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Thursday, 18 October 1956

Dr DONALD CAMERON (OXLEY, QUEENSLAND) . - in reply - 1 should like to thank the House for the generous way that it has received this bill, and also for the remarks of approbation that have been made about officers of the Department of Health, particularly the Director-General of Health and the principal of the Division of Nursing, as well as other officers. They have done a great deal of investigation work in getting this measure ready, and I am very grateful to them for what they have done. I propose to reply briefly, as far as I can, to the various matters that have been raised by honorable members during the debate on the motion for the second reading, but first I should like to say that this is not a measure which any one claims will immediately bring into operation a vast new network of services or will make some immediate, revolutionary change in the state of affairs that prevails at present. No one makes any claims of that nature for it. What I said in my second-reading speech was that I believed it would be very valuable. I believe that it will, and that time will make it more valuable still. I accept the view of honorable members that it may be susceptible of amendment later on. It is, I believe, a beginning, and it establishes a principle, and

I hope that we can work on it. I have no doubt that it will require changes in the future, and I hope that when they are made they will be received as well as the original measure has been received to-day.

I would also like to make it plain that we are not, in this measure, asking the States to undertake some new commitments of a nature that they are not familiar with. In fact, in every State except Tasmania, to which I will refer a little later, there are already organizations of what we may call district nurses, which are assisted by the State governments. We are proposing to supplement the resources of those organizations still further. I want to emphasize that this is a measure to assist voluntary organizations. If new ones are set up and can attract subsidies from the State governments, we are prepared to assist them, provided that the requisite conditions are fulfilled. So, while it is perfectly true that the bill provides that Commonwealth assistance shall not exceed State assistance, it does not appear to me that there is any reason to imagine that the States will suddenly reverse the procedure which they have employed for years and cease to assist these organizations.

There has been some discussion about the position of hospitals, and one or two honorable members have suggested that perhaps this bill may be construed as an endeavour to keep people away from hospitals. That is a perfectly baseless fear. The Government has no intention of doing anything like that, and I do not think that there is any real substance in the idea that it might do so. There is no antagonism at all to hospital services. There are many cases which are suitable only for treatment in hospital, and the fact that this measure, I hope, will provide more assistance to domiciliary medicine I am sure will not have the effect of making general practitioners averse to sending patients to hospitals when they really ought to be in them.

Now, sir, I should like to say a few things about the finances of hospitals, and I shall say them in no partisan spirit. There has been considerable discussion to-day about the provision of finance for hospitals, so I should not like it to be thought that the Commonwealth Government is indifferent to this question. 1 acknowledge straight away that there is an immense problem of hospital finance existing in Australia. But let me make it plain to the House how hospitals are financed and the part that the Commonwealth plays in doing so. Hospitals are, of course, basically the responsibility of the States and within the control of State governments. Funds for them are State funds which come from three sources. First, they come from loans, the amount of which is allotted, not by the Commonwealth Government, but by the Australian Loan Council. Secondly, they come from the many millions of pounds by which the Commonwealth has supplemented loan raisings. The third source, of course, is the tax reimbursement which the States receive according to the formula. It is within the prerogative of the States, and, in fact, a matter for them, to decide how much of those funds they make available for their hospitals.

There has been some discussion during the debate about the question of free hospitals, and I want to point out that this is not a decision which can be made by the Commonwealth Government, nor, in fact, does it attempt to do so. It is purely a decision to be made by each State government, and, in fact, it is made on a different basis . in each State. If public hospitals charge patients who go into public wards, then that is a decision made by the government of the State and is entirely separate from any decisions made by the Commonwealth Government. But, in fact, there have been made available, directly or indirectly by this Government, in addition to what the States themselves make available from the funds about which I have just been speaking, other very considerable sums of money over the last six years. In hospital benefits alone, from 30th June, 1949 to 30th June, 1956, the States received from the Commonwealth Government, by way of hospital benefits to supplement what other funds they had for hospitals, no less a sum than nearly £60,000.000.

Mr Thompson - ls that government hospitals?

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - Yes, government hospitals.

Mr Thompson - And not the others?

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - It has been made available by way of hospital bed subsidy. Some of it would have been for private hospitals, but of course, very little.

The vast bulk of it would have been for the State or public hospitals. In any event, it is a very large amount. In addition to that, the Commonwealth Government is providing, in instalments for capital expenditure by the States on mental hospitals, the sum of £10,000,000, and over and above that, the Commonwealth has assumed all the responsibility for providing capital expenditure for all the chest or tuberculosis hospitals which are being built all over Australia and which has amounted, in the same period of time, to a little more than £7,000,000. So, we have now come to a sum of something like £77,000,000, not all yet expended, but most of it expended within the last six years. When honorable members opposite stand up in this House, therefore, and say that the Commonwealth is perhaps not doing all it could for the State hospitals, all I can say is that the record for six years is not a bad one.

Having said that about the hospitals, 1 want to come back to the particular things which honorable members have said about the provisions of the bill. 1 was rather amazed to hear the honorable member for Dalley (Mr. O'Connor) say that the standard of general practice in Australia had deteriorated in recent years. Perhaps his experience of general practice is more extensive than mine, but all I can say is that I am very surprised that he should think so. Two honorable members raised the question of the Brown Sisters and whether they will be eligible for subsidy under this legislation. That brings me to say something about the basis on which we have decided we should calculate the allotment of funds to the various district nursing societies. We must have some basis for doing it. As I have pointed out, the object of this bill is to assist voluntary organizations. We propose, in general terms, that for those that are already in existence, a sum of money should be provided when they add another nurse to their staff, roughly equivalent to the salary which that nurse would be paid; but that does not mean that the society is, therefore, compelled to use that sum of money specifically to pay a nurse's salary. It is only a basis of calculation to arrive at a sum, and it will, of course, be paid into the general funds of the society and used for whatever purpose the society wishes to use it. It is a matter of no concern to the

Commonwealth whether the society pays its nurses a salary, or whether they work without salary. The basis of calculation is merely taken as, roughly, the amount of a nurse's salary, and the society will add it to its general funds and use it as it wishes. The Brown Sisters, therefore, will be just as eligible as will any other organization to receive the subsidy.

The honorable member for Wilmot (Mr. Duthie) referred to bush nursing in Tasmania and pointed out that this was entirely a government service. As this is a bill to assist voluntary organizations, it would not, of course, be feasible, proper or, indeed, sensible to pay the subsidy to governments. On the one hand, the organization is already, apparently, adequately provided for by its own State government, and on the other hand, the Bush Nursing Association of Tasmania, in particular, and other bush nursing associations in general, maintain hospitals for which they are entitled to draw hospital benefits under the National Health Act, so that they are in fact already being assisted by the Commonwealth.

The honorable member for Port Adelaide (Mr. Thompson) asked whether the Government would make the subsidy available - I think I have this right - to the head-quarters of an organization or to its various branches. I do not think that that question is susceptible of being answered categorically. Each case would have to be judged on its merits. The general intention is not to make the conditions onerous for a society, but to treat the matter as sensibly as possible. In general terms, it probably would be easier for the Government to negotiate direct with the head-quarters of an organization, but that may not always be the case. In any event, the honorable member will realize that the bill provides that the organization must first attract a State subsidy. If it is doing that, then it can attract Commonwealth subsidy to match the State subsidy.

Mr Thompson - The State treats the society as a whole.

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - Yes, we also would probably treat it as a whole, but we do not want to attach onerous conditions to the societies. We intend to examine each case and treat it on its merits. I do not think that T have left any questions unanswered.

Mr Duthie - What would be the position if the number of nurses were reduced?

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - I think we will deal with that when it occurs. The honorable member for Adelaide (Mr. Chambers) asked what would we do if an organization had branches in, different States. In general terms, the answer to that is the same as the answer I have given to the honorable member for Port Adelaide about different branches in the State.

I am grateful to the House for the reception it has given to this bill.

Question resolved in the affirmative.

Bill read a second time, and reported from committee without amendment or debate; report adopted.

Bill - by leave - read a third time.

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