Senator TAMBLING (Parliamentary Secretary to the Minister for Health and Aged Care.) (8:02 PM) —We are speaking tonight to the Health Insurance Amendment (Diagnostic Imaging Services) Bill 1999. This is a bill to amend the Health Insurance Act 1973 in relation to diagnostic imaging services. The aim of the bill is to ensure the quality of diagnostic imaging services provided by medical practitioners in rural and remote Australia. It also seeks to maintain and enhance the quality of service provided by general practitioners who have been supplying diagnostic imaging services to their communities for a number of years. These two categories of providers have exemptions under the act to provide specialist type diagnostic imaging services in their particular communities. There are good reasons why exempt practitioners should be able to provide specialist type services, including providing access in rural areas and maintaining continuity of care in communities where a medical practitioner may have provided these services over a long period of time. The bill introduces a program of continuing medical education and quality assurance programs for these practitioners. These quality assurance programs are being jointly developed by the Australian College of Rural and Remote Medicine, the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Radiologists. Participation in these programs would be required under this bill in order for general practitioners to maintain their exemptions and continue to provide diagnostic imaging services in their communities. This bill is a vital component of the quality enhancement measures being undertaken in the area of diagnostic imaging and in developing partnerships between professional groups involved in the delivery of these services.

Senator Carr, in his comments, raised a number of issues. Let me address a couple of them. Firstly, Senator Carr referred to the issue of professional accreditation, particularly for sonographers. The Department of Health and Aged Care is providing funding to a number of professional groups to assist in the development and implementation of accreditation guidelines for diagnostic imaging. Specifically in relation to this bill, the department is funding the Australasian sonographer accreditation registry to develop and implement accreditation of a sonographer education and training program. The department is also supporting the Australian College of Rural and Remote Medicine in the development and maintenance of accreditation programs for rural, non-specialist radiology providers. Accreditation will continue to be discussed in consultation with interested parties and we will continue to build on a range of quality measures that have been or are being implemented.

Secondly, Senator Carr turned his attention to what he described as `second-best service' for rural residents. This bill will in fact promote an increased level of service by ensuring participation in quality assurance programs and continuing medical education. General practitioners in rural areas provide a broad range of services as access to specialists is not as great as in metropolitan areas. This will enable medical practitioners in rural and remote areas to broaden their skills and to provide a level of service that may not otherwise be available. By enabling GPs to undertake particular diagnostic imaging services and enhance their skills, patients do not have to travel vast distances to receive these specialised services and, through the linkage between payment of Medicare benefits and quality assurance, the bill aims to ensure that the level of service provided to rural patients is not compromised.

Thirdly, Senator Carr made a number of points with regard to what he considered to be inadequate consultation and a dominance of sectoral interests. I assure Senator Carr and others that consultation on the bill has been ongoing with interested parties since 1990, in fact right through the period of the Labor administration and well before that of the current Howard government. The Australian College of Rural and Remote Medicine, the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Radiologists have all been involved in these consultations and are currently developing the CME and QA program referred to in the bill. The Department of Health and Aged Care consults widely with a number of interested groups on a regular basis. These groups comprise the peak medical groups and technical groups involved in providing diagnostic imaging services.

In relation to the use of telemedicine, to facilitate quality service in rural areas the Commonwealth is working with state and territory governments through the Australia-New Zealand Telehealth Committee, known as ANZTC, an advisory committee to the Australian Health Ministers' Advisory Council, to develop and implement national telehealth policies and standards that are aligned with sound clinical practice. The Commonwealth is participating in the ANZTC's national telehealth think tank to be held in late May of this year. The think tank will guide the preparation of a five-year national telehealth strategic plan that will recommend key strategies for the integration of telehealth activity with mainstream health care provision for consideration by AHMAC at its meeting in October this year.

Recognising the importance of facilitating the implementation of telehealth and telemedicine applications that are clinically and cost effective, the Commonwealth has funded a project to develop a generic evaluation methodology for telehealth applications focusing on teraradiology, telepsychiatry and telerenal medicine. The project is being managed jointly by the Department of Health and Aged Care and ANZTC and is expected to be completed in the very near future.

On the issue that was raised with regard to confusion with what I would describe as professional supervision requirements for ultrasound, this bill should not be confused with professional supervision requirements for ultrasound, which were introduced on 1 September last year. Professional supervision of nuclear medicine, magnetic resonance imaging, diagnostic mammography and computered tomography has been progressively introduced since 1994. Professional supervision of ultrasound services is not an attempt to downgrade the status of sonographers, nor is it a reflection on the current quality of services. The key driver of the requirement is to strengthen the link between the specialist who bills Medicare for the provision of an ultrasound service and the responsibility for the quality of service provided.

Senator Carr made the point that there was a failure to consult. The introduction of professional supervision followed an extensive consultation process with groups involved in the provision of ultrasound services, including the Australian Institute of Radiography, the Australian Sonographers Association and the Australasian Sonographer Accreditation Registry. There are consultative mechanisms in place to ensure that relations with ultrasound providers are improved and maintained. An ultrasound group has been established to provide advice on the delivery of ultrasound services under the Medicare benefits schedule. Membership of the ultrasound group consists of representatives from the following associations: the Urological Society of Australia, the Health Insurance Commission, the Royal Australian College of Radiologists, the Royal Australian College of Obstetricians and Gynaecologists, the Cardiac Society of Australia and New Zealand, the Royal Australasian College of Surgeons, the Australia and New Zealand Association of Physicians in Nuclear Medicine, the Australian Society of Ultrasound in Medicine, the Royal Australian College of General Practitioners and the Australian Sonographers Association.

The ultrasound group is continuing to monitor the impact of the introduction of professional supervision and will be working to ensure that accreditation issues relating to ultrasound providers, including sonographers, are addressed. Professional supervision for ultrasound requires a specialist or consultant physician to be available to monitor and influence the conduct and diagnostic quality of an examination. The specialist must be available to personally attend on the patient if necessary. In order to balance patient access with quality, a number of exemptions to the ultrasound provisions apply, and these include where ultrasounds are performed in a remote or rural area, in an emergency, by general practitioners who are providing a threshold number of services prior to 1 September 1999 and by a general practitioner offering services in a nursing home or patient's residence. So that there are not unintended consequences, particularly for the provision of ultrasound services in rural and remote areas, the Department of Health and Aged Care has been consulting with professional groups via the ultrasound group on possible amendments to this definition. These will be considered further through the ultrasound group and, if required, proposed amendments will be circulated for comment and consideration.

The reality for rural and remote areas is that general practitioners provide a broad range of services as access to specialists is not as great as in metropolitan areas. The aim of this bill is to promote an increased level of service by ensuring participation in quality assurance programs and continuing medical education. This will enable medical practitioners in rural and remote areas to broaden their skills and to provide a level of service that may not otherwise be available. By enabling GPs to undertake particular diagnostic imaging services, patients do not have to travel vast distances to receive these specialist services. Through the linkages between the payment of Medicare benefits and quality assurance, the bill aims to ensure that the level of service provided to rural patients is not compromised.

The government is consulting actively with all of the groups mentioned by Senator Carr, particularly including the Institute of Radiographers, on issues that affect them. I can certainly give assurances that it is this government's commitment to maintaining a very high level of health standard in rural and remote areas that is one of the paramount and primary reasons behind this particular legislation. I am pleased that the opposition have indicated that they will support the legislation. I take on notice their view that there are other issues that they would like to see addressed at later stages connected with other legislation. We will certainly take those points into account as further legislation will be brought before the parliament in due course.

Question resolved in the affirmative.

Bill read a second time, and passed through its remaining stages without amendment or debate.