(1) (a) Why did the department introduce a new system of funding for the Community Nursing Care Program in March 2001; (b) how does the department determine individual veterans' clinical funding; and (c) what is the formula used to determine veteran funding.

(2) Why has the department moved away from basing its community nursing funding from fifth year registered nurses.

(3) How many veterans use the Community Nursing Care Program.

(4) Is the Government aware of the considerable concern exhibited by the nursing providers that they can no longer maintain their relevant state awards, employer statutory obligations and adequate service to veterans due to the change in funding arrangements.

(5) How many veterans have been transferred to alternate providers or forced into residential placement following funding decisions that have been deemed inadequate by nursing providers since March 2001.

(6) Why has the Exceptional Case Unit that determines the level of funding from veterans who have exceptional clinical needs been removed from the direction of an independent body and returned to the internal direction of the department.

(7) (a) What proportion of the department's budget for community nursing goes into real health; and (b) what proportion goes into the auditing and administering of these services.

(8) Why has the Government added clause 2, section 2 into the contract for community nursing providers about the restriction of free speech.

(9) With reference to documents: Guidelines for the Provision of Community Nursing Care, April 2001 (Schedule of fees for community nursing providers: Section 5.5, Part 2) and Guidelines for the Provider of Community Nursing Care, November 1997 (booklet 7, Schedule of fees), which identify reductions in the initial funding offered for veteran patients; (a) Does the Government explain this reduction by the fact it has removed the medical supply packages from the funding offered to the nursing providers; and (b) can the Government confirm that the veterans now pay this cost.

(10) (a) How much funding is going into multiple assessments of veterans to continually prove their clinical needs so they can receive ongoing funding for nursing services; and (b) can the Government confirm that much of this multiple assessment of veterans is cost shifted to Aged Care and to state health services budgets.

(11) Can the Government explain clause 2.2 in section 3 of the contract for the nursing providers that a shower two-to-three times a week is sufficient as frequent showering can affect skin integrity and cause fatigue.

(12) By what means can the Government ensure that the new contract and funding arrangement is providing adequate services to veterans.

(1) (a) When the Department initiated reforms to the community nursing program in May 1998, a commitment was given to service providers that within six months a review of the schedule of fees would be commenced. Following an open tender process, Health Outcomes International (HOI) was appointed to conduct the review. The findings and recommendations of the review provided the basis for the new schedule of fees that was introduced with the May 2001 community nursing contracts.

(b) and (c) The funding formula is set out in the Guidelines for the Provision of Community Nursing Care, April 2001. The Guidelines provide information for contracted agencies on how to classify a veteran in accordance with the community nursing classification system and sets out the fees that relate to each of the classifications. The nursing provider assesses and then classifies each veteran according to his or her particular care needs. The fee for each of these classifications is based on the average care needs of all the veterans in each class.

The funding for an individual veteran or war widow through the exceptional case process is based on a clinical assessment of the actual service requirements for each case and a fee is offered by the exceptional case unit based on this assessment.

The fees for both schedule of fee patients and for exceptional cases include all the costs associated with the administration of the community nursing organisation. These include direct client time; general time; community development; teaching training and research; travel; salary and wages oncosts; organisational overheads and the costs associated with capital development. The community nursing provider claims this fee each 28 days that the veteran remains in their care.

(2) The Department uses the award rate for fifth year registered nurses for the registered nurse salary calculation in the scheduled fee. However, for exceptional case funding, the rate used is the average of the highest level for a registered nurse in each State or Territory.

(3) For the 2000/2001 financial year, 29,941 veterans and war widows accessed community nursing services.

(4) The Department has a practice of open consultation with its contracted community nursing providers. In these consultations, while some providers are expressing concern about the level of fees, other providers are satisfied with the fees. The Department is continuing to work with providers to resolve any ongoing concerns.

(5) I am advised that Departmental records indicate that 27 veterans and war widows have been transferred to alternative contracted community nursing providers on the request of a contracted community nursing provider who did not accept the funding offered. In every case, the second community nursing providers accepted the veterans and war widows at the original funding level offered.

The Department is not aware of any veterans or war widows going into nursing homes or hostels because of the funding offered to community nursing providers.

(6) At the time of the implementation of the reform process in the community nursing program, the Department entered into a limited and fixed term contract for the management of exceptional cases with MACSEARCH LTD, the research and consulting company of the University of Western Sydney, Macarthur. At the cessation of the contract, the Exceptional Case Unit (ECU) was established to manage applications for exceptional cases. While the ECU is attached to the Department, independent contractors staff it. These contractors have specialist community nursing skills.

(7) (a) For the 2000/2001 financial year, the Department expended $49,756,944.74 on the community nursing program.

(b) The expenditure for administration and the audit process was $567,677 or 1.14 % of the total expenditure.

(8) Clause 2, Section 2 in the current contractual arrangement relates to the replacement of personnel by the contractor. The Clause neither mentions free speech nor places any restrictions on it.

(9) The Department removed consumables from the community nursing fee in the May 2001 contract. The decision was based on findings of the Fees Review that identified a number of issues with the system including significant variations between organisations in expenditure on consumables. These variations indicated that some providers were obtaining the consumables used during nursing visits through the Rehabilitation Appliances Scheme (RAP) or through the Rehabilitation Pharmaceuticals Benefit Scheme (RPBS), despite their inclusion in the fees.

The removal of consumables from the schedule of fees also allowed providers equal access to consumables at no cost to themselves.

(a) The removal of consumables from the fee has led to a reduction in some fees. There were other changes in fees, both increases and decreases, associated with the findings and recommendations of the Review of Fees.

(b) All veterans and war widows are required to pay a co-payment of $3.50 for pharmaceutical products that are supplied under script by the RPBS. However, when all pharmaceutical purchases exceed the safety net of $182, veterans and war widows do not pay any contribution for further prescriptions.

Veterans and war widows requiring equipment and “equipment based”consumables such as diabetic or continence products, are supplied through the Rehabilitation Appliances Program (RAP) and do not contribute to the cost of these products.

(10) (a) Assessments are built into the fee for each community nursing classification. Before any community nursing is provided, the provider undertakes a full assessment of the veteran to identify any particular needs and care requirements. With those veterans who have complex care requirements, more than one assessment may be necessary. Often this includes discipline specific or targeted assessments such as for wound assessment, occupational therapy, continence or an Aged Care or ACAT assessment.

(b) No, there is no cost shifting to the Aged Care or to state health budgets. Where a veteran or war widow may be unsafe or unable to be cared for any longer at home, they, like all Australian citizens, require an ACAT assessment as an essential and necessary step in gaining appropriate hostel or nursing home admission.

(11) Clause 2.2, Section 3 is contained within the Showering Guidelines. The Showering Guidelines reflect current best practice in the aged care field that is to shower a frail, elderly patient two to three times a week. This clause must be read in the context of the provider undertaking a full nursing assessment of the veteran and their living conditions.

As a person ages, their skin becomes drier and less supple. Frequent washing can strip the body of moisture, causing unhealthy, dry skin in the elderly. Additionally, the process of showering can be fatiguing for the elderly, especially for those people suffering from certain chronic conditions (ie. Chronic Airways Limitation). This creates a situation whereby it is clinically appropriate to limit the number of showers taken by an ageing person.

Of course, in some circumstances the nursing assessment may identify a need for more frequent showering. This may be because a veteran or war widow has a clinical condition, for example incontinence, or lives in a climate which necessitates a greater level of showering. In these circumstances, funding is available to deliver the appropriate level of showering.

(12) The contractual arrangement with community nursing providers outlines the Department's administrative and care requirements. To ensure the adequacy of service arrangements, the Department utilises the services of the state based community nursing advisers, the external audit program and clinical reviews undertaken as a part of the exceptional case process. Combined with industry consultations, and regular surveys of the veteran community, the Department identifies any problems in care so they can be responded to appropriately.