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Thursday, 26 March 1987
Page: 1652


Mr MacKELLAR(9.58) —We are debating the Veterans' Affairs Legislation Amendment Bill 1987. I am very pleased to comment on this legislation because of its importance to the many thousands of veterans and their dependants in the electorate of Warringah and, of course, in the wider Australian community. The Minister for Aboriginal Affairs (Mr Holding) informed the House in his second reading speech that the main purpose of the Bill is to introduce into the veterans' affairs sphere the poverty traps reforms announced by the Treasurer (Mr Keating) in his statement on 19 September 1985. The second objective is to introduce measures to combat health fraud which reflect those provisions contained in the Health Insurance Act. Finally, there are what the Minister calls numerous minor administrative changes and corrections to errors which have come to light since the veterans' entitlements legislation came into operation on 22 May last year.

Before proceeding to a closer examination of the Bill, I make the observation that this Government has treated Australia's veterans community very badly indeed.


Mr Hurford —Rubbish!


Mr MacKELLAR —The Minister at the table says `Rubbish'. I will substantiate my statement. The Government has introduced substantial and continual changes. While the philosophy behind those changes can perhaps be lauded, they have been managed so poorly that it is my experience-and I am sure that that experience has been shared-from the representations being received in my electorate office that the process of constant adjustment has subjected the veterans' community to unnecessary distress and a great deal of uncertainty. The result is that there is now a genuine and very understandable discontent towards the administration of veterans' affairs by the Hawke Labor Government.

I am sure that my colleagues will not have forgotten the Repatriation Legislation Amendment Bill 1985, which was introduced into this House on 17 May 1985 in order to remove the effects of the High Court decision in the case Repatriation Commission v. O'Brien. To put it succinctly, it was a Bill to remove a definition of `standard of proof' which was considered by the Labor Government to be too generous. I am sure that my colleagues will also recall that it was the coalition parties which were responsible for the insertion into that Bill of a sunset clause so that the changes to the standard of proof would cease six months after the commencement of the Act-a device which forced the Government to address this most important matter in a more responsible manner than it otherwise would have done. Then, in October 1985, we saw the new Veterans' Entitlements Bill, a Bill, it was said, to simplify, consolidate and rationalise the repatriation legislation. Let us see what the President of the Repatriation Commission tells us in his 1985-86 annual report. He said:

The new Act is not perfect, but represents an acceptable compromise basis for administration of the various Veterans programs.

The experience of this Parliament would suggest that such wording is an ominous portent of legislation that is not really appropriate to today's needs and which will require ongoing adjustments and changes. Surely that process is already occurring in this amending Bill before us today, which contains 83 clauses, the majority of which are to correct errors and other administrative adjustments. This, let me remind the House, is in legislation which is not yet 12 months old.

Looking directly at the health fraud provisions in the Bill, we see that there is not considered to be direct financial impact from the changes-a factor which must be gratifying to the veterans community as an indication that they are regarded as a group of responsible people who are not involved in health fraud. It is a shame that the Department of Veterans' Affairs does not show them a similar degree of respect in the manner in which the legislation and the administrative changes are being managed, because that manner is one of total insensitivity. This Government was insensitive in the way in which it attempted to avoid the implications of the O'Brien standard of proof case. It was insensitive in the way in which it introduced the veterans entitlements legislation. It has been insensitive in the way it has amended the pharmaceutical concessions available to war widows. It is insensitive in its current handling of the domiciliary nursing aspects of repatriation health care. The legislation before us today makes a multitude of changes which cause further uncertainty to the veteran community.

Let us consider, for example, clause 10 and specifically its definition of a dependent child. Just to remind the House, for many years the repatriation legislation defined a dependent child as one who is in the custody, care and control of an eligible person. Along came the 1986 simplified and rational legislation, which altered and broadened this definition. Now, just some nine months later, in today's Bill we find this definition removed and we are returned to the pre-1986 situation and the much narrower conditions which applied then. Thousands of dependent children are involved in these changes. I repeat, it is this insensitivity to the difficulties that these on/off changes cause the veterans that concerns me deeply, because these people are generally older members of the community. Many of them are suffering from severe war disabilities, and the vast majority of them are heavily reliant on repatriation welfare assistance.

As I have foreshadowed, another example of the unfeeling administration of this Hawke Labor Government is its amendment to the provisions which make pharmaceuticals available to war widows. Put quite simply, this will repeal the availability of drugs under a specific repatriation pharmaceutical benefit scheme and make available only the reduced range of drugs listed in the national health scheme. The Minister for Veterans' Affairs (Senator Gietzelt) might be interested to hear that my electorate office has received a steady flow of representations from war widows, distressed that drugs which they have long had prescribed and received under repatriation concessions must now be purchased and paid for from a pensioner's income. I am sure that the Treasurer would not understand that, because he has not been in his electorate for so long that it is a joke. I dare say that the Minister at the table, the Minister for Community Services (Mr Hurford), occasionally visits his electorate. He might ask his electorate representatives whether in fact my experience in my electorate office has been repeated in his, and whether these war widows are coming in and saying: `What the blazes is going on about pharmaceuticals?'. What these people think of the Hawke Government's election commitment in 1983-that it would extend liberal treatment to all ex-service personnel disabled as a result of war service, and to their dependants-is not fit to be printed.

Another group of veterans who will now believe that that commitment has a very hollow ring about it, is all those who have for many years been receiving excellent and dedicated domiciliary nursing care, and now they find that the system is being cut back by new administrative arrangements hich have as their sole objective, a substantial reduction in the cost of this service. The result, put quite simply, is bureaucracy gone mad with a domiciliary nursing system now having to make assessments, for example, as to how many showers a patient might now receive each week. One might think that it is a bit of an exaggeration. I do not for one moment exaggerate. This is the sort of decision which is now being taken as a result of the decisions of this present Government.

The changes now under way in repatriation domiciliary nursing care are, at the very best, a callous expression of budgetary restraint, being regarded as more important than a caring and effective nursing service for veterans and their dependants. I acknowledge that expenditure on domiciliary nursing has increased from $10.7m in 1983-84, the first full year of this present Hawke Government, to $17.9m in 1985-86. While the associated servicing figures have been very difficult to obtain from the Department of Veterans' Affairs, I understand that in 1985-86 some 1,017,000 visits were made by domiciliary nurses. This would suggest an average cost per visit of about $17.50, a figure which makes the domiciliary nursing system highly cost effective when compared with the $17 per visit which will be charged by the untrained personal carers who will replace many of the highly-trained visiting nurses. Therein lies my concern.

This Government is severely cutting back on a cost-effective system which offers quality health care by way of trained nurses, and will force many veteran patients into alternative arrangements, including the use of untrained personal carers under its home and community care program. Regrettably, it is clear that the Government is preoccupied with simply cutting back on costs and is prepared to sacrifice quality health care in that process. Nothing I have seen from the Department of Veterans' Affairs indicates a concern with these quality considerations. For example, a departmental document simply states that `costs in this area are increasing rapidly' and that `the Department intends to impose controls on the provision of domiciliary nursing'.

Where is the acknowledgment that much of this increase is due to demographic factors which are now pushing the number of aged World War II veterans and their dependants eligible for treatment from 320,000 in 1981 to almost 370,000 at 30 June 1986? There is none! There is no mention of it. Rather, I find only the simplistic statement that costs are increasing rapidly and must be controlled. The departmental instruction I have seen goes on to suggest:

The intention is to ensure that domiciliary nursing care is provided only to entitled veterans and dependants for the period where it is essential.

Is this to imply that domiciliary nursing has been provided to other than entitled veterans and in the past in non-essential circumstances? Where is the evidence to substantiate that inference? One is left to ponder whether it is merely a departmental smokescreen to justify a penny-pinching attack on a highly successful and highly cost-effective health care system.

Another of my concerns is that the iniquitous term `improved controls' will mean in practical terms that there will be a reduction in the nursing care received by veterans; that nurse-patient relationships may be ignored in the interests of meeting bureaucratic standards of servicing; and that veterans will be forced into alternative nursing care systems if-and I emphasise `if'-such alternative care is available and if the veterans can afford such alternative private nursing care.

One alarming piece of bureaucratic control within the new arrangements is the establishment of nursing assessment teams to assist in advising on the extent of domiciliary nursing car require. So, Mr Deputy Speaker, if you are a veteran with an apparent need for extensive nursing care, a decision will be made by a nursing assessment team in consultation with a local medical officer as to the amount and type of domiciliary nursing care you require and receive. Once that is prescribed, heaven help the veteran if his or her condition varies and warrants more extensive assistance-back to the nursing assessment team through the local medical officer for another prescribed formula of nursing care. This in no way is to reflect on the dedication and integrity of the people in these teams. Rather, it is to question whether a committee is the right mechanism to determine the health care needs of veterans. It has been suggested to me that some of these assessment teams are already bogged down with assessment and review cases and that this is causing delays in veterans receiving appropriate nursing attention.

We are talking about people sometimes in very great need. Delays may not seem long to those who are in good health but to those of older age and suffering the disabilities caused by war service delays can be extremely distressing indeed. Having just thought about that, can there be any doubt whatsoever that my use of the word `insensitive' to describe this Government's handling of its veterans' affairs responsibilities is-I say this regretfully-both accurate and appropriate?

I believe, and I am sure most members of this House believe, that Australia has a commitment to the repatriation and welfare of those who have suffered in war on behalf of this nation. The Australian Labor Party, let me remind honourable members opposite, made a commitment in 1983 to treat our veterans liberally. It has pluperfectly failed to do so. While the legislation before the House will be supported for administrative reasons, it must also be acknowledged as yet another unsettling development in four years of totallly uncaring administration of the Australian veteran community by this Hawke socialist Labor Government.