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Thursday, 24 June 2010
Page: 4411


Senator FIERRAVANTI-WELLS (5:45 PM) —I rise to speak on the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010. After all the ups and downs, it is interesting to see this bill finally come up. I want to place on the record that Minister Roxon has made comments in the other place criticising the coalition for supposedly blocking this. Here we are, almost at the death knell, and because they could not get their act together and get their programming right we are now dealing with this in a hurried manner. It has been shuffled down the list repeatedly.

Indeed, that is also the case with the National Preventive Health Agency and the legislation dealing with that. I raise this because we have to put up with the comments from Minister Roxon. She cannot get her facts right and so she puts out these silly press releases that tell us that it is being blocked by the opposition. The preventive health agency bill is one that I inherited when I became shadow minister for ageing, looking after health and ageing in this place. It has been sitting on my shelf for the last six or seven months. Why? Because this government has not been able to get its act together. It was with Senator Cormann when he was looking after health in this place, so can I just tell the minister to either get a copy of the Senate procedures and understand them or go back to the people that put order and procedure into the Senate and complain to them. Do not come out and complain to the opposition if you are having a hissy fit because your bills are not getting through the Senate.

Having said that, I now turn to the healthcare identifiers legislation. This bill is another example of this, and because of the time constraints I will not go through the various things this bill actually does. I do want to say that it is very important. This is a bill that goes to e-health. We support e-healt; indeed, it was an initiative started by the coalition. But it was very important that this bill be correct to ensure that the improvements in patient safety, medical care, privacy and coordination have a critical and solid foundation in relation to its future. It is important that we get this right.

In the lead-up to the last federal election we heard many promises from the former Prime Minister on health. For example, ‘We are going to plan to fix the hospitals.’ Indeed, one of the points we keep hearing about healthcare identifiers and e-health—and we heard it again last week in relation to the COAG inquiry—is that they are important. Yes, it is, but it is important that we do get it right. It is also interesting to see that there was a whole range of promises in relation to a whole lot of things on the grand hospital plan. Might I say that this was a plan approved by the gang of four, so again it was one of those rushed jobs where the formalities did not actually start until three weeks before COAG. Of course, the Prime Minister—the former Deputy Prime Minister—was right in there making those decisions.

I will not trawl through the various problems in relation to health, but I will say that in relation to e-health there were concerns about the original legislation. When we examine the history of this legislation we see a repeat of common features of the Rudd record on health: planning, rushed legislation and a lack of appropriate consultation with stakeholders. The lack of consultation, and putting out draft legislation where so much of the legislation was actually in regulations that were not put out, really caused a lot of angst for stakeholders. It was because of this angst that the coalition pushed for a Community Affairs inquiry. Regrettably, at the time of the hearing we still did not have the regulations. And as so much of the parameters of this was going to be in the regulations it was really unfortunate that they were not out in the public arena. Now, here we are, and it is, as I said, the death knell.

Another concern that was raised following the lack of consultation time available to stakeholders was the fact that this system was due to commence on 1 July this year. It defies belief that the government has delayed—and this comment needs to be made—providing software manufacturers and developers with the specifications to enable them to design the appropriate IT framework or to integrate healthcare identifiers into existing packages.

Concerns were also raised about the breadth of this legislation. In particular, there was potential for privacy laws to be overridden if the action was in relation to disclosure under any other law. Given the reports in the press, particularly in the Australian on 2 March this year—and we trawled through this at the committee hearing—about concerns and allegations raised against Medicare Australia staff in relation to inappropriate viewing of confidential patient records without authority in the past financial year, it was really important that the parameters in relation to access to healthcare identifying information work were properly delineated.

There were additional concerns in the minority report and I contributed to that minority report. It must be stressed that, whilst we do not oppose this legislation, we thought it was important that stakeholders be given that further opportunity for consultation through the committee process. One of the concerns was this potential function creep and the use of healthcare identifiers being extended to other purposes. The final concern was the possibility that the scheme would not be ready for implementation on 1 July.

The coalition presented eight amendments to the government and in a press release on 21 June the responsible shadow minister, Dr Southcott, stated that there were discussions in relation to amendments put to the government. They covered four basic areas: to prescribe the requirements for assigning a healthcare identifier to a healthcare provider or recipient as a schedule in the bill; to confirm that the operator of the health identifying service can only be changed by legislation; to provide a guarantee of a right of appeal or review under section 9 of the proposed legislation; and to delete the provisions which allow the healthcare identifier to be released if permitted under another law. We believed that these amendments would significantly improve the legislation and urged the government to support them.

We are very pleased that Minister Roxon has significantly backed down from the original legislation. We believed that the Labor government needed to go much further to ensure important privacy protections and prevent function creep. Therefore, we are pleased that Minister Roxon has heeded our concerns and accepted six of our amendments—namely, those going to requiring legislation to change the service operator from Medicare, those requiring legislation to proscribe the data source, definitions for healthcare providers to be done by way of legislation and not regulation which is very important, and requirements for assigning identifiers to be done by legislation and again not by regulation.

Our two remaining amendments were in relation to limiting the disclosure of information and removing a person’s ability to disclose information under another law, a concern raised at the inquiry. Following discussions with stakeholders such as NETA and after exploring the issue with the government, there are legitimate concerns with the operation of the outstanding two amendments about the potential to overly restrict the use of health identifiers and potentially expose clinicians to offences for aspects of routine health care. As I said, very little time was afforded to stakeholders to submit their views on the draft legislation and not all these concerns were addressed. For legislation such as this, which is very important and deals with highly confidential healthcare information, it is vital that it is right.

I conclude by saying that the coalition will not oppose the legislation and we will not oppose the government’s amendments. We will also not be moving our amendments, given most of our concerns have been taken up by government amendments. I am not sure what the position is in relation to the Green amendments and Senator Siewert may clarify that. We saw some Greens amendments which allow individuals to opt out of the identifier scheme. The coalition will not support the Greens amendments which we believe are unnecessary at this stage. Critically, this will be dealt with in the next step which is the electronic health record. This will be an opt-in system in that you will have to provide explicit consent to have a personally controlled electronic health record.