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Tuesday, 16 August 2011
Page: 8186


Ms GAMBARO (Brisbane) (17:40): I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. It establishes a new statutory authority, the National Health Performance Authority, and is designed to monitor and report on the performance of hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services.

On the surface, this seems to be another Labor attempt at creating much more big bureaucracy and even more big government, and it is very typical that Labor's version of health reform is more bureaucracy. It is about a bigger waste of money by duplicating more government departments that overlap already with existing agencies and it does not provide for what is needed at the grassroots level. It does not provide for more doctors. It does not provide for more nurses. All it does is create more boards, more secretariats and more and more bureaucracy.

A wide range of stakeholders have expressed extreme concern. There is a list of stakeholders who have expressed concern, but I will just deal with a couple of them today. The AMA has called for a deferral. The RACGP has concerns. A number of bodies have expressed concerns, particularly on what the performance indicators are going to be. How will the authorities monitor and report on those performance indicators?

The bill has very scant detail on how all of this is going to work in a real setting. It has very scant detail on how the three national government agencies—the Australian Commission on Safety and Quality in Health Care, the National Health Performance Authority, the Hospital Pricing Authority—will be able to work together to deliver improvements in the Australian healthcare system. The bill does not give the NHPA enforcement powers. It will be unable to compel any state or territory government to act to provide performance data. What is the point of that? Additionally, it cannot compel individual providers to make changes that will result in much better performance.

There is a whole level of confusion out there in the healthcare sector. I regularly meet with doctors and other health professionals who do not understand what these new Medicare Locals are going to do. No details are being provided. What will they do? What will be the interaction between stakeholders and the community? There is a whole level of confusion, and what this bill does is bring in another layer of confusion and another layer of bureaucracy.

The AMA has very grave concerns about the bill. The AMA has concerns about what data will have to be collected and how it will have to be supplied. We on this side are all concerned that this legislation does not provide for appropriate interaction between the authority and the Australian Commission on Safety and Quality in Health Care, the commission or the proposed independent Hospital Pricing Authority. There will be important synergies between these organisations that should be reflected in this legislation. For example, it is reasonable to expect that performance indicators formulated by the authority will be contingent upon the indicators relating to healthcare safety and quality matters that the commission formulates. The functions of the authority include the monitoring and the preparing of reports on matters relating to the performance of private hospitals and other bodies or organisations that provide healthcare services. The explanatory memorandum states that these measures will have no regulatory impact on individuals and businesses. Who believes that? We do not believe that that is a true statement of what is going to happen out there. The collection and the provision of data to the authority by very small hospitals, of which I have many in my electorate of Brisbane, and organisations that provide healthcare services, such as medical practices, will potentially have a significant impact on them, especially if it requires the development of new systems. And there will have to be new systems implemented to gather all of this data. As if private medical practices do not have enough bureaucracy already; they will be required to collect and report the data. The full regulatory cost impacts for these entities should be properly assessed. We have to be certain that the activity of the data collection and the reporting by the healthcare providers is not onerous and does not detract resources away from the primary health care that they provide day in, day out to thousands of my constituents in the electorate of Brisbane.

It may also be appropriate for the government to provide financial assistance to these entities for the additional cost of collecting and reporting against these performance indicators, because there will be a whole new level of procedures and bureaucracies that will have to be put in place in these medical practices and small private hospitals. Further, there is no certainty yet on the type of information to be collected. The legislation makes no provision for the type and the scope of the data to be collected—a very important aspect, seeing that information is the key of this particular bill. What cost is going to be involved in collecting the additional information that private practitioners and hospitals have to collect? As I mentioned, smaller private hospitals and medical practices will struggle to collect and provide data as opposed to getting on with their core business, which is primary health care.

Managers of local hospital networks or hospitals must be provided reports indicating 'poor performance', but there is no indication of what constitutes 'poor performance' and what devices will be used to compel these organisations to provide data or to take those very steps to correct this poor performance. The coalition oppose the establishment of this new bureaucracy and we stated that in the 2010 election. We propose to redirect the $109 million in the case of the NHPA to frontline services to make sure there is real action on hospitals, real action on funding nursing and a real plan for better mental health policies. These were well received by the people of Brisbane when we released these policies in the lead-up to the election. The people of Brisbane need more health services. What they do not need is more bureaucracy. They need more doctors, more nurses and more health professionals, not more agencies that collect data at the expense of very good primary health care.

The lack of clarity in the role that the authority has and the extensions of the levels of non-core improvements make it very difficult to see what is good about this bill. There are a number of local, state and national performance monitoring schemes already operating in the sector. Are you going to bring in another layer of bureaucracy? I have spoken to nurses. I have nurses in my family who spend their day, day in, day out, filling out paperwork and they feel severely impeded in their ability to care for their patients. Nurses are telling me the same thing. What they want is more resources. They want more staff to provide better care. They do not need to have good clinical staff taken away from the bedside, which is what we all expect, to undertake yet more onerous data collection.

Another cause of concern is the ineptitude that we already see in our state from the Bligh government running the health system in Queensland. The Bligh government will close down the Royal Children's Hospital and there has been absolutely no consultation. Again, they are taking away key, important services for one of the fastest growing areas—the inner city of Brisbane and the inner north. There are still ongoing battles that constituents come to me with day in, day out, including the nurses' payroll issues, which still have not been solved. Still many of my constituents come to talk to me and ask for my assistance in just getting some simple payroll issues rectified. And here we have more bureaucracy coming into health when in Queensland we cannot even get our payroll issues right. So imagine what putting another layer of bureaucracy is going to do to an already dysfunctional health system in Queensland. Elective surgery waiting lists continue to grow in my state and continue to grow in the electorate of Brisbane. To add further red tape to the system would only result in further problems in Queensland. This bill has many, many flaws. The government really needs to go back to the drawing board on this one.