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Wednesday, 24 November 2010
Page: 3607


Mr LAMING (1:22 PM) —The problem is that we all think we have got time, as Jack Kornfield said, but in health care, that is not the case. We have been waiting too long for solutions to the flawed and vexed challenges in the Australian health system. We know well that there are schisms running between federal and state provision, between private and public, and between after hours and working-hours care. The Federal Financial Relations Amendment (National Health and Hospitals Network) Bill 2010 takes us no closer to solutions to those challenges. I guess that today is an appeal to the government on behalf of Australians in every corner of this country who ask: ‘What is actually happening?’ and ‘What is changing?’ It possibly reflects an overwhelming and pervading fixation by those opposite on the shell-and-pea game of fiddling with financial systems but not on actually getting down to working out what is going to deliver a better health system.

It seems good to have a national framework and it seems great to have local networks and an omniscient Commonwealth government that is able to make decisions from Canberra about the provision of community and public health in every corner of this great land. In reality we know that the tension that has existed for 100 years between the federalism of devolving responsibilities down to local communities and the other argument that we centralise to try and make sure that those decisions are as perfect as possible, has never really got us any closer to improving our health system. What has changed are revolutionary ideas about how we engage with community health from a hospital. We need to step away from the notion that people inside a hospital are so fixated on acute care that they cannot think about community care—this notion that because you work in a hospital you do not understand what it is like outside the hospital. We need to understand that our clinical staff and our researchers are the people who think about community, public and preventive health every moment of their waking lives and we need to involve them in that process. When this Labor government had a moment to think about how it would fix the challenge of the health system and had the audacity to set a date, I think everyone was struck by the possibility that they could actually get somewhere. In fact, we have seen that nothing happened by that date. We now have a new Prime Minister who is rolling out the same old bureaucratic changes that are almost a reflection of their own impotence that they cannot get down and sort out public and community health.

It is one thing to believe that if we take money from one pot, put it into a bigger pot and reassign it to where it was in the first place, things somehow will be better. I do not mean to demean or diminish the very hard work that has been done in drafting these changes, but I beg of every person listening to this debate to ask yourself, ‘How will public health provision in your community be different? How will it be improved?’ Here we are, in 2010, waving goodbye to another year of a Labor administration, but this side of the chamber has to ask the very important question, ‘What has changed?’ You cannot keep putting off what should have been done the day before yesterday until the day after tomorrow, because ultimately the things that were easy become hard, and the things that are hard become impossible. We need to join together as a nation and say that taking over 100 per cent of community funding and assigning it to the Commonwealth sounds seductive. But in reality this is a job that is done by communities; a job that is tailored to Indigenous communities, mining communities and rural communities. The case that has to be made by those opposite is that Canberra can do that; that case has not yet been made. They have not yet made the case that the states are failing in their role for any other reason than vertical fiscal inequity—they are not adequately funded to do the job. Sure, we all collect the GST and then it is reassigned after it has run through a Commonwealth Grants Commission process, but there are no longer adequate partnerships between Commonwealth and state, and these national partnership arrangements that are a billion dollars here and there simply have not done the job.

Before government members get too excited about the increased amounts in health care, let us add them all up. In 2009-10 that amount was $12.074 billion and next year it will rise to $14.74 billion. Unadjusted, that is an increase of just under 20 per cent. That is what used to happen under the old hospital arrangements, the old four-year funding agreements, where there were unadjusted increases of between 17 and 26 per cent. I commend the government for increasing health funding but that is what every government has always done, all of the time. Some governments will increase it more in some years than in others, but it is no more legitimate to say that we ripped funding out of the health system than it is to say that the Labor government rips funding out of the school halls program because it spent it all last year and not this year. It is silly economics. There are times when more money goes into health and other times when less goes in. Obviously, the previous coalition government had to pay off a massive Labor debt so we focused on doing that for very good reasons. When it comes to funding hospitals both sides of this chamber can lay claim to good and bad, but while this government is in power we need to ask, ‘What has it done this year and what did it do last year?’

The great frustration to many is that we keep having these administrative bills brought before the House. We dream that by setting up an independent funding authority, then a performance authority, then a Health and Hospitals Fund and then local networks, in some cases things will somehow be better. That case has not been made by the government. I know that they are seduced by the notion of large nationwide corporate structures that are controlled out of Canberra. But let us be honest: we have had a situation where we ran down the power of school principals and of hospital superintendents and it was centralised to either district offices or state governments. We have a system where we have slowly eked out of state bureaucracies the power to deliver services and centralised it here in Canberra. Then we have had the power of Canberra bureaucracies stripped away from them and centralised in ministers’ offices and finally we have had Labor ministers who complained they could not get in through the Prime Minister’s door—because all decision making resides there. Eventually it becomes intellectual constipation, waiting for an omnipotent prime minister to make decisions like some sort of communist decree that comes out of China or Soviet Russia.

We need to trust local clinicians. All we asked of the government was that we involve ordinary everyday folk in hospital boards, particularly in New South Wales and Queensland. We know that these hospitals and their decision making have basically drawn away like an outgoing tide from the local population. People turn up but cannot get into emergency and they wait on waiting lists that never materialise into an operation. They just want to know why. They know a lot of money is spent on health, but they do not understand how. I am not going to stand here and say that we need to slash the health bureaucracy. I am not going to say that we have frontline staff who are not performing clinical services and who therefore need to be done away with. No, that is overly simplistic. What we need to know is that leading figures in each community can be part of a hospital board.

Of course we need to resolve the issue of whether these hospital boards actually run the hospitals or simply monitor them. The role of a hospital board fundamentally is to be a conduit for passing information between a hospital, which makes the decisions, and the community, which is affected by them; and that is utterly legitimate. The criticism from Queensland Labor was that we have the butcher, baker and candlestick maker on the hospital board and they cannot possibly run a hospital. But they are ordinary, everyday people who have a grasp of what it takes to serve and what it takes to deliver health care. We need to incorporate these skills of people who are not necessarily health professionals into how health decisions are made. That was the simple request from this side of the chamber.

How the Labor government responded was fascinating. They simply said, ‘We will allow local decisions to be made as well.’ But the decisions will be made by $570 million of extra bureaucracy in a fourth layer of government that controls the health system. So we have the curious situation where the Commonwealth is involved in immunisation services, the state governments are involved in delivering immunisation services, local jurisdictions and city councils deliver immunisation, and now, thanks to Mr Rudd and Ms Gillard, a fourth level of administration will be running our hospital system. Worst of all it is a fourth level we cannot vote out, a fourth level that has no accountability to ordinary Australians, a fourth level that we have to blame in this post-Rudd environment where everyone is responsible for everything and the last thing we need is a situation where we do not know who is not performing.

The great attraction of clearing up this complex miasma of health decision making in Australia is to determine who delivers services most effectively and let them get on with competing to be a provider. But we remain, after all of these reforms, with a health system that has this curious bipartite purchaser arrangement and a single public provider that does not work with the private system. We still have a public system where the faster they work, the quicker they go broke and a private system where the faster they work, the richer they get. That challenge has to be resolved, but it is a nexus that we have not even begun to scratch the surface of.

The solutions are right in front of us but the government is not looking. You only need to see the complex cancer services or the eye operations that are being delivered through private providers, through streamlined systems, at a fraction of the price and with 100 per cent outcomes. I ask the other side of the chamber: why don’t we learn how those cancer services are delivered?

Let me throw a complex notion over to that side of the House; which is, that potentially the private system may do parts of our health work better than a public system will ever do. Let us also face the fact that some public services may well remain more efficient and more effective than private services ever can be. Why don’t we engage in a partnership to work out how those things are best done? Why don’t public hospitals accept that there are some things they simply cannot do as well as private hospitals? Why don’t we reach out across the fiscal divide and involve private services as a competing entity in provision? It is a simple challenge. Let us face it, they are the reasons people in my community of Redlands cannot get to see a doctor, wait for hours in casualty, sit on waiting lists for operations that will never happen and of course end up in medical wards taking up valuable acute bed space.

I put a simple challenge to the government: what are they doing for aged care provision, for the wages of our aged-care nurses and for the infrastructure costs of building aged-care facilities? There has been almost no movement on that in four years. An integral part of a functioning health system is to return people who are discharged to the community. I set the challenge to the government: what is happening with transitional care? What is happening to engage the private sector? What is happening to connect hospitals with community health care? It is one thing to say the federal government should be running community and public health, but where does that leave the states? Completely unengaged in the process. The last thing you want is for the jurisdiction paying 40 per cent of the hospital bills to have no interest in community health.

It would have been much simpler to have a dollar-for-dollar national partnership arrangement on this question and keep all eight jurisdictions in the room on community health. But, no, this government has lost seven of them and will go it alone in providing community health. The greatest mistake of the legislation we debate today is that seven jurisdictions walk away from community, preventative and public health and are no longer engaged. That is a great loss.

We all know the current funding arrangements and how we use partnership payments and health care special payments to fund the health system, which is primarily the responsibility of the states in the public area but the states are not adequately funded to do it. A courageous government would have stepped in and fixed that problem. They would have looked at that vertical fiscal inequity and said that a component of taxation should automatically be given to state governments. I challenge the other side of the chamber again to tell me why, if you are operating in a state government, you are simply incapable of providing these health services.

All of our states are big enough, smart enough, hairy enough and ugly enough to run community health and hospitals. You do not leave this chamber to join a state legislature and suddenly have no compassion or care or ability to run a health system. The states are just like us—they can do it if you give them the means. But they do not have the means because they do not have the funding. The healthcare costs index—which is a product of a technology index, a population’s hospital utilisation factor and health inflation—is going up by 10 per cent per year and the GST takings of six per cent cannot keep up. Why don’t we just fix that by covering the four per cent out of federal revenue? It would be far simpler.

To the other side of the chamber I say this: it is seductive and attractive to build massive, nationwide networks of bureaucrats, but in the end the question you have not answered is, ‘Why can’t it be done locally, reporting to a national partnership with priorities?’ Those priorities are clear. How we can fix it is clear. We need an auditor-general in health that actually examines the role and performance of health providers, and it should not have state government membership. Whoever is providing the health should not also be writing the monitoring and evaluation plans and then filtering the reports. We need to have a system where we engage the private sector. We need to remove the massive fiscal schisms that run through the health system. But that was all too hard. So today instead we debate a pea and shell game of moving money from one jurisdiction to another and then handing it right back and calling it a breakthrough in health. (Time expired)


The DEPUTY SPEAKER (Hon. Peter Slipper)—Before calling the honourable member for Dobell, I would commend to the member for Bowman the provisions of standing order 64.