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Wednesday, 4 November 1992
Page: 2586


Mr HOWE (Minister for Health, Housing and Community Services) (5.13 p.m.) —I move:

  That the Bill be now read a second time.

It is generally accepted that health care consumers can suffer adverse outcomes from health services. Some of these are known and accepted risks of procedures and treatments, even when these procedures and treatments are expertly performed. However, sometimes adverse patient outcomes are attributable to poor quality of patient care.

  While little direct data on the incidence or causes of adverse patient outcomes are available in Australia, United States data suggest that approximately 4 per cent of all hospital admissions result in avoidable adverse outcomes not associated with the patient's original condition. Four per cent of all hospital admissions in Australia could translate into approximately 170,000 patients per year with avoidable adverse outcomes.

  Effective quality assurance is an important way of reducing the incidence of adverse patient outcomes. It is a positive approach to the reduction of adverse patient outcomes. It can be achieved by providing funds for initiatives and studies which identify problem areas, by encouraging activities to address such problems, and by providing appropriate legislative protection for quality assurance activities so that health professionals feel able to participate. The Government has provided some seminal funding for quality assurance activities in this year's Budget. This legislation seeks to provide the statutory protective framework for quality assurance activities.

Quality Assurance Activities

  Quality assurance embraces a wide range of activities. These include: hospital based peer review processes, such as clinical audits into surgical mortality rates; academic studies into the incidence or causes of adverse patient outcomes; peer committees to counsel or assist other practitioners who are having difficulties which may lead to adverse patient outcomes; and the performance evaluation of individual health care professionals for the purpose of determining the clinical privileges of that professional.

  There is widespread support amongst medical practitioners and consumers for open, positive and voluntary participation in such activities to prevent adverse patient outcomes and raise the quality of health care delivery. In terms of outcome, quality assurance activities are the embodiment of the phrase `prevention is better than cure'.

  In the past these activities have been inhibited by the fear of health professionals that information generated by quality assurance activities may be used by patients in personal injury litigation. In addition, there is a fear held by health care professionals who participate in any peer review activities which can affect another practitioner's practising rights, that that colleague may sue the participants if they are dissatisfied with the outcome.

  A number of States and Territories have introduced legislation to address these concerns and this Bill is based on current legislation in New South Wales, Queensland, Victoria, South Australia, Tasmania and the Australian Capital Territory. However, the existing States and Territory legislation will not prevent actions under Commonwealth legislation or in courts exercising Federal jurisdiction to subpoena material created solely for the purpose of quality assurance activities. This Bill also provides protection for national projects and studies which are undertaken by the medical colleges or other professional associations across all or a number of States and Territories.

  This Bill will promote the undertaking of a range of quality assurance activities by providing statutory protection in the form of confidentiality of quality assurance information and immunity to quality assurance activities and committees which are declared by the Minister. The Government recognises that conferring confidentiality and immunity on the activities of a particular group of professionals has the capacity to affect individual rights and interests. For this reason, a number of checks and balances have been built into the Bill.

  In summary, activities will only be declared under the Bill on the application of those carrying out the activity and after the Minister has satisfied himself or herself that among other things, it is in the public interest to provide the protection. The Minister's declaration will be by way of a disallowable instrument and so will be subject to parliamentary scrutiny.

  In circumstances where information gained by a quality assurance activity may relate to a serious criminal offence, the Minister may authorise the disclosure of the information for law enforcement, royal commissions or other prescribed purposes. Further, before members of committees established for the purposes of evaluating the services provided by other health care professionals will be entitled to the protection of immunity from suit, their participation will have to have been in good faith. The Bill will not provide immunity in relation to proceedings for the breach of the laws of procedural fairness, thus providing balancing protection for affected health care professionals.

Confidentiality

  The confidentiality provisions of this legislation will only make confidential, information which is created solely for the purposes of quality assurance activities. It will not make secret, information which is generated in the ordinary course of health care, such as hospital records. It will also permit disclosure of non-identifying and aggregated information—an important factor in promoting the educational and practical use of information obtained.

Disclosure of Information

  This Bill prohibits the disclosure of information which has been created solely for the purpose of authorised quality assurance activities and studies, and which may identify individuals directly or indirectly, unless all those concerned consent to the disclosure.

Statutory Immunity

  This legislation also provides statutory immunity to members of authorised committees carrying out quality assurance activities such as credentialling. This will hopefully encourage high quality health care professionals to participate in these activities without fear of suit. At the same time, it is important that the person whose conduct is being assessed is treated in accordance with the principles of procedural fairness throughout these quality assurance activities. These provisions again seek to balance these competing interests in a manner that is broadly acceptable to the community.

A Complementary Approach

  A cooperative approach is integral to the success of quality assurance activities. This legislation embraces this concept by complementing the existing State and Territory laws.

Conclusion

  This legislation is intended to encourage quality assurance activities and responsible activities such as credentialling in a very direct way. Many doctors have indicated to me their strong concern for improving the quality of health care and reducing the number of adverse patient outcomes. This Bill provides the protective framework to foster these activities for the benefit of the whole community. I commend this Bill to the House and I present the explanatory memorandum to this Bill.

  Debate (on motion by Mr Downer) adjourned.