Senator LEES (1:09 PM) —I want to look at waste in our health system. I am not talking about $5 million being diverted to a building in Canberra; I am talking about billions and billions of dollars being wasted and not being spent appropriately. As we know, our health system is under increasing pressure from a range of sources, and so we cannot afford to waste even as much as a few cents. The increased pressure is coming from a more informed and more demanding consumer, from an ageing population and from new medicines and technologies that are expensive. It is coming because there is better and earlier detection of disease; and it is coming from more defensive medicine, from increasing costs for those who are going private and from ongoing blame shifting and buck-passing between the state, territory and federal governments.

We spend about 8½ per cent of our GDP on health—and that is less than do many comparable OECD countries—and from that we achieve above-average health outcomes. So the total amount of money that we are spending is roughly sufficient. As we can see from the United States experience, spending more money does not mean a better health system, nor does it guarantee improved access. I argue that we can find the extra money that we need within the existing health system if we eliminate, or at least substantially reduce, waste.

In my brief time today I want to look at five general areas where waste is readily identified, and many of these are interrelated. They include: waste in how we are using our hospitals; waste in the Pharmaceutical Benefits Scheme; waste in subsidising insurance products, particularly the 30 per cent rebate; waste because we are not adequately funding our GPs, nurses, allied health professionals and others in the preventative part of the system; and waste because of the structure of our health system—and that brings in many of those things I have just mentioned.

In looking at each of these, I will begin with our hospitals. These are very much at the expensive end of our health system, but they have become a place of last resort. If you cannot get the appropriate service you need then it is off to your nearest public hospital. So we have a lot of people in hospital who should not be there: they should never have been there, they should not be there at all or they have been there far too long. On the other side of the coin, we have many people urgently trying to get into our hospitals who should be there, but the beds are taken or there are not sufficient nurses to staff beds—and that is a separate issue.

Provision of more hospital beds, as some state governments tend to promise us at election time, is not the answer. We must look at ensuring that appropriate services are available to patients, such as older Australians who get stuck in hospital beds because they cannot go home after an illness or surgery: they cannot go home because home services are not adequate or not available, or families are not able to look after them or, indeed, because they need a higher level of care. This need for a higher level of care may be only temporary; it could only be a few days or maybe a couple of weeks. But respite beds are no longer available in our nursing homes. These beds are either permanently taken or fully booked, and there are very few rehabilitation places or step-down facilities. From time to time we have 20, 30, 40 or more elderly folk who are stuck and bored in teaching hospitals in beds that are urgently needed for others.

People with severe drug and alcohol problems can also spend time in general wards in our hospitals, as appropriate services are frequently unavailable. You can add to the list people with mental illness who, thanks to the closing of many specialist facilities, have nowhere else to go. In Adelaide, in at least two of our major hospitals, we have a policy of employing security guards, one on one, for mental health patients who have to wait in casualty. On occasions this wait can be not a few hours but days, because of the shortage of mental health staff and mental health beds. People in crisis suffering psychotic episodes have entered our hospitals and ended up having bones broken by those unqualified people employed to restrain them: they may be qualified to act as bouncers in nightclubs, but they are certainly not qualified to deal with patients in crisis in our hospitals.

People with disabilities can also find hospitals to be their last resort. For chronic conditions such as asthma, where coordinated care trials have proved to be so successful, programs to help people to stabilise their condition and keep them out of hospital are underfunded or, indeed, no longer funded at all. Also there is pressure on emergency departments, because many doctors can no longer bulk-bill or are not practising after hours. Families simply cannot afford to put $40, $80 or $120 down on the table if they have two or three sick children, and so they head for emergency.

There are some new initiatives assisting with this particular issue, but you still look at waits of four and five hours just to be seen by a doctor if the condition with which you have reported to emergency is not life threatening. I just looked at one example, and that was New South Wales: 25 per cent of patients are waiting at least eight hours to get a bed. They have been classified as in need of admission, and they are still waiting hour after hour.

To finish with hospitals, I want to mention one other issue, that is, maternity services. I am not suggesting that new mothers should be immediately pushed out as soon as baby comes in order to free up a bed. Certainly mothers should not be discharged from hospital until breastfeeding is established or unless there is a midwife available to follow her home. Full community midwifery programs will shorten stays in hospital and save costs overall. One recent analysis was conducted at St George Hospital in Sydney and reported in the Australian Health Review last year. It found the cost difference favouring midwifery care of $2,579 versus $3,483. That is a saving of almost a thousand dollars per birth. The evidence in New Zealand and in South Australia's program in the northern suburbs and in Fremantle in Western Australia's midwifery program all back this up: giving women choice actually saves money.

Moving on to the Pharmaceutical Benefits Scheme, the PBS: cutting money from the PBS across the board just to save money is absolutely counterproductive. To restrict access for the sake of saving money is counterproductive and, indeed, can lead to higher costs to the health budget as a whole. There are a number of research papers on this, and the most recent I have seen is research in the US by Dr Susan Horn.

However, there are some improvements we can make to our PBS. These need to be aimed at appropriate prescribing; a cooling-off period before new medications, new drugs, that are listed become available; and a system where a script—with a similar appearance to the regular script you get from a doctor—for other alternatives should be trialed. About 60 per cent of GP consultations end with a script for medication, and this is what the public is generally used to. Let us support doctors, let us help them with the software they need for their computers, to give scripts that look much the same as those currently used but which set out things like maybe an exercise program, maybe a dietary regime, maybe some support mechanisms to help someone quit smoking. The media coverage that often goes with the approval of new drugs can leave doctors the next day facing someone across the desk who has heard all about this wonderful new drug, wants it and is absolutely sure that it will help their condition. But the doctor may have absolutely no details on this drug or, at best, perhaps has just received a brochure from the drug company saying how wonderful it is. There is no chance for the doctor to get some detail on any adverse side effects, for example, and no chance for independent information.

What we need is a break of perhaps a couple of weeks. Some doctors have recommended they want a break of four to eight weeks between the listing of a new drug and the actual prescribing of that drug. We need time to get information out to doctors, similar to the information now provided to pharmacists and, in particular, to get information out to specialists. The National Prescription Service has a role to play here, but time is what is needed to get the details out. There are some positive things happening in the PBS area, but a lot more has to be done, including ensuring the availability of sample packs and some limits on the lobbying activities of drug company representatives directly to doctors. In some countries, this is simply not allowed at all.

I will move on to the enormous amount of money this government is splurging on the private health insurance rebate. We are now looking at $2.5 billion being flushed down the insurance black hole for little if any benefit either to the public hospital system that it was supposed to be benefiting or, indeed, in particular, for the sickest in our community. Generally, it is helping the well-off bypass queues and obtain a high-class service with lots of frills. Now that is fine. Anyone who wants this sort of service is more than welcome to have it, to pay for it; the public should not be subsidising it. People are certainly not reluctant to continue to use our public hospitals. In Victoria, a survey in 2001 showed that more than half of those with private health insurance chose not to declare it, not to use it. In Western Australia, despite the rebate, the actual public hospital admissions, compared with private hospital admissions, have increased.

Let us quickly look at what we could do with $2.5 billion extra in our health system. We could increase our public hospital spending by 10 per cent, directing that into urgently needed infrastructure; that is around about $600 million to $650 million. We could put the Commonwealth dental program back; that is $100 million to $120 million. We could fund nurses working in aged care to the same level that nurses working in hospitals are funded, and helping therefore with some of the shortages in nursing homes; that is around $96 million. We could lift the Commonwealth spending on indigenous health to the same level that the rest of us enjoy; that is around $200 million. We could have a 10 per cent boost in the aged care budget for respite care, to ensure they have dental programs—and the lack of dental support in aged care is leading to things like malnutrition, bedsores and a whole lot of horrific problems—and also for additional aged care packages; that is around $300 million.

This still leaves us, after you have spent on all those things, around $1 billion to spend on other services for those Australians who are most in need and, in particular, on more appropriate services that will keep people out of hospital. These include additional support for quality GP services. In this area, I would digress quickly and say we need again to look at how many GPs, how many doctors, we have in this country. I do not believe that the official figures are anywhere near accurate. They are probably around 15 per cent too low. This, in itself, is putting more pressure on doctors working out there and on hospital waiting rooms. Indeed, I do not think that the recent claims of a 4.3 per cent increase in rural GP numbers can be substantiated; I think they are talking about output, not the number of people on the ground.

We must encourage collaborative group practice—and that includes nurse practitioners, allied health workers and, where appropriate, dentists. The general shortage of nurses is causing some difficulty in this area, but I applaud the work of the Divisions of General Practice in coordinating appropriate health services.

I turn briefly to the world of cost shifting, buck passing and blame shifting. This involves the state, territory and Commonwealth governments and it goes on incessantly. Much of the inappropriate hospital admissions involve cost shifting. Let us look at aged care—probably the most well-known area. The Commonwealth is responsible for aged care. When it does not supply enough services, when there are not enough nursing home beds, people end up in hospitals, and that is funded by state or territory governments. A shortage of GPs—again, the Commonwealth puts the money in there—means further pressure on our hospitals which, again, are funded by state and territory governments. Patients are given only a day or two worth of medication when leaving hospital—which is from a state funded pharmacy—instead of the full course that was necessary. The patient is then required to go off to the doctor, for which there is a bill to the Commonwealth. If a script is required on the PBS, there is another bill to the Commonwealth. This shifts costs from the state to the Commonwealth. I could probably spend another 15 minutes here just talking about the cost shifting and buck passing that goes on. There is an enormous waste of money, time and effort and enormous pressure is put on patients, particularly those leaving hospital who are not well anyway and who are basically dismissed early. For them to then have to work their way through the Commonwealth system to get the support they need is absolutely ridiculous.

Given time constraints, I do not have a lot of time in which to speak on this occasion. I will take some more opportunities later on to go through my suggestions for the restructuring of our health system to ensure that people are actually able to access the appropriate services, not end up in a queue in our public hospitals. This largely involves a regional system of funding our health services, with a pooling of Commonwealth and state funds and the delivery of services at the local level, whereby I think there is a far better chance of getting appropriate services.

I will close by directly challenging the new health minister, Senator Patterson, to ensure that the coming budget tackles the waste in our health system and directs resources to appropriate services. This coming budget must be a budget for the long term. The minister will be judged, in particular, on how her budget impacts on those who are the sickest in our community.