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Wednesday, 23 October 2002
Page: 8533


Mr BILLSON (9:58 AM) —The Health Care (Appropriation) Amendment Bill 2002 proposes to amend the Health Care Appropriation Act 1998. The good news is that this amendment is designed to facilitate the paying of a greater amount of funds to the states and territories for their public hospitals. The act provides the legislative basis for those Commonwealth grants under the financial assistance package negotiated as part of the 1998-2003 Australian health care agreements. That health care agreement processes the main way in which Commonwealth funds are funnelled to the states and territories for the provision of health care for all of our constituents, for all of our communities. Primarily, funding through this agreement from the federal government goes to funding public hospitals.

It is important to note that what has given rise to the need for this amendment is the fact that the Commonwealth is being exceptionally generous in not exercising some of the mechanisms within that agreement—mechanisms agreed to by the states and territories—that would have seen some downward pressure on those grants paid to the states and territories. Those particular measures relate to the private health insurance system and how, within those agreements, the public hospital system, with the agreement of the states and territories, would have seen an acknowledgment of an increased uptake in private health insurance by a reduction in some of the funding going to the public health system. The Commonwealth has decided not to exercise those provisions. That decision, along with the increased funding and some of the other indexation issues that are part of that agreement, has given rise to the amount included in subsection 4(3) being increased from $29,655,056,000 to $31,800,000,000. They are huge sums of money and they reflect the Commonwealth's commitment to the public health system and, more specifically, hospitals managed by the states and territories.

What we are talking about today is amending that provision in the bill so that the Commonwealth can pay up to that amount. As I mentioned earlier, there were issues around the government's decision to forgo the right to clawback any funding from the states in recognition of increased private health insurance coverage. There was also a decision by the government in August 1998 to offer the states and territories more funding under the 1998-2003 health care agreement. There was also a decision in December 1999 to recognise the importance of wages and salaries in the provision of health care. It is a labour intensive industry, and we have incorporated in the indexation mechanism for the grants a wage cost index to take account of how important wage movements are. There are also other routine indexation issues. The net result of this is that the Commonwealth can provide more money to the states and territories at a time when we are seeing remarkable increases and sustained growth in private health insurance coverage—something I think all of us who like that choice and recognise that the health system works best when the private and the public system complement one another would appreciate. Changes that the Commonwealth has introduced have transformed the private hospital system from what Russell Schneider at the Australian Health Insurance Association described as a `cottage industry' into a growing sector.

In the principal city of Frankston in my electorate of Dunkley there is plenty of interest in co-locating a private hospital to the site of the Frankston Public Hospital and relocating the Frankston Tennis Club to another area of public open space and recreational facilities that was part of the old golf course. In our community, in particular, where we have strong private health insurance coverage, we are seeing that reflected in new investment with Peninsula Private Hospital. We are also seeing Beleura travelling well and the Bays Hospital Group have also been expanding to take up the extra demand. We are seeing more Commonwealth funding to the states and territories primarily going into the public hospital system at a time when we are also seeing a significant proportion of communities in all electorates across Australia with private health insurance. We are getting a growth in resources in the health care sector from both a public and private hospital perspective. That is something worth celebrating and it is why I think everyone would support the bill today. I cannot imagine too many people being unhappy with a bill that proposes to give more money to the states and territories for hospitals.

The key thing is that it is not the only area in which increased resources are showing the Commonwealth's leadership in making sure that Australian citizens have the health care that they seek and that they rightly deserve. The increase in private health insurance take-up means a decrease in pressure on public hospitals. Minister Andrews, who has joined us in the chamber, is doing a remarkably good job in his portfolio. Hopefully I will be able to say he is doing an even more remarkable job if the aged care bed outcomes are attractive for my electorate—so there is some encouragement for you, Minister. Minister Andrews explained in his second reading speech how these changed amounts play out in the amendment to the upper level—the high watermark—of the funds that the Commonwealth can make available. If you look through the budget estimates, you see that there is population data factored into these estimates which the minister needs to take into account and there are some changes and finetuning in the appropriate distribution of funding responsibilities. In May 2003 we will know the precise make-up of the state and territory share of that growth in funding and we will see to what extent that increased upper limit is reached once those negotiations have proceeded.

It gives rise to something I would like to spend some time talking about. All federal members know of a concerned constituent seeking an earlier entrance into a public hospital for an operation or something like that. It is a long road to hoe as a federal member: our mechanisms and our capacity to influence those decisions at a hospital level are fairly circuitous. As was mentioned earlier, the Commonwealth does provide a huge amount of funding to the states and territories. The states and territories supplement that from their own resources and then that goes to individual hospitals and health care systems. That is apportioned and management arrangements are made about how their facilities will operate. Then the patients come in and the facilities have to work through those decisions about priorities, about resourcing and about the pace with which non-elective and elective surgery is carried out.

Where we have a constituent who is not happy with the elective surgery waiting times—and in Victoria we have seen a lot of public discussion about how those elective surgery waiting times are stretching out more and more—that causes concern for them, particularly if they need a hip replacement operation. That is not viewed by the health system as the highest priority procedure, but for the person suffering the great deal of pain, discomfort and loss of mobility it is a vitally important procedure. As federal members we can seek to advocate our views to our hospitals; but at the end of the day it is a medical decision, it is a balancing of competing medical demands and a medical case needs to be made for an increase in the urgency of that procedure. The Frankston Hospital in my electorate of Dunkley has been quite open to representations along those lines, focusing on the issue of the medical urgency. That often involves providing advice to the patient that they really need to see their doctor and have their doctor argue the case to the registrars about the urgency of their procedure.

That is one issue, but the issue I wish to talk about today deals with accident and emergency departments. Much of the funding that goes through from the bill we are discussing today finds its way into the hospitals and then finds its way to provide that first response for people when they are feeling they need instant emergency medical attention. Frankston Hospital is a remarkable place. We had the good fortune and the misfortune of being in the location of the supplementary election that decided the fate of the government at the last state election. Besides the travelling circus of ministers, aspirant ministers, and promises, pledges and all those sorts of things, there was quite a deal of attention given to the Frankston Hospital. The then Labor opposition made a mountain of promises about that. I support the state member for Frankston, Andrea McCall, in seeking to make sure that those promises are kept. It is a little hard to know which ones were kept as there were so many. But, in fairness to the state government, there has been a lot going on at the Frankston Hospital and I will leave it to Ms McCall to work out whether it was everything that was promised.

Frankston Hospital has been a perpetual building site. It has been a place of ongoing redevelopment and expansion, much welcomed by the local community. Whether it is all that was promised is something that state political players can sort out, but it has been a place of great change and a very dynamic place. I would like to pay tribute to the board, the management and the staff at Frankston Hospital for maintaining and improving service levels at a time when their workplace has been a building site. The place looks like a war zone at some stages: there are bits of building hanging out in some places and in some corridors you walk through there are wooden panels to guide your way through. We went to some functions there for the Centenary of Federation because funding was allocated for a religious sanctuary within the hospital for all denominations, as people look to their faith to give them strength at a time when they are looking for healing and support. To get there, we had this rat run through the hospital. Why? Because there was so much work going on. But over that time the emergency department has continued to be, I think, the most remarkable performing emergency department of the hospitals throughout Victoria. It has continued to soldier on, catering for an ever-increasing population in our region.

Home and community care is the great bane of many outer metropolitan members' lives, and it may be that the minister at the table, the Minister for Ageing, would know this too. Why is it? It is because the Commonwealth hands over the money and then the states allocate it. In the past there has been a remarkable bias and higher per capita funding for home and community care services to the inner metropolitan areas, so they are luxuriating in resources for home and community care. But, if you happen to be a frail aged person eligible for home care assistance and living in an outer metropolitan area, you have got a real raffle on your hands. You have got a lot of work to do to get access to services that are not anywhere near the level or the duration that you would get in inner Melbourne. You may have exactly the same condition, and there may be exactly the same justification for services, but, purely because you are in an outer metropolitan area and there has been a historical bias towards higher funding levels in inner metro, you get reduced levels of service. That is unsatisfactory and successive state governments have wimped it; they have wimped reallocating and redistributing those funds more equitably across all of the community.

Why have they done that? Obviously, if you are luxuriating in services in inner metro, you do not want the money to disappear. You do not want a reduction in the name of equity just because some of your fellow Australians in outer metropolitan areas, who are in exactly the same condition as you are, are not getting anywhere near the same level of service. What has been the solution? The states, particularly Victoria, have constantly demanded growth funding. Why is this? That papers over the inequity in the way the current funding is allocated. They say, `Give us more growth funding' so that they can play catch-up footy for the outer metropolitan and rural areas because they are not prepared to bite the bullet on the funding outcomes.

It is the same issue when it comes to the funding of emergency departments. The inner metropolitan areas in Melbourne have traditionally had a seven-layered arrangement for funding emergency departments. If you happened to be one of the big inner metro hospitals you had money; you had substantial funds. If you happened to be in an outer metropolitan community, such as the one I represent in Frankston, you had to make do with far fewer resources to begin with, a growing demand from a population that is ever-expanding in your catchment, and an expectation from the local community that all cases, irrespective of their complexity, can be accommodated. Gone are the days when the accident and emergency department could handle a nick or a cut. Critical rescue, emergency and urgent cases are all expected to be catered for in these outer metropolitan areas such as the one I represent.

To the credit of the state government, I think they have recognised the nonsense in the old funding model and they are moving to a different arrangement. That different arrangement will now provide other signals as to how funding will be provided. The changes have gone from the old ED categories, E1 to E7—I will not go into all the gory details—to what is essentially a two-tiered model. A two-tiered model should go some way towards addressing this inequity, but again they have failed to bite the bullet. In the case of the Frankston Hospital, the accident and emergency department is located, quite wisely, near the entrance; and just across the hall is a medi-clinic which is operated by local GPs and is funded through Medicare; you just swipe your card. So, if you have got a low-order GP kind of condition that needs to be attended to—it might be after hours or you might be having difficulty getting into a hospital; we know about the shortage of GPs in the region that my friend the member for Flinders, Greg Hunt, and I represent—you go to the hospital and they say, `Right. Triage. Yes, you've got a GP thing. Off you go to the medi-clinic.' You get attention, you get treatment, it is clocked up on Medicare, and the bill is sent to the Commonwealth. The consequence of that is that higher order, higher complexity cases end up going, as they should, to the accident and emergency department.

I have a slide here that is very hard to read into Hansard, but I will try to explain it. In the case of the Frankston Hospital, the number of rescue and emergency patients who are seen in that hospital actually amounts to the total number of cases seen in other hospitals. The average of patients in category 1, 2 and 3 funding, which is rescue, emergency and urgent, is actually greater than it is for some of the inner metropolitan hospitals. I wish to explore this issue further but today I simply want to highlight the fact that the funding level for one of the inner metro hospitals starts at about $9 million. For an outer metropolitan hospital it is about $5½ million. That is the starting position, and then there are some changes made in terms of throughput and the like. What is missed is the complexity. What is missed are the actual demands placed on those professionals who, in the case of the Frankston Hospital in the accident and emergency department, do a remarkable job.

I am calling for the Commonwealth, with the $30 billion funding allocation, to use those resources to give leverage to the states and territories to make sure that the accident and emergency services provided in outer metropolitan communities, like the community in the Greater Frankston-Mornington Peninsular area, are more responsive to the actual demands they face. It is a terrific hospital that is doing a terrific job under difficult circumstances. It deserves our support and it has a right to expect a proper level of resourcing—and whatever I can do to support that, I will.