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Wednesday, 28 May 2003
Page: 15154


Mr BARTLETT (10:57 AM) —The Health Care (Appropriation) Amendment Bill 2003 provides for Commonwealth funding to states and territories for the next five years to help them with the public hospitals they administer. It provides for substantially increased funding for that purpose. You would never guess that, listening to the misleading and simplistic rhetoric from the other side or to the squeals and howls from some of the state premiers. Let me look at this legislation in detail and at what it does offer.

This appropriation bill provides for funding for the next five years of $42 billion for states and territories for their public hospitals—that is $42 thousand million over the next five years, which is an increase of $10 billion and an increase of 17 per cent in real, post-inflation terms. This funding increase takes account of population increases, it takes account of the impact of inflation, it takes account of the impact of ageing and it takes account of the impact of utilisation rates of demand for public hospitals. As a digression, a misunderstanding of that key point is the reason that members opposite—assisted by some in the media—have chosen to run this line about a cut of $1 billion out of the forward estimates. The point is that those forward estimates were based on projected utilisation rates in public hospitals. This five-year agreement is based on the new projected rates of utilisation in public hospitals.

The fact is, since the last five-year Medicare agreement was signed up the rate of increase of utilisation of public hospitals fell below what was anticipated. The reason for that was that most of the increases in hospital admissions over the past five years have gone into private hospitals, not into public hospitals. In fact, looking at increases in admissions, four out of five of those increased patient numbers have actually gone into private hospitals, taking the pressure off the public hospital system. So this is not a cut; it is an absolute nonsense to say it is a cut of $1 billion from the forward estimates. This package represents an increase of $10 billion. How, in all honesty, unless they totally misunderstand the basis of the calculation of these figures, can anyone possibly argue that a $10 billion increase is a cut in funding? This is an increase of 17 per cent in real terms in Commonwealth funding to state and territory governments, to assist with their public hospitals.

The Howard coalition government is serious about its commitment to health in this country and a look at the record makes that very evident. Since this government came to office in 1996, Commonwealth spending on health has increased by 65 per cent. We have increased health funding in this country by 65 per cent. To break that down, under the Australian health care agreements we have had two increases, counting those in this current bill, in funding for public hospitals. The first increase, five years ago, raised the Australian health care agreement from the $24 billion that it was under the former agreement—that is, under the last Labor government—to $32 billion, which was an increase of 28 per cent in real terms. Now, on top of that very large increase, we have increased it again by another $10 billion. So, in fact, over the life of the last two five-year agreements, the Commonwealth government's commitment to public hospital spending will have risen from $24 billion to $42 billion, an increase of 75 per cent.

This government has been serious about delivering extra funding for public health in this country. We could also refer to the increased funding that we have seen under Medicare and the proposed further increase in this budget of an extra $917 million for Medicare in this country. We could add to that the extra funding that has gone to health under the private health insurance rebate, to assist people who want private health insurance, to encourage greater membership in private health insurance and to take the pressure off the public hospital system. That has happened. Over the term of this government, membership in private health insurance has increased from 30 per cent to 44 per cent, an increase of 14 per cent, taking substantial pressure off the public hospital system and saving the public hospital system hundreds of millions of dollars that it would have had to spend had those people been accessing public hospitals.

Let us look at this bill a little more closely. As I have said, over the next five years there will be an increase of $10 billion—that is $10,000 million—to bring to $42 billion the total going to the states to assist them in administering their public hospitals. This bill also carries with it some obligations on the part of the states. There is no doubt that this is part of the reason the states have been kicking up a bit of a fuss. This bill requires the states to pull their weight. There is nothing unreasonable about that. If the Commonwealth government is committing substantially increased funds to the states for public hospitals, the states must also do their part. They cannot use this as an excuse to withdraw their own funding and let the Commonwealth carry the burden, as they have been trying to do in recent years.

The obligations as part of this agreement are as follows. Firstly, the Commonwealth must be provided by the states with independently verified details of public hospital expenditure over the five years of the current agreement—the agreement that is just coming to a close. We want to know where they have spent the money, and we want to see that verified independently. Secondly, we want to see a commitment from the states to specific levels of funding over the next five years. We want to be sure that the states will contribute the increased money that they need to spend, that they will in fact match the increase that the Commonwealth government is giving them. We want them to say, `Okay, the Commonwealth government is giving us a 17 per cent increase in real terms; we will match that and also give our hospitals a 17 per cent increase.' We cannot allow the states to use the Commonwealth's increase as an excuse for them to withdraw their funding, as they have in the past. So this agreement quite rightly requires that commitment from the state governments. Thirdly, it requires a commitment to a new and more transparent reporting framework. It requires a recommitment from the states to the Medicare principles. It requires the states to provide the Commonwealth with the performance data required under the current five-year agreement so that we can see just how effectively they have spent their money.

These are quite reasonable, appropriate and necessary requirements. The Commonwealth government is giving the states billions of dollars—over the last five years it has given $32 billion and over the next five years it will give $42 billion—to help with their public hospitals. Australian taxpayers, who are funding this increased spending, need to know that that money is being spent appropriately. They need to know that the states are spending it on hospitals and they need to know that the states are willing to match the Commonwealth's commitment with their own commitment to funding their hospitals. Taxpayers need to know that the state governments are carrying their share of the responsibility for public hospitals.

What have we had from the states? We have had feigned outrage, squealing, screaming and carrying on, with them saying that this is not fair. They say that it is not fair that they are asked to match our increase in funding and it is not fair that they are asked to be accountable. It is most fair, most reasonable and most necessary. It is little wonder that the states have responded this way: if we look back at the record over the past few years, the Australian Institute of Health and Welfare study shows that the states' share of public health spending has in fact fallen over the past five years, from 47.2 per cent to 43.1 per cent. So in just the last five years the state governments have managed to shift about four per cent of the costs of public hospital spending from themselves onto the Commonwealth government. They have been quite happily playing this game, taking the money from the Commonwealth, diverting their own funds elsewhere and not keeping up with their responsibilities to fund their public hospitals. The Commonwealth has been left carrying the can and picking up the bill for the failure of the state governments.

We can see that if we look at the position in New South Wales. This offer provides an increase in funding from the Commonwealth of $3.4 billion over the next five years, to increase Commonwealth funding to New South Wales public hospitals from $10.7 billion to $14.1 billion. This is an increase of 31 per cent. Look at the record, though, in New South Wales. The Commonwealth government has been contributing substantially. Over the last five years, the Commonwealth government has committed an extra 17.7 per cent to the New South Wales government. But what has been the response of the New South Wales government in funding its own hospitals? Has there been an increase of 17.7 per cent to match the Commonwealth's commitment, or an increase of even half that—of eight or nine per cent? No. The New South Wales government has in fact reduced funding to its own hospitals. There has been a fall of 1.1 per cent over the past five years.

So the Commonwealth have been giving the New South Wales government a large increase in funding and the New South Wales government, far from even matching that and far from even keeping its funding static, has actually been reducing its funding and letting the Commonwealth carry most of the load for public hospitals in New South Wales. This is simply not good enough. The New South Wales government has not been carrying its share of the burden. It has been willing to see the Commonwealth take an increasing load. No wonder we need to see these measures of accountability in this legislation.

If we look at the evidence, at the indicators in New South Wales, we can see the state of public hospitals because of the failure of the New South Wales government. Look at the growing lists for so-called elective surgery. It is not really elective surgery, because in many cases people are in severe pain and need to have that attended to. Voters in New South Wales will recall that back in 1995 Premier Carr promised that, if hospital waiting lists were not halved within his first term, he would resign. Far from being halved, those hospital waiting lists have grown.

Let us look at the growing number of days in New South Wales public hospitals where those hospitals are on code red—that is, where they cannot accept emergency patients, except those with life threatening conditions, and they have to turn away ambulances because they do not have the capacity within their emergency departments. It is alarming. Let me read a small part of the Sydney Morning Herald of 14 March this year. It said:

Sydney's three main hospital emergency units, St Vincent's, Prince of Wales and Royal Prince Alfred, were simultaneously in code red mode—unable to take non-life-threatening cases—on at least one occasion over the past two weeks ...

Three of Sydney's main hospitals were all on code red at the same time. So what do we have? We have an ambulance coming to one, being sent to another and then on to another. We have three hospitals at the same time being unable to take emergency patients, except those with life threatening conditions. Ambulances were potentially being turned away. According to the doctor's notes quoted in this article:

Patients had been treated in ambulances in car parks because there had been no beds available in emergency units.

This is a gross failure on the part of the New South Wales government to adequately look after patients in public hospitals. The article goes on to say:

Patients were regularly kept in emergency departments because no ward beds were available.

Cubicles in emergency wards equipped and staffed for one bed commonly had two, a `potentially life threatening' situation.

This is simply not good enough. The New South Wales government has not been doing its part.

Closer to home, I might add, we have seen the same problem locally, with threats to our own public hospitals. Two years ago we had threats when consideration was given by the Wentworth Area Health Service to closing day surgery in our local hospital at Springwood. It was only the strong outrage from the local community that forced the government to back down on that and commit to keeping day surgery. Over the past years, we have had a slow attrition at the Blue Mountains Hospital at Katoomba, where we have had a gradual but steady withdrawal of specialist services. We have seen the removal of the haematologist, the kidney specialist and obstetricians, and we have seen the failure of the state government to bring enough anaesthetists to Katoomba hospital to adequately support the surgery that needs to occur there. Then 18 months ago we had the outrageous proposal by the New South Wales government to close the maternity services at Katoomba hospital. It was only because of the immediate and community wide protest and outrage that the government backed down on that and committed to restoring maternity services at Katoomba hospital, but still there is no guarantee that they will continue. Yes, they are okay temporarily, but, looking at their record, there is no guarantee that the government will deliver on that.

Look at Nepean hospital. We have recently heard in the news again of the cover-up of a case at Nepean hospital, which services a lot of my electorate. A woman died there tragically last year from meningococcal disease because she was not adequately attended to when she turned up at the hospital for treatment. The report into that incident was completed in November last year but not released to the public until March this year. Coincidental, isn't it? Not only has the New South Wales government failed to adequately fund hospital services in New South Wales; they have been happy to cover up problems and to make sure that such news does not leak out until after the state election.

I will go back to the situation of the red alert. We have had the same thing at Nepean hospital—again, appallingly, covered up by the New South Wales government. The New South Wales government's officially released records on the number of hours of red alert at Nepean hospital for October and November last year showed 47 hours and 44 hours respectively. But, looking at the hospital's own computer system, those figures are shown as being 290 and 230 hours for the months of October and November. So there has been a gross cover-up, a gross deception on the part of the New South Wales government, to match its gross failure to adequately fund hospitals in this state.

The New South Wales government has been failing the people of New South Wales and it has been trying to deceive the people of New South Wales at the same time. This appropriation bill provides for the New South Wales government an extra $3.4 billion over the next five years, but the New South Wales government must play their part. They have to turn around their failure and neglect of the last five years. They have to commit to matching this increased spending. People in New South Wales who can see the Commonwealth government giving increased funding want to see the New South Wales government carrying their burden and playing their part as well. If you look at it in a broader context—in the context of the burgeoning state taxes in New South Wales, the massive windfalls they have had from stamp duty and the fact that this year alone the New South Wales government will get $8.7 billion in GST revenue—in spite of all that extra funding going to the state government and in spite of the extra funding from the Commonwealth, they have still failed miserably to deliver public hospital services to the people of New South Wales.

I want to make a couple of comments about the Medicare commitment in this current budget. We have heard a lot from the other side about it. The Medicare commitment will give an increase in spending of $917 million over the next four years. We have had this nonsense from the other side that we are somehow trying to cut it. How could you possibly say that an increase in spending of $900 million plus could be somehow threatening Medicare? We have also had the nonsense from the other side about what they will do to supposedly restore bulk-billing rates. Remember that never under Labor did bulk-billing rates reach more than 80 per cent. In spite of their rhetoric, in spite of all the nonsense we are hearing and in spite of all these empty promises, Labor could never get bulk-billing rates to over 80 per cent. This latest proposal we have heard from them is not going to do anything to achieve that.

This government is at least committed to trying to restore bulk-billing rates for pensioners and concession card holders. The other side are promising lots of extra money. They are promising to do now what they could never do—and never came close to doing—in 13 years in government and, as well as that, they are leaving a large unfunded black hole. With the comments we have heard from the other side, it is pretty obvious where that money will be coming from. They will want to remove the private health insurance rebate, adding immediately something like $750 per annum to the cost of health insurance for some nine million Australians and driving people out of private health insurance and back into the public hospital system which Labor will fail to adequately support.

The Health Care (Appropriation) Amendment Bill 2003 represents another aspect of the Commonwealth government's commitment to public health in this country, with an increase of $10 billion over the next five years, and it requires the state governments to do their part. The state governments must match the Commonwealth's increase and do their part in looking after the health of residents in this country. (Time expired)