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Tuesday, 16 August 2011
Page: 8206


Dr SOUTHCOTT (Boothby) (19:01): It must be hard being a Labor government member and talking about the government's health plans, because you really have to keep up. Every year the government has a new health plan. I think we are onto the Rudd-Gillard government's health policy mark 4 or 5. Before Kevin Rudd was elected Prime Minister he was going to fix the public hospitals by mid-2009 and he was going to step in and take them over if the states did not come up to the plate. Last year, while Kevin Rudd was still Prime Minister, he described his reforms as the most historic changes since Medicare. Those reforms did not proceed. Only just last month Prime Minister Gillard described these reforms as the most fundamental changes since Medicare.

It is really hard to have anything complimentary to say about this government's approach to health because after almost four years in government they have no runs on the board. There are no improvements to the health system or to health services that they can point to. Their legacy will be statutory authorities and more bureaucracy but no improvements in health services.

The National Health Reform Amendment (National Health Performance Authority) Bill 2011 is yet another example. It is another bill which proposes to establish another statutory authority. It does it by amending the National Health and Hospitals Network Act 2010, legislation only passed by the House at the end of March. This bill, amongst other things, aims to create the National Health Performance Authority. We already know that there will be future amendments to establish the independent hospital pricing authority. The current bill is the second step in the government's plan to reform the healthcare system. It changes the title of the act to the National Health Reform Act 2011 to reflect the changes made to the government's historic health reforms under the new Prime Minister Gillard.

I move to the functions of the authority itself. The purpose of the National Health Performance Authority will be to monitor and report on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and other bodies that provide healthcare services. There is a lack of clarity about the role and function of the authority. It has an extremely wide-ranging purpose statement. This is the problem across everything that the government has done on health.

When the previous Labor government introduced Medicare, that had a clarity of purpose. When the previous Howard government introduced the private health insurance rebate, that had a clarity of purpose which everyone understood. It was simple. No-one can follow the twists and turns, backflips and changes that have occurred in health under this government. On the specific performance authority the Bills Digest compiled by the Parliamentary Library states:

This lack of detail combined with the lack of power attributed to the Authority raises questions about the extent to which the Authority can achieve its objectives as set out in the Bill … or as articulated by Government.

This legislation raises more questions than it answers. There are absolutely no details about the performance indicators that the authority will monitor. We have a government authority that does not know what it is meant to be reporting on. They are meant to decide that themselves.

If the government were serious about this authority, the legislation would outline a minimum scope for the areas of performance to be assessed by them. It is also unclear how many primary healthcare providers will be monitored directly by the NHPA or what the scope of the monitoring will be. It is unclear whether general practice will be monitored. This is an area where clarity is needed, and has been requested by the Royal Australian College of General Practitioners.

We do not know how often the NHPA is going to report, how detailed those reports are going to be, or what they are going to contain. But, worst of all, it seems the authority will be limp when it comes to the power to compel organisations to provide information to the authority. The authority will be relying on the goodwill of healthcare organisations to provide the data they need. Indeed, the Bills Digest again states that the legislation:

… does not give the Authority any enforcement powers; it cannot compel state and territory governments, private and non-government organisations to provide performance data and it cannot compel individual providers to make changes that will lead to better performance.

On the reform agenda more broadly we in the opposition have repeatedly called for the government to provide all the provisions to establish their full reform agenda to this parliament at the one time. They should provide the legislative provisions to establish all their new government bodies at one time so that this House and those affected by the changes—the stakeholders and the community at large—can see just how all these bodies are going to interact before these measures are considered by the parliament. Instead, we have been drip-fed bill after bill and amendment after amendment and have been forced to put their health reform agenda together like a puzzle, working out where each piece is meant to fit.

These constant changes and amendments are just another example that the health minister is struggling to get this right. This is further demonstrated by the fact that the minister ignored the outcomes of COAG and produced a bill that walked all over the states and territories anyway. The content of their bill was contrary to, and overrode, the outcomes of the heads of agreement signed at the COAG meeting in February 2011. The states and territories actually own and manage the public hospital system. The states and territories are responsible for the planning of their state-wide health services, and the minister needs to remember that. This is compounded by the fact that the authority will have no power to compel the state and territories or their hospitals to provide information. The minister is now having to make substantial amendments to correct this attempt to walk over the states. The states won the battle and the minister has had to retreat. What we see today in the news is more back-downs and more retreating from their 'historic' health reforms—and I do not think this will be the last word on that.

There have been so many backflips by this government. The capitation payment for diabetes for general practice was not well thought through and was opposed by every health group, and the government backflipped on that. The lack of after-hours cover between the wind-down of the divisions of general practice and the tier 1, 2 and 3 payments for after-hours care and the establishment of Medicare Local were, again, not well thought through and the government had to back down on them. The social work and OT access to Medicare for people with mental health issues were, again, not well thought through and the government had to back down on them.

Every time an announcement in health is made, it is 'historic' and is 'delivering on the government's health reform agenda', but I fear that, like every other historic announcement, this will be a case of over-promising and under-delivering. As I speak to GPs, specialists, allied health providers and people who work both in primary care and in the hospital system, no-one believes that this government has a capacity to improve the running of health services. No-one believes that adding extra layers of bureaucracy and having more managers and more bureaucrats will improve health for patients or improve their journeys through the health system. The government have a long list of health announcements where they have over-promised and under-delivered. They promised 64 GP superclinics; there are currently 13 operational. This is a $650.4 million program. They announced Medicare Local, a $416 million program, which is already off to a false start with the revelation that, despite opening on 1 July, the organisations will take up to 12 months to become operational.

But the worst part of this reform is that this is just another great, big, new bureaucracy. At the time the original historic announcement was made—Kevin Rudd's announcement that this was the most significant change in health since Medicare—then Prime Minister Rudd and health minister Roxon promised that their reforms to the healthcare system would not lead to further bureaucracy. I can safely stand here today and tell the parliament that they have failed in this promise. The National Health Performance Authority is another layer of compliance and another reporting burden for healthcare organisations. The creation of this new authority to report on the performance of healthcare organisations will mean extra time that these healthcare organisations will have to spend filling out paperwork, writing extra reports and sending through data when they should be in the consulting rooms treating patients.

The government have been very successful at creating reports, reviews and working groups and adding layer upon layer of bureaucracy to everything they touch. The Department of Health and Ageing is no different. We see lots of new acronyms coming out of the department of health, each adding its own layer of paperwork. We have the introduction of the NHPA, the LHNs and the MLs, while being very vague about what they are meant to do. Even these organisations that have been established already do not know what they are meant to do. We have the National Health Performance Authority looking at and reporting on the success of Medicare Locals and we have the Medicare Locals looking at and reporting on the success of primary health care including the GP superclinics. Around and around we go and, where the paperwork stops, nobody knows. This is just another layer in the thousand-layer cake of the measuring and monitoring of our health providers. The only thing that we know for sure—the only thing we are absolutely guaranteed of—is that there will be more red tape, more paperwork and more wasted time under the proposal currently before the House. What we need is less talk, fewer discussion papers and reviews, less paperwork, less bureaucracy and more doctors, more nurses and more allied health practitioners on the front line, delivering those services that our communities really need.

There is a wide belief that the provisions of this bill will severely risk the current high standard of medical services delivered throughout the community. There have been calls from the peak medical body, the Australian Medical Association, for the legislation to be deferred. There were many common themes throughout the submissions to the House and Senate committees around a lack of clarity about the legislation and the authority, ambiguity over what the authority will actually do, a lack of goals and objectives for the authority, duplication of work with pre-existing agencies and, most importantly, concern from stakeholders over the extra administrative burden that this agency will create. In its current form, this bill should not be before this House. That is clearly highlighted by the number of amendments that the government have had to move to fix their own legislation. The opposition will be moving for the deferral of this legislation until such time as the government have presented all legislation which deals with so-called health reform.