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Health Workforce Australia Bill 2009

CHAIR —Our next witness is from Catholic Health Australia. Good morning, Mr Laverty. Welcome back. I know that you have information on parliamentary privilege and the protection of witnesses. We have your submission, thank you very much. If you would like to, make an opening statement and then we will go to questions.

Mr Laverty —Thank you for having Catholic Health Australia appear again before this inquiry. If you do not mind me observing: we are pleasantly surprised that this inquiry exists in the first place. We would have hoped that this piece of legislation was relatively uncontroversial, could have been put to the Senate and all those present might vote yes, because we think this is worthwhile and, in fact, overdue legislation that we are delighted to give our support to.

We offer that support in part because some 12 or 10 months ago we put a proposal to the Australian government to establish what we called a national health workforce commission. We suggested in our policy blueprint that we might establish a national health workforce planning resource. We were looking for the coordination of clinical training across the nation. We were looking for long-term policy planning to advise health ministers around the country on solving some of the shortages within the health workforce. We were also seeking an injection of new funds both to incentivise school leavers into the health workforce and to overcome some of the blockages that exist between education and service providers in managing clinical placements. That was our aspiration some eight months ago. When we look at the drafting of this bill, literally all of those areas are covered, so it would be very difficult for us to give anything but our absolute endorsement to the legislation.

Because we have appeared before this inquiry before, you will be aware that Catholic Health Australia represents some 75 hospitals around the nation. Within our organisations, there are some 38,000 staff. We employ 27,000 nurses and, appearing before you today, we have vacancies or shortfalls of nurses within our own hospitals of about 1,600, so the pressure for our network of not-for-profit hospitals is significant. That pressure around the nation for nurses, doctors, allied health workers and those that are serving the sick and the elderly in our community should not be understated.

We think this legislation goes a long way to remedying some of the problems that are the causes of those shortfalls. Some years ago, education of doctors and nurses in particular was principally conducted in hospital. When that change occurred to teaching of nurses in universities, we perhaps as a community did not put in place the infrastructure sufficiently to manage the training of nurses in universities and their clinical placements in hospitals. That problem has become more obvious in recent years.

We now have a situation where some of our universities that interrelate with our hospitals are saying, ‘We, as hospital providers, are not offering enough clinical places.’ The universities have in recent times been putting that pressure on the hospitals. They have said that is indeed our problem. This bill, and the funds that are supporting the establishment of Health Workforce Australia, will go a substantial way to resolving that particular issue—that is, the reasons why we have blockages in being able to take particularly nurses on clinical placements into hospitals.

With our endorsement of the bill, there are some questions that we think need to be considered. The principal one is whether or not, in the construction of the governance arrangements for how Health Workforce Australia is going to be overseen, the needs of the non-government sector, the not-for-profit sector, are going to be properly respected in an ongoing manner. The proposal to establish a board to oversee Health Workforce Australia would give, if I am correct, nine or eight board positions to governments from around Australia and then four, if you include the position of chair, to representatives outside government.

It is creating a governance arrangement whereby governments around Australia will still have a very important, indeed a majority, say in the direction that this body takes. That is appropriate. We recognise that it is government funds that are establishing this. But we think one of the opportunities that Health Workforce Australia has is to recognise that it is not just government hospitals in which clinical training is undertaken. Of our not-for-profit hospital network, eight are teaching hospitals. The introduction of this bill and the changed opportunity to access new resources for clinical placements is creating within our hospitals the opportunity to expand our teaching or tertiary hospitals from eight to a larger number. Some of our hospitals are now looking at this opportunity to expand their teaching facilities because of this very positive initiative that the Australian government and the Council of Australian Governments is supporting.

So within that context we would say to this inquiry that we recognise the need for governments to be represented in the majority of the board that is to be put in place, but we are looking for assurances that the needs of the not-for-profit sector, the non-government sector, universities, colleges, are also going to be properly represented in this governance structure, such that when Health Workforce Australia comes to undertaking its work, it will not simply become another funding stream for state and territory governments to access clinical placements; that there will be a genuine commitment to ensuring that those hospitals, those aged-care services and those community care services, where clinical placements can occur outside of the government system, will be able to utilise the opportunity that Health Workforce Australia is providing.

In referring to aged care, I think that is an opportunity that Health Workforce Australia is also going to open up. Clinical placements occur within some aged-care providers around Australia at the moment. We see an opportunity for many more clinical placements to occur within aged-care service providers. You will be aware that one in nine aged-care beds around Australia is operated by Catholic service providers. We are very interested in ensuring that we can expand opportunities for clinical placements within aged care, and we think the establishment of Health Workforce Australia, the funding that comes with it, provides that very opportunity.

If we do not get the governance structure right and if we do not have a commitment from the establishment of Health Workforce Australia that the not-for-profit sector, the non-government sector, is equally respected in the priorities of the work that Health Workforce Australia is going to undertake, this opportunity could be missed, and we think that would be an opportunity that we can avoid in the way that we establish the governance arrangements for Health Workforce Australia.

There are some things that the bill does not allow for that are still problems that will continue to persist in addressing health workforce needs around Australia. It is not explicit, within the construct of the bill, that there will be a focus on strategies to attract school leavers or people looking for new careers to enter the health profession in the first place. It is inferred in the legislation, in that there is the ability for Health Workforce Australia to develop strategies and to provide advice to the ministers, and indeed, the ministers can then give directions to Health Workforce Australia to undertake certain works. So we are not saying that the legislation necessarily needs to be redrafted to ensure that we are putting effort into attracting people into the health workforce in the first place.

We are also aware that the bill will not necessarily be undertaking the redesign of health workforce positions that we think is so important. We have to acknowledge that we have a scarce resource of people willing to work within our health system around Australia, and indeed around the world. One of the ways in which we can properly solve the challenges that we face is to look at redesigning who does what within our health system. Others do not necessarily share this view. Perhaps those that spoke immediately before me do not necessarily share this view.

CHAIR —Or later today.

Mr Laverty —I would not be at all surprised. But we think that Health Workforce Australia, in the way that it is being established, with the opportunity for it to provide advice to ministers on what is necessary—and, indeed, for ministers to give directions to Health Workforce Australia on where it should be focusing—at a point in time it may be that this body is the forum within which we have this important debate. One of the challenges we have at the moment is that we do not have a forum in which those that have interest in medical training, those that have interest in nursing training, those that have interest in the provision of service, and then, indeed, the consumers themselves, can come together to look at how we properly allocate who does what within the health system. We think Health Workforce Australia has that opportunity, and for that reason we look forward, in the years ahead, to be able to encourage ministers, and indeed encourage the board of governance of Health Workforce Australia, to take that on.

We also recognise that perhaps the most important issue as to why I think we have too few nurses, too few staff available to work in aged care in particular, but also within hospitals around Australia, is pay for health professionals. We note Health Workforce Australia is not commissioned to address that but, again, the drafting of the legislation perhaps gives that opportunity at a point in time to be looking at and considering these issues. In fact, I would go as far as to say many of the arguments that are going to be put before this inquiry will probably relate to some of the outlying issues, or some of the overarching issues indeed, as to why we have a shortage of health workforce in Australia.

Others might criticise the legislation as not trying to capture all of those particular problems. Legislation should not have to do that. It should create a forum, a vehicle—in this case, an independent body—in which all governments will be represented, in which these issues can be dealt with at some stage in the future. We would say to the government, to the Council of Australian Governments, through its sponsorship of this body that is to be established, do not think that the passage of this legislation is the end of the game when it comes to solving health workforce shortages around Australia. This bill is a terrific step, but it is only one component of a very complex set of issues about why we do not have enough people working in hospitals, in aged care and community care today, and why, once this legislation is passed, we must continue to work to address those other issues.

It is our hope—indeed, it is why we put the effort, some 10 months ago, into proposing that a body like this be established—that this in time becomes the forum in which all of these issues can be properly addressed to improve the availability of staff for today and into the future to serve the sick and the elderly around Australia. Thanks, Senators.

CHAIR —Thank you, Mr Laverty. Senators, you have time for one question each. I am just going to say thank you for putting aged care into the discussion, Mr Laverty. It is the first time that it has come up in the submissions we have had.

Mr Laverty —Thank you.

Senator ADAMS —I will ask you about the research side of Health Workforce Australia, a question I asked the group before. In relation to the Australian Institute of Health and Welfare, how do you see them fitting into the research arm of this body?

Mr Laverty —I would hope that it remains, as it is today, an independent entity. But there is a risk that, when you put everything under the one umbrella, you are not necessarily having the sufficient diversity of opinion that I think is healthy in these types of questions to lead yourself to what are sensible solutions. So whilst Health Workforce Australia needs to take on a policy, a research function, I would hope very much that that does not necessarily mean that we are somehow rearranging the responsibilities that the institute has at the moment, and that it can retain the independence and the premier position that it has as the provider of reliable and independent data on health workforce and other issues affecting the Australian community.

Senator ADAMS —Good, thank you.

Senator CAROL BROWN —I want to talk about what effect you think Health Workforce Australia may have on the workforce shortages, particularly in the rural and remote areas. How do you think that going to this new system will assist in that area?

Mr Laverty —We have been in a fortunate position of being able to work with the National Health Workforce Taskforce, and I would like to commend their CEO, Peter Carver, for the way in which he has undertaken a consultation process with the non-government sector, the not-for-profit sector, to provide for us an opportunity to contribute to how the clinical placement structure is likely to operate at the coalface. One of the operational proposals that is being considered is that regions be established to oversee the operation or allocation of clinical placements to government hospitals, to non-government hospitals, and to interrelate with the university and the training system. That provides the opportunity for rural, regional and underserved areas to be properly represented. If regions around Australia are established, and if there is an equitable allocation of resources—and, again, that would be for the board of governance of Health Workforce Australia to properly oversee—we would have a degree of confidence that, by having a new focus on clinical placements in country, regional and underserved areas, this would enable students to undertake their training within those country, regional, underserved areas. As the evidence that was given before me indicated, if a person undertakes their training in a country area, they are more likely to stay or contribute to that particular geographic area. That also opens up the important need for a reporting mechanism to ensure that when Health Workforce Australia reports back to the Australian parliament, through either an estimates process or its annual report-back to the minister, there is a transparency or an accountability in place to ensure that country and underserved areas are properly addressed.

How do you best do that? Our hospital network is broadly represented in parts of country Australia. We have some 550 aged-care providers around Australia. Our aged-care network is perhaps the dominant provider of aged care in country, regional and underserved areas. Our country hospitals, our aged-care providers, are most interested in creating and providing opportunities for nurse clinical placements and medical clinical placements within country areas. That will only be properly put in place if the balance of the allocation of clinical placements between government and non-government service providers is properly managed and the voice of aged care is very firmly represented at the board table. I have a concern that aged care could very easily be lost in this process, because the needs of doctors, the needs of nurses in urban settings, are very obvious, and that has perhaps been a traditional method by which we have trained doctors and nurses in the capital cities and within some of our own hospitals—the Brisbane Mater; St Vincent’s in Sydney and Melbourne—so we are guilty of that to a certain extent. But this is an opportunity for a circuit-breaker, to say that there is a strong network of hospitals and aged care run by the non-government sector in Australia, which are in a position to access the opportunity that these new clinical placements provide, and the only way we will ensure that is if the governance arrangements of the establishment of Health Workforce Australia give proper regard to aged care and country and regional needs. That is the role that we will be focusing on as Health Workforce Australia moves to its establishment and implementation stage.

Senator BOYCE —Mr Laverty, are you suggesting then that Health Workforce Australia should be taking over all planning for workforce or, as earlier submitters have suggested, that their role should be some oversighting and some development of innovative models by Health Workforce Australia in the planning area?

Mr Laverty —If we get it right, that is the opportunity that HWA has. At the moment, the different states and territories and the Commonwealth each undertake their own individual initiatives in attraction, retention and governance.

Senator BOYCE —But you are seeing Health Workforce Australia operating at a high level, not at an individual placement level?

Mr Laverty —I think that if it were to find itself caught up in the detail of the individual placements it would spend all of its time on that and it would be ignoring the goodwill and the infrastructure that already exist to take care of that. The universities, the hospitals and the aged-care providers are properly positioned to oversee the clinical placement allocation around the country and we think the proposal for the establishment of health regions to which responsibility is given for the allocation of places is a model that has a degree of merit. There are some others that we would seek to explore in more detail.

The role of Health Workforce Australia at a national level should certainly be to bring to one place the coordination, the policy planning, of national strategies so that we do not have, as we have at the moment, states competing against each other to attract nurses and, in effect, stealing them from each other. One of the initiatives that we have put in place in this current uncoordinated environment is a program called Nurse the Nation and I would invite you to visit

CHAIR —Is Nurse the Nation yours?

Mr Laverty —It is a Catholic Health Australia sponsored initiative. It is seeking to provide opportunities for nurses around Australia to find job vacancies and to easily transfer themselves around the nation from one hospital to the other, recognising that the history of Federation means that that is a pretty complicated thing. We have put in place our own arrangement whereby you might, through a very simple website, register your interest in working in another state, and the hospital that is looking to appoint someone with your qualifications then takes care of that easy transfer to get you to that job anywhere in Australia. That is something that the Catholic community has put in place in response to the lack of coordination that currently exists between states, territories and the Commonwealth.

I would encourage all governments around Australia to put a clause or a sunset provision into their own workforce initiatives at the moment and, at a point in time, roll them all into Health Workforce Australia. If we set it up right, if it is given the support that it needs to do the job properly, it provides that opportunity in the years ahead.

Senator BOYCE —I think we have had almost unanimous concerns raised about the structure of the board. How would you propose that the legislation would be amended in that area?

Mr Laverty —Greater balance needs to be given to those who work outside the government sector. Greater balance needs to be given to the university sector. Greater balance needs to be given to private hospitals, to not-for-profit public hospitals, to aged care. There should be an acknowledged provision for a space on the board of governance to address the needs of the aged-care community. If it is not there, it will become the second cousin to the hospital network. The government representation should be in the majority. The majority of funds are coming from government. This is a government initiative. We are not arguing against that, but we certainly think there could be a greater balance.

We are not actually asking for dedicated positions, either. We do not think that would necessarily be helpful. But we would be seeking, in the construct of this board, a greater balance. At the moment there is a representation of, if I am accurate, nine—or, rather, eight government positions to—

Senator BOYCE —Nine government positions.

Mr Laverty —So it is nine government positions to four. That is a two-thirds/one-third allocation and we do not think that provides sufficient balance.

Senator ADAMS —I have a question on the way the board is made up. With the amount of money that is going to be allocated to the organisation, do you think that you should have people with legal and/or financial skills on that board? This is a very complex thing, because you have got representation from the states and territories. We do not know who those people are going to be, whether they are high-profile government officials or how much practical background they have got, and then we have got this one member to be nominated by the Commonwealth and, once again, we do not know where that person is coming from. How do we make sure that the chief executive officer in the day-to-day management has got the financial skills or the legal skills? I just see this as an area competing with your organisation, with all the allies—the nursing, the universities. Should the research arm have a place there? It is getting to be a very heavy type of board and we have really only got those three positions available. I am just trying to tease out where we go with this. What is important?

Mr Laverty —I would not be proposing to this committee that specific portfolios be allocated. I think all of us have experience on particular boards, and it is an unusual arrangement where, particularly in legislation, you say, ‘There shall be one lawyer and there shall be one accountant.’ I do not think that is necessarily the solution. I have a degree of faith in the ability of the selection process to ensure both a representation of the various interests that need to be on the board and a mix of—

Senator BOYCE —You are suggesting that the states would consult each other on this, Mr Laverty, are you?

Mr Laverty —I would not dare suggest that for a minute! But I have a degree of confidence that the Commonwealth, in exercising its selection power, will give opportunity to ensure there is a sufficient professional skill set. The funds that have been allocated on an annual basis—from memory there is $25 million in year 1 for the establishment of the staff and I think that rises to $35 million in year 2—suggest that there should be the ability to employ sufficient legal counsel on the staff of HWA and to have sufficient financial advice, which will work its way up to the board.

This board should have the job of representing the sometimes diverse—in fact, nearly always diverse—interests of the healthcare community. I think that is the proper role of this board of governance. Is its current proposed size sufficient to achieve all of those interests in the one go? Perhaps not, and there is an opportunity to consider if we need to be reviewing the size of that board. I would not want to leave this inquiry with the suggestion that we want to go to war on that one. I am quite happy, with all of the gains that this particular bill is giving, to live with some of the downsides, and if it is only governance and board positions that might be the concern before this particular inquiry, I would say, ‘Vote yes in the Senate and let’s get on to actually establishing it. We’ll work it out as we go along.’

Senator ADAMS —I do not look at it that way, but the board sets the direction. This board is supposed to start on 1 July this year. If you do not have the right direction, where are you going to go with the rest of it? That is the reason that I have been concentrating so much on the composition of the board, because I have seen boards fail, as you will have, and there has been a reason: because they have been put together too quickly and their role has not been defined.

Mr Laverty —It is for that reason that the only black mark we put against this legislation is whether or not the governance arrangements are right. We think there is an opportunity for a slight expansion in the size of the board, to bring balance to the non-government and not-for-profit sector so that we are properly ensuring this board does have all the representative interests in the one place, and we are then putting faith in the selection process to ensure that the right people are selected, because I do not think you can ever enshrine in legislation the selection process to ensure that you get the right people. That needs a degree of discretion and, indeed, the opportunity for the minister to withdraw a board director’s commission if an appointment is made that is later found to be inappropriate.

Senator CAROL BROWN —Health Workforce Australia is about taking a national approach, and you in your submission talk about the perception that state and territory health departments have focused more on workforce needs or their own publicly operated services than the entirety of the health system and your hope that Health Workforce Australia will see the end of a more narrow, short-term approach. It is great that the federal government has got the states and territories together and that they have come together and signed off on a COAG agreement. In terms of governance, you would understand that there would need to be their stake in that board as well, and to me that is pretty simple to understand, because you want them to stay on board and you want them to implement any changes or reforms across the nation. That brings me to the expert committees, which to me is where you have that opportunity to bring in the professionals that have worked in the area and know what is going on. I suggest to you that at this point in time we obviously need the states and territories to be involved quite closely.

Mr Laverty —I think in my opening remarks I suggested that the nine positions that exist for governments are appropriate, given that that is where the funding is coming from. I would, however, point out that the Catholic sector alone, across our 75 hospitals, has 10 per cent of all hospital beds in Australia. So one in 10 hospital beds is operated by the Catholic community. That makes us larger than some states that are going to have representation around this board table.

Senator CAROL BROWN —That is Tasmania.

Mr Laverty —I wouldn’t dare suggest it! In that context, I would be seeking that the board, from its establishment, have regard to the non-government sector, and in that I refer to the for-profit private hospitals and the not-for-profit private hospitals operated by the Catholic Church and, indeed, some other faith based organisations around Australia.

A substantial amount of hospital care—in our case, one in 10 beds nationally—is operated outside of the government sector, so it would be a lost opportunity if we allowed the establishment of a board of directors, and indeed an agency, that was not properly focused on the fact that this large amount of training can occur outside of the government system, with the opportunity for more training to occur outside of the government system.

Again, our discussions and involvement with the National Health Workforce Taskforce to date have given us the confidence that the needs of the not-for-profit sector in an operational sense are currently being considered. The National Health Workforce Taskforce is to be commended in the way that it has gone about involving the non-government sector in its work. I am looking to ensure—and, indeed, looking to enshrine—through the establishment of the governance arrangements that that role for the not-for-profit sector, hospital and aged care is properly considered so that in a few years time you do not have to have people like me agitating to say, ‘We got this wrong back in 2009 when we set it up.’

CHAIR —Senator Boyce, you have a couple of questions on notice.

Senator BOYCE —Yes. Firstly, does Catholic Health Australia represent the Catholic private hospitals and the Catholic educational institutions offering health teaching?

Mr Laverty —Within the membership of Catholic Health Australia are 21 public hospitals, 54 private hospitals and 550 aged care providers.

Senator BOYCE —So not the teaching institutions?

Mr Laverty —Sorry, eight of our hospitals are teaching institutions, within which universities, both Catholic and non-Catholic, have a substantial presence.

Senator BOYCE —The question that you may want to take on notice is the number of clinical placements that Catholic Health Australia currently offers.

Mr Laverty —To date?

Senator BOYCE —If you could break those down by profession, that would be good.

Mr Laverty —We will have a go at that.

CHAIR —You do not have those on tap, Mr Laverty?

Mr Laverty —Hardly.

CHAIR —Thank you very much for your submission and your evidence.

Mr Laverty —Thank you.

[11.32 am]