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Thursday, 15 September 2011
Page: 6201


Senator DI NATALE (Victoria) (12:42): There are few things more important to a nation than the health of its people and it is no surprise that Australians consistently rate health care as one of the issues that remains most important to them. Reform of the nation's health system should therefore be high on the agenda of any government. The National Health Reform Amendment (National Health Performance Authority) Bill 2011 is part of this government's health reform package. It is important, though, that we put this bill in its proper context. This is hospital finance reform, not genuine health reform. It is certainly an improvement in the way that hospitals are currently funded, but real health reform is something far greater than what we will be debating today.

Genuine health reform means, firstly, serious action on the issue of illness prevention. We are one of the most hospitalised countries on earth. We have an epidemic of non-communicable disease—cancer, heart disease and diabetes are all on the rise. By preventing illness, we improve people's quality of life but there are also enormous savings to be made. To their credit the government has done some good work in this area. The establishment of the Preven­tative Health Taskforce and now the Australian National Preventive Health Agency are important first steps. It does however remain to be seen what the specific mandate for the agency will be and what role they will have in determining government policy.

The government are also to be congratul­ated for their work on tobacco control. Plain packaging is a bold initiative and they deserve credit for taking this issue on. One of the reasons I am here in this place is that through my medical practice I have seen people die from the effects of smoking and to have the opportunity to challenge big tobacco's campaign on this issue through Senate committees has been a vindication of the role of politics in effecting the health of ordinary people. Of course, there is much, much more that we need to see happen. The Greens would like to see action on alcohol, with better warning labels and a much more rational taxation and pricing system. More needs to be done on the issue of obesity, from better planning of our cities and towns to improved food labelling, such as the adoption of traffic-light labelling. Primary care is a major area of potential reform, and the government's health reform package addresses this but only peripherally, through Medicare Locals. Now, Medicare Locals do offer some promise, but many of the details in this area remain clear.

We have also just begun the journey towards a more comprehensive public dental health system, and the Greens are proud to be taking a central role in the development of a public health system for this nation. Of course, this is a work in progress and there is more to be done in this area.

Finally, health reform also means tackling those things that lie outside of the health system, such as housing, education and employment. We know that differences in health are a marker of inequalities right across society, so achieving good health is a marker of a much fairer society.

I will now move onto the details of the National Health Reform Amendment (National Health Performance Authority) Bill 2011. The bill establishes the National Health Performance Authority, one of three agencies being created as part of the government's reform agenda. The health reform agenda is driven by several problems that Australian governments have long known about. The first is escalating costs. State spending on health and hospitals has been growing by almost 10 per cent per year and is taking up an increasing proportion of our state budgets. As a result, the Com­monwealth share of hospital funding has declined over time. Health care is certainly a worthy use of taxpayers' money, and few Australians would begrudge money being spent on providing better hospitals. But, without reform, the states would have an increasingly difficult time in keeping up with these rising costs. These reforms go some way towards addressing that problem. State governments now know that, by 2014-15, 45 per cent of the growth in hospital costs will be met by the Commonwealth, rising to 50 per cent by 2017-18. However, in our view, these measures do not go far enough.

A second problem is that of transparency. The rising costs of health care, within the hospital system in particular, mean that every dollar is critical. There will never be enough beds, and emergency waiting times will never be short enough. This is made worse if our health dollars are not being spent as efficiently as they possibly can be. This bill and these reforms attempt to increase efficiency by creating a national funding pool and by moving towards a system of activity based funding nationwide. With funding based on a national efficient price and provided directly to local hospital networks, we will have much better insight into where each health dollar is being spent. But we also need to be cautious, because some hospitals, particularly those in regional communities, may not be able to complete: this is not a level playing field.

Cost-shifting is a further problem. A complexity of funding and delivery arrange­ments in the national hospital network means that there are numerous opportunities to move treatment between state and federal jurisdictions. Hospitals are of course under pressure—they have got finite budgets—so there are incentives to do things such as discharge patients early so medicines can be subsidised federally through the PBS or have Medicare funds cover outpatients' specialist appointments.

So will these reforms do what it was initially touted they would do—that is, end the so-called blame game between Canberra and the states? I think that is highly unlikely. Much bolder reforms are necessary for that to happen. Nevertheless, they are generally sensible reforms, and the Greens will see them through the parliament.

As I said, this bill establishes the National Health Performance Authority. The authority is to monitor and report on the performance of the health system and, in particular, all hospitals and local hospital networks. The authority will itself formulate performance indicators, collect and analyse information, and make public the reports it prepares so that all Australians will have more insight into the functioning of their healthcare system. It is hard to argue against the need for better and nationally consistent performance data. With better data, we can measure the impacts of other reforms. We can know if they are working. We can identify problems and inefficiencies that are otherwise hidden. A standard for nationally consistent performance indicators will also help us to spot where things are being done correctly. In conjunction with the Australian Commission on Safety and Quality in Health Care, this will mean that best practices can be shared, and it will increase the efficiency of the system as a whole.

The authority itself will consist of a chair appointed by the Commonwealth, a deputy chair agreed to by the states and five members agreed to by both levels of government. The bill stipulates that one member of the performance authority must have experience and/or knowledge of the healthcare needs of people living in regional or rural areas. This is to be especially welcomed. Australians in the regions have been long underserved by our healthcare system. It is a huge challenge, because those with fewer options struggle—they have longer distances and longer waits to access services, particularly when compared to city dwellers and the sorts of services that they take for granted. The Greens hope that this member of the authority will work to ensure that the data the authority collects and reports on can be used to improve the services offered to rural and regional Australians. The Health Performance Authority is also to be welcomed if it empowers Australian citizens to make more informed choices about their own health care. The government's MyHospitals website, as it stands, leaves much to be desired. It has not sparked a revolution in consumer choice, because knowing that a hospital is underperforming is only useful if you do have a choice. Nonetheless, it is to be expected that the advent of the authority will improve the amount and quality of information that can be offered to Australian consumers who are facing choices that have an enormous impact on their lives. We are also optimistic that the data collected and published will help researchers and help inform the work of the Commission on Safety and Quality in Health Care.

We do have some reservations with this bill. The performance authority faces some rather large challenges. The data that it is to gather, analyse and report will not collect itself. It must be done at the coalface—in our nation's clinics and hospitals. The burden of collecting more data and new metrics to measure performance may be significant. Who will do this work? Will they be resourced or otherwise assisted in this task? These are important questions that need to be answered. There are also questions around the flow of data. It appears the authority will be relying on the states to collect and forward the data. How can we be sure the data will be timely, complete and accurate? We cannot yet anticipate all the incentives that there will be for delay or obfuscation.

The authority itself is obliged to report to the minister and the parliament. The bill does not specify the contents of these reports or the time lines for their delivery. Clause 111 states that the report is to be made available 'as soon as practicable'. One trusts that health professionals and staff of the authority will take their mandate seriously and deliver in a timely fashion; however, trust may not be good enough, because nobody likes to be the bearer of bad news.

As I said previously, it is a positive thing that the authority is to have a representative with expertise in rural medicine who will be able to advocate and advise on the specific challenges of that field. Through the authority, no other field of expertise is so honoured. The bill does not ensure, for instance, that the authority will have expertise in primary or acute care. Of course, from a practical point of view, there are many important areas of knowledge that would be valuable to the authority and we cannot amend the bill to accommodate all of them. Five members are not enough to cover the broad range of expertise, and we do not want to turn away any qualified and dedicated health experts who might thereby become ineligible. All we can rely on is clause 62(7) of the bill, which allows the authority to 'consult such persons and bodies as it considers appropriate'.

The bill makes some specific provisions for the case where adverse findings are reported about a particular hospital or local hospital network. Clause 62(4) of the bill gives state health ministers 30 days in which to provide written comments. However, it is not clear what the end result of this consultation is to be, apart from keeping the relevant stakeholders in the loop. The authority, according to clause 62(4)(e), must have 'regard to any comments' so offered. This is vague enough to cover all imaginable responses, from a hasty rewrite of the report in question to no response whatsoever. We would have liked more assurance that the performance indicators that are developed by the authority will not be created in a vacuum. For instance, there would appear to be some overlap between these performance indicators and those developed by the Commission on Safety and Quality in Health Care.

Ultimately, resourcing these changes will be critical. We are confident that the authority will be well funded, with $118.6 million in funding over four years to address all of these problems. The Greens are therefore cautiously optimistic about the authority's role. We are satisfied that it represents a modest improvement, and so we will vote for this bill today. But we will also be watching very closely how the hospital authority performs in the years ahead. Most importantly, we hope that this bill will serve as the impetus for further reform—reform that is much wider ranging and that addresses those issues within the health system that are in urgent need of attention—a much greater focus on illness prevention and a much greater focus on the primary health care sector. This is reform that will genuinely improve Australia's healthcare system, and we hope that this is one small step on that journey.