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Wednesday, 14 September 1983
Page: 828

Mr RUDDOCK(11.41) —In this discussion of clauses 31 to 45, I want to raise a number of very specific questions which I hope the Minister for Health ( Dr Blewett) will be able to address. I hope that he will be able to allay my concern and that of people in my electorate who are associated with particular private hospitals. In the scheme outlined by the Minister for clauses 31 to 45, I note that private hospitals are to be categorised and that the daily insurance benefit and Commonwealth bed subsidy will vary according to the categorisation. The Minister has indicated the wide variety of hospitals. There are major surgical hospitals and religious and charitable organisations run hospitals providing care and services comparable with the major public hospitals, and he has mentioned others at the extreme. Presumably those major surgical hospitals will be category A, and those that are categorised as bush nursing and other small hospitals in rural areas with few beds of the character of a nursing home, will be categorised as classification C.

The Minister gave the details which the Bill does not provide, because clause 9 really empowers the Minister to specify the categories of private hospitals for the purposes of the Act and the daily amount of bed payment and to provide for consultation with State Ministers in relation to categorising those hospitals. Later, of course, in clause 44, there are certain provisions that provide access to premises for the purpose of inspecting books and presumably examining the premises and the like for the purpose of assessing hospitals. Later, in clause 45, there is provision for review of decisions that the Minister might take, and particularly the basis on which he categorises hospitals against certain principles, which he will be enunciating later, in certain regulations. I note that the appeals that can be taken are in relation to approval of premises as private hospital, the conditions of approval of premises as a private hospital, the revocation of approval of premises as a private hospital, the characterisation of particular private hospitals and the conditions attached to approval.

The Minister has indicated, in his three tier structure, that category A hospitals will receive a $120 a day basic benefit and the $40 a day Commonwealth bed subsidy, making a total of $160; that category B hospitals will receive $100 a day benefit and $30 a day subsidy totalling $130; and that category C hospitals will receive $80 a day benefit and a $20 bed subsidy, making $100 a day. He makes that point and of course, at this stage, organisations are worried about the category into which they are likely to be placed.

I want to develop one other matter before proceeding specifically to the subject of the hospitals about which I am concerned. The Minister made the point that the categorisation that he envisages is necessary because the steep increases that have occurred in public hospital charges over the past two years have allowed some private hospitals to increase their fees in line with those increases in public hospital charges. The Minister ascribes that as a reason for his belief that that has happened. Implicit in his remarks is a suggestion that private hospitals are charging excessive fees and, presumably, as a result of this categorisation, he will be able to bring those fees down significantly and reduce the income of private hospitals. Obviously that would be of very considerable concern to the religious institutions that are involved and to the private businesses that in some cases are involved and particularly if the organisations have not been run on a profitable basis or if the profit is unreasonably low. I note that provision is made for assessment and for officers of the Department to be able to undertake certain reviews.

I know that the Minister has received the same brief that I have in relation to a particular hospital in my electorate. I refer to the religious hospital run by the Sisters of the Little Company of Mary-the Mount St Margaret Hospital. This is an approved hospital under the New South Wales Mental Health Act of 1958; it holds a licence for 170 beds; it is a third schedule charitable and religious institution without government subsidy; and it has never received either directly or indirectly government funds for its capital projects. The hospital admits voluntary and involuntary psychiatric patients under the fifth schedule of the hospital system in New South Wales. There are seven specialised areas in the hospital which cater for varying treatments including acute, suicidal anxiety neurosis, psychosis, extremely disturbed patients and psycho-geriatric units including Alzheimer's syndrome and Korsakoff's disease, in various stages. I have particular knowledge of the unit dealing with senile dementia patients. I have been a member of a board of a hospital that has looked for some time at the way in which it might extend its program to provide for those who are suffering from senile dementia. The Mount St Margaret's unit for catering for psycho- geriatric patients is unique. It is one of the leading facilities that are examined by many others that are interested in this work. The sisters have pursued a very worthwhile initiative.

The hospital fees are set on the basis of providing sufficient income to cover operating costs and an ongoing program for updating indoor and outdoor facilities for the treatment of patients. The hospital has certainly very excellent facilities. It has a very excellent program for the training of psychiatric nurses. In fact, it is one of the only private hospitals of which I am aware that has a nurses' training school. It has been involved in this work for something of the order of 50 years. It also has a social work department and a pharmacy department serviced by appropriately qualified staff. It had an extensive occupational and diversional therapy program designed for the daily rehabilitation of patients. The hospital also hopes to be shortly accredited under the hospital standards for accreditation. It has recently involved itself in very considerable capital work in updating some of its facilities to ensure that they are able to be fire rated and to ensure that the premises, in a way in which many public hospitals in New South Wales are not, will meet final inspection and approval from the Board of Fire Commissioners of New South Wales.

This is an outstanding hospital, yet I am told that it has never been inspected for the purposes of categorisation. All psychiatric hospitals have been categorised in category C and this has caused very considerable concern to the sisters. If, as I see from the smiles on the officers' faces and perhaps the Minister's face, a different system is to operate, hopefully I and other members could be informed. When I last saw the sisters several weeks ago they had not received any news in relation to this. There had been no inspection. Of course they had invited the Minister to visit the hospital. I think this is a very firm case, amongst others, for clear categorisation which takes into account the special nature of this hospital and the service it has given.

I understand that the hospital fees will be reduced under the program from something of the order, at the moment, of $140 a day for private patients or $ 120 a day for those in shared ward accommodation, to $100 a day. That involves a very considerable loss to the sisters, who have not been running a profit-making enterprise. This hospital is a very important matter. No doubt others that might be assessed provide very specialised services, services way above those provided in what were described by the Minister as simple bush hospitals somewhat akin to nursing homes. Those factors need to be taken into account. I know there is provision for appeal, and I have mentioned that, but I think it is very important that those who are worried about this categorisation have their anxiety cleared up as quickly as possible. I think it is very unfair that people have been left in this situation where it has been suggested that all psychiatric hospitals will simply be lumped into category C.