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Thursday, 17 November 1983
Page: 2921


Mr GROOM(9.23) —It is a great pleasure to follow the honourable member for Grayndler (Mr Leo McLeay) in this debate. He is certainly one of the better informed members of the Government on this and related matters. I cannot understand why he is not the Minister. Perhaps it is because he would turn up late for Cabinet meetings. I say that because of some personal knowledge of the honourable member. The Bill we are now debating is an omnibus Bill which amends the Health Insurance Act 1973, the National Health Act 1953, the Nursing Homes Assistance Act 1974 and the Medical Research Endowment Act 1937. The honourable member for Mackellar (Mr Carlton), with his usual expertise, covered many of the issues in this legislation now before the House, but I want to comment on some of those matters.

Many of the provisions we are now discussing are not major policy matters. Many of them are really machinery matters and are not of great moment, but some issues are raised by this legislation. Much of the debate has related to nursing homes. I concur with some of the remarks made by the honourable member for Grayndler. Others I would certainly disagree with. Most of the significant amendments in the legislation relate to the administration of the Government's nursing home program. I believe the efforts of the previous Government in this area were exceptionally good. I think back to the efforts made by Senator Dame Margaret Guilfoyle when she was the responsible Minister and to her successor, Senator Chaney, and the generous amounts of money they provided through their ministries for nursing homes around Australia.

One thing to which the Fraser Government responded very well was the need and aspirations of people living in smaller communities and towns around Australia. In many towns in country areas nursing home accommodation was expanded and in some cases was provided for the first time. This is particularly important, because it is very sad when an elderly person has to leave his or her district to go to a nursing home many miles away. It is important that we try to provide accommodation for such people in their own environment, among their own families and friends and in familiar surroundings. I am sure that no honourable member would disagree with that contention. It is important that the provision of accommodation of this kind continues. Certainly we would have to agree that needs in Australia have not yet been fully satisfied.

I am concerned by one comment made by the Minister for Health (Dr Blewett) in his second reading speech:

While Australia overall has very adequate provision of nursing home accommodation-

He was suggesting by implication that he felt that overall an adequate amount of nursing home accommodation was available. The fact is that in many areas of Australia the need and demand have not been satisfied. It is important that the Minister is not complacent and that he recognise the needs. It is important that the Government is not complacent. It must do more, if it can, to provide more accommodation. I know that there is an argument that we should encourage people to remain in their own homes to be looked after by relatives or perhaps even to look after themselves. I may get on to that in a moment. Certainly the area I know best, my State of Tasmania, has a need. The nursing homes in Tasmania are screaming out for more beds and accommodation because they have large waiting lists, and it just is not good enough. It is very hard to determine accurately how long the waiting lists really are. I could not give the House a figure because sometimes people are on different waiting lists for different homes, waiting for suitable accommodation. The point is that there is a need which has not yet been satisfied.

I agree with the notion that the ideal is for our senior citizens to remain in their own homes, if they can, or to live with their adult children or other relatives. No matter what the age or state of health of people may be, they can still make contributions to the community. This has to be recognised. They can pass on their wisdon and experience to younger generations, and the best way in which to do this obviously is for them to live in a normal environment in their own homes or with members of their own families. It is not as easy to pass on their wisdom if they are in an aged persons' home. That is the ideal, but ideals cannot always be achieved. Many people do not have their own home. They cannot afford to live in their own accommodation. In some cases they cannot care for themselves and, of course, in many cases members of their own family are unwilling, unfortunately, to provide accommodation for them. So, there is a job for the Government and it must obviously continue to assist these people and provide more accommodation, if possible.

A problem I want to raise with the House and the Minister relates to the cost being borne by the pensioner when staying, for example, in a nursing home or a hostel. In many cases such people are required to pay a very large percentage of their pension by way of board. In some cases the home gobbles up the whole pension, so there is nothing left for individuals, to pay for additional needs, the little personal things that they might require in order to enjoy life a little more. That is very sad. In those cases, the pensioner has to rely on perhaps additional means that he or she might have, or help from relatives. That is not a very satisfactory situation. I understand that the Government recommends that 87 1/2 per cent of the pension of patients in nursing homes go to the home and that, where the patient occupies a hostel bed, the proportion should be 85 per cent. However, I know that certainly in my own electorate those recommendations are not always followed. This is causing hardship. It is something of which I am sure the Minister is aware and that must be watched very carefully.

I wish to make a few comments about the isolated patients' travel and accommodation assistance scheme, IPTAAS, which is also dealt with in part of the legislation that we are now considering. This is a very valuable scheme and especially important to people who live in isolated areas. It gives them assistance in travelling to places where they can receive expert specialist medical care. It was a very excellent initiative of the Fraser Government and I am glad to say that the scheme is continuing. Indeed, the legislation embodies improvements which I am pleased to see. Two criteria are applied for eligibility under the scheme. One is that a person must be travelling to see a specialist medical practitioner and the other is that the person must travel a certain distance so to do. The distance specified is 200 kilometres from one's home to the place where one receives attention. In some instances, such as where one resides on an island, special conditions apply. I have in mind King Island, which has its own problems and is within my electorate.

While I am pleased to note the proposed improvements to the scheme, I would like to mention certain aspects briefly to the Minister. I have already, on a number of occasions, made representations to him concerning patients on the north-west coast of Tasmania. That area is about halfway between Melbourne and Hobart. For official reasons, the Department has decided that Hobart is to be considered closer to the north-west coast than Melbourne. Physically, that is probably correct-depending on which part of the coast one lives in. The trouble is that many people go to Melbourne to receive their medical care; it is more convenient in many ways. One hops on a plane and one's destination is an hour away. To go to Hobart takes about four and a half hours, yet it is suggested that people should go there to receive attention under the scheme. I want to direct to the attention of the Minister two cases for his consideration. One is that of a man who was operated on in Launceston, Tasmania. The surgeon who performed the operation would not operate again although the man remained very ill. The man was referred to a specialist in Melbourne but the specialist could not operate on him for two months because of a heavy waiting list, so in turn the patient was referred to a specialist in Canberra. That specialist performed an operation and it was very successful, but the patient was not entitled to receive assistance under the scheme.

In another case, a person had a life saving operation performed in Melbourne. His doctor on the north-west coast said that he should go there because there was a risk to his health if he travelled for four and a half hours by car to Hobart. Also a trip in a light aircraft across Tasmania can be very rough indeed . Therefore, it was recommended that the patient go to Melbourne by an ordinary commercial flight. Special arrangements were made; the patient went to Melbourne . Again the operation was successful. There were good reasons why the patient should actually go to Melbourne. Melbourne is a large population centre and more convenient in many respects for people living on the north-west coast. So, I hope that the Minister will give special consideration to people living in that area the next time he brings down amendments and thus help such people living in my electorate and others in similar situations elsewhere in Australia. I do not want to be parochial about this matter.

The provision of skilled but non-specialist medical or related services is also important. There are people who have to travel large distances for dental care, for specialist optometry and for the fitting of prostheses-artificial arms and legs and so on. At the moment no assistance is provided under IPTAAS to these people. Again, I would hope that such assistance could be expanded to include people seeking such specialist services. I acknowledge again that under this legislation the Government is expanding the scheme to some degree. For that we are most grateful. There is always the matter of cost, but there is also the matter of equity and fairness to individuals in the community and when one analyses the scheme and the way in which it operates one sees that in some cases equity does not prevail. I ask the Minister please to look at the scheme again and bring down more amendments to establish a greater degree of equity for our citizens. Time is of the essence so I will wind up my remarks and allow time for other speakers to contribute. In short, the Opposition supports these amendments and I join in that support.