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Thursday, 18 October 1956

Mr WHITLAM (Werriwa) .- No honorable member can take exception to this bill. I do not think the most ambitious Minister would be dissatisfied with the praise which it has been accorded. However, I think it is possible to exaggerate its significance for sick persons and the generosity of the Commonwealth. We are told that after 50 years there are now only 150 district nurses in Australia. I think that is less than one for every 200 nurses in public hospitals, mental hospitals, and repatriation hospitals. The bill contemplates that the Commonwealth will pay the salaries of all additional nurses engaged by organizations which already conduct home-nursing services, and that it will pay half the salaries of the nurses engaged by any new organization established to conduct home-nursing services. Those facts emerge from the second-reading speech made by the Minister for Health (Dr.

Donald Cameron). The only financial commitment which emerges from the bill is that the Commonwealth's subsidy to an organization shall not exceed the amount paid to that organization by the government of the State in which it operates. So one sees that in fact the Commonwealth's commitments are quite nebulous and artcertain to be very small.

If it has taken 50 years to get 150 women into this occupation, we can imagine that its subsequent growth, even with the encouragement afforded by this measure, is not likely to impose a burden on the Commonwealth exchequer. The Minister contemplates at the very most that in some years' time the home-nursing organizations may have quadrupled their employment of nurses. If another 450 nurses are engaged by the existing organizations the Commonwealth will be committed to an expenditure of about £450,000. If new organizations which are established employ another 450 nurses, the Commonwealth will be committed to an expenditure of half thai amount. That is assuming that the salary of these nurses would average £1,000 a year. 1 think many nurses would be happy if their salary did, in fact, average thai amount. Looking at it from the cool standpoint of the outlay involved, one sees very little expenditure on the part of the Commonwealth.

Then one compares the Commonwealth's commitment here with the commitment that the States have undertaken regarding hospitalization in general. One finds that in the last year for which the Commonwealth Statistician has published figures. 1954-55, the six States spent £44,689,000 in maintaining public and mental hospitals. That averages out at nearly £5 per head oi the Australian population. I repeat that the States have spent £44,689,000 which in view of the maximum commitment ot £450,000 a year which the Minister envisages in this bill, is 100 times the amount that the Commonwealth can conceivably be committed to under this bill as interpreted by the Minister in his secondreading speech.

The debate has ranged very widely, as you will recall, Mr. Speaker, because you have always taken an active interest in this and other social service matters and have been very regular in your attendance during the proceedings of the House. So you will know that the debate has ranged very widely. Therefore, I propose to pursue the debate in some of its nearer reaches. I would think that the truest statement the Minister made was as follows: -

Since the war, it has been impossible for hospital construction to be maintained at a rate in any way commensurate with the growth in population.

That is a statement which will be very swiftly disowned next week by whatever Minister is in charge of the States Grants (Special Financial Assistance) Bill. We are told, on every occasion, by the responsible Ministers that the States are receiving all the money they require for their functions and that if they carry out those funcions inadequately, it is not because of the inadequacy of their finances but because of the inadequacy of their administration. I am not concerned whether functions such as the conduct of hospitals are carried on by local governments as in the United Kingdom, by State governments as in Australia, or by the Commonwealth. The main thing is that the provision of hospitals is one of the necessities which we all admit in a modern society. Yet since the war, under the system, be it Federal or State, wherever one places the blame, the standard of hospital provision in Australia has declined. The waiting list for all hospitals has increased. The period for which patients have stayed in all hospitals has decreased. That is not because the process of healing has been accelerated or because illness has increased disproportionately. It is because we are not installing beds, as the Minister for Health rightly said, at the same rate as we are acquiring population by immigration and by natural increase.

Our rate of immigration is the largest per head of population in the world and our rate of natural increase is larger than it is in most industrial countries. Accordingly, one would think that the proper way in which to approach hospital provision in this country would not be merely by means of this chicken feed, relatively - this provision of an extra £1 for every £100 which is already being spent. That is the maximum amount contemplated. At the moment, no amount is actually forecast. Looked at in that light, this bill surely shrinks into insignificance.

The Minister's main justification for the bill was not a humanitarian but a financial one. The more district nurses that were made available the more the necessity for installing hospital beds would be obviated. The oldest section of the population, who are the main recipients of the ministrations of district nurses, do, in fact, appreciate the opportunity of staying at home. They do not need constant attention. It is enough for them to receive a daily or weekly visit from a qualified nurse. They do not feel as lonely and they get the more personal attention of their family. Their families appreciate their being at home because they do not have to visit them, at some expense and trouble, in public institutions. But surely it is a rather mercenary way to look at it when one says, as the Minister has said, " Let us provide more district nurses, and we will escape the obligation of spending money on the erection of hospitals ".

The other lesson which emerges from the Minister's speech - other than the fact that hospital construction in Australia has been inadequate since the war - is that it is possible for the Commonwealth to make direct subsidies for this sort of purpose. Whenever a question is asked or a suggestion is made in a speech in this place that the Commonwealth should subsidize some activity, the invariable reply to the question, either immediately or at the conclusion of the debate, is that it is a matter for the State governments and that they can subsidize it out of their reimbursements under the uniform taxation system. It is said thai it is not a matter which the Commonwealth administers and that, therefore, it is not a matter which the Commonwealth could subsidize. Yet here we have a case in which the Commonwealth is directly subsidizing one of those functions which, hitherto, has always been carried on - to quote the usual story - by the States.

So never let it be said again that the Commonwealth cannot subsidize these things. If it wishes to subsidize them it can, just as it has granted subsidies with respect to aged persons' homes and just as it has granted the subsidy under the Commonwealth Aid Roads Act. Indeed, the amount of money involved in these matters is quite disproportionate to the amount of publicity involved. We have spent the greater part of to-day discussing a matter which will involve, at the very most, in about ten years, the expenditure of £450,000 a year, which is no greater than we dispose of in the discussion on the Estimates in every minute of every sitting day for a fortnight or three weeks.

The concluding point that I wish to make is that this is one of the very few points where the Commonwealth has concerned itself with the provision of hospitals. The other point where the Commonwealth has concerned itself with the provision of hospitals is in regard to repatriation hospitals. As long as we have a system of administration under which the Commonwealth is unwilling to take over further obligations in attending to the sick, we shall have demarcation and jurisdictional disputes between public hospitals and repatriation hospitals. Many honorable members have had cases of this kind: An ex-serviceman, while he has been a patient in a repatriation hospital, has been found to be suffering from a serious illness - a serious illness, however, which was not caused by his war service. Then the repatriation administration has been under the necessity of putting him out of the repatriation hospital, however serious his illness may have been, and letting him find some public hospital in which he can receive attention. I believe that a great number of members have come in contact with such cases. Therefore, the position should be in this country as it is in the United Kingdom or in unitary States, where hospitals, whether veterans' hospitals or public hospitals, are run or financed by the same authority. In the United Kingdom, for instance, people receive attention in hospitals whenever they need it. A British citizen does not have to go to one hospital if he is an ex-serviceman suffering from a disease caused by war service, and to another hospital if he is suffering from another disease or is in any category other than that of ex-serviceman. If a British citizen is suffering from a condition requiring hospital treatment he or she enters hospital and, if necessary and if desired, automatically receives treatment without charge.

The Australian system of hospitalization is unduly cumbrous and irksome because patients who enter any public hospital in Australia now, except in Queensland, are subject to a means test, whilst people who wish to enter repatriation hospitals have to submit to an examination of the cause of their particular disabilities. There are, in fact, thousands - not just hundreds - of people in Australia whose job it is to determine whether persons are eligible for treatment in repatriation hospitals, or are required to pay for treatment in public hospitals. Would not we streamline the procedure and have a more humane, as well as a more economic and efficient, system if everybody who needed hospital treatment were freely admitted to public hospitals? That could be done and all these jurisdictional and demarcation issues would disappear overnight if the Commonwealth were to say to the States, " We shall accept the administration of hospitals ", and if the States said, " Yes, we shall pass the hospitals over to you ". If the Commonwealth took over the hospitals and spent on them, proportionally, the money and care which it spends on repatriation hospitals, which are, I believe, the best hospitals in Australia, everybody in this country would be immeasurably better off in respect of medical treatment.

This is not something beyond our means. It has been done in the United Kingdom under the system introduced by a Labour government and maintained by a Conservative government. It is practical and feasible in a properly run modern State. But as long as we have this absurd federal system applying to health, then we shall always have this passing of the buck, with the States saying, "We do not get enough money from the Commonwealth to erect and conduct hospitals, and we now have to charge for admission ", and the Commonwealth saying, " That is a State matter; therefore we can wipe our hands of it ". This unctuous Pilate-like attitude is surely at least two decades out of date.

It ought to be possible for all medica treatment for the whole population to be given in public hospitals, run by the same authority and financed by the same authority. I know that it will be said that hospitals have always been a State responsibility, and that under the Constitution we cannot do anything about them. But if we look at the Constitution we shall see that the word " hospital " did not occur in it until the 1946 amendment, in which it occurs in connexion with hospital benefits. An examination of the budgets of the States in 1901, when federation came into being, shows that the subsidy paid by State governments to all the hospitals within their borders were even less than the amount which will be paid by the Commonwealth under this bill, the objects of which are limited. Because hospitals are not mentioned in the Constitution, we cannot administer hospitals, but this bill shows that we can spend anything on them that we wish to spend. Therefore, I take this opportunity to make a plea for the co-ordination and the modernization of Australian hospitals on a national basis. Perhaps it suits some of the wealthier parts of Australia, some of the wealthier cities, the big capitals, to have the system as it is. But people fall sick in the outback just as much as in the cities, and if we are to have uniformity in health services - and not least in hospital services - throughout Australia, wherever Australian men and women live and work, we ought to have the hospitals financed and administered by the Commonwealth. I believe that the States would jump at the opportunity of the Commonwealth taking over the hospitals. If they did not they could never thereafter complain about the Commonwealth's parsimony.

I wish to conclude by saying that this bill is a good step in the right direction, but it is only one step, a very tentative step. It will provide, at the very most, only £1 for every £100 that is already being spent on hospitals in Australia. It will pay, at the most, for only one nurse in every 200 nurses in Australia. I hope the Minister is encouraged by the cordial reception the measure has received on all hands to do better in subsequent sessions of the Parliament.

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