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Monday, 26 November 2012
Page: 13188


Mr DUTTON (Dickson) (17:20): The Health and Other Legislation Amendment Bill 2012 covers a number of areas; I want to start, though, with the non-contentious ones, if you like. The first is in relation to the Food Standards Australia New Zealand Act 1991, which is a good example of cross-Tasman cooperation. Food safety, labelling, additives, energy and foods are addressed through the Australia New Zealand Food Standards Code. Amendments in 2010 to the food standards act created referencing inaccuracies which this bill intends to address.

Food from Australia and New Zealand enjoys a reputation for high quality in both domestic and international markets. It is important that our regulatory regime supports the continuation of that reputation—although it is interesting that the amendments were not dealt with at the time of the original changes in 2010.

This bill also raises the issue of medical training by seeking to amend the Health Insurance Act 1973 to include Medicare benefits for supervisors of trainee medical specialists. Australians benefit from world-class medical specialists. The training of new specialists is naturally required to meet attrition and to grow our nation's specialist medical workforce. The supervision of trainee medical specialists is an important part of the professional development of the next generation of specialists. As a nation, we need to ensure that there are no impediments to such training and all parties involved are appropriately remunerated.

As described in the explanatory memorandum, this amendment provides that a professional service performed by a specialist trainee under the supervision of another medical practitioner is deemed to have been undertaken by the supervising medical practitioner. This ensures that the supervising medical practitioner attracts the Medicare benefit for the professional service. Normally, only the medical practitioner performing the service is able to attract the Medicare benefit. Since 2011, delegated legislation has enabled this process. This amendment will create primary legislation for that purpose.

Of course, the training of medical specialists is only one of many issues that need to be addressed in relation to our health workforce. Unfortunately this is another area of the health portfolio which has been touched by the health minister's management style. The minister is fond of character assassination of the Leader of the Opposition—so much so, I think, that her portfolio is neglected. And why? Well, you only have to look at their respective legacies to understand why this minister would seek to denigrate Tony Abbott's outstanding performance as health minister. The contrast is indeed very telling.

The Leader of the Opposition was responsible for delivering nine new medical schools to build our medical workforce. The current health minister failed to plan ahead for internships for trainee doctors. This issue should not have been a surprise to an attentive minister. Australia should not export world-class medical graduates that we desperately need for our own nation, all because the minister failed to plan ahead. Similarly, Tony Abbott set up the Chronic Disease Dental Scheme, which has invested billions of dollars into dental care for those needing it most. The current minister ripped out a billion dollars from dental care. Tony Abbott's investments in policies as health minister achieved excellent outcomes in many other areas of the portfolio, including the introduction of graphic health warnings on cigarette packs. This made a significant contribution to the coalition achieving a dramatic reduction in smoking from 23.8 per cent in 1995 to 16.6 per cent in 2007. In government, the coalition presided over substantial investment in health, going from $19½ billion in 1995-96 to $51.8 billion in 2007-08, meaning Tony Abbott left the portfolio having completed this 166 per cent rise in health funding. This pattern was repeated across the portfolio. Indeed, child immunisation was dramatically increased from a low of 52 per cent in 1995 for 0-to-6-year-olds to an all-time high of 90 per cent of children aged 12 to 15 months being fully immunised. In just two years to November 2005, under the Strengthening Medicare initiative, 750 GP practices began to employ nurses. Tony Abbott initially boosted medical research infrastructure by $200 million and then followed that up with a massive commitment in the 2006-07 budget for $500 million for the National Health and Medical Research Council and $170 million for new research fellowships. Contrast that to this minister, who presided over claims of ripping money out of medical health and research in the last budget in May last year. As minister, Tony Abbott put an extra $2 billion into our nation's hospitals. Tanya Plibersek has ripped out $1.6 billion from hospitals in MYEFO this year alone.

This bill also amends the Industrial Chemicals (Notification and Assessment) Act 1989. The Australian Customs and Border Protection Service have a mammoth task in protecting our nation. It is important that the legislative framework they rely upon keeps pace with their operations. This bill seeks to amend the Industrial Chemicals (Notification and Assessment) Act 1989 to reflect how chemicals are actually kept under the control of customs during transhipment. Transhipment of chemicals involves the import of a chemical into Australia with the express intention of re-exporting the chemical without opening the package, within 30 days. The bill removes the requirement that Customs keep the chemical at the port or airport during the period of transhipment. Given the government's challenges in relation to border protection—which are anything but routine, and of their own making—relatively routine matters such as this seem to be the extent of what the government is able to competently manage.

That leaves us with the contentious issue of this bill—that is, the issue surrounding Medicare. It is Labor's latest health hiccup. Medicare is a brand which belongs to the Australian people and, as the law currently stands, the use of the name 'Medicare' is protected by section 41C of the Human Services (Medicare) Act 1973. That creates an offence for the use of the name 'Medicare' in connection with a business, trade, profession or occupation.

In 2010, when the member for Griffith was Prime Minister and the Attorney-General was then health minister, they initiated a so-called health reform agenda. It is now a matter of public record that their working relationship was less than ideal and, no doubt, that was part of the reason why health reform never really got off the ground. Labor's health agenda included primary healthcare organisations to be known as Medicare Locals. Medicare Locals have since been established as companies, and I am advised that these entities may be guilty of an offence pursuant to section 41C. Indeed, item 22 of this bill seeks to repeal subsection 41C(6) and replace it with an exemption from offence provisions for activity authorised by the secretary or a prescribed delegate. This has the clear purpose of retrospectively legalising the government's franchising of the Medicare brand to Medicare Locals and also gives the government great scope for similar future activities.

The reason I say that this is the latest Labor health hiccup is that this government obviously, when they dreamt up the idea of Medicare Locals, were assisted by the same advisers who talked about Fuelwatch and GroceryWatch. Really, it was a pitch to the average Australian; it was not founded in trying to deliver better health services.

Indeed, when you talk to many of the Medicare Local offices around the country, they are at pains to point out that they did not want to be called Medicare Locals. They do not deliver medical services at a Medicare Local. They do not process Medicare claims at a Medicare Local. You cannot go in off the street with your sick child to a Medicare Local to claim back or to seek advice about a Medicare claim or a visit to a doctor or specialist. That is not what a Medicare Local is about. And this government, in quickly getting policy together which branded these things as Medicare Locals, gave no consideration to the value of the brand of Medicare this country has known for a long period of time. Really, they were about a cheap line in a Sunday newspaper. This has come back to bite this government because what they did in the process was to set up a potential breach of the act—their own act—by these entities which have been set up as companies and are failing to meet the legislation, it seems, and that is why the government seeks to move in relation to this matter.

I have put on the public record in the past that I do support some form of coordination at a primary care level. The game as we continue to age as a population, the game as we continue to have this rapid onset of chronic disease, is to manage care as best as we can and try to keep people away from tertiary settings. That is the aim of private providers, health insurance and medical products; equally, it is the aim of people within the public sector. We must as a country make sure that we provide every assistance to those people, so it is right that we have some form of primary care coordination.

That indeed is the reason Tony Abbott established a different network, the Divisions of General Practice, which provided coordination of task and role to provide assistance to GP services. But the delivery of primary care otherwise has to be targeted in a fashion whereby we can keep people away from expensive tertiary settings, where they are inclined to pick up a common bug in a public hospital, particularly if they are an older patient. For all of these reasons, which have been well documented, which go beyond these couple of reasons, it has to be the task to make sure that we keep people away from tertiary hospitals if that is at all possible. We support a coordination role but what we do not support is the mushrooming of bureaucracy and the huge cost that goes with that. That seems to underscore every single judgement this government makes. We want to make sure we can get money back into the hands of patients. We want to make sure that doctors and nurses get to deliver services that are going to help these patients.

Let us look at the Gillard government record on health. People think: 'A Labor government should be good at health. They are not good at the economy, they are not good at education, they are not good at inspiring business to invest and grow, because they keep whacking these great big new taxes on Australian industry. So, surely, they must be good at health.' But it is interesting to look at the record of the Gillard government on health. They have cut $2.8 billion by means-testing private health insurance rebates and a further $700 by not paying the rebate on private health insurance increases above CPI. They have cut $390 million by completely removing rebates from lifetime health cover loading. They have robbed over $1 billion in dividends from Medibank that should have been putting downward pressure on premiums. Another $1 billion has been cut from the dental health scheme by abandoning chronically ill patients who are now lining up on public lists and will wait in pain a lot longer to receive those services. In some cases, those people will not receive those dental services at all. There have been hundreds of million of dollars in multiple cuts to the Medicare safety net, including obstetrics and IVF. That is the record of the Gillard government. They have limited the number of new medicines going onto the PBS by politicising the process and ignoring the independent evaluation of those listings and the ultimate advice that flows to government to list those drugs, in some cases to make for a much better life or transform the lives of sick patients.

The Gillard government also dramatically cut, by $1.6 billion, the health payments to states and territories only a few weeks ago when the Treasurer announced the MYEFO. And the reason that this is particularly offensive to Australian patients is that many of the cuts come in this financial year alone. This is the case. I was in a regional hospital in Geelong last week. That hospital had already budgeted for this financial year but is going to have money ripped away from it for proceedings it has already performed over the last six months. What sort of government says to a health service in regional Victoria or in regional Queensland, or to an Indigenous community in the Northern Territory, 'You've set your budget for this financial year. We're now going to come along now and cut part of that budget out'? That is an unacceptable arrangement for anybody and it raises the issue quite dramatically in my mind of sovereign risk. It is one of the hallmarks, sadly, of this government.

You cannot say to health services, 'We want you to continue to perform elective surgery and to put on doctors and nurses and open up extra beds and perform extra work to try to help people alleviate some of the pain that they might have because they have got a bung knee or need a hip replacement.' You cannot say to those people, 'We're now going to strip out funding for those services'—those services having already been performed. What that will ultimately lead to is a downgrading in services for the rest of the financial year.

In the case of Geelong last week, if you are ripping up to $5 million out of a six-month period, that has the effect of taking $10 million out of that budget over the course of 12 months. What is going to happen in a situation where up to 70 per cent of your hospital expenditure is wages? You are going to cut back on those wages. You are going to say to doctors and nurses, 'We don't want you to perform that surgery.' That is what is going to happen and that is the legacy of this government. That is why, when we talk about these health bills, it is so important that we talk about the impact on patients.

What is quite often lost in these debates when Labor talks about putting on new bureaucrats and building up the bureaucracy is that the patients are the ones that suffer. The Labor Party may be well intentioned in setting up new bureaucracies—they have created 12 of them over the last five years—but, in the end, what it does is deprive money from patients, from frontline services. As Sarah Henderson rightly pointed out the other day, if the Geelong Hospital or elsewhere cuts back on elective surgery it is the patients, real people—people's mums and dads, grandparents and brothers and sisters—who are the ones that are going to miss out on valuable elective surgery.

To make it worse, this government hits those that have private health insurance. And, because we have universal health system in this country, if people drop their private health insurance they can turn up at a public hospital the next day. They have the same entitlement, regardless of income, to turn up at a public hospital and demand to be treated in an emergency department or to see a doctor or to be put on a waiting list. That puts enormous additional pressure on public hospitals.

I do not think anybody in this place would suggest that public hospitals right around the country are in a state where they can take thousands of more admissions each week without additional assistance. That is the crazy arrangement that this government has created over the course of the last five years. People say: 'What has Labor done? What achievements can Labor chalk up or be proud of in health?' They have cut now almost $4 billion, as I say, from private health insurance. They have cut out $1.6 billion over the forward estimates to hospital funding. This minister ripped a billion dollars out of the chronic disease dental scheme, and people who are waiting desperately for that service will be put to the back of the queue or join public waiting lists and that will make it harder for those people who are already on those public waiting lists.

That is the legacy of this Gillard government. The fact that they have presided over yet another health hiccup when it comes to the name of Medicare should not surprise anybody. This government did not think that Medicare was a brand that needed protecting. They did not think that they were unwittingly directing companies into breaking the law. But it seems, on the advice that I have, that that is exactly what this government did. Do you know why? Because they did not think through the policy. They wanted to have a good headline in a newspaper somewhere. That was it—start, finish. This government really have treated the health portfolio as they have treated every other portfolio, and that is with contempt and incompetence. This health minister treated the health portfolio as they have treated every other portfolio, and that is with contempt and incompetence.

This health minister can come into this chamber and explain to the Australian people why a billion dollars has been ripped out of the chronic disease dental scheme and why, when 80 per cent of people who used that scheme were concessional card holders, those people have been denied those services going forward. Why is it that this government have ripped $1.6 billion out of hospital funding when they say to the Australian public that they are going to put so much more money into public hospitals? Why do they do that? And why would they do it out of this year's budget, the money having already been budgeted for? In most cases, if not all cases, the money has at least partly been spent. Why would this government preside over such a debacle? Because they are not a government worthy of governing this country.

There will be amendments in relation to this bill, and there will be a lot more scrutiny applied to this government because people understand, day by day, that this government really has not achieved in the health portfolio anything like what it is they want the Australian people to believe they have achieved. We will be having more to say in the coming months and in the run-up to the next federal election about why we think this government has failed in relation to health, why this government has failed pensioners and self-funded retirees around the country who are reliant on our health system. Why is it that this government has not delivered for those people in particular? Why, for children suffering with chronic diseases who require urgent dental work, has $1 billion been ripped out of that scheme that went to help those sick children before? These are the questions that people will be asking themselves in the run-up to the next election.

It is the position of the opposition to oppose bad policy where we see it and to try and praise the government where they have good policy. But, as I say, it is increasingly difficult to distinguish this portfolio from communications, which has been a disaster for the government; from education, which has been a disaster for the government; from economic management, which has been a disaster for the government. That is the position of the opposition.