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Community Affairs Legislation Committee
17/10/2012
Estimates
HEALTH AND AGEING PORTFOLIO
Australian Commission on Safety and Quality in Health Care

Australian Commission on Safety and Quality in Health Care

[14:49]

CHAIR: Welcome.

Senator DI NATALE: I have some questions on the antimicrobial resistance subcommittee. It is an issue I have pursued through some of the other agencies. The reason for me asking this is we have a real issue. Some authorities are saying by 2030 we might not have treatment for simple illnesses like pneumonia. A simple operation like an appendectomy might not be possible because of antibiotic resistance. It is something I am very keen to pursue. I am aware that the terms of reference of the committee have just been signed off. How many staff are available to support the work of the committee.

Dr Smith : We currently have a program manager responsible for healthcare acquired infection within the commission, Marilyn Cruickshank. This committee sits under her responsibility. We have two staff who, on a part-time basis, support the work of the committee along with their other work in addition to Marilyn's involvement with the committee.

Senator DI NATALE: What sort of FTE hours are we talking about dedicated specifically to supporting the work of the committee?

Dr Smith : I would have to take that on notice to get you specific hours because the committee has met only the once. There were two preliminary meetings of the members, who are currently now formulating most of the committee but the committee itself has met once. I think I would be anticipating something along the lines of a few hours a week at most.

Senator DI NATALE: Perhaps you could give me a more detailed answer. Is it right to say that the committee is only being funded until June of next year?

Dr Smith : Certainly the funding that the commission is providing to maintain the committee is through until June 2013. The subsequent funding is yet to be decided.

Senator DI NATALE: I suppose they have a very big mandate. In particular, they need to develop a national strategy to minimise antibiotic resistance as well as develop a comprehensive national antibiotic usage surveillance system. As a result of the expert committee that was established in 1998, JETACAR, we saw an expert subcommittee established called EAGAR, which had essentially the same mandate—to provide independent scientific policy advice on antibiotic resistance issues. In 2003 we saw the development of a national antibiotic resistance surveillance strategy. That went nowhere. Why is this going to be any different? You are talking a couple of hours of staff and you talking about a committee that is funded to the end of next year. We have been through this before. We have had essentially group of experts develop a strategy. It went nowhere. We are back to where we started from—getting a group of experts together to develop a strategy. I have no confidence that the work of this committee is going to lead to any meaningful change on the issue.

Dr Smith : The Chief Medical Officer is the chair of the committee that this committee reports to. I might ask him if he has comments to answer your question.

Senator DI NATALE: I think it is called a hospital handball.

Ms Halton : I think he has already commented. He can add more if he wishes.

Prof. Baggoley : There are a couple of things to add. One is over the last decade the issue of anti-microbial resistance both nationally and internationally has gained a significantly higher profile. So the understanding that this is an issue that is required to be addressed is certainly much higher. If you look, for example, at the work of the National Prescribing Service and its work with the community and with general practice that has been under way during the course of this year, that was work not undertaken 10 years ago. We have the National Antimicrobial Utilisation Surveillance Program and the Australian Group on Antimicrobial Resistance. You go to chemists now and you see signs asking 'do you really need antibiotics?'

The environment has changed. There are far more activities that are taking place than took place 10 years ago. And there is a much broader understanding of the issues of communicable diseases, of antimicrobial resistance and of hand hygiene now amongst health ministers than there would have been 10 years ago. So the environment has changed, the World Health Organisation has taken this on as a major issue, we have antimicrobial resistance weeks and we cannot ignore this. What we have seen is a lot of preparatory work for what is now quite serious work going forward. I would also say that the work on developing the strategy that I mentioned earlier has been accompanied by $100,000 to develop the report for the antimicrobial resistance plan, so serious funding has gone into this.

Senator FIERRAVANTI-WELLS: I will put these questions on notice. Does that figure in the portfolio budget statement at page 288 represent the Commonwealth's contribution? Is that my understanding?

Dr Smith : Are you talking about the 2010-11 figure?

Senator FIERRAVANTI-WELLS: I am talking about 2011-12.

Dr Smith : I do not have those particular figures with me. The amounts that are in the portfolio budget statement, as I understand it, do represent the Commonwealth's contribution.

Senator FIERRAVANTI-WELLS: And then you have contributions from the states?

Dr Smith : That is correct. We are a COAG funded organisation.

Senator FIERRAVANTI-WELLS: They are, I assume, represented by revenues from independent sources?

Dr Smith : That is correct.

Senator FIERRAVANTI-WELLS: I will put the rest of my financial questions on notice. I want to ask questions about the national residential medication chart and the development of the chart which started in August 2010. Has the phased implementation of the chart commenced?

Dr Smith : Yes, I do believe that has commenced as a pilot scheme.

Senator FIERRAVANTI-WELLS: How many facilities will initially be involved?

Dr Smith : I would have to take that on notice to provide you with that information.

Senator FIERRAVANTI-WELLS: And the framework for it to be fully implemented?

Dr Smith : Again, I can take that on notice.

Senator FIERRAVANTI-WELLS: Will there be reviews and possible revisions during the implementation period?

Dr Smith : Certainly the whole intention of piloting is to ensure that the end product meets needs as much as possible.

Senator FIERRAVANTI-WELLS: Tell me, what is the cost of this project?

Dr Smith : Again, I would have to take that on notice to give you an accurate figure.

Senator FIERRAVANTI-WELLS: Do you work with the National Prescribing Service on medication safety?

Dr Smith : We certainly work with the National Prescribing Service on a number of issues mostly to do with our involvement in primary care, in out-of-hospital care and in raising public awareness around antimicrobial resistance and other issues. It has been a very fruitful relationship we have had with them.

Senator FIERRAVANTI-WELLS: So these are examples of where you have coordinated the activities with the NPS?

Dr Smith : Indeed.

Senator FIERRAVANTI-WELLS: How much funding to you dedicate to medication safety each year over the forward estimates?

Dr Smith : Because we are a COAG funded organisation, the forward estimates are not yet decided for our organisation but I can provide you with information for past years on notice.

Ms Halton : The commission essentially has a charter for whole of health system quality and safety. There have been a small number of projects in the medications area, a number of which do not overlap with NPS. I would not want you to leave this with the impression that there is duplication. For example, the charts and work done on medications does not duplicate in any way what the National Prescribing Service does.

Dr Smith : Indeed, that is correct.

Ms Halton : There is quite a clear distinction in the role with what the National Prescribing Service does. In any event I would not say this is a large part of the commission's work at all.

Senator FIERRAVANTI-WELLS: On page 288 of the portfolio budget statement there are amounts there over the forward estimates. Are they still on foot or are you intending, in light of your previous answer, that those could be revised?

Dr Smith : The final decision as to the contribution made by the states and territories is a matter for the states and territories.

Senator FIERRAVANTI-WELLS: I meant for the Commonwealth.

Dr Smith : Under our process the Commonwealth then matches the contribution made by the states and territories and, as such, it is as yet uncertain.

Senator FIERRAVANTI-WELLS: I note in particular that your budget triples from 2012-13 to 2013-14. So that figure is still in the air?

Dr Smith : That figure is still not decided.

Senator FIERRAVANTI-WELLS: Can you tell me if there have been any revisions to the national safety and quality health service standards since your pilot?

Dr Smith : The standards are now published on our website. There have been some minor changes—just a few words, which have been articulated on the website—since they were released in June. And certainly now they are finalised to be used starting from next year.

Senator FIERRAVANTI-WELLS: Are all jurisdictions set to commence accreditation as of January next year and is there a distinction between jurisdictions as to which health service providers must comply with the standards?

Dr Smith : I think the answer to both of those questions is yes. Our information is that all jurisdictions are now preparing to commence under the new accreditation scheme from next year and, in fact, all are agreed as to the process.

Senator FIERRAVANTI-WELLS: What is the process and the consequences for non-compliance? Also, what protocols are there to ensure there is consistent compliance between jurisdictions?

Dr Smith : As the chief executive may have said at the last meeting, the responsibility for the determination of action as a result of non-compliance is one which rests with each of the separate jurisdictions. As a process of transition during 2013, the commission has set up a number of arrangements to support hospitals to ensure that they optimise their chance of passing the accreditation process. One of those, for example, is to extend from 90 days to 120 days the time for remediation of any issues that are raised during accreditation. There is a whole set of safety and quality improvement guides and workbooks which have now been finalised and are available on our website. Hard copies are actually being supplied to all of the hospitals that are undertaking accreditation next year and more will be distributed to other hospitals as time goes by. So, in the end, we are expecting very few hospitals not to be able to meet these fundamental safety and quality requirements. But the response, which is determined by each of the jurisdictions, we are promoting should be a positive, constructive and supportive one to enable them to actually come up to those standards.

Senator RHIANNON: Ms Halton, does the federal government currently provide funding to any organisation that opposes a woman's right to terminate an unplanned pregnancy?

Ms Halton : Not that I am aware of under this program. Can you give us more detail? Have you got a question that goes to a particular organisation?

Senator RHIANNON: Could you take it on notice so that we can confirm it. I am asking the question so that I can get the detail. You say you are not aware of it, so it sounds as though there may be—

Ms Halton : We fund pregnancy support, family planning, the call line et cetera. None of these, that I am aware of, does not support a woman's right to choose.

Senator RHIANNON: Are you aware that there are some agencies that present that they are supplying information to women who are pregnant but actually discourage women from choosing to have an abortion for an unplanned pregnancy?

Ms Halton : Is this related to what we fund, or is it a general question?

Senator RHIANNON: My question was: are you aware whether there are some groups doing that? I would like to know whether those groups are receiving funding.

Ms Halton : I do not think this has moved on from the last time we talked about this.

Senator RHIANNON: time has elapsed—that is why I am asking the question.

Ms Halton : Nothing has changed, from our perspective, since that time.

Senator RHIANNON: Does the federal government support the states directing healthcare funding to organisations that do not agree with a woman's right to choose to terminate an unintended pregnancy?

Ms Halton : Again, your question is not clear. Do we support the states in providing generalised funding in respect of health services? Yes, we do. Do we give them specific funding which is meant to be targeted to organisations that do not support a woman's right to choose? No, we do not.

Senator RHIANNON: Do you provide specific information to the states that the funding that you provide to them should not go to organisations that do not agree with a woman's right to terminate an unwanted pregnancy?

Ms Halton : No, we do not. We give them general funding but we do not give them funding which is specifically directed to organisations that do not support a woman's right to choose. We give them specific funding for health generally. Most of that, as you would be aware, goes into state hospitals. As to what they do in terms of health funding for other organisations, it is important to understand that we do not give them a sack of green dollars that we can then track through and we do not monitor every organisation to which the states provide funding.

Senator RHIANNON: So we can take it from that that it could end up that organisations that do not agree with a woman's right to terminate an unintended pregnancy are being funded by state governments? That could be an outcome?

Ms Halton : I think it is a big stretch to say that our money could go there. Any money that a state has, as with any jurisdiction, can be spent in whatever way it chooses. We do not provide moneys other than to be provided for health purposes, we do not provide moneys for any particular requirements, unless it is under the NPAs—and senators are well aware of the conditions that we put on NPAs.

Senator RHIANNON: The federal government is currently finalising the National Primary Healthcare Strategic Framework—

Ms Halton : Which is not actually under this program, Senator, but keep going.

Senator RHIANNON: In a recent discussion paper there was no mention of the role of NGOs in providing healthcare in the community. I think we would agree it has always been acknowledged that NGOs have an important role to play in preventive health services, particularly to marginalised populations. Are you supportive of the continuing role of NGOs as part of the primary healthcare system and will the framework reflect your support?

Ms Halton : The framework is in respect of our relationship with the states and territories. There is a another framework in respect of primary healthcare; that was published some time ago. I think you will find it is all encompassing in terms of everyone playing their part in respect of primary care. The particular strategy to which you refer, on which a discussion paper was put out recently, is specifically about the relationship between the Commonwealth and the states.

Senator RHIANNON: Commercial and for-profit organisations are by their very nature driven by the need to generate outcome. Do you support these organisations receiving government funding to deliver services to marginalised and socially disadvantaged communities?

Ms Halton : Is that a question of financing, or is it a question of philosophy?

Senator RHIANNON: I asked you a question: do you support these organisations?

Ms Halton : Are you asking us whether we philosophically support, whether we approve of or whether we provide financial support?

Senator RHIANNON: Considering what your job is, it is about financial support. Do you support commercial and for-profit organisations receiving government funding to deliver services to marginalised and socially disadvantaged communities?

Ms Halton : If you consider that general practice is by and large a for-profit enterprise then yes, we do provide funding to private enterprise to provide services to marginalised populations.

Senator FIERRAVANTI-WELLS: If we cut out for-profits we will not have any doctors in Australia, will we?

Senator RHIANNON: Chair, that is not what I explored in the question. It was obviously about marginalised and socially disadvantaged communities.

CHAIR: Senator Rhiannon, I think you need to be clearer with the question in terms of the process. I was confused by the question.

Senator RHIANNON: Under new Commonwealth funding I see that there is funding for medical services that many would expect would include services to terminate pregnancies. I understand that the policy requires health departments generally to provide access in this way. What items are you going to fund? What data is being collected to ensure that these services are provided?

Ms Halton : Sorry, but I really do not understand your question—and I do not think Senator Moore understands it either.

Senator RHIANNON: Under the new Commonwealth funding there is funding for a range of medical services that many expect will include abortion services. In the majority of states—I think it is all states apart from South Australia—women cannot access abortions in public hospitals. Are there any plans for this to change and what role will the department play in that?

Ms Halton : That is a question for the state governments.

Senator RHIANNON: Considering the importance of women's health in terms of pregnancy and the impact that unwanted pregnancies can have on women's health, wouldn't your department give consideration to driving progressive change in this area?

Ms Halton : No. We do not get involved in what state governments deliver by way of health services.

[15:13]

CHAIR: We will now move to outcome 14, Biosecurity and Emergency Response.

Senator FIERRAVANTI-WELLS: I want to get the actual expenses for 2010-11, including a breakdown of administered and departmental expenses. Under this new program, things that were previously in 14.1 are still under the Health Protection Fund?

Ms Morris : Yes. In 2010-11 the administered expenditure was $176,352,000.

Senator FIERRAVANTI-WELLS: And departmental?

Ms Morris : In 2010-11 it was $2,592,000.

Senator FIERRAVANTI-WELLS: And what was the actual expense for 2011-12?

Ms Morris : Departmental actual expenditure for 2011-12 was $5,729,000 and administered actual expenditure was $75,373,000.

Senator FIERRAVANTI-WELLS: In terms of the 2012-13 expenses on page 238, are you on track with those figures in the budget?

Ms Morris : Yes, we are progressing well through the budget.

Senator FIERRAVANTI-WELLS: And there are no changes to estimated expenditure?

Ms Halton : There are no extra items.

Senator FIERRAVANTI-WELLS: And staff variations? The average staffing level has gone from 156 to 142. Is that part of the efficiency dividend? I take it the drops are all due to the efficiency dividend or natural attrition.

Ms Halton : There is a combination of items coming off. We had that conversation earlier today about the budget—that there have been lumps of expenditure. Sometimes lumps of expenditure come with staffing and those staffing numbers come off. But yes, it is a combination of initiatives ceasing and efficiency.

Senator FIERRAVANTI-WELLS: And the forward estimates at page 240 remain the same?

Ms Morris : Yes, there is no change to the forward estimates.

Senator FIERRAVANTI-WELLS: There has been some movement of those programs but can I take it that the subprograms remain as set out on page 335 under the Health Protection Fund?

Ms Morris : They would be.

Senator FIERRAVANTI-WELLS: You can take that on notice. I will put that as part of the information. There are about 10 of them there. I will ask for some information in relation to each of those.

Senator DI NATALE: Antibiotic resistance was previously in this area—I recall that was the information I was given at last estimates—so I have got a few more questions to ask on this issue. My question relates to the 2003 strategy on antibiotic resistance. Has any evaluation been done of the strategy that was produced by the department?

Ms Morris : I would have to take that on notice. I cannot tell you off the top of my head.

Senator DI NATALE: The strategy said in particular that progress reports would be done regularly, with updates given to the expert committee, EAGAR. Can you fill me in on when the last report was and whether those reports are publicly available?

Ms Morris : I will have to take that on notice.

Senator DI NATALE: Is the strategy still active, or is it defunct? What status does it have? If it is inactive, what are the reasons for that?

Ms Morris : I think I will just take that suite of questions on notice and look into it for you.

Senator DI NATALE: In one of the questions on notice from the last estimates there was an answer that the Communicable Diseases Network and the Public Health Laboratory Network were essentially responsible for providing advice on antimicrobial issues. Do you have any specific advice that has been provided by those agencies, and would you be able to table that?

Ms Morris : I do not have it to hand today; I would not be bringing advice over several years from the various subcommittees. I can look at whether there has been any specific advice.

Senator DI NATALE: In the establishment of the new antimicrobial committee, what expert advice was sought from the previous committee which was essentially charged with the same task?

Prof. Baggoley : I can provide a response to that. The National Health and Medical Research Council has had a range of experts providing advice on antimicrobial resistance, including Professor John Turnidge. John Turnidge and Professor John McCallum are now both on the AHMRC representing the National Health and Medical Research Council. We have a close relationship with the NHMRC. It was felt that having two separate committees—one within the NHMRC and also the broader group which has a more direct access to AHMRC and health ministers—would be a duplication of work. So this is all now being consolidated.

Senator DI NATALE: I was not able to explore this previously but it is certainly relevant here because I have been informed that this is the area that was charged with implementing the results of the antimicrobial strategy. Does the department, and in particular this area, see itself as the lead agency when it comes to providing a coordinated approach in the area of antimicrobial resistance?

Prof. Baggoley : In relation to the antimicrobial resistance standing committee, given its broad-ranging representation I believe it is best placed to provide broad national input on this topic. As I mentioned earlier, with its going through a principal committee on which all chief health officer sit and then going to AHMRC, it enables the deliberation of this committee to be considered right across the states and territories and the Commonwealth, and I think it has a far better chance of having visibility and having its work seriously considered.

Ms Halton : I think I can give you an additional answer that: he is in charge on this. You asked who is responsible inside the department. The answer is that the CMO is in charge on this issue.

Senator DI NATALE: Does that include ensuring that information relating to non-human use of antibiotics, particularly in intensive animal agriculture, agriculture and so on, will also be the mandate of the committee? One of the problems is that it has fallen between the two different areas; both of them have a responsibility but no-one seems to be prepared to take a lead role. I will certainly hold you to that issue. For example, with APVMA and the role that the states and territories play when it comes to veterinarians, off-label use and all those sorts of issues, which seem to be happening in an incredibly disjointed and uncoordinated way, are we to understand that this committee will take responsibility for coordinating all of those issues, bearing in mind that they are not within the health portfolio?

Ms Halton : No. He has responsibility for coordinating inside the portfolio. The point you make about relationships across agriculture et cetera are absolutely well made. Following on from this, I am happy to undertake to write to my colleagues in agriculture.

I should make the point. We talked about food earlier. The Food Regulation Standing Committee has a representative deputy secretary come from agriculture to that meeting and PSC—which is a terrible name, nearly as good as FRSC—and PSC and FRSC do have a conversation about a whole series of things. We will write to them to make the point that this working is going on in health and we will make sure that there is high-level liaison, and the next estimates we will be able to tell you what has been going on.

Senator DI NATALE: For future estimates hearings this is one issue I will be pursuing. I would be really grateful if you could give me as much information as possible.

Ms Halton : Yes, happy to do that, Senator. We agree with you that this is a major problem.

Senator DI NATALE: I will finish off by saying that these issues were identified 10 years ago. We are going through the same thing we went through 10 years ago and nothing happened then, and I am concerned that nothing is going to happen now.

CHAIR: Thank you. We will now go to outcome 13.

[15:25]

Senator FIERRAVANTI-WELLS: I have questions in relation to the closure of the Chronic Disease Dental Scheme, also in relation to the new scheme and in relation to the Child Dental Benefits Schedule, and a minor matter, the dental health program alleviating pressure on public dental waiting lists. I am following the advice I was told by the officers that they come in 13 and 13.2.

Ms Flanagan : They also occur under medical benefits.

Senator FIERRAVANTI-WELLS: Where is the most appropriate place?

Ms Flanagan : If you want to ask them here.

Senator FIERRAVANTI-WELLS: I can ask them here but they should go under medical benefits.

Ms Flanagan : Some of them should go under outcome 3.

Senator FIERRAVANTI-WELLS: I will start with some global questions about outcome 13 in terms of financial figures and actual expense for 2010-11. Do you have that or could you give me the reference to the annual report?

Ms Flanagan : Hopefully someone will have the reference in the annual report 2010-11.

Senator FIERRAVANTI-WELLS: The same for 2011-12.

Ms Flanagan : Yes, in terms of the PBS they are on page 223.

Senator FIERRAVANTI-WELLS: In relation to the portfolio budget statement at page 223 can you tell me whether you are on track in the budget?

Ms Flanagan : Absolutely. This one is a little more difficult because program 13.1 is, of course, blood and organ donation services, so we have the Organ and Tissue Donation and Transplantation Authority.

Senator FIERRAVANTI-WELLS: This is a bit like our NICNAS.

Ms Flanagan : Also, under program 13.3 public hospitals information, most of the expenditure is reported by Treasury because it goes out to the states and territories under the health reform agreement, but a lot of the administration of that money actually occurs within this outcome. It is a little more complex.

Senator FIERRAVANTI-WELLS: Okay. For all intents and purposes there are no changes since the last budget. The staff variation was 290 down to 239?

Ms Flanagan : Yes.

Senator FIERRAVANTI-WELLS: What about the forward estimates on page 226, do they remain the same?

Ms Flanagan : Yes.

Senator FIERRAVANTI-WELLS: In relation to 13.1 I will put on notice issues about subprogramming and the moneys in relation to those subprograms.

I might ask my questions now in relation to the dental matters. In relation to the proposed scheme that the government has announced, the $4.1 billion dental program which is not due to commence until 2014, is there funding available for this proposal?

Ms Flanagan : In the 2012-13 budget there was a package announced of, I think, $515.3 million and comprised a number of elements. One of the largest of those was a figure of around $345 million to go to the states and territories. We are actually negotiating that agreement now with the states and territories. We have sent them out a draft national partnership agreement and we are working to having that signed and ready to go by the end of November, so from the beginning of December we would expect and hope that money will flow to the states under that particular budget initiative.

Senator FIERRAVANTI-WELLS: Yes, but what about the $4.1 billion? That is a component to the states but what about—

Ms Flanagan : The $4.1 billion is a separate new package that has been announced in addition to the budget package announced. In August the government announced this further new package.

Senator FIERRAVANTI-WELLS: Yes, that is what I am after in relation to that. These questions are in relation to the closure of the old scheme and the start of the new scheme. That is what I am talking about.

Ms Flanagan : There is another component and that is the money that was also given in the budget for dental.

Senator FIERRAVANTI-WELLS: With the funding for the new dental proposals, other than what is already in the budget, will that come out of the health and ageing portfolio or somewhere else in government?

Ms Flanagan : It has been announced and the government is currently—

Senator FIERRAVANTI-WELLS: Trying to find the money!

Ms Flanagan : looking at the broader budget strategy.

Senator FIERRAVANTI-WELLS: Ms Halton does not have any more money in her cookie jar.

Ms Halton : No, I think it was my magic pudding, Senator.

Senator FIERRAVANTI-WELLS: Magic pudding. So, where is the money going to come from?

Ms Halton : That is a matter for Treasury, the finance department and the centre of government, as you would well know. Balancing of budgets is a process that occurs right across government. We play our part in both spending and saving.

Senator FIERRAVANTI-WELLS: How much funding will be provided for each new initiative by year according to the six-year timeframe announced by the government?

Ms Flanagan : We can probably take on notice the breakup across year as I do not have it you, but in terms of the $4.1 billion package that we are talking about at the moment, $2.7 billion will be provided as a child dental benefit.

Senator FIERRAVANTI-WELLS: Is that per the release of 29 August?

Ms Flanagan : Yes. It should be.

Ms Halton : We can give it to you.

Ms Flanagan : I will just finish doing the totals then. $1.3 billion will be go to the states and territories under a new national partnership agreement that we will negotiate with them to provide adult public dental services. That will be in addition to the money that states and territories already spend because, of course, the states and territories also have a role in providing dental. Also there will be a $225 million flexible grants program for dental capital infrastructure and workforce initiatives that will be particularly targeted to outer metropolitan and rural and regional areas. The officers can give you the breakup by year of the package.

Mr Maskell-Knight : The Child Dental Benefits Schedule starts in 2013-14. I will round to the nearest million. There will be $194 million in that first year, $586 million in 2014-15, $617 million and 2015-16, $650 million in 2016-17 and $684 million in 1718. The new National Partnership Agreement for Adult Public Dental Services will be $201 million in 2014-15, $296 million in 2015-16, $391 million in 2016-17 and $391 million in 2017-18. For the flexible grants there will be $51 million in 2014-15, $56 million in 2015-16, $61 million in 2016-17 and $61 million the following year.

Senator FIERRAVANTI-WELLS: How many patients will receive treatment and how many services will be provided under each initiative by year and by jurisdiction? Do you want to take that on notice?

Mr Maskell-Knight : We cannot do it by jurisdiction. The Child Dental Benefits Schedule is an entitlement program and is dependent on take-up, but an estimated 3.4 million children will be eligible for it. For the national partnership agreement we estimate the amount of money available will provide services to about 1.4 million adults.

Senator FIERRAVANTI-WELLS: Can you tell me how many patients would be eligible for services each year over the forward estimates?

Mr Maskell-Knight : The eligibility for the Child Dental Benefits Schedule will be pretty much the same from year to year. It will be 3.4 million and will grow slightly as population grows. Eligibility for state public dental services is a matter for states and territories. We can provide an estimate of how many people in each jurisdiction would be eligible as things stand at the moment.

Senator FIERRAVANTI-WELLS: In relation to those patients who are currently eligible for the Medicare Chronic Disease Dental Scheme, will they be guaranteed priority in the public system?

Ms Flanagan : On that, I think the point has been made that the Chronic Disease Dental Scheme is non-means tested and there were a range of services provided in the upper end expensive services. The intention is for the national partnership agreement to go to low-income concessional groups of people which is around five million Australians.

Senator FIERRAVANTI-WELLS: They will get priority?

Ms Flanagan : The intention is that they will be, I suppose, the criteria that we will ask the states to consider in delivering these services.

Senator FIERRAVANTI-WELLS: You obviously have a breakdown of the people who were receiving treatments under the old coalition scheme. Have you done a bit of a cross-section of how many of those were concessional and how many were, say, over 65?

Ms Flanagan : I do not know whether we have done it by age. I think we have looked at it by concessional.

Senator FIERRAVANTI-WELLS: Were about two-thirds of them concessional?

Ms Flanagan : It was around that, yes, if not higher.

Mr Maskell-Knight : Senator, the last estimate we had for concessions it was 77 per cent. It was 77 per cent of the 660,000 people that have received a service in the last two years.

Senator FIERRAVANTI-WELLS: What about before July 2014? What guarantee can you give the people currently on the scheme with concession cards that they will be able to access and receive treatment in the public system before July 2014? If they cannot, what is going to happen to those people in the meantime?

Ms Flanagan : As I said, we are currently negotiating an agreement with the states to spend about $344 million over two years, I think it is. The people who are treated in the public dental system at the moment are very often those who have been treated by the Chronic Disease Dental Scheme—that is, low-income people with dental needs. So it is quite difficult to separate out—and they have a choice—those who go to the public dental system and those who have received treatment under the Chronic Disease Dental Scheme. It is very, very hard to tell, but we are negotiating with the states and territories. We can give you the targets—I think they were published in the budget—of the level of services by state that we are expecting to see delivered under this partnership agreement.

Senator FIERRAVANTI-WELLS: I will take that. I was also wondering whether you have any data on current waiting times, on average and by jurisdiction, for public dental services in Australia. I would envisage that you probably do. Can you take that on notice?

Ms Flanagan : Yes, we can take that on notice.

Senator FIERRAVANTI-WELLS: In relation to my portfolio I have come across older people who started on the scheme, were maybe halfway through and of course now will not be able to access any services. Is that the case? What happens to older people in that situation?

Ms Flanagan : We have sought advice from the dental profession about how long it might take to complete a course of treatment that has already been started. That is one of the reasons the scheme is taking three months to close; the expert advice we got was that it would be possible to complete treatment within three months if it had been started.

Senator FIERRAVANTI-WELLS: We are talking here about a lot of older Australians. Most of them, for all intents and purposes, would understand that the scheme is closing. Will there be some sort of proactive contacting of those people? Or will it just be up to them to front up to the dentist and say, 'I didn't complete my treatment; will you finish it?' Or will you just let those fall by the wayside if they do not come up? Do you see what I am getting at?

Ms Flanagan : Absolutely. I do not know whether the officers have information, but I think there has been a lot of contact, particularly with dentists, through Human Services.

Mr Maskell-Knight : Letters were sent to patients who have used the scheme in the last two years, in the days surrounding the announcement of the closure of the scheme and before the scheme was formally closed to new patients on 8 September. Those letters were also sent to dental practitioners and to general practitioners. That was done by the Department of Human Services. They sent out 607,633 closure notices to patients and a total 44,832 letters to general practitioners and dental practitioners. We are in the process of finalising with our Department of Human Services colleagues a further reminder letter that will go out the week after next.

Senator FIERRAVANTI-WELLS: The minister's press release refers to 1.4 million services over the next six years for adults. Can you tell me how many patients will be eligible for this limited number of services? The old scheme provided seven million services, I understand, in the last year alone, and there are over five million people with concession cards. With so many patients going without treatment, how will they be triaged?

Mr Maskell-Knight : I might start at the back end of that question, and then you can remind me of the front end. The states have very sophisticated triage systems in place at the moment. Some of them, I believe, use external providers. But basically they ring up, and there is a set of triage questions that then determine whether someone receives emergency treatment or priority treatment or gets added to the waiting list.

Senator FIERRAVANTI-WELLS: How many patients would be eligible for the limited number of services over the next six years?

Mr Maskell-Knight : As you said, there are about five million concession card holders.

Senator FIERRAVANTI-WELLS: Those five million will be eligible?

Mr Maskell-Knight : I think you are possibly leaping to a conclusion that is not quite right. The minister's press release talked about 1.4 million services. She effectively meant patients who receive a course of treatment. You cannot compare that with the seven million services that have been provided under the Chronic Disease Dental Scheme, because that counts everything a dentist does as an individual service.

Senator FIERRAVANTI-WELLS: The cap was $4,200. What was the average amount paid for patients? Do you have those statistics?

Mr Maskell-Knight : We would undoubtedly have it someone. We have the numbers to work it out. It was I think around $1,381.

Senator FIERRAVANTI-WELLS: Of those it was provided to it appears that, on average, three-quarters were on the concession card?

Mr Maskell-Knight : Three-quarters of the people who received that were concession card holders.

Senator FIERRAVANTI-WELLS: How did the arrangements or the conditions for the public dental funding in the budget for 2012-13 differ from those planned for your new scheme? Are we looking at different arrangements or conditions?

Ms Flanagan : This will be a less sophisticated version of the national partnership agreement. We want to start collecting data on the mix of services provided et cetera, but we know that some of the states and territories are not at a point where they can provide us fairly detailed data. So this agreement in part will be about establishing a better monitoring system for the bigger agreement we will negotiate in the future. But in terms of, I suppose, the principle that underlies this agreement, and that will also underlie the bigger agreement, is that we expect services to be delivered to low-income people or people on concessions, as a priority group, and to those who are Indigenous. With, for example, disabled kids we know that the public dental system usually is a better way. They treat these kids more often and they are therefore more expert at doing them. We would expect that they would still be able to be treated in the public system. So they are the same sort of objectives in terms of the people who would have access to services under this agreement.

Senator FIERRAVANTI-WELLS: In regard to the work you are doing with the states, what about the workforce issue? I recall at estimates I asked a number of times whether there had been any assessment done at a federal level to see that there were enough dentists in the public health system to cope with your proposed system. My recollection was that that assessment had not been done or that Health Workforce Australia were going to do some work for you. I cannot remember exactly. Do you remember that discussion?

Ms Flanagan : Absolutely. And Health Workforce Australia is going to look at the dental workforce for us. But in the interim as part of the announcements in the 2012-13 budget there were a number of workforce measures. Some of it was around expanding the intern scheme for dentists to actually give them a placement in the public dental system. Also, the public dental system uses a lot of oral health therapists, particularly for children—in schools. So we are also looking at some money to actually help out with oral health therapists.

We were also interested in distribution of the workforce, because, as we know, services provided in rural and regional areas for dental, just as for medical and others, sometimes can be quite difficult. Allied with that was also an oral health promotion campaign around getting better oral health for Australians. So there was a whole package of measures, including some workforce ones that underpinned this bigger package that is coming forth.

Senator FIERRAVANTI-WELLS: Can you confirm that the flexible grant funding for dental, announced as part of this package, will be provided between 2014 and 2018?

Ms Flanagan : There is a $225 million flexible grants program in the $4 billion package.

Senator FIERRAVANTI-WELLS: And that is between 2014 and 2018?

Ms Flanagan : Yes.

CHAIR: Senator Fierravanti-Wells, do you have many more questions in this area, because we have the inquiry next week?

Senator FIERRAVANTI-WELLS: I have more questions in one area that is not going to be covered next week. Continuing on, how will this assist in the development of infrastructure prior to 2014? So there will be no spending for infrastructure before 2014?

Ms Flanagan : We mainly focused on the workforce initiatives. So that is part of the $500 million expenditure. But, certainly, from 2014 on there is an intention to do that. I would also say that one of the other things we are negotiating under the national partnership agreement now with the states and territories is in fact that if they want to make a case to use some of the money for capital infrastructure or for putting in more chairs, or whatever, then that is contemplated as part of what they can spend their money on. So, in effect, there is the possibility of using some of that money for capital infrastructure in the public dental system now.

Senator FIERRAVANTI-WELLS: Is alleviating pressure on public dental waiting lists a separate program?

Ms Flanagan : That is 2012-13.

Senator FIERRAVANTI-WELLS: And that will likely be covered in the inquiry as well, so I might leave those questions for Senator Bushby.

Senator SMITH: I am interested in the number of children who might currently be receiving benefit under the Medicare Chronic Disease Dental Scheme. What is contemplated for the transition of children to the new arrangement? I want to read a statement and perhaps you can provide a commentary for me. What has been suggested is that children who do suffer with chronic disease and have enjoyed the benefit of the Medicare Chronic Disease Dental Scheme will have reduced levels of care under the proposed new scheme, which is limited to basic dentistry only, and only a $1,000 maximum rebate over two years, compared with the comprehensive care and maximum possible expenditure of $4,250 per two-year period under the Medicare Chronic Disease Dental Scheme?

CHAIR: I think that is a question for the inquiry next week into the bill. That is quite specific. Senator Di Natale has questions about organ donation. Are you finished with dental Senator Fierravanti-Wells?

Senator FIERRAVANTI-WELLS: Given the time I will put my question on financials on notice.