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Monday, 2 June 2003
Page: 15674


Mr QUICK (8:08 PM) —This budget, like so many put up by the Treasurer, has disappeared off the media radar screen, but not for most Australian families. The budget, like those stones I used to flick across the river, bounced several times and then sank without trace. True, it raised some instant comment as it skimmed stylishly. True, it sent out large ripples as it sank beneath the surface, and those ripples did cause wash around the edges. In discussing this budget, I am not going to boringly rave on about statistics, percentage increases and alleged decreases, or whether or not states and territories have matched funding. Rather than ideologically attacking the budget, I believe it is far better to realistically assess the budget against its impact on families in my electorate. Let us take off the blinkers and the rose-tinted glasses and genuinely see what it means for them. Following this, I wish to raise issues that I see as crucial to the development of society and the well-being of its citizens here in my electorate and throughout our great country, then I will judge the budget's influences on those issues.

My electorate, like those of all of us in this place, has individual needs and particular requirements. A predetermined budget template does not necessarily see those needs met and addressed. I tried to look at this budget's impact on my families—I will attempt to personalise it. Having various ministers stand up in this place and wax lyrical about the hundreds of millions of dollars being proposed to be spent in the out years is fine, but what does it really mean for families in Bridgewater, Lauderdale, Blackmans Bay, Cygnet, Lindisfarne and Dover? Families in my electorate need jobs and job security. Those with pre school-aged children want to be able to access child care facilities, and be able to afford this care. They want their school-aged children to have the best available cost-effective educational opportunities. They want to be able to access a doctor locally, and preferably one who bulk-bills. They want to be able to readily access Job Network programs if made redundant. They want to be able to have their frail, aged parents gain places in hostels and nursing homes.

Health is the right of all Australians. It should not matter where you live or how much you earn. All Australians are entitled to access affordable quality health care. The consequences of the philosophy that people should pay for this right can be seen when a sick child is not treated by a doctor because her parents simply do not have the up-front fees, or when a 94-year-old man is being separated from his lifetime partner because he does not meet the subjective bureaucratic ACAT criteria. These cases—the reality of what is happening to people in my electorate—are what the budget should address so that we can pride ourselves in our universal health system, that is for all Australians. Health is one of the most important issues for Australian families. The lack of funding for the state governments in the Australian health care agreements is not understood in the glib media coverage it receives, but it certainly is by someone on a hospital waiting list who understands that more funds are needed if his or her operations are to be scheduled quickly. I believe all Australians have the right to expect access to doctors and to a health system that treats people with dignity and respect throughout their lifetimes.

I have nothing but respect for health professionals but, no matter how good these people are, without a properly funded and resourced system there are going to be major problems. This may seem unsubstantiated, so I would like to share some cases that my constituents have brought to my attention. Hospital waiting lists are of great concern to many people. One of my constituents recently wrote to me:

I had an unfortunate accident and was fitted with a colostomy bag which the hospital informed me would be removed in six months time. Now two years later on I rang the hospital to see what was happening only to be told it will be several more years before this minor surgery can be performed. I understand the hospital system is over loaded but this is totally unacceptable and inhumane way to treat tax payers and citizens.

The only advice I could pass on to this man was that the limited availability of the specialist surgeon and the number of urgent cases on the waiting list had led to the hospital's inability to confirm a date. A review by a specialist may move him up the list. There was only one colorectal surgeon at the Royal Hobart Hospital with so many patients requiring surgery for illnesses such as bowel cancer. One wonders when minor surgery will be seen to—in this case minor surgery would give this 40-year-old constituent a much higher quality of life.

Another case that touched the hearts of my staff and me was that of Mr James Gribbin. Mr Gribbin, a 94-year-old man, was continually assessed by the Aged Care Assessment Team—ACAT—as low care. His 94-year-old wife was in a high care nursing home. Mr Gribbin desperately wanted to gain admission to the same place but was not even on the waiting list due to his assessment as low care. Mr Gribbin was hospitalised three times this year—once for a stroke, once for pneumonia and once for malnourishment. Mr Gribbin required a walking frame for mobility, no longer held a driver's licence and received visits from the district nurse, home help and Meals on Wheels. Mr Gribbin was in hospital again in April, where a reassessment took place. Yet again he was classified as low care. While in hospital he was diagnosed with pancreatic cancer, with a prognosis of only a few weeks to live. On compassionate grounds alone it would seem obvious that the solution should have been to place Mr Gribbin in the high-care category to enable him to be considered by the home his wife was a resident in.

Finally, after much discussion and many phone calls, the federal Department of Health and Ageing put forward a suggestion: that the home could take in Mr Gribbin with their own assessment. But, by this time, it was worked out that Mr Gribbin was gravely ill and he chose to be placed in the Whittle Ward, the palliative care hospice. Mr Gribbin died on 25 April this year. After spending most of their adult life together, Mr and Mrs Gribbin were separated because Mr Gribbin did not meet a partly subjective, bureaucratic criterion. Without real compassion in guidelines, the humanity of aged care is devalued.

The demise of bulk-billing and the attack on Medicare has resulted in people who simply cannot afford to take themselves or their children to their local GP, putting yet more pressure on our emergency departments, which are already suffering from lack of funds. Medicare was founded to ensure universality in our health system. It is not about free health. As taxpayers and citizens, Australians have already paid for it with taxes and their Medicare levy. The latest offering from the Howard government, the so-called `fairer Medicare', penalises the people who pay for Medicare and reduces Medicare to a safety net for a two-tiered system.

Bulk-billing increased every year under Labor governments, but it has been in decline since the Howard government was elected in 1996. Bulk-billing by GPs has fallen by 11 per cent since the Howard government came to office. I am afraid to say that, in my electorate of Franklin, the rate of GP bulk-billing has fallen to 53.6 per cent—a decline of almost five per cent in the last year. The average patient contribution in Franklin has risen by 12.5 per cent to $9.34. What this means for the average family is that, hopefully, they or their children get sick on payday. Families without health care cards are expected to pay upfront fees. A constituent of mine recently asked whether the doctor would bill her, and she was told that you pay on the day. This meant that she could not see her GP.

The latest package that the Howard government has offered will see families with two children, who earn over the cut-off point for a health care card, $32,000, pay even more to visit a doctor. I can assure you that there are many families in my electorate who cannot afford this increase. This limits their choice and many will go to hospital casualty departments, putting even more pressure on public hospitals—yet the Howard government is offering the states and territories less in hospital funding. The package offered by the Howard government is heading towards an Americanised, user pays, two-tiered health care system. It is not merely political rhetoric that a `fairer Medicare' from the government will lead to unfair outcomes. Francis Sullivan of Catholic Health Australia said:

This package disproportionately hits the hard up and the sick and erodes the value of the Medicare entitlement for people without concession cards. Families and people on meagre incomes will find bulk billing elusive.

Tim Woodruff of the Doctors Reform Society stated:

Working families with one income will be reduced to taking just one of three sick kids to the doctor and then sharing the treatment in a desperate attempt to afford health care.

As I said, the issue of Medicare has been prominent in this budget.

My GP, Dr Riddoch, has raised this subject with me on numerous occasions. I received from him on Friday a concise, constructive solution to what I consider a real national health problem—one that will not go away. It needs bipartisan support and should be considered in terms of what is best for Australian families, not from a position of cost-benefit analysis. He says in his letter:

The Scheduled Fee and its reduced rebate failed to keep pace with the cost of living, and have done so ever since. This is why the AMA recommended fee for a standard GP consultation is now about twice the Scheduled Fee.

All along the majority of GPs, even if they have not bulk-billed have generally continued to charge pensioners and health care card holders, lower income earners and many children lower fees. By so doing they have demonstrated their altruism, but at the same time they have continued to subsidise the health system and have inadvertently fed the lie that the price of a standard GP consultation is worth $25.05.

Almost all GPs would bulk bill if the rebate were appropriate.

Compare GP fees with those of other professionals and tradesmen. They are lower than a visit to the hairdresser.

Small wonder that General Practice is in a state of crisis. Why train for years, remain committed to continuing education, work for long hours, deal with many varied and complex health issues and put up with being so undervalued?

Successive Federal Governments—

and I will add here, mine too—

have imposed a mass of impositions on GPs. There are more certificates than the proverbial stick can be poked at. Examples include special certificates for Centrelink, authority for the PBS, extra forms for childhood immunisation.

In relation to medical indemnity, he goes on to say:

Contrary to the utterances of the Minister for Health, and her colleague the Minister for Revenue & Assistant Treasurer, this has not been handled well and, for us in Tasmania at least, does not offer a secure future.

He goes on to say:

What can be done to improve the situation?

· The most important and immediate action must be the restoration of the confidence and self-esteem of the current General Practice workforce.

· They should receive adequate remuneration for their services. When Medibank was created we were “rewarded” with 85% of the “common fee”. The Relative Values Study has shown that an appropriate fee for a standard consultation should be in the range of $45-50, 85% of which is $38.25-42.50.

· There are many other items of GP which deserve to be remunerated more highly, notably home and nursing home visits.

· Together with a raising of the status of GPs should come increased funding for places in medical schools and in GP training programs. Ideally there should be one program—in my opinion this should be run by the RACGP.

· The recent plethora of time-consuming incentives for General Practice ... should be abolished.

· A “no fault” insurance scheme for the victims of medical misadventure should be introduced.

He goes on to say:

Failure to implement these essential changes will result in further degradation of General Practice to the detriment of health care throughout Australia.

Yours faithfully,

Dr Graeme Riddoch

I now turn to the much vaunted, by the government at least, Job Network. What a shambles the Job Network competitive tendering process has been. What a waste of resources and time and what an insult to the long-term unemployed in this country. Let me put on the record how this government have short-changed the unemployed of this country. Since they came to government in 1996, seven years ago, the number of long-term unemployed has barely changed. From the inception of the Job Network process, it has become a lottery to see who will be awarded contracts and for the duration of each contract transition, believe it or not, the system shuts down for two months. In my electorate of Franklin, `Geoff' came to my office because he had qualified for intensive assistance during May but none of the Job Network agencies was able to register him during the transition period. He had the opportunity to commence work as a security guard but he needed assistance to pay for his first aid course and the security licence.

In Bridgewater, an area of exceptionally high unemployment, Job Network 3 has cut down the number of providers from three to two. Mission Employment was closing and could not take him on. Job Futures were setting up but their contract commences from 1 July. Workskills, which were continuing, were adamant, as was the department, that nothing could be done to help `Geoff'. My office put a call through to the minister's office and they were very helpful. They helped organise for Workskills to take `Geoff' on and he was able to commence work. The question that arises is: why does it require ministerial intervention to get someone registered for and access to intensive assistance? One wonders how many other people across Australia are affected in the same way but do not have access to ministerial assistance? How good is a system that virtually shuts down for two months to change providers? I really feel for the long-term unemployed who have to ply their way through such a ridiculous system.

Before I leave this subject, Mr Deputy Speaker, I draw your attention to the fact that half the Job Network provider offices are closing by 1 July. There will be fewer than 1,000 offices for the country and many regional areas will be without direct access to a provider. In Bridgewater, as I have said, the number of providers will be reduced to two. For the eastern shore area of Rosny there will be only two providers, reduced from five—a great choice for the unemployed. One wonders and speculates that Job Network 4 will probably see just two or three providers for the whole country. By that stage it will be close to a complete privatisation of the CES, except that it will have been done by stealth over 10 years.

There is much more that could be said and elaborated on about this budget—the issue of early intervention, the crisis in the unmet need for child care for thousands of Australian families and, in my mind, the wrongful emphasis by this government in restructuring education. Where is this government's real commitment to liaise with and adequately resource state education ministers to see the following issues properly addressed: smaller class sizes for every one of our early childhood students and the mandating of full-time specialist teachers in the areas of music, physical education, libraries and special education in all Australian schools with over 150 students. I would argue that concerns over $150,000 university fees are irrelevant if students entering our high schools will not be taught by premium maths and science teachers. Many of those students are not capable of coping socially and academically.

In the last few moments, I would also like to raise the issue of the inability of many of my constituents to access legal aid. Once again we have this territorial stupidity between state and Commonwealth governments about whose fault it is and who is specially required to top up funding. I am lucky that just around the corner from my electorate office there is a wonderful community legal centre. It is the first point of call for many people who do not understand the complex nature of our legal system. But to send people around there only for them to be told, `It doesn't seem to quite fit the criteria'; `The funding is only for Commonwealth issues'; `This is a state issue'; `Go away and see a lawyer' is just like saying to poor old Mr Gribbin, `You're 94 and you don't meet the criteria. Fend for yourself. You are one of those victims of society.'

We are a country rich in resources and in wonderful people. We have so much going for us. In the last few parliaments I have said that our priorities are all screwed up. I am not a great advocate for spending endless amounts of money on defence. I think that some of the initiatives taken by this government in our allocation of resources in the area of antiterrorism and the like would be better placed in strengthening our communities. We need to be proactive rather than reactive. Hopefully state and territory ministers can get together, come up with packages and stop this stupid silo mentality. Let us make decisions for the benefit of all Australians and ensure that in this wonderful country there are opportunities for all to reach their potential. I thank you for the opportunity to speak on the 2003-04 budget.