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COMMUNITY AFFAIRS LEGISLATION COMMITTEE
02/11/2005
HEALTH AND AGEING PORTFOLIO
Office of Aboriginal and Torres Strait Islander Health

CHAIR —We will proceed now to outcome 7, Indigenous health. We have 30 minutes to deal with three outcomes, so I suggest we deal with each in 10 minutes.

Senator CROSSIN —I want to ask you about the Overcoming Indigenous disadvantage report produced by the Productivity Commission. Does the department accept the statistical conclusions by the Australian Institute of Health and Welfare in the headline indicators in that report?

Ms Halton —Sorry, the AIHW’s conclusions in the Productivity Commission report?

Senator CROSSIN —Two things here. First of all, the headline indicators in the Productivity Commission report.

Ms Halton —I think we have discussed in the past that the Productivity Commission has chosen a group of indicators for a variety of reasons. I am not completely au fait with why. You could have a debate long and hard about whether they are the right group or the wrong group. Do they point to a general issue in respect of disadvantage? No-one has any contest with that. Could we have a lengthy statistical argument about the precise details? Some of them, probably. Is it worth it? Maybe not.

Senator CROSSIN —Are the headline indicators for the baseline data similar?

Ms Halton —I do not have it in front of me, Senator. Can you point to the particular issue?

Senator CROSSIN —I think that the issue it goes to is your tracking of Indigenous health outcomes. Do they in any way line up with the indicators that were used in the Productivity Commission report?

Ms Halton —Sorry, I am a bit confused. The AIHW report?

Senator CROSSIN —There are two. I want to know the comparison between the two, really.

Ms Halton —I do not know that we have done that detailed analysis.

Ms McLaughlin —We have not done a detailed analysis of that, Senator. There are some indicators in the Overcoming Indigenous disadvantage report that match some of the indicators that AIHW measures.

Senator CROSSIN —So a person could not look at that report and look at your statistics and draw the same conclusion. Is that right?

Ms McLaughlin —They are not health department statistics. They are AIHW and ABS statistics, largely, that are used. The Overcoming Indigenous disadvantage report tends to report on a current point in time. The AIHW and ABS statistics are doing comparisons over time.

Ms Halton —It is also a fair comment that we tend to do a level of analysis which goes, in a sense, below some of those things. The ABS tends to report on more broadly based things. No-one disputes, for example, issues in relation to longevity. We have talked about that here before.

Senator CROSSIN —What is the baseline data that the department is now using in terms of Indigenous health outcomes?

Ms McLaughlin —The most recent data that we have been provided with is from the AIHW ABS report, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples, 2005, which you may be aware does show some important improvements in Indigenous health over the period 1991 to 2002: for example, a 25 per cent decrease in mortality in Western Australia for Indigenous people, a decrease in infant mortality over the same period and some significant decreases in mortality from circulatory disease.

Senator CROSSIN —That is predominantly the baseline data that you use. Is that how you track your performance in closing the gap in Indigenous health, using that data when it is produced every so often?

Ms Halton —Yes and no, Senator. You are quite right, we pay very close attention to what the AIHW produce. For that matter, we also pay attention to what the Productivity Commission produce. I think the minister put out quite a long press release when the AIHW data was produced, because to see broadly based data which actually shows some improvement is fantastic and we are delighted. But, as you know, sometimes the kinds of achievements that we are looking at go to the things that are the precursors: for example, longevity issues are in respect of death rates et cetera; issues around improvement in immunisation, issues in terms of improvement in screening; I could go on.

So, yes, you are right. In terms of how are we going in aggregate, that data is particularly important for us. In terms of how we tell whether the individual components of what we are doing are making a difference, sometimes that does not give us enough granularity.

Senator CROSSIN —Have you set any targets or performance indicators for Indigenous health improvements?

Ms McLaughlin —Not at this stage, Senator. We are developing at the moment—in fact, have almost finished developing—a national Aboriginal and Torres Strait Islander health performance framework which will measure performance in relation to Aboriginal and Torres Strait Islander health at three levels. It will look at health outcomes and health condition, it will look at the social determinants of health and it will measure the performance of the entire health system for Aboriginal and Torres Strait Islander people. At this stage it will not include benchmarks or targets. It may get to that point in the future.

Ms Podesta —As part of that process we are also conducting three service-level data collections, including service activity report, drug and alcohol services report, and Bringing Them Home counsellors data collection, which will be used to inform the reporting under the health performance framework.

Senator CROSSIN —What is the time line for those?

Ms Podesta —It is part of the health performance framework that was agreed in principle by the health ministers in January.

Ms McLaughlin —The first report will be published in late 2006.

Senator CROSSIN —The framework would be at a state where I could ask about that in February?

Ms Halton —You can have the framework now if you would like it.

Senator CROSSIN —I thought you said it was a draft or being developed.

Ms McLaughlin —It is an in principle agreement. We are now waiting for the states and territories to populate what will be included in the health performance framework in terms of the data that we will be collecting so that there will be a national consistency.

Ms Halton —I am happy for you to have what has been agreed so far. It will not give you every line by line detail but it will give you a feeling.

Senator CROSSIN —Okay. Can I go to one particular issue. I understand that Mutijulu, which is the Indigenous community near Uluru or, as it was known, Ayers Rock, had a grant of money from OATSIH of $68,000 for the community to employ a substance abuse worker. The $68,000 is to cover wages, admin and activities. Would you have any idea, or can you take on notice, whether the funds have become available?

Ms Podesta —We will have to take that level of detail on notice.

Senator CROSSIN —Yes, okay. I want to know whether the funds have become available through the office of OATSIH in Alice Springs for the substance abuse worker in Mutijulu, how much funding has been provided and what these funds are expected to cover.

Ms Podesta —Certainly, Senator.

Senator CROSSIN —The funding became available in light of the recent media. We want to know if in fact that funding has been passed on to the community and what it is for.

Ms Savage —The funding has been allocated. It was, indeed, in advance of the media attention, and we will certainly get you the details on whether they have received it and whether that worker is in place.

Senator CROSSIN —And what the $68,000 is for. ‘Wages, admin and activities’ does not seem to leave a lot for wages, really, at the end of the day, if it is only $68,000.

Ms Savage —Most certainly. Mutijulu is provided with other funding from OATSIH for its primary health care services, so it may just be the wage component and other operational costs drawn from its base funding.

Senator CROSSIN —Can you find me the details of that?

Ms Savage —Certainly.

Senator CROSSIN —How much money is currently committed to the OPAL fuel program?

Ms Savage —In 2005-06 a total of $2.3 million. Over the next four years, including 2005-06, it is a total of $9.426 million.

Senator MOORE —Is that spread evenly across each of those years?

Ms Savage —Essentially. There are slight differences. I can go through that, but it is essentially around $2.3 million, $2.4 million.

Senator CROSSIN —How many Central Australian communities will this roll-out cover?

Ms Savage —There are currently 16 communities in the central desert region that are registered communities in receipt of OPAL. In the roll-out of the regional strategy, we expect there to be at least a further seven communities in the designated area, six roadhouses and a number of pastoral properties. We will really only be able to determine that as we do further work in that area.

Senator CROSSIN —I might get you to take on notice, then, to provide me with a list of those rather than to name them all now. How many communities who will not get OPAL fuel have indicated to the department that they want this fuel?

Ms Savage —No communities have indicated to us directly that they would not want the fuel. It is fair to say that some of the communities in that area have expressed an interest in the OPAL fuel even in advance of the announcement.

Senator CROSSIN —I think you have misunderstood my question. It was, basically, how many communities have expressed an interest in getting the fuel that will not be able to get the fuel?

Ms Savage —You are talking about our capacity this year to roll out?

Senator CROSSIN —Yes.

Ms Savage —We anticipate that in the central desert roll-out of the regional strategy most of the communities will be able to. I cannot give you the exact figure of anybody who would miss out. Our calculations are to cover all the communities in that defined region.

Senator CROSSIN —In the central desert.

Ms Savage —In the central desert, yes.

Senator CROSSIN —That would be a triangle between Coober Pedy, Alice Springs and Warburton, do you think?

Ms Savage —No, not quite. I can define the region if you would just bear with me for a moment.

Senator CROSSIN —Take it on notice. We have an inquiry and I just wanted to ask a few initial questions about it.

Ms Halton —We will give you a map with a shaded area that shows all the communities that are covered.

Senator CROSSIN —Okay.

Ms Savage —It is not quite a triangle and not quite an oblong.

Ms Halton —I think it probably defies a geometrical description!

Senator CROSSIN —I can picture it. I was there last week, and it was 42 degrees, so it was damn hot I have to tell you. On the Greg Cavanagh inquest that was held at Mutijulu, I want to take this opportunity publicly to say that the community were very angry about the photo that appeared on the front page of the Australian, not having given that newspaper the authority to take those photos. They are very upset, angry and humiliated about that. Publicly I think a defence of the community should be made. Anyway, the Cavanagh inquest heard that there are an estimated 600 petrol sniffers across the central desert and we know 60 people have died in the Territory over the past seven years. Do you know how many people there are with a known serious petrol sniffing habit in the central region?

Ms Savage —It depends on how exacting you are about ‘the region’ and whether I, in my mind, have got the same region that you have got in your mind, but the estimates are 600 to 1,000.

Ms Podesta —It varies. The type of activity of that group is significantly varied, from occasional users to substantial users, and we are very conscious of the response needing to recognise that there is experimentation through to chronic use.

Senator CROSSIN —Do you know how many would be seriously disabled as a result of sniffing?

Ms Savage —I would not know that exact figure.

Ms Podesta —We certainly can provide the statistics on the number of people who have sought assistance.

Ms Savage —I might get you to take it on notice, then.

CHAIR —Senator, before you go on, we decided that we would allocate some of this time for hearing services. Are there senators with questions on hearing services?

Senator CROSSIN —Yes, me. I am trying to go as quickly as I can!

CHAIR —If no-one else has any questions, you might as well take the time until 10.30, however you wish to divide it between those two areas.

Senator CROSSIN —Thank you. Probably some of these questions you can take on notice. How much does a disabled person cost the health care system in that region each year if they are diagnosed as being a sniffer? How many people are known to have died from petrol sniffing in that region? I might leave it there, I think.

Ms Halton —Senator, just before you move off the issue, can I provide you with one piece of information. One thing that the department is trying to do is work very closely with OIPC and take some leadership in relation to petrol sniffing. There is a secretaries’ retreat every year, and at the last secretaries’ retreat I raised the issue of the need to have a whole-of-government approach in relation to petrol sniffing. That met with a considerable level of agreement amongst my colleagues.

OATSIH, together with OIPC, are spearheading a real effort to try and develop a whole-of-government response in respect of petrol sniffing. I would like to underscore that this is something that we regard as being a very serious issue, particularly in relation to Central Australia. It is a problem elsewhere as well, but we are trying to work across government to acknowledge that there is no one single solution to petrol sniffing and a whole-of-government approach is needed if we are going to tackle the issue.

Senator CROSSIN —It is just a precursor. You know the Senate has an inquiry into this.

Ms Halton —Absolutely, and we will be happy to talk to that Senate inquiry.

Senator CROSSIN —I have an extensive range of questions here, but I wanted to go to this, mainly because it is an area I am particularly interested in: it has been brought to my attention that there is a problem in Indigenous communities, particularly in remote Australia, in accessing asthma spacer devices because of the prohibitive cost. In fact, there is a community that has had to make a spacer out of a plastic Coke bottle. It is linked to the cost, as I understand it.

There was an article recently published in the Australian Family Physician where around 80 per cent of Aboriginal community-controlled health services in a recent survey reported that Aboriginal people with asthma had difficulty accessing these devices for optimal asthma care. The AIHW report on asthma in 2005 also made mention of this. What is the department doing to address the fact that asthma spacer devices are inaccessible to a substantial proportion of people attending community health services?

Ms Halton —This is the first time I have heard of this. In all seriousness, I have never had it raised with me. I have never had it raised with me by GPs when I go out to communities and I have never had it raised with me in relation to section 100. I am happy to look at the issue, but this is the first time that I have heard about it.

Senator CROSSIN —I have a photo here that was emailed to me of a spacer device that has been made out of a Coke bottle, probably because of this: the spacer devices cannot be funded under the PBS because it only funds medication, not devices, and the cost of the devices is prohibitive for some Indigenous people. Is there scope for an appropriation of funds from elsewhere for these devices to be provided to Aboriginal community health services?

Ms Halton —Let me take a look at it. As I say, this is the first time I have heard of this as an issue. If you have something in terms of people who have been raising the issue, I am very happy to take all that material away and come back to you.

Senator CROSSIN —An example has been drawn to my attention. The Department of Veterans’ Affairs apparently provides funding for these spacers, which appears to be under the PBS schedule.

Ms Halton —You would be aware that the RPBS includes a variety of items, including devices—including, as I understand it, things like incontinence pads—which are not available more broadly.

Senator CROSSIN —Yes, that is true, but I assume for Veterans’ Affairs it is because they are probably seniors. Getting an asthma spacer device under the PBS seems to be prohibitive for Indigenous people through an Aboriginal community-controlled health service. Is the department currently scoping any policy options on how these spacer devices might be made available through Aboriginal community-controlled health services?

Ms Halton —The answer is no, because it has never been raised with us. As I say, I am very happy to look at the issue.

Senator CROSSIN —I might give you a copy of this photo and this paper before you go.

Ms Halton —Would you mind? That would be great. I am happy to look at it.

Senator Patterson —Do you know how much spacers cost?

Senator CROSSIN —About $26, $28?

Ms Murnane —Maybe between $10 and $20.

Senator CROSSIN —It depends. If you get them through the Asthma Foundation, they are cheaper. Of course, the Asthma Foundation is not where these people would be.

Ms Murnane —If there is an AMS there, maybe they could buy them in bulk.

Ms Halton —We will have a look at it.

Ms Murnane —Then they could purchase them when they have been bought in bulk.

Ms Halton —If there is a significant health need there, that is something that we would expect AMSs to be able to deal with. We will talk with Mark Wenitong of the Indigenous Doctors Association in terms of the particular things that he is seeing in this respect.

Senator CROSSIN —I will put the rest of the questions on notice. I did want to go to hearing services.

Senator MOORE —I have one question on Indigenous health. It is clarification from the annual report on page 190, which is the financial resources summary. With that financial process, what is the explanation for the significant underspend?

Mr Thomann —This is what we discussed at the last estimates hearings.

Senator MOORE —Yes.

Mr Thomann —We had a budget estimate of $287 million. Is that the figure you are referring to?

Senator MOORE —Yes.

Mr Thomann —The actual expenditure was $265 million and therefore we recognise a variation there of $21.6 million. Those funds have been fully committed to capital projects. Therefore, they are not expensed in 2004-05 but will be expensed this year and in the two following out years. They are recognised in the department’s commitments.

Senator MOORE —No money has gone back?

Mr Thomann —No money has gone back.

Senator MOORE —The reason I am asking this question is that somebody has read the annual report, which I think you would be very pleased about, and there is no footnote that explains that.

Ms Halton —We will footnote, Senator.

Senator MOORE —It is a fairly significant issue and there is nothing that explains it.

Ms Halton —In the bright-blue version, or whatever colour we go for next year, it will be footnoted.

Senator MOORE —For their peace of mind, in terms of the process, there was no underspend and no money was returned? That money is committed?

Ms Halton —That is exactly right.

Mr Thomann —Yes. It will be recognised in additional estimates—rephrasing the funds to the years in which they will be expended.

Senator MOORE —Thank you.

Senator CROSSIN —Where are you at with implementing the Workplan for Future Action in Ear and Hearing Health? As you know, that was a plan that was jointly released back in August 2003. I do not think I asked questions about it last year, simply because I assumed you would probably be working on it last year. Could you provide me very quickly with an update on where that plan may well be going?

Ms Savage —There are a number of things that have been progressed. We are currently facilitating further development of Aboriginal health worker training and competencies for both general Aboriginal health workers and specialist roles, including child, maternal and hearing health. We are supporting a regional assessment of uptake and promotion of otitis media recommendations for guidelines through a project that is auspiced by the Far Western Regional Health Services, SA Department of Health. That involves a number of stakeholders, the Royal Australian College of Physicians and six Aboriginal community-controlled health services. It is essentially to test the best way to implement evidence based guidelines that were developed some time ago, which you are very familiar with.

Since the last time we were here, there has been an Indigenous person appointed to the hearing service advisory group and, as you would be aware, there has been a budget measure also with the hearing services for those on CDEP and for those over 50.

Senator CROSSIN —Yes, but that does not kick in until December. Is that correct?

Ms Savage —That is right, although it is not actually me who is across that.

Senator CROSSIN —I am still trying to work my way through Australian Hearing and Hearing Services, and just when I thought I had it sorted out you moved it away.

Ms Savage —That is some of the activity that OATSIH in particular is involved in.

Senator CROSSIN —The Hearing Services Advisory Committee is an advisory group to the department or to the minister?

Ms Savage —To the minister.

Senator CROSSIN —Can you provide me with a list of who is on that committee?

Ms Murnane —We will do that, yes.

Senator CROSSIN —If there is any further or better detail about how you are implementing that plan, could you take that on notice?

Ms Savage —Yes, certainly.

Senator CROSSIN —I wanted to update all of my statistics, which I have not done since 2003, about the number of clients who are accessing a range of services. Is it best I put that on notice? Do they go to you or Australian Hearing?

Ms Savage —It depends on what services you are talking about.

Senator CROSSIN —The community service obligation.

Ms Savage —Australian Hearing.

Senator CROSSIN —I might have worked it out after all. The community service obligation was a question I asked in February this year and you gave me the general principles. I am assuming that that document is still as it stands. The MOU has not been updated at all, has it?

Ms Halton —We need the hearing specialist.

Senator CROSSIN —Is the memorandum of understanding between Hearing Services and the Office of Hearing Services still as it was back in February of this year when I asked that question?

Mr Kingdon —It is substantially the same but we are in the process of negotiating a change because of the new Indigenous additional activities which will have to be included in that. That was the one I talked about at the last hearing, where we have an extra $10.1 million.

Senator CROSSIN —When will they be signing the new MOU?

Mr Kingdon —Very soon.

Senator CROSSIN —So I will ask for an update about it next February. Very quickly, just to warn you, I have a question on notice about the six work force strategies contained in the report on Commonwealth funded hearing services. They were incorporated into the work plan. Are they the strategies you are talking about that are now being implemented in the work plan? Is that correct?

Ms Savage —Yes, Senator. It also links with the national Aboriginal and Torres Strait Islander health work force strategic framework—I may have too many words in there—to develop national standards and/or competencies for Aboriginal health workers.

CHAIR —I think we have come to the end of Hearing Services. Can I thank Hearing Services and Indigenous Health. You may now go home or back to the office as you see fit. I call now the last outcome, Health system capacity and quality.

[10.33 pm]

CHAIR —We turn now to the Health Services Improvement Division.

Senator POLLEY —In the last 12 months to 30 June this year, how many overseas trained doctors have come to Australia on schemes sponsored by the department? Could we also have a breakdown of the GPs versus specialists and where they have been located?

Mr Lennon —I do not have the numbers for the last 12 months but I have them in the period when the Commonwealth began its recruitment program for overseas trained doctors, which was about the beginning of 2004. From that time until 12 October 2005, as a result of recruitment programs sponsored by the Australian government—that is, through recruitment agencies that were hired through the department of health—225 overseas trained doctors have been placed in rural, remote and other areas of work force shortage by the recruitment agencies. Another 111 doctors have signed employment contracts and will soon commence work in Australia.

You asked me for information about the break-up of those doctors. Of the 225 doctors working in Australia as a result of the initiative, 168 are working as general practitioners and 57 are working as specialists. Approximately 65 per cent or two-thirds of those doctors are working in locations outside of a capital city.

Senator POLLEY —Could we then have on notice the figures for the last 12 months and the actual locations?

Mr Lennon —We are happy to do that, Senator.

Senator POLLEY —Can you also tell me from what countries these doctors have come?

Mr Lennon —They would be from a variety of countries but I am happy to provide that information on notice for you.

Senator POLLEY —Can you also tell me how many of these doctors have come out as permanent residents?

Mr Lennon —I can also provide that information for you on notice.

Senator POLLEY —Is the department aware of a story published in the Medical Observer of 30 September 2005 that an Australian company recruiting doctors from overseas was charging up to $5,000 for these recruitment services?

Mr Lennon —Yes, I am aware of that story. Certainly that is not the case in relation to recruitment agencies that have been hired by the Australian government to obtain Australian doctors. The way the system works in that case is that the Australian government pays the recruitment agency a fee for a successful placement, but that is only at the point that the overseas trained doctor is placed, is in work and is Medicare billing.

Senator POLLEY —You believe there are adequate safeguards to ensure that those practices are not taking place?

Mr Lennon —The actual regulatory arrangements for recruitment agencies generally would be a matter for the states and territories. We have sponsored a body to represent nationally recruitment agencies in the medical field and that body has set up a series of standards that ensure that all of its members operate ethically in this field.

Senator POLLEY —Where can doctors lodge complaints about such practices?

Mr Lennon —Doctors can lodge complaints about such practices either with the body which has been established by the Commonwealth or by the relevant regulatory body in each of the relevant states or territories.

Senator POLLEY —Can you tell me the name of the body that has been established?

Mr Lennon —Its precise name I cannot recall at this point but I am happy to provide it to you, along with information about its method of operation, its principles and contact details.

Senator POLLEY —Thank you. The federal government taskforce was set up in June of 2003 to investigate the recruitment and assessment processes of overseas trained doctors. It is not clear what this taskforce has actually achieved. Can you outline their achievements?

Mr Lennon —Yes, I can do that for you. The taskforce has actually achieved a lot. It is responsible, first of all, for the recruitment activity that I have just spoken about, so it has organised the engagement of the recruitment firms and it has done that by way of competitive tenders. It currently has contracts with 16 recruitment agencies that it manages. As I said, as far as recruitment goes, the runs are on the board. We have, through our recruitment agencies, successfully placed 225 overseas trained doctors who are here and working in areas of work force shortage.

Senator POLLEY —I have to suggest that people living in rural and regional Australia, particularly in my home state of Tasmania, would not agree with you.

Mr Lennon —I note what you are saying. As I indicated, approximately two-thirds of the doctors recruited have been recruited to work outside of capital cities.

Senator POLLEY —How often does the task force meet?

Mr Lennon —The task force is a group that operates within Health Workforce Branch. It is a group of approximately a dozen permanent public servants who are working on issues around overseas trained doctors. It does have a reference group which negotiates with, dialogues with and includes all the major stakeholders—medical stakeholders and representatives of overseas trained doctors organisations, for example, that it regularly consults with.

Senator POLLEY —How often do they meet?

Mr Lennon —The task force which operates within the department meets continuously. They work full-time on these activities. The reference group meets approximately once every six months.

Senator POLLEY —When did they last meet?

Mr Lennon —The reference group last met in May this year.

Senator POLLEY —Can you provide a list of the members of that task force?

Mr Lennon —Of the reference group?

Senator POLLEY —Of the actual task force.

Mr Lennon —I could provide you with a list of the public servants who make up the members of the overseas trained doctors group—that group of permanent public servants within my branch.

Senator POLLEY —Thank you.

Mr Lennon —Yes, I could do that.

Senator POLLEY —And the reference group you referred to as well?

Mr Lennon —Yes, happy to do that.

Senator POLLEY —The department apparently backs a self-regulatory model of the industry. How is that addressing the issues that have been highlighted?

Mr Lennon —I think you are referring to the issue of unethical practices in the industry. The self-regulatory model which we financially support is something where the department took a proactive stance and actually funded an organisation to be set up to establish regulatory standards. We believe it has promoted higher quality amongst recruitment agencies and ethical practices. Individual states operate their own regulatory arrangements in relation to recruitment agencies, some of which are not self-regulatory; some of which are. That applies across the board, not only to the medical profession or health workers but to recruitment activities generally. In answer to your question, the department saw advantage in promoting a quality mechanism, which it did through a self-regulatory arrangement.

Senator POLLEY —Has any consideration been given to allowing overseas trained doctors and their families that are here on temporary visas to have access to Medicare?

Mr Lennon —Some overseas trained doctors can have access to Medicare. Permanent residents and citizens obviously can. Most of the overseas trained doctors in Australia are permanent residents or citizens of Australia. Temporary resident doctors, just like temporary resident anything else, do not have access to the same range of Medicare benefits as permanent residents or citizens of Australia, so that is really a much bigger issue than a question specifically about doctors. It is about a general policy position that is taken that temporary residents should not as of right have access to all of the benefits of the Medicare system that permanent residents of Australia have.

Ms Lyons —That is not a framework that we set.

Senator POLLEY —It is a bit ironic, isn’t it, that we are bringing these overseas trained doctors out here essentially to help run Medicare, yet they themselves and their families cannot have access to that service.

Mr Lennon —As soon as they become permanent residents of this country or citizens of this country—in other words, make a long-term commitment to stay in this country—they get that right.

Senator McLUCAS —How many doctors do you think we might have lost because of that issue of OTDs who are not permanent residents not being able to access Medicare?

Mr Lennon —That is an impossible question to answer, Senator, with respect. My feeling would be that it is not very many. Australia has a lot of attractions for overseas trained doctors. In addition, temporary resident doctors can take out private health insurance if they so desire. I am sure that the employers of the doctors who need the services of quality doctors will make suitable arrangements to make sure that they are able to make it sufficiently attractive for the doctors to operate in Australia, which has indeed been the case. Australia continues to attract significant numbers of appropriately qualified overseas trained doctors.

Senator McLUCAS —Not quite enough.

Senator POLLEY —Are you aware of any particular cases that have been brought to your attention of doctors that we have lost?

Mr Lennon —No, I am not.

Senator POLLEY —None at all?

Mr Lennon —I am not aware of any individual case where it has been brought to my attention that a doctor has decided not to come to this country because they were not able to fully access the Medicare benefits system.

Senator McLUCAS —That is an impossible question to answer. How many doctors do you know of who have decided to depart Australia, usually after an incident in the family, because they are not supported in their access to medical services?

Mr Lennon —I am not personally aware of any. I am aware that representations have been made from time to time by various groups that temporary resident overseas trained doctors coming here should have access to the benefits of the Medicare arrangements. Those sorts of arguments have been put from time to time.

Senator McLUCAS —Thank you.

Senator ADAMS —There is a quite a lengthy statement here in your annual report on recruitment, which is good. Of these overseas trained doctors, how many have not passed their entrance exam?

Mr Lennon —All of the doctors must achieve medical registration before they can begin to provide any type of medical services, whether they be through the public hospital system or in the community through the Medicare system. Every doctor that operates in Australia must achieve medical registration from a state or territory medical board which declares them to be safe and competent to practise. The answer is all of those doctors have achieved medical registration.

Senator POLLEY —Are we moving on to e-health now?

CHAIR —Yes, that is part of outcome 9. Go ahead.

Senator POLLEY —The Productivity Commission has delivered a scathing report on HealthConnect. In Impacts and advances in medical technology the Productivity Commission said:

After seven years of R&D and 30 independent evaluation reports—some unpublished—many unresolved issues remain, including database design, privacy, security and access control measures, and stakeholder liability.

Then:

The evaluation studies and trials have been deficient in a number of respects. The consultants examined only a narrow range of benefits and did not adequately demonstrate how HealthConnect would generate the claimed benefits.

How much money has been budgeted to date for HealthConnect?

Ms Halton —Senator, can I just make a comment? Firstly, the PC report is not an evaluation of HealthConnect and I really do not think it should be portrayed in that way. Essentially HealthConnect is a series of interrelated initiatives which go to transitioning the whole Australian health care system to an electronic environment. The particular report, as I understand it, that you are referring to was not an evaluation of HealthConnect, it was a technology report. Is that correct? Can we be clear which report you are quoting from?

Senator POLLEYImpacts and advances in medical technology.

Ms Halton —Yes, exactly. It is about technology more broadly. I have to say that that particular report does not, to my mind, tackle some of the issues in relation to e-health. It has constrained its analysis in a way which is not consistent with where the broad direction of e-health is going. We might have our views about how they have produced their report—that is fine; that is our business—but essentially we need to distinguish between a particular series of pilots called HealthConnect, which were designed to explore and test the whole world of electronic health, and the policy direction that is now in place in respect to this. They really are two different things. Yes, we have existing pilots in place; yes, we continue to learn some things from those; but the broad direction in relation to how we advance electronic health I think is a separate thing and I think it is important not to confuse those. But Dr Richards can give you more detail on that.

Dr Richards —HealthConnect is a change management strategy. It is not actually a set of hardware or software or pieces of technology. The Productivity Commission, in commenting on HealthConnect, commented on a series of pilots or trials of electronic health records in a variety of ways and in a variety of places around Australia, and commented on them in terms of a health technology assessment model as opposed to a change management model, which is what HealthConnect in fact is. The Productivity Commission is entitled to their view in terms of assessing some of the technologies that may or may not have been used in various pilots and trials of electronic health around the country, but that does not move us away from the point that the secretary just made that HealthConnect is in fact not a technology, HealthConnect is a change management strategy.

Senator POLLEY —Could we quickly deal with these questions and the ones you cannot answer can be taken on notice. How much money has been budgeted to date for HealthConnect?

Dr Richards —For the implementation of HealthConnect there was a total appropriation in the 2004-05 budget of $128.3 million over four years.

Senator POLLEY —How much of that has been spent to date?

Dr Richards —To date the 2004-05 appropriation has largely been spent.

Senator Patterson —It was done in conjunction with the South Australian and Tasmanian governments as well—in cooperation with them.

Senator POLLEY —Has any of the money been returned?

Ms Halton —No.

Senator POLLEY —How much of that money was spent on consultants?

Dr Richards —Mr Shepherd may wish to give a detailed answer. My advice is that around $2 million was spent on consultants.

Mr Shepherd —The exact figure is $2.7 million on consultancies.

Senator POLLEY —How much of this money was spent on evaluation studies?

Mr Shepherd —I am happy to take that question on notice.

Senator POLLEY —How much of that was spent on pilot projects and trials?

Mr Shepherd —The majority of the appropriation for 2004-05 was spent on grants to state and territory implementation projects. The remainder of the money was spent on core pieces of national infrastructure, work that has now been progressed via the National E-Health Transition Authority.

Senator POLLEY —Can we get those figures on notice?

Mr Shepherd —Absolutely.

Senator POLLEY —Thank you. What is the budget for HealthConnect for 2004-05 through to 2008-09? Can you give that to me broken down by year?

Dr Richards —Yes, we can take that on notice and provide that information.

Senator POLLEY —What actions is the department taking to address the criticism that I have, obviously, outlined, which you have explained tonight you have some disagreement with?

Ms Halton —We have not, Senator. That is exactly my point. That is a particular perspective which is not informed by what, indeed, is the approach, so we are not taking a particular series of actions to address those criticisms because I do not believe they are valid. Mr Shepherd has just indicated, for example, the significant investment that every government in Australia has made in respect of setting up the National E-Health Transition Authority, which is a company owned by every government in this country. A significant investment has been made in providing the core infrastructure. It is a bit like the infrastructure you need to enable the internet; this is the infrastructure you need to enable e-health. That is the kind of thing that is going on. These are the sorts of initiatives that we can now very solidly ground in the experience we had of trying in Tasmania and of working in South Australia and of dealing with the particular issues in the Northern Territory. This is why I think the Productivity Commission comments are, frankly, a little odd.

Dr Richards —I have been heading up the e-Health Implementation Group in the department since January this year and I have not had any contact from the Productivity Commission in that time at all.

Senator POLLEY —Has anyone else got any questions?

CHAIR —Have you got a question, Senator McLucas?

Senator McLUCAS —No, not on that.

CHAIR —Senator Polley, we have only got a couple of minutes, but go right ahead.

Senator POLLEY —I want to move on to online billing. How many doctors’ offices use HIC Online for non-bulk-billed consultations?

Ms Halton —That is not an issue for us. That is an issue for Medicare Australia.

Senator Patterson —Human Services.

Senator POLLEY —Okay.

Senator McLUCAS —And I could waste three minutes talking about why they should be here, but I won’t!

Ms Halton —We couldn’t possibly comment!

Senator POLLEY —Can you tell me, then, how many doctors this represents?

Ms Halton —Again, that is a matter that we cannot comment on.

Senator POLLEY —The proportion of doctors’ services claimed on bulk-billing is not yours either?

Ms Halton —Issues in respect of bulk-billing statistics is not this program. Issues to do with the approach to billing, be it bulk-billed or patient-billed, are matters relevant to the medical and pharmaceutical services program, and regrettably those officers have gone home.

Senator POLLEY —And the proportion of GP services claimed through HIC Online?

Senator McLUCAS —It is all HIC. But, on that, are there any plans afoot to reintroduce the HIC Online proposal from A Fairer Medicare?

Ms Halton —Policy is as it is announced, Senator.

Senator McLUCAS —Has there been any analysis of that proposal to bulk-bill at point of service?

Ms Halton —You would be aware that Minister Hockey has got some issues in relation to how billing occurs. I think he has been quite public in talking about that; but that is a matter for Minister Hockey.

Senator McLUCAS —I understand that, but it would have, in my view, quite significant ramifications for health expenditure if that were to happen.

Ms Halton —And you would be aware that from a policy perspective we would have some opinions about such matters.

Senator McLUCAS —Exactly, and you have not been asked to liaise with—

Ms Halton —We are having an ongoing dialogue with them on a range of issues. Obviously, the impact of service delivery on policy issues would be a part of the dialogue we are having.

Senator McLUCAS —And that dialogue does include as an agenda item—I do not know if you have agendas in dialogues—a discussion about the reconsideration of reimbursement at point of service?

Ms Halton —I think Minister Hockey is in the public arena talking about an approach to billing. I would not characterise anything he said as being a revisiting of those earlier initiatives, no, but I think he has signalled publicly his interest in streamlining and facilitating consumer access in relation to billing. To the extent that there are policy implications in any of the things he is considering, you are quite right; that is an ongoing matter of discussion between us and them. The technology side of that is theirs. The policy side of it is ours.

CHAIR —I think the point now has been reached. I need to thank the minister, thank Ms Halton and officers of her department.

Ms Halton —Senator Humphries, can I, just for the record—because it is good to have these things on the record—acknowledge that this was Brett Lennon’s last estimates. He does not look old enough, but he is retiring.

CHAIR —I see.

Ms Halton —I would like to put on record my thanks to him for his sterling service to the department and, no doubt, to the senators in his time. It is important that we acknowledge people as they go to other occupations.

CHAIR —Indeed it is.

Ms Halton —Thank you for your indulgence.

CHAIR —Thank you, members.

Committee adjourned at 11.01 pm