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Tuesday, 25 November 2003
Page: 22759


Ms HALL (5:47 PM) —The member for Herbert really needs to look at this whole issue and see that it is not the fault of the Queensland government that we are faced with this catastrophic medical indemnity situation. Rather, it is due to the inaction of the federal government at a time when all the signals were that there was a major problem. I am very disappointed that the member would stoop to such a level and that the government will not take responsibility for the situation that we are in at the moment. Unfortunately, the doctors I have spoken to are still deeply concerned about the medical indemnity insurance crisis. They are appreciative of the fact that they do not have to pay the levy now but they are most concerned about what is going to happen in 18 months time.

I rise to support the Medical Indemnity Amendment Bill 2003 because we need to at least draw a line in the sand at this particular time. I cannot emphasise strongly enough the importance of resolving the issue of medical indemnity insurance. If this issue is not resolved, the whole health system of this country could collapse; it is of such importance. Doctors need to have certainty, patients need to have certainty and everybody needs to have faith in the system. The previous speaker congratulated the former and current health ministers. I do not think that those congratulations are in order. I really believe that this has been very badly handled by the government. It has actually been grossly mishandled. I feel that, if there is anything that points to the fact that the Howard government is incompetent, it is the handling of this issue and the general handling of the health system. It is of vital importance to the people that we represent in this House that they have certainty that if they get sick they can see a doctor and that they can afford to see a doctor. It was only when we reached the crisis stage of all those doctors in New South Wales resigning that the government decided to take this matter seriously. We on this side of the House are not opposed to the interim arrangements that are in place, but we really feel that a lot more needs to be done. It is a challenge that I hope the government can meet.

I would like to detail the history of this crisis that we are faced with. In November 2001—two years ago—UMP collapsed. When it collapsed, it had an estimated liability of $460 million. The government agreed to take responsibility for UMP's IBNR liabilities but, in doing so, it signalled that it was going to pass them on directly to UMP members and former members through the now famous IBNR levy. The scheme of arrangement was passed into law by the Medical Indemnity Act 2002 and the Medical Indemnity (IBNR Indemnity) Contribution Act 2002. Whilst the liability was $460 million, the Howard government would recoup $580 million over 10 years from doctors. This was done to allow for the fact that the money it recouped should actually represent the present value of the $460 million. The calculations for this are certainly questionable. It is a credit to the minister that he is going back and actually looking at this.

The first batch of levies arrived with doctors just a few months ago and that triggered massive public resignations within the public hospital system. In the region that I represent in this parliament—that is, the Central Coast—11 doctors resigned. Those resignations were to take effect three months after the date they were given. In actual fact, some doctors have already removed themselves from the public hospital system. This has created a lot of problems for people living in an area where there is already a doctor shortage and where there is an elderly population with high medical needs. So the shortage of doctors and the fact that doctors are now charging more and are no longer working in the public system have already created a problem in the area that I represent in this parliament.

When these levy bills arrived, very little information from the government arrived with them. Doctors felt that the government had not been at all courteous to them and they did not understand how these levies had been calculated. They disputed the calculations, claiming that the IBNR liabilities were overestimated given recent tort law reform. That takes me back to the previous speaker, the member for Herbert, who addressed the issue of tort law reform. I would have to say that, if the state governments had not acted with tort law reform when they did, the situation would be a lot worse.


Mr Ciobo —We led the charge!


The DEPUTY SPEAKER (Ms Gambaro)—The honourable member for Shortland has the call.


Ms HALL —In New South Wales the state government picked up the liability for medical indemnity insurance within public hospitals. This issue has created a great deal of angst within the community. Specialists objected to the high costs of the levy and doctors argued that the Howard government had no long-term solution to the medical indemnity crisis. It is interesting to hear the member for Moncrieff interjecting. I hope that when he makes his contribution to this House he admits that the government he is part of has failed the people of Australia, has not acted in their best interests and has certainly left doctors in the lurch wondering what is going to happen.

As recently as this afternoon, I was speaking to a constituent in my area who is a specialist. He told me that this government's actions were not good enough and that three doctors who were working in private practice in my electorate had all left and gone to the public sector. Each of those doctors says that that is because of the crisis in medical indemnity insurance and the government's failure to address it. They found that this government had been most destructive and obstructive in the way it had handled this matter. So I really believe that it does stand condemned to a large extent on its handling of this ever so important matter.

In October 2003, doctors' discontent led to mass walkouts from public hospitals, with the vast majority of doctors in New South Wales threatening to walk out. It was only because of this that the new Minister for Health and Ageing had crisis negotiations with the AMA. That led to the government agreeing to a moratorium on the IBNR levy payments. I must say that that was welcomed. If that situation had been allowed to continue then I think our health system would be in total chaos. But the review and the moratorium are not enough—we need action and we need the issue satisfied once and for all.

The health minister is on a panel that will report to the Prime Minister on 10 December. We on this side of the House will be watching that with great interest. This committee is supposed to have consulted widely with the community, but comments have been made to me that they do not think this has happened. They believe that consultation has been limited. That is both from the consumer side and from the doctors. That consultation was supposed to look at financial sustainability, transparency and comprehensibility for all parties. It was supposed to provide affordable, comprehensive and secure cover for doctors. That is important for every person in Australia because, if that cover is not available, it really does threaten our health services throughout the nation. By doing that, it was supposed to enable Australia's medical work force to provide care and continue to practice to its full potential, and safeguard the interests of consumers and the community.

I would like to just touch on an issue that is very dear to my heart and something that is impacting on my electorate at this very moment. Yesterday there were reports in the Newcastle Herald that Belmont Hospital—the hospital where I had my youngest child—has signalled that it is going to close the maternity ward. That hospital delivers 650 babies a year; it is situated in a growth area and it is a strong community based hospital. You might ask why this hospital is thinking of closing its maternity ward.


Mr Ciobo —Not enough funding.


Ms HALL —I can hear the member on my left showing total disregard for the people of the Shortland electorate—for the mothers who wish to have their children at Belmont Hospital—just as the government has constantly shown disregard for the people of Shortland, and that is reflected in the decline in the bulk-billing rate and the crisis that I am talking about now. The medical indemnity crisis has worsened in the area of anaesthetists and obstetricians in Australia. The shortages are leading to an end to the delivery of babies at Belmont Hospital; they are talking about having all deliveries at the John Hunter Hospital.

I thought it would be quite interesting to go through a few facts about what has happened in the area of gynaecology and obstetrics in Australia. A survey that was done in 2002 looked at the work force. Doctors were asked who was likely to deliver babies in the next 10 years. In one year's time only 66 per cent of those obstetricians will be delivering babies—that is a drop of one-third. In five years time the work force will be down to 44 per cent, and in 10 years time it will be down to 24 per cent. That is a crisis facing Australia. That is a crisis that each and every member of this House should be concerned about. In the Hunter there has been a drop of one-third in the number of obstetricians in one year and a drop of over half in five years. In 10 years time it looks as though only one-quarter of the obstetricians will be practising. It is like that throughout Australia. The retirement rate for obstetrician gynaecologists is something like 50 to 60 a year. The replacement rate is somewhere between 46 to 49 per year, and that leaves a gap of 10 or more obstetricians per year. The problem is Australia wide; it is not peculiar to Belmont Hospital.

Looking at the Hunter Valley obstetrics work force, at the John Hunter Hospital in 2002 there was a loss of four doctors—that is, public sector obstetricians—who have ceased work, and another obstetrician will leave in 2004. There will be a net loss of six people. At Belmont Hospital no obstetricians have left, but three have gone from the private sector and they are working solely through Belmont Hospital. That shows how important Belmont Hospital is and how it has the support of the community it services. At Maitland Hospital one obstetrician has left but has been replaced by one staff specialist. A total of four people practise at Maitland, but the mixture has changed from four private obstetricians to three, and one staff specialist. People are moving to the public sector because they fear the problems associated with medical indemnity insurance. Wyong Hospital, which services part of the Shortland electorate, is about to lose an obstetrician.

That shows that there is a decline in the work force. There are problems with the number of anaesthetists at all these hospitals. The private sector is shrinking and the public sector is shrinking. There has been a net loss of 11 or 12 obstetrician gynaecologists between 2002 and 2004. That is a real concern to the people of the Hunter and to the people that I am representing in this place. The issue of anaesthetists is causing constant problems and it is one that must be dealt with. It can only be dealt with if the government really turn their minds to solving the problem of medical indemnity insurance, not just putting in place stopgap proposals like this. We wait and we look with interest on this side of the House to see what happens.

Finally I would like to return to the issue of Belmont Hospital and say that I can see absolutely no reason why the people of the Shortland electorate, the people of Eastlake Macquarie, should be disadvantaged by no longer being able to have their babies delivered at Belmont Hospital—a strong community hospital, a hospital that has the support of the whole community, a hospital that has a sound record of caring for and commitment to the community, a hospital that has three committed obstetricians that are prepared to work in that public system. At 6.30 p.m. on Thursday, 11 December a public meeting will be held at the Belmont Sportsman's Club. People of the area will come together and we will be sending a strong message about how important Belmont Hospital is and how important it is to the people of the Hunter to be able to have their babies delivered there. My message to the government is: deal with this issue now and ensure that women in the future can deliver their babies with the security of knowing that an obstetrician will be there to look after them during their confinement. The government must act in Australia's interest because if we do not have a sound medical indemnity insurance system in this country then our whole health system will be on the verge of collapse.