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Tuesday, 16 August 2011
Page: 8192


Mr TEHAN (Wannon) (18:01): I rise to speak on the National Health Reform Amendment (National Health Performance Authority) Bill 2011. I would love to be standing here tonight saying that what we have is real reform for the Australian health system but, sadly, we do not. I have some personal experience with this because my mother, the late Marie Tehan, introduced serious health reform in the state of Victoria between 1992 and 1996. That period was incredibly challenging for the then government because the Cain-Kirner government had left the state of Victoria with a $33 billion debt. The interest on that debt was equal to that of delivering a large state government department. So when the Kennett government came in they were faced with getting the budget back in order—sadly, an all too familiar story—but also with really having to drive reform through.

My mother, the late Marie Tehan, had four principles by which she went about achieving reform in the state of Victoria. She wanted to put people first rather than institutions or systems. She wanted to ensure a fair distribution of limited resources to obtain value for taxpayers' funds and to provide a better health status and outcome for all Victorians. There were two major ways that she set about doing this. The first was to introduce casemix funding, which has been rolled out not only by other states in the Commonwealth but also overseas. Also, she introduced health networks. The bottom line was that an extra 30,000 patients were treated by Victorian acute hospitals in the first 12 months. On the category 1 waiting list that is for people who are waiting for heart surgery and life-saving surgery, 30,000 more patients were treated. That is what real reform is about.

After Neil Blewett stated in this parliament that those reforms were 'the most imaginative set of reforms to deal with the hospital system in this country in the last half a dozen years', an Age editorial in February 1994, with the headline 'Healthy praise', said:

Dr Neal Blewett, the former federal Labor health minister who retired on Thursday, used his retirement speech in the House of Representatives to praise the Victorian government’s health changes and to congratulate its health minister, Mrs Tehan, for introducing casemix funding in public hospitals.

The editorial went on to say:

In calling her changes ‘the most imaginative set of reforms to deal with the hospital system in this country in the last half a dozen years’, Dr Blewett not only speaks the truth, but gives a generous and genuine endorsement his former colleagues could do well to acknowledge.

I think that is true. It is sad that what we have before us here has not taken up the gauntlet and put real reform at the heart of our national health system.

Sadly, instead, what we are seeing once again is the creation of another great big bureaucracy. This is not putting the resources where they need to go. The resources need to go where there will deliver outcomes for patients, not where they will deliver outcomes for bureaucrats. These reforms, sadly, are not going to do this. I do not know why we need to always head down this path where we seem to think that having more people in charge overseeing the system will lead to better results. What we need to see is more doctors, more nurses and greater throughput of patients through our hospitals. What we need to see is better results from that throughput, better management and better health outcomes. This is what should be at the heart of this reform process, but it is not.

Some might see this as just partisan statements on behalf of our side, the coalition, but it is not. When you look at what some serious medical groups have said on this issue you will see that it highlights that we are not alone in saying that these reforms really lack the necessity of delivering a better health system in this country. The AMA, for instance, have called for the legislation to be deferred. They want an assessment of the impact of the legislation. They want to know the detail of what data will have to be collected and supplied. They dispute the government claims that the NPA will not have a regulatory impact on businesses or individuals and they fear that smaller private hospitals and medical practices will not be able to cope with as yet undefined data collection. They want open and transparent processes and accountability to parliament. These are serious issues, yet this government is not taking them into consideration.

The Consumer Health Forum says that there is a need for the legislation to outline at least a minimum scope for areas of performance to be assessed. It wants more details on the functions of the NPA and greater safeguards for patients. These comments and criticisms come from major stakeholders and should be taken seriously by the government.

The Australian Private Hospitals Association fears yet another layer of compliance burden, requiring multiple reports to multiple government agencies. Surely a simple reporting system would be at the heart of reform rather than another process leading to multiple reporting requirements. The Australian Private Hospitals Association wants parliamentary scrutiny of the data hospitals will be required to provide.

The Royal Australian College of General Practitioners warn that the provisions of this bill 'hold long-term threats to harm the current high standard of medical services, and consequently health services, delivered to the community'—very worrying—and that these provisions could drive health management to be focused on performance and cost cutting more than patient care. They had concerns about virtually every aspect of the bill. They warned of significant overlap between this new bureaucracy and the existing Australian Commission on Safety and Quality in Health Care. So, not only are we getting extra bureaucracy, we are once again getting extra regulation. Real reform would cut the number of bureaucrats needed to administer the system. Real reform would cut the regulatory burden on our hospitals, both public and private. We do not see that with this bill.

The Australian Institute for Primary Care and Ageing warned about functional overlap between the two bodies. The Council of Procedural Specialists could see 'no justification or compelling case' as to why the NPA was needed. There is still a lot more explaining for the government to do on this bill. The Australian Institute of Health and Welfare, an independent body, already collects reliable, regular and relevant information and statistics on hospitals and health care. We are still waiting to see some key definitions in the regulations on this bill, including how outcomes are going to be measured, probably the most difficult aspect of introducing any reform in the health system.

This is another area where the federal government, the Gillard government, seems to have a tin ear. The Gillard government has ignored the outcomes of COAG and produced a bill that has ridden roughshod over the states and territories. The minister has completely failed to recognise that the states and territories actually own and manage public hospitals. Why not introduce a system where you pick the best reforms that have occurred in each state and then encourage the other states to implement those? If they have been shown to deliver results in one state, surely other states would take them up and implement them. Wouldn't that be better than this system of producing a large bureaucracy in Canberra and telling the rest of the country how it should be done? Fortunately, in the recent negotiations the states have reasserted their dominant role in running public hospitals and local hospital networks. But we have to ensure now that the funding does not place a large burden on these state run hospitals and make sure that they can access the money to deliver the health outcomes that we so desperately need in this country.

There is no doubt that real reform is still needed in our national health system, but once again we have to be very careful about how we go about achieving it. We have to ensure that in the ultimate outcome patients and taxpayers are the winners. As I highlighted earlier, we are dealing with limited resources. We cannot continue to raise our debt ceiling on and on and upwards and upwards. We have reached $110 billion in the space of a bit over three years. If we continue to raise that debt ceiling then the limited resources that we can put to our health networks will diminish, not increase. That is an important thing that we must realise.

We also have to ensure that we put people first. I have been a bureaucrat, and I have a lot of respect for the people who work hard in our Public Service. But we have to understand that the role of the bureaucracy is not to grow; the role of the bureaucracy is to deliver results on the ground. Sadly, it would seem that what we are seeing once again is growth here in Canberra rather than funding to the local hospital networks and to driving the reform process through the hospital networks to deliver for patients.

I wish I was here saying that Dr Neal Blewett's advice to his Labor colleagues had been taken on board, that they had looked at what real reform had occurred already in our existing state networks and that they had used that as the basis to drive real reform nationally. Sadly, that has not been the case. I think once again we are going to see a continuation of the blame game, which we were promised was going to end under this Gillard government and, before it, the Rudd government. Hopefully, this is not another broken promise, but we do seem to be heading down that path where the blame game has not ended but will become a reality once again.

I wish that I could stand up here today and say that this has been a bill which will drive another major reform through our health networks. Sadly, I do not think that is the case, and we are going to have to wait for the coalition government to get in and then drive real reform into our national health system. This will not end the blame game. It will lead, sadly, to waiting lists growing rather than receding, and that will then lead to a lot of blame being apportioned from the Commonwealth towards the states, with the states being left with no alternative but to look at the federal government and say, 'It is your reforms which have led to this.'

I hope dearly that this is not the case for patients right across Australia, but given the way this government has rolled out and implemented its policies in the last four years one has to be very sceptical about how the government goes about implementing anything. Sadly, I think these health reforms are going to be like everything else that this government has touched and not end in a good result. (Time expired)