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Community Affairs Legislation Committee
05/06/2013
Estimates
HEALTH AND AGEING PORTFOLIO
Australian Institute of Health and Welfare

Australian Institute of Health and Welfare

[10:07]

Senator RHIANNON: I notice on the AIHW website the most recent report about induced abortion is a 2005 publication Use of routinely collected national datasets for reporting on induced abortion in Australia. Is there a more current publication on this?

Mr Kalisch : No. That is the latest data we have available. It was really drawn from a research report that was undertaken around 2003 and then repeated in 2004 to look at a method of producing national statistics about induced abortion in Australia. It was tested by us with our collaborating unit the National Perinatal and Epidemiology Statistics Unit, NPESU, which is based at the University of New South Wales. It produced estimates of induced abortion in 2003 and then 2004. We have no intention to undertake that work at this stage.

Senator RHIANNON: I might have misunderstood your response then. Were you saying that part of the reason this work was undertaken was to explore the methodology, or was it about actually assembling the data, or both?

Mr Kalisch : It was about seeing whether the data was sufficiently robust and could be drawn from a range of sources to produce some robust estimates. I can give you a bit of a sense of the methodology. Selected Medicare data that was assuming that specified services provided out of hospital are only for induced abortion were combined with data for specific procedures and diagnoses from the national hospital morbidity database. Final estimates were produced by applying a correction factor to account for private patients who received induced abortion services but who did not claim a Medicare benefit. That methodology was repeated in a report that was released in 2006. I think that was a subsequent one. That was relating to data for the 2004 year.

Senator RHIANNON: At the end of the executive summary it states: 'The methodology developed for this report will be used by the AIHW to regularly report on the estimated number of induced abortions in Australia.' I gather from your previous answer that that has not happened.

Mr Kalisch : No.

Senator RHIANNON: Why has that not happened?

Mr Kalisch : Perhaps I can just give you a bit of a sense of the funding of the AIHW. We receive about 30 per cent of our total revenues from our government appropriation. So 70 per cent of our revenues come from fee-for-service activity. Unless we were to receive special funding to do this series, to do this work regularly, we would not have the financial wherewithal to be able to do it. The institute runs a pretty tight ship. We do a lot of reporting across health, hospitals, disability, child protection, juvenile justice and prisoner health, and from an appropriation of only $16 million we can only do so much.

Senator RHIANNON: So when in 2005 the executive summary set out that intention, at the time did you have the funding? Has something changed subsequently? It is quite a clear position that was set out.

Mr Kalisch : I will take that on notice if I can, just to find out a little more information about the context. One of the dimensions I should note is that I am not sure whether this report was put out by the institute or put out by one of our collaborating units and whether it was actually their desire and intention to keep replicating this information but resource priorities across the institute did not make that possible.

Senator RHIANNON: It had at the bottom of the report 'AIHW National Perinatal Statistics Unit'.

Mr Kalisch : That indicates to me that it probably was the collaborating unit that put out that perspective and it was not necessarily—

Senator RHIANNON: And that was their intention?

Mr Kalisch : It might have been their intention but at the end of the day they might not have received the resources to be able to do that. It was not necessarily a decision made by the organisation as a whole.

Senator RHIANNON: Could you take on notice, if you cannot let us know now, on what basis that decision was made not to proceed?

Mr Kalisch : I will see what I can find. It does go back a number of directors before me.

Senator RHIANNON: Thank you. With the data that we have, could you supply a breakdown of both datasets by state and/or region?

Mr Kalisch : I will see what is available from the information that we have in our records.

Senator RHIANNON: If you cannot supply it in that way, can you provide details of how to access the data?

Mr Kalisch : Again, I will just see what we have in our records and what was collected and produced at the time. Unless it is in the form in which that information was collected and estimated at the time—it will not be possible for us to redo that or for NPESU to redo that.

Senator RHIANNON: I am not asking for a redo; I am actually asking for the data that you have collected.

Mr Kalisch : We will see what is available, Senator.

Senator RHIANNON: Would there be any problem in releasing it?

Mr Kalisch : I do not envisage so—not at the state level.

Senator RHIANNON: May I also have any datasets that correlate socioeconomic status of regions with abortion data?

Mr Kalisch : We will see what is available.

Senator RHIANNON: So you are happy to take that on notice?

Mr Kalisch : Yes.

Senator FIERRAVANTI-WELLS: I want to follow up on your report and the media release in relation to a rise in hospital admissions for older Australians. Drilling down, you say that hospital admissions for older Australians are rapidly rising. You talk about a nine per cent increase between 2007-08 and 2011-12. Can you break down for me those people over age 85, those 592 admissions that you refer to—just a breakdown of the nature of those in terms of acute as opposed to subacute? Do you have that sort of—

Mr Kalisch : I do not have that information on me. We produce about 150 reports a year.

Senator FIERRAVANTI-WELLS: Of course.

Mr Kalisch : I can certainly take that on notice and see what we can provide you. One of the features that we saw—and obviously you would expect that with an ageing population, and the figures do largely relate to the 85 and above age group. I am more than happy to get that information if it is available.

Senator FIERRAVANTI-WELLS: Ms Halton, I would like to ask more in relation to the specifics of some of those findings but I will reserve those for the age care section—that is probably best.

Prof. Halton : Sure, although of course the age care people cannot necessarily comment on hospital issues.

Senator FIERRAVANTI-WELLS: Where would be the most appropriate place to pursue this?

Prof. Halton : In a way it would be the hospitals area.

Senator FIERRAVANTI-WELLS: So that is—

Prof. Halton : Acute care, which is next.

Senator FIERRAVANTI-WELLS: I will do it then, thanks.

CHAIR: Senator, maybe some of those questions can go across both of those, so we will see how we go.

Senator SIEWERT: I want to follow up on any further work you have done on looking into income management or engagement with any evaluation on income management. Have you taken on any more work as part of the evaluation of income management?

Mr Kalisch : Not on income management per se. I am aware of one report that we have been doing on some of the outcomes particularly around eye health, ear health and some of the earlier and subsequent results in terms of specialist appointments and various other check-ups. I can certainly provide that report to you.

Senator SIEWERT: If you could. When did you complete that work?

Mr Kalisch : From my recollection—unfortunately I do not have the details with me—it was earlier this year.

Senator SIEWERT: If you could provide that, that would be appreciated. So you have not taken on any further work as part of the ongoing evaluation?

Mr Kalisch : No. That was some work that we were committed to do in terms of monitoring some of the health outcomes.

Senator SIEWERT: I appreciate that you are going to give me the reports. What are the top-line outcomes?

Mr Kalisch : The top line, from what I recall from the report—as I mentioned to other senators, we produce about 150 reports a year, so this is really going back into the recesses. In terms of the follow-up, what we saw was that it did take some time for people to get follow-up services, particularly, where that was recommended. But a large number did and they were receiving services.

Senator SIEWERT: You do not have any role—or any evaluation—in looking at the place-based income management outside of the NT?

Mr Kalisch : No. We are doing some work around looking at some of the evaluation on the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes and providing some support to that evaluation process, but not around the place-based measures per se.

Senator SIEWERT: I presume, therefore, your work was included in the report that COAG has just reviewed.

Mr Kalisch : Yes.

Senator SIEWERT: In terms of how single parents are coping with the changes in the income management system, are you doing any work around the health and welfare of single parents and their families?

Mr Kalisch : No. The one thing that we are working on at the moment is—if I can do a bit of a publicity plug—the next version of Australia's welfare, which we are required to do every two years. That does have some feature work around employment, education and, I suppose, looking at poverty, low income and wealth amongst particular groups. So it does have some of that broad information but it is nothing in terms of the very specific details that you are dealing with.

Senator SIEWERT: When is that report due?

Mr Kalisch : It is due legislatively any time before 31 December this year. We are looking to put that out around early August. We are trying to get our two major reports, Australia's welfare and Australia's health, pretty much in a 12-month cycle. Australia's health will be, if you are looking for it, around June next year.

Senator SIEWERT: Are you able to tell us any trends that have been picked up yet in that work, or do I have to wait?

Mr Kalisch : I think you will have to wait.

Senator SIEWERT: Damn!

Mr Kalisch : I should also say that most of the information is what we readily draw from the Australian Bureau of Statistics on those broad participation patterns, so that is readily available now.

Senator SIEWERT: Can I ask about the area around—you mentioned employment—employment of older Australians? A report released last week or the week before talked about participation of older women but it is not just about older women; I realise that. Will the work you are talking about pick up that specific issue? And are you doing any other work on that?

Mr Kalisch : Yes, that work around the Australia's welfare publication will have some specific aspects around the participation of older people. We have detected the same dimension that other people have noted of very good and rising participation rates for older men and older women. It seems to be a dimension, particularly amongst older women, of younger cohorts moving through and maintaining their participation rates to the point where, from what we can see of Australia's participation at older ages compared to other countries, Australian participation rates are holding up very well and actually are well above the OECD average—which is in some stark contrast to participation rates that we have seen for people in the prime working age categories, where we are actually below the OECD average.

Senator SIEWERT: One of the issues that I have been pursuing fairly strongly, because it has come out of the other work we have been looking at around Newstart, is cohorts of people who are suffering from age discrimination when trying to get into the workforce. Are there specific demographics that are holding their participation rates?

Mr Kalisch : We have seen increases in participation particularly amongst 60- to 64-year-olds and 65- to 69-year-olds.

Senator SIEWERT: Is that in—

Mr Kalisch : I do not know whether it is people regaining employment or just maintaining employment. I suspect it is more the latter.

Senator SIEWERT: Maintaining?

Mr Kalisch : Maintaining employment rather than retiring early.

Senator SIEWERT: Will the report indicate that? Are you able to pick that up?

Mr Kalisch : No, not from the aggregate statistics. You would need to do a more thorough investigation of this particular issue. I think it certainly is something worth pursuing.

Senator SIEWERT: Will it look into the employment type that is maintaining that participation?

Mr Kalisch : Part time or full time is probably the level that we are focusing on. But if you were to look at this thoroughly you would want to look at particularly occupations—

Senator SIEWERT: That is what I am going to. Anecdotally you are told that people doing manual labour have injury problems and those sorts of things much earlier and then it find it harder to find work, but a lot of that is anecdotal.

Mr Kalisch : I would expect the employment patterns for older people to pretty much mirror the rest of the economy, where there is a large service sector.

Senator SIEWERT: I take that point. I am looking into the issues around discrimination of older people, who report a lot of trouble regaining work. But that is not going to show up in—

Mr Kalisch : No. We do not have that detailed information. You would need to do a thorough study. Certainly the broad indications are very positive but whether that holds for everyone—I would not presume that.

Senator CAROL BROWN: I want to turn to work that you have done on vaccinations, particularly in Aboriginal and Torres Strait Islander rates. Are you able to help me there, Mr Kalisch?

Mr Kalisch : I do not have the information on that particular aspect. I know that the vaccination rates certainly have been holding up and in fact have been improving in Indigenous communities.

Prof. Halton : The big report on vaccination, Senator, that was recently released was produced by the performance authority, not by the AIHW.

Senator CAROL BROWN: Okay. Can you quickly run through your work program now? What are you working on?

Mr Kalisch : What we are doing, as I mentioned, is some of our legislative requirements in terms of Australia's welfare this year and Australia's health next year. We also have a very substantial work program across age care with taking on the national age care data clearing house from July next year. We are pursuing further information and work with the states and territories around a unit record child protection collection. We are working on youth justice reporting. You would probably have seen a number of bulletins that we produce each year around the number of people in detention and supervision. We are working with states and territories around a prisoner health collection and working with them on, I suppose, the next report a couple of years out. There is further work on mental health services reporting with the National Mental Health Commission as well as through the department. Palliative care reporting is another area of focus, as well as looking at some reporting in the disability and functioning space. That is just one area. We just received a contract from the department and the Australian National Preventive Health Agency to do some work on replicating a burden-of-disease study, a $5 million study over the next three years. And we are in negotiation with the department for a new vascular disease monitoring centre that would cover cardiovascular, kidney and diabetes. That is a major of piece of work and we expect that to be finalised at least in time for the new work to start from 1 July. There is a lot of cancer data and reporting. We have put out some reports on men's health in particular over recent years, as well as doing work on hospital reporting. A lot of the hospital reporting also looks at trying to improve the nature of the data and hopefully the timeliness as well, particularly around some work we have done with the College of Surgeons around elective surgery categorisation, where we do not believe that there are consistent approaches to the data being prepared across each of the states and territories. And we have worked with the College of Surgeons and with states and territories and other clinicians to put forward a set of recommendations that health ministers have accepted to improve the quality and comparability of that information.

Senator CAROL BROWN: Did you say that that is completed and those recommendations have been accepted?

Mr Kalisch : It is my understanding that they have been accepted. They still need to be implemented. It will be, I would guess, six to 12 months before we start seeing data being produced in a more comparable form.

Senator CAROL BROWN: Are those recommendations public?

Mr Kalisch : I am not aware that they are but we hope that the report will be able to be made public now that the recommendations and the approach have been accepted.

Senator CAROL BROWN: I expect there will a lot of interest in that area.

Mr Kalisch : There is probably a lot of interest from a number of people who are very interested in that area. I have to say it is a report on methodology and on approaches for collecting information, so I am not sure it is going to be one of our bestsellers.

Senator CAROL BROWN: I do not think I agree!

Mr Kalisch : It might be of interest to this place.

Senator CAROL BROWN: Obviously you are keen to ensure that the data you produce is accessible to as many Australians as possible. I have heard you talking about how that can be achieved in terms of ICT. Has there been more work done on that? If so, can you give me a brief overview?

Mr Kalisch : I can give you a bit of a sense of some things that we are doing at the institute. We have produced our own electronic validation process to try to work with data providers so that they can provide data to us in a cleaner, more accurate form and therefore we are able to put it out more quickly. So we have been able to improve the timeliness of a lot of our data releases. We are also looking at, in a number of areas, putting out confidentialised unit record files and also data cubes so that data analysts can get access to some of the data in a safe environment where privacy of individuals and organisations will not be compromised, as well as trying to put out bulletins and information that are well presented so that the broader community and the media can understand some of the information as well. We do hold a significant information resource from a number of providers—from states and territories and the Commonwealth government and also from agencies as diverse as homelessness services. So it is a very valuable resource for policy purposes and it should be used for policy purposes. Our sense is that we would like to make that information as available as possible, and we have good mechanisms within our institute for dealing with the privacy and security aspects. Certainly ICT and web facilities provide us with the ability to do it. If you are interested in pursuing this a bit further, I draw your attention to our mental health services online publication, which provides a very interactive web facility for people. They can drill down to different levels of disaggregation. We are also able to update it every two to three months as new data becomes available. So it is not like the old days where you would wait for 12 months for a new 200-page hard copy document to be available; now we can update it every two to three months and we have new data coming out as it is ready for us.

Senator CAROL BROWN:    Thank you for that. I will go to the mental services online and have a look and provide my feedback next time.

Mr Kalisch : Thank you. Look forward to it.

CHAIR: Thank you very much, Mr Kalisch. That ends whole of portfolio, corporate matters. We will come back in 15 minutes.

Prof. Halton : Just before we do, I said that I would take advice from Finance in relation to the questions we were asked about decisions taken but not yet announced. Finance have advised me—and I would also draw the senators' attention to the Hansard of the Senate estimates for the department of finance for Wednesday, 29 May, where this matter was covered—that it is a matter for the government when it announces decisions which are taken but not yet announced. Officials are not in a position to say anything further about these decisions, including which portfolios may or may not have decisions which have not been announced. As I said, David Tune answered in these terms to, I believe, Senator Cormann. So, to confirm what I thought was the case, no, I cannot answer those questions, Senator.

CHAIR: Thank you very much, Ms Halton. It is on record and we will make sure that Senator Fierravanti-Wells knows that that has been read into the record.

Prof. Halton : Thanks very much.

Proceedings suspended from 10:31 to 10:48

CHAIR: I know we have questions from a number of senators. Senator Abetz has some questions in this area, so I thought as he is here he may as well get his questions answered first. Senator Abetz?

Senator ABETZ: Thank you very much, Chair, and thank you to representatives of the department. I have just noticed the title 'Professor'. When did that occur?

Prof. Halton : Quite a while ago, Senator.

Senator ABETZ: Apologies; I was not aware of it. Well done in any event. Look, my questions relate to the announcement by Minister Plibersek and Parliamentary Secretary Neumann about supporting paid leave for living organ donors. My questions are more from the workplace relations perspective. I understand from the department of employment and workplace relations that they were not consulted prior to this announcement. I am just wondering with whom, if with anybody, the department did liaise prior to this announcement?

Mr Butt : Unfortunately I cannot advise you, we would have to actually go and check about who was consulted before the announcement was made. I am aware that the Department of Education, Employment and Workplace Relations are advising us on workplace relations issues now in relation to the lead-up to the implementation of the scheme.

Senator ABETZ: But would have thought or hoped that certain facts and information would have been gleaned prior to an announcement, rather than trying to cobble it together after an announcement.

Mr Butt : Senator, as I say, I could not advise you. We would have to go away and check because the officers responsible for that are actually not here at the moment.

Senator ABETZ: All right, if you could take that on notice for us. Why have we only committed money for two years?

Mr Butt : It is a trial. We are actually looking at a two-year period and we are looking at an evaluation of the trial and the outcome of the trial in 2014-15. Then obviously government will need to make decisions about whether it is extended or not.

Senator ABETZ: So this is only available to people that are employed?

Mr Butt : That is right. It is a contribution to the costs for employers to enable people who are living donors to go on leave for the duration of the period that they are required, which is often four to six weeks, because it largely relates to kidney transplants and there is obviously a lot of work-up time and then recovery time involved.

Senator ABETZ: Yes, understood. I am aware of some of those situations. Will the employer be required to provide leave?

Mr Butt : No. It is a voluntary arrangement and ultimately it is an issue between the employer and the employee. From our perspective it is a reimbursement to the employer so that they can then come to those arrangements with the employee. They may want to top up what we are proposing in terms of providing the minimum wage. That is a decision they need to make.

Senator ABETZ: What I do not understand is, if it is a voluntary thing, where the employee takes leave without pay, why would you—sorry, that is not the case?

Prof. Halton : It is not leave without pay.

Mr Butt : No. Often the donor would take leave with pay at the moment. They are actually using up their leave time to make the donation.

Senator ABETZ:    But, if a donor did not have any annual leave, or did not have any leave available to him or her, and was reduced to taking leave without pay, they would not be reimbursed?

Mr Butt : They would be eligible for it as well.

Senator ABETZ: They would be eligible if they were taking leave without pay?

Mr Butt : Yes.

Prof. Halton : I think the important thing to understand here is: this is not about any financial advantage to the donor. It is actually about neutralising the position. So essentially it removes any problem that a donor might have if their employer does not have a leave arrangement which enables them to take paid leave to go ahead and make a donation. A number of people have raised this over a period of years. In fact, the parliamentary secretary as she then was, minister as she now is, could tell you that this is an issue that is often raised about an impediment to actually providing a living donation—that people simply did not have any leave that would enable them to do it.

Senator ABETZ:    If a worker is taking leave with pay, the Commonwealth taxpayer will be reimbursing whatever the national minimum wage is at the time to the employer?

Mr Butt : To the employer, yes

Senator ABETZ: Where I was at was: if there is an employee taking leave without pay, in circumstances where the employer is not paying the employee, the employee is still eligible?

Mr Butt : That is right. Again, it is a relationship between the employer and the employee, but that would need to be worked out between them, and we would pay the employer.

Senator ABETZ: Yes, but the relationship between the employer and employee is, for example, I am going to donate a kidney and I will need six, eight weeks?

Prof. Halton : Six weeks.

Mr Butt : Six weeks.

Senator ABETZ: Yes, six to eight weeks off without pay, and the boss says, 'That's fine; do so.'

Prof. Halton : Or the employee can say to the employer: 'In my current employment arrangements, I either have no leave or I would have to take my sick leave. There is a scheme that would enable me to take what we would describe in the Public Service as miscellaneous leave, for which there is some recompense to you, the employer, to continue to enable me to receive an income.'

Senator ABETZ:    What I am getting at is, if during that six or eight week period, the employer has no liability to the employee by way of wage payments, why would we be directing the national minimum wage to the employer rather than to the employee direct? If it is a reimbursement for wages paid out by the employer, I can understand why it is going to the employer, but if it is income for the employee—

Prof. Halton : No.

Senator ABETZ:    Sorry?

Prof. Halton : No, so we are not ever going to pay the employee.

Senator ABETZ: I know that, and that is what I believe could be—and this is what I want to explore—a design fault in the scheme in circumstances.

Prof. Halton : Let us be clear about this. We are very clear that there are major problems with us, government, paying donors directly in terms of that being seen as, and possibly being construed as, paying for organs, which we absolutely cannot go near. This is anathema in this whole space. It is absolutely the case that this enables an employee to go to an employer and ensure that as a minimum, for the period that they take off, they have access to that national minimum. There is no notion that we would pay an employer and that money not be passed on, either via paid leave or by a new variety of leave, or a new recompense arrangement, to the donor. There is no notion, therefore, that with this money available, you would say to the employee: 'So sad; go on leave without pay.' The whole point here is that there is a source of income available to facilitate people having that conversation with their employer so they can take a variety of paid leave, sometimes at this national minimum, in order to facilitate the donation.

Mr Butt : And to add to that, Senator, it is a compensation payment. So there has to be evidence that the employer is actually paying the person.

Prof. Halton : Paying the person.

Senator ABETZ: So, if there is no leave and the business cannot afford to have somebody off work for eight weeks and be paying them for no productive input, that person then will not be able to avail themselves of the scheme?

Prof. Halton : No. That is not true. If you think about it, if you are a small business and you have not very many workers, at the moment that worker may actually have sick leave and the worker will say, 'I'm taking sick leave; I'm going,' so you pay the full cost. Under these arrangements, there is this minimum amount which is available to the employer—

Senator ABETZ: Yes, but we are saying where there is no sick leave, where there is no leave available—

Prof. Halton : But, even in that case, say in the current world they say they cannot afford to lose them, if there is no income going to the person, there is no cost. There is an opportunity cost; the person is not there. That is the case anyway. If you want to donate a kidney to your brother, you are going to go and donate that kidney to your brother. The issue is the financial cost. This actually means that the employer has access to a pool of money which they can then provide to the employee.

Senator ABETZ: Yes, but it is not going to cover the wages bill, because it is only going to be the national minimum wage. I looked at some figures just the other day, and it is a relatively small percentage that are actually on the national minimum wage.

Prof. Halton : It is a contribution.

Senator ABETZ: Of course it is a contribution, but there will still be a financial gap for the business, especially if the employee has taken up all of his or her leave entitlements.

Prof. Halton : If they are taking up their leave entitlements, that is a potential cost the business is going to wear anyway. This offsets that cost to the business, so that is a positive.

Senator ABETZ: Where employers are making good arrangements, those sorts of arrangements should be encouraged. All I am trying to get at is the mechanism of how it works if somebody has taken up all their sick leave, miscellaneous leave, carers leave, whatever leave it might be and there is nothing left, what the circumstances are, especially with a struggling business.

Prof. Halton : Yes, certainly for the business, if they otherwise say to the person, 'Well, if you are going, you have to go on leave without pay,' it means the money passes through the business to the employee. That is how it works. As Mr Butt has already said, this is a two-year trial. One of the things we have to look at is how this works. As I have said to you, there were a number of very, very sound policy reasons why—I think the sector is pretty much unanimous that we should not be paying people direct because of all of the moral, ethical and other issues that go with that. It is set at this national minimum for a variety of reasons. We will do two years. We are going to evaluate it to see how it works. This something people have advocated to us very, very strongly as assisting. And in fact the minister and I were just talking during the break about the fact that our organ donation numbers have continued to rise really significantly, and how pleased we are about that. This is exactly what we were just discussing. This is part of the package which is looking to improve yet further this organ donation arrangement. This is new. We have to see how it goes, and that is why we are going to evaluate it.

Senator ABETZ: In the statement, I think these words are attributed to the parliamentary secretary:

A significant amount of time is required for medical evaluation prior to surgery, resulting in some donors needing to take leave-without-pay from work during this period.

The statement itself recognises the leave without pay situation and scenario. So that is what I was seeking to determine. Let us see how it all works out. Thank you very much.

Senator CAROL BROWN: Senator Abetz may have already asked this question, but the scheme is not compulsory?

Prof. Halton : No.

Senator CAROL BROWN: So the employer does not have to participate?

Prof. Halton : No.

[11:02]

CHAIR: Thank you. Now we will go into Outcome 13.1. Does anyone have any questions on 13.1?

Senator DI NATALE:    I have some questions on the dental spend from the last budget and the preparations for the future spend under the national partnership agreements and the Grow Up Smiling initiative.

Prof. Halton : GUS as it is known now, Senator. Yes, we can do it in outcome 1.3.3, Senator.

Senator DI NATALE:    And I have some questions about hospital funding adjustments mid-year, and the funding that has been basically restored to Victoria. Again, would that be under 13.3?

Prof. Halton : Yes.

Senator DI NATALE:    Finally, some questions about activity based funding—13.3 again?

Prof. Halton : Yes.

Senator DI NATALE: Good, thank you.

Senator FIERRAVANTI-WELLS:    I just want to check the questions that I anticipate in relation to hospital admissions for older Australians.

Prof. Halton : 13.3, Senator. If any of that flows into aged care, obviously we can do that.

Senator FIERRAVANTI-WELLS:    Also, the other day in Finance I asked some questions in relation to the Health And Hospitals Fund. Where is the most appropriate place to ask questions on timing, budget, opening— those sorts of things—in relation to those projects?

Prof. Halton : 10.6, Senator.

CHAIR: Senator Smith, a couple of the things you indicated interest in could actually be in 13.1, so do you want to give them a go?

Senator SMITH: Yes. I am keen to understand what we know of the incidence of Australians travelling abroad to get organ transplants and where they might be travelling to. Do we measure that in any official way? I would also like to ask about what we might know about admissions into Australia's health system as a result of people having had less than satisfactory transplants abroad, and infection and those sorts of things. Can we deal with that here?

Prof. Halton : Yes, but I think you will find we do not know very much.

Senator SMITH: That was my concern.

Prof. Halton : So we will do it, and I think we will take a lot of it on notice. I suspect you will find this one of these very grey areas about which we know very, very little.

CHAIR: We may well have some input from the Chief Medical Officer.

Senator SMITH: Grey currently, but I hope not grey permanently, because I do think it is probably an area that we need to give increasing attention to.

Prof. Halton : I think the difficulty you will have in this area is that we actually do not collect data on why people are leaving the country.

Senator SMITH: What about why people are entering the health system?

Prof. Halton : We may, but we may not know what the source of the donation was. So anybody who is actually admitted to a hospital because they have got a particular health issue will code up the health issue; we will not code up what the source of it was.

Senator SMITH: But travelling overseas for an organ transplant is such a significant event in someone's life, I would have thought that, on admission to the health system, it is the sort of thing that someone would reveal.

Prof. Halton : Very probably, but that does not mean there is data about it.

Senator SMITH: This is why I think this is a grey area but one that is going to need increasing attention. Perhaps Ms Cass could provide some commentary.

CHAIR: Ms Cass, Senator Smith talked about his issues there. Do you want a specific question or do you just want to talk generally?

Ms Cass : I am not aware of substantive data on the number of patients in the public hospital system that come back here for follow-up treatment after an overseas transplant, so I think it is best if we take that on notice and see if there is any data available.

Prof. Halton : Yes, but can I say that I do not think the Organ and Tissue Donation and Transplantation Authority can go on a long, searching expedition for something which I think is probably nonexistent. They cannot create something here which does not exist.

Senator SMITH: It does not exist at the moment, but I am perhaps pointing to what might become an important future policy issue for the government. There was a report in the Medical Journal of Australia in 2005—so some time ago—which identified up to 16 patients who had travelled overseas for commercial kidney transplantation between 1990 and 2004. So it is a grey issue but not a new one. Of the 16 patients, it was found that they were more likely to develop infections, with a variety of quite serious infections, including HIV, as a result of the treatment that was undertaken overseas. I accept the fact that there might not be much on it at the moment, but I would be very keen to understand what you do have and, more particularly, what work might be being done to monitor this particular issue given that it is a cost to the health system if we are not doing anything to advise people of some of the risks of transplants internationally. If this Medical Journal of Australia report specifically talks about people travelling to India and China, then I would suggest it might be an issue worthy of some further attention.

Prof. Halton : Yes. Senator, can I make a couple of observations about this. If the numbers are, as you report from that MJA article—and I do not remember that article—that is 16 over a period of 14 years. That is basically one point nothing significant a year.

Senator SMITH: Sorry, I missed that.

Prof. Halton : It is one point whatever a year. In truth, big data collection systems in hospitals will not be changed for one possible patient a year—even rising to a 100 per cent increase of two possible patients a year. I think the source of information on this, particularly if you are interested, is probably to talk to the relevant colleges about what they know about it. Big data systems are almost never changed around that kind of incidence, but the colleges may have a perspective. I do not know whether Professor Baggoley has a perspective on that.

Prof. Baggoley : This conversation, of course, is most important in that it is of concern that people might travel overseas for a transplant. You have mentioned risks of infection. There is also the issue of a proper and ongoing follow-up. The point that Professor Halton has made in relation to interaction with colleges on this matter—particularly, the Royal Australasian College of Physicians may be able to shed some light, even if it is anecdotal—does warrant a follow-up, and I can certainly do that. It would be hard to imagine such people going overseas without the knowledge of their treating medical practitioner. That is an avenue I can and will follow up.

Prof. Halton : Yes, and exactly as Professor Baggoley says, there would not be one patient who would leave the country in respect of a transplant who would not have been under the care of a physician in this country, which means they must have been receiving medical advice. It would be completely legitimate and appropriate to make sure that treating physicians advise people appropriately on what the issues and risks et cetera are, so that, if they do choose to undertake that course, they do so fully informed.

Can I make the point, however, that in the period raised in the MJA article, 1990 to 2004, remember that the donation rate at that point was really very low. In fact, the thing that Ms Cass and her organisation have been pursuing with vigour—and, dare I suggest, success—is to improve our donation rate. As I was just saying in answer to that earlier question, Minister McLucas and I were just discussing really how well that program is going in terms of lifting our rate. Ms Cass and I had a conversation on the telephone yesterday about not counting our chickens but really how pleased we are with the numbers and where they are tracking this year. So what you would be hoping is that fewer and fewer people would find it necessary, in their minds, to pursue that option.

Senator SMITH: 'Hoping' is the word that you use, Secretary, and I am not so sure that that is necessarily demonstrated in the evidence, and that is what I want to get to find. While more Australians might be accessing the arrangements and the regime that we have set up domestically, it does not necessarily mean that fewer people will travel abroad, because they may not be able to access it domestically; they may not be taking the advice of their physician. Clearly there was a report back in 2004, 2005 which pointed to 16 people. I would be keen to understand what we know in 2013 about this particular issue and what would happen if Australia were to advocate internationally for much tighter restrictions around organ transplanting, how organs were accessed. For example, I think that Iran is the only country that has a legal organ trafficking regime—but we will leave that for another time. So I am keen to understand what we know about the problem at the moment from the perspective of the Department of Health and Aging.

Ms Cass : Senator, we can certainly pursue contacts with colleges and The Transplantation Society of Australia and New Zealand, which might have some more current information.

Senator SMITH: Yes. This will not come as a surprise to people; I think the New South Wales parliament is doing some work around the international elements of organ transplanting. Thank you.

CHAIR: Are there any further questions under 13.1? Senator Furner.

Senator FURNER: In the budget announcements for the Australian Bone Marrow Donor Registry, there was some additional support provided, which also puts demand on transplants, so this is tackling against registrations. How will the department be working with the Australian Bone Marrow Donor Registry to increase those registrations in this area?

Mr Woodley : Senator, I am sorry, would you mind repeating the question?

Senator FURNER: I was asking about the budget announcements in support of the Australian Bone Marrow Donor Registry, looking at how the demand for transplants are tackling against registrations and how the department will be working with the Australian Bone Marrow Donor Registry to increase those registrations.

Mr Woodley : The measure more specifically was to support Australians seeking bone marrow transplants from sources overseas. So, where the Australian register has been consulted and an appropriate match is not immediately available, the Australian government supports a process of seeking and obtaining appropriate materials from overseas. The measure supports the continuing growth in that program to ensure that all Australians who require that treatment receive it.

Senator FURNER: So, in terms of looking at a wider international pool for donors, how does that measure operate?

Mr Woodley : By tapping into the international pool of potential donors, it vastly increases Australians' potential to receive the matched tissue that they require in these circumstances.

Mr Butt : Senator, we first tap into the Australian register, which has about 160,000 people registered on it, to see whether there is an Australian donor available. If there is not an Australian donor available, we then go into the international registers, which actually gives us access to about 20 million registered people around the world, and that number is growing.

Senator FURNER: What is the process in tapping into the international register? Do you have to go through each individual country, or is there a global registry that you contact?

Mr Woodley : The Australian register has contacts with its international counterparts, and it is quite an efficient procedure.

Senator FURNER: How expedient is the process? Is it a case of identifying a prospective donor and then getting that person engaged?

Mr Woodley : The process is that the treating clinician and the hospital contact the department, they apply, they indicate whether or not the Australian register has been interrogated, and if a match has not been found then they apply to the department. Those applications are assessed by a medical officer and approval is given and processes are set in train to identify an appropriate match overseas and to arrange for the transportation of that material.

Senator FURNER: Okay. Thank you.

Senator SMITH: Just on that point, you would record the incidence of people accessing organs through that mechanism?

Prof. Halton : This is not organs.

Mr Woodley : No, it is not organs. But, yes, we have data on that.

Senator SMITH: Could you perhaps take that on notice and provide information about the incidence of those requests annually?

Mr Woodley : We can certainly provide a trend over a number of years.

Senator SMITH: A trend, yes. Great.

[11:18]

CHAIR: As there are no further questions on 13.1, we will turn to 13.2, Medical indemnity.

Senator FURNER: I just want some feedback on the robustness of the medical indemnity sector, which has been improved through government support.

Mr Porter : There are four medical indemnity insurers operative in the Australian market at the moment. They are all in a very healthy financial state. They exceed minimum capital reserve requirements quite substantially; in fact, some of them are so well cashed up, if I may put it that way, that they are looking at acquisitions in other places. For example, there has been the purchase of one insurer by another insurer, announced in April, with subsequent consolidation in the market, obviously. The largest indemnity insurer has purchased a private health insurer, to use some of their spare funds, for example. In general, they are in a very healthy financial position and certainly we do not have any concerns about their satisfaction of minimum capital reserve requirements.

Senator FURNER: Can you provide to the committee how these improvements have impacted on the government expenditure on medical indemnity?

Mr Porter : What we have been seeing over time is that, as the financial circumstances of the insurers improve, they are using that leverage to keep premiums stable or in fact decline premiums in some aspects. That in turn has flowed through to particularly our Premium Support Scheme program. The Premium Support Scheme is a program whereby, if a doctor's gross indemnity costs exceed 7½ per cent of their income, the government subsidises 80 per cent of the remaining cost of the premium over that 7½ per cent threshold. With the healthy financial status and increased competition in the market, with premiums coming down, we have seen a reduction over time on the number of doctors who are qualifying for that program, and in turn there has been a reduction in expenditure. Two years ago in the budget there was an announcement that we would look at the Premium Support Scheme subsidies, and we have started to recalibrate some of those in respect of this very healthy financial state of the industry. So there has been a general decline in that particular element of the indemnity programs.

Senator FURNER: How many doctors exceed the indemnity threshold?

Mr Porter : 2,200, for the most recent 12-month period.

Senator FURNER: How does that relate to previous years? I guess that is a decrease.

Mr Porter : Yes, it is, and it has been stable at 2,200 for about two years. It did reach a high of about 3,500 four or five years ago but has steadily been decreasing over time. Again, as premiums decrease and incomes increase, the number of doctors going over that 7.5 per cent threshold has obviously declined.

Senator FURNER: Thanks, Mr Porter.

Senator SMITH: Mr Porter, are you involved in any discussions around the National Injury Insurance Scheme?

Mr Porter : Yes, we are.

Senator SMITH: Have concerns been raised by any of the insurers about the implication of the scheme for them?

Mr Porter : Yes, insurers are obviously very active in this space. We participate in a number of working groups facilitated by the Department of Families, Housing Community Services, and Indigenous Affairs and also the Treasury. Our role is very much to assist the insurers and assist the other government agencies in facilitating communication and exploring some of those potential policy impacts. At the moment the specific impacts are a little unclear, obviously, as the schemes are being developed, and certainly the pilots will give us a very good indication as to where some of the boundary issues may lie.

Senator SMITH: Is your branch or the Department of Health and Ageing involved in that Treasury advisory group?

Mr Porter : Yes.

Senator SMITH: It is a formal member of that group?

Mr Porter : Yes.

Senator SMITH: You just mentioned pilot programs, or pilot work. Can you explain that a little bit?

Mr Porter : The National Disability Insurance Scheme pilots. That is not NIIS, obviously, Senator. The NIIS is not due to start until later in the decade, but we are very much engaged with FaHCSIA, Treasury and our insurance stakeholders in terms of making sure that we are very clear about where the impacts may be.

Senator SMITH: Are any of the papers that the Department of Health and Ageing prepare for that advisory group publically available?

Mr Porter : I am not aware that they are, but I understand that there will fairly soon be some publications arising out of Treasury in this respect. But work that we do is very much in-confidence within that group.

Senator SMITH:    Secretary, is it possible for the department to provide to me perhaps a summary of the advice or the issues from its perspective that it might be providing to the task force group?

Prof. Halton : Senator, I am sorry, but we cannot do that. Because this is a current matter of policy consideration, we can tell you that we are providing advice but we cannot tell you the content of that advice, even at a high level.

Senator SMITH: Okay. Thanks, Chair.

[11:24]

CHAIR: As there are no further questions on 13.2, a number of senators have questions on 13.3, so I think we will go issue by issue. Senator Fierravanti-Wells, if you want to start.

Senator FIERRAVANTI-WELLS: I want to start by going back to the MYEFO hospital cuts and Victoria, if I may. Can you provide an insight into why Victoria was the only state to get a temporary reprieve from the MYEFO cuts to hospital funding?

Ms Flanagan : Senator, I do not know that I would call it a reprieve, because the deal is that it was agreed that the $107 million would be paid to local hospital networks direct, but the consequence of that is that other funding that was going to be provided into Victoria through other streams or means is going to be reviewed and possibly not paid. So there will be theoretically a zero sum gain in terms of the funding that flows through to the Victorian government.

Senator FIERRAVANTI-WELLS: So how was that determined?

Ms Flanagan : In what sense?

Senator FIERRAVANTI-WELLS: You chose to question the word 'reprieve', but how was that reprieve for Victoria determined? Was it a directive from the Prime Minister's office, or was it from the Minister for Health and Ageing?

Ms Flanagan : It was a decision of government.

Senator FIERRAVANTI-WELLS: Yes, but did it come from the Prime Minister's office or the health minister's office?

Ms Flanagan : It was a decision of government.

Senator FIERRAVANTI-WELLS: Can you take us through the process by which the MYEFO cuts were returned to Victorian hospitals? Give me the nuts and bolts of this process.

Ms Flanagan : I will start and my colleagues can perhaps assist. Government decided that it would, in effect, reinstate the money that had been withdrawn from the local hospital networks in Victoria. We then set up a process where we involved the central agencies, because one of the issues here was around the fact that Treasury actually makes the payments under the Health Reform Agreement. It was necessary to introduce—I cannot remember the terminology—a determination into parliament, so the department of finance was involved in that. So there was a multidepartmental working group set up to put in place the various elements in order to deliver this. I do not know whether my colleagues want to—

Senator FIERRAVANTI-WELLS: So how long did this whole process take, Ms Flanagan?

Ms Flanagan : Probably a month or two. We tried to do it as quickly as possible. I do not know when the payments were made. I think we did it over two or three payment runs. We got all of the payments made to the local hospital networks. We needed to engage with each of them, and there are 86 local hospital networks in Victoria. We needed to have, in effect, a contract or an agreement with them in terms of what they would do with the funding—that is, that they would maintain services. So there was a lot of paperwork in terms of us engaging with them individually, needing to get the paperwork back and then making the payments. Mr Sebar might be able to give you more information—I think there were two or three payment dates.

Mr Sebar : Payments began to local hospital networks in Victoria on 2 April and there were a range of payments over that month. The final payment was made on 30 April.

Senator FIERRAVANTI-WELLS: Which hospitals were the first to have their money returned? You obviously have a process by which you started with certain hospitals first. Can you tell me what that process was? How did you determine which ones would get their money first and which ones then had to wait till the latter part of the process?

Ms Flanagan : Senator, I would not couch it in that way. The thing was that I think we tried to engage with all of the 86 LHNs as quickly as possible. We did not make a choice in terms of which ones we were going to pay first; it was really based on how quickly we could get the paperwork out, how quickly they could get it back to us et cetera.

Senator FIERRAVANTI-WELLS: So you went to all 86 together?

Ms Flanagan : We certainly, I think, tried to do that, yes. We mailed out to all 86 at the same time, then the process was how quickly they could get back to us and we could finalise.

Senator FIERRAVANTI-WELLS: There was a process, and payment came according to how quickly they met their requirements in the process. So those that tarried or did not move as quickly as others did not get their payments until the latter part; yes?

Ms Flanagan : Yes.

Senator FIERRAVANTI-WELLS: So each was required to sign—what was it?—a memorandum of understanding. Is that what it was, Ms Flanagan?

Mr Sebar : No it was a funding agreement.

Senator FIERRAVANTI-WELLS: Was it a standard one, or was there a template for it?

Mr Sebar : Each local hospital network in Victoria signed a similar funding agreement. The funding agreement was adjusted for each of the individual details of the allocations.

Senator FIERRAVANTI-WELLS: But there was a template?

Mr Sebar : There was.

Senator FIERRAVANTI-WELLS: Could you make that available to us?

Mr Sebar : Yes.

Senator FIERRAVANTI-WELLS: Thank you. One without the details, if you don't mind.

I will take you back to the answer that Ms Flanagan gave. The media reports were that there were about 2,300 people on the Victorian elective surgery waiting lists. There were effectively over 3,000 Victorian patients—according to the media reports—that this process added to elective waiting lists and patient elective surgery lists. Can you tell me, in the light of all those discussions that we have had in order to set up the National Health Funding Pool, how this all fits in? How does this method of payment direct to the local hospital networks sit with the requirements under the national agreement and the National Health Funding Pool?

Ms Flanagan : Senator, this was decided, as a one-off process, to get the individual amounts to the local hospital networks as quickly as possible. We knew what those amounts were, because we had information from the Victorian government in terms of how much they had reduced each individual local hospital network. So we had the amounts very quickly and it was decided by government that this would be the quickest way to get the funding to the local hospital networks. The issue with the National Health Funding Pool arrangements—and Mr Maskell-Knight might help me here; he is not yet at the table—is that the funding is actually paid into a national funding pool and then paid out of that. So the states and the Commonwealth put money into the National Health Funding Pool and then it is paid out.

Senator FIERRAVANTI-WELLS: Yes; we trawled through this, Ms Flanagan.

Ms Flanagan : Yes.

Senator FIERRAVANTI-WELLS: We went through a whole lot of Senate time and effort trawling through, firstly, the necessity for a funding pool. We have been through various iterations; I do not want to trawl through that. But I know that you and other witnesses gave evidence about the fundamental need for a funding pool and we went through that. But now you have very easily discarded those very cogent needs for a funding pool, gone around it, and paid the local hospital networks directly. My question is: aren't those criticisms of the funding pool now very much justified, because you just went around the process?

Ms Flanagan : Again, no, I do not think that that is the fact at all. This was an unusual circumstance in one particular jurisdiction. The government decided that what it wanted to do was to re-instate the money with the local hospital networks as quickly as possible. There was a mechanism that could be implemented fairly quickly to do that. I have seen no appetite at all to continue to do this. This was a one-off circumstance and it was decided by government that it would do this in this particular way.

Senator FIERRAVANTI-WELLS: Tell me, what provisions of the brief National Health Reform Agreement—I think I have got the latest iteration of it—did you act under, or did just act completely outside of that?

Ms Flanagan : The $107 million that we are talking about is in fact not a payment under the National Health Reform Agreement. It was agreed by government that it would pay this $107 million to local hospital networks. So it is, in effect, outside of the National Health Reform Agreement funding flows, which is why it was decided it would be done in this way. That is why there was a separate determination into parliament to appropriate that funding.

Senator FIERRAVANTI-WELLS: That determination was pursuant to what? I am just trying to find the head power to make that decision.

Ms Flanagan : It was a decision of government, and in order to implement it it needed to introduce—I think this is the technical term—a determination or a disallowable instrument. Mr Maskell-Knight might know.

Mr Maskell-Knight : The instrument established a special account under the Financial Management and Accountability Act.

Senator DI NATALE: I think Senator Fierravanti-Wells has asked most of my questions. Just to go back to that issue of the funding agreement: were there any specific conditions or obligations placed on the individual hospital networks?

Ms Flanagan : Yes, there were. It was around maintaining service levels. I think there were particular clauses that we had in the funding agreement, where we expected them to maintain what they were doing. Just by way of background, the Victorian government had already made service-level agreements with the local hospital networks, I think, in around September-October. In effect, what we asked them to do with the reinstatement of this funding was to maintain those.

Mr Sebar : There were additional requirements of Victorian local hospital networks that they provide any current statements of priorities, the service agreements between the Victorian government and the individual local hospital network; that they provide those within two weeks of signature; that they provide any variations to those statements of priorities that might occur throughout the remainder of the financial year; and that they provide a statement, by 31 July, confirming that funds under the agreement were expended on the provision of public hospital services, a brief report on the performance of the LHN and what those funds were spent on, and a copy of their annual report, once available.

Senator DI NATALE: A copy of the annual report?

Mr Sebar : Of the LHN annual report.

Senator DI NATALE: What sort of reporting requirements were asked of them?

Mr Sebar : That they provide a statement that they spent the funding on—

Senator DI NATALE: Services.

Mr Sebar : public hospital services and that they report on how they expended those funds. So they reported on what they spent the money on and whereabouts in the hospital they spent the money.

Senator DI NATALE: In terms of the agreements, and in ensuring that they continued to spend money on the existing agreements, does that relate to ensuring also that some of the cuts that were made—the withdrawal of some elective services, the closure of emergency departments and so on—were restored, as well?

Mr Sebar : Yes, that is correct.

Senator DI NATALE: I suppose the bigger question for me is: why was Victoria considered to be a special case?

Ms Flanagan : We were saying earlier on—I do not think you were here—that under the health reform arrangements the states are the systems managers of hospitals. They have the primary responsibility for running hospitals in this nation. These parameter variations occur all the time; they are part of the agreement—

Senator DI NATALE: Not of that scope and not midyear, but we will not revisit that.

Ms Flanagan : There are—

Senator DI NATALE: We will agree to disagree on that point.

Ms Flanagan : certainly parameters set down, and that was what was implemented. No other jurisdiction that we are aware of acted in the same way as Victoria. Victoria immediately applied these revisions to their local hospital networks. We are not aware of any other jurisdiction that acted in that way. I think it subsequently came to light that Queensland may have done something like that.

Senator DI NATALE: Well they have.

Ms Flanagan : Certainly at that time we were not aware of that. Victoria appeared to be the only jurisdiction that had passed on the cuts or the parameter variations in full to their local hospital networks.

Senator DI NATALE: But you would know that that is a function of the way the more developed local hospital network model applies in Victoria, and that the reason that Queensland did not apply the cuts in the same way, at that time, was because it took a little longer for the impact of those cuts to be felt. They have subsequently been felt and cuts have been announced in Queensland. Given the rationale, is there an intention to restore the funding in Queensland?

Ms Flanagan : No. I think the government made it clear that this was a one-off for Victoria and, as I think I have indicated, what the government is looking to do is pay less money into Victoria in other areas.

Senator DI NATALE: But you have explained that the rationale for singling out Victoria was that those cuts flowed on to services in Victoria. They have now flowed on to services in Queensland, so it seems to me that if you are going to apply that rationale in Victoria, why would you not apply it in Queensland?

Prof. Halton : There is probably an additional part to that answer, Senator, and they had—

Senator DI NATALE: To which answer?

Prof. Halton : To the answer that Ms Flanagan gave you. She said that the cuts had flowed on. An additional part of the answer is something she said earlier, which is that there were also funds available in Victoria that the federal government decided to re-allocate. So there were Commonwealth funds that were going to otherwise flow to Victoria, which the Commonwealth government decided to re-allocate.

Senator DI NATALE: Sorry, with all respect, I do not think that explains why the same approach could not have been used in Queensland?

Prof. Halton : I am not aware that there were unexpended funds available in Queensland.

Senator DI NATALE: So if there were unexpended funds available, would the same—

Prof. Halton : That is a matter for government, but my understanding is that the circumstances were different in that respect.

Senator DI NATALE: It strikes me as being highly unusual that we would single out one state when the same implication is felt across other states. I think I will leave it there. I think Senator Fierravanti-Wells has pursued most of the questions I had in that area.

Senator FIERRAVANTI-WELLS: Just for clarification, I wanted to ask a set of questions in relation to the new legislation—the definitions bill. Then I have some questions, a follow up of an answer to a question on notice on the National Partnership Agreement on Improving Public Hospital Services. Then I have some questions in relation to the rise in hospital admissions for older Australians.

Senator CAROL BROWN: I want to ask a general question about the funding that is provided under our national partnership agreements and the National Health Reform Agreement. Are you able to give me some details, state by state, about what funding the Commonwealth provides?

Mr Sebar : Certainly. In terms of the National Health Reform—

Senator CAROL BROWN: Sorry. I do not mean to interrupt, but are you giving me information from this budget?

Mr Sebar : From this budget; that is correct. I was going to query whether you were after information just for the 2013-14 year, given you are looking state by state, or whether you were after multiple financial years.

Senator CAROL BROWN: Multiple financial years.

Mr Sebar : In 2013-14 for New South Wales it is $4.485 billion under the National Health Reform specific purpose payment. I might deal with National Health Reform first and then come back to the national partnership agreements. For Victoria it is $3.487 billion; for Queensland it is $2.831 billion; Western Australia, $1.535 billion; South Australia, $1.014 billion; Tasmania, $310 million; the ACT, $233 million; and the Northern Territory, $144 million—giving a national total of $14.040 billion.

In 2014-15 for New South Wales it is $4.927 billion; Victoria, $3.846 billion; Queensland, $3.130 billion; Western Australia, $1.724 billion; South Australia, $1.126 billion; Tasmania, $339 million; ACT, $271 million; and Northern Territory, $168 million—a national total of $15.531 billion.

In 2015-16, New South Wales, $5.410 billion; Victoria, $4.240 billion; Queensland, $3.457 billion; Western Australia, $1.933 billion; South Australia, $1.248 billion; Tasmania, $370 million; ACT, $312 million; and Northern Territory, $195 million—a national total of $17.164 billion.

Finally, in 2016-17 New South Wales is $5.939 billion; Victoria is $4.673 billion; Queensland is $3.816 billion; Western Australia, $2.163 billion; South Australia, $1.382 billion; Tasmania, $403 million; ACT, $357 million; and Northern Territory $223 million—a national total of $18.956 billion.

For the figures that I will give you for national partnership agreement, I will need to go to a different page.

Senator CAROL BROWN: The figures that you gave obviously indicate Commonwealth funding increasing for public hospitals around Australia.

Mr Sebar : That is correct. For the national partnership agreement payments we can provide details regarding individual agreements, but we do not have with us a consolidated level of information for all national partnership agreements, as they are spread across—

Senator CAROL BROWN: Can you take that on notice for me, because I would like that information.

Senator DI NATALE: I have just got some questions on the dental funding in the 2012-13 budget. I also have questions on the dental reform package, the child Medicare entitlement—GUS, I suppose it is called—the national partnership agreement, flexible grants program and so on. Let us start with the budget money from 2012-13—a total of $346 million for investment in public dental. I think it was termed a waiting-list blitz. Can I ask how much of the $70 million allocated in the 2012-13 budget has been spent, whether all of it has been expended, and how much of the 2013-14 amount has been spent?

Mr Maskell-Knight : Of the 2012-13 money under the national partnership agreement, it will all be spent tomorrow—that being the day on which the payment run that Treasury operates works. It will all be spent tomorrow. We have already spent about $22 million—

Senator DI NATALE: A good day to go to the dentist then!

Mr Maskell-Knight : so the rest of it will go out. We have not spent any of the 2013-14 money yet.

Senator DI NATALE: Have you got a breakdown, state by state, of the $70 million?

Mr Maskell-Knight : We certainly do, Senator, somewhere in here. New South Wales, $22.3 million; Victoria, $17.2 million; Queensland, $13.5 million; Western Australia, $5.8 million; South Australia, $5.6 million; Tasmania, $2.5 million; ACT, $1.1 million; and Northern Territory, $1.2 million. That actually adds up to $69.2 million. The other $800,000 was departmental.

Senator DI NATALE: Good. Can I ask about how the allocations were made? On what basis were they made? Is it just population?

Mr Maskell-Knight : It was made on the basis of the concession-card-holder population. There was a small flag fall added for the three smaller states on the basis that if you just do it on a per capita basis the amounts they get are very small.

Senator DI NATALE: Turning to the workforce money, I think there was a total of $158 million over the forward estimates—$14 million for 2012-13 budget. Was that all spent?

Mr Maskell-Knight : Senator, I am not responsible for those programs, and the Acute Care Division is not. We may be able to give a partial answer but you are better off waiting until Health Workforce Division arrives.

Senator DI NATALE: So, later on this afternoon?

Prof. Halton : 10 o'clock tonight actually, Senator.

Senator DI NATALE: That is lovely, yes! I have to be there anyway, so that is okay. Perhaps we will just put that on ice. In terms of the money that goes to the states, how are you tracking the outcomes? What is the process for doing that?

Mr Maskell-Knight : We have established a regime where, from now on, we are making two payments a year—one in August and one in February. They are contingent on the states providing data essentially about what they have done in the preceding six months.

Senator DI NATALE: On the activity?

Mr Maskell-Knight : Yes.

Senator DI NATALE: Are things like waiting lists part of that?

Mr Maskell-Knight : We are asking the states to report on waiting lists, but the actual payments are linked to the additional activity they carry out.

Senator DI NATALE: Just turning to the national partnership agreements over the coming years, have all the states signed up? I am talking about the partnerships for dental. The public funding that was announced was the $1.2 billion for the state dental care. Have all the states signed on?

Mr Maskell-Knight : No, we have not started in-depth discussions with them yet.

Senator DI NATALE: Have any of the states signed on?

Mr Maskell-Knight : No, the money does not start for another 15 months, so we have yet to start conversations with them. We are hoping to get a bit of information from their reports under the first national partnership agreement to inform the conversations we do have.

Senator DI NATALE: I am just looking at an answer from the health minister in Victoria, who says that they have signed. The question about the agreement was asked by Ms Hartland, the Upper House member for Western Metropolitan. She asked specifically about whether Victoria had signed on and implied that she thought Victoria had not signed on. The Minister for Health in Victoria said that the information she had was wrong; that Victoria had signed. He said the implementation agreement was signed. He went on:

So her information is flat wrong.

He then went on to say that Victoria worked hard to advocate for a change in the arrangement because the complex formula invented by the federal government as part of the deal worked against states and that the formula was changed, and that is why they had signed on.

Mr Maskell-Knight : I think, that there was a degree of miscommunication going on. Having two national partnership agreements about the same thing starting at slightly different times leads people to mix the two of them up.

Senator DI NATALE: The question was asked very specifically:

The national partnership agreement for adult public dental services announced in August last year will provide $1.3 billion for states and territories from 1 July 2014.

Senator DI NATALE: Do I take it that the minister may have been a little confused in his response?

Mr Maskell-Knight : Yes.

Ms Flanagan : Victoria was the last one to sign this current agreement.

Senator DI NATALE: That is very helpful. Thank you. At this stage there is not much more to ask about the national partnership agreement. We have not spoken to any states, we do not know where they stand, and those discussions will commence, one hopes, shortly.

Mr Maskell-Knight : Yes.

Senator DI NATALE: Good. Thank you. Now I move to Grow Up Smiling, the Medicare funded dentistry for young children. That commences on 1 January next year. What preparations are being made for that scheme? Can you just give me an update?

Mr Maskell-Knight : The rules to give effect to the scheme were tabled in the House of Representatives on Monday last week. They set out the schedule of benefits and a range of conditions around them. You need to understand that this is a joint effort between ourselves and our colleagues in the Department of Human Services. They are going to be responsible for the nuts and bolts and the mechanics of informing families that are eligible, of communicating with providers about what the schedule is and what the rules are, and so on. We have had lengthy and frequent discussions with our colleagues over there. They assure us that they are on track for it all to happen on 1 January next year.

Senator DI NATALE: I understand it is not directly your area, but could you perhaps just indicate whether there has been any information provided to families at this stage? Has there been any advertising done?

Mr Maskell-Knight : Eligibility will only be determined on 1 January for that calendar year. DHS is unable to tell anybody yet that they are eligible, because while they may be eligible for the family tax benefit this year they may not be next year.

Senator DI NATALE: We are not broadly informing them of the eligibility criteria, more generally?

Ms Flanagan : Senator, a number of the things we have been considering in the lead-up to GUS are about the things we need to do to inform families that might be entitled under this, and also about engaging with the dental profession about when it is coming on so that they are also aware.

Senator DI NATALE: Yes, of course. That will probably to help avoid some of the mistakes that have been made previously.

Ms Flanagan : Certainly I have talked to Mr Maskell-Knight and his team about having a planned engagement strategy from now on. It is not just with the Grow Up Smiling initiative; we have got a very big round of capital investments that are occurring. We are intending to look to put out guidelines on how people might apply for those. They will need information about what it can be used for and how to apply for it. Because there is a whole range of measures around what we are doing with dental and, as you have mentioned, the workforce measures, we do need to think, some time out, what the engagement strategy will be leading up to the actual implementation of some of these measures.

Senator DI NATALE: Can I ask about the schedule? Has the benefit schedule been completed yet?

Mr Maskell-Knight : Yes, it was in the rules that were tabled last week. Having said that, we have decided to align the fees with the fees paid by the Department of Veterans' Affairs. They will be indexing their dental and other allied health provider fees on 1 November this year. When they do that we will need to make an amendment to the schedule to reflect the fees that DVA are going to be offering.

Senator DI NATALE: Is that information—the schedule—publicly available?

Mr Maskell-Knight : Which information?

Senator DI NATALE: The schedule: what items will be—

Mr Maskell-Knight : Yes, it is in the Dental Benefits Rules 2013 that were tabled—

Senator DI NATALE: Last week?

Mr Maskell-Knight : Yes.

Senator DI NATALE: How do I get access to that?

Mr Maskell-Knight : We can send you a link.

Senator DI NATALE: It is online; fine. Obviously, the profession was engaged in the development of the benefit schedule?

Mr Maskell-Knight : Yes.

Ms Flanagan : They certainly were. We can give you some detail about that engagement.

Senator DI NATALE: Great; that would be helpful.

Mr Maskell-Knight : There was a public consultation process through late April and May. But before that we had been having general conversations with the ADA late last year, and we have been having much more targeted conversations all this year. We sent them a draft of the schedule at the end of January. We had a bit of email exchange to and fro. We then had several meetings with them on 19 and 20 of February, where we went into more detail than I care to think about, about how different dental procedures work. They then provided some written clarification around some of their concerns. We took those on board in the further development of the schedule. We have also been in communication with them about the proposed policy position around informed financial consent and compliance rules. We sent them a paper on 11 April and we had a teleconference with them later on in April. They were then part of the general consultation process and provided a submission in response to that.

Senator DI NATALE: Good. In terms of eligibility, I take your point that obviously individuals will not know if they are eligible until the start of next year. Will they be told they are eligible, and how do they actually prove their eligibility criteria? What are the mechanics for how that works?

Mr Maskell-Knight : They will be written to by the Department of Human Services to tell them that they are eligible. Their Medicare file that DHS holds will then be annotated in some electronic way, but they will have a letter that they can take along to a dental provider and say, 'My child is eligible under Grow Up Smiling.'

Senator DI NATALE: So there is no way of actually having a particular Medicare card linked to eligibility, is there? They literally have to have that piece of paper with them?

Mr Maskell-Knight : Virtually, there is, so if you have the Medicare—

Senator DI NATALE: I suppose all I am asking is: do they need to go in with this piece of paper or will they be able to go into a Medicare office with their Medicare card and then eligibility will be determined at that point?

Mr Maskell-Knight : I think I am getting confused between a Medicare office and a dental office. If they go into the dental office it would be helpful to have the letter with them, but they can ring up or the receptionist can ring up Medicare and confirm that they are eligible. Whereas, if they have an account that they have paid themselves and they take it into a Medicare office, it is an automatic process.

Senator DI NATALE: Yes, okay.

Ms Flanagan : Senator, just to add to that, because it is one of the things that the minister has asked us. As you know, this is a capped benefit. At the time that you are having some work done, how might you know before the dentist starts the work that you have got, perhaps, $500 or whatever left under your cap?

Prof. Halton : A cap?

Ms Flanagan : Sorry, no pun intended. I do not think you can get capping under this—but anyway. So, we have been exploring how we can do that. At the moment you can ring up and ask, but we are looking at perhaps even mobile apps or being able to access through Google, so the individual will be able to access it to check what balance they have left.

Senator DI NATALE: Thank you.

CHAIR: Senator Furner, you have one follow-up question on dental.

Senator FURNER: How many recipients will be beneficiaries of the dental national partnership agreements, which the states are yet to sign up to?

Mr Maskell-Knight : Under the second national partnership agreement, we estimate that about 1.4 million people should be able to be treated, with the same average complexity as the ones that are being treated at the moment.

Senator FURNER: And, on notice, can you identify the breakdown per state on that?

Mr Maskell-Knight : Sure.

CHAIR: Senator Fierravanti-Wells.

Senator FIERRAVANTI-WELLS: Can I explore the intention of the new power to prescribe public hospitals by the Commonwealth Minister for Health in the National Health Reform Amendment (Definitions) Bill 2013? What is the purpose of this bill? I would have thought that, as a department, you would be aware of public hospitals that exist, given the payments that are being made through the national pool for distribution to all public hospitals and the reports on public hospital performance by the National Health Performance Authority.

CHAIR: Senator, can I just check whether this bill is currently under discussion. I have to admit my ignorance. Is this bill currently under debate?

Prof. Halton : I was just about to raise this. It has been introduced.

CHAIR: It has been introduced. Senator, we have to be careful about how much we go into detail.

Prof. Halton : Exactly.

Senator FIERRAVANTI-WELLS: Where is it at? Has it come to the Senate yet?

CHAIR: It has not come to the Senate but it has still been introduced. It is a public bill under debate.

Prof. Halton : It is.

CHAIR: With points of clarification, I will just see how we go.

Prof. Halton : Senator, let me be clear. I think that we can go to some matters of fact, but as soon as we get anywhere beyond that we are—

CHAIR: We will just work through and see how we go.

Senator FIERRAVANTI-WELLS: I have got the explanatory memorandum up in front of me and it tells me that it will amend the definitions of local hospital network, public hospital, private hospital and primary healthcare organisation. Can I just be clear: is it the definitions that now are being applied through the National Health Reform Agreement that will be affected? I am sorry, I am not sure what the background is to this.

CHAIR: That question is okay.

Senator FIERRAVANTI-WELLS: What part will it affect? Ms Anderson, can you help me on that?

Ms Anderson : Yes, that is correct. This is seeking to modify the definitions in the National Health Reform Act.

Senator FIERRAVANTI-WELLS: So it will be a different definition to what the department and the National Health Performance Authority have been acting on? We have just had a discussion earlier with Ms Flanagan about payments that have been made to local hospital networks. One would assume that those local hospital networks have now been defined under existing parameters. So the definition will change?

Ms Anderson : No, it will not disrupt any of the mechanisms currently in place. It is seeking to clarify the definitions for the purposes of reporting by the National Health Performance Authority.

Senator FIERRAVANTI-WELLS: In what way?

Ms Anderson : In the National Health Reform Act there is a provision that empowers the National Health Performance Authority to report and monitor the performance of public hospitals, private hospitals, Medicare Locals and local hospital networks. It makes reference to those terms and those terms are also defined in the act, in section 5. When we sought to implement the act through the minister's making of a determination, which specified what constitutes a public hospital by jurisdiction, we were thwarted in those efforts. What became clear in the work we did at officials levels was that these lists are not entirely stable over time. So we went out and sought advice on what a particular jurisdiction defined as, say, their public hospitals and received back a list, but then found as little as three weeks later that the list had changed.

Senator FIERRAVANTI-WELLS: As Ms Flanagan has just found. Is this another 'beds'? I will be coming to beds, but is this a similar situation as the definition of beds?

Ms Flanagan : This is a beds issue.

Senator FIERRAVANTI-WELLS: This is a beds issue?

Ms Flanagan : It is a definition.

Senator FIERRAVANTI-WELLS: So we have been talking about public hospitals. How a public hospital is defined in one jurisdiction is different to how it is defined in another?

Ms Anderson : It goes more to the way in which the list is constructed and what a jurisdiction would choose to put under that heading of public hospital, but there are subtle differences, yes.

Senator FIERRAVANTI-WELLS: So, in the absence of that, how have we been dealing at a Commonwealth level and how has DoHA been dealing? What is DoHA's understanding of a public hospital?

Ms Anderson : Probably that is less material than what we are trying to achieve through the amendment.

Senator FIERRAVANTI-WELLS: Well, Ms Anderson, we talk public hospitals all the time here. In the last three or four years we have been talking public hospitals. All of a sudden now we are going to redefine what a public hospital is?

Ms Anderson : With respect, Senator, that is not the intention of the legislation. It is seeking to crystallise and clarify, for the purposes of monitoring and reporting. Each jurisdiction is responsible for the passing of legislation which establishes public hospitals. It is the province of state and territory governments. We are not seeking to step into that space. We are trying to stabilise and formalise the construction of a list for monitoring and reporting by a national body. It is actually a reasonably straightforward set of amendments which draws directly from the advice provided by state and territory health ministers.

Ms Flanagan : Senator, can I just perhaps elaborate a little. I was involved in the setting up of the MyHospitals website, where you did need to know what a hospital was. We had a very interesting dialogue with the states when we got to actually putting up what they defined as a hospital. There are in fact, in states that I will not necessarily mention, there might be a multipurpose service or you might only have one or two hospital beds and you will have some aged-care beds et cetera. We would not necessarily define that as a hospital, but it was known to the community as a hospital because that was what it was termed.

Senator FIERRAVANTI-WELLS: And, for the purposes of those state governments, it may well have been known as a public hospital.

Ms Flanagan : Yes, and technically it might not have been a hospital but it was known to the local community as a hospital. This is just trying to clarify the definition in order to make it easier for the National Health Performance Authority to report.

Senator FIERRAVANTI-WELLS: Can I just clarify then for the record that this is not part of that 2010 agenda in which former Prime Minister Rudd was talking about local hospital networks bringing together small groups of hospitals? There was discussion about amalgamating local health services and reducing the number of local hospital networks.

Ms Flanagan : This has nothing to do with the structure of Local Hospital Networks. That is certainly my understanding.

Senator FIERRAVANTI-WELLS: So it has nothing to do with assertions that Victoria has too many public hospitals governed by local community boards; it is a separate agenda?

Ms Flanagan : And will be pursued in a different way, I would imagine, Senator.

Senator FIERRAVANTI-WELLS: Does that mean you are still going to pursue the fact that Victoria has too many public hospitals governed by local community boards, but you will pursue that separately?

Ms Flanagan : That is a decision that government may wish to pursue, but it is certainly not the agenda that is being contemplated here.

Senator FIERRAVANTI-WELLS: And you are not suggesting or proposing amalgamations of hospitals, particularly small hospitals, through this definition?

Ms Flanagan : The states as system managers manage that, Senator.

Senator FIERRAVANTI-WELLS: Thank you. I have questions of the National Health Performance Authority.

CHAIR: You can go ahead.

Senator FIERRAVANTI-WELLS: I have one question on beds. It would not be an estimates without a question for Ms Flanagan on beds!

CHAIR: I would hate to stop that happening, Senator.

Senator FIERRAVANTI-WELLS: At E13221, I got an answer about 2.96.2—a very edifying answer, Ms Flanagan. I cannot help but comment: what do 2.96.2 and 2.58.3 and 35.2 mean in terms of beds?

Prof. Halton : A short person, maybe, Senator!

Ms Flanagan : I do not know whether Ms Smith wants to answer the bed question. We have talked about this before, so this one might actually be a timing issue or it is the bed equivalent, so it is in terms of the services that are provided. It is subacute.

Ms Anderson : Senator, as has been communicated in prior estimates hearings, the currency is beds and bed-equivalents. Some of the services which were established under the national partnership agreement funding for subacute care are not in hospitals; they are in community based locations. They are sometimes services into people's homes. There is a formula which converts those services which are not attached to a particular bed into a bed count for the purposes of establishing a quantitative count for the deliverable under the agreement. But, in fact, they are services which do not gravitate around a bed in a ward; they are services provided outside in the community or—

Senator FIERRAVANTI-WELLS:    Can you provide me with a link to that formula?

Ms Anderson : Yes, I will make information available.

Ms Flanagan : We can provide it to you. It is an agreement we have with the states and territories on how they count the services. We will take that on notice.

Senator FIERRAVANTI-WELLS: Thank you. Ms Halton, there were some questions that I foreshadowed that had that ageing overlay. They are more pertinent to the hospital component of it. Should I ask them in ageing and then have them referred to the hospital component in answering them, if need be?

Ms Flanagan : Senator, because this is the hospital bit, you could start perhaps here.

CHAIR: We have just run out of time, Ms Flanagan.