Senator LEES (1:53 PM) —It will be no news to anyone listening to this debate that the states and the Commonwealth are at loggerheads yet again over funding for our public hospitals and have gone back into their respective trenches. It happens time after time after time. The battle has as usual seen accusations fly as to who is putting in how much money and who should be putting in how much more. The Commonwealth argues this time that it has put in a real increase of 17 per cent in funding. It argues that the states are the ones that are being difficult and that their intransigence is all down to their having Labor governments. The states, on the other hand, accuse the Commonwealth of not offering a real increase but a decrease in what was expected of about $1 billion over the life of the agreement. The federal minister has refused to attend meetings with state health ministers. Accusations have been flying from the state health ministers back to the Commonwealth about the offer. Indeed, the Commonwealth has made it clear that it is not going to increase the offer.

The minister argues that savings should be made because more public hospital services are being provided to non-admitted public patients than has been previously the case. I presume that that means—and perhaps the minister can fill us in on this when we get to the committee stage—more pressure is put on accident and emergency services and that there is more day surgery. I guess we will get to the committee stage of the Health Care (Appropriation) Amendment Bill 2003 later. Also, the Commonwealth argues that because there has been a reduction in the rate of growth in the use of our public hospitals they deserve to face these cuts. I presume that it revolves around the increased use of private hospitals for elective surgery. Other issues that are facing our public hospitals include beds being closed because the hospitals have run out of funds or because they simply cannot find the nurses to staff them. Most public hospitals do not seem to have reduced their waiting lists; nor to any great extent have they reduced any of the other waiting lists. Besides the ones for elective surgery there are many waiting lists for visits to specialists and in some cases, unfortunately, urgent treatment such as for cancer.

Minister, we see that the usage of private hospitals has gone up. The number of people accessing private hospitals has certainly jumped, but the pressure on the public system has not come down. It has not come down in any really measurable amount and certainly not to the point where people can expect timely access and that that access can be assured on the basis of merit. I believe it is simply not fair or reasonable for the Commonwealth to ignore what is actually happening on the ground in our public hospitals. Some ideological, wished for scenario of people all rushing off to private hospitals if they have any sort of problem with waiting in the public system is not going to happen. For some it is a financial issue: they simply cannot afford private health insurance. They do not want to risk the gap they may be faced with if they go private. For some it is a case of up-front fees for the specialist to begin with. For others it involves the nature of their illness or when or where it occurs. Most private hospitals do not operate a 24-hour emergency service. It will be interesting to see the state by state figures on how many private hospitals are offering a 24-hour accident and emergency service.

So where does the truth lie? As usual, it is between the two extremes. The Australian Institute of Health and Welfare says that the states are falling behind in the amount that they contribute to our hospitals. It points out that the share of funding that the states put in has fallen from 45.4 per cent in 1998-99, when the last health care agreement was signed, to around 43 per cent in 2000-01. Of the total moneys put in during that period, the Commonwealth's contribution has stayed stable at around 48 per cent. The missing nine or 10 per cent, for those who are doing their maths, is down to non-government contributions.

We must look at what the Senate can do as far as this ongoing battle between the Commonwealth and the states is concerned. As it is an appropriation bill we will be supporting the legislation. Yes, we can attempt to increase the amount—and I note that there is at least one amendment being circulated that is directed towards doing that—but I cannot imagine that that will be acceptable to the minister and to the government. As the minister has previously said, the Commonwealth has made an offer and it is not going to move. As we look at the legislation specifically, there are certainly some positives. I congratulate the minister on her direction to the states that they must declare publicly the level of funding that they are going to provide. I also congratulate her for the improved performance reporting framework that is being put in place under this legislation. I also agree that the states should match the Commonwealth funding, and I believe they should give a public commitment to doing so as soon as possible.

Debate interrupted.