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Tuesday, 16 August 2011
Page: 8198


Mr LAMING (Bowman) (18:31): In joining the debate on the bill for the Health Performance Authority I certainly want to retain the very optimistic view that we have in Australia of a top-three-performing health system. It performs as such for very good reason: we have great people. Never let us forget that health systems perform because of the people in them, not the systems around them. It is important to get both right, but the absolutely necessary and sufficient element in that is the people. The great concern, then, is the zest and the zeal that was very much expounded by the previous speaker. This Labor zeal to reform is a privilege that is earned, not an automatic right of government. This government needs to remember that every one of its revolutions, as each revolution arrives, it is less funded than the previous one. So as these progressively less well funded revolutions occur, that zeal to reform and tip upside down and change and poke, with the desperate hope that it will be better, reminds me of that famous quote: I came, I saw, I was a little confused, I revolutionised—and not very much changed.

The great concern of people on the ground is that bureaucracy, certainly in health, has become this thousand-layer cake upon which ANHPA is effectively the icing—yet another layer in an attempt to keep measuring and monitoring health providers. I think everyone in this chamber would agree that we are trying to do exactly the opposite in health: we are trying to free up and deliberate the great ideas on the ground without compromising, obviously, the very important fiscal requirements of running a health system and containing the cost curve that every Western economy is battling with. We do not have that focus in this legislation. When we look for performance, let us read the detail and see if the word 'performance' is even defined. It is not. In this legislation is poor performance even defined? It is not. So the very notion of a health performance authority or agency is based on this hope, as you are running around with that hammer, that just to build one more bureaucracy could make the difference that the health system is yearning for. That hope is probably utterly futile because what we have are highly performing, competitive states operating in a very tight economic circumstances, and we know that in many cases with public services in states around this country the faster they work the quicker they go broke. Nothing will change with this legislation.

We have tonight in the great city of Gladstone, Queensland, a top-10 city in my state, no surgical coverage for 60,000 people. If there is an incident or a disaster on the Bruce Highway or if there is some need for urgent surgery, Queensland Health will instruct emergency officials in the hospital there to stabilise the patient and then throw them in an ambulance to Rockhampton. There is nothing in this legislation that changes that. Without appearing carping or negative, the great fear I have is that when Australians look at the health system they wonder: can I access a GP for my child when they need one? Can I go to hospital and hope to be seen in a reasonable time in an emergency? Can I get that operation without being continually shuffled from a waiting list to a waiting list to a waiting list? And I suspect if you are a senior you worry about bed block and the ability to be able to shift from being an inpatient to return to your aged-care facility and know that there are provisions available for that.

Those are the four prisms through which we need to examine any reform, because that is what Australians demand of us as law makers. They are not interested that we have been able to convene an authority and who the person is who will lead it or what the reporting arrangements are. They do not know that the AIHW collects data, that the Safety and Quality Council on Health Care collects data, that the COAG Reform Council is collecting data and that the ABS is doing the Australian Health Survey. And now what do we have for you, courtesy of the Labor Party? We have got ANHPA to collect more data. That is right. Do any of these bodies collect data together? Do any of these agencies say, 'I'm sorry, that was incomplete?' Do any of these agencies actually look at each other's data, pull it together and make sure it is reporting off the same platform? Of course not. We have just added in another data collector.

Do not look at me, please, as the guy who does not love health data, but it is not the sufficient element to get a functional health system. We are all collecting the data. The problem is it is not being processed; it is not being collected on a level platform; it is not being compared equally between jurisdictions. Will ANHPA do that? Alas, no. That is not their brief. Their brief can be most closely compared to the CGRIS, the coordinator-general that FaHCSIA have created in their own office to oversee Indigenous services in remote areas. This individual, who works extraordinarily hard visiting communities and writing large reports about how the data is incomplete and how things should be happening but they are not, is utterly powerless. The CGRIS is funded to write these reports upon which nothing is done. This individual could not even employ his own staff. He is meant to be independent of government and writing independent advice, but FaHCSIA employed all his staff. So the same problem that we see in FaHCSIA, the inability to report independently, will simply exist in Health, where there are effectively data collection agencies and rewards for doing the right thing in hospitals. But what will happen when we take money away from hospitals not doing things so well? The patients suffer. I come back to this element of performance. How do you screw down efficiency in a hospital without affecting quality? How do you make a doctor work faster without him jettisoning teaching? There is nothing contained in this legislation to ensure that occurs. When we employ public doctors in public hospitals, some of them are slower because they teach. How is this going to be measured under some of these reporting arrangements?

I go no further than outpatients where this weekend just gone Queensland Health dictated to the second largest hospital in the state that only two outpatient visits will be allowed before that patient has to be returned to their GP for another piece of paper, another referral. Then they can go back and see another two outpatient specialists before they are returned again to their local doctor—hitting up Medicare and sitting in the queue, which is the social cost of travelling to a GP. That is not integrated care. That is a direct result of the federal goal to set benchmarks around how often patients can be seen in outpatients, to encourage throughput in outpatients and, obviously, to create room—which we support—for new outpatients.

Queensland Health responded as any provider would: it capped the visits to outpatients. So a 50-year-old woman diagnosed with diabetes, late stage, low levels of literacy who has been brought into the hospital and referred to that particular hospital can see the diabetic doctor and can be referred across to the dietician. But, after that, down come the shutters. She must go straight down to her GP, wait in the waiting room and get another referral before she can come back and see the podiatrist or the cardiologist, let alone go back to the diabetic doctor again to report on what has happened. This is how we know that providers will respond in an exquisitely rationed environment where you do not have the incentives running the right way.

This legislation will not free up the consultants and the staff to do innovative and imaginative things because those immediately above them in the bureaucracy will be so panicked about having to report data that they will not allow the freedom. We do not reward clinicians for great innovation. There is nothing in this legislation that will allow that to happen.

I speak on behalf of patients who are looking for an interstate operation. Mr Deputy Speaker, from a smaller state like Tasmania, you will know that not every one of our eight jurisdictions, while they do an extraordinary job, can do every operation. We are a health system one-twentieth the size of the United States. Australia's health system, a great health system as it is, cannot expect to provide in every one of our eight jurisdictions every operation known to the health system. At some point there has to be consolidation, not just for breakthrough operations but for operations that are not done as frequently anymore like clipping a large aneurysm in the brain. Most of them are done with an internal platinum coil, but some of them are still so large that we have to do open brain surgery. There are so few of them done that in many jurisdictions there is barely one a year. Do we have to keep funding a doctor and keep that doctor trained to do one operation or is it more sensible to send that person across to a larger state? What happens? Up come the walls of bureaucracy. Does anything in this bill fix the problem for the lady with vascular disease of the brain who needs an operation on the Circle of Willis and waits weeks and weeks while hospital systems shuffle responsibility between each other and the respective states refuse to free up operating time? This is not addressed at all by a performance agency as described in this legislation at all. It will remain.

I want to tempt, for the optimism of the other side, an almost euphoric optimism that by creating this new body all things can be fixed in the health system. It is actually much harder than that. The right to reform a health system is a privilege that is earned. It is not an automatic shift to a new revolution because we need another press release. I said about our previous Prime Minister that he would revolutionise everything else and I said, 'I promise you he has not fixed the health system, but this ex-prime minister has one more revolution up his sleeve and that is the revolution of the health system,' and sure enough it came along and it came along just a couple of weeks after the opposition leader announced, so insightfully, hospital boards for the struggling health systems of New South Wales and Queensland. What were they? They were effectively administrative and reporting boards to oversee the work of bureaucrats in each one of our hospitals. They provided information to the public and they also took information directly to bureaucrats and obtained answers. Whether you like the idea of hospital boards or not, it was only weeks later that we were sold by this administration the notion of equally local boards that happened to cover regions as large as nine major hospitals.

To hear the previous speaker saying that decisions sometimes are better made locally is one of the great understatements from this current government, because there is nothing local about the Medicare Locals. The word 'Medicare' is only in there at the insistence of the staffers of the previous Prime Minister. So we are left with this curious term Medicare Locals that actually is an amalgamation of a number of divisions.

The previous speaker really loves local health decision making. What was wrong with basing it on divisions? What was wrong with working with our existing structures? They were completely adequate for that role. Instead, we are left with Medicare Locals that—wait for it—do not conform to local hospital boundaries. Here are our hospital boundaries and the Medicare Locals run across like this so patients are in one hospital boundary and a different Medicare Local. It should have been quite easy to fix. And would it not have been that hard also to align those boundaries with ambulance boundaries so that the ambulance takes you to the hospital where you live and where they work? It was not hard to do that either.

It was not hard to align some of those boundaries with local boundaries of interest like local government areas, because they run the emergency responses in most states I have been to. But what happens is they do not do it very often, they often do not have the capacity and then they find themselves with a conflict of interest because the large hospital is located in a different local government area to those where the people are affected. The Queensland floods were such a great example. Toowoomba was mostly focused on Toowoomba needs. All the other local government jurisdictions had neither the capacity to respond to the floods nor the ambulance services to go out and reach the Australians that needed them most. Another simple solution has been completely passed up.

I have spoken about the surgeons. I have spoken about the patients that rely on services. I have talked about how outpatients effectively will not change and how, if it does, we could compromise teaching. I have talked about waiting for a waiting list by being on a waiting list for the waiting list and by being constantly passed over. The only way off a state government waiting list in many cases, regrettably, is to get sicker until you need it urgently, give up waiting and take out private health cover or, for many tragically, to pass away. That is not the health system that we signed up for. We as a nation signed up for a responsive system that rewarded innovation. It is easy to say but will not be fixed with this notion of a performance authority.

The one glimmer of optimism—and I have been asked for optimism from the other side so I will give it to them—is that there are great people on the ground who will decipher the health minister's press release. It is one page. They try to work out what she is going on about and what this means for their job? The one thing about reform is that, when you threaten everyone with their jobs in reform, the first thing they focus on is keeping their job, and most of the health professionals right now are seriously wondering, 'Where will my program be when Medicare Locals evolves?'

What is the relationship with state community health, when in many major cases and jurisdictions they have refused to merge until 2015 or later? When people are frightened like that you do not get the innovation you need. You get perverse reactions and people often operating to work out a way to save their jobs. We do not have any undertaking yet on whether there will be a state based role for divisions and it seems almost inconceivable that this large number of Medicare Locals can operate completely independently and find the capacity they need to do training and operate as political bodies as well as funding bodies and then also to be reporting directly to Canberra. To do so without some form of state collaboration means that Medicare Locals cannot talk to state governments. That has been wiped out.

There are a number of concerns I have about this legislation that have not been addressed. Australians will look back on us and judge us harshly. They will look at the health system five years from now and they will judge the administration today for the decision they made. I remind them, without giving gratuitous advice, that they will look at waiting lists. They will look at the availability of a hospital doctor. They will not appreciate seeing public hospitals secretly bulking-billing patients, undercutting GPs, suspending continuity of care and, most importantly, undermining deputised medical services, the very after-hours care that ensures that people who get sick at night have their medical records transferred back to GPs. That is all wiped out as well. This is a government that does not understand after-hours care or how to deliver it. And it can all be solved with a hotline. They will learn that it is not that simple. Health care is extraordinarily complex. You tamper with it with great care and caution and you make sure that you have the best minds on your side when you do it.