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Thursday, 4 October 1984
Page: 1277


Senator RYAN (Minister for Education and Youth Affairs)(9.39) —I move:

That the Bills be now read a second time.

I seek leave to have the second reading speeches incorporated in Hansard.

Leave granted.

The speeches read as follows-

HEALTH LEGISLATION AMENDMENT BILL 1984

By this Bill the Government proposes to make certain amendments to-

The Epidemiological Studies (Confidentiality) Act 1981,

The Health Insurance Act 1973,

The National Health Act 1953, and

The Tuberculosis Act 1948.

The Epidemiological Studies (Confidentiality) Act 1981 provides for the confidentiality of information on personal affairs which is collected for those epidemiological studies prescribed under the Act. The amendments to that Act, proposed in clauses 3, 4 and 5 of this Bill, are designed to ensure that the Act provides for confidentiality in relation to information regarding the affairs of deceased persons as well as the living.

The need for the amendment arose out of concerns that the references to ' population' and 'persons' in paragraph (a) of the definition of an ' epidemiological study' in sub-section 3 (1) of the Act might be construed so as to exclude the affairs of deceased persons from the scope of the Act. The proposed amendment is intended to resolve any possible doubts for the future and is not seen to effect an alteration in the law.

I now turn to that part of the Bill which amends the Health Insurance Act. The Medicare legislation which came into effect on 1 February this year removed the Commonwealth's power to approve public hospital beds. This reflected the Government's policy that such matters, relating to the administration of public hospitals, were the responsibility of the States. However the Commonwealth, through its health insurance responsibilities, retains an interest in ensuring that fund benefits are paid in the correct circumstances. The amendments proposed at clause 7 and 8 remove any doubt that fund benefits are payable to private patients in both private and public hospitals.

Clause 8 of the Bill will allow certificates under section 3B of the Health Insurance Act to be issued up to 14 days before they come into effect. At present they can be issued up to seven days before they come into effect. Section 3B certificates are issued by medical practitioners and state that a long stay in-patient of a hospital is in need of acute care for a certain period . This certificate entitles the long stay patient to the full level of health fund benefit, and exempts him or her from the requirement to pay a patient contribution. The amendment allows more time, in cases where section 3B certificates are referred for review by an acute care advisory committee, for the determination of whether the certificate is to be varied or revoked before it comes into effect. This will reduce the likelihood of such patients being faced with a retrospective payment to the hospital.

I wish to emphasise that this legislative amendment is only one facet of a comprehensive review of the operational aspects relating to the arrangements for long stay patients in hospitals. A number of other matters are being addressed administratively, with the aim of removing many of the concerns that have been expressed. These matters include the development of uniform national guidelines on what constitutes 'acute care' for use in the context of the section 3B arrangements. In the near future these guidelines will be distributed to all doctors and should assist in achieving a greater understanding of the whole assessment and decision making process. It is emphasised that despite the formulation of these guidelines, it will continue to remain the responsibility of individual doctors, based on their professional judgment, to assess whether patients are in need of acute care. In addition, the form of the section 3B certificate is being re-designed and, among other things, the revised certificate will include a statement making clear that the penalties which apply for the provision of false information, and which have been of concern to the medical profession, will not apply to the bona fide expression of medical opinion. A general streamlining of the section 3B processing procedures is also being undertaken in the interests of reducing the possibility of patients incurring financial hardship when section 3B certificates are referred for review by an acute care advisory committee.

The effect of clause 9 of the Bill is to enable the Minister for Health to determine that a health service and its associated fee, which are not listed in the medical benefits schedule, shall be treated for the purpose of the health legislation as if that health service and fee were included in the schedule. Currently there is a 'pay-under' scheme which ensures that Medicare benefits are paid where a medical service not listed in the schedule but regarded as a legitimate service, is carried out. The practice for many years has been to pay benefits under the nearest item in the schedule.

New section 3C, which would be inserted into the principal Act by this clause, applies both to individual health sevices and classes of services. Determinations made under section 3C would be subject to tabling in both Houses of Parliament and scrutiny by either House. Services specified in determinations would be subject to the same legal provisions which would apply if they were in the medical benefits schedule. Modifications were made to the 'pay under' scheme from 1 November 1983. This reduced, but did not entirely remove, the need to continue to use this practice for certain categories of sevice. The Attorney- General (Senator Gareth Evans) subsequently indicated that as the arrangements were not authorised by legislation, appropriate action should be taken to remedy the situation. I should point out that it takes some time to have new items introduced into the medical benefits schedule, and of course it is unacceptable to defer payment of Medicare benefits while this is taking place. In addition, it is undesirable to clutter up the schedule further by including services which are used only infrequently or are transient in nature. Taking all these factors into account, the mechanism which this clause contains is both appropriate and essential for the proper payment of Medicare benefits in those cases where a legitimate service is not covered by the medical benefits schedule.

I now turn to the clauses in the Bill which provide for the nursing home benefits provisions in the National Health Act to be amended. These are clauses 11 and 12, 15 to 21 inclusive and 26. The proposed amendments will enable Commonwealth nursing home benefits to be paid for patients temporarily absent from nursing homes. It is anticipated that this will also facilitate the admission of respite care patients who will be able to take the place of patients temporarily absent. The proposed amendments will authorise one of a number of initiatives announced in the Budget to assist aged and disabled people . The Government has been concerned that these people should be helped to maintain maximum independence. The present rigidities in the nursing home benefits arrangements have inhibited this, and have led to some nursing home patients incurring severe financial burdens. The arrangements have deterred nursing home patients from leaving nursing homes for short periods, consequently restricting the beds available for respite care.

The Minister for Health (Dr Blewett) has received many representations on behalf of patients who have had to be temporarily hospitalised and who have experienced severe financial difficulties through having to pay the full nursing home fee during their absence to ensure that their bed is available upon their return to the nursing home. At present such a patient is often required to pay both the patient contribution and an amount equivalent to the Commonwealth nursing home benefits to ensure his or her bed is retained. Similar problems are experienced by patients who temporarily leave a nursing home, for example to stay with relatives.

Clause 12 of the Bill provides for the proprietor and the patient, or a person acting on the patient's behalf, to enter into a common form of agreement covering the patient's temporary absence. The purpose of the agreement will be to record clearly but simply the essential obligations of the patient and the proprietor in relation to the patient's temporary absence. While clause 12 refers to some of the matters that may be covered in the agreements, it is the intention of the Miniser for Health to consult with the nursing home industry and with organisations representing patients to ensure that the common form of agreement enables clear and equitable arrangements to be entered into.

Where the temporary absence of a qualified nursing home patient is covered by an agreement, clause 12 also provides for Commonwealth nursing home benefits to be payable for a period or periods of temporary absence totalling up to 28 days in a year. Should the agreed periods of temporary absence exceed 28 days, the benefits will cover the first 28 days. So, during these periods of up to 28 days in each year, it is proposed that patients will be required to meet from their own resources a bed retention fee not exceeding the difference between the full fee and the commonwealth nursing home benefits. Proprietors will be encouraged to use the beds of temporarily absent patients for the provision of short term respite care whenever practicable. Clauses 15 and 17 of the Bill provide for such respite care patients to be subject to admission procedures similar to those applying to other patients. Proprietors will only be able to admit patients approved as needing respite care in a nursing home. Provision is made, in clause 26 of the Bill, for reconsideration by the Minister for Health and, subsequently, review by the Administrative Appeals Tribunal of refusals to approve the admission or persons as respite care patients. Short term respite care patients will not be charged fees greater than the difference between the full fee for the bed, less the Commonwealth nursing home benefits.

The new arrangements will ensure, therefore, that neither the temporarily absent patient nor any respite care patient will suffer any disadvantage in respect of fees paid compared with other patients accommodated in the home. The discussions with the nursing home industry will include an exploration of the practical measures that can be taken to maximise the use of temporarily vacant beds for short term respite care. The Government fully recognises the sacrifices that can be involved for relatives and others involved in caring for frail aged people in the community. It knows that there are occasions when short term respite care is of vital importance to the welfare of aged and disabled people and of those caring for them. I believe that this respite care initiative has the potential to assist significantly in meeting such needs.

The proposed amendments will permit comparable arrangements to apply to repatriation patients as well as to other nursing home patients, and will enable a separate common form of agreement to be developed to meet the special circumstances of those patients. It is also proposed to negotiate similar arrangements for patients accommodated in deficit-financed nursing homes. This measure will not have any significant financial impact for the government. Its full year cost to the Commonwealth in additional nursing home benefits is estimated to be less than $4m. It will, however, alleviate a source of financial hardship for a significant number of aged and disabled people and offers the promise of improving the quality of life of them and of those caring for them. The Bill provides for the arrangements to come into effect from a date to be proclaimed, giving time for their proper negotiation and development.

Clause 13 of the Bill proposes to amend the National Health Act to permit the Commonwealth to fund the maintenance of privately purchased wireless hearing aids and associated equipment. Honourable senators will no doubt know that the National Health Act empowers the Commonwealth to make arrangements for the supply of hearing aids, which it does through the agency of the National Acoustic Laboratories. Wireless hearing aids in particular are supplied for the teaching in educational institutions of children who are deaf or have severe hearing defects. Unfortunately the acoustic laboratories have been unable to keep pace with the demand for aids in recent years, and some institutions and individuals have had to purchase wireless hearing aids privately. This situation is regrettable. The Government is anxious that these institutions and individuals should not be forced to pay the cost of batteries and maintenance for which the Commonwealth would otherwise have paid had the institutions or individuals not purchased their aids privately. The proposed amendment to the Act will authorise the Commonwealth to meet the battery and mantenance costs. It should be noted that even when the Commonwealth is meeting these costs, there will still be some saving to the Government over the capital outlay that would be required if the privately purchased aids which become faulty were to be replaced at Commonwealth expense. I am pleased to inform honorable senators, however, that negotiations are under way with private sector suppliers of wireless hearing aids to ensure that the National Acoustic Laboratories will be able more adequately to meet community demands for these devices.

Clause 14 of the Bill deals with the provision of aids to sick and disabled people. As honourable senators will be aware, the Commonwealth provides funds for the supply of medical and surgical aids and for other assistance such as the modification of homes to help the sick and disabled in their daily lives. Clause 14 provides for the Commonwealth to enter into arrangements with the States, the Territories and certain bodies corporate, which will avoid undue complexity in the administration of such schemes. The proposed arrangements provide for the Commonwealth, while funding the schemes, to transfer ownership of certain medical and surgical aids to the State or other body concerned. This latter provision is seen as being desirable since some aids, wheelchairs for example, are recycleable in nature, and would be distributed only to persons in need on a loan basis. The transfer of ownership to the States of such aids will facilitate the accountability of those aids and assist considerably the administration of the schemes.

I refer now to clauses 22, 23 and 24 of the Bill which relate to the Health Benefits Reinsurance Trust Fund. These proposed amendments, which are of a technical nature only, would have the effect of making the trust fund a trust account for the purposes of the Audit Act. At the time of the establishment in 1977 of its predecessor, the Hospital Benefits Reinsurance Trust Fund, it was intended that the trust fund be incorporated within the Commonwealth public account and thus be subject to the Audit Act. However, the Attorney-General's Department recently advised that the existing provisions of the National Health Act have the effect that it is not part of the Commonwealth public account. Consequently the present Health Benefits Reinsurance Trust Fund also cannot legally form part of the Commonwealth public account. Notwithstanding the legal position, the transactions of the trust fund have been audited by the Auditor- General and the proposed amendments would enable that to continue. The proposed amendments would have no financial impact on registered health benefits organisations nor on the Commonwealth Government.

I turn now to clause 25 of the Bill. This is a purely machinery change which takes account of the fact that the protection afforded to 'authorised persons' under the principal Act is adequately covered in the Crimes Act 1914. The clause removes the provisions prescribing offences for molesting, intimidating, bribing or influencing authorised officers.

By the clauses 27 and 28 of the Bill, the Government proposes to amend the Tuberculosis Act 1948 to phase out the operation of tuberculosis allowances in the light of the almost total eradication of the disease in Australia. In March 1950 the then Government approved the current scheme of allowances, which came into force on 13 July 1950. The scheme was one of several measures adopted at that time to implement the nation-wide campaign against tuberculosis. The purpose of the scheme was to help prevent the spread of tuberculosis by providing financial assistance to persons, and their dependants, who were required to refrain from working and to undergo treatment while they were infected.

When the allowances were originally introduced, they were set at levels which were generally higher than those for social security beneficiaries. Over the years the difference in money terms of about $5 per week maximum between tuberculosis allowances and other benefits, for example invalid pension and sickness benefit, has not changed so that the added value of the tuberculosis allowance is now relatively small. At the peak of the scheme-at 30 June 1951- allowances were being paid to 6,605 sufferers. This compares with 299 sufferers receiving the allowance at 31 December 1976 and only 150 at 31 December 1983. The Government considers that the scheme of tuberculosis allowances has achieved its aim and that there is no longer any justification for continuing to pay higher benefits to the few simply because they suffer from a particular condition, which no longer represents a serious threat to the Australian community. Accordingly, the Government has decided to treat tuberculosis as it would any other disease for social welfare purposes. The amendment of the Tuberculosis Act 1948 will remove the necessity for special handling by the Department of Social Security of tuberculosis cases. The entitlement of people currently receiving tuberculosis allowances will continue. The Bill does not effect any change in the rights of existing sufferers. I commend the Bill to the Senate.

SOCIAL SECURITY AND REPATRIATION LEGISLATION AMENDMENT BILL (NO. 2) 1984

This Bill is an omnibus Bill to give effect in the main to those Budget measures for 1984-85 which require-

amendments to the Aged or Disabled Persons Homes Act 1954;

amendments to the Delivered Meals Subsidy Act 1970; and

legislation to make further provision for the Anzac Hostel in Brighton, Victoria.

Aged or Disabled Persons Homes Act 1954

Under this Act, the Commonwealth currently pays a hostel care subsidy and a personal care subsidy to approved organisations providing hostel type accommodation and services for aged and disabled people. In the near future, a respite care bed subsidy will commence to be payable to approved organisations to assist those families and individuals who care for aged and disabled persons in their homes but who require a facility to allow short breaks from the demands of care at home.

The rates of subsidy payable are-

$10 per week per eligible person provided with hostel care services; and

$50 per seek per eligible person provided with both hostel care and personal care services.

The respite care bed subsidy will be-

$10 per week per eligible person provided with a respite care bed for a period of less than 15 days in a period of 28 days; and

$50 per week per eligible person provided with a respite care bed for a period of 15 days or more in a period of 28 days.

The Bill will increase these rates of subsidy from $10 to $11 per week, and from $50 to $55 per week, respectively, as from 15 January 1985, which is the first prescribed date for payment in January 1985. The new arrangements are estimated to add $2.9m to outlays in the remainder of 1984-85 and $6m in the full year 1985-86. Up to 38,000 people are estimated to benefit by receipt of services under the program.

Delivered Meals Subsidy Act 1970

Under this Act, the Commonwealth currently pays a subsidy to approved organisations providing meals under the meals-on-wheels program. The rates of subsidy payable are-

55c for each meal which includes a vitamin C supplement; and

50c for each other meal.

The Bill will increase the rate of subsidy for each meal which includes a vitamin C supplement to 65c per meal where the approved organisation meets new conditions of service delivery as from 1 January 1985. These conditions have not yet been finally determined, but will relate to the operation and management of approved organisations concerning service delivery. An example of such conditions is that service delivery would have to be made on at least 5 days in each week. The new conditions will be published in the Gazette. An approved organisation which decides not to meet these new conditions would remain eligible for the current rates of subsidy. The new arrangements are estimated to add $750,000 to outlays in the remainder of 1984-85 and $1.5m in the full year 1985-86. Up to 50,000 people are estimated to benefit by receipt of services under the program.

Anzac Hostel, Brighton, Victoria

The Anzac Hostel at Brighton, Victoria, has been held by the Repatriation Commission since World War 1 on a trust created at that time and subsequently varied by the Repatriation Fund (Baillieu Gift) Act 1937. A term of the trust has been that the Anzac Hostel should be used as a hostel for permanently and totally incapacitated Australian soldiers and sailors of World War 1.

Since the creation of the trust, the Repatriation Commission has assumed responsibility for providing medical treatment to many thousands of veterans of World War II and the later conflicts and to eligible dependants of deceased veterans. In view of the declining number of World War I veterans and the increasing number of frail aged veterans, especially of World War II, it has been decided to utilise the Anzac Hostel more effectively by enabling the Repatriation Commission to provide an expanded range of residential and day care services at the hostel for those eligible to receive repatriation treatment. It is proposed to introduce a Southern Melbourne Aged Care Service centred on the Anzac Hostel. The need to travel long distances for care is a very significant problem for aged persons. This facility will reduce that burden for many veterans and war widows. In order to be able to so utilise the Anzac Hostel, it is necessary to change the terms of the trust by varying the purposes for which the Anzac Hostel may be used by the Repatriation Commission. The revised purposes of the trust are set out in Part VI of the Bill.

Other changes

The Bill will also amend the Social Security Act 1947 and the Repatriation Act 1920. First, both Acts will be amended to ensure that a dependent child who is in receipt of an income security payment under the Social Security Act 1947 or the Tuberculosis Act 1948 will be disregarded in calculating the entitlement of another person under the Social Security Act 1947 or the Repatriation Act 1920. It is already the case that a dependent child in receipt of invalid pension, a rehabilitation allowance in lieu of that pension, or a supporting parent's benefit under the Social Security Act 1947 is disregarded under those Acts. This measure will therefore provide a general rule in these situations which will remove some minor anomalies. There will be no savings in 1984-85, with savings of $0.15m in 1985-86.

Second, the Social Security Act 1947 will be amended to remedy a minor anomaly which disadvantages some people receiving family allowance. Currently, the Act requires the Department of Social Security to be satisfied within three months of the child's sixteenth birthday that a dependent child who turns 16 years of age became a student child.

While there are administrative procedures designed to enable the Department to be satisfied that such a dependent child becomes a student child, there are some cases which fall through the net. The amendment will ensure that a person receiving family allowance will not lose entitlement merely because the administrative procedures do not work as intended. There are no savings in this measure, but the program will operate more effectively and efficiently. I commend the Bill to the Senate.

Debate (on motion by Senator Reid) adjourned.