rushed to Rockhampton, two examples from members in my home state of Queensland alone.

Hopefully based on this, the government have identified that Australia needs major reform of the health system. They are right—something historic needs to be done to improve our health system. But their solution is more bureaucracy, a bureaucracy that will be charged with monitoring and reporting on the performance of local hospitals, primary healthcare organisations and other bodies that provide healthcare services. That is a very broad role for the National Health Performance Authority. It is an especially broad task when you read through the legislation and discover that nowhere is there a definition of 'performance'. This is a body set up to monitor performance without clarity on what a well or performing health service actually is.

This is obviously cause for reservations. There are no key performance indicators, KPIs. How then will this statutory body assess performance? That is a big question which has been left unanswered. It is a question that could have been resolved through a proper inquiry. The government did conduct an inquiry. However, true to form, it was brief, it was conducted in haste and it did not address many major questions and concerns that continue to hang over this debate, questions that none of the members opposite has been able to answer. The haste with which this inquiry was conducted is made clear in a statement made in the dissenting report:

… that a number of stakeholders that wanted to contribute to the Inquiry were unable to due to the haste with which the Inquiry was conducted.

It seems to me that the Gillard government may be trying to rush this amendment through for political reasons, rather than as true reform which will actually address health problems and provide real outcomes for Australians. Major stakeholders have concerns, including the Australian Medical Association which is calling for the legislation to be deferred as it would like to see an assessment of the impact of the legislation and details of what data must be provided to the authority by health provider organisations. That is right: as well as having no performance indicators, it is unclear what data health services have to provide.

Those opposite have spoken tonight about accountability, fixing hospitals and historic reform, but how will health providers be accountable to this body? It has no disciplinary powers. There is no way this body will be able to compel the states to improve services. Is it simply going to be a toothless tiger? Simply establishing an authority, a body of bureaucrats with the word 'performance' in its name, does not improve services. It does not make anyone accountable or improve performance in any way. Without any definitions, without indicators or benchmarks, how will this body work? That is the question stakeholders want answered, that is the question the coalition wants answered and that is the question Australians deserve to have answered.

Furthermore, as stated by the Australian Healthcare and Hospitals Association, the legislation:

… fails to recognise the formal role of state/territory governments as majority funders and system managers of public health services including overall responsibility … for the performance …

It is not real reform. It is, in fact, a backward step from what the current Prime Minister's predecessor announced. Then Prime Minister Rudd promised historic reform, yet when that agreement simply could not be reached, perhaps for reasons mentioned previously, Prime Minister Gillard still heralded her 'historic reform'. However, it seems that, while the current Prime Minister was busy announcing historic reform, her Minister for Health and Ageing was quickly realising that without some serious consultation with the states and subsequent amendments this legislation would be unacceptable since so many changes had been made without the states' agreement. An emergency meeting was called and the resulting communique from that meeting stated that ministers from the states and territories insisted that they are the performance managers of public hospitals in Australia. So what is the new body now going to do?

On top of this, we have heard tonight from the member for Hasluck that there are already many organisations that collect data about the performance of health providers—yet another example of duplication which again raises the question of why this body is needed. Why funnel more taxpayers' money to bureaucracy for information that is already being collected? Every dollar that goes into funding data collection for a statutory body is yet another dollar removed from frontline care, from saving the lives of those such as the young boy who died from a burst appendix.

Members opposite have attacked the Leader of the Opposition tonight, accusing him of standing in the way of Australians accessing health care. A statistic is not health care. A patient who is suffering in a waiting room for hours is not comforted by the knowledge that someone somewhere is recording how long they are waiting. They are confused and angry because that data collection just soaked up funding that might have meant they would see a doctor sooner.

A local surgeon in my electorate, Dr Christian Rowan, came to see me the other day. We were discussing the health system in Queensland, and he reminisced to me about completing his residency in Brisbane during the 1990s, recalling that an entire wing of his former hospital that was once full of beds is now full of bureaucrats. Queensland Health proudly announces on their website that they are the third-largest employer in Australia; however, a report put forward by the Australian Medical Association's Queensland branch shows that in 2008-2009 they employed 13,645 managerial and clerical staff—an increase from just 5,060 in 1995—compared to just 6,715 doctors. Additionally, these 6,715 doctors spend approximately 20 per cent of their time filling out paperwork, caught up in red tape. That is 20 per cent of their time not spent with patients, not addressing the 180,000-plus patients on the elective surgery list—20 per cent of time spent on bureaucracy on top of the paperwork already being administered by a bureaucracy twice the size of the doctors workforce.

This report was compiled back in the first round of 'historic reform' under former Prime Minister Kevin Rudd and was put together to ensure such reform would be right for Queensland. I cannot imagine the disappointment that organisation would feel knowing that we are currently debating reform that is proposing to establish a bureaucratic body to somehow measure the performance of the health system that already suffers a problem with bureaucracy. When the legislation has no clarity, how will providers know how they will be affected? How will they know how their patients will be affected? Do the bureaucrats who will comprise these bodies know? Simply announcing 'historic reforms' does not cut it.

We need less talk, we need fewer bureaucrats and we need fewer amendments. We need more action; indeed, we need more outcomes. What we really need are more patients receiving better treatment, resulting in more healthy Australians. This bill simply does not give me any confidence that this will happen. It is unclear, it overlaps and it creates a growing administrative burden. It is flawed legislation, and I have grave doubts that it will provide any real outcomes for Australians.