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Thursday, 10 November 1983
Page: 2558


Dr BLEWETT (Minister for Health)(11.34) —I move:

That the Bill be now read a second time.

The Bill before the House will amend the Health Insurance Act 1973, the National Health Act 1953, the Nursing Homes Assistance Act 1974 and the Medical Research Endowment Act 1937. The most significant amendments relate to the administration of the Government's nursing home program. The Government is concerned that proper priorities should be set in developing services for aged people. Inquiries conducted during the past decade have addressed this matter and there is a general consensus that there are serious imbalances in the services provided for the care of the aged. While Australia overall has very adequate provision of nursing home accommodation its community care and domiciliary services are underdeveloped as are its facilities for hostel care. The priorities of the Government as expressed in its election policy for the care of the aged are to moderate growth in the nursing home sector and encourage the further development of hostel, community and domiciliary care services. Currently it costs the Commonwealth $600,000 a year in recurrent expenditure for each 50-bed nursing home that is approved. For this reason, it is vital for the Government to restrict nursing home growth if it is to find funds for urgently needed hostel, community and domiciliary services for the care of the aged.

Another important element of the Government's aged care policy is to encourage the development of assessment so that aged people can be guided to the available services most appropriate to their needs. The amending legislation before the House is an initial step in pursuing these priorities. The principal matters concerning the Government's nursing homes program which are the subject of the amendments apply to both the National Health Act and the Nursing Homes Assistance Act. Under this legislation the Minister for Health, instead of the permanent head, will be empowered to approve new or additional nursing home accommodation. The need for such accommodation will be assessed in accordance with principles to be tabled in the Parliament, and therefore subject to the scrutiny of both Houses.

Further changes affecting nursing home approvals are made in clause 34, which would amend the National Health Act, and clause 60, which would amend the Nursing Homes Assistance Act. These provisions insert new sections 39A and 3A into the relevant statutes and enable the Minister to grant a certificate, or in other words, an approval in principle, to an applicant. This approval in principle guarantees the holder that if he applies for approval of the completed nursing home or alterations to an approved nursing home under either Act within a period of 12 months or such longer time as the Minister allows, the approval will not be refused on needs grounds. The legislation provides further for specifications to be imposed on the certificate and, where appropriate, that admission to the nursing home will be confined to persons representing a special need for which the certificate was granted. An example of special need would be where nursing home approval is granted to cater specifically for crippled children or patients of a particular ethnic origin.

To ensure that a full and comprehensive assessment of nursing home need can be effected, the proposed new sub-section 39A (1) of the National Health Act and proposed section 3A (1) of the Nursing Homes Assistance Act allow the Minister to invite interested persons to make application for a nursing home in a specified region. To date the approval system has operated on a first in, first served basis. The purpose of the published invitation is to enable a more informed evaluation to be made, particularly having regard to the existing aged care accommodation and services in the area, their effectiveness and what a future appropriate mix of accommodation and services should be. The legislation specifically provides for the invitation by interested parties to be published in the Commonwealth of Australia Gazette. The practice to be adopted by my Department will be for the relevant details also to be published in appropriate local and capital city newspapers having regard to the needs of the area.

Consideration of nursing home applications has been deferred while the new growth control guidelines are being settled and the arrangements proposed in this Bill are being put in place. Honourable members will note that the provisions concerning nursing home approvals and decisions by the Minister in that regard will come into effect from a date to be proclaimed. This date will be the date when the principles have been formulated and tabled in Parliament. Let me assure the House that the Government is conscious of the need to enable evaluation of nursing home accommodation requirements to be undertaken as soon as possible.

The Government's aged care policy will be underwritten by an effective system of assessing the medical, social and emotional needs of the aged and disabled to enable them to be guided to the most appropriate, available services. Ulti- mately, such assessment will be a precondition for aged persons being admitted to a nursing home, or for receiving Commonwealth subsidised community care in their own home or a hostel. A complementary form of assessment is the classification of a nursing home patient as requiring extensive care. Currently, approval of entry to a nursing home, and approval of a person's eligibility for the higher extensive care benefit, can be made only by a Commonwealth Medical Officer. This system does not involve any personal contact. The proposed amendments are a step towards achieving more meaningful assessment procedures.

The Bill provides for the Minister, instead of the permanent head, to grant or refuse applications for admission to a nursing home or for classification as a patient requiring extensive care. As a consequence, these decisions will be appealable to the Administrative Appeals Tribunal. Significantly, the Bill also provides the Minister with greater flexibility to delegate powers for the approval of admissions and patient classification. This will enable these decisions to be delegated not only to a Commonwealth Medical Officer but also to others such as those participating in assessment units. Honourable members will recall that $2m was allocated to my Department in this year's Budget for the development of assessment procedures and the establishment of assessment units.

The Government is concerned that the interests and welfare of nursing home patients should be safeguarded. There is a need to protect patients from the unscrupulous practices of a few nursing home proprietors. For example, in a case where a proprietor is given power of attorney over a patient's affairs, that patient may need to be protected by a trust fund or similar arrangement. The proposed amendment will enable conditions of approval to be imposed on proprietors of nursing homes to preclude practices and arrangements which are detrimental to the interests and welfare of patients.

This Bill also applies uniform conditions of approval to both government and non-government nursing homes. The existing provisions of the National Health Act exempt government nursing homes from statutory conditions which relate to the number of beds in an approved nursing home, and the approval of patients for admission to a nursing home. Government nursing homes have in practice been subjected to restrictions on the approved number of beds since 1981. That practice is formalised in this legislation, for both new government nursing homes and additional beds in existing government nursing homes. It is proposed that formalised assessment procedures will also apply in government nursing homes.

In introducing this measure the Commonwealth recognises the importance of developing co-ordinated approaches to assessment which should be followed in deciding to admit a patient to any nursing home, including a government nursing home. The legislative amendments before the House will permit this. I have written to State Health Ministers advising them of the amendments. In recognition of the continuing need for consultation of these matters the legislative changes affecting State government nursing homes will come into effect from a date to be proclaimed. The statutory conditions relating to fees control and charging policies will continue not to apply to government homes, because their financial operations are subject to State government policies.

Honourable members will appreciate that it is necessary for my Department to have details of current nursing home proprietorship to administer the nursing homes program. The present legislation places the onus of notification on the person leaving the system, that is, the outgoing proprietor. Administrative difficulties will be minimised by clauses 43 and 71 of the Bill which will require the incoming proprietor to notify the Department of the impending change in ownership. Such an arrangement will enable the Department to advise new proprietors of the nature of the Government's nursing home program and of the responsibilities placed upon them under the legislation.

The Bill also provides for ministerial and then Administrative Appeals Tribunal review in respect of a range of decisions. The principal decisions involved relate to the need for new and additional nursing home accommodation, approvals of nursing homes and additional services, admission and classification of patients, imposition or alteration of conditions of approval, other than fees determinations where ministerial review would continue to apply, and suspension or revocation of a nursing home's approval.

Provisions for the amendment of the Medical Research Endowment Act are included in Part III of the Bill. Under the current provisions of that Act the Minister for Health, on the advice of the National Health and Medical Research Council administers the medical research endowment fund. This fund is the major channel through which the Government provides financial support for medical research in Australia. The House will recall, Mr Deputy Speaker, that in the Budget the Government provided for an appropriation of $37.979m to the fund for 1983-84. This represents an increase of some 28 per cent over the funding for the previous year and is an indication of the Government's commitment to foster and to encourage first class medical research in this country.

The existing legislation was enacted in 1937 and, consequently, does not conform to modern legislative concepts in respect of auditing and financial management. The current position is that the fund, and bequests to it, are maintained in Commonwealth Trading Bank accounts separate from the public account, administered by the Minister for Health, and subject to annual audit by the Commonwealth Auditor-General in accordance with the Act. However, in view of the magnitude of the Government's appropriation to the fund, it is considered appropriate to bring it within the public account and the concomitant audit and accounting provisions.

Inherent in this proposal is the transfer to the Minister for Finance of the responsibility for investment of surplus money in the fund. On the other hand, authority to approve grants from the fund will remain with the Minister for Health. I emphasise, however, that the Minister for Finance can delegate the investment power to a senior officer of the Department of Health and it is envisaged that a delegation will be made to the First Assistant Director-General , National Health and Medical Research Council. Such an arrangement will, in fact, permit the fund to be administered in much the same way as now, but it will give the advantage of ensuring the use of modern accounting and audit procedures.

The Bill also provides, Mr Deputy Speaker, for the Act to be amended so that the report to Parliament of work done under the Act for the preceding year is to be presented as soon as practicable after 31 December each year but that, in any case, it must be furnished to the Minister for Health within nine months of that date. This provision, which differs from the usual six months for such reports, takes account of the particular method of preparing the report whereby the text of the document consists mainly of reports prepared by selected researchers on their projects. These reports must, of course, be couched in terms understandable to the informed layperson and this procedure takes considerably more time than is the case with reports prepared within departments or agencies. Experience has shown that the report can normally be presented to Parliament within nine months of the end of each year but that it could not be presented within six months. Accordingly, this amendment will avoid the Minister for Health having regularly to seek an extension of what would be an unrealistic deadline. These amendments will not have any financial impact .

I now turn to clauses 27 to 32 of the Bill which will amend the provisions of the National Health Act relating to the isolated patients' travel and accommodation allowances scheme, the purpose of which is to remove certain anomalies and overcome some deficiencies inherent in the scheme. The amendments will generally allow greater flexibility in the operation and administration of the scheme and, in some instances, will enable patients in isolated areas to obtain benefits where previously the legislation precluded payment. Specifically , IPTAAS benefits will be extended to patients referred by an optometrist to an ophthalmologist, and by a dentist to a specialist or consultant physician for treatment arising from a dental service. Currently, claims for payment under the scheme are not accepted until after the patient has returned home. The amendment in the Bill will allow, in cases of hardship or in special circumstances, for interim payments to be made. The amendments will also allow greater flexibility in the approval of further specialist treatment, and in certification of the need for an attendant or escort. The scheme will also be expanded to assist families where a patient, attendant or escort dies while away from home.

Honourable members will appreciate that during the 1982-83 financial year out of a total of $9.2m paid in travel and accommodation allowances, some $2m was for accommodation allowances. Given that approximately 50 per cent of persons in receipt of allowances stay with relatives, it is considered that the present allowance based on accommodation rates at commercial premises is unnecessarily generous in reimbursing persons for private accommodation. The amendments will therefore empower the Director-General of Health to determine an accommodation allowance in relation to specified classes of accommodation, by instrument published in the Commonwealth of Australia Gazette. The financial implications of these amendments are expected to be minimal.

Clause 53 of the Bill provides for the repeal of section 91 of the National Health Act. This section has restricted the number of friendly society dispensaries in each State which can supply pharmaceutical benefits to all members of the public, whether they are members of a friendly society or not. Friendly society pharmacies in excess of this restricted number receive only a limited approval to supply pharmaceutical benefits only to members of the friendly society, to their spouses and children. There are currently only eight limited approvals in Australia. This amendment will remove the discriminatory legislation against friendly society dispensaries and allow all friendly society dispensaries to be placed on the same footing as private pharmacies. The amendment will have no financial impact.

Clause 56 of the Bill provides for amendments to the secrecy provisions in section 135A of the National Health Act. This amendment brings the secrecy provisions more into line with similar provisions of the Health Insurance Act and will remove the confusion and ambiguity which has existed because of conflicting interpretations of existing provisions. The new provisions, whilst protecting the privacy of innocent persons, will enable the permanent head of the Department of Health to divulge to specified persons, such as State regulatory authorities, information acquired under the Act about the affairs of a person in certain circumstances. They are that that person has been convicted of any certain specified offences, or the Minister for Health has certified it desirable for the administration of certain Federal, State and Territory legislation, or where it is necessary in the public interest, that such information be divulged. The amendment will also allow information to be disclosed to a court with respect to the affairs of a person who is a party to the proceedings. These amendments have no financial impact.

The Bill at clauses 13 and 14 will also amend the provisions of the Health insurance Act relating to costs involved in proceedings before a medical or optometrical service committee of inquiry. Under the Health Insurance Act as it now stands, provision exists for a practitioner to request a review by a medical or optometrical services review tribunal of a determination made by the Minister following recommendations from a medical or optometrical services committee of inquiry. Where a request for a review is lodged, provision currently exists in the legislation for the costs incurred by the practitioner in relation to proceedings before the tribunal to be borne by the Commonwealth unless the tribunal otherwise directs.

This approach is out of step with the usual practice in courts and the Administrative Appeals Tribunal. The Joint Committee of Public Accounts in its report on medical fraud and overservicing recommended that the Commonwealth should not be automatically required to meet the costs of doctors who request a review of a ministerial determination, but should require such doctors to meet their own costs unless the tribunal or court decides otherwise. The Government has generally accepted the Committee's recommendation. The effect of clause 13 of the Bill would be that practitioners who request a review of a ministerial determination on overservicing by a tribunal will now meet their own costs. The savings to the Commonwealth under the proposed arrangement would be minimal- probably less than $10,000 a year at today's prices-but the amendment would bring the operation of the medical and optometrical services review tribunals into line with the practice of other administrative tribunals. The repeal of section 123A by clause 14 would mean that, where a practitioner lodges an appeal to a prescribed court, normal court procedures would apply and the awarding of costs would be left to the court to decide. To date there have been no such appeals.

The Health Insurance Act will also be amended to simplify the referral procedures currently in force in respect of persons suffering from cleft lip or cleft palate conditions. The amendment removes the requirement that patients certified as having a cleft lip or cleft palate condition be formally referred for treatment before services rendered to them by an accredited dental practitioner attract Commonwealth medical benefits. Experience has shown that this referral is unnecessary.

The Bill provides for a number of amendments to the Health Insurance Act 1973 in respect of the health care card arrangements. The first of these is the restoration to unemployed school leavers of their legal entitlement to a health care card inadvertently denied to them by the operation of social security legislation introduced by the previous Government. This legislation in effect made school leavers ineligible for health care cards in their own right during the six-week period before they become eligible for unemployment benefit. The correction of this anomaly is provided for in clause 5 of the Bill. To avoid causing hardship to such persons, the matter has been dealt with administratively and consequently no additional expenditure is involved in 1983- 84.

Clause 5 of the Bill removes the discrepancy that occurred following the introduction of the family income supplement. This discrepancy was between the health care card income test for sole parents and that for married parents with the same number of children. This amendment will give legislative authority for administrative action taken by the Department of Social Security from May 1983 which corrected the anomaly. The estimated additional expenditure for this measure by way of Commonwealth medical benefits in 1983-84 is $30,000.

Clauses 6 and 7 of the Bill provide for the issuing of health care cards to persons in receipt of unemployment and special benefits for a period of 12 weeks instead of the present period of two or three weeks. This will result in administrative savings to the Government estimated at $4m for 1983-84. Against this there is an offsetting cost of an estimated $1m in 1983-84 in health care card benefits payable to people issued with 12-week cards who will continue to use the card after their eligibility for unemployment or special benefits has expired.

Clause 5 of the Bill excludes the new remote area allowance, to be introduced from May 1984, from the definition of income for the purposes of the health care card income test for low income earners. The allowance will be paid to pensioners and beneficiaries living in income tax zone A. These people generally receive little or no benefit from the tax rebate applicable to residents of this area as their income is often below the tax threshold. The allowance will reduce any zone rebate otherwise applicable. The exclusion of the remote area allowance for health care card income test purposes is considered by the Government to be necessary in the interest of equity for these persons.

This Bill also permits the Director-General of Social Security to obtain information from a third party which may affect the entitlement of another person to a health care card. At present a third party can only be required to furnish a report on matters which might affect the continuation of entitlement to a health care card. It has often been found that applicants for health care cards are not able to provide satisfactory details of, for example, their income and it is considered desirable for the Director-General of Social Security to have the power to obtain this information.

Finally, I am pleased to inform the House that a further amendment is to be made to the Health Insurance Act by clause 4 of the Bill to bring within the category of eligible pensioner, and therefore eligible for the attendant benefits that are available, persons in receipt of the new spouse carer's pension. This pension is a new Government initiative announced in the 1983-84 Budget which will become payable as from next month. It is to be payable to husbands providing full time care to an aged or invalid pensioner wife. The estimated cost of Commonwealth fringe benefits associated with the introduction of the allowance is $0.4m in 1983-84 and $0.4m in 1984-85. I commend the Bill to the House.

Debate (on motion by Mr Carlton) adjourned.