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Repatriation Institutions (Staff) Bill 1991



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House: House of Representatives Portfolio: Veterans' Affairs

Purpose To declare Parliament's intentions in relation to the terms and conditions of employment of Commonwealth employees affected by the proposed integration of repatriation health institutions into the State's health systems.

Background This Bill and the Veterans' Entitlements (Provisions of Treatment) Amendment Bill 1991 form the legislative basis for the proposed integration of repatriation health institutions into the State's health systems.

The proposal for the integration of repatriation health institutions with State health systems has its origins in a report, titled the Review of the Repatriation Hospital System (the Review), conducted between March 1984 and June 1985. The Review recommended major changes to the repatriation hospital system, including immediate increases in staff and equipment spending; an extensive rationalisation; and incorporation into the State hospital system. The Government's 1986 response to the Review was to endorse its recommendations that planning should commence with the States on rationalisation of services and for the eventual integration of repatriation health institutions with State health systems when they are no longer needed for Commonwealth purposes. For the foreseeable future the repatriation hospital system was to continue as a separate and independent unit for veterans and war widows. 1 In August 1988, the Government clarified its policy further.

"The Commonwealth's major objectives in the negotiations with the States will be to obtain priority of access for veterans and war widows; to maintain high quality health care for them; to provide greater freedom of choice of hospital for them; and to preserve the rights and conditions of hospital staff." 2

The Government made guarantees that no repatriation health institution would be integrated unless its major objectives were achieved. The Returned Servicemens' League (RSL) was assured that no final decisions would be taken

"if the RSL had reasonable cause for dissatisfaction with the arrangements proposed." 3

The Government considered it possible to achieve its objectives by 1 July 1995 therefore enabling integration to be completed by then. Earlier integration of some hospitals was expected where agreement on arrangements could be reached before 1995.

Integration of repatriation health institutions with State health systems has been viewed as inevitable in the reports of a number of reviews undertaken since the early seventies. The maintenance of a separate hospital service is considered inappropriate by the Repatriation Commission for a number of reasons, including:

"Increasing demands from veterans to be treated in local hospitals rather than in a Repatriation General Hospital (RGH) in a capital city. The families of older veterans find it increasingly difficult to travel long distances to visit veterans;

The declining number of veterans in the treatment population and the large proportion of these requiring chronic care;

Pressure from staff and visiting medical officers in the RGHs to retain the hospitals as viable institutions and to increase the existing levels of community patients; The belief that almost 20 years after the cessation of the last major hostilities and 45 years after the conclusion of World War II there is no longer justification for a separate Commonwealth hospital system with special emphasis on specific war traumas... Most veterans now require treatment for injury or illness shared by the population at large; and

Advice from Defence that the use by the Defence Force of the RGHs is substantially less as civilian hospitals are used increasingly as a matter of convenience". 4

The Department of Veterans' Affairs (DVA) operates a RGH in each State to provide acute care and diagnostic and treatment services to eligible veterans and their dependents. The DVA also operates auxiliary health institutions in some States to provide hospital treatment and short terms nursing and convalescent care for patients needing less acute treatment services. The Commonwealth outlaid, in 1989- 90, $245.2 million on medical services and benefits and $644.2 million on hospital services for veterans and their dependents. Currently, approximately 51% of veterans are treated outside RGHs. In 1989- 90, 622 512 bed days were provided to veterans in RGHs, while 445 597 bed days were provided in public hospitals and 225 434 bed days in private hospitals.

The Government intends to fulfil its responsibility for the health care of veterans and war widows, after integration, by setting up a Private Patients Scheme to cover all veterans and war widows. The Health Program Review begun in November 1988 was charged with developing option for post integration hospital services. During 1989, Cabinet approved arrangements developed be the review for the Private Patient Scheme. In July 1989, the Minister for Veterans' Affairs wrote to all State Health Ministers and major ex- service organisations outlining the Scheme.

"Under the Scheme, entitled veterans and war widows will: *continue to receive free treatment from their Department of Veterans' Affairs local medical officers; *have choice of specialist, at no cost to them, subject to the specialist's fees being in accord with, or less than, the Medicare benefits schedule fee; *have free treatment as private patients (shared accommodation) in a public hospital of their choice, without requiring prior approval from the Department; *where the public hospital system cannot meet their medical need within reasonable time, private hospital care (shared ward) will be available; *continue to have access to sufficient beds at the RGHs to meet special requirements". 5

The Scheme, which has evolved into the Repatriation Private Patient Principles and which the Veterans' Entitlements (Provision of Treatment) Amendment Bill 1991 proposes to give effect to, is intended to be the means by which the Government delivers on its guarantees of access and quality of care to the ex- service community. It is largely modelled on the arrangements which currently apply for veterans in some areas outside the capital cities.

One of the most controversial aspects of the Government's guarantees is that it would obtain priority of access for veterans and war widows in the proposed integrated hospital system. Priority of access does not however imply priority in all situations. Senator Tate summed up the situation from the Government's point of view as follows:

"The phrase `priority of access' has never embraced the proposition that a veteran would get priority over anyone with a more critical medical need. It does not happen now, and it never will. Apart from anything else, that would constitute a breach of medical ethics. But the Commonwealth's private patient scheme would ensure that veterans and war widows in need of hospital treatment get the hospital access they need through a wider and better use of private hospitals, the public hospital system and the integrate repatriation hospitals". 6

The above position is reiterated by the Minister in the Second Reading Speech to the Veterans' Entitlements (Provision of Treatment) Amendment Bill 1991 as follows:

"I should emphasise that the term `priority of access does not embrace the proposition that veterans or war widows would get priority entry to a hospital over a patient with more urgent medical needs. This does not happen now and it never will. Such a situation would constitute a breach of medical ethics. However, the Repatriation Private Patient Principles ensure that veterans and war widows in need of hospitalisation get the necessary access through better use of the integrated Repatriation hospitals, the public hospital system and private hospitals".

At present, veterans have a system of dedicated repatriation hospitals to ensure access to hospital services. Under the proposes Repatriation Private Patient Principles it would appear that they will have access equivalent to a fully insured private patient.

Main Provisions Part 2 (clauses 7- 13) of this Bill deals with the intentions of Parliament in relation to the terms and conditions of employment of Commonwealth employees affected by the proposed integration of repatriation health institutions into the State's health systems. Clause 8 provides that Parliament intends that the Commonwealth should do its best to negotiate an agreement under which Commonwealth employees affected by an integration are to receive offers of continuing employment from a State before a transfer takes place and that as many of those job offers as possible are to be offers of comparable employment.

Clause 9 provides that Parliament intends that the Commonwealth should, in order to minimise disruption to the careers of Commonwealth employees affected by an integration, do its best to negotiate an agreement under which a State, for at least 3 years, is to operate a transferred repatriation institution as an institution that provides services that are comparable to those provided when it was run by the Repatriation Commission.

Clause 10 provides that Parliament intends that the Commonwealth should do its best to negotiate an agreement under which certain employment conditions are to apply to Commonwealth employees affected by an integration who accept an offer of continuing employment made by a State for as long as they continue to be employed by that State, including: * that all accrued recreation, long service and sick leave be transferred at full value to the State health system; * the affected employee be allowed to take the same amount of maternity leave they would have been entitled to take had they remained in Commonwealth employment; and * that prior service be recognised by the State health system for purposes fo determining seniority, future leave entitlements or redundancy payments.

It will be the intention of Parliament that, if the salary of a Commonwealth employee affected by an integration is reduced as the result of him/her accepting an offer of continuing employment from a State, the Commonwealth should supplement his/her income. In addition, it will be the intention of Parliament that the Commonwealth should be able to determine the amount of income supplementation that is to be payable and the period during which income support will be payable (clause 11).

Clause 13 provides that Parliament intends that Commonwealth employees affected by an integration who accept an offer of continuing employment from a State should be able, at his/her option, to remain in a Commonwealth superannuation scheme for as long as he/she continue to be employed by the State.

Part 3 (clauses 14- 16) of this Bill provides for the separation from Commonwealth employment of Commonwealth employees affected by an integration who receive offers of State employment. Basically, clause 14 provides that where a Commonwealth employee affected by an integration accepts an offer of continuing employment from a State, he/she will be taken to have resigned from Commonwealth employment on the day the Commonwealth repatriation institution becomes a State institution. Where a Commonwealth employee is offered a comparable job in a State institution before it becomes a State institution, and either does not accept, or accepts the offer but then withdraws it, he/she will be taken to have resigned from Commonwealth employment on the day the repatriation institution becomes a State institution.

References 1. Statement on the Review of the Repatriation Hospital System by the Minister for Veterans' Affairs, Senate Hansard, 30 April 1986, p. 2055. 2. Minister for Veteran's Affairs, Press Release, 14 August 1988. 3. Ibid.

4. The Annual Reports of The Repatriation Commission and the Department of Veterans' Affairs 1989- 90, Vol. 1, pp. 7 and 8. 5. Ibid., p. 97. 6. Question without Notice, Senate Hansard, 8 November 1990.

Bills Digest Service 11 November 1991 Parliamentary Research Service

For further information, if required, contact D Daniels on 06 2772413 or P Mackey on 06 2772412 of the Parliamentary Research Service, Department of the Parliamentary Library.

This Digest does not have any official legal status. Other sources should be consulted to determine the subsequent official status of the Bill.

Commonwealth of Australia 1991.

Except to the extent of the uses permitted under the Copyright Act 1968, no part of this publication may be reproduced or transmitted in any form or by any means, including information storage and retrieval systems, without the prior written consent of the Parliamentary Library, other than by Members of the Australian Parliament in the course of their official duties.

Published by the Department of the Parliamentary Library, 1991.