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Tuesday, 17 June 2003
Page: 11700


Senator CROSSIN (6:27 PM) —I rise this evening to comment on the impact of the Health Care (Appropriation) Amendment Bill 2003 on the Northern Territory. This bill seeks to amend the Health Care (Appropriation) Act. It is, of course, the means by which the government is able to have moneys appropriated in this parliament and a means by which the provision of health care is provided, under a legislative basis, for grants of financial assistance under the Australian health care agreements. The amendments to the original bill extend the operation of the act for a second five-year period commencing in a few weeks time, on 1 July 2003. This bill enables the Commonwealth to enter into a new Australian health care agreement and, one would argue, to maintain funding to the states, pending settlement of any existing agreements. As I said, this bill provides the legislative basis for grants of financial assistance for the provision of hospital services or projects or programs that will be conducted during the coming five years starting 1 July 2003. This extends these agreements for a second five-year period.

There are other minor legislative changes in terms of the administrative arrangements of this act, but the fundamental issue about this act and the issue that has been the source of much attention around the nation for the last few months is the appropriation from the consolidated revenue fund of an amount, according to this bill, not exceeding $42 billion for hospital services provided. On the face of that one might say that that is a fair amount of money and a fair commitment from the federal government. But if you have a look at the history of this health care agreement you will know that this is in fact $1 billion short of what the federal government had promised state and territory ministers.

I will give a bit of background to what this is going to mean for states and territories, not least of all for the Northern Territory. The states and territories have had many discussions and meetings with the federal minister, Kay Patterson—when, of course, she bothers to attend—in relation to the details of this funding. On 2 May this year, a joint communique was distributed by the state and territory health ministers. It says:

Federal Health Minister Kay Patterson today confirmed the Commonwealth's health care funding offer represented a $1 billion real cut to the States and Territories.

Of course health ministers unanimously rejected this offer at a meeting in Canberra on 2 May 2003, a meeting that was held to discuss the next Australian health care agreements. Ministers from the states and territories went on to say that in the federal budget this year there is an attempt by this government to kill Medicare and that the health minister has `tried to bury public hospitals'. The state and territory ministers have continued their fight for the right of ordinary Australians to affordable and accessible health care following the federal government's move to dismantle Medicare, as we saw in the announcements of the budget some weeks ago, and the real cut in funding to the states of the money that is to be appropriated through this bill to the state and territory health care agreements. Let us have a look at what some of the state and territory ministers have had to say. They say that the key principles that should underpin the Australian health care agreements include:

* Maintaining and developing Australia's health care system based on the Medicare principles of universality, equity and access;

* Maintaining and developing the key components of Australia's health care system, including Medicare, sustainable public hospital-related services, the Pharmaceutical Benefits Scheme, aged care services and the public health system in general; and

* Recognition that the policy decisions of the Commonwealth do not exist in a vacuum and can have serious consequences for State and Territory-based health services.

In respect of the Northern Territory, the consequences are severe. A $1 billion cut from this health care agreement or $1 billion not realised as promised by the federal government—a federal government that has refused to ensure an additional $1 billion in its health reform package—so an agreement that consists of $42 billion rather than $43 billion, translates to a shortfall in the Northern Territory of $16 million. The impact of this government not realising its promises under the state and territory health care agreement is a shortfall of $16 million in relation to the Northern Territory. This government would say: `All right. States and territories now have to make up that funding shortfall themselves. They now have to put on the table a commitment for money to make up the difference. We have taken our hands off the wheel here. We are not going to take full responsibility for funding your public hospital system. You've got to find some of the money yourself.'

Let us have a look, though, at a profile of the Northern Territory. Eighty per cent of the funding by which the Northern Territory government has to operate comes from the federal government by virtue of the fact that we are a territory and not a state. In the other states, Commonwealth moneys coming to the state are around the 40 per cent mark. We in the Northern Territory rely very significantly on the money that is appropriated through the Commonwealth government. When you have a shortfall of $16 million in the Northern Territory, you have to ask yourself where or how do you find that shortfall when you already rely on 80 per cent of your funding coming from the Commonwealth for all services across the board.

The other thing in the Northern Territory is that there is one private hospital based in Darwin offering a very, very limited range of services. It does not offer an intensive care service or a neonatal intensive care service. It offers very limited services in terms of emergency procedures or extensive and complicated procedures. By and large, the fact that you have private health care cover in the Northern Territory can mean very little if you live in a remote community, if you live on one of the islands or if you live in a place like Tennant Creek, Alice Springs or Gove. There is very little benefit in having private health insurance. Therefore we cannot have an answer that simply says: `We will take the strain off public hospitals and encourage people to go to a private hospital—that is the answer. Reduce the money from the public hospitals and put the onus and the responsibility onto a private hospital. People will then go to a private hospital. It will take the strain off the public hospital.' It does not work like that in the Northern Territory—never has, never will—because of the lack of private hospitals, the lack of access to the provision of private services and the extreme overreliance that all of the public in the Northern Territory have on the public health system. They have a reliance on the federal government supporting them and committing to ensuring that the public health system is fully resourced, funded and supported.

Let us put on top of that the complicated layer of statistics we have for Indigenous health. I do not have those statistics with me here tonight—that will incur another 20-minute speech at another time. Everybody knows that Indigenous people rely very heavily on the public health system and the public hospital system. That is the only system they rely on. We know the figures when it comes to Indigenous health across a whole range of issues—renal health, diabetes, heart disease, rheumatic fever and even access to the provision of specialists to assist with a whole range of other areas. They are a total group of our population that rely 100 per cent on the public hospital system.

We have a government here that want to get state and territory ministers to sign up to a state and territory health care agreement that has $1 billion less than they had promised originally, which has a dramatic impact on the Northern Territory to the tune of $16 million. The states, as I understand it, are pushing ahead. An article in the Canberra Times last Saturday said that state and territory health ministers voted only last Friday to continue their campaign to ensure that this agreement is not signed and that they will press ahead with further discussions to try to get this government to understand that there is a need to ensure that the public hospital system and the public health system are adequately funded. I understand that, in relation to the $1 billion less than promised for health, the federal government are claiming that the extra money is not needed because the private health insurance rebate is easing the burden on the public hospital system. That is not an excuse, when you look at the profile of the health system in the Northern Territory and the reliance on the public health system in the Northern Territory.

Let us just take an example of what has been happening in the Northern Territory in the last six months in relation to health. We know that this year's budget—the 2003 budget—shows a withdrawal of funding from the public hospitals. It is already in the forward estimates, and it is to fund the so-called A Fairer Medicare package. Instead of recognising the pressure that emergency departments in public hospitals face, this government is diminishing the funding to public hospitals by $918 million over four years. We know that emergency departments in private hospitals are overloaded simply due to the fact that Australians, and in particular Territorians, are finding it harder to see a doctor who bulk-bills. Of course, we do not have an emergency department at a private hospital in the Northern Territory. Our people up there, everybody up there—Indigenous and non-Indigenous people—are solely reliant on the public hospital system. We know in the Northern Territory that 90 per cent of patients who are presenting to the Royal Darwin Hospital's accident and emergency section each night after the hours of six o'clock are presenting with non-emergency assistance—that is, the accident and emergency departments at the Royal Darwin Hospital and, more than likely, the Alice Springs Hospital are full of patients that present with GP related and minor problems.

The changes that the Howard government are proposing will simply place a further burden on our already overworked public hospitals. Parents with sick children are waiting at the hospital for hours at night simply because they cannot afford to see a doctor during the day or the few doctors who bulk-bill in the Northern Territory are booked for several days in advance. The situation in the Northern Territory is literally at crisis point. We have, of course, the outrageous situation where the shadow minister for health in the Northern Territory, Sue Carter, is laying the blame for all of this at the feet of my colleague Minister Jane Aagaard in the Northern Territory government and is suggesting that the new and refurbished accident and emergency department that was planned under the Country Liberal Party has not gone ahead and at fault is the Labor Party since it came into government in 2001.

As Minister Aagaard was able to reveal on 30 April during a debate in the Legislative Assembly in the Northern Territory, the accident and emergency section has been rebuilt and has been refurbished and, yes, there is a delay in opening it. It is not going to be opened in the coming weeks as planned, and why is that? It is because the Country Liberal Party were so inept and so negligent in their forward planning that in their forward estimates and budgets they simply budgeted for a building to be built and not for any ongoing recurrent costs. They put no money aside in the following years for staffing, airconditioning or equipment. The Country Liberal Party were only able to find money for a building. There was no money for forward on-costs, for forward operating costs. And they now seek to lay the blame at Minister Aagaard's feet for the fact that this A and E department is not going to be opened on schedule; they want to lay the blame for all of that at the feet of the Labor government in the Northern Territory. Not only is this is a Country Liberal Party that could not manage their own health system up there; they cannot even seem to manage their own leadership problems at this point in time.

We have a chronic situation in the Northern Territory when it comes to access to doctors and to services. People are going to the public hospital after hours because they cannot afford to go to a doctor. There are no doctors who bulk-bill in the Northern Territory who are taking on new patients. The situation is at crisis point. Therefore, in order to get attention for your children after hours for minor problems, you have to present yourself at the hospital. As I said, 90 per cent of the people who present themselves to the accident and emergency departments in Darwin and Alice Springs are not presenting because they have been in an accident or they have an emergency; they have GP related problems. In the Territory our public hospital is bottlenecked; it is crammed. It is at crisis point. On top of that, we have a federal government that wants to sign up to a state and territory health care agreement that has $16 million less in its bucket of funding for the Northern Territory. As well, it purports to have released A Fairer Medicare package that is going to relieve the burden on people in the Northern Territory. It simply will not.

I recently conducted a survey in Palmerston, which is a large city outside of Darwin, and although not surprised at the responses regarding the decline in the bulk-billing rate I was alarmed at the fact that 67 per cent of the people said that there had been occasions when they had deliberately not been to see a doctor because of the prohibitive cost. So 67 per cent of people were telling me that they do not go to a doctor because of the cost of visiting that doctor. So what do they do? They wait till after hours. They wait till after 4.21 p.m. and present at the accident and emergency department of Royal Darwin Hospital. They are prepared to sit there, along with 90 per cent of the other patients who turn up, for hours at a time to see someone. They present if they feel sick in the stomach, if they have the flu, if they have a headache or if they have other minor symptoms that should be treated on a day-to-day basis by GPs—if this government took hold of the health care system in this country, shaped it and formed it and produced something that was actually meeting the needs of the Australian public.

We have a bill before us that wants to appropriate money to the state and territory governments—$1 billion less than was initially promised—and the impact of that is $16 million less for the Northern Territory. As I said before, in the Northern Territory we have a situation where the Country Liberal Party is happy to point the finger at the Labor Party locally for the problems at the accident and emergency department, but those problems stem from Canberra. The problems are initiated here by this federal government—a federal government which is refusing to accept the fact that this agreement does not give the state and territory ministers the money they need to have a decently funded public health system, a decently publicly funded public hospital system. That $16 million less for the Northern Territory is a huge amount when it comes to looking after the needs of Indigenous and non-Indigenous people there. We already rely on the Commonwealth for 80 per cent of our funding. We do not have a private system on which we can rely; we are solely reliant on the public hospital system. This is a government which refuses to acknowledge that, refuses to fund the public hospital system properly and refuses to ensure that the Northern Territory government has got the resources it needs to provide a fair, equitable and accessible health care system to everybody in the Northern Territory, no matter the size of their wallet and no matter where they live in the Northern Territory.