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Tuesday, 16 October 1984
Page: 1793


Senator CROWLEY(9.50) —I have listened to Senator Baume with great interest. If I understand him correctly, I presume that the Liberal Party will go to the electorate in the coming weeks saying that one of its policies is to increase the number of nursing home beds. I assume that the Liberal Party will go to the electorate of Australia saying: 'We want more nursing home beds because there are all these people on the 35-day rule all around the country who are desperately going to need these beds'. I ask Opposition senators how they think that policy will go down with the electorate. It will make a great policy. I am sure that they will draw in a significant number of votes with it. But next I would ask them: How will you pay for these beds? I thought the Opposition did not believe in increasing taxes. I suppose the money for this will come from the same source as everything else that the Liberals promise-magic. They want beds and they want them all provided for. I will be interested to hear how Senator Baume manages on the campaign trail.

Senator Baume's arguments are curious. He said in the course of the debate that previously people were allowed 60 days, but this provision was rarely used. As Senator Zakharov and I interjected at the time, that is quite so. That is entirely the Government's point-60 days is a period that is almost never needed on any estimate, and after broad consultation with the medical and nursing professions, 35 days was judged to be more than an adequate assessment of the time in which most people recovered from acute illness. If people have not recovered and if they are in need of continuing acute care, then all that has to happen is that the medical person in charge of the patient fills out the form requiring a continuation of care. Somehow or other, Senator Baume has the bureaucrats in there doing all sorts of terrible things to elderly patients who may or may not be still acute patients. In fact, as the legislation quite clearly spells out and as the Minister has clearly spelled out, this is a medical professional decision. It is not a bureaucratic decision. There are bureaucratic guidelines, if one wishes to call them bureaucratic. There are clear guidelines under which the medical profession makes a professional decision.


Senator Walters —You do not understand.


Senator CROWLEY —If Senator Walters suggests once again that I do not understand I might really begin to wonder whether she has a brain at all. I have a very good understanding of what Senator Baume said. The medical profession is well able, in exercising its professional judgment, to decide what is an acute need and what is not. It may well be understood by most doctors that continuing need for rehabilitation and continuing inability to go elsewhere could well be classified as continuing need for acute care.


Senator Crichton-Browne —Who do you blame so far, the doctors or the bureaucrats ?


Senator CROWLEY —I do not lay blame anywhere. I do not know why Senator Crichton -Browne wants to judge and blame anybody. We are addressing a proposed change in legislation to deal with a very reasonable proposal. As Senator Baume said, 60 days was never needed and 35 days has been judged by the medical profession and all other people involved in the consultations as being adequate. I do not see why the Opposition should get so upset by a reasonable decision.

Senator Baume then said that poor people did not have beds to go to. The professional decision about acute care has nothing to do with whether or not there are sufficient beds. That is a separate issue. Indeed, it may be a pressure on people, but it is a separate issue from a professional judgment about whether or not continuing acute care is needed. I think that Opposition senators should address these questions as separate instead of furphying and confusing both themselves and anybody who is listening by mixing the two together. As Senator Giles said, there is an insufficient supply of beds in some areas and an inappropriate distribution of nursing home beds. But I ask Opposition senators whether they really intend to go to the people of Australia saying that they will give them more nursing home beds? Or are they also in the business of economic rationalisation and appreciation that we do not need more nursing home beds, but better placed and better distributed beds, better rehabilitation services and better domiciliary care services? I think that Senator Baume's argument could be shot down in flames, principally because he confuses two issues. One is about bed distribution and one is a medical professional decision about acute medical treatment. Whilst they clearly have a close relationship to each other, they are not decisions that intermingle with each other.


Senator Peter Baume —There is not much compassion in that approach.


Senator CROWLEY —It has nothing to do with compassion, Senator.


Senator Peter Baume —I am sure that your approach does not; that is right.


Senator CROWLEY —I have spent a lot of time in this area and I do not find the measure of my compassion judged on whether or not I can refute a silly Liberal argument, but it might be quite compassionate to voters, if they are listening, to decide that facts help them. That would be very compassionate, instead of the furphies that the honourable senator was floating. I wanted not to address that issue, but I was tempted by Senator Baume's comments to make those remarks before moving to the only point that I wish to address in the Health Legislation Amendment Bill 1984 that is being debated cognately with the Social Security and Repatriation Legislation Amendment Bill (No. 2) 1984. A number of the points that are to be addressed by the Health Legislation Amendment Bill have been covered fairly adequately. I wish to make a few comments about the proposed amendments addressing epidemiological studies. The other parts of the Bill have been addressed by some and will be addressed further and, no doubt, summed up by the Minister.

In the Senate the other day I raised by way of a question to the Attorney- General (Senator Gareth Evans) concerns that I have and that I have had brought to me about restrictions to epidemiological studies under the proposed privacy legislation. That legislation is not due to be introduced this session but will be introduced in the autumn session next year. The proposed privacy legislation had drawn considerable support from the Australian Law Reform Commission and had caused considerable concern amongst colleagues of mine and others who are in the business of epidemiological scientific research.

The privacy proposals had suggested that no epidemiological research could use records without permission from the persons listed in those records. This, of course, was prospectively enormously restrictive for researchers. The task of seeking permission for use of records from patients concerned would very much hamper any research, I think to the point of effectively preventing adequate research in very many areas. Again, such proposals under the privacy legislation did not address the difficulties of seeking permission from persons deceased. I am in no way flippant about that; but the privacy legislation did not address those sorts of difficulties.

Much research addresses such information as is contained in records. For example, an area in which I have had an interest is studies in the occupational health area looking at past records of any and how many deaths, or any association between the work situation and the death, and the mortality and/or morbidity of people in a certain work situation-for example, in asbestos mines. It is vitally important that adequate epidemiological research can address those records, but the research is inordinately hampered by the requirement that permission be obtained from every person listed in those records. Any good researcher will, where possible, seek that permission; but to have it as a requirement-that is, that every person whose records are to be used be approached and that permission be given-would be unduly restrictive on that research.

There are hospital records throughout the country that can very usefully provide researchers with essential information in the cause of adequate medical research. There are records of early childhood development and very many other series of records. To seek permission of the people listed in those records, particularly if one is doing longitudinal research studies, would be almost impossible. I suggest, therefore, that the people involved in shaping the privacy legislation would be well advised to look thoroughly at the amendments of the Epidemiological Studies (Confidentiality) Act contained in this health legislation, particularly the previous health legislation but including these amendments, because this health legislation provides for confidentiality. It ensures that no information from those records can be used that would indicate the identity of any person listed in them, but that requirement of confidentiality then enables very thorough and comprehensive epidemiological research to be undertaken and records to be comprehensively used. This Bill will make it quite clear that the legislation covers deceased persons, so that records pertaining to dead people, whatever the cause of death, are also covered under this epidemiological amendment.

The amendment to the legislation is very useful, particularly as many of the studies sometimes require adequate research into the records of people now deceased. The amendment makes quite clear that when epidemiological research refers to 'persons' or 'people', it refers to the affairs of deceased persons as well as to the living. I simply suggest for the record that this is a very useful amendment. It is very precise in the clarifications it introduces. I think it would be of great benefit for the proposers of privacy legislation to look at this legislation under the health area for further help in framing the epidemiological research proposals under the Attorney-General's Department. I commend the Bills.