Senator WEST (6:01 PM) —I rise to speak on the report In the pink or in the red? from the inquiry into the provision of health services on Norfolk Island which was undertaken by the Joint Standing Committee on the National Capital and External Territories, of which I am a member and with which I have made one visit to Norfolk Island to look at some of their health facilities.

Norfolk Island is a small island off Australia which is part of Australian territory. It is part of the Commonwealth of Australia, but it has a lot of self-government and autonomy. It is not part of Australia's taxation system; it has to rely on its own forms of revenue raising and, as such, it is responsible for its own health care. Medicare does not operate on Norfolk Island. There would be a lot of Australian people who travel to Norfolk Island who do not realise that Norfolk Island is not covered by Medicare arrangements. If they find themselves getting sick, they may well incur quite significant health costs, particularly if they have to be evacuated back to the mainland.

There is a small hospital on Norfolk Island—20-odd beds—and the staff endeavour to provide good care. There is a shortage there as well of doctors in general practice. They need three or four; they are down to two or three. They have a lot of visiting specialists who come through. The buildings are very old, very antiquated. The aged care services are appalling. They are part of a ward at one end of the old, ramshackle hospital and there is no privacy. It would fail accreditation on the mainland on every count, I would think—with the exception of the nursing standards and the medical care that is given, because the care that is given is given with love and tenderness. But the Norfolk Island government does not seem to want to bite the bullet and look at this particular issue. There is also some accommodation in unit-type facilities for about three or four people, and these also are less than adequate and are certainly something that the government in the territory has to start to address.

We saw the facilities that the doctors who visit are expected to stay in: the accommodation for them is substandard as well. We saw some of the facilities that they are expected to work in, and they are not particularly good. We also saw the mortuary, which is appalling. The lining on the ceiling was falling down and there were rust marks everywhere, but the people on Norfolk Island had known no more salubrious circumstances than that and I guess they thought that that was okay.

There is a problem on Norfolk Island in the health area of how to dispose of sharps and other medical contaminants and medical waste. They tend to be just taken up to the tip, a match is put to them and they are burnt there. That is not good enough in this day and age. It is certainly not good enough in controlling and reducing communicable diseases. The health issues on this island have to be addressed, either by the Commonwealth or by the Norfolk Island government. We were very concerned about the state of the buildings.

The ambulance is run on a voluntary basis. The ambulance resides at the hospital, and that is fine. But to get the ambulance out of where it is parked under cover, you have to drive through all of the hospital complex and down a drive before you can get out onto the highway. There is no direct route from the ambulance parking area to the main road, so it can take an extra couple of minutes to get the ambulance out.

They do not wear seatbelts. There is a huge need for public health work. The rate of smoking is quite high. One of the recommendations of the committee is that seatbelts should be worn in cars. The government in Norfolk Island have pooh-poohed this and have said that they are not going to do that because the speed limit is only 50 kilometres an hour. If you get two vehicles confronting one another at that speed, it is the equivalent of 100 kilometres an hour. In my experience in nursing, I have seen many people very seriously injured in low speed accidents. The roads are narrow and winding, so speed may not be possible. There are also quite a number of cattle that roam the area, and I am sure that a car—even at 30, 40 or 50 kilometres—coming into contact with a beast the size of a cow can certainly make a bit of a mess of things.

Another issue, which I mentioned to you earlier, is that there are no Medicare arrangements there. I really think that the tourism industry does have a major role to play in making sure that people take out travel health insurance when they go to Norfolk Island or that they check the health insurance that they have in Australia to see that it does have coverage. We are talking in terms of $30,000 or $40,000 to be medically evacuated, and that is certainly an issue of concern and an issue that would have a big impact upon people's pockets.

The Norfolk Island territory itself is a very interesting social study because some people on that island are exceedingly wealthy—very rich—and they have the capacity to move off island very quickly and very easily. Also, a lot of people are not rich—they are quite poor—and they do not have the same options that the wealthy people in this particular place do.

We recommended making seatbelts compulsory. We recommended lowering the blood alcohol limit for drivers to a level comparable with the mainland. We also want to suggest to them that they increase their restrictions on smoking in public and private places, to make it more like the mainland as well. The price of alcohol and tobacco on the island is very cheap—there are some good duty frees for those who are travelling back to Australia—but the cheapness of these products does have a bit of an impact potentially on issues like domestic violence, substance abuse and drink driving. These all have social and medical impacts upon the people who live on the island, so that issue needs to be addressed.

As for the future health needs of the island, the technology that is used there is very old. The surgeons go over and they can do a cholecystectomy but it is the old laparotomy type cholecystectomy. It is not laparoscopic; they do not have that equipment. The increasing use of technology in health care is going to impose a big burden upon this island as to how they are going to be able to afford it. If they cannot afford that, they want to attract surgeons and specialists to the island on a visiting basis. How are they going to be able to do it without the equipment for them to use? It is very important that we look at this.

We also recognise there is a need for a more identifiable method of medical evacuations taking place. A lot of people just make an assumption that the Defence Force—the RAAF—will be able to undertake the evacuations. That certainly has changed over the years, and evacuations by the RAAF are basically a last ditch, last call option. It can take considerable time for the RAAF to mobilise a unit of crew to travel with the aircraft, and you are losing valuable time. We have suggested that maybe they could negotiate with the Royal Flying Doctor Service to actually look at some of this, because the Royal Flying Doctor Service also operate on the mainland, providing a number of primary health care and emergency focuses; it is not just emergency evacuations. They are certainly entering into a very good primary health care focus through taking out their allied health professionals and their specialist nursing areas as well as the doctors, so it certainly needs to be looked at.

The provision of health care on this island is certainly an issue that not just the Norfolk Island government have to look at but the Commonwealth government have to address as well. But the Norfolk Island government really must take into consideration how in the future they are going to fund the health service needs of the island, what health service needs will be provided for on the island and what people will have to leave the island for, particularly if you are going to see things happening such as the airline that services the island going belly up.

Question resolved in the affirmative.