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Thursday, 11 March 2010
Page: 2231


Ms LIVERMORE (10:12 AM) —I am pleased to speak this morning in support of the Healthcare Identifiers Bill 2010 and its related bill. This bill is designed to establish a national Healthcare Identifiers Service. It also sets out arrangements for its operation and its functions, which will be to assign, issue and maintain healthcare identifiers for individuals, healthcare providers and organisations. This bill is one of many that we have had before the parliament through the term of this government that is about preparing our healthcare system for the future, making sure that the healthcare system that Australians rely on now will be there for them well into the future, delivering the care and the services they need.

When the Rudd Labor government took office in 2007 we knew that we had a lot of work ahead of us to undo the damage done to Australia’s health system by 11 years of the Howard government’s neglect and underfunding. Who can forget the legacy of the former Howard government’s health minister, now Leader of the Opposition, Tony Abbott, who presided over the ripping out of $1 billion from the public hospital system? Our constituents are still feeling the effects of his decision to cap GP training places each time they call their local doctor’s clinic to be told that there will be a week’s wait to see a doctor or, even worse, that the books at that particular clinic are closed to new patients.

We got to work on this huge task straightaway. Already in our two years of office the government has put significant new funding into health and put forward initiatives to solve some of the immediate problems we inherited from the previous coalition government. There has been a 50 per cent increase in hospital funding over the next five years in Australian healthcare agreements with the states and territories, and this represents a $64 billion investment. We have committed an unprecedented $1.1 billion investment towards training our doctors, nurses and health professionals, not the least of which is a 35 per cent increase in the number of GP training places. We are funding a rural doctors incentive scheme that now extends to 500 additional communities, and I am pleased to say that a number of those communities are in my electorate. As a result, there are incentives for 2,400 additional doctors to encourage them to stay in the bush.

There is now a greater emphasis on preventative measures, including an $872 million investment in programs to be rolled out in schools, workplaces and local communities to focus on reducing risk factors such as smoking and obesity and encourage people to increase their physical activity and eat healthily. For the first time, the Australian government is investing more than $1.8 billion directly into expanding emergency departments, post-acute care and elective surgery. Also for the first time, the Australian government is investing directly in the capital needs of local hospitals. Rockhampton Base Hospital, which is the largest hospital in Capricornia, received $76 million in last year’s budget for an expansion that will mean more operating facilities, more training facilities and a capacity for the hospital to deliver more cancer services in the future.

This funding, which is not insignificant, and these initiatives deal with some of the most pressing issues, such as waiting lists, infrastructure and workforce. But we know that we have a health system that is stretched to breaking point right now and is in no shape to cope with the demands of the future. That is why the government has also engaged in the extremely challenging work of looking at the structural reform required to meet those and other future demands. The report produced last year by the Health and Hospitals Reform Commission was very clear—our health system is not prepared for future challenges, for a number of reasons. Those challenges are well known to all of us. First of all, we know that we are facing an ageing population, and that means an increase in the healthcare needs of the overall community and an increase in the cost of meeting those needs. Our population overall will grow, calling for more health services infrastructure and a larger health workforce.

The rates of chronic disease are projected to grow. For example, type 2 diabetes is projected to increase by more than 520 per cent between 2002 and 2032. That is a staggering increase over a relatively short time. The workforce shortages that already impact on our health system will not go away. We need to be training more health professionals and doing more to make the most of the skills of the various parts of the health workforce. The recent Intergenerational report reinforced the need for change. That report included estimates that by halfway through the century health costs would consume the entire revenue raised by state governments. Furthermore, the ballooning of health costs presents risks to the entire Australian economy. In light of those warnings, the only answer is reform of the health system in a big way.

Again, the work of the Health and Hospitals Reform Commission highlighted the weaknesses in our present system that need to be addressed if our health system is to be strong and sustainable into the future, if it is going to be there for all Australians in the way we have rightly come to expect. The first of these weaknesses is that there is too much blame and fragmentation going on amongst governments. At the moment we have eight different health systems split between our states and territories, and we also have Commonwealth funding for various parts of the health system but this is not necessarily in any logical order. Responsibilities for health between the different levels of government are very unclear, resulting in duplication, cost shifting and blame shifting.

The classic example that always comes to my mind is a community in my electorate where there is a small rural hospital and right next to the hospital is a GP clinic. The same doctor services the public hospital and has the right of private practice. There is no problem with that, but you end up with patients being sent over to have a procedure done in his clinic, I do not believe for any clinical reason—it is the same doctor—but the cost then does not come out of the Queensland Health budget attached to the hospital; it is billed to the Commonwealth through Medicare. I do not think there is any healthcare impact of people having to walk from the hospital to the surgery, but it just highlights the unnecessary cost shifting and complication that is there, just in one small town in my electorate. If you can imagine that happening right across the health system, you can understand why that fragmentation and those incentives for cost shifting are such a problem.

There are also gaps and poor coordination in health services that people need. So, again, particularly elderly people or people with chronic illnesses will be accessing a suite of different services being provided by a whole range of health providers. Some of those are going to be Commonwealth funded and some will be state funded, and some will be half and half. When there are those gaps or this lack of coordination, you can just see that there is room for people to fall through the cracks and not have their health needs met, or certainly not have them met in an efficient or timely manner.

There is too much pressure on our public hospitals and health professionals. In Australia we have much higher rates of hospital admission than other comparable countries. Our public hospitals are just the default for anything that happens in our health system, and of course we know that that is not the most efficient or cost-effective way of dealing with many of the health problems that we have. Certainly as we look into the future, where chronic disease is going to take up much more of the health system’s time and resources, public hospitals will not necessarily be the answer to meeting those needs.

There is also too much waste and inefficiency. The Commonwealth government currently funds states with block grants for public hospital services. Even though we know that some states are delivering services more efficiently than others, it is still difficult to identify exactly where that is happening and to reward those who are meeting best practice. The government has seen the warnings in the Intergenerational report and from the Health and Hospitals Reform Commission and have also listened to the views and experiences of thousands of health professionals and advocates during more than 100 consultations in hospitals and communities around the country. We are convinced that now is the time to act if we are to build an efficient and reliable healthcare system, and that is what we are going to do.

A major part of the government’s reform plan for health was announced last week. For the first time the Commonwealth government will take on majority funding responsibility for public hospitals, along with full funding and policy responsibility for GP and primary health care. The government will use its position as the majority funder of health and hospital services to impose strong national standards for health care and build a nationally unified health system. That is the plan that will go for discussion to the COAG meeting with the premiers at the beginning of April. We hope that the premiers can come on board with that plan because the warning in the Intergenerational report was that state revenue bases are just not going to be able to handle the pressures coming down the line towards them—the demands from the healthcare system. They are not going to have the financial wherewithal to deal with those pressures and this is a way for the Commonwealth government to step up and take on that financial responsibility—but, through assuming that responsibility, we also want to be able to build a properly unified health system that overcomes some of those current weaknesses that were identified in the Health and Hospitals Reform Commission report.

As I said at the outset, this bill is part of the government’s looking to the future and looking to what we need to do to prepare a future health system that is strong, sustainable and on a financially secure footing. One of the areas that the Health and Hospitals Reform Commission spent some time on in their report was the whole question of e-health—electronic health. That is what this bill is taking steps towards. The Healthcare Identifiers Service will be asked to provide a national capability to accurately and uniquely identify individuals and healthcare providers to enable reliable healthcare related communication between individuals, providers and provider organisations. This is something that the previous government and COAG have been working towards for some time now. There is a general recognition that we have to do much more in the area of e-health if we are to capture the efficiencies, increase effectiveness and have better coordination within our healthcare system.

I was reading through the national e-health strategy, which was prepared for the government by Deloittes. They put the benefits of e-health as moving towards an individual electronic health record that each patient, each person, in Australia will have control of and that will seamlessly and efficiently transfer information about that individual patient to all the sections of the healthcare system that they interact with. The challenge that the national e-health strategy report puts out is:

The Australian health system is straining to deal with increasing cost and demand pressures and a shortage of skilled health workers. Given this reality, we need to move to a system where every interaction between consumers and care providers achieves maximum impact on health outcomes and where scarce financial and human resources are deployed as effectively as possible.

I believe an individual electronic health record does give consumers and individuals much more power and input into managing their health and their interaction with the health system. It also means that care providers and healthcare managers can reliably and securely access and share health information in real time across geographic and health sector boundaries.

When you look at what we are missing out on in this area under the present system, you see there are real costs. Most seriously and significantly, costs occur in the medical areas when there are bits of paper held all over the place—some in the public hospitals and some with your GP. Some of the figures show that up to 10 per cent of visits to GPs are of people seeing that GP for the first time. I am not sure whether that is the figure I read in preparation for today, but I wonder whether it might be even a higher figure than that. When you have people travelling around in an electorate like mine, where a lot of people are doing fly-in fly-out work in the mining industry, there is a lot of mobility between communities. Studies have found that up to 18 per cent of medical errors are due to the inadequate availability of patient information, because at the moment it is up to patients to be transferring all of that information and taking that information with them and making sure they are giving it to the right person at the right time. These adverse events coming out of that lack of coordination represent approximately $3 billion in avoidable annual expenditure, money that could be better spent absorbing additional health sector demands driven by an ageing and sicker population. The government is convinced that this is the right way to go, that we should be moving towards the development of electronic health records, but putting in place the Healthcare Identifiers Service is the first step. 

The previous speaker talked about the issues of privacy and the integrity and security of information contained in any electronic health system. That is a big part of what the Healthcare Identifiers Service will be doing. This legislation also makes minor amendments to the Privacy Act 1988 and the Health Insurance Act 1973 to support the robust privacy framework which has been developed for the Healthcare Identifiers Service. Privacy and security of that information is very important.

I notice, in reading the e-health strategy documents, that with an electronic health record the idea is for the consumer, the individual, to have control, to have access to that record. In some ways, that actually gives some more security and more peace of mind than might otherwise be the case. That kind of electronic sharing of data brings with it a trail or a record so that the individual consumer can keep track of who has accessed that information. I know that I have a health file at the Rockhampton Base Hospital, but how do I know where it is right now, who might be looking at it, who looked at it yesterday or what they did with it? The evidence there on electronic health records indicates that there is the capacity for those records to have an electronic trail that would allow consumers to give themselves peace of mind on who is accessing their information, when and why.

This legislation is very clear on the importance of that privacy. It explicitly limits the adoption, use and disclosure of healthcare identifiers to healthcare information management and communication purposes as part of delivering healthcare services or for other related purposes. There are also penalties for the misuse of healthcare identifiers by the Healthcare Identifiers Service operator or any other persons or organisations.

We are going to continue towards the development of this electronic health capacity, because we see that it is complementary to what we are trying to do in reducing the fragmentation and duplication that goes on in our current system. I support the legislation that is before the House.