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Wednesday, 13 May 1970


Dr EVERINGHAM (Capricornia) - In respect of clause 19 I wish to take up the point made by my 2 colleagues with regard to the registration of specialists. This whole matter of appointing these committees arose out of the differentiation of Schedules for specialists and general practitioners. It is a totally new concept which came in at the last minute. These committees of approval and appeal had to be worked out at the last minute - so much at the last minute that the Minister for Health (Dr Forbes) has now had to move an amendment. Honourable members on this side of the House considered this anomaly and came up with a very similar amendment, not on the basis that the Minister has quoted that the Australian Medical Association decided, but on the basis that common sense decided. The Government should not be asking the AMA - an essentially politically organised organisation - to decide on specialist qualifications. The Royal Colleges, the academic bodies, should be asked to do this sort of thing.

If we had an Australian Labor Party health scheme, of course, this whole sorry business of differential rebates could very quickly be tipped into the ashcan, because we propose to make specialist services at a high level of efficiency available free to those who want them free - not by pushing anybody into any kind of conscription, not by forcing specialists to accept salaried services, but by making conditions so attractive for them that that is what they would want to do, as 1 explained in the second reading stage of the debate. This has been proved the most efficient, the most popular, the most economical and the most sensible way under the Kaiser scheme in America. The question is not: Can the GP do this job or can the specialist do it better and should he get a higher fee? It is the whole subject of the standards of medical practice. We have had statements by the AMA itself and the Royal Australian College of General Practitioners that standards ought to be set. They said this as long ago as 3rd April last year in the AMA gazette and I have no doubt that they consulted with the Minister or his advisers on this.

This whole business of quality of care has been gone into. Why is there not something in the Bill about this? Why do we have to have stopgaps and makeshifts to block up the leaks in a scheme that has only been half thought out? Why do we not have a fundamental reappraisal of the sort of standards we want in specialised care in this country? Why do we have to try to get in the Committee stages of this Bill some sort of answer from the Minister as to what he thinks about the policing of standards by the profession? This is no system of policing standards, deciding whether a fellow is a specialist in this field or that field. What we want to say is: Is this doctor capable of performing one of those thousand-odd procedures that we will discuss in 25 minutes tomorrow? I realise that it is ridiculous for this Committee to have to go through every one of those procedures and decide exactly whether or not it should bc listed as a specialist procedure.

What we should be doing is setting up highly specialised academic committees to advise this Government on a proper health service for this nation, on proper health standards for this nation, on the accreditation of doctors, on quality control, on accreditation of hospitals and on the audit of medical care in clinics, private or public. This is the sort of thing going on overseas. It has been a burning quest' on for many years in America, but this Government says nothing about it. The excuse it gives is that this is a State matter. It says that it will leave this to the States because it is primarily their responsiblity. An honourable member opposite interjects to say: That is right'. Of course it is. So what does the Government do when we suggest that those very States whose responsibility it is to achieve standards of medical care should have 1 nominee on this committee for each State? The Government says that it does not matter because already one of the appointees to one of these royal colleges will have had experience on the specialist register of that State. What kind of quality control do you get with an arrangement like that? lt is the old story of the dog chasing its tail. All the Government is doing is resorting to stop gap measures - attempting to plug the leaks in th:s leaky ship and hoping that it will stay afloat. No doubt it will for a while, because we have nothing better. 1 would like to develop this theme because it is vital to the whole concept of a national health scheme. Unfortunately, by doing so I will prejudice the right of my colleagues to d'scuss other clauses up to clause 21, for we have only 64 minutes remaining in which to discuss those clauses. I submit that the Minister has no valid reason for rejecting the Opposition's suggestion that a State appointee be allowed to sit on the State committees which will decide spec:alist qualifications. Specialist qualifications are not an important issue but if you are to include them, for heaven's sake allow the people who have been responsible for the quality of medical care over all these years and whom Government supporters say are responsible for this matter to appoint at least one of their number to this committee of 5 or 6 doctors.

Amendment agreed to.


The CHAIRMAN - The question now is:

That clause 19, as amended, be agreed to.

Does the honourable member for Maribyrnong desire to move amendment No. 11 standing in his name?







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