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Tuesday, 19 June 2012
Page: 3674

Senator BOYCE (Queensland) (17:22): It is interesting that Senator Brown used the word 'rollout' in her contribution to this debate on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. In fact, there is no rollout. There is simply a system in which you can lodge your interest to be involved in what is happening on 1 July. It reminds us of this government's 'ability' to roll out the NBN in Tasmania. It leads us to the same sort of mismanagement, waste and inability to implement which we saw during that rollout and which is now happening with this rollout. I certainly share Senator Brown's hope that e-health will be useful to the people of Tasmania, but I do not have any certainty around that. I also hope that it will be useful to the people of Queensland, but again I do not have any certainty around that. I hope it will be useful to the people of Australia, but there cannot be any certainty around that either.

As numerous speakers have pointed out this afternoon, e-health is a noble aim. It is certainly something that we should do. Because of the work of successive governments in Australia—our current statistical collection and our work to date on definitions and standardisation of all manner of things within the health area—we are possibly in a better position to do it. We are in a better position than almost any other country in the world to do this well.

But today we are talking about the introduction of the personally controlled e-health records aspect of an e-health system. Once again, we are looking at fantastic rhetoric and zilch delivery, zilch implementation. The personally controlled e-health record system is supposed to start on 1 July. As Senator Di Natale said earlier, it will be a 'soft launch'. It will be a very soft launch. It will be an almost ghostly launch—a Mary Celeste launch—because there is nothing in this ship to launch. It is simply a shell waiting to be populated. Fine. But this government should not go on with nonsense about what is going to happen.

Minister Roxon, the former health minister, talked about the e-health revolution that would be coming. It was in January 2011 when she started talking about the e-health revolution. She said:

After the outstanding success of the e-health conference in Melbourne earlier this month, there is strong momentum behind delivering the Government’s $466.7 million PCEHR system by July 2012.

It is fine for Senator Brown to try to suggest that this system is part of the national health and hospital reforms of this government, but it is in fact as meaningful as almost anything else they have done—which is almost nothing. There has been no real progress. Of course they now have to talk about a soft launch. Having gone from the big bang of 'Wow, we're going to have an e-health system that will be the envy of the world,' they are now saying, 'Well, people can just choose to let us know that they would like to be involved from 1 July.' There is at least some vague hope on that basis that the PCEHR legislation will achieve long term some of what it has set out to achieve.

But it is a complete nonsense for this government to try to claim that this legislation is some sort of a move, a reform, a revolution. They need to fess up to the fact that they could not work out how to do it. They could not work how to get it right and now they are going to take the easy option which was suggested to them all along. But of course this government loves to talk the rhetoric, fail to implement, waste money and mismanage as it goes.

As has been noted by other speakers, the coalition will not be opposing this legislation, because we think the idea of having personally controlled e-health records and a proper e-health system is an excellent idea. We are, however, like many stakeholders outside this place, concerned about this government's ability to implement a sensible system that will work. Despite all the promises made by NEHTA, the transitional authority for this program, and DOHA, the personally controlled e-health record system is simply nowhere near ready to launch. It is an idea still. This government needs to confess that it is still just an idea; it is just a ghost of an e-health system.

Key components of the PCEHR are not finished and are nowhere near being finished. Key issues identified during a number of inquiries—and I note one of them was by the Senate Community Affairs Legislation Committee, of which both you and I are members, Madam Acting Deputy President Moore—such as safety, liability and privacy have not been successfully resolved. The coalition, in its minority report to the PCEHR committee last year, suggested that it would be wise for the government to delay the launch until they knew that they had it right and that some of the systems they were intending to use had been trialled in real-life situations. We were concerned this would be a completely dysfunctional system that would cause more harm than good.

One of the key aspects for a functioning e-health system is the public's confidence in it. If it has serious errors or serious problems in its early days, it will take years to regain the trust of the public. I am told that the National E-Health Transition Authority was called to Minister Plibersek's office in recent weeks and was basically told: 'Stop the spin. It's not ready. It won't be ready. 'Let's wind back the rhetoric and the expectations. Let's start talking about soft launches and people choosing to get involved in registering, but let's stop the nonsense about the e-health revolution.' So we have a complete backtrack by this government.

One thing that has not been wound back is the spending. I am somewhat amused by Senator Carol Brown's view that more than $300 million for the hospital system in Tasmania would be sufficient to overcome the unique challenges of the Tasmanian health system. We have some unique challenges in my home state of Queensland in the health and hospitals system too, where over $1 million a day is being forced to be spent to pay the interest rate on the wages bill of the debacle of a health pay system that the former Bligh government implemented. I think perhaps the unique challenge faced by so many of these hospital systems is their Labor state governments which cannot, as this government cannot, properly implement and effectively discipline their own spending.

Let us look, for example, at the liability and risk issues associated with this legislation. Key medical indemnity insurers are warning GPs not to participate as they could be exposed to a new wave of litigation. Insurers are telling doctors not to use the e-health system and the PCEHRs until the issues are settled. The President of Medical Defence Australia, Julian Rait, said his organisation had serious concerns about the legal liabilities doctors would face if they used the PCEHRs and would 'advise members not to participate until these problems are properly addressed'.

As for safety, the fundamental issue of any medical system, one of the comments that came out of the estimates process was that NEHTA had just one document that it could show to the Senate committee demonstrating its interest and concern in the safety of the PCEHRs. It was called the Clinical safety case report. Thirty-three pages of that 34-page document detailed a huge number of safety risks that the PCEHR system was subject to. On page 32, the document says that 'the feedback to date on the clinical safety recommendations has not described to what degree they have been accepted into the design and if they will be included in future specifications'. So, in fact, none of these safety risks have been properly assessed for their level of danger and what needs to happen to get them properly out of the system. Clearly the question of who is going to be liable if things go wrong has been completely avoided. There is no answer to the question: 'Is the system safe?' There is no system, as I said before, so how are they going to know if it is safe? Yet $1.1 billion has been spent on this.

Just last Friday, we had the extraordinary situation of the CEO of NEHTA, Mr Paul Fleming, announcing that the NASH—the National Authentication Service for Health—was not going to be ready for 1 July. They gave the contract to IBM well over 18 months ago—again, to the distress of the local industry. Medical software providers in Australia were shocked when IBM got the job of providing the NASH. One of them even commented to me: 'They have just gone for the safe option. No-one ever got sacked for hiring IBM.' Apparently someone should get sacked for hiring IBM, because the NASH was due on 30 June and it will not be finished.

In the past, Paul Fleming has described the National Authentication Service for Health as:

… a key foundational component for eHealth in Australia. It is essential that the identity of people and organisations involved in each eHealth transaction can be assured, and this requires high quality digital credentials. The NASH, Australia’s first nationwide secure and authenticated service for healthcare delivery organisations and personnel to exchange sensitive eHealth information, will provide this.

That is the description of the NASH.

In March 2011, NEHTA gave the contract to IBM to design this key foundational component. Guess what? On 15 June, Mr Fleming quite happily said that the fact that the delivery of the NASH has been delayed to a date that no-one can tell us:

… will have no impact on the launch of the personally controlled eHealth records system in July, or the ability for consumers to register for an eHealth record.

Let us note that term 'register'. He went on to say:

Australians will be able to register for an eHealth record in July as intended.

That actually was not what was intended. They were supposed to be able to register and use the e-health system from 1 July. They will not be doing that. That is not what will be happening. And, when queried, Mr Fleming said they did not know when IBM were going to fix the problem and when we would have a NASH to go along with the system. Yet the most serious problems raised were around safety, security and privacy. That is what the NASH is designed to protect.

In the Australian last Friday Karen Dearne said:

THE Gillard government's $1.1 billion e-health records program will launch without the key user verification system in place, with the National E-Health Transition Authority (NEHTA) conceding it has failed to deliver the project on time.

I just find it bizarre that this is what happened. But why should we find it bizarre that providing this and implementing it properly is way beyond the skills of this government or its appointees? As I said earlier, we support this legislation because we believe an e-health system is a national imperative. If it functions properly, it will save the public purse millions. But it has to be done properly, it has to be done intelligently and, far more to the point, it has to be done honestly and transparently. That has not happened to date with the way NEHTA has suggested that not having a key component of e-health ready in time for the so-called launch on 1 July is not a problem. I would love to know when someone is going to take responsibility for NEHTA and for the fact that this has gone from being an e-health revolution in early 2011 through to a 'soft launch' where people can put their names forward to say they would like to be involved if they want to, when and if it finally gets delivered.

I am pleased that the government are now slowing down the implementation of e-health, but I am completely displeased that they cannot simply be honest or transparent about the problems that they have encountered along the way. We are all aware of the problems that have come out of the UK, where over £6 billion was invested and wasted by the former Labour government. To everyone's shock and horror, it could not be reclaimed. It was simply wasted and closed down.

We are in a great position in Australia. We currently have 3.6 million people who are registered to receive primary care with their doctors. We are one of the few countries in the world that can actually tell you we have 3.6 million people registered for primary care by their doctors. So why wouldn't we look at using those people as the starting point—the people who have the chronic healthcare programs with their GPs? Why wouldn't we start with that group? These people would benefit from the fact that they will not have to cart X-rays around with them. They will not have to have test after test. They will not have to tell their story over and over. Why wouldn't we start there instead of creating some sort of money-eating machine that we have no hope of implementing successfully and nationally for so long?

There are so many issues that I think we need to work on with regard to these bills. We will be checking to make sure that the legislation does work as intended over time, that people do have sufficient confidence in the security and safety of the system to actually use it and that clinicians find the system functional for them.

I am disappointed at the approach that has been taken almost consistently by NEHTA, the lack of transparency, the lack of consultation with stakeholders until after the event and the lack of honesty here in suggesting, 'We don't need NASH, really.' Yes, they will get a system cobbled together to get them through, but to say that is as good as the one we have just paid $48 million to IBM for is just bizarre. So let us hope this is a good outcome for Australians.