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Tuesday, 16 October 1984
Page: 1795


Senator WALTERS(10.01) —This evening we are debating the Health Legislation Amendment Bill and the Social Security and Repatriation Legislation Amendment Bill (No. 2). Like many other speakers, I will confine my comments to the Health Legislation Amendment Bill. The main problem the Opposition sees in this Bill is, as Senator Peter Baume said earlier, with the 35-day rule. I will explain to the Senate the 35-day rule. Senator Crowley obviously understands so little about it that she informed us tonight that there are bureaucratic guidelines associated with acute care. She has so little knowledge of the matter that she is completely unaware that a report came down which was very critical of the Department of Health because there are no guidelines, but I will come to that later.

The 35-day rule relates to a certificate that must be signed by a doctor if a patient is to continue to receive a full acute care benefit in either a public or a private hospital. So we have the situation whereby a patient who has been taken to hospital for some illness must have a doctor's certificate after 35 days saying that he needs acute care in the hospital or he must be discharged, otherwise he will be charged for full hospital care. As Senator Baume indicated earlier, under our Government a patient could receive acute care in hospital for 60 days after which time the doctor had the discretion of signing the certificate that the patient needed to remain in hospital for longer under four different headings. The first was acute care; the second was an acute phase of a patient's condition; the third was continued management for medical reasons as an in-patient; and the fourth was acute rehabilitation. The doctor had the flexibility of being able to say that a patient could stay in hospital for longer than 60 days for any one of those reasons. Under the new legislation the doctor has one area only in which he can do so. After 35 days-only 35 days-the doctor must sign the certificate and he is allowed only to take acute care into consideration.

As I indicated a little earlier, Senator Crowley said by way of interjection to Senator Baume when he said that doctors had great difficulty in assessing what acute care was that they should go back to medical school to find out. I believe Senator Crowley is a doctor. Obviously she has not given this matter any thought at all. A report entitled 'Report on Task Force Established to Review Private Hospital Categorisation Arrangements' was put down in the Senate a little while ago. In that report under the heading 'General Observations' the Task Force calls for

. . . clarification from the Acute Care Advisory Committees through the Department of Health to the health funds, as to the meaning of 'acute care'.

This Task Force, set up by the Government, has come forward with a recommendation that there should be guidelines. Yet we heard tonight from Senator Crowley that there are already bureaucratic guidelines. That is absolute rubbish. Senator Crowley should have done her homework. She should know-I am sure the Minister for Social Security (Senator Grimes) knows-


Senator Grimes —Senator--


Senator WALTERS —I ask the Minister to allow me to make my speech.


Senator Grimes —May I just ask a question?


Senator WALTERS —If the Minister does not know he should go and find out. We heard Senator Crowley say that doctors should go back to medical school if they do not understand what 'acute care' is. We heard her say that there are bureaucratic guidelines which define this term. We have been told that it is very simple; yet we have the Government's own Task Force calling for:

. . . clarification from the Acute Care Advisory Committees through the Department of Health to the health funds, as to the meaning of 'acute care'.

Under the previous Government we had some flexibility. Under this Government there are no guidelines. There is nothing to define 'acute care'. If a doctor is wrong, what then? If a doctor is wrong he could be fined $10,000 or face five years in gaol. What doctor will run the risk of a $10,000 fine or five years in gaol because he is unaware of any guidelines-because there are none-which would tell him what acute care is?

Let us have a look at the type of patients liable to suffer from this 35-day proposal. Senator Crowley told us tonight that she has compassion. She has compassion but she has not done her homework on the legislation. The Senate seems full of doctors tonight. They ought to realise that under the existing legislation psychiatric patients can be classed as being in the acute phase but when they pass from that phase they can be classed under the acute rehabilitation phase or under the continued management for medical reasons phase . Those are the three classifications which previously enabled doctors to extend a patient's stay. So a psychiatric patient who passed from the acute phase could have stayed in hospital because he was in need of acute rehabilitation or continued management for medical reasons.

Let us have a look at the case to which Senator Peter Baume referred, of a patient who has suffered a stroke. After 35 days in hospital, under this Government's proposal, that patient must be tossed out of the hospital or pay for his treatment out of his own pocket if a nursing home bed cannot be found for him. Doctors know that under the old scheme after suffering a stroke a patient passes from being classified as needing acute treatment to being treated as an in-patient needing continued management for medical reasons. In the new scheme there is no allowance for that stage and a doctor must tell his patient that he must leave. But we do not have the nursing home beds to cater for such patients. Senator Giles said tonight: 'Yes, there are States where no nursing home beds are available but we do not know what happens to the patient in that situation'.

Let us have a look at the case of a surgical patient who may have been admitted to hospital for some major operation but who has also developed medical complications. That patient, once past the acute phase, could develop all sorts of medical complications and would perhaps need rehabilitation or continued management for medical reasons, both of which classifications no longer come under the present legislation relating to the 35-day rule, because the 35-day rule accounts only for acute care.


Senator Grimes —That is dreadful. You are a disgrace.


Senator WALTERS —It does not matter how much the Minister in this place blusters and goes on about the matter, saying that I am a disgrace. The fact is that the Government's own report came down with recommendations that guidelines should be issued to explain to the funds and the doctors what 'acute care' means. As Senator Grimes says, obviously acute care is in the eye of the beholder. Many things are covered by the expression.

What about terminally ill patients, once they have passed the acute care stage? Patients have been taken out of hospital because they have not been able to have the acute care certificate legitimately-


Senator Grimes —Because the doctor is unwilling to sign the certificate.


Senator WALTERS —'Because the doctor is unwilling to sign the certificate', says Senator Grimes. What utter rot. It is because there are no guidelines that say that the doctor has enough flexibility to say that the-


Senator Grimes —Because the doctor is playing politics with a dying patient; it is a disgrace and you know it is a disgrace.


Senator WALTERS —For Senator Grimes to come into this place and say that a doctor will not sign the certificate and allow a patient to die because he is being political is a disgrace and a continuation of the doctor bashing that has been engaged in by the Australian Labor Party for-


Senator Grimes —You are now lying deliberately.


Senator WALTERS —We will see.


The DEPUTY PRESIDENT —Order! Senator Grimes will withdraw that remark.


Senator Grimes —I will withdraw the remark but the honourable senator is quite deliberately lying and she knows it.


The DEPUTY PRESIDENT —No, you must withdraw the remark without conditions.


Senator Grimes —I will withdraw it.


Senator WALTERS —We will see what Hansard has to say tomorrow morning. On a previous occasion in this place when Senator Grimes said I was lying the next day I explained exactly what happened, and that was recorded in Hansard.


Senator Grimes —You did not.


Senator WALTERS —Senator Grimes apologised to me in his room-


Senator Grimes —I did not.


Senator WALTERS —But he did not apologise to me in this chamber.


Senator Grimes —I did not apologise to you under any circumstances, ever.


Senator WALTERS —He apologised to me and said: 'Did I really say that?'.


Senator Grimes —You are a disgraceful and outrageous old witch.


Senator WALTERS —When I answered, 'Yes' in his room, he said to me: 'Oh, I am sorry'.


Senator Grimes —I did not.


Senator WALTERS —But in this Senate chamber he has not apologised.


Senator Grimes —I did not.


Senator WALTERS —It is time he did.


The DEPUTY PRESIDENT —I ask Senator Grimes to cease interjecting.


Senator Grimes —I have never apologised to you and I will not in future.


The DEPUTY PRESIDENT —Senator Grimes, you must cease interjecting. Senator Walters has the call.


Senator WALTERS —Thank you very much, Mr Deputy President. We will see what Hansard says tomorrow. Senator Grimes said that the doctors refused to sign the certificates for political reasons only. But I have said that a patient has left a home and died. That is the interjection the Minister made when I made that claim. If a pensioner is in hospital, perhaps after having had a stroke, after 35 days if no acute care is being undertaken the doctor must decide whether to sign a certificate. If the doctor is unable to sign a certificate saying that acute care is to be undertaken, that pensioner is up for $12.40 a day-$86.80 a week. A patient who has had a stroke could be in the home for a month. The cost would be $347.20 a month. Yet we are told that Medicare is wonderful, that Medicare will look after everyone and that is is good for patients and for pensioners.

We have been told that the one per cent levy for Medicare will give people free hospitalisation. Nothing was said about free hospitalisation for 35 days; just free hospitalisation. Nothing was said about pensioners being aware that after 35 days they will have to pay $12.40 a day. There was no mention of that. How can a pensioner, who will be able to go home eventually, spend a month in a public hospital and maintain his home when he is paying $86.80 a week for a bed? We have been told that the costs of Medicare are better for nine out of 10 patients. But the people and patients in Australia are waking up to the fact that when they go to the doctor they pay the 15 per cent gap because they are not allowed to insure for the gap. The more they go to the doctor, the more they realise that Medicare is not cheaper for them. The majority of patients insure privately for private hospitalisation, so they have to pay for private hospital insurance. They pay the 15 per cent gap every time they go to the doctor. They pay the one per cent levy.

If we look at the levy we find there are tremendous anomalies. Once more, the Government is really ignoring and, indeed, disadvantaging the single income earner. A single income earner, with no children, on a salary of $15,000 a year pays $150 a year. A similar single income earning family with one child pays $ 150 a year. What does a two-income family with no dependent children, one partner with an income of $8,000 and the other with an income of $7,000, pay? They have a combined income of $15,000 and yet they pay only $80. A two-income family with no children on $15,000 pays $80 a year but a single income family on the same income, with one dependent child, pays $150. Is there any justice in that, or is this Government still hell bent on penalising the single income family as it does in other actions in the Budget, such as the decision not to increase the dependent spouse rebate?

We were told by the Minister, Dr Blewett, that the one per cent levy would be identified on everyone's payslip. It has not been identified on anyone's payslip . We have no idea what we are paying as our one per cent levy; it is included with the tax. We were told by the Minister in his second reading speech that the levy would be identified, but he has not done that. We were told that Medicare was good for everyone-the best health scheme that Australia could possibly have. But it was not good enough for him when his daughter needed an appendicectomy. He did not just take the doctor on duty. It was not good enough for him. What he says is good enough for everyone else is not good enough for him. I do not blame him one bit because it would not be good enough for my daughter either. I want the doctor of my choice. Dr Blewett wanted the doctor of his choice for his daughter and I do not blame him one bit. I agree with him that there should be a choice and there certainly would be under our scheme.


Senator Grimes —You are a fascist like your relatives.


The DEPUTY PRESIDENT —Order! Senator Grimes will withdraw that remark.


Senator Grimes —What is the problem, Mr Deputy President?


The DEPUTY PRESIDENT —Senator Grimes, your remark was that Senator Walters is a fascist. You must withdraw.


Senator Bolkus —He is right.


Senator Grimes —I will withdraw that.


Senator Peter Baume —Mr Deputy President, Senator Bolkus just said 'he is right' . I ask that that be withdrawn too.


Senator Grimes —Mr Deputy President, I take a point of order. I wonder whether it is legitimate for the honourable senator to rise in this place and tell deliberate untruths about a member of another House of parliament, as Senator Walters is doing about Dr Blewett. I think it is terribly important that we consider that because what the good senator is doing is deliberately telling untruths about Dr Blewett. Of course, she is also trying to indulge in the practice of discussing the private medical problems of a person in this place. That would be very interesting indeed if in the future we could do that about ourselves or about our relatives. Mr Deputy President, I ask you to consider whether Senator Walters is allowed, under the guise of the legislation and using tactics which have nothing to do with this legislation, to get up in this place and make accusations about the Minister for Health and about the daughter of the Minister for Health which I consider an absolute outrage. Senator Walters's husband would be taken before the Medical Council if he did the same thing outside this place.


The DEPUTY PRESIDENT —Order! Senator Grimes, you have made your point of order. I have to tell you that remarks which reflect directly on individual members are out of order. Questions of whether remarks about the behaviour of members are true or not are a matter for debate. You will be speaking later in the debate and if you dispute the interpretations that Senator Walters put on the events that happened you are entitled to reply during the debate. There is no point of order.


Senator Grimes —Mr Deputy President, if I can take a point of order again--


The DEPUTY PRESIDENT —You may not take the same point of order. If you wish to take a different point of order you may. I have ruled on that point of order.


Senator Grimes —Mr Deputy President, I will take a different point of order. We have a standing order which says that senators should not reflect on members of another chamber. I put it to you that Senator Walters, by getting up and telling deliberate lies about a member of another chamber, is in fact contravening that standing order.


The DEPUTY PRESIDENT —Standing order 418 rules out of order any imputation of improper motives or improper behaviour to members of the House of Representatives.


Senator Grimes —Isn't that what she has done?


The DEPUTY PRESIDENT —As it has been described I do not think that is correct.


Senator Grimes —Good. So we can reply in kind, can we?


The DEPUTY PRESIDENT —You may reply during the debate as long as you are in order. Before I go any further, Senator Bolkus made a remark that he should withdraw, supporting an improper remark that has been withdrawn by Senator Grimes.


Senator Bolkus —Mr Deputy President, I gather the remark I have to withdraw is the one made by Senator Grimes that Senator Walters is a fascist. Despite the fact that most people in this Parliament believe it, I withdraw it.


The DEPUTY PRESIDENT —Senator Bolkus, you will withdraw it without qualification .


Senator Bolkus —I withdraw it without qualification, as I said.


Senator WALTERS —Mr Deputy President, this is as old as the Senate, I guess.


Senator Peter Baume —We will get on to telephones one day.


Senator Bolkus —You are scum, Baume. You scum. Come over here and explain that.


Senator WALTERS —Mr Deputy President, I am not quite sure what is going on--


Senator Bolkus —Senator Baume knows-the little gutter rat.


Senator WALTERS —But obviously Senator Bolkus is objecting very strongly. It sounds as though he has a terribly guilty conscience about something.


The DEPUTY PRESIDENT —Senator Bolkus, your interjection is very improper. You will cease interjecting.


Senator Grimes —You are a charmer, a real charmer.


Senator WALTERS —I have not got a clue what that is about. This attempt by Senator Grimes to intimidate me is as old as the hills, as old as the Senate. He has tried so often in this place. He has taken five minutes of my time on pointless points of order.


The DEPUTY PRESIDENT —Order! Senator Walters, I think it would help the proceedings of the Senate if you were to return to the Bill. There are too many interjections from the Government benches.


Senator WALTERS —Mr Deputy President, I will certainly return to the Bill. A little earlier I was referring to the doctor bashing that goes on in this place by Senator Grimes in particular and by Dr Blewett in the other place. A little while ago we had the Penington Inquiry into Rights of Private Practice in Public Hospitals. We have Press statements which say that Dr Blewett claimed in his submission-if honourable senators remember this was the result of all the doctors going on strike for the first time in the history of Australia-that pathology services had risen by 105 per cent over seven years. Mr Penington said they had not risen by 105 per cent, as Dr Blewett said, but by 39.7 per cent. He claimed that radiology services rose by 55 per cent over seven years but Mr Penington found that they had actually fallen by 14.1 per cent. The cost of pathology services rose by only 13.1 per cent over nine years, and for radiology services the cost fell by 15.4 per cent over nine years. He could not even give the right figures to the inquiry he set up. We also know that Senator Grimes and Mr Blewett have concentrated on fraud and overservicing.


Senator Cook —Dr Blewett.


Senator WALTERS —He is not a medical doctor; but, Dr Blewett. He has said that fraud and overservicing were costing the taxpayer millions and millions of dollars. We also know that the Professor of Statistics at Macquarie University, Professor Don McNeil, said that the Minister's figures were totally wrong, and that there was nothing he abhorred more as a statistician and as a scientist than having policies based on incorrect figures. Professor McNeil did not have any axe to grind but he said that the Department of Health and the Minister ought to take more cognisance of how things should be done. I turn now to the categorisation of hospitals by the Minister, the report on which I have referred to already. As we all know, we now have just three categories--


Senator Crowley —On a point of order, Mr Deputy President, I draw your attention to standing order 421, which asks that honourable senators not continue to be irrelevant or tediously repetitious. Not only is the honourable senator being tediously repetitious but also she is being tediously repetitious quite wide of the Bill with which we are dealing. She is not addressing the legislation to hand at all but is ranging often across every other tediously repeated subject. I ask you to rule under standing order 421 that she cease.


The DEPUTY PRESIDENT —Order! There is no point of order.


Senator WALTERS —Mr Deputy President, I have only a few minutes left. Members of the Government do not like what they are hearing and so, as usual, they take points of order to take up time. The Government has made an incredible mess of Medicare. Dr Blewett has also messed up the categorisation of hospitals. The report of the task force established to review private hospital categorisation arrangements said:

. . . the step in benefits between categories is too great, leading to distinct anomalies. Furthermore, the penalty for a hospital at the top of the range that just fails to meet the criteria for a higher category . . . is extreme.

The task force recommends to the Department that there should be five categories , not three, as the Minister and the Government have provided. As a result of this Medicare muddle, we find that there are waiting lists all over Australia.


Senator Crowley —Boring!


Senator WALTERS —Victoria has a waiting list of 30,000 people. Senator Crowley says it is boring to mention this. Around 30,000 people are waiting for surgery in Victoria. New South Wales is not sure what its waiting list is because its Government will not count those waiting. Tasmania has a waiting list of 3,500, and so it goes on. I urge the Government to re-examine the 35-day rule and thereby avoid the need for extra nursing home beds. The rule is harsh, unjust and lacks compassion.

Debate interrupted.