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Wednesday, 25 February 1987
Page: 723


Dr BLEWETT (Minister for Health)(4.46) —I move:

That the Bill be now read a second time.

The need for an independent body to collect information and evaluate programs in the health and welfare area has been voiced by a number of groups and parliamentary committees over recent years. In 1979, the Senate Standing Committee on Social Welfare reported on the need for evaluation in Australian health and welfare services. The Committee reported:

The essential prerequisites for evaluation-that is, the determination of needs, the setting of goals and objectives, the establishment of standards and the collection of appropriate data-are at present given a low priority . . . It is imperative that proper evaluation occurs in order to provide information essential to the proper planning of the health and welfare system and to the efficient and effective operation of agencies!

In the following year, 1980, a Joint Committee of Public Accounts reported on substantial overpayments to chemists under the pharmaceutical benefits scheme, and recommended the establishment of a Bureau of Health Economics to provide independent, objective and publicly available analysis of economic facts and issues relating to the Australian health industry.

The Committee identified two major functions for such an organisation; the first being to monitor and analyse the Government's expenditure on health to ensure that moneys are being spent according to priorities. The second function was to examine issues relating not only to central aspects of health care but also those aspects that cross the boundaries between various areas of health operations.

In the same year the Commission of Inquiry into the Efficiency and Administration of Hospitals, chaired by Mr James Jamison, gave support to the recommendation of the Commonwealth Parliamentary Joint Committee of Public Accounts that a Bureau of Health Economics be established. This Committee envisaged that the Bureau would undertake identification of internal and external factors influencing efficiency in hospitals and other health institutions. It also recommended that the Bureau collate comparative statistics and financial data on a national basis. The coalition Government failed to respond to any of these recommendations.

Unlike our predecessors we acted. The establishment of the Australian Institute of Health within the Commonwealth Department of Health in August 1984 was a first step in response to the recommendations made by those committees. At that time the functions of the Institute were to research a wide range of health issues with a special focus on public health, social medicine, health statistics, and health economics. With the creation of the Institute it became clear that there was a need for additional broad public health expertise in Australia. So just one year after the establishment of the Institute, I supported the establishment of an independent inquiry into research and teaching of public health and tropical medicine to be conducted by an American expert, Dr Kerr White. The report, which I tabled in February 1986, recommended the establishment of two national independent statutory authorities, one for health statistics, and the other for technology and health services assessment.

The need for these two centres was based upon the lack of comprehensive Australia-wide information and effective assessment processes in the $16 billion per annum health industry, financed by the Commonwealth and managed by the States. The administrative complexities and high costs which would be incurred to establish two new authorities were considered by the Government to be unnecessary in view of the overlap with the then existing functions of the Australian Institute of Health. After detailed consideration of these issues the Government decided that the Institute of Health could effectively encompass both of these functions.

The Better Health Commission in its report last year, `Looking Forward to Better Health', stated that a national health data base was widely recognised as essential for health advancement in countries around the world. It was heavily critical of the collection of health statistics in Australia and used as support for its assertions a comparison by the World Health Organisation of the major health statistical collections of 16 developed countries. Australia was ranked very low, being last in the collection of hospital statistics. Responsibility for this abysmal state of affairs must rest above all with the conservative coalition which has governed this country for 31 of the last 40 years. It is simply not possible to remedy such a situation in less than a decade. The Better Health Commission gave support to the recommendation of the Kerr White Report for the establishment by legislation of a National Centre for Health Statistics.

The Bill before the House will establish the Australian Institute of Health, which will:

collect and provide assistance in the production of health related statistics;

conduct and promote research into the health of the people of Australia; and

undertake studies into the provision and effectiveness of health services and health technology.

These functions are fully defined in the Bill and are intended to establish the Australian Institute of Health as an effective independent statistical and research organisation to provide both Commonwealth and State governments with a reliable base for policy formulation. This Bill will allow the Institute to obtain wide support in achieving its objectives through:

actual and perceived independence and long-term viability;

the co-operation of the States on data provision;

legislative guarantees to the States of the confidentiality of statistics;

the support of professional bodies;

enlisting respected researchers from outside the Public Service; and

the clear definition and maintenance of the role of the Institute.

The Government has acted to ensure that the independence of the Institute is recognised by the introduction of this Bill which establishes it as a statutory authority. The Institute will be dealing with highly sensitive information relating to private health related organisations, the health of individuals and the financial position of States and Territories. It is therefore vital that the Institute be independent and be seen to be independent. The composition of the Institute includes three State and Territory representatives and reflects the importance of the State and Territory authorities in collecting and supplying health statistics.

In drafting the Bill the proposed policy guidelines for statutory authorities and government business enterprises have been followed closely. The Institute will be subject to the written directions of the Minister, the functions and constitution of the Institute are clearly established, and the reporting requirements of the Institute are defined in the legislation. The financial arrangements are set out including those necessary for trust money and property.

The Government believes that, to ensure the effective operation of the Institute, it is important that the functions of the Institute do not compete with those of the Australian Bureau of Statistics and that the two bodies are mutually supportive. To ensure close co-operation, the Commonwealth Statistician or his nominee is to be appointed as a member of the Institute. Secondly, the Australian Institute of Health will have an ethics committee. The functions and composition of the ethics committee are to be determined by regulation based upon recommendations from the National Health and Medical Research Council, and it will be responsible for approving persons to whom data may be released. Thirdly, the Director of the Institute is empowered to employ staff other than under the Public Service Act in order to attract pre-eminent researchers to work for the Institute. These measures and the others I have outlined will ensure that the Institute will be grounded on high ethical principles and will attract quality researchers.

There will be no financial impact from this Bill. To date the Institute has received administrative support, such as the payment of salaries, from the Department of Health, and accounts have been processed through the Department of Finance. There is an administrative infrastructure operating within the Institute responsible for its day to day operations and sufficient expertise exists within this infrastructure to satisfy the additional requirements of a statutory authority given that the Department of Health will continue to provide some services.

I am confident that the Australian Institute of Health as a statutory authority will be in a strong position to develop a far greater knowledge and understanding of the health of the Australian people, and will contribute significantly to the needs for assessment and evaluation identified by the many inquiries into Federal health. With the public health challenges now faced by this country this Bill is both appropriate and timely. I commend this Bill to the House, and I present the explanatory memorandum to the Bill.

Debate (on motion by Mr Blunt) adjourned.