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Community Affairs Legislation Committee
28/02/2018
Estimates
HEALTH PORTFOLIO
Department of Health

Department of Health

[9:04]

CHAIR: I now welcome Senator the Hon. Bridget McKenzie representing the Minister for Health and officers of the Department of Health. Ms Beauchamp, it's good to see you. Minister, do you wish to make an opening statement?

Senator McKenzie: No, I don't, thanks, Chair.

CHAIR: All right then we will get started on cross-portfolio corporate matters. Senator Watt.

Senator WATT: Welcome, Minister/Deputy Leader. It's a pleasure to be on this side of the table from you. I'm sure you'll find it a pleasure as well.

Senator McKenzie: It's great to be here too, Senator Watt.

Senator WATT: We have deliberately tried to keep our number of cross-portfolio matters to a minimum so that we can home in on programs, but there are probably two or three cross-portfolio issues that we want to raise because they do seem to cross a range of programs. The first is to do with medical schools in Australia. Ms Beauchamp, this might be more properly directed to you, but, if you've got other people you want to bring up, that's fine. Do you know how many medical schools there are in Australia at the moment?

Ms Beauchamp : I will call on the experts in terms of the exact number of medical schools across Australia.

Mr Hallinan : There are 21 medical programs I believe from 20 universities.

Senator WATT: So there is one university that offers more than one?

Mr Hallinan : There's one that offers more than one and there is a new private one, so I'll correct that. I think it's 22 now.

Senator WATT: So 22 in 21 universities approximately?

Mr Hallinan : Yes.

Senator WATT: Do you know approximately how many students graduate from medical schools in Australia each year?

Mr Hallinan : It's roughly 3,200 Commonwealth supported students and around 500 international students per annum.

Senator WATT: That's good. I was going to ask you for a split between domestic and international. When you say 'Commonwealth funded places' are they the domestic students?

Mr Hallinan : Yes, funded through the department of education grants arrangements.

Senator WATT: So 3,200 Australian students graduate every year?

Mr Hallinan : Approximately.

Senator WATT: Do you know how many internship places there are every year? I think that's another way of saying training places once they do graduate.

Mr Hallinan : There have been enough internship places in the system to cope with all graduating doctors certainly for the last five years. I'm not sure precisely what the number is, but I know that there are vacancies in states at the moment for internship positions.

Senator WATT: I understand that some of these internship programs are funded by the Commonwealth and some are funded by the states; is that correct?

Mr Hallinan : Yes. The states provide a guarantee for internships for Commonwealth supported students and the Commonwealth has a small internship program called the Commonwealth Medical Internships program for 100 internships provided for international students.

Senator WATT: But you are saying that even at the present day there are more internship places available in Australian hospitals for new graduates than there are new graduates?

Mr Hallinan : This year I think we filled 87 of the 100 places in the Commonwealth Medical Internships program.

Senator WATT: They're for the international students?

Mr Hallinan : They're for the international students. By state and territory I understand—I don't have the precise details, because it's not something that we administer as a department—there are somewhere in the order of 30 or 40 vacancies across the country.

Senator WATT: Sorry, could you just say that last bit again?

Mr Hallinan : Somewhere in the order of 30 to 40 vacancies across country is the last information I have from my colleagues.

Senator WATT: Is there any difference between internship places available in urban hospitals and the rural and regional ones?

Mr Hallinan : In what way?

Senator WATT: Are there more vacancies for internships in rural and regional hospitals than there are in urban hospitals?

Mr Hallinan : I don't have that information.

Senator WATT: I'm thinking that everything we hear about the rural health workforce is that it is difficult to find people to work in rural and regional environments, and I would expect that would be the case for the internships as well?

Mr Hallinan : I wouldn't want to make that judgement.

Senator WATT: Maybe if you could take that on notice for us?

Mr Hallinan : Yes. I will see what I can do, but it's not information that we hold. It's something we would have to try to obtain from states and territories.

Senator WATT: You're probably aware that some health stakeholders have made public comments expressing concern about the lack of opportunities for rural students to undertake their internships in rural settings. I've got some of those quotes here, but have you seen some of that commentary as well?

Mr Hallinan : Yes, we're aware of that.

Senator WATT: For instance, the Australian Medical Students' Association has said:

Many graduates of our existing rural medical schools desperately want to stay in rural locations to undertake the next stage of their training, but they can’t find the training places or rotation opportunities they need.

Is that a fair assessment of the situation?

Mr Hallinan : Certainly that's the feedback that we have from some of the stakeholders in the sector. A concern that's been raised with me is one where students, who may be graduating in a rural location, may have to move to a city for an internship.

Senator WATT: Because they can't find an internship in a rural and regional setting?

Mr Hallinan : Potentially, yes.

Senator WATT: There are more graduates in rural settings than there are places for them to undertake their internship rurally?

Mr Hallinan : I'd have to say that that's anecdotal information that's provided to the Commonwealth through some of our consultation forums. We don't have clear data on precisely where the internships are located though.

Senator WATT: From the department's point of view, you don't know for sure what the balance is between rural graduates and rural internships, but the feedback you're getting from stakeholders is that they're out of whack?

Mr Hallinan : You quoted the Medical Students' Association, and we've had similar feedback from that organisation.

Senator WATT: I will put to you a couple of other comments. Again, the Australian Medical Students' Association has said:

The problem that we face at the moment is a shortage of specialty training places in rural areas … any new medical school in a rural area is unlikely to actually provide for rural doctors …

Do you agree with that comment?

Mr Hallinan : There is a challenge around vocational training places, particularly for non-general practitioners, in rural Australia. The Commonwealth's had a couple of programs in place to try to assist in the creation, or establishment, of specialist training arrangements or vocational training arrangements in rural areas, one being a specialist training program. The predominance of training for vocational medicine is provided by states and territories through the hospital networks. The Commonwealth's role has largely been to try to increase the capacity for training in rural areas but, yes, that's been something that has been raised with the department for a number of years.

Senator WATT: The only other one I was going to put to you is from the Medical Deans Australia and New Zealand who say:

…the most important answer to the geographical inequity in our health workforce lies in creating 'flipped' training programs that allow doctors to complete their specialist training in regional areas…

Again, as you say, the feedback you've been getting, and consistent with these kind of comments, is that there is concern about there not being enough rural training places for rural graduates—that's a fair assessment of the feedback?

Mr Hallinan : Yes. We have had other feedback around whether or not there's enough training happening in rural areas, in general, at undergraduate levels as well. In fairness, there has been both feedback to say that there is, potentially, not enough vocational training—so post-graduation of medical school in rural areas—to support an end-to-end continuum of training but also that there could be some capacity for expanded undergraduate training in parts of rural Australia.

Senator WATT: I know that there's a specific proposal floating around for a new medical school in regional Australia and that's the Murray Darling Medical School. Does the department have a view on that proposal?

Mr Hallinan : There's been a proposal from Charles Sturt University and La Trobe for a joint medical program through the Murray-Darling region. There's been no consideration by government on that proposal, but the department has been doing some reviews of undergraduate training arrangements and vocational training arrangements that will be considered by government at some stage in the near future.

Senator WATT: Based on that feedback that you've received from stakeholders, do you think there's a need for a new medical school in regional Australia at the moment?

Mr Hallinan : I can't answer that at this stage. There's been quite a lot of feedback, and it will be subject to consideration of government.

Senator WATT: Has any estimate—

CHAIR: Can I just jump in there, Senator Watt? What would be the process? Who would make a final determination as to whether a new medical school should be established?

Mr Hallinan : A medical school would be funded through the Commonwealth grants arrangements from the department of education. In order to do that, you'd require new policy consideration of the government through a cabinet process. There may be supplementary funding through the Department of Health through some of the programs that we run as well.

Senator WATT: Did you give me an answer on whether any estimate has been undertaken to determine the cost of this new Murray-Darling medical school?

Mr Hallinan : I think the proposal itself had some costs in it. I'm not sure what they were off the top of my head. It's been around for a number of years now.

Senator WATT: Over the morning tea break or once we finish asking questions, could you try to work out what that cost is that you've been provided with. Can you call someone back at the office?

Mr Hallinan : Yes.

Ms Beauchamp : We're supporting government in considering a number of options in this place and I think we're probably not in a position to provide you with details of the costings until the minister and government have considered the proposals coming forward.

Senator WATT: Why is that?

Ms Beauchamp : Because they're probably cabinet and budget in confidence

Senator WATT: But what Mr Hallinan was saying is that it sounds like Charles Sturt and La Trobe have themselves put to you an estimate of the cost, so I would be interested to know what they think. That's not something that government is deciding.

Ms Beauchamp : We would be able to provide information that's publicly available from those organisations, but, in considering any further options, I think that is, as Mr Hallinan said, a decision for government.

Senator WATT: I've never heard of a medical school being built in Australia for a million dollars. We're talking usually tens of millions, if not more than a hundred million dollars for a new medical school, aren't we?

Ms Beauchamp : It's not for me to speculate on the exact costs.

Senator WATT: Well, what's been the cost of the most recent medical school that has been established in Australia? We're not talking 50c.

Mr Hallinan : The most recent one—

Senator McKenzie: No, Senator Watt, you're probably right—not 50 cents.

Senator WATT: So we're talking at least tens of millions of dollars.

Mr Hallinan : I think the most recent one wasn't government funded.

Senator WATT: The most recent government-funded one would be at least tens of millions of dollars between the capital, research staff, the teaching staff—

Mr Hallinan : I'd have to take it on notice. I think Curtin in Western Australia was probably the last one we were involved with.

Senator WATT: Senator McKenzie, can you confirm whether the Murray-Darling medical school is in the coalition agreement between the Nationals and the Liberals?

Senator McKenzie: No, I can't confirm that.

Senator WATT: Is that because you don't know what's in the agreement?

Senator McKenzie: I said I can't confirm that.

Senator WATT: Have you seen the coalition agreement?

Senator McKenzie: I think that is outside the budget parameters, and those questions were addressed to Senator Cormann yesterday or the day before.

Senator WATT: Yes, but I'm asking you specifically about something that—

Senator McKenzie: And I said I can't confirm that. I've answered the question.

Senator WATT: But you're not ruling out that there's a proposal for a new medical school, the Murray-Darling medical school, in the coalition agreement?

Senator McKenzie: I think it's public knowledge that, for many years, the National Party grassroots policy proposal for a Murray-Darling Basin medical school has been on the public record.

Senator WATT: That's the National Party grassroots. What about the National Party members of parliament?

Senator McKenzie: Again, Senator Watt, I've answered it three times. We can keep doing this dance, but I won't be confirming that.

Senator WATT: Why is this agreement so secret?

CHAIR: I think that's outside the parameters of this hearing, Senator Watt.

Senator McKenzie: Senator Watt, I really just don't think—

Senator WATT: The agreement, in a general sense is, but—

Senator McKenzie: Joel's not getting any traction with this. I don't suggest you go down that track.

Senator WATT: You don't think he is?

Senator McKenzie: I think there are bigger fish to fry.

Senator WATT: I haven't come in here to ask a general question about the coalition agreement. I've asked specifically about something to do with the health portfolio that everyone is talking about being in this coalition agreement?

Senator McKenzie: And I've answered the question Senator Watt three times.

Senator WATT: You've answered it by not answering it, by not confirming it.

CHAIR: The minister has addressed the question, Senator Watt. Let's move on.

Senator WATT: Is the government progressing the idea of this new Murray-Darling medical school?

Senator McKenzie: Well, I think the officers have given you the work that they're doing around addressing the maldistribution of rural workforce shortages and maldistribution around health workforce in rural areas, and that's the work that we're doing.

Senator WATT: So it is being considered?

Senator McKenzie: It is across a range of initiatives and places, but I think what Mr Hallinan raised is an important thing to remember in this conversation; it is state governments that determine where the internship arrangements and training places are. I know your own state has done some great work in addressing rural workforce shortages. Other states, such as South Australia, are happy to fly in locums with that additional cost, rather than provide for local training places in the region. So I think it's different state to state. Some do it better than others, but obviously at a Commonwealth level we're seeking to ensure that the maldistribution is addressed—doing everything we can.

Senator WATT: So, based on what you have said and what the officials have said, it does sound like this proposal is being considered by government.

Senator McKenzie: I wouldn't draw that inference, Senator Watt. What you can draw from what I've said and Mr Hallinan has said—

Senator WATT: It may not be the only one.

Senator McKenzie: Sorry, can I answer the question?

Senator WATT: Yes.

Senator McKenzie: What you can take from our conversation is that the government is very, very committed to addressing the maldistribution of the rural health workforce and we have been for many, many years, under ministers other than me, Senator Nash and David Gillespie.

Senator WATT: As a National Party member and as the shadow minister—sorry—

Senator McKenzie: Don't get ahead of yourself, Senator Watt.

Senator WATT: As the Minister for Rural Health, do you personally support this proposal for the Murray-Darling medical school?

Senator McKenzie: I support addressing the workforce shortage.

Senator SINGH: Can I just add to that, Ms Beauchamp actually did say before that this would be a consideration of cabinet, that costings were budget in confidence, so is this being considered by cabinet, Senator McKenzie?

Ms Beauchamp : If I could just clarify, I think there was a process started some time ago, in December 2016, looking at the allocation of medical places and the health workforce more generally, so the department, with the Department of Education, has been talking to a range of stakeholders around the assessment of medical schools and places, and we're in the process, and have been in the process, of consulting—receiving submissions, analysing those—and as part of that process, we will be putting advice to government in terms of the outcome of that review. That commenced, as I said, in December 2016.

Senator SINGH: But, when Senator Watt was asking about the costings, you said that this was budget in confidence?

Ms Beauchamp : I said any proposal would be considered as budget in confidence. I think we're looking at all options. Some of the consultations have happened, some of the proposals have been put forward, and, yes, of course, in our normal course of business, we would be looking at the costs of various proposals put to us.

Senator SINGH: So the Murray-Darling medical school is under consideration in the current budget process?

Ms Beauchamp : We're looking at more broadly medical training places.

Senator WATT: Senator McKenzie, the only other question I've got on this is: what electorates would the Murray-Darling medical school be located in? I understand the proposal is for a multicampus university?

Senator McKenzie: Are you talking about a proposal put forward by La Trobe and CSU?

Senator WATT: Charles Sturt, yes.

Senator McKenzie: Yes. So the Murray-Darling medical school proposal—obviously, as the, name suggests, is in the Murray-Darling Basin—and that doesn't include the Canberra section of the Murray-Darling Basin.

Senator WATT: 'Does not'?

Senator McKenzie: It does not. I know some people say Canberra is part of the Murray-Darling Basin, but obviously if you look where CSU is located, there was a proposal—in the original proposal around Orange, Albury-Wodonga and Bendigo—and Mildura, I think.

Senator WATT: And Wagga Wagga?

Senator McKenzie: Yes, in the public proposal for the Murray-Darling medical school, I can't recall in detail, because it's been around for many years—

Ms Beauchamp : I think Minister Hunt announced it back in October 2017.

Senator McKenzie: I can get you a copy of the original public document, if you like.

Senator WATT: Sure. That would be good. In general terms, what did he announce?

Ms Beauchamp : He announced that consideration was being given to a network of rural clinical schools across the Murray-Darling region.

Senator WATT: You've mentioned towns like Wagga Wagga, Orange, Mildura—

Senator McKenzie: Albury-Wodonga—I'm talking about the CSU La Trobe Murray-Darling Basin proposal.

Senator WATT: Yes. Wagga Wagga is in the federal electorate of Riverina, isn't it?

Senator McKenzie: Yes.

Senator WATT: Which is held by your—

Senator McKenzie: Leader.

Senator WATT: Current new leader, Mr McCormack.

Senator McKenzie: Yes.

Senator WATT: Is this a personal priority for him as the new Deputy Prime Minister?

Senator McKenzie: I'm not sure, but he has been a strong advocate for the Murray-Darling Basin medical school for many years.

Senator WATT: Right. Is it of any concern whatsoever that we've heard that there are already more internship places available in rural and regional settings than there are graduates to fill those places?

Senator McKenzie: The problem is—and I'm happy if the department would like to take you through some of the data they have around the maldistribution of the rural workforce—that, whilst we may be graduating the right amount of medical graduates, they're not all being dispersed in the places that they need to be dispersed in, and that is because state governments are in charge of the internship provisions. Some states, such as your own home state, as I said earlier, are doing a great job; other states, such as South Australia, aren't providing those opportunities for graduates to get their training in the regions. So, because of the way health is delivered in this country, it needs to be a strong partnership between state and Commonwealth, saying, 'Righto, we're going to address the maldistribution.' So I can absolutely guarantee you our priority is to address the maldistribution, and I think the secretary has taken you through a range of initiatives that government has done in the past and that we are looking to do in the future to get it right.

Senator WATT: So your current leader is a strong advocate of the new medical school—

Senator McKenzie: Of health workforce in the regions.

Senator WATT: But you also said he is a strong advocate of this proposal—

Senator McKenzie: Yes, that's all on public record.

Senator WATT: which would include a campus in his electorate for an institution, which you can't confirm is in the coalition agreement or not—but it may well be, and if it ever comes to light we'll know. That's in an environment where we've got more training places than we can fill in rural and regional Australia. Does that seem like a good use of taxpayers' money?

Senator McKenzie: Senator Watt, I think you've conflated a few issues. I'm talking about the original Murray-Darling Basin medical school proposal put forward many years ago—prior to the last election, I think, or even prior to the election before that.

Senator WATT: Was it in the coalition agreement then as well?

Senator McKenzie: I wasn't in the leadership team at that time, Senator Watt.

Senator WATT: So you see it now, but not then?

Senator McKenzie: That's been a very public proposal by CSU and La Trobe for, I think, the last two elections, so that's the proposal I've been talking about, where those campuses would be and what was in that particular document. I think taxpayers—particularly taxpayers in rural and regional Australia—expect us to spend money on ensuring that they have equitable access to health services.

Senator WATT: Absolutely.

Senator McKenzie: Are you suggesting they shouldn't, Senator Watt?

Senator WATT: No, you know I'm not doing that and I could reel off the cuts—

Senator McKenzie: Well, I couldn't quite tell, as you kind of went—

Senator WATT: Do you want me to start going through the cuts to regional health that your government has made?

Senator McKenzie: I am very happy to go through record funding in every state as far as—

Senator WATT: I also think that regional Australians want to see taxpayers' money used well; and, if there are vacancies already in training places, they want to see something done about that before we pump out more medical graduates than can find a job.

Senator McKenzie: I think we can walk and chew gum at the same time, Senator Watt, and we've got a range of initiatives that we are developing and have done and will continue to do to address this problem.

Senator WATT: That's probably it on this topic.

CHAIR: I think we'll move on. I will just see if anyone has any further questions in this particular area. We're verging into an area where—to be honest, I don't think there was a massive crossportfolio aspect to that line of questions. Can we just—

Senator WATT: Infrastructure, workforce—

Senator SINGH: Quite a lot, actually.

Senator McKenzie: He's cross.

Senator WATT: I'm not cross. I will get cross later; don't worry. I'm not cross yet. It's too early to be cross.

CHAIR: If this part of the program is going to have any meaning, we do have to focus on crossportfolio matters.

Senator WATT: Sure. I'm happy for you to give somebody else a go.

CHAIR: Senator Di Natale.

Senator DI NATALE: Firstly, I have general questions on health expenditure. I am interested in an update, the latest figures, the percentage increase in health expenditure since we last spoke.

Ms Beauchamp : Is it on an annual basis, or over the forward estimates?

Senator DI NATALE: I want both, actually. If you have got an update on both, that would be helpful—and where those increases have come from. And let me congratulate you on your appointment, too. I do not think we have had an opportunity to at Senate estimates yet.

Ms Beauchamp : Thank you.

Senator DI NATALE: These are standard questions that I ask at the beginning of every estimates session.

Ms Beauchamp : Indeed. In terms of the 2017-18 budget, there is a total annual expenditure forecast for $94.9 billion, which is a 3.2 per cent increase on the previous year. Over the forward estimates, we're seeing growth rates of health expenditure in the order of 3½ per cent each year.

Senator DI NATALE: Okay, thank you. Where is that coming from, predominantly?

Ms Beauchamp : In terms of which programs?

Senator DI NATALE: Yes.

Mr Wann : The overall whole-of-government movements in expenses, just looking at the big programs—the MBS, the PBS and the like—for 2017-18 at MYEFO was $23.792 billion for the MBS—

Senator DI NATALE: What percentage increase does that represent?

Mr Wann : close to four per cent, 3.9 per cent—and, for the PBS, $11.717 billion. That's a reduction of 5.2 per cent.

Senator DI NATALE: A 5.2 per cent reduction?

Mr Wann : Yes, year on year.

Senator DI NATALE: What do you attribute that reduction to?

Mr Wann : That would be a result of savings measures in that space, plus new and amended listings, plus parameter variations based on actuals coming through—so, rebasing our anticipated expenses.

Senator DI NATALE: And you might have something to add, Mr Cormack?

Mr Cormack : Yes, certainly, the measures that Mr Wann outlined are part of the story. The single biggest contributor to containment in growth in the PBS has been due to price disclosure arrangements. And I think that needs to be considered in the context of the government's policy commitment to list all PBAC approved medicines. With that policy parameter in place, we are still able to achieve sustainable growth in the financial outlays.

Senator DI NATALE: So there has been a 5.2 per cent reduction—that $11 billion represents a 5.2 per cent reduction. Is that right?

Mr Wann : That is year on year. In terms of over the forwards, there's a slightly different profile.

Senator DI NATALE: Can you talk to that? There are obviously some price disclosure changes that have just recently passed.

Mr Wann : Price disclosure does have its ongoing impact, and this obviously does not take into account possible new listings that might occur in the future. So it's based on the existing cohort of medicines that we've got in the program and the effects of previous policies on those.

Senator DI NATALE: Okay, understood. Good. Okay—the other programs? I just wanted to know if price disclosure was the biggest factor behind that 5.2 per cent, I think.

Mr Wann : Yes, it would be. For private health insurance, it was $6.361 billion. That's a two per cent increase.

Senator DI NATALE: That is effectively the rebate, yes?

Mr Cormack : Yes.

Mr Wann : Yes. Hospitals—

Senator DI NATALE: Sorry, can you give me what the forecast is over the forwards for the PHI rebate?

Mr Wann : Yes. In 2017-18 it is $6.361 billion; in 2018-19 it is $6.504 billion; in 2019-20 it is $6.647 billion; and in 2020-21 it is $6.812 billion.

Senator DI NATALE: Okay, so we're approaching $7 billion over the forwards. Thank you.

Mr Wann : Other major hospitals for 2017-18 are $19.563 billion. That's a five per cent increase. Primary care, including mental health, is $1.535 billion.

Senator DI NATALE: Okay, that's all I need—that's great. That's all I wanted with regard to some of those top-line issues. I have a couple of other whole-of-portfolio issues. Some are on Closing the Gap, and I also have some stuff on welfare testing. I suppose the question that I have now is whether the department was consulted on the reintroduction of drug testing for welfare recipients.

Ms Beauchamp : Senator, we've been involved with the Department of Social Services for some time on this project.

Senator DI NATALE: Have you provided advice to the department regarding the very significant concerns that have been expressed by a number of health experts, particularly experts in the drug and alcohol field?

Ms Beauchamp : We've provided advice in relation to the availability of treatment services and the like in the particular areas that are being looked at.

Senator DI NATALE: You've provided advice in terms of treatment availability but not in terms of the concerns that people have about other aspects of the trial?

Ms Beauchamp : The Department of Social Services is responsible for the policy around this in terms of informing government.

Senator DI NATALE: I'm aware of that, but I suppose that the Department of Health has the expertise when it comes to drug and alcohol treatment, and to aspects relating to the professional care of individuals who may have used illicit substances. Have you provided advice in terms of the concerns that many drug and alcohol clinicians have expressed regarding the trial?

Ms Beauchamp : We've been providing advice all the way through on a whole range of matters.

Senator DI NATALE: Including expressing concerns from those drug and alcohol academics and clinicians?

Ms Beauchamp : In terms of expressing concerns, I think those would have come from the stakeholders and not specifically from us.

Senator DI NATALE: With regard to stakeholders, can I ask—I have to remember the new acronym for the illicit drug advisory group. Is it ANCD? What's the—

Dr Studdert : I think you're referring to ANACAD, the Australian National Advisory Council on Alcohol and Drugs.

Senator DI NATALE: ANACAD, that's right, yes. Have they provided any recent advice to the department?

Dr Studdert : No, Senator.

Senator DI NATALE: When was the last time ANACAD met?

Dr Studdert : I don't have that quite at hand. I can get that to you shortly.

Senator DI NATALE: But they haven't provided—

Dr Studdert : It was late last year.

Senator DI NATALE: So they haven't provided any advice that you're aware of to the Department of Social Services regarding the trial and the introduction of the trial?

Dr Studdert : No, Senator.

Senator DI NATALE: Why have a drug advisory group if they're not providing advice?

Dr Studdert : They provide advice to the Minister for Health and other ministers in the portfolio on a range of matters both based on requests that they get from the ministers or that they provide based on their technical knowledge and expertise. But on this matter they have not.

Senator DI NATALE: You've got an expert body set up and it's made up, effectively, of drug and alcohol experts. It's there with the explicit intent of providing advice and you're about to implement a trial of drug testing for welfare recipients, but the department hasn't sought advice from the advisory body with expertise in this area?

Dr Studdert : As the secretary said, the Department of Social Services has been the lead on this policy initiative. We provided advice on a range of matters, largely on request, including around services funded in the areas that are being looked at, but that has been the extent of that at this stage.

Senator DI NATALE: But don't you find it remarkable that you would have an expert body set up with the intent to provide advice on drug and alcohol issues and the department has not sought advice from it?

Dr Studdert : I couldn't comment on that.

Senator DI NATALE: I can. Perhaps I can ask you why hasn't advice being sought from the expert committee on drugs and alcohol?

Dr Studdert : I would have to check the range of matters consulted on over the last year. But, to my knowledge, at this stage, that has not been raised with them.

Senator DI NATALE: Let me ask then about the accuracy and reliability of drug testing. Who is providing that advice to the department?

Dr Studdert : On the general issues of accuracy and reliability of drug testing and the nature of treatment services, we work with the PHNs to fund treatment services. They work closely with providers in their regions. We have our own medical advisers in-house that provide us with a range of advice on technical issues related to testing and treatment and services that are contemporary and best practice, and that is shared with PHNs and other entities that we work with.

Senator DI NATALE: Have you made any changes to the trial since it was rejected by the Senate last year? Sorry, have you recommended any changes to the trial since it was rejected?

Dr Studdert : I would have to check on that. I don't believe so. As I have said, we have provided advice on request as the measure has evolved.

Senator DI NATALE: With regards to the advice you have provided around treatment, recent analysis shows that demand outstrips treatment two to one. Has that been a feature of the advice you have provided to the Department of Social Services?

Dr Studdert : We have provided advice on the range of services the Commonwealth funds in the areas that have been looked at. The availability and access varies across the country and it varies over time. So in terms of specific availability in specific regions, we can get up-to-date advice at any point in time from PHNs as they may happen to know about it but it is also something that does change over time. The secretary has just asked me about providing additional funding. There is an intention with the trial to provide additional funding to bolster access to services in areas where this trial will be conducted. That is a good point.

Senator DI NATALE: I will have more questions later on specifically around that. I will ask a couple of questions around the recent Closing the Gap report. I know that this will be handled in a later estimates session. I am interested in the fact that we had the 10-year anniversary of Closing the Gap and we see a number of targets still yet to be met and, in fact, some questions about whether existing targets were on track to meet even those ones where it looks like there might be some progress.

The thing I am most interested in is that there is clearly underspending of MBS and PBS item numbers. When you consider the burden of disease in those communities, there is a significant underspend when it comes to MBS on PBS expenditure. It is about half and one-third respectively of what is needed to address the burden of disease. In short, if you look at access to Medicare item numbers and you look at the burden of disease, we are only accessing Medicare about half of what is required. We are seeing Aboriginal people only accessing about half of what is required and, with regard to the PBS, one-third of what is required if were to meet existing burden of disease. And of course we know that that is associated with a much higher level of preventable admissions. What strategies has the department got in place to ensure that we see better access to MBS and PBS items, so that we can actually make some progress to closing the gap?

Ms Beauchamp : Before I ask Ms Edwards to respond, I just want to check with the chair: normally Fridays is allocated—

CHAIR: This would normally be Friday.

Senator DI NATALE: This is about MBS and PBS expenditure.

Ms Beauchamp : I'm happy to answer it, but—

CHAIR: I did listen to the framing of the question, I think the senator has framed it in such a way that—my position is to answer it to the degree you can answer it but refer it to Friday if you think that the correct people to answer the question will be more available then.

Ms Beauchamp : That's absolutely fine. We can do that, particularly in the context of MBS and PBS. The other thing is do I assume we have finished cross-portfolio? We're traversing a number of program areas, or outcome areas. It doesn't matter, but—

CHAIR: Cross-portfolio has always been one of these grey areas. I suspect we need to wipe it from the program, because it's not used correctly. We really appreciate the latitude that the department gives us in this area. Answer to the degree you feel able to answer it, but with knowledge that it will be more fully answered on Friday.

Ms Beauchamp : Okay, so I might hand over to Ms Edwards, thank you.

Ms Edwards : Going to MBS and PBS and access to those programs by Aboriginal and Torres Strait Islander people, we understand there's a gap in access and so on, and that's one of the things that is part of our strategy in order to improve the health of Indigenous people. Just to go back one step, I wouldn't like to leave the impression that we agree that that’s the sole or predominant strategy in order to improve the health of Aboriginal and Torres Strait Islander people. It is an important part of what we are doing.

Senator DI NATALE: Part if it—yes, I agree.

Ms Edwards : As you would be aware, we also have a specific Indigenous health program. That's an important part of work, but it's set inside the context of the whole of the health department. We work very closely together and with colleagues across the Commonwealth on increasing access to the MBS, both MBS access through people who visit an Aboriginal controlled community health centre and also those, about 51 per cent of Aboriginal and Torres Strait Islander people, who go to a non-ACCHO related service, increasing access to those, increasing the take up of item 715.

Senator DI NATALE: Yes, I suppose my question is how. The outcome would be an increased access to MBS and PBS, but how are you going to do it?

Ms Edwards : We're using existing levers, including the Indigenous incentive. I wasn't prepared for these questions fully, so I haven't got the key details of it, but there's an incentive for practices who deal with Aboriginal and Torres Strait Islander patients. We're having a good look at that to make sure it's dealing with what we need to do. We're actually interrogating our data much more carefully, because, as you say, we know there's a gap between the access by Indigenous and non-Indigenous people. But our identified data is patchy. Not a huge number of Aboriginal and Torres Strait Islander people choose to identify through Medicare as Indigenous, so we want to make sure that we increase that data so we can watch what's going on. We know that 35 per cent-ish of poor health is caused by things other than the health system for Aboriginal people, and that's going to have an access both on their actual health and, we know on education, employment—all those others things. We also know that things happening outside the health centre have an impact on whether Aboriginal and Torres Strait Islander people seek medical care, and follow through with their treatments and so on. So we're working with our colleagues across the whole Commonwealth to make sure Aboriginal people do seek access to care and so on.

It's a much broader question than just having access to MBS and PBS. You would be aware that there's a specific PBS program to make sure that Aboriginal and Torres Strait Islander people can access medicines at a cheaper rate, and we're having a look to make sure that's got the coverage it does. There were some measures last year to make it easier for dispensing of remote medicines. We're looking at those, how we make sure we do that. It's a multipronged approach. But, yes, we accept that there's some work still to do to make sure that we have parity in access to MBS and PBS, and perhaps above parity if it's needed, through the whole range of services.

Senator DI NATALE: If you've got anything more you want to put on notice, I'd appreciate that.

Ms Edwards : Happy to do that.

Senator WATT: For the next bracket of questions I had, you might need some of the preventative health people as well. It covers preventative health and public policy research, but particularly focusing on tobacco. Ms Beauchamp, can you confirm whether Australia is a signatory to the World Health Organization's Framework Convention on Tobacco Control.

Ms Beauchamp : I'll wait for the relevant officers to arrive.

Senator DI NATALE: I've also got some questions in this area as well.

CHAIR: Okay, but again I feel we are going into a specific program area, so I will ask you, Ms Beauchamp, if you feel that the questions have strayed too much into a portfolio area where the correct officers are not in the room, to refer them to the later session.

Senator WATT: I'm going to try and keep these questions fairly general.

Ms Beauchamp : We're in outcome 2, so I'm happy to make sure the relevant officers are here.

Senator WATT: Can you confirm that Australia is a signatory to the World Health Organization's Framework Convention on Tobacco Control?

Dr Studdert : Yes, Australia is.

Senator WATT: What's the department doing to enforce and implement the convention in Australia, in general terms?

Dr Studdert : There are a range of articles and elements of the convention. I'd have to get you some detailed advice, article by article, but I think it's fair to say Australia's considered a leader in the international arena in terms of enacting the convention, and tobacco control measures more broadly.

Senator WATT: There's a particular recommendation for article 5.3 of the convention that states:

Parties should, in addition, raise awareness about the tobacco industry's practice of using individuals, front groups and affiliated organizations to act, openly or covertly, on their behalf or to take action to further the interests of the tobacco industry.

Are you aware that's one of the recommendations of the convention?

Dr Studdert : Yes.

Senator WATT: Again in general terms, can you tell us what damage is caused either to individuals or to the health system through smoking?

Ms Beauchamp : I might hand over to the Chief Medical Officer.

Senator WATT: There he is—Professor Murphy.

Prof. Murphy : The health effects of tobacco are very well known, as you know. A range of cancers, a range of chronic lung diseases and, in particular, a range of cardiovascular diseases are caused by smoking. The economic costs directly attributable to tobacco abuse are huge—many billions of dollars—but they're well described.

Senator WATT: So, huge economic costs. It's great that we've brought smoking rates down, but is it fair to say that smoking is still one of the deadliest—

Prof. Murphy : That's a fair comment. Smoking is of no value to anybody, and stopping smoking has clear health benefits.

Senator WATT: For people who continue smoking, it's deadly and there are huge economic costs.

Prof. Murphy : Correct.

CHAIR: Again, Senator Watt, we're really in a specific outcome here.

Senator WATT: Well, we've just talked about the cost to the health system, as well as preventative health measures.

Senator DI NATALE: That's a pretty general interpretation. I've got a whole lot of questions on this that I'm holding back for outcome 2. I'm not sure what the relevance is to these guys.

CHAIR: I really think we need to move on.

Senator WATT: Professor Murphy, given those facts, do you think that political parties accepting donations from the tobacco industry is consistent with this recommendation?

Prof. Murphy : I don't think it's appropriate for me to answer that.

Senator WATT: This might be something that either you or Dr Studdert have a view on or know something about. The tobacco control convention also has recommendations about meetings with the tobacco industry. Does the department invite stakeholders from the industry to come to departmental meetings or briefings?

Dr Studdert : No.

Senator WATT: Tobacco industry representatives aren't welcome at departmental meetings or briefings?

Dr Studdert : It's been a long time since there's been anyone from the tobacco industry in the health department!

Senator WATT: I'm very pleased to hear that.

Senator McKenzie: We're adhering to the framework.

Senator WATT: That's good. So the department is adhering to the framework. That's very good.

Senator McKenzie: The government is.

Senator WATT: The government is? Okay. The department's website has a page headed 'Public notification of meetings between the Australian Government Department of Health and the Tobacco Industry'. I notice that the page hasn't been updated since 28 February 2017, which is a year ago today, and the last meeting recorded was 6 October 2016. Can you confirm that the Department of Health has not had any meetings with anyone from the tobacco industry since 6 October 2016?

Dr Studdert : There certainly haven't been any meetings in the department. The department does participate in a cross-government committee around the issue of illicit tobacco, and in that space there have been some consultations—not led by us—from what is now the Department of Home Affairs with industry around that matter. In the past, the department has sat in on those meetings. I would have to check and take on notice whether that has occurred in the last year. I suspect that's the post from 2016 that you mentioned. I'm fairly certain that since then we have not participated, but I can confirm that.

Senator WATT: Okay, if you could—and it might be a good idea to get that page updated as well.

Dr Studdert : I suspect there's nothing to update it with, but, yes, certainly we can do that.

Senator WATT: Minister, you just said that the government adheres to the World Health Organization framework about tobacco control.

Senator McKenzie: Yes.

Senator WATT: Do you know personally how many Australians die from smoking-related diseases each year?

Senator McKenzie: Too many.

Senator WATT: I think it's actually about 15,000 per year.

Senator McKenzie: Yes, it's absolutely devastating, which is why, I think, the coalition government but indeed all governments, Labor and coalition, over many, many years, at a state and federal level, have really led the world in cessation-of-smoking strategies and programs.

Senator WATT: Just to clarify: with the recent portfolio changes, your predecessor in this role, Mr Gillespie, had responsibility for tobacco policy; does that now fall under you as well?

Senator McKenzie: Yes.

Senator WATT: You'd be aware that smoking rates in rural and remote Australia are particularly high, compared to—

Senator McKenzie: Yes, particularly in Indigenous cohorts—yes, I'm aware.

Senator WATT: In fact I think it has been estimated that smoking rates in rural and remote Australia are up to twice as high as in metropolitan areas.

CHAIR: This is clearly a question for a later outcome, Senator Watt. Can we move on?

Senator WATT: I won't be much longer. Minister, given what you've said—that the government adheres to the framework, and the coalition government takes it seriously—do you know how much the federal National Party accepted in tobacco donations in the 2016-17 financial year?

Senator McKenzie: I can take that on notice.

Senator WATT: You don't know that it's $15,700?

Senator McKenzie: I don't. I said I'd take it on notice.

Senator WATT: Right. Your predecessor, Mr Gillespie, has said that he was quite conflicted about your party's acceptance of tobacco donations and that he had personal concerns about it. Do you share those concerns?

Senator McKenzie: I said I'd take it on notice. As you know, political donations are a matter for our party organisation.

Senator WATT: But you've said that the coalition government takes this seriously.

Senator McKenzie: Absolutely.

Senator WATT: The government adheres to the framework.

Senator McKenzie: I think I know the bow you're trying to draw here, but—

Senator WATT: It's not a very long bow; it's a pretty short bow.

Senator McKenzie: if you look at the actual actions—the policies developed, the interaction and work that we do with states, the promotional campaign, our work around illicit tobacco—on every practical and pragmatic measure, to decrease smoking rates in this country, our government is absolutely pursuing—

Senator WATT: Why do you still take their money?

Senator McKenzie: I said that's a matter for the National Party organisation.

Senator WATT: Why don't you, as the minister, the Deputy Leader and, only a few days ago, the Acting Leader of the National Party, direct the National Party to stop taking these donations?

Senator McKenzie: I've said the matter is an issue for the National Party organisation, and I—

Senator WATT: So you have no control over them?

CHAIR: Senator Watt—

Senator McKenzie: as you, as a singular senator; I'm sure if you were directing the federal Labor Party—

Senator WATT: Well, we stopped in 2004. The Liberals stopped in 2013.

CHAIR: Senator Watt, I've given you extraordinary latitude in this—

Senator McKenzie: And that was a decision for your organisation, and rightly so.

CHAIR: Excuse me, Minister.

Senator WATT: It was the right decision, was it?

Senator McKenzie: It's a decision for the organisation.

CHAIR: Excuse me, Minister. Senator Watt. Order!

Senator McKenzie: Sorry; I really want to be clear, Chair, for Senator Watt, because he's trying to infer that a party organisation may or may not—I'll have to check on the value of the donation in the time frame he's speaking about—

Senator WATT: There were three different donations.

Senator McKenzie: What you're trying to infer is that that has affected our determination, as both ministers responsible in this space and part of a coalition government committed to decreasing smoking rates, and the evidence does not substantiate what you're trying to say.

Senator WATT: Except for the fact that smoking rates—

Senator McKenzie: I'm happy to stand by our policies.

Senator WATT: Except for the fact that smoking rates—

CHAIR: These questions have now gone completely outside the bounds of this hearing.

Senator WATT: are twice as high in rural and regional Australia.

Senator McKenzie: And I've said: that's not good enough. That's why we're doing so much to try and change it.

CHAIR: Senator O'Neill.

Senator WATT: No, no; a couple of questions specifically about the minister.

CHAIR: No. Senator O'Neill.

Senator WATT: No, a couple of questions about the minister. Have you or your office had any meetings with anyone from the tobacco industry since you became the minister?

Senator McKenzie: I'll have to take that on notice.

Senator WATT: Well, have you?

Senator McKenzie: I haven't.

Senator WATT: You haven't, and you're going to take on notice whether your office has?

Senator McKenzie: I'll take that on notice about my office.

Senator SINGH: Senator McKenzie, can I finally ask, on that: do you agree that you have a conflict of interest, as the Minister for Rural Health, that your party is taking donations from tobacco companies?

Senator McKenzie: I don't.

Senator SINGH: You don't see that as a conflict of interest?

Senator McKenzie: No, not at all, because I know the work that we're doing to decrease tobacco usage in this country and my personal commitment to ensuring that that happens.

Senator SINGH: But you agree with Professor Murphy that tobacco kills?

Senator McKenzie: I'm not conflicted at all. As I said, I'll have to take on notice if the donation was received and how much it was for. I don't know that, so I can't be conflicted about something I don't know.

Senator SINGH: But you don't think that you have a conflict of interest—as the Minister for Rural Health and knowing, as Professor Murphy has outlined, that tobacco kills 15,000 Australians a year—that your party is taking donations from tobacco companies?

Senator McKenzie: I point again to the evidence of the weight of policy initiatives and work the government is doing and I am doing in this space, and my predecessors have done in this space, to show that we're absolutely committed to decreasing smoking rates in this country.

Senator WATT: You say that you're for rural and regional Australians, and smoking rates are twice as high in rural and regional Australia—

Senator McKenzie: Yes. It's a tragedy.

Senator WATT: that you say you care about, and you're taking donations from the tobacco industry.

CHAIR: I'm not hearing questions. I'm hearing commentary. Senator O'Neill, you have the call.

Senator WATT: Will tobacco industry representatives be invited to attend this year's budget dinner?

CHAIR: Senator O'Neill, if you don't want the call, Senator Smith, you have the call.

Senator SMITH: I was going to ask questions around Indigenous health, but I'll leave them till Friday, but they are specifically around the MBS 715 and the utilisation of that specific Indigenous health initiative.

CHAIR: Senator O'Neill, do you want the call?

Senator O'NEILL: Could I go to some questions around mental health and, particularly, headspace.

CHAIR: Thank you very much for coming along, Ms Cole.

Senator O'NEILL: I've only got a few questions.

CHAIR: Again, let's remember to try and keep this cross-portfolio.

Senator O'NEILL: In January this year the minister announced $110 million for child and youth mental health. Part of this funding—my understanding is around $30 million—went to headspace national office, and it was not to be used for commissioning new headspace services. Then we saw, a few weeks later, the announcement around a new headspace service in Lithgow. What evidence, analysis or other details were provided to enable the government to choose Lithgow as a new headspace site?

Ms Cole : About a year ago, perhaps a bit longer, we provided some advice to the minister around the selection of 10 additional headspace sites. In that, we did an analysis, some modelling, about how those headspace sites could be selected in terms of need, population analysis, where other services were available and so forth. We identified more sites than were actually chosen in that process, and Lithgow was one of those sites that we considered in that initial process.

Senator O'NEILL: In addition to the 10—this is just an extra one that was on the list?

Ms Cole : It was in the initial list that we considered. The population of youth in that area is actually a bit small for a full headspace centre, so we considered it in terms of whether or not a satellite would be an appropriate way to respond to the need in that area. Subsequent to those initial discussions, there has been some concern and some work with the PHN, because there has been a little cluster of youth suicide in that area. So we raised the issue again.

Senator O'NEILL: What other locations were provided by the same mechanism you have just described, but not selected?

Ms Cole : There were about 15. I'd have to take that on notice.

Senator O'NEILL: If you could provide that in the course of the day, that would be helpful.

Ms Cole : Yes.

Senator O'NEILL: Thank you very much. Was the headspace national office consulted by the department regarding the Lithgow decision?

Ms Cole : I believe it was, but I'll just confirm with the relevant officer. We usually consult with headspace national office on all of our discussions around potential new centres.

Ms Gleeson : Headspace national were consulted as part of determining the original list of 15. They weren't consulted immediately prior to the final decision around Lithgow.

Senator O'NEILL: They were not consulted?

Ms Gleeson : Immediately prior to the decision around Lithgow.

Senator O'NEILL: Okay, so when you talk about the list of 15, is that the 10 additional sites plus a further five?

Ms Cole : That's correct.

Senator O'NEILL: So we're referring to only a further five, but one of them was Lithgow?

Ms Gleeson : That's correct.

Senator O'NEILL: Is there a reason why you didn't consult headspace prior to the announcement, seeing as they are the deliverer of the service?

Ms Cole : Headspace national office is not the deliverer of the services. The funding goes to the relevant PHN, which is, in this case, Nepean Blue Mountains. It is a satellite service. It's not a completely new service, so the question was whether or not an outreach service with a physical location, which is how we describe a satellite service, could be provided by either of the two closest headspace centres in the region.

Senator O'NEILL: So does this indicate a pattern going forward that you will be announcing headspaces, but you won't be alerting headspace national to that? You're just going to deal directly with the PHNs and cut them out?

Ms Cole : The headspace national office had been consulted originally on the Lithgow inclusion on the list of 15; they indicated that they saw a need in that area. I guess the issue was, in a sense, that we were looking at a satellite extension from an existing headspace centre, and the role of the national headspace office under the current system is to make sure that any services provided under the headspace logo are appropriately accredited and have the appropriate safety and quality provisions in place.

Senator O'NEILL: It is pretty surprising, given their signature role in overseeing it, that you did not consult them before you made the announcement. I will just leave that as a comment. Where does the funding for the Lithgow headspace, which is a satellite—is that correct?

Ms Cole : That's correct.

Senator O'NEILL: Where's that funding coming from?

Ms Cole : We have some contingencies—we always set aside contingencies when we do our planning for additional headspace centres. The funding was available within the contingency funding provided for the 10 additional centres.

Senator O'NEILL: Help me understand here: there's a funding envelope for the 10 headspace centres?

Ms Cole : Yes, that's correct.

Senator O'NEILL: And out of that bucket of 10, you've now spread it further to give it to the 111th?

Ms Cole : It's not 111 centres, because it's a satellite of an existing centre.

CHAIR: Senator O'Neill, we're really in outcome 2 here.

Senator O'NEILL: I've got three questions to go, if I can.

Senator SMITH: I am particularly curious to know why this is in cross-portfolio and not in a program.

CHAIR: I haven't heard one cross-portfolio question.

Senator O'NEILL: I might have one for you.

CHAIR: We've got Senator Griff, who is waiting with an actual corporate question.

Senator GRIFF: It sounds like she's nearly finished.

Senator O'NEILL: I have; I've got just a couple of quick ones to go. Can the department provide the date when the minister signed off—

CHAIR: No. Why can't we ask these questions in outcome 2, Senator O'Neill?

Senator O'NEILL: I've only got a couple to go.

Senator SMITH: No, I think you've probably wasted our generosity.

Senator O'NEILL: Chair, it would be easier to just get them done. I've got three questions left and the people are at the table.

Can the department provide the date when the minister signed off on the decision that he made when choosing Lithgow as a new location?

Ms Cole : We'll take that on notice.

Senator O'NEILL: We know that the funding for headspace hasn't been indexed. It's based on historic levels. Has headspace written to you to formally to ask for funding indexation?

Ms Cole : It's been a topic of discussion primarily with the PHNs as they have funding responsibility for headspace centres. In the past, so some years ago when headspace continued to run the funding for the services directly, there were some discussions around those issues, yes.

Senator O'Neill interjecting

CHAIR: I'm happy for you to come back in outcome 2. I said Senator Griff could have a question in this space. After the break we're going straight to sport. I'm going to throw the call to Senator Griff. We're happy to come back to this topic in outcome 2, but I am going to throw the call to Senator Griff until the break. After the break we will come back with outcome 3—Sport and Recreation—move on to outcome 4, and then we'll go to outcome 2, where mental health questions should correctly reside.

Senator GRIFF: Ms Beauchamp, my questions actually relate to how, in 2016-17, the department paid the Pharmaceutical Society of Australia a total of $829,906, as part of a contract, to update its professional practice standards and code of ethics. Is this the first time the department has paid this society, or any society, to update their standards?

Ms Beauchamp : Senator, can you give me the date of that again?

Senator GRIFF: I can give you contract note, if you like, but it was in the 2016-17 year.

Mr Cormack : Senator, the specific officer who can give you details of our arrangements with the Pharmaceutical Society will come to the table shortly, and we'll take the detail of notice. But we have had arrangements in the past, and in the present, with the Pharmaceutical Society. They're the professional association for the pharmacy profession. They are an active partner in many of the programs associated with the community pharmacy agreement. But I will have to come back to you shortly with the specific details of that engagement.

Senator GRIFF: So you will also provide me with any other dates of any other periods where you've done this?

Mr Cormack : Yes.

Senator GRIFF: Does the department, as a matter of course, pay private industry bodies to update their own standards and codes of conduct?

Mr Cormack : The best way to answer that is: when we have a specific government program in place, which we do have, which is the sixth CPA—that's the current agreement that we have with the community pharmacy sector—we will, as part of those sorts of programs, engage the most relevant organisation to deliver the programs. Clearly, if we are looking at enhancing the role of the pharmacy profession, which of course we certainly do—and here comes the expert—we will engage with the relevant professional association. They're not an industry body; they're a professional association. Their principal role is to enhance the overall professional quality of services delivered by pharmacists in the community pharmacy sector, the hospital sector or wherever else pharmacists practice. Ms Shakespeare can probably give you a little bit more information on that.

Senator GRIFF: In that instance, could you provide on notice a list of other bodies that you have done the same thing with and the dollar amounts over the last 10 years?

Ms Shakespeare : I'm sorry, Senator, I missed the first part of the question. Could you please repeat the information you're seeking about the Pharmaceutical Society?

Senator GRIFF: The primary question was: on how many other occasions have you actually issued a contract for them to update their own professional standards? And then I asked what other industry bodies have you paid to actually update their professional standards or code of conduct?

Ms Shakespeare : Certainly we can take that on notice. There are particular examples of pieces of work we've asked the Pharmaceutical Society to update standards around. Biosimilars is one of them. The government has been undertaking policy work to promote the use of biosimilars, which includes education and resources for pharmacists to educate them about biosimilars, particularly in the environment where they may be substituting those at pharmacy level on a script.

Senator GRIFF: With this particular contract the actual contract period was May 2016 to July 2017. How long did the new standards and code actually take to develop?

Ms Shakespeare : I'm fairly certain that that contract period related to the work to update around biosimilars, but I would need to check that those are the right dates. And I'd say that the work would have been completed within the time periods for the contract.

Senator GRIFF: Okay, and would they actually come into force at the end of that period?

Ms Shakespeare : Yes. My understanding is they've now been launched.

Senator GRIFF: You will provide me with that information as well?

Ms Shakespeare : Yes.

Senator GRIFF: What are the substantive differences between the previous and the updated versions? If you briefed them and asked them to conduct this exercise, were there significant reasons for you needing to have them do that?

Ms Shakespeare : Around biosimilars components?

Senator GRIFF: Just biosimilars?

Ms Shakespeare : Particularly in the standards, yes.

CHAIR: Senator Griff, thank you for asking questions in the right place. I really appreciate it.

Senator SMITH: Just before we do go to the break, I want it noted that coalition senators acted in good faith by allowing Senator O'Neill to bring that matter to cross-portfolio when it clearly was not a cross-portfolio issue and could have been dealt with in the relevant program area.

CHAIR: I think the committee as a whole needs to look at whether 'cross-portfolio' has any meaning or should be deleted from the program in future estimates. Thank you all very much. After the break we will resume with Sport and Recreation, and then we will go back to outcome 4. And then we'll see how we're going.

Proceedings suspended from 10 : 15 to 10 : 30