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Wednesday, 11 November 1959


Mr CLAREY (Bendigo) .- First of all, I want to express my entire disagreement with the statement of the honorable member for Mallee (Mr. Turnbull) that the Labour Party stands for the restriction of the right of private doctors to prescribe. If there is any interference with the right of doctors to prescribe it is occurring at the present time under the pensioner medical scheme. I bring to the notice of the Minister for Health (Dr. Donald Cameron) a matter which I have raised with him before. That is the prescribing of the drug butazolidine, generally referred to as BTZ This drug has been largely used by doctors for the treatment of rheumatic and arthritic conditions. Recently, instructions were given to remove it from the pensioners' list. Two other drugs which I think have a quinine base were put in its place. The doctors who have made representations to me on the matter have made it clear that they found butazolidine did a much better job to relieve arthritic and rheumatic complaints than the two drugs which have taken its place. I made representations to the Minister because, as one who has suffered from arthritis, I know the pain that it brings and I think that if there is anything that will relieve it quickly, persons who otherwise would have to undertake treatment lasting up to a month before obtaining relief, are entitled to have it prescribed for them. Whilst the two drugs that have been substituted for butazolidine may be cheaper, if butazolidine does the job better the pensioner should have it, and the doctor should not be compelled to prescribe another drug.

I want to make it clear to the House that the Labour Party believes that any national health legislation should impose on the Commonwealth Government the responsibility of putting into operation a health scheme which will be both preventive and curative. The 'task of a health scheme is to do whatever is humanly possible to give the people the greatest possible measure of good health. One is rather surprised, when reading the Minister's second-reading speech, to find that the question of cost is constantly raised. The cost does not matter so long as we are a healthy people.

Apparently everybody has lost sight of the fact that the economic implications of an adequate national health scheme are of untold advantage. If one were to compare the statistics for days gone by with those for to-day one would find that absences through sickness in industry are by no means as great in proportion to the number of persons employed as they were. The economic value of a health system under which people who take ill can be readily treated is that their absence from work is short and their skill and know-how is rapidly brought back to industry. That is something which should be remembered and prized. If it costs money to do that, the better economic position of the nation enables the community more readily to meet the cost than if the system were not in operation.

So, I suggest that we have to consider, first, not so much the cost of the scheme, but its value to the nation. I can recall in the early days of my association with industry any number of cases in which sick persons continued at work because their income was low and they had no resources behind them. They continued working until they could not work any longer. What was the result? Very often, they were subject to very long periods of absence from work as a consequence of their illness. Sometimes a worker reached such a state, particularly with pneumonia, that there was very little chance of recovery. So, whatever it costs the nation, there is a corresponding gain of great value to the community as a whole.

It has been stated that the taxpayers' interest is being protected. The taxpayer is to-day paying for health benefits. He is the person who bears the burden of any health legislation that we pass. Therefore, the taxpayer is entitled to say, " I desire to secure from this health scheme the very best medical attention, the very best hospital attention and the very best pharmaceutical benefits that can be made available to me ". If the taxpayer does not get those things he is entitled to complain, to object, and to make his objections heard.

Having said that, I want now to get on to two provisions of the bill which, in my opinion, are controversial. I shall deal, particularly, with hospital benefits and pharmaceutical benefits. In respect of hospital benefits, I want to draw the attention of the Minister to a statement which he made in his second-reading speech and which I feel gives a very wrong impression of the position of persons who are in benevolent homes, rest homes and similar institutions. So that there can be no misunderstanding, I shall read from the Minister's speech. He said -

Notwithstanding the very limited way in which these homes can be regarded as hospitals, the Commonwealth has nevertheless always accepted their patients as hospital patients for the purposes of payment of Commonwealth hospital benefit and, accordingly the patients in these institutions who are insured with a registered hospital benefits organization have been, still are, and will continue to be entitled to payment of Commonwealth hospital benefits amounting in all to £7 a week.

I agree with that. That amount is being paid in respect of benevolent homes and similar institutions. But I take exception to the Minister's next statement, which is -

Many of these patients are social service pen.sioners and are thus entitled both to pension payments amounting now to £4 15s. a week, as well as Commonwealth benefit of £1 a day, if insured, thus giving them altogether £11 15s. a week from the Commonwealth towards the cost of their accommodation in these institutions.

The position in Victoria - I presume this is the position in other States as well - is that there are two types of patients in the benevolent homes. First, you have what are called ambulatory patients - those who are able to get about and look after themselves. To them, the benevolent home is their home. Those patients pay a certain portion of their pensions to the home for their maintenance and they receive a small amount for themselves. But in respect of patients who are in the infirmary wards - patients who are unable to look after themselves and who require nursing and occasional medical attention, X-rays and so on - £7 a week is paid to the benevolent home, but no payment whatever is made by the pensioner in respect of his maintenance in the home. So instead of a portion of the pension being available to the institution in addition to the £7 a week, only £1 a day is available to it and no payment in respect of his maintenance is made by the pensioner who is in the infirmary ward.

I make the point that persons who are suffering from chronic diseases or conditions that require them to be in bed for long periods are entitled, as human beings, to receive exactly the same consideration and attention as any other section of the community. I cannot see why the payment for maintenance of a person who is so infirm and unable to look after himself that he must enter a benevolent home should be £1 a day when the payment for a person in a hospital recognized by the Department of Health is £1 16s. a day. I concede that perhaps the benevolent homes do not have X-ray facilities, but the benevolent home with which I am most closely associated - the Bendigo Benevolent Home - has its own doctor who visits patients. Patients in that home receive careful nursing attention and their needs are catered for in every respect. If urgent medical attention is required they are admitted to the Bendigo Hospital, next door, and at the earliest possible moment are returned to the benevolent home. A payment of only £1 a day to institutions looking after that type of person is totally inadequate and not in accordance with the standards that we as Australians believe they should have. As human beings, they are entitled to the fullest possible consideration under any Commonwealth health scheme. I express my intense dissatisfaction with what is taking place with regard to benevolent homes.

Then you have the hospitals that are registered as hospitals, which are attended by doctors and which accommodate patients who are suffering from chronic diseases and other illnesses. But because those patients constitute a fair proportion of the inmates of the hospitals - I am referring particularly to a hospital in my electorate called Mr Carmel - the hospitals have been denied, in respect of those patients, certain advantages that have been prescribed in the legislation. It may be that this legislation will cover a hospital of that description. I endorse the plea that was made to-night by the honorable member for St. George (Mr. Clay) that the clauses of the bill that are under consideration will be interpreted and administered in a generous and charitable spirit, so that hospitals that are doing a good job will receive the financial assistance necessary to enable them to carry out their activities properly.

I desire now to deal with pharmaceutical benefits. Like many other honorable members, I express my complete opposition to the proposal that a charge of 5s. be made for all future prescriptions dispensed by chemists under the pharmaceutical benefits scheme. I shall certainly vote against this proposal in the committee stage, and I hope that it will be defeated Of all the proposals that have been placed before us in this measure, the proposal dealing with pharmaceutical benefits is that upon which the least information has been given to the House. We are told that a charge of 5s. is to be made for a prescription. We are told that the cost of the pharmaceutical benefits scheme has been rising year after year, and that within the foreseeable future it may amount to £30,000,000 a year. But no indication has been given to the House of the average cost of prescriptions under the scheme. We have no information as to the cost of prescriptions paid for by patients in the course of twelve months. We have no idea of the magnitude of the work involved in the matter, and we certainly have no information whatever from the Government as to how much it is anticipated will be obtained by the introduction of the 5s. charge for prescriptions.

When the Treasurer (Mr. Harold Holt) submitted his Budget, he made it clear that persons suffering from chronic illnesses who had to have prescriptions repeated would not be required to pay 5s. in respect of each repeat prescription. But under the legislation no exceptions are made. A fee of 5s. is to be charged in respect of every prescription. A complete change of front has taken place between the making of the Treasurer's statement and the drafting of this bill. No reason has been given why the promised alleviation has not been forthcoming.

I want to make it clear - I think it is necessary to do so - that although a good deal has been said about the pensioner medical scheme, not every pensioner is able to receive the benefit of it. Although the legislation of 1953 provided that all persons then in receipt of pensions were to be entitled to the advantages of the pharmaceutical benefits scheme for pensioners, it brought into operation a means test for future pensioners. Any pensioner who is receiving £2 a week in addition to the pension of £4 15s. is denied the right of participating in the pharmaceutical benefits scheme. So it will be seen that persons in the low income group will be hit by the introduction of the 5s. charge for prescriptions.

The Minister stated in his speech some of the possible reasons why the pharmaceutical benefits scheme was costing extra money. I should like to point out that there are very few instances in which greater changes have taken place in respect of any matter giving service to the people than in regard to the drugs which are now used for curative purposes. I suggest that a new era in medicine started entirely as a consequence of the development of the sulphanilimide drugs. The sulphanilimides which brought in a new method of attacking disease, particularly diseases which very frequently cost people their lives, were followed by the introduction of penicillin. Penicillin was a further advance and because its use resulted in bacteria and germs becoming resistant to it, it became necessary for pharmaceutical science to tackle the whole question from entirely new angles so as to evolve drugs which would be able to deal with the resistant germs. The consequence of all this has been the evolution of many types of drugs used for very many purposes aimed to give, in the shortest possible time, relief and cure from disease and restore the person concerned to normal health.

As a result of this advance in pharmaceutical science, the cost involved in the preparation of these particular drugs has become exceedingly high. I say quite frankly that chemists are giving to the Government of Australia to-day service in respect of pharmaceutical benefits at an extremely reasonable price and in my opinion it is entirely unfair to place upon them the burden of having to get themselves into difficulties with the public over the payment of 5s. for each prescription.

If any medical or health scheme is to be of benefit to the community, it involves cooperation between three essential groups. There is, first of all, the Government which may lay down the laws and plans in respect of health. But any scheme which the Government introduces has no possibility of success unless, with that scheme, it has the full co-operation of both the medical profession and the pharmacists.

One must say that from the inception of medical benefits, away back in the 1940's, the chemists, throughout all the intervening period, have given the fullest co-operation to whatever government was in power at the time their co-operation was being sought. It has been given freely and in full measure and for that reason I feel that in the particular alterations now being made the Government of the day should show its appreciation of the co-operation given by the pharmacists by at least treating them in a manner which will enable them to be free of a good many of the difficulties they are experiencing at the present time.

There are certain proposals in this legislation which I think are entirely unfair. One was mentioned by the honorable member tor Mallee (Mr. Turnbull). I refer to clause 21 which provides for a new section, 104a, to be inserted in the principal act. With the comments that were made as to the undesirability of this particular provision and expressed, to a certain extent, by the honorable member for Mallee, I agree. Personally, I can see no reason why it should be in the legislation. The order contained in the proposed new section 104a is as follows -

The Director-General may require an approved pharmaceutical chemist to furnish to him, within a time specified by him and in accordance with a form supplied by him and with any directions contained in the form, a statement, signed by or on behalf of the approved pharmaceutical chemist, setting out particulars of stocks of drugs or medicinal preparations in his possession or under his control ....

That means an enormous amount of work for the chemist. It means that practically every time the request is made he has to take stock of all the things that he has on his premises which could be used in connexion with the pharmaceutical benefits scheme. There is no suggestion in this provision that there shall be any payment for the work involved. There is only a direction that the work shall be done and if it is not done to the satisfaction of the Director-General then appropriate action can be taken by the Minister or his department. Whether that provision will be carried out in a reasonable manner or in an unreasonable manner, nobody can say. But the point is that the provision is there and one never knows how it cnn or will be used in order to embarrass a chemist.

The next thing I wish to point out is that this proposal in regard to the 5s. fee for prescriptions might well wreck the whole scheme of pharmaceutical benefits. At the present time the chemists are very dissatisfied with the deal they are receiving from the Government. The Minister may be making some progress in his negotiations with them. Whether he is or not I do not know; but I do know that the chemists are exceedingly dissatisfied with the treatment they are receiving compared with the medical profession.

As to the medical profession, the bill provides that matters affecting the doctors have to be the subject of consultation and agreement; and unless agreement is reached no alteration which will affect the doctors can be made. But with respect to the chemists, there is no such provision. They can be consulted and their views heard, but after that the Government is in the position of saying, " We will do this or that " and the chemists have no further say in the matter. On the advisory committee, as was pointed out also, I think, by the honorable member for Mallee, there are to be four representatives of the Government and four of the pharmacists with one government member as chairman who has the deciding or casting vote.

I know that in the industrial world, it there were a dispute between employers and workers and if a group were appointed for the purposes of settling it, consisting of four workers and four employers, with an employer having the right to give the casting vote to decide the issue, we would have considerably more industrial disputes in Australia than is the case. It is obviously unfair that a person who is employed by an authority which is interested in the matter should have the casting or the deciding vote in the matter. 1 sincerely hope that action will be taken to see that if there cannot be consultation and agreement with the chemists, their matters can be decided by an authority with an independent chairman or arbitrator. This will enable justice to be done.

In the few minutes left to me, I want to say this, and I make no apology for doing so: I believe that in every nation the fight against disease should be carried on with unrelenting vigour. That is not a phrase of mine; it is taken from the Declaration of Philadelphia. The fight against disease must be carried on with unrelenting vigour within the boundaries of each nation. I believe that it is the function and the task of the government of the day to see that everything necessary is done to give every man, woman and child in Australia preventive or curative medicine and necessary hospital or other treatment free of cost to themselves. We say that education is essential for the progress of the nation, and education is free. Two things are necessary for the progress of the nation - education and health. Both should be free. Both should be the right of every member of the community, and Opposition members will never be satisfied until a health scheme is introduced here that entitles everybody from the day of their birth to the day of their death to the fullest measure of treatment in respect of their health, so as to build and maintain a healthy and strong nation.







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